High-risk Community Sample Research Articles

Identifying vulnerable mother-infant dyads: a psychometric evaluation of two observational coding systems using varying interaction periods.

Clinical services require feasible assessments of parent-infant interaction in order to identify dyads requiring parenting intervention. We assessed the reliability and predictive validity of two observational tools and tested whether briefer forms could be identified which retain acceptable psychometric properties over short observation periods. A stratified high-risk community sample of 250 mother-infant dyads from The Wirral Child Health and Development Study completed 7-min play-based interaction at 6-8 months. Film-footage was independently coded by two trained raters using PIIOS and NICHD-SECCYD systems. Incremental predictive validity was assessed from 3, 5 and 7 min observation to attachment outcomes (Strange Situation; 14 months) and infant mental health (BITSEA; 14 and 30 months). Excellent inter-rater reliability was evident at code and subscale level for each tool and observation period. Stability of within-rater agreement was optimal after 5 min observation. ROC analysis confirmed predictive (discriminant) validity (AUCs >0.70) to top decile age 2 mental health outcomes for PIIOS total score and a brief 3-item composite from NICHD-SECCYD (sensitivity, intrusiveness, positive regard; NICHD-3), but not to attachment outcomes. Logistic regression showed dyads rated at-risk for externalizing problems using NICHD-3 were also at significantly higher risk for insecurity at 14 months (OR = 2.7, p = 0.004). PIIOS total and NICHD-3 ratings from 5 min observation are both reliable and valid tools for use in clinical practice. Findings suggest NICHD-3 may have greater utility due to its comparative brevity to train and code, with suitability for use over a broader developmental time frame (3-24 months).

Neurobiological metric of cortical delay discounting differentiates risk for self- and other-directed violence among trauma-exposed individuals.

Self- and other-directed violence (SDV/ODV) contribute to elevated rates of mortality. Early trauma exposure shows robust positive associations with these forms of violence but alone does not distinguish those at heightened risk for later engagement in SDV/ODV. Novel assessment metrics could aid early identification efforts for individuals with vulnerabilities to violence perpetration. This study examined a novel neurobiological measure of impulsive choice for reward as a potential moderator of associations between childhood trauma exposure and lifetime SDV/ODV. A high-risk community sample of 177 adults (89 men; 50.3%) were assessed for childhood trauma exposure, engagement in SDV (e.g., suicide attempts), and ODV (e.g., assault). A cortical delay discounting (C-DD) measure was created using a multivariate additive model of gray matter thickness across both hemispheres, previously found to be positively associated with susceptibility to impulsivity and externalizing disorders. Childhood trauma exposure was positively associated with ODV and SDV; however, these relationships differed as a function of C-DD. Engagement in ODV increased as scores on C-DD increased, and SDV increased as scores on C-DD decreased. Furthermore, moderation revealed biological sex differences, as the association between childhood trauma and SDV depended on C-DD for women but not for men. Findings from the present work demonstrate that risk conferred by childhood trauma exposure to violence varied as a function of a C-DD. Together, these findings point to the utility of neurobiological markers of impulsive decision-making for differentiating risk for violence among individuals with a history of trauma exposure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Feasibility and acceptability of implementing an intimate partner violence and parenting group intervention in a community agency serving a high-risk community sample: A pilot study

Intimate partner violence (IPV) is associated with several negative outcomes for victims and their children and is often considered a form of child maltreatment by child protection services (CPS). Despite this, there is a gap in the literature regarding IPV interventions for higher-risk families involved with CPS. This paper describes preliminary effectiveness, feasibility, and acceptability of a parenting/IPV intervention provided to an underserved and socioeconomically disadvantaged community sample of women, many of whom were referred by CPS. This group intervention was implemented within a community agency serving low-income families. Seventy-nine women participated in the intervention, 67 of whom also participated in the research component of the study. Participants completed self-report questionnaires at pre- and post-intervention to obtain quantitative measures of IPV, parenting, and mental health. Participants also completed a semi-structured interview to obtain qualitative data regarding acceptability and feasibility of the intervention. Reduced depression (t (41) = 3.53, p <.01, d = 0.52), anxiety (t(41) = 2.70, p <.05, d = 0.39), and frequency of exposure to IPV (t(36) = 2.94, p <.01, d = 0.28) were observed from pre- to post-intervention. Qualitative data suggests participants found the intervention to be acceptable and feasible. Additionally, participants reported increased recognition of their own experiences with IPV and its impact on them, their parenting, and their children. Results suggest this intervention is feasible to implement and acceptable to participants and the community agency in which it was implemented. Future directions for research and program development are discussed.

Callous-unemotional traits and anxiety in adolescents: a latent profile analysis to identify different types of antisocial behavior in a high-risk community sample

ObjectiveCallous-unemotional (CU) traits are associated with a more severe and chronic trajectory of antisocial behavior. The present study aimed to identify different classes of CU and anxiety and to compare these classes on overt and covert antisocial behavior and several clinical correlates.MethodIn a prospective high-risk cohort of adolescents (N = 679; mean age = 14.77, SD = 0.81), latent profile analysis was conducted using CU traits and anxiety symptoms as indicators, and multi-informant aggressive and rule breaking behavior as distal outcomes. Post-hoc analyses with binary logistic regression and a series of ANCOVA were performed on identified classes assessing violent aggression, property offending, and clinical correlates.ResultsThree classes were found, a reference group (low CU, low anxiety; N = 500), a high CU-low anxiety group (N = 98), and an intermediate CU-high anxious group (N = 81). The high CU-low anxiety group scored highest on property offenses, while the intermediate CU-high anxious group scored highest on aggressive behavior. The intermediate CU-high anxious group scored highest on psychotic experiences, while the high CU group scored highest on internet gaming addiction problems and bullying victimization.ConclusionThese findings provide further evidence for diverse variants of CU traits in a high-risk community sample. Future prospective studies should point out whether and to what extent adolescents with CU traits with and without anxiety develop criminal careers and psychiatric disorders in adulthood.

Clarifying the synergistic effects of emotion dysregulation and inhibitory control on physical aggression.

Rising rates of violence underscore the need to better understand how systems that regulate distress and impulse control jointly modulate aggression risk. The goals of the current study were to investigate the unique and interactive effects of emotional dysregulation and inhibitory control on the perpetration of physical aggression. We recruited a high-risk community sample of 206 adults (M/SDage =33.55/10.89 years old; 47.1% female) who reported a range of physically aggressive behaviors. All participants completed a self-report measure (Difficulties in Emotion Regulation Scale), neuropsychological testing (Color Word Interference Test), and clinical interviewing (Lifetime History of Aggression Interview), and a subset of individuals (n=134) underwent a neuroanatomical scan. As expected, the interplay of emotional and inhibitory control explained unique variance in physical aggression above and beyond their main effects. The positive association between emotion dysregulation and aggression strengthened as inhibitory control decreased. Cortical thickness in two right prefrontal clusters, one that peaked in the superior frontal gyrus and one that peaked in the caudal middle frontal gyrus, was also associated with the interactive effects of emotional dysregulation and inhibitory control. Notably, thickness in the superior frontal gyrus mediated the association between emotion dysregulation and physical aggression at low levels of inhibitory control. Using a multilevel and multimethod approach, the present study revealed neuroanatomical correlates of emotion-cognition interactions that have translational relevance to violence perpetration. These findings extend previous work primarily focused on functional-based neural assessments and point to the utility of examining neuroanatomical correlates of emotion-cognition interactions for understanding human aggression.

A Longitudinal Course of ICD-11 Adjustment Disorder Symptom Profiles: A 12-Month Follow-Up Study

Introduction: Adjustment disorder is frequently diagnosed in clinical practice; however, the course of adjustment disorder over time has not yet been studied extensively. Methods: This longitudinal study was one of the first that aimed to analyze trajectories of adjustment disorder symptoms in a 12-month follow-up among a high-risk community sample (n = 205) exposed to various stressors. Adjustment disorder symptoms were measured at baseline and 12-month follow-up with the Brief Adjustment Disorder New Module based on the definition of adjustment disorder provided in the 11th Edition of International Classification of Diseases (ICD-11) released in 2018 by the World Health Organization (WHO). Results: A latent transition analysis of adjustment symptoms identified four distinct trajectories: “high symptom,” “recovery,” “onset,” and “low symptom.” We found 46% of ICD-11 adjustment disorder at baseline, and 29% of the sample was classified as having a high-symptom adjustment symptom profile. The high-symptom profile was predicted by ongoing stressors, female gender, and higher education. Conclusion: Study findings indicate that adjustment disorder among high-risk samples, in particular, those exposed to ongoing stressors, could have a high-symptom course over 12 months.

A multidimensional examination of psychopathy traits and gray matter volume in adults.

Uncovering the neurobiological abnormalities that may contribute to the manifestation of psychopathic traits is an important step toward understanding the etiology of this disorder. Although many studies have examined gray matter volume (GMV) in relation to psychopathy, few have examined how dimensions of psychopathic traits interactively relate to GMV, an approach that holds promise for parsing heterogeneity in neurobiological risk factors for this disorder. The aim of this study was to investigate the affective-interpersonal (Factor 1) and impulsive-antisocial (Factor 2) dimensions of psychopathy in relation to cortical surface and subcortical GMV in a mixed-gender, high-risk community sample with significant justice-system involvement (N = 156, 50.0% men). Cortex-wide analysis indicated that (i) the Factor 1 traits correlated negatively with GMV in two cortical clusters, one in the right rostral middle frontal region and one in the occipital lobe, and (ii) the interaction of the affective-interpersonal and impulsive-antisocial traits was negatively associated with GMV bilaterally in the parietal lobe, such that individuals high on both trait dimensions evidenced reduced GMV relative to individuals high on only one psychopathy factor. An interactive effect also emerged for bilateral amygdalar and hippocampal GMV, such that Factor 1 psychopathic traits were significantly negatively associated with GMV only at high (but not low) levels of Factor 2 traits. Results extend prior research by demonstrating the neurobiological correlates of psychopathy differ based on the presentation of Factor 1 and 2 traits.

Residential Greenness Positively Associated with the Cortisol to DHEA Ratio among Urban-Dwelling African American Women at Risk for HIV.

As ecosystems that support human health, societies, and civilization change in the era of the Anthropocene, individuals with disproportionate balance of salivary hormones may be at greatest risk of morbidity and mortality. Vulnerable communities, in particular, are overburdened by inequities in features of built environments linked to health disparities. This study examined the cross-sectional association of greenness in the built environment with the ratio of cortisol to dehydroepiandrosterone (DHEA) in an urban-dwelling high-risk community sample of African American women (n = 84, age 18-44years). Saliva samples, collected across 2 consecutive days, were assayed for cortisol and DHEA. Controlling for sexual violence, perceived stress, education, and income, as well as crime, traffic density, and vacant properties, we observed a significant positive cross-sectional association between greenness and the cortisol to DHEA ratio, (β = 7·5, 95% CI: 0.89, 14.19). The findings highlight environmental influence on stress response at waking when there is the greatest individual variation. Implications for advancing our understanding of the waking ratio of cortisol to DHEA as a potential marker of physiological resilience are discussed.

An Analysis of Monoamine-Related Genotypes and Childhood Trauma in Relation to Psychopathic Traits in Men and Women

Psychopathy is of great interest to criminologists, given its consistent association with violence, offending, and antisocial behavior. However, the etiology of psychopathy, particularly in terms of a gene × environment (G×E) interaction, has had little examination in the literature. One study has examined the direct and interactive effects of two genotypes (MAOA, 5-HTT) and childhood trauma on psychopathic traits using a high-risk forensic sample of adult males, and identified G×E interactions that may help us understand this complex phenotype. However, given the difficulties replicating G×E research, particularly with antisocial phenotypes, this study conducts a replication and expansion of prior research by examining direct and interactive effects of three genotypes (MAOA, 5-HTT, DRD4) and childhood trauma on psychopathy using a high-risk community sample of males and females. Results only partially support prior findings, illustrating the need for additional replication research in the biopsychosocial and epigenetic arenas.

Prevalence and Risk Factors of Nonmedical Prescription Opioid Use Among Transgender Girls and Young Women

Nonmedical prescription opioid use is a pressing public health issue in the United States. Transgender youth, including adolescent girls and young women who were assigned male at birth and currently identify as women, female, transgender women, or another diverse gender identity along the transfeminine gender spectrum, are more likely than their cisgender peers to report illicit substance use and meet diagnostic criteria for substance use disorders. However, relatively little is known about the experiences of these populations in the current era of opioid addiction and misuse. To report the prevalence of and risk factors associated with lifetime nonmedical prescription opioid use in a high-risk community sample of transgender adolescent girls and young women who are sexually active. This cross-sectional study used 2012 to 2015 baseline data from Project LifeSkills, a randomized clinical trial of a behavioral intervention to reduce the risk of HIV acquisition and transmission among a diverse sample of transgender adolescent girls and young women recruited from Boston, Massachusetts, and Chicago, Illinois. A total of 297 transgender girls and women aged 16 to 29 years who were sexually active were included in this analysis. Data were analyzed from June 2019 to August 2019. Transgender woman identification. Self-reported lifetime nonmedical prescription opioid use. Among 297 transgender adolescent girls and young women (mean [SD] age, 23.4 [3.5] years), 145 (48.8%) identified as non-Hispanic/Latinx black, 76 (25.6%) identified as non-Hispanic/Latinx white, 37 (12.5%) identified as Hispanic/Latinx, 7 (2.4%) identified as non-Hispanic/Latinx Asian, and 32 (10.8%) identified as multiracial or other race/ethnicity. Thirty-five participants (11.8%) reported lifetime nonmedical prescription opioid use. Young transgender women who smoked cigarettes monthly or less (adjusted odds ratio, 3.92; 95% CI, 1.10-13.89) and who smoked daily (adjusted odds ratio, 5.69; 95% CI, 1.87-17.33) had greater odds of nonmedical prescription opioid use compared with those who did not smoke. Additionally, participants who identified as a sexual orientation other than heterosexual, gay, lesbian, or bisexual had significantly greater odds of lifetime nonmedical prescription opioid use compared with those who identified as heterosexual (adjusted odds ratio, 3.69; 95% CI, 1.07-12.72). These findings suggest that transgender adolescent girls and young women have similar prevalence of lifetime nonmedical prescription opioid use compared with the US general population prevalence of 12.5%. These findings may serve as a call-to-action for public health surveillance studies and evidence-based interventions to be comprehensively tailored to examine and respond to specific trends of substance use, particularly opioid use disorder, among transgender populations.

Maternal Depressive Symptoms and Warm Responsiveness Across the Transition to Parenthood

Depression is the leading cause of disability worldwide. Postpartum depression effects up to 12.4% of women and negatively impacts parenting behaviors as early as infancy. This study examined the associations between maternal depressive symptoms and warm responsiveness from the third trimester of pregnancy through 18 months postpartum. This study assessed a high risk community sample (N = 682) of first-time mothers, ranging in age from 14–36 years old, with a majority identifying as African American and low income. Maternal depressive symptoms were assessed with a self-report measure, the Beck Depression Inventory II, prenatally and at six and 12 months postpartum, while maternal warm responsiveness data were coded via in-home observations with the Landry Observational measure at four, eight, and 18 months postpartum. Latent growth curve modeling was used to assess the associations between depressive symptoms and warm responsiveness over time. The change in depressive symptoms was −4.92 (SE = 0.39, p < 0.0001) demonstrating that depressive symptoms decreased over time. The change in warm responsiveness was −0.55 (SE = 0.06, p < 0.0001) demonstrating that warm responsiveness also decreased over time. Greater depressive symptoms prenatally were significantly associated with less warm responsiveness at 4 months postpartum (B = −0.03, SE = 0.01, p < 0.01). However, changes in depressive symptoms were not significantly associated with changes in warm responsiveness over time. It is important to assess for symptoms of depression during pregnancy in order to provide women the opportunity to have access to more resources and support.

Mothers' History of Child Sexual Abuse and Child Behavior Problems: The Mediating Role of Mothers' Helpless State of Mind.

This investigation evaluated a theoretically specified model of associations among mothers' history of child sexual abuse (CSA), a helpless state of mind (SOM) with regard to the mother-child relationship, and increased behavior problems in the next generation. Moreover, we evaluated the moderating influence of child gender on predicted relations between mothers' CSA severity and helpless SOM (i.e., moderated mediation). Participants were 225 biological mother-preschooler dyads (48% female; 46.4% Latinx) drawn from an ongoing, longitudinal study of representation and regulation in child development. Mothers' history of CSA was assessed when their children were 4 years old and emerged as a prominent risk factor in this diverse, high-risk community sample with 40% of mothers reporting contact-based sexual abuse prior to age 18. Mediation analyses revealed a significant indirect pathway from a continuous rating of mothers' CSA severity to increased externalizing behavior problems from ages 4 to 8 in the next generation via mothers' helpless SOM at age 6. Further, this indirect path was significant for mother-daughter dyads, but not for mother-son dyads. This investigation contributes to the neophyte literature on intergenerational CSA effects by revealing the impact of a mother's CSA history on her SOM regarding the mother-child relationship, particularly when parenting daughters. Clinical interventions that enhance survivors' awareness of and reflection on their SOM regarding the parent-child relationship may attenuate intergenerational CSA effects on child adaptation.

Effects of Formal and Informal Deviant Labels in Adolescence on Crime in Adulthood

The study reported in this article used labeling theory to examine the relationship between multiple labels in adolescence and self-reported criminal behavior in adulthood. This study used childhood, adolescent, and adult interviews (N = 357) from the Lehigh Longitudinal Study, which followed a high-risk community sample of individuals recruited from child welfare caseloads and other group settings in Pennsylvania. Structural equation modeling was used to estimate the effects of three measures of labeling (formal legal system involvement, false stops by the police, and reflected parental perceptions) on crime in adulthood. Gender differences also were examined. Reflected parental perceptions of adolescents as deviant were significantly associated with criminal behaviors in adulthood, but both legal system labels (that is, formal legal system involvement and false stops by the police) were not. There were no gender differences in the effect of labeling on later criminal behaviors.

Stress responsivity and the structure of common mental disorders: Transdiagnostic internalizing and externalizing dimensions are associated with contrasting stress appraisal biases.

Biased stress appraisals critically relate to the origins and temporal course of many-perhaps most-forms of psychopathology. We hypothesized that aberrant stress appraisals are linked directly to latent internalizing and externalizing traits that, in turn, predispose to multiple disorders. A high-risk community sample of 815 adolescents underwent semistructured interviews to assess clinical disorders and naturalistic stressors at ages 15 and 20. Participants and blind rating teams separately evaluated the threat associated with acute stressors occurring in the past year, and an appraisal bias index (i.e., discrepancy between subjective and team-rated threat) was generated. A 2-factor (Internalizing and Externalizing) latent variable model provided an excellent fit to the diagnostic correlations. After adjusting for the covariation between the factors, adolescents' threat overestimation prospectively predicted higher standing on Internalizing, whereas threat underestimation prospectively predicted elevations on Externalizing. Cross-sectional analyses replicated this pattern in early adulthood. Appraisals were not related to the residual portions of any diagnosis in the latent variable model, suggesting that the transdiagnostic dimensions mediated the connections between stress appraisal bias and disorder entities. We discuss implications for enhancing the efficiency of emerging research on the stress response and speculate how these findings, if replicated, might guide refinements to psychological treatments for stress-linked disorders. (PsycINFO Database Record

The Family Socialization Interview-Revised (FSI-R): a Comprehensive Assessment of Parental Disciplinary Behaviors.

Elucidating the complex mechanisms by which harsh parenting increases risk of child psychopathology is key to targeted prevention. This requires nuanced methods that capture the varied perceptions and experiences of diverse families. The Family Socialization Interview-Revised (FSI-R), adapted from an interview developed by Dodge et al. (Child Development, 65, 649-665, 1994), is a comprehensive, semi-structured interview for characterizing methods of parental discipline used with young children. The FSI-R coding system systematically rates parenting style, usual discipline techniques, and most intense physical and psychological discipline based on rater judgment across two eras: (1) birth to the previous year, and (2) the previous year to present. The current study examined the psychometric properties of the FSI-R in a diverse, high-risk community sample of 386 mothers and their children, ages 3 to 6years. Interrater reliability was good to excellent for codes capturing physically and psychologically harsh parenting, and restrictive/punitive parenting styles. Findings supported the FSI-R's convergent and incremental validity. Importantly, the FSI-R demonstrated incremental utility, explaining unique variance in children's externalizing and internalizing symptoms beyond that explained by traditional surveys and observed parenting. The FSI-R appeared particularly promising for capturing risk associated with young children's depressive symptoms, as these were generally not significantly associated with other measures of harsh parenting. Overall, findings support the added value of the FSI-R within a multi-method assessment of disciplinary practices across early child development. Future implications for prevention are discussed.

Nutritional supplementation to reduce child aggression: a randomized, stratified, single-blind, factorial trial.

While some studies suggest that nutritional supplementation may reduce aggressive behavior in children, they have not examined whether its efficacy may be enhanced in conjunction with other treatment approaches. This study tests the hypothesis that a nutritional supplementation of omega-3, multivitamins, and minerals over 3months, combined with cognitive behavior therapy, will reduce childhood aggression. In this randomized, single-blind, stratified, factorial trial, a high-risk community sample of 290 children aged 11-12years were randomized into Nutrition only, cognitive behavioral therapy (CBT) only, Nutrition+CBT, and Control groups. The primary outcome measures of child- and parent-reported aggressive and antisocial behavior were collected at 0months (baseline), 3months (end of treatment), 6months (3months posttreatment), and 12months (9months posttreatment). The trial ('Healthy Brains & Behavior: Understanding and Treating Youth Aggression (HBB)' was registered at ClinicalTrials.gov at https://clinicaltrials.gov/ct2/show/NCT00842439 RESULTS: For child self-reports, children in the Nutrition only group showed reduced externalizing behavior compared to Controls at 3months. At 6months, the Nutrition+CBT group scored lower on externalizing behavior compared to both CBT only and Control groups. Findings were more in evidence for an Aggressive-Reactive form of antisocial behavior than for a Callous-Proactive form. Effect sizes were in the small-to-medium range (d=-.33 to -.37). Group differences were not sustained 9months posttreatment, and no other effects were significant. Findings provide some limited support for the efficacy of omega-3, vitamin, and mineral supplementation in reducing aggressive behavior in children, and represent the first evaluation of nutritional supplements in conjunction with CBT.

Parent and peer influences on emerging adult substance use disorder: A genetically informed study.

The present study utilizes longitudinal data from a high-risk community sample to examine the unique effects of genetic risk, parental knowledge about the daily activities of adolescents, and peer substance use on emerging adult substance use disorders (SUDs). These effects are examined over and above a polygenic risk score. In addition, this polygenic risk score is used to examine gene-environment correlation and interaction. The results show that during older adolescence, higher adolescent genetic risk for SUDs predicts less parental knowledge, but this relation is nonsignificant in younger adolescence. Parental knowledge (using mother report) mediates the effects of parental alcohol use disorder (AUD) and adolescent genetic risk on risk for SUD, and peer substance use mediates the effect of parent AUD on offspring SUD. Finally, there are significant gene-environment interactions such that, for those at the highest levels of genetic risk, less parental knowledge and more peer substance use confers greater risk for SUDs. However, for those at medium and low genetic risk, these effects are attenuated. These findings suggest that the evocative effects of adolescent genetic risk on parenting increase with age across adolescence. They also suggest that some of the most important environmental risk factors for SUDs exert effects that vary across level of genetic propensity.

Reflective functioning in parents of school-aged children.

Parental reflective functioning (RF) has garnered tremendous support as a predictor of secure attachment in infancy, though little work has examined RF among parents of older children. In this study, we used a high-risk community sample of parent-child dyads (N = 117) to explore whether parental RF comprises self- and child-focused factors, whether parental RF is associated with parent and child attachment security, and whether parental RF mediates the association between parent and child attachment security. Results suggested that parental RF can be characterized as having both self- and child-focused components, and that child-focused parental RF is associated with child but not parent attachment security. Further, child-focused parental RF indirectly mediates the association between parent attachment avoidance and child attachment security. These findings extend previous work on parental RF to parents of school-age children and, in so doing, inform developmental models of attachment relationships in middle childhood. Discussion focuses on the importance of these findings in informing theory, prevention, clinical practice, and policy.

Optimizing Prediction of Psychosocial and Clinical Outcomes With a Transdiagnostic Model of Personality Disorder.

Transdiagnostic models hold promise for transforming research and treatment practices for personality disorders (PDs), but widespread acceptance and implementation of such approaches will require persuasive evidence of construct validity and clinical utility. Toward that end, the authors examined the criterion-related validity of a transdiagnostic PD model in relation to psychosocial and clinical outcomes in a high-risk community sample of 700 young adults. Participants and their mothers completed semistructured interviews to assess young adults' PD symptomatology, psychosocial functioning, suicidality, and mental health treatment use. Bifactor modeling revealed an overarching dimension of PD severity-capturing symptoms across all PD categories-that strongly predicted all functional and clinical outcomes in multivariate analyses. Effect sizes for lower-order, specific PD processes were comparatively modest for functional outcomes; however, they provided clinically significant information about suicide risk and treatment use. The authors discuss implications of a transdiagnostic perspective for research on PD etiology, classification, and treatment.

Risk for behavior problems in children of parents with substance use disorders.

Using a high-risk community sample (N = 567), the current study examined risk for externalizing and internalizing problems in the children of parents with recovered and current substance use disorders (SUDs). This study also tested whether parenting mediated the relations between these variables. Results suggest that children of parents with current diagnoses were at elevated risk for externalizing and internalizing problems, but children of parents with recovered diagnoses were only at risk for externalizing problems. Perceived parental consistency of support mediated the relations between parent current SUD and child externalizing and internalizing problems. Disruption of the home environment may in part explain why children of parents with SUDs are at risk for externalizing and internalizing problems. However, even after parent SUD has remitted, children remain at risk for externalizing problems, suggesting multiple mechanisms by which parents confer risk for psychopathology.