Applying ideation-to-action theories to predict suicidal behavior among adolescents.

BACKGROUND: Although many risk factors for adolescent suicidal behavior have been identified, less is known about distinct risk factors associated with the progression from suicide ideation to attempts. Based on theories grounded in the ideation-to-action framework, we used structural equation modeling to examine risk and protective factors associated with the escalation from suicide ideation to attempts in adolescents. METHODS: In this cross-sectional study, data from the 2013 and 2015 Hawaii High School Youth Risk Behavior Surveys (N = 8,113) were analyzed. The sample was 54.0% female and racially/ethnically diverse. Risk factors included depression, victimization, self-harm, violent behavior, disinhibition, and hard substance use, and protective factors included adult support, sports participation, academic achievement and school safety. RESULTS: One in 6 adolescents (16.4%) reported suicide ideation, and nearly 1 in 10 (9.8%) adolescents had made a suicide attempt. Overall, disinhibition predicted the escalation to attempts among adolescents with suicide ideation, and higher academic performance was associated with lower suicide attempt risk. Depression and victimization were associated with suicide ideation. LIMITATIONS: This study examined data from the Youth Risk Behavior Survey, and other known risk factors such as anxiety and family history of suicide were not available in these data. CONCLUSIONS: Findings provide guidance for targets for clinical interventions focused on suicide prevention. Programs that incorporate behavioral disinhibition may have the greatest potential for reducing suicide attempt risk in adolescents with suicidal thoughts.

Effects of parenting adults with disabilities on later-life health: The role of intergenerational ambivalence.

According to family systems theory, strains from parenting an adult with disabilities may spill over to parents' relationships with their other children and disrupt family dynamics and their well-being in later-life. This study examined whether parental ambivalence toward their nondisabled children is greater in families of adults with disabilities (developmental disabilities [DD] or serious mental illnesses [SMI]) than families without any adult children with disabilities. The study also investigated whether ambivalence mediates the associations between having an adult child with DD or SMI and parents' health. Data were from the 2011 Wisconsin Longitudinal Study in which aging parents (Mage = 71; n = 6,084) were asked about their relationship with each of their adult children. Multilevel regression models and multilevel structural equation models were estimated to analyze the data. Our findings showed that parents of an adult with SMI felt greater ambivalence toward their nondisabled adult children than comparison group parents of adult children without disabilities, whereas no significant differences were found between parents of an adult child with DD and comparison group parents. Parental ambivalence toward their nondisabled adult children played a significant indirect role in the negative association between having a child with SMI and parental physical and mental health. The findings have implications for clinical practice with aging families of adults with disabilities and suggest the need for additional research to better understand intergenerational parent-adult child dynamics in these families. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Mortality in parents after the death of a child.

OBJECTIVE: The death of a child is a traumatic stressor that takes a toll on the health of parents. This study examined long-term impacts of the death of a child on the risk of early mortality in bereaved parents. In a follow-up analysis, a twin subsample was analyzed to examine potential genetic confounding. METHOD: We analyzed data from the Midlife in the United States (MIDUS) study. The primary sample consists of two groups of MIDUS 2 participants (2004-06); (1) parents who experienced the death of a child prior to MIDUS 2 (n = 451) and (2) comparison parents who had not experienced death of any children (n = 1804) (mean age = 63). We also analyzed 52 twin pairs in which one twin experienced the death of a child and 271 twin pairs in which both twins had all living children. Mortality status of parents was assessed in 2017. RESULTS: Parents who had experienced the death of a child had a 32% higher likelihood of early mortality (defined as dying earlier than life expectancy) than their peers who did not have any deceased children, and they were more likely to die of heart disease. Analyses of the twin subsample revealed significantly lower concordance for early mortality among the pairs with a bereaved twin than among control twins, consistent with non-genetic effects. CONCLUSIONS: The findings suggest that the death of a child has lasting impacts on the risk of early mortality in bereaved parents. This study provides the first U.S. estimate of bereavement effects on mortality extending through the parents' full life course, with significant public health implications. In addition, analysis of concordance of early death rates in the twin subsample suggests the impact on mortality of parental bereavement, net of genetic factors.

Lifelong Parenting of Adults With Developmental Disabilities: Growth Trends Over 20 Years in Midlife and Later Life.

This research examined how parenting adults with developmental disabilities affects parental well-being beyond midlife and into old age. Parents of adults with developmental disabilities ( n = 249) and parents of adults without disabilities ( n = 9,016), studied in their early 50s and mid-60s, were longitudinally tracked into their early 70s. Compared to parents of adults without disabilities, parents of adults with disabilities showed a pattern of normative functioning in their 50s, followed by poorer well-being in their mid-60s, and further declines in health and well-being into the early 70s. Aging parents who co-resided with their adult child with disabilities were particularly vulnerable, experiencing a steeper increase in depressive symptoms and body mass index (BMI) than parents whose child with disabilities lived away from home.

Family-Peer Linkages for Children with Intellectual Disability and Children with Learning Disabilities.

Family interactions are potential contexts for children with intellectual and learning disabilities to develop skillful social behaviors needed to relate effectively with peers. This study examined problem solving interactions within families of elementary school-age children (7-11 years) with intellectual disability (n = 37), specific learning disabilities (n =48), and without disabilities (n = 22). After accounting for group differences in children's behaviors and peer acceptance, across all groups, mothers' behaviors that encouraged egalitarian problem solving predicted more engaged and skillful problem solving by the children. However, mothers' controlling, directive behaviors predicted fewer of these behaviors by the children. Fathers' behaviors had mixed associations with the children's actions, possibly because they were reactive to children's unengaged and negative behaviors. For the children, greater involvement, more facilitative behaviors, and less negativity with their families were associated with greater acceptance from their peers, supporting family-peer linkages for children at risk for peer rejection.

Sibling Relationships in Adolescence and Early Adulthood With People Who Have Intellectual Disability.

Cross-sectional (N = 106) and longitudinal (N = 35) samples of siblings (ages 11-38) reported on closeness and conflict in their relationships with sisters and brothers with intellectual disability. For closeness, confirmatory factor analysis (CFA) distinguished feelings of emotional closeness from reciprocal sharing behaviors for these siblings. Age effects and changes over time indicated increasing emotional closeness and a general reduction in conflict from adolescence to young adulthood, with stable reciprocal sharing. Cross-sectionally, closeness was greater when siblings were involved in caregiving, and conflict was less when siblings no longer co-resided. Sibling constellation features (sex, birth order, age spacing) had limited effects at this developmental period. Findings support a combination of life-span developmental change and enduring attachment in these sibling relationships.

The Relative Risk of Divorce in Parents of Children With Developmental Disabilities: Impacts of Lifelong Parenting.

We prospectively examined the risk of divorce in 190 parents of children with developmental disabilities compared to 7,251 parents of children without disabilities based on a random sample drawn from the community and followed longitudinally for over 50 years. A significant interaction between the parental group status and number of children was found: In the comparison group, having a larger number of children was related to an increased risk of divorce, whereas the number of children did not increase divorce risk among parents of children with developmental disabilities.

Coping and psychological health of aging parents of adult children with developmental disabilities.

Among aging parents (mean age  =  65, N  =  139) of adults with developmental disabilities, we examined the effectiveness of multiple forms of coping with caregiver burden. As expected, accommodative strategies of adapting to stress (secondary engagement), used frequently in later life, buffered the impact of caregiver burden, whereas disengagement and distraction strategies exacerbated the effects of burden on depression symptoms. Most effects were similar for mothers and fathers, and all coping strategies, including active strategies to reduce stress (primary engagement), had greater effects for the parents with co-resident children. Vulnerability to caregiver burden was greatest when the aging parents with co-resident children used disengagement and distraction coping, but those who used engagement coping were resilient.

Parental bereavement during mid-to-later life: pre- to postbereavement functioning and intrapersonal resources for coping.

The death of a child when parents are in mid-to-late life is a traumatic event for aging parents. In order to evaluate adjustment, the impact of unanticipated versus anticipated deaths, and the effects of internal resources for coping with bereavement, we examined pre- and postbereavement functioning, using the 1992/94 and 2004/06 waves of the Wisconsin Longitudinal Study, for parents (M age = 54 and 65 years, respectively) whose adult child died between these dates (n = 175). The results revealed a general pattern of adaptation in which most bereaved parents were functioning as well as a matched comparison group (n = 175), though more depression symptoms were present both before and after the death of the child for the mothers of children who died from long-term illnesses and the fathers of children who committed suicide, suggesting that conditions predating the death were chronic strains for these parents. Intrapersonal resources, including a sense of purpose in life and high levels of agreeableness, were associated with better functioning, particularly for bereaved parents whose children's deaths were not anticipated. The study places parental bereavement in the context of normative aging and the framework of chronic life strain.

Parental distress, parenting practices, and child adaptive outcomes following traumatic brain injury.

Moderate and severe pediatric traumatic brain injuries (TBI) are associated with significant familial distress and child adaptive sequelae. Our aim was to examine the relationship between parental psychological distress, parenting practices (authoritarian, permissive, authoritative), and child adaptive functioning 12-36 months following TBI or orthopedic injury (OI). Injury type was hypothesized to moderate the relationship between parental distress and child adaptive functioning, demonstrating a significantly stronger relationship in the TBI relative to OI group. Authoritarian parenting practices were hypothesized to mediate relationship between parental distress and child adaptive functioning across groups. Groups (TBI n = 21, OI n = 23) did not differ significantly on age at injury, time since injury, sex, race, or SES. Parents completed the Brief Symptom Inventory, Parenting Practices Questionnaire, and Vineland-II. Moderation and mediation hypotheses were tested using hierarchical multiple regression and a bootstrapping approach, respectively. Results supported moderation and revealed that higher parental psychological distress was associated with lower child adaptive functioning in the TBI group only. Mediation results indicated that higher parental distress was associated with authoritarian parenting practices and lower adaptive functioning across groups. Results suggest that parenting practices are an important area of focus for studies attempting to elucidate the relationship between parent and child functioning following TBI.

Marital satisfaction and parenting experiences of mothers and fathers of adolescents and adults with autism.

The association of marital satisfaction with parenting burden and quality of the parent?child relationship was examined in 91 married mothers and fathers of co-residing adolescents and adults with autism spectrum disorders. Within-couple differences between mothers and fathers in how child characteristics related to these parenting experiences were also evaluated. Multilevel modeling was used to control for the dependency in couple data. Marital satisfaction was an important predictor of parenting experiences, particularly for fathers. Mothers reported feeling closer to their son or daughter than did fathers. Fathers' parenting experiences were more strongly impacted by child characteristics than were mothers' parenting experiences. Results emphasized the connection between the marital relationship and parenting experiences and overlapping but unique experiences of mothers and fathers.

Husbands' and wives' alcohol use disorders and marital interactions as longitudinal predictors of marital adjustment.

In this longitudinal study, the relationships among wives' and husbands' lifetime alcoholism status, marital behaviors, and marital adjustment were tested. Participants were 105 couples from the Michigan Longitudinal Study (MLS), an ongoing multimethod investigation of substance use in a community-based sample of alcoholics, nonalcoholics, and their families. At baseline (T1), husbands and wives completed a series of diagnostic measures, and lifetime diagnosis of alcohol use disorder (AUD, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), was assessed. Couples completed a problem-solving marital interaction task 3 years later at T2, which was coded for the ratio of positive to negative behaviors. Couples also completed a measure of marital adjustment at T4 (9 years after T1 and 6 years after T2). Results showed that husbands' lifetime AUD predicted lower levels of their wife's positive marital behaviors 3 years later but was not related to their own or their wife's marital adjustment 9 years from baseline. By contrast, wives' lifetime AUD had direct negative associations with their own and their husband's marital satisfaction 9 years later, and wives' marital behaviors during the problem-solving task predicted their own and their husband's marital satisfaction 6 years later. Findings indicate that marital adjustment in alcoholic couples may be driven more by the wives' than the husbands' AUD and marital behavior. Implications for intervention with alcoholic couples were discussed.

Trajectories of emotional well-being in mothers of adolescents and adults with autism.

Raising an adolescent or adult child with a developmental disability confers exceptional caregiving challenges on parents. We examined trajectories of 2 indicators of emotional well-being (depressive symptoms and anxiety) in a sample of primarily Caucasian mothers (N = 379; M age = 51.22 years at Time 1) of adolescent and adult children with an autism spectrum disorder (ASD; M age = 21.91 years at Time 1, 73.2% male). We also investigated within-person associations of child context time-varying covariates (autism symptoms, behavior problems, residential status) and maternal context time-varying covariates (social support network size and stressful family events) with the trajectories of emotional well-being. Data were collected on 5 occasions across a 10-year period. Average patterns of stable (depressive symptoms) and improved (anxiety) emotional well-being were evident, and well-being trajectories were sensitive to fluctuations in both child and maternal context variables. On occasions when behavior problems were higher, depressive symptoms and anxiety were higher. On occasions after which the grown child moved out of the family home, anxiety was lower. Anxiety was higher on occasions when social support networks were smaller and when more stressful life events were experienced. These results have implications for midlife and aging families of children with an ASD and those who provide services to these families.

Long-term Effects of Child Death on Parents' Health Related Quality of Life: A Dyadic Analysis.

This study examines the long-term effects of child death on bereaved parents' health-related quality of life (HRQoL). Using data from the Wisconsin Longitudinal Study, we compared 233 bereaved couples and 229 comparison couples (mean age = 65.11 years) and examined the life course effects of child death on parents' HRQoL. Variations in bereavement effects were examined by gender and for different causes of death. Bereaved parents had significantly worse HRQoL than comparison group parents, and there was no evidence of gender differences for this effect. With respect to the cause of a child's death, bereaved parents whose child died in violent circumstances had particularly low levels of HRQoL. Multilevel models indicated that marital closeness mitigated the negative effects of bereavement.

Parenting with mild intellectual deficits: parental expectations and the educational attainment of their children.

We examined how the educational expectations that parents with mild intellectual deficits had for their children shaped their children's attainment, and how parents' own intellectual limitations affected this process. We identified 612 parents with mild intellectual deficits and 2,712 comparison parents from the Wisconsin Longitudinal Study, a prospective longitudinal study in which participants were followed from ages 18 to 64. Compared to the norm, parents with mild intellectual deficits expected their children to complete less education, even after controlling for sociodemographic background variables, and children of parents with mild intellectual deficits did, in fact, complete fewer years of education. For both groups, parental expectations were the strongest predictor of attainment. Results suggest that disparities in education are shaped in part by parents' beliefs about educational opportunities.

Sibling relationship quality and social functioning of children and adolescents with intellectual disability.

We examined sibling relationships for children and adolescents with intellectual disability and assessed implications for their social functioning. Targets (total N = 212) had either intellectual disability, a chronic illness/physical disability, or no disability. Nontarget siblings reported on relationship quality, sibling interactions were observed, and teachers reported on social adjustment. Group comparisons highlighted the asymmetrical hierarchy and low conflict unique to siblings and targets with intellectual disability. Sibling relationships characterized by high warmth/closeness, positive affect, and few negative behaviors were predictive of fewer behavior problems for the targets at school. Both high warmth/ closeness and high conflict predicted greater social competence for the targets with intellectual disability, though warmth, conflict, and sibling management had different implications depending on the sibling's gender.

Factors predictive of midlife occupational attainment and psychological functioning in adults with mild intellectual deficits.

The life course of individuals with mild intellectual deficits and the factors that account for heterogeneity in their midlife outcomes were examined. Past research has shown that such individuals are at risk for poor occupational attainment in adulthood and more compromised psychological functioning, including increased depression. Although predictors varied for men and women, in general greater midlife occupational attainment was predicted by continuation of education beyond high school, having role models for achievement, and social participation earlier in adulthood. Midlife psychological functioning was predicted by having role models of achievement, having discussed plans for the future with parents and teachers, and achievement of aspirations set in high school. Implications for contemporary models of transition planning are discussed.

Siblings of adults with mild intellectual deficits or mental illness: differential life course outcomes.

The present study contrasted the later life sibling relationships, patterns of family formation, and psychological distress and well-being of siblings of adults with disabilities to a nondisabled normative group. The authors identified 268 siblings of adults with mild intellectual deficits (ID) and 83 siblings of adults with mental illness (MI) from the Wisconsin Longitudinal Study (R. M. Hauser & W. H. Sewell, 1985; R. M. Hauser, J. Sheridan, & J. R. Warren, 1998), a prospective longitudinal study that followed participants from age 18 years to age 64 years. Compared with the norm (n = 791), siblings of adults with mild ID had more contact with family members and were more likely to live in the same state as the sibling with the disability but reported less affective closeness. Siblings of adults with MI reported more psychological distress, less psychological well-being, and less adaptive personality characteristics compared with the norm, particularly for siblings of men with MI. There were no differences between groups in the patterns of marriage and childbearing.

Long-term effects of the death of a child on parents' adjustment in midlife.

The death of a child is a traumatic event that can have long-term effects on the lives of parents. This study examined bereaved parents of deceased children (infancy to age 34) and comparison parents with similar backgrounds (n = 428 per group) identified in the Wisconsin Longitudinal Study. An average of 18.05 years following the death, when parents were age 53, bereaved parents reported more depressive symptoms, poorer well-being, and more health problems and were more likely to have experienced a depressive episode and marital disruption than were comparison parents. Recovery from grief was associated with having a sense of life purpose and having additional children but was unrelated to the cause of death or the amount of time since the death. The results point to the need for detection and intervention to help those parents who are experiencing lasting grief.

Expressed emotion and familial interaction: a study with agoraphobic and obsessive-compulsive patients and their relatives.

Patients with panic disorder with agoraphobia (n = 40) or obsessive- compulsive disorder (n = 61) participated in a 10-min problem-solving interaction with their primary relative. Relatives were categorized as hostile or nonhostile toward the patient on the basis of a measure of expressed emotion (EE). Observed interactions between patients and their hostile relatives, relative to those of dyads with a nonhostile relative, were marked by higher rates of relatives' criticism and of patients' negativity but not by higher rates of negative reciprocity. Analyses of sequences indicated that the dyads with a hostile relative had a higher rate of sequences in which the relative was first critical and the patient then negative than was the case for dyads with nonhostile relatives. Moreover, hostile relatives were more frequently critical than nonhostile relatives whether patients' preceding behavior was positive, negative, or neutral. The findings are consistent with the stress-vulnerability model of the effect of EE on mental health, in that patients living with a high EE relative appear to be exposed to higher levels of interpersonal stress.