Symptomatic and Functional Outcomes Among Individuals at High Risk for Psychosis Participating in Step-Based Care.

Validated, multicomponent treatments designed to address symptoms and functioning of individuals at clinical high risk for psychosis are currently lacking. The authors report findings of a study with such individuals participating in step-based care-a program designed to provide low-intensity, non-psychosis-specific interventions and advancement to higher-intensity, psychosis-specific interventions only if an individual is not meeting criteria for a clinical response. Among individuals with symptomatic or functional concerns at enrollment, 67% met criteria for a symptomatic response (median time to response=11.1 weeks), and 64% met criteria for a functional response (median time to response=8.9 weeks).

Suicidal thoughts and behaviors among gender and sexual minorities: Adults ages 25-44 show highest rates of past month suicidal thoughts.

INTRODUCTION: Sexual and gender minority (SGM) people are at increased risk for suicidal thoughts and behaviors relative to their cisgender heterosexual peers. However, most research in this area has focused on youth, limiting our understanding of suicide risk among SGM adults. METHODS: To address this gap in the literature, the present study examined suicidal thoughts and behaviors among SGM adults across different age groups using a sample of 10,620 US adults. RESULTS: Consistent with the literature on youth, SGM adults showed higher rates of suicidal thoughts and behaviors than cisgender heterosexual adults. When examining prevalence rates across various age groups, young adults (18-25) showed greater suicidal thoughts and behaviors relative to adults ages 45+. However, adults ages 25-44 actually showed the highest rate of past month suicidal thoughts compared to adults ages 18-25. CONCLUSION: These findings suggest that suicide risk for SGM extends beyond youth and highlights the need for more research on middle-age SGM adults. Additional resources for SGM adults that are not only tailored toward youth and young adults are warranted.

Within-Person Relationship between Attenuated Positive Symptoms and Suicidal Ideation among Individuals at Clinical High Risk for Psychosis.

Individuals at clinical high-risk for psychosis (CHR-P) are at increased risk for suicide. However, the relationship between attenuated positive symptoms and suicidal ideation are not well understood, particularly as they interact over time. The current study addressed this gap in the literature. We hypothesized that greater attenuated symptoms would be concurrently and prospectively associated with suicidal ideation. Further, we hypothesized that suspiciousness and perceptual abnormalities would have the strongest relationship with suicidal ideation. Within-person variation in symptoms and suicidal ideation were examined across 24 treatment sessions for individuals at CHR-P. Attenuated positive symptoms (unusual thought content, suspiciousness, grandiose ideas, perceptual abnormalities, and disorganized communication) and suicidal ideation were assessed at each session. Logistic mixed effect models examined concurrent and time-lagged relationships between symptoms and suicidal ideation among 36 individuals at CHR-P. Results indicated that suicidal ideation was more likely during weeks when participants reported more severe total attenuated positive symptoms. Further, suspiciousness was uniquely associated with suicidal ideation, both concurrently and at the following session. Post hoc models examined the reverse direction of this relationship, demonstrating that suicidal ideation also prospectively predicted suspiciousness at the following session. These results suggest that within-person attenuated symptoms, particularly suspiciousness, are associated with suicidal ideation among individuals at CHR-P. However, the bidirectional relationship between suspiciousness and suicidal ideation raises questions about causal nature of this relationship. Further research is needed to examine the dynamic interplay of suspiciousness and suicidal ideation.

Variability in suicidal ideation during treatment for individuals at clinical high risk for psychosis: The importance of repeated assessment.

AIM: Suicide risk is elevated among individuals at clinical high risk for psychosis (CHR-P). The current study examined variability in suicidal ideation during treatment for individuals at CHR-P. METHODS: A retrospective chart review was used to examine the course of suicidal ideation during 16 sessions of individual psychotherapy for 25 individuals at CHR-P. RESULTS: Suicidal ideation was reported by 24% of participants at session 1 and 16% at session 16, with minimal within-subject change in the presence of suicidal ideation across the two time points. However, a more fine-grained investigation at each session indicated that 60% of individuals at CHR-P experienced suicidal ideation at least once during treatment. Additionally, there was great variability in suicidal ideation both within and between participants over the course of the 16 sessions. CONCLUSIONS: These findings highlight the importance of repeated assessment when examining suicidal ideation as a treatment outcome for individuals at CHR-P.

The role of personal and perceived peer norms in bullying and sexual harassment perpetration.

Bullying, cyberbullying, and sexual harassment can be impacted by both personal attitudes and perceived social norms, although few empirical studies on this topic have been conducted with high school students. In this cross-sectional study, 233 high school students completed measures about personal normative attitudes, perceptions of peer norms, and perpetration of bullying, cyberbullying, and sexual harassment. Consistent with social norms theory, students perceived themselves to hold more prosocial (i.e., antibullying/antisexual harassment) personal normative attitudes than they perceived the typical student in their school to hold (i.e., peer norms). Path analyses revealed that students' personal normative attitudes (e.g., antibullying/antiharassment) were negatively related to their bullying, cyberbullying, and sexual harassment perpetration, although perceived peer norms were negatively related to sexual harassment perpetration only. Multiple-group path analysis revealed significant gender differences. Personal normative attitudes related to females' behavior for all forms of perpetration and only sexual harassment and cyberbullying for males (with more antibullying/antiharassment attitudes relating to less perpetration), although associations for males were stronger. Perceived peer norms related to bullying perpetration for males only. Results are discussed with regard to social-cognitive and peer contextual factors and implications for social norms interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Student Knowledge Gain Following the Second Step Child Protection Unit: the Influence of Treatment Integrity.

Treatment integrity is an important yet understudied component of school-based prevention programming, particularly for sensitive topics such as child sexual abuse prevention (CSA). This study examined student- and teacher-level characteristics, including components of treatment integrity, that contributed to greater knowledge gain among students participating in the Second Step Child Protection Unit (CPU). The study was conducted with 1132 students and 57 teachers from four elementary schools enrolled in a randomized controlled trial of the CPU. Students were administered assessments at pre-test, post-test, 6-month follow-up, and 12-month follow-up. Teachers were observed and rated on Content Integrity (CI; adherence to content), Process Integrity (PI; teacher enthusiasm, encouragement, behavior management), and Dose Received (DR; student behavior and interest) when delivering the lessons. Hierarchical linear growth modeling indicated that students who received the CPU made gains in the knowledge of CSA concepts and skills over a 12-month follow-up period. Girls had significantly greater CSA knowledge than boys immediately after the intervention, with gender remaining significant even when accounting for level-3 variables. Older children had better knowledge scores at post-test, but growth over time results revealed that younger students made greater gains. For students in 2nd through 4th grade, CI was more important for post-test outcomes, while for all students, CI and grade taught were important to post-test scores. Teachers of lower grades had students with a faster growth rate on correct responses to vignettes. Implications for CSA prevention programming and future research are discussed.

Randomized controlled trial of the Child Protection Unit: Grade and gender as moderators of CSA prevention concepts in elementary students.

BACKGROUND: Despite the importance of child sexual abuse (CSA) prevention, there are few recent randomized controlled trials of school-based CSA prevention programs. OBJECTIVES: (1) To evaluate the effects of the Second Step Child Protection Unit (CPU) on students' CSA prevention concept knowledge, ability to recognize, report, and refuse unsafe touches, and perceptions of teacher-student relations and (2) investigate the moderating role of age and gender on program effectiveness. PARTICIPANTS AND SETTING: Eight elementary schools in a large suburban school district in the northeast United States were randomly assigned to the intervention or control condition, with analyses conducted on a total of 2172 students. METHODS: Students in intervention schools received the 6-week CPU and those in the control schools were exposed to business as usual. Students were administered assessments at baseline and then at post-test. RESULTS: Univariate Analyses of Covariance revealed that students in the intervention schools had significantly higher scores on all outcomes than students in the control schools at post-test, even after controlling for baseline scores. Children in younger grades made greater gains from the program, and girls scored higher than boys in CSA knowledge and ability to recognize, refuse, and report unsafe touches, but both boys and girls made significant gains. CONCLUSIONS: Results support the importance of beginning early with school-based CSA prevention efforts. Although boys are still at a relative disadvantage in terms of their knowledge and ability in this area, they are able to make gains at the same rate as girls.

Teacher Outcomes from the Second Step Child Protection Unit: Moderating Roles of Prior Preparedness, and Treatment Acceptability.

Teachers play a critical role in child sexual abuse (CSA) prevention and intervention efforts. We examined the impact of the Second Step Child Protection Unit (CPU) on improving teacher awareness, attitudes, and teacher-student relations for 161 teachers. Teacher baseline scores and treatment acceptability were examined as moderators. Structural equation modeling (SEM) revealed a significant effect of the CPU on teachers' awareness, attitudes, and teacher-student relations, particularly for teachers with lower prior knowledge, attitudes, and student relationships. Teachers' acceptability of the CPU also moderated outcomes, where a higher level of acceptability of CSA interventions was associated with an increase in outcomes.