Homeless Youths and Young Adults in Los Angeles: Prevalence of Mental Health Problems and the Relationship Between Mental Health and Substance Abuse Disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults is increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems, as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorder included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

Sexual Assault History and Health-Related Outcomes in a National Sample of Women

This study examined correlates of past-year chronic medical conditions and lifetime contact with health care professionals for mental health and substance abuse problems in women with differing histories of sexual victimization  ( N  = 627)  identified from the National Comorbidity Survey (e.g., assault in childhood, adulthood, or both life phases). Posttraumatic stress disorder (PTSD) and stressful life events were associated with greater odds of chronic medical conditions among women sexually assaulted in childhood only. Additional traumatic events were associated with greater odds of chronic medical conditions among victims of adult sexual assault. Older age and being married were associated with greater odds of lifetime health care professional contact for mental health/substance abuse issues among certain victim subgroups. Stressful life events were related to greater help-seeking for child victims, and traumatic events were related to greater help-seeking in adult victims. Alcohol dependence symptoms and PTSD were each associated with greater odds of lifetime health care professional contact among women victimized in both life phases, whereas depression was related to greater odds of help-seeking for women victimized in one life phase only. Psychosocial factors may play unique roles in health outcomes for women with different sexual assault histories.     

The relationship between childhood sexual abuse and sexual health practices of homeless adolescents

This study explored the gender differences in sexual self-concept, personal resources for sexual health, safe sex behaviors, and risky sexual behaviors among homeless adolescents with and without histories of sexual abuse. Data for this secondary analysis were collected in 2003 to 2004 in the first phase of a larger repeated-measures sexual health intervention study; 371 homeless youth between 16 and 23 years of age (M = 19.26, SD = 1.83) were recruited from a street outreach center. The majority (64.6%) of participants were males. Self-report instruments were completed at the outreach center via audio computer-assisted self-interview (A-CASI) format. It was found that female participants were better off than males on numerous measures of sexual health behaviors and attitudes. Sexually abused participants had significantly less future time perspective (p = .05), fewer sexual self-care behaviors (p = .04), and less social support than nonabused participants (p = .01) and almost significantly more sexual risk-taking (p = .08). However, no significant differences were found between abused and nonabused participants on sexual self-concept, self-efficacy or intention to use condoms, safe sex behaviors, AIDS knowledge, assertive communication, or self-efficacy to perform testicular/ breast self-exams. Overall, participants who did not report a history of sexual abuse had significantly more sexual health resources and engaged in fewer sex-risk behaviors than those who reported having been abused. These differences have notable implications for screening adolescents for a history of sexual abuse. Adolescents who report sexual abuse should receive risk counseling and be screened regularly for the development of sexual risk behaviors.     

Parental Psychological Control and Adolescent Problem Behaviors: The Role of Depressive Symptoms

Parental psychological control has consistently been linked to greater engagement in problem behaviors among adolescents, including over-eating behaviors, under-eating behaviors, risky cyber behaviors, and substance use. Previous research has suggested that child characteristics, such as temperament, may moderate this association. However, little research has examined characteristics of the adolescent that may place them at greater risk for experiencing such problem behaviors as a result of psychologically controlling parenting. Therefore, the current study examined the role of adolescents’ depressive symptoms as a risk factor (moderator) for the association between parental psychological control and adolescent problem behaviors. Participants included 161 adolescents (M_age?=?14.42, SD?=?1.73; 80.7% Caucasian; 59.6% female) living in a University city in a Mid-Atlantic state. Participants completed survey questionnaires about parental psychological control, problematic eating behaviors, risky cyber behaviors, substance use, and depressive symptoms. Results indicated that psychological control was significantly and positively associated with under-eating behaviors. Psychological control was also found to be associated positively with risky cyber behaviors and substance use, but only for adolescents who reported greater depressive symptoms. The findings provide support for the role of depressive symptoms as a risk factor for the associations between psychological control and problem behaviors among adolescents.     

Parental Monitoring and Adolescent Risk Behaviors: The Moderating Role of Adolescent Internalizing Symptoms and Gender

Parental monitoring can reduce adolescents’ engagement in risky behaviors; however, adolescents’ internalizing symptoms may alter the effectiveness of parental monitoring. The current study examines independent and interactive effects of maternal and paternal monitoring, adolescent’s internalizing symptoms, and adolescent gender on sexual behaviors and substance use with data from 659 of the 15-year-olds enrolled in the NICHD Study of Early Child Care and Youth Development. Results suggest girls who experienced less maternal monitoring and more internalizing symptoms—both independently and interactively—engaged in more risky sexual behaviors. Greater substance use was associated with less maternal and paternal monitoring for girls and boys, more internalizing symptoms for girls, and interactively with less maternal and paternal monitoring depending on girls’ levels of internalizing symptoms. The current study highlights the unique influences of mothers’ and fathers’ monitoring efforts on adolescent risky behavior based on the adolescent’s level of internalizing symptoms.     

The Relationship Between Family Stress and Behavioral Health Among African American Adolescents

African American youth, especially those who live in low-income communities, are at increased risk for experiencing higher juvenile justice involvement, poorer mental health, low school engagement, higher illicit drug use, and STIs, relative to their higher income peers and those from other ethnic backgrounds. However, few studies have examined the relationship between family stressors and these multiple youth concerns. This study examines the relationship between family stress (i.e., having an adult in the home with a history of mental illness, substance use, and incarceration) and youth concerns such as substance use, mental health challenges, low school engagement, juvenile justice involvement, and STI risk behaviors. A total of 638 African American adolescents living in predominantly low-income, urban communities participated in the study by completing self-report measures on the above constructs. Logistic regressions controlling for age, gender, socioeconomic status, and sexual orientation indicated that adolescents who reported higher rates of family stress were significantly more likely to report mental health problems, delinquent behaviors, juvenile justice involvement, drug use, risky sex, and lower school engagement factors. Findings suggest that attending to the developmental concerns of youth also requires addressing the needs of the family unit.     

Developmental trajectories of co-occurring depressive, eating, antisocial, and substance abuse problems in female adolescents

Growth trajectories of co-occurring symptomatology were examined in a community sample of 493 female adolescents who were followed annually from early to late adolescence. On average, depression, eating disorder, and substance abuse symptoms increased over time, whereas antisocial behavior decreased. Increases in each symptom domain were associated with relative increases in all other domains. Initial depressive and antisocial behavior symptoms predicted future increases in the other; substance abuse and antisocial behavior symptoms also showed prospective reciprocal relations. Initial depression predicted increases in eating disorder and substance abuse symptoms. Initial eating disorder symptoms predicted increases in substance abuse problems. Finally, the results suggest that the developmental covariation between depressive and eating disorder symptoms and between antisocial behavior and substance abuse symptoms was accounted for by distinct but related 2nd-order growth parameters.     

Treatment outcomes for female offenders: relationship to number of Axis I diagnoses

This article describes a study that examined the relationship between multiple Axis I mental health diagnoses and treatment outcomes for female offenders in prison substance abuse treatment programs. Preliminary findings of the effectiveness of therapeutic community (TC) treatment, modified for female offenders, relative to a control cognitive behavioral treatment condition, are presented. The hypothesis--that participants who fit into multiple diagnostic categories have more dysfunctional symptoms and behaviors at baseline--was confirmed; however, a hypothesized relationship between the number of Axis I diagnoses and 6 month treatment outcomes across five domains (mental health, trauma exposure, substance use, HIV needle risk behaviors, and HIV sexual risk) was not supported. Across all Axis I mental health groups, TC treatment was significantly more effective than the control condition overall, as well as on measures of mental health symptoms and HIV sexual risk. These findings suggest that this TC treatment program, as modified, is an effective model for women with varied diagnoses and diagnostic complexities.     

The Relationship of Adverse Childhood Experiences to PTSD,Depression, Poly-Drug Use and Suicide Attempt in Reservation-Based Native American Adolescents and Young Adults

Adverse childhood experiences (ACEs) are associated with numerous risk behaviors and mental health outcomes among youth. This study examines the relationship between the number of types of exposures to ACEs and risk behaviors and mental health outcomes among reservation‐based Native Americans. In 2011, data were collected from Native American (N = 288; 15–24 years of age) tribal members from a remote plains reservation using an anonymous web‐based questionnaire. We analyzed the relationship between six ACEs, emotional, physical, and sexual abuse, physical and emotional neglect, witness to intimate partner violence, for those <18 years, and included historical loss associated symptoms, and perceived discrimination for those <19 years; and four risk behavior/mental health outcomes: post‐traumatic stress disorder (PTSD) symptoms, depression symptoms, poly‐drug use, and suicide attempt. Seventy‐eight percent of the sample reported at least one ACE and 40 % reported at least two. The cumulative impact of the ACEs were significant (p < .001) for the four outcomes with each additional ACE increasing the odds of suicide attempt (37 %), poly‐drug use (51 %), PTSD symptoms (55 %), and depression symptoms (57 %). To address these findings culturally appropriate childhood and adolescent interventions for reservation‐based populations must be developed, tested and evaluated longitudinally.     

How Does the Neighborhood “Come through the Door?” Concentrated Disadvantage,Residential Instability,and the Home Environment for Preschoolers

Living in a disadvantaged neighborhood is associated with heightened risk for poor school readiness and health outcomes in early childhood, and the home environment is thought to be a primary mechanism by which neighborhood context impacts preschoolers. This study examined the effects of neighborhood concentrated disadvantage and neighborhood residential instability on the home physical environment and home learning environment for preschoolers in economically disadvantaged families (N = 187). Using structural equation modeling, mothers' perceived neighborhood disorder and depressive symptoms were examined as mechanisms by which neighborhood context “comes through the door.” Mothers' neighborhood social embeddedness was also explored as a protective factor. Results showed that concentrated disadvantage was negatively associated with the quality of the home physical environment, and residential instability was negatively associated with the quality of the home learning environment. Concentrated disadvantage had an indirect effect on the home learning environment through mothers' perceived neighborhood disorder and depressive symptoms. The effects of concentrated disadvantage on the home environment were buffered by mothers' neighborhood social embeddedness. Study findings advance understanding of socioeconomic‐ and place‐based disparities in developmental outcomes and identify potential targets for interventions aimed at lessening effects of neighborhood disadvantage on families with young children.     

Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD

Children diagnosed with attention-deficit/hyperactivity disorder (ADHD; n = 142) were prospectively monitored into adolescence (13-18 years old) to evaluate their risk for elevated substance use relative to same-aged adolescents without ADHD (n = 100). Probands reported higher levels of alcohol, tobacco, and illicit drug use than did controls. Group differences were apparent for alcohol symptom scores but not for alcohol or marijuana disorder diagnoses. Within probands, severity of childhood inattention symptoms predicted multiple substance use outcomes: childhood oppositional defiant disorder/conduct disorder (ODD/CD) symptoms predicted illicit drug use and CD symptoms. Persistence of ADHD and adolescent CD were each associated with elevated substance use behaviors relative to controls. Further study of the mediating mechanisms that explain risk for early substance use and abuse in children with ADHD is warranted.     

The impact of a history of sexual abuse on high-risk sexual behaviors among females attending alternative schools

The goal of this study was to explore whether a history of sexual abuse is associated with high-risk sexual behaviors among female adolescents attending alternative schools in a large urban city in the southwestern United States, and to examine the role of depression and substance abuse in explaining this association. One hundred eighty-four sexually active female adolescents constituted the sample for this analysis. Forty-nine (26.6%) reported that they were forced to have sex. Having a history of sexual abuse substantially increased sexual risk behaviors. Adolescents reporting a history of sexual abuse, compared to those who did not report such a history, were significantly more likely to have initiated sexual activity (intercourse) before age 14, to have had three or more sexual partners in the last 3 months, and to have had a history of sexually transmitted diseases. These associations remained significant after controlling for age, ethnicity, and family income. Depression and substance abuse did not explain the association between sexual abuse and high-risk sexual behaviors. It seems reasonable to conclude that adolescents with a history of sexual abuse have greater difficulty practicing safe sexual behaviors than do those who have not been sexually abused. Given the prevalence of child sexual abuse and the extent of its impact, it is critical that intervention strategies for adolescent females address the issue of abuse and help them adopt self-protective sexual behaviors. The findings also highlight the importance of targeting adolescents who attend alternative schools.     

Supporting the Need for an Integrated System of Care for Youth with Co-occurring Traumatic Stress and Substance Abuse Problems

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.     

Characteristics of seriously emotionally disturbed youth with and without substance abuse in intensive case management

Youth with emotional disturbance who have substance abuse problems are of particular concern to child-serving agencies. Approximately 22% of the youth served in New York State's Intensive Case Management Program for Children and Youth (CYICM) have identified substance abuse problems. We compared youths enrolled in CYICM who abuse substances with those who do not abuse substances. Adolescents with substance abuse problems differed from non-abusing adolescents. The abusing cohort was most likely to be emancipated minors, not enrolled in school, less likely to be members of a minority group, and more likely to have private health care coverage. They also evidenced a different constellation of symptoms than the non-abusing cohort, with abusers tending to display suicidal symptoms and behaviors and sexual acting out. Abusers were also more likely to have been admitted to private psychiatric hospitals and to have had crisis contacts in emergency rooms. Similar to non-abusers, however, abusers spent significantly fewer days as inpatients in state hospitals, and had fewer admissions to these hospitals following their enrollment in CYICM.     

The Effects of Social Capital and Neighborhood Characteristics on Intimate Partner Violence: A Consideration of Social Resources and Risks

Intimate partner violence (IPV) is a growing public health problem, and gaps exist in knowledge with respect to appropriate prevention and treatment strategies. A growing body of research evidence suggests that beyond individual factors (e.g., socio‐economic status, psychological processes, substance abuse problems), neighborhood characteristics, such as neighborhood economic disadvantage, high crime rates, high unemployment and social disorder, are associated with increased risk for IPV. However, existing research in this area has focused primarily on risk factors inherent in neighborhoods, and has failed to adequately examine resources within social networks and neighborhoods that may buffer or prevent the occurrence of IPV. This study examines the effects of neighborhood characteristics, such as economic disadvantage and disorder, and individual and neighborhood resources, such as social capital, on IPV among a representative sample of 2412 residents of Toronto, Ontario, Canada. Using a population based sample of 2412 randomly selected Toronto adults with comprehensive neighborhood level data on a broad set of characteristics, we conducted multi‐level modeling to examine the effects of individual‐ and neighborhood‐level effects on IPV outcomes. We also examined protective factors through a comprehensive operationalization of the concept of social capital, involving neighborhood collective efficacy, community group participation, social network structure and social support. Findings show that residents who were involved in one or more community groups in the last 12 months and had high perceived neighborhood problems were more likely to have experienced physical IPV. Residents who had high perceived social support and low perceived neighborhood problems were less likely to experience non‐physical IPV. These relationships did not differ by neighborhood income or gender. Findings suggest interesting contextual effects of social capital on IPV. Consistent with previous research, higher levels of perceived neighborhood problems can reflect disadvantaged environments that are more challenged in promoting health and regulating disorder, and can create stressors in which IPV is more likely to occur. Such analyses will be helpful to further understanding of the complex, multi‐level pathways related to IPV and to inform the development of effective programs and policies with which to address and prevent this serious public health issue.     

The Protective Effects of Religious Beliefs on Behavioral Health Factors Among Low Income African American Adolescents in Chicago

Religious involvement has long been argued to have protective effects for negative behavioral health outcomes for vulnerable youth. This study builds on the existing resilience literature and need for more studies that examine protective factors associated with behavioral health. A sample of 638 low-income African American adolescents in Chicago to examine within group variations of the influence of religious involvement on delinquency, school engagement, substance use and sexual risk behaviors, and whether such relationships differ by gender, sexual orientation, and socioeconomic status. Logistic regression findings documented that greater religious involvement was protective with regards to lower rates of delinquency, drug use, risky sexual behaviors and higher rates of school engagement, and that gender, sexual orientation and socioeconomic status varied for several of these relationships. Overall findings are discussed with regards to future research.     

Cognitive Social Maturity, Life Change Events, and Health Risk Behaviors among Adolescents: Development of a Structural Equation Model

Purpose: To examine the roles of cognitive social maturity and life change events in a structural equation model (SEM) to explain adolescents' use of marijuana, tobacco, and alcohol. Methods: Data were derived from 1322 9th and 10th graders in a HIV prevention study. Students completed a survey of their cognitive social maturity, recent life events and substance use habits. A model from a study on the metabolic control of adolescents with diabetes was modified to apply to health risk behaviors. Results: A SEM was tested and fit the data well. Lower cognitive social maturity and greater life change events significantly predicted health risk behaviors. Life events partially mediated the relationship between cognitive social maturity and health risk behaviors. Conclusions: Adolescents' social thought processes are related to their recent life events, which in turn are related to their substance use behaviors. Suggestions are made for interventions to improve adolescents' cognitive social maturity.     

School absenteeism and mental health among sexual minority youth and heterosexual youth

Adolescent school absenteeism is associated with negative outcomes such as conduct disorders, substance abuse, and dropping out of school. Mental health factors, such as depression and anxiety, have been found to be associated with increased absenteeism from school. Sexual minority youth (youth who are attracted to the same sex or endorse a gay, lesbian, or bisexual identity) are a group at risk for increased absenteeism due to fear, avoidance, and higher rates of depression and anxiety than their heterosexual peers. The present study used longitudinal data to compare sexual minority youth and heterosexual youth on excused and unexcused absences from school and to evaluate differences in the relations between depression and anxiety symptoms and school absences among sexual minority youth and heterosexual youth. A total of 108 14- to 19-years-old adolescents (71% female and 26% sexual minority) completed self-report measures of excused and unexcused absences and depression and anxiety symptoms. Compared to heterosexual youth, sexual minority youth reported more excused and unexcused absences and more depression and anxiety symptoms. Sexual minority status significantly moderated the effects of depression and anxiety symptoms on unexcused absences such that depression and anxiety symptoms were stronger predictors of unexcused absences for sexual minority youth than for heterosexual youth. The results demonstrate that sexual minority status and mental health are important factors to consider when assessing school absenteeism and when developing interventions to prevent or reduce school absenteeism among adolescents.