Journal of Clinical Child and Adolescent Psychology最新文献

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.

We call for clinical trials researchers to carefully consider questions about use of intention-to-treat (ITT) analysis and per protocol analysis. We discuss how questions about efficacy and mechanisms of efficacy are appropriately answered through the application of per protocol analysis. ITT analysis is well-suited and appropriate for addressing questions related to treatment effectiveness, typically adherence to the treatment with respect to an outcome. While guided by admirable intentions, ITT analysis is often not guided by the right questions, leading to ITT misapplication. We address additional misconceptions that often lead to ITT misapplication, including issues relating to treatment noncompletion and violation of random assignment. We further highlight future directions and implications, particularly that future clinical child and adolescent research trial designs will be increasingly characterized by hybrid trials that combine elements of efficacy, effectiveness, and implementation research, where ITT and per protocol analysis will be appropriately applied to answer the right questions.

Objective: The development of depressive symptoms often increases in adolescence, and for Black American youth, can result in disproportionately long-lasting and deleterious outcomes. Despite the epidemiological trend, scant research has examined the longitudinal development of heterogeneous patterns of depressive symptoms among Black American youth. Moreover, less is known on the impact of contextual covariates on depressive symptom trajectories among Black American youth. The investigation into within-group differences of depressive symptoms is crucial for culturally informed interventions.

Methods: The sample consisted of 472 Black American youth and their primary caregivers from eight counties in Georgia who provided data at five time points (i.e., youth ages 11 to 15). Hypotheses were tested with latent class growth analysis to investigate multiple trajectories of depressive symptoms, and examine sociocultural and familial covariates of trajectory group, including caregiver depressive symptoms, involved vigilant parenting, racial discrimination experiences, Black pride, and internalized racism.

Results: Four-classes of depressive symptoms were identified including stable low (58.4%); high start, decreasing (20%); later onset (13%); and high and increasing (8.5%). Family and race-related predictors differentiated youth's depressive symptom trajectories class and identified warning signs for high-symptomology trajectories.

Conclusions: Findings provide novel insights into developmental patterns of depressive symptoms and the role of contextual and sociocultural factors within a sample of Black American youth. Implications include treatment and prevention recommendations.

Objective: Black American adolescents are beleaguered with the most frequent and severe experiences of racial discrimination (RD) among their peers. To protect Black adolescents' mental health and developmental outcomes from the pernicious impact of discrimination, parents and other proximal adults and peers often utilize racial socialization (RS), or communications and behaviors emphasizing the importance of race and the harms of racism. While several recent RS reviews have been conducted across ethnicity, a modern review investigating RS practices related to and predictive of Black adolescent psychosocial outcomes is needed.

Method: To ground our critical systematic review of 45 articles, we first highlighted the ways RD impacts the lives of Black adolescents. Then, drawing from integrative models for Black youth development, we synthesized recent psychological, academic, and sociocultural literatures to describe the role of RS in Black adolescents' wellness.

Results: The impact of various tenets of RS was seen most clearly as a protective factor against RD with respect to adolescents' mental health (e.g. depression), academic achievement (e.g. GPA), and sociocultural identity (e.g. public and private racial regard) development. Cultural socialization, a strategy related to extolling pride for one's race, was the most consistent RS protective factor, with novel RS constructs (e.g. parental competency) emerging as a method to buffer youth internalizing and externalizing problems.

Conclusions: Recommendations are made for future research on understudied components of RS and multiple methods and reporters to capture a more holistic depiction of RS practices. We emphasize preventative and intervening approaches to reduce the impetus for RS and its impact, including burgeoning clinical and community-level programs and the importance for provider training to yield positive mental health outcomes for Black adolescents.