A qualitative analysis of strategies for managing suicide-related events during deployment from the perspective of Army behavioral health providers,chaplains, and leaders

The purpose of this qualitative study was to investigate the use of strategies for managing suicide-related events (SREs; i.e., suicide deaths, suicide attempts, and suicidal ideation with a plan and intent to die) during deployment from the perspective of Army decision makers: behavioral health providers (BHPs), chaplains, and leaders. A total of 76 Army personnel participated in individual interviews or focus groups. Participants identified unit watch, weapon removal, medical evacuations, and debriefings as common strategies used to manage SREs in deployed settings. Many of these strategies were highlighted as short-term solutions only. Participants also underscored the importance of unit cohesion and communication among leaders, BHPs, and chaplains to effectively manage SREs. The need for structured guidelines for successfully managing SREs in deployed settings is discussed.     

Prenatal Treatment of Congenital Adrenal Hyperplasia—Not Standard of Care

Congenital adrenal hyperplasia (CAH) due to steroid 21-hydroxylase deficiency is a common autosomal recessive disorder due to mutations in the CYP21A2 gene. Since genetic counselors play a crucial role in educating families about inherited disorders, they need to have thorough knowledge regarding the pathophysiology of CAH especially the effects on the fetus, the complex genetics of this disorder, and the controversies surrounding experimental prenatal dexamethasone treatment. Affected female fetuses may have varying degree of virilization of the external genitalia. Starting in the 1980's, supraphysiologic glucocorticoid treatment was used to decrease the virilization of the external genitalia of affected female fetuses. However, recent clinical observations, animal studies and greater awareness of the details of human fetal adrenal physiology raise concerns regarding the safety of this prenatal treatment. We review the pathophysiology of CAH, the safety and ethical considerations of prenatal dexamethasone treatment and the views of multiple medical societies that conclude that this experimental therapy should only be done in prospective trials approved by ethical review boards.     

Utilizing Benchmarking to Study the Effectiveness of Parent–Child Interaction Therapy Implemented in a Community Setting

Benchmarking is a program evaluation approach that can be used to study whether the outcomes of parents/children who participate in an evidence-based program in the community approximate the outcomes found in randomized trials. This paper presents a case illustration using benchmarking methodology to examine a community implementation of Parent–Child Interaction Therapy (CI-PCIT) utilized as a child maltreatment prevention effort. Data were collected from 83 parent–child dyads. Change scores were compared to treatment and control effect sizes aggregated from the PCIT literature. Pre-post results indicated significant positive changes in child behavior for CI-PCIT completers. Benchmarking analyses revealed that parents who completed CI-PCIT reported significantly greater positive child outcomes than the aggregate control group benchmark, and significantly less than observed in the treatment benchmark. A summary of decision points and implications for utilizing this methodology in the child maltreatment field are postulated.     

Images of exercising: Exploring the links between exercise imagery use, autonomous and controlled motivation to exercise, and exercise intention and behavior

Objectives

In the present study, we tested a model examining the relationships between exercise imagery use, motivational regulations for exercise engagement, intention to exercise, and self-reported exercise behavior. This work represents an initial attempt to examine relationships between a new type of exercise imagery (enjoyment imagery) and motivational regulations for exercise.

Design

Cross-sectional.

Method

Exercisers with a mean age of 40.29 years (SD = 13.29; 177 female, 141 male) completed measures of the targeted variables.

Results

Structural equation modeling analyses revealed direct and indirect (via motivational regulations) links between imagery and exercise-related outcomes. Technique and enjoyment imagery were positively related to autonomous motivation. Conversely, appearance imagery was positively associated with controlled motivation. Direct relationships were evidenced between energy imagery and self-reported exercise behavior, and between appearance imagery and intention to exercise.

Conclusions

The potential motivational functions served by different exercise imagery types are discussed, and the inclusion of enjoyment imagery in future exercise imagery research is recommended.     

Exploring programmatic moderators of the effectiveness of marriage and relationship education programs: a meta-analytic study

This study uses meta-analytic methods to explore programmatic moderators or common factors of the effectiveness of marriage and relationship education (MRE) programs. We coded 148 evaluation reports for potential programmatic factors that were associated with stronger intervention effects, although the range of factors we could code was limited by the lack of details in the reports. Overall, we found a positive effect for program dosage: moderate-dosage programs (9-20 contact hours) were associated with stronger effects compared to low-dosage programs (1-8 contact hours). A programmatic emphasis on communication skills was associated with stronger effects on couple communication outcomes, but this difference did not reach statistical significance for the relationship quality/satisfaction outcome. There was no evidence that institutionalized MRE programs (formal manuals, ongoing presence, formal instructor training, multiple evaluations) were associated with stronger effects. Similarly, there was little evidence of differences in program setting (university/laboratory vs. religious). We discuss possible explanations for these findings and implications for program design and evaluation.     

Preventing suicide through improved training in suicide risk assessment and care: an American Association of Suicidology Task Force report addressing serious gaps in U.S. mental health training

There are twice as many suicides as homicides in the United States, and the suicide rate is rising. Suicides increased 12% between 1999 and 2009. Mental health professionals often treat suicidal patients, and suicide occurs even among patients who are seeking treatment or are currently in treatment. Despite these facts, training of most mental health professionals in the assessment and management of suicidal patients is surprisingly limited. The extant literature regarding the frequency with which mental health professionals encounter suicidal patients is reviewed, as is the prevalence of training in suicide risk assessment and management. Most importantly, six recommendations are made to address the longstanding insufficient training within the mental health professions regarding the assessment and management of suicidal patients.