Mental disorder,subsistence strategies,and victimization among gay,lesbian, and bisexual homeless and runaway adolescents

This study compares participation in deviant subsistence strategies, street victimization, and lifetime prevalence of five mental disorders (conduct disorder, major depressive disorder, post‐traumatic stress disorder, alcohol abuse, and drug abuse) among heterosexual males and females (n = 366) and gay, lesbian, and bisexual (n = 63) homeless and runaway adolescents from the first wave of a longitudinal study of homeless youth in four Midwestern states. The results indicate that gay, lesbian, and bisexual adolescents were more likely to have been physically and sexually abused by caretakers, were more likely to engage in risky survival strategies when on their own (including survival sex), were more likely to be physically and sexually victimized when on the streets, and were more likely to meet criteria for mental disorder than were their heterosexual counterparts.     

Self‐Mutilation and Homeless Youth: The Role of Family Abuse,Street Experiences,and Mental Disorders

Self‐mutilation, which is the act of deliberately harming oneself, has been overlooked in studies of homeless and runaway youth. Given their high rates of abuse and mental health disorders, which are associated with self‐mutilation, homeless and runaway youth provide an ideal sample in which to investigate factors associated with self‐mutilation among a nonclinical population. Based on interviews with 428 homeless and runaway youth aged 16 to 19 years in 4 Midwestern states, the current study revealed widespread prevalence of self‐mutilation among these young people. Multivariate analyses indicated that sexual abuse, ever having stayed on the street, deviant subsistence strategies, and meeting diagnostic criteria for depression were positively associated with self‐mutilation. The findings are interpreted using stress theory and affect‐regulation models.     

Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents

This study compares participation in deviant subsistence strategies, street victimization, and lifetime prevalence of five mental disorders (conduct disorder, major depressive disorder, post-traumatic stress disorder, alcohol abuse, and drug abuse) among heterosexual males and females (n = 366) and gay, lesbian, and bisexual (n = 63) homeless and runaway adolescents from the first wave of a longitudinal study of homeless youth in four Midwestern states. The results indicate that gay, lesbian, and bisexual adolescents were more likely to have been physically and sexually abused by caretakers, we more likely to engage in risky survival strategies when on their own (including survival sex), were more likely to be physically and sexually victimized when on the streets, and were more likely to meet criteria for mental disorder than were their heterosexual counterparts.     

Gender Differences in Sexually Abused Children and Adolescents: A Multicenter Study in Turkey

The purpose of this study was to examine gender-based differences in abuse-related characteristics and post-abuse psychiatric disorders among sexually abused children and adolescents. The researchers retrospectively examined files, judicial reports, and social examination reports of 1,250 sexually abused youth cases. Results showed that boys were more often victimized by penetration, force, and physical violence. Incidence of sexual abuse by family members, familiar persons, and multiple persons was higher among girls. In addition, a higher rate of major depressive disorder as well as alcohol consumption and cigarette smoking were found in sexually abused girls. No difference was observed between boys and girls in terms of post-traumatic stress disorder, conduct disorder, and other mental disorders. Intellectual disability was more frequent in boys.     

Civil Citations for Cannabis Possession: Alternatives to Arrest for Adolescent Substance Use

Results from the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health (NSDUH) have indicated that approximately 8% of responding adolescents ages 12–17 engaged in illicit substance use during the past year; the most commonly reported substance used was marijuana (Substance Abuse and Mental Health Services Administration (SAMHSA), NSDUH series H-44, HHS publication no. (SMA) 12-4713, Substance Abuse and Mental Health Services Administration, Rockville, MD, 2012). Importantly, marijuana use places adolescents at risk of arrest when found in possession of cannabis. Drug abuse violations are associated with multiple consequences for the youth, their families, and communities. Policy makers, therefore, have encouraged the use of civil citations to reduce drug abuse related arrests for youth. Purpose: The current study sought to identify and describe civil citations use for youth marijuana possession. Methods: Using a secondary dataset, we examined aggregate arrests in a Central Florida county. Results: During a 3-year period, 1635 arrests were made for cannabis possession. The vast majority of such arrests were for multiple charges (n?=?1272; 78%). For those arrested due to cannabis possession alone (n?=?363; 22%), over 75% were adults (n?=?281). Therefore, only 82 youth were arrested under the charge, accounting for less than one quarter of all arrests for F.S. §893.13.6b (2013). However, the majority of these youth were detained in juvenile assessment centers (65%, n?=?59); a rate markedly higher than their adult counterparts (37%, n?=?105). Discussion: Due to the concerns associated with arrest and detainment, the authors contend efforts should be made to increase use of civil citations for youth with cannabis possession when possible. Implications for policy are presented.     

Self-reported and case file maltreatment: Relations to psychosocial outcomes for youth in foster care

The aim of the current study was to explore the relation between maltreatment and psychosocial outcomes for youth in foster care, and how this relation differs according to reporter type (self-report or case file). Participants included 285 children and adolescents and their caregivers who completed self-report questionnaires about lifetime maltreatment and psychosocial adjustment. Youths' case files containing lifetime maltreatment reports were obtained from Division of Social Services (DSS), and were coded for physical and sexual abuse, emotional maltreatment, and neglect using the Modified Maltreatment Classification System (MMCS; English & LONGSCAN Investigators, 1997). Crosstabs analysis was used to summarize proportions of youth whose caregivers reported clinically significant internalizing and externalizing and average to high adaptive functioning within groups of youth who had a) neither self-reported nor case file maltreatment, b) only case file maltreatment, c) only self-reported maltreatment, and d) both case file and self-reported maltreatment for each maltreatment type (physical and sexual abuse, emotional maltreatment, and neglect). Results showed that externalizing symptoms differ according to reporter type for physical and sexual abuse, and that internalizing symptoms differ according to reporter type for sexual abuse. Implications for methodology in maltreatment research are discussed.     

Parents and Peers in Relation to Early Adolescent Problem Behavior

Concurrent and prospective associations between parent‐youth dyadic hostility and adolescent externalizing and internalizing problem behavior were examined in a sample of 416 families. Parenting control, parents’ well‐being, and youths’ affiliation with deviant peers were included as integral covariates. Information from multiple sources was analyzed using structural equation modeling. Concurrently, youth externalizing problems were associated with dyadic hostility, deviant peers, inadequate parenting control, and fathers’ well‐being (inversely). Internalizing problems were associated with inadequate parenting control and lower levels of fathers’ well‐being. Prospectively, some of these relations continued over 2 years, with a few new associations emerging. A process model is proposed in which parent‐youth dyadic hostility during early adolescence influences parenting, peer relations, and parents’ well‐being over time.     

Predictors of self‐reported sexually transmitted diseases among homeless and runaway adolescents

Path analysis was used to investigate factors associated with self‐reported sexually transmitted diseases among 569 homeless and runaway adolescents in four Midwestern states. Youth were interviewed by outreach workers directly on the streets, in shelters, and in drop‐in centers. Results indicated that family abuse was positively related to substance use, affiliation with friends who sold sex, and time on own. Early family abuse indirectly increased the likelihood of self‐reported sexually transmitted diseases through time on own, substance use, friends selling sex, and risky sexual behaviors. Finally, substance use and affiliation with friends who sold sex was positively associated with risky sexual behaviors, which in turn was related to self‐reported sexually transmitted diseases. No significant gender interactions were found for this model.     

The Mental Health Advantage of Immigrant‐Background Youth: The Role of Family Factors

Children of immigrant background, despite problems with acculturation, poverty, and discrimination, have better mental health than children of native parents. We asked whether this is a result of immigrant families' characteristics such as family structure and relations. Using a new comparative study on the integration of immigrant‐background youth conducted in England, Germany, the Netherlands, and Sweden (N = 18,716), particularly strong associations with mental health (internalizing and externalizing problems) were found for family structure, family cohesion, and parental warmth. Overall, half of the advantage in internalizing and externalizing problems among immigrant‐background youth could be accounted for by our measures of family structure and family relations, with family cohesion being particularly important.     

Relationships of sexual, physical, and emotional abuse to emotional and behavioral problems among incarcerated adolescents

This study examined the relationships of sexual, physical and emotional abuse to emotional (internalizing) and behavioral (externalizing) problems among incarcerated girls and boys. Participants were youth who were remanded to the correctional facilities within a statewide juvenile correctional system in a southern state in the United States of America. Each participant completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographic characteristics. Multiple regression analyses indicated that girls were more likely than boys to internalize their problems. The only abuse variable that was positively and significantly associated with emotional problems was emotional abuse. Greater behavioral problems were significantly related to youths being younger in age, white ethnicity, history of sexual abuse, and history of physical abuse. There were overall gender differences for internalizing problems, but not for externalizing problems among incarcerated adolescents. Furthermore, physical and sexual abuses were related to externalizing problems but not to internalizing problems. Thus, different types of abuse appear to have different effects on adolescent behavior. Implications for future research and practice are discussed.     

Mothering,Fathering, and Externalizing Behavior in Toddler Boys

This study examined the effects of reported maternal and paternal support, psychological control, and spanking on externalizing behavior of toddler boys. Questionnaires were administered to both parents of 104 two‐parent families with a 3‐year‐old son. Both maternal and paternal psychological control was related to boys' externalizing behavior. Interaction effects were found, in that the association between maternal spanking and boys' externalizing behavior was stronger when levels of maternal support were high. High levels of paternal support strengthened the association between maternal support and boys' externalizing behaviors. Results suggest that the associations between specific parenting dimensions and children's externalizing behavior need to be considered within the context of other parenting dimensions that are displayed within the family.     

Relationships of Sexual,Physical, and Emotional Abuse to Emotional and Behavioral Problems Among Incarcerated Adolescents

ABSTRACT

This study examined the relationships of sexual, physical and emotional abuse to emotional (internalizing) and behavioral (externalizing) problems among incarcerated girls and boys. Participants were youth who were remanded to the correctional facilities within a statewide juvenile correctional system in a southern state in the United States of America. Each participant completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographic characteristics. Multiple regression analyses indicated that girls were more likely than boys to internalize their problems. The only abuse variable that was positively and significantly associated with emotional problems was emotional abuse. Greater behavioral problems were significantly related to youths being younger in age, white ethnicity, history of sexual abuse, and history of physical abuse. There were overall gender differences for internalizing problems, but not for externalizing problems among incarcerated adolescents. Furthermore, physical and sexual abuses were related to externalizing problems but not to internalizing problems. Thus, different types of abuse appear to have different effects on adolescent behavior. Implications for future research and practice are discussed.     

The Impact of Childhood Sexual Abuse on Later Sexual Victimization among Runaway Youth

Path analysis was used to investigate the impact of childhood sexual abuse on later sexual victimization among 372 homeless and runaway youth in Seattle. Young people were interviewed directly on the streets and in shelters by outreach workers in youth service agencies. High rates of both childhood sexual abuse and street sexual victimization were reported, with females experiencing much greater rates compared with their male counterparts. Early sexual abuse in the home increased the likelihood of later sexual victimization on the streets indirectly by increasing the amount of time at risk, deviant peer affiliations, participating in deviant subsistence strategies, and engaging in survival sex. These findings suggest that exposure to dysfunctional and disorganized homes place youth on trajectories for early independence. Subsequently, street life and participation in high‐risk behaviors increases their probability of sexual victimization.     

Associations Between Victimization and Adolescents' Self‐Reported Responses to Peer Provocation Are Moderated by Peer‐Reported Aggressiveness

Many early adolescents experience peer victimization, but little research has examined how they respond to aggression by peers. Thus, in a large sample of early adolescents (N = 648; M age = 12.96; SD = 0.30; 52.0% female), we examined (1) the associations between peer‐reported victimization and self‐reported responses to peer provocation, and (2) whether these associations were moderated by peer‐reported aggression. In particular, we predicted that the reported use of assertion, a strategy generally viewed as socially skillful, would be associated with less victimization, but only for youth low on peer‐reported aggression. Results were consistent with this hypothesis. Moreover, seeking adult intervention was associated with greater victimization for youth high on peer‐reported aggression. Implications for research and practice are discussed.     

Interpersonal trauma and associated psychopathology in girls and boys living in residential care

Out-of-home placement in e.g. residential care is the most common intervention for children and adolescents at risk and studies have shown that this population exhibits high prevalence rates of traumatic events. Associations with specific psychopathology need to be studied in order to sensitize caregivers to the specific needs of this population. The present study aimed to assess the relationship between interpersonal traumatic experiences and specific psychopathological symptoms in a high-risk population of girls and boys living in youth welfare institutions in residential care. 370 adolescents living in 64 different Swiss institutions and their professional caregivers filled out questionnaires on traumatic experiences and psychopathology and took part in structured clinical interviews. They were grouped in 3 different subgroups: no interpersonal trauma, single interpersonal trauma and multiple interpersonal trauma, i.e. interpersonal trauma in two or more domains. Furthermore, associations between the identity of the perpetrator (if the perpetrator was known vs. unknown to the victim) and psychopathology were examined. One third of participants reported multiple interpersonal trauma with female adolescents being more often affected. Multiple interpersonal trauma was associated with more internalizing and externalizing symptoms, but this association was only found with self-reported psychopathology. Male adolescents with multiple interpersonal trauma seemed to be more vulnerable to substance use and affective disorders, while female adolescents with multiple interpersonal trauma tended to have disorders of attention, activity and conduct disorders. Interpersonal trauma (compared to no interpersonal trauma) was not associated with higher rates of PTSD. Furthermore, associations between interpersonal trauma and psychopathology were stronger when the perpetrator was known to the victim.Our results suggest that interpersonal trauma, especially multiple interpersonal trauma, seem to be associated with mental health problems beyond the symptoms of PTSD in this high-risk population. Concepts of residential care institutions should contain trauma-sensitive care and include psychiatric liaison services in order to take into account the specific needs of adolescents in residential care.     

Substance use in youth adopted from foster care: Developmental mechanisms of risk

Children who enter foster care are at unique risk for developing substance abuse due to experiencing early life stressors. A large body of research has revealed robust effects of various stressors on later substance use, implicating the role of early neurobiological changes that create chronic internalizing problems. However, less literature has investigated externalizing behavior as a mechanism underlying this relationship. Moreover, few studies have examined these mechanisms through a model of cumulative risk. The present study examined whether the prospective association between cumulative pre-adoptive risk (e.g., maltreatment, age at placement, foster placement instability, ever having lived with birth parent) and adolescent/young-adult substance use was mediated by childhood internalizing and externalizing problems in youth adopted from foster care. Participants included 82 adoptees, most with histories of prenatal substance exposure (72%). We tested parent-rated internalizing and externalizing problems across 5 years in childhood as simultaneous mediators of cumulative risk and level of substance use 11–15 years later. Bootstrapping mediation procedures, controlling for age, prenatal substance exposure, adolescent/young adult mental health symptomatology, and youth participation in follow-up, revealed a significant indirect effect of cumulative risk on substance use through childhood internalizing problems, but not externalizing problems. These results underline the importance of mitigating early risk for children in the child welfare system and call for targeting childhood emotion dysregulation to reduce likelihood of substance abuse among previously high-risk adoptees. Nevertheless, low rates of substance use overall in the present sample underscore the positive impact of adoptive placement on mitigating risk for substance abuse among foster youth.     

Multiple Family Group Therapy in a Drug and Alcohol Rehabilitation Centre

In the last decade there has been increasing interest in working systemically with groups of families. Multiple family groups (MFGs) have been used in mental health settings with schizophrenia, eating disorders and drug and substance abuse. This article describes the MFG program used in Higher Ground Alcohol and Drug Rehabilitation Trust, a rehabilitation centre in Auckland, (New Zealand). Higher Ground provides an 18‐week residential therapeutic program for people with a severe substance abuse disorder. The MFG in Higher Ground focuses on developing better communication patterns and better boundaries between family members, fostering mutual support, and promoting self‐responsibility.     

THE EFFICACY OF MARITAL AND FAMILY THERAPY: AN EMPIRICAL OVERVIEW, CONCLUSIONS, AND RECOMMENDATIONS

Based primarily on the contributions to this Special Issue of JMFT, this article provides an overview of the empirical research on the efficacy of marital and family therapy for the following disorders and problems: schizophrenia; affective (mood) disorders; slected externalizing, internalizing, and pervasive developmental disorders of childhood; adolescent conduct disorder; marital distress and the prevention of divorce; alcoholism; adult and adolescent drug abuse; and various chronic adult, adolescent, and childhood physical disorders. Convincing scientific evidence supports the efficacy of broadly defined marital and family therapy for the treatment of many disorders, as well as its superiority to standard and individual treatments for certain disorders and populations. We conclude with recommendations for future research as well as for collaborative initiatives between marital/family therapists and other professionals working in the marriage and family field.     

The self and mental health: self-salience and the emergence of internalizing and externalizing problems

How do schemas about self-salience--the importance of the self versus the collective in social relations--affect mental health? We propose that self-salience shapes the likelihood of experiencing internalizing or externalizing problems. Schemas that privilege others over the self increase the risk of internalizing symptoms, including depressive symptoms and anxiety, whereas those that privilege the self over others predispose individuals to externalizing behaviors of antisocial behavior and substance abuse. Furthermore, we propose that these schemas contribute to the gender differences that exist in these problems. We test these predictions with data from adolescents, the stage at which these problems and the gender differences in them arise. Results show that self-salience underlies both internalizing and externalizing problems. In addition, schemas about self-salience help explain the gender differences found in mental health problems.     

Victimization and posttraumatic stress disorder among runaway and homeless adolescents

This article presents lifetime and 12-month prevalence rates and comorbidity for posttraumatic stress disorder (PTSD) among a sample of 428 homeless and runaway adolescents. Data are from baseline interviews of a longitudinal diagnostic study of 428 (187 males; 241 females) homeless and runaway adolescents aged 16-19 years (mean age = 17.4 years, SD = 1.05). The data were collected by full-time street interviewers on the streets and in shelters in eight Midwestern cities of various populations. About one-third (35.5%) of the runaways met lifetime criteria for PTSD and 16.1% met 12-month criteria for the disorder. More than 90% of the adolescents who met criteria for PTSD met criteria for at least one of the other four diagnoses. Multivariate analyses indicated that correlates of PTSD were age of adolescent, being female, having experienced serious physical abuse and/or sexual abuse from an adult caretaker, and having been assaulted or injured by weapon when on the street. The multiplicative interaction between sexual abuse by caretaker and sexual assault when the adolescents were on their own was statistically significant, indicating that rape victims were highly likely to meet criteria for PTSD regardless of early sexual abuse. At very high levels of early sexual abuse, the probability of meeting criteria for PTSD converges with that for sexual assault victims.