Cheryl A. King

Prevalence of depression by race/ethnicity: findings from the National Health and Nutrition Examination Survey III.

Depression prevalence was examined by race/ethnicity in a nationally representative sample. The Diagnostic Interview Schedule was administered to 8449 (response rate=96.1%) participants (aged 15-40 years). Prevalence of major depressive disorder was significantly higher in Whites than in African Americans and Mexican Americans; the opposite pattern was found for dysthymic disorder. Across racial/ethnic groups, poverty was a significant risk factor for major depressive disorder, but significant interactions occurred between race/ethnicity, gender, and education in relation to prevalence of dysthymic disorder.

Social and Interpersonal Factors Relating to Adolescent Suicidality: A Review of the Literature

This article reviews the empirical literature concerning social and interpersonal variables as risk factors for adolescent suicidality (suicidal ideation, suicidal behavior, death by suicide). It also describes major social constructs in theories of suicide and the extent to which studies support their importance to adolescent suicidality. PsychINFO and PubMed searches were conducted for empirical studies focused on family and friend support, social isolation, peer victimization, physical/sexual abuse, or emotional neglect as these relate to adolescent suicidality. Empirical findings converge in documenting the importance of multiple social and interpersonal factors to adolescent suicidality. Research support for the social constructs in several major theories of suicide is summarized and research challenges are discussed.

Children of Depressed Mothers 1 Year After the Initiation of Maternal Treatment: Findings From the STAR*D-Child Study

OBJECTIVE Maternal depression is a consistent and well-replicated risk factor for child psychopathology. The authors examined the changes in psychiatric symptoms and global functioning in children of depressed women 1 year following the initiation of treatment for maternal major depressive disorder. METHOD Participants were 1) 151 women with maternal major depression who were enrolled in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study and 2) their eligible offspring who, along with the mother, participated in the child STAR*D (STAR*D-Child) study (mother-child pairs: N=151). The STAR*D study was a multisite study designed to determine the comparative effectiveness and acceptability of various treatment options for adult outpatients with nonpsychotic major depressive disorder. The STAR*D-Child study examined children of depressed women at baseline and involved periodic follow-ups for 1 year after the initiation of treatment for maternal major depressive disorder to ascertain the following data: 1) whether changes in childrens psychiatric symptoms were associated with changes in the severity of maternal depression and 2) whether outcomes differed among the offspring of women who did and did not remit (mother-child pairs with follow-up data: N=123). Childrens psychiatric symptoms in the STAR*D-Child study were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), and maternal depression severity in the STAR*D study was assessed by an independent clinician, using the 17-item Hamilton Depression Rating Scale (HAM-D). RESULTS During the year following the initiation of treatment, maternal depression severity and childrens psychiatric symptoms continued to decrease over time. Decreases in the number of childrens psychiatric symptoms were significantly associated with decreases in maternal depression severity. When childrens outcomes were examined separately, a statistically significant decrease in symptoms was evident in the offspring of women who remitted early (i.e., within the first 3 months after the initiation of treatment for maternal depression) or late (i.e., over the 1-year follow-up interval) but not in the offspring of nonremitting women. CONCLUSIONS Continued efforts to treat maternal depression until remission is achieved are associated with decreased psychiatric symptoms and improved functioning in the offspring.

Youth-Nominated Support Team for Suicidal Adolescents (Version 1): a randomized controlled trial.

In this study, the authors investigated the efficacy of the Youth-Nominated Support Team-Version 1 (YST-1), a psychoeducational social network intervention, with 289 suicidal, psychiatrically hospitalized adolescents (197 girls, 92 boys). Adolescents were randomly assigned to treatment-as-usual plus YST-1 or treatment-as-usual only. Assessments were completed pre- and postintervention (6 months). There were no main effects for YST-1 on suicide ideation or attempts, internalizing symptoms, or related functional impairment. Relative to other girls, however, those who received YST-1 reported greater decreases in self-reported suicidal ideation (actually treated analytic strategy) and significantly greater decreases in mood-related functional impairment reported by their parents (intent to treat and actually treated analytic strategies). This is the first randomized controlled clinical trial to investigate the efficacy of a social network intervention with suicidal youths.

Predictors of Comorbid Alcohol and Substance Abuse in Depressed Adolescents

OBJECTIVE To identify clinical profiles discriminating depressed adolescents on the basis of comorbid alcohol/substance use disorders and to determine whether or not profiles with high predictive power are gender-specific. METHOD One hundred three adolescent inpatients with major depression (65 girls, 38 boys) participated in a comprehensive diagnostic evaluation. Independent assessments of depression, suicidality, and psychosocial adjustment were conducted using well-validated instruments. RESULTS Gender-specific clinical profiles were identified that predicted alcohol/substance abuse in depressed adolescents with high levels of sensitivity (90%). The significant discriminant function for depressed girls included the following predictors: longer depressive episodes, more conduct problems and psychosocial impairment, and more active involvement in relationships with boys. The significant discriminant function for depressed boys included conduct disorder, older age, and schoolwork problems. These profiles correctly identified most depressed adolescents with comorbid alcohol/substance abuse. CONCLUSIONS Given that alcohol abuse and depression are associated with highly impaired social functioning and increased risk of self-harm, sensitivity in case identification is critical. Clinicians should conduct comprehensive assessments of alcohol/substance abuse in depressed adolescents with the identified clinical profiles.

Alcohol Consumption in Relation to Other Predictors of Suicidality among Adolescent Inpatient Girls

This study of 54 adolescent inpatient girls examined alcohol consumption in relation to depression severity and family dysfunction as predictors of suicidal ideation and behavior. Although alcohol consumption, depression severity, and family dysfunction were intercorrelated, regression analyses revealed their differential importance to the prediction of self-reported suicidal ideation and severity of clinician-documented suicidal ideation or behavior (none, ideation, intent, gesture, attempt). Self-reported ideation was strongly predicted by depression severity and family dysfunction; severity of clinician-documented suicidal ideation or behavior was predicted by alcohol consumption and family dysfunction. Implications for assessment and treatment are discussed.

The Youth-Nominated Support Team-Version II for suicidal adolescents: A randomized controlled intervention trial.

The purpose of this study was to examine the efficacy of the Youth-Nominated Support Team-Version II (YST-II) for suicidal adolescents, an intervention based on social support and health behavior models, which was designed to supplement standard treatments. Psychiatrically hospitalized and suicidal adolescents, 13-17 years of age, were randomly assigned to treatment-as-usual (TAU) + YST-II (n = 223) or TAU only (n = 225). YST-II provided tailored psychoeducation to youth-nominated adults in addition to weekly check-ins for 3 months following hospitalization. In turn, these adults had regular supportive contact with adolescents. Adolescents assigned to TAU + YST-II had an average of 3.43 (SD = 0.83) nominated adults. Measures included the Suicidal Ideation Questionnaire-Junior (SIQ-JR; W. M. Reynolds, 1988), Childrens Depression Rating Scale-Revised (E. O. Poznanski & H. B. Mokros, 1996), Beck Hopelessness Scale (A. T. Beck & R. A. Steer, 1993), and Child and Adolescent Functional Assessment Scale (CAFAS; K. Hodges, 1996). YST-II had very limited positive effects, which were moderated by history of multiple suicide attempts, and no negative effects. It resulted in more rapid decreases in suicidal ideation (SIQ-JR) for multiple suicide attempters during the initial 6 weeks after hospitalization (small-to-moderate effect size). For nonmultiple attempters, it was associated with greater declines in functional impairment (CAFAS) at 3 and 12 months (small effect sizes). YST-II had no effects on suicide attempts and no enduring effects on SIQ-JR scores.

Self-reported Barriers to Professional Help Seeking Among College Students at Elevated Risk for Suicide

Abstract Objectives: This study sought to describe self-reported barriers to professional help seeking among college students who are at elevated suicide risk and determine if these barriers vary by demographic and clinical characteristics. Participants: Participants were 165 non–treatment seekers recruited as part of a Web-based treatment linkage intervention for college students at elevated suicide risk (from September 2010 through December 2011). Methods: Data were collected using Web-based questionnaires. Two coders coded students’ responses to an open-ended question about reasons for not seeking professional help. Results: The most commonly reported barriers included perception that treatment is not needed (66%), lack of time (26.8%), and preference for self-management (18%). Stigma was mentioned by only 12% of students. There were notable differences based on gender, race, and severity of depression and alcohol abuse. Conclusions: Efforts aimed at reaching students at elevated risk for suicidal behavior should be particularly sensitive to these commonly described barriers.

Prediction of Positive Outcomes for Adolescent Psychiatric Inpatients

OBJECTIVE To identify individual, parent/family, and treatment follow-through predictors of outcome for adolescent psychiatric inpatients 6 months after hospital discharge. METHOD Eighty-nine adolescents participated in a comprehensive baseline evaluation during psychiatric hospitalization. Baseline measures included the Diagnostic Interview Schedule for Children, Social Adjustment Inventory for Children and Adolescents, Reynolds Adolescent Depression Scale (RADS), and Suicidal Ideation Questionnaire-Junior (SIQ-Jr). Structured telephone follow-up interviews assessed treatment follow-through, suicidal behaviors, rehospitalizations, living changes, and social adaptive functioning. The RADS and SIQ-Jr were also readministered. RESULTS Baseline indices of adolescent functioning emerged as the strongest predictors of outcomes. Hierarchical multiple regression analyses indicated that baseline depression severity, a cluster of parent/family indices, and medication follow-through were significant predictors of outcome depression severity. Baseline social adaptive functioning, presence/absence of conduct disorder, and medication follow-through were significant predictors of outcome social adaptive functioning. CONCLUSIONS The nature and course of adolescent psychopathology was difficult to disrupt, with baseline characteristics as the strongest predictors of outcome. Nevertheless, the significance of medication follow-through as a predictor suggests that treatment-related gains are possible.

Depressed Adolescents with a History of Sexual Abuse: Diagnostic Comorbidity and Suicidality

OBJECTIVE To determine the nature of comorbid psychopathology and suicidality associated with a history of sexual abuse in depressed adolescents. METHOD Twenty-four depressed adolescent inpatients with a history of sexual abuse were compared with a matched control group of 24 depressed adolescent inpatients on measures of depression, suicidal ideation and behavior, and posttraumatic stress disorder (PTSD) symptoms. RESULTS Depressed adolescents with a history of sexual abuse had a higher prevalence of comorbid PTSD than did those without such a history. Chronicity and severity of abuse were significant contributors to a PTSD diagnosis. No differences were found in depression severity, specific depressive symptoms, or suicidal behavior. CONCLUSION Comorbidity of depressive disorders and PTSD are common among adolescent inpatients with a history of chronic sexual abuse. The need for thorough assessment of depression and PTSD with appropriate interventions for sexually abused adolescents is clear.