Depressive symptoms as a link between barriers to care and sexual risk behavior of HIV-infected individuals living in non-urban areas.

HIV-infected individuals living in non-urban areas have been proposed to be particularly vulnerable for sexual risk behavior because of barriers to adequate care. The current study examined the association of barriers to care and sexual risk behavior with a focus on depressive symptoms as a link between the two variables. One-hundred-and-one sexually active HIV-infected individuals living in non-urban areas in New England participated by completing self-report measures in a computer-administered format. Four barriers to care were examined: geographical barriers and distance to services; access to and quality of medical and psychological services; community stigma; and personal resources. The results indicated barriers to care, and in particular those pertaining to access to and quality of medical and psychological services were related to depressive symptoms, which, in turn, were related to sexual risk behavior. The findings suggest that interventions to reduce sexual risk behavior in non-urban settings could include not only increasing the availability of quality services but targeting depressive symptoms of HIV-infected individuals.

The role of family stressors and parent relationships on adolescent functioning.

This study examined the association between cumulative family stressors (divorce, interparental conflict, maternal depression) and adolescent functioning as well as the protective role of the parent-adolescent relationship as perceived by the adolescent when family stressors are present. Two hundred and thirty-one adolescents, their mothers, and their social studies teachers served as the subjects. Results indicated that, as family stressors increased, adolescent functioning deteriorated. Furthermore, a positive parent-adolescent relationship as perceived by the adolescent was associated with less deterioration in all areas of functioning. The role of the relationship in protecting the adolescent supported both a stress buffering model and a main effect model.

Disease status in African American single mothers with HIV: the role of depressive symptoms.

The association between depressive symptoms and 2 measures of HIV disease status in 73 African American single mothers was examined. Hierarchical multiple regression analyses revealed that clinician-rated depressive symptoms predicted subjective, but not objective, parameters of disease status 12 to 14 months later. More symptoms of depression at the 1st assessment predicted an increase in physical complaints over the course of the study. Results suggest that researchers and clinicians interested in enhancing quality of life among African American single mothers with HIV infection, an understudied population within the HIV-AIDS literature, should consider both subjective and objective measures of the disease.

Adolescent sexual risk behavior: a multi-system perspective.

Adolescents are at high risk for a number of negative health consequences associated with early and unsafe sexual activity, including infection with human immunodeficiency virus, other sexually transmitted diseases, and unintended pregnancy. As a result, researchers have attempted to identify those factors that influence adolescent sexual risk behavior so that meaningful prevention and intervention programs may be developed. We propose that research efforts so far have been hampered by the adoption of models and perspectives that are narrow and do not adequately capture the complexity associated with the adolescent sexual experience. In this article, we review the recent literature (i.e., 1990-1999) pertaining to the correlates of adolescent sexual risk-taking, and organize the findings into a multisystemic perspective. Factors from the self, family, and extrafamilial systems of influence are discussed. We also consider several methodological problems that limit the literature's current scope, and consider implications of the adoption of a multisystemic framework for future research endeavors. We conclude with a discussion of the implications of the available research for practitioners working to reduce sexual risk behavior among adolescents.

Introduction to special section: the role of longitudinal data with child psychopathology and treatment: preliminary comments and issues.

Longitudinal data can play an important role in child psychopathology and treatment. This article introduces a review of some of the research questions that longitudinal designs can answer and how longitudinal studies have been used in evaluating traditional syndromes in child clinical psychology. We then introduce the articles in this special section.

Cascading toward divorce: the roles of marital and child factors.

This longitudinal study examined the role of marital and child factors in predicting divorce potential and actual divorce occurrence. Participants included 140 young adolescents (73 girls, 67 boys; mean age = 13 years 2 months) and their parents. Child-related (number of children in the family, the presence of a male child in the family, and the adolescent's level of anxiety-withdrawal and conduct disorder problems) and intramarital (marital satisfaction and, for some analyses, divorce potential) factors served as predictors. For both wife and husband data, lower levels of marital satisfaction predicted higher current levels of divorce potential, and, in turn, divorce potential predicted greater likelihood for divorce up to 7 years later. No child-related variables predicted divorce potential or divorce occurrence.

Parental divorce during early adolescence in Caucasian families: the role of family process variables in predicting the long-term consequences for early adult psychosocial adjustment.

The relationship between parental divorce occurring during adolescence and young adult psychosocial adjustment was examined, as was the role of family process variables in clarifying this relationship. Participants were young Caucasian adults from divorced (n = 119) and married (n = 123) families. Assessments were conducted during adolescence and 6 years later during early adulthood. Young adults from married families reported more secure romantic attachments than those from divorced families; however, differences were not evident in other domains of psychosocial adjustment after demographic variables were controlled. Three family process variables (parent-adolescent relationship, interparental conflict, and maternal depressive symptoms) were examined as potential mediators and moderators of the association between parental divorce and young adult adjustment. No evidence supporting mediation or moderation was found; however, the parent-adolescent and parent-young adult relationships, particularly when the identified parent was the father, emerged as significant predictors of young adult psychosocial adjustment.

Role of parenting in adolescent deviant behavior: replication across and within two ethnic groups.

The role of 2 parenting variables, monitoring and communication, in adolescent deviant behavior was examined within 4 samples; Black Americans living in Montgomery, Alabama, and the Bronx, New York, and Hispanics living in the Bronx, New York, and San Juan, Puerto Rico. The participants comprised 907 14- to 16-year-old adolescents and their mothers recruited through high schools in 3 communities. The results indicated that higher levels of parental monitoring, but not parent--adolescent communication, predicted lower levels of adolescent deviance in each of the samples. The replication of these findings in samples that vary by ethnicity and location provides strong support for the generalizability of the association between parental monitoring and low levels of adolescent deviant behavior.

The Family Health Project: psychosocial adjustment of children whose mothers are HIV infected.

The psychosocial adjustment of 87 inner-city African American children 6-11 years old whose mothers were HIV infected was compared with that of 149 children from a similar sociodemographic background whose mothers did not report being HIV infected. Children were not identified as being HIV infected. Mother reports, child reports, and standardized reading achievement scores were used to assess 4 domains of adjustment: externalizing problems, internalizing problems, cognitive competence, and prosocial competence. The results indicated that, on average, children from both groups had elevated levels of behavior problem scores and low reading achievement scores when compared with national averages. Relative to children whose mothers were not infected, those whose mothers were HIV infected were reported to have more difficulties in all domains of psychosocial adjustment. Potential family processes that may explain the findings are discussed.

Role of maternal functioning and parenting skills in adolescent functioning following parental divorce.

While divorce has been associated with impaired child functioning, the mechanisms within the divorce process leading to such an outcome have rarely been examined. The following hypothesis was examined: Divorce is associated with poor parental adjustment or disrupts parenting behavior, or both, which leads to poor adolescent functioning. Subjects were 121 and 93 young adolescents from intact and recently divorced families, respectively, and their mothers and teachers. Mothers completed measures assessing parental conflict and depression, observers coded parenting skills during a mother-adolescent interaction, and teachers completed measures assessing adolescent functioning. Although the magnitude of differences was not large, analyses of variance indicated that the divorced sample was functioning poorer than the married sample on all measures except interparental conflict. Path analysis suggested that parental functioning and parenting skills play a role in adolescent functioning following divorce.

Traumatic stress in HIV-infected women.

This study assesses the prevalence of specific traumatic stressors that meet criterion A for the Diagnostic and Statistical Manual of Mental Disorders' (DSM-IV) diagnosis of posttraumatic stress disorder (PTSD) and symptoms of PTSD in a representative sample of HIV-infected women. The study also assesses the impact of these stressors and symptoms on the clinical progression of HIV infection. The Life Stressor Checklist and the Impact of Events Scale-Revised were administered via interview to 67 Africa-American women beyond the initial stages of HIV infection. The ratio of CD4 t-cells to CD8 t-cells were abstracted from medical records at dates that approximated psychological interviews and were examined at two points in time 12 to 14 months apart. The prevalence of traumatic stressors and PTSD symptoms were high among HIV-infected women. Traumatic stressors were significantly associated with a lower CD4 to CD8 ratio at the 1-year follow-up. Among women who reported a traumatic event, those who also met criteria for PTSD evidenced a lower CD4 to CD8 ratio at the follow-up assessment. The study concludes that prevention and treatment efforts targeted at HIV-infected women must take into account traumatic stressors and PTSD symptoms and their potential impact on the course of the disease.

Predicting recidivism in juvenile delinquents: the role of mental health diagnoses and the qualification of conclusions by race.

Seventy-five male youths were evaluated while incarcerated in a juvenile facility in the state of Georgia. Twenty-one to 32 months following discharge, criminal files were examined for records of reincarceration. The recidivism rate was approximately one-third of the initial sample. Crime-related and mental health variables were entered into discriminant function analyses to determine models for predicting recidivism. For the total sample, earlier age at first arrest and higher severity of crime significantly discriminated recidivists from nonrecidivists. Presence of a substance abuse disorder appeared to be a positive prognostic indicator for nonrecidivism. Subsequently, separate sets of analyses were conducted by race, showing clearly that the results were qualified by race, and that differential processes may be operating for African-American vs Caucasian youth when considering recidivism.

Juvenile sex offenders: similar to, or different from, other incarcerated delinquent offenders?

The purpose of the present study was to compare incarcerated juvenile sex offenders to incarcerated youth who committed confrontational but nonsex offenses, and to those youth who committed only nonconfrontational, nonsex offenses. Furthermore, comparisons were made between two subtypes of sex offenders: those youth convicted for rape or sodomy vs those convicted for child molestation. Eighty-three male juvenile delinquents served as participants. Teachers within the correctional facility completed an instrument which allowed the examination of the two areas of interest: externalizing problems and internalizing problems. The results indicated that sex offenders generally, and particularly those who had committed only sex offenses, were perceived as having fewer externalizing and internalizing problems. No differences emerged between the two subtypes of sex offenders. Implications, as well as limitations, of the findings are discussed.

Suicide attempts among juvenile delinquents; the contribution of mental health factors.

This study examined which, if any, of four variables (depression, hopelessness, conduct problems, substance abuse) differentiated suicide attemptors from nonattemptors among incarcerated juvenile delinquents. Fifty-one male youth served as subjects. The predictor variables were collected by either a standardized interview or an orally administered questionnaire. Youth self-report data regarding suicide attempts were collected. The results indicated that depression served as a predictor of suicide attempts but only in white, not black, youth. Suicide attempts also were reported three times more often in white than black participants. Implication, as well as limitations, of the findings are discussed.

Maternal depressive mood: the role of the father in preventing adolescent problem behaviors.

The current study examines the role of the father-adolescent relationship as a buffer for maternal depressive mood in a nonclinic young adolescent sample (n = 282). Internalizing and externalizing problems, as well as grade point average, were examined. Results indicated that, for all three variables, maternal depressive mood was associated with poorer functioning. Of most importance, for internalizing and externalizing problems, a good father-adolescent relationship served to buffer the adolescent from maternal depressed mood. This effect existed regardless of the gender of the adolescent or parental marital status. The findings suggest that behavior problems are associated with even mild levels of one family stressor, maternal depressive mood, and that these problems can be counteracted through an intrafamilial support system--the father. Implications for the behavior therapist are considered.

Prospective associations among family form, family processes, and adolescents' alcohol and drug use.

The present study was designed to disentangle and define the unique contributions of family form and family processes to substance use and association with deviant peers among adolescents. Eighty adolescents and their mothers participated in the study; half were from divorced single-parent families and half were from families in which the parents were still married. Maternal assessments of interparental conflict and the quality of the mother-adolescent relationship were used to prospectively forecast adolescent reports of substance use and affiliation with deviant peers one year later. The results revealed that mother-adolescent conflict predicted adolescent alcohol use, and maternal acceptance-rejection predicted both drug use and affiliation with deviant peers. These findings support the hypothesis that family processes rather than family form forecast adolescents' substance use and deviant peer affiliation. Clinical implications of the findings are discussed.

Does parent training with young noncompliant children have long-term effects?

The current study was a long-term follow-up (approx. 14 yr following treatment) of 26 late adolescents/young adults (17 yr and older) who had participated in parent training with their mothers when they were young (2-7 yr old) noncompliant children. Parent training, consisting of teaching mothers to use attends and rewards for appropriate behavior, clear commands and time-out, had reduced deviant behavior and increased compliance immediately following treatment. At this follow-up, these individuals were compared to a matched community sample on various measures of delinquency, emotional adjustment, academic progress and relationship with parents. No differences emerged between the two groups on any of the measures, suggesting that noncompliant children who participated in parent training during their early years are functioning as well as nonclinic individuals as they move into adulthood.

Interparental conflict and adolescent problem behavior: an examination of mechanisms.

The purpose of the present study was to examine several competing hypotheses which have been utilized to explain the negative relationship between interparental conflict and child/adolescent problems. These mechanisms of operation have included modelling, genetic transmission, disrupted parenting, the role of perceptual/appraisal processes of the conflict, and an inhibition hypothesis. One hundred and forty-two young adolescents and their mothers served as subjects. Eighty were from intact families and 62 from recently divorced families. Data were collected from the perspective of the adolescent, mother, behavioral observer, and social studies teacher. The results indicated that intact and divorced samples had to be considered separately as different pathways contributed to adolescent behavior problems in the two samples. For externalizing problems, a direct path between interparental conflict and problem behavior existed for the divorced sample whereas an indirect path through the adolescent's perceptions of the conflict existed for the intact sample. The different context in which the interparental conflict occurred for the two samples was offered as an explanation of this difference. For internalizing problems a significant direct path existed between conflict and problem behavior for both samples; however, the indirect paths through the adolescent's perceptions and through poor parenting skills contributed only for the divorced sample. The results suggest that various mechanisms appear to operate in influencing how interparental conflict influences behavior problems of young adolescents. Both the type of problem examined and the marital status of the parents appear important in determining the relative impact of the mechanisms. Implications for the behavior therapist are noted.

Juvenile firesetting: a unique syndrome or an advanced level of antisocial behavior?

The current study examined whether juvenile firesetting represents a unique syndrome or an advanced level of antisocial behavior. Thirty-six incarcerated juvenile delinquents, all of whom met criteria for a diagnosis of Conduct Disorder, served as subjects and were categorized into one of three groups: firesetters, non-firesetters but comparable to firesetters in number of conduct disorder symptoms, and non-firesetters who displayed fewer conduct disorder symptoms than the other two groups. Caregivers completed the Child Behavior Checklist on the youth to provide information about the severity and range of psychopathology. The results indicated that firesetters and non-firesetters who had a comparable number of symptoms did not differ from one another on the CBCL subscales of adolescent psychopathology but both differed from the group with fewer symptoms. These results suggest that firesetting does represent an advanced level of antisocial behavior, but that firesetting is not a unique syndrome, at least not in terms of caretakers' perceptions of the youths' problematic behavior. Implications for treatment of firesetters are presented.

Child resiliency in inner-city families affected by HIV: the role of family variables.

This study examined the role of family variables in child resiliency within a sample of African-American, inner-city children whose mothers are HIV-infected. Variables from three dimensions of the family were included: family structural variables, maternal variables, and mother-child (parenting) variables. The participants were 82 children between the ages of 6 and 11 and their HIV-infected mothers. Correlational analyses indicated that resiliency was associated only with three parenting variables: parent-child relationship, parental monitoring, and parental structure in the home. Hierarchical regression analyses indicated a multiplicative relationship between parental monitoring and parent-child relationship and between parental monitoring and parental structure in the home, suggesting that parenting variables potentiate each other. Clinical implications of the findings are considered.