An Introduction to Assessing Anxiety in Child and Adolescent Multiethnic Populations: Challenges and Opportunities for Enhancing Knowledge and Practice

Interpersonal Life Stress and Inflammatory Reactivity as Prospective Predictors of Suicide Attempts in Adolescent Females

Adolescents' suicidal behavior frequently is preceded by interpersonal stress, but not all who experience distress attempt to end their lives. Recent theories have posited individual differences in stress-related inflammatory reactivity may be associated with psychopathology risk; this study examined inflammatory reactivity as a moderator of the prospective association between interpersonal stress and adolescents' suicidal behavior. Participants included 157 at-risk adolescent females (ages 12 to 16 years) and assessed individual differences in proinflammatory cytokine responses to a brief laboratory-based social stressor, both interpersonal and non-interpersonal life events, and suicidal behavior over an 18-month follow-up period. Measuring levels of the key proinflammatory cytokines interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) before and after an experimentally-induced social stressor, results revealed that blunted cytokine reactivity heightened the effect of high interpersonal stress exposure on risk for suicidal behaviors over the subsequent 9 months. Significant effects were not revealed for non-interpersonally themed stress. Finding highlight the urgent need for more research examining inflammation reactivity among adolescents.

Cognitive Errors, Anxiety Sensitivity, and Anxiety Control Beliefs

This study examined the interrelations among negative cognitive errors, anxiety sensitivity, and anxiety control beliefs and explored their unique and specific associations with anxiety symptoms in a community sample of youth. Existing research has suggested that these constructs are related to childhood anxiety disorder symptoms; however, additional research is needed to test the interrelations among negative cognitive errors, anxiety sensitivity, and anxiety control beliefs and to determine if they show unique and specific associations with anxiety symptoms. The results of this study indicated that negative cognitive errors, anxiety sensitivity, and anxiety control beliefs were associated with each other and that they demonstrated unique concurrent associations with childhood anxiety disorder symptoms. Moreover, certain cognitive biases showed specificity in their association with anxiety symptoms versus depressive symptoms.

Examination of Measurement Invariance Across Culture and Gender on the RCMAS-2 Short Form Among Singapore and U.S. Adolescents

Tests of measurement invariance were conducted across culture and gender on the Revised Children’s Manifest Anxiety Scale–Second Edition (RCMAS-2) Short Form in a sample of 1,003 Singapore and U.S. adolescents. The results of multi-group confirmatory factor analyses across culture and gender supported at least partial measurement invariance. ANOVA results indicated significant cultural and gender effects, with U.S. adolescents reporting higher levels of anxiety than Singapore adolescents, but with a negligible effect size, and females reporting higher levels of anxiety than males on the RCMAS-2 Short Form. Implications of the findings of the study are discussed.

Factor structure of measures of anxiety and depression symptoms in African American youth

Previous research has suggested that the factor structure of anxiety measures is different in African American samples compared to majority population samples. However, these findings may be due to misuse of analytic methods rather than meaningful differences in the underlying presentation of anxiety. To address this, we examined the factor structure of two measures of child anxiety: the Revised Children's Anxiety and Depression Scale and the Multidimensional Anxiety Scale for Children in a sample of 229 African American youth. Contrary to previous research, confirmatory factor analyses yielded good fit for the original factor structures of both measures. These results suggest that the underlying factor structure of these measures may not be significantly different for African American and majority population youth as previously thought. The effect of data analytic procedures on subsequent conclusions and theory is discussed and recommendations are made.

A confirmatory factor analysis of the Beck Anxiety Inventory in African American and European American young adults

The anxiety literature is particularly sparse as it relates to African Americans, and there are few studies to date that have examined the factor structure of anxiety assessment tools within this population. The current study investigated the original two-factor structure of the Beck Anxiety Inventory (BAI) in addition to two extant factor structures of the BAI in a non-clinical sample of African American and European American young adults. One hundred twenty one European American and 100 African American young adults completed the BAI. Results of a confirmatory factor analysis indicated that the previous factor structures of the Beck Anxiety Inventory do not provide the best fit for either the African American or the European American sample. An exploratory factor analysis revealed that an alternative, two-factor model provided the best fit for the sample, particularly for the African American sample. Implications and suggestions for future research are discussed.

Negative Thinking as a Coping Strategy Mediator of Pain and Internalizing Symptoms in Adolescents with Sickle Cell Disease

The objective of this study was to examine the role of coping strategies, specifically negative thinking, in mediating the association of pain with symptoms of anxiety and depression in adolescents with sickle cell disease. Fifty-two 12-18-year-old adolescents with sickle cell disease completed a daily pain diary and paper-and-pencil measures of pain, pain coping, depression and anxiety. Symptoms of depression and anxiety were within the non-clinical range. Preliminary analyses indicated that lower family income was associated with higher reports of pain and negative thinking. Mediation regression analyses supported negative thinking as mediating the association of: (1) pain intensity with depression, and (2) pain interference with daily activities with anxiety. Findings highlight negative thinking as a factor compromising adolescents' adaptation to sickle cell pain; however, further investigation is required to determine the mediating influence of pain coping. Associations for lower income emphasize the multiple risk factors experienced by many of these adolescents.

Pain, disability, and symptoms among siblings of children with functional abdominal pain

OBJECTIVE

To examine reports of pain, disability, and somatic and psychological symptoms among siblings of children with functional abdominal pain (FAP) and siblings of "healthy" comparison children.

METHODS

This survey study explored two groups of participants (FAP and healthy) consisting of (1) children with FAP and their siblings and parents and (2) healthy comparison children and their siblings, and parents. Participants included 13 FAP families and 10 healthy comparison families. Siblings and children were between 8 and 14 years of age. Measures included the Behavioral Assessment System for Children, Abdominal Pain Index, Children's Somatization Inventory, Functional Disability Inventory, and Family Inventory of Life Events. Cross-sectional data were analyzed using correlations and analysis of variance techniques.

RESULTS

Siblings of children with FAP reported significantly greater mean levels of emotional/ behavioral symptoms than siblings of healthy comparison children. No significant between-group differences were identified in FAP and healthy comparison parents' reports of siblings' pain or emotional/behavioral symptoms. There were significantly more persons with pain problems living in the homes of FAP families. Among FAP families, a greater number of parent-reported family stressful life events was significantly associated with sibling functional disability and somatic symptoms.

CONCLUSION

This investigation suggests that siblings of children with FAP experience more emotional/behavioral symptoms than peers and that their symptoms are not readily identified by parents. These findings highlight the importance of considering the psychological functioning of "unaffected" siblings and family stressors when children present with recurrent pain complaints.

Depression and ethnicity as intermediary variables among dissociation, trauma-related cognitions, and PTSD symptomatology in youths

The study of childhood posttraumatic stress disorder (PTSD) has grown in recent years, and several variables have been closely linked to the etiology of this condition. Prominent examples include dissociation, trauma-related cognitions, and depression, but no empirically based model regarding these variables has been presented. We examined 90 adolescents housed in a state-run facility for youths who experienced maltreatment, violence, and/or other traumas. Utilizing psychometrically strong dependent measures, we identified a structural equation model with depression as a key mediating variable between (1) dissociation and trauma-related cognitions and (2) PTSD symptomatology. In addition, African American status was found to weaken this relationship, whereas multiracial status was found to strengthen this relationship. These results are discussed within the context of contemporary integrative theories regarding the developmental psychopathology of PTSD in youths.

Current Measures of PTSD for Children and Adolescents

OBJECTIVE

To review measures of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PSS) for children and adolescents.

METHODS

We reviewed broad-based child mental health journals within the disciplines of pediatrics, child psychology, and trauma, from 1995 to 2004, to identify measures of PTSD and PSS for children and adolescents. The review includes a summary of the psychometric properties and associated features of the measures and the clinical domains and types of studies using each measure.

RESULTS

Seven measures of PTSD and PSS were identified, including clinician-administered interviews and self-report questionnaires. Sixty-five articles containing the measures were categorized into eight trauma domains. We found there is little consensus over measures used within each trauma domain.

CONCLUSIONS

Few measures of PTSD and PSS have been designed specifically for young people. Further directions for measurement of PTSD in this age group are discussed to prevent under-diagnosis and under-treatment for youth.