Daniel W. Cox

Occupational Engagement Scale–Student: Development and Initial Validation

The Occupational Engagement Scale–Student (OES-S)—a 9-item measure of occupational engagement in college students—was developed and initial validity evidence is presented. Using two samples of college students, exploratory and confirmatory factor analyses supported the measure’s unidimensionality. Criterion validity was supported via the OES-S predicting (a) vocational identity, (b) academic major satisfaction, (c) gains in personal development, (d) gains in vocational competence, and (e) gains in general education. Implications for practice, theory, and future research are discussed.

Linking partner emotional support, partner negative interaction, and trauma with psychological distress: Direct and moderating effects

While research evidence has consistently demonstrated the link between social relationships and psychological distress, there is debate over the strength of perceived emotional support compared with perceived negative interaction on psychological distress and whether the relation between social relationships and psychological distress is direct or moderating. In this study, we examined the relation between partner emotional support, partner negative interaction, and trauma on psychological distress. Our sample of married or romantically partnered people was drawn from a nationally representative U.S. data set (N = 5,383). The direct effects of romantic partner emotional support and romantic partner negative interaction on psychological distress were evaluated and compared. Further, we evaluated the moderating effects of partner emotional support and partner negative interaction on the relation between trauma history and psychological distress. Hierarchical regression models revealed that (a) people exposed to trauma experienced greater psychological distress, (b) partner emotional support was linked with reduced distress, (c) partner negative interaction was linked with increased distress, (d) partner negative interaction accounted for more variance in psychological distress compared with partner emotional support, and (e) neither partner emotional support nor partner negative interaction moderated the relation between trauma and distress. These findings indicate that partner negative interaction has a stronger relation with psychological distress than partner emotional support. Further, they support the direct effects of social relationships on psychological distress over the moderating effects.

Gender Differences on Documented Trauma Histories: Inpatients Admitted to a Military Psychiatric Unit for Suicide-related Thoughts or Behaviors

Suicide is a leading cause of death among men and women in the United States Military. Using a retrospective chart review design, the current study investigated gender differences on documented traumas for people admitted to a military inpatient psychiatric unit for suicide-related thoughts or behaviors (N = 656). Men more often had no documented lifetime traumas and women more often had 2 or more trauma types. Women had significantly more documented incidences of childhood sexual abuse, adulthood sexual assault, adulthood physical assault, and pregnancy loss. The gender gap in documented trauma types for childhood and adulthood traumas persisted even after adjusting for demographic variables, psychiatric diagnoses, and comorbid trauma types (i.e., trauma types other than the one being used as the dependent variable). Given the observed gender differences in documented traumas, professionals working with military women admitted for suicide-related thoughts or behaviors need to consider trauma in the context of treatment.

A Guide for the Assessment and Treatment of Suicidal Patients With Traumatic Brain Injuries

People with traumatic brain injuries (TBIs) are at elevated risk for suicide. Postinjury cognitive limitations, personality factors, and psychological problems may independently or in conjunction with preinjury correlates contribute to suicidal thoughts and behaviors. Rehabilitation practitioners can best serve the needs of this high-risk population by increasing their knowledge and competence in evidence-informed approaches to suicide prevention. This article provides a review of suicide nomenclature, epidemiology, risk and protective factors, as well as evidence-informed assessment, management, and treatment practices for suicidal patients. The science of clinical practice in the area of rehabilitation and suicide prevention is in its infancy. Practitioners who provide treatment for suicidal patients with TBI are encouraged to adapt and individualize existing evidence-informed suicide assessment and prevention practices for implementation within their settings. Each patient with a TBI who endorses suicidal thoughts and/or behaviors presents a complex array of clinical challenges associated with the nature of his or her brain injury, preinjury, and postinjury functioning. Clinical as well as research recommendations are provided in the context of an understanding of such challenges and an overriding objective of minimizing suicide risk during the recovery process and maximizing treatment gains.

Evaluation of a Group Intervention for Veterans Who Experienced Military- Related Trauma

Abstract Military-related trauma and veteran status have been linked with posttraumatic stress symptoms, depressive symptoms, and other personal and interpersonal difficulties. While many treatment evaluations for people with posttraumatic stress exist, few veteran populations or group formats have been evaluated. This report presents an evaluation of the Veterans Transition Program (VTP)–a group-based treatment for veterans who experienced a military-related trauma that is negatively impacting their lives. Fifty-six veterans attended the VTP; all attended every session and completed pre- and post-tests assessing posttraumatic stress and depressive symptoms. Significant pre- to post-test improvement was found on all scales. These findings demonstrate the potential benefit of the VTP and encourage further research.

Validity Evidence for a Perceived Social Support Measure in a Population Health Context

The Medical Outcomes Study-Social Support Scale (MOS-SS) is a self-report measure of perceived social support. It was originally developed to assess perceived social support in a longitudinal study of patients’ medical outcomes. Recently, the MOS-SS was adopted by population health researchers. The purpose of population health research is to examine predictors of various health outcomes within and between populations. The aim of the present study was to investigate validation practices in population health and compare them to measurement standards common to psychology and education. To do this, we examined the published research that evaluated MOS-SS score validity. Findings indicated that few validity studies were conducted with samples most relevant to population health research. We discuss these findings and make suggestions for future population health research validation practices.

The Edinburgh Postnatal Depression Scale (EPDS): A Review of the Reported Validity Evidence

The Edinburgh Postnatal Depression Scale (EPDS; Cox et al. Br J Psychiatr 150:782–786, 1987) is used internationally for the detection of postpartum depression in women. We reviewed the validity evidence of the EPDS and examined the extent to which the reported evidence is in line with the modern view of validity. Of the 57 articles included, 30 (52.6 %) included internal consistency, 29 (51 %) discussed predictive validity, 27 (47.4 %) reported on concurrent validity, 16 (28.1 %) studies addressed the internal structure of the EPDS, and 15 (26.3 %) included convergent validity. Fewer articles reviewed response processes (1.8 %), six (10.5 %) discussed content validity of the scale, five (8.8 %) addressed face validity of the EPDS, three studies (5.3 %) discussed discriminant validity, and two studies (3.5 %) included consequences. Certain sources of validity evidence such as response processes and consequences need to be accumulated to strengthen the score inferences of the EPDS.

How Parental Reactions Change in Response to Adolescent Suicide Attempt

This study examined parental reactions to adolescents’ suicide attempts and the association of reactions with future suicidal self-directed violence. Participants were 81 mothers and 49 fathers of 85 psychiatric inpatient adolescents. Maternal hostility and paternal anger and arguing predicted future suicide attempts. From pre- to post-attempt, mothers reported feeling increased sadness, caring, anxiety, guilt, fear, and being overwhelmed; fathers reported increased sadness, anxiety, and fear. Findings have clinical implications; improving parent-child relationships post-suicide attempt may serve as a protective factor for suicide.

Attachment avoidance, alexithymia, and gender: Examining their associations with distress disclosure tendencies and event-specific disclosure.

Distress disclosure has been linked with reduced psychological distress, increased wellbeing, and successful psychotherapeutic outcome. Because of the importance of distress disclosure, researchers have worked to develop and improve theoretical models of disclosure to facilitate counseling practices that reduce impediments to disclosure. Presently, we conducted a 2-part study to investigate distress disclosure’s associations with attachment avoidance, gender, and alexithymia—3 constructs frequently linked with disclosure. In Part 1, we examined the extent to which attachment avoidance, alexithymia, and gender predicted general disclosure tendencies. In Part 2, we examined the extent to which attachment avoidance, alexithymia, and gender predicted event-specific disclosure. Participants were recruited from a crowdsourcing website (N = 178 in Part 1; N = 108 in Part 2). In Part 1, alexithymia partially mediated the association between attachment avoidance and disclosure tendencies, and the link between attachment avoidance and alexithymia was stronger for men than women. In Part 2, the association between distress intensity and event-specific disclosure was weaker for people with high levels of alexithymia. Implications for counseling theory and practice are discussed.

Posttraumatic stress mediates traditional masculinity ideology and romantic relationship satisfaction in veteran men.

Veteran men have high rates of adherence to traditional masculinity ideology, posttraumatic stress disorder (PTSD) symptoms, and romantic relationship dissatisfaction. However, there is a paucity of studies investigating how these constructs relate to one another in veteran men. We examined the relation between masculinity ideology and relationship satisfaction and the extent to which this relation was mediated by PTSD symptoms. Next, we tested this mediating effect with traditional male role norms hypothesized to inhibit cognitive-emotional processing of traumatic events (i.e., self-reliance, toughness, dominance, restrictive emotionality) and male role norms with no hypothesized relation with cognitive–emotional processing (i.e., avoidance of femininity, importance of sex, negativity toward sexual minorities). Participants were veteran men with a history of military-related trauma who were in a romantic relationship at the time of study participation (N = 76). Veterans completed measures of traditional masculinity ideology endorsement, PTSD symptoms, and relationship satisfaction. Findings indicated that PTSD partially mediated the association between endorsement of traditional masculinity ideology and relationship functioning in veterans. These findings can be used to inform PTSD interventions with veteran men and their romantic partners.