Psychometric properties of the Generalized Anxiety Disorder 7-item scale in youth: Screening in a primary care sample.

BACKGROUND: Anxiety disorders in youth are frequently underdiagnosed and untreated, partly due to a lack of screening in primary care. The Generalized Anxiety Disorder 7-item (GAD-7) scale is a brief self-report measure designed to screen for anxiety in primary care settings. However, little is known about the psychometrics of this scale with adolescents. METHODS: Participants included 579 youth age 11 to 17 years who received screening for depression in a primary care setting through a web-based application, VitalSign6, over a 4-year period. Psychometric analyses were completed based on classical test theory (CTT) and item response theory (IRT). RESULTS: Using CTT and IRT methods, the GAD-7 has a unidimensional structure with good psychometric properties. In addition, the IRT analysis demonstrates that items 1 and 2 are strongly associated with the total score, and thus are good choices as a 2-item screening tool. Convergent validity was demonstrated, with high correlations between the GAD-7 and other measures of anxiety, and discriminant validity was also demonstrated, with low correlations to measures of other psychological states. CONCLUSIONS: This psychometric evaluation of the GAD-7 provides support for the utility of this measure with adolescents. The GAD-2 is a good estimate of GAD-7 total score.

Stress, Coping, and Mood Among Latino Adolescents: A Daily Diary Study.

The current study examines whether daily coping moderates the effects of daily stress on same-day mood and next-day mood among 58 Latino adolescents (Mage  = 13.31; 53% male). The daily diary design capitalized on repeated measurements, boosting power to detect effects and allowing for a robust understanding of the day-to-day experiences of Latino adolescents. Hierarchical linear modeling revealed that on days when youth reported higher levels of peer and academic stress, they also reported more negative moods. However, only poverty-related stress predicted mood the following day. Engagement coping buffered the effect of poverty-related stress on next-day negative and positive mood, while disengagement exacerbated the effects of academic and peer stress. The need for interventions promoting balanced coping repertoires is discussed.

Comprehensive phenotyping of depression disease trajectory and risk: Rationale and design of Texas Resilience Against Depression study (T-RAD).

Depression has a chronic and recurrent course often with early onset and is the leading cause of disability worldwide. In contrast to diagnoses for other conditions which rely on precise medical tests, the diagnosis of depression still focuses exclusively on symptom reports. As a result, heterogeneous patient groups are included under broad categories. Furthermore, in the absence of companion diagnostic tests, choosing specific treatments for patients remains imprecise with only one-third of patients entering remission with initial treatment, with others requiring multiple intervention steps to achieve remission. In addition to improving treatment outcomes, disease prevention is essential to reduce overall disease burden. Adolescence is a critical window where complex emotional, social, familial, and biological shifts may predispose to lifelong depression. Thus, personalized medicine, integrating individual variability in genes, brain function, and clinical phenotypes, can offer a comprehensive approach to provide precise diagnosis, novel drug development, optimal treatment assignment, and prevention of illness and its associated burden. Texas Resilience Against Depression study (T-RAD) encompasses two natural history, longitudinal (10 + years), prospective studies (D2K and RAD), each enrolling 2500 participants. The D2K study follows participants (ages 10 years and older) who have a current or past diagnosis of depression or bipolar disorder. The RAD study follows participants aged 10-24 years who are at risk for depression but not yet suffering from the disease. The T-RAD study will help to uncover the socio-demographic, lifestyle, clinical, psychological, and neurobiological factors that contribute to mood disorder onset, recurrence, progression, and differential treatment response.

Impact of Emergency Shelter Utilization and Kinship Involvement on Children's Behavioral Outcomes.

Youth in child welfare often experience emergency shelter care, a type of congregate setting, while a permanent placement is arranged. The present longitudinal study explored the impact of initial emergency shelter placement on long-term externalizing behavior (i.e., aggression, delinquency) and internalizing symptom (i.e., anxiety, depression) trajectories, and whether kinship involvement moderated the effect of shelter placement on behavioral outcomes. The sample consisted of 282 youths (55.3% male) with an average age of 9.90 years ( SD = 2.37); 36.9% experienced an emergency shelter placement. Data were collected from the Illinois Department of Children and Family Services. Caseworkers completed the Child and Adolescent Needs and Strengths, which measured youths' behavioral outcomes. Results suggested that shelter care was not associated with externalizing behavior trajectories. However, shelter care was associated with internalizing symptoms among children with less kinship involvement. Results from this study suggest that best practices for shelter care should leverage kinship involvement.

Implementing the Bounce Back trauma intervention in urban elementary schools: A real-world replication trial.

The current study provides the first replication trial of Bounce Back, a school-based intervention for elementary students exposed to trauma, in a different school district and geographical area. Participants in this study were 52 1st through 4th graders (Mage = 7.76 years; 65% male) who were predominately Latino (82%). Schools were randomly assigned to immediate treatment or waitlist control. Differential treatment effects (Time × Group Interaction) were found for child-reported posttraumatic stress disorder (PTSD) and parent-reported child coping, indicating that the immediate treatment group showed greater reductions in PTSD and improvements in coping compared with the delayed group. Differential treatment effects were not significant for depression or anxiety. Significant maintenance effects were found for both child-reported PTSD and depression as well as parent-reported PTSD and coping for the immediate treatment group at follow-up. Significant treatment effects were also found in the delayed treatment group, showing reductions in child-reported PTSD, depression, and anxiety as well as parent-reported depression and coping upon receiving treatment. In conclusion, the current study suggests that Bounce Back is an effective intervention for reducing PTSD symptoms and improving coping skills, even among a sample experiencing high levels of trauma and other ongoing stressors. (PsycINFO Database Record

Father involvement in child welfare: Associations with changes in externalizing behavior.

Nonresident fathers can have a significant impact on children's behavioral outcomes. Unfortunately, the impact of nonresident father involvement on the behavioral outcomes of children with child welfare involvement has received scant attention in the literature, a limitation the current study sought to address. A sample of 333 children in state custody in Illinois between the ages of six and 13 participated and were assessed using the externalizing behavior scale of the Child and Adolescent Needs and Strengths (CANS) at regular intervals throughout their time in care. Father involvement was measured through a review of case files and interviews with child welfare workers. Growth trajectories were fit to children's externalizing behavior across time and were predicted using Time 1 characteristics. Father involvement, total non-father relative involvement, and gender (girls) was associated with lower baseline externalizing behavior and the African American children in the sample experienced higher baseline externalizing behavior. However, only Time 1 father involvement predicted slope trajectories after controlling for Time 1 externalizing behavior; more father involvement was associated with lower externalizing behavior trajectories. These results suggest that even in the unique and stressful context of child welfare, father involvement can be protective regarding children's externalizing behaviors.

Emergency shelter care utilization in child welfare: Who goes to shelter care? How long do they stay?

Emergency shelter care for children entering foster care is widely used as a temporary first placement, despite its contraindications. However, little research has examined predictors of utilization (e.g., entry into care, length of stay in care). A sample of 123 children (ages 6-13) entering foster care was studied to explore the variables associated with an initial placement in shelter care versus kinship care and variables associated with children staying less than 30 days in the shelter versus 30 days or longer. After applying a classification tree analysis (CTA via Optimal Data Analysis), results indicated that variables across the child's ecology--specifically the microsystem, mesosystem, and exosystem--were associated with increased emergency shelter utilization, including older age, entering as a dependency case, more relatives and fictive kin with barriers to involvement in the child's life, and the child welfare agency serving the child. These results suggest that although emergency shelter care utilization may be determined by a complex interaction of variables across the child's ecology, policy and programmatic attention to some of these risk factors might be effective in limiting utilization so that children can enter care with a more long-term, family-based placement.

Parent perspectives from participating in a family component for CBITS: Acceptability of a culturally informed school-based program.

This study explored parents' responses to a family component developed as an addition to the Cognitive Behavioral Intervention for Trauma in Schools (CBITS). The family component was developed to improve engagement and participation in CBITS and to support parents' own skill-building. To evaluate the acceptability and feasibility of the family component from the perspective of parents who participated, qualitative interviews were conducted with 15 low-income, Latino parents (80% female; 80% immigrants; average age = 38.07). Themes emerged across 3 primary categories: Need for CBITS + Family, Results of Participating in CBITS + Family, and Implications for Feasibility. Parents agreed that there was a need for programs like CBITS and expressed a firm belief in the importance of parental involvement with their children and schools. Parents reported a high level of satisfaction with the family component and indicated that it was beneficial to them, culturally relevant, and that they would recommend it to others. Still, some logistical barriers to participation and areas for improvement were noted. Overall, the results of this study indicate that CBITS + Family is an appropriate, acceptable, and feasible intervention for Latino families. Supplemental data from children whose parents participated in the program provide further support for the value of the family component. Clinical implications for implementing culturally sensitive, school-based interventions with parents are discussed. (PsycINFO Database Record

The Protective Effect of Kinship Involvement on the Adjustment of Youth in Foster Care.

Child maltreatment and family dysfunction (e.g., conflict) can have a long-term deleterious impact on youth well-being. Using a child welfare sample, this study examined whether dysfunction in the nuclear family of origin was associated with adjustment problems, including internalizing and externalizing behavior problems, beyond the effect of child maltreatment, and whether extended family (kinship) involvement protected against youth's adjustment problems. Participants included 171 children and adolescents (mean age = 10.15; 50.3% female) who entered foster care due to child maltreatment. Results indicated that greater dysfunction in the nuclear family of origin and child maltreatment were independently associated with greater internalizing and externalizing behavior problems. Results also showed that kinship involvement was protective against externalizing behavior problems. Moreover, kinship involvement buffered the association between dysfunction in family of origin and internalizing behaviors only at low levels of family dysfunction. These results support policies that encourage the involvement of extended and noncustodial family members in the lives of maltreated youth following their entry into foster care.

Follow-up treatment utilization by hospitalized suicidal adolescents.

This study examines treatment utilization in a sample of 99 adolescents who were psychiatrically hospitalized due to a risk of suicide and followed for 6 months. Descriptive information regarding participants' use of various forms of outpatient and intensive treatment, including emergency, inpatient, and residential care is presented. In addition, the relationships between utilization of mental health services and various characteristics of the adolescents and their families were assessed. Overall treatment engagement was high, with 78 participants (79%) receiving some care for the duration of the follow-up period and 91 (92%) participating in at least one session of outpatient treatment, although the extent of utilization was highly variable. In addition, 28 participants (28%) were rehospitalized during follow-up. Both family and individual characteristics were associated with differences in adolescents' participation in follow-up treatment. Specifically, adolescents with a family history of mood disorders were more likely to participate in outpatient treatment and less likely to require intensive treatments. Conversely, more impaired baseline functioning and suicide attempts during the follow-up period were associated with greater utilization of intensive treatments and less utilization of outpatient therapy. Given that 19 participants (19%) in our sample attempted suicide during the follow-up interval, the findings of this study suggest that, in spite of high rates of outpatient treatment engagement, rates of suicide attempts and use of intensive treatment services remain high. These results suggest the need for improved outpatient care, as well as possibly longer inpatient stays and more elaborate discharge and transition planning.

Examining the impact of a family treatment component for CBITS: when and for whom is it helpful?

This study compared the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), as it is typically delivered, to CBITS-plus-family treatment component (CBITS + Family), developed through a community partnership. This study used a quasi-experimental design, capitalizing on ongoing CBITS implementation within a school system. In total, 32 parent/student dyads were recruited in CBITS groups and 32 parent/student dyads were recruited in CBITS + Family groups. Parents and students in both conditions completed pre- and posttreatment measures, in addition to a 6-month posttreatment follow-up assessing symptoms. Families were low-income and predominately Latino. Children were 59% female with an average age of 11.70. Participating parents were 84% female with an average age of 38.18. The majority of parents (80%) were immigrants and 70% reported not finishing high school. Parents who received CBITS + Family showed significant improvements in attitudes toward mental health, school involvement, and primary control coping, while demonstrating significant reductions in involuntary engagement and inconsistent discipline. CBITS + Family appears to be most beneficial for children with high symptom severity in terms of reducing posttraumatic stress disorder symptoms and disengagement coping. Finally, greater improvements in parent variables predicted larger symptom reductions among children within the CBITS + Family group. This study suggests that CBITS + Family is beneficial for parents of children exposed to trauma and may be especially helpful for children with high initial symptom severity. Children in CBITS + Family appear to benefit most when their parents show larger improvements in school involvement and greater reductions in parental inconsistency and involuntary engagement.