Predictors of Individual and Interpersonal Adjustment Among Non-offending Partners of Individuals With Histories of Sexual Offenses.

Recent research indicates that the consequences of sexual offenses extend beyond target victims, including to non-offending partners of individuals with sexual offense histories. However, little research has focused on non-offending partners' wellbeing and relationships with persons with sexual offense histories leading up to and following acts of sexual aggression. Non-offending partners may be secondary victims of their partners' offenses in managing psychological difficulties (e.g., guilt, shame), social stigma and isolation, fear for their safety, or difficulties in their romantic relationships resulting from their partners' sexual offenses, often with minimal supports. The current study examined key correlates of individual and interpersonal adjustment among 207 non-offending partners of individuals with histories of sexual offenses who were residing in Canada (n = 36) or the United States (n = 171). Findings indicate that positive changes due to the offense (i.e., improved finances), self-esteem, interpersonal adjustment, instrumental support, lower levels of acceptance, and humor positively predicted individual adjustment. Interpersonal adjustment was predicted by trust, intimacy, partner's stress communication, and problem-focused and emotion-focused common dyadic coping. Findings highlight the need for services for non-offending partners, including interventions that address self-esteem and practical difficulties resulting from the offense, and couples therapy to address trust issues, intimacy concerns, and shared coping with stressors related to the offense.

Paraphilic Interests Versus Behaviors: Factors that Distinguish Individuals Who Act on Paraphilic Interests From Individuals Who Refrain.

Little is known about distinct factors linked with acting on paraphilic interests or refraining from engaging in paraphilic behaviors. Participants from Canada and the United States (N = 744), aged 19-42 years (M = 29.2; SD = 3.18), were recruited through Amazon's Mechanical Turk. Participants completed questionnaires about their paraphilic interests and behaviors, as well as potential key factors linked to behavioral engagement (i.e., perceptions of consent, sexual excitation/inhibition, impulsivity, moral disengagement, empathy). Results indicated that higher moral disengagement and impulsivity, lower sexual control (i.e., high sexual excitation, low sexual inhibition), and maladaptive understandings of consent were best able to differentiate individuals who reported highly stigmatized (e.g., hebephilia, pedophilia, coprophilia) or Bondage and Dicipline, Dominance and Submission, Sadism and Masochism(BDSM)/Fetish paraphilic interests and engagement in the paraphilic behaviours associated with these interests relative to individuals who did not report such paraphilic interests or behaviors. Moreover, higher moral disengagement, impulsivity, and maladaptive perceptions of consent were best able to differentiate non-consensual paraphilic interests and behaviours (e.g., voyeurism, exhibitionism) compared to individuals who did not report these paraphilic interests or behaviours. These results provide future directions for the exploration of mechanisms that may contribute to engagement in paraphilic behaviors and may be targets for intervention aimed at preventing engagement in potentially harmful paraphilias.

Youths' Perceived Impact of Invalidation and Validation on Their Mental Health Treatment Journeys.

Youths' experiences in seeking and accessing help for mental health problems can have pervasive and lasting effects on personal and interpersonal functioning. In particular, youth who experience validating experiences presumably persevere in seeking help and generally have positive treatment outcomes, whereas youth who experience invalidation are also likely to experience, at least in the short term, ruptures in therapeutic relationships, shame, and reluctance to seek services. The goal of the current study was to expand on previous research assessing youths' interactions with mental health providers, allied professionals, family members, and peers, with a focus on subjective experiences of validation and invalidation. The current study investigated both validating and invalidating experiences in seeking, accessing, and maintaining professional services among 31 Canadian youth (n = 20 girls, n = 11 boys; 12 to 21 years old [M = 16.97, SD = 2.01]) who were diagnosed or self-identified with at least one of five conditions: depression (n = 26), anxiety (n = 22), eating disorders (n = 9), autism spectrum disorder (n = 2), or conduct disorder or oppositional defiant disorder (n = 2). Youth were recruited using convenience (e.g., posted advertisements in mental health clinics) and snowball sampling methods. Journey mapping methodology (i.e., participants created visual representations of milestones of their mental health journeys) was employed accompanied by semi-structured interviews to prompt youth to expand on their experiences (e.g., "Could you describe what was happening in your life when you first felt you would need support for your mental health?"). Four themes emerged using inductive thematic analysis, marked by the presence (validation) or lack (invalidation) of: feeling heard, feeling seen, feeling understood, and receiving helpful actions. Participants also reported key consequences of validation and invalidation. Findings broaden a conceptualization of validation across supportive relationships and an understanding of factors that enhance or impede the formation or maintenance of therapeutic relationships with youth. Clinical implications and limitations are discussed.

Beyond the Label: Asexual Identity Among Individuals on the High-Functioning Autism Spectrum.

Researchers have suggested that asexuality, which has been conceptualized traditionally as a persistent lack of sexual attraction to others, may be more common among individuals with autism spectrum disorder than in the neurotypical population. However, no studies to date have considered how these individuals understand and conceptualize their sexual identity. The aim of this study was to provide a more nuanced understanding of asexuality among individuals with high-functioning autism spectrum disorder (HF-ASD) than has been done in the past. Individuals with ASD, 21-72 years old (M = 34.04 years, SD = 10.53), were recruited from online communities that serve adults with ASD and Amazon's Mechanical Turk to complete an online survey of sexual and gender identity. Overall, 17 (5.1%) participants who met study criteria (N = 332) self-identified as asexual. However, 9 of the 17 people identifying as asexual expressed at least some sexual attraction to others. In addition, based on open-ended responses, some participants linked their asexual identity more with a lack of desire or perceived skill to engage in interpersonal relations than a lack of sexual attraction. Results suggest that researchers should be cautious in attributing higher rates of asexuality among individuals with ASD than in the general population to a narrow explanation and that both researchers and professionals working with individuals with ASD should consider multiple questions or approaches to accurately assess sexual identity.

The Impact of Demographic, Clinical, and Institutional Factors on Psychiatric Inpatient Length-of-Stay.

The average length of inpatient stay (LOS) for psychiatric care has declined substantially across Canada and the United States during the past two decades. Although LOS is based presumably on patient, hospital, and community factors, there is little understanding of how such factors are linked with LOS. The purpose of this study was to explore potential individual and systemic factors associated with LOS in a large-scale, longitudinal dataset. Study participants consisted of individuals 11 years of age and older admitted for psychiatric conditions to a New Brunswick hospital between April 1, 2003 and March 31, 2014 (N = 51,865). The study used a retrospective cohort design examining data from the New Brunswick Discharge Abstract Database, administrative data comprised of all inpatient admissions across provincial hospitals. Hierarchical regression analysis was used to estimate the association of individual, facility, and system-level factors with psychiatric LOS. Results indicated that hospital-level factors and individual-level characteristics (i.e., discharge disposition, aftercare referral, socioeconomic status (SES)) account for significant variability in LOS. Consistent with extant literature, our results found that hospital, clinical, and individual factors together are associated with LOS. Furthermore, our results highlight demographic factors surrounding living situation and available financial supports, as well as the match or mismatch between preferred language and language in which services are offered.

Longitudinal examination of youth readmission to mental health inpatient units.

OBJECTIVE: Significant barriers exist for youth in obtaining mental health services. These barriers are exacerbated by growing demand, attributed partially to children and adolescents who have repeat hospital admissions. The purpose of this study was to identify demographic, socioeconomic and clinical predictors of readmission to inpatient psychiatric services in New Brunswick, Canada. METHOD: Key demographic, support and clinical predictors of readmission were identified. The New Brunswick Discharge Abstract Database (DAD) was used to compile a cohort of all children and adolescents ages 3-19 years with psychiatric hospital admissions between 1 April 2003 and 31 March 2014 (N = 3825). Primary analyses consisted of Kaplan-Meier survival methods with log-rank tests to assess time-to-readmission variability, and Cox regression to identify significant predictors of readmission. RESULTS: In total, 27.8% of admitted children and adolescents experienced at least one readmission within the 10-year period, with 57.3% readmitted to hospital within 90 days following discharge. Bivariate results indicated that male, upper-middle socioeconomic status (SES) youths aged 11-15 years from nonrural communities were most likely to be readmitted. Notable predictors of increased readmission likelihood were older age, being male, higher SES, referral to care by medical practitioner, discharge to another health facility, psychosis, and previous psychiatric admission. CONCLUSION: A significant portion of the variance in readmission was accounted for by youth demographic characteristics (i.e. age, SES, geographic location) and various support structures, including referrals to inpatient care and aftercare support services. KEY PRACTITIONER MESSAGE: Readmission to inpatient psychiatric care among youth is affected by a number of multifaceted risk factors across individual, environmental and clinical domains. This study used provincial population-scale longitudinal administrative data to demonstrate the influence of various individual and demographic factors on likelihood of readmission, which is notably absent from the majority of studies that make use of smaller, short-term data samples. Ensuring that multiple factors outside of the clinical context are considered when examining readmission among youth may contribute to a more thorough understanding of youth hospitalization patterns.

A qualitative investigation of expected versus actual initial sexual experiences before age 16.

INTRODUCTION: Individuals often develop expectations prior to their initial sexual experiences based on external messages from peers and the broader culture. According to sexual script theory (Simon & Gagnon, 1986), these expectations form schemas about how an initial sexual experience should occur. When reality deviates from these schemas, dissatisfaction can occur (McCormick, 1987). The current study examines the contrast between expectations and reported initial sexual experiences before age 16. METHODS: Forty young adult participants were recruited from four local Atlantic Canadian universities (77.5% women; M age = 20.20, SD = 1.31; 75% heterosexual; 77.5% Caucasian). Semi-structured qualitative interviews on participants' actual initial sexual experiences, expectations of initial sexual experiences, and perceived consequences of initial sexual experiences were conducted. Thematic analysis of the interviews was conducted using a grounded theory framework. RESULTS: Findings indicated that respondents' expectations were influenced by sources such as various media, peers, family, and religion. Initial sexual experiences reportedly met, surpassed, or failed to meet participants' expectations. The presence or absence of a discrepancy between expected and actual sexual experiences was perceived to shape subsequent sexual encounters. A theoretical model of development and adaptations of sexual experience expectations was developed in accordance with these results. CONCLUSIONS: Comparisons between expected and actual initial sexual experiences can be perceived by youth as having consequences on their personal and interpersonal well-being. Honest communication between parents, educators, and youth should therefore be prioritized in order to establish more realistic expectations of initial sexual experiences.

Comparing Strategies for Providing Child and Youth Mental Health Care Services in Canada, the United States, and The Netherlands.

This paper reviews how child and youth mental health care services in Canada, the United States, and the Netherlands are organized and financed in order to identify systems and individual-level factors that may inhibit or discourage access to treatment for youth with mental health problems, such as public or private health insurance coverage, out-of-pocket expenses, and referral requirements for specialized mental health care services. Pathways to care for treatment of mental health problems among children and youth are conceptualized and discussed in reference to health insurance coverage and access to specialty services. We outline reforms to the organization of health care that have been introduced in recent years, and the basket of services covered by public and private insurance schemes. We conclude with a discussion of country-level opportunities to enhance access to child and youth mental health services using existing health policy levers in Canada, the United States and the Netherlands.

The Covariation of Sexual Fantasies and Behaviors Among Self-Identified Sexually Aggressive Criminal and Noncriminal Samples.

This study examined the association of sexually appetitive fantasies and sexually coercive behaviors among adult men convicted of nonsexual crimes (n = 159) and adult men with no criminal histories (n = 219). Individuals completed the Multidimensional Assessment of Sex and Aggression (MASA) and, on the basis of these reports, were classified whether or not they had ever attempted to assault or coerce someone sexually. Consistent with fewer opportunities to engage in sexual behavior, individuals with criminal histories reported generally less preoccupation, compulsivity, and frequency than did noncriminal individuals. Regardless of criminal history, self-identified sexually coercive men reported significantly more sexually appetitive fantasy and behavior in general and sexually deviant behavior in particular than did noncoercive males. Implications of these findings for research, theory, and dispositional decisions are discussed.

A Qualitative Examination of Withdrawing Sexual Consent, Sexual Compliance, and Young Women's Role as Sexual Gatekeepers.

Introduction: Withdrawing consent for sex may be difficult for young women due to gendered sexual scripts and male persistence. Method: 40 students from Canadian universities (31 women; Mean age = 20.20 years; 75% heterosexual) were asked open-ended questions about sexual experiences and consent; data were analyzed using thematic analysis. Results: Women perceived that: (1) women were responsible for communicating consent, (2) they were unaware it was acceptable to withdraw consent or did not know how to, (3) male partners often persisted in response to withdrawal of consent, and (4) these experiences factored into compliance. Conclusion: Sexual consent education, at least in North America, should increase emphasis on withdrawing consent.

Bootstrapping persistence risk indicators for juveniles who sexually offend.

This research was supported by research grants MH54263-01 from the National Institute of Mental Health and 94-IJ-CX-0049 from the National Institute of Justice. The authors wish to express their deep appreciation to the staff in the numerous institutions at which we have tested for their considerable commitment of time and energy to our research program. We also thank all the offenders who participated in our research. Special thanks are due to David Cerce and Alison Martino for coordinating the coding of files and organizing all of our data, to Nick Fadden and Karen Fadden for help in coordinating and collecting the Minnesota data, and to Karen Locke for her programming and data processing skills.

Alcohol distribution reforms and school proximity to liquor sales outlets in New Brunswick.

OBJECTIVES: The purpose of this project was to evaluate how changes to the sale of alcohol in New Brunswick would be distributed across urban and rural communities, and low- and high-income neighbourhoods. The study objectives were to 1) estimate the population living close to alcohol outlets before and after liquor distribution reforms, 2) identify communities or regions that would be more or less affected, and 3) determine whether expanding access to alcohol products would reduce school proximity to retailers. METHODS: Data from Statistics Canada, Desktop Mapping Technologies Inc. (DMTI), and geocoded publicly available information were spatially linked and analyzed using descriptive statistics. The populations living within 499 m, 500-999 m and 1-5 km of an outlet were estimated, and the distances from schools to stores were examined by geographic characteristics and neighbourhood socio-economic status. RESULTS: Permitting the sale of alcohol in all grocery stores throughout the province would increase the number of liquor outlets from 153 to 282 and would increase the population residing within 499 m of an outlet by 97.49%, from 19 886 to 39 273 residents. The sale of alcohol in grocery stores would result in an additional 35 liquor sales outlets being located within 499 m of schools. Low-income neighbourhoods would have the highest number and proportion of stores within 499 m of schools. CONCLUSION: The findings of this study demonstrate the importance of considering social, economic and health inequities in the context of alcohol policy reforms that will disproportionately affect low-income neighbourhoods and youth living within these areas.

Individual, family, peer, and academic characteristics of male juvenile sexual offenders.

This study examined the individual functioning, interpersonal relations, and academic performance of 115 male juveniles who were divided into 5 demographically matched groups (sexual offenders with peer/adult victims, sexual offenders with child victims, violent nonsexual offenders, nonviolent nonsexual offenders, and nondelinquent youths). Parents and youths completed self-report instruments, behavior rating inventories, and a video-recorded interaction task, and teachers completed a rating measure. Results showed that juvenile sexual offenders, like juvenile nonsexual offenders, had more behavior problems, more difficulties in family and peer relations, and poorer academic performance than did nondelinquent youths. However, juvenile sexual offenders and nonsexual offenders did not differ on any of the measures of individual or interpersonal adjustment. The implications of these findings for research, theory, and treatment are discussed.

The emotional health and well-being of Canadians who care for persons with mental health or addictions problems.

The purpose of this project was to examine the emotional health and well-being of Canadian caregivers of persons with significant mental health or addictions problems. We assessed the emotional health of caregivers by care-receiver condition type (i.e. mental health or addictions vs. physical or other health problems), levels of caregiver stress and methods particularly for reducing stress among caregivers of persons with mental health or addictions disorders. Weighted cross-sectional data from the 2012 General Social Survey (Caregiving and Care Receiving) were modelled using weighted descriptive and logistic regression analyses to examine levels of stress and the emotional health and well-being of caregivers by care-receiver condition type. Caregivers of persons with mental health or addictions problems were more likely to report that caregiving was very stressful and that they felt depressed, tired, worried or anxious, overwhelmed; lonely or isolated; short-tempered or irritable; and resentful because of their caregiving responsibilities. The results of this study suggest that mental health and addictions caregivers may experience disparate stressors and require varying services and supports relative to caregivers of persons with physical or other health conditions.

A longitudinal analysis of predictors of male and female adolescents' transitions to intimate sexual behavior.

PURPOSE: Determining predictors of sexual transitions is essential for developing health interventions. METHODS: Adolescents (13-16 years) completed baseline and 6-month surveys assessing psychosocial factors and sexual behavior. RESULTS AND CONCLUSIONS: Lower self-esteem for boys and higher lifetime alcohol use for girls predicted transitions to more intimate sex. These differential profiles may warrant tailored health initiatives.

Individual beliefs, attitudes, and victimization histories of male juvenile sexual offenders.

This study examined the individual beliefs and attitudes (e.g., sexuality, aggression, criminality) and victimization histories of 100 male youths who were divided equally into four demographically similar groups: (a) sexual offenders in residential placement, (b) sexual offenders in outpatient treatment, (c) nonsexual offenders in residential placement, and (d) nonsexual offenders in outpatient treatment. Based on youths' reports on the Multidimensional Assessment of Sex and Aggression and the Millon Adolescent Clinical Inventory, results showed that juvenile sexual offenders in residential placement had the most negative sexual and aggressive attitudes. There were also other noted differences between the two groups of sexual offenders as well as between youths with histories of sexual offenses and juvenile offenders with no such histories. The implications of these findings for research, theory, treatment, and risk assessment are discussed.