Family processes: Risk, protective and treatment factors for youth at risk for suicide.

Family factors have continually been identified as potential risk and protective factors for youth at risk for suicide. This paper reviews family processes that not only are associated with suicide risk, but also might be malleable enough to target in treatment. We also review family intervention components have been incorporated into most youth suicide treatments. Unfortunately research on if these family processes moderator, mediator or change as a result of treatment is limited. Recommendations for future research are offered.

From postcard to book cover: illustrating connections between medical history and digital humanities.

This article illustrates the value and impact of collaboration among scholars, archivists, and librarians working across universities and government institutions, and how changes in medium-from a born-physical photograph and printed postcard to a digital reproduction to a simultaneously born-digital and printed book-create new possibilities for scholarly analysis, interpretation, and dissemination, which in turn suggest future directions for research and engagement across fields of inquiry. In doing so, this article argues that history matters by illuminating past networks that, through humanistic inquiry, continue to connect people, ideas, and institutions in the present and into the future.

Family Care Curriculum: A Parenting Support Program for Families Experiencing Homelessness.

Purpose In the United States, families with children characterize the fastest growing portion of the homeless population. Parenting for families experiencing homelessness presents unique challenges since families facing homelessness are disproportionately more likely to experience a myriad of interpersonal and contextual stressors that heighten the risk of parents engaging in suboptimal parenting approaches. This article describes the development and implementation of the Family Care Curriculum (FCC) train-the-trainer parenting support program specifically designed to support positive parenting in families experiencing homelessness. Description The FCC is a 6-week theory-based parenting intervention aimed to create positive shifts in parental attitudes to enhance sensitive and nurturing parenting and positive parent-child relationships. FCC assists parents in reflecting on how their own experiences contribute to some of their parenting beliefs, patterns, and behaviors. Parents are coached to imagine and understand the emotions, attachment, and developmental needs behind their children's behaviors so they can maintain empathic and nurturing parenting responses in the context of cumulative and chronic stress. Parents are supported through learning to engage in self-care. A unique and important feature of the FCC is the inclusion of a culturally sensitive approach that takes into consideration the effects of racism, classism, and oppression on parent-child relationships. Conclusion FCC was designed, implemented, and championed by expert providers in the fields of family therapy, social work, and pediatrics to support parents experiencing homelessness. FCC adds to the body of effective attachment-based, trauma-informed, and culturally sensitive parenting interventions for improving parent-child relations and family health amongst vulnerable populations.

Emotion-based preventive intervention: Effectively promoting emotion knowledge and adaptive behavior among at-risk preschoolers.

Effectiveness studies of preschool social-emotional programs are needed in low-income, diverse populations to help promote the well-being of at-risk children. Following an initial program efficacy study 2 years prior, 248 culturally diverse Head Start preschool children participated in the current effectiveness trial and received either the Emotion-Based Prevention Program (EBP) or the I Can Problem Solve (ICPS) intervention. Pre- and postdata collection included direct child assessment, teacher report, parent interview, and independent observations. Teachers implementing the EBP intervention demonstrated good and consistent fidelity to the program. Overall, children in EBP classrooms gained more emotion knowledge and displayed greater decreases in negative emotion expressions and internalizing behaviors across the implementation period as compared to children in ICPS classrooms. In addition, cumulative risk, parental depressive symptoms, and classroom climate significantly moderated treatment effects. For children experiencing more stress or less support, EBP produced more successful outcomes than did ICPS. These results provide evidence of EBP sustainability and program effectiveness, as did previous findings that demonstrated EBP improvements in emotion knowledge, regulation skills, and behavior problems replicated under unsupervised program conditions.

Attachment-based family therapy for depressed and suicidal adolescents: theory, clinical model and empirical support.

Attachment-Based Family Therapy (ABFT) is a manualized family-based intervention designed for working with depressed adolescents, including those at risk for suicide, and their families. It is an empirically informed and supported treatment. ABFT has its theoretical underpinnings in attachment theory and clinical roots in structural family therapy and emotion focused therapies. ABFT relies on a transactional model that aims to transform the quality of adolescent-parent attachment, as a means of providing the adolescent with a more secure relationship that can support them during challenging times generally, and the crises related to suicidal thinking and behavior, specifically. This article reviews: (1) the theoretical foundations of ABFT (attachment theory, models of emotional development); (2) the ABFT clinical model, including training and supervision factors; and (3) empirical support.

Attachment based treatments for adolescents: the secure cycle as a framework for assessment, treatment and evaluation.

The emergence of attachment-based treatments (ABTs) for adolescents highlights the need to more clearly define and evaluate these treatments in the context of other attachment based treatments for young children and adults. We propose a general framework for defining and evaluating ABTs that describes the cyclical processes that are required to maintain a secure attachment bond. This secure cycle incorporates three components: (1) the child or adult's IWM of the caregiver; (2) emotionally attuned communication; and (3) the caregiver's IWM of the child or adult. We briefly review Bowlby, Ainsworth, and Main's contributions to defining the components of the secure cycle and discuss how this framework can be adapted for understanding the process of change in ABTs. For clinicians working with adolescents, our model can be used to identify how deviations from the secure cycle (attachment injuries, empathic failures and mistuned communication) contribute to family distress and psychopathology. The secure cycle also provides a way of describing the ABT elements that have been used to revise IWMs or improve emotionally attuned communication. For researchers, our model provides a guide for conceptualizing and measuring change in attachment constructs and how change in one component of the interpersonal cycle should generalize to other components.

Combining attachment-based family therapy and cognitive behavioral therapy to improve outcomes for adolescents with anxiety.

Increases in adolescent anxiety over the past several years suggest a need for trauma-informed, culturally responsive interventions that help teens cope with environmental stressors like those associated with the COVID-19 pandemic. Although abundant evidence supports the efficacy of cognitive behavioral therapy (CBT) in treating adolescent anxiety, not all teens respond positively to CBT. CBT does not typically include strategies that address important family factors that may be impacting the teen's functioning, such as the attachment relationship. Attachment-based family therapy (ABFT) addresses the attachment relationship and other factors that contribute to the adolescent's anxiety and related distress. By enhancing positive parenting behaviors, such as acceptance and validation of the adolescent's distress and promotion of their autonomy, ABFT sessions may repair the attachment relationship and increase the family's ability and willingness to engage in CBT tasks aimed at reducing anxiety. This theoretical paper describes the ABFT model and proposes that implementing ABFT sessions prior to CBT could result in better clinical outcomes for adolescents with anxiety disorders by improving the context within which the anxiety symptoms and treatment are experienced. Given that ABFT is sensitive and responsive to family and other contextual factors, adolescents from marginalized communities and those from less individualistic cultures may find the model to be more acceptable and appropriate for addressing factors related to their anxiety. Thus, a combined ABFT+CBT model might result in better outcomes for adolescents who have not historically responded well to CBT alone.

Immersive and reflective recall of a suicidal episode: Implications for assessing and treating suicidal adolescents.

OBJECTIVE: The present study tested the validity and clinical utility of adolescents' reports of two distinct modes of processing during the recall of a suicidal episode in the Suicide Narrative Interview (SNI). Recall Intensity (RI) items were designed to capture a tendency to become immersed in thoughts and feelings during the interview, while Meaning Making (MM) items were designed to assess more distant and reflective processing. METHOD: The construct and predictive validity of pretreatment MM and RI was tested in a 16-week randomized clinical trial (RCT) for depressed and suicidal adolescents (N = 113, Mage = 14.95, 84.1% female, 51.8% Black/African American). Adolescents rated MM and RI immediately following the SNI during a baseline assessment. RESULTS: Baseline MM was associated with protective factors related to reduced suicidality, and RI was associated with several risk factors for suicidal symptoms. Adolescents who reported high MM and low RI reported greater reductions in both suicidal ideation and depressive symptoms during the RCT. CONCLUSIONS: The results support MM and RI as two distinct modes of how adolescents process memories of suicidal episodes and highlight the potential clinical utility of RI and MM in assessing and treating suicidal adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"The Most Disastrous and Fatal Epidemic": Mortality Statistics During the 1890 Russian Influenza Epidemic in Connecticut.

During the Russian influenza pandemic, which reached the United States in late 1889, US public health officials attempted to document the number of deaths associated with this disease outbreak. A historical perspective illuminates the complex categories used to classify deaths from influenza-associated diseases; substantial changes in weekly, monthly, and yearly death totals; and thoughtful efforts by health officials to measure the epidemic as it happened. The 1114 influenza deaths reported by the Connecticut State Board of Health in the 3 years after the January 1890 outbreak must be supplemented by the notable increases in the number of deaths from respiratory diseases, which elevates the likely toll to more than 7000 deaths during the epidemic. Whereas historians of public health have primarily examined efforts to control communicable diseases, this case study of mortality statistics reported by town officials and analyzed by the Connecticut State Board of Health demonstrates how officers of the local boards of health also responded to unexpected outbreaks of a familiar disease such as influenza. Understanding how organizations measured influenza-associated mortality illustrates an important stage in the development of American public health and also makes an important contribution to studying pandemics in history.

Family relationships and the interpersonal theory of suicide in a clinically suicidal sample of adolescents.

In a sample of suicidal adolescents (N = 117), we sought to identify how adolescents' attachment to their parents related to a key mechanism of suicide from the Interpersonal Theory of Suicide (IPTS). We tested both attachment-anxiety and attachment-avoidance, to both mother- and father-figures as correlates of the IPTS construct, perceived burdensomeness (PB). In addition, we tested PB as a mediator between these attachment variables and adolescent suicide ideation in a path analysis. Our path analysis indicated both mother- and father-related attachment anxiety were associated with PB and PB was related to suicide ideation. We also found an indirect effect of father-related attachment anxiety on suicide ideation. This study provides empirical support for earlier systemic work that proposes how family relationships may influence an adolescent's suicidal ideation. Finally, we provide practical clinical suggestions for how therapists may implement a systemic framework to address a suicidal adolescent and their family relationships.

How did we get here: what are droplets and aerosols and how far do they go? A historical perspective on the transmission of respiratory infectious diseases.

The COVID-19 pandemic has exposed major gaps in our understanding of the transmission of viruses through the air. These gaps slowed recognition of airborne transmission of the disease, contributed to muddled public health policies and impeded clear messaging on how best to slow transmission of COVID-19. In particular, current recommendations have been based on four tenets: (i) respiratory disease transmission routes can be viewed mostly in a binary manner of 'droplets' versus 'aerosols'; (ii) this dichotomy depends on droplet size alone; (iii) the cut-off size between these routes of transmission is 5 µm; and (iv) there is a dichotomy in the distance at which transmission by each route is relevant. Yet, a relationship between these assertions is not supported by current scientific knowledge. Here, we revisit the historical foundation of these notions, and how they became entangled from the 1800s to today, with a complex interplay among various fields of science and medicine. This journey into the past highlights potential solutions for better collaboration and integration of scientific results into practice for building a more resilient society with more sound, far-sighted and effective public health policies.

Anxiety-related difficulties in goal-directed behavior predict worse treatment outcome among adolescents treated for suicidal ideation and depressive symptoms.

Although treatments for youth at risk for suicide have been successful, they are not similarly effective for everyone. Anxiety may interfere with adolescents' ability to engage with therapy and explain why some adolescents do not respond as well as others to treatment. The current study tested whether an anxiety diagnosis predicted treatment outcome among a sample of adolescents with suicidal ideation and depressive symptoms participating in either attachment-based family therapy or family-enhanced nondirective supportive therapy (N = 129; M age = 14.87, SD = 1.68; 81.9% female). The data set that the current study used had a high representation of Black/African American adolescents (48.8% of sample), which is valuable, as few studies have included adequate representation of this population. A significant indirect effect (.88; 95% confidence interval [.01, 2.64]) showed that across both treatment conditions, participants who met criteria for an anxiety disorder had greater difficulties engaging in goal-directed behavior midtreatment, and these difficulties, in turn, predicted more posttreatment suicidal ideation. The effect of anxiety on treatment outcome via difficulties with goal-directed behavior was nonspecific to the treatment condition. However, attachment-based family therapy was superior to family-enhanced nondirective supportive therapy in improving this aspect of emotion regulation among adolescents who did not have anxiety. In addition, difficulties with goal-directed behavior on treatment outcome were worse for adolescents' who reported greater attachment avoidance to their parents. Future research should test whether targeting goal-directed behavior and attachment avoidance would result in better treatment outcome for adolescents with suicidal ideation and anxiety. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

La Grippe or Russian influenza: Mortality statistics during the 1890 Epidemic in Indiana.

BACKGROUND: The Russian influenza, which began in late 1889, has long been recognized as a major global epidemic yet available statistical evidence for morbidity and mortality has not been fully examined using historical and epidemiological tools. This study of cases and deaths in Indiana during the extended time period associated with the Russian influenza is the first scholarly effort to determine the number of victims from this influenza outbreak across a broad regional case study in the US. METHODS: The sources for this study include historical records from the US Census, Annual Reports from the Indiana State Board of Health, and death notices published in newspapers. The available evidence is analyzed using historical and epidemiological methods to determine the consistency of reporting categories, the accuracy of death records, and the applicability of contemporary categories for measuring mortality. RESULTS: In the 3 years during and following the outbreak of "Russian influenza" in January 1890 in the state of Indiana, approximately 3200 died specifically of this disease while a total of 11 700 died of influenza and other respiratory diseases. These results confirm that extremely widespread influenza contributed to higher than normal death rates by causing additional deaths in related categories, especially pneumonia and other respiratory diseases. CONCLUSIONS: More reliable and thorough analysis of morbidity and mortality during the Russian influenza based on systematic and critical review of local, regional, and national statistics can inform contemporary understanding of the long-term history of influenza epidemics.

A Randomized Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Youth Who Are Suicidal.

OBJECTIVE: To evaluate the efficacy of attachment-based family therapy (ABFT) compared with a family-enhanced nondirective supportive therapy (FE-NST) for decreasing adolescents' suicide ideation and depressive symptoms. METHOD: A randomized controlled trial of 129 adolescents who are suicidal ages 12- to 18-years-old (49% were African American) were randomized to ABFT (n = 66) or FE-NST (n = 63) for 16 weeks of treatment. Assessments occurred at baseline and 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms. RESULTS: There was no significant between-group difference in the rate of change in self-reported ideation (Suicidal Ideation Questionnaire-Jr; F1,127 = 181, p = .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a significant decrease in suicide ideation (t127 = 12.61, p < .0001; effect size, d = 2.24). Adolescents receiving FE-NST showed a similar significant decrease (t127 = 10.88, p < .0001; effect size, d = 1.93). Response rates (ie, ≥50% decrease in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST. CONCLUSION: Contrary to expectations, ABFT did not perform better than FE-NST. The 2 treatments produced substantial decreases in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes could be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators. CLINICAL TRIAL REGISTRATION INFORMATION: Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov; NCT01537419.

Comprehensive Screening for Suicide Risk in Primary Care.

INTRODUCTION: Suicide is a major public health problem and a complex clinical challenge. Assessment and early identification could be enhanced with screening tools that look beyond depression. The purpose of this study was to identify profiles of risk behaviors and social stress associated with suicidal ideation and behavior using the Behavioral Health Screen. METHODS: The study used screening data from 2,513 primary care patients (aged 14-24 years). Data were collected between 2008 and 2012, and were analyzed in 2016. RESULTS: Latent class analysis identified a high and low risk profile. Domains of primary influence included substance use, sexual assault, same-sex behavior, and unsafe sex. The high-risk group was 11 times more likely to have made a suicide attempt, five times more likely to report a history of suicidal ideation and behavior, and three times more likely to report recent suicidal ideation and behavior. CONCLUSIONS: Risk behaviors and social stress contribute to the risk for suicide above and beyond depression and should be assessed during routine primary care visits with adolescents. The Behavioral Health Screen can screen all these domains and thus assist primary care providers in assessing for both psychiatric and social stress factors associated with youth suicide.

Emotional Reactivity to Negative Adult and Peer Events and the Maintenance of Adolescent Depressive Symptoms: a Daily Diary Design.

Emotional reactivity to negative interpersonal events has been consistently linked with depressive symptoms in studies with adults. However, little is known about the role that emotional reactivity plays in the maintenance of depressive symptoms during adolescence. A structured diary, administered to 132 economically disadvantaged adolescents (53% female, 76% African American) at age 14, measured adolescent daily reports of negative events involving parents, teachers, and peers and ratings of negative and positive affect. We examined the relationship between emotional reactivity (changes in negative and positive affect that correspond with negative events) and the maintenance of depressive symptoms between ages 13 and 15. We also tested unique effects of different types of emotional reactivity, depending on the type of interpersonal event. Results provided support for the emotional reactivity model for negative teacher events: heightened reactivity to negative teacher events was related to the maintenance of depressive symptoms. Findings suggest that adolescents' emotional reactivity to teachers has important implications for the continuity of depressive symptoms during early adolescence for disadvantaged youth.

Attachment-Based Family Therapy With a 13-Year-Old Girl Presenting With High Risk for Suicide.

This article describes the application of Attachment-Based Family Therapy (ABFT) to the treatment of a 13-year-old female adolescent presenting with high risk of suicide, complicated by a history of depression and sexual trauma. The article begins with an overview of ABFT, including (a) how attachment theory guides treatment; (b) the structure of the clinical model; and (c) the data that provide empirical support. A case example is then presented that exemplifies the primary clinical procedures used to reach therapeutic goals in ABFT, including attachment repair and autonomy/competence promotion. Weekly changes in suicide ideation and depression scores are presented. The article concludes with a discussion about implications for family-based treatment of suicidal youth.