Youth Depression in the Family Context: Familial Risk Factors and Models of Treatment

Research on parent risk factors, family environment, and familial involvement in the treatment of depression in children and adolescents is integrated, providing an update to prior reviews on the topic. First, the psychosocial parent and family factors associated with youth depression are examined. The literature indicates that a broad array of parent and family factors is associated with youth risk for depression, ranging from parental pathology to parental cognitive style to family emotional climate. Next, treatment approaches for youth depression that have been empirically tested are described and then summarized in terms of their level of parent inclusion, including cognitive–behavioral therapy, interpersonal therapy, and family systems approaches. Families have mostly not been incorporated into clinical treatment research with depressed adolescents, with only 32% of treatments including parents in treatment in any capacity. Nonetheless, the overall effectiveness of treatments that involve children and adolescents exclusively is very similar to that of treatments that include parents as agents or facilitators of change. The article concludes with a discussion of the implications of these findings and directions for further research.     

The Family of Instruments That Assess Suicide Risk

In suicide assessment, Becks Scale for Suicide Ideation is used widely, though other adult and youth instruments are available. A creative, positive instrument is the Reasons for Living. Advantages of suicide questionnaires include rapid assessment, access to information that may be difficult to obtain by observations and verbal interaction, ease of completion for some, availability of established norms for some instruments, and indirect information provided by questionnaire responding. Disadvantages are the temptation to accept responses uncritically, the possibility that therapists or clients view the questionnaires as superseding the therapeutic relationship, the implication that suicide tendencies are static, and, at times, cost. Overall, sound clinical judgment is paramount when assessing for suicide.     

The Role of Families and Care Givers as Risk and Protective Factors in Preventing Youth Violence

This paper reviews research which discusses the risk and protective functions that families and other caregivers provide in influencing the development of aggressive behavior in youth. Currently, there is an emphasis on providing violence prevention programs in the school environment, typically with little parental or caregiver involvement. By enhancing the role of families and caregivers in youth violence prevention programs, we assert that an unique opportunity exists to both address specific risk factors for violence while enhancing the protective features of the family. Relatedly, the risk literature on youth violence indicates that the most influential risk factors (i.e., the family, community, and peers) have their principle impact on youth aggression outside the school. We suggest a shift in the focus of violence prevention programming that is more inclusive of families as both a risk and protective agent. In support of this position, relevant theory and reviews of exemplary family-involved programs are offered. Challenges to involving youth caregivers are identified and recommendations for overcoming those challenges suggested. Last, recommendations for future research and public policy in the prevention of youth violence are offered.     

A School-Based Suicide Risk Assessment Protocol

Suicide remains the third leading cause of death among young people in the United States. Considering that youth who contemplate suicide generally exhibit warning signs before engaging in lethal self-harm, school-based mental health professionals can play a vital role in identifying students who are at risk for suicidal behavior. Nevertheless, the assessment of vulnerable children and adolescents is a challenging undertaking, with many variables considered relevant to the determination of a student's suicide risk level. This article introduces school-based mental health professionals to the Student Suicide Risk Assessment Protocol, an evaluation tool developed by the author to aid in the determination of student suicide potential, assist with the selection of appropriate interventions, and allow for documentation of school personnel's actions taken to mitigate a student's suicide risk.     

Youth Suicide Intervention Using the Satir Model

Youth suicide is a social issue that needs serious consideration among families, therapists and helping professionals. This article presents an actual case of a youth who completed suicide, and discussion of the hypothetical Satir model treatment of this youth while alive. The Satir model has numerous interventions that have current applications toward dealing with suicidal youth in a humanist and hopeful way, fostering youths' desire to live and to become more positively involved in their lives. In the past, Satir focused on coping stances in communication, and now the coping stances give a deeper understanding into the internal world.     

Protective Factors Against Suicide Attempt Risk Among African American Women Experiencing Intimate Partner Violence

Protective factors (hope, spirituality, self-efficacy, coping, social support–family, social support–friends, and effectiveness of obtaining resources) against suicide attempts were examined in economically, educationally, and socially disadvantaged African American women (100 suicide attempters, 100 nonattempters) who had experienced recent intimate partner violence. Significant positive associations were found between all possible pairs of protective factors. Bivariate logistic regressions revealed that higher scores on each of the seven protective factors predicted nonattempter status; multivariate logistic regressions indicated that higher scores on measures of hope or social support–family showed unique predictive value for nonattempter status. Further, the multivariate model accurately predicted suicide attempt status 69.5% of the time. Partial support was found for a cumulative protective model hypothesizing a linear relationship between the number of protective factors endorsed and decreased risk for suicide attempts. Implications of these findings for community-based preventive intervention efforts and future research are discussed.     

Risk Factors for Adolescent Marijuana Use Across Cultures and Across Time

An integrated analysis of the data from 3 different studies was conducted to examine the early psychosocial predictors of later marijuana use among adolescents. Longitudinal analysis of interview data was performed. The data used in the analysis were derived from (a) a sample of 739 predominantly White adolescents representative of the northeastern United States, (b) a sample of 1,190 minority adolescents from the East Harlem section of New York City, and (c) a sample of 1,374 Colombian adolescents from two cities in Colombia. South America. In 2 of the samples, participants were interviewed in their homes, and in the 3rd study, participants were assessed in school. The predictors included a number of variables from (a) the personality domain, reflecting the adolescents' conventionality and intrapsychic functioning; (b) the family domain, representing the parent-child mutual attachment relationship and parental substance use; (c) the peer domain, reflecting the peer group's delinquency and substance use; and (d) the adolescents' own use of legal drugs. The dependent variable was adolescent marijuana use. The results of the analysis demonstrated remarkable consistency in the risk and protective factors for later marijuana use across the 3 samples, attesting to the robust nature of these predictors and their generalizability across gender, time, location, and ethnic/cultural background. These findings have important implications for designing intervention programs. Programs aimed at preventing adolescent marijuana use can be designed to incorporate universal features and still incorporate specific components that address the unique needs of adolescents from different groups.     

冠脉介入术支架内血栓的危险因素和预防策略

支架内血栓形成是经皮冠状动脉介入治疗罕见但极为严重的并发症,常导致患者心肌梗死和死亡。其危险因素包括抗血小板治疗、支架因素、介入操作因素、患者及病变因素等。预防的关键在于积极防治上述危险因素,主要包括延长抗血小板治疗疗程、选择合适的支架类型和操作技术、开发新型支架和抗血小板药物,同时注意冠心病二级预防。     

Protective Factors as Moderators of Risk Factors in Adolescence Bullying

The present study examined the role played by protective factors in moderating the effects of risk factors over bullying and victimization in a sample of 679 male adolescents recruited in Italian high schools. Boys’ involvement in bullying revealed that one in three students has bullied others at least sometimes in the previous three months, and one in six has been victimized at the same rate; victimization decreases with age. The family related risk factor (conflicting parents) was positively associated with bullying and with victimization (together with punitive parenting); the same applied for risk factor related to the individual ways of dealing with problems (emotionally oriented coping skills). Protective factors related to the family context (supportive and authoritative parents) and to the individual (problem solving coping skills) were negatively associated to bullying and victimization. Hierarchical regression analyses revealed a moderating effect of supportive parenting on punitive parenting and on emotionally oriented coping strategies in predicting victimization. Problem solving coping strategies helped buffer the negative impact of emotionally oriented coping strategies over bullying. Implications of results for practitioners and for future studies are addressed.     

Violence Exposure and Early Adolescent Alcohol Use: An Exploratory Study of Family Risk and Protective Factors

In this short-term longitudinal exploratory interview study, the relations between exposure to community violence and subsequent alcohol use were examined, with a focus on caregiver and family variables as moderators. Maternal caregivers and their children (N =101 families; 98% African American; M child age = 11.2 yrs) were interviewed separately and completed measures of violence exposure, caregiver and child adjustment, including substance use, and family functioning. Family interaction was also videotaped and coded. Child alcohol use at Time 2 was positively associated with all forms of violence exposure, and was negatively related to felt acceptance from caregiver, but was not associated with caregiver-rated family competence, observer-rated family interaction, maternal problems with alcohol, or maternal psychopathology. Logistic regression analyses predicting child alcohol use at Time 2 indicated that exposure to community violence increased risk of alcohol use, and felt acceptance from the caregiver decreased the likelihood of alcohol use, but did not buffer the effects of violence exposure on alcohol use. Implications and future directions are discussed.     

家庭因素与青少年犯罪的关系研究述评

随着犯罪理论（如社会控制理论、依恋理论、社会学习理论和问题行为理论）的不断发展,家庭因素与青少年犯罪关系的研究重点已由最初的家庭结构变量（如家庭完整性、家庭经济状况）逐渐扩展并聚焦在家庭功能变量（如家庭气氛、亲子依恋和亲子沟通等）和家庭成员行为变量（如教养方式、父母监控等）。近年来该研究领域开始深入探讨青少年认知过程在教养方式与青少年犯罪之间所起的中介作用,以及儿童青少年的人格、社区环境、神经生物学等变量与家庭因素的交互作用。最后本文总结了该领域研究的最新趋势和以往研究的不足     

The Practice of Suicide Assessment and Management by Marriage and Family Therapists

Abstract

Over 90% of mental health providers encounter suicidal clients. However, the majority of marriage and family therapists (MFTs) are not exposed to suicide-specific trainings within their clinical coursework. Due to the lack of consistent training protocols for suicide assessment and management among MFTs, this qualitative study identified common MFT responses to suicidal clients, including assessment of risk severity and intervention modalities. Responses were then compared to best practices for suicidal clients. Participants inconsistently adhered to best practices identified in the larger field of mental health, revealing the need for increased MFT training on suicide to ensure appropriate and effective care.     

自杀高危人群的识别及预防研究

自杀是由严重心理危机导致的行为.通过描述自杀高危人群存在的时代状况,从社会学与心理-精神病学的维度分析了高危人群的自杀成因,进而对其自杀前的异常言行表现、自杀的方式及当前各种预防措施进行讨论.同时,对中国文化语境下的自杀及其预防展开了反思与展望.     

中国自杀未遂的流行特征及影响因素研究

自杀是一个严重的社会问题和公共卫生问题。但目前尚未完全了解自杀的影响因素以及预防自杀的方法。流行病学研究表明自杀未遂是自杀的重要预测因素,了解自杀未遂的特征以及影响因素将有助于减少自杀行为的发生。本文对自杀未遂的流行特征以及影响因素进行了综述。     

Suicidal Adolescents' Social Support from Family and Peers: Gender-Specific Associations with Psychopathology

Perceptions of social support from family, non-family adults, and peers were examined in relation to the psychopathology reported by 220 suicidal adolescents (152 females) during a psychiatric hospitalization. Results of regression analyses showed that, among females, family support was negatively related to hopelessness, depressive symptoms, and suicidal ideation. Among males, peer support was positively associated with depressive symptoms and suicidal ideation. Across gender, more peer support was associated with more externalizing behavior problems; whereas, family support was negatively related to these problems and to alcohol/substance abuse. Paralleling normative findings, age was positively associated with peer support, and females perceived more peer support than did males. Findings extend previous research on social support to suicidal adolescents, and broaden the literature by examining extrafamilial support and a broader range of relevant psychopathology. That is, perceived social support relates to psychiatric impairment differentially by gender, and normative, age-related variations in perceptions of social support are detected even among highly impaired adolescents. Clinical implications and directions for future research are discussed.     

脑卒中患者家属的焦虑状况及其影响因素分析

了解脑卒中患者家属的焦虑状况及其影响因素。采用焦虑自评量表（SAS）及自制的一般状况调查问卷对240名脑卒中患者家属进行问卷调查。脑卒中患者家属的焦虑状况明显高于国内常模（P〈0．01）;其中家属的性别、年龄、文化程度、与患者关系、患者神经功能缺损程度及医疗费用的缴付方式与患者家属的焦虑有关（P〈0．01）。患者家属的...     

自杀“守门人”培训研究述评

在西方国家,自杀“守门人”培训被认为是最有效的自杀预防策略之一.自杀“守门人”培训的具体内容包括传授基础知识、识别自杀征兆、初步评估自杀风险和转介自杀高危个体等4个方面;研究发现自杀“守门人”培训对受训者的知识、态度和干预技能有显著的积极影响,但其对自杀率的影响仍需今后的研究详细探讨;目前的研究存在以下不足:1)随机对照研究少;2)难以评估培训对自杀率的真实影响;3)评价指标单一,缺乏统一的评估工具.未来的研究应弥补现有研究的不足,并重视自杀“守门人”培训的跨文化研究.     

家庭功能与中学生自杀态度的关系

为考察抑郁、冲动性在家庭功能与中学生自杀态度关系中的链式中介效应,使用家庭功能问卷、抑郁自评量表、Barratt冲动性量表和自杀态度问卷对517名中学生进行调查。研究显示：（1）冲动性在家庭功能与中学生自杀态度之间具有中介作用;（2）抑郁在家庭功能与中学生冲动性之间具有中介作用。（3）抑郁在家庭功能与中学生自杀态度间具有中介作用。因此,抑郁和冲动性在家庭功能与中学生自杀态度之间起链式中介作用。     

Family Conflict and Forgiveness Among Survivors of Suicide

This study explored the lived experiences of immediate family members who were left behind and their intra- and interpersonal struggles with other family members and their coping efforts to overcome these struggles. We used interpretative phenomenological analysis for data collection and analysis and conducted in-depth interviews with 11 participants in Korea. Two superordinate themes, with two ordinate themes in each, were identified: (a) family conflict after a family member’s suicide (“discordant grieving” and “suicide loss as a catalyst for family conflict”) and (b) forgiveness (“struggling to forgive other family members, the deceased, and themselves” and “the process and importance of forgiveness”). The implications of these findings are discussed.     

Risk and Resiliency Factors Influencing Suicidality Among Urban African American and Latino Youth

For decades, suicide rates among minority African American and Latino young people have been stable and, when compared with Whites, relatively low. This is no longer the case, underscoring the need for documenting and understanding the problem of suicidality in this population. We report on the prevalence and predictors of suicidality among 879 urban adolescents in the Reach for Health study. All youth resided in economically disadvantaged neighborhoods; 69% were African American, 16% Latino, and 15% reported mixed or other ethnicity. In the past year, 15% had seriously considered suicide; 13% had made a suicide plan, 11% had attempted suicide at least once, and 4% reported multiple attempts. Risk factors significantly related to suicidal ideation are being female, having basic needs unmet, engaging in same-gender sex, and depression. Resiliency factors include family closeness and, marginally, religiosity. Risk factors related to reports of suicide attempts are being female, being Hispanic, and depression; family closeness is strong resiliency factor. Family composition, ethnic identity, coping style, peer support, and school attachment are not significant correlates of suicidal ideation or attempts.