Limited research has examined factors distinguishing between patterns of adolescent suicidal thou... more Limited research has examined factors distinguishing between patterns of adolescent suicidal thoughts and behaviors. The current study examined demographic, school, family, and mental health differences across patterns identified by Romanelli and colleagues (2022): history of thoughts only, plans with thoughts, attempt with thoughts and/or plans, and attempt without thoughts. The current study includes 4,233 students (Mage = 14.65 years, SD = 2.06) with a history of suicide risk referred to school Student Assistance Program teams. The sample was approximately 60.7% female, 59.8% White (16.0% Black, 15.4% multiracial, 8.8% other), and 14.4% Hispanic. Results indicated that the “attempt without thoughts” group was small with no differentiating characteristics. However, membership in the other three groups was predicted by demographic, school, family, and mental health factors. These results support the importance of examining suicidal thoughts, plans, and attempts as distinct indicato...
Suicide and depression are serious public health issues for adolescents. To increase the effectiv... more Suicide and depression are serious public health issues for adolescents. To increase the effectiveness of interventions for youth depression and suicide, research on the mechanisms of change within existing interventions is an area of increasing interest. Using outcomes data from a large randomized controlled trial and observational coding of therapy sessions, this study addressed whether therapist adherence to core relational interventions in the caregiver–adolescent attachment task of attachment-based family therapy (ABFT) contributes to change in posttreatment outcomes (suicidality, depression, and family functioning). The sample included 58 youth who received ABFT. Trained coders rated 58 taped recordings of the attachment task for each individual using an adherence measure developed for the randomized controlled trial. Findings revealed several associations between therapist adherence and outcomes. First, the attachment task was associated with a reduction in adolescent depression scores posttreatment, at the 95% confidence interval, as well as in suicidality, at the 90% confidence interval. Second, adherence in the first half of treatment (before the attachment task) led to enhanced family cohesion at mid-treatment. Finally, a mediation analysis indicated that greater adherence in the attachment task of ABFT increased family cohesion, which, in turn, improved depression outcomes posttreatment. This study provides support for family cohesion—which, in this study, led to reductions in youth depression symptoms posttreatment—as a mechanism of change in the attachment task of ABFT. Clinical implications, study limitations, and future research are reviewed.
. Background: Suicide is a serious public health problem for LGBTQ+ adolescents and young adults.... more . Background: Suicide is a serious public health problem for LGBTQ+ adolescents and young adults. Attachment-based family therapy (ABFT) is one of the few suicide treatment models that has been tested with this population. The challenge remains in how to implement ABFT into the ecology of LGBTQ+ service settings. Aims: In this study, we tested the feasibility, acceptability, and preliminary effectiveness of ABFT in LGBTQ+ community settings. Method: Ten participants were enrolled in 16 weeks of ABFT across three LGBTQ+ organizations. Feasibility (treatment completion) and acceptability (Working Alliance Inventory [WAI]; opinions about treatment [OAT]) were measured for youth and caregivers. Depression and suicide outcomes were assessed for nine participants. Results: ABFT was demonstrated to be both feasible and acceptable. All participants completed treatment, and there were no dropouts. Adolescents/young adults and their caregivers reported high WAI and adequate OAT scores throughout treatment. There was a significant decrease in suicidal ideation (β = −12.16, t(10) = −3.14, p < .01). Decreases in depression, however, were not significant (β = −1.83, t(9.11) = −0.88, p = .40). Limitations: The small sample limits our ability to estimate treatment effectiveness. A larger effectiveness trial is warranted. Conclusion: ABFT is a promising treatment for LGBTQ+ service settings.
Depressive symptoms and self-harm, i.e. non-suicidal self-injury and suicidal behaviors, are high... more Depressive symptoms and self-harm, i.e. non-suicidal self-injury and suicidal behaviors, are highly prevalent in youngsters involved in Child Welfare System (CWS) services. Little research investigates, however, why these CWS youngsters are at risk. We explored whether trust in caregiver support and communication about experiences with primary caregivers, are associated with CWS youngsters' depressive symptoms and/or self-harm. An anonymous online survey of 271 CWS youngsters (10-21 years of age, 57.2% female) was used to assess trust and communication, and depressive symptoms/self-harm. Results showed significant negative associations between self-reported trust in maternal and paternal support, and depressive symptoms/self-harm. Communication about experiences with one's biological mother mediated the relationship between trust in maternal support and depressive symptoms/self-harm. Furthermore, the presence of an additional trustworthy caregiver buffered the impact of low ...
Developmental and behavioral pediatrics has emerged as an area of special interest and new respon... more Developmental and behavioral pediatrics has emerged as an area of special interest and new responsibility for pediatricians. The aim of this study was to evaluate the impact of training, experience, and other factors on pediatricians' satisfaction with their abilities to care for children with developmental, behavioral and psychosocial problems. A questionnaire was sent to 211 pediatricians working in primary care clinics in the community in Israel. Items included personal characteristics and experience, practice and satisfaction with the care of children with developmental, behavioral and psychosocial problems. Overall, pediatrician satisfaction with their personal abilities in this domain was defined as the dependent variable on multivariate analysis. The response rate was 76.3% (n = 161). Pediatricians' satisfaction with their overall professional ability to care for children with developmental, behavioral and psychosocial problems was significantly and positively associated with the following independent variables: (i) satisfaction with training received in the child development field; (ii) satisfaction with psychiatric updates; (iii) general satisfaction with the available child development services; (iv) prescription of methylphenidate to children with attention deficit/hyperactivity disorder; and (v) having completed their medical studies in a country in which the issue is emphasized. Imparting more knowledge and skills in child development and behavioral pediatrics in pediatric residency and continuing education programs will help improve the attitudes of primary care pediatricians towards developmental and behavioral problems, encourage them to treat these patients and their families, and better the quality of care.
Limited research has examined factors distinguishing between patterns of adolescent suicidal thou... more Limited research has examined factors distinguishing between patterns of adolescent suicidal thoughts and behaviors. The current study examined demographic, school, family, and mental health differences across patterns identified by Romanelli and colleagues (2022): history of thoughts only, plans with thoughts, attempt with thoughts and/or plans, and attempt without thoughts. The current study includes 4,233 students (Mage = 14.65 years, SD = 2.06) with a history of suicide risk referred to school Student Assistance Program teams. The sample was approximately 60.7% female, 59.8% White (16.0% Black, 15.4% multiracial, 8.8% other), and 14.4% Hispanic. Results indicated that the “attempt without thoughts” group was small with no differentiating characteristics. However, membership in the other three groups was predicted by demographic, school, family, and mental health factors. These results support the importance of examining suicidal thoughts, plans, and attempts as distinct indicato...
Suicide and depression are serious public health issues for adolescents. To increase the effectiv... more Suicide and depression are serious public health issues for adolescents. To increase the effectiveness of interventions for youth depression and suicide, research on the mechanisms of change within existing interventions is an area of increasing interest. Using outcomes data from a large randomized controlled trial and observational coding of therapy sessions, this study addressed whether therapist adherence to core relational interventions in the caregiver–adolescent attachment task of attachment-based family therapy (ABFT) contributes to change in posttreatment outcomes (suicidality, depression, and family functioning). The sample included 58 youth who received ABFT. Trained coders rated 58 taped recordings of the attachment task for each individual using an adherence measure developed for the randomized controlled trial. Findings revealed several associations between therapist adherence and outcomes. First, the attachment task was associated with a reduction in adolescent depression scores posttreatment, at the 95% confidence interval, as well as in suicidality, at the 90% confidence interval. Second, adherence in the first half of treatment (before the attachment task) led to enhanced family cohesion at mid-treatment. Finally, a mediation analysis indicated that greater adherence in the attachment task of ABFT increased family cohesion, which, in turn, improved depression outcomes posttreatment. This study provides support for family cohesion—which, in this study, led to reductions in youth depression symptoms posttreatment—as a mechanism of change in the attachment task of ABFT. Clinical implications, study limitations, and future research are reviewed.
. Background: Suicide is a serious public health problem for LGBTQ+ adolescents and young adults.... more . Background: Suicide is a serious public health problem for LGBTQ+ adolescents and young adults. Attachment-based family therapy (ABFT) is one of the few suicide treatment models that has been tested with this population. The challenge remains in how to implement ABFT into the ecology of LGBTQ+ service settings. Aims: In this study, we tested the feasibility, acceptability, and preliminary effectiveness of ABFT in LGBTQ+ community settings. Method: Ten participants were enrolled in 16 weeks of ABFT across three LGBTQ+ organizations. Feasibility (treatment completion) and acceptability (Working Alliance Inventory [WAI]; opinions about treatment [OAT]) were measured for youth and caregivers. Depression and suicide outcomes were assessed for nine participants. Results: ABFT was demonstrated to be both feasible and acceptable. All participants completed treatment, and there were no dropouts. Adolescents/young adults and their caregivers reported high WAI and adequate OAT scores throughout treatment. There was a significant decrease in suicidal ideation (β = −12.16, t(10) = −3.14, p < .01). Decreases in depression, however, were not significant (β = −1.83, t(9.11) = −0.88, p = .40). Limitations: The small sample limits our ability to estimate treatment effectiveness. A larger effectiveness trial is warranted. Conclusion: ABFT is a promising treatment for LGBTQ+ service settings.
Depressive symptoms and self-harm, i.e. non-suicidal self-injury and suicidal behaviors, are high... more Depressive symptoms and self-harm, i.e. non-suicidal self-injury and suicidal behaviors, are highly prevalent in youngsters involved in Child Welfare System (CWS) services. Little research investigates, however, why these CWS youngsters are at risk. We explored whether trust in caregiver support and communication about experiences with primary caregivers, are associated with CWS youngsters' depressive symptoms and/or self-harm. An anonymous online survey of 271 CWS youngsters (10-21 years of age, 57.2% female) was used to assess trust and communication, and depressive symptoms/self-harm. Results showed significant negative associations between self-reported trust in maternal and paternal support, and depressive symptoms/self-harm. Communication about experiences with one's biological mother mediated the relationship between trust in maternal support and depressive symptoms/self-harm. Furthermore, the presence of an additional trustworthy caregiver buffered the impact of low ...
Developmental and behavioral pediatrics has emerged as an area of special interest and new respon... more Developmental and behavioral pediatrics has emerged as an area of special interest and new responsibility for pediatricians. The aim of this study was to evaluate the impact of training, experience, and other factors on pediatricians' satisfaction with their abilities to care for children with developmental, behavioral and psychosocial problems. A questionnaire was sent to 211 pediatricians working in primary care clinics in the community in Israel. Items included personal characteristics and experience, practice and satisfaction with the care of children with developmental, behavioral and psychosocial problems. Overall, pediatrician satisfaction with their personal abilities in this domain was defined as the dependent variable on multivariate analysis. The response rate was 76.3% (n = 161). Pediatricians' satisfaction with their overall professional ability to care for children with developmental, behavioral and psychosocial problems was significantly and positively associated with the following independent variables: (i) satisfaction with training received in the child development field; (ii) satisfaction with psychiatric updates; (iii) general satisfaction with the available child development services; (iv) prescription of methylphenidate to children with attention deficit/hyperactivity disorder; and (v) having completed their medical studies in a country in which the issue is emphasized. Imparting more knowledge and skills in child development and behavioral pediatrics in pediatric residency and continuing education programs will help improve the attitudes of primary care pediatricians towards developmental and behavioral problems, encourage them to treat these patients and their families, and better the quality of care.
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