Authors: Rebecca Kauten, Jessica M. LaCroix, Amber Fox, & Marjan Ghahramanlou-Holloway
Abstract:... more Authors: Rebecca Kauten, Jessica M. LaCroix, Amber Fox, & Marjan Ghahramanlou-Holloway
Abstract: Loneliness has been conceptualized both as an objective state of physical alienation and a subjective state of distress due to feeling alone. The construct of loneliness has been empirically linked with a variety of mental health conditions including depression, hopelessness, suicide ideation, and/or suicide-related behaviors. This chapter examines loneliness and suicide through Aaron Beck’s cognitive behavioral theory and largely through Erik Erickson’s theory of psychosocial development. More specifically, we review how ambivalence resulting from competing drives of connectedness, authenticity, and self-protection may contribute to loneliness and explore manifestations of loneliness and suicidality during childhood, adolescence, young adulthood, middle adulthood, and older adulthood. Intervention strategies to address loneliness in the context of suicide are explored, and recommendations for clinical practice and future areas of empirical inquiry are presented.
AUTHORS: Marjan Ghahramanlou-Holloway, Kari Koss, Anderson Rowan, Jessica M. LaCroix, Kanchana Pe... more AUTHORS: Marjan Ghahramanlou-Holloway, Kari Koss, Anderson Rowan, Jessica M. LaCroix, Kanchana Perera, Jaime Carreno, & Joseph Grammer
ABSTRACT: United States (U.S.) Armed Forces personnel express concerns about the stigma of seeking mental health treatment and the potential impact of treatment seeking on their military careers. To date, there is a lack of empirical data on the association between mental health treatment utilization and military career-related outcomes. This study examined short- and long-term military career outcomes among U.S. Air Force (USAF) personnel who obtained outpatient mental health care. Phase 1 involved a retrospective chart review (N = 370) across nine USAF mental health outpatient clinics. Phase 2 involved a prospective case control comparison of the career-trajectories of USAF personnel who sought mental health treatment (n = 332) versus those who did not (n = 1147) after matching for military rank, time in grade, and occupational code. Nearly a third of service members seeking mental health care experienced some type of career-impacting recommendation. Higher military rank, superior-encouraged referral, greater distress measured at intake by the Outcome Questionnaire-45, and prior inpatient psychiatric care significantly predicted such recommendations. Mental health treatment seekers were three times more likely to experience a medical board evaluation and nearly twice as likely to receive a military discharge. Commander-directed service members were more likely to receive career-affecting recommendations than those who self-referred to treatment or who were encouraged by superiors. Proactive, early self-referral for mental health treatment is one strategy for sustaining a military career. Department of Defense stigma reduction campaigns should provide empirically derived information about the potential impact of mental health treatment on military careers.
Objectives: Military psychiatric inpatients with and without a lifetime history of nonsuicidal se... more Objectives: Military psychiatric inpatients with and without a lifetime history of nonsuicidal self-injury (NSSI), combined with a history of at least one suicide attempt, were compared on suicide ideation severity, number of suicide attempts, and Interpersonal-Psychological Theory of Suicide variables. Methods: Data was derived from baseline assessments performed in a psychotherapy randomized controlled trial. Lifetime history of NSSI and lifetime number of suicide attempts were assessed using the Columbia Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011). Results: Individuals with versus without a combined lifetime history of attempted suicide and NSSI showed significant elevations on thwarted belongingness and acquired capability for suicide. No significant between-group differences were found on perceived burdensomeness, frequency, duration, and controllability of suicide ideation, or number of lifetime suicide attempts. Conclusion: A history of NSSI, above and beyond attempted suicide, appears to increase service members’ social alienation and acquired capability for suicide.
Authors: Victoria A. Colborn, Jessica M. LaCroix, Laura L. Neely, Jennifer Tucker, Kanchana Perer... more Authors: Victoria A. Colborn, Jessica M. LaCroix, Laura L. Neely, Jennifer Tucker, Kanchana Perera, Samantha E. Daruwala, Geoffrey Grammer, Jennifer Weaver, Marjan Ghahramanlou-Holloway
Abstract: A history of multiple suicide attempts conveys greater risk for suicide than a single attempt. Impulsivity may partially explain the association between multiple attempts and increased risk. We examined trait impulsivity, ability to engage in goal-directed behaviors, and impulse control among psychiatrically hospitalized United States military personnel and their dependents. Individuals with a history of multiple versus single attempts had significantly higher motor impulsivity, indicating spur of the moment action. Providers are encouraged to directly assess and treat motor impulsivity among suicidal individuals. Further research should explore whether motor impulsivity is a mechanism of change in psychosocial suicide prevention interventions.
Authors: Kristen M. Ruscio, Ph.D., Victoria A. Colborn, B.S., Christina L. Yang, B.S., Kari R. Ko... more Authors: Kristen M. Ruscio, Ph.D., Victoria A. Colborn, B.S., Christina L. Yang, B.S., Kari R. Koss, M.A., Laura L. Neely, Psy.D., Jamie T. Carreno, Ph.D., Jessica M. LaCroix, Ph.D., and Marjan Ghahramanlou-Holloway, Ph.D
Expressed emotion (EE) refers to the criticism, hostility, and emotional over-involvement family members may display toward an individual diagnosed with a psychiatric disorder. Recent research has explored EE in relation to suicide risk, yet the association between EE and recurrence of suicidal behaviors remains understudied. The present paper provides an illustrative review of the links between EE, psychiatric symptom recurrence, and suicide risk, proposes a new conceptual framework – the Expressed Emotion-Suicidal Behavior Recurrence model (EE-SBR), and provides recommendations for future research and clinical practice within the fields of suicidology and family psychology. Researchers and clinicians are encouraged to consider the role of the family and EE as they relate to relapse prevention efforts.
Authors: Kristen Kochanski-Ruscio, Ph.D., M. Elicia Nademin, Ph.D., Kanchana Perera, MSc., Jessic... more Authors: Kristen Kochanski-Ruscio, Ph.D., M. Elicia Nademin, Ph.D., Kanchana Perera, MSc., Jessica M. LaCroix, Ph.D., Margaret Baer, B.A., Helena O. Hassen, B.A., Maj David Englert, Ph.D., and Marjan Ghahramanlou-Holloway, Ph.D. Objectives: We compared United States military decedents who died by suicide on their first attempt with decedents who had made multiple attempts. Methods: Death investigation files for 217 United States Air Force (USAF) personnel who died by suicide between 1996 and 2006 were coded for demographic, psychosocial, and psychiatric characteristics. Results: Among USAF suicide decedents, 77% died by suicide on their first attempt and 23% had a documented history of at least one prior attempt, Decedents with a history of prior attempts were more likely to have an interpersonal stressor within 3 months of death and were twice as likely to have a documented Axis I diagnosis. Conclusions: There were few differences between military suicide decedents based on history of prior attempts. Further research is needed to inform military suicide prevention endeavors.
Although recent social psychological objectification research has focused on men sexually objecti... more Although recent social psychological objectification research has focused on men sexually objectifying women, there are numerous other domains and methods by which people treat others as objects. This paper incorporates Nussbaum’s (1995) delineation of seven ways to objectify a person with Holland and Haslam’s (2013) conceptualization of objectification as 1) treating another person as a thing, and 2) denying the other’s personhood. Four of the methods of objectification that Nussbaum (1995) describes—instrumentalization, fungibility, violability, and ownership—amount to treating another person as a thing, whereas the other three—denial of autonomy, of agency, and of subjective experience—are means of denying personhood. We review social psychological research that pertains to each of these seven means of objectification and show that objectification is distinguishable from closely related social psychological phenomena to the extent that 1) Agents treat Others as instrumental tools to achieve their own ends, and 2) Agents deny Others at least one aspect of personhood. This review not only includes research on interpersonal treatment, but intergroup treatment and institutional treatment as well.
OBJECTIVES:
The current study was conducted to synthesise evaluations of couple-based HIV preven... more OBJECTIVES:
The current study was conducted to synthesise evaluations of couple-based HIV prevention interventions, assess the efficacy of these interventions in reducing sexual risk, and identify moderators of intervention efficacy.
METHODS:
A comprehensive literature search identified 29 interventions (22 reports; N=5168 couples) that met the inclusion criteria, including enrolment of both members of a heterosexual couple, measurement of condom use at baseline and follow-up, and sufficient statistical information to calculate effect sizes. Effect sizes were analysed using fixed-effects and random-effects assumptions; factors related to intervention efficacy were identified using metaregression.
RESULTS:
Overall, there were significant increases in condom use from baseline to follow-up (d+=0.78, 95% CI 0.48 to 1.09) and significant decreases in partner concurrency (d+=0.37, 95% CI 0.13 to 0.60). Condom use increased to a greater extent when studies were conducted toward the beginning of the epidemic, were located in countries scoring lower on the Human Development Index, enrolled serodiscordant couples, and delivered intervention content in multiple contexts. Couples who had been together longer, reported higher incidence of sexually transmitted infection, were provided voluntary counselling and testing, and provided outcome measures during face-to-face interviews also reported larger increases in condom use.
CONCLUSIONS:
Couple-based interventions are efficacious in reducing unprotected sex within the context of romantic relationships. Future research should continue to improve risk reduction for couples.
Journal of Acquired Immune Deficiency Syndromes, 2014
OBJECTIVES:
This meta-analysis was conducted to synthesize evaluations of mass media-delivered H... more OBJECTIVES:
This meta-analysis was conducted to synthesize evaluations of mass media-delivered HIV prevention interventions, assess the effectiveness of interventions in improving condom use and HIV-related knowledge, and identify moderators of effectiveness.
STUDY SELECTION:
We systematically searched electronic databases, relevant Web sites, related journals, and reference lists of previous reviews and included studies. Studies that quantitatively evaluated the effectiveness of mass media-delivered HIV prevention using pre-/post-campaign assessments, targeted the general population, reported outcomes of interest, and were available as of September 30, 2013 were eligible for inclusion.
DATA EXTRACTION AND SYNTHESIS:
Raters coded report, intervention, and sample characteristics. The standardized mean difference, d, comparing pretest and posttest assessments was calculated for each study sample. Effect sizes were analyzed incorporating random-effects assumptions.
RESULTS:
Of the 433 obtained and screened reports, 54 reports containing evaluations of 72 interventions using 93 samples (N = 142,196) met the selection criteria and were included. Campaigns were associated with increases in condom use [d+ = 0.25, 95% confidence interval (CI) = 0.18 to 0.21], transmission knowledge (d+ = 0.30, 95% CI = 0.18 to 0.41), and prevention knowledge (d+ = 0.39, 95% CI = 0.25 to 0.52). Increases in condom use were larger for longer campaigns and in nations that scored lower on the human development index. Increases in transmission knowledge were larger to the extent that respondents reported greater campaign exposure, for more recent campaigns, and for nations that scored lower on the human development index.
CONCLUSIONS:
Mass media interventions may be useful in reducing global HIV/AIDS disparities because of their reach and effectiveness.
The tomboy in contemporary U.S. culture is a complex identity, providing meaning to many girls an... more The tomboy in contemporary U.S. culture is a complex identity, providing meaning to many girls and women. In this article, we argue tomboy as a gendered social identity also provides temporary “protections” to girls and women in three main ways. First, tomboy identity can excuse masculine-typed behavior in girls and women and, in doing so, protect women from presumptions about sexual reputation and sexual orientation. Second, tomboy identities can provide some protection for lesbian girls and women who prefer to not divulge their sexual orientation. And, third, tomboy identity can gain women limited privilege to spaces for which masculinity is an unspoken requirement. The temporary nature of the protections provided to tomboys undermines the ability of tomboys to truly transcend the binary gender system.
Authors: Rebecca Kauten, Jessica M. LaCroix, Amber Fox, & Marjan Ghahramanlou-Holloway
Abstract:... more Authors: Rebecca Kauten, Jessica M. LaCroix, Amber Fox, & Marjan Ghahramanlou-Holloway
Abstract: Loneliness has been conceptualized both as an objective state of physical alienation and a subjective state of distress due to feeling alone. The construct of loneliness has been empirically linked with a variety of mental health conditions including depression, hopelessness, suicide ideation, and/or suicide-related behaviors. This chapter examines loneliness and suicide through Aaron Beck’s cognitive behavioral theory and largely through Erik Erickson’s theory of psychosocial development. More specifically, we review how ambivalence resulting from competing drives of connectedness, authenticity, and self-protection may contribute to loneliness and explore manifestations of loneliness and suicidality during childhood, adolescence, young adulthood, middle adulthood, and older adulthood. Intervention strategies to address loneliness in the context of suicide are explored, and recommendations for clinical practice and future areas of empirical inquiry are presented.
AUTHORS: Marjan Ghahramanlou-Holloway, Kari Koss, Anderson Rowan, Jessica M. LaCroix, Kanchana Pe... more AUTHORS: Marjan Ghahramanlou-Holloway, Kari Koss, Anderson Rowan, Jessica M. LaCroix, Kanchana Perera, Jaime Carreno, & Joseph Grammer
ABSTRACT: United States (U.S.) Armed Forces personnel express concerns about the stigma of seeking mental health treatment and the potential impact of treatment seeking on their military careers. To date, there is a lack of empirical data on the association between mental health treatment utilization and military career-related outcomes. This study examined short- and long-term military career outcomes among U.S. Air Force (USAF) personnel who obtained outpatient mental health care. Phase 1 involved a retrospective chart review (N = 370) across nine USAF mental health outpatient clinics. Phase 2 involved a prospective case control comparison of the career-trajectories of USAF personnel who sought mental health treatment (n = 332) versus those who did not (n = 1147) after matching for military rank, time in grade, and occupational code. Nearly a third of service members seeking mental health care experienced some type of career-impacting recommendation. Higher military rank, superior-encouraged referral, greater distress measured at intake by the Outcome Questionnaire-45, and prior inpatient psychiatric care significantly predicted such recommendations. Mental health treatment seekers were three times more likely to experience a medical board evaluation and nearly twice as likely to receive a military discharge. Commander-directed service members were more likely to receive career-affecting recommendations than those who self-referred to treatment or who were encouraged by superiors. Proactive, early self-referral for mental health treatment is one strategy for sustaining a military career. Department of Defense stigma reduction campaigns should provide empirically derived information about the potential impact of mental health treatment on military careers.
Objectives: Military psychiatric inpatients with and without a lifetime history of nonsuicidal se... more Objectives: Military psychiatric inpatients with and without a lifetime history of nonsuicidal self-injury (NSSI), combined with a history of at least one suicide attempt, were compared on suicide ideation severity, number of suicide attempts, and Interpersonal-Psychological Theory of Suicide variables. Methods: Data was derived from baseline assessments performed in a psychotherapy randomized controlled trial. Lifetime history of NSSI and lifetime number of suicide attempts were assessed using the Columbia Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011). Results: Individuals with versus without a combined lifetime history of attempted suicide and NSSI showed significant elevations on thwarted belongingness and acquired capability for suicide. No significant between-group differences were found on perceived burdensomeness, frequency, duration, and controllability of suicide ideation, or number of lifetime suicide attempts. Conclusion: A history of NSSI, above and beyond attempted suicide, appears to increase service members’ social alienation and acquired capability for suicide.
Authors: Victoria A. Colborn, Jessica M. LaCroix, Laura L. Neely, Jennifer Tucker, Kanchana Perer... more Authors: Victoria A. Colborn, Jessica M. LaCroix, Laura L. Neely, Jennifer Tucker, Kanchana Perera, Samantha E. Daruwala, Geoffrey Grammer, Jennifer Weaver, Marjan Ghahramanlou-Holloway
Abstract: A history of multiple suicide attempts conveys greater risk for suicide than a single attempt. Impulsivity may partially explain the association between multiple attempts and increased risk. We examined trait impulsivity, ability to engage in goal-directed behaviors, and impulse control among psychiatrically hospitalized United States military personnel and their dependents. Individuals with a history of multiple versus single attempts had significantly higher motor impulsivity, indicating spur of the moment action. Providers are encouraged to directly assess and treat motor impulsivity among suicidal individuals. Further research should explore whether motor impulsivity is a mechanism of change in psychosocial suicide prevention interventions.
Authors: Kristen M. Ruscio, Ph.D., Victoria A. Colborn, B.S., Christina L. Yang, B.S., Kari R. Ko... more Authors: Kristen M. Ruscio, Ph.D., Victoria A. Colborn, B.S., Christina L. Yang, B.S., Kari R. Koss, M.A., Laura L. Neely, Psy.D., Jamie T. Carreno, Ph.D., Jessica M. LaCroix, Ph.D., and Marjan Ghahramanlou-Holloway, Ph.D
Expressed emotion (EE) refers to the criticism, hostility, and emotional over-involvement family members may display toward an individual diagnosed with a psychiatric disorder. Recent research has explored EE in relation to suicide risk, yet the association between EE and recurrence of suicidal behaviors remains understudied. The present paper provides an illustrative review of the links between EE, psychiatric symptom recurrence, and suicide risk, proposes a new conceptual framework – the Expressed Emotion-Suicidal Behavior Recurrence model (EE-SBR), and provides recommendations for future research and clinical practice within the fields of suicidology and family psychology. Researchers and clinicians are encouraged to consider the role of the family and EE as they relate to relapse prevention efforts.
Authors: Kristen Kochanski-Ruscio, Ph.D., M. Elicia Nademin, Ph.D., Kanchana Perera, MSc., Jessic... more Authors: Kristen Kochanski-Ruscio, Ph.D., M. Elicia Nademin, Ph.D., Kanchana Perera, MSc., Jessica M. LaCroix, Ph.D., Margaret Baer, B.A., Helena O. Hassen, B.A., Maj David Englert, Ph.D., and Marjan Ghahramanlou-Holloway, Ph.D. Objectives: We compared United States military decedents who died by suicide on their first attempt with decedents who had made multiple attempts. Methods: Death investigation files for 217 United States Air Force (USAF) personnel who died by suicide between 1996 and 2006 were coded for demographic, psychosocial, and psychiatric characteristics. Results: Among USAF suicide decedents, 77% died by suicide on their first attempt and 23% had a documented history of at least one prior attempt, Decedents with a history of prior attempts were more likely to have an interpersonal stressor within 3 months of death and were twice as likely to have a documented Axis I diagnosis. Conclusions: There were few differences between military suicide decedents based on history of prior attempts. Further research is needed to inform military suicide prevention endeavors.
Although recent social psychological objectification research has focused on men sexually objecti... more Although recent social psychological objectification research has focused on men sexually objectifying women, there are numerous other domains and methods by which people treat others as objects. This paper incorporates Nussbaum’s (1995) delineation of seven ways to objectify a person with Holland and Haslam’s (2013) conceptualization of objectification as 1) treating another person as a thing, and 2) denying the other’s personhood. Four of the methods of objectification that Nussbaum (1995) describes—instrumentalization, fungibility, violability, and ownership—amount to treating another person as a thing, whereas the other three—denial of autonomy, of agency, and of subjective experience—are means of denying personhood. We review social psychological research that pertains to each of these seven means of objectification and show that objectification is distinguishable from closely related social psychological phenomena to the extent that 1) Agents treat Others as instrumental tools to achieve their own ends, and 2) Agents deny Others at least one aspect of personhood. This review not only includes research on interpersonal treatment, but intergroup treatment and institutional treatment as well.
OBJECTIVES:
The current study was conducted to synthesise evaluations of couple-based HIV preven... more OBJECTIVES:
The current study was conducted to synthesise evaluations of couple-based HIV prevention interventions, assess the efficacy of these interventions in reducing sexual risk, and identify moderators of intervention efficacy.
METHODS:
A comprehensive literature search identified 29 interventions (22 reports; N=5168 couples) that met the inclusion criteria, including enrolment of both members of a heterosexual couple, measurement of condom use at baseline and follow-up, and sufficient statistical information to calculate effect sizes. Effect sizes were analysed using fixed-effects and random-effects assumptions; factors related to intervention efficacy were identified using metaregression.
RESULTS:
Overall, there were significant increases in condom use from baseline to follow-up (d+=0.78, 95% CI 0.48 to 1.09) and significant decreases in partner concurrency (d+=0.37, 95% CI 0.13 to 0.60). Condom use increased to a greater extent when studies were conducted toward the beginning of the epidemic, were located in countries scoring lower on the Human Development Index, enrolled serodiscordant couples, and delivered intervention content in multiple contexts. Couples who had been together longer, reported higher incidence of sexually transmitted infection, were provided voluntary counselling and testing, and provided outcome measures during face-to-face interviews also reported larger increases in condom use.
CONCLUSIONS:
Couple-based interventions are efficacious in reducing unprotected sex within the context of romantic relationships. Future research should continue to improve risk reduction for couples.
Journal of Acquired Immune Deficiency Syndromes, 2014
OBJECTIVES:
This meta-analysis was conducted to synthesize evaluations of mass media-delivered H... more OBJECTIVES:
This meta-analysis was conducted to synthesize evaluations of mass media-delivered HIV prevention interventions, assess the effectiveness of interventions in improving condom use and HIV-related knowledge, and identify moderators of effectiveness.
STUDY SELECTION:
We systematically searched electronic databases, relevant Web sites, related journals, and reference lists of previous reviews and included studies. Studies that quantitatively evaluated the effectiveness of mass media-delivered HIV prevention using pre-/post-campaign assessments, targeted the general population, reported outcomes of interest, and were available as of September 30, 2013 were eligible for inclusion.
DATA EXTRACTION AND SYNTHESIS:
Raters coded report, intervention, and sample characteristics. The standardized mean difference, d, comparing pretest and posttest assessments was calculated for each study sample. Effect sizes were analyzed incorporating random-effects assumptions.
RESULTS:
Of the 433 obtained and screened reports, 54 reports containing evaluations of 72 interventions using 93 samples (N = 142,196) met the selection criteria and were included. Campaigns were associated with increases in condom use [d+ = 0.25, 95% confidence interval (CI) = 0.18 to 0.21], transmission knowledge (d+ = 0.30, 95% CI = 0.18 to 0.41), and prevention knowledge (d+ = 0.39, 95% CI = 0.25 to 0.52). Increases in condom use were larger for longer campaigns and in nations that scored lower on the human development index. Increases in transmission knowledge were larger to the extent that respondents reported greater campaign exposure, for more recent campaigns, and for nations that scored lower on the human development index.
CONCLUSIONS:
Mass media interventions may be useful in reducing global HIV/AIDS disparities because of their reach and effectiveness.
The tomboy in contemporary U.S. culture is a complex identity, providing meaning to many girls an... more The tomboy in contemporary U.S. culture is a complex identity, providing meaning to many girls and women. In this article, we argue tomboy as a gendered social identity also provides temporary “protections” to girls and women in three main ways. First, tomboy identity can excuse masculine-typed behavior in girls and women and, in doing so, protect women from presumptions about sexual reputation and sexual orientation. Second, tomboy identities can provide some protection for lesbian girls and women who prefer to not divulge their sexual orientation. And, third, tomboy identity can gain women limited privilege to spaces for which masculinity is an unspoken requirement. The temporary nature of the protections provided to tomboys undermines the ability of tomboys to truly transcend the binary gender system.
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Papers by Jessica M. LaCroix
Abstract: Loneliness has been conceptualized both as an objective state of physical alienation and a subjective state of distress due to feeling alone. The construct of loneliness has been empirically linked with a variety of mental health conditions including depression, hopelessness, suicide ideation, and/or suicide-related behaviors. This chapter examines loneliness and suicide through Aaron Beck’s cognitive behavioral theory and largely through Erik Erickson’s theory of psychosocial development. More specifically, we review how ambivalence resulting from competing drives of connectedness, authenticity, and self-protection may contribute to loneliness and explore manifestations of loneliness and suicidality during childhood, adolescence, young adulthood, middle adulthood, and older adulthood. Intervention strategies to address loneliness in the context of suicide are explored, and recommendations for clinical practice and future areas of empirical inquiry are presented.
ABSTRACT: United States (U.S.) Armed Forces personnel express concerns about the stigma of seeking mental health treatment and the potential impact of treatment seeking on their military careers. To date, there is a lack of empirical data on the association between mental health treatment utilization and military career-related outcomes. This study examined short- and long-term military career outcomes among U.S. Air Force (USAF) personnel who obtained outpatient mental health care. Phase 1 involved a retrospective chart review (N = 370) across nine USAF mental health outpatient clinics. Phase 2 involved a prospective case control comparison of the career-trajectories of USAF personnel who sought mental health treatment (n = 332) versus those who did not (n = 1147) after matching for military rank, time in grade, and occupational code. Nearly a third of service members seeking mental health care experienced some type of career-impacting recommendation. Higher military rank, superior-encouraged referral, greater distress measured at intake by the Outcome Questionnaire-45, and prior inpatient psychiatric care significantly predicted such recommendations. Mental health treatment seekers were three times more likely to experience a medical board evaluation and nearly twice as likely to receive a military discharge. Commander-directed service members were more likely to receive career-affecting recommendations than those who self-referred to treatment or who were encouraged by superiors. Proactive, early self-referral for mental health treatment is one strategy for sustaining a military career. Department of Defense stigma reduction campaigns should provide empirically derived information about the potential impact of mental health treatment on military careers.
Results: Individuals with versus without a combined lifetime history of attempted suicide and NSSI showed significant elevations on thwarted belongingness and acquired capability for suicide. No significant between-group differences were found on perceived burdensomeness, frequency, duration, and controllability of suicide ideation, or number of lifetime suicide attempts. Conclusion: A history of NSSI, above and beyond attempted suicide, appears to increase service members’ social alienation and acquired capability for suicide.
Abstract: A history of multiple suicide attempts conveys greater risk for suicide than a single attempt. Impulsivity may partially explain the association between multiple attempts and increased risk. We examined trait impulsivity, ability to engage in goal-directed behaviors, and impulse control among psychiatrically hospitalized United States military personnel and their dependents. Individuals with a history of multiple versus single attempts had significantly higher motor impulsivity, indicating spur of the moment action. Providers are encouraged to directly assess and treat motor impulsivity among suicidal individuals. Further research should explore whether motor impulsivity is a mechanism of change in psychosocial suicide prevention interventions.
Expressed emotion (EE) refers to the criticism, hostility, and emotional over-involvement family members may display toward an individual diagnosed with a psychiatric disorder. Recent research has explored EE in relation to suicide risk, yet the association between EE and recurrence of suicidal behaviors remains understudied. The present paper provides an illustrative review of the links between EE, psychiatric symptom recurrence, and suicide risk, proposes a new conceptual framework – the Expressed Emotion-Suicidal Behavior Recurrence model (EE-SBR), and provides recommendations for future research and clinical practice within the fields of suicidology and family psychology. Researchers and clinicians are encouraged to consider the role of the family and EE as they relate to relapse prevention efforts.
Objectives: We compared United States military decedents who died by suicide on their first attempt with decedents who had made multiple attempts.
Methods: Death investigation files for 217 United States Air Force (USAF) personnel who died by suicide between 1996 and 2006 were coded for demographic, psychosocial, and psychiatric characteristics.
Results: Among USAF suicide decedents, 77% died by suicide on their first attempt and 23% had a documented history of at least one prior attempt, Decedents with a history of prior attempts were more likely to have an interpersonal stressor within 3 months of death and were twice as likely to have a documented Axis I diagnosis.
Conclusions: There were few differences between military suicide decedents based on history of prior attempts. Further research is needed to inform military suicide prevention endeavors.
The current study was conducted to synthesise evaluations of couple-based HIV prevention interventions, assess the efficacy of these interventions in reducing sexual risk, and identify moderators of intervention efficacy.
METHODS:
A comprehensive literature search identified 29 interventions (22 reports; N=5168 couples) that met the inclusion criteria, including enrolment of both members of a heterosexual couple, measurement of condom use at baseline and follow-up, and sufficient statistical information to calculate effect sizes. Effect sizes were analysed using fixed-effects and random-effects assumptions; factors related to intervention efficacy were identified using metaregression.
RESULTS:
Overall, there were significant increases in condom use from baseline to follow-up (d+=0.78, 95% CI 0.48 to 1.09) and significant decreases in partner concurrency (d+=0.37, 95% CI 0.13 to 0.60). Condom use increased to a greater extent when studies were conducted toward the beginning of the epidemic, were located in countries scoring lower on the Human Development Index, enrolled serodiscordant couples, and delivered intervention content in multiple contexts. Couples who had been together longer, reported higher incidence of sexually transmitted infection, were provided voluntary counselling and testing, and provided outcome measures during face-to-face interviews also reported larger increases in condom use.
CONCLUSIONS:
Couple-based interventions are efficacious in reducing unprotected sex within the context of romantic relationships. Future research should continue to improve risk reduction for couples.
This meta-analysis was conducted to synthesize evaluations of mass media-delivered HIV prevention interventions, assess the effectiveness of interventions in improving condom use and HIV-related knowledge, and identify moderators of effectiveness.
STUDY SELECTION:
We systematically searched electronic databases, relevant Web sites, related journals, and reference lists of previous reviews and included studies. Studies that quantitatively evaluated the effectiveness of mass media-delivered HIV prevention using pre-/post-campaign assessments, targeted the general population, reported outcomes of interest, and were available as of September 30, 2013 were eligible for inclusion.
DATA EXTRACTION AND SYNTHESIS:
Raters coded report, intervention, and sample characteristics. The standardized mean difference, d, comparing pretest and posttest assessments was calculated for each study sample. Effect sizes were analyzed incorporating random-effects assumptions.
RESULTS:
Of the 433 obtained and screened reports, 54 reports containing evaluations of 72 interventions using 93 samples (N = 142,196) met the selection criteria and were included. Campaigns were associated with increases in condom use [d+ = 0.25, 95% confidence interval (CI) = 0.18 to 0.21], transmission knowledge (d+ = 0.30, 95% CI = 0.18 to 0.41), and prevention knowledge (d+ = 0.39, 95% CI = 0.25 to 0.52). Increases in condom use were larger for longer campaigns and in nations that scored lower on the human development index. Increases in transmission knowledge were larger to the extent that respondents reported greater campaign exposure, for more recent campaigns, and for nations that scored lower on the human development index.
CONCLUSIONS:
Mass media interventions may be useful in reducing global HIV/AIDS disparities because of their reach and effectiveness.
Abstract: Loneliness has been conceptualized both as an objective state of physical alienation and a subjective state of distress due to feeling alone. The construct of loneliness has been empirically linked with a variety of mental health conditions including depression, hopelessness, suicide ideation, and/or suicide-related behaviors. This chapter examines loneliness and suicide through Aaron Beck’s cognitive behavioral theory and largely through Erik Erickson’s theory of psychosocial development. More specifically, we review how ambivalence resulting from competing drives of connectedness, authenticity, and self-protection may contribute to loneliness and explore manifestations of loneliness and suicidality during childhood, adolescence, young adulthood, middle adulthood, and older adulthood. Intervention strategies to address loneliness in the context of suicide are explored, and recommendations for clinical practice and future areas of empirical inquiry are presented.
ABSTRACT: United States (U.S.) Armed Forces personnel express concerns about the stigma of seeking mental health treatment and the potential impact of treatment seeking on their military careers. To date, there is a lack of empirical data on the association between mental health treatment utilization and military career-related outcomes. This study examined short- and long-term military career outcomes among U.S. Air Force (USAF) personnel who obtained outpatient mental health care. Phase 1 involved a retrospective chart review (N = 370) across nine USAF mental health outpatient clinics. Phase 2 involved a prospective case control comparison of the career-trajectories of USAF personnel who sought mental health treatment (n = 332) versus those who did not (n = 1147) after matching for military rank, time in grade, and occupational code. Nearly a third of service members seeking mental health care experienced some type of career-impacting recommendation. Higher military rank, superior-encouraged referral, greater distress measured at intake by the Outcome Questionnaire-45, and prior inpatient psychiatric care significantly predicted such recommendations. Mental health treatment seekers were three times more likely to experience a medical board evaluation and nearly twice as likely to receive a military discharge. Commander-directed service members were more likely to receive career-affecting recommendations than those who self-referred to treatment or who were encouraged by superiors. Proactive, early self-referral for mental health treatment is one strategy for sustaining a military career. Department of Defense stigma reduction campaigns should provide empirically derived information about the potential impact of mental health treatment on military careers.
Results: Individuals with versus without a combined lifetime history of attempted suicide and NSSI showed significant elevations on thwarted belongingness and acquired capability for suicide. No significant between-group differences were found on perceived burdensomeness, frequency, duration, and controllability of suicide ideation, or number of lifetime suicide attempts. Conclusion: A history of NSSI, above and beyond attempted suicide, appears to increase service members’ social alienation and acquired capability for suicide.
Abstract: A history of multiple suicide attempts conveys greater risk for suicide than a single attempt. Impulsivity may partially explain the association between multiple attempts and increased risk. We examined trait impulsivity, ability to engage in goal-directed behaviors, and impulse control among psychiatrically hospitalized United States military personnel and their dependents. Individuals with a history of multiple versus single attempts had significantly higher motor impulsivity, indicating spur of the moment action. Providers are encouraged to directly assess and treat motor impulsivity among suicidal individuals. Further research should explore whether motor impulsivity is a mechanism of change in psychosocial suicide prevention interventions.
Expressed emotion (EE) refers to the criticism, hostility, and emotional over-involvement family members may display toward an individual diagnosed with a psychiatric disorder. Recent research has explored EE in relation to suicide risk, yet the association between EE and recurrence of suicidal behaviors remains understudied. The present paper provides an illustrative review of the links between EE, psychiatric symptom recurrence, and suicide risk, proposes a new conceptual framework – the Expressed Emotion-Suicidal Behavior Recurrence model (EE-SBR), and provides recommendations for future research and clinical practice within the fields of suicidology and family psychology. Researchers and clinicians are encouraged to consider the role of the family and EE as they relate to relapse prevention efforts.
Objectives: We compared United States military decedents who died by suicide on their first attempt with decedents who had made multiple attempts.
Methods: Death investigation files for 217 United States Air Force (USAF) personnel who died by suicide between 1996 and 2006 were coded for demographic, psychosocial, and psychiatric characteristics.
Results: Among USAF suicide decedents, 77% died by suicide on their first attempt and 23% had a documented history of at least one prior attempt, Decedents with a history of prior attempts were more likely to have an interpersonal stressor within 3 months of death and were twice as likely to have a documented Axis I diagnosis.
Conclusions: There were few differences between military suicide decedents based on history of prior attempts. Further research is needed to inform military suicide prevention endeavors.
The current study was conducted to synthesise evaluations of couple-based HIV prevention interventions, assess the efficacy of these interventions in reducing sexual risk, and identify moderators of intervention efficacy.
METHODS:
A comprehensive literature search identified 29 interventions (22 reports; N=5168 couples) that met the inclusion criteria, including enrolment of both members of a heterosexual couple, measurement of condom use at baseline and follow-up, and sufficient statistical information to calculate effect sizes. Effect sizes were analysed using fixed-effects and random-effects assumptions; factors related to intervention efficacy were identified using metaregression.
RESULTS:
Overall, there were significant increases in condom use from baseline to follow-up (d+=0.78, 95% CI 0.48 to 1.09) and significant decreases in partner concurrency (d+=0.37, 95% CI 0.13 to 0.60). Condom use increased to a greater extent when studies were conducted toward the beginning of the epidemic, were located in countries scoring lower on the Human Development Index, enrolled serodiscordant couples, and delivered intervention content in multiple contexts. Couples who had been together longer, reported higher incidence of sexually transmitted infection, were provided voluntary counselling and testing, and provided outcome measures during face-to-face interviews also reported larger increases in condom use.
CONCLUSIONS:
Couple-based interventions are efficacious in reducing unprotected sex within the context of romantic relationships. Future research should continue to improve risk reduction for couples.
This meta-analysis was conducted to synthesize evaluations of mass media-delivered HIV prevention interventions, assess the effectiveness of interventions in improving condom use and HIV-related knowledge, and identify moderators of effectiveness.
STUDY SELECTION:
We systematically searched electronic databases, relevant Web sites, related journals, and reference lists of previous reviews and included studies. Studies that quantitatively evaluated the effectiveness of mass media-delivered HIV prevention using pre-/post-campaign assessments, targeted the general population, reported outcomes of interest, and were available as of September 30, 2013 were eligible for inclusion.
DATA EXTRACTION AND SYNTHESIS:
Raters coded report, intervention, and sample characteristics. The standardized mean difference, d, comparing pretest and posttest assessments was calculated for each study sample. Effect sizes were analyzed incorporating random-effects assumptions.
RESULTS:
Of the 433 obtained and screened reports, 54 reports containing evaluations of 72 interventions using 93 samples (N = 142,196) met the selection criteria and were included. Campaigns were associated with increases in condom use [d+ = 0.25, 95% confidence interval (CI) = 0.18 to 0.21], transmission knowledge (d+ = 0.30, 95% CI = 0.18 to 0.41), and prevention knowledge (d+ = 0.39, 95% CI = 0.25 to 0.52). Increases in condom use were larger for longer campaigns and in nations that scored lower on the human development index. Increases in transmission knowledge were larger to the extent that respondents reported greater campaign exposure, for more recent campaigns, and for nations that scored lower on the human development index.
CONCLUSIONS:
Mass media interventions may be useful in reducing global HIV/AIDS disparities because of their reach and effectiveness.