Bridget E. Weller

Suicide attempts in a longitudinal sample of adolescents followed through adulthood: evidence of escalation

OBJECTIVES This study was designed to examine escalation in repeat suicide attempts from adolescence through adulthood, as predicted by sensitization models (and reflected in increasing intent and lethality with repeat attempts, decreasing amount of time between attempts, and decreasing stress to trigger attempts). METHOD In a prospective study of 180 adolescents followed through adulthood after a psychiatric hospitalization, suicide attempts, and antecedent life events were repeatedly assessed (M = 12.6 assessments, SD = 5.1) over an average of 13 years 6 months (SD = 4 years 5 months). Multivariate logistic, multiple linear, and negative binomial regression models were used to examine patterns over time. RESULTS After age 17-18, the majority of suicide attempts were repeat attempts (i.e., made by individuals with prior suicidal behavior). Intent increased both with increasing age, and with number of prior attempts. Medical lethality increased as a function of age but not recurrent attempts. The time between successive suicide attempts decreased as a function of number of attempts. The amount of precipitating life stress was not related to attempts. CONCLUSIONS Adolescents and young adults show evidence of escalation of recurrent suicidal behavior, with increasing suicidal intent and decreasing time between successive attempts. However, evidence that sensitization processes account for this escalation was inconclusive. Effective prevention programs that reduce the likelihood of individuals attempting suicide for the first time (and entering this cycle of escalation), and relapse prevention interventions that interrupt the cycle of escalating suicidal behavior among individuals who already have made attempts are critically needed. (PsycINFO Database Record

Developmental Trajectories of Suicidal Thoughts and Behaviors From Adolescence Through Adulthood

OBJECTIVE Little is known about the patterns among individuals in the long-term course of suicidal thoughts and behaviors (STBs). The objective of this study was to identify developmental trajectories of STBs from adolescence through young adulthood, as well as risk and protective covariates, and nonsuicidal outcomes associated with these trajectories. METHOD A total of 180 adolescents (ages 12-18 years at recruitment) were repeatedly assessed over an average of 13.6 years (2,273 assessments) since their psychiatric hospitalization. Trajectories were based on ratings of STBs at each assessment. Covariates included psychiatric risk factors (proportion of time in episodes of psychiatric disorders, hopelessness, trait anxiety, impulsivity, and aggression in adulthood, sexual and physical abuse, parental history of suicidal behavior), protective factors (survival and coping beliefs, social support in adulthood, parenthood), and nonsuicidal outcomes (social adjustment and functional impairment in adulthood, school drop-out, incarcerations). RESULTS Using a Bayesian group-based trajectory model, 4 trajectories of STBs were identified: an increasing risk class (11%); a highest overall risk class (12%); a decreasing risk class (33%); and a low risk class (44%). The 4 classes were associated with distinct patterns of correlates in risk and protective factors and nonsuicidal outcomes. CONCLUSION Adolescents and young adults have heterogeneous developmental trajectories of STBs. These trajectories and their covariates may inform strategies for predicting STBs and targeting interventions for individuals at risk for suicidal behavior.

Profiles of Malawian adolescents at risk for HIV infections: Implications for targeted prevention, policy, and practices

Abstract Young people are at the center of the HIV epidemic. In fact, HIV has been referred to as a “youth-driven disease” worldwide. This cross-sectional study identified a typology of risk for HIV among Malawian adolescents, examined the distribution of HIV status within each group in the typology, and tested the association between class membership and changes in sexual behaviors to avoid HIV. The sample was restricted to males and females between the ages of 15 and 18 from three regions in Malawi who reported never having been married. Latent Class Analysis was conducted to examine youth population clusters based on shared characteristics. A chi-squared test was used to test whether class membership was associated with changes in sexual behaviors to avoid HIV. The study results indicate that two classes of risk exist among Malawian youths in this sample: At High Risk class and At Risk class. Individuals in the At High Risk class were significantly more likely than the At Risk class to perceive themselves as currently infected with HIV. The At High Risk class was not significantly less likely than the At Risk class to report changes in their sexual behaviors to avoid HIV. Findings are discussed and recommendations are suggested for clinicians to consider the heterogeneity among Malawi adolescents and tailor services accordingly. We provide suggestions on potential interventions that target the specific needs for the two groups to mitigate the spread of HIV among adolescents in Malawi.

Linking students to appropriate interventions: A typology for social workers based on general strain theory

• Summary: The present study employed recent elaborations on general strain theory (GST) to develop a typology of vicarious and anticipated strain. The typology also considered gender-race combinations. The study used a sample of 11,222 adolescents who completed the School Success Profile for school assessment purposes. • Findings: Latent class analysis identified four patterns of vicarious and anticipated strain among adolescents. The patterns varied by sample members’ gender-race combinations. The latent class solution was replicated with two subsamples and validated by testing its association with behavior problems. • Application: Evidence-based practices are suggested for students experiencing different combinations of strain, and specific applications for social work practice are presented.

Diabetes-Specific and General Life Stress and Glycemic Outcomes in Emerging Adults with Type 1 Diabetes: Is Race/Ethnicity a Moderator?

Objective This study examines whether race/ethnicity moderates relationships of (a) diabetes stress and general life stressors with (b) diabetes outcomes of glycemic control and diabetic ketoacidosis (DKA) among emerging adults (aged 18-25 years) with type 1 diabetes (T1D). Method Using a T1D Exchange Registry sample of non-Hispanic White, African American, and Hispanic emerging adults (N = 3,440), multiple group analyses were used to determine whether race/ethnicity moderates the relationships between stress and diabetes outcomes. Results The relationships between the two stress types and glycemic control did not differ between African American and non-Hispanic Whites. However, as compared with non-Hispanic Whites, the association between higher diabetes-specific stress and poorer glycemic control was significantly stronger for Hispanics, and Hispanics had poorer glycemic control when they experienced a relatively fewer number of general life stressors than non-Hispanic Whites. The relationships between the type of stress (diabetes-specific and general stress) and DKA did not differ across racial/ethnic groups. Conclusions Future research should evaluate possible mechanisms that contribute to the different relationships of stress with glycemic control among Hispanics compared with non-Hispanic Whites.

Applying Evidence-Based Practice in Group Work at an Alternative High School

Social workers often are reluctant to use evidence-based practice in group work. Part of this reluctance is because of the perceived rigidity of the process and its emphasis on research. However, social workers can rely on the four cornerstones of evidence-based practice—research, clinical experience, personal views, and client’s perspective—to provide an evidence-based group intervention. In this article, the authors illustrate how social workers used the four cornerstones at one alternative high school to provide an evidence-based group intervention. These cornerstones were used from the beginning of the process, which started with choosing the type of intervention, through the end of the process, which concluded with assessing the intervention. In this article, the authors show that it is possible for social workers to provide an evidence-based group intervention, while remaining flexible, thereby contributing to social workers’ knowledge of how to use evidence-based practice with groups.

Estimated Prevalence of Psychiatric Comorbidities in U.S. Adolescents With Depression by Race/Ethnicity, 2011-2012.

PURPOSE Comorbid psychiatric conditions in adolescents with depression are a public health concern. However, little is known about the prevalence of comorbidities in separate racial/ethnic groups. This study estimated the national prevalence of comorbidities for black, Hispanic, and white adolescents separately, and compared the prevalence of comorbidities between adolescents with and without depression. METHODS This secondary analysis used data from the 2011-2012 National Survey of Childrens Health, a nationally representative, cross-sectional survey of U.S. youth. We restricted the sample to 12-17 year olds, and obtained unweighted and weighted descriptive statistics. Using weighted probit regression models, we examined differences in prevalence of comorbidities by adolescents with and without depression for each racial/ethnic group. RESULTS For black, Hispanic, and white adolescents with depression, the prevalence of comorbidities ranged from 8% to 61% and varied by race/ethnicity (e.g., depression and anxiety were comorbid for 47% of black, 54% of Hispanic, and 59% of white adolescents). For all racial/ethnic groups, adolescents with depression had a higher prevalence of attention deficit hyperactivity disorder than adolescents without depression. However, only black and Hispanic adolescents with depression had a significantly higher prevalence of anxiety and behavior problems than their counterparts without depression. In each racial/ethnic group, the prevalence of autism spectrum disorder did not differ between adolescents with and without depression. CONCLUSIONS This study detected important differences in the prevalence of comorbid psychiatric conditions by race/ethnicity. Findings highlight the need for targeted interventions for black and Hispanic adolescents with depression that concurrently treat anxiety and behavior problems.