Elizabeth E. Lloyd-Richardson

Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts

Non-suicidal self-injury (NSSI) is a prevalent behavioral problem, yet many fundamental aspects of NSSI remain unknown. This case series study reports on the diagnostic correlates of adolescents with a recent history of NSSI and examines the relation between NSSI and suicide attempts. Data are from clinical interviews with 89 adolescents admitted to an adolescent psychiatric inpatient unit who engaged in NSSI in the previous 12 months. Results revealed that 87.6% of adolescents engaging in NSSI met criteria for a DSM-IV Axis I diagnosis (M=3.0, S.D.=2.2, range=0 to 8 diagnoses), including externalizing (62.9%), internalizing (51.7%), and substance use (59.6%) disorders. Most adolescents assessed also met criteria for an Axis II personality disorder (67.3%). Overall, 70% of adolescents engaging in NSSI reported a lifetime suicide attempt and 55% reported multiple attempts. Characteristics of NSSI associated with making suicide attempts included a longer history of NSSI, use of a greater number of methods, and absence of physical pain during NSSI. These findings demonstrate the diagnostic heterogeneity of adolescents engaging in NSSI, highlight the significant overlap between NSSI and suicide attempts, and provide a point of departure for future research aimed at elucidating the relations between non-suicidal and suicidal self-injury.

Longitudinal Study of Nonsuicidal Self-Injury Among Young Adolescents: Rates, Correlates, and Preliminary Test of an Interpersonal Model

This study examined rates, correlates and an interpersonal model of nonsuicidal self-injury (NSSI) among a sample of 508 sixth, seventh, and eighth graders. Questionnaires assessing NSSI, related health-risk behaviors, and relationships with parents were administered two times over an 11-month period. Overall, 7.5% reported engaging in NSSI within the past year with no significant differences across genders, ethnicities, or grade. Those engaging in NSSI were more likely to report having smoked cigarettes, taken drugs, and engaged in maladaptive eating behaviors. Consistent with an interpersonal model, those engaging in NSSI reported significant increases in the quality of their relationships with fathers over time. Clinical implications include considering the role of family members in efforts to prevent and treat NSSI.

Self-Mutilative Behavior in Adolescents Who Attempt Suicide by Overdose

OBJECTIVE To examine the cognitive/affective and behavioral symptoms of adolescent suicide attempters with self-mutilative behavior (SMB). METHOD Adolescents evaluated after a suicide attempt that occurred between 1996 and 2000 were divided into two groups: suicide attempters with a history of SMB (n = 52) and suicide attempters without SMB (n = 43). The groups were then compared on psychiatric diagnosis, suicide intent, depression, hopelessness, loneliness, anger, reckless behavior, substance use, and family functioning. RESULTS Carving on the skin and picking at a wound were the most commonly reported SMBs, occurring in about one third of the sample. The SMB group was significantly more likely to be diagnosed with oppositional defiant disorder, major depression, and dysthymia and had higher scores on measures of hopelessness, loneliness, anger, risk taking, reckless behavior, and alcohol use than did the non-SMB group. Loneliness increased the odds of SMB almost 6-fold. CONCLUSIONS Adolescent suicide attempts with SMB are associated with greater cognitive/affective and behavioral symptoms. Adolescent suicide attempters should be routinely screened for SMB.

A Prospective Study of Weight Gain During the College Freshman and Sophomore Years

OBJECTIVE To assess the prevalence of weight gain among male and female college freshmen. METHODS Study 1 examined weight change over freshman and sophomore years among 904 students attending a state university in Indiana, from 2002-2004. Study 2 examined weight and BMI change over the freshman year among 382 students attending a private university in Rhode Island, from 2004-2006. RESULTS 77% of Study 1 participants and 70% of Study 2 participants gained weight during their freshman year, largely during the first semester. In Study 1, weight gain averaged 3.5 kg in females and males; in Study 2, weight gain averaged 1.6 kg for females and 2.5 kg for males. Students continued to gain weight their sophomore year, with females 4.2 kg and males 4.3 kg heavier than at start of college. Overweight/obesity rates increased from baseline to end of freshman year for Study 1 (21.6% to 36%) and Study 2 participants (14.7% to 17.8%). CONCLUSION The first years of college may be a critical developmental window for establishing weight gain prevention efforts.

‘Adventure therapy’ combined with cognitive-behavioral treatment for overweight adolescents

Objective:Since peers have such an important influence on adolescents, we evaluated the efficacy of adding peer-based ‘adventure therapy’ to a standard cognitive-behavioral weight control program for overweight adolescents.Methods:Adolescents (N=76) aged 13–16 years and 20 to 80% overweight (M=60.56%, s.d.=15.17%), were randomly assigned to one of two treatment conditions: cognitive-behavioral group treatment with ‘adventure therapy’ similar to Outward Bound® (cognitive-behavioral treatment with peer-enhanced adventure therapy (CBT+PEAT)) or cognitive-behavioral group treatment with aerobic exercise (CBT+EXER). Anthropometric and psychosocial measures were obtained at baseline, at the end of the 16-week intervention, and at 10 months following randomization.Results:Adolescents assigned to both treatment conditions demonstrated significant weight loss over time, F=29.06, df=2, 53, P<0.01. Average weight loss did not differ significantly between groups (−5.31 kg for CBT+PEAT and −3.20 kg for CBT+EXER) at the end of treatment. There was a significant difference in the percentage of participants maintaining a minimum 4.5 kg (10 pounds) weight loss (35% in the CBT+PEAT condition vs 12% in the CBT+EXER condition, P=0.042) 10 months from randomization. We also observed a significant age by treatment group interaction, such that older adolescents randomized to CBT+PEAT demonstrated more than four times the weight loss of older adolescents assigned to CBT+EXER (M=−7.86 kg vs M=−1.72 kg) at the end of treatment.Conclusions:Peer-based ‘adventure therapy’ is a promising adjunct to standard cognitive-behavioral weight control intervention for adolescents, and may be most effective for older adolescents.

Predictors of Attrition and Weight Loss in an Adolescent Weight Control Program

Objective: To evaluate demographic and psychosocial predictors of attrition and weight loss in a behaviorally based adolescent weight control trial.

Bupropion and cognitive–behavioral treatment for depression in smoking cessation

This study is a randomized, double-blind, placebo-controlled clinical trial examining the effects of an intensive cognitive-behavioral mood management treatment (CBTD) and of bupropion, both singularly and in combination, on smoking cessation in adult smokers. As an extension of our previous work, we planned to examine the synergistic effects of CBTD and bupropion on smoking cessation outcomes in general and among smokers with depression vulnerability factors. Participants were 524 smokers (47.5% female, M (age) = 44.27 years) who were randomized to one of four 12-week treatments: (a) standard, cognitive-behavioral smoking cessation treatment (ST) plus bupropion (BUP), (b) ST plus placebo (PLAC), (c) standard cessation treatment combined with cognitive-behavioral treatment for depression (CBTD) plus BUP, and (d) CBTD plus PLAC. Follow-up assessments were conducted 2, 6, and 12 months after treatment, and self-reported abstinence was verified biochemically. Consistent with previous studies, bupropion, in comparison with placebo, resulted in better smoking outcomes in both intensive group treatments. Adding CBTD to standard intensive group treatment did not result in improved smoking cessation outcomes. In addition, neither CBTD nor bupropion, either alone or in combination, was differentially effective for smokers with single-past-episode major depressive disorder (MDD), recurrent MDD, or elevated depressive symptoms. However, findings with regard to recurrent MDD and elevated depressive symptoms should be interpreted with caution given the low rate of recurrent MDD and the low level of depressive symptoms in our sample. An a priori test of treatment effects in smokers with these depression vulnerability factors is warranted in future clinical trials.

Motivation and Patch Treatment for HIV+ Smokers: A Randomized Controlled Trial

AIMS To test the efficacy of two smoking cessation interventions in a HIV positive (HIV+) sample: standard care (SC) treatment plus nicotine replacement therapy (NRT) versus more intensive motivationally enhanced (ME) treatment plus NRT. DESIGN Randomized controlled trial. SETTING HIV+ smoker referrals from eight immunology clinics in the northeastern United States. PARTICIPANTS A total of 444 participants enrolled in the study (mean age = 42.07 years; 63.28% male; 51.80% European American; mean cigarettes/day = 18.27). INTERVENTIONS SC participants received two brief sessions with a health educator. Those setting a quit date received self-help quitting materials and NRT. ME participants received four sessions of motivational counseling and a quit-day counseling call. All ME intervention materials were tailored to the needs of HIV+ individuals. MEASUREMENTS Biochemically verified 7-day abstinence rates at 2-month, 4-month and 6-month follow-ups. FINDINGS Intent-to-treat (ITT) abstinence rates at 2-month, 4-month and 6-month follow-ups were 12%, 9% and 9%, respectively, in the ME condition, and 13%, 10% and 10%, respectively, in the SC condition, indicating no between-group differences. Among 412 participants with treatment utilization data, 6-month ITT abstinence rates were associated positively with low nicotine dependence (P = 0.02), high motivation to quit (P = 0.04) and Hispanic American race/ethnicity (P = 0.02). Adjusting for these variables, each additional NRT contact improved the odds of smoking abstinence by a third (odds ratio = 1.32, 95% confidence interval = 0.99-1.75). CONCLUSIONS Motivationally enhanced treatment plus NRT did not improve cessation rates over and above standard care treatment plus NRT in this HIV+ sample of smokers. Providers offering brief support and encouraging use of nicotine replacement may be able to help HIV+ patients to quit smoking.

Sibling Effects on Substance Use in Adolescence: Social Contagion and Genetic Relatedness

Prior research on sibling contagion for substance use has not attended to individual differences in the sibling relationship that may be influenced by genetic similarity. The authors utilizing data on a sample of twin and nontwin siblings participating in the National Longitudinal Study of Adolescent Health (Add Health). Although monozygotic twins had the highest levels of sibling contact and mutual friendships, the pattern of results for other sibling types were not consistent with genetic models, and biometric analysis indicated that shared environmental factors influenced these sibling relationship features. Application of DeFries-Fulker regression models provided evidence that sibling contact and mutual friendships represent a source of social contagion for adolescent smoking and drinking independent of genetic relatedness. The results are interpreted using a social contagion framework and contrasted with other competing models such as those focused on the equal environments assumption and niche selection.

Gendered dimensions of smoking among college students

Ethnographic research, including interviews, focus groups, and observations were conducted to explore gendered dimensions of smoking among low level smokers, including the acceptability of smoking in different contexts; reasons for smoking; the monitoring of self and friends’ smoking; and shared smoking as a means of communicating concern and empathy. Important gendered dimensions of smoking were documented. Although males who smoked were described as looking manly, relaxed, and in control, among females, smoking was considered a behavior that made one look slutty and out of control. Young women were found to monitor their own and their friends’ smoking carefully and tended to smoke in groups to mitigate negative perceptions of smoking. Gender-specific tobacco cessation programs are warranted on college campuses.