Treatment Readiness in Psychiatric Residential Care for Adolescents.

There are many factors to consider when treating adolescents with psychiatric challenges, including whether they are willing and interested in participating in treatment. This study aimed to explore how treatment readiness impacts treatment experience for adolescents in psychiatric residential care who came into treatment with moderate to severe depression. All participants (N = 1,624; Mage = 15.58, SD = 1.46) were admitted to a large, multi-state psychiatric residential system between January 2020 and March 2022. Patients were 95.6% White, 99% non-Hispanic, and 64.7% identified as female. At intake, all patients were administered an assessment which includes the multi-dimensional Behavioral Health Screen (BHS) that assesses psychopathology and risk factors, a working alliance scale, depression, and well-being measures. Patients were also asked how they were admitted to the program, using a single item, multiple choice question as an informal treatment readiness measure, yielding three readiness groups: precontemplation, contemplation, or preparation. Regression analysis results indicated that patients' readiness level was associated with different baseline characteristics (e.g., age, gender, psychopathology symptoms, risk factors) and week 3 outcomes (e.g., decreased symptoms, well-being, alliance, satisfaction). The clinical implications, as well as limitations and future directions, will be discussed.

Measuring Depression in Young Adults: Preliminary Development of an English Version of the Teate Depression Inventory.

Depression is a common and debilitating condition that impacts individuals with various cultural backgrounds, medical conditions, and life circumstances. Thus, assessment tools need to be useful among different cultural groups. The 21-item Teate Depression Inventory (TDI) was developed in Italy, is designed to assess major depression, and focuses on cognitive and affective rather than somatic symptoms. This study aims to examine the factor structure and concurrent validity of the TDI English version among a non-clinical population in the United States. Participants included 398 adults (mean age 19.89 years, SD = 2.72, range: 18 to 46 years old) who completed the TDI and The Center for Epidemiologic Studies Depression Scale-Revised (CESD-R). The results supported a three-factor bifactor structure of the TDI (Positive Affect, Negative Affect, and Daily Functioning), which largely corresponds to the Tripartite Model of affective disorders. These findings support the use of TDI scores as measures of depressive symptoms among U.S. young adults, offering researchers and practitioners a brief and useful tool.

Parent experiences during and after adolescent suicide crisis: A qualitative study.

Parents of adolescents who have suicide crises (i.e. suicide attempt and/or significant ideation) are often highly involved in the care management, treatment and preventing future suicides of their children. How they experience these suicide crises, and the period afterward, has not been well studied. The purpose of this study was to understand parents' (defined in this study as any legal guardian of an adolescent taking on a parental role) experience of adolescent suicide crises and its impact on themselves and the family system. Semi-structured interviews were conducted with parents (N = 18) of adolescents who had a suicide crisis in the past 3 years. Thematic analysis was used with a combined inductive-deductive coding approach, drawing from Diamond's conceptualization of family treatment engagement for suicidal youth and iterative close readings of transcripts. Five themes emerged related to parent experience: Trauma of the Experience (subtheme: Feelings of Failure); Living in Fear; Alone and Seeking Connection; Lasting Impact; and A New Normal (subtheme: Turn the Pain to Purpose). Parents experienced these events as traumatic, damaging their sense of self. They experienced long periods of time where fear and loneliness dominated their lives. Recovery was both an individual and a family process, occurring in tandem with, but distinct from, adolescent experiences. Descriptions and illustrative quotes illustrate parent experiences and their understanding of the impact on the family system. Results highlighted that parents require support both for themselves and as caregivers for adolescents around an adolescent's suicide crisis and that family-focused services are vital.

Validation of a parent report on externalizing symptoms scale: A downward extension of the behavioral health screen.

Externalizing problems are common in children ages 6-14, can have lifelong consequences, and may pose a particular risk when combined with other risk factors and symptoms (like depression and anxiety). Schools are uniquely positioned to assess and address these types of behavioral health concerns, but many school-based assessments do not focus on mental health distress (partially because they often lack the infrastructure for identification, screening, and referral). To address this gap, the Behavioral Health Works program student mental health software system has integrated teacher training, psychometrically strong assessments, feedback, and referral tools. However, this self-report tool for adolescents needed to be adapted for younger children. Thus, a parent-report version was added as well as new scales for better assessing this age group. The present study examines the psychometric properties of the new parent-report attention-deficit hyperactivity disorder (ADHD) and oppositional defiant/conduct scales within a sample of 440 children referred for school-based assessments. Overall, the new scales demonstrated good structural validity, measurement invariance across most demographic groups, discrimination in item response theory analyses, and evidence of convergent validity and good classification accuracy in relation to a validation battery. These externalizing scales are distinct and precise and show promise for improving the effectiveness of school-based programs for identifying at-risk children. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Identifying Youth at Risk for Suicidal Thoughts and Behaviors Using the "p" factor in Primary Care: An Exploratory Study.

Suicide is a major, preventable public health problem. The general factor of psychopathology ("p" factor) might help improve detection and prediction of individuals at risk for suicide. This cross-sectional proof-of-concept study tests whether the p-factor score is associated with suicidal thoughts and behaviors (STB) better than a depression scale alone. Youth (N = 841; mean age 18.02, SD = 3.36) in primary care were universally screened using the Behavioral Health Screen (BHS). Factor analysis and ROC results showed the BHS assesses the p-factor, and the p-factor score demonstrates higher classification accuracy of several types of STB than a depression scale. The p-factor could help clinicians in the identification of youths with STB.

Adolescent suicide risk, firearm access, and family functioning: Screening in primary care.

INTRODUCTION: Suicide is a serious mental health concern and the second leading cause of death for adolescents in the United States. Suicide risk is a complex interaction of social, psychological, and physiological factors. Previous research has identified family functioning as being related to adolescent suicide risk, but it is not well studied in clinical settings. This study uses the Behavioral Health Screen-Primary care (BHS-PC) to examine the relationship between current suicide risk in adolescent and a dysfunctional family environment. METHOD: Adolescents presenting for primary care appointments (n = 6,609; age 14-17) completed the BHS-PC, a broad-based, psychometrically validated screening tool that measures a wide range of adolescent behavioral and mental health concerns. Using data from the BHS-PC, hierarchical logistic regression modeling was used to build and compare models of current suicide risk to determine the effect of including family factors. Fisher's Exact test was utilized to examine the relationship between family functioning and firearm access, a critical factor in youth safety and risk of completing suicide. RESULTS: In the final model, three family functioning related variables were associated with current suicide risk in adolescents: never talking to adult family member about their concerns, witnessing violence in the home, and arguing in the home. In addition, all but one family functioning factor was related to adolescent firearm access. CONCLUSIONS: Family functioning and access to firearms are critical to understanding adolescent suicide risk. Utilizing a holistic approach in primary care to screen for adolescent suicide risk may improve clinical response and linkages to care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Barriers to mental health services among college students screened in student health: A latent class analysis.

Background: Almost a third of college students experience significant mental health concerns, but many do not receive adequate services. This study investigated barriers to mental health services among college students screened in a student health center primary care service. Method: Students (N = 1662) presenting for primary care completed mental health screenings and a barrier measure in the student health center of a university. Latent class analysis created barrier profiles. Results: Three barrier profiles were identified (none, logistical, all barriers). Profiles related to gender (p < .001), with logistical/all barrier profiles more likely amongst female students. No significant difference found by race. Students with higher depression scores were more likely to report logistical barriers than no barriers (p < .001). Conclusion: Programs must address multiple barriers to successfully engage students in treatment. Tailored interventions, including in primary care, should assess and respond to individual barriers, not just common ones.

Maternal and paternal attachment in high-risk adolescents: Unique and interactive associations with anxiety and depressive symptoms.

Anxiety and depressive symptoms are common, comorbid, and consequential for adolescents. Attachment theory suggests that styles of relationships with parents, developed from patterns of interactions over time, contribute to risk for these internalizing symptoms. This may be especially relevant for high-risk, clinically severe adolescents. However, most research focuses primarily on attachment relationships to mothers. Some theoretical perspectives also suggest that attachment to other caregivers (such as fathers) may not only be uniquely important for understanding internalizing symptoms but may also interact with maternal attachment. Therefore, it is important to examine these attachment relationships in tandem. The present study examines associations between attachment and internalizing symptoms in a sample of 1,141 youth (12-20 years old; 54.0% female, 96.5% White) from a multisite residential treatment facility. Youth reported on attachment anxiety and avoidance with both parents, as well as anxiety and depressive symptoms. Response surface analyses were used to examine curvilinear, interactive, and fit effects using a model comparison approach. Overall, for patterns of anxious attachment, the best-fitting models reflected simple additive and linear effects. For avoidant attachment, best-fitting models included interactions and fit patterns, suggesting the meaning of maternal attachment was dependent on paternal and vice versa. After accounting for covariates, however, maternal attachment was the sole predictor in most models except attachment avoidance predicting depressive symptoms. These results have implications for attachment theory and research, and further work untangling these complex effects may inform clinical practice for high-risk adolescents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Family and Peer Relationships in a Residential Youth Sample: Exploring Unique, Non-Linear, and Interactive Associations with Depressive Symptoms and Suicide Risk.

Close relationships are consequential for youth depressive symptoms and suicide risk, but nuanced research examining intersecting factors is needed to improve identification and intervention. This study examines a clinical, residential sample of 939 adolescents and young adults ages 10 to 23 years old (M = 15.84, SD = 1.53; 97.7% white, 99.5% non-Hispanic, 55% female). The final model found that family conflict, parental criticism, verbal bullying, and interactions with friends were associated with depressive symptoms in the expected directions, and there were significant interactions with family, peer, and demographic variables. However, most associations with suicide risk were indirect. Associations involving family factors, peer factors, depressive symptoms, and suicide are not always straightforward, and should be understood within a microsystemic context.