Prison or treatment? Gender, racial, and ethnic inequities in mental health care utilization and criminal justice history among incarcerated persons with borderline and antisocial personality disorders.

OBJECTIVE: Borderline and antisocial personality disorders are characterized by pervasive psychosocial impairment, disproportionate criminal justice involvement, and high mental health care utilization. Although some evidence suggests that systemic bias may contribute to demographic inequities in criminal justice and mental health care among persons experiencing these mental health conditions, no research to date has explicitly examined such differences. HYPOTHESES: Women and White persons would be more likely to endorse internalizing symptoms and have a more extensive history of mental health service utilization, whereas men, persons from minoritized racial groups, and persons identifying as Hispanic/Latino would be more likely to endorse externalizing symptoms and have more extensive histories of involvement with the criminal justice system. METHOD: This study examined gender, racial, and ethnic differences in symptom presentation, criminal justice history, and mental health care utilization in a sample of 314 adults with comorbid borderline and antisocial personality disorders enrolled in prison-based substance use treatment programs in the United States. RESULTS: Results suggested that men with these personality disorders were more likely to have early extensive criminal justice involvement, whereas women and White people had more extensive mental health treatment histories. Women were also more likely to endorse a range of internalizing symptoms, and White and non-Hispanic participants were more likely to endorse a history of reckless behavior. Notably, however, many associations-particularly, racial differences in symptom presentation and mental health utilization history and gender differences in symptom presentation-did not persist after we controlled for preincarceration employment and educational attainment. CONCLUSION: Results highlight a range of gender, racial, and ethnic inequities in criminal justice involvement and mental health utilization among this high-risk high-need population. Findings attest to the likely impact of societal, structural, and systemic factors on trajectories of persons affected by this comorbidity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

Military experiences, connection to military identity, and time since military discharge as predictors of United States veteran suicide risk.

Veterans navigating the military-to-civilian transition appear at elevated risk for suicide. However, research on the transition-suicide association often fails to consider co-occurring risk factors. The independent association of time since military discharge and suicide among veterans therefore remains unclear. Data from 1,495 post-Vietnam community veterans provided estimates of suicide risk, military-based stressful experiences, connection to military identity, and recency of military discharge. Hierarchical regression analyses examined independent, incremental utility of factors associated with suicide risk after controlling for quality of life, age, and duration of military service among the total veteran sample and a subsample discharged from military service within five years prior. The resulting model explained 41% of variance in suicide risk in the total veteran sample and 51% of variance in suicide risk in the recently discharged subsample. Recency of discharge, combat exposure, moral injury, poor quality of life, and poor psychological wellness showed statistically significant, independent associations with suicide risk, whereas connection to military identity did not show significant, independent associations. Results highlight the salience of the military-to-civilian transition as an independent risk factor for veteran suicide even after controlling for military-based stressful experiences, military identity, quality of life, age, and service duration.

Mental health clinicians' attitudes toward narcissistic personality disorder.

Narcissistic personality disorder (NPD) is an underdiagnosed psychiatric condition in which there is minimal research to support a validated treatment regimen. As a result, it is unclear how mental health practitioners approach NPD patients and the outcomes of clinical management. Given this gap in current mental health practice, this article explores the attitudes of clinicians toward treating NPD patients and the clinician-reported outcomes of managing NPD patients. The study uses a qualitative and quantitative approach to analyze the results of a 16-question survey about clinicians' experiences working with NPD patients. 173 participants were recruited from online psychology interest forums between April 2019 to August 2019. The data were analyzed using the Statistical Package for the Social Scientist (SPSS-26). The qualitative data showed that clinicians find NPD patients to be difficult and challenging. Additionally, clinicians report minimal experience treating NPD and high treatment drop-out rates. The quantitative data were evaluated using Pearson correlation coefficients. These results show that clinicians who view NPD as a diagnosis worth treating report more benefit from their care. These results also showed that participants who report formal didactic training in NPD have better results with their patients. The data also show that clinicians feel group therapy can be helpful in treating NPD, despite reporting that it is often not offered to NPD patients. This is an area that can direct future NPD research to develop a comprehensive approach to NPD management. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Correlación entre actividad cariogénica y concentración de fluoruro en saliva en alumnos que asisten a escuelas que participan en el programa preventivo de la Facultad De Odontología de la Universidad de El Salvador / Correlation between cariogenic activity and fluoride concentration in saliva in students attending schools that participate in the preventive program of the Faculty of Dentistry of the University of El Salvador

El objetivo de esta investigación fue determinar la correlación entre actividad cariogénica y concentración de ion fluoruro en saliva en alumnos que asisten a escuelas que participan en el programa preventivo de la Facultad de Odontología de la Universidad de El Salvador. El diseño se enmarca en un estudio de tipo analítico, transversal, cualitativo cuantitativo en el cual se describe la correlación existente entre las diferentes variables del estudio. Los sujetos en estudio (N= 50) provenientes de escuelas que participan y no participan en el programa preventivo de la Facultad de Odontología se dividieron en tres grupos: Grupo A (n = 20) cuyas características eran no presentar actividad de caries y pertenecer al programa preventivo, Grupo B (n = 15) presentaban actividad de caries y pertenece al programa preventivo y el Grupo C (n = 15) que era un grupo control el cual no participa en el programa preventivo y presentaba actividad de caries. La información se obtuvo por medio de análisis de laboratorio y exámenes clínicos, la actividad cariogénica se determino en base a los índices CPOD y ceod, la concentración de fluoruro en saliva se determino por el método 9214 modificado de IUPAC. Toda la información se proceso en Microsoft Excel de Windows XP, el análisis estadístico se realizo en el programa Minitab 14 aplicando el coeficiente de P. La correlación encontrada entre concentración de fluoruro en saliva y actividad cariogénica en la población estudiada tuvo un valor de P = 0.031 Los resultados que se obtuvieron demuestran que existe una correlación entre ambas variables, pero estadísticamente no es altamente significativa, concluyendo que el fluoruro presente en saliva como factor individual no nos determina si tiene incidencia o no sobre la actividad cariogénica.

The objective of this research was to determine the correlation between cariogenic activity and concentration of fluoride ion in saliva in students who attend schools that participate in the preventive program of the Faculty of Dentistry of the University of El Salvador. The design is part of an analytical, cross-sectional, qualitative quantitative study in which the existing correlation between the different variables of the study is described. The study subjects (N = 50) from schools that participate and do not participate in the preventive program of the Faculty of Dentistry were divided into three groups: Group A (n = 20) whose characteristics were not presenting caries activity and belonging to the preventive program, Group B (n = 15) presented caries activity and belongs to the preventive program and Group C (n = 15) which was a control group which did not participate in the preventive program and presented caries activity. The information was obtained through laboratory analysis and clinical examinations, the cariogenic activity was determined based on the CPOD and ceod indices, the concentration of fluoride in saliva was determined by the modified IUPAC method 9214. All the information was processed in Microsoft Excel of Windows XP, the statistical analysis was carried out in the Minitab 14 program applying the P coefficient. The correlation found between fluoride concentration in saliva and cariogenic activity in the studied population had a value of P = 0.031 The results obtained show that there is a correlation between both variables, but it is not statistically highly significant, concluding that the fluoride present in saliva as an individual factor does not determine whether or not it has an effect on cariogenic activity.