Concurrent Trajectories of Change in Adolescent and Maternal Depressive Symptoms in the TORDIA Study

Depression has a heightened prevalence in adolescence, with approximately 15 % of adolescents experiencing a major depressive episode by age 18. Depression in adolescence also poses a risk for future distress and impairment. Despite treatment advances, many adolescents relapse after initial remission. Family context may be an important factor in the developmental trajectory of adolescent depression, and thus in enhancing treatment. This study examined concurrent change over time in adolescent and maternal depressive symptoms in the context of the Treatment of Resistant Depression in Adolescents study. Participants were 334 adolescents (mean age: 16; SD: 1.6; 70 % female, 84 % Caucasian), and their mothers (n = 241). All adolescents were clinically depressed when they entered the study and had received previous selective serotonin reuptake inhibitor (SSRI) treatment. Adolescents received acute treatment for 12 weeks and additional treatment for 12 more weeks. Adolescent depression and suicidal ideation were assessed at 0, 6, 12, 24, 48 and 72 weeks, while maternal depressive symptoms were assessed at 0, 12, 24, 48 and 72 weeks. Latent basis growth curve analyses showed a significant correlation over 72 weeks between trajectories of maternal and adolescent depressive symptoms, supporting the hypothesis of concurrent patterns of change in these variables. The trajectories were correlated more strongly in a subsample that included only dyads in which mothers reported at least one depressive symptom at baseline. Results did not show a correlation between trajectories of maternal depressive symptoms and adolescent suicidal ideation. These findings suggest that adolescent and maternal depressive symptoms change in tandem, and that treatment for adolescent depression can benefit the wider family system. Notably, most mothers in this sample had subclinical depressive symptoms. Future research might explore these trajectories in dyads with more severely depressed mothers.     

Suicidal ideation in adolescence: Depression,substance use,and other risk factors

The interrelationships of depression and suicide with adolescent drug use, delinquency, eating disorders, and the risk factors for these different problems were investigated among 597 9th and 11th graders in an urban high school. There is a strong association of drug use with suicidal ideation among girls, and a stronger relationship with attempts among girls and boys. Suicidal youths are ill-adjusted and display a lack of attachment and commitment to family and school. Causal models indicate that poor interpersonal interactions with parents, absence of peer interactions, and life events lead to depression, which in turn leads to suicidal ideation. Depressive symptoms are the strongest predictors of suicidal ideation. Among females, depression predicts drug involvement, and in turn, drug use increases suicidal ideation. Drug use is only one class of problem behaviors that constitutes a risk factor for suicidal behavior in adolescence. Delinquency and eating disorders also have direct effects on suicidal ideation beyond those of depressive affect. As for drug involvement, these problem behaviors are more predictive of suicidal behavior among girls than boys. Similarity and specificity of the predictors for problem behaviors within and between the sexes are discussed. Although young women use drugs to handle feelings of depression, drug use appears ineffective in the long run in relieving these depressive feelings. Understanding the dynamics of suicidal ideation in adolescence has important public health implications, since ideation is a strong predictor of attempts, especially among females.Revised version of a presentation at the Workshop on Adolescent Depression, Princeton, NJ, June 3, 1987.Work on this research has been partially supported by Research Grants DA00064, DA01097, DA03196, and DA02867, and by Research Scientist Award DA00081 from the National Institute on Drug Abuse; and awards from the John D. and Catherine MacArthur Foundation and the Research Foundation for Mental Hygiene, New York State Psychiatric Institute. Partial support for computer costs was provided by Mental Health Clinical Research Center Grant MH30906-07 from NIMH to the New York State Psychiatric Institute.Received Ph.D. in Sociology from Columbia University. Research interests include adolescent psychosocial development, epidemiology and risk factors for drug use, and interpersonal networks.Work on this research was carried out while a Research Associate at the School of Public Health, Columbia University. Received Ph.D. in Sociology from Columbia University. Research interests include personal networks and social support systems in chronic illness, societal factors in mental health, psychosocial consequences of drug use and abuse, panel mortality, and survey methodology.Received M.P.H. from Columbia University. Research interests include reliability and child psychiatry.     

Differences in Non-Suicidal Self-Injury and Suicide Attempts in Adolescents

As suicide attempts and self-injury remain predominant health risks among adolescents, it is increasingly important to be able to distinguish features of self-harming adolescents from those who are at risk for suicidal behaviors. The current study examined differences between groups of adolescents with varying levels of self-harmful behavior in a sample of 373 high school students with a mean age of 15.04 (SD = 1.05). The sample was 48% female and the distribution of ethnicity was as follows: 35% Caucasian, 37.2% African-American, 16% Multi-ethnic, 9.2% Hispanic, and 2.3% Asian. The sample was divided into three groups: no history of self-harm, non-suicidal self-injury (NSSI) only, and NSSI in addition to a suicide attempt. Differences in depressive symptoms, suicidal ideation, social support, self-esteem, body satisfaction, and disordered eating were explored. Results indicated significant differences between the three groups on all variables, with the no self-harm group reporting the lowest levels of risk factors and highest levels of protective factors. Further analyses were conducted to examine specific differences between the two self-harm groups. Adolescents in the NSSI group were found to have fewer depressive symptoms, lower suicidal ideation, and greater self-esteem and parental support than the group that also had attempted suicide. The clinical implications of assessing these specific psychosocial correlates for at-risk adolescents are discussed.     

At-Home Environment, Out-of-Home Environment, Snacks and Sweetened Beverages Intake in Preadolescence, Early and Mid-Adolescence: The Interplay Between Environment and Self-Regulation

Obesity-related behaviors, such as intake of snacks and sweetened beverages (SSB), are assumed to result from the interplay between environmental factors and adolescents’ ability to self-regulate their eating behaviors. The empirical evidence supporting this assumption is missing. This study investigated the relationships between perceptions of at-home and out-of-home food environment (including SSB accessibility, parental, and peers’ social pressure to reduce intake of SSB), nutrition self-regulatory strategies (controlling temptations and suppression), and SSB intake. In particular, we hypothesized that these associations would differ across the stages of preadolescence, early and mid-adolescence. Self-reported data were collected from 2,764 adolescents (10–17 years old; 49 % girls) from 24 schools in the Netherlands, Poland, Portugal, and the United Kingdom. Path analysis indicated that direct associations between peers’ social influence and SSB intake increased with age. Direct negative associations between at-home and out-of-home accessibility and SSB intake as well as direct positive associations between parental pressure and intake become significantly weaker with age. Accessibility was related negatively to self-regulation, whereas higher social pressure was associated with higher self-regulation. The effects of the environmental factors were mediated by self-regulation. Quantitative and qualitative differences in self-regulation were observed across the stages of adolescence. The associations between the use of self-regulatory strategies and lower SSB intake become significantly stronger with age. In preadolescence, SSB intake was regulated by means of strategies that aimed at direct actions toward tempting food. In contrast, early and mid-adolescents controlled their SSB intake by means of a combination of self-regulatory strategies focusing on direct actions toward tempting food and strategies focusing on changing the psychological meaning of tempting food.     

Suicidal Behavior Among Homeless and Runaway Adolescents

The present study considered risk factors associated with suicidal ideation and the likelihood of a suicide attempt in a sample of 297 homeless and runaway youth from four Midwestern states. It was hypothesized that sociodemographic characteristics, family factors, suicide exposure, street factors, externalizing behavior, and internalizing behavior would be related to suicidal ideation and to the likelihood of a suicide attempt. It was also hypothesized that suicidal ideation would mediate the relationship between the other predictor variables and the likelihood of a suicide attempt. Over half the sample (53.9%) endorsed some level of suicidal ideation, and over one quarter (26.3%) attempted suicide in the year prior to the interview. Univariate and multivariate results indicated that sexual abuse by a family member, knowing a friend who attempted suicide, drug abuse, and internalization were highly related to suicidal ideation. In the absence of suicidal ideation, sexual abuse, sexual victimization while on their own, and internalization were highly related to the likelihood of a suicide attempt. Finally, the hypothesized mediating effect was found for both sexual abuse and internalization.     

Adolescents’ Suicidal Thinking and Reluctance to Consult General Medical Practitioners

Appropriate help-seeking is widely recognized as a protective factor, and vital for early treatment and prevention of mental health problems during adolescence. General medical practitioners (GPs), that is, family doctors, provide a vital role in the identification of adolescents with mental health problems and the provision of treatment as well as access to other specialists in mental health care services. The current study examined the association between suicidal ideation and intentions to seek help from a GP for suicidal thoughts, emotional problems and physical health problems, using a sample of 590 Australian high school students that was 56.7% female and aged 13–18 years (M = 15.56 years, SD = .66 years). Higher levels of suicidal ideation and general psychological distress were related to lower intentions to seek help from a GP for suicidal and physical problems. The results suggest that even at subclinical levels, increases in suicidal ideation or psychological distress may lead to help avoidance. School personnel and other gatekeepers need to be aware of this trend in order to be more assertive in encouraging and supporting appropriate help-seeking for mental health problems. School health promotion programs should consider including information to explicitly address the help-negation process.     

The Moderating Effects of Parenting Styles on African-American and Caucasian Children’s Suicidal Behaviors

Given that parenting practices have been linked to suicidal behavior in adolescence, examining the moderating effect of parenting styles on suicidal behavior early in development could offer potential insight into possible buffers as well as directions for suicide prevention and intervention later in adolescence. Hence, the moderating effects of parenting styles, including authoritarian, permissive, and features of authoritative parenting, on depressed and aggressive children’s suicidal behavior, including ideation and attempts, were evaluated with young children (N = 172; 72% male, 28% female) ranging from 6 to 12 years of age. African American (69%) and Caucasian (31%) children admitted for acute psychiatric inpatient care completed standardized measures of suicidal behavior, depressive symptoms, and proactive and reaction aggression. Their parents also completed standardized measures of parental distress and parenting style. Hierarchical regression analyses revealed that, while statistically controlling for age and gender, children who endorsed more depressive symptoms or reactive aggression reported more current and past suicidal behavior than children who endorsed fewer depressive or aggressive symptoms. The significant positive relationship observed between depressive symptoms and childhood suicidal behavior, however, was attenuated by parental use of authoritarian parenting practices for African-American and older children but not for younger and Caucasian children. The ethnic/racial difference observed for the buffering effect of authoritarian parenting practices offers potential theoretical and clinical implications for conceptualizing the moderating effects of parenting styles on African-American and Caucasian children’s suicidal behavior.     

Sexual Orientation,Parental Support,and Health During the Transition to Young Adulthood

Some recent studies suggest that sexual minorities may have worse health-related outcomes during adolescence because they report lower levels of family connectedness, a key protective resource. Using data from wave 3 of the National Longitudinal Study of Adolescent Health (n = 11,153; 50.6% female; mean age = 21.8 years), this study extends prior research on adolescents to young adults. We examine whether lesbian, gay, and bisexual (LGB) young adults report lower levels of parental support than their heterosexual peers and whether differences in parental support help explain why LGB young adults tend to have worse health-related outcomes. We find that lesbian and bisexual women report lower levels of parental support than heterosexual women and that gay men report lower levels of parental support than bisexual and heterosexual men. Compared to heterosexual women, lesbian and bisexual women have higher odds of suicidal thoughts and recent drug use; bisexual women also have higher odds of elevated depressive symptomatology and heavy drinking. Gay men have higher odds of suicidal thoughts than heterosexual men. With the exception of heavy drinking, parental support either partially or fully mediates each of the observed associations. Even though the transition from adolescence to young adulthood is characterized by increased independence from parents, parental support remains an important correlate of health-related outcomes during this stage of life. Sexual minorities report lower levels of parental support during young adulthood, which helps explain why they have worse health-related outcomes. Interventions designed to strengthen relationships between LGB young adults and their parents could lead to a reduction in health disparities related to sexual orientation.     

One-Year Follow-Up of Suicidal Adolescents: Parental History of Mental Health Problems and Time to Post-Hospitalization Attempt

This longitudinal study of recently hospitalized suicidal youth examined parental mental health history in addition to several indices of adolescent functioning as risk factors for time-to-suicide attempt over a 1-year period. Participants were 352 adolescents (253 girls, 99 boys; ages 13–17 years) who participated in self-report and interview assessments within 1 week of hospitalization and 6 weeks, 3, 6, and 12 months post-hospitalization. Multivariable proportional hazards regression modeled time-to-suicide attempt. Results indicate that adolescents were almost twice as likely to make a suicide attempt if they had at least one biological parent with mental health problems. Risk was also increased for adolescents with baseline histories of multiple previous suicide attempts, more severe suicidal ideation and more severe functional impairment. Findings suggest the need to consider the family system when intervening with suicidal youth.     

Restrictive Emotionality,Depressive Symptoms,and Suicidal Thoughts and Behaviors Among High School Students

Depression and suicidal thoughts and behaviors are prevalent among youth today. The current study sought to further our understanding of the correlates of depression and suicidality by assessing the relationship between restrictive emotionality (difficulty understanding and expressing emotions) and depressive symptoms and suicidal ideation and attempts among adolescents. A large group of high school students (n = 2189, 58.3% male; 13–18 years of age) completed a self-report survey as part of a 2-stage suicide screening project. Logistic regression analyses were used to assess the association between restrictive emotionality and depressive symptoms, suicidal ideation, and suicide attempts. Those reporting high restrictive emotionality were 11 times more likely to have elevated depressive symptom scores, 3 times more likely to report serious suicidal ideation (after controlling for depressive symptoms), and more than twice as likely to report a suicide attempt (after controlling for depressive symptoms) than those reporting low restrictive emotionality. Restrictive emotionality partially mediated the relationship between depressive symptoms and suicidal ideation and behavior. The pattern of association between restrictive emotionality and the outcome variables was similar for boys and girls. Restrictive emotionality is highly associated with elevated depressive symptoms and suicidal thoughts and behaviors among high school students, and may be a useful specific target in prevention and treatment efforts.     

Antecedents of Suicide among Youth Aged 11–15: A Multistate Mixed Methods Analysis

Suicide is the second leading cause of death for youth aged 11 to 15, taking over 5,500 lives from 2003 to 2014. Suicide among this age group is linked to risk factors such as mental health problems, family history of suicidal behavior, biological factors, family problems, and peer victimization and bullying. However, few studies have examined the frequency with which such problems occur among youth suicide decedents or the context in which decedents experience these risk factors and the complex interplay of risk that results in a decedent’s decision to take his/her own life. Data from a random sample of 482 youth (ages 11–15) suicide cases captured in the National Violent Death Reporting System from 2003 to 2014 were analyzed. The sample had fewer girls than boys (31 vs. 69?%) and comprised primarily White youth (79?%), but also African Americans (13?%), Asians (4?%), and youth of other races (4?%). Narrative data from coroner/medical examiner and law enforcement investigative reports were coded and analyzed to identify common behavioral patterns that preceded suicide. Emergent themes were quantified and examined using content and constant comparative analysis. Themes regarding antecedents across multiple levels of the social ecology emerged. Relationship problems, particularly with parents, were the most common suicide antecedent. Also, a pattern demonstrating a consistent progression toward suicidal behavior emerged from the data. Narratives indicated that youth were commonly exposed to one or more problems, often resulting in feelings of loneliness and burdensomeness, which progressed toward thoughts and sometimes plans for or attempts at suicide. Continued exposure to negative experiences and thoughts/plans about suicide, and/or self-injurious acts resulted in an acquired capacity to self-harm, eventually leading to suicide. These findings provide support for theories of suicidal behavior and highlight the importance of multi-level, comprehensive interventions that address individual cognitions and build social connectedness and support, as well as prevention strategies that increase awareness of the warning signs and symptoms of suicide, particularly among family members of at-risk youth.     

Adolescent egocentrism: The association among imaginary audience behavior,cognitive development,and parental support and rejection

Two theoretical perspectives have been advanced to account for heightened egocentrism during early adolescence. One perspective assumes that formal operational thought is associated with increased self-consciousness. The second perspective proposes that parental support and affection diminish egocentrism, while parental rejection enhances self-conscious reactions by young adolescents. Data analysis using responses from 251 early adolescents (131 males, 120 females) on measures of cognitive development and perceived parental support revealed that (a) formal operations diminished adolescent egocentrism, while (b) perceived parental relations were predictive of self-consciousness. Contrary to posttheoretical assumptions, seventh graders functioning at the level of concrete operations were higher in self-conscious egocentrism than were formal-operations youths. Further, perceived parental support was associated with diminished egocentrism, while perceived parental rejection was predictive of heightened self-consciousness.Her research interests focus on early adolescent development.His research interests focus on personality and social development during adolescence.His research interests focus on clinical and counseling psychology and psychotherapy.     

The Relative Influence of Different Domains of Social Connectedness on Self-Directed Violence in Adolescence

Previous research has linked greater social connectedness with a lowered risk of self-directed violence among adolescents. However, few studies have analyzed the comparative strength of different domains of connectedness (e.g., family, peers and school) to determine where limited resources might best be focused. Data to address that gap were taken from the Centers for Disease Control and Prevention’s Student Health and Safety Survey, administered to 4,131 7th–12th graders (51.5% female; 43.8% Hispanic; 22.6% African American or Black). Logistic regressions (controlling for age, gender, race/ethnicity, family structure, academic performance, and depressive symptoms) suggest that family connectedness was a stronger predictor than connectedness to peers, school, or adults at school for non-suicidal self-harm, suicidal ideation, suicide plans, and non-fatal suicidal behavior. In some analyses, peer connectedness was unexpectedly a risk factor. Results have implications for prevention of suicide in adolescence, especially in the context of the current trend towards school-based prevention programs.     

Epidemiology of Suicide Attempts among Youth Transitioning to Adulthood

Suicide is the second leading cause of death for older adolescents and young adults. Although empirical literature has identified important risk factors of suicidal behavior, it is less understood if changes in risk factors correspond with changes in suicide risk. To address this knowledge gap, we assessed if there were different trajectories of suicidal behavior as youth transition into young adulthood and determined what time-varying risk factors predicted these trajectories. This study used four waves of data spanning approximately 13 years from the National Longitudinal Study of Adolescent Health. The sample included 9027 respondents who were 12–18 years old (M?=?15.26; SD?=?1.76) at Wave 1, 50% male, 17% Hispanic, and 58% White. The results indicated that 93.6% of the sample had a low likelihood for suicide attempts across time, 5.1% had an elevated likelihood of attempting suicide in adolescence but not young adulthood, and 1.3% had an elevated likelihood of attempting suicide during adolescence and adulthood. The likelihood of a suicide attempt corresponded with changes on depression, impulsivity, delinquency, alcohol problems, family and friend suicide history, and experience with partner violence. Determining how suicide risk changes as youth transition into young adulthood and what factors predict these changes can help prevent suicide. Interventions targeting these risk factors could lead to reductions in suicide attempts.     

The Association Between Family Factors and Depressive Disorders in Adolescents

The main aim of this study was to examine the familial factors (parental psychopathology and attachment to parents) in depressed adolescents. Another aim was to compare level of psychosocial impairment, use of mental health services, suicidal ideation and attempt, and the clinical features of depression (e.g., severity and age of onset) among depressed adolescents with depressed parent(s) with those whose parent(s) do not have any depression. Result showed that the adolescent depression was significantly associated with an elevated rate of having a depressed mother. Perceived level of attachment to parents, as measured using the Inventory of Parent and Peer Attachment, was significantly lower among depressed adolescents than among adolescents without any psychiatric disorders. Depressed adolescents with depressed parents reported significantly higher suicidal ideation and had more recurrent depressive episodes than depressed adolescents with nondepressed parent(s). Our results imply the importance of shifting our focus from universal programs to family-based prevention and intervention programs for depression.     

Peer Rejection,Affiliation with Deviant Peers,Delinquency, and Risky Sexual Behavior

Risky sexual behavior poses significant health risks by increasing sexually transmitted infections and unintended pregnancies. Previous research has documented many factors related to risky sexual behavior. This study adds to the literature by proposing a prospective, developmental model of peer factors related to risky sexual behavior. Developmental pathways to risky sexual behavior were examined in a sample of 517 individuals (51 % female; 82 % European American, 16 % African American, 2 % other) followed from age 5–27. Structural equation models examined direct and indirect effects of peer rejection (assessed via peer nominations at ages 5, 6, 7, and 8), affiliation with deviant peers (assessed via self-report at ages 11 and 12), and delinquency (assessed via maternal report at ages 10 and 16) on risky sexual behavior (assessed via self-report at age 27). More peer rejection during childhood, affiliation with deviant peers during pre- adolescence, and delinquency in childhood and adolescence predicted more risky sexual behavior through age 27, although delinquency at age 16 was the only risk factor that had a significant direct effect on risky sexual behavior through age 27 above and beyond the other risk factors. Peer rejection was related to subsequent risk factors for girls but not boys. Peer risk factors as early as age 5 shape developmental pathways through childhood and adolescence and have implications for risky sexual behavior into adulthood.     

Sibling Relationships and Empathy Across the Transition to Adolescence

Although socioemotional competencies have been identified as key components of youths’ positive development, most studies on empathy are cross-sectional, and research on the role of the family has focused almost exclusively on parental socialization. This study examined the developmental course of empathy from age 7 to 14 and the within-person associations between sibling warmth and conflict and youths’ empathy. On three occasions across 2?years, mothers, fathers, and the two eldest siblings from 201 White, working- and middle-class families provided questionnaire data. Multilevel models revealed that, controlling for youths’ pubertal status and parental education, girls’ empathy increased during the transition to adolescence and then leveled off, but boys’ lower levels of empathy remained relatively unchanged. Moreover, controlling for parental responsiveness and marital love, at times when firstborns and second-borns reported more sibling warmth and less sibling conflict than usual, they also reported more empathy than usual. The within-person association between sibling warmth and empathy also became stronger over time. Findings highlight gender differences in empathy development and the unique role of siblings in shaping each other’s socioemotional characteristics during adolescence.     

The Relationship of Impulsivity-Inattention and Verbal Ability to Overt and Covert Antisocial Behaviors in Children

Research has linked many risk factors in childhood and early adolescence to antisocial behaviors in later adolescence and early adulthood; however, less attention has focused on the interaction among factors in the prediction of distinct forms of antisocial behaviors. This study investigated the additive and synergistic association of inattention-impulsivity and verbal ability with overt and covert antisocial behaviors using a high risk community sample of 270 (49.8% female) children. Multiple regression analyses indicated kindergarten inattention-impulsivity was significantly related to overt and covert antisocial behaviors and the interaction of inattention-impulsivity and verbal ability significantly predicted covert but not overt antisocial behaviors during kindergarten and first grade. Kindergarten verbal ability did not buffer the association of impulsivity-inattention with covert antisocial behavior; rather higher verbal ability was associated with increased risk for covert antisocial behavior in the presence of high levels of impulsivity-inattention. The association of inattention-impulsivity with higher levels of overt and covert antisocial behavior begins during childhood, and may set off developmental trajectories associated with the acceleration of antisocial behavior in adolescence.     

Negotiating the Early Developing Body: Pubertal Timing,Body Weight,and Adolescent Girls’ Substance Use

Despite knowledge that early pubertal timing predicts adolescent girls’ substance use, it is still unclear whether this relationship persists beyond early adolescence and whether it is conditional on girls’ body weight. This study examined the moderating role of body weight in the association between early pubertal timing and adolescent girls’ substance use using three waves of data from the National Longitudinal Study of Adolescent Health. The analytic sample included 5,591 adolescent girls attending middle-schools and high-schools in the United States (ages 10–15, 71% White, 14% Black). Results indicated that early pubertal timing was associated with substance use risk but effects were attenuated after controlling for prior use. Body weight moderated the association between early pubertal timing and girls’ reported number of substances tried in middle adolescence. Body weight magnified the risk of having tried one substance, but buffered the risk of having tried three substances. Among those girls who did use substances, body weight did not moderate the relationship between early pubertal timing and heavy substance use. It is concluded that the substance use risk associated with early pubertal timing is most salient during the developmental period in adolescence when sensitivity to bodily changes may be heightened.     

Suicidal Ideation and Distress Among Immigrant Adolescents: The Role of Acculturation, Life Stress, and Social Support

Acculturative stress and social support play important roles in suicide-related phenomena among adolescent immigrants. To examine their contributions, measures of acculturative and general life stress and a measure of multiple sources of social support were used to predict psychological distress and suicidal ideation among Korean-born high school students residing in the US. Korean students who were sojourning without both parents were compared to Korean students who immigrated with both parents, Korean students who remained in Korea, and American high school students in the US (total N = 227; 56.8% female). The sojourning group reported higher levels of life stress, distress, psychological symptoms, and suicidal ideation than the other groups. Within the two acculturating groups, levels of distress, symptoms, and suicidal ideation were associated with life stress, lack of parental support, and not living with both parents. The findings have important implications for suicide prevention among immigrant adolescents, and imply that parental support is particularly protective.