Family Conflict in Adolescents with Acute Suicidality, Depression, and Controls

Family conflict in adolescents with type 1 diabetes (T1D) has been linked to worse disease management (i.e., glycemic control, adherence to treatment regimen) and reduced quality of life. We sought to examine parental risk factors associated with increased levels of diabetes-specific family conflict and to investigate the discrepancies between parent and adolescent reports of conflict. Adolescents with T1D and their parents (N = 120 dyads) completed measures of diabetes-specific family conflict. Adolescents also reported on health-related quality of life, and parents reported on demographic information. Clinical data were obtained from adolescents' medical records. Adolescents reported significantly greater levels of conflict than their parents around direct diabetes management tasks (e.g., checking blood sugars) and indirect management tasks (e.g., carrying supplies for high or low blood sugars). Several demographic factors were associated with family conflict, including parental education, marital status, and household income. Discrepancies between parent and adolescent reports of family conflict were significantly associated with diabetes-related outcomes. Specifically, higher quality of life was related to discrepancies between parent and adolescent reports of conflict around indirect management tasks. In addition, poorer glycemic control was related to discrepancies between parent and adolescent reports of family conflict around direct diabetes management tasks. These results support obtaining both the adolescent and parent report of conflict for unique information regarding family functioning. (PsycINFO Database Record

Family conflict exacerbates the course of bipolar disorder (BP) among adults. However, few studies have examined family conflict among adolescents with BP, and fewer have looked at adolescent-reported and parent-reported family conflict separately. Subjects were 89 adolescents, aged 13 to 19 years, with a diagnosis of BP on the basis of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (KSADS-PL). Subjects were divided into high-conflict and low-conflict groups using a median split on the Conflict Behavior Questionnaire (child report and parent report). The χ(2) analyses and independent samples t tests were performed for univariate analyses. Multivariable logistic regression analyses were performed on variables with P<0.2. Parent-reported and adolescent-reported Conflict Behavior Questionnaire scores were significantly correlated (r=0.50, P<0.001). High parent-reported family conflict was positively associated with recent manic symptoms, externalizing comorbidities, and dimensional scores reflecting emotional dysregulation. High adolescent-reported family conflict was positively associated with recent manic symptoms and emotional dysregulation, and negatively associated with socioeconomic status and lifetime psychiatric hospitalization. Bipolar subtype was significantly associated with high versus low family conflict. The limitations of this study included being a cross-sectional study, use of a medium-sized sample, and lack of a control group. Despite substantial agreement between adolescents and parents regarding the amount of family conflict, there were meaningful differences in the factors associated with adolescent-reported and parent-reported conflict. These findings demonstrate the importance of ascertaining family conflict from adolescents as well as from parents. Moreover, these findings can potentially inform family therapy, which is known to be effective for adolescents with BP.

Less parental monitoring of adolescents' diabetes self-care and more family conflict are each associated with poorer diabetes outcomes. However, little is known about how these two family factors relate with one another in the context of self-care and glycemic control. Diabetes self-care was evaluated as a mediator of the associations among parental monitoring, family conflict, and glycemic control in early adolescents with type 1 diabetes. Adolescent-parent dyads (n = 257) reported on the frequency of parental monitoring, family conflict, and diabetes self-care. Hemoglobin A1c was abstracted from medical charts. Structural equation modeling was used for mediation analysis. A mediation model linking parental involvement and family conflict with A1c through diabetes self-care fit the data well. Monitoring and conflict were inversely correlated (β = -0.23, p < .05) and each demonstrated indirect associations with A1c (standardized indirect effects -0.13 and 0.07, respectively) through their direct associations with self-care (β = 0.39, p < .001 and β = -0.19, p < .05, respectively). Conflict also was positively associated with higher A1c (β = 0.31, p < .01). Elevated family conflict and less parental monitoring are risk factors for poorer glycemic control, and diabetes self-care is one mediator linking these variables. Interventions to promote parental monitoring of diabetes management during early adolescence may benefit from emphasizing strategies to prevent or reduce family conflict.

Using a daily diary method, this study assessed daily episodes of family and peer conflict among 578 adolescents in the 9th grade to examine potential bidirectional associations between the family and peer domains. Adolescents completed a daily diary checklist at the end of each day over a 14-day period to report events of conflict and their emotional states for a given day. Overall, the within-person models provided evidence for the bidirectional nature of family peer linkages across gender and ethnicity. Adolescents experienced more peer conflict on days in which they argued with parents or other family members, and vice versa. Effect of family conflict further spilled over into peer relationships the next day and 2 days later, whereas peer conflict predicted only the following day family conflict. Adolescents' emotional distress partially explained these short-term spillovers between family and peer conflict.

Objective: This study examined cross-sectional and prospective differences in mental health and family functioning among caregivers aware of their child’s self-injurious thoughts and behaviors (SITB), caregivers unaware of their child’s SITB, and caregivers of children without SITB. Methods: Data were drawn from an epidemiological U.S. sample of 11,303 children (ages 9-10) and their caregivers who participated in three-yearly assessments as part of the Adolescent Brain and Cognitive Development Study. Caregivers reported on their child’s SITB, family conflict, and their own mental health problems. Children reported on their SITB, family conflict, parental monitoring, and parental acceptance. Results: Compared to caregivers of non-SITB children (81%), both aware (9.9%) and unaware (9.1%) caregivers reported more externalizing problems at baseline and family conflict at baseline and follow-up. Their children reported more family conflict and lower parental monitoring and acceptance at baseline and follow-up. Relative to unaware caregivers and those with non-SITB children, aware caregivers reported higher levels of internalizing problems at baseline and higher odds for SITB at baseline and follow-up. Children of aware caregivers reported lower family conflict and higher parental monitoring and acceptance at baseline, relative to children of unaware caregivers. However, aware caregivers reported higher levels of family conflict at baseline and one year later. Conclusions: Caregivers of children with SITB, whether aware or unaware, experienced externalizing problems and long-term negative effects on family functioning. Aware caregivers faced greater psychological distress. Family-focused interventions that address the quality of parent-child relationships and caregivers’ mental health are vital to reducing youth SITB risk.

Introduction: Increased peripheral inflammation has been consistently documented in both adult and pediatric depression. However, elevated levels of C-reactive protein (CRP), a nonspecific biomarker for inflammation, have been primarily reported in adults; whether CRP plays a similar role in adolescent depression has not been conclusively established. In our prior work, we identified relationships between CRP and reward neurocircuitry in adolescents with psychiatric symptoms (N = 64) but not with depressive symptoms. Extending this work, we sought to examine CRP across the full range of mood and anxiety symptom severity in a larger, clinically diverse cohort of psychotropic medication-free adolescents and healthy controls (HCs). Methods: Subjects were adolescents (N = 127, age: 15.17 ± 2.19 years, 78 female) with psychiatric symptoms (n = 96, including previous cohort of 64) and HC (n = 31). All completed a semi-structured psychiatric evaluation and dimensional assessments for depression, anxiety, anhedonia, and suicidality. Group-comparison and correlation analyses utilized nonparametric statistics controlled for body mass index, sex, and age at pFWE < 0.05. Results: No group differences were identified in CRP levels between the clinical cohort and HCs. In addition, correlations between CRP and clinical symptomatology were not significant in either the whole sample or the psychiatric group. Conclusions: We found that, unlike in adults, CRP was not associated with depressive symptoms. This suggests that inflammation in pediatric depression is more narrowly delimited at the onset of psychiatric symptoms and may only become systemic with chronicity.

Prevention of Depression in Children and Adolescents

Few studies have examined the relationship between diabetes-related family conflict and parent fear of hypoglycemia (FOH) in adolescents, thus the current research evaluated this connection. This study specifically examined three subdimensions of FOH which parents of children with diabetes may experience: maintaining blood glucoses higher than medical recommendations, worrying about and/or feeling helplessness about preventing low blood glucoses, and worrying about social consequences associated with low blood glucoses. At the baseline visit of an RCT aimed at improving health outcomes of youth with elevated A1C (9-12% in the last year) , caregivers completed the Diabetes Family Conflict Scale and the Parent Hypoglycemia Fear Survey. N=1child-caregivers dyads (child age=14.7±1.9 years, T1D duration=6.5±3.4 years, A1C=9.9±1.6%; 53% female; 77% continuous glucose monitor; 82% insulin pump) . In three separate regression models, no child demographic or T1D clinical characteristics other than A1C were associated with family conflict. After controlling for A1C, only Worry/Helplessness About Low Blood Glucose (b=0.182; p=0.025) and Worry About Negative Social Consequences (b=0.532; p=0.008) significantly predicted parent-reported family conflict; Maintain High Blood Glucose (b=0.082; p=0.73) was not significant. This is the first study to demonstrate that caregivers’ worry about their adolescents having low blood glucoses is associated with diabetes-specific family conflict- a common adherence barrier for adolescents with T1D and their families. This finding supports screening caregivers for fear of hypoglycemia and incorporating into treatment when providing intervention for families with high levels of conflict. Important next steps include dyadic data analysis to understand how fear of hypoglycemia symptoms among child-caregiver dyads affect family conflict. Disclosure H.Manis: Other Relationship; Abbott Diabetes. H.K.O'donnell: None. G.T.Alonso: None. S.Majidi: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. R.Wadwa: Advisory Panel; Dompé, Consultant; Beta Bionics, Inc., Other Relationship; Tandem Diabetes Care, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care, Inc. K.A.Driscoll: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113363)

Family cohesion and family conflict are important protective and risk factors respectively in the development of child psychopathology. Our study examines parent-adolescent discrepancy of the family environment constructs, family cohesion and family conflict, and their associations with adolescent impairment. The sample consists of 141 parent-adolescent dyads evaluated at an outpatient behavioral health clinic. The mean adolescent age is 14.8 (range 11–18) while the mean parent age is 48.9 (range 32–67). Findings show that adolescents report significantly less family cohesion but do not differ significantly in reports of family conflict. Greater family cohesion is associated with less adolescent impairment by multiple reporters. Nonetheless, greater family conflict is associated with more adolescent impairment by the same reporter. The results show that both adolescent and parent reports of family cohesion and conflict are important to consider when integrating information gathered in a clinical assessment.

Objective: To explore the relationship between family conflict and adolescent future suicidal behavior. Methods: A total of 7 072 adolescents who participated in the baseline survey and the first follow-up survey of Shandong Adolescent Behavior and Health Cohort were included in the analysis. They were sampled from 8 middle schools in 3 counties of Shandong province, China. A self-reported questionnaire was used to measure suicidal behavior, family conflict, depression, and demographic characteristics. Logistic regression model was used to analyze the relationship between family conflict and suicidal behavior. Results: In the baseline survey, the age of 7 072 subjects was (14.58±1.45) years, and boys and girls accounted for 50.0% respectively. 750 people (10.6%) had any suicidal behavior, of which 707 (10.0%), 258 (3.6%) and 190 (2.7%) had suicidal ideation, suicide planning and suicide attempt, respectively. The family conflict scores of the suicidal group were higher than those of the non-suicidal group. After adjusting for covariates, logistic regressions showed that family conflict was associated with increased risk of suicidal behavior (OR=1.05, 95%CI: 1.01-1.10), suicidal ideation (OR=1.05, 95%CI: 1.00-1.09), suicide planning (OR=1.08, 95%CI: 1.01-1.16) and suicide attempt (OR=1.10, 95%CI: 1.02-1.19). Further stratified by gender, results showed no significant association between family conflict and suicidal behavior in girls; the association of family conflict with suicidal behavior was more significant in boys, especially for suicidal ideation and suicide planning, and the OR value of the latter was higher than the former. The results were stable after sensitivity analysis in males. Conclusions: Family conflict might increase the risk of adolescent suicidal behavior, especially in males. Harmonious family environment and good family atmosphere are of great significance to adolescent suicide prevention and control.

Effects of Growth in Family Conflict in Adolescence on Adult Depressive Symptoms: Mediating and Moderating Effects of Stress and School Bonding

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Keywords: Alcohol abuse; Comorbidity; mental health; substance use; emerging adulthood; adolescence

Abstracts

We aimed to explore the association between family conflict and HPA axis activity, especially with respect to the potential modulating effect of puberty. A total of 205 adolescents and 244 adult parents were recruited. Family conflict was assessed by the family conflict subscale of the Family Environmental Scale and serial salivary cortisol was measured in all participants. A marginally lower AUCg at 30 minutes after wake up in the morning and a significant lower AUCg at 60 minutes and 90 minutes in adult parents with high family conflict was found when compared to those with low family conflict. In adolescents, there were significant interaction effects between pubertal status and family conflict on AUCg (interaction p values <0.05). Among the adolescents with low family conflict, those at late/post pubertal status had higher AUCg than their pre/early pubertal counterparts but this difference was not observed in the adolescents with high family conflict. Adverse family environment is associated with HPA axis dysfunction in adults and late/post pubertal adolescents and pubertal maturation plays a critical role in modulating the association between family environment and HPA axis function.