Journal of Clinical Child and Adolescent Psychology最新文献

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: Suicidal thoughts and behaviors are a leading cause of death, injury, and hospitalization among adolescents. Few evidence-based interventions exist, and these tend to be inaccessible for most youth. Electronic safety plan interventions represent a new avenue to disseminate an evidence-based suicide prevention tool. However, it is not clear whether youth find electronic, self-guided safety plans helpful, nor whether they will use the resulting safety card when experiencing suicidal thoughts or urges. This study examines adolescents' perceptions and use of an electronic, self-guided safety plan intervention.

Method: We recruited 322 adolescents with a past-year history of suicidal thoughts or behaviors, ages 13-17 (55.9% white and non-Hispanic; majority reporting diverse sexual orientations and genders) online via social media to participate in this two-part longitudinal study. At baseline, participants completed the electronic safety plan interventions and reported on key aspects of its usefulness and areas of improvement. Participants reported their use and perceptions of the plan one month later.

Results: Results suggested that adolescents understood, liked, and believed they would use a self-guided safety plan. One month later, about ⅓ of youth who experienced suicidal thoughts or urges used their safety card. Open-ended responses highlighted several features that adolescents enjoyed, including clarity, ease of use, and privacy. Participants also highlighted key areas for improvement, including formatting and language.

Conclusion: This study provides initial support for adolescent use of electronic self-guided safety plans. Next steps include updating this intervention based on youth feedback and testing the effectiveness of this tool using gold standard research methods.

Objective: Although life stress has been linked to adolescent suicidal ideation, most past research has been cross-sectional, and potential processes characterizing this relation remain unclear. One possibility may be a lack of emotional clarity. Informed by stress generation, the current study examined prospective relations between episodic life stress, lack of emotional clarity, and suicidal ideation in an adolescent clinical sample.

Methods: The sample consisted of 180 youths (M_age = 14.89; SD = 1.35; 71.7% female; 78.9% White; 43.0% sexual minority) recruited from a psychiatric inpatient facility. Suicidal ideation severity was assessed at baseline and 18-month follow-up. Lack of emotional clarity and life stress were assessed at baseline, as well as 6-, and 12-month follow-ups. Two random-intercepts cross-lagged panel models were created to estimate within-person relations for variables of interest.

Results: At the within-person level, lack of emotional clarity at baseline predicted greater 6-month impact of interpersonal dependent stressors (b = 0.29, p = .012, 95% CI [0.07, 0.52]), which subsequently predicted a greater 12-month lack of emotional clarity (b = 0.41, p = .005, 95% CI [0.12, 0.70]). Next, a 12-month lack of emotional clarity but not interpersonal dependent stress, predicted greater 18-month suicidal ideation (b = 0.81, p = .006, 95% CI [0.23, 1.30]; R² = .24, p < .001). No significant relations were found for the lack of emotional clarity and independent stress.

Conclusions: Results support the stress generation hypothesis and suggest that future research should be conducted evaluating whether bolstering youth's understanding of their emotional experiences may reduce subsequent suicidal ideation.

Objective: The current study utilized latent profile analysis to identify distinct profiles of suicidal ideation among Black male adolescents and compared profiles on socioecological determinants of suicide and psychological symptoms.

Method: A sample of 457 Black male adolescents (mean age = 15.31, SD = 1.26) completed self-report measures of suicidal ideation, racial discrimination, community violence exposure, anxiety symptoms, depressive symptoms, and posttraumatic stress symptoms.

Results: Results of the latent profile analysis revealed a three-profile model: a low ideation profile, with low levels of all forms of suicidal ideation; a general death ideation profile with elevated general thoughts of death and dying; and a high, concealed ideation profile with high levels on all suicidal ideation items, except communicating the ideation to others. ANOVAs revealed that levels of psychological symptoms were significantly different for each profile, with the high, concealed ideation profile showing the highest levels. The low ideation profile had significantly lower scores than the two other profiles on community violence exposure, but the other two profiles did not differ significantly from one another. Further, the general death ideation profile had significantly higher scores on racial discrimination than the other two profiles, but the other two profiles did not differ significantly from one another.

Conclusions: The current study supports recent socio-cultural theories of suicidal ideation and behavior in Black youth and highlights the need for increased access to care and services for Black boys who are exposed to socioecological factors that heighten suicidal ideation.

Objective: Despite decades of research, relatively little is known about short-term predictors of suicidal thoughts and behavior. Intensive longitudinal methods are increasingly applied to investigate near-term risk factors of suicidal thoughts in daily life. The aim of this study was to examine short-term predictors of daily-level suicidal thoughts in a high-risk adolescent sample using the interpersonal-psychological theory of suicidal behavior (IPTS) as a guiding framework; the theory proposes that interpersonal experiences of thwarted belongingness in combination with perceived burdensomeness lead to suicidal desire.

Methods: Seventy-eight adolescents hospitalized due to suicide risk responded to one survey/day for 28 days after discharge (n = 1621 unique observations). Multilevel models examined IPTS-informed predictors of same- and next-day suicidal urge intensity.

Results: Partial and time-dependent support for the theory was found. The hypothesized two-way interaction between burdensomeness and thwarted belongingness (either family or peer) was significantly associated with increasing same-day, but not next-day, suicidal ideation; specifically, greater belongingness attenuated adverse impact of burdensomeness. The only significant predictor of next-day ideation was higher previous-day burdensomeness. Baseline burdensomeness also emerged as a predictor of day-to-day suicidal ideation.

Conclusion: Using a theoretically informed model, this study offers an in-depth examination of short-term predictors of suicidal ideation among high-risk adolescents. Findings underscore the importance of fostering peer and family relationships in reducing suicidal thoughts in the post-discharge period. Results additionally suggest that both state- and trait-level burdensomeness have lasting influence on suicidal thoughts during this high-risk period. These findings could inform intervention efforts for high-risk youth.

Objective: Native American adolescents are disproportionately burdened by suicidality. Here, we examine patterns of reporting of suicide ideation and suicide attempt among Native American youth compared to those from other ethnoracial backgrounds, as this data is important for grounding commonly subscribed to frameworks of suicide risk (e.g., ideation-to-action).

Method: Data are from the Youth Risk Behavior Surveillance Survey (N = 54,243; grades 9-12; 51.0% female) and Minnesota Student Survey (N = 335,151; grades 8, 9, 11; 50.7% female). Comparing Native American youth to peers from other ethnoracial backgrounds, we examined two suicide reporting patterns: 1) odds of reporting suicide attempt among those who reported ideation and 2) odds of reporting suicide ideation among those who reported an attempt.

Results: Across both samples, when reporting suicide ideation, youth from other ethnoracial backgrounds were 20-55% less likely than Native American youth to also report attempt. While few consistent differences were observed between Native American youth and those from other racial minority backgrounds in patterns of co-reporting suicide ideation and attempt across samples, White youth were between 37% and 63% less likely than Native American youth to report a suicide attempt without also reporting ideation.

Conclusions: The increased odds of engaging in a suicide attempt with or without reporting ideation question the generalizability of widely held frameworks of suicide risk to Native American youth and have important implications for suicide risk monitoring. Future research is needed to illuminate how these behaviors unfold over time and the potential mechanisms of risk for engaging in suicide attempts in this disproportionately burdened group.Abbreviations: YRBSS: Youth Risk Behavior Surveillance Survey; MSS: Minnesota Student Survey.