Comorbid mood and adjustment disorders among pathological gamblers seeking treatment in Hong Kong

Research findings on comorbidity and pathological gambling are non–existent in Chinese communities. The objectives of this study were to: (a) determine the prevalence of comorbid mood and adjustment disorders among pathological gamblers seeking treatment in Hong Kong; (b) compare demographic profiles and clinical features in pathological gamblers with and without comorbid mood and adjustment disorders; and (c) explore the association and temporal relationship between pathological gambling and comorbid mood and adjustment disorders. Assessment instruments included demographic data, BSI, SCID-I, ASI and LIFE-RIFT. Results showed that about two-thirds (63.7%; n = 128) of 201 participants reported lifetime comorbid psychiatric disorders. Most common comorbid disorders were mood disorders (29.4%; n = 59) and adjustment disorders (20.9%; n = 42). Pathological gamblers with comorbid mood or adjustment disorders showed more severe levels of psychopathology, impairment in psychosocial functioning and gambling problems. This study is important because it is the first scientific comorbidity study among pathological gamblers in a Chinese context.     

Perceptions of emerging adults who accessed residential treatment and entered a parental role

Youth who accessed residential mental health treatment (RT) continue to experience challenges related to their emotional and behavioral disorders, and continue to struggle in several life domains. Some of these youth also become parents. The purpose for this report was to explore the perceptions of emerging adults who accessed RT as a child or youth, and who became parents, about their life domains. These participants (n = 12) reported continued challenges in several domains of living, and some reported that impending parenthood helped motivate them to improve their behaviors. Many reported continued reliance on previous social workers. Implications for practice are discussed.     

Psychological Symptoms of Sexually Victimized Children and Adolescents Compared With Other Maltreatment Subtypes

The differential effects of sexual victimization and other forms of maltreatment on psychological functioning are not well understood. A sample of sexually victimized children and adolescents (N = 70; 6.3–17.9 years) and a group of youth with a history of nonsexual maltreatment (N = 108; 6.7–16.9 years) were compared using measures of mental health and psychosocial functioning. Assessments included standardized clinical interviews on individual maltreatment history and current psychopathology as well as questionnaires on behavioral and emotional symptoms, including posttraumatic stress symptoms. The results from this study suggest that the risk of experiencing any current mental disorders was independent of type of maltreatment. The risk of meeting the criteria for a current diagnosis of major depression, however, is greater among youth with a history of maltreatment that includes sexual victimization. The significant impact of sexual victimization on posttraumatic stress symptoms was found to be nonsignificant after controlling for age and gender effects. The results indicate that the outcomes of child maltreatment depend on type of maltreatment, but age and gender must be taken into account.     

Studies of resilience among youth experiencing homelessness: A systematic review

This article systematically reviews studies exploring resilience among youth experiencing homelessness. We searched eight databases, and 21 articles fit the inclusion criteria and represented four methodologies: qualitative (n = 7, 33.3%), survey and secondary data analysis (n = 8, 38.1%), quantitative (n = 4, 19.1%), and mixed-method (n = 2, 9.5%) designs. Studies indicate that youth experiencing homelessness rely on informal social networks for survival, and that spirituality, mental health, and creativity are associated with enhanced coping. More experimental and intervention studies are necessary to support evidence-based resilience practices. Additionally, researchers need to exercise more self-awareness about how stereotypical pejorative paradigms may constrain innovative, strengths-based scholarship.     

Mid-Adolescents’ and Adults’ Recognition of Vocal Cues of Emotion and Social Intent: Differences by Expression and Speaker Age

Previous research has suggested that the ability to recognize vocal portrayals of socio-emotional expressions improves with age throughout childhood and adolescence. The current study examined whether stimulus-level factors (i.e., the age of the speaker and the type of expression being conveyed) interacted with listeners’ developmental stage to predict listeners’ recognition accuracy. We assessed mid-adolescent (n = 50, aged 13–15 years) and adult (n = 87, 18–30 years) listeners’ ability to recognize basic emotions and social expressions in the voices of both adult and youth actors. Adults’ emotional prosody was better recognized than that of youth, and adult listeners were more accurate overall than were mid-adolescents. Interaction effects revealed that youths’ accuracy was equivalent to adult listeners’ when hearing adult portrayals of anger, disgust, friendliness, happiness, and meanness, and youth portrayals of disgust, happiness, and meanness. Our findings highlight the importance of speaker characteristics and type of expression on listeners’ ability to recognize vocal cues of emotion and social intent.     

Therapeutic Engagement of Adolescents with Emotional and Behavioral Disorders

Youth engagement is increasingly recognized as a preferred approach and often necessary step in the treatment of emotional and behavioral disorders. The purpose of this study was to explore the degree and quality of youth engagement in the therapeutic process, compare engagement scores between youth accessing residential and day treatment, and explore the association between engagement and interpersonal difficulties in a sample of youth with an emotional and/or behavior disorder in residential and day treatment programs based in Southern Ontario. Cross-sectional surveys of standardized measures were administered to youth and a separate survey to their Prime Workers. Relevant constructs included client engagement (as rated by youth and Prime Workers), and youth-rated behavioral screen, interpersonal problems and family functioning. Both Prime Workers and youth rated youth as moderately high in their level of engagement in therapy. Furthermore, Prime Worker and youth ratings did not significantly differ statistically, suggesting that youth may have actually engaged at a moderate level. Interpersonal problems were shown to be negatively associated with youth engagement, and family functioning approached significance for only youth in residential treatment. Assessing youth engagement during the treatment process as an intervention technique may highlight areas where greater clinical efforts are needed. Future considerations include testing methods of sharing and discussing results of an engagement measure within the context of a one-on-one clinical encounter with youth.     

Gender Differences in Self-Conscious Emotions and Motivation to Quit Gambling

Considerable gender differences have been previously noted in the prevalence, etiology, and clinical features of problem gambling. While differences in affective states between men and women in particular, may explain differential experiences in the process of gambling, the role of affect in motivations for quitting gambling and recovery has not been thoroughly explored. The aim of this study was to examine gender differences within a sample of problem gamblers motivated to quit with or without formal treatment, and further, to explore the interactions between gender, shame and guilt-proneness, and autonomous versus controlled reasons for change. Motivation for change and self-conscious emotional traits were analyzed for 207 adult problem gamblers with an interest in quitting or reducing their gambling (96.6 % not receiving treatment). Overall, gender differences were not observed in clinical and demographic characteristics. However, women exhibited greater shame [F(1,204) = 12.11, p = 0.001] and guilt proneness [F(1,204) = 14.16, p < 0.001] compared to men, whereas men scored higher on trait detachment [F(1,204) = 7.08, p = 0.008]. Controlling for demographic and clinical characteristics, general linear models revealed that autonomous motivation for change was associated with higher guilt-proneness, greater problem gambling severity, and the preparation stage of change; whereas controlled forms of motivation were significantly associated with higher shame-proneness and greater problem gambling severity. No gender effects were observed for either motivation for change. These findings suggest that the process of change can be different for shame-prone and guilt-prone problem gamblers, which may impact behavioral outcomes.     

Prevalence and Correlates of Sex Exchange Among a Nationally Representative Sample of Adolescents and Young Adults

The present study examines prevalence and correlates of exchanging sex for drugs, money, food shelter, or other favors (sex exchange) among a nationally representative sample of youth and young adults. Adolescents and young adults (n = 11,620, 53% female, 47% male) from the National Longitudinal Study of Adolescent Health were used for the current sample. Participants completed in-home interviews at both waves. Results revealed that sex exchange was reported by 4.9% (n = 569) of the population in wave 2 or wave 3, and 4.6% (n = 26) of those who exchanged sex did so at both waves. More males reported exchanging sex than females (n = 332 versus n = 237). Respondents who reported child sexual abuse were more likely to exchange sex (95% CI 2.51–4.28, p < .05) than respondents who reported any other form of child abuse. Both males and females who engaged in sex exchange were at greater risk for sexually transmitted infections; however, the odds of ever exchanging sex were highest among males who ever had gonorrhea (OR = 6.2; 95% CI 3.75–10.3). Although sex exchange has been studied extensively among homeless and runaway youth, the current study reveals sex exchange also occurs in the general population.     

Mental Health and Behavioral Outcomes of Sexual and Nonsexual Child Maltreatment Among Child Welfare-Involved Youth

Our research team used the nationally representative National Survey of Child and Adolescent Well-Being II to explore the differences in mental health and behavioral outcomes between children who enter the child welfare system with substantiated sexual abuse and those who enter with exclusively nonsexual maltreatment. The sample included 380 children between the ages of 8 to 17.5 who were substantiated for maltreatment (sexual and nonsexual) and had the same caregivers at both wave 1 and 2 (n = 380). Results show that the average age of children in the sample was 11 years old, and the results corroborate literature that has indicated children and youth with histories of childhood sexual abuse experience significantly more post-traumatic stress disorder symptoms than children with histories of nonsexual maltreatment. This finding held after controlling for baseline trauma symptoms and all covariates, including race, age, placement type, and caregiver characteristics. Childhood sexual abuse was not significantly related to an increase in behavioral symptoms after controlling for covariates. Implications for research and practice are offered.     

Pediatric Emergency Department Visits for Mental Health Crisis: Prevalence of Cyber-Bullying in Suicidal Youth

The objective of this work is to (1) study the prevalence of cyber-bullying amongst adolescents referred by Pediatric Emergency Department (PED) for urgent psychiatric assessment and (2) to examine the association between cyber-bullying and suicidal behavior to assist emergency department professionals in screening for risk and triage. This is a retrospective study of patients referred by PED to an urgent psychiatric clinic. Data was extracted for those with bullying victimization. Clinical variables included demographics, reason for referral, type of bullying, substance use, abuse, past psychiatric history, diagnosis and outcome. The cyber-bullying group was compared to those with traditional bullying and a group with no-bullying. Data analysis was conducted using Chi squares, multinomial and bimodal logistic regression. The urgent psychiatric clinic assessed 805 patients in 24 months, the prevalence of bullying was 26.9 % (n = 217). The prevalence of Cyber-bullying was 13.5 % (n = 109) and traditional bullying was 13.4 % (n = 108). Cyber-bullying victims have more suicidal ideation (χ² = 7.82, p = .005; 85.3  vs. 69.4 %), more sexual abuse (χ² = 5.75, p = .02; 29.4  vs. 15.7 %), more emotional abuse (χ² = 10.8, p = .01; 30.3  vs. 12.0 %) and physical abuse (χ² = 6.13, p = .01; 27.5  vs. 13.9 %) and a higher inpatient admission rate. Suicidal ideation is the presenting problem in more than two-thirds of patients, especially females, with history of cyber-bullying who present to the PED. Screening questions about cyber-bullying could assist emergency room professionals in establishing risk and making triage decisions.     

Grandfriends,an Intergenerational Program for Nursing-Home Residents and Preschoolers: A Randomized Trial

Intergenerational programs may improve meaningful engagement for people with dementia and for attitudes toward older people in youth. Grandfriends, a 12-week program increased passive engagement and enjoyment among nursing home residents when interacting with preschoolers (n = 21) in comparison to usual activities. Grandfriends participants (n = 20) did not show changes on quality of life, agitation, or sense of community in comparison to residents (n = 20) randomized to usual care. Suggestions for future programs are given.     

Children’s Psychosocial Rehabilitation: Clinical Outcomes for Youth with Serious Emotional Disturbance Living in Foster Care

Children living in foster care are an especially vulnerable population who often come to the attention of Medicaid mental health providers. These children experience a high incidence of emotional and behavioral disorders and may have specialized treatment needs related to their living arrangement status. This study assessed whether Children’s Psychosocial Rehabilitation could effectively treat youth with severe emotional and behavioral disorders who live in foster care. Analysis of data from an open trial of 218 clinically-impaired youth, aged 3–18 years, revealed no reliable differences in treatment outcome between foster versus non-foster children, with a trend toward more favorable outcomes for foster youth. Findings justify further study of the effectiveness of this Medicaid-funded service for the treatment of youth in care.     

The Influence of Family Structure on Sexual Activity in a Randomized Effectiveness Trial for Minority Youth

This study examined the influence of family structure on the outcomes of a sex education program in Miami, Florida. Using an experimental design, data collection occurred at pretest, 3-month, and 6-month follow-up with a sample of teenagers from high schools with a large majority of minority youth, assigned into treatment (n = 549) and control (n = 424) groups. Results indicated family structure had no influence on predicting teen sexual activity at pretest or at 3- or 6-month follow-up. Additional research using experimental designs is needed to assess the influence of family structure on other areas of adolescent development.     

Strengthening Support to Families: Basing a Family Support Worker at a Primary School in Melbourne,Australia

This mixed methods study examines the benefits of basing a family support worker (FSW) at a primary school in Melbourne, Australia. The school has a number of high needs families requiring extensive support from school staff. Pre and post intervention data was collected on the time spent on social problems in the school community. These included managing students with behavioural and emotional issues, providing support and practical assistance to parents with problems and liaising with agencies to access support for students and families. Pre and post intervention Strengths and Difficulties Questionnaires were completed by teachers whose students and families were clients of the FSW (n = 8) and compared with non clients (n = 10). Semi-structured interviews were held with FSW clients (n = 6), class teachers (n = 3) the assistant principal, principal and the FSW. Employing a FSW showed a reduction in the amount of time spent on welfare cases for teachers, and therefore a monetary saving for the school. Qualitative data collected from school staff and FSW clients was overwhelmingly positive. Having a FSW based at a primary school provides savings in teacher time, and expenses to the school. Teachers are freed to concentrate on education and the parents valued the relationship provided by the FSW.     

The need to do it all: Exploring the ways in which treatment foster parents enact their complex role

Treatment foster care (TFC) is an appealing approach for treating youth with emotional and behavioral disorders because it combines the potential for intensive interventions with opportunities for growth and development in a family-based setting. To accomplish this, TFC requires treatment foster parents to simultaneously play roles of both substitute caregiver/parent and front-line professional. This requires that treatment foster parents excel at both the behaviorally focused elements of an interventionist while simultaneously enacting the more relationally-based aspects of a parent. To date there has been little in the literature to explore the extent to which practicing treatment foster parents actually utilize both behavioral and relational approaches in their work with youth. This paper uses baseline data from a randomized trial (n = 247) to explore eight potential approaches that treatment foster parents might use (including: monitoring/supervision, approaches to discipline, consistency of responses to behaviors, time together, adult-child conflict, positive affect towards the child, perspective taking/empathy building, and communication) as well as a measure of their own assessment of their role. Results show that treatment foster parents recognize the complexities of their role, and most view themselves more as parents than as treatment providers. Substantial variation was evident on all examined dimensions of the treatment parent role (except supervision/monitoring). Variations in treatment parent approaches were most significantly related to child's age and their own view of their role. The paper concludes with discussion of implications and directions for future research.     

Family Functioning and Mental Health of Transgender and Gender-Nonconforming Youth in the Trans Teen and Family Narratives Project

Transgender and gender-nonconforming (TGN) youth are at increased risk for adverse mental health outcomes, but better family functioning may be protective. This study describes TGN youth’s mental health and associations with family functioning in a community-based sample. Participants were from 33 families (96 family members) and included 33 TGN youth, ages 13 to 17 years; 48 cisgender (non-transgender) caregivers; and 15 cisgender siblings. Participants completed a survey with measures of family functioning (family communication, family satisfaction) and mental health of TGN youth (suicidality, self-harm, depression, anxiety, self-esteem, resilience). TGN youth reported a high risk of mental health concerns: suicidality (15% to 30%), self-harm (49%), clinically significant depressive symptoms (61%); and moderate self-esteem (M = 27.55, SD = 7.15) and resiliency (M = 3.67, SD = 0.53). In adjusted models, better family functioning from the TGN youth’s perspective was associated with better mental health outcomes among TGN youth (β ranged from ?0.40 to ?0.65 for self-harm, depressive symptoms, and anxious symptoms, and 0.58 to 0.70 for self-esteem and resiliency). Findings from this study highlight the importance of considering TGN youth’s perspectives on the family to inform interventions to improve family functioning in families with TGN youth.     

Narcissistic Implications in Gambling Disorder: The Mediating Role of Emotion Dysregulation

Gambling Disorder (GD) is a complex psychopathology involving a numbers of cognitive, behavioral, emotional and neurobiological determinants. Previous research suggests that GD may frequently co-occur with Narcissistic Personality Disorder. However, there is still a lack of study investigating Pathological Narcissism (PN) in both its vulnerable and grandiose facets among clinical population. Moreover, emotional dysregulation is commonly thought to underlie GD albeit research on this topic remains poor. The present study aims to investigate the role of both vulnerable and grandiose narcissism in relation to GD as well as the mediator role played by emotion dysregulation in such link. We administered to a sample of addicted gamblers (n = 74) and a sample of heathy controls (n = 105), the South Oaks Gambling Screen (SOGS), the Pathological Narcissism Inventory (PNI) and the Difficulties in Emotion Regulation Scale (DERS). Differences across groups emerged on the scores obtained on the PNI and DERS. Moreover, we found positive associations between SOGS scores and both PNI and DERS. Also, strategic addicted gamblers showed higher levels of vulnerable narcissism compared to others. Finally, emotion dysregulation difficulties appeared to fully mediate the relationship between grandiose narcissism and GD severity. Grandiose and vulnerable narcissism appear important variables involved in GD. Also, emotion regulation deficits seem to account for GD and to explain the pathways by which grandiose narcissism leads to GD. Clinical implications and future directions are discussed.     

Introduction

The present study investigates whether hypothesized cognitive mechanisms of change mediate the efficacy of cognitive-behavioral therapy (CBT) delivered online for treating depression and anxiety disorders. Articles were included by searching MEDLINE, PsychInfo and PsychArticles databases from January 1980 to March 2011. The inclusion criteria were as follows: (a) randomized clinical trials investigating the role of CBT delivered online, (b) patient sample had clinical or subclinical intensity emotional problems, (c) at least one measure of cognitions was included, (d) the inclusion of a control group, and (e) sufficient data provided to allow calculation of effect sizes. Eleven articles were selected. Results revealed a moderate overall effect size of CBT (d = .67, P < .05) on the combined cognitive and emotional outcomes. A positive impact of online CBT on cognitive factors (d = .69, P < .05) and emotional outcomes (d = .63, P < .05) was independently demonstrated. In conclusion, cognitive-behavioral therapy delivered online can be used as an efficacious treatment for patients with emotional disorders. Assuming causal effects, the data indicate that cognitive factors are an important mechanism of change in online CBT. Future online CBT focusing on changing cognitions are likely to be efficacious.     

Eating Disordered Behaviors and Body Disapproval in Adolescent Males Adjudicated for Sexual and Nonsexual Crimes

Using a large sample of adjudicated delinquent male youth (N = 696), we compared data from youth who had been adjudicated for sexually aggressive crimes and those who had been adjudicated for nonsexual offenses on eating dysfunction, body disapproval, history of sexual abuse, and pornography exposure. The sample included 526 (75.8%) youth adjudicated for sexual offenses and 170 (24.4%) youth adjudicated for nonsexual crimes. The average age of the sample was 16.8 years (SD = 1.6), and approximately half of the sample (47.7%, n = 310) self-identified as White. The results of hierarchical multiple regressions indicated that sexually aggressive youth scored significantly higher than nonsexually offending youth on both eating dysfunction and body disapproval measures. Pornography exposure and substance use predicted body disapproval and eating dysfunction in the entire sample of adjudicated youth. History of sexual abuse was a significant predictor of body disapproval in all adjudicated youth but was not a significant predictor of eating dysfunction. Implications for research and practice are offered.