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Abstract: Background: Justice-involved individuals are at elevated risk for suicidal behavior; however, research examining risk for suicidal behavior in pretrial jail diversion programs (pretrial diversion) is limited. Aims: We aimed to test (1) associations between depressive symptoms and alcohol and drug use, and suicide attempt history (SAH), and (2) interactions between depressive symptoms and alcohol and drug use in relation to SAH among adults in an urban pretrial jail diversion program. Method: The design was cross-sectional, including self-report assessments and file reviews of historical information. Adults ( N = 274; M age = 33.72; 73.7% men; 52.6% non-Hispanic Black) completed assessments within two weeks of beginning the pretrial program. Results: Depressive symptoms were positively associated with SAH after adjusting for other covariates. The significant depressive symptoms by alcohol use interaction indicated that adults with low to average depressive symptoms evidenced a similar likelihood of SAH to those with high depressive symptoms when they also had elevated alcohol use scores. Limitations: We used cross-sectional self-report data. Conclusion: It may be important to conduct suicide risk assessments for justice-involved people who use alcohol even when depressive symptoms are low.

Although the overrepresentation of people with mental illness in the criminal justice system is known, research is needed to identify the frequency of criminal justice involvement and criminogenic treatment needs in inpatient populations to improve continuity of care and access to appropriate treatments. The purpose of this study is to document the frequency of criminal justice involvement among people receiving inpatient community care, as has been done for persons with mental illness in correctional institutions, and to test the association between criminogenic risk and psychiatric symptomatology. The present study uses two samples (n = 94 and n = 142) of adults from two separate acute psychiatric inpatient hospitals in Texas. Data on psychiatric symptoms, mental health history, criminal risk, and criminal justice history were gathered from file review and self-report. Linear and negative binomial regressions were used to test associations of interest. In both samples, the frequency of prior criminal justice involvement was over 50%. The current results indicate there is a significant, positive association between measures of criminal risk and psychiatric symptoms. These findings highlight the need to address the reciprocal association between mental illness and criminal risk among people receiving inpatient psychiatric treatment with appropriate assessment and treatment.

Suicide is the leading cause of death in jails across the United States, making suicide prevention a priority of jail mental health care. Nonsuicidal self-injury (NSSI) is also concerning during jail incarceration. This chapter reviews terminology, rates, and statistics of suicide and NSSI behaviors across jail settings, as well as risk and protective factors. We discuss unique considerations for jail settings (e.g., motivations for suicidal behaviors and NSSI) and reentry into the community after jail incarceration. In addition, we review guidelines for practice, including suicide risk screening and assessment, and suicide risk management, with a focus on the development and implementation of suicide prevention and intervention plans for mental health, correctional, and administrative staff team, including sentinel event reviews. We also provide sample clinical scenarios for consideration. Approaching suicide prevention and intervention as a collaborative team effort across staff roles within the jail system is vital.

AimsThe aims of this network meta-analysis (NMA) were to examine nonunion rates and functional outcomes following various operative and nonoperative treatments for displaced mid-shaft clavicle fractures.MethodsInitial search strategy incorporated MEDLINE, PubMed, Embase, and the Cochrane Library for relevant randomized controlled trials (RCTs). Four treatment arms were created: nonoperative (NO); intramedullary nailing (IMN); reconstruction plating (RP); and compression/pre-contoured plating (CP). A Bayesian NMA was conducted to compare all treatment options for outcomes of nonunion, malunion, and function using the Disabilities of the Arm Shoulder and Hand (DASH) and Constant-Murley Shoulder Outcome scores.ResultsIn all, 19 RCTs consisting of 1,783 clavicle fractures were included in the NMA. All surgical options demonstrated a significantly lower odds ratio (OR) of nonunion in comparison to nonoperative management: CP versus NO (OR 0.08; 95% confidence interval (CI) 0.04 to 0.17); IMN versus NO (OR 0.07; 95% CI 0.02 to 0.19); RP versus NO (OR 0.07; 95% CI: 0.01 to 0.24). Compression plating was the only treatment to demonstrate significantly lower DASH scores relative to NO at six weeks (mean difference -10.97; 95% CI -20.69 to 1.47).ConclusionSurgical fixation demonstrated a lower risk of nonunion compared to nonoperative management. Compression plating resulted in significantly less disability early after surgery compared to nonoperative management. These results demonstrate possible early improved functional outcomes with compression plating compared to nonoperative treatment. Surgical fixation of mid-shaft clavicle fractures with compression plating may result in quicker return to activity by rendering patients less disabled early after surgery. Cite this article: Bone Jt Open 2021;2(8):646–654.

We aimed to demonstrate the utility of an item-level network analysis approach to suicide risk by testing the interpersonal psychological theory of suicide (IPTS) among 402 psychiatric inpatients. We hypothesized that specific thwarted belongingness (TB) or perceived burdensomeness (PB; Interpersonal Needs Questionnaire items) facets would positively relate to passive or active suicide ideation and that these facets would positively relate to each other and form distinct clusters. We also tested TB and PB facets central to the networks as predictors of suicide ideation compared with the full TB and PB subscales. Face-valid items congruent with latent constructs proposed by the IPTS (i.e., feelings of burden on society, feeling that one does not belong) were the only two facets uniquely predictive of passive and active suicide ideation. Facets of TB and PB did not form distinct clusters. Item-level network analysis may have important conceptual, assessment, predictive, and clinical implications for understanding suicide risk.

Rates of harmful alcohol use are high among justice-involved individuals and may contribute to violent recidivism. Robust treatments for alcohol-related violence in criminal justice systems are thus a public health priority. In this analysis of existing randomized controlled trial data ( N = 105), we examined the impact of a brief motivational intervention (BMI) for harmful substance use on violent recidivism among individuals in a pretrial jail diversion program. Results indicated that, after controlling for violence history, the intervention’s impact on violent recidivism was moderated by baseline harmful alcohol use. Specifically, among people with severe alcohol problems at baseline, the BMI + standard care group had less violent recidivism at a 1-year follow-up than participants randomized to standard care alone. This finding was unchanged when we accounted for psychopathic traits. Our study provides preliminary evidence that a BMI may be useful for decreasing violent recidivism among heavy drinkers in criminal justice systems.

Objectives Describe the incidence of venous thromboembolism (VTE) in patients with pelvic and lower extremity long bone trauma in the setting of modern prophylaxis. Design Retrospective health-system database study. Setting Multi-center health care system. Patients Database query from 2010 to 2017 identified 11,313 adult trauma patients who received open reduction internal fixation of pelvic, acetabular, femoral neck, or intertrochanteric fractures, or received intramedullary nailing (IMN) of the femoral or tibial shaft. Patients with incomplete prophylaxis, prior history of VTE, coagulopathy, or concomitant lower extremity fracture were excluded. Intervention Mechanical and chemical VTE prophylaxis following pelvic or lower extremity fracture fixation. Main outcome measurements VTE rates. Results The overall VTE rate was 0.82% [0.39% deep venous thromboses (DVT); 0.43% pulmonary emboli (PE)]. By procedure, pelvic open reduction and internal fixation (ORIF) and femoral IMN had the highest VTE rates 1.70% (0.98% DVT; 0.78% PE) and 1.33% (0.75% DVT; 0.58% PE), whereas tibial IMN had the lowest incidence of VTE 0.34% (0.17% DVT; 0.17% PE). Among hip fractures, femoral neck ORIF had a VTE rate of 0.98% (0.59% DVT; 0.39% PE), whereas intertrochanteric ORIF had lower rates of 0.59% (0.20% DVT; 0.39% PE). Conclusions Despite adherence to modern VTEp protocols, nonpreventable VTE occur in 0.82% of pelvic and lower extremity orthopaedic trauma patients. Incidence ranged between 0.34% and 1.70% depending on injury/fixation method with the highest rate observed in pelvis ORIF followed by femoral IMN. In the era of pay for quality performance, it is important for health systems and auditing agencies to reconcile the difference between preventable and nonpreventable VTEs. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Suicide risk is elevated among college-aged students and individuals exposed to cumulative interpersonal trauma. This study used the interpersonal theory of suicide as a framework to test the relation between cumulative interpersonal trauma and suicide ideation through the indirect effects of cumulative interpersonal trauma via depression, thwarted belongingness (TB), and perceived burdensomeness (PB), in serial. Participants were 261 college students who endorsed prior trauma and completed cross-sectional study measures online. An atemporal serial mediation model indicated that cumulative interpersonal trauma significantly and indirectly related to suicide ideation through depressive symptoms, TB, and PB. The relation between cumulative interpersonal trauma and suicide ideation was explained by greater depressive symptoms, TB, and PB, in serial. Therefore, depressive symptoms, TB, and PB may be important modifiable clinical targets for college students with a history of cumulative interpersonal trauma.

Study Design: This was a biomechanical study. Objective: Shape loss of surgical spine rods has been implicated as a factor leading to postsurgical loss of alignment correction. Our objective was to compare the degree of shape loss in surgical spine rods of different compositions under physiological conditions that were bent before or after being autoclaved. Methods: 10 CoCr and 10 commercially pure titanium (CPTi) surgical spine rods were contoured using a machine press. Five CoCr and 5 CPTi rods were bent before being autoclaved (preoperative bent group); 5 CoCr and 5 CPTi rods were bent after being autoclaved (intraoperative bent group). All rods were immersed in a phosphate-buffered saline bath at body temperature (37.2°C ± 2°C). Changes in radius of curvature were measured at different time intervals over an 8-week course using a high-definition scanner. Results: Each rod demonstrated shape loss in radius of curvature (range = 1.04-9.99 mm) over the duration of the study. Intraoperatively bent CPTi rods demonstrated the largest shape loss (range = 8.73-9.99 mm; median 9.33 mm; P < .01). Preoperatively bent CPTi (range = 1.04-1.71 mm; median = 1.39 mm; P < .01) and intraoperatively bent CoCr (range = 1.11-2.11 mm; median = 2.01 mm; P < .01) rods underwent the least amount of shape loss. Conclusion: CPTi spinal rods bent after autoclave may lead to considerable loss of alignment correction. In addition, our results suggest that preautoclave bent CPTi and CoCr spinal rods bent after autoclave may be a more ideal choice of implant because they may provide more resistance to shape loss over time.

The interpersonal theory of suicide hypothesizes that suicide ideation (SI) emerges specifically in the context of hopelessness about the immutability of thwarted belongingness (TB) and perceived burdensomeness (PB; i.e., interpersonal hopelessness). The psychometrics of the Interpersonal Hopelessness Scale (IHS), which could be used to test this hypothesis directly, have not been rigorously evaluated. Participants (U.S. adults reporting past-year SI) completed online self-report assessments at Waves 1 (W1; N = 595) and 2 (W2; N = 215), 1 week apart. Confirmatory factor analyses supported a two-factor structure, IHS-TB and IHS-PB. Correlations indicated strong concurrent validity. Hurdle negative binomial regressions indicated that W1 IHS-TB and IHS-PB scores were associated with SI presence and severity at both waves, but this was inconsistent when adjusting for other W1 variables. IHS-TB and IHS-PB demonstrated excellent internal consistency and moderate to good test–retest reliability. The IHS could improve theory testing and suicide risk assessment and management.

The recently released 11th edition of the International Classification of Diseases (ICD-11) classifies posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as distinct, yet related, disorders within the spectrum of trauma and stress-related disorders. This study aimed to explore the construct validity of the International Trauma Questionnaire (ITQ), a measure of ICD-11 PTSD and CPTSD symptoms among prison governors (i.e., wardens in the U.S. and Canada). Trauma-exposed prison governors (N = 409) aged 26 to 82 years (M = 50.04, SD = 7.97) provided their data online anonymously. Confirmatory factor analyses were performed to evaluate the construct validity of ITQ scores. When using the five-point item response scale, our five first-order factor model produced the best fit to the data; however, when using a dichotomous item scale, the first-order two-factor PTSD and disturbances of self-organization (DSO) model produced the best fit to the data. These results indicate that item-coding and estimation methods can significantly impact conclusions about the best-fitting model for this measure among trauma-exposed prison governors.

Nonsuicidal self-injury (NSSI) is associated with significant distress, impairment, and suicide risk among young adults. Negative affectivity and self-critical cognitions are linked to NSSI but have rarely been considered jointly alongside indicators of NSSI severity (e.g., frequency, recency, number of methods). To address this gap, we examined depressive symptoms and self-criticism as concurrent and prospective predictors of NSSI urges among depressed young adults over six weeks. Baseline NSSI severity was positively related to baseline depressive symptoms, which predicted follow-up NSSI urges; however, baseline depressive symptoms did not predict later NSSI urges when controlling for baseline NSSI severity. In contrast, self-criticism was not associated with baseline NSSI severity, but predicted follow-up NSSI urges, even when controlling for prior NSSI severity. Using within-person longitudinal path models, depressive symptoms were positively associated with NSSI urges at the same assessment but did not prospectively predict later NSSI urges; however, self-criticism did predict later NSSI urges, but was not related to concurrent NSSI urges. Thus, depressive symptoms may serve as an indicator of overall NSSI risk but may be less informative than self-criticism in predicting within-person changes in NSSI urges over time (e.g., during treatment). These findings inform NSSI theories and highlight potential NSSI prevention and intervention targets.

Background Cervical spine blunt trauma patients with the presence of a cerebrovascular injury may be given initiation of heparin anticoagulation treatment prior to necessary surgical stabilization. Literature regarding the safety and efficacy of these procedures while a patient is on active anticoagulation is limited, requiring further investigation. The primary research question for this study is: Can cervical spine decompression and fusion in the context of a blunt cerebrovascular injury and anticoagulation therapy be completed safely? To accomplish this a comparison of outcomes and perioperative complications was made to a control group. Methods A total of 63 trauma patients requiring cervical spine decompression and fusion from 2013 to 2015 were identified at our North American level 1 trauma center. Evaluation of patient injury data, bleeding events, postoperative infections, and neurologic outcomes was collected from chart review. The American Spinal Injury Association (ASIA) grading system was used to measure change in postoperative neurologic outcomes. Results Of 63 patients, 14 had a concomitant cerebrovascular injury that required perioperative anticoagulation treatment. In the 14 patients receiving anticoagulation, 11 had anterior and 3 had posterior stabilization. A total of 2 patients experienced a complication (pneumonia and hardware failure), but neither was related to anticoagulation. An elevated prothrombin time value was noted postoperatively in 1 patient, but with no adverse outcome. No bleeding or thrombotic events, surgical site infection, or neurologic deterioration occurred. The difference in postoperative ASIA grades between groups was not significantly different (P = .57). Conclusions The operative cohort receiving anticoagulation therapy did not demonstrate an increase affinity for perioperative complications or a decline in ASIA scores postoperatively when compared to a control cohort. Clinical Relevance Patients with a cerebrovascular injury receiving anticoagulation treatment can undergo safe and successful cervical spine stabilization procedures. Level of Evidence Therapeutic level III.

Study Design:Retrospective cohort study.Objective:To evaluate inpatient outcomes in dialysis dependent patients undergoing elective cervical spine surgery.Methods:A total of 1605 dialysis dependent patients undergoing elective primary or revision cervical spine surgery for degenerative conditions were identified from the National Inpatient sample from 2002 to 2012 and compared to 1 450 642 nondialysis-dependent patients undergoing the same procedures. The National Inpatient Sample is a de-identified database; thus, no institutional review board approval was needed.Results:Dialysis dependence was associated with higher inpatient mortality rates (7.5% vs 1.9%; P < .001) as well as both major (17.3% vs 0.6%; P < .001) and minor (36.8% vs 10.5%; P < .001) complication rates as compared with nondialysis-dependent patients. Dialysis-dependent patients had substantially increased mean lengths of stay (9.8 days compared with 2.0 days; P < .001) and total hospital charges ($141 790 compared with $46 562; P < .001).Conclusion:Dialysis-dependence is associated with drastically increased complication rates, risk of mortality, and represent a significant financial and psychosocial burden to patients undergoing elective cervical spine surgery. Both surgeons and patients should be aware of these risks while planning elective surgeries.

STUDY DESIGN This is a retrospective case series. OBJECTIVE Define the anatomic variations and the risk factors for such within the operative corridor of the transpsoas lateral interbody fusion. SUMMARY OF BACKGROUND DATA The lateral interbody fusion approach has recently been associated with devastating complications such as injury to the lumbosacral plexus, surrounding vasculature, and bowel. A more comprehensive understanding of anatomic structures in relation to this approach using preoperative imaging would help surgeons identify high-risk patients potentially minimizing these complications. MATERIALS AND METHODS Age-sex distributed, naive lumbar spine magnetic resonance imagings (n=180) were used to identify the corridor for the lateral lumbar interbody approach using axial images. Bilateral measurements were taken from L1-S1 to determine the locations of critical vascular, intraperitoneal, and muscular structures. In addition, a subcohort of scoliosis patients (n=39) with a Cobb angle >10 degrees were identified and compared. RESULTS Right-sided vascular anatomy was significantly more variant than left (9.9% vs. 5.7%; P=0.001). There were 9 instances of "at-risk" vasculature on the right side compared with 0 on the left (P=0.004). Age increased vascular anatomy variance bilaterally, particularly in the more caudal levels (P≤0.001). A "rising-psoas sign" was observed in 26.1% of patients. Bowel was identified within the corridor in 30.5% of patients and correlated positively with body mass index (P

Rejection is a direct threat to an individual's need to belong that has serious consequences for mental health. Rejection sensitivity may explain why some individuals are more likely to perceive rejection in social situations and experience subsequent psychological distress. The current study examined suicide ideation among psychiatric inpatients (N = 103) through the lenses of the rejection sensitivity model and the interpersonal theory of suicide. We hypothesized that rejection sensitivity would be indirectly associated with suicide ideation (i.e., a cognitive-affective reaction to social rejection) through greater perceptions of rejection (i.e., thwarted belongingness and perceived burdensomeness, constructs from the interpersonal theory of suicide), in parallel. Results from bootstrapped parallel mediation regression procedures indicated that the relation between rejection sensitivity and suicide ideation was significantly indirectly associated through the additive effect of thwarted belongingness and perceived burdensomeness, such that greater rejection sensitivity was associated with greater thwarted belongingness and perceived burdensomeness and subsequently greater suicide ideation. Further, rejection sensitivity was significantly indirectly associated with suicide ideation independently through thwarted belongingness, but not perceived burdensomeness. These findings provide support for the rejection sensitivity model and the interpersonal theory of suicide in an effort to advance our conceptualization of suicide risk among psychiatric inpatients.

Objective: Criminal justice involvement, substance use, and suicide pose significant public health concerns; however, the unique and synergistic effects of these experiences among high-risk individuals remain understudied. We hypothesized positive main effects for alcohol-related severity, drug-related severity, current criminal justice involvement, and thwarted belonging (TB) on suicide ideation history (SIH) and suicide attempt history (SAH) and that TB would moderate these associations. Method: We report on cross-sectional analyses of self-report assessments completed by 824 adult residential substance use patients. Results: Multinomial logistic regression analyses indicated that as alcohol- and drug-related severity increases, the probability of SIH and SAH increases; however, TB was only associated with a higher SIH probability. Significant two-way interactions (current criminal justice involvement*TB; alcohol-related severity*TB) indicated that (1) those high in TB with current criminal justice involvement were more likely to report a SIH than those without current criminal justice involvement; and (2) those low in TB and alcohol-related severity had the lowest SAH probability, whereas those low in TB and high in alcohol-related severity had the highest SAH probability. Conclusion: The unique and combined effects of interpersonal and contextual risk factors may improve suicide risk conceptualization and assessment, and allow for tailored treatments for this high-risk population. WOS:000641276600008 33876498 Q1

Purpose This paper mains to bring attention to the potential impact COVID-19 could have on suicide risk among individuals who are incarcerated and those reentering the community after incarceration (i.e. reentry), with particular emphasis on the USA, as well as provide possible solutions to mitigate suicide risk. Design/methodology/approach This paper provides an overview of the association between the COVID-19 pandemic policies and suicide, the vulnerabilities specific to prisoners during the COVID-19 pandemic, relevant suicide risk factors among prisoners, the possible impact of COVID-19 on suicide risk during reentry and proposed solutions for moving forward to mitigate both risks for COVID-19 and suicide. Findings This paper highlights that prisoners and individuals reentering the community are particularly vulnerable to COVID-19 and suicide risk and COVID-19-related stressors may further exacerbate known suicide risk factors (e.g. psychiatric symptoms, lack of positive social ties, low feelings of belonging, feelings of burden, economic problems) and suicidal thoughts and behaviors. This paper also discusses barriers (e.g. lack of funds, access to health and mental health care, COVID-19 testing and personal protective equipment) to managing COVID-19 and suicide risk within prisons and during reentry. Originality/value This paper provides a review of scalable solutions that could mitigate the impact of COVID-19 and suicide risk during this pandemic among prisoners and those reentering the community, such as psychoeducation, self-help stress management, telehealth services, increased access and reduced cost of phone calls, reduced or eliminated cost of soap and sanitization supplies in prisons and early release programs.

This study tested current perceived social support (CPSS) as a moderator of the relation between previous substance use (PSU) and lifetime suicide attempt (SA) history among 200 NGRI inpatients. Results indicated no significant CPSS main effect. PSU was associated with greater odds of multiple prior lifetime SA. Moderation indicated those low in PSU but high in CPSS were least likely to report multiple prior lifetime SA. Conversely, NGRI inpatients with high CPSS and high PSU were most likely to report multiple lifetime SA. Our study suggests CPSS and PSU assessments may inform suicide risk assessments and interventions among NGRI inpatients.

OBJECTIVES To compare patient admission comorbidity profiles, length of stay, readmission rate, postoperative complications, mortality rate, and cost of care between acute geriatric hip fractures (HF) and elective total hip arthroplasties (THA). METHODS Retrospective cohort. SETTING Multicenter health care system. PATIENTS Eighteen thousand forty-two geriatric HF treated with operative fixation or arthroplasty and 8761 elective total hip patients were reviewed. MAIN OUTCOME MEASUREMENTS Charlson Comorbidity Index, length of stay, ICU admission, readmission rate, postoperative complications, mortality rates, and cost of care. RESULTS Medical comorbidities: chronic pulmonary disease, chronic kidney disease, coronary artery disease, heart failure, liver cirrhosis, and cerebrovascular disease were higher in HF patients as was mean Charlson Comorbidity Index (P < 0.001). Albumin was lower and HgbA1c higher in HF patients (P < 0.001). Average length of stay was 5.0 versus 2.6 days (P < 0.001) with 8.5% of HF patients being managed in the ICU versus 1.8% of THA patients. Readmission rates for HF and THA patients were 21.4% and 6.2%, respectively (P < 0.001). Minor and major complications were higher in the HF cohort (P < 0.001), as were 30-day (1.97% vs. 0.17%) and 1-year mortality rates (3.49% vs. 0.40%) (P < 0.001). Mean hospital cost of care was nearly 15,000 US dollars more expensive in HF patients when compared to the elective THA cohort (P < 0.001). CONCLUSIONS HF patients have increased comorbidity burdens, lengths of stay, ICU admissions, readmission rates, complications, mortality, and costs of care than patients with elective total hip arthroplasty. In the era of pay for quality performance, health systems must reconcile the difference between these 2 patient cohorts. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objective Research suggests distinct criminal risk factors, not mental illness, are more strongly associated with most criminal behaviors. This notion has been supported among inpatient persons with mental illness (PMI) when examining antisocial cognitions; however, other key criminogenic risk factors (the Big Four and Central Eight risk factors) have not been examined among psychiatric inpatient PMI. Hypotheses We hypothesized that criminal justice (CJ)-involved PMI would endorse significantly greater criminogenic risk compared to non-CJ-involved PMI and that these risk factors would significantly and accurately identify whether PMI had CJ involvement. Additionally, we hypothesized that PMI with and without a history of CJ involvement would not significantly differ on their reported psychiatric symptomatology. Method We examined all Central Eight criminal risk factors and psychiatric symptomatology among psychiatric inpatient PMI (N = 142) with (n = 74) and without (n = 68) CJ involvement histories. Results Multivariate analysis of variance and discriminant function analysis indicated significant differences between the Big Four and Central Eight criminal risk factors when classifying CJ and non-CJ groups. The Big Four risk factors correctly classified 85.9% of participants, and the Central Eight correctly classified 99.3% of participants into CJ and non-CJ groups; however, psychiatric symptoms only correctly classified 57.7% of participants into CJ and non-CJ groups. Conclusions Criminal risk factors appear to be more strongly associated with CJ involvement among PMI than psychiatric symptomatology; therefore, psychotherapeutic intervention on criminal risk factors, not only mental illness, may decrease criminal recidivism among CJ-involved PMI. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The interpersonal theory of suicide (ITS) has accumulated empirical support; however, less research has investigated the clinical utility of ITS constructs in suicide risk assessment. The current study sought to increase the clinical utility of the Interpersonal Needs Questionnaire (INQ), an assessment of thwarted belongingness (TB) and perceived burdensomeness (PB), among 318 adult psychiatric outpatients while considering statistical methodology (i.e., multicollinearity and partialling). Results emphasized PB in the prediction of concurrent desire for death/suicide when TB was simultaneously considered. The interaction between TB and PB did not enhance prediction of concurrent desire for death/suicide. Independently, PB was a stronger predictor than TB of concurrent desire for death/suicide in the total sample and gender subsamples. Estimated probabilities of concurrent desire for death/suicide across INQ scores and preliminary INQ clinical cutoff scores are provided to enhance clinical application. These findings suggest the INQ could provide valuable information for suicide risk assessment and conceptualization.

Suicide risk is elevated among psychiatric inpatients; however, research has not examined moderators of the associations between perceived social support and thwarted belongingness (TB) and perceived burdensomeness (PB), such as involvement with criminal associates. Adult psychiatric inpatients (

Objective:To determine whether percutaneous transiliac–transsacral screw fixation improves pain, ambulation, length of stay, and the rate of disposition to home in patients with sacral fragility fractures.Design:Retrospective cohort study.Setting:Single academic Level 1 trauma center.Patients/Partic

Introduction Femoral neurovascular injury is an uncommon, but potentially devastating complication following surgical approaches to the hip. The intraoperative misplacement of the anterior acetabular retractor is the most commonly cited mechanism for this injury yet there is no gold standard for a proper insertion location in the literature We examined the course of the femoral neurovasculature about the hip to identify safest location for retractor insertion and furthermore demographic populations who are at-risk for injury due to a decreased distance between the hip joint and the femoral neurovasculature. Methods A total of 100 non-pathologic hip magnetic resonance imaging (MRI) studies from adult patients were included. Patients were chosen at random from our medical center's digital radiographic archive and their demographic data recorded. Mean distances between the anterior acetabular wall and the femoral artery were measured at three axial levels (acetabular dome, superior iliopectineal ridge, and inferior iliopectineal ridge). Results Our data showed the femoral neurovascular structures pass closer in proximity to the acetabular wall as they progress distally about the hip. An average direct separation distance of 40.1 mm was seen at the acetabular dome while measurements at the inferior iliopectineal ridge demonstrated an average distance of 20.5 mm. Additionally, statistically significant (p 45 years-old, Discussion By undertaking a large-scale MRI evaluation of the femoral neurovasculature about the hip, not only were we able to approximate the location of the femoral neurovascular bundle as it passes the hip joint, but also the safest location for insertion of anterior acetabular retractors at the level of the acetabular dome or above in close proximity to the bony cortex. Additional care should be taken placing retractors in patients when demographic risk factors including female gender, age >45 years old, stature

Individuals forensically committed to a state hospital are at an increased risk of suicide; however, there is extremely limited research examining suicide risk estimates and risk factors among inpatients deemed not guilty by reason of insanity (NGRI). This study aimed to determine (a) rates of suicidal ideation history, suicide attempt history, and current distress due to suicidal ideation, and (b) the associations between psychiatric symptom severity, criminal risk factors, and suicide risk. NGRI inpatients (n = 207) from 2 state hospitals were administered assessments of psychiatric symptom severity and criminal risk factors (i.e., criminal tendencies and antisocial personality traits). Results indicated 46.4% of participants reported at least 1 previous suicide attempt, 58% reported previous suicidal ideation, and 10.1% reported some level of current distress due to suicidal ideation. Binary logistic regression results indicated psychiatric symptom severity, not criminal tendencies or antisocial personality traits, was associated with a greater likelihood of current distress due to suicidal ideation. There was a significant interaction between criminal tendencies and antisocial personality, which indicated that individuals higher in criminal tendencies and lower in antisocial personality traits are predicted to have the greatest probability of reporting current distress due to suicidal ideation. Additionally, psychiatric symptom severity and antisocial personality traits were associated with a greater likelihood of a suicide attempt history, whereas criminal tendencies were associated with a decreased likelihood. Clinical implications are discussed, particularly the need for suicide risk assessments and management to consider both psychiatric symptoms and criminal risk factors. (PsycINFO Database Record

© 2018 Elsevier Ltd Post-operative rehabilitation and weight-bearing protocols are important to fracture fixation outcomes, yet there is a dearth in the literature concerning universal treatment guidelines following plate fixation of extremity fractures. There are controversies regarding time to allow weight-bearing and range of motion for most fractures of the upper and lower extremity. This lack of a consensus has led to varying practice guidelines and differing anecdotal protocols between treating surgeons. This review attempts to establish consensus guidelines for the post-operative rehabilitation required for patients following plate fixation of common upper and lower extremity fractures.

Acquired capability for suicide is posited to develop through repeated exposure to physically painful and psychologically provocative events; however, there is limited research evaluating the assessment of painful and provocative events. The current study examined the factor structure, validity, and reliability of the Painful and Provocative Events Scale (PPES). Categorical exploratory and confirmatory factor analyses were conducted in a sample of undergraduate students (N = 732). A 15-item PPES with a 3-factor solution best fits the data; however, both the subscales derived from factor analyses yielded inconsistent validity and reliability. Despite addressing limitations of previous psychometric investigations of the PPES, the inconsistent findings of the current study suggest the theoretical reconceptualization of painful and provocative events and the subsequent development of a valid and reliable assessment of painful and provocative events is needed to take the place of current versions of the PPES.

Abstract. Background: Approximately 20% of suicide decedents have had contact with a mental health professional within 1 month prior to their death, and the majority of mental health professionals have treated suicidal individuals. Despite limited evidence-based training, mental health professionals make important clinical decisions related to suicide risk assessment and management. Aims: The current study aimed to determine the frequency of suicide risk assessment and management practices and the association between fear of suicide-related outcomes or comfort working with suicidal individuals and adequacy of suicide risk management decisions among mental health professionals. Method: Mental health professionals completed self-report assessments of fear, comfort, and suicide risk assessment and management practices. Results: Approximately one third of mental health professionals did not ask every patient about current or previous suicidal thoughts or behaviors. Further, comfort, but not fear, was positively associated with greater odds of conducting evidence-based suicide risk assessments at first appointments and adequacy of suicide risk management practices with patients reporting suicide ideation and a recent suicide attempt. Limitations: The study utilized a cross-sectional design and self-report questionnaires. Conclusion: Although the majority of mental health professionals report using evidenced-based practices, there appears to be variability in utilization of evidence-based practices.

Research suggests it is important to consider criminogenic needs among individuals with severe mental illness. This study aimed to determine the severity of criminal thinking in community-based clinical samples, understand the association between criminal thinking and psychiatric and criminal justice outcomes, and compare these associations between consumers enrolled in Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment (FACT) programs. Participants ( N = 234) were male and female consumers enrolled in ACT and FACT programs in five states. Results revealed no significant differences in criminal thinking when comparing participants by program type or history of criminal justice involvement. There were significant positive relations between general criminal thinking and psychiatric symptomatology and the number of lifetime arrests, a negative association between recovery attitudes and general criminal thinking, and ACT participants reported a greater number of lifetime psychiatric hospitalizations than FACT participants. Result implications are discussed with specific reference to treatment programming.

Suicide in rural areas has not received significant attention in the research literature to this point, although suicide rates are higher among adults and older adults in rural areas than in urban areas. The aims of the study were as follows: (1) establish the feasibility of assessing suicide ideation and history of suicidal behavior; (2) determine preliminary estimates of the prevalence of suicide ideation, and history of suicide attempts; and (3) examine the effectiveness and acceptability of safety and referral plans for individuals whose responses indicated elevated suicide risk, in rural communities with limited access to referral care. Participants were 96 adults aged 40 to 85 years old (M = 57.34, SD = 11.47) residing in West Texas. Our results indicate that 26% of participants endorsed a lifetime history of suicide ideation and/or suicide attempt(s) and 12.5% reported suicide ideation in the past year. In addition, 93.4% of participants reported that participation in our suicide-focused study was an excellent or good experience. Results suggest that individuals in rural communities are willing to talk about suicide, found the experience helpful, and were satisfied with the referral process.

The interpersonal theory of suicide posits that thwarted belongingness (TB) and perceived burdensomeness (PB) increase suicide ideation; however, studies have found mixed results regarding this hypothesis among psychiatric inpatients. This study aimed to (a) demonstrate how assessing TB and PB using the Interpersonal Needs Questionnaire (INQ) can provide clinically useful information and (b) investigate how statistical methodology may impact the clinical application of the INQ. Participants were 139 (Sample 1) and 104 (Sample 2) psychiatric inpatients. In both samples, ordinal logistic regression results indicated TB and PB, separately, were significant predictors of suicide ideation-related outcomes; however, when examined as simultaneous predictors, TB was no longer a significant predictor. The interaction between TB and PB was not significant for either sample. Despite this, TB and PB scores provided clinically relevant information about suicide ideation-related outcomes. For example, the highest scores on TB and PB indicated a 93% and 95% chance of having some level of distress due to suicide ideation (Sample 1), a 91% and 92% chance of having some level of desire for death, and a 79% and 84% chance of having some level of desire for suicide, respectively (Sample 2). This study also proposes clinical cutoff scores for the INQ (for TB and PB, respectively, cutoff scores were 22 and 17 for distress due to suicide ideation, 33 and 17 for desire for death, and 31 and 22 for desire for suicide). Although these results indicate that multicollinearity between TB and PB may create interpretational ambiguity for clinicians, TB and PB may each be useful separate predictors of suicide ideation-related outcomes in psychiatric inpatient settings and should be incorporated into suicide risk assessment. Key practitioner message The 15-item Interpersonal Needs Questionnaire (an assessment of thwarted belongingness and perceived burdensomeness) should be incorporated into suicide risk assessment. Among psychiatric inpatients, greater thwarted belongingness and perceived burdensomeness, as separate predictors, were associated with increased levels of distress due to suicide ideation, desire for death, and desire for suicide. The highest scores on thwarted belongingness and perceived burdensomeness indicated a 79% to 95% chance of experiencing an elevated level of distress due to suicide ideation, desire for death, or desire for suicide. Recommended clinical cutoff scores were provided. For example, thwarted belongingness cutoff score of 31 and perceived burdensomeness cutoff score of 22 maximized the sensitivity and specificity of the INQ to detect some level of desire for suicide.

The Psychological Inventory of Criminal Thinking Styles (PICTS) is commonly used to assess criminal thinking (thoughts related to criminal behavior); however, the item wording may not be an appropriate assessment for individuals without a criminal history (laypersons) who still may be at risk of engaging in crime. Therefore, a layperson version of the PICTS may more accurately assess criminal thinking among this group. This study examined the psychometric properties of the PICTS–Layperson–Short Form (PICTS-L-SF). Participants were 619 college students without a criminal justice involvement history. Analyses of the PICTS-L-SF indicated that a bifactor model fit the data better than a one- and two-factor model (general criminal thinking; proactive and reactive criminal thinking). Results provide strong evidence for the reliability and validity of the PICTS-L-SF, suggesting it can be used with individuals who are not criminal justice involved to assess criminal thinking.

Abstract. Background: Mental health care providers commonly encounter suicide ideation and suicidal behaviors among their patients despite a frequent lack of adequate knowledge and competence regarding suicide risk management. Aims: This study examined the associations among self-perceived sufficiency of training, self-efficacy, anxiety, and attitudes related to working with suicidal individuals. Method: Participants were 289 mental health care providers who completed a self-report survey. Results: Path analysis results indicated that perceived sufficiency of training was indirectly associated with negative attitudes (i.e., avoidance and discomfort) and cognitive and somatic anxiety about working with suicidal individuals through assessment self-efficacy. Limitations: The current study utilized cross-sectional data, and there were occupational heterogeneity and geographical homogeneity among the mental health care providers sampled. Conclusion: These findings suggest that sufficient suicide-related training focused on risk assessment may decrease mental health professionals' negative and anxious reactions toward suicidal individuals and enhance confidence in suicide risk management.

ObjectiveInstitutional violence in state hospitals is a public health problem that has been severely understudied. Given the personal (ie, staff and patients) and fiscal harms associated with institutional violence, more research into contributing factors for violence is needed. The overarching aim of this study then was to examine associations among psychiatric symptoms, criminal risk factors, and institutional violence.MethodsParticipants were 200 male, female, and transgender forensic mental health inpatients adjudicated Not Guilty by Reason of Insanity and committed to the California Department of State Hospitals. Participants completed a psychiatric symptom measure, and measures of and associated with criminal risk. Institutional violence was recorded from file review and includes physical violence toward staff or patients for 6-months prior to and post patient participation in this study.ResultsAfter adjusting for previous institutional violence, results indicated that psychiatric symptoms were not associated with follow-up institutional violence; however, criminal risk was associated with follow-up institutional violence. Unexpectedly, 2 aspects of criminal risk, antisocial cognitions and associates, were not associated with follow-up institutional violence after adjusting for previous institutional violence. Results also provided a tentative cutoff score on the Self-Appraisal Questionnaire for predicting follow-up institutional violence.ConclusionsThese results have important implications for treating and managing patients at risk for institutional violence, including the need to assess criminogenic risk and leverage treatments that target these risk factors as a best practice approach.

Suicidal ideation is elevated among individuals who engage in BDSM practices and those with sexual and gender minority (SGM) identities. There is limited research on the intersectionality of these identities and how they relate to suicidal ideation, especially within a theoretical framework of suicide risk, such as the interpersonal theory of suicide. Thus, we tested the indirect relation between BDSM disclosure and suicidal ideation through thwarted belongingness and perceived burdensomeness, as well as the moderating role of SGM identity on these indirect associations. Participants were 125 (M(age) = 28.27 years; 64% cisgender men) individuals recruited via online BDSM-related forums who endorsed BDSM involvement and recent suicidal ideation. Results indicated significant moderated mediation, such that BDSM disclosure was indirectly negatively related to suicidal ideation through lower thwarted belongingness, but not perceived burdensomeness, among SGM individuals. This was due to the significant relation between BDSM disclosure and thwarted belongingness. There were no significant moderated mediation or indirect effects related to perceived burdensomeness. We also provide supplemental analyses with positive ideation (i.e., positive thoughts toward life) as the criterion variable. In conclusion, BDSM disclosure appears to be protective against suicidal ideation through thwarted belongingness but only for SGM individuals. This work furthers our understanding of the impact of intersecting marginalized identities on suicide risk and resilience. Implications, limitations, and future directions are further discussed.

BACKGROUND. The relation between psychopathic traits and suicide ideation (SI) is frequently discussed but little research has examined potential mechanisms underlying this association. The interpersonal theory of suicide (ITS) proposes two mechanisms in the pathogenesis of suicidal desire: thwarted belongingness (TB) and perceived burdensomeness (PB). This study cross-sectionally tested TB and PB as possible explanatory links in the relation between psychopathic traits and SI. METHOD. Archival data from 784 male United Kingdom prisoners (M(age) = 37.21, SD = 9.97) were analyzed using structural equation modeling. RESULTS. Psychopathic traits were indirectly associated with SI through more specific suicide-promoting processes—namely, TB and PB. More specifically, results indicated that Egocentricity and Stimulus Seeking were indirectly associated with SI through PB and TB in combination. However, results indicated specific indirect effects of TB in the relations between the Antisocial Behavior, Egocentricity, and Stimulus Seeking facets, and SI; whereas, specific indirect effects for PB were only significant in the relations between Egocentricity and Stimulus Seeking facets and SI. CONCLUSION. Preliminary results are consistent with the ITS and suggest that psychopathic traits may be distal risk markers for SI and provide direction for future research that could inform suicide prevention efforts among male prisoners high in such traits.

Objective Categorical data analysis is relevant to suicide risk and prevention research that focuses on discrete outcomes (e.g., suicide attempt status). Unfortunately, results from these analyses are often misinterpreted and not presented in a clinically tangible manner. We aimed to address these issues and highlight the relevance and utility of categorical methods in suicide research and clinical assessment. Additionally, we introduce relevant basic machine learning methods concepts and address the distinct utility of the current methods. Method We review relevant background concepts and pertinent issues with references to helpful resources. We also provide non-technical descriptions and tutorials of how to convey categorical statistical results (logistic regression, receiver operating characteristic [ROC] curves, area under the curve [AUC] statistics, clinical cutoff scores) for clinical context and more intuitive use. Results We provide comprehensive examples, using simulated data, and interpret results. We also note important considerations for conducting and interpreting these analyses. We provide a walk-through demonstrating how to convert logistic regression estimates into predicted probability values, which is accompanied by Appendices demonstrating how to produce publication-ready figures in R and Microsoft Excel. Conclusion Improving the translation of statistical estimates to practical, clinically tangible information may narrow the divide between research and clinical practice.

Study design Retrospective cohort study. Objective The aim of this study was to determine whether the level of a cervical disc herniation (CDH) procedure will uniquely impact performance-based outcomes in elite athletes of the National Football League (NFL). Summary of background data Comparative assessments of postsurgical outcomes in NFL athletes with CDH at different levels are unknown. Further, the surgical decision-making for these types of injuries in professional football athletes remains controversial. Methods NFL players with a CDH injury at a definitive cervical level were identified through a review of publicly available archives. Injuries were divided into upper- (C2-C4) and lower-level (C4-T1) CDH. The impact on player outcomes was determined by comparing return to play statistics and calculating a "Performance Score" for each player on the basis of pertinent statistical data, both before and after surgery. Results A total of 40 NFL athletes met inclusion criteria. In the upper-level group, 10 of 15 (66.6%) players successfully returned to play an average of 44.6 games over 2.6 years. The lower-level cohort had 18 of 25 (72%) players return to play with an average of 44.1 games over 3.1 years. There was no significant difference in the rate of return to play (P = 0.71). Postsurgical performance scores of the upper and lower-level groups were 1.47 vs. 0.69 respectively, with no significant difference between these groups (P = 0.06). Adjacent segment disease requiring reoperation occurred in 10% of anterior cervical discectomy and fusion patients. In 50% of foraminotomy patients, a subsequent fusion was required. Conclusion A uniquely high percentage of upper-level disc herniations develop in NFL athletes, and although CDH injuries present career threatening implications, an upper-level CDH does not preclude a player from successfully returning to play at a competitive level. In fact, these athletes showed comparable postsurgical performance to those athletes who underwent CDH procedures at lower cervical levels. Level of evidence 4.

Background Context The use of a novel lumbar pedicle cortical bone trajectory (CBT) screw has recently gained popularity, allowing for a minimally invasive approach and potentially improved screw purchase. However, to date, no studies have identified the ideal patient population to utilize this technology. Purpose This study reports the bone mineral density (BMD) using Hounsfield units (HUs) along a CBT screw pathway. Patients with a greater difference in density of bone in the lumbar vertebrae between the fixation points of the CBT and traditional pedicle screw may be optimal candidates to realize the advantages of this technique. Study Design/Setting A cross-sectional observational anatomic study was carried out. Patient Sample The sample comprised 180 randomly selected patients with lumbar computed tomography imaging from L1 to L5 spinal levels. Outcome Measures This study used computed tomography image-derived HUs as a metric for BMD. Methods A total of 180 patients without previous lumbar surgery with computed tomography imaging of the lumbar spine met the inclusion criteria. Patients were chosen randomly from an institutional database based on age (evenly distributed by decade of life) and gender. Hounsfield units were measured at the expected end fixation point for both a cortical (superior/posterior portion of the vertebral body) and traditional pedicle trajectory (mid-vertebral body). Results Hounsfield unit values measured at the end fixation point for the CBT screw were significantly greater than that of the traditional pedicle screw in all age groups. The relative difference in HU values significantly increased with each decade of age (p Conclusions Bone mineral density as measured by HU values for the fixation point of the CBT screw is significantly greater than that of the traditional pedicle screw. This difference is even more pronounced when comparing osteoporotic and elderly patients to the general population. The data in this study suggest that the potential advantages from the CBT screw such as screw purchase may increase linearly with age and in osteoporotic patients.

To date, no study has examined rates of suicide ideation or theory-based risk factors for suicide ideation among bondage and discipline, dominance and submission, and sadomasochism (BDSM) practitioners. Participants were 321 adults that endorsed BDSM involvement. Thirty-seven percent of the sample indicated a nonzero level of suicide ideation. Thwarted belongingness and perceived burdensomeness (PB) were positively associated with suicide ideation and their interactive effect predicted additional variance in suicide ideation after adjusting for depressive symptoms. Overall, shame and guilt were positively associated with suicide ideation and these relations were mediated by thwarted belongingness and PB in parallel adjusting for depressive symptoms; however, there were some differences between demographic subgroups. Among BDSM practitioners, stigma-related internalized feelings (i.e., shame and guilt) may be associated with increased thwarted belongingness and PB, which are associated with suicide ideation.

To evaluate the association between the timing of hip fracture surgery with postoperative length of stay and outcomes.Retrospective review using the American College of Surgeons National Surgical Quality Improvement Program database.National inquiry database incorporating 140 academic and private medical centers.Seventeen thousand four hundred fifty-nine patients who underwent surgery for a hip fracture between 2006 and 2013 were identified from the National Surgical Quality Improvement Program database.Surgical management of hip fractures was performed at the discretion of participating surgeons.Thirty-day outcomes including postoperative length of stay, readmission rates, reoperation rates, complications, and mortality rates.Of the 17,459 patients, 4107 (23.5%) were operated on within 24 hours, 8740 (50.1%) within 24-48 hours, and 4612 (26.4%) more than 48 hours after hospital admission. Increased time to surgery was associated with longer postoperative hospital length of stay. Prolonged time to surgery did not adversely affect postoperative outcomes.Although a delay in the management of hip fractures is associated with an increase in postoperative hospital length of stay, 30-day postoperative outcomes are not adversely affected in patients undergoing hip fracture fixation.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.