ARRIVE Together: A Qualitative Process Evaluation of the New Jersey State Police Co-responding Pilot Program

Law enforcement personnel are often first to respond to calls involving behavioral health emergencies. However, encounters with law enforcement are more dangerous and lethal for people with behavioral health conditions. Co-responding models, wherein law enforcement and behavioral health professionals respond to calls together, are among the top programs developed to improve responding to behavioral health crises. The current study describes a qualitative process evaluation of a co-responding pilot program in New Jersey: "Alternative Responses to Reduce Instances of Violence & Escalation" (ARRIVE Together). The evaluation centered on the experience of the co-responding team as to their perceptions of specific deployments and of the program implementation overall. Semi-structured interviews were conducted following 10 consecutive encounters (three interviews per encounter; February-March 2022). Transcripts were transcribed and thematically analyzed by two trained researchers independently. Once thematically analyzed, researchers determined a consensus and developed a SWOT analysis report. Thematic analysis produced six major themes: communication, staffing, training, resources, community outreach, and deployments with minors. Overall, participants were enthusiastic about the program, but they shared numerous observations about ways in which the program could be improved. Sample size, the brief follow-up window, and lack of generalizability to other contexts were among the most limiting factors. Further research should include an effectiveness evaluation and extend to urban and suburban communities and communities of color. Future research should also explore after-response affects including accessibility to follow-up care. The current study gives insight into piloting a co-responding model for approaching behavioral health crisis calls.

The impact of different neurobehavioral symptoms on suicidal ideation and perceived likelihood of future suicidality

Existing literature suggests that psychological and functional impairment, independent of head injury severity, can increase suicide risk. This study explores the impacts of self-perceived dysfunction within four neurobehavioral symptom clusters-vestibular (e.g., dizziness, balance), somatosensory (e.g., headaches, nausea, vision), affective (e.g., anxious, irritable mood), and cognitive (e.g., concentration, memory, indecision)-on current suicidal ideation and the perceived likelihood of future suicidal ideation and attempts. Community participants (n = 309; Mage = 36.88; 51.6% female; 79.6% White) completed the Neurobehavioral Symptom Inventory (NSI) and the Self-Injurious Thoughts and Behaviors-Short Form (SITBI-SF). Quantile regression analysis was used to explore the effects of the four neurobehavioral symptom clusters at different levels of suicidal ideation intensity, perceived likelihood of future suicidal ideation, and self-perceived likelihood of future suicide attempt. Controlling for past head injuries and suicide attempts, affective symptoms were significantly associated with a moderate and high average intensity of current suicidal ideation. Somatosensory symptoms were significantly associated with a moderate perceived likelihood of future suicidal ideation. Finally, vestibular symptoms were significantly associated with a moderate perceived likelihood of a future suicide attempt. These findings highlight the critical need to consider a broader spectrum of symptoms, including chronic physical symptoms, when assessing suicide risk. Furthermore, they underscore the need to expand beyond affective symptoms as an explanation for increased suicidality and examine additional mechanisms through which chronic physical symptoms can increase suicide risk.

Psychometric Properties of the MMPI-3 in a Sample of Black and White American Undergraduate Students: Examining Group Differences and Convergent/Discriminant Validity with the ASEBA Adult Self-Report

The current study examined MMPI-3 internal and external psychometric properties with a focus on the impact of racialized group membership (Black and White Americans). The second aim was to examine convergent/discriminant MMPI-3 scale associations with a different broadband, hierarchical self-report assessment tool [Adult Self-Report (ASR)]. Consistent with findings on prior MMPI iterations, we expected to observe no clinically meaningful mean differences on MMPI-3 scale T-scores. We hypothesized that validity coefficients between MMPI-3 and ASR scales measuring similar constructs would be stronger (convergent validity) and the inverse for scales measuring disparate constructs (discriminant validity). We also expected coefficient magnitude consistency across racial groups. The final sample was composed of 254 undergraduates (74.4% female; 63.8% White, 36.2% Black). Results suggest 1) MMPI-3 substantive scale mean T-scores are comparable between White and Black American undergraduates; 2) MMPI-3 scales correlate with ASR scale scores in expected ways with regard to internalizing problems, rule breaking and impulsivity, thought problems, and substance use (but not overall externalizing, aggression, attention problems, and intrusiveness); and 3) convergent and discriminant associations between MMPI-3 and ASR scales are consistent across White and Black Americans. This work provides support for MMPI-3 use with racially diverse individuals, considers next steps for understanding MMPI-3 scale score functioning in diverse populations, and provides novel information on MMPI-3 correspondence with the ASR.

An Examination of the Treatment Utility of the MMPI-2-RF: Prediction of Post-Treatment Depressive Symptoms and Increased Understanding of the Therapeutic Alliance in an Inpatient Mood Disorder Treatment

The study examined the ability of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) substantive scales to predict depressive symptoms in a psychiatric inpatient setting. The indirect effect of patient-rated alliance with their treatment team on these relationships was also investigated. Participants included 678 (52.5% female, 97.1% White) inpatients diagnosed with a mood disorder. MMPI-2-RF scales, Patient Health Questionnaire (PHQ-9) at intake and discharge, and Working Alliance Inventory-Short at discharge were used to test study hypotheses regarding MMPI-2-RF predictive utility and the influence of alliance. Jacobson and Truax's (1991) reliable change index (RCI) was calculated to identify those who did (74% of the sample) and did not (24%) make reliable and clinically significant depressive symptom change, and the predictive utility of MMPI-2-RF scores in distinguishing these groups was examined. MMPI-2-RF scales assessing internalizing and somatic dysfunction accounted for an additional 2% to 8% of the variance in depressive symptoms reported at discharge, above and beyond depressive symptoms reported at intake. Somatic scales were also able to differentiate groups based on clinically significant change on the PHQ-9 (small-sized effect). The relationship between MMPI-2-RF scales and depressive symptoms at discharge was indirect through alliance in 64% of models. Clinical implications are discussed.

Preferences for a potential therapist's suicide lived experience and use of therapy

The present study is an examination of laypersons' preferences regarding therapists with lived mental health experiences. Specifically, we investigated participants' preferences for a treatment with a therapist who has sought personal therapy, experienced suicidal ideation, or made a suicide attempt. Additionally, we explored how participants' personal experiences may impact these preferences. Three hundred ninety-eight community members were recruited to complete an online survey through Amazon's Mechanical Turk. Participants completed delayed discounting paradigms which involve choices between a therapist with the experience (e.g., suicidal ideation) and a therapist without the experience providing treatment with varied levels of therapeutic efficacy (i.e., average percentage of client recovery). Overall, participants were willing to lose therapeutic efficacy in order to work with a therapist who has not been in prior mental health treatment (9.36% efficacy loss), experienced suicidal ideation (19.43% efficacy loss), and engaged in suicide attempts (20.18% efficacy loss). Across these therapist options, the strongest preference was for therapists with prior treatment compared to the other two conditions. Preferences differed somewhat depending on the participant's social stigma, history of suicide attempts, and prior suicidal ideation; however, these effects were small in size. Overall, participants preferred less effective therapists without a history of personal therapy, suicidal ideation, and suicide attempts, compared to more effective therapists with a history of these experiences. Findings from this study highlight the pervasiveness of negative attitudes toward suicidal thoughts and behaviors and lived experience. If replicable, these results emphasize a need for destigmatization of these experiences in mental health care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Assessing the clinical utility of MMPI-2-RF interpersonal theory of suicide proxy indices in psychiatric hospitalization setting

INTRODUCTION

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF Ben-Porath & Tellegen, 2008/2011) has been applied to suicide risk assessment through derived proxy indices of perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide (Anestis et al., 2018, Joiner, 2005). However, limited research has examined the clinical utility of these proxy indices outside the outpatient setting. This study examined the performance of these proxy indices in identifying past-month suicide ideation intensity and attempts upon admission to a psychiatric inpatient program and changes in suicidal ideation intensity at discharge. We expected these indices and their interaction would be associated with suicide ideation intensity and attempts at baseline and with a lack of significant improvement in suicide ideation intensity at discharge, including when controlling for MMPI-2-RF Suicide/Death Ideation (SUI) scale scores.

METHOD

Participants were 1007 patients in a private inpatient psychiatric hospital in the southwestern United States, 968 of whom completed study measures at admission and discharge. Participants were administered the C-SSRS and MMPI-2-RF upon admission, while the C-SSRS was administered again prior to discharge. A series of moderation analyses were conducted to examine the main and interaction effects of the MMPI-2-RF derived proxy indices on suicidal ideation intensity and suicide attempts at admission. Logistic regression analyses were conducted to examine whether MMPI-2-RF proxy index scores at admission were associated with changes in suicidal ideation intensity at discharge.

RESULTS

Neither the proxy indices nor their interaction was associated with all study outcomes. The acquired capability for suicide proxy index and its interaction with other indices were not associated with suicide attempt status at admission. However, high thwarted belongingness proxy index scores were associated with greater suicidal ideation intensity at admission; high perceived burdensomeness proxy index scores were indicative of a lack of significant change in suicide ideation intensity at discharge.

CONCLUSION

These results indicate a need to further examine these proxy indices in high acuity samples.

Evaluating Measures of Externalizing Personality Pathology Traits in Black and White American Adolescents in a Program for at-Risk Youths

Adolescent personality assessment measures can aid in the identification of traits that are associated with various types of maladjustment. Externalizing personality pathology traits (e.g., antisocial, borderline, and narcissistic personality disorder features) are particularly relevant for many problematic outcomes, yet measures that assess these traits have not been validated extensively in diverse samples. The present study aimed to examine the properties of measures of externalizing personality pathology traits in a sample of White (n = 184) and Black (n = 99) adolescents participating in a residential program for at-risk youth. The fit of the proposed structure for these measures was tested in the sample as a whole and in each racial group separately. Associations between these measures and the count of disciplinary infractions received while in the program were also tested. Measures were found to have less than optimal fit in this sample, especially among Black adolescents. Suggestions for future research and clinical use of these measures are discussed.

Mental Health Treatment Seeking and History of Suicidal Thoughts Among Suicide Decedents by Mechanism, 2003-2018

IMPORTANCE

Understanding mental health and substance use treatment seeking and suicidality among suicide decedents is important to determine prevention efforts.

OBJECTIVE

To evaluate differences in treatment seeking and suicidality between suicide decedents who died by firearms and those who died by other methods.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional data were collected on 234 652 suicide decedents from 2003 to 2018. Participant information was reported by their state of residence to the National Violent Death Reporting System. Statistical analysis was performed from July 1, 2021, to January 21, 2022.

MAIN OUTCOMES AND MEASURES

Main outcomes were treatment for mental health and substance use at time of death, previous treatment for mental health and substance use, history of suicidal ideation or plans, history of suicide attempts, and disclosure of suicidal ideation or plans.

RESULTS

A total of 234 652 participants (182 520 male [77.8%]; 205 966 White [87.8%]; mean [SD] age, 46.3 [18.2] years [range, 3-112 years]) were included in this study. Compared with suicide decedents who died by another method (n = 117 526 [50.1%]), those who died by firearm (n = 117 126 [49.9%]) were more likely to have disclosed thoughts or plans of suicide within the month prior to death (odds ratio [OR], 1.16 [95% CI, 1.13-1.18]) and were less likely to have previously attempted suicide (OR, 0.44 [95% CI, 0.43-0.46]). Compared with those who died by poisoning, those who used a firearm were more likely to have had a history of suicidal thoughts or plans (OR, 1.19 [95% CI, 1.15-1.23]) and to have disclosed their thoughts or plans of suicide within the month prior to death (OR, 1.06 [95% CI, 1.03-1.10]). Compared with those who died by hanging, those who used a firearm were more likely to have disclosed their thoughts or plans of suicide to another person within the month prior to their death (OR, 1.14 [95% CI, 1.11-1.17]).

CONCLUSIONS AND RELEVANCE

These findings provide information that suggests who is at risk to die by firearm suicide. Community-based interventions in suicide prevention could help reduce access to firearms during a time of crisis. The finding that firearm suicide decedents were more likely to disclose their suicidal thoughts or plans provides an important avenue for prevention.

MMPI-3 scale predictors of reactions to ostracism in a sample of racially diverse college students

We examined the ability of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) scales to predict reflexive reactions to rejection elicited via a Cyberball task. In an effort to expand the criterion-related and incremental validity knowledge of the MMPI-3, we specifically focused on scale associations with the following adverse reflexive reactions: feelings of rejection, low positive and high negative affect, and high perceived threats to social needs. We hypothesized 10 substantive scales that assess negative emotionality, self-esteem, paranoia, and interpersonal difficulties to be positively associated with these adverse reactions, while we expected four scales indicative of interpersonal antagonism to be inversely related. The sample included 180 undergraduate students (80.6% female, 17.2% male; 59.5% White, 40.5% people of color), and analyses were conducted using the full sample and race-based subsamples. Results partially supported hypotheses, most notably in the case of indicators of mood/negative emotionality, Self-Doubt, and Self-Importance. Results were largely consistent across race-based subsamples with some notable exceptions. Our findings provide support for the validity of the MMPI-3 scales and their ability to assess reactions to an interpersonal stressor via a behavioral paradigm. Limitations (e.g., reliance on college student sample) and future directions (e.g., need for replication with larger samples) are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Dispositional characteristics in firearm ownership and purchasing behavior during the 2020 purchasing surge

RATIONALE

In 2020 the U.S. saw a firearm purchasing surge that was synchronous with the onset of the SARS-CoV-2 (COVID-19) pandemic and notable community unrest. Extant literature has highlighted a potential cohort effect among 2020 firearm purchasers and the importance of characterizing these individuals to inform policy and interventions. Dispositional traits have received minimal attention in the firearm literature overall, despite research that indicates dispositional traits impact intervention interest, access, and effectiveness.

OBJECTIVE

The current study examined two dispositional traits indicated as important in firearm research - threat sensitivity (THT) and disinhibition (DIS). We hypothesized that 1) firearm owners overall would have lower THT and higher DIS relative to non-firearm owners, 2) mean levels of DIS (but not THT) would be higher among firearm owners who purchased during the 2020 purchasing surge relative to firearm owners who did not and non-firearm owners, and 3) DIS (but not THT) would be related to future plans for purchasing such that mean levels of DIS would be highest amongst those who have plans.

METHODS

This study used an online-recruited sample (N = 3500) matched to 2010 US Census data.

RESULTS

Firearm owners demonstrated lower THT and higher DIS than non-firearm owners. 2020 firearm purchasers had higher DIS compared to non-firearm owners and non-purchasing firearm owners, while firearm owners who did not purchase had lower THT compared to non-owners and 2020 purchasers. Plans to purchase in the next 12 months was associated with higher DIS relative to those undecided or without plans.

CONCLUSIONS

In combination with prior research, findings suggest elevated DIS may drive purchasing as a danger and distress management strategy, while low THT may protect against emotion-based firearm purchasing. Further research is needed to clarify the directionality of these relationships and to identify other dispositional characteristics of those purchasing firearms in 2020.

Predicting suicide attempt history in a psychiatric inpatient sample: A replication and extension

Stanley et al. (Psychological Assessment, 2018, 20, 1249) examined Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, Minnesota Multiphasic Personality Inventory-2 Restructured Form: Manual for administration, scoring, and interpretation, 2008/2011, University of Minnesota Press) profile configurations to predict which individuals engage in suicidal behavior using an outpatient psychiatric sample. Their results revealed that an interaction of overarousal [Hypomanic Activation (RC9) or Activation (ACT)] and shutdown [Demoralization (RCd)] indicators predicted increased history of suicide attempts. The purpose of the present study was to replicate and extend these results to a psychiatric inpatient sample in order to determine their generalizability to a clinically severe, at-risk population. The present study examined 581 valid MMPI-2-RF protocols of adult psychiatric inpatients who endorsed any level of suicide ideation on the Columbia-Suicide Severity Rating Scale (C-SSRS; Posner et al., The American Journal of Psychiatry, 2011, 168, 1266) in the 2 weeks prior to admission. Results revealed that in four of the six models tested, shutdown (Low Positive Emotions [RC2], Helplessness/Hopelessness [HLP]) but not overactivation (RC9, ACT) indicators provided an additional prediction of suicide attempt history beyond Suicidal/Death Ideation (SUI) and the covariates. The two models containing RCd did not provide additional predictive value above Suicidal/Death Ideation (SUI) with main effects or interaction terms. Overall, our results do not replicate those of Stanley et al. (Psychological Assessment, 2018, 20, 1249). Furthermore, while SUI was the best predictor of a history of suicide attempts, results indicate the main effects of RC2 and HLP were negative predictors of prior suicide attempts. Limitations of the study and clinical implications of the results are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Underreporting on the MMPI-2-RF extends to extra-test measures of suicide risk

Detection of underreporting in suicide risk assessment remains a significant concern in clinical practice. The aim of this research is to examine whether underreporting based on elevated Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) K-r and L-r scale scores may aid in identifying patients with suppressed scores on the Suicide/Death Ideation scale (SUI) and extra-test measures of suicide risk. We anticipated that, in voluntarily admitted psychiatric inpatients (N = 1,011) and individuals receiving outpatient services in a university-affiliated psychology clinic (N = 521), those indicated as underreporting would produce lower mean scores across SUI and extra-test measures of suicide risk, and that the magnitudes of the associations between SUI and extra-test scores would be strongest for those underreporting. A series of t tests and correlational analyses were conducted in both samples. Although those classified as underreporting consistently produced lower mean scores for SUI and extra-test measures of suicide risk, the magnitudes of the associations were consistently significant and stronger only in outpatients without K-r or L-r scale elevations. Clinical implications for this research include examining K-r elevations when assessing suicide risk and incorporating a therapeutic assessment approach to suicide risk assessment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Assessing Physical Pain Perception and Psychological Distress Tolerance through the MMPI-2-RF: A Comparison of Multimethod Measures

While transdiagnostic factors are important domains in clinical assessment and treatment, there is little research to link such constructs to widely accepted and utilized broadband assessments such as the Minnesota Multiphasic Personality Inventory, 2nd edition - Restructured Form (MMPI-2-RF). A handful of studies suggest the ability of the MMPI-2-RF scales to capture variance in transdiagnostic constructs; however, this literature relies solely on self-report criterion measures, despite evidence that self-report and behaviorally-indexed correlates of psychopathology may measure varied aspects of the intended construct and can often yield differing results. The current study investigated MMPI-2-RF scales' ability to assess two widely examined transdiagnostic constructs, distress tolerance and pain perception, across both self-report and behavioral indicators. The sample included 115 undergraduate students who completed a valid MMPI-2-RF and multimethod measures of pain perception and distress tolerance. The results aligned with prior research in areas of internalizing symptoms, psychopathy, and suicide risk factors in self-report, but not behaviorally-based, assessment. Implications of this inconsistency, the association between clinical assessment and transdiagnostic constructs, and the heterogeneity of the distress tolerance and pain perception constructs are discussed.

Preferences regarding therapists' history of personal therapy or suicidal ideation: A comparison of undergraduates and mental healthcare providers

A majority of mental health care providers seek personal therapy (i.e., are prosumers), and many providers experience suicidal ideation. Although mental health care providers may have more awareness of mental health than undergraduates, stigma is prevalent across both mental health care professionals and within universities. Furthermore, suicidality is a particularly stigmatized aspect of mental health. Stigma may affect a client's willingness to work with therapists who are prosumers. Although client preferences have implications for treatment engagement, retention, and outcomes (Swift & Callahan, 2009, 2010; Swift, Callahan, & Vollmer, 2011), we are unaware of any research that considers clients' preferences regarding a prosumer therapist. The current study used a delay discounting paradigm to compare undergraduates' and mental health care providers' preferences of a prosumer therapist (i.e., with or without prior treatment history or prior suicidal ideation). We hypothesized that mental health care providers would be more accepting of a prosumer therapist, compared to undergraduates. Across both samples we expected a therapist with prior personal therapy to be more preferred than a therapist who has experienced prior suicidal ideation. Results were as expected, which may indicate a greater degree of mental health stigma among undergraduates compared to the mental health profession and greater stigma toward suicide in comparison to therapy experience in general. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Suicide Ideation Among Male Prisoners: Preliminary Evidence That Psychopathic Traits are Indirectly Linked to Suicide Ideation Through Thwarted Interpersonal Needs

BACKGROUND

The relation between psychopathic traits and suicide ideation (SI) is frequently discussed but little research has examined potential mechanisms underlying this association. The interpersonal theory of suicide (ITS) proposes two mechanisms in the pathogenesis of suicidal desire: thwarted belongingness (TB) and perceived burdensomeness (PB). This study cross-sectionally tested TB and PB as possible explanatory links in the relation between psychopathic traits and SI.

METHOD

Archival data from 784 male U.K. prisoners (Mage  = 37.21, SD = 9.97) were analyzed using structural equation modeling.

RESULTS

Psychopathic traits were indirectly associated with SI through more specific suicide-promoting processes - namely TB and PB. More specifically, results indicated that Egocentricity and Stimulus Seeking were indirectly associated with SI through PB and TB in combination. However, results indicated specific indirect effects of TB in the relations between the Antisocial Behavior, Egocentricity, and Stimulus Seeking facets, and SI, whereas specific indirect effects for PB were only significant in the relations between Egocentricity and Stimulus Seeking facets and SI.

CONCLUSION

Preliminary results are consistent with the ITS and suggest that psychopathic traits may be distal risk markers for SI and provide direction for future research that could inform suicide prevention efforts among male prisoners high in such traits.

Personality Assessment and Psychotherapy Preferences: Congruence between Client Personality and Therapist Personality Preferences

Consideration of client preferences has been emphasized as important to therapeutic outcomes, such as treatment engagement and retention. Although studies have investigated several client and therapist characteristics associated with client preferences, few have considered whether people have preferences regarding a potential therapist's personality. The current study extended prior research on client preferences by examining the influence of participants' Big Five personality traits on preferences for therapist personality characteristics utilizing latent profile analysis. We expected congruence between client personality traits and preferred psychotherapist personality traits. In both undergraduate and community samples, results indicated that participants generally prefer a psychotherapist with personality characteristics similar to their own. Our findings establish the presence of preferences based on personality factors and have implications for future research directions and the role of personality assessment in routine clinical practice.

Assessing the Clinical Utility of the MMPI-2-RF in Detecting Suicidal Ideation in a High Acuity, Partially-Hospitalized Veteran Sample

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) has demonstrated utility in suicide risk assessment. Limited research with the MMPI-2-RF in higher acuity populations exists, particularly regarding the impact of possible underreporting on prediction of suicide risk. The current study serves to extend previous findings of the utility of clinically indicated MMPI-2-RF scales and proxy indices in 293 veterans (83.62% White, 85.32% male, and 74.40% with past-week suicide ideation) enrolled in a Veterans Affairs Medical Center partial psychiatric hospitalization program. Differences in self-report indicators and MMPI-2-RF scales and proxy indices relevant in assessing suicide ideation between veterans indicated as possibly underreporting and those who were not and the ability of the scales and proxy indices to predict current suicide ideation were examined. These indicators, scales, and proxy indices, with the exception of SUI, were significantly impacted by underreporting, and none of the examined scales or proxy indices (or their interaction) were consistently associated with self-reported suicide ideation after accounting for SUI. However, SUI was consistently associated with suicide ideation and was less influenced by under-reporting. In acutely ill psychiatric patients, SUI may be the most robust indicator of current suicide ideation.

The Validity of the Personality Assessment Inventory-Adolescent in Assessing Callous-Unemotional Traits in At-Risk Adolescents

This study examines the validity of the Personality Assessment Inventory-Adolescent (PAI-A; Morey) in assessing callous-unemotional (CU) traits within two independent samples of at-risk adolescents from a residential intervention program. The study tests the extent to which CU traits are represented within PAI-A scales with respect to empirically- or theoretically-related indicators, such as antisociality, aggression, low warmth, low social connectedness, and subdued internalizing psychopathology. The PAI-A substantive scales statistically accounted for an average of 55.0% of the variance in total scores on the Inventory of Callous-Unemotional Traits (ICU; Frick) across samples. Broadly, PAI-A substantive scales evinced theoretically-consistent relations with CU traits. Consistent with expectations, CU traits were broadly related to PAI-A-assessed constructs of antisocial features, aggression, low warmth and social disconnection, but not to subdued internalizing symptoms. Moreover, some of the PAI-A clinical, treatment consideration, and interpersonal scales or subscales demonstrated differential relations across the traits. Implications for assessment of CU traits using the PAI framework are discussed. Overall, this research adds to the literature on CU traits in broadband personality assessment and provides a foundation for future research on CU traits using the PAI-A.

Psychopathic Traits' Differential Relations With Aggression Forms: Considering the Roles of Gender and Gender Role Adherence

Research has yielded inconsistent findings between psychopathy and aggression, with findings varying as a function of type of psychopathic trait (i.e., affective, behavioral) and aggression form (i.e., physical, relational). Although some research has explored the role of gender in these relations, gender role adherence has received scant attention. Using an undergraduate sample (N = 320), we aimed to clarify mixed findings on how psychopathic traits relate to aggression forms across males and females; examine how psychopathic traits relate to gender role adherence; and ascertain the roles of gender and gender role adherence in the relations between psychopathic traits and aggression. Psychopathic traits manifested differential relations with gender role adherence such that Psychopathic Personality Inventory-Revised (PPI-R) Fearless Dominance was most strongly and positively associated with Bem Sex-Role Inventory (BSRI) Masculinity, whereas PPI-R Self-Centered Impulsivity and Coldheartedness were negatively associated with BSRI Femininity. BSRI Masculinity and Femininity were uniquely and differentially associated with aggression forms, and remained associated with aggression forms above and beyond both psychopathy and gender. In addition, BSRI Masculinity moderated the relations between PPI-R Self-Centered Impusivity and physical aggression such that those high in both Masculinity and Self-Centered Impulsivity were most prone to physical aggression. In contrast, although BSRI Femininity was negatively associated with aggression, it did not buffer against aggression in the presence of psychopathic traits. Overall, our results underscore the importance of considering gender role adherence in understanding differences in psychopathy and aggression.

An Examination of Triarchic Psychopathy Constructs in Female Offenders

This study sought to expand scientific knowledge on psychopathic personality traits in female offenders by evaluating the relationship between MMPI-2-RF triarchic scales and self-reported external variables in a sample of 205 female offenders. Results indicated that boldness was inversely related to internalizing dysfunction, including suicidal behavior, psychosis, youth conduct problems, problems stemming from alcohol use, and a history of outpatient mental health treatment. Meanness was positively related to internalizing dysfunction as well as youth conduct problems, anger, prison disciplinary reports, and psychosis. Disinhibition was associated with a history of abuse in childhood, suicidal behavior, internalizing dysfunction, problems associated with alcohol and drug use, family history of mental illness, prison disciplinary reports for violence, number of previous criminal charges, and anger. Consistent with views of psychopathy as a configural condition, interactive effects of boldness with disinhibition and meanness were observed for multiple key external variables (e.g., conduct problems, substance use, nonsuicidal self-injurious behavior). This study provides further evidence for the triarchic conceptualization of psychopathy in female offenders and lends additional support for the validity of MMPI-2-RF triarchic psychopathy scales.

Investigating the Relationship Between Social and Economic Policy Views, Firearm Ownership, and Death by Firearm in a Sample of Suicide Decedents

Extant literature provides evidence for the frequent use and lethality of firearms in suicide and the ability of means safety measures to prevent suicides; however, little evidence exists to provide an understanding of the characteristics that differentiate suicide decedents who die by firearm from those who die by other methods. In this study, we build on prior findings regarding the characteristics of those who die by firearms by examining the relationship between social and economic policy views and both firearm ownership and death by firearm in a sample of 160 American suicide decedents. We hypothesized that individuals with more conservative social and economic policy views would have higher rates of firearm ownership and would be more likely to die by firearm than would individuals with more liberal social and economic policy views. Furthermore, we hypothesized that differences in the likelihood of dying by a firearm would be accounted for by firearm ownership, providing preliminary evidence for a specific mechanism through which risk for death by firearm is conferred. As expected, suicide decedents with conservative social and economic policy views owned firearms at higher rates than did decedents with moderate or liberal views. The use of a firearm, the most common method across all decedents, was higher in individuals with conservative policy views. These results represent a novel angle from which to consider the importance of means safety efforts focused on firearm ownership and storage and limit concerns that firearm specific suicide research has relied too heavily on samples that are not representative of typical American suicide decedents.

Psychopathic personality traits as a form of dispositional capability for suicide

The capability to enact lethal self-harm has recently been highlighted as a critical risk factor for suicidal behavior. Klonsky and May's (2015) three step theory of suicide (3ST) expanded upon the construct of the capability for suicide by dividing it into categories: dispositional, acquired, and practical. The current study examined constructs of Patrick and colleagues' (2009) triarchic model of psychopathy as indicators of dispositional capability in gun owners, a sample at heightened risk for death by suicide (Anestis and Houtsma, 2017). We anticipated that specific psychopathic traits would exhibit robust associations with other components of the capability for suicide. In a sample of 300 gun-owning adults, Boldness was uniquely related to all indicators of practical capability in both male and female gun owners, and a Boldness*Meanness interaction predicted the highest levels of some capability components. These results are consistent with theoretical conceptualizations of the triarchic model. Our findings indicate that, among US gun owners, dispositional factors may impact comfort with and aptitude with guns, which may enhance our understanding of which gun owners are at the greatest risk of gun suicide should they develop suicidal thoughts.

Differentiating suicide decedents who died using firearms from those who died using other methods

Studies have documented a link between gun ownership and suicide, but little is known about characteristics of those most likely to use a gun in a suicide attempt rather than alternative methods. We examined which factors differentiate suicide decedents who died using a gun from those who died by other methods. We further examined whether such findings are consistent within the subcomponent of our larger sample comprised entirely of gun owning suicide decedents. Data reflect 267 suicide decedents, with data provided by individuals who identified as having lost someone to suicide (loss survivors). Within the full sample, a higher proportion of gun-owning and male suicide decedents died by firearm. Further, individuals who had previously discussed suicide or engaged in one or more non-lethal suicide attempts were less likely to die by suicide using a gun. Within the subsample of gun owning suicide decedents, a greater proportion of decedents who stored guns at home and in unsecure locations died from self-inflected gunshot wounds. These findings add clarity to the relationship between firearm ownership and death by suicide at the individual level. Furthermore, these findings are consistent with the notion that means safety implementation may represent a vital suicide prevention tool.

Handgun Legislation and Changes in Statewide Overall Suicide Rates

OBJECTIVES

To examine the extent to which 4 laws regulating handgun ownership were associated with statewide suicide rate changes.

METHODS

To test between-group differences in statewide suicide rate changes between 2013 and 2014 in all 50 states and the District of Columbia with and without specific laws, we ran analyses of covariance.

RESULTS

We found significant differences in suicide rate changes from 2013 to 2014 in states with mandatory waiting periods and universal background checks relative to states without such laws. States with both laws differed significantly from those with neither. No significant differences in rate changes were noted for open carry restrictions or gun lock requirements.

CONCLUSIONS

Some state laws regulating aspects of handgun acquisition may be associated with lower statewide suicide rates. Laws regulating handgun storage and carrying practices may have a smaller effect, highlighting that legislation is likely most useful when its focus is on preventing gun ownership rather than regulating use and storage of guns already acquired. Public Health Implications. The findings add to the increasing evidence in support of a public health approach to the prevention of suicide via firearms, focusing on waiting periods and background checks.

Examination of MMPI-2-RF Substantive Scales as Indicators of Acute Suicidal Affective Disturbance Components

A new suicide-specific diagnostic entity, acute suicidal affective disturbance (ASAD), was recently proposed to fill a void in the nomenclature. Although several studies have examined the reliability, validity, and potential clinical utility of ASAD, no studies have examined personality indicators of ASAD. This study sought to examine the association between personality and psychopathology factors, as assessed by the Minnesota Multiphasic Personality Inventory-2-Revised Form (MMPI-2-RF), and constructs that comprise ASAD in a sample of 554 psychiatric outpatients who completed all measures prior to their intake appointments. A smaller subset of patients (N = 58) also completed a measure designed to assess lifetime ASAD symptoms. Results indicated that ASAD symptoms were associated with traits characterized by emotional turmoil and atypical cognitive processes. Further, suicide-related criteria that comprise ASAD were related to low positive emotionality and hopelessness, whereas the overarousal criteria were associated with somatic symptoms and an inability to tolerate frustration and stress. These findings expand on previous research that examines the convergent and discriminant validity of ASAD and could inform clinical treatment by providing insight into personality traits that might be associated with acute suicide risk.

Understanding the Relationship Between Suicidality and Psychopathy: An Examination of the Interpersonal-Psychological Theory of Suicidal Behavior

A number of studies have reported a bifurcated relationship between psychopathy and suicidality, such that suicidality is positively related to Factor 2 (impulsive-antisocial lifestyle) of psychopathy but negatively related or unrelated to Factor 1 (affective-interpersonal deficits). The present study aims to expand these findings by investigating this relationship through the lens of the interpersonal-psychological theory of suicidal behavior across both undergraduate and forensic samples. We hypothesized that, although both Factors 1 and 2 would be associated with the acquired capability for suicide, Factor 2 would exhibit a unique relationship with suicidal desire (perceived burdensomeness and thwarted belongingness). Results were largely supportive of these hypotheses, although differences were noted across samples and measures. Findings highlight the importance of precision in the assessment of antisociality and suggest potential differences in the construct of psychopathy between non-criminal and criminal samples.

Burdensomeness, Belongingness, and Capability: Assessing the Interpersonal–Psychological Theory of Suicide With MMPI-2-RF Scales

Given the emerging body of literature demonstrating the validity of the interpersonal–psychological theory of suicide (IPTS), and the importance of increasing our understanding of the development of risk factors associated with suicidal behavior, it seems worthwhile both to expand IPTS research via Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) correlates and to expand the availability of methods by which to assess the constructs of the IPTS. The present study attempted to do so in a large adult outpatient mental health sample by (a) inspecting associations between the IPTS constructs and the substantive scales of the MMPI-2-RF and (b) exploring the utility of MMPI-2-RF scale–based algorithms of the IPTS constructs. Correlates between the IPTS constructs and the MMPI-2-RF scales scores largely followed a pattern consistent with theory-based predictions, and we provide preliminary evidence that the IPTS constructs can be reasonably approximated using theoretically based MMPI-2-RF substantive scales. Implications of these findings are discussed.

Suicide Rates and State Laws Regulating Access and Exposure to Handguns

OBJECTIVES

Using previous research, we examined the impact of 4 handgun laws (waiting periods, universal background checks, gun locks, and open carrying regulations) on suicide rates.

METHODS

We used publicly available databases to collect information on statewide laws, suicide rates, and demographic characteristics for 2013.

RESULTS

Each law was associated with significantly lower firearm suicide rates and the proportion of suicides resulting from firearms. In addition, each law, except for that which required a waiting period, was associated with a lower overall suicide rate. Follow-up analyses showed a significant indirect effect on overall suicide rates through the proportion of suicides by firearms, indicating that the reduced overall suicide rate was attributable to fewer suicide attempts, fewer handguns in the home, suicide attempts using less lethal means, or a combination of these factors. States that implemented any of these laws saw a decreased suicide rate in subsequent years, whereas the only state that repealed 1 of these laws saw an increased suicide rate.

CONCLUSIONS

Our results were supportive of a potentially vital role in suicide prevention for state legislation that limits access and exposure to handguns.

Measuring Moral Injury: Psychometric Properties of the Moral Injury Events Scale in Two Military Samples

As the construct of moral injury has gained increased conceptual and empirical attention among military personnel and veterans, preliminary attempts to operationalize and measure the construct have emerged. One such measure is the Moral Injury Event Scale (MIES). The aim of the current study was to further evaluate the MIES's psychometric properties in two military samples: a clinical sample of Air Force personnel and a nonclinical sample of Army National Guard personnel. Exploratory and confirmatory factor analyses across both samples supported a three-factor solution: transgressions by others, transgressions by self, and betrayal. Transgressions-Others was most strongly associated with posttraumatic stress; Transgressions-Self was most strongly associated with hopelessness, pessimism, and anger; and Betrayal was most strongly associated with posttraumatic stress and anger. Results support the construct validity of the MIES, although areas for improvement are indicated and discussed.

Stopping the revolving door: effectiveness of mental health court in reducing recidivism by mentally ill offenders

OBJECTIVES

This study compared recidivism outcomes among criminal offenders with mental illness who were assigned to a mental health court (MHC) or a traditional criminal court. It also explored potential differences in outcomes between subgroups of offenders, including felony and misdemeanor offenders and violent and nonviolent offenders.

METHODS

Data were obtained from court databases. Offenders in the MHC (N=198) and the traditional criminal court (N=198) were matched by propensity scores and followed for 12 months after the index offense. Data for the 12 months preceding the index offense were obtained for MHC participants. Intent-to-treat analyses were conducted, using both between-group and within-subjects designs.

RESULTS

After control for covariates, logistic and Cox regressions indicated that MHC assignment predicted a lower overall rate of recidivism and longer time to rearrest for a new charge compared with assignment to traditional court. The groups did not significantly differ on the severity of the offense associated with rearrest. The findings largely held for felony, misdemeanor, violent, and nonviolent offenders, with the exception of analyses involving time to rearrest for violent offenders. Within-subjects analyses suggested that after MHC participation, there were improvements in occurrence of rearrest and time to rearrest but a tendency for rearrest to be associated with more severe offenses. Within the MHC group, recidivism outcomes did not significantly differ by class of offense.

CONCLUSIONS

The results suggest that an MHC can be effective in reducing recidivism among offenders with mental illness and also indicate that persons who commit more severe offenses may be appropriate candidates for MHC.

Reading the Road Signs

This study examined the utility of the Minnesota Multiphasic Personality Inventory–2 Restructured Form (MMPI-2-RF) Validity Scales in prediction of premature termination in a sample of 511 individuals seeking services from a university-based psychology clinic. Higher scores on True Response Inconsistency–Revised and Infrequent Psychopathology Responses increased the risk of premature termination, whereas higher scores on Adjustment Validity lowered the risk of premature termination. Additionally, when compared with individuals who did not prematurely terminate, individuals who prematurely terminated treatment had lower Global Assessment of Functioning scores at both intake and termination and made fewer improvements. Implications of these findings for the use of the MMPI-2-RF Validity Scales in promoting treatment compliance are discussed.

The Utility of MMPI-2-RF Substantive Scales in Prediction of Negative Treatment Outcomes in a Community Mental Health Center

This study examined the utility of the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) substantive scales in the prediction of premature termination and therapy no-shows while controlling for other relevant predictors in a university-based community mental health center, a sample at high risk of both premature termination and no-show appointments. Participants included 457 individuals seeking services from a university-based psychology clinic. Results indicated that Juvenile Conduct Problems (JCP) predicted premature termination and Behavioral/Externalizing Dysfunction and JCP predicted number of no-shows, when accounting for initial severity of illness, personality disorder diagnosis, therapist experience, and other related MMPI-2-RF scales. The MMPI-2-RF Aesthetic-Literary Interests scale also predicted number of no-shows. Recommendations for applying these findings in clinical practice are discussed.

The influence of gender role on the prediction of antisocial behaviour and somatization

BACKGROUND

Previous research has demonstrated a sex-differentiated relationship between antisocial behaviour and somatization. One explanation posited is that societal expectations about male and female behaviour may influence a sex-differentiated expression of a common diathesis, but this idea has not been directly tested.

AIMS

The current study examined the potential contribution of gender role in the prediction of antisocial and somatic symptomatology, controlling for biological sex, impulsivity and negative affect.

METHODS

Linear regression was used to examine the influence of gender role on somatic and antisocial symptomatology. Path analysis was used to examine whether relationships among these variables differed significantly for men and women. Participants were 349 undergraduate students in southeastern USA.

RESULTS

Masculine gender role was positively related to antisocial behaviour, while feminine gender role was negatively related to antisocial behaviour. Gender role did not predict somatization.

CONCLUSIONS

Gender role may be important to the expression of antisocial behaviour, but does not influence somatic symptoms. Current findings underscore the need to consider that observed sex differences in antisocial behaviour might actually be affected by gender role, and highlight the importance of considering societal expectations of male and female behaviour when examining apparent sex differences in behaviour.

Examining the Impact of Gender on the Factor Structure of the Psychopathic Personality Inventory—Revised

Research on the factor structure of psychopathy has yielded mixed results, supporting anywhere from one to three factors. Additionally, most of this research has used all-male samples, and the possibility of structural invariance across gender has not been examined. Using a mixed-gender sample of 360 undergraduates, the factor structure of the Psychopathic Personality Inventory—Revised was examined using confirmatory factor analysis and multiple group analysis. One-, two-, and three-factor models were tested and compared with each other. When males and females were combined, none of the three models provided adequate fit to the data. Multiple group analyses revealed partial invariance across gender for all three models. Model comparison criteria supported use of both the one- and two-factor models, taking into account variable factor structure across gender. The importance of considering structural differences based on biological sex when assessing psychopathic traits is discussed.

When it comes to evaluating psychodynamic therapy, the devil is in the details

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). As Shedler noted, some researchers have reflexively and stridently dismissed psychodynamic therapy (PT) as ineffective without granting outcome studies on this modality a fair hearing. We applaud Shedler's efforts to bring PT into the scientific mainstream and hope that his article encourages investigators to evaluate claims regarding PT's efficacy with a more objective eye. Nevertheless, as Shedler also observed, one reason for the scientific community's premature dismissal of PT is traceable to some psychodynamic practitioners' historical antipathy toward controlled research and propensity to overstate PT's efficacy. Regrettably, Shedler falls prey to the latter error by glossing over key methodological details, ignoring crucial findings that run counter to his position, and overstating the quality and quantity of the evidence base for PT. Because of space constraints, we focus only on a handful of the more serious shortcomings of Shedler's analysis (a more complete review of these issues is available from the first author on request).

Examination of racial differences on the MMPI-2 clinical and restructured clinical scales in an outpatient sample

The current study examined the possibility of differential predictive accuracy of selected Minnesota Multiphasic Personality Inventory-Second Edition (MMPI-2) clinical and Restructured Clinical (RC) scales in a group of Black and White mental health center clients. Results indicate that Black clients scored higher than White clients on one non-K-corrected clinical scale and 4 RC scales. All these differences produced medium effect sizes and were clinically significant according to Greene's (1987) criterion. These differences, however, were not accompanied by differential predictive accuracy of the scales in Black versus White clients. Although additional research is needed, especially on the RC scales, this study indicates that the MMPI-2 is not a biased predictor of symptomatology for Black versus White test takers.