Psychological and Autonomic Correlates of Emotion Dysregulation among Women in Substance Use Disorder Treatment.

BACKGROUND: Emotion regulation is increasingly recognized as important for the prevention and treatment of substance use disorder (SUD). However, there is an identified lack of physiological indexes of emotion dysregulation in SUD treatment studies, critically needed to better understand the link between emotion regulation capacity (measured physiologically) and self-report health outcomes among individuals in SUD treatment. OBJECTIVE: To examine the association between respiratory sinus arrhythmia (RSA) and self-report health outcomes among women in SUD treatment. METHODS: This is a cross-sectional study based on baseline data from 217 women enrolled in a randomized control trial to study a mind-body intervention as an adjunct to SUD treatment. All participants were enrolled in community-based outpatient treatment. Participants were administered questionnaires to examine sample characteristics, mental health symptoms, and interoceptive awareness and mindfulness skills. RSA data was gathered as an index of emotion dysregulation. Descriptive statistics, bivariate correlations, and regression were used in the analyses. RESULTS: Findings highlight the extensive trauma histories, low SES, and the high symptoms of distress in this sample. RSA was only significantly correlated with interoceptive awareness after controlling for age and BMI. Measures of symptomatic distress and mindfulness were not correlated with RSA. Conclusions/Importance: Results provide the first evidence of RSA as an index of interoceptive awareness in this population. The inclusion of biomarkers such as RSA in SUD clinical studies may help identify individuals that are in need of targeted treatments that include interoceptive awareness training focused on improving emotion regulation.

Trajectories of parent-adolescent relationship quality among at-risk youth: parental depression and adolescent developmental outcomes.

BACKGROUND: Although the parent-adolescent relationship has been studied intensely, predictors and consequences of changes in the quality of the relationship across time have not been examined. OBJECTIVES: This study examined the role of parent depression on changes in the parent-adolescent relationship, defined as support and conflict, and subsequent effects of relationship change on adolescent psychosocial outcomes including risky behavior, substance use, depressive symptoms, and hopelessness. METHOD: Using data from a large prevention study, the sample included 110 youth at risk for high school drop out from the control condition; the sample was 48.2% of female, with a mean age of 15.9years. The data, gathered from adolescents and their parents across a period of approximately 18months, were analyzed using growth mixture modeling. RESULTS: Three distinct trajectories for parent-adolescent conflict (high-decreasing, low-increasing, low-stable trajectory) were identified as well as a single growth model for support, which revealed a slight decline in support across time. Parent depression was a significant predictor of perceived support, but not of membership in trajectories of conflict. Low parent-adolescent support was associated with adolescent depression and hopelessness measured 18months post-baseline. Adolescents in the low but increasing conflict trajectory and those having a parent with depression reported increased depression and hopelessness 18months later. DISCUSSION: Parent-Adolescent support and conflict were associated with adolescent emotional outcomes, particularly depression and hopelessness. The findings provide evidence that will inform prevention strategies to facilitate parent-adolescent support, minimize the negative impact of relationship conflict, and thereby promote healthy psychosocial outcomes for at-risk adolescence.

Impact of social discrimination, job concerns, and social support on Filipino immigrant worker mental health and substance use.

BACKGROUND: The personal and social impact of mental health problems and substance use on workforce participation is costly. Social determinants of health contribute significantly to health disparities beyond effects associated with work. Guided by a theory-driven model, we identified pathways by which social determinants shape immigrant worker health. METHOD: Associations between known social determinants of mental health problems and substance use (social discrimination, job and employment concerns, and social support) were examined using structural equation modeling in a sample of 1,397 immigrants from the Filipino American Community Epidemiological Study. RESULTS: Social discrimination and low social support were associated with mental health problems and substance use (P < 0.05). Job and employment concerns were associated with mental health problems, but not substance use. CONCLUSIONS: The integration of social factors into occupational health research is needed, along with prevention efforts designed for foreign-born ethnic minority workers.

Suicide Risk at Young Adulthood: Continuities and Discontinuities From Adolescence.

Young adult suicide is an important social problem, yet little is known about how risk for young adult suicide develops from earlier life stages. In this study the authors report on 759 young adults who were potential high school dropouts as youth. At both adolescence and young adulthood, measures of suicide risk status and related suicide risk factors are collected. With a two-by-two classification on the basis of suicide risk status at both adolescence and young adulthood, the authors distinguish four mutually exclusive groups reflecting suicide risk at two life stages. Using ANOVA and logistic regression, both adolescent and young adult suicide risk factors are identified, with evidence of similarity between risk factors at adolescence and at young adulthood, for both individual-level and social-context factors. There is also support for both continuity and discontinuity of adolescent suicide risk. Implications for social policy are discussed.

The Scale of Body Connection: A Multisample Study to Examine Sensitivity to Change Among Mind-Body and Bodywork Interventions.

Purpose: The purpose of this measurement study was to examine the Scale of Body Connection (SBC) sensitivity to change among mind-body or bodywork interventions and to explore the concurrent validity in relation to emotion dysregulation and mindfulness skills. Methods: This study was based on multiple clinical trials that had used the SBC to evaluate changes in body awareness (BA) and bodily dissociation (BD) in response to a mind-body or bodywork intervention. To test for sensitivity to change, t tests were used to examine change and estimate effect sizes. To explore convergent validity, Pearson's product-moment correlations between the SBC subscales and Five-Facet Mindfulness Questionnaire (FFMQ) and Difficulties in Emotion Regulation Scale (DERS) were calculated among a subset of the studies, which also included these measures. Results: The BA and BD scales consistently detected significant positive responses to a range of intervention types (yoga, mindfulness meditation, BA, multimodal therapy, and bodywork), demonstrating SBC sensitivity to change. With a few exceptions, the effect sizes across studies for BA were above 0.35, indicating near moderate-to-large effect sizes. The effect sizes for BD, as a measure of responsiveness, were much smaller than for BA; however, four of the studies had effect sizes between 0.54 and 0.86. Concurrent validity with the DERS was supported by moderate-to-large correlations, and with the FFMQ, it was significant with the BA scale in one included study. Conclusions: The results of this study further establish SBC validity and sensitivity to change across a range of mind-body therapies and confirm prior findings of moderate-to-strong internal consistency reliability. The findings support the use of this brief scale to assess key dimensions of BA and BD in practice and research.

Multi-system influences on adolescent risky sexual behavior.

We examined multi-system influences on risky sexual behavior measured by cumulative sexual risk index and number of nonromantic sexual partners among 4,465 single, sexually experienced adolescents. Hierarchical Poisson regression analyses were conducted with Wave I-II data from the National Longitudinal Study of Adolescent Health. Individual and family factors predicted both outcome measures. Neighborhood set predicted cumulative sexual risk index only, and peer factors predicted the number of nonromantic sexual partners only. School set did not predict either outcome. There were significant associations among risky sexual behavior, drug use, and delinquent behaviors. The results highlight the need for multifaceted prevention programs that address relevant factors related to family, peer and neighborhood influence as well as individual factors among sexually active adolescents.

Longitudinal effects of interoceptive awareness training through mindful awareness in body-oriented therapy (MABT) as an adjunct to women's substance use disorder treatment: A randomized controlled trial.

BACKGROUND: Training in interoceptive awareness is a promising behavioral approach for improving substance use disorder (SUD) treatment. This study examined the longitudinal effects of Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to women's SUD treatment. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation. METHODS: Women in intensive outpatient treatment for SUD at three community clinics were recruited and randomly assigned to one of three study conditions Treatment as Usual (TAU) + MABT, TAU + Women's Health Education (WHE), and TAU only. Four assessments were delivered over one year (N = 187) baseline, 3, 6 and 12 months to examine primary outcome of percent days abstinent from substance use, and secondary outcomes of emotion dysregulation, craving, psychological distress, mindfulness and interoceptive awareness. Changes in outcomes across time were assessed using multilevel mixed effects linear regression. RESULTS: Substance use improved significantly for MABT vs. TAU at 6 months and 12 months. Positive longitudinal effects on secondary outcomes for MABT were evident on respiratory sinus arrhythmia (RSA), a physiological index of emotion regulation; on craving; and on interoceptive awareness skills. Analyses based on participants who completed >75% of the intervention sessions revealed additional immediate significant improvements for MABT vs. TAU and WHE on depressive symptoms and emotion regulation difficulties and longitudinal improvement on mindfulness skills. CONCLUSIONS: Results show MABT to be efficacious for longitudinal health outcomes to support women's recovery as an adjunct to community-based SUD treatment.

The relationship of physical activity to health status and quality of life in cerebral palsy.

PURPOSE: To compare the influence of functional level, ambulatory, and physical activity performance on self-reported health status and quality of life (QOL) of youth with cerebral palsy (CP) and with typical development. METHODS: A cross-sectional comparison cohort design was used in 81 youth with CP, ages 10 to 13 years and 30 youth with typical development. Participants wore the StepWatch monitor for 7 days and completed the Activity Scale for Kids, Child Health Questionnaire-Child Form, and Youth Quality of Life Questionnaire. Multiple regression analysis was used. RESULTS: Self-reported activity performance influenced self-reported physical (beta = 0.36), behavioral (beta = 0.32), and emotional (beta = 0.29) health. Functional level and performance did not influence QOL. CONCLUSIONS: Measures of ambulatory and physical activity and youth-reported health status separated from the measure of QOL seem helpful in defining the specific health issues of ambulatory youth with CP and have implications for physical activity intervention.

Measuring dimensions of body connection: body awareness and bodily dissociation.

OBJECTIVE: This study aimed to test the preliminary psychometric properties of the Scale of Body Connection (SBC), a 20-item self-report measure, designed to assess body awareness and bodily dissociation in mind-body intervention research. METHODS: The SBC items were based on common expressions of awareness in body therapy. Content validity was established by a panel of experts. The validity and reliability of the scale was examined with an undergraduate sample. To assess the scale's discriminant validity, the respondents were asked to indicate exposure to specific traumas. RESULTS: Confirmatory factor analysis, used to examine the scale's construct validity, indicated acceptable goodness-of-fit indices, and revealed uncorrelated subscales, reflecting independent dimensions. Cronbach's alpha revealed equal internal consistency reliability for each subscale for both men and women. Body awareness scores did not differ between individuals with and without reported trauma exposure. Bodily dissociation scores differed between individuals with and without past experience with physical trauma, suggesting the applicability of this subscale for use with populations with trauma histories. CONCLUSIONS: The results provide preliminary evidence of the construct validity and internal consistency reliability of the SBC.

Scale of Body Connection: A multi-sample construct validation study.

The Scale of Body Connection (SBC) was created to address the need for a self-report measure to examine body awareness and bodily dissociation in mind-body research. Developed in the U.S.A., it has been translated into many languages and tested for validity of scale translation. The burgeoning of mind-body research and the widespread use of the SBC scale underscored the need for critical assessment of the instrument's measurement properties. Thus, a broader evaluation of the SBC was designed using large samples from eight international, cross-sectional studies drawn from community (i.e., non-clinical) populations. Specifically, we assessed scale distribution properties and internal consistency reliabity, and using confirmatory factory analysis we evaluated scale contruct validity and compared male/female measurement models. The results indicated acceptable reliability for both the body awareness and bodily dissociation scales, and a good fit between the proposed theoretic model and the data, providing evidence of construct validity across all samples. Mean differences in body awareness were observed for males vs. females in most samples, with females generally showing higher body awareness compared to males. Multi-group structural equation modeling demonstrated a stable latent factor structure and factor loadings, indicating equivalent measurement models for males and females. In summary, this multi-sample study demonstrated SBC construct validity that supports its use in clinical research as a brief, readily translated, easy to administer measure of body awareness and bodily dissociation.

The mediating roles of anxiety depression, and hopelessness on adolescent suicidal behaviors.

The purpose of this study was to explore the roles of anxiety, depression, and hopelessness as mediators between known risk factors and suicidal behaviors among 1,287 potential high school dropouts. As a step toward theory development, a model was tested that posited the relationships among these variables and their effects on suicidal behaviors. Structural equation models, estimated separately by gender, revealed support for the model, and substantial similarities between males and females. The results showed direct effects of depression and hopelessness on suicidal behaviors for males, and direct effects of hopelessness, but not depression, for females. For both males and females, anxiety was directly linked to depression and hopelessness; drug involvement had both direct and indirect effects on suicidal behavior. As hypothesized, lack of family support showed indirect influences on suicidal behaviors through anxiety for both males and females. The results have important implications for future model development regarding adolescent suicidal behaviors.

Effects of Social Determinants on Chinese Immigrant Food Service Workers' Work Performance and Injuries: Mental Health as a Mediator.

OBJECTIVE: The effects of social discrimination, job concerns, and social support on worker mental health and the influence of mental health on occupational health outcomes have been documented intermittently. We propose an integrated, theory-driven model to distinguish the impact of social determinants on work performance and injuries and the mediating effects of mental health problems. METHODS: The US Chinese immigrant food service workers (N = 194) completed a multimeasure interview; we tested the integrated model using structural equation modeling. RESULTS: Mental health problems, which were associated with decreased work performance and increased injuries, also mediated relationships between job/employment concerns and both work performance and injuries but did not mediate the influences of discrimination and social support. CONCLUSIONS: This research reveals mechanisms by which social determinants influence immigrant worker health, pointing to complementary strategies for reducing occupational health disparities.

Life Course Associations between Victimization and Aggression: Distinctive and Cumulative Contributions.

The connections between early maltreatment and later aggression are well established in the literature, however gaps remain in our understanding of developmental processes. This study investigates the cascading life course linkages between victimization experiences from childhood through early adulthood and later aggressive behavior. The diverse, at-risk sample is of particular importance to child and adolescent specialists, as it represents highly vulnerable youth accessible through conventional school settings. In addition to direct pathways from proximal life periods, path analysis revealed significant indirect mediated pathways through which earlier life victimization contributes to aggressive behaviors in later life periods as well as revictimization. Multivariate regressions support theorized cumulative effects of multi-form victimization as well as distinct contributions of victimization domains (emotional, witnessing, physical, property, and sexual) in explaining aggressive behavior. Consistent with theorizing about the developmental impact of early maltreatment, results bolster the importance of interrupting pathways from victimization to revictimization and later aggression. Findings are evaluated in light of implications for early identification and prevention programming.

Life Course Associations between Victimization and Aggression: Distinct and Cumulative Contributions.

The connections between early maltreatment and later aggression are well established in the literature, however gaps remain in our understanding of developmental processes. This study investigates the cascading lifecourse linkages between victimization experiences from childhood through early adulthood andlater aggressive behavior. The diverse, at-risk sample is of particular importance to child and adolescent specialists, as it represents highly vulnerable youth accessible through conventional school settings. In addition to direct pathways from proximal life periods, path analysis revealed significant indirect mediated pathways through which earlier life victimizationcontributes to aggressive behaviors in later life periods as well as revictimization. Multivariateregressions support theorized cumulative effects of multi-form victimization as well as distinct contributions of victimization domains (emotional, witnessing, physical, property, and sexual) in explaining aggressive behavior.Consistent with theorizing about the developmental impact of early maltreatment, results bolster the importance of interrupting pathways from victimization to revictimization and later aggression. Findings are evaluated in light of implications for early identification and prevention programming.

Interdisciplinary research training in substance abuse and addictions.

Considerable evidence shows that the management of complex problems of and related to substance abuse and addictions require comprehensive approaches based on solid research. Nonetheless, timely and widespread dissemination of research findings remains uncommon, hindering nursing practice, impeding the health of individuals and families, and imposing untoward costs for society. Shifts in science paradigms underscore the need for efficient and effective interdisciplinary research teams to carry out innovative research within a translational science framework. This means that early career investigators will need the knowledge and skills to conduct research as part of an interdisciplinary team and to contribute systematically to translational research in the area of substance abuse and addictions. This brief report describes a nursing research training program sponsored by the National Institute on Drug Abuse that evolved into an interdisciplinary program administrated within a school of nursing. Factors conducive to program development are described, along with the structure and elements of the program and examples of the scholars' projects and accomplishments. The common benefits of interdisciplinary research training for both predoctoral and postdoctoral research scholars include consistent exposure to new and alternative scientific models and methodological approaches as well as endurance of cross-discipline network connections. Benefits and challenges of this program carry implications for the design of future nursing research training programs in the field of substance abuse and addictions.

School difficulties and co-occurring health risk factors: substance use, aggression, depression, and suicidal behaviors.

PROBLEM: Effective prevention requires understanding vulnerable populations, early signs of health risks, and the impact of social contexts. We tested a model of co-occurring mental health risks among at-risk youth experiencing school difficulties. METHODS: We analyzed data from a random sample of 336 at-risk youth, grades 9-12, who completed a comprehensive risk/protective factors assessment. FINDINGS: Simultaneously controlling for correlations among health risks, we observed systematic associations among risk factors, with generally consistent patterns for males and females. CONCLUSIONS: The findings underscore the importance of developing interventions that incorporate contextual influences and of identifying common adaptable strategies for attenuating co-occurring health risks for at-risk youth.

Testing a model of depression among Thai adolescents.

PROBLEM: This predictive correlational study was designed to test a comprehensive model of depression for Thai adolescents. METHODS: This sample included 800 high school students in Chiang Mai, Thailand. Data were collected using self-reported measures of depression, negative automatic thoughts, effective social problem solving, ineffective social problem solving, rumination, parental care, parental overprotection, and negative life events. FINDINGS: Structural equation modeling revealed that negative automatic thoughts, effective and ineffective social problem solving mediated the effects of rumination, negative life events, and parental care and overprotection on adolescent depression. CONCLUSION: These findings provide new knowledge about identified factors and the mechanisms of their influence on depression among Thai adolescents, which are appropriate for targeting preventive interventions.

Distinct Stress and Resource Profiles Among At-Risk Adolescents: Implications for Violence and Other Problem Behaviors.

This study tests for the presence of subgroups among youth at-risk for school drop-out and whether those groups differ on levels of violence and related problem behaviors. Latent profile analysis was employed with a diverse adolescent sample (N = 849) to identify and describe subgroups based on assessment of stress and coping resources, resulting in four distinct groups: Low Risk, Unprotected, Risk Only, and High Risk. Tests across these groups demonstrated significant heterogeneity in violent behaviors, substance use, and school disengagement. The value of stress and protective resource assessment and tailoring interventions to meet the differing needs of vulnerable youth is discussed.

Multi-Domain Risk and Protective Factor Predictors of Violent Behavior among At-risk Youth.

This study extends prior examination of adolescent violence etiology, drawing on an ethnically diverse, community accessed, yet emotionally vulnerable sample (N = 849) of adolescents at-risk for school drop-out. A balanced risk and protective factor framework captured theorized dimensions of strain, coping, and support resources. We tested the combined and unique contribution of risk and protective components spanning individual, peer/school, and family predictor domains, including victimization histories. Hierarchical regressions yielded significant overall explanation of violent behaviors as well as unique predictors within each of the three domains. Tests for sex differences and moderating effects suggested that levels of risk and protective factors differed for males and females, although the functional relationships to violence were the same for both sexes. Results are discussed relative to prevention and early intervention programs; particularly the importance of understanding adolescent violent behaviors within a context that addresses stress and distress.