Feasibility and acceptability of caring contacts texts for suicide prevention among veterans recently separated from military service.

The primary purpose of this single-arm mixed-methods pilot trial was to examine the feasibility, acceptability, and preliminary effects of a text message-based version of Caring Contacts, Caring Contacts texts (CC-t), among veterans recently separated from military service. Twenty-four veterans (Mage = 32.92, SD = 8.16; 75% male; 50% Black; 91.7% non-Hispanic/Latinx) were recruited through the Department of Veterans Affairs (VA) and enrolled in CC-t, which involved approximately five text messages sent by the study team expressing care and concern over the course of 3 months. Participants completed pre- and postintervention assessments and an interview, during which self-reported feasibility and acceptability of CC-t, and preliminary effects of CC-t on health care engagement and suicide risk were assessed. Self-reported feasibility and acceptability of CC-t were also assessed among VA staff involved in the study. Among veterans and VA staff, scores on the Feasibility of Intervention Measure (M = 17.91 and M = 15.67, respectively) and Acceptability of Intervention Measure (M = 18.19; M = 19.33, respectively) were above the mean, suggesting that CC-t was easy to engage in or implement and was well-tolerated. These findings were reinforced in the qualitative feedback, which suggested that veterans found the text messages to be comfortable, convenient, and had a positive impact on their mood. Quantitative results provided preliminary evidence for improved veteran health care engagement following CC-t. CC-t appears to be feasible and acceptable among veterans and VA staff and holds promise as a primary suicide prevention for veterans making the transition from military service to civilian life. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Massed written exposure therapy delivered to veterans with posttraumatic stress symptoms on an acute inpatient mental health unit.

Written exposure therapy (WET) is a brief, manualized trauma-focused treatment typically delivered in five individual weekly sessions. Given the brevity and effectiveness of WET, researchers have begun to focus on its delivery in a massed format. However, only one case study examining massed delivery has been published to date. As such, the objective of the current study was to examine the acceptability, feasibility, and preliminary effectiveness of massed WET among veterans with a trauma- and stressor-related disorder receiving care on an acute inpatient mental health unit. Veterans (N = 26) were assessed prior to, immediately after, and 1 month following massed WET. Most veterans found massed WET to be useful and acceptable. Recruitment and retention rates suggested that the treatment was feasible. Notably, the results revealed statistically significant reductions in overall posttraumatic stress symptoms, ηp 2 = .81, p < .001; depressive symptoms, ηp 2 = .71, p < .001; and functional impairment, ηp 2 = .42, p = .002. These findings add to a growing body of literature highlighting the preliminary effectiveness of WET across various settings, populations, and delivery formats. Limitations include the small sample size and uncontrolled design.

Comparing the interactions of risk factors by method of suicide among veterans: A moderated network analysis approach.

Despite the well-established link between firearm access and suicide, less is known about other variables that may influence the risk for death by self-inflicted gunshot versus other methods of suicide. As individual factors have demonstrated limited predictive ability, scholars have called for studies that consider the multifaceted relations between myriad variables. One alternative to the typical cause-and-effect approach for investigating various forms of psychopathology is network analysis. However, few studies have applied this method to suicidal outcomes, particularly in the context of a veteran population. Data from 19,234 male veteran suicide decedents (89.1% White; Mage = 57.16, SD = 18.64) acquired from the National Violent Death Reporting System were used to investigate characteristics of veteran suicide decedents who died by self-inflicted gunshot (gun; 66.4%) versus alternative methods (nongun, e.g., poisoning, hanging; 33.5%). Results of the overall moderated network model indicated that veterans in the gun group were more likely to have a physical health problem that contributed to the suicide than veterans in the nongun group. Additionally, results of the moderated network model revealed several pairs of associated circumstances whose relationships were significantly moderated by method of suicide, the three strongest of which included having a physical health problem that contributed to the suicide. Overall, results suggest that public health prevention and intervention efforts aimed at reducing the overall burden of physical health problems among male veterans may mitigate the risk of firearm suicides. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Bifactor Evaluation of Self-Report and Clinician-Administered Measures of PTSD in Veterans.

The PTSD Checklist for DSM-5 (PCL-5) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) are two of the most widely used and well-validated PTSD measures providing total and subscale scores that correspond with DSM-5 PTSD symptoms. However, there is little information about the utility of subscale scores above and beyond the total score for either measure. The current study compared the proposed DSM-5 four-factor model to a bifactor model across both measures using a sample of veterans (N = 1,240) presenting to a Veterans Affairs (VA) PTSD specialty clinic. The correlated factors and bifactor models for both measures evidenced marginal-to-acceptable fit and were retained for further evaluation. Bifactor specific indices suggested that both measures exhibited a strong general factor but weak lower-order factors. Structural regressions revealed that most of the lower-order factors provided little utility in predicting relevant outcomes. Although additional research is needed to make definitive statements about the utility of PCL-5 and CAPS-5 subscales, study findings point to numerous weaknesses. As such, caution should be exercised when using or interpreting subscale scores in future research.

The Military Health History: An Educational Initiative to Improve Veteran Healthcare.

INTRODUCTION: As a result of the nature of military service, veterans are a unique patient population with many special health considerations. For various reasons, measures are often not taken by clinicians to address such special considerations. This results in a healthcare disparity for veterans first described by Dr. Jeffrey Brown in 2012. To address this disparity, we introduced "the military health history" to third-year medical students at a large medical school in the southeastern United States. Our objective was to assess the effectiveness of this educational intervention and determine its potential role in creating a future in which veteran healthcare is of the highest quality. MATERIALS AND METHODS: This study was approved as a quality assurance/quality improvement project by both Louisiana State University Health Science Center and Southeast Louisiana Veteran Healthcare System IRB offices. A short lecture outlining the components of the military health history was presented to 186 third-year medical students. The students were given the opportunity to answer five survey questions before and after the lecture. These questions assessed the students' current confidence performing a military health history, perceived importance of doing so, and likelihood of future implementation. To determine useful retention of the lecture material, the post-lecture survey was readministered to the same population sample 6 months after the lecture. A series of repeated measures analyses of variance were conducted to examine changes in mean levels of confidence, importance, and likelihood of ascertaining military history during a patient encounter at pre- and post-presentation as well as at the 6 month follow-up. RESULTS: Results revealed a significant effect of time on importance, Wilks' Lambda = 0.74, F (2, 87) = 15.41, P < 0.001; confidence, Wilks' Lambda = 0.61, F (2, 87) = 27.58, P < 0.001; and likelihood of ascertaining a military history during a future patient encounter, Wilks' Lambda = 0.46, F (2, 88) = 50.58, P < 0.001. Results are demonstrated in detail in Table I of the manuscript. CONCLUSION: The lecture resulted in a statistically significant increase over 6 months in both the likelihood and confidence parameters. The team believes that this result indicates that the students demonstrated useful retention of the lecture material. Our hope is that these students continue to employ the military health history throughout their years of clinical work. In the future, we plan to survey veterans immediately following Veterans Health Administration clinic visits with members of our study population to assess the patient's perceived benefit of the military health history. The team will continue to investigate ways in which military health curricula can be implemented in undergraduate medical education.

Psychometric properties of the PTSD checklist for DSM-5 in treatment-seeking Black veterans.

OBJECTIVE: Despite widespread use of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-fifth edition (PCL-5) across various trauma-exposed populations, little is known about the psychometric properties of the instrument in certain ethnic minority groups with increased risk of trauma exposure, including Black veterans. To this end, the current study examined the internal consistency of the PCL-5, convergent validity using correlations between the PCL-5 and another measure of PTSD, and discriminant validity using correlations between the PCL-5 and other commonly occurring psychiatric symptoms, including depression as well as alcohol and substance misuse. METHOD: The sample was composed of 327 Black veterans (84% male, Mage = 51.87, SD = 13.72) presenting to a PTSD specialty clinic at a large Veterans Affairs hospital in the Midwest United States to receive psychological services. In addition to a diagnostic interview, veterans were asked to complete a brief battery of self-report questionnaires to assist with diagnostic clarification and treatment planning. RESULTS: The PCL-5 demonstrated excellent internal consistency. Furthermore, the PCL-5 was significantly and positively correlated with PTSD diagnostic status, suggesting evidence of convergent validity. Finally, the PCL-5 was strongly correlated with symptoms of depression and moderately correlated with alcohol and substance misuse. CONCLUSIONS: Findings suggest that the PCL-5 is a psychometrically sound measure to assess PTSD symptoms among Black veterans. Considering the brevity of PCL-5 administration, clinicians should consider utilizing this and other psychometric tests in clinical care to reduce disparities in health equity among Black patients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Obsessive-compulsive symptoms, perceived burdensomeness, and thwarted belongingness: Associations and implications among US veterans.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is among the most debilitating psychiatric disorders worldwide, but has gone relatively unnoticed within the US veteran population. Simultaneously, suicide rates continue to remain high within this population despite the high volume of veterans who receive psychiatric care. With recent research demonstrating OCD's unique relationship with suicidality, it is imperative to explore this association and factors that may explain this association within veterans. METHODS: The present study investigated OCD symptoms and their relationship with two known risk factors of suicide, perceived burdensomeness (PB) and thwarted belongingness (TB), in two samples of veterans. RESULTS: In the first study (N = 100), OCD symptoms were found to be uniquely related to both PB and TB even after covarying for demographics, trauma exposure, and probable depression. In the second study (N = 99), these relationships were replicated longitudinally. OCD symptoms at baseline were found to be indirectly related to suicidal ideation severity at a 1-month follow-up via PB and TB at post-treatment. CONCLUSION: This study highlights the importance of assessing and addressing OCD symptoms within veterans due to the unique relationship these symptoms have with suicidal constructs. A deeper understanding of the impact of OCD within the veteran population will inform future prevention and intervention efforts.

Co-Occurring Posttraumatic Stress Disorder Symptoms and Alcohol Use Behaviors: The Mediating Role of Drinking to Cope with PTSD Symptoms.

OBJECTIVE: Posttraumatic stress disorder (PTSD) symptoms and hazardous drinking often co-occur. One widely acknowledged explanation for this co-occurrence is the self-medication hypothesis. However, only one study to date has explicitly examined the extent to which drinking to cope with trauma-related symptoms, rather than drinking to cope with negative affect more broadly, accounts for this association. METHOD: Survey data were collected from a nationally representative sample of adults (n = 360; 48.9% female, Mage = 38.50 years, SD = 10.23). RESULTS: Results revealed a significant indirect effect of PTSD symptom severity on alcohol use frequency and alcohol use-related problems via drinking to cope with PTSD symptoms but not alcohol use quantity or binge drinking frequency. Drinking to cope with negative affect did not indirectly mediate the relations between PTSD symptom severity and any of the alcohol use-related outcomes. CONCLUSIONS: Findings will be discussed with regard to previous and future research.

When safe firearm storage isn't enough: Examining risk profiles among firearm suicide decedents.

INTRODUCTION: Suicide is a leading cause of death in the United States, and firearms are the most frequently used suicide method. Research suggests risk for firearm suicide increases with greater access to firearms (e.g., storing loaded or unlocked). Although safe firearm storage is promoted as a means of risk reduction, no studies have explored factors differentiating firearm suicide decedents who stored firearms safely vs. those who stored unsafely prior to death. METHODS: Utilizing data from the National Violent Death Reporting System, the current study aimed to determine which factors distinguish firearm suicide decedents who stored firearms safely vs. those who stored unsafely. The current sample included decedents for whom data were available on whether the firearm used in the suicide was stored loaded or unloaded (n = 4269) and unlocked or locked (n = 6273) prior to their death. RESULTS: Results revealed using a long gun in the suicide (as opposed to a handgun) was associated with five times greater odds of storing unloaded prior to death, suggesting this safe firearm storage practice alone does not mitigate risk among all long gun owners. CONCLUSION: These findings indicate a need to increase suicide prevention efforts within the long gun owning community.

Differences in Anxiety Sensitivity Among Black and White Veterans.

Black Americans are at greater risk for more severe and enduring consequences of anxiety disorders than White Americans, highlighting the need to identify malleable risk and maintenance factors. The current study aimed to examine racial differences in anxiety sensitivity and anxiety sensitivity facets between Black and White veterans (N = 285; 58% Black, 77% Male; Mage = 43.51, SD = 11.87) presenting to a PTSD specialty clinic at a Veterans Affairs (VA) hospital. In addition to a diagnostic interview, veterans were asked to complete a brief battery of self-report questionnaires to assist with diagnostic clarification and treatment planning. Results revealed a significant difference in anxiety sensitivity total scores between Black (M = 44.5, SD = 17.2) and White veterans (M = 36.1, SD = 17.7), such that Black veterans evinced higher levels. When examining anxiety sensitivity subfacets, Black veterans also evinced elevated levels of physical (M = 14.4, SD = 6.6) and cognitive concerns (M = 15.2, SD = 6.5) compared to White veterans (M = 9.8, SD = 6.2; M = 11.7, SD = 6.6, respectively). Results indicate that anxiety sensitivity is a relevant risk factor among Black veterans. Future studies should examine the extent to which anxiety sensitivity is modifiable in such populations.

Evaluating the long-term (Three Year) durability of brief interventions targeting risk factors for psychopathology.

Despite their brevity, prior work indicates that computer-based interventions can substantially impact risk factors for psychopathology including anxiety sensitivity (AS), thwarted belongingness (TB), and perceived burdensomeness (PB). However, very few studies have assessed the long-term (> 1 year) effects of these interventions. The primary aim of the current study was to evaluate post-hoc, the long-term (3 year) durability of brief interventions targeting risk factors for anxiety and mood psychopathology using data from a pre-registered randomized clinical trial. Moreover, we were interested in evaluating whether mitigation in these risk factors mediated long-term symptom change. A sample determined to be at-risk for anxiety and mood pathology based on elevations on several risk factors (N = 303) was randomly assigned to one of four experimental conditions focused on: (1) reducing TB and PB; (2) reducing AS, (3) reducing TB,PB, and AS; or (4) a repeated contact control condition. Participants were assessed at post-intervention, one, three, six, 12, and 36 month follow-ups. Participants in the active treatment conditions showed sustained reductions in AS and PB through long-term follow-up. Mediation analyses suggested that reductions in AS mediated long-term reductions in anxiety and depression symptoms. These findings suggest that brief and scalable risk reduction protocols have long-term durability and efficacy both in terms of reducing risk factors for psychopathology.

Posttraumatic stress and alcohol use among Hispanic/Latina survivors of interpersonal trauma: Associations with anxiety sensitivity and distress tolerance.

OBJECTIVE: Hispanic/Latina students experience elevated rates of binge drinking, interpersonal trauma, and posttraumatic stress disorder (PTSD) symptoms. Research has indicated anxiety sensitivity (AS; i.e., fear of anxiety-related bodily sensations) and distress tolerance (DT; i.e., ability to tolerate negative emotional states) are modifiable psychological mechanisms related to alcohol use and PTSD symptoms. However, a dearth of literature has focused on factors that may account for associations between alcohol use and PTSD among Hispanic/Latina students. METHOD: The project examined, among 288 Hispanic/Latina college students (Mage = 23.3 years, SD = 5.4) with interpersonal trauma histories, the indirect effects of PTSD symptom severity on (a) alcohol use and (b) alcohol use motives (i.e., coping, conformity, enhancement, social) via DT and AS, evaluated as parallel statistical mediators. RESULTS: Results PTSD symptom severity had an indirect effect on (a) alcohol use severity; (b) conformity motives for alcohol use; and (c) social motives for alcohol use via AS but not DT. PTSD symptom severity was associated with coping-oriented drinking via both AS and DT. CONCLUSIONS: This research has the potential to advance culturally-informed literature on factors that may impact co-occurring PTSD symptoms and alcohol use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Engaging stakeholders to develop a suicide prevention learning module for Louisiana firearm training courses.

BACKGROUND: Firearm suicide is a significant public health problem in the United States of America among the general and veteran populations. Broad-based preventive strategies, including lethal means safety, have been emphasized as a key approach to suicide prevention. Prior research has identified ways to improve the reach and uptake of lethal means safety messages. However, few resources have been created with these lessons in mind. METHODS: Louisiana firearm owners and instructors were recruited through a larger project, Veteran-Informed Safety Intervention and Outreach Network, as well as a publicly available database of firearm instructors to participate in focus groups to provide feedback on an existing suicide prevention learning module (developed in Utah) for use by firearm instructors. Their feedback was used to adapt the module, which included a brief video and PowerPoint presentation. Firearm owners and instructors were then invited back for another round of focus groups to provide feedback on this adapted learning module. Team-based rapid qualitative analysis was conducted to identify themes across transcripts from these four focus groups. RESULTS: Firearm owners and instructors agreed on several key themes, including the importance of messenger relatability and aligning the lethal means safety message with firearm owner values. Feedback suggested these themes were adequately addressed in the adapted learning module and contributed to overall module acceptability. The final theme, present across the original and adapted learning modules (i.e., Utah and Louisiana), was openness to further information and training on firearm suicide prevention. CONCLUSION: Consistent with a public health approach to suicide prevention, the current study used stakeholder engagement to develop a suicide prevention learning module perceived as representative, accurate, and acceptable to Louisiana firearm owners and instructors. These findings can be used to inform firearm suicide prevention efforts in other states.

Posttraumatic Stress, Alcohol Use, and Alcohol Use Motives among Non-Hispanic Black/African American College Students: The Role of Emotion Regulation.

OBJECTIVE: The associations between posttraumatic stress disorder (PTSD) symptom severity, alcohol use, and alcohol use motives are well-established. Emotion regulation difficulties have been implicated in the association between PTSD symptoms and alcohol use. A dearth of empirical work, however, has examined these associations among Black/African American college students, a population with high prevalence of exposure to potentially traumatic events, PTSD symptomatology, and alcohol-related consequences. METHODS: This study examined PTSD symptoms, emotion regulation difficulties, and alcohol use severity and motives among a sample of Black/African American trauma-exposed college students (N = 282; 77.4% identified as female; M age = 22.36, SD = 4.71). RESULTS: PTSD symptom severity was related to alcohol use and coping and conformity motives for alcohol use through heightened emotion regulation difficulties. Findings were significant above and beyond the effects of trauma load (i.e., number of potentially traumatic event types experienced). CONCLUSIONS: This study extends past work to an understudied population and contributes to groundwork for culturally informed interventions.

Acceptability, feasibility, and utility of a safety aid reduction treatment in underserved veterans: a pilot investigation.

Access to mental health services, particularly for veterans residing in underserved communities, remain scarce. One approach to addressing availability barriers is through the use of group-based transdiagnostic or unified treatment protocols. One such protocol, Safety Aid Reduction Treatment (START), previously termed False Safety Behavior Elimination Treatment (FSET), has received increasing empirical support. However, prior research has only examined this treatment among civilians with a primary anxiety diagnosis. Thus, the purpose of the current study was to replicate and extend prior research by examining the acceptability, feasibility, and utility of START among veterans, particularly those living in underserved communities, and across a wider array of diagnoses. Veterans (n = 22) were assessed prior to, immediately after, and one month following the 8-week treatment. The majority of veterans found START useful and acceptable. Additionally, recruitment and retention rates suggest that the treatment was feasible. Notably, results revealed reductions in overall anxiety, depression, and safety aid usage, which were maintained throughout the brief follow-up period. These findings add to a growing body of literature highlighting the utility of transdiagnostic approaches in the amelioration of various anxiety and related disorders. Limitations include the small sample size and uncontrolled design.

Examining the unique and interactive associations of gender and race on PTSD symptom severity among military sexual trauma survivors.

OBJECTIVE: Despite a robust association between military sexual trauma (MST) and posttraumatic stress disorder (PTSD), few studies have examined factors that are associated with increased symptom severity. To this end, the current study was designed to examine the unique and interactive effects of gender and race on PTSD symptoms using a sample of MST survivors. METHOD: The sample included 126 veterans (71% Women, 29% Men; 70% Black/African American and 30% White/Caucasian) presenting for psychological services to a MST specialty clinic at a large Southeastern Veterans Affairs (VA) hospital. As part of their intake evaluation, veterans completed a diagnostic interview and battery of self-report questionnaires. RESULTS: Results revealed a main effect of gender and race such that veteran men and Black/African American veterans were found to have increased PTSD symptom severity. However, there was not a significant gender by race interaction. CONCLUSION: Findings are discussed with regard to previous research and treatment implications. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Pain and posttraumatic stress: Associations among women veterans with a history of military sexual trauma.

OBJECTIVE: Chronic pain and posttraumatic stress disorder (PTSD) are two highly prevaxlent and comorbid conditions common within veteran populations. Notably, those with comorbid pain and PTSD tend to have more severe presentations and poorer quality of life than those with either disorder alone. Despite this well-established relationship, limited research has examined the association between pain and PTSD symptom severity among women veterans with a history of military sexual trauma (MST). METHOD: The current study included 107 women veterans presenting for psychological services to an MST specialty clinic at a large southeastern Veterans Affairs (VA) hospital in the United States. RESULTS: Findings indicated a significant relationship between pain and overall PTSD symptom severity, as well as the intrusions and arousal and reactivity symptom clusters. Contrary to prediction, there was not a significant relationship between pain interference and PTSD symptom or cluster severity. CONCLUSION: Results highlight the importance of inquiring about pain when working with women veterans with a history of MST. Future research aimed at disentangling the casual relationship between pain and PTSD symptoms is crucial to enhance our understanding of these constructs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Intersection of anxiety and negative coping among Asian American medical students.

Purpose: Asian Americans comprise 21% of matriculating medical students in the United States but little is known about their mental health. With the growing focus on addressing the mental health of medical students, this systematic, nationwide survey assesses the relationship between anxiety and depression symptoms and coping skills among Asian American medical students. Materials and methods: A survey tool comprised of Patient Health Questionnaire-9, General Anxiety Disorder-7, and questions related to coping were emailed to members of the Asian Pacific American Medical Students Association enrolled in a United States medical school during the 2016-2017 academic year. We evaluated associations between anxiety and coping as well as depression and coping. Results: A total of 511 Asian American medical students completed the survey. Anxiety symptoms were positively correlated with an increase in negative coping skills. Depressive symptoms were not correlated with an increase in negative coping skills. Conclusion: Professionals and medical schools that aim to improve the mental health of medical students should be aware of the needs of specific populations. Asian American students who experience anxiety were more likely to utilize avoidant or negative coping strategies. In addition, Asian American students who experience depressive symptoms were not more likely to utilize these negative coping strategies. Further research must be done to evaluate the factors that influence the use of negative coping strategies to better address anxiety within the Asian American medical student population.