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Britton PC, Karras E, Stecker T, Klein J, Crasta D, Brenner LA, Pigeon WR. The Veterans Crisis Line: Relations among immediate call outcomes and treatment contact and utilization following the call. Suicide Life Threat Behav 2024. [PMID: 38687175 DOI: 10.1111/sltb.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Crisis line callers experience reductions in distress and suicidal ideation and utilize more health care following calls. The purpose of this study was to determine whether changes in distress and suicidal ideation during a call are associated with later healthcare contact and utilization. METHOD Veterans Crisis Line calls from 599 veterans were extracted with call dates between 12/1/2018 and 11/30/2019. Calls were coded for changes in distress and suicidal ideation and linked with VA medical records to obtain healthcare data. Generalized Linear Mixed Modeling was used to examine the associations of changes in distress and suicidal ideation with healthcare contact (yes/no) and utilization (days of treatment) in the month (30 days) following the call. RESULTS Reductions in distress were associated with behavioral (i.e., mental and substance use) healthcare utilization, F(1, 596) = 4.52, p = 0.03, and reductions in suicidal ideation were associated with any healthcare utilization, F(1, 596) = 6.45, p = 0.01. Changes in distress and suicidal ideation were not associated with healthcare contact. CONCLUSION Responders need to help resolve distress and suicidal ideation and link callers with treatment. Unresolved distress and suicidal thoughts may signify later problems with treatment utilization. Research is needed to determine causality.
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Affiliation(s)
- Peter C Britton
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Klein
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
| | - Dev Crasta
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Lisa A Brenner
- Rocky Mountain MIRECC for Suicide Prevention, VA Eastern Colorado Health Care System, Denver, Colorado, USA
- Department of Psychiatry, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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Crasta D, Funderburk JS, Gray TD, Cordova JV, Britton PC. Brief relationship support as a selective suicide prevention intervention: Piloting the Relationship Checkup in veteran couples with relationship and mental health concerns. Suicide Life Threat Behav 2023; 53:787-801. [PMID: 37594162 PMCID: PMC10591926 DOI: 10.1111/sltb.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/02/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Close relationship problems play a key role in many contemporary theories of suicide. However, the potential of relationship support in suicide prevention is understudied. This study explores the feasibility, safety, acceptability, and promise of utilizing the 3-session Relationship Checkup (RC) in veterans with mental health and romantic relationship concerns. METHODS We conducted a single-arm pilot of telehealth RC in veterans with a positive mental health screen and their romantic partners. Couples completed baseline and post-treatment assessments of study outcomes. RESULTS Feasibility analyses showed we were able to recruit an elevated-risk sample (30% history of attempts or interrupted attempts), take them through the service (90% treatment completion), and had minimal harm events (no suicidal behavior, no physical harm in arguments). Multimethod acceptability analyses suggested high satisfaction with the program, though some desired more intensive services. Couples reported improvements in relationship functioning, emotional intimacy, thwarted belongingness, depression, and posttraumatic stress. Perceived burdensomeness only improved for identified patients and drinking did not change for either partner. CONCLUSION The RC is a feasible, safe, and acceptable strategy for providing relationship support to couples at elevated risk. Although further randomized trials are needed, RC shows promise to reduce relationship-level and individual-level suicide risk factors.
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Affiliation(s)
- Dev Crasta
- Center of Excellence for Suicide Prevention, US Department of Veterans Affairs, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer S Funderburk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Tatiana D Gray
- Department of Psychology, Springfield College, Springfield, Massachusetts, United States
| | - James V Cordova
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Peter C Britton
- Center of Excellence for Suicide Prevention, US Department of Veterans Affairs, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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Trabold N, King PR, Crasta D, Iverson KM, Crane CA, Buckheit K, Bosco SC, Funderburk JS. Leveraging Integrated Primary Care to Enhance the Health System Response to IPV: Moving toward Primary Prevention Primary Care. IJERPH 2023; 20:5701. [PMID: 37174219 PMCID: PMC10178447 DOI: 10.3390/ijerph20095701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
Intimate partner violence (IPV) is a prominent public health problem in the United States, with significant health impacts that are often severe and persistent. Healthcare systems have been called upon to improve both the systematic identification and treatment of IPV largely by adopting secondary and tertiary prevention efforts. Research to date demonstrates both benefits and challenges with the current strategies employed. In this paper, we summarize current knowledge about the healthcare system's response to IPV and evaluate the strengths, limitations, and opportunities. We offer recommendations to broaden the continuum of healthcare resources to address IPV, which include a population health approach to primary prevention.
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Affiliation(s)
- Nicole Trabold
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Rochester Institute of Technology, College of Health Science and Technology, Rochester, NY 14623, USA
| | - Paul R King
- Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY 14215, USA
- Department of Counseling, School, and Educational Psychology, University at Buffalo, Buffalo, NY 14260, USA
| | - Dev Crasta
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY 14424, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Cory A Crane
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Rochester Institute of Technology, College of Health Science and Technology, Rochester, NY 14623, USA
| | - Katherine Buckheit
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
| | - Stephen C Bosco
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
| | - Jennifer S Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
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Britton PC, Karras E, Stecker T, Klein J, Crasta D, Brenner LA, Pigeon WR. Veterans Crisis Line Call Outcomes: Treatment Contact and Utilization. Am J Prev Med 2023; 64:658-665. [PMID: 36805255 DOI: 10.1016/j.amepre.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Crisis lines are a central component of suicide prevention strategies in the U.S. and for the Department of Veterans Affairs. The purpose of this study is to evaluate the impact of calling the Veterans Crisis Line on treatment contact and utilization. METHODS Call records from 599 veterans who called in 2019 were linked with medical records and analyzed in 2020. Multilevel generalized linear modeling examined pre-post changes in treatment contact (yes/no) and utilization (number of days of care). RESULTS In the month after the call, 85% of callers made contact with health care, and 79% made contact with behavioral health care. Callers were more likely to make contact with health care in the month after the call than in the preceding month (AOR=6.27, 95% CI=4.22, 9.32) and more likely to make contact with behavioral health care (AOR=10.21, 95% CI=6.66, 15.67). Days of health care nearly doubled to 4.82, and days of behavioral health care more than doubled to 3.52. CONCLUSIONS Among veteran callers who are linked to medical records, calling the Veterans Crisis Line may increase contact and utilization of health care and behavioral health care. These findings support crisis lines that are linked with healthcare systems in public health strategies for suicide prevention.
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Affiliation(s)
- Peter C Britton
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Tracy Stecker
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - John Klein
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York
| | - Dev Crasta
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lisa A Brenner
- Rocky Mountain MIRECC for Suicide Prevention, Denver, Colorado; Department of Psychiatry, School of Medicine, University of Colorado, Denver, Colorado
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Crasta D, Crane CA, Trabold N, Shepardson RL, Possemato K, Funderburk JS. Relationship Health and Intimate Partner Violence in Integrated Primary Care: Individual Characteristics and Preferences for Relationship Support across Risk Levels. Int J Environ Res Public Health 2022; 19:ijerph192113984. [PMID: 36360867 PMCID: PMC9654718 DOI: 10.3390/ijerph192113984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 05/27/2023]
Abstract
This study explores differences in characteristics and relationship treatment preferences across different levels of intimate partner violence (IPV) among Veterans Affairs (VA) primary care patients. In Fall 2019, we sent a mail-in survey assessing relationship healthcare needs to N = 299 Veterans randomly sampled from 20 northeastern VA primary care clinics (oversampling female and younger Veterans). We compared those reporting past year use or experience of physical/sexual aggression, threats/coercion, or injury (Severe IPV; 21%), to those only reporting yelling and screaming (Verbal Conflict; 51%), and denying any IPV (No IPV; 28%). Participants across groups desired 2-6 sessions of face-to-face support for couples' health and communication. No IPV participants were older and had preferred treatment in primary care. The Verbal Conflict and Severe IPV groups were both flagged by IPV screens and had similar interest in couple treatment and relationship evaluation. The Severe IPV group had higher rates of harms (e.g., depression, alcohol use disorder, relationship dissatisfaction, fear of partner) and higher interest in addressing safety outside of VA. Exploratory analyses suggested differences based on use vs. experience of Severe IPV. Findings highlight ways integrated primary care teams can differentiate services to address dissatisfaction and conflict while facilitating referrals for Severe IPV.
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Affiliation(s)
- Dev Crasta
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY 14424, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Cory A. Crane
- College of Health Science and Technology, Rochester Institute of Technology, Rochester, NY 14623, USA
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
| | - Nicole Trabold
- College of Health Science and Technology, Rochester Institute of Technology, Rochester, NY 14623, USA
| | - Robyn L. Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Kyle Possemato
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Jennifer S. Funderburk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
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Goodman M, Sullivan SR, Spears AP, Crasta D, Mitchell EL, Stanley B, Dixon L, Hazlett EA, Glynn S. A Pilot Randomized Control Trial of a Dyadic Safety Planning Intervention: Safe Actions for Families to Encourage Recovery (SAFER). Couple Family Psychol 2022; 11:42-59. [PMID: 36945697 PMCID: PMC10026708 DOI: 10.1037/cfp0000206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A recent systematic review on family and suicide prevention efforts identified a lack of family-based safety planning interventions for adults. To address this gap, The Safe Actions for Families to Encourage Recovery (SAFER) intervention was created. SAFER is a novel, manualized, 4- session, family-based treatment intervention that provides the tools and structure to support family involvement in Safety Planning Intervention (SPI) for Veterans at moderate risk for suicide. The SAFER intervention includes the use of psychoeducation, communication skills training, and development of a Veteran, and a complementary supporting partner, SPI. This Stage II (2aii) randomized clinical trial (RCT) evaluated the preliminary efficacy of this innovative and much-needed approach. Thirty-nine Veterans and an associated supporting partner were randomized to receive either SAFER or currently mandated (i.e., standard) individual Safety Planning Intervention (I-SPI). Veterans in the SAFER condition as compared to I-SPI exhibited significant monthly decrements in suicide ideation as measured by the Columbia Suicide Severity Rating Scale (B=-0.37; p=.032). Moreover, a treatment-by-time interaction emerged when predicting improvements in Veteran suicide-related coping (B=0.08; p=.028) and supporting partner support of Veteran's coping efforts (B=0.17; p=.032). However, the treatment effect for Veteran coping was not significant in dyadic analyses (B=0.07; p=.151) after controlling for the partner's support (B=0.16; p=.009). Self-reported appraisals of relational factors and self-efficacy were not impacted by condition for either Veterans or supporting partners. This initial efficacy pilot trial suggests that a brief dyad-based SPI has the potential to improve Veteran suicide symptoms and help family members support the Veteran's coping efforts. However more intensive family work may be required for changes in self-perceptions of burdensomeness, belongingness, and caregiver perceptions of the Veteran as a burden. Nonetheless, SAFER's discussion and disclosure about suicide symptoms facilitated more robust development of SPI for the Veteran and their accompanying supporting partner.
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Affiliation(s)
- Marianne Goodman
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sarah R. Sullivan
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Angela Page Spears
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - Dev Crasta
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Emily L. Mitchell
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - Barbara Stanley
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Lisa Dixon
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Erin A. Hazlett
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shirley Glynn
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Research Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Peltz JS, Crasta D, Daks JS, Rogge RD. Shocks to the system: The influence of COVID-19-related stressors on coparental and family functioning. Dev Psychol 2021; 57:1693-1707. [PMID: 34807690 DOI: 10.1037/dev0001206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In addition to the fears associated with contracting COVID-19, the pandemic has forced families across the United States to quickly transition to new patterns of living. These transitions present new stressors, including health-related concerns, new demands placed on families by lockdowns and stay-at-home orders, and the possibility of losing a job or inability to pay bills. Such stressors have the potential to disrupt collaboration between coparents in addition to basic family functioning. Drawing upon a family systems perspective, the current study thus sought to examine links between COVID-19-related stressors and family cohesion through coparental functioning. A total of 1,003 parent/caregivers (97% from the United States; 82% Caucasian, 74% female; M = 40.9 years old, SD = 8.5; Mincome = $83,631, SDincome = $36,320) of school-age children completed an initial online survey from the end of March to the end of April of 2020. Of the initial sample, a total of 685 parents/caregivers completed weekly diaries for a month. Based on multilevel modeling, results suggested that, at the between-family level, coparental conflict mediated the impact of the stress of parenting/work demands and financial stress on family cohesion. At the within-family level, weekly spikes in health-related stress were associated with corresponding spikes in coparental conflict, which, in turn, were associated with drops in family cohesion. Results from the current study suggest that beyond the fears associated with contracting the COVID-19 virus, other key stressors associated with the emerging pandemic played a role in increasing coparental conflict, ultimately exacerbating family functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jack S Peltz
- Department of Psychological Sciences, Daemen College
| | - Dev Crasta
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs
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Britton PC, Crasta D, Bohnert KM, Kane C, Klein J, Pigeon WR. Shorter and longer-term risk for non-fatal suicide attempts among male U.S. military veterans after discharge from psychiatric hospitalization. J Psychiatr Res 2021; 143:9-15. [PMID: 34438203 DOI: 10.1016/j.jpsychires.2021.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
Abstract
Although there are key differences in shorter-term (days 1-90) and longer-term (days 91-365) risk factors for suicide after discharge from inpatient psychiatry, there are no comparable data on non-fatal suicide attempts. Risk factors for non-fatal attempts in the first 90 days after discharge were compared with those over the remainder of the year to identify temporal changes in risk. Records were extracted from 208,554 male veterans discharged from Veterans Health Administration acute psychiatric inpatient units from 2008 through 2013. Proportional hazard regression models identified correlates of non-fatal attempts for 1-90 days and 91-365 days; adjusted piecewise proportional hazards regression compared risk between these time frames. 5010 (2.4%) veterans made a non-fatal attempt, 1261 (0.60%) on days 1-90 and 3749 (1.78%) on days 91-365. Risk across both time frames was highest among younger veterans ages 18-59, and those hospitalized with a suicide attempt or suicidal ideation. It was lowest among those with a dementia diagnosis. Risk estimates were generally stable over time but increased among those with substance use disorders and decreased among those with sleep disturbance and discharged against medical advice. Estimates of some risk factors for non-fatal attempts change over time in the year after discharge and differ from those that change for suicide. Different preventive approaches may be needed to reduce shorter and longer-term risk for non-fatal attempts and suicide in the year after discharge.
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Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Dev Crasta
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kipling M Bohnert
- Department of Public Health, Michigan State University, Lansing, MI, USA; Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Cathleen Kane
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA
| | - John Klein
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Crasta D, Spears AP, Sullivan SR, Britton PC, Goodman M. Better off with you: Exploring congruity between caregivers’ and Veterans’ experience of efforts to cope with suicide. Military Psychology 2021. [DOI: 10.1080/08995605.2021.1959222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dev Crasta
- Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Angela Page Spears
- Department of Veterans Affairs, VISN 2 Mental Illness Research, Education, & Clinical Center, Bronx, New York, USA
| | - Sarah R. Sullivan
- Department of Veterans Affairs, VISN 2 Mental Illness Research, Education, & Clinical Center, Bronx, New York, USA
| | - Peter C. Britton
- Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Marianne Goodman
- Department of Veterans Affairs, VISN 2 Mental Illness Research, Education, & Clinical Center, Bronx, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
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Elliott L, Crasta D, Khan M, Roth A, Green T, Kolodny A, Bennett AS. Validation of the Opioid Overdose Risk Behavior Scale, version 2 (ORBS-2). Drug Alcohol Depend 2021; 223:108721. [PMID: 33895681 PMCID: PMC8113089 DOI: 10.1016/j.drugalcdep.2021.108721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the factor structure of a revised and expanded opioid overdose risk behavior scale and assess its associations with known overdose indicators and other clinical constructs. BACKGROUND Opioid-related overdose remains high in the U.S. We lack strong instrumentation for assessing behavioral risk factors. We revised and expanded the opioid overdose risk behavior scale (ORBS-1) for use among a broader range of people who use opioids. SETTING & SAMPLING FRAME Using respondent-driven sampling we recruited adults (18+) reporting current unprescribed opioid use and New York City residence. METHOD Participants (N = 575) completed the ORBS-1, ORBS-2, and a variety of clinical measures and then completed the ORBS-2 and overdose risk outcomes across monthly follow-up assessments over a 13-month period. RESULTS Principal components analysis was used to identify six ORBS-2 subscales, Prescription Opioid Misuse, Risky Non-Injection Use, Injection Drug Use, Concurrent Opioid and Benzodiazepine Use, Concurrent Opioid and Alcohol Use, and Multiple-Drug Polysubstance Use. All subscales showed moderate non-parametric correlations with the ORBS-1 and with corresponding clinical constructs. Five of the subscales were significantly (p < .01) positively associated with self-reported non-fatal overdose. Of note, the Risky Non-Injection Use subscale was the most strongly associated with past-month overdose indicators. CONCLUSIONS Psychometrics for the opioid overdose risk behavior subscales identified suggest the ongoing utility of risk behavioral instrumentation for epidemiological research and clinical practice focused on risk communication and minimization. Use of the entire ORBS-2 measure can provide insight into the proximal/behavioral factors of greatest concern to reduce overdose mortality.
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Affiliation(s)
- Luther Elliott
- New York University School of Global Public Health, Center for Drug Use and HIV/HCV Research (CDUHR), United States.
| | - Dev Crasta
- Department of Veterans Affairs Center of Excellence for Suicide Prevention
| | - Maria Khan
- New York University School of Medicine Department of Population Health
| | | | - Traci Green
- Brandeis University Heller School for Social Policy and Management
| | - Andrew Kolodny
- Brandeis University Heller School for Social Policy and Management
| | - Alex S. Bennett
- New York University School of Global Public Health and Center for Drug Use and HIV/HCV Research (CDUHR),Corresponding Authors – ;
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Crasta D, Rogge RD, Maniaci MR, Reis HT. Toward an optimized measure of perceived partner responsiveness: Development and validation of the perceived responsiveness and insensitivity scale. Psychol Assess 2021; 33:338-355. [PMID: 33600200 DOI: 10.1037/pas0000986] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Perceived partner responsiveness (PPR; Reis & Shaver, Handbook of personal relationships, 1988, Wiley)-the belief that one's partner will attend to core concerns-is a construct in basic relationship research that can help evaluate intimacy in couple therapy. However, research into PPR is hampered by a lack of standardized measurement. Three studies were undertaken to develop and evaluate an optimized self-report PPR measure. In Study 1, n = 2,334 respondents completed 246 candidate items derived from 19 PPR measures. Exploratory factor analyses identified two underlying dimensions, Responsiveness and Insensitivity. Item response theory was used to develop two 8-item subscales for the Perceived Responsiveness and Insensitivity scale (PRI), both of which showed incremental prediction over global satisfaction. In Study 2, n = 173 respondents completed the brief PRI along with measures of global relationship evaluations and concrete relationship behaviors every other week for 8 weeks. Random intercept cross-lagged panel models found the PRI subscales were more sensitive than global evaluations to fluctuations in support and conflict. In Study 3, n = 161 heterosexual couples completed the brief PRI along with self-reports of responsive and insensitive behaviors. Actor-partner interdependence models demonstrated the PRI subscales were associated with partners' self-reported behaviors even after controlling for own behaviors. Thus, the PRI offers a PPR measure that demonstrates desirable properties for treatment research including (a) incremental validity over global satisfaction, (b) ability to detect meaningful change over time, and (c) sensitivity to partners' behaviors in the relationship. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Ronald D Rogge
- Department of Clinical and Social Sciences in Psychology
| | | | - Harry T Reis
- Department of Clinical and Social Sciences in Psychology
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Crasta D, Daks JS, Rogge RD. Modeling suicide risk among parents during the COVID-19 pandemic: Psychological inflexibility exacerbates the impact of COVID-19 stressors on interpersonal risk factors for suicide. J Contextual Behav Sci 2020; 18:117-127. [PMID: 32923357 PMCID: PMC7476891 DOI: 10.1016/j.jcbs.2020.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 01/08/2023]
Abstract
Public health researchers have raised the concern that both the 2019 coronavirus disease (COVID-19) pandemic and the ensuing public health response will increase interpersonal stressors associated with suicide risk. The Acceptance and Commitment Therapy (ACT) framework conceptualizes psychological flexibility as an important way to reduce the impact of painful and even catastrophic events on psychological suffering. The current study examines psychological flexibility as a potential moderator of the prevailing interpersonal model of suicide risk. METHODS A sample of 1003 parents (73% female, 82% Caucasian 86% in romantic relationships) were recruited as part of a larger study on the COVID-19 pandemic and family functioning from Mach 27th to the end of April 2020, the height of the United States' "first wave." Participants completed measures of psychological flexibility (the Multidimensional Psychological Flexibility inventory; MPFI), interpersonal constructs (perceived burdensomeness and thwarted belongingness), desire for death, COVID-19 related stressors (resource strain and loss due to COVID-19). RESULTS Moderated-mediation path models highlighted a significant indirect association between COVID-19 stressors and desire for death mediated by perceived burdensomeness to others. This indirect pathway was moderated by psychological inflexibility such that links were strongest at high levels of inflexibility and weak or non-significant at low levels of inflexibility. Results were generally consistent across five of the six facets of inflexibility. DISCUSSION The findings highlight the value of targeting psychological inflexibility as an important strategy to reduce suicide risk during the COVID-19 pandemic. Implications of patterns of results across different facets for treatment approach are discussed.
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Affiliation(s)
- Dev Crasta
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, United States
- Department of Psychiatry, University of Rochester Medical Center, United States
| | - Jennifer S Daks
- Department of Psychology, University of Rochester, United States
| | - Ronald D Rogge
- Department of Psychology, University of Rochester, United States
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Hangen F, Crasta D, Rogge RD. Delineating the Boundaries Between Nonmonogamy and Infidelity: Bringing Consent Back Into Definitions of Consensual Nonmonogamy With Latent Profile Analysis. J Sex Res 2020; 57:438-457. [PMID: 31584295 DOI: 10.1080/00224499.2019.1669133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
To gain insight into the mixed findings surrounding Consensual Nonmonogamy (CNM), this study developed the Triple-C model of commitment, conceptualizing relationship structures with three key dimensions: mutual consent, communication, and comfort. Latent profile analyses in an online sample (N = 1,658) identified five classes of relationship structures: two monogamous groups (68%; representing earlier- and later-stage relationships), CNM relationships (7.7%, marked by low interest in monogamy and high levels of mutual consent, comfort, and communication around commitment and EDSA), partially-open relationships (13%, with more mixed attitudes toward monogamy and lower consent, comfort, and communication), and one-sided EDSA relationships (11%, in which one partner desires monogamy while the other partner engages in EDSA with low levels of mutual consent, comfort, and communication). The monogamous and CNM groups demonstrated high levels of relationship and individual functioning, whereas the partially-open and one-sided nonmonogamous groups demonstrated lower functioning. These findings highlight the diversity of nonmonogamy that likely exists within self-report classifications like "swingers" and "open relationships," providing a possible explanation for the mixed findings in previous work. Decision tree analyses identified a 4-item algorithm (COMMIT4) that classifies individuals into these groups with 93% accuracy, offering a tool for incorporating relationship structure diversity in future work.
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Affiliation(s)
| | - Dev Crasta
- VA VISN2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs and Department of Psychology, University of Rochester
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Rogge RD, Crasta D, Legate N. Is Tinder-Grindr Use Risky? Distinguishing Venue from Individuals' Behavior as Unique Predictors of Sexual Risk. Arch Sex Behav 2020; 49:1263-1277. [PMID: 31832853 DOI: 10.1007/s10508-019-01594-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Abstract
Geosocial networking apps (GSN; e.g., Tinder, Grindr) have rapidly increased in popularity, showing associations with greater sexual risk-taking. This study sought to distinguish between risks associated with intensive partner-seeking (i.e., individuals seeking out casual sex frequently across many venues) and risks associated with specific venues (e.g., GSNs, dating websites, offline activities). Expanding upon a literature predominantly focused on the population of men who have sex with men (MSM), we recruited a broader range of sexual identities. A convenience sample of 3180 participants from the U.S. (18-75 years old, 69% female, 75% Caucasian, 68% heterosexual) completed an anonymous, cross-sectional online survey. Logistic regressions yielded adjusted odds ratios highlighting the unique links between each predictor and sexual risk-taking. MSM/WSW indicators, quantity of partner-seeking and specific venues-particularly GSN use-emerged as robust predictors of sexual risk, increasing the odds of reporting all six outcomes examined: (1) having three or more sex partners in the last year, (2) having hookups in the last 2 months, (3) having hookups involving alcohol or (4) drug use, (5) condomless sexual activity with new partners in the last 2 months, and (6) ever having had a sexually transmitted infection. Although a large portion of risk originated from the proclivities of the individuals seeking casual sex, both online and offline methods of partner-seeking also contributed significant risk, suggesting that specific venues like GSN apps could be used as methods of targeting higher-risk behaviors. The results also highlight the importance of moving beyond MSM when addressing sexual risk.
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Affiliation(s)
- Ronald D Rogge
- Department of Clinical and Social Sciences in Psychology, University of Rochester, 462 Meliora Hall, RC Box 270266, Rochester, NY, 14627-0266, USA.
| | - Dev Crasta
- Department of Clinical and Social Sciences in Psychology, University of Rochester, 462 Meliora Hall, RC Box 270266, Rochester, NY, 14627-0266, USA
| | - Nicole Legate
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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Crasta D, Funk JL, Lee S, Rogge RD. Out Drinking the Joneses: Neighborhood Factors Moderating the Effects of Drinking on Relationship Quality over the First Four Years of Marriage. Fam Process 2018; 57:960-978. [PMID: 29280141 DOI: 10.1111/famp.12335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Neighborhood quality has been cross-sectionally linked to both relationship behaviors and relationship well-being. Consistent with the Vulnerability Stress-Adaptation model of relationship functioning (Karney & Bradbury, 1995), we hypothesized that associations between social behaviors (e.g., drinking) and relationship quality could be moderated by neighborhood factors. Specifically, we characterized neighborhoods along multiple dimensions using multiple methods (self-report, census) to investigate how neighborhood factors might clarify ambiguous effects of alcohol use on marital functioning. A nationally recruited sample of 303 newlywed couples completed a baseline assessment around the time of marriage and was then assessed yearly across the first 4 years of marriage (94% retention). Three level HLM slope-intercept models were used to model changes in relationship satisfaction across the first 4 years of marriage. Results suggested that, for couples living in highly disordered neighborhoods, positive shifts in overall levels of drinking within specific waves of assessment were associated with corresponding negative shifts in satisfaction whereas in neighborhoods without perceived disorder, this effect was reversed. For couples living in neighborhoods with low levels of domestic structures (high census rates of single renters without children), within-couple discrepancies favoring higher rates of husband drinking in specific waves predicted poorer relationship quality for both partners in those same waves whereas those same discrepancies predicted higher satisfaction in high domesticity neighborhoods (high census rates of married homeowners with children). The findings provide insight into the different roles of alcohol use in relationship maintenance and highlight the importance of using external context to understand intradyadic processes.
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