Responding to Adolescents at Risk of Suicide: Implications of the Ideation-to-Action Framework.

Though suicide is the second leading cause of death among adolescents, it continues to be difficult to predict. Recent research has led to the development of the ideation-to-action framework, which provides a new conceptualization of suicide risk. The implications of this approach for assessment and intervention in medical settings are discussed.

Life Values as an Intrinsic Guide for Cardiopulmonary Rehabilitation Program Engagement: A QUALITATIVE ANALYSIS.

PURPOSE: Participation in cardiovascular and pulmonary rehabilitation (CVPR) programs can lead to improved functional abilities and improved quality of life, but attendance and adherence to these programs remain suboptimal. Behavioral therapies have emphasized the importance of life value identification as a guide for goal setting and behavior change for both psychological and physical health conditions. Individuals who choose to engage in behaviors that align with their life values are thought to be intrinsically reinforced. The purpose of the following qualitative study was to interview patients enrolled in CVPR about their own life values and motivating factors related to healthy behavior changes. METHODS: Thirty cardiac or pulmonary patients were recruited from a CVPR program and participated in a semistructured interview about their life values and motivating factors related to program engagement. The data were transcribed and analyzed thematically. RESULTS: Participants identified a wide range of values related to program engagement, and only half of the participants endorsed health as a value. The most frequently endorsed life values included being active, family, and independence. The interviews indicated that, although patients make lifestyle changes in the program to improve their physical health, there are often other values that primarily guide their choice to engage in and maintain lifestyle behaviors. CONCLUSIONS: Life values can serve as a powerful guide for individual behavior change. The present study suggests that the piloting of brief values interventions early in CVPR treatment is warranted and has the potential to improve patient outcomes.

Mountaintop Removal Coal Mining and Emergent Cases of Psychological Disorder in Kentucky.

Although mountaintop removal (MTR) coal extraction techniques have been employed in Appalachia for decades, relatively little research has examined its potential psychological impact on people living in close proximity to MTR activity. The current study taps the State Emergency Department Database (Healthcare Cost and Utilization Project, Kentucky State Emergency Department Database, 2008) to examine the relative risk for diagnoses of depressive, substance use, and anxiety disorders originating in areas with and without MTR activity. Logistical regression analyses, controlling for ethnicity, rurality, mean income, and gender, indicated that MTR independently predicts greater risk for depressive (OR 1.37) and substance use disorders (OR 1.41), but not anxiety disorders. Overall, these findings have public health policy implications, build on other evidence of increased risk of negative mental health outcomes related to MTR, and lend some support to the validity of solastalgia related to environmental change.

Psychological health and academic success in rural Appalachian adolescents exposed to physical and sexual interpersonal violence.

Interpersonal violence (IPV) in adolescence is a serious public health concern and may have lasting behavioral effects and implications for adult relationships. Adolescents from 2 rural Appalachian high schools in 2011/2012 were surveyed using the Centers for Disease Control and Prevention Youth Risk Behavioral Surveillance (YRBS) survey, which assessed (a) physical IPV within a dating relationship, (b) sexual IPV (defined as forced sex/rape), and (c) those who experienced both. We present baseline rates of each form of IPV for these rural male and female adolescents and assessed the strength and statistical significance of these associations between physical and sexual IPV and other risk factors using χ2 tests and relative risk ratios. Results suggested that each form of IPV was associated with greater risk for depression and suicidal behaviors, substance use, risky sexual behaviors for both sexes, and lower academic grades for females. Relative risk ratios tended to be more robust and statistically significant for females compared with males on most risk behaviors. Furthermore, victimization for both forms of IPV was more pernicious for these students than either form of IPV alone. We discuss the implications of these results for students, parents, school personnel, and mental health providers in these communities. (PsycINFO Database Record

The relationship between stigma and self-reported willingness to use mental health services among rural and urban older adults.

The large number of rural older adults suffering from untreated psychiatric illnesses suggests that stigma may be a significant barrier to the utilization of mental health services in this population. The current study examines self-stigma, public stigma, and attitudes toward specialty mental health care in a community sample of older adults living in a geographically isolated rural area, a rural area adjacent to a metropolitan area, and an urban area. One hundred and 29 older adults age 60 and above from the 3 geographic areas completed self-report measures of these constructs, and differences on the measures were assessed among the groups. Results indicated that older adults living in isolated rural counties demonstrated higher levels of public and self-stigma and lower levels of psychological openness than older adults in urban areas even after accounting for education, employment, and income. However, no differences emerged in reported willingness to use specialized mental health care in the event of significant distress. Results are discussed in the context of rural values, beliefs, and community structural factors. We further suggest that conventional binary rural/urban distinctions are not sufficient to understand the relationship between rurality and stigma.

Establishing community partnerships to support late-life anxiety research: lessons learned from the Calmer Life project.

OBJECTIVES: This article outlines the development of the Calmer Life project, a partnership established between researchers and faith-based and social service organizations to examine the effectiveness of cognitive behavioral therapy (CBT) incorporating religious/spiritual components for older African Americans in low-income communities. METHOD: The program was designed to bypass several barriers to delivery of CBT within the specified community; it allows multimodal delivery (in person or by telephone) that occurs outside traditional mental health settings through faith-based organizations and neighborhood community centers. It includes religion/spirituality as an element, dependent upon the preference of the participant, and is modular, so that people can select the skills they wish to learn. Established relationships within the community were built upon, and initial meetings were held in community settings, allowing feedback from community organizations. RESULTS: This ongoing program is functioning successfully and has strengthened relationships with community partners and facilitated increased availability of education and services in the community. The lessons learned in establishing these partnerships are outlined. CONCLUSIONS: The growth of effectiveness research for late-life anxiety treatments in underserved minority populations requires development of functional partnerships between academic institutions and community stakeholders, along with treatment modifications to effectively address barriers faced by these consumers. The Calmer Life project may serve as a model.

VA community mental health service providers' utilization of and attitudes toward telemental health care: the gatekeeper's perspective.

CONTEXT: Mental health (MH) providers in community-based outpatient clinics (CBOCs) are important stakeholders in the development of the Veterans Health Administration (VA) telemental health (TMH) system, but their perceptions of these technologies have not been systematically examined. PURPOSE: The purpose of this study was to investigate the attitudes of CBOC providers about TMH services, current utilization of these technologies in their clinics, and sources of knowledge regarding TMH. METHOD: The study employed a mixed-methods design to examine aspects of TMH in CBOCs located in a VA network in the south-central United States. Semistructured, on-site group interviews conducted with 86 CBOC MH providers were followed by in-depth phone surveys with an MH provider identified as a key informant at each of 36 CBOCs in the VA network. FINDINGS: The utilization of TMH services varied widely between CBOCs, and the scope of services provided typically focused on delivery of medication management, with little provision of psychological services. Further, several important barriers to expanded use of TMH were identified, including limited education and training and shortage of dedicated space for TMH encounters. CONCLUSIONS: General attitudes toward TMH were positive, and most CBOC providers indicated that they would like to expand use of TMH in their clinics.

Diagnosis and treatment of depression and anxiety in rural and nonrural primary care: national survey results.

OBJECTIVE: Data from the 2006 National Ambulatory Medical Care Survey were examined for differences in the diagnosis and treatment of depressive and anxiety disorders in rural and nonrural primary care settings. METHODS: A sample of 11,658 patient visits to primary care providers was examined. ICD-9-CM codes were used to identify prevalence rates of depressive and anxiety disorder diagnoses. Treatments also were examined with criteria from American Psychiatric Association practice guidelines. RESULTS: No rural-nonrural differences were found in diagnosis rates for depression (about 3%) or anxiety disorders (about 1.5%). Approximately 67% of individuals with a depressive disorder and 36% of those with an anxiety disorder received a recommended treatment during the visit, with no rural-nonrural differences. CONCLUSIONS: Although few differences were found between rural and nonrural primary care visits, these data support the notion that anxiety and depression are underdiagnosed in primary care. Moreover, recognition and diagnosis often do not translate into adequate treatment in both rural and nonrural primary care settings.

Empirically supported treatments in rural community mental health centers: a preliminary report on current utilization and attitudes toward adoption.

Rural community mental health centers (CMHCs) face numerous problems that might be alleviated by the dissemination of empirically supported treatments (ESTs). The current study lays the groundwork for EST dissemination by examining current treatment practices in rural clinics as well as the attitudes of decision makers toward ESTs and perceived barriers to their adoption. Twenty-five rural and 38 non-rural clinical directors responded to a mailed survey. Rural respondents were as likely as non-rural respondents to report EST use in their clinic for most anxiety disorders, and more likely to report use of an EST for major depressive disorder and obsessive-compulsive disorder. However, ESTs represent a relatively small proportion of the treatments reported for depression and anxiety disorders. Attitudes toward manualized ESTs did not differ between groups. Further, rural and nonrural clinics did not see the barriers to the adoption of ESTs as insurmountable. These preliminary results suggest that rural CMHCs are open to the use of ESTs and should be included in widespread dissemination initiatives.

Threat-related processing supports prospective memory retrieval for people with obsessive tendencies.

Obsessive-compulsive disorder can result in a variety of deficits to cognitive performance, including negative consequences for attention and memory performance. The question addressed in the current study concerned whether this disorder influenced performance in an event-based prospective memory task. The results from a subclinical population indicated that, relative to non-anxious controls and mildly depressed controls, people with obsessive-compulsive tendencies (washing compulsions) incur decrements in remembering to respond to cues related to a neutral intention (respond to animals). This deficit was ameliorated by giving the subclinical group an intention about a threat-related category (respond to bodily fluids) and cueing them with concepts that they had previously rated as particularly disturbing to them. Thus, their normal attentional bias for extended processing of threat-related information overcame their natural deficit in event-based prospective memory.

If we build it, they might come: an empirical investigation of supply and demand in the recruitment of rural psychologists.

Past research has established that practicing doctoral level psychologists tend to cluster in metropolitan areas, leaving the rural population gravely underserved. Discussions of this problem have assumed that psychologists hold negative attitudes toward rural work for many reasons, leading to a supply shortage. The present study attempts to examine the accuracy of this hypothesis by examining attitudes of current doctoral students in clinical psychology. Eight hundred eighty-four students responded to an online survey. Results indicate that attitudes toward rural practice were not overwhelmingly negative as predicted. Additionally, a significant number of respondents endorsed positive attitudes toward rural practice. A follow-up study was conducted to determine if the shortage of rural psychologists might be attributed to a lack of demand from rural employers. A search of three popular job resources revealed that few rural jobs were advertised, indicating weak demand for psychologists in rural areas. Results indicate that efforts to recruit psychologists to rural areas should be rethought, and increasing the visibility of available opportunities for psychologists should be made a priority.