Latent profiles and psychosocial correlates of persistent self-injury among incarcerated adults.

Self-directed violence (SDV), including both suicide and non-suicidal self-injury, represents a major challenge for carceral systems. Persistent self-injury (PSI) is an understudied SDV subtype, especially within the carceral context. The present study addressed three research questions: (a) do naturally occurring SDV subgroups occur within a carceral population (e.g., PSI versus other classes); (b) how SDV groups may be differentiated by verbal or behavioral SDV; and (c) whether demographic, mental health, and incarceration-related factors are associated with SDV subgroups. We conducted a secondary analysis of existing data from a statewide carceral electronic medical record (N = 3527). Latent class analysis supports two SDV subtypes: episodic and persistent self-injury. The PSI class was characterized by significantly greater verbal expressions and behavioral acts of SDV compared to the episodic group. Correlates of the PSI subtype included older age, male sex, prior SDV, and lower depressive symptoms. Findings are discussed with respect to the proposed Diagnostic and Statistical Manual self-injury focused disorder, influential factors on SDV in carceral settings, and recommendations for future research and practice.

Entrapment and Defeat Scales: Factor Structure Assessment and Variation by Gender and Sexual Identity among Adults in the United Kingdom.

Entrapment and defeat are empirically-supported suicide risk factors. Their measurement is the subject of some debate, however. Also, limited work exists examining sexual and gender minority (SGM) differences in these suicide risk factors despite overall elevated rates of suicidal thoughts and behaviors (STBs) for SGM persons. The present study examined (1) entrapment and defeat differences by sexual orientation and gender identity, (2) factor structure and criterion validity of the Entrapment Scale (E-Scale) and the Defeat Scale (D-Scale), and (3) measurement invariance by sexual orientation (subsamples were too small for gender identity). A sample of 1,027 adults living in the United Kingdom completed a cross-sectional online questionnaire assessing mental health. Analysis of Variance and Kruskal-Wallis testing revealed: (1) all sexual minority (i.e., gay/lesbian, bisexual, and other SM) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to their heterosexual counterparts, and; (2) gender minority (i.e., transgender and gender diverse) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to cisgender persons. Supported by suicide theory, confirmatory factor analysis showed modest support for a two-factor E-Scale (internal and external), and a one-factor D-Scale. All entrapment and defeat scores displayed significant moderate positive correlations with suicidal ideation. E- and D-scale scores displayed high intercorrelation, tempering confidence in conclusions regarding the facture structure findings. Item threshold-level responding varied by sexual orientation for the D-Scale but not the E-Scale. Results are discussed with respect to suicide theory and measurement, public health, and clinical practice.

A qualitative assessment and short-term mediation analysis of defeat, entrapment, and suicide.

OBJECTIVES: The Integrated Motivational-Volitional Model (IMV) of Suicide is growing in empirical support. The present study advances IMV research through two aims: (1) to qualitatively probe the subjective experiences of defeat, internal entrapment, and external entrapment, and (2) conducting a 3-month prospective mediation analysis using quantitative and qualitative metrics of defeat and entrapment. METHODS: The study featured an online two-point survey separated by 3 months. Participants were 255 adults living in the United Kingdom. RESULTS: Persons endorsing qualitative defeat and internal entrapment in their narratives also showed higher quantitative scores on corresponding IMV and suicide-related self-report scales. Internal entrapment mediated the effect of baseline defeat on 3-month suicidal ideation, whereas external entrapment mediated the association of baseline defeat on 3-month suicide attempt likelihood. Quantitative assessment of entrapment was more significantly associated with suicide attempts and ideation within mediation tests compared to corresponding qualitative variables. CONCLUSIONS: IMV model principles are largely supported by findings. Mediation results support further consideration of entrapment and defeat within clinical practice and public health-focused suicide research. Understanding the complexity of entrapment narratives represents an important next step for conducting qualitative IMV-focused research with minoritized and high-risk suicide populations.

A psychometric assessment of the Military Suicide Attitudes Questionnaire (MSAQ).

Suicide rates remain high among military populations. Stigmatizing beliefs about suicide contribute to the problem of heightened suicide risk as a deterrent for help-seeking. Measurement of military suicide stigma is therefore an important gap in the literature as a necessity toward the development of military suicide prevention programming. This paper assessed the factor structure, reliability, and validity of the Military Suicide Attitudes Questionnaire (MSAQ). Study 1 featured secondary analysis of a suicide risk dataset from active duty treatment-seeking military personnel (N = 200). Study 2 was a secondary analysis of a statewide assessment of Army National Guard service members' beliefs about mental health and suicide (N =1116). Factor analyses results collectively supported a four-factor Military Suicide Attitudes Questionnaire (MSAQ) structure: discomfort, unacceptability, support, and empathic views. Subscale reliabilities ranged from 0.77 to 0.83 across samples. Unacceptability and support displayed significant negative correlations with psychological distress. Men displayed more negative suicide-related beliefs compared to women counterparts. Discomfort and unacceptability beliefs displayed significant positive associations with perceived barriers to care. The final short version of the MSAQ is an efficient, multi-dimensional measure of military suicide-related beliefs. The instrument can be used for public health assessment and program evaluation in military settings.

Morality, Risk-Taking and Psychopathic Tendencies: An Empirical Study.

Research in empirical moral psychology has consistently found negative correlations between morality and both risk-taking, as well as psychopathic tendencies. However, prior research did not sufficiently explore intervening or moderating factors. Additionally, prior measures of moral preference (e.g., sacrificial dilemmas) have a pronounced lack of ecological validity. This study seeks to address these two gaps in the literature. First, this study used Preference for Precepts Implied in Moral Theories (PPIMT), which offers a novel, more nuanced and ecologically valid measure of moral judgment. Second, the current study examined if risk taking moderates the relationships between psychopathic tendencies and moral judgment. Results indicated that models which incorporated risk-taking as a moderator between psychopathic tendencies and moral judgment were a better fit to the data than those that incorporated psychopathic tendencies and risk-taking as exogenous variables, suggesting that the association between psychopathic tendencies and moral judgment is influenced by level of risk-taking. Therefore, future research investigating linkages between psychopathic tendencies and moral precepts may do well to incorporate risk-taking and risky behaviors to further strengthen the understanding of moral judgment in these individuals.

Military self-stigma as a mediator of the link between military identity and suicide risk.

US military Veterans are at greater risk for suicide than those who have never served in the US military. Recent federal calls include the need to investigate military-specific suicide risk and protective factors among military-affiliated populations. To date, no study has examined the link between military identity, self-stigma, and suicide risk. The current study used a nationally representative sample of post-Vietnam US military Veterans (N = 1,461) in order to determine relationships between military identity, self-stigma, and suicide risk. Idealism (OR = 0.86) with less odds of elevated suicide risk, whereas individualism (OR = 1.15) and military self-stigma (OR = 1.39) were associated with increased odds of elevated suicide risk. Military self-stigma was found to mediate the relationship between military identity components and suicide risk. Implications for conceptualization of military Veteran identity, suicide prevention, and future research are discussed.

State- and Provider-Level Racism and Health Care in the U.S.

INTRODUCTION: This study examines the associations between state-level and provider sources of racism and healthcare access and quality for non-Hispanic Black and White individuals. METHODS: Data from 2 sources were integrated: (1) data from the Association of American Medical Colleges' Consumer Survey of Health Care Access (2014-2019), which included measures of self-reported healthcare access, healthcare quality, and provider racial discrimination and (2) administrative data compiled to index state-level racism. State-level racism composite scores were calculated from federal sources (U.S. Census, Department of Labor, Department of Justice). The data set comprised 21,030 adults (n=2,110 Black, n=18,920 White) who needed care within the past year. Participants were recruited from a national panel, and the survey employed age-insurance quotas. Logistic and linear regressions were conducted in 2020, adjusting for demographic, geographic, and health-related covariates. RESULTS: Among White individuals, more state-level racism was associated with 5% higher odds of being able to get care and 6% higher odds of sufficient time with provider. Among Black individuals, more state-level racism was associated with 8% lower odds of being able to get care. Provider racial discrimination was also associated with 80% lower odds of provider explaining care, 77% lower odds of provider answering questions, and 68% lower odds of sufficient time with provider. CONCLUSIONS: State-level racism may engender benefits to healthcare access and quality for White individuals and may decrease access for Black individuals. Disparities may be driven by both White advantage and Black disadvantage. State-level policies may be the actionable levers of healthcare inequities with implications for preventive medicine.

Preliminary Evaluation of a Prescription Opioid Misuse Prevention Program Among Rural Middle School Students.

Adolescent opioid misuse, addiction, and overdose have emerged as national health crises. Nearly 17% of high school students have misused prescription opioids. The purpose of this study was to evaluate the reach and acceptability of a widely-used prescription opioid misuse prevention program, This Is (Not) About Drugs© (TINAD), and its preliminary efficacy at improving opioid misuse knowledge, opioid misuse attitudes, self-efficacy to avoid opioid misuse, and intentions to misuse opioids. Participants were 576 7th grade students (Mage = 11.8; 51% boys; 39% Hispanic, 31% White, 20% Black) from a rural county in the southeastern U.S. All participants received the TINAD program and completed pretest and immediate posttest assessments. The program was school-based and implemented in collaboration with school teachers and administrators. Over 91% of all eligible students in the school district participated in the TINAD program. Most participants found the program acceptable-over 83% of students liked the program. Approximately 9% of participants reported prior misuse of prescription opioids. After participating in TINAD, students self-reported higher knowledge and self-efficacy as well as safer attitudes. However, there was no change in intentions to misuse opioids in the future. Effects of the program were consistent across gender, socioeconomic status, race/ethnicity, and previous opioid misuse. TINAD is acceptable and shows promise for improving opioid-related cognitions. However, more rigorous experimental and longitudinal research is needed to understand whether TINAD reduces opioid misuse over time. Given the limited research on adolescent opioid misuse prevention, this study lays the ground work for future randomized control trials.

The Coping Self-Efficacy Scale: Psychometric properties in an outpatient sample of active duty military personnel.

Active duty military service members endure a unique constellation of stressors while deployed or at home. Yet, assessment of protective factors against these stressors among active duty service members represents an under studied area. The present study advances the assessment of protective factors through the psychometric evaluation of the Coping Self-Efficacy Scale (CSES) in a clinical sample of military service members in mental health or substance abuse treatment (n = 200). Cross-sectional data were drawn from military medical records and a supplemental self-report questionnaire. Data extracted included demographic (e.g., sex, age), military characteristics (e.g., rank, years in service), physical health and mental health (e.g., anxiety, depression), and coping self-efficacy. Findings suggest a 3-factor (i.e., problem-focused coping, thought-stopping, and getting social support) CSES structure with acceptable internal consistency. Further, there were small-to-moderate associations with physical and mental health outcomes, providing evidence of construct validity. There were few significant associations with military-related characteristics. Finally, controlling for covariates, thought-stopping beliefs explained unique variance in suicide-related behaviors. Together, findings support the use of the CSES to measure coping-related beliefs in military service members. Recommendations are offered for future research and practice with active duty service members.