Objective: Alcohol use problems and impulsivity predict intimate partner violence (IPV) perpetration. Adaptive cognitive emotion regulation skills may be a protective moderating factor in the relation between impulsivity and IPV perpetration. However, the relationships among impulsivity, adaptive emotion regulation, and IPV perpetration have rarely been studied in a dyadic context. This work examined the moderating influence of both actors' and their partners' adaptive emotion regulation skills on the relationship between impulsivity and IPV perpetration after accounting for alcohol use problems. Method: One hundred adult romantic couples completed this study. All couples had a history of AUD and physical IPV in their current relationship. Data analyses were conducted using four mixed effects models with indistinguishable dyads to examine the interactive effects between impulsivity and both partners' and actors' adaptive emotion regulation skills in predicting physical and psychological IPV perpetration severity. Results: Contrary to hypotheses, no interaction effects emerged. Contrary to prior literature, adaptive cognitive emotion regulation skills were not related to IPV perpetration for either actors or partners after accounting for impulsivity and alcohol use problem severity. Conclusions: For couples at high risk for alcohol-related IPV, cognitive emotion regulation skills may not be sufficient to prevent perpetration. It is critical to continue examining therapeutically modifiable protective factors against IPV in high risk dyadic contexts.

Intimate partner violence (IPV) occurs at elevated rates among Veterans, with recent meta-analyses estimating 31.8% of Veterans use IPV and 24.3% of Veterans experience IPV. While Johnson's (2008) typology distinguishes IPV types based on control patterns, limited research has applied latent class analysis to identify IPV typologies that incorporate measures of coercive control. This study used latent class analysis to examine patterns of IPV use and experience among Veterans in primary care, focusing on coercive control dynamics and their associations to mental health outcomes. Cross-sectional survey data were collected from 299 Veterans in romantic relationships receiving care at 20 community-based outpatient clinics in Western and Central New York. Measures included the Conflict Tactics Scale-Revised, Women's Experience with Battering scale, Proximal Antecedents of Violent Episodes, and correlated mental health assessments. Latent class analysis identified four distinct IPV typologies based on use and experience patterns: low-to-no conflict (26%), psychological IPV with negotiation (36%), high psychological/low physical without control (26%), and multitype IPV with control (13%). Veterans in the multitype class with coercive control showed significantly higher rates of depression, posttraumatic stress disorder symptoms, alcohol misuse, and suicidal ideation compared to other classes. Over half (51%) of Veterans in this sample reported propensity for using violence to control their partner. Results demonstrate heterogeneous IPV patterns among Veterans, with coercive control dynamics associated with severe mental health comorbidity. Findings support the need for differentiated screening and intervention approaches in Veterans Health Administration settings, with particular attention to coercive control assessment for comprehensive IPV evaluation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Agapé is a light-touch relationship enhancement smartphone app. This study used data from a longitudinal study of couples using the Agapé app to explore change within an array of behavioral processes to uncover patterns of interconnected change, thereby providing some of the first quantitative insights into how various relationship processes might be linked as relationships change over time. A sample of 405 couples in long-term relationships (810 partners, 50% women, 75% white, together M = 4.5 yrs, 50% living together, 33% currently dissatisfied) completed assessments across their first month of using Agapé. Men and women significantly improved on 15 of the 16 relationship processes assessed. As the study lacked a randomized control condition, it remains unclear if those improvements were due to using the Agapé app or to factors like expectancy effects, regression to the mean, self-selection, demand characteristics, or general participation effects. Network analyses explored correlational linkages among the self-reported pre-post changes observed. Results highlighted increases in three processes (quality time spent together, perceived partner responsiveness, and gratitude toward partner) as the processes most proximally linked to increases in relationship quality. The network findings also uncovered a number of patterns of interconnected change to be explored in future studies (e.g., increases in couples talking about their relationships to increases in mindful awareness within those relationships to increases in gratitude and quality time to increases in relationship quality). Thus, the results offer some of the first comprehensive multivariate (albeit correlational) insights toward understanding how relationship processes might work in concert with one another within a broader multivariate pattern of self-reported relationship change.

The rate of death by suicide is a significant health concern for veterans and is significantly higher than in nonveteran populations, likely due to the relatively higher proportion of veterans using firearms as lethal means of suicide. Family members and other supporters are often highly aware of a veteran’s suicidal thoughts and of their firearm ownership; thus, they may play a role in suicide prevention. This paper describes the development and feasibility testing of a lethal means safety strategy with family members and close friends of veterans. A telephone-based coaching strategy was developed using an educational website, worriedaboutaveteran.org, that presents information about suicide, guidelines for communication, and other information about securing lethal means. This coaching strategy is innovative in its approach of working with a concerned family member or friend without the direct involvement of the veteran, while encouraging collaboration with the veteran around reducing access to lethal means. Family members of 23 veterans at risk for suicide were engaged in a telephone-based coaching clinical project to encourage the use of a lethal means safety strategy to reduce suicide risk. Results suggested the intervention is feasible and that most participants accessed and integrated information from the website with coaching support and roleplay practice of recommended communication methods. These results provide initial support that family members can learn and use the communication strategies and that it can result in a reduction of veterans’ immediate access to lethal means.

Intimate partner violence (IPV) and alcohol misuse are highly prevalent among military individuals (i.e., active duty service members and veterans) and couples, and associated with poorer mental health and relationship functioning. Yet, it is less clear whether military individuals and their partners also experience more severe symptoms in the context of IPV, compared to civilians. This information is critically important to better characterize the impacts of IPV and co-occurring alcohol misuse among high-risk samples to facilitate more informed clinical assessment and intervention procedures. The current study examined differences between military couples and their civilian couple counterparts, and differences between military and civilian participants, on trauma exposure, alcohol use problem severity, mental health, and relationship factors. Participants were 92 different-sex couples (25 military couples) who reported physical IPV and alcohol use disorder in their current relationship. Results of multilevel models indicated that individual military participants and military couples reported greater posttraumatic stress symptoms and alcohol problem severity compared to non-military counterparts. Individual military participants reported greater depression and infidelity; and military couples reported greater trauma exposure. Findings highlight that even among a high-risk sample, those with prior military service - at both individual and dyadic levels - emerged with more severe clinical presentations in certain domains as compared to civilians with IPV and AUD.

Intimate partner violence (IPV) poses a tremendous public health burden across large health care systems. While the predominant response to IPV focuses on individual screening and referral, relationship and family services provide an opportunity to prevent low-risk verbal aggression from escalating and to address some forms of bidirectional physical IPV. This study examines mental health and screening variables associated with IPV experience and subsequent referral to family services using a large national data set of N = 256,894 patients screened for IPV in the first year of the Veterans Health Administration's adoption of a national IPV screen. Of those screened, 7.4% reported any IPV, 1.4% reported severe IPV, and only 0.1% received a referral for couple and family services within the next 90 days. Mental health conditions associated with greater likelihood of IPV (e.g., personality disorders, posttraumatic stress disorder, substance use disorders, and depression) were in turn associated with greater likelihood of referral. Despite the overlap between IPV and mental health conditions that benefit from couple-based interventions, referrals remained infrequent. Referrals were often placed by a different clinic than the service assessing the IPV. Risk behaviors for severe violence (e.g., choking) and suicide ideation were also associated with increased couple and family service referrals, underscoring the need for integrated assessment and risk management. These findings highlight important opportunities for health care systems to enhance the alignment of IPV screening and appropriate treatment recommendations by strengthening screening-to-referral pathways for family services and integrating systematic safety assessments. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Emotion regulation (ER) processes are directly associated with intimate partner violence (IPV) perpetration. ER also underlies two salient and commonly co-occurring risk factors for IPV: trauma exposure and alcohol use disorder (AUD). However, the relationship between trauma exposure and ER has rarely been explored in dyadic contexts. Thus, this study examined the extent to which trauma exposure and adaptive and maladaptive cognitive ER strategies were related to IPV perpetration in a sample of couples with AUD. We also examined whether ER strategies moderated the relation between trauma exposure and IPV. Participants were adult romantic couples (N = 100 couples) with AUD and physical IPV in their current relationship. Data analysis was conducted using a multilevel mixture modeling framework, focusing on level 1 (within person) associations. Four separate models were run to examine the interactive effects of trauma exposure and both adaptive and maladaptive ER strategies on psychological and physical IPV outcomes. Greater trauma exposure and maladaptive ER were associated with greater psychological IPV perpetration. Greater adaptive ER was marginally associated with less physical IPV. Contrary to hypotheses, no interaction effects emerged. While not all hypotheses were supported in this examination, results suggest that the associations among trauma exposure, ER, and IPV warrant further attention as a potential treatment target for individuals and couples.

Although safety plans (SPs), following the Stanley-Brown Safety Planning Intervention protocol, are required for suicidal veterans receiving treatment in the Veterans Health Administration (VHA), prior studies have shown that they are frequently incomplete or are not sufficiently personalized to the unique circumstances of each patient. In two studies, we examined SP completeness, SP quality (i.e., degree to which the SP was clear, actionable, and personalized), and SP fidelity (i.e., sum of completeness and quality). We also examined which SP steps were associated with a reduced likelihood of future psychiatric rehospitalizations (Study 1) and suicide attempts (Study 2) following hospital discharge. Participants were veterans admitted to two VHA acute inpatient psychiatric units for suicide risk (Study 1: N = 78; Study 2: N = 132). SPs were coded by independent raters on completeness, quality, and fidelity; step scores (e.g., Step 1 quality) were summed to create whole plan scores (e.g., SP quality). In Study 1, 52.5% of participants had a SP and, in Study 2, 93.1% of participants had a SP. In Study 1, whole plan scores were not associated with subsequent psychiatric hospitalization status, but higher Step 2 (internal coping) fidelity scores were associated with decreased likelihood of rehospitalization (AHR = 0.05, 95% CI [0.30, 0.84], p = .008). In Study 2, higher whole plan quality (AHR = 0.79, 95% CI [0.66, 0.95], p = .012) and fidelity (AHR = 0.84, 95% CI [0.71, 0.99], p = .040) scores were associated with a decreased likelihood of future suicide attempt. Step 1 (warning signs) quality (HR = 0.48, 95% CI [0.30, 0.76], p = .002) and fidelity scores (AHR = 0.57, 95% CI [0.37, 0.90], p = .016) were associated with a decreased likelihood of future suicide attempt. The association of SP characteristics differs by outcome of interest, and fidelity of internal coping strategies may contribute to preventing rehospitalizations, whereas quality and fidelity of warning signs may help prevent future suicide attempts. Overall, results suggest that mandating SPs without training and implementation strategies to ensure quality is not enough.

ObjectiveCrisis 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.MethodVeterans 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.ResultsReductions 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.ConclusionResponders 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.

BACKGROUND:In the US, over 50% of suicide deaths are by firearm injury. Studies have found that limiting access to firearms, including storing them temporarily outside of the home or locking and unloading them securely at home, helps prevent suicide. Family members and other loved ones are in a unique position to encourage secure firearm storage. This paper describes the development of a workshop to empower loved ones of individuals at risk for suicide to discuss secure firearm storage in New York State.METHODS:Using a multistakeholder engagement framework, we partnered with New York State county-level suicide prevention coalitions, local firearms experts, and other stakeholders to develop a 90-min workshop addressing secure firearm storage for suicide prevention. Pilot workshops were co-facilitated by a suicide prevention coalition member and a local firearms expert. Feedback gathered via surveys from workshop attendees and interviews with workshop co-facilitators were used to revise workshop content and inform dissemination. Following pilot workshops, a 1-day training event was held for potential future facilitators, and survey data were collected to assess trainee experiences and interest in facilitating future workshops. Data analysis included rapid qualitative analysis of interviews and statistical analysis of survey responses about acceptability of workshop.RESULTS:Four pilot workshops included a total of 23 attendees. Pilot workshop attendees endorsed willingness and confidence to discuss secure firearm storage with a family member or loved one. The training event included 42 attendees, of which 26 indicated interest in facilitating a workshop within the next year. Co-facilitators agreed on several key themes, including the importance of having a "trusted messenger" deliver the firearms portion of the workshop, keeping the conversation focused on firearm safety for suicide prevention, and developing interventions that reflect firearm owning community's culture.CONCLUSIONS:Consistent with a public health approach to suicide prevention, this study leveraged a multistakeholder engagement framework to develop a community-based workshop empowering loved ones of individuals at risk for suicide to discuss secure firearm storage. The workshop will be disseminated across New York State. We noted positive and collaborative relationships across stakeholder groups, and willingness to facilitate the workshop among both suicide prevention and firearm stakeholders.

Objective:Concerned allies often call crisis lines and other call centers about their loved ones' mental health. Callers to Coaching Into Care, a non-crisis call center, often report concerns about suicide risk in Veterans yet little is known about how best to support those callers. We conducted a documentation review to understand standard operating procedures, barriers, and opportunities for risk reduction. Method:Across 1,581 unique callers with an initial call over a 6 month period, 225 callers (14.2%) were identified for contact note review and coding. Results:Calls were frequently characterized by current suicidal ideation (62.7%), suicide attempts (24.0%), and access to lethal means (35.6%), although use of lethal means safety interventions was infrequently documented (12.9%). The majority of callers were coded as open to intervention (83.4%). After coaching, 16% of Veterans who were previously not connected to mental health care had connected to care in the community or VA. Conclusions:There was substantial heterogeneity in assessments and interventions used, particularly related to documentation of access to lethal means; however, there is an opportunity to provide risk reduction education and communication skill building for family and friends of Veterans. Those closest to Veterans report being open to learning new ways to engage with Veterans around safety and mental wellness.

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.

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 cri-sis lines that are linked with healthcare systems in public health strategies for suicide prevention. Am J Prev Med 2023;64(5):658-665. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

IntroductionClose 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. MethodsWe 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. ResultsFeasibility 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. ConclusionThe 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.

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.

Introduction: This study evaluates the effectiveness of the Veterans Crisis Line on immediate call outcomes (i.e., caller distress, suicidal ideation, and suicidal urgency) for veterans who provide identifying information. Methods: Coders rated pre- and post-distress, suicidal ideation, and suicidal urgency for 647 calls from 2019 veteran callers. Intraclass correlation coefficients examined inter-rater reliability. Multilevel generalized linear modeling examined pre-post changes. Results: Inter-rater reliability was good for distress, excellent for suicidal ideation, and fair for urgency. Callers had 5 times greater odds of a reduction in distress (AOR=5.03, 95% CI=3.98, 6.49), almost 5 times greater odds of a reduction in suicidal ideation (AOR=4.92, 95% CI=3.49, 6.94), and 11 times greater odds of a reduction in suicidal urgency (AOR=11.01, 95% CI=2.72, 44.50) at the end of calls than at the beginning. Conclusions: Veterans Crisis Line callers who provide identifying information experience reductions in distress and suicidal ideation during the call. Research is needed to examine the reduction in suicidal urgency because of fair reliability, generalizability of results to other callers, post-call treatment contact and engagement, and risk for suicide attempts and death. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

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.

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.

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).