The role of relationship dissatisfaction in the dyadic associations between attachment insecurity and intimate partner violence among couples seeking therapy

Prototyping the implementation of a suicide prevention protocol in primary care settings using PDSA cycles: a mixed method study

Introduction

In Canada, approximately 4,500 individuals die by suicide annually. Approximately 45% of suicide decedents had contact with their primary care provider within the month prior to their death. Current versus never smokers have an 81% increased risk of death by suicide. Those who smoke have additional risks for suicide such as depression, chronic pain, alcohol, and other substance use. They are more likely to experience adverse social determinants of health. Taken together, this suggests that smoking cessation programs in primary care could be facilitators of suicide prevention, but this has not been studied.

Study objectives

The objectives of the study are to understand barriers/facilitators to implementing a suicide prevention protocol within a smoking cessation program (STOP program), which is deployed by an academic mental health and addiction treatment hospital in primary care clinics and to develop and test implementation strategies to facilitate the uptake of suicide screening and assessment in primary care clinics across Ontario.

Methods

The study employed a three-phase sequential mixed-method design. Phase 1: Conducted interviews guided by the Consolidated Framework for Implementation Research exploring barriers to implementing a suicide prevention protocol. Phase 2: Performed consensus discussions to map barriers to implementation strategies using the Expert Recommendations for Implementing Change tool and rank barriers by relevance. Phase 3: Evaluated the feasibility and acceptability of implementation strategies using Plan Do Study Act cycles.

Results

Eleven healthcare providers and four research assistants identified lack of training and the need of better educational materials as implementation barriers. Participants endorsed and tested the top three ranked implementation strategies, namely, a webinar, adding a preamble before depression survey questions, and an infographic. After participating in the webinar and reviewing the educational materials, all participants endorsed the three strategies as acceptable/very acceptable and feasible/very feasible.

Conclusion

Although there are barriers to implementing a suicide prevention protocol within primary care, it is possible to overcome them with strategies deemed both acceptable and feasible. These results offer promising practice solutions to implement a suicide prevention protocol in smoking cessation programs delivered in primary care settings. Future efforts should track implementation of these strategies and measure outcomes, including provider confidence, self-efficacy, and knowledge, and patient outcomes.

Relationship dynamics associated with emotional IPV perpetration and victimization: A meta-analysis

Emotional intimate partner violence (IPV) is the most common form of IPV and frequently co-occurs with other forms of IPV. Risk factors of IPV can give insight to potential pathways and consequences associated with IPV, enhancing treatment efforts. This meta-analysis examined relationship dynamics associated with IPV perpetration and victimization. Our study found victimization of controlling behavior, demand/withdrawal relationship pattern, perpetration of controlling behavior, jealousy, relationship distress, perpetrator's power in the relationship, anxious attachment, and traditional gender roles were all significantly associated with IPV perpetration. For IPV victimization, victimization of controlling behaviors, fear of the perpetrator, relationship distress, anxious and avoidant attachment, and traditional gender roles were all found to be significantly associated. Relationship satisfaction was found to be negatively associated with emotional IPV perpetration and victimization. Implications for clinicians are discussed.

Who seeks sex therapy? Sexual dysfunction prevalence and correlates, and help-seeking among clinical and community samples

Sexual dysfunctions (SD; e.g., female sexual interest/arousal disorder, erectile disorder, female orgasmic disorder, delayed ejaculation, genito-pelvic pain/penetration disorder, etc.) affect up to a third of individuals, impairing sexuality, intimate relationships, and mental health. This study aimed to compare the prevalence of SDs and their sexual, relational, and psychological correlates between a sample of adults consulting in sex therapy (n = 963) and a community-based sample (n = 1,891), as well as examine barriers to sexual health services for SD and the characteristics of individuals seeking such services. Participants completed an online survey. Analyses showed that participants in the clinical sample reported lower levels of sexual functioning and sexual satisfaction and higher levels of psychological distress than participants in the community-based sample. Moreover, higher SD rates were related to lower relational satisfaction and higher psychological distress in the community sample, and to lower sexual satisfaction in both samples. Among participants in the community sample who sought professional services for SD, 39.6% reported that they were unable to access services, and 58.7% reported at least one barrier to receiving help. This study provides important data regarding the prevalence of SD and the link between SD and psychosexual health in clinical and nonclinical samples, as well as barriers to treatment access.

Is it really that important to you? How the topics of conflict and emotional reactions to conflicts explain the associations between attachment insecurities and relationship satisfaction

This study sought to examine the intermediary roles of different topics of conflict and negative emotions following conflicts in the associations between attachment insecurities and relationship satisfaction in a sample of 253 mixed-gender couples from the community. Results from path analyses based on the Actor-Partner Interdependence Model showed that attachment anxiety and attachment avoidance were associated with the perception, in both partners, of experiencing more conflicts in the relationship. In turn, the more participants perceived conflicts related to major issues and daily annoyances, the more they reported negative emotions following conflicts and lower relationship satisfaction. Participants' report of conflicts related to major issues was also related to their partner's lower relationship satisfaction. Findings highlight the significance of accounting for the topics on which couples argue and of using an attachment-based framework to help couples deal with the negative emotions that they experience following conflicts.

Young People’s Voices and Science for Overcoming Toxic Relationships Represented in Sex Education

The scientific literature has presented evidence of how fiction series impact the socialisation of young people’s relationships. However, there is a gap in the evidence on how dialogic interactions overcome the negative impact of the fiction series on the socialisation of toxic relationships. This research analyses dialogic interactions based on scientific evidence related to toxic relationships that contribute to overcoming this type of relationship. First, we developed a communicative content analysis of eight episodes of one of the most-watched fiction series by young people, Sex Education. After that, we conducted four communicative interviews with the young audience to collect their voices about the impact of these toxic relationships represented in this fiction series in their daily conversations. The results indicate that in such cases, there is a need to promote dialogic interactions about this fiction series, focusing the dialogue on which type of masculinity develops a toxic relationship and which, on the contrary, promotes healthy relationships.

Romantic attachment, childhood stability, depression, and PTSD in couples with an incarcerated partner

Incarceration has a multitude of effects on prisoners' finances, health, education, employment, and family relationships. Incarceration complicates the maintenance of attachment bonds between romantic partners. Data from the Multi-site Family Study on Incarceration, Parenting, and Partnering were analyzed to examine the effects of childhood stability on adult romantic attachment while controlling for the effects of PTSD and depression within the carceral population. Findings indicate that posttraumatic stress disorder (PTSD) and depression have statistically significant effects on adult romantic attachment. PTSD on romantic attachment for men is statistically significant (p < 0.05) at -0.193 with an overall standardized effect of -0.086. For women, the effect is statistically significant (p < 0.01) at -0.235 with an overall standardized effect of -0.1. Effects of depression on romantic attachment for men is statistically significant (p < 0.001) -0.129 with an overall standardized effect of -0.229. For women, depression is also statistically significant (p < 0.001) at -0.153 with a standardized effect of -0.265. We examined the effects of childhood stability on adult romantic attachment while controlling for the effects of PTSD and depression within the carceral population. Findings supported our hypothesis that individuals with better childhood stability will experience better romantic attachments. Findings related to our hypothesis that having a partner with better childhood stability is positively associated with better romantic attachment produced mixed results. Clinical implications are discussed, and future directions call for research, practice, and training to improve outcomes for justice-involved romantic partners, their attachment, and consideration of covariates of depression and PTSD.