A 6-month, prospective, randomized controlled trial of customized adherence enhancement versus a bipolar-specific educational control in poorly adherent adolescents and young adults living with bipolar disorder.

OBJECTIVE: Few studies have addressed medication adherence in adolescents and young adults (AYAs) with bipolar disorder (BD). This 6-month prospective randomized-controlled trial (RCT) tested customized adherence enhancement for adolescents and young adults (CAE-AYA), a behavioral intervention for AYAs versus enhanced treatment as usual (ETAU). METHODS: Inclusion criteria were AYAs age 13-21 with BD type I or II with suboptimal adherence defined as missing ≥20% of medications. Assessments were conducted at Screening, Baseline, and weeks 8, 12 and 24. Primary outcome was past 7 day self-reported Tablets Routine Questionnaire (TRQ) validated by electronic pillbox monitoring (SimpleMed). Symptom measures included the Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS). RESULTS: The mean sample age (N = 36) was 19.1 years (SD = 2.0); 66.7% (N = 24) female, BD Type I (81%). The mean missed medication on TRQ for the total sample was 35.4% (SD = 28.8) at screening and 30.4% (SD = 30.5) at baseline. Both CAE-AYA and ETAU improved on TRQ from screening to baseline. Baseline mean missed medication using SimpleMed was 51.6% (SD = 38.5). Baseline HAM-D and YMRS means were 7.1 (SD = 4.7) and 6.0 (SD = 7.3), respectively. Attrition rate at week 24 was 36%. Baseline to 24-week change on TRQ, adjusting for age, gender, educational level, living situation, family history, race, and ethnicity, showed improvement favoring CAE-AYA versus ETAU of 15%. SimpleMed interpretation was limited due to substantial missing data. There was a significant reduction in depression favoring CAE-AYA. CONCLUSIONS: CAE-AYA may improve adherence in AYAs with BD, although conclusions need to be made cautiously given study limitations. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier: NCT04348604.

Pathways to Adulthood in Rural America: A Latent Profile and Latent Transition Analysis of Adult Social Roles.

The transition to adulthood is characterized by the assumption of adult social roles, which are well documented in the literature; however, rural young adults remain understudied, especially using nationally representative samples. Therefore, this study analyzed a rural subsample of young adults from Add Health (N = 2562, 63.8% white, 34.2% Black, 50% female) using latent profile and latent transition analyses. Latent profiles at the average ages of 21-22 and 28-29 were identified highlighting transitions in education, work, and family formation. Two profiles previously unidentified in the literature emerged, high school graduates living with parents and prolonged transitioners, characterized by living with parents and limited transitions in romantic relationships and parenthood. Rural young people most likely to be in these profiles were male, Black, and from disadvantaged backgrounds. High school graduates living with parents and prolonged transitioners also had high probabilities of living in a rural area late in the transition to adulthood. Female and Black rural young adults had the highest probabilities of transitioning from the high school graduates living with parents profile to the prolonged transitioners profile. These empirically established role transitions and pathways to adulthood in rural communities can help inform investments, policies, and future research to support rural young adults following varying pathways during the transition to adulthood.

Religiousness and Levels of Hazardous Alcohol Use: A Latent Profile Analysis.

Prior person-centered research has consistently identified a subgroup of highly religious participants that uses significantly less alcohol when compared to the other subgroups. The construct of religious motivation is absent from existing examinations of the nuanced combinations of religiousness dimensions within persons, and alcohol expectancy valuations have yet to be included as outcome variables. Variable-centered approaches have found religious motivation and alcohol expectancy valuations to play a protective role against individuals' hazardous alcohol use. The current study examined latent religiousness profiles and hazardous alcohol use in a large, multisite sample of ethnically diverse college students. The sample consisted of 7412 college students aged 18-25 (M age = 19.77, SD age = 1.61; 75% female; 61% European American). Three latent profiles were derived from measures of religious involvement, salience, and religious motivations: Quest-Intrinsic Religiousness (highest levels of salience, involvement, and quest and intrinsic motivations; lowest level of extrinsic motivation), Moderate Religiousness (intermediate levels of salience, involvement, and motivations) and Extrinsic Religiousness (lowest levels of salience, involvement, and quest and intrinsic motivations; highest level of extrinsic motivation). The Quest-Intrinsic Religiousness profile scored significantly lower on hazardous alcohol use, positive expectancy outcomes, positive expectancy valuations, and negative expectancy valuations, and significantly higher on negative expectancy outcomes, compared to the other two profiles. The Extrinsic and Moderate Religiousness profiles did not differ significantly on positive expectancy outcomes, negative expectancy outcomes, negative expectancy valuations, or hazardous alcohol use. The results advance existing research by demonstrating that the protective influence of religiousness on college students' hazardous alcohol use may involve high levels on both quest and intrinsic religious motivation.

Identity in young adulthood: Links with mental health and risky behavior.

The present study was conducted to contribute to our understanding of young adult identity development by deriving latent profiles from intrapersonal and interpersonal indices of identity synthesis and confusion. A sample of 9737 college-attending young adults completed measures of identity, mental health, and health risk behaviors. Four latent profiles emerged: Synthesized (high synthesis, low confusion), Diffused (moderate synthesis, high confusion), Elevated (high synthesis and confusion), and Moderate (moderate synthesis and confusion). The Synthesized profile was associated with the highest well-being and the lowest levels of internalizing, externalizing, and health risks. The Diffused and Elevated profiles were both associated with low well-being and with high internalizing, externalizing, and risky behaviors - with the Elevated profile highest on all of the negative outcomes. The Moderate profile scored intermediately on well-being, internalizing, externalizing, and health risks. These results are discussed in terms of the role of identity within a successful transition to adulthood.

Helping adolescents and young adults (AYA) with cancer manage identity distress: Enhancing clinician-AYA patient communication to promote identity development.

OBJECTIVE: A cancer diagnosis during adolescence and young adulthood (AYA) disrupts AYAs' identity formation, a critical task for healthy development, and contributes to psychological distress called identity distress. Clinical communication is central to promoting AYAs' healthy identity development. We sought to identify aspects of clinician-diagnosed AYA communication that can promote AYAs' identity development and potentially buffer them from distress. METHODS: In-depth, semi-structured interviews were conducted with two groups (AYA oncology clinicians and diagnosed AYAs). Transcripts were thematically analyzed to capture communication that clinicians and AYAs perceive promotes AYAs' identity development and buffers related distress. RESULTS: Fourteen diagnosed AYAs and 7 clinicians identified three clinician- or AYA-led communication approaches and associated strategies that they perceive can buffer identity distress and promote identity development: 1) clinicians' using person-centered communication (e.g., empathic communication); 2) promoting AYAs' control/self-management of care (e.g., not dictating AYAs' behavior); and 3) prioritizing/seeing the person behind the patient (e.g., knowing the AYA as a person). CONCLUSION/PRACTICE IMPLICATIONS: Both AYA oncology clinicians and diagnosed AYAs can communicate in ways that protect AYAs' identity development and related psychological well-being. Findings can be implemented into targeted communication skills interventions to teach health-promoting behavior and augment AYAs' psychosocial oncology care.

Converging identities: dimensions of acculturation and personal identity status among immigrant college students.

The present study was designed to ascertain the extent to which dimensions of acculturation would differ across personal identity statuses in a sample of 2,411 first- and second-generation, immigrant, college-attending emerging adults. Participants from 30 colleges and universities around the United States completed measures of personal identity processes, as well as of heritage and American cultural practices, values, and identifications. Cluster-analytic procedures were used to classify participants into personal identity statuses based on the personal identity processes. Results indicated that, across ethnic groups, individuals in the achieved and searching moratorium statuses reported the greatest endorsement of heritage and American cultural practices, values, and identifications; and individuals in the carefree diffusion status reported the lowest endorsement of all the cultural variables under study. These results are discussed in terms of the convergence between personal identity and cultural identity processes.

The roles of identity formation and moral identity in college student mental health, health-risk behaviors, and psychological well-being.

OBJECTIVES: This study examined the roles of identity formation and moral identity in predicting college student mental health (anxiety and depressive symptoms), health-risk behaviors (hazardous alcohol use and sexual risk taking), and psychological well-being (self-esteem and meaning). METHOD: The sample comprised 9,500 college students (aged 18-25 years, mean = 19.78, standard deviation = 1.61; 73% female; 62% European American), from 31 different universities, who completed an online self-report survey. RESULTS: Structural equation models found that identity maturity (commitment making and identity synthesis) predicted 5 of the health outcomes (except sexual risk taking), and moral identity predicted all of the health outcomes. In most cases identity maturity and moral identity also interacted in predicting mental health and psychological well-being, but not health-risk behaviors. CONCLUSIONS: The maturity and specific contents of identity may both play unique and often interactive roles in predicting college student health. Thus, college student health might be bolstered by helping them establish appropriate identity commitments.

Associations between Family Factors and Youth Substance Use Across the Rural-Urban Continuum: A Person-/Variable-Centered Approach.

Few studies have evaluated the influence of both family factors and geographic location on youth substance use. To address this gap, a person-/variable-centered approach was used to: (1) identify latent profiles of family risk and protective factors for substance use, (2) test profile membership as a predictor of lifetime and 30-day substance use, (3) test rurality, as measured by school geographic location, as a predictor, and (4) explore interaction effects between profile membership and rurality. Youth (N=9,104; 53% female) residing in a state in the southeastern U.S. completed a statewide substance abuse and risk behavior survey including questions about family risk and protective factors and substance use behaviors. Using latent profile analysis to identify subgroups of participants with similar means and variances on the family factors, four latent profiles emerged. Risk of 30-day and lifetime substance use varied across profiles, with the profile characterized by high family-level protective factors and low family-level risk factors indicating the lowest risk for substance use. Urban youth had increased odds of reporting lifetime marijuana use compared to suburban youth; however, geographic location did not appear to confer significantly increased or decreased risk across other substances. No significant interaction results were found. These results emphasize the importance of family functioning on substance use regardless of geographic location, and that evidence-based prevention programming that reduces family risk, strengthens family protection, and is accessible to all types of communities is important to reducing or delaying substance use among youth.

Health Disparities among Rural Individuals with Mental Health Conditions: A Systematic Literature Review.

There is growing concern about the availability of healthcare services for rural patients. This systematic literature review evaluates original research on health disparities among rural and urban populations with mental health conditions in North America. Using PRISMA guidelines, we used four electronic databases (Pubmed, Cochrane, PsychInfo, Web of Science) and hand searches and included original research conducted in the United States or Canada before July 2021 that compared health outcomes of patients with any mental health disorder in rural versus non-rural areas. Both qualitative and quantitative data were extracted including demographics, mental health condition, health disparity measure, rural definition, health outcome measures/main findings, and delivery method. To evaluate study quality, the modified Newcastle Ottawa Scale was used. Our initial search returned 491 studies and 17 studies met final inclusion criteria. Mental health disorders included schizophrenia (4 studies), PTSD (10), mood disorders (9), and anxiety disorders (6). Total sample size was 5,314,818 with the majority being military veterans. Six studies (35.2%) showed no significant rural-urban disparities while eleven (64.7%) identified at least one. Of those, nine reported worse outcomes for rural patients. The most common disparities were diagnostic differences, increased suicide rates and access problems. This review found mixed results regarding outcomes in rural patients with mental health disorders. Disparities were found regarding risk of suicide and access to services. Telehealth in addition to in person outreach to these rural communities may be alternatives to impact these outcomes.

Young Adult Caregiving Daughters and Diagnosed Mothers Navigating Breast Cancer Together: Open and Avoidant Communication and Psychosocial Outcomes.

For many diagnosed mothers and their daughters, breast cancer is a shared experience. However, they struggle to talk about cancer. This is particularly true when the daughter is in adolescence or young adulthood, as they tend to be more avoidant, which is associated with poorer biopsychosocial outcomes. When daughters are their mother's caregivers, daughters' burden and distress are heightened. Young adult caregiving daughters (YACDs) are the second most common family caregiver and encounter more distress and burden than other caregiver types. Yet, YACDs and their diagnosed mothers receive no guidance on how to talk about cancer. Thirty-nine mother/YACD pairs participated in an online survey to identify challenging topics and strategies for talking about cancer, and to explore associations between openness/avoidance and psychosocial outcomes. YACDs and mothers reported the same challenging topics (death, treatment-related issues, negative emotions, relational challenges, YACDs' disease risk) but differed on why they avoided the topic. YACDs and mothers identified the same helpful approaches to navigate conversations (openness, staying positive, third-party involvement, avoidance). Avoidance was correlated with more distress whereas openness was correlated with better psychosocial outcomes. These results provide a psychosocial map for a mother-YACD communication skills intervention, which is key to promoting healthy outcomes.

Association Between Symptom Severity and Medication Adherence in Adolescents with Bipolar Disorder Demonstrating Suboptimal Adherence.

Objective: While medication non-adherence is common in bipolar disorder (BD), few studies have specifically assessed non-adherent BD adolescents and young adults (AYAs). This analysis, using screening and baseline data from an ongoing randomized controlled trial, examined the relationship between BD symptoms and adherence in poorly adherent AYAs. Methods: AYAs ages 13-21 had sub-optimal adherence defined as missing ⩾ 20% of prescribed BD medication. Mean sample (N = 36) age was 19.1 years (SD = 2.0), 66.7 % (N = 24) female, 25.0 % (n = 9) non-white. Adherence was measured via: 1) self-reported Tablets Routine Questionnaire (TRQ) and 2) electronic monitoring (SimpleMed pillbox). Symptoms were measured with the Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS), and the Clinical Global Impression Scale (CGI). Results: Mean percentage of missed BD medications using TRQ was 34.9 (SD = 28.9) at screening and 30.6 (SD = 33.0) at baseline. Mean percentage of missed medication using SimpleMed at baseline was 42.1 (SD = 37.0). The correlation between TRQ and SimpleMed was r = 0.36 (p = 0. 13). Neither CGI nor age were correlated with adherence. Neither TRQ nor SimpleMed were significantly related to HAM-D. YMRS was positively associated with worse adherence for TRQ (r = 0.36, p = 0.03), but not significantly associated with SimpleMed. Adherence did not differ by other demographic attributes. Conclusion: Adherence levels varied widely in AYA with BD. Adherence monitoring increased adherence by approximately 4.5%, and use of electronic pill monitoring identified a greater proportion of missed medication vs. self-report. BD symptoms may not consistently identify AYA with adherence challenges.

Modification of an Intervention to Improve Adherence in Adolescents and Young Adults With Bipolar Disorder.

Objective: Managing bipolar disorder (BD) is particularly challenging for adolescents and young adults (AYAs) ages 16 to 21. Few interventions exist that address self-management in AYAs with BD. Thus, this study aimed to modify the customized adherence enhancement behavioral intervention for AYAs through an iterative, patient-centered process. Method: The Obesity-Related Behavioral Intervention Trials (ORBIT) model was used for intervention development. In phase 1a, adherence barriers and facilitators were identified to refine intervention content. Phase 1b occurred following curriculum modification to ensure that the modified intervention was relevant and usable by the target population. Data were collected via focus groups and interviews with AYAs with BD, parents, and providers. Transcripts were analyzed using directed content analysis. Results: Phase 1a included focus groups/interviews with AYAs (n = 10), parents (n = 4), and providers (n = 9) who described the difficulties and successes in managing BD symptoms, improving adherence, and transitioning care from caregivers. Phase 1b included an advisory board composed of 8 phase 1a participants who provided feedback on modified session activities, module delivery, and curriculum. Phase 1b involved usability testing with new participants (n = 8), revealing the need for modifiable language based on developmental level, more engaging visual images, and confirmation that topics were salient to AYAs with BD. Conclusion: Though sample sizes were small and not representative of the population of AYAs with BD, the ORBIT methodology informed the adaptation of the customized adherence enhancement intervention to improve adherence in AYAs with BD. Important next steps are to conduct a pilot randomized clinical trial of customized adherence enhancement for AYAs.

The Role of the Rural Context in the Transition to Adulthood: A Scoping Review.

Rural adolescents are transitioning to adulthood in the context of growing disparities. To advance research on the social, behavioral, and contextual factors that influence rural young adult development, this study conducted a scoping review. The review sought to identify how researchers defined rural and how/which theories guided their work; how they integrated the rural context into the research design and methods; and how they used variables, concepts, and outcomes to measure rural experiences. Included articles were published between January 2009 and November 2020, included young adults ages 18-29, measured adult role achievement and/or behavioral health outcomes and reported on these outcomes for young adults, and focused on a rural sample within the United States. A systematic search of four databases resulted in 25 empirical articles for the inductive, qualitative analysis. Most studies used atheoretical approaches focusing on outcomes related to adult social roles, substance use, and mental health. Five themes emerged focused on the definitions of rural, the level of integration into the research design and method, and variables salient to the rural experience. These results reveal that future research should clearly define the rural context and better integrate the rural context into the conceptualization, design, methods, and implications of the empirical research.

A customized adherence enhancement program for adolescents and young adults with suboptimal adherence and bipolar disorder: Trial design and methodological report.

BACKGROUND: The onset of bipolar disorder (BD) is common during late adolescence and young adulthood (AYA). Suboptimal medication adherence is a critical yet modifiable risk factor for negative outcomes among AYAs with BD. METHODS: This research used an iterative process (e.g., focus groups, advisory board, cognitive interviews) to modify an existing adherence intervention to address suboptimal adherence in AYAs with BD. The modified version of Customized Adherence Enhancement for Adolescents and Young Adults (CAE-AYA) will be compared to an Enhanced Treatment as Usual condition (ETAU) in 40 AYAs intervention using a 6-month prospective, randomized controlled trial (RCT) in a high-risk group of 16-21 year old AYAs with BD with demonstrated non-adherence to their prescribed BD medications. CONCLUSIONS: This report describes the methodology and design of the ImprovinG adhereNce In adolescenTs with bipolar disordEr (IGNITE) study. If successful, the CAE-AYA approach has the potential to advance care for vulnerable youth with BD.

Examining the light and dark sides of emerging adults' identity: a study of identity status differences in positive and negative psychosocial functioning.

Identity is a critical developmental task during the transition to adulthood in Western societies. The purpose of the present study was to evaluate an empirically based, cluster-analytic identity status model, to examine whether all four of Marcia's identity statuses (diffusion, foreclosure, moratorium, and achievement) would emerge empirically, and to identify different patterns of identity formation among American college-attending emerging adults. An ethnically diverse sample of 9,034 emerging-adult students (73% female; mean age 19.73 years) from 30 U.S. universities completed measures of identity exploration (ruminative, in breadth, and in depth) and commitment (commitment making and identification with commitment), identity synthesis and confusion, positive and negative psychosocial functioning, and health-compromising behaviors. The identity status cluster solution that emerged provided an adequate fit to the data and included all four of Marcia's original identity statuses, along with Carefree Diffusion and Undifferentiated statuses. Results provided evidence for concurrent validity, construct validity, and practical applicability of these statuses. Implications for identity research are discussed.

Through the eyes of a child: Sibling perspectives on having a sibling diagnosed with autism.

BACKGROUND: Sibling perspectives on the experiences of families caring for an autistic child are often overlooked in autism research. While qualitative research on these lived experiences has grown, it continues to primarily focus on parent reports. AIMS: This study explored how having a sibling with autism impacts the non-autistic siblings within a family systems framework. The goal of the current study was to expand the literature by exploring the impacts of autism on the sibling subsystem as reported by the parents and the non-autistic siblings themselves. METHODS AND PROCEDURES: The researchers interviewed 15 non-autistic siblings (aged 7-17) and 15 parents of children with autism to understand the experience of growing up with a sibling with autism. Content analysis was used to develop the interview protocol and analyze responses. Parent and non-autistic sibling reports of both siblings' effects on each other's development are triangulated with existing research. RESULTS: Findings indicate novel emotional skill-building occurs in non-autistic siblings, as well as some unique risk factors for internalizing and externalizing problems if non-autistic siblings' needs become deprioritized. Family stress, external relationships, intrapersonal and social skill development, and other implications of this unique relationship are discussed.

Drinking game behaviors among college students: how often and how much?

BACKGROUND: Participation in drinking games (DG) has been identified as a common health-risk behavior among college students. However, research suggests that the frequency of DG participation alone may not pose a significant health risk; rather, gaming may be most hazardous when large amounts of alcohol are consumed. OBJECTIVES: The present study was designed to examine whether specific gaming behaviors (frequency of play and amount of consumption) place gamers at elevated risk for negative drinking outcomes. METHOD: Students from 30 U.S. colleges completed self-report questionnaires via the Internet about their drinking attitudes and behaviors. Four groups of student gamers (N = 2,230) were examined: low frequency/low consumption (n = 1,047), low frequency/high consumption (n = 453), high frequency/low consumption (n = 326), and high frequency/high consumption (n = 404). RESULTS: Multilevel regression analyses indicated that the frequency x consumption interaction emerged as a significant predictor of negative drinking consequences. Follow-up analyses indicated that quantity of alcohol consumed during DG predicted negative drinking consequences for high-frequency gamers only. CONCLUSIONS/SCIENTIFIC CONTRIBUTION: The present results challenge the assumption that all drinking-gaming practices pose equivalent health risks for gamers. Considering only participation in or level of consumption during DG may not tell the complete story with respect to the health hazards involved with gaming behaviors among college students.

Academic achievement, employment, age and gender and students' experience of alternative school.

The purpose of this cross-sectional study was to explore associations between academic achievement, employment, gender, and age in relation to students' sense of school membership and perception of adults in school. The sample consisted of 102 secondary, alternative school students. Results indicated that students with a more positive perception of school personnel also reported a greater sense of school membership. Male students and older students had a more negative perception of administrators relative to female and younger students. In addition, students who worked tended to report higher grades than students who did not. Study implications are discussed.

Frequency of drinking games participation and alcohol-related problems in a multiethnic sample of college students: do gender and ethnicity matter?

INTRODUCTION: A drinking game (DG) is a high-risk, social drinking activity that consists of certain rules (i.e., when to drink and how much to consume) designed to promote inebriation and that requires each player to perform a cognitive and/or motor task (Zamboanga et al., 2013). Research suggests that non-White or female students who play DGs are at an increased risk of experiencing alcohol-related problems. Thus, this study examined whether the associations between DG participation and alcohol-related problems were similar for men and women and across ethnic groups. METHOD: College students (N=7409; 73% women; 64% White, 8% Black, 14% Hispanic, 14% Asian) from 30 U.S. colleges/universities completed self-report questionnaires. RESULTS: Controlling for age, site, Greek membership (i.e., membership in a fraternity or sorority), and typical alcohol consumption, results indicated that the association between DG participation and alcohol-related problems was stronger for men compared to women. With respect to ethnicity, the association between these variables was stronger among Black women than Black men. CONCLUSIONS: Findings from this large-scale study highlight the need to closely investigate how gender and ethnicity moderate the associations between DG participation and alcohol-related problems. College intervention efforts designed to address high-risk drinking behaviors such as DG participation might consider paying close attention to ethnic minority populations, perhaps particularly Black women.

Religiousness and disordered eating: does religiousness modify family risk?

The purpose of this study was to evaluate the role of intrinsic and extrinsic religiousness in modifying family risk on disordered eating among women. We hypothesized that intrinsic religiousness would buffer the impact of family risk whereas extrinsic religiousness would increase the risk. In a survey of 876 college women between the ages of 18 and 29, the results showed that, when intrinsic religiousness was higher, there was no relationship between family risk and disordered eating. When intrinsic religiousness was lower, there was a significant positive relationship between family risk and disordered eating. These findings support the hypothesized buffering effect of intrinsic religiousness. For extrinsic religiousness, there was a stronger relationship between family risk and disordered eating when extrinsic religiousness was higher than when it was lower, supporting the hypothesized enhanced vulnerability effect. Future research should actively explore other moderating variables as well as aspects of religiousness that may contribute to risk and resiliency in disordered eating.