A Developmental Cascade Analysis of Peer Rejection, Depression, Anxiety, and Externalizing Problems from Childhood through Young Adulthood.

The need to belong with peers is an essential component of development, and when individuals face peer rejection they often experience a host of negative outcomes, including internalizing and externalizing problems. There exists conflicting evidence whether peer rejection precedes, succeeds, or reciprocally influences psychopathology. This study used two longitudinal community samples recruited from Portuguese schools with data from middle childhood through early adulthood. The obtained data measured mean levels and assessed stability of peer rejection, and peer rejection's association with demographic and psychopathology variables concurrently across development. Analyses fit developmental cascade models of peer rejection, depression, anxiety, and externalizing problems. Mean peer rejection levels remained relatively stable over time, and peer rejection scores were mildly to moderately correlated at measurement points closer together but attenuated at timepoints that were further apart in time. At some timepoints, age, and parental SES and education were associated with peer rejection. Peer rejection was associated with depression, anxiety, and externalizing problems concurrently at each time point (r = ~0.3-0.5). Developmental cascade models supported depression and anxiety temporally preceding peer rejection and some reciprocal relationships between depression and peer rejection. Anxiety was a robust temporal precedent of psychopathology and peer rejection.

Anxiety and Depression from Childhood to Young Adulthood: Trajectories and Risk Factors.

This study aimed to (1) evaluate how population levels of anxiety and depression grow and correlate from middle childhood through early adulthood, and (2) determine whether sex, family socioeconomic status, parental education, academic achievement, learning disabilities, or externalizing symptoms predict anxiety and/or depression levels and growth trajectory. We used two longitudinal samples (N = 445, 448) of Portuguese children. Mean depression levels increased from mid-childhood through adolescence before stabilizing in early adulthood and were most strongly predicted by academic achievement and learning disabilities. Mean anxiety levels increased until adolescence before decreasing across early adulthood and were most strongly predicted by academic achievement, learning disabilities, and externalizing symptoms. Quadratic models of growth fit best for both depression and anxiety, and depression and anxiety growth trajectories were strongly correlated. Though anxiety and depression trajectories differ in pattern and predictors, the two are highly interrelated and pathways to comorbid anxiety and depression should be characterized.

Self-compassion and dissonance-based interventions for body image distress in young adult women.

Self-compassion interventions have been suggested as a potentially more acceptable way to address body image distress compared to interventions that emphasize challenging (often firmly entrenched) thin-ideals. In the current randomized controlled trial, young adult women endorsing body image concerns were randomized to a self-compassion (SC) intervention consisting of one in-person session plus one week of self-guided practice (n = 50), a similarly-structured dissonance-based (DB) intervention (n = 50), or a waitlist (WL) control (n = 51). Both brief interventions were acceptable and were more effective than WL. The two interventions did not differ significantly from each other in reducing the global measure of body dissatisfaction, improving body appreciation, or reducing appearance-contingent self-worth. The DB intervention alone decreased thin-ideal internalization, but only among participants with initially high scores. More participants initially expressed a preference for the SC rationale, and at post-test SC participants reported a higher likelihood of recommending the intervention they had received to others. Change in self-compassion emerged as a possible mechanism of action within both interventions, suggesting it may be useful to integrate aspects of both approaches to enhance acceptability and provide the greatest benefits.

Referral patterns and demographic factors predict treatment dropout in suicidal youth.

INTRODUCTION: Due to increasing suicide rates, treatment engagement among suicidal youth is paramount. Identification of factors that predict treatment dropout could aid in bolstering treatment engagement. In this study, we examine whether demographic factors, specific treatment referrals, and interactions among referrals predict treatment dropout in youth deemed at risk for suicide. METHODS: Youth (N = 3606) were screened for suicide using the Early Identification, Referral, and Follow-up (EIRF) system across three community behavioral health centers. If considered at-risk, all were provided mental health referrals and some were provided family support, crisis hotline, and/or school support referrals. Analyses were performed to analyze dropout patterns based on the binary logistic regression framework. RESULTS: Being older (OR = 1.06, p < 0.001) and being male (OR = 1.28, p < 0.001) were related to greater odds of dropping out from referrals, while being referred to family support (OR = 0.13, p < 0.001), and being referred to a crisis hotline (OR = 0.58, p < 0.001) were associated with smaller odds of dropping out. Interactions were also analyzed. CONCLUSION: Monitoring utilization and referral patterns is essential to appropriately meet the needs of youth at-risk for suicide. Specifically, referring youth for family support and to use a crisis hotline may be particularly helpful in retaining treatment engagement.

Adaptation and Pilot Testing of the Women's Recovery Group for Young Adults (WRG-YA).

Gender specific substance use disorder treatment has demonstrated promise in adult women, but is relatively unexplored in young adults. To address the specific needs of young adult females, the manual-based Women's Recovery Group (WRG) was adapted for women ages 18-25. Treatment engagement and retention, group cohesiveness, satisfaction, and substance use outcomes were measured during group treatment and at 1-month follow up. This pilot supports the feasibility and initial acceptability of the adapted form of the WRG for young adults. Data from this study may inform future gender specific treatment approaches for substance use disorders in younger populations.

Adverse childhood experiences in African Americans: Framework, practice, and policy.

Adverse childhood experiences (ACEs) disproportionately impact African Americans because of profound subjection to historical-systemic oppression in addition to personal and intergenerational trauma exposure. This article utilizes a biopsychosocial-cultural framework to understand the correlates of ACE exposure in African Americans and attends to the cultural factors that contribute to resilience. We review the evidence base for culturally informed, preventive-interventions, as well as strategies for bolstering this work by capitalizing on cultural strengths that are salient in the African American community. We also highlight pertinent policy initiatives guided by recent strategic outlines by the Centers for Disease Control and Prevention. These policies provide the backdrop for the recommendations offered to facilitate the healthy biopsychosocial development of individuals and families. These recommendations can contribute to the expansion and creation of new policies that aim to strengthen individual coping in the face of adversity, enhance family bonds and resilience, and promote community capacity to reduce ACE exposure in African Americans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perceived Parental Knowledge and Adolescent Substance Use Outcomes.

BACKGROUND: Whether parental permission of alcohol and other drug use in a home environment is protective against substance-related negative outcomes remains controversial. We investigated substance use at home, with or without parental knowledge, and its association with substance-related consequences. METHODS: The sample consisted of 21,207 U.S. students in the 6th to 12th grades surveyed between 2009 and 2017. Substance use patterns and rates of negative outcomes were analyzed by comparing groups of participants who had not used at home, or had used at home with and/or without parental knowledge. RESULTS: Adolescents who used substances at home without parental knowledge used alcohol and substances in greater amounts, and tended to have more negative outcomes than those who did not. Students who had not used at home or had used only with parental knowledge tended to have lower levels of use and negative outcomes. CONCLUSIONS: Using at home without parental knowledge was a consistent risk factor for substance-related negative outcomes. These results highlight the importance of screening adolescents for the use of alcohol or drugs in the home without parental knowledge, as well as attempting to prevent substance use in the household.

Somatic symptoms in treatment-naïve Hispanic and non-Hispanic patients with major depression.

BACKGROUND: Somatic complaints are a major driver of health care costs among patients with major depressive disorder (MDD). Some epidemiologic and clinical data suggest that Hispanic and non-Hispanic Black patients with MDD endorse higher levels of somatic symptoms than non-Hispanic White patients. METHODS: Somatic symptoms in 102 Hispanic, 61 non-Hispanic Black, and 156 non-Hispanic White patients with treatment-naïve MDD were evaluated using the somatic symptom subscale of the Hamilton anxiety rating scale (HAM-A). The other seven items of the HAM-A comprise the psychic anxiety subscale, which was also evaluated across ethnicities. RESULTS: Hispanic patients reported significantly greater levels of somatic symptoms than non-Hispanic patients, but levels of psychic anxiety symptoms did not differ by ethnicity. Levels of somatic symptoms did not significantly differ between Black and White non-Hispanic patients. Within the Hispanic sample, somatic symptom levels were higher only among those who were evaluated in Spanish; Hispanics who spoke English showed no significant differences versus non-Hispanics. CONCLUSIONS: In this medically healthy sample of patients with MDD, monolingual Spanish-speaking Hispanic patients endorsed high levels of somatic symptoms. Clinicians should be mindful that the depressive experience may manifest somatically and be judicious in determining when additional medical work-up is warranted for somatic complaints.

Benefits of Sequentially Adding Cognitive-Behavioral Therapy or Antidepressant Medication for Adults With Nonremitting Depression.

OBJECTIVE: Adults with major depressive disorder frequently do not achieve remission with an initial treatment. Addition of psychotherapy for patients who do not achieve remission with antidepressant medication alone can target residual symptoms and protect against recurrence, but the utility of adding antidepressant medication after nonremission with cognitive-behavioral therapy (CBT) has received little study. The authors aimed to evaluate the acute and long-term outcomes resulting from both sequences of combination treatments. METHODS: Previously untreated adults with major depression who were randomly assigned to receive escitalopram, duloxetine, or CBT monotherapy and completed 12 weeks of treatment without achieving remission entered an additional 12 weeks of combination treatment. For patients who did not achieve remission with CBT, escitalopram was added (CBT plus medication group) to their treatment, and for those who did not achieve remission with an antidepressant, CBT was added (medication plus CBT group) to their treatment. Patients who responded to the combination treatment entered an 18-month follow-up phase to assess risk of recurrence. RESULTS: A total of 112 patients who did not achieve remission with a monotherapy entered combination treatment (41 who responded to monotherapy but did not achieve remission and 71 who did not respond to monotherapy). Overall, remission rates after subsequent combination therapy were significantly higher among patients who responded to monotherapy but did not achieve remission (61%) than among patients who did not respond to monotherapy (41%). Among patients who responded to monotherapy but did not achieve remission, the remission rate in the CBT plus medication group (89%) was higher than in the medication plus CBT group (53%). However, among patients whose depression did not respond to monotherapy, rates of response and remission were similar between the treatment arms. Higher levels of anxiety, both prior to monotherapy and prior to beginning combination treatment, predicted poorer outcomes for both treatment groups. CONCLUSIONS: The order in which CBT and antidepressant medication were sequentially combined did not appear to affect outcomes. Addition of an antidepressant is an effective approach to treating residual symptoms for patients who do not achieve remission with CBT, as is adding CBT after antidepressant monotherapy. Patients who do not respond to one treatment modality warrant consideration for addition of the alternative modality.

Early Identification of Youth at Risk for Suicidal Behavior.

Background: Early identification and appropriate referral services are priorities to prevent suicide. Aims: The aim of this study was to describe patterns of identification and referrals among three behavioral health centers and determine whether youth demographic factors and type of training received by providers were associated with identification and referral patterns. Method: The Early Identification Referral Forms were used to gather the data of interest among 820 youth aged 10-24 years who were screened for suicide risk (females = 53.8%). Descriptive statistics and binary logistic regressions were conducted to examine significant associations. Results: Significant associations between gender, race, and age and screening positive for suicide were found. Age and race were significantly associated with different patterns of referrals and/or services received by youths. For providers, being trained in Counseling on Access to Lethal Means was positively associated with number of referrals to inpatient services. Limitations: The correlational nature of the study and lack of information about suicide risk and comorbidity of psychiatric symptoms limit the implications of the findings. Conclusion: The results highlight the importance of considering demographic factors when identifying and referring youth at risk to ensure standard yet culturally appropriate procedures to prevent suicide.

Associations of Suicide Prevention Trainings with Practices and Confidence among Clinicians at Community Mental Health Centers.

OBJECTIVE: This study examined whether (1) behavioral health providers were more likely to implement best practices when they were more confident in their abilities, (2) number of suicide prevention trainings was positively associated with perceived confidence in abilities and implementation of evidence-based practices, and (3) specific trainings were more impactful than others on increasing providers' level of confidence and/or practices. METHOD: Providers (N = 137) at three rural community behavioral health centers who had opportunities to attend multiple suicide prevention trainings completed the Zero Suicide Workforce Survey, a measure to evaluate staff knowledge, practices, and confidence in caring for patients at risk of suicide. RESULTS: There was a moderate association between provider's practice and confidence. The number of attended trainings had a significant correlation with both practice and confidence. Particular trainings demonstrated differential effects on provider's practice and confidence. CONCLUSION: These results suggest that behavioral health providers who are confident in their skills in assessing and treating suicide risk are more likely incorporate best practices into their clinical work. Also, it appears there is a small but significant benefit to multiple trainings for increasing both practice and confidence among providers.

Genome-Wide Association Studies of a Broad Spectrum of Antisocial Behavior.

Importance: Antisocial behavior (ASB) places a large burden on perpetrators, survivors, and society. Twin studies indicate that half of the variation in this trait is genetic. Specific causal genetic variants have, however, not been identified. Objectives: To estimate the single-nucleotide polymorphism-based heritability of ASB; to identify novel genetic risk variants, genes, or biological pathways; to test for pleiotropic associations with other psychiatric traits; and to reevaluate the candidate gene era data through the Broad Antisocial Behavior Consortium. Design, Setting, and Participants: Genome-wide association data from 5 large population-based cohorts and 3 target samples with genome-wide genotype and ASB data were used for meta-analysis from March 1, 2014, to May 1, 2016. All data sets used quantitative phenotypes, except for the Finnish Crime Study, which applied a case-control design (370 patients and 5850 control individuals). Main Outcome and Measures: This study adopted relatively broad inclusion criteria to achieve a quantitative measure of ASB derived from multiple measures, maximizing the sample size over different age ranges. Results: The discovery samples comprised 16 400 individuals, whereas the target samples consisted of 9381 individuals (all individuals were of European descent), including child and adult samples (mean age range, 6.7-56.1 years). Three promising loci with sex-discordant associations were found (8535 female individuals, chromosome 1: rs2764450, chromosome 11: rs11215217; 7772 male individuals, chromosome X, rs41456347). Polygenic risk score analyses showed prognostication of antisocial phenotypes in an independent Finnish Crime Study (2536 male individuals and 3684 female individuals) and shared genetic origin with conduct problems in a population-based sample (394 male individuals and 431 female individuals) but not with conduct disorder in a substance-dependent sample (950 male individuals and 1386 female individuals) (R2 = 0.0017 in the most optimal model, P = 0.03). Significant inverse genetic correlation of ASB with educational attainment (r = -0.52, P = .005) was detected. Conclusions and Relevance: The Broad Antisocial Behavior Consortium entails the largest collaboration to date on the genetic architecture of ASB, and the first results suggest that ASB may be highly polygenic and has potential heterogeneous genetic effects across sex.

Emotional Benefits and Barriers of Psychological Services Scale: Initial construction and validation among African American women.

The current study used the Health Belief Model to develop a measure that assessed the emotional benefits and barriers of professional psychological services in an African American women sample. Data from 251 African American women recruited from online organizations from across the United States (n = 164) and a Midwestern university psychology subject pool (n = 87) were used for exploratory factor analysis. Results revealed a 2-factor structure of the Emotional Benefits and Barriers of Psychological Services (EBBPS) Scale: Life Enhancement and Concerns about Distress, respectively. Confirmatory factor analysis was performed with data from 208 African American women who were recruited from a Midwestern university psychology subject pool (n = 81), Mturk (n = 104), and online organizations across the United States (n = 23). Results confirmed the EFA 2-factor model and demonstrated superior fit compared with a unidimensional model as well as a 3 factor model. Both factors exhibited excellent internal consistency. Construct validity was supported given that EBBPS factors were correlated with theoretically related constructs, like psychological help-seeking attitudes, intentions to seek counseling, and cultural identity, as well as uncorrelated with theoretically unrelated constructs, like psychological distress. These findings support the utility and cultural relevance of the EBBPS with African American women. (PsycINFO Database Record

Childhood emotional abuse, self/other attachment, and hopelessness in African-American women.

There is evidence that individuals emotionally abused as children endorse more hopelessness, a precursor of suicidal behavior in adulthood. However, there has been little focus on this association among African-Americans or on factors that may mediate the childhood emotional abuse (CEA) - adult hopelessness link. The present study examined whether CEA is linked to hopelessness in adulthood in African-American women suicide attempters and if adult self and other attachment models mediate this association. Participants included 116 African-American women recruited from a large, urban hospital. Results revealed that CEA had no direct effect on hopelessness in adulthood, but did have an indirect effect on hopelessness through attachment models. Bootstrapping analyses showed that higher levels of CEA were related to more negative self and other attachment models, which were then linked to higher levels of hopelessness. Implications for targeting attachment in suicide intervention programs are discussed.

Rigorous tests of gene-environment interactions in a lab study of the oxytocin receptor gene (OXTR), alcohol exposure, and aggression.

Naturalistic studies of gene-environment interactions (G X E) have been plagued by several limitations, including difficulty isolating specific environmental risk factors from other correlated aspects of the environment, gene-environment correlation (rGE ), and the use of a single genetic variant to represent the influence of a gene. We present results from 235 Finnish young men in two lab studies of aggression and alcohol challenge that attempt to redress these limitations of the extant G X E literature. Specifically, we use a latent variable modeling approach in an attempt to more fully account for genetic variation across the oxytocin receptor gene (OXTR) and to robustly test its main effects on aggression and its interaction with alcohol exposure. We also modeled aggression as a latent variable comprising various indices, including the average and maximum levels of aggression, the earliest trial on which aggression was expressed, and the proportion of trials on which the minimum and maximum levels of aggression were expressed. The best fitting model for the genetic variation across OXTR included six factors derived from an exploratory factor analysis, roughly corresponding to six haplotype blocks. Aggression levels were higher on trials in which participants were administered alcohol, won, or were provoked. There was a significant main effect of OXTR on aggression across studies after controlling for covariates. The interaction of OXTR and alcohol was also significant across studies, such that OXTR had stronger effects on aggression in the alcohol administration condition. © 2015 Wiley Periodicals, Inc.

Twins' rearing environment similarity and childhood externalizing disorders: a test of the equal environments assumption.

The equal environments assumption (EEA) of the twin method posits that environmental influences that are etiologically relevant to a given phenotype are no more likely to be shared by monozygotic (MZ) than dizygotic (DZ) twin pairs. One method of testing the EEA is to evaluate whether increased rearing environment similarity in MZ twin pairs compared to DZ twin pairs is related to increased phenotypic correlation. In a sample of 885 twin pairs, we contrasted similarity in rearing environment between MZ and DZ twin pairs, examined the correlation between similarity in rearing environment and conduct disorder (CD), oppositional-defiant disorder (ODD), inattention, and hyperactivity-impulsivity symptom dimensions, and tested the effects of differential similarity in rearing environments between MZ and DZ twin pairs by testing whether rearing environment similarity moderated the correlations for the externalizing symptom dimensions. We found that MZ twins experienced substantially more similar rearing environments than DZ twins, but that there was little evidence that MZ and DZ correlations for the externalizing symptom dimensions varied by rearing environment similarity. Thus, these results constitute evidence for the validity of the EEA for childhood externalizing disorders.