Suicidality Among Adolescent Alberta Indians

A high rate of suicide attempts and suicide ideation characterized a sample of 229 grade 7 to 9 adolescents resident on seven reserves in central Alberta. The prevalence of suicidality for these adolescent Indians was very similar to rates reported for Navajo youth and for 8th- and 10th-grade American non-Indian students. Comparison of Indian and non-Indian suicidality risk factors showed somewhat elevated levels of family disruption and psychological problems among Indian adolescents. Compared to Canadian nonadolescents, substance abuse levels were high, and conditions necessary to modeling were virtually omnipresent. Suicide ideation was significantly elevated for Indian adolescents with low psychological well-being, no father in the home, and a prior suicide in the household. Controlling for age, risk factors for suicide attempts were heavy alcohol use, no father in the home, sleeping problems, and low psychological well-being. The high rates of adolescent Native suicide imply that a much higher proportion of their suicide attempts succeed. Targeted, community-based counselling and educational programs are needed to address these problems.     

Adolescent Attitudes About Death in Relation to Suicidality

This study examined psychiatrically disturbed adolescents' history of exposure to suicide attempts, completions, and other deaths in relation to attitudes about life and death. A primary goal of the study was to study the mediating processes involved in the impact of loss on suicidality. Adolescents who experienced the suicide of a friend or immediate family member reported a weaker attraction to life and stronger attraction to death than adolescents lacking this experience. Exposure to attempted suicide resulted in attitudes indicating a stronger attraction to death and repulsion by life. We conclude that a comprehensive history of loss and assessment of current attitudes toward death are important aspects of evaluation and subsequent treatment of at-risk adolescents.     

Suicidality in Bipolar Disorder: The Role of Emotion‐Triggered Impulsivity

A growing body of research suggests that impulsive responses to emotion more robustly predict suicidality than do other forms of impulsivity. This issue has not yet been examined within bipolar disorder, however. Participants diagnosed with bipolar I disorder (n = 133) and control participants (n = 110) diagnosed with no mood or psychotic disorder completed self‐report measures of emotion‐triggered impulsivity (Negative and Positive Urgency Scales) and interviews concerning lifetime suicidality. Analyses examined the effects of emotion‐triggered impulsivity alone and in combination with gender, age of onset, depression severity, comorbid anxiety, comorbid substance use, and medication. A history of suicide ideation and attempts, as well as self‐harm, were significantly more common in the bipolar disorder group compared with the control group. Impulsive responses to positive emotions related to suicide ideation, attempts, and self‐harm within the bipolar group. Findings extend research on the importance of emotion‐triggered impulsivity to a broad range of key outcomes within bipolar disorder. The discussion focuses on limitations and potential clinical implications.     

Psychosocial Correlates of Suicidal Ideation in Adolescent Psychiatric Inpatients

The Beck Scale for Suicide Ideation (BSI) was administered to 121 inpatients between 12 and 17 years old who were diagnosed with mixed psychiatric disorders. Twelve background and clinical characteristics, previously found to be associated with adolescent suicidal ideation, were entered into a multiple regression to estimate the BSI scores, along with the Beck Anxiety Inventory, the revised Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS), and the Youth Self-Report. The BHS and the BDI were the only two variables that contributed unique variance to the explanation of the BSI scores.     

Posttraumatic Stress Disorder Symptom Severity and Emotion Regulation in Acute-Care Psychiatric Inpatients: Associations With Suicidality

Posttraumatic stress disorder (PTSD) symptomatology has been positively associated with suicidality (suicidal ideation and attempts), but less is known about factors that might exacerbate that association. The present study examined the main and interactive effects of PTSD symptom severity and difficulties in emotion regulation in association with four suicidality outcomes. Participants included 128 adults in an acute-care psychiatric inpatient setting. Results revealed that PTSD symptom severity was significantly incrementally associated with self-reported suicidal ideation (ß = .30, p = .02). Difficulties in emotion regulation were significantly associated with suicide as the reason for current admission (p = .01). The interactive effect of PTSD symptom severity and difficulties in emotion regulation was significant only for self-reported suicidal ideation (ß = .24, p < .001). Participants with high levels of PTSD symptom severity and difficulties in emotion regulation exhibited the highest level of suicidal ideation. Clinical implications and future directions are discussed.     

SCL--90--R Symptom Patterns for Adolescent Psychiatric Inpatients

We collected Symptom Check List-90-Revised (SCL-90-R) symptom pattern and severity data from a sample of 486 adolescent psychiatric inpatients. Preliminary comparison of these data with previously published data for adolescent nonpatients suggested no meaningful differences in overall symptom severity, although the data suggested higher Positive Symptom Distress index (PSDI) scores for inpatients, less severe somatization and psychoticism symptoms for inpatient males compared to nonpatient males, and more severe depressive symptoms for inpatient females compared to nonpatient females. Future studies should be directed toward farther analyses of such data and the development of representative and generalizable adolescent inpatient norms for the SCL-90-R.     

Childhood Characteristics of Adolescent Inpatients with Early-Onset and Adolescent-Onset Disruptive Behavior

Childhood characteristics are associated with life-course-persistent antisocial behavior in epidemiological studies in general population samples. The present study examines this association in an inpatient sample. The purpose is to identify easily measurable childhood characteristics that may guide choice of treatment for adolescent psychiatric inpatients with severe disruptive behavior. Patients (N?=?203) were divided into two groups with either early-onset (EO) or adolescent-onset (AO) disruptive behavior, based on ages at which professional care was used for disruptive behavior, referral to special education, and criminal offences. Both groups differed on several childhood characteristics. No gender differences in these characteristics were found. Logistic regression analysis indicated that individuals with grade retention in primary school, childhood impulsive behavior, and a history of physical abuse, had the highest probability of being member of the EO group. These characteristics are reasonably easy to identify, likely apply to other clinical samples as well, and may help clinicians to target their treatment.     

MMPI and Rorschach Indices of Schizophrenic and Depressive Diagnoses Among Adolescent Inpatients

Although adolescent norms have been developed for the MMPI (e.g., Marks, Seeman, & Haller, 1974) and Rorschach (e.g., Exner, 1986a), little is known regarding the discriminate diagnostic validity of these measures with adolescents. This study investigated the usefulness of these measures in the detection of depression and schizophrenia among adolescent inpatients. Subjects (mean age = 15.3) consisted of 134 adolescents who received Rorschach and MMPI administrations at hospital admission. Clinical diagnoses resulted in the following groupings for this sample: schizophrenia = 15, dysthymic disorder = 41, major depression = 26, conduct disorder = 28, personality disorder = 18. MMPI scale Sc elevation was found to be the most effective single predictor of schizophrenic diagnoses, with a hit rate of .76, sensitivity of .62, and specificity of .78. Neither MMPI scale D scores nor Rorschach DEPI scores were found to be significantly related to patients' diagnoses. Results were interpreted in terms of prior findings in adult psychiatric populations and in relation to implications for the clinical assessment of adolescents.     

Utility of the SCL-90-R With Depressed and Conduct-Disordered Adolescent Inpatients

We assessed the ciiagnosric utility of the Symptom Checklist-90-Revised (SCL-9O-R) in a sample of adolescent inpatients. In Part 1 (n = 73), convergent and discriminant validity were demonstrated for SCL-90-R scales measuring depression and paranoid ideation, Canonical correlation showed that SCL-90-R scales tapped two dimensions of adolescent psychopathology, a primary dimension of dysphoria and a secondary dimension of anger and mistrust. In Part 2 (n = 50), adolescents diagnosed as having major depression showed significant elevations on scales measuring depression, anxiety, an obsessive-compulsive features. Although several scales had high diagnostic specificity for major depression and conduct dsorder, sensitivity was low.     

Prediction of Suicide Intent in Aboriginal and Non-Aboriginal Adolescent Inpatients: A Research Note

The relationship among depressive symptoms, anxiety, hopelessness, and suicidal intent was explored in a group of 77 adolescents who had been hospitalized after attempting suicide. Regression analyses indicated that hopelessness was the only significant predictor of suicide intent in Caucasian patients, and depressed mood was the only significant predictor in the Aboriginal group. Clinicians should be aware that measures of hopelessness may be of limited value in assessing suicidal risk in Aboriginal adolescents.     

Unidimensionality of the Brief Symptom Inventory (BSI) in Adult and Adolescent Inpatients

This study investigated the factor structure of the Brief Symptom Inventory (BSI; Derogatis, 1992) for adult and adolescent psychiatric inpatients. The BSI was administered to 217 adults and 188 adolescents at admission, and discharge from a private psychiatric hospital. Principal components factor analyses revealed that most variance among dimension scores was accounted for by one unrotated factor. Factorial invariance was evident across adult and adolescent samples for admission and discharge scores. Our findings are consistent with previous research on the BSI and Symptom Checklist-90-R (Derogatis, 1977), suggesting that both instruments measure primarily a unidimensional construct of general psychological distress.     

Clinical Validity of a Dimensional Assessment of Self- and Interpersonal Functioning in Adolescent Inpatients

The Social Cognition and Object Relations Scale–Global Version (SCORS–G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS–G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS–G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS–G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS–G with adolescents.     

Unique and Interactive Associations of Callous-Unemotional Traits,Impulsivity and Grandiosity with Child and Adolescent Conduct Disorder Symptoms

The construct of psychopathy remains underrepresented in the clinical diagnosis of Conduct Disorder (CD) as the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) only addresses one out of the three dimensions of child psychopathy, Callous Unemotional (CU) traits. This study tests if and to what extent there are unique and interactive associations of CU traits, impulsivity, and grandiosity with child and adolescent CD symptoms. Data were collected from two separate community samples of children (N?=?1599; Mage?=?9.46, SD?=?1.65; 52% female) and adolescents (N?=?2719; Mage?=?16.99, SD?=?0.99; 49% female), who were followed longitudinally after a year. Hierarchical linear regression analyses were conducted, testing cross-sectional and longitudinal associations with CD symptoms, taking into account all three psychopathy dimensions. The cross-sectional findings indicate that only youth presenting a combination of all three psychopathy dimensions scored above the clinical cut-off score for CD. On the other hand, longitudinal findings provided evidence that the combination of high initial levels of CD and CU traits as well as the combination between CD, grandiosity, and impulsivity can lead to clinical levels of future CD symptoms. Findings also indicated that CU traits and impulsivity more strongly predicted adolescent than child CD symptoms, and that CU traits were more strongly associated with boys’ than girls’ CD symptoms. Findings support the inclusion of CU traits as a specifier for the diagnosis of CD, and provide evidence that other psychopathy dimensions can also help clinicians to better understand and treat youth with CD, and should be considered for future revisions of the DSM.     

Impulsivity and religiosity

The Junior I₆ Impulsiveness Inventory and the Attitude Towards Religion scale ASC4B were administered to 569 schoolchildren aged 11–17 yr. Positive Attitude scores were found to be inversely related to both impulsiveness and venturesomeness. This finding supports the theory that impulsivity is related to toughmindedness and supports the value of the independent operationalization of impulsiveness and venturesomeness in the discussion of social attitudes. However, while the Imp(ulsiveness) scale behaves as predicted by Eysenck's theory, the behaviour of the Vent(uresomeness) scale is more problematic. It is suggested that future research on the nature of impulsivity and its relationship with social attitudes might benefit from considering the two components of the Vent scale, namely risk-taking and sensation-seeking, separately.     

The Difficulties in Emotion Regulation Scale: Factor Structure and Association with Nonsuicidal Self-Injury in Adolescent Inpatients

Research suggests that difficulties in emotion regulation are an important correlate of nonsuicidal self-injury (NSSI) in adults. Research examining this link in adolescents is limited by the lack of comprehensive instruments to assess difficulties in emotion regulation. Against this background, the aims of the current study were to (a) confirm the six-factor structure of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, Journal of Psychopathology and Behavioral Assessment, 23(4), 253?C263, 2004) in a sample of adolescent inpatients (N?=?218); (b) explore the relation between different aspects of emotion dysregulation and lifetime NSSI while controlling for psychopathology and sex; and (c) assess the clinical utility of the DERS in detecting lifetime NSSI status. Fit indices obtained through Confirmatory Factor Analysis indicated that the six-factor structure of the DERS fit the data adequately and that most items loaded strongly on their respective latent factor. All six latent factors were significantly correlated with each other, with the exception of lack of emotional awareness and difficulties engaging in goal-directed behavioral when distressed. Regression analyses revealed that only the limited access to emotion regulation strategies subscale accounted for a significant portion of the variance in NSSI when controlling for other aspects of emotion dysregulation, sex, and psychopathology. Receiver Operating Characteristic analysis indicated that the DERS limited access to emotion regulation strategies subscale score has moderate diagnostic accuracy in detecting the presence of NSSI. The optimal cut-off score was 21.5 when detecting NSSI among inpatient adolescents. Results provide further support for the relation between emotion regulation difficulties and NSSI. The DERS appears to be a useful measure of detecting NSSI in clinical samples of adolescents.     

Impulsivity and Paced Tapping

The purpose of this study was to test the hypothesis that impulsivity is positively related to both the intraindividual variability and the rate of performance of a paced tapping task. Selected experimental conditions which have been demonstrated to influence paced tapping were included in the experimental design of the tapping task. The independent variables in the tapping task were: feedback vs. no feedback; tempo; concurrent cognitive task (counting) vs. no concurrent cognitive task. Three measures of tapping performance were computed: absolute or total error of tapping, tapping rate, and the intraindividual variability of tapping. The results confirm the hypothesis that impulsivity is positively related to rate of paced tapping, although the degree of relationship varied under different experimental conditions within the paced tapping task. Intraindividual variability of tapping was not significantly related to impulsivity, but the results were suggestive of a positive relationship.     

Impulsivity and paced tapping

The purpose of this study was to test the hypothesis that impulsivity is positively related to both the intraindividual variability and the rate of performance of a paced tapping task. The independent variable in the tapping task were: feedback vs. no feedback; tempo; concurrent cognitive task (counting) vs. no concurrent cognitive task. Three measures of tapping performance were computed: absolute or total error of tapping, tapping rate, and the intraindividual variability of tapping. The results confirm the hypothesis that impulsivity is positively related to rate of paced tapping, although the degree of relationship varied under different experimental conditions within the paced tapping task. Intraindividual variability of tapping was not significantly related to impulsivity, but the results were suggestive of a positive relationship.