Sa Shen

The Columbia-suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults

OBJECTIVE Research on suicide prevention and interventions requires a standard method for assessing both suicidal ideation and behavior to identify those at risk and to track treatment response. The Columbia-Suicide Severity Rating Scale (C-SSRS) was designed to quantify the severity of suicidal ideation and behavior. The authors examined the psychometric properties of the scale. METHOD The C-SSRSs validity relative to other measures of suicidal ideation and behavior and the internal consistency of its intensity of ideation subscale were analyzed in three multisite studies: a treatment study of adolescent suicide attempters (N=124); a medication efficacy trial with depressed adolescents (N=312); and a study of adults presenting to an emergency department for psychiatric reasons (N=237). RESULTS The C-SSRS demonstrated good convergent and divergent validity with other multi-informant suicidal ideation and behavior scales and had high sensitivity and specificity for suicidal behavior classifications compared with another behavior scale and an independent suicide evaluation board. Both the ideation and behavior subscales were sensitive to change over time. The intensity of ideation subscale demonstrated moderate to strong internal consistency. In the adolescent suicide attempters study, worst-point lifetime suicidal ideation on the C-SSRS predicted suicide attempts during the study, whereas the Scale for Suicide Ideation did not. Participants with the two highest levels of ideation severity (intent or intent with plan) at baseline had higher odds for attempting suicide during the study. CONCLUSIONS These findings suggest that the C-SSRS is suitable for assessment of suicidal ideation and behavior in clinical and research settings.

Childhood Depressive Symptoms and Early Onset of Alcohol Use

OBJECTIVES. Few studies have assessed the relationship between depressive symptoms and early onset of alcohol use in children and early adolescents. We aimed to determine whether depressive symptoms in children are associated with subsequent initiation of alcohol use and, if so, whether this association is merely a result of demographic, parental, and/or individual risk factors shared by depression and alcohol use or independent of these shared risk factors. METHODS. Analyses were based on a subsample of 10- to 13-year-old children (N = 1119) from the Boricua Youth Study, a longitudinal study of psychopathology among Puerto Rican children and early adolescents. Children in the study were assessed over 3 waves between 2000 and 2004. In-person structured interviews were conducted with both parents and children. RESULTS. Depressive symptoms and alcohol use shared some significant risk and protective factors, such as parental psychopathology, parenting, child exposure to violence, and antisocial behaviors. After controlling for these factors, the association between depressive symptoms and alcohol use was reduced, but childhood depressive symptoms were still positively associated with subsequent alcohol use initiation. Children with medium or high levels of depressive symptoms were more than twice as likely to use alcohol as those with <2 depressive symptoms. CONCLUSIONS. The finding of the current study that early life depressive symptoms may lead to earlier onset of alcohol use indicates the importance of identifying and treating depressive symptoms in preadolescent children. It also demonstrates the importance of examining shared risk and protective factors for understanding the relationship between depressive symptoms and alcohol use.

Culture and Psychiatric Symptoms in Puerto Rican Children: Longitudinal Results from One Ethnic Group in Two Contexts.

BACKGROUND The development of youth psychopathology may be associated with direct and continuous contact with a different culture (acculturation) and to distress related to this process (cultural stress). We examine cultural experiences of Puerto Rican families in relation to youth psychiatric symptoms in two different contexts: one in which migrant Puerto Ricans reside on the mainland as an ethnic minority and another in which they reside in their place of origin. METHODS SAMPLE Probability samples of 10- to 13-year-old youth of Puerto Rican background living in the South Bronx, New York City (SB) and in the San Juan Metropolitan area in Puerto Rico (PR) (N = 1,271) were followed over time. measures: Three assessments of internalizing psychiatric symptoms (elicited through the DISC-IV) and of antisocial behaviors (ASB) quantified through a six-point index were carried out. Independent variables included scales of adult and child acculturation and cultural stress, and other putative correlates. DATA ANALYSIS Within each study site, multilevel linear regression models were examined. RESULTS Parental acculturation was associated with ASB in youth at both sites, but youth acculturation itself was not related to psychiatric symptoms. At both contexts, cultural stress was a more consistent correlate of youth psychiatric symptoms than acculturation after controlling for nativity, maternal education, child gender, stressful life events and parental psychopathology. However, the strength of the youth cultural stress association decreased over time. CONCLUSION The association between cultural factors and child psychiatric symptoms is not restricted to contexts where an ethnic group is a minority.

Maternal depression and child BMI: longitudinal findings from a US sample.

To examine the association between maternal depression and child body mass index (BMI) from Kindergarten (K) to fifth grade.

Parental Familism and Antisocial Behaviors: Development, Gender, and Potential Mechanisms

OBJECTIVE To examine the relation between parental familism (strong values of attachment to nuclear and extended family members) and youth antisocial behaviors over time. METHOD Puerto Rican children 5 to 13 years of age at baseline residing in the South Bronx in New York (n = 1,138) and in the Standard Metropolitan Area in San Juan and Caguas, Puerto Rico (n = 1,353) were followed over two waves 1 year apart from 2000 to 2004. Parental familism was assessed using an adaptation of the Sabogal Familism Scale. Level of youth past-year antisocial behaviors was measured by the Antisocial Behavior Index. The association between familism and Antisocial Behavior Index over three waves was examined through mixed models stratified by age and gender, adjusted by site (South Bronx or San Juan), propensity scores reflecting site differences in family income, maternal age and education, plus environmental and child risk factors. Specific family processes were examined as potential mediators. RESULTS Parental familism was protective against antisocial behaviors in girls (estimate = -0.11, standard error = 0.03, p < .001 for 5- to 9-year-olds; estimate = -0.15, standard error = 0.03, p < .0001 for those ≥ 10 years old). For boys, parental familism was only protective in 5- to 9-year-olds (estimate = -0.09, standard error = 0.03, p = .0008). The protective effect of parental familism on antisocial behaviors operated mostly through parent-child relationships for 5- to 9-year-old children and parental attitudes/behaviors toward youth high-risk behaviors for both age groups. CONCLUSIONS Familism may protect youth against increasing levels of antisocial behaviors (except for boys who are ≥ 10 years old). Incorporating familism as part of therapeutic approaches addressing antisocial behaviors for youth may be helpful.

Longitudinal Mental Health Service and Medication Use for ADHD Among Puerto Rican Youth in Two Contexts

OBJECTIVE The study describes prevalence and rates of services and medication use and associated factors over time among Puerto Rican youths with attention-deficit/hyperactivity disorder (ADHD). METHOD Longitudinal data are obtained on Puerto Rican children ages 5 through 13 years in the south Bronx in New York (n = 1,138) and two metropolitan areas in Puerto Rico (n = 1,353). The Diagnostic Interview Schedule for Children-IV is the diagnostic tool. Five composite measures of risk factors: negative family influences, ineffective structuring, environmental risks, child risks, and maternal acceptance are constructed to relate services and medication use to risk variables. RESULTS ADHD prevalence is similar in Puerto Rico and the south Bronx. Overall mental health services, medication, and psychostimulant use is lower in Puerto Rico across three time points. Most participants never received treatment at any time point. More environmental risks, negative child traits, and low maternal warmth are associated with more services, even after adjusting for comorbidity. When risk variables are controlled, the effects of ADHD on services use decrease. Previous treatment is a strong predictor of subsequent treatment. CONCLUSIONS Rates of services and medication use are lower in Puerto Rico. Context seems to be more important than ethnicity in predicting mental health services and medication use among Puerto Rican children with ADHD. Other psychiatric diagnoses and general risk variables are important correlates of services and medication use.

Reliability and Validity of Proposed DSM-5 ADHD Symptoms in a Clinical Sample of Adults

The DSM-5 ADHD and Disruptive Behaviors Work Group proposed two major changes for diagnosis of attention deficit hyperactivity disorder (ADHD) in adults: (1) inclusion of four new impulsivity symptoms and (2) reduction in the number of symptoms required for assigning an ADHD diagnosis. In this case-control study, the performance of these modifications was assessed in a clinical sample of 133 adult subjects (68 ADHD cases and 65 non-ADHD control subjects). The proposed new impulsivity symptoms for adults do not improve ADHD diagnosis enough to overcome potential negative effects of changing the criteria. However, fewer symptoms than the six-of-nine threshold required by DSM-IV provided the best cutoff point for identifying adults who are impaired.

Interorganizational Relationships Among Family Support Organizations and Child Mental Health Agencies

This study examined: (1) qualitative aspects of close working relationships between family support organizations and child mental health agencies, including effective and ineffective characteristics of the relationship and aspects that they would change, and (2) the impact of the working relationship upon the family support organization. Semi-structured interviews were conducted with 40 directors of family support organizations characterized as having a close working relationship with a child mental health agency. Three main themes emerged regarding the quality of the working relationship: (a) interactional factors, including shared trust, communication, collaboration and service coordination; (b) aspects of the inner context of the family support organization, mental health agency, or both, including alignment of goals and values and perceptions of mental health services; and (c) outer contextual factors external to the organizations, such as financial and county regulations. Responses to the perceived impact of the relationship was divided into two themes: positive impacts (e.g. gained respect, influence and visibility), and negative impacts (e.g. lack of trust). This study lays the foundation for future research to better understand the mechanisms underlying interorganizational relationships in communities among different types of providers to create a more seamless continuum of services for families of children with mental health conditions.