The relations between childhood maltreatment, shame, guilt, depression and suicidal ideation in inpatient adolescents

Is shyness related to depression and suicide risk?

INTRODUCTION

Suicidal behavior is an important health issue, representing a leading cause of mortality, particularly among young adults. Depression was found to be predictive of suicide risk and predicted by shyness. Consequently, we tested a model wherein shyness leads to depression, which in turn leads to suicide risk. Moreover, we expected gender to moderate the effect of shyness on depression and suicide risk.

METHODS

A convenience sample of 478 first-year college students (51% women, Age: M = 25.42, SD = 3.61) completed online self-report questionnaires assessing suicide risk, depression, shyness, and demographic variables.

RESULTS

As expected, shyness was significantly correlated with depression (r = 0.40) and suicide risk (r = 0.24), and depression and suicide risk were also correlated with each other (r = 0.57). Depression statistically mediated the relationship between shyness and suicide risk (indirect effect for women = 0.92, SE = 0.16; for men = 0.72, SE = 0.17). Gender did not moderate the mediation effect. However, a direct link between shyness and suicide risk was found only among men (direct effect = 0.52, SE = 0.21).

CONCLUSIONS

The results suggest that shyness may be a significant factor in the development of depression and suicide risk, potentially serving as a valuable marker for identifying at-risk individuals. Moreover, clinicians should be aware of these associations, particularly among men, in order to maintain and support mental health as well as reduce suicidality.

The relationship between childhood maltreatment subtypes and adolescent internalizing problems: The mediating role of maladaptive cognitive emotion regulation strategies

BACKGROUND

While childhood maltreatment is understood to be a significant risk factor for adolescent internalizing problems (depression and anxiety), underlying mechanisms linking each type of maltreatment to internalizing problems in adolescents remain unclear. Moreover, the current state of knowledge regarding the associations between maladaptive cognitive emotion regulation strategies and each type of maltreatment, as well as their impact on adolescent internalizing problems, is limited. Additionally, it remains unclear whether these maladaptive strategies mediate this relationship.

OBJECTIVE

This study sought to investigate the effects of childhood maltreatment types on adolescent internalizing problems and to explore whether the overall and specific types of maladaptive strategies mediate these associations.

METHODS

Using a cross-sectional design, adolescents (N = 7071, Mage = 14.05 years, SDage = 1.54) completed online questionnaires assessing childhood maltreatment, maladaptive cognitive emotion regulation strategies (including rumination, catastrophizing, self-blame, and other-blame), anxiety, and depression. The hypothesized mediating effects were tested using the Lavaan package in R software (4.1.2).

RESULTS

Different maltreatment types had varying effects on adolescent internalizing problems. Emotional neglect, emotional abuse, and sexual abuse significantly affected anxiety and depression, whereas physical neglect and physical abuse did not. Other than physical neglect and physical abuse, overall maladaptive strategies mediated the relationship between the other three types of maltreatment (emotional abuse, emotional neglect, and sexual abuse) and internalizing problems (anxiety and depression). For specific maladaptive strategies, rumination mediated the effects of physical abuse, emotional abuse, emotional neglect, and sexual abuse on internalizing problems (anxiety and depression). In contrast, catastrophizing mediated the relationship between physical neglect, emotional abuse, emotional neglect, sexual abuse and internalizing problems (anxiety and depression).

CONCLUSIONS

These results suggest that the effects of maltreatment types on internalizing problems are different and that maladaptive strategies, particularly rumination and catastrophizing, are important mechanisms through which childhood maltreatment affects internalizing problems. This is a reminder that mental health workers need to consider the different effects of maltreatment types when intervening and recognize the importance of prioritizing interventions for rumination and catastrophizing.

Trajectories of parental harshness and exposure to community violence differentially predict externalizing and internalizing mental health problems in legal system-involved youth

Youth with legal system involvement are especially likely to experience parental harshness (PH) and exposure to community violence (ETV), two common forms of life stress. However, most studies examine these stressors separately or collapse across them in ways that preclude examination of their co-occurrence. Consequently, it is unclear 1) how PH and ETV simultaneously fluctuate across development and 2) how these fluctuations predict future mental health problems in legal system-involved youth. We used group-based multi-trajectory modeling to estimate simultaneous trajectories of PH and ETV in 1027 legal system-involved youth and regression analyses to understand how trajectory membership predicted mental health problems three years later. Four trajectories of co-occurrence were identified (1: Low; 2: Moderate and Decreasing; 3: Moderate PH/High ETV; 4: High PH/Moderate ETV). Compared to the Low trajectory, all trajectories with PH/ETV elevations predicted violent crime and substance problems; trajectory 3 (Moderate PH/High ETV) predicted nonviolent crime and depression/anxiety symptoms; trajectory 4 (High PH/Moderate ETV) predicted depression diagnosis. These results elucidate how PH and ETV typically co-occur across adolescence for legal system-involved youth. They also reveal important commonalities and dissociations among types of mental health problems.

Childhood maltreatment and suicidal ideation among Chinese adolescents: Moderated mediation effect of perceived social support and maladaptive cognitive emotion regulation strategies

BACKGROUND

Although previous studies have shown that childhood maltreatment is a risk factor for adolescent suicidal ideation, less is known about the mediating and moderating mechanisms underlying this association.

OBJECTIVE

The current study aimed to investigate the relationship between childhood maltreatment and suicidal ideation among adolescents, as well as the mediating role of maladaptive cognitive emotion regulation strategies (maladaptive CERSs) and the moderating role of perceived social support.

METHODS

In a cross-sectional design, 4005 adolescents (Mage = 14.24 years, SD = 1.53; 49.0 % males) completed self-report questionnaires regarding childhood maltreatment, maladaptive CERSs, perceived social support and suicidal ideation, along with their basic information.

RESULTS

After controlling for gender, family location, family structure, and depression, childhood maltreatment was positively related to adolescent suicidal ideation, and maladaptive CERSs were found to mediate this association. Moderated mediation analyses revealed that perceived social support buffered the associations between maladaptive CERSs and adolescent suicidal ideation.

CONCLUSIONS

The findings assist in understanding the mechanisms of maladaptive CERSs and perceived social support in the relationship between childhood maltreatment and suicidal ideation and can provide new perspectives for researchers designing interventions for suicidal ideation.

Interpersonal trauma, shame, and substance use: A systematic review

BACKGROUND

Interpersonal trauma is a risk factor for a wide array of adverse mental health outcomes, including substance use. Research has begun investigating the role of shame in the intersection between substance use and interpersonal trauma. The current systematic review summarizes the existing literature documenting the relation among shame, substance use, and interpersonal trauma.

METHOD

Articles were collected using a Boolean search strategy of terms related to interpersonal trauma, substance use, and shame across six databases. Independent search and screening by three researchers led to a final review of 27 articles, 15 of which were qualitative studies.

RESULTS

Findings highlight robust associations among shame, interpersonal violence, and substance use across varied samples. Findings emphasize that increased shame is associated with greater substance use among survivors of interpersonal violence and elevated shame and greater interpersonal violence are present among individuals who use substances given the high prevalence rates. Burgeoning research suggests that shame mediates the relationship between interpersonal violence and substance use.

CONCLUSION

Results from our review suggest that shame may be an important treatment target for individuals presenting with substance use and a history of interpersonal violence. Future studies, with longitudinal designs, are needed to parse out the temporal relation among shame, substance use, and interpersonal violence.

Childhood maltreatment patterns and suicidal ideation: mediating roles of depression, hope, and expressive suppression

Childhood maltreatment has long-term negative effects on individuals' physical and mental well-being, and may increase the risk for suicidal ideation. However, how different patterns of childhood maltreatment affect subsequent suicidal ideation and the underlying mediating mechanisms remain unclear, particularly among Chinese adolescents. This study used latent profile analysis to identify patterns of childhood maltreatment among adolescents and explored how these patterns predicted subsequent suicidal ideation via depression, hope, and expressive suppression. This study used a two-wave, 1-year longitudinal design and included 2156 adolescents (Mage = 13.97 years, SDage = 1.61 years; 49.6% females). We identified three patterns of childhood maltreatment: low maltreatment, high psychological neglect, and high maltreatment. Compared with the low maltreatment group, the high maltreatment group indirectly predicted subsequent suicidal ideation 1 year later via depression through hope and expressive suppression, whereas the direct effect on suicidal ideation was not significant. Compared with the low maltreatment group, the high psychological neglect group had a significant direct effect on subsequent suicidal ideation and indirectly predicted suicidal ideation through depression or hope. Identifying patterns of childhood maltreatment among adolescents will assist mental health workers in developing targeted interventions to effectively alleviate suicidal ideation.

Do dimensions of childhood adversity differ in their direct associations with youth psychopathology? A meta-analysis

Growing evidence supports the unique pathways by which threat and deprivation, two core dimensions of adversity, confer risk for youth psychopathology. However, the extent to which these dimensions differ in their direct associations with youth psychopathology remains unclear. The primary aim of this preregistered meta-analysis was to synthesize the associations between threat, deprivation, internalizing, externalizing, and trauma-specific psychopathology. Because threat is proposed to be directly linked with socioemotional development, we hypothesized that the magnitude of associations between threat and psychopathology would be larger than those with deprivation. We conducted a search for peer-reviewed articles in English using PubMed and PsycINFO databases through August 2022. Studies that assessed both threat and deprivation and used previously validated measures of youth psychopathology were included. One hundred and twenty-seven articles were included in the synthesis (N = 163,767). Results of our three-level meta-analyses indicated that adversity dimension significantly moderated the associations between adversity and psychopathology, such that the magnitude of effects for threat (r's = .21-26) were consistently larger than those for deprivation (r's = .16-.19). These differences were more pronounced when accounting for the threat-deprivation correlation. Additional significant moderators included emotional abuse and youth self-report of adversity. Findings are consistent with the Dimensional Model of Adversity and Psychopathology, with clinical, research, and policy implications.

Why emotional neglect brings suicidal ideation? The mediating effect of meaning in life and the moderating effect of post-stress growth

BACKGROUND

Emotional neglect during childhood has long-lasting negative effects on individuals, and it is often hidden and unrecognized. Previous research has not fully understood its unique effects on mental health outcomes, especially when considering the co-occurrence with other forms of maltreatment. The meaning-making coping and growth model suggests that individuals achieve positive psychological outcomes by constructively integrating negative experiences into their self-concept, which may be a protective mechanism against the detrimental effects of emotional neglect.

OBJECTIVE

This study aimed to examine the relationship between emotional neglect and suicidal ideation among undergraduates, accounting for the presence of emotional abuse and physical neglect, and to investigate the mediating role of meaning in life and the moderating role of post-stress growth in this relationship.

METHODS

A self-reported survey was conducted with 3132 undergraduate students from a university in South China. The survey assessed emotional neglect, emotional abuse, physical neglect, suicidal ideation, post-stress growth, and meaning in life.

RESULTS

Meaning in life partially mediated the relationship between emotional neglect and suicidal ideation. Post-stress growth moderated the association between emotional neglect and the sense of meaning in life, in particular the moderation effect was stronger when emotional abuse was weaker.

CONCLUSIONS

Meaning in life mediated the relationship between emotional neglect and suicide ideation. Post-stress growth moderated the mediation effect such that it was weakened among individual with a higher level of post-stress growth. This study contributes to the understanding of the psychopathological processes following emotional neglect and the development of positive personal changes thereafter.

Depression, Anxiety, and Posttraumatic Stress Disorder Following Intimate Partner Violence: The Role of Self-Criticism, Guilt, and Gender Beliefs

Intimate partner violence (IPV) predicts anxiety, depression, and posttraumatic stress disorder (PTSD), yet the role of cognition in these pathways is poorly understood. This study explored whether self-criticism, guilt, and gender beliefs predicted psychological symptoms, using self-report data from 50 Colombian female IPV survivors with diverse socioeconomic statuses. Self-criticism and guilt were high and significantly associated with IPV. Self-criticism significantly predicted depression and PTSD, whilst only guilt predicted anxiety. Traditional gender role beliefs were associated with emotional abuse, but not with self-criticism, guilt, or symptoms. In conclusion, self-criticism and guilt are important treatment targets for female IPV survivors, regardless of gender beliefs.

Associations between humiliation, shame, self-harm and suicidality among adolescents and young adults: A systematic review

BACKGROUND

Suicide is the second leading cause of death among young people worldwide. Research indicates that negative social contexts involving familial and peer relationships have far-reaching influences on levels of suicidality in later life. While previous systematic reviews have focused on evaluating associations between negative life events such as abuse and bullying in childhood and subsequent suicidality, this systematic review examines the prevalence of, and association between the processes of humiliation and shame in later self-harm, suicidal ideation, and suicide among adolescents and young adults.

METHODS

A systematic literature search of databases including MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, and Embase was conducted to identify potential studies. ProQuest was searched to identify relevant grey literature research. A combination of MESH terms and keywords was used. All original quantitative studies published in English that examined the prevalence, or association between humiliation or shame and suicidal behaviours and/or death by suicide were included. Studies were assessed for methodological quality using Joanna Briggs Institute critical appraisal tools. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022289843].

RESULTS

Narrative synthesis was performed. A total of 33 studies reporting the prevalence of, or association between humiliation (n = 10) or shame (n = 23) and suicidal thoughts/behaviours were included. The prevalence of humiliation among those with any suicidality ranged from 18% to 28.1%, excluding an outlier (67.1%), with two studies presenting a significant association between humiliation and self-harm in their fully adjusted analyses. The studies that outlined humiliation and suicidal thinking (intent/suicide plan) had no association after adjustment for confounders. For shame, half of the studies found an association in adjusted models (n = 10), and this was evident for both suicidal ideation and self-harm.

CONCLUSION

To our knowledge, this is the first study to attempt a systematic review on this topic. The dearth of research in this field of enquiry is reflective of unique challenges associated with assessments of humiliation and shame in various clinical settings amongst adolescent and young adult populations. Nonetheless, given the importance and relevance of the psychological imprint of humiliation in youth morbidity and mortality in the field of mental health, it is timely to attempt such a systematic review. In light of the associated role of humiliation and shame in self-harm and suicidality among young people, we recommend that these processes need to be explored further via prospective studies and assessed as part of a comprehensive bio-psycho-social assessment when focusing on life stressors for adolescent and young adults presenting with suicidality to emergency departments and mental health services.

From Maltreatment to Psychiatric Disorders in Childhood and Adolescence: The Relevance of Emotional Maltreatment

Different forms of maltreatment are thought to incur a cumulative and non-specific toll on mental health. However, few large-scale studies draw on psychiatric diagnoses manifesting in early childhood and adolescence to identify sequelae of differential maltreatment exposures, and emotional maltreatment, in particular. Fine-grained multi-source dimensional maltreatment assessments and validated age-appropriate clinical interviews were conducted in a sample of N = 778 3 to 16-year-olds. We aimed to (a) substantiate known patterns of clinical outcomes following maltreatment and (b) analyse relative effects of emotional maltreatment, abuse (physical and sexual), and neglect (physical, supervisory, and moral-legal/educational) using structural equation modeling. Besides confirming known relationships between maltreatment exposures and psychiatric disorders, emotional maltreatment exerted particularly strong effects on internalizing disorders in older youth and externalizing disorders in younger children, accounting for variance over and above abuse and neglect exposures. Our data highlight the toxicity of pathogenic relational experiences from early childhood onwards, urging researchers and practitioners alike to prioritize future work on emotional maltreatment.

Psychosocial Identity, Intimacy and Suicidality in Young Adults

OBJECTIVE

Suicidality in young adults is a serious and growing clinical and social problem. The theory of psychosocial ego development assumes that identity and intimacy are two key factors for adaptation and vulnerability in early adulthood. The aim of the present study was to test whether psychosocial identity and intimacy are related to suicidality in young adults, even when controlling for confounding variables (depressive symptoms, sex, age, health and economic assessment, religious commitment, and pandemic-related distress).

METHOD

Respondents aged 18-25 (n = 607) completed the Identity-Confusion and Intimacy-Isolation subscales from the Modified Erikson Psychosocial Stage Inventory, as well as the Patient Health Questionnaire-9, the Suicidal Behaviors Questionnaire-Revised and answered questions about the pandemic-related distress and various sociodemographic factors.

RESULTS

At the level of bivariate analyses, both identity and intimacy were negatively associated with suicidal risk in the overall sample and with the frequency of suicidal ideation in the suicide risk subsample (n = 242). Weaker identity, but not intimacy, was associated with belonging to a suicide risk group in multivariable logistic regression. Moreover, ordinal regression showed that, in the subgroup with suicide risk, identity was negatively associated with the frequency of suicidal thoughts.

CONCLUSIONS

Identity is a negative correlate of suicidality in young adults. Identity-focused therapy may be a promising target for intervention in suicidal young adults.

Child maltreatment and youth suicide risk: A developmental conceptual model and implications for suicide prevention

Experiences of child abuse and neglect are risk factors for youth suicidal thoughts and behaviors. Accordingly, suicide risk may emerge as a developmental process that is heavily influenced by the rearing environment. We argue that a developmental, theoretical framework is needed to guide future research on child maltreatment and youth (i.e., adolescent and emerging adult) suicide, and to subsequently inform suicide prevention efforts. We propose a developmental model that integrates principles of developmental psychopathology and current theories of suicide to explain the association between child maltreatment and youth suicide risk. This model bears significant implications for future research on child maltreatment and youth suicide risk, and for suicide prevention efforts that target youth with child maltreatment experiences.

Examining associations, moderators and mediators between childhood maltreatment, social functioning, and social cognition in psychotic disorders: a systematic review and meta-analysis

Childhood maltreatment (CM) has been related to social functioning and social cognition impairment in people with psychotic disorders (PD); however, evidence across different CM subtypes and social domains remains less clear. We conducted a systematic review and meta-analysis to quantify associations between CM, overall and its different subtypes (physical/emotional/sexual abuse, physical/emotional neglect), and domains of social functioning and social cognition in adults with PD. We also examined moderators and mediators of these associations. A PRISMA-compliant systematic search was performed on 24 November 2022 (PROSPERO CRD42020175244). Fifty-three studies (N = 13 635 individuals with PD) were included in qualitative synthesis, of which 51 studies (N = 13 260) with 125 effects sizes were pooled in meta-analyses. We found that CM was negatively associated with global social functioning and interpersonal relations, and positively associated with aggressive behaviour, but unrelated to independent living or occupational functioning. There was no meta-analytic evidence of associations between CM and social cognition. Meta-regression analyses did not identify any consistent moderation pattern. Narrative synthesis identified sex and timing of CM as potential moderators, and depressive symptoms and maladaptive personality traits as possible mediators between CM and social outcomes. Associations were of small magnitude and limited number of studies assessing CM subtypes and social cognition are available. Nevertheless, adults with PD are at risk of social functioning problems after CM exposure, an effect observed across multiple CM subtypes, social domains, diagnoses and illness stages. Maltreated adults with PD may thus benefit from trauma-related and psychosocial interventions targeting social relationships and functioning.

A Three-Way Interaction of Sex, PER2 rs56013859 Polymorphism, and Family Maltreatment in Depressive Symptoms in Adolescents

The prevalence of depressive symptoms in adolescents is 12-18% and is twice as frequent in females. Sleep problems and thoughts of death are depressive symptoms or co-occurrent phenomena. Family maltreatment is a risk factor for later depressive symptoms and the period circadian regulator (PER) has been studied in relation to neurotransmitters, adaptation to stress, and winter depression. The purpose of this work was to study the relation of the three-way interactions of sex, PER2 rs56013859, and family maltreatment in relation to core depressive symptoms, sleep complaints, and thoughts of death and suicide in self-reports from a cohort of Swedish adolescents in 2012, 2015, and 2018. Cross-sectional and longitudinal analyses with linear and logistic regressions were used to study the relationships to the three outcomes. The three-way interaction was related to core depressive symptoms at both baseline and six years later. In contrast, the model did not show any relation to the other dependent variables. At 13-15 years, a sex-related differential expression was observed: females with the minor allele C:C/C:T exposed to family maltreatment showed higher levels of core depressive symptoms. Six years later, the trend was inverted among carriers of minor alleles.

Is Rejection, Parental Abandonment or Neglect a Trigger for Higher Perceived Shame and Guilt in Adolescents?

Theories of development point out that childhood experiences are relevant across the lifespan, and that the parent-child relationship is essential for a child's physical and psychological wellbeing. The aim of this study is to investigate whether parental abandonment influences self-conscious emotions such as guilt and shame. This quasi-experiment included 230 adolescents and teenagers (M = 17.1, SD = 1.82), and data were collected via a self-reported questionnaire administered online. We used the Guilt Inventory, the Experience of Shame Scale, the Childhood Trauma Questionnaire, and the Parental Acceptance/Rejection Questionnaire. Results indicated that the child's environment was significantly associated with feelings of shame. Abuse is associated with both guilt and shame, while paternal rejection is associated with guilt. The environment in which children and teenagers develop is associated with how they perceive themselves in relation to others. This study underlines the importance of considering child development conditions and the paramount importance of social work assistance for abandoned children and teenagers.

Childhood Maltreatment, Executive Function, and Suicide Attempts in Adolescents

Evidence suggests that child maltreatment is a risk factor for adolescent suicidal behavior. However, the differential influence of distinct forms of child maltreatment on adolescent suicide attempts is understudied and the factors that might exacerbate or ameliorate these associations warrant attention. We examined the associations between two distinct forms of child maltreatment (threat and deprivation) and suicide attempt history, and investigated whether executive function domains moderated these associations. Participants were 119 adolescents (M = 15.24, SD = 1.46, 72.3% female) recruited from an inpatient psychiatric hospital during hospitalization for suicidal thoughts and behaviors. Results indicated that the executive function domains of initiation, shifting, and planning/organization moderated the associations between threat and suicide attempt history. Associations between threat and suicide attempt history were significant only when initiation and shifting T-scores were lower (OR = 1.22, p = .03 and OR = 1.32, p = .01, respectively). The association between threat and suicide attempt history trended toward significance when planning/organization T-scores were lower (OR = 1.15, p = .10). None of the executive function domains moderated the link between deprivation and suicide attempt history. Findings highlight the need for research investigating whether initiation, shifting, and planning/organization might be amendable to intervention in the context of threat-related child maltreatment.

Comorbid eating, depressive, and anxiety psychopathology is associated with elevated shame in women with food insecurity

OBJECTIVE

To compare participants with current food insecurity and different psychopathology profiles on shame, guilt, anxiety, and depression using a cross-sectional design.

METHOD

Women with current food insecurity (n = 99; 54% White) were placed into four groups based on their endorsement of symptoms of psychopathology: eating disorder with depression/anxiety comorbidity (ED-C group; n = 17), depression/anxiety only (Depression/anxiety group; n = 34), eating disorder only (ED group; n = 12), and No-diagnosis group (n = 36). Groups were compared on self-report measures of shame, guilt, depression, and anxiety using analysis of covariance.

RESULTS

The presence of an eating disorder was associated with quadruple the risk of screening positive for comorbid depression and anxiety. The ED-C group reported elevated shame relative to the ED and No-diagnosis groups. The ED-C group reported the highest levels of anxiety, followed by the Depression/anxiety group, and the ED and No-diagnosis groups.

DISCUSSION

The presence of an eating disorder with comorbidity among women with food insecurity is associated with heightened shame. Given shame's status as a transdiagnostic predictor of psychopathology, it may serve as a putative mechanism underlying the relationship between food insecurity and eating disorder comorbidity.

PUBLIC SIGNIFICANCE STATEMENT

Women with food insecurity and an ED were more likely to also screen positive for depression and/or anxiety than women with food insecurity and no ED. Overlap between ED, depression, and anxiety was associated with elevated shame, a harmful, maladaptive emotion with negative psychosocial consequences.

Childhood trauma and depressive symptoms in bipolar disorder: A network analysis

BACKGROUND

Childhood trauma is related to an increased number of depressive episodes and more severe depressive symptoms in bipolar disorder. The evaluation of the networks of depressive symptoms-or the patterns of relationships between individual symptoms-among people with bipolar disorder with and without a history of childhood trauma may assist in further clarifying this complex relationship.

METHODS

Data from over 500 participants from the Heinz C. Prechter Longitudinal Study of Bipolar Disorder were used to construct a series of regularised Gaussian Graphical Models. The networks of individual depressive symptoms-self-reported (Patient Health Questionnaire-9; n = 543) and clinician-rated (Hamilton Depression Rating Scale-17; n = 529)-among participants with bipolar disorder with and without a history of childhood trauma (Childhood Trauma Questionnaire) were characterised and compared.

RESULTS

Across the sets of networks, depressed mood consistently emerged as a central symptom (as indicated by strength centrality and expected influence); regardless of participants' history of childhood trauma. Additionally, feelings of worthlessness emerged as a key symptom in the network of self-reported depressive symptoms among participants with-but not without-a history of childhood trauma.

CONCLUSION

The present analyses-although exploratory-provide nuanced insights into the impact of childhood trauma on the presentation of depressive symptoms in bipolar disorder, which have the potential to aid detection and inform targeted intervention development.

Inter-relationships of depressive and anxiety symptoms with suicidality among adolescents: A network perspective

BACKGROUND

Persons with suicidality including suicidal ideation (SI), suicide plans (SP) and/or suicide attempts (SA) are at higher risk for future suicide than those without suicidality. To reduce the risk of future suicide, it is important to understand symptoms of emotional distress that have the strongest links with SI, SP and SA. This network analysis examined item-level relations of depressive and anxiety symptoms with suicidality among adolescents during the COVID-19 pandemic.

METHODS

Adolescents between 12 and 20 years of age were assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and individual binary reponse (no/yes) items assessing SI, SP, and SA during the pandemic. The structure of depressive symptoms, anxiety symptoms and suicidality was characterized using "Expected Influence" and "Bridge Expected Influence" as centrality indices in the symptom network. Network stability was tested using a case-dropping bootstrap procedure. Node-specific predictive betweenness was computed to examine short paths of anhedonia, other depressive symptoms and anxiety symptoms with suicidality. A Network Comparison Test (NCT) was conducted to examine whether network characteristics differed based on gender.

RESULTS

Prevalence rates of depressive symptoms, anxiety symptoms, and suicidality were 44.60 % (95% confidence interval (CI) = 41.53-47.67 %), 31.12 % (95%CI = 28.26-33.98 %), and 16.95 % (95%CI = 14.63-19.26 %), respectively, in the study sample. The network analysis identified GAD3 ("Worry too much") as the most central symptom, followed by GAD6 ("Irritability") and PHQ6 ("Guilt") in the sample. Additionally, PHQ6 ("Guilt"), GAD6 ("Irritability"), and PHQ2 ("Sad mood") were bridge nodes linking depressive and anxiety symptoms with suicidality. A flow network indicated that the connection between S ("Suicidality") and PHQ6 ("Guilt") reflected the strongest connection, followed by connections of S ("Suicidality") with GAD2 ("Uncontrollable worrying"), and S ("Suicidality") with PHQ2 ("Sad mood"). Finally, PHQ2 ("Sad mood") was the main bridge node linking anhedonia with other depressive and anxiety symptoms and suicidality in the sample.

CONCLUSIONS

Findings highlight the potential importance of reducing specific depressive and anxiety symptoms as possible means of reducing suicidality among adolescents during the pandemic. Central symptoms and key bridge symptoms identified in this study should be targeted in suicide prevention for at-risk adolescents.

Treatment of Comorbid Disorders, Syndromes, and Symptoms of Posttraumatic Stress Disorder Related to Childhood Maltreatment with STAIR-NT

Abstract. Background: Early interpersonal traumatic events, such as childhood maltreatment, increase the risk of developing complex posttraumatic stress symptoms. The biphasic treatment program STAIR-NT (Skills Training for Affective and Interpersonal Regulation with Narrative Therapy), developed specifically for this patient group, combines interventions to improve emotion regulation and interpersonal skills with narrative therapy. Objective: Many affected patients with PTSD after childhood maltreatment also suffer from various comorbid mental disorders and symptoms that can affect and impede the course and outcome of treatment with STAIR-NT. Method: Based on experience from a current treatment study, we provide recommendations for integrating treatment of comorbid mental symptoms into STAIR-NT. Results / Conclusion: Training affective and interpersonal regulation skills in the first treatment phase offers various interventions to efficiently adapt transdiagnostic mechanisms such as emotion dysregulation. In cases of severe comorbid mental disorders or symptoms, adding disorder-specific interventions to STAIR-NT may be indicated.

Childhood maltreatment influences suicidal behavior: Rumination mediates and regulatory emotional self-efficacy moderates

To investigate the mediating role of rumination in the association between childhood maltreatment and suicidal behavior, and the moderating role of regulatory emotional self-efficacy, university students (N = 1,458) from 5 universities in China completed questionnaires in classrooms. Path analyses showed emotional maltreatment had the greatest positive association with suicidal behavior and rumination compared with other types of childhood maltreatment. Rumination partly mediated the relationship between childhood maltreatment and suicidal behavior. High regulatory emotional self-efficacy moderated the relation between ruminating childhood maltreatment and suicidal behavior.

Childhood maltreatment and suicidal ideation in Chinese children and adolescents: the mediating role of mindfulness

BACKGROUND

Childhood maltreatment (CM) has been associated with suicidal ideation (SI) in children and adolescents, yet the mediating role of mindfulness in this association remains unclear. This study aims to test the mediation of mindfulness in CM-SI association among a large sample of Chinese children and adolescents.

METHODS

A population-based cross-sectional study of 3455 children and adolescents aged 10-17 years from southwest China Yunnan province was conducted. Information from the participants was collected by using a comprehensive self-administered questionnaire. The Chinese version of the Childhood Trauma Questionnaire (CTQ), Five Facet Mindfulness Questionnaire (FFMQ), and the Beck Scale for Suicidal Ideation (BSSI) were used to measure CM, mindfulness and SI. Univariate and multivariate binary logistic regression models were used to estimate the crude and adjusted associations between CM, mindfulness and SI (one-week, one-year, lifetime). Pathway analysis was subsequently performed to test the mediation of mindfulness in CM-SI association.

RESULTS

The findings showed that mindfulness, CM and SI were significantly correlated with each other (p < 0.05). Mindfulness is a significant mediator in CM-SI association, accounted for 7.5, 11.4, and 17.6% of the total associations for one-week SI, one-year SI, and lifetime SI, respectively. For the five types of CM, the highest level of mediation via mindfulness had been found for physical neglect (PN) and one-year SI (34.3%), followed by emotional neglect (EN) and one-year SI (30.2%), sexual abuse (SA) and one-year SI (25.4%).

CONCLUSIONS

Our study findings highlight the intervention potential of mindfulness in preventing CM associated suicidal risk. Future longitudinal studies are warranted to corroborate the effectiveness of mindfulness-based intervention for Chinese children and adolescents.

Child Sexual Abuse and Suicide: Essentials for the Forensic Nurse

Sexual abuse can result in significant negative sequelae for victims. One particularly harmful consequence is suicidal ideation, which can lead to suicide attempts and even death. It is essential to screen children and adolescents for suicidal ideation when providing medical forensic care after disclosure of acute or nonacute sexual abuse/assault. Forensic nurses must feel confident in their abilities to assess suicide risk and provide appropriate intervention and referrals. A thorough understanding of the relationship between sexual abuse and suicidal ideation and behaviors can assist the forensic nurse in the development of practice behaviors to better identify, intervene, and prevent suicidal ideation and behaviors among youth experiencing sexual abuse.

Development of a scale for parent-to-baby emotions: Concepts, design, and factor structure

Aim

Although infant crying is a prerequisite for a baby's survival, it often leads to negative consequences for the caregivers. We hypothesized that this would be mediated by a primary emotion that we feel directly in response to an internal or external event. Hence, this study aimed to develop a new scale to measure basic and self-conscious emotions as primary emotions towards an infant's cry.

Methods

We conducted a cross-sectional web survey including the scale for parent-to-baby emotions (SPBE)-with 73 items elicited from a literature review-targeted at mothers at 1 month after childbirth (N = 879). A series of explanatory and confirmatory factor analyses were conducted using item parcels. Internal consistency of the scale was calculated by omega indices. We also examined measurement invariance of the scale.

Results

The theory-driven six basic emotions bifactor model (comparative fit index [CFI] = 0.968, root mean square of error approximation [RMSEA] = 0.070) and four self-conscious emotions factor model (CFI = 0.973, RMSEA = 0.079) were judged as the best models. They were stable in terms of configural, measurement, and structural invariances across parity.

Conclusion

The SPBE we created is a psychometrically robust measure to assess the primary emotions under the rubric of parent-to-baby emotions. It is a promising tool for measuring parent-to-baby emotions in clinical and research settings.

Suicidal ideation in college students having major depressive disorder: Role of childhood trauma, personality and dysfunctional attitudes

BACKGROUND

Suicide in college students is a major public health concern. Suicidal ideation (SI) is associated with childhood trauma, personality, dysfunctional attitudes and depressive symptoms, but how they interact to predict SI remains unclear.

METHODS

Using cross-sectional design and convenience sampling method, a survey was conducted among 565 college students having major depressive disorder (MDD). The Childhood Trauma Questionnaire, Eysenck Personality Questionnaire, Dysfunctional Attitudes Scale and Hamilton Depression Scale assessed participants' psychosocial factors. Chi-square test, t-test, Pearson correlation, and Structural Equation Model were used in data analysis.

RESULTS

Overall, 66.02% of participants with MDD had SI. Those with SI showed significant differences in physical abuse, emotional abuse, physical neglect, emotional neglect, psychoticism, neuroticism, extroversion, dysfunctional attitudes and depressive symptoms compared with those without SI. Childhood trauma, psychoticism, neuroticism, extroversion and dysfunctional attitudes affected SI through chain mediation. In addition, depressive symptoms, psychoticism, neuroticism and extroversion directly affected SI.

LIMITATIONS

The convenience sampling method may limit the generalizability of the findings. Results may be biased due to the self-report nature of the data collection procedure, the number of research subjects and differences in suicide risk assessment. The cross-sectional study cannot be used to infer causality.

CONCLUSIONS

The factors of childhood trauma, personality and dysfunctional attitudes affect SI through chain mediation. In addition, depressive symptoms and personality independently predict the occurrence of SI.

The psychological factors mediating/moderating the association between childhood adversity and depression: A systematic review

Accumulating evidence suggests that individuals with a history of childhood adversity are at greater risk for developing depression. Potential psychological mechanisms have not been well-established. Our study aims to identify psychological variables consistently mediating/moderating the link between childhood adversity to depression. We systematically searched articles from 1990 to October 2021 on online databases including PubMed, Web of Science and PsycINFO. Studies that examined a mediating/moderating role of psychological variables between childhood adversities and depression were included. Totally, 33 records were included. The review identified maladaptive schema, negative automatic thoughts, and avoidance as mediators of the relationship between childhood adversity and depression. Additionally, resilience was identified as both a mediator and moderator of the association between childhood adversity and depression. In general, cognitive dysfunction, avoidance behaviors and impaired resilience may be a by-product of childhood adversity and may contribute to increased risk for depression. Interventions that target at challenging negative cognition and improving resilience may be effective to prevent or treat depression in individuals with a history of childhood adversity.

Sex and age moderate the trajectory of guilt among children and adolescents with and without recent suicidal ideation

We aimed to examine whether the trajectories of ecologically derived guilt differ among a transdiagnostic sample of youth with and without recent suicidal ideation and whether sex and age moderated this association. We assessed guilt 3 times a day over a 2-week period via ecological momentary assessment (EMA) technology in 102 children recruited from the community, outpatient, and inpatient settings. The average age of children was 10.95 y.o. (SD = 2.26, range 8-16) and the majority were male (54.9%) and White (76.5%). We found that the real-world guilt during a two-week EMA period was higher among youth with greater suicidal ideation severity in the past six months. Moreover, there was a significant moderating effect of sex and age on this association, such that the association between suicidal ideation severity and guilt was particularly strong among females compared to males and youth who were 10 years old or older. The findings were maintained when we adjusted for the relevant demographic and clinical characteristics, including age, minority status, parental income, EMA response rate, and current internalising symptoms. These preliminary findings highlight the clinical relevance of assessing and targeting feelings of guilt in the day-to-day lives of youth, particularly for females and older youth.

Self-Compassion Moderates the Association Between Body Dissatisfaction and Suicidal Ideation in Adolescents: A Cross-Sectional Study

Identifying risk and protective factors for suicidal ideation during adolescence is essential for suicide prevention. One potential risk factor is body dissatisfaction which appears to peak during adolescence. The present study investigated the self-compassion buffering effects in the relationship between body dissatisfaction and suicidal ideation. A convenience sample comprising 580 adolescents (mean age 16.35 years; SD = .87; range 14-18 years) was recruited from public schools. The results indicated a strong positive association between body dissatisfaction and suicidal ideation (Cohen's f 2 = .25). The association was significantly moderated by the self-compassion (β =  - .16, SE = .04, p = .01, t  = 2.4.34, .95% CI [- .16, - .01]). Structural equation modeling analysis showed that the lack of self-kindness was associated with a moderate suicidal ideation level (Cohen's f 2 = .14). Also, higher levels of self-judgment predicted suicidal ideation with a moderate to large effect size (Cohen's f 2 = .28). The findings suggest that therapeutic programs designed to develop self-compassion should be implemented to reduce the risk of suicidal ideation among adolescents with body dissatisfaction. The findings empirically show that a higher degree of self-judgment is strongly associated with suicidal thoughts among adolescents, which must be systematically addressed in clinical studies on suicidal risk.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11469-021-00727-4.

Psychometric Validation of the Persian Self-Compassion Scale Youth Version

Objectives

Empirical research investigating self-compassion is a rapidly developing field, and it is potentially crucial in early adolescence. The primary aim of the present study was to psychometrically evaluate the Persian translation of the Self-Compassion Scale Youth version (SCS-Y) and evaluate its factor structure among young adolescents. The second aim was to explore the buffering effect of self-compassion against the negative effect of difficulties in emotion regulation on COVID-19-related anxiety.

Methods

A sample of young students (n = 532; mean age 13.57 years) completed an online survey, which included the SCS-Y, Patient Health Questionnaire, Difficulties In Emotion Regulation Scale, Coronavirus Anxiety Scale, Youth Life Orientation Test, Brief Resilience Scale, and Brief 10-Item Big Five Inventory. First-order (six-factor) confirmatory factor analysis (CFA) and bi-factor exploratory structural equation modeling (ESEM) analysis were used to evaluate the factor structure of the SCS-Y.

Results

Results showed that the SCS-Y had very good internal consistency (Cronbach's alpha coefficient: 0.88; McDonald's omega coefficient: 0.90), composite reliability (0.87), and adequate test-retest reliability after 4 weeks (0.60). The first-order (six-factor) CFA and bi-factor ESEM analysis demonstrated the SCS-Y had excellent dimensionality. Further analysis found negative associations between self-compassion with both depression and neuroticism, and positive associations between self-compassion with both resilience and optimism. Moreover, self-compassion moderated the association between emotion dysregulation and anxiety generated by the COVID-19. Overall, the findings indicated that the SCS-Y had acceptable criterion-related validity, convergent validity, and discriminant validity.

Conclusions

The findings provide evidence that the SCS-Y is a reliable and valid instrument for assessing the six factors of self-compassion among younger adolescents. Based on the study's findings, self-compassion appears to be a protective factor against mental health problems during the COVID-19 pandemic for younger adolescents.

Shame and guilt in the suicidality related to traumatic events: A systematic literature review

BACKGROUND

Shame and guilt are involved in suicidality and in post-traumatic stress disorder. However, few studies have explored the implication of those emotions in the suicidality of patients exposed to traumatic events.

OBJECTIVE

The objective of this literature review was to examine the implication of shame and guilt in the suicidality of individuals who have experienced potentially traumatic events or been diagnosed with post-traumatic stress disorder. These two emotions are part of post-traumatic stress disorder and suicidality. Moreover, when individuals perceive that their coping strategies are inadequate, they may view suicide as a relief from suffering.

METHOD

This review was conducted according to PRISMA method. We used combinations of search words for traumatization, suicide ideation and behavior and shame and guilt to search for empirical studies in common databases in psychology and medicine.

RESULTS

Among 137 identified articles, 9 full texts were retained. Results suggest that shame and guilt were involved in all aspects of suicidality in patients who had experienced traumatic events or been diagnosed with post-traumatic stress disorder. The degree of shame and guilt differed with the type of traumatic event, notably affecting individuals who had experienced military combat, physical or sexual abuse, or emotional or physical neglect.

CONCLUSION

Shame and guilt are implicated in suicide's risk. Future research is now needed to determine whether greater attention to these two emotions would enhance our understanding and anticipation of suicidal behavior in those who have experienced a potentially traumatic event or been diagnosed with post-traumatic stress disorder.

A pilot spectroscopy study of adversity in adolescents

Background

Childhood adversity is a global health problem affecting 25-50% of children worldwide. Few prior studies have examined the underlying neurochemistry of adversity in adolescents. This cross-sectional study examined spectroscopic markers of trauma in a cohort of adolescents with major depressive disorder (MDD) and healthy controls. We hypothesized that historical adversity would have a negative relationship with spectroscopic measures of glutamate metabolites in anterior cingulate cortex.

Methods

Adolescent participants (aged 13-21) underwent a semi-structured diagnostic interview and clinical assessment, which included the self-report Childhood Trauma Questionnaire (CTQ), a 28-item assessment of childhood adversity. Proton magnetic resonance spectroscopy (1H-MRS) scans at 3 Tesla of an anterior cingulate cortex (ACC) voxel (8 cm3) encompassing both hemispheres were collected using a 2-dimensional J-averaged sequence to assess N-acetylaspartate (NAA), Glx (glutamate+glutamine) and [NAA]/[Glx] concentrations. Generalized linear models assessed the relationships between CTQ scores and metabolite levels in ACC.

Results

Thirty-nine participants (17 healthy controls, 22 depressed participants) underwent 1H-MRS and completed the CTQ measures. There were decrements in [NAA]/[Glx] ratio in the ACC of participants with childhood adversity while no significant relationship between CTQ total score and any of the ACC metabolites was found in the combined sample. Exploratory results revealed a positive association between Glx levels and CTQ scores in depressed participants. Conversely the [NAA]/[Glx] ratio had a negative association with total CTQ scores in the depressed participants. Emotional Abuse Scale showed a significant negative relationship with [NAA]/[Glx] ratio in the combined sample when adjusted for depression severity.

Conclusions

Our findings suggest that childhood adversity may impact brain neurochemical profiles. Further longitudinal studies should examine neurochemical correlates of childhood adversity throughout development and in populations with other psychiatric disorders.

Feasibility of Using Child Maltreatment Measurement Instruments in the Primary Care Setting: A Systematic Review

PROBLEM

Child maltreatment is a devastating epidemic affecting millions of children and adolescents in the United States (U.S.) every year. Primary care providers (PCPs) encounter these victims but need resources to aid in the recognition of maltreatment. The purpose of this review is to evaluate child maltreatment measurement instruments and determine feasibility of use by U.S. PCPs.

ELIGIBILITY CRITERIA

A systematic search was conducted in the PubMed, CINAHL, and PsycInfo databases from 2014 until 2020. Eligibility criteria included articles conducted in the U.S., with use of a child maltreatment measurement instrument, and subjects less than 18 years old. Eligible articles were reference searched to find the original studies for each instrument and were included if they were published in a peer-reviewed paper, could be located, and addressed the development or validation of the instrument.

SAMPLE

Of the 3816 articles, 111 used a child maltreatment measurement instrument. Sixteen of the 27 identified instruments were evaluated for feasibility using a quality rating with criteria including psychometrics, construct measurement, administration, availability, and cost.

RESULTS

Six instruments were recommended for use by PCPs.

CONCLUSIONS

This is the first review evaluating the use of child maltreatment measurement instruments by PCPs and it highlights the combination of psychometric evaluation and other pertinent feasibility criteria to recommend several instruments for use by PCPs.

IMPLICATIONS

Use of these instruments by PCPs may serve to identify children and families who are at risk for or suffering from maltreatment.

Perceived Social Status and Suicidal Ideation in Maltreated Children and Adolescents

Recent decades have seen an alarming increase in rates of suicide among young people, including children and adolescents (“youth”). Although child maltreatment constitutes a well-established risk factor for suicidal ideation in youth, few efforts have focused on identifying factors associated with maltreated youths’ increased risk for suicidal ideation, especially across development. The present study examined the relations between maltreated youths' (N = 279, M = 12.06 years, 52% female, 53% Latinx) perceptions of their social status and suicidal ideation and compared those relations between pre-adolescents and adolescents. Findings revealed unique developmental patterns: Perceived social status was associated with suicidal ideation, but only in adolescents, who showed greater risk for suicidal ideation if they viewed themselves as lower ranked in society and lower risk for suicidal ideation if they viewed themselves as higher ranked in society. Findings have implications for scientific and practical efforts aimed at better understanding and preventing suicide in a high-risk developmental population.

Stressful events and adolescents' suicidal ideation during the COVID-19 epidemic: A moderated mediation model of depression and parental educational involvement

This study examined the association between stressful events and adolescents' suicidal ideation and determined the roles of depression as a mediator and parental educational involvement as a moderator during the COVID-19 epidemic. Survey data from a sample of 1595 Chinese adolescents and their parents were subjected to path analysis. The results indicated that stressful events of the COVID-19 epidemic were significantly positively associated with adolescents' suicidal ideation, and this association was mediated by depression. In addition, adolescents' parental educational involvement significantly moderated the path from depression to suicidal ideation. These results highlight the importance of identifying the underlying key mechanisms that moderate the mediated paths between stressful events and adolescents' suicidal ideation during the COVID-19 epidemic. The findings also provide implications for parents and education staff regarding the importance of improving parental educational involvement to prevent adolescents' suicidal ideation during the COVID-19 epidemic.

Prevalence and Correlates of Mental Health Problems among Chinese Adolescents with Frequent Peer Victimization Experiences

This study investigated the prevalence and correlates of mental health outcomes, particularly depression, anxiety, and insomnia, in adolescents with frequent peer victimization experiences (FPVEs). In this cross-sectional study, 490 adolescents reported having FPVEs (prevalence, 4.2%; mean age, 13.40 ± 1.38 years old; 52.2% male) completed a series of surveys to evaluate their demographic factors and mental health status. The results showed that the prevalence of depression, anxiety, and insomnia were 50.3%, 33.8%, and 40.2%, respectively. Older age, being female, being left behind, and more adverse childhood experiences were correlated with more symptoms of depression, anxiety, and insomnia among adolescents with FPVEs. At the same time, social support and self-compassion were good for ameliorating these mental health problems. Implications for intervention programs designed to improve the mental health of adolescents with FPVEs were also discussed.

Shame, guilt, and suicidal thoughts: The interaction matters

OBJECTIVES

This study examined associations between generalized shame and guilt, and suicidal ideation.

METHODS

Individuals attending outpatient mental health services (N = 100) completed study measures at a single time point. Correlation and regression analyses examined associations between recent suicidal ideation and generalized shame and guilt, both concurrently and interacting, controlling for depressive symptoms and history of previous suicide attempt.

RESULTS

When examined concurrently, guilt - but not shame - remained significantly associated with suicidal ideation, after accounting for effects of depressive symptoms and past suicide attempt. A significant shame × guilt interaction revealed the association between guilt and suicidal ideation intensified with higher shame.

CONCLUSIONS

Findings emphasize consideration of generalized shame and guilt - and their interaction - when working with patients exhibiting suicidal thoughts.

PRACTITIONER POINTS

Shame and guilt are self-conscious emotions that, when generalized and excessive, may confer risk for suicidal ideation Generalized guilt may be uniquely linked with suicidal ideation, yet this association may also amplified by shame Both shame and guilt - and their interaction - are important to consider when working with patients exhibiting suicidal thoughts.

Hypersexuality and Trauma: a mediation and moderation model from psychopathology to problematic sexual behavior

INTRODUCTION

. Hypersexuality is a clinical condition regarding the psychopathology of sexual behavior. In this study, we aimed to investigate the role of trauma, through the post-traumatic stress-disorder (PTSD), depression, shame and guilt on the hypersexual behavior.

METHODS

. Through an online platform, a convenience sample of 1025 subjects was recruited (females: n=731; 71.3%; males: 294; 28.7%; age: 29.62±10.90). Recruited subjects compiled a psychometric protocol composed by the Hypersexual Behavior Inventory (HBI) to assess hypersexuality, the International Trauma Questionnaire (ITQ) for PTSD, the Patient Health Questionnaire (PHQ-9) to evaluate depression and the State Shame and Guilt Scale (SSGS) for shame and guilt. Then a mediation/moderation model was performed for the data analysis.

RESULTS

. There was a statistically significant direct effect of post-traumatic symptoms (ITQTotal) on hypersexual behavior (HBTotal). Furthermore, indirect effects were also statistically significant, providing support to the hypothesis that depression and guilt would be serial mediators of trauma-hypersexual behavior relations. The paths through depression and guilt have been found to be the most significant with moderate and high indirect effects on hypersexuality. Moreover, male gender, as covariate variable, is a relevant risk factor for hypersexual behavior.

CONCLUSION

. We found the relationship between hypersexuality and trauma describing a possible etiological pathway mainly involving depression, shame and guilt. Hypersexuality can be considered as a reactive form of a major affective psychopathology representing a tip of the iceberg hiding the real issues of a suffering personality. Clinicians and researchers should therefore consider hypersexual behavior in the light of a symptomatic manifestation of a major psychopathology involving the affective aspects of personality.

[Assessment of Maltreatment in Childhood and Adolescence]

Assessment of Maltreatment in Childhood and Adolescence In view of mounting evidence for substantial prognostic relevance of child maltreatment for the future developmental course, assessment of maltreatment in children and adolescents is increasingly gaining attention. At the same time, maltreatment assessment is replete with difficulties, ranging from the definition of maltreatment and establishment of threshold values determining when events meet prognostically relevant criteria, to poor agreement between sources. The aim of this paper is to provide an overview of instruments for assessing maltreatment in children and adolescents. This overview serves as a point of departure to emphasize the importance of various sources for the purpose of assessing maltreatment and to consider the unique role of the child's or young person's perspective. We conclude with preliminary proposals regarding the role of maltreatment assessment in clinical practice.

Conceptual Analysis: A Social Neuroscience Approach to Interpersonal Interaction in the Context of Disruption and Disorganization of Attachment (NAMDA)

Humans are strongly dependent upon social resources for allostasis and emotion regulation. This applies especially to early childhood because humans-as an altricial species-have a prolonged period of dependency on support and input from caregivers who typically act as sources of co-regulation. Accordingly, attachment theory proposes that the history and quality of early interactions with primary caregivers shape children's internal working models of attachment. In turn, these attachment models guide behavior, initially with the set goal of maintaining proximity to caregivers but eventually paving the way to more generalized mental representations of self and others. Mounting evidence in non-clinical populations suggests that these mental representations coincide with differential patterns of neural structure, function, and connectivity in a range of brain regions previously associated with emotional and cognitive capacities. What is currently lacking, however, is an evidence-based account of how early adverse attachment-related experiences and/or the emergence of attachment disorganization impact the developing brain. While work on early childhood adversities offers important insights, we propose that how these events become biologically embedded crucially hinges on the context of the child-caregiver attachment relationships in which the events take place. Our selective review distinguishes between direct social neuroscience research on disorganized attachment and indirect maltreatment-related research, converging on aberrant functioning in neurobiological systems subserving aversion, approach, emotion regulation, and mental state processing in the wake of severe attachment disruption. To account for heterogeneity of findings, we propose two distinct neurobiological phenotypes characterized by hyper- and hypo-arousal primarily deriving from the caregiver serving either as a threatening or as an insufficient source of co-regulation, respectively.

A Psychometric Evaluation of the Guilt and Shame Experience Scale (GSES) on a Representative Adolescent Sample: A Low Differentiation between Guilt and Shame

The Guilt and Shame Experience Scale (GSES) is a new, brief self-report instrument for assessing experiences of guilt and shame. It includes two distinct scales: feelings of shame and feelings of guilt. The present report focuses on results from a final validation study using a nationally representative sample of 7899 adolescents (M age = 14.5 ± 1.1 years, 50.7% boys) who participated in the 2014 Health Behavior in School-aged Children study. For factor analysis, the dataset was divided into two groups. One group (n = 3950) was used for the Exploratory Factor Analysis (EFA) and the second (n = 3949) for the Confirmatory Factor Analysis (CFA). The EFA results in a one-factor model of the GSES scale, while the CFA suggests a two-factor solution mirroring two scales, feelings of shame and feelings of guilt. Both models have a good fit to the data, and the scale also showed high internal consistency (Cronbach's alpha = 0.89). A nonparametric comparison of different sociodemographic groups showed a higher disposition for experiencing guilt and shame among girls, students of the ninth grade, and religious respondents. A comparison of the results to previously published results obtained from adults indicates that adolescence is a developmental period involving low differentiation between moral emotions like guilt and shame compared with adulthood. Moreover, positive association with religious attendance shows a need of addressing these issues in a pastoral care setting.