Illness In Youth Research Articles

Altered learning from positive feedback in adolescents with anorexia nervosa.

Anorexia nervosa (AN) is characterized by severe restriction of calorie intake, which persists despite serious medical and psychological sequelae of starvation. Several prior studies have identified impaired feedback learning among individuals with AN, but whether it reflects a disturbance in learning from positive feedback (i.e., reward), negative feedback (i.e., punishment), or both, and the extent to which this impairment is related to severity and duration of illness, has not been clarified. Participants were female adolescents with AN (n = 76) and healthy teen volunteers (HC; n = 38) between the ages of 12-18 years who completed a probabilistic reinforcement learning task. A Bayesian reinforcement learning model was used to calculate separate learning rates for positive and negative feedback. Exploratory analyses examined associations between feedback learning and duration of illness, eating disorder severity, and self/parent reports of reward and punishment sensitivity. Adolescents with AN had a significantly lower rate of learning from positive feedback relative to HC. Patients and HC did not differ in learning from negative feedback or on overall task performance measures. Feedback learning parameters were not significantly associated with duration of illness, eating disorder severity, or questionnaire-based reports of reward and punishment sensitivity. Adolescents with AN showed a circumscribed deficit in learning from reward that was not associated with duration of illness or reported sensitivity to reward or punishment. Subsequent longitudinal research should explore whether differences in learning from positive feedback relate to course of illness in youth with AN.

The growing interdisciplinarity of developmental psychopathology: Implications for science and training.

The field of developmental psychopathology has grown exponentially over the past decades, and has become increasingly multifaceted. The initial focus on understanding abnormal child psychology has broadened to the study of the origins of psychopathology, with the goals of preventing and alleviating disorder and promoting healthy development. In this paper, we discuss how technological advances and global events have expanded the questions that researchers in developmental psychopathology can address. We do so by describing a longitudinal study that we have been conducting for the past dozen years. We originally planned to examine the effects of early adversity on trajectories of brain development, endocrine function, and depressive symptoms across puberty; it has since become an interdisciplinary study encompassing diverse domains like inflammation, sleep, biological aging, the environment, and child functioning post-pandemic, that we believe will advance our understanding of neurobehavioral development. This increase in the breadth in our study emerged from an expansion of the field; we encourage researchers to embrace these dynamic changes. In this context, we discuss challenges, opportunities, and institutional changes related to the growing interdisciplinarity of the field with respect to training the next generation of investigators to mitigate the burden of mental illness in youth.

Everyday life during the childhood cancer trajectory-childhood cancer survivors' descriptions of the role of caring support.

Being diagnosed with cancer in childhood often has a direct impact on the child's opportunities to participate in activities and the child's sense of belonging in different life situations. Experiences of illness in youth affect the lives of these individuals in numerous ways and they need pronounced support to regain their normal life after treatment. To illustrate how childhood cancer survivors describe the role of the caring support provided by healthcare professionals at diagnosis and during the cancer trajectory. A mixed methods approach was applied. Swanson's Theory of Caring was used to deductively analyze the answers in a study-specific questionnaire with Likert scales (1-5). Descriptive and comparative statistics and exploratory factor analyses were performed. Sixty-two former patients, diagnosed with solid tumors/lymphoma in 1983 to 2003 in Sweden, participated. The mean time passed since treatment was 15.7 years. Swanson's caring processes Being with and Doing for were the most prominent loading categorical factor indicators. Higher scores for healthcare professionals being emotionally present (Being with), doing for others what they would do for themselves (Doing for) and being willing to understand the sick child's situation (Knowing) were highlighted by survivors older than 30 years, compared to those younger than 30 years (p = 0.041, p = 0.045, and p = 0.013, respectively). An increased vulnerability regarding their ability to cope with difficulties (Maintain belief) was found among participants who were treated during adolescence, related to schoolchildren (p = 0.048), and among those who had been treated with extra-cranial irradiation in comparison with no extra-cranial irradiation (p = 0.004). The role of having a partner in comparison with being single was underlined among those who felt they had acquired the tools they needed to take care of themselves (Enabling) (p = 0.013). The total explained variance was 63%. A person-centered care approach during treatment for childhood cancer, reflected by a caring model, highlights the role of healthcare professionals being emotionally present, involving children, performing actions, and with an approach that has potential long-term implications. Childhood cancer patients and survivors need not only clinically competent professionals, but professionals who provide caring interactions with compassion.

5.6 Online Trends AND Mental Health Implications

The goal of this presentation is to summarize and review findings from recently published articles describing a wide range of interactions between mental illness in youth and online habits and experiences, and how they inform contemporary child and adolescent psychiatry.

The Combined Effects of Youth and Parent Illness Intrusiveness on Depressive Symptoms in Adolescents with Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) presents physical and emotional challenges for families and imposes significant lifestyle intrusions on both youth and parents. The present study examined the effects of IBD disease activity and youth illness intrusiveness on depressive symptoms in adolescents, and the moderating influence of parent illness intrusiveness on these associations. Adolescents and parents completed measures of illness intrusiveness; youth completed a measure of depressive symptoms. Physicians provided estimates of IBD disease activity. Mediation analysis revealed an IBD disease activity → youth intrusiveness → youth depressive symptoms indirect effect. Moderated mediation analyses revealed this indirect effect to be greater among youth whose parents endorsed more IBD-related intrusions. Youth encountering greater activity disruptions related to IBD are vulnerable to depressive symptoms. When parents also experience IBD-induced intrusions, youth are at even greater risk for depressive symptoms. Clinical implications are discussed within the context of youths' and parents' experiences of IBD.

The Impact of the COVID-19 Pandemic on Youth with Chronic Pain and Their Parents: A Longitudinal Examination of Who Are Most at Risk.

Objectives: Chronic pain and mental illness in youth and parents are poised to reach new heights amidst the societal and healthcare impacts of the COVID-19 pandemic. Evidence from natural disasters (i.e., hurricanes) suggests that a degree of personal impact and individual personality may moderate the effects of high stress events, such as the COVID-19 pandemic, on mental health. Methods: In a pre-existing cohort of 84 youth with chronic pain (Mage = 14.39; 12–18 years; 67.8% female) and 90 parents (86.7% female), we examined changes in youth pain interference and youth and parent mental health (depression, anxiety) from before to during the first wave of the COVID-19 pandemic, and the influence of personal impact of the pandemic (i.e., financial, familial, health, social, occupational, and educational domains) and individual personality (neuroticism, conscientiousness, extroversion). Results: Overall, youth reported significantly lower pain interference and anxiety as compared to pre-pandemic; however, those more personally impacted by the pandemic reported worsening pain interference and anxiety symptoms. Overall, parents reported greater depressive symptoms as compared to pre-pandemic; however, those more personally impacted by the pandemic reported increased anxiety symptoms. Personality traits (high neuroticism, and low conscientiousness and extroversion) predicted worsened pain and mental health, and exacerbated effects of COVID-19-related personal impact on youth and parent anxiety symptoms. Discussion: Identifying risk and resilience profiles in youth and parents at high risk for worsening pain and mental health may better inform matching interventions to individual need.

Factors Affecting Mental Health among Youth Post COVID-19

On 11th March 2020, the World Health Organization (WHO) declared the COVID- 19 outbreak to be a pandemic, prompting considerable concern around the world. The pandemic has had a devastating impact on the post-pandemic world, affecting every aspect of the system, including the financial and labour markets. The post-pandemic COVID-19 has had an impact on many spheres of social and economic life. In fact, it has been highlighted as a source of mental health illnesses among youth. The purpose of this study is to determine what causes mental illness in youth post-COVID-19 pandemic. A total of 300 youths participated in this study. As a research tool, questionnaires were distributed to ascertain how young people perceive the factors that can lead to mental illness. Questions for the survey were taken from the YoungMinds Malaysia initiative. Job and financial concerns are also discussed in detail. Consequently, the study has been able to determine how youth's mental health perceptions may differ from those of other age groups.

Factors Affecting Mental Health among Youth Post COVID-19

On 11th March 2020, the World Health Organization (WHO) declared the COVID- 19 outbreak to be a pandemic, prompting considerable concern around the world. The pandemic has had a devastating impact on the post-pandemic world, affecting every aspect of the system, including the financial and labour markets. The post-pandemic COVID-19 has had an impact on many spheres of social and economic life. In fact, it has been highlighted as a source of mental health illnesses among youth. The purpose of this study is to determine what causes mental illness in youth post-COVID-19 pandemic. A total of 300 youths participated in this study. As a research tool, questionnaires were distributed to ascertain how young people perceive the factors that can lead to mental illness. Questions for the survey were taken from the YoungMinds Malaysia initiative. Job and financial concerns are also discussed in detail. Consequently, the study has been able to determine how youth's mental health perceptions may differ from those of other age groups.

Neurocognitive and social cognitive impairments in remission and symptomatic states of early-onset schizophrenia spectrum disorders.

Previous studies demonstrated neurocognitive impairments in early-onset schizophrenia (EOS) and other psychotic spectrum disorders (PSD). This study aimed to compare remitted and symptomatic cases in terms of neurocognition and theory of mind (ToM). 50 healthy controls (HC) and 106 patients diagnosed schizophrenia in remission (EOS-R, n = 38), symptomatic schizophrenia (EOS-S, n = 34), and other PSD (n = 34) were included in our study. The Positive and Negative Symptom Scale, Columbia-Suicide Severity Rating Scale, Reactive and Proactive Aggression Questionnaire were used to evaluate psychopathology. A cognitive battery was conducted to measure verbal learning/memory, visual learning/memory, executive functions (EF), inhibition, processing speed (PS), verbal fluency skills. Reading Mind in Eyes Test (RMET) and Faux-Pas tests were implemented to assess ToM. Principal Component Analysis was used to identify cognitive domain scores. Patient groups had poorer performance in cognitive domains than the HC group. The cognitive impairment and psychopathology levels of EOS-R and the PSD groups were comparable for all cognitive domains. The EOS-S group also had poorer scores in Rey verbal learning score (d = 0.87), RMET (d = 0.72), verbal fluency (d = 0.66), PS/EF (d = 0.82) and visual learning/memory (d = 0.83) test scores than the PSD group. Only RMET (d = 0.72) and executive function/processing speed domain (d = 0.63) were significantly impaired in the EOS-S group than the EOS-R group Cognitive impairments seen in remitted psychotic disorders were on the same continuum. Impaired EF/PS and ToM skills could be a cognitive marker for symptomatic illness in youth.

45.3 The Utility of Child and Adolescent Mobile Psychiatric Services (CAMPS) for Youth

The incidence rates of mental illness in youth are increasing in the United States; however, structural and cost barriers in accessing treatment result in low treatment rates and high dropout rates. Given the complex, interconnected risk factors affecting youths’ functioning, home-based mental health services can be utilized to address some barriers. In 2019, the Child and Adolescent Mobile Psychiatric Services (CAMPS) team was piloted, comprising a case manager, social worker, and child and adolescent psychiatrist. Referrals included high-risk clinic patients. Frequency of visits and timing of discharge was explored during a weekly collaborative conference. Measures were administered at the start and completion of the program, including parental distress, impairment, barriers to treatment, use of services to date, and an exit survey. All procedures were approved by the University at Buffalo IRB. In the first 15 months, 28 families provided some data and 11 provided complete data. Of the 28, 12 identified as African American, 11 White, 3 Hispanic, and 2 Multiracial. The patients’ age range was 5 to 18 years (mean = 12). Twenty-six families had government-subsidized health insurance. Referrals were for functional impairment (74%), severe mood dysregulation (19%), or posthospital discharge (7%). Since enrollment in CAMPS, families’ overall attendance rate increased from 66% to 84%. A paired t test comparing each family’s pre- to postattendance rate showed significant improvement (t = 4.04; p < 0.001). A paired t test of parent-rated youth impairment (n = 11) suggested marginal reduction (t = 1.96; p = 0.08). Parental stress (pre = 41.1, post = 38.6) and barriers to treatment (mean number of barriers: pre = 1.92, post = 1.77) did not significantly differ. In the presurvey (n = 25), 7 families reported a history of hospitalization, 7 made a prior crisis call, and 15 reported difficulty with attending school. In posttreatment surveys (n = 11), no child was hospitalized, 2 families made a crisis call, and only 1 reported school attendance issues. Ten families found the program helpful, and 100% felt more informed about their child’s mental health needs. While our small sample size is a limitation, data indicate improvements in treatment engagement, school attendance, and decreased hospitalization rates.

Electronic Device Utilization, Bullying, School Experiences, and Discharge Destination of Youth Admitted to an Inpatient Unit for Psychiatric Illness

ABSTRACT The rate of admission to treatment facilities for psychiatric illness in youth is rising. There is also concern for their use of screen-time behaviors. The purpose of the present study was to explore hospitalized youth ratings for their utilization of social media and electronic devices, and their school experiences including bullying, and to compare their ratings to the provincial norm. The discharge plans were also examined. A survey with standardized questions taken from a provincial survey was administered while youth were in hospital. The mean age of the 111 youth who participated was 15.3 years (SD 1.4), and 78 (70%) identified as female. A high percentage of youth reported five or more hours of daily social media use, being bullied and bullying others; 57% reported a moderate to severe problem with digital media use. Adolescent patients reported greater problematic behaviors than the average adolescent. An unexpected finding was that many patients were discharged from the hospital to residential treatment programs. Youth reported many concerns with bullying, high use of electronics and poor school experiences. Many patients were discharged to specialized community residential treatment programs, which can be seen as essential components for the continuity of mental health treatment.

Developmental Coupling of Cerebral Blood Flow and fMRI Fluctuations in Youth

To support brain development during youth, the brain must balance energy delivery and consumption. Previous studies in adults have demonstrated high coupling between cerebral blood flow and brain function as measured using functional neuroimaging, but how this relationship evolves over adolescence is unknown. To address this gap, we studied a sample of 831 children and adolescents (478 females, ages 8-22) from the Philadelphia Neurodevelopmental Cohort who were scanned at 3T with both arterial spin-labeled (ASL) MRI and resting-state functional MRI (fMRI). Local coupling between cerebral blood flow (CBF, from ASL) and the amplitude of low frequency fluctuations (ALFF, from fMRI) was first quantified using locally weighted regressions on the cortical surface. We then used generalized additive models to evaluate how CBF-ALFF coupling was associated with age, sex, and executive function. Enrichment of effects within canonical functional networks was evaluated using spin-based permutation tests. Our analyses revealed tight CBF-ALFF coupling across the brain. Whole-brain CBF-ALFF coupling decreased with age, largely driven by coupling decreases in the inferior frontal cortex, precuneus, visual cortex, and temporoparietal cortex (pfdr<0.05). Furthermore, we found that females had stronger coupling in the frontoparietal network than males (pfdr<0.05) and that better executive function was associated with decreased coupling in the somatomotor network (pfdr<0.05). These results emphasize that CBF-ALFF coupling undergoes development in youth and is linked to individual differences in cognition. As such, this relationship may be a valuable marker of both normal brain development and abnormalities associated with neuropsychiatric illness in youth.

Evaluation of the TRxANSITION Index–Parent Version for Assessment of Readiness to Transition to Adult Care Among Youth with Chronic Conditions

PurposeTo develop and evaluate a parent-proxy measure of youth HCT readiness: the TRxANSITION Index–Parent Version. Design and methodsWe recruited parents (77% female) and youth (ages 12 to 25) to complete transition readiness measures during outpatient clinic visits. The TRxANSITION Index—Parent Version contains two domains: the Parent Knowledge Domain assessing a parent's knowledge of their youth's illness, and the Parent Proxy Domain, which provides a parental perspective regarding a youth's transition readiness skills. We evaluated the TRxANSITION Index – Parent Version for differences between parent and youth reports of HCT readiness, associations between parent's score and youth's characteristics, and item-category, item-sub-index, and sub-index category correlations. ResultsData from 93 parents-youth dyads were analyzed. Parents scored significantly higher than youth in the Parent Knowledge Domain and similarly in the Parent Proxy Domain. Parents of daughters had significantly higher scores in the Parent Knowledge Domain than parents of sons and reported similar scores to Parents of sons in the Parent Proxy Domain. Only the self-management sub-index significantly correlated with youth's age. The sub-index-domain, item-sub-index, and item-domain correlations assessed were generally large in magnitude (r > 0.5). ConclusionsThe TRxANSITION Index–Parent Version shows promise as a means of assessing parent knowledge of a youth's illness and may provide an accurate proxy assessment of a youth HCT readiness skills. Practice implicationsObtaining parental perspective on a youth's HCT readiness may provide useful clinical information during the transition process.

Stigma by Association: Parent Stigma and Youth Adjustment in Inflammatory Bowel Disease.

Examine the indirect association between parents' experience of stigma (i.e., associative stigma) and youth depressive symptoms through the serial effects of associative stigma on parent and youth illness intrusiveness in pediatric inflammatory bowel disease (IBD). During routine clinic visits, 150 youth with well-controlled IBD (ages 10-18 years) completed measures of perceived illness intrusiveness and depressive symptoms. Parents completed measures of associative stigma and illness intrusiveness. Pediatric gastroenterologists provided ratings of IBD disease severity. Structural equation modeling revealed significant direct associations for associative stigma → parent illness intrusiveness, parent illness intrusiveness → youth illness intrusiveness, and youth illness intrusiveness → youth depressive symptoms. Results also revealed a significant associative stigma → parent illness intrusiveness → youth illness intrusiveness→ youth depressive symptoms serial mediation path, indicating that parents' experience of associative stigma indirectly influenced youth depressive symptoms through its sequential effects on parent and youth perceived illness intrusiveness. Parents who face stigma related to their child's IBD (i.e., associative stigma) are more likely to experience IBD-induced lifestyle intrusions (i.e., illness intrusiveness), which in turn is associated with youths' illness intrusiveness and ultimately youth depressive symptoms. These findings provide further evidence for the important role of illness-related stigma in pediatric IBD, particularly the transactional relation between parents' associative stigma and youths' illness appraisals and emotional functioning. The clinical implications of our results for addressing adjustment difficulties in youth with IBD are also discussed.

The Wicked Problem of Stigma for Youth Living With Anxiety.

Anxiety disorders typically emerge in childhood and, if left untreated, can lead to poor health and social outcomes into adulthood. Stigma contributes to the burden of mental illness in youth. Mental health stigma has been conceptualized as a wicked problem and efforts to address this complexity require a greater understanding of how stigma operates in the lives of youth. Fifty-eight youth in Manitoba, Canada aged 10 to 22 years and living with anxiety took part in the study. Data collection involved in-depth interviews and arts-based methodologies. Youth living with anxiety faced stigma at three levels: (a) interpersonal, (b) intrapersonal, and (c) structural. Stigma held by others, internalized by youth and embedded in social institutions led to compromised relationships with family and peers, low self-esteem and self-efficacy, reduced help-seeking, and discrimination in school, workplace and health care settings. Implications and potential strategies for addressing these levels of stigma are discussed.

Qualitative findings from administrators of the EMPATHY (Empowering a multimodal pathway toward healthy youth) programme using the SBIRT framework

ABSTRACT Comprehensive programmes to help reduce substance misuse/mental illness in youth should combine Screening, Brief Intervention, and Referral to Treatment (SBIRT). EMPATHY, an SBIRT programme, was part of a school-based prevention initiative to reduce symptoms of substance misuse in youth in Grades 6–12, along with reducing symptoms of depression, suicidal thinking, and anxiety. To better understand the feasibility of school-based SBIRT, we retrieved perspectives of administrators primarily through interviews. The level of engagement and interest of youth in the programme was high; however, two significant barriers were: (1) the need for parental consent/involvement; and (2) a systemic gap in treatment choices for youth with mild to moderate symptomology. Therapeutic alliance with students was reportedly a significant factor contributing to benefits.

The Contributions of Illness Stigma, Health Communication Difficulties, and Thwarted Belongingness to Depressive Symptoms in Youth with Inflammatory Bowel Disease.

Youth with inflammatory bowel disease (IBD) often experience difficulties communicating about their disease. It is suspected that the stigmatizing nature of IBD symptoms contributes to youths' health communication difficulties, leaving youth feeling disconnected from their social environment and potentially resulting in decreased social belongingness and poorer emotional functioning. In this study, we tested an illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms serial mediation model. It was anticipated that youth illness stigma would confer a serial indirect effect on youth depressive symptoms through the sequential effects of stigma on health communication difficulties and thwarted social belongingness. Seventy-five youth with IBD between the ages of 10 and 18 completed measures of perceived illness stigma, health communication difficulties, thwarted belongingness, and depressive symptoms. Results indicated a significant illness stigma → thwarted belongingness → depressive symptoms simple mediation path. Importantly, findings also revealed a significant serial mediation path for illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms. Youth who perceive greater IBD stigma appear to experience increased difficulty communicating about their IBD with others, which in turn is associated with feelings of thwarted social belongingness and ultimately elevated depressive symptoms. These findings suggest that difficulty communicating about IBD is one potential route by which illness stigma has a negative impact on youth adjustment outcomes. Results could also inform clinical interventions to address IBD stigma and health communication difficulties associated with the social and emotional challenges in youth with IBD.

Thematic analysis of youth mental health providers' perceptions of neuropsychological assessment services.

A growing number of quantitative studies have investigated the utility of neuropsychological assessment in mental health settings. However, to the best of our knowledge, no previous study has qualitatively explored youth mental health providers' perceptions of neuropsychological assessment services. A more in-depth understanding of the perceived advantages and barriers associated with neuropsychological assessment in youth mental health settings is critical to better inform policy, practice and service uptake. Thus, the aim of this study was to qualitatively explore clinicians' views about neuropsychological assessments for youth with mental health concerns. A single open-ended qualitative question, included as part of an anonymous cross-sectional online survey, was completed by clinicians (N = 206) treating or assessing adolescents and young adults within Australian primary care mental health centres (headspace). Responses were analysed using an inductive approach to thematic analysis. Five main themes were identified. Clinicians (a) identified barriers to accessing neuropsychological assessments (53%), (b) indicated a range of mixed outcomes following neuropsychological assessment (39%), (c) highlighted a need for neuropsychological assessments (22%), (d) reported a lack of awareness about this resource (10%) and (e) described practice issues associated with neuropsychological services (4%). This study uncovered perceived factors contributing to reduced access to neuropsychological assessment in Australian youth mental health settings. Given potential adverse outcomes resulting from this clinical service gap, efforts should be made to address factors contributing to poorer access, thereby mitigating the impact of poor access on the management of mental illness in youth. Several strategies, including funding neuropsychological assessments, are discussed.

Youth and Parent Illness Appraisals and Adjustment in Pediatric Inflammatory Bowel Disease

Youth with inflammatory bowel disease (IBD) and their parents are at increased risk for psychological adjustment difficulties, potentially due to the uncertain and intrusive nature of IBD. However, empirical investigations have yet to assess the contribution of these unique disease features to adjustment outcomes. Our aim was to examine: 1) the influence of youth and parent perceptions of illness uncertainty and illness intrusiveness on youth adjustment; and 2) examine the influence of youth and parent perceived uncertainty and intrusiveness on parent adjustment. Youth with IBD (N = 107) and their primary caregiver completed measures of illness uncertainty, illness intrusiveness, and psychological adjustment. Results revealed that youth illness uncertainty was more closely associated with youth depressive symptoms than was youth perceived intrusiveness. Further, youth illness perceptions were more closely associated with youth depressive symptoms compared to parent perceptions; however, results also suggested that parent illness perceptions may indirectly impact youth adjustment through their influence on youth illness perceptions. Finally, parent illness intrusiveness demonstrated a more robust association with parent adjustment compared to parent illness uncertainty, and both youth and parent illness intrusiveness were independently related to parent adjustment. Findings highlighted the transactional nature of adjustment in pediatric IBD and the importance of examining clinically relevant youth and parent subjective illness perceptions, like uncertainty and intrusiveness, in investigations of youth and parent adjustment outcomes in this population.

Disease Severity and Depressive Symptoms in Adolescents With Inflammatory Bowel Disease: The Mediating Role of Parent and Youth Illness Uncertainty.

The objective of this study is to examine parent and youth appraisals of illness uncertainty as potential serial mediators in the relation between disease severity and youth depressive symptoms in adolescents with inflammatory bowel disease (IBD). Participants were 85 adolescents 13-18 years of age (Mage = 15.75, SD =1.51) with a confirmed diagnosis of IBD (Crohn's disease, 59%; ulcerative colitis, 41%) and a primary caregiver. At a scheduled outpatient visit, caregivers completed a measure of illness uncertainty, while adolescents completed measures of illness uncertainty and depressive symptoms. Pediatric gastroenterologists provided global estimates of disease severity. Path analysis revealed several significant direct and indirect associations among the modeled variables. Importantly, results provided support for the hypothesized disease severity→parent illness uncertainty→youth illness uncertainty→youth depressive symptoms serial mediation path (95% confidence interval = 0.04 to 1.10). Results indicate that increased disease activity may serve to magnify the unpredictable nature of IBD for parents, reflected in heightened perceptions of illness uncertainty. Our findings also suggest that increased parent illness uncertainty has a significant influence on youth illness uncertainty appraisals, which in turn translates into elevated depressive symptoms in adolescents with IBD. The clinical implications of our findings and suggestions for future studies are discussed.