Suicidality and depression among african american adolescents: the role of family and peer support and community connectedness

Risk and protective factors for suicidal thoughts and behaviors among Black female and male youth with depression symptoms - United States, 2004-2019

BACKGROUND

From 2004 to 2019, suicide rates among Black youth increased by 122 % for females and 65 % for males. Guided by the interpersonal theory of suicide, this study explored how perceptions of social support and parental involvement may contribute to suicidal behavior among Black youth aged 12-17 years.

METHODS

Data are from the 2004-2019 National Survey on Drug Use and Health (NSDUH). Multivariable logistic regression with backwards elimination was conducted to determine if characteristics associated with outcomes of interest (i.e., suicidal ideation, made a suicide plan, and made a suicide attempt) differed by sex. The characteristics examined included: age, poverty level, health insurance coverage, currently receiving mental health treatment, grades for last completed semester, parental involvement, frequency of arguments or fights with parents, frequency of fights at school or work, parental attitudes, and availability of emotional support.

RESULTS

Over 400,000 Black youth with depression symptoms reported suicidal thoughts and behaviors (80 % female). Females had increased odds of suicidal ideation and making a plan if they had no one to talk to about serious problems. Males had increased odds of attempting suicide if they reported academic struggles.

LIMITATIONS

This is a cross-sectional study and potential biases may affect generalizability of results.

CONCLUSIONS

Risk and protective factors identified in this study aligned with the interpersonal theory of suicide. Evidence-based interventions that focus on increasing connectedness and self-esteem may be effective for Black youth struggling with suicidal ideation. Preventing suicide requires a comprehensive approach including prevention strategies for individuals, families, and communities.

Suicide Attitudes Among Suicide Loss Survivors and Their Adaptation to Loss: A Cross-Cultural Study in Japan and the United States

Survivors' adaptation to a suicide loss is likely influenced by their attitudes toward suicide and their respective sociocultural contexts. Our study aimed to compare suicide attitudes and their association with depressive symptoms and sense of community safety in Japanese and American suicide loss survivors. A total of 193 Japanese survivors and 232 American survivors completed online surveys. The results show that Japanese survivors tended not to consider suicide as an illness or to recognize that others understood their experience but were more likely than American survivors to consider suicide as justifiable. Regression analyses indicated that taking suicide as a right was associated with depressive symptoms. Further, their sense of being understood by others was positively correlated with perceived community safety in both samples, but justifying suicide and considering it to be an illness was positively related to perceived community safety only among Japanese survivors.

Investigating the Interplay Between Mental Health Conditions and Social Connectedness on Suicide Risk: Findings from a Clinical Sample of Adolescents

This study examined whether school and community connectedness buffer the relationships between mental health conditions and suicide risk in a clinical sample of adolescents with histories of substance use disorders. Data from 294 adolescents were examined, with approximately 58% reporting lifetime suicidal ideation and/or prior attempts. Multinomial logistic regression was used to examine main and interaction effects on a three-category measure of suicide risk. Depression severity and panic disorder were associated with elevated suicidal ideation risk, whereas disordered eating was associated with elevated risk of attempts. Higher school-based positive peer interactions, school safety, and neighborhood social connection levels were associated with reduced suicide attempt risk. Moderation analyses revealed that high neighborhood social connection levels may partially mitigate the elevated likelihood of attempting suicide associated with disordered eating. Findings suggest clinical populations of adolescents may benefit from approaches aiming to promote social connectedness, further supporting a comprehensive approach to suicide prevention.

Psychosocial Factors Associated With Perinatal Anxiety and Perinatal Depression Among Adolescents: A Rapid Review

The current review examined the influence of psychosocial factors on adolescents' perinatal anxiety (PA) and perinatal depression (PND) across geographical regions. Three databases were searched for articles published between 2017 and 2022 and 15 articles were reviewed. We categorized factors into social, cultural, and environmental domains. Social factors included adolescent caregiver trust/attachment, social support, perceived social support, trauma/poly-traumatization, and peer solidarity. Cultural factors included feelings of shame, marital satisfaction, partner's rejection of pregnancy, lack of parental involvement in care, parenting stress, childhood household dysfunction, and adverse childhood events. Environmental factors included neighborhood support, food insecurity, domestic violence, going to church, going out with friends, and sources for obtaining information. Routine assessment of psychosocial factors among perinatal teens is crucial to identify those at higher risk for PA and PND. Further research is necessary to examine the influence of cultural and environmental factors on PA, PND, and perinatal outcomes among adolescents. [Journal of Psychosocial Nursing and Mental Health Services, 62(2), 13-22.].

A randomized controlled trial of enhanced mentoring program practices for children of incarcerated caregivers: Assessing impacts on youth and match outcomes

Parental incarceration is an adverse childhood experience that is associated with heightened risk for negative outcomes in youth. Mentoring programs seek to mitigate this risk by providing children of incarcerated parents (COIP) with a supportive relationship that fosters positive outcomes. The current study presents findings from a longitudinal evaluation of enhanced mentoring program practices designed for supporting COIP. One thousand three hundred and thirty-four COIP mentees, their parents or guardians, and their mentors were randomly assigned to receive either enhanced or business as usual (BAU) mentoring. Mentees who received enhanced mentoring demonstrated improved positive self-cognitions, and reduced internalizing behavior problems, intentions to use substances, and substance use, compared with youth who received BAU mentoring. The enhancements had no impact on the quality of mentoring relationships and the enhanced matches had shorter mentoring relationships compared with BAU matches. This evaluation demonstrates that the enhanced mentoring program practices for COIP had significant, positive impacts on outcomes for this special population of youth and suggests that enhanced practices tailored to COIP should be implemented throughout the duration of the mentoring relationship to be most effective.

Adolescent Mothers' Psychological Wellbeing during Pregnancy and Infant Emotional Health

OBJECTIVE

Although many studies have identified risk factors for adolescent pregnancy, much less is known about factors that support pregnant adolescents' psychological wellbeing and offspring outcomes. This study drew on strength-based frameworks to investigate family and neighborhood factors linked to social connectedness that predict psychological wellbeing during adolescent pregnancy and offspring outcomes.

METHOD

Participants included 135 adolescent mothers (ages 14-21; 90% Black American) assessed annually since childhood as part of a longitudinal study. During preadolescence (ages 11-13), data on contextual stressors and neighborhood support were gathered from participants' caregivers; participants also rated their perceived trust/attachment with caregivers before and during pregnancy. To assess changes in psychological wellbeing, adolescents reported positive and depressed mood before and during pregnancy. A path analysis model tested the prospective associations between family and neighborhood factors, psychological wellbeing during pregnancy, and offspring outcomes (birth outcomes; observed infant positive/negative emotions at age 3-months).

RESULTS

Positive mood decreased from pre-pregnancy to pregnancy, whereas depressed mood remained stable. Adjusting for pre-pregnancy mood, perceived caregiver trust/attachment during pregnancy was associated with prenatal positive mood. Prenatal positive mood, in turn, reduced risk of preterm birth and indirectly predicted positive infant emotions via birth outcomes. Neighborhood support in preadolescence predicted lower prenatal depressed mood, but depressed mood did not predict infant outcomes beyond positive mood. Contextual life stress was not associated with prenatal mood after adjusting for family and neighborhood support.

CONCLUSIONS

Findings highlight changes in positive-valence emotions during adolescent pregnancy that may have unique associations with birth outcomes and offspring emotions.

Associations Between Family Factors, Social Integration, and Suicidal Ideation Across the Life Course of an Urban African American Cohort

Suicide is a problem on the rise but not studied extensively among African Americans. It is critical to identify risk factors for suicidal ideation to reduce risk. This study examines whether family and social factors over the life course predict suicidal ideation among African American adults in midlife. We conducted multiple logistic regression analyses on data from a longitudinal cohort of African Americans first assessed in childhood to identify associations with suicidal ideation in midlife (ages 33-42). Findings suggested living without one's mother in childhood (vs. living with mother alone; aOR = 3.69, p = .017) and parental rule-setting in adolescence (aOR = 0.79, p = .047) were associated with suicidal ideation. Having a lifetime drug disorder (aOR = 2.19, p = .046) or major depression by young adulthood (aOR = 3.58, p < .001) was also associated with an increased risk of suicidal ideation. Findings highlight the importance of intervention for children in mother-absent homes for improving mental health outcomes. Family interventions that promote parental rule-setting and addressing drug problems and depressive symptoms early in the life course offer an area for intervention to reduce suicide over the long term.

Attachment to Peers and School: Longitudinal Moderators of the Relation Between Caregiver Psychological Distress and Adolescent Hopelessness

Research has yet to determine how relationships outside of the family system may buffer negative outcomes associated with hopelessness among racial minority youth. In a sample of Black American youth (N = 512; 49% females) and their parents or caregivers, this study used longitudinal growth models to explore whether youth relationships (attachment to peers and attachment to school) moderated the association between caregiver distress (depressive symptoms and traumatic stress), and youth hopelessness. Adolescents' gender was examined to determine if there were gender differences present in these associations. Four linear growth models showed a significant change in levels of hopelessness over time for youth and a significant positive relation between caregiver distress and youth level of hopelessness. Attachment to peers and attachment to school did not equally moderate the relation between caregiver psychological distress and youth hopelessness. The type of caregiver distress had a differential effect on youth hopelessness in the context of the moderation models and based on gender. The type of caregiver distress had a differential effect on youth hopelessness in the context of the moderation models and based on gender. Implications for the importance of non-familial attachments among Black American youth with distressed parents are discussed.

A longitudinal study of positive mental health and coping among Indigenous adults with type 2 diabetes

OBJECTIVE

Indigenous Peoples and scholars call for strengths-based approaches to research inclusive of Indigenous resiliency and positive outcomes. The purpose of this study was to examine positive mental health for Indigenous adults with type 2 diabetes and to determine if positive mental health is linked to community connectedness (a coping resource) and active coping (a coping response).

METHODS

Participants (N  = 194 at baseline) were randomly selected from clinical records, at least 18 years old with a type 2 diabetes diagnosis, and self-identified as American Indian.

RESULTS

Latent growth curve models revealed that average positive mental health was predicted to decrease over the four waves of the study, although not for participants with above-average active coping at baseline. Community connectedness at baseline was associated with higher initial levels of positive mental health. Within-person change in active coping and community connectedness were both associated with increases in positive mental health.

CONCLUSION

This study aligns with previous research demonstrating that coping can influence health outcomes, and furthers the stress process literature by showing that active coping and community connectedness can impact positive mental health for Indigenous adults with Type 2 Diabetes.

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.

Self-reported anxiety and depression problems and suicide ideation among black and latinx adults and the moderating role of social support

Suicide is a critical public health problem. Over the past decade, suicide rates have increased among Black and Latinx adults in the U.S. Though depression is the most prevalent psychiatric contributor to suicide risk, Black and Latinx Americans uniquely experience distress and stress (e.g., structural adversity) that can independently operate to worsen suicide risk. This makes it important to investigate non-clinical, subjective assessment of mental health as a predictor of suicide ideation. We also investigate whether social support can buffer the deleterious impact of poor mental health on suicide ideation.We analyzed data from 1,503 Black and Latinx participants of the Washington Heights Community Survey, a 2015 survey of residents of a NYC neighborhood. Multivariable logistic regression was conducted to examine the effect of subjectively experienced problems with anxiety and depression on suicide ideation independent of depression diagnosis, and the role of social support as a moderator.Estimated prevalence of past two-week suicide ideation was 5.8%. Regression estimates showed significantly increased odds of suicide ideation among participants reporting moderate (OR = 8.54,95% CI = 2.44-29.93) and severe (OR = 16.84,95% CI = 2.88-98.46) versus no problems with anxiety and depression, after adjustment for depression diagnosis. Informational support, i.e., having someone to provide good advice in a crisis, reduced the negative impact of moderate levels of anxiety and depression problems on suicide ideation.Findings suggest that among Black and Latinx Americans, subjective feelings of anxiety and depression account for a significant portion of the suicide ideation risk related to poor mental health. Further, social support, particularly informational support, may provide protection against suicide ideation.

Cultural Considerations in Working with Black and African American Youth

This article seeks to provide an exploration of the contributors to the mental health of Black and African Americans. We explore the foundations of racism in this country as well as factors leading to systemic racism. It is important to gain an understanding of the multifaceted contributors to disparities in health care and mental health care. Black children and adolescents experience more poverty, discrimination, marginalization, and racism compared with their white counterparts in the United States (APA, 2017). These are factors that greatly impact the mental health of this population. In addition to exploring examples of disparities in diagnosis, treatment, and research on Black youth, we also provide recommendations for clinicians seeking to provide exemplary culturally sensitive care that recognizes the diverse and multifaceted nature of this population.

Depression, anxiety, stress, and satisfaction with life: Moderating role of interpersonal needs among university students

Depression, anxiety, and stress are ranked among the top mental health concerns faced by university students in recent times perpetuated by the proliferation of digitalization. Thus, this study was performed to assess the relationship between depression, anxiety, stress, and satisfaction with life, with interpersonal needs (perceived burdensomeness and thwarted belongingness) as moderators. A cross-sectional study using a convenient sampling method was conducted among 430 Malaysian private university students (Mean aged= 20.73 years; SD = 1.26 years). A self-administered questionnaire comprising the Depression, Anxiety and Stress Scale (DASS-21), Satisfaction with Life Scale, and Interpersonal Needs Questionnaire were used. Students who experienced lower depression and anxiety reported higher satisfaction with life under the influence of low perceived burdensomeness. Perceived burdensomeness, when coupled with depression (β = 0.76, p < 0.01) and anxiety (β = 0.79, p < 0.01), contributed 15.8% of variance in satisfaction with life. Students who experienced stress reported higher satisfaction with life under the influence of high thwarted belongingness (β = 0.73, p < 0.01), contributing 17.3% of the variance in satisfaction with life. For university students who experienced depression and anxiety symptoms, mental health practitioners may need to be cognizant of how to support students' education and management of their perceived burdensomeness perceptions.

HIV and suicide risk across adolescence and young adulthood: an examination of socio-demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

Introduction

As children become adolescents and young adults (AYA), their risk for attempting suicide increases dramatically, with chronic health conditions an important risk factor. This study examined correlates of suicidality across development in AYA living with perinatally acquired HIV (AYALPHIV) and those perinatally HIV‐exposed but uninfected (AYAPHEU).

Methods

Data come from an ongoing longitudinal New York City‐based study (N = 339) with AYALPHIV and AYAPHEU interviewed every 12–18 months from 2003 to 2019 (mean enrolment age = 12 years; current mean age = 27 years). The Diagnostic Interview Schedule for Children (adolescent or young adult version) assessed psychiatric disorders and first‐reported suicide attempt. Generalized estimating equations were used to examine associations between first‐reported suicide attempt and socio‐demographic, contextual and psychosocial correlates measured concurrently across six timepoints.

Results

At enrolment, 51% of participants were female, 72% heterosexual, 60% Black and 50% Latinx. Attempted suicide was significantly higher among AYALPHIV (27%, CI 21–33%) compared to AYAPHEU (16%, CI 10–22%), with an OR of 1.74 (CI 1.04–2.92) in a model adjusting for age. For AYALPHIV, anxiety (OR 2.66, CI 1.46–4.85), mood (OR 3.62, CI 1.49–8.81) and behaviour disorders (OR 5.05, CI 2.15–11.87) and past‐year arrest (OR 3.05, CI 1.26–7.4), negative life events (OR 1.27, CI 1.11–1.46), city stress (OR 2.28, CI 1.46–3.57), pregnancy (OR 2.28, CI 1.08–4.81) and HIV stigma (OR 2.46, CI 1.27–4.75) were associated with increased odds of attempted suicide, while identifying as heterosexual (OR 0.27, CI 0.14–0.52), higher personal (OR 0.45, CI 0.26–0.80) and family self‐concept (OR 0.36, CI 0.22–0.57) were protective. Interactions by HIV status and age were found: substance use was more strongly associated with attempted suicide among AYAPHEU than AYALPHIV, while negative life events and higher religiosity were more strongly associated with increased odds of attempted suicide among AYA ≥ 19 versus ≤ 18 years.

Conclusions

AYALPHIV compared to AYAPHEU faced unique risks for attempted suicide as they age into adulthood, with the highest risk among AYALPHIV experiencing HIV stigma or pregnancy and the highest risk among AYAPHEU with substance use. Assessing for suicide risk and correlates with attention to ageing can inform preventive interventions tailored to meet AYALPHIV and AYAPHEU needs.

Resilience and Depressive Symptoms Mediated Pathways from Social Support to Suicidal Ideation Among Undergraduates During the COVID-19 Campus Lockdown in China

Purpose

The COVID-19 pandemic has greatly affected people's mental health. The direct and indirect pathways between social support and suicidal ideation in the period are still unclear. This study explores the pathways from social support to suicidal ideation through resilience and depressive symptoms among undergraduates during the COVID-19 campus lockdown.

Methods

During two weeks of the COVID-19 campus lockdown, a total of 12,945 undergraduates at a university in eastern China completed the questionnaire including sociodemographic characteristics, suicidal ideation, social support, resilience, and depressive symptoms. A structural equation modeling (SEM) approach was used to analyze the direct and indirect pathways from social support to suicidal ideation via the mediators of resilience and depressive symptoms.

Results

Of the 12,917 undergraduates included in this study, 7.4% (n = 955) reported they sometimes had suicidal ideation, 0.8% (n = 109) reported they often had suicidal ideation, 0.9% (n = 122) reported they always had suicidal ideation, and 13.2% (n = 1704) reported they had depressive symptoms. Social support exerted significant direct (β = -0.058), indirect (β = -0.225), and total (β = -0.283) effects on suicidal ideation; 20.5% of the total effect was direct, and 79.5% was indirect. Social support predicted suicidal ideation through resilience (β = -0.038), and depressive symptoms (β = -0.087), explaining 13.4%, and 30.7% of the total effect, respectively. Social support predicted suicidal ideation through the sequential mediation of resilience and depressive symptoms (β = -0.099), explaining 35.0% of the total effect.

Conclusion

This is the first study to provide the evidence of pathways from social support to suicidal ideation through resilience and depressive symptoms during the COVID-19 campus lockdown among undergraduates in China. Both direct and indirect pathways from social support to suicidal ideation were identified as intervention targets to reduce suicidal ideation.

Protective factors for suicidal ideation among Black adolescents indirectly exposed to community violence

OBJECTIVE

Community violence exposure has been identified as a risk factor for Black youth suicide ideation. However, little is known about factors that protect community violence exposed youth against suicide ideation. The current study examined associations between knowledge of family member and peers' community violence exposure and Black youth's subsequent suicidal ideation, and investigated self-worth and social support as protective factors.

METHOD

Participants were a community sample of Black youth (N = 447, 47.4% female; Mage = 11.77, SD = 0.35) who reported about community violence exposure, self-worth, social support, and suicide ideation in grades 6 and 7.

RESULTS

Regression analyses revealed that grade 6 knowledge of family member and peers' community violence exposure was associated with increases in suicide ideation assessed in grade 7. Self-worth attenuated the association between knowledge of others' community violence exposure and suicide ideation for male adolescents. For female adolescents, social support attenuated the association between knowledge of others' community violence and suicide ideation.

CONCLUSIONS

Findings highlight the consequential impact of knowledge about community violence for Black youth's suicidal ideation. Enhancing protective factors for Black youth is an important target for intervening with exposure to violence and reducing suicide ideation.

Family and peer support moderates the relationship between distress tolerance and suicide risk in black college students

ObjectivesThe relationship between distress tolerance and suicide risk was examined in black college students, as well as the moderating role of family and peer support in this relationship. Parent and peer support were studied separately in their relationship to overall suicidality.MethodOne-hundred twenty-five Black undergraduate students completed self-report measures that assessed study variables.ResultsUsing moderation analyses, distress tolerance was significantly associated with overall suicidality, such that increased tolerance was associated with decreased risk. Higher family support was significantly associated with decreased suicide risk, while peer support was not. However, both family and peer support significantly moderated the relationship between distress tolerance and suicide risk. For both types of support, the relationship between distress tolerance and suicide risk was significant when support was low.ConclusionsSocial support appears to be an important protective factor for suicide risk in black college students.

Better Together: Family and Peer Support for Black Young Adults During the COVID-19 Pandemic and the Black Lives Matter Movement

The study investigated how the COVID-19 pandemic and the Black Lives Matter (BLM) movement impacted Black young adults’ social relationships and how receiving support from family or peers differentially influenced psychological adjustment. Surveys were sent in January 2021 and respondents included a total of 346 Black adults (66% female; mean age 26.2). A 2X2 repeated measures analysis of variance with social convoys and events was performed. Separate hierarchical regression analyses were performed with psychological well-being, psychological distress, and psychological need satisfaction. The pandemic negatively impacted relationships with peers. The BLM movement had favorable effects on both peer and family relationships. Family support relating to the pandemic and peer support relating to the BLM movement were associated with heightened psychological adjustment. The beneficial effects of pandemic-related support were mediated by greater psychological need satisfaction. The results indicate how important family and peer support are to individuals’ psychological adjustment during pivotal events.

A Trauma- and Justice, Equity, Diversity, and Inclusion (JEDI)-Informed Approach to Suicide Prevention in School: Black Boys' Lives Matter

Black boys have been dying by suicide at an increasing rate. Although the reasons for this increase are unknown, suicide in Black boys is likely influenced by multiple, intersecting risk factors, including historical and ongoing trauma. Schools can serve as an important mechanism of support for Black boys; however, without intentional anti-racist frameworks that acknowledge how intersecting identities can exacerbate risk for suicide, schools can overlook opportunities for care and perpetuate a cycle of racism that compromises the mental health of Black youth. By recognizing their own implicit biases, modeling anti-racist practices, listening to and recognizing the strengths and diversity of Black youth, and fostering school-family-community partnerships, school psychologists can help transform the school environment to be a safe and culturally affirming place for Black youth. This paper outlines how school psychologists can apply a trauma- and Justice, Equity, Diversity, and Inclusion (JEDI)-informed approach to suicide prevention in order to more holistically support Black boys, disrupt patterns of aggressive disciplinary procedures, and improve school-based suicide prevention programs. By applying this lens across a multitiered systems of support (MTSS) framework, school psychologists can help to prevent the deaths of Black boys and begin to prioritize the lives of Black boys.

Early Age of Cannabis Initiation and Its Association With Suicidal Behaviors

Background:

Suicide rates in the U.S. have continued to rise over the last 2 decades. The increased availability and broader legalization of cannabis is a public health concern, particularly among adolescents. The objective of this study was to examine the association between the age of cannabis initiation and lifetime suicidal ideations and attempts in a sample of adults aged 18 or older.

Methods:

Data are from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 to 2003 (N = 15 238). The primary objective of the CPES was to collect data about the prevalence of mental disorders, impairments associated with these disorders, and their treatment patterns from representative samples of majority and minority adult populations in the U.S. Logistic regression analyses were conducted to test the association between cannabis initiation age (early ⩽14 years old; later >14 years old) and outcomes of lifetime suicide ideation and attempts. Cigarette use, cannabis use, gender, income, race, education, and age were controlled for the analyses.

Results:

Overall, 12.5% of participants reported suicide ideation, while 4.2% reported attempt. Early cannabis use was associated with a higher risk of suicide ideation (AOR = 3.32, 95% CI [2.75, 3.80]) than later cannabis use (AOR = 2.15, 95% CI [1.92, 2.39]). Early cannabis use was associated with a higher risk of suicide attempt (AOR = 4.38, 95% CI [3.48, 5.52]) than later cannabis use (AOR = 2.56, 95% CI [2.14, 3.06]). Wald chi-squared tests revealed significant differences between the early and late initiation for both ideation (χ2 = 26.99; P < .001) and attempts (χ2 = 26.02; P < .001).

Conclusions:

Significant associations were found between early initiation of cannabis and suicide behaviors. As suicide rates continue to rise, it is recommended that clinicians, treatment providers, and other professionals consider the use of cannabis at an early age as a risk for subsequent suicide behaviors.

Predictors of Attempted Suicide Among Youth Living With Perinatal HIV Infection and Perinatal HIV-Exposed Uninfected Counterparts

BACKGROUND

Suicide is a leading cause of death among adolescents and young adults (AYA). AYA living with perinatally acquired HIV infection (AYALPHIV) are at higher risk of attempted suicide when compared with AYA who were perinatally HIV-exposed but uninfected (AYAPHEU). To inform interventions, we identified risk and protective factors of attempted suicide among AYALPHIV and AYAPHEU.

SETTING

Data were obtained from a longitudinal New York City-based study of AYALPHIV and AYAPHEU (n = 339; enrollment age 9-16 years) interviewed approximately every 12-18 months.

METHOD

Our main outcome was suicide attempt at any follow-up. The DISC was used to assess psychiatric disorder diagnoses and attempted suicide and the Child Depression Inventory to assess depressive symptoms. Psychosocial and sociodemographic risk factors were also measured. Analyses used backward stepwise logistic regression modeling.

RESULTS

At enrollment, 51% was female individuals, 49% Black, 40% Latinx, and 11% both Black and Latinx. Attempted suicide prevalence was significantly higher among AYALPHIV compared with AYAPHEU (27% vs 16%, P = 0.019), with AYALPHIV having 2.21 times the odds of making an attempt [95% confidence interval: (1.18 to 4.12), P = 0.013]. Higher Child Depression Inventory scores were associated with an increased risk of attempted suicide in both groups and the total sample. The presence of DISC-defined behavior disorder increased the risk of attempted suicide in the total sample and the AYALPHIV subgroup. Religiosity was protective of attempted suicide in AYALPHIV.

CONCLUSIONS

AYALPHIV had increased suicide attempts compared with AYAPHEU. Religiosity was protective in AYALPHIV. Highlighting a need for prevention of early mental health challenges was associated with risk.

Suicide in African American Adolescents: Understanding Risk by Studying Resilience

Historically, suicide rates for African American adolescents have been low,relative to rates for youth of other racial-ethnic backgrounds. Since 2001, however, suicide rates among African American adolescents have escalated: Suicide is now the third leading cause of death for African American adolescents. This disturbing trend warrants focused research on suicide etiology and manifestation in African American adolescents, along with culturally sensitive and effective prevention efforts. First, we revisit leading suicide theories and their relevance for African American adolescents. Next, we discuss health promotive and protective factors within the context of African American youth development. We also critique the current status of suicide risk assessment and prevention for African American adolescents. Then, we present a heuristic model of suicide risk and resilience for African American adolescents that considers their development within a hegemonic society. Finally, we recommend future directions for African American adolescent suicidology. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Resilience mediates the association between self-harm and suicidal ideation in Chinese left-behind children

Background

A significant association between self-harm (SH) and suicide ideation (SI) has been found in Chinese left-behind children (LBC). Existing literature suggests that resilience might be a mediator in this association. However, this hypothesis has not been effectively discussed. The major aim of our study is to analyze the possible mediation of resilience in SH-SI association in Chinese LBC.

Methods

A population-based clustering sampling survey of 2619 LBC was conducted in southwestern China Yunnan province. Self-developed structured questionnaire was used to collect relevant information. Univariate and multivariate Logistic regression models were applied to estimate the associations between SH and SI, resilience and SI, and SH and resilience. Path analysis was adopted to measure the mediation of resilience, as well as its 5 dimensions, in the association between SH and SI. A subgroup analysis was further done to explore the mediation of resilience in the associations between SH severity and SI, SH repetition and SI, among self-harmed LBC.

Results

Compared with LBC who reported no SH behaviors, the odds ratio (OR) for SI was 3.37 (95% CI: 2.63–4.31) among self-harmed LBC. Based on the path model, resilience significantly mediated a quarter of the total association between SH and SI. Among the 5 dimensions of resilience, emotion regulation, interpersonal assistance, and family support were the strongest mediators. Subgroup analysis revealed that, the mediation of resilience was only significant for SH severity and SI.

Conclusions

Resilience played as a prominent mediator in SH-SI association among Chinese LBC. Resilience-centered intervention measures could be considered to reduce suicidal risk of this disadvantageous group.

Suicidal ideations and Attempts Within the Family Context: The Role of Parent Support, Bonding, and Peer Experiences with Suicidal Behaviors

The rate of suicidality is increasing faster in Black American youth than in any other group in the USA. Researchers have found that family-level factors are important environmental factors for predicting depression and anxiety among Black youth, but less is known about how family- and friendship-level factors are associated with suicidal ideation and attempts among Black youth. This secondary analysis used the data from the National Longitudinal Study of Adolescents to Adult Health with a sample of Black adolescents (N = 4232) with a mean age of 16 years. The predictors included parental and other contextual factors on the outcome, which was suicidal behaviors. A multinomial analysis was employed to assess which factors contributed to or prevented suicidal behaviors. Our results indicated that parental support was significantly and positively associated with reporting suicidal ideation and attempts. The results indicated that Black youth with a decrease in parental support were 41% more likely to report ideation and 68% more likely to report attempting suicide compared to those reporting no parental support. Findings from our study support the assertion that the influence from the familial microsystem is pronounced in modifying suicidal behavior of Black youth.

Bullying victimization, psychosocial functioning, and protective factors: Comparing African American heterosexual and sexual minority adolescents in Chicago's Southside

African American heterosexual and sexual minority (SM) adolescents report widespread bullying victimization (BV), which is associated with poorer psychosocial functioning. However, studies examining potential protective factors that moderate this association are limited. Using data from a cross-sectional study conducted in Chicago, we examined the association between BV and psychosocial functioning among a sample of heterosexual (n = 475) and SM (n = 105) African American adolescents and examined whether four empirically-supported protective factors moderated these associations. Among SM adolescents, having close parents was protective against psychosomatic symptoms for those who reported high BV and having caring teachers was protective against substance use for those who reported both high and low BV. Among heterosexual adolescents, having close parents was protective against substance use for those who reported high BV but having high neighborhood support exacerbated the risk of developing psychosomatic symptoms for those who reported high BV. Implications for school and parental-based interventions are discussed.

Does Kinship vs. Foster Care Better Promote Connectedness? A Systematic Review and Meta-Analysis

Internationally, there is an increasing trend toward placing children in kinship vs. foster care. Prior research suggests that children in kinship care fare better compared to children in foster care; however, the reasons for this remain unclear. We conducted a systematic review and meta-analysis to examine the hypothesis that kinship care better preserves children's connectedness to caregiver, birth family, culture, and community; which, in turn, is associated with more optimal child outcomes. Thirty-one studies were reviewed that compared children aged 0-18 years in kinship care vs. foster care on levels of connectedness, three of which had outcomes that permitted meta-analysis. Findings indicated that children in kinship vs. foster care were more likely to feel connected to family in general; however, there was not a clear advantage for kinship vs. foster care for caregiver, birth parent, cultural, and community connectedness. While levels of connectedness were generally associated with more adaptive child outcomes for children in both kinship and foster care, no reviewed studies examined the hypothesis that children's connectedness may mediate the relationship between placement type and child well-being and placement outcomes. Results are discussed with respect to limitations and policy implications of the current evidence-base and the need for more rigorous research to help identify how to improve child well-being in home-based care.

Mobilising social support to improve mental health for children and adolescents: A systematic review using principles of realist synthesis

Social support is a well-recognised protective factor for children's mental health. Whilst many interventions exist that seek to mobilise social support to improve children's mental health, not much is known about how to best do this. We sought to generate knowledge about the ways in which social support can be mobilised to improve children's mental health. We conducted a systematic review, which followed the principles of a realist synthesis. The following databases were searched: PubMed, CINAHL, Ovid MEDLINE, PsychINFO, EMBASE, Child and Adolescent Studies, EconLit and SocINDEX. Studies were included if the age of participants was between 0 and 18 years and they evaluated or described programme theories of interventions that sought to improve children's mental health by mobilising social support. Relevance and quality of studies were assessed, and data were extracted and analysed narratively. Thirty-three articles were included. Studies varied substantially with regard to the detail in which they described the processes of mobilising social support and expected mechanisms to improve children's mental health. Those that provided this detail showed the following: Intervention components included explaining the benefits of social support and relationships to families and modelling friendly relationships to improve social skills. Pathways to improved outcomes reflected bi-directional and dynamic relationships between social support and mental health, and complex and long-term processes of establishing relationship qualities such as trust and reciprocity. Parents' ability to mobilise social support for themselves and on behalf of children was assumed to impact on their children's mental health, and (future) ability to mobilise social support. Although interventions were considered affordable, some required substantial human and financial resources from existing systems. Mobilising social support for vulnerable children can be a complex process that requires careful planning, and theory-informed evaluations can have an important role in increasing knowledge about how to best address social support and loneliness in children.

Effect of occupational therapy on self-determination skills of adolescents at risk of emotional and behavioral disorders: A randomized controlled trial

Background: Self-determination skills enable to support an individual’s needs and make decisions to function independently. Improvement of self-determination skills has had a positive result for adolescents at risk of Emotional and Behavioral Disorders (EBD). The aim of this study was to investigate the effect of occupational therapy interventions on the self-determination skills of adolescent girls at risk of emotional-behavioral disorders.

Methods: In this single-blind control trial study, 14-16-years-old girl students (n=54) at risk of EBD were recruited by cluster sampling from secondary high schools of Tehran, Iran. Youth self-report Questionnaire (YSR) was used to include adolescents at risk of EBD in the study and were randomized into the intervention (n=27) and control group (n=27) by block randomization. The Student Self-Determination Scale (SDSS) and the Self-determination Parent Perception Scale (SDPPS) were used to collect data. Students in the intervention group participated in 8 – once a week- sessions of occupational therapy and the control group received no training. Data were analyzed by repeated-measures analysis of variance (RMANOVA), Bonferroni test and SPSS 16.0 version. The significance level was set at 0.05.

Results: The score of self-determinations (SDSS) increased significantly in the intervention group after the intervention (p<0.001). Although the mean scores of self-determination at follow-up have increased in the intervention group compared to the post-test. No significant differences were found (p>0.05); also, the score of parents' perception of student self-determination (SDPPS) increased but there were not significantly different (p=0.064).

Conclusion: The findings indicated self-determination skills could be taught to adolescents at risk of EBD in OT sessions. Since self-determination has been identified as the necessary skills for adolescents at-risk to transition into adulthood, occupational therapists have an important role in promoting self-determination skills in adolescents at risk of EBD.

Voicing Jordanian Adolescents' Suicide

BACKGROUND

Studies focusing on adolescent suicide in Arab countries are particularly scarce, with the few available undertaken from within an epidemiological paradigm.

OBJECTIVE

This study aimed to understand Jordanian adolescents' perceptions, beliefs, and attitudes toward suicide.

METHODS

A qualitative design using 12 dual-moderator focus group discussions was conducted in public schools. Participants were selected from the three main regions of the country (rural southern, urban central, and suburban northern). Participants included Jordanian adolescent boys and girls, aged 14-17 years, who reported experiencing mild to moderate depressive symptoms. A relational content analysis approach was used for coding data, and a content analysis was used to identify salient thematic categories. Data were analyzed using NVivo software.

RESULTS

Four themes emerged, including perceived risk factors, perceived protective factors, active and passive suicidal ideations, and e-games and Internet influences. Main risk factors were depression; anxiety; stigma, shame, and isolation; family issues; life pressures; and guilt. Conversely, religiosity, perceived positive family functioning, and availability of long-term goals seemed to confer resilience to adolescents' suicidal ideation and behavior. Passive suicidality (having death wishes without any plans to complete suicide) was noticed most among participants who feared jeopardizing the family's reputation if they committed suicide. Several boys with active suicidal ideations used the Blue Whale Challenge e-game to learn how to complete suicide and relinquish their problems.

DISCUSSION

Suicide is a multifactorial problem requiring multimodal strategies. Evidence from this research suggests that those most passionate about the outcome of interest are encouraged to redouble efforts to reduce modifiable risk factors, enrich protective factors, target the underlying psychiatric illness that informs suicidal ideations and behavior, and research the effect of social media and Internet activity more deeply. Parents are advised to monitor the online activities of their children and familiarize themselves with the digital applications they use.

Relationships Between Different Dimensions of Social Support and Suicidal Ideation in Young People with Major Depressive Disorder

BACKGROUND

Suicidal ideation (SI) is a common feature of depression and is closely associated with suicidal behaviour. Social support is implicated as an important determinant of suicide, but it is unclear how different social support dimensions influence SI in young people with depression. This study examines relationships between social support dimensions and SI in young people with major depressive disorder (MDD).

METHODS

283 Australians aged 15-25, diagnosed with MDD, were recruited from two clinical trials conducted in youth-specific outpatient mental health services. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to evaluate perceived support from Family, Friends, and a Significant Other. Suicidal ideation was assessed using the Suicidal Ideation Questionnaire (SIQ). Hierarchical regression was used to explore associations between social support and SI, controlling for demographics and depression severity.

RESULTS

A hierarchical regression model predicted 9% of the variability in SI, with depression severity being the most significant predictor. Family Support was inversely related to SI and uniquely contributed 2% of the variance; β = -0.15 (95% CI -0.27 - -0.02) p < .05. Demographics and support from Friends or a Significant Other were not significantly associated with SI.

LIMITATIONS

Findings are correlational; it cannot be determined that increasing family support would decrease SI severity.

CONCLUSION

Perceived Family Support was negatively associated with SI in young people with MDD. This suggests that family members might play important roles in suicide prevention efforts. More work is needed exploring ways to empower families to develop adaptive family functioning and support.

The effects of perceived discrimination, social support and ethnic identity on mental health of immigrant adolescents

Background: The number of immigrants has been increasing. Immigrant adolescents experience an acculturation process that affects particularly their ethnic identity, perceived discrimination, and relationships with their peers, which would have significant impact on their mental health. The ethnic composition of social environments might affect this relationship. Objective: The main purpose of the current research is to examine the effect of peer attachment, social support, ethnic identity, and perceived discrimination on immigrant adolescents' mental health. Method: The sample included 226 Syrian immigrants (X¯ age = 13.31, SD=1.67, 70.8 % girls). Adolescents live in a homogenous social environment where proportion of Syrian is higher. Two hierarchical regression models were used to predict depression and emotional problems. In both models, the predictive roles of social and psychological factors were examined in separate steps. Results: The regression analysis results for depression emphasized peer attachment, social support, and ethnic identity did not affect the depression after controlling the effect of emotional problems. Similarly, regression analysis results for emotional problems showed that peer attachment, social support, and ethnic identity did not affect depression after controlling the effect of emotional problems. The results also revealed that perceived discrimination was a risk factor for both depression and emotional problems. Conclusions: The results underlined the importance of psychological variables on immigrant adolescents' depression. Past research emphasized that ethnic identity and peer support had a buffering effect on mental health. The current study participants were living in a different area where they attended schools for only immigrants. The social environment was totally different from the host culture. These reasons may account for why social support from ethnic peers and ethnic identity development did not emerge as a protective factor in the present study. The results will further be discussed in terms of the importance of interaction between ethnic and host culture.

How stressful life events and violence are related to mental health: the protective role of social relations in African context

Adolescents are universally expected to be at risk for heightened stress and violence, and subsequently to mental health problems. Good social relationships may protect their mental health, but research has mainly focused on singular relations, such as peer popularity or general social support. The current study analyses the buffering role of multiple relationships in an African context. First, how stressful life-events and violent experiences are associated to mental health, and, second, whether good social relationships with parents, siblings and peers can buffer mental health from stress and violence. The participants were 415 Ghanaian students (aged 14-17 years, M = 16.51; 71% girls). They indicated mental health by depressive symptoms and psychological distress and reported the quality of parental (support and control), sibling (warmth and rivalry) and peer relationships, and exposure to stressful life-events and violence. Hierarchical linear regression models with main and interaction effects were used to analyze the data. Only stressful life-events, but not violence, were associated with higher levels of depressive and psychological distress symptoms. Positive sibling relationships played a buffering mental health role, as stressful life-events were not related with increased depressive symptoms among adolescents enjoying warm and intimate siblingships. No protective function was found for parental or peer relationships, although good maternal and peer relationships were associated with lower levels of depressive symptoms in general.

Short-Term and Long-Term Resilience Among At-Risk Adolescents: The Role of Family and Community Settings

Objective: Given the severe consequences associated with maltreatment, establishing an understanding of pathways to resilience among trauma-exposed youth is a critical public health aim. Longitudinal research has either examined short-term or long-term responses to traumatic events, which prevents testing for a) individual differences between resilience subtypes and b) consistency of short-term, resilient responses over time. Additionally, post-traumatic stress and depression represent the two most common symptom patterns in youth exposed to maltreatment, however few studies have simultaneously investigated resilience to these outcomes. In response, the current study employs a dimensional analytic approach to distinguish between short-term (the ability to demonstrate adaptive responses to ongoing adversities) and long-term (lack of distress over several years in response to a prior adversity) resilience. Consistent with an ecological perspective, the study examines whether family- and community-level protective factors are similarly or uniquely associated with different resilience subtypes.Method: Participants included 943 individuals (469 male, 474 female) from a nationally-representative, at-risk sample of adolescents who completed self-report measures of maltreatment exposure, depressive symptoms and post-traumatic stress symptoms at ages 12, 16, and 18. During the age 12 visit, participants' caregivers completed self-report measures of family routines and neighborhood social cohesion.Results: Overall, we found that family routines uniquely buffered against trauma-related distress across resilience conceptualizations, while social cohesion played a role in short-term resilience to depressive symptoms (p <.05). Participant gender did not moderate these results (p > .05).Conclusion: These findings highlight the importance of understanding resilience dimensionally for adolescents exposed to maltreatment.

Primary and Secondary Prevention of Youth Suicide

Youth suicide is a national and global public health crisis. Pediatricians can use primary and secondary prevention strategies to intervene with youth before or after the onset of suicidal behaviors. Universal suicide risk screening programs can be used to identify youth in medical settings who may otherwise pass through the health care setting with undetected suicide risk. Pediatricians are uniquely positioned to help foster resilience in their young patients and equip families of at-risk youth with safety plans and lethal means safety counseling. Pediatricians on the frontlines of this critical public health crisis require education and training in detecting suicide risk, managing those who screen positive, and connecting their patients to much needed mental health interventions and treatments. Evidence-based suicide risk screening and assessment tools, paired with interventions, are feasible and potentially life-saving in the medical setting.

Patterns of Social Connectedness and Psychosocial Wellbeing among African American and Caribbean Black Adolescents

Adolescents are connected to multiple and interrelated settings (e.g., family, school), which interact to influence their development. Using the National Survey of American Life-Adolescent (NSAL-A), a nationally representative cross-sectional survey, this study examined patterns of social connection and Black adolescents' wellbeing and whether social connection-wellbeing links differed by ethnicity and gender. The sample included 1170 Black adolescents ages 13-17 (69% African American, 31% Caribbean Black, 52% female, mean age 15). Latent profile analysis was used to identify profiles of adolescent connections across family, peer, school, religion, and neighborhood settings. Four profiles of social connection emerged: unconnected, minimal connection, high family connection, and well-connected. The profiles differed in life satisfaction, self-esteem, mastery, coping, perceived stress, and depressive symptoms. The well-connected profile, characterized by connection to all five settings, had significantly higher life satisfaction, self-esteem, mastery, and coping, and lower perceived stress compared to the unconnected and minimal connection profiles and lower depressive symptoms than the unconnected profile. The well-connected profile also had better self-esteem and coping compared to the high family connection profile. The youth in the unconnected profile had significantly lower self-esteem and mastery and significantly higher depressive symptoms than the minimally connected youth. Moderation analyses showed no differences by ethnicity. However, differences by gender were observed for the association between connectedness and life satisfaction. The results support the critical need to examine connectedness across multiple settings and within group heterogeneity among Black youth to develop strategies to promote their psychosocial wellbeing.

Association of Suicide Attempt With Seroprevalence of Toxoplasma gondii in Adolescents

In this study, we aimed to explore the potential pathophysiological relationship between suicide attempts and Toxoplasma gondii infection. Fifty patients aged between 12 and 18 years who attempted suicide and 50 healthy adolescents were included in this study. All adolescents were evaluated by a child psychiatrist using a semistructured interview and Rosenberg Self-Esteem Scale (RSES), Children's Depression Inventory (CDI), and Inventory of Parent and Peer Attachment. T. gondii IgM and IgG antibodies of patients and control subjects were analyzed from blood samples by enzyme-linked immunosorbent assay. Psychiatric disorders particularly mood disorders were more common in adolescents in the patient group. Adolescents attempting suicide were found to have worse relationships with their parents; their CDI scores were higher, and their RSES scores were lower than their healthy peers. There were no significant differences between the patient and the control groups in terms of Toxoplasma IgG antibody positivity. Although the seropositivity of Toxoplasma IgG antibody was higher in the patient group than that in the control group, the difference between the two groups was not statistically significant.

Depression in African American and Black Caribbean Youth and the Intersection of Spirituality and Religion: Clinical Opportunities and Considerations

This article reviews the risk and protective factors, symptom presentation, and the significant interface of spirituality and religion of depression in African American and black Caribbean children and adolescents and their families. The article provides practical implications for diagnosis and treatment of depression in this special population of youth.

Online help-seeking prior to diagnosis: Can web-based resources reduce the duration of untreated mood disorders in young people?

OBJECTIVE

Mood and anxiety disorders typically begin in adolescence or early adulthood, but those at the age of highest risk are among those least likely to access mental health services. However, they may be more likely than other demographic groups to seek help online. The goal of the present study was to investigate the online help- and information-seeking activity of young people newly diagnosed with mood and anxiety disorders in order to better understand how digital resources might serve this population.

METHOD

Participants, aged 15 to 35, with a diagnosis of a mood or anxiety disorder were eligible if they had received their first mental health diagnosis within 24 months. Participants were interviewed with the Pathways to Care Questionnaire, which inquires about online activity prior to one's first interaction with mental healthcare providers.

RESULTS

Forty people participated (depression n = 30, bipolar disorder n = 5, generalized anxiety disorder n = 5); average age 21 years (SD=3.2), 60% female. Eighty-one percent reported seeking help and/or information about their symptoms online. The gap between symptom onset and in-person help seeking was 91.90 weeks (SD=133.7). Most participants (85%) reported they would be open to communicating with a mental health professional online.

CONCLUSION

A majority of young people experiencing clinically-significant symptoms seek help online. However, the gap between symptom onset and treatment initiation remains unacceptably long. Better strategies are needed to translate young people's interest in online resources into meaningful care, whether through web-based services or facilitated pathways to traditional treatment.

Psychopathological and Psychosocial Repercussions of Suicide in the Family

Background:

Although the relationship between the occurrence of suicide and the presence of psychosocial suffering in bereaved relatives is clear, there are still few studies that deal with the detail of these repercussions and the therapeutic conduction given to them for the suicide.

Objective:

to carry out an integrative review on the psychopathological and psychosocial repercussions of suicide in the family, with emphasis on the detail of the main psychopathological characteristics presented by the individuals and the psychosocial impacts of mourning.

Method:

An integrative review was performed. The guiding question considered Population Intervention Comparator Outcome Setting and the revision protocol is in agreement with Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. The search occurred in the bases: Periodicals CAPES, PsycINFO and PubMed. Original articles were included, without language restriction that emphasized psychopathological and psychosocial aspects of the mourners after suicide. We excluded review studies, clinical cases, editorials and retrospectives.

Results:

The process of suicide mourning for family members is a complex event, marked by stigma and can predispose patients to mental illness and suicidal behavior, especially in the early years of mourning. In addition, it is necessary to expand the scope of evidence on the effectiveness of support and intervention with this population.

Conclusion:

Bereaved families need specialized preventive support insofar as the complexity of bereavement becomes a vulnerability factor for mental illness.

When do peers matter? The moderating role of peer support in the relationship between environmental adversity, complex trauma, and adolescent psychopathology in socially disadvantaged adolescents

INTRODUCTION

This study examined the longitudinal associations between environmental adversity (defined in terms of exposure to violence in the neighborhood, school, and media), complex trauma (operationalized as experiences of abuse and neglect), and adolescents' internalizing and externalizing symptoms.

METHODS

Using a cross-lagged panel research design, we investigated the moderating role of peer support in these relationships in a sample of 644 adolescents from a severely disadvantaged district of Lima, Peru, who were followed up in a 1-year prospective study.

RESULTS AND CONCLUSIONS

We found significant unidirectional dynamic relations, where both types of adversity were associated with higher levels of internalizing and externalizing symptoms. Peer support significantly moderated this effect, but only for complex trauma, in that higher levels of peer support were associated with a decreased impact of complex trauma on internalizing and externalizing symptoms. These findings highlight the importance of social relations and the quality of peer relations in particular as factors that may mitigate the risk of early exposure to trauma.

Social Functioning and Suicide Risk in a Community Sample of Adolescents

Suicide is the second leading cause of death among young people. Both mental illness and social factors are associated with suicide in adolescents, and youth with mental disorders often experience social deficits, which may compound risk. The cumulative effects of mental disorders and social factors on suicidal ideation and behaviors (SIB) in adolescents have not previously been explored. Adolescents 13-18 years of age (N = 6,447; 49% female, 65% non-Hispanic White) participated in the National Comorbidity Survey Replication Adolescent Supplement. Adolescents were interviewed to assess mental health diagnoses, history of SIB, and relationship quality. Parents completed self-reports about adolescent mental health and family characteristics. Logistic regression estimated associations of friend, sibling, and family relationships with 12-month SIB and lifetime suicide attempt (SA); associations between relationships, SIB, and SA were compared across classes of mental disorders. Friendship negativity (odds ratio [OR] = 1.20, 95% confidence interval (CI) [1.04, 1.40]), and family conflict (OR = 1.26, 95% CI [1.13, 1.41]), were positively associated with SIB, beyond the risk conferred by mental disorders, particularly mood disorders (OR = 4.75, 95% CI [3.20, 7.05]). Friendship positivity (OR = 0.89, 95% CI [0.80, 0.99]); sibling relationship positivity (OR = 0.79, 95% CI [0.68, 0.91]); family cohesion (OR = 0.77, 95% CI [0.69, 0.87]); maternal care (OR = 0.76, 95% CI [0.69, 0.84]); and paternal care (OR = 0.68, 95% CI [0.59, 0.78]), were inversely associated with SIB. Sibling relationship positivity, family conflict, and paternal care were similarly associated with SA. Self-reported adolescent friend and family relationship characteristics are associated with SIB and SA beyond the risk conferred by mental disorders. This suggests that perceptions of friend and family relationships may be an appropriate target to reduce suicide risk among adolescents.

Posttraumatic Stress Disorder and Mental Distress Following the 2004 and 2005 Florida Hurricanes

OBJECTIVE

Community characteristics, such as perceived collective efficacy, a measure of community strength, can affect mental health outcomes following disasters. We examined the association of perceived collective efficacy with posttraumatic stress disorder (PTSD) and frequent mental distress (14 or more mentally unhealthy days in the past month) following exposure to the 2004 and 2005 hurricane seasons.

METHODS

Participants were 1486 Florida Department of Health workers who completed anonymous questionnaires that were distributed electronically 9 months after the 2005 hurricane season. Participant ages ranged from 20 to 79 years (mean, 48; SD, 10.7), and the majority were female (79%), white (75%), and currently married (64%). Fifty percent had a BA/BS degree or higher.

RESULTS

In 2 separate logistic regression models, each adjusted for individual sociodemographics, community socioeconomic characteristics, individual injury/damage, and community storm damage, lower perceived collective efficacy was significantly associated with a greater likelihood of having PTSD (OR, 0.93; 95% CI, 0.90-0.96), and lower collective efficacy was significantly associated with frequent mental distress (OR, 0.94; 95% CI, 0.92-0.96).

CONCLUSIONS

Programs enhancing community collective efficacy may be a significant part of prevention practices and possibly lead to a reduction in the rate of PTSD and persistent distress postdisaster. (Disaster Med Public Health Preparedness. 2019;13:44-52).

Advanced practice registered nurses attitudes toward suicide in the 15- to 24-year-old population

PURPOSE

The purpose of this study is to assess advanced practice registered nurses (APRNs) attitudes toward suicide in the 15- to 24-year-old population.

DESIGN AND METHODS

A convenience sample of national psychiatric and pediatric APRNs was obtained from postings on professional websites and sending invitations to members utilizing anonymous Qualtrics^ⓒ survey that included demographic questions and the Suicide Opinion Questionnaire (SOQ).

FINDINGS

The pediatric APRNs demonstrated more positive attitudes toward suicide as measured by the SOQ when individual items were analyzed.

PRACTICE IMPLICATIONS

One of the outcomes of this study is to raise awareness and foster prevention related to suicide for advanced practice registered nurses and the 15- to 24-year-old population.

Shame and Depressive Symptoms: Self-compassion and Contingent Self-worth as Mediators?

Research has identified the experience of shame as a relevant predictor of depressive symptoms. Building upon resilience theory, this is the first study to investigate if self-compassion and/or contingent self-worth (i.e., family support and God's love) mediate the link between shame and depressive symptoms. Participants were 109 African Americans, within the age range of 18 and 64, who sought service following a suicide attempt from a public hospital that serves mostly low-income patients. Findings suggest that shame was related to depressive symptoms through self-compassion but not through contingent self-worth, underscoring the significant role that self-compassion plays in ameliorating the aggravating effect of shame on depressive symptoms. Results highlight the value of incorporating self-compassion training into interventions for suicidal African Americans in an effort to reduce the impact of shame on their depressive symptoms and ultimately their suicidal behavior and as a result enhance their capacity for resilience.

Lessons Learned from 50 Years of Violence Prevention Activities in the African American Community

PURPOSE

This article covers violence prevention (homicide and suicide) activities in the African American community for nearly 50 years.

METHOD

Drawing on lived experience the works of early and recent efforts by African American physicians, the author illustrates we know a great deal about violence prevention in the African American community.

RESULTS

There remains challenges of implementation and political will. Further, most physicians, like the public, are confused about the realities of homicide and suicide because of the two different presentations both are given in the media and scientific literature.

CONCLUSIONS

Responses to homicide and suicides should be based on science not distorted media reports. There are violence prevention principles that, if widely implemented, could stem the tide of violence.

Childhood cumulative contextual risk and depression diagnosis among young adults: The mediating roles of adolescent alcohol use and perceived social support

This study examined associations between cumulative contextual risk in childhood and depression diagnosis in early adulthood, testing two adolescent mediating mechanisms, alcohol use and perceived social support from family and friends, while accounting for the stability of internalizing problems over time and examining possible gender moderation. Multiple group mediation analyses were conducted using parent- and adolescent-report as well as hospital records data from the Northern Finland Birth Cohort 1986 (N = 6963). Our analyses demonstrated that the association between cumulative contextual risk in childhood and depression diagnosis in adulthood is mediated by adolescent alcohol use and perceived social support both for boys and girls. The findings highlight potentially malleable mediating mechanisms associated with depression in vulnerable youth that could be targets in selective depression preventive interventions.