Guest editorial: Deconstructing disorder: An ordered reaction to a disordered environment

Dynamic suicide topic modelling: Deriving population-specific, psychosocial and time-sensitive suicide risk variables from Electronic Health Record psychotherapy notes

In the machine learning subfield of natural language processing, a topic model is a type of unsupervised method that is used to uncover abstract topics within a corpus of text. Dynamic topic modelling (DTM) is used for capturing change in these topics over time. The study deploys DTM on corpus of electronic health record psychotherapy notes. This retrospective study examines whether DTM helps distinguish closely matched patients that did and did not die by suicide. Cohort consists of United States Department of Veterans Affairs (VA) patients diagnosed with Posttraumatic Stress Disorder (PTSD) between 2004 and 2013. Each case (those who died by suicide during the year following diagnosis) was matched with five controls (those who remained alive) that shared psychotherapists and had similar suicide risk based on VA's suicide prediction algorithm. Cohort was restricted to patients who received psychotherapy for 9+ months after initial PTSD diagnoses (cases = 77; controls = 362). For cases, psychotherapy notes from diagnosis until death were examined. For controls, psychotherapy notes from diagnosis until matched case's death date were examined. A Python-based DTM algorithm was utilized. Derived topics identified population-specific themes, including PTSD, psychotherapy, medication, communication and relationships. Control topics changed significantly more over time than case topics. Topic differences highlighted engagement, expressivity and therapeutic alliance. This study strengthens groundwork for deriving population-specific, psychosocial and time-sensitive suicide risk variables.

The Trauma Recovery Actions Checklist: Applying Mixed Methods to a Holistic Gender-Based Violence Recovery Actions Measure

Gender-Based Violence (GBV) trauma recovery models have evolved in such a way that survivors are viewed as actively engaging in a multitude of strategies. In addition to seeking help and coping, survivors engage in diverse lifestyle, social, spiritual, and practical strategies to promote their health and wellbeing. This exploratory sequential mixed-methods study develops an instrument to measure the holistic recovery actions used by GBV survivors. The qualitative phase combined recovery action codes from interviews with 50 GBV survivors in three different survivor samples to create an initial six-concept 41-item Trauma Recovery Actions Checklist (TRAC). The quantitative psychometrics phase used data from 289 American GBV survivors. Results revealed a five-factor 35-item final version (sharing/connecting; building positive emotions; reflecting and creating healing spaces; establishing security; and planning the future). There were positive significant correlations between sharing/connecting and depression scores, and between sharing/connecting, reflecting, and building security with PTSD scores. No correlations were found between any recovery action type and the barriers to help-seeking subscales of Problem Management Beliefs, Discrimination, or Unavailability. However, there were significant negative correlations between Shame and Financial barriers and Sharing/Connecting, and between Feeling Frozen, Constraints, and Establishing Security. Implications for research, clinical practice and ways of understanding survivorship recovery are suggested.

Deliberate Context-Driven Conceptualization in Psychological Assessment

Clinical formulation and case conceptualization in clinical psychological assessment typically organize a client's presenting problems within a psychological framework and narrative that explains the cluster of symptoms, etiological and maintenance factors, and explaining both how and why a client is struggling or suffering. However, many of the most commonly used models of case conceptualization, as well as the preponderance of tests and measures used in psychological assessment, minimize or ignore the impacts of contextual factors, including dominant culture's expectations for normative behavior and the client's history of trauma and adverse and negative events. This paper presents a rationale and model for encouraging psychologists conducting clinical psychological assessment to be deliberate in first considering contextual factors in case conceptualization before relying entirely on primarily intrapsychic models. While contextual conceptualizations will not always replace (or join) intrapsychic models of case formulation, being deliberate and explicit about at least considering them is an important way to mitigate some of psychologists' biases and has the potential to situate a narrative of client difficulties in a way that takes at least some of the burden off the client.