Youth Psychopathology Research Articles

Understanding the effects of neighborhood disadvantage on youth psychopathology.

In 1942, Shaw and McKay reported that disadvantaged neighborhoods predict youth psychopathology (Shaw & McKay, ). In the decades since, dozens of papers have confirmed and extended these early results, convincingly demonstrating that disadvantaged neighborhood contexts predict elevated rates of both internalizing and externalizing disorders across childhood and adolescence. It is unclear, however, how neighborhood disadvantage increases psychopathology. Our study sought to fill this gap in the literature by examining the Area Deprivation Index (ADI), a composite measure of Census tract disadvantage, as an etiologic moderator of several common forms of psychopathology in two samples of school-aged twins from the Michigan State University Twin Registry (N = 4815 and 1030 twin pairs, respectively), the latter of which was enriched for neighborhood disadvantage. Across both samples, genetic influences on attention-deficit hyperactivity problems were accentuated in the presence of marked disadvantage, while nonshared environmental contributions to callous-unemotional traits increased with increasing disadvantage. However, neighborhood disadvantage had little moderating effect on the etiology of depression, anxiety, or somatic symptoms. Such findings suggest that, although neighborhood disadvantage does appear to serve as a general etiologic moderator of many (but not all) forms of psychopathology, this etiologic moderation is phenotype-specific.

Are We Thinking about the Same Disorder? A Trifactor Model Approach to Understand Parents’ and Their Adolescents’ Reports of Borderline Personality Pathology

Multiple informant assessment is the norm when evaluating borderline personality pathology (BPP) in adolescence, especially by including reports from both parents and adolescents. However, these reports tend to be discrepant, and it is unclear how to integrate. The current study used a trifactor model to isolate sources of variance in parents’ and adolescents’ reports of BPP due to their shared and unique perspectives in a sample of 652 inpatient adolescents (63% female; Mage = 15.31, SD = 1.45) and their parents (81% mothers). Consensus/agreement was characterized by the externalizing features of BPP whereas idiosyncratic views of adolescent BPP covered the full latent BPP construct, suggesting that simple aggregation of parent and adolescent reports is inappropriate. Measurement invariance suggested that unique perspectives were characterized by slightly different operationalizations of BPP and response biases for specific features of BPP. Attachment security and parents’ interpersonal problems predicted shared and unique perspectives differently for female and male adolescents. Lastly, we found that shared and unique perspectives differentially predicted interview based BPP, length of stay, and adolescent mentalizing. In sum, findings replicate previous evidence of parent-child informant discrepancy in youth psychopathology, broadly, and provide insights specific to BPP. Discussion includes practical recommendations for assessment and interpretation of BPP assessment.

Mapping Normative Trajectories of Cognitive Function and Its Relation to Psychopathology Symptoms and Genetic Risk in Youth

BackgroundAdolescence hosts a sharp increase in the incidence of mental disorders. The prodromal phases are often characterized by cognitive deficits that predate disease onset by several years. Characterization of cognitive performance in relation to normative trajectories may have value for early risk assessment and monitoring. MethodsYouth aged 8 to 21 years (N = 6481) from the Philadelphia Neurodevelopmental Cohort were included. Performance scores from a computerized neurocognitive battery were decomposed using principal component analysis, yielding a general cognitive score. Items reflecting various aspects of psychopathology from self-report questionnaires and collateral caregiver information were decomposed using independent component analysis, providing individual domain scores. Using normative modeling and Bayesian statistics, we estimated normative trajectories of cognitive function and tested for associations between cognitive deviance and psychopathological domain scores. In addition, we tested for associations with polygenic scores for mental and behavioral disorders often involving cognition, including schizophrenia, bipolar disorder, attention-deficit/hyperactivity disorder, and Alzheimer’s disease. ResultsMore negative normative cognitive deviations were associated with higher general psychopathology burden and domains reflecting positive and prodromal psychosis, attention problems, norm-violating behavior, and anxiety. In addition, better performance was associated with higher joint burden of depression, suicidal ideation, and negative psychosis symptoms. The analyses revealed no evidence for associations with polygenic scores. ConclusionsOur results show that cognitive performance is associated with general and specific domains of psychopathology in youth. These findings support the close links between cognition and psychopathology in youth and highlight the potential of normative modeling for early risk assessment.

Risk and Resilience Measures Related to Psychopathology in Youth.

Childhood adversity places youth at risk for multiple negative outcomes. The current study aimed to understand how a constellation of risk and resilience factors influenced mental health outcomes as a function of adversities: socioeconomic status (SES) and traumatic stressful events (TSEs). Specifically, we examined outcomes related to psychosis and mood disorders, as well as global clinical functioning. The current study is a longitudinal follow up of 140 participants from the Philadelphia Neurodevelopmental Cohort (PNC) assessed for adversities at Time 1 (Mean age: 14.11years) and risk, resilience, and clinical outcomes at Time 2 (mean age: 21.54years). In the context of TSE, a limited set of predictors emerged as important; a more diverse set of moderators emerged in the context of SES. Across adversities, social support was a unique predictor of psychosis spectrum diagnoses and global functioning; emotion dysregulation was an important predictor for mood diagnoses. The current findings underscore the importance of understanding effects of childhood adversity on maladaptive outcomes within a resilience framework.

Higher socioeconomic status and less parental psychopathology improve prognosis in youths with bipolar disorder

BackgroundTo identify prospectively ascertained individual and family factors that are associated with improvement in Bipolar Disorder (BD) among youths who initially presented with poor course. Methods82 youths with BD with persistent poor mood symptomatology (“predominantly ill course”) were compared to 70 youths with BD who at intake had poor course, but showed improvement during the follow-up (“ill with improving course”), (ages 12.3 ± 3.3, vs. 11.7 ± 3.3 years old, at intake). Improvement was measured by the percentage of time euthymic during a mean follow-up of 12.8 years. Youths and parents were interviewed to assess psychopathology, functioning, treatment, and familial functioning and psychopathology. ResultsCompared to the ill group, since intake, the improving group showed significantly lower subthreshold depression and hypo/mania, Attention Deficit Hyperactivity Disorder, and Disruptive Behavior Disorders. Parental Socioeconomic Status (SES) remained unchanged over time in the ill group, but progressively increased in the improving group. Importantly, the change in SES predated the improvement in the mood trajectory. The most influential variables that predicted improvement were higher SES, and absence of parental BD and Substance Use Disorder (SUD). Parental SUD also negatively affected the parental SES, which was directly associated with worse mood course. LimitationsPredominantly self-reported White samples may limit generalizability; other factors potentially associated with outcome (e.g., treatment adherence), were not ascertained. ConclusionsIn addition to treating mood/comorbid psychopathology in symptomatic BD youths, to improve their prognosis, it is crucial to address their parent's BD and SUD and promote parental education/employment.

Use of latent profile analysis and k-means clustering to identify student anxiety profiles

BackgroundAnxiety disorders are often the first presentation of psychopathology in youth and are considered the most common psychiatric disorders in children and adolescents. This study aimed to identify distinct student anxiety profiles to develop targeted interventions.MethodsA cross-sectional study was conducted with 9738 students in Yingshan County. Background characteristics were collected and Mental Health Test (MHT) were completed. Latent profile analysis (LPA) was applied to define student anxiety profiles, and then the analysis was repeated using k-means clustering.ResultsLPA yielded 3 profiles: the low-risk, mild-risk and high-risk groups, which comprised 29.5, 38.1 and 32.4% of the sample, respectively. Repeating the analysis using k-means clustering resulted in similar groupings. Most students in a particular k-means cluster were primarily in a single LPA-derived student profile. The multinomial ordinal logistic regression results showed that the high-risk group was more likely to be female, junior, and introverted, to live in a town, to have lower or average academic performance, to have heavy or average academic pressure, and to be in schools that have never or occasionally have organized mental health education activities.ConclusionsThe findings suggest that students with anxiety symptoms may be categorized into distinct profiles that are amenable to varying strategies for coordinated interventions.

Supplemental Material for Reliability and Validity of Bifactor Models of Dimensional Psychopathology in Youth

Supplemental Material for Reliability and Validity of Bifactor Models of Dimensional Psychopathology in Youth

Supplemental Material for Genetic Variance in Conscientiousness Relates to Youth Psychopathology Beyond Executive Functions

Supplemental Material for Genetic Variance in Conscientiousness Relates to Youth Psychopathology Beyond Executive Functions

Cumulative Effects of Prenatal and Concurrent Maternal Distress on Psychiatric Disorders in Adolescent Offspring

Background: Mental disorders affect 20% of children and adolescents globally and are among the most chronic and costly problems affecting youth. Offspring exposure to maternal disorders (depression, anxiety, and/or stress) prenatally as well as in adolescence increases the risk of psychopathology in adolescence. Objective: Exposure to maternal distress in pregnancy, as well as in adolescence, has independently been linked to psychopathology in youth. However, our understanding of the cumulative effects of exposure to maternal distress over time remains incomplete. Methods: 1964 participants enrolled in the 2014 Ontario Child Health Study (OCHS) aged 12-17 years completed the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). Maternal prenatal distress was defined as mother-reported depression and/or anxiety during pregnancy requiring treatment. Maternal concurrent distress was self-reported when offspring were 12-17 years of age using the Kessler Psychological Distress Scale (K6). We examined associations between increasing levels of exposure to maternal distress (no exposure, prenatal exposure only, concurrent exposure only, both prenatal and concurrent exposure) and the risk of psychiatric disorder in 12-17-year-olds. Results: The odds of major depressive disorder (OR=1.29, 95% CI: 1.01-1.67) and ADHD (OR=1.30, 95% CI: 1.02-1.65) increased with increasing exposure to maternal distress. Associations between increasing levels of maternal distress and several psychiatric disorders were amplified in males. Conclusions: The accumulation of exposure to maternal distress over time predicts offspring psychopathology in adolescence and emphasizes the significance of the early detection of maternal distress and ongoing monitoring and intervention to reduce the burden of mental disorders in offspring.

Loneliness in Gender-Diverse and Sexual Orientation-Diverse Adolescents: Measurement Invariance Analyses and Between-Group Comparisons.

Youth loneliness is a risk factor for myriad adverse psychosocial outcomes, making it a potentially informative construct for assessment and treatment research. Minority stressors may place LGBTQ+ (lesbian, gay, bisexual, transgender, and queer) youths at high risk of loneliness. However, the prevalence of loneliness across gender and sexual identities cannot be precisely estimated or compared without establishing that common measures assess the construct equivalently across groups. In a preregistered study, we determined the optimal structure of the UCLA Loneliness Scale and investigated whether it showed invariance across gender and sexual identities in a national U.S. sample of adolescents with elevated depressive symptoms (N = 2,431; https://osf.io/52ctd). Results supported strict invariance, indicating that loneliness scores can be meaningfully compared across groups in this sample. Exploratory analyses indicated that loneliness levels and LGBTQ+ identity predicted levels of depression and anxiety. We discuss implications for research on loneliness, health disparities, and psychopathology in high-symptom youths.

ICCareD: The Development of an Algorithm to Identify Factors Associated With Distress Among Caregivers of Children and Youth Referred for Mental Health Services.

Caregiver well-being plays an important role in children's development and a number of factors have been found to impact distress levels among caregivers of children and youth referred for mental health services. Further, caregiver distress impacts youth psychopathology, its acuity as well as related mental health interventions. The purpose of this study was to develop and validate an algorithm for identifying caregivers who are at greatest risk of experiencing caregiver distress. This algorithm was derived from, and will be embedded in, existing comprehensive interRAI child and youth instruments. Ontario data based on the interRAI Child and Youth Mental Health assessment instruments (ChYMH and ChYMH-DD) were analyzed to identify predictors of distress among caregivers of children and youth ages 4–18 years. Starting with proactive aggression, the algorithm uses 40 assessment items to assign one of 30 nodes that are grouped into five levels of risk. The interRAI ChYMH Caregiver Distress (iCCareD) algorithm was validated using longitudinal data from mental health agencies across Ontario and was found to be a good predictor among this sample with a c-statistic of 0.71 for predicting new or ongoing caregiver distress and 65% for both sensitivity and specificity using algorithm values of 3 or greater. This algorithm provides an evidence-based decision-support tool embedded within a comprehensive assessment tool that may be used by clinicians to inform their selection of supports and services for families.

Parental Mental Illness as a Risk Factor for Adolescent Psychiatric Disorders: A Registry-Based Study of Specialized Child and Adolescent Health Services

Parental mental illness is a major risk factor for youth psychopathology, but few studies have used data from child and adolescent mental health services (CAMHS) to investigate this group. We used a unique linkage between a CAMHS-registry and a large population-based survey of Norwegian adolescents aged 16–19 years. Nine hundred and seventy adolescents received CAMHS, of whom 87 (9%) were registered with a parent with mental illness. These adolescents had increased odds for a range of psychiatric disorders and comorbidity compared with CAMHS-patients. These findings underscore the need to consider parental mental illness when assessing and treating adolescents with psychiatric disorders.

Psychometric Evaluation of a Barriers to Mental Health Treatment Questionnaire for Latina/o/x Caregivers of Children and Adolescents.

BackgroundKnowledge regarding barriers faced by Latina/o/x caregivers in accessing youth mental health services (MHS) have largely depended on resource intensive interview-based assessments.ObjectiveWe evaluated a questionnaire for Latina/o/x caregivers of youths that presents a briefer and more feasible alternative.MethodWe conducted a psychometric evaluation of the Barriers to Treatment Questionnaire - Latina/o/x Caregivers (BTQ-LC) with a sample of 598 Latina/o/x caregivers from across the United States. Descriptive statistics and confirmatory factor analyses were used to identify common barriers to services, confirm the factor structure of the scale, and establish construct validity.ResultsDescriptive statistics suggest that not knowing where and how to access services, and normalization of youth psychopathology were the most frequently reported barriers among caregivers of youth with clinically elevated problems on the CBCL. Confirmatory factor analysis suggests that the BTQ-LC was best represented by a three-factor structure: (1) structural, (2) perceptions regarding mental health problems, and (3) services. Our finding suggest that the BTQ-LC could also be used as a single factor as fit indices ranged from acceptable to poor. BTQ-LC scales were all negatively correlated with the utilization of common youth MHS (i.e., psychological counseling, medical doctors, school professionals).ConclusionsThe BTQ-LC represents an important step towards improving our understanding and assessment of barriers to services contributing to mental health disparities among Latina/o/x youths.

32.1 ASSESSING PARENTING STYLES AND THEIR CONNECTION TO CHILD WELL-BEING AND PSYCHOPATHOLOGY

The assessment of parenting is decades old, reflecting the field’s recognition—in both research and clinical practice—of the incredible influence caregivers have on their children. This presentation will provide an overview of parenting styles and behaviors, the various ways they have been assessed, and their associations with youth psychopathology and well-being. Using a narrative review approach, the talk will highlight several well-studied parenting constructs (eg, warmth, behavioral control, hostility/psychological control, emotion socialization parenting behaviors), a selection of measurement modalities (ie, self-report, parent-child observation, physiological), and representatives of each modality (eg, Coping with Children’s Negative Emotions Scales, the Relationship Affect Coding System, interbeat intervals). Finally, emphasis will be placed on the relations between parenting behaviors and youth psychopathology (eg, internalizing and externalizing symptoms) and well-being (eg, social competence, academic achievement, prosocial behavior, effective emotion regulation). In addition to learning about historical and current approaches to parenting assessment in the context of youth psychopathology and wellness, participants will be introduced to novel approaches, including wearables, used to measure associations between parenting behaviors and parent-child co-regulation. Relevant racial and cultural considerations in the relations between parenting style/behaviors and youth outcomes will also be reviewed. The assessment of parenting is an art and science that continues to evolve and advance empirically based interventions for improving parent-child relationships and treating youth psychopathology.

High value correlates of caregiver reported counseling service need and utilization for adolescents at-risk for childhood maltreatment and neglect.

Adolescents with a history of child maltreatment experience increased risk for psychopathology that sets them on a trajectory towards a range of difficulties in adulthood. Various factors influence caregivers’ decisions to seek mental health services (MHS) that could improve developmental outcomes. The present study applied a machine learning algorithm, elastic net, to a sample of 878 adolescent-caregiver dyads from the Longitudinal Studies of Child Abuse and Neglect. Analyses simultaneously examined a large number of factors to determine their ability to discriminate between caregivers who perceived a need for MHS and those who did not, as well as caregivers who utilized MHS and those who did not. Results highlight family demographics, chronic parental stressors, youth psychopathology, and exposure to recent adversities as good classifiers of caregiver perceived need for (77.6%; sensitivity = .77; specificity = .78) and utilization of (71%; sensitivity = .71; specificity = .71) adolescent MHS. Elastic net identified adolescent clinical externalizing and internalizing problems, and parental stress related to child(ren)’s behavior as high value classifiers of both outcomes. Youth living with non-kin caregivers were also significantly more likely to utilize MHS. Findings highlight the importance of assessing clinical need, stress related to child(ren)’s behavior, and caregiver kinship in understanding the likelihood that at-risk families will seek adolescent MHS.

Youth psychopathology: Universal or culture-specific? Testing the syndrome models of youth self-report in Chinese population.

The debate on whether psychiatric symptoms are universal and to what extent they are affected by culture is generally divided between the universalist and relativist approaches. This study compared Achenbach/Rescorla's model and Weisz's model of youth self-report in 2521 Chinese adolescents (mean age = 12 years). Indigenous exploratory factor analyses were conducted to explore the factor structure of youth self-report (YSR), and the derived models were tested with confirmatory factor analysis. These analyses indicated good support of the Chinese YSR models for males and females. Further analyses revealed three syndromes, namely anxious/depressed, somatic complaints, and aggressive behaviors, which represented broad internalizing and externalizing factors. These syndromes consistently demonstrated high correlations across the different models, indicating their universal nature. Conversely, some unique factors emerged in the Chinese YSR model, such as weight concern and rule-breaking behavior, which may reflect underlying culture-bound factors. Our findings support a combined perspective to the universalist and relativist approaches, which argues that some syndromes including Anxious/Depressed, Somatic Complaints, Aggressive Behavior and Attention Problems are more likely to be universal in male adolescents, while a new emerging syndrome like Weight Concern may reflect the socioeconomic, culture, and lifestyle changes that are currently emerging in China.

Youth mental health service preferences and utilization patterns among Latinx caregivers

Latinx caregivers underutilize traditional youth mental health services (MHS) relative to their White counterparts. Disparities may be explained by barriers preventing engagement in traditional MHS. A potential mismatch between available services and preferred culturally appropriate healing practices may also contribute to treatment disparities. The current study examined Latinx caregivers’ perceived need for and utilization of support services in relation to family characteristics, youth problem-type, and barriers to care. Findings were contextualized by assessing caregiver preferences for addressing youth psychopathology. The study consisted of 598 Latinx caregivers from across the United States. Descriptive statistics and binary logistic regression models were used to conduct exploratory analyses. The most frequently used sources of support for youths were medical doctors, school professionals, family or friends, psychological counseling or therapy, and parenting classes. Caregiver perceived need for and utilization of services was generally greater among youths with clinically elevated internalizing or externalizing problems. While Latinx caregivers report needing and utilizing a variety of services to address youth psychopathology, they frequently ranked psychological counseling as their most preferred format. Problem-specific service need and utilization was found for medical (i.e., clinical internalizing problems) and religious services (i.e., minister or faith healer; clinical externalizing problems). Youth and family characteristics and barriers to care were differentially associated with service need and utilization across formats. Our findings suggest a need to increase access to youth psychological counseling services among Latinxs and highlight additional avenues for integrating MHS into formats that caregivers frequently report needing and utilizing.

Identifying profiles of brain structure and associations with current and future psychopathology in youth

Brain structure is often studied as a marker of youth psychopathology by examining associations between volume or thickness of individual regions and specific diagnoses. However, these univariate approaches do not address whether the effect of a particular region may depend on the structure of other regions. Here, we identified subgroups of individuals with distinct profiles of brain structure and examined how these profiles were associated with concurrent and future youth psychopathology. We used latent profile analysis to identify distinct neuroanatomical profiles of subcortical region volume and orbitofrontal cortical thickness in the ABCD study (N = 9376, mean age = 9.91, SD = 0.62). We identified a five-profile solution consisting of a reduced subcortical volume profile, a reduced orbitofrontal thickness profile, a reduced limbic and elevated striatal volume profile, an elevated orbitofrontal thickness and reduced striatal volume profile, and an elevated orbitofrontal thickness and subcortical volume profile. While controlling for age, sex, and intracranial volume, profiles exhibited differences in concurrent psychopathology measured dimensionally and categorically and in psychopathology at 1-year follow-up measured dimensionally. Results show that profiles of brain structure have incremental validity for associations with youth psychopathology beyond intracranial volume.

Impact of Loneliness on Diurnal Cortisol in Youth during COVID-19

BackgroundLoneliness is associated with psychopathology in youth, though we do not know how loneliness gets under the skin in ways that impact long-term health and development. Loneliness may influence youths' patterns of diurnal cortisol, a predictor of health across the lifespan. The COVID-19 pandemic represents a salient period in which to study this question as the physical-distancing measures put in place to contain the virus have resulted in greater loneliness in youth.MethodsWe examined the prospective association between loneliness and diurnal cortisol in youth during the COVID-19 pandemic using hierarchical linear modelling.ResultsGreater loneliness was associated with higher levels of cortisol at waking, B=0.10, p=.002, and a blunted cortisol awakening response, B=-0.003, p =.003, a pattern of functioning that increases risk for adverse mental and physical health outcomes across the lifespan.ConclusionThis study is the first to examine the association between loneliness and diurnal cortisol in early adolescence and identified a mechanism contributing to biological markers of distress during the COVID-19 pandemic. Findings underscore the importance of developing and distributing strategies to mitigate feelings of loneliness among youth.

Paternal Borderline Symptoms and Offspring Outcomes in Young Adulthood.

Borderline personality disorder symptoms (BPDsx) in mothers have been linked to psychopathology in their offspring. However, it is still unclear whether BPDsx in fathers influences offspring psychopathology and, if so, how this risk transmission may occur. A total of 448 father-mother-offspring triads completed a longitudinal study following children from birth until age 20 and included self-report questionnaires and clinical interviews when children were 15 and 20 years old. Results revealed that paternal BPDsx were predictive of youth BPDsx and internalizing symptoms, even after controlling for maternal BPDsx. Chronic family stress was a significant mediator of the relationship between paternal BPDsx and offspring BPDsx, internalizing symptoms, and externalizing symptoms. Fathers' expressed emotion and child temperament were not significant mediators. Although offspring sex predicted youth outcomes, it was not a significant moderator of the association between paternal BPDsx and offspring symptoms. Finally, controlling for comorbid paternal disorders weakened the association between paternal BPDsx and youth psychopathology.