Effects of parental mental health and family environment on impulsivity in preadolescents: a longitudinal ABCD study®.

Introduction: Impulsivity is a known risk factor for the development of substance use disorders and other psychiatric conditions that is influenced by both genetics and environment. Although research has linked parental mental health to children's impulsivity, potential mediators of this relationship remain understudied. The current investigation leverages the large national Adolescent Brain Cognitive Development (ABCD) Study to assess the mediating role of family conflict - an important social context for youth development - in the relationship between parental mental health and youth impulsivity. Methods: Data were from the first three annual waves of the ABCD study (Baseline N = 11,876 children, Mage = 9.9 years; 48% female; 52% White). Parental mental health conditions were self-reported internalizing, externalizing, and total problems. Youth completed the family conflict scale, and Urgency, Planning (lack of), Perseverance (lack of), Sensation Seeking, and Positive Urgency (UPPS-P) scale to measure impulsivity. To determine if within-family change in conflict from baseline to year 1 explained changes in the strength of relations between baseline parental mental health and year 2 youth impulsivity, longitudinal causal mediation analyses were conducted, controlling for demographic factors (i.e., age, sex, race, household income, parental education, marital status), as well as baseline levels of family conflict and outcomes. Separate mediation models were run for each mental health condition and each UPPS-P subscale. Results: Above and beyond bivariate relations, longitudinal mediation models, which included covariates, showed family conflict significantly (ps < 0.001) mediated relations between all three parental mental health conditions and all but one (i.e., sensation seeking) UPPS-P subscales. The proportion mediated through family conflict for internalizing problems and total problems on facets of impulsivity (except sensation seeking) ranged from 9% (for lack of perseverance) to 17% (for lack of planning). Proportion mediated via family conflict for externalizing problems on youth's impulsivity (except sensation seeking) was slightly higher, ranging between 13% (lack of perseverance) to 21% (lack of planning). Discussion: Family conflict may be an important intergenerational factor linking parental mental health and youth's impulsivity. Addressing parental mental health and family conflict may help curb increased impulsivity in youth, and in turn reduce adolescent substance use disorders.

Shift and Persist in Mexican American Youth: A Longitudinal Test of Depressive Symptoms.

This paper tested whether shift-&-persist coping, or coping involving the combination of cognitive reappraisal, acceptance, and optimism (Chen & Miller, Perspectives on Psychological Science, 2012, 7, 135), attenuates the risks presented by economic hardship and ethnic discrimination for change in depressive symptoms from 9th to 12th grade, in a sample of 674 Mexican American youth (Mage W1 = 10.86; 50% female; 72% US born) and whether this effect depends on ethnic pride. Structural equation modeling indicated that, when accounting for economic hardship, shift-&-persist was associated with fewer concurrent depression symptoms. Youth with lower ethnic pride who endorsed high levels of shift-&-persist were protected against the negative impacts of peer ethnic discrimination on depressive symptoms. Future research on ethnic discrimination should examine patterns of coping and identity that can mitigate risk.

Greater loss of face and family honor values are associated with greater positive expectancies and substance abuse among Middle Eastern/Northern African U.S. college students.

BACKGROUND: Traditional cultural orientation is protective against substance use for Asian Americans and Latinos. However, little empirical research has examined traditional cultural values and substance use among Middle Eastern and North African (MENA) individuals. MENA cultures tend to emphasize maintaining family honor and personal social integrity, which may influence substance use cognitions and behavior. OBJECTIVE: Test whether loss of face and family honor influenced risky alcohol/cannabis use via positive expectancies. We expected that greater loss of face and family honor values would predict lower positive expectancies and risky substance use. METHODS: MENA college students (N = 246; 58.6% women) were recruited via Qualtrics Panels and completed an online survey. We tested path models, estimating direct and indirect effects of cultural predictors, adjusting for age, gender, generation status, marital status, and living situation. Substance use was modeled as risk categories (low- versus high-risk) and as count-type outcomes using zero-inflated models. RESULTS: Greater family honor values predicted higher positive alcohol and cannabis expectancies (b = .24-.32, p < .001). Greater loss of face values also predicted more positive expectancies (b = .22-.24, p < .001). Mediation analysis generally indicated that cultural factors were indirectly associated with risky use via positive expectancies. CONCLUSION: MENA college students' greater family honor and loss of face values are associated with greater alcohol and cannabis use, in part through positive expectancies. Cultural pressures may enhance the perceived benefits of alcohol and cannabis use. Substance use intervention programs should integrate MENA college students, and address family honor and loss of face as culturally-salient risk indices.

Drug and alcohol treatment utilization and barriers among Black, American Indian/Alaskan Native, Latine, Asian/Pacific Islander/Native Hawaiian, and White adults: Findings from NESARC-III.

BACKGROUND: Existing epidemiological data suggest differences across racial/ethnic groups in drug and alcohol treatment utilization and barriers to treatment and typically include only Black, Latine, and White adults. The objective of this study was to examine whether disparities remain for DSM-5 lifetime alcohol use disorder (AUD) and drug use disorder (DUD) treatment utilization and barriers across Black, American Indian/Alaska Native (AI/AN), Latine, Asian/Pacific Islander/Native Hawaiian (Asian/PI/NH), and White adults. METHODS: The current study conducted secondary analyses on data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). Regression analyses, followed by pairwise comparisons, investigated differences across racial/ethnic groups. RESULTS: Analyses indicated differences across racial/ethnic groups in AUD treatment utilization. White and AI/AN adults were more likely to utilize a health care professional than were Black adults. Asian/PI/NH and Latine adults were more likely to endorse language as a barrier to AUD treatment than were White adults. Black adults were more likely to use 12-step programs for DUD treatment utilization than were White and Latine adults, and Black and White adults were more likely to use outpatient programs than were Latine adults. Further, Black adults were more likely than Asian/PI/NH and Latine adults to use specialty DUD treatment. AI/AN, Asian/PI/NH, and White adults were more likely to endorse fear of what others would think as a barrier to DUD treatment relative to Black adults. AI/AN adults were more likely to endorse fear of being hospitalized relative to Black, Latine, and White adults. Asian/PI/NH and Latine adults were more likely to indicate that the hours were inconvenient relative to Black and White adults. White adults were more likely to endorse a family member objected relative to Black adults. AI/AN and White adults were more likely to endorse they stopped on their own relative to Black, Asian/PI/NH, and Latine adults. Further, AI/AN and White adults reported the greatest number of barriers to DUD treatment. CONCLUSIONS: Differences remain across racial/ethnic group in drug and alcohol treatment utilization and barriers to treatment. Future research aimed at increasing treatment utilization across racial/ethnic groups should focus on social determinants of health.

More frequent negative social exchanges are associated with higher suicide ideation and risk in men service members/veterans.

INTRODUCTION: Suicide is a leading cause of death in military service members/veterans (SM/Vs). Positive social exchanges (e.g., emotional support) buffer against suicide risk but the influence of negative social exchanges (e.g., unwanted advice) is understudied. METHOD: The current study explored (1) the contributions of positive and negative social exchanges as simultaneous correlates of suicide ideation and risk, (2) whether positive social exchanges mitigated the association of negative social exchanges and suicide ideation and risk, and (3) if facets of social exchanges were uniquely related to suicide ideation and risk. SM/Vs men (N = 508) completed self-report questionnaires. RESULTS: Roughly 27% endorsed suicide ideation. Between 23.62 and 41.14% reported elevated suicide risk. Adjusted analyses revealed higher negative social exchanges, particularly insensitive behaviors, and lower positive social exchanges were associated with higher suicide ideation and risk. The magnitude of positive and negative social exchanges with suicide ideation or risk was statistically similar. Higher positive social exchanges did not attenuate the association of negative social exchanges and suicide ideation or risk (p > 0.05). CONCLUSION: Higher negative social exchanges are equally strong correlates of suicide ideation and risk as positive social exchanges. Decreasing insensitive behaviors may reduce suicide ideation and risk in men SM/Vs.

Mexican-Origin Youths' Trajectories of Internalizing Symptoms from Childhood into Adolescence and Associations with Acculturation Processes.

We examined depression and anxiety symptom trajectories in Mexican-origin youth (N = 674) and tested longitudinal associations with acculturation dimensions. We used eight waves of data from the California Families Project, collected annually from 5th (Mage = 10.86, SD = 0.51) to 12th (Mage = 16.79, SD = 0.50) grade. Major depression disorder (MD) and generalized anxiety disorder (GAD) symptoms were assessed by structured psychiatric interview. Cultural measures, selected based on theory and empirical evidence, included English/Spanish use, familism, traditional gender role (TGR) attitudes, and ethnic pride. Symptom trajectories were modeled using latent growth analyses, and parallel process growth models examined covariation between internalizing and acculturation trajectories. Models adjusted for child sex, nativity, mother's education, and family income. MD symptoms decreased across adolescence on average, with steeper decreases among boys and children born in Mexico. GAD symptoms also decreased on average, with higher mean levels among girls. Age 10 Spanish use, familism, and ethnic pride were inversely related to age 10 MD symptoms. Steeper increases in Spanish use, familism, and ethnic pride predicted decreasing MD. Higher age 10 MD predicted increasing Spanish use and decreasing English use. Greater age 10 TGR attitudes predicted higher age 10 GAD but steeper declines in GAD and MD. Increasing ethnic pride slopes predicted decreasing GAD. Greater childhood TGR attitudes, and the maintenance of Spanish use, familism, and ethnic pride into adolescence, were associated with more optimal trajectories of MD and GAD symptoms. Interventions for Mexican-origin youth internalizing problems should encourage the retention of heritage culture strengths, including familism and ethnic pride.

An Ecological Momentary Assessment Study Investigating the Function of Hoarding.

This study examined the function of hoarding behaviors and the relations between hoarding and a series of cognitive and affective processes in the moment using ecological momentary assessment. A matched-groups design was used to compare college students with higher hoarding symptoms (n = 31) and matched controls (n = 29). The two groups did not differ in what function they reported acquiring served, and positive automatic reinforcement was the most commonly reported function in both groups. Engaging in hoarding-relevant behaviors did not predict change in positive or negative affect when controlling for previous affect. Emotional reactivity and experiential avoidance in the moment were both elevated in the higher hoarding group compared to controls, while momentary mindfulness and negative affect differentiation were lower. Overall, these findings support the importance of emotion regulation processes in hoarding. They also suggest individuals may not be successfully regulating affect in the moment with hoarding behaviors, despite efforts to do so. It may be useful to evaluate processes such as striving for positive affect in hoarding disorder in the future.

Dr. Liu et al. Reply.

While there is growing acceptance within the field that measurement-based care (MBC) is a valuable and effective care quality improvement strategy, broad and sustained implementation continues to be elusive for most organizations.1 This is partly attributable to the lack of proven implementation strategies for MBC. Although implementation science has made significant progress in recent years,1 more work is needed to identify the most effective and efficient strategies for MBC implementation across a range of service delivery contexts.

Evaluation of the Brief Adjustment Scale-6 (BASE-6): A measure of general psychological adjustment for measurement-based care.

The current study evaluated the Brief Adjustment Scale-6 (BASE-6), a measure of general psychological adjustment. The psychometric properties of the BASE-6 are documented using 3 adult samples, including online participants (Sample 1: n = 459), college students (Sample 2: n = 244), and a clinical sample (Sample 3: n = 296). Acceptability ratings comparing the BASE-6 to the Outcome Questionnaire-45.2 (OQ-45.2; Lambert et al., 1996) are provided. Factor analyses showed the items were well represented by a single factor, indicating a unidimensional factor structure. The BASE-6 demonstrated good internal consistency (α = .87-.93) and there was good test-retest reliability (intraclass correlation = .77) across 1 week. In Samples 1 and 2, there was moderate to high convergent validity with the OQ-45.2 total score (r = .66-.81, p < .001), and Symptom Distress (r = .66-.80, p < .001), Interpersonal (r = .54-.68, p < .001), and Social Role (r = .57-.69, p < .001) subscales. In Sample 3, there was high convergent validity with the Patient Health Questionnaire-9 (r = .80, p < .001) and the Generalized Anxiety Disorder-7 (r = .76, p < .001). BASE-6 item and total scores were generally higher in the clinical sample compared with the nonclinical samples. Participants perceived the BASE-6 as easier to use, and more acceptable on a weekly basis compared with the OQ-45.2. Results provide preliminary evidence that the BASE-6 has acceptable psychometric properties and may show promise in the context of measurement-based care. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Institutional betrayal following military sexual trauma is associated with more severe depression and specific posttraumatic stress disorder symptom clusters.

OBJECTIVE: Preliminary research suggests that perceptions of institutional betrayal are associated with more severe symptoms of posttraumatic stress disorder (PTSD) and depression, as well as suicide attempts in military sexual trauma (MST) survivors. However, results have not been replicated. Additionally, associations of institutional betrayal with specific PTSD symptom clusters or sexual function are understudied. METHOD: Female service members/veterans who reported experiencing MST (N = 679) completed self-report measures of PTSD and depression symptom severity, suicidal ideation, and sexual function. Institutional betrayal was assessed from free-text descriptions of self-reported index traumas. RESULTS: Institutional betrayal was significantly associated with more severe depression and PTSD symptoms, including avoidance, negative alterations in cognitions and mood, re-experiencing, and dysphoric arousal. CONCLUSIONS: Targeting specific PTSD and depressive symptoms through evidence-based treatment may be important for managing institutional betrayal sequelae. Future research should identify specific strategies to help support survivors in their recovery following institutional betrayal.

Familism, sibling relationship qualities, and sibling sex constellation as predictors of alcohol use among Mexican-origin adolescents.

Sibling relationship qualities and traditional family values (i.e., familism) are contextual factors relevant for early substance use risk among Mexican-origin adolescents. Yet limited research has examined whether familism moderates the effects of sibling relationship features on alcohol use. The present study examined whether familism enhanced or reduced the effects of sibling intimacy, negativity, and sibling deviance on later alcohol use, also testing whether sibling sex constellation (sisters, brothers, mixed) modified the patterns of influence. We analyzed two waves of data (N = 404) from the California Families Project, a longitudinal study of Mexican-origin youth. Using zero-inflated Poisson models, we examined unique and intersecting prospective influences of age 14 sibling contexts and familism on the likelihood of and degree of engagement in alcohol use at age 16. Results indicated a complex interplay of sibling features, familism values, and alcohol use patterns. Familism moderated the effects of sibling intimacy on later alcohol use patterns. For those with lower familism, increasing intimacy was associated with higher probability of any use, but decreasing degree of use (especially for brother pairs and sister pairs). Among those with higher familism, increasing intimacy predicted reduced probability of any use, but increases in the degree of use (for sister and mixed pairs). More sibling negativity was related to reduced alcohol use probability for brothers, and increased alcohol use in mixed sibling pairs. Sibling deviance was associated with greater age 16 alcohol use. This study highlights cultural considerations for including siblings in substance use prevention programs for Mexican-origin youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mind the Gap: Considering Disparities in Implementing Measurement-Based Care.

Synergistic advancements in evidence-based practice, implementation science, health care policy, and health information technology (HIT) have led to increasing efforts to broadly implement measurement-based care (MBC)-the systematic use of repeated outcome measures to monitor treatment progress and support clinical decision making1-in psychiatric services. Much of this work has been done with adult populations, and more efforts are needed for MBC to gain traction in child and adolescent psychiatry. In this Letter to the Editor, we describe a quality improvement (QI) project that leveraged HIT to implement MBC in the child and adolescent psychiatry department of a regional pediatric tertiary-care center and report long-term (5-year) implementation outcomes (ie, adoption and penetration). Although a myriad of implementation strategies was used, here we focus on the most complex strategy-integrating a digital measurement-feedback system (MFS) into standard workflow. Then, we discuss pitfalls and lessons learned with special attention to potential unintended effects of QI efforts on existing health disparities.

Comparing in-the-moment skill coaching effects from tailored versus non-tailored acceptance and commitment therapy mobile apps in a non-clinical sample.

Mobile apps are promising for teaching how to practice psychological skills in high-risk and in vivo momentary situations, but there has been minimal research on the immediate effects of app-based skill coaching on mental health in-the-moment. This study analyzed the mobile app data in a non-clinical sample of 39 adults participating in a larger randomized controlled trial, with participants randomized to an acceptance and commitment therapy (ACT) mobile app that tailors skill coaching based on in-the-moment variables (n = 17) or an app that provides randomly selected skill coaching (n = 22). Data were collected before and after each ACT skill coaching session on proximal outcome (depression, anxiety, and engagement in meaningful activity) and ACT process variables. Multilevel models indicated significant immediate improvements on average following ACT skill coaching sessions on all proximal outcome and ACT process variables, although with relatively small effects ranging between 0.17 and 0.27 SD units change. Larger immediate pre-to-post effects from ACT coaching sessions were found for anxiety, experiential avoidance, and cognitive fusion in the tailored app versus random app condition. Overall, results suggest that an ACT app can have immediate, in-the-moment effects on psychological functioning, which may be enhanced by tailoring skills to current context.

Specific PTSD symptom clusters mediate the association of military sexual trauma severity and sexual function and satisfaction in female service members/veterans.

BACKGROUND: Sexual satisfaction and function are vastly understudied in female service members/veterans (SM/Vs). Military sexual trauma (MST) is associated with poorer sexual satisfaction and function, but the mechanism through which MST relates to sexual satisfaction and function is unknown. Posttraumatic stress disorder (PTSD) is one of the most frequent diagnoses following MST, and those with poorer sexual satisfaction and function experience higher PTSD symptoms, particularly numbing and anhedonia symptom clusters. In this study, we examined which symptom clusters (re-experiencing, avoidance, negative alterations in cognition and mood [NACM], anhedonia, dysphoric and anxious arousal) mediated the relationship between MST and sexual satisfaction and function. METHOD: Female SM/Vs (N = 1,189) completed self-report measures of MST severity (none, harassment only, assault), PTSD, sexual satisfaction, and sexual function, as well as a demographic inventory. RESULTS: Anhedonia and dysphoric arousal fully mediated the association between assault MST and sexual satisfaction and function. NACM fully mediated the association between harassment and assault MST and sexual satisfaction. Finally, dysphoric arousal significantly mediated the association of harassment MST with sexual satisfaction and function. LIMITATIONS: Data was cross-sectional and based on self-report. CONCLUSIONS: The relationship between MST and sexual satisfaction and function may be mediated through specific PTSD symptom clusters. As there are no evidenced-based treatments to improve sexual satisfaction and function in female SM/Vs, additional research is needed to develop and pilot interventions. Among those with a history of MST, targeting NACM, anhedonia, and dysphoric arousal may be most effective in addressing sexual concerns.

Mexican-origin youth substance use trajectories: Associations with cultural and family factors.

The current study identified alcohol and cannabis use trajectories among a sample of Mexican-origin youth and examined cultural and familial correlates from childhood to adolescence. Mexican-origin youth (N = 674) from Northern California were assessed annually from ages 10 to 17 (8 waves). Latent class growth modeling examined variability in developmental trajectories for last 3-month alcohol and cannabis use frequency. Analyses also examined between-trajectory differences in youth's cultural practices and values, family cultural conflict, general parent-child conflict, and parental monitoring at 4 time points from ages 10 to 16. Analyses resulted in a 4-class model for alcohol use, comprising nonusers (62%), early-increasing (10%), adolescent-limited (11%), and late-onset (17%) subgroups, and a 4-class model for cannabis use, including nonusers (74%), early-increasing (8%), occasional use (16%), and high-declining (2%) subgroups. Findings suggested that early language use (higher English at age 10 and lower Spanish at age 12) was a temporally distal marker for several alcohol and cannabis use trajectories, whereas lower traditional family values at ages 14 and 16 were associated with several classes characterized by early substance use. Elevations in familial (parent-child conflict, parental monitoring) risk factors co-occurred in time and generally suggested temporally proximal connections with substance use behavior. Further, there was evidence that a less prominent decline in certain protective factors (e.g., father monitoring) was associated with reductions in substance use. These findings inform the literature by describing youth subgroups with variable risk for substance use development, and suggest modifiable risk factors associated with more frequent substance use trajectories. (PsycINFO Database Record

Child- and Family-Focused Cognitive Behavioral Therapy for Pediatric Bipolar Disorder: Applications for Suicide Prevention.

Despite high rates of suicide ideation (SI) and behavior in youth with pediatric bipolar disorder (PBD), little work has examined how psychosocial interventions impact suicidality among this high-risk group. The current study examined SI outcomes in a randomized clinical trial comparing Child- and Family-Focused Cognitive Behavioral Therapy (CFF-CBT) for PBD versus psychotherapy treatment-as-usual (TAU). Although not designed for suicide prevention, CFF-CBT addresses child and family factors related to suicide risk and thus was hypothesized to generalize to the treatment of suicidality. Participants included 71 youth aged 7-13 years (M = 9.17, SD = 1.60) with DSM-IV-TR bipolar I, II, or not otherwise specified randomly assigned, with parent(s), to receive CFF-CBT or TAU. Both treatments consisted of 12 weekly and 6 monthly booster sessions. Suicide ideation was assessed via clinician interview at baseline, posttreatment, and 6-month follow-up. Results indicated that SI was prevalent pretreatment: 39% of youth reported current suicidal thoughts. All youth significantly improved in the likelihood and intensity of ideation across treatment, but group differences were not significant. Thus, findings suggest that early intervention for these high-risk youth may reduce SI, and at this stage of suicidality, youth may be responsive to even nonspecialized treatment.

Evaluating an Adjunctive Mobile App to Enhance Psychological Flexibility in Acceptance and Commitment Therapy.

The primary aims of this study were to evaluate the feasibility and potential efficacy of a novel adjunctive mobile app designed to enhance the acquisition, strengthening, and generalization of acceptance and commitment therapy (ACT) skills being taught in therapy. A sample of 14 depressed/anxious clients receiving ACT used the ACT Daily app for 2 weeks in a pre-post, open trial design. Participants reported a high degree of program satisfaction. Clients significantly improved over the 2-week period on depression and anxiety symptoms as well as a range of psychological inflexibility measures. Analyses of mobile app data indicated effects of ACT Daily skill coaching on in-the-moment measures of inflexibility and symptoms, with unique effects found for acceptance and mindfulness. Adjunctive ACT mobile apps appear promising in enhancing therapy effects on psychological inflexibility and outcomes. A tailored skill coaching approach like ACT Daily based on randomly prompted assessments may be especially promising.

Cultural Orientation Trajectories and Substance Use: Findings From a Longitudinal Study of Mexican-Origin Youth.

Cultural adaptation may influence Latino youth substance use (SU) development, yet few longitudinal studies have examined cultural change over time and adolescent SU outcomes. Using longitudinal data collected annually across ages 10-16 from 674 Mexican-origin youth (50% female), the authors characterized cultural adaptation patterns for language use (English and Spanish use), values (American values and familism values), and identity (ethnic pride), and examined whether these cultural adaptation patterns were associated with differential SU risk. Youth with increasing bilingualism and high/stable family values had lower SU risk compared to youth who primarily spoke English and endorsed decreasing family values, respectively. Ethnic pride trajectories were not associated with SU. Findings highlight the importance of considering cultural change related to Latino youth SU.

Twelve-Month Outcomes of a Randomized Trial of the Positive Thoughts and Action Program for Depression Among Early Adolescents.

This study was conducted to examine the 12-month effects on depression and depressive symptoms of a group-based cognitive-behavioral preventive intervention for middle school students (Positive Thoughts and Actions, or PTA), relative to a brief, individually administered supportive intervention (Individual Support Program, or ISP). A randomized clinical trial was conducted with 120 early adolescents (73 girls and 47 boys; age 12-14 years) drawn from a school-based population who had elevated depressive symptoms. Youths completed measures of depressive symptoms at baseline, post-intervention, and 6 and 12 months into the follow-up phase. Measures of internalizing problems, externalizing problems, school adjustment, interpersonal relationships, and health behavior were obtained from parents and/or youth. Multilevel models indicated that the effect of PTA on youth-reported depressive symptoms persisted until 12-month follow-up; d = 0.36 at post-intervention, d = 0.24 at 6-month follow-up, and d = 0.21 at 12-month follow-up. PTA youths also reported lower internalizing symptoms at post-intervention, d = 0.44, and at 12-month follow-up, d = 0.39. Time-limited effects were found for parent-reported internalizing symptoms and health behavior. Onset of new depressive episodes did not differ based on intervention group (21 % ISP; 17 % PTA). Results demonstrate support for the long-term efficacy of PTA, a cognitive-behavioral preventive intervention in which youths engage in personal goal-setting and practice social-emotional skills.