Differential associations between Social Anxiety Disorder, family cohesion, and suicidality across racial/ethnic groups: Findings from the National Comorbidity Survey-Adolescent (NCS-A)

Increased risk of suicide among patients with social anxiety disorder

AIMS

Increasing evidence has established a strong association between social anxiety disorder and suicidal behaviours, including suicidal ideation and suicide attempts. However, the association between social anxiety disorder and suicide mortality remains unclear.

METHODS

This study analysed data from 15,776 patients with social anxiety disorder, extracted from a nationwide Taiwanese cohort between 2003 and 2017. Two unexposed groups without social anxiety disorder, matched by birth year and sex in 1:4 and 1:10 ratios, respectively, were used for comparison. Suicide deaths during the same period were examined. Psychiatric comorbidities commonly associated with social anxiety disorder, including schizophrenia, bipolar disorder, major depression, alcohol use disorder (AUD), substance use disorder (SUD), obsessive-compulsive disorder, autism, and attention deficit hyperactivity disorder, were identified.

RESULTS

Time-dependent Cox regression models, adjusted for demographic factors and psychiatric comorbidities, revealed that individuals with social anxiety disorder had an increased risk of suicide (hazard ratio: 3.49 in the 1:4 matched analysis and 2.84 in the 1:10 matched analysis) compared with those without the disorder. Comorbidities such as schizophrenia, bipolar disorder, major depression, AUD, and SUD further increased the risk of suicide in patients with social anxiety disorder.

CONCLUSION

Social anxiety disorder is an independent risk factor for suicide death. Additional psychiatric comorbidities, including schizophrenia, major affective disorders, and AUD, further increased social anxiety disorder-related suicide risk. Therefore, mental health officers and clinicians should develop targeted suicide prevention strategies for individuals with social anxiety disorder.

Suicidality in first-generation, second-generation and non-immigrant youth in Canada

Background

The number of people migrating globally has drastically increased in the last two decades and continues to rise. Although adult migrants are typically in better health than the population they migrate to, the evidence regarding migrant children's health, and especially their mental health, is mixed.

Objectives

To assess whether the prevalence of suicidal ideation and suicide attempt differs between first- and second-generation immigrant youth, compared to non-immigrants, and whether other sociodemographic factors moderate any associations.

Methods

We analyzed a subsample of youth aged 15-17 years from the 2019 Canadian Health Survey on Children and Youth - a national, representative, cross-sectional survey. We conducted multivariable logistic regression analysis, with past-year suicidal ideation and suicide attempt as outcomes and migrant status as exposure. We also investigated whether sociodemographic factors (including sex, family income, parental divorce) moderated these associations using interaction terms.

Results

Second-generation immigrants had almost twice the risk of first-generation immigrants and non-immigrants of having attempted suicide (OR 1.68, 95%CI: 1.07, 2.63). The association between second-generation immigrant status and suicide attempt was stronger among those not from low-income households (OR 2.04, 95%CI: 1.30, 3.21) and those with divorced parents (OR 5.19, 95%CI: 1.41, 19.12). The association between second-generation immigrant status and suicidal ideation was stronger among males (OR 1.78, 95% CI: 1.04, 3.07) and those with divorced parents (OR 4.13, 95%CI 1.40, 12.14). Additionally, some effects among first-generation immigrants varied by time since arrival.

Relevance

The healthy immigrant effect with respect to suicidality does not appear to pass from the first-generation to the second-generation. The magnitude of effect among second generation immigrant youth varies according to other sociodemographic factors.

Unraveling Familism and Depressive Symptoms among Dominican Women: A Multidimensional Analysis

Familism is a multidimensional construct that includes familial support. However, limited research examines whether the sub-components of familism equally contribute to mental health and whether familism protects against depression beyond social support. To address these gaps, we test associations between the multidimensional components of familism (familial support, familial obligations, family as referents) and social support with depressive symptoms among immigrant Dominican women in New York City. We tested associations between the multidimensional components of familism, specifically, familial support, familial obligations, and family as referents (Sabogal et al., 1987), as well as social support, with depressive symptoms among 419 women. Multiple regression analysis indicated that whereas familial support predicted decreases in depressive symptoms (β = - 0.15), family obligations, and family as referents did not. However, only social support predicted decreased depressive symptoms (β= - 0.18) when accounting for covariates and familism subscales. Controlling for covariates, age predicted decreased depressive symptoms (β = - 0.19), whereas self-rated poor health exhibited the inverse effect (β = 0.17). These findings highlight the need for a nuanced understanding of familism, social support, and the association of cultural and demographic values on Latina mental health. These results illustrate the need for further analysis of social support and the multiple components of the familism construct.

Negative emotion differentiation buffers against intergenerational risk for social anxiety in at-risk adolescent girls

Social anxiety disorder (SAD) tends to emerge during adolescence and is more prevalent among those assigned female at birth. Parental social anxiety confers risk for adolescent SAD but less is known regarding protective factors. Research suggests that emotion differentiation (the ability to discriminate between similarly valenced emotions, e.g., fear vs. sadness vs. anger) may be protective, as it is associated with adaptive psychosocial outcomes. However, little work has examined how emotion differentiation influences the development of SAD, particularly during periods of higher risk such as adolescence. In a longitudinal study of adolescent girls at high temperamental risk for SAD (aged 11-14-years; n=114), we tested whether emotion differentiation (derived using negative and positive emotion ratings from 16-day ecological momentary assessments at baseline) moderated the relationship between parental and adolescent social anxiety symptoms across two years. Results revealed significant moderation by negative (but not positive) emotion differentiation (p=.042): Baseline parental social anxiety was positively associated with adolescent social anxiety symptoms at two-year follow-up but only at lower (vs. higher) levels of emotion differentiation, even after controlling for baseline depressive symptoms. Exploratory analyses showed that these effects were unique to avoidance of social situations (p=.014). Findings highlight the protective effects of emotion differentiation and have important clinical implications for understanding and treating SAD.

Linear and curvilinear association of pain tolerance and social anxiety symptoms among youth with different subgroups of childhood trauma

BACKGROUND

Social anxiety is a common symptom that occurs after exposure to childhood trauma (CT), and pain tolerance is a protective factor against social anxiety in generic populations with CT. However, few studies have investigated whether and how this association varies across different CT subgroups. Thus, this study aimed to investigate (1) the effects of pain tolerance on social anxiety symptoms among youth with different subgroups of CT; (2) the nonlinear relationship between pain tolerance and social anxiety symptoms among different CT categories.

METHODS

In this study, 15,682 college or university students with experiences of CT were identified in a large sample and divided into five CT subgroups. Linear and quadratic regression models were conducted to explore the association between pain tolerance and social anxiety symptoms among youth with different CT subgroups.

RESULTS

The results of model revealed a linear relationship between pain tolerance and social anxiety symptoms among youth with most CT subgroups. Notably, an inverted U-shaped curve was found between pain tolerance and social anxiety symptoms in youth with emotional abuse. Social anxiety symptoms increased gradually with pain tolerance scores between 0 and 16, and then sharply decreased when scores reached above 16.

LIMITATIONS

Limited by self-report measurements, the results of this study focused only on perceived pain tolerance and ignored behavioral pain tolerance.

CONCLUSION

These findings highlight the importance of assessing pain tolerance thresholds in youth with emotional abuse and improving pain tolerance to prevent social anxiety symptoms in youth with different subgroups of CT.

Interpersonal Well-Being and Suicidal Outcomes in a Nationally Representative Study of Adolescents: A Translational Study

Adolescent suicide continues to rise despite burgeoning research on interpersonal risk for suicide. This may reflect challenges in applying developmental psychopathology research into clinical settings. In response, the present study used a translational analytic plan to examine indices of social well-being most accurate and statistically fair for indexing adolescent suicide. Data from the National Comorbidity Survey Replication Adolescent Supplement were used. Adolescents aged 13-17 (N = 9,900) completed surveys on traumatic events, current relationships, and suicidal thoughts and attempts. Both frequentist (e.g., receiver operating characteristics) and Bayesian (e.g., Diagnostic Likelihood Ratios; DLRs) techniques provided insight into classification, calibration, and statistical fairness. Final algorithms were compared to a machine learning-informed algorithm. Overall, parental care and family cohesion best classified suicidal ideation, while these indices and school engagement best classified attempts. Multi-indicator algorithms suggested adolescents at high risk across these indices were approximately 3-times more likely to engage in ideation (DLR = 3.26) and 5-times more likely to engage in attempts (DLR = 4.53). Although equitable for attempts, models for ideation underperformed in non-White adolescents. Supplemental, machine learning-informed algorithms performed similarly, suggesting non-linear and interactive effects did not improve model performance. Future directions for interpersonal theories for suicide are discussed and clinical implications for suicide screening are demonstrated.

Joint trajectories of loneliness, depressive symptoms, and social anxiety from middle childhood to early adolescence: associations with suicidal ideation

This study examined the joint trajectories of loneliness, depressive symptoms, and social anxiety from middle childhood to early adolescence and their associations with suicidal ideation. A total of 643 Chinese elementary school students (55.2% male; Mage = 9.01; SD = 0.75; range = 7 to 11 years at T1) completed measures on six occasions at 6-month intervals. Parallel process latent class growth models revealed five distinct trajectories of loneliness, depressive symptoms, and social anxiety: "congruent-low" (45.1%), "moderately low with predominant loneliness and depressive symptoms" (15.7%), "moderate with predominant loneliness and depressive symptoms" (4.2%), "moderately low with predominant social anxiety" (24.9%), and "congruent-high" (10.1%). The highest suicidal ideation was observed among adolescents who persistently experienced two or three symptoms, followed by those who persistently experienced one predominant symptom, and finally, adolescents who persistently experienced low levels of all three symptoms. The findings highlight the importance of individual differences considerations in understanding the joint patterns of loneliness, depressive symptoms, and social anxiety among youth during the transition into adolescence and the need for more sophisticated intervention programs tailored to the unique characteristics of the relevant trajectories to reduce the risk of suicidal ideation.

Correlation between negative life events and suicide attempts among Yi adolescents with HIV/AIDS in Liangshan Prefecture

OBJECTIVE

To investigate the incidence of suicide attempts among adolescents with HIV/AIDS in Liangshan Prefecture, Sichuan Province, as well as the correlation between negative life events, sleep, exercise, drug therapy and suicide attempts.

METHODS

A total of 180 Yi adolescents aged 11-19 years with HIV/AIDS in a county of Liangshan Prefecture, Sichuan Province, China, were investigated by census. The main outcome indicators included the incidence of suicide attempts and whether negative life events, sleep, exercise, drug therapy and other factors were related to suicide attempts.

RESULTS

We found that the incidence rate of suicide attempts among Yi adolescents with HIV/AIDS in Liangshan Prefecture was 13.9%. Negative life events were a risk factor for suicide attempts (OR = 1.047, p < 0.001, 95% CI 1.027-1.067). In the factors of negative life events, adaptation was a risk factor for suicide attempts (OR = 1.203, p = 0.026, 95% CI 1.022-1.416), and academic pressure showed a tendency to be a risk factor for suicide attempts (OR = 1.149, p = 0.077, 95% CI 0.985-1.339). However, the punishment factor, interpersonal stress factor and loss factor had no significant correlation with suicide attempts. There was no significant correlation between sleep, exercise, drug therapy and suicide attempts.

CONCLUSION

The proportion of suicide attempts among Yi adolescents with HIV/AIDS in Liangshan Prefecture is high and should be considered. Negative life events are independent risk factors for suicide attempts, and it is necessary to strengthen the screening and early intervention for suicide attempts in HIV/AIDS adolescents with definite negative life events.

Social phobia of Ethiopian students: meta-analysis and systematic review

BACKGROUND

Social anxiety disorder is defined as the fear of social situations, incorporating situations that involve contact with strangers. People highly fear embarrassing themselves which includes situations like social gatherings, oral presentations, and meeting new people. People with social phobia have nonspecific fears of practicing vague or, performing specific tasks like eating or speaking in front of others. In people with social anxiety disorder, worry can arise from both the circumstance itself and embarrassment from others, for students, social phobia is an overwhelming fear of speaking in front of others or giving presentations in class. The prevalence of social phobia among different studies in Ethiopia was inconsistent and inconclusive therefore, this study showed the cumulative burden of social phobia among students in Ethiopia.

METHOD

Observational studies published on social phobia and associated factors among students in Ethiopia were included in this study based on the criteria after independent selection by two authors. Data were extracted by Microsoft Excel spreadsheet to be exported to Stata version 11 for further analysis. The random-effect model was used to estimate the pooled effect size of social phobia and its effect on the previous studies with 95% confidence intervals. Funnel plots analysis and Egger regression tests were conducted to detect the presence of publication bias. Sub-group analysis and sensitivity analysis were done.

RESULT

A total of 2878 study participants from seven studies were included in this meta-analysis and systematic review. The pooled prevalence of social phobia among students in Ethiopia was 26.81% with a 95% CI (22.31-31.30). The pooled effect size of social phobia in Oromia, Amhara, and SNNPs regions was 24.76%, 24.76%, and 29.47%, respectively. According to the subgroup analysis, university, and college/high school students were 28.05% and 25.34% respectively. Being female [AOR = 2.11 (95% CI 1.72-2.60)], having poor social support [AOR = 2.38 (95% CI 1.54-3.70)], substance use [AOR = 2.25 (95% CI 1.54-3.30)], single parent [AOR = 5.18 (95% CI 3.30-8.12)], and rural residence [AOR = 2.29 (95% CI 1.91-2.75)] were significantly associated in this meta-analysis in Ethiopia.

CONCLUSION

The pooled prevalence of social phobia in this meta-analysis and systematic review was high (26.81%) among students therefore, the educational bureau needs to work on decreasing the burden of social phobia to raise the academic achievement and creativity of the students. In therapeutic advice like exposure to presentations, family members take the responsibility for the students' therapy and expose them to various social interactions.

Everyday Conflict in Families at Risk for Violence Exposure: Examining Unique, Bidirectional Associations with Children's Anxious- and Withdrawn-Depressed Symptoms

Exposure to family conflict during childhood increases risk for the development of anxiety and mood problems, though the potential for bidirectionality in this association remains unknown. It is also unclear whether nonviolent family conflict is related to children's anxious- and withdrawn-depressive symptoms within high-risk family contexts, independent of more severe events such as children's exposure to violent victimization. Participants included 1,281 children and their caregivers identified as being at high risk for family violence, interviewed prospectively at ages 6, 8, and 10 about family conflict, children's anxious- and withdrawn-depressive behaviors, and children's victimization experiences. After controlling for cumulative victimization prior to and between each time point, significant cross-lagged, bidirectional associations were identified between family conflict and children's anxious- and withdrawn-depressive symptoms across ages 6 and 8, but not across ages 8 and 10. Invariance testing revealed no differences in model fit between boys and girls and minimal differences depending on whether families were reported for maltreatment prior to recruitment. Findings are partially supportive of a conceptualization of the family-child relationship that is reciprocal, while highlighting the role of daily negative familial interactions, over and above experiences of victimization, in predicting anxious- and withdrawn-depressed symptoms in early and middle childhood.

Emotional Strengths and Difficulties in Italian Adolescents: Analysis of Adaptation through the SDQ

An adolescent’s knowledge of him/herself (positive aspects and weaknesses) is shaped by interactions with external and internal factors, including the family context and the educational environment. The assessment of this knowledge serves to construct the concept of self-esteem. The main objective of the present study was to examine the prevalence of self-reported emotional and behavioral symptoms in a representative sample of Italian adolescents and their relationship with gender and age, using Goodman’s Strengths and Difficulties Questionnaire (SDQ). A total of 440 adolescents (49.8% female) aged 15–18 years from the southern Italy region participated. The results show the prevalence of emotional and behavioral symptoms in the analyzed sample. Gender differences were also found in the variables under study. In conclusion, the SDQ test is offered as an agile, simplified, and effective tool, to be proposed to all formative agents who are concerned with the interest and care not only of young people, but also of the future of socio-political realities.

Family processes: Risk, protective and treatment factors for youth at risk for suicide

Family factors have continually been identified as potential risk and protective factors for youth at risk for suicide. This paper reviews family processes that not only are associated with suicide risk, but also might be malleable enough to target in treatment. We also review family intervention components have been incorporated into most youth suicide treatments. Unfortunately research on if these family processes moderator, mediator or change as a result of treatment is limited. Recommendations for future research are offered.

Positive Relationships with Adults and Resilience to Suicide Attempt among New Mexico Hispanic Adolescents

Suicide is a leading cause of adolescent death and has increased in recent years. The purpose of this study was to examine the effect that relationships with adults at home and in the community had on the probability of suicide attempts of Hispanic teenagers in New Mexico. Data from the 2019 New Mexico Youth Risk and Resiliency Survey were analyzed to identify the ways in which relationships with adults influenced suicide attempts among Hispanic adolescent students. The examined factors included: relationships with adults in the home and in the community and with same-age friends, and participation in hobbies or organizations outside of school. The resiliency factors were similar for male and female Hispanic students. As positive relationships with adults at home or in the community increased, the probability of suicide attempts decreased by 37-54%. Positive relationships with same-age friends were also associated with reduced suicide attempts. Community organization involvement and hobbies affected males and females differently. Adults at home and in the community can decrease the risk of suicide for Hispanic teenagers through supportive relationships. Hybrid programs focusing on adolescent health, positive communication, and academic support, which integrate adults from home and community environments, show promise in reducing suicidal thoughts and other risk behaviors.

Familial Factors in the Development of Social Anxiety Disorder

The purpose of the current article is to explore familial factors that influence the development of social anxiety disorder (SAD) in children and adolescents, including parenting, sibling relationships, and family environment. A multitude of interrelated genetic and familial factors have been found to cause and maintain SAD in children and adolescents. There are many challenges in diagnosing and treating the disorder. Knowledge and awareness of familial factors provide insight on targeted treatments that prevent or ameliorate SAD. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 23-34.].

The role of empathy and social anxiety in Latinx adolescents' indirect peer aggression during the transition to high school

The primary purpose of this study was to evaluate the relationship between decreased empathy (i.e., cognitive and affective) and indirect and cyber peer aggression among Latinx adolescents during their transition to high school. Further, we examined the degree to which social anxiety moderated this relationship. Participants were 469 Latinx ninth graders, ages 13-17 years (M = 14.52, SD = 0.58; 58% girls). Adolescents completed the Revised Peer Experiences Questionnaire, Cyber Peer Experiences Questionnaire, Basic Empathy Scale, and Social Anxiety Scale for Adolescents at two different time points, 3 months apart. Hierarchical linear regression analyses revealed concurrent and prospective relationships between lower cognitive empathy and the perpetration of both indirect and cyber aggression. In addition, social anxiety moderated the concurrent associations between both types of empathy and both types of aggression perpetration. Results suggest that interventions that facilitate cognitive empathy and decrease social anxiety may help to reduce adolescents' indirect and cyber aggression toward peers throughout the high school transition.

Predicting Patterns of Treatment Response and Outcome for Adolescents Who Are Suicidal and Depressed

OBJECTIVE

Although several treatments have been shown to be effective in treatment of youth suicidal thoughts and behaviors (STBs), there is a pressing need to account for the substantial variation in adolescents' response to and outcomes from these treatments.

METHOD

Secondary analyses of data from a 16-week randomized trial of Attachment-Based Family Therapy (ABFT) and Family-Enhanced NonDirective Supportive Therapy (FE-NST) identified distinct classes of adolescents' treatment response. Established risk factors for STBs, along with treatment condition and sociodemographic variables, were then tested as predictors of class membership.

RESULTS

Three patterns of adolescents' treatment response and outcome were identified: a) nonresponders (15.8%), b) good responders (57.5%), and c) partial responders (26.7%). After controlling for initial symptom severity, nonresponders were more likely to have higher levels of nonsuicidal self-injury and pessimism and were more likely to meet diagnostic criteria for major depressive disorder (MDD) than good or partial responders. Partial responders were more likely than good responders to meet criteria for MDD and to have higher perceived burdensomeness.

CONCLUSION

Although most adolescents showed significant symptom reductions with both treatments, adolescents with higher pretreatment levels of pessimism, MDD, nonsuicidal self-injury, and perceived burdensomeness were less likely to show an optimal pattern of treatment benefit. The findings point to heterogeneity in treatment response that may require adapting treatments for adolescents with these pretreatment profiles.

CLINICAL TRIAL REGISTRATION INFORMATION

Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov; NCT01537419.

[Association of suicidal ideation with family environment and psychological resilience in adolescents]

OBJECTIVE

To study the association of suicidal ideation with family environment and psychological resilience in adolescents.

METHODS

Cluster sampling was used to perform an investigation among 3 230 junior and senior high school students in Xinxiang of Henan Province, China December 2014. A general social information questionnaire, 11-Item Kutcher Adolescent Depression Scale(KADS-11), Family Environment Scale-Chinese Version (FES-CV) and Connor-Davidson Resilience Scale (CD-RISC; Chinese version ) were used for evaluation. A multivariate logistic regression analysis and a case-control study were used to investigate the association of suicidal ideation with family environment and psychological resilience in adolescents.

RESULTS

A total of 2 960 usable questionnaires were received. Among the 2 960 adolescents, 247 (8.50%) had suicidal ideation (98 boys and 149 girls). The multivariate logistic regression analysis showed that after adjustment for age and sex, single-parent/remarried family was associated with an increased risk of suicidal ideation (OR=2.655). Suicidal ideation in boys was negatively correlated with family cohesion (OR=0.750, P<0.001) and organization (OR=0.855, P=0.036) and was positively correlated with family conflict (OR=1.159, P=0.017). Suicidal ideation in girls were negatively correlated with family cohesion (OR=0.771, P<0.001), emotional expression (OR=0.815, P=0.001) and intellectual-cultural orientation (OR=0.915, P=0.037). The adolescents with suicidal ideation had a significantly lower total score of psychological resilience than those without suicidal ideation (P<0.05). Compared with those without suicidal ideation, the adolescents with suicidal ideation had significantly lower scores on 4 factors of the CD-RISC (ability, tolerance of negative emotions, acceptance of changes and control) (P<0.05).

CONCLUSIONS

Family cohesion is a protective factor against suicidal ideation in adolescents. Family organization in boys and family emotional expression in girls are associated with a decreased risk of suicidal ideation. Enhanced psychological resilience may help to reduce the incidence of suicide ideation in adolescents.

Relationships between affective states and childhood internalizing disorders

Internalizing disorders are mainly defined as psychosomatic, anxiety and depression problems. The aim of this study was to analyze the relationships between dairy affective states and internalizing disorders in early adolescence (10-12 years old), considering the influence of sex. The participants of the study were 367 children aged between 10 and 12 (190 girls and 177 boys). The results showed that fear was the best predictor for all internalizing disorders, and the only common predictor for all of them. The prediction of boys' internalizing disorders was based only in fear, whereas the prediction for girls involved more variables besides fear. An early detection/regulation of these affective states (particularly fear) may be useful for the prevention and treatment of child internalizing disorders.

Suicidality in Subjects With Anxiety or Obsessive-Compulsive and Related Disorders: Recent Advances

PURPOSE OF REVIEW

Historically, anxiety disorders have not been considered as important determinants of suicide, but in the last years, many works have challenged this assumption. Here, we will review the available evidence on the relationship between suicide and anxiety disorders (e.g., obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, panic disorder, and body dysmorphic disorder), with special emphasis on findings published in the last years.

RECENT FINDINGS

Overall, anxiety disorders increase the risk of suicide. Specifically, 16% of patients with social anxiety disorder reported suicidal ideation in the previous month, and 18% of them had a history of suicide attempts. Similarly, in patients with panic disorder, suicidal ideation prevalence ranged between 17 and 32%, and 33% of them had a history of suicide attempts. Generalized anxiety disorder (GAD) was the most frequent anxiety disorder in completed suicides (present in 3% of people who committed suicide) and also subthreshold GAD was clearly linked to suicide ideation. Post-traumatic stress disorder was positively associated with suicidal ideation, and in patients with obsessive-compulsive disorder, suicide ideation rates ranged from 10 to 53% and suicide attempts from 1 to 46%. Body dysmorphic disorders presented a suicide ideation prevalence of about 80%. Suicide risk is increased in subjects with anxiety disorder. This risk is higher in the presence of comorbidities, but it is not clear whether it is independent from such comorbidities in some disorders.

Disparities in Anxiety and its Disorders

Much of the scientific work addressing the enigmas of anxiety and its disorders has been conducted among European Americans. This work has led to great progress into the nature of anxiety psychopathology, including etiologic, maintenance, and relapse processes. Moreover, evidenced-based treatments for anxiety and its disorders have arguably been among the best in the field of psychopathology for well over two decades. Yet, the progress thus far attained on the nature and treatment of anxiety disorders has not benefited all members of society equally. In fact, there are striking gaps of inequalities in anxiety disorder research and practice. The population in the United States (U.S.) and many parts of the industrialized world is rapidly changing in terms of diversity, and gaps between segments of society are growing in many instances (e.g., financial inequity). Health disparities in anxiety disorders are not a generic issue, but rather, reflect a systematic difference disproportionately affecting groups often not afforded a high social status ranking. We developed this Special Issue in the Journal of Anxiety Disorders to call attention to matters of inequality in anxiety disorders. The present special issue is designed to contextualize contemporary health disparity work on anxiety and its disorders. The special issue highlights three domains of study that are starting to guide research and practice in this arena, including sociocultural and contextual influences on anxiety and its disorders; intra-individual transdiagnostic mechanisms underpinning the expression and etiology/maintenance of anxiety psychopathology; and the close interconnection between anxiety processes and health status and health compromising behaviors. By covering a range of issues interconnected by their focus on understanding health disparity issues, it is hoped that this issue will: alert readers to the significance of this work at different levels of analysis; illustrate the many domains currently being explored via innovative approaches; and identify fecund areas for future systematic study.

Association between Suicide Ideation and Attempts and Being an Immigrant among Adolescents, and the Role of Socioeconomic Factors and School, Behavior, and Health-Related Difficulties

The risk of suicide behaviors in immigrant adolescents varies across countries and remains partly understood. We conducted a study in France to examine immigrant adolescents' likelihood of experiencing suicide ideation in the last 12 months (SI) and lifetime suicide attempts (SA) compared with their native counterparts, and the contribution of socioeconomic factors and school, behavior, and health-related difficulties. Questionnaires were completed by 1559 middle-school adolescents from north-eastern France including various risk factors, SI, SA, and their first occurrence over adolescent's life course (except SI). Data were analyzed using logistic regression models for SI and Cox regression models for SA (retaining only school, behavior, and health-related difficulties that started before SA). Immigrant adolescents had a two-time higher risk of SI and SA than their native counterparts. Using nested models, the excess SI risk was highly explained by socioeconomic factors (27%) and additional school, behavior, and health-related difficulties (24%) but remained significant. The excess SA risk was more highly explained by these issues (40% and 85%, respectively) and became non-significant. These findings demonstrate the risk patterns of SI and SA and the prominent confounding roles of socioeconomic factors and school, behavior, and health-related difficulties. They may be provided to policy makers, schools, carers, and various organizations interested in immigrant, adolescent, and suicide-behavior problems.