Evaluating Suicide Risk Stratification in Outpatient Settings: A Vignette-Based Approach.

Suicide risk assessment and stratification are a key suicide prevention strategy in mental health care systems that treat military service members and veterans. The aim of the current mixed-method project was to address a gap in our knowledge as to how therapists make these important clinical decisions. This manuscript reports the results of a project during which six vignettes were developed reflecting varying levels of risk according to the Rocky Mountain MIRECC Risk Stratification Table. Mental health therapists were asked to evaluate the risk level of each vignette, determine a treatment disposition, and provide justification for their ratings. The results of the study indicate that therapists can reliably evaluate risk, but that treatment planning tended to be based more on vignette-specific factors than essential features of the risk model. The qualitative findings revealed variations in the definition and perception of foundational concepts, suggesting a need for further research and training in these domains. Overall, the results support the use of vignettes as a method to assess clinical decision-making and provide several areas for further training and research.

Change in Event Centrality and Posttraumatic Stress Disorder Symptoms During Intensive Treatment.

Event centrality, defined as the extent to which a traumatic event becomes a core component of a person's identity (Berntsen & Rubin, 2006), is both a correlate and predictor of posttraumatic stress disorder (PTSD) symptoms, over and above event severity. These findings suggest that decreasing the perceived centrality of a traumatic event to one's identity might result in decreases in PTSD symptom severity. To date, few studies have examined how centrality is affected by PTSD treatment. The present study tested the hypotheses that change in centrality would be associated with both change in PTSD symptom severity and discharge PTSD symptom severity in an exposure-based PTSD partial hospitalization program (N = 132; 86.0% White; 85.2% female; M age = 36 years). At discharge (i.e., after approximately 6 weeks of treatment), both PTSD symptoms and centrality had significantly decreased, ds = .70 and .98, respectively, with large effect sizes. Decreases in Centrality of Events Scale (CES) scores at posttreatment, baseline CES scores, and baseline PTSD Checklist for DSM-5 (PCL-5) scores were associated with change (i.e., decrease) in PCL-5 scores, p < .001, as well as with posttreatment PCL-5 scores, p < .001. Decreases in CES scores over time, baseline CES scores, and baseline PCL-5 scores explained 31% of the variance in PCL-5 change and 34% of the variance in posttreatment PCL-5 scores. The results indicate the potential importance of decreasing the centrality of a traumatic event in PTSD treatment and recovery.

An Integrated Model of Posttraumatic Stress and Growth.

A number of recent models have examined cognitive predictors of posttraumatic stress and posttraumatic growth (S. Barton, A. Boals, & L. Knowles, 2013; J. Groleau, L. Calhoun, A. Cann, & G. Tedeschi, 2013; K. N. Triplett, R. G. Tedeschi, A. Cann, L. G. Calhoun, & C. L. Reeve, 2012). The current study examined an integrated model of predictors of distress and perceived growth in 194 college undergraduates. Domains covered included the roles of core belief challenge, event centrality, posttrauma cognitions, and event-related rumination. Negative cognitions about the self and the centrality of the event directly predicted both growth and distress, although intrusive rumination predicted only posttraumatic stress disorder symptoms, and deliberate rumination predicted only posttraumatic growth. Future research should continue to examine the shared and unique predictors of postevent growth and distress.

Comparison of telehealth and in-person mental health care in military veterans and active-duty service members.

Telehealth services are increasingly utilized to improve mental health care access for active-duty service members (ADSM) and military veterans. This article examines mental health outcomes for veterans (n = 4,536) and ADSMs (n = 378) who met Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnostic criteria for depression, posttraumatic stress disorder, or generalized anxiety disorder (N = 4,914) and were treated at Cohen Veterans Network Clinics using either telehealth or in-person treatment modalities. Results demonstrate small but statistically significant advantages for telehealth in terms of discharge scores, rates of clinically significant change, and efficiency of treatment. For depression and posttraumatic stress disorder, veterans reported greater changes than ADSMs, but there was no interaction between treatment modality and client type. These findings support the use of telehealth as a viable option for mental health care in these populations, while suggesting several areas requiring further study. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Treatment outcomes after screening positive for suicidal ideation in United States military veterans.

Suicidal ideation is a significant risk factor for suicidal behaviors, precipitating increased levels of clinical assessment and concern. The purpose of the current study was to determine if screening positive for ideation significantly predicted treatment outcomes in a non-VHA veteran population. Participants were military veterans seen at a Cohen Veterans Network clinic between January 1, 2016, and December 31, 2021. Of 12,178 episodes of care, 673 (5.5%) were positive screens (moderate or high risk on the C-SSRS) and 234 (1.9%) were high risk. Overall, a positive screen was not a significant predictor of the reason for discharge or whether it was planned or unplanned. However, meeting the criteria for being high risk was associated with negative treatment outcomes in terms of the reason for discharge and the planned or unplanned nature of the discharge. These findings emphasize the significance of stratifying suicide risk as well as the advantages of routinely gathering data on reasons for client discharge.

Confirmatory factor and measurement invariance analyses of the emotion regulation questionnaire.

Emotion regulation is widely studied in many areas of psychology and the number of publications on emotion regulation has increased exponentially over the past few decades. Additionally, interest in the relationships between emotion dysregulation processes and psychopathology has drastically increased in recent years. The Emotion Regulation Questionnaire (ERQ) was developed to measure two specific constructs related to emotion control: reappraisal and suppression (Gross & John, 2003). In its initial validation study and subsequent analyses, the instrument was shown to possess sound psychometric properties, but, to date, inquiry regarding the measure's characteristics has been limited. Factor analytic examinations of commonly used instruments are recommended to validate the properties of a given measure and increase researchers understanding of the measured constructs. The current study examined the psychometric properties of the ERQ in a sample of 1,188 undergraduates through confirmatory factor analysis. Additionally, tests of measurement invariance were employed in order to examine potential structural differences based on gender and ethnicity. The current study supported the original structure of the measure with all demographic groups and exceptional fit was demonstrated. Additional normative data for gender and ethnic groups are included. Results support the use of the instrument in future research.

Moral decision making, religious strain, and the experience of moral injury.

OBJECTIVE: Moral injury is the lasting psychological, spiritual, and behavioral effects of having perpetrated acts that transgress moral boundaries. Contemporary models of moral injury in military veterans examine the role of transgressive acts, moral appraisals of these acts, and the symptoms of moral injury. However, little research has examined potential pathways between these elements. The current study examined appraisals of one's acts and religious strain as potential mediators of the link between transgressive acts and symptoms of moral injury. Further, given the inherent importance of moral cognitions in the appraisal process, we tested whether the acts to appraisals link was moderated by altruism in military veterans. METHOD: An online survey, distributed using crowdsourcing software, was completed by military veterans. The survey included measures of transgressive acts, appraisals of these acts, religious strain, altruism, and self- and other-directed symptoms of moral injury. Mediation and moderated serial mediation were used to test the hypotheses. RESULTS: Our results indicated appraisals and religious strain significantly mediated the acts to symptoms pathway for both self- and other-directed aspects of moral injury. This pathway was significantly moderated by altruism such that a stronger link exists between acts and appraisals at higher levels of altruism. CONCLUSION: Overall, these findings suggest that religious functioning and moral decision making are important aspects of the experience of moral injury and are worthy of future study. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A test of a resilience based intervention for mental health problems in Iraqi internally displaced person camps.

Background and Objectives: The mental health needs of those in internally displaced persons camps are significant and are compounded by a number of barriers to care. Traditional methods of mental health care are often not feasible and thus a need exists for interventions that can successfully meet these conditions. The current study introduces and tests a new positive-psychology intervention, GROW, which was designed specifically for use in internally displaced persons camps. Design: Pre-Post-Follow-up longitudinal examination of those who participated in the GROW intervention group (N = 766). Methods: The study includes three waves of data for the intervention, which was administered in a group format, using paraprofessionals, over a two-week period in internally displaced persons camps in Iraq. Results: The results indicate significant decreases in symptoms of PTSD for participants from pre- to post-intervention and demonstrates these changes were maintained at a three-month follow-up. Post hoc results indicated participants who were older, female, or who attended more sessions were more likely to respond to the intervention. Conclusions: These data provide initial support for the intervention and suggest additional research to more fully validate this intervention are warranted.

Measures of morally injurious experiences: A quantitative comparison.

A recent body of literature has examined the psychological effects of perpetrating or failing to prevent acts that violate one's sense of right and wrong. The objective of this study was to examine and compare correlations between the two most widely used instruments measuring this construct in a sample of military veterans and relevant psychosocial variables. Individuals (N = 182) who reported military combat experience completed the Moral Injury Events Scale and the Moral Injury Questionnaire-Military Version, along with measures of combat exposure, depression, posttraumatic stress disorder, alcohol concerns, anger, guilt, and shame. Results indicate similar correlations between the morally injurious experiences instruments and negative psychosocial variables, but different correlations with combat exposure. Implications for further research in the conceptualization and treatment of morally injurious experiences are discussed.

Longitudinal predictors of desire to re-enlist in the military among male and female national guard soldiers.

Given the cost and burden associated with training and recruitment of military members, identifying predictors of military retention remains an important goal. The aim of the current study was to examine predictors of male and female service members' likelihood of remaining in the National Guard following combat deployment in support of Operation Iraqi Freedom. Using a prospective, longitudinal design, this study assessed a wide range of predictors including mental health functioning, personality variables, deployment stressors, and various domains of quality of life. Results indicated perceived unit support was the strongest predictor of intention to re-enlist for both male and female participants. However, significant gender differences emerged as predeployment depression and a trend toward perceived life threat during deployment were predictors of men's intention to re-enlist, whereas the predeployment personality dimension of introversion (low positive emotionality) and postdeployment life stressors were predictors of women's intention to re-enlist. Surprisingly, no postdeployment mental health variables predicted National Guard soldiers' intention to re-enlist. Findings from this study suggest factors associated with National Guard service members' retention or attrition from the military may be amenable to intervention.

Path analytic examination of a cognitive model of PTSD.

Ehlers and Clark (2000) developed a cognitive model of posttraumatic stress disorder (PTSD) symptom maintenance which implicated the role of posttraumatic cognitions and aspects of the trauma memory in maintaining symptoms via an increased sense of current threat. The aim of the current study was to empirically test a variant of this model using path analysis. Participants in the current study were 514 undergraduates at a midwestern university who reported experiencing at least one traumatic event. Path analyses examined various models of the possible relationships between one's posttraumatic cognitions and the centrality of the traumatic event to the sense of self (considered an aspect of memory integration) in predicting current level of PTSD symptoms. Results indicate that both event centrality and posttraumatic cognitions are unique and independent predictors of current symptom level. Overall, the results of this study support aspects of Ehlers and Clark's cognitive model of PTSD; cognitive appraisals of the self and centrality of the event were highly related to levels of distress. However, the current study suggests that overly integrated trauma memories may lead to greater distress and not poorly integrated ones as suggested by Ehlers and Clark.

WITHDRAWN: Path analytic examination of a cognitive model of PTSD.

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Social anxiety across ethnicity: a confirmatory factor analysis of the FNE and SAD.

Previous research has established that social anxiety occurs at different rates in African American and European American populations (Grant et al., 2005), while psychometric investigations of widely used measures of psychopathology show differences in factor structure based on ethnic background (Carter, Miller, Sbrocco, Suchday, & Lewis, 1999; Chapman, Williams, Mast, & Woodruff-Borden, 2009). The current study examined response characteristics of 1276 African American and European American undergraduates completing the Fear of Negative Evaluation and Social Avoidance and Distress Scales (Watson & Friend, 1969). Confirmatory factor analyses failed to demonstrate factorial invariance in the two ethnic samples, and Wald tests suggested several items on both measures be dropped for African Americans. Results suggest the FNE and SAD operate differently across ethnic groups. Implications for the cross-cultural measurement of social anxiety and the importance of continued rigorous psychometric inquiry of commonly used measures are discussed.

An examination of the differential effects of the experience of DSM-IV defined traumatic events and life stressors.

Recent evidence suggests that individuals exposed to traumatic events report similar, if not lower, levels of posttraumatic stress disorder (PTSD) symptoms than individuals exposed to nontraumatic stressful life events [J. Anxiety Disord. 19 (2005) 687-698; Br. J. Psychiatry 186 (2005) 494-499]. The current study compared the level of self-reported PTSD symptoms in a large sample (n=668) of trauma and nontrauma exposed college students. Participants were assessed for past trauma history as well as current symptoms of PTSD, depression, social interaction anxiety, and current positive and negative affect. Results indicated that while those who had experienced a traumatic event reported statistically significantly higher levels of PTSD symptoms, these differences were no longer clinically significant after other psychological distress factors were accounted for. Additional analyses suggested that those who had experienced events of an interpersonal nature had significantly higher levels of PTSD symptoms than those who had experienced other types of events.

A factor analytic comparison of five models of PTSD symptoms.

This study examined the factor structure of PTSD symptoms in a sample of college students (n=344) reporting exposure to a range of traumatic events. The sample was randomly split and an exploratory factor analysis was conducted with half of the sample. The factor structure obtained in the exploratory analysis was evaluated against three other models using confirmatory factor analysis utilizing the second half of the sample. This series of factor analyses identified and confirmed a three-factor symptom structure consisting of intrusion/avoidance, dysphoria, and hyperarousal clusters. These results add to the body of literature which has found that PTSD includes a cluster of symptoms shared with other diagnoses (dysphoria) and a more specific factor related directly to the effects of encountering traumatic experiences.