Andrea L. Hazen

Racial/ethnic differences in parental endorsement of barriers to mental health services for youth.

The present study investigated parental endorsement of barriers to care in a racially/ethnically diverse, at-risk sample of youth with mental health needs by testing the following hypotheses: (1) African American, Asian/Pacific Islander American, and Latino youth would have higher levels of unmet need compared to Non-Hispanic Whites (NHWs); (2) Parents of ethnic minority youth would report a greater number of barriers to mental health services for their children than would parents of NHWs; (3) The pattern of greater barrier endorsement by parents of ethnic minorities compared to parents of NHWs would persist across different barrier types; (4) Barrier endorsement would be related to unmet need for mental health services. As hypothesized, ethnic minority youth had higher levels of unmet need as compared to NHWs. However, despite this finding, parents of ethnic minority youth reported fewer barriers than did parents of NHWs, and this pattern generally persisted across barrier types. Furthermore, barrier endorsement was unrelated to unmet need. Post hoc analyses suggest the influence of cultural factors upon barrier endorsement, indicating the importance of taking such influences into account in future research on barriers to care.

The Relation Between Violence Exposure and Conduct Problems Among Adolescents: A Prospective Study

This study tested the hypothesis that exposure to community violence, intimate partner violence, and child maltreatment independently contribute to the prediction of conduct problems over a 2-year period. Participants were a subsample of youth ages 12 to 17 years (N = 423) from the Patterns of Care study, which drew a stratified random sample of high-risk youth receiving services from public service sectors. Exposure to community violence significantly predicted conduct disorder and externalizing problems 2 years later when potential confounds were controlled. Child maltreatment predicted conduct disorder but not externalizing symptoms. Exposure to intimate partner violence was not related to either outcome. Exposure to community violence contributed to the development of conduct disorder and externalizing symptoms, even when exposure to child maltreatment or intimate partner violence was controlled. Results are discussed in terms of implications for treatment and prevention of youth conduct problems.

Referral sources, diagnoses, and service types of youth in public outpatient mental health care: A focus on ethnic minorities

Racial/ethnic variations in clinical and service delivery characteristics among youth in public outpatient mental health services were examined using data from San Diego County mental health service programs for fiscal year 1996 to 1997 (N=3,962). Differences in referral sources, primary diagnoses, and service types were investigated for three racial/ethnic groups (African Americans, Asian/Pacific Islander Americans, and Latinos) compared to non-Hispanic whites. Controlling for age, gender, functional impairment, and prior service use, significant differences by race/ethnicity were found for all three variables studied. Possible explanations for these variations and future directions for research are discussed.

Adolescent alcohol and drug abuse and health.

PURPOSE To examine the relationship of adolescent alcohol and drug use over a 5-year period to cumulative health problems in late adolescence and young adulthood. METHODS We prospectively examined self-reported health problems in a sample of adolescents, some of whom received treatment for substance use disorders and had consistently poor substance use outcomes (n = 38), some of whom received treatment for substance use disorders and had positive substance use outcomes (n = 30), and a low alcohol and drug use community comparison group (n = 48). Data regarding health-related problems of these adolescents (mean, 15.9 years; 83% Caucasian; 56.5% female) were collected at 2, 4, and 6 years following initial assessments. RESULTS Alcohol and/or drug involvement severe enough to warrant treatment during adolescence was associated with more cumulative health problems and severe health problems for girls and more cumulative health problems for boys. Protracted and continuous abuse of alcohol and drugs was associated with more cumulative and severe health problems for girls and more severe health problems for boys. CONCLUSIONS These results suggest that significant health problems and concerns are related to both brief and protracted alcohol and drug abuse during adolescence. Health problems will likely become even more evident as early-onset, chronic substance abusers continue to age.

Lifetime patterns of social phobia: a retrospective study of the course of social phobia in a nonclinical population.

This study describes the natural course of social phobia as recalled by a sample of nonclinical subjects and explores, using qualitative research methods, perceived risk factors and factors that may cause changes in its course. Thirty‐nine respondents with a lifetime diagnosis of social phobia were interviewed using a semistructured interview schedule based on DSM‐IV criteria. Four main lifetime patterns emerged: a slight worsening of social phobic symptoms over time, no change, slight improvement and complete remission. Thirty‐eight percent of the sample was in remission at the time of interview. The mean age of onset was 12.8 ± 4.1 years. The average duration of illness was 29.0 ± 12.7 years. Factors perceived by respondents to precipitate social phobia, using content analysis, were family and school environment, onset of adolescence, low self‐esteem, temperament and poverty. Factors perceived to improve symptoms were building self‐esteem, exposure, determination, maturity and counseling. Factors perceived to worsen symptoms were avoidance, exposure to negative attention and comorbid disorders. Depression and Anxiety 7:113–121, 1998.

Use of Mental Health Services by Youths in Public Sectors of Care

The present paper examined the lifetime rates of mental health service use in a representative sample of youths identified as receiving services in at least one sector of care in a publicly funded service system of a large, metropolitan area. Service use was examined in relation to age, gender, mental health diagnostic status, and service sector involvement. Participants were 1,706 youths ages 6–17 years who were active in at least one of the following service sectors: alcohol and drug services, child welfare, juvenile justice, mental health, and special education services for serious emotional disturbance. Structured service use and diagnostic interviews were administered to youths and their caregivers. High lifetime rates of mental health service use were found. Eighty-seven percent of the sample used at least one outpatient service, 45% used at least one inpatient service, and 71% reported use of a school-based service. Youths involved with the mental health and special education sectors had the highest rates of service use. In contrast, youths enumerated from the juvenile justice system tended to have the lowest rates of use. Additional research is needed to refine our understanding of the factors associated with the observed patterns of service use.

Childhood sexual abuse and adolescent substance use: A latent class analysis

Children who have exposure to child sexual abuse (CSA) are at particular risk for developing substance abuse in adolescence, but the extent to which CSA may shape patterns of adolescent substance use remains uncertain. The aim of this paper is to characterize the variations in patterns of adolescent substance use and to examine the association between CSA and qualitatively distinct patterns of adolescent substance use. Latent class analyses identified homogenous groups of adolescents with similar patterns of substance use using a sample of 1019 adolescents (mean age: 15.9 years; range: 13-18) who were selected from five publicly funded service systems. Different patterns of latent class structures were identified in boys and girls (a 4-class solution for girls and a 3-class solution for boys). CSA was associated with an increased risk of being a heavy polysubstance user in girls, even after adjustment of age, race/ethnicity, parental substance use, sibling use, peer use, psychopathology and other forms of childhood maltreatment including physical abuse and neglect. Findings indicate that female victims of CSA who are involved with public service systems are at high risk for developing multiple-substance use in adolescence.

Substance involvement among youths in child welfare: the role of common and unique risk factors.

This study examines risk factors for substance involvement for youths involved with the child welfare (CW) system. In addition to common risk factors examined in general population studies; this research examines risk factors unique to youths in the CW system, including age at entry into CW and number of out-of-home placements. Participants included 214 youths ages 13 to 18, randomly sampled from youths active to CW in San Diego County, California. Severity of substance involvement was assessed through structured diagnostic interviews determining lifetime substance use, abuse, and dependence. Hierarchical regression analyses including demographics, psychosocial variables, maltreatment history, CW placement variables, and the interaction of age at entry into CW and number of out-of-home placements revealed that both common and CW-specific risk factors were associated with the severity of youth substance involvement. Multiple-placement changes, later entry into the CW system, and multiple-placement changes at an older age are associated with higher risk for more serious substance involvement for youths in CW.

Child Maltreatment Profiles and Adjustment Problems in High-Risk Adolescents

The purpose of this article is to identify profiles of maltreatment experiences in a sample of high-risk adolescents and to investigate the relationship between the derived profiles and psychological adjustment. Participants are 1,131 youth between the ages of 12 and 18 years involved with publicly funded mental health and social services. Information on physical, sexual, and emotional maltreatment and psychological symptoms are obtained in interviews with adolescents and their primary caregivers. Using latent profile analysis, three maltreatment profiles are identified: “sexual + physical + emotional maltreatment,” “physical + emotional maltreatment,” and “low maltreatment.” Adolescents in the two maltreatment profiles generally have significantly higher scores on symptom scales compared with those in the “low maltreatment” profile, but scores in the two maltreatment profiles do not differ. Findings highlight the need for agencies to identify and provide appropriate intervention for youth who experience multiple types of maltreatment.

Is screening for depression in the perinatal period enough? The co-occurrence of depression, substance abuse, and intimate partner violence in culturally diverse pregnant women.

BACKGROUND The perinatal period provides unique opportunities to identify and intervene with the co-occurrence of perinatal depression, intimate partner violence (IPV), and substance use problems. Psychosocial screening recommended for women seen in maternal child health settings tends to target single rather than multiple risk factors; there is limited research examining the co-occurrence of these issues especially in racially and ethnically diverse women across the perinatal period. These analyses explore the relationships of sociodemographic, psychosocial, and behavioral characteristics in a large, diverse sample of women. METHOD Women receiving perinatal services at routinely scheduled visits, including the 6-week postpartum visit, were recruited from 10 community obstetric/gynecologic clinics. Data were collected on perinatal depression, IPV, maternal substance use, and sociodemographic characteristics by bilingual, bicultural research assistants. RESULTS A total of 1868 women were screened, 1526 (82%) Latina, 1099 (58.8%) interviewed in Spanish; 20.4% (n=382) screened positive for depressive symptoms based on an Edinburgh Postnatal Depression Scale score of 10 or above, 20.9% reported harmful drinking, 4.3% reported drug use, 23% reported substance use problems, and 3.5% reported current or recent IPV. Women who were Black, Asian, Pacific Islander, or other race/ethnicity had greater odds for depressive symptoms relative to women who were Hispanic or Latino (odds ratio [OR]=1.81, p=0.005). Women reporting substance use problems (OR=2.37, p<0.0001) and IPV (OR=3.98, p<0.0001) had higher odds for depressive symptoms. CONCLUSION In a predominately Latina sample, 1 in 5 mothers (20.4%) screened positive for depressive symptoms and over one third (36.7%) reported one or more psychosocial issues during the perinatal period. Screening for multiple risk factors rather than just one can help clinicians tailor interventions for the successful management of psychosocial issues.