Effectiveness of Dialectical Behavior Therapy (DBT) in a Forensic Psychiatric Hospital.

Dialectical behavior therapy (DBT) has strong evidence in support of its effectiveness in reducing suicide attempts, anger, impulsivity, and substance abuse. It has been implemented in a variety of forensic settings to help with these challenges, despite limited research on the efficacy of DBT within this population. The current study presents treatment outcomes from an established DBT program in a maximum-security forensic facility. Outcomes included self-reported functioning, behavioral outcomes, and assessment of DBT skills knowledge among inpatients who participated in either comprehensive DBT or DBT skills training. Behaviorally, the study found a significant decrease in rates of patient assaults and reduced use of "Pro re nata" (PRN) medication for anxiety or agitation over the course of DBT treatment. During the first six months of treatment, self-reported symptoms of depression, emotional and behavioral dysregulation, and psychological inflexibility significantly decreased. Within this time frame, patients also displayed a significant decrease in the use of dysfunctional coping skills and a significant increase in knowledge pertaining to emotion regulation and interpersonal effectiveness. The results of this study largely support the use of DBT in forensic settings.

Training, skills, and leadership experience: The need to expand clinical psychology training as illustrated by psychology leadership stories.

Training for clinical psychologists is grounded in training models emphasizing clinical work, scholarship, and research. Rigorous competencies, varying by clinical specialty area, guide the specifics of training within domains of knowledge, skills, and aptitudes-with the goal of ensuring well-trained clinical psychologists. Research further illuminates the skills, characteristics, and experiences needed to maximize the effectiveness of clinical care provided by trained clinical psychologists. In addition, data indicate that clinical psychologists spend an average of 20% of their work time in management and leadership activities beyond clinical duties of direct care, requiring expanded and additional skills beyond those formally conceptualized and broadly included in graduate training. We utilize descriptions of three clinical psychologists' leadership journeys to illustrate the gap in training filled by these bootstrapping autodidacts when successes led to promotion to higher levels of responsibility and leadership. Our proposed solution is a call to action. We call for consideration of an expansion of clinical psychology training by (a) overtly translating currently taught clinical skills into needed leadership skills to consistently fill the gap rather than relying on individuals to acquire enough experience to adequately perform the translation themselves, and (b) adding both pragmatic and theoretical leadership skills into an expanded training curriculum. We strongly urge this rethinking and expansion of training to adequately support and foster future clinical psychologists in administrative and other leadership roles. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Depression Screening at a Community Health Fair: Descriptives and Treatment Linkage.

OBJECTIVE: Health fairs are a cost-efficient platform for dissemination of preventive services to vulnerable populations. Effectiveness of depression screenings and associated treatment linkage via community health fairs warrants investigation. METHODS: This study offers the first examination of a depression screening at a community health fair in 261 adult men (18-87years). The PHQ-9 was administered via interview by graduate students and on-site psychiatric nurses were available for a brief consultation for those interested. RESULTS: Over a quarter of participants screened positive for at least moderate depressive symptomatology. Of those who screened positive, 35.8% met with an on-site psychiatric nurse for a consultation. At six-month follow-up, none of the participants given a referral made an appointment at the community mental health agency. CONCLUSION: This suggests the importance of providing on-site clinician consultations at health fairs and the need for a more coordinated system to schedule future appointments while at the event. IMPACT STATEMENT: Community health fairs reach vulnerable populations, such as those who are uninsured and who have not spoken with a professional about mental health concerns. By conducting depression screening and providing onsite access to a mental health consultation at community health fairs, participants are better able to identify their depressive symptoms and are introduced to ways to treat depression.

Connectedness to family, school, peers, and community in socially vulnerable adolescents.

Youth who feel connected to people and institutions in their communities may be buffered from other risk factors in their lives. As a result, increasing connectedness has been recommended as a prevention strategy. In this study, we examined connectedness among 224 youth (ages 12-15), recruited from an urban medical emergency department, who were at elevated risk due to bullying perpetration or victimization, or low social connectedness. Regression analyses examined multiple domains of connectedness (family, school, peer, community) in relation to adjustment. Youth who felt more connected to parents reported lower levels of depressive symptoms, suicidal ideation, non-suicidal self-injury, and conduct problems, higher self-esteem and more adaptive use of free time. Youth who felt more connected to their school reported lower levels of depressive symptoms, suicidal ideation, social anxiety, and sexual activity, as well as higher levels of self-esteem and more adaptive use of free time. Community connectedness was associated with less social anxiety but more sexual activity, and peer connectedness was not related to youth adjustment in this unique sample. Findings suggest that family and school connectedness may buffer youth on a trajectory of risk, and may therefore be important potential targets for early intervention services.

Suicidal ideation and suicide attempts among youth who report bully victimization, bully perpetration and/or low social connectedness.

The current study examined characteristics of bullying involvement and social connectedness in relation to suicide ideation and attempts in a sample of youth who report bully victimization, bully perpetration, and/or low social connectedness. The sample was comprised of 321 youth (67% female), ages 12-15 years (M = 13.6), recruited from an emergency department in the Midwest region of the United States. Results indicated that lower levels of social connectedness and higher levels of bully victimization and perpetration were significantly associated with suicide ideation and attempts. Level of social connectedness did not moderate the relationship between bullying involvement and suicide risk. The associations between the severity of subtypes of bully victimization and perpetration (verbal, relational, physical), electronic bullying involvement, and suicide risk were examined. Results highlight a continuum in severity of bullying involvement and social connectedness associated with suicide risk. Implications of these results are discussed.

Protective Role of Religious Involvement Against Depression and Suicidal Ideation Among Youth with Interpersonal Problems.

This study examined religious involvement-private religious practices (PRP), organizational religiousness (OR), and religious support (RS)-in relation to depressive symptoms and suicidal ideation (SI) and its protective role, considering youths' school and parent-family connectedness. Youth, ages 12-15 (n = 161), were screened for peer victimization, bullying perpetration, and low social connectedness, and assessed for depressive symptoms, SI, school connectedness, parent-family connectedness, and religious involvement. Results indicated PRP and RS were associated with lower levels of depressive symptoms; PRP and OR were associated with less SI. Controlling for connectedness, PRP remained associated with less SI only. Results suggest the importance of considering religious involvement as a target of youth depression and suicide prevention interventions.

Connectedness and Perceived Burdensomeness among Adolescents at Elevated Suicide Risk: An Examination of the Interpersonal Theory of Suicidal Behavior.

The interpersonal theory of suicidal behavior emphasizes the constructs of perceived burdensomeness, thwarted belongingness, and acquired capacity, which warrant investigation in adolescents at risk for suicide due to interpersonal stressors. This study examined one component of the interpersonal theory of suicidal behavior, "suicidal desire" (suicidal ideation), in 129 adolescents (12-15 years) recruited from a general medical emergency department who screened positive for bully victimization, bully perpetration, or low interpersonal connectedness. Greater perceived burdensomeness combined with low family connectedness was a significant predictor of suicidal ideation. This suggests the importance of addressing connectedness and perceptions of burdensomeness in prevention and early intervention efforts with at-risk adolescents.

Columbia-suicide severity rating scale: predictive validity with adolescent psychiatric emergency patients.

OBJECTIVE: Despite the high prevalence of psychiatric emergency (PE) visits for attempted suicide and nonsuicidal self-injury (NSSI) among adolescents, we have limited information about assessment tools that are helpful in predicting subsequent risk for suicide attempts among adolescents in PE settings. This study examined the predictive validity of a highly promising instrument, the Columbia-Suicide Severity Rating Scale (C-SSRS). METHOD: Participants were 178 adolescents (44.4% male; ages 13-17 years) seeking PE services. The C-SSRS interview and selected medical chart data were collected for the index visit and subsequent visits during a 1-year follow-up. RESULTS: A suicide risk concern was the most common chief complaint (50.6%) in this sample, and nearly one third of the adolescents (30.4%) reported a lifetime history of suicide attempt at index visit. Sixty-two adolescents (34.8%) had at least one return PE visit during follow-up. Lifetime history of NSSI predicted both return PE visits and a suicide attempt at return visit. The C-SSRS intensity scale score was a significant predictor of a suicide attempt at return visit for both the full sample of adolescents and the subsample who reported suicidal ideation at their index visit. In this subsample, one specific item on the intensity scale, duration, was also a significant predictor of both a return PE visit and a suicide attempt at return visit. CONCLUSIONS: The C-SSRS intensity scale and NSSI had predictive validity for suicide attempts at return visit. Results also suggest that duration of adolescents' suicidal thoughts may be particularly important to risk for suicidal behavior, warranting further study.

Teen options for change: an intervention for young emergency patients who screen positive for suicide risk.

OBJECTIVE: Previous research has documented the feasibility of screening in emergency departments for adolescent suicide risk. This randomized trial examined the effectiveness of Teen Options for Change (TOC), an intervention for adolescents seeking general medical emergency services who screen positive for suicide risk. METHODS: Participants were 49 youths, ages 14 to 19, seeking services for nonpsychiatric emergencies. They screened positive for suicide risk because of recent suicidal ideation, suicide attempt, or depression plus substance abuse. Youths were randomly assigned to the TOC intervention or to enhanced treatment as usual. Depression, hopelessness, and suicidal ideation were assessed at baseline and two months later. RESULTS: Adolescents assigned to TOC showed greater reductions in depression than adolescents assigned to the comparison group (Cohen's d=1.07, a large effect size). Hopelessness, suicidal ideation, and substance abuse outcomes trended positively (nonsignificantly), with small to moderate effect sizes. CONCLUSIONS: TOC may be a promising, brief intervention for adolescents seeking emergency services and at risk of suicide.