Gender Minority Stress and Resilience Measure: A Meta-Analysis of the Associations with Mental Health in Transgender and Gender Diverse Individuals.

Transgender and gender diverse (TGD) individuals are more likely to experience mental health difficulties than cisgender individuals due to unique stressors related to their stigmatized gender identity and/or expression. This meta-analysis examined the associations between gender minority stressors and resilience factors, as measured by the Gender Minority Stress and Resilience Measure (GMSR; Testa et al., 2015), and two types of mental health symptoms (i.e., depression and anxiety). A comprehensive literature search and study inclusion process following PRISMA guidelines identified 69 sources, representing 47 unique samples. Mean effect sizes revealed significant positive associations between all GMSR minority stress subscales and anxiety and depression symptoms (rs = .22 to .40) with larger correlations for proximal stressors compared to distal stressors. The GMSR resilience subscales were significantly negatively correlated with anxiety and depression symptoms (rs = -.07 to -.16). These findings highlight the robust relationship between gender minority stressors and mental health symptoms among TGD individuals and indicate a need for addressing these stressors both by reducing exposure to external stressors and by addressing the internalization of those stressors in clinical settings. The small effects for the resilience subscales suggest a need to examine additional resilience factors that may be more pertinent to mental health among TGD individuals.

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).

Comfort Expressing Emotions and Suicide Ideation: Evidence of Indirect Effects Via Perceived Burdensomeness and Thwarted Belongingness.

OBJECTIVE: Emotion regulation strategies and related constructs have been implicated both as risk and protective factors in a range of mental health outcomes among young adults. To expand upon this previous research, we examined comfort expressing four discrete emotions (i.e., love, happiness, sadness, and anger) as factors that protect against suicide ideation in young adults, within the context of the interpersonal theory of suicide. METHOD: The sample consisted of 449 college students (73.1% female, 70.6% Hispanic, Mage = 20.5 years) taking part in a larger study of mood and well-being. Students were recruited from a psychology participant pool and completed self-report measures at a single time point for course credit. Comfort expressing emotions and suicide ideation were assessed using the Measure of Verbally Expressed Emotion (MoVEE) and Adult Suicidal Ideation Questionnaire (ASIQ), respectively. Perceived burdensomeness and thwarted belongingness were assessed using the Interpersonal Needs Questionnaire (INQ). RESULTS: Preliminary analyses revealed negative associations between comfort expressing all four emotions and suicide ideation (rs = -.13 to -.26). Results from structural equation modeling supported indirect effects from comfort expressing happiness and sadness to suicide ideation, via perceived burdensomeness and thwarted belongingness. An indirect effect was also identified from comfort expressing love to suicide ideation, via thwarted belongingness. CONCLUSIONS: Results suggest that comfort expressing emotions (particularly sadness and happiness) is a protective factor against suicide ideation for young adults. These findings suggest that suicide-prevention efforts may wish to focus on increasing comfort expressing emotions to trusted support networks as potential intervention targets.HIGHLIGHTSComfort expressing emotions is negatively associated with suicide ideation.Comfort expressing emotions is associated with belongingness and burdensomeness.Comfort expressing emotions may be a potential target for suicide prevention.

Substance Use Outcomes from Two Formats of a Cognitive-Behavioral Intervention for Aggressive Children: Moderating Roles of Inhibitory Control and Intervention Engagement.

Although cognitive-behavioral interventions have reduced the risk of substance use, little is known about moderating factors in children with disruptive behaviors. This study examined whether aggressive preadolescents' inhibitory control and intervention engagement moderates the effect of group versus individual delivery on their substance use. Following screening for aggression in 4th grade, 360 children were randomly assigned to receive the Coping Power intervention in either group or individual formats. The sample was primarily African American (78%) and male (65%). Assessments were made of children's self-reported substance use from preintervention through a six-year follow-up after intervention, parent-reported inhibitory control at preintervention, and observed behavioral engagement in the group intervention. Multilevel growth modeling found lower increases in substance use slopes for children with low inhibitory control receiving individual intervention, and for children with higher inhibitory control receiving group intervention. Children with low inhibitory control but who displayed more positive behavioral engagement in the group sessions had slower increases in their substance use than did similar children without positive engagement. Aggressive children's level of inhibitory control can lead to tailoring of group versus individual delivery of intervention. Children's positive behavioral engagement in group sessions is a protective factor for children with low inhibitory control.

Effects of Autonomic Nervous System Functioning and Tornado Exposure on Long-Term Outcomes of Aggressive Children.

This study examined whether pre-disaster indicators of sympathetic and parasympathetic activity moderated the relation between degree of disaster exposure from an EF-4 tornado and changes in the externalizing and internalizing behavior problems of children at-risk for aggression. Participants included 188 children in 4th-6th grades (65% male; 78% African American; ages 9-13) and their parents from predominantly low-income households who were participating in a prevention study when the tornado occurred in 2011. Fourth-grade children who exhibited elevated levels of aggressive behavior were recruited in three annual cohorts. Parent-rated externalizing and internalizing problems were assessed prior to the tornado (Wave 1; W1), and at 4-12 months (W2), 16-24 months (W3), 42-28 months (W4) and 56-60 months (W5) post-tornado. Children's pre-tornado Skin Conductance Level (SCL) reactivity and Respiratory Sinus Arrhythmia (RSA) withdrawal were assessed at W1 using SCL and RSA measured during resting baseline and during the first 5 min of the Iowa Gambling Task (IGT). Children and parents reported their exposure to tornado-related trauma and disruptions at Wave 3. Children displayed less reduction in externalizing problems if there had been higher child- or parent-reported tornado exposure and less RSA withdrawal, or if they had lower parent-reported TORTE and less SCL reactivity or lower SCL baseline. Highlighting the importance of children's pre-disaster arousal, higher levels of disaster exposure negatively affected children's level of improvement in externalizing problems when children had less vagal withdrawal, and when tornado exposure disrupted the protective effects of higher SCL reactivity and higher SCL baseline.

The Effects of Polyvictimization on Mental and Physical Health Outcomes in an LGBTQ Sample.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are at elevated risk for violent victimization and often experience increased health disparities compared to their non-LGBTQ counterparts. The present study examined associations between polyvictimization and mental and physical health in an LGBTQ sample. Participants included 385 LGBTQ individuals involved in a larger health-needs assessment of LGBTQ individuals living in the southeastern United States. The sample primarily identified as gay/lesbian (63.4%), cisgender (78.7%), and White (66.5%), and the mean participant age was 34.82 years (SD = 13.45). A latent class analysis (LCA) was conducted on seven items assessing different types of violence exposure. The LCA identified a three-class model, with classes characterized by low trauma exposure (71.4%), nondiscriminatory violence (15.1%), and high trauma exposure (13.5%). Differences in demographic characteristics, perceptions of mental and physical health, and diagnoses of specific health conditions were assessed across classes. The high-trauma class reported poorer perceived physical and mental health compared to the other two classes, with mean differences in past-month poor health days ranging from 11.38 to 17.37. There were no differences between the classes regarding specific physical health conditions; however, the high-trauma and nondiscriminatory violence classes had significantly higher rates of anxiety, depression, drug abuse, and suicidality than the low-trauma class, ORs = 2.39-23.83. The present findings suggest that polyvictimization is an important risk factor for poor health among LGBTQ individuals. These results have implications for addressing health disparities among the broader LGBTQ community.

Effects of a universal prevention program on externalizing behaviors: Exploring the generalizability of findings across school and home settings.

Universal prevention approaches have significantly reduced children's conduct problems and aggressive behavior in the school setting, but it has not been clear whether the effects generalize into children's behavior in home and community settings in later elementary school years. The present study examined this issue using a classroom-randomized design, with 1030 students in 70 fourth and fifth grade Italian classes. The intervention model is the Coping Power Universal and the classroom teachers delivered it. Coping Power Universal produced a significant reduction in both parents' and teachers' rated conduct problems, relative to control classes, indicating that universal prevention can produce significant reductions in children's conduct problems that generalize into the home and community settings. The intervention also increased children's prosocial behaviors in school and home settings. The Coping Power Universal is a short intervention model that is believed to be a useful strategy for children's behavioral problems in the broad population.

Trajectories of tornado-related posttraumatic stress symptoms and pre-exposure predictors in a sample of at-risk youth.

OBJECTIVE: The current study examined how severity of disaster exposure and predisaster individual and family characteristics predicted trajectories of disaster-related posttraumatic stress symptoms (PTSS) in children over 4 years following a devastating EF-4 tornado. METHOD: Participants (n = 346; 65% male; 77.5% African American) were 4th-6th-graders and their caregivers, from predominantly low-income households, who were already participating in a longitudinal study of indicated prevention effects for externalizing outcomes when the tornado occurred in 2011. Latent class trajectory analyses were used to identify disaster-related PTSS trajectory groups across the 4-year postdisaster period. RESULTS: Three groups were identified: (1) a group that declined (recovery) in PTSS over time (15.90%); (2) a group that was stable and low in PTSS over time (76.87%); and (3) a group that was stable and high (chronic) in PTSS over time (7.23%). Multinomial logistic regression analyses revealed that greater tornado exposure predicted membership in the declining trajectory group relative to the low-stable group. Positive parenting and pretornado caregiver trauma exposure also moderated how disaster exposure, particularly perceived life threat, predicted PTSS trajectories. CONCLUSIONS: Some youth reported elevated disaster-related PTSS repeatedly for 4 years following a devastating tornado. Consistent with the concept of equifinality, results suggest that there are several pre-exposure risk factors that may increase risk for a chronic PTSS trajectory following disaster exposure. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Group versus individual format of intervention for aggressive children: Moderators and predictors of outcomes through 4 years after intervention.

This study originated in collaboration with Thomas Dishion because of concerns that a group format for aggressive children might dampen the effects of cognitive-behavioral intervention. Three hundred sixty aggressive preadolescent children were screened through teacher and parent ratings. Schools were randomized to receive either an individual or a group format of the child component of the same evidence-based program. The results indicate that there is variability in how group-based cognitive-behavioral intervention can affect aggressive children through a long 4-year follow-up after the end of the intervention. Aggressive children who have higher skin conductance reactivity (potentially an indicator of poorer emotion regulation) and who have a variant of the oxytocin receptor gene that may be associated with being hyperinvolved in social bonding have better outcomes in their teacher-rated externalizing behavior outcomes over time if they were seen individually rather than in groups. Analyses also indicated that higher levels of the group leaders' clinical skills predicted reduced externalizing behavior problems. Implications for group versus individual format of cognitive-behavioral interventions for aggressive children, and for intensive training for group therapists, informed by these results, are discussed.

Cognitive Behavioral Intervention for Youth at Risk for Conduct Problems: Future Directions.

This article briefly overviews the history of cognitive behavioral intervention (CBI) for children displaying early signs, or actual diagnoses, of conduct disorders. A series of randomized control trials have identified evidence-based CBI programs for children with these behavior problems at various developmental stages from preschool through adolescence. Although it is critically important for the field to disseminate these existing programs as developed, we argue that it is important to also move beyond the existing evidence-based programs. Research should continue to test new comprehensive, multicomponent interventions, fueled by our evolving understanding of active mechanisms that contribute to children's externalizing behavior problems. The future of research in this area can also benefit from a focus on four central issues. First, research can address how single interventions can have meaningful impact on a range of transdiagnostic outcomes because the intervention mechanisms may affect those various outcomes. Second, rooted in implementation science, we are beginning to understand better how evidence-based programs can be disseminated in the real world, examining key issues such as the adequacy of training approaches and the role of therapist and organizational characteristics. Third, a major focus of research can be on how to optimize intervention outcomes, including a focus on microtrials, on tailoring of interventions, on examining rigorously how interventions are delivered, and on the integration of technology and of other approaches such as mindfulness training into CBI. Fourth, research can explore how the therapeutic relationship and the therapists' characteristics can play substantial roles in effective CBI with conduct problem children.

Toward Tailored Interventions: Sympathetic and Parasympathetic Functioning Predicts Responses to an Intervention for Conduct Problems Delivered in Two Formats.

Coping Power is an evidence-based preventive intervention for youth with aggressive behavior problems that has traditionally been delivered in small group formats, but because of concerns about potentially diminished effects secondary to aggregation of high-risk youth, an individual format of Coping Power has been developed. The current study examined whether physiological characteristics of the child may provide information about which intervention delivery format works best for that individual. Indicators of sympathetic and parasympathetic nervous system functioning were examined in 360 fourth-grade children (65% male; 76.4% self-reported African-American) who were randomly assigned to Group Coping Power (GCP) or Individual Coping Power (ICP) (Lochman et al. 2015). Longitudinal assessments of teacher- and parent-reported proactive and reactive aggression were collected through a 1-year follow-up. For children with higher initial levels of aggression, those with lower parasympathetic functioning at pre-intervention showed greater reductions in teacher-rated proactive aggression in the ICP condition than the GCP condition. For children with high parasympathetic functioning, there was no differential effect of intervention format. Regardless of intervention format, youth with lower levels of sympathetic functioning at pre-intervention demonstrated greater reductions in teacher-rated proactive aggression. These findings suggest that physiological indicators may be worth considering in future studies examining which youth respond best to specific types of interventions.

Using Early Childhood Behavior Problems to Predict Adult Convictions.

The current study examined whether teacher and parent ratings of externalizing behavior during kindergarten and 1st grade accurately predicted the presence of adult convictions by age 25. Data were collected as part of the Fast Track Project. Schools were identified based on poverty and crime rates in four locations: Durham, NC, Nashville, TN, Seattle, WA, and rural, central PA. Teacher and parent screening measures of externalizing behavior were collected at the end of kindergarten and 1st grade. ROC curves were used to visually depict the tradeoff between sensitivity and specificity and best model fit was determined. Five of the six combinations of screen scores across time points and raters met both the specificity and sensitivity cutoffs for a well-performing screening tool. When data were examined within each site separately, screen scores performed better in sites with high base rates and models including single teacher screens accurately predicted convictions. Similarly, screen scores performed better and could be used more parsimoniously for males, but not females (whose base rates were lower in this sample). Overall, results indicated that early elementary screens for conduct problems perform remarkably well when predicting criminal convictions 20 years later. However, because of variations in base rates, screens operated differently by gender and location. The results indicated that for populations with high base rates, convictions can be accurately predicted with as little as one teacher screen taken during kindergarten or 1st grade, increasing the cost-effectiveness of preventative interventions.

The Causal Influence of Perceived Social Norms on Intimate Partner Violence Perpetration: Converging Cross-Sectional, Longitudinal, and Experimental Support for a Social Disinhibition Model.

Across three studies, we develop a model of the direct and indirect paths through which the perceived prevalence (perceived descriptive norms [PDN]) of intimate partner violence (IPV) among peers may influence individuals' likelihood of engaging in IPV. Study 1 replicated and extended previous cross-sectional research by demonstrating a positive longitudinal association between PDN and subsequent IPV perpetration. Study 2 further showed the influence of PDN on IPV perpetration to be mediated through its relation to perceived peer acceptance of IPV (perceived injunctive norms [PIN]), which in turn predicted personal IPV acceptance. Study 3 built on this model using an experimental paradigm to show that increasing PDN leads to corresponding increases in PIN and, in turn, personal IPV acceptance, which both predicted IPV perpetration. Furthermore, the effects of PIN on personal IPV acceptance and IPV propensity were strongest for dominance-oriented individuals. Results bear important implications for social norms-based interventions for IPV.

Autonomic functioning in reactive versus proactive aggression: The influential role of inconsistent parenting.

Research has consistently supported autonomic nervous system (ANS) functioning as a predictor of aggressive behavior in youth. Several studies have further examined how the functioning of the sympathetic (SNS) and parasympathetic (PNS) branches of the ANS interact with environmental factors to predict behavioral outcomes. One factor that has yet to be studied in this context however, is parenting practices. Given that many interventions for externalizing behavior target parenting practices, such as increasing consistent discipline, it may be particularly important to assess whether parenting practices interact with SNS and PNS functioning in the child to influence risk for aggressive behavior. Therefore, the current study addressed this question by examining inconsistent discipline as a moderator of the relationship between baseline SNS versus PNS activity and reactive versus proactive aggression. Data were collected from a sample of fourth graders identified as at-risk for aggression (N = 188). Results indicated that baseline SNS activity was positively related to proactive aggression under high levels of inconsistent discipline, but negatively related to proactive aggression under very low levels of inconsistent discipline. Baseline PNS activity was negatively associated with reactive aggression under low levels of inconsistent discipline. No main effects were found for SNS or PNS functioning and either form of aggression, emphasizing the importance of taking a biosocial approach to examining the predictors of aggressive behavior in at-risk youth. Results from this study help to better understand the circumstances under which children are most likely to exhibit reactive versus proactive aggression, better informing targeted prevention and treatment.

Pre-Post Tornado Effects on Aggressive Children's Psychological and Behavioral Adjustment Through One-Year Postdisaster.

Using a risk-resilience framework, this study examined how varying levels of exposure to a natural disaster (EF-4 tornado) and children's characteristics (sex; anxiety) influenced the behavioral and psychological adjustment of children who shared a common risk factor predisaster (elevated aggression) prior to exposure through 1-year postdisaster. Participants included 360 children in Grades 4-6 (65% male; 78% African American) and their parents from predominantly low-income households who were already participating in a longitudinal study of indicated prevention effects for externalizing outcomes when the tornado occurred in 2011. Fourth-grade children who were screened for overt aggressive behavior were recruited in 3 annual cohorts (120 per year, beginning in 2009). Parent-rated aggression and internalizing problems were assessed prior to the tornado (Wave 1), within a half-year after the tornado (Wave 2), and at a 1-year follow-up (Wave 3). Children and parents rated their exposure to aspects of tornado-related traumatic experiences at Wave 3. Children displayed less reduction on aggression and internalizing problems if the children had experienced distress after the tornado or fears for their life, in combination with their pre-tornado level of anxiety. Higher levels of children's and parents' exposure to the tornado interacted with children's lower baseline child anxiety to predict less reduction in aggression and internalizing problems 1 year after the tornado. Higher levels of disaster exposure negatively affected at-risk children's level of improvement in aggression and internalizing problems, when life threat (parent- and child-reported) and child-reported distress after the tornado were moderated by baseline anxiety.