Journal of Clinical Child and Adolescent Psychology最新文献

Objective: Studies demonstrating associations between experiences of racism and traumatic stress symptoms have predominantly been conducted in adults, due in large part to the lack of available tools for assessing racism-based traumatic stress symptoms (RBTSS) in youth. This investigation sought to address this gap by developing and validating the first measure of RBTSS for ethnoracially minoritized adolescents.

Method: The Youth Racism-Based Traumatic Stress Symptom Scale (YRaBTSSS) was developed by drawing on relevant literature. Following iterative refinement based on feedback obtained via focus groups with adolescents, it was tested in two U.S. samples of 12-17-year-old ethnoracially minoritized adolescents (Study 1: n = 401, 50.6% female; Study 2: n = 651; 48.08% female) recruited through CloudResearch. Participants completed a demographic survey, the YRaBTSSS, and measures of trauma, racial/ethnic discrimination, and mental health.

Results: An exploratory factor analysis in Study 1 indicated that the YRaBTSSS is comprised of a single factor representing RBTSS. The final RBTSS scale had excellent internal consistency (α = 0.98) and significant factor loadings (0.72-0.87). The factor structure was replicated in Study 2. The YRaBTSSS demonstrated convergent validity through significant associations with related measures of PTSD symptoms (p < .001) and racial stress (p < .001). Finally, RBTSS were significantly associated with symptoms of anxiety (p < .01), depression (p < .01), and conduct problems (p < .05).

Conclusions: Findings show preliminary evidence for the reliability and validity of the YRaBTSSS. This measure presents new opportunities to investigate the effects of racism on ethnoracially minoritized adolescents from a traumatic stress perspective.

Objectives: The purpose of this study was to examine longer-term outcomes of a school-based randomized controlled trial comparing a telehealth-delivered adolescent depression prevention program, Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), to services as usual (SAU) across 17 public schools.

Method: Adolescents (N = 242; M_age = 14.80 years, SD = .70; 65% female; 21% Black; 13% Hispanic/Latinx) with elevated depression screening scores completed surveys through 15-month follow-up (approximately 1-year post-intervention). Adolescents completed a diagnostic interview to measure depression diagnoses at baseline and 15-month follow-up. Depression symptoms and diagnoses were primary outcomes and anxiety symptoms were secondary.

Results: Hierarchical linear modeling results indicated that adolescents in both IPT-AST and SAU demonstrated similar decreases in depression and anxiety symptoms during the follow-up and total study periods, supporting hypotheses regarding the follow-up period but not the total study. Baseline depression diagnostic status moderated intervention effects on anxiety symptoms such that, among adolescents without a depression diagnosis at baseline, those in IPT-AST showed greater reductions in anxiety symptoms than those in SAU. Exploratory analyses indicated SAU adolescents were more likely to endorse elevated depression symptoms (i.e. above a clinical cutoff) compared to IPT-AST adolescents. The hypothesis regarding depression diagnoses was partially supported; although diagnosis rates and timing to episode onset did not differ between IPT-AST and SAU, exploratory restricted mean survival time analyses demonstrated that adolescents in IPT-AST gained approximately one month free of diagnosis compared to those in SAU.

Conclusion: Findings highlight the importance of school-based depression prevention programming for reducing longer-term risk.

Objective: Research to date has produced compelling evidence of the potentially traumatic consequences of racial discrimination among Black adolescents and adults. Seldom explored, however, is how the potentially traumatic effects of racial discrimination may be shared across the family context. To clarify the relevance of racial trauma across the family system, the current study examined the relationship between racial discrimination and trauma symptoms among a sample of Black adolescent-caregiver dyads.

Method: Data were drawn from a larger self-report survey study examining Black family life experiences. For this study, data from 202 Black adolescents (Mage = 14.50, 52% female) and their caregiver (Mage = 41.63, 83% female) were used to test actor-partner interdependence models examining the associations of racial discrimination and trauma symptoms.

Results: Significant actor effects revealed that racial discrimination was positively associated with self-reported trauma symptoms among adolescents and caregivers. Additionally, partner effects were found, such that adolescent and caregiver experiences of discrimination were positively associated with the trauma symptoms of their family member. Analyses also revealed that the association between racial discrimination and trauma symptoms among caregivers was dependent upon youth experiences of racial discrimination.

Conclusion: The current study lends credence to theories linking racism and trauma-related symptomatology across the life course and family system. Collectively, study findings highlight the importance of understanding the effects of racism beyond the individual and underscores the value and need for family tailored interventions that can repudiate the shared impact and potential intergenerational effects of racial discrimination across Black families.

Objective: The purpose of this systematic review and meta-analysis is to provide an updated examination of the adolescent Dialectical Behavioral Therapy (DBT) literature and synthesize study findings across treatment settings (e.g. inpatient, outpatient, school), and treatment levels (e.g. clinical intervention, targeted, universal prevention). We also provide meta-analytic findings of the impact of DBT across key problem behaviors: depression, emotion dysregulation, suicidal and self-harm behaviors, externalizing problems, and eating disorders.

Method: A reference database search was used to identify studies conducted on adolescent DBT interventions from 2000 through 2023 (N = 72). In addition to ensuring that the review process conformed to the PRISMA statement, we independently verified that each study met inclusion criteria before triple coding each article to examine variables of interest and extracted outcome data needed to conduct meta-analyses.

Results: DBT appears to demonstrate effectiveness in improving mental health outcomes in adolescents across a range of psychiatric problems. To meet these treatment needs, DBT interventions have been appropriately adapted based on care setting, suggesting empirical support in inpatient, residential, partial hospitalization, and intensive outpatient programs, as well as in outpatient settings, juvenile correctional facilities, and schools.

Conclusions: The growing evidence base for adolescent DBT appears to reflect its promise and versatile clinical utility. Clinical implications and recommendations for future directions are discussed, including the need for more randomized controls and representation of diverse communities.

Objective: While suicidal behaviors among adolescents declined from 1991 to 2017, suicides among Black youth increased. There is limited research on suicidal help-seeking behaviors among Black adolescents, which is essential for effective suicide prevention and intervention. This study examined suicidal help-seeking behaviors and treatment preferences among Black youth and caregivers, using the Psychological Framework of Radical Hope to explore strategies for fostering hope and healing.

Methods: This qualitative study included Black youth (ages 14-19), caregivers, health and mental health providers, and community members (N = 55). Participants were predominantly Black (96%) and female (53%), with ages ranging from 14 to 68 years. Semi-structured interviews, conducted in 60-90-min virtual focus groups, explored experiences with suicidal help-seeking, service needs, and support preferences. Constant comparative methodology was employed to organize and categorize data into themes.

Results: Youth balanced ideas of faith and agency toward help-seeking behaviors. In contrast, caregivers, providers, and community members were less optimistic about the service needs of Black youth being met largely due to historical and current experiences with systemic barriers. Participant groups discussed how collective memory informs their experiences and inspires them to have hope for positive change.

Discussion: Suicide-specific interventions should integrate strategies for fostering hope, faith, and agency individually and collectively with diverse groups to support Black youth suicidal help-seeking behaviors. Clinical strategies are provided to support the design of interventions to effectively address suicidal help-seeking behaviors for Black youth and their caregivers.

Objective: Leveraging data from a previously conducted randomized trial, we examined whether Project RISE - a digital single-session intervention focused on minority stress - was associated with equal improvements in levels of internalized stigma, identity pride, hopelessness, depression, and anxiety among youth with a single minoritized or multiply-minoritized identities. We also tested whether higher levels of social support moderated outcomes.

Method: Participants randomly assigned to the intervention were included (n = 261 adolescents 13-16 years old; M age = 15; 51% youth of color; 68% transgender/gender-diverse). Two-way multivariate analysis of covariances examined potential group differences across outcomes, between individuals holding multiple minoritized identities versus one. Moderation analyses were used to investigate whether social support moderated RISE outcomes.

Results: Identifying with multiple minoritized identities was associated with higher levels of identity pride immediately post-intervention. Identifying as a gender minority was associated with slightly greater identity pride post-intervention. Youth who endorsed gender minority identities reported higher levels of hopelessness, depression, and anxiety at 2-week follow-up, relative to cisgender youth. No other differences emerged.

Conclusions: Multiply-minoritized youth, especially gender minority youth, experienced significantly higher levels of identity pride after completing Project RISE. Results highlight the importance of applying an intersectional minority stress framework to online intervention design and considering social contexts (e.g. high versus low social support) when selecting treatments for youth with intersecting identities. Clinicians should consider how interventions specifically addressed intersectional identities when providing evidence-based care.

Objective: Anxiety often rises after the transition to high school, yet little is known about how these changes occur for lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents who face unique minority stressors. This study examined longitudinal differences in anxiety trajectories between LGBTQ and cisgender heterosexual adolescents and evaluated whether self-esteem served as a protective factor.

Method: Participants were 367 adolescents (M_age = 14.05 years; 60.5% cisgender girls; 46.6% White, 18.8% Black, 17.4% Asian, 5.7% Arab/Middle Eastern/North African, 5.2% Multiracial, 3.5% Hispanic/Latinx; 22% [n = 80] LGBTQ, 78% [n = 287] cisgender heterosexual) from 38 Michigan high schools. Anxiety symptoms (Generalized Anxiety Disorder-7) and self-esteem (Rosenberg Self-esteem Scale) were assessed across five waves during ninth and tenth grade. Multiple-group latent curve modeling evaluated group differences and self-esteem's predictive role.

Results: LGBTQ adolescents entered high school with significantly higher anxiety symptoms than their cisgender heterosexual peers. Although their symptoms declined over time, they remained significantly higher than those of cisgender heterosexual adolescents, whose anxiety levels were stable. Higher initial self-esteem predicted lower initial anxiety for both groups; however, decreases in anxiety over time emerged only among LGBTQ adolescents with self-esteem at least 1 SD above the group mean.

Conclusions: Self-esteem emerges as a critical protective factor against the development of anxiety symptoms. Given heightened anxiety symptoms for LGBTQ adolescents following the transition to high school, interventions bolstering self-esteem may be especially beneficial for reducing anxiety in this population.