Sample Of Adolescent Psychiatric Inpatients Research Articles

Trauma-related symptoms in adolescents: the differential roles of sexual abuse and mentalizing.

Major gaps remain in our knowledge regarding childhood sexual abuse (CSA) related symptoms in adolescent psychiatric inpatients, as well as potential resilience factors like mentalizing. CSA is a risk factor for the early emergence of borderline personality features, posttraumatic stress, and sexual concerns. Mentalizing, which involves the capacity to understand our reactions and that of others in psychological terms, is a resilience factor for self and interpersonal functioning. The aim of this study was to address knowledge gaps by examining the contributions of CSA and mentalizing in a latent factor composed of borderline personality features, posttraumatic stress, and sexual concerns in a sample of adolescent psychiatric inpatients. We hypothesized that CSA and mentalizing would independently explain the variance in this latent factor. Participants were 273 adolescents aged 12-17 recruited from an adolescent inpatient psychiatric clinic. They completed the Reflective Function Questionnaire for Youth (RFQ-Y), the Trauma Symptom Checklist for Children (TSCC), and the Borderline Personality Features Scale for Children (BPFS-C). CSA was assessed using the Child Attachment Interview (CAI), the Computerized Diagnostic Interview Schedule for Children (C-DISC), as well as the Childhood Trauma Questionnaire (CTQ). 27.5% of adolescent psychiatric inpatients reported CSA. CSA and mentalizing were independently associated with a latent factor consisting of posttraumatic stress, borderline personality features, and sexual concerns. CSA explained 5.0% and RF explained 16.7% of the variance of the latent factor. When we consider both the unique and the shared contribution of CSA and mentalizing, the model explained 23.0% of the variance of this factor. CSA and mentalizing independently explained variance in a latent factor constituted of borderline personality features, posttraumatic stress, and sexual concerns. The direct effect of mentalizing was stronger and mentalizing explained comparatively more variance of trauma-related symptoms in adolescent psychiatric inpatients. The findings are consistent with the theory that mentalizing is an internal resilience factor in adolescent psychiatric inpatients. By implication, clinical interventions focused on promoting the development of mentalizing, such as Mentalization Based Treatment, may palliate mental health difficulties manifested by adolescent psychiatric inpatients including those associated with CSA.

2.133 Adverse Childhood Experiences Moderate the Relationship Between Minoritized Status and Engaging in Substance Use Among Adolescent Psychiatric Inpatients

Adverse childhood experiences (ACEs; parental death, bullying) are linked to developing psychiatric disorders and substance use. Individuals with a minoritized status due to race, ethnicity, sexuality, or gender identity often have more ACEs. ACEs are linked to substance use, hypothesized due to coping. The study objective was to test whether the relationship between minoritized status and ever using a substance depends on ACEs in a sample of adolescent psychiatric inpatients.

Suicidal behavior and stress generation in adolescents.

Stress generation has potential to account for recurrent suicidal behavior. The current study represents a first step toward evaluating this possibility in a sample of adolescent psychiatric inpatients (n = 99; 79.80% female) followed over six months. At index admission, participants completed baseline measures of depressive symptom severity, suicidal ideation, lifetime history of suicide attempts, and negative life events using a contextual threat life stress interview. Negative life events since baseline were assessed at the follow-up assessment. Consistent with the stress generation hypothesis, lifetime number of suicide attempts prospectively predicted higher rates of dependent, but not independent, stress. Bayesian analyses also yielded substantial support for an association with overall dependent stress, but provided more modest support for specificity to this form of life stress relative to independent stress. Implications of these findings and directions for future research further clarifying the role of stress generation in suicidal behavior are discussed.

Sexual orientation, gender, and attempted suicide among adolescent psychiatric inpatients.

Lesbian, gay, bisexual, and queer (LGBQ) and female youth report disproportionately high rates of attempted suicide. Previous studies have not addressed the association between sexual orientation, gender, and attempted suicide among adolescent psychiatric inpatients. This study examined LGBQ orientation as a correlate of attempted suicide above and beyond other risk factors (e.g., age, rurality, trauma exposure, psychopathology), and also examined the interaction between gender and sexual orientation with regard to attempted suicide. We conducted a chart review study that included 550 adolescent psychiatric inpatients admitted to a public psychiatric hospital. Adolescents completed standardized intake assessments and self-report measures of sociodemographics, history of attempted suicide, psychopathology, and trauma history. Sexual orientation, gender, and their interaction were evaluated as predictors of attempted suicide using sequential logistic regression. LGBQ youth were more than 3 times more likely (odds ratio [OR] = 3.08) than non-LGBQ peers to have attempted suicide, and female youth were more than twice as likely to have attempted suicide compared with male patients (OR = 2.44). There was not a significant LGBQ orientation by gender interaction. These findings demonstrate the importance of LGBQ orientation and female gender as risk factors for suicidal behavior in a sample of adolescent psychiatric inpatients. Although limited by the self-report and retrospective nature of the data collected, these findings suggest the importance of initial and ongoing assessment of gender, sexual orientation, and suicidality in inpatient youth and the need for additional research to inform effective intervention efforts in this high-risk population. (PsycINFO Database Record

Eating-related Psychopathology and Food Addiction in Adolescent Psychiatric Inpatients.

Our aims were to investigate the relationship between food addiction and mental disorders including eating disorders (ED), eating-related psychopathology and body mass index-standard deviation score in a sample of adolescent psychiatric inpatients. Food addiction was assessed with the Yale Food Addiction Scale (YFAS). Eating-related psychopathology was measured with the Three-Factor Eating Questionnaire (TFEQ). Psychiatric diagnoses were assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The sample consisted of n = 242 adolescent psychiatric inpatients, of which n = 37 (15.3%) met criteria for an ED. Multiple regression analysis was used to examine the association between YFAS symptom count, TFEQ scales and ED controlling for age and gender. Food addiction frequency was 16.5%, and the mean YFAS symptom count was 2.39 (SD: 1.60). In patients with food addiction, TFEQ scale scores were significantly higher than patients without food addiction. Frequency of ED was 42.9% in patients with and 9.9% in patients without food addiction. The TFEQ subscales disinhibition and hunger as well as diagnosis of ED were associated with YFAS symptom count. Food addiction in adolescent psychiatric inpatients occurs with rates higher than those seen in community samples of children, adolescents and adults. Food addiction might be associated with eating styles related to susceptibility to hunger and feelings of loss of control. The implications of high-YFAS scores in restricting-type anorexia nervosa warrant further investigations to explore which and how the respective items are interpreted in this ED subgroup. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Le questionnaire d’alexithymie pour enfants (QAE) : étude sur une population clinique de 105 adolescents hospitalisés en pédopsychiatrie

ObjectiveThe 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used measure of alexithymia in non-clinical or clinical populations. The TAS-20 evaluates three dimensions of the alexithymia construct: the difficulty identifying feelings (DIF), the difficulty describing feelings (DDF) and externally oriented thinking (EOT). The TAS-20 is also used in adolescents or children, and the psychometric properties of the scale have not been systematically evaluated in these populations. Recently several studies have shown systematic age differences in the factor structure and a decrease of the quality of the measurement with age. Notably, low reliability measured by the Cronbach α coefficient has been found for the EOT factor. Taking into account the limitations of the TAS-20 in pre-adult populations the Alexithymia Questionnaire for Children (AQC), an adaptation of the TAS-20, has been proposed by a reformulation of the TAS-20 items (Rieffe et al., 2006). Two studies in healthy children found satisfactory psychometric properties with the three-factor structure demonstrating adequate parameters in the confirmatory factorial analyses (CFA). In the two studies low reliabilities of the EOT factor were reported, and recent studies in adolescents using the TAS-20 found that a two-factor model (DDF, DIF) had a better fit than the original three-factor model. Thus, the aim of the present study was firstly to verify the psychometric properties of the AQC in a sample of adolescents presenting various psychiatric disorders and secondly to test the adequacy of the bi- or tridimensional model of the scale. MethodOne hundred and five adolescents (27 males, 78 females) with a mean age of 15.06 years (sd=1.55, range: 12–18 years) were hospitalized in the adolescent psychiatric department of the Erasme Hospital (Bruxelles, Belgium) for various psychiatric disorders. The main diagnoses were: adjustment disorder (n=56, 53.5%), mood or anxiety disorders (n=17, 16.2%), impulse control disorder (n=11, 10.5%). The subjects completed the French version of the AQC. CFA were done testing the adequacy of the three or two-factor structure of the scale. Two indices were considered: the normed χ2 (ratio of χ2 and degrees of freedom) and the root mean square error of approximation (RMSEA). The values for acceptable fit were normed χ2<3 and RMSEA<0.05. Cronbach α were also calculated. ResultsFit indices for the three-factor model were respectively 1.165 and 0.0303 for the normed χ2 and RMSEA. For the two-factor model, the values were respectively 0.819 and 0. Thus, these two well-fitting models were compared using the χ2-difference test, which indicated a significantly better fit for the two-factor model over the three-factor model (χ2-difference=151.447, delta df=114, P<0.05). The values of the Cronbach α coefficients were respectively 0.72, 0.75, 0.18 for DIF, DDF and EOT subscales. Moreover, the values of the Cronbach α coefficients were respectively 0.71 and 0.83 for the full scale and the scale without the EOT items. ConclusionThe Alexithymia Questionnaire for Children had satisfactory psychometric properties found in a sample of adolescent psychiatric inpatients. Taking into account firstly the superiority of the two-factor model over the classical three-factor model and secondly the low value of the Cronbach α for the EOT factor, it is proposed to use only the twelve-item scale by excluding the EOT items.

E002 Positive and negative experiences of parents and speech therapists on the effects of paediatric cochlear implantation and subsequent rehabilitation

La recherche sur l’alexithymie nécessite la mise au point d’instruments de mesure parmi lesquels l’échelle d’alexithymie de Toronto à 20 items (TAS-20) est considérée comme la référence. La TAS-20 comprend trois sous-échelles ou dimensions mesurant l’incapacité à identifier ses sentiments (DIF), l’incapacité à décrire ses sentiments (DDF) et la tendance à avoir des pensées tournées vers l’extérieur (EOT). L’étude de l’alexithymie chez l’enfant et l’adolescent rend nécessaire d’utiliser des instruments adaptés comme l’échelle d’alexithymie chez l’enfant (QAE) qui a été mise au point à partir d’une reformulation des items de la TAS-20. Deux études de validation ont montré les qualités psychométriques du QAE dans des populations d’enfants sains. L’objet de la présente étude était de vérifier les qualités psychométriques du QAE dans une population de 105 adolescents hospitalisés en psychiatrie pour des troubles divers. L’analyse factorielle confirmatoire a montré l’adéquation des données à la structure tridimensionnelle de l’échelle mais une structure bidimensionnelle sans la dimension EOT s’est avérée significativement supérieure. La cohérence interne mesurée par le coefficient α de Cronbach avait pour valeur 0,71 ou 0,83 pour l’échelle globale (20 items) ou pour l’échelle à 12 items sans le facteur EOT. En conclusion il est recommandé chez les enfants ou adolescents de ne prendre en considération que les dimensions DDF et DIF du QAE et en utilisant la sommation de ces deux sous-échelles.The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used measure of alexithymia in non-clinical or clinical populations. The TAS-20 evaluates three dimensions of the alexithymia construct: the difficulty identifying feelings (DIF), the difficulty describing feelings (DDF) and externally oriented thinking (EOT). The TAS-20 is also used in adolescents or children, and the psychometric properties of the scale have not been systematically evaluated in these populations. Recently several studies have shown systematic age differences in the factor structure and a decrease of the quality of the measurement with age. Notably, low reliability measured by the Cronbach α coefficient has been found for the EOT factor. Taking into account the limitations of the TAS-20 in pre-adult populations the Alexithymia Questionnaire for Children (AQC), an adaptation of the TAS-20, has been proposed by a reformulation of the TAS-20 items (Rieffe et al., 2006). Two studies in healthy children found satisfactory psychometric properties with the three-factor structure demonstrating adequate parameters in the confirmatory factorial analyses (CFA). In the two studies low reliabilities of the EOT factor were reported, and recent studies in adolescents using the TAS-20 found that a two-factor model (DDF, DIF) had a better fit than the original three-factor model. Thus, the aim of the present study was firstly to verify the psychometric properties of the AQC in a sample of adolescents presenting various psychiatric disorders and secondly to test the adequacy of the bi- or tridimensional model of the scale.One hundred and five adolescents (27 males, 78 females) with a mean age of 15.06 years (sd = 1.55, range: 12–18 years) were hospitalized in the adolescent psychiatric department of the Erasme Hospital (Bruxelles, Belgium) for various psychiatric disorders. The main diagnoses were: adjustment disorder (n = 56, 53.5%), mood or anxiety disorders (n = 17, 16.2%), impulse control disorder (n = 11, 10.5%). The subjects completed the French version of the AQC. CFA were done testing the adequacy of the three or two-factor structure of the scale. Two indices were considered: the normed χ2 (ratio of χ2 and degrees of freedom) and the root mean square error of approximation (RMSEA). The values for acceptable fit were normed χ2 < 3 and RMSEA < 0.05. Cronbach α were also calculated.Fit indices for the three-factor model were respectively 1.165 and 0.0303 for the normed χ2 and RMSEA. For the two-factor model, the values were respectively 0.819 and 0. Thus, these two well-fitting models were compared using the χ2-difference test, which indicated a significantly better fit for the two-factor model over the three-factor model (χ2-difference = 151.447, delta df = 114, P < 0.05). The values of the Cronbach α coefficients were respectively 0.72, 0.75, 0.18 for DIF, DDF and EOT subscales. Moreover, the values of the Cronbach α coefficients were respectively 0.71 and 0.83 for the full scale and the scale without the EOT items.The Alexithymia Questionnaire for Children had satisfactory psychometric properties found in a sample of adolescent psychiatric inpatients. Taking into account firstly the superiority of the two-factor model over the classical three-factor model and secondly the low value of the Cronbach α for the EOT factor, it is proposed to use only the twelve-item scale by excluding the EOT items.

Comment on Merydith and Phelps (2009): “Convergent Validity of the MMPI–A and MACI Scales of Depression”

In 2009, Merydith and Phelps reported convergent validity of scales in the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) and the Millon Adolescent Clinical Inventory (MACI) that assess depression with a sample of adolescent psychiatric inpatients. This comment addresses analysis of these data, cites selected research on sex and the two inventories, and restates the recommendation that researchers routinely examine such data separately by sex before proceeding with combined-sex analyses.

Nicotine use and dependence and their association to psychiatric disorders in a large sample of adolescent psychiatric inpatients

The purpose of this research was to evaluate the level of nicotine dependence (ND) and to examine its association to psychiatric disorders in a representative clinical sample of adolescent psychiatric inpatients. The modified Fagerstrom Tolerance Questionnaire (mFTQ) was used to assess the level of ND. Psychiatric DSM-IV diagnoses were obtained by using the Schedule for affective disorder and schizophrenia for school-age children (K-SADS-PL). Of the total of 342 inpatients in the study sample, 259 (75.7%) reported to be current smokers. A sum score 6 or higher in the mFTQ, indicating a high level of ND, was found in 37.9% of all smokers. An increased likelihood for high level of ND was associated with substance related disorders (OR 5.1, 95% CI 2.8–9.3), conduct disorder and oppositional defiant disorders (OR 2.4, 95% CI 1.4–4.4). The usefulness of mFTQ in measuring ND among adolescent inpatients is apparent. Therefore, it can be recommended to be used as a routine screening instrument for ND among adolescents hospitalized due to psychiatric disorders.

The relationship between child sexual abuse and academic achievement in a sample of adolescent psychiatric inpatients

Objectives: To examine the relationship between sexual abuse and academic achievement in an adolescent inpatient psychiatric population. Individual factors expected to influence this relationship were measured to explore the way they each interacted with sexual abuse and its relationship to academic achievement. Method: Eighty-one adolescent psychiatric inpatients participated in the study (aged 12–18 years: M = 16.0). Participants were administered tests of academic achievement (dependent variable) and intelligence, and completed a number of self-report measures of their experience of different types of maltreatment, their perception of the parenting they received, socio-economic status, substance abuse, and psychopathology. Results: Hierarchical regression analysis revealed that intelligence was the main predictor of academic achievement (uniquely explaining 26% of the variance). A number of interaction effects were also significant indicating that intelligence, substance abuse, internalizing behavior problems, externalizing behavior problems all influenced the relationship between sexual abuse and academic achievement. Discussion: Examining the impact of sexual abuse is complex because it is typically an experience embedded in a range of other risk factors, such as poverty, family dysfunction, and other types of maltreatment. This study demonstrated coexistence between sexual abuse and a number of other variables, including other maltreatment types and parental overprotection, underscoring the requirement for complex models of research that more accurately reflect the experience of abused children.

The inventory of suicide orientation-30: Further validation with adolescent psychiatric inpatients

The present study examined the construct validity of the Inventory of Suicide Orientation-30 (ISO-30; King & Kowalchuk, 1994) with a sample of adolescent psychiatric inpatients. The ISO-30 is designed to assess five dimensions of risk factors related to suicide: hopelessness, suicide ideation, low self-esteem, inability to cope with emotions, and social isolation and withdrawal. Participants included 202 psychiatric hospitalized (106 boys, 96 girls) adolescents, ages 14 to 17 years. Confirmatory factor analyses provided support for the fit of the original five-factor oblique model. Reliability estimates of the study measures were adequate. Evidence of discriminant, convergent, and incremental validity estimates of the ISO-30 were strong. Contributions and limitations of the present findings are discussed.

Self-reported value of spiritual issues among adolescent psychiatric inpatients.

Reports on a survey of a prospective, uncontrolled sample of adolescent psychiatric inpatients on the importance of spiritual issues to them. Results indicated that the vast majority of adolescents in this sample indicated that spiritual beliefs are considered important. Notes that a majority reported that mental health professionals rarely asked them about their beliefs in the spiritual areas. Observes that nearly all the patients reported having a chaplain-led spiritual group that they perceived as a helpful part of the therapeutic milieu.

Dual diagnosis and adolescent psychiatric inpatients.

Recognition is growing that many individuals with mental health disorders also suffer from substance use disorders. Providers of adolescent mental health services are in need of prevalence data and instruments that can assist in screening for alcohol and other drug use problems. This study provides data on the concurrent validity of using the Substance Abuse Subtle Screening Inventory with mental health patients and data on the prevalence of substance use disorders in a sample of adolescent psychiatric inpatients.

Racial differences in adolescent self-report: A comparative validity study using homogeneous MMPI content measures.

Minnesota Multiphasic Personality Inventories (MMPIs) were administered to an urban-mixed-race sample of adolescent psychiatric inpatients and outpatients (N = 218). Racial differences were noted on 4 of the 13 raw Wiggins scale scores, with scores for African-American patients more elevated on Poor Health, Feminine Interests, Phobias, and Psychoticism. A backward multiple-regression procedure was used to predict raw Wiggins scale scores from parent descriptions as measured by the Personality Inventory for Children clinical scales. Predictors supported the validity of the Organic Symptoms, Social Maladjustment, Family Problems, Authority Conflict, and Hypomania scales, and to some extent, Poor Morale, Depression, Poor Health, and Phobias. Predictors differed across racial groups for 9 of the scales, with particular discrepancies in predictive meaning for Poor Health, Hypomania, Family Problems, and Authority Conflict. Implications for MMPI-A content scales are discussed.