Trauma-focused guided self-help interventions for posttraumatic stress disorder: A meta-analysis of randomized controlled trials.

Trauma-focused guided self-help (TF-GSH) is an important alternative to psychological therapy delivered by a therapist. This meta-analysis evaluates the efficacy of TF-GSH in reducing posttraumatic stress disorder  (PTSD) symptoms and comorbid depressive and anxiety symptoms. A total of 17 trials were included that compared a TF-GSH intervention (N = 610) to various control comparators (N = 570). Control conditions included treatment as usual (k = 2), waiting list (k = 11), phone monitoring (k = 1), nontrauma writing (k = 1), general support (k = 1), and supportive counseling (k = 1). A moderate- to large-sized effect favouring TF-GSH was observed for PTSD (k = 17, g = -0.81, 95% confidence interval [CI]: -1.24, -0.39) and a moderate-sized effect was observed for depressive (k = 13, g = -0.73, 95% CI: -1.16, -0.31) and anxiety (k = 11, g = -0.72, 95% CI: -1.18, -0.27) symptoms, with considerable heterogeneity. Moderator analyses were all not statistically significant. Results indicate that TF-GSH is a promising treatment for PTSD and comorbid depressive and anxiety symptoms. We discuss the nature, extent, and quality of the literature to provide a point of departure for future research. TF-GSH (and unguided self-help) may not be appropriate for certain individuals at certain times. Exploring a broad range of treatment delivery modalities will move the field closer towards a model of evidence-based care in which the likely appropriate dose and type of intervention can be matched to individuals based on presenting problems and other variables.

Reexamining the latent structure of suicidal thoughts using taxometric analysis: Implications for testing ideation to action theoretical models of suicidal thoughts and behavior.

A central question in psychological science concerns whether psychological constructs are best conceptualized as dimensional or consist of one or more categories. The present study uses contemporary taxometric procedures to examine the latent structure of suicidal thoughts, with implications for how suicidal thoughts and behavior (STB) ought to be conceptualized, assessed, measured, and managed. Three nonredundant taxometric procedures (MAMBAC, MAXEIG, and L-Mode) were performed on various sets of indicators, and analyses were replicated across two large samples that included large numbers of individuals reporting current and recent STB. Results provide further evidence that the latent structure of suicidal thoughts is best understood as dimensional. However, inconsistent findings across studies and the relatively small number of taxometric studies conducted to date both suggest that it is premature to draw clear or definitive conclusions about the latent structure of STB being dimensional or categorical based on taxometric evidence. We report a meta-analysis of the current literature which evidences this ambiguity. We provide a detailed, critical discussion of the STB taxometric literature and outline key directions for future taxometric studies in this area, particularly how taxometric analysis relates to testing "ideation to action" theoretical models, which hypothesize that the development of suicidal ideation and the progression from suicide desire to attempting suicide are distinct processes with distinct explanations/mechanisms. It remains entirely possible that qualitatively distinct types of STB (e.g., representing ideation vs. action) or populations have different latent structures indicating different levels of risk. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cautions, concerns, and future directions for using machine learning in relation to mental health problems and clinical and forensic risks: A brief comment on "Model complexity improves the prediction of nonsuicidal self-injury" (Fox et al., 2019).

Machine learning (ML) is an increasingly popular approach/technique for analyzing "Big Data" and predicting risk behaviors and psychological problems. However, few published critiques of ML as an approach currently exist. We discuss some fundamental cautions and concerns with ML that are relevant when attempting to predict all clinical and forensic risk behaviors (risk to self, risk to others, risk from others) and mental health problems. We hope to provoke a healthy scientific debate to ensure that ML's potential is realized and to highlight issues and directions for future risk prediction, assessment, management, and prevention research. ML, by definition, does not require the model to be specified by the researcher. This is both its key strength and its key weakness. We argue that it is critical that the ML algorithm (the model or models) and the results are both presented and that ML needs to be become machine-assisted learning like other statistical techniques; otherwise, we run the risk of becoming slaves to our machines. Emerging evidence potentially challenges the superiority of ML over other approaches, and we argue that ML's complexity significantly limits its clinical utility. Based on the available evidence, we believe that researchers and clinicians should emphasize identifying, understanding, and explaining (formulating) individual clinical needs and risks and providing individualized management and treatment plans, rather than trying to predict or putting too much trust in predictions that will inevitably be wrong some of the time (and we do not know when). (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Enduring Effects of Parental Alcohol, Tobacco, and Drug Use on Child Well-being: A Multilevel Meta-Analysis.

The effects of psychoactive substance abuse are not limited to the user, but extend to the entire family system, with children of substance abusers being particularly at risk. This meta-analysis attempted to quantify the longitudinal relationship between parental alcohol, tobacco, and drug use and child well-being, investigating variation across a range of substance and well-being indices and other potential moderators. We performed a literature search of peer-reviewed, English language, longitudinal observational studies that reported outcomes for children aged 0 to 18 years. In total, 56 studies, yielding 220 dependent effect sizes, met inclusion criteria. A multilevel random-effects model revealed a statistically significant, small detriment to child well-being for parental substance abuse over time (r = .15). Moderator analyses demonstrated that the effect was more pronounced for parental drug use (r = .25), compared with alcohol use (r = .13), tobacco use (r = .13), and alcohol use disorder (r = .14). Results highlight a need for future studies that better capture the effect of parental psychoactive substance abuse on the full breadth of childhood well-being outcomes and to integrate substance abuse into models that specify the precise conditions under which parental behavior determines child well-being.Registration: PROSPERO CRD42017076088.

Adverse childhood experiences research: commonalities with similar, arguably identical, literatures and the need for integration.

Adverse childhood experiences (ACEs) and their impact cannot be clearly distinguished from other distressing life experiences. Much can be therefore be learned by integrating ACEs research with similar, well-established literatures. Future research needs to explain individual differences in relationships between ACEs and particular variables and locate reliable and strong risk factors for ACEs themselves.

How to Do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses.

Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question. The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information. We outline core standards and principles and describe commonly encountered problems. Although this guide targets psychological scientists, its high level of abstraction makes it potentially relevant to any subject area or discipline. We argue that systematic reviews are a key methodology for clarifying whether and how research findings replicate and for explaining possible inconsistencies, and we call for researchers to conduct systematic reviews to help elucidate whether there is a replication crisis.

Characterizing self-injurious cognitions: Development and validation of the Suicide Attempt Beliefs Scale (SABS) and the Nonsuicidal Self-Injury Beliefs Scale (NSIBS).

Self-injurious cognitions (SICs) are cognitions about deliberately injuring oneself (self-injurious behavior [SIB]). Existing measures of the content of SICs provide varying coverage, highlighting a lack of consensus regarding which cognitions characterize SIB. Additionally, a central, unresolved conceptual and measurement issue concerns whether to conceptualize suicide attempts (SA) and nonsuicidal self-injury (NSSI), 2 forms of SIB, as separate constructs. We developed the Suicide Attempt Beliefs Scale (SABS) and the Nonsuicidal Self-Injury Beliefs Scale (NSIBS) to clarify which SICs characterize SA and NSSI and what factor structure best explains SA and NSSI cognitions. A series of factor analyses across 6 samples (N = 3,313) revealed that the SABS consists of 7 correlated factors and the NSIBS consists of 10 correlated factors. Both instruments contain factors that describe how SIB relates to oneself and others and demonstrate moderate to excellent test-retest reliability over 2-4 weeks and strong internal consistency; 95% of the correlations between SABS and NSIBS subscales were ≤ r = .5. Both instruments demonstrated small to moderate-sized correlations with a range of clinical variables, measures of well-being, and purportedly similar, existing SIB constructs. Various analyses indicate that SA and NSSI SICs are similar but distinct phenomena, supporting the use of separate terminology and definitions of SA and NSSI, and pointing to the importance of separating SA and NSSI in research and clinical practice. We hope that the development of the SABS and NSIBS may unify the field somewhat in its understanding and measurement of the basic constituent elements of SICs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Reconceptualizing Anxiety as a Continuum That Ranges From High Calmness to High Anxiety: The Joint Importance of Reducing Distress and Increasing Well-Being.

We first replicate a study by Vautier and Pohl (2009), who used the State-Trait Anxiety Inventory (STAI) to reexamine the structure of anxiety. Using two large samples (N = 4,138 and 1,824), we also find that state and trait anxiety measure continua that range from high calmness to high anxiety. We then significantly extend previous findings and make the clinical importance of this topic more explicit by characterizing the (linear or nonlinear) form of the relationship between the calmness-anxiety continuum and other psychiatric variables for the first time. This form is critical to understanding anxiety problems, as discontinuities in relationships with other psychological conditions could be used to define a natural boundary of problematic anxiety. Baseline levels on the calmness-anxiety continuum are found to have a near linear relationship with changes in depression, aggression, and substance misuse over time. Taken together, these results indicate the joint importance and usefulness of treating anxiety problems and promoting calmness, as doing so may promote resilience from developing other psychiatric conditions. Psychiatric and psychological interventions that are grounded in this continuum conceptualization would logically be stopped when an individual reports experiencing high levels of calmness. Our results point to the usefulness of early intervention and prevention (when people begin to move away from high calmness) and instilling resilience (by providing interventions to move people toward high calmness). (PsycINFO Database Record

The Center for Epidemiologic Studies-Depression (CES-D) scale measures a continuum from well-being to depression: Testing two key predictions of positive clinical psychology.

BACKGROUND: Two core but untested predictions of Positive Clinical Psychology (PCP) are that (1) Many psychiatric problems can be understood as one end of bipolar continua with well-being, and (2) that reducing psychiatric symptoms will provide an equal (near linear) decrease in risk for several other psychiatric variables, irrespective of position on continua. AIMS: We test these predictions in relation to a purported well-being/depression continuum, as measured by the Center for Epidemiologic Studies-Depression (CES-D), a popular measure of depressive experiences in research and clinical practice. METHOD: A large (N=4138), diverse sample completed the CES-D, which contains a mixture of negatively worded and positively worded items (e.g., "I felt sad," "I enjoyed life"). The latter are conventionally reverse scored to compute a total score. We first examined whether purportedly separate well-being and depression CES-D factors can be reconceptualised as a bipolar well-being/depression continuum. We then characterised the (linear or nonlinear) form of the relationship between this continuum and other psychiatric variables. RESULTS: Both predictions were supported. When controlling for shared method bias amongst positively worded items, a single factor well-being/depression continuum underlies the CES-D. Baseline levels on this continuum are found to have near linear relationships with changes in anxiety symptoms, aggression, and substance misuse over time, demonstrating that moving from depression to well-being on the CES-D provides an equal decrease in risk for several other psychological problems irrespective of position on the continuum. LIMITATIONS: The CES-D does not measure well-being as comprehensively as established scales of well-being. CONCLUSIONS: Results support calls for mental health services to jointly focus on increasing well-being and reducing distress, and point to the value of early intervention and instilling resilience in order to prevent people moving away from high levels of well-being.

A meta-analysis of perceptions of defeat and entrapment in depression, anxiety problems, posttraumatic stress disorder, and suicidality.

BACKGROUND: There is a burgeoning literature examining perceptions of being defeated or trapped in different psychiatric disorders. The disorders most frequently examined to date are depression, anxiety problems, posttraumatic stress disorder (PTSD), and suicidality. AIMS: To quantify the size and consistency of perceptions of defeat and entrapment in depression, anxiety problems, PTSD and suicidality, test for differences across psychiatric disorders, and examine potential moderators and publication bias. METHOD: Random-effects meta-analyses based on Pearson's correlation coefficient r. RESULTS: Forty studies were included in the meta-analysis (n = 10,072). Perceptions of defeat and entrapment were strong (around r = 0.60) and similar in size across all four psychiatric disorders. Perceptions of defeat were particularly strong in depression (r = 0.73). There was no between-study heterogeneity; therefore moderator analyses were conducted in an exploratory fashion. There was no evidence of publication bias. LIMITATIONS: Analyses were cross-sectional, which precludes establishing temporal precedence or causality. Some of the meta-analyses were based on relatively small numbers of effect sizes, which may limit their generalisability. CONCLUSIONS: Perceptions of defeat and entrapment are clinically important in depression, anxiety problems, PTSD, and suicidality. Similar-sized, strong relationships across four different psychiatric disorders could suggest that perceptions of defeat and entrapment are transdiagnostic constructs. The results suggest that clinicians and researchers need to become more aware of perceptions of defeat and entrapment.

Evaluation of the CHUMS Child Bereavement Group: A Pilot Study Examining Statistical and Clinical Change.

This article describes the largest evaluation of a UK child bereavement service to date. Change was assessed using conventional statistical tests as well as clinical significance methodology. Consistent with the fact that the intervention was offered on a universal, preventative basis, bereaved young people experienced a statistically significant, small to medium-sized decrease in symptoms over time. This change was equivalent across child age and gender. Type of bereavement had a slight impact on change when rated by parents. Potential clinical implications are highlighted, and various limitations are discussed that we hope to address using an experimental design in future research.

A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents.

Post-traumatic stress disorder (PTSD) is a complex and chronic disorder that causes substantial distress and interferes with social and educational functioning. Consequently, identifying the risk factors that make a child more likely to experience traumatic distress is of academic, clinical and social importance. This meta-analysis estimated the population effect sizes of 25 potential risk factors for PTSD in children and adolescents aged 6-18 years across 64 studies (N=32,238). Medium to large effect sizes were shown for many factors relating to subjective experience of the event and post-trauma variables (low social support, peri-trauma fear, perceived life threat, social withdrawal, comorbid psychological problem, poor family functioning, distraction, PTSD at time 1, and thought suppression); whereas pre-trauma variables and more objective measures of the assumed severity of the event generated small to medium effect sizes. This indicates that subjective peri-trauma factors and post-event factors are likely to have a major role in determining whether a child develops PTSD following exposure to a traumatic event. Such factors could potentially be assessed following a potentially traumatic event in order to screen for those most vulnerable to developing PTSD and target treatment efforts accordingly. The findings support the cognitive model of PTSD as a way of understanding its development and guiding interventions to reduce symptoms.