Carla Kmett Danielson

Prevalence and correlates of dating violence in a national sample of adolescents.

OBJECTIVE Dating violence is an important but understudied public health concern in adolescents. This study sought to examine the lifetime prevalence of serious forms of dating violence in 12- to 17- year-olds, risk and protective factors associated with dating violence, and the relation between dating violence and mental health. METHOD A nationally representative sample of adolescents (N = 3,614) completed a telephone-based interview that assessed serious forms of dating violence (i.e., sexual assault, physical assault, and/or drug/alcohol-facilitated rape perpetrated by a girlfriend, boyfriend, or other dating partner). RESULTS Prevalence of dating violence was 1.6% (2.7% of girls, 0.6% of boys), equating to approximately 400,000 adolescents in the U.S. population. Risk factors included older age, female sex, experience of other potentially traumatic events, and experience of recent life stressors. Findings also suggested that dating violence is associated with posttraumatic stress disorder and major depressive episode after controlling for demographic variables, other traumatic stressors, and stressful events. CONCLUSIONS These findings indicate that dating violence is a significant public health problem in adolescent populations that should be addressed through early detection, prevention, and intervention.

Distress Tolerance and Early Adolescent Externalizing and Internalizing Symptoms: The Moderating Role of Gender and Ethnicity

A large body of research has examined the development of internalizing and externalizing symptoms in childhood and early adolescence. Notably, there is significant concomitant impairment associated with early adolescent symptomatology, as well as association of these symptoms with future development of psychopathology, poor physical health, self-destructive thoughts and behaviors, criminal behavior, and HIV risk behaviors. Drawing on negative reinforcement theory, the current study sought to examine the potential role of distress tolerance, defined as the ability to persist in goal-directed activity while experiencing emotional distress, as a potential mechanism that may underlie both internalizing and externalizing symptoms among 231 Caucasian and African American youth (M age=10.9 years; 45.5% female; 54.5% Caucasian ethnicity). A series of regressions resulted in significant moderated relationships, such that low distress tolerance conferred increased risk for alcohol use among Caucasians, delinquent behavior among African Americans, and internalizing symptoms among females. Clinical implications, including the potential role of negative reinforcement models in early intervention with young adolescents, are discussed.

Trauma-Related Risk Factors for Substance Abuse Among Male Versus Female Young Adults

Clinical efforts to reduce risk for Substance Use Disorders (SUDs) among young adults rely on the empirical identification of risk factors for addictive behaviors in this population. Exposure to traumatic events and Posttraumatic Stress Disorder (PTSD) have been linked with SUDs in various populations. Emerging data, particularly from adolescent samples, suggest that traumatic event exposure increases risk for SUDs for young women, but not young men. The purpose of the current study was to examine trauma-related risk factors for alcohol and drug abuse among a national sample of young adults and compare such risk factors between men and women. Participants were 1753 young adults who participated in the 7-8 year follow-up telephone-based survey to the original National Survey of Adolescents. In the full sample, 29.1% met criteria for substance abuse. Trauma-related risk factors for alcohol and drug abuse differed for men and women. Clinical implications of these results are discussed.

Longitudinal pathways of victimization, substance use, and delinquency: findings from the National Survey of Adolescents.

Using a nationally representative sample of 3614 adolescents, age 12 to 17 years, this study examines longitudinal associations among interpersonal victimization (i.e., sexual abuse, physical abuse and/or assault, and witnessed community and domestic violence) and high risk behavior (i.e., alcohol use, drug use, and delinquent behavior). A bidirectional relationship was hypothesized between high risk behavior and victimization for the full sample. Descriptive results indicated that a high correlation between types of high risk behavior, with over 50% of adolescents having engaged in at least one type of high risk behavior by Wave 2 in the study. Results suggested strong links between victimization and high risk behaviors, whereas sequential order of the constructs across time was dependent on gender and type of victimization. Specifically, hypotheses concerning victimization and high risk behavior were fully supported with boys, but different patterns emerged in the data for girls.

Exposure to interpersonal violence and risk for PTSD, depression, delinquency, and binge drinking among adolescents: Data from the NSA-R

Interpersonal violence (IPV) is associated with a range of subsequent negative outcomes; however, research has yet to test whether IPV operates as a specific risk factor for separate psychopathology outcomes, such as posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, delinquent acts, or binge drinking. To address this, cumulative exposure to IPV and non-IPV-related traumatic events, PTSD symptoms, depressive symptoms, delinquent acts, and binge drinking were measured 3 times over approximately 3 years among a nationally representative sample of adolescents aged 12-17 (N = 3,614 at Wave 1). Results demonstrated that cumulative IPV exposure predicted subsequent PTSD, depression, delinquency, and binge drinking (βs = .07, .12, .10, and .09, respectively; all ps < .01) when all cross-relationships (e.g., the effect of delinquency on future binge drinking) were in the model. Exposure to non-IPV traumatic events generally did not confer vulnerability to subsequent psychopathology outcomes. Overall, findings from this study advance the literature in this area by exploring consequences for adolescents following cumulative IPV exposure.

The role of traumatic event history in non‐medical use of prescription drugs among a nationally representative sample of US adolescents

BACKGROUND Building on previous research with adolescents that examined demographic variables and other forms of substance abuse in relation to non-medical use of prescription drugs (NMUPD), the current study examined potentially traumatic events, depression, posttraumatic stress disorder (PTSD), other substance use, and delinquent behavior as potential correlates of past-year non-medical use of prescription drugs. METHOD A nationally representative sample of 3,614 non-institutionalized, civilian, English-speaking adolescents (aged 12-17 years) residing in households with a telephone was selected. Demographic characteristics, traumatic event history, mental health, and substance abuse variables were assessed. NMUPD was assessed by asking if, in the past year, participants had used a prescription drug in a non-medical manner. Multivariable logistic regressions were conducted for each theoretically derived predictor set. Significant predictors from each set were then entered into a final multivariable logistic regression to determine significant predictors of past-year NMUPD. RESULTS NMUPD was endorsed by 6.7% of the sample (n = 242). The final multivariable model showed that lifetime history of delinquent behavior, other forms of substance use/abuse, history of witnessed violence, and lifetime history of PTSD were significantly associated with increased likelihood of NMUPD. CONCLUSIONS Risk reduction efforts targeting NMUPD among adolescents who have witnessed significant violence, endorsed abuse of other substances and delinquent behavior, and/or endorsed PTSD are warranted. Interventions for adolescents with history of violence exposure or PTSD, or those adjudicated for delinquent behavior, should include treatment or prevention modules that specifically address NMUPD.

Systematic Investigation of Initiatives to Reduce Seclusion and Restraint in a State Psychiatric Hospital

OBJECTIVES This study used an experimental design to examine the effect of systematic implementation of behavioral interventions on the rate of seclusion and restraint in an inpatient psychiatric hospital. METHODS With a variant of the multiple-baseline design, a model designed to reduce seclusion and restraint was implemented at a large state-funded hospital in the southeastern United States. The implementation schedule was established such that each of five inpatient units was randomly assigned to implement the intervention components in a different order, and each unit served as its own control. Participants were patients and staff, for a total of 89,783 patient-days over a 3.5-year period from January 2005 through June 2008. The components included trauma-informed care training, changes to unit rules and language, changes to the physical characteristics of the therapeutic environment, and involvement of patients in treatment planning. The rate of inpatient psychiatric seclusion and restraint (per patient day) was tracked continuously during the 3.5-year period. RESULTS A significant reduction of 82.3% (p=.008) in the rate of seclusion and restraint was observed between the baseline phase (January 2005 through February 2006) and the follow-up, postintervention phase (April 2008 through June 2008). After control for illness severity and nonspecific effects associated with an observation-only phase, changes to the physical environment were uniquely associated with a significant reduction in rate of seclusion and restraint during the intervention rollout period. CONCLUSIONS These data suggest that substantial reductions in use of seclusion and restraint are possible in inpatient psychiatric settings and that changes to the physical characteristics of the therapeutic environment may have a significant effect on use of seclusion and restraint.

Risky Behaviors and Depression in Conjunction With—or in the Absence of—Lifetime History of PTSD Among Sexually Abused Adolescents

Posttraumatic stress disorder (PTSD) is often considered the primary problematic outcome of child sexual abuse (CSA). However, a number of other, relatively understudied negative sequelae appear to be prevalent as well. Data from 269 adolescents with a CSA history from the National Survey of Adolescents—Replication Study were therefore used to examine the prevalence of risky behaviors (i.e., problematic alcohol and drug use, delinquent behavior) and depression in this sample. The frequencies of these problems in youth with and without a history of PTSD also were examined. Results indicated that risky behaviors and depression were reported as or more frequently than PTSD. Among youth with a history of PTSD, depression and delinquent behavior were more common than among those without a history of PTSD. However, there were no differences between adolescents with and without a history of PTSD in reported problematic substance use. Findings highlight the need for comprehensive trauma-informed interventions for CSAexposed adolescents.

PTSD and comorbid disorders in a representative sample of adolescents: The risk associated with multiple exposures to potentially traumatic events.

Research has consistently found connections between experiencing a potentially traumatic event (PTE) and the development of psychopathology. Although it has been established that experiencing traumatic events is associated with PTSD and comorbid disorders (Kilpatrick, Acierno, Saunders, Resnick, & Schnurr, 2003), research has not fully addressed how experiencing multiple PTEs is associated with these disorders over and beyond experiencing a single traumatic event. A diathesis-stress model of posttraumatic stress disorder (PTSD; McKeever & Huff, 2003) provides a framework to understand the connection between experiencing multiple PTEs and the development of psychopathology: as an individual’s cumulative risk factors grow (e.g., growing up in a chaotic childhood household, experiencing a PTE, etc.), the likelihood of developing a disorder increases. In order to appropriately allocate our limited healthcare resources, it is crucial to identify risk factors for the development of psychopathology in order to provide appropriate interventions to those at highest risk. Unfortunately, many researchers have found that exposure to multiple PTEs is the norm rather than the exception. For example, in a nationally representative population sample, Kessler, Sonnega, Bromet, Hughes, and Nelson (1995) found that 34% of men and 25% of women reported experiencing 2 or more PTEs. When considering solely criminal victimizations, Resnick, Kilpatrick, Dansky, Saunders, and Best (1993) found that 36.8% of women surveyed in their nationally representative household sample of adult women had experienced a criminal victimization (i.e., homicide, rape, sexual molestation,

Child maltreatment in depressed adolescents: differences in symptomatology based on history of abuse.

Research has demonstrated that youth who are sexually or physically abused are at greater risk for developing depression. Although the association between depression and child maltreatment has been well documented, much less is known about the potential differences in the clinical presentation of depressive symptomatology among these victims. The current study examines differences in symptoms of depression in adolescents based on differing histories of abuse (i.e., sexual abuse only, physical abuse only, sexual and physical abuse, and no history of sexual or physical abuse), abuse incident characteristics, and gender. Participants were drawn from a subsample (n = 548) from the National Survey of Adolescents who met criteria for major depressive episode in the past year. Results indicate significant differences in severity of depression and specific depressive symptoms based on type of abuse experienced and gender. Implications for the clinical assessment and treatment of depressed adolescents with regard to abuse history are discussed.