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Moran P, Chandler A, Dudgeon P, Kirtley OJ, Knipe D, Pirkis J, Sinyor M, Allister R, Ansloos J, Ball MA, Chan LF, Darwin L, Derry KL, Hawton K, Heney V, Hetrick S, Li A, Machado DB, McAllister E, McDaid D, Mehra I, Niederkrotenthaler T, Nock MK, O'Keefe VM, Oquendo MA, Osafo J, Patel V, Pathare S, Peltier S, Roberts T, Robinson J, Shand F, Stirling F, Stoor JPA, Swingler N, Turecki G, Venkatesh S, Waitoki W, Wright M, Yip PSF, Spoelma MJ, Kapur N, O'Connor RC, Christensen H. The Lancet Commission on self-harm. Lancet 2024; 404:1445-1492. [PMID: 39395434 DOI: 10.1016/s0140-6736(24)01121-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 10/14/2024]
Affiliation(s)
- Paul Moran
- Centre for Academic Mental Health, Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
| | - Amy Chandler
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Pat Dudgeon
- Poche Centre for Indigenous Health, School of Indigenous Studies, University of Western Australia, Perth, WA, Australia
| | | | - Duleeka Knipe
- Centre for Academic Mental Health, Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane Pirkis
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Jeffrey Ansloos
- Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Melanie A Ball
- Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Kate L Derry
- Poche Centre for Indigenous Health, School of Indigenous Studies, University of Western Australia, Perth, WA, Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Veronica Heney
- Institute for Medical Humanities, Durham University, Durham, UK
| | - Sarah Hetrick
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Ang Li
- Department of Psychology, Beijing Forestry University, Beijing, China
| | - Daiane B Machado
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil; Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | | | - David McDaid
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Thomas Niederkrotenthaler
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Matthew K Nock
- Department of Psychology, Harvard University, Boston, MA, USA
| | - Victoria M O'Keefe
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Joseph Osafo
- Department of Psychology, University of Ghana, Accra, Ghana
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | - Soumitra Pathare
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Shanna Peltier
- Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Tessa Roberts
- Unit for Social and Community Psychiatry, Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jo Robinson
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Orygen, Melbourne, VIC, Australia
| | - Fiona Shand
- Black Dog Institute, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Stirling
- School of Health and Social Sciences, Abertay University, Dundee, UK
| | - Jon P A Stoor
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Natasha Swingler
- Orygen, Melbourne, VIC, Australia; Royal Children's Hospital, Melbourne, VIC, Australia
| | - Gustavo Turecki
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Svetha Venkatesh
- Applied Artificial Intelligence Institute, Deakin University, Geelong, VIC, Australia
| | - Waikaremoana Waitoki
- Faculty of Māori and Indigenous Studies, The University of Waikato, Hamilton, New Zealand
| | - Michael Wright
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Paul S F Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention and Department of Social Work and Social Administration, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Michael J Spoelma
- Black Dog Institute, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Navneet Kapur
- Centre for Mental Health and Safety and National Institute for Health Research Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; Mersey Care NHS Foundation Trust, Prescot, UK
| | - Rory C O'Connor
- Suicidal Behaviour Research Lab, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Christensen
- Black Dog Institute, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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2
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Monteith LL, Holder N, Iglesias CD, Holliday R. Institutional Betrayal and Closeness Among Women Veteran Survivors of Military Sexual Trauma: Associations with Self-Directed Violence and Mental Health Symptoms. J Trauma Dissociation 2024; 25:315-333. [PMID: 36069509 DOI: 10.1080/15299732.2022.2120152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
Institutional betrayal is defined as harm caused by an institution to an individual in the context of trust and dependence. High institutional betrayal is associated with poorer health outcomes, and high levels of trust, dependence, or identification with the institution (institutional closeness) may exacerbate the negative effects of institutional betrayal. While military sexual trauma is prevalent among women Veterans and associated with high rates of institutional betrayal, studies of the impact of military sexual trauma-related institutional betrayal have been limited in size and scope and have not examined the potential role of institutional closeness. We conducted a secondary analysis of national survey data collected from women Veterans who screened positive for military sexual trauma (n = 229). Hierarchical logistic and linear regression were used to examine associations between predictor variables (institutional betrayal, institutional closeness, and their interaction) and outcomes of interest and adjusted for age, education, and military sexual assault history. Institutional betrayal was associated with increased odds of suicidal ideation and suicide attempt during or following military service, as well as more severe symptoms of depression and posttraumatic stress disorder (PTSD). Institutional betrayal was not associated with non-suicidal self-injury or lifetime substance misuse. Counter to hypotheses, institutional closeness did not moderate relationships between institutional betrayal and mental health symptoms or self-directed violence. Results underscore the necessity of preventing and addressing institutional betrayal among women Veterans who experience military sexual trauma.
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Affiliation(s)
- Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, USA
| | - Nicholas Holder
- Mental Health, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, School of Medicine, San Francisco, California, USA
| | - Christe'An D Iglesias
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Ryan Holliday
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, USA
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3
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Zelkowitz RL, Halverson TF, Patel TA, Beckham JC, Calhoun PS, Pugh MJ, Kimbrel NA. Nonsuicidal self-injury methods among U.S. Veterans: Latent class analysis and associations with psychosocial outcomes. Psychiatry Res 2023; 329:115558. [PMID: 37890405 DOI: 10.1016/j.psychres.2023.115558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a debilitating concern among U.S. veterans, with wall/object-punching commonly endorsed as an NSSI method. We examined how this behavior relates to other NSSI methods and psychosocial outcomes. We conducted a latent class analysis (LCA) of NSSI methods among 1,138 Gulf War Era veterans, (77.9% male), 21.7% of whom endorsed lifetime NSSI. We categorized classes based on their associations with age, sex, combat and military sexual assault exposure, then examined the association of class membership with psychosocial indicators. LCA results supported four classes: 1) High punching/banging NSSI (2.5%); 2) Multimethod NSSI methods (6.3%); 3) High-risk, multimethod NSSI (3.1%); and 4) Low-risk NSSI (88.1%). Psychosocial indicators (suicide attempt, ideation, possible depressive or posttraumatic stress disorders, poor psychosocial functioning) were worse for members of the NSSI classes versus those in the low-risk group. A subset of U.S. veterans may engage in NSSI primarily via punching/banging methods. All patterns of NSSI engagement were associated with negative psychosocial outcomes relative to those in the low-risk class of the behavior.
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Affiliation(s)
- Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Tate F Halverson
- Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
| | - Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Mary Jo Pugh
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA; Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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4
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Aurora P, LoSavio ST, Kimbrel NA, Beckham JC, Calhoun PS, Dillon KH. Examining the daily relationship between guilt, shame, and substance use among veterans with psychiatric disorders. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 8:100174. [PMID: 37753347 PMCID: PMC10518500 DOI: 10.1016/j.dadr.2023.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/09/2023] [Accepted: 06/09/2023] [Indexed: 09/28/2023]
Abstract
Background Shame and guilt are key emotions known to amplify trauma-related symptoms in veterans. Maintenance of symptoms is facilitated by avoidance behaviors, such as substance use. However, limited research has examined the associations between shame, guilt, and substance use in daily life. Methods The current study sought to examine the cross-lagged association between shame, guilt, and substance use. Forty veterans completed 28 days of experience sampling reporting on their current emotional experiences and use of substances. Results Results suggest a reciprocal relationship among shame and guilt and substance use, such that shame and guilt separately predicted subsequent substance use, and substance use predicted subsequent shame and guilt. Conclusions These results highlight the dynamic relationship among shame, guilt, and substance use and suggest the potential value of conceptualizing these clinical targets as mutually reinforcing to inform integrative intervention strategies that can interrupt the in-the-moment cascade of negative consequences.
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Affiliation(s)
- Pallavi Aurora
- Durham VA Health Care System, Durham NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Stefanie T. LoSavio
- Durham VA Health Care System, Durham NC, USA
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Nathan A. Kimbrel
- Durham VA Health Care System, Durham NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Jean C. Beckham
- Durham VA Health Care System, Durham NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Patrick S. Calhoun
- Durham VA Health Care System, Durham NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Kirsten H. Dillon
- Durham VA Health Care System, Durham NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Halverson TF, Dillon KH, Weber DM, Dennis PA, Beckham JC, Calhoun PS, Kimbrel NA. Interpersonal stress and nonsuicidal self-injury disorder in veterans: An ecological momentary assessment study. Suicide Life Threat Behav 2023; 53:546-556. [PMID: 37052380 PMCID: PMC10523856 DOI: 10.1111/sltb.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/24/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023]
Abstract
INTRO Nonsuicidal self-injury (NSSI) is associated with marked functional impairment and is a robust predictor of suicide attempts. Prevalence rates of NSSI, and self-directed violence more broadly, are elevated among military veterans. Despite the inclusion of interpersonal difficulty in the diagnostic criteria for NSSI disorder, the relationship between interpersonal risk factors and NSSI is not well-characterized, especially among veterans. This ecological momentary assessment (EMA) study investigated the hypothesis that interpersonal stressors and associated distress would precede and predict NSSI urge and engagement-but not vice versa-via cross-lagged multilevel modeling. METHOD Forty veterans with NSSI disorder completed a 28-day EMA protocol with three daily prompts assessing NSSI urges, NSSI engagement, the occurrence of interpersonal stressors, and associated subjective interpersonal distress. RESULTS Interpersonal stressors preceded and predicted subsequent NSSI urges, but not NSSI engagement, whereas subjective interpersonal distress preceded and predicted both NSSI urges and NSSI engagement. CONCLUSION Results identified interpersonal stressors as a risk factor for NSSI urges, and interpersonal distress as a risk factor for both NSSI urges and NSSI engagement. Findings highlight the importance of temporally assessing interpersonal factors related to NSSI and suggest that interpersonal distress may be a modifiable risk factor for NSSI.
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Affiliation(s)
- Tate F Halverson
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Kirsten H Dillon
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Danielle M Weber
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul A Dennis
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
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Dillon KH, Hertzberg JA, Mosher TM, Levi R, Elbogen EB, Calhoun PS, Morland LA, Beckham JC. Development and refinement of the mobile anger reduction intervention for veterans with posttraumatic stress disorder. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023:2023-71134-001. [PMID: 37166919 PMCID: PMC10638458 DOI: 10.1037/tra0001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Problematic anger is commonly reported among veterans with posttraumatic stress disorder (PTSD) and is associated with numerous psychosocial impairments. There is a clear need to develop innovative and effective anger interventions. One of the cognitive mechanisms associated with anger is the hostile interpretation bias, which is the tendency to interpret ambiguous interpersonal situations as hostile. The current study presents a successive cohort design methodology to develop and refine a mobile treatment application, entitled Mobile Anger Reduction Intervention (MARI), which uses interpretation bias modification techniques to modify hostile interpretation bias. METHOD Two cohorts (total N = 13) of veterans with PTSD and problematic anger used the MARI application for 4 weeks. After each cohort, qualitative and quantitative data were used to modify the MARI application. The intervention is described, as well as the qualitative and quantitative findings and subsequent changes made to the mobile application based on participant feedback. RESULTS Treatment adherence was high (90% of participants completed all sessions). Participants reported that they found the treatment helpful and easy to use and experienced improvements in hostile interpretation bias and problematic anger. CONCLUSIONS This study demonstrates the utility of a successive cohort treatment design for the development of mobile interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Kirsten H. Dillon
- Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Duke University Medical Center, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Jeffrey A. Hertzberg
- Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Duke University Medical Center, Durham, North Carolina, USA
| | - Tiffany M. Mosher
- Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Duke University Medical Center, Durham, North Carolina, USA
| | - Ryan Levi
- Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Duke University Medical Center, Durham, North Carolina, USA
| | - Eric B. Elbogen
- Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Duke University Medical Center, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- National Center on Homelessness Among Veterans, Washington, DC, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Duke University Medical Center, Durham, North Carolina, USA
- National Center on Homelessness Among Veterans, Washington, DC, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Leslie A. Morland
- University of California, San Diego, La Jolla, California, USA
- National Center for PTSD, Pacific Islands Division, Honolulu, Hawaii, USA
| | - Jean C. Beckham
- Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Duke University Medical Center, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
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7
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Patel TA, Blakey SM, Halverson TF, Mann AJD, Calhoun PS, Beckham JC, Pugh MJ, Kimbrel NA. Experiential Avoidance, Posttraumatic Stress Disorder, and Self-Injurious Thoughts and Behaviors: A Moderation Analysis in a National Veteran Sample. Int J Cogn Ther 2023; 1:10.1007/s41811-023-00164-2. [PMID: 37360585 PMCID: PMC10288701 DOI: 10.1007/s41811-023-00164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 06/28/2023]
Abstract
Experiential avoidance (EA) is associated with posttraumatic stress disorder (PTSD) and self-injurious thoughts and behaviors (SITBs) across different populations, and extant literature has demonstrated a strong relationship between PTSD and SITBs. However, no study has explored the potential moderating role EA plays in the association of PTSD with nonsuicidal self-injury (NSSI), suicidal ideation, and suicide attempts. The objective of the present study was to determine if EA would moderate the association with PTSD and SITBs such that the association between PTSD and individuals SITBs would be stronger among individuals with higher EA. In a large national sample of Gulf War Era veterans (N = 1,138), EA was associated with PTSD, lifetime and past-year NSSI, current suicidal ideation, and lifetime suicide attempts in bivariate analyses. Multivariate analyses detected a significant EA by PTSD interaction on lifetime NSSI (AOR = 0.96), past-year NSSI (AOR = 1.03), and suicide attempts (AOR =1.03). Probing of the interactions revealed that the respective associations between PTSD, lifetime and past-year NSSI, and suicide attempts were stronger at lower levels of EA (i.e., better), counter to our hypotheses. These preliminary findings contextualize the relationship between these variables in a Gulf War veterans sample and signal the need to further investigate these relationships. Further, these findings highlight the need for advancement in assessment and intervention of EA and SITBs.
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Affiliation(s)
- Tapan A. Patel
- Department of Psychology, Florida State University; Tallahassee, FL
| | | | - Tate F. Halverson
- Durham VA Health Care System; Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC
| | | | - Patrick S. Calhoun
- Durham VA Health Care System; Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC
| | - Jean C. Beckham
- Durham VA Health Care System; Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC
| | - Mary J. Pugh
- VA Salt Lake City Healthcare System, Salt Lake City; UT
- University of Utah School of Medicine Department of Medicine; Salt Lake City, UT
| | - Nathan A. Kimbrel
- Durham VA Health Care System; Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC
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8
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Vest BM, Goodell EMA, Homish DL, Homish GG. Effects of Social Network Characteristics on Mental Health Outcomes Among United States Army Reserve and National Guard Soldiers. Community Ment Health J 2022; 58:1268-1278. [PMID: 34981277 PMCID: PMC9250539 DOI: 10.1007/s10597-021-00935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
We sought to examine the relative salience of multiple social network structural characteristics (e.g., size, composition, quality, substance use) for understanding soldiers' mental health symptoms (anger, anxiety, depression, PTSD). Data are drawn from soldiers (N = 421) participating in the Operation: SAFETY study. Negative binomial regression models examined the relationship between ten social network characteristics and mental health outcomes, controlling for age, sex, years of military service, and deployment history. Greater number of close network ties was associated with fewer symptoms of anger, anxiety, and depression (ps < 0.05), but not PTSD. Having more illicit drug-using network ties was associated with greater severity of anxiety symptoms (p < 0.05). Finally, more days spent drinking with network members was related to higher levels of anger (p < 0.05). Interpersonal relationships that entail substance use are associated with greater anxiety and anger while a greater number of close ties is associated with fewer anger, anxiety, and depression symptoms.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA.
| | - Erin M Anderson Goodell
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Hruska B, Anderson L, Barduhn MS. Multilevel analysis of sleep quality and anger in emergency medical service workers. Sleep Health 2022; 8:303-310. [PMID: 35450834 DOI: 10.1016/j.sleh.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Poor sleep quality characterizes the emergency medical service (EMS) profession. Anger is particularly affected by sleep disturbance and may be related to sleep quality at both between- and within-person levels, yet this has never been examined. The current study performed a multilevel analysis of the relationship between sleep quality and anger among EMS workers. DESIGN Ecological momentary assessment PARTICIPANTS: Seventy-nine EMS workers employed at an emergency medical service provider in Central New York. MEASUREMENTS Participants completed 8 daily assessments that inquired about sleep quality and anger. RESULTS EMS workers who typically experienced poorer sleep quality reported greater anger levels; for instance, workers who routinely experienced poor sleep quality reported anger levels that were 18%-35% higher compared to workers receiving fair sleep quality. Regardless of their typical sleep quality, days when workers experienced poorer sleep than usual was characterized by higher levels of anger: on a day when a worker experienced poorer sleep quality than usual for them, their anger levels were 5% higher on that day regardless of their typical sleep quality. CONCLUSIONS EMS workers regularly experiencing poor sleep quality experience more anger. However, even workers who typically have better sleep quality experience anger elevations following poor sleep. These findings suggest that interventions targeting both between- and within-person factors impacting sleep may be important for addressing sleep quality's influence on anger in the EMS profession.
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Affiliation(s)
- Bryce Hruska
- Department of Public Health, Syracuse University, Syracuse, NY, USA.
| | - Lauren Anderson
- Department of Public Health, Syracuse University, Syracuse, NY, USA
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Gromatsky M, Patel TA, Wilson SM, Mann AJ, Aho N, Carpenter VL, Calhoun PS, Beckham JC, Goodman M, Kimbrel NA. Qualitative analysis of participant experiences during an ecological momentary assessment study of nonsuicidal self-injury among veterans. Psychiatry Res 2022; 310:114437. [PMID: 35183989 PMCID: PMC9169428 DOI: 10.1016/j.psychres.2022.114437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
Abstract
Ecological momentary assessment (EMA) is a useful tool to investigate antecedents and consequences of nonsuicidal self-injury (NSSI), a robust predictor of Veteran suicide risk. Despite elucidating temporal changes among dynamic variables, EMA remains underutilized to study NSSI among veterans, perhaps due to concerns of safety and utility. The present study analyzed data collected from semi-structured interviews of veterans following a 28-day EMA study of NSSI, including benefits, challenges, and recommendations for improvement. Participants included 34 veterans endorsing NSSI history, most meeting criteria for NSSI Disorder. Qualitative analysis of de-identified transcripts used the rigorous and accelerated data reduction (RADaR) technique and thematic analysis. Findings revealed all veterans reported at least one emotional/social benefit to participation, including finding it therapeutic, gaining self-awareness/insight, and improved social functioning. Challenges and recommendations were primarily technology-related, including adjustment to device use. Many expressed interest in incorporation of clinical resources, use of personal devices/VA app, and ability to share responses with providers. Assessment frequency/content was never described as triggering suicidal/nonsuicidal urges and over half of participants noted urge/behavior reduction. Results support acceptability and safety of EMA for NSSI among veterans and potential clinical utility as a psychotherapy adjunct to promote self-awareness and NSSI reduction.
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Affiliation(s)
- Molly Gromatsky
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468, United States; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Tapan A. Patel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Sarah M. Wilson
- Durham Veterans Affairs (VA) Health Care System, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Adam J. Mann
- Department of Psychology, University of Toledo, Toledo, OH
| | - Natalie Aho
- Durham Veterans Affairs (VA) Health Care System, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | | | - Patrick S. Calhoun
- Durham Veterans Affairs (VA) Health Care System, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Jean C. Beckham
- Durham Veterans Affairs (VA) Health Care System, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nathan A. Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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11
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Dillon KH, Glenn JJ, Dennis PA, Mann AJ, Deming CA, Aho N, Hertzberg JS, DeBeer BB, Meyer EC, Morissette SB, Gratz KL, Silvia PJ, Calhoun PS, Beckham JC, Kimbrel NA. Affective states and nonsuicidal self-injury (NSSI): Results from an ecological momentary assessment study of veterans with NSSI disorder. Suicide Life Threat Behav 2022; 52:256-267. [PMID: 34855236 PMCID: PMC8995315 DOI: 10.1111/sltb.12818] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The affective states most strongly associated with nonsuicidal self-injury (NSSI) remain poorly understood, particularly among veterans. This study used ecological momentary assessment (EMA) to examine relationships between affect ratings and NSSI urges and behaviors among veterans with NSSI disorder. METHODS Participants (N = 40) completed EMA entries via mobile phone for 28 days (3722 total entries). Entries included intensity ratings for five basic affective states, as well as NSSI urges and behaviors, during the past 4 hours. RESULTS Bivariate analyses indicated that each affect variable was significantly associated with both NSSI urges and behaviors. Angry/hostile and sad were most strongly associated with both NSSI urges and behaviors. A multivariate regression revealed that angry/hostile, disgusted with self, and happy (inversely related) were contemporaneously (within the same period) associated with NSSI behaviors, whereas all five basic affective states were contemporaneously associated with NSSI urges. In a lagged model, angry/hostile and sad were associated with subsequent NSSI urges but not behaviors. CONCLUSIONS Findings highlight the relevance of particular affective states to NSSI and the potential utility of targeting anger in treatments for NSSI among veterans. There is a need for future EMA research study to further investigate temporal relationships between these variables.
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Affiliation(s)
- Kirsten H. Dillon
- Durham VA Health Care System, Durham, NC,Duke University School of Medicine, Durham, NC,Correspondence concerning this article should be sent to: Kirsten H. Dillon, PhD, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705,
| | - Jeffrey J. Glenn
- Durham VA Health Care System, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC
| | - Paul A. Dennis
- Durham VA Health Care System, Durham, NC,Duke University School of Medicine, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC
| | - Adam J. Mann
- Durham VA Health Care System, Durham, NC,Duke University School of Medicine, Durham, NC
| | | | - Natalie Aho
- Durham VA Health Care System, Durham, NC,Duke University School of Medicine, Durham, NC
| | - Jeffrey S. Hertzberg
- Durham VA Health Care System, Durham, NC,Duke University School of Medicine, Durham, NC
| | - Bryann B. DeBeer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX,Central Texas Veterans Health Care System, Temple, TX,Texas A&M University Health Science Center, College Station, TX
| | - Eric C. Meyer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX,Central Texas Veterans Health Care System, Temple, TX,Texas A&M University Health Science Center, College Station, TX,Baylor University Department of Psychology and Neuroscience, Waco, TX
| | | | | | | | - Patrick S. Calhoun
- Durham VA Health Care System, Durham, NC,Duke University School of Medicine, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Jean C. Beckham
- Durham VA Health Care System, Durham, NC,Duke University School of Medicine, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC
| | - Nathan A. Kimbrel
- Durham VA Health Care System, Durham, NC,Duke University School of Medicine, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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12
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Patel TA, Dillon KH, Cassiello-Robbins C, Calhoun PS, Beckham JC, Kimbrel NA. Anger, impulsivity and wall/object punching in a sample of U.S. veterans with psychiatric disorders. J Psychiatr Res 2022; 147:269-273. [PMID: 35074743 PMCID: PMC8882153 DOI: 10.1016/j.jpsychires.2022.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/16/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
Abstract
Nonsuicidal self-injury (NSSI) has been identified as one of the strongest predictors of suicide attempts. Wall/object punching is a particularly prevalent form of NSSI among male veterans that has been linked to both impulsivity and anger. The objective of the present study was to examine the indirect effect of impulsivity on wall/object punching via anger. Participants included 124 veterans (32 identified as women, 92 identified as men) with at least one psychiatric disorder. A third of the sample met criteria for NSSI disorder (33.1%) with nearly a half of the remaining sample endorsing NSSI. Almost half (41.94%) of the sample endorsed wall/object punching. Consistent with our hypothesis, impulsivity was significantly associated with anger, which was, in turn, significantly associated with wall/object punching. Impulsivity was found to be indirectly related to wall/object punching via anger. These findings underscore the significance of assessing and treating anger among veterans engaging in wall/object punching. Improving our knowledge of anger and impulsivity and their relationship with this particularly prevalent form of NSSI among veterans may lead to a better understanding of suicide risk among veterans and inform future treatments.
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Affiliation(s)
- Tapan A Patel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kirsten H Dillon
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA.
| | - Clair Cassiello-Robbins
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Jean C Beckham
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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