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1.
Qual Life Res ; 32(9): 2551-2560, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37131053

RESUMO

PURPOSE: Researchers and service providers typically assess pediatric Health-Related Quality of Life (HRQOL) by collecting independent reports from parents and youth. An emerging body of work indicates that patterns of parent-youth reports yield information germane to understanding youth outcomes. We identified patterns of HRQOL among youth and their parents seeking mental health treatment and examined links between agreement patterns and mental and physical health functioning. METHODS: Participants included 227 youth (mean age = 14.40 years, SD = 2.42; 63% female) and parent dyads presenting at a mood disorders clinic between 2013 and 2020. We assessed HRQOL using parallel youth and parent forms of the Pediatric Quality of Life Inventory Generic Core Scales. We also assessed youth clinical correlates of depression, suicidal ideation, and impairment, as well as health information via electronic health record (e.g., psychotropic medication usage, BMI). RESULTS: Latent class analysis showed three parent-youth reporting patterns: Low-Low (LL), High-High (HH), and Parent Low-Youth High (PL-YH). Relative to youth in the HH group, youth in the LL and PL-YH groups reported significantly greater depressive symptoms and had higher rates of suicidal ideation and psychotropic medication use. In addition, youth in the LL group reported significantly greater levels of impairment. CONCLUSIONS: Parent-youth patterns of HRQOL reporting can reveal clinically meaningful information and indicate poorer functioning for certain groups (LL, PL-YH) of youth. These findings have implications for improving accuracy of risk assessments that leverage HRQOL data.


Assuntos
Transtornos do Humor , Qualidade de Vida , Humanos , Criança , Adolescente , Feminino , Masculino , Qualidade de Vida/psicologia , Pais/psicologia , Ideação Suicida
2.
J Child Psychol Psychiatry ; 62(1): 58-65, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32227601

RESUMO

BACKGROUND: Suicidal behavior is highly familial. Neurocognitive deficits have been proposed as an endophenotype for suicide risk that may contribute to the familial transmission of suicide. Yet, there is a lack of research on the neurocognitive functioning of first-degree biological relatives of suicide attempters. The aim of the present study is to conduct the largest investigation to date of neurocognitive functioning in community youth with a family history of a fatal or nonfatal suicide attempt (FH). METHODS: Participants aged 8-21 years from the Philadelphia Neurodevelopmental Cohort completed detailed clinical and neurocognitive evaluations. A subsample of 501 participants with a FH was matched to a comparison group of 3,006 participants without a family history of suicide attempt (no-FH) on age, sex, race, and lifetime depression. RESULTS: After adjusting for multiple comparisons and including relevant clinical and demographic covariates, youth with a FH had significantly lower executive function factor scores (F[1,3432] = 6.63, p = .010) and performed worse on individual tests of attention (F[1,3382] = 7.08, p = .008) and language reasoning (F[1,3387] = 5.12, p = .024) than no-FH youth. CONCLUSIONS: Youth with a FH show small differences in executive function, attention, and language reasoning compared to youth without a FH. Further research is warranted to investigate neurocognitive functioning as an endophenotype for suicide risk. Implications for the prevention and treatment of suicidal behaviors are discussed.


Assuntos
Ideação Suicida , Tentativa de Suicídio , Adolescente , Atenção , Função Executiva , Família , Humanos
3.
Br J Psychiatry ; 215(3): 552-558, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30919791

RESUMO

BACKGROUND: Although there are extensive data on clinical psychopathology in youth with suicidal ideation, data are lacking regarding their neurocognitive function. AIMS: To characterise the cognitive profile of youth with suicidal ideation in a community sample and evaluate gender differences and pubertal status effects. METHOD: Participants (N = 6151, age 11-21 years, 54.9% females) from the Philadelphia Neurodevelopmental Cohort, a non-help-seeking community sample, underwent detailed clinical evaluation. Cognitive phenotyping included executive functioning, episodic memory, complex reasoning and social cognitive functioning. We compared participants with suicidal ideation (N = 672) and without suicidal ideation (N = 5479). Regression models were employed to evaluate differences in cognitive performance and functional level, with gender and pubertal status as independent variables. Models controlled for lifetime depression or general psychopathology, and for covariates including age and socioeconomic status. RESULTS: Youth with suicidal ideation showed greater psychopathology, poorer level of function but better overall neurocognitive performance. Greater functional impairment was observed in females with suicidal ideation (suicidal ideation × gender interaction, t = 3.091, P = 0.002). Greater neurocognition was associated with suicidal ideation post-puberty (suicidal ideation × puberty interaction, t = 3.057, P = 0.002). Exploratory analyses of specific neurocognitive domains showed that suicidal ideation-associated cognitive superiority was more prominent in post-pubertal males compared with females (Cohen's d = 0.32 and d = 0.11, respectively) across all cognitive domains. CONCLUSIONS: Suicidal ideation was associated with poorer functioning yet better cognitive performance, especially in post-pubertal males, as measured by a comprehensive cognitive battery. Findings point to gender and pubertal-status specificity in the relationship between suicidal ideation, cognition and function in youth. DECLARATION OF INTEREST: R.B. serves on the scientific board and reports stock ownership in 'Taliaz Health', with no conflict of interest relevant to this work. M.A.O. receives royalties for the commercial use of the Columbia-Suicide Severity Rating Scale from the Research Foundation for Mental Hygiene. Her family owns stock in Bristol-Myers Squibb. All other authors declare no potential conflict of interest.


Assuntos
Desenvolvimento do Adolescente , Disfunção Cognitiva/etiologia , Função Executiva , Ideação Suicida , Pensamento , Adolescente , Criança , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Philadelphia/epidemiologia , Escalas de Graduação Psiquiátrica , Psicopatologia , Fatores de Risco , Fatores Sexuais , Adulto Jovem
4.
Psychol Med ; 49(2): 325-334, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29655375

RESUMO

BACKGROUND: Traumatic stressors during childhood and adolescence are associated with psychopathology, mostly studied in the context of post-traumatic stress disorder (PTSD) and depression. We investigated broader associations of traumatic stress exposure with psychopathology and cognition in a youth community sample. METHODS: The Philadelphia Neurodevelopmental Cohort (N = 9498) is an investigation of clinical and neurobehavioral phenotypes in a diverse (56% Caucasian, 33% African American, 11% other) US youth community population (aged 8-21). Participants were ascertained through children's hospital pediatric (not psychiatric) healthcare network in 2009-2011. Structured psychiatric evaluation included screening for lifetime exposure to traumatic stressors, and a neurocognitive battery was administered. RESULTS: Exposure rate to traumatic stressful events was high (none, N = 5204; one, N = 2182; two, N = 1092; three or more, N = 830). Higher stress load was associated with increased psychopathology across all clinical domains evaluated: mood/anxiety (standardized ß = .378); psychosis spectrum (ß = .360); externalizing behaviors (ß = .311); and fear (ß = .256) (controlling for covariates, all p < 0.001). Associations remained significant controlling for lifetime PTSD and depression. Exposure to high-stress load was robustly associated with suicidal ideation and cannabis use (odds ratio compared with non-exposed 5.3 and 3.2, respectively, both p < 0.001). Among youths who experienced traumatic stress (N = 4104), history of assaultive trauma was associated with greater psychopathology and, in males, vulnerability to psychosis and externalizing symptoms. Stress load was negatively associated with performance on executive functioning, complex reasoning, and social cognition. CONCLUSIONS: Traumatic stress exposure in community non-psychiatric help-seeking youth is substantial, and is associated with more severe psychopathology and neurocognitive deficits across domains, beyond PTSD and depression.


Assuntos
Disfunção Cognitiva/etiologia , Função Executiva , Uso da Maconha , Trauma Psicológico/complicações , Transtornos Psicóticos/etiologia , Percepção Social , Transtornos de Estresse Pós-Traumáticos/etiologia , Estresse Psicológico/complicações , Ideação Suicida , Pensamento , Adolescente , Adulto , Criança , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Uso da Maconha/epidemiologia , Philadelphia/epidemiologia , Trauma Psicológico/epidemiologia , Transtornos Psicóticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estresse Psicológico/epidemiologia , Adulto Jovem
5.
J Clin Psychol Med Settings ; 23(2): 99-111, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26531132

RESUMO

Although pediatric hospitals specialize in providing care to children and adolescents, at The Children's Hospital of Philadelphia (CHOP), our team has been providing behavioral health services for two unique parent populations-parents with a child in the Newborn Infant Intensive Care Unit and pregnant women carrying fetuses with specific birth defects and receiving prenatal care in the Center for Fetal Diagnosis and Treatment. A new training program was developed to expand the scope of pediatric psychologists' practice to include perinatal behavioral health services, specifically for these two unique parent populations served at CHOP. The program includes direct service provision for adult mental health concerns, as well as education and support to help families cope with the existing medical conditions. This article describes the training program and its implementation as a model of training for other pediatric hospitals. The roles of psychologists embedded in these units and hospital privileges are discussed.


Assuntos
Adaptação Psicológica , Anormalidades Congênitas , Hospitais Pediátricos , Pais , Adolescente , Criança , Feminino , Humanos , Recém-Nascido , Gravidez
6.
Child Adolesc Psychiatr Clin N Am ; 33(3): 277-291, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38823803

RESUMO

Recognition of the high prevalence of children's mental health conditions and challenges to accessing needed care faced by children and their families have been long-standing concerns, emerging well before the onset of the COVID-19 pandemic. Global data examining the prevalence of at least one mental health and/or substance-use disorder for 2516 million people aged 5 to 24 years in 2019 found that at least 293 million people were affected by at least one mental health disorder and 31 million affected by a substance-use disorder.


Assuntos
COVID-19 , Controle de Infecções , Transtornos Mentais , Pandemias , Adolescente , Criança , Pré-Escolar , Humanos , Adulto Jovem , COVID-19/epidemiologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Saúde Mental , Serviços de Saúde Mental
7.
Child Adolesc Psychiatr Clin N Am ; 33(3): 423-435, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38823814

RESUMO

Suicide is a complex public health issue impacting many children and adolescents-and their families-each year, and it requires a complex public health solution. Local, state, and national collaboratives that leverage evidence-based strategies, foster community engagement, and prioritize equity are necessary to holistically address this issue. Here, the authors discuss the necessary steps for fostering inclusive community partnerships and outline the rationale for partnering with schools, youth groups, faith organizations, parent-teacher organizations, clinical settings, and professional organizations, as well as collaborating with the juvenile justice and child welfare systems and working together to foster suicide prevention policy.


Assuntos
Prevenção do Suicídio , Humanos , Adolescente , Criança , Colaboração Intersetorial , Comportamento Cooperativo
8.
Child Adolesc Psychiatr Clin N Am ; 33(1): 95-109, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37981341

RESUMO

The American Academy of Child and Adolescent Psychiatry (AACAP) promotes the healthy development of children, adolescents, and families through advocacy, education, and research. This requires effectively meeting the mental health needs of historically minoritized communities. A diverse clinician workforce is an essential component of meeting those needs. This article will discuss AACAP's strategic plan for diversifying the workforce, this will be done with 3 main points: promoting diversity, equity, and inclusion (DEI) across all mission area, creating a pipeline of child and adolescent psychiatrists, and monitoring DEI activities and progress on an organizational level.


Assuntos
Psiquiatria Infantil , Psiquiatria , Adolescente , Estados Unidos , Humanos , Criança , Psiquiatria Infantil/educação , Mão de Obra em Saúde , Recursos Humanos , Psiquiatria do Adolescente/educação
9.
Artigo em Inglês | MEDLINE | ID: mdl-38869751

RESUMO

Accumulating evidence supports the presence of a general psychopathology dimension, the p factor ('p'). Despite growing interest in the p factor, questions remain about how p is assessed. Although multi-informant assessment of psychopathology is commonplace in clinical research and practice with children and adolescents, almost no research has taken a multi-informant approach to studying youth p or has examined the degree of concordance between parent and youth reports. Further, estimating p requires assessment of a large number of symptoms, resulting in high reporter burden that may not be feasible in many clinical and research settings. In the present study, we used bifactor multidimensional item response theory models to estimate parent- and adolescent-reported p in a large community sample of youth (11-17 years) and parents (N = 5,060 dyads). We examined agreement between parent and youth p scores and associations with assessor-rated youth global functioning. We also applied computerized adaptive testing (CAT) simulations to parent and youth reports to determine whether adaptive testing substantially alters agreement on p or associations with youth global functioning. Parent-youth agreement on p was moderate (r =.44) and both reports were negatively associated with youth global functioning. Notably, 7 out of 10 of the highest loading items were common across reporters. CAT reduced the average number of items administered by 57%. Agreement between CAT-derived p scores was similar to the full form (r =.40) and CAT scores were negatively correlated with youth functioning. These novel results highlight the promise and potential clinical utility of a multi-informant p factor approach.

10.
Artigo em Inglês | MEDLINE | ID: mdl-23487193

RESUMO

The effects of RU-486, a glucocorticoid antagonist, on HIV infection and replication in depressed and nondepressed women were studied using ex vivo models of HIV infection. RU-486 treatment of cells decreased HIV reverse transcriptase activity of monocyte-derived macrophages in a model of acute infectivity. RU-486 also decreased HIV viral replication in the chronically-infected T-cell line ACH-2, but not in the promonocyte cell line U1. No differences were associated with depression status. Thus, glucocorticoid antagonism may suppress HIV infectivity and replication ex vivo. Studies to determine the role of glucocorticoid antagonists in the host defense against HIV should be performed.


Assuntos
Infecções por HIV/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Mifepristona/uso terapêutico , Replicação Viral/efeitos dos fármacos , Adolescente , Adulto , Linhagem Celular , Depressão/tratamento farmacológico , Depressão/etiologia , Depressão/virologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/fisiopatologia , Humanos , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Linfócitos T/efeitos dos fármacos , Linfócitos T/virologia , Carga Viral/efeitos dos fármacos , Adulto Jovem
11.
Am J Psychiatry ; 180(9): 645-659, 2023 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-37073513

RESUMO

Investigators from minoritized backgrounds are underrepresented in psychiatric research. That underrepresentation contributes to disparities in outcomes of access to mental health care. Drawing on lived experience, scholarly qualitative reports, and empirical data, the authors review how the underrepresentation of minoritized researchers arises from interlocking, self-reinforcing effects of structural biases in our research training and funding institutions. Minoritized researchers experience diminished early access to advanced training and opportunities, stereotype threats and microaggressions, isolation due to lack of peers and senior mentors, decreased access to early funding, and unique community and personal financial pressures. These represent structural racism-a system of institutional assumptions and practices that perpetuates race-based disparities, in spite of those institutions' efforts to increase diversity and in contradiction to the values that academic leaders outwardly espouse. The authors further review potential approaches to reversing these structural biases, including undergraduate-focused research experiences, financial support for faculty who lead training/mentoring programs, targeted mentoring through scholarly societies, better use of federal diversity supplement funding, support for scientific reentry, cohort building, diversity efforts targeting senior leadership, and rigorous examination of hiring, compensation, and promotion practices. Several of these approaches have empirically proven best practices and models for dissemination. If implemented alongside outcome measurement, they have the potential to reverse decades of structural bias in psychiatry and psychiatric research.


Assuntos
Pesquisa Biomédica , Tutoria , Humanos , Grupos Minoritários , Racismo Sistêmico , Recursos Humanos
12.
J Am Acad Child Adolesc Psychiatry ; 62(2): 135-150, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35358662

RESUMO

OBJECTIVE: Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health care systems, emergency departments, schools, and juvenile justice programs. However, the prevalence, outcome, and impact of outbursts are difficult to quantify because they are transdiagnostic and not explicitly defined by current diagnostic nosology. Research variably addresses outbursts under the rubrics of tantrums, anger, irritability, aggression, rage attacks, or emotional and behavioral dysregulation. Consistent methods for identifying and assessing impairing emotional outbursts across development or systems of care are lacking. METHOD: The American Academy of Child and Adolescent Psychiatry Presidential Task Force (2019-2021) conducted a narrative review addressing impairing emotional outbursts within the limitations of the existing literature and independent of diagnosis. RESULTS: Extrapolating from the existing literature, best estimates suggest that outbursts occur in 4%-10% of community children (preschoolers through adolescents). Impairing emotional outbursts may respond to successful treatment of the primary disorder, especially for some children with attention-deficit/hyperactivity disorder whose medications have been optimized. However, outbursts are generally multi-determined and often represent maladaptive or deficient coping strategies and responses. CONCLUSION: Evidence-based strategies are necessary to address factors that trigger, reinforce, or excuse the behaviors and to enhance problem-solving skills. Currently available interventions yield only modest effect sizes for treatment effect. More specific definitions and measures are needed to track and quantify outbursts and to design and assess the effectiveness of interventions. Better treatments are clearly needed.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtornos do Humor , Criança , Adolescente , Humanos , Transtornos do Humor/epidemiologia , Ira , Agressão/psicologia , Humor Irritável
13.
Child Adolesc Psychiatr Clin N Am ; 31(2): 211-221, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35361360

RESUMO

Suicide rates continue to increase among children and adolescents in the United States, with suicide remaining the second leading cause of death for youth aged 10 to 24 years of age. Most studies of suicide among children and adolescents have not focused on youth of color because of research suggesting that suicide was a health threat for white youth. Research showing shifting trends in suicide for minoritized youth of color has increased national focus, revealing disparities in recognition and treatment of suicidal behaviors for racially and culturally diverse youth.


Assuntos
Comportamento do Adolescente , Prevenção do Suicídio , Adolescente , Adulto , Criança , Humanos , Ideação Suicida , Estados Unidos/epidemiologia , Adulto Jovem
14.
JAMA Netw Open ; 5(6): e2218746, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35759263

RESUMO

Importance: Adolescent suicidality (ie, suicidal ideation or attempts) is a major public health concern. Cyberbullying experiences and perpetration have become increasingly prevalent and are associated with mental health burden, but their roles as independent suicidality risk factors remain unclear. Data are needed to clarify their contribution to teen suicidality to inform suicide prevention efforts. Objective: To examine whether cyberbullying experiences and perpetration are distinct stressors divergent from other forms of peer aggression experiences in their association with suicidality in early adolescence. Design, Setting, and Participants: This cross-sectional analysis used data collected between July 2018 and January 2021 from the Adolescent Brain Cognitive Development (ABCD) study, a large, diverse sample of US children aged 10 to 13 years. Exposures: Youth reports of cyberbullying experiences or perpetration. Main Outcomes and Measures: The main outcome was youth-reported suicidality (past or present, as reported in the ABCD 2-year follow-up assessment). Covariates included demographics, established environmental risk and protective factors for youth suicidality, psychopathology, and experiences or perpetration of offline peer aggression. Results: A total of 10 414 ABCD participants were included in this study. Participants had a mean (SD) age of 12.0 (0.7) years and 4962 (47.6%) were female; 796 (7.6%) endorsed suicidality. A total of 930 (8.9%) reported experiencing cyberbullying and 96 (0.9%) reported perpetrating cyberbullying. Of the perpetrators, 66 (69.0%) also endorsed experiencing cyberbullying. Controlling for demographics, experiencing cyberbullying was associated with suicidality (odds ratio [OR], 4.2 [95% CI, 3.5-5.1]; P < .001), whereas perpetrating cyberbullying was not (OR, 1.3 [95% CI, 0.8-2.3]; P = .30). Experiencing cyberbullying remained associated with suicidality when accounting for negative life events, family conflict, parental monitoring, school environment, and racial and ethnic discrimination (OR, 2.5 [95% CI, 2.0-3.0]; P < .001) and when further covarying for internalizing and externalizing psychopathology (OR, 1.8 [95% CI, 1.4-2.4]; P < .001). Both being a target and being a perpetrator of offline peer aggression were associated with suicidality (OR, 1.5 [95% CI, 1.1-2.0] for both), controlling for all covariates described earlier. Cyberbullying experiences remained associated with suicidality (OR, 1.7 [95% CI, 1.3-2.2]; P < .001, controlling for all covariates) when included with offline peer aggression experiences and perpetration. Conclusions and Relevance: In this cross-sectional study, experiencing-but not perpetrating-cyberbullying was associated with suicidality in early adolescence. This association was significant over and above other suicidality risk factors, including offline peer aggression experiences or perpetration. These findings can inform adolescent suicide prevention strategies, and they suggest that clinicians and educational staff working with this population should routinely evaluate for adolescents' experience with cyberbullying.


Assuntos
Cyberbullying , Suicídio , Adolescente , Criança , Estudos Transversais , Cyberbullying/psicologia , Feminino , Humanos , Masculino , Grupo Associado , Ideação Suicida
15.
Pediatr Qual Saf ; 7(3): e571, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35720862

RESUMO

Introduction: Standardized suicide risk assessment improves the detection of individuals at risk of suicide. We conducted a quality improvement initiative in a system of outpatient behavioral health practices affiliated with a free-standing children's hospital to implement standardized suicide risk assessment for new patients. Methods: Clinicians received education in suicide risk assessment and were trained to use an evidence-based suicide risk assessment tool, the Columbia Suicide Severity Rating Scale (C-SSRS). We standardized workflow processes and integrated the C-SSRS in the electronic health record with a feature to communicate instances of elevated risk across care teams through a problem list. We analyzed C-SSRS responses and adherence to standardized processes and compared the percentage of patients with a suicide-related item on the problem list before and after implementation. We assessed clinician knowledge through a survey. All patients with identified suicide risk received treatment to reduce their risk of suicide in the context of usual care. Results: For 3,972 new patient visits occurring postimplementation (November 2016-December 2018), the average monthly adherence to the standardized process was 97.7%. The mean monthly incidence of nonspecific active suicidal thoughts was 16%, aborted suicide attempts were 2%, and actual suicide attempts were 3%. The mean monthly incidence of a suicide-related item documented on the problem list was 5.66% in the postimplementation period compared with 1.47% in the 1-year preimplementation. Clinicians demonstrated statistically significant increases in knowledge about suicide risk factors and assessment. Conclusions: Standardization of suicide risk assessment processes improved detection and documentation of suicide risk in a pediatric outpatient behavioral health setting.

16.
Focus (Am Psychiatr Publ) ; 20(2): 252-262, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37153135

RESUMO

Objective: Youth suicide rates in the United States have been increasing in recent years, especially in Black Americans, the reasons for which are unclear. Environmental adversity is key in youth suicidality; hence there is a need to study stressors that have a disproportionate impact on Black youths. We aimed to disentangle the unique contribution of racial/ethnic discrimination from other adversities associated with childhood suicidal ideation and attempts (suicidality). Method: We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, which included a large, diverse sample of US children (N = 11,235, mean age 10.9 years, 20.2% Black), assessed for multiple environmental adversities including discrimination. Multivariate regression models tested the association of self-reported racial/ethnic discrimination with suicidality, covarying for multiple confounders including other discrimination types (toward non-US-born individuals, sexual orientation-based, and weight-based). Matched analyses contrasted effects of racial/ethnic discrimination and racial identity on suicidality. Results: Black youths reported more discrimination and higher suicidality rates than non-Black youths. High racial/ethnic discrimination was positively and significantly associated with suicidality, adjusting for other discrimination types (odds ratio = 2.6, 95% CI = 2.1-3.2). Findings remained significant after adjusting for multiple suicidality risk factors. Once experienced, racial/ethnic discrimination was similarly associated with suicidality in White, Black, and Hispanic youths. Matched analyses revealed that racial/ethnic discrimination was associated with suicidality (relative risk = 2.7, 95% CI = 2-3.5), whereas Black race was not (relative risk = 0.9, 95% CI = 0.7-1.2). Conclusion: Racial/ethnic discrimination is disproportionately experienced by Black children, and is associated with preadolescent suicidality, over and above other adversities. Findings highlight the need to address discrimination as part of suicide prevention strategies. Cross-sectional design hampers causal inferences.Reprinted from J Am Acad Child Adolesc Psychiatry, Argabright et al., Association Between Discrimination Stress and Suicidality in Preadolescent Children, S0890-8567(21)01355-1, copyright 2021, with permission from Elsevier.

17.
J Am Acad Child Adolesc Psychiatry ; 61(5): 686-697, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34425231

RESUMO

OBJECTIVE: Youth suicide rates in the United States have been increasing in recent years, especially in Black Americans, the reasons for which are unclear. Environmental adversity is key in youth suicidality; hence there is a need to study stressors that have a disproportionate impact on Black youths. We aimed to disentangle the unique contribution of racial/ethnic discrimination from other adversities associated with childhood suicidal ideation and attempts (suicidality). METHOD: We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, which included a large, diverse sample of US children (N = 11,235, mean age 10.9 years, 20.2% Black), assessed for multiple environmental adversities including discrimination. Multivariate regression models tested the association of self-reported racial/ethnic discrimination with suicidality, covarying for multiple confounders including other discrimination types (toward non-US-born individuals, sexual orientation-based, and weight-based). Matched analyses contrasted effects of racial/ethnic discrimination and racial identity on suicidality. RESULTS: Black youths reported more discrimination and higher suicidality rates than non-Black youths. High racial/ethnic discrimination was positively and significantly associated with suicidality, adjusting for other discrimination types (odds ratio = 2.6, 95% CI = 2.1-3.2). Findings remained significant after adjusting for multiple suicidality risk factors. Once experienced, racial/ethnic discrimination was similarly associated with suicidality in White, Black, and Hispanic youths. Matched analyses revealed that racial/ethnic discrimination was associated with suicidality (relative risk = 2.7, 95% CI = 2-3.5), whereas Black race was not (relative risk = 0.9, 95% CI = 0.7-1.2). CONCLUSION: Racial/ethnic discrimination is disproportionately experienced by Black children, and is associated with preadolescent suicidality, over and above other adversities. Findings highlight the need to address discrimination as part of suicide prevention strategies. Cross-sectional design hampers causal inferences.


Assuntos
Ideação Suicida , Suicídio , Adolescente , Criança , Estudos Transversais , Feminino , Hispânico ou Latino , Humanos , Masculino , Tentativa de Suicídio/psicologia , Estados Unidos/epidemiologia
18.
J Affect Disord ; 299: 318-325, 2022 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-34910961

RESUMO

BACKGROUND: Limited research has simultaneously focused on sociodemographic differences in who receives recommended adolescent depression screening in primary care and who endorses elevated depression and suicide risk on these screeners. We describe screening and risk rates in a large pediatric primary care network in the United States after the network expanded its universal depression screening guideline to cover all well-visits (i.e., annual medical checkups) for adolescents ages 12 and older. METHODS: Between November 15, 2017 and February 1, 2020, there were 122,682 well-visits for adolescents ages 12-17 (82,531 unique patients). The Patient Health Questionnaire - Modified for Teens (PHQ-9-M) was administered to screen for depression. RESULTS: A total of 99,961 PHQ-9-Ms were administered (screening rate=81.48%). The likelihood of screening was higher among adolescents who were female, 12-14 years of age at their first well-visit during the study, White, Hispanic/Latino, or publicly-insured (i.e., Medicaid-insured). Additionally, 5.92% of adolescents scored in the threshold range for depression symptoms and 7.19% endorsed suicidality. Heightened depression and suicide risk were observed among adolescents who were female, 15-17 years of age at their first well-visit during the study, Black, Hispanic/Latino, attending urban primary care practices, or Medicaid-insured. Odds of endorsing suicidality were also higher among teens who identified as other races. LIMITATIONS: Limitations related to data available in the electronic health record and reliance on data from a single hospital system are noted. CONCLUSIONS: Findings highlight misalignments in screening and risk status that are important to address to ensure more equitable screening implementation and health outcomes.


Assuntos
Depressão , Atenção Primária à Saúde , Adolescente , Criança , Depressão/diagnóstico , Depressão/epidemiologia , Registros Eletrônicos de Saúde , Feminino , Humanos , Programas de Rastreamento , Ideação Suicida , Estados Unidos/epidemiologia
19.
Curr Psychiatry Rep ; 13(2): 111-5, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21312010

RESUMO

Sickle cell disease (SCD), the most common genetic hemoglobin disorder, affects more than 70,000 Americans, primarily those of African and Mediterranean descent. SCD, characterized by chronic hemolytic anemia; recurrent, episodic painful episodes; vaso-occlusive complications affecting multiple organ systems; and increased risk of infections, is associated with a shortened life span for affected individuals. However, recent medical advances have significantly increased survivability and quality of life for individuals with SCD. Despite these advances, adolescents with SCD continue to face many challenges of living with a chronic condition that requires lifelong medical management that may place them at risk of psychiatric symptoms and disorders. Studies focusing on children and adolescents with SCD suggest greater risks for psychosocial difficulties and depressive and anxiety symptoms. This article describes findings from a structured psychiatric interview administered to 40 adolescents and their parents. The rates of reported psychiatric diagnosis were significantly higher than those reported for the general population. Awareness of risks for psychiatric disorders in SCD could lead to increased identification and interventions that may improve medical and psychiatric outcomes.


Assuntos
Anemia Falciforme/complicações , Transtornos Mentais/complicações , Transtornos Mentais/diagnóstico , Adolescente , Anemia Falciforme/psicologia , Ansiedade/complicações , Ansiedade/diagnóstico , Ansiedade/psicologia , Criança , Depressão/complicações , Depressão/diagnóstico , Depressão/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Entrevista Psicológica , Masculino , Qualidade de Vida , Adulto Jovem
20.
Child Adolesc Psychiatr Clin N Am ; 30(2): 389-399, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33743946

RESUMO

Suicide rates continue to rise among children and adolescents; suicide is the second leading cause of death in the United States. Although research studies have identified factors associated with suicide risks for youths, none distinguishes those who have suicidal ideation from those who most likely will make an attempt or die by suicide. Most studies focus on psychiatric diagnoses associated with suicide risks. Recent studies suggest that cross-cutting symptom profiles may be a stronger predictor of risks for suicide than diagnosis. This article provides an overview of emotional dysregulation as it relates to suicidal ideation, intent, and behaviors for youth.


Assuntos
Transtornos Mentais , Suicídio , Adolescente , Criança , Humanos , Fatores de Risco , Ideação Suicida , Tentativa de Suicídio , Estados Unidos/epidemiologia
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