Reducing suicidal ideation through evidence-based treatment for posttraumatic stress disorder.

BACKGROUND: Suicide is a major public health concern in military and civilian contexts. Veteran populations are at increased risk for suicide, especially veterans with mental health disorders such as Posttraumatic Stress Disorder (PTSD). Suicidal ideation (SI) is a primary risk factor for suicide. METHODS: We investigated changes in SI in a multi-site sample of treatment seeking veterans from three separate Veterans Health Administration (VA) medical centers (n = 289) who received Prolonged Exposure (PE) therapy, an evidence-based treatment (EBT) for PTSD. SI and PTSD symptoms were assessed, using self-report instruments, throughout routine clinical care. RESULTS: Both PTSD and SI symptoms reduced over the course of treatment (d-type effect sizes of 1.47 and 0.27, respectively). While SI was associated with PTSD symptoms at all time points, appropriately specified, time lagged models indicated that changes in PTSD symptoms were predictive of future declines in SI, while the converse was not true. CONCLUSIONS: Results indicate that treating PTSD symptoms with an EBT for PTSD can be an effective way to reduce SI, at least partially, and for some patients. These data are significant in light of the resources and programming devoted to addressing SI in the VA relative to available empirical evidence regarding the effectiveness of developed strategies. The findings demonstrate the importance of facilitating EBT referrals for specific disorders as a component of broad-based suicide outreach and preventions strategies.

Personality and Perpetration: Narcissism Among College Sexual Assault Perpetrators.

Theory and research suggest that narcissism plays an important role in perpetration of sexual aggression. As narcissism is a multidimensional construct, our objective was to clarify the relation between perpetration and three aspects of narcissism. College men (N = 234) completed the Narcissistic Personality Inventory (NPI), Narcissistic Personality Disorder (NPD) subscale of the Structured Clinical Interview for DSM Disorders-II (SCID-N) Personality Questionnaire, and Hypersensitive Narcissism Scale (HSNS). Perpetrators had higher scores on NPD traits, which were also associated with frequent perpetration. HSNS scores were only associated with perpetration via alcohol and/or drugs. Only the maladaptive facets of NPI narcissism correlated with perpetration. Narcissism seems to have been understudied in nonincarcerated perpetrators.

Addressing the gender gap: Prolonged exposure for PTSD in veterans.

As the proportion of women serving in the United States military continues to increase, more female veterans are being treated for posttraumatic stress disorder (PTSD) in Department of Veterans Affairs (VA) health care settings. Prolonged Exposure (PE) therapy is an evidence-based treatment for PTSD and is often used in VA settings. However, only a few studies have investigated the effectiveness of PE specifically for female veterans with appropriate power. Results of these studies have varied, with similar effects between female and male veterans on par with civilian effects, and more recently, better outcomes for female veterans receiving PE compared with male veterans. The current study contextualizes the evidence from those studies and considers new data regarding clinical outcomes pre- and posttreatment for a large (N = 325) sample of male and female veterans treated with PE in a PTSD specialty clinic. Results indicate a large statistically significant decrease in PTSD as measured by PTSD Checklist (PCL) scores for both male and female veterans treated with PE (d = 1.33). No difference in effectiveness and no difference in treatment completion rates were found between male and female veterans. Our findings support the effectiveness of PE for the treatment of PTSD in female as well as male veterans. Results are compared and contrasted to previous findings in the literature taking into account heterogeneity in methodological and ecological factors among the studies. Emphasis is placed on context of care issues to further the empirical conversation regarding meeting the mental health needs of female veterans. (PsycINFO Database Record

Impulsivity and sexual assault in college men.

Although impulsivity has been consistently linked to perpetration of sexual aggression, results lack clarity because they do not account for the substantial heterogeneity associated with the construct. The UPPS-P model (Lynam, Smith, Whiteside, & Cyders, 2006), which was proposed to clarify the multidimensional nature of impulsivity, has yet to be applied to sexual aggression. We measured UPPS-P Impulsivity in a sample of male college students who also self-reported on perpetration of sexual aggression. As predicted, impulsivity distinguished perpetrators from nonperpetrators. Perpetrators scored higher than non-perpetrators on Negative Urgency, Positive Urgency, and lack of Premeditation. Results suggest that the impulsivity traits most relevant to sexual aggression are the tendency to act impulsively when experiencing intense emotions (Positive and Negative Urgency) and lack of forethought and planning (lack of Premeditation).

A prospective study of sexual assault and alcohol use among first-year college women.

This study prospectively examined the relation between alcohol use and sexual assault in a sample (N = 319) of first-year college women. Both frequency of drinking and frequency of binge drinking were measured. Over the course of their freshman year, 19.3% reported experiencing at least one sexual assault. Frequent binge drinking and frequent drinking predicted a subsequent sexual assault; however, experiencing a sexual assault did not predict changes in alcohol use. Frequent binge drinking demonstrated a stronger association with sexual assault than did frequent drinking. Findings help clarify the relation between alcohol use and sexual assault in college women and call for continued differentiation in assessment of alcohol use.

Effects of participation in a sexual assault risk reduction program on psychological distress following revictimization.

The current study followed women who participated in a sexual assault risk reduction program and a wait-list control group for 4 months. Those women in both groups who reported being revictimized (N = 147) were assessed to determine the effect of program participation on psychological distress. Intervention group participants reported a significant reduction in both psychological distress and posttraumatic stress disorder (PTSD) symptoms at follow-up relative to wait-list control participants, even after controlling for frequency of revictimization. Significantly fewer intervention participants met criteria for PTSD from Time 1 to Time 2. Hierarchical multiple regression analyses indicated frequency and severity of victimization and behavioral and characterological self-blame, and use of avoidance coping explained a significant amount of the variance in distress following revictimization. Implications for future research and risk reduction programs are discussed.