Functional Neurological Disorder Responds Favorably to Interdisciplinary Rehabilitation Models.

BACKGROUND: Functional neurological disorder (FND) is difficult to treat and costly. Interdisciplinary chronic pain rehabilitation programs (iCPRPs) are multidimensional functional restoration interventions for pain; their impact on FND specifically has not been assessed. OBJECTIVE: The purpose of this study was to assess iCPRP's impact on functioning in FND. METHODS: Data were examined retrospectively from an Institutional Review Board-approved registry capturing admission and discharge data from patients participating in an outpatient iCPRP. Subjective measures included pain-related disability, depression, anxiety, and stress scores, whereas objective measures included physical functioning measures (timed up and go, stair climbing test, and 6-min walk test). Pre-iCPRP and post-iCPRP measures were compared using a paired t-test approach. RESULTS: Forty-nine FND patients completed care and showed pre-measures and postmeasures. Statistically significant reductions in subjective measures of pain-related disability (46.40-20.91; P < 0.001, d = 1.92), depression (20.38-4.81; P < 0.001, d = 1.53), anxiety (15.09-6.29; P < 0.001, d = 1.18), and stress (21.96-9.70; P < 0.001, d = 1.21) scores were observed. Statistically significant changes in objective measures of mean timed up and go scores (decreased from 15.96 to 8.87 s), stair climbing test scores (increased from 40.98 to 71.93 steps), and mean 6-minute walk test scores (increased from 0.21 to 0.30 miles) were also observed across the group. CONCLUSIONS: While preliminary and based on a small patient sample, these findings support the use of interdisciplinary care models for FND treatment. Clinical and investigational implications are explored.

Systems of cissexism and the daily production of stress for transgender and gender diverse people.

Background: Transgender and gender diverse (TGD) people encounter a range of minority stressors (e.g., harassment, victimization, misgendering) that impact many areas of life. Much of the empirical literature on gender minority stress has utilized frameworks that were developed with a focus on sexual orientation and were often limited to cisgender sexual minorities (lesbian, gay, bisexual, and other non-heterosexual individuals), leaving questions about how well existing models fit the experiences of TGD people. Aims: To expand understandings of gender minority stress, we conducted a daily diary study where participants detailed the types of stressors they encountered on a daily basis for 56 days. Methods: There were 181 TGD participants recruited into the study (M age = 25.6 years; SD = 5.6), with 167 retained in the daily surveys from which these analyses were conducted. Results: The written responses revealed a variety of stressors, some of which are novel to the literature. Many participants reported instances of non-affirmation, such as misgendering, as well as vicarious stress when learning of oppressive experiences impacting other TGD people and seeing negative media portrayals of the lives of TGD individuals. Participants also reported bodily vigilance when being on alert for how others were perceiving their gender. Other stressors included rejection, political oppression, physical violence, uneasiness from others, and the enforcement of gender binarism. Discussion: These findings highlight gaps in the existing understandings of marginalization for TGD people that must be addressed to ensure that frameworks include and center the experiences of gender minorities.

Experiences of hospitalization for suicide ideation and suicide attempt in gender diverse adults.

INTRODUCTION: This study sought to investigate general perceptions of suicide-related hospital-based care that Transgender/Gender Diverse (TGD) adults have experienced as well as correlates of their perceived usefulness of this care. METHODS: Data were collected via a cross-sectional online survey of N = 3718 self-identified TGD individuals. Single-item self-report measures of all constructs of interest were used. RESULTS: A total of n = 1056 participants indicated hospitalization for either a past suicide attempt (SA) or suicidal ideation (SI). Irrespective of being hospitalized for SI or SA, perceived usefulness of hospital-based care was low with 50% or more of participants rating their care as some degree of unhelpful. Older age, general trust in mental healthcare providers, and voluntary admission were related to higher perceived helpfulness of care for both SI and SA admissions. Higher pride in TGD identity was positively related to perceived helpfulness of care but only for admissions related to SAs. CONCLUSION: Improving perceived usefulness of hospital-based care may be important for improving subsequent suicide-related help-seeking. Increasing training and provision of care that improves trust with mental healthcare providers and potentially reduces need for involuntary admission may help improve hospital-based, suicide-related care in TGD adults.

Entrapment and suicidal ideation: The protective roles of presence of life meaning and reasons for living.

OBJECTIVE: The integrated motivational-volitional model of suicide proposes that feelings of entrapment play a key role in the development of suicidal ideation. The model also posits a set of motivational moderators which either facilitate or hinder the development of suicidal thinking when entrapment is present. These motivational moderators include factors such as attitudes, future goals, thwarted belongingness, and social support. Two previously studied protective factors against suicide, reasons for living and life meaning, have received support in suicidology and might serve as motivational moderators in this model. METHODS: The current cross-sectional study included college students (N=195) oversampled for recent suicidal ideation who took a series of self-report questionnaires online. RESULTS: Our findings demonstrated that both reasons for living and life meaning are protective against the relation between entrapment and suicidal ideation, especially when presence of life meaning and reasons for living of high. Search for life meaning was found demonstrated a less protective relation with SI severity, particularly when reasons for living were low. CONCLUSION: Both motivational moderators demonstrated protective relationships with suicidal ideation and may be relevant to suicide prevention strategies. Limitations and future directions are discussed.

Suicide exposure in transgender and gender diverse adults.

OBJECTIVE: The purpose of this study is to examine the psychological effects of suicide exposure for Transgender and Gender Diverse (TGD) adults. METHOD: Using data from a national online survey of 2784 self-identified TGD adults, the current study investigated the prevalence of suicide death and suicide attempt exposure and demographic and mental health correlates. RESULTS: Nearly sixty percent of the sample (57.9%) reported they were close to at least one person who attempted suicide, and more than a quarter of the sample reported they were close to at least one person who died by suicide. Exposure to either the suicide attempt or death of another individual was related to multiple indicators of psychological distress. CONCLUSIONS: Exposure to the suicidal behavior of close others is prevalent in TGD individuals: over half of participants were close to someone who attempted suicide, more than in population-based studies of suicide exposure. Exposure appears to have a potential effect on recent indicators of psychological distress and suicide risk, which is important to consider when working in TGD communities.

An interdisciplinary chronic pain rehabilitation program effectively treats impairment in sexual function, depression, alexithymia, and pain in women with chronic pelvic pain.

PURPOSE: Chronic pelvic pain (CPP) in women is often associated with marked emotional distress and disability, with particular impairments in sexual functioning. Research supports the efficacy of interdisciplinary chronic pain rehabilitation programs (ICPRPs) in treating chronic pain, however less is known about their utility in CPP. METHODS: This retrospective study examined pain-related sexual impairment, emotional symptoms, and pain severity in CPP patients before and after completing a 3-4 week ICPRP. Predictors of post-treatment sexual impairment were also investigated. Participants included 58 female CPP patients and 58 age-matched females with non-pelvic chronic pain (NPCP). RESULTS: All participants reported robust improvements across outcome measures. Women with CPP reported greater pre- and post-treatment impairment in sexual function than NPCP patients, despite significant treatment-related improvements. In contrast, CPP patients also reported higher levels of depression at baseline but showed greater treatment related-improvements. In participants with CPP, treatment-related improvements in depression, alexithymia, and pain severity significantly explained decreases in pain-related sexual impairment following treatment, whereas none of these variables explained sexual impairment outcomes in women with NPCP. CONCLUSION: Results demonstrate that ICPRPs can effectively treat CPP, particularly through changes in depression and alexithymia. Future research should examine whether specific interventions can be added in ICPRPS to address CPP-related sexual impairment.

Suicide-Specific Cognitions, Attentional Fixation, and Worst-Point Suicidal Ideation.

OBJECTIVE: The fluid vulnerability theory of suicide posits that each person has a baseline risk for suicide, which is comprised of both stable and dynamic factors. The current study investigated the unique involvement of suicide-specific cognitions and attentional fixation on recent suicidal ideation (SI) and SI at its worst. METHOD: Data were analyzed from a sample of N = 126 undergraduate students with a history of SI. Path analyses were used to analyze the relationship between suicide-specific cognitions, attentional fixation, and SI (current and worst point). RESULTS: Results revealed that suicide-specific cognitions were directly related to both recent SI and worst-point SI. Suicide-specific cognitions had a significant, indirect effect with worst-point SI through attentional fixation, but this effect was not significant when using recent SI. CONCLUSION: These data support the need for interventions to target cognitive contents and contexts (e.g., fixation) to reduce escalation of SI. Future work would benefit from replicating and extending results in studies that include prospective designs and the assessment of suicidal behaviors.

Non-suicidal self-injury, suicide ideation, and past suicide attempts: Comparison between transgender and gender diverse veterans and non-veterans.

BACKGROUND: Transgender and gender diverse (TGD) individuals, especially veterans, experience elevated rates of non-suicidal self-injury (NSSI) and suicide related behaviors compared to gender majority individuals. Research has yet to compare TGD veterans to non-veterans or look at correlates of NSSI and related behaviors to suicide related outcomes. This study examines prevalence and suicide related correlates of NSSI among TGD veterans and TGD non-veterans. METHOD: Data analyzed in the were part of the Trans Lifeline Mental Health Survey. Both TGD veterans (N = 313) and non-veterans (N = 3,972) completed an online, cross-sectional survey that included self-report measures of NSSI, suicidal ideation (SI), and suicidal attempt (SA) along with lifetime hospitalization and avoidance of care due to NSSI. RESULTS: Results of this paper indicate that prevalence of NSSI, SI, and SA are elevated in both the TGD veterans and non-veteran subpopulations. Further, veterans compared to non-veterans have a lower prevalence of NSSI but higher prevalence of hospitalization when self-harm is inflicted, reflecting more healthcare utilization or increased severity of NSSI episodes. Additionally, veterans were less likely to avoid care due to NSSI. Further, veteran status seemed to be a protective factor against demographic differences that increased rates of NSSI history in non-veteran TGD individuals. LIMITATIONS: The limitations of this study include its cross-sectional study design, one question assessing SA, and few TGD male veterans. CONCLUSION: NSSI is an important risk factor in future suicide related outcome such as SI and SA. Further, differences in healthcare utilization among TGD veterans and non-veterans are apparent.