Longitudinal trajectories of suicidal ideation and attempts in adolescents with psychiatric disorders in Chile: study protocol

INTRODUCTION

Adolescent suicide is a worldwide public health problem, being the second and the third leading cause of death in the 15-29 and the 15-19 age groups, respectively. Among adolescents, it is estimated that for every suicide, there are 100-200 suicide attempts. Although 79% of suicides in the world occur in low/middle-income countries, most of scientific evidence comes from high-income and low-risk countries. In recent years, adolescent suicide rates have steadily increased in Chile. Deaths caused by self-harm increased by 220% in the population aged 10-19 years between 2000 and 2015. The Maule Region is one of the regions of Chile with the highest levels of suicide among those aged 15 and 19 years old. The objective of this study is to evaluate the trajectories of ideation and suicidal attempts in adolescents with psychiatric disorders treated within the public health system of the Maule Region, Chile, based on different clinical, psychological and neuropsychological factors.

METHOD

A prospective naturalistic study of a clinical sample of adolescents under psychiatric treatment in the Maule Region, Chile. Adolescents will be evaluated using a thorough protocol that includes suicide-related clinical variables. The study seeks to establish patterns of change in the trajectories of ideation and suicide attempts among adolescents.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Scientific Ethics Committee of the Universidad Católica del Maule in Chile. This protocol was registered in ClinicalTrials.gov. The results of this study will be disseminated to health centres through executive reports and feedback sessions. In addition, the most relevant findings will be presented in scientific articles, conferences and seminars open to the community.

TRIAL REGISTRATION NUMBER

NCT04635163.

Validación de la Escala de Fortalezas Familiares en población adulta chilena

El enfoque de las fortalezas familiares sugiere que las familias son capaces de surgir y salir exitosas de los desafíos de la vida cotidiana. Teniendo esto en cuenta, el objetivo de este estudio fue validar la Escala de Fortalezas Familiares, adaptada de un estudio en España, en una población chilena. Para esto, la muestra estuvo formada por 324 adultos chilenos que debían completar el instrumento de 12 ítems. El modelo de dos factores de la escala fue validado mediante un análisis factorial confirmatorio (χ2/gl = 2.86; rmsr = 0.041; rmrsea = 0.076; cfi = 0.950; tli = 0.937), y se encontró que los dos factores se relacionan con aspectos de la autoeficacia familiar y la percepción de adaptación en las familias; en ambos casos se estimaron valores de confiabilidad de escala adecuados (alfa de Cronbach de .91 y .72, respectivamente). Estos resultados permiten avalar la utilización de la escala en la población chilena, lo que podrá contribuir en el avance del conocimiento respecto al funcionamiento familiar, así como guiar intervenciones de prevención y promoción con familias dirigidas a potenciar fortalezas y recursos protectores garantes de una parentalidad respetuosa y afectiva, y al mejoramiento de la calidad de vida familiar.

Interactive associations of parental support, demands, and psychological control, over adolescents' beliefs about the legitimacy of parental authority

The present study examined the relationship between parental support, demand, psychological control and adolescents' beliefs about the legitimacy of parental authority for personal and multifaceted issues in a sample of 1342 Chilean adolescents (M = 16.38, SD = 1.24, age range 14-20). Results from multiple regression analyses separated by age indicated that demand was positively associated with adolescents' beliefs about the legitimacy of parental authority for personal and multifaceted issues and that psychological control was negatively associated with adolescents' legitimacy beliefs concerning personal issues. Furthermore, parental support moderated the relationship between parental demand and adolescents' beliefs about parental legitimacy for personal and multifaceted issues: those who display high levels of demand showed stronger beliefs about parental legitimacy at high level of support. These results support the interactive effect of parental support and demand on adolescent development.

Chilean Adaptation and Validation of the Early Adolescent Temperament Questionnaire-Revised Version

The aim of this study was to develop an adapted version of the Early Adolescent Temperament Questionnaire-Revised (EATQ-R) that would be valid and reliable for assessing temperament and its components in Chileans between 12 and 18 years of age. Originally, Ellis and Rothbart (2001) developed this questionnaire (EATQ-R) to be used in North American adolescents. For the study in Chile, a translation protocol was developed, to maintain the original instrument's cultural and linguistic equivalence in the adapted version. Psychometric properties of the EATQ-R, such as factor structure, internal consistency, and convergent validity, were also assessed. The adaption and validation was carried out in two stages, with two different studies. The first study, which included 612 adolescent students from educational establishments in the cities of Santiago and Concepcion, Chile, developed the Chilean version of the 83-item EATQ-R, which has 13 dimensions, belonging to 4 theoretical factors with adequate internal consistency (Cronbach's alpha = 0.79-0.82). The second study assessed the questionnaire's convergent validity, through its application to 973 adolescent students in Santiago. Results show that the effortful control subscale was significantly inversely related to indicators of adolescent maladjustment, such as substance abuse and behavioral problems. In addition, it was directly associated with indicators of self-concept, including self-esteem and self-efficacy. The opposite pattern was observed when considering negative affect. These findings coincide with current knowledge on the relationship between temperament and adjustment in adolescents.

Brief report: Agreement between parent and adolescent autonomy expectations and its relationship to adolescent adjustment

While disagreement in autonomy expectations between parents and their adolescent children is normative, it may also compromise adolescent adjustment. This study examines the association between parents' and adolescents' agreement on autonomy expectations by cognitive social domains and adolescent adjustment. A sample of 211 Chilean dyads of adolescents (57% female, M_age = 15.29 years) and one of their parents (82% mothers, M_age = 44.36 years) reported their expectations for the age at which adolescents should decide on their own regarding different issues in their life. Indexes of parent-adolescent agreement on autonomy expectations were estimated for issues of personal and prudential domains. Greater agreement in the prudential than in the personal domain was observed. For boys and girls, higher agreement in adolescent-parent autonomy expectations in the personal domain was associated with lower substance use. A negative association between level of agreement in adolescent-parent autonomy expectations in the prudential domain and externalizing behaviors and substance use was found.

Parental and individual predictors of trajectories of depressive symptoms in Chilean adolescents

Depressive symptoms are prevalent in adolescence, but not all adolescents experience the same level or evolution of symptoms, suggesting the need to identify differences in trajectories of symptoms. We used Growth Mixture Modeling to analyze different trajectories of depressive symptoms in a sample of 1,072 Chilean adolescents (12-15 years old, 54% female). First, a baseline model was selected and then adolescent irritability, maternal warmth, demandingness and disrespect were introduced to the model as predictors of class membership. Four latent class trajectories of depressive symptoms were identified: high persistent (12%), low stable (56%), high decreasing (15%) and low increasing (17%). Low stable was the most prevalent class, and was characterized by higher maternal warmth and lower maternal disrespect and adolescent irritability while high persistent was characterized by the opposite maternal characteristics. Significant gender differences in class membership were observed. The results highlight the importance of identifying different trajectories of depressive symptoms and specific predictors of each trajectory. The association of parenting dimensions with trajectories of persistent depressive symptoms provides evidence that parenting can serve as both a protective and risk factor for adolescent adjustment.