Developmental pathways from child maltreatment to adolescent suicide-related behaviors: The internalizing and externalizing comorbidity hypothesis

Joint developmental trajectories of internalizing and externalizing problems from mid-childhood to late adolescence and childhood risk factors: Findings from a prospective pre-birth cohort

There is limited evidence on heterogenous co-developmental trajectories of internalizing (INT) and externalizing (EXT) problems from childhood to adolescence and predictors of these joint trajectories. We utilized longitudinal data from Raine Study participants (n = 2393) to identify these joint trajectories from 5 to 17 years using parallel-process latent class growth analysis and analyze childhood individual and family risk factors predicting these joint trajectories using multinomial logistic regression. Five trajectory classes were identified: Low-problems (Low-INT/Low-EXT, 29%), Moderate Externalizing (Moderate-EXT/Low-INT, 26.5%), Primary Internalizing (Moderate High-INT/Low-EXT, 17.5%), Co-occurring (High-INT/High-EXT, 17%), High Co-occurring (Very High-EXT/High-INT, 10%). Children classified in Co-occurring and High Co-occurring trajectories (27% of the sample) exhibited clinically meaningful co-occurring problem behaviors and experienced more adverse childhood risk-factors than other three trajectories. Compared with Low-problems: parental marital problems, low family income, and absent father predicted Co-occurring and High Co-occurring trajectories; maternal mental health problems commonly predicted Primary Internalizing, Co-occurring, and High Co-occurring trajectories; male sex and parental tobacco-smoking uniquely predicted High Co-occurring membership; other substance smoking uniquely predicted Co-occurring membership; speech difficulty uniquely predicted Primary Internalizing membership; child's temper-tantrums predicted all four trajectories, with increased odds ratios for High Co-occurring (OR = 8.95) and Co-occurring (OR = 6.07). Finding two co-occurring trajectories emphasizes the importance of early childhood interventions addressing comorbidity.

Childhood maltreatment and internalizing/externalizing disorders in trauma-exposed adolescents: Does posttraumatic stress disorder (PTSD) severity have a mediating role?

Childhood maltreatment is associated with wide-ranging psychopathology at all stages of life. In the current study, we investigated whether posttraumatic stress disorder (PTSD) severity mediated the association between childhood maltreatment and internalizing and externalizing disorders among 262 South African trauma-exposed adolescents (aged 12-18 years). Childhood maltreatment and PTSD symptom severity were assessed using the Childhood Trauma Questionnaire and the Child PTSD Checklist, respectively. Psychiatric disorders were assessed utilizing the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version and were grouped into internalizing or externalizing disorders. Hierarchal logistic regression was used to assess the association of childhood maltreatment subtype with internalizing and externalizing disorders, controlling for age and gender, with PTSD symptom severity added to the final model. We found that sexual abuse was significantly associated with internalizing disorders, although this effect was no longer significant when PTSD was added to the model demonstrating that PTSD mediated the association between sexual abuse and internalizing disorders. Physical abuse, but not PTSD, was associated with externalizing disorders. Physical abuse, emotional neglect, and PTSD were associated with comorbid internalizing and externalizing disorders. These findings have implications for intervention and prevention strategies targeted at trauma-exposed adolescents with a history of childhood maltreatment.

Adolescent and children suicides in Turkey: Analysis of data from the Turkish Statistical Institute (2002-2022)

Suicides in children and adolescents have different characteristics from other age groups because of their unique physical and psychosocial dynamics. Having more information on childhood and adolescent suicides and knowing their characteristics will lead to the development of prevention strategies. This study aimed to evaluate demographic characteristics, suicide methods, and causes of suicides in individuals aged <19 years using 2002 and 2022 data from the Turkish Statistical Institute. Of 1746 suicide cases, 813 (46.6 %) were recorded in male teens and 933 (53.4 %) in female teens aged <15 years. Of 7698 suicide cases, 4041 (52.5 %) were reported in male teens and 3657 (47.5 %) in female teens aged 15-19 years. Family incompatibility was the most common cause of suicides in children and adolescents. The most common suicide method was hanging. Population data show a decreasing trend, particularly in developed and developing countries, among children and adolescents. Therefore, suicide is an important problem in children and adolescents, who constitute a critical dynamic population for the socioeconomic future of societies.

Child maltreatment and suicidal ideation among justice-and welfare-involved adolescents in Nigeria: Investigating the mediating role of social support and emotion regulation

BACKGROUND

Suicidal ideation is a global public health burden and justice and welfare-involved adolescents are more affected than the general population. Past studies have examined its risk and protective factors among adolescents. However, the association between child maltreatment and suicidal ideation remains an under-studied topic among at-risk adolescents in low- and middle-income countries. This study filled this gap by examing the association between child maltreatment and suicidal ideation among two high-risk adolescents in Nigeria METHODS: The purpose of this study was to examine the nexus between child maltreatment and suicidal ideation. A cross-sectional design was adopted through multi-stage sampling. Suicidal ideation was measured using a validated self-report Massachusetts Youth Screening Instrument (MAYSI-2). Child maltreatment was measured using a validated self-report intrusment (ICAST-C). The sample comprised 205 respondents: justice-involved adolescents (102 (49.8 %) and welfare-involved adolescents (103 (50.2 %). Among them, 151 (73.7 %) were males, while 54 (26.3 %) were females.

RESULTS

Half (51 %) of the adolescents in detention and 39 % of the adolescents in residential care reported suicidal ideation. Emotional abuse (OR = 0.072; 95CI% -412, 0.75, p < .001), no parent is alive (OR = 0.502; 95CI% 0.234-3.15; p < .001), one parent is alive (OR = 0.522; 95 %CI 0.207, 3.09; p < .025) and female gender (OR = -0.22; 95CI% -1.37- 207; p < .008) predicted suicidal ideation. Suicidal ideation was comorbid with depressed-anxious symptoms (OR = 1.46; 95 %CI 1.172, 1.83; p < .001) accounting for 31 % (Nagelkerke R2) of the variance. Social support had an indirect effect on suicidal ideation via emotional abuse (OR = 0.072; 95 % CI = -412-0.75).

CONCLUSION

The findings underscore the influence of child maltreatment and family background on suicidal ideation. Interventions should include emotional abuse in suicide screening. Children who have lost one or both parents should be the primary focus of interventions.

Trajectories of maternal parenting stress and adolescent behavioral symptoms in unmarried families: The role of family immigration status

BACKGROUND

Maternal parenting stress during childhood may have important influences on offspring internalizing and externalizing behaviors during adolescence in unmarried households, but it is unclear whether effects differ across different trajectory patterns of maternal parenting stress and for native-born vs. immigrant families.

METHODS

Using data from the Future of Families and Child Wellbeing Study, we identified trajectory patterns of maternal parenting stress from ages 1-9 years using semi-parametric group-based trajectory modeling. We used negative binomial regression models to estimate associations between maternal parenting stress trajectories and adolescent behavioral symptoms at age fifteen.

RESULTS

Five maternal parenting stress trajectory groups were identified among the 1982 unmarried families included in this study, representing consistently low (9.2 %), consistently mild (54.2 %), moderate and decreasing (14.4 %), moderate and increasing (16.0 %) and consistently high (6.2 %) levels of maternal parenting stress. For adolescent internalizing symptoms, all maternal parenting stress trajectory groups exhibited higher symptoms compared to the consistently low group: IRR for consistently mild: 1.21 (95 % CI: 0.98-1.56); IRR for moderate/decreasing: 1.34 (95 % CI: 1.04-1.74); IRR for moderate/increasing: 1.62 (95 % CI: 1.28-2.13); and IRR for consistently high: 1.74 (95 % CI = 1.29-2.41). Similar results were observed for adolescent externalizing symptoms. Stronger effects of maternal parenting stress trajectories on adolescent externalizing symptoms were observed among native-born vs. immigrant families.

LIMITATIONS

Differential attrition and same-source bias may lead to under- or over-estimation of the associations of interest.

CONCLUSIONS

Interventions targeting unmarried families with elevated maternal parenting stress during childhood may reduce behavioral symptoms in adolescence.

Childhood Maltreatment and Adolescent Risky Behavior: Mediating the Effect of Parent-Adolescent Conflict and Violent Tendencies

Childhood maltreatment experiences are an important public health issue associated with a variety of short- and long-term social and psychological outcomes. Despite the negative impact of these experiences, little research has examined the mechanisms underlying the relationship between childhood maltreatment and adolescent risky behavior, which is a critical step in developing intervention services to prevent such behavior during adolescence. The present study aimed to examine the mediating role of parent-adolescent conflict and violent tendency in the relationships between childhood maltreatment and adolescent risky behavior in adolescence. Participants were 303 high school students, 60.1% female (n = 182) and 39.9% (n = 121) male, from four different high schools in Türkiye. It was found that childhood maltreatment was significantly and positively associated with adolescent risky behavior. In addition, that parent-adolescent conflict and violent tendencies mediated the relationship between childhood maltreatment and adolescent risky behavior. And also parent-adolescent conflict mediated the relationship between childhood maltreatment and violent tendencies and adolescent risky behavior. The results of this study suggest that parent-adolescent conflict and violent tendencies are important in increasing the impact of childhood maltreatment on adolescent risky behavior. In order to reduce the impact of maltreated childhood experiences on risky behavior, interventions can be designed to increase positive adolescent-parent relationships and reduce violent tendencies.

Longitudinal trajectories of suicidal ideation among child welfare-involved 7- to 12-year-old children

BACKGROUND

Young children involved in the child welfare system (CWS) are at high risk for suicidal ideation (SI) at a time when overall rates of suicide death in this age group are rising. Yet risk factors for and changes in SI over time are poorly understood in this population.

METHOD

We combined data from two large representative longitudinal studies of children involved in the United States CWS. We examined patterns of SI among children who were between ages 7 and 12 years at the initial survey wave (N = 2,186), assessed at three waves using a measure of SI in the past 2 weeks. We conducted a multinomial regression to understand the baseline demographic, child maltreatment, and mental health characteristics that distinguish the trajectories.

RESULTS

There were eight different subgroups (Non-Ideators, Late Ideators, Boomerang Ideators, Delayed Ideators, Desisters, Boomerang Non-Ideators, Late Desisters, and Persisters). Differences in race, type of maltreatment, sex, and mental health symptoms were identified when comparing Persisters (SI at all three waves) to other groups.

CONCLUSIONS

These findings can help researchers and practitioners to develop strategies for better identifying CWS-involved children who are in greatest need of suicide risk monitoring and intervention.

Long-term impact of the Fostering Healthy Futures for Preteens program on suicide-related thoughts and behaviors for youth in out-of-home care: A randomized controlled trial

Youth in out-of-home care are at high risk for suicide-related thoughts and behaviors (STB), yet there are no known efficacious interventions that reduce STB for this population. Fostering Healthy Futures for Preteens (FHF-P) is a 9-month community-based mentoring and skills training preventive intervention for children in out-of-home care. A randomized controlled trial enrolled 156 participants aged 9-11 years who were placed in out-of-home care over the prior year. Participants were 48.9% female, 54.1% Hispanic, 30.1% Black, and 27.1% American Indian. Follow-up interviews, conducted 7-12 years postintervention (85.2% retention rate), asked young adult participants, aged 18-22, to self-report lifetime STB as indexed by non-suicidal self-injury, suicidal thoughts, plans, and/or attempts. There was a nonsignificant reduction in the odds of STB for the intervention group at follow-up (OR = 0.74; CI, 0.32, 1.69). However, FHF-P significantly moderated the effect of baseline STB; control youth who reported baseline STB had 10 times the odds of young adult STB (OR = 10.44, CI, 2.28, 47.78), but there was no increase in the odds of adult-reported STB for intervention youth. Findings suggest that FHF-P buffers the impact of pre-existing STB on young adult STB for care-experienced youth. Further research is needed to identify mechanisms that may reduce STB in this population.

Profiles of socioemotional functioning in children with and without CPS-subtantiated maltreatment: Associations with child maltreatment and dating violence

OBJECTIVE

Person-centered approaches are essential for characterizing heterogeneity in child development as it relates to child maltreatment (CM) and dating violence. The present study had two aims: 1) identify person-centered patterns of childhood socioemotional functioning, 2) examine whether patterns of child socioemotional functioning mediate the association between CM and dating violence.

PARTICIPANTS AND SETTING

Wave 1 comprised N = 680 children ages 10-12 years with and without experiences of CPS-substantiated CM facing socio-economic challenge. Wave 2 included N = 407 emerging adults ages 18-24 years old.

METHODS

Children participated in a summer camp research program at Wave 1 and a follow up interview at Wave 2. Participant CM history and socioemotional functioning was assessed at Wave 1. Exposure to dating violence was assessed at Wave 2. A latent profile analysis identified patterns of socioemotional functioning. Then regression analyses examined associations of socioemotional functioning with CM and dating violence.

RESULTS

Three profiles of child socioemotional functioning were identified (well-regulated/low distress, high externalizing/high aggression, high internalizing). CM was significantly associated with membership in the high externalizing/high aggression class. Patterns of child socioemotional functioning did not mediate the association between CM and dating violence, although number of subtypes of CM had a significant positive direct effect on dating violence.

CONCLUSIONS

Results underscore the multidimensional nature of socioemotional functioning and the predictive power of number of subtypes of CM on dating violence. Results can be harnessed by clinicians and policy makers to identify those at risk and interrupt cycles of violence.

Association between negative life events and suicidal behavior in adolescents: roles of core self-evaluation, depression and gender

PURPOSE

Negative life events are essential proximal factors that may induce suicidal behavior in adolescents, but the mechanisms connecting this link remain to further explored. The present study aimed to investigate the relationship between negative life events (NLEs) and adolescents' suicidal behavior, and the roles of core self-evaluation, depression and gender playing between them.

METHODS

Using the whole-group sampling approach, 5296 Chinese adolescents (51.5% males, Meanage = 12.93) took part in this cross-sectional study in September 2021 and completed a battery of surveys including NLEs, suicidal behavior, CSE (core self-evaluation) and depression. Logistic regression and latent structural equation models were used to test the direct and indirect effects between NLEs and suicide behavior with multi-group path analysis, gender differences in this serial mediating effect were also tested.

RESULTS

After controlling for age and gender, NLEs were directly associated with adolescents' suicidal behavior. CSE and depression played significant serial mediating effects in this relationship. Moreover, significant gender differences were obtained in these serial mediating pathways, with stronger effects in girls.

CONCLUSION

Integrating the environmental, individual cognitive and emotional factors, our findings would be helpful in understanding the mechanism of these antecedents on adolescents' suicide behavior, which has specific practical significance for preventing and reducing suicidal behavior.

Quantifying the Importance of Non-Suicidal Self-Injury Characteristics in Predicting Different Clinical Outcomes: Using Random Forest Model

Existing research on non-suicidal self-injury (NSSI) among adolescents has primarily concentrated on general risk factors, leaving a significant gap in understanding the specific NSSI characteristics that predict diverse psychopathological outcomes. This study aims to address this gap by using Random Forests to discern the significant predictors of different clinical outcomes. The study tracked 348 adolescents (64.7% girls; mean age = 13.31, SD = 0.91) over 6 months. Initially, 46 characteristics of NSSI were evaluated for their potential to predict the repetition of NSSI, as well as depression, anxiety, and suicidal risks at a follow-up (T2). The findings revealed distinct predictors for each psychopathology. Specifically, psychological pain was identified as a significant predictor for depression, anxiety, and suicidal risks, while the perceived effectiveness of NSSI was crucial in forecasting its repetition. These findings imply that it is feasible to identify high-risk individuals by assessing key NSSI characteristics, and also highlight the importance of considering diverse NSSI characteristics when working with self-injurers.

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.

Bisphenol AF exposure synergistically increases the risk for suicidality among early adolescents with child maltreatment: A prospective cohort study

BACKGROUND

Child maltreatment (CM) is correlated with suicidality risk among adolescents. Additionally, exposure to bisphenol AF (BPAF) may increase this risk. However, the combined effect of CM and BPAF exposure remains unknown and should be further investigated.

METHODS

In this study, 1,475 early adolescents (mean age = 12.48 years) from the Chinese Early Adolescents Cohort were enrolled. Data were collected at three time points with an interval of 12 months between 2019 and 2021. Participants' history of CM and suicidality (including suicidal ideation and suicidal attempts) were evaluated using a self-report questionnaire. Blood samples were obtained from participants to measure serum BPAF concentrations at baseline. Group-based trajectory modeling was employed to identify different developmental trajectories of suicidality across the three waves. After adjusting for potential confounders, the association between CM and BPAF exposure on suicidal ideation and suicidal attempts was assessed using logistic regression and Poisson regression analyses.

RESULTS

Participants with CM were associated with a risk of one- and two-year incident suicidality (all ps < 0.05), and BPAF levels were positively associated with two-year incident suicidal ideation (adjusted OR = 1.68, 95% CI: 1.13-2.50). Additionally, middle and high levels of BPAF exposure synergistically increase the risk for one- and two-year incident suicidal ideation among participants with CM (adjusted ORs = 2.00-3.83). Similarly, participants exposed to high-level BPAF as well as CM were at a greater risk of one- and two-year incident suicidal attempts than those with low-level BPAF exposure and no CM (adjusted incidence rate ratio [IRRs] = 2.82-4.34). Moreover, compared with participants with a low developmental trajectory of suicidality across the three waves, high BPAF exposure exhibited a significant synergistic effect on participants with CM in the persistently high suicidal ideation trajectory and the increasing suicidal attempts trajectory (all ps < 0.05). Sex subgroup analysis revealed that females were more susceptible to the synergistic effect of BPAF and CM exposure on suicidality than males.

CONCLUSIONS

Environmental factors and the psychological status of individuals may synergistically increase their susceptibility to suicidality. These results offer novel insights into enhancing our understanding of suicidality among adolescents.

Prediction of suicidal ideation among preadolescent children with machine learning models: A longitudinal study

BACKGROUND

Machine learning (ML) has been widely used to predict suicidal ideation (SI) in adolescents and adults. Nevertheless, studies of accurate and efficient models of SI prediction with preadolescent children are still needed because SI is surprisingly prevalent during the transition into adolescence. This study aimed to explore the potential of ML models to predict SI among preadolescent children.

METHODS

A total of 4691 Chinese children (54.89 % boys, Mage = 10.92 at baseline) and their parents completed relevant measures at baseline and the children provided 6-month follow-up data for SI. The current study compared four ML models: Random Forest (RF), Decision Tree (DT), Support Vector Machine (SVM), and Multilayer Perceptron (MLP), to predict SI and to identify variables with predictive value based on the best-performing model among Chinese preadolescent children.

RESULTS

The RF model achieved the highest discriminant performance with an AUC of 0.92, accuracy of 0.93 (balanced accuracy = 0.88). The factors of internalizing problems, externalizing problems, neuroticism, childhood maltreatment, and subjective well-being in school demonstrated the highest values in predicting SI.

CONCLUSION

The findings of this study suggested that ML models based on the observation and assessment of children's general characteristics and experiences in everyday life can serve as convenient screening and evaluation tools for suicide risk assessment among Chinese preadolescent children. The findings also provide insights for early intervention.

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.

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.

Alexithymia as a mediator of the associations between child maltreatment and internalizing and externalizing behaviors in adolescence

Child maltreatment is a global concern that profoundly affects individuals throughout their lives. This study investigated the relationships between various forms of child maltreatment and behavior problems involving internalization and externalization during adolescence. Data obtained from a diverse sample of 1802 Canadians aged 14-18 years was used to examine the mediating role of alexithymia-a difficulty in recognizing and expressing emotions-in these associations. Results indicated that adolescents who experienced sexual abuse, emotional abuse, and exposure to intimate partner violence (IPV) in their childhood exhibited higher levels of alexithymia, which was correlated with elevated levels of both internalizing and externalizing problems. Physical abuse and parental neglect were only associated with externalizing problems. Gender differences also emerged, with gender-diverse adolescents reporting a higher prevalence of maltreatment, alexithymia, and behavior problems compared with their peers. However, alexithymia's mediating role was consistent across genders. Overall, this study highlights the intricate relationships between child maltreatment, alexithymia, and adolescent behavior problems. The findings of this study how different forms of child maltreatment significantly shape behavioral outcomes and indicate the importance of interventions in enhancing emotional awareness and expression in adolescents with a childhood history of maltreatment.

Uncovering the symptom relationship between anxiety, depression, and internet addiction among left-behind children: A large-scale purposive sampling network analysis

Facing long-term separation from their parents, left-behind children are at risk of the co-occurrence of internalizing and externalizing problems. Although previous research has gained substantial information examining the relationship between anxiety, depression, and internet addiction at the aggregate level of variables, little is known about the heterogeneity and interactions between these components at the symptom level with a large-scale purposive sample. Adopting the network approach, two network pathways, depression and anxiety, and associations between these variables and internet addiction were constructed. Our sample included 5367 left-behind children (Mage = 13.57; SDage = 1.37; 50.07% females). Relevant bridging, central symptoms, and network stability were identified. Two relatively stable networks were obtained. For the network of anxiety and depression, sleep problems and tachycardia were vital bridging symptoms. Central symptoms, including tachycardia, restlessness, fatigue, and emptiness, were symptoms of depression. For the network of symptoms of anxiety, depression, and internet addiction, the bridging symptoms remained the same, and the central symptoms included tachycardia, restlessness, loss of control, and emptiness. By identifying relevant bridging and central symptoms, those with higher levels of these symptoms could be regarded as intervention targets, providing a reference for the current issue of valuing diagnosis over prevention in left-behind children.

Hot and cool executive function in the development of behavioral problems in grade school

Despite the well-established link between children's executive function and behavioral adjustment, it remains unclear whether the hot and cool aspects of executive function are uniquely associated with children's behavioral problems. Using longitudinal data spanning in the grade school (N = 1,140), this study aimed to examine whether hot and cool executive function skills may be uniquely related to the development of behavioral problems. Hot and cool executive function skills were measured with tasks, standardized tests, and questionnaires at 54 months and in the first grade, respectively. Internalizing and externalizing problems were evaluated by teachers using questionnaires throughout the grade school. The results indicated that, independent of each other, hot and cool executive function skills were uniquely and negatively related to the development of internalizing and externalizing problems over time at the between-individual level, adjusting for within-individual fluctuations. Moreover, internalizing and externalizing problems were positively related at the between-individual level across the grade school. Findings provide needed evidence to clarify the relations between hot and cool executive function and children's behavioral problems, emphasizing the importance of both aspects of executive function in understanding the development of behavioral problems in school-age children.

Longitudinal relationship between child maltreatment, bullying victimization, depression, and nonsuicidal self-injury among left-behind children in China: 2-year follow-up

BACKGROUND

Left-behind childre (LBC) in China are deeply concerned by society because of their high risk of emotional and behavioral problems. Depression and nonsuicidal self-injury are the most harmful and worrying negative emotional and behavioral problems in LBC. Unfortunately, LBCs are in unfavorable environments for a long time and are prone to negative interpersonal interactions. Child maltreatment and bullying victimization, as the two most typical negative interpersonal interactions in family and school environments, maybe the key risk factors for depression and nonsuicidal self-injury among LBCs. However, we are less known of the longitudinal effects of child maltreatment and bullying victimization on LBC's depression and nonsuicidal self-injury and their underlying mechanisms.

AIMS

This study used a two-year longitudinal design with three-time points to investigate the longitudinal effects of child maltreatment and bullying victimization on depression, nonsuicidal self-injury, and the mediating role of negative thoughts and self-compassion.

MATERIALS & METHODS

A sample of 592 LBC (390 were males, Mage at time 1 = 9.56, SDage = 0.65; 202 were females, Mage at time 1 = 9.43, SDage = 0.63) completed a set of questionnaires at three-time points. This study used SPSS software (version 25.0) and MPLUS software (version 8.3) for all analyses.

RESULTS

(1) Child maltreatment not only affects depression and nonsuicidal self-injury but also affects depression and nonsuicidal self-injury through negative thoughts. Child maltreatment affects depression through self-compassion and does not affect nonsuicidal self-injury. (2) Bullying victimization affects depression and nonsuicidal self-injury through negative thoughts and bullying victimization further affects depression through self-compassion but does not affect nonsuicidal self-injury.

CONCLUSION

This study revealed the effects of negative interpersonal interactions (child maltreatment, bullying victimization) on LBC's adverse emotions and behaviors, and their underlying mechanisms, which helps to provide parents, schools, and psychoeducational workers with a new perspective on intervention.

Personality Pathology and Suicide Risk: Examining the Relationship Between DSM-5 Alternative Model Traits and Suicidal Ideation and Behavior in College-Aged Individuals

BACKGROUND

This study examines the link between personality pathology and suicide risk regarding the DSM-5 alternative model of personality disorders.

METHOD

The study investigates the facets, domains, internalizing, and externalizing of personality pathology and their correlation and predictive significance for suicidal ideation and behavior. This study examined a diverse and balanced sample of 1,398 college students aged between 18- and 29-year-olds from nine colleges in Kafrelshiekh University, with nearly equal representation of both genders (687 males, 711 females), a mix of rural and urban residents (807 rural, 591 urban), and a wide range of socioeconomic backgrounds (15 very low SES, 84 low SES, 878 moderate SES, 364 high SES, and 57 very high SES). The Personality Inventory for the DSM-5 (PID-5) was utilized to assess personality pathology. Columbia-Suicide Severity Rating Scale (C-SSRS) was used to evaluate suicidal ideation and behavior.

RESULTS AND DISCUSSION

Logistic regression reveals significant associations between personality traits and suicidal ideation (e.g., Anhedonia, Suspiciousness) and behavior (e.g., Risk Taking, Depressivity). Negative Affect and Detachment are significantly linked to suicidal ideation, while Detachment, Disinhibition, and Psychoticism are linked to suicidal behavior. Internalizing personality pathology predicts both ideation and behavior, indicating a contribution to suicidal thoughts and self-destructive acts. Externalizing is a significant predictor of suicidal behavior.

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.

The Timing Effect of Childhood Maltreatment in Depression: A Systematic Review and meta-Analysis

Although empirical evidence has confirmed the causal relationship between childhood maltreatment and depression, findings are inconsistent on the magnitude of the effect of age of exposure to childhood maltreatment on psychological development. This systematic review with meta-analysis aims to comprehensively synthesize the literature on the relationship between exposure age of maltreatment and depression and to quantitatively compare the magnitude of effect sizes across exposure age groups. Electronic databases and grey literature up to April 6th, 2022, were searched for English-language studies. Studies were included if they: 1) provided the information on exposure age; and 2) provided statistical indicators to examine the relationship between childhood maltreatment and depression. Fifty-eight articles met eligibility criteria and were included in meta-analyses. Subgroup analyses were conducted based on subtypes of maltreatment and measurements of depression. Any kind of maltreatment (correlation coefficient [r] = 0.17, 95% CI = 0.15-0.18), physical abuse (r =0.13, 95% CI = 0.10-0.15), sexual abuse (r = 0.18, 95% CI = 0.15-0.21), emotional abuse (r = 0.17, 95% CI=0.11-0.23), and neglect (r = 0.08, 95% CI=0.06-0.11) were associated with an increased risk of depression. Significant differential effects of maltreatment in depression were found across age groups of exposure to maltreatment (Q = 34.81, p < 0.001). Age of exposure in middle childhood (6-13 years) had the highest risk of depression, followed by late childhood (12-19 years) and early childhood (0-6 years). Implications of the findings provide robust evidence to support targeting victimized children of all ages and paying closer attention to those in middle childhood to effectively reduce the risk of depression.

Prevalence and associated factors of internet addiction among Chinese adolescents: association with childhood trauma

Introduction

Internet addiction (IA) is common among adolescents and may have severe consequences. This study aimed to investigate the prevalence and factors associated with IA among middle school students of Hunan Province, China. Relevance between IA and childhood trauma was also explored.

Methods

One thousand six hundred ten students were enrolled in this cross-sectional study. Data collected included demographics; internet addiction (revised-Chen internet addiction scale); childhood trauma (CTQ-SF); depression, anxiety, and stress symptoms (DASS-21); suicidal behaviors, as well as non-suicidal self-injury (NSSI). Cramer's V analysis, univariable logistic regression and multivariable logistic regression were used for associations and identifying independent relevance of IA, respectively.

Results

The prevalence of IA was 12.8%. Cramer's V analysis showed that IA was associated with emotional abuse, emotional and physical neglect, NSSI, suicidal behaviors, stress, anxiety and depressive symptoms, physical disorder history. Regression analysis showed that IA was independently associated with emotional neglect (OR = 3.062, 95% CI: 2.083, 4.501, p < 0.001); physical neglect (OR = 2.328; 95% CI: 1.590, 3.409, p < 0.001); depressive symptoms (OR = 2.218, 95% CI: 1.467, 3.353, p < 0.001) nationality (OR = 1.888, 95% CI: 1.034, 3.447, p = 0.006) and age (OR = 1.253, 95% CI: 1.066, 1.471, p = 0.006).

Discussion

IA is common among middle school students. Attention should be paid to students with childhood trauma since they have a higher risk for IA, which may increase the risk for suicidal behaviors.

Gender-specific co-developmental trajectories of internalizing and externalizing problems from middle childhood to early adolescence: Environmental and individual predictors

This study aimed to identify gender-specific co-developmental trajectories of internalizing and externalizing problems from middle childhood to early adolescence, along with key environmental and individual predictors among Chinese youth. A total of 1653 Chinese elementary school students (M age = 9.40; SD = 0.51; 54.57% boys) participated in assessments at six time points, using 6-month assessment intervals. Parallel process latent class growth modeling identified four trajectories for boys: Congruent-low (65.74%), moderate-decreasing internalizing and moderate-stable externalizing problems (18.40%), high increasing-internalizing and low-stable externalizing problems (8.20%), and high decreasing-internalizing and low-stable externalizing problems (7.65%). Three trajectories were identified for girls: Congruent-low (81.09%), moderate co-occurring (7.19%), and high increasing-internalizing and low-stable externalizing problems (11.72%). Multivariate logistic regression analyses revealed that peer victimization served as an environmental risk predictor for the adverse co-developmental trajectories of internalizing and externalizing problems for boys and girls. High sensation-seeking and low self-control served as individual risk variables predicting the trajectories of high increasing-internalizing and low-stable externalizing problems, and low self-control also predicted the trajectories of high decreasing-internalizing and low-stable externalizing problems for boys. The findings highlight the importance of gender differences in understanding the progression of internalizing and externalizing problems and inform effective strategies for prevention and intervention.

Distinct brain network features predict internalizing and externalizing traits in children and adults

Internalizing and externalizing traits are two distinct classes of behaviors in psychiatry. However, whether shared or unique brain network features predict internalizing and externalizing behaviors in children and adults remain poorly understood. Using a sample of 2262 children from the Adolescent Brain Cognitive Development (ABCD) study and 752 adults from the Human Connectome Project (HCP), we show that network features predicting internalizing and externalizing behavior are, at least in part, dissociable in children, but not in adults. In ABCD children, traits within internalizing and externalizing behavioral categories are predicted by more similar network features concatenated across task and resting states than those between different categories. We did not observe this pattern in HCP adults. Distinct network features predict internalizing and externalizing behaviors in ABCD children and HCP adults. These data reveal shared and unique brain network features accounting for individual variation within broad internalizing and externalizing categories across developmental stages.

Co-Developmental Trajectories of Parental Psychological Distress and Child Internalizing and Externalizing Problems in Childhood and Adolescence: Associations with Self-Harm and Suicide Attempts

Growing evidence has suggested that parental mental illness and child internalizing and externalizing problems tend to co-occur and engender risk for adverse child outcomes; however, there is considerable heterogeneity in their joint developmental trajectories. This study aimed to evaluate the joint developmental trajectories of maternal and paternal psychological distress and child internalizing and externalizing problems from early childhood to middle adolescence. Given that suicide and self-harm are major public health issues in adolescence and often occur in the context of other mental health issues, we also examined the association between these joint trajectories and these outcomes in adolescence. Parallel-process latent class growth analysis was applied to 14 years of follow-up data from a large-scale, nationally representative sample of youths participating in the UK's Millennium Cohort Study (MCS; n = 12,520, 50.9% male). Results showed the best-fitting solution had four trajectory classes: (1) low symptoms, 59.0%; (2) moderate symptoms in children, 22.5%; (3) notable symptoms in fathers, 10.7%; and (4) co-occurring maternal and child symptoms, 7.8%. The trajectory groups differed in their self-harm and suicide attempts in adolescence, underscoring the possible importance of the roles of both parental distress and child problem behaviors processes in these outcomes. Future studies will be valuable to rigorously test the directionality and the respective roles of parents and children in this association. Our findings suggest the need for two-generation mental health intervention programs that are tailored based on co-developmental trajectory group membership.

Suicide attempts due to child abuse: A perspective into the Nepalese legal framework and societal norms

Children who experience violence are more prone to develop high-risk behaviour, mental illness and anxiety disorder. Nepalese law is against any form of physical violence but corporal punishment by parents on children continues in patriarchal Nepalese society. We describe a case of a young boy who attempted suicide twice due to maltreatment and discuss the legal and social issues involved.

Circumstances Contributing to Suicide Among U.S. Adolescents Aged 10-19 Years With and Without a Known Mental Health Condition: National Violent Death Reporting System, 2013-2018

PURPOSE

Suicide is the second leading cause of death for adolescents in the United States; however, suicide is preventable and a better understanding of circumstances that contribute to death can inform prevention efforts. While the association between adolescent suicide and mental health is well established, multiple circumstances contribute to suicide risk. This study examines characteristics of adolescents who died by suicide and differences in circumstances between those with and without known mental health conditions at the time of death.

METHODS

Logistic regression models were used to estimate adjusted odds ratios and 95% confidence intervals of circumstances contributing to suicide between decedents with and without known mental health conditions using data from the 2013 to 2018 National Violent Death Reporting System (analyzed in 2021).

RESULTS

Decedents with a known mental health condition were 1.2-1.8 times more likely to experience problematic alcohol misuse, substance misuse, family and other nonintimate relationship problems, and school problems; however, there were no significant differences between those with and without a known mental health condition for the preceding circumstances of arguments or conflicts, criminal or legal problems, or any crisis occurring within the two weeks prior to death.

DISCUSSION

A comprehensive suicide prevention approach can address not only mental health conditions as a risk factor but also life stressors and other crises experienced among adolescents without known mental health conditions.

Child maltreatment, parent-child relationship quality, and parental monitoring in relation to adolescent behavior problems: Disaggregating between and within person effects

BACKGROUND

Parent-child relationship quality (PCRQ) and parental monitoring (PM) are associated with adolescent behavior problems following child maltreatment (CM). Whether these associations are best characterized as between (trait) or within-person (state) differences is unknown.

OBJECTIVE

Disaggregate between and within-person effects for PCRQ and PM on adolescent behavior problems and test whether these effects vary as a function of prior CM.

PARTICIPANTS AND SETTING

Participants (n = 941) are from the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN).

METHODS

Multi-level modeling was employed using PCRQ, PM, and adolescent behaviors assessed at ages 12, 14, and 16 and confirmed CM prior to age 12.

RESULTS

At the between-person level, adolescents with higher average levels of PCRQ and PM had significantly lower initial levels of externalizing (b = -9.47 and -5.54, respectively, p's < 0.05; possible range 0-66) and internalizing behaviors (b = -4.45 and -6.41, respectively, p's < 0.001; possible range 0-62). At the within-person level, greater declines in externalizing and internalizing behaviors were found when individuals reported higher-than-usual levels of PCRQ (b = -4.99 and -2.59, respectively, for externalizing and internalizing, p's < 0.001) and PM (b = -3.58 and -1.69, respectively, for externalizing and internalizing, p's < 0.001). There was an interaction between PM and CM on internalizing behaviors over time (b = -1.15, p = 0.026).

CONCLUSIONS

There are between and within-person effects of PCRQ and PM on adolescent behavior problems. Adolescents with CM histories and low levels of PM may be at risk for sustained internalizing behaviors.

A Longitudinal Examination of Child Maltreatment Dimensions, Emotion Regulation, and Comorbid Psychopathology

Childhood maltreatment is a toxic stressor that occurs in the family context and is related to adverse outcomes including elevations in internalizing symptomology and externalizing symptomology. In the present study, we tested the role of threat and deprivation dimensions of child maltreatment in the etiology of comorbid psychopathology in emerging adulthood. Additionally, we investigated emotion regulation and emotion lability/negativity as mechanisms underlying the relationship between child maltreatment dimensions and emerging adult psychopathology. To address these aims, we used a longitudinal sample of emerging adults (N = 413, Mage = 19.67, 78.0% Black, 51.1% female) who had previously participated in research assessments at age 10-12. Using a person-centered approach with latent profile analysis, we identified three classes of emerging adulthood psychopathology characterized by different levels of symptom severity and comorbidity between internalizing and externalizing symptoms. Emerging adults who experienced deprivation only, compared to those who were not maltreated, were more likely to belong to a comorbid and severe psychopathology class versus the other identified psychopathology classes. There was also a significant indirect pathway from experiences of both threat and deprivation to a high externalizing class via emotion lability/negativity. Our results contribute to current models of childhood adversity and psychopathology and have implications for interventions to prevent psychopathology among emerging adults exposed to child maltreatment.

Bullying Victimization, Future Orientation, and Suicidal Ideation of African American Youth in an Under-Resourced Community: A Moderated-Mediation Approach

African American youth living in low-resourced communities are at high risk for bullying victimization which is positively associated with suicidal ideation. This study explored whether positive future orientation mediated the relationship between bullying victimization and suicidal ideation. This study engaged 627 African American adolescents and measured bullying victimization, internalizing problems, suicidal ideation, future orientation, and several covariates. Major findings indicated that controlling for gender, socioeconomic status, school motivation, and perceived teacher support, internalizing problems mediated the relationship between bullying victimization and suicidal ideation. Furthermore, both the effect of bullying victimization on suicidal ideation and the mediating effect of internalizing problems were moderated by future orientation. The effects were weakened when the level of future orientation increased. The implications for future research and supporting resiliency are discussed based on these findings.

Dimensions of childhood maltreatment and adult risky behaviors: Differential affective and inhibitory control mechanisms

BACKGROUND

While childhood maltreatment has been identified as a robust risk factor for a myriad of poor outcomes, significant gaps in our understanding still remain regarding mechanisms of this risk transmission across the lifespan.

OBJECTIVE

Informed by recent dimensional models, the objective of this study was to examine how unique dimensions of childhood maltreatment relate to adult risky behaviors via interactions between cognitive control and affective processes across Positive and Negative Valence Systems.

PARTICIPANTS AND SETTING

Our sample consisted of 110 community adults (M/SD_age = 31.92/10.58 years old, 52.7 % male).

METHODS

Participants completed a neuropsychological test of inhibitory control and self-report measures of childhood maltreatment, recent adult risky behaviors, and indices of affective processing.

RESULTS

Moderated-mediation analyses revealed that childhood experiences of neglect and abuse exhibited distinct mechanisms of risk transmission related to adult risky behaviors. Specifically, disruptions in inhibitory control and reward-related processes were linked to adult risky behavior in the context of Childhood Deprivation (95%CI = -0.166/-0.002), whereas negative affective processes were associated with adult risky behavior in the context of Childhood Threat (95 % CI = 0.015/0.157).

CONCLUSIONS

Findings provide empirical support for novel dimensional theories of childhood maltreatment and suggest that distinct regulatory processes are impacted by these early life experiences, which may confer risk into adulthood.

The relationship between abuse and neglect and adolescent suicidality: A moderated mediation model

Abuse and neglect can lead to suicide in adolescents; however, the internal mechanisms between abuse and neglect and suicidality remain unclear. We hypothesized that abuse and neglect could affect adolescent suicidality, and that mediating and moderating mechanisms exist between these two variables. We tested the mediating effects of stressful life events (misunderstanding and discrimination by others, poor academic performance, failed exams, interpersonal problems, and school punishment) on suicidal tendencies and moderating effects of resilience among 5,852 adolescents from 37 middle schools in five provinces of North, south, East, west, and central China. We used a questionnaire to collect data and adopted structural equation modeling to verify the correlation, mediating, and moderating effects among the variables. The results showed that stressful life events mediated the relationship between abuse, neglect, and suicide. Furthermore, resilience moderated the direct effect and second half of the mediating effect.

Co-occurrence, stability and manifestation of child and adolescent mental health problems: a latent transition analysis

Background

Complex constellations of socio-emotional and behavioural problems (i.e., mental health problems) in childhood and adolescence are common and heighten the risk for subsequent personality, anxiety and mood disorders in adulthood. Aims of this study included the examination of patterns of mental health problems (e.g., externalizing-internalizing co-occurrence) and their transitions to reported mental disorders by using a longitudinal person-centered approach (latent class and latent transition analysis).

Methods

The sample consisted of 1255 children and adolescents (51.7% female, mean age = 12.3 years, age range 8–26 years) from three time points of the comprehensive mental health and wellbeing BELLA study. Children and their parents completed the German SDQ (Strength and Difficulties Questionnaire, Goodman, 1997) and reported on diagnoses of ADHD, depression, and anxiety.

Results

Latent class analysis identified a normative class, an emotional problem class, and a multiple problem class. According to latent transition analysis, the majority of the sample (91.6%) did not change latent class membership over time; 14.7% of individuals showed a persistent pattern of mental health problems. Diagnoses of mental disorders were more likely to be reported by individuals in the emotional problem or multiple problem class.

Conclusions

Results highlight the need for early prevention of mental health problems to avoid accumulation and manifestation in the transition to adolescence and young adulthood.

The Interaction Effects Between Father-Child Relationship Quality and Parent-perpetrated Maltreatment on Adolescent Behavior Problems

Despite ample evidence supporting the positive and important role fathers play in youth well-being, currently little is known about the potential buffering effects of positive father-child relationships on adolescent behavioral functioning, especially within the context of child maltreatment. Clarifying whether positive parent-child relationships are helpful in the presence of maltreatment perpetrated by the same or another parent is critical for designing and implementing successful family-based interventions for positive youth development. Thus, the present study aimed to investigate the unique and combined effects of the perpetrator of child maltreatment (i.e., maltreatment perpetrated by fathers versus mothers alone) and father-child relationship quality on adolescent internalizing and externalizing problems. A series of Ordinary Least Squares multiple regressions were conducted on a sample of 14-year-old high-risk youth (N = 661) drawn from the Longitudinal Studies of Child Abuse and Neglect. The results indicated that both father-perpetrated maltreatment and mother-alone maltreatment were associated with higher levels of internalizing and externalizing problems. Higher quality of father-child relationships was associated with lower levels of internalizing but was not significantly associated with externalizing problems. Higher quality father-child relationships had a buffering impact against adolescent internalizing and externalizing problems when adolescents were maltreated by mothers alone. The findings suggest that policy and practical efforts seeking to build resilience of youth should strive to nurture and leverage positive, non-maltreating father-child relationships. Such efforts may support the positive development of adolescents, even in the face of mother-perpetrated maltreatment.

The joint development of externalizing and internalizing behaviors in black and Hispanic youth and the link to late adolescent substance use

There is a need to understand how the joint development of externalizing and internalizing behaviors is related to substance use, particularly among historically understudied and often disadvantaged populations. Latent class models were used to estimate patterns of externalizing behaviors and internalizing behaviors in the form of depressive and anxious symptoms from age 6 to 14 among 390 Black and Hispanic youth. Then, growth curve models of substance use between the ages of 15 and 19 were estimated as a function of joint latent class membership. Only elevated levels of externalizing behaviors were associated with higher levels of substance use through age 18. Internalizing behaviors appeared to serve as a protective factor among those with moderate displays of externalizing behavior only. Additionally, growth in substance use from ages 15 to 19 was slower among those who displayed the highest level of externalizing behaviors, and internalizing behaviors appeared to moderate growth (and serve as protective factor) among those who displayed moderate levels of externalizing behaviors. The findings underscore the importance of pattern profiles based on observations of the joint development of problem behaviors to assess risk for substance use, particularly in understudied populations where risk/protective factors may operate in a unique manner.

Correlates and predictors of the severity of suicidal ideation in adolescence: an examination of brain connectomics and psychosocial characteristics

BACKGROUND

Suicidal ideation (SI) typically emerges during adolescence but is challenging to predict. Given the potentially lethal consequences of SI, it is important to identify neurobiological and psychosocial variables explaining the severity of SI in adolescents.

METHODS

In 106 participants (59 female) recruited from the community, we assessed psychosocial characteristics and obtained resting-state fMRI data in early adolescence (baseline: aged 9-13 years). Across 250 brain regions, we assessed local graph theory-based properties of interconnectedness: local efficiency, eigenvector centrality, nodal degree, within-module z-score, and participation coefficient. Four years later (follow-up: ages 13-19 years), participants self-reported their SI severity. We used least absolute shrinkage and selection operator (LASSO) regressions to identify a linear combination of psychosocial and brain-based variables that best explain the severity of SI symptoms at follow-up. Nested-cross-validation yielded model performance statistics for all LASSO models.

RESULTS

A combination of psychosocial and brain-based variables explained subsequent severity of SI (R2  = .55); the strongest was internalizing and externalizing symptom severity at follow-up. Follow-up LASSO regressions of psychosocial-only and brain-based-only variables indicated that psychosocial-only variables explained 55% of the variance in SI severity; in contrast, brain-based-only variables performed worse than the null model.

CONCLUSIONS

A linear combination of baseline and follow-up psychosocial variables best explained the severity of SI. Follow-up analyses indicated that graph theory resting-state metrics did not increase the prediction of the severity of SI in adolescents. Attending to internalizing and externalizing symptoms is important in early adolescence; resting-state connectivity properties other than local graph theory metrics might yield a stronger prediction of the severity of SI.

Internalizing and Externalizing Symptoms in Adolescents With and Without Experiences of Physical Parental Violence, a Latent Profile Analysis on Violence Resilience

Questionnaire data from a cross-sectional study on social resilience in adolescence, with a sample of N = 1,974 Swiss seventh grade high school students ages 12-14 (M = 11.76; SD = 0.65) was used to identify and compare violence resilience profiles. Person-centered latent profile analysis (LPA) was applied and allowed for the grouping of adolescents into profiles of internalizing (depression/anxiety, dissociation) and externalizing symptoms (peer aggression, peer victimization, classroom disruption) and differentiation of adolescents with (n = 403) and without (n = 1,571) physical parental violence experiences. Subsequently, a multinomial logistic regression analysis was conducted to further investigate the sociodemographic predictors of violence resilience profiles. With LPA, we identified four distinct profiles for both adolescent groups (with and without parental physical violence experiences). The results showed three particularly burdened profiles of adolescents, one with higher externalizing and one with higher internalizing symptoms, which did not occur simultaneously to the same extent. Furthermore, the third profile contained adolescents with both elevated internalizing and externalizing symptoms, the comorbid profile. The fourth profile consisted of the majority of adolescents, who exhibited little or no internalizing and externalizing symptoms, the so-called no/low symptomatic profile. A differentiated view of the symptoms can create added value regarding the understanding of violence resilience. Moreover, in the multinomial logistic regression, significant associations were found between the profiles and adolescents' gender in the group of adolescents with parental physical violence experiences, but none were found in relation to sociocultural status and migration background.

Suicidality in patients with primary diagnosis of panic disorder: A single-rate meta-analysis and systematic review

BACKGROUND

This study investigated the lifetime suicide attempt and ideation rates among patients with panic disorder (PD).

METHODS

Online databases regarding lifetime suicide attempt and ideation rates in patients with PD were searched up to May 2021.

RESULTS

The suicide attempt and ideation rates were 0.17 (95% CI: 0.16, 0.18) and 0.23 (95% CI: 0.22, 0.25). The suicide attempt rates among female and male patients were 0.17 (95% CI: 0.14, 0.20) and 0.15 (95% CI: 0.12, 0.19). When PD was comorbid with anxiety, depression, substance abuse, and personality disorders, the suicide attempt rates increased to 0.23 (95% CI: 0.20, 0.26), 0.23 (95% CI: 0.18, 0.27), 0.25 (95% CI: 0.20, 0.31), and 0.25 (95% CI: 0.23, 0.28), respectively.

LIMITATIONS

The suicide attempt and ideation by age, suicide ideation by sex, and suicide ideation by comorbidity with other mental disorders were passed in our meta-analysis as sample size was small. Stratification analysis on ethnicity, marital status, education levels, resident location, and severity of PD should be considered in the future.

CONCLUSION

The lifetime suicide ideation and attempt rates in patients with PD were higher than general populations but lower than patients with bipolar or depression. The lifetime suicide attempt rate in female patients was slightly higher than male patients. When PD was comorbid with one other mental illness, the lifetime suicide attempt rate increased by about 50%.

Search for solutions, learning, simulation, and choice processes in suicidal behavior

Suicide may be viewed as an unfortunate outcome of failures in decision processes. Such failures occur when the demands of a crisis exceed a person's capacity to (i) search for options, (ii) learn and simulate possible futures, and (iii) make advantageous value-based choices. Can individual-level decision deficits and biases drive the progression of the suicidal crisis? Our overview of the evidence on this question is informed by clinical theory and grounded in reinforcement learning and behavioral economics. Cohort and case-control studies provide strong evidence that limited cognitive capacity and particularly impaired cognitive control are associated with suicidal behavior, imposing cognitive constraints on decision-making. We conceptualize suicidal ideation as an element of impoverished consideration sets resulting from a search for solutions under cognitive constraints and mood-congruent Pavlovian influences, a view supported by mostly indirect evidence. More compelling is the evidence of impaired learning in people with a history of suicidal behavior. We speculate that an inability to simulate alternative futures using one's model of the world may undermine alternative solutions in a suicidal crisis. The hypothesis supported by the strongest evidence is that the selection of suicide over alternatives is facilitated by a choice process undermined by randomness. Case-control studies using gambling tasks, armed bandits, and delay discounting support this claim. Future experimental studies will need to uncover real-time dynamics of choice processes in suicidal people. In summary, the decision process framework sheds light on neurocognitive mechanisms that facilitate the progression of the suicidal crisis. This article is categorized under: Economics > Individual Decision-Making Psychology > Emotion and Motivation Psychology > Learning Neuroscience > Behavior.

The mediating role of internalizing and externalizing symptoms in the relationship between childhood trauma and suicidality among adolescents: a structural equation model

BACKGROUND

The objective of this study is to investigate the direct and indirect effects of childhood trauma, internalizing symptoms, and externalizing symptoms on suicidality among adolescents, thereby establishing a structural equation model.

METHODS

The present study uses a cross-sectional descriptive design. Among 147 adolescents aged 12-17, 93 outpatients diagnosed with major depressive disorder and 54 controls were included in the study. They completed the Early Trauma Inventory Self-Report (Short Form) and Columbia Suicidality Severity Rating Scale. Their parents completed the Child Behavior Checklist. Analyses were performed using Pearson's correlation and structural equation modelling.

RESULTS

Childhood trauma had both direct and indirect effects, via internalizing symptoms and externalizing symptoms, on suicidality. Internalizing symptoms had a direct effect on suicidality. Meanwhile, externalizing symptoms were not directly associated with suicidality, but indirectly associated via internalizing symptoms.

CONCLUSIONS

Findings provide in-depth understanding of the mediating role of internalizing symptoms and externalizing symptoms in the relationship between childhood trauma and suicidality, suggesting that the therapeutic interventions for both internalizing symptoms and externalizing symptoms may be important to prevent suicide in adolescents with childhood trauma.

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.

Examining Longitudinal Associations between Externalizing and Internalizing Behavior Problems at Within- and Between-Child Levels

Externalizing and internalizing behavior problems are known to often co-occur, but mechanisms underlying this co-occurrence remain unclear: whether the associations are due to causal influences of one domain on the other or due to common risk processes influencing both domains. This study aimed to better understand the sources of co-occurring behavior problems by disentangling within- and between-child levels of associations between the two across the five years of childhood, from pre-kindergarten to Grade 3. We analyzed a longitudinal sample of 1060 children from non-urban settings in the U.S. using random-intercept cross-lagged panel models (RI-CLPMs) as an alternative to the commonly-used standard CLPMs. Results indicate that co-occurring externalizing and internalizing problems can be explained partly by a unidirectional influence from externalizing to internalizing problems operating within children and partly by stable differences between children that influence both domains of problems. Further analyses indicate that an executive function deficit in early childhood is an important shared risk factor for both problems, suggesting the utility of executive function interventions in preventing or addressing externalizing and internalizing problems in childhood.

Resilience Factors in the Association Between Depressive Symptoms and Suicidality

PURPOSE

To investigate whether life satisfaction and optimism might reduce the risk of suicidal thoughts and behaviors among adolescents with depressive symptoms.

METHODS

Participants were 1,904 youth from the NEXT Generation Health Study, a national sample of U.S. adolescents, followed over 7 years from 2009/2010 to 2015/2016. Longitudinal latent profile analysis and logistic regressions were conducted.

RESULTS

We identified three subgroups of adolescents with different patterns of depressive symptoms across the first six waves: "Low" (40%), "Mild" (42%), and "Moderate to Severe" (18%). The Moderate to Severe (OR = 14.47, 95% CI [6.61, 31.66]) and Mild (OR = 3.90, 95% CI [2.22, 6.86]) depression profiles had significantly higher odds of developing suicidality than the Low depression profile. Both life satisfaction and optimism moderated the association between depressive symptom profile and suicidality. The difference in suicidality risk between the Mild and Low depression profiles was significantly attenuated at high versus low levels of life satisfaction, with a difference of -.08, 95% CI [-.14, -.03]. In addition, the difference in suicidality risk between the Moderate to Severe and Low depression profiles was attenuated at high versus low levels of optimism, with a difference of -.11, 95% CI [-.21, -.01].

CONCLUSIONS

For adolescents transitioning to young adulthood, resilience factors such as life satisfaction and optimism may buffer against suicidality risk in the face of mild or moderate to severe depressive symptoms.

Interactive effects of childhood maltreatment and tonic respiratory sinus arrhythmia on young adults' depressive symptoms

The goal of the current study was to investigate the moderating effect of tonic respiratory sinus arrhythmia (RSA) in the relation between childhood maltreatment and depression symptoms among young adults. A total of 98 participants (70 women) aged 17-22 years completed questionnaires on childhood maltreatment and depressive symptoms. RSA data were obtained during a resting condition in the laboratory. Results indicated that childhood maltreatment interacted with tonic RSA to predict depressive symptoms, even after controlling for age and body mass index (BMI) of each participant. Specifically, higher levels of childhood maltreatment were associated with higher levels of depressive symptoms, but only among young adults who exhibited lower tonic RSA. The results indicated that the association between childhood maltreatment and depressive symptoms depends on young adults' physiological functioning/flexibility. Findings suggest that consideration of external environmental factors in combination with internal physiological factors is critical to understand young adults' mental health.

Childhood maltreatment, psychiatric symptoms, and suicidal thoughts among adolescents receiving substance use treatment services

INTRODUCTION

Childhood maltreatment experiences are associated with future suicidal thoughts and suicide attempts, yet the roles of specific psychiatric symptoms mediating this relation remain to be clarified. To clarify these relations, we tested a model incorporating multiple forms of childhood maltreatment (sexual abuse, physical punishment, emotional neglect), past year psychiatric disorder symptoms during adolescence (anxiety, mood, and conduct disorders) and recent suicidal thoughts.

METHODS

We administered structured interviews to 394 adolescents receiving outpatient substance use treatment services in the Southeastern United States (280 males; Mage = 16.33; SDage = 1.15). Structural equation models (SEMs) were used to evaluate the degree to which relations between childhood maltreatment and suicidal thoughts were mediated by specific past-year psychiatric symptoms.

RESULTS

Mood disorder symptoms significantly mediated the relation between neglect/negative home environment and suicidal thoughts. This path of influence did not vary by gender.

CONCLUSIONS

Childhood maltreatment and subsequent psychopathology influence suicidal thoughts among adolescents receiving substance use treatment services. The findings of the present study have implications for the adaptation and delivery of substance use treatment services to adolescents to enhance treatment engagement and outcomes.