Clinical Sample Of Adolescents Research Articles

Prospective Relations between Life Stress, Emotional Clarity, and Suicidal Ideation in an Adolescent Clinical Sample

ABSTRACT Objective Although life stress has been linked to adolescent suicidal ideation, most past research has been cross-sectional, and potential processes characterizing this relation remain unclear. One possibility may be a lack of emotional clarity. Informed by stress generation, the current study examined prospective relations between episodic life stress, lack of emotional clarity, and suicidal ideation in an adolescent clinical sample. Methods The sample consisted of 180 youths (M age = 14.89; SD = 1.35; 71.7% female; 78.9% White; 43.0% sexual minority) recruited from a psychiatric inpatient facility. Suicidal ideation severity was assessed at baseline and 18-month follow-up. Lack of emotional clarity and life stress were assessed at baseline, as well as 6-, and 12-month follow-ups. Two random-intercepts cross-lagged panel models were created to estimate within-person relations for variables of interest. Results At the within-person level, lack of emotional clarity at baseline predicted greater 6-month impact of interpersonal dependent stressors (b = 0.29, p = .012, 95% CI [0.07, 0.52]), which subsequently predicted a greater 12-month lack of emotional clarity (b = 0.41, p = .005, 95% CI [0.12, 0.70]). Next, a 12-month lack of emotional clarity but not interpersonal dependent stress, predicted greater 18-month suicidal ideation (b = 0.81, p = .006, 95% CI [0.23, 1.30]; R 2 = .24, p < .001). No significant relations were found for the lack of emotional clarity and independent stress. Conclusions Results support the stress generation hypothesis and suggest that future research should be conducted evaluating whether bolstering youth’s understanding of their emotional experiences may reduce subsequent suicidal ideation.

Screening for diabetes distress and depression in routine clinical care for youth with type 1 diabetes.

The purpose of this study is to examine diabetes distress as a potential mediator of the relationship between depression symptoms and diabetes outcomes, including hemoglobin A1c (hemoglobin A1c [HbA1c]) and diabetes management behaviors in a clinical sample of adolescents and young adults. In a pediatric diabetes clinic, 716 youth (ages 12-21 years) completed measures of diabetes distress (Problem Areas in Diabetes-Teen [PAID-T]), a single-item of diabetes distress, and depression (Patient Health Questionnaire [PHQ-9]) as part of standard care. Electronic health records were extracted for the "Six Habits" and glycemic management (HbA1c). Overall, 3.6% (n = 26) of adolescents had clinically elevated diabetes distress and depression symptoms, 5.0% had diabetes distress alone, 8.7% had depression symptoms alone, and 82.7% had neither clinical elevation of diabetes distress nor depression symptoms. Results of mediation analysis demonstrated diabetes distress (both full and single-item measures) fully mediated the relationship between depression symptoms and HbA1c (p < .001). Also, mediation analysis results showcase incomplete mediation of the effect of the Six Habits score on HbA1c appears by PAID-T Diabetes Distress. In a clinical sample of youth with type 1 diabetes, both depressive symptoms and diabetes distress are associated with HbA1c. Furthermore, diabetes distress fully mediates the relationship between depressive symptoms and HbA1c. As part of standard clinical care, the single-item screener for diabetes distress captured similar results as the full-scaled PAID-T. With limited clinical resources, providers may consider focusing assessment and interventions on the psychological factor of diabetes distress within the diabetes clinic to maximize the impact on glycemic control and consider the use of single-item screening to identify distress.

A multi-method assessment of emotional processes predicting longitudinal anxiety symptom trajectories in an adolescent clinical sample

ObjectiveEmotion recognition, reactivity, and regulation are important in the development and maintenance of anxiety disorders. Whether and how these processes differentiate between different trajectories in anxiety remain unclear. The current study examined emotional processes as prospective predictors of anxiety symptom trajectories in psychiatrically hospitalized youth. MethodParticipants were 180 adolescents (Mage = 14.89; SD = 1.35) from a psychiatric inpatient unit. At index hospitalization, participants completed a behavioral task assessing facial emotion recognition, and self-report measures of emotion dysregulation and reactivity. They completed a self-report measure on anxiety symptoms at baseline and 3, 6, 12, and 18 months post-discharge. Latent growth curve analysis was conducted to identify subgroups of individuals based upon their trajectory of anxiety symptoms across 18-months. ANOVAs were used to examine subgroup differences in emotional processing variables. ResultsThree distinct trajectories were identified, a stable moderate-to-high anxiety group, a group with moderate-to-high anxiety at baseline with symptom improvement over time, and a group characterized by relatively stable low-to-moderate anxiety throughout the study. The two initially moderate-to-high anxiety groups scored higher for emotion dysregulation and emotion reactivity at baseline compared to the low-to-moderate anxiety group. Emotion regulation difficulties relating to emotional non-acceptance were higher for the stable moderate-to-high anxiety group than for the moderate-to-high anxiety group that experience symptom improvement over time. ConclusionsThese findings may have clinical implications for discharge planning. Future studies should explore emotion regulation with a focus on non-acceptance of one’s emotional experiences as a potential target of intervention in individuals with elevated anxiety.

The relationship between bullying victimization and impairment in personality functioning in a clinical adolescent sample.

Problematic interpersonal relationships may represent both, a risk factor for the development or trigger of personality disorder (PD) symptoms and its consequences. Since peer relationships become more and more important in adolescence, the current study explores the cross-sectional association between recent bullying experiences and levels of impairment in personality functioning according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) alternative model of personality disorders (AMPD; Criterion A) in help-seeking adolescents (N = 493). Logistic and multiple regression analyses revealed that patients who were frequently bullied in the past 3 months (i.e., at least once a week) were more likely to reach the diagnostic threshold for PD according to the AMPD (OR = 1.71, p = .025) and showed higher levels of impairment in identity (β = .41, p < .001), empathy (β = .26, p = .002), and intimacy (β = .30, p = .001), but not self-direction, compared to patients who did not report any bullying experiences. Occasional bullying in the past 3 months (i.e., every few weeks) was neither associated with a greater likelihood to reach the diagnostic threshold for PD nor with greater impairments in identity, self-direction, empathy, or intimacy compared to no bullying. While the current study provides support for a correlation between bullying experiences and personality dysfunction (particularly in the elements identity and intimacy), longitudinal research is needed to clarify whether experiences of bullying cause or trigger personality dysfunction or/and vice versa. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A detailed hierarchical model of psychopathology in Chinese clinical sample: Based on the SCL-90-R measure

ObjectiveThe Hierarchical Taxonomy of Psychopathology (HiTOP)model is an impressive effort to overcome shortcomings of traditional diagnostic systems. However, almost all of the quantitative empirical evidence used to structure the model comes from Western cultures and is built upon traditional diagnostic categories. This study aims to provide a detailed Chinese version of the HiTOP structure, ranging from symptoms based on The Symptom Checklist 90-R (SCL-90-R) up to the general factor. MethodsWe explored the detailed hierarchical structure of the SCL-90-R scale in adult (N = 34,222) and adolescent (N = 1973) clinical sample from Shanghai Mental Health Center, using extended bass-ackwards approach to draw the HiTOP model. ResultsThe Chinese HiTOP structure had a general factor at the top, 4 higher-order spectra (Internalizing, Externalizing, Broad Thought Disorder and Somatization and Somatic Anxiety) and 6 subfactors (Distress, Somatoform, Hostility, Fear, Psychosis and OCD) across both adult and adolescent samples. In addition, the adult sample contained 2 other subfactors: a) Sleep, and b) Suicide and Guilt. At the symptom level, some items were posited to components diverged from the original SCL-90-R subscales. ConclusionsThese findings offer the first description of the HiTOP structure in two Chinese samples and demonstrate that the SCL-90-R can be used to examine the HiTOP structure. The Somatization spectrum first emerged as a higher-order dimension, suggesting structural differences between Western and Eastern cultures. The results also suggest that transdiagnostic research should (1) further examine the positioning of somatoform symptoms using measures in other Eastern samples, and (2) place more emphasis on interpreting SCL-90-R results across different cultures.

The relationship between game genre, monetization strategy and symptoms of gaming disorder in a clinical sample of adolescents.

Gaming disorder (GD) has been introduced as a new diagnosis in the International Classification of Disease 11 (ICD-11). Currently, there's limited understanding of how various video games may differentially contribute to the risk of developing GD. The main aim of this study was to examine the relationship between individuals' game genre preferences, their preferred games' monetization strategies, and GD Symptoms. A total of 85 patients undergoing treatment for GD at a child and youth psychiatric clinic were included in the study. Their preferred games were classified into five novel genres based on gameplay similarities and objectives, and further categorized based on their monetization strategy. Symptom burden of GD, measured with Game Addiction Scale for Adolescents (GASA), was highest for those playing Free-to-Play (F2P) games and lowest for Pay-to-Play (P2P) players. Players of Competitive Games endorsed higher GD symptom burden, whereas players of Story-driven games reported lower GD symptom burden. Symptoms of GD were associated with attention-deficit hyperactivity disorder (ADHD) diagnosis in males. This study reveals that game genre preference is influenced by sex, age, and certain psychiatric diagnoses. The categorizing of games into genres is increasingly complex and our research introduces a novel categorization in a developing research field. The result of this study suggests that the monetization model is important to consider while trying to understand the relationship between game characteristics and GD symptoms.

Cross-sectional and longitudinal changes in body composition, anxiety, and depression in a clinical sample of adolescents with anorexia nervosa.

Eating disorders among children and adolescents have increased in prevalence, and mortality rates for anorexia nervosa are among the highest for any psychiatric disorder. Our current study aimed to (a) examine the cross-sectional relationship between body composition and anxiety/depressive symptoms among 97 adolescents and young adults who have been diagnosed with anorexia nervosa, (b) examine the longitudinal changes in body composition and anxiety/depressive symptoms over three months (from baseline to follow-up visit), and (c) examine the longitudinal relationship between change in body composition and change in anxiety/depression over three months. A retrospective chart review was conducted within an interdisciplinary eating disorder clinic between August 2019 and December 2021. In total, 97 adolescents aged 11-20 years old with diagnoses of anorexia nervosa were included in the analyses. Body composition data were collected at each visit along with parent- and youth-report measures of symptoms of anxiety/depression symptoms. Findings indicated adolescents demonstrated some improvement in body composition, as well as parent-reported reductions in anxiety/depression symptoms. Based on parent reports, increased BMI percentile was associated with improvements in anxiety/depression symptoms. On the other hand, youth did not report significant changes in anxiety/depressive symptoms. Additionally, there were no associated improvements with body composition measures, which may be associated with continued body dissatisfaction or symptoms of anxiety and depression predating the eating disorder. These results suggest the importance of including interventions addressing depression, anxiety, and body image as part of treatment.

Methods and functions of non-suicidal self-injury in an adolescent and young adult clinical sample

BackgroundNon-suicidal self-injury (NSSI) is an emerging critical medical condition among adolescents and young adults worldwide. They use different methods for expressing their emotional needs. The aim of this study was to identify the methods of NSSI used by adolescents and young adults who presented with different psychiatric disorders, and their utilized functions.Subjects/materials and methodsA case–control study was done on 100 late adolescent and young adult patients who attended Suez Canal University with psychiatric disorders. Sociodemographic data was obtained then they were assessed by the Mini-International Neuropsychiatric Interview and the Brief Non-suicidal Self-Injury Assessment Tool.ResultsAmong the case group, 54% used scratching for self-harm while 36% used cutting. The most common body areas were hands (44%) and arms (42%). Eighty percent of the case group endorsed non-suicidal self-harm for dealing with anger, while 78% to cope with uncomfortable feelings and 72% to relieve stress with no statistically significant difference between males or females, nor among psychiatric comorbidities.ConclusionThe most common method of NSSI was scratching and it was followed by cutting and banging. The most common body areas were hands and arms. Patients endorsed NSSI for various motives and several functions. However, Items on the automatic negative reinforcement scales were the most common functions, especially when dealing with anger.

Investigating the Interplay Between Mental Health Conditions and Social Connectedness on Suicide Risk: Findings from a Clinical Sample of Adolescents.

This study examined whether school and community connectedness buffer the relationships between mental health conditions and suicide risk in a clinical sample of adolescents with histories of substance use disorders. Data from 294 adolescents were examined, with approximately 58% reporting lifetime suicidal ideation and/or prior attempts. Multinomial logistic regression was used to examine main and interaction effects on a three-category measure of suicide risk. Depression severity and panic disorder were associated with elevated suicidal ideation risk, whereas disordered eating was associated with elevated risk of attempts. Higher school-based positive peer interactions, school safety, and neighborhood social connection levels were associated with reduced suicide attempt risk. Moderation analyses revealed that high neighborhood social connection levels may partially mitigate the elevated likelihood of attempting suicide associated with disordered eating. Findings suggest clinical populations of adolescents may benefit from approaches aiming to promote social connectedness, further supporting a comprehensive approach to suicide prevention.

Cumulative risk exposure is associated with increased risk for PTSD but not depression or anxiety. Results from a UK clinical sample of children and adolescents

Background Childhood adversity can include traumatic experiences and exposure to other risk factors; consistently predicting poorer psychosocial outcomes in adulthood. Relatively little research has investigated the impact of cumulative risk exposure in childhood. Using data collected in a specialist clinical setting, we investigated the associations between risk exposure, psychopathology and psychosocial functioning. Method Participants were children attending the Attachment and Trauma service at Great Ormond Street Hospital in London ( N = 132, M = 10.25, SD = 3.35). Data was collected via routine clinical practice during multi-disciplinary assessments. Data was collected on developmental and trauma history, psychopathology, and functioning (CGAS), using standardised measures, clinical interviews, and observations. Results All children had experienced at least one risk factor, with 78% reporting multiple exposures, including witnessing interpersonal violence (52%), neglect (48%), and physical abuse (42%). Other risk exposures included exposure to alcohol (17%) and substances (24%) in-utero, as well as social risk factors such as multiple foster placements in some cases. In this sample, 65% of children met criteria for at least one psychiatric diagnosis (Anxiety = 31%, PTSD = 28%, Depression = 8%). High levels of functional impairment were found, with 52% of children falling into the highest categories of ‘obvious’ or ‘severe’ problems. Multiple risk exposure significantly predicted PTSD (OR 9.64 (1.1, 83.7)), but did not predict anxiety, depression, or functional impairment. Conclusion This study highlights the rates of cumulative risk exposure in this clinical sample. The findings demonstrate the importance of detailed and accurate clinical assessments in ascertaining trauma histories in children with known histories of adversity and maltreatment. There are implications for assessment and treatment, such as the importance of clear guidelines on treating PTSD in children with complex trauma histories.

Parent and Teacher Ratings of Tonic and Phasic Irritability in a Clinical Sample.

Research on tonic (persistently angry or grumpy mood) and phasic (temper tantrums/outbursts) irritability in youth has utilized community samples and information from parents and youth. We examined whether tonic and phasic irritability are empirically distinguishable and have similar correlates using teacher, in addition to parent, reports in a clinical sample of children and adolescents. The sample included youth aged 5-18 evaluated at a university outpatient clinic, with complete information from 2481 parents and 2449 teachers. We conducted confirmatory factor analysis (CFA) using items from several parent- and teacher-report inventories and examined concurrent associations with psychopathology and functioning. The CFA supported a two-factor model consistent with tonic and phasic irritability in both parent- and teacher-reports. Parent-reported tonic irritability was associated with higher rates of depression and anxiety disorders, suicidality, and antidepressant medication use. Teacher-reported tonic irritability was associated with elevated rates of depression and antidepressant use. Both parent- and teacher-reported phasic irritability were linked to higher rates of ADHD combined type, oppositional defiant/conduct disorders, and referral for rages. Parent- and teacher-reported tonic and phasic irritability were all associated with impaired social functioning. Parents and teachers can distinguish tonic and phasic irritability, which are associated with internalizing and externalizing problems, respectively. Findings were generally consistent across informants, and with prior studies using community samples.

Behavioral and Emotional Problems in Children and Adolescents with Obesity: A Preliminary Report.

Parent-child agreement regarding emotional and behavioral problems in adolescents with obesity was measured. One hundred Italian adolescents with obesity (36 males, 64 females, mean age ± SD: 15.3 ± 1.61 years, mean body mass index, BMI: 37.9 ± 5.48 kg/m2), hospitalized for a 3-week multidisciplinary body weight reduction program at Istituto Auxologico Italiano, Piancavallo-Verbania, Italy, and one of their parents (n = 100, 40 fathers, 60 mothers) participated in the study. Achenbach's Child Behavior Checklist (CBCL) for parents and the Youth Self Report (YSR) for teens were administered. Most of the CBCL and YSR scores were normal, with more borderline and clinical scores being found in CBCL (29% of borderline scores in attention problems, 28% in affective problems, and 26% in ADHD; 32% of clinical scores in affective problems, 23% in withdrawn/depressed, and 22% in anxiety problems and somatic complains subscales) than in YSR (19% of borderline scores in affective behaviors and 17% in somatic complains; 15% of clinical scores in anxiety problems and 17% in withdrawn/depressed subscale). Young females reported greater anxiety problems (p = 0.009), oppositional defiant problems (p = 0.029), anxiety/depressed (p = 0.030), and internalizing problems (p = 0.045) than males. Pearson's coefficients ranged between 0.273 to 0.517. This study provides information on the cross-informant evaluation of psychological profiles with CBCL and YSR in a clinical sample of adolescents with obesity and their parents.

Measurement Invariance of the WISC-V across a Clinical Sample of Children and Adolescents with ADHD and a Matched Control Group.

Measurement invariance of the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) 10-primary subtest battery was analyzed across a group of children and adolescents with ADHD (n = 91) and a control group (n = 91) matched by sex, age, migration background, and parental education or type of school. First, confirmatory factor analyses (CFAs) were performed to establish the model fit for the WISC-V second-order five-factor model in each group. A sufficiently good fit of the model was found for the data in both groups. Subsequently, multigroup confirmatory factor analyses (MGCFAs) were conducted to test for measurement invariance across the ADHD and control group. Results of these analyses indicated configural and metric invariance but did not support full scalar invariance. However, after relaxing equality constraints on the Vocabulary (VC), Digit Span (DS), Coding (CD), Symbol Search (SS), and Picture Span (PS) subtest intercepts as well as on the intercepts of the first-order factors Working Memory (WM) and Processing Speed (PS), partial scalar invariance could be obtained. Furthermore, model-based reliability coefficients indicated that the WISC-V provides a more precise measurement of general intelligence (e.g., represented by the Full-Scale IQ, FSIQ) than it does for cognitive subdomains (e.g., represented by the WISC-V indexes). Group comparisons revealed that the ADHD group scored significantly lower than the control group on four primary subtests, thus achieving significantly lower scores on the corresponding primary indexes and the FSIQ. Given that measurement invariance across the ADHD and the control group could not be fully confirmed for the German WISC-V, clinical interpretations based on the WISC-V primary indexes are limited and should only be made with great caution regarding the cognitive profiles of children and adolescents with ADHD.

Risk-taking and self-harm behaviors as markers of adolescent borderline personality disorder.

Adolescence is a critical period for early identification and intervention of borderline personality disorder (BPD). Risk-taking and self-harm behaviors (RSB) have been identified as promising early markers of BPD and correlates of depression in school-based samples. The present study aimed, first, to examine the association between RSB and BPD in a clinical sample of adolescents and, second, to examine whether RSB are also linked to depression. N = 405 participants (82.7% female) were recruited from an outpatient clinic for adolescents with RSB. RSB assessed included truancy, excessive media use, alcohol, tobacco, and illicit drug use, sexual risk-taking, and self-harm behavior. Regression analyses and generalized linear models were performed to examine the associations between individual RSB or patterns of RSB (identified using latent class analysis, LCA) and a diagnosis and severity of BPD or depression. All RSB (except excessive media use) were positively associated with BPD diagnosis and severity. In contrast, only non-suicidal self-injury (NSSI) and suicide attempts were positively associated with depression diagnosis and severity, while illicit drug use was negatively associated with depression severity. The LCA yielded two classes differing in the occurrence of RSB. The high RSB class was more likely to have a BPD diagnosis and greater BPD severity than the low RSB class. Classes did not differ regarding depression diagnosis or severity. As NSSI and suicide attempts were associated with both BPD and depression, the presence of additional RSB, besides self-harm behavior, may represent a specific risk marker for BPD in adolescents.

Understanding Comorbidity Between Non-Suicidal Self-Injury and Depressive Symptoms in a Clinical Sample of Adolescents: A Network Analysis.

Non-suicidal self-injury (NSSI) and depression often co-occur among adolescents with more severe clinical symptoms. This study examined the network structures of NSSI and depressive symptoms in adolescents. Participants were recruited in the psychiatric outpatient clinics of three tertiary hospitals between April 10 and July 10, 2023. All participants been already found with self-injury behaviors in outpatient when enrolled. NSSI diagnostic criteria and Patient Health Questionnaire-9 (PHQ-9) were utilized to collect NSSI and depressive symptoms separately. We performed a network analysis to visualize the correlation between each symptom and to identify core and bridging symptoms in comorbidities. A total of 248 patients were enrolled in the study, with a mean age of 15.48 (SD = 1.62). Based on the PHQ-9 scores and grades, our results showed that the incidence of depression in adolescents with non-suicidal self-injury behavior was relatively high (N=235, 94.76%), with the majority having severe depression. The network analysis revealed that nodes D-6 "feeling bad, failing or letting yourself or your family down", D-1 "little interest or pleasure" and D-4 "feeling tired" were the most vital and most central symptoms. The most crucial bridging symptom is the node NSSI-8 "frequent thinking about self-injury", which connects the NSSI to the depression comorbid network. This study offers a significant symptom-level conceptualization of the association between NSSI and depressive symptoms in a clinical sample of adolescents, which not only enhances our understanding of the comorbid but also identifies potential treatment targets to prevent and treat comorbidity between adolescent NSSI and depression.

Supplemental Material for The Relationship Between Bullying Victimization and Impairment in Personality Functioning in a Clinical Adolescent Sample

Supplemental Material for The Relationship Between Bullying Victimization and Impairment in Personality Functioning in a Clinical Adolescent Sample

Interpersonal violence and suicide risk: Examining buffering effects of school and community connectedness

BackgroundExposure to interpersonal violence is associated with elevated suicide risk. Preventing suicide among high-risk adolescents is most often discussed from a clinical treatment perspective, resulting in a gap in research examining whether school and community connectedness can buffer the relationships between forms of interpersonal violence and suicide risk in clinical samples of adolescents. MethodsBaseline data from 294 adolescents who received substance use treatment were analyzed to help fill this gap in research. Adolescents in this sample were at greater risk for suicidal thoughts and behaviors given their histories of substance use disorders and high rates of interpersonal violence, with 57% reporting experiencing at least one form of abuse/violence. Independent variables included lifetime exposure to physical abuse, sexual abuse, and weapon violence; moderators included various measures of school and community connectedness. Multinomial logistic regression models were estimated to examine the main and interaction effects predicting a three-category measure of suicide risk: non-suicidal, suicidal ideation only, and prior suicide attempts. ResultsSexual abuse survivors had the highest predicted probability of a prior suicide attempt when reporting lower levels of teacher support, school-based positive peer interactions, or neighborhood social connection, but at higher levels of these protective factors, their predicted probability was similar to those not exposed to sexual abuse. The same protective pattern was observed for physical abuse survivors with high neighborhood social connection. ConclusionThe buffering effects observed in this study identified dimensions of school and community social connectedness as protective factors for youth exposed to abuse. Although promoting social connectedness is often cited as a universal suicide prevention approach, tailored efforts to enhance connectedness within this population may also be a promising secondary prevention strategy. Thus, in addition to clinical treatment, more emphasis should be placed on systems-level approaches to reducing risk among youth most vulnerable to suicide.

Symptoms characteristics of personality disorders associated with suicidal ideation and behaviors in a clinical sample of adolescents with a depressive disorder.

Pathological personality traits have repeatedly been identified as important risk factors for suicidal ideation and behaviors. Moreover, impulsive-aggressive traits, have shown a consistent association with suicidal behaviors across the lifespan. Adolescence represents a critical period for the emergence of different personality traits, mood disorders, and suicidal behaviors, but the relationship between these variables remain poorly understood. These variables were examined in a cross-sectional case-control design involving three groups: 30 adolescents with a depressive disorder and past suicide attempt (Mean Age = 16.2, Females = 26), 38 adolescents with a depressive disorder but without past suicide attempt (Mean age = 16.0, Females = 29), and 34 healthy adolescent controls (Mean age = 15.2, Females = 22). Suicidal ideations were indexed using Suicidal Behavior Questionnaire (SBQ-R), psychiatric disorder assessed using a semi-structured questionnaire (K-SADS-PL), depressive symptoms with the Beck Depressive Inventory (BDI), symptoms characteristics of personality disorders with the Scheduled Clinical Interview for the DSM-IV (SCID-II) screening questionnaire, and impulsivity with the Barratt Impulsivesness Scale (BIS). Findings showed that impulsivity (F = 11.0, p < 0.0001) and antisocial symptoms characteristics of personality disorders (p < 0.001, d = 0.70) displayed the most robust association with adolescent suicide attempts. Borderline symptoms characteristics of personality disorders did not discriminate attempters from non-attempters but presented high correlations with suicidal ideation and depression severity. In an item-wise analysis, suicide attempt status was uniquely correlated with symptoms characteristics of an antisocial personality disorder. Suicide attempt status also correlated with non-suicidal self-injury and a chronic feeling of emptiness. The caveats of this cross-sectional study include the stability of symptoms characteristics of personality disorders in adolescence and the limited sample size. In sum, suicidal behaviors were characteristically correlated with increased impulsivity and antisocial symptoms characteristics of personality disorders, but other symptoms characteristics of personality disorders were relevant to adolescent depression and suicidal ideation. Understanding the emergence of symptoms characteristics of personality disorders and suicidal behaviors in a developmental context can ultimately inform not only the neurobiological origin of suicidal behaviors, but also provide new avenues for early detection and intervention.

Autistic Characteristics in a Nationally Representative Clinical Sample of Adolescents Seeking Medical Gender-Affirming Treatment in Norway.

Several studies have reported on the intersection of autism and gender incongruence (GI) in clinical populations. This study aims to investigate autistic characteristics and registered autism spectrum diagnoses (ASD) in a clinical cohort of 83 adolescents referred to the National Gender Team for Children and Adolescents in Norway during 2020. Parents completed the Social Responsiveness Scale (SRS). Background information and registered psychiatric diagnoses were extracted from patient files. The results showed that 25% of the participants scored within the clinical range on the SRS: 27.4% of adolescents who were assigned female at birth (AFAB) and 19.0% of adolescents who were assigned male at birth (AMAB). AFAB had significantly higher scores on SRS Total Scale and the Social Motivation and Autistic Mannerisms subscales compared to the female norm group. AMAB had higher scores on the Social Motivation subscale and lower scores on the Social Awareness subscale, compared to the male norm population. Information from patient files revealed that 67.5% had one or more registered psychiatric diagnosis. 9.6% had received an ASD diagnosis, all AFAB. 18.1% had received an attention deficit hyperactivity disorder (ADHD) diagnosis. The most common psychiatric diagnoses were depression (25.3%) and anxiety disorders (18.1%). Further, 44.6% had a history of self-harm, and 15.7% had a history of a suicide attempt. The results showed an overrepresentation of ASD diagnoses and autistic characteristics measured by SRS for AFAB. There was an overrepresentation of psychiatric diagnoses for both the AFAB and the AMAB group in this study sample. Implications for treatment and future research are discussed.

Implicit Identification with Death, Clinician Evaluation and Suicide Ideation among Adolescent Psychiatric Outpatients-The Mediating Role of Depression

Implicit identification with death (i.e., subconsciously self-associating oneself with death), measured by the Death-Suicide Implicit Association Test (D/S-IAT), is associated with Suicide Ideation (SI). Our understanding of the mechanisms underlying this association is limited. The current study examined (1) the mediating role of depression between D/S-IAT and recent SI and (2) the association between SI, D/S-IAT, and clinician evaluation of SI among a clinical sample of adolescents. 148 adolescents aged 10–18 years (69.4% female) from two outpatient clinics were assessed at intake. Participants completed D/S-IAT and self-report measures for recent SI and depression during intake. Findings indicate that depression is a mediator between D/S-IAT and recent SI, controlling for gender, site differences, and past suicidal thoughts and behaviors. D/S-IAT and clinician evaluation were correlated with recent SI but not beyond depression. Our findings highlight the importance of examining the underlying psychological mechanisms regarding the association between D/S-IAT and suicide.