Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 11 de 11
Filtrar
Mais filtros

Bases de dados
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
J Subst Use Addict Treat ; 158: 209232, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38061631

RESUMO

INTRODUCTION: The Family Assessment Task (FAsTask) is an observer-rated parent-child interaction task used in adolescent substance use intervention. The parental monitoring component of the FAsTask is thought to provide an objective assessment of parental monitoring that can guide treatment planning and circumvent the potential limitations of self-report measures. Yet, the factor structure, measurement invariance, and concurrent validity of the parental monitoring FAsTask has not been evaluated; doing so is essential to effectively guide clinical care. This study examined if the parental monitoring FAsTask can be reliably administered across adolescent age and sex, and to identify which components of the parental monitoring FAsTask are most consistently associated with adolescent substance use. METHODS: The study pooled data from 388 adolescent-caregiver dyads across six separate clinical trials (adolescents [Mage = 15.7, 57.5% male, 61.9% White, 31.2% Latine]; caregivers [Mage = 42.14, 88.7% female, 72.7% White, 24.2% Latine]). Dyads completed the FAsTask and the Timeline Followback at baseline, prior to randomization. Analyses proceeded in three steps. First, exploratory factor analysis (EFA) was conducted in half of the sample, followed by a confirmatory factor analysis (CFA) in the second half of the sample. Second, measurement invariance was tested as a function of adolescent age and biological sex. Third, a series of structural equation models were used to assess the associations of each factor with alcohol use, binge drinking, and cannabis use. RESULTS: EFA and CFA indicated the presence of four factors (labeled Supervised/Structured, Active Monitoring, Task Engagement, and Parental Rules/Strategies). Evidence of measurement invariance was found across adolescent age and sex. The Supervision/Structure was negatively associated with adolescent alcohol use, binge drinking, and cannabis use. CONCLUSIONS: The parental monitoring FAsTask demonstrates validity and retains its structure across adolescent age and sex. Items focused on parental supervision and structure are most strongly associated with adolescent substance use and may best inform clinical care for adolescent substance use.


Assuntos
Consumo Excessivo de Bebidas Alcoólicas , Transtornos Relacionados ao Uso de Substâncias , Humanos , Masculino , Adolescente , Feminino , Psicometria , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Consumo de Bebidas Alcoólicas , Etanol , Pais
2.
BMC Psychiatry ; 23(1): 320, 2023 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-37147604

RESUMO

BACKGROUND: Juvenile legal involved youth (JLIY) experience disproportionately high rates of suicidal and self-injurious thoughts and behaviors (SSITB). Many JLIY lack access to evidence-based treatment specifically designed to treat SSITB, thereby increasing the overall risk of suicide. The overwhelming majority of JLIY are not placed in secure facilities and almost all incarcerated youth are eventually released to the community. Consequently, SSITB are a major concern of JLIY residing in the community and it is critical that this population has access to evidence-based treatment for SSITB. Unfortunately, most community mental health providers who treat JLIY have not been trained in evidence-based interventions that are specifically designed to SSITB, which often leads to youth experiencing prolonged periods of SSITB. Training community mental health providers who serve JLIY in the detection and treatment of SSITB shows promise for decreasing the overall suicide risk for JLIY. METHODS: The current proposal aims to reduce SSITB among JLIY, and thus reduce mental health disparities in this vulnerable and underserved youth population, by increasing access to evidence-based treatment strategies specifically designed to treat SSITB behaviors. We will implement an agency-wide training among at least 9 distinct community mental health agencies that serve JLIY referred to treatment by a statewide court system in the Northeast. Agencies will be trained in an adapted version of the COping, Problem Solving, Enhancing life, Safety, and Parenting (COPES+) intervention. Training will be implemented via a cluster-randomized stepped wedge trial that proceeds through multiple phases. DISCUSSION: This research engages multiple systems (i.e., juvenile legal and mental health systems) serving JLIY and has the potential to directly inform treatment practices in juvenile legal and mental health systems. The current protocol has significant public health implications as the primary goals are to reduce SSITB among adolescents involved in the juvenile legal system. By implementing a training protocol with community-based providers to help them learn an evidence-based intervention, this proposal aims to reduce mental health disparities in a marginalized and underserved population. TRIAL REGISTRATION: osf.io/sq9zt.


Assuntos
Comportamento Autodestrutivo , Suicídio , Humanos , Adolescente , Ideação Suicida , Área Carente de Assistência Médica
3.
Addict Behav ; 125: 107154, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34735980

RESUMO

Cannabis refusal self-efficacy, defined as confidence in the ability to refuse cannabis or to avoid cannabis use, is associated with decreased cannabis use. Juvenile justice-involved youth are at high risk for cannabis use and may have lower refusal self-efficacy. While court-involved, non-incarcerated (CINI) and incarcerated youth are groups that are both at high-risk for cannabis use, the experience of incarceration may impact the measurement of refusal self-efficacy for cannabis. The factor structure, measurement invariance, and concurrent validity of the Brief Situational Confidence Questionnaire for Cannabis (BSCQ-M) was assessed among CINI (n = 148) and incarcerated (n = 199) youth (80.7% male, Mage = 16.3). Confirmatory factor analyses indicated that a correlated 3-factor model including positive/good times, negative internal, and negative external situational factors best fit the data. Multigroup measurement invariance testing revealed that the BSCQ-M demonstrated configural, metric, scalar, and residual invariance across CINI and incarcerated samples, indicating measurement invariance across the two groups. Negative binomial regressions revealed that BSCQ-M scores were significantly negatively associated with concurrent cannabis use. Results suggest that the BSCQ-M is a brief, psychometrically sound measure of refusal self-efficacy for cannabis among juvenile justice-involved youth that can be utilized with both CINI and incarcerated youth.


Assuntos
Cannabis , Adolescente , Análise Fatorial , Feminino , Humanos , Masculino , Psicometria , Autoeficácia , Inquéritos e Questionários
4.
Acad Emerg Med ; 27(4): 283-290, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31596987

RESUMO

OBJECTIVES: In the United States, rates of teenage pregnancy and sexually transmitted infections (STIs) remain exceptionally high, and racial and ethnic disparities persist. Emergency departments (EDs) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single-center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multicenter ED data exist. The objectives of this study were to 1) determine the prevalence of sex without contraceptives in a large multicenter adolescent ED study and 2) assess patient demographic and risky behaviors associated with sex without contraceptives. METHODS: Participants aged 14 to 17 years (n = 3,247) in 16 pediatric EDs across the United States completed an electronic survey. Questions focused on validated measures of risky sex; use of alcohol, tobacco, marijuana, and other drugs; and depression and violence. In this secondary analysis, we constructed univariable and multivariable models to identify demographic and behavioral factors associated with sex without contraceptives (our primary outcome), separately for adolescent males and females. RESULTS: In the prior year, 17.4% (236/1,356) of males and 15.8% (299/1,891) of females had sex without contraceptives. In the multivariable model, sex without contraceptives for both genders was more likely among teens who were black, with conduct problems and participated in casual sex, binge drinking, or cannabis use. Sex without contraceptives was also more likely among Hispanic and cigarette-smoking males, as well as depressed females. CONCLUSIONS: Adolescent ED patients across the United States are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition. These adolescents report a number of problem behaviors, including substance use, which are strongly correlated with unprotected sex. The ED visit may be an opportunity to identify at-risk adolescent patients, address risky behaviors, and intervene to improve adolescent health.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Comportamento do Adolescente , Feminino , Humanos , Masculino , Prevalência , Assunção de Riscos , Distribuição por Sexo , Inquéritos e Questionários , Estados Unidos/epidemiologia
5.
Arch Suicide Res ; 22(4): 569-583, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29206570

RESUMO

Puerto Rican adolescents, as well as other Latinos/as, have been identified at higher risk for suicidal ideation and attempts compared to other ethnic groups. However, research designed to better understand suicidality among Puerto Rican adolescents is rare. OBJECTIVE: A socio-cognitive vulnerability model of suicidal ideation was tested in adolescents living in Puerto Rico. METHOD: Multiple group path analyses were performed to assess the effect of self-reported socio-environmental and vulnerability factors on suicidal ideation, by sex, in 233 students from the metropolitan area of San Juan, Puerto Rico. RESULTS: Overall, the model explained a large amount of the variance in suicidal ideation (r2 = .59 for females and r2 = .48 for males). Depressive symptoms had the strongest total effect on suicidal ideation for both sexes (r = .69 for females and r = .53 for males) and negative life events were the most salient socio-environmental factor. Hopelessness had a direct effect on suicidal ideation for males only. Externalizing behaviors had a direct effect on suicidal ideation for both males and females, but it was particularly strong for females. CONCLUSION: Results support the mediating role of vulnerability factors and the differential importance of socio-environmental and vulnerability factors in understanding suicidal ideation among Puerto Rican adolescents. The relevance of exploring different developmental paths to suicidal ideation, separately by sex, is discussed.


Assuntos
Comportamento do Adolescente , Depressão/diagnóstico , Ideação Suicida , Tentativa de Suicídio , Adolescente , Comportamento do Adolescente/etnologia , Comportamento do Adolescente/psicologia , Meio Ambiente , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Porto Rico/epidemiologia , Fatores de Risco , Autoimagem , Comportamento Sexual/psicologia , Fatores Socioeconômicos , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Tentativa de Suicídio/etnologia , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia
6.
Pediatr Emerg Care ; 29(11): 1180-8, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24168879

RESUMO

OBJECTIVE: The objective of this study was to determine feasibility and acceptability of a brief pediatric emergency department (PED) prevention intervention to delay/prevent initiation of alcohol use in 12-to 14-year-olds. METHODS: Medically stable 12- to 14-year-olds presenting to the PED who were accompanied by a parent and who had not initiated alcohol use were eligible. Adolescent-parent dyads completed a computerized assessment and were randomized to either brief targeted prevention intervention (BPI) or enhanced standard care (ESC). Families randomized to BPI participated in a PED-based motivational interviewing and skill building-based session with a trained counselor. Parents randomized to BPI had telephone boosters at 1 and 3 months. Families randomized to ESC received standard care and adolescent substance use pamphlets. All dyads completed 6-month follow-up assessments to assess alcohol use-related outcomes. RESULTS: Two hundred twenty-eight families were approached: 122 were eligible and 104 were enrolled (85%). Mean youth age was 13 (SD, 0.83) years, 51% were female, and 90% of parents were females. Of the 104 enrolled, 5 withdrew; 99 (94%) completed the assessment battery in the PED in less than 30 minutes. All BPI dyads completed the counseling session in the PED. However, only 53% of BPI parents completed the booster telephone sessions. Brief targeted prevention intervention acceptability items were rated favorably (82%-100%) by both parents and adolescents. There were no differences between BPI and ESC on substance-related outcomes, although the study was not adequately powered for this purpose because it was designed as a feasibility study. CONCLUSIONS: A BPI in the PED is both feasible and acceptable, but phone boosters proved less feasible. Larger samples and further study are needed to identify efficacy of the BPI in delaying onset of alcohol use in teens.


Assuntos
Comportamento do Adolescente , Consumo de Bebidas Alcoólicas/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Promoção da Saúde/organização & administração , Entrevista Motivacional/organização & administração , Pediatria/organização & administração , Adolescente , Aconselhamento , Estudos de Viabilidade , Feminino , Promoção da Saúde/métodos , Humanos , Intenção , Masculino , Entrevista Motivacional/métodos , Folhetos , Relações Pais-Filho , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Grupo Associado , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Psicologia do Adolescente , Rhode Island , Inquéritos e Questionários , Telefone
7.
J Abnorm Child Psychol ; 41(6): 1005-13, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23588400

RESUMO

Although non-suicidal self-injury (NSSI) and suicide attempts (SA) frequently co-occur among youth, there is increasing evidence that both the risk factors and the phenomenology of the behaviors are distinct. This study examined how individuals who engage in NSSI only, individuals who attempt suicide only, and those who have histories of both NSSI and at least one suicide attempt may differ in terms of cognitions and perceived social support. Participants were 185 adolescents (78.1 % female) between the ages of 13 and 18 recruited from a psychiatric inpatient facility in the northeastern United States. One hundred forty-eight teens were identified with a history of self-injurious behavior and divided into three groups: NSSI only (n = 45), SA only (n = 24) or both NSSI and SA (NSSI+SA; n = 79). Analyses showed that the NSSI+SA group exhibited more cognitive errors, negative self-statements, and negative views of self, world, and future, as well as less perceived familial support than either the NSSI or SA only groups. There were no differences between groups on perceived support from teachers or peers. No significant demographic or diagnostic differences were found between the NSSI and SA groups. Limitations and clinical implications of the current research are discussed.


Assuntos
Cognição , Depressão/psicologia , Comportamento Autodestrutivo/psicologia , Apoio Social , Tentativa de Suicídio/psicologia , Adolescente , Adolescente Hospitalizado/psicologia , Depressão/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Análise Multivariada , New England/epidemiologia , Fatores de Risco , Comportamento Autodestrutivo/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos
8.
Arch Gen Psychiatry ; 68(3): 253-62, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21383263

RESUMO

CONTEXT: Many youth with depression do not respond to initial treatment with selective serotonin reuptake inhibitors (SSRIs), and this is associated with higher costs. More effective treatment for these youth may be cost-effective. OBJECTIVE: To evaluate the incremental cost-effectiveness over 24 weeks of combined cognitive behavior therapy plus switch to a different antidepressant medication vs medication switch only in adolescents who continued to have depression despite adequate initial treatment with an SSRI. DESIGN: Randomized controlled trial. SETTING: Six US academic and community clinics. PATIENTS: Three hundred thirty-four patients aged 12 to 18 years with SSRI-resistant depression. INTERVENTION: Participants were randomly assigned to (1) switch to a different medication only or (2) switch to a different medication plus cognitive behavior therapy. MAIN OUTCOME MEASURES: Clinical outcomes were depression-free days (DFDs), depression-improvement days (DIDs), and quality-adjusted life-years based on DFDs (DFD-QALYs). Costs of intervention, nonprotocol services, and families were included. RESULTS: Combined treatment achieved 8.3 additional DFDs (P = .03), 0.020 more DFD-QALYs (P = .03), and 11.0 more DIDs (P = .04). Combined therapy cost $1633 more (P = .01). Cost per DFD was $188 (incremental cost-effectiveness ratio [ICER] = $188; 95% confidence interval [CI], -$22 to $1613), $142 per DID (ICER = $142; 95% CI, -$14 to $2529), and $78,948 per DFD-QALY (ICER = $78,948; 95% CI, -$9261 to $677,448). Cost-effectiveness acceptability curve analyses suggest a 61% probability that combined treatment is more cost-effective at a willingness to pay $100,000 per QALY. Combined treatment had a higher net benefit for subgroups of youth without a history of abuse, with lower levels of hopelessness, and with comorbid conditions. CONCLUSIONS: For youth with SSRI-resistant depression, combined treatment decreases the number of days with depression and is more costly. Depending on a decision maker's willingness to pay, combined therapy may be cost-effective, particularly for some subgroups. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00018902.


Assuntos
Terapia Cognitivo-Comportamental/economia , Transtorno Depressivo Maior/economia , Transtorno Depressivo Maior/terapia , Inibidores Seletivos de Recaptação de Serotonina/economia , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Adolescente , Terapia Combinada/economia , Análise Custo-Benefício , Cicloexanóis/economia , Cicloexanóis/uso terapêutico , Transtorno Depressivo Maior/psicologia , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Masculino , Cloridrato de Venlafaxina
9.
J Am Acad Psychiatry Law ; 37(3): 363-70, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19767501

RESUMO

The contract for safety is a procedure used in the management of suicidal patients and has significant patient care, risk management, and medicolegal implications. We conducted a literature review to assess empirical support for this procedure and reviewed legal cases in which this practice was employed, to examine its effect on outcome. Studies obtained from a PubMed search were reviewed and consisted mainly of opinion-based surveys of clinicians and patients and retrospective reviews. Overall, empirically based evidence to support the use of the contract for safety in any population is very limited, particularly in adolescent populations. A legal review revealed that contracting for safety is never enough to protect against legal liability and may lead to adverse consequences for the clinician and the patient. Contracts should be considered for use only in patients who are deemed capable of giving informed consent and, even in these circumstances, should be used with caution. A contract should never replace a thorough assessment of a patient's suicide risk factors. Further empirical research is needed to determine whether contracting for safety merits consideration as a future component of the suicide risk assessment.


Assuntos
Contratos/legislação & jurisprudência , Relações Médico-Paciente , Segurança/legislação & jurisprudência , Prevenção do Suicídio , Suicídio/legislação & jurisprudência , Adolescente , Adulto , Criança , Prova Pericial/legislação & jurisprudência , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Medição de Risco/legislação & jurisprudência , Gestão de Riscos
10.
Child Adolesc Psychiatr Clin N Am ; 12(4): 649-65, vi, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14579644

RESUMO

It has been estimated that for each completed suicide, there are 15 to 20 nonfatal suicide attempts. A prior suicide attempt can create a major elevation in the risk of subsequent attempt. A prior suicide attempt also is a strong predictor for eventual completed suicide. Consequently, management of an adolescent who attempts suicide is important. In this article, the authors examine various issues related to suicide risk in adolescents. The article focuses on key issues that should be included in a thorough assessment of adolescents who are referred for an evaluation during a suicidal crisis. The empirical literature is used as a guide for identifying risk factors that should be monitored and managed as part of a comprehensive treatment plan.


Assuntos
Intervenção em Crise , Tentativa de Suicídio/psicologia , Adolescente , Atitude Frente a Morte , Criança , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Serviços de Saúde Mental/normas , Prevalência , Fatores Sexuais , Tentativa de Suicídio/estatística & dados numéricos
11.
Suicide Life Threat Behav ; 32(2): 139-45, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12079030

RESUMO

The role of neighborhood factors in predicting hopelessness among adolescent suicide attempters was examined in this study. Forty-eight adolescents who attempted suicide were administered measures of hopelessness and depression. Family socioeconomic status (SES) was calculated based on family demographics and characteristics of neighborhood context were examined using a geocoding software package. Adolescents who lived in neighborhoods with weak social networks reported higher levels of hopelessness, even after controlling for SES and depression. These preliminary findings suggest that environmental context may play a role in the emotional status of adolescents who attempt suicide.


Assuntos
Depressão/psicologia , Motivação , Características de Residência , Meio Social , Tentativa de Suicídio/psicologia , Adolescente , Feminino , Humanos , Masculino , Determinação da Personalidade , Fatores de Risco , Apoio Social , Fatores Socioeconômicos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA