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OBJECTIVES/BACKGROUND: Prior research identified a connection between evening chronotype and suicidality, but the mechanism underlying that connection is not well understood. The Integrated Motivational Volitional (IMV) Model of Suicide may provide a theoretical explanation for this link. The current project includes a three-time point longitudinal survey to examine whether 1) suicide intent likelihood varies across time, 2) chronotype affects suicide intent likelihood prospectively, and 3) defeat and entrapment explain the association between chronotype and suicide intent likelihood. PATIENTS/METHODS: Participants (n = 187 UK adults) completed a baseline survey (demographics, chronotype (morning-eveningness; MEQ), defeat and entrapment, and perceived intent to make a future suicide attempt), and follow-up surveys (MEQ and suicide intent likelihood) 3 and 6 months later. RESULTS: Results indicated that suicidal intent at 6-month follow-up was lower than baseline or 3-month follow-up. It was also found that strong evening chronotype at baseline is associated with increased suicidal intent 6 months later, and that defeat mediates this relationship. CONCLUSION: Our theoretically informed findings shed light on the psychological mechanisms linking chronotype (i.e., eveningness) and future suicide intent by highlighting the role of defeat and entrapment. We propose that feelings of defeat might be derived from evening types' experiences of social jetlag (resulting from conflict between biologically driven sleep schedules and externally dictated social schedules), which consequently drives entrapment and greater future suicide intent. Within this context, defeat and entrapment may be good transdiagnostic and modifiable target variables for future intervention development.

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OBJECTIVE: Contemporary approaches to suicide assessment and treatment incorporate reasons for living (RFL) and reasons for dying (RFD). This study qualitatively explored individuals' self-described RFL and RFD in the context of suicidal thinking and behaviors. METHOD: Within a community United Kingdom (UK) sample, adults (N = 331, aged 16+) responded to eight open-ended questions probing their experiences of suicide, defeat, and entrapment. Utilizing these data, which were collected from a larger online survey examining risk and protective factors for suicidal behaviors, this study explored RFL and RFD within these narratives. After the research team established an initial code book, RFL and RFD codes were subsequently analyzed through inductive and deductive thematic analyses. RESULTS: The present study identified five complimentary RFD-RFL themes: (1) Hopelessness-Hopefulness, (2) Stress of Responsibilities-Duty to Responsibilities, (3) Social Disconnection-Social Connection, (4) Death as Sin-Desire for an Afterlife, and (5) Temporary Escapes as Coping-Entrapment (i.e., a lack of escape). Three subthemes within the RFD theme Entrapment were General/Unspecified, By Feelings, and Within Self. CONCLUSIONS: Identified themes reflect the existing quantitative RFL and RFD literature. The identified RFL and RFD themes are discussed with reference to their clinical applications in advancing suicide-specific assessments and interventions. We propose a dimensional framework for RFD and RFL which informs future suicidal behaviors research and practice.

The study highlights the complex co-existence of reasons for dying and reasons for living.Reasons for living and dying should be explored in parallel in a therapeutic setting.The relative value placed on RFL/RFD by the individual should also be considered.

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BACKGROUND: Self-directed violence (SDV) comprises both suicide and self-injury and represents a pressing problem among incarcerated persons. Negative impacts of SDV in correctional settings also extend to behavioral health clinicians (BHCs) (e.g., job turnover). Correctional SDV risk assessment and management standards include staff training as part of the comprehensive approach. The Core Competency Model for Corrections (CCM-C) is a novel, evidence-informed training program for BHCs covering both clinician self-management and clinical care skills. METHODS: This pilot trial is a type 3 hybrid implementation-effectiveness approach. It will employ a wait-list control sequential cross-over design. Participants (N = 50-100) will be BHCs employed by the North Carolina Department of Adult Corrections. Following stratification for years of clinical experience, BHCs will be randomly assigned to (1) a training group that receives CCM-C immediately and (2) a wait-list control receiving CCM-C approximately 6 weeks later. Electronically administrated survey evaluation will occur across baseline and two follow-up (i.e., 2 weeks after each training session) time points. DISCUSSION: The primary outcome is feasibility assessed through collaboration with a Corrections Advisory Panel and feedback from BHCs. Secondary effectiveness outcomes that will be evaluated over time include SDV-related knowledge, attitudes, stigma, and intent to use training content. We will examine a tertiary outcome, namely compassion fatigue. Clinical trial limitations and impacts are discussed. TRIAL REGISTRATION: Clinicaltrials.gov, NCT06359574. This study was registered on 04/05/2024.

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BACKGROUND: Improved understanding of how US service members transition from chronic/baseline to acute suicide risk is warranted. One such model, the Integrated Motivational Volitional Model of Suicide, posits entrapment as central to this process. However, entrapment has not been extensively investigated within military populations. METHODS: This study examines the factor structure, reliability, and predictive validity of the Entrapment Scale (E-Scale) within a military population. Exploratory structural equation modeling (SEM) and confirmatory factor analysis compared one- versus two-factor structures of the E-Scale. Autoregressive SEM assessed if E-Scale scores predicted suicidal ideation and suicide attempt likelihood at 6- and 12-month follow-up, and examined whether the impact of entrapment was moderated by social support (i.e., appraisal, tangible, and belonging). RESULTS: Results favored a two-factor solution (external and internal) of entrapment. The relationship between entrapment and suicide outcomes was moderated by perceived social support but in unexpected directions. Unexpectedly, social support strengthened the relationship between external entrapment and suicide outcomes for most models. Only tangible support moderated the relationship between internal entrapment (IE) and suicide outcomes as predicted. CONCLUSIONS: IE is linked with suicidal ideation in the short-term, whereas external entrapments relationship with suicide outcomes may reflect more persistent social challenges for military members.

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BACKGROUND: Adverse childhood experiences (ACEs) are important factors for population mental and physical health. While considerable public health literature demonstrates the global relevance of ACEs, more recent research shows that benevolent childhood experiences (BCEs) might be important to consider in their direct and mitigating roles for psychological distress and other mental health outcomes. There is little evidence of latent class examinations involving both ACEs and BCEs among adults in western nations. The present study sought to replicate and extend prior literature by: (1) assessing the extent to which past latent class groupings reproduce in present samples, and (2) analyzing the association of latent classes of childhood experiences with psychological distress and suicidal thoughts and behaviours (STBs). We examined psychological distress (i.e., depression, anxiety, post-traumatic stress, general wellbeing) and STBs (i.e., suicidal ideation, self-harm ideation and behaviour, entrapment, and defeat). METHOD: Data were drawn from two nationwide cross-sectional online survey studies in the United Kingdom. The first sample (N = 488) was drawn from a study on suicidal behaviour, and the second sample (N = 447) was from a study concerning risk for interpersonal violence. RESULTS: Results largely replicated an existing four class solution of childhood experiences: Class 1 (Moderate ACEs/High BCEs; 17.6%), Class 2 (High ACEs/Moderate BCEs; 15.3%), Class 3 (Low ACEs/High BCEs; 48.3%), and Class 4 (Low ACEs/Moderate BCEs; 18.8%). Class 2 (High ACEs/Moderate BCEs) was associated with consistently worse psychological distress and STBs. Classes containing high BCEs (1 and 3) were characterized by generally lower levels of psychological distress and STBs. CONCLUSIONS: Results affirm the potential value for jointly considering ACEs and BCEs to understand psychological distress and STBs. ACEs and BCEs may serve foundational roles in theories of suicide. The protective role of BCEs hypothesized in resiliency theory may be supported. Prevention practice and research implications are discussed.

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BACKGROUND: Hate-motivated behaviour (HMB) ranges from microaggressions to criminal acts and is a public health concern with wide-ranging consequences. AIMS: The current study aimed to examine the mental health correlates of HMB perpetration, victimisation and co-occurring victimisation/perpetration. METHODS: Participants (n = 447) completed an online cross-sectional survey assessing demographic factors, HMB (perpetration and victimisation), positive mental wellbeing and symptoms of depression and anxiety. RESULTS: HMB victimisation was associated with lower positive mental wellbeing and increased symptoms of anxiety and depression. However, neither HMB perpetration nor co-occurring perpetration/victimisation were associated with any of the three mental health outcome measures. CONCLUSION: Experiencing HMB as a victim is linked to increased psychological distress. Additional research, which focuses on sampling populations who are known to be at greater risk for involvement in HMB, is needed to fully understand the impact of the victim-offender overlap on mental health outcomes.

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OBJECTIVES: Bystander intervention (BI) is a prevention approach commonly used for interpersonal violence, but is less studied for problematic alcohol use (PAU). Domestic graduate and international students' life experiences bring a unique context for the potential application of BI to PAU. METHODS AND MEASURES: We conducted a mixed methods study that consisted of a needs assessment and focus groups at a southeastern university in the U.S. The aims of this study were to understand (1) differences in PAU BI opportunities for domestic graduate versus international students, (2) reasons for differences in PAU BI use, and (3) barriers/facilitators in use of PAU BI. RESULTS: Overall, participants had few opportunities to use BI. Domestic graduate students had slightly more opportunities compared to international students. Most prominent reasons for lack of opportunities included not wanting to drive, the cost of drinking, and holding a graduate student identity (e.g. not interested in heavy drinking). Trusting others to be responsible for themselves was a common barrier noted for not using BI for PAU. CONCLUSION: PAU BI programs should contextualize experiences of domestic graduate and international students to provide appropriate skill development that considers unique barriers and facilitators to intervention use.

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Self-directed violence (SDV), including both suicide and non-suicidal self-injury, represents a major challenge for carceral systems. Persistent self-injury (PSI) is an understudied SDV subtype, especially within the carceral context. The present study addressed three research questions: (a) do naturally occurring SDV subgroups occur within a carceral population (e.g., PSI versus other classes); (b) how SDV groups may be differentiated by verbal or behavioral SDV; and (c) whether demographic, mental health, and incarceration-related factors are associated with SDV subgroups. We conducted a secondary analysis of existing data from a statewide carceral electronic medical record (N = 3527). Latent class analysis supports two SDV subtypes: episodic and persistent self-injury. The PSI class was characterized by significantly greater verbal expressions and behavioral acts of SDV compared to the episodic group. Correlates of the PSI subtype included older age, male sex, prior SDV, and lower depressive symptoms. Findings are discussed with respect to the proposed Diagnostic and Statistical Manual self-injury focused disorder, influential factors on SDV in carceral settings, and recommendations for future research and practice.

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OBJECTIVE: Suicide remains a public health problem within the United Kingdom (UK) and globally. Impulsivity is a key risk factor within the Integrated Motivational-Volitional Model (IMV) of Suicide warranting further study. The current study applied a multi-dimensional impulsivity framework (UPPS-P) to differentiate suicidality subgroups within an IMV framework (i.e., no suicidal behavior, suicidal ideation only, and suicide attempt). Impulsivity subscales were evaluated as moderators of the suicidal ideation-future suicide attempt link. METHOD: Adults living in the UK (N = 1027) completed an online survey addressing demographics, impulsivity, psychological distress, and lifetime suicidal behavior. We used analysis of variance (ANOVA) and linear regression with simple slopes analyses to investigate study objectives. RESULTS: Data analyses revealed that: (1) four impulsivity subtypes (negative urgency, positive urgency, lack of premeditation, sensation-seeking) differentially distinguished suicidal behavior groups; (b) negative urgency, positive urgency, and lack of premeditation were meaningfully associated with suicide outcomes, and (c) negative urgency served as a moderator of the suicidal ideation-future attempt link. CONCLUSIONS: Urgency, regardless of positive or negative valence, is important for understanding differences in lifetime suicidal behavior. Sensation-seeking may play a protective role for direct suicidal behavior. Negative urgency may be the most prominent aspect of impulsivity when considered as an IMV moderator. Findings are contextualized with respect to impulsivity and IMV frameworks. Clinical implications involve accounting for negative urgency in suicide risk assessment and intervention.

Urgency matters when differentiating persons with lifetime suicidal behavior.Negative urgency may be the most robust impulsivity IMV moderator.Suicide theory and prevention should account for the role of negative urgency.

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The Life Attitudes Schedule-Short Form (LAS-SF) is a measure of suicide proneness featuring various conceptual models. We tested four competing LAS-SF factor structures, as well as construct validity with mental health and suicide metrics. Community dwelling adults (N = 488) completed an online cross-sectional survey. Results supported a four factor (i.e., death-related, health-related, injury-related, and self-related subscales) LAS-SF structure with one higher order factor. Death-related, injury-related, and self-related subscales demonstrated moderate positive associations with mental health and suicidal ideation. Death-related and self-related subscales showed links with suicidal ideation, as well as suicide and depression risk (controlling for other factors). This study is important in highlighting suicide proneness theory may need to be refined. LAS-SF uses include possible risk screening in clinical settings and future focus on the psychological death aspects of the LAS-SF in prospective research. Study limitations include lack of sample diversity and cross-sectional design.

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Entrapment and defeat are empirically-supported suicide risk factors. Their measurement is the subject of some debate, however. Also, limited work exists examining sexual and gender minority (SGM) differences in these suicide risk factors despite overall elevated rates of suicidal thoughts and behaviors (STBs) for SGM persons. The present study examined (1) entrapment and defeat differences by sexual orientation and gender identity, (2) factor structure and criterion validity of the Entrapment Scale (E-Scale) and the Defeat Scale (D-Scale), and (3) measurement invariance by sexual orientation (subsamples were too small for gender identity). A sample of 1,027 adults living in the United Kingdom completed a cross-sectional online questionnaire assessing mental health. Analysis of Variance and Kruskal-Wallis testing revealed: (1) all sexual minority (i.e., gay/lesbian, bisexual, and other SM) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to their heterosexual counterparts, and; (2) gender minority (i.e., transgender and gender diverse) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to cisgender persons. Supported by suicide theory, confirmatory factor analysis showed modest support for a two-factor E-Scale (internal and external), and a one-factor D-Scale. All entrapment and defeat scores displayed significant moderate positive correlations with suicidal ideation. E- and D-scale scores displayed high intercorrelation, tempering confidence in conclusions regarding the facture structure findings. Item threshold-level responding varied by sexual orientation for the D-Scale but not the E-Scale. Results are discussed with respect to suicide theory and measurement, public health, and clinical practice.

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Sexual and gender minority (SGM) individuals endure a number of health disparities, such as higher rates of violence, mental health conditions, and medical concerns. These disparities are exacerbated by the fact that SGM individuals face stigmatizing health care provider and system-related experiences. The primary purpose of this study was to quantify health service providers' SGM health competency by developing a measure, namely the Health Care Competency Assessment Form-Sexual and Gender Minority Patients (HCAF-SGM). Further, we examined correlates of SGM health competency based on leading theories of prejudice, primarily the dual process model of prejudice and social identity theory. The study comprised two phases: item development and pilot testing, followed by a primary online survey administration with several health care professionals and training organizations (N = 155). Study findings supported a one-factor HCAF-SGM score, suggesting that health care providers view their competency regarding SGM individuals in a holistic manner, without differentiating between knowledge, attitude, and skill. The measure was found to be negatively associated with right-wing authoritarianism and positively correlated with specific social identities most salient to the topic of SGM health (i.e., health care professional and SGM). The HCAF-SGM shows promise as a reliable and valid assessment of perceived provider health care competency. Implications for SGM health-related measurement, clinical supervision, and training are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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BACKGROUND: Suicide is a pressing matter for the military. Not only does it pose a health risk, but suicide also compromises operational readiness. Despite provision of suicide prevention clinical best practices, the Department of Defense suffers several challenges (e.g., clinician shortages) limiting the agency's ability to effectively respond to service member suicide. Implementation of evidence-based suicide-specific group therapy is a possible solution to service member well-being needs and system challenges. Service members can also gain coping skills useful beyond managing suicidal thoughts and behaviors. METHODS: This 2-arm non-inferiority randomized controlled trial compares a group therapy format of Brief Cognitive Behavioral Therapy (i.e., G-BCBT) with Dialectical Behavior Therapy (DBT) Skills Group. Both therapies are delivered in-person at a United States Naval Medical Center. Participants (N = 136) are active-duty service members with recent suicidal thoughts or suicidal behavior. Evaluation features electronically delivered questionnaires at baseline, after each treatment session, and at 3- and 6-month follow-up. DISCUSSION: The primary outcome concerns G-BCBT impacts on suicidal ideation. Secondary outcomes of interest are suicide attempt, psychological distress (e.g., symptoms of depression, anxiety), and self-regulatory skills (e.g., emotion regulation). We also examine self-regulatory skills as treatment moderators. Clinical trial strengths and limitations are reviewed. TRIAL REGISTRATION: This study was registered at Clinicaltrials.gov (protocol NCT05401838).

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OBJECTIVES: The Integrated Motivational-Volitional Model (IMV) of Suicide is growing in empirical support. The present study advances IMV research through two aims: (1) to qualitatively probe the subjective experiences of defeat, internal entrapment, and external entrapment, and (2) conducting a 3-month prospective mediation analysis using quantitative and qualitative metrics of defeat and entrapment. METHODS: The study featured an online two-point survey separated by 3 months. Participants were 255 adults living in the United Kingdom. RESULTS: Persons endorsing qualitative defeat and internal entrapment in their narratives also showed higher quantitative scores on corresponding IMV and suicide-related self-report scales. Internal entrapment mediated the effect of baseline defeat on 3-month suicidal ideation, whereas external entrapment mediated the association of baseline defeat on 3-month suicide attempt likelihood. Quantitative assessment of entrapment was more significantly associated with suicide attempts and ideation within mediation tests compared to corresponding qualitative variables. CONCLUSIONS: IMV model principles are largely supported by findings. Mediation results support further consideration of entrapment and defeat within clinical practice and public health-focused suicide research. Understanding the complexity of entrapment narratives represents an important next step for conducting qualitative IMV-focused research with minoritized and high-risk suicide populations.

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Assessing resilience among alternative sexuality (alt-sex; e.g., kink, polyamory) community members is imperative as alt-sex individuals often face discrimination and possess intersecting marginalized identities. The Brief Resilience Scale (BRS) has extensive psychometric support; however, prior research indicates both a one- and two-factor (i.e., succumbing and resilience) structure. Further, the psychometric properties of the BRS have not been examined among alt-sex community members. As such, the current study examined the BRS factor structure among alt-sex individuals and measurement invariance across demographic groups (i.e., sexual orientation, gender identity, and sexual assault history). Confirmatory factor analyses and multi-groups invariance analyses were conducted. The two-factor BRS model demonstrated better fit to the data. Model fit did not differ by sexual orientation or gender identity. Measurement invariance was observed by lifetime sexual assault history, with higher factor loadings on succumbing items among alt-sex community members with a lifetime history of sexual assault. Our findings support use of the BRS to measure resilience among alt-sex individuals. Succumbing, or weakened resilience, is a salient factor for alt-sex community members who are sexual assault survivors, warranting further attention.

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The rate of college student mental health difficulties has been climbing, leading to overburdened college counseling centers. We propose the Holistic Prevention & Intervention Model (HPIM) as one solution in which campus and community resources work collaboratively to support students experiencing psychological distress and alleviate clinical demands. The HPIM moves from autonomous solutions to organizational-based strategies on a continuum of proactive to reactive interventions. We discuss how this model can be tailored and implemented for college campuses across the United States, including examining the resources available to the campus, the overall campus culture, and college demographics that affect risk and protective factors.

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OBJECTIVE: This paper advances understanding of the kink community by examining mental health and coping-self efficacy (CSE) variation by gender and sexual orientation. DESIGN: Adult members of the National Coalition for Sexual Freedom (N = 332) completed an online cross-sectional health assessment. MAIN OUTCOME MEASURES: The assessment included the Coping Self-Efficacy (CSE) Scale; Depression and Anxiety Stress Scale-21; and Alcohol Use Disorders Identification Test. RESULTS: Transgender and non-binary persons reported consistently low coping beliefs and poor mental health. Queer sexual minority persons reported low CSE thought stopping and high anxiety. Several CSE thought stopping moderation effects on mental health were observed. CONCLUSIONS: Findings may inform clinical implications, as bolstering coping-related beliefs and skills via cognitive-behavioral therapy may offer mental health benefit to kink practitioners.

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Access to effective, replicable services is critical to reduce known mental health disparities for sexual and gender minority or LGBTQ+ veterans (lesbian, gay, bisexual, transgender, queer, questioning, and related identities). This paper examines the impact of a manualized 10-week health education group, called PRIDE in All Who Served on veteran patient experience, protective factors (e.g., identity acceptance), and mental health outcomes (e.g., suicide risk) at 10 Department of Veterans Affairs (VA) facilities. Implementation facilitation strategies (e.g., consultation, staff training) supported adoption at new sites and initial facilitators and barriers are described. Forty-four veterans (M = 47.21 years old) completed outcome surveys before and after the group. Significant improvement in acceptance concerns, identity uncertainty, community involvement, and likelihood of future suicide attempts were observed; other changes in mental health symptoms were not replicated in this sample (e.g., depression, anxiety). Open-ended veteran feedback reflected improved social support and engagement and increased self-understanding as the most frequent themes. At the facility level, Healthcare Equality Index scores (a Human Rights Campaign measure of affirmative care climate) improved from 30% to 90% achieving top-performer/leader status from pre- to postimplementation. Manualized approaches, like PRIDE in All Who Served, that are based on established minority stress models and can be spread for use with diverse LGBTQ+ veterans (e.g., age, race, gender identity, sexual orientation, rurality, housing) are needed. The PRIDE in All Who Served program is an increasingly available resource to VA clinicians advocating for greater health equity within a national healthcare setting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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The coronavirus disease (COVID-19) pandemic has substantially impacted psychological health in the U.S and has disproportionately impacted underresourced individuals. Despite the higher need for mental health services during this time, service availability and access were disrupted due to increased demand, social distancing recommendations, and stay-at-home orders. Thus, it is crucial to understand factors that predict the desire for psychological services for underresourced individuals. The present study examined factors at multiple levels of Bronfenbrenner's socioecological model (Bronfenbrenner, 1994) to determine which factors best predicted the desire for mental health services including individual, group, in-person, and online services. The sample consisted of 155 underresourced adults in North Carolina. Participants completed an online survey of mental health symptoms, coping strategies, COVID-19 related stressors, and provided demographic information including ZIP code, which was used to classify urban-central and urban-outlying dwellers. Results from univariate general linear models demonstrated that depression symptoms, venting as a coping strategy, COVID-related stress, and living in more rural regions were all significant predictors of the desire for psychological services. Venting as a predictor of the desire for services may signify a general misunderstanding regarding the purpose of psychotherapy as well as the need for individuals to gain social support and connectedness during a pandemic. This study helps to clarify individual-level and contextual factors that impact the desire for psychological services during a global pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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Hate-motivated behavior (HMB) comprises a continuum ranging from microaggressions to criminal acts. The measurement of HMB is limited primarily to one or two minoritized groups in any given instrument. Current HMB research also lacks a way to assess the full range of acts and motivations for bias-based behavior. The present study fills gaps in HMB measurement by conducting a psychometric study of the Hate-Motivated Behavior Checklist (HMBC). The HMBC is a self-report instrument of HMB perpetration; the instrument also has sections capturing victim target group (e.g. race, sexual orientation, disability) and perpetrator motivation for HMB commission (e.g., perceived threat, impulsivity). We conducted an online cross-sectional survey of community-dwelling adults and college students (N = 463). Measures assessed demographic information, HMB, and social-political characteristics. Confirmatory factor analysis, item response theory analyses, between-groups analyses (e.g., Analysis of Variance), and descriptive statistics were used to examine HMBC properties. Primary findings included (1) poor model fit of the HMBC behaviors score; (2) good model fit with high reliability for an HMBC behaviors score adapted to binary (no/yes) scoring; (3) men reported meaningfully higher HMB scores compared to women; (4) the most common target classification for HMB was based on political affiliation; and (5) perceived intrusion was the most cited reason for committing HMB. Our findings are an important step in refining the HMBC. The instrument represents a potentially useful tool for HMB research, surveillance, and intervention evaluation. Future directions in HMBC research include application to extremist and criminal samples, replication and extension of the binary scoring to include cut-score derivation, and validation against behavioral outcomes.

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