Robert H. Aseltine

Supportive interactions, negative interactions, and depressed mood

Research on the association between social relationships and emotional functioning has emphasized the health-promoting effects of social support. Yet there is reason to believe that the absence of negative social interactions may be more important for mental health than the presence of supportive interactions. In this investigation we clarify important characteristics concerning the source, the recipient, and the combined influence of support and negativity. Data are presented regarding supportive and negative interactions with spouse, relatives, and friends; regression analyses suggest that negative interactions are more predictive of depressed mood than supportive interactions (specifically with spouse and friends). We also document several specifications suggesting directions for future research on the special importance of interactions in intimate relationships and the synergistic effects of situations in which supportive and negative interactions both occur.

Adverse childhood experiences and mental health in young adults: a longitudinal survey

BackgroundAdverse childhood experiences (ACEs) have been consistently linked to psychiatric difficulties in children and adults. However, the long-term effects of ACEs on mental health during the early adult years have been understudied. In addition, many studies are methodologically limited by use of non-representative samples, and few studies have investigated gender and racial differences. The current study relates self-reported lifetime exposure to a range of ACEs in a community sample of high school seniors to three mental health outcomes–depressive symptoms, drug abuse, and antisocial behavior–two years later during the transition to adulthood.MethodsThe study has a two-wave, prospective design. A systematic probability sample of high school seniors (N = 1093) was taken from communities of diverse socioeconomic status. They were interviewed in person in 1998 and over the telephone two years later. Gender and racial differences in ACE prevalence were tested with chi-square tests. Each mental health outcome was regressed on one ACE, controlling for gender, race/ethnicity, and SES to obtain partially standardized regression coefficients.ResultsMost ACEs were strongly associated with all three outcomes. The cumulative effect of ACEs was significant and of similar magnitude for all three outcomes. Except for sex abuse/assault, significant gender differences in the effects of single ACEs on depression and drug use were not observed. However, boys who experienced ACEs were more likely to engage in antisocial behavior early in young adulthood than girls who experienced similar ACEs. Where racial/ethnic differences existed, the adverse mental health impact of ACEs on Whites was consistently greater than on Blacks and Hispanics.ConclusionOur sample of young adults from urban, socio-economically disadvantaged communities reported high rates of adverse childhood experiences. The public health impact of childhood adversity is evident in the very strong association between childhood adversity and depressive symptoms, antisocial behavior, and drug use during the early transition to adulthood. These findings, coupled with evidence that the impact of major childhood adversities persists well into adulthood, indicate the critical need for prevention and intervention strategies targeting early adverse experiences and their mental health consequences.

Marital Disruption and Depression in a Community Sample

The extent to which marital disruption causes poor mental health is not well characterized even after 20 years of research. This is due in large part to the fact that previous research has ignored the possibility of selection. The present analysis is based on a representative community sample and was designed to take a step toward correcting these problems and to explore a number of specifications overlooked in previous research. The aggregate results show that marital disruption is associated with an increase of approximately one-third of a standard deviation on a screening scale of depression over a three-year interval between waves of data collection. The effect is more pronounced among women than men and is confined to people other than those who are escaping marriages with serious long-term problems. No evidence is found that the depressogenic effect of marital disruption can be explained by increased financial pressures or other secondary changes in roles. However, increased emotional reactivity to these changes is shown to play a powerful role in promoting depression among the recently divorced. The implications and limitations of these results are discussed.

An Outcome Evaluation of the SOS Suicide Prevention Program

OBJECTIVES We examined the effectiveness of the Signs of Suicide (SOS) prevention program in reducing suicidal behavior. METHODS Twenty-one hundred students in 5 high schools in Columbus, Ga, and Hartford, Conn, were randomly assigned to intervention and control groups. Self-administered questionnaires were completed by students in both groups approximately 3 months after program implementation. RESULTS Significantly lower rates of suicide attempts and greater knowledge and more adaptive attitudes about depression and suicide were observed among students in the intervention group. The modest changes in knowledge and attitudes partially explained the beneficial effects of the program. CONCLUSIONS SOS is the first school-based suicide prevention program to demonstrate significant reductions in self-reported suicide attempts.

Social structure, life stress and depressive symptoms in a high school-aged population

Data from a randomly selected sample of 1,208 high school-aged adolescents were used to examine the means through which life stress is associated with depressive symptoms. Analyses focus on family structure, socioeconomic status, and gender as background risks which directly and indirectly influence symptoms, as well as vulnerability contexts that shape differential responsiveness to stressful experiences. Findings indicate (1) significant gender differences in aspects of stress exposure and in additive models of stress effects, but stresses and supports do not explain the significant gender difference in depressive symptoms; (2) girls in low education backgrounds have the highest levels of depressive symptoms; (3) there are no gender differences in vulnerability to stress; (4) children in single-parent families have higher symptom levels, effects explained by economic conditions and stress exposure--they are no more vulnerable than others to the depressing effects of these stresses; and (5) both boys and girls in low SES backgrounds are more vulnerable to a wide range of stresses and support deficits.

The impact of cumulative childhood adversity on young adult mental health: measures, models, and interpretations.

Research studies investigating the impact of childhood cumulative adversity on adult mental health have proliferated in recent years. In general, little attention has been paid to the operationalization of cumulative adversity, with most studies operationalizing this as the simple sum of the number of occurrences of distinct events experienced. In addition, the possibility that the mathematical relationship of cumulative childhood adversity to some mental health dimensions may be more complex than a basic linear association has not often been considered. This study explores these issues with 2 waves of data drawn from an economically and racially diverse sample transitioning to adulthood in Boston, Massachusetts, USA. A diverse set of childhood adversities were reported in high school and 3 mental health outcomes -- depressed mood, drug use, and antisocial behavior -- were reported 2 years later during the transition to adulthood. Our results suggest that both operationalization and statistical modeling are important and interrelated and, as such, they have the potential to influence substantive interpretation of the effect of cumulative childhood adversity on adult mental health. In our data, total cumulative childhood adversity was related to depressive symptoms, drug use, and antisocial behavior in a positive curvilinear manner with incremental impact increasing as adversities accumulate, but further analysis revealed that this curvilinear effect was an artifact of the confounding of high cumulative adversity scores with the experience of more severe events. Thus, respondents with higher cumulative adversity had disproportionately poorer mental health because of the severity of the adversities they were exposed to, not the cumulative number of different types of adversities experienced. These results indicate that public health efforts targeting prevention of childhood adversities would best be aimed at the most severe adversities in order to have greatest benefit to mental health in young adulthood.

Race and ethnic differences in depressed mood following the transition from high school.

Young adulthood is a period of increased mental health risk, with evidence linking psychological disorder to problematic role transitions. To our knowledge, there has been little or no research that examines the forces shaping minority mental health at this time. Using a diverse, urban sample of young adults who are followed over a two-year period, this paper examines the link between race/ethnicity and depressed mood and the transitional roles and interpersonal experiences that mediate this association. Findings indicate that blacks and Hispanics have elevated depressed mood relative to whites and Asian Americans, independent of socioeconomic background factors. The underrepresentation of blacks and Hispanics in four-year colleges largely explains the differences in depressed mood between members of these groups and Asian American youth. In contrast, comparisons of black and Hispanic youth to white youth highlight problems in peer and parental relations among individuals in the former groups. Overall, findings suggest that the heightened depressed mood among Hispanics and blacks relative to whites and Asian Americans reflects their increasingly disadvantaged pathways into adulthood, characterized by poorer prospects for educational advancement and more problematic relationships subsequent to the high school years.

An Evidence-Based Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) Curriculum for Emergency Department (ED) Providers Improves Skills and Utilization

SUMMARY Objective: Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices. Methods: ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure. Results: Among 402 ED providers, 74% reported <10 hours of prior professional alcohol-related education and 78% had <2 hours exposure in the previous year. At 3-month follow-up, scores for self-reported confidence in ability, responsibility to intervene, and actual utilization of SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources. Conclusions: ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term.

The Variable Effects of Stress on Alcohol Use from Adolescence to Early Adulthood

Despite evidence of a strong association between stress and level of drinking in adolescent populations, the role of stress in accounting for changes in drinking behavior throughout the adolescent years is unclear. This study uses a linear growth curve analysis to examine the determinants of within-individual changes in drinking frequency and binge drinking across five waves of data from a community sample of adolescents who were followed into young adulthood. Predictors of drinking include: stressful life events, parental and peer social support, and parental and peer relationship problems. Findings indicate significant effects of stressful life events and parental support and conflict on both the frequency and intensity of alcohol use. Although age-related changes in these variables coincide with changes in drinking behavior, they do not account for drinking variability over this period. Results from conditional models demonstrate that the impact of the stress is contingent on age, and that the strong associations between drinking and stress evidenced during the high school years weaken considerably as individuals move into their late teens and early twenties. Discussion centers on the complex motivations for and facilitators of drinking as young people mature and change environments over the adolescent years.

Depression and the social developmental context of adolescence.

This article examines the interrelations of personal and social factors in fostering longitudinal patterns of depressive symptoms, using 3 waves of data from high school students in the Boston area. Previously depressed and nondepressed youths differed markedly in their emotional responsiveness to family and friend relations. Chronically depressed youths were unresponsive to family problems, but were highly reactive to peer relations. Among previously asymptomatic youths, family relations exerted greater effects on depressed mood than relations with peers. Further analyses suggest a process through which chronic family turmoil shapes long-term mental health while also intensifying the distancing from family and investment in peer relationships that typically occurs in adolescence. Findings illustrate the importance of modeling transactions between personal and environmental factors in research on adolescent mental health and development.