Erin Emerson

Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths.

OBJECTIVES We examined associations of race/ethnicity, gender, and sexual orientation with mental disorders among lesbian, gay, bisexual, and transgender (LGBT) youths. METHODS We assessed mental disorders by administering a structured diagnostic interview to a community sample of 246 LGBT youths aged 16 to 20 years. Participants also completed the Brief Symptom Inventory 18 (BSI 18). RESULTS One third of participants met criteria for any mental disorder, 17% for conduct disorder, 15% for major depression, and 9% for posttraumatic stress disorder. Anorexia and bulimia were rare. Lifetime suicide attempts were frequent (31%) but less so in the prior 12 months (7%). Few racial/ethnic and gender differences were statistically significant. Bisexually identified youths had lower prevalences of every diagnosis. The BSI 18 had high negative predictive power (90%) and low positive predictive power (25%) for major depression. CONCLUSIONS LGBT youths had higher prevalences of mental disorder diagnoses than youths in national samples, but were similar to representative samples of urban, racial/ethnic minority youths. Suicide behaviors were similar to those among representative youth samples in the same geographic area. Questionnaires measuring psychological distress may overestimate depression prevalence among this population.

Tracing the Roots of Early Sexual Debut Among Adolescents in Psychiatric Care

OBJECTIVE To identify the most important social and personal characteristics related to early sexual debut among troubled teenagers. METHOD One hundred ninety-eight youths aged 12-19 years were recruited from outpatient mental health clinics and completed self-reports and interviews about their age of sexual debut; family, peer, and partner relationships (e.g., parental hostile control, negative peer influence, need for intimacy); and personal characteristics (e.g., achievement motivation, externalizing problems). Broad-band (externalizing, internalizing) and narrow-band (depression/anxiety, delinquency) psychopathology was assessed with the Youth Self-Report and Child Behavior Checklist. RESULTS Optimal Data Analysis was used to generate a classification tree model to identify variables associated with whether or not youths initiated oral, vaginal, and/or anal sexual activity before or after age 14. Three social context variables (parental hostile control, negative and positive peer influence) and one personal characteristic (externalizing problems) correctly classified 87.4% of teenagers as initiating sexual activity at < or =14 or >14 years of age. CONCLUSIONS Parental behavior and peer influence were the most important variables associated with the timing of sexual debut. Results support a social-personal framework for understanding sexual risk-taking among adolescents in psychiatric care, and the data offer relatively strong evidence that specific factors could be used to identify troubled teens at risk for early sexual debut.

Exploring factors that underlie racial/ethnic disparities in HIV risk among young men who have sex with men.

Young men who have sex with men (YMSM) are among the highest risk groups for HIV, and the risk distribution varies by race/ethnicity. Prevalence rates are consistently higher for minority YMSM. Factors underlying these disparities are poorly understood. We examined disparities in HIV risk among a community-based sample of Black, Latino, and non-Hispanic Caucasian YMSM age 16–24. To address gaps in the literature, we examined factors between and within racial/ethnic groups across domains including: sexual and substance use behaviors, sexualized and other social contexts, psychological well-being, HIV attributes and prevention skills, and sexual minority stress.

I Can Use a Condom, I Just Don’t: The Importance of Motivation to Prevent HIV in Adolescent Seeking Psychiatric Care

Youth continue to show high HIV infection rates, and adolescents with mental health problems are especially at risk. We used longitudinal data to test a cognitive-behavioral model of risky sexual behavior among 175, ethnically diverse urban adolescents seeking mental health services. Path analyses of the cross-sectional data revealed that Motivation was a strong predictor of Behavioral Skills and Sexual Risk Taking. The model explained 42% of the variance in Sexual Risk Taking with age included—29% without age. In the longitudinal path analyses, Motivation had a significant negative effect on levels of Sexual Risk Taking 6 months later, controlling for Information, Behavioral Skills, age, and baseline levels of Sexual Risk Taking. These longitudinal effects explained 60% of the variance in Sexual Risk Taking. These results underscore the need to address motivational factors in HIV prevention programs designed for adolescents with mental health problems.

Does substance use moderate the effects of parents and peers on risky sexual behaviour

Abstract We investigated the moderating effects of drug/alcohol use in the past 3 months on the relationships of peer influence, parental permissiveness, and teen disposition (i.e., achievement motivation, attitude toward school, and value placed on health) with adolescent risky sexual behaviour. Participants were 207 adolescents receiving psychiatric care. Substance use did not moderate the relationship between adolescent disposition and risky sex. By contrast, peer influence and parental permissiveness were linked to risky sex but only for teens who reported using drugs/alcohol. Controlling for other predictors in the model, negative peer influence explained 21% and parental permissiveness explained 13% of the variance in risky sex among substance users, but less than half of 1% of the variance among non-substance users. The disinhibiting effects of substance use on decision-making and the need for effective parental monitoring to reduce opportunities for risk behaviour are discussed.

Trauma History and PTSD Symptoms in Juvenile Offenders on Probation

Abstract Detained and incarcerated juveniles are found to have heightened rates of trauma and post-traumatic stress disorder (PTSD). Less is known about probation youth, who represent the majority of juveniles in the criminal justice system. This study examined trauma history and PTSD and associations with behavioral health problems among 13- to 17-year-old juveniles on probation (N = 61). Most (93%) reported at least one traumatic event, and 12% met diagnostic criteria for PTSD. Trauma exposure and PTSD symptoms were associated with mental health problems but not substance use or risky sexual behavior. Findings underscore the importance of addressing trauma history in probation youth.

Condom-Related Problems Among a Racially Diverse Sample of Young Men Who Have Sex with Men

We described frequencies of condom-related problems in a racially diverse sample of young men who have sex with men (YMSM), and tested these condom-related problems as an explanation for racial disparities in HIV rates among YMSM. Participants were 119 YMSM from a longitudinal study of sexual minority health behaviors. Almost all participants (95.4%) experienced at least one condom error. On average, African American and non-African American YMSM experienced the same number of recent condom-related problems. Therefore, differences in condom-related problems are unlikely to explain racial disparities in HIV rates among YMSM. When serving YMSM, providers should both promote condom use and explain steps to correct condom use.

Family environment, coping, and mental health in adolescents attending therapeutic day schools.

OBJECTIVE This study examined associations among family environment, coping, and emotional and conduct problems in adolescents attending therapeutic day schools due to mental health problems. METHODS Adolescents (N = 417; 30.2% female) ages 13-20 (M = 15.25) reported on their family environment (affective involvement and functioning), coping (emotion-focused support-seeking, cognitive restructuring, avoidant actions), and emotional and conduct problems. RESULTS Poorer family environment was associated with less emotion-focused support-seeking and cognitive restructuring, and more emotional and conduct problems. Emotional problems were negatively associated with cognitive restructuring, and conduct problems were negatively associated with all coping strategies. Cognitive restructuring accounted for the relationship between family environment and emotional problems. Cognitive restructuring and emotion-focused support-seeking each partially accounted for the relationship between family functioning and conduct problems, but not the relationship between family affective involvement and conduct problems. CONCLUSIONS Findings implicate the role of coping in the relationship between family environment and adolescent mental health.

History of Sexual Abuse and Development of Sexual Risk Behavior in Low-Income, Urban African American Girls Seeking Mental Health Treatment

Objective: This study examined relationships between sexual abuse and patterns of sexual risk-taking among low-income, urban African American adolescent girls seeking mental health treatment. Method: Participants (N = 158) were 12- to 16-year-old African American girls recruited from outpatient mental health clinics serving urban, mostly low-socioeconomic status communities in Chicago, Illinois and followed for two years between 2003 and 2010. This study included self-reports of sexual abuse and four waves (T2–T5) of self-reported data on sexual experience and sexual risk-taking (number of partners, inconsistent condom use, and sex with a risky partner). Latent curve modeling was used to examine patterns of sexual behavior over the four time points with sexual abuse and mental health symptoms as covariates. Results: Sexual abuse was significantly associated with T2 sexual experience, T2–T4 number of partners, T3 inconsistent condom use, and T2–T3 having a risky partner. These relationships decreased when mental health symptoms were controlled. Conclusions: This longitudinal study revealed a complex relationship between sexual abuse and sexual risk that would be missed if sexual risk were assessed at a single time point. Findings supported early intervention to delay onset of sexual risk behavior among low-income African American girls with mental health concerns and histories of sexual abuse.

Affect recognition among adolescents in therapeutic schools: Relationships with posttraumatic stress disorder and conduct disorder symptoms

BACKGROUND Posttraumatic stress disorder (PTSD) and conduct disorder (CD) symptoms often co-occur in adolescence, but little is known about whether they show common or distinct emotional processing deficits. METHOD We examined the effects of PTSD and CD symptoms on facial affect processing in youth with emotional and behavior problems. Teens enrolled in therapeutic day schools (N = 371; ages 13-19) completed a structured diagnostic assessment and the Diagnostic Analysis of Nonverbal Accuracy-2 facial affect recognition task. RESULTS PTSD symptoms were associated with deficits in the recognition of angry facial expressions, specifically the false identification of angry faces as fearful. CD symptoms were associated with greater difficulty correctly identifying sadness. CONCLUSIONS Findings suggest specificity in the relationships of PTSD and CD symptoms with emotional processing.