AIMS:To examine data from an early intervention program for mental health following recent sexual assault (SA) to compare referral and service utilization rates before and after a community-based outreach model was implemented. METHODS:In July 2022, mental health clinicians from the early intervention program, which is housed within an academic medical center, began providing outreach within the community's SA advocacy center. Analyses compared differences in average monthly program referrals and service utilization rates 18 months before and after the outreach model. RESULTS:Independent samples t-tests indicated that while monthly average program referrals did not change (8.67 [SD=4.49] vs. 8.22 [SD=3.37], p=0.74), the monthly average service utilization rates were higher (58% [SD=23%] vs. 28% [SD=22%], p<0.01) after implementation of community outreach. DISCUSSION:Community outreach models that coordinate care among hospitals and SA advocacy centers may improve engagement with early mental health intervention after recent SA.

Healthcare workers (HCWs) report elevated distress. Accessible and personalized mental health intervention programs for HCWs are limited. Technology-based intervention support programs could mitigate adverse health outcomes in HCWs. Using a feasibility approach, we report engagement with a technology-based mental health screening, brief intervention, and referral to treatment program designed for HCWs from a quality improvement project. 598 HCWs across seven hospital units were invited to participate. Participants were not recruited as a treatment-seeking sample. HCWs completed a baseline survey and could opt-in to brief, tailored text-based screenings with real-time feedback. HCWs completed a 90-day follow-up survey. Of the 598, 80 (13

Background Increased sensitivity and reactivity to contextualized sound triggers is the defining feature of misophonia. Emotion regulation (ER) fluctuates at a momentary level, is a malleable misophonia risk factor, and characterizes maladaptive cognitive, affective, and behavioral responses to aversive stimuli in individuals with misophonia. As misophonia symptom expression varies due to context (e.g., sound exposure), it is likely that misophonia also fluctuates momentarily. Understanding real-time associations between momentary ER and misophonia symptoms would help 1) better characterize misophonia and 2) inform an understanding of misophonia symptoms, symptom trajectories, and tailored interventions; yet, experience sampling studies of misophonia are limited. Method Interval- and event-contingent ecological momentary assessment methods measured misophonia, ER strategies (techniques to manage emotions), and ER abilities (capacity to manage emotions) over a 30-day period three times per day to capture ER and misophonia during and outside of triggers. Sixty individuals screening positive for misophonia were recruited, and participants completed ∼3000 momentary surveys. Results Intraclass correlation coefficients suggested between 23-52% of individual variability in momentary misophonia, ER abilities, and ER strategies was due to momentary-level changes. In multilevel models, within- and between-individual domains of ER strategies and abilities were related to misophonia both during and not during triggers, controlling for: 1) time since most recent trigger and 2) trigger anticipation for individuals not endorsing a current trigger. Discussion Results suggest meaningful individual variability in misophonia, ER strategies, and ER abilities. Findings will inform follow-on just-in-time adaptive interventions targeting momentary misophonia variability.

Adults residing in communities that experience mass violence incidents (MVI) frequently experience adverse mental and behavioral health outcomes. However, little is known about the impact of experiencing the death of a close acquaintance during an MVI, which limits response efforts. Using a household probability sample of adults from six MVI-affected communities, this study examined the prevalence and correlates of posttraumatic stress disorder (PTSD), depression, and prolonged grief (PGD) among individuals residing in MVI-affected communities who experienced the death of a close acquaintance. 41.7% and 22.8% met criteria for past-year PTSD and depression, respectively. Nearly 1 in 5 and 1 in 10 met criteria for current PTSD and depression, respectively. Approximately 3.7% met criteria for PGD. Prior trauma exposure, low social support, and binge drinking were strong correlates of adverse outcomes. Individuals who experience the MVI-related death of an acquaintance in their community may be particularly vulnerable and warrant additional support.

OBJECTIVE:Types of interpersonal loss through death, such as suicide bereavement, are associated with increased suicide risk. Quantification of suicide risk is less understood across the spectrum of traumatic (e.g., violent) and natural loss, representing a significant literature gap that could be addressed to inform the assessment of and intervention on suicide risk in bereaved adults. METHOD:A web panel of 2,034 adult participants was administered via Qualtrics to gather data on suicide risk across loss types in bereaved individuals. Loss groups included (a) anticipated medical causes, (b) sudden medical causes, (c) car crash, (d) suicide, (e) homicide, and (f) fatal overdose. We also included individuals reporting no significant loss. RESULTS:Individuals with an anticipated medical loss reported the lowest suicide risk, with the highest risk reported by individuals experiencing suicide or homicide loss. Adjusting for perceived social support, individuals reporting an anticipated medical loss had lower suicide risk relative to suicide and homicide loss, while individuals with a sudden medical loss reported lower suicide risk than suicide loss. Individuals endorsing suicide loss described higher suicide risk than the no-loss group, and individuals in the homicide loss group reported higher suicide risk relative to the no-loss condition. CONCLUSION:Suicide risk was most elevated in traumatic loss conditions, particularly homicide and suicide loss groups. Results inform assessment and intervention surrounding bereaved individuals and suggest that individuals experiencing specific types of traumatic loss (i.e., suicide and homicide loss) are at the highest suicide risk and therefore may warrant additional screening and clinical attention. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objective: One technique for tailoring interventions and matching evidence-based procedures to idiographic problems is just-in-time adaptive approaches, also referred to as ecological momentary intervention. These technology-based approaches involve real-time delivery of evidence-based skills when most needed, which can be tailored to individual data inputs. The current article reviews just-in-time adaptive ecological momentary assessment (JITA-EMA; Schneider et al., 2023) and ecological momentary interventions (EMIs; Heron & Smyth, 2010) with respect to the field of trauma-related psychopathology in the modern age of technology. Method: We provide a broad, narrative overview. Heterogeneity in posttraumatic psychopathology, posttraumatic psychopathology diagnostic classification models, and applicability of technology are reviewed. Next, we discuss JITA-EMA and EMI frameworks, EMA of posttraumatic psychopathology, EMI outcomes, and JITA-EMA and EMI outcomes. We conclude by discussing clinical application and considering dilemmas, ethical issues, and limitations. Future research directions and potential treatment adaptations and innovations are given. Results: JITA-EMA/Is have the potential to reinforce skill acquisition and uptake in evidence-based treatments if implemented as standalones or in conjunction with established, evidence-based interventions. Conclusions: JITA-EMA and EMIs may eventually inform clinical and research efforts by affording an understanding of how idiographic variability in biopsychosocial factors relates to changes in etiology, course, and treatment outcomes.

Loss of a loved one leads to variable psychological responses. While many individuals endure long-term psychological difficulties following losses, others do not. Understanding psychosocial correlates of perceived growth in individuals who have lost loved ones and psychopathology and mental health outcomes across different types of loss could inform clinical interventions and broaden the knowledge base of relevant psychosocial correlates and psychological outcomes in this population. Using a national sample, we examined the relationships between perceived posttraumatic growth (PTG) and psychosocial variables, namely posttraumatic stress disorder symptoms, social support, and discrimination across individuals (N = 2,034) losing someone to natural loss (e.g., cancer; n = 514) and traumatic loss (e.g., homicide, suicide, and fatal overdose; n = 1,015). We included a control group of individuals not reporting loss (n = 505) to use as a comparison group and examined group differences in psychological and growth-oriented outcomes. In regression models across each group, social support and posttraumatic stress disorder symptoms were associated with perceived PTG. For the traumatic loss group, psychopathology was generally higher relative to natural and control conditions. There were no significant group differences in perceived PTG. The findings highlight the importance of considering differences in psychological functioning and the role of psychosocial correlates in perceived PTG across loss types. The results inform clinical interventions for bereaved individuals and add to our knowledge base in the areas of psychosocial correlates of psychopathology and psychological growth across loss types. Results also suggest that perceived PTG may not vary across different types of loss, informing perceived PTG conceptual models.

Background: Resilience research offers numerous definitions, such as (1) recovery from stressors despite symptoms; and (2) subclinical symptoms after adversity. Different conceptualizations, however, have little else in common, suggesting that resilience is complex. Construct complexity results in barriers to conducting programmatic research and informing clinical application of resilience interventions. Efforts to distill a consensus description may be useful. Theoretical Framework: The current article integrates resilience definitions using a contextual behavioral science (CBS) framework. We consider the role of context in shaping flexible behavior repertoires in response to stressors, aligning with extant models of resilience. The article's objectives are to: (1) review resilience definitions and research methods; (2) aggregate definitions to form a consensus perspective based on CBS and behavior-analytic principles; and (3) suggest CBS-informed innovations for research methods and clinical application to positively affect societies. Key Insights: Resilience is best understood by understanding contextual factors shaping behavioral repertoires. Conducting idiographic assessments of resilience using within-individual designs and experience sampling could enhance research methods and clinical application of resilience. Developing process-based conceptualizations targeting contextual factors affecting resilience in clinical settings may be beneficial to uptake and application. Future Directions: Use of strategies posed could facilitate enhanced prediction and utility of psychological resilience, which would be useful for future prospective studies designed to insulate individuals from effects of adverse events. A CBS-informed research and clinical agenda can facilitate more successful dissemination and implementation in populations experiencing adversity, which could promote enhanced resilience at a societal level.

Screening, brief intervention, and referral to treatment (SBIRT) is a widely used public health approach for delivering early intervention for substance misuse. SBIRT adaptations that incorporate content on interpersonal violence and posttraumatic stress disorder (PTSD) symptoms may be warranted, as experiences of interpersonal violence are prevalent and associated with greater substance misuse; however, more research is needed to refine the delivery of PTSD-substance use content within the SBIRT model. This study examined clinical data collected as part of a web-based SBIRT developed for co-occurring substance misuse and PTSD symptoms after interpersonal violence to characterize the clinical symptoms and responses of adults presenting to agencies serving intimate partner and sexual violence survivors. The respondents (N = 52) completed self-report measures during the SBIRT tool to personalize the recommendations, as well as motivational enhancement exercises. Descriptive statistics were conducted. The results underscored high rates of probable PTSD, substance use, and trauma-related motives for substance use. The respondents were ready to change their substance use on average after receiving personalized feedback. Many expressed values related to trauma recovery and self-empowerment, perceived these values as useful for substance use reduction, and set goals to seek mental health services or reduce their drinking quantity. The findings point to several clinical targets for integrated PTSD-substance misuse interventions for interpersonal violence survivors.

Exposure to trauma is a pervasive stressor that globally impacts millions of children and adults and can lead to severe adjustment problems. Although receiving evidence-based trauma-focused mental health treatment can effectively reduce distress associated with exposure to trauma, over half of those who schedule an intake session fail to attend, known as preintake attrition. Understanding factors that predict preintake attrition is essential for improving clinical care and triaging the allocation of clinic resources. This study examined clinic archival data sourced from an outpatient training clinic that focuses on delivering evidence-based trauma treatment. Data included records from 249 clients (n = 96 children; n = 153 adults) who completed a phone screen at the clinic between January 2022 and December 2023. Of the 249 total clients placed on the clinic waitlist, 52% (n = 129) attended their intake appointment. Results indicated that certain factors assessed during the initial phone screen (demographic characteristics, index trauma, and referral source) predicted preintake attrition. Notably, waitlist duration also emerged as a predictor of attrition; children who did not attend their intake spent nearly twice as many days on the waitlist compared with children who attended their intake. These findings provide insight into predictors of preintake attrition and suggest potential targets for developing strategies to increase engagement in trauma-focused treatment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BACKGROUND:Bereavement following suicide and fatal overdose is associated with posttraumatic stress disorder (PTSD) and prolonged grief (PG). However, information about plausible explanations for these associated symptoms is scarce. Leveraging data from two assessment points, we examine the prospective roles of stigmatization, guilt, shame, and avoidant coping on PTSD and PG symptom severity and whether these relations are similar across groups. METHODS:We analyzed data (N = 212) from suicide- and overdose-bereaved adults who completed two waves of data collection (T1 and T2; six months apart) as part of a larger study of traumatic loss. Multigroup path analysis with serial mediation was used to estimate models of PTSD and PG symptomatology. Stigmatization (T1) and guilt (T1) were modeled as predictors, while shame (T1) and avoidant coping (T2) were modeled as mediators explaining PTSD (T2) and PG symptoms (T2). RESULTS:Prospective relations between T1 stigma, T1 guilt, T2 PTSD and T2 PG symptoms were mediated by T1 shame and serially mediated by T2 avoidant coping. Multigroup analyses indicated similar relations across suicide and overdose-bereaved adults, but a stronger effect from T2 avoidant coping on outcomes for overdose bereaved adults. LIMITATIONS:Online self-report and use of a convenience sample are limitations. CONCLUSION:Our results suggest shame and avoidance may help explain elevated symptoms of PTSD and PG in the context of suicide and overdose bereavement. Accordingly, transdiagnostic interventions that concurrently target shame-related cognitions and behavioral avoidance may be promising and warrant further attention.

The current study examined differences in acute stress and depression symptoms, alcohol use, and drug use between sexual minority and heterosexual survivors in the weeks following a sexual assault. The sample included 26 sexual minority and 66 heterosexual survivors (N= 92, 94.4% cisgender women, 51.1% White, and 31.5% Black) who completed screening during a follow-up mental health service after receiving a sexual assault medical forensic examination. Group differences on brief mental health and substance use screening measures were examined using χ2tests andttests. Sexual minority survivors reported higher acute stress symptoms and were more likely to report drug use in the past 2 weeks, but no differences in depression symptoms and alcohol use were found. Results highlight the need for increased research on sexual minority survivors’ unique experiences and needs following recent sexual assault.

The COVID-19 pandemic has impacted health care workers (HCWs) and systems. Health care workers are susceptible to psychological and physical impacts from COVID-19, as these individuals work in stressful environments. It is clear that COVID-19 has exacerbated psychological and physical health difficulties for HCWs. In line with evidence-based models for promoting workplace well-being (e.g. Stanford Model of Professional Fulfillment), understanding cultural, systemic, and individual factors exacerbating duress for HCWs is imperative for designing intervention and prevention efforts in health care systems. The current manuscript consists of data from a quality improvement project of qualitative (N = 224) assessments of burnout, coping, and contextual factors contributing to psychological and physical health in HCWs in a large health care system during the early stages of the COVID-19 pandemic. Mental and physical health difficulties experienced by HCWs were evident through qualitative assessments. Despite experiencing mental health problems and physical difficulties, many individuals engaged in self-care practices. Overall, HCWs felt supported by individual units. Health care workers reported that strengthening communication, protecting time off, and being shown appreciation may promote and protect morale. These data inform intervention and policy change efforts in health care systems, particularly prevention and intervention strategies focusing on modification of systems and individual behaviors to enhance psychological well-being in line with evidence-based intervention models.

Despite the high prevalence of suicide and fatal overdose, and the morbidity associated with these forms of bereavement, little is known about the loss-related needs of adults bereaved by these two causes, including whether survivors' needs differ from those losing significant persons to other forms of sudden death and how these needs may relate to psychiatric symptomatology. Using a newly validated measure (the Sudden Bereavement Needs Inventory) and an online survey design, the purpose of this study was to examine the needs of adults (N = 403) who have experienced the suicide or fatal overdose of a close other within the past five years, to compare these needs with those of individuals bereaved by a sudden natural death, and to explore how the importance of specific need categories relates to psychiatric symptomatology. Results showed great overlap between adults bereaved by suicide and fatal overdose across all bereavement need categories, with notable differences between these two groups and those bereaved by a sudden-natural loss (e.g., cardiac arrest). Further, among the suicide and overdose bereaved, the self-rated importance of specific need categories accounted for much of the variation in symptoms of prolonged grief, posttraumatic stress, and depression, with relational needs and meaning-based needs emerging as most strongly related to psychiatric symptoms. Study results may suggest the importance of addressing specific needs in therapy among overdose and suicide bereaved individuals to promote adaptive outcomes.

Importance Intimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated. Objective To assess the effect of an electronic health record (EHR)-based multifactorial intervention screening on the detection of IPV risk in primary care practice. Design, Setting, and Participants This cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study. Intervention A noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template. Main Outcomes and Measures The main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures. Results The study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]). Conclusions and Relevance The intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV.

Skills for Psychological Recovery (SPR) is an evidence-informed, early intervention for teaching survivors coping skills in the aftermath of recent disasters. Although SPR has not been tested following recent sexual assault, there is theoretical support for applying SPR to the needs of recent sexual assault survivors. The current study is the first to describe the application of SPR among survivors of recent sexual assault. SPR was administered by two master-level clinicians over the telephone to five people who experienced a sexual assault in the last month. Clients completed up to five SPR sessions. Mean scores of measures of Posttraumatic Stress Disorder (PTSD; PTSD Primary Care Screen), depression (Patient Health Questionnaire-2), and alcohol misuse (Alcohol Use Disorders Identification Test-Concise) were calculated pre- and post-intervention. Clients reported a reduction in PTSD symptoms (pre-intervention mean = 4.4; postintervention mean = 2.8), depression (pre-intervention mean = 3.6; post-intervention mean = 2.2), and alcohol misuse (pre-intervention mean = 4.5; post-intervention mean = 3.2) at post-intervention. Results are presented using a case series approach. Findings suggest that SPR may be an effective strategy for reducing early trauma-related symptoms among recent survivors of sexual assault. Future investigations should explore the feasibility, acceptability, and efficacy of delivering SPR with larger, multiculturally diverse samples of recent sexual assault survivors.

To slow the spread of COVID-19 many mental health providers transitioned to telehealth delivery of trauma-focused treatment for maltreated children. However, these providers faced myriad challenges, including equitable access to equipment and technical demands of telehealth software. Training clinics overseeing pre-doctoral clinical psychology interns experienced the added challenge of providing quality supervision and training via telehealth. This study involves a retrospective application of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to describe the innovative adaptation to a telehealth service delivery model in a training clinic providing evidence-based trauma-focused treatment to children and their families. Mixed methods data from clinic records and intern evaluations indicate that compared to pre-COVID (February 2019 - February 2020), during early COVID (April 2020 - April 2021) more patients accessed clinic services, interns reported fewer hours of individual supervision, and interns reported greater satisfaction with their training experiences. Implications for ongoing provision of telehealth services are discussed.

BACKGROUND:Problematic alcohol use (PAU) is highly prevalent in the United States. Although bereavement, a highly stressful and ubiquitous experience across the lifespan, is believed to increase the risk for PAU based on a small number of studies, research using large diverse samples of bereaved adults has yet to be conducted. Therefore, relations between PAU and bereavement remain poorly understood, hampering the reach and effectiveness of alcohol interventions. The current study addresses this limitation by investigating rates and correlates of PAU and service utilization among a large national sample of bereaved adults. METHODS:Participants were adults who reported the death of a significant other in their lifetime (N = 1529). Most participants identified as female (69.1%) and White (68.2%), with an average age of 44.7 (SD = 16.29). Online self-report surveys assessed the prevalence of PAU using the AUDIT-C, mental health service utilization, and associated characteristics. RESULTS:Nearly one-third (n = 463; 30.3%) screened positive for PAU, which surpasses rates found in the general US population. After accounting for other characteristics, time since the death (OR, 3.63; 95% CI, 2.59-5.08) and meeting presumptive criteria for depression (OR, 2.28; 95% CI, 1.64-3.18) and prolonged grief disorder (PGD; OR, 1.66; 95% CI, 1.13-2.25) significantly increased risk for PAU among the bereaved. Approximately half (n = 244; 52.7%) of bereaved adults with PAU received any mental health service since the death. Time since the death (OR, 4.19; 95% CI, 2.38-7.48) and presumptive depression (OR, 2.16; 95% CI, 1.25-3.74) were associated with service utilization after accounting for other characteristics. CONCLUSIONS:The high prevalence of PAU among bereaved adults, particularly among those with a diagnosis of PGD, and limited use of support services underscore the need for greater empirical attention and integrated substance use care for bereaved adults.

ImportanceIntimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated.ObjectiveTo assess the effect of an electronic health record (EHR)–based multifactorial intervention screening on the detection of IPV risk in primary care practice.Design, Setting, and ParticipantsThis cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study.InterventionA noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template.Main Outcomes and MeasuresThe main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures.ResultsThe study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]).Conclusions and RelevanceThe intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV.Trial RegistrationClinicalTrials.gov Identifier: NCT06284148