Relationship between ruminative style and adolescent depression.

BACKGROUND: The role of rumination in depression remains controversial. We aimed to establish the ruminative tendency style theory (RTST), discuss the occurrence of depression in adolescents with rumination as the core, and explore the different associations between adolescent ruminative tendency, ruminative style, and depression. METHODS: This study employed an online questionnaire survey of 1110 Chinese adolescents aged 12-17 years, assessing ruminative tendency, ruminative style, stressful life events, depressive state, depressive trait, the Big Five personality traits, and social support. Conditional process analysis was used to test the chain mediation effect with Ruminative Style as a moderator. After screening for the predictor variables, a logistic regression risk prediction model was established and validated internally. RESULTS: The chain mediation effect of ruminative tendency and depressive trait between stressful life events and depressive state was significant, with the indirect effect accounting for 63.4%. Ruminative Style negatively moderated the relationship between Ruminative Tendency and Depressive Trait (ß=-0.053，P＜0.001). The risk prediction model for depressive state showed good calibration and clinical utility. Area under the curve values for the validation and training sets were 0.926 and 0.927, respectively. CONCLUSION: Different associations may exist between adolescent ruminative tendency, ruminative style, and depression, and the proposal of ruminative style is of great significance for intervention in adolescent depression.

Exploring the impact of stressful life events on quality of life: meaning making and narrative reconstruction.

PURPOSE: Stressful life events have the capacity to disrupt an individual's worldview and life goals, leading to existential questions and identity loss. The subjective perception of identity is intricately linked with quality of life (QoL), and how individuals derive meaning from these stressful life events significantly influences their well-being. This article explored the impact of stressful life events on individuals' QoL, and examined the potential for enhancing QoL through meaning making and narrative reconstruction. METHODS: Qualitative interviews were conducted with 11 individuals reporting diminished QoL and analysed using thematic analysis. RESULTS: The study reveals that stressful life events confront interviewees with the vulnerability of their values in life and the limits of their control, leading them to question their own beliefs and purpose in life. Consequently, these events prompt individuals to reconstruction their narratives to adapt to new life circumstances. CONCLUSIONS: The study suggests that "securing the base," including strong social relations and security in economic and housing conditions, is a prerequisite for enhancing QoL. The insights on "the base" have profound implications for QoL. Recognizing their fundamental importance, policymakers, healthcare professionals, and social service providers can support mechanisms to enhance these foundations, improving overall well-being for individuals and communities.

Trait anxiety and corresponding neuromarkers predict internet addiction: A longitudinal study.

Background and Aims: The high prevalence of internet addiction (IA) has become a worldwide problem that profoundly affects people's mental health and executive function. Empirical studies have suggested trait anxiety (TA) as one of the most robust predictors of addictive behaviors. The present study investigated the neural and socio-psychological mechanisms underlying the association between TA and IA. Methods: Firstly, we tested the correlation between TA and IA. Then we investigated the longitudinal influence of TA on IA using a linear mixed effect (LME) model. Secondly, connectome-based predictive modeling (CPM) was employed to explore neuromarkers of TA, and we tested whether the identified neuromarkers of TA can predict IA. Lastly, stressful life events and default mode network (DMN) were considered as mediating variables to explore the relationship between TA and IA. Findings: A significant positive correlation between TA and IA was found and the high TA group demonstrated higher IA across time. CPM results revealed that the functional connectivity of cognitive control and emotion-regulation circuits and DMN were significantly correlated with TA. Furthermore, a significant association was found between the neuromarkers of TA and IA. Notably, the CPM results were all validated in an independent sample. The results of mediation demonstrated that stressful life events and correlated functional connectivity mediated the association between TA and IA. Conclusions: Findings of the present study facilitate a deeper understanding of the neural and socio-psychological mechanisms linking TA and IA and provide new directions for developing neural and psychological interventions.

The Impact of Recent Life Events, Internalizing Symptoms, and Emotion Regulation on the Severity of Non-Suicidal Self-Injury in Adolescents: A Mediation Analysis.

Background: Previous studies have demonstrated a strong association between recent stressful life events and non-suicidal self-injury (NSSI) among adolescents. Internalizing symptoms and difficulty in emotion regulation (DER) may mediate this relationship. This study aimed to investigate the relationship between recent stressful life events and NSSI severity in adolescents and the potential moderating role of internalizing symptoms and DER. Methods: A total of 224 adolescent inpatients (78.6% female) participated in the study, with an age range of 12-18 years old. Data on recent stressful life events, internalizing symptoms, DER, and NSSI behaviors were collected using a clinician-rated questionnaire. A structural equation model was used to test the hypothesized model. Results: The rate of NSSI reporting among adolescents in the past 12 months was 65.18%. Recent stressful life events were found to be directly associated with NSSI severity (ß = 0.128, P = 0.023). A chain-mediating effect between recent stressful life events and NSSI was also confirmed (ß = 0.034, P = 0.023), with DER and internalizing symptoms playing a chain-mediating role and DER having a significantly indirect association with NSSI through internalizing symptoms. Conclusion: Recent stressful life events appear to play a role in the etiology of NSSI, particularly punishment and interpersonal relationship events that warrant special attention. DER and internalizing symptoms play a chain-mediating role in the relationship between life events and NSSI. Reducing recent stressful life events, screening for internalizing symptoms, and improving emotion regulation may decrease NSSI behavior among adolescents.

Multivariate association between psychosocial environment, behaviors, and brain functional networks in adolescent depression.

BACKGROUND: Adolescent depression shows high clinical heterogeneity. Brain functional networks serve as a powerful tool for investigating neural mechanisms underlying depression profiles. A key challenge is to characterize how variation in brain functional organization links to behavioral features and psychosocial environmental influences. METHODS: We recruited 80 adolescents with major depressive disorder (MDD) and 42 healthy controls (HCs). First, we estimated the differences in functional connectivity of resting-state networks (RSN) between the two groups. Then, we used sparse canonical correlation analysis to characterize patterns of associations between RSN connectivity and symptoms, cognition, and psychosocial environmental factors in MDD adolescents. Clustering analysis was applied to stratify patients into homogenous subtypes according to these brain-behavior-environment associations. RESULTS: MDD adolescents showed significantly hyperconnectivity between the ventral attention and cingulo-opercular networks compared with HCs. We identified one reliable pattern of covariation between RSN connectivity and clinical/environmental features in MDD adolescents. In this pattern, psychosocial factors, especially the interpersonal and family relationships, were major contributors to variation in connectivity of salience, cingulo-opercular, ventral attention, subcortical and somatosensory-motor networks. Based on this association, we categorized patients into two subgroups which showed different environment and symptoms characteristics, and distinct connectivity alterations. These differences were covered up when the patients were taken as a whole group. CONCLUSION: This study identified the environmental exposures associated with specific functional networks in MDD youths. Our findings emphasize the importance of the psychosocial context in assessing brain function alterations in adolescent depression and have the potential to promote targeted treatment and precise prevention.

Stressful life events in electronic health records: a scoping review.

OBJECTIVES: Stressful life events, such as going through divorce, can have an important impact on human health. However, there are challenges in capturing these events in electronic health records (EHR). We conducted a scoping review aimed to answer 2 major questions: how stressful life events are documented in EHR and how they are utilized in research and clinical care. MATERIALS AND METHODS: Three online databases (EBSCOhost platform, PubMed, and Scopus) were searched to identify papers that included information on stressful life events in EHR; paper titles and abstracts were reviewed for relevance by 2 independent reviewers. RESULTS: Five hundred fifty-seven unique papers were retrieved, and of these 70 were eligible for data extraction. Most articles (n = 36, 51.4%) were focused on the statistical association between one or several stressful life events and health outcomes, followed by clinical utility (n = 15, 21.4%), extraction of events from free-text notes (n = 12, 17.1%), discussing privacy and other issues of storing life events (n = 5, 7.1%), and new EHR features related to life events (n = 4, 5.7%). The most frequently mentioned stressful life events in the publications were child abuse/neglect, arrest/legal issues, and divorce/relationship breakup. Almost half of the papers (n = 7, 46.7%) that analyzed clinical utility of stressful events were focused on decision support systems for child abuse, while others (n = 7, 46.7%) were discussing interventions related to social determinants of health in general. DISCUSSION AND CONCLUSIONS: Few citations are available on the prevalence and use of stressful life events in EHR reflecting challenges in screening and storing of stressful life events.

Association between traumatic events with suicidality among adolescents: A large-scale cross-sectional study of 260,423 participants.

Traumatic events have significant negative impacts throughout one's life. We aimed to comprehensively examine the early associations between traumatic events and suicidality among adolescents. In a cross-sectional sample of 260,423 adolescents in Deyang, China in September 2021, we assessed individual traumatic events, cumulative types, and patterns, alongside suicide risk scores and ideation, attempts, or plans. Linear and Poisson regression models adjusted for demographic confounders evaluated the association. Robust associations existed between interpersonal violence-related traumatic events and higher suicidality, with physical abuse demonstrating the strongest correlation. Moreover, suicide risk scores displayed a clear trend, indicating a progressively stronger association with suicidality as cumulative traumatic event types increased. Four distinct traumatic patterns emerged, including low traumas, high physical abuse, high death/serious injuries of a loved one, and multiple traumas, with the latter showing the strongest association with suicidality. Notably, the stratified analysis showed these associations were more pronounced in females, urban residents, only children, left-behind children, and those aged 13-15, while weaker in participants from families with intact parental relationships and middle socioeconomic status. Understanding the role of demographic factors and traumatic patterns in identifying at-risk youth can enable early detection and targeted interventions for suicide-related concerns.

Life Stress and Unmarried, Black Fathers' Attitudes Toward Attachment: The Moderating Role of Shift-and-Persist.

Unmarried, Black fathers' positive engagement contributes to children's health and development beginning in early infancy. For many men, preparations for parenthood begin before birth as expectant fathers formulate parenting attitudes that can promote secure infant-father attachment relationships. This study examined aspects of life stress as predictors of prenatal attitudes toward attachment -- the extent to which expectant fathers endorsed promoting attachment security in their infants. Further, we considered whether shift-and-persist cognitive strategies -- a psychological resilience factor focused on shifting to positive focus and future-orientation -- moderated these associations. A sample of 121 unmarried, Black men expecting the birth of a child were recruited during the 2nd or 3rd trimester of their partner's pregnancy. Expectant fathers reported on childhood trauma, recent negative life experiences, and depressive symptomology. Fathers also completed a survey assessment of shift-and-persist strategies, as well as a newly developed scale assessing attitudes toward attachment. Depressive symptoms and negative life events were directly, positively related to attitudes toward attachment. The association between positive attitudes toward attachment and both negative life events and depressive symptomology was moderated by fathers' ability to shift-and-persist. Specifically, aspects of life stress were generally unrelated to attitudes toward attachment when shift-and-persist was low, but related to more positive attitudes toward attachment when shift-and-persist was high. Preliminary findings point to the potential steeling effects of shift-and-persist strategies for expectant fathers facing moderate levels of life stress.

Identity Development and Disruption in Older Adults During COVID-19: A Longitudinal, Mixed-Methods Study.

OBJECTIVES: Disruptive life events, such as the COVID-19 pandemic, may trigger adjustment and revision of older adults' identities. This mixed-methods study explored how older adults perceived their identities changing as a result of the pandemic, and how such identity dynamics related to pandemic-related events and well-being. METHOD: Participants included 2248 older adults who participated in the longitudinal COVID-19 Coping Study spanning from April/May 2020 to April/May 2021. Mean age was 67.8 years, 70% were women, and 93% were white. We used qualitative thematic analysis to identify the ways the pandemic affected participants' identities. We then investigated the association between identity themes and testing positive for COVID-19, having a friend or family member hospitalized or die due to COVID-19, or being vaccinated. Finally, we tested whether identity disruption was associated with 12-month trajectories of well-being (including life satisfaction, loneliness, depressive symptoms, anxiety, and self-rated health) using latent growth curve models. RESULTS: Some participants reported positive identity themes, such as rethinking and revising priorities and realization of strength and resilience. Others indicated harmful effects, including identity disruption. Individuals reporting identity disruption had worse well-being at baseline and remained consistently worse over time. DISCUSSION: Findings highlight that identity remains malleable in later-life, and that stressful events like the COVID-19 pandemic may trigger positive adaptive identity processes, but can also cause identity disruption that is associated with persistently worse well-being over time.

Prenatal exposures to phthalates and life events stressors in relation to child behavior at age 4-6: A combined cohort analysis.

Prenatal exposures to chemical and psychosocial stressors can impact the developing brain, but few studies have examined their joint effects. We examined associations between prenatal phthalate exposures and child behavior, hypothesizing that prenatal stressful life events (PSLEs) may exacerbate risks. To do so, we harmonized data from three U.S. pregnancy cohorts comprising the ECHO-PATHWAYS consortium. Phthalate metabolites were measured in single mid-pregnancy urine samples. When children were ages 4-6 years, mothers completed the Child Behavior Checklist (CBCL), from which a Total Problems score was calculated. Mothers additionally provided recall on their exposure to 14 PSLEs during pregnancy. Primary models examined problem behaviors in relation to: (1) phthalate mixtures calculated through weighted quantile sums regression with permutation test-derived p-values; and (2) joint exposure to phthalate mixtures and PSLEs (counts) using interaction terms. We subsequently refitted models stratified by child sex. Secondarily, we fit linear and logistic regression models examining individual phthalate metabolites. In our main, fully adjusted models (n = 1536 mother-child dyads), we observed some evidence of weak main effects of phthalate mixtures on problem behaviors in the full cohort and stratified by child sex. Interaction models revealed unexpected relationships whereby greater gestational exposure to PSLEs predicted reduced associations between some phthalates (e.g., the metabolites of di-2-ethylhexyl phthalate, di-n-octyl phthalate, di-iso-nonyl phthalate) and problem behaviors, particularly in males. Few associations were observed in females. Additional research is needed to replicate results and examine potential mechanisms.

Interplay between polygenic risk for mood disorders and stressful life events in bipolar disorder.

BACKGROUND: Although genetic and environmental factors are involved in the aetiology of bipolar disorder [BD], studies focused on their interplay are lacking. The current investigation examines interactions and correlations between polygenic risk scores [PRS] for BD and major depressive disorder [MDD] with stressful life events [SLEs] in liability for BD. METHODS: This study used data from 1715 participants (862 bipolar cases and 853 controls) taken from UK and Canadian samples. The List of Threatening Experiences Questionnaire recorded SLEs that occurred 6 months before interview for controls and 6 months prior to the first (Canadian sample) and worst (UK sample) depressive and manic episodes for bipolar cases. PRS-BD and PRS-MDD were calculated from the Psychiatric Genomics Consortium. RESULTS: For the worst depressive episode, the PRS-MDD was significantly correlated with total number of SLEs (ß = 0.13, 95 % CI:0.04-0.22, p = 0.003) and dependent SLEs (ß = 0.09, 95 % CI:0.02-0.16, p = 0.007). After correction for multiple testing nominally significant correlations were detected for PRS-BD with total number of SLEs (ß = 0.11, 95 % CI:0.02-0.20, p = 0.015) and dependent SLEs (ß = 0.08, 95 % CI:0.01-0.15, p = 0.019). Among bipolar cases, these associations were slightly stronger but were only of nominal significance for total number of SLEs (PRS-MDD: ß = 0.19, 95 % CI:0.04-0.35, p = 0.015; PRS-BD: ß = 0.16, 95 % CI:0.01-0.32, p = 0.042) and dependent SLEs (PRS-MDD: ß = 0.14, 95 % CI:0.03-0.26, p = 0.015; PRS-BD: ß = 0.12, 95 % CI:0.004-0.24, p = 0.043). No other significant gene-environment correlations or interactions were found. LIMITATIONS: Use of a larger sample size would be beneficial. CONCLUSIONS: The relationship between SLEs and genetic risk for mood disorders may be best explained through correlations rather than interactions.

Perceived Stressful Life Events and Suicide Risk in Adolescence: The Mediating Role of Perceived Family Functioning.

AIM: Suicidal behavior is a serious public health problem and a major cause of death among adolescents. Three categories of major risk factors have been identified: psychological factors, stressful life events, and personality traits. Severe and objective stressful life events (SLEs), such as childhood mistreatment or abuse, have been clearly associated with higher rates of suicide risk. However, the relationship between suicide risk and adolescents' perceptions of the SLE impact is not as clear. This paper studies the relationship between SLE impact perception and suicide risk and the possible mediating role of perceived family functioning in this relationship. The need for longer-term or more intense psychological or psychiatric treatment in relation to SLE impact perception is also addressed. METHOD: One hundred forty-seven adolescents aged 11-17 were consecutively recruited from the Child and Adolescent Mental Health Outpatient Services Department of a general hospital in Madrid, Spain. Self-informed questionnaires were used to assess suicide risk, SLEs, and family functioning. In addition, the clinical records of the participants were consulted to collect information about their treatment histories, including the number of appointments and the duration of follow-up. RESULTS: SLE impact perception correlates significantly with suicide risk, the number of clinical appointments, the duration of treatment, and the perceived level of family functioning. The mediation model of the family functioning perception variable in the relationship between SLE impact perception and suicide risk is significant. The linear regression model of SLE impact perception and family functioning perception on suicide risk is also significant, accounting for 25.7% of the variance. CONCLUSIONS: Beyond the clear and proven effect of serious and objective SLEs, the perceived impact of SLEs reported by adolescents is related to an increased risk of suicide and more intense psychological and/or psychiatric follow-up. This relationship is mediated by the perceived level of family functioning. Adolescents' perceptions of their life experiences and perceived family support may be key determinants of suicide risk prevention.

Stressful life events exhibit complex patterns of associations with depressive symptoms in two population-based samples using network analysis.

BACKGROUND: Stressful life events (SLEs) constitute key risk factors for depression. However, previous studies examining associations between SLEs and depression have been limited by focusing on single events, combining events into broad categories, and/or ignoring interrelationships between events in statistical analyses. Network analysis comprises a set of statistical methods well-suited for assessing relationships between multiple variables and can help surpass several limitations of previous studies. METHODS: We applied network analysis using mixed graphical models combining two large-scale population-based samples and >34,600 randomly sampled adults to investigate the associations between SLEs and current depressive symptoms in the general population. RESULTS: Numerous SLEs were uniquely associated with specific symptoms. Strong pairwise links were observed between SLEs during the past year and individual symptoms, e.g., between having experienced illness or injury and sleeping problems, having been degraded or humiliated and feeling blue, and between financial problems and hopelessness and being worried and anxious. Several SLEs, such as financial problems, sexual abuse, and having been degraded or humiliated, were associated with symptoms across more than one timepoint. More recent SLEs were generally more strongly associated with depressive symptoms. Several life events were strongly interrelated, such as multiple forms of abuse, and financial problems, unemployment, divorce, and serious illness or injury. LIMITATIONS: Limitations include a retrospective SLE measure, cross-sectional data, a brief self-report measure of depressive symptoms, and possible attrition bias in the sample. CONCLUSIONS: Our findings may have implications for public health efforts seeking to improve population mental health.

Examining insomnia disorder and stress generation among individuals who have experienced involuntary job loss.

OBJECTIVE: Depressed individuals generate more stressful life events than non-depressed individuals. Like depressive symptoms, the symptoms of insomnia disorder may lead to impaired decision-making, daytime sleepiness, fatigue, and emotion dysregulation, yet the prospective relationship with insomnia disorder and stress generation has not previously been investigated. We hypothesized that insomnia disorder within the first three months of involuntary job loss would lead to an increased number of stressful life events three-months later. METHODS: This project employed a longitudinal design consisting of two timepoints occurring approximately 3 months apart. A sample 136 participants with complete data was sourced from the Assessing Daily Activity Patterns through Occupational Transitions study. Insomnia disorder was diagnosed using the Duke Structured Interview for Sleep Disorders, and the number of stressful life events was assessed using the Life Events and Difficulties Schedule. RESULTS: A cross-lagged panel analysis utilizing Poisson and logistic regression techniques indicated that insomnia disorder at study baseline predicted an increased number of all stressful life events at follow-up (RR = 1.36, p = .01); conversely, stressful life events at baseline did not predict insomnia disorder (OR = 0.98, p = .87). CONCLUSION: These results support a stress-generation hypothesis of insomnia disorder. Findings highlight insomnia disorder as a potential target for intervention in the prevention of additional stress exposure among recently unemployed individuals, who have been shown to be at increased risk for adverse health and health disparities.

Mental health problems, stressful life events and new-onset urinary incontinence in primary school-age children: a prospective cohort study.

Emotional/behaviour problems and exposure to stressful life events are thought to contribute to new onset of urinary incontinence (UI) amongst children who have attained bladder control. However, very few prospective studies have examined these associations. We assessed whether mental health problems and stressful life events were associated with subsequent new onset in UI using multivariable logistic regression in a prospective UK cohort (n = 6408). Mothers provided information on their child's symptoms of common mental disorders (Development and Wellbeing Assessment, 7 years), stressful life events (7-8 years) and wetting (day and night, 9 years). There was strong evidence that separation anxiety symptoms were associated with new-onset UI in the fully adjusted model (OR (95% CI) = 2.08 (1.39, 3.13), p < 0.001). Social anxiety, attention-deficit hyperactivity disorder and oppositional defiant disorder symptoms were associated with new-onset UI, but these associations attenuated following adjustment for child developmental level and earlier emotional/behaviour problems. There was weak evidence for a sex interaction with stressful life events (p = 0.065), such that females experiencing more stressful life events were at higher risk of new-onset UI (fully adjusted model OR (95% CI) = 1.66 (1.05, 2.61), p = 0.029), but there was no association in males (fully adjusted model OR (95% CI) = 0.87 (0.52, 1.47), p = 0.608). These results suggest that separation anxiety and stressful life events in girls may lead to an increase in UI.

Stressful life events and depressive symptoms during COVID-19: A gender comparison.

The COVID-19 pandemic precipitated a wide range of public health, economic, social, and political shocks, setting in motion life events that reverberated to affect individuals' mental health. Moving beyond a checklist approach, this study drew on individuals' own words to identify both conventional and novel sources of stress during COVID-19 and examine the role of stressful life events in producing gender disparities in depressive symptoms. Drawing on a 2021 U.S. nationally representative survey, we coded text responses to an open-ended question on stressful life events and conducted descriptive and regression analyses (n = 1733). The analyses revealed three key findings. First, men were more likely to report having experienced no stressful life events or else mention politics as a source of stress. Women, by comparison, were more likely to report the following as stressful-inability to socialize, paid work, care work, health, or the death of loved ones. Second, for both women and men, respondents reporting no stressful life events had the lowest, and those reporting finances as the most stressful life event had the highest, depressive symptoms. Third, women had higher depressive symptoms than men, and mediation analysis showed that stressful life events explained approximately a third of the gender gap in depressive symptoms. The findings indicate that policies attending to people's financial stress are important for mitigating mental health risks in turbulent times. Interventions that reduce women's exposure to stressful life events are also crucial to bridging gender disparities in mental health.

Association of Stressful Life Events With Oral Health Among Japanese Workers.

BACKGROUND: Psychological stress can cause various mental and physical health problems. The previous results on stress and oral health are inconsistent, possibly because of the narrow stress measurements. We aimed to examine the association between a broader range of stressful life events and oral health among workers. METHODS: This cross-sectional study analyzed anonymous individual data from a national survey in Japan. Data on stressful life events, oral health problems which are one or more of tooth pain, gum swelling/bleeding, and difficulty chewing, and covariates were obtained using a self-reported questionnaire. Covariates used included gender, age group, and disease under treatment. Logistic regression analysis was used to estimate the association between stressful life events and oral health problems. We then estimated the causal treatment effects of stress using the augmented inverse-probability weighting (AIPW) method. RESULTS: Among the 274,881 subjects, 152,850 men (55.6%) and 122,031 women (44.4%) with a mean age of 47.0 (standard deviation, 14.4) years, 4.0% reported oral health problems, with a prevalence of 2.1% among those without any stress. The prevalence increased with stress score, reaching 15.4% for those with the maximum stress score. The adjusted odds ratio of this group compared to those without any stress was 9.2 (95% confidence interval [CI], 8.2-10.3). The estimated prevalence of oral health problems by the AIPW analysis was 2.2% (95% CI, 2.1-2.3%) for those without any stress and 14.4% (95% CI, 12.1-16.7%) for those with the maximum stress scores. CONCLUSION: There was a clear dose-response association between stressful life events and oral health problems.

Black Adolescent Self-Perceptions: The Roles of Ethnic Identity and Stress Exposure.

Ethnic identity is associated with various positive outcomes for Black adolescents, but more information is needed about its potential to protect adolescents exposed to stress. Stressful life events predict a range of health outcomes, yet few studies have examined their association with adolescent self-perception. Ethnic identity may serve as protection from stress. This study examines longitudinal data to understand relationships between ethnic identity, stressful life events, and self-perception (i.e., social competence, behavioral conduct, and global self-worth). The sample included 140 adolescents (65% female; 93% Black) with an average age of 12.55 (SD = 0.85). Results indicate stressful life events are associated with behavioral conduct self-perception, and ethnic identity is associated with global self-worth. Ethnic identity behavior and other group orientation are associated with self-perception. Ethnic identity and ethnic identity behavior moderate the relationship between stressful life events and behavioral conduct self-perception. Understanding the connections between adolescent stressors and strengths provides insight into research, practice, and policy directions to promote positive outcomes.

Interpersonal theory of suicide and stressful life events in a clinical sample of adolescents in Spain.

AIMS: The interpersonal theory of suicide (ITPS) provides a theoretical model for suicidal behaviour. It includes two interpersonal variables, thwarted belongingness (TB) and perceived burdensomeness (PB). This study tested the relationship between ITPS interpersonal variables and suicide risk (presence/absence of suicidal ideation and suicide attempts throughout life) in a clinical sample of Spanish adolescents. We also assessed the potential mediation effect of these variables in the well-established relationship between stressful life events (SLE) and suicide risk. METHODS: We recruited 147 adolescents aged 11-17 from the Child and Adolescent Mental Health Outpatient Services of the Jiménez Díaz Foundation (Madrid, Spain). Different questionnaires were administered to assess suicidal behaviour and SLE (SITBI, The Stressful Life Events Scale) and to calculate proxy measures for ITPS interpersonal factors (SDQ, STAXI-NA, CDI). RESULTS: TB and PB significantly correlated with suicide risk. PB played a mediating role in the relationship between SLE and suicide risk: adolescents reporting SLE were more likely to enact suicide behaviours when they experienced higher PB. Patients scoring higher PB were more likely to receive more intense treatment but tended to abandon intervention promptly. CONCLUSIONS: ITPS seems useful for predicting suicide risk in an adolescent clinical sample. The results suggest an important role for PB in the SLE-suicide risk relationship and may impact the treatment process. Our exploratory findings should be addressed in future studies.