Adolescent Psychiatry - Volume 10, Issue 4, 2020

Background and Goals: The current study investigated the relationship between gang involvement and multiple mental health difficulties; anxiety, depression, paranoia, victim trauma and perpetrator trauma. Additionally, it examined the mediating influence of an individual’s exposure to violence within this relationship. Method: One hundred adolescents aged 11-16 years old completed two questionnaires and an interview which investigated their friendship groups, exposure to violence and mental well-being. Eighteen participants were identified as current or ex-gang members and the other eighty-two were classified as the nongang comparison group. Results: Findings show that gang members displayed more symptoms of depression and perpetrator trauma compared to non-gang members. The relationship between gang involvement and these mental health difficulties was mediated by exposure to violence. Conclusion: Discussion focuses on the need for researchers, practitioners and policymakers to acknowledge the relationship between gang involvement and mental health difficulties and implement additional strategies to support young people currently or previously involved in gangs.

Background: Examining the effectiveness and adequacy of adolescents’ psychiatric inpatient treatment through multiple perspectives is crucial to provide the best care. Objectives: The aims of the current study were to examine the consistencies and discrepancies between patients and clinicians and to understand how each group considered the timing of improvement of symptoms and psychosocial difficulties of adolescents during a psychiatric inpatient stay. Methods: The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA, assessing symptoms and psychosocial difficulties) was rated on a weekly basis by patients and clinicians during a psychiatric inpatient stay. Data were collected from 297 patients, 58.2% females. Results: Both clinicians and patients reported a significant decrease of the HoNOSCA scores from admission to discharge, revealing that inpatient treatment is perceived as helping the adolescents to alleviate their symptoms and psychosocial difficulties. However, the item-by-item analyses indicated that patients and clinicians reported difficulties in different symptoms and psychosocial domains. Moreover, the week-by-week analyses revealed discrepancies in the perception of the time-course of clinical outcome- changes between clinicians and patients, as well as between males and females, and between voluntarily and involuntarily admitted patients. Conclusion: By integrating perspectives of patients and clinicians and their respective timelines, as well as by taking into account the mode of admission and the patient’s gender, this study provides a deeper understanding of the evolution of clinical outcome during adolescents’ hospitalizations, which allows to adapt their treatment and therewith, to help patients more efficiently.

Background and Objective: The high prevalence of adolescent self-harm within mental health services presents considerable management concerns, exacerbated by a lack of clear evidence regarding therapeutically effective approaches. This shortfall perpetuates traditional risk-averse practice, despite likely inadequacies in mitigating self-harm through failing to address underlying psychological mechanisms. Therapeutic risk, defined as an approach whereby clinicians support individual risk-taking, may be an alternative that yields improved recovery outcomes. However, related research is adult-focused and provides limited detail on its features, practical delivery and impact on recovery. Consequently, the current study explored the experiences of professionals delivering a therapeutic risk ethos, including their conceptualisation of it and its impact on young people. Methods: Semi-structured interviews were conducted with seven mental health support workers employed by a residential healthcare provider, which promotes a therapeutic risk approach. The provider supported service users aged 15 - 20 experiencing complex psychopathology who, following inpatient discharge, presented a high risk of self-harm and suicidality. Interview data was thematically analysed. Discussion and Conclusion: Staff participants provided their understanding of a therapeutic risk approach, suggesting risk is viewed as positive and beneficial to recovery, alongside the promotion of service user freedom and flexible therapeutic risk management. The perceived therapeutic risk incorporates both permission and support, which facilitate the exploration of underlying feelings and alternative actions. Additionally, therapeutic risk promotes positive recovery outcomes due to empowered service users having increased control over their lives. They argued this can reduce psychological distress, encouraging the development of emotional regulation and adaptive coping strategies.

Background: Suicidal ideation (SI) and suicide attempts (SAs) among adolescents are a significant public health concern worldwide. The current study extends previous research by exploring the association between adverse childhood experiences (ACEs) and SI and SAs in a sample of inpatient adolescents as well as identifying specific predictors for increased risk of SI and SAs. Methods: Associations between ACE scores and self-reported SI and SAs were explored in a sample of 154 inpatient adolescents via clinical interview and by analyzing the association between cumulative ACE scores and scores on the Suicidal Tendency scale of a larger personality measure. We also tested for independent relationships between 19 ACEs and SI and SAs to determine unique predictors for suicidality. Results: One-way ANOVA analyses revealed that those who attempted suicide reported significantly more ACEs compared to those who did not attempt suicide. Witnessing violence in the home, school, or neighborhood and experiences of discrimination increased one’s likelihood to attempt suicide by two to threefold, while sexual abuse, neglect, and physical abuse increased this likelihood by three-to-fourfold. Stepwise linear regression analyses demonstrated that emotional abuse, living with someone who had mental health problems or attempted suicide were most associated with elevated Suicidal Tendency scores on a personality measure. Conclusion: Early identification, education and intervention are imperative to limit or eliminate ACEs from occurring. The impact of cumulative as well as specific ACEs on suicide risk should be closely considered as areas for such intervention. Areas for future research include extending to include more diverse populations such as the LGBTQ community as well as more ethnically and racially diverse populations.

Background: The separation of anxiety disorder and depressive disorder as two distinct disorders is often questioned. The aim of the current study is to examine whether there is a different profile of life events and personality characteristics for anxiety and depression disorders in adolescents. Methods: One hundred forty-six adolescents participated in the study; 57 boys and 89 girls, ranging in age from 11-18 years (mean=15.08+1.97). The study group included 92 adolescents with a clinical diagnosis of depression or anxiety, and the comparison group included 54 teenagers with no known psychopathology. Results: Multinomial logistic regression produced different predictive profiles for anxiety disorder and depressive disorders. Life event variables, especially minor life events and early traumas, were found to be predictors for depression. Furthermore, an interaction was found between early trauma and minor life events in the prediction of depression, such that the existence of trauma weakened the statistical correlation between minor life events and the onset of depression. In addition, contrary to the literature regarding adults, it was found that during adolescence, personality variables have a unique contribution as predictive factors for vulnerability to the onset of anxiety and depression, thus reducing the significance of life events. Conclusion: Our findings suggest that different profiles of life events and personality characteristics can be identified for the two disorders. In addition, it appears that early traumas are a dominant factor that overshadow more recent life events at the onset of depression among adolescents.

Background: Young mothers have higher rates of mental health problems, yet can be difficult to engage in care. Few interventions exist targeting the full range of mental health problems these women face. While transdiagnostic psychotherapies have been utilized in adolescent groups, they have not been tested in young mothers. Objective: Our objective was to examine the feasibility and acceptability of a public health nurse-delivered transdiagnostic CBT-based resilience curriculum for young mothers in a supported school setting, and to determine preliminary estimates of the program’s effects. Methods: 56 mothers, 21 years of age or younger were recruited from a supported high school program in Canada. Using a pretest/post-test design with no control group, measures of maternal depression, anxiety, emotion regulation, and offspring behaviour were collected immediately before and after the completion of the weekly 10-session intervention. Results: The intervention was feasible and acceptable to young mothers. While few statistically significant changes were noted in the complete sample, for those with moderate-severe depression at baseline, program participation resulted in clinically meaningful improvements in depression, anxiety, and emotion regulation. Conclusion: Provision of a transdiagnostic CBT-based resilience-building program delivered by public health nurses in a supported school setting was both feasible and well-tolerated. Given the preliminary nature of this study, its clinical utility is unclear, though it may have benefits for young mothers with more significant mental health problems at baseline.