Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System.

A comprehensive Dialectical Behavior Therapy (DBT) program was created within a VA Health Care System for patients with recent psychiatric hospitalization, suicidality and/or significant emotion dysregulation. The program was notable for being one of a relatively small number of comprehensive DBT programs in the VA system, and for including patients with psychosis and psychotic disorder, with a majority of patients (58%) having a documented history of psychosis or endorsing psychotic symptoms in assessments. We describe the process of creating this program at a VA medical center and present preliminary program evaluation data. All patients completed assessments of suicidality (C-SSRS), emotion dysregulation (DERS), skills use and dysfunctional coping (DBT-WCCL), borderline symptomatology (BSL-23), and depression (PHQ-9) at program entry and subsequently every 6-8 weeks through program completion. Suicide attempts and hospitalizations were also tracked. Twelve patients completed multiple (up to six) assessment timepoints, allowing for evaluation of change during treatment. Patients demonstrated improvements on most measures and no hospitalizations or suicide attempts during active treatment, and the subsample with psychosis showed average improvements on every outcome measure. Eleven of 12 patients completed a full six-month rotation.

Behind bars but connected to family: Evidence for the benefits of family contact during incarceration.

Incarceration separates individuals from their families and communities, strictly limiting and controlling contact with the outside world. Despite these barriers, those who maintain contact with their families during incarceration tend to function more adaptively postrelease. Within a longitudinal framework, the current study examines mechanisms (i.e., family connectedness, postrelease planning) by which contact with family during incarceration may impact postrelease functioning (i.e., recidivism, substance misuse, mental illness, community functioning), considering differences between type of contact (visits, phone calls, letters) and whether it occurred in a jail or prison setting. Participants included 507 adults incarcerated in a local jail (Mage = 32 years, SD = 10 years; 70% male; 44.3% Black, 36.4% White; 59.5% parents). Structural equation modeling results demonstrated having more frequent contact with family during incarceration predicts increases in family connectedness, which in turn predicts better mental health during the first-year postrelease. Although not related to frequency of contact, making plans for postrelease predicted adaptive community functioning during the first-year postrelease. There were no differences in the overall model based on type of contact or incarceration in a jail versus prison setting. These findings suggest maintaining contact with family during incarceration can facilitate more psychologically healthy adjustment during the stressful process of reentering society. Furthermore, incarcerated individuals should be encouraged to make plans for postrelease while still incarcerated either independently or in collaboration with family. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Nonsuicidal Self-Injury and Borderline Personality Features as Risk Factors for Suicidal Ideation Among Male Veterans With Posttraumatic Stress Disorder.

U.S. veterans are at increased risk for suicide compared to their civilian counterparts and account for approximately 20% of all deaths by suicide. Posttraumatic stress disorder (PTSD) and borderline personality features (BPF) have each been associated with increased suicide risk. Additionally, emerging research suggests that nonsuicidal self-injury (NSSI) may be a unique risk factor for suicidal behavior. Archival data from 728 male veterans with a PTSD diagnosis who were receiving care through an outpatient Veterans Health Administration (VHA) specialty PTSD clinic were analyzed. Diagnosis of PTSD was based on a structured clinical interview administered by trained clinicians. A subscale of the Personality Assessment Inventory was used to assess BPF, and NSSI and suicidal ideation (SI) were assessed by self-report. Findings revealed that NSSI (58.8%) and BPF (23.5%) were both relatively common in this sample of male veterans with PTSD. As expected, each condition was associated with significantly increased odds of experiencing SI compared to PTSD alone, odds ratios (ORs) = 1.2-2.6. Moreover, co-occurring PTSD, NSSI, and BPF were associated with significantly increased odds of experiencing SI compared with PTSD, OR = 5.68; comorbid PTSD and NSSI, OR = 2.57; and comorbid PTSD and BPF, OR = 2.13. The present findings provide new insight into the rates of NSSI and BPF among male veterans with PTSD and highlight the potential importance of these factors in suicide risk.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Autoagresiones no suicidas y características del Trastorno de Personalidad Limítrofe como Factores de Riesgo para Ideación Suicida entre Veteranos varones con Trastorno de Estrés Postraumático ALNS, TPL E IS ENTRE VETERANOS VARONES CON TEPT Los veteranos estadounidenses tienen un riesgo de suicidio mayor que su contraparte civil, dando cuenta de aproximadamente el 20% de las muertes por suicidio. El Trastorno de Estrés Postraumático (TEPT) y los síntomas del Trastorno de Personalidad Limítrofe (TPL) han sido asociados individualmente con un aumento del riesgo suicida. Adicionalmente, la investigación emergente sugiere que las autolesiones no suicidas (ALNS) pueden ser un factor de riesgo único para la conducta suicida. Se analizaron datos de archivo de 728 veteranos varones con diagnóstico de TEPT que estaban recibiendo atención a través de una clínica ambulatoria especializada en TEPT de la Administración de Salud de Veteranos (VHA, por sus siglas en inglés). El diagnóstico de TEPT se basó en una entrevista clínica estructurada administrada por clínicos entrenados. Se usó una subescala del Inventario de Evaluación de la Personalidad para evaluar TPL, y las ALNS e Ideación Suicida (IS) fueron evaluadas por auto-reporte. Los hallazgos revelaron que las ALNS (58.8%) y las características de TPL (23.5%) fueron ambas relativamente comunes en esta muestra de varones veteranos con TEPT. Como era esperado, cada condición se asoció con una probabilidad significativamente aumentada de experimentar IS comparado al TEPT solo, odds ratio (ORs) = 1.2-2.6. Más aún, la co-ocurrencia de TEPT, ALNS y TPL se asoció a una probabilidad significativamente mayor de experimentar IS comparado con TEPT, OR = 5.68; TEPT y ALNS comórbidos, OR=2.57; y TEPT comórbido con TPL, OR=2.13. Los presentes hallazgos proveen una nueva visión en las tasas de ALNS y características de TPL entre los varones veteranos con TEPT y destacan la potencial importancia de estos factores en el riesgo de suicidio.

The Subjective Court Experiences of Intimate Partner Violence Victims: Does Motherhood Matter?

Many women with children experience intimate partner violence (IPV). These survivors are particularly important to assist, because countless have complex safety concerns related to their children. Mothers' concerns about their children have been shown to impact their decision making related to abuse, but researchers have not closely explored what happens during mothers' interactions with help sources. This study examined whether women with (n = 98) and without (n = 44) children differ in a) their court experiences through their perceptions of procedural and distributive justice, and b) the context of their lives surrounding the court experience. We also explored the relationship between contextual factors and procedural and distributive justice. Results indicate participants were relatively satisfied with their court experiences, despite experiencing reabuse, danger, and fear throughout court processes. Mothers reported significantly higher levels of distributive justice and contact with the abusive partner than non-mothers. However, mothers did not differ significantly from non-mothers with regard to procedural justice, fear, danger, reabuse or reliance on the abusive partner. Results of multiple regression analyses indicated the interaction between fear and motherhood significantly predicted participants' perceptions of distributive justice, as did the interaction between danger and motherhood. In these interactions, mothers' fear and perceptions of danger were not related to their perception of distributive justice. However, non-mothers who reported higher levels of fear and danger perceived less distributive justice. Results suggest mothers and non-mothers enter the system with similar life contexts, and that these contextual factors impact their perceptions of court outcomes differently.

The Goals of IPV Survivors Receiving Orders of Protection: An Application of the Empowerment Process Model.

Protection orders (POs) are a widely recommended and commonly used intervention for intimate partner violence (IPV), but evidence for their effectiveness is mixed. This mixed methods study used the framework of empowerment to explore the goals of petitioners who seek POs, and the extent to which one group of experts considers these goals to be a good fit with the court's intent. We collected data in three phases: (a) We conducted a qualitative study to generate a list of goals (n = 10); (b) we administered the list to a sample of IPV survivors (n = 157); and (c) we surveyed a group of attorneys (n = 10). Results showed that petitioners endorse many goals for seeking POs and that while their highest priority goals relate to safety, other nearly universally endorsed goals are more psychological in nature, such as moving on with one's life. Petitioners also use the orders to navigate complex relationships, helping themselves to set boundaries in addition to sending a clear message to respondents. Our group of lawyers viewed petitioners' highest priority goals as a relatively good fit with the system, but was fairly pessimistic about the likelihood of success. Petitioners' ratings of progress toward their goals, at the time of the PO hearing, differed markedly from lawyers' perceptions. Implications for research and practice are discussed.