Michele Galietta

The schedule of attitudes toward hastened death

The authors examined the reliability and validity of the Schedule of Attitudes toward Hastened Death (SAHD), a self‐report measure of desire for death previously validated in a population of individuals with the acquired immunodeficiency syndrome (AIDS), among terminally ill patients with cancer.

Burden and Benefit of Psychosocial Research at the End of Life

BACKGROUND The impact of psychosocial research participation has not been examined systematically in palliative care settings. Concerns are often raised regarding the potential for distress among terminally ill patients. This is particularly true when death and dying are the focus of research. Therefore, it is important to understand the specific ways psychosocial research could potentially harm or be helpful to participants. OBJECTIVE To assess the burden and benefits of participation in psychosocial research addressing end-of-life issues among patients receiving inpatient palliative care. DESIGN Sixty-eight terminally ill patients with cancer who had an average life expectancy of less than 2 months, were administered a brief self-report questionnaire to assess whether participation in psychosocial research was burdensome and/or beneficial. The specific factors that contributed to their perceptions were also identified. RESULTS The majority of patients reported no burden associated with participation (75%) and found the experience as moderately to highly beneficial (68%). Factors most frequently identified as burdensome included the length of the interview (21%), structure of the questionnaires (18%), and difficulty discussing end-of life issues (12%). Although some patients reported some distress while discussing end-of-life issues (19%), few endorsed a high level of distress (6%). Factors most frequently identified as beneficial were the social interaction (75%), sense of contributing to society (57%), and the opportunity to discuss their illness (47%). CONCLUSIONS Participants in psychosocial end-of-life research are unlikely to experience significant burden from participation and, in fact, may benefit.

Impact of treatment for depression on desire for hastened death in patients with advanced AIDS.

BACKGROUND Despite the development of multi-drug regimens for HIV, palliative care and quality-of-life issues in patients with advanced AIDS remain important areas of clinical investigation. OBJECTIVE Authors assessed the impact of treatment for depression on desire for hastened death in patients with advanced AIDS. METHOD Patients with advanced AIDS (N=372) were interviewed shortly after admission to a palliative-care facility, and were reinterviewed monthly for the next 2 months. Patients diagnosed with a major depressive syndrome were provided with antidepressant treatment and reinterviewed weekly. Desire for hastened death was assessed with two questionnaire measures. RESULTS Desire for death was highly associated with depression, and it decreased dramatically in patients who responded to antidepressant treatment. Little change in desire for hastened death was observed in patients whose depression did not improve. Although improved depression was not significantly associated with the use of antidepressant medication, those individuals prescribed antidepressant medication showed the largest decreases in desire for hastened death. DISCUSSION Successful treatment for depression appears to substantially decrease desire for hastened death in patients with advanced AIDS. The authors discuss implications of these findings for palliative-care treatment and the physician-assisted suicide debate.

Dialectical Behavior Therapy for the Treatment of Stalking Offenders

The need for effective mental health interventions for specific offender populations has become clear in recent decades. In particular, individuals who engage in stalking and harassment have increasingly attracted the attention of the public and mental health and criminal justice professionals, however no evidence-based treatment currently exists for this population. We adapted Dialectical Behavior Therapy (DBT) for the treatment of this offender group, in part because of the high prevalence of personality disorders. This study describes the application of a 6-month treatment program to a sample of 29 individuals, 14 of whom completed treatment. Treated offenders were significantly less likely to re-offend with another stalking offense (0 of 14) compared to treatment drop-outs (26.7%) or to published recidivism data (47%). Measures intended to help determine the nature of changes revealed increased thought suppression, but are qualified by the high degree of defensive responding. These preliminary data suggest that DBT holds promise for reducing stalking behaviors and warrants further study.

Adapting Dialectical Behavior Therapy (DBT) for the Treatment of Psychopathy

Few mental abnormalities create more havoc for society than the psychopathic personality, however interventions specifically designed to address this form of psychopathology are few. One treatment that has received growing attention in the forensic mental health community is Dialectical Behavior Therapy (DBT). This paper describes an adaptation of DBT for the treatment of psychopathic offenders. A case study is used to highlight salient elements of this treatment approach, as well as the challenges to successful treatment posed by this population of offenders.

Assessing Risk for Recidivism in Individuals Convicted of Stalking Offenses Predictive Validity of the Guidelines for Stalking Assessment and Management

This study examined the internal validity and predictive accuracy of the Guidelines for Stalking Assessment and Management (SAM), a structured professional judgment risk assessment tool for stalking. Interviewers rated 89 stalking offenders on the Psychopathy Checklist: Screening Version (PCL:SV) and SAM Nature (N) and Perpetrator (P) subscales. Researchers obtained stalking and violence outcomes prospectively from several sources, for an average follow-up period of 2.5 years. Cox Proportional Hazard analyses including SAM and PCL:SV scores demonstrated a significant positive relationship between SAM total and subscale scores in predicting stalking recidivism, whereas PCL:SV scores were negatively associated with recidivism. However, the SAM clinical risk ratings did not significantly predict stalking reoffending. There were also no significant associations between SAM scores and violent outcomes. These findings provide mixed support for the use of the SAM as a risk assessment tool for stalking offenders.

Evaluating risk assessment instruments for intimate partner stalking and intimate partner violence.

Research indicates that most stalking victims are harassed by a prior intimate partner and that this group of victims is at a higher risk for violence than other stalking victims. Furthermore, many researchers found a relationship between prior intimate partner stalking (IPS) and intimate partner violence (IPV). The present study focused on identification of overlapping and unique risk factors among IPS and IPV offenders. This was done by examining the accuracy and utility of abridged versions of the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER) and the Guidelines for Stalking Assessment and Management (SAM) in a sample of 158 low-risk offenders charged with crimes targeting an intimate partner. Follow-up ranged from one to 8.5 years; outcome variables were renewed (or continued) stalking and violent reoffending. Receiver operating characteristic (ROC) curves indicated that both instruments had weak, nonsignificant predictive validity for both violent or stalking reoffending when considered in isolation. However, each instrument added significantly to the logistic regression model when predicting stalking recidivism when entered after the PCL:SV and relevant covariates, but neither improved predictive accuracy when added after the other was already in the model. Neither instrument added to logistic regression models predicting violent reoffending. Analysis of individual items revealed that items measuring distress and violations of supervision (SAM) and violations of court orders (B-SAFER) were the most consistent predictors of renewed stalking but not violence. The findings of this study question the utility of these tools for predicting violent reoffending but provide qualified support for the prediction of stalking.

Psychopathology of Stalking Offenders: Examining the Clinical, Demographic, and Stalking Characteristics of a Community-Based Sample:

This study examined the correlates of stalking behavior and psychopathology among stalking offenders assessed using a rigorous diagnostic tool. A total of 137 stalking offenders were interviewed and diagnosed using the Structured Clinical Interview for DSM-IV Axis I and Axis II Disorders. Analyses examined the extent to which stalking behaviors and offender characteristics differed across diagnostic groups. Study participants were African American (29%), Hispanic (28%), or Caucasian (28%), and had an average age of 36 years old (SD = 11). The most common instant offenses were stalking/harassment (53%) and violation of an order of protection or criminal contempt (18%). Seventy-two percent met criteria for a clinical diagnosis, and there were high rates of comorbidity: psychotic disorder (10%), mood or anxiety disorder (31%), substance use disorder (46%), and personality disorder (50%). Over a quarter (28%) of the sample’s stalking behaviors occurred in the absence of psychopathology. Clinical implications and future research directions are discussed.