High sensitivity and specificity screening for clinically significant intimate partner violence.

The U.S. Preventive Services Task Force has recommended that clinicians screen patients for intimate partner violence (IPV). This article aims to develop and test the first screeners for clinically significant physical and psychological IPV (i.e., acts meeting criteria in the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2019) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). The goal was to derive screeners that (1) are maximally brief, while still achieving high sensitivity and specificity; (2) assess perpetration and victimization when either men or women are reporting; and (3) use ICD-11/DSM-5 criteria as the reference standard. Random samples of active duty service members at 82 installations worldwide were obtained via e-mail invitation (2006: N = 54,543; 2008: N = 48,909); their response rates were excellent for long general population surveys with no payment (2006: 44.7%, 2008: 49.0%). The population of spouses at the participating installation was invited by mailed postcard (2006: N = 19,722; 2008: N = 12,127; response rates-2006: 12.3%, 2008: 10.8%). Clinically significant physical intimate partner violence can be effectively screened with as few as four items, with sensitivities > 90% and specificities > 95%; clinically significant psychological intimate partner violence can be screened with two items. Men and women can be screened with equivalent accuracy, as can those committing the violence and those victimized by it. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Self-reporting DSM-5/ICD-11 clinically significant intimate partner violence and child abuse: Convergent and response process validity.

Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) and International Classification of Diseases-11th Revision (ICD-11; proposed) now include criteria for clinically significant (a) intimate partner violence (IPV) and neglect and (b) child abuse and neglect. However, existing measures of IPV and child abuse do not allow for assessment of established criteria. The current study examines the convergent and response process validity of the Family Maltreatment (FM) measure of clinically significant physical and psychological IPV and child abuse. Participants (N = 126) completed the FM via computer and measures of IPV (Revised Conflict Tactics Scale; Straus, Hamby, Boney-McCoy, & Sugarman, 1996) and child abuse (Parent-Child Conflict Tactics Scale; Straus, Hamby, Finkelhor, Moore, & Runyan, 1998) via paper-and-pencil. Participants who endorsed acts of aggression on the FM completed an audio-recorded computerized interview recounting the 2 most severe incidents. Verbalized incidents (n = 138) were coded for clinically significant family maltreatment. Results largely supported the convergent validity of the FM. Agreement of acts endorsed on the FM with those endorsed on convergent measures was excellent for IPV and physical child abuse, yet poor for psychological child abuse. Further, in support of the response process validity of the FM, comparison with observer ratings of interviews indicated few "false positives" and no "false negatives" on the FM across the examined types of clinically significant IPV and child abuse. In summary, the FM is a promising measure for the assessment of clinically significant physical and psychological abuse as defined in the DSM-5 and ICD-11 (proposed). (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Risk for suicide attempts among United States Air Force active duty members with suicide ideation: An ecological perspective.

OBJECTIVE: Differentiating suicide attempters from suicide ideators has been named a critical suicidology frontier (Klonsky & May, 2013). Per Bronfenbrenner's (1977, 1994) ecological systems theory, risk/protective factors from four ecological levels (individual, family, workplace, and community) were used to predict last year suicide attempt status among active duty service members expressing suicide ideation. METHOD: Active duty U.S. Air Force members (N = 52,780, 79.3% male, 79.2% non-Hispanic White, M age = 31.8 years) anonymously completed an online community assessment administered biennially at 82 bases worldwide. Last year suicide ideation and attempts were concurrently measured, as were an array of co-occurring risk and protective factors. RESULTS: Among the 1,927 (approximately 4%) service members self-reporting suicidal ideation, 152 also reported a last year suicide attempt (7.9% of the ideators, 8.7% of men vs. 6.1% of women). However, in multivariate models, military member sex was not a significant moderator. In bivariate models, numerous individual, family/spouse/parent, and community factors were associated with suicide attempt status. In the final multivariate model for the whole sample, risk for a last year attempt was associated with years in the military, social support, and alcohol use problems, but not depression. Among active duty military in relationships, attempt status risk was associated with years in the military, social support, and intimate partner violence victimization. However, the effect sizes for these models were small. CONCLUSIONS: Beyond a focus on depression, addressing alcohol misuse, facilitating resilient and nonviolent couple/family relationships, and increasing social support may enhance suicide attempt prevention efforts among military members. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Identifying unique and shared risk factors for physical intimate partner violence and clinically-significant physical intimate partner violence.

Intimate partner violence (IPV) is a significant public health concern. To date, risk factor research has not differentiated physical violence that leads to injury and/or fear (i.e., clinically significant IPV; CS-IPV) from general physical IPV. Isolating risk relations is necessary to best inform prevention and treatment efforts. The current study used an ecological framework and evaluated relations of likely risk factors within individual, family, workplace, and community levels with both CS-IPV and general IPV to determine whether they were related to one type of IPV, both, or neither for both men and women. Probable risk and promotive factors from multiple ecological levels of influence were selected from the literature and assessed, along with CS-IPV and general IPV, via an anonymous, web-based survey. The sample comprised US Air Force (AF) active duty members and civilian spouses (total N = 36,861 men; 24,331 women) from 82 sites worldwide. Relationship satisfaction, age, and alcohol problems were identified as unique risk factors (in the context of the 23 other risk factors examined) across IPV and CS-IPV for men and women. Other unique risk factors were identified that differed in prediction of IPV and CS-IPV. The results suggest a variety of both established and novel potential foci for indirectly targeting partner aggression and clinically-significant IPV by improving people's risk profiles at the individual, family, workplace, and community levels. Aggr. Behav. 41:227-241, 2015. © 2014 Wiley Periodicals, Inc.

Hazardous alcohol use and intimate partner violence in the military: understanding protective factors.

Hazardous alcohol use is a well-established risk factor for men's intimate partner violence (IPV), with dozens of studies demonstrating the association. The current study extends understanding of the hazardous alcohol use-IPV link by examining what factors moderate this association in a more systematic and broader way that has been done in past studies. Individual, family, workplace, community, and developmental factors were tested as moderators of the hazardous alcohol use and IPV link in a large, representative sample of active duty service members (the 2006 Community Assessment), and the results were tested for replicability in a hold-out sample. Two family variables (relationship satisfaction and parent-child satisfaction), 1 community variable (community safety), and 3 developmental variables (years in the military, marital length, and family income/pay grade) cross-validated as significant moderators of the association between men's hazardous alcohol use and IPV. Across the significant moderators, the association between hazardous alcohol use and men's IPV was weakened by maturation/development, improved community safety, and better relationship functioning. No individual or workplace variables were significant moderators for men, and there were no significant moderators found for women. The results support the importance of a developmental and relational perspective to understanding the hazardous alcohol use-IPV link, rather than solely an individual coping perspective.

Child emotional aggression and abuse: definitions and prevalence.

OBJECTIVE: Research on and intervention for child emotional abuse and emotional aggression toward children have been severely hampered because there have been no agreed-upon, clinically usable definitions. METHODS: We have (a) proposed and field-tested a set of criteria to operationally define child emotional abuse for clinical settings and (b) used these criteria to design a parent-report measure of parental emotional aggression and child emotional abuse that could be used in research. In this paper, we review the development and field trials of these criteria for making substantiation decisions. RESULTS: Agreement between master reviewers and field decisions was extremely high in a 5-site development trial (96% agreement, κ=.89) and a 41-site dissemination trial (90% agreement, κ=.73). We compare these criteria to other research criteria in the literature. We then present data collected using a self-report measure designed to parallel these criteria from an anonymous online survey of US Air Force personnel and their spouses. The final sample (N=52,780) was weighted to be representative of the United States civilian population. The prevalence of parents' emotionally aggressive acts was much higher than the prevalence of emotional abuse (acts plus impact), but rates of parents' acts of emotional aggression were lower than those typically reported in the literature. Additional analyses tested for differential effects due to gender of perpetrator (i.e., mothers or fathers), age of victim, and clustering within families. These factors did not drive rates of aggression or abuse. CONCLUSIONS: In sum, the criteria developed and proposed appear to support reliable clinical decision making regarding child emotional abuse and can be translated to research survey tools that better capture the continuum of parents' emotional aggression and child emotional abuse than the measures that are currently available, advancing the state of the science with respect to child emotional abuse.

Preventive impacts of reliable family maltreatment criteria.

OBJECTIVE: The U.S. Air Force recently implemented system-wide changes that both (a) clarified the criteria used to determine when family maltreatment has occurred and (b) made the process by which these decisions are made more consistent. The current study examined the effects of these changes on family maltreatment recidivism. METHOD: Official records were obtained from the Air Force Family Advocacy Program. All cases decided during the last year of the old system and the first year of the new system at each base (total N = 14,298) were examined. For each incident, it was determined (a) whether the incident met criteria and (b) whether the same offender committed family maltreatment again within 1 year of the initial incident. RESULTS: Overall substantiation rates were significantly lower (p = .003) under the new system (47%) than the old (56%). After the change, significant interaction effects were obtained for both alleged (b = -.51, p = .004) and substantiated (b = -.55, p = .015) reoffense, in that 1-year reoffense rates decreased significantly among initially substantiated cases but remained unchanged among initially unsubstantiated cases. Indeed, rates of substantiated reoffense by substantiated offenders were cut in half (from 14% to 7%). CONCLUSIONS: Reductions in overall substantiation rates were most likely due to the use of more stringent criteria. The results of the recidivism analyses suggest that clear criteria and consistent decision processes can have secondary preventive effects on family maltreatment in their own right, possibly due to increases in informal community sanctions.

Risk for suicidal ideation in the U.S. Air Force: an ecological perspective.

OBJECTIVE: Suicidal members of the U.S. military often fail to disclose their suicidal urges and behaviors. Military suicide prevention efforts may therefore be enhanced if they also target less stigmatized psychosocial factors that may decrease risk of suicidality. In keeping with Bronfenbrenner's (1977, 1994) model, this study simultaneously examined 4 ecological levels (i.e., individual, family, workplace, and community) of factors variously associated with increased or decreased risk for suicidal ideation. METHOD: Active-duty U.S. Air Force members (N = 52,780; 79.3% male; 79.2% non-Hispanic White; mean age = 31.78 years, SD = 7.38) completed the 2006 Community Assessment survey (a biennial, anonymous survey conducted at 82 U.S. Air Force bases worldwide), including the Centers for Disease Control and Prevention's (2008) 5-item measure of past-year suicidality along with scales assessing an array of potential predictors. RESULTS: The 1-year rate of suicidal ideation, defined as (a) more than rarely thinking about suicide or (b) ever seriously considering suicide, was approximately 4%. In multivariate models, for men and women, individual- (depressive symptoms and alcohol problems), family- (relationship satisfaction and intimate partner victimization), workplace- (hours worked), and community-level (social support) variables were retained in the final model. However, some sex differences in retained predictors were noted (e.g., men: dissatisfaction with the U.S. Air Force way of life; women: workplace relationship satisfaction and financial stressors). CONCLUSIONS: Addressing depressive symptoms and alcohol use, facilitating healthy relationship functioning, and increasing job satisfaction and social support may aid military suicide prevention efforts. These findings illustrate the importance of attending to multiple levels of potential influence when designing integrated suicide prevention and intervention programs.

Unique risk and protective factors for partner aggression in a large scale air force survey.

The objective of this study is to examine risk factors of physical aggression against a partner in a large representative Active Duty Air Force sample. A stratified sample of 128,950 United States Active Duty members were invited to participate in an Air Force-wide anonymous online survey across 82 bases. The final sample (N = 52,780) was weighted to be representative of the United States Air Force. Backward stepwise regression analyses were conducted to identify unique predictors of partner physical aggression perpetration within and across different ecological levels (individual, family, organization, and community levels). Relationship satisfaction, alcohol problems, financial stress, and number of years in the military were identified as unique predictors of men's and women's perpetration of violence against their partner across ecological levels. Parental status, support from neighbors, personal coping, and support from formal agencies also uniquely predicted men's but not women's perpetration of violence across ecological levels. This study identified specific risk factors of partner violence that may be targeted by prevention and intervention efforts aimed at different levels of impact (e.g., family interventions, community-wide programs).

Recent suicidal ideation and suicide attempts in a large-scale survey of the U.S. Air Force: prevalences and demographic risk factors.

One-year prevalences of self-reported noteworthy suicidal ideation and nonfatal suicide attempts were assessed in a large sample of U.S. Air Force active duty members (N = 52,780). Participants completed the 2006 Community Assessment, which was conducted online. Over 3% of male and 5.5% of female participants reported having experienced noteworthy suicidal ideation during the previous year, and 8.7% of those with ideation reported a recent suicide attempt. Demographic factors predicting significantly increased risk for suicidal ideation included female gender, low rank, and non-Christian religious affiliation; unmarried men were also at increased risk. Groups that were at increased risk for nonfatal suicide attempts included low-ranking men and Hispanic women. Implications for prevention efforts are discussed.

Validation of a new self-report measure of parental attributions.

Attributional theory and empirical evidence suggest that a tendency to make stable, global self-causal attributions for undesirable events is associated with negative outcomes. However, existing self-report measures of parental attributions do not account for the possibility that dysfunctional parent-causal attributions for child misbehavior might be important predictors of poor family functioning. To address these concerns, the authors developed and tested a new measure of both parent-causal and child-responsible attributions for child misbehavior in a sample of 453 community couples. Structural validity, convergent validity, discriminant validity, internal consistency, and temporal stability of the new measure were examined. As expected, confirmatory factor analysis resulted in 2 factors, Child-Responsible (9 items) and Parent-Causal (7 items); the final model was cross-validated in a holdout sample. The final scale demonstrated adequate internal consistency (alphas = .81-.90), test-retest reliability (rs = .55-.76), and convergent and discriminant validity. Dysfunctional parent-causal and child-responsible attributions significantly predicted parental emotional problems, ineffective discipline, parent-child physical aggression, and low parenting satisfaction. Associations with parent-child aggression and parenting satisfaction were generally larger than with partner aggression and relationship satisfaction.

Making faces: testing the relation between child behavior problems and mothers' interpretations of child emotion expressions.

We examined the relations between preschool boys' behavior problems and mothers' interpretations of children's emotion expressions. A sample of 31 mothers of oppositional boys and 28 control mothers responded to standard stimuli depicting child emotional reactions to maternal control attempts; mothers were instructed to think of the stimuli as either (a) their own child or (b) an unfamiliar child. Mothers of oppositional boys were more likely to generate negative interpretations than were control mothers when thinking of their own children; however, this difference did not generalize to the explicitly unfamiliar child condition. Mothers of oppositional boys demonstrated negative and comparison mothers demonstrated positive interpretive tendencies toward their own children. Findings suggest that child emotion cues may trigger biased maternal cognitions even in the absence of child misbehavior.