Social anxiety symptoms among youth with chronic health conditions: trajectories and related factors.

Purpose: This study explored three-year trajectories of social anxiety symptoms among youth with chronic health conditions and investigated factors influencing those trajectories.Methods: Participants (N = 439) were recruited from eight pediatric rehabilitation centers. The Social Anxiety Scale for Children-Revised measured social anxiety across four time points. Latent Class Growth Analysis was used to study trajectories and logistic regression to identify related factors.Results: A three-class solution was supported: a "high anxiety and stable" group (17.1%), a "moderate anxiety and stable" group (44.4%), and a "low anxiety and stable" group (38.5%). Youth in the "moderate and stable" group were less likely to be male compared to the "low and stable" group. Youth in the "high and stable" group were more likely to have greater cognitive symptoms and less likely to have higher levels of social participation compared to the "low and stable" group. Youth in both the "high and stable" and "moderate and stable" groups were less likely to have high support from classmates or close friends compared to the "low and stable" group. Moreover, both the "high and stable" and "moderate and stable" groups were less likely to have positive family functioning.Conclusion: Youth with chronic conditions belonging to "high and stable" and "moderate and stable" social anxiety trajectories can be distinguished from those in a "low and stable" trajectory using personal, functional, and environmental level variables.Implications for RehabilitationYouth with chronic health conditions are at risk of developing and maintaining moderate to high levels of social anxiety symptoms as they move through adolescence.Compared to youth with "low and stable" social anxiety, those with "moderate and stable" social anxiety are less likely to be male, have high peer support or high family functioning.Compared to youth with "low and stable" social anxiety, those with "high and stable" social anxiety are more likely to have greater cognitive symptoms, and less likely to have high social participation, high peer support, or high family functioning.Rehabilitation and other professionals should not only consider factors that are functional in nature; they should also consider personal and environmental level factors when supporting youth with chronic health conditions who experience social anxiety symptoms.

Youth with chronic health problems: how do they fare in main-stream mentoring programs?

BACKGROUND: Youth with chronic physical health problems often experience social and emotional problems. We investigate the relationship between participation in the Big Brothers Big Sisters of Canada community-based mentoring programs (BBBS) and youth social and mood outcomes by youth health status. METHODS: Youth newly enrolled in BBBS were classified by health status (one or more chronic physical health problems without activity limitation, n = 191; one or more chronic physical health problems with activity limitation, n = 94; no chronic health problem or activity limitation, n = 536) and mentoring status (yes/no) at 18 month follow-up. Youth outcomes measured at follow-up were social anxiety, depressed mood, and peer self-esteem. RESULTS: Youth with chronic health problems and activity limitation were more likely to live with two biological parents, use mental health or social services, and have parents who reported difficulties with depressed mood, social anxiety, family functioning and neighbourhood problems. At 18 month follow-up, mentored youth in this health status group experienced fewer symptoms of social anxiety and higher peer self-esteem compared to non-mentored youth. Mentored youth with chronic health problems without activity limitation and mentored youth with no health problems or limitations did not show significant improvements in social anxiety and peer self-esteem. Regardless of their health status, mentored youth reported fewer symptoms of depressed mood than non-mentored youth. CONCLUSIONS: Youth with chronic health problems, particularly those with activity limitation as well, demonstrate a capacity to experience social and mood benefits associated with mentoring.

Dimensionality of the PTSD Checklist in a Canadian Aboriginal Sample.

BACKGROUND AND PURPOSE: The PTSD Checklist-Civilian Version (PCL-C) is a widely used screening instrument measuring posttraumatic stress disorder (PTSD). However, to our knowledge, the factor structure of the PCL-C has not been examined in an Aboriginal population. Considerable research indicates that PTSD symptoms are characterized by 4 factors, with both the "King model" and the "Simms model" supported by the literature. METHODS: Using confirmatory factor analysis on the PCL-C, we examined whether these models and the overall scale were supported in an Aboriginal community sample (N = 273). RESULTS: The data supported both models. However, the 4 factors were highly correlated, providing some support for a 1-factor model as well. CONCLUSIONS: Our data support use of the PCL-C in Aboriginal health research.

Mentoring Relationships and the Mental Health of Aboriginal Youth in Canada.

We compared the mentoring experiences and mental health and behavioral outcomes associated with program-supported mentoring for 125 Aboriginal (AB) and 734 non-Aboriginal (non-AB) youth ages 6-17 participating in a national survey of Big Brothers Big Sisters community mentoring relationships. Parents or guardians reported on youth mental health and other outcomes at baseline (before youth were paired to a mentor) and at 18 months follow-up. We found that AB youth were significantly less likely than non-AB youth to be in a long-term continuous mentoring relationship. However, AB youth were more likely than non-AB youth to be in a long-term relationship ending in dissolution. AB youth were also more likely than non-AB youth to have been mentored by a female adult. AB youth were significantly more likely than non-AB youth to report a high quality mentoring relationship, regular weekly contact with their mentor, and monthly mentoring activities. Structural equation model results revealed that, relative to non-mentored AB youth, AB youth with mentors experienced significantly fewer emotional problems and symptoms of social anxiety. These relationships were not found for non-AB youth. Our findings suggest that mentoring programs may be an effective intervention for improving the health and well-being of AB youth.

Three-year trajectories of global perceived quality of life for youth with chronic health conditions.

PURPOSE: Objectives of this longitudinal study were to examine 3-year trajectories of global perceived quality of life (QOL) for youth with chronic health conditions, as obtained from youth and parent reports, and to identify personal and environmental factors associated with the trajectory groups for each perspective. METHODS: Youth with various chronic conditions aged 11-17 years and one of their parents were recruited from eight children's treatment centers. Latent class growth analysis was used to investigate perceived QOL trajectories (separately for youth and parent perspectives) over a 3-year period (four data collection time points spaced 12 months apart). Multinomial logistic regression was employed to identify factors associated with these trajectories. RESULTS: A total of 439 youth and one of their parents participated at baseline, and 302 (69 %) of those youth/parent dyads completed all four data collection time points. Two QOL trajectories were identified for the youth analysis: 'high and stable' (85.7 %) and 'moderate/low and stable' (14.3 %), while three trajectories were found for the parent analysis: 'high and stable' (35.7 %), 'moderate and stable' (46.6 %), and 'moderate/low and stable' (17.7 %). Relative to the 'high and stable' groups, youth with more reported pain/other physical symptoms, emotional symptoms, and home/community barriers were more likely to be in the 'moderate and stable' or 'moderate/low and stable' groups. Also, youth with higher reported self-determination, spirituality, family social support, family functioning, school productivity/engagement, and school belongingness/safety were less likely to be in the 'moderate and stable' or 'moderate/low and stable' groups, compared to the 'high and stable' groups. CONCLUSION: Findings suggest that youth with chronic conditions experience stable global perceived QOL across time, but that some individuals maintain stability at moderate to moderate/low levels which is related to ongoing personal and environmental influences. Potential benefits of universal strategies and programs to safeguard resilience for all youth and targeted interventions to optimize certain youths' global perceived QOL are indicated.

The Role of Program-Supported Mentoring Relationships in Promoting Youth Mental Health, Behavioral and Developmental Outcomes.

This study examined the relationship between youth mentoring status and behavioral, developmental, and emotional outcomes for 859 youths aged 6-17 participating in a national survey of Big Brothers Big Sisters community mentoring relationships (MRs). Youth self-reported behaviors and mental health occurred at the baseline assessment (before being paired to a mentor) and at 18 months follow-up. Youth mentoring status was categorized as follows: (1) continuous MR less than 12 months (n = 131); (2) continuous MR 12 or more months (n = 253); (3) dissolved MR less than 12 months (n = 110); (4) dissolved MR 12 or more months (n = 70); 5) MR with a second mentor (re-matched; n = 83); and (6); never mentored (n = 212). Structural equation model results at 18 months revealed that mentored youths, especially those in MR lasting 12 or more months (continuous or dissolved), reported significantly fewer behavioral problems and fewer symptoms of depression and social anxiety than did non-mentored youths. They also reported stronger coping skills and emotional support from parents. Mentored girls and boys in long-term relationships experienced positive outcomes. Re-matched girls displayed better outcomes than did never-mentored girls while there was some evidence of harmful outcomes for re-matched boys. Threats to internal validity are examined including the possibility of pre-existing baseline differences between mentored and non-mentored youths. Implications for mentoring programs are discussed.

Mentoring Relationship Closures in Big Brothers Big Sisters Community Mentoring Programs: Patterns and Associated Risk Factors.

Previous research suggests that early mentoring relationship (MR) closures may have harmful consequences for the health and well-being of youth participating in community-based mentoring programs. However, knowledge of the factors that lead some MRs to close early has been slow to emerge. This study examined patterns and correlates of early versus on-time MR closures among 569 youth participating in Big Brothers Big Sisters community mentoring programs. Thirty-four percent of youth experienced an early MR closure prior to the end of the program's 12 month period of commitment. The probability of closure was highest at 12 months into the MR. Early closures were positively associated with youth gender (girls), behavioral difficulties, and match determination difficulties. Early and on-time closures were associated with youth extrinsic motives for joining the program. Early MR closures were negatively associated with youth perceptions of parent emotional support, parent social support, high quality MR, weekly contact in MR, and parent support of the MR. Implications for programming are discussed.

Maternal factors and the emotional and behavioural functioning of adolescents with chronic health conditions.

PURPOSE: This study investigated the association between mothers' mental health and education and the emotional and behavioural functioning of adolescents with chronic health conditions over time. METHODS: Data were drawn from an ongoing study. Study participants (N = 363) were recruited through eight children's rehabilitation centres. Logistic regression models were estimated. RESULTS: There were significantly reduced odds that girls would display clinical signs of hyperactivity/inattention one year later compared to boys when a maternal mental health condition was present (OR = 0.10; p < 0.01). Where low maternal education was present, girls were more likely to display peer relationship problems one year later (OR = 3.72; p < 0.01). For both genders, having a mother with less than a high school education was also associated with conduct problems one year later (OR = 2.89; p < 0.01). CONCLUSIONS: Findings support a link between maternal factors and emotional and behavioural functioning in adolescents with chronic conditions. A holistic and family-centred approach to assessment and service delivery is indicated. Implications for Rehabilitation When conducting clinical assessments, service providers should consider associations between maternal education and mental health and the emotional and behavioural functioning of adolescents with chronic health conditions. A holistic and family-centred approach to assessment and service delivery is indicated to ensure adolescents with chronic conditions and their families receive support for interrelated needs.

ICF-based functional components and contextual factors as correlates of perceived quality of life for youth with chronic conditions.

PURPOSE: To explore International Classification of Functioning, Disability and Health (ICF)-based functional components and contextual factors associated with perceived quality of life (QOL) for youth with chronic conditions from the perspective of youth and parents. METHOD: Baseline data were obtained from a longitudinal study examining predictors of changes in perceived QOL for youth with chronic conditions. 439 youth aged 11-17 (and one of their parents) completed a questionnaire. Standardized tools were used to measure youth functioning, contextual factors and perceived QOL. Multivariate linear regression analyses, controlling for socio-demographic and health information, were conducted to explore correlations among youth functioning/contextual factors and youth and parent perceptions of youth QOL. RESULTS: Significant (p ≤ 0.05) negative correlates with both youth and parent perceptions of youth QOL included pain/other physical symptoms and emotional symptoms. Significant factors positively correlated with youth and parent perceptions of youth QOL included school productivity and spirituality. Other significant positive correlates of youth perspectives were family social support and school belongingness/safety. Family functioning was positively correlated, and youth social anxiety and environmental barriers were negatively correlated, with parent perceptions of youth QOL. CONCLUSIONS: This study provides preliminary evidence of factors upon which services aimed at improving perceived QOL of youth with chronic conditions could be based. IMPLICATIONS FOR REHABILITATION: This study supports the utility of clinicians assessing the QOL of youth with chronic conditions in terms of youths' and their families' perspectives. This is the first study to identify key factors that impact perceived QOL at one point in time across a group of youth with chronic conditions, offering clinicians a main starting-point for considering youths' strengths and needs and the supportiveness of the environment. Findings suggest youth and families would benefit from the availability of services that encompass the full scope of the ICF.

The measurement properties of mentoring relationship quality scales for mentoring programs.

The measurement properties of two new scales designed to measure global and engagement mentoring relationship quality (Global Mentoring Relationship Quality Scale and Quality of Mentoring Relationship Engagement Scale) were examined among 272 mentors, 491 children, and 554 parents participating in Big Brothers Big Sisters community mentoring programs across Canada. Results demonstrated their unidimensionality, moderate convergent validity, good external validity, and weak-to-moderate reporter concordance. Longitudinal analyses demonstrated good predictive validity of mentor and parent mentoring relationship quality scales with respect to predicting mentoring relationship status.

Predictors of Change Over Time in the Activity Participation of Children and Youth with Physical Disabilities.

Little is known about predictors of change over time in the intensity of the leisure and recreational activity participation of children with physical disabilities. This study reports data from 402 children/youth with physical disabilities (216 boys and 186 girls), ages 6 to 15, collected on three occasions over a 3-year period. Latent growth curve modeling was used to determine the significant child, family, and community predictors of change in the intensity of their participation in five types of activities (recreational, active physical, social, skill-based, and self-improvement). Differences in predictors were examined for boys versus girls, and older versus younger children. Significant predictors of change were found only for recreational and active physical activities. The findings indicate that factors associated with change in participation intensity are dependent on the type of activity, and vary as a function of children's sex and age. Implications for research and service delivery are discussed, including the importance of a contextualized, holistic, and developmental approach to intervention.

An evaluation of the paediatric acquired brain injury community outreach programme (PABICOP).

PRIMARY OBJECTIVE: To examine the utility of a coordinated, family/community-focused programme (PABICOP) vs. a standard approach for improving outcomes for children with ABI and their families. RESEARCH DESIGN: Pre-test-post-test design, with comparison group and follow-up. METHODS AND PROCEDURES: Ninety-six children (64 children receiving PABICOP services and 32 children receiving standard care) participated in the study. Measures were completed at baseline and 3 and 12 months later. MAIN OUTCOMES AND RESULTS: Parents/caregivers with more than 10 contacts with PABICOP scored significantly higher on an ABI knowledge quiz than either parents/caregivers with 10 contacts or less or the comparison group at post-test and follow-up. Parents/caregivers with 10 contacts or less with PABICOP reported significantly greater improvements in children's school and total competence on the CBCL than either parents/caregivers with more than 10 contacts or the comparison group at post-test and follow-up. CONCLUSIONS: PABICOP may be more useful for enhancing knowledge of ABI for parents/caregivers and for integrating children into the community over a 1-year period than a standard approach. The amount of service received appears to influence outcomes.

Gender differences in the effects of family adversity on the risk of onset of DSM-III-R social phobia.

Utilizing a random probability sample of Canadian residents aged 15-64 (n = 8116), this study assessed gender differences in the onset of social phobia and the moderating influence of gender on indicators of childhood family adversity hypothesized to increase the risk of developing the disorder. Results revealed statistically significant "gender by family adversity" interactions that varied by disorder sub-type. Among males, absence of a parent or other adult close confidant during childhood was associated with an elevated risk of developing social phobia (all diagnosed cases and the non-generalized sub-type). Risk factors unique to females included parental conflict while growing up (all diagnosed cases), childhood physical abuse by a father figure (generalized sub-type), and maternal mania (non-generalized sub-type). Results highlight the importance of distinguishing between social phobia sub-types in gender-based research as well as the use of family adversity measures that capture the parenting behaviors and mental health status of both parents.

Distinguishing generalized anxiety disorder from major depression: prevalence and impairment from current pure and comorbid disorders in the US and Ontario.

Estimation of comparative disease burden in epidemiological surveys is complicated by the fact that high comorbidities exist among many chronic conditions. The easiest way to take comorbidity into consideration is to distinguish between pure and comorbid conditions and to evaluate the incremental effects of comorbid conditions in prediction equations. This approach is illustrated here in an analysis of the effects of pure and comorbid major depression (MD) and generalized anxiety disorder (GAD) on a number of different measures of role impairment in the US National Comorbidity Survey (NCS) and the Mental Health Supplement to the Ontario (Canada) Health Survey (the Supplement). Pure MD and pure GAD were found to have roughly equal independent associations with role impairments. The incremental effects of having comorbid MD and GAD were found to vary depending on the outcome under investigation. The paper closes with a discussion of the methodological complexities associated with generalizing to comorbidities that involve rare conditions or more than two disorders.

Prevalence and age of onset for drug use in seven international sites: results from the international consortium of psychiatric epidemiology.

This study compares lifetime prevalence and age of first use (onset) for alcohol, cannabis, and other drugs in six international sites. Data from seven epidemiologic field surveys that used compatible instruments and study designs were compiled for cross-site analyses by the International Consortium of Psychiatric Epidemiology (ICPE). The world health organization's composite international diagnostic instrument (WHO-CIDI) and additional items were used to ascertain drug use in each site. Lifetime use rates were estimated for alcohol, cannabis, and other illicit drugs. Survival analyses were used to estimate age of onset. Study settings and main results: use of alcohol twelve or more times ranged in descending order from the Netherlands (86.3%), United States (71.7%), Ontario, Canada (71.6%); São Paulo, Brazil (66.1%), Munich, Germany (64.9%), Fresno, California (USA) (51.9%), to Mexico City (43.2%). Use of cannabis five or more times in a lifetime ranged from 28.8 in the United States to 1.7% in Mexico City, and other drugs ranged from United States (19.4%) to Mexico City (1.7%). Age of first use was similar across study sites. This study demonstrates the fundamental uniformity of onset patterns by age as contrasted with wide variations in lifetime prevalences across sites. Study findings suggest that drug use patterns may change among emigrating populations from low consumption nations as a consequence of international resettlement in nations with higher rates. Methodological limitations of the study along with recommendations for future international comparative research are discussed.