Adverse Childhood Experiences and Suicidality and Self-Harm in Persons in Secure Forensic Care.

Prior research suggests a greater degree of suicidality and self-harm behavior in those involved with criminal justice and forensic mental health systems. Such individuals also evidence increased exposure to early childhood adversity, which is often associated with suicide risk. Other significant predictors of suicidality have been noted within forensic populations, however, including indicators of specific psychopathology and situational and demographic factors. These populations present with overlapping risk factors that remain underexamined. In the current study, 182 persons residing in secure forensic psychiatric care following incidents of illegal and aggressive behavior were evaluated. Adverse childhood experiences and other empirically derived potential predictors of suicide attempts and self-harm were examined via binomial logistic regression. Findings indicate frequent experiences of early adversity across participants, and that a combination of race, individual adverse childhood experiences, number of biological children, and diagnoses of either posttraumatic stress disorder or borderline personality disorder were significant predictors of suicide attempts, self-harm behavior, and first hospitalization resulting from a suicide attempt. Clinical and research implications are discussed.

Impact of adverse childhood experiences (ACEs) on adult alcohol consumption behaviors.

BACKGROUND: Long term negative physical and mental health problems occur from the lack of appropriate interventions targeting the adult population who experienced adverse childhood experiences (ACEs) and partake in risky alcohol consumption behaviors. OBJECTIVE: This study aimed to identify the risk for alcohol consumption behaviors, specifically binge drinking (BD) and any drinking (AD), among adults with a history of adverse childhood experiences (ACEs). METHODS: Behavioral Risk Factor Surveillance System (BRFSS) 2011-2012 data were used. Descriptive statistics were completed followed by simple and multiple logistic regression to determine the strength of association between ACEs and alcohol consumption, controlling for sociodemographic factors. RESULTS: The final adjusted sample size was 69,793. Adults who experienced household abuse were 30% more likely to BD (Odds Ratio (OR): 1.30, 95% Confidence Interval (CI): 1.20-1.41) and 21% more likely for AD (OR: 1.21, 95% CI: 1.14-1.28) in the past month. Males were over two times more likely to BD (OR: 2.12, 95% CI: 1.96-2.29) and 60% more likely for AD (OR: 1.60, 95% CI: 1.51-1.69) in the past month compared to females. Individuals who completed some college were at higher risk of BD (OR: 1.51, 95% CI: 1.26-1.82), whereas those who graduated college were nearly two and a half times more likely to report AD in the past month (OR: 2.27, 95% CI: 1.99-2.59) compared to individuals with less than high school education. CONCLUSION: Adults who experienced household abuse, are male, or possess at least some college education are at increased risk for BD and AD.

The impact of trauma on the onset of mental health symptoms, aggression, and criminal behavior in an inpatient psychiatric sample.

Experiences of trauma and maltreatment are frequent predictors of poor physical and mental health outcomes in adulthood. Existing literature also suggests an impact of developmental adversity on criminality and aggressive behavior, though little research exists describing the effects of cumulative adversity in forensic mental health samples. In the current study of 381 forensic mental health inpatients, rates of trauma, neglect, and parental substance abuse are reported in comparison with community norms. Cumulative adversity and the occurrence of foster care placement are examined via linear and logistic regression analyses in relation to age at first arrest, first psychiatric hospitalization, and onset of aggression, as well as history of suicide attempts and non-suicidal self-injury. Results revealed that experiences of developmental adversity were more common among participants than have been reported in community samples using the ACE survey, and that there were differential effects of gender on the prevalence of traumas experienced. Cumulative adversity scores were significantly associated with all outcomes, though the addition of foster care placement to the model significantly contributed to understanding outcomes, and in some cases, removed the effect of cumulative adversity. Implications and direction for future study are discussed.

Alignment of Epidemiology Practice and Academic Competencies through Effective Collaboration.

BACKGROUND: Online learning has recently garnered increased attention as technology use in the classroom grows. However, most of the published approaches regarding this topic in postgraduate education centers on clinical environments. Models of partnerships between applied public health agencies and academic centers to produce mutually beneficial online learning opportunities for graduate-level public health courses have not been explored in the literature. METHODS: East Tennessee State University (ETSU) and the Tennessee Department of Health (TDH) partnered to build three online, asynchronous epidemiology modules for an interdisciplinary audience of graduate students. The goals of the modules were to (1) introduce students to a public health issue, (2) provide students with hands-on learning about data and information available through TDH, and (3) allow students to connect theory to practice by having them create a product for use by TDH. TDH created topic-specific modules that would be used within the infectious disease, chronic disease, and cancer epidemiology courses, and piloted during the 2015-2016 academic term. RESULTS: Conference calls between the two institutions occurred in the spring and the summer of 2015. Two of the three epidemiology modules were presented to ETSU staff for critique and edits at an in-person meeting during the summer. The methods of delivery for each section within a module varied from recorded webinar format to self-guided instruction. One module utilized available learning tools provided by the Centers of Disease Control and Prevention, while the other module was constructed entirely using TDH data. Both modules included various exercises and assignments to be conducted in class and as homework and concluded with the student being asked to construct a learning product as a final project. The ETSU-TDH team decided that this learning product would be provided back to TDH for possible future use. DISCUSSION: The innovative partnership between a state government agency and an academic institution has demonstrated the need for such collaborations in public health. Understanding how applied public health practice would utilize what is learned in the classroom and preparing students for real-world application may be the missing link between theory and practice.