Tracy Stecker’s research while affiliated with United States Department of Veterans Affairs and other places

Insomnia, characterized by difficulty initiating or maintaining sleep, is a robust transdiagnostic correlate of suicidal ideation (SI). Nevertheless, there remains a lack of research exploring factors that may account for this association. One approach to advancing our understanding of these associations, is to draw from theoretical models of suicide including the interpersonal theory of suicide (IPTS). According to the IPTS, the desire for suicide emerges when one feels intractably socially disconnected (i.e., lonely and perceiving oneself as a burden). Initial research suggests that social disconnectedness explains, in part, the association between insomnia and suicidal ideation severity. However, less research has investigated this veterans in underserved communities, a sample at heightened risk for suicide. Using an outpatient treatment seeking sample of veterans (N = 83; M age = 53.51 SD = 15.04; 52% Black/African American; 81% male), we modeled the indirect effect of insomnia severity on SI severity through social disconnectedness. Although insomnia severity was not directly associated with SI severity, there was a positive and statistically significant indirect effect of insomnia on SI severity through social disconnectedness. These findings extend prior research examining mechanisms that may help explain the link between insomnia and suicidality. Results highlight the importance of including transdiagnostic risk markers like insomnia and social disconnectedness in comprehensive suicide risk assessment. Future research should seek to establish the temporal nature of these relationships.

Introduction Previous research has identified a variety of barriers to mental health care among military personnel and veterans, despite high rates of mental health symptoms. The current study is the first to examine beliefs about mental health treatment barriers among post‐9/11 military personnel and veterans at elevated suicide risk not involved in treatment and whether these beliefs are associated with treatment initiation, engagement, or suicidal behaviors. Methods Four hundred and twenty‐two participants reported on beliefs about treatment during a cognitive behavioral treatment session and responded to follow‐up questionnaires on mental health treatment initiation, engagement, and suicidal behaviors over 12 months. Beliefs identified in the therapy session were coded thematically, and rates of treatment initiation, engagement, and suicidal behavior were examined by belief category. Results Nine belief themes emerged. Participants reporting logistical barriers and preferences about treatment type were least likely to initiate mental health treatment and participated in the fewest number of sessions, respectively. Participants endorsing beliefs about stigma or using other ways to cope were most likely to engage in suicidal behavior. Conclusions The current findings point to specific beliefs that may identify individuals who would benefit from systemic and individual interventions for mental health treatment engagement.

Objective Alcohol use disorder (AUD) is among the most prevalent substance use disorders in the USA. Despite availability of effective interventions, treatment initiation and engagement remain low. Existing interventions target motivation and practical barriers to accessing treatment among individuals established within treatment systems. In contrast, Cognitive Behavioral Therapy for Treatment-Seeking (CBT-TS) aims to elicit and modify treatment-seeking beliefs to increase treatment-seeking behaviors among treatment-naïve samples. We aim to understand which beliefs were endorsed by those who did/did not initiate treatment, including changes in number of drinking days. Method We examined treatment seeking beliefs elicited during CBT-TS among community-based adults with moderate–severe AUD with no treatment history. In this study, we discuss which beliefs were modifiable (i.e. those discussed during the intervention among individuals who subsequently attended treatment and may be associated with treatment-seeking behaviors). Results Of the 194 participants who received the intervention, 16 categories of beliefs were endorsed. Of the 38 participants (19.6%) who attended treatment, the most frequently endorsed belief was ‘Not wanting specific types of substance use treatment or supports’ (50%), a belief that may inhibit treatment seeking. The idea ‘Treatment is positive’ (47%) was also frequently cited, a belief that may facilitate treatment seeking. Conclusions This study describes the beliefs that were more frequently endorsed among adults with moderate–severe, but untreated AUD who reported attending treatment following CBT-TS. Findings point to the potential of discussing and modifying treatment-seeking beliefs among treatment-naïve adults with severe AUD to increase treatment-seeking behaviors.

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.

Objective: Although not all trauma-exposed individuals develop posttraumatic stress disorder (PTSD) symptoms or nonsuicidal self-injury (NSSI), it has been suggested that those who use NSSI as a means of coping with PTSD symptoms increase their acquired capability for suicide. This study sought to test the relationship between PTSD symptom clusters, functions of NSSI, and suicide capability (i.e., fearlessness about death [FAD]) in a trauma-exposed sample of individuals with a history of self-injury. Method: Self-report data were collected from undergraduates (N = 58) who ranged in age from 18 to 38 years (M = 19.62, SD = 3.28). Participants were primarily female (86.2%). Most participants were identified as White (81%), 12.1% as African American/Black, 1.7% as Asian, 1.7% as American Indian/Alaskan Native, and 3.5% as Biracial. A parallel mediation model was employed. Results: Global PTSD symptoms exhibited a statistically significant positive relationship with intrapersonal (e.g., emotion regulation) and interpersonal (e.g., social) functions of NSSI. However, only intrapersonal functions were statistically significantly related to FAD. Although PTSD symptoms did not demonstrate a direct relationship with FAD, there was an indirect effect of PTSD symptoms on FAD through intrapersonal functions of NSSI. Conclusions: Engaging in NSSI for the purpose of managing PTSD symptoms may contribute to FAD beyond the presence of PTSD symptoms or NSSI. Clinical interventions that promote adaptive emotional regulation strategies may help to thwart increases in FAD for trauma-exposed samples.

Background and aims: There is little RCT evidence that brief interventions improve treatment seeking in individuals with severe alcohol use disorder (AUD) or treatment seeking reduces alcohol use. The aim was to test the efficacy of a brief intervention to increase treatment seeking in treatment naïve adults with severe AUD and measure its effects on alcohol use. Design: Parallel group, non-pharmacologic RCT with intervention (n = 197) and active control (n = 203) conditions, with blinded assessors conducting follow-ups at 1, 3 and 6 months. Setting: Online recruitment in a 17-county region of upstate New York, USA. Participants: Inclusion criteria consisted of ages ≥18 years, Alcohol Use Disorders Identification Test score ≥16, exceeds recommended limits for alcohol use and no history of AUD treatment. n = 400; 50% female; 79% white; mean age, 40.7; mean education, 14.6 years. Intervention and comparator: One-session telephone-delivered interventions: Cognitive-Behavioral Therapy for Treatment Seeking (CBT-TS; intervention), review of a National Institute on Alcohol Abuse and Alcoholism pamphlet on AUD treatment (control). Measurements: Self-report of any AUD treatment use over 3 months (primary outcome) and two standard measures of alcohol use over 6 months (secondary outcomes). Findings: Intent-to-treat analyses were used. Assessment follow-up rates were ≥93%. Any alcohol-related treatment use over 3-month follow-up was obtained by 38 (19%) intervention participants and 36 (18%) control participants, a non-significant difference, χ2 [1] = 0.16, P = 0.689. Secondary analysis showed a significant interaction term between sex and intervention assignment (β = -1.197, P = 0.027). The interaction suggested CBT-TS was effective in men (22% vs 13%), although the evidence was somewhat weak (P = 0.071), and it was not effective in women (17% vs 24%). Conclusions: A one-session cognitive-behavioral therapy intervention to increase treatment seeking in treatment naïve adults with severe alcohol use disorder did not increase treatment seeking.