Utilization of and Barriers to Treatment Among Suicide Decedents: Results From the Army Study to Assess Risk and Resilience Among Servicemembers (Army STARRS)Zuromski, Kelly L.; Dempsey, Catherine L.; Ng, Tsz Hin Hinz; Riggs-Donovan, Charlotte A.; Brent, David A.; Heeringa, Steven G.; Kessler, Ronald C.; Stein, Murray B.; Ursano, Robert J.; Benedek, David; Nock, Matthew K.
doi: 10.1037/ccp0000400pmid: 31008631
Objective: To examine suicide decedents’ use of mental health treatment and perceived barriers to initiating and maintaining treatment. Method: We used a psychological autopsy study conducted as part of the Army Study to Assess Risk and Resilience Among Servicemembers (Army STARRS) that compared suicide decedents (n = 135) to soldiers in two control conditions: those propensity-score-matched on known sociodemographic and Army history variables (n = 137) and those with a history of suicidal thoughts in the past 12 months (n = 118). Informants were next of kin and Army supervisors. Results: Results revealed that suicide decedents were significantly more likely to be referred to services and to use more intensive treatments (e.g., medication, overnight stay in hospital) than propensity-matched controls. However, decedents also were more likely to perceive significant barriers to treatment-seeking. All differences observed in the current study were between propensity-matched controls and decedents, with no observed differences between suicide ideators and decedents. Conclusions: Many suicide decedents used some form of mental health care at some point in their lives; however, they also were more likely than propensity-matched controls to perceive barriers that may have prevented service use. The lack of differences between suicide ideators and decedents suggests that more information is needed, beyond knowledge of treatment utilization or perceived barriers, to identify and intervene on those at highest risk for suicide. These findings underscore the importance of reducing attitudinal barriers that may deter suicidal soldiers from seeking treatment, and also improving risk detection among those who are attending treatment.
Model Complexity Improves the Prediction of Nonsuicidal Self-InjuryFox, Kathryn R.; Huang, Xieyining; Linthicum, Kathryn P.; Wang, Shirley B.; Franklin, Joseph C.; Ribeiro, Jessica D.
doi: 10.1037/ccp0000421pmid: 31219275
Objective: Efforts to predict nonsuicidal self-injury (NSSI; intentional self-injury enacted without suicidal intent) to date have resulted in near-chance accuracy. Incongruence between theoretical understanding of NSSI and the traditional statistical methods to predict these behaviors may explain this poor prediction. Whereas theoretical models of NSSI assume that the decision to engage in NSSI is relatively complex, statistical models used in NSSI prediction tend to involve simple models with only a few theoretically informed variables. The present study tested whether more complex statistical models would improve NSSI prediction. Method: Within a sample of 1,021 high-risk self-injurious and/or suicidal individuals, we examined the accuracy of three different model types, of increasing complexity, in predicting NSSI across 3, 14, and 28 days. Univariate logistic regressions of each predictor and multiple logistic regression with all predictors were conducted for each timepoint and compared with machine learning algorithms derived from all predictors. Results: Results demonstrated that model complexity was associated with predictive accuracy. Multiple logistic regression models (AUCs 0.70–0.72) outperformed univariate logistic models (average AUCs 0.56). Machine learning models that produced algorithms modeling complex associations across variables produced the strongest NSSI prediction across all time points (AUCs 0.87–0.90). These models outperformed all multiple logistic regression models, including those involving identical study variables. Machine learning algorithm performance remained strong even after the most important factor across algorithms was removed. Conclusions: Results parallel recent findings in suicide research and highlight the complexity that underlies NSSI.
Anger and Depression Among Incarcerated Male Youth: Predictors of Violent and Nonviolent Offending During Adjustment to IncarcerationKelly, Erin L.; Novaco, Raymond W.; Cauffman, Elizabeth
doi: 10.1037/ccp0000420pmid: 31204840
Objective: Anger and depression are associated with a number of psychosocial problems, and their comorbidity may exacerbate maladjustment among incarcerated youth. The present study aims to identify whether anger and its different facets (cognitive, arousal, and behavioral), either independently or when conjoined with depressed mood, affects violent and nonviolent institutional infractions. Method: Male adolescents (14–17 years of age) were recruited within 48 hr of arrival at a juvenile detention facility and were administered psychometric measures of anger (Novaco Anger Scale) and depression (Center for Epidemiological Studies–Depression scale) at baseline, 1 month, and 2 months. Offending within the facility was assessed via self-report and institutional records. Results: Controlling for prior offending and other background factors, individuals having high anger scores were more likely to offend over the 2-month period, compared to those with lower levels of anger. Novaco Anger Scale scores, especially the Behavioral facet, predicted both official- and self-reported (violent and nonviolent) institutional offending. There was evidence for the interaction of depression and anger at baseline predicting self-reported offending at 1 month only. Conclusions: Given that juveniles’ self-report of emotional distress, particularly anger, is predictive of their violent and nonviolent infractions, focused intervention programs could reduce behavior problems during incarceration that add to juveniles’ maladjustment and continued exposure to adversities.
The Therapeutic Alliance in Individual Resiliency Training for First Episode Psychosis: Relationship With Treatment Outcomes and Therapy ParticipationBrowne, Julia; Mueser, Kim T.; Meyer-Kalos, Piper; Gottlieb, Jennifer D.; Estroff, Sue E.; Penn, David L.
doi: 10.1037/ccp0000418pmid: 31219276
Objective: The therapeutic alliance has long been considered an essential part of treatment. Despite a large body of work examining the alliance–outcome relationship, very few studies have examined it within individuals with first episode psychosis (FEP). Method: The present study examined the alliance at Session 3, 4, or 5 and its relationship to 2-year treatment outcomes and therapy participation in a sample of 144 FEP clients who received specialized FEP treatment at U.S. clinics. Furthermore, we examined between-therapist and within-therapist (client) effects of the alliance on outcomes. Results: Results indicated that a better alliance was related to improved mental health recovery, psychological well-being, quality of life, total symptoms, negative symptoms, and disorganized symptoms at the end of treatment. In addition, the between-therapist effect of the alliance was significantly related to better mental health recovery whereas the within-therapist (client) effect of the alliance was related to better quality of life, total symptoms, and negative symptoms at the end of treatment. Conclusions: A stronger alliance was related to improved treatment outcomes in FEP. Future work should consider examining mediators of the alliance-outcome relationship as well as how changes in the alliance relate to changes in outcomes over time.
Predictors of Treatment Attendance in Cognitive and Dynamic Therapies for Major Depressive Disorder Delivered in a Community Mental Health SettingGibbons, Mary Beth Connolly; Gallop, Robert; Thompson, Donald; Gaines, Averi; Rieger, Agnes; Crits-Christoph, Paul
doi: 10.1037/ccp0000414pmid: 31204838
Objective: Our goal was to evaluate treatment attendance patterns, including both treatment completion and premature termination from treatment, for 2 evidence-based psychotherapies for major depressive disorder (MDD) delivered in a community mental health setting. We explored rates of premature termination across the course of treatment as well as the factors that predicted and moderated premature termination and treatment completion. Method: This investigation included 237 patients with MDD who participated in a noninferiority trial comparing short-term dynamic psychotherapy (DT) to cognitive therapy (CT). Patients in both conditions were offered 16 sessions of treatment and had up to 5 months to complete treatment. All patients completed an extensive self-report battery at treatment baseline as well as measures of the therapeutic alliance and opinions about treatment following Session 2. Results: Premature termination from both treatments was high with 27% of patients discontinuing treatment very early after only an intake session or a single treatment session. Patients in CT were significantly more likely to terminate treatment prematurely, χ2(3) = 14.35, p = .002. Baseline physical health functioning, subthreshold psychotic symptoms, Session 2 ratings of agreement on tasks, and Session 2 ratings of treatment sensibility all independently predicted premature termination of services. Trauma history significantly moderated very early termination of treatment, χ2(3) = 10.26, p = .017, with patients with high trauma histories more likely to complete DT but terminate prematurely from CT. Conclusions: Very early termination from services was higher in CT compared with DT. Including techniques to improve engagement in both therapies and matching patients to treatment based on predictors/moderators may be effective ways to optimize treatment engagement.