This study is designed to measure the suicide risk assessment practices of clinicians across the Veterans Healthcare Administration. Outcomes of interest include the risk factors and warning signs that clinicians deem important when determining risk, and testing for variability between clinicians when assessing risk.
Project Summary: The purpose of this study is to compare the effectiveness of the HOME (Home-Based Mental Health Evaluation) intervention with care as usual for Veterans who have transitioned from inpatient to outpatient care. The study consists of four assessments that will gather information on post-discharge treatment engagement, mood related symptoms, and suicidal ideation. See a description of the HOME clinical project.
The proposed investigation is a pilot study intended to establish the safety and tolerability of lithium augmentation of standard psychopharmacological treatment of PTSD for combat veterans seeking treatment at the Denver VA Medical Center.
Traumatic brain injury is an important medical problem for Veterans. Individuals with traumatic brain injuries are at increased risk for various psychiatric problems, including those associated with suicide. This study seeks to better understand the relationship between these factors.
The purpose of this study is to compare the effectiveness of the SAFE VET (Suicide Assessment and Follow-up Engagement: Veteran Emergency Treatment) intervention versus enhanced usual care on Veterans’ suicide attempts, suicide ideation, outpatient mental health or substance abuse treatment, and suicide-related coping. SAFE VET uses a standardized intervention that is specifically adapted for use in the Emergency Department to mitigate suicide risk.
The National Center on Homelessness among Veterans was established, in part, to assist the Department of Veterans Affairs (VA) in programming efforts to provide care for Veterans who are homeless or at-risk for homelessness. An immediate goal of the Center is to enlist research and clinical expertise to increase understanding regarding traumatic brain injury (TBI) among the homeless Veteran population.
The research team hypothesizes that, similar to other populations, active acupressure treatments will help promote stress resilience, improve cognition and sleep, helping to reduce suicidal ideation and ultimately suicidal behavior. In addition to these potential functional benefits in Veterans, active acupressure is an independent, portable, safe and no-cost (once learned) intervention that is non-pharmacological and therefore has no side effects. The study aims to address a need (reducing military/Veteran suicidality) that has to date gone largely unmet, a need that is also currently a Department of Defense priority.
This proposed project will be the first to replicate a groundbreaking psychological treatment for suicide prevention among those with moderate or severe traumatic brain injury, Window to Hope (WtoH), developed by PI Simpson and colleagues in Sydney, Australia. WtoH has been successfully evaluated in a Randomized Controlled Trial (RCT), in which treated Australian civilians (n=17) with severe TBI recorded significant decreases in hopelessness. The current project aims to (i) undertake the cross-cultural adaptation of the WtoH program; (ii) establish the acceptability and feasibility of WtoH within the VAMC context; and (iii) conduct a RCT within the VAMC to replicate the results from the original trial (efficacy). Deliverables are expected to include an intervention suitable for a larger trial and broader dissemination.
University of Utah National Center for Veterans Studies and American Psychological Association jointly sponsored Military and Veteran Suicide Prevention Clinical Best Practices Consensus Meeting in Washington, DC
Olson-Madden J, Brenner LA, Corrigan JD, Emrick CD, Britton PC. (2012). "Substance Use and Mild Traumatic Brain Injury Risk Reduction and Prevention: A Novel Model for Treatment," Rehabilitation Research and Practice, vol. 2012, Article ID 174579, 6 pages, 2012. doi:10.1155/2012/174579.
Traumatic brain injury (TBI) and substance use disorders (SUDs) frequently co-occur. Individuals with histories of alcohol or other drug use are at greater risk for sustaining TBI, and individuals with TBI frequently misuse substances before and after injury. Further, a growing body of literature supports the relationship between comorbid histories of mild TBI (mTBI) and SUDs and negative outcomes. Alcohol and other drug use are strongly associated with risk taking. Disinhibition, impaired executive function, and/or impulsivity as a result of mTBI also contribute to an individual’s proclivity towards risk-taking. Risk-taking behavior may therefore, be a direct result of SUD and/or history of mTBI, and risky behaviors may predispose individuals for subsequent injury or continued use of substances. Based on these findings, evaluation of risk-taking behavior associated with the co-occurrence of SUD and mTBI should be a standard clinical practice. Interventions aimed at reducing risky behavior among members of this population may assist in decreasing negative outcomes. A novel intervention (Substance Use and Traumatic Brain Injury Risk Reduction and Prevention (STRRP)) for reducing and preventing risky behaviors among individuals with co-occurring mTBI and SUD is presented. Areas for further research are discussed.
Osman, A., Bagge, C. L., Freedenthal, S., Gutierrez, P.M., & Emmerich, A. (2011). Development and evaluation of the social anxiety and depression life interference-24 (SADLI-24) inventory. Journal of Clinical Psychology, 67(1), 82-98.
We describe the development of a new self-report instrument, the Social Anxiety and Depression Life Interference-24 (SADLI-24) inventory. We initially retained 30 content specific items for the instrument (Study 1). In Study 2 (N = 438), we established a 2-factor solution, Social Anxiety Life Interference-12 (SALI-12) and Depression Life Interference-12 (DLI-12). We also examined estimates of known-groups and concurrent validity. Confirmatory factor analysis in Study 3 (N = 430) provided support for the oblique two-factor structure. In Study 4 (N = 179), we provided additional support for estimates of known-groups validity. In Study 5 (N = 63), we evaluated estimates of test-retest reliability. Both SADLI-24 scale scores showed good estimates of internal consistency.
Osman, A., Freedenthal, S., Fang, Q., Willis, J., Norizuki, T., & Gutierrez, P.M. (2011). The UTSA Future Disposition Inventory: Further analyses of reliability, validity, and potential correlates in non-clinical samples. In A. M. Columbus (Ed.) Advances in psychology research. Hauppauge, NY: Nova Science Publishers, Inc.
Osman, A., Freedenthal, S., Gutierrez, P.M., Wong, J. L., Emmerich, A., & Lozano, G. (2011). The Anxiety Depression Distress Inventory-27 (ADDI-27): A short version of the Mood and Anxiety Symptom Questionnaire-90. Journal of Clinical Psychology, 67(6), 591-608.
The authors conducted three studies to construct and examine the psychometric properties of a 27-item version of the Mood and Anxiety Symptom Questionnaire-90 (MASQ-90; Watson & Clark, 1991a). The Anxiety Depression Distress Inventory-27 (ADDI-27) contains three empirically derived scales: Positive Affect, Somatic Anxiety, and General Distress, which are relevant dimensions of the tripartite model of affect. Each scale is composed of nine items, and the estimate of scale reliability for each scale score was >= .80 across the three studies. Results of exploratory and confirmatory factor analyses provided adequate support for a 3-factor model. Additional estimates of concurrent validity documented the ADDI-27 scales' convergent and discriminant validity. We also identified three construct relevant correlates for each scale score. Overall, the ADDI-27 appears to be a content valid, reliable, and multidimensional measure of the tripartite model of affect.
Osman, A., Gutierrez, P.M., Bagge, C. L., Fang, Q., & Emmerich, A. (2010). Reynolds adolescent depression scale-second edition: A reliable and useful instrument. Journal of Clinical Psychology, 66(12), 1324-1345.
The authors conducted two studies to address issues of the dimensionality, scale reliability, and psychometric properties of scores on the Reynolds Adolescent Depression Scale-Second Edition (RADS-2; Reynolds, 2002) in samples of adolescent psychiatric inpatients. In Study 1 (N=262), they used bifactor analysis to further evaluate the general and specific components of the RADS-2. In Study 2 (N=196), they used confirmatory factor analysis to evaluate the fit of a 1-factor model, the original 4-factor model, a second-order model, and a bifactor model to a new sample data. In both studies, the total RADS-2 and content-specific subscale scores showed acceptable estimates of reliability (i.e., scale reliability estimates >.80). Estimates of concurrent validity were also examined. Scores of the RADS-2 total and content-specific subscale scores were useful in differentiating between the responses of youth with mood disorder diagnoses and those with other primary psychiatric disorder diagnoses. The authors also conducted correlation analyses to identify potential correlates for the total RADS-2 scale and the proposed subscale scores.
Osman, A., Gutierrez, P.M., Barrios, F., Wong, J. L., Freedenthal, S., & Lozano, G. (2010). Development and Initial Psychometric Properties of the UTSA Future Disposition Inventory. Journal of Clinical Psychology, 66(4), 1-20.
We describe the development and initial psychometric properties of a 24-item self-report measure, the University of Texas at San Antonio Future Disposition Inventory (UTSA FDI). This instrument is designed to evaluate future related thoughts and feelings that are associated with suicide-related risk behaviors: positive focus, suicide orientation, and negative focus. The items were generated by clinical and nonclinical samples. The structure of the instrument was defined in a sample of 350 university undergraduate students (Study 1). Using CFA, we confirmed the fit of the 3-factor solution in an independent sample of college age students (n=452; Study 2). Scale reliability estimates were good (all rho's>or=.80) in both studies. Known-groups validation analyses showed that scores on each scale were useful in differentiating the responses of the study groups. Correlates for the scales were identified when scores on measures of suicide-related risk and general psychological symptoms were included as validation self-report instruments.
Osman, A., Gutierrez, P.M., Schweers, R., Fang, Q., Holguin-Mills, R. L., & Cashin, M. (2010). Psychometric Evaluation of the Body Investment Scale for Use with Adolescents. Journal of Clinical Psychology, 66(3), 259-276.
We conducted two studies to examine the psychometric properties of the Body Investment Scale (BIS; Orbach & Mikulincer, 1998) in U.S. adolescent samples. The BIS was designed to assess bodily experiences that are associated with suicide-related behaviors. In Study 1, confirmatory factor analysis (CFA) with data from a combined sample of 204 high school adolescents (83 boys, 121 girls) and 197 psychiatric inpatient (101 boys, 96 girls) adolescents provided moderate support for the oblique four-factor solution: Body Feelings (rho=.86, 95% CI=.83-.89), Body Touch (rho=.71, 95% CI=.65-.76), Body Care (rho=.78, 95% CI=.71-.81), and Body Protection (rho=.78, 95% CI=.73-.82); robust comparative fit index=.88 and the robust Tucker Lewis Index=.83. The second-order factor model also provided moderate fit to the data. In Study 2, results of the CFA with data from adolescent psychiatric inpatients (N=205; 101 boys, 104 girls) provided additional support for the four-factor solution. In addition, results of the receiver operating characteristic and logistic regression analyses showed that scores on the Body Feelings and Body Protection scales were most useful in differentiating the responses of suicidal and nonsuicidal adolescents, all Cohen's d values >.30. The study also examined associations between scores on the BIS scales and the validation self-report measures of hopelessness, suicide-related behavior, and reasons for living.
Osman, A., Gutierrez, P.M., Smith, K., Fang, Q., Lozano, G., & Devine, A. (2010). The Anxiety Sensitivity Index-3: Analyses of Dimensions, Reliability Estimates, and Correlates in Nonclinical Samples. Journal of Personality Assessment, 92(1), 45-52.
We investigated the factor structure, reliability estimates, and correlates of the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007) in 2 studies. We established a bifactor model in Study 1 as an alternative representation of the structure of the ASI-3. Analyses of gender differences on the total ASI-3 and subscale scores were not statistically significant (Study 1, N = 462). In Study 2 (N = 293), results of a series of confirmatory factor analyses provided stronger support for the fit of the bifactor model compared with 2 alternative models. Estimates of scale reliability were adequate (all rho values > or = .80) and not "p" (as in italic p for significance). in the 2 studies. In addition, using simultaneous regression analyses, we found anxiety-specific correlates for the total ASI-3 and subscale scores to include responses on self-report measures of interpersonal sensitivity, obsessive-compulsive anxiety, paranoid ideation, and phobic anxiety.
Osman, A., Gutierrez, P.M., Wong, J. L., Freedenthal, S., Bagge, C. L., & Smith, K. D. (2010). Development and Psychometric Evaluation of the Suicide Anger Expression Inventory--28. Journal of Psychopathology and Behavior Assessment, 32, 595-608.
Osman A, Wong JL, Bagge CL, Freedenthal S, Gutierrez PM, Lozano G. The Depression Anxiety Stress Scales-21 (DASS-21): Further Examination of Dimensions, Scale Reliability, and Correlates. J Clin Psychol. 2012 Dec;68(12):1322-38.
OBJECTIVES: We conducted two studies to examine the dimensions, internal consistency reliability estimates, and potential correlates of the Depression Anxiety Stress Scales-21 (DASS-21; Lovibond & Lovibond, 1995). METHOD: Participants in Study 1 included 887 undergraduate students (363 men and 524 women, aged 18 to 35 years; mean [M] age = 19.46, standard deviation [SD] = 2.17) recruited from two public universities to assess the specificity of the individual DASS-21 items and to evaluate estimates of internal consistency reliability. Participants in a follow-up study (Study 2) included 410 students (168 men and 242 women, aged 18 to 47 years; M age = 19.65, SD = 2.88) recruited from the same universities to further assess factorial validity and to evaluate potential correlates of the original DASS-21 total and scale scores. RESULTS: Item bifactor and confirmatory factor analyses revealed that a general factor accounted for the greatest proportion of common variance in the DASS-21 item scores (Study 1). In Study 2, the fit statistics showed good fit for the bifactor model. In addition, the DASS-21 total scale score correlated more highly with scores on a measure of mixed depression and anxiety than with scores on the proposed specific scales of depression or anxiety. Coefficient omega estimates for the DASS-21 scale scores were good. CONCLUSIONS: Further investigations of the bifactor structure and psychometric properties of the DASS-21, specifically its incremental and discriminant validity, using known clinical groups are needed.
Project Summary: The intent of the clinical demonstration project, Home-Based Mental Health Evaluation (HOME) is to enhance the VA infrastructure for ensuring that Veterans with recent suicidal crises receive the care they need during the often difficult transition from psychiatric inpatient hospitalization to home. This is accomplished by calling the Veteran within 24 business hours of the Veteran’s discharge from the inpatient unit to assess safety and review the safety plan and discharge plan. Then, a HOME clinician will meet the Veteran in the home environment to review and revise aftercare plans and will follow-up with them weekly by phone to assess risk and encourage treatment engagement. The primary goal of the HOME project is to increase engagement with aftercare and decrease the risk of suicide during this time of transition and elevated suicide risk. The HOME demonstration project is being conducted at the Denver and Salt Lake City VAMCs. See a description of the HOME research project.
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