Suicide among veterans with amyotrophic lateral sclerosis.

BACKGROUND: The purpose of this study was to estimate the risk of death by suicide for those with amyotrophic lateral sclerosis (ALS) seeking care within the Veterans Health Administration (VHA). METHODS: This was a retrospective, cohort study. Extended Cox regression models were used to compare the hazard of suicide between the ALS and the unexposed groups. RESULTS: The hazard of suicide was 3.98 times higher for those with ALS than for those without (95% confidence interval [CI] , 2.64-6.00; P < .0001). After adjusting for covariates, those with ALS remained at increased risk (hazard ratio, 3.48; 95% CI, 2.31-5.24; P < .001). CONCLUSIONS: Among those seeking care in the VHA, individuals with ALS are at increased risk for dying by suicide. Additional suicide prevention efforts, including strategies for reducing access to lethal means, are warranted.

Examining the Contributions of Disability to Suicidality in the Context of Depression Symptoms and Other Sociodemographic Factors.

We examined the contribution of disability status to suicidality when accounting for depression and sociodemographic risk factors in 438 American adults, 82 (18.7%) of whom identified as having disabilities. Participants with disabilities had significantly higher depression scores and were more likely to be unemployed and unpartnered, all of which were also associated with increased suicidality. However, disability remained a significant predictor of suicidality even when depression and sociodemographic risk factors were accounted for in a linear regression. Other significant predictors of suicidality in this regression were female gender, depression symptoms, and family and friend suicide history; identifying as a member of a religion was a significant protective factor against suicidality. Our findings suggest that the contribution of disability to suicidality goes beyond that which can be explained by increased depression symptoms and sociodemographic vulnerability.

"It's Awful When We Get It Wrong": An Exploratory Qualitative Study of Vocational Rehabilitation Counselors' Perspectives on Suicide.

Despite the high prevalence of suicide among people with disabilities, little research has explored suicide in the context of the vocational rehabilitation (VR) system. We analyzed the responses of 27 VR counselors who responded to an open-ended qualitative prompt regarding their experiences with suicide training and competency. Key themes included a desire for more training on suicide and the experience of seeking and receiving suicide training and experience outside of VR. Responses also underscored the heavy emotional impact of working with suicidal clients, especially when one feels unprepared to do so. These results suggest that it is important to provide VR counselors with resources and training for addressing suicide in their client populations.

"I Honestly Would Not Have Known What to Do": An Exploratory Study of Perspectives on Client Suicide Among Vocational Rehabilitation Support Staff.

Despite the high prevalence of suicide both overall and among people with disabilities in particular, little research has explored suicide in the context of the vocational rehabilitation (VR) system or in counseling support staff in general. We analyzed the responses of 14 VR support staff who responded to an open-ended qualitative prompt regarding their experiences with suicide training and competency. Key themes included a perceived lack of and desire for more training regarding suicide, seeking and receiving suicide training outside of VR, and a perceived lack of resources for working with suicidal clients. Responses also underscored the heavy emotional impact of working with these clients, especially when one feels unprepared to do so. These results suggest that it is important to provide VR support staff with resources and training for addressing suicide in their client populations.

Examining the roles of disability-related body esteem and perceived burdensomeness in suicidal ideation among adults with vision- and mobility-related disabilities.

PURPOSE/OBJECTIVE: People with disabilities (PWD) generally exhibit an increased risk of suicidal ideation (SI) and behaviors. Underlying cognitive states, namely perceived burdensomeness, have been identified as a contributor to the increased risk of suicidal thoughts and behaviors in PWD. However, the role of body esteem in the development of SI in this population remains unexamined, despite its salience in other populations. In this study, we examined whether the interaction of perceived burdensomeness and body esteem contributed to the perceived likelihood of future SI among PWD, and whether this relationship was further moderated by disability type. METHOD: Participants included 119 adults with self-reported vision- and mobility-related disabilities who participated in a larger study focused on disability and suicide involving interviews and self-report measures. We examined the interaction between perceived burdensomeness and disability-related body esteem on self-reported likelihood of future SI and whether this interaction was further moderated by disability type (i.e., vision- or mobility-related disability). RESULTS: Greater perceived burdensomeness was associated with a greater perceived likelihood of future SI only for participants with vision impairments and at low levels of body esteem. CONCLUSIONS/IMPLICATIONS: The combination of experiences of perceived burdensomeness and low body esteem may be particularly relevant to SI among people with vision-related versus mobility-related disabilities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impacts of a PECS instructional coaching intervention on practitioners and children with autism.

There is a growing research literature on the potential benefits of augmentative and alternative communication (AAC) for individuals with autism; however few studies have investigated implementation of AAC within real-life contexts. Thus, the purpose of this study was to investigate the impact of training for practitioners in implementation of aided AAC, and to examine implementation of Picture Exchange Communication System (PECS) in real-life contexts. In particular, this study involved the implementation of instructional coaching to increase opportunities offered by behavioral therapists for their preschool-aged clients to use PECS to make requests. Results indicated increases in therapist implementation of AAC and client use of AAC in trained contexts, with limited generalization to untrained contexts.

The Association between Physical and Psychological Domestic Violence Experienced during the COVID-19 Pandemic and Mental Health Symptoms.

Research has shown that rates of domestic violence generally increased during the coronavirus 2019 (COVID-19) pandemic, likely related to mitigation efforts that promoted staying at home and lockdown protocols. However, the link between pandemic-related domestic violence victimization and mental health outcomes has been less explored. The present study examined the possible association between exposure to domestic physical and psychological violence during the COVID-19 pandemic and depressive and post-traumatic stress symptoms (PTSS) in an online sample of American adults recruited in December 2021. Data from 604 participants were analyzed. Forty-four percent of participants (n = 266) reported experiencing physical domestic violence, psychological domestic violence, or both during the pandemic, with psychological violence more commonly reported than physical violence. Exposure to both forms of violence was associated with higher rates of depressive and post-traumatic stress symptoms. Given the high rates and negative associations between psychological domestic violence and mental health symptoms in this sample, healthcare providers should assess for domestic violence exposure even if no indications of physical abuse are present or if there were not concerns about domestic violence exposure prior to the pandemic. Potential psychological sequalae should also be assessed if a patient has a positive history of domestic violence victimization.

Supervising and supporting trainees with disabilities in the Veterans Administration Healthcare System: An overlooked but critical need and opportunity.

Trainees with disabilities are chronically underrepresented in psychology and face many barriers throughout their training. Directors of Clinical Training and supervisors within the Veterans Administration Healthcare System (VAHCS), one of the largest employers of trainees with disabilities, have a unique opportunity to address this area of critical need. However, they must first understand the barriers facing psychology trainees with disabilities in VAHCS settings, including discrimination in trainee selection, barriers to obtaining reasonable accommodations, and attitudinal and cultural barriers. In this article, we illustrate how those barriers may present in VAHCS settings specifically and provide suggestions and frameworks for how the VAHCS can create accessible, disability-affirmative training environments in which trainees can truly thrive. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Methodological considerations for collecting and analyzing data on multiply marginalized psychology trainees with disabilities.

OBJECTIVE/PURPOSE: Historically, psychology trainees from marginalized communities have been underrepresented both as researchers and as participants in research on trainee experiences and outcomes. The current research can be used to develop evidence-based strategies to understand and improve the recruitment, retention, advancement, and overall training experiences of trainees with marginalized identities. METHOD: We review the existing literature on the experiences of psychology trainees, particularly that focused on trainees from marginalized backgrounds. RESULTS: Quantitative, qualitative, and archival data collection and analysis methods each carry their own benefits and limitations, which must be considered and addressed intentionally to optimize the impact of research findings for multiply marginalized individuals. Mixed methods approaches are also discussed. Matching each limitation with a research design strategy is recommended, including the use of sample weights from population archival data to contextualize sample results, incorporating flexibility for reasonable accommodations for intensive qualitative studies, and other strategies. CONCLUSIONS/IMPLICATIONS: We provide guidance on selecting a methodology based on specific research and dissemination goals within this area and discuss implications and recommendations for both rehabilitation psychology specifically and the field more broadly. Training programs, governing bodies, faculty, researchers, and other invested parties have shared accountability to deliver diverse, equitable, and inclusive education and training experiences, and conducting high-quality research on the experiences of multiply marginalized trainees, including those with disabilities, is a key component of that process. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Shifting the discourse on disability: Moving to an inclusive, intersectional focus.

Individuals with disabilities comprise one of the largest marginalized groups in the United States and experience systemic barriers in health care. In Westernized communities, disability has historically been conceptualized via the medical model, which considers disability an individual-level deficit in need of correction. Although other models of disability (e.g., social model) have been developed to address the medical model's ableist shortcomings, these fail to consistently acknowledge intersectionality. Specifically, these models fail to consider that (a) a disabled individual may hold other marginalized or oppressed identities and (b) these intersecting oppressions may exacerbate health inequities. Intersectionality, which originates from Black feminist literature, describes the ways that systems of power and oppression (e.g., racism, sexism) interact to form an individual's unique experience. To date, the intersection of disability and other marginalized identities has been neglected in psychology and related fields, leaving little guidance for how scholars, clinicians, and other stakeholders can address disability via an intersectional lens. The present article discusses how a disability-affirmative, intersectional approach can serve as a strategy for challenging and reforming oppressive systems across the field of psychology. We assert that, ultimately, this approach has the potential to optimize and expand access to equitable, inclusive mental health care, and we propose actionable steps psychologists can take in research, practice, training, and policy in pursuit of this aim. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Models of Gender Dysphoria Using Social Media Data for Use in Technology-Delivered Interventions: Machine Learning and Natural Language Processing Validation Study.

BACKGROUND: The optimal treatment for gender dysphoria is medical intervention, but many transgender and nonbinary people face significant treatment barriers when seeking help for gender dysphoria. When untreated, gender dysphoria is associated with depression, anxiety, suicidality, and substance misuse. Technology-delivered interventions for transgender and nonbinary people can be used discretely, safely, and flexibly, thereby reducing treatment barriers and increasing access to psychological interventions to manage distress that accompanies gender dysphoria. Technology-delivered interventions are beginning to incorporate machine learning (ML) and natural language processing (NLP) to automate intervention components and tailor intervention content. A critical step in using ML and NLP in technology-delivered interventions is demonstrating how accurately these methods model clinical constructs. OBJECTIVE: This study aimed to determine the preliminary effectiveness of modeling gender dysphoria with ML and NLP, using transgender and nonbinary people's social media data. METHODS: Overall, 6 ML models and 949 NLP-generated independent variables were used to model gender dysphoria from the text data of 1573 Reddit (Reddit Inc) posts created on transgender- and nonbinary-specific web-based forums. After developing a codebook grounded in clinical science, a research team of clinicians and students experienced in working with transgender and nonbinary clients used qualitative content analysis to determine whether gender dysphoria was present in each Reddit post (ie, the dependent variable). NLP (eg, n-grams, Linguistic Inquiry and Word Count, word embedding, sentiment, and transfer learning) was used to transform the linguistic content of each post into predictors for ML algorithms. A k-fold cross-validation was performed. Hyperparameters were tuned with random search. Feature selection was performed to demonstrate the relative importance of each NLP-generated independent variable in predicting gender dysphoria. Misclassified posts were analyzed to improve future modeling of gender dysphoria. RESULTS: Results indicated that a supervised ML algorithm (ie, optimized extreme gradient boosting [XGBoost]) modeled gender dysphoria with a high degree of accuracy (0.84), precision (0.83), and speed (1.23 seconds). Of the NLP-generated independent variables, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) clinical keywords (eg, dysphoria and disorder) were most predictive of gender dysphoria. Misclassifications of gender dysphoria were common in posts that expressed uncertainty, featured a stressful experience unrelated to gender dysphoria, were incorrectly coded, expressed insufficient linguistic markers of gender dysphoria, described past experiences of gender dysphoria, showed evidence of identity exploration, expressed aspects of human sexuality unrelated to gender dysphoria, described socially based gender dysphoria, expressed strong affective or cognitive reactions unrelated to gender dysphoria, or discussed body image. CONCLUSIONS: Findings suggest that ML- and NLP-based models of gender dysphoria have significant potential to be integrated into technology-delivered interventions. The results contribute to the growing evidence on the importance of incorporating ML and NLP designs in clinical science, especially when studying marginalized populations.

Valuing the insider-professional perspective of disability: A call for rehabilitation psychologists to support disabled psychologists and trainees across the profession.

PURPOSE/OBJECTIVE: In this commentary, I call for rehabilitation psychologists to support and advocate for trainees and psychologists with disabilities across the profession as an extension of the foundational principles of the study. RESEARCH METHOD/DESIGN: I reviewed the literature on psychologists and psychology trainees with disabilities, as well as the foundational principles of rehabilitation psychology. RESULTS: A growing body of literature documents both the presence of psychologists and psychology trainees with disabilities and the barriers that they often encounter in the field. One of the foundational principles of rehabilitation psychology and the acknowledgment of the insider-outsider perspective of disability, which holds that disabled individuals, by nature of their lived experience, have unique perspectives on disability that enrich our overall understanding of it. CONCLUSION/IMPLICATIONS: Through their combination of lived experience and professional expertise, disabled psychologists and trainees bring a critical insider-professional perspective to the field, both inside and outside of rehabilitation psychology. It is both important and in line with our foundational principles that rehabilitation psychologists advocate for psychologists and trainees with disabilities in all settings, so that their important insider-professional perspective on disability can continue to advance the field. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Investigating the teaching experiences of psychology graduate students with disabilities: A qualitative study.

PURPOSE/OBJECTIVE: Graduate students and faculty with disabilities are underrepresented in psychology and face many barriers in graduate education and training. Teaching is a major component of graduate training and faculty preparation, but there is a dearth of research on the teaching experiences of psychology graduate students with disabilities. The objective of this study was to explore the teaching experiences of psychology graduate students with disabilities. RESEARCH METHOD/DESIGN: We conducted semistructured interviews with 12 disabled psychology graduate students who had teaching experience as part of their graduate programs. Interviews were analyzed using phenomenological coding. RESULTS: Common themes among participants were lack of disability disclosure; lack of accommodations for teaching and guidance of how to receive them; and supportive and nonsupportive resources and mentors in their graduate teaching experiences. CONCLUSIONS/IMPLICATIONS: Disabled graduate student teachers often lack environments and resources where they can receive disability-specific support and accommodations for teaching. Faculty and programs should develop and promote disability-affirmative training cultures that actively support graduate student teachers with disabilities, including departmental cultures that de-stigmatize disability disclosure and accommodations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Ever-changing but always constant: "Waves" of disability discrimination during the COVID-19 pandemic in the United States.

The ongoing novel coronavirus 2019 (COVID-19) pandemic has had considerable effects on the disability community. As the pandemic has progressed and changed, the manifestations of these effects have differed, and yet the underlying causes-ableism including the devaluation of disabled lives-have remained consistent. In this commentary, we explore the impact of the pandemic on the disability community in the United States, conceptualizing four distinct but overlapping "waves" of discrimination: 1) healthcare rationing and missed opportunities for disability inclusion, 2) access to resources, supplies, and accommodations; 3) vaccine access; and 4) long COVID and disability identity. Throughout our discussion of these waves, we detail the discrimination faced by people with disabilities, the underlying ableism that perpetuates it, and the resilience shown by the disability community. We end with a call for combating systemic ableism in healthcare and public health systems.

Intersection of discriminations: Experiences of women with disabilities with advanced degrees in professional sector in the United States.

PURPOSE/OBJECTIVE: Women with disabilities are typically expected to work in underpaid positions and earn much less when compared with men with disabilities or women without disabilities. In this study, we interviewed women who are at the other end of this spectrum-women with disabilities who were engaged in a high-skilled professional sector. We report their lived experiences and how the intersections of their identities impact, contradict, and collide with the aforementioned assumption. We use feminist disability theory and Crenshaw's theory of intersectionality to inform our research. Research Method/Design: In-depth semistructured qualitative interviews adopting a phenomenological framework were conducted with 37 women with disabilities who hold advanced degrees and work in higher-paying professions. RESULTS: Some of the themes generated from our analysis of the interviews included isolation and hopelessness, a sense of tokenism or de-legitimization, limitations of provided accommodations, the intersection of gender and disability, and how multiple layers of identity fuel marginalization. CONCLUSIONS/IMPLICATIONS: Despite their success in placement, women with disabilities in the United States still experience numerous barriers in professional sectors. It is imperative to better understand the implications of intersectionality and how discrimination and marginalization can also impact those with successful employment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Guidelines to Address Barriers in Clinical Training for Trainees with Sensory Disabilities.

Disability is an important facet of diversity. Although diversity in clinical training in health service psychology has improved considerably, training often neglects accessibility and inclusion for individuals with sensory disabilities. The limited research to date documents that trainees with sensory disabilities (TSD) report extensive barriers and are consistently under-represented in clinical settings. Further, few resources have been developed to guide accommodating TSD in clinical training. Accordingly, our goals in this article are two-fold: (1) to highlight the barriers in clinical training faced by TSD and (2) to provide recommendations for trainees, supervisors, clinical leadership, and directors of clinical training to improve accessibility and inclusion for TSD. We offer vignettes to illustrate barriers faced by TSD and suggest guidelines to improve access for TSD.

Creating academic-community partnerships to jointly enhance advocacy and research on violence and disability: Two case examples.

OBJECTIVE: This article describes the use of community-based participatory research (CBPR) to foster bidirectional and equitable academic-community partnerships in two studies related to interpersonal violence and disability. METHOD: We analyzed our methods and experiences in conducting these studies to focus on the ways in which CBPR methodology was used to jointly promote and enhance research and advocacy surrounding violence and disability in the research processes themselves and the resulting assessment and intervention products. RESULTS: Our use of CBPR methodology allowed us to identify and address critical issues related to violence in the disability community, such as disability-related forms and experiences of violence, concerns and barriers linked to mandated reporting laws, and inaccessible measures and interventions, and to address them in research products. Additionally, our bidirectional academic-community partnerships led us to address overall accessibility of the research process itself as a means by which to amplify advocate voices in science. CONCLUSIONS: Full, meaningful, and equitable participation of people with disabilities at every stage of the research process allows for the creation of partnerships that jointly advance research and advocacy around violence and disability. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining the potential applicability of the minority stress model for explaining suicidality in individuals with disabilities.

PURPOSE/OBJECTIVE: The purpose of this conceptual article is to discuss the minority stress model and its potential applicability as a model for examining the higher rates of suicidality in people with disabilities. METHOD: This conceptual article is based in the empirical literature on the minority stress model and the literature exploring the experiences of both proximal (e.g., internalized stigma, self-concealment) and distal (e.g., harassment, violence, and discrimination) minority stress among people with disabilities. It also draws from the literature on suicidality and disability. RESULTS: After establishing the higher rates of suicidality among people with disabilities as evidenced in the existing literature and discussing our gaps in the knowledge about the factors that drive this phenomenon, I discuss the minority stress model, which posits that elevated rates of suicidality among individuals with disabilities can be explained by a combination of proximal and distal stressors related to one's marginalized status. I then discuss the ways in which this model could be applied to suicidality and psychological distress in individuals with disabilities, drawing on research that establishes that they experience these proximal and distal stressors at high rates. CONCLUSIONS: The minority stress model is potentially useful for conceptualizing the higher rates of suicidality among people with disabilities, both alone and in conjunction with other models of suicide, in a manner that addresses disability justice and the experiences and effects of chronic, pervasive marginalization. Recommendations for research, and policy, including strategies for addressing both internalized ableism and disability-related discrimination and harassment, are provided. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychology predoctoral internship match rates by disability type.

Objective: The objective of this study was to analyze the match rates of psychology predoctoral internship applicants by disability type. Method: Through the use of publicly available data from the 2008, 2011, 2012, 2015, and 2016 Association of Psychology Postdoctoral and Internship Centers internship applicant surveys, differences in match rate for applicants with different types of disabilities, as compared with nondisabled applicants, were analyzed. Additionally, trends in match rates for applicants with different disability types over time were analyzed. Results: Across disability type, applicants with disabilities tended to have lower match rates than did applicants without disabilities. These differences were particularly large in applicants with physical/orthopedic disabilities and learning disabilities. These gaps in match rates were narrowing for some types of disabilities but widening for others. Conclusion: Disabled internship applicants experience consistent, negative disparities internship match rates compared with their nondisabled peers. Psychologists must take action to identify and ameliorate the causes of these disparities and address the chronic underrepresentation of psychologists with disabilities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Retrospective and Current Peer Victimization in College Students with Disabilities: Examining the Intersectionality of Sexual Orientation and Gender.

The present, exploratory study examined retrospective and current peer victimization in a multi-university sample of 58 college students with disabilities, 18 (31%) of whom identified as sexual minorities. Fifty-seven participants reported peer victimization during childhood, and approximately half reported experiencing peer victimization in the past 2 months. Students who identified as sexual minorities reported more retrospective victimization but current victimization did not differ between the two groups. Current and retrospective peer victimization were significantly correlated with present psychological distress. Professionals who work with students with disabilities should be aware of the high prevalence of peer victimization and its psychological correlates in this population.