Adolescent Clinical Populations Research Articles

Gender similarities and differences in non-suicidal self-injury in an adolescent clinical sample

ABSTRACT Non-suicidal self-injury (NSSI) continues to be an important problem in adolescents, and it was aimed to investigate the relationship between suicide probability, cyberbullying, impulsivity, and aggression with NSSI history in the adolescent clinical population on the basis of gender. 267 adolescents with a history of NSSI and 210 without were included. They filled the Inventory of Statements About Self-Injury (ISAS), Cyberbullying and Online Aggression Screening Scale (COASS), Buss-Perry Aggression Questionnaire (BPAQ), Suicide Probability Scale (SPS), Barratt Impulsiveness Scale-11-Short Form (BIS-11-SF). Four subscales and total scores of SPS, BPAQ, BIS-11-SF total scores were found to be significantly higher in males with a history of NSSI. BPAQ, BIS-11-SF motor, and attention impulsiveness, BIS-11-SF total scores, four subscales, and total scores of SPS were found to be significantly higher in females with a history of NSSI. Lower BIS-11-SF non-planning impulsivity, higher SPS/suicide ideation and hostility scores, and lower father’s education level were found to be the best predictive factors for ISAS total scores in males. In females, experience cyberbullying, lower age, higher SPS/suicide ideation and total scores were the best predictors. Knowing the factors associated with NSSI and the differences between genders will be effective in both preventing NSSI and shaping treatment modalities.

Psychometric properties and normative data of the Latvian and Russian language versions of the strengths and difficulties questionnaire (SDQ) in the Latvian general adolescent population

Objectives Mental health screening instruments are essential in population health research and clinical practice. The strengths and difficulties questionnaire (SDQ) self-report version has been widely used across the globe to screen for mental health problems in adolescent populations. This study aimed to explore the psychometric properties of the Latvian and Russian language versions of the SDQ in a representative sample of a general population of Latvian adolescents and establish the population-based normative scores. Materials and methods This analysis was based on data from the international Health Behaviour in School-aged Children study year 2017/2018 Latvian database. The sample comprised 2683 Latvian and 1321 Russian-speaking 11-, 13-, and 15-year-old adolescents. Results Significant language-based variance was observed in the mean scores of the externalising subscales of the SDQ, with Latvian-speaking adolescents reporting higher levels of conduct problems and hyperactivity. The reliability was satisfactory (ordinal alpha >0.7) only for the prosocial behaviour, emotional, internalising problems, and total difficulties subscales, while conduct, hyperactivity, peer, and externalising problems scales demonstrated lower internal consistency (ordinal alpha 0.5–0.7). Confirmatory factor analysis (CFA) did not support the hypothesised narrow-band five-factor or broad-band three-factor structure of the SDQ. The normative banding scores were calculated for both language variants. Conclusions This study suggests that the self-report SDQ must be used cautiously in Latvian adolescents because some SDQ subscales lack reliability. When used in population research, the internalising subscales seem more reliable than the externalising ones. More research is needed regarding the reliability of the SDQ in clinical adolescent populations.

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.

Mindful awareness and resilience skills for adolescents (MARS-A): a mixed-methods study of a mindfulness-based intervention for a heterogeneous adolescent clinical population.

Mindful Awareness and Resilience Skills for Adolescents (MARS-A) is a mindfulness-based intervention adapted for the adolescent population. While previous studies have explored the benefits of MARS-A in various single-diagnosis populations, the aim of this study was to assess MARS-A for a heterogenous clinical adolescent population with mental health and/or chronic diagnoses, focusing on the underlying suffering present in all these conditions rather than its effects on a single diagnosis itself. Qualitative data was collected through interviews to understand post-intervention participant perspectives and experiences. Quantitative data was collected through measures to investigate preliminary secondary outcomes. After participating in MARS-A, participants reported qualitative benefits in enhanced well-being, including coping with difficult emotions and managing sleep and/or pain. Quantitative results showed a reduction in functional disability, psychological distress, perceived stress, and depressive symptoms; increase in positive affect; and benefit in coping with pain and chronic conditions. MARS-A shows great potential in a heterogeneous clinical adolescent population.

Validation of a parent-proxy, obesity-specific Health-Related Quality of Life measure - sizing them up - in Singaporean adolescents seeking obesity treatment

Background Condition-specific measures of Health-Related Quality of Life (HRQoL) are more sensitive than generic tools. Sizing Them Up (STU) is a parent-proxy, obesity-specific HRQoL measure which was found to be reliable and valid internationally, but has yet to be utilised in Singapore. Objectives Our study aims to i) validate STU in adolescents seeking obesity therapy in KK Women’s and Children’s Hospital (KKH); and ii) determine demographic factors associated with STU scores. Methods We recruited 91 adolescents aged between 11 and 17 years old and their parents from KKH between June 2022 and January 2023. Parents completed STU and the generic Pediatric Quality of Life Inventory (PedsQL) upon recruitment, and repeated STU at least 2 weeks later. Results 65% of participants were males, with a mean Body Mass Index (BMI) of 32.3 ± 5.1 kg/m2 and mean age of 13.6 ± 1.8 years old. STU demonstrated strong internal consistency (overall Cronbach’s α = 0.85) and moderate test-retest reliability (intraclass correlation coefficients = 0.30-0.70). There was high correlation between STU scores and i) the adolescents’ BMI; and ii) equivalent domains of PedsQL, suggesting moderate to strong construct and convergent validity respectively. Indian adolescents, lower parental education level and single parents were associated with poorer STU scores. Conclusion STU is a reliable, valid obesity-specific HRQoL measure in a local clinical population of adolescents undergoing obesity therapy, and can help clinicians to understand parents’ impression of the impact of obesity on their child. Knowing the demographic variables associated with STU can enable clinicians to identify adolescents whose HRQoL are disproportionately affected by obesity.

DSM-5 Non-Suicidal Self-Injury Disorder in a Clinical Sample of Adolescents with Recurrent Self-Harm Behavior

Introduction Non-suicidal self-injury disorder (NSSID) is a new diagnosis proposed in DSM-5 with a need of further study, especially in adolescent clinical populations where non-suicidal self-injury (NSSI) is particularly prevalent. We aimed to study characteristics of NSSID and estimate an optimal cutoff frequency level of NSSI behavior. Methods Data were collected from 103 outpatient adolescents (ages 12–18) with recurrent self-harm behavior. Results Adolescents with NSSID reported significantly more frequent NSSI behavior and suicide attempts than adolescents without NSSID. Frequency of NSSI, global functioning, depressive symptoms, number of self-harm methods and anxiety symptoms best discriminated between adolescents with and without NSSID. An optimal cutoff level for a diagnosis of NSSID was found to be ≥15 days with NSSI during the last year, which led to a reduction in the rate of adolescents diagnosed with NSSID from 54% to 46%. Conclusion This study shows that NSSID is a highly impairing disorder characterized by high risk of multiple NSSI and suicide attempts, decreased functioning and other associated psychiatric disorders. Clinical awareness of these risks are important to ensure early detection and treatment. Future prospective longitudinal studies are needed to further validate the characteristics of the NSSID diagnosis and its clinical utility.

Gender difference in the associations of childhood maltreatment and non-suicidal self-injury among adolescents with mood disorders.

Non-suicidal self-injury (NSSI) is a common feature among adolescents with mood disorders. Although childhood maltreatment has shown to be associated with non-suicidal self-injury (NSSI), previous studies have yielded mixed results in terms of different subtypes of childhood maltreatment and only few studies have investigated the effects of gender. The present cross-sectional study investigated effects of different types of childhood maltreatment on NSSI, as well as the role of gender in these effects. In this cross-sectional study, a total of 142 Chinese adolescent inpatients with mood disorders (37 males and 105 females) were consecutively recruited within a psychiatric hospital. Demographic and clinical characteristics were collected. Participants were administered the Childhood Trauma Questionnaire (CTQ), the Functional Assessment of Self-Mutilation (FASM). 76.8% of the sample reported engaging NSSI in the previous 12 months. Female participants were more likely to engage in NSSI than males (p < 0.001). Participants in the NSSI group reported significantly more experiences of emotional abuse (p < 0.001) and emotional neglect (p = 0.005). With regards to gender differences, female participants who have experienced emotional abuse were more likely to engage in NSSI (p = 0.03). As a whole, NSSI represents a frequent phenomenon among adolescent clinical populations and females were more likely to engage in NSSI than males. NSSI was significantly related to experiences of childhood maltreatment and specifically related to emotional abuse and emotional neglect over and above other types of childhood maltreatment. Females were more sensitive to emotional abuse than males. Our study highlights the importance of screening for subtypes of childhood maltreatment as well as considering the effects of gender.

Factor and network analysis of psychosis-like experiences and depressive symptoms in a sample of Finnish adolescents entering psychiatric services.

Psychosis-Like Experiences (PLEs) and depressive symptoms are correlated in clinical adolescent populations. However, symptom-level associations between the two phenomena are not clear. We analysed factor structures of a PLE instrument, the Prodromal Questionnaire-Brief (PQ-B), based on dimensions of positive symptoms of schizophrenia, and a depression measurement instrument, the Beck Depression Inventory (BDI-21A) and performed a network analysis of item-level associations between the two measures. The sample consisted of 417 adolescents (range 13-18 years of age, mean 14.9 years, 72.4% females) entering secondary psychiatric services at Helsinki metropolitan area, Finland. Confirmatory factor analysis resulted in adequately fitting 2-factor solution, one for PQ-B and one for BDI-21, with a strong correlation coefficient of 0.605 between the two factors. In the network analysis, PQ-B and BDI-21 both formed their own clusters, and two significant pathways were estimated between PQ-B and BDI-21 clusters: 1. the association between paranoid thinking and distorted body image, and 2. the association between somatic preoccupation and worry about problems of one's mind. Even though on a general, factor level, PLEs and depressive symptoms were strongly correlated, unique associations between symptoms of the two constructs were sparse. These findings should be considered in the psychiatric assessment and in the care of adolescents.

A Survey of Bullying Experiences in a Child and Adolescent Psychiatric Clinic Population

AbstractObjectivesThe study hypothesis is that regardless of "zero-tolerance policies," bullying is still occurring in schools. The study objective is to assess the prevalence of bullying in a child and adolescent psychiatric clinic patient population and gather information from students about their experiences with bullying, the response of school staff, and results of corrective actions taken.MethodsA proposal was approved by the University of Missouri Internal Review Board to conduct this study. 101 randomly selected patients who are students in the mid-Missouri area were interviewed at the University of Missouri Child and Adolescent Psychiatry Clinic. All school districts in the surveyed area currently endorse a zero-tolerance bullying policy. After obtaining a guardian’s consent, each participant was asked a standard series of questions inquiring whether they had been bullied ever or in the past 12 months, bullied someone else, or witnessed bullying. Details including category, location, and action taken were also collected.ResultsOf the 101 study participants, 80% reported having been bullied at some point in their lifetime and 49% in the past year. The most common form of bullying was emotional/verbal, which was reported by 77 participants. 43 participants reported they had been victims of physical bullying. 25 participants reported cyber bullying and 11 reported sexual bullying. Of the 81 patients who reported experiencing bullying, 52% were male and 48% were female. The study population was 75% Caucasian, 11% African American, 7% biracial, and 7% other. The bullied population was 80% Caucasian, 11% African American, 4% biracial, and 5% other. When asked where at school bullying occurs the most, responses were as follows: 23% playground, 21% classroom, 20% hallway, 13% lunchroom, 11% restroom, and 13% somewhere else. 66.3% of participants reported never having bullied someone and 74% of participants responded that they would intervene if they saw someone getting bullied. 67 participants reported that they had previously acted against bullying, and 37% of these stated nothing happened as a result of their action. 22% of participants got the bully to stop and 13% got them to stop temporarily. 16% reported that their bully got in trouble, but 9% reported they themselves got in trouble after taking action.ConclusionsDespite zero-tolerance policies in place, a significant portion of bullied students reported that no action was taken even after reporting their bully. The threat of suspension or expulsion for the child accused may prevent school staff from taking these reports more seriously. Evidence-based methods, such as Positive Behavioral Interventions and Supports, are recommended to prevent bullying victimization. Many of these methods focus on creating a safe, inclusive environment by positively reinforcing expected behavior. There is also substantial evidence that educational programs can be successful in bullying reduction. As demonstrated by the results of this study, zero-tolerance policies alone are not sufficient bullying prevention. Revision to current policy is necessary to protect students in schools.FundingNo Funding

Clinical improvement of teens participating in a dbt skills training

IntroductionDialectical behavioural therapy (DBT) developed by Linehan has been shown to be widely effective in improving emotional regulation capacity in patients diagnosed with borderline personality disorder in adults and adolescents, but also for other profiles of emotional dysregulation, even in the general non-clinical population through emotional regulation skills training programs in schools.ObjectivesThe objective was to describe psychopathological characteristics and to evaluate clinical outcome variables (self-harm, suicide attempts, admissions and emotional regulation difficulties) in young patients who participated in the DBT skills training group carried out by the child and adolescent psychiatry team of Hospital del Mar (Barcelona) between February 2020 and April 2022.MethodsProspective longitudinal study with two evaluations (before starting the group and after finishing it). The clinical variables were evaluated by reviewing the medical records, and the improvement in emotional regulation difficulties was evaluated through the Difficulties in Emotion Regulation Scale (DERS) adaptation to adolescents before and after the intervention.ResultsA total of 36 participants have been referred and assessed to participate in the previously mentioned emotional regulation program. The mean age was 15.6 years (14-17 years old). 100% of the participants were female. All of them met criteria for BPD according to the SCID-II questionnaire; but only 23 patients (63.9%) had BPD as their main diagnosis. 63.9% (n=23) presented psychiatric comorbidities, being 27.8% (n= 10) ADHD, 30.6% (n= 11) substance use disorder and 47.2% (n= 17) eating disorders,77.8% (n=28) had presented self-injurious behaviour, 52% (n=18) had committed a suicide attempt, requiring hospital admission in 36.2% (n=13) at some point in their lives before the therapy group. In the three months after the end of the group, admissions were reduced to 17% (n=6), suicide attempts to 14.8% (n=5) and non-suicidal self-injurious behaviours to 27.8% (n=10).The mean score of all participants on the DERS scale was 129.91 points before participating in the DBT skills group and 105 points right after the group finished. Higher scores translate into greater emotional regulation difficulties.ConclusionsThe reduction in DERS scores, self-injurious behaviours, suicide attempts, and admissions was notable for all participants. It remains to add the results of the groups currently in operation and perform the statistical analysis of all the results. It is necessary to continue studying and testing the benefits of DBT both in the clinical adolescent population and in the general child and adolescent population in order to generalize the promising results observed in our sample. At Hospital del Mar, we will continue to expand the DBT program so that more children and adolescents with emotional dysregulation can benefit.Disclosure of InterestNone Declared

Comparison of adolescent referred involuntarily or voluntarily to psychiatric hospitalization

Purpose of the study To study in an adolescent clinical inpatient population how clinical, background and psychological factors differ between adolescents referred voluntarily or involuntarily. Methods In this prospective cohort study, we compared adolescents (age 13–17 years, n = 206) who had been referred to psychiatric hospitalization for the first time in their life either voluntarily (n = 144) or involuntarily (n = 62). We gathered from clinical records data on the source, mode and reason for referral as well as on whether after referral the subjects were admitted to the hospital voluntarily or not, and whether they were committed to involuntary hospitalization after the observation period. Diagnostics was based on Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) interview, supplemented by information from clinical records. Structured self-reports provided information on family background, depressive symptoms, substance use, defense styles, self-image and perceived social support. Results The majority of referrals due to psychotic symptoms were involuntary, whereas self-harm was the primary reason for involuntary and voluntary referrals in comparable extent. After diagnostic evaluation, no significant difference in psychotic disorders was observed between the two groups, but anxiety disorders were more prevalent among inpatients referred voluntarily than involuntarily. Among adolescents referred involuntary, parents were more often unemployed and had mental health problems. In self-assessments, mature defense style and more positive self-image were associated with adolescents referred involuntarily compared with those referred voluntarily. Conclusions Not only psychiatric but also psychological and social factors were associated with involuntary referral for psychiatric hospitalization in adolescents.

Executive functions mediate the association between ADHD symptoms and anxiety in a clinical adolescent population.

ObjectiveAttention-deficit/hyperactivity disorder (ADHD) is associated with a high prevalence of anxiety disorders in children and adolescents. The reasons for this association are poorly understood. Preliminary findings with young adults have suggested that executive functions and functional impairment may mediate the relationship between symptoms of ADHD and mixed anxiety and depressive symptoms. The objective of this study was to explore whether ADHD symptoms, executive functions and functional impairment predict anxiety in a clinical adolescent population. In addition, we investigated the possible mediating role of executive functions and functional impairment in this relationship.MethodOne hundred adolescents with ADHD and their parents completed the ADHD Rating Scale IV (ADHD RS-IV), the Behavior Rating Inventory of Executive Function (BRIEF), and the Weiss Functional Impairment Rating Scale (WFIRS) in relation to an RCT study. The adolescents also completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED). Analyses were conducted using regression and a serial multiple mediator model.ResultsIn the regression analyses, parent-rated ADHD symptoms were unable to predict anxiety, but ADHD inattention symptoms predicted anxiety in the self-ratings. Executive dysfunction and functional impairment predicted anxiety in both the parent- and self-reports. In the mediation analyses ADHD symptoms alone did not predict anxiety, but executive dysfunction mediated this relationship as expected. Functional impairment mediated this relationship indirectly through executive functions. The results were similar in the parent- and self- reports.ConclusionThe results pinpoint executive dysfunction as an important treatment target for alleviating anxiety in adolescents with impairing ADHD symptoms.

Role of Gender in Phemenon of Non-Suicidal Self-Injuries and Suicide Attempt Among Clinical Population of Adolescents

Abstract Non suicidal self-injury is defined as intentional self-inflicted injury without the intent to die. Suicide attempt is defined as a nonfatal, self-directed, potentially injurious behavior with the intent to die. Although distinct behaviors, they are frequently associated and possibly clinically related. The aims of this study are to explore demographic data, social-demographic differences between genders, co-occurrence of non-suicidal self-injuries with suicide attempt, their association with gender and clinical variables. Retrospective cohort study on 143 patient admitted in Clinic for mental disorders „Dr Laza Lazarevic“, aged 14 to 18 years, between January 2015 and January 2016. Information were obtained from database and included two categories of variables: socio-demographic (age, gender, education level, current living situation) and clinical variables (abuse, neglect, peer violence, aggressive behavior, non-suicidal self-injuries, suicide attempt and others). The mean age of adolescents was 15.8 years, with female being more frequent in the sample (51.4%). The incidence of Mood disorders was significantly higher (p&lt;0.05) in female compared to male (χ²꞊3,96, df꞊1, rC꞊0.16, p꞊0.04). A significantly higher incidence (p&lt;0.05) of non-suicidal self-injury (χ²꞊11.15, df꞊1, rC꞊0.27, p꞊0.001) and suicide attempt was found in female compared to male (χ²꞊5.38, df꞊1, rC꞊0.19, p꞊0.02). No statistically significant difference was found in their simultaneous occurrence compared to total population of hospitalized adolescents. The findings of the present study demonstrated that non-suicidal selfinjury and suicide attempt occur in clinical population of adolescent more often among female then in male adolescents.

0657 Evening chronotype moderates the relationship between maternal and offspring’s depressive symptoms in a clinical population of adolescents

Abstract Introduction Although depression has shown a strong familial aggregation tendency, there are some moderators between parental and offspring’s depression. Meanwhile, it is known that evening chronotype is a risk factor for depression. Therefore, this study aimed to evaluate the moderating role of chronotype in the relationship between maternal and adolescent depressive symptoms in a clinical sample. Methods Seventy-five adolescents who visited a sleep or psychiatric clinic with a major complaint of sleep disturbance or emotional problems agreed to participate, 51 adolescents and at least one biological parent who completed questionnaires were included in the current analysis (17 male adolescents, aged 9-17 yrs). Adolescent’s chronotype were measured by the reduced Morningness-Eveningness Questionnaire (rMEQ). Depressive symptoms in adolescents and parents were assessed by the Depression Self-Rating Scale for Children (DSRSC) and the Patient Health Questionnaire (PHQ-9), respectively. General linear models were applied to examine the interaction between parental depression and adolescent’s chronotype on adolescent’s depression, in which age and gender were entered as covariates. Results Mothers of adolescents with clinical depression (DSRSC&amp;gt;15, n=38) also reported more depressive symptoms (PHQ-9: 4.81±4.37 vs. 2.69±2.46, t=-2.14, p=0.039). But father’s depressive symptoms were not related with adolescent’s depression. In the current clinical sample, the prevalence of evening chronotype in adolescents was up to 45.1% (n=23). Adolescents with either non-evening or evening chronotype reported comparable level of depressive symptoms (DSRSC: 20.37±6.26 vs. 19.00±8.42, t=0.66, p=0.513). There was a significant interaction between maternal depressive symptoms and chronotype on offspring’s depressive symptoms (F=4.05, p=0.044). Specifically, maternal depressive symptoms were associated with offspring’s depressive symptoms only in adolescents with evening chronotype. Conclusion Our study suggested that adolescents with evening chronotype might be at an elevated risk of the transgenerational transmission of depression. Hence, our findings supported the need to consider circadian factors and maternal depression in identifying at-risk adolescents. Support (If Any) This work was supported by the Shanghai Sailing Program awarded to Dr. Wanqi Sun (Shanghai Science and Technology Committee, 19YF1442200).

The Utility of the Modified Fels Knee Skeletal Maturity System in Limb Length Prediction.

Predicting ultimate lower extremity length is important in the treatment of lower limb length discrepancy (LLD), congenital limb deficiency, and other etiologies. Utilizing skeletal age over chronological age improves the prediction of ultimate lower extremity length. The recently described modified Fels knee skeletal maturity system allows for skeletal age estimation via imaging always available in LLD patients. We sought to compare the accuracy of the modified Fels knee skeletal maturity system versus chronological age in ultimate limb length prediction of a modern adolescent clinical population. The medical records of all patients treated at our institution over a 20-year period with unilateral lower extremity pathology and available lower extremity imaging before and after reaching skeletal maturity were reviewed. Skeletal maturity was defined radiographically by closed distal femoral, proximal tibial, and proximal fibular physes. The femoral, tibial, and lower extremity length was measured in all radiographs. The modified Fels knee skeletal maturity system was applied to all radiographs obtained before maturity to estimate skeletal age. The accuracy of 3 widely utilized lower extremity length prediction systems was compared when utilizing estimated Fels skeletal age versus chronological age inputs. A total of 245 radiographs (109 before maturity) from 43 patients were eligible for inclusion. On cross-sectional analysis, linear modeling using Fels skeletal ages was uniformly associated with higher (improved) R2 values than chronological age-based models. On longitudinal analysis, skeletal age mixed-effects models had significantly lower (improved) Akaike information criterion and Bayesian information criterion values than chronological age models in all cases. Cohen d values were also significantly different (P<0.05) for the skeletal age models compared with chronological age models in all cases. In the treatment of LLD, the modified Fels knee skeletal maturity system can be readily applied to available imaging to improve the prediction of ultimate femoral, tibial, and lower extremity length. This skeletal maturity system may have significant utility in the estimation of ultimate LLD and determination of appropriate timing of epiphysiodesis. Level III.

The Effects of Social Rank and Neighborhood and School Environment on Adolescent Depression and Suicidal Ideation: A Structural Equation Modeling Approach.

Depression and suicide constitute major public health problems, and their prevalence has been increasing among adolescents in the United States. More research is needed to understand the association between multilevel risk factors and depression and suicidal ideation in adolescents, particularly factors related to perceived social rank and environmental stress. The present study examined relationships among family mental history of mental illness, in-utero and perinatal complications, social rank factors, environmental factors, and depression and suicidal ideation in the past month in a clinical population of adolescents. A cross-sectional survey was administered in outpatient clinics to 197 adolescents ages 12-18 who were primarily Black and female. Findings from structural equation modeling showed the largest effects for the social rank factor on depression and suicidal ideation in the past month. These findings highlight the importance of preventive interventions for coping with social hierarchies to prevent depression and suicidal ideation.

Fear Conditioning Deficits in Children and Adolescents with Psychopathic Traits: a Study in a Clinical Population

Deficits in fear conditioning related to psychopathy have been widely studied in adults. However, evidence in children and adolescents is scarce and inconsistent. This research aimed to expand knowledge about fear conditioning in psychopathy and its dimensions in child and early adolescent clinical populations. Participants were 45 boys (outpatients) aged 6–14 years (M = 10.59, SD = 2.04). They were assessed with the parents’ and teachers’ versions of the Child Problematic Traits Inventory (CPTI). A fear conditioning paradigm (Neumann et al., in Biological Psychology, 79(3), 337–342, 2008) for children and adolescents was used. Conditioned stimuli (CS+ and CS-) were geometric shapes and the unconditioned stimulus (US) was an unpleasant sound of metal scraping on slate (83 dB). Difference scores (CS+ minus CS-) in skin conductance responses (SCR) and self-reported cognitive and affective measures were considered as indices of fear conditioning. Results showed that: a) deficits in fear conditioning were related to some psychopathy dimensions but not to psychopathy as a unitary construct; b) the Impulsivity-Need for Stimulation dimension was a predictor of impaired fear conditioning at a cognitive level; c) the interaction of Callous-Unemotional and Impulsivity-Need for Stimulation dimensions was a significant predictor of impaired electrodermal fear conditioning; d) by contrast, the Grandiose-Deceitful dimension, was marginally associated with a greater electrodermal fear conditioning. In conclusion, psychopathy dimensions and their interactions, but not psychopathy as a whole, predicted deficits in fear conditioning as measured by SCR and cognitive indices. These findings confirm the notion that psychopathic traits are associated with deficits in fear conditioning in child and adolescent clinical populations and provide support for a multidimensional approach to youth psychopathy.

Impact of physical exercise on depression and anxiety in adolescent inpatients: A randomized controlled trial

BackgroundPhysical exercise therapy is of proven efficacy in the treatment of adults with depression, but corresponding evidence is lacking in depressed adolescent inpatients. The aim of this study was to document the effect of add-on treatment with structured physical exercise in a clinical population of adolescents hospitalized for depression and anxiety in a psychiatric hospital. MethodsA group of 52 adolescent inpatients was randomly assigned to a physical exercise or control program three to four times per week over a six-week period (20 hours in total). The primary outcome was the Hospital Anxiety Depression Scale (HADS) for evaluation of depression and anxiety symptoms. Secondary outcomes were psychological self-assessments, diagnostic interviews, and physical examinations. ResultsSix participants were lost in each group, leaving 20 inpatients each in the intervention and control groups. A linear mixed model with F-test revealed a significant interaction in favor of physical exercise in reducing the mean depression score (HADS-D) by 3.8 points [95% (CI), range 1.8 to 5.7], compared to a mean reduction score of 0.7 [95% (CI), range -0,7 to 2.0] in the control group. No significant interaction was found for anxiety symptoms (HADS-A). LimitationsThe investigation was limited to the six-week hospital window and the small sample size prevented exploring differences in social characteristics. ConclusionStructured physical exercise add-on therapy integrated into the psychiatric hospitalization of adolescents has led to a reduction in their depressive symptoms, demonstrating its effectiveness in the care of adolescent inpatients with depression.

Psychometric Properties of the Hypoglycemia Fear Survey in a Clinical Sample of Adolescents with Type 1 Diabetes and Their Caregivers.

A previously published exploratory factor analysis suggested that the Hypoglycemia Fear Survey-Child and Parent Versions, is comprised of three subscales: Maintain High Blood Glucose, Helplessness/Worry About Low Blood Glucose, and Worry About Negative Social Consequences. The primary aim of this study was to confirm this three-factor model with a clinical population of adolescents with type 1 diabetes (T1D) and their caregivers. Participants included N = 1,035 youth ages 10-17.99 years with T1D, and their female (N = 835) and/or male (N = 326) caregivers who completed the Hypoglycemia Fear Survey independently during a routine medical appointment. We conducted confirmatory factor analysis and examined reliability of the Hypoglycemia Fear Survey and its associations with demographics and clinical outcomes (e.g., mean blood glucose, glycemic control). Confirmatory factor analysis supported the three-factor model in youth and female and male caregivers. The internal consistencies for Maintain High Blood Glucose, Helplessness/Worry About Low Blood Glucose, and Worry About Negative Social Consequences were acceptable. The majority of demographic and clinical outcome variables correlated as hypothesized with the three subscales. Using a large clinical sample of adolescents with T1D and their caretakers, we confirmed the three-factor model for the Hypoglycemia Fear Survey, which is sufficiently reliable to be used in a clinical setting. Important areas of future research include examining moderators for the effect of fear of hypoglycemia on clinical outcomes, and possible inclusion of items related to modern diabetes devices.

Coronavirus Disease 2019 Emergency and Remote Eye Movement Desensitization and Reprocessing Group Therapy With Adolescents and Young Adults: Overcoming Lockdown With the Butterfly Hug.

The coronavirus disease 2019 (COVID-19) pandemic has represented an individual and collective trauma with an impact on mental health. Restrictive measures such as lockdowns have increased risk factors for the development or triggering of various psychopathologies. Timely psychological intervention has constituted a protective factor that has been indicated as a form of prevention. The main objective of this study was to measure changes in the levels of traumatic stress and anxiety in a clinical population of adolescents and young adults aged 13 to 24 years – already assisted by the local primary and specialty care services before the pandemic – following a trauma-focused psychotherapeutic group intervention according to the eye movement desensitization and reprocessing protocol, conducted remotely before the end of the first lockdown. The Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI) scales, and the Emotion Thermometer were administered pre- and post-treatment. At the end of the treatment, the Post-Traumatic Growth Inventory (PTGI) questionnaire was administered. The results show that there was a significant improvement pre- and post-intervention in the scores of the scales STAI, IES-R, and Emotion Thermometer with a reduction in post-traumatic symptoms related in particular to the domains of intrusiveness and hyperarousal. The domain of avoidance was less significantly modified by therapy. This overall clinical improvement did not correlate with any of the demographic variables of the sample. In addition, the results show a significant positive global perceived change (PTGI) that did not correlate with the reduction of anxiety or post-traumatic symptoms measured by the other self-report scales. The explored use of telemedicine has revealed a valuable clinical opportunity.