Difficulties with emotion regulation within PTSD clusters and moral injury subtypes.

Treatment and research centered on trauma-related mental health issues have largely focused on posttraumatic stress disorder (PTSD); however, moral injury is another important mental health concern requiring attention. There is a paucity of research examining how PTSD and moral injury affect emotion regulation. The current investigation examined how PTSD clusters and moral injury subtypes were uniquely associated with difficulties with emotion regulation. Participants consisted of 253 previously deployed military personnel who were recruited online. To be included in the study, participants had to verify that they had served in the U.S. Military, had been deployed as part of their military service, and endorsed elevated levels of symptoms associated with PTSD and/or moral injury. A hierarchical linear regression was conducted to examine the association between PTSD symptom clusters, moral injury subtypes, and difficulties with emotion regulation. Results indicated that alterations in arousal and reactivity was the only PTSD symptom cluster associated with difficulties with emotion regulation. Self-transgressions was the only facet of moral injury significantly associated with difficulties with emotion regulation. This is the first study to examine the association between emotion dysregulation, PTSD symptom clusters, and moral injury in previously deployed U.S. Military.

Efficacy of CBT for Treatment Seeking (CBT-TS) in Untreated Veterans and Service Members at Risk for Suicidal Behavior.

OBJECTIVE: Military members and Veterans at-risk for suicide are often unlikely to seek behavioral health treatment. The primary aim of this study was to test the efficacy of brief CBT for Treatment Seeking (CBT-TS) to improve behavioral health treatment utilization among U.S. military service members and Veterans at-risk for suicide. METHODS: A total of 841 participants who served in the U.S. military since 9/11 and who reported suicidality but were not in behavioral health treatment were recruited to participate in this trial. Participants were randomly assigned to either brief CBT-TS delivered by phone or an assessment-only control condition. Follow-up assessments were conducted at baseline and months 1, 3, 6, and 12 to track treatment utilization and symptoms. RESULTS: CBT-TS resulted in significantly greater behavioral health treatment initiation within 1 month compared to the control condition (B = .93, p < .001); and the higher treatment initiation persisted for 12 months post intervention. CONCLUSIONS: This study employed a low-cost, easily implementable one-session intervention administered by phone. The study provides evidence that CBT-TS is efficacious in promoting behavioral health treatment initiation in an adult population at risk for suicidal behavior and showed enduring benefits for 6-12 months. CBT-TS provides a unique strategy for treatment engagement for at-risk adults unlikely to seek treatment. TRIAL REGISTRATION: Clinicaltrials.gov NCT05077514.

Opioid use disorder and its association with self-reported difficulties participating in social activities.

BACKGROUND AND OBJECTIVES: Difficulties participating in social activities are associated with increased mortality and are underemphasized in addressing the opioid epidemic. This study assessed the association of difficulties participating in social activities and opioid use disorder (OUD) and suicidal ideation and suicide attempts and difficulties participating in social activities among individuals with OUD. METHODS: Data on OUD, difficulties participating in social activities, suicidal ideation, suicide attempts, and other characteristics were assessed in 398,962 respondents from the 2008-2017 National Survey of Drug Use and Health. Logistic regressions examined the association of difficulties participating in social activities and OUD, and then among only respondents with OUD, difficulties participating in social activities and suicidal ideation and suicide attempts. RESULTS: Respondents with OUD reported higher levels of difficulties participating in social activities compared with respondents without OUD (severe difficulties: odds ratio [OR] = 4.10, 95% confidence interval [CI] = 3.40-4.93). Among those with OUD, difficulties participating in social activities were associated with suicidal ideation (severe difficulties: OR = 2.45, 95% CI = 1.77-3.38), but not attempts. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: The findings indicate that people with OUD experience difficulties participating in social activities and these difficulties are associated with suicidal ideation. It may be important to address difficulties participating in social activities within the context of OUD treatment, potentially as it relates to suicide prevention. This is the first study utilizing 10 years of nationally representative data to assess difficulties participating in social activities, OUD, and suicidal ideation and suicide attempts. Difficulties participating in social activities represent an under-addressed, potentially important therapeutic target to address OUD.

The Relationship Between Pain Severity, Insomnia, and Suicide Attempts Among a National Veteran Sample Initiating Pain Care.

OBJECTIVE: We assessed the longitudinal association of suicide attempts by moderate to severe pain and insomnia before and after the initiation of pain services among veterans. METHODS: A cohort of 221,817 veterans initiating pain care was divided into four subgroups: a) no/mild pain + no insomnia (LowPain-NoINS), b) no/mild pain + insomnia (LowPain-INS), c) moderate/severe pain + no insomnia (HighPain-NoINS), and d) moderate/severe pain + insomnia (HighPain-INS). Data on diagnoses, pain severity, demographics, medications, and suicide attempts were extracted from Veterans Health Administration data sets. RESULTS: Overall, there were 2227 (1.0%) suicide attempts before initiating pain services and 1655 (0.8%) after initiating pain services. Cox proportional hazard models accounting for key covariates revealed that patients in the HighPain-INS group were significantly more likely to attempt suicide in the year after the initiation of pain services relative to all subgroups (versus LowPain-NoINS: hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.21-1.72; versus LowPain-INS: HR = 1.71, 95% CI = 1.23-2.38; versus HighPain-NoINS: HR = 1.17, 95% CI = 1.01-1.34) even after accounting for prior attempts. Adjusted logistic regression analyses found that patients with moderate/severe pain and insomnia had higher odds of attempting suicide in the year before initiating pain services compared to all subgroups (versus LowPain-NoINS: HR = 1.75, 95% CI = 1.50-2.05; versus LowPain-INS: HR = 1.41, 95% CI = 1.09-1.82; versus HighPain-NoINS: HR = 1.21, 95% CI = 1.07-1.37). CONCLUSIONS: These results suggest that those with both moderate/severe pain and insomnia are more likely to have a history of suicide attempts and are at greater risk of a suicide attempt relative to those with insomnia with low/mild pain and those with moderate/severe pain with no insomnia. Suicide prevention efforts for chronic pain and insomnia could address pain and insomnia within the same intervention or in parallel.

Pain Conditions and Suicide Attempts in Military Veterans: A Case-Control Design.

OBJECTIVE: Specific pain conditions such as back pain and migraines are associated with increased risk of suicide mortality after accounting for key covariates. The purpose of the current study was to assess the associations of specific pain conditions with suicide attempts. DESIGN: Case-control. SETTING: Veterans Health Administration (VHA). SUBJECTS: Individuals who utilized VHA services with a record of a suicide attempt (N = 30,051) in Fiscal Years 2013 and 2014 were identified and propensity score matched with controls with no such record (N = 30,051). METHODS: Data on pain condition diagnoses (back pain, arthritis, migraine, headaches, psychogenic pain, neuropathy, fibromyalgia) psychiatric diagnoses, medical comorbidity, and demographics were extracted from VHA medical record and suicide surveillance datasets. RESULTS: Unadjusted logistic regression analyses found that each of the pain conditions were associated with suicide attempts (e.g., back pain: Odds ratio [OR]=3.25, 95% Confidence Interval [CI]=3.12-3.39). After adjusting for mental health conditions, medical comorbidity, and each of the pain conditions, the effects were attenuated across pain conditions; however, remained significant for each of the pain conditions except for fibromyalgia. Specifically, back pain (OR = 1.25, 95% CI = 1.19-1.32), migraines (OR = 1.29, 95% CI = 1.14-1.46), headaches (OR = 1.33, 95% CI = 1.19-1.48), and neuropathic pain (OR = 1.52, 95% CI = 1.33-1.74) were each associated with increased odds of a suicide attempt. Fibromyalgia was the only pain condition associated with re-attempt status (OR = 1.25, 95% CI = 1.08-1.45). CONCLUSIONS: Specific pain conditions are associated with increased odds of suicide attempts even after including key covariates. LIMITATIONS: Limitations of the study include the retrospective study design and lack of examination into additional variables including prescription opioid use, pain intensity, and pain duration. The case-control design also limits the ability to draw causal or temporal conclusions.

Opioid use disorders, psychiatric comorbidities, and risk for suicide attempts among veterans seeking pain care.

BACKGROUND: The purpose of this study was to assess the associations of comorbid opioid use disorders and psychiatric disorders with suicide attempts among veterans seeking pain care. METHODS: The cohort (N = 226 444) was selected by identifying pain care initiation from 2012 to 2014 using national Veterans Health Administration (VHA) data. Data on opioid use disorders (OUD), psychiatric disorders, medical comorbidity, demographics at baseline, and suicide attempts in the year following the initiation of pain care were extracted from VHA databases. Relative excess risk due to interaction (RERI) was used to assess departure from additivity of effects. RESULTS: Adjusted models indicated that both comorbid OUD and depression (RERI = 1.07) and comorbid OUD and AUD (RERI = 1.23) were significantly associated with additive risk of suicide attempt. In adjusted multiplicative interaction models, only comorbid OUD and bipolar disorder was significantly associated with suicide attempts; however, this association was protective (HR = 0.54). CONCLUSIONS: The current findings highlight the importance of addressing opioid use disorders and alcohol use disorders and depression together to mitigate the risk of suicidal behavior.

Interactive effects of PTSD and substance use on suicidal ideation and behavior in military personnel: Increased risk from marijuana use.

BACKGROUND: The current study examines the unique and interactive effects of posttraumatic stress disorder (PTSD) symptoms and days using alcohol, opioids, and marijuana on PTSD symptoms, suicidal ideation, and suicidal behavior up to 1 year, later in a high-risk sample of military personnel not active in mental health treatment. METHODS: Current and former military personnel at risk for suicide (N = 545; M age = 31.91 years, standard deviation = 7.27; 88.2% male) completed self-report measures of PTSD symptoms, past 30 days heavy alcohol use, opioid use, marijuana use, and current suicidal ideation via telephone at baseline and 1, 3, 6, and 12 months later. PTSD symptoms and the substance use variables (and relevant covariates) were entered as predictors of changes in PTSD symptoms, the likelihood of suicidal ideation, suicidal ideation severity, and the likelihood of suicidal behavior during the 11-month follow-up period. RESULTS: PTSD symptoms predicted PTSD symptoms 1 month later. PTSD symptoms and marijuana use predicted the likelihood of suicidal ideation 1 month later and suicidal behavior during the 11-month follow-up period. The interaction between PTSD symptoms and marijuana use significantly predicted increased PTSD symptoms over time and suicidal behavior. At high, but not low levels of PTSD symptoms, more days using marijuana predicted increased PTSD symptoms over time and the likelihood of suicidal behavior. CONCLUSIONS: Results suggest marijuana, especially for military personnel experiencing elevated PTSD symptoms may negatively impact suicidal thoughts and behavior. These results are relevant to suggestions that medical marijuana could be used in treating or augmenting treatment for PTSD.

Alcohol and Suicide Risk: Examining the Role of Meaning-Making.

OBJECTIVE: Conceptual understandings of meaning-making suggest that it may have protective value in regard to alcohol misuse and suicidal behavior. Accordingly, the aim of this study was to examine whether meaning-making attenuated the relationship between alcohol misuse and suicide risk severity in a population of active-duty service members. METHODS: The sample (N = 97) was recruited while presenting for emergency behavioral health services in circumstances indicative of high-risk suicidality: endorsing current suicidal ideation with intent to die. Those who reported ideation with a lifetime history of a past suicide attempt were conceptualized as being in a more severe category of suicide risk than ideation without a lifetime history of a past suicide attempt. Participants completed the Suicidal Behaviors Questionnaire-Revised, Meaning in Life Questionnaire, Alcohol Use Disorders Identification Test consumption questions, and items that assessed demographic variables. Data were analyzed using chi-squared test of independence, Fisher's exact test, Kendall rank correlation coefficient, and logistic regression modeling. RESULTS: Regression analysis identified a statistically significant association between number of drinks consumed daily and reporting a lifetime history of a past suicide attempt, odds ratio (OR) = 1.60, 95% confidence interval (CI) [1.11, 2.32], p = .01. Number of drinks consumed remained significant even after adjusting for both the search for and presence of meaning, OR = 1.70, 95% CI [1.16, 2.51], p = .01. These results remained unchanged even when adjusting for gender, race, ethnicity, and relationship status. No statistically significant interaction effects were noted between meaning-making and alcohol consumption. CONCLUSIONS: Meaning-making did not appear to attenuate the effect of alcohol misuse on suicide risk severity in a sample of service members at high-risk of suicidality. Additional research is needed to better understand the relationship among meaning-making, alcohol misuse, and suicidal behavior.

Prescription Opioid Craving: Relationship With Pain and Substance Use-Related Characteristics.

BACKGROUND: Craving is associated with prescription opioid use in opioid-addicted pain patients. OBJECTIVES: This study evaluated the relationship between craving for prescription opioids and selected pain and substance use characteristics. METHOD: In this cross-sectional study, patients (N = 106) being treated for opioid dependence were recruited from one of three sites from December 2012 to April 2013. Participants completed the multi-dimensional Desire for Drugs Questionnaire to assess craving, and other questionnaires to assess pain, substance use, and demographic characteristics. Data were analyzed using Pearson product-by-moment correlations, ANOVAs, and multiple linear regressions. RESULTS: At the bivariate level, desire-and-intention to use prescription opioids and craving for relief from negative states were positively associated with both pain severity and interference. Linear regression analyses revealed significant positive associations between Desire-and-Intention subscale scores and obsessive thoughts and compulsive behaviors associated with prescription opioids and pain severity. Negative Reinforcement subscales scores were positively associated with obsessive thoughts and compulsive behaviors associated with prescription opioids and the outcome expectancies of pain reduction, but not pain severity. CONCLUSIONS/IMPORTANCE: This study extended previous research assessing the link between pain and craving by demonstrating that desire-and-intention, but not craving for the negative reinforcing effects are associated with pain severity after considering various substance use characteristics. Additional research is needed to clarify the relationship between pain and aspects of craving while also considering pain-specific covariates. This study highlights that the multi-dimensionality of craving is an important aspect to consider when clinicians and researchers evaluate the relationship between pain and craving.

Physical Pain and History of Suicidal Behaviors in Alcohol-Dependent Patients Entering Treatment in Poland.

BACKGROUND: Individuals with alcohol use disorders have been shown to be at increased risk for suicidal behaviors and chronic pain. OBJECTIVES: The aim of this study was to conduct initial analyses of the association between current physical pain and the likelihood of suicidal behavior history in alcohol-dependent patients entering treatment in Poland. METHODS: A sample of 366 (73.5% men and 26.5% women) participants were recruited from alcohol treatment centers in Warsaw, Poland. Information was obtained about a history of lifetime suicidal behavior, past 4-week pain level, demographics, social functioning, childhood abuse, depressive symptoms, severity of alcohol and sleep problems. RESULTS: A total of 118 individuals (32.2%) reported at least one suicidal behavior during their lifetime. In unadjusted analyses, there was a significant association between a history of lifetime suicidal behavior and a moderate or greater experience of physical pain during the last four weeks. Other variables that were significantly associated with suicidal behaviors were: younger age, history of childhood abuse, depressive symptoms, sleep problems, consequences of drinking, and lower social support. In the multivariate logistic regression analysis, only experience of moderate or greater pain, age, and depressive symptoms remained significantly associated with a history of suicidal behavior. CONCLUSIONS: The experience of physical pain is significantly associated with a lifetime history of suicidal behavior in alcohol-dependent patients. Clinicians should be aware of these associations when conducting assessments and treating alcohol use disorders.

Evaluation of knowledge and confidence following opioid overdose prevention training: A comparison of types of training participants and naloxone administration methods.

BACKGROUND: The purpose of the current study was to assess the effect of opioid overdose prevention training on participants' knowledge about opioid overdose and confidence to recognize and respond to opioid overdose situations as a function of naloxone administration (i.e., injection vs. intranasal spray) and participant type (friend/family, provider, "other"). METHODS: Opioid overdose prevention trainings were offered throughout a mid-sized metropolitan area in the northeast. Participants (n = 428) were trained to administer naloxone via intramuscular injection (n = 154) or intranasal spray (n = 274). All training participants were given pre-post assessments of knowledge about opioid overdose and confidence to recognize and respond to opioid overdose situations. RESULTS: Participants' overall knowledge and confidence increased significantly from pre- to post-training (ps < .001). There was no significant association between knowledge and route of administration or participant type. Knowledge significantly increased from pre- to post-training in all participant types (ps < .001). Confidence improved significantly from pre- to post-training across both routes of administration (ps < .001). However, confidence was higher among those who were trained using the intranasal naloxone compared to those who were trained using the intramuscular injection naloxone at pre- (p = .011) and post-training (p < .001). Confidence increased from pre- to post-training in each of the participant types (ps < .001). Post-hoc tests revealed that confidence was higher among providers and friends/family members compared to "other" participants, such as first responders, only at post-training (p < .05). CONCLUSIONS: Opioid overdose trainings are effective in increasing knowledge and confidence related to opioid overdose situations. Findings suggest that trainees are more confident administering naloxone via intranasal spray compared to injection. Future research should attempt to identify other factors that may increase the likelihood of trainees' effectively intervening in opioid overdose situations.

Psychometric assessment of the craving to tan questionnaire.

BACKGROUND: Researchers and clinicians suggest that excessive tanning may be a behavioral addiction. Given the significance of craving in substance use, craving may be a useful construct to assess in those who tan. OBJECTIVE: We designed this study to assess the psychometric properties of an alcohol craving measure adapted to measure past-week craving to tan. METHODS: Undergraduate students (n = 421) who reported past-month tanning completed a battery of questionnaires that assessed demographics, tanning-related characteristics, and psychopathology, in addition to the Craving to Tan Questionnaire (CTQ). RESULTS: Analyses provided support for a single factor CTQ with good internal consistency, construct validity and convergent validity. CTQ scores were significantly higher among problematic versus non-problematic and dependent versus non-dependent tanners. CTQ scores were also associated with several tanning-related characteristics, such money spent on tanning in a typical month, frequency of tanning, and frequency of tanning-related problems. Additional analyses found that past-week craving to tan was significantly associated with greater obsessive compulsive and body dysmorphic symptoms. CONCLUSIONS: It may be useful in clinical settings to identify those experiencing problems with tanning and in research to further clarify the conceptualization of addiction-like tanning. However, the CTQ needs further evaluation.

Tanning addiction and psychopathology: Further evaluation of anxiety disorders and substance abuse.

BACKGROUND: Little research has investigated the correlates of problematic tanning and tanning dependence. OBJECTIVE: We sought to identify characteristics associated with problematic tanning and tanning dependence, and to evaluate simultaneously the associations of variables as correlates of problematic tanning and tanning dependence. METHOD: To assess tanning-related characteristics, psychopathology, and demographics, we administered questionnaires to 533 tanning university students; 31% met criteria for tanning dependence, 12% for problematic tanning. RESULTS: Both problematic tanning and tanning dependence were significantly associated with being female (P < .001 and P < .001, respectively) and with screening positive on measures of obsessive-compulsive (P < .001 and P = .005, respectively) and body dysmorphic (P = .019 and P < .001, respectively) disorders. Frequency of tanning in the past month was the strongest correlate of problematic tanning (P < .001) and tanning dependence (P < .001) when included in a model that controlled for shared variance among demographics and psychopathology. LIMITATIONS: The sample was recruited from 1 university and contained only self-report measures. CONCLUSION: Results suggest that many who engage in excessive tanning may also have significant psychiatric distress. Additional research is needed to characterize compulsive, problematic tanning and its rates, correlates, and risk factors among diverse samples.

Nonmedical use of pain medications in dental patients.

BACKGROUND: Substance use is overrepresented in dental clinics that provide affordable care and dental clinics provide potential access to opioid analgesics. Research is needed to better understand prescription opioid misuse in this population. OBJECTIVE: The purpose of this study was to assess the prevalence and correlates of the misuse of prescription opioids in adults seeking dental care from a low-cost dental training clinic. METHODS: Patients were recruited from a university school's dentistry patient emergency and admission services clinic. Patients (n = 369) within the waiting area of the clinic completed a self-report questionnaire about their nonmedical use of prescription pain medications, medication diversion and use of substances. RESULTS: Approximately 37.9% (140/369) of those who completed the study survey reported at least some nonmedical use of pain medications within the past 30 days. Use was associated with diversion of medication, and use of tobacco, marijuana, and sedatives. CONCLUSIONS: Within this sample from a dental clinic, nonmedical use of prescription pain medications was more common than in the general population. This suggests that dental clinics may be an appropriate setting for provider education and patient-based intervention strategies to reduce nonmedical use of pain medications.

Tired winners: the effects of cognitive resources and prior winning on risky decision making.

Previous research has shown mixed results regarding the effects of cognitively draining tasks, sometimes reporting that the depletion of cognitive resources increases risk taking and other times reporting that depletion leads to increases in risk aversion. Additionally, evidence has been provided demonstrating that both winning and losing can increase future risk-taking. This experiment was designed to assess the interaction between cognitive resource depletion and outcomes in blackjack on risky decision making. A 2 × 2 between subjects design was employed in which 81 university undergraduates were randomized to either a cognitive resource depletion condition or control condition and then a winning condition or losing condition. Participants completed a self-report measure of decision making and then a completed a task in which they could make actual wagers to win a lottery. Evidence is provided for the conclusion that people become risk averse to lottery style gambles after cognitive depletion and losing. Research and clinical implications are discussed.

A randomized clinical trial to assess feasibility, acceptability and preliminary effects of telehealth-delivered cognitive-behavioral therapy for perceived social isolation among individuals with opioid use disorders.

BACKGROUND: The purpose of this study was to report on feasibility, acceptability, and initial efficacy data cognitive-behavioral therapy for perceived isolation (CBT-PSI) compared to health education among individuals with opioid use disorders (OUD) reporting elevated loneliness. METHODS: Participants (n = 125) with OUD reporting elevated loneliness were recruited using online advertising to participate in a telehealth-delivered randomized clinical trial. Participants received either a 6-session CBT-PSI (n = 63) or health education (n = 62). Measures assessing loneliness, quantity of social interactions, perceived social support, substance use, substance use consequences, and treatment engagement among others, were completed at baseline, post-intervention, and 1- and 2-months post-intervention. Participants also reported on treatment acceptability for both conditions. RESULTS: Target enrollment was met with loneliness, social disconnectedness measures, and substance use reflecting a clinically severe sample. Retention was high (> 80%) for both conditions. Participants rated both Health Education and CBT-PSI as acceptable, helpful, and useful interventions to address loneliness and opioid use. Loneliness was reduced and quantity of social interactions and perceived social support were increased to the same extent for both conditions and across the follow-up assessments. Opioid use and overall substance use were reduced in both conditions; however, the reductions among participants received CBT-PSI were significantly greater compared to Health Education. CONCLUSIONS: This study supports the feasibility and acceptability of CBT-PSI. CBT-PSI findings related to loneliness, substance use, and other social connectedness outcomes are encouraging. Additional testing of CBT-PSI in a fully-powered trial is warranted.

Differences in the relation of binge drinking and prescription drug misuse to suicide ideation and attempts between college-aged adults and adults above the age of 25: Findings from the 2015-2019 National Survey on Drug Use and Health (NSDUH).

OBJECTIVE: To clarify the role of age in risk associated with drug misuse and binge drinking, this study examines the differential relations of binge drinking and prescription drug misuse to risk of suicidal ideation and attempts in young adults of college age (18-24) compared to those above the age of 25. METHODS: We used data from the National Survey on Drug Use and Health (NSDUH) for the years 2015 through 2019 (N = 269,078). RESULTS: The study found that, for adults above college age, the presence of any past-month binge drinking was associated with a higher likelihood of past-year suicide ideation (b = 0.427, OR = 1.532, 95%CI [1.388, 1.692]) and attempts (b = 0.637, OR = 1.891, 95%CI [1.271, 2.813]) compared to college-aged adults. Similarly, past-month prescription drug misuse showed stronger associations with past-year suicide ideation (b = 0.831, OR = 2.297, 95%CI [1.952, 2.701]) and attempts (b = 0.539, OR = 1.715, 95%CI [1.264, 2.327]) in adults above college age. CONCLUSION: These findings highlight that binge drinking and prescription drug misuse appears to become more strongly associated with suicide ideation and attempts after adults age beyond young adulthood.

Beliefs about mental health treatment, treatment initiation, and suicidal behaviors among veterans and service members at-risk for suicide and not in treatment.

INTRODUCTION: Previous research has identified a variety of barriers to mental health care among military personnel and veterans, despite high rates of mental health symptoms. The current study is the first to examine beliefs about mental health treatment barriers among post-9/11 military personnel and veterans at elevated suicide risk not involved in treatment and whether these beliefs are associated with treatment initiation, engagement, or suicidal behaviors. METHODS: Four hundred and twenty-two participants reported on beliefs about treatment during a cognitive behavioral treatment session and responded to follow-up questionnaires on mental health treatment initiation, engagement, and suicidal behaviors over 12 months. Beliefs identified in the therapy session were coded thematically, and rates of treatment initiation, engagement, and suicidal behavior were examined by belief category. RESULTS: Nine belief themes emerged. Participants reporting logistical barriers and preferences about treatment type were least likely to initiate mental health treatment and participated in the fewest number of sessions, respectively. Participants endorsing beliefs about stigma or using other ways to cope were most likely to engage in suicidal behavior. CONCLUSIONS: The current findings point to specific beliefs that may identify individuals who would benefit from systemic and individual interventions for mental health treatment engagement.

Further evaluation of the construct, convergent and criterion validity of the Gambling Urge Scale with university-student gamblers.

BACKGROUND: Research has documented the prevalence of problem gambling among university students, and craving is one factor that may provoke and maintain episodes of gambling. OBJECTIVES: We designed this study to assess elements of construct, convergent and criterion validity of the Gambling Urge Scale (GUS) when administered to regularly gambling university students. METHODS: Students (n = 250) recruited from three universities during the spring semester, 2012, were randomly assigned to one of four conditions to test the impact of cue exposure to one of two types of stimuli (gambling versus non-gambling activity), and two types of presentation format (photographic versus imagery scripts), on current craving to gamble. RESULTS: Self-reported craving increased significantly following exposure to gambling cues, but not following exposure to engaging non-gambling cues, regardless of the format by which cues were presented. Among those exposed to gambling cues, GUS craving scores were significantly correlated with all three subscales of another measure of craving to gamble, gambling-related problems, passionate attachment to gambling, distorted gambling beliefs and gambling refusal self-efficacy. CONCLUSIONS: These findings provide further support for the construct, convergent and criterion validity of the GUS as a measure of subjective craving in university student gamblers.

Stereotypical images and implicit weight bias in overweight/obese people.

PURPOSE: In this brief report, an unanswered question in implicit weight bias research is addressed: Is weight bias stronger when obese and thin people are pictured engaging in stereotype consistent behaviors (e.g., obese-watching TV/eating junk food; thin-exercising/eating healthy) as opposed to the converse? METHODS: Implicit Associations Test (IAT) data were collected from two samples of overweight/obese adults participating in weight loss treatment. Both samples completed two IATs. In one IAT, obese and thin people were pictured engaging in stereotype consistent behaviors (e.g., obese-watching TV/eating junk food; thin-exercising/eating healthy). In the second IAT, obese and thin people were pictured engaging in stereotype inconsistent behaviors (e.g., obese-exercising/eating healthy; thin-watching TV/eating junk food). RESULTS: Implicit weight bias was evident regardless of whether participants viewed stereotype consistent or inconsistent pictures. However, implicit bias was significantly stronger for stereotype consistent compared to stereotype inconsistent images. CONCLUSION: Implicit anti-fat attitudes may be connected to the way in which people with obesity are portrayed.