Measurement invariance of the Grief Facilitation Inventory with respect to youth gender, race, ethnicity, and age.

The Grief Facilitation Inventory (GFI) assesses caregiver grief facilitation behaviors among bereaved youth. Initial analyses supported the GFI's reliability and validity. The purpose of this study was to evaluate measurement invariance of the GFI across gender, race/ethnicity, and age. Participants were 558 clinic-referred youth aged 7-18 (58.8% female; 43.6% Latino(a), 24.9% White, 14.9% Black, 16.6% Multiracial). Multigroup confirmatory factor analyses provided evidence of measurement invariance for ongoing connection, caregiver grief expression, and existential continuity and support-but not grief inhibition/avoidance-across subgroups. Results suggest that ongoing connection, caregiver grief expression, and existential continuity and support are measuring similar constructs, to a similar degree, across demographics, thereby supporting generalizability and clinical utility of these subscales. The grief inhibition/avoidance subscale should be used with caution and interpreted in the context of low reliability for Black, Latino(a), and younger youth, with further research needed to improve conceptualization and measurement of this subscale.

Protective Factors in the Context of Childhood Bereavement: Youth Gratitude, Future Orientation, and Purpose in Life.

The objective of the study was to examine potential associations between positive youth development constructs (gratitude, future orientation, purpose in life) and psychological functioning (posttraumatic stress symptoms, depressive symptoms, maladaptive grief reactions) among bereaved youth and test whether these associations vary by age. A diverse sample of 197 clinic-referred bereaved youth (56.2% female; M = 12.36, SD = 3.18; 36.1% Hispanic, 23.7% White, 20.1% Black, 11.9% Multiracial, and 8.2% another race/ethnicity) completed self-report measures of psychological functioning and positive youth development constructs. Linear regression models indicated that gratitude and purpose were associated with lower posttraumatic stress and depressive symptoms among bereaved youth. Future orientation was associated with higher posttraumatic stress symptoms. Results were consistent across age. If replicated longitudinally, gratitude and purpose may be important protective factors against negative mental health outcomes in the aftermath of losing a loved one.

Caregiver behaviors associated with positive youth development among bereaved children.

Grounded in Multidimensional Grief Theory, this study examined the cross-sectional associations between child-reported caregiver grief facilitation behaviors (ongoing connection, grief expression, existential continuity and support, grief inhibition/avoidance) and positive youth development outcomes (future orientation, gratitude, social responsibility) in treatment-seeking bereaved children ages 7 to 18 (N = 170; 54.1% girls; 35.9% Hispanic/Latinx, 24.9% White, 17.8% Black) from the United States. Results indicate that higher levels of perceived caregiver existential continuity and support (behaviors theorized to promote the continuity of child routines and reassurance of a positive future after experiencing a death) were associated with greater future orientation and social responsibility values among participants. Findings suggest that in the wake of a death, structured and supportive caregiver responses may be related to children's positive outlook on their future and commitment to others.

Validation of the four-item very brief University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index screening tool for children and adolescents.

OBJECTIVE: Experiencing traumatic events places children and adolescents at risk for developing posttraumatic stress disorder (PTSD), often leading to adverse mental health consequences. Although well-validated measures of PTSD are available, very brief screening tools are needed to assess PTSD when resources are limited. This study was conducted to develop and validate the four-item University of California at Los Angeles (UCLA) PTSD Reaction Index for DSM-5-Very Brief Form (RI-5-VBF) to be used in settings requiring rapid and efficient screening. METHOD: Item response theory (IRT) models were used to derive RI-5-VBF scores from the UCLA PTSD Reaction Index for DSM-5 and assess its internal consistency using a sample of 1,785 youth (Mage = 12.32 years, SD = 2.78) seeking support at an academic medical center clinic or bereavement center. Receiver operating characteristic (ROC) analyses and diagnostic efficiency statistics were used to assess discriminant groups validity and screening utility of the RI-5-VBF scores. Differential item functioning (DIF) analyses were used to examine possible bias across age, gender, race, ethnicity, and clinical setting versus bereavement center setting. RESULTS: IRT models identified four items with the highest discrimination within each PTSD subscale. The RI-5-VBF scores exhibited acceptable internal consistency (α = .74). ROC analyses indicated that an RI-5-VBF score of 9 maximized sensitivity and specificity. DIF analyses did not find evidence of bias across age, gender, race, ethnicity, or clinical versus bereavement center settings. CONCLUSION: These findings provide support for the reliability and validity of the RI-5-VBF. Findings highlight the utility of the RI-5-VBF as a brief screening measure for PTSD in children and adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Identity-based bullying and mental health among Black and Latino youth: The moderating role of emotional suppression.

The current study examined the prevalence of identity-based bullying, the unique links between identity-based bullying and mental health (i.e., depressive and posttraumatic stress symptoms [PTSS]), and emotional suppression as a potential moderator of these links. Participants were 899 clinic-referred Black and Latino youth aged 7-18 years (M = 13.37 years, SD = 2.75, 60.8% female). Regression analyses indicated youth who experienced identity-based bullying victimization reported worse depressive symptoms and PTSS, controlling for co-occurring trauma exposure and demographic characteristics. We did not find evidence that emotional suppression moderated these associations. The findings highlight the potentially traumatic nature of identity-based bullying victimization in treatment-seeking Black and Latino youth and speak to the need for identity-based bullying risk screening.

Prevalence and correlates of externalizing behaviors among youth seeking treatment following trauma exposure.

OBJECTIVE: Trauma-exposed youth often experience impairing externalizing problems (EXTs), yet the relationship between EXTs, trauma exposure, and posttraumatic stress symptoms (PTSS) are not well understood. To examine the extent of their co-occurrence, we report the rates and correlates of youth EXTs relative to clinically elevated PTSS in a sample of youth referred to a trauma and grief specialty clinic. METHOD: Self- and caregiver-report measures were obtained from 260 youth ages 7-19 years (M = 11.92, SD = 3.21; 53.5% female) during a pretreatment assessment. The sample was divided into 4 groups according to the youths' PTSS and EXT score elevations, and these groups were then compared according to rates of youth depressive symptoms, youth suicidal ideation, and caregiver strain. RESULTS: The 4 groups were comorbid PTSS and EXTs (18%); EXTs-only group (36%); PTSS-only group (13%), and subclinical symptom group (34%). The comorbid PTSS and EXTs group had the highest scores on all other child and caregiver symptom measures. Compared to the subclinical group, youth in the PTSS-only group had increased depressive symptoms and suicidal ideation, whereas youth in the EXTs-only group had elevated levels of caregiver strain. CONCLUSION: Co-occurring PTSS and EXTs is a common presentation among trauma-exposed youth referred to treatment. These youth are also likely to suffer from other problems of clinical concern, including suicidal ideation, and their problems are associated with caregiver distress. More research is needed to examine unique risk and resiliency factors related to the development of youth EXTs in response to trauma exposure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Developmental Manifestations of Grief in Children and Adolescents: Caregivers as Key Grief Facilitators.

The death of a loved one represents one of the most distressing and potentially traumatic life events in childhood and adolescence. Grief reactions in youth are influenced by ongoing developmental processes and manifest differently depending on the child's age and developmental stage. These grief-related processes unfold within youths' caregiving context, as children and adolescents rely heavily on the adults in their environment to navigate and cope with the death of a loved one. Despite the field's increasing recognition of the potential for maladaptive grief reactions to impede functioning over time, few longitudinal research studies on childhood grief currently exist. In this article, we will (a) provide a brief overview of the childhood bereavement literature; (b) review the new DSM-5 and ICD-11 Prolonged Grief Disorder diagnostic criteria through a developmentally-informed lens; (c) describe how grief reactions manifest in children and adolescents of different ages through the lenses of multidimensional grief theory and relational developmental systems theory; (d) highlight key moderating factors that may influence grief in youth, and (e) discuss a primary moderating factor, the caregiving environment, and the potential mechanisms through which caregivers influence children's grief.

Addressing grief reactions among incarcerated adolescents and young adults using trauma and grief component therapy.

OBJECTIVE: To determine whether male adolescents incarcerated in a juvenile justice facility would participate in and benefit from a grief-focused, evidence-based group treatment program. Few studies have examined the effectiveness of evidence-based, grief focused treatments for incarcerated adolescents, although these youths are reported to experience higher rates of bereavement than those in the general population. METHOD: Between 2015 and 2020, 63 male adolescents incarcerated at a secure correctional facility in the midwestern United States received group treatment for symptoms of maladaptive grief using an evidenced-based intervention called Trauma and Grief Component Therapy for Adolescents (TGCTA; Saltzman et al., 2017). Data collection before and after treatment included a brief screening measure, demographic information on each youth, and the Persistent Complex Bereavement Disorder (PCBD) Checklist, scored according to multidimensional grief theory (Layne et al., 2017). RESULTS: Mean PCBD grief domain scores decreased significantly for separation distress and circumstance-related distress from baseline to after TGCTA (Layne et al., 2014) group participation. After group completion, the association between PCBD grief symptoms and functional impairment was unchanged in the family domain, decreased in the school domain, and increased in the peers/friends domain. In the 5- to 15-week period after the group versus the 5- to 15-week period before the group, there was a 50% reduction in the number of behavioral incident reports involving TGCTA group participants, while 63 matched control participants had no change in behavioral incident reports. CONCLUSION: Study findings demonstrate the feasibility of treating maladaptive grief with youths in the juvenile justice system and provide preliminary evidence that grief-focused treatment may reduce maladaptive grief symptoms and improve behavioral functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Siblings' experience during pediatric intensive care hospitalization.

PURPOSE: The impact on children who visit an ill sibling in the pediatric intensive care unit (PICU) is unknown. The aim of this study was to describe the experiences of siblings of acutely critically ill or injured children hospitalized in the PICU. DESIGN AND METHODS: A qualitative approach using one-to-one interviews was conducted to gain an understanding of the experience of 9- to 17-year-old children who visited their siblings in the PICU. Thematic analysis was used to develop a description of the experiences of the siblings. FINDINGS: Sixteen siblings (mean age, 12.5 years) indicated that visiting their critically ill sister or brother in the PICU can cause negative reactions. The data revealed two major themes within the overall sibling experience-stressors, coping-and nine subthemes. Predominant sibling stressors included pre-illness stressors, the PICU environment, the appearance of the ill child, uncertainty, and parental stress. Siblings coped mainly via distractions, social support, and spirituality and by reflecting on the sibling relationship. Support from friends, family members, and the community was reported to be helpful. CONCLUSIONS: Siblings visiting the PICU may experience a broad range of physical, emotional, and social responses. PRACTICE IMPLICATIONS: Future research should fully incorporate the sibling perspective when designing interventions to mitigate the potentially distressing effects of PICU visitation on the family.

Caregiver behaviors and childhood maladaptive grief: Initial validation of the Grief Facilitation Inventory.

The Grief Facilitation Inventory (GFI) is a newly-developed measure of caregiver behaviors theorized to facilitate or hinder children's adaptive grief reactions. We examine its factor structure, reliability, and validity. An exploratory factor analysis identified four factors: Ongoing Connection, Existential Continuity/Support, Caregiver Grief Expression, and Grief Inhibition/Avoidance. Both child- and caregiver-report versions had adequate-to-good internal consistency. The child-report GFI showed evidence of criterion-referenced validity via significant correlations with measures of child maladaptive grief and other psychological symptoms. Results provide preliminary evidence of the reliability, validity, and clinical utility of the GFI as a measure of caregiver grief-facilitation behaviors.

Racial, ethnic, and neighborhood income disparities in childhood posttraumatic stress and grief: Exploring indirect effects through trauma exposure and bereavement.

Previous findings suggest that experiences with systems of oppression that disproportionately affect individuals based on race and neighborhood residency (e.g., systemic racism, neighborhood income disadvantage [NID]) can be associated with higher odds of developing psychological problems following traumatic events. Although race/ethnicity and NID residency are often associated, they are separate concepts that play unique roles in mental health outcomes among youth. Residents of Black, Latinx, and income-disadvantaged communities also have an increased risk of exposure to polyvictimization and the loss of multiple loved ones. Studies have not carefully delineated the potential relations between race/ethnicity and NID residency, polyvictimization, accumulated losses, and trauma and grief outcomes in youth. We examined mediation models to investigate whether polyvictimization, the loss of multiple loved ones, and exposure to violent death were potential mechanisms through which race/ethnicity and NID would predict trauma and grief outcomes in youth. Participants (N = 429) included Black (19.9%), Latinx (36.0%), and White (27.3%) children and adolescents who were assessed through a routine baseline assessment at a trauma and grief outpatient clinic. Black youth reported significantly elevated posttraumatic stress and maladaptive grief symptoms through higher polyvictimization and violent death exposure relative to White youth, ßs = .06-.12, ps <.001. Latinx identity and NID were positively and directly associated with specific domains of maladaptive grief reactions, ßs = .10-.17, ps < .001. If replicated longitudinally, these findings suggest that polyvictimization and violent death exposure may be mechanisms through which Black youth develop more severe traumatic stress and grief reactions.

Geospatial identification of high youth suicide risk areas via electronic health records: Avenues for research and prevention efforts.

OBJECTIVE: As suicide risk screening becomes more common in healthcare settings, geospatial coding of behavioral health data may offer a means for identifying areas of elevated suicide risk for use in public health prevention efforts. The present study demonstrates an analytic approach for using universal suicide risk screening data to identify areas of elevated suicide risk. METHOD: Data were drawn from standard suicide risk screens recorded in electronic health records of a large pediatric emergency department. A total of 12,400 suicide risk screening responses were recorded, among youth aged 11-19 years (mean = 14.60, SD = 2.16; 57.2% girls, 47.8% Hispanic/Latinx, 72.1% White). A total of 86 unique ZIP codes had at least 50 completed screens, representing 9139 respondents. RESULTS: Rates of positive screens ranged from 6.17% to 31.03% (mean = 18.33, SD = 5.14) for any suicide-related behavior and from 0.0% to 19.61% (mean = 9.14, SD = 3.43) for suicide attempt. Rates of positive screens approximated a normal distribution. CONCLUSIONS: Results demonstrated several areas with elevated rates of positive suicide risk screens, within the hospital catchment area. The proposed method capitalizes on large-scale screening data, provides an estimate of areas of relative increased risk, and may be used to inform public health responses to suicide prevention.

Identifying Bereavement-Related Markers of Mental and Behavioral Health Problems Among Clinic-Referred Adolescents.

Objective: This study examined bereavement-related risk markers (number of deaths, cause of death, and relationship to deceased) of mental and behavioral health problems (suicidal thoughts or behaviors, self-injury, depression, posttraumatic stress, and substance use) in a national sample of clinic-referred bereaved adolescents. Method: Participants included 1281 bereaved youth aged 12-21 years (M=15, SD=1.8; 62.1% female), from the National Child Traumatic Stress Network Core Data Set. Results: Generalized linear mixed-effects regression models controlling for demographics and other traumas revealed that youth bereaved by multiple deaths had higher posttraumatic stress scores than youth bereaved by a single death (Estimated difference ±SE=3.36 ± 1.11, p=0.003). Youth bereaved by suicide were more likely to report experiencing suicidal thoughts or behaviors (AOR=1.68, p=0.049) and alcohol use (AOR=2.33, p<0.001) than youth bereaved by natural causes. Youth bereaved by homicide were at greater risk for substance use than youth bereaved by natural death (AOR=1.76, p=0.02). Compared to parentally bereaved youth, youth who lost a peer were more likely to use alcohol (AOR=2.32, p=0.02) or other substances (AOR=2.41, p=0.01); in contrast, parentally bereaved youth were more likely to experience depression compared to those who experienced the death of an adult relative or unrelated adult (range of AOR: 0.40 to 0.64, p-values<0.05). Conclusion: These bereavement-related contextual factors can serve as early markers of mental and behavioral health problems among bereaved youth.

Supporting children and adolescents following parental bereavement: guidance for health-care professionals.

Death of a parent in childhood and adolescence is a distressing life event. Childhood grief reactions are distinct from those in adults, and are affected by developmental and contextual factors such as age of the child and changes in caregiving environments. Following parental bereavement, children and adolescents face unique emotional and behavioural challenges, and are susceptible to several adverse biopsychosocial outcomes. Empirically supported interventions can help young people to navigate the many grief-related challenges, and the core treatment components include grief psychoeducation, building emotion identification and regulation skills, cognitive coping and restructuring, grief and trauma processing, memorialising and continuing bonds, meaning making, involvement of caregivers in grief treatment, and future planning. Health-care professionals often interact with children and adolescents following bereavement; therefore, it is important they have the foundational knowledge and skills to communicate effectively about the death, recognise and normalise different ways grief can manifest across development, and support surviving caregivers in facilitating adaptive grief in their children.

Performance of the interpersonal needs questionnaire in adolescent clinical samples: Confirmatory factor analyses and evaluation of measurement invariance.

OBJECTIVE: This study evaluated the factor structure, internal consistency reliability, construct and criterion validity, and measurement invariance of the Interpersonal Needs Questionnaire (INQ) among adolescents. METHOD: Participants (N = 539) included three distinct samples of youth drawn from two outpatient psychology clinics and an inpatient psychiatric unit. The combined sample was 63.3% female and had a mean age of 14.95 years (SD = 1.31 years). All participants completed the INQ as well as measures of depressive symptoms and suicide ideation. RESULTS: Confirmatory factor analyses indicated that the removal of three items from the thwarted belongingness subscale of the INQ was needed to achieve acceptable model fit. The resulting combined 12-item scale demonstrated good factor structure, internal consistency reliability, construct validity, and criterion validity. The modified 12-item INQ also demonstrated scalar invariance across subgroups defined by sex, race, and age. CONCLUSIONS: Findings support the use of this reduced 12-item version of the INQ among adolescents. Youth may have difficulty accurately responding to changes in item valence; thus, future research with youth should consider using a 12-item version of the INQ that avoids valence changes within subscales.

Suicide Safety Planning: Clinician Training, Comfort, and Safety Plan Utilization.

Extant literature has demonstrated that suicide safety planning is an efficacious intervention for reducing patient risk for suicide-related behaviors. However, little is known about factors that may impact the effectiveness of the intervention, such as provider training and comfort, use of specific safety plan elements, circumstances under which providers choose to use safety planning, and personal factors which influence a provider's decision to use safety planning. Participants were (N = 119) safety plan providers who responded to an anonymous web-based survey. Results indicated that most providers had received training in safety planning and were comfortable with the intervention. Providers reported that skills such as identifying warning signs and means safety strategies were routinely used. Providers who reported exposure to suicide were more likely to complete safety plans with patients regardless of risk factors. In addition, almost 70% of providers indicated a need for further training. These data provide important considerations for safety plan implementation and training.

Measurement Invariance of the Persistent Complex Bereavement Disorder Checklist With Respect to Youth Gender, Race, Ethnicity, and Age.

The Persistent Complex Bereavement Disorder (PCBD) Checklist was constructed to facilitate the developmentally sensitive assessment of proposed PCBD criteria in bereaved children and adolescents 8-18 years of age. Initial analyses of the PCBD Checklist provided support for the hypothesized two-factor model. The purpose of the present study was to evaluate the measurement invariance of the PCBD Checklist with respect to gender (boys and girls), race/ethnicity (White, Black, and Hispanic youth), and age (school age, preadolescent, and adolescent youth). Participants were 594 youth (50.4% female) aged 7-18 years (M = 11.91, SD = 2.80) who were evaluated as part of standard care at a community-based grief support center. Youth self-identified as Hispanic (n = 184, 30.8%), non-Hispanic white (n = 179, 30.0%), and African American/Black (n = 136, 22.8%). A series of stepwise, multigroup confirmatory factor analyses provided evidence in support of the PCBD Checklist's measurement invariance for all three groups concerning configural invariance, metric invariance, and scalar invariance. These results suggest that PCBD Checklist Criterion B and C scores are measuring similar latent variables, to a similar degree, across gender, race/ethnicity, and age. Establishing the cross-group equivalence of the PCBD Checklist is an important endorsement of its generalizability and clinical utility in that it can be administered to diverse populations with confidence that it is measuring proposed PCBC diagnostic criteria similarly across subgroups.

Initial Validation and Measurement Invariance of the Active Inhibition Scale Among Traumatized and Grieving Youth.

The Active Inhibition Scale (AIS; Ayers, Sandler, & Twohey, 1998) is an 11-item, self-report measure of emotional suppression among children and adolescents. Previous research with the AIS has linked emotional suppression to several clinically significant outcomes, such as posttraumatic stress symptoms (PTSS) and suicide, among trauma-exposed and bereaved youth; however, there are no published evaluations of its psychometric properties. We examined the factor structure and criterion validity of the AIS in two samples. Sample 1 included youth (M = 12.22 years, SD = 2.96, range: 6-18 years; 55.4% female) referred to an outpatient psychology clinic specializing in childhood trauma and grief. Sample 2 included youth (M = 13.18 years, SD = 2.58, range: 8-18 years; 61.8% female) referred to a community grief counseling center. Confirmatory factor analytic results supported a one-factor solution, Cronbach's α = .94. Additionally, AIS scores correlated positively with PTSS, depression, and maladaptive grief, rs = .43-.64. Evidence of factorial invariance was found across gender, race/ethnicity, and age group. Emotional suppression scores were higher among girls compared to boys, Black and Hispanic youth compared to White youth, and older compared to younger age groups. The magnitude of correlations between AIS and symptom measure scores was comparable across groups. These results support the reliability and criterion validity of the AIS with diverse youth populations and underscore the role that emotional suppression may play in explaining group differences in mental health symptoms.

Associations between dimensions of religiousness and psychosocial functioning among bereaved youth.

Using a sample of recently bereaved youth (N = 2,425; Mage = 15.31, SD = 1.50), this study examined associations between dimensions of religiousness and current functioning. Youth reported on their religious service attendance, religious coping, and the importance of religious beliefs and substance use, academic achievement, depressive symptoms, and self-esteem. Greater religious service attendance was associated with lower substance use and the greater importance of religious beliefs was associated with lower substance use and greater self-esteem. Greater religious coping was associated with greater academic achievement. Findings suggest distinct dimensions of religiousness may have differential implications for adolescent functioning after experiencing loss.

Historical Trends in Concerns About Social Issues Across Four Decades Among U.S. Adolescents.

This study examined adolescents' concerns about social issues and how these concerns have changed over historical time. Separate cohorts of U.S. high school seniors (N = 110,953; 51.1% female) reported their worries about four social issues (crime/violence, economic problems, hunger/poverty, race relations) every year from 1976 to 2015. Youth were most concerned with crime/violence, followed by economic problems, hunger/poverty, and race relations. Adolescents' social concerns varied by demographic characteristics and cohort, paralleling specific historical events and appearing responsive to the political challenges of the time. Initiatives seeking to engage youth within the political process may benefit from providing opportunities for teens to participate in civic activities aimed to address these issues.