Determining the MMPI-3 SUI scale's cross-sectional and prospective utility in suicide risk assessment.

OBJECTIVE: In-depth suicide risk assessments are particularly important to long-term suicide prevention. Broadband measures of psychopathology, such as the Minnesota Multiphasic Personality Inventory (MMPI) instruments, assess suicide risk factors and various mental health comorbidities. With the recent release of the MMPI-3, the Suicidal/Death Ideation (SUI) scale underwent revisions to improve its construct validity and detection of suicide risk factors. Thus, we hypothesized the MMPI-3 SUI scale would demonstrate medium to large associations with suicidal experience and behaviors, future ideation, and interpersonal risk factors of suicide. METHODS: A sample of 124 college students screened for elevated depressive symptoms completed a brief longitudinal study. Participants completed a baseline session including the MMPI-3 and criterion measures and three brief follow-ups every 2 weeks. RESULTS: SUI scores were most robustly associated with increased risk for past suicidal ideation, planning, and perceived burdensomeness. Prospectively assessed suicidal ideation was also meaningfully associated with SUI. SUI scale elevations indicate an increased risk of suicide-related risk factors. CONCLUSION: The MMPI-3 is a valuable tool to inform long-term suicide prevention for those experiencing elevated depressive symptoms as the SUI scale can assess past, current, and future suicide-related risk factors, including suicidal ideation and behaviors.

Perceptions of grief reactions in family members of incarcerated individuals: A vignette-based experiment.

We examined perceptions of individuals grieving the loss of a family member to incarceration. Participants (N = 1095) were randomized to a vignette that varied by race-ethnicity, crime type, and grief trajectory to assess their perceptions. Results indicated: (1) participants perceived prolonged grief as less appropriate than resilience; (2) Black family members grieving someone who committed a violent crime as more appropriate compared to White family members; and (3) women endorsed both grief trajectories as more appropriate and indicated greater comfort supporting the family member. Lastly, participants indicated prolonged, White and Latinx grievers should seek therapy more than resilient or Black individuals.

Association between perceived social support and suicide ideation distress among psychiatric inpatients: The role of thwarted interpersonal needs.

INTRODUCTION: The interpersonal theory of suicide posits that thwarted belongingness (TB) and perceived burdensomeness (PB) are proximal risk factors for suicide ideation; however, there are mixed results regarding this hypothesis among psychiatric inpatients. OBJECTIVE: The current study examined the mediating role of TB and PB in the relationship between perceived social support (i.e., support from family, friends, a significant other, and total) and suicide ideation distress among psychiatric inpatients. METHODS: Participants (short-term psychiatric inpatients; N = 139) were administered self-report assessments cross-sectionally. RESULTS: Nonparametric mediation results indicated that the total (additive) indirect effects of TB and PB, in parallel, were significant in all models, yet there were only significant specific (unique) indirect effects of PB. CONCLUSION: TB and PB, in combination, may be proximal risk factors for suicide ideation distress among psychiatric inpatients with lower perceived social support from family, friends, a significant other, and in total. These findings are congruent with the interpersonal theory of suicide's propositions that the combination of TB and PB increases the risk for suicide ideation. Clinicians may consider using interventions that target increasing perceived social support and decreasing TB and PB (i.e., cognitive behavioral therapy and social skills training) for this population.

Screening Utility of the PHQ-2 and PHQ-9 for Depression in College Students: Relationships with Substantive Scales of the MMPI-3.

We investigated the validity and screening effectiveness of the PHQ-2 and PHQ-9 scores in 229 college students in a cross-sectional design. PHQ associations with Minnesota Multiphasic Personality Inventory-3 internalizing scales suggest PHQ scores are effective screening tools for college students and may aid in effective triage and service needs.

Interpersonal Risk Factors, Sexual and Gender Minority Status, and Suicidal Ideation: Is BDSM Disclosure Protective?

Suicidal ideation is elevated among individuals who engage in BDSM practices and those with sexual and gender minority (SGM) identities. There is limited research on the intersectionality of these identities and how they relate to suicidal ideation, especially within a theoretical framework of suicide risk, such as the interpersonal theory of suicide. Thus, we tested the indirect relation between BDSM disclosure and suicidal ideation through thwarted belongingness and perceived burdensomeness, as well as the moderating role of SGM identity on these indirect associations. Participants were 125 (Mage = 28.27 years; 64% cisgender men) individuals recruited via online BDSM-related forums who endorsed BDSM involvement and recent suicidal ideation. Results indicated significant moderated mediation, such that BDSM disclosure was indirectly negatively related to suicidal ideation through lower thwarted belongingness, but not perceived burdensomeness, among SGM individuals. This was due to the significant relation between BDSM disclosure and thwarted belongingness. There were no significant moderated mediation or indirect effects related to perceived burdensomeness. We also provide supplemental analyses with positive ideation (i.e., positive thoughts toward life) as the criterion variable. In conclusion, BDSM disclosure appears to be protective against suicidal ideation through thwarted belongingness but only for SGM individuals. This work furthers our understanding of the impact of intersecting marginalized identities on suicide risk and resilience. Implications, limitations, and future directions are further discussed.

The moderating role of pessimism in the association between retrospective relational peer victimization, interpersonal risk factors, and suicide ideation.

Peer victimization (PV) is a serious concern for youth and is associated with subsequent suicide ideation in young adulthood. The interpersonal theory of suicide may provide a framework for understanding suicide ideation in this population. Specifically, thwarted belongingness (TB) and perceived burdensomeness (PB) have been significantly associated with suicide ideation among young adults with a history of peer victimization. Additionally, the personality trait of pessimism is associated with elevated suicide ideation. Thus, this study tested the association between self-reported frequency of retrospective relational (i.e., verbal and indirect) PV in primary and secondary school, thwarted interpersonal needs (TB and PB), and current suicide ideation, as well as how these relations may vary based on current pessimism. Participants were 330 undergraduate students. Nonparametric bootstrap moderated mediation procedures were used to test hypotheses. Results indicated significant indirect effects of frequency of retrospective relational PV and suicide ideation through PB and TB. Contrary to predictions, results did not indicate significant moderated mediation; however, the association between PB and suicide ideation was stronger at lower pessimism levels. We also provide supplemental analysis with optimism as the moderator. These findings suggest that clinicians may consider targeting TB, PB, as well as pessimism and optimism among those with a history of relational PV when assessing and intervening on current suicide ideation. Implications, limitations, and future directions are further discussed.

The Potential for Transmission of Coronaviruses via Sports Equipment; A Cricket Case Study.

A review of literature on the role of fomites in transmission of coronaviruses informed the development of a framework which was used to qualitatively analyse a cricket case study, where equipment is shared and passed around, and identify potential mitigation strategies. A range of pathways were identified that might in theory allow coronavirus transmission from an infected person to a non-infected person via communal or personal equipment fomites or both. Eighteen percent of potential fomite based interactions were found to be non-essential to play including all contact with another persons equipment. Six opportunities to interrupt the transmission pathway were identified, including the recommendation to screen participants for symptoms prior to play. Social distancing between participants and avoiding unnecessary surface contact provides two opportunities; firstly to avoid equipment exposure to infected respiratory droplets and secondly to avoid uninfected participants touching potential fomites. Hand sanitisation and equipment sanitisation provide two further opportunities by directly inactivating coronavirus. Preventing players from touching their mucosal membranes with their hands represents the sixth potential interruption. Whilst potential fomite transmission pathways were identified, evidence suggests that viral load will be substantially reduced during surface transfer. Mitigation strategies could further reduce potential fomites, suggesting that by comparison, direct airborne transmission presents the greater risk in cricket.

The Potential for Airborne Transmission of SARS-CoV-2 in Sport: A Cricket Case Study.

A review of risk factors affecting airborne transmission of SARS-CoV-2 was synthesised into an 'easy-to-apply' visual framework. Using this framework, video footage from two cricket matches were visually analysed, one pre-COVID-19 pandemic and one 'COVID-19 aware' game in early 2020. The number of opportunities for one participant to be exposed to biological secretions belonging to another participant was recorded as an exposure, as was the estimated severity of exposure as defined from literature. Events were rated based upon distance between subjects, relative orientation of the subjects, droplet generating activity performed (e. g., talking) and event duration. In analysis we reviewed each risk category independently and the compound effect of an exposure i. e., the product of the scores across all categories. With the application of generic, non-cricket specific, social distancing recommendations and general COVID-19 awareness, the number of exposures per 100 balls was reduced by 70%. More impressive was the decrease in the most severe compound ratings (those with two or more categories scored with the highest severity) which was 98% and the reduction in exposures with a proximity <1 m, 96%. Analysis of the factors effecting transmission risk indicated that cricket was likely to present a low risk, although this conclusion was somewhat arbitrary omitting a comparison with a non-cricketing activity.

Physical performance and perception of foot discomfort during a soccer-specific match simulation. A comparison of football boots.

Football boots are marketed with emphasis on a single key performance characteristic (e.g. speed). Little is known on how design parameters impact players' performance. This study investigated the impact of boot design on performance maintenance and perceived foot comfort during a 90-minute match simulation drill. Eleven male university football players tested two commercially available "sprint boots" known to generate significantly different plantar pressures (high=Boot H and low=Boot L) . Players completed a modified Soccer-specific Aerobic Field Test on a 3G pitch. Heart rate, rated perceived exertion and perceived foot discomfort were assessed for each 15-min interval. Power generation was assessed pre- and post-match simulation. A significantly higher mean heart rate was seen for Boot L in the 60th-75th and 75th-90th minute intervals (P = 0.017, P = 0.012 respectively). Perceived exertion did not differ between boots (P ≥ 0.302). Power generation significantly decreased in Boot H between pre- and post-match (P = 0.042). Both boots increased discomfort with significantly more plantar discomfort felt in the last 30 min in Boot H (75th min: P = 0.037; 90th min: P = 0.048). The results imply that a comfortable boot design may improve maintenance of performance during match-play.

BRIEF MOTIVATIONAL INTERVENTION FOR SUBSTANCE USE MAY DECREASE VIOLENCE AMONG HEAVY ALCOHOL USERS IN A JAIL DIVERSION PROGRAM.

Rates of harmful alcohol use are high among justice-involved individuals and may contribute to violent recidivism. Robust treatments for alcohol-related violence in criminal justice systems are thus a public health priority. In this analysis of existing randomized controlled trial data (N = 105), we examined the impact of a brief motivational intervention (BMI) for harmful substance use on violent recidivism among individuals in a pretrial jail diversion program. Results indicated that, after controlling for violence history, the intervention's impact on violent recidivism was moderated by baseline harmful alcohol use. Specifically, among people with severe alcohol problems at baseline, the BMI + standard care group had less violent recidivism at a 1-year follow-up than participants randomized to standard care alone. This finding was unchanged when we accounted for psychopathic traits. Our study provides preliminary evidence that a BMI may be useful for decreasing violent recidivism among heavy drinkers in criminal justice systems.

Examining violence among Not Guilty by Reason of Insanity state hospital inpatients across multiple time points: the roles of criminogenic risk factors and psychiatric symptoms.

OBJECTIVE: Institutional violence in state hospitals is a public health problem that has been severely understudied. Given the personal (ie, staff and patients) and fiscal harms associated with institutional violence, more research into contributing factors for violence is needed. The overarching aim of this study then was to examine associations among psychiatric symptoms, criminal risk factors, and institutional violence. METHODS: Participants were 200 male, female, and transgender forensic mental health inpatients adjudicated Not Guilty by Reason of Insanity and committed to the California Department of State Hospitals. Participants completed a psychiatric symptom measure, and measures of and associated with criminal risk. Institutional violence was recorded from file review and includes physical violence toward staff or patients for 6-months prior to and post patient participation in this study. RESULTS: After adjusting for previous institutional violence, results indicated that psychiatric symptoms were not associated with follow-up institutional violence; however, criminal risk was associated with follow-up institutional violence. Unexpectedly, 2 aspects of criminal risk, antisocial cognitions and associates, were not associated with follow-up institutional violence after adjusting for previous institutional violence. Results also provided a tentative cutoff score on the Self-Appraisal Questionnaire for predicting follow-up institutional violence. CONCLUSIONS: These results have important implications for treating and managing patients at risk for institutional violence, including the need to assess criminogenic risk and leverage treatments that target these risk factors as a best practice approach.

A comparison of criminogenic risk factors and psychiatric symptomatology between psychiatric inpatients with and without criminal justice involvement.

OBJECTIVE: Research suggests distinct criminal risk factors, not mental illness, are more strongly associated with most criminal behaviors. This notion has been supported among inpatient persons with mental illness (PMI) when examining antisocial cognitions; however, other key criminogenic risk factors (the Big Four and Central Eight risk factors) have not been examined among psychiatric inpatient PMI. HYPOTHESES: We hypothesized that criminal justice (CJ)-involved PMI would endorse significantly greater criminogenic risk compared to non-CJ-involved PMI and that these risk factors would significantly and accurately identify whether PMI had CJ involvement. Additionally, we hypothesized that PMI with and without a history of CJ involvement would not significantly differ on their reported psychiatric symptomatology. METHOD: We examined all Central Eight criminal risk factors and psychiatric symptomatology among psychiatric inpatient PMI (N = 142) with (n = 74) and without (n = 68) CJ involvement histories. RESULTS: Multivariate analysis of variance and discriminant function analysis indicated significant differences between the Big Four and Central Eight criminal risk factors when classifying CJ and non-CJ groups. The Big Four risk factors correctly classified 85.9% of participants, and the Central Eight correctly classified 99.3% of participants into CJ and non-CJ groups; however, psychiatric symptoms only correctly classified 57.7% of participants into CJ and non-CJ groups. CONCLUSIONS: Criminal risk factors appear to be more strongly associated with CJ involvement among PMI than psychiatric symptomatology; therefore, psychotherapeutic intervention on criminal risk factors, not only mental illness, may decrease criminal recidivism among CJ-involved PMI. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Plate Fixation With Cancellous Graft for Scaphoid Nonunion With Avascular Necrosis.

PURPOSE: Currently, there is no consensus on the optimal treatment for scaphoid nonunion with avascular necrosis (AVN). Various techniques, often involving vascularized corticocancellous bone grafting, have been proposed. The authors hypothesized that similar outcomes might be possible with volar plate fixation augmented with autogenous pure cancellous graft. METHODS: The authors performed a retrospective chart review of 13 cases of scaphoid nonunions with AVN in 12 patients treated with plate fixation and pure cancellous bone grafting. Surgical management included a volar incision, reduction, impaction of cancellous bone graft from the ipsilateral olecranon and/or distal radius, and application of a volar locking plate. Postoperative outcome measures included time to union based on computed tomography, patient-reported pain and disability scores, grip strength, range of motion, and return to work and sports. RESULTS: The average patient was 32 years old (range, 17-50 years) and treated an average of 18 months after initial injury (range, 6-49 months). Two of 12 patients (15.7%) were female, 3 of 12 patients (25%) were smokers, and 5 of 12 patients (41.7%) had failed union with previous screw fixation. Twelve scaphoids (92.3%) were treated for AVN associated with a proximal pole fracture, and 1 (7.7%) for AVN proximal to a scaphoid waist fracture. Mean follow-up was 19.5 months (range, 12-29 months). Union was achieved in all patients. Two scaphoids (15%) achieved union by 12 weeks, 7 scaphoids (54%) by 18 weeks, 2 scaphoids (15%) by 24 weeks, and 2 scaphoids (15%) by 30 weeks (range, 8.9-28 weeks). Mean Disabilities of the Arm, Shoulder, and Hand score improved from 30.6 ± 6.2 before surgery to 17.2 ± 6.5 after surgery. All 11 employed patients returned to work, although 3 (27.2%) did not return to full capacity. CONCLUSIONS: Scaphoid plate fixation and pure nonvascularized cancellous bone grafting for scaphoid nonunion with AVN yields excellent union rates and good patient-reported and functional outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Outcomes of Unstable Scaphoid Nonunion With Segmental Defect Treated With Plate Fixation and Autogenous Cancellous Graft.

PURPOSE: Treatment of scaphoid nonunion with a segmental defect presents a challenging clinical problem. Various techniques have been proposed, often involving structural grafting with vascularized and nonvascularized bone. The authors hypothesize that satisfactory clinical and radiographic outcomes are possible with a relatively simplified technique of volar plate fixation with autogenous, purely cancellous graft. METHODS: The authors performed a retrospective review of 34 patients with scaphoid nonunions with segmental defects, treated with plate fixation and purely cancellous bone grafting. Cases with avascular necrosis were excluded. Surgical management included a volar incision, reduction, bone grafting from the ipsilateral distal radius and/or olecranon, and application of a volar locking plate. Postoperative outcome measures included time to union based on computed tomography, return to work and sports, patient-reported pain and disability scores, grip strength, and range of motion. RESULTS: Thirty-four patients with an average age of 31 years (range, 16-55 years) were treated with volar plate fixation and cancellous grafting, an average of 34 months after initial injury. Twenty-six patients (76%) were treated for nonunion at the scaphoid waist, 7 (21%) at the proximal pole, and 1 (3%) at the distal pole. Mean final follow-up was 18.7 months (range, 12-34 months). When union was defined by computed tomography evidence of healing, 2 (6%) scaphoids healed by 6 weeks after surgery, 28 (82%) healed by 12 weeks, and 100% healed by 18 weeks. Mean Disabilities of the Arm, Shoulder, and Hand score improved from 27.1 ± 7.3 before surgery to 11.8 ± 5.8 after surgery. Grip strength, corrected for hand dominance, improved from 77.5% of the nonsurgical side before surgery to 90.5% after surgery. All employed patients returned to work, although 3 (9%) did not return to full capacity. CONCLUSIONS: The combination of scaphoid plate fixation and pure cancellous bone grafting for scaphoid nonunion with segmental defects yields reliable union rates and good patient outcomes. Autogenous cancellous grafting may be an alternative to more technically demanding or morbid grafting procedures for the treatment of scaphoid nonunion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Do criminal associates impact psychiatric inpatients' social support and interpersonal needs?

Suicide risk is elevated among psychiatric inpatients; however, research has not examined moderators of the associations between perceived social support and thwarted belongingness (TB) and perceived burdensomeness (PB), such as involvement with criminal associates. Adult psychiatric inpatients (N = 142) completed assessments. Perceived social support was negatively associated with TB and PB; however, associates' criminal involvement did not moderate these associations. A significant interaction indicated a stronger negative association between perceived social support and TB when participants spent more time with associates. Therefore, time spent with associates, regardless of criminal involvement, may be a relevant interpersonal suicide risk factor.

Experiential avoidance, cognitive fusion, and suicide ideation among psychiatric inpatients: The role of thwarted interpersonal needs.

OBJECTIVE: The interpersonal theory of suicide posits the simultaneous presence of thwarted belongingness and perceived burdensomeness (i.e., thwarted interpersonal needs) leads to active suicide ideation. According to the psychological flexibility model, psychological inflexibility is in part a product of cognitive fusion (i.e., becoming entangled or wrapped up in one's thoughts) and experiential avoidance (i.e., avoidance of internal private experiences, which include thoughts and feelings). We hypothesized that thwarted belongingness and perceived burdensomeness, in parallel, would mediate the positive relation between experiential avoidance and suicide ideation and between cognitive fusion and suicide ideation. METHOD: Participants were 118 adult psychiatric inpatients who completed self-report assessments of thwarted interpersonal needs, cognitive fusion, experiential avoidance, and suicide ideation. RESULTS: Using bootstrapped parallel mediation regression procedures, results indicated thwarted belongingness and perceived burdensomeness mediated, in parallel, the positive relation between experiential avoidance and suicide ideation and between cognitive fusion and suicide ideation. Additionally, thwarted belongingness, but not perceived burdensomeness, independently mediated the relation between cognitive fusion and suicide ideation. CONCLUSION: The current findings indicate that psychological inflexibility variables are associated with increased thwarted interpersonal needs and suicide ideation. The findings of this study provide support for the integration of the interpersonal theory of suicide and psychological flexibility model to improve our conceptualization of suicide risk among psychiatric inpatients. Clinical or methodological significance summary: The findings of this study provide support for the integration of the interpersonal theory of suicide and psychological flexibility model to improve our conceptualization of suicide risk among psychiatric inpatients.

Can subjective comfort be used as a measure of plantar pressure in football boots?

Comfort has been shown to be the most desired football boot feature by players. Previous studies have shown discomfort to be related to increased plantar pressures for running shoes which, in some foot regions, has been suggested to be a causative factor in overuse injuries. This study examined the correlation between subjective comfort data and objective plantar pressure for football boots during football-specific drills. Eight male university football players were tested. Plantar pressure data were collected during four football-specific movements for each of three different football boots. The global and local peak pressures based on a nine-sectioned foot map were compared to subjective comfort measures recorded using a visual analogue scale for global discomfort and a discomfort foot map for local discomfort. A weak (rs = -0.126) yet significant (P < 0.05) correlation was shown between the peak plantar pressure experienced and the visual analogue scale rated comfort. The model only significantly predicted (P > 0.001) the outcome for two (medial and lateral forefoot) of the nine foot regions. Subjective comfort data is therefore not a reliable measure of increased plantar pressures for any foot region. The use of plantar pressure measures is therefore needed to optimise injury prevention when designing studded footwear.

Suicide Risk Among BDSM Practitioners: The Role of Acquired Capability for Suicide.

OBJECTIVE: Bondage and discipline, dominance and submission, and sadomasochism (BDSM) practitioners are at increased risk for suicidal thoughts and behaviors. We hypothesized the association between (a) lifetime frequency of BDSM-related sexual behaviors and (b) BDSM identification and suicide attempt status would be mediated by acquired capability components (i.e., fearlessness about death and pain tolerance). Gender differences were examined. METHOD: Participants were 576 BDSM practitioners (meanage = 28.71; 66.7% male) recruited from online BDSM-related groups, cross-sectionally. RESULTS: Among males, the total indirect effect of acquired capability components in the relation between BDSM-related sexual behaviors and suicide attempt status was significant. The specific indirect effect of perceived pain tolerance in the relation between both BDSM-related sexual behaviors and BDSM identification and suicide attempt status was significant. There were no significant effects for females. Additionally, 12% reported a suicide attempt history. CONCLUSION: Among males, BDSM-related sexual behaviors and BDSM identification were associated with increased acquired capability components, which were positively associated with suicide attempt status.

The clinical application of suicide risk assessment: A theory-driven approach.

The interpersonal theory of suicide posits that thwarted belongingness (TB) and perceived burdensomeness (PB) increase suicide ideation; however, studies have found mixed results regarding this hypothesis among psychiatric inpatients. This study aimed to (a) demonstrate how assessing TB and PB using the Interpersonal Needs Questionnaire (INQ) can provide clinically useful information and (b) investigate how statistical methodology may impact the clinical application of the INQ. Participants were 139 (Sample 1) and 104 (Sample 2) psychiatric inpatients. In both samples, ordinal logistic regression results indicated TB and PB, separately, were significant predictors of suicide ideation-related outcomes; however, when examined as simultaneous predictors, TB was no longer a significant predictor. The interaction between TB and PB was not significant for either sample. Despite this, TB and PB scores provided clinically relevant information about suicide ideation-related outcomes. For example, the highest scores on TB and PB indicated a 93% and 95% chance of having some level of distress due to suicide ideation (Sample 1), a 91% and 92% chance of having some level of desire for death, and a 79% and 84% chance of having some level of desire for suicide, respectively (Sample 2). This study also proposes clinical cutoff scores for the INQ (for TB and PB, respectively, cutoff scores were 22 and 17 for distress due to suicide ideation, 33 and 17 for desire for death, and 31 and 22 for desire for suicide). Although these results indicate that multicollinearity between TB and PB may create interpretational ambiguity for clinicians, TB and PB may each be useful separate predictors of suicide ideation-related outcomes in psychiatric inpatient settings and should be incorporated into suicide risk assessment. KEY PRACTITIONER MESSAGE: The 15-item Interpersonal Needs Questionnaire (an assessment of thwarted belongingness and perceived burdensomeness) should be incorporated into suicide risk assessment. Among psychiatric inpatients, greater thwarted belongingness and perceived burdensomeness, as separate predictors, were associated with increased levels of distress due to suicide ideation, desire for death, and desire for suicide. The highest scores on thwarted belongingness and perceived burdensomeness indicated a 79% to 95% chance of experiencing an elevated level of distress due to suicide ideation, desire for death, or desire for suicide. Recommended clinical cutoff scores were provided. For example, thwarted belongingness cutoff score of 31 and perceived burdensomeness cutoff score of 22 maximized the sensitivity and specificity of the INQ to detect some level of desire for suicide.