Tally Moses

Stigma and Self-Concept Among Adolescents Receiving Mental Health Treatment

Although studies indicate that adolescents diagnosed with mental disorders are stigmatized by the American public, we know very little about the extent to which stigma is experienced by these youth and its effects on their well-being. This cross-sectional study utilizes interviews with 60 adolescents treated in a wraparound program to examine: (a) the extent to which adolescents diagnosed and treated for psychiatric disorders experience mental illness stigma and cope by using secrecy, (b) the extent to which stigmatization is associated with self-concept (self-esteem, mastery, future outlook) and morale (depression), and (c) which clinical and demographic characteristics are associated with perceived stigma. A secondary purpose was to explore the usefulness with adolescents of stigma measures created and adapted primarily from Links adult stigma scales (Link et al., 1991, 1997). The results support both optimistic and pessimistic interpretations regarding stigma and its effects on adolescents diagnosed and treated for mental disorders. The scales developed for this study demonstrate good internal consistency and construct validity and show promise as tools for further research on stigma as experienced by youth.

Adolescents’ Commitment to Continuing Psychotropic Medication: A Preliminary Investigation of Considerations, Contradictions, and Correlates

This mixed-method study examines (1) the extent to which fifty adolescents receiving wraparound treatment and prescribed psychotropic medication for various psychiatric disorders report that they would continue taking medication if the decision was entirely their own (termed “medication commitment”); (2) their general subjective experiences with medication; and (3) which medication experiences and clinical, social, and demographic factors are associated with greater medication commitment. We found that most adolescents (62%) would discontinue treatment; these “less committed” youth were more likely to report various negative medication perceptions and experiences in open-ended questions, relative to “committed” youth. Multivariate analysis indicated that significant correlates of commitment to medication were: taking antipsychotic medication, greater perceived family support, and lack of perceived coercion to take the medication; clinical or demographic factors were not significantly related to medication commitment. The results reinforce the importance of addressing youths’ concerns about medication and maximizing their participation in treatment decision-making.

Adolescents’ Perspectives About Brief Psychiatric Hospitalization: What is Helpful and What is Not?

Significant numbers of adolescents receive inpatient psychiatric services, yet we know little about their experiences: what about hospitalization is perceived as helpful and what is counter-productive or even harmful? In this study, eighty adolescents hospitalized for the first time in a psychiatric program were interviewed within a week of discharge (using a semi-structured interview format), and asked to describe what did and did not help them. Multiple themes emerged relating to helpful experiences and these were grouped in three categories: interpersonal support, therapy and psycho-education, and environment; Unhelpful/harmful experiences were classified in four categories: rigidity and confinement, lack of treatment responsiveness, frightening/anxiety-provoking experiences, and other. Participants provided rich feedback that both reinforces existing practices and offers ways for programs to change practices to better meet adolescents’ developmental needs. Some factors noted as key therapeutic ingredients, especially the helpful role of peers, have not previously been included in hospital satisfaction surveys.

Youth participation in qualitative research: Challenges and possibilities

Research often excludes youth participants, omitting their social and psychological realities, undermining their rights to participate and benefit from research, and weakening the validity of research. Researchers may be discouraged from including youth due to logistical (e.g. gaining access) or ethical (e.g. coercion risks based on developmental level) concerns. Increased discussion is needed around appropriate methods to use with child and youth participants that manage challenges related to developmental capacities, legal status, power differentials, and unpredictable aspects of qualitative research. This paper pools experiences of six researchers, describing solutions we have developed in studies employing varied qualitative methodologies with varied vulnerable youth subpopulations. We detail successful approaches to access, compensation, consent, assent, and confidentiality. Social work researchers are wellsuited to navigate the challenges, and we share our examples with the aim of facilitating increased youth participation in research.

Parents' Conceptualization of Adolescents' Mental Health Problems: Who Adopts a Psychiatric Perspective and Does It Make a Difference?

How parents give meaning to the problems of adolescents diagnosed with mental disorders and receiving treatment is likely related to important outcomes including parental well-being and commitment to treatment, as well as their own behaviors and reactions to their child. The aim of this cross-sectional, mixed-method study of 70 parents of adolescents receiving wraparound mental health services is to examine: (1) how parents conceptualize their child’s MH problems; (2) factors related to parents’ conceptualization of youths’ problems using medical model terms; and (3) associations between parents’ problem conceptualization and their emotional or coping responses to their child having psychiatric problem(s). Content analysis indicated that 54.3% of parents definitively conceptualized adolescents’ problems using psychiatric terms, 37.1% reported uncertainty about the nature of their child’s problems, and 8.6% gave alternative, non-psychiatric explanations for their child’s problems. We found significant relationships between parents’ problem conceptualization and their attitudes and experience with MH treatment, demographics, as well as with adolescents’ clinical characteristics. Parents who conceptualized problems using psychiatric terminology were more likely to express sadness and pessimism relative to other parents, though there were no differences in expressions of worry, guilt, pragmatism and optimism by problem conceptualization.

Coping strategies and self-stigma among adolescents discharged from psychiatric hospitalization: A 6-month follow-up study

Background: The effects of mental illness stigma on adolescents receiving psychiatric treatment may largely be determined by their coping strategies. Yet, little is known about adolescents’ use of stigma-coping strategies, or how helpful these are for addressing stigma-related stress. Aims: This study explores how adolescents discharged from psychiatric hospitalization anticipate coping with a hypothetical social stigma event related to hospitalization. We examine how well anticipated coping strategies predict adolescents’ self-stigma ratings following 6 months. To evaluate the direction of causality, the reverse order of effects, the influence of self-stigma on coping strategies, is also assessed. Methods: A voluntary sample of 80 adolescents participated in two face-to-face interviews that assessed coping and self-stigma. Anticipated (baseline) and actual (follow-up) coping strategies were measured with a modified Response to Stress Questionnaire (primary and secondary control engagement coping, disengagement) and two stigma-specific strategies developed for this study (disconfirming stereotypes and aggression/confrontation). Relationships between anticipated coping strategies and self-stigma were assessed with ordinary least squares (OLS) regression; multivariate general linear modeling (GLM) and structural equation modeling (SEM) explored the reverse associations. Results: Youth reporting higher self-stigma ratings at follow-up anticipated using more disengagement and effort to disconfirm stereotypes and less secondary control engagement coping at baseline. Anticipated use of secondary control engagement coping was uniquely significant in predicting participants’ self-stigma when controlling for baseline self-stigma. At the same time, higher baseline self-stigma ratings predicted less adaptive coping (disengagement and effort to disconfirm stereotypes) at follow-up. Conclusions: The results point to the particular importance of secondary control engagement coping for helping to mitigate the impact of peer prejudice or discrimination on self-stigma among youth receiving psychiatric services. At the same time, higher initial levels of self-stigma likely drive less adaptive coping with peer stigma. These bidirectional influences point to a vicious cycle between internalizing negative stereotypes and coping in ways that perpetuate negative outcomes.

What helps or undermines adolescents’ anticipated capacity to cope with mental illness stigma following psychiatric hospitalization

Background: Better understanding of the individual and environmental factors that promote adolescents’ use of more or less adaptive coping strategies with mental illness stigma would inform interventions designed to bolster youth resilience. Aims: This cross-sectional study draws on data from research on adolescents’ well-being after discharge from a first psychiatric hospitalization to explore the relationships between anticipated coping in reaction to a hypothetical social stigma scenario, and various factors conceptualized as ‘coping resource’ and ‘coping vulnerability’ factors. Focusing on coping strategies also identified in the companion article, we hypothesize that primary and secondary control engagement coping would relate to more coping resource and less coping vulnerability factors, and the opposite would be true for disengagement, aggression/confrontation and efforts to disconfirm stereotypes. Methods: Data were elicited from interviews with 102 adolescents within 7 days of discharge. Hypothesized coping resource factors included social resources, optimistic illness perceptions, better hospital experiences and higher self-esteem. Vulnerability factors included more previous stigma experiences, desire for concealment of treatment, more contingent self-worth, higher symptom levels and higher anticipated stress. Multivariate ordinary least squares (OLS) regression was used to analyze associations between coping strategy endorsement and correlates. Results: Although some coping correlates ‘behaved’ contrary to expectations, for the most part, our hypotheses were confirmed. As expected, youth anticipating reacting to the stigmatizing situation with greater disengagement, aggression/confrontation or efforts to disconfirm stenotypes rated significantly lower on ‘coping resources’ such as self-esteem and higher on vulnerability factors such as symptom severity. The opposite was true for youth who anticipated exercising more primary and secondary control engagement coping. Conclusions: This study begins to identify factors that promote more and less adaptive coping strategies among youth at high risk for social stigma. Some factors that can be modified in the shorter term point to useful directions for clinical interventions.

Examining the Link Between Stress Events and Prosocial Behavior in Adolescents More Ordinary Magic

Scholarship regarding adolescent resilience has typically defined resilience as the absence of negative outcomes rather than the existence of positive outcomes. This study drew on the challenge model of resilience, which anticipates a curvilinear relationship between stress exposure and adaptive functioning, to test whether adolescents reporting moderate levels of stress exposure were more likely to evidence prosocial behavior than youth exposed to more or less stress. Using data from approximately 13,000 adolescents, we tested three analytic models and investigated hypothesized moderation by coping, social resources, and markers of adolescent status. Our results did not align with the challenge model. Instead, we found that stress exposure was differentially associated with measures of prosocial behavior, that social resources supported volunteering but impeded helping a peer in some instances, and that markers of historically marginalized status were more predictive of stopping peer harassment than volunteering. Implications for future research are discussed.

Suicide Attempts Among Adolescents with Self-Reported Disabilities

This study examines the relative risk for suicide attempts (SA) among high-school students self-identifying with one or more disability classifications (nine); assesses the extent to which youth with disabilities are disproportionately vulnerable to risk factors that predict suicidal behavior among all adolescents; and explores whether disability status adds to risk for SA after accounting for a comprehensive set of known risk and protective factors for SA. Analyses using Wisconsin’s 2012 Dane County Youth Assessment Survey data found that youth in each disability category were 3–9 times more likely to report suicide attempt(s) relative to peers, and the endorsement of multiple disabilities tripled the risk SA relative to youth reporting a single disability. Some disability sub-groups, including youth reporting autism spectrum disorder, hearing, and vision impairments reported surprisingly high rates of SA. While youth with disabilities reported disproportionate exposure to adversity in every life domain examined, similar to youth reporting SA, disability status added unique risk for suicidal behavior. This suggests that disability may be a ‘fundamental cause’ of suicidal behavior, a question that requires further investigation.