The intersection of nonsuicidal self-injury and suicide-related behavior: Patterns of elevated risk and implications for college mental health

Objective: To analyze the overlap of nonsuicidal self-injury (NSSI) and suicide-related behaviors (SRB) among college students with regard to demographics, mental health, and coping styles. Participants: Respondents were 572 undergraduate students at a southwestern public university. Methods: Data were collected in 2015. Respondents completed a demographic survey and assessments of NSSI, SRB, internalizing symptoms (ie, anxiety, stress, and depression), aggression, and negative coping strategies. The survey was administered via a Web-based procedure. Results: Women reported more frequent cutting behaviors than men. Endorsement of NSSI was also associated with an increased likelihood of lifetime SRB. A subgroup of students endorsing both NSSI and SRB demonstrated poorer mental health, more negative coping, and self-reported female sex. Conclusions: College healthcare providers may benefit from competency-based training in techniques for the combination treatment of NSSI and SRB, as well as culturally based models of suicide.     

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.     

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.     

Early Sexual Initiation and Mental Health: A Fleeting Association or Enduring Change?

The present research examined how the within‐person association between sexual initiation and internalizing symptoms decays over time, using data with annual measurement occasions across adolescence (N = 1,789) and statistical models of within‐person change. Sexual initiation was associated with increased levels of internalizing symptoms for early‐initiating girls (ninth grade, approximately age 15), but not for on‐time‐initiating girls or for boys. The association between girls' early sexual initiation and internalizing symptoms declined precipitously over time. Indeed, 1 year after sexual debut, early‐initiating girls were similar to on‐time or noninitiating girls on internalizing symptoms, suggesting early sexual initiation does not produce lasting detriments to girls' mental health. Findings inform how researchers perceive sexual initiation, both as a developmental milestone and as a prevention target.     

Cumulative Environmental Risk and Youth Problem Behavior

Using data from Wave 1 (n = 5,070) and Wave 2 (n = 4,404) of the National Longitudinal Study of Adolescent Health, we examined the relationship between cumulative risk exposure and youth problem behavior. Cross‐sectional analyses revealed a positive, linear association between cumulative risk and problem behaviors. The association between cumulative risk and externalizing problems was stronger for White youth than for Black youth. The association between cumulative risk and internalizing problems was stronger for girls than for boys, and stronger for White youth than for Black and Hispanic youth. Cumulative risk predicted change over time in internalizing problems. Findings support the theoretical notion that adolescents experience diminished psychological comfort when risk factors are present across several social domains.     

Gender Roles, Externalizing Behaviors, and Substance Use Among Mexican-American Adolescents

A sample of 60 male and 91 female Mexican-American adolescents (age 13-18) were administered measures of positive (i.e., assertive masculinity, affective femininity) and negative (i.e., aggressive masculinity, submissive femininity) gender roles, internalizing and externalizing problem behaviors, peer substance use, and own substance use (alcohol, cigarettes, marijuana). Negative gender roles were significantly correlated with internalizing and externalizing problems for both boys and girls, with aggressive masculinity also predicting peer substance use for both genders. Assertive masculinity significantly predicted lower alcohol use in boys, and this effect was not mediated by internalizing problems, externalizing problems, or peer substance use. Negative gender roles significantly predicted higher alcohol use in girls, but this effect was almost completely mediated by internalizing problems, externalizing problems, and peer substance use. Results are discussed in terms of gender role socialization among Mexican Americans.     

Peer Crowd Affiliation and Internalizing Distress in Childhood and Adolescence: A Longitudinal Follow‐Back Study

Concurrent and longitudinal associations between peer crowd affiliation and internalized distress were examined in a sample of 246 youth (148 girls, 98 boys). Children completed measures of depression, social anxiety, loneliness, and self‐esteem when they were in grades 4 to 6 (Time 1), and again 6 years later during adolescence (grades 10 – 12; Time 2). At Time 2, adolescents also reported their self‐concept and their identification with reputation‐based peer crowds, including Populars, Jocks, Brains, Burnouts, Non‐Conformists, and None/Average crowds. Results indicated that adolescents' report of peer crowd affiliation was concurrently associated with self‐concept and levels of internalizing distress. Follow‐back analyses of internalizing trajectories revealed that Populars/Jocks had experienced significant declines in internalizing distress across development, whereas Brains exhibited some increases in internalizing distress between childhood and adolescence.     

Predicting Well‐Being and Internalizing Symptoms in Late Adolescence From Trajectories of Externalizing Behavior Starting in Infancy

This study aimed to examine the long‐term prediction of well‐being and internalizing symptoms from trajectories of externalizing behavior problems in 921 children from a population‐based sample. We found that a high stable trajectory of externalizing behavior from infancy (age 1.5) to mid‐adolescence (age 14.5) predicted lower scores on life satisfaction and flourishing for both girls and boys (age 18.5). The high stable trajectory also predicted higher levels of depressive symptoms in boys and anxiety symptoms in girls (age 18.5). The findings are noteworthy as they document how a person‐oriented study of externalizing behavior problems starting in infancy can predict well‐being and internalizing in late adolescence. The findings underline the importance of early health promotion and problem intervention efforts.     

Linking Childhood Maltreatment With Girls' Internalizing Symptoms: Early Puberty as a Tipping Point

Earlier physical maturation may often be preceded by a range of adversities and life stressors. This study investigates childhood maltreatment, internalizing symptoms, and pubertal timing in girls residing in foster care (N = 100, M = 11.54 years old at Time 1). Girls were assessed at two time points 2 years apart. There were no direct effects of maltreatment on internalizing symptoms; rather, childhood sexual abuse predicted earlier pubertal development which, in turn, was associated with higher levels of internalizing symptoms concurrently and longitudinally. This distinctive role for early pubertal timing suggests that the heightened sexual circumstances of puberty may be especially disturbing for girls whose lives have already been disrupted by inappropriate and unwanted sexual experiences.     

Effect of Environmental Risk and Externalizing Comorbidity on Internalizing Problems Among Economically Disadvantaged African American Youth

This study examined the effects of racial discrimination, community violence, and stressful life events on internalizing problems among African American youth from high‐poverty neighborhoods (N = 607; 293 boys; M_age = 16.0 years, SD = 1.44 years). Mediated effects via externalizing problems on these relations were also examined, given the high comorbidity rate between internalizing and externalizing problems. Externalizing problems partially mediated the effect of stressful life events on internalizing problems and fully mediated the effect of racial discrimination for boys but not for girls. Exposure to violence had a significant indirect effect on internalizing problems via externalizing problems. The findings call for greater attention to internalizing problems among African American youth and pathways to internalizing problems via externalizing problems.     

Role of Parent and Peer Relationships and Individual Characteristics in Middle School Children's Behavioral Outcomes in the Face of Community Violence

This study examines processes linking inner‐city community violence exposure to subsequent internalizing and externalizing problems. Hypothesized risk and protective factors from 3 ecological domains—children's parent and peer relationships and individual characteristics—were examined for mediating, moderating, or independent roles in predicting problem behavior among 667 children over 3 years of middle school. Mediation was not found. However, parent and peer variables moderated the association between exposure and internalizing problems. Under high exposure, normally protective factors (e.g., attachment to parents) were less effective in mitigating exposure's effects than under low exposure; attachment to friends was more effective. Individual competence was independently associated with decreased internalizing problems. Variables from all domains, and exposure, were independently associated with externalizing problems. Protective factors (e.g., parent attachment) predicted decreased problems; risk factors (e.g., friends' delinquency) predicted increased problems. Results indicate community violence reduction as essential in averting inner‐city adolescents' poor behavioral outcomes.     

Observed Interactions Indicate Protective Effects of Relationships With Parents for Referred Adolescents

This study examined whether the quality of parent–adolescent interactions moderate the association between stressful life events and internalizing and externalizing problems in referred adolescents (N=101, M age 13.41 years, SD=1.81). Adolescents and their parents reported on psychological problems at the time of referral and 4 years later. At follow‐up parents reported on stressful life events and an interaction task was conducted to observe autonomy and relatedness promoting behaviors. For adolescents exposed to stressful events, levels of internalizing and externalizing problems went up except if observed parent–adolescent interactions were characterized by high autonomy and relatedness. The results implied that autonomy and relatedness protect adolescents against the deleterious effects of stressful life events. These findings build on previous research showing for psychologically vulnerable adolescents that parenting that promotes autonomy while maintaining relatedness is associated with resilience in times of stress.     

Internalizing Symptoms,Peer Substance Use,and Substance Use Initiation

This study used longitudinal survey and social network data covering sixth through ninth grades to test whether internalizing symptoms make early adolescents more prone to (1) exposure to and (2) influence by substance‐using peers. Random effects regressions revealed that increases in symptoms were significantly associated with increases in the proportion of friends who used cigarettes, alcohol, and marijuana; some associations weakened across grades. Event history models revealed that the effect of friends' smoking on smoking initiation decreased as internalizing symptoms increased; symptoms did not moderate the effects of friends' alcohol and marijuana use on alcohol and marijuana use initiation. These findings counter the influence hypothesis of the co‐occurrence of internalizing symptoms with substance use and partly support the exposure hypothesis.     

Caregiver–Adolescent Dyadic Disagreement and Problem Behaviors of Adolescents in the Child Welfare System

Parents and adolescents often provide different ratings of youths' behavior problems, yet few studies have examined such disagreement and its effect on later adjustment, especially among at‐risk adolescents. The purpose of this study was to investigate, among a sample of adolescents in foster care, whether the degree of caregiver–adolescent disagreement on adolescents' internalizing problems would be associated with adolescent externalizing problem behaviors over time. Two measures of adolescent caregiver agreement, the Pearson's r and intraclass correlations, were used with data drawn from a nationally representative study of children on foster care. Growth curve analyses of 180 adolescents revealed that the higher adolescent and caregiver agreement on adolescents' internalizing problems at Wave I, the slower the increase in externalizing problems over time.     

African American Adolescent Girls in Impoverished Communities: Parenting Style and Adolescent Outcomes

The relationship between parenting style and adolescent functioning was examined in a sample of 302 African American adolescent girls and their mothers who lived in impoverished neighborhoods. Although previous research has found that authoritative parenting, as compared with authoritarian, permissive, and disengaged parenting, is associated with positive adolescent outcomes in both European American, middle‐class and large multiethnic school‐based samples, these parenting categories have not been fully explored in African American families living at or near poverty level. Data were collected from adolescent girls and their self‐identified mothers or mother figures using in‐home interviews and self‐administered questionnaires. Parenting style was found to be significantly related to adolescent outcome in multiple domains including externalizing and internalizing behaviors, academic achievement, work orientation, sexual experience, and pregnancy history. Specifically, teens whose mothers were disengaged (low on both parental warmth and supervision/monitoring) were found to have the most negative outcomes.     

Can Organized Youth Activities Protect Against Internalizing Problems Among Adolescents Living in Violent Homes?

Using longitudinal data from a subsample of Hispanic, African American, and White youth enrolled in the Project on Human Development in Chicago Neighborhoods (N = 1,419), we examined the effects of both parental involvement in domestic violence and youth participation in organized out‐of‐school‐time activities on internalizing symptoms during adolescence. We also examined the extent to which participation in organized activities protected youth against the internalizing consequences of domestic violence. We found that intensive participation in either afterschool programs or extracurricular activities was inversely associated with youth internalizing problems. Moreover, we found that intensive participation in afterschool programs weakened the association between parents' domestic violence and youths' internalizing problems.     

Detained girls' treatment engagement over time: The role of psychopathology and quality of life

Although treatment engagement is considered important to achieve positive outcomes, it is still not well known why some girls in detention are more engaged in treatment than others. This is the first study to examine to what extent psychopathology and self-perceived quality of life (QoL) are related to treatment engagement. Participants were 108 detained girls (M_age = 16.21) who completed standardized questionnaires about mental health problems and QoL, and were interviewed with a structured diagnostic interview to assess DSM-IV psychiatric disorders. One and two months after this baseline assessment, the girls reported how much they engaged in treatment. The results showed low levels of treatment engagement and no significant changes in treatment engagement over time. Overall, detained girls with internalizing disorders reported higher treatment engagement scores, while the reverse was true for girls with externalizing disorders. Regarding QoL, the girls with greater satisfaction about their physical and psychological health and about their environment reported higher treatment engagement, while the opposite was true for the domain of social relationships. Our findings emphasize the need for strength-based and motivational approaches and techniques in residential treatment programs for girls, in order to enable change.     

Longitudinal Associations of the Attainment of Developmental Tasks With Psychological Symptoms in Adolescence: A Meta‐Analysis

The present meta‐analysis integrates results from 310 longitudinal studies on associations of the attainment of 10 developmental tasks with psychological symptoms (e.g., internalizing or externalizing symptoms, anxiety, and depression). Higher initial success with getting access to a peer group, building friendships, preparing for a future career, body acceptance, as well as developing a personal identity, a value system, and socially responsible behavior predicted lower levels of symptoms at follow‐up and stronger declines of symptoms over time when controlling for initial symptom levels. Furthermore, higher initial symptom levels predicted lower attainment of these tasks at follow‐up as well as lower progress in task attainment. In contrast, more initial romantic/sexual involvement predicted an increase in symptoms over time, while higher initial symptoms were related to an increase in romantic/sexual involvement. Associations with autonomy varied between different forms of autonomy, while acquisition of a gender role was not related with psychological symptoms.     

Behavioral adjustment of Chinese adoptees: The role of pre-adoption experiences

PurposeIn the current study we examined associations between children's pre-adoption experiences (type of pre-adoption care and early deprivation) and their adaptive and maladaptive behavioral adjustment. Associations with prosocial behavior, attention problems, internalizing and externalizing behavioral problems were investigated.MethodsParental ratings of pre-adoption experiences and behavioral adjustment of 891 adopted Chinese girls aged between 4 and 12 year were obtained. The children were adopted from institutional care (n = 595), foster care (n = 66) or a combination of institutional and foster care (n = 228). Prosocial behavior was assessed using the Strengths and Difficulties Questionnaire (SDQ). Attention problems, internalizing and externalizing behavioral problems were assessed using the Child Behavior Checklist for ages 4–18 (CBCL). In addition to the main effects of pre-adoption experiences, we tested interaction effects between pre-adoption experiences and age at adoption, controlling for several family and child background variables.ResultsHierarchical regression analyses revealed that type of pre-adoption care was not associated with behavioral adjustment. Early deprivation, on the other hand, was negatively associated with prosocial behavior, and positively associated with attention problems, internalizing and externalizing problems. Interaction analyses revealed no significant associations.ConclusionsThe results showed that pre-adoption deprivation increased the risk for less optimal behavioral adjustment. The effects however were small, leaving room for other explaining factors both in the pre- and post-adoption environment of the child.