Examining the roles of disability-related body esteem and perceived burdensomeness in suicidal ideation among adults with vision- and mobility-related disabilities.

PURPOSE/OBJECTIVE: People with disabilities (PWD) generally exhibit an increased risk of suicidal ideation (SI) and behaviors. Underlying cognitive states, namely perceived burdensomeness, have been identified as a contributor to the increased risk of suicidal thoughts and behaviors in PWD. However, the role of body esteem in the development of SI in this population remains unexamined, despite its salience in other populations. In this study, we examined whether the interaction of perceived burdensomeness and body esteem contributed to the perceived likelihood of future SI among PWD, and whether this relationship was further moderated by disability type. METHOD: Participants included 119 adults with self-reported vision- and mobility-related disabilities who participated in a larger study focused on disability and suicide involving interviews and self-report measures. We examined the interaction between perceived burdensomeness and disability-related body esteem on self-reported likelihood of future SI and whether this interaction was further moderated by disability type (i.e., vision- or mobility-related disability). RESULTS: Greater perceived burdensomeness was associated with a greater perceived likelihood of future SI only for participants with vision impairments and at low levels of body esteem. CONCLUSIONS/IMPLICATIONS: The combination of experiences of perceived burdensomeness and low body esteem may be particularly relevant to SI among people with vision-related versus mobility-related disabilities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Crisis response planning rapidly reduces suicidal ideation among U.S. military veterans receiving massed cognitive processing therapy for PTSD.

Posttraumatic stress disorder (PTSD) is common among U.S. military veterans and is associated with increased risk of suicidal thoughts and behaviors. Crisis response planning (CRP), a brief safety planning-type intervention, has been shown to rapidly reduce suicidal ideation and suicide attempts in emergency and acute care settings. CRP's effectiveness when combined with trauma-focused therapies remains unknown. In this randomized pragmatic clinical trial with one-year follow-up, 157 U.S. military personnel and veterans were randomly assigned to receive CRP or self-guided safety planning (SP) prior to beginning massed cognitive processing therapy (CPT) for PTSD. Among 51 (32.5 % of sample) participants endorsing suicidal ideation at baseline, reductions in the severity of suicidal ideation were significantly larger and faster in CRP (F(11,672)= 15.8, p < .001). Among 106 participants denying suicidal ideation at baseline, 8.5 % of CRP participants versus 11.9 % of SP participants (OR=0.69, 95 % CI=0.19-2.52) reported new-onset suicidal ideation during any follow-up assessment. PTSD symptoms significantly reduced over time with no differences between groups. Results support the effectiveness of CRP for rapidly reducing suicidal ideation and managing suicide risk during outpatient treatment for PTSD.

Group brief cognitive behavioral therapy for suicide prevention compared to dialectal behavior therapy skills group for military service members: a study protocol of a randomized controlled trial.

BACKGROUND: Suicide is a pressing matter for the military. Not only does it pose a health risk, but suicide also compromises operational readiness. Despite provision of suicide prevention clinical best practices, the Department of Defense suffers several challenges (e.g., clinician shortages) limiting the agency's ability to effectively respond to service member suicide. Implementation of evidence-based suicide-specific group therapy is a possible solution to service member well-being needs and system challenges. Service members can also gain coping skills useful beyond managing suicidal thoughts and behaviors. METHODS: This 2-arm non-inferiority randomized controlled trial compares a group therapy format of Brief Cognitive Behavioral Therapy (i.e., G-BCBT) with Dialectical Behavior Therapy (DBT) Skills Group. Both therapies are delivered in-person at a United States Naval Medical Center. Participants (N = 136) are active-duty service members with recent suicidal thoughts or suicidal behavior. Evaluation features electronically delivered questionnaires at baseline, after each treatment session, and at 3- and 6-month follow-up. DISCUSSION: The primary outcome concerns G-BCBT impacts on suicidal ideation. Secondary outcomes of interest are suicide attempt, psychological distress (e.g., symptoms of depression, anxiety), and self-regulatory skills (e.g., emotion regulation). We also examine self-regulatory skills as treatment moderators. Clinical trial strengths and limitations are reviewed. TRIAL REGISTRATION: This study was registered at Clinicaltrials.gov (protocol NCT05401838).

Impact of the COVID-19 Pandemic on Indicators of Psychological Health and Suicidal Ideation Within an Active Duty U.S. Military Population.

INTRODUCTION: The COVID-19 pandemic has had a significant impact on the psychological health of individuals. The pandemic has contributed to increased anxiety, elevated rates of depression, and worsening suicidal ideation among civilians. Reported rates of burnout are also elevated as employees and employers adapted to ever-changing work environments, finding it increasingly difficult to maintain a work-life balance. The objective of this study is to determine how the COVID-19 pandemic impacted the psychological health and rates of suicidal ideation of active duty military personnel in the USA. MATERIALS AND METHODS: A total of 2055 military personnel and military-adjacent employees stationed at a U.S. Air Force base completed a self-report survey that was administered six times from January 2020 to December 2021. Validated scales assessed measures of psychological health and suicidal ideation. General Estimating Equations were used to examine how indicators of time and psychological health predicted suicidal ideation in a military population. RESULTS: Life satisfaction, happiness, feeling life is worthwhile, depression severity, and suicidal ideation did not statistically change across the six time points. Worry (P < .01) and depression (P < .001) did decrease significantly, while burnout (P = .01) significantly increased across these time points. Feeling life is worthwhile significantly predicted reduced suicidal ideation (B = -.19; SE = 0.05), while depression (B = 0.11; SE = 0.03), depression severity (B = 0.24; SE = 0.05), worry (B = 0.06; SE = 0.02), and burnout (B = 0.15; SE = 0.07) predicted increased suicidal ideation. CONCLUSIONS: The rates of depression and worry decreased throughout the pandemic for those in the study while rates of suicidal ideation remained constant, demonstrating the potential resilience of military personnel and military-adjacent employees in response to the COVID-19 pandemic. However, burnout increased and significantly predicted elevated rates of suicidal ideation, highlighting the importance of focusing on reducing workplace stressors for military personnel.

Methodological considerations for collecting and analyzing data on multiply marginalized psychology trainees with disabilities.

OBJECTIVE/PURPOSE: Historically, psychology trainees from marginalized communities have been underrepresented both as researchers and as participants in research on trainee experiences and outcomes. The current research can be used to develop evidence-based strategies to understand and improve the recruitment, retention, advancement, and overall training experiences of trainees with marginalized identities. METHOD: We review the existing literature on the experiences of psychology trainees, particularly that focused on trainees from marginalized backgrounds. RESULTS: Quantitative, qualitative, and archival data collection and analysis methods each carry their own benefits and limitations, which must be considered and addressed intentionally to optimize the impact of research findings for multiply marginalized individuals. Mixed methods approaches are also discussed. Matching each limitation with a research design strategy is recommended, including the use of sample weights from population archival data to contextualize sample results, incorporating flexibility for reasonable accommodations for intensive qualitative studies, and other strategies. CONCLUSIONS/IMPLICATIONS: We provide guidance on selecting a methodology based on specific research and dissemination goals within this area and discuss implications and recommendations for both rehabilitation psychology specifically and the field more broadly. Training programs, governing bodies, faculty, researchers, and other invested parties have shared accountability to deliver diverse, equitable, and inclusive education and training experiences, and conducting high-quality research on the experiences of multiply marginalized trainees, including those with disabilities, is a key component of that process. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supervising and supporting trainees with disabilities in the Veterans Administration Healthcare System: An overlooked but critical need and opportunity.

Trainees with disabilities are chronically underrepresented in psychology and face many barriers throughout their training. Directors of Clinical Training and supervisors within the Veterans Administration Healthcare System (VAHCS), one of the largest employers of trainees with disabilities, have a unique opportunity to address this area of critical need. However, they must first understand the barriers facing psychology trainees with disabilities in VAHCS settings, including discrimination in trainee selection, barriers to obtaining reasonable accommodations, and attitudinal and cultural barriers. In this article, we illustrate how those barriers may present in VAHCS settings specifically and provide suggestions and frameworks for how the VAHCS can create accessible, disability-affirmative training environments in which trainees can truly thrive. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Differences in suicide risk correlates and history of suicide ideation and attempts as a function of disability type.

BACKGROUND: Disability status is associated with correlates of suicide risk (perceived burdensomeness, thwarted belongingness, negative future disposition, felt stigma, suicidal ideation, and suicide attempts). AIMS: This study aimed to examine whether suicide-related correlates differ significantly as a function of disability type. METHODS: Individuals with mobility and vision disabilities (N = 102) completed semistructured interviews and online-based questionnaires. Analysis of variance/analysis of covaiance and Fisher's exact tests were conducted to examine whether mean levels of suicide-related correlates differed significantly between individuals with blindness/low vision (n = 63) versus mobility-related (n = 39) disabilities. RESULTS: No significant between-group differences were observed for most outcomes; however, individuals with vision disabilities reported higher mean levels of felt stigma and positive future disposition than those with mobility-related disabilities. LIMITATIONS: The limited representation of disabilities among participants precludes generalization to individuals with other forms of disability and the cross-sectional design prevents inference about causality. CONCLUSIONS: Interventions targeting cognitive processes that underlie suicide risk may be applicable to people with mobility and vision disabilities.

An empirical investigation of the distinction between passive and active ideation: Understanding the latent structure of suicidal thought content.

INTRODUCTION: Although the distinction between passive and active suicidal ideation is well accepted by suicide researchers and clinicians, there has been very little empirical investigation into this distinction. The current study addressed this gap by examining the latent structure of suicidal ideation based on thought content. METHOD: Participants from two distinct samples of U.S. adults (n1 = 6200; n2 = 10,625) completed a self-report assessment of eight commonly experienced suicidal thoughts using the Self-Injurious Thoughts and Behaviors Interview-Revised. Exploratory structural equation modeling was used to examine the latent structure of suicidal thoughts. RESULTS: The two-factor model demonstrated significantly better fit than the one-factor solution across both samples. Thoughts typically classified as passive ideation strongly loaded onto one factor, whereas thoughts typically classified as active ideation loaded onto the second factor. The two factors were highly correlated and some suicidal thoughts exhibited meaningful cross-loading. CONCLUSION: Our results suggest that passive and active ideation are two distinct constructs. Although they often co-occur, passive and active ideation are not nested constructs and should not be viewed as gradients of one underlying construct. Our findings suggest that at a minimum both passive and active ideation should be included in all suicide risk assessments and screenings.

Guidelines to Address Barriers in Clinical Training for Trainees with Sensory Disabilities.

Disability is an important facet of diversity. Although diversity in clinical training in health service psychology has improved considerably, training often neglects accessibility and inclusion for individuals with sensory disabilities. The limited research to date documents that trainees with sensory disabilities (TSD) report extensive barriers and are consistently under-represented in clinical settings. Further, few resources have been developed to guide accommodating TSD in clinical training. Accordingly, our goals in this article are two-fold: (1) to highlight the barriers in clinical training faced by TSD and (2) to provide recommendations for trainees, supervisors, clinical leadership, and directors of clinical training to improve accessibility and inclusion for TSD. We offer vignettes to illustrate barriers faced by TSD and suggest guidelines to improve access for TSD.

Impact of Treatment Setting and Format on Symptom Severity Following Cognitive Processing Therapy for Posttraumatic Stress Disorder.

Preliminary data suggest cognitive processing therapy (CPT) significantly reduces posttraumatic stress disorder (PTSD) symptom severity among military personnel and veterans when delivered over 12 days and combined with daily recreational activities (Bryan et al., 2018). The present study aimed to examine how therapy pace (i.e., daily vs. weekly sessions) and setting (i.e., clinic vs. recreational) impacts change in PTSD symptom severity. Forty-five military personnel and veterans diagnosed with PTSD chose to receive CPT (a) daily at a recreational facility with recreational programming, (b) daily on a university campus without recreational programming, and (c) weekly on a university campus without recreational programming. PTSD symptom severity was assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Reductions in CAPS-5 and PCL-5 scores were large and statistically significant across all three settings (Cohen's ds > 2.1). As compared to reductions in CAPS-5 and PCL-5 scores in daily therapy at a recreational facility (CAPS-5: d = 1.63-2.40; PCL-5: d = 1.99-2.17), reductions in CAPS-5 and PCL-5 scores were significantly larger in daily therapy on campus, CAPS-5: t(80) = -2.9, p = .005, d = 2.23-2.69; PCL-5: t(78) = 2.6, p = .010, d = 2.54-4.43, but not weekly therapy on campus, CAPS-5: t(80) = 0.2, p = .883, d = 1.04-2.47; PCL-5: t(78) = 1.0, p = .310, d = 1.77-3.44. Participants receiving daily therapy on campus and weekly therapy on campus also had higher rates of clinically significant improvement and good end-state functioning. Results support the effectiveness of CPT across multiple treatment settings and formats and suggest that daily CPT may be less effective when delivered in combination with recreational activities.

Assessment of Latent Subgroups With Suicidal Ideation and Suicidal Behavior Among Gun Owners and Non-Gun Owners in the US.

Importance: Firearm ownership is associated with increased risk for suicide. Objective: To examine patterns of associations among suicidal thoughts and behaviors among gun owners and non-gun owners in the US. Design, Setting, and Participants: In this survey study, cross-sectional online survey data were collected from March to April 2020 from US adults recruited via Qualtrics Panels. Quota sampling was used to approximate US census demographics. Main Outcomes and Measures: The primary outcomes were past-year passive suicidal ideation, active suicidal ideation, suicidal planning, suicidal behaviors, and nonsuicidal self-injury as measured by items from the Self-Injurious Thoughts and Behaviors Interview-Revised (SITBI-R). Simple latent class analysis (LCA) was used to assign participants to separate classes based on posterior probabilities, and multigroup LCA was used to assess whether the same construct was measured in specified groups. Results: Of 65 079 adults invited to participate, 10 625 (16.3%) completed the survey; 9153 responded "yes" or "no" to the firearm ownership item and were included in the analysis. Of these 9153 respondents (4695 [51.3%] male; mean [SD] age, 46.7 [16.8] years), 2773 (30.3%) reported owning a gun and 6380 (69.7%) reported not owning a gun. Compared with non-gun owners, gun owners were more likely to be male (1779 [64.2%] vs 2916 [45.7%]; χ21, 263.3; P < .001) and White (2090 [75.4%] vs 3945 [61.8%]; χ25, 232.9; P < .001) and to have served in the military (772 [27.8%] vs 609 [9.5%]; χ21, 571.4; P < .001). Five distinct patterns of SITBI-R item endorsement were extracted using simple LCA. Multigroup LCA indicated that the probability of SITBI-R item endorsement differed between gun owners and non-gun owners across subgroups. Among gun owners, the probability of past-month nonfatal suicide attempts was highest in class 4 (ranging from 16.8% for reaching out for help to 27.2% for starting, then changing one's mind). Gun owners in class 4 were characterized by high probabilities of endorsing thoughts about specific ways or methods to attempt suicide (100%) and preparatory behavior (100%). Among non-gun owners, the probability of nonfatal suicide attempts was highest in class 5 (ranging from 14.9% for reaching out for help to 29.7% for starting, then changing one's mind). Non-gun owners in class 5 were characterized by high probabilities of endorsing passive suicidal ideation (84.0%-100%), active suicidal ideation (86.7%-95.0%), and thoughts about specific ways or methods to attempt suicide (97.4%) and a specific place (92.1%) to attempt suicide. Conclusions and Relevance: In this study, in subgroups with lower probabilities of suicide attempt, gun owners and non-gun owners showed similar patterns of suicide risk item endorsement, but when the probability of a suicide attempt increased, gun owners were less likely than non-gun owners to endorse passive and active suicidal ideation. These findings suggest that assessing a broader range of suicide risk indicators may improve risk detection.

Assessing the clinical utility of MMPI-2-RF interpersonal theory of suicide proxy indices in psychiatric hospitalization setting.

INTRODUCTION: The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF Ben-Porath & Tellegen, 2008/2011) has been applied to suicide risk assessment through derived proxy indices of perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide (Anestis et al., 2018, Joiner, 2005). However, limited research has examined the clinical utility of these proxy indices outside the outpatient setting. This study examined the performance of these proxy indices in identifying past-month suicide ideation intensity and attempts upon admission to a psychiatric inpatient program and changes in suicidal ideation intensity at discharge. We expected these indices and their interaction would be associated with suicide ideation intensity and attempts at baseline and with a lack of significant improvement in suicide ideation intensity at discharge, including when controlling for MMPI-2-RF Suicide/Death Ideation (SUI) scale scores. METHOD: Participants were 1007 patients in a private inpatient psychiatric hospital in the southwestern United States, 968 of whom completed study measures at admission and discharge. Participants were administered the C-SSRS and MMPI-2-RF upon admission, while the C-SSRS was administered again prior to discharge. A series of moderation analyses were conducted to examine the main and interaction effects of the MMPI-2-RF derived proxy indices on suicidal ideation intensity and suicide attempts at admission. Logistic regression analyses were conducted to examine whether MMPI-2-RF proxy index scores at admission were associated with changes in suicidal ideation intensity at discharge. RESULTS: Neither the proxy indices nor their interaction was associated with all study outcomes. The acquired capability for suicide proxy index and its interaction with other indices were not associated with suicide attempt status at admission. However, high thwarted belongingness proxy index scores were associated with greater suicidal ideation intensity at admission; high perceived burdensomeness proxy index scores were indicative of a lack of significant change in suicide ideation intensity at discharge. CONCLUSION: These results indicate a need to further examine these proxy indices in high acuity samples.

Underreporting on the MMPI-2-RF extends to extra-test measures of suicide risk.

Detection of underreporting in suicide risk assessment remains a significant concern in clinical practice. The aim of this research is to examine whether underreporting based on elevated Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) K-r and L-r scale scores may aid in identifying patients with suppressed scores on the Suicide/Death Ideation scale (SUI) and extra-test measures of suicide risk. We anticipated that, in voluntarily admitted psychiatric inpatients (N = 1,011) and individuals receiving outpatient services in a university-affiliated psychology clinic (N = 521), those indicated as underreporting would produce lower mean scores across SUI and extra-test measures of suicide risk, and that the magnitudes of the associations between SUI and extra-test scores would be strongest for those underreporting. A series of t tests and correlational analyses were conducted in both samples. Although those classified as underreporting consistently produced lower mean scores for SUI and extra-test measures of suicide risk, the magnitudes of the associations were consistently significant and stronger only in outpatients without K-r or L-r scale elevations. Clinical implications for this research include examining K-r elevations when assessing suicide risk and incorporating a therapeutic assessment approach to suicide risk assessment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Marine Suicide Prevention and Intervention REsearch (M-SPIRE) study: A randomized clinical trial investigating potential treatment mechanisms for reducing suicidal behaviors among military personnel.

Suicides within the U.S. Armed Forces remain elevated. Brief cognitive behavioral therapy for suicide prevention (BCBT) has demonstrated preliminary efficacy as a psychotherapeutic intervention that reduces suicide attempts among U.S. Army Soldiers. The generalizability of BCBT's effects in other military groups and its underlying mechanisms of action remain unknown, however. The Marine Suicide Prevention and Intervention REsearch (M-SPIRE) study is designed to test the efficacy of BCBT for the prevention of suicide attempts among active duty U.S. Marines with recent suicidal ideation or attempts and to identify potential mechanisms of change contributing to BCBT's effects. In this protocol paper, we describe M-SPIRE's rationale and methods with a particular emphasis on measuring treatment fidelity and BCBT's hypothesized mechanisms of action.

Assessing the Clinical Utility of the MMPI-2-RF in Detecting Suicidal Ideation in a High Acuity, Partially-Hospitalized Veteran Sample.

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) has demonstrated utility in suicide risk assessment. Limited research with the MMPI-2-RF in higher acuity populations exists, particularly regarding the impact of possible underreporting on prediction of suicide risk. The current study serves to extend previous findings of the utility of clinically indicated MMPI-2-RF scales and proxy indices in 293 veterans (83.62% White, 85.32% male, and 74.40% with past-week suicide ideation) enrolled in a Veterans Affairs Medical Center partial psychiatric hospitalization program. Differences in self-report indicators and MMPI-2-RF scales and proxy indices relevant in assessing suicide ideation between veterans indicated as possibly underreporting and those who were not and the ability of the scales and proxy indices to predict current suicide ideation were examined. These indicators, scales, and proxy indices, with the exception of SUI, were significantly impacted by underreporting, and none of the examined scales or proxy indices (or their interaction) were consistently associated with self-reported suicide ideation after accounting for SUI. However, SUI was consistently associated with suicide ideation and was less influenced by under-reporting. In acutely ill psychiatric patients, SUI may be the most robust indicator of current suicide ideation.

Examining the role of stigma and disability-related factors in suicide risk through the lens of the Interpersonal Theory of Suicide.

Research has largely not identified processes contributing to the relationship between physical disability and suicide risk. This cross-sectional research is aimed at examining the associations among felt stigma, perceived burdensomeness, disability severity, and perceptions about future suicidal ideation and attempts. Adults (N = 127) with physical disabilities recruited through online and printed advertisements completed self-report measures and semi-structured interviews. We anticipated that felt stigma would be associated with individuals' perceived likelihood of future suicidal ideation and attempts indirectly through perceived burdensomeness, and that these relationships would be moderated by the impact of disability on three important life domains. Results from a series of moderated mediation analyses partially supported study hypotheses and indicated indirect relationships of stigma to suicide-related perceptions. However, disability severity in the three examined domains did not moderate these indirect relationships. Felt stigma and perceived burdensomeness may contribute to self-perceptions of suicide risk among individuals with physical disabilities.

Fearlessness about death does not differ by suicide attempt method.

Modern theories of suicide, such as the Interpersonal Theory of Suicide, have overcome past conceptual limitations within suicide research by examining factors that help differentiate suicide attempters from those who experience suicidal ideation, but never attempt suicide. One such factor that has been studied extensively is fearlessness about death. Given the varying levels of lethality for different methods used in suicide attempts, an important question is if different levels of fearlessness about death are needed for specific methods. The central aim of this study was to test whether various methods for suicide are associated with different levels of fearlessness about death in a large sample of suicide attempt survivors. Participants were 620 suicide attempt survivors from active military, veteran, and civilian populations. Suicide attempt status was confirmed by two independent raters coding qualitative accounts and participants indicating at least one past attempt with intent to die on other survey items. Results indicated that fearlessness about death does not differ by attempt method and that nearly all methods are statistically equivalent to one another. Despite several methods requiring significantly more time facing mortal fear and severe physical anguish (e.g., cutting, hanging/asphyxiation), as well as certain means being much more lethal (e.g., firearm), differences in ability to enact a suicide attempt with a particular method was not associated with fearlessness about death. This may further indicate the importance of clinicians focusing on practical capability aspects (e.g., means safety, access, comfort with method) with patients at an increased risk for suicide.

Prospective Validity of the Suicide Cognitions Scale Among Acutely Suicidal Military Personnel Seeking Unscheduled Psychiatric Intervention.

Background and Aim: The Suicide Cognitions Scale (SCS) was developed to assess a broad range of suicide-related cognitions. Research to date supports the scale's factor structure, internal consistency, and construct validity. The present study tested the scale's prospective validity for suicide attempts among 97 military personnel presenting to an emergency department or psychiatric outpatient clinic for an unscheduled walk-in evaluation. Method: Cox regression and receiver operator characteristic analyses were conducted to test the prospective validity of the SCS. Results: Results supported the prospective validity of the SCS (area under the curve [AUC] = 0.69) and indicate the scale's performance is comparable to an empirically supported measure of suicide ideation (AUC = 0.75). The SCS performance was not reduced by removing items containing the word suicide. Limitations: Homogeneous sample comprised of US soldiers, predominantly male, with recent suicidal ideation. Conclusion: Results support the SCS as an indicator of subsequent risk for suicidal behavior when used in acute care settings, and suggest the scale's performance is similar to more traditional suicide risk screening methods that depend on honest self-disclosure of suicidal thoughts.