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  1. Article ; Online: Managing post-sexual assault suicide risk.

    Gilmore, Amanda K / Ward-Ciesielski, Erin F / Smalling, Anna / Limowski, Anne R / Hahn, Christine K / Jaffe, Anna E

    Archives of women's mental health

    2020  Volume 23, Issue 5, Page(s) 673–679

    Abstract: Suicidal ideation and suicidal behavior are common after experiencing a sexual assault. Therefore, it is imperative to assess for and manage suicidal ideation using evidence-based techniques after a sexual assault medical forensic examination (SAMFE). We ...

    Abstract Suicidal ideation and suicidal behavior are common after experiencing a sexual assault. Therefore, it is imperative to assess for and manage suicidal ideation using evidence-based techniques after a sexual assault medical forensic examination (SAMFE). We assessed factors associated with higher suicidal ideation identified in a post-SAMFE mental health screening conducted over the phone and strategies to manage suicide risk. We also discuss three case examples and unique considerations when assessing post-SAMFE suicide risk. It was found that among individuals who completed a post-SAMFE screen, individuals who have been previously hospitalized for a mental health problem, who had higher acute stress symptoms, and who were homeless reported more suicidal ideation than those without those histories or symptom presentations. No matter the risk factors for suicidal ideation post-SAMFE, it is essential to screen all individuals post-SAMFE due to their high risk for suicidal ideation and death by suicide.
    MeSH term(s) Adolescent ; Adult ; Depression/psychology ; Female ; Humans ; Mental Health ; Middle Aged ; Risk Factors ; Sex Offenses/psychology ; Stress Disorders, Post-Traumatic/psychology ; Suicidal Ideation ; Suicide/psychology ; Suicide, Attempted/psychology ; United States ; Young Adult
    Language English
    Publishing date 2020-07-05
    Publishing country Austria
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1463529-X
    ISSN 1435-1102 ; 1434-1816
    ISSN (online) 1435-1102
    ISSN 1434-1816
    DOI 10.1007/s00737-020-01047-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Safety and Efficacy of Exposure-Based Risk Reduction Through Family Therapy for Co-occurring Substance Use Problems and Posttraumatic Stress Disorder Symptoms Among Adolescents: A Randomized Clinical Trial.

    Danielson, Carla Kmett / Adams, Zachary / McCart, Michael R / Chapman, Jason E / Sheidow, Ashli J / Walker, Jesse / Smalling, Anna / de Arellano, Michael A

    JAMA psychiatry

    2020  Volume 77, Issue 6, Page(s) 574–586

    Abstract: Importance: No empirically supported treatments have been evaluated to address co-occurring substance use problems (SUP) and posttraumatic stress disorder (PTSD) symptoms among adolescents in an integrative fashion. This lack is partially owing to ... ...

    Abstract Importance: No empirically supported treatments have been evaluated to address co-occurring substance use problems (SUP) and posttraumatic stress disorder (PTSD) symptoms among adolescents in an integrative fashion. This lack is partially owing to untested clinical lore suggesting that delivery of exposure-based PTSD treatments to youth with SUP might be iatrogenic.
    Objective: To determine whether an exposure-based, integrative intervention for adolescents with SUP and PTSD symptoms-risk reduction through family therapy (RRFT)-resulted in improved outcomes relative to a treatment-as-usual (TAU) control condition consisting primarily of trauma-focused cognitive behavioral therapy.
    Design, setting, and participants: This randomized clinical trial enrolled 124 participants who were recruited from November 1, 2012, through January 30, 2017. Adolescents (aged 13-18 years) who engaged in nontobacco substance use at least once during the past 90 days, experienced at least 1 interpersonal traumatic event, and reported 5 or more PTSD symptoms were enrolled. Blinded assessments were collected at baseline and at 3, 6, 12, and 18 months after baseline. Recruitment and treatment took place in community-based child advocacy centers in the Southeastern United States. Data were analyzed from August 2 through October 4, 2018, and were based on intention to treat.
    Interventions: Participants were randomized to receive RRFT (n = 61) or TAU (n = 63).
    Main outcomes and measures: Primary outcomes focused on number of nontobacco substance-using days measured with the timeline follow-back method and PTSD symptom severity using the UCLA (University of California, Los Angeles) PTSD Reaction Index for DSM-IV completed by adolescents and caregivers. Secondary outcomes focused on marijuana, alcohol, and polysubstance use and PTSD criterion standard (re-experiencing, avoidance, and hyperarousal) symptom severity.
    Results: In all, 124 adolescents (mean [SD] age, 15.4 [1.3] years; 108 female [87.1%]) were randomized. For primary outcomes relative to TAU, RRFT yielded significantly greater reductions in substance-using days from baseline to month 12 (event rate [ER], 0.28; 95% CI, 0.12-0.65) and month 18 (ER, 0.10; 95% CI, 0.04-0.24). Significant reductions in PTSD symptoms were observed within groups for RRFT from baseline to months 3 (β = -9.25; 95% CI, -12.95 to -5.55), 6 (β = -16.63; 95% CI = -20.40 to -12.87), 12 (β = -17.51; 95% CI, -21.62 to -13.40), and 18 (β = -19.02; 95% CI, -23.07 to -14.96) and for TAU from baseline to months 3 (β = -9.62; 95% CI, -13.16 to -6.08), 6 (β = -13.73; 95% CI, -17.43 to -10.03), 12 (β = -15.53; 95% CI, -19.52 to -11.55), and 18 (β = -13.88; 95% CI, -17.69 to -10.09); however, between-group differences were not observed.
    Conclusions and relevance: In this study, RRFT and TAU demonstrated within-group improvements in SUP and PTSD symptoms, with greater improvement for substance use and PTSD avoidance and hyperarousal symptoms among adolescents randomized to RRFT compared with TAU. No evidence of the worsening of SUP was observed in either condition. These results suggest that this exposure-based treatment is safe, feasibly delivered by community-based clinicians, and offers an effective approach to inform clinical practice.
    Trial registration: ClinicalTrials.gov Identifier: NCT01751035.
    MeSH term(s) Adolescent ; Cognitive Behavioral Therapy ; Family Therapy/methods ; Female ; Humans ; Implosive Therapy/methods ; Male ; Risk Reduction Behavior ; Stress Disorders, Post-Traumatic/complications ; Stress Disorders, Post-Traumatic/therapy ; Substance-Related Disorders/complications ; Substance-Related Disorders/therapy
    Language English
    Publishing date 2020-02-05
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
    ZDB-ID 2701203-7
    ISSN 2168-6238 ; 2168-622X
    ISSN (online) 2168-6238
    ISSN 2168-622X
    DOI 10.1001/jamapsychiatry.2019.4803
    Database MEDical Literature Analysis and Retrieval System OnLINE

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