Comparing the interactions of risk factors by method of suicide among veterans: A moderated network analysis approach.

Despite the well-established link between firearm access and suicide, less is known about other variables that may influence the risk for death by self-inflicted gunshot versus other methods of suicide. As individual factors have demonstrated limited predictive ability, scholars have called for studies that consider the multifaceted relations between myriad variables. One alternative to the typical cause-and-effect approach for investigating various forms of psychopathology is network analysis. However, few studies have applied this method to suicidal outcomes, particularly in the context of a veteran population. Data from 19,234 male veteran suicide decedents (89.1% White; Mage = 57.16, SD = 18.64) acquired from the National Violent Death Reporting System were used to investigate characteristics of veteran suicide decedents who died by self-inflicted gunshot (gun; 66.4%) versus alternative methods (nongun, e.g., poisoning, hanging; 33.5%). Results of the overall moderated network model indicated that veterans in the gun group were more likely to have a physical health problem that contributed to the suicide than veterans in the nongun group. Additionally, results of the moderated network model revealed several pairs of associated circumstances whose relationships were significantly moderated by method of suicide, the three strongest of which included having a physical health problem that contributed to the suicide. Overall, results suggest that public health prevention and intervention efforts aimed at reducing the overall burden of physical health problems among male veterans may mitigate the risk of firearm suicides. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) anchored to one's own suicide attempt.

OBJECTIVE: Emerging evidence indicates that a nontrivial proportion of suicide attempt (SA) survivors develop clinically significant posttraumatic stress disorder (PTSD) symptoms related to their suicide attempt (SA-PTSD). However, SA-PTSD is rarely assessed in either clinical practice or research studies, due at least in part to a lack of research examining approaches to assessing SA-PTSD. This study examined the factor structure, internal consistency, and concurrent validity of scores on a version of the PTSD Checklist for DSM-5 (PCL-5) specifically anchored to one's own SA (PCL-5-SA). METHOD: We recruited a sample of 386 SA survivors who completed the PCL-5-SA and related self-report measures. RESULTS: A confirmatory factor analysis (CFA) that specified a 4-factor model consistent with the DSM-5 conceptualization of PTSD indicated that the PCL-5-SA had acceptable fit in our sample, χ²(161) = 758.03, RMSEA = 0.10, 90% CI =[0.09-0.11], CFI = 0.90, and SRMR = 0.06. The PCL-5-SA total and subfactor scores demonstrated good internal consistency (ωs = 0.88-0.95). Significant positive correlations of PCL-5-SA scores with anxiety sensitivity cognitive concerns, expressive suppression, depression symptoms, and negative affect provided evidence for concurrent validity (rs = .25-.62). CONCLUSION: Results suggest that SA-PTSD, when measured with a specific version of the PCL-5, is a conceptually coherent construct that operates consistent with the DSM-5 conceptualization of PTSD stemming from other traumatic events. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The perceived impact of pandemic scale (PIPS): Initial development and examination among U.S. military veterans.

The COVID-19 pandemic has had significant impacts, including increases in mental health problems, distress, interpersonal conflict, unemployment, loss of income, housing instability, and food insecurity. Veterans may be particularly vulnerable to such impacts given their burden of mental and physical health problems. Few existing measures assess pandemic impact, and none have been validated for use with Veterans. We developed such a measure (the Perceived Impact of the Pandemic Scale; PIPS) and examined its psychometric performance in a national sample of US Veterans. Survey data from 567 Veterans were collected between 12/2020 and 2/2021. To examine PIPS factor structure, split sample exploratory/confirmatory factor analyses (EFA/CFA) were conducted to identify and test the most plausible model among an initial set of 18 items. Based on tests of factor extraction and factor loadings, 15 items clearly loaded onto three distinct factors. Internal reliability of all factors was ω > 0.8 and CFA model fit was good (χ2(87) = 167.39, p < .001; SRMR = 0.068; RMSEA = 0.060 [95% CI: 0.05, 0.07], CFI = 0.92). Mean factor scores were significantly positively correlated with measures of depression and loneliness, and negatively correlated with perceived social support. Results suggest the PIPS assesses three internally reliable factors comprised of perceived impact of the pandemic on interpersonal relationships, financial impact, and personal health and well-being. Construct validity with US Veterans was supported. The PIPS may be useful for examining the potentially disparate impact of pandemics on different populations. Research is needed to validate the PIPS in non-Veteran populations.

Study protocol to assess de-implementation of the initial provider encounter for diagnosis and treatment of obstructive sleep apnea: the DREAM (Direct Referral for Apnea Monitoring) Project.

BACKGROUND: Obstructive sleep apnea (OSA) is a very common and serious health condition which is highly prevalent among U.S. military Veterans. Because the demand for sleep medicine services often overwhelms the availability of such services, it is necessary to streamline diagnosis and treatment protocols. The goals of this study are to, (1) assess the efficacy of de-implementing the initial provider encounter for diagnosis and treatment of OSA; (2) determine the negative predictive value (NPV) of home sleep apnea testing (HSAT); (3) develop HSAT usage recommendations for various at-risk patient populations. METHODS: This is a large, pragmatic study that will take place in 3 VA sleep medicine programs: San Francisco, CA; Portland, OR; and Pittsburgh, PA. All Veterans referred for new sleep apnea evaluations at these sites will be included in this four-year study. Outcomes will include time from referral for OSA to sleep testing and treatment; positive airway pressure (PAP) treatment adherence measures; patient-reported clinical outcomes and measures of satisfaction; determination of the NPV of HSAT; HSAT usage recommendations for at-risk patient populations. DISCUSSION: The DREAM (Direct Referral for Apnea Monitoring) Project will inform sleep medicine providers and clinical organizations regarding strategies to streamline diagnosis and treatment protocols for OSA. Results of this study should have significant impact on clinical practices and professional guidelines. Trial registration The majority of this project is an observational study of clinical procedures. Therefore, clinical trial registration is not required.

An initial investigation of the association between DSM-5 posttraumatic stress disorder symptoms and nonsuicidal self-injury functions.

OBJECTIVE: Despite the well-established link between posttraumatic stress disorder (PTSD) and nonsuicidal self-injury (NSSI), little is known about factors that may lead to self-injury among trauma-exposed individuals. Moreover, no research to date has examined these relations in the context of the newly revised Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) PTSD criteria. Thus, the purpose of the current study was to explore the associations between DSM-5 PTSD symptom clusters (i.e., intrusion, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity) and self-injury functions using a small sample of college students. METHOD: Participants (N = 81) were recruited for a lifetime history of NSSI and trauma exposure. RESULTS: Findings revealed a statistically significant path from PTSD avoidance symptoms to NSSI social functions and from PTSD negative alterations in cognitions and mood symptoms to NSSI intrapersonal functions, even after controlling for relevant covariates. CONCLUSIONS: Results of the current study highlight the importance of assessing for NSSI among trauma-exposed individuals. Considering that NSSI is a risk factor for suicidal behavior and potentially a clinically distinct diagnosis, future research should continue to explore these associations using larger, more diverse clinical samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Establishing a Reading Mindset Measure: A Validation Study.

Much attention has been given to the development and validation of measures of growth mindset and its impact on learning, but the previous work has largely been focused on general measures of growth mindset. The present research was focused on establishing the psychometric properties of a Reading Mindset (RM) measure among a sample of upper elementary school students and validating the measure via its relations with standardized measures of word reading and comprehension. The RM measure was developed to capture student beliefs about their ability, learning goals, and effort during reading. Item Response Theory (IRT) was used to select items that optimally measured the RM measure from a pool of existing items from previous research (Petscher et al., 2017). The final five-item RM measure predicted reading comprehension outcomes above and beyond the effects of word reading, indicating that this measure may be an important tool for diagnosing non-cognitive areas of improvement for developing readers. The implications, limitations, and future directions for expanding upon the measure were discussed.

Correlates of death among SARS-CoV-2 positive veterans: The contribution of lifetime tobacco use.

Despite a growing body of research examining correlates and consequences of COVID-19, few findings have been published among military veterans. This limitation is particularly concerning as preliminary data indicate that veterans may experience a higher rate of mortality compared to their civilian counterparts. One factor that may contribute to increased rates of death among veterans with COVID-19 is tobacco use. Indeed, findings from a recent meta-analysis highlight the association between lifetime smoking status and COVID-19 progression to more severe or critical conditions including death. Notably, prevalence rates of tobacco use are higher among veterans than civilians. Thus, the purpose of the current study was to examine demographic and medical variables that may contribute to likelihood of death among veterans testing positive for SARS-CoV-2. Additionally, we examined the unique influence of lifetime tobacco use on veteran mortality when added to the complete model. Retrospective chart reviews were conducted on 440 veterans (80.5% African American/Black) who tested positive for SARS-CoV-2 (7.3% deceased) at a large, southeastern Veterans Affairs (VA) hospital between March 11, 2020 and April 23, 2020, with data analysis occurring from May 26, 2020 to June 5, 2020. Older age, male gender, immunodeficiency, endocrine, and pulmonary diseases were positively related to the relative risk of death among SARS-CoV-2 positive veterans, with lifetime tobacco use predicting veteran mortality above and beyond these variables. Findings highlight the importance of assessing for lifetime tobacco use among SARS-CoV-2 positive patients and the relative importance of lifetime tobacco use as a risk factor for increased mortality.

Development of the Interpretation Bias Index for PTSD.

Cognitive models of posttraumatic stress disorder (PTSD) implicate interpretation biases as a maintaining factor of symptoms. Existing measures index symptoms and negative beliefs in PTSD patients, but not threatening interpretation of socially-ambiguous information, which would further inform cognitive models of PTSD. Here we describe the development of a measure of interpretation bias specific to individuals with PTSD. Studies 1 and 2 utilized analog samples to identify the smallest set of items capable of differentiating PTSD-specific interpretation biases. Study 3 utilized a clinical sample to examine the factor structure of the 9-item Interpretation Bias Index for PTSD (IBIP). A bifactor model fit the IBIP best, comprising a general PTSD factor and two subfactors. The IBIP was most strongly related to PTSD symptoms and demonstrated sensitivity and specificity to detecting true PTSD cases. The IBIP has potential clinical utility for tracking interpretation bias in PTSD, or even screening for PTSD diagnoses.