Exploring whether mental health crisis text conversations that include discussion of firearms differ from those without firearms.

BACKGROUND: Firearm violence represents a public health crisis in the United States. Yet, there is limited knowledge about how firearms are discussed in the context of mental health emergencies representing a major gap in the current research literature. This study addresses this gap by examining whether the content of mental health crisis text conversations that mention firearms differ from those that do not mention firearms in a large, unique dataset from a national crisis text line. METHODS: We examined data from over 3.2 million conversations between texters to Crisis Text Line and volunteer crisis counselors between September 2018 and July 2022. We used a study developed text classification machine learning algorithm that builds on natural language processing to identify and label whether crisis conversations mentioned firearms. We compared the frequency of psychosocial factors between conversations that mention firearms with those that did not. RESULTS: Results from a generalized linear mixed-effects model demonstrated that. conversations mentioning firearms more frequently were associated with suicide, racism, physical, sexual, emotional, and unspecified abuse, grief, concerns about a third party, substance use, bullying, gender and sexual identity, relationships, depression, and loneliness. Further, conversations mentioning firearms were less likely to be related to self-harm and eating/body image. CONCLUSIONS: These results offer an initial glimpse of how firearms are mentioned in the context of acute mental health emergencies, which has been completely absent in prior literature. Our results are preliminary and help sharpen our understanding of contextual factors surrounding mental health emergencies where a firearm is mentioned.

The Use of Crisis Services Following the Mass School Shooting in Uvalde, Texas: Quasi-Experimental Event Study.

BACKGROUND: Mass shootings result in widespread psychological trauma for survivors and members of the affected community. However, less is known about the broader effects of indirect exposure (eg, media) to mass shootings. Crisis lines offer a unique opportunity to examine real-time data on the widespread psychological effects of mass shootings. OBJECTIVE: Crisis Text Line is a not-for-profit company that provides 24/7 confidential SMS text message-based mental health support and crisis intervention service. This study examines changes in the volume and composition of firearm-related conversations at Crisis Text Line before and after the mass school shooting at Robb Elementary School on May 24, 2022, in Uvalde, Texas. METHODS: A quasi-experimental event study design was used to compare the actual volume of firearm-related conversations received by Crisis Text Line post shooting to forecasted firearm conversation volume under the counterfactual scenario that a shooting had not occurred. Conversations related to firearms were identified among all conversations using keyword searches. Firearm conversation volume was predicted using a seasonal autoregressive integrated moving average model trained on the 3 months of data leading up to the shooting. Additionally, proportions of issue tags (topics coded post conversation by volunteer crisis counselors at Crisis Text Line after the exchange) were compared in the 4 days before (n=251) and after (n=417) the shooting to assess changes in conversation characteristics. The 4-day window was chosen to reflect the number of days conversation volume remained above forecasted levels. RESULTS: There was a significant increase in the number of conversations mentioning firearms following the shooting, with the largest spike (compared to forecasted numbers) occurring the day after the shooting (n=159) on May 25, 2022. By May 28, the volume reverted to within the 95% CI of the forecasted volume (n=77). Within firearm conversations, "grief" issue tags showed a significant increase in proportion in the week following the shooting, while "isolation/loneliness," "relationships," and "suicide" issue tags showed a significant decrease in proportions the week following the shooting. CONCLUSIONS: The results suggest that the Uvalde school shooting may have contributed to an increase in demand for crisis services, above what would be expected given historical trends. Additionally, we found that these firearm-related crises conversations immediately post event are more likely to be related to grief and less likely to be related to suicide, loneliness, and relationships. Our findings provide some of the first data showing the real-time repercussions for the broader population exposed to school shooting events. This work adds to a growing evidence base documenting and measuring the rippling effects of mass shootings outside of those directly impacted.

Preliminary Research Priorities for Factors Influencing Individual Outcomes for Users of the US National Suicide Prevention Lifeline.

Importance: Since July 2022, calling or texting 988 in the US connects callers to the National Suicide Prevention Lifeline following a law passed by Congress to simplify access to the mental health crisis line in the US. Compared with other areas of suicide research, knowledge regarding how and to what extent crisis lines prevent suicide crises and suicide deaths remains in its infancy. The state of this research is briefly reviewed and critical directions for future research on factors that may influence effectiveness are suggested. Observations: The new 988 line stands to improve access to critical lifesaving measures in the moments of a suicidal crisis. However, urgent questions remain regarding how to improve effectiveness of crisis lines. Available evidence suggests that crisis lines are often effective at reducing immediate distress and reducing suicide risk, but substantial gaps remain in understanding how crisis lines work. Conclusions and Relevance: Future research is recommended with suicide prevention crisis lines, such as 988, to identify and test factors influencing effectiveness, including conversation, consumer, dyadic, and structural-level characteristics. Existing research, while minimal, suggests that prescription of 988 to prevent suicide death is clinically warranted, but much more work is needed to optimize care.

Future Directions in Suicide and Self-Injury Revisited: Integrating a Developmental Psychopathology Perspective.

The recent rise in suicide rates among children and adolescents has made suicide prevention in youth a major focus of government agencies and mental health organizations. In 2012, Nock presented future directions in the study of self-injurious thoughts and behavior (SITBs), highlighting the need to better examine which risk factors are associated with "each part of the pathway" to suicidal and non-suicidal self-injury in order to inform prevention and intervention efforts. Over the past decade, we have made important advances in understanding the development of SITBs and effective interventions. However, there are still major gaps of knowledge in our understanding of how to prevent suicide. Researchers have recently called for more studies focusing particularly on the pathway from suicidal ideation to suicidal behavior. However, we caution against prioritizing only a part of the suicide risk continuum (e.g., the transition from suicidal ideation to suicidal behavior) while minimizing research focusing on earlier developmental points of the pathway to suicide (e.g., the first development of suicidal ideation). We emphasize that childhood and adolescence represent a critical opportunity to intervene and prevent SITBs by altering developmental trajectories toward persistent and escalating SITBs over time. We advocate for integrating a developmental psychopathology perspective into future youth suicide research that focuses on how and when risk for SITBs first emerges and develops across childhood into emerging adulthood. This research is critical for informing interventions aimed at bending developmental pathways away from all SITBs. Here, we describe the need for future research that integrates key developmental psychopathology principles on 1) the identification of the continuum from developmentally typical to atypical as SITBs first emerge and develop, particularly among young children in early to middle childhood, 2) the way in which expressions of and risk for SITBs change across development, 3) how SITBs dynamically move along a continuum from typical to atypical over time, and 4) suicide prevention efforts. We also offer recommendations for future directions that focus on identifying disparities in SITBs occurring among minoritized youth within a developmental psychopathology perspective.

Informing the study of suicidal thoughts and behaviors in distressed young adults: The use of a machine learning approach to identify neuroimaging, psychiatric, behavioral, and demographic correlates.

Young adults are at high risk for suicide, yet there is limited ability to predict suicidal thoughts and behaviors. Machine learning approaches are better able to examine a large number of variables simultaneously to identify combinations of factors associated with suicidal thoughts and behaviors. The current study used LASSO regression to investigate extent to which a number of demographic, psychiatric, behavioral, and functional neuroimaging variables are associated with suicidal thoughts and behaviors during young adulthood. 78 treatment seeking young adults (ages 18-25) completed demographic, psychiatric, behavioral, and suicidality measures. Participants also completed an implicit emotion regulation functional neuroimaging paradigm. Report of recent suicidal thoughts and behaviors served as the dependent variable. Five variables were identified by the LASSO regression: Two were demographic variables (age and level of education), two were psychiatric variables (depression and general psychiatric distress), and one was a neuroimaging variable (left amygdala activity during sad faces). Amygdala function was significantly associated with suicidal thoughts and behaviors above and beyond the other factors. Findings inform the study of suicidal thoughts and behaviors among treatment seeking young adults, and also highlight the importance of investigating neurobiological markers.

A review of associations between parental emotion socialization behaviors and the neural substrates of emotional reactivity and regulation in youth.

As highlighted by Eisenberg, Cumberland, and Spinrad (1998), parents play a critical role in children's socioemotional development, in part, by shaping how children and adolescents process, respond to, and regulate their emotions (i.e., emotional reactivity/regulation). Although evidence for associations between parenting behavior and youth's emotional processing has relied primarily on behavioral measures of emotion, researchers have begun to examine how parenting is related to the neural substrates of youth's reactivity and regulation. This article reviews a growing literature linking parental behavior with structural brain development as well as functional activity and connectivity in neural regions supporting emotional reactivity/regulation during infancy, childhood, and adolescence. By focusing on normative parental behaviors, we evaluate the evidence for associations between typical variations in caregiving and neural processes thought to support youth's emotional reactivity/regulation. The purpose of this review is to (1) extend the model put forth by Eisenberg and colleagues to consider the ways that parenting behaviors are related to neural substrates of youth's emotional reactivity and regulation; (2) review the empirical evidence for associations between parenting, particularly parental "emotion-related socialization behaviors" (ERSBs), and neural substrates of youth's emotional reactivity/regulation; and (3) recommend future directions for this emerging area of research. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Suicidal Ideation Among Anxious Youth: A Preliminary Investigation of the Role of Neural Processing of Social Rejection in Interaction with Real World Negative Social Experiences.

Suicidal ideation increases in adolescence, especially for anxious youth, and is a frequent precursor to suicide. This study examined whether neural processing of social rejection interacted with negative social experiences to predict suicidal ideation. Thus, to our knowledge this is the first study to examine how brain function may interact with the environment to contribute to suicidal ideation in youth, consistent with a developmental psychopathology perspective. Thirty-six anxious youth (ages 11 to 16) completed diagnostic interviews and questionnaires, an ecological momentary assessment (EMA) protocol, and a functional magnetic resonance imaging paradigm. Results showed that youth experienced greater severity of suicidal ideation when they exhibited heightened activation to social rejection in the right anterior insula and also experienced high levels of peer victimization or EMA-measured daily negative social experiences. Findings provide preliminary evidence that alterations in neural processing of social rejection interacts with exposure to negative social experiences to contribute to suicidal ideation.

Parenting and Youth Onset of Depression Across Three Years: Examining the Influence of Observed Parenting on Child and Adolescent Depressive Outcomes.

Concurrent associations between parenting behaviors and youth depression are well established. A smaller body of work has demonstrated longitudinal associations between aspects of parenting and youth risk for depression; however, this limited longitudinal work has predominantly relied upon self- and parent-report questionnaire measures and is thus affected by biases related to retrospective recall and common method variance. The present study used behavioral observation measures of parenting and clinical interview measures of youth depression to examine prospective relationships between observed parental support, responsiveness, criticism, and conflict and youths' onset of a depressive episode in a 3-year longitudinal design. Participants included 585 community youth age 8-16 (M = 11.92, SD = 2.39, 56.6% female) and a participating caregiver. Parental behavior was coded by trained observers in the context of a 5-min conflict resolution discussion at the baseline assessment. Youth onset of depression was subsequently assessed every 6 months for a period of 3 years using the Schedule for Affective Disorders and Schizophrenia for School Aged Children (KSADS) to ascertain whether youth experienced onset of depressive episode over the follow-up. Logistic regression analyses indicated that greater parental conflict at baseline predicted higher odds of youth experiencing a depressive onset across the 3-year follow up period, even after controlling for youth and caregiver history of depression at baseline. Findings suggest that parental conflict is particularly influential in youth vulnerability to depression.

The influence of family factors on time to suicidal ideation onsets during the adolescent developmental period.

Family factors are associated with suicidal behavior in youth, but little is known about how the joint influence of multiple family factors prospectively predicts onsets of suicidal ideation (SI) in adolescence, a developmental period characterized by increases in SI and risk for suicide. This study investigated whether parent history of SI interacted with either positive or negative parent-child relationship quality to longitudinally predict time to SI onsets during the transition into and across adolescence. Specifically, we used a longitudinal, multi-wave design and survival analyses to examine whether the interaction between these family factors prospectively predicted time to emergence of SI onsets (assessed at 6 month intervals over 3 years) in a community sample of youth ages 8 to 15 (N = 238; 57% girls). Results supported an interaction effect, such that more negative relationship quality with parents predicted earlier emergence of SI among those youth whose parents had no history of SI. However, negative parent relationship quality did not amplify risk among youth with parent history of SI; all youth with a parent history of SI were more likely to experience earlier emergence of SI regardless of level of negative relationship quality. Findings did not support an interaction between low levels of parent-child positive relationship quality and parent history of ideation. Implications for the role of family factors in the etiology and prevention of SI are discussed.

Prefrontal Cortical Response to Negative Social Words Links Social Risk to Depressive Symptoms in Adolescence.

Research suggests that altered emotion processing may be one important pathway linking social risk factors and depressive symptoms. We examined the extent to which neural response to negatively valenced social information might help to account for the relationship between social risk and depressive symptoms in youth. Forty-nine youth were scanned while identifying the emotional valence of words that connoted social status. They also completed questionnaires assessing self-reported social risk factors and depressive symptoms. Mediation analysis revealed that reduced dorsolateral prefrontal cortex activity in response to negative social status words explained the positive association between social risk and depressive symptoms. These findings suggest that social risk factors present during adolescence may contribute to depressive symptoms by influencing the neural substrates of emotion processing.

Maternal Affective Expression and Adolescents' Subjective Experience of Positive Affect in Natural Settings.

This study investigated the association between maternal affective expression during laboratory-based interaction tasks and adolescents' experience of positive affect (PA) in natural settings. Participants were 80 healthy adolescents and their mothers. Durations of maternal positive (PA) and negative affective (NA) expressions were observed during a conflict resolution task and a positive event planning interaction task. Ecological momentary assessment (EMA) procedures were employed to assess adolescents' momentary and peak experience of PA in daily life. Results indicated that maternal NA, but not maternal PA, was related to adolescents' EMA-reported PA. Adolescents whose mothers expressed more NA experienced less PA in daily environments. Results suggest that adolescents' exposure to maternal negative affective behavior is associated with adolescents' subjective daily well-being.

Effect of Parenting and Peer Stressors on Cognitive Vulnerability and Risk for Depression among Youth.

Parenting behaviors influence clinical depression among youth, but little is known about the developmental processes that may account for this association. This study investigated whether parenting is associated with the onset of clinical depression and depressive symptoms through negative cognitive style, particularly under conditions of high exposure to stressors, in a community sample of children and adolescents (N = 275; 59% girls). Observational methods were used to assess positive and negative parenting during a laboratory social-evaluative stressor task. Depressive symptoms and clinical depressive episodes were repeatedly assessed over an 18-month prospective follow-up period. Results supported a conditional indirect effect in which low levels of observed positive parenting during a youth stressor task were indirectly associated with an increased likelihood of experiencing an episode of depression and worsening depressive symptoms over the course of the study through youth negative cognitive style, but only for youth who also experienced a high number of peer stressors. These findings elucidate mechanisms through which problematic parenting may contribute to risk for the development of clinical depression during the transition into and across adolescence. Implications for depression interventions are discussed.

Childhood Emotional Maltreatment as a Robust Predictor of Suicidal Ideation: A 3-Year Multi-Wave, Prospective Investigation.

Despite literature suggesting a relationship between child maltreatment and suicidal ideation, few studies have examined the prospective course of this relationship. The current study examined this relationship in a sample of 682 community youth who were followed over the course of 3 years. Repeated measures of suicidal ideation, emotional maltreatment, and depressive symptom severity were examined in multi-wave path analysis models. Overall, results suggest that emotional maltreatment over time contributes uniquely to the prospective prediction of suicidal ideation, even when controlling for age, previous suicidal ideation, biological sex, and depression symptom severity. Unlike previous studies that have only measured emotional maltreatment at one-time point, the current study demonstrates that emotional maltreatment contributes unique risk to suicidal ideation prospectively among youth. Results speak to the importance of examining emotional maltreatment and suicidal ideation within prospective models of risk and suggest that emotional maltreatment is a robust predictor of suicidal ideation, over and above history of suicidal ideation and depression.

Linking Maternal Socialization of Emotion Regulation to Adolescents' Co-rumination With Peers.

Mounting research supports that co-rumination, the tendency to seek peer support by engaging in extensive negatively focused discussion, is a risk factor for adolescent psychopathology. It is unclear, though, how this interpersonal tendency develops. Parental responses to adolescents' negative affect likely shape how youth utilize peer relationships to regulate distress, as they shift to reliance on peer support during this developmental stage. For example, nonsupportive parental responses may fail to instill healthy regulation strategies, resulting in ineffective forms of peer support, such as co-rumination. Conversely, high levels of supportive parental responses to adolescents' negative affect may motivate youth to also express more negative affect with peers, leading to co-rumination. Eighty-nine healthy adolescents (9-17) and their mothers completed surveys and a support-seeking interaction. Only supportive maternal responses, including maternal affection, were associated with adolescents' co-rumination. These analyses indicate that some forms of parental support are associated with adolescents' tendency to co-ruminate.

The neurobiology of self-face recognition in depressed adolescents with low or high suicidality.

This study sought to test whether the neurobiology of self-processing differentiated depressed adolescents with high suicidality (HS) from those with low suicidality (LS) and healthy controls (HC; N = 119, MAGE = 14.79, SD = 1.64, Min = 11.3, Max = 17.8). Participants completed a visual self-recognition task in the scanner during which they identified their own or an unfamiliar adolescent face across 3 emotional expressions (happy, neutral or sad). A 3-group (HS, LS, HC) by 2 within-subject factors (2 Self conditions [self, other] and 3 Emotions [happy, neutral, sad]) GLM yielded (a) a main effect of Self condition with all participants showing higher activity in the right occipital, precuneus and fusiform during the self- versus other-face conditions; (b) a main effect of Group where all depressed youth showed higher dorsolateral prefrontal cortex activity than HC across all conditions, and with HS showing higher cuneus and occipital activity versus both LS and HC; and (c) a Group by Self by Emotion interaction with HS showing lower activity in both mid parietal, limbic, and prefrontal areas in the Happy self versus other-face condition relative to the LS group, who in turn had less activity compared to HC youth. Covarying for depression severity replicated all results except the third finding; In this subsequent analysis, a Group by Self interaction showed that although HC had similar midline cortical structure (MCS) activity for all faces, LS showed higher MCS activity for the self versus other faces, whereas HS showed the opposite pattern. Results suggest that the neurophysiology of emotionally charged self-referential information can distinguish depressed, suicidal youth versus nonsuicidal depressed and healthy adolescents. Neurophysiological differences and implications for the prediction of suicidality in youth are discussed. (PsycINFO Database Record

Emotion Socialization in Anxious Youth: Parenting Buffers Emotional Reactivity to Peer Negative Events.

Anxious youth exhibit heightened emotional reactivity, particularly to social-evaluative threat, such as peer evaluation and feedback, compared to non-anxious youth. Moreover, normative developmental changes during the transition into adolescence may exacerbate emotional reactivity to peer negative events, particularly for anxious youth. Therefore, it is important to investigate factors that may buffer emotional reactivity within peer contexts among anxious youth. The current study examined the role of parenting behaviors in child emotional reactivity to peer and non-peer negative events among 86 anxious youth in middle childhood to adolescence (Mean age = 11.29, 54 % girls). Parenting behavior and affect was observed during a social-evaluative laboratory speech task for youth, and ecological momentary assessment (EMA) methods were used to examine youth emotional reactivity to typical daily negative events within peer and non-peer contexts. Results showed that parent positive behaviors, and low levels of parent anxious affect, during the stressful laboratory task for youth buffered youth negative emotional reactivity to real-world negative peer events, but not non-peer events. Findings inform our understanding of parenting influences on anxious youth's emotional reactivity to developmentally salient negative events during the transition into adolescence.

Depression from childhood into late adolescence: Influence of gender, development, genetic susceptibility, and peer stress.

Depression is a debilitating mental illness with clear developmental patterns from childhood through late adolescence. Here, we present data from the Gene Environment Mood (GEM) study, which used an accelerated longitudinal cohort design with youth (N = 665) starting in 3rd, 6th, and 9th grades, and a caretaker, who were recruited from the general community, and were then assessed repeatedly through semistructured diagnostic interviews every 6 months over 3 years (7 waves of data) to establish and then predict trajectories of depression from age 8 to 18. First, we demonstrated that overall prevalence rates of depression over time, by age, gender, and pubertal status, in the GEM study closely match those trajectories previously obtained in past developmental epidemiological research. Second, we tested whether a genetic vulnerability-stress model involving 5-HTTLPR and chronic peer stress was moderated by developmental factors. Results showed that older aged adolescents with SS/SL genotype, who experienced higher peer chronic stress over 3 years, were the most likely to be diagnosed with a depressive episode over time. Girls experiencing greater peer chronic stress were the most likely to develop depression. This study used repeated assessments of diagnostic interviewing in a moderately large sample of youth over 3 years to show that depression rates increase in middle to late adolescence, or postpubertally, and that the gender difference in depression emerges earlier in adolescence (age 12.5), or postpubertally. Additionally, genetically susceptible older adolescents who experience chronic peer stress were the most likely to become depressed over time.

Parent relationship quality buffers against the effect of peer stressors on depressive symptoms from middle childhood to adolescence.

During the transition to adolescence, several developmental trends converge to increase the importance of peer relationships, the likelihood of peer-related stressors, and the experience of depressive symptoms. Simultaneously, there are significant changes in parent-child relationships. The current study sought to evaluate whether positive relationship quality with parents continued to serve a protective effect by buffering the relationship between stressful life events, especially peer stress, and increases in depressive symptoms throughout the transition to adolescence. Participants in a large (N = 692) 2-site accelerated longitudinal study were recruited in 3rd, 6th, and 9th grade and followed every 3 months for 1 year. At baseline, parents and youth reported on parent-child relationship quality, and every 3 months thereafter reported on their levels of stressors and depressive symptoms. Parent relationship quality moderated the relationship of person-level fluctuations in peer stressors, such that there was a stronger association between peer stressors and increases in depressive symptoms in youth with lower levels of positive parental relationship quality. This effect was specific to peer stressors. These results suggest that low levels of parent relationship quality leave youth particularly vulnerable to the depressogenic effects of peer stressors from childhood through adolescence.

Associations among negative parenting, attention bias to anger, and social anxiety among youth.

Theories of affective learning suggest that early experiences contribute to emotional disorders by influencing the development of processing biases for negative emotional stimuli. Although studies have shown that physically abused children preferentially attend to angry faces, it is unclear whether youth exposed to more typical aspects of negative parenting exhibit the same type of bias. The current studies extend previous research by linking observed negative parenting styles (e.g., authoritarian) and behaviors (e.g., criticism and negative affect) to attention bias for angry faces in both a psychiatrically enriched (ages 11-17 years; N = 60) and a general community (ages 9-15 years; N = 75) sample of youth. In addition, the association between observed negative parenting (e.g., authoritarian style and negative affect) and youth social anxiety was mediated by attention bias for angry faces in the general community sample. Overall, findings provide preliminary support for theories of affective learning and risk for psychopathology among youth.

Observed positive parenting behaviors and youth genotype: evidence for gene-environment correlations and moderation by parent personality traits.

Gene-environment correlations (rGE) have been demonstrated in behavioral genetic studies, but rGE have proven elusive in molecular genetic research. Significant gene-environment correlations may be difficult to detect because potential moderators could reduce correlations between measured genetic variants and the environment. Molecular genetic studies investigating moderated rGE are lacking. This study examined associations between child catechol-O-methyltransferase genotype and aspects of positive parenting (responsiveness and warmth), and whether these associations were moderated by parental personality traits (neuroticism and extraversion) among a general community sample of third, sixth, and ninth graders (N = 263) and their parents. Results showed that parent personality traits moderated the rGE association between youths' genotype and coded observations of positive parenting. Parents with low levels of neuroticism and high levels of extraversion exhibited greater sensitive responsiveness and warmth, respectively, to youth with the valine/valine genotype. Moreover, youth with this genotype exhibited lower levels of observed anger. There was no association between the catechol-O-methyltransferase genotype and parenting behaviors for parents high on neuroticism and low on extraversion. Findings highlight the importance of considering moderating variables that may influence child genetic effects on the rearing environment. Implications for developmental models of maladaptive and adaptive child outcomes, and interventions for psychopathology, are discussed within a developmental psychopathology framework.