Partnership building for scale-up in the Veteran Sponsorship Initiative: Strategies for harnessing collaboration to accelerate impact in suicide prevention.

OBJECTIVE: To evaluate the implementation and trust-building strategies associated with successful partnership formation in scale-up of the Veteran Sponsorship Initiative (VSI), an evidence-based suicide prevention intervention enhancing connection to U.S. Department of Veterans Affairs (VA) and other resources during the military-to-civilian transition period. DATA SOURCES AND STUDY SETTING: Scaling VSI nationally required establishing partnerships across VA, the U.S. Department of Defense (DoD), and diverse public and private Veteran-serving organizations. We assessed partnerships formalized with a signed memorandum during pre- and early implementation periods (October 2020-October 2022). To capture implementation activities, we conducted 39 periodic reflections with implementation team members over the same period. STUDY DESIGN: We conducted a qualitative case study evaluating the number of formalized VSI partnerships alongside directed qualitative content analysis of periodic reflections data using Atlas.ti 22.0. DATA COLLECTION/EXTRACTION METHODS: We first independently coded reflections for implementation strategies, following the Expert Recommendations for Implementing Change (ERIC) taxonomy, and for trust-building strategies, following the Theoretical Model for Trusting Relationships and Implementation; a second round of inductive coding explored emergent themes associated with partnership formation. PRINCIPAL FINDINGS: During this period, VSI established 12 active partnerships with public and non-profit agencies. The VSI team reported using 35 ERIC implementation strategies, including building a coalition and developing educational and procedural documents, and trust-building strategies including demonstrating competence and credibility, frequent interactions, and responsiveness. Cultural competence in navigating DoD and VA and accepting and persisting through conflict also appeared to support scale-up. CONCLUSIONS: VSI's partnership-formation efforts leveraged a variety of implementation strategies, particularly around strengthening stakeholder interrelationships and refining procedures for coordination and communication. VSI implementation activities were further characterized by an intentional focus on trust-building over time. VSI's rapid scale-up highlights the value of partnership formation for achieving coordinated interventions to address complex problems.

Situational stress and suicide attempt behavior in Army soldiers and veterans: Insights from the Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study.

INTRODUCTION: Prevention of suicide-related behaviors is considered a top clinical priority within the Departments of Veterans Affairs and Defense. Despite previous literature attesting to the likely importance of situational stress as a key correlate of acute changes in suicide risk, longitudinal research into associations between situational stress and suicide-related outcomes among military personnel has been relatively limited. METHODS: The current study examined associations between situational stress, recent suicide attempt, and future suicide attempt using data from 14,508 Army soldiers and recently discharged veterans enrolled in the Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Studies (STARRS-LS). RESULTS: Recent situational stress was more common among recently discharged veterans (vs. soldiers), those with a recent suicide attempt (vs. those without), and those with a subsequent suicide attempt (vs. those without). Job loss was more closely associated with suicide attempts among soldiers, whereas financial crisis, police contact, and death, illness, or injury of close others were more closely associated with suicide attempts among recently discharged veterans. CONCLUSION: Findings further highlight situational stress as a salient risk factor for suicide-related outcomes among military personnel, particularly among recently discharged veterans. Implications for screening and treatment of at-risk military personnel are discussed.

Understanding changes in aggression among U.S. army soldiers: The role of trauma exposure during deployment.

Aggression is one of the leading concerns reported by United States service members and veterans. Trauma and posttraumatic stress disorder (PTSD) symptoms have emerged as key drivers of aggression. Research to date, however, has largely overlooked the effect of aggression on increasing risk of trauma exposure and subsequent PTSD. The current study addresses this gap by examining whether (a) pre-deployment aggression predicts trauma exposure on deployment and post-deployment PTSD, (b) trauma exposure on deployment and post-deployment PTSD predict post-deployment aggression, and (c) trauma exposure on deployment and post-deployment PTSD symptoms explain changes in aggressive behavior from pre-to post-deployment. Data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Pre/Post Deployment Study (PPDS) on nationally representative sample of 8558 Active-duty Army soldiers were analyzed. Results revealed positive correlations between pre-deployment aggression (assessed via items from the Joint Mental Health Advisory Team 7), trauma exposure on deployment (assessed via items from the Deployment Stress Scale), post-deployment PTSD symptoms (assessed via items from the civilian PTSD Checklist and PTSD Checklist for DSM-5), and post-deployment aggression. Further, pre-deployment aggression predicted trauma exposure on deployment and post-deployment PTSD; trauma exposure on deployment and post-deployment PTSD predicted post-deployment aggression; and changes in aggression from pre-to post-deployment were partially mediated by trauma exposure on deployment and post-deployment PTSD symptoms. Collectively, these findings highlight the utility of identifying and addressing pre-deployment aggression in mitigating trauma exposure and later psychopathology.

Quantifying College Students' Bystander Behavior to Prevent Sexual Assault and Intimate Partner Violence: Can We Make Improvements?

Sexual assault and intimate partner violence (IPV) are prevalent on college campuses, and bystander intervention programs are often employed as a method for preventing such violence. Unfortunately, there are concerns about current strategies for the measurement and quantification of bystander behavior. Accounting for the opportunity to engage in bystander behavior is theorized to be important, but it remains unclear if doing so improves the validity of the measurement of bystander behavior. The current study compares four methods of quantifying bystander behavior when information about the opportunity to help is also available. First-year undergraduate students (n = 714) from three universities participated. Participants completed the risky situations subscale of the Bystander Behavior Scale, using a modified response scale to measure both bystander behavior and opportunity for such behavior. Measures of criterion variables theorized to be linked with bystander behavior (efficacy to intervene, responsibility to intervene, and moral courage) were also completed. Four types of bystander behavior scores were calculated: breadth, missed opportunity, offset, and likelihood. Likelihood scores, which reflect the likelihood of engaging in bystander behavior when presented with the opportunity to help, correlated more strongly with the criterion variables than other scores. Likelihood scores demonstrated added value in quantifying bystander behavior over other scoring methods. Findings from the current study add to the knowledge of how best to measure and quantify bystander behavior. Such knowledge has significant implications for research on correlates of bystander behavior and evaluations of bystander intervention programs for sexual assault and IPV prevention.

Challenges and Considerations in Treating Negative and Cognitive Symptoms of Schizophrenia Spectrum Disorders.

Background: The prototypical patient with schizophrenia spectrum disorders (SSDs) is often thought to possess positive symptoms. However, patients with SSDs can present with predominantly negative and cognitive symptoms, which can create diagnostic and treatment challenges. Case Presentation: A 33-year-old female veteran presented to the emergency department with diminished speech output, markedly blunted affect, tangential speech, was not oriented to situation, and appeared to be responding to internal stimuli. Following inpatient admission, the veteran was diagnosed with schizoaffective disorder, which was misdiagnosed as major depressive disorder and borderline personality disorder during her military service. She was initially treated with olanzapine injections and psychotherapy but continued to experience worsening symptoms, resulting in multiple hospitalizations. After starting clozapine, she demonstrated marked improvement and continued with outpatient mental health care. Conclusions: Predominant negative and cognitive symptom presentations of SSDs require unique considerations to accurately identify and provide optimal treatment for the patient. Clozapine is a promising treatment for addressing these symptoms. This case demonstrates how careful multidisciplinary evaluations, review of health records, collateral information from family members, and other diagnostic and treatment considerations in patients with predominant negative and cognitive symptoms of SSDs can refine and enhance the clinical care offered to such patients.

Predictors of symptom reduction following intensive weekend treatment for panic disorder: An exploratory study of veterans.

BACKGROUND: Recent evidence implicates intensive panic control treatment (IPCT) - a full panic control treatment protocol compressed into a single weekend - as a viable alternative for Veterans with panic disorder who are unable or unwilling to commit to standard weekly cognitive behavioral therapy (CBT). However, no studies to date have examined pretreatment predictors of response to IPCT. Knowledge of such predictors may be important for understanding which Veterans are best suited for IPCT relative to standard CBT. METHODS: Participants were military Veterans with a primary diagnosis of panic disorder (N = 26) who participated in three open trials of IPCT. Pretreatment predictors were tested within linear regression models used to predict panic disorder severity at 2-week and 6-month follow-up assessments. Pretreatment predictors included: Panic disorder severity, agoraphobic avoidance, PTSD symptoms, anxiety sensitivity, and age. RESULTS: Pretreatment symptoms of PTSD predicted reduced treatment response at 2-week but not 6-month follow-up, whereas pretreatment anxiety sensitivity predicted reduced response at 6-month but not 2-week follow-up. LIMITATIONS: Current findings are tempered by the exploratory nature of the analyses and a small sample. CONCLUSIONS: Our study offers tentative evidence that success in IPCT may be linked to a distinct pretreatment profile relative to that of standard weekly therapy. These preliminary findings should be confirmed in larger studies that directly compare pretreatment predictors of intensive versus standard weekly CBT for panic disorder.

Party frequency, party-safety strategies, and sexual victimization among first-year female college students.

Objective: This study examined whether the use of party-safety strategies weakens the association between frequency of party attendance and sexual victimization among first-year female college students. Participants: First-year female college students (n = 450) from three universities in the United States participated in this study. Methods: Participants completed questionnaires on frequency of party attendance, use of party-safety strategies, and sexual victimization. Results: Frequency of party attendance was positively associated with sexual victimization. This association was moderated by use of party-safety strategies: frequency of party attendance was unrelated to sexual victimization when students reported greater use of party-safety strategies. However, frequency of party attendance was positively related to sexual victimization when students reported lower use of party-safety strategies. Conclusions: Teaching and reinforcing party-safety strategies may be helpful additions to efforts to prevent sexual victimization on college campuses.

Prevalence of Sexual Victimization Among Female and Male College Students: A Methodological Note With Data.

This study provides insight on how sample recruitment methods may affect reported rates of sexual victimization on college campuses. The study compares sexual victimization rates among students who complete surveys after initial requests with those who complete them only after multiple reminders. Using probability sampling methods, undergraduate students from 12 universities were invited to complete a survey on campus violence; initial invitations were followed with up to five reminders. Women (n = 1,008) and men (n = 344) who completed surveys were categorized as early, middle, or late responders based on the number of reminders required to convert them from non-responders to responders. About 24.2% of women and 15.6% of men reported sexual victimization in the previous two months. In initial analyses, female early and late responders did not differ on sexual victimization, but males did. Male late responders reported higher rates of sexual victimization than early responders. In sensitivity analyses that re-defined early and late responders, women who were early responders reported more sexual victimization than women who were late responders, while men who were early responders reported less sexual victimization than men who were late responders. These findings suggest that researchers may underestimate sexual victimization rates for male college students unless multiple attempts are made to solicit their participation. Researchers are encouraged to utilize multiple reminders to increase research participation.

Adverse Consequences to Assisting Victims of Campus Violence: Initial Investigations Among College Students.

Despite growing interest in the use of bystander education programs to address the problems of sexual and relationship violence on college campuses, little knowledge exists on adverse consequences experienced by students intervening as a bystander. The current study examined the prevalence and correlates of adverse consequences of bystander intervention in two samples of first-year college students. In Study 1, 281 students completed a measure of negative consequences experienced when acting as a bystander to help someone at risk of sexual assault, relationship abuse, or stalking. Efficacy for bystander behavior was also assessed. Approximately one third of the students (97/281) reported having tried to help someone who had been at risk of violence during the previous academic year. Of these, approximately 17% (16/97) reported experiencing a negative consequence from having tried to help. Experiencing negative consequences was associated with lower levels of bystander efficacy. In Study 2, conducted at a different university, 299 students completed measures of negative consequences resulting from intervening as a bystander and efficacy for bystander behavior. Students also participated in virtual-reality simulations that provided opportunities to intervene as a bystander. Again, approximately one third of the students (99/299) reported having tried to help someone at risk of violence. Of these, 20% (20/99) reported experiencing a negative consequence. Two of the adverse consequences (physically hurt, got into trouble) were negatively associated with bystander efficacy and observed effectiveness of bystander behavior in the virtual simulations. Results of exploratory analyses suggest that training in bystander intervention might reduce the likelihood of experiencing adverse consequences.

The Bystander Behavior (For Friends) Scale: Factor Structure and Correlation With Prior Victimization.

The Bystander Behavior (for Friends) Scale (BBS) offers a promising method of studying prosocial bystander behavior in the context of sexual assault and intimate partner violence. The underlying structure of the BBS has only been studied in the development sample, which was predominantly White and from one university in the Northeast region of the United States. This single sample raises questions about the replicability and generalizability of the factor structure. In addition, confirmatory factor analytic (CFA) methods, which are favored for binary data, were not used in the developmental sample. There also is limited research on individual characteristics that may relate to engagement in different types of bystander behavior. The primary aims of the current study were to (a) use CFA to evaluate the factor structure of the BBS in a sample of university undergraduates recruited from four universities and (b) test associations between prior victimization (general and family-specific) and BBS factors. University undergraduates (n = 556) from four U.S. universities comprised the sample. Weighted least squares CFA confirmed the original four-factor model of the BBS, namely, Risky Situations, Accessing Resources, Proactive Behaviors, and Party Safety. The Proactive Behaviors factor was positively associated with both general and family-specific prior victimization. The Risky Situations and Party Safety factors were positively associated with general prior victimization but were not associated with family-specific prior victimization. The Accessing Resources factor was not associated with either general or family-specific prior victimization. The BBS is multidimensional, and the factor structure is robust. The different associations between certain types of bystander behavior and prior victimization highlight the potential value in considering the BBS factors separately.

Measuring Teen Dating Violence Perpetration: A Comparison of Cumulative and Single Assessment Procedures.

Objective: There are concerns about the measurement of teen dating violence (TDV) perpetration. The current study compares data on TDV perpetration derived from a cumulative assessment procedure and a single assessment procedure. The prevalence and frequency of TDV perpetration are examined, as well as their associations with hypothesized precursors of TDV. Method: A sample of court-referred adolescents (n = 147, Mage = 15.85) completed a baseline assessment that included measures of three hypothesized precursors to TDV: externalizing problems, exposure to community violence, and attitudes about dating violence. For the cumulative assessment procedure, adolescents then completed up to 6 phone interviews on their TDV perpetration (physical, sexual, and emotional), once every 2 weeks over the course of a 3-month period. Data from these interviews were aggregated to form a cumulative measure of TDV perpetration over the 3 months. For the single assessment procedure, adolescents completed an identical interview on their TDV perpetration in a lab assessment 3 months after baseline, but were asked about perpetration over the entire 3 months. Results: Results of within-subjects comparisons indicated that, compared to the single assessment procedure, the cumulative assessment procedure yielded higher prevalence and greater frequency of physical, sexual, and emotional TDV. Across analytic methods, all types of TDV perpetration were more strongly related to externalizing problems, and sexual TDV perpetration was more strongly related to exposure to community violence, when measured cumulatively. Conclusions: Cumulative assessment procedures might provide a more sensitive and valid measurement of TDV perpetration than single assessment procedures.

Bystander programs addressing sexual violence on college campuses: A systematic review and meta-analysis of program outcomes and delivery methods.

OBJECTIVES: This systematic review and meta-analysis evaluates the effectiveness of bystander programs that address sexual violence on college campuses. Program effects on student attitudes/beliefs and bystander behavior were examined. Durability of program outcomes and the influence of program-delivery methods (e.g., facilitator-led programs vs. video, online or poster campaign programs) and program-parameters (e.g., program length) were also evaluated. METHODS: Twenty-four studies met criteria for inclusion in the meta-analysis, and 207 separate results from these studies were coded. RESULTS: Students who participated in a bystander program, compared to those who had not, had more pro-social attitudes/beliefs about sexual violence and intervening to prevent it, and engaged in more bystander behavior. Program effects diminished over time, but meaningful changes persisted for at least three months following program delivery. Longer programs had greater effects than shorter programs on attitudes/beliefs. CONCLUSIONS: Bystander programs can be a valuable addition to colleges' violence prevention efforts.

Heart Rate and Heart Rate Variability in Parents at Risk for Child Physical Abuse.

The present study examined heart rate and heart rate variability (i.e., respiratory sinus arrhythmia [RSA]) in a sample of 48 general population parents (41.7% fathers), who were either at high risk (n = 24) or low risk (n = 24) for child physical abuse. During baseline assessments of heart rate and RSA, parents sat quietly for 3 min. Afterward, parents were presented with a series of anagrams (either easy or difficult) and were instructed to solve as many anagrams as possible in 3 min. As expected, high-risk (compared with low-risk) parents evinced significantly higher resting heart rate and significantly lower resting RSA. During the anagram task, high-risk parents did not evince significant changes in heart rate or RSA relative to baseline levels. In contrast, low-risk parents evinced significant increases in heart rate and significant decreases in RSA during the anagram task. Contrary to expectations, the anagram task difficulty did not moderate the study findings. Collectively, this pattern of results is consistent with the notion that high-risk parents have chronically higher levels of physiological arousal relative to low-risk parents and exhibit less physiological flexibility in response to environmental demands. High-risk parents may benefit from interventions that include components that reduce physiological arousal and increase the capacity to regulate arousal effectively.

Cyber Victimization, Psychological Intimate Partner Violence, and Problematic Mental Health Outcomes Among First-Year College Students.

Both cyber victimization and psychological intimate partner violence (IPV) have been associated with negative mental health outcomes among adolescents and young adults. The present study examined relations among cyber victimization, psychological IPV, and mental health outcomes (depressive symptoms, antisocial behavior) among first-year college students. Consistent with polyvictimization theory, we hypothesized that cyber victimization and psychological IPV would be related to each other. We also hypothesized that each would uniquely contribute to depressive symptoms and antisocial behavior, after accounting for the other. Participants (N = 342, M age = 18.33 years; 50% male) completed questionnaires during a single lab visit. Results indicated that cyber victimization and psychological IPV were related to each other, and both contributed uniquely to depressive symptoms, but only cyber victimization contributed uniquely to antisocial behavior. Exploratory analyses indicated that experiencing both cyber victimization and psychological IPV was necessary for increased depressive symptoms and antisocial behavior. This study is the first to establish a unique relation between cyber victimization and mental health problems, after accounting for psychological IPV. The findings also suggest a need to consider multiple forms of victimization when considering relations between specific types of victimization and mental health problems.