Adolescent Binge Drinking Is Associated With Accelerated Decline of Gray Matter Volume.

The age- and time-dependent effects of binge drinking on adolescent brain development have not been well characterized even though binge drinking is a health crisis among adolescents. The impact of binge drinking on gray matter volume (GMV) development was examined using 5 waves of longitudinal data from the National Consortium on Alcohol and NeuroDevelopment in Adolescence study. Binge drinkers (n = 166) were compared with non-binge drinkers (n = 82 after matching on potential confounders). Number of binge drinking episodes in the past year was linked to decreased GMVs in bilateral Desikan-Killiany cortical parcellations (26 of 34 with P < 0.05/34) with the strongest effects observed in frontal regions. Interactions of binge drinking episodes and baseline age demonstrated stronger effects in younger participants. Statistical models sensitive to number of binge episodes and their temporal proximity to brain volumes provided the best fits. Consistent with prior research, results of this study highlight the negative effects of binge drinking on the developing brain. Our results present novel findings that cortical GMV decreases were greater in closer proximity to binge drinking episodes in a dose-response manner. This relation suggests a causal effect and raises the possibility that normal growth trajectories may be reinstated with alcohol abstinence.

A prospective study of religion/spirituality and depressive symptoms among adolescent psychiatric patients.

OBJECTIVE: Previous research has uncovered relationships between religion/spirituality and depressive disorders. Proposed mechanisms through which religion may impact depression include decreased substance use and enhanced social support. Little investigation of these topics has occurred with adolescent psychiatric patients, among whom depression, substance use, and social dysfunction are common. METHOD: 145 subjects, aged 12-18, from two psychiatric outpatient clinics completed the Beck Depression Inventory-II (BDI-II), the Fetzer multidimensional survey of religion/spirituality, and inventories of substance abuse and perceived social support. Measures were completed again six months later. Longitudinal and cross-sectional relationships between depression and religion were examined, controlling for substance abuse and social support. RESULTS: Of thirteen religious/spiritual characteristics assessed, nine showed strong cross-sectional relationships to BDI-II score. When perceived social support and substance abuse were controlled for, forgiveness, negative religious support, loss of faith, and negative religious coping retained significant relationships to BDI-II. In longitudinal analyses, loss of faith predicted less improvement in depression scores over 6 months, controlling for depression at study entry. LIMITATIONS: Self-report data, clinical sample. CONCLUSIONS: Several aspects of religiousness/spirituality appear to relate cross-sectionally to depressive symptoms in adolescent psychiatric patients. Findings suggest that perceived social support and substance abuse account for some of these correlations but do not explain relationships to negative religious coping, loss of faith, or forgiveness. Endorsing a loss of faith may be a marker of poor prognosis among depressed youth.

Cognitive risk factors and suicide attempts among formerly hospitalized adolescents: a prospective naturalistic study.

OBJECTIVE: To examine the relationship between cognitive variables and time until suicide attempts among 180 adolescents who were monitored for as much as 6.9 years after discharge from an inpatient psychiatry unit. METHOD: In a prospective naturalistic study, adolescents were assessed at the time of their psychiatric hospitalization and semiannually thereafter. Suicidal behavior at index hospitalization and over the follow-up period was assessed with semistructured psychiatric diagnostic interviews. At hospitalization, cognitive risk factors were assessed with a problem-solving task and with questionnaires assessing hopelessness, expectations for posthospitalization suicidal behavior, reasons for living, and dysfunctional attitudes. RESULTS: Expectations about future suicidal behavior were related to posthospitalization suicide attempts. Among youths with previous suicide attempts, higher levels of hopelessness were associated with increased risk, and greater survival and coping beliefs were associated with decreased risk for posthospitalization suicide attempts. Hopelessness and survival and coping beliefs were not related to posthospitalization attempts among adolescents without prior suicidal behavior, and hopelessness was not predictive after controlling for overall severity of depression. CONCLUSIONS: Expectations for suicidal behavior, hopelessness, and survival and coping beliefs provide important prognostic information about later suicidal behavior and should be targeted in interventions with suicidal youths.

Suicide attempts among formerly hospitalized adolescents: a prospective naturalistic study of risk during the first 5 years after discharge.

OBJECTIVE: To examine risk for suicide attempts among 180 consecutively referred adolescents during the first 5 years after discharge from an inpatient psychiatry unit. METHOD: In a prospective naturalistic study, adolescents were assessed at psychiatric hospitalization and semiannually thereafter for up to 5 years with semistructured psychiatric diagnostic interviews and self-report questionnaires. RESULTS: Approximately 25% of the adolescents attempted suicide and no adolescents completed suicide within the first 5 years after discharge. The first 6 months to 1 year after discharge represented the period of highest risk. The number of prior attempts was the strongest predictor of posthospitalization attempts. Affective disorders by themselves did not predict later suicide attempts but were related to posthospitalization attempts when accompanied by a history of past suicide attempts. Independent of psychiatric diagnoses, severity of depressive symptoms and trait anxiety also predicted suicide attempts. Similar to the effect with affective disorders, depressive symptoms were most strongly related to posthospitalization suicidality among adolescents with a prior history of suicide attempts. CONCLUSIONS: Particularly among youths with prior suicidal behavior, clinicians should be alert to the above constellation of psychiatric predictors of posthospitalization suicidal behavior.

Psychiatric diagnoses of previous suicide attempters, first-time attempters, and repeat attempters on an adolescent inpatient psychiatry unit.

OBJECTIVE: To compare psychiatric diagnoses of hospitalized adolescents who (a) have made previous but no recent suicide attempts, (b) have recently made their first suicide attempt, (c) have recently made a second or subsequent attempt, or (d) have never made an attempt. METHOD: Semistructured psychiatric diagnostic interviews were used to determine psychiatric diagnoses and history of recent and previous suicidal behavior of 269 consecutively admitted adolescents to an inpatient psychiatric facility. Forty-nine previously suicidal youths, 28 first-time attempters, and 33 repeat attempters were compared with 159 nonsuicidal youths in prevalence of Axis I psychiatric disorders and psychiatric comorbidity with affective disorder. RESULTS: Previous attempters and repeat attempters both reported more affective disorders, whereas first-time attempters reported more adjustment disorders than nonsuicidal youths. Previous attempters and nonsuicidal youths reported the most externalizing disorders. CONCLUSIONS: Previous attempters on an inpatient unit have multiple psychiatric problems. Like repeat attempters, they often are depressed, but like nonsuicidal youths, they also exhibit significant externalizing behaviors. Interventions with these adolescents should focus not only on immediate presenting problems, but also on ameliorating their long-term risk of posthospitalization suicidal behavior.

Suicidal ideation and behavior and noncompliance with the medical regimen among diabetic adolescents.

OBJECTIVE: To examine (1) the 1-year and lifetime prevalence of suicidal thoughts and behavior among adolescents with insulin-dependent diabetes mellitus (IDDM), (2) the relationship between suicidal thoughts and serious noncompliance with the medical regimen, and (3) factors including psychiatric disorder, self-efficacy expectations, and hopelessness that might mediate the relationship between suicidal thoughts and noncompliance. METHOD: Semistructured and structured interview instruments and self-report questionnaires were used to determine history of suicidal thoughts and behavior, serious noncompliance with the medical regimen, current psychiatric disorder, hopelessness, and self-efficacy expectations among 91 adolescents attending outpatient clinic appointments. RESULTS: The rate of suicidal ideation among the diabetic adolescents was higher than expected, but the rate of suicide attempts was comparable with that reported for the general population. Suicidal thoughts were strongly associated with serious noncompliance with the medical regimen. Duration of IDDM and psychiatric diagnosis were related to both suicidal ideation within the previous year and lifetime suicidal ideation. Diagnosable psychiatric disorder and not living in a two-parent home were related to noncompliance with medical treatment. CONCLUSIONS: Suicidal thoughts and serious noncompliance with the medical regimen are strongly associated among diabetic teenagers, and psychiatric disorder is a common correlate of both.

Psychiatric disorders in youths with IDDM: rates and risk factors.

OBJECTIVE: To determine prevalence rates, associated features and risk factors for psychiatric disorders subsequent to the diagnosis of IDDM in youths. RESEARCH DESIGN AND METHODS: Using a longitudinal, naturalistic design, 92 youths from 8 to 13 years old at onset of IDDM were followed from their initial diagnosis. They were repeatedly assessed by semistructured interview and diagnosed by operational criteria. RESULTS: By the 10th year of IDDM and the mean age of 20 years, an estimated 47.6% of the sample developed psychiatric disorder. Major depressive, conduct, and generalized anxiety disorders were the most prevalent, and major depression had a significantly higher estimated rate (27.5%) than each other disorder. The highest incidence rates were during the 1st year of the medical condition. Initial maternal psychopathology increased the risk of psychiatric disorder in the subjects, and maternal depression was a specific risk factor for depression in the subjects. Earlier psychiatric disorder in the subjects also increased the risk of later disorder. CONCLUSIONS: The results converge with findings from other studies, suggesting elevated psychiatric morbidity in contemporary samples of young people with IDDM. The morbidity partly reflects the high incidence of major depression in adolescence and generalized anxiety disorder in young adulthood. Monitoring the psychological status of young patients and their mothers may help to identify diabetic children at risk for psychiatric disorder and facilitate prevention or treatment efforts. Monitoring may be particularly beneficial during the 1st year of the IDDM.

Major depressive disorder in youths with IDDM. A controlled prospective study of course and outcome.

OBJECTIVE: To determine whether IDDM affects the course of major depressive disorder (MDD) in youths. RESEARCH DESIGN AND METHODS: The study samples include 24 youths with IDDM (of a group of 92) who developed MDD during a longitudinal follow-up of 10 years, on average, since onset of the medical condition, and 30 depressed psychiatric control subjects, matched on relevant variables. Both groups were repeatedly assessed by semistructured interviews and diagnosed by operational criteria. RESULTS: In diabetic subjects, median time to recovery from the first episode of MDD was 6.4 months; by 12 months from onset, 69% of the youths will have recovered. Within 2 years of recovery, 32% were at risk for a new episode; by 6.5 years, altogether 47% are estimated to have a recurrence. Only 37.5% of diabetic subjects received treatment for the first episode of depression, and 50% received treatment for the second episode. Overall rates of recovery and recurrence were indistinguishable in the diabetic and psychiatric control groups. However, young women with diabetes were at nine times greater risk for recurrent depression than their male counterparts, and diabetic subjects eventually spent more time being depressed than the control subjects. CONCLUSIONS: The course characteristics of MDD in young diabetic subjects and psychiatric control subjects appear to be similar in several regards. However, the eventual propensity of diabetic youths for more protracted depressions and the higher risk of recurrence among young diabetic women suggest that the mental health of patients with IDDM should be closely monitored. The findings confirm that depression is undertreated among patients in the primary health care sector.

First-time suicide attempters, repeat attempters, and previous attempters on an adolescent inpatient psychiatry unit.

OBJECTIVE: To compare clinical characteristics of hospitalized adolescents who (1) have recently made their first suicide attempt, (2) have recently made a second or subsequent attempt, (3) have made previous but no recent attempts, or (4) have never made an attempt. METHOD: Semistructured psychiatric diagnostic interviews were used to determine history of recent and previous suicidal behavior among 225 consecutively admitted adolescents to an inpatient psychiatric facility. Twenty-seven first-time attempters, 32 repeat attempters, and 40 previously suicidal youths were compared with 126 nonsuicidal youths in terms of severity of self-reported depressive symptoms, state anxiety, trait anxiety, state anger, and trait anger. RESULTS: Repeat attempters and previous attempters both reported more depressive symptomatology and trait anxiety than did nonsuicidal youths. In addition, youths with a previous history of suicide attempts, but no recent attempts, evidenced more trait anger than all other groups. First-time suicide attempters reported levels of distress that were intermediate to the other groups. CONCLUSIONS: Repeat attempters and previous attempters in hospital settings both report more distress than do nonsuicidal youths. Interventions should focus not only on resolution of immediate crises, but also on youths' ability to cope with ongoing difficulties that engender depression and chronic anxiety.

A longitudinal study of life events and metabolic control among youths with insulin-dependent diabetes mellitus.

In a study of school-age children with new-onset insulin-dependent diabetes mellitus (IDDM), life stress, metabolic control (glycosylated hemoglobin), and psychiatric and psychosocial variables were assessed repeatedly for up to 6 years. Life stress was defined as the number of undesirable life events and extent of life change necessitated by all life events. In univariate longitudinal analyses, total life change units were related to metabolic control, with a trend for number of undesirable events to be associated with metabolic control. In multivariate analyses, metabolic control was related to life change units, whether the glycosylated hemoglobin was in the 1st year of IDDM, IDDM duration, and the diagnosis of pervasive noncompliance with medical regimen. The relationship of life stress to metabolic control among youths with diabetes in significant but clinically modest and may be partially mediated by serious noncompliance with the medical regimen.

Suicidal ideation and suicide attempts among youth with insulin-dependent diabetes mellitus.

OBJECTIVE: To investigate the prevalence and correlates of suicidal behaviors among youth with insulin-dependent diabetes mellitus (IDDM) for up to 12 years after disease onset. METHOD: The occurrence of suicidal ideation and suicide attempts was assessed shortly after disease onset and repeatedly thereafter as part of a longitudinal study of diabetic children. Initial psychiatric status and symptomatology, characteristics of the medical illness, and sociodemographic variables were considered as potential correlates of suicidal behaviors. RESULTS: Young patients evidenced higher than expected rates of suicidal ideation, but relatively few attempted suicide over the follow-up. Among those who did attempt suicide, diabetes-related methods commonly were used. Suicidal ideation shortly after IDDM onset was related only to concurrent severity of depressive symptoms. Suicidal ideation over the follow-up was associated with later noncompliance with the medical regimen. CONCLUSIONS: Clinicians should be alert to the possibility of suicidal ideation among youth with IDDM because of the prevalence of those cognitions, the potential lethality of attempts due to insulin misuse, and the relationship of suicidal thoughts to later noncompliance with the medical regimen.

Suicidal behaviors and childhood-onset depressive disorders: a longitudinal investigation.

In this longitudinal study, the rates and correlates of suicidal ideation and suicide attempts were determined among outpatient youths with depressive disorders and youths with other psychiatric disorders. At study entry, about 66% of the subjects evidenced suicidal ideation and 9% already attempted suicide. The rate of ideation remained fairly stable over time, whereas the rate of attempts reached 24% by the average age of 17 years. Major depressive and dysthymic disorders were associated with significantly higher rates of suicidal behaviors than were adjustment disorder with depressed mood and nondepressive disorders. In the presence of affective disorders, comorbid conduct and/or substance use disorders further increased the risk of suicide attempts.

Prevalence and predictors of pervasive noncompliance with medical treatment among youths with insulin-dependent diabetes mellitus.

School-age children were assessed longitudinally for up to 9 years, after the onset of their insulin-dependent diabetes mellitus (IDDM), to determine the time-dependent risk of the psychiatric diagnosis of noncompliance with medical treatment and to examine protective and risk factors. The cumulative risk for this diagnosis over the 9 years was .45. Noncompliance tended to emerge in middle adolescence and was found to be protracted. Social competence, self-esteem, and aspects of family functioning at IDDM onset and initial psychiatric status did not predict noncompliance. However, noncompliance was associated with having major psychiatric disorder later in the course of IDDM.

Cognitive and social cognitive development of depressed children and adolescents.

Depressed juveniles show evidence of functional impairment in various cognitive and social domains. Actual school performance seems to be more consistently affected by depression than cognitive and intellectual abilities. In addition, depressed youth appear to be less socially adept than nondepressed peers, although depression does not consistently impair social-cognitive abilities. Indications that depressed youth show mild declines in tested verbal performance over time and that residual problems in social functioning persist after symptomatic recovery suggest that major depression may have negative effects on development in childhood.

Psychological functioning of children with insulin-dependent diabetes mellitus: a longitudinal study.

Assessed school-age youth repeatedly over the first 6 years of their insulin-dependent diabetes mellitus (IDDM) to determine self-perceived psychological adjustment. After the first year of IDDM, Ss exhibited a mild increase in depressive symptoms. Anxiety decreased for boys but increased for girls over the duration of IDDM. In contrast, self-esteem remained stable regardless of rehospitalizations or degree of metabolic control. Ss' adjustment shortly after IDDM onset, as reflected by levels of depression, anxiety, and self-esteem, were predictors of later adjustment. In general, Ss found the implications of IDDM more upsetting and the regimen more difficult with time, and girls were more upset by their illness than boys. The degree to which children were upset by the implications and management of IDDM varied as a function of their anxiety and depression.

Psychological functioning among mothers of children with insulin-dependent diabetes mellitus: a longitudinal study.

Mothers of children with newly diagnosed insulin-dependent diabetes mellitus (IDDM) were assessed repeatedly over a period of 6 years in order to determine the psychological correlates of managing this chronic illness. Both maternal depression and overall emotional distress after the 1st year of the IDDM increased slightly with illness duration and were also influenced by other factors. Mothers' adjustment shortly after their children were diagnosed with IDDM was a strong predictor of their long-term emotional symptomatology. However, mothers' symptoms over time were not related to medical aspects of IDDM (i.e., the extent of the children's metabolic control, number of rehospitalizations, or their compliance with the medical regimen) and were also unrelated to the levels of depression or anxiety reported by their children. Mothers generally found it easier to cope with the IDDM the longer their children had the illness. However, the degree to which mothers perceived the IDDM to be bothersome or difficult to manage at any given point in time was associated with their overall levels of emotional distress.

Presenting problems of sexually abused girls receiving psychiatric services.

Twenty-three behaviors among those suggested in the literature to be associated with sexual abuse were studied in 195 girls, ages 2-18 years, who were consecutive admissions to three Midwestern mental health agencies. Results indicated that sexually inappropriate behaviors, sleep disturbance, depressed mood, and delinquent behavior occurred more frequently in young abuse victims than in clinic comparisons. Sexually inappropriate behaviors and running away appeared more often in older sexually abused girls, than they appeared in older clinic comparisons. These comparisons of the presenting problems of sexually abused and nonabused girls suggested there are few behavioral "markers" of sexual abuse in clinical samples and that sexual abuse may not be a unique contributing factor in the ontogeny of childhood psychopathology.

Family functioning and metabolic control of school-aged children with IDDM.

The relationship of two aspects of family life to metabolic control were examined as part of a longitudinal study of school-aged children with newly diagnosed insulin-dependent diabetes mellitus (IDDM). Glycosylated hemoglobin level was the primary index of metabolic control; weight-adjusted insulin dosage served as an indirect index. Neither the quality of family life nor aspects of the parents' marriage predicted the child's metabolic control over the next 3-4 mo, and they were also unrelated to concurrent weight-adjusted insulin dosage. Longitudinal data spanning a 6-yr period of the child's diabetes also failed to reveal an association between aspects of family life and metabolic control. The significance of the findings are discussed in light of the sample's characteristics and possible methodological constraints.

Imagery, encoding specificity, and prose recall in 6-year-old children.

Partial pictures depict only selected portions of prose passages. Partial pictures hypothetically aid retention by inducing young children to generate imagery for nonpictured prose. Results from two hundred eighty-eight 6-year-old children indicated that (a) partial pictures at study facilitate recall, (b) identical study and retrieval prompts facilitate recall, and (c) imagery instructions and training do not affect retention. Partial pictures apparently help children to encode information more efficiently at study, but there is no evidence that young children generate images with the aid of the partial picture cues, nor that they have a retrieval deficit for these images as suggested by M. Ruch and J. Levin.