Adam Bryant Miller

A within-person approach to risk for suicidal ideation and suicidal behavior : Examining the roles of depression, stress, and abuse exposure

Objective: This study tests a novel, within-person model that reexamines depression and stress as risk factors for suicidal ideation and behavior among adolescent girls with and without sexual/physical abuse histories. Method: This longitudinal study includes data from 220 adolescent girls between 12 and 16 years of age (M = 14.69 years, SD = 1.37; 61% White). At baseline, adolescents reported the presence or absence of prior abuse as part of a clinical interview. At baseline and every 3 months for 18 months, adolescents completed measures of suicidal ideation and behavior, depressive symptoms, and stress. Results: Multilevel models examined within-person mean, deviations from within-person mean, depression, and stress and their interactions with abuse as predictors of suicidal ideation and behavior. In addition to within-person mean depression, higher-than-usual depression (odds ratio [OR] = 1.99) and higher-than-usual stress (OR = 1.53) predicted greater risk of suicidal ideation at each follow-up assessment. Periods of higher-than-usual stress (1 SD increase) and periods of higher-than-usual depression (1 SD increase) were associated with an 82% and 57% increase in the odds of suicidal behavior, respectively, but only among those with abuse histories. Conclusion: Depression, stress, and abuse are well-known risk factors for suicidal ideation and behavior; however, it has been unclear for whom, and when, these factors have their greatest impact. These results show that depression and stress are potent risk factors among those with a history of abuse and that within-person elevations in these risk factors signal increased short-term risk of suicidal ideation and behavior.

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

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

Emotion Reactivity and Regulation in Adolescent Girls Following an Interpersonal Rejection

Failures in emotion regulation, especially as a result of interpersonal stress, are implicated as transdiagnostic risk factors for psychopathology. This study examines the effects of an experimentally timed targeted interpersonal rejection on emotion reactivity and regulation in typically developing adolescent girls. Girls (n = 33, ages 9–16 years, M = 12.47, SD = 2.20) underwent fMRI involving a widely used emotion regulation task. The emotion task involves looking at negative stimuli and using cognitive reappraisal strategies to decrease reactions to negative stimuli. Participants also engaged in a social evaluation task, which leads participants to believe a preselected peer was watching and evaluating the participant. We subsequently told participants they were rejected by this peer and examined emotion reactivity and regulation before and after this rejection. Adolescent girls evidence greater reactivity via higher self-reported emotional intensity and greater amygdala activation to negative stimuli immediately after (compared with before) the rejection. Self-reported emotional intensity differences before and after rejection were not observed during regulation trials. However, on regulation trials, girls exhibited increased prefrontal activation in areas supporting emotion regulation after compared with before the rejection. This study provides evidence that a targeted rejection increases self-report and neural markers of emotion reactivity and that girls increase prefrontal activation to regulate emotions after a targeted rejection.

Dimensions of deprivation and threat, psychopathology, and potential mediators: A multi-year longitudinal analysis.

Prior research demonstrates a link between exposure to childhood adversity and psychopathology later in development. However, work on mechanisms linking adversity to psychopathology fails to account for specificity in these pathways across different types of adversity. Here, we test a conceptual model that distinguishes deprivation and threat as distinct forms of childhood adversity with different pathways to psychopathology. Deprivation involves an absence of inputs from the environment, such as cognitive and social stimulation, that influence psychopathology by altering cognitive development, such as verbal abilities. Threat includes experiences involving harm or threat of harm that increase risk for psychopathology through disruptions in social-emotional processing. We test the prediction that deprivation, but not threat, increases risk for psychopathology through altered verbal abilities. Data were drawn from the Child Development Project (N = 585), which followed children for over a decade. We analyze data from assessment points at age 5, 6, 14, and 17 years. Mothers completed interviews at age 5 and 6 on exposure to threat and deprivation experiences. Youth verbal abilities were assessed at age 14. At age 17, mothers reported on child psychopathology. A path analysis model tested longitudinal paths to internalizing and externalizing problems from experiences of deprivation and threat. Consistent with predictions, deprivation was associated with risk for externalizing problems via effects on verbal abilities at age 14. Threat was associated longitudinally with both internalizing and externalizing problems, but these effects were not mediated by verbal abilities. Results suggest that unique developmental mechanisms link different forms of adversity with psychopathology.

Suicidal Thoughts and Behavior in Children and Adolescents: An Ecological Model of Resilience

There has been increasing interest in the identification of factors that promote resilience to suicidal thoughts and behaviors in high-risk youth. The present review summarizes and critiques the current literature on protective factors that promote resilience to suicidal thoughts and behaviors in those children and adolescents who are at high risk for these outcomes. In contrast to earlier work on this topic, which primarily focused on internal, psychological protective factors, the current review articulates an ecological model of resilience in youth that spans multiple domains, including the individual, parents, family, friends, peers, school, community, and culture. This model encompasses individual assets such as problem-solving ability and emotion regulation as well as ecological resources such as parent–child relationship quality, family functioning, peer acceptance, supportive school climate, and engagement in meaningful activities and interests. The present review suggests that future research on resilience to suicidality in youth may benefit from taking a multi-dimensional approach that is grounded in current theories on suicidal thoughts and behavior. The results also suggest that suicide prevention and intervention programs for youth may benefit from a domain-spanning approach that helps teens to enhance their connection to friends, family, and community while teaching them vital internal coping skills.

Effects of cognitive distortions on the link between dating violence exposure and substance problems in clinically hospitalized youth

PURPOSE The purpose of the present study was to examine whether cognitive distortions (e.g., cognitive errors; negative views of self, world, and future) influence the association between dating violence and problematic substance use behaviors in a sample of psychiatrically hospitalized adolescents. METHOD Participants included 155 adolescents, aged 13-17 years, who had initiated dating. Adolescents completed measures of dating violence, substance-related problems (alcohol and marijuana), and cognitive distortions. RESULTS Logistic regressions were conducted to examine the direct and interactive effects of dating violence exposure and cognitive distortions on likelihood of recent problematic substance use. Results suggested a main effect of dating violence on problematic alcohol and other drug use as well as an interactive effect of dating violence and cognitive distortions. Specifically, the relationship between dating violence and odds of substance-related problems was higher among those with greater (vs. fewer) cognitive distortions. CONCLUSION Study results suggest the need for careful screening of cognitive distortions among adolescent dating violence victims, particularly those in mental health treatment.

A comparison of automated dispensing cabinet optimization methods

PURPOSE Results of a study comparing two methods of optimizing automated dispensing cabinets (ADCs) are reported. METHODS Eight nonprofiled ADCs were optimized over six months. Optimization of each cabinet involved three steps: (1) removal of medications that had not been dispensed for at least 180 days, (2) movement of ADC stock to better suit end-user needs and available space, and (3) adjustment of par levels (desired on-hand inventory levels). The par levels of four ADCs (the Day Supply group) were adjusted according to average daily usage; the par levels of the other four ADCs (the Formula group) were adjusted using a standard inventory formula. The primary outcome was the vend:fill ratio, while secondary outcomes included total inventory, inventory cost, quantity of expired medications, and ADC stockout percentage. RESULTS The total number of medications stocked in the eight machines was reduced from 1,273 in a designated two-month preoptimization period to 1,182 in a designated two-month postoptimization period, yielding a carrying cost savings of

Childhood Emotional Maltreatment as a Robust Predictor of Suicidal Ideation: A 3-Year Multi-Wave, Prospective Investigation.

44,981. The mean vend:fill ratios before and after optimization were 4.43 and 4.46, respectively. The vend:fill ratio for ADCs in the Formula group increased from 4.33 before optimization to 5.2 after optimization; in the Day Supply group, the ratio declined (from 4.52 to 3.90). The postoptimization interaction difference between the Formula and Day Supply groups was found to be significant (p = 0.0477). CONCLUSION ADC optimization via a standard inventory formula had a positive impact on inventory costs, refills, vend:fill ratios, and stockout percentages.