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Garofano JS, Borden L, Van Eck K, Ostrander R, Parrish C, Grados M, Chiappini EA, Reynolds EK. Subtypes of Depressed Youth Admitted for Inpatient Psychiatric Care: A Latent Profile Analysis. Res Child Adolesc Psychopathol 2024; 52:713-725. [PMID: 38109023 DOI: 10.1007/s10802-023-01157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
Depressed youth frequently present with comorbid symptoms. Comorbidity is related to a poorer prognosis, including treatment resistance, academic problems, risk of suicide, and overall impairment. Studies examining the latent structure of depression support the notion of multiple presentations of depressed youth; however, it is unclear how these presentations are represented among acutely impaired youth. Participants (n = 457) in this naturalistic study were admitted to a psychiatric inpatient unit (Mean age = 14.33 years, SD = 1.94;76% female;46.6% Black/African-American). Selected subscales from the parent-report Behavior Assessment System for Children, Second Edition, were utilized as indicators in a latent profile analysis. Subgroups were validated based on their relationships with meaningful clinical correlates (e.g., family factors, discharge diagnosis) and further described by their associations with demographic variables. A five-class model provided the best balance of fit and parsimony. Subtypes of depressed youth included Predominantly Depressed (39.1%), Oppositional (28.2%), Severely Disruptive (12.3%), Anxious-Oppositional (11.6%), and Anxious-Withdrawn (8.8%). Comorbid symptoms were present in four of the five classes (60.9% of sample). High levels of externalizing symptoms were a prominent clinical feature associated with three classes (52.1% of the sample). Construct validity of the respective classes was demonstrated by differential association with clinical correlates, family characteristics, and demographics. Findings suggest that depressed youth presenting for acute inpatient psychiatric care displayed varied clinical presentations. The identified latent groups aligned with existing research reflecting comorbidity with anxiety, inattention, and externalizing disorders. Findings underscore the need for an increased clinical appreciation of comorbidity and encourage more targeted and effective prevention and treatment strategies.
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Affiliation(s)
- Jeffrey S Garofano
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Lindsay Borden
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn Van Eck
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Rick Ostrander
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carisa Parrish
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Children's Mercy/ University of Missouri, Kansas City, MO, USA
| | - Marco Grados
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erika A Chiappini
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth K Reynolds
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Davis A, Van Eck K, Copeland-Linder N, Phuong K, Belcher HME. Hospitalization and Mortality for Insured Patients in the United States with COVID-19 with and without Autism Spectrum Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-05971-2. [PMID: 37022580 PMCID: PMC10077315 DOI: 10.1007/s10803-023-05971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/07/2023]
Abstract
Autism spectrum disorder (ASD) is a neuropsychiatric condition that may be associated with negative health outcomes. This retrospective cohort study reveals the odds of hospitalization and mortality based on ASD for a population of insured patients with COVID-19. The odds of hospitalization and mortality for people with ASD were found to be greater than individuals without ASD when adjusted for sociodemographic characteristics. Hospitalization and mortality was associated with a dose-response increase to comorbidity counts (1 to 5+). Odds of mortality remained greater for those with ASD when adjusting for comorbid health conditions. ASD is a risk factor for COVID-19 mortality. Comorbid health conditions play a particular role in increasing the odds of COVID-19 related hospitalization and death for ASD patients.
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Affiliation(s)
- Amber Davis
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, USA
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA
| | - Kathryn Van Eck
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, USA
- Kennedy Krieger Institute, Center for Diversity in Public Health Leadership Training, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Nikeea Copeland-Linder
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, USA
- Kennedy Krieger Institute, Center for Diversity in Public Health Leadership Training, 716 North Broadway, Baltimore, MD, 21205, USA
| | | | - Harolyn M E Belcher
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, USA.
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA.
- Kennedy Krieger Institute, Center for Diversity in Public Health Leadership Training, 716 North Broadway, Baltimore, MD, 21205, USA.
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Stepanova E, Langfus JA, Youngstrom EA, Evans SC, Stoddard J, Young AS, Van Eck K, Findling RL. Finding a Needed Diagnostic Home for Children with Impulsive Aggression. Clin Child Fam Psychol Rev 2023; 26:259-271. [PMID: 36609931 DOI: 10.1007/s10567-022-00422-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/09/2023]
Abstract
Aggressive behavior is one of the most common reasons for referrals of youth to mental health treatment. While there are multiple publications describing different types of aggression in children, it remains challenging for clinicians to diagnose and treat aggressive youth, especially those with impulsively aggressive behaviors. The reason for this dilemma is that currently several psychiatric diagnoses include only some of the common symptoms of aggression in their criteria. However, no single diagnosis or diagnostic specifier adequately captures youth with impulsive aggression (IA). Here we review select current diagnostic categories, including behavior and mood disorders, and suggest that they do not provide an adequate description of youth with IA. We also specifically focus on the construct of IA as a distinct entity from other diagnoses and propose a set of initial, provisional diagnostic criteria based on the available evidence that describes youth with IA to use for future evaluation.
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Affiliation(s)
- Ekaterina Stepanova
- Virginia Commonwealth University, 1308 Sherwood Ave, Richmond, VA, 23220, USA.
| | - Joshua A Langfus
- University of North Carolina at Chapel Hill, 235 E Cameron Ave, CB# 3270, Chapel Hill, NC, 27514, USA
| | - Eric A Youngstrom
- University of North Carolina at Chapel Hill, 103 Westchester Pl, Chapel Hill, NC, 27514-5237, USA
| | - Spencer C Evans
- University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA
| | - Joel Stoddard
- University of Colorado Anschutz Medical Campus, Aurora, 13123 East 16Th Ave, Aurora, CO, 80045, USA
| | - Andrea S Young
- Johns Hopkins University, 1800 Orleans Street, Bloomberg 12N, Baltimore, MD, 21287, USA
| | - Kathryn Van Eck
- Johns Hopkins University, 1800 Orleans Street, Bloomberg 12N, Baltimore, MD, 21287, USA
| | - Robert L Findling
- Virginia Commonwealth University, 501 N 2Nd St 4Th Floor, PO Box 980308, Richmond, VA, 23298-0308, USA
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Rybczynski S, Ryan TC, Wilcox HC, Van Eck K, Cwik M, Vasa RA, Findling RL, Slifer K, Kleiner D, Lipkin PH. Suicide Risk Screening in Pediatric Outpatient Neurodevelopmental Disabilities Clinics. J Dev Behav Pediatr 2022; 43:181-187. [PMID: 34657090 DOI: 10.1097/dbp.0000000000001026] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the implementation of universal suicide risk screening in pediatric neurodevelopmental disabilities (NDD) medical clinics, analyze demographic and clinical characteristics of eligible patients, describe outcomes of positive screenings, and describe factors that influenced participation in screenings. METHODS A suicide risk screening protocol was developed and implemented for medical clinic patients aged 8 to 18 years. Registered nurses screened patients using the "Ask Suicide-Screening Questions" tool during triage. Positive screenings were referred for further assessment and mental health management. Demographics and clinical data were extracted from medical records using retrospective chart reviews. RESULTS During the 6-month study period, 2961 individual patients presented for 5260 screening eligible patient visits. In total, 3854 (73.3%) screenings were completed with 261 (6.8%) positive screenings noted. Screenings were declined in 1406 (26.7%) visits. Parents of children with cognitive impairments were more likely to decline screening. Clinics serving children with autism spectrum disorder had higher rates of positive screenings compared with all other clinic attendees. Seventy-two of 187 children (38.5%) with positive screenings were identified and referred to outpatient mental health referrals. Seven (2.5%) of these children required acute psychiatric treatment. CONCLUSION Routine screening, identification of increased suicide risk, and referral to mental health care among children with NDD are feasible. It remains unclear whether variation in rates among youth with and without NDD may indicate true differences in suicide risk or cognitive impairments or reflect psychiatric comorbidities. High rates of declined participation may have influenced identification of children with NDD and suicide risk. Preliminary findings identified groups of children with NDD at heightened risk for suicidal ideation and behavior. Further research is needed to assess the validity of suicide risk screening tools in children with neurodevelopmental disorders.
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Affiliation(s)
- Suzanne Rybczynski
- Kennedy Krieger Institute, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Taylor C Ryan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Forefront Suicide Prevention, University of Washington, Seattle, WA
| | - Holly C Wilcox
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathryn Van Eck
- Kennedy Krieger Institute, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mary Cwik
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Roma A Vasa
- Kennedy Krieger Institute, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert L Findling
- Kennedy Krieger Institute, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
| | - Keith Slifer
- Kennedy Krieger Institute, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel Kleiner
- Kennedy Krieger Institute, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paul H Lipkin
- Kennedy Krieger Institute, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract
OBJECTIVE Serious mental illness places a considerable burden on the mental health service system in the United States. To date, no research has examined the availability of psychiatric emergency walk-in and crisis services. The goal of this study was to examine temporal trends, geographic variation, and characteristics of psychiatric facilities that provide emergency psychiatric walk-in and crisis services across the United States. METHODS The authors used cross-sectional, annually collected data covering the 2014-2018 period from the National Mental Health Services Survey (N-MHSS), a representative survey of both public and private mental health treatment facilities in the United States. RESULTS Overall, 42.6% of all U.S. mental health facilities did not offer any mental health crisis services between 2014 and 2018. A third of all facilities (33.5%) offered emergency psychiatric walk-in services, and just under one-half (48.3%) provided crisis services. When examining population-adjusted estimates, the authors noted a 15.8% (1.52-1.28 per 100,000 U.S. adults) and 7.5% (2.01-1.86 per 100,000 U.S. adults) decrease in walk-in and crisis services, respectively, from 2014 to 2018. Large geographic variation in service availability was also observed. CONCLUSION A large proportion of psychiatric facilities in the United States do not provide psychiatric walk-in or crisis services. Availability of these services either has stayed flat or is declining. Disparities, particularly around U.S. borders and coasts, suggest policy efforts would be valuable for ensuring equitable service availability.
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Affiliation(s)
- Luther G. Kalb
- Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Calliope Holingue
- Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma K. Stapp
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Kathryn Van Eck
- Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Marcell AV, Johnson SB, Nelson T, Labrique AB, Eck KV, Skelton S, Aqil A, Gibson D. Protocol for the Feasibility, Acceptability, and Preliminary Efficacy Trial of text4FATHER for Improving Underserved Fathers' Involvement in Infant Care. J Health Care Poor Underserved 2021; 32:1110-1135. [PMID: 34421016 DOI: 10.1353/hpu.2021.0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While father engagement in infant care is widely advocated and research demonstrates that it contributes to improved outcomes, few approaches engage fathers, especially racial/ethnic minority underserved fathers, during maternity care. This study protocol describes the text4FATHER's feasibility, acceptability, and preliminary efficacy trial from mid-pregnancy through two months postnatal age.
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Van Eck K, Thakkar M, Matson PA, Hao L, Marcell AV. Adolescents' Patterns of Well-Care Use Over Time: Who Stays Connected. Am J Prev Med 2021; 60:e221-e229. [PMID: 33648787 PMCID: PMC8068632 DOI: 10.1016/j.amepre.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Well-care use can positively impact adolescents' current and future health. Understanding adolescents' longitudinal well-care use is critical to determine to whom and when to target engagement strategies to improve healthcare access. This study describes prospective well-care use patterns from childhood through adolescence stratified by sex. METHODS The sample (N=6,872) was drawn from the Child/Young Adult component of the household-based 1979 National Longitudinal Survey of Youth consisting of biological children born to female respondents (1980-1997). Well-care use (routine checkup with a doctor within last year) data were assessed from age 5 years (1986-2003) until age 17 years (1998-2015). Conducted in 2019, latent class analyses stratified by sex identified well-care use patterns reported over 7 biennial time points adjusted for cohort, race/ethnicity, urbanicity, maternal education, and insurance. RESULTS A total of 4 well-care use classes emerged for female adolescents: the majority belonged to Engaged (37%) and Moderately Engaged (39%) classes and the remainder belonged to Gradually Re-engaged (14%) and Disengaged-with-Rebound (10%) classes. A total of 3 classes emerged for male adolescents: the majority belonged to the Persistently Disengaged (48%) class and the remainder belonged to Engaged (34%) and Gradually Re-engaged (18%) classes. For both sexes, comparing each cohort with the first, Engaged class membership increased for subsequent cohorts. Less engaged well-care use classes had more non-Hispanic White adolescents living in rural areas with lower insurance coverage. Maternal education differentiated well-care use classes for male but not for female adolescents, being higher for male adolescents in the Engaged class than in other classes. CONCLUSIONS These findings highlight that well-care use patterns for both sexes changed during the transition from childhood to adolescence and that class membership differed by covariates. These results suggest that sex-specific strategies may be needed to enhance adolescents' well-care use engagement over time.
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Affiliation(s)
- Kathryn Van Eck
- Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Psychiatry, Kennedy Krieger Institute, Baltimore, Maryland
| | - Madhuli Thakkar
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Pamela A Matson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lingxin Hao
- Department of Sociology, Johns Hopkins Krieger School of Arts & Sciences, Baltimore, Maryland
| | - Arik V Marcell
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Zisman CR, Patti MA, Kalb LG, Stapp EK, Van Eck K, Volk H, Holingue C. Complementary and Alternative Medicine Use in Children with a Developmental Disability and Co-occurring Medical Conditions. Complement Ther Med 2020; 53:102527. [PMID: 33066848 DOI: 10.1016/j.ctim.2020.102527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The primary aim of this study was to evaluate differences in the prevalence of complementary and alternative medicine (CAM) usage among children with and without developmental disabilities (DD). Secondarily, the association between CAM usage and comorbid chronic medical conditions was explored among children with DD. DESIGN Data come from the 2012 Child Complementary and Alternative Medicine Supplement of the National Health Interview Survey, a nationally representative sample of children in the United States between the ages of 4 and 17 (n = 10,218).Main outcome measures Multiple logistical regression models provided insight into the relationships between parent-report CAM usage, DD, and chronic medical conditions. RESULTS Children with developmental disabilities were more likely to use CAMs compared to their typically developing peers (21% vs 16%). Children with DDs and comorbid chronic medical conditions used CAMs at even higher rates (23% vs 18%). CONCLUSIONS Results indicated that children with DD, especially those with a co-occurring chronic medical condition, use CAMs more often that typically developing children. Given scarcity of information on safety and effectiveness, clinical providers need to be alert to which children may be more likely to be exposed to CAMs. Communication between parents and providers needs to include discussion of CAM treatments.
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Affiliation(s)
- Corina R Zisman
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, 9000 Rockville Pike, Bethesda, MD, 20892, United States.
| | - Marisa A Patti
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, United States
| | - Luther G Kalb
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, United States; Wendy Klag Center for Autism and Developmental Disabilities, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States; Department of Neuropsychology, Kennedy Krieger Institute, 1750 E Fairmount Ave, Baltimore, MD, 21231, United States
| | - Emma K Stapp
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive MSC 3720, Bldg. 35A, Bethesda, MD 20892-3720, United States
| | - Kathryn Van Eck
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States; Department of Psychiatry, Kennedy Krieger Institute, 1741 Ashland Ave, Baltimore, MD, 21205, United States
| | - Heather Volk
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, United States; Wendy Klag Center for Autism and Developmental Disabilities, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States
| | - Calliope Holingue
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, United States; Wendy Klag Center for Autism and Developmental Disabilities, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States; Department of Neuropsychology, Kennedy Krieger Institute, 1750 E Fairmount Ave, Baltimore, MD, 21231, United States
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Stapp EK, Williams SC, Kalb LG, Holingue CB, Van Eck K, Ballard ED, Merikangas KR, Gallo JJ. Mood disorders, childhood maltreatment, and medical morbidity in US adults: An observational study. J Psychosom Res 2020; 137:110207. [PMID: 32745641 PMCID: PMC7855245 DOI: 10.1016/j.jpsychores.2020.110207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/13/2020] [Accepted: 07/26/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Mood disorders, child maltreatment, and medical morbidity are associated with enormous public health burden and individual suffering. The effect of mood disorders on medical morbidity, accounting for child maltreatment, has not been studied prospectively in a large, representative sample of community-dwelling US adults. This study tested the effects of mood disorders and child maltreatment on medical morbidity, and variation by subtypes. METHODS Participants were noninstitutionalized US adults in the National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093 wave 1, N = 34,653 wave 2). Mood disorders included lifetime DSM-IV episodes of depression, dysthymia, mania, or hypomania. Child maltreatment was defined as sexual, physical, or emotional abuse, or physical or emotional neglect before age 18. Survey-weighted zero-inflated poisson regression was used to study effects on medical morbidity, a summary score of 11 self-reported medical conditions. Results were adjusted for age, sex, ethnicity/race, income, substance use disorders, smoking, and obesity. RESULTS Mood disorders and child maltreatment additively associated with medical morbidity at study entry and three years later, with similar magnitude as obesity and smoking. Mania/hypomania (incidence rate ratio [IRR] 1.06, 95% CI 1.01-1.10) and child sexual (IRR 1.08, 95% CI 1.04-1.11) and emotional (IRR 1.05, 95% CI 1.01-1.10) abuse were associated with higher medical morbidity longitudinally. CONCLUSIONS Child maltreatment is common, and its long-range negative effect on medical morbidity underscores the importance of trauma-informed care, and consideration of early life exposures. History of mania/hypomania should be considered in medical practice, and physical health must be emphasized in mental health care.
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Affiliation(s)
- Emma K Stapp
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Stacey C Williams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luther G Kalb
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Kennedy Krieger Institute, Baltimore, MD, USA
| | - Calliope B Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Kennedy Krieger Institute, Baltimore, MD, USA
| | | | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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10
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Young AS, Youngstrom EA, Findling RL, Van Eck K, Kaplin D, Youngstrom JK, Calabrese J, Stepanova E, The Lams Consortium. Developing and Validating a Definition of Impulsive/Reactive Aggression in Youth. J Clin Child Adolesc Psychol 2019; 49:787-803. [PMID: 31343896 DOI: 10.1080/15374416.2019.1622121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The goal of this study is to develop a rational data-driven definition of impulsive/reactive aggression and establish distinctions between impulsive/reactive aggression and other common childhood problems. This is a secondary analysis of data from Assessing Bipolar: A Community Academic Blend (ABACAB; N = 636, ages 5-18), Stanley Medical Research Institute N = 392, ages 5-17), and the Longitudinal Assessment of Manic Symptoms (LAMS; N = 679, ages 6-12) studies, which recruited youths seeking outpatient mental health services in academic medical centers and community clinics. Following Jensen et al.'s (2007) procedure, 3 judges independently rated items from several widely used scales in terms of assessing impulsive/reactive aggression. Principal components analyses (PCA) modeled structure of the selected items supplemented by items related to mood symptoms, rule-breaking behavior, and hyperactivity/impulsivity to better define the boundaries between impulsive/reactive aggression and other common childhood symptoms. In the rational item selection process, there was good agreement among the 3 experts who rated items as characterizing impulsive/reactive aggression or not. PCA favored 5 dimension solutions in all 3 samples. Across all samples, PCA resulted in rule-breaking behavior, aggression-impulsive/reactive (AIR), mania, and depression dimensions; there was an additional hyperactive/impulsive dimension in the LAMS sample and a self-harm dimension in ABACAB and Stanley samples. The dimensions demonstrated good internal consistency; criterion validity coefficients also showed consistency across samples. This study is a step toward developing an empirically derived nosology of impulsive aggression/AIR. Findings support the validity of the AIR construct, which can be distinguished from manic and depressive symptoms as well as rule-breaking behavior.
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Affiliation(s)
- Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Robert L Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Kathryn Van Eck
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Dana Kaplin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Jennifer K Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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11
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Hill K, Van Eck K, Goklish N, Larzelere-Hinton F, Cwik M. Factor structure and validity of the SIQ-JR in a southwest American Indian tribe. Psychol Serv 2018; 17:207-216. [PMID: 30475042 DOI: 10.1037/ser0000298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Previous literature is severely limited in evaluation of psychometric properties of suicide screening methods in American Indian (AI) populations, despite the disproportionate burden of suicide faced within AI communities. The purpose of the current study was to examine the psychometric properties of the Suicidal Ideation Questionnaire-Junior (SIQ-JR) for AI youth using 2 community samples of AI adolescents from a Southwestern tribe. The present study sample was comprised of 114 participants (n = 91 and n = 23), ages 10-19 years of age, from 2 studies, both of which were administered the SIQ-JR within 90 days of an index suicide attempt. Findings indicated that a two-factor model resulted in appropriate fit indices with AI youth, a general ideation index and an active ideation index. Scores on the active ideation and general ideation indices were also related to cumulative stress, self-reported suicidal ideation and previous suicide attempt, providing a measure of convergent validity. Finally, use of cutpoint of 20, rather than published cutpoint of 31, evidenced marginally better positive and negative predictive values, with sensitivity within acceptable ranges. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Kyle Hill
- Center for American Indian Health, Bloomberg School of Public Health, Johns Hopkins University
| | - Kathryn Van Eck
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
| | - Novalene Goklish
- Center for American Indian Health, Bloomberg School of Public Health, Johns Hopkins University
| | | | - Mary Cwik
- Center for American Indian Health, Bloomberg School of Public Health, Johns Hopkins University
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Myer EN, Petrikovets A, Slocum PD, Lee TG, Carter-Brooks CM, Noor N, Carlos DM, Wu E, Van Eck K, Fashokun TB, Yurteri-Kaplan L, Chen CCG. Risk factors for explantation due to infection after sacral neuromodulation: a multicenter retrospective case-control study. Am J Obstet Gynecol 2018; 219:78.e1-78.e9. [PMID: 29630890 DOI: 10.1016/j.ajog.2018.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Sacral neuromodulation is an effective therapy for overactive bladder, urinary retention, and fecal incontinence. Infection after sacral neurostimulation is costly and burdensome. Determining optimal perioperative management strategies to reduce the risk of infection is important to reduce this burden. OBJECTIVE We sought to identify risk factors associated with sacral neurostimulator infection requiring explantation, to estimate the incidence of infection requiring explantation, and identify associated microbial pathogens. STUDY DESIGN This is a multicenter retrospective case-control study of sacral neuromodulation procedures completed from Jan. 1, 2004, through Dec. 31, 2014. We identified all sacral neuromodulation implantable pulse generator implants as well as explants due to infection at 8 participating institutions. Cases were patients who required implantable pulse generator explantation for infection during the review period. Cases were included if age ≥18 years old, follow-up data were available ≥30 days after implantable pulse generator implant, and the implant was performed at the institution performing the explant. Two controls were matched to each case. These controls were the patients who had an implantable pulse generator implanted by the same surgeon immediately preceding and immediately following the identified case who met inclusion criteria. Controls were included if age ≥18 years old, no infection after implantable pulse generator implant, follow-up data were available ≥180 days after implant, and no explant for any reason <180 days from implant. Controls may have had an explant for reasons other than infection at >180 days after implant. Fisher exact test (for categorical variables) and Student t test (for continuous variables) were used to test the strength of the association between infection and patient and surgery characteristics. Significant variables were then considered in a multivariable logistic regression model to determine risk factors independently associated with infection. RESULTS Over a 10-year period at 8 academic institutions, 1930 sacral neuromodulator implants were performed by 17 surgeons. In all, 38 cases requiring device explant for infection and 72 corresponding controls were identified. The incidence of infection requiring explant was 1.97%. Hematoma formation (13% cases, 0% controls; P = .004) and pocket depth of ≥3 cm (21% cases, 0% controls; P = .031) were independently associated with an increased risk of infection requiring explant. On multivariable regression analysis controlling for significant variables, both hematoma formation (P = .006) and pocket depth ≥3 cm (P = .020, odds ratio 3.26; 95% confidence interval, 1.20-8.89) remained significantly associated with infection requiring explant. Of the 38 cases requiring explant, 32 had cultures collected and 24 had positive cultures. All 5 cases with a hematoma had a positive culture (100%). Of the 4 cases with a pocket depth ≥3 cm, 2 had positive cultures, 1 had negative cultures, and 1 had a missing culture result. The most common organism identified was methicillin-resistant Staphylococcus aureus (38%). CONCLUSION Infection after sacral neuromodulation requiring device explant is low. The most common infectious pathogen identified was methicillin-resistant S aureus. Demographic and health characteristics did not predict risk of explant due to infection, however, having a postoperative hematoma or a deep pocket ≥3 cm significantly increased the risk of explant due to infection. These findings highlight the importance of meticulous hemostasis as well as ensuring the pocket depth is <3 cm at the time of device implant.
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Abstract
OBJECTIVE Given the link between negative body image and depression symptoms, body image may affect the association between ADHD and depression symptoms. We evaluated the degree to which a variety of body image constructs mediated the association between ADHD and depression symptoms. METHOD Participants were undergraduate psychology students ( N = 627, age: M = 20.23, SD = 1.40, 60% female, 47% European American) who completed an online assessment. RESULTS Results indicated that ADHD symptoms were indirectly associated with increased depression symptoms, and that negative evaluation of physical appearance, overweight preoccupation, and body dissatisfaction mediated the association between ADHD and depression symptoms. ADHD symptoms were also directly associated with increased depression symptoms. CONCLUSION Body image appears to play a role in the association between ADHD and depression symptoms for college students. Implications for future research and clinical practice are discussed.
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Affiliation(s)
- Kathryn Van Eck
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA.,2 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kate Flory
- 3 University of South Carolina, Columbia, USA
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14
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Hart SR, Van Eck K, Ballard ED, Musci RJ, Newcomer A, Wilcox HC. Subtypes of suicide attempters based on longitudinal childhood profiles of co-occurring depressive, anxious and aggressive behavior symptoms. Psychiatry Res 2017; 257:150-155. [PMID: 28755606 DOI: 10.1016/j.psychres.2017.07.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/03/2017] [Accepted: 07/16/2017] [Indexed: 01/14/2023]
Abstract
Because suicide attempts are multi-determined events, multiple pathways to suicidal behaviors exist. However, as a low-frequency behavior, within group differences in trajectories to attempts may not emerge when examined in samples including non-attempters. We used longitudinal latent profile analysis to identify subtypes specific for suicide attempters based on longitudinal trajectories of childhood clinical symptoms (i.e., depression, anxiety, and aggression measured in 2nd, 4th-7th grades) for 161 young adults (35.6% male; 58.6% African American) who attempted suicide between ages 13-30 from a large, urban community-based, longitudinal prevention trial (n = 2311). Differences in psychiatric diagnoses, suicide attempt characteristics, criminal history and traumatic stress history were studied. Three subtypes emerged: those with all low (n = 32%), all high (n = 16%), and high depressive/anxious, but low aggressive (n = 52%) symptoms. Those with the highest levels of all symptoms were significantly more likely to report a younger age of suicide attempt, and demonstrate more substance abuse disorders and violent criminal histories. Prior studies have found that childhood symptoms of depression, anxiety and aggression are malleable targets; interventions directed at each reduce future risk for suicidal behaviors. Our findings highlight the link of childhood aggression with future suicidal behaviors extending this research by examining childhood symptoms of aggression in the context of depression and anxiety.
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Affiliation(s)
- Shelley R Hart
- Department of Child Development, California State University, Chico, CA, USA; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn Van Eck
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth D Ballard
- Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Rashelle J Musci
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alison Newcomer
- Psychology Department, The Catholic University of America, Washington DC, USA
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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15
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Ballard ED, Cwik M, Van Eck K, Goldstein M, Alfes C, Wilson ME, Virden JM, Horowitz LM, Wilcox HC. Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department. Prev Sci 2017; 18:174-182. [PMID: 27678381 PMCID: PMC5247314 DOI: 10.1007/s11121-016-0717-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The pediatric emergency department (ED) is a critical location for the identification of children and adolescents at risk for suicide. Screening instruments that can be easily incorporated into clinical practice in EDs to identify and intervene with patients at increased suicide risk is a promising suicide prevention strategy and patient safety objective. This study is a retrospective review of the implementation of a brief suicide screen for pediatric psychiatric ED patients as standard of care. The Ask Suicide Screening Questions (ASQ) was implemented in an urban pediatric ED for patients with psychiatric presenting complaints. Nursing compliance rates, identification of at-risk patients, and sensitivity for repeated ED visits were evaluated using medical records from 970 patients. The ASQ was implemented with a compliance rate of 79 %. Fifty-three percent of the patients who screened positive (237/448) did not present to the ED with suicide-related complaints. These identified patients were more likely to be male, African American, and have externalizing behavior diagnoses. The ASQ demonstrated a sensitivity of 93 % and specificity of 43 % to predict return ED visits with suicide-related presenting complaints within 6 months of the index visit. Brief suicide screening instruments can be incorporated into standard of care in pediatric ED settings. Such screens can identify patients who do not directly report suicide-related presenting complaints at triage and who may be at particular risk for future suicidal behavior. Results have the potential to inform suicide prevention strategies in pediatric EDs.
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Affiliation(s)
- Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-3345, MSC 1282, Bethesda, MD, 20892, USA.
| | - Mary Cwik
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn Van Eck
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clarissa Alfes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Ellen Wilson
- Pediatric Emergency Department, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jane M Virden
- Pediatric Emergency Department, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lisa M Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Holly C Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Van Eck K, Warren P, Flory K. A Variable-Centered and Person-Centered Evaluation of Emotion Regulation and Distress Tolerance: Links to Emotional and Behavioral Concerns. J Youth Adolesc 2016; 46:136-150. [DOI: 10.1007/s10964-016-0542-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/11/2016] [Indexed: 11/24/2022]
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17
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Musci RJ, Hart SR, Ballard ED, Newcomer A, Van Eck K, Ialongo N, Wilcox H. Trajectories of Suicidal Ideation from Sixth through Tenth Grades in Predicting Suicide Attempts in Young Adulthood in an Urban African American Cohort. Suicide Life Threat Behav 2016; 46:255-65. [PMID: 26395337 DOI: 10.1111/sltb.12191] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 06/26/2015] [Indexed: 11/27/2022]
Abstract
The trajectory of suicidal ideation across early adolescence may inform the timing of suicide prevention program implementation. This study aimed to identify developmental trajectories of suicidal ideation among an urban cohort of community-residing African Americans (AA) longitudinally followed from middle school through early adulthood (ages 11-19 years). Subtypes based on the developmental course of suicidal ideation from late childhood through mid-adolescence were identified using longitudinal latent class analysis (LLCA) with 581 AA adolescents (52.7% male; 71.1% free or reduced school meals). The developmental trajectories of suicidal ideation were then used to predict suicide attempts in young adulthood. Our LLCA indicated two subtypes (i.e., ideators and nonideators), with 8% of the sample in the ideator class. This trajectory class shows a peak of suicidal ideation in seventh grade and a steady decline in ideation in subsequent grades. Additionally, suicidal ideation trajectories significantly predicted suicide attempt. Results of these analyses suggest the need for suicide prevention approaches prior to high school for AA youth.
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Affiliation(s)
- Rashelle J Musci
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shelley R Hart
- Department of Child Development, California State University, Chico, CA, USA
| | | | - Alison Newcomer
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Kathryn Van Eck
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nicholas Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Van Eck K, Ballard E, Hart S, Newcomer A, Musci R, Flory K. ADHD and Suicidal Ideation: The Roles of Emotion Regulation and Depressive Symptoms Among College Students. J Atten Disord 2015; 19:703-14. [PMID: 24470539 DOI: 10.1177/1087054713518238] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE ADHD appears to increase risk for both depression and suicidal ideation, while ADHD and depression are also associated with emotion regulation deficits. Thus, we evaluated the degree to which depression mediated the association between ADHD and suicidal ideation, as well as the degree to which emotion regulation deficits moderated the association ADHD shared with depression and suicidal ideation in a nonclinical sample. METHOD Participants were undergraduate psychology students (N = 627; age: M = 20.23, SD = 1.40; 60% female; 47% European American) who completed an online assessment. RESULTS Results indicated that ADHD indirectly increased suicidal ideation through depression. Emotion regulation deficits of accepting negative emotions, emotional awareness, and goal-oriented behavior moderated the indirect effect of ADHD on suicidal ideation. CONCLUSION Depression appears to play an important mediating role in suicidal ideation for college students with ADHD, and specific emotion regulation deficits appear to amplify the effects of ADHD on depression and suicidal ideation.
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Affiliation(s)
- Kathryn Van Eck
- University of South Carolina, Columbia, SC, USA University of Maryland, Baltimore, MD, USA
| | | | | | - Ali Newcomer
- Johns Hopkins University, Baltimore, MD, USA Catholic University of America, Washington, DC, USA
| | | | - Kate Flory
- University of South Carolina, Columbia, SC, USA
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Van Eck K, Flory K, Willis D. Does distress intolerance moderate the link between ADHD symptoms and number of sexual partners? ACTA ACUST UNITED AC 2014; 7:39-47. [DOI: 10.1007/s12402-014-0140-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 05/14/2014] [Indexed: 11/29/2022]
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Van Eck K, Markle RS, Dattilo L, Flory K. Do peer perceptions mediate the effects of ADHD symptoms and conduct problems on substance use for college students? Psychology of Addictive Behaviors 2014; 28:431-42. [DOI: 10.1037/a0036226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Prior research findings have been mixed as to whether attention-deficit/hyperactivity disorder (ADHD) is related to illicit drug use independent of conduct problems (CP). With the current study, the authors add to this literature by investigating the association between trajectories of ADHD symptoms across childhood and adolescence and onset of illicit drug use, with and without controlling for CP. In a longitudinal panel study of a community sample of 754 girls and boys recruited in kindergarten, this research question was examined with a combination of growth mixture modeling (to model parent-reported ADHD symptom trajectories) and survival analysis (to model youth-reported initiation of illicit drug use). Results revealed a 3-class model of ADHD trajectories, with 1 class exhibiting no or minimal symptoms throughout childhood and adolescence, another class showing a convex shape (an increase, then a decrease in symptoms) across time, and a third class showing a concave shape (a decrease, then a slight increase in symptoms) over time. The concave-trajectory class demonstrated significantly earlier onset of illicit drug use than the minimal-problem class, with the convex-trajectory class falling between (but not significantly different from either of the other two classes). These results did not change when the authors added CP to the model as a covariate. Implications of findings for theory and practice are discussed.
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Affiliation(s)
- Patrick S Malone
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA.
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