Three-year follow-up of suicide prevention-focused group therapy for veterans.

The purpose of this study was to determine the long-term effects of a suicide prevention-focused group therapy for veterans recently discharged from an inpatient psychiatry setting following a suicidal crisis. There was interest in examining the impact of mechanisms of change identified in previous research on the group, including group cohesion, working alliance, and group sessions attended. Data were abstracted from the electronic medical record 3 years following completion of a previous study that involved the group therapy. A series of generalized linear and logistic mixed models were conducted to measure the associations between group cohesion, working alliance, session attendance, and health service utilization and suicide attempts. Thirty randomly selected veterans from the original sample completed a semistructured interview to discuss their experience in the group therapy. Study team members reviewed each transcription to identify themes related to veterans' experiences in the suicide prevention-focused group therapy. No suicides were observed in the 3-year follow-up period. When examining the full sample (N = 134), session attendance and inpatient hospitalization were not significantly associated but were positively associated after removing subjects who attended zero sessions (N = 93). Higher group cohesion was associated with a reduced likelihood of inpatient psychiatric hospitalization and greater engagement in outpatient mental health services. Four themes emerged regarding veterans' experience in the group through an analysis of the semistructured interviews. Suicide prevention-focused group therapy among veteran service members was not associated with an elevated risk of mortality. Future research is needed to further elucidate mechanisms of change and moderators of response. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Improving Medical Student Attitudes Toward Suicide Prevention Through a Patient Safety Planning Clerkship Initiative.

OBJECTIVE: This project aimed to understand medical students' attitudes toward suicide prevention and their experiences in an innovative clerkship training program that engaged students in patient safety planning. METHODS: Medical students were invited to complete the Attitudes to Suicide Prevention (ASP) scale to explore student perceptions of suicide prevention and risk assessment. Seventy-five psychiatry clerkship students also completed a new safety planning training program with at-risk patients on psychiatry inpatient units. Each student observed a patient safety plan being completed, discussed this process with the resident or attending, completed a safety plan with another patient, and then debriefed with the observing physician. Participants completed the ASP before and after the rotation. RESULTS: The cross-sectional data (n=490) showed that student perceptions of suicide prevention were generally positive (M=27.8, SD=6.1) with variation among classes, but many students did not fully recognize the potential effectiveness of suicide risk reduction strategies. After the clerkship intervention, students were significantly more likely to report that working with suicidal patients was rewarding (p=0.035) and less likely to report discomfort assessing patients for suicide risk (p=0.001). CONCLUSIONS: Medical educators can reinforce the process and efficacy of suicide interventions by modeling the described initiative. Psychiatry clerkship training that intentionally engages students in safety planning with patients is generalizable, and these skills could be extended to the student burnout crisis. Longitudinal studies will help determine how individual perceptions change through medical school and whether students apply safety planning skills in psychiatry and other specialties to care for suicidal patients.

Measuring the impact of suicide attempt posttraumatic stress.

OBJECTIVE: To examine the associations between posttraumatic stress symptoms (PTS) following a medically serious suicide attempt with suicidal ideation, related interpersonal constructs, and outpatient mental health service utilization. METHODS: The study utilized an existing data set from a clinical trial consisting of 66 patients recruited at a level 1 trauma center following medical admission for a suicide attempt. Measures of suicide attempt-related PTS (SA-PTS), suicidal ideation, perceived burdensomeness, thwarted belongingness, and outpatient medical and mental health utilization were completed at 1 and 3 months. A series of mixed-effects regression models were used to analyze the data. RESULTS: Greater SA-PTS at 1 month was associated with significantly greater suicidal ideation, thwarted belongingness, and perceived burdensomeness across 1 and 3 months. CONCLUSIONS: Addressing PTS following a medically serious suicide attempt may aid in addressing suicide-specific constructs and improve the recovery trajectory following hospitalization.

Social Support Mediates the Association between Disclosure of Suicide Attempt and Depression, Perceived Burdensomeness, and Thwarted Belongingness.

OBJECTIVE: Prior research has found disclosure of concealable stigmatized statuses, including suicide attempt survivorship, to be associated with positive mental health outcomes. This study sought to test the mediating effect of self-reported social support on the association between disclosure of suicide attempt and suicide risk factors in a sample of undergraduate college students. METHOD: Data were analyzed from 149 undergraduate college students with a history of one or more suicide attempts. Three parallel mediation analyses tested the simultaneous mediating effect of family social support and peer social support on the association between suicide attempt disclosure and suicide risk factors. RESULTS: Significant total indirect effects in all models indicated family social support and peer social support simultaneously mediated the association between disclosure of suicide attempt and depression, perceived burdensomeness, and thwarted belongingness. The indirect effect on thwarted belongingness via peer social support was stronger than the indirect effect via family social support. CONCLUSIONS: Disclosure of suicide attempt was associated with higher social support, which was associated with lower suicide risk factors. In a therapeutic context, it is important to consider social support when discussing disclosure of suicide attempt.

Pilot randomized clinical trial of the Teachable Moment Brief Intervention for hospitalized suicide attempt survivors.

OBJECTIVE: The aim of this study was to further evaluate the acceptability and feasibility of the Teachable Moment Brief Intervention (TMBI). METHOD: A single blind, pilot randomized controlled trial of the TMBI + care as usual (CAU) compared to CAU was conducted for patients who survived a recent suicide attempt that required medical inpatient hospitalization. The intervention was delivered on medical/surgical and inpatient psychiatry units in the medical center. Interviews were completed at baseline, 1, 3, and 12 months. RESULTS: Patients reported high ratings of satisfaction with the TMBI. Interventionists representing fields of Psychiatry, Social Work, and Counseling were able to deliver the intervention with fidelity to the treatment manual with equal adherence ratings. The TMBI patients were more likely to maintain a positive recovery trajectory on motivation and engagement in mental health services at 3 months. CONCLUSION: The TMBI provides an option for targeted intervention to health care providers as they engage patients admitted to an acute medical setting after a serious suicide attempt. This is the second pilot study demonstrating enhanced motivation in the post-hospitalization period.

Validating the Suicide Status Form for the Collaborative Assessment and Management of Suicidality in a Psychiatric Adolescent Sample.

BACKGROUND: For adults, the Collaborative Assessment and Management of Suicidality (CAMS; Jobes, (2006, Managing suicidal risk: A collaborative approach, New York, Guilford) and Jobes, (2016, Managing suicidal risk: A collaborative approach, New York, Guilford)) is a treatment framework with replicated evidenced-based support for effectiveness. The current study is a psychometric validation of the Suicide Status Form (SSF-IV), the main assessment and treatment planning tool for CAMS, in an adolescent psychiatric sample. METHODS: Data were collected from 100 adolescents, aged 12-17, in inpatient settings (mean age = 14.6; 67.5% female, 80% white). Adolescents were administered Part A of the SSF-IV, as well as measures of overall suicide risk (both explicit and implicit), mental pain, Stress, Agitation, reasons for living, and self-esteem. RESULTS: Confirmatory factor analysis found a two-factor model to fit the data best, with Psychological Pain, Stress, and Agitation loading on one factor, and Hopelessness and Self-Hate on another. All of the core SSF constructs except Stress were significantly correlated with concurrent measures, and SSF overall suicide risk was significantly correlated with self-reported and implicit suicidality. Adolescents with suicide attempt history reported significantly higher scores on most core SSF items compared to no attempt history. CONCLUSIONS: These results provide initial psychometric validation of the SSF for use with adolescents and indicate that it does not need to be adapted or modified for this age group.

Evaluation of Structured Assessment and Mediating Factors of Suicide-Focused Group Therapy for Veterans Recently Discharged from Inpatient Psychiatry.

The current study investigated the impact of adding the Suicide Status Form (SSF) to a suicide-focused group therapy for veterans recently discharged from an inpatient psychiatry setting. A sample of 141 veterans was enrolled and randomized into a Usual Assessment Group Therapy or SSF-Assessment Group Therapy. Participants completed interviews at baseline, 1, and 3 months. No significant differences were observed between groups regarding group attendance (IRR = 1.01, Std. Err = 0.08, 95% CI = 0.87, 1.18) or client satisfaction (ß = 0.23, Std. Err = 0.66, p = 0.73, d = -.25). No main effects were observed across the study on secondary outcomes of interest for suicidal ideation and overall symptom distress, although participants in both treatment conditions reported significant improvements on these outcomes over the course of the study. Patients in the Usual Assessment Group Therapy demonstrated greater reductions in overall symptom distress across the 3-month follow-up window (ß = 6.08, Std. Err = 2.04, p = 0.003; f2 = 0.05). Follow-up path analyses revealed that more frequent session attendance was significantly related to less suicidal ideation at 1-month, higher working alliance between individual members and group facilitators was associated with greater suicidal ideation at 1-month, and higher group cohesion among group members at 1-month was significantly associated with less thwarted belongingness at 1-month. Although the SSF did not improve the impact of an existing suicide-focused group therapy, the study findings support future research on group treatments for suicidal veterans.

Patterns of opioid use during initial buprenorphine/naloxone treatment in relation to changes in opioid management laws in Kentucky.

BACKGROUND AND OBJECTIVES: There is limited information on the most commonly used opioid reported at the time of presentation for treatment with buprenorphine/naloxone and the extent to which state policy may impact type of opioid use reported. METHODS: Retrospective study, total N = of 595 from four different medical locations from January 1, 2009 to July 1, 2016 that provided buprenorphine/naloxone treatment in Louisville, Kentucky. Study aims included identifying the most commonly used opioid at the time of treatment before and after the creation of a state-wide opioid prescribing surveillance system (ie, the 2012 House Bill 1 [HB1]), and determine the extent to which clinical setting, sex, age, and insurance type impacted type of opioid reported during the intake appointment. RESULTS: Non-heroin opioid use decreased in the academic and private practice settings following passage of HB1, while heroin use increased in all three settings. After controlling for clinical setting and demographic characteristics, there was a significant increase in patients who reported using heroin (vs. non-heroin opioid) (RR = 25.00, p ≤ .001, CI = 12.08-51.73) and a significant increase in patients who reported using opioid agonists (vs. non-heroin opioid) (RR = 6.56, p ≤ .001, CI = 4.10-10.50) following enactment of HB1. DISCUSSION AND CONCLUSIONS: After the passage of HB1, there was a significant increase in patients reporting heroin use and opioid agonists compared to non-heroin opioids when presenting for treatment. SIGNIFICANT SIGNIFICANCE: There has been a notable shift in the opioid epidemic, which is evident in the outpatient treatment settings. (Am J Addict 2018;27:560-566).

Denial of Suicide Attempt Among Hospitalized Survivors of a Self-Inflicted Gunshot Wound.

OBJECTIVE: Evidence suggests that suicide attempts by self-inflicted gunshot wound (GSW) are underreported and may in turn affect disposition following hospitalization. This study aimed to evaluate the clinical characteristics and use of services among individuals who do not disclose suicidal intent following a self-inflicted GSW. METHODS: Electronic medical record data from 128 survivors of self-inflicted GSWs at a level 1 trauma center were analyzed to identify factors associated with nondisclosure of a suicide attempt to medical staff. RESULTS: Results indicated that 29% of patients denied that a self-inflicted GSW was a suicide attempt, and 43% of patients who denied suicidal intent were identified by the psychiatric consultation and liaison service as presenting under circumstances suspicious of a suicide attempt. Logistic regression analyses indicated that patients who denied having attempted suicide were 10.86 times more likely to be discharged to home than patients who disclosed suicidal intent. In a multiple regression model, no clinical or demographic characteristics were significantly associated with nondisclosure of suicide intent. CONCLUSIONS: Patients' nondisclosure of suicidal intent following a self-inflicted GSW may present a barrier to care for patients whose injuries are the result of a suicide attempt. Implications for reducing barriers to care for a high-risk population are discussed, including the impact of nondisclosure on future treatment and the potential utility of brief interventions for suicide risk reduction.

Implementation of Rocking Chair Therapy for Veterans in Residential Substance Use Disorder Treatment [Formula: see text].

BACKGROUND: Substance use disorder (SUD) and mental health diagnosis negatively affect Veteran homelessness. OBJECTIVE: Assess the acceptance and feasibility of rocking chair therapy as a self-implemented intervention for mood and substance cravings. PICOT: For homeless Veterans in SUD treatment, how does adding vestibular stimulation by use of a rocking chair compared with treatment as usual affect levels of anxiety and substance cravings? RESULTS: Two significant findings were observed. First, a greater number of minutes spent rocking was associated with significantly greater scores on the Expectancy scale of the Alcohol Craving Questionnaire (ACQ; p = .05), suggesting participants experiencing higher urges and desires to drink rocked to self-soothe. Second, a significant association was observed between a greater number of minutes spent rocking and lower scores on the ACQ Purposefulness subscale ( p = .03), indicating greater time rocking was associated with fewer urges and desires that are connected with the intent and plan to drink. CONCLUSION: Vestibular stimulation by rocking in a rocking chair may increase the ability to self-regulate mood and substance cravings, thereby potentially reducing risk of relapse and recurrent chronic homelessness.

Measuring a conceptual model of the relationship between compulsive cell phone use, in-vehicle cell phone use, and motor vehicle crash.

OBJECTIVES: Previous research suggests that anticipation of incoming phone calls or messages and impulsivity are significantly associated with motor vehicle crash. We took a more explanative approach to investigate a conceptual model regarding the direct and indirect effect of compulsive cell phone use and impulsive personality traits on crash risk. METHODS: We recruited a sample of 307 undergraduate college students to complete an online survey that included measures of cell phone use, impulsivity, and history of motor vehicle crash. Using a structural equation model, we examined the direct and indirect relationships between factors of the Cell Phone Overuse Scale-II (CPOS-II), impulsivity, in-vehicle phone use, and severity and frequency of previous motor vehicle crash. Self-reported miles driven per week and year in college were included as covariates in the model. RESULTS: Our findings suggest that anticipation of incoming communication has a direct association with greater in-vehicle phone use, but was not directly or indirectly associated with increasing risk of previous motor vehicle crash. Of the three latent factors comprising the CPOS-II, only anticipation was significantly associated with elevated cell phone use while driving. Greater impulsivity and use of in-vehicle cell phone use while driving were directly and significantly associated with greater risk of motor vehicle crash. CONCLUSIONS: Anticipation of incoming cellular contacts (calls or texts) is associated with greater in-vehicle phone use, while greater in-vehicle cell phone use and impulsive traits are associated with elevated risk of motor vehicle crashes.

Examining the Impact of Suicide Attempt Function and Perceived Effectiveness in Predicting Reattempt for Emergency Medicine Patients.

While previous studies have examined motivational aspects of self-directed violence, few studies have included specific motivations in predictive models for future suicide attempts. The current study utilized a sample of 160 individuals treated in an acute emergency setting following a suicide attempt who completed an interview battery that included an assessment of functional aspects of the index suicide attempt. A follow-up interview was conducted at 6 months to ascertain subsequent suicide attempts. The functional domains of suicide attempts were labeled as reduction-of-distress, communication, perceived better alternative to living, and self-loathing. Above and beyond other known risk factors, including history and highest lethality of previous self-injury, suicide attempts that served a communication function (OR = 0.18, p = .02, CI = 0.04, 0.73) and higher ratings of clinical dysfunction (OR = 3.41, p = .05, CI = 1.02, 11.36) were associated with a significant reduction in likelihood to engage in a suicide attempt during the 6-month follow-up window. Including the perceived effectiveness of the index suicide attempt in getting one's needs met strengthened the overall model predicting a suicide attempt in the follow-up window and was an independent risk factor above and beyond other variables in the model OR = 1.75, p = .04, CI = 1.02, 3.01). Assessment of functional aspects of suicide attempt is feasible and may improve formulation of risk in a population where typical risk factors for suicide are ubiquitous.

Relative Impact of Risk Factors, Thwarted Belongingness, and Perceived Burdensomeness on Suicidal Ideation in Veteran Service Members.

OBJECTIVE: We tested the associations between individualized risk factors, empirically validated constructs specific to suicide risk (i.e., thwarted belongingness and perceived burdensomeness, and two methods for conceptualizing suicidal ideation based on Suicide Index Score (SIS) and overall severity score of the Beck Scale for Suicide Ideation [BSS]). METHOD: The current study included a sample of 134 suicidal Veterans who were recruited from an inpatient psychiatry unit of a Veterans Affairs Medical Center. Participants completed the BSS, Interpersonal Needs Questionnaire, Outcome Questionnaire-45.2, Alcohol Use Disorder Identification Test, Drug Abuse Screening Test, and abbreviated versions of the Posttraumatic Stress Disorder Checklist-Military version (PCL-M) and Insomnia Severity Index. We used ordinary least squares regression with bootstrapping to conduct analyses due to the skewed distributions observed in the suicidal ideation outcomes. RESULTS: Thwarted belongingness was the only statistically significant correlate of the SIS, indicating a stronger desire to be dead than alive as Veterans perceived themselves as being increasingly disconnected and isolated from others (B = 0.36, standard error [SE] = 0.01, p = 0.005). In contrast, greater overall severity scores on the BSS were associated with higher ratings on the PCL-M (B = 0.21, SE = 0.07, p = 0.02) and for thwarted belongingness (B = 0.27, SE = 0.09, p = 0.04). Problematic alcohol use was significantly associated with lower overall severity scores (B = -.27, SE = 1.17, p < 0.001). CONCLUSION: Findings may inform clinical strategies for conceptualizing and targeting factors associated with suicidal risk.

Time to Remission for Depression with Collaborative Care Management (CCM) in Primary Care.

BACKGROUND: Collaborative care management (CCM) has been shown to have superior outcomes to usual care (UC) for depressed patients with a fixed end point. This study was a survival analysis over time comparing CCM with UC using remission (9-item Patient Health Questionnaire [PHQ-9] score <5) and persistent depressive symptoms (PDSs; PHQ-9 score ≥10) as end points. METHODS: A retrospective cohort study of 7340 patients with depression cared for at 4 outpatient primary care clinics was conducted from March 2008 through June 2013. All adult patients diagnosed with depression (International Classification of Diseases, 9th Revision [ICD-9], codes 296.2-3) or dysthymia (ICD-9 code 300.4) with an initial PHQ-9 score ≥10 were included. CCM was implemented at all clinics between 2008 and 2010. Kaplan-Meyer survival curves for time to remission and PDSs were plotted. A Cox proportional hazards model was used to adjust for expected differences between patients choosing CCM versus UC. RESULTS: Median time to remission was 86 days (95% confidence interval [CI], 81-91 days) for the CCM group versus 614 days (95% CI, 565-692 days) for the UC group. Likewise, median duration of PDSs was 31 days (95% CI, 30-33 days) for the CCM group versus 154 days (95% CI, 138-182 days) for the UC group. In the Cox proportional hazards model, which controlled for covariates such as age, sex, race, diagnosis, and initial PHQ-9 score, CCM was associated with faster remission (hazard ratio of the CCM group [HRCCM], 2.48; 95% CI, 2.31-2.65). CONCLUSIONS: This study demonstrated that patients enrolled in CCM have a faster rate of remission and a shorter duration of PDSs than patients choosing UC.

Technology-Enhanced Stepped Collaborative Care Targeting Posttraumatic Stress Disorder and Comorbidity After Injury: A Randomized Controlled Trial.

Posttraumatic stress disorder (PTSD) and its comorbidities are endemic among injured trauma survivors. Previous collaborative care trials targeting PTSD after injury have been effective, but they have required intensive clinical resources. The present pragmatic clinical trial randomized acutely injured trauma survivors who screened positive on an automated electronic medical record PTSD assessment to collaborative care intervention (n = 60) and usual care control (n = 61) conditions. The stepped measurement-based intervention included care management, psychopharmacology, and psychotherapy elements. Embedded within the intervention were a series of information technology (IT) components. PTSD symptoms were assessed with the PTSD Checklist at baseline prerandomization and again, 1-, 3-, and 6-months postinjury. IT utilization was also assessed. The technology-assisted intervention required a median of 2.25 hours (interquartile range = 1.57 hours) per patient. The intervention was associated with modest symptom reductions, but beyond the margin of statistical significance in the unadjusted model: F(2, 204) = 2.95, p = .055. The covariate adjusted regression was significant: F(2, 204) = 3.06, p = .049. The PTSD intervention effect was greatest at the 3-month (Cohen's effect size d = 0.35, F(1, 204) = 4.11, p = .044) and 6-month (d = 0.38, F(1, 204) = 4.10, p = .044) time points. IT-enhanced collaborative care was associated with modest PTSD symptom reductions and reduced delivery times; the intervention model could potentially facilitate efficient PTSD treatment after injury.

The development and implementation of a brief intervention for medically admitted suicide attempt survivors.

OBJECTIVE: The current study endeavored to establish the feasibility and acceptability of a brief intervention for medically admitted suicide attempt survivors. METHOD: Fifty patients admitted to a Level 1 trauma center were recruited following a suicide attempt. The first 10 patients provided information on what constituted usual care, which in turn informed the creation of the intervention manual and research design. The next 10 patients informed refinement of the intervention and research procedures. The final 30 patients were randomized in a pre-post research design to receive the teachable moment brief intervention plus usual care or usual care only. Patients were assessed prior to randomization and 1 month later by blinded research assistants. Outcomes included patient satisfaction, readiness to change problematic behaviors, reasons for living, and suicidal ideation. RESULTS: Patients rated the brief intervention as "good" to "great" on all items related to client satisfaction. Significant group × time interactions were observed for readiness to change (ß=9.02, S.D.=3.73, P=.02) and reasons for living (ß=29.60, S.D.=10.22, P=.004), suggesting greater improvement for those patients who received the brief intervention. CONCLUSIONS: Patients admitted to an acute inpatient medical setting may benefit from a brief intervention that complements usual care by focusing specifically on the functional aspects of the suicide attempt in a collaborative, patient-centered manner.

Suicide Attempt Characteristics Among Veterans and Active-Duty Service Members Receiving Mental Health Services: A Pooled Data Analysis.

Past suicidal behaviors are among the strongest and most consistent predictors of eventual suicide and may be particularly salient in military suicide. The current study compared characteristics of suicide attempts in veterans (N = 746) and active-duty service members (N = 1,013) receiving treatment for acute suicide risk. Baseline data from six randomized controlled trials were pooled and analyzed using robust regression. Service members had greater odds of having attempted suicide relative to veterans, though there were no differences in number of attempts made. Service members also had higher rates of premilitary suicide attempts and nonsuicidal self-injury (NSSI). Veterans disproportionately attempted suicide by means of overdose. In veterans, combat deployment was associated with lower odds of lifetime suicide attempt, while history of NSSI was associated with greater attempt odds. Neither was significantly associated with lifetime suicide attempt in service members. Implications for suicide assessment and treatment are discussed.

Correlates of suicidal ideation in physically injured trauma survivors.

Epidemiologic studies have documented that injury survivors are at increased risk for suicide. We evaluated 206 trauma survivors to examine demographic, clinical, and injury characteristics associated with suicidal ideation during hospitalization and across 1 year. Results indicate that mental health functioning, depression symptoms, and history of mental health services were associated with suicidal ideation in the hospital; being a parent was a protective factor. Pre-injury posttraumatic stress disorder symptoms, assaultive injury mechanism, injury-related legal proceedings, and physical pain were significantly associated with suicidal ideation across 1 year. Readily identifiable risk factors early after traumatic injury may inform hospital-based screening and intervention procedures.

Compulsive cell phone use and history of motor vehicle crash.

PURPOSE: Few studies have examined the psychological factors underlying the association between cell phone use and motor vehicle crash. We sought to examine the factor structure and convergent validity of a measure of problematic cell phone use, and to explore whether compulsive cell phone use is associated with a history of motor vehicle crash. METHODS: We recruited a sample of 383 undergraduate college students to complete an online assessment that included cell phone use and driving history. We explored the dimensionality of the Cell Phone Overuse Scale (CPOS) using factor analytic methods. Ordinary least-squares regression models were used to examine associations between identified subscales and measures of impulsivity, alcohol use, and anxious relationship style, to establish convergent validity. We used negative binomial regression models to investigate associations between the CPOS and motor vehicle crash incidence. RESULTS: We found the CPOS to be composed of four subscales: anticipation, activity interfering, emotional reaction, and problem recognition. Each displayed significant associations with aspects of impulsivity, problematic alcohol use, and anxious relationship style characteristics. Only the anticipation subscale demonstrated statistically significant associations with reported motor vehicle crash incidence, controlling for clinical and demographic characteristics (relative ratio, 1.13; confidence interval, 1.01-1.26). For each 1-point increase on the 6-point anticipation subscale, risk for previous motor vehicle crash increased by 13%. CONCLUSIONS: Crash risk is strongly associated with heightened anticipation about incoming phone calls or messages. The mean score on the CPOS is associated with increased risk of motor vehicle crash but does not reach statistical significance.