Examining Perceptions About Mental Health Care and Help-Seeking Among Rural African American Families of Adolescents

Rural African American children living in poverty have a higher prevalence rate of mental health disorders than their urban counterparts. While access to mental health services is lacking in resource scarce rural communities, African American rural residents may also be the most likely to confront significant barriers to care and help-seeking. Studies of mental health help-seeking behavior among rural families are rare, even rarer are studies of African Americans living in these areas. To address this gap, the current study examined perceptions about help-seeking for adolescents with mental health problems among rural African American families. Data were obtained from African American mothers in rural Georgia to assess their perceptions of the mental health service system, help-seeking processes, and service experiences. A mixed-method approach was implemented, integrating a quantitative survey (n = 163) with qualitative interviews (subsample n = 21). Most of the mothers expressed confidence in mental health care providers’ to help. Preferred sources of support, however, were family, church, and schools. Community stigma towards children with mental health problems and their families was a frequently endorsed perceived barrier to help-seeking. Although cultural mistrust was one of the two most frequently endorsed barriers in the survey, it did not emerge as a universal barrier to help-seeking for the mothers in this sample. Implications for research, policy, and practice include addressing family concerns about stigma, preferences for informal support and non-specialty services in addressing adolescents’ mental health problems, and building community resources to enable all youth to participate in community life.     

Contextual Socioeconomic Status and Mental Health Counseling Use Among US Adolescents with Depression

Most adolescents with depressive disorders do not receive any mental health services, even though effective treatments exist. Although research has examined numerous individual-level factors associated with mental health service use among depressed adolescents, less is known about the role of contextual factors. This study examines the relationship between contextual-level socioeconomic status (SES) and clinic-based mental health counseling use among US adolescents with high depressive symptoms in urban and suburban areas. Data from the first two waves of the National Longitudinal Study of Adolescent Health (N = 1,133; 59 % female) were analyzed using multilevel logistic models in which adolescents were nested within counties. After controlling for individual-level predisposing, enabling, and need characteristics, as well as county racial/ethnic composition, county SES was positively associated with clinic-based counseling use among depressed youth. A one standard deviation increase in the county affluence index was associated with 43 % greater odds of receiving any clinical counseling services. Furthermore, the positive relationship between county affluence and clinical counseling use was no longer significant after controlling for the county supply of mental health specialist physicians. The results indicate that county residential context is a key correlate of mental health service use among depressed adolescents, such that those who live in lower SES counties with fewer mental health specialists are less likely to receive treatment.     

Factors that Influence Mental Health Stigma Among 8th Grade Adolescents

Unmet mental health need is a significant problem for adolescents. Although stigma is identified as a major barrier to the use of mental health services among youth, there is limited research on this topic. In-depth interviews (n=57) among a sample of 8th grade students in a suburban, mid-Atlantic community portray adolescent mental health attitudes and how these views are shaped. Satisfactory personal experiences with mental health services as well as accurate mental health knowledge contribute to positive mental health attitudes among teens. The anticipation of negative responses towards mental health care-seeking from family members, peers, and school staff are key factors in teens’ comfort and willingness to address mental health concerns. The research provides critical information on the factors that contribute to the development of stigma and emphasizes the need to address stigma in youth mental health education, programs, and treatment plans. Authors are affiliated with the Johns Hopkins Bloomberg School of Public Health, Department of Population and Family Health Sciences. Dr. Chandra has a background in adolescent health, and is particularly interested in improving the accessibility and appropriateness of youth mental health services and involving young people in the translation of research into practice. Dr. Minkovitz is interested in improving preventive service delivery, enhancing quality of care, and understanding maternal factors that influence children’s receipt of health care     

Invited Commentary: Childhood and Adolescent Obesity: Psychological and Behavioral Issues in Weight Loss Treatment

The prevalence of childhood and adolescent obesity has tripled in the past three decades. This increase has been accompanied by a dramatic rise in obesity-related health complications among American youth. Thus, many obese youth are now experiencing illnesses that will threaten their life expectancy in the absence of significant weight loss. Despite these concerns, a relatively modest body of research has focused on the treatment of adolescent obesity. Results from trials investigating the efficacy of behavioral and pharmacological treatments, like studies of these interventions with adults, suggest that individuals typically lose 5–10% of their initial weight. Unfortunately, weight regain is common. Given the increase in the number of obese adolescents, coupled with the modest results from more conservative treatment approaches, it is not surprising that bariatric surgery for adolescents who suffer from extreme obesity has grown in popularity. The weight losses after surgery are impressive and many adolescents, like adults, experience significant improvements in their physical and mental health postoperatively. However, only a small fraction of adolescents and adults who are heavy enough for bariatric surgery present for surgical treatment. Among those who undergo surgery, a significant minority appear to struggle with a number of behavioral and psychosocial issues that threaten their lifelong success. With all of this in mind, the current obesity problem in the United States and other Westernized countries likely will present a significant challenge to both current and future medical and mental health professionals who work with adolescents and young adults.     

Weight Perception, Substance Use, and Disordered Eating Behaviors: Comparing Normal Weight and Overweight High-School Students

Disordered eating behaviors and substance use are two risk factors for the development of serious psychopathology and health concerns in adulthood. Despite the negative outcomes associated with these risky behaviors, few studies have examined potential associations between these risk factors as they occur during adolescence. The importance of accurate or inaccurate weight perception among adolescents has received increased interest given documented associations with nutritional beliefs and weight management strategies. This study examined the associations among the perceptions of weight and substance use with disordered eating behaviors among a diverse sample of normal weight and overweight adolescent males and females. Data came from the 2007 National Youth Risk Behavior Survey (YRBS). The sample consisted of 11,103 adolescents (53.4% female; 44% Caucasian, 21% African American; 13% Hispanic; age responses ranged from 12 and under to 18 and over), with 31.5% meeting criteria for being either at-risk for obesity or already obese (i.e., overweight). As hypothesized, overestimation of weight among normal weight adolescents and accurate perceptions of weight among overweight adolescents were associated with higher rates of disordered eating behaviors. In normal weight adolescents, use of all three substances (tobacco, binge drinking, and cocaine) was associated with each disordered eating behavior. In contrast, findings revealed differences for overweight adolescents between the type of substance use and disordered eating behavior. Post hoc analyses revealed that gender moderated some of these relationships among overweight individuals. Implications for the development and implementation of secondary prevention programs aimed at reducing disordered eating behaviors, substance use, and obesity risk among normal and overweight adolescents are considered.     

Homophobic Name-Calling Among Secondary School Students and Its Implications for Mental Health

Although homophobic verbal victimization has been associated with negative mental health outcomes, little actually is known about its general prevalence and relationship to mental health among adolescents. In addition, the relationship of homophobic name-calling to mental health in gender non-conforming adolescents is not well understood. This study examined the relationship between homophobic verbal victimization and mental health in adolescents, accounting for their sexual orientation and level of gender non-conformity. Survey data was collected from 513 adolescents (ages 11–17) who attended eight schools in and around Amsterdam, the Netherlands; 56.7 % of the participating adolescents were female and 11.1 % reported same-sex attractions. As hypothesized, male adolescents and those with same-sex attractions were more likely to report victimization from homophobic name-calling than were their female and non-same-sex attracted peers. Contrary to expectations, homophobic name-calling was not independently associated with psychological distress after controlling for gender, sexual attractions, gender non-conformity, and other negative treatment by peers. The hypothesis that homophobic name-calling would be more strongly associated with psychological distress in male, same-sex attracted, and gender non-conforming adolescents was also not supported. The results suggest that same-sex attracted and gender non-conforming youth are particularly vulnerable to homophobic name-calling, in the Netherlands as in other contexts, but also that other forms of peer victimization may be more strongly related to mental health.     

Examining Multiracial Youth in Context: Ethnic Identity Development and Mental Health Outcomes

Although multiracial individuals are the fastest growing population in the United States, research on the identity development of multiracial adolescents remains scant. This study explores the relationship between ethnic identity, its components (affirmation, exploration), and mental health outcomes (anxiety, depressive symptoms) within the contexts of schools for multiracial adolescents. The participants were multiracial and monoracial minority and majority high school students (n = 4,766; 54.6 % female). Among the participants, 88.1 % were Caucasian, 7.4 % were African American, and 4.5 % were multiracial. The research questions examined the relationship between ethnic identity exploration and affirmation on mental health outcomes and explored the role school context plays in this relationship. The findings suggested that multiracial youth experience more exploration and less affirmation than African Americans, but more than Caucasians. In addition, multiracial youth were found to have higher levels of mental health issues than their monoracial minority and majority peers. Specifically, multiracial youth had higher levels of depressive symptoms than their African American and Caucasian counterparts. Multiracial and Caucasian youth had similar levels of anxiety but these levels were significantly higher than African Americans. School diversity did not influence mental health outcomes for multiracial youth. These findings provide insight into the experiences of multiracial youth and underscore the importance of further investigating factors that contribute to their mental health outcomes.     

Body Dissatisfaction,Living Away from Parents,and Poor Social Adjustment Predict Binge Eating Symptoms in Young Women Making the Transition to University

The current study explored how body dissatisfaction and challenges associated with the transition to university predicted symptoms of binge eating. Participants were 101 female full-time first-year university students (M=18.3 years of age; SD=.50) who completed a background questionnaire and a web-based daily checklist assessing binge eating. Hierarchical Generalized Linear Modeling results showed that participants who were more dissatisfied with their bodies were three times as likely to report symptoms of binge eating compared to participants who were less dissatisfied. Participants who lived away from home were three times as likely to report symptoms of binge eating compared to participants living with parents. Finally, poor perceived social adjustment to the university context was associated with an increased likelihood of binge eating. Discussion calls for more research exploring the role that university challenges and adjustment play in predicting eating problems.

Profiles of Problematic Behaviors Across Adolescence: Covariations with Indicators of Positive Youth Development

Previous analyses of data from the 4-H Study of Positive Youth Development (PYD) have examined concurrent trajectories of positive development and risk/problem behaviors among adolescents, finding complex and not necessarily inverse relationships among them. In this article, we expand on prior research by employing a person-centered approach to modeling risk behaviors, assessing development from approximately 6th grade through 12th grade among 4,391 adolescents (59.9 % female). Latent profiles involving the problematic behaviors of delinquency, depressive symptoms, substance use, sexual activity, disordered eating behaviors, and bullying were then assessed for concurrent relationships with the Five Cs of PYD: Competence, Confidence, Character, Caring, and Connection. We found six latent profiles, based primarily on mental health, aggression, and alcohol use, with significant differences in Confidence levels among many of the profiles, as well as some differences in the four other Cs. We discuss directions for future research and implications for application to youth policies and programs.     

Gender,General Strain Theory,Negative Emotions,and Disordered Eating

Much of the prior work on General Strain Theory (GST) has focused on how strain and negative emotions interrelate to produce criminal—especially violent—activity. Very little research has extended GST to examine other types of non-criminal, negative behavior, such as self-harming behaviors associated with disordered eating, a traditionally female-specific self-directed outcome. Using a sample of 338 young adults (54% female, 95% white), this article applies GST to disordered eating by examining how strain and negative emotions relate to this particular outcome across gender. Findings indicate that two types of strain measures predict depressive symptoms among males and females, that inequitable strainful experiences relate to disordered eating among females but not males, that depressive symptoms but not anger increase disordered eating for both males and females, and that membership in Greek organizations (sororities or fraternities) is associated with disordered eating but only for males. Implications for theory and directions for future research are highlighted.     

Acculturation,Gender, Depression,and Cigarette Smoking Among U.S. Hispanic Youth: The Mediating Role of Perceived Discrimination

Hispanic youth are at risk for experiencing depressive symptoms and smoking cigarettes, and risk for depressive symptoms and cigarette use increase as Hispanic youth acculturate to U.S. culture. The mechanism by which acculturation leads to symptoms of depression and cigarette smoking is not well understood. The present study examined whether perceived discrimination explained the associations of acculturation with depressive symptoms and cigarette smoking among 1,124 Hispanic youth (54% female). Youth in Southern California completed surveys in 9th–11th grade. Separate analyses by gender showed that perceived discrimination explained the relationship between acculturation and depressive symptoms for girls only. There was also evidence that discrimination explained the relationship between acculturation and cigarette smoking among girls, but the effect was only marginally significant. Acculturation was associated with depressive symptoms and smoking among girls only. Perceived discrimination predicted depressive symptoms in both genders, and discrimination was positively associated with cigarette smoking for girls but not boys. These results support the notion that, although Hispanic boys and girls experience acculturation and discrimination, their mental health and smoking behaviors are differentially affected by these experiences. Moreover, the results indicate that acculturation, gender, and discrimination are important factors to consider when addressing Hispanic youth’s mental health and substance use behaviors.     

Sexual Attraction and Trajectories of Mental Health and Substance Use During the Transition from Adolescence to Adulthood

Previous research suggests that sexual minority youth have poorer health-related outcomes than their heterosexual peers. The purpose of this study is to determine whether sexual orientation disparities in mental health and substance use increase, decrease, or remain the same during the transition from adolescence to adulthood. Data are from Waves 1–4 of the National Longitudinal Study of Adolescent Health (n = 8,322; 55% female). Respondents were in grades 7–12 at Wave 1 and aged 24–32 at Wave 4. Latent growth curve modeling is used to compare the mental health and substance use trajectories of youth who consistently report heterosexual attraction versus those who consistently report lesbian, gay, or bisexual (LGB) attraction, those who report a transition to LGB attraction, and those who report a transition to heterosexual attraction. Among women and men, sexual orientation disparities in depressive symptoms and suicidal thoughts persist, but do not increase, during the transition from adolescence to adulthood. The same pattern is observed for disparities in smoking, heavy drinking, and marijuana use among women. Among men, disparities in substance use are only observed between those who report consistent heterosexual attraction and those who transition to heterosexual attraction. Disparities between these groups persist over time for heavy drinking and marijuana use but decrease over time for smoking. While this study finds evidence of numerous disparities in mental health and substance use outcomes during adolescence and young adulthood, particularly among young women, there is no indication that these disparities get larger over time.     

Gender differences associated with young people's emotional reactions to sexual intercourse

The differences between male and female adolescents' emotional reactions to their most recent occasion of sexual intercourse were examined. The sample included 932 sexually active Australian secondary school students who completed a self-report questionnaire concerning their sexual behavior. The majority of young people reported that they felt happy or good following their most recent occasion of sex. Females were more likely than males to report negative emotions such as feeling bad and used, but there was no difference between the percentage of males and the percentage of females who reported feeling guilty. Girls were more likely to feel bad, used, or guilty last time if they were drunk/high or had sex with someone who was not a steady partner. Boys who had sex with someone other than a steady partner last time were more likely to feel guilty. Peer and parental influences were also associated with feelings of guilt. Girls who were more confident that they could talk to one of their parents/guardians about sex, and boys who believed that most of their peers were sexually active, were less likely to have felt guilty.Received B.A. (Hons) from University of Queensland. Research interests include adolescents mental and sexual health.Received B.A.(Hons) from University of Queensland. Interested in the areas of sex roles and sexual behavior among adolescents.Received Ph.D. from Murdoch University. Research interests include population studies of sexual behavior and mental health.Received M.B.B.S., M.D. from University of Sydney. Research interests include adolescent health, psychological response in disasters, coping with grief and loss and living with HIV/AIDS.     

The relationship between physical activity and mental health among adolescents in six middle-income countries: A cross-sectional study

Physical inactivity and poor mental health are emerging worldwide youth problems. Using the Global School-based Health Survey, this secondary data analysis study examined the link between physical activity and adolescent mental health among 23,372 adolescents between 11 and 17 years of age in six middle-income countries. The authors assessed physical activity by participation in (a) exercise for 60 min and (b) walking/biking in any day of a week in the past 7 days. The authors assessed mental health by the presence of (a) loneliness, (b) anxiety, (c) depression, (d) suicidal ideation, and (e) suicide attempts in the past 12 months. There was a low prevalence of physical activity among the participants. In general, there was a low prevalence of 12-month mental health problems among adolescents. Further research may incorporate physical activity to promote positive youth mental health for possible cost-effective interventions.     

The Effects of Gender and Family,Friend, and Media Influences on Eating Behaviors and Body Image During Adolescence

The current study expands upon body image research to examine how gender, self-esteem, social support, teasing, and family, friend, and media pressures relate to body image and eating-related attitudes and behaviors among male and female adolescents (N = 177). Results indicated that adolescents were dissatisfied with their current bodies: males were concerned with increasing their upper body, whereas females wanted to decrease the overall size of their body. Low self-esteem and social support, weight-related teasing, and greater pressures to lose weight were associated with adolescents’ negative body esteem, body image, and eating attitudes. Females displayed more high risk eating behaviors—which were associated with more psychosocial risk factors—than males, whose high risk attitudes and behaviors were only associated with low parental support and greater pressure to be muscular. Reducing adolescents’ perceptions of appearance-related pressure from family and friends may be key for enhancing body image and decreasing links between low self-esteem and negative eating behaviors and weight-related perceptions. Rheanna N. Ata is currently a research assistant at the Weight Control and Diabetes Research Center, Miriam Hospital/Brown University. She is interested in body image and eating disorders and completed this research during her undergraduate studies at the College of the Holy Cross. Alison Bryant Ludden is a developmental psychologist whose research focuses on social relationships and problem behaviors during adolescence, with a special interest in school as a developmental context. She is an assistant professor of psychology at the College of the Holy Cross. Megan M. Lally is currently a graduate student in psychology at Pepperdine University. She completed this research during her undergraduate studies at the College of the Holy Cross.     

Social class,socialization practices,and psychosomatic ailments in adolescents

The relationships among social class, socialization practices, and psychosomatic ailments have been reported by several psychological and sociological studies. However, a careful review of these studies reveals some contradictory results. In addition to inadequate sample size, these studies have been carried out on children of preschool and grade school ages. We collected data from 1518 high school aged adolescents who had unbroken families and who might be regarded as products of their families' class and socialization practices. Our findings suggest definite effects of socioeconomic status on the mental health of the developing female children. The effects of some socialization practices, such as parental dominance, restrictiveness, punishment types, and warmth, on psychosomatic incidences are further examined. Implications of the present study are discussed.Received his Ph.D. from Vanderbilt University. Major interests include sociology of mental illness and deviant behavior. Currently he is working on a book concerning the mentally ill.Received his Ph.D. from Iowa State University. Major interests include methodology and social disorganization. Current research is in social gerontology and applied statistics.     

Mental Health and Educational Experiences Among Black Youth: A Latent Class Analysis

Disproportionately lower educational achievement, coupled with higher grade retention, suspensions, expulsions, and lower school bonding make educational success among Black adolescents a major public health concern. Mental health is a key developmental factor related to educational outcomes among adolescents; however, traditional models of mental health focus on absence of dysfunction as a way to conceptualize mental health. The dual-factor model of mental health incorporates indicators of both subjective wellbeing and psychopathology, supporting more recent research that both are needed to comprehensively assess mental health. This study applied the dual-factor model to measure mental health using the National Survey of American Life—Adolescent Supplement (NSAL-A), a representative cross-sectional survey. The sample included 1170 Black adolescents (52% female; mean age 15). Latent class analysis was conducted with positive indicators of subjective wellbeing (emotional, psychological, and social) as well as measures of psychopathology. Four mental health groups were identified, based on having high or low subjective wellbeing and high or low psychopathology. Accordingly, associations between mental health groups and educational outcomes were investigated. Significant associations were observed in school bonding, suspensions, and grade retention, with the positive mental health group (high subjective wellbeing, low psychopathology) experiencing more beneficial outcomes. The results support a strong association between school bonding and better mental health and have implications for a more comprehensive view of mental health in interventions targeting improved educational experiences and mental health among Black adolescents.     

Psychosocial Correlates of Shape and Weight Concerns in Overweight Pre-Adolescents

Shape and weight concerns among overweight pre-adolescents heighten risk for eating disorders and weight gain. Treatment and prevention efforts require consideration of psychosocial factors that co-occur with these concerns. This study involved 200 overweight pre-adolescents, aged 7–12 years (M age = 9.8; SD = 1.4), presenting for family-based weight control treatment. Hierarchical regression was used to examine the influence of pre-adolescents’ individual characteristics and social experiences, and their parents’ psychological symptoms, on shape and weight concerns as assessed by the Child Eating Disorder Examination. Findings revealed that higher levels of dietary restraint, greater feelings of loneliness, elevated experiences with weight-related teasing, and higher levels of parents’ eating disorder symptoms predicted higher shape and weight concerns among overweight pre-adolescents. Interventions addressing overweight pre-adolescents’ disordered eating behaviors and social functioning, as well as their parents’ disordered eating behaviors and attitudes, may be indicated for those endorsing shape and weight concerns.     

Promoting Daily Well-being in Adolescents using mHealth

Adolescents are at increased risk for developing mental health problems. The Grow It! app is an mHealth intervention aimed at preventing mental health problems through improving coping by cognitive behavioral therapy (CBT)-inspired challenges as well as self-monitoring of emotions through Experience Sampling Methods (ESM). Yet, little is known about daily changes in well-being and coping during a stressful period, like the COVID-19 pandemic. The current study aimed to elucidate daily changes in positive and negative affect, and adaptive coping, and to better understand the within-person’s mechanisms of the Grow It! app. The sample consisted of 12–25-year old Dutch adolescents in two independent cohorts (cohort 1: N?=?476, Mage?=?16.24, 76.1% female, 88.7% Dutch; cohort 2: N?=?814, Mage?=?18.45, 82.8% female, 97.2% Dutch). ESM were used to measure daily positive and negative affect and coping (cohort 1: 42 days, 210 assessments per person; cohort 2: 21 days, 105 assessments). The results showed that, on average, adolescents decreased in daily positive affect and adaptive coping, and increased in their experienced negative affect. A positive relation between adaptive coping and positive affect was found, although independent of the CBT-based challenges. Latent class analysis identified two heterogeneous trajectories for both positive and negative affect, indicating that the majority of participants with low to moderate-risk on developing mental health problems were likely to benefit from the Grow It! app.

     

Quality of Social Relationships and the Development of Depression in Parentally-Bereaved Youth

Fear of abandonment has been found to be associated with mental health problems for youth who have experienced a parent’s death. This article examines how youth’s fears of abandonment following the death of a parent lead to later depressive symptoms by influencing relationships with caregivers, peers, and romantic partners. Participants were 109 youth ages 7–16 (50% male), assessed 4 times over a 6-year period. The ethnic composition of the sample was non-Hispanic Caucasian (67%), Hispanic (16%), African American (7%), Native American (3%), Asian (1%), and Other (6%). Youth’s fears of abandonment by their surviving caregiver during the first year of data collection were related to their anxiety in romantic relationships 6 years later, which, in turn, was associated with depressive symptoms measured at 6 years. Youth’s caregiver, peer, and romantic relationships at the 6-year follow-up were related to their concurrent depressive symptoms. The relationship between youth’s attachment to their surviving caregiver and their depressive symptoms was stronger for younger participants. Implications of these findings for understanding the development of mental health problems following parental bereavement are discussed.