Joanna Herres

Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings.

PURPOSE Lesbian, gay, bisexual, and questioning (LGBQ) youth exhibit significantly higher rates of mental health problems, including anxiety, depression, suicidal ideation, and nonsuicidal self-injury than their heterosexual peers. Past studies tend to group LGBQ youth together; however, more recent studies suggest subtle differences in risk between sexual minority groups. This study examined differences in mental health symptoms across male and female youth who are attracted to the same sex (gay and lesbian), opposite sex (heterosexual), both sexes (bisexual), or are unsure of whom they were attracted to (questioning) in a sample of 2,513 youth (ages 14-24 years). METHODS Data were collected using the Behavioral Health Screen-a Web-based screening tool that assesses psychiatric symptoms and risk behaviors-during routine well visits. RESULTS Bisexual and questioning females endorsed significantly higher scores on the depression, anxiety, and traumatic distress subscales than did heterosexual females. Lesbians, bisexual females, and questioning females all exhibited significantly higher lifetime suicide scores than heterosexual females. Interestingly, bisexual females exhibited the highest current suicide scores. Gay and bisexual males endorsed significantly higher scores on the depression and traumatic distress subscales than did heterosexual males. Gay males also exhibited higher scores on the anxiety subscale than heterosexual males, with bisexual males exhibiting a nonsignificant trend toward higher scores as well. CONCLUSIONS Findings highlight varying level of risk across subgroups of LGBQ youth and suggest the importance of considering LGBQ groups separately in the context of a behavioral health assessment, especially for females.

Attachment based treatments for adolescents: the secure cycle as a framework for assessment, treatment and evaluation

The emergence of attachment-based treatments (ABTs) for adolescents highlights the need to more clearly define and evaluate these treatments in the context of other attachment based treatments for young children and adults. We propose a general framework for defining and evaluating ABTs that describes the cyclical processes that are required to maintain a secure attachment bond. This secure cycle incorporates three components: (1) the child or adult’s IWM of the caregiver; (2) emotionally attuned communication; and (3) the caregiver’s IWM of the child or adult. We briefly review Bowlby, Ainsworth, and Main’s contributions to defining the components of the secure cycle and discuss how this framework can be adapted for understanding the process of change in ABTs. For clinicians working with adolescents, our model can be used to identify how deviations from the secure cycle (attachment injuries, empathic failures and mistuned communication) contribute to family distress and psychopathology. The secure cycle also provides a way of describing the ABT elements that have been used to revise IWMs or improve emotionally attuned communication. For researchers, our model provides a guide for conceptualizing and measuring change in attachment constructs and how change in one component of the interpersonal cycle should generalize to other components.

Bullying, depression, and suicide risk in a pediatric primary care sample

BACKGROUND Suicide is a serious public health concern for US youth. Research has established an association between bullying and suicide risk. However, several questions remain regarding this relationship. AIMS The present study examined (a) whether experiences of verbal, physical, and cyber bullying were uniquely associated with general suicide risk; (b) whether each specific form of bullying was related to suicide attempt; and (c) whether depression moderated the relationship between each type of bullying and suicide risk. METHOD The sample included medical records of 5,429 youth screened in primary care when providers had mental health concerns. Patients were screened using the Behavioral Health Screen (BHS), which assessed a range of mental health problems and behaviors, including bullying, depression, and suicide. RESULTS All types of bullying were associated with suicide risk, but verbal bullying was uniquely associated with suicide attempt. Depression significantly moderated the relationship between each type of bullying and suicide risk. CONCLUSION The study’s limitations include the use of cross-sectional and self-report data [corrected]. When medical providers evaluate suicide risk, bullying should be considered as a possible precipitant, especially if the patient is depressed. Verbal bullying may be particularly important in understanding severity of suicide risk.

Narrative Focus Predicts Symptom Change Trajectories in Group Treatment for Traumatized and Bereaved Adolescents

Growing evidence supports the effectiveness of Trauma and Grief Component Therapy for Adolescents (TGCT-A) in reducing posttraumatic stress disorder (PTSD) symptoms and maladaptive grief (MG) reactions. This pilot study explored whether the specific focus of students’ narratives (i.e., focus on trauma vs. focus on loss) as shared by TGCT-A group members would predict initial pretreatment levels, as well as pre- to posttreatment change trajectories, of PTSD symptoms and MG reactions. Thirty-three adolescents from three middle schools completed a 17-week course of group-based TGCT-A. PTSD and MG symptoms were assessed at pretreatment, twice during treatment, and at posttreatment. The focus (trauma vs. loss) of each students narrative was coded using transcripts of members’ narratives as shared within the groups. The reliable change index showed that 61% of students reported reliable pre–post improvement in either PTSD symptoms or MG reactions. Students whose narratives focused on loss both reported higher starting levels and showed steeper rates of decline in MG reactions than students whose narratives focused on trauma. In contrast, students whose narratives focused on trauma reported higher starting levels of PTSD than students who narrated loss experiences. However, narrative focus was not significantly linked to the rate at which PTSD symptoms declined over the course of treatment. This study provides preliminary evidence that TGCT-A treatment components are associated with reduced PTSD symptoms and MG reactions. Loss-focused narratives, in particular, appear to be associated with greater decreases in MG reactions.

Emotional reactivity to daily events in youth with anxiety disorders

ABSTRACT Background: Although research supports associations between anxiety and emotional reactivity in adults (Cisler, J. M., Olatunji, B. O., Feldner, M. T., & Forsyth, J. P. (2010). Emotion regulation and the anxiety disorders: an integrative review. Journal of Psychopathology and Behavioral Assessment, 32(1), 68–82.), few studies have examined emotional reactivity in anxious youth (e.g., Carthy et al., 2010; Tan, P. Z., Forbes, E. E., Dahl, R. E., Ryan, N. D., Siegle, G. J., Ladouceur, C. D., & Silk, J. S. (2012). Emotional reactivity and regulation in anxious and nonanxious youth: a cell-phone ecological momentary assessment study. Journal of Child Psychology and Psychiatry, 53(2), 197–206.). Methods: Using daily diary methodology, this study examined both negative affect (NA) and positive affect (PA) reactivity to daily events in youth diagnosed with anxiety (N = 68; 60% female; 78% non-Hispanic White; M age = 11.18 years, SD = 3.17). We also examined whether parent-reported emotion regulation would predict emotional reactivity. Results: Participants reported more NA on days they experienced more negative parent and teacher events and less PA on days that they experienced more negative peer events. Additionally, better emotion regulation was associated with less NA reactivity to negative teacher events and to both negative and positive academic events. Conclusions: Interpersonal events have a salient effect on daily affect for anxious youth. Youth anxiety therapists should target emotion regulation associated with negative events involving adults and address barriers to developing and maintaining positive peer relationships.

Unique Interactions of Interpersonal Trauma and Positive Peer and Family Experiences on Traumatic Distress Among Pediatric Primary Care Patients

Individuals with histories of interpersonal trauma are at increased risk for posttraumatic stress disorder (PTSD). Risk of PTSD is particularly salient during critical periods of development, such as adolescence and emerging adulthood. However, little is known about the unique effects and interactions of protective factors and interpersonal trauma on PTSD symptoms in adolescents and young adults. The current study tested whether positive peer and family experiences decrease the associations between interpersonal trauma and PTSD symptoms and whether these associations differed by victim–perpetrator relationships. Participants included 3,618 adolescents and young adults (aged 14-24 years) who completed the Behavioral Health Screen—a web-based screening tool that assesses psychiatric symptoms and associated risk factors—during a routine visit across 10 primary care sites in Pennsylvania. In support of the stress buffering hypothesis, results revealed that positive peer and family experiences buffered the effects of interpersonal trauma by a romantic partner and an adult in the home. Future research should examine whether programs aimed at improving peer or family relationships improve outcomes for traumatized youth.

Comprehensive Screening for Suicide Risk in Primary Care

INTRODUCTION Suicide is a major public health problem and a complex clinical challenge. Assessment and early identification could be enhanced with screening tools that look beyond depression. The purpose of this study was to identify profiles of risk behaviors and social stress associated with suicidal ideation and behavior using the Behavioral Health Screen. METHODS The study used screening data from 2,513 primary care patients (aged 14-24 years). Data were collected between 2008 and 2012, and were analyzed in 2016. RESULTS Latent class analysis identified a high and low risk profile. Domains of primary influence included substance use, sexual assault, same-sex behavior, and unsafe sex. The high-risk group was 11 times more likely to have made a suicide attempt, five times more likely to report a history of suicidal ideation and behavior, and three times more likely to report recent suicidal ideation and behavior. CONCLUSIONS Risk behaviors and social stress contribute to the risk for suicide above and beyond depression and should be assessed during routine primary care visits with adolescents. The Behavioral Health Screen can screen all these domains and thus assist primary care providers in assessing for both psychiatric and social stress factors associated with youth suicide.

Evaluating referral, screening, and assessment procedures for middle school trauma/grief-focused treatment groups.

There is a need to delineate best practices for referring, assessing, and retaining students suspected of posttraumatic stress (PTS) and maladaptive grief (MG) in school-based treatment. Evidence-based risk-screening procedures should accurately include students who are appropriate for group treatment and exclude students who do not require treatment or who are better served by other forms of intervention and support. We described and evaluated the sequence of steps used to screen 7th- and 8th-grade students (N = 89) referred by school staff as candidates for an open trial of group-based Trauma and Grief Component Therapy for Adolescents (TGCTA; Saltzman et al., in press). We used t tests to compare included versus excluded students on PTS symptom and MG reaction scores (University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index; Grief Screening Scale) during the group screen, individual interview, and treatment-implementation phases. Logistic regressions tested the incremental utility of including measures of both trauma exposure and related emotional and conduct problems (Strengths and Difficulties Questionnaire) in the screening battery. Results suggest that the group screen helped to detect mental health needs and that the individual interview further identified students with PTS and emotional problems. Conduct problems and trauma exposure predicted attrition among students who qualified for treatment. MG incrementally predicted students who advanced from the group screening to the individual interview, and trauma exposure incrementally predicted attrition from treatment. Findings yield implications for improving research and practice, including procedures for enhancing school-based referral, screening, assessment, and selection procedures.

A Socioecological Model of Risk Associated With Campus Sexual Assault in a Representative Sample of Liberal Arts College Students

Campus sexual assault (CSA) is a growing area of research and public health concern, yet little research has considered the sociocultural context in which CSA occurs or the effect of sociocultural factors on the posttraumatic stress disorder (PTSD) symptoms of CSA survivors. This study describes the results of a web-based census survey administered to students at a liberal arts college. Of the 1,611 students who completed the survey (74% female; 71.4% White, 4.3% African American, 12% Hispanic), 13.5% reported experiencing at least one type of completed or attempted CSA. Female students, participants in Greek life, and students who reported victimization prior to college were more likely to report having experienced CSA. CSA was positively correlated with PTSD symptoms, and this relationship was stronger for racial/ethnic minorities, those who reported less sense of community, and those who were more aware of campus services to address CSA. This study demonstrates multiple levels of sociocultural influence on the mental health of college students who have experienced CSA and may suggest ways for improving prevention and intervention strategies to address CSA and its consequences.

Emotion regulation and spillover of interpersonal stressors to postsession insight among depressed and suicidal adolescents.

Objective: Little is known about the extent to which previous weeks’ stressful events spill over and influence adolescents’ abilities to derive insight from treatment sessions. Even less is known about factors that moderate clients’ vulnerabilities to these spillover effects. The current study examined the spillover of negative interpersonal events to postsession insight and the role of difficulties in emotion regulation in this spillover effect. Method: Participants were 129 adolescents with moderate to severe depressive symptoms and suicidal ideation (Mage = 14.96, 83% female, 56% African American/Black) participating in a comparative efficacy trial of Attachment-Based Family Therapy (ABFT) and Family-Enhanced Nondirective Supportive Therapy (FE-NST). A within-subject mediation model tested presession negative affect as a mediator of spillover of past week’s events on postsession insight. We then examined baseline difficulties in emotion regulation (DERS) as a between-subjects moderator of the mediation model. Results: Negative affect partially mediated (44%) the spillover of the past week’s negative events on adolescents’ ratings of postsession insight (p = .03, 95% confidence interval, CI [−.09., −.002]). Baseline DERS increased adolescents’ vulnerabilities to spillover effects (p = .01, 95% CI [−.28, −.03]). Negative interpersonal events from the past week influence presession negative affect and spill over to adolescents’ abilities to gain insight from their treatment sessions. Adolescents who began treatment with greater DERS were particularly vulnerable to these spillover effects. Findings indicate the need for therapists to adapt sessions to individual differences in depressed and suicidal adolescents’ exposure to negative interpersonal events preceding treatment and in their vulnerabilities to spillover and emotion dysregulation.