Military Sexual Trauma and Suicide Mortality.

INTRODUCTION: The Veterans Health Administration health system uses a clinical reminder in the medical record to screen for military sexual trauma. For more than 6 million Veterans, this study assessed associations between military sexual trauma screen results and subsequent suicide mortality. METHODS: For Veterans who received Veterans Health Administration services in fiscal years 2007-2011 and were screened for military sexual trauma (5,991,080 men; 360,774 women), proportional hazards regressions evaluated associations between military sexually trauma and suicide risk. Models were adjusted for age, rural residence, medical morbidity, and psychiatric conditions, obtained from medical records at the year military sexual trauma screening occurred. Analyses were conducted in 2014. RESULTS: Military sexual trauma was reported by 1.1% of men and 21.2% of women. A total of 9,017 Veterans completed suicide during the follow-up period. Hazard ratios for military sexual trauma were 1.69 (95% CI=1.45, 1.97) among men and 2.27 (95% CI=1.76, 2.94) among women. Suicide risk associated with military sexual trauma remained significantly elevated in adjusted models. CONCLUSIONS: Study results are among the first population-based investigations to document sexual trauma as a risk factor for suicide mortality. Military sexual trauma represents a clinical indicator for suicide prevention in the Veterans Health Administration. Results suggest the importance of continued assessments regarding military sexual trauma and suicide risks and of collaboration between military sexual trauma-related programs and suicide prevention efforts. Moreover, military sexual trauma should be considered in suicide prevention strategies even among individuals without documented psychiatric morbidity.

mHealth in the Wild: Using Novel Data to Examine the Reach, Use, and Impact of PTSD Coach.

BACKGROUND: A majority of Americans (58%) now use smartphones, making it possible for mobile mental health apps to reach large numbers of those who are living with untreated, or under-treated, mental health symptoms. Although early trials suggest positive effects for mobile health (mHealth) interventions, little is known about the potential public health impact of mobile mental health apps. OBJECTIVE: The purpose of this study was to characterize reach, use, and impact of "PTSD Coach", a free, broadly disseminated mental health app for managing posttraumatic stress disorder (PTSD) symptoms. METHODS: Using a mixed-methods approach, aggregate mobile analytics data from 153,834 downloads of PTSD Coach were analyzed in conjunction with 156 user reviews. RESULTS: Over 60% of users engaged with PTSD Coach on multiple occasions (mean=6.3 sessions). User reviews reflected gratitude for the availability of the app and being able to use the app specifically during moments of need. PTSD Coach users reported relatively high levels of trauma symptoms (mean PTSD Checklist Score=57.2, SD=15.7). For users who chose to use a symptom management tool, distress declined significantly for both first-time users (mean=1.6 points, SD=2.6 on the 10-point distress thermometer) and return-visit users (mean=2.0, SD=2.3). Analysis of app session data identified common points of attrition, with only 80% of first-time users reaching the app's home screen and 37% accessing one of the app's primary content areas. CONCLUSIONS: These findings suggest that PTSD Coach has achieved substantial and sustained reach in the population, is being used as intended, and has been favorably received. PTSD Coach is a unique platform for the delivery of mobile mental health education and treatment, and continuing evaluation and improvement of the app could further strengthen its public health impact.

Aggressive behavior among military veterans in substance use disorder treatment: the roles of posttraumatic stress and impulsivity.

This study examined posttraumatic stress disorder (PTSD) symptom severity and impulsivity as predictors of aggressive behavior among 133 male military veterans entering substance abuse treatment who endorsed difficulty controlling anger in the past year. At treatment intake, participants completed measures assessing PTSD symptom severity, impulsivity and aggressive behavior. Perpetration of aggressive behavior was reassessed 4 months later. Results from multivariate models indicated that PTSD symptom severity and impulsivity explained unique variance in aggressive behavior at intake but not follow-up. Mediation models indicated that the association between PTSD symptom severity and aggressive behavior was accounted for by impulsivity. The identification of impulsivity as a key mediator between trauma symptoms and aggressive behavior has significant clinical and research implications. Based on these findings, clinicians are encouraged to consider a standard assessment of impulsivity and the selection of interventions that target impulsivity as a trans-diagnostic process among at-risk client populations.

Individual and family predictors of the perpetration of dating violence and victimization in late adolescence.

Teen dating violence is a crime of national concern with approximately one-fourth of adolescents reporting victimization of physical, psychological, or sexual dating violence each year. The present study examined how aggressive family dynamics in both childhood and early adolescence predicted the perpetration of dating violence and victimization in late adolescence. Children (n = 401, 43 % female) were followed from kindergarten entry to the age of 18 years. Early adolescent aggressive-oppositional problems at home and aggressive-oppositional problems at school each made unique predictions to the emergence of dating violence in late adolescence. The results suggest that aggressive family dynamics during childhood and early adolescence influence the development of dating violence primarily by fostering a child's oppositional-aggressive responding style initially in the home, which is then generalized to other contexts. Although this study is limited by weaknesses detailed in the discussion, the contribution of longitudinal evidence including parent, teacher, and adolescent reports from both boys and girls, a dual-emphasis on the prediction of perpetration and victimization, as well as an analysis of both relations between variables and person-oriented group comparisons combine to make a unique contribution to the growing literature on adolescent partner violence.

Posttraumatic stress disorder symptom severity predicts aggression after treatment.

This study examined the relation between posttraumatic stress disorder (PTSD) severity and aggression (verbal, psychological, and physical aggression) in a longitudinal dataset. Participants were 175 males in PTSD residential treatment who were assessed at pre-treatment, post-treatment, and at 4-month follow-up. Post-treatment PTSD severity predicted aggression at post-treatment and 4-month follow-up, adjusting for age, pre-treatment PTSD severity, and pre-treatment aggression. When examining the relation between aggression and specific PTSD symptom clusters, post-treatment Reexperiencing, Avoidance/Numbing and Hyperarousal symptoms predicted aggression at posttreatment and 4-month follow-up. These results support the hypothesis that post-treatment PTSD severity may be an important marker of post-treatment aggression risk and may offer unique information important to clinicians and patients focused on the development and maintenance of adaptive, non-aggressive relationships after intensive PTSD treatment.

Beliefs and attributions of partner violence perpetrators: the physical and psychological violence of adolescent males.

Partner violence is a crime of national concern. Understanding the cognitions of adolescent males who perpetrate partner violence is critical to develop appropriate interventions. One hundred and thirty-two partnered undergraduate males were assessed on gender beliefs, relationship beliefs, and partner attributions. More than 80% of males endorsed psychological or physical violence perpetration in the past year. Adolescent males who perpetrated psychological or physical partner violence were more likely to endorse hostile beliefs about women, negative partner attributions, and unrealistic relationship beliefs, as compared with nonviolent adolescents. Further, the relationship belief that partners cannot change and hostile partner attributions significantly predicted the frequency of psychological partner violence. The relationship belief disagreement is destructive predicted the frequency of physical partner violence, controlling for the influence of psychological violence. Clinical implications and future directions are discussed.

A multilevel examination of interpartner intimate partner violence and psychological aggression reporting concordance.

Low concordance of reports across partners has consistently been observed when partners report the frequency of intimate partner violence (IPV) and psychological aggression (PA) in their relationship. Researchers have been unsuccessful in the quest to discover systematic biases across reporters, perhaps due to examining constructs that are not the source of bias (e.g., gender, victim/perpetrator status) or examining potentially fruitful constructs using underpowered statistics or erroneous conceptualizations (e.g., examining variables at a dyadic, rather than an individual, level). We used multilevel modeling with two samples (Ns = 88 and 164 couples) to examine husbands' and wives' relationship satisfaction as individual-level correlates of husband- and wife-perpetrated IPV and PA reporting concordance. Consistent with prior literature, low to moderate levels of agreement were observed, and gender and victim/perpetrator status were not consistently associated with reporting concordance. In contrast, for both husbands and wives, relationship satisfaction was associated with reporting concordance such that high relationship satisfaction was related to reporting less of one's partner's PA than the partner reported, whereas low relationship satisfaction was related to reporting more of one's partner's PA than the partner reported. A similar pattern of results emerged for the reporting of IPV, but results did not cross validate between samples. These findings suggest that relationship satisfaction may lead to either reluctance, or increased willingness, to attribute negative relationship events to partner behavior, potentially due to partner blame and relationship schemas. In addition, the influence of individual-level factors may be occluded when aggregated across partners to examine correlates of interpartner reporting concordance.

Intensive referral to 12-step dual-focused mutual-help groups.

BACKGROUND: This study implemented and evaluated procedures to help clinicians effectively refer dually diagnosed (substance use and psychiatric disorders) patients to dual-focused mutual-help groups (DFGs). METHODS: Using a cohort cyclical turnover design, individuals with dual diagnoses beginning a new outpatient mental health treatment episode (N=287) entered a standard- or an intensive-referral condition. Participants provided self-reports of 12-step mutual-help (DFG and substance-focused group [SFG]) attendance and involvement and substance use and psychiatric symptoms at baseline and six-month follow-up. The intensive referral intervention focused on encouraging patients to attend DFG meetings. RESULTS: Compared to patients in the standard condition, those in the intensive referral intervention were more likely to attend and be involved in DFGs and SFGs, and had less drug use and better psychiatric outcomes at follow-up. Attending more intensive-referral sessions was associated with more DFG and SFG meeting attendance. More need fulfillment in DFGs, and more readiness to participate in SFGs, were associated with better alcohol and psychiatric outcomes at six months. However, only 23% of patients in the intensive-referral group attended a DFG meeting during the six-month follow-up period. CONCLUSIONS: The intensive referral intervention enhanced participation in both DFGs and SFGs and was associated with better six-month outcomes. The findings suggest that intensive referral to mutual-help groups focus on its key components (e.g., linking patients to 12-step volunteers) rather than type of group.

The influence of abuse victimization on attendance and involvement in mutual-help groups among dually diagnosed male veterans.

Although abuse victimization and dual diagnosis are associated with poor functioning across numerous domains, their impact on attendance and involvement in mutual-help groups (MHGs) is not well understood. This study examined the impact of physical or sexual abuse victimization on MHG attendance and involvement and the influence of abuse on the association between MHG involvement and outcomes of abstinence and psychiatric health. Participants were 217 dually diagnosed men assessed at intake into mental health treatment and 6 months later. Compared with nonabused patients, sexually abused patients exhibited more substance use, psychiatric, and social problems at baseline and attended and were involved with MHGs more than nonabused patients at follow-up. Moreover, MHG involvement was most predictive of abstinence for sexually abused patients, as compared with nonabused and physically abused patients. Although dually diagnosed patients with abuse histories demonstrate more severe initial problems, they are likely to utilize MHGs, which may benefit efforts to achieve abstinence.

Parenting schemas and the process of change.

Parents' childrearing behaviors are guided by schemas of the caregiving role, their functioning in that role, what children need in general, and what their own children are like in particular. Sometimes, however, parenting schemas can be maladaptive because they are too rigid or simple, involve inappropriate content, or are dominated by negative affect. In this article, we describe parenting schemas and provide an overview of empirical work documenting the characteristics of maladaptive parenting schemas. We review how intervention practices common to multiple therapeutic approaches (cognitive-behavior therapy, family therapy, parent training, attachment-based interventions, and psychoanalytic parent-infant psychotherapy) attempt to modify schemas to promote more optimal functioning among parents. We highlight how research in cognitive science may explain, in part, treatment effectiveness.