High and low levels of adolescent peer status are associated longitudinally with socioevaluative concern.

This study examined linear and curvilinear longitudinal associations between peer status (i.e., likeability and popularity) and socioevaluative concern, a socio-cognitive feature characterized by attunement to judgment from peers. A sample of 716 adolescents (Mage = 16.01, SD = 1.25; 54% female; 46.5% White; 69.5% reduced-price lunch) was assessed twice annually. Likeability and popularity were assessed with peer nominations at Time 1. Measures of general (rejection sensitivity, peer importance) and online (digital status seeking, online status importance) socioevaluative concern were obtained at Times 1 and 2. High and low levels of likeability were longitudinally associated with increased peer importance, while high and low levels of popularity were associated with increased digital status seeking, and decreased online status importance for girls.

Adolescent Peer Experiences and Prospective Suicidal Ideation: The Protective Role of Online-Only Friendships.

Objective: This study examined characteristics of online-only friendships among suicidal and non-suicidal adolescents. In addition, the extent to which adolescents' online-only friendships may offer a protective function, buffering the effects of peer stressors (i.e., friendship stress, relational victimization) on prospective suicidal ideation, was examined.Method: Adolescents aged 10 to 14 (n = 630) were assessed at baseline (Time 1) and one-year follow-up (Time 2). Measures of suicidal ideation, sociometric relational victimization, friendship stress, depressive symptoms, online-only friendship status and quality, and online-only friendship quality compared to in-person friendship quality, were obtained at Time 1 using sociometric procedures and self-report questionnaires. Self-report measures of suicidal ideation were collected at Time 2.Results: Descriptive results suggested that online-only friendships are relatively common among youth (38.3%), particularly for those experiencing suicidal ideation (46.3%). Suicidal and non-suicidal adolescents reported comparable levels of intimate disclosure within their online-only friendships. Although adolescents without suicidal ideation endorsed more support from in-person friendships, suicidal adolescents endorsed similar levels of support from their online-only and in-person friendships. Moderation analyses indicated that the association between both relational victimization and friendship stress and prospective suicidal ideation was attenuated among youth who reported having one or more online-only friend.Conclusion: Online-only friendships are common and may offer protective benefits for youth, particularly those experiencing suicidal ideation. Future studies should examine the specific mechanisms by which online-only friendships may confer this benefit.

Emotional Responses to Social Media Experiences Among Adolescents: Longitudinal Associations with Depressive Symptoms.

OBJECTIVE: The degree to which adolescent social media use is associated with depressive symptoms has been the source of considerable debate. Prior studies have been limited by a reliance on cross-sectional data and measures of overall "screen time." This study examines prospective associations between adolescents' emotional responses to social media experiences and depressive symptoms, and examines gender differences in these processes. METHOD: A school-based sample of 687 adolescents (48.6% girls; Mage = 14.3; 38.1% White, 29.4% Hispanic, 23.0% Black) completed measures of positive and negative emotional responses to social media experiences and depressive symptoms at two time points, one year apart. RESULTS: Higher levels of depressive symptoms were associated with more frequent negative emotional responses to social media experiences one year later, whereas greater positive emotional responses to social media were associated with later depressive symptoms. Girls reported overall greater emotional responses to social media experiences, but gender did not moderate associations between these emotional responses and depressive symptoms. CONCLUSION: Findings highlight the importance of examining adolescents' positive and negative emotional experiences in the context of social media use, and the ways in which these experiences intersect with depressive symptoms, so as to identify youth who may be most vulnerable to negative effects of social media use.

Predictors and moderators of marijuana and heavy alcohol use outcomes in adolescents treated for co-occurring substance use and psychiatric disorders in a randomized controlled trial.

BACKGROUND: The current study identifies predictors and moderators of substance use outcomes for 111 adolescents with co-occurring substance use and psychiatric disorders who participated in a randomized controlled trial that compared the effectiveness of two home-based treatments: an integrated cognitive behavioral therapy (I-CBT) protocol, in which masters-level clinic staff received intensive training and ongoing supervision in the use of this protocol versus a treatment-as-usual (TAU) comparison condition in which therapists received a continuing education-style CBT workshop in the same protocol. METHOD: The study conducted exploratory predictor and moderator analyses of marijuana and heavy alcohol use outcomes using candidate variables across four domains of psychological characteristics: adolescent substance use, adolescent psychiatric symptoms, parent, and family. RESULTS: Regardless of treatment condition, low parental monitoring at baseline, as assessed by a videotaped interaction task, but not self-report, predicted greater percentage of marijuana use and heavy alcohol use days over the 6-month follow-up period. If parents entered treatment with low levels of parental monitoring, adolescents in the I-CBT condition reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU over the 6-month follow-up period. Greater adolescent aggression and parental emotion dysregulation at baseline also predicted greater percentage of marijuana use days over the 6-month follow-up period for the sample as a whole. Adolescents in the I-CBT condition who reported low positive urgency at baseline reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU care over the 6-month follow-up period. CONCLUSION: The article discusses implications for clinical decision-making, improving treatment effectiveness, and tailoring interventions for adolescents with co-occurring substance use and psychiatric disorders.

Parental Monitoring Predicts Depressive Symptom and Suicidal Ideation Outcomes in Adolescents Being Treated for Co-Occurring Substance Use and Psychiatric Disorders.

BACKGROUND: Comorbidity of substance use disorders (SUDs) with mood disorders and other psychiatric conditions is common. Parenting processes and family functioning are impaired in adolescents with SUDs and mood disorders, and parent/family factors predict intervention response. However, limited research has examined the relationship between parent/family factors and mood symptom treatment response in adolescents with comorbid SUDs and psychiatric conditions. METHOD: This study examined the predictive effects of parenting processes and family functioning on depressive symptoms and suicidal ideation (SI) in a randomized controlled trial of integrated cognitive-behavioral therapy vs. treatment as usual for 111 adolescents with comorbid SUDs and psychiatric disorders. Measures of parenting processes, family functioning, depressive symptoms, and SI were completed at baseline and 3-, 6-, and 12-month follow-ups. Exploratory analyses involved mixed-effects regression models. RESULTS: Across treatment conditions, depressive symptoms and SI improved over 12 months. Family functioning domains of family roles (d=0.47) and affective involvement (d=0.39) significantly improved across treatment conditions over 12 months. Higher baseline parental monitoring predicted improved trajectory of depressive symptoms (d=0.44) and SI (d=0.46). There were no significant predictive effects for baseline family functioning or other parenting processes (listening, limit setting). LIMITATIONS: Limitations include the modest sample, attrition over follow-up, and generalizability to samples with higher rates of mood disorders and/or uncomplicated mood disorders. CONCLUSIONS: Parental monitoring may be an important prognostic indicator of depressive symptoms and SI in adolescents with co-occurring SUDs and psychiatric conditions, and therefore may be useful to assess and target in treatment, in addition to family functioning.

A randomized trial of an integrated cognitive behavioral treatment protocol for adolescents receiving home-based services for co-occurring disorders.

The current study conducted a preliminary test of whether community mental health clinic staff could implement a multicomponent cognitive behavioral treatment, developed for adolescents with substance misuse (alcohol and/or marijuana) and comorbid psychiatric symptoms. We randomized a total of 111 families, with an adolescent 12-18 years old, referred to a home-based services program for youth with co-occurring substance use and mental health problems, to receive treatment from either masters-level therapists who received intensive cognitive behavioral therapy (I-CBT) training or from masters-level therapists who took part in a typical brief continuing education-style CBT workshop (treatment as usual, or TAU). Each family's therapist and insurance company determined the frequency and intensity of treatment. We administered follow-up assessments at 3, 6, and 12 months. There was a small, but not statistically significant, reduction in the percent days of heavy drinking and marijuana use over time for both conditions, with the overall effect across the three follow-up points favoring the I-CBT condition. There were no differences on alcohol use days or other drug use. There was also a small, but nonsignificant, positive effect over time on externalizing symptoms, depressed mood, and anxiety, favoring the I-CBT condition. Youth in the I-CBT condition relative to TAU had significantly fewer juvenile justice contacts, while the pattern of costly service use varied, with higher rates at 6-month and lower rates at 12-month follow-ups. If therapists pay greater attention to parent training and provide more parent-adolescent communication sessions, outcomes may improve above standard community care. Training enhancements, to better meet the needs of community therapists and their clinic settings, may also produce better overall results for parents and adolescents.

Social Rejection and Suicidal Ideation and Attempts among Adolescents Following Hospitalization: a Prospective Study.

Despite research indicating that stressful life events are associated with subsequent suicidal ideation (SI) and behavior, there is a lack of clarity regarding whether specific types of life events are differentially related to SI and attempts. The current prospective study examines whether social rejection related life events are proximally related to SI and suicide attempts in a clinically acute sample of adolescents. Adolescents aged 12 to 18 (n = 219) were followed for 6 months after discharge from inpatient hospitalization. A contextual threat interview of stressful life events between index admission and 6-month follow-up was administered. Participants were also assessed for current SI and suicide attempts at baseline and 6-month follow-up. Results from a multiple linear regression model indicated a significant prospective association between number of social rejection stressors and SI, even after controlling for baseline depressive symptoms, SI at study entry, gender, age, and number of non-social rejections stressors. An Anderson-Gill recurrent events model was conducted to examine the relationship between SR stressors and suicide attempts. Results demonstrated that the 31 days following a major social rejection stressor were associated with heightened risk for prospective suicide attempts. However, social rejection stressors were not more strongly related to risk for suicide attempt than non-social rejection stressors. These findings help clarify the role of social rejection as a precipitant of suicidal crises and have potential to inform more accurate, targeted risk assessment.

Preliminary Associations among Relational Victimization, Targeted Rejection, and Suicidality in Adolescents: A Prospective Study.

This study examined associations between multiple types of interpersonal and noninterpersonal stressors and the subsequent occurrence of suicide ideation and attempts among female adolescents. Adolescents ages 12 to 18 years old (n = 160) at elevated risk for suicidal thoughts and behaviors were followed for 18 months, divided into two 9-month epochs for data analysis (Periods 1 and 2). Exposure to acute relational victimization, targeted rejection, nonspecified interpersonal, and noninterpersonal life stressors over the first 9-month epoch (Period 1) was assessed using semistructured interviews and an independent life stress rating team. Participants also completed phone-based semistructured interviews of suicidal thoughts and behaviors. Preliminary analyses showed significant prospective associations between acute targeted rejection and nonspecified interpersonal stress during Period 1 and suicide ideation during Period 2, as well as relational victimization and noninterpersonal stress during Period 1 and suicide attempts during Period 2. However, in logistic regression analyses that adjusted for prior suicidality and depressive symptoms, relational victimization during Period 1 (but not targeted rejection, nonspecified interpersonal or noninterpersonal events) was associated with increased odds of suicide attempt during Period 2. Therefore, acute relational victimization exposure is associated with heightened risk for suicidal behaviors in female adolescents. Future studies should examine potential mediators and moderators of this association, and these stressors should be considered for inclusion in clinical screening tools.

Adolescent but Not Parent Report of Irritability Is Related to Suicidal Ideation in Psychiatrically Hospitalized Adolescents.

OBJECTIVE: Identifying trans-diagnostic risk factors for suicidality may improve assessment and treatment. This study examined the degree to which clinician ratings of adolescent irritability, based on adolescent versus parent report, were associated with adolescent suicidal ideation beyond established risk factors (i.e., female gender, depressive, substance use, oppositional defiant, conduct, and post-traumatic stress disorders). METHODS: Hierarchical linear regression was used to analyze 322 adolescent inpatients (40.4% male) and 197 parents. RESULTS: Adolescent-rated irritability (p<0.001) and depression (p<0.001) were positively associated with adolescent suicidal ideation beyond all other factors. Parent-rated adolescent irritability was unrelated to adolescent suicidal ideation. CONCLUSION: Results suggest irritability is an important factor in determining suicide risk, and adolescent report of irritability may be more important in gauging suicide risk than parent report.

Elucidating the relation between childhood emotional abuse and depressive symptoms in adulthood: The mediating role of maladaptive interpersonal processes.

OBJECTIVE: The purpose of this study is to assess the potential unique and relative mediating effects of three interpersonal risk factors (i.e., excessive reassurance-seeking [ERS], negative feedback seeking [NFS], and rejection sensitivity [RS]) in the relationship between childhood emotional abuse (CEA) and depressive symptoms. METHOD: One hundred eighty-five undergraduates were followed over a four-month interval. Participants completed assessments of childhood abuse history, ERS, NFS, and RS, and depressive symptoms at baseline, as well as depressive symptoms at four-month followup. RESULTS: Findings from single-mediator analyses indicated that RS and NFS, but not ERS, mediated the relationship between CEA and prospective depressive symptoms, after accounting for childhood sexual and physical abuse, as well as baseline depressive symptoms. In our multi-mediator model, only RS remained a significant mediator of the relationship between CEA and prospective depressive symptoms. CONCLUSIONS: The current study provides preliminary evidence that negative behavioral styles may function as a mechanism linking prior experiences of CEA to subsequent depressive symptoms. Clinical implications of these findings suggest that targeting maladaptive behavioral tendencies, particularly RS, may be an effective adjunct in behavioral modification treatments of CEA victims at risk for depression.

Rejection sensitivity and depression: mediation by stress generation.

Rejection sensitivity has been found to confer risk for depression. The process through which this occurs remains unclear. This risk factor also has been associated with negative behavioral tendencies and interpersonal difficulties. Drawing on these different lines of research, the current investigation aimed to evaluate stress generation, the tendency for depression-prone individuals to experience higher rates of life stressors that are at least in part influenced by their own behavior, as a potential mechanism mediating the link between rejection sensitivity and subsequent depressive symptoms. Sixty-six adults with a history of depression were followed over a 4-month interval and completed assessments of rejection sensitivity and depressive symptoms at baseline, and depressive symptoms, a diagnostic interview for depression, and a contextual threat life stress interview at 4-month follow-up. Consistent with the stress generation hypothesis, rejection sensitivity predicted higher rates of dependent stressors, but not independent ones, over the 4-month prospective follow-up period. Furthermore, prospectively occurring dependent stressors mediated the relationship between baseline rejection sensitivity and depressive symptoms at follow-up. The finding that stress generation may operate as a mediating mechanism underlying the pathway between rejection sensitivity and depression lends preliminary support for the importance of targeting maladaptive behavioral tendencies in rejection-sensitive individuals in clinical settings.

Sociodemographic predictors of suicide means in a population-based surveillance system: findings from the National Violent Death Reporting system.

BACKGROUND: Multivariate studies of specific suicide means are relatively rare, given the logistical challenges associated with the low base rate of suicide in the general population. Thus, information on individual characteristics associated with specific suicide means remains relatively wanting. The current study provided the largest examination to date of sociodemographic characteristics associated with different means of lethality among suicide decedents, using data from a multi-state population-based surveillance system. METHODS: Multivariate logistic regression was used with data for 20,577 suicide decedents in the National Violent Death Reporting System from 2003 to 2005. RESULTS: Firearm decedents were more likely male, elderly, non-Hispanic white, married, veterans, and born in the U.S. Hanging and suffocation decedents were more likely male, young, racial/ethnic minorities, never married, non-veterans, and foreign-born. Decedents that jumped from heights were more likely female, older, non-Hispanic black, never married, non-veterans, and foreign-born. Decedents who used sharp instruments were more likely older, never married, and foreign-born. Self-poisoned decedents were more likely female, middle-age, non-Hispanic white, and not married. Regarding specific poisons, alcohol was more likely to be used by middle-age decedents; gas by males, elderly, and married individuals; over-the-counter drugs by females, adolescents, and foreign-born decedents; prescription drugs by females, middle-aged, and U.S. born individuals; and street drugs by males and racial/ethnic minorities. LIMITATIONS: The data were drawn from 18 states and so cannot be regarded as nationally representative. CONCLUSIONS: Substantial sociodemographic variability exists across different suicide means. Recognition of this variability may help to tailor prevention efforts involving means restriction.