Better off with you: Exploring congruity between caregivers' and Veterans' experience of efforts to cope with suicide.

The interpersonal theory of suicide posits people are more likely to consider suicide when they perceive themselves as alone and as a burden. However, there is limited research on whether these self-perceptions reflect caregiver experiences. As part of a larger study of collaborative safety planning, 43 Veteran/caregiver dyads (N = 86 individuals) completed measures of belongingness and burdensomeness, caregiver burden, family problem solving, and suicide-related coping. We conducted dyad-level actor interdependence models allowing two types of social coping (i.e., general problem solving and suicide-specific coping) to predict Veteran's self-views and caregiver interpersonal perceptions. Results suggested that Veteran social coping predicted lower Veteran thwarted belonginess and burdensomeness and caregiver involvement in problem solving was similarly associated with their own lower caregiver emotional burden. But examination of cross-partner effects demonstrated that greater Veteran coping was associated with greater time burden for caregivers. Findings suggest that social coping is associated with positive perceptions at the individual level (i.e., Veterans and caregivers to themselves) but does not indicate positive effects at the partner level. Clinicians working with Veterans may wish to involve supports in care to encourage effective collaboration that meets both caregiver/recipient needs.

Is Tinder-Grindr Use Risky? Distinguishing Venue from Individuals' Behavior as Unique Predictors of Sexual Risk.

Geosocial networking apps (GSN; e.g., Tinder, Grindr) have rapidly increased in popularity, showing associations with greater sexual risk-taking. This study sought to distinguish between risks associated with intensive partner-seeking (i.e., individuals seeking out casual sex frequently across many venues) and risks associated with specific venues (e.g., GSNs, dating websites, offline activities). Expanding upon a literature predominantly focused on the population of men who have sex with men (MSM), we recruited a broader range of sexual identities. A convenience sample of 3180 participants from the U.S. (18-75 years old, 69% female, 75% Caucasian, 68% heterosexual) completed an anonymous, cross-sectional online survey. Logistic regressions yielded adjusted odds ratios highlighting the unique links between each predictor and sexual risk-taking. MSM/WSW indicators, quantity of partner-seeking and specific venues-particularly GSN use-emerged as robust predictors of sexual risk, increasing the odds of reporting all six outcomes examined: (1) having three or more sex partners in the last year, (2) having hookups in the last 2 months, (3) having hookups involving alcohol or (4) drug use, (5) condomless sexual activity with new partners in the last 2 months, and (6) ever having had a sexually transmitted infection. Although a large portion of risk originated from the proclivities of the individuals seeking casual sex, both online and offline methods of partner-seeking also contributed significant risk, suggesting that specific venues like GSN apps could be used as methods of targeting higher-risk behaviors. The results also highlight the importance of moving beyond MSM when addressing sexual risk.

Out Drinking the Joneses: Neighborhood Factors Moderating the Effects of Drinking on Relationship Quality over the First Four Years of Marriage.

Neighborhood quality has been cross-sectionally linked to both relationship behaviors and relationship well-being. Consistent with the Vulnerability Stress-Adaptation model of relationship functioning (Karney & Bradbury, 1995), we hypothesized that associations between social behaviors (e.g., drinking) and relationship quality could be moderated by neighborhood factors. Specifically, we characterized neighborhoods along multiple dimensions using multiple methods (self-report, census) to investigate how neighborhood factors might clarify ambiguous effects of alcohol use on marital functioning. A nationally recruited sample of 303 newlywed couples completed a baseline assessment around the time of marriage and was then assessed yearly across the first 4 years of marriage (94% retention). Three level HLM slope-intercept models were used to model changes in relationship satisfaction across the first 4 years of marriage. Results suggested that, for couples living in highly disordered neighborhoods, positive shifts in overall levels of drinking within specific waves of assessment were associated with corresponding negative shifts in satisfaction whereas in neighborhoods without perceived disorder, this effect was reversed. For couples living in neighborhoods with low levels of domestic structures (high census rates of single renters without children), within-couple discrepancies favoring higher rates of husband drinking in specific waves predicted poorer relationship quality for both partners in those same waves whereas those same discrepancies predicted higher satisfaction in high domesticity neighborhoods (high census rates of married homeowners with children). The findings provide insight into the different roles of alcohol use in relationship maintenance and highlight the importance of using external context to understand intradyadic processes.

The Veterans Crisis Line: Relations among immediate call outcomes and treatment contact and utilization following the call.

OBJECTIVE: Crisis line callers experience reductions in distress and suicidal ideation and utilize more health care following calls. The purpose of this study was to determine whether changes in distress and suicidal ideation during a call are associated with later healthcare contact and utilization. METHOD: Veterans Crisis Line calls from 599 veterans were extracted with call dates between 12/1/2018 and 11/30/2019. Calls were coded for changes in distress and suicidal ideation and linked with VA medical records to obtain healthcare data. Generalized Linear Mixed Modeling was used to examine the associations of changes in distress and suicidal ideation with healthcare contact (yes/no) and utilization (days of treatment) in the month (30 days) following the call. RESULTS: Reductions in distress were associated with behavioral (i.e., mental and substance use) healthcare utilization, F(1, 596) = 4.52, p = 0.03, and reductions in suicidal ideation were associated with any healthcare utilization, F(1, 596) = 6.45, p = 0.01. Changes in distress and suicidal ideation were not associated with healthcare contact. CONCLUSION: Responders need to help resolve distress and suicidal ideation and link callers with treatment. Unresolved distress and suicidal thoughts may signify later problems with treatment utilization. Research is needed to determine causality.

Coaching third parties for suicide prevention.

Objective: Concerned allies often call crisis lines and other call centers about their loved ones' mental health. Callers to Coaching Into Care, a non-crisis call center, often report concerns about suicide risk in Veterans yet little is known about how best to support those callers. We conducted a documentation review to understand standard operating procedures, barriers, and opportunities for risk reduction. Method: Across 1,581 unique callers with an initial call over a 6 month period, 225 callers (14.2%) were identified for contact note review and coding. Results: Calls were frequently characterized by current suicidal ideation (62.7%), suicide attempts (24.0%), and access to lethal means (35.6%), although use of lethal means safety interventions was infrequently documented (12.9%). The majority of callers were coded as open to intervention (83.4%). After coaching, 16% of Veterans who were previously not connected to mental health care had connected to care in the community or VA. Conclusions: There was substantial heterogeneity in assessments and interventions used, particularly related to documentation of access to lethal means; however, there is an opportunity to provide risk reduction education and communication skill building for family and friends of Veterans. Those closest to Veterans report being open to learning new ways to engage with Veterans around safety and mental wellness.

Engaging suicide prevention and firearm stakeholders in developing a workshop promoting secure firearm storage for suicide prevention.

BACKGROUND: In the US, over 50% of suicide deaths are by firearm injury. Studies have found that limiting access to firearms, including storing them temporarily outside of the home or locking and unloading them securely at home, helps prevent suicide. Family members and other loved ones are in a unique position to encourage secure firearm storage. This paper describes the development of a workshop to empower loved ones of individuals at risk for suicide to discuss secure firearm storage in New York State. METHODS: Using a multistakeholder engagement framework, we partnered with New York State county-level suicide prevention coalitions, local firearms experts, and other stakeholders to develop a 90-min workshop addressing secure firearm storage for suicide prevention. Pilot workshops were co-facilitated by a suicide prevention coalition member and a local firearms expert. Feedback gathered via surveys from workshop attendees and interviews with workshop co-facilitators were used to revise workshop content and inform dissemination. Following pilot workshops, a 1-day training event was held for potential future facilitators, and survey data were collected to assess trainee experiences and interest in facilitating future workshops. Data analysis included rapid qualitative analysis of interviews and statistical analysis of survey responses about acceptability of workshop. RESULTS: Four pilot workshops included a total of 23 attendees. Pilot workshop attendees endorsed willingness and confidence to discuss secure firearm storage with a family member or loved one. The training event included 42 attendees, of which 26 indicated interest in facilitating a workshop within the next year. Co-facilitators agreed on several key themes, including the importance of having a "trusted messenger" deliver the firearms portion of the workshop, keeping the conversation focused on firearm safety for suicide prevention, and developing interventions that reflect firearm owning community's culture. CONCLUSIONS: Consistent with a public health approach to suicide prevention, this study leveraged a multistakeholder engagement framework to develop a community-based workshop empowering loved ones of individuals at risk for suicide to discuss secure firearm storage. The workshop will be disseminated across New York State. We noted positive and collaborative relationships across stakeholder groups, and willingness to facilitate the workshop among both suicide prevention and firearm stakeholders.

Brief relationship support as a selective suicide prevention intervention: Piloting the Relationship Checkup in veteran couples with relationship and mental health concerns.

INTRODUCTION: Close relationship problems play a key role in many contemporary theories of suicide. However, the potential of relationship support in suicide prevention is understudied. This study explores the feasibility, safety, acceptability, and promise of utilizing the 3-session Relationship Checkup (RC) in veterans with mental health and romantic relationship concerns. METHODS: We conducted a single-arm pilot of telehealth RC in veterans with a positive mental health screen and their romantic partners. Couples completed baseline and post-treatment assessments of study outcomes. RESULTS: Feasibility analyses showed we were able to recruit an elevated-risk sample (30% history of attempts or interrupted attempts), take them through the service (90% treatment completion), and had minimal harm events (no suicidal behavior, no physical harm in arguments). Multimethod acceptability analyses suggested high satisfaction with the program, though some desired more intensive services. Couples reported improvements in relationship functioning, emotional intimacy, thwarted belongingness, depression, and posttraumatic stress. Perceived burdensomeness only improved for identified patients and drinking did not change for either partner. CONCLUSION: The RC is a feasible, safe, and acceptable strategy for providing relationship support to couples at elevated risk. Although further randomized trials are needed, RC shows promise to reduce relationship-level and individual-level suicide risk factors.

Veterans Crisis Line Call Outcomes: Treatment Contact and Utilization.

INTRODUCTION: Crisis lines are a central component of suicide prevention strategies in the U.S. and for the Department of Veterans Affairs. The purpose of this study is to evaluate the impact of calling the Veterans Crisis Line on treatment contact and utilization. METHODS: Call records from 599 veterans who called in 2019 were linked with medical records and analyzed in 2020. Multilevel generalized linear modeling examined pre-post changes in treatment contact (yes/no) and utilization (number of days of care). RESULTS: In the month after the call, 85% of callers made contact with health care, and 79% made contact with behavioral health care. Callers were more likely to make contact with health care in the month after the call than in the preceding month (AOR=6.27, 95% CI=4.22, 9.32) and more likely to make contact with behavioral health care (AOR=10.21, 95% CI=6.66, 15.67). Days of health care nearly doubled to 4.82, and days of behavioral health care more than doubled to 3.52. CONCLUSIONS: Among veteran callers who are linked to medical records, calling the Veterans Crisis Line may increase contact and utilization of health care and behavioral health care. These findings support crisis lines that are linked with healthcare systems in public health strategies for suicide prevention.

Leveraging Integrated Primary Care to Enhance the Health System Response to IPV: Moving toward Primary Prevention Primary Care.

Intimate partner violence (IPV) is a prominent public health problem in the United States, with significant health impacts that are often severe and persistent. Healthcare systems have been called upon to improve both the systematic identification and treatment of IPV largely by adopting secondary and tertiary prevention efforts. Research to date demonstrates both benefits and challenges with the current strategies employed. In this paper, we summarize current knowledge about the healthcare system's response to IPV and evaluate the strengths, limitations, and opportunities. We offer recommendations to broaden the continuum of healthcare resources to address IPV, which include a population health approach to primary prevention.

Relationship Health and Intimate Partner Violence in Integrated Primary Care: Individual Characteristics and Preferences for Relationship Support across Risk Levels.

This study explores differences in characteristics and relationship treatment preferences across different levels of intimate partner violence (IPV) among Veterans Affairs (VA) primary care patients. In Fall 2019, we sent a mail-in survey assessing relationship healthcare needs to N = 299 Veterans randomly sampled from 20 northeastern VA primary care clinics (oversampling female and younger Veterans). We compared those reporting past year use or experience of physical/sexual aggression, threats/coercion, or injury (Severe IPV; 21%), to those only reporting yelling and screaming (Verbal Conflict; 51%), and denying any IPV (No IPV; 28%). Participants across groups desired 2-6 sessions of face-to-face support for couples' health and communication. No IPV participants were older and had preferred treatment in primary care. The Verbal Conflict and Severe IPV groups were both flagged by IPV screens and had similar interest in couple treatment and relationship evaluation. The Severe IPV group had higher rates of harms (e.g., depression, alcohol use disorder, relationship dissatisfaction, fear of partner) and higher interest in addressing safety outside of VA. Exploratory analyses suggested differences based on use vs. experience of Severe IPV. Findings highlight ways integrated primary care teams can differentiate services to address dissatisfaction and conflict while facilitating referrals for Severe IPV.

Veterans Crisis Line Call Outcomes: Distress, Suicidal Ideation, and Suicidal Urgency.

INTRODUCTION: This study evaluates the effectiveness of the Veterans Crisis Line on immediate call outcomes (i.e., caller distress, suicidal ideation, and suicidal urgency) for veterans who provide identifying information. METHODS: Coders rated pre- and post-distress, suicidal ideation, and suicidal urgency for 647 calls from 2019 veteran callers. Intraclass correlation coefficients examined inter-rater reliability. Multilevel generalized linear modeling examined pre-post changes. RESULTS: Inter-rater reliability was good for distress, excellent for suicidal ideation, and fair for urgency. Callers had 5 times greater odds of a reduction in distress (AOR=5.03, 95% CI=3.98, 6.49), almost 5 times greater odds of a reduction in suicidal ideation (AOR=4.92, 95% CI=3.49, 6.94), and 11 times greater odds of a reduction in suicidal urgency (AOR=11.01, 95% CI=2.72, 44.50) at the end of calls than at the beginning. CONCLUSIONS: Veterans Crisis Line callers who provide identifying information experience reductions in distress and suicidal ideation during the call. Research is needed to examine the reduction in suicidal urgency because of fair reliability, generalizability of results to other callers, post-call treatment contact and engagement, and risk for suicide attempts and death.

A Pilot Randomized Control Trial of a Dyadic Safety Planning Intervention: Safe Actions for Families to Encourage Recovery (SAFER).

A recent systematic review on family and suicide prevention efforts identified a lack of family-based safety planning interventions for adults. To address this gap, The Safe Actions for Families to Encourage Recovery (SAFER) intervention was created. SAFER is a novel, manualized, 4- session, family-based treatment intervention that provides the tools and structure to support family involvement in Safety Planning Intervention (SPI) for Veterans at moderate risk for suicide. The SAFER intervention includes the use of psychoeducation, communication skills training, and development of a Veteran, and a complementary supporting partner, SPI. This Stage II (2aii) randomized clinical trial (RCT) evaluated the preliminary efficacy of this innovative and much-needed approach. Thirty-nine Veterans and an associated supporting partner were randomized to receive either SAFER or currently mandated (i.e., standard) individual Safety Planning Intervention (I-SPI). Veterans in the SAFER condition as compared to I-SPI exhibited significant monthly decrements in suicide ideation as measured by the Columbia Suicide Severity Rating Scale (B=-0.37; p=.032). Moreover, a treatment-by-time interaction emerged when predicting improvements in Veteran suicide-related coping (B=0.08; p=.028) and supporting partner support of Veteran's coping efforts (B=0.17; p=.032). However, the treatment effect for Veteran coping was not significant in dyadic analyses (B=0.07; p=.151) after controlling for the partner's support (B=0.16; p=.009). Self-reported appraisals of relational factors and self-efficacy were not impacted by condition for either Veterans or supporting partners. This initial efficacy pilot trial suggests that a brief dyad-based SPI has the potential to improve Veteran suicide symptoms and help family members support the Veteran's coping efforts. However more intensive family work may be required for changes in self-perceptions of burdensomeness, belongingness, and caregiver perceptions of the Veteran as a burden. Nonetheless, SAFER's discussion and disclosure about suicide symptoms facilitated more robust development of SPI for the Veteran and their accompanying supporting partner.

Shocks to the system: The influence of COVID-19-related stressors on coparental and family functioning.

In addition to the fears associated with contracting COVID-19, the pandemic has forced families across the United States to quickly transition to new patterns of living. These transitions present new stressors, including health-related concerns, new demands placed on families by lockdowns and stay-at-home orders, and the possibility of losing a job or inability to pay bills. Such stressors have the potential to disrupt collaboration between coparents in addition to basic family functioning. Drawing upon a family systems perspective, the current study thus sought to examine links between COVID-19-related stressors and family cohesion through coparental functioning. A total of 1,003 parent/caregivers (97% from the United States; 82% Caucasian, 74% female; M = 40.9 years old, SD = 8.5; Mincome = $83,631, SDincome = $36,320) of school-age children completed an initial online survey from the end of March to the end of April of 2020. Of the initial sample, a total of 685 parents/caregivers completed weekly diaries for a month. Based on multilevel modeling, results suggested that, at the between-family level, coparental conflict mediated the impact of the stress of parenting/work demands and financial stress on family cohesion. At the within-family level, weekly spikes in health-related stress were associated with corresponding spikes in coparental conflict, which, in turn, were associated with drops in family cohesion. Results from the current study suggest that beyond the fears associated with contracting the COVID-19 virus, other key stressors associated with the emerging pandemic played a role in increasing coparental conflict, ultimately exacerbating family functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Toward an optimized measure of perceived partner responsiveness: Development and validation of the perceived responsiveness and insensitivity scale.

Perceived partner responsiveness (PPR; Reis & Shaver, Handbook of personal relationships, 1988, Wiley)-the belief that one's partner will attend to core concerns-is a construct in basic relationship research that can help evaluate intimacy in couple therapy. However, research into PPR is hampered by a lack of standardized measurement. Three studies were undertaken to develop and evaluate an optimized self-report PPR measure. In Study 1, n = 2,334 respondents completed 246 candidate items derived from 19 PPR measures. Exploratory factor analyses identified two underlying dimensions, Responsiveness and Insensitivity. Item response theory was used to develop two 8-item subscales for the Perceived Responsiveness and Insensitivity scale (PRI), both of which showed incremental prediction over global satisfaction. In Study 2, n = 173 respondents completed the brief PRI along with measures of global relationship evaluations and concrete relationship behaviors every other week for 8 weeks. Random intercept cross-lagged panel models found the PRI subscales were more sensitive than global evaluations to fluctuations in support and conflict. In Study 3, n = 161 heterosexual couples completed the brief PRI along with self-reports of responsive and insensitive behaviors. Actor-partner interdependence models demonstrated the PRI subscales were associated with partners' self-reported behaviors even after controlling for own behaviors. Thus, the PRI offers a PPR measure that demonstrates desirable properties for treatment research including (a) incremental validity over global satisfaction, (b) ability to detect meaningful change over time, and (c) sensitivity to partners' behaviors in the relationship. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Validation of the Opioid Overdose Risk Behavior Scale, version 2 (ORBS-2).

OBJECTIVE: To examine the factor structure of a revised and expanded opioid overdose risk behavior scale and assess its associations with known overdose indicators and other clinical constructs. BACKGROUND: Opioid-related overdose remains high in the U.S. We lack strong instrumentation for assessing behavioral risk factors. We revised and expanded the opioid overdose risk behavior scale (ORBS-1) for use among a broader range of people who use opioids. SETTING & SAMPLING FRAME: Using respondent-driven sampling we recruited adults (18+) reporting current unprescribed opioid use and New York City residence. METHOD: Participants (N = 575) completed the ORBS-1, ORBS-2, and a variety of clinical measures and then completed the ORBS-2 and overdose risk outcomes across monthly follow-up assessments over a 13-month period. RESULTS: Principal components analysis was used to identify six ORBS-2 subscales, Prescription Opioid Misuse, Risky Non-Injection Use, Injection Drug Use, Concurrent Opioid and Benzodiazepine Use, Concurrent Opioid and Alcohol Use, and Multiple-Drug Polysubstance Use. All subscales showed moderate non-parametric correlations with the ORBS-1 and with corresponding clinical constructs. Five of the subscales were significantly (p < .01) positively associated with self-reported non-fatal overdose. Of note, the Risky Non-Injection Use subscale was the most strongly associated with past-month overdose indicators. CONCLUSIONS: Psychometrics for the opioid overdose risk behavior subscales identified suggest the ongoing utility of risk behavioral instrumentation for epidemiological research and clinical practice focused on risk communication and minimization. Use of the entire ORBS-2 measure can provide insight into the proximal/behavioral factors of greatest concern to reduce overdose mortality.

Shorter and longer-term risk for non-fatal suicide attempts among male U.S. military veterans after discharge from psychiatric hospitalization.

Although there are key differences in shorter-term (days 1-90) and longer-term (days 91-365) risk factors for suicide after discharge from inpatient psychiatry, there are no comparable data on non-fatal suicide attempts. Risk factors for non-fatal attempts in the first 90 days after discharge were compared with those over the remainder of the year to identify temporal changes in risk. Records were extracted from 208,554 male veterans discharged from Veterans Health Administration acute psychiatric inpatient units from 2008 through 2013. Proportional hazard regression models identified correlates of non-fatal attempts for 1-90 days and 91-365 days; adjusted piecewise proportional hazards regression compared risk between these time frames. 5010 (2.4%) veterans made a non-fatal attempt, 1261 (0.60%) on days 1-90 and 3749 (1.78%) on days 91-365. Risk across both time frames was highest among younger veterans ages 18-59, and those hospitalized with a suicide attempt or suicidal ideation. It was lowest among those with a dementia diagnosis. Risk estimates were generally stable over time but increased among those with substance use disorders and decreased among those with sleep disturbance and discharged against medical advice. Estimates of some risk factors for non-fatal attempts change over time in the year after discharge and differ from those that change for suicide. Different preventive approaches may be needed to reduce shorter and longer-term risk for non-fatal attempts and suicide in the year after discharge.

Sexual Dysfunction and Preferences for Discussing Sexual Health Concerns Among Veteran Primary Care Patients.

BACKGROUND: Sexual health is an important, yet often overlooked, aspect of overall health. Veterans may be particularly at risk for sexual dysfunction. The objectives of this study were to assess the prevalence and correlates of sexual dysfunction and examine preferences among veterans for discussing sexual problems. METHODS: In this cross-sectional study, we mailed 1500 surveys to a random sample of primary care patients from 3 Veterans Affairs medical centers; 313 were returned (21% response rate) and 248 had complete data. Veterans (M age = 49.4 years) were mostly White (86.7%), women (60.9%), and married (79.0%). The Arizona Sexual Experience Scale was used to screen for sexual dysfunction. RESULTS: Half of veterans, 62.3% of women and 32.0% of men, screened positive for sexual dysfunction. More than 60% of veterans agreed that the primary care team should provide information, proactively ask, and inquire on medical history forms about sexual problems; 59.3% were open to meeting with behavioral health providers. CONCLUSIONS: Primary care providers should ask veterans about sexual health, as sexual dysfunction was prevalent, especially among women and among men over age 65. Most veterans were receptive to being asked about sexual problems in primary care and preferred to be asked rather than bring it up.

Delineating the Boundaries Between Nonmonogamy and Infidelity: Bringing Consent Back Into Definitions of Consensual Nonmonogamy With Latent Profile Analysis.

To gain insight into the mixed findings surrounding Consensual Nonmonogamy (CNM), this study developed the Triple-C model of commitment, conceptualizing relationship structures with three key dimensions: mutual consent, communication, and comfort. Latent profile analyses in an online sample (N = 1,658) identified five classes of relationship structures: two monogamous groups (68%; representing earlier- and later-stage relationships), CNM relationships (7.7%, marked by low interest in monogamy and high levels of mutual consent, comfort, and communication around commitment and EDSA), partially-open relationships (13%, with more mixed attitudes toward monogamy and lower consent, comfort, and communication), and one-sided EDSA relationships (11%, in which one partner desires monogamy while the other partner engages in EDSA with low levels of mutual consent, comfort, and communication). The monogamous and CNM groups demonstrated high levels of relationship and individual functioning, whereas the partially-open and one-sided nonmonogamous groups demonstrated lower functioning. These findings highlight the diversity of nonmonogamy that likely exists within self-report classifications like "swingers" and "open relationships," providing a possible explanation for the mixed findings in previous work. Decision tree analyses identified a 4-item algorithm (COMMIT4) that classifies individuals into these groups with 93% accuracy, offering a tool for incorporating relationship structure diversity in future work.

Modeling suicide risk among parents during the COVID-19 pandemic: Psychological inflexibility exacerbates the impact of COVID-19 stressors on interpersonal risk factors for suicide.

Public health researchers have raised the concern that both the 2019 coronavirus disease (COVID-19) pandemic and the ensuing public health response will increase interpersonal stressors associated with suicide risk. The Acceptance and Commitment Therapy (ACT) framework conceptualizes psychological flexibility as an important way to reduce the impact of painful and even catastrophic events on psychological suffering. The current study examines psychological flexibility as a potential moderator of the prevailing interpersonal model of suicide risk. METHODS: A sample of 1003 parents (73% female, 82% Caucasian 86% in romantic relationships) were recruited as part of a larger study on the COVID-19 pandemic and family functioning from Mach 27th to the end of April 2020, the height of the United States' "first wave." Participants completed measures of psychological flexibility (the Multidimensional Psychological Flexibility inventory; MPFI), interpersonal constructs (perceived burdensomeness and thwarted belongingness), desire for death, COVID-19 related stressors (resource strain and loss due to COVID-19). RESULTS: Moderated-mediation path models highlighted a significant indirect association between COVID-19 stressors and desire for death mediated by perceived burdensomeness to others. This indirect pathway was moderated by psychological inflexibility such that links were strongest at high levels of inflexibility and weak or non-significant at low levels of inflexibility. Results were generally consistent across five of the six facets of inflexibility. DISCUSSION: The findings highlight the value of targeting psychological inflexibility as an important strategy to reduce suicide risk during the COVID-19 pandemic. Implications of patterns of results across different facets for treatment approach are discussed.

Positive and negative evaluation of relationships: Development and validation of the Positive-Negative Relationship Quality (PN-RQ) scale.

Three studies were undertaken to develop the Positive-Negative Relationship Quality scale (PN-RQ), conceptualizing relationship quality as a bidimensional construct in which the positive qualities of a relationship are treated as distinct from its negative qualities. Analyses in emerging adults (Study 1: N = 1,814), in online respondents (Study 2: N = 787) with a 2-week follow-up, and in a single group pre-intervention-post-intervention study (Study 3: N = 54) of the Promoting Awareness, Improving Relationships (PAIR) program provided support for (a) positive and negative qualities as distinct dimensions via confirmatory factor analysis (CFA), (b) the PN-RQ representing an item response theory-optimized measure of these 2 dimensions, (c) substantive differences between indifferent (low positive and negative qualities) and ambivalent (high positive and negative qualities) relationships potentially obscured by unidimensional scales, (d) high levels of responsiveness of the PN-RQ scales to change over time, (e) the unique predictive validity offered over time by the PN-RQ scores beyond that offered by scores of current unidimensional measures of relationship quality, and (f) the unique longitudinal information gained by using the PN-RQ as a bidimensional outcome measure in an intervention study. Taken together, the studies offer promising support for the PN-RQ scales suggesting that they have the potential to advance both basic and applied research. (PsycINFO Database Record