Associations Between Service Members’ Posttraumatic Stress Disorder Symptoms and Partner Accommodation Over Time
When service members manifest symptoms of posttraumatic stress disorder (PTSD), intimate partners may engage in behaviors to accommodate their partners’ experiences (e.g., helping service members avoid situations that could make them uncomfortable, not expressing own thoughts and feelings to minimize PTSD‐related conflict), which may inadvertently serve to maintain or increase PTSD symptoms over time. In a sample of 274 male service member/female civilian couples, we evaluated hypothesized bidirectional pathways between self‐reported service member PTSD symptoms and partner accommodation, assessed four times over an approximately 18‐month period. A random‐intercept cross‐lagged panel model disaggregating between and within effects revealed that, on average, couples in which the service member had higher levels of total PTSD symptoms also scored higher in partner accommodation, between‐couple correlation, r = .40. In addition, at time points when service members’ PTSD symptoms were higher relative to their own average symptom level, their partners’ level of accommodation was also higher than their personal average, within‐couple correlation r = .22. Longitudinally, service member PTSD symptom scores higher than their personal average predicted subsequent increases in partner accommodation, β = .19, but not vice versa, β = .03. Overall, the findings indicate both stable and time‐specific significant associations between service member PTSD symptoms and partner accommodation and suggest that higher levels of PTSD symptoms are a significant driver of later increases in partner accommodation. These findings add further support for treating PTSD in an interpersonal context to address the disorder and concomitant relational processes that can adversely impact individual and relational well‐being.
Male service members’ and civilian wives’ perceptions of partner connection regarding deployment and PTSD symptoms
In general, a sense of understanding and connection is an important aspect of marital relationships. In the context of military couples in which a service member may have symptoms of posttraumatic stress disorder (PTSD), spouses’ understanding of the nature and causes of service member PTSD symptoms may be protective for both partners’ marital satisfaction. However, partners may vary in the degree to which they understand and connect around (a) historical experiences of combat and deployment versus understanding and connecting around (b) any ongoing manifestation of PTSD symptoms post deployment. In a sample of 58 male Army service members and their civilian wives drawn from a larger study of military couple functioning, we found that a measure of “Combat/Deployment connection” and a measure of “PTSD connection” were strongly correlated with each other yet not isomorphic. Both Combat/Deployment connection and PTSD connection had unique predictive effects for marital satisfaction. Both husbands and wives reported higher levels of PTSD connection relative to Combat/Deployment connection. At low or average levels of Combat/Deployment connection, higher levels of PTSD symptoms were associated with lower levels of marital satisfaction, whereas at high levels of Combat/Deployment connection, this association was no longer signiﬁcant. No such moderation effects were found for PTSD connection. The utility of distinguishing these two domains of potential connection for military couples is discussed.
Probation Officers’ and Supervisors’ Perspectives on Critical Resources for Implementing Specialty Mental Health Probation
This paper presents the results of a qualitative study designed to explore and identify the resources that probation officers need to implement specialized mental health probation caseloads, a promising practice that enhances mental health treatment engagement and reduces recidivism among people with mental illnesses. Our research team conducted a directed content analysis guided by the Practical, Robust Implementation and Sustainability Model (PRISM) to analyze qualitative interviews with 16 specialty mental health probation officers and their supervising chiefs. Results indicated five components and resources related to multiple PRISM constructs: (1) meaningfully reduced caseload sizes (intervention design), (2) officers’ ability to build rapport and individualize probation (organizational staff characteristics), (3) specialized training that is offered regularly (implementation and sustainability infrastructure), (4) regular case staffing and consultation (implementation and sustainability infrastructure), and (5) communication and collaboration with community-based providers (external environment). Agencies implementing specialized mental health probation approaches should pay particular attention to selecting officers and chiefs and establishing the infrastructure to implement and sustain specialty mental health probation.
Social support among people with mental illnesses on probation
Debt, Incarceration, and Re-entry: a Scoping Review
People involved with the criminal justice system in the United States are disproportionately low-income and indebted. The experience of incarceration intensifies financial hardship, including through worsening debt. Little is known about how people who are incarcerated and their families are impacted by debt and how it affects their reentry experience. We conducted a scoping review to identify what is known about the debt burden on those who have been incarcerated and their families and how this impacts their lives. We searched 14 data bases from 1990 to 2019 for all original research addressing financial debt held by those incarcerated in the United States, and screened articles for relevance and extracted data from pertinent studies. These 31 studies selected for inclusion showed that this population is heavily burdened by debt that was accumulated in three general categories: debt directly from criminal justice involvement such as LFOs, preexisting debt that compounded during incarceration, and debts accrued during reentry for everyday survival. Debt was generally shown to have a negative effect on financial well-being, reentry, family structure, and mental health. Debts from LFOs and child support is very common among the justice-involved population and are largely unpayable. Other forms of debt likely to burden this population remain largely understudied. Extensive reform is necessary to lessen the burden of debt on the criminal justice population in order to improve reentry outcomes and quality of life.
“Let Me Be Bill-free”: Consumer Debt in the Shadow of Incarceration
Low-income U.S. households are increasingly burdened by unaffordable debt, with profound long-term economic and health consequences. Households of color are disproportionately negatively affected. This article examines the nexus of this rising indebtedness and mass incarceration through the experiences of a particularly marginalized group, people with mental illness. Drawing on qualitative research with 31 individuals with mental illness and recent incarceration in the city of New Haven, Connecticut, we show how carceral institutions and predatory financial practices intersect to create complex entanglements for poor and vulnerable people. While a growing body of scholarship focuses on criminal justice fines and fees, we highlight other types of debt that add to the overall burden, describing how incarceration deepens people’s existing debts of poverty and adds new debts from in-prison costs and identity theft. After release, those debts complicate the search for housing, employment, and financial stability, leading to further debt, stressing social relationships and reproducing social and economic inequality. The experiences of people with mental illness illuminates structures of marginalization and disadvantage that affect many others involved with the criminal justice system.
The Effects of Hopelessness on Chronic Disease Among African Americans and Caribbean Blacks: Findings from the National Survey of American Life (NSAL)
This paper examines the relationship between hopelessness on chronic disease in a national sample of African Americans (3570) and Caribbean Blacks (1438) Using the National Survey of American Life. A multivariate negative binomial regression examined whether chronic disease is associated with hopelessness, controlling for sociodemographic characteristics. Overall, 13.14% of the sample reported they were highly hopeless, and 31.5% indicated they were moderately hopeless. About 19% of respondents experienced chronic disease. Bivariate associations showed that those who have ever had chronic disease significantly differed from those who did not in regard to age, gender and spirituality. Multivariate results showed that respondents who ever have had chronic disease reported significantly higher hopelessness scores than those with no chronic disease. The study findings contribute to the current body of literature by supporting findings from smaller studies on the relationship between depression and hopelessness in African Americans and Caribbean Blacks.
Opportunity beckons: a case for community practice within the classroom
Current trends point toward the marginalization of community practice in the field of social work and social work education. Since community practice education is heavily informed by trends in the field, the opportunity for educational expansion is immediate and great. This moment necessitates a move toward methods of community practice education that emphasize practitioner skill development in theory, creativity, collaboration, understanding, and investment. In an attempt to address the need for community-practice education, the authors present a challenging and innovative assignment for graduate students that encouraged university/community partnerships through experiential community experiences.
Preoperative Optimism Related to Low Anxiety in Patients 1 Month After Open Heart Surgery
Anxiety can contribute to poor prognosis in cardiac patients. Few studies have examined the role of optimism in anxiety after open heart surgery (OHS). This study investigated the influence of preoperative optimism on post-OHS anxiety, adjusting cardiac indices used by cardiac surgeons. Data were collected before and 1 month after OHS in 481 patients (58% men; age, 62.4 ± 11.94 years). Optimism was measured using the Life Orientation Test. Anxiety was measured using the Trait Anxiety Inventory. Medical and cardiac indices were retrieved from the Society of Thoracic Surgeon’s national database. Multiple regression analyses showed that greater pre-OHS optimism was associated with lower levels of post-OHS anxiety (F[6, N = 306] = 50.18, p < 0.001, R2 = 0.502). No other factors showed similar protection. Pre-OHS anxiety, younger age, and minority status were associated with anxiety in the critical recovery month. The findings demonstrate the potential benefit of optimism against post-OHS anxiety, which may have clinical implications for improving disease management.
Depression After Open Heart Surgery: Influences of Optimism, Sex, and Event-Related Medical Factors
Postoperative depression is a multifaceted condition that can limit quality of life and potentially decrease the survival benefits of open heart surgery (OHS). We postulated that sex, pre-event character strengths, medical, and certain surgery indicators would predict post-event/myocardial infarction depression. To identify predictors, we collected three-wave survey data from 481 OHS patients at a large academic referral institution (age, 62+; female, 42%) and included key medical and surgical information. The final model (F[7, N = 293] = 28.15, p < 0.001, R = 0.408) accounted for over two fifths of the variance in post-OHS depression. Pre-event/OHS optimism mitigated post-OHS depression. Being female, older, living alone, longer surgical perfusion time, absence of left main disease greater than 50%, and pre-OHS depression were associated with the increased likelihood of post-OHS depression. Our findings suggest that teaching optimism to OHS patients might be beneficial in reducing the risk of postoperative depression and that female patients should be monitored more closely for the development of depression through an interdisciplinary approach.
Perceived Discrimination as a Mediator of ACEs and Psychological Distress
The authors investigated the role of perceived discrimination in the association between adverse childhood experiences and psychological distress in adulthood in a sample of individuals (n = 125) at a university-based couple and family therapy clinic. Results showed that a majority had experienced four or more adverse experiences, indicating a high risk of negative health outcomes. A significant indirect effect of adverse experiences through perceived discrimination on psychological distress, even with gender, race/ethnicity, and household income as covariates, was noted. Findings underscore the importance of incorporating assessment of perceived discrimination in therapy with clients presenting with childhood adversity and psychological distress.
Psychometric properties of the Italian version of the Interpersonal Needs Questionnaire‐15 (INQ‐15‐I)
Objective: The Interpersonal Needs Questionnaire (INQ‐15) is a self‐report measure of thwarted belongingness and perceived burdensomeness, two constructs associated with suicidal ideation. The objective of the current study was to translate the INQ‐15 from English to Italian (INQ‐15‐I) and to test its factor structure, reliability, and validity in Italian samples. Method: We examined (a) whether the components of the hypothesized two‐factor measurement model are invariant across a community sample (N = 510) and a clinical sample (N = 259); (b) the relations between the INQ‐15‐I factors and measures of depression (Beck Depression Inventory‐II), hopelessness (Beck Hopelessness Scale), and suicidal ideation (Beck Scale for Suicide Ideation); (c) the reliability and psychometric properties of the INQ‐15‐I. Results: Results from multigroup confirmatory factor analyses supported the adequacy of the two‐factor model to represent thwarted belongingness and perceived burdensomeness. The model is invariant across community and clinical groups, showing excellent fit. The two INQ‐15‐I scales measure highly intercorrelated constructs. Both significantly correlate with depression, hopelessness, and suicidal ideation, and correlations are high in the clinical sample. Conclusion: The INQ‐15‐I is a valid and reliable measure of thwarted belongingness and perceived burdensomeness. Implications for research, assessment, and intervention in suicidal ideation are discussed.
Hopelessness, Interpersonal, and Emotion Dysregulation Perspectives on Suicidal Ideation: Tests in a Clinical Sample
Objective: The present study directly compared three perspectives of suicidality: Interpersonal Theory of Suicide (IPTS), Hopelessness Theory, and a perspective emphasizing emotion dysregulation. Method: 219 adults seeking outpatient psychological services completed questionnaires during intake between November 2015 and February 2019. Patients were included if they completed surveys related to thwarted belongingness (TB), perceived burdensomeness (PB), hopelessness, depressive symptoms, negative affect, and Borderline Personality Disorder (BPD) symptoms. Analyses tested the ability of TB, PB, depressive symptoms, hopelessness, and emotion dysregulation to relate to total scores on Beck Scale for Suicide Ideation. We employed Pearson’s correlations and linear regressions to investigate these relations. Results: Constructs related to emotion dysregulation—negative affect (r = 0.161, p < .05) and Borderline Personality Disorder symptoms (r = 0.284, p < .01)—were significantly correlated with suicidal ideation, as were those relevant to Hopelessness Theory—depressive symptoms (r = 0.46, p < .01) and hopelessness (r = 0.45, p < .01)— and IPTS—TB (r = 0.36, p < .01) and PB (r = 0.43, p < .01). Notably the combinations of constructs as proposed by theories were significantly associated with suicidal ideation, but did not improve upon single constructs. This indicated that theoretically relevant constructs alone were strongly associated with suicidal ideation, but were not bested by interactions. Conclusions: This project compared constructs relevant to three theories of suicidality among a sample of treatment seeking outpatients. Findings indicated that suicidal ideation assessment was similarly informed by Hopelessness Theory and IPTS, and to a lesser degree emotion dysregulation. The cross sectional nature of the data and the reliance upon self-report measures limit the inferences that can be made.
The Process of Change in Systemic Family Therapy
This chapter provides a comprehensive review of the research on the processes of change in systemic family therapy (SFT). We begin by clearly defining SFT process research including what it fully entails: systemically oriented mechanisms and contexts of change. Our review of the research is uniquely organized according to our view of the evolution of SFT practice (a) beginning with an overview of process findings from the traditional schools of SFT, (b) followed by findings from empirically supported treatments in SFT, and then (c) finalized by an assessment of the research from an integrative perspective of SFT including common and unique change processes (systemic alliances, systemic engagement and retention, systemic reframing, and systemic enactments). Following this overview, we provide directions for future areas of research that will need to be explored in order to more fully articulate the pathways of change in SFT including the need to better clarify the contexts in which certain process are most important. Finally, several implications for SFT training and practice are articulated including how this review points to the need for a potential paradigm shift that squarely places systemically oriented principles of change and client system‐centered integration and at the heart of our work.
The measurement of interpersonal interactions with continuous spatiotemporal data: Application to a study of the effects of resource competition on racial group interactions
We describe a sequential qualitative ➔ quantitative mixed-method procedure used to construct conceptually grounded quantitative metrics of interpersonal behavior from continuous spatiotemporal data. Metrics were developed from data collected during an experiment in which racially diverse participants interacted with self-resembling avatars at social events hosted in the virtual world Second Life. In the qualitative stage, the researchers conceptualized four distinct patterns of movement from overhead video recreations of participants interacting during the social events. In the quantitative stage, these patterns of movement were operationalized into metrics to reflect each type of observed interpersonal behavior. The metrics were normalized through a series of transformations, and construct validity was assessed through correlations with self-report measures of intergroup behavior. Finally, the metrics were applied to an analysis of the virtual-world study examining the influence of resource competition on racial group interactions. The findings contribute to our understanding of the influence of resource competition on Blacks’, Asians’, and Whites’ group dynamics. Applications of these metrics for the future of the psychological study of interpersonal behavior are discussed.
Predictors of Latinx Youth Health and Emotional Well-being: Social Determinants of Health Perspective
Latinx youth disproportionately experience numerous negative social determinants of health (SDOH) that can have deleterious impacts on health outcomes. Yet, limited research is available on the role of SDOH on the well-being of Latinx adolescents. Utilizing data from the Fragile Families and Child Wellbeing Study, this study examined the association between variables representing five discrete domains of SDOH and health and emotional well-being outcomes among youth of Latinx mothers (N = 745). The study included 15-year-old youth of Latina mothers who were retained in the most recent wave of data collection (wave 6). Using Mplus8, we performed structural equation modeling to determine whether exogenous indicators of five domains of SDOH (economic stability, education, neighborhood and built environment, social and community context, and health care access) predicted adolescent health status and emotional well-being. SDOH specific to social, educational, and neighborhood factors emerged as significant predictors of health and well-being. Yet, variation existed in regard to which SDOH were most important for each outcome variable. Findings suggest that several SDOH, including economic stability, education, neighborhood and built environment, and social and community context, are particularly important for Latinx adolescent well-being. Implications for social work practice and policy are presented. Future studies should examine the longitudinal impact of SDOH and should examine Latinx youth by nativity.
Climate of Fear: Provider Perceptions of Latinx Immigrant Service Utilization
Latinx immigrants endure stressors throughout the immigration process that detrimentally impact their health and wellbeing. Yet, they also face substantial barriers to accessing and utilizing services. These barriers might be heightened under the Trump administration, which has implemented policies facilitating increased immigration enforcement and punitive immigration practices. This study utilizes data collected from providers who serve Latinx immigrants in the border state of Texas to better understand current immigrant service utilization behaviors. Individual interviews and focus groups were conducted shortly after the last presidential election to inquire about recruitment, retention, program completion, and resources to address key client risk factors. Applying grounded theory analysis strategies, interviews, and focus group recordings were coded for key themes. Data demonstrated central concerns held by providers serving immigrants, and especially those who are undocumented or in mixed-status families. Concerns were related to the following three themes: (1) undocumented immigrant stressors, (2) limited resources for undocumented immigrants, and (3) service utilization barriers. Lack of services for undocumented immigrants and fear related to service utilization were prominent subthemes. These findings extend our knowledge of stressors and barriers of access and utilization for immigrants during this time period of increased immigration enforcement which have valuable implications for practice and future research. Providers can take concrete actions to educate immigrants, regardless of documentation status, on how their clients’ identities will be protected. In addition, intentional trust-building strategies are essential to help overcome fear of utilizing services. Future research should ascertain perspectives of immigrant families, as this study drew perspectives only from providers.
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Substantiated allegations of failure to protect in the child welfare system: Against whom, in what context, and with what justification?
Failure to protect (FTP), a sub-type of neglect, is used by child welfare systems to categorize and substantiate allegations of child maltreatment. Scholars and advocates have raised concerns that FTP is disproportionately used to substantiate mothers and people of color for harm perpetrated by others, particularly in the contexts of sexual abuse and domestic violence. Limited data exist about how FTP is used in practice or if substantiation of FTP varies by context across gendered or racialized groups. This study extends our understanding of use of FTP by examining who workers substantiate for FTP, in what context, and the justifications they use. Data for this study were drawn from child welfare records in a large, Midwestern county. Mixed methods were used to analyze data from 150 maltreatment referrals which included at least one substantiated allegation of FTP. Findings indicate that the contexts and rate at which caregivers were substantiated for FTP differed significantly across gendered groups. Mothers were most frequently substantiated for FTP in the contexts of sexual abuse, physical abuse, and domestic violence. Fathers were most frequently substantiated in the context of substance use. In addition, rates of FTP substantiation varied across racialized groups. Black caregivers were substantiated disproportionately across all contexts. White caregivers were overrepresented among those substantiated for FTP in the context of substance use. Notably, justification for substantiation decisions was often not documented in data. Implications for policy and practice are discussed.
Children and the Welfare State: The Need for a Child-Centered Analysis
Variation in child well-being across rich Western nations suggests that the welfare state may play a role in shaping child well-being. However, welfare scholars have largely overlooked children in their analyses. This paper seeks to bring children to the center of welfare state analysis by examining how comparative welfare state theory can consider child well-being. The paper begins with an examination of Esping-Andersen’s seminal work, The Three Worlds of Welfare Capitalism, which has come to frame welfare state analysis for nearly three decades. Next, the paper explores the main critiques of Esping-Andersen’s work, with special attention paid to the feminist critique and the construction of alternative feminist and family policy regimes. Finally, this paper extends and reworks Esping-Andersen’s Three Worlds to offer a new framework for conducting child-centered welfare state analyses.