Rose M. Giaconia

The Long-Term Sequelae of Child and Adolescent Abuse: A Longitudinal Community Study.

The purpose of the present study was to examine the relationship between childhood and adolescent physical and sexual abuse before the age of 18 and psychosocial functioning in mid-adolescence (age 15) and early adulthood (age 21) in a representative community sample of young adults. Subjects were 375 participants in an ongoing 17-years longitudinal study. At age 21, nearly 11% reported physical or sexual abuse before age 18. Psychiatric disorders based on DSM-III-R criteria were assessed utilizing the NIMH Diagnostic Interview Schedule, Revised Version (DIS-III-R). Approximately 80% of the abused young adults met DSM-III-R criteria for at least one psychiatric disorder at age 21. Compared to their nonabused counterparts, abused subjects demonstrated significant impairments in functioning both at ages 15 and at 21, including more depressive symptomatology, anxiety, psychiatric disorders, emotional-behavioral problems, suicidal ideation, and suicide attempts. While abused individuals were functioning significantly more poorly overall at ages 15 and 21 than their nonabused peers, gender differences and distinct patterns of impaired functioning emerged. These deficits underscore the need for early intervention and prevention strategies to forestall or minimize the serious consequences of child abuse.

Traumas and posttraumatic stress disorder in a community population of older adolescents

OBJECTIVEnThe prevalence of DSM-III-R traumas and posttraumatic stress disorder (PTSD) and their impact on psychosocial functioning were examined in a community population of older adolescents.nnnMETHODSnSubjects were 384 adolescents participating in an ongoing longitudinal study. When subjects were aged 18 years, the NIMH Diagnostic Interview Schedule, Version IIIR, was used to identify lifetime traumatic events and diagnoses of PTSD, major depression, phobias, and substance dependence. Behavioral, emotional, and academic functioning in later adolescence was evaluated through self-report measures and school records.nnnRESULTSnMore than two fifths of adolescents experienced at least one DSM-III-R trauma by age 18 years; PTSD developed in 14.5% of these affected youths or 6.3% of the total sample. Youths with PTSD demonstrated widespread impairment at age 18, including more overall behavioral-emotional problems, interpersonal problems, academic failure, suicidal behavior, and health problems, as well as an increased risk for additional disorders. An equally striking finding was that youths who experienced traumas but did not develop PTSD also showed deficits in many of these areas when compared with their peers who had not experienced traumas.nnnCONCLUSIONSnThe substantial risk faced by youths in community settings for experiencing traumas and PTSD, along with associated impairments in later adolescence, underscores the need for programs of prompt intervention.

Prevalence of Psychiatric Disorders in a Community Population of Older Adolescents

In a community study of 386 Caucasian working-class older adolescents, a sizeable proportion met lifetime criteria for selected DSM-III-R diagnoses. Alcohol abuse/dependence had the highest lifetime prevalence rate (32.4%), followed by phobias (22.8%), drug abuse/dependence (9.8%), major depression (9.4%), and, least commonly, post-traumatic stress disorder (6.3%) and obsessive compulsive disorder (2.1%). Significant gender differences were found for major depression, post-traumatic stress disorder, and alcohol abuse/dependence, whereas socioeconomic differences occurred in major depression, phobias, and drug abuse/dependence. Adolescents with specific psychiatric disorders had significantly poorer functioning on measures of behavioral problems, interpersonal problems, self-esteem, and school performance. Results suggest the importance of identifying psychiatric disorder in adolescence, and the need for preventive strategies and prompt treatment.

Early psychosocial risks for adolescent suicidal ideation and attempts

OBJECTIVEnAn ongoing, 14-year, longitudinal community study examined psychosocial risks for adolescent suicidal ideation and attempts, as well as the link between earlier suicidal behavior and later functioning.nnnMETHODnNearly 400 youths were followed between the ages of 5 and 18 years. Suicidal ideation was assessed at age 15 and lifetime suicide attempts were determined at age 18. Risk factors covered developmental periods from birth to age 15, and most were measured prospectively using multiple informants. Late-adolescent functioning (at age 18) was based on both self-reports and school records.nnnRESULTSnFor both genders, the early onset (by age 14) of psychiatric disorders significantly increased the risk for suicidal ideation at age 15 and suicide attempts by age 18. Early gender-specific risks for suicidal ideation included preschool behaviors that are counter to typical gender norms, such as aggressive behavior in females and dependence in males. Suicidal ideation at age 15 and suicide attempts were both associated with deficits in later adolescence (at age 18) in behavioral and social-emotional functioning.nnnCONCLUSIONSnSuicidal ideation at age 15 was a marker of distress with long-term implications for later functioning. The early gender-specific risk factors for suicidal behavior identified in this study can aid in developing strategies for prevention and early intervention.

General and Specific Childhood Risk Factors for Depression and Drug Disorders by Early Adulthood

OBJECTIVEnTo identify childhood risk factors that predict depression and drug disorders by early adulthood, distinguishing between general risk factors for both disorders and specific risk factors for each individual disorder.nnnMETHODnWithin a longitudinal community study (N = 360), familial and behavioral-emotional characteristics were assessed in early childhood (ages 5, 6, and 9 years). At age 21, the Diagnostic Interview Schedule, version III-revised, provided lifetime diagnoses of major depression and drug abuse/dependence.nnnRESULTSnSibling substance use disorders predicted depression and drug disorders for both genders. Feelings of anxiety, depression, and peer rejection were general predictors for females. Specific risk factors for depression were parental depression and anxious/depressed behavior in both genders and peer problems for males. Specific risk factors for drug abuse/dependence were larger family size, lower socioeconomic status, hyperactivity, attention problems, and aggression. Parental substance abuse and having younger parents were specific risk factors for drug disorders in males.nnnCONCLUSIONSnFamilial and behavioral-emotional risk factors for depression and drug disorders were primarily specific, suggesting separate pathways. The unique perspectives of multiple informants facilitate early identification.

Psychosocial Risks for Major Depression in Late Adolescence: A Longitudinal Community Study

OBJECTIVEnAn ongoing 14-year longitudinal study examined psychosocial antecedents of major depression in late adolescence in a community population.nnnMETHODnSubjects were 385 adolescents followed between the ages of 5 and 18 years. Early health, familial, behavior, academic, and environmental risks for major depression were identified using data collected at ages 5, 9, 15, and 18 years. At age 18, a lifetime diagnosis of major depression was assessed using the NIMH Diagnostic Interview Schedule (DIS-III-R).nnnRESULTSnFor males, neonatal health problems, dependence problems at age 5 years, perceived unpopularity and poorer perceptions of their role in the family at age 9 years, remarriage of a parent, early family discord, and anxiety at age 15 years significantly increased the risk of developing major depression. Females with major depression, compared with nondepressed females, had older parents and came from larger families, and at age 9 years had greater perceived unpopularity and anxiety, lower self-esteem, and poorer perceptions of their role in the family. Depressed females also reported more stressful life events, including death of parent and pregnancy.nnnCONCLUSIONSnUnderscoring the importance of early psychosocial factors in the later development of major depression and pointing to specific risks, our findings can aid in developing strategies for prevention and early intervention.

Major depression in the transition to adulthood: risks and impairments.

An ongoing longitudinal community study (N = 375) examined childhood risks and later adult impairments associated with 1-year Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) diagnoses of major depression during the transition to adulthood. Risks from birth to age 9 were reported by mothers, participants, and teachers. Teacher-reported hostility at age 6 predicted later depression. At age 9, self-perceptions of anxiety/depression, unpopularity, familial rejection, and abuse were potent risks. For men, neonatal and childhood health problems predicted later depression. For women, risks included family constellation, parental death, and poor academic achievement at age 9. Men and women who were depressed at age 18, age 21, or both demonstrated extensive psychosocial impairments in early adulthood, including poor overall functioning, interpersonal and behavioral problems, low self-esteem, and suicidality.

Ages of Onset of Psychiatric Disorders in a Community Population of Older Adolescents

OBJECTIVEnAges of onset of psychiatric disorders, as well as the link between early onset and later psychosocial functioning, were examined in a community population of older adolescents.nnnMETHODnSubjects were 386 adolescents who were participants in an ongoing 14-year longitudinal study. At age 18, lifetime diagnoses and ages of onset of major depression, phobias, post-traumatic stress disorder, and substance disorders were assessed using the NIMH Diagnostic Interview Schedule, Revised Version. Behavioral, emotional, and academic functioning in later adolescence were evaluated through self-report measures and school records.nnnRESULTSnAlmost one fourth of the adolescents met criteria for at least one disorder by age 14. Simple phobias emerged earliest (by early childhood), whereas for major depression and substance disorders the peak risk periods for onset were midadolescence. The early onset (by age 14) of disorders was associated with continued impairments in behavioral and emotional functioning in late adolescence (at age 18). Furthermore, the early onset of disorders, compared to later onset (ages 15 through 18), increased the risk for additional co-occurring disorders.nnnCONCLUSIONSnThe striking levels of early psychopathology and associated long-term deficits in functioning found in this community population underscore the need for programs of early intervention.

Risk and resilience in late adolescence.

Differences among three outcome groups of late adolescents identified as at risk for major depression were investigated. Adolescents with major depression, with other psychiatric diagnoses, and with no diagnoses differed in major areas of functioning and well-being, with the most difficulties shown by those with depression. The phenomenon of resilience was examined among the at-risk adolescents with no diagnosis, revealing that family cohesion and social support are associated with resilience. Implications for social work practice and research include the need to focus on promoting family strengths.

Adolescent Protective Factors Promoting Resilience in Young Adults at Risk for Depression

In a longitudinal, community-based study, adolescent protective factors for those at risk for depression were identified that were associated with resilient outcomes in young adulthood. For those with childhood risk factors for major depression, significant protective factors included family cohesion, positive self appraisals, and good interpersonal relations. Findings may help inform the development of prevention and treatment programs for adolescents vulnerable to depression. Implications for future research and clinical practice are discussed.