At-risk Youth Research Articles

Sustainability of Treatment Programs Utilizing Medications for Opioid Use Disorders in Incarcerated Young Adults.

The epidemic of opioid overdose brought a major health crisis to the front line of public health in the United States. Early efforts have focused on the prevention of production, distribution, and consumption of the drugs. However, there is little information about youth populations at risk for opioid overdose and their response to targeted treatment plans. The San Bernardino County Youth Opioid Response (SBCYOR) coalition in collaboration with the San Bernadino County (SBC) Probation Department organized a safety net system for at-risk youth by improving communication among county resources. This program mainly focused on individuals aged 12 to 24 years in the county's detention centers along with educational and prevention projects such as naloxone programs for first responders in the region. To describe the impact of the SBCYOR program on at-risk youth, we compare the frequencies of patients referred and treated with medications for opioid use disorder (MOUD) at the SBC Probation Department, which was responsible for individuals from age 12 to less than 18 years, with those from the West Valley Detention Center (WVDC), which was responsible for adults (18 to 24 years of age), from September 2020 through June 2022. Similar proportions of youths were referred for treatment of opioid use disorder (OUD) at the respective sites (3.7% SBC Probation Department, 3.6% WVDC). Of these, however, 78.0% were treated with MOUD at SBC Probation Department compared with only 7.1% at WVDC. SBCYOR coalition partners were able to transform their services into a comprehensive medical and behavioral health program for the incarcerated youth population at risk for OUD.

Patterns of Adolescent Peer Affiliation among Youth At-Risk of Maltreatment

This study examined patterns of peer affiliations and their associations with child maltreatment, substance use, and future expectations. This study focused on 844 adolescents from the Longitudinal Studies of Child Abuse and Neglect. We identified four distinct peer-affiliation patterns: (1) no affiliation with peers who engage in either prosocial or deviant behaviors; (2) affiliation with peers using substances; (3) affiliation with peers who engage in severe deviant behaviors; and (4) affiliation with peers who engage in prosocial behaviors. Youth with sexual abuse experiences were more likely to be affiliated with peers who engage in severe deviant or prosocial behaviors. We also found different substance use and future expectations depending on peer affiliations. This study highlights the importance of examining both prosocial and deviant peer affiliations.

Traumatic and Adverse Childhood Experiences and Developmental Differences in Psychiatric Risk

While adverse childhood experiences (ACEs) are known to impart significant risk for negative mental health and cognitive outcomes in youth, translation of ACE scores into clinical intervention is limited by poor specificity in predicting negative outcomes. This work expands on the ACE framework using a data-driven approach to identify 8 different forms of traumatic and adverse childhood experiences (TRACEs) and reveal their differential associations with psychiatric risk and cognition across development. Building upon the traditional ACEs model, this study aimed to characterize unique components of commonly co-occurring TRACEs and to examine moderation of longitudinal change in mental health and cognitive development during adolescence. This work draws from youth and their caregivers who completed up to 4 annual behavioral assessments from 2016 to 2021 as part of the ongoing Adolescent Brain Cognitive Development (ABCD) study. Data collection was performed at 21 regionally-distributed sites across the United States. Analyses for this work were conducted January 2023 through November 2023. Youth participants in the ABCD study's exposure to 268 different TRACEs, which were distilled into adversity components using nonlinear principal components analysis. Mixed-effects and latent change score models considered TRACEs components as moderators of longitudinal change in internalizing and externalizing mental health problems, as well as longitudinal change in cognitive ability. Data were distilled from 11 876 youth participants, who were grouped into dyads with a caregiver. ABCD study youth participants were 9 to 10 years old at baseline assessment (year 0) and 12 to 13 years old at ABCD year 3. A total of 5679 participants (47.8%) were female. Analyses revealed that TRACEs organized into 8 thematic adversity components (e.g., family conflict, interpersonal violence). At baseline assessment (year 0), exposure to nearly every adversity component was associated with poorer mental health and diminished cognitive ability. Yet across time, it was observed that different forms of adversity were variably linked to both increases and decreases in internalizing and externalizing problems. For example, while peer aggression (t = 5.31) and family conflict (t = 5.67) were associated with increases in both internalizing and externalizing problems over early adolescence, community threat (t = 2.82) and poverty (t = 2.07) were linked to decreased problems, potentially representing adaptive suppression of symptoms. Finally, adversity types related to resource deprivation (eg, poverty, caregiver maladjustment) were associated with declines in cognitive ability over early adolescence. In this cohort study, distinct forms of TRACEs differentially moderated developmental changes in psychiatric risk and cognitive ability in different ways, offering the possibility for precision-based prediction of risk for youth. Such findings could be used in targeted early prevention and intervention strategies for at-risk youth.

A Systematic Review of Resilience in At-Risk Youth for Psychotic Disorders: An Analysis of Protective and Risk Factors from Recent Literature.

Psychotic disorders in youth pose significant challenges for mental health services, necessitating a detailed understanding of the interplay between risk factors and resilience. This systematic review aimed to assess how resilience factors might buffer the adverse effects of risk factors on the development of psychosis among youth, thereby informing targeted interventions. Studies were selected based on criteria including a focus on individuals aged up to 25 years old at risk for psychosis, the examination of both risk factors and resilience, and the use of validated instruments for measuring outcomes. Literature searches were conducted across several databases, such as PubMed, Scopus, and Web of Science. Data extraction emphasized odds ratios (ORs) and hazard ratios (HRs) for risk factors, including familial, developmental, and socio-environmental influences. The review included and analyzed nine studies, encompassing a diverse sample of 140,972 participants. Significant findings indicate that highly supportive familial and community environments significantly reduce the risk of psychosis onset. For instance, children with strong family support and engagement in structured activities demonstrated a 40% lower incidence of developing psychotic symptoms [p < 0.05]. Furthermore, the presence of neurobehavioral deficits, such as impaired verbal memory and attention, emerged as significant predictors of psychosis, with these children exhibiting a threefold increase in risk compared to their peers [OR = 3.2, 95% CI: 2.1-4.8, p < 0.01]. Resilience factors play a critical role in mitigating the impact of psychosocial and neurobiological risks in the development of psychosis among youths. Interventions enhancing resilience could potentially alter the trajectory of psychosis development, emphasizing the need for early and targeted psychosocial interventions to support at-risk populations. This study underscores the importance of fostering resilience through both individual-focused and community-based strategies to prevent the onset of psychotic disorders in vulnerable young populations.

Six of one, half a dozen of the other? Examining measurement properties of different potentially traumatic event polyvictimization operationalizations using a multiverse analysis framework.

Numerous differences exist between and within research projects related to assessment and operationalization of potentially traumatic events (PTEs) for youth, especially when measuring polyvictimization. However, few studies have systematically examined how polyvictimization measurement differences influence PTE's relation to functioning. This study sought to address these knowledge gaps by conducting a secondary data multiverse replication (SDMR) to systematically (re)evaluate PTE polyvictimization measurement approaches. Participants included 3297 adolescents (Mage = 14.63; 50.59% female; 65.15% white) from the National Survey of Adolescents-Replication study who completed a structured interview on PTE exposure and emotional and behavioral health (i.e., posttraumatic stress and major depressive disorder, drug and alcohol use, and delinquency). Results indicated that PTE operationalizations using a count variable tended to demonstrate better model performance and prediction of youth at-risk of emotional and behavioral health challenges, compared to models using a binary (yes/no) PTE operationalization. Differences in model performance and prediction were less distinct between models examining multiple forms of a single type of PTE (e.g., maltreatment, community violence), compared to models examining multiple PTE types. These findings emphasize the importance of using multidimensional approaches to PTE operationalization and the need for more multiverse analyses to improve PTE evidence-based assessment.

Causes Behind Escalation of Juvenile Delinquency in Quetta City A Case Study of Juvenile Prisoners in Balochistan Province

Juvenile delinquency is a substantial issue both universally and nationally, mostly in Balochistan. This study objects to explore the causes backing to juvenile delinquency in Quetta city of Balochistan Province. The research was conducted at one of the Jail, located in Quetta city of Province of Balochistan. Data was collected through two rounds of interviews: one with juvenile offenders and another with legal professionals. Information on the juveniles’ age, education, socioeconomic background, family history, and employment status was gathered through structured questionnaires. The collected data was analyzed and compiled to identify the underlying causes of delinquency. The results revealed that juvenile delinquency in Quetta is driven by multiple factors, with poverty and illiteracy emerging as the most significant contributors. These findings underscore the urgent need for targeted interventions to address the socio-economic challenges faced by at-risk youth in the region and gives a comprehensive approach that tackle systematic issues, support families and provide opportunities for youth.

Shaping the Future Orientation of At-Risk Young Adults: The Role of Social Networks

Although future orientation (FO) is considered an important resiliencepromoting factor among at-risk youth, little is known concerning the FO of at-risk young adults. The current study explored the FO of at-risk young adults, including its motivational, cognitive and behavioral components, and investigated the contribution of various attributes of youths’ social networks. Participants were 230 at-risk young adults (18–25) who participated in Yated, the national program for at-risk young people in Israel. Results indicated relatively high levels of FO across its three components, with motivational FO being significantly higher than the behavioral and cognitive components. Attributes of the social network contributed significantly to young people’s FO. Specifically, adequacy of support was associated with motivational and behavioral FO, whereas having larger networks predicted higher levels of cognitive and behavioral FO. These findings highlight the multifaceted nature of FO and the significant yet differential impact of attributes of at-risk youths’ social networks.

Effect of comorbid psychologic and somatic symptom trajectories on early onset substance use among U.S. youth in the ABCD study

BackgroundAdolescent substance use (SU) is often motivated by a desire to alleviate undesirable symptoms. To test the self-medication hypothesis, we examined associations between comorbid psychologic and somatic symptom trajectories across early adolescence and early onset SU. MethodsUsing Adolescent Brain Cognitive Development Study® data, we differentiated youth who reported no SU at baseline based on their comorbid anxiety, depression, pain, somatic and somnolence symptom trajectories. The outcome, early onset SU (by age 13–14 years) was derived from self-reported alcohol (≥full drink), tobacco (full regular/e-cigarette), marijuana, or other drug use over 5 years. Results8311 participants were classified with Asymptomatic (27.8 %), Low/stable (39 %), Moderate/persistent (25.3 %) or High/worsening trajectories (7.9 %) from age 9.97 ± 0.74 to 13.57 ± 0.88 years. Early onset SU was 56 % higher for Moderate-High compared to Asymptomatic-Low symptom trajectory groups (12.5 % vs. 8.5 %; OR 1.56 [95 % CI 1.33, 1.79]). Adjusted for covariates, the High/worsening group was more likely than the Asymptomatic group to report use of any substance (adj.OR 2.13 [95 % CI 1.40, 3.25], Alcohol (adj.OR 2.80 [95 % CI 1.56, 5.02]), Tobacco (adj.OR 2.09 [95 % CI 1.23, 3.55]), and Marijuana (adj.OR 2.33 [95 % CI 1.36, 3.99]). Longitudinal, time-lagged analyses revealed potential feedback effects of earlier depression on subsequent SU, and earlier SU on later depression (p < 0.001). ConclusionHigher comorbid symptom trajectories emerging in late childhood increased the likelihood of early onset SU. Since negative feedback loops may contribute to symptom persistency, ongoing and potentially harmful SU for at-risk youth, addressing comorbid symptoms that emerge during late childhood is warranted.

Resilience in the aftermath of trauma: Classes of adjustment in at-risk youth.

Youth who have been exposed to potentially traumatic events are at risk of developing chronic and severe adjustment problems. However, some youth exposed to potentially traumatic events exhibit better-than-expected adaptation. Person-centered analyses, based on multiple criteria for adaptive behavior and adversity, are well-suited to empirically identifying different patterns of adaptation among high-risk youth. Data from 381 youth from three at-risk subgroups in Portugal were collected using self-reported measures of trauma history, trauma-related symptomatology, coping skills, and perceived social support. Distinct classes of adaptation after traumatic experiences were examined with latent class analysis. Four classes were identified: (a) trauma-related psychopathology class (13.6%), (b) adaptive resilience class (36.8%), (c) low resources class (11.4%), and (d) high resources class (38.2%). Trauma-related psychopathology class and low resources class were characterized by high levels of maladjustment. Similarly to the low resources class, the trauma-related psychopathology class reported a significantly higher likelihood of trauma-related psychopathology and higher levels of problem-solving skills. The adaptive resilience class and high resources class also reported lower levels of maladjustment, and the high resources class reported higher levels of coping skills and lower levels of externalizing problems than any other class. Clinicians treating children's internalizing mental health or externalizing behavior problems should assess trauma history and trauma-related psychopathology, as well as protective resources that may enhance resilience such as skills for problem solving and social support seeking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Administration of Youth Justice Through the Lens of Community-Based Service Providers: Risk Factors and Programming Challenges

Since the Youth Criminal Justice Act of 2003 in Canada, the juvenile justice system has prioritized diverting youth away from in-custody sentences (incarceration in jail, prison, or other facilities) and towards a community-based system of justice. Despite this shift, there is limited research directly examining the experience of community-based service providers that were responsible for this shift in adjudicating youth. To understand the experience of working with youth involved in the system, we conducted semi-structured interviews with youth justice workers from one of the largest community-based organizations in a western Canadian province that offer alternatives to custody for at-risk youth. Findings provide a complex depiction of youth risk factors and illustrate the successes and challenges of administering youth justice in a community context.

The effects of folk-dance in schools on physical and mental health for at-risk adolescents: a pilot intervention study.

We present the findings from a pilot study to evaluate the effects of a six-week adapted folk-dance intervention on physical and mental health for at-risk adolescents conducted in schools. At-risk adolescents are at particular risk for sedentary behavior, poor mental health, and lower quality of life, and are likely to benefit from motivating and health-promoting activities such as dance. However, it can be challenging to conduct and evaluate evidence-based interventions with this population. We conducted a convergent parallel mixed-method design using pre-post measures of mental well-being, as well as pre-post measures using inertial measurement units to assess physical activity during a 6-week adapted folk-dance intervention. At the completion of the study, we conducted semi-structured interviews with all stakeholder groups. We observed significant improvements in mental well-being, as indicated by increased WEMWBS and MHC-SF scores, while the UCLA score showed no significant change, with these outcomes independent of age and gender. Furthermore, at-risk adolescents reduced the time spent in stationary/resting position, while their heart rates were also reduced by ∼15% in such conditions. Our results suggest that at-risk youth who participated in adapted folk-dance became more enthusiastic and showed more willingness to move over the course of the intervention. Quantitative results were supported by interviews, which found that participants responded positively to the adapted folk-dance classes, and reported both elevated physical exertion and high levels of enjoyment. The mixed-method research design also provided insights into the suitability of data collection methods for this hard-to-reach population. We report on these outcomes, including best practices for working within schools on health-promoting physical activities.

Development and implementation determinants of competency frameworks for mental health clinicians and service providers working with youth: a scoping review protocol

IntroductionDespite high prevalence, access to mental healthcare for Canadian youth is limited, with less than 20% receiving adequate treatment. Marginalised and at-risk youth face particular challenges, including cultural misunderstandings, long...

Barriers and Facilitators to Accessing Opioid Agonist Therapy for Street-involved Adolescents and Young Adults in Vancouver.

Opioid agonist therapy (OAT) remains the first-line therapy for people with opioid use disorder. Whereas overdose rates among adolescents and young adults (AYAs) remain high, little is known about their access to OAT. Therefore, we sought to evaluate factors that shape access to OAT among AYAs aged 14 to 26 years. Data were derived from the At-Risk Youth Study, a prospective cohort study that involves street-involved AYAs who use illicit substances in Vancouver, Canada. Generalized estimating equations were used to identify factors associated with OAT enrollment from September 2005 to October 2021. A total of 759 AYAs reported at least weekly opioid or OAT use, with a median age of 23 years and 65.7% self-identifying as male. At baseline, 147 participants (19.4%) were on OAT, and another 199 (26.2%) initiated OAT during study follow-up (median number of follow-up visits, 5 [Q1-Q3, 2.5-8]). In a multivariable analysis, being <19 years old (adjusted odds ratio [AOR], 0.40; 95% confidence interval [CI], 0.23-0.71), Indigenous ancestry (OR, 0.72; 95% CI, 0.52-1.00), homelessness (AOR, 0.65; 95% CI, 0.54-0.77), drug dealing (AOR, 0.73; 95% CI, 0.61-0.87), daily opioid use (AOR, 0.47; 95% CI, 0.40-0.55), and nonfatal overdose (AOR, 0.73; 95% CI, 0.60-0.89) were negatively associated with OAT use. This study identified a low rate of OAT access among AYAs. Adolescents and young adults were less likely to be on OAT if they were <19 years old, Indigenous, and possessed certain risk markers. These findings highlight the need for mitigation strategies to facilitate OAT access for this population and for additional harm reduction measures to support AYAs who do not want to use OAT.

The unintended consequence of school suspension: How school suspension impacted future grades and misconduct

The goals of this study were to explore the mechanism via which school suspension leads to adverse academic and behavioral consequences. The author utilized the theoretical framework of general strain theory and assessed whether bonds with school, a prosocial bond preventing deviant outcomes, functioned as a mediator in the path between school suspension and students’ future performance. Based on four waves of longitudinal data of at-risk youth, the study employed structural equation modeling and bootstrapping methods to examine the nexus of suspension, perceived school environment, and adverse academic and behavioral outcomes. Findings revealed that school suspension deteriorated subsequent ratings of school environment among youth respondents. Further, an indirect effect between suspension and worsening of grades was observed and this indirect effect resulted in low ratings of school environment. Although suspension directly predicted future misconduct, no mediation effect of school environment was identified in this link. Implications for intervention programming are discussed.

Development and Implementation of Postdischarge Text Messages to Adolescents With Suicidal Thoughts and Behaviors Through Caring Contacts: Implementation Study.

Youth suicide is a pressing public health concern, and transitions in care after a suicidal crisis represent a period of elevated risk. Disruptions in continuity of care and emotional support occur frequently. "Caring contacts" validating messages post discharge have the potential to enhance connections with patients and have been shown to improve outcomes. More recently, positive outcomes have been noted using caring contact text messages (SMS and MMS), which hold promise for engaging patients in a pediatric setting, but there are few studies describing the large-scale implementation of such an approach. This study aims to describe the process of developing and implementing automated caring contacts within a quality improvement framework, using a standardized series of supportive texts and images, for adolescents discharged from high-acuity programs at a large midwestern pediatric hospital. We describe lessons learned, including challenges and factors contributing to success. We implemented the caring contacts intervention in 3 phases. Phase 1 entailed developing supportive statements and images designed to promote hope, inclusivity, and connection in order to create 2 sets of 8 text messages and corresponding images. Phase 2 included piloting caring contacts manually in the hospital's Psychiatric Crisis Department and Inpatient Psychiatry Unit and assessing the feasibility of implementation in other services, as well as developing workflows and addressing legal considerations. Phase 3 consisted of implementing an automated process to scale within 4 participating hospital services and integrating enrollment into the hospital's electronic medical records. Process outcome measures included staff compliance with approaching and enrolling eligible patients and results from an optional posttext survey completed by participants. Compliance data are presented for 4062 adolescent patients eligible for caring contacts. Overall, 88.65% (3601/4062) of eligible patients were approached, of whom 52.43% (1888/3601) were enrolled. In total, 94.92% (1792/1888) of enrolled participants completed the program. Comparisons of the patients eligible, approached, enrolled, and completed are presented. Primary reasons for eligible patients declining include not having access to a mobile phone (686/1705, 40.23%) and caregivers preferring to discuss the intervention at a later time (754/1705, 44.22%). The majority of patients responding to the optional posttext survey reported that the texts made them feel moderately to very hopeful (219/264, 83%), supported (232/264, 87.9%), that peers would be helped by these texts (243/264, 92%), and that they would like to keep receiving texts given the option (227/264, 86%). This study describes the successful implementation of automated postdischarge caring contacts texts to scale with an innovative use of images and demonstrates how a quality improvement methodology resulted in a more effective and efficient process. This paper also highlights the potential for technology to enhance care for at-risk youth and create more accessible, inclusive, and sustainable prevention strategies.

Clinical and sociodemographic features of the Texas resilience against depression (T-RAD) study: Findings from the initial cohort

ObjectiveThe burden of major depressive disorder is compounded by a limited understanding of its risk factors, the limited efficacy of treatments, and the lack of precision approaches to guide treatment selection. The Texas Resilience Against Depression (T-RAD) study was designed to explore the etiology of depression by collecting comprehensive socio-demographic, clinical, behavioral, neurophysiological/neuroimaging, and biological data from depressed individuals (D2K) and youth at risk for depression (RAD). MethodsThis report details the baseline sociodemographic, clinical, and functional features from the initial cohort (D2K N = 1040, RAD N = 365). ResultsOf the total T-RAD sample, n = 1078 (76.73 %) attended ≥2 in-person visits, and n = 845 (60.14 %) attended ≥4 in-person visits. Most D2K (84.82 %) had a primary diagnosis of any depressive disorder, with a bipolar disorder diagnosis being prevalent (13.49 %). RAD participants (75.89 %) did not have a psychiatric diagnosis, but other non-depressive diagnoses were present. D2K participants had 9-item Patient Health Questionnaire scores at or near the moderate range (10.58 ± 6.42 > 24 yrs.; 9.73 ± 6.12 10–24 yrs). RAD participants were in the non-depressed range (2.19 ± 2.65). While the age ranges in D2K and RAD differ, the potential to conduct analyses that compare at-risk and depressed youth is a strength of the study. The opportunity to examine the trajectory of depressive symptoms in the D2K cohort over the lifespan is unique. LimitationsAs a longitudinal study, missing data were common. ConclusionT-RAD will allow data to be collected from multiple modalities on a clinically well-characterized sample. These data will drive important discoveries on diagnosis, treatment, and prevention of depression.

Who is at risk? Applying the biopsychosocial model to explain non-violent and violent delinquency in youth

Research has highlighted the relevance of biological measures in explaining antisocial behavior, but the inclusion of such measures in clinical practice is lagging behind. According to the integrative biopsychosocial model, biological measures should be studied together with psychological and social-environmental factors. In this data-driven study, we applied this comprehensive model to explain non-violent and violent delinquency of 876 at-risk youth (715 male, 9–27 years), by combining nine biological (autonomic-nervous-system; endocrinological), nine psychological, and seven social-environmental measures. Using latent-class-regression analysis we uncovered four distinct psychologically-driven biological clusters, which differed in non-violent and violent delinquency-risk, moderated by social-environmental variables: a biological–psychopathic traits; low problem; high problem; and biological–reactive group. Individual vulnerabilities to (non-)violent delinquency depended on social-environmental context that differed between clusters. These findings highlight the importance of biological and psychological factors, in the context of social-environmental factors, in explaining (non)-violent delinquency.

“I Have Moments Where I Am Down, But It Has Made Me Resilient”: Mental Health Strengths Among Youth At-Risk for and Living with HIV

“I Have Moments Where I Am Down, But It Has Made Me Resilient”: Mental Health Strengths Among Youth At-Risk for and Living with HIV

Externalizing Behaviors/Violence Exposure and Suicide Among U.S. Adolescents

IntroductionThis study examines associations between externalizing behaviors/violence exposure and suicidal behavior among US high school students from 1991-2021 MethodsData for this cross-sectional study were drawn from the Youth Risk Behavior Survey and the total sample contained data on 234,588 adolescents. Logistic regression models were used to assess the relationship between externalizing behaviors/violence exposure and suicidal behavior. To assess trends over time, models were then assessed for multiplicative interactions between externalizing behaviors/violence exposure and time by sex. State-level trends were also assessed. All analyses were conducted in 2024 ResultsThe prevalence of externalizing behaviors/violence exposure increased among youth with an injurious suicide attempt. Logistic regression models indicated statistically significant associations across suicidal behaviors with a higher magnitude of association observed among those with an injurious suicide attempt. For instance, compared to those who did not carry a gun, those who carried a gun had 6.32 (95% CI: 4.78, 8.36) times the odds of injurious suicide attempt vs. no attempt and 2.66 (95% CI: 2.00, 3.53) times the odds of non-injurious suicide attempt vs. no attempt. Stronger associations arose among male individuals. Among those with an injurious suicide attempt in 2021, state-level differences in weapon access emerged ConclusionsAdolescents with externalizing behaviors/violence exposure are at an increased risk of an injurious suicide attempt. The relationship varies over time and by sex. Culturally adaptive and structurally competent approaches to mental health and mechanisms to identify at-risk youth are imperative.

Examining the association of familial and social stress, trauma, and support on mood, anxiety, and behavioral symptoms and diagnoses in youth at risk for bipolar disorder and controls

IntroductionYouth with a family history of bipolar disorder (At-Risk) have a higher risk of developing psychiatric disorders and experiencing environmental stressors than youth without such family history (Control). We studied the differential associations of familial and environmental factors on developing psychiatric diagnoses and symptoms, in At-Risk and Control youth. MethodsAt-Risk and Control youth (N = 466, ages 9–22) were systematically assessed for severity of symptoms, psychiatric diagnoses, and self-reported measures of stress and social support. We tested the association of family history and measures of stress or support with symptom severity and diagnoses. ResultsAt-Risk youth had higher symptom severity scores and were more frequently diagnosed with psychiatric disorders (all p values < 0.001). When predicting mood symptom severity, family history had an interaction effect with stressful life events (p < 0.001) and number of distinct traumatic events (p = 0.001). In multivariate models, At-Risk status predicted anxiety disorders (OR = 2.7, CI 1.3–5.4, p = 0.005) and anxiety severity (Coefficient = 0.4, CI 0.2–0.7, p < 0.001) but not mood or behavioral disorder diagnoses or severity. LimitationsMeasures of stress and social support were based on self-report. Not all participants had passed through the period of risk for developing the outcomes under study and the follow up period was variable. We could not fully study the differential impact of physical or sexual abuse due to low frequency of occurrence in controls. ConclusionAt-Risk youth exhibit more severe mood symptoms compared to Controls when exposed to similar levels of stress or trauma. At-Risk youth are also more prone to develop anxiety which may be a precursor for bipolar disorder.