Adverse childhood experiences as risk factors for serious mental disorders and inpatient hospitalization among adolescents

Adverse Childhood Experiences and alcohol use among U.S.-born and immigrant Latinx youth: the roles of social support and stress hormones

The biobehavioral correlates of Adverse Childhood Experiences (ACEs) among Latinx youth have been strikingly understudied. The purpose of this study was to 1) examine the effects of T-ACEs (e.g., maltreatment, family dysfunction) and E-ACEs (e.g., family deportation, community violence) in alcohol use, 2) test whether social support moderated these associations and 3) explore whether ACEs and alcohol use were related via adrenocortical hormones (i.e., cortisol, dehydroepiandrosterone [DHEA]). A total of 100 Latinx youth, between the ages of 13 and 19, participated in this study (53% female). Community samples of United States (U.S.)-born (N = 54) and immigrant Latinx (N = 46) youth provided morning saliva samples and completed self-report questionnaires. Results highlighted that for immigrant youth, social support buffered the effects of E-ACEs on alcohol use, F(9,89)= 3.34, p = .01, R2 = .25. Although our mediation hypothesis was not supported, the direct effects of T-ACEs (β = .25, t (94) = 2.21, p = .03) and E-ACES (β = -.24, t (94) = -2.23, p = .03) on DHEA were significant for the entire sample. Preventing maltreatment and reducing community-level adversities seem critical for optimal child development, as exposure to these may increase alcohol use risk and affect HPA Axis functioning. Increasing extrafamilial support may be particularly salient for immigrant Latinx youth, as many experience extended immigration-related periods of separation from family members.

Comparison of adolescent referred involuntarily or voluntarily to psychiatric hospitalization

PURPOSE OF THE STUDY

To study in an adolescent clinical inpatient population how clinical, background and psychological factors differ between adolescents referred voluntarily or involuntarily.

METHODS

In this prospective cohort study, we compared adolescents (age 13-17 years, n = 206) who had been referred to psychiatric hospitalization for the first time in their life either voluntarily (n = 144) or involuntarily (n = 62). We gathered from clinical records data on the source, mode and reason for referral as well as on whether after referral the subjects were admitted to the hospital voluntarily or not, and whether they were committed to involuntary hospitalization after the observation period. Diagnostics was based on Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) interview, supplemented by information from clinical records. Structured self-reports provided information on family background, depressive symptoms, substance use, defense styles, self-image and perceived social support.

RESULTS

The majority of referrals due to psychotic symptoms were involuntary, whereas self-harm was the primary reason for involuntary and voluntary referrals in comparable extent. After diagnostic evaluation, no significant difference in psychotic disorders was observed between the two groups, but anxiety disorders were more prevalent among inpatients referred voluntarily than involuntarily. Among adolescents referred involuntary, parents were more often unemployed and had mental health problems. In self-assessments, mature defense style and more positive self-image were associated with adolescents referred involuntarily compared with those referred voluntarily.

CONCLUSIONS

Not only psychiatric but also psychological and social factors were associated with involuntary referral for psychiatric hospitalization in adolescents.

Adverse childhood experiences as risk factors for recurrent admissions in young psychiatric inpatients

BACKGROUND

Patients who require psychiatric inpatient treatment early in life are a particularly at-risk population. Factors such as adverse childhood experiences (ACEs) are, however, not well studied in those requiring psychiatric inpatient treatment during both childhood or adolescence and adulthood. Thus, the aim of the current study was to investigate, in young adult inpatients, the risk factors for prior admissions in Child and Adolescent Psychiatry, with a focus on ACEs.

MATERIALS AND METHODS

An explorative population-based systematic chart investigation of psychiatric inpatients aged 18-25 was conducted at the University Hospital Tulln, Austria. Data analysis was done with descriptive methods and Pearson's chi- squared-, Fisher's exact-, Mann-Whitney-U-tests and predictive logistic regression models.

RESULTS

The sample comprised 390 inpatients (51.8% female), with an average age of 20 years at first psychiatric hospital admission. Those with a former child and adolescent psychiatry inpatient treatment (10.3%) were predominantly female (77.5%). Their number of documented ACEs was increased compared to those without former child and adolescent psychiatry admissions (2 vs 1.1), with up to twice as many experiences of family dysfunction, neglect or abuse. Sexual abuse (OR: 3.0), having been an adopted or fostered child (OR: 4.5), and female sex (OR: 3.0) were identified as main risk factors. Furthermore, former child and adolescent psychiatry inpatients suffered from higher rates of psychosomatic or personality disorders, comorbidities and functional impairment, and were readmitted twice as often in young adulthood.

CONCLUSION

Young adult inpatients with reoccurring psychiatric inpatient treatments have increased rates of severe ACEs. Thus, special attention should be given to identifying ACEs, evaluating needs for psychosocial support and therapy, and meeting these needs after discharge.

Multi-center nationwide study on pediatric psychiatric inpatients 2000-2018: length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnostic profiles

Inpatient treatment is an important part of child and adolescent psychiatric (CAP) care. This nationwide study explores the changes in length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnoses of CAP inpatients in Finland in 2000, 2011 and 2018. We obtained comprehensive questionnaire data on each study year from 93 to 95% of all CAP wards in Finland. We split the 1276 inpatients into two age groups in each study year: under 13 and 13-18. The median length of stay in inpatient treatment decreased from 82.0 days in 2000 to 20.5 days in 2018 (p < 0.001) and recurrent hospitalization increased from 38 to 46%. General functioning, which was evaluated by the Children's Global Assessment Scale, deteriorated by an average of six points between 2000 and 2018. Violent threats decreased from 21.5 to 16.6% and violent acts decreased from 26.9 to 20.3%. Suicidal threats decreased from 42.6 to 23.3% in those aged under 13 and remained stable among those aged 13-18. In the 13-18 group, there was an increase in the diagnoses of ADHD, from 5.0 to 16.9% and depression, from 25.1 to 41.7%. However, psychosis decreased from 23.2 to 12.6% in the older age group. In the whole cohort, anxiety disorders increased from 7.6 to 15.6%. The overall picture does not show that CAP inpatients have become more disturbed. While the general functioning of CAP inpatients deteriorated somewhat over the 2000-2018 study period, symptoms of suicidality and violence remained stable or decreased. There was also a continuous increase in short-term treatment.

Adverse Childhood Experiences, Depression, Resilience, & Spirituality in African-American Adolescents

Research shows that exposure to adverse childhood experiences (ACEs) is common among adolescents and that exposure to ACEs is associated with an increased risk of depression in adolescents. Furthermore, it is unknown whether resilience and spirituality moderate the association between ACEs and depression in African-American adolescents. Thus, the present study examined the prevalence of ACEs and the association between ACEs and the risk for depression in African-American adolescents and examined whether this association is moderated by resilience and spirituality. Survey data were collected from African-American adolescents who attended youth-targeted events held by churches in Houston, TX. An expanded ACE tool was used to collect data and respondents were dichotomized into two groups based on their summed ACE scores, i.e., 0-3 ACEs versus 4-19 ACEs. Logistic regression was conducted to examine the association between ACEs and the likelihood of depression and to examine whether this association is moderated by resilience and spirituality. The results indicate that half of the sample had been exposed to four or more ACEs and that ACEs are negatively associated with depression: higher levels of resilience and spirituality suggest a lower likelihood of depression. These results suggest the need to explore the prevalence of cumulative ACEs among homogenous samples of African-American adolescents and the need to continue exploring and addressing the prevalence of individual ACEs among homogenous samples of African-American adolescents. No clinical trials were performed for this study.

Population-attributable risk of adverse childhood experiences for high suicide risk, psychiatric admissions, and recurrent depression, in depressed outpatients

Background: Population-attributable risk (PAR) may help estimate the potential contribution of adverse childhood experiences (ACEs) to serious clinical presentations of depression, characterized by suicidality, previous psychiatric admissions, and episode recurrence. Objective: To determine the PAR of ACEs for serious clinical presentations of depression (high suicide risk, previous psychiatric admissions, and recurrent depression) in outpatients with ICD-10 clinical depression. Method: Systematic chart review of 1,013 adults who were assessed and/or treated in a mental health clinic in Santiago, Chile for a major depressive episode. Data were collected on demographics and clinical characteristics of depression. Exposure to ACEs was determined with the Brief Physical and Sexual Abuse Questionnaire, assessing seven types of ACEs. Multivariable logistic regression analysis was used to assess the association between exposure to ACEs and suicidality, previous psychiatric admissions, and recurrence. Predicted probabilities were used for calculations of PAR. Results: Of the 1,001 study participants with complete data, 53.3% had recurrent depression, 13.5% had high suicide risk, and 5.0% had previous psychiatric admissions. Exposure to at least one ACE was recorded for 69.0% of the sample. Exposure to at least one ACE and specific types of ACEs (i.e. childhood sexual abuse and traumatic separation from caregiver) were associated with serious clinical presentations of depression. A dose-response relationship was observed between cumulative exposure to ACEs and the most serious clinical presentations of depression. ACEs were attributed to a significant proportion of disease: 61.6% of previous psychiatric admissions, 45.0% of high suicide risk, and 14.5% of recurrent depression. Conclusions: A substantial proportion of serious clinical presentations of depression among outpatients are associated with ACEs. Early detection of depressive episodes associated with ACEs, and tailored treatment for these patients, may potentially reduce the incidence of serious complications in this population.

Adolescent Inpatients with Depression: Comparison to Inpatients without Depression and to Peers without Psychiatric Disorders

Background:

Family background, social support and psychological characteristics are known to be associated with depression in adolescence, but scientific data in complex, naturalistic settings are scarce.

Objective:

To investigate the characteristics of adolescent psychiatric inpatients with depressive disorders compared to peers without psychiatric disorders and to adolescent psychiatric inpatients without depression.

Methods:

The study population of 206 inpatients (13-17 years old) and 203 age and gendermatched non-referred adolescents was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) interview, and clinical interview and clinical records when available. Structured self-reports provided information on family background, defense styles, self-image and perceived social support. We compared firstly subjects with current depressive disorders (n=120) to subjects without any psychiatric disorder (n=159) and secondly within the inpatient population, those with depressive disorders (n=117) to those with any other psychiatric diagnoses (n=89).

Results:

Current depressive disorders were characterized by worse self-image, less mature defenses and less perceived social support particularly from the family. Adversities in the family were more prevalent in subjects with depression compared to subjects without any psychiatric diagnosis, while among inpatients, no significant differences were observed. Psychiatric comorbidity was common in all inpatients, whereas suicidality was more prevalent among inpatients with depression.

Conclusions:

Negative self-image, less mature defense style and low perceived social support particularly from the family were characteristics of depression in adolescents.

Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis

BACKGROUND

The Center for Disease Control (CDC) and Kaiser Permanente developed the Adverse Childhood Experiences (ACE) scale to identify negative experiences in childhood. The goal of this study is to systematically review outcomes associated with the ACEs in the CDC-Kaiser ACE scale to understand the diversity of outcomes associated with this scale.

METHODS

The authors conducted a search of English language articles published through September 30, 2016 using OVID Medline®; Ovid Medline® Daily; Epub Ahead of Print, In-Process & Other Non-indexed citations; ERIC®; HAPI®; and SCOPUS®. Articles were selected by trained reviewers based on a priori inclusion criteria including: research, healthy sample, used the CDC-Kaiser ACE scale, and assessed some health outcome. Two reviewers used an abstraction form to independently collect data from each study. Unadjusted and adjusted odds ratio associated with ACE scale scores were aggregated and compared.

RESULTS

From 3167 unique titles, we identified 96 articles that assessed health outcomes associated with the ACEs in the CDC-Kaiser ACE scale. There were more studies focusing on psychosocial/behavioral outcomes than medical outcomes. The majority of the included studies were retrospective, observational, and relied on the same data set. Psychosocial/behavioral outcomes had higher odds ratio than medical outcomes with increasing ACE scale scores.

CONCLUSIONS

Exposure to multiple ACEs is associated with a wide variety of outcomes. This data suggests a benefit of screening for ACEs using this scale and highlights the need to find interventions to ameliorate their effects.

Research on Relationships between Sexual Identity, Adverse Childhood Experiences and Non-Suicidal Self-Injury among Rural High School Students in Less Developed Areas of China

Purpose: The objective of this study was to examine the influence of sexual identity and adverse childhood experiences (ACEs) on non-suicidal self-injury (NSSI) among rural high school students in less developed areas of China. Methods: Behavior risk factors data collected from 1810 students from a high school in Jiangxi province, China. Five measures of childhood abuse and household dysfunction were summarized, and ACE was divided into 0, 1, 2, 3–5 ACEs. Logistic regression analysis was used to explore the influence of sexual identity, adverse childhood experiences, and their interaction with non-suicidal self-injury. Results: Compared with heterosexual students, high school students who identify as lesbian, gay, or bisexual (LGB) have a higher tendency of non-suicidal self-injury (AOR = 3.250, 95% CI = 1.69–6.28, p < 0.01). There was also a graded relationship between cumulative ACEs exposure and non-suicidal self-injury behaviors (AOR = 1.627, 95% CI = 1.02–2.60, p < 0.05). Odds for NSSI are higher among students with both experienced ACEs and identified as LGB (AOR = 2.821, 95% CI = 1.51–5.29, p < 0.05). Conclusions: Non-suicidal self-injury is associated with ACEs exposure and with those who identify as LGB, and the NSSI odds are greater when students identify as LGB and have experienced ACEs. More interventions to reduce non-suicidal self-injury should focus on LGB and ACEs and more attention needs to be paid to those who identify as LGB and have been exposed to ACEs.

Mental Health Promotion for Gender Minority Adolescents

The current study uses an ecological model of biopsychosocial vulnerability to guide the description of risk and protective factors for the mental health of gender minority (i.e., transgender and gender non-conforming) adolescents at the individual, family, community, and societal levels. Minority stress is the vulnerability of youth who are lesbian, gay, bisexual, and transgender (LGBT) to adverse mental health outcomes due to stigma. In addition, unlike cisgender (non-transgender) LGB individuals, gender minorities may experience internal stress related to gender dysphoria. Gender dysphoria may lead to interaction with health care providers who may not be educated in the care of gender minority youth. The ecological model is an organizing framework for understanding domains of health risks that affect such youth to assist nurses in intervening to promote the health of gender minority adolescents. Specific attention is paid to the potential contributions of psychiatric-mental health nurses to the care of gender minority adolescents. [Journal of Psychosocial Nursing and Mental Health Services, 56(12), 22-30.].

Rehospitalization to a child and adolescent psychiatry unit: Role of trauma and bullying

OBJECTIVE

Psychiatric rehospitalizations results in a significant burden to patients, families, and health care systems. Understanding psychiatric rehospitalizations offers an opportunity to identify weaknesses in current systems of care. The objective of this study was to test the hypothesis that a history of trauma or ongoing bullying increases the risk of psychiatric rehospitalization.

METHOD

Retrospective cohort study of 366 individual patients (71% female) admitted to a pediatric psychiatry unit between 1/1/2015 and 12/31/2015. The primary outcome measure was rehospitalization to the same psychiatric hospital unit within one year of first discharge. Trauma was defined as having a history of Post-Traumatic Stress Disorder, Reactive Attachment Disorder, or a filed Suspected Abuse and Neglect of a Child report by the end of first hospitalization. Ongoing bullying was identified by medical record review.

RESULTS

History of trauma (Odds Ratio (OR) = 3.2, 95% Confidence Interval (CI) = 1.8-5.6, p < 0.0001) and ongoing bullying (OR = 2.2, CI = 1.2-3.9, p = 0.009) were significantly associated with increased rates of rehospitalizations. We controlled for the following covariates: Patient Health Questionnaire-9 Modified (PHQ-9M) score, gender, age, relative age, initial length of stay, disrupted family system, and sexual orientation/identity.

CONCLUSION

History of trauma or ongoing bullying are important risk factors for pediatric psychiatric rehospitalization.

Predictors of Partial Hospital Readmission for Young Children with Oppositional Defiant Disorder

This study aimed to: (1) examine rates of readmission among young children with oppositional defiant disorder (ODD) following discharge from a psychiatric partial hospital treatment program, and (2) examine child factors (i.e., age, sex, co-occurring diagnoses, suicidality) and family factors (i.e., parental depression, stress) as prospective predictors of readmission. Participants were 261 children (ages 3-7 years) who entered the study at the time of their initial program admission and who met DSM-IV criteria for ODD. Of these 261 children, 61 (23%) were subsequently readmitted, with most readmissions occurring within 1 year. Cox regression survival analyses demonstrated that younger child age, child suicidal thoughts and behavior, and child PTSD diagnosis were associated with decreased time to readmission. Findings suggest that young children with ODD who present with co-occurring suicidality or PTSD are at risk for readmission following partial hospitalization, with implications for treatment and aftercare planning.

High Beck Depression Inventory 21 scores in adolescents without depression are associated with negative self-image and immature defense style

Beck Depression Inventory (BDI) is widely used in assessing adolescents' psychological wellbeing, but occasionally the result diverges from diagnostics. Our aim was to identify factors associated with discrepancies between BDI scores and diagnostic assessment in adolescent psychiatric patients and general population. The study comprised 206 inpatients (13-17 years old) and 203 age and gender matched non-referred adolescents. Study subjects filled self-reports on depression symptoms (BDI-21), alcohol use (AUDIT), defense styles (DSQ-40) and self-image (OSIQ-R), and on background information and adverse life events. Diagnostics was based on K-SADS-PL interview, and/or clinical interview and clinical records when available. We compared subjects who scored in BDI-21 either 0-15 points or 16-63 points firstly among subjects without current unipolar depression (n = 284), secondly among those with unipolar depression (n = 105). High BDI-21 scores in subjects without depression diagnosis (n = 48) were associated with female sex, adverse life events, parents' psychiatric problems, higher comorbidity, higher AUDIT scores, worse self-image and more immature defense styles. Low BDI-21 scores among subjects with depression diagnosis (n = 23) were associated with male sex, more positive self-image and less immature defense style. In conclusion, high BDI-21 scores in the absence of depression may reflect a broad range of challenges in an adolescent's psychological development.

Mediators between adverse childhood experiences and suicidality

We investigated whether psychiatric symptomatology, impulsivity, family and social dysfunction, and alcohol use mediate the relationship between adverse childhood experiences (ACEs) and suicidality. The study population comprised 206 adolescent psychiatric inpatients and 203 age- and gender-matched adolescents from the community. ACEs and suicidality were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version, the Life Events Checklist, and a structured background data collection sheet. Psychiatric symptomatology was measured using the Symptom Checklist -90. Impulsivity, social dysfunction, and family dysfunction were measured using the Offer Self-Image Questionnaire, and alcohol use was assessed with the Alcohol Use Disorders Identification Test. A simple mediation test and multiple mediation analyses were conducted. A positive direct effect of ACEs on suicidality was observed. Also seen was a positive indirect effect of ACEs on suicidality through psychiatric symptomatology, impulsivity, and family and social dysfunctions. Alcohol misuse did not, however, mediate the relationship between ACEs and suicidality. According to the multiple mediation analyses, psychiatric symptomatology was the most significant mediator, followed by impulsivity. Psychiatric symptoms, impulsivity, and family and social dysfunctions are factors that should be taken into consideration when assessing suicidality in adolescents.

Using self-report surveys at the beginning of service to develop multi-outcome risk models for new soldiers in the U.S. Army

BACKGROUND

The U.S. Army uses universal preventives interventions for several negative outcomes (e.g. suicide, violence, sexual assault) with especially high risks in the early years of service. More intensive interventions exist, but would be cost-effective only if targeted at high-risk soldiers. We report results of efforts to develop models for such targeting from self-report surveys administered at the beginning of Army service.

METHODS

21 832 new soldiers completed a self-administered questionnaire (SAQ) in 2011-2012 and consented to link administrative data to SAQ responses. Penalized regression models were developed for 12 administratively-recorded outcomes occurring by December 2013: suicide attempt, mental hospitalization, positive drug test, traumatic brain injury (TBI), other severe injury, several types of violence perpetration and victimization, demotion, and attrition.

RESULTS

The best-performing models were for TBI (AUC = 0.80), major physical violence perpetration (AUC = 0.78), sexual assault perpetration (AUC = 0.78), and suicide attempt (AUC = 0.74). Although predicted risk scores were significantly correlated across outcomes, prediction was not improved by including risk scores for other outcomes in models. Of particular note: 40.5% of suicide attempts occurred among the 10% of new soldiers with highest predicted risk, 57.2% of male sexual assault perpetrations among the 15% with highest predicted risk, and 35.5% of female sexual assault victimizations among the 10% with highest predicted risk.

CONCLUSIONS

Data collected at the beginning of service in self-report surveys could be used to develop risk models that define small proportions of new soldiers accounting for high proportions of negative outcomes over the first few years of service.

Self-rated psychopathic traits in a sample of treatment-seeking adolescent girls with internalizing and externalizing disorders: comparisons to girls in the community

BACKGROUND

Psychopathy research has thus far focused mostly on child, male, and delinquent samples, but the results are most likely non-generalizable to adolescent girls with mental health disorders.

AIM

The present study aimed to compare self-rated psychopathic traits between female psychiatric outpatients and girls in the community, and to investigate how psychopathic traits relate to psychiatric disorders.

METHOD

The outpatient sample comprised 163 girls aged 15-17-years recruited from municipal mental health services. Psychiatric diagnoses were assessed based on the ICD-10 classification. The community sample comprised 355 girls from secondary, vocational, and high schools. The Youth Psychopathic trait Inventory (YPI) served as a self-assessment tool.

RESULTS

Treatment-seeking girls exhibit a more impulsive and irresponsible lifestyle than do girls in the community. Girls with externalizing psychopathology, unlike those with an internalizing disorder, exhibit more deficient affective experience than do girls in the community. Psychopathic traits associate with having a psychiatric disorder, a depressive disorder, ADHD, and a conduct disorder.

CONCLUSIONS

The psychiatric examination of treatment-seeking adolescent girls would likely benefit from screening for psychopathy and its underlying components.

Rethinking the Measurement of Adversity

Research on adverse childhood experiences (ACEs) has unified the study of interrelated risks and generated insights into the origins of disorder and disease. Ten indicators of child maltreatment and household dysfunction are widely accepted as ACEs, but further progress requires a more systematic approach to conceptualizing and measuring ACEs. Using data from a diverse, low-income sample of women who received home visiting services in Wisconsin ( N = 1,241), this study assessed the prevalence of and interrelations among 10 conventional ACEs and 7 potential ACEs: family financial problems, food insecurity, homelessness, parental absence, parent/sibling death, bullying, and violent crime. Associations between ACEs and two outcomes, perceived stress and smoking, were examined. The factor structure and test-retest reliability of ACEs was also explored. As expected, prevalence rates were high compared to studies of more representative samples. Except for parent/sibling death, all ACEs were intercorrelated and associated at the bivariate level with perceived stress and smoking. Exploratory factor analysis confirmed that conventional ACEs loaded on two factors, child maltreatment and household dysfunction, though a more complex four-factor solution emerged once new ACEs were introduced. All ACEs demonstrated acceptable test-retest reliability. Implications and future directions toward a second generation of ACE research are discussed.

Changes in the clinical features of child and adolescent psychiatric inpatients: a nationwide time-trend study from Finland

BACKGROUND

Few studies have focused on the recent trends in clinical features child and adolescent inpatient.

AIMS

This study focuses on the change in the characteristics of child and adolescent psychiatric inpatients in Finland.

METHODS

The data collection was carried out on selected study days in 2000 and 2011. Questionnaires were sent to the psychiatrists of all child and adolescent wards in Finland.

RESULTS

By comparing the data obtained in 2000 (n = 504) and 2011 (n = 412), several changes were found: the percentage of girls in adolescent wards grew and the diagnoses of depression, anxiety disorders, attention deficit hyperactivity disorder and eating disorders increased. In contrast, the diagnoses of psychosis and conduct or oppositional disorders decreased. General functioning was evaluated with the Childreńs Global Assessment Scale (CGAS). There were no changes in the distribution of CGAS scores among child inpatients, whereas among adolescents the share of inpatients with lowest CGAS scores (1-30) increased significantly. The mean length of stay dropped.

CONCLUSIONS

The growing percentage of girls in adolescent wards is associated with an increase in diagnoses that are more prevalent among girls than boys, namely depression, anxiety, and eating disorders. The changes in the distribution of diagnoses may be due to changes in diagnostic or referral practices, or reflect true changes in the prevalence of disorders among children and adolescents in need of inpatient treatment. The share of adolescent inpatients with the poorest general functioning has increased. The observed shortening in inpatient treatment time seems to be a result of changes in treatment practices.

Psychometric properties of the Symptom Checklist-90 in adolescent psychiatric inpatients and age- and gender-matched community youth

BACKGROUND

The Symptom Checklist-90 (SCL-90) is a questionnaire that is widely used to measure subjective psychopathology. In this study we investigated the psychometric properties of the SCL-90 among adolescent inpatients and community youth matched on age and gender.

METHODS

The final SCL-90 respondents comprised three subsets: 201 inpatients at admission, of whom 152 also completed the instrument at discharge, and 197 controls. The mean age at baseline was 15.0 years (SD 1.2), and 73 % were female. Differential SCL-90 item functioning between the three subsets was assessed with an iterative algorithm, and the presence of multidimensionality was assessed with a number of methods. Confirmatory factor analyses for ordinal items compared three latent factor models: one dimension, nine correlated dimensions, and a one-plus-nine bifactor model. Sensitivity to change was assessed with the bifactor model's general factor scores at admission and discharge. The accuracy of this factor in detecting the need for treatment used, as a gold standard, psychiatric diagnoses based on clinical records and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) interview.

RESULTS

Item measurement properties were largely invariant across subsets under the unidimensional model, with standardized factor scores at admission being 0.04 higher than at discharge and 0.06 higher than those of controls. Determination of the empirical number of factors was inconclusive, reflecting a strong main factor and some multidimensionality. The unidimensional factor model had very good fit, but the bifactor model offered an overall improvement, though subfactors accounted for little item variance. The SCL-90s ability to identify those with and without a psychiatric disorder was good (AUC = 83 %, Glass's Δ = 1.4, Cohen's d = 1.1, diagnostic odds ratio 12.5). Scores were also fairly sensitive to change between admission and discharge (AUC 72 %, Cohen's d = 0.8).

CONCLUSIONS

The SCL-90 proved mostly unidimensional and showed sufficient item measurement invariance, and is thus a useful tool for screening overall psychopathology in adolescents. It is also applicable as an outcome measure for adolescent psychiatric patients. SCL-90 revealed significant gender differences in subjective psychopathology among both inpatients and community youth.

Violent Victimization Among Disadvantaged Young Adults Exposed to Early Family Conflict and Abuse: A 24-Year Prospective Study of the Victimization Cycle Across Gender

Significant associations between childhood victimization and later revictimization have materialized in previous literature; yet, the victimization cycle has been primarily explored with indicators of sexual assault, although insight into linkages between other forms of victimization remains limited. This study examined connections from family conflict exposure and physical abuse in childhood to violent crime victimization in adulthood, assessing also gender differences and neighborhood influences. Results from logistic regression and hierarchical linear modeling with data from the Chicago Longitudinal Study, a panel of 1,539 low-income, ethnic/racial minority children, unearthed a significant relation between family conflict exposure and later revictimization. Moderated by gender, these analyses showed girls exposed to frequent family conflict are particularly vulnerable to revictimization in adulthood. Exploratory analyses unveiled a potential linkage between childhood physical abuse and later revictimization for men. Neighborhood effects marginally influenced results in one instance. Public health implications are discussed.

Characteristics of Youth Presenting to a Canadian Youth Concurrent Disorders Program: Clinical Complexity, Trauma, Adaptive Functioning and Treatment Priorities

OBJECTIVE

This study describes clinical characteristics of youth presenting for service at a Canadian youth concurrent mental health and substance use disorders (SUD) program.

METHOD

Participants were 100 adolescents and emerging adults (aged 14-25) who attended a Canadian concurrent mental health and substance use disorders outpatient program. SUDs were assigned using the Structured Clinical Interview for DSM-IV. Self-reported mental health symptoms, trauma exposure and adaptive functioning were also assessed.

RESULTS

Eighty-three percent of participants scored over the clinical cut-off on at least one mental health scale and 33% reported at least one suicide attempt. Sixty-six percent met criteria for a current SUD; 96% met lifetime criteria. Exposure to adverse events was nearly universal (94%). Almost half of female (46%) and almost a third of male (31%) participants endorsed symptoms consistent with posttraumatic stress disorder (PTSD). Youth reported impairment and need for support in multiple domains of functioning, including school, peer, family and mental health. Substance use was least likely to be identified as a treatment priority.

CONCLUSIONS

High rates of adverse events and PTSD highlight the need for trauma-informed care when providing services to this vulnerable population. Functional impairment in domains related to developmental transitions and tasks underscores the need for a developmental lens and integrated treatment that goes beyond mental health and SUD symptoms and addresses developmentally relevant domains during this transitional age.