Pub Date : 2025-01-31DOI: 10.1016/j.jaacop.2024.10.009
Ritika Merai BA , Tesia Shi BS , August X. Wei BS , Donna A. Ruch PhD , Jeffrey A. Bridge PhD , Maryland Pao MD , Lisa M. Horowitz PhD, MPH
Objective
Significant racial disparities exist in youth suicide rates. Research has identified family connectedness as a strong protective factor against suicide. However, the role of family in youth mental health can vary based on cultural factors that may differ across race and/or ethnicity. This study aimed to evaluate how race/ethnicity moderates the association between suicide risk and family connectedness.
Method
This secondary analysis of Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study 1 included youth ages 12 to 17 years. Data were obtained for race/ethnicity, family connectedness (combined score of 2 items, range 2 [low] to 10 [high]), and the Ask Suicide-Screening Questions (ASQ) tool. Binary logistic regression assessed the association between family connectedness and positive ASQ screen, with race/ethnicity as a moderator.
Results
Data for 5,514 participants (50.9% female, 45.8% non-Hispanic White, mean [SD] age = 15.0 [1.7] years) were analyzed. Of all participants, 23.5% (1,293/5,514) screened positive for suicide risk. Overall, participants reported high family connectedness (mean [SD] = 8.2 [1.74]). Multiracial participants had the lowest average family connectedness (7.93) and the highest screen positive rate (28.34% [70/247]). For a 1-unit increase in family connectedness, the odds of screening positive were significantly lower for Black/African American participants (odds ratio 0.54, 95% CI 0.49-0.59) compared to White participants (odds ratio 0.46, 95% CI 0.43-0.49) (difference: z = −3.17, p = .001).
Conclusion
The protective effect of family connectedness for suicide risk may vary by race/ethnicity. In this study, family connectedness was less protective against suicide risk for Black/African American youth compared to White youth. Findings highlight the importance of cultural considerations in family-based interventions for suicide prevention.
Plain language summary
There are significant racial disparities in youth suicide rates, with family connectedness as one of the strongest protective factors against suicide. This study evaluated how race/ethnicity moderates the relation between suicide risk and family connectedness using data from the Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study which included youth aged 12-17 years. Family connectedness may be less protective against suicide risk for Black/African American youth compared to White youth. In addition, multiracial youth were at higher risk with the lowest average family connectedness and the highest screen positive rate for suicide risk. These results highlight the importance of cultural considerations in family-based interventions for suicide prevention.
目的青少年自杀率存在显著的种族差异。研究发现，家庭联系是防止自杀的有力保护因素。然而，家庭在青少年心理健康中的作用可能因文化因素而异，这些文化因素可能因种族和/或族裔而异。本研究旨在评估种族/民族如何调节自杀风险与家庭联系之间的关联。方法对急诊科青少年自杀风险筛查（ED-STARS）研究1的二次分析纳入了12至17岁的青少年。获得了种族/民族、家庭连通性（2项综合得分，范围2[低]到10[高]）和询问自杀筛查问题（ASQ）工具的数据。二元逻辑回归评估家庭连通性与阳性ASQ筛查之间的关系，种族/民族是调节因素。结果共分析了5514名参与者的数据（50.9%为女性，45.8%为非西班牙裔白人，平均[SD]年龄= 15.0[1.7]岁）。在所有参与者中，23.5%（1293 / 5514）的自杀风险筛查呈阳性。总体而言，参与者报告的家庭连通性较高（平均值[SD] = 8.2[1.74]）。多种族参与者的平均家庭连通性最低（7.93），筛查阳性率最高（28.34%）[70/247]。对于家庭联系增加1个单位，黑人/非裔美国人参与者的筛查阳性几率显著低于白人参与者（优势比0.54,95% CI 0.49-0.59）（优势比0.46,95% CI 0.43-0.49）（差异：z = - 3.17, p = .001）。结论家庭连通性对自杀风险的保护作用可能因种族而异。在这项研究中，与白人青年相比，家庭联系对黑人/非裔美国青年自杀风险的保护作用较弱。研究结果强调了文化因素在以家庭为基础的自杀预防干预中的重要性。青少年自杀率存在明显的种族差异，家庭联系是防止自杀的最强保护因素之一。本研究评估了种族/民族如何调节自杀风险与家庭联系之间的关系，使用的数据来自急诊科自杀风险青少年筛查（ED-STARS）研究，该研究包括12-17岁的青少年。与白人青年相比，家庭联系对黑人/非裔美国青年防止自杀风险的保护作用可能更弱。此外，多种族青少年的自杀风险更高，平均家庭联系最低，自杀风险筛查阳性率最高。这些结果强调了文化因素在以家庭为基础的自杀预防干预中的重要性。
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Pub Date : 2025-01-28DOI: 10.1016/j.jaacop.2025.01.003
Talitha West MD, JD , Junaid Rana MD , Samreen Awan MD , Adam J. Sagot DO, FAPA
Objective
Religiosity and spirituality have demonstrated protective associations against suicidal ideation and behavior in adults. Despite accumulating evidence of similar associations in adolescents, no systematic review to the authors’ knowledge has examined associations between religiosity/spirituality and adolescent suicidality. The authors hypothesized that, in general, religiosity and spirituality would function as protective factors against suicidality in adolescent populations. This systematic review summarizes global findings on this topic, with particular focus on at-risk groups including racial, religious, and sexual minorities.
Method
PubMed, Web of Science, Embase, and CINAHL were searched for relevant studies on December 18, 2023. Eligible articles were from peer-reviewed journals, included subjects ages 10 to 25, and employed measures of suicidality and religiosity/spirituality. Studies were evaluated using the Mixed Methods Appraisal Tool.
Results
Inclusion criteria were met by 61 studies (340,170 participants); 49 were cross-sectional, 7 were longitudinal, and several were qualitative or used mixed methods. Of studies, 67.2% found protective associations between religiosity/spirituality and suicidality, 8.2% reported risk associations, 8.2% described complex associations, and 16.4% found no association. Mediators included general social support. Moderators included levels of parental monitoring. Studies of ethnoracially minoritized adolescents suggested a protective role for religiosity, whereas results in religiously minoritized and LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and others) adolescents were equivocal.
Conclusion
A substantial majority of studies demonstrated that greater investment in religiosity/spirituality predicted reduced suicidality in adolescents. Findings suggest that religiosity and spirituality can provide adolescents with reasons for living and should be addressed in clinical practice and prevention efforts. Limitations include the cross-sectional design of most included studies, preventing causal inferences. Future research should evaluate spiritually inclusive therapeutic and preventive interventions for adolescents.
Plain language summary
This review of 61 worldwide studies found that adolescents who reported being more religious or spiritual were less likely to think about suicide or attempt suicide. Religion and spirituality appeared more strongly associated with lesser suicidality for teenagers from racial minorities than for teenagers from religious or sexual and gender minorities. Religious groups can provide social support for teens who are at risk for suicide. Mental health providers may collaborate with religious groups on suicide prevention efforts.
Study registration information
Prevalence of Neurodevelopmental Disorders am
目的：在成人中，宗教信仰和精神信仰已经证明了对自杀意念和行为的保护作用。尽管有越来越多的证据表明在青少年中也存在类似的关联，但就作者的知识而言，还没有对宗教信仰/灵性与青少年自杀倾向之间的关联进行系统的回顾。作者假设，在一般情况下，宗教信仰和灵性可以作为青少年群体中防止自杀的保护因素。本系统综述总结了关于这一主题的全球调查结果，特别关注包括种族、宗教和性少数在内的高危群体。方法于2023年12月18日检索pubmed、Web of Science、Embase和CINAHL的相关研究。符合条件的文章来自同行评议的期刊，包括10至25岁的受试者，并采用自杀和宗教信仰/灵性的测量。使用混合方法评估工具对研究进行评估。结果61项研究（340170名受试者）符合纳入标准；横断面法49例，纵向法7例，定性法或混合法多例。在研究中，67.2%的人发现宗教信仰/灵性与自杀之间存在保护性联系，8.2%的人报告有风险联系，8.2%的人描述了复杂的联系，16.4%的人没有发现联系。调解包括一般社会支持。调节因素包括父母监控的水平。对少数民族青少年的研究表明，宗教信仰对青少年有保护作用，而对少数民族青少年和LGBTQ+（女同性恋、男同性恋、双性恋、变性人、酷儿等）青少年的研究结果则不明确。结论绝大多数研究表明，对宗教信仰/灵性的更多投资可以降低青少年的自杀率。研究结果表明，宗教信仰和灵性可以为青少年提供生活的理由，应在临床实践和预防工作中加以解决。限制包括大多数纳入研究的横断面设计，防止因果推论。未来的研究应评估对青少年的精神包容的治疗和预防干预措施。对61项全球研究的回顾发现，那些自称更有宗教信仰或精神信仰的青少年不太可能想到自杀或企图自杀。与宗教或性和性别少数群体的青少年相比，宗教和灵性与少数族裔青少年较少的自杀倾向之间的关系更为密切。宗教团体可以为有自杀倾向的青少年提供社会支持。心理健康提供者可以与宗教团体合作预防自杀。原住民儿童神经发育障碍患病率：系统回顾https://www.crd.york.ac.uk/PROSPERO/view/CRD42021238669.Diversity纳入声明本文的一位或多位作者自认为是科学中一个或多个历史上未被充分代表的种族和/或族裔群体的成员。本文的一位或多位作者自认为是科学界一个或多个历史上未被充分代表的性和/或性别群体的成员。我们积极地在我们的作者群体中促进性别和性别平衡。我们积极努力促进在我们的作者群体中纳入历史上代表性不足的种族和/或民族群体。在引用与本工作科学相关的参考文献的同时，我们也积极地在我们的参考文献列表中促进性别和性别平衡。在引用与本工作科学相关的参考文献的同时，我们还积极努力促进在我们的参考文献列表中纳入历史上代表性不足的种族和/或民族群体。
{"title":"Systematic Review: A 25-Year Global Publication Analysis of the Role of Spirituality and Religiosity in Suicidal Risk Assessment in Adolescents","authors":"Talitha West MD, JD , Junaid Rana MD , Samreen Awan MD , Adam J. Sagot DO, FAPA","doi":"10.1016/j.jaacop.2025.01.003","DOIUrl":"10.1016/j.jaacop.2025.01.003","url":null,"abstract":"<div><h3>Objective</h3><div>Religiosity and spirituality have demonstrated protective associations against suicidal ideation and behavior in adults. Despite accumulating evidence of similar associations in adolescents, no systematic review to the authors’ knowledge has examined associations between religiosity/spirituality and adolescent suicidality. The authors hypothesized that, in general, religiosity and spirituality would function as protective factors against suicidality in adolescent populations. This systematic review summarizes global findings on this topic, with particular focus on at-risk groups including racial, religious, and sexual minorities.</div></div><div><h3>Method</h3><div>PubMed, Web of Science, Embase, and CINAHL were searched for relevant studies on December 18, 2023. Eligible articles were from peer-reviewed journals, included subjects ages 10 to 25, and employed measures of suicidality and religiosity/spirituality. Studies were evaluated using the Mixed Methods Appraisal Tool.</div></div><div><h3>Results</h3><div>Inclusion criteria were met by 61 studies (340,170 participants); 49 were cross-sectional, 7 were longitudinal, and several were qualitative or used mixed methods. Of studies, 67.2% found protective associations between religiosity/spirituality and suicidality, 8.2% reported risk associations, 8.2% described complex associations, and 16.4% found no association. Mediators included general social support. Moderators included levels of parental monitoring. Studies of ethnoracially minoritized adolescents suggested a protective role for religiosity, whereas results in religiously minoritized and LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and others) adolescents were equivocal.</div></div><div><h3>Conclusion</h3><div>A substantial majority of studies demonstrated that greater investment in religiosity/spirituality predicted reduced suicidality in adolescents. Findings suggest that religiosity and spirituality can provide adolescents with reasons for living and should be addressed in clinical practice and prevention efforts. Limitations include the cross-sectional design of most included studies, preventing causal inferences. Future research should evaluate spiritually inclusive therapeutic and preventive interventions for adolescents.</div></div><div><h3>Plain language summary</h3><div>This review of 61 worldwide studies found that adolescents who reported being more religious or spiritual were less likely to think about suicide or attempt suicide. Religion and spirituality appeared more strongly associated with lesser suicidality for teenagers from racial minorities than for teenagers from religious or sexual and gender minorities. Religious groups can provide social support for teens who are at risk for suicide. Mental health providers may collaborate with religious groups on suicide prevention efforts.</div></div><div><h3>Study registration information</h3><div>Prevalence of Neurodevelopmental Disorders am","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 3","pages":"Pages 347-378"},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-24DOI: 10.1016/j.jaacop.2024.11.006
Stefanie R. Russman Block PhD , Hannah C. Becker PhD (Candidate) , Dana E. Díaz PhD , Elizabeth R. Duval PhD , D. Angus Clark PhD , Dareen Al-Qawasmeh PA (Candidate) , Alexis Walker-VanSingel MSW , Kristin A. Mannella BS , K. Luan Phan MD , Christopher S. Monk PhD , Kate D. Fitzgerald MD
<div><h3>Objective</h3><div>To address problems with the current categorical diagnostic classification system for mental health, the National Institute of Mental Health created the Research Domain Criteria (RDoC) initiative, which encourages researchers to link dimensionally assessed psychological constructs with transdiagnostic psychopathology to expedite discovery of biological mechanisms and clinical translation. Two constructs that were theorized by the RDoC to be pertinent to anxiety symptoms across categorical anxiety disorders and the spectrum of severity are acute threat (AT; fear of a present danger) and potential threat (PT; anxiety about a distant or uncertain danger). However, these constructs are often conflated in research and lack valid self-report measures, especially among youth.</div></div><div><h3>Method</h3><div>The present study examined how self-reported AT and PT distinctly associate with the following: (1) dimensional anxiety symptom severity, and (2) neural response to threat, among youth 7 to 17 years of age with clinically significant anxiety (ie, anxiety disorder diagnosis, n = 119) and those with subclinical to no anxiety (ie, no anxiety disorder diagnosis, n = 41). AT and PT scores were derived from 3 self/parent-report measures of youth anxiety; expert consensus was used to designate each item as indexing either AT or PT, followed by a generation of AT and PT general factor scores from bifactor models fit to clinical experts’ ratings. Anxiety severity was assessed with a structured clinical interview using the Pediatric Anxiety Rating Scale. Neural response to threat was measured using the Emotional Faces Shifted Attention Task, performed during functional magnetic resonance imaging. Finally, AT and PT factor scores were tested as predictors of clinical anxiety severity and neural activation to threat.</div></div><div><h3>Results</h3><div>AT factor scores positively associated with clinically assessed anxiety severity and right posterior insula response to threat faces across the whole sample. PT factor scores also associated with greater clinician-measured anxiety severity, but only among participants with subclinical to no anxiety, and did not associate with brain activity.</div></div><div><h3>Conclusion</h3><div>Results support the RDoC theory that AT and PT are distinct and clinically relevant constructs that can be assessed via youth self-report. Understanding how AT and PT uniquely relate to anxiety severity may contribute to the development of targeted anxiety treatment and prevention for youth by elucidating which domains of functioning specifically contribute to disorder heterogeneity or symptom severity.</div></div><div><h3>Plain language summary</h3><div>Acute threat (fear of immediate danger) and potential threat (anxiety about a distant or uncertain danger) are thought to contribute to anxious behavior but are often conflated and lack valid self-report measures in youth. In this study, items from 3 self
目的为了解决当前心理健康分类诊断系统存在的问题，美国国家心理健康研究所（National Institute of mental health）创建了研究领域标准（RDoC）倡议，鼓励研究人员将维度评估的心理构建与跨诊断精神病理学联系起来，以加快发现生物学机制和临床转化。根据RDoC的理论，有两种构式与分类焦虑症的焦虑症状和严重程度有关，即急性威胁（AT，对当前危险的恐惧）和潜在威胁（PT，对遥远或不确定危险的焦虑）。然而，这些概念在研究中经常被混为一谈，缺乏有效的自我报告措施，尤其是在年轻人中。方法对7 ~ 17岁有临床显著焦虑（即焦虑障碍诊断，n = 119）和亚临床至无焦虑（即无焦虑障碍诊断，n = 41）青少年自我报告的AT和PT与以下方面的显著相关性进行研究：(1)维度焦虑症状严重程度和(2)对威胁的神经反应。AT和PT得分来源于青少年焦虑的3个自我/父母报告测量；使用专家共识来指定每个项目作为AT或PT的索引，然后从符合临床专家评级的双因素模型生成AT和PT一般因素得分。使用儿科焦虑评定量表进行结构化临床访谈，评估焦虑严重程度。对威胁的神经反应是通过功能性磁共振成像进行的“情绪面孔转移注意力任务”来测量的。最后，测试了AT和PT因子得分作为临床焦虑严重程度和对威胁的神经激活的预测因子。结果在整个样本中，sat因子得分与临床评估的焦虑严重程度和右侧后岛对威胁面孔的反应呈正相关。PT因子得分也与临床测量的更大的焦虑严重程度相关，但仅在亚临床至无焦虑的参与者中，并且与大脑活动无关。结论支持RDoC理论，即AT和PT是不同的、具有临床相关性的构念，可以通过青少年自我报告进行评估。了解AT和PT如何独特地与焦虑严重程度相关，可能有助于通过阐明哪些功能领域特别有助于障碍异质性或症状严重程度，为青少年提供有针对性的焦虑治疗和预防。急性威胁（对眼前危险的恐惧）和潜在威胁（对遥远或不确定危险的焦虑）被认为是导致焦虑行为的原因，但在青少年中经常被混为一谈，缺乏有效的自我报告措施。本研究采用焦虑行为自量表和父母报告量表中的三项内容，对160名年龄在7 - 17岁、焦虑症状严重程度在正常到异常范围内的青少年进行急性和潜在因素评分。作者发现，在整个样本中，急性威胁与焦虑症状的严重程度和急性威胁相关的大脑活动有关。然而，在没有焦虑症诊断的青少年中，潜在威胁仅与焦虑症状严重程度有关。这些发现表明，维度和分类的方法可能是必要的，以充分了解焦虑精神病理的本质。多样性和包容性声明本文的一位或多位作者自认为是科学中一个或多个历史上未被充分代表的种族和/或族裔群体的成员。本文的一位或多位作者自认为是科学界一个或多个历史上未被充分代表的性和/或性别群体的成员。我们积极地在我们的作者群体中促进性别和性别平衡。
{"title":"Research Domain Criteria (RDoC) Constructs of Acute and Potential Threat Differentially Associate With Pediatric Anxiety","authors":"Stefanie R. Russman Block PhD , Hannah C. Becker PhD (Candidate) , Dana E. Díaz PhD , Elizabeth R. Duval PhD , D. Angus Clark PhD , Dareen Al-Qawasmeh PA (Candidate) , Alexis Walker-VanSingel MSW , Kristin A. Mannella BS , K. Luan Phan MD , Christopher S. Monk PhD , Kate D. Fitzgerald MD","doi":"10.1016/j.jaacop.2024.11.006","DOIUrl":"10.1016/j.jaacop.2024.11.006","url":null,"abstract":"<div><h3>Objective</h3><div>To address problems with the current categorical diagnostic classification system for mental health, the National Institute of Mental Health created the Research Domain Criteria (RDoC) initiative, which encourages researchers to link dimensionally assessed psychological constructs with transdiagnostic psychopathology to expedite discovery of biological mechanisms and clinical translation. Two constructs that were theorized by the RDoC to be pertinent to anxiety symptoms across categorical anxiety disorders and the spectrum of severity are acute threat (AT; fear of a present danger) and potential threat (PT; anxiety about a distant or uncertain danger). However, these constructs are often conflated in research and lack valid self-report measures, especially among youth.</div></div><div><h3>Method</h3><div>The present study examined how self-reported AT and PT distinctly associate with the following: (1) dimensional anxiety symptom severity, and (2) neural response to threat, among youth 7 to 17 years of age with clinically significant anxiety (ie, anxiety disorder diagnosis, n = 119) and those with subclinical to no anxiety (ie, no anxiety disorder diagnosis, n = 41). AT and PT scores were derived from 3 self/parent-report measures of youth anxiety; expert consensus was used to designate each item as indexing either AT or PT, followed by a generation of AT and PT general factor scores from bifactor models fit to clinical experts’ ratings. Anxiety severity was assessed with a structured clinical interview using the Pediatric Anxiety Rating Scale. Neural response to threat was measured using the Emotional Faces Shifted Attention Task, performed during functional magnetic resonance imaging. Finally, AT and PT factor scores were tested as predictors of clinical anxiety severity and neural activation to threat.</div></div><div><h3>Results</h3><div>AT factor scores positively associated with clinically assessed anxiety severity and right posterior insula response to threat faces across the whole sample. PT factor scores also associated with greater clinician-measured anxiety severity, but only among participants with subclinical to no anxiety, and did not associate with brain activity.</div></div><div><h3>Conclusion</h3><div>Results support the RDoC theory that AT and PT are distinct and clinically relevant constructs that can be assessed via youth self-report. Understanding how AT and PT uniquely relate to anxiety severity may contribute to the development of targeted anxiety treatment and prevention for youth by elucidating which domains of functioning specifically contribute to disorder heterogeneity or symptom severity.</div></div><div><h3>Plain language summary</h3><div>Acute threat (fear of immediate danger) and potential threat (anxiety about a distant or uncertain danger) are thought to contribute to anxious behavior but are often conflated and lack valid self-report measures in youth. In this study, items from 3 self","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 4","pages":"Pages 984-995"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1016/j.jaacop.2025.01.002
Zachary W. Adams PhD , Trey V. Dellucci PhD, MPH , Jon Agley PhD , Kristina Bixler PhD , Maggie Sullivan BA , Jesse D. Hinckley MD, PhD , Leslie A. Hulvershorn MD
Objective
Substance use disorders (SUDs) often develop during adolescence, forecasting myriad health problems across the lifespan. Implementing responsive clinical services requires information about the prevalence of SUDs by age, substance class, and severity. However, no reports have summarized those data using DSM-5 criteria.
Method
Using 2022 National Survey on Drug Use and Health (NSDUH) data from participants 12 to 25 years of age (n = 26,276), the prevalence and severity of DSM-5 SUDs was estimated across age cohorts (12-13, 14-15, 16-17, 18-20, and 21-25 years) via χ2 tests of independence. The Cramer V (φc) was also calculated for each outcome to approximate the effect size between age group and substance use outcome.
Results
Although past-year rates for alcohol and cannabis use were higher overall as age cohort increased, the prevalence of disordered use and proportional distribution of SUD severity (mild, moderate, severe) did not differ across age cohorts among those who used alcohol (φc = 0.04) and cannabis (φc = 0.04) in the past year. Conversely, the prevalence and severity of SUDs generally varied across age groups among those who reported past-year use of less commonly used substances (heroin, methamphetamine).
Conclusion
Meeting criteria for an SUD was common among youth with past-year substance use. Allocation of developmentally appropriate prevention and treatment resources should account for the distribution of mild to severe SUDs across adolescence. The field would likely benefit from further study of these issues in diverse samples.
Plain language summary
This study analyzed data from the 2022 National Survey on Drug Use and Health. It explored the prevalence and severity of substance use disorders among adolescents and young adults aged 12 to 25. The prevalence and severity of substance use disorders among those who use alcohol and cannabis did not differ across age cohorts. It varied across age groups among those who reported past-year use of less commonly used substances (heroin, methamphetamine). The authors emphasized the importance of early screening to identify problematic substance use, since youth can develop mild to severe substance use disorders even in early adolescence.
物质使用障碍（SUDs）通常发生在青春期，预示着一生中无数的健康问题。实施响应性临床服务需要按年龄、物质类别和严重程度分类的sud患病率信息。然而，没有报告使用DSM-5标准总结这些数据。方法利用2022年全国药物使用与健康调查（NSDUH）数据（n = 26,276），通过χ2独立性检验估计12-13岁、14-15岁、16-17岁、18-20岁和21-25岁年龄组中DSM-5 sud的患病率和严重程度。还计算了每个结果的Cramer V (φc)，以估计年龄组与药物使用结果之间的效应大小。结果尽管过去一年酒精和大麻使用率总体上随着年龄队列的增加而增加，但在过去一年酒精（φc = 0.04）和大麻（φc = 0.04）的人群中，无序使用的患病率和SUD严重程度（轻度、中度、重度）的比例分布在不同年龄队列中没有差异。相反，在报告过去一年中使用较少使用物质（海洛因、甲基苯丙胺）的人群中，sud的患病率和严重程度在各年龄组中普遍存在差异。结论在过去一年药物使用的青少年中，符合SUD标准的情况较为普遍。与发育相适应的预防和治疗资源的分配应考虑到青春期轻度至重度sud的分布情况。该领域可能会受益于在不同样本中进一步研究这些问题。这项研究分析了2022年全国药物使用和健康调查的数据。它探讨了12至25岁的青少年和年轻人中物质使用障碍的流行程度和严重程度。在使用酒精和大麻的人群中，物质使用障碍的患病率和严重程度在各年龄组之间没有差异。在报告过去一年使用不太常用物质（海洛因、甲基苯丙胺）的人群中，这一比例因年龄组而异。作者强调了早期筛查的重要性，以确定有问题的物质使用，因为青少年甚至在青春期早期就可能出现轻微到严重的物质使用障碍。
{"title":"Estimated Prevalence of Substance Use Disorders Among US Adolescents and Emerging Adults by Substance Class, Severity, and Age, 2022","authors":"Zachary W. Adams PhD , Trey V. Dellucci PhD, MPH , Jon Agley PhD , Kristina Bixler PhD , Maggie Sullivan BA , Jesse D. Hinckley MD, PhD , Leslie A. Hulvershorn MD","doi":"10.1016/j.jaacop.2025.01.002","DOIUrl":"10.1016/j.jaacop.2025.01.002","url":null,"abstract":"<div><h3>Objective</h3><div>Substance use disorders (SUDs) often develop during adolescence, forecasting myriad health problems across the lifespan. Implementing responsive clinical services requires information about the prevalence of SUDs by age, substance class, and severity. However, no reports have summarized those data using <em>DSM-5</em> criteria.</div></div><div><h3>Method</h3><div>Using 2022 National Survey on Drug Use and Health (NSDUH) data from participants 12 to 25 years of age (n = 26,276), the prevalence and severity of <em>DSM-5</em> SUDs was estimated across age cohorts (12-13, 14-15, 16-17, 18-20, and 21-25 years) via χ<sup>2</sup> tests of independence. The Cramer V (φ<sub><em>c</em></sub>) was also calculated for each outcome to approximate the effect size between age group and substance use outcome.</div></div><div><h3>Results</h3><div>Although past-year rates for alcohol and cannabis use were higher overall as age cohort increased, the prevalence of disordered use and proportional distribution of SUD severity (mild, moderate, severe) did not differ across age cohorts among those who used alcohol (φ<sub><em>c</em></sub> = 0.04) and cannabis (φ<sub><em>c</em></sub> = 0.04) in the past year. Conversely, the prevalence and severity of SUDs generally varied across age groups among those who reported past-year use of less commonly used substances (heroin, methamphetamine).</div></div><div><h3>Conclusion</h3><div>Meeting criteria for an SUD was common among youth with past-year substance use. Allocation of developmentally appropriate prevention and treatment resources should account for the distribution of mild to severe SUDs across adolescence. The field would likely benefit from further study of these issues in diverse samples.</div></div><div><h3>Plain language summary</h3><div>This study analyzed data from the 2022 National Survey on Drug Use and Health. It explored the prevalence and severity of substance use disorders among adolescents and young adults aged 12 to 25. The prevalence and severity of substance use disorders among those who use alcohol and cannabis did not differ across age cohorts. It varied across age groups among those who reported past-year use of less commonly used substances (heroin, methamphetamine). The authors emphasized the importance of early screening to identify problematic substance use, since youth can develop mild to severe substance use disorders even in early adolescence.</div></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 4","pages":"Pages 959-971"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-15DOI: 10.1016/j.jaacop.2024.10.008
Denise López Sosa BA , Kate Simmons BS , Ashley R. Karlovich MS , Natalie Mastalerz BA , Spencer C. Evans PhD
Objective
Researchers have differentiated forms (overt, relational) and functions (proactive, reactive) of aggressive behavior; however, the assessment options for measuring these constructs in youth remain limited. This study examined the parent-report Peer Conflict Scale (PCS) for measuring forms and functions of youth aggressive behavior in English and Spanish, including short- and long-form versions.
Method
Participants were caregivers of 653 youths (ages 6-17; 57% male; 48% Hispanic) throughout North America. The PCS and other measures of emotional, behavioral, and social functioning were collected by parent-report in English (51%) and Spanish (49%). Analyses examined the descriptive characteristics, internal consistency, validity correlations, factor structure, and measurement invariance of the PCS.
Results
All PCS scales showed good or excellent internal consistency (αs/ωs = .82-.97). Convergent and discriminant validity hypotheses were generally supported, but with limited specificity to aggression dimensions. The independent forms-by-functions model (4 factors) fit best, although support was also found for general aggression, forms or functions, and paired form-by-function models (1-4 factors; root mean square error of approximation <0.07, comparative fit index and Tucker-Lewis index >0.96). The PCS demonstrated invariance and acceptable fit across language, gender, and age groups.
Conclusion
Findings support the reliability, validity, and utility of the PCS for assessing youth aggressive behavior as rated by English- and Spanish-speaking caregivers, whether via full-length (40-item) or brief (20-item) versions. Given that parent-rated PCS dimensions are highly correlated yet distinct, clinicians and researchers could use it to measure and model the aspects of aggressive behavior most relevant to their goals: general aggression, forms, functions, or forms and functions.
Plain language summary
Children and adolescents who engage in aggressive behavior face challenges at home, in school, and in their day-to-day activities. Few instruments can measure both the forms and the functions of aggression in youth, and even fewer have been validated among Spanish-speaking caregivers. Using a large online survey, this study examined a parent-report questionnaire, the Peer Conflict Scale (PCS), in terms of how well it measures the forms and functions of aggressive behavior among diverse youth. Results support the reliability and validity of the PCS, in full-length and short versions, and in English and Spanish.
Diversity & Inclusion Statement
We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires
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Pub Date : 2025-01-15DOI: 10.1016/j.jaacop.2024.09.012
Carmen Lopez-Arvizu MD , Danielle L. Steelesmith PhD , Brittany N. Hand PhD, OTR/L , Rui Huang PhD , Amanda J. Thompson PhD , Elyse N. Llamocca PhD , Bridget A. Quinn BS , Cynthia A. Fontanella PhD , John V. Campo MD
Objective
To identify correlates of deliberate self-harm (DSH) in youth with autism and/or intellectual disability (ID).
Method
This retrospective longitudinal cohort analysis used claims data for youth ages 5 to 24 years continuously enrolled in Medicaid in a midwestern state for 6 months and diagnosed with autism and/or ID between 2010 and 2020 (N = 41,230). Cox proportional hazards regression examined associations between demographic and clinical variables and time to DSH for study cohorts with autism and/or ID.
Results
Autism was diagnosed in 34.3% of the sample, ID was diagnosed in 30.6%, and both autism and ID were diagnosed in 35.1%. Sample youth were predominantly male (73.4%) and had an internalizing (74.8%) or externalizing (62.1%) mental health condition. At least 1 DSH event was identified for 734 youths (2.6%) with autism and 686 youths (2.7%) with ID during follow-up. Increased risk of DSH was associated with older age; female sex; history of abuse or neglect; and co-occurring externalizing problems, internalizing problems, substance use, and thought problems for the autism cohort and ID cohort and with the presence of a chronic complex medical condition in the autism cohort. Risk of DSH was significantly lower for youth with moderate ID and youth eligible for Medicaid via disability and foster care.
Conclusion
Risk factors for DSH in youth with autism and ID are similar to those in neurotypical youth and include increasing age, trauma, mental health conditions, substance use, and female sex. Clinician and consumer education regarding suicide risk and its correlates in youth with autism and ID warrants study.
Plain language summary
This study of youth aged 5 to 24 enrolled in Ohio Medicaid found that 2.6% of youth with autism and 2.7% of youth with intellectual disabilities (ID) had at least one deliberate self-harm (DSH) event between 2010 and 2020. Youth who were older, female, had a history of abuse or neglect, and had co-occurring externalizing, internalizing, substance use, or thought problems, had increased risk for DSH. Risk of DSH was lower for youth with moderate ID and those eligible for Medicaid via disability and foster care.
{"title":"Correlates of Deliberate Self-Harm in Youth With Autism and/or Intellectual Disability","authors":"Carmen Lopez-Arvizu MD , Danielle L. Steelesmith PhD , Brittany N. Hand PhD, OTR/L , Rui Huang PhD , Amanda J. Thompson PhD , Elyse N. Llamocca PhD , Bridget A. Quinn BS , Cynthia A. Fontanella PhD , John V. Campo MD","doi":"10.1016/j.jaacop.2024.09.012","DOIUrl":"10.1016/j.jaacop.2024.09.012","url":null,"abstract":"<div><h3>Objective</h3><div>To identify correlates of deliberate self-harm (DSH) in youth with autism and/or intellectual disability (ID).</div></div><div><h3>Method</h3><div>This retrospective longitudinal cohort analysis used claims data for youth ages 5 to 24 years continuously enrolled in Medicaid in a midwestern state for 6 months and diagnosed with autism and/or ID between 2010 and 2020 (N = 41,230). Cox proportional hazards regression examined associations between demographic and clinical variables and time to DSH for study cohorts with autism and/or ID.</div></div><div><h3>Results</h3><div>Autism was diagnosed in 34.3% of the sample, ID was diagnosed in 30.6%, and both autism and ID were diagnosed in 35.1%. Sample youth were predominantly male (73.4%) and had an internalizing (74.8%) or externalizing (62.1%) mental health condition. At least 1 DSH event was identified for 734 youths (2.6%) with autism and 686 youths (2.7%) with ID during follow-up. Increased risk of DSH was associated with older age; female sex; history of abuse or neglect; and co-occurring externalizing problems, internalizing problems, substance use, and thought problems for the autism cohort and ID cohort and with the presence of a chronic complex medical condition in the autism cohort. Risk of DSH was significantly lower for youth with moderate ID and youth eligible for Medicaid via disability and foster care.</div></div><div><h3>Conclusion</h3><div>Risk factors for DSH in youth with autism and ID are similar to those in neurotypical youth and include increasing age, trauma, mental health conditions, substance use, and female sex. Clinician and consumer education regarding suicide risk and its correlates in youth with autism and ID warrants study.</div></div><div><h3>Plain language summary</h3><div>This study of youth aged 5 to 24 enrolled in Ohio Medicaid found that 2.6% of youth with autism and 2.7% of youth with intellectual disabilities (ID) had at least one deliberate self-harm (DSH) event between 2010 and 2020. Youth who were older, female, had a history of abuse or neglect, and had co-occurring externalizing, internalizing, substance use, or thought problems, had increased risk for DSH. Risk of DSH was lower for youth with moderate ID and those eligible for Medicaid via disability and foster care.</div></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 3","pages":"Pages 477-484"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144914065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.jaacop.2025.01.001
Tesia Shi BS , Ritika Merai BA , Nathan J. Lowry BA , Donna A. Ruch PhD , Jeffrey A. Bridge PhD , Maryland Pao MD , Lisa M. Horowitz PhD, MPH
Objective
Nonsuicidal self-injury (NSSI), defined as harming one’s own body without suicidal intent, is a strong risk factor for suicidal thoughts and behaviors in adolescents. One promising protective factor that can mitigate suicide risk conferred by NSSI is connectedness. This study aimed to examine the association between connectedness (family, school, peer, and overall), NSSI, and suicide risk in pediatric emergency department patients.
Method
This is a secondary analysis of data from the Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study. Youth ages 12 to 17 years completed questions on demographics; past-year NSSI history; the Ask Suicide-Screening Questions (ASQ) tool; and 2 items each on family, school, and peer connectedness. Overall connectedness was a composite of the 6 items. Multivariable logistic regressions assessed the associations between connectedness, NSSI, and suicide risk.
Results
Data were analyzed from 5,406 participants (55.2% female, 45.9% non-Hispanic White, mean [SD] age = 15.0 [1.7]). Out of all participants, 23.3% (1,258/5,406) screened positive for suicide risk, and 18.1% (981/5,406) reported past-year NSSI history. For every 1-point increase from mean family connectedness, the odds of screening positive for suicide risk decreased by 62% (odds ratio 0.38, 95% CI 0.31-0.46) for youth with NSSI and 70% (odds ratio 0.30, 95% CI 0.27-0.34) for youth without NSSI (difference: z = 1.96, p = .05).
Conclusion
Connectedness was protective against suicide risk across the sample regardless of NSSI history. However, family connectedness was less protective for youth with NSSI compared with youth without NSSI. Future research should examine connectedness in greater detail and the quality of different relationships that could be protective for at-risk youth.
Plain language summary
Nonsuicidal self-injury (NSSI), the act of harming one’s own body without suicidal intent, is a strong risk factor for suicidal thoughts and behaviors (STBs) in adolescents. One important protective factor that can decrease suicide risk and NSSI is connectedness. This study aimed to examine relations among types of connectedness (family, school, peer and overall), NSSI, and suicide risk in pediatric emergency department patients. All domains of connectedness (family, school, peer and overall) were found to be associated with lower suicide risk, regardless of NSSI history. However, family connectedness was associated with less of a buffering effect for youth with NSSI compared to youth without NSSI. System-level interventions that strengthen family, school, and peer networks have the potential to reduce youth suicidality risk.
目的非自杀性自伤（non - suicide self injury，简称NSSI）是青少年产生自杀念头和行为的重要危险因素。一个有希望的保护因素可以减轻自伤带来的自杀风险是连通性。本研究旨在探讨儿科急诊科患者的连通性（家庭、学校、同伴和整体）、自伤和自杀风险之间的关系。方法：本研究是对急诊部青少年自杀风险筛查（ED-STARS）研究数据的二次分析。12至17岁的青少年完成人口统计问题；过去一年自伤史；询问自杀筛选问题（ASQ）工具；家庭，学校和同伴关系各2项。整体连通性是6个项目的综合。多变量逻辑回归评估了连通性、自伤和自杀风险之间的关系。结果5406名参与者（55.2%为女性，45.9%为非西班牙裔白人，平均[SD]年龄= 15.0[1.7]）。在所有参与者中，23.3%（1,258/5,406）筛查出自杀风险阳性，18.1%（981/5,406）报告了过去一年的自伤史。平均家庭联系度每增加1点，有自伤的青少年自杀风险筛查呈阳性的几率降低62%（优势比0.38,95% CI 0.31-0.46），没有自伤的青少年自杀风险筛查呈阳性的几率降低70%（优势比0.30,95% CI 0.27-0.34）（差异：z = 1.96, p = 0.05）。结论：无论自伤史如何，整个样本的连通性都对自杀风险有保护作用。然而，与没有自伤的青少年相比，家庭连通性对自伤青少年的保护作用较弱。未来的研究应该更详细地检查联系和不同关系的质量，这些关系可能对有风险的青少年有保护作用。非自杀性自伤（non - suicide self injury，简称NSSI）是青少年产生自杀念头和行为的重要因素，是一种没有自杀意图的伤害自己身体的行为。一个重要的保护因素可以降低自杀风险和自伤是连通性。本研究旨在探讨儿科急诊科患者的联系类型（家庭、学校、同伴和整体）、自伤和自杀风险之间的关系。所有领域的联系（家庭、学校、同伴和整体）都被发现与较低的自杀风险相关，无论自伤史如何。然而，与没有自伤的青少年相比，家庭连通性对自伤青少年的缓冲作用较小。加强家庭、学校和同伴网络的系统级干预措施有可能降低青少年自杀风险。
{"title":"The Relationships Between Nonsuicidal Self-Injury, Connectedness, and Suicide Risk in Youth Presenting to the Emergency Department","authors":"Tesia Shi BS , Ritika Merai BA , Nathan J. Lowry BA , Donna A. Ruch PhD , Jeffrey A. Bridge PhD , Maryland Pao MD , Lisa M. Horowitz PhD, MPH","doi":"10.1016/j.jaacop.2025.01.001","DOIUrl":"10.1016/j.jaacop.2025.01.001","url":null,"abstract":"<div><h3>Objective</h3><div>Nonsuicidal self-injury (NSSI), defined as harming one’s own body without suicidal intent, is a strong risk factor for suicidal thoughts and behaviors in adolescents. One promising protective factor that can mitigate suicide risk conferred by NSSI is connectedness. This study aimed to examine the association between connectedness (family, school, peer, and overall), NSSI, and suicide risk in pediatric emergency department patients.</div></div><div><h3>Method</h3><div>This is a secondary analysis of data from the Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study. Youth ages 12 to 17 years completed questions on demographics; past-year NSSI history; the Ask Suicide-Screening Questions (ASQ) tool; and 2 items each on family, school, and peer connectedness. Overall connectedness was a composite of the 6 items. Multivariable logistic regressions assessed the associations between connectedness, NSSI, and suicide risk.</div></div><div><h3>Results</h3><div>Data were analyzed from 5,406 participants (55.2% female, 45.9% non-Hispanic White, mean [SD] age = 15.0 [1.7]). Out of all participants, 23.3% (1,258/5,406) screened positive for suicide risk, and 18.1% (981/5,406) reported past-year NSSI history. For every 1-point increase from mean family connectedness, the odds of screening positive for suicide risk decreased by 62% (odds ratio 0.38, 95% CI 0.31-0.46) for youth with NSSI and 70% (odds ratio 0.30, 95% CI 0.27-0.34) for youth without NSSI (difference: <em>z</em> = 1.96, <em>p</em> = .05).</div></div><div><h3>Conclusion</h3><div>Connectedness was protective against suicide risk across the sample regardless of NSSI history. However, family connectedness was less protective for youth with NSSI compared with youth without NSSI. Future research should examine connectedness in greater detail and the quality of different relationships that could be protective for at-risk youth.</div></div><div><h3>Plain language summary</h3><div>Nonsuicidal self-injury (NSSI), the act of harming one’s own body without suicidal intent, is a strong risk factor for suicidal thoughts and behaviors (STBs) in adolescents. One important protective factor that can decrease suicide risk and NSSI is connectedness. This study aimed to examine relations among types of connectedness (family, school, peer and overall), NSSI, and suicide risk in pediatric emergency department patients. All domains of connectedness (family, school, peer and overall) were found to be associated with lower suicide risk, regardless of NSSI history. However, family connectedness was associated with less of a buffering effect for youth with NSSI compared to youth without NSSI. System-level interventions that strengthen family, school, and peer networks have the potential to reduce youth suicidality risk.</div></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 3","pages":"Pages 439-447"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144914061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.jaacop.2024.10.007
Maya L. Saulsbury BS , Stevi N. Gligorovic BS , Benjamin Jung PhD , Megan G. Jiao BS , Jenny C. Jean MD , Gustavo Sudre PhD , Philip Shaw BM BCh, PhD , Luke J. Norman PhD
Objective
The association between family environment factors, such as family conflict and parental monitoring, and attention-deficit/hyperactivity disorder (ADHD) behaviors is well established. However, it is unclear whether ADHD behaviors precede changes in familial functioning, whether certain family dynamics increase ADHD behaviors, or if the association is reciprocal.
Method
Data from 7,425 children across 4 waves of the Adolescent Brain and Cognitive Development Study were analyzed. ADHD behaviors were evaluated using the Child Behavior Checklist. Family conflict and parental monitoring were assessed using the Family Environment Scale and the Parental Monitoring Survey, respectively. Random-intercept cross-lagged panel modeling was employed to explore potential within-subject temporal associations between ADHD behaviors and the family environment.
Results
At the within-subject level, increases in ADHD behaviors were associated with subsequent increases in family conflict (B = .02, 95% CI [0.002, 0.04], p = .03, adjusted p = .04) and reductions in parental monitoring (B = −.006, 95% CI [−0.01, −0.0006], p = .03, adjusted p = .04). Similar findings emerged when restricting analyses to 1,315 participants meeting diagnostic criteria for ADHD. These findings were not moderated by sex, race/ethnicity, household income, or medication status. Among participants with ADHD, cross-lagged associations involving ADHD behaviors remained significant after controlling for time-varying externalizing and internalizing behaviors, which did not show significant cross-lagged associations with family conflict or parental monitoring.
Conclusion
These findings indicate that worsening ADHD behaviors can negatively impact the family environment. Despite small effect sizes, this study bolsters the case for early detection and treatment to help young people with ADHD, potentially mitigating impact on family dynamics.
Plain language summary
This study used data from the Adolescent Brain and Cognitive Development℠ (ABCD) Study to explore how attention-deficit/hyperactivity disorder (ADHD) behaviors and family dynamics influence each other over time. The authors found that increases in ADHD behaviors led to higher family conflict and reduced parental monitoring. These findings highlight for clinicians the importance of considering the impact of ADHD on family dynamics. Early intervention and family-based interventions focusing on communication and behavior management may help reduce family strain and improve longterm outcomes for children with ADHD.
目的探讨家庭冲突、父母监控等家庭环境因素与儿童注意缺陷多动障碍（ADHD）行为的关系。然而，目前尚不清楚ADHD行为是否先于家庭功能的改变，是否某些家庭动态会增加ADHD行为，或者这种关联是相互的。方法对7425名儿童的4波青少年脑与认知发展研究数据进行分析。使用儿童行为检查表评估ADHD行为。分别采用家庭环境量表和父母监控问卷对家庭冲突和父母监控进行评估。采用随机截距交叉滞后面板模型来探索ADHD行为与家庭环境之间潜在的受试者内时间关联。结果在受试者水平上，ADHD行为的增加与随后家庭冲突的增加（B = 0.02, 95% CI [0.002, 0.04], p = 0.03，调整后p = 0.04）和父母监护的减少相关(B =−。006, 95% CI[−0.01,−0.0006],p = 0.03，调整后p = 0.04)。当对1315名符合ADHD诊断标准的参与者进行限制分析时，也出现了类似的发现。这些发现不受性别、种族/民族、家庭收入或药物状况的影响。在ADHD参与者中，在控制了时变的外化和内化行为后，涉及ADHD行为的交叉滞后关联仍然显著，而与家庭冲突或父母监控的交叉滞后关联不显著。结论ADHD行为恶化会对家庭环境产生负面影响。尽管影响很小，但这项研究支持了早期发现和治疗ADHD的案例，以帮助患有ADHD的年轻人，潜在地减轻对家庭动态的影响。本研究使用来自青少年大脑和认知发展（ABCD）研究的数据，探索注意力缺陷/多动障碍（ADHD）行为和家庭动态如何随着时间的推移相互影响。作者发现，多动症行为的增加导致了家庭冲突的增加和父母监督的减少。这些发现为临床医生强调了考虑ADHD对家庭动态影响的重要性。早期干预和以家庭为基础的干预，侧重于沟通和行为管理，可能有助于减少家庭压力，改善ADHD儿童的长期预后。
{"title":"A Large-Scale Examination of Attention-Deficit/Hyperactivity Disorder Behaviors and Family Functioning Over Time Using Random-Intercept Cross-Lagged Panel Modeling","authors":"Maya L. Saulsbury BS , Stevi N. Gligorovic BS , Benjamin Jung PhD , Megan G. Jiao BS , Jenny C. Jean MD , Gustavo Sudre PhD , Philip Shaw BM BCh, PhD , Luke J. Norman PhD","doi":"10.1016/j.jaacop.2024.10.007","DOIUrl":"10.1016/j.jaacop.2024.10.007","url":null,"abstract":"<div><h3>Objective</h3><div>The association between family environment factors, such as family conflict and parental monitoring, and attention-deficit/hyperactivity disorder (ADHD) behaviors is well established. However, it is unclear whether ADHD behaviors precede changes in familial functioning, whether certain family dynamics increase ADHD behaviors, or if the association is reciprocal.</div></div><div><h3>Method</h3><div>Data from 7,425 children across 4 waves of the Adolescent Brain and Cognitive Development Study were analyzed. ADHD behaviors were evaluated using the Child Behavior Checklist. Family conflict and parental monitoring were assessed using the Family Environment Scale and the Parental Monitoring Survey, respectively. Random-intercept cross-lagged panel modeling was employed to explore potential within-subject temporal associations between ADHD behaviors and the family environment.</div></div><div><h3>Results</h3><div>At the within-subject level, increases in ADHD behaviors were associated with subsequent increases in family conflict (<em>B</em> = .02, 95% CI [0.002, 0.04], <em>p</em> = .03, adjusted <em>p</em> = .04) and reductions in parental monitoring (<em>B</em> = −.006, 95% CI [−0.01, −0.0006], <em>p</em> = .03, adjusted <em>p</em> = .04). Similar findings emerged when restricting analyses to 1,315 participants meeting diagnostic criteria for ADHD. These findings were not moderated by sex, race/ethnicity, household income, or medication status. Among participants with ADHD, cross-lagged associations involving ADHD behaviors remained significant after controlling for time-varying externalizing and internalizing behaviors, which did not show significant cross-lagged associations with family conflict or parental monitoring.</div></div><div><h3>Conclusion</h3><div>These findings indicate that worsening ADHD behaviors can negatively impact the family environment. Despite small effect sizes, this study bolsters the case for early detection and treatment to help young people with ADHD, potentially mitigating impact on family dynamics.</div></div><div><h3>Plain language summary</h3><div>This study used data from the Adolescent Brain and Cognitive Development℠ (ABCD) Study to explore how attention-deficit/hyperactivity disorder (ADHD) behaviors and family dynamics influence each other over time. The authors found that increases in ADHD behaviors led to higher family conflict and reduced parental monitoring. These findings highlight for clinicians the importance of considering the impact of ADHD on family dynamics. Early intervention and family-based interventions focusing on communication and behavior management may help reduce family strain and improve longterm outcomes for children with ADHD.</div></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 4","pages":"Pages 899-910"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-09DOI: 10.1016/j.jaacop.2024.09.011
Gladys N. Pachas MD, MPH , Harrison T. Reeder PhD , A. Eden Evins MD, MPH , Kelly Casottana BS , Marta Borrego Mahiques BA , Alec Bodolay BS , Caroline A. Gray MSW , Kevin W. Potter PhD , Alex S. Keuroghlian MD, MPH , Randi M. Schuster PhD
<div><h3>Objective</h3><div>Sexual diverse (SD) and gender diverse (GD) youth are at increased risk for adverse mental health outcomes compared to heterosexual/cisgender youth (HC). In this study, we aimed to examine youth risk profiles. We hypothesized that there would be a synergistic effect of SD+GD on mental health outcomes.</div></div><div><h3>Method</h3><div>In 2022, a total of 23,915 adolescents in grades 6 to 12 from 60 schools completed the voluntary, confidential Substance Use and Risk Factor (SURF) survey. Questions included screeners for substance use and mental health distress. Regression models examined associations between mental health outcomes and HC, GD, SD, and SD+GD.</div></div><div><h3>Results</h3><div>Mean age was 14.7 years; 25% identified as SD, 5.3% as GD, and 5.2% as SD+GD. Compared to HC, SD+GD youth had higher odds of depression (95% CI = 4.8-6.3), anxiety (95% CI = 4.9-6.5), suicidal thoughts (95% CI = 7.7-10.1), plans (95% CI = 6.7-8.8), attempts (95% CI = 7.0-10.7), nonsuicidal behavior (95% CI = 7.19-9.55), psychotic-like experiences (PEs) (95% CI = 4.1-5.4), emotional reactivity (ER) (95% CI = 22.1-24.5), alcohol use (95% CI = 1.2-2.4), cannabis use (95% CI = 2.3-4.0), smoking (95% CI = 9.4-26.6), and vaped nicotine (95% CI = 1.5-2.6) (all <em>p</em> < .04). Compared to SD only, SD+GD had higher odds of depression (95% CI = 1.5-2.0), anxiety (95% CI = 1.5-2.0), suicidal thoughts (95% CI = 1.7-2.3), plans (95% CI = 1.5-2.1), attempts (95% CI = 1.4-2.2), nonsuicidal behavior (95% CI = 1.67–2.27), PEs (95% CI = 1.6-2.2), ER (95% CI = 8.0-18.3), and smoking (95% CI = 2.3-7.8) (all <em>p</em> < .001). Compared to GD only, SD+GD had higher odds of depression (95% CI = 1.3-4.5), anxiety (95% CI = 1.8-6.4), suicidal thoughts (95% CI = 1.4-4.7), plans (95% CI = 1.1-4.1), nonsuicidal behavior (95% CI = 1.4-6.3), PEs (95% CI = 1.1-3.7), and ER (95% CI = 6.9-9.6) (all <em>p</em> < .03).</div></div><div><h3>Conclusion</h3><div>Although the GD only group is small, these findings on intersectional SD+GD identities have significant implications for adolescent mental health.</div></div><div><h3>Plain language summary</h3><div>This study examined mental health and substance use risks in adolescents who identify as sexually diverse (SD) or gender diverse (GD), and especially those who identify as both. The authors used the Substance Use and Risk Factor survey, and data were collected from nearly 24,000 adolescents from 60 schools in Massachusetts. The authors found that adolescents who identify as both (SD+GD) are at a significantly higher risk of experiencing depression, anxiety, suicidal thoughts and behaviors, and substance use compared to their heterosexual/cisgender peers. SD and GD adolescents are also at a higher risk of depression, anxiety, and emotional reactivity compared to heterosexual/cisgender peers. These findings suggest that the combined challenges of being both SD and GD put adolescents at a higher risk fo
目的与异性恋/顺性青年（HC）相比，性多样性（SD）和性别多样性（GD）青年出现不良心理健康结果的风险更高。在这项研究中，我们的目的是检查青少年的风险概况。我们假设SD+GD对心理健康结果有协同效应。方法2022年，来自60所学校的23,915名6 - 12年级青少年完成了自愿、保密的物质使用和风险因素（SURF）调查。问题包括物质使用和精神健康困扰的筛查。回归模型检验了心理健康结果与HC、GD、SD和SD+GD之间的关系。结果患者平均年龄14.7岁；25%为SD， 5.3%为GD， 5.2%为SD+GD。HC相比,SD + GD青年抑郁症的几率也会更高(95% CI = 4.8 - -6.3)、焦虑(95% CI = 4.9 - -6.5),自杀的念头(95% CI = 7.7 - -10.1),计划(95% CI = 6.7 - -8.8),尝试(95% CI = 7.0 - -10.7),非人弹行为(95% CI = 7.19 - -9.55), psychotic-like经验(PEs) (95% CI = 4.1 - -5.4),情感反应(ER) (95% CI = 22.1 - -24.5),使用酒精(95% CI = 1.2 - -2.4),吸食大麻(95% CI = 2.3 - -4.0),吸烟(95% CI = 9.4 - -26.6),和vap尼古丁(95% CI = 1.5 - -2.6)(所有p & lt; .04点)。与仅使用SD相比，SD+GD具有更高的抑郁（95% CI = 1.5-2.0）、焦虑（95% CI = 1.5-2.0）、自杀念头（95% CI = 1.7-2.3）、计划（95% CI = 1.5-2.1）、企图（95% CI = 1.4-2.2）、非自杀行为（95% CI = 1.67-2.27）、pe （95% CI = 1.6-2.2）、ER （95% CI = 8.0-18.3）和吸烟（95% CI = 2.3-7.8）的几率（均p <； 0.001）。与GD相比，SD+GD有更高的抑郁（95% CI = 1.3-4.5）、焦虑（95% CI = 1.8-6.4）、自杀念头（95% CI = 1.4-4.7）、计划（95% CI = 1.1-4.1）、非自杀行为（95% CI = 1.4-6.3）、pe （95% CI = 1.1-3.7）和ER （95% CI = 6.9-9.6）的几率(均p <；结论虽然只有GD的群体很小，但这些交叉SD+GD身份的研究结果对青少年心理健康具有重要意义。本研究调查了性多元化（SD）或性别多元化（GD）青少年的心理健康和物质使用风险，特别是那些两者都认同的青少年。作者使用了物质使用和风险因素调查，并从马萨诸塞州60所学校的近2.4万名青少年中收集了数据。作者发现，与异性恋/顺性同龄人相比，两者都认同的青少年（SD+GD）经历抑郁、焦虑、自杀念头和行为以及药物使用的风险要高得多。与异性恋/顺性同龄人相比，SD和GD青少年也有更高的抑郁、焦虑和情绪反应风险。这些研究结果表明，青少年作为社会障碍和社会性别障碍的双重挑战使他们面临更高的不良心理健康结果风险，这突出表明需要为这一群体提供专门的心理健康支持。
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