Jessica M. LaCroix

Behavioral Interventions for African-Americans to Reduce Sexual Risk of HIV: A Meta-Analysis of Randomized Controlled Trials

Context:African Americans constitute 13% of the US population yet account for nearly 50% of new HIV infections. Implementation of efficacious behavioral interventions can help reduce infections in this vulnerable population. Objectives:To examine the efficacy of behavioral interventions to reduce HIV for African Americans among 78 randomized controlled trials that sampled at least 50% African Americans (N = 48,585, 81% African American), measured condom use or number of sexual partners, and provided sufficient information to calculate effect sizes. Methods:Independent raters coded participant characteristics, design and methodological features, and intervention content. Weighted mean effect sizes, using both fixed- and random-effects models, were calculated; positive effect sizes indicated more condom use and fewer sexual partners. Results:Compared with controls, participants who received an HIV risk reduction intervention improved condom use at short-term, intermediate, and long-term assessments; change was better among men who have sex with men and people already infected with HIV, and when interventions provided intensive content across multiple sessions. Intervention participants reduced their number of sexual partners in interventions with intensive interpersonal skills training and in younger samples, especially at delayed intervals. Conclusions:Sexual risk reduction interventions for African Americans increased condom use without increasing the number of sexual partners. Translating these interventions and further enhancing them continue as a high priority.

The Efficacy of Exercise in Reducing Depressive Symptoms among Cancer Survivors: A Meta-Analysis

Introduction The purpose of this meta-analysis was to examine the efficacy of exercise to reduce depressive symptoms among cancer survivors. In addition, we examined the extent to which exercise dose and clinical characteristics of cancer survivors influence the relationship between exercise and reductions in depressive symptoms. Methods We conducted a systematic search identifying randomized controlled trials of exercise interventions among adult cancer survivors, examining depressive symptoms as an outcome. We calculated effect sizes for each study and performed weighted multiple regression moderator analysis. Results We identified 40 exercise interventions including 2,929 cancer survivors. Diverse groups of cancer survivors were examined in seven exercise interventions; breast cancer survivors were examined in 26; prostate cancer, leukemia, and lymphoma were examined in two; and colorectal cancer in one. Cancer survivors who completed an exercise intervention reduced depression more than controls, d + = −0.13 (95% CI: −0.26, −0.01). Increases in weekly volume of aerobic exercise reduced depressive symptoms in dose-response fashion (β = −0.24, p = 0.03), a pattern evident only in higher quality trials. Exercise reduced depressive symptoms most when exercise sessions were supervised (β = −0.26, p = 0.01) and when cancer survivors were between 47–62 yr (β = 0.27, p = 0.01). Conclusion Exercise training provides a small overall reduction in depressive symptoms among cancer survivors but one that increased in dose-response fashion with weekly volume of aerobic exercise in high quality trials. Depressive symptoms were reduced to the greatest degree among breast cancer survivors, among cancer survivors aged between 47–62 yr, or when exercise sessions were supervised.

Behavioural interventions to reduce sexual risk for HIV in heterosexual couples: a meta-analysis.

Objectives The current study was conducted to synthesise evaluations of couple-based HIV prevention interventions, assess the efficacy of these interventions in reducing sexual risk, and identify moderators of intervention efficacy. Methods A comprehensive literature search identified 29 interventions (22 reports; N=5168 couples) that met the inclusion criteria, including enrolment of both members of a heterosexual couple, measurement of condom use at baseline and follow-up, and sufficient statistical information to calculate effect sizes. Effect sizes were analysed using fixed-effects and random-effects assumptions; factors related to intervention efficacy were identified using metaregression. Results Overall, there were significant increases in condom use from baseline to follow-up (d+=0.78, 95% CI 0.48 to 1.09) and significant decreases in partner concurrency (d+=0.37, 95% CI 0.13 to 0.60). Condom use increased to a greater extent when studies were conducted toward the beginning of the epidemic, were located in countries scoring lower on the Human Development Index, enrolled serodiscordant couples, and delivered intervention content in multiple contexts. Couples who had been together longer, reported higher incidence of sexually transmitted infection, were provided voluntary counselling and testing, and provided outcome measures during face-to-face interviews also reported larger increases in condom use. Conclusions Couple-based interventions are efficacious in reducing unprotected sex within the context of romantic relationships. Future research should continue to improve risk reduction for couples.

Effectiveness of mass media interventions for HIV prevention, 1986-2013: a meta-analysis.

Objectives:This meta-analysis was conducted to synthesize evaluations of mass media–delivered HIV prevention interventions, assess the effectiveness of interventions in improving condom use and HIV-related knowledge, and identify moderators of effectiveness. Study Selection:We systematically searched electronic databases, relevant Web sites, related journals, and reference lists of previous reviews and included studies. Studies that quantitatively evaluated the effectiveness of mass media–delivered HIV prevention using pre-/post-campaign assessments, targeted the general population, reported outcomes of interest, and were available as of September 30, 2013 were eligible for inclusion. Data Extraction and Synthesis:Raters coded report, intervention, and sample characteristics. The standardized mean difference, d, comparing pretest and posttest assessments was calculated for each study sample. Effect sizes were analyzed incorporating random-effects assumptions. Results:Of the 433 obtained and screened reports, 54 reports containing evaluations of 72 interventions using 93 samples (N = 142,196) met the selection criteria and were included. Campaigns were associated with increases in condom use [d+ = 0.25, 95% confidence interval (CI) = 0.18 to 0.21], transmission knowledge (d+ = 0.30, 95% CI = 0.18 to 0.41), and prevention knowledge (d+ = 0.39, 95% CI = 0.25 to 0.52). Increases in condom use were larger for longer campaigns and in nations that scored lower on the human development index. Increases in transmission knowledge were larger to the extent that respondents reported greater campaign exposure, for more recent campaigns, and for nations that scored lower on the human development index. Conclusions:Mass media interventions may be useful in reducing global HIV/AIDS disparities because of their reach and effectiveness.

Motor impulsivity differentiates between psychiatric inpatients with multiple versus single lifetime suicide attempts

A history of multiple suicide attempts conveys greater risk for suicide than a single attempt. Impulsivity may partially explain the association between multiple attempts and increased risk. We examined trait impulsivity, ability to engage in goal-directed behaviors, and impulse control among psychiatrically hospitalized United States military personnel and their dependents. Individuals with a history of multiple versus single attempts had significantly higher motor impulsivity, indicating spur of the moment action. Providers are encouraged to directly assess and treat motor impulsivity among suicidal individuals. Further research should explore whether motor impulsivity is a mechanism of change in psychosocial suicide prevention interventions.

Tomboy as Protective Identity

The tomboy in contemporary U.S. culture is a complex identity, providing meaning to many girls and women. In this article, we argue tomboy as a gendered social identity also provides temporary “protections” to girls and women in three main ways. First, tomboy identity can excuse masculine-typed behavior in girls and women and, in doing so, protect women from presumptions about sexual reputation and sexual orientation. Second, tomboy identities can provide some protection for lesbian girls and women who prefer to not divulge their sexual orientation. And, third, tomboy identity can gain women limited privilege to spaces for which masculinity is an unspoken requirement. The temporary nature of the protections provided to tomboys undermines the ability of tomboys to truly transcend the binary gender system.

Retrospective and prospective examination of outpatient mental health utilization and military career impacts.

United States (U.S.) military personnel express concerns about the potential impact of seeking mental health care on their careers. To date, there is a lack of empirical data on the association between mental health treatment utilization at a military treatment facility and career-related outcomes. This study examined short- and long-term military career outcomes among U.S. Air Force (USAF) personnel receiving outpatient mental health care. Phase 1 involved a retrospective chart review (N = 370) across nine USAF mental health outpatient clinics. Phase 2 involved a prospective case control comparison of the career-trajectories of USAF personnel who sought mental health treatment (n = 332) versus those who did not (n = 1147) after matching for military rank, time in grade, and occupational code. Overall, nearly a third of service members received career-affecting recommendations from their mental health treatment provider. Commander-directed service members were more likely to receive career-affecting recommendations than those self-referred or superior-encouraged. Younger age, higher rank, superior-encouraged referral, greater self-reported distress during first contact, and history of psychiatric inpatient care were predictors of receiving career-affecting recommendations. Service members receiving outpatient mental health care, compared to those without a military history of mental health care, were three times more likely to experience a medical board evaluation and nearly twice as likely to receive a discharge. Proactive, early self-referral for mental health treatment is one strategy for sustaining a military career. Department of Defense stigma reduction campaigns should provide empirically derived information about mental health treatment utilization and military career-related outcomes.

Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps

Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines (N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines (N = 40) was matched to a non-treatment-seeking sample of Marines (N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls (p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed.

The Link between Posttraumatic Stress Disorder and Functionality among United States Military Service Members Psychiatrically Hospitalized Following a Suicide Crisis

Posttraumatic stress disorder (PTSD) is one of the most commonly diagnosed psychiatric disorders in the United States and has been linked to suicidal thoughts and behaviors, yet the role of a PTSD diagnosis on functional impairment among suicidal individuals remains unknown. This study examined the association between PTSD status and functional impairment among military psychiatric inpatients admitted for acute suicide risk (N = 166) with a lifetime history of at least one suicide attempt. Measures of functionality included: (1) alcohol use; (2) sleep quality; (3) social problem-solving; and (4) work and social adjustment. Thirty-eight percent of the sample met criteria for PTSD. Women were more likely than men to meet criteria for PTSD (p = 0.007), and participants who met PTSD criteria had significantly more psychiatric diagnoses (p < 0.001). Service members who met PTSD criteria reported more disturbed sleep (p = 0.003) and greater difficulties with work and social adjustment (p = 0.004) than those who did not meet PTSD criteria. However, functionality measures were not significantly associated with PTSD status after controlling for gender and psychiatric comorbidity. Gender and number of psychiatric comorbidities other than PTSD were significant predictors of PTSD in logistic regression models across four functionality measures. Future studies should assess the additive or mediating effect of psychiatric comorbidities in the association between impaired functioning and PTSD. Clinicians are encouraged to assess and address functionality during treatment with suicidal individuals, paying particular attention to individuals with multiple psychiatric diagnoses.

Non-Suicidal Self-Injury Elevates Suicide Risk among United States Military Personnel with Lifetime Attempted Suicide

Military psychiatric inpatients with and without a lifetime history of non-suicidal self-injury (NSSI), combined with a history of at least one suicide attempt, were compared on suicide ideation severity, number of suicide attempts, and Interpersonal-Psychological Theory of Suicide variables. Data were derived from baseline assessments performed in a psychotherapy randomized controlled trial. Lifetime history of NSSI and lifetime number of suicide attempts were assessed using the Columbia Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011). Individuals with versus without a combined lifetime history of attempted suicide and NSSI showed significant elevations on thwarted belongingness and acquired capability for suicide. No significant between-group differences were found on perceived burdensomeness, frequency, duration, and controllability of suicide ideation, or number of lifetime suicide attempts. A history of NSSI, above and beyond attempted suicide, appears to increase service members’ social alienation and acquired capability for suicide.