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Patients may present to the emergency department for sexual assault care under the influence of drugs or alcohol. However, many emergency nurses are not prepared to meet their unique needs or aware of follow-up behavioral health resources. The purpose of this study was to (1) summarize current resources provided to patients and processes for referral to behavioral health services after sexual assault care, (2) explore emergency nurses' attitudes and behaviors toward patient substance use, and (3) explore nurses' perceptions of adjunct mobile health interventions for follow-up behavioral health care and describe anticipated barriers to use. Fifteen emergency nurses participated in semi-structured qualitative interviews. Participants had mixed perceptions of patient intoxication during sexual assault care. They felt that conversations about substance use may be more appropriate after the ED visit. Participants recognized the opportunity to connect ED patients with substance use treatment or prevention resources but perceived that there are few local service providers. Most participants were not referring patients with substance use issues to behavioral health services after sexual assault care and said that their emergency departments did not have processes for referral to these services. Acceptability of mobile health for follow-up behavioral health care was high, but participants had concerns for patient privacy and internet access. Participants gave recommendations to improve referral practices and patient engagement with mobile health interventions. This study highlights the need for emergency nurses to consider patient intoxication during sexual assault care and opportunities to connect patients with resources post-assault. [ABSTRACT FROM AUTHOR]

Background Limited research has addressed the role of anhedonia in predicting suicidality and/or nonsuicidal self-injury (NSSI) in adults, despite evidence suggesting that loss of interest or pleasure may increase vulnerability for self-inflicted harm, even beyond other depressive symptoms. Methods In the current study, we explored the role of symptoms of depression and recent changes in anhedonia in predicting suicidality, NSSI ideation, and perceptions of NSSI helpfulness among individuals with a history of NSSI or suicide attempts ( N = 187). Results We found that changes in anhedonia partially mediated the effect of depression on suicidality, and fully mediated the effect of depression on perceptions of NSSI helpfulness. Anhedonia did not predict NSSI ideation above and beyond depression symptoms, and did not significantly predict NSSI frequency when accounting for suicidality. Compared to individuals with a history of NSSI only or suicide attempt only, people with a history of both NSSI and suicide attempt evidenced greater risk and symptomatology. Conclusions Results confirm the relation between anhedonia and suicidality evidenced in past research, but suggest a complex relationship between anhedonia, depression, and facets of non-suicidal self-injury. [ABSTRACT FROM AUTHOR]

Behavioral motivation is regulated through the behavioral inhibition system (BIS) and the behavioral approach system (BAS), which underlie responses to emotional stimuli and are thought to influence emotion dysregulation. Research shows that mindfulness may increase the efficacy of emotion regulation among those with psychological symptoms, but the relationships between behavioral motivation and mindfulness have been only minimally explored. This study examines relationships between behavioral motivation systems and emotion dysregulation as mediated by mindfulness facets. Mediation was tested in a sample of 246 college students ( M age = 19.28, 61.8% female, 81.3% Caucasian) using a multiple mediator bootstrapping method. Results revealed an indirect relationship between BIS sensitivity and increased emotion dysregulation through underutilization of three distinct mindfulness skills: act with awareness, non-judging, and non-reactivity. Mindfulness facets did not mediate relationships between BAS sensitivity and emotion dysregulation, though BAS Reward Responsiveness directly predicted increased emotion dysregulation while BAS Drive was marginally associated with decreased emotion dysregulation. Findings delineate specific relationships between BIS/BAS, mindfulness skills, and emotion dysregulation while suggesting mindfulness training may be useful for BIS sensitive individuals. [ABSTRACT FROM AUTHOR]

Potential mechanisms underlying the pathway between borderline personality features and indices of social support have yet to be elaborated, despite that social difficulties are a hallmark feature of borderline personality disorder (BPD). We hypothesized that rejection sensitivity, or the tendency to anxiously anticipate and readily perceive social rejection, might be one mechanism leading to the negative social impact associated with BPD symptoms. To test this hypothesis, a sample of college students (N=165) completed self-report measures in the laboratory. With rejection sensitivity in the model, borderline features did not directly predict number of social supports. However, borderline features indirectly predicted decreased number of social supports via increased rejection sensitivity. Conversely, borderline features directly predicted social support satisfaction but did not evidence an indirect effect through rejection sensitivity. The results of this research suggest that rejection sensitivity is an important individual difference by which borderline features leads to the lower levels of social support demonstrated in past research. Future directions, such as examining potential mediators of social support perception, are discussed. [ABSTRACT FROM AUTHOR]

People who are incarcerated are likely to meet criteria for at least one substance use disorder and need access to treatment. Access to such interventions was limited prior to the COVID-19 pandemic and has almost certainly been restricted further due to implementation of procedures intended to stop the spread of the virus. In this brief commentary, we discuss how COVID-19 has revealed the already tenuous access that people who are incarcerated have to behavioral health services, and the pitfalls of reliance on the U.S. carceral system as a response to addiction. [ABSTRACT FROM AUTHOR]

Managing complex psychiatric disorders like PTSD and bipolar disorder is challenging in Federally Qualified Health Centers (FQHCs) delivering care to U.S residents living in underserved rural areas. This protocol paper describes SPIRIT, a pragmatic comparative effectiveness trial designed to compare two approaches to managing PTSD and bipolar disorder in FQHCs. Treatment comparators are: 1) Telepsychiatry Collaborative Care, which integrates consulting telepsychiatrists into primary care teams, and 2) Telepsychiatry Enhanced Referral, where telepsychiatrists and telepsychologists treat patients directly. Because Telepsychiatry Enhanced Referral is an adaptive intervention, a Sequential, Multiple Assignment, Randomized Trial design is used. Twenty-four FQHC clinics without on-site psychiatrists or psychologists are participating in the trial. The sample is patients screening positive for PTSD and/or bipolar disorder who are not already engaged in pharmacotherapy with a mental health specialist. Intervention fidelity is measured but not controlled. Patient treatment engagement is measured but not required, and intent-to-treat analysis will be used. Survey questions measure treatment engagement and effectiveness. The Short-Form 12 Mental Health Component Summary (SF-12 MCS) is the primary outcome. A third (34%) of those enrolled (n = 1004) are racial/ethnic minorities, 81% are not fully employed, 68% are Medicaid enrollees, 7% are uninsured, and 62% live in poverty. Mental health related quality of life (SF-12 MCS) is 2.5 standard deviations below the national mean. We hypothesize that patients randomized to Telepsychiatry Collaborative Care will have better outcomes than those randomized to Telepsychiatry Enhanced Referral because a higher proportion will engage in evidence-based treatment. [ABSTRACT FROM AUTHOR]