Stephen Tueller

The Short Form of the Revised Almost Perfect Scale

We created a shorter and more refined item set from the Almost Perfect Scale–Revised (APS–R; Slaney, Mobley, Trippi, Ashby, & Johnson, 1996; Slaney, Rice, Mobley, Trippi, & Ashby, 2001) to measure 2 major dimensions of perfectionism: standards (high performance expectations) and discrepancy (self-critical performance evaluations). In Study 1, after testing the internal structure of the measure (N = 749), a subset of the current APS–R items was derived (Short Almost Perfect Scale [SAPS]) that possessed good psychometric features, such as strong item–factor loadings, score reliability, measurement invariance between women and men, and criterion-related validity through associations with neuroticism, conscientiousness, academic performance, and depression. Controlling for neuroticism and conscientiousness, factor mixture modeling supported a 2-factor, 3-class model of perfectionism, and results were consistent with labeling the classes as nonperfectionists and adaptive and maladaptive perfectionists. Measurement results were cross-validated in a separate sample (N = 335). Study 2 also provided substantial evidence for the convergent, discriminant, and criterion-related validity of SAPS scores. Both studies supported the SAPS as a brief and psychometrically strong measure of major perfectionism factors and classes of perfectionists.

Mental Health and Substance Abuse Treatment Stigma Among Soldiers

Few studies have compared persons in treatment to those not in treatment with regard to perceived stigma. We surveyed soldiers to examine differences in stigma perceptions among those in treatment for substance abuse and/or mental health problems (n = 470) and those not in treatment (n = 966). Analyses revealed that soldiers in treatment perceived greater stigma regarding mental health treatment compared with soldiers not in treatment. These findings support the notion that personnel most in need of treatment perceive greater stigma associated with these services and as a result may be less likely to pursue them. We discuss the implications of our findings for theory, research, and practice.

Outcome findings from the HOPE demonstration field experiment

Research Summary More than 1,500 probationers in four sites were randomly assigned to probation as usual (PAU) or to Honest Opportunity Probation with Enforcement (HOPE), which is modeled on Hawaiis Opportunity Probation with Enforcement (Hawaii HOPE) program that emphasizes close monitoring; frequent drug testing; and swift, certain, and fair (SCF) sanctioning. It also reserves scarce treatment resources for those most in need. The four sites offered heterogeneity in organizational relationships and populations as well as implementation that was rated very good to excellent—thus, providing a robust test of the HOPE supervision model. Recidivism results suggest that HOPE/SCF supervision was not associated with significant reductions in arrests over PAU with the exception of a reduction in drug-related arrests in one site. There were significant—albeit conflicting—differences in time to revocation, with survival models suggesting shorter times to revocation in two sites and longer times to revocation in one site. Policy Implications HOPE—or the more general SCF approach to community supervision—has been widely praised as an evidence-based practice that reduces substance use, violations, new arrests, and revocations to prison. Substantial reductions in return to prison have been associated with claims of significant cost savings for HOPE/SCF over PAU despite the need for additional resources for warning and violation hearings, drug testing, and warrant service. Results from this recently completed, four-site randomized control trial (RCT) showed that recidivism arrest outcomes were largely similar between those on HOPE/SCF probation and those on PAU and are consistent with findings from the Delaware Decide Your Time (DYT) RCT reported in this issue. No differences in arrests between HOPE and PAU probationers suggest that HOPE can be implemented to provide greater adherence to an idealized probation in which violations are met with a swift (but non-draconian) response without compromising public safety. Nevertheless, the larger numbers of revocations for HOPE probationers in two sites, coupled with the additional expenses for drug testing, warrant service, and so on associated with HOPE, also suggest that overall cost savings may not be realized. Although additional research is needed to determine whether there are groups for whom HOPE may be more effective than PAU, HOPE/SCF seems unlikely to offer better outcomes and lower costs for broad classes of moderate-to-high–risk probationers.

Evaluating the Long-Term Effects of Prisoner Reentry Services on Recidivism: What Types of Services Matter?

We analyzed data collected for a large multi-site evaluation of 12 prisoner reentry programs in 12 states to examine the impact of pre-release services on time to rearrest and number of rearrests up to 56 months post-release for male offenders. A two-stage matching quasi-experimental design was used to define the comparison groups and multivariate models were used to examine the relationships among service and program receipt and recidivism. Participation in the reentry program was associated with longer time to arrest and fewer arrests after release. However, the specific services delivered as part of the program showed modest or inconsistent impacts on recidivism. Services that focused on individual change were more beneficial than services that focused on practical skills and needs. Practitioners should consider careful sequencing of program and service delivery in prison, linking in-prison services to post-release assistance, and evaluating all services and programs for fidelity and effectiveness.

Caregiver instability and early life changes among infants reported to the child welfare system.

This study describes the extent of caregiver instability (defined as a new placement for 1 week or longer in a different household and/or with a new caregiver) in a nationally representative sample of infants, followed for 5-7 years. Data were drawn from the National Survey of Child and Adolescent Well-Being (NSCAW), a longitudinal study of 5,501 children investigated for child maltreatment. The analysis sample was restricted to 1,196 infants. Overall, 85.6% of children who were infants at the time of the index maltreatment experienced at least one caregiver instability event during their first 2 years of life. Caregiver instability was associated with the child having a chronic health condition and the caregiver being older than 40 years of age at baseline. The levels of instability reported in this study from infancy to school entry are extremely high. Children with more risk factors were significantly more likely to experience caregiver instability than children with fewer risk factors. The repeated loss of a young childs primary caregiver or unavailable, neglectful care can be experienced as traumatic. Some evidence-based programs that are designed to work with young maltreated children can make a substantial positive difference in the lives of vulnerable infants.

Relaxation training assisted by heart rate variability biofeedback: Implication for a military predeployment stress inoculation protocol

Decreased heart rate variability (HRV) is associated with posttraumatic stress disorder (PTSD) and depression symptoms, but PTSDs effects on the autonomic stress response and the potential influence of HRV biofeedback in stress relaxation training on improving PTSD symptoms are not well understood. The objective of this study was to examine the impact of a predeployment stress inoculation training (PRESTINT) protocol on physiologic measures of HRV in a large sample of the military population randomly assigned to experimental HRV biofeedback-assisted relaxation training versus a control condition. PRESTINT altered the parasympathetic regulation of cardiac activity, with experimental subjects exhibiting greater HRV, that is, less arousal, during a posttraining combat simulation designed to heighten arousal. Autonomic reactivity was also found to be related to PTSD and self-reported use of mental health services. Future PRESTINT training could be appropriate for efficiently teaching self-help skills to reduce the psychological harm following trauma exposure by increasing the capacity for parasympathetically modulated reactions to stress and providing a coping tool (i.e., relaxation method) for use following a stressful situation.

Help-seeking behaviors among active-duty military personnel: utilization of chaplains and other mental health service providers

Military chaplains not only conduct religious services, but also provide counseling and spiritual support to military service members, operating as liaisons between soldiers and mental health professionals. In this study, active-duty soldiers (N = 889) reported help-seeking behaviors and mental health. Using logistic regressions, we describe the issues for which soldiers reported seeking help, then outline the characteristics of those who are most likely to seek help from a chaplain. Of the soldiers who sought help from a chaplain within the previous year, 29.9% reported high levels of combat exposure, 50.8% screened positive for depression, 39.1% had probable PTSD, and 26.6% screened positive for generalized anxiety disorder. The participant’s unit firing on the enemy, personally firing on the enemy, and seeing dead bodies or human remains predicted seeing a chaplain. Future research should examine ways to engage soldiers who have had more combat experiences with the chaplain community to address spiritual issues.

The latent structure of psychiatric symptoms across mental disorders as measured with the PANSS and BPRS-18

Raw data were used from five studies of adults with mental illnesses (N=4,480) in an attempt to identify a psychiatric symptoms factor structure, as measured by the Positive and Negative Syndrome Scale or the Brief Psychiatric Rating Scale, that was generalizable across participant characteristics. First, the fit of four extant models was tested via confirmatory factor analysis (CFA), then exploratory factor analyses (EFA) were conducted with a 50% random sample, followed by a CFA with the remaining 50% to confirm the EFA factor structure. Measurement invariance of the factor structure was also examined across diagnosis, sex, race, age, and hospitalization status. The extant models were not generalizable to these data. However, a 4-factor (Affective, Positive, Negative, Disorganized Cognitive Processing) model was identified that retained all items and showed invariance across participant characteristics. It is possible to obtain a psychiatric symptoms factor structure that is generalizable across patient characteristics, which has clinical and research implications. Specifically, future research examining the impact of various interventions on psychiatric symptoms among adults with mental illnesses should confirm, and assuming good model-data fit, use the 4-factor model identified in this study.

Proximal Risk Factors for Short-Term Community Violence Among Adults With Mental Illnesses

OBJECTIVE This study examined the role of static indicators and proximal, clinically relevant indicators in the prediction of short-term community violence in a large, heterogeneous sample of adults with mental illnesses. METHODS Data were pooled from five studies of adults with mental illnesses (N=4,484). Follow-up data were available for 2,579 participants. A hierarchical linear regression assessed the incremental validity of a series of variable clusters in the prediction of violence risk at six months: static characteristics (age, sex, race-ethnicity, and primary diagnosis), substance use (alcohol use and drug use at baseline), clinical functioning (psychiatric symptoms at baseline and recent hospitalization), recent violence, and recent victimization. RESULTS Results demonstrated improved prediction with each step of the model, indicating that proximal indicators contributed to the prediction of short-term community violence above and beyond static characteristics. When all variables were entered, current alcohol use, recent violence, and recent victimization were positive predictors of subsequent violence, even after the analysis controlled for participant characteristics. CONCLUSIONS This study provides empirical evidence for three proximal, clinically relevant indicators in the assessment and management of short-term violence risk among adults with mental illnesses: current alcohol use, recent violence, and recent victimization. Consideration of these indicators in clinical practice may assist in the identification of adults with mental illnesses who are at heightened risk of short-term community violence.

Drug and alcohol trajectories among adults with schizophrenia: Data from the CATIE study

OBJECTIVE The primary aim is to describe drug and alcohol trajectories in adults with schizophrenia. METHOD Growth mixture models were used to examine disordered and non-disordered use and abstinence in the Clinical Antipsychotic Trials of Intervention Effectiveness study. RESULTS Five classes - always abstinent; fluctuating use, abuse, and occasional abstinence; occasional (ab)use; stopped (ab)use; abusing - fit best. Overlap exists between always abstinent drug and alcohol classes; less overlap exists across other classes. CONCLUSION There is heterogeneity in drug and alcohol use among adults with schizophrenia. The lack of overlap between classes, save always abstinent, suggests modeling drug and alcohol use separately.