Symptoms characteristics of personality disorders associated with suicidal ideation and behaviors in a clinical sample of adolescents with a depressive disorder.

Introduction: Pathological personality traits have repeatedly been identified as important risk factors for suicidal ideation and behaviors. Moreover, impulsive-aggressive traits, have shown a consistent association with suicidal behaviors across the lifespan. Adolescence represents a critical period for the emergence of different personality traits, mood disorders, and suicidal behaviors, but the relationship between these variables remain poorly understood. Methods: These variables were examined in a cross-sectional case-control design involving three groups: 30 adolescents with a depressive disorder and past suicide attempt (Mean Age = 16.2, Females = 26), 38 adolescents with a depressive disorder but without past suicide attempt (Mean age = 16.0, Females = 29), and 34 healthy adolescent controls (Mean age = 15.2, Females = 22). Suicidal ideations were indexed using Suicidal Behavior Questionnaire (SBQ-R), psychiatric disorder assessed using a semi-structured questionnaire (K-SADS-PL), depressive symptoms with the Beck Depressive Inventory (BDI), symptoms characteristics of personality disorders with the Scheduled Clinical Interview for the DSM-IV (SCID-II) screening questionnaire, and impulsivity with the Barratt Impulsivesness Scale (BIS). Results: Findings showed that impulsivity (F = 11.0, p < 0.0001) and antisocial symptoms characteristics of personality disorders (p < 0.001, d = 0.70) displayed the most robust association with adolescent suicide attempts. Borderline symptoms characteristics of personality disorders did not discriminate attempters from non-attempters but presented high correlations with suicidal ideation and depression severity. In an item-wise analysis, suicide attempt status was uniquely correlated with symptoms characteristics of an antisocial personality disorder. Suicide attempt status also correlated with non-suicidal self-injury and a chronic feeling of emptiness. Discussion: The caveats of this cross-sectional study include the stability of symptoms characteristics of personality disorders in adolescence and the limited sample size. In sum, suicidal behaviors were characteristically correlated with increased impulsivity and antisocial symptoms characteristics of personality disorders, but other symptoms characteristics of personality disorders were relevant to adolescent depression and suicidal ideation. Understanding the emergence of symptoms characteristics of personality disorders and suicidal behaviors in a developmental context can ultimately inform not only the neurobiological origin of suicidal behaviors, but also provide new avenues for early detection and intervention.

Respiratory sinus arrhythmia, negative social interactions, and fluctuations in unmet interpersonal needs: A daily diary study.

INTRODUCTION: This study examined daily fluctuations in the unmet interpersonal needs of thwarted belongingness and perceived burdensomeness in response to daily negative social interactions, as well as the moderating role of respiratory sinus arrhythmia (RSA) across adolescents at lower and higher risk for suicidal ideation. METHODS: Fifty five adolescents with major depressive disorder (MDD, i.e., higher-risk group) and without MDD (i.e., lower-risk group) completed measures of resting RSA, and daily measures of negative social interactions, perceived burdensomeness, and loneliness, as a proxy for thwarted belongingness, for 10 consecutive days. Within-person analyses examined the association between daily negative social interactions and unmet interpersonal needs, and the moderating roles of RSA and higher-risk group status. Between-person analyses also examined the association between RSA and unmet interpersonal needs across groups. RESULTS: At the within-person level, participants reported more unmet interpersonal needs on days when they reported more negative social interactions. At the between-person level, higher RSA was associated with decreased loneliness in both groups, and decreased burdensomeness among the higher-risk group. CONCLUSIONS: Negative social interactions are associated with daily unmet interpersonal needs. Higher RSA may serve as a protective factor mitigating risk for unmet interpersonal needs, particularly burdensomeness, among adolescents at higher risk for suicidal ideation.

Depression, anxiety, and suicidal ideation in a population-based cohort of young adults before and during the first 12 months of the COVID-19 pandemic in Canada.

OBJECTIVES: Findings from a birth cohort study indicated that the mental health of young adults had not worsened during the first wave of the COVID-19 pandemic, compared to 2018. This study examined longitudinal changes in mental health between March 2018 and June 2021 in the context of protracted public health mitigation measures about 12 months after the onset of the pandemic. METHODS: Participants from the Quebec Longitudinal Study of Child Development (n = 2120 at inception; n = 1461 during the COVID-19 pandemic), a population-based cohort of individuals born in 1997/1998, reported on their depressive and anxiety symptoms as well as suicidal ideation prior to the pandemic in 2018 (age 20), and during the pandemic in the summer of 2020 (age 22) and spring of 2021 (age 23). RESULTS: Depressive (Cohen's d = 0.15 [95% CI: 0.09 to 0.20]) and anxiety (Cohen's d = 0.33 [95% CI: 0.27 to 0.39]) symptoms increased between 2018 and 2021 for both males and females, but suicidal ideation did not change. There was also a significant increase in moderate to severe depressive (31.7% to 36.3%) and anxiety (14.7% to 24.8%) symptoms from 2018 to 2021. Youth who were students, those who were experiencing financial stress, food insecurity, and loneliness, and those without pre-existing poor mental health experienced the largest increase in depressive and anxiety symptoms over time. CONCLUSION: These findings highlight the mental health burden experienced by young adults during the COVID-19 pandemic, highlighting the need for preventive services and continued longitudinal follow-ups of these youths.

RéSUMé: OBJECTIFS: Les résultats d'une étude de cohorte de naissance ont indiqué que la santé mentale des jeunes adultes ne s'était pas détériorée au cours de la première vague de la pandémie de la COVID-19, en comparaison à 2018. La présente étude examine maintenant les changements longitudinaux de la santé mentale entre mars 2018 et juin 2021, dans le contexte de mesures prolongées de santé publique, environ 12 mois après le début de la pandémie. MéTHODES: Les participants de l'Étude longitudinale du développement des enfants du Québec (n = 2120 à la création; n = 1461 pendant la pandémie de COVID-19), une cohorte basée sur la population de personnes nées en 1997­98, ont rapporté leurs symptômes de dépression et d'anxiété ainsi que leurs idéations suicidaires avant la pandémie en 2018 (20 ans), pendant la pandémie à l'été 2020 (22 ans) ainsi qu'au printemps 2021 (23 ans). RéSULTATS: Les symptômes de dépression (d de Cohen = 0,15 [95% IC: 0,09 à 0,20]) et d'anxiété (d de Cohen = 0,33 [95% IC: 0,27 à 0,39]) ont augmenté entre 2018 et 2021 chez les hommes et les femmes, mais les idéations suicidaires n'ont pas changé. Une augmentation significative des symptômes dépressifs modérés à sévères (31,7 % à 36,3 %) et des symptômes d'anxiété (14,7 % à 24,8 %) a également été observée entre 2018 et 2021. Les jeunes qui étaient étudiants, ceux qui rapportaient un stress financier, de l'insécurité alimentaire et de la solitude, ainsi que ceux qui avaient une bonne santé mentale en prépandémie, ont connu la plus forte augmentation des symptômes de dépression et d'anxiété au fil du temps. CONCLUSION: Ces résultats mettent en évidence l'impact de la pandémie de la COVID-19 sur la santé mentale des jeunes adultes, et soulignent la nécessité de mettre en place des services de prévention et de poursuivre le suivi longitudinal de ces jeunes.

Respiratory sinus arrhythmia moderates the interpersonal consequences of brooding rumination.

Brooding rumination is an intrapersonal emotion regulation strategy associated with negative interpersonal consequences. Resting respiratory sinus arrhythmia (RSA), a psychophysiological marker of self-regulatory capacity, may buffer the association between maladaptive emotion regulation and negative interpersonal behaviors. The current work examines the moderating effect of RSA on the association between brooding rumination and different negative interpersonal consequences. Across three convenience samples, individuals with lower RSA showed a stronger association between brooding rumination and more negative interpersonal behaviors as well as less perception of received instrumental social support (Study 1; n = 154), higher levels of interviewer-rated interpersonal stress (Study 2; n = 42) and a stronger indirect association between brooding rumination and depressive symptoms via daily interpersonal stress (Study 3; n = 222). These findings highlight the negative interpersonal consequences of brooding rumination, particularly among individuals with lower RSA.

Suicidal ideation and behavior in youth in low- and middle-income countries: A brief review of risk factors and implications for prevention.

Although global rates of suicide have dropped in the last 30 years, youth in low- and middle-income countries (LMICs) continue to be highly represented in suicide statistics yet underrepresented in research. In this review we present the epidemiology of suicide, suicidal ideation, and suicide attempts among youth in LMICs. We also describe population-level (attitudes toward suicide, socioeconomic, and societal factors) and individual-level clinical and psychosocial risk factors, highlighting specific considerations pertaining to youth in LMICs. These specific considerations in risk factors within this population can inform how multi-level prevention strategies may be targeted to meet their specific needs. Prevention and intervention strategies relying on the stepped-care framework focusing on population-, community-, and individual level targets while considering locally- and culturally relevant practices are key in LMICs. In addition, systemic approaches favoring school-based and family-based interventions are important among youth. Cross-culturally adapted multimodal prevention strategies targeting the heterogeneity that exists in healthcare systems, suicide rates, and risk factors in these countries should be accorded a high priority to reduce the burden of suicide among youth in LMICs.

Group-based trajectories and predictors of adherence to physical distancing during the COVID-19 pandemic.

Objective: This study sought to identify psychosocial predictors of trajectories of adherence to physical distancing alongside changes in public health measures during the COVID-19 pandemic. Design: A three-time point longitudinal survey during the first two waves of the COVID-19 pandemic. Methods: Participants (N = 1003) completed self-report measures of adherence to physical distancing over an 8-month period at the start (T1) and end (T2) of the first wave of the pandemic, and the start of the second wave of the pandemic (T3). Participants also completed measures of their health beliefs related to the self and others, social norms, emotional distress, and sociodemographic characteristics. Results: Using group-based trajectory modeling, four trajectories of adherence to physical distancing emerged: a high-adherence trajectory, a slow-declining trajectory, a fluctuating trajectory, and a fast-declining trajectory. The most important psychosocial predictors of poorer adherence trajectories included perceptions of lower self-efficacy and higher barriers to adherence, as well as lower prosocial attitudes towards physical distancing. Conclusion: Public health messages targeting these factors may be most relevant to promote sustained adherence to physical distancing over time in the context of a pandemic.

Heart rate variability moderates the between- and within-person associations between daily stress and negative affect.

Stress exposure increases risk for depressive symptoms. However, there are substantial individual differences in affective responses to stress. High-frequency heart rate variability (HF-HRV), a marker of vagally-mediated parasympathetic activity, has been conceptualized as a psychophysiological index of emotion regulation that may moderate individuals' responses to stress. Using a daily diary design, we tested whether individual differences in resting HF-HRV moderated the association between daily child-related stress and negative affect among a sample of 84 heterosexual couples with preschool-aged children. After controlling for participants' age, gender, socioeconomic status, employment status, and ethnicity, hierarchical linear modeling revealed that resting HF-HRV moderated both the between-person and within-person associations between self-reported child-related stress and daily negative affect. Between-person analyses indicated that the strength of the positive association between mean daily child stress and negative affect across the daily diary period increased with decreasing resting HF-HRV. Similarly, within-person analyses indicated that on days when participants reported more child-related stress than usual, the magnitude of the increase in negative affect on that day was inversely related to resting HF-HRV. Taken together, these findings suggest that lower resting HF-HRV may index vulnerability to stress-related disturbances in negative affect. This increased negative affective response to daily stress may be one pathway through which individuals with lower resting HF-HRV are at increased risk for depressive symptoms over time.

Socio-demographic, social, cognitive, and emotional correlates of adherence to physical distancing during the COVID-19 pandemic: a cross-sectional study.

OBJECTIVES: In order for physical distancing directives to be effective at lowering and flattening the epidemic peak during a pandemic, individuals must adhere to confinement guidelines. Recent reviews highlight the paucity of research on empirical correlates of adherence to physical distancing and quarantine directives. METHODS: In this cross-sectional study, 1003 individuals were recruited using quota sampling to form a sample approximately representative of the population of Quebec (Canada) in terms of age, gender, and urbanicity. Participants completed an online survey on adherence to physical distancing during the COVID-19 pandemic. This survey evaluated socio-demographic, health, cognitive, emotional, and social factors related to physical distancing. RESULTS: Individuals aged 70 and older (OR = 1.67, 95% CI = 1.04-2.67), women (OR = 1.35, 95% CI = 1.02-1.79), and those who were not essential workers (OR = 3.28, 95% CI = 2.24-4.81) reported more physical distancing. Injunctive personal norms (OR = 1.67, 95% CI = 1.23-2.31), perceived benefits of physical distancing to others (OR = 1.47, 95% CI = 1.12-1.93), and descriptive social norms (OR = 1.26, 95% CI = 1.04-1.52) were independent predictors of adherence status. Individuals adhered more to physical distancing if they believed that it was their civic duty to do so and that physical distancing helped protect others, and if they perceived that most other people were following these directives. In contrast, perceived personal risk and emotional factors were not independently related to physical distancing. CONCLUSION: These results highlight the importance of health beliefs and perceived social norms in shaping responses to physical distancing directives. These findings offer insights into ways to frame public health communications to promote physical distancing during a pandemic.

RéSUMé: OBJECTIFS: Afin d'assurer l'efficacité des directives de distanciation physique à aplatir la courbe épidémique lors d'une pandémie, les membres de la communauté doivent respecter les règles de confinement. Des revues de la littérature mettent en évidence le manque de données empiriques sur les corrélats de l'adhérence aux directives de distanciation physique et de quarantaine. MéTHODES: Dans cette étude transversale, 1 003 individus ont été recrutés en utilisant une méthode d'échantillonnage par quota afin de constituer un échantillon approximativement représentatif de la population du Québec, Canada, en termes d'âge, de genre, et de ruralité. Les participants ont complété une enquête en ligne sur l'adhérence à la distanciation physique durant la pandémie de la COVID-19. Cette enquête a évalué l'association entre l'adhérence à la distanciation physique et les facteurs sociodémographiques, médicaux, cognitifs, émotionnels, et sociaux. RéSULTATS: Les individus âgés de 70 ans et plus (RC = 1,67, IC95% = 1,04­2,67), les femmes (RC = 1,35, IC95% = 1,02­1,79) et ceux qui n'étaient pas des travailleurs essentiels (RC = 3,28, IC95% = 2,24­4,81) ont rapporté plus de distanciation physique. Les normes injonctives personnelles (RC = 1,67, IC95% = 1,23­2,31), la perception de bénéfices de la distanciation physique pour les autres (RC = 1,47, IC95% = 1,12­1,93), et les normes sociales descriptives (RC = 1,26, IC95% = 1,04­1,52) étaient des facteurs prédictifs indépendants de l'adhérence. L'adhérence à la distanciation physique était plus probable chez les individus qui croyaient qu'il était de leur devoir civique de respecter les directives et que la distanciation physique aidait à protéger les autres, et qui percevaient que la plupart des autres personnes respectaient aussi ces directives. La perception du risque personnel et les facteurs émotionnels n'étaient pas associés de façon indépendante à la distanciation physique. CONCLUSION: Ces résultats soulignent l'importance des croyances sur la santé et des normes sociales perçues dans la réponse aux directives de distanciation physique. Ces résultats suggèrent différentes façons d'optimiser la présentation des communications de santé publique afin de promouvoir la distanciation physique lors d'une pandémie.

Implicit Affect, Heart Rate Variability, and the Metabolic Syndrome.

OBJECTIVE: Greater negative affect has been associated with an increased risk of the metabolic syndrome (METs). However, all studies to date have examined this association using explicit affect measures based on subjective ratings of emotional experiences. Prior studies suggest that implicit affect, representing the automatic, prereflective appraisal process involved in conscious emotional experiences, is associated with physiological stress responses independent of explicit affect. Furthermore, low resting heart rate variability (HRV) may increase the risk of stress-related diseases. The goals of this study were to evaluate the associations between implicit and explicit affect and METs and to assess whether these associations were amplified by lower HRV. METHODS: This secondary analysis of a larger study included 217 middle-aged women who completed measures of implicit affect, explicit affect, high-frequency HRV, and the different components of METs. RESULTS: There was a significant interaction between implicit negative affect and HRV predicting METs (odds ratio = 0.57, 95% confidence interval = 0.35-0.92), such that the combination of higher implicit affect and lower HRV was associated with a greater likelihood of METs. Similarly, there was a main effect of implicit negative affect as well as an interaction between implicit negative affect and HRV on the lipid accumulation product (b (standard error) = -0.06 (0.02), 95% confidence interval = -0.11 to -0.02), a combination of waist circumference and triglycerides. CONCLUSIONS: Higher implicit negative affect in the context of lower HRV may be related to a greater risk of METs. The present findings highlight the relevance of including implicit affect measures in psychosomatic medicine research.

Association between romantic partners' rumination and couples' conflict is moderated by respiratory sinus arrhythmia.

Close relationships are an important social context in which emotional experiences, regulation, and coregulation unfold. This interpersonal emotion regulation process is likely intertwined with the self-regulatory capacities and social skills of each individual dyad member. This study aimed to examine whether respiratory sinus arrhythmia (RSA), a physiological marker related to self-regulation, moderates the impact of rumination, a maladaptive emotion regulation strategy, on couples' conflict. A dyadic, longitudinal design examined the association among RSA, rumination, and couples' conflict in a sample of 83 cohabiting romantic partners raising young children. At baseline, rumination and RSA from each romantic partner were assessed. Couples' conflict was reported at 3 time points over the following 12 months. Actor-partner interdependence modeling examined the mutual contributions of each couple member's rumination to couples' conflict, as well as the moderating impact of RSA. Results indicated that rumination from both members of the dyad were independently associated with couples' conflict across the 12-month period. Furthermore, RSA moderated the association between one's partner's rumination and couples' conflict, such that high actor RSA attenuated the positive association between partner's rumination and couples' conflict. The findings highlight the interdependent nature of emotion regulation within close relationships, and the impact of RSA on interpersonal emotion regulation processes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Attachment style and changes in systemic inflammation following migration to a new country among international students.

Attachment style may influence the acculturation process by shaping the types of social relationships that individuals form and maintain. Social relationship quantity and quality have been linked to chronic low-grade systemic inflammation, an immune process associated with risk for age-related diseases. The goal of this study was to investigate whether attachment style moderates the change in systemic inflammation during the early phases of the acculturation process, a period associated with rapid changes in social functioning. In this 5-month longitudinal study, 58 new international students completed the Adult Attachment Scale and provided blood samples for C-reactive protein (CRP) analysis shortly after arrival in the host country as well as 2 and 5 months later. Results indicated that individuals with higher attachment anxiety experienced larger increases in CRP over time. During a period of rapid changes in social functioning, attachment anxiety promotes immune changes that may increase health risk over time.

Regional Variations in Suicide and Undetermined Death Rates among Adolescents across Canada.

OBJECTIVE: Trends in rates of adolescent suicide and undetermined deaths in Canada from 1981 to 2012 were examined, focusing specifically on variations between Canadian regions. Exploratory hypotheses were formulated for regional variability in adolescent suicide rates over time in Canada. METHODS: A descriptive time trend analysis using public domain vital statistics data was performed. All deaths from 1981 to 2012 among 15 to 19 year olds coded as suicides or undetermined intent according to the International Classification of Diseases, 9th and 10th Revisions were included. RESULTS: While there was an overall stability in adolescent suicide and undetermined death rates across Canada, regional analyses showed that Quebec experienced a 7.6% annual reduction between 2001 and 2012 while the Prairies and Atlantic provinces experienced significant annual increases since 2001. Ontario and British Columbia have had non-significant fluctuations since 2001. The trends remained similar overall when excluding undetermined deaths from the analyses. CONCLUSIONS: Variations in adolescent suicide trends across provinces were found. Factors such as provincial suicide action and prevention legislation contributing to these variations remain to be studied, but these regional differences point towards the need for better consistency of suicide prevention strategies across the country.

OBJECTIF: Les tendances des taux de suicide adolescent et des décès indéterminés au Canada de 1981 à 2012 ont été examinées, en mettant spécialement l'accent sur les variations entre les régions canadiennes. Des hypothèses exploratoires ont été formulées pour la variabilité régionale des taux de suicide adolescent avec le temps au Canada. MÉTHODES: Une analyse descriptive de l'évolution dans le temps utilisant les données des statistiques vitales du domaine public a été menée. Tous les décès de 1981 à 2012 chez les 15 à 19 ans codés comme suicides ou de cause indéterminée selon la Classification internationale des maladies, 9e et 10e révisions, étaient inclus. RÉSULTATS: Même s'il y avait une stabilité générale des taux de suicide adolescent et des décès indéterminés au Canada, les analyses régionales montraient que le Québec a connu une diminution annuelle de 7,6 % entre 2001 et 2012 alors que les Prairies et les provinces de l'Atlantique ont enregistré des hausses annuelles significatives depuis 2001. L'Ontario et la Colombie-Britannique ont eu des fluctuations non significatives depuis 2001. Les tendances sont demeurées semblables généralement en excluant les décès indéterminés des analyses. CONCLUSIONS: Des variations des tendances du suicide adolescent entre les provinces ont été constatées. Les facteurs contribuant à ces variations demeurent à étudier, comme les plans d'action et les mesures législatives provinciales de prévention du suicide. Ces différences régionales indiquent le besoin d'une meilleure cohésion des stratégies de prévention du suicide dans tout le pays.

High-Frequency Heart Rate Variability Reactivity and Trait Worry Interact to Predict the Development of Sleep Disturbances in Response to a Naturalistic Stressor.

BACKGROUND: High-frequency heart rate variability (HF-HRV) reactivity was proposed as a vulnerability factor for stress-induced sleep disturbances. Its effect may be amplified among individuals with high trait worry or sleep reactivity. PURPOSE: This study evaluated whether HF-HRV reactivity to a worry induction, sleep reactivity, and trait worry predict increases in sleep disturbances in response to academic stress, a naturalistic stressor. METHOD: A longitudinal study following 102 undergraduate students during an academic semester with well-defined periods of lower and higher academic stress was conducted. HF-HRV reactivity to a worry induction, trait worry using the Penn State Worry Questionnaire, and sleep reactivity using the Ford Insomnia Stress Reactivity Test were measured during the low stress period. Sleep disturbances using the Pittsburgh Sleep Quality Index were assessed twice during the lower stress period and three times during the higher stress period. RESULTS: Greater reductions in HF-HRV in response to the worry induction predicted increases in sleep disturbances from the lower to the higher academic stress period. Trait worry moderated this association: individuals with both higher trait worry and greater HF-HRV reactivity to worry had larger increases in stress-related sleep disturbances over time, compared to participants with lower trait worry and HF-HRV reactivity. A similar, but marginally significant effect was found for sleep reactivity. CONCLUSION: This study supports the role of HF-HRV reactivity as a vulnerability factor for stress-induced sleep disturbances. The combination of high trait worry and high HF-HRV reactivity to worry might identify a subgroup of individuals most vulnerable to stress-related sleep disturbances.

Parent-youth agreement on self-reported competencies of youth with depressive and suicidal symptoms.

OBJECTIVE: A multi-informant approach is often used in child psychiatry. The Achenbach System of Empirically Based Assessment uses this approach, gathering parent reports on the Child Behaviour Checklist (CBCL) and youth reports on the Youth Self-Report (YSR), which contain scales assessing both the child's problems and competencies. Agreement between parent and youth perceptions of their competencies on these forms has not been studied to date. METHOD: Our study examined the parent-youth agreement of competencies on the CBCL and YSR from a sample of 258 parent-youth dyads referred to a specialized outpatient clinic for depressive and suicidal disorders. Intraclass correlation coefficients were calculated for all competency scales (activity, social, and academic), with further examinations based on youth's sex, age, and type of problem. RESULTS: Weak-to-moderate parent-youth agreements were reported on the activities and social subscales. For the activities subscale, boys' ratings had a strong correlation with parents' ratings, while it was weak for girls. Also, agreement on activities and social subscales was stronger for dyads with the youth presenting externalizing instead of internalizing problems. CONCLUSION: Agreement on competencies between parents and adolescents varied based on competency and adolescent sex, age, and type of problem.

The CBCL dysregulated profile: an indicator of pediatric bipolar disorder or of psychopathology severity?

BACKGROUND: To evaluate whether the Child Behavior Checklist Dysregulated Profile (CBCL-DP) can be used as an effective predictor of psychopathological severity as indicated by suicidality and comorbidities, as well as a predictor of pediatric bipolar disorder (PBD). METHOD: CBCL-DP scores for 397 youths seeking treatment for mood disorders were calculated by summing the t-scores of the Anxious/Depressed, Aggressive Behaviors, and Attention Problems subscales such that a clinical cut-off of 210 was used to indicate the presence of a dysregulated profile. Suicidality and an increased number of diagnoses were used as markers of illness severity. RESULTS: Those with a dysregulated profile presented more severe suicidal ideation when compared to those without the profile. They also had a significantly larger number of Axis I diagnoses. Groups did not differ in the amount of individuals diagnosed with PBD. LIMITATIONS: Suicidal ideation was assessed by a third-party informant and not from the youths themselves. No other forms of suicidal behavior such as self-harm or suicide attempt were measured. Also there may not be complete convergence between parental reports on behavior and youth reports, which might have affected the results. CONCLUSIONS: These findings suggest that the CBCL-DP is an effective indicator of psychopathological severity through its association with more comorbidities and more severe suicidality. Earlier detection of psychopathological severity through an initial screening tool could aid clinicians in planning treatment and providing quicker and more structured care based on the client's needs.