Measurement invariance of suicide screening measures across military branch.

Military suicide rates are near all-time highs. To help clinicians and researchers study suicide risk factors in military samples, the Military Suicide Research Consortium (MSRC) developed a set of brief suicide-risk screening measures. While previous research has examined the reliability of these screening measures, it remains unclear if measurement differences exist across different military branches. This is an important omission given that establishing measurement equivalence or invariance (ME/I) across groups is a prerequisite for making group comparisons, which are necessary for accurately identifying and effectively intervening with groups at heightened risk. This study examined the ME/I of four MSRC screening measures (e.g., Depressive Symptom Index - Suicidality Subscale; Interpersonal Needs Questionnaire; Suicidal Behaviors Questionnaire - Revised; Suicide Intent Scale) using a sample of 4,487 participants across military branches (Army; National Guard; Navy; Marine; Air Force) using a series of multiple-group confirmatory factor analyses (MGCFA). We assessed configural, threshold, and loading invariance, with results indicating that the brief screening measures are fully invariant between individuals from different military branches and that these suicide screeners can be used to examine differences across branches in future research. Research and applied implications are discussed.

Seeking help despite the stigma: Experiential avoidance as a moderated mediator.

The help-seeking literature identifies a model wherein public stigma of seeking help is internalized as self-stigma of seeking help, which, in turn, decreases help-seeking outcomes. The current study considered whether experiential avoidance, or a tendency to avoid painful thoughts or emotions, moderates how strongly these stigmata relate to help-seeking intentions among university students. Specifically, this study tested whether experiential avoidance moderates (a) the direct relationship between self-stigma of seeking psychological help and help-seeking intentions and (b) the indirect relationship between public stigma and help-seeking intentions. Conditional process modeling in a university student sample (N = 235) supported these hypotheses. The direct relationship between self-stigma and help-seeking intentions was nonsignificant and weaker for those who reported low experiential avoidance than for those who reported high experiential avoidance. Results also demonstrated a moderated indirect effect wherein the relationship between self-stigma and intentions was nonsignificant among those reporting low levels of experiential avoidance. This suggests that self-stigma may predict help-seeking intentions when avoidance of therapy functions as a means for avoiding unpleasant emotions. These findings suggest that interventions designed to decrease experiential avoidance by increasing openness to unpleasant emotions may offer a novel avenue to attenuate the impact of self-stigma on help-seeking intentions without requiring the difficult task of reducing stigma altogether. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Age differences in public stigma, self-stigma, and attitudes toward seeking help: A moderated mediation model.

OBJECTIVE: Stigma is commonly identified as a key reason that older adults are especially unlikely to seek mental health services, although few studies have tested this assumption. Our objectives were to: (a) examine age differences in public and self-stigma of seeking help, and attitudes toward seeking help, and (b) see whether age moderates an internalized stigma of seeking help model. METHODS: A total of 5,712 Canadians ranging in age from 18 to 101 completed self-report measures of public stigma of seeking help, self-stigma of seeking help, and help-seeking attitudes. RESULTS: Older participants had the lowest levels of stigma and the most positive help-seeking attitudes. Age also moderated the mediation model, such that the indirect effect of public stigma on help-seeking attitudes through self-stigma was strongest for older participants. CONCLUSION: Our findings have implications for the influence of stigma and attitudes as barriers to treatment across the adult lifespan, and for stigma reduction interventions.

Do self-compassion and self-coldness distinctly relate to distress and well-being? A theoretical model of self-relating.

The current research tested a theoretical model of self-relating that examined the unique relationships of self-compassion and self-coldness with distress and well-being. Self-coldness has recently been identified as theoretically distinct from self-compassion, rather than part of a unitary self-compassion construct. As such, the incremental value of self-compassion and self-coldness on clinically relevant outcomes is unclear. Therefore, the current research tested a theoretical model of the unique relationships of self-compassion and self-coldness and both distress and well-being among university students (N = 457) and community adults (N = 794), as well as interactions between these 2 constructs. Structural equation modeling results in both samples revealed that self-compassion was uniquely related to well-being (ßs = .36-.43), whereas self-coldness was uniquely related to distress (ßs = -.34) and well-being (ßs = .65-.66). Consistent with the Theory of Social Mentalities, across samples self-compassion more strongly related to well-being, whereas self-coldness more strongly related to distress. Self-compassion did not demonstrate a unique direct relationship with distress, but it did buffer the relationship between self-coldness and distress in both samples and the relationship between self-coldness and well-being in the community sample. Overall, results suggest that clinicians would benefit from tailoring the use of self-compassion and self-coldness interventions. Implications for future research and practice are discussed. (PsycINFO Database Record

Self-affirming values to increase student veterans' intentions to seek counseling.

Student veterans experiencing mental health concerns could benefit from seeking counseling (Rudd, Goulding, & Bryan, 2011), though they often avoid these services. Self-affirmation interventions have been developed to increase openness to health-related behaviors (Sherman & Cohen, 2006), and may also help promote psychological help-seeking intentions. This study explored whether a self-affirmation intervention increased intentions to seek counseling in a sample of 74 student veterans who had not previously sought counseling services. Participants completed pretest (Time 1) measures of distress and help seeking (i.e., self-stigma, attitudes, and intentions to seek counseling). A week later (Time 2), participants completed one of two conditions: (1) a self-affirmation intervention before viewing a psychoeducational video and brochure or (2) only the psychoeducational video and brochure before completing the same help-seeking measures as Time 1. A week after the intervention (Time 3), participants again completed the help-seeking measures. A focused longitudinal mediation model was conducted, examining the effect of the self-affirmation experimental condition on help-seeking intentions. Compared with those in the psychoeducation-only group, student veterans who completed the self-affirmation intervention reported increased intentions to seek counseling both immediately postintervention (Time 2) and a week later (Time 3). (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Two is more valid than one: Examining the factor structure of the Self-Compassion Scale (SCS).

The Self-Compassion Scale (SCS; Neff, 2003a) is the most widely used measure of self-compassion. Self-compassion, as measured by the SCS, is robustly linked to psychological health (Macbeth & Gumley, 2012; Zessin, Dickhaüser, & Garbade, 2015). The SCS is currently understood as exhibiting a higher-order structure comprised of 6 first-order factors and 1 second-order general self-compassion factor. Recently, some researchers have questioned the internal validity of this 1-factor conceptualization, and posit that the SCS may instead be comprised of 2 general factors-self-compassion and self-coldness. The current paper provides an in-depth examination of the internal structure of the SCS using oblique, higher-order, and bifactor structural models in a sample of 1,115 college students. The bifactor model comprised of 2 general factors-self-compassion and self-coldness-and 6 specific factors demonstrated the best fit to the data. Results also indicated the Self-Coldness factor accounted for unique variance in depression, anxiety, and stress, whereas the Self-Compassion factor only accounted for unique variance in its association with depression, providing further evidence for the presence of 2 distinct factors. Results did not provide support for the 1-factor composition of self-compassion currently used in research. Implications for using, scoring, and interpreting the SCS are discussed. (PsycINFO Database Record

Can reflecting on personal values online increase positive beliefs about counseling?

This research developed and tested an online values-affirmation exercise to attenuate threat and enhance positive beliefs about counseling among individuals struggling with mental health concerns. There is evidence that reflecting on personal values (values-affirmation) is an effective approach to eliciting self-affirmation-a psychological process that temporarily bolsters self-worth in order to forestall maladaptive, self-protective responses to counseling information. The present study utilized a randomized 2-group between-subjects design to test the effectiveness of a values-affirmation exercise with an online sample (N = 186) of adults who reported struggling with a mental health concern. It was predicted that values-affirmation would reduce threat related to reading mental health information and increase positive beliefs about counseling. Results indicated that those in the values-affirmation condition reported fewer negative emotions such as feeling upset, irritable, hostile, and scared after reading mental health information, indicating that the information was perceived as less threatening. There was also evidence that engaging in values-affirmation was associated with greater anticipated growth in counseling and greater intent to seek counseling, reflecting greater positive beliefs about counseling. Overall, the results suggest that reflecting on personal values may have the potential to enhance the positive effects of online psychoeducation. (PsycINFO Database Record

Masculinity and barriers to seeking counseling: The buffering role of self-compassion.

Less than 1/3 of college men seek psychological help per year when experiencing mental health concerns. Many believe this is because socialized masculine norms are incongruent with help-seeking decisions. In line with this, adherence to masculine norms, like emotional control and self-reliance, is consistently linked to factors associated with lower use of counseling. Identifying constructs that buffer, or reduce, the relationship between masculine norm adherence and common barriers to seeking help, like help-seeking self-stigma and resistance to self-disclosing, could shed light on mechanisms through which effective interventions could be developed. As such, this study examined whether self-compassion, or the ability to show oneself kindness and understanding in the face of challenges, moderated the relationship between masculine norm adherence and both help-seeking self-stigma and the risks associated with self-disclosing to a counselor in a sample of 284 undergraduate men (Mage = 19.68, range = 18-30). Results indicate that self-compassion is associated with lower levels of help-seeking self-stigma and disclosure risks. Additionally, and perhaps more importantly, self-compassion buffered the relationship between overall masculine norm adherence and each of these barriers. Furthermore, when specific masculine norms were examined, self-compassion buffered the relationship between emotional control and disclosure risks. These results support the need for future research focused on the development and assessment of self-compassion based interventions aimed at decreasing the barriers undergraduate men experience toward seeking psychological help. (PsycINFO Database Record

Does self-stigma reduce the probability of seeking mental health information?

An important first step in seeking counseling may involve obtaining information about mental health concerns and treatment options. Researchers have suggested that some people may avoid such information because it is too threatening due to self-stigma and negative attitudes, but the link to actual help-seeking decisions has not been tested. Therefore, the purpose of the present study was to examine whether self-stigma and attitudes negatively impact decisions to seek information about mental health concerns and counseling. Probit regression models with 370 undergraduates showed that self-stigma negatively predicted decisions to seek both mental health and counseling information, with attitudes toward counseling mediating self-stigma's influence on these decisions. Among individuals experiencing higher levels of distress, the predicted probabilities of seeking mental health information (8.5%) and counseling information (8.4%) for those with high self-stigma were nearly half of those with low self-stigma (17.1% and 15.0%, respectively). This suggests that self-stigma may hinder initial decisions to seek mental health and counseling information, and implies the need for the development of early interventions designed to reduce help-seeking barriers.

Adaptation of the Steen Happiness Index (SHI) to Brazil: A Comparison of the Psychometric Properties of the SHI and the Subjective Happiness Scale.

This study examined the psychometric properties of the Steen Happiness Index (SHI)-a measure of authentic happiness designed for intervention research-in a sample of Brazilian security workers. The SHI has yet to be used in a Brazilian sample and has the potential to assess both eudaimonic and hedonic happiness in Brazil. The psychometric properties of the SHI were also compared with those of the Subjective Happiness Scale (SHS), a widely used happiness measure, using classical test theory and item response theory. Military police officers, civilian police officers, and military firefighters (N = 435) completed the SHI, SHS, and measures of well-being, optimism, and psychopathological symptoms. Exploratory factor analysis provided support for a one-factor SHI-rather than the three-factor structure found in previous research. The unidimensional SHI also better discriminated between low, medium, and high levels of happiness, and did not demonstrate a ceiling effect when compared with the SHS. Advantages and disadvantages of both scales are discussed.

Measurement Invariance of the Self-Stigma of Mental Illness Scale: A Cross-Cultural Study.

The current study assessed the measurement invariance of the Self-stigma of Mental Illness scale (SSOMI) across Chinese and US samples and assessed whether the SSOMI differentially relates to distress levels across Chinese and US participants. We included 487 participants in China and 550 in the US (mean age was 19.52 in China and 19.29 in the US). The results indicated that partial measurement invariance of the SSOMI scale across China and the United States participants was established. Furthermore, we observed validity evidence for the SSOMI scale through its correlations with a well-established self-stigma measure and measures of depression, anxiety, and stress. Finally, we found that the SSOMI scale is more strongly linked to symptoms of depression, anxiety, and stress in China than it is in the United States, supporting previous research. These findings enable researchers to utilize the scale cross-culturally (i.e., with participants of Chinese and US origin), and to develop and implement interventions targeting mental illness stigma in both China and the United States.

Evaluating optimism in children and adolescents: Adaptation, factor structure, convergent validity, and invariance of the Brazilian version of the Youth Life Orientation Test (YLOT).

This study adapted and examined the psychometric properties of the Youth Life Orientation Test (YLOT)-a measure to evaluate dispositional optimism and pessimism-in a Brazilian sample of children and adolescents aged between 5 and 16 years. The factor structure, reliability, convergent validity, and invariance of the YLOT were evaluated within and across four age groups (N1 = 266, N2 = 246, N3 = 211, and N4 = 253). Participants were 976 students (51.9% girls) who answered the YLOT and subjective well-being measures and 350 parents (51.6% female) who answered a parent-report measure of optimism. Confirmatory factor analyses suggested an oblique two-factor model best fit the data, indicating that optimism and pessimism are independent factors. These factors demonstrated adequate reliability and convergent validity evidence with well-being measures. Additionally, scalar invariance was obtained, and latent mean analyses indicated optimism decreases and pessimism increases in participants from 5 to 13 years old. These results support the use of YLOT in Brazil. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining the Dimensionality, Reliability, and Invariance of the Depression, Anxiety, and Stress Scale-21 (DASS-21) Across Eight Countries.

This study evaluated the dimensionality, invariance, and reliability of the Depression, Anxiety, and Stress Scale-21 (DASS-21) within and across Brazil, Canada, Hong Kong, Romania, Taiwan, Turkey, United Arab Emirates, and the United States (N = 2,580) in college student samples. We used confirmatory factor analyses to compare the fit of four different factor structures of the DASS-21: a unidimensional model, a three-correlated-factors model, a higher order model, and a bifactor model. The bifactor model, with three specific factors (depression, anxiety, and stress) and one general factor (general distress), presented the best fit within each country. We also calculated ancillary bifactor indices of model-based dimensionality of the DASS-21 and model-based reliability to further examine the validity of the composite total and subscale scores and the use of unidimensional modeling. Results suggested the DASS-21 can be used as a unidimensional scale. Finally, measurement invariance of the best fitting model was tested across countries indicating configural invariance. The traditional three-correlated-factors model presented scalar invariance across Canada, Hong Kong, Romania, Taiwan, and the United States. Overall, these analyses indicate that the DASS-21 would best be used as a general score of distress rather than three separate factors of depression, anxiety, and stress, in the countries studied.

Modeling stigma, help-seeking attitudes, and intentions to seek behavioral healthcare in a clinical military sample.

OBJECTIVE: This study examined the relationship between public and self-stigma of seeking behavioral health services, and help-seeking attitudes and intent in a sample of active duty military personnel currently being assessed for traumatic brain injuries in a military health center. Although it has been suggested that many military personnel in need of care do not seek services due to concerns with stigma it is not fully clear what role different types of stigma play in the process. METHOD: Using previously collected data from a clinical sample of 97 military personnel, we conducted path analyses to test the mediation effects of self-stigma on the relationship between public stigma and attitudes toward and intentions to seek behavioral health care. RESULTS: In contrast to a model of military stigma but in line with research with civilian samples, results from this study indicate that self-stigma fully mediates the relationship between public stigma and help-seeking attitudes and intentions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These results indicate that programming aimed at increasing mental health care use in the military might best focus on reducing self-stigma associated with seeking mental health services.