Gender differences in the development and adult outcome of co-occurring depression and delinquency in adolescence

Using a dual trajectory modeling approach, we examined co-occurring trajectories of depression and delinquency from age 11 to age 18 and their relation to adult outcome six years later in a community sample of 1423 (674 boys) adolescents. We also examined the effects of childhood externalizing, internalizing, and social problems on trajectory membership for depression and delinquency. The results showed that although more girls than boys were likely to follow high-level, co-occurring trajectories on depression and delinquency, the adult outcome of adolescents following high-level trajectories on both domains was poorer for boys than for girls. However, the combination of decreasing depression symptoms and increasing delinquency symptoms across adolescence was related with poorer adult outcomes for girls compared to boys. Finally, whereas boys' high-level co-occurring trajectory of depression and delinquency was predicted by childhood aggression, girls' equivalent trajectory was predicted by childhood depression and delinquency. The findings support the "gender paradox" effect (Loeber & Keenan, 1994) stating that in disorders with an unequal gender ratio, members of the gender with the lower prevalence rate tend to be more seriously affected in terms of comorbidity and poor outcome.     

Co-occurring mental health and substance use problems in offenders: implications for risk assessment

We undertook a secondary data analysis to study issues relevant to co-occurring mental health and substance disorder in a combined sample of offenders (N = 3,197). Using the Personality Assessment Inventory, we compared the frequency of depressive, traumatic stress, and personality disorder symptom elevations across offenders with and without substance problems, identified the extent to which co-occurring problems were accompanied by risk factors for suicide and aggression, and tested for gender differences. Offenders with substance problems were more likely than others to have increased mental health problems and risk factors for suicide or aggression. Women with substance problems, compared with men, had higher depression, traumatic stress, and borderline features, in addition to lower antisocial features. The frequency with which suicide and aggression risk factors were associated with mental health problems was generally similar across men and women. Measurement issues relevant to co-occurring disorder and risk assessment are discussed.     

A comparison of health disparities among transgender adults in Colorado (USA) by race and income

Transgender individuals face heightened risks for discrimination, harassment, and violence that impact their psychosocial well-being and physical health. However, few studies have thoroughly examined the general physical and mental health of transgender adults or within-group health differences by race/ethnicity and income. To that end, after controlling for health insurance status, age, and engagement in exercise, this study asks: (a) Are transgender people of color more likely than White transgender individuals to experience poor health outcomes? and (b) Is lower annual household income among transgender adults associated with poorer health outcomes? The study analyzes secondary data from a survey of transgender adults (N = 417) in one state in the western United States using multiple linear regression and logistic regression models. Results showed that transgender people of color had significantly greater odds than their White counterparts of having arthritis/rheumatoid arthritis/gout/lupus/fibromyalgia, or asthma but lower odds of being told by a provider that they had depression. Having a lower income was significantly associated with worse general health as well as multiple indicators of poor physical and mental health, including depression, anxiety, and suicidal ideation. We discuss implications for health care delivery for transgender people and for future research.     

Social hierarchy and depression: the role of emotion suppression

Position in the social hierarchy is a major determinant of health outcomes. We examined the associations between aspects of social hierarchy and depressive symptoms with a specific focus on one potential psychological mechanism: emotion suppression. Suppressing negative emotion has mental health costs, but individuals with low social power and low social status may use these strategies to avoid conflict. Study 1 assessed perceived social power, tendency to suppress negative emotion, and depressive symptoms in a community sample of women. Low social power was related to greater depressive symptoms, and this relationship was partially mediated by emotion suppression. Study 2 examined education as a proxy for social hierarchy position, anger suppression, and depressive symptoms in a national, longitudinal cohort study (The coronary artery risk development in young adults [CARDIA] study; Cutter et al., 1991). Much as in study 1, low education levels were correlated with greater depressive symptoms, and this relationship was partially mediated by anger suppression. Further, suppression mediated the relationship between low education and subsequent depression up to 15 years later. These findings support the theory that social hierarchy affects mental health in part through a process of emotion suppression.     

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.     

Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample

In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD?=?5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR?=?0.85, 95% CI: 0.78-0.93; social support AOR?=?0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR?=?0.79, 95% CI: 0.71-0.89; social support AOR?=?0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR?=?0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.     

Temperament as a moderator of the relation between neighborhood and children's adjustment

Although proposed by bioecological models, there has been minimal empirical examination of whether children's individual differences moderate neighborhood effects on development. We used an urban community sample (8-12 years, N = 316) to examine interactions among neighborhood characteristics (problems and social organization) and children's temperament (fear, irritability and impulsivity) in predicting psychosocial adjustment. The main effects of neighborhood and temperament on outcomes were consistent with previous research. Findings show that development is challenging in disadvantaged neighborhoods whatever one's temperament, however, some effects of neighborhood were conditioned by temperament, particularly children's fear and irritability. Neighborhood problems were more strongly related to lower social competence for fearful and for less irritable children. Neighborhood problems were more strongly related to higher internalizing problems for low-fear children. Neighborhood social organization was more strongly related to greater social competence for low-fear children. Findings are discussed in relation to "diathesis-stress" and "differential responsiveness" models of temperament.     

The Multilevel Relationships of HIV‐Related Stigma to Child and Caregiver Mental Health among HIV‐Affected Households in South Africa

HIV/AIDS‐related (HAR) stigma is still a prevalent problem in Sub‐Saharan Africa, and has been found to be related to mental health of HIV‐positive individuals. However, no studies in the Sub‐Saharan African context have yet examined the relationship between HAR stigma and mental health among HIV‐negative, HIV‐affected adults and families; nor have any studies in this context yet examined stigma as an ecological construct predicting mental health outcomes through supra‐individual (setting level) and individual levels of influence. Multilevel modeling was used to examine multilevel, ecological relationships between HAR stigma and mental health among child and caregiver pairs from a systematic, community‐representative sample of 508 HIV‐affected households nested within 24 communities in KwaZulu‐Natal, South Africa. Two distinct dimensions of HAR stigma were measured: individual stigmatizing attitudes, and perceptions of community normative stigma. Findings suggest that individual‐level HAR stigma significantly predicts individual mental health (depression and anxiety) among HIV‐affected adults; and that community‐level HAR stigma significantly predicts both individual‐level mental health outcomes (anxiety) among HIV‐affected adults, and mental health outcomes (PTSD and externalizing behavior scores) among HIV‐affected children. Differentiated patterns of relationships were found using the two different stigma measures. These findings of unique relationships identified when utilizing two conceptually distinct stigma measures, at two levels of analysis (individual and community) suggest that HAR stigma in this context should be conceptualized as a multilevel, multidimensional construct. These findings have important implications both for mental health interventions and for interventions to reduce HAR stigma in this context.     

Co-occurring Mental Health Problems and Peer Functioning Among Youth with Attention-Deficit/Hyperactivity Disorder: A Review and Recommendations for Future Research

It is well established that children and adolescents with attention-deficit/hyperactivity disorder (ADHD) frequently experience co-occurring mental health problems in addition to difficulties in their peer relationships. Although substantial research has focused on the extent to which peer functioning contributes to subsequent co-occurring mental health problems, much less research has considered how co-occurring mental health problems affect peer functioning domains. Therefore, the purpose of this review is to examine the effect of co-occurring mental health problems on the peer functioning of youth with ADHD. The impact of co-occurring externalizing (i.e., oppositional defiant disorder, conduct disorder) and internalizing (i.e., anxiety, depression) symptoms are reviewed, with a focus on whether these co-occurring symptoms exacerbate, attenuate, or have no effect across peer domains of social skills/competence, peer status, and friendship among youth with ADHD. Drawing from a developmental psychopathology framework, this review then draws attention to relevant causal processes and developmental cascades (including social-cognitive, affective, and family and parenting factors) in offering promising avenues for future work.     

Effectiveness of cognitive behavioural group therapy for social phobia in a community clinic: a benchmarking study

This study used a benchmarking strategy to investigate the transportability of cognitive behavioural group therapy (CBGT) for social phobia to a community mental health clinic. The influence of common exclusion criteria on effect sizes was also examined. Patients (N=153) attended seven 4-h sessions of CBGT, which resulted in significant reductions in symptoms of social anxiety and depression. Effect sizes compared favourably to previous efficacy and effectiveness studies of both group and individual treatment. More than half of the treatment completers achieved reliable change. One-third achieved clinically significant change (CSC) on the Social Phobia Scale and the Beck Depression Inventory, but fewer achieved CSC on the Social Interaction and Anxiety Scale. Restricting the sample on the basis of depression symptoms, age above or below 50 years, comorbidity, alcohol problems, or student status did not significantly moderate effect sizes for social anxiety. It is concluded that CBGT is effective within community mental health clinics.     

Mental Health, Social Environment and Sexual Risk Behaviors of Adolescent Service Users: A Gender Comparison

We examined individual mental health problems (depression, conduct disorder, and substance abuse) and social environment (family, peer, and neighborhood) factors associated with the sexual risk behaviors of male and female adolescents. Interviews with 778 adolescents, aged 14 to 18, showed that both mental health problems and social environment were related to adolescents' involvement in sexual risk behaviors. Conduct disorder symptoms, substance abuse or dependence symptoms, and the interaction between peer misbehavior and neighborhood problems were significantly associated with risky sexual behaviors. Peer misbehavior was a particularly strong factor related to sexual risk behaviors for youths who lived in neighborhoods with multiple problems. The only gender differences were found in age, with older males more likely to report engaging in high risk sexual behaviors. This study suggests the utility of multidimensional intervention strategies to deal with various adolescent problem behaviors, including risky sexual behaviors, within the context of their social environment.     

Examining the relation between adolescent social anxiety,adolescent delinquency (abstention), and emerging adulthood relationship quality

Background and Objectives: Social anxiety symptoms and delinquency are two prevalent manifestations of problem behavior during adolescence and both are related to negative interpersonal relationships in adolescence and emerging adulthood. This study examined the relation between social anxiety and delinquency in adolescence and the interplay between adolescent social anxiety and delinquency on perceived relationship quality in emerging adulthood. Design and Methods: In a 10-year long prospective study (T1, n = 923; T2, n = 727; Mage T1 = 12; 49% female), we examined competing hypotheses using regression analyses: the protective perspective, which suggests social anxiety protects against delinquency; and the co-occurring perspective, which suggests social anxiety and delinquency co-occur leading to increased negative interpersonal outcomes. Results: In adolescence, the relation between social anxiety and delinquency was consistent with the protective perspective. In emerging adulthood, consistent with the co-occurring perspective, ever-delinquents (but not delinquency abstainers) with higher social anxiety reported less perceived best friend, mother, and father support compared to delinquents with lower social anxiety. There was no interaction between anxiety and delinquency in predicting perceived conflict. Conclusion: This study highlights the importance of examining the relation between social anxiety and delinquency with regards to different interpersonal outcomes.     

Identifying Emergent Social Networks at a Federally Qualified Health Center-Based Farmers’ Market

Identifying potential mechanisms connecting farmers’ market interventions with health, economic, and community outcomes could inform strategies for addressing health disparities. The present study used social network theory to guide the in-depth examination of naturally occurring social interactions at a farmers’ market located at a federally qualified health center located in a rural, low-income community. Trained observers recorded 61 observation logs at the market over 18 weeks. Thematic analysis revealed a range of actors and nonhuman facilitators instrumental to the farmers’ market context. These actors connected with one another for communication and relationship development, economic and financial exchange, education, resource sharing, community ownership of the farmers’ market, and conflict resolution. These interactions provided opportunities for social networks to develop among attendees, which may have facilitated the acquisition of social supports related to improved health, economic and community outcomes. Results provide insight into the role social networks may play in mediating the relationship between a farmers’ market intervention and individual benefits. Findings also contribute to defining the typology of social networks, which may further disentangle the complex relationships between social networks and health outcomes. Future research should identify strategies for purposefully targeting social networks as a way to reduce diet-related health disparities.     

Exposure to Verbal Parental Aggression and Sexual Activity Among Low Income African American Youth

The study examined whether witnessing verbal parental aggression (VPA) was related to sexual activity among mostly low income African American youth, and whether psychological symptoms mediated this relationship. Five hundred and sixty-three African American high school adolescents (ages 13–19) completed self-administered questionnaires, which assessed demographics, psychological problems (e.g., depression, anxiety, aggression and posttraumatic stress disorder symptoms), witnessing VPA, and sexual activity. Participants who witnessed high versus no VPA were 2 times more likely to report sexual activity. This relationship was mediated by aggression for males and females, and posttraumatic stress disorder symptoms for females only. Youth service providers should be trained to understand the prevalence of co-occurring problems such as exposure to VPA, aggression, PTSD symptoms, and sexual activity, with the goal of more effectively supporting the healthy development of African American youth.     

Knowledge and beliefs regarding the consequences of cigarette smoking and their relationships to smoking status in a biracial sample

The purpose of this investigation was to evaluate carefully smoking-related knowledge and beliefs and their relationships to smoking status in a large, heterogeneous sample of smokers and nonsmokers in two settings: (a) a large, biracial southern city and (b) a small midwestern community. Participants were 611 (198 male, 413 female) adult respondents to a random-dialing telephone survey in Fargo, North Dakota (n = 200), and Memphis, Tennessee (n = 411). Each participant was given the Smoking Attitudes Survey, which assesses generalized health beliefs as well as health-related problems associated with smoking. Participants' knowledge of smoking-associated diseases (e.g., lung cancer) and of diseases not associated with smoking (e.g., kidney stones) was assessed. Stepwise regression analysis of composite knowledge scores revealed four independent predictors of the health consequences of smoking: education, race, smoking status, and income. Smokers, compared to nonsmokers, reported less knowledge related to the health consequences of smoking, were more likely to be male, were less concerned with the health consequences of smoking, and were more concerned about the health consequences of cholesterol. The best predictor of smokers who had never attempted cessation was their greater concern over weight control when compared to smokers with a history of smoking cessation attempts. The results are discussed in terms of smoking prevention and intervention efforts.     

Socioeconomic Status,Emotional/Behavioral Difficulties,and Social Competence among Preschool Children in Japan

Socioeconomic status (SES) is an important contextual factor influencing children’s development. However, there have been limited attempts to examine either the impact of relative poverty on child development or the relationships between specific SES indicators and mental health domains. This study elucidates these relationships in Japanese preschool children who experience high levels of relative poverty. Participants were 3218 Japanese children aged 5–6 years. Their mothers completed self-report questionnaires on SES indicators and the Strengths and Difficulties Questionnaire to measure emotional/behavioral problems. Children’s teachers evaluated children’s social competence using the Social Skills Questionnaire for Preschoolers. Each SES indicator had an inverse relationship with all emotional/behavioral problem domains in the univariate analysis. In the multivariate analysis, lower family income consistently predicted higher scores on all emotional/behavioral problem domains, whereas lower maternal and paternal education levels independently predicted higher scores in specific domains. Each SES indicator had positive relationships with all social competence dimensions in the univariate analysis. Higher family income consistently predicted higher social competence in the multivariate analysis. However, paternal education level only predicted self-control, and maternal education did not predict social competence. Family income and parental education levels were significant independent predictors of emotional/behavioral problems and social competence. Thus, this study suggests that SES does affect child outcomes in a country where there is a high level of relative poverty and underscores the importance of assessing income and education status separately in order to identify their potentially unique associations with development among preschool children.     

Cognitive behavioural group therapy for social phobia: evidence of transportability to community clinics

Cognitive Behavioural Group Therapy (CBGT) for social phobia has been shown to be efficacious within research units and effective within a variety of real world clinical settings. However, most effectiveness studies of CBGT for social phobia have (a) used protocols without demonstrated efficacy, (b) not included direct comparison groups, and/or (c) contained features of efficacy trials. This study addressed these limitations by using a benchmarking strategy to compare outcomes from the same CBGT protocol used in both a research unit and a community clinic. Research (N = 71) and community (N = 94) patients completed the same 12-session protocol, which resulted in significant reductions in social anxiety and life interference at post-treatment. Compared to research unit patients, community patients had more severe symptoms and life interference at pre-treatment, and were more likely to be male, use medication, have comorbid disorders, and have lower educational attainment. Importantly, degree of improvement on social anxiety symptoms and life interference did not differ across the treatment settings for either completer or intention-to-treat analyses. There was some evidence that being younger, single, and having a depression diagnosis were associated with dropout. Pre-treatment symptoms and number of diagnoses predicted post-treatment symptoms. Consistent with previous uncontrolled trials, it is concluded that CBGT is effective within community mental health clinics.     

Early childhood predictors of boys’ antisocial and violent behavior in early adulthood

Research on early childhood predictors of violent behaviors in early adulthood is limited. The current study investigated whether individual, family, and community risk factors from 18 to 42 months of age were predictive of violent criminal arrests during late adolescence and early adulthood using a sample of 310 low-income male participants living in an urban community. In addition, differences in trajectories of overt conduct problems (CP), hyperactivity/attention problems (HAP), and co-occurring patterns of CP and HAP from age 1½ to 10 years were investigated in regard to their relationship to violent and nonviolent behaviors, depression, and anxiety at age 20. Results of multivariate analyses indicated that early childhood family income, home environment, emotion regulation, oppositional behavior, and minority status were all significant in distinguishing violent offending boys from those with no criminal records. In addition, trajectories of early childhood CP, but not attention deficit hyperactivity disorder, were significantly related to self-reports of violent behavior, depressive symptoms, and anxiety symptoms. Implications for the prevention of early childhood risk factors associated with adolescent and adult violent behavior for males are discussed.     

Subjective social status, objective socioeconomic status, and cardiovascular risk in women.

OBJECTIVE: Subjective perceptions of personal social status may relate to health beyond the effects of objective socioeconomic status (SES). The authors examined the relationship between subjective social status (SSS) and psychosocial, behavioral, and physical cardiovascular risk factors in middle-aged women. DESIGN: Ninety-two women (90.2% White) completed ladder-based, pictorial self-report measures of SSS relative to others in their community and in the United States. Psychosocial measures of depression, anxiety, pessimism, stress, and social support and behavioral risk factors of fruit and vegetable consumption, leisure physical activity, and body-mass index were obtained. In addition, women underwent measurement of clinic blood pressure and assessment of daytime ambulatory systolic and diastolic blood pressure (SBP; DBP) over 2 consecutive days. RESULTS: Community SSS was significantly inversely related to anxiety, pessimism, stress, and daytime ambulatory DBP after controlling for objective SES and U.S. SSS. Women with lower U.S. SSS showed less healthy dietary and exercise behaviors and, contrary to predictions, lower clinic and ambulatory DBP. CONCLUSION: This study provides additional evidence that perceptions of one's position in the social hierarchy could have important health implications beyond the impact of objective SES. Further, the cardiovascular risk implications of perceived community versus U.S. social status appear to be distinct.