Nonsuicidal Self‐Injury among Adolescents: A Training Priority for Primary Care Providers

Primary care providers were surveyed to determine how prepared they feel to address nonsuicidal self‐injury (NSSI) among adolescents, their interest in training on NSSI, and factors associated with routinely asking about NSSI when providing health supervision. Participants included family medicine physicians (n = 260), pediatricians (n = 127), family nurse practitioners (n = 96), and pediatric nurse practitioners (n = 54). Almost 50% felt unprepared to address NSSI, and over 70% wanted training in this area. Overall, relative to other areas of mental health care, clinicians felt least prepared to address and wanted more training on NSSI. Just 27% reported they routinely inquired about NSSI during health supervision. Factors associated with routinely asking about NSSI were identifying as female (OR = 2.37; 95% CI = 1.25–4.49), feeling better prepared to address NSSI (OR = 1.51; 95% CI = 1.04–2.20), and more frequently using a psychosocial interview to identify adolescents in distress (OR = 1.23; 95% CI = 1.02–1.48). Teaching clinicians to assess NSSI within a psychosocial interview may increase screening for and identification of the behavior among adolescents in primary care.     

Psychological distress and resilience as risk and protective factors of psychoactive substance use among Chinese nonengaged youth

Nonengaged youth (NEY) are those who have neither been working nor studying for a prolonged period of time. They are at risk of psychoactive substance use, but relevant studies are scarce. Based on a population‐based telephone survey and referrals, we anonymously interviewed 479 Hong Kong Chinese NEY aged 15–24 years. Of them, 14.8–23.7% reported moderate to severe depression, anxiety, and stress. Moreover, one fourth of the participants (24.8%; n = 119) had used psychoactive substances. Adjusted analyses showed that these three psychological distress variables were positively associated with, while resilience was negatively associated with, both ever‐use of psychoactive substances and intention to use such substances in the next 12 months. Loneliness was associated only with intention to use psychoactive substances. The mediating role of psychological distress was shown: Anxiety significantly mediated the association between resilience and ever‐use of psychoactive substances, whereas depression mediated that between resilience and behavioural intention. Resilience was not a significant moderator on the relationship between psychological distress and ever‐use of psychoactive substance use or behavioural intention to use those substances. The findings suggest that anti‐drug interventions should outreach NEY and should include mental health support as well as building up resilience, as NEY are prone to psychological distress that increases risk of substance use.     

Loneliness and psychological distress

Research on relationships between loneliness and psychological symptoms has generally shown significant positive associations across a wide spectrum of psychopathologies. However, such results may be artificial, to some extent, given the high intercorrelations of typical psychopathology measures. In the current study, we examined associations between psychological symptoms, assessed by the Symptom Check List-90 (SCL-90; Derogatis, Lipman, & Covi, 1973) and loneliness, as measured by the UCLA-R Loneliness Scale (Russell, Peplau, & Cutrona, 1980), in college students. Using partial correlations to control for the confounding influence of generalized distress, relationships between loneliness and individual dimensions of distress were examined. Results indicate a significant association between loneliness and interpersonal sensitivity (low self-esteem) and depression. Other dimensions of distress were not significantly related to loneliness. In addition, no sex differences in patterns of association were observed. Results support the notion that self-blame and self-devaluation are strong correlates of loneliness.     

Psychological and Social Characteristics Associated with Religiosity in Women’s Health Initiative Participants

Measures of religiosity are linked to health outcomes, possibly indicating mediating effects of associated psychological and social factors. We examined cross-sectional data from 92,539 postmenopausal participants of the Women’s Health Initiative Observational Study who responded to questions on religious service attendance, psychological characteristics, and social support domains. We present odds ratios from multiple logistic regressions controlling for covariates. Women attending services weekly during the past month, compared with those not attending at all in the past month, were less likely to be depressed [OR = 0.78; CI = 0.74–0.83] or characterized by cynical hostility [OR = 0.94; CI = 0.90–0.98], and more likely to be optimistic [OR = 1.22; CI = 1.17–1.26]. They were also more likely to report overall positive social support [OR = 1.28; CI = 1.24–1.33], as well as social support of four subtypes (emotional/informational support, affection support, tangible support, and positive social interaction), and were less likely to report social strain [OR = 0.91; CI = 0.88–0.94]. However, those attending more or less than weekly were not less likely to be characterized by cynical hostility, nor were they less likely to report social strain, compared to those not attending during the past month.     

Suicidal Ideation and Behavior in Adolescents Aged 12–16 Years: A 17‐Year Follow‐Up

The prevalence of suicidal ideation/behavior in 1983 or 1987 and its association with future mental health in 2001 were evaluated in a provincially representative sample of Canadian adolescents (n = 1,248) aged 12 to 16 years. Approximately 13.3% (95% CI = 11.5–15.3) of adolescents self‐reported suicidal ideation/behavior. Adolescent agreement with parent (κ = .07) and teacher (κ = .05) reports at baseline was low because adults identified so few subjects. In adulthood, the associations between adolescent self‐reports of suicidal behavior/ideation and major depression and other mental health indicators were explained by respondent sex and adolescent emotional problems reported in 1983/1987. Adolescents with suicidal behavior/ideation often are not recognized by their parents and teachers and may be at risk for persistent psychiatric problems attributable to coexisting mental health problems early‐on.     

Friendship,Depression, and Suicide Attempts in Adults: Exploratory Analysis of a Longitudinal Follow‐Up Study

Social support is thought to protect against the risk of suicidal behavior in young people and late life, but less is known about the role of friendship in adults. We explored the effect of friendship on suicide attempt risk during 1‐year follow‐up of 132 adults presenting with major depressive episode (MDE). Items from the Social Adjustment Scale–Self‐Report were used as an index of frequency and quality of recent friendship contacts. Survival methods tested associations of friendship with risk of suicide attempt, recurrent MDE, and related outcomes during follow‐up. Impaired friendship predicted greater risk of suicide attempt in an unadjusted Cox model. This association was stronger for quality (p = .009) than frequency (p = .081) of friendship contacts. In the adjusted model, the effect of friendship on suicide attempts was largely explained by self‐reported depression severity. Friendship has a potentially bidirectional relationship with depression, and its effect on suicidal behavior appears to occur through its relationship with depression. Future research should examine the effect of antidepressant treatment on friendship and be designed to test mediation models of relationships between friendship, depression, and suicidal behavior.     

Changes in sleep quality and levels of psychological distress during the adaptation to university: The role of childhood adversity

Stress-related sleep disturbances are common, and poor sleep quality can negatively affect health. Previous work indicates that early-life adversity is associated with compromised sleep quality later in life, but it is unknown whether it predicts greater declines in sleep quality during stressful life transitions. We propose and test a conceptual model whereby individuals who reported experiencing greater levels of child maltreatment would experience greater psychological distress during a stressful life transition, which in turn would contribute to greater declines in sleep quality, relative to their quality of sleep before the stressful transition. Controlling for potential confounding variables (e.g., age, gender), structural equation modelling demonstrated that psychological distress experienced during a stressful transition (i.e., beginning life at university) mediated the relationship between childhood emotional neglect and changes in sleep quality. The hypothesized model demonstrated a good overall fit to the data, χ ² (15) = 17.69, p = .279, CFI = .99, TLI = .97, SRMR = .04, RMSEA = .04 (90% CI <0.001–0.09). Emotional neglect (β = .22) was positively associated with psychological distress which in turn was positively associated with poor sleep quality (β = .31) during a stressful transition. Future research should aim to understand the specific stressors in the university environment that are most challenging to individuals who faced early-life emotional maltreatment. These findings will help inform interventions to facilitate adaptation to a new environment and improve sleep quality for these university students.     

Childhood Parental Death and Lifetime Suicide Attempt of the Opposite‐Gender Offspring in a Nationwide Community Sample of Korea

Although previous studies have shown that childhood parental death influences suicide attempts of their offspring, few studies have examined influence of gender and age at exposure. Koreans show the third highest suicide rate in the world, and many children and adolescents lost their parents during and after the Korean War. A total of 12,532 adults, randomly selected through a one‐person‐per‐household method, completed the Korean version of the Composite International Diagnostic Interview and questionnaire for suicidal ideation, plan, and attempt (response rate 80.2%). A total of 2,332 subjects experienced biological parental death in childhood (18.6%). Male suicide attempts were associated with age of exposure to maternal death from 0 to 4 years (adjusted OR = 4.48, 95% CI 1.32–15.18) and from 5 to 9 years (adjusted OR = 5.52, 95% CI 1.97–16.46), but not with paternal death, after adjusting for age, education years, marital status, monthly income, and psychiatric comorbidities. Female suicide attempts were associated with paternal death from 5 to 9 years (adjusted OR = 2.20, 95% CI 1.13–4.27), but not with maternal death. Childhood parental death is significantly associated with lifetime suicide attempt in the opposite‐gender offspring, especially when exposure occurs before age 10.     

Loneliness predicts suicidal ideation and anxiety symptoms in long-term childhood cancer survivors

Background/ObjectiveLong-term childhood cancer survivors (CCS) are at risk for adverse late effects. However, not all of them are well understood. The present study addressed loneliness, a previously under-researched mental health risk in cancer survivor populations. We assessed the prevalence of loneliness and its impact on psychological symptoms over time. Method: A registry-based sample of N = 633 adult long-term CCS underwent medical and psychological assessments and took part in a follow-up survey 2.5 years later. Psychological symptoms (somatic, anxiety, depression symptoms, and suicidal ideation) were measured using the Patient Health Questionnaire. We calculated linear regression models of symptoms at follow-up to investigate the impact of loneliness over time (controlling for symptoms at baseline and relevant confounders). Results: Loneliness was reported by 17.70% of CCS. In multivariate linear regression analyses, loneliness was still predictive of more severe anxiety symptoms and suicidal ideation over two years later. Loneliness did not predict somatic and depression symptoms at follow-up (which increased with age). Conclusions: Loneliness affected a significant number of CCS and was a risk factor for persistent anxiety symptoms and suicidal ideation. The extent to which young cancer patients’ re-integration into society is successful could thus have important implications for well-being in adulthood.     

Loneliness, depression, social support, and quality of life in older chronically ill Appalachians

This study's purpose was to describe loneliness and to examine the relationships between loneliness, depression, social support, and QOL in chronically ill, older Appalachians. In-person interviews were conducted with a convenience sample of 60 older, chronically ill, community-dwelling, and rural adults. Those with dementia or active grief were excluded. The UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1985), Geriatric Depression Scale (Shiekh & Yesavage, 1986), Katz ADL scale (Katz, Down, & Cash, 1970), MOS Social Support Scale (Sherbourne & Stewart, 1991), and a visual analog scale for Quality of Life (Spitzer et al., 1981) scale were used. Diagnoses were obtained through chart reviews. SPSS was used for data analyses. The majority of the 65% female sample (M age = 75 years) were married and impoverished. Participants' number of chronic illnesses averaged more than 3. Over 88% of participants reported at least 1 area of functional impairment. Loneliness was prevalent with UCLA loneliness scores indicating moderate to high loneliness, ranging from 39 to 62 (possible scores were 20-80). Higher loneliness scores correlated with depression, lower Qol, and lower social support, particularly lower emotional support. This study provides evidence that loneliness is a significant problem for older chronically ill Appalachian adults and that it may be related to low emotional support. Further, it provides evidence that this population may be significantly lonely and may not self-identify as lonely. Screening for loneliness and designing interventions that target the emotional aspects of loneliness could be important in this population.     

Measuring executive function skills in young children in Kenya: Associations with school readiness

Most of what is known about the association between children’s executive function (EF) and school readiness skills is derived from research conducted in Western countries. We tested whether these associations were evident in a middle‐income country context. Participants were 1,480 children, aged 4–7 years old, who participated in an endline assessment of the Tayari program, an early childhood education (ECE) model that is being delivered by the Kenyan education system. High rates of task completion, low rates of floor effects, and high rates of assessor quality ratings supported the feasibility of large‐scale direct assessments of EF with young children. Assessor ratings of children’s attention‐related behaviors during testing were positively associated with their performance on EF tasks (rs = 0.12–0.27). An EF composite score was not related to demographic factors or to children’s exposure to the Tayari program. However, the EF composite score was uniquely associated with performance‐based measures of early literacy (β = 0.18, 95% confidence interval [CI] = 0.05, 0.31), early numeracy (β = 0.16, 95% CI = 0.07, 26), and social‐emotional competencies (β = 0.12, 95% CI = 0.03, 0.20), even after adjustment for multiple covariates. These results are discussed with respect to the ways in which EF skills inform ongoing efforts to invest in ECE in low‐ and middle‐income countries.     

Nomophobia and self-reported smartphone use while driving: An investigation into whether nomophobia can increase the likelihood of illegal smartphone use while driving

In Australia, illegal smartphone use while driving is on the rise, increasing the likelihood drivers could be distracted and crash. Smartphones avail users a sense of belonging, connectedness, and access to information. As such, the sensation of being without one’s smartphone has developed into the prevalence of nomophobia, defined as the fear and anxiety associated with being without smartphone. The aim of the current study was to specifically examine the relationship between smartphone use while driving and nomophobia by 1) determining the types and frequency of illegal phone use while driving and, 2) exploring the relationship between nomophobia and illegal phone use while driving. The sample consisted of 2,774 Victorian smartphone users (47.0% male) with a valid driver’s licence. Driver’s nomophobia levels were measured using the Nomophobia Questionnaire (NMP-Q), while driver’s smartphone use was measured using an original scale developed by the authors. A binary logistic regression was conducted which showed that the longer average time spent per day on a smartphone and a lack of knowledge of the mobile phone road law were the strongest positive predictors of illegal use (OR = 1.32, 95% CI = 1.09–1.60; OR = 1.84, 95% CI = 1.48–2.28, respectively). However, only one nomophobia factor (i.e., access to information) significantly predicted illegal smartphone use (OR = 1.06, 95% CI = 1.04–1.09). Smartphone use is a complex and contextual behaviour, therefore, focusing on the fear of being without in dependency overlooks the nuances of the need to be with. This study offered several practical interventions that may mitigate illegal smartphone use and reduce the likelihood of crashes among Victorian road users.     

Encountering the Body at the Site of the Suicide: A Population‐Based Survey in Sweden

Encountering the body of a child who died by suicide at the site of death is believed to be especially harmful for bereaved parents. We investigated the association between encountering the body at the site of the suicide and psychological distress in 666 suicide‐bereaved parents. Parents who had encountered their child's body at the site of the suicide (n = 147) did not have a higher risk of nightmares (relative risk [RR] 0.95, 95% confidence interval [CI] 0.67–1.35), intrusive memories (RR 0.97, 95% CI 0.84–1.13), avoidance of thoughts (RR 0.97, 95% CI 0.74–1.27), avoidance of places or things (RR 0.91, 95% CI 0.66–1.25), anxiety (RR 0.93, 95% CI 0.64–1.33), or depression (RR 0.94, 95% CI 0.63–1.42) compared with parents who had not encountered the body (n = 512). Our results suggest that losing a child by suicide is sufficiently disastrous by itself to elicit posttraumatic responses or psychiatric morbidity whether or not the parent has encountered the deceased child at the site of death.     

Loneliness and psychological health of orthopaedic patients’ caregivers: does gender make a difference?

Although research evidence indicates that loneliness is detrimental to mental health in diverse populations, impact of loneliness on psychological distress of orthopaedic patients’ caregivers has been given little research attention. The present study examined the association of loneliness with psychological health, and explored gender differences in the loneliness and psychological health association among orthopaedic patients’ caregivers. Participants were 250 patients’ caregivers drawn from a national orthopaedic hospital in eastern Nigeria. Data was collected by means of self-report measures translated into the local dialect of the caregivers. Multiple regression results showed that loneliness positively predicted psychological distress in the total sample. Loneliness did not predict psychological distress of male caregivers, but it positively predicted psychological distress of female caregivers. In order to promote orthopaedic patients caregivers’ mental health, gender-based differentials in the link between loneliness and psychological distress should be addressed by researchers and healthcare practitioners.     

Cultural and emotional components of loneliness and depression

The relation between loneliness and depression and the distinction between emotional and social loneliness were examined by administering the University of California, Los Angeles (UCLA) Loneliness Scale, the Belcher Extended Loneliness Scale (BELS), the Beck Depression Inventory, and self-report questions about social and emotional loneliness to the following four groups: foreign (Chinese-descent) students in American universities, Chinese students in Taiwanese universities, American students in American universities, and depressed American clients. Depressed clients reported not only more depression but also more overall loneliness than did any of the other groups; they also were more likely to report emotional loneliness or both emotional and social loneliness than were the other three groups. Foreign students, in contrast, reported more social loneliness than did Taiwanese students. Results substantiate the view that loneliness is not a unitary concept and suggest that the UCLA Loneliness Scale and the BELS emphasize emotional rather than social loneliness and that emotional loneliness is a greater component of depression than is social loneliness.     

Aspiration Strain and Mental Health: The Education‐Contingent Role of Religion

This study examines whether dimensions of religious involvement (i.e., perceived divine control, private religious practices, and religious social integration) buffer associations between aspiration strain and mental health outcomes (i.e., psychological distress, loneliness, and optimism). We also test three‐way interactions to determine whether the stress‐buffering effects of religious involvement are amplified among undereducated persons. We test our hypotheses with cross‐sectional survey data from Vanderbilt University's Nashville Stress and Health Study (2011–2014), a probability sample of non‐Hispanic white and black adults from Davidson County, Tennessee (n = 1,252). Results from multivariate regression models confirmed: (1) aspiration strain was positively associated with psychological distress and loneliness, and negatively associated with optimism; and (2) religious involvement attenuated these associations, but only for respondents with less than or equal to a high school education. We discuss the implications and limitations of our findings and outline avenues for future research.     

Anxieties about aging and death and psychological distress: The protective role of emotional complexity

Death and aging anxieties are related to higher psychological distress, but no study has examined whether these relationships are moderated by emotional complexity, an important indicator of adaptive emotional regulation among older adults. Participants (N = 188; mean age = 57; range = 29–100) rated their death and aging anxieties, general psychological distress, and reported their emotions on a daily basis over 14 days. Results showed that emotional complexity moderated the relationship between each of the two anxieties and psychological distress (i.e., the positive relationship between the two anxieties and psychological distress existed only among subjects with low emotional complexity). The findings suggest that emotional complexity buffers against psychological distress, and can be further explored as a facilitating mechanism in protecting against the negative mental health effects of aging and death anxieties.     

Sex differences in social support, loneliness, and depression among Korean college students

This study examined the sex differences in reports of social support (network size and satisfaction), loneliness, and depression among Korean college students and examined whether measures of social support and loneliness predicted depression scores. In the sample were 452 college students enrolled in four universities in Korea. The women reported a larger social support network size and being less satisfied with their support than the men. Women reported higher scores on the Revised UCLA Loneliness Scale and the Beck Depression Inventory than men. Social support satisfaction scores and network size on the Social Support Questionnaire-6 and scores on the Loneliness Scale predicted scores on Depression in both the groups. Loneliness was the largest predictor of Depression for either sex. The amount of variance in Depression accounted for by Loneliness was 35% for women and 24% for men.     

父母心理控制与青少年抑郁的关系：一个有调节的中介模型

采用父母心理控制问卷、孤独感问卷、意志控制问卷和抑郁问卷对688名中学生（平均年龄15.62岁,男生314人）进行调查,考察了心理控制对青少年抑郁的影响、孤独感的中介作用以及意志控制的调节作用。结果发现：（1）在控制了年龄和性别之后,父母心理控制能正向预测青少年的抑郁;（2）孤独感在父母心理控制和青少年抑郁关系中起部分中介作用;（3）孤独感的中介作用受到意志控制的调节。因此,父母心理控制与青少年抑郁之间既存在中介效应又存在调节效应。