Psychiatric disorders among employment requiring firearms.

Individuals who carry guns as a requirement of employment frequently experience hazards that can be stress inducing, violent, traumatizing, or cause personal injury. This study used data from the Collaborative Psychiatric Epidemiological Surveys (CPES; n = 20,013), to examine mental health diagnoses of individuals that ever worked at a job requiring a firearm. Consistent with existing literature, the findings indicated that those who worked in professions requiring a firearm showed similar risk of mental health diagnoses as law enforcement officers which includes symptoms of trauma, mood disorders, and alcohol use. Further, race/ethnic differences emerged in patterns of mental health diagnoses, suggesting sociocultural differences influence diagnoses. These findings indicate the necessity for further investigation of the understudied area of mental health of those within employment positions that require firearms.

A Sample of Predominately African American Domestic Violence Victims' Responses to Objective Risk Assessments.

One area of significant concern for researchers of domestic violence is identifying the utility of objective risk assessment tools on diverse samples. This study included a sample of predominately African American women (n = 57) living in a domestic violence shelter. The study compared the Danger Assessment (DA) and the Ontario Domestic Assault Risk Assessment (ODARA) to evaluate their responses of their risk for re-abuse. Results revealed a moderate to strong correlation between the DA and ODARA (r = .73). Offender's age, habitation, and pregnancy status were not related to the victim's perceptions of risk for future abuse. Implications of these findings are discussed.

Prevalence Rates of Acute Stress Disorder Symptomatology and Association to Juvenile Crime Involvement.

Little is known about the relationship between acute stress disorder and criminal behavior among youth. This study examined data from the National Comorbidity Survey-Adolescent Supplement (NCS-A). Participants in this survey, which took place between February 2001 and January 2003, consisted of 10,148 youth between the ages of 13 and 18 years. Because the NCS-A was conducted prior to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), symptoms of posttraumatic stress disorder from the fourth edition of the DSM were mapped to DSM-5 criteria for ASD. Due to changes in the DSM-5 criteria for ASD, youth in this study were described as having "ASD symptomatology." Youth with ASD symptomatology were significantly more likely to report involvement in crimes than youth without any lifetime diagnosis, regardless of whether the crimes resulted in arrest. The data presented here provide a more accurate picture of the relationship between ASD and crime. These data suggest that it may be useful to develop prevention and intervention strategies that provide education and support to at-risk youth who develop ASD symptoms. The quality of life for untreated youth decreases significantly, and untreated youth are likely at risk for criminal involvement, suicide, and other comorbid psychiatric disorders.

E-cigarettes, alcohol use, and mental health: Use and perceptions of e-cigarettes among college students, by alcohol use and mental health status.

INTRODUCTION: Electronic cigarettes (e-cigarettes) are popular among college students, who display risky alcohol use patterns. However, little is known about patterns of co-use of e-cigarettes and alcohol. Further, relationships between e-cigarette use and mental illness among college students are unclear. METHODS: College student participants (N = 631) at a northeastern U.S. university were invited via email to participate in a survey about e-cigarettes and alcohol use. Mental health was self-reported diagnosis of psychiatric (depression, bipolar disorder, schizophrenia, PTSD, anxiety disorder, personality disorder), and substance (alcohol and other drug) use disorders. Current use of e-cigarette, combustible cigarette, and other tobacco products were assessed via self-reported past 30-day use frequency. Alcohol consumption was assessed via number of self-reported standard alcoholic beverages consumed during a typical drinking episode. Participants also reported regarding co-use of alcohol, e-cigarettes and/or combustible cigarettes. Participants were categorized as non-drinkers, moderate drinkers or binge drinkers, and associations between e-cigarette use, drinking patterns and mental health diagnoses were examined. RESULTS: E-cigarette use was associated with drinking alcohol χ2 = 18.62, p < .001, and binge drinking (vs. moderate drinking) χ2 = 12.20, p < .001. Students who had tried e-cigarettes reported drinking more alcohol per episode (χ2 = 15.94, p < .001). E-cigarette use was more prevalent among those with psychiatric and substance use disorders χ2 = 11.65, p < .001. CONCLUSIONS: Drinking college students (especially binge drinkers) and those with mental illness may have heightened risks for e-cigarette use. More research is needed to elucidate relationships between risky alcohol and/or nicotine use and mental illness, and to guide appropriate prevention and intervention efforts for vulnerable college students.

Predictors of Competency to Stand Trial in Connecticut's Inpatient Juvenile Competency Restoration Program.

There are substantial differences between adults and juveniles in the context of competency restoration. Among juveniles, factors such as maturity level, age, intellectual functioning, and psychiatric diagnoses may affect competency to stand trial. In this study, subjects included all juveniles who were admitted to the Albert J. Solnit Children's Center for inpatient competency restoration in the period spanning January 1, 2005, through December 31, 2012. Sixty-one juveniles were referred during this period, and 58 were included in the final analyses. Several demographic and clinical variables were tested to identify which factors were associated with successful competency restoration. There was a high rate of psychiatric comorbidity in the sample, with 54 of 58 juveniles (93%), having more than one Axis I disorder. IQ was the only significant predictor of successful competency restoration. These findings suggest that cognitive limitations may be a robust predictor of competency restoration among juveniles who are deemed incompetent to stand trial. Furthermore, policy makers may want to consider more specialized services for youths whose intellectual deficits are severe enough to impact their ability to regain competency. Limitations of this study, policy recommendations, and suggestions for future research are discussed.

Correlates of improvement in substance abuse among dually diagnosed veterans with post-traumatic stress disorder in specialized intensive VA treatment.

Substantial rates of substance use comorbidity have been observed among veterans with Post-Traumatic Stress Disorder (PTSD), highlighting the need to identify patient and program characteristics associated with improved outcomes for substance abuse. Data were drawn from 12,270 dually diagnosed veterans who sought treatment from specialized intensive Veterans Health Administration PTSD programs between 1993 and 2011. The magnitude of the improvement in Addiction Severity Index (ASI) alcohol and drug use composite scores from baseline was moderate, with effect sizes (ES) of -.269 and -.287, respectively. Multivariate analyses revealed that treatment in longer-term programs, being prescribed psychiatric medication, and planned participation in reunions were all associated with slightly improved outcomes. Reductions in substance use measures were associated with robust improvements in PTSD symptoms and violent behavior. These findings suggest not only synergistic treatment effects linking improvement in PTSD symptoms with substance use disorders among dually diagnosed veterans with PTSD, but also to reductions in violent behavior. Furthermore, the findings indicate that proper discharge planning in addition to intensity and duration of treatment for dually diagnosed veterans with severe PTSD may result in better outcomes. Further dissemination of evidence-based substance abuse treatment may benefit this population.

Self-reported Barriers to Treatment Engagement: Adolescent Perspectives from the National Comorbidity Survey-Adolescent Supplement (NCS-A).

The objective of this study was to assess youth self-reported treatment barriers in the past 12 months to obtain youth's perspective on reasons they seek treatment, do not engage in treatment, or terminate treatment. The present study uses data from the National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative survey administered to youth ages 13-18 that was conducted between February 1, 2001 and January 30, 2004. A total of 10,123 youth participated in the NCS-A study and provided the information on which the current paper draws its data. Within the past 12 months over 63% of youth reported seeking treatment to manage and cope with emotions. The greatest percentage of youth reported that they did not seek treatment because they wanted to handle the problem on their own (59.3%). The greatest percentage of youth reported that treatment was terminated because they wanted to handle the problem on their own (57.5%). Findings suggest professionals need to educate youth about the importance of professional treatment to increase engagement. If providers can motivate youth to see the value of treatment and help them understand that there can be positive outcomes, they may be less likely to terminate prematurely.

Crime and psychiatric disorders among youth in the US population: an analysis of the National Comorbidity Survey-Adolescent Supplement.

OBJECTIVE: Current knowledge regarding psychiatric disorders and crime in youth is limited to juvenile justice and community samples. This study examined relationships between psychiatric disorders and self-reported crime involvement in a sample of youth representative of the US population. METHOD: The National Comorbidity Survey-Adolescent Supplement (N = 10,123; ages 13-17 years; 2001-2004) was used to examine the relationship between lifetime DSM-IV-based diagnoses, reported crime (property, violent, other), and arrest history. Logistic regression compared the odds of reported crime involvement with specific psychiatric disorders to those without any diagnoses, and examined the odds of crime by psychiatric comorbidity. RESULTS: Prevalence of crime was 18.4%. Youth with lifetime psychiatric disorders, compared to no disorders, had significantly greater odds of crime, including violent crime. For violent crime resulting in arrest, conduct disorder (CD) (odds ratio OR = 57.5; 95% CI = 30.4, 108.8), alcohol use disorders (OR = 19.5; 95% CI = 8.8, 43.2), and drug use disorders (OR = 16.1; 95% CI = 9.3, 27.7) had the greatest odds with similar findings for violent crime with no arrest. Psychiatric comorbidity increased the odds of crime. Youth with 3 or more diagnoses (16.0% of population) accounted for 54.1% of those reporting arrest for violent crime. Youth with at least 1 diagnosis committed 85.8% of crime, which was reduced to 67.9% by removing individuals with CD. Importantly, 88.2% of youth with mental illness reported never having committed any crime. CONCLUSION: Our findings highlight the importance of improving access to mental health services for youthful offenders in community settings, given the substantial associations found between mental illness and crime in this nationally representative epidemiological sample.

The Effect of Social Problem Solving Skills in the Relationship between Traumatic Stress and Moral Disengagement among Inner-City African American High School Students.

This study examined the relationship between traumatic stress, social problem solving, and moral disengagement among African American inner-city high school students. Participants consisted of 45 (25 males and 20 females) African American students enrolled in grades 10 through 12. Mediation was assessed by testing for the indirect effect using the confidence interval derived from 10,000 bootstrapped resamples. The results revealed that social problem-solving skills have an indirect effect on the relationship between traumatic stress and moral disengagement. The findings suggest that African American youth that are negatively impacted by trauma evidence deficits in their social problem solving skills and are likely to be at an increased risk to morally disengage. Implications for culturally sensitive and trauma-based intervention programs are also provided.

Race and incarceration in an aging cohort of Vietnam veterans in treatment for post-traumatic stress disorder (PTSD).

Cross sectional studies have addressed the incarceration of Vietnam veterans with post-traumatic stress disorder (PTSD), but no studies have examined changes in incarceration as they age. This study examines patterns of incarceration among Vietnam veterans treated in specialized veterans affairs (VA) intensive PTSD programs over time. Data was drawn from admission data from the initial episode of treatment of Caucasian and African American Vietnam veterans entering VA specialized intensive PTSD programs between 1993 and 2011 (N = 31,707). Bivariate correlations and logistic regression were used to examine associations among race and incarceration over time and the potentially confounding influence of demographic and clinical covariates on this relationship. Rates of reported incarceration declined from 63 to 43%. Over time, African American veterans were 34% more likely than Caucasian veterans to have a lifetime history of incarceration while interaction analysis showed steeper declines for Caucasians than African Americans. Rates of incarceration among these Vietnam veterans declined as they aged. Furthermore, African American veterans were substantially more likely than Caucasian veterans to have been incarcerated and showed less decline as the cohort aged. While reduced, needs for clinical PTSD services remain among aging combat veterans.