Aubrey R. Dueweke

Social-Cognitive and Social-Behavioral Correlates of Suicide Risk in College Students: Contributions from Interpersonal Theories of Suicide and Depression

Joiner’s interpersonal-psychological theory of suicide (IPTS) is predated by literature examining maladaptive interpersonal behaviors associated with depression; however, research has not examined the potential relevance of such behaviors for the IPTS. The current study aimed to expand understanding of suicide risk by examining two maladaptive interpersonal behaviors in the context of Joiner’s IPTS model. Structural equation modeling examined associations between depressive symptoms, social-cognitive predictors of suicide, maladaptive interpersonal behaviors, and suicide risk in 228 college students (53.9% female; M = 19.5 years, SD = 1.8). Social-cognitive IPTS variables mediated the relation between depressive symptoms and maladaptive interpersonal behavior. Both social-cognition and maladaptive interpersonal behavior mediated the effect of depressive symptoms on suicide risk. Findings have the potential to add to our understanding of the interplay of social-cognitive factors and interpersonal behaviors associated with suicide risk. Directions for future research are discussed.

Need, access, and the reach of integrated care: A typology of patients.

Introduction: This paper is a report on a study exploring a potential typology of primary care patients referred for integrated behavioral health care (IBHC) services. We considered whether primary care patients could be grouped into meaningful clusters based on perceived need for behavioral health services, barriers to accessing care, and past-year service utilization. We also described the development of a working partnership between our university-based research team and a federally qualified health center (FQHC). Method: A total of 105 adult primary care patients referred for same-day behavioral health appointments completed a brief self-report questionnaire assessing past-year behavioral health concerns, service utilization, and perceived barriers to utilization. Results: Hierarchical and k-means cluster analyses revealed 3 groups: (a) Well-Served patients, characterized by high perceived need for services, high service use, and low barriers to service use (40%); (b) Underserved patients, characterized by high perceived need, low service utilization, and high barriers to service use (20%); and (c) Subclinical patients, characterized by low perceived need, low service use, and low barriers to service use (20%). Clusters were reliably differentiated by age, primary language, insurance status, and global functioning. Discussion: We found primary care patients could be grouped into 3 categories and that 60% (Underserved and Subclinical) represented groups less commonly seen in traditional mental health (MH) settings. IBHC may be a promising approach for extending the reach of MH care, and partnerships between FQHCs and university-based research teams may be a promising approach for conducting research on the IBHC service-delivery model.

Inadequacy of the PHQ-2 depression screener for identifying suicidal primary care patients.

Introduction: The Patient Health Questionnaire–2 (PHQ-2) depression screener has been praised for its brevity and ability to identify depressed primary care patients. Additionally, it is often used as the first of a two-step screening process for suicide risk. Despite its decent performance as a depression screener, the PHQ-2 cannot be assumed to be an adequate screener for suicide risk. In the present study, we examine the utility of the PHQ-2 for identifying suicidal patients. Method: We examined data from 548 adult primary care patients at a Federally Qualified Health Center in the mid-Southern region of the United States who completed the PHQ-2 as part of the full administration of the Patient Health Questionnaire–9 (PHQ-9). Results: Cross-tabulation analyses revealed 22 of the 157 (14.0%) patients endorsing suicidal ideation fell below the conventional clinical cutoff of 3 on the PHQ-2. Logistic regression analyses indicated a positive screen on the PHQ-2 did not improve explanation of suicidal ideation beyond the base model, and only 3 items from the first 8 PHQ-9 questions (depressed mood, feeling like a failure, and psychomotor retardation/agitation) were significant explanatory variables for suicidal ideation. Discussion: Providers should consider asking about suicide directly, rather than relying on depression screeners to identify suicidal patients. We also recommend providers pay particular attention to any indication that patients feel like a failure or like they have let their loved ones down, in addition to endorsement of depressed mood.

Suicide interventions in primary care: A selective review of the evidence.

Introduction: About half of people who die by suicide visit their primary care provider (PCP) within 1 month of doing so, compared with fewer than 1 in 5 contacting specialty mental health. Thus, primary care is an important setting for improving identification and treatment of suicide risk. This review identifies and summarizes evidence for the effectiveness of intervention components for suicide risk in primary care. Method: We searched the PsycINFO database to identify relevant articles. We considered publications reporting the effectiveness of a packaged intervention for management of suicide risk in primary care or any other brief (i.e., single-session) intervention for suicide risk in the present review. Results: Four major components to suicide interventions in primary care emerged: (a) educating practitioners, (b) screening for suicide risk and/or mood disturbance, (c) managing depression symptoms, and (d) assessing and managing suicide risk. Although practitioner education and screening for suicide risk are important, they are insufficient for effective suicide prevention programs. Collaborative treatment of depression by multidisciplinary teams can reduce rates of suicidal ideation in primary care patients. Recent evidence also indicates a single-session crisis response planning intervention may be effective at reducing suicidal ideation and attempts. Discussion: Integration of behavioral health specialists trained in suicide risk assessment and management could be important for improving suicide prevention in primary care patients. This condensed review of the evidence serves as a resource for practitioners who are hoping to implement brief, effective interventions for suicide risk to better serve their patients.

Open to Diversity: Openness to Experience Predicts Beliefs in Multiculturalism and Colorblindness Through Perspective Taking

The present research examines the influence of personality on ideologies about diversity in society. In two studies (N = 668), we test whether Openness to Experience predicts beliefs in multiculturalism and colorblindness, and whether these relationships are mediated by perspective-taking tendencies. In Study 1, Openness positively predicted multiculturalism but negatively predicted colorblindness through ethnic perspective taking – findings that were independent of empathy, age, gender, and race/ethnicity. In Study 2, we attempted to replicate and extend our findings by using different measures of multiculturalism and colorblindness and a more general, interpersonal operationalization of perspective taking. Results indicate Openness positively predicted both multiculturalism and colorblindness through interpersonal perspective taking (also independent of age, gender, and race/ethnicity), suggesting the pattern of findings varied as a function of perspective-taking type. Implications for the complexity of the Openness dimension and future research directions are discussed.

Cost-savings analysis of primary care behavioral health in a pediatric setting: Implications for provider agencies and training programs.

This study investigated economic savings associated with primary care behavioral health (PCBH) in a diverse sample of 248 pediatric patients seen at a Federally Qualified Health Center. We sought to determine the (a) overall cost savings from PCBH and (b) incremental costs and savings of services provided by doctoral trainees versus full-time behavioral health employees (BHEs). Data were extracted from patient medical records for the 2015–2016 training year. We calculated the per-patient costs for BHEs (n = 5; served 223 patients) and trainees (n = 2; served 25 patients) from administrative data. Savings associated with PCBH were computed based on reductions in monthly health care charges after versus before the initial PCBH visit for each patient. There was a significant reduction in health care charges after an initial PCBH visit, with an overall (i.e., average across provider types) net savings of

The impact of anxiety on health care utilization among Hispanic and non-Hispanic youth

38 per patient. Stated differently, each dollar spent on PCBH returned approximately

Can brief behavioral health interventions reduce suicidal and self-harm ideation in primary care patients?

1.16 in reduced health care charges. There was no significant difference in cost-savings between BHEs and trainees. Uncertainty in several key study parameters (i.e., BHE salary, changes in health charges) may have influenced the results. These findings suggest that PCBH services with pediatric patients hold promise in terms of economic sustainability, including when trainees are involved in service delivery. Implications of the study findings for policymakers, provider agencies, and doctoral training programs in psychology are discussed.

The positive predictive value of the PHQ-2 as a screener for depression in Spanish-Speaking Latinx, English-speaking Latinx, and non-Latinx White primary care patients.

This study examined differences in health service utilization among anxious and non-anxious youth primary care patients. We further examined the moderating role of Hispanic ethnicity on the relation between anxiety and service utilization. Past 4-year health care utilization was examined in a group of 6962 American youth (51.10% male; 53.10% Hispanic). Youth with an anxiety disorder had significantly more medical visits over the prior 4-year period than youth without an anxiety disorder. Hispanic youth utilized health care services at higher rates than non-Hispanic youth; however, ethnicity did not moderate the relation between youth anxiety and health care utilization.

Beliefs about Causes of Mental Illness Predict Provider Referrals to Behavioral Health

Objective: We examined whether brief behavioral health visits reduced suicidal and self-harm ideation among primary care patients and compared the effectiveness of interventions that targeted ideation directly (i.e., safety planning) with those that targeted ideation indirectly through management of underlying mental illness (e.g., behavioral activation). Method: We examined first- and last-visit data from 31 primary care patients with suicidal or self-harm ideation seen by behavioral health consultants. Results: Patients reported significantly lower frequencies of suicidal and self-harm ideation at their final visit than at their initial visit. Patients whose ideation was targeted directly showed greater improvements than patients whose ideation was targeted indirectly. Discussion: Although preliminary, results suggest mild to moderate suicidal ideation could be addressed in primary care through integration of behavioral health consultants into the medical team.