Same, opposite and both-sex attracted adolescents' mental health, safe-sex practices and substance use.

This study examined mental health, substance use, and sexual health across sexual attraction groups. 428 adolescents recruited from school-based health centers completed self-report measures. 72% were only opposite-sex attracted, 19% both-sex attracted, 3% same-sex attracted, 4% not sure. Reported partners did not always align with reported attraction. Compared to opposite-sex attracted youth, 1) both-sex attracted youth had significantly higher rates of marijuana use (OR=1.75, p=.04), depressive symptoms (OR=2.62, p=.001) and inconsistent condom use (OR=1.71, p=.05); 2) the "not sure" group had higher anxiety symptoms (OR=4, p=.01). This study highlights the importance of considering sexual attraction in providing quality care to young people.

Effect of Electronic Screening With Personalized Feedback on Adolescent Health Risk Behaviors in a Primary Care Setting: A Randomized Clinical Trial.

Importance: Health risk behaviors are a leading cause of morbidity during adolescence. Screening and counseling for health risk behaviors are recommended but infrequently performed. Objective: To test the effect of an electronic screening and feedback tool on clinician counseling and adolescent-reported health risk behaviors. Design, Setting, and Participants: A randomized clinical trial compared electronic screening and feedback on an intention-to-treat basis with usual care among 300 youths 13 to 18 years of age at 5 pediatric clinics in the Pacific Northwest. Outcomes were assessed via electronic survey at 1 day and 3 months after the initial visit. Study data collection occurred from March 13, 2015, to November 29, 2016, and statistical analysis was conducted between February 6, 2017, and June 20, 2018. Interventions: Youths in the intervention group (n = 147) received electronic screening and personalized feedback with clinician clinical decision support. Youths in the control group (n = 153) received standard screening and counseling as provided by their clinic. Main Outcomes and Measures: Youths' report of receipt of counseling during the visit and risk behaviors at 3 months. Results: In the final study sample of 300 youths (intervention group, 75 girls and 72 boys; mean [SD] age, 14.5 [1.4 years]; and control group, 80 girls and 73 boys; mean [SD] age, 14.5 [1.4] years), 234 (78.0%) were aged 13 to 15 years. After adjusting for age, sex, and random effect of clinic, youths in the intervention group were more likely to receive counseling for each of their reported risk behaviors than were youths in the control group (adjusted rate ratio, 1.32; 95% CI, 1.07-1.63). Youths in the intervention group had a significantly greater reduction (ß = -0.48; 95% CI, -0.89 to -0.02; P = .02) in their risk behavior scores at 3 months when compared with youths in the control group. Conclusions and Relevance: Electronic screening of health risk behavior with clinical decision support and motivational feedback to teens can improve care delivery and outcomes. Trial Registration: ClinicalTrials.gov identifier: NCT02360410.

Changes in peer norms as a mediator of reduction in adolescent alcohol use.

Background: Evidence from college samples suggests that changes in peer norms (perception about peer use) mediate changes in alcohol use. There is relatively little intervention-based research in adolescents. Objectives: To investigate whether changes in peer norms mediate the relationship between a brief intervention to reduce alcohol use, and level of use; additionally, to determine whether any mediation effects differ by adolescent age. Methods: Eighty-four adolescents aged 14-18 (Mean = 16.49, SD = 1.00), presenting to school-based health centers with moderate to high risk alcohol use were randomized to receive an electronic screening and feedback tool (Check Yourself) in addition to their visit, or their visit alone. Check Yourself includes provision of normative feedback regarding adolescent alcohol use. Measures of self-reported alcohol use, and peer norms were collected at baseline and 2-month follow-up. Results: Changes in perceptions of the proportion of peers using alcohol significantly mediated the relationship between the intervention and all three alcohol outcomes (frequency, typical quantity, and maximum quantity) such that reductions in perceived peer use were associated with reduced use. Moderated mediation suggested that these effects were stronger for younger adolescents compared with older adolescents. Perceptions of the frequency and quantity of peer use were not significant mediators of alcohol use. Conclusions/Importance: Results suggest that integrating normative feedback regarding peer alcohol use is a promising approach in adolescent focused school interventions. They extend previous findings by suggesting that perceptions of the proportion of peers using may be particularly meaningful, and that effects may be more pronounced in younger adolescents.

Screening and brief intervention with adolescents with risky alcohol use in school-based health centers: A randomized clinical trial of the Check Yourself tool.

Background: This study aimed to compare care delivery and alcohol and marijuana use for adolescents with risky alcohol use who received a school-based health center (SBHC) visit with and without the Check Yourself tool, an electronic tool that gives motivational feedback on substance use and summarizes results for providers. Methods: We conducted a randomized controlled trial with 148 adolescents aged 13-18 who met criteria for moderate- to high- risk alcohol use, recruited from urban SBHCs. Participants were randomized to receive their SBHC visit with (n = 73) or without (n = 75) the Check Yourself screening and feedback tool. All SBHC providers received a brief training on motivational interviewing. Results: Adolescents who received the Check Yourself tool + SBHC visit reported higher levels of alcohol (67%) and marijuana (73%) counseling from the provider during their visit, compared with those who received a SBHC visit without the tool (40% and 45%, respectively, Ps < .005), and had higher motivation to decrease marijuana use relative to those who did not (P = .02). Relative to baseline, adolescents in both groups reduced their typical number of drinks of alcohol, maximum number of drinks of alcohol, and hours high on marijuana over time (Ps < .02) at 2-month follow-up. Conclusion: When adolescent patients are given an electronic screening and feedback tool, it can prompt providers to increase counseling of adolescents with substance use risk. Overall, participants who had a visit with a trained provider reported high satisfaction with care and decreased the amount of alcohol use over 2 months, suggesting that SBHCs are an excellent venue for delivery of brief substance use interventions.

Adolescent Health Risk Behaviors: Parental Concern and Concordance Between Parent and Adolescent Reports.

OBJECTIVE: We investigated which adolescent health risk behaviors are of concern to parents generally, according to adolescent age, gender, and in the context of perceived risk. We compared adolescent and parent reports of the presence of health-risk behaviors and factors predicting agreement. METHODS: Three hundred adolescents aged 13 to 18 years (mean, 14.5 years; 52% female) who presenting for well care completed an electronic screening tool used to assess health-risk behaviors. Parents completed parallel measures of their child's behavior and parental concern. Adolescent and parent reports were compared using McNemar test. Hierarchical linear regression was used to examine predictors of agreement. RESULTS: High parental concern was most commonly reported for screen time and diet. When parents identified their adolescent as at-risk, high parental concern was near universal for mental health but less commonly reported for substance use. There were no differences in parental concern according to adolescent gender. Parents of older adolescents expressed more concern regarding physical activity and alcohol. Compared with adolescents, parents were more likely to report risk regarding anxiety, fruit and vegetable consumption, and physical activity, and less likely to report risk regarding screen time, sleep, and marijuana use. Younger adolescent age and higher family relationship quality were predictive of stronger parent-adolescent agreement. CONCLUSIONS: Parents in well-care visits commonly have concerns about adolescent lifestyle behaviors. Although parents are more likely to report concern when they know about a behavior, parental concern is not always aligned with parental awareness of risk, particularly for substance use. Parent report of higher prevalence of some risk behaviors suggests their input might assist in risk identification.

Systematic review and meta-analysis of dropout rates in individual psychotherapy for generalized anxiety disorder.

BACKGROUND: Despite being a relatively prevalent and debilitating disorder, Generalized Anxiety Disorder (GAD) is the second least studied anxiety disorder and among the most difficult to treat. Dropout from psychotherapy is concerning as it is associated with poorer outcomes, leads to service inefficiencies and can disproportionately affect disadvantaged populations. No study to date has calculated a weighted mean dropout rate for GAD and explored associated correlates. METHODS: A systematic review was conducted using PsycINFO, Medline and Embase databases, identifying studies investigating individual psychotherapies for adults with GAD. Forty-five studies, involving 2224 participants, were identified for meta-analysis. RESULTS: The weighted mean dropout rate was 16.99% (95% confidence interval 14.42%-19.91%). The Q-statistic indicated significant heterogeneity among studies. Moderator analysis and meta-regressions indicated no statistically significant effect of client age, sex, symptom severity, comorbidity, treatment type, study type (randomized trial or not), study quality, number of sessions or therapist experience. CONCLUSIONS: In research investigating psychotherapy for GAD, approximately one in six clients can be expected to drop out of treatment. Dropout rate was not significantly moderated by the client, therapist or treatment variables investigated. Future research should specify the definition of dropout, reasons for dropout and associated correlates to assist the field's progression.

Alliance rupture and repair processes and therapeutic change in youth with borderline personality disorder.

OBJECTIVES: This study aimed to investigate alliance rupture and repair processes in psychotherapy for youth with borderline personality disorder. It sought to examine whether alliance processes differ between treatments, across the phases of therapy, and what associations these processes might have with therapeutic outcomes. DESIGN: The study involves repeated measurement of both process and outcome measures. Hypotheses were addressed using within- and between-subjects analyses. METHODS: Forty-four people, aged 15-24, with a diagnosis of BPD were randomized to receive either 16 sessions of Cognitive Analytic Therapy (CAT) or a supportive treatment known as Befriending. In addition to pre-post outcome assessments, alliance processes were rated using the observer-based Rupture Resolution Rating Scale. RESULTS: Results indicated that CAT and Befriending did not differ in terms of number of ruptures, although CAT was associated with more stages of rupture resolution. Examination of alliance processes across time pointed to increasing ruptures, more frequent confrontation ruptures and increasing rupture resolution, suggesting increased volatility, directness and productivity in the therapeutic process across time. Contrary to hypotheses, there was no consistent link between alliance processes and outcome. However, two specific phases were significant. Early treatment ruptures were associated with poor outcome whereas greater late treatment resolution was associated with better outcomes. CONCLUSIONS: This study suggests that alliance processes can differ across treatments and the phases of therapy in psychotherapy for youth with BPD. Alliance ruptures are more likely to be problematic early in therapy but later in therapy, they appear to be opportunities for therapeutic growth. PRACTITIONER POINTS: Alliance ruptures are more likely than not to occur in any given session with a young person with Borderline Personality Disorder. Early in therapy, withdrawal type ruptures are more frequent, whereas late in therapy, confrontation ruptures are more frequent. Late in therapy, alliance ruptures should be viewed as opportunities for therapeutic change, rather than barriers to good outcomes.

The relationship between the readiness for change and clinical outcomes in response to multidisciplinary pain management.

OBJECTIVE: The pain stages of change questionnaire (PSOCQ) has been designed to assess the willingness of chronic pain patients to engage in self-management approaches. This study sought to examine the utility of the PSOCQ as a predictor of treatment completion and the relationship with treatment outcome. DESIGN: A convenience sample, uncontrolled, pre- and post-intervention cohort design. SETTING: Multidisciplinary pain management center. PATIENTS: Two hundred and sixty-one participants with chronic nonmalignant pain. INTERVENTIONS: Eight-week program of either cognitive behavioral therapy group or a functional restoration group. OUTCOME MEASURES: Brief Pain Inventory average pain rating. The Short Form Health Survey (SF-36 version 2) mental health and physical functioning subscales as well as the PSOCQ. RESULTS: Results suggest that those higher on precontemplation and lower on the other scales are less likely to complete treatment. A two-way multiple analysis of variance also found that when comparing those who progress through stages with those who stagnate or regress, "progressors" show significantly more improvement in measures of mood and functionality but not pain. The treatment groups did not appear to have significantly different outcomes in terms of stage of change. CONCLUSIONS: These findings suggest that the PSOCQ may be useful in making treatment more efficient, both by predicting who is less likely complete treatment and by providing targeted treatments according to patients' readiness to engage in self-management.