Network structure reveals clusters of associations between childhood adversities and development outcomes.

Exposure to childhood adversity is common and associated with a host of negative developmental outcomes. The most common approach used to examine the consequences of adversity exposure is a cumulative risk model. Recently, we have proposed a novel approach, the dimensional model of adversity and psychopathology (DMAP), where different dimensions of adversity are hypothesized to impact health and well-being through different pathways. We expect deprivation to primarily disrupt cognitive processing, whereas we expect threat to primarily alter emotional reactivity and automatic regulation. Recent hypothesis-driven approaches provide support for these differential associations of deprivation and threat on developmental outcomes. However, it is not clear whether these patterns would emerge using data-driven approaches. Here we use a network analytic approach to identify clusters of related adversity exposures and outcomes in an initial study (Study 1: N = 277 adolescents aged 16-17 years; 55.1% female) and a replication (Study 2: N = 262 children aged 8-16 years; 45.4% female). We statistically compare our observed clusters with our hypothesized DMAP model and a clustering we hypothesize would be the result of a cumulative stress model. In both samples we observed a network structure consistent with the DMAP model and statistically different than the hypothesized cumulative stress model. Future work seeking to identify in the pathways through which adversity impacts development should consider multiple dimensions of adversity.

HPA axis response and psychosocial stress as interactive predictors of suicidal ideation and behavior in adolescent females: a multilevel diathesis-stress framework.

Prior studies suggest that hypothalamic-pituitary-adrenal (HPA) axis stress response is a relatively stable risk factor for suicidal behavior in adults, and also that fluctuations in developmentally salient social stress (i.e., peer stress) predict acute suicidal ideation and behavior in adolescent females. Here, we test the hypothesis that periods of high peer stress are prospectively associated with concurrent episodes of suicidal ideation and behavior, but that abnormal cortisol responses to stress at baseline act as a diathesis that strengthens this stressor-suicidality link, using a longitudinal, multi-wave study design. We measured cortisol responses to an adolescent modification of the Trier Social Stress Test in 220 adolescent females recruited for mental health concerns, and measured stress (peer, academic, and mother-child) and suicidal ideation and behaviors repeatedly across 18 months. Logistic multilevel models revealed the predicted interaction between altered cortisol response and elevated periods of peer stress in predicting suicidal behavior, but not ideation. Higher-than-usual peer stress predicted suicidal ideation regardless of HPA function, but predicted suicide attempt only among those with blunted cortisol responses. Results suggest that peer stress serves to trigger suicidal ideation among female youth, but only triggers suicidal behavior among those with blunted cortisol reactivity.

Adolescents' Depressive Symptoms and Subsequent Technology-Based Interpersonal Behaviors: A Multi-Wave Study.

This study examined the longitudinal effects of adolescents' depressive symptoms on engagement in technology-based social comparison and feedback seeking (SCFS) behaviors. A total of 816 adolescents (54.7% girls; Mage =14.1 at Time 1) participated at three times points, each one year apart. Adolescents reported technology-based SCFS, depressive symptoms, and frequencies of technology use (cell phones, Facebook, and Instagram). Multiple group (by gender) latent growth curve models examined concurrent and lagged effects of depressive symptoms on SCFS, controlling for adolescent's underlying trajectories of SCFS and overall frequencies of technology use. Results indicated that higher levels of depressive symptoms were concurrently associated with greater SCFS after accounting for adolescents' typical patterns of SCFS. For boys only, higher depressive symptoms were prospectively associated with later increases in SCFS. Results highlight the importance of social media as a unique context in which depressed adolescents may be at risk for maladaptive interpersonal behavior.

Parents and friendships: a longitudinal examination of interpersonal mediators of the relationship between child maltreatment and suicidal ideation.

This study examined parental relationship quality, friendship quality, and depression as mediators of the association between child maltreatment (CM) and adolescent suicidal ideation (SI). Participants were 674 adolescents (46% female; 55% African American) involved in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Data were collected via youth self-report at ages 12, 16, and 18. CM before age 12 predicted poor parental relationships and depression, but not poor friendships, at age 16. Age 16 depression was negatively associated with parental relationship quality and positively associated with SI at age 18. An indirect path from CM to SI via depression was significant, suggesting that the early CM affects depression severity, which in turn is associated with SI. Strong friendship quality (age 16) was associated with SI at age 18; however, there was no significant indirect path from CM to SI via friendships. Results suggest that: 1) CM before age 12 affects parental relationships in adolescence; 2) depression and friendships are related to suicide ideation in later adolescence; and 3) depression partially mediates the association between CM and SI. Results highlight the importance of assessing for a history of CM, quality of interpersonal relationships, and depression severity among youth reporting SI.

PTSD and marital satisfaction in military service members: examining the simultaneous roles of childhood sexual abuse and combat exposure.

Childhood sexual abuse (CSA) is relatively common and is associated with a multitude of negative outcomes in adulthood, including posttraumatic stress disorder (PTSD) and lower marital satisfaction. However, CSA has been understudied in military samples. The purpose of the present study was to examine the relative contributions of CSA and combat exposure to PTSD and marital satisfaction. Two hundred eighteen National Guard/Reserve veterans who deployed overseas between 2001 and 2008 completed self-report measures of CSA, marital satisfaction, combat exposure, and PTSD symptom severity. Data were analyzed using linear regression and path analysis to evaluate a comprehensive model including all variables. CSA accounted for unique variance in PTSD symptom severity independent of combat exposure. CSA also had a negative direct association with marital satisfaction, independent of combat exposure and PTSD symptom severity. In contrast, combat exposure had only a negative indirect association with marital satisfaction via PTSD when all variables were examined simultaneously. CSA accounted for unique variance in both PTSD symptom severity and marital satisfaction in this sample of combat veterans. Clinically, results suggest that assessment and treatment of CSA is indicated for military veterans suffering from PTSD. Further, treatment of CSA may improve marital satisfaction, which may positively affect psychological functioning in the veteran.

The relation between child maltreatment and adolescent suicidal behavior: a systematic review and critical examination of the literature.

A large body of research suggests that child maltreatment (CM) is associated with adolescent suicidal ideation and attempts. These studies, however, have not been critically examined and summarized in a manner that allows us to draw firm conclusions and make recommendations for future research and clinical work in this area. In this review, we evaluated all of the research literature to date examining the relationship between CM and adolescent suicidal ideation and attempts. Results generally suggest that childhood sexual abuse, physical abuse, emotional abuse, and neglect are associated with adolescent suicidal ideation and attempts across community, clinical, and high-risk samples, using cross-sectional and longitudinal research designs. In most studies, these associations remain significant when controlling for covariates such as youth demographics, mental health, family, and peer-related variables. When different forms of CM are examined in the same multivariate analysis, most research suggests that each form of CM maintains an independent association with adolescent suicidal ideation and suicide attempts. However, a subset of studies yielded evidence to suggest that sexual abuse and emotional abuse may be relatively more important in explaining suicidal behavior than physical abuse or neglect. Research also suggests an additive effect-each form of CM contributes unique variance to adolescent suicide attempts. We discuss the current limitations of this literature and offer recommendations for future research. We conclude with an overview of the clinical implications of this research, including careful, detailed screening of CM history, past suicidal behavior, and current suicidal ideation, as well as the need for integrated treatment approaches that effectively address both CM and adolescent suicidal ideation and suicide attempts.

How Do Cognitive Distortions and Substance Related Problems Affect the Relationship Between Child Maltreatment and Adolescent Suicidal Ideation?

OBJECTIVE: The present study, informed by the cognitive-behavioral theory of suicide, is among the first studies to examine cognitive distortions and substance related problems as potential mediators and moderators of the relation between child maltreatment (CM) and suicidal ideation (SI) in adolescent psychiatric inpatients. METHOD: The sample included 185 adolescents (71.4% female; 84% White) admitted to a psychiatric inpatient unit. Participants completed self-report measures assessing cognitive errors, negative cognitive triad, substance related problems, and SI. Participants and their parents completed a semi-structured diagnostic interview assessing CM history. RESULTS: In this clinical sample, we found that child maltreatment was associated with suicidal ideation only for youth with current substance abuse problems, indicating moderation. Contrary to predictions, substance related problems did not mediate the association between child maltreatment and adolescent SI. Further, cognitive errors and negative cognitive triad did not mediate or moderate the association between CM and SI. However, there were significant unique effects for both cognitive errors and negative cognitive triad on SI, suggesting that adolescents with more severe cognitive distortions report greater SI, regardless of CM history. CONCLUSIONS: Clinically, results suggest that practitioners should carefully screen for and address any substance misuse among victims of maltreatment to prevent clinically significant SI. Study results also suggest that interventions that incorporate cognitive restructuring may help decrease risk for severe SI in adolescent clinical samples in general.

Enhancing attributional style as a protective factor in suicide.

BACKGROUND: We applied Needles and Abramson (1990) recovery model of cognitive vulnerability to the suicide. Previous research has found that individuals who make global and stable attributions to positive events (an enhancing attributional style) are more resilient to depression and recover faster if they do become depressed. Building upon past research, we hypothesized that an enhancing attributional style would buffer the relationship between depressive symptoms and suicidal ideation. We also explored possible mediators of this effect. Specifically, we hypothesized that the reduction in suicidal ideation may be due to changes in depressive symptoms. METHOD: Two hundred and nine diverse undergraduates participated in a four-week prospective study. RESULTS: Results of a moderated Poisson regression analysis demonstrate that enhancing attributional style buffers the relationship between baseline depressive symptoms and followup suicidal ideation, controlling for baseline depressive symptoms. A mediated moderation analysis using structural equation modeling did not support the hypothesis that the reduction in suicidal ideation was due to a reduction in depressive symptoms. LIMITATIONS: Limitations include an unselected college sample with a low base rate of suicidal ideation, the use of self-report measures, and assessing only suicidal ideation not behaviors. CONCLUSIONS: Results suggest that enhancing attributional style is a viable protective factor in suicide. Moreover, the buffering effect is due to direct reduction in suicidal ideation, rather than simply a reduction in depressive symptoms. Since attributional styles are modifiable, findings suggest that modifying negative attributional styles can be useful to prevent suicide in a clinical setting.