Role of Comorbid Depression and Co-occurring Depressive Symptoms in Outcomes for Anxiety-Disordered Youth Treated with Cognitive-Behavioral Therapy

This study examined the role of comorbid depressive disorders (major depressive disorder or dysthymic disorder) and co-occurring depressive symptoms in treatment outcome and maintenance for youth (N = 72, aged 7–14) treated with cognitive-behavioral therapy for a principal anxiety disorder (generalized anxiety disorder, separation anxiety disorder, or social phobia). Hierarchical linear modeling examined treatment outcome and maintenance in terms of severity of the principal anxiety disorder. Results indicated that higher levels of child-reported depressive symptoms predicted less favorable treatment outcome. Higher levels of mother-reported depressive symptoms predicted less favorable treatment maintenance at a 1-year follow-up. Results suggest that co-occurring depressive symptoms play a role in effective treatment for anxiety-disordered youth and support the merits of treatment adaptations for these youth.     

Low Parental Warmth and High Youth Impairment: A Recipe for Perceived Burdensomeness?

Theory and research document the role of perceived burdensomeness in the development of suicide ideation, including in youth. There is a critical need to identify and evaluate variables that foster perceived burdensomeness in youth, with an eye toward advancing etiological models and informing prevention approaches for at-risk youth who are not yet actively suicidal. The current study examined and replicated a conceptual model wherein the association between low parental warmth and burdensomeness is moderated by youth impairment. Participants were 75 and 150 clinic referred youths in Study 1 and Study 2, respectively, with anxiety-related difficulties. Youth impairment significantly moderated the association between low parental warmth and youth perceived burdensomeness such that the association was negative and statistically significant at high levels of impairment, but not at low levels of impairment. The moderation effect was statistically significant in both studies while controlling for anxiety and depressive symptoms. These findings provide insight into variables that are associated with a sense of burdensomeness toward others in youth, and identify potential targets for preventing or intervening to reduce perceived burdensomeness in clinic-referred youth.     

In Eating‐Disordered Inpatient Adolescents,Self‐Criticism Predicts Nonsuicidal Self‐Injury

We examined the role of depressive traits—self‐criticism and dependency—in nonsuicidal self‐injury (NSSI) and suicidal ideation among inpatient adolescents with eating disorders. In two studies (N = 103 and 55), inpatients were assessed for depressive traits, suicidal ideations, and NSSI. In Study 2, motivation for carrying out NSSI was also assessed. In both studies, depression predicted suicidal ideation and self‐criticism predicted NSSI. In Study 2, depression and suicidal ideation also predicted NSSI. The automatic positive motivation for NSSI was predicted by dependency and depressive symptoms, and by a two‐way interaction between self‐criticism and dependency. Consistent with the “self‐punishment model,” self‐criticism appears to constitute a dimension of vulnerability for NSSI.     

A Test of the Perfectionism Social Disconnection Model among Ethnic Minority Youth

Perfectionistic self-presentation (PSP) has been identified as a vulnerability factor in the development of depressive disorders during early adolescence. The Perfectionism Social Disconnection Model (PSDM) offers a theoretical framework suggesting PSP leads to depressive symptoms via interpersonal problems and social disconnection. Previous studies have supported the role of social disconnection as a mediator in the relation between PSP and suicidal ideation, but have not evaluated interpersonal problems in the model. Furthermore, the generalizability of the model has not been established for community and ethnic minority samples. Using cross-sectional data, the present study addresses these gaps by evaluating the PSDM and including social anxiety and loneliness as indicators of interpersonal problems and social disconnection, respectively, as predictors of youth depressive symptoms. The sample includes 289 (51.2% females) predominately low income and Latino and African American youth in fifth through seventh grade in three public schools. As predicted, social anxiety mediates the relationship between both PSP and loneliness and PSP and depressive symptoms. Moreover, mediational analyses indicate that social anxiety accounts for the relation between PSP and depression. Consistent with the PSDM model, the relationship between PSP and youth depressive symptoms is mediated sequentially through both social anxiety and loneliness, but primarily among the Latino sample.     

Suicidal Risk in Adolescent Residential Treatment: Being Female Is More Important Than a Depression Diagnosis

We investigated the relationship between gender and clinician diagnosis of a depressive disorder at intake on variables reflecting depression among adolescents in residential treatment. It was hypothesized that females diagnosed with a depressive disorder would have the highest scores on measures of suicide risk, the number of symptoms of a major depressive episode, suicidal behavior, and suicidal ideation. Results indicated partial support for the predicted comparisons. Females diagnosed with a depressive disorder scored significantly higher on measures of depressive symptom count and suicidal ideation. Surprisingly, females without a diagnosis of a depressive disorder had higher suicide risk scores than the remaining groups. The results of this study highlight the importance of assessment and treatment of internalizing disorders in youth entering residential programs, particularly female adolescents.     

Peer victimization and suicidal ideation: The role of gender and depression in a school-based sample

The current study investigated the relations among traditional and cyber victimization, depressive symptoms, suicidal ideation, and gender in a school-based sample of 403 9th grade (13 to 16-year-old) adolescents. Path analyses indicated that both traditional victimization and cyber victimization were associated with suicidal ideation indirectly through depressive symptoms. Although there was little evidence of gender differences in the associations among peer victimization and depressive symptoms and suicidal ideation, the relation between depressive symptoms and suicidal ideation was found to be significantly stronger for girls than boys. The current investigation confirms the complexity of the association between peer victimization and suicidal ideation and that depressive symptoms, as well as gender, may play a role in this complex relation. Future research should continue to explore the associations among victimization, depressive symptoms, and suicidal ideation within a social ecological framework.     

Current suicide proneness and past suicidal behavior in adjudicated adolescents

Youth recently assigned to probation (n = 233) were assessed for current suicide proneness, depression, and hopelessness, as well as for recent suicide ideation, previous suicide ideation, or suicide attempt(s). The Life Attitudes Schedule-Short Form (LAS-SF) was used to assess suicide proneness. As per the LAS-SF, suicide proneness was defined broadly to include current engagement in overtly suicidal behavior as well as in risk-taking and potentially injury-producing behaviors, coupled with a lack of engagement in health and safety behaviors, or self-enhancement behaviors. As expected, current suicide proneness was significantly associated with a history of suicide ideation and attempts, recent ideation, and current depression and hopelessness for adjudicated youth. Gender differences were obtained between the strength of the association between suicide proneness and depressive symptoms. A subgroup of adjudicated youth (n = 39) was then interviewed about their suicidal behaviors. Among other things, these youth indicated that the majority of their previous suicide attempts were committed impulsively.     

Suicidality as a function of impulsivity, callous-unemotional traits, and depressive symptoms in youth

Suicidality represents one of the most important areas of risk for adolescents, with both internalizing (e.g., depression, anxiety) and externalizing-antisocial (e.g., substance use, conduct) disorders conferring risk for suicidal ideation and attempts (e.g., Bridge, Goldstein, & Brent, 2006). However, no study has attended to gender differences in relationships between suicidality and different facets of psychopathic tendencies in youth. Further, very little research has focused on disentangling the multiple manifestations of suicide risk in the same study, including behaviors (suicide attempts with intent to die, self-injurious behavior) and general suicide risk marked by suicidal ideation and plans. To better understand these relationships, we recruited 184 adolescents from the community and in treatment. As predicted, psychopathic traits and depressive symptoms in youth showed differential associations with components of suicidality. Specifically, impulsive traits uniquely contributed to suicide attempts and self-injurious behaviors, above the influence of depression. Indeed, once psychopathic tendencies were entered in the model, depressive symptoms only explained general suicide risk marked by ideation or plans but not behaviors. Further, callous-unemotional traits conferred protection from suicide attempts selectively in girls. These findings have important implications for developing integrative models that incorporate differential relationships between (a) depressed mood and (b) personality risk factors (i.e., impulsivity and callous-unemotional traits) for suicidality in youth.     

Suicidal Ideation and Eating Disorder Symptoms in Adolescents: The Role of Interoceptive Deficits

Eating disorder symptoms and suicidal ideation are relatively common, and often begin to emerge in adolescence. Interoceptive deficits, or the inability to perceive and accurately identify the physiological condition of the body, is an established risk factor for both eating disorders and suicidal thoughts and behaviors. Despite this, longitudinal research examining the temporal dynamics between these variables is scarce, especially within adolescent samples. Using a three-wave longitudinal design, the present study tested bidirectional relationships between interoceptive deficits, eating disorder symptoms, and suicidal ideation to examine whether interoceptive deficits predicted eating disorder symptoms and suicidal ideation over the course of a year among a sample of adolescents. Participants were 436 community adolescents recruited from local middle- and high-schools. Data were collected at baseline, 6-month follow-up, and 12-month follow-up. Study measures assessed current suicidal ideation, eating disorder symptom severity, and interoceptive deficits. Autoregressive cross-lagged modeling was conducted in MPlus. We found baseline eating disorder symptoms significantly predicted suicidal ideation at 6-month follow-up when controlling for baseline suicidal ideation. Baseline interoceptive deficits significantly predicted eating disorder symptoms 6-months later, while 6-month follow-up interoceptive deficits significantly predicted 12-month follow-up suicidal ideation. Our findings highlight the need for early and regular assessment of suicidal ideation and eating disorder symptoms in adolescents. Given that interoceptive deficits was a shared risk factor for both conditions within this sample, these results underscore the need for targeted interventions aimed at improving interoception.     

Diagnostic morbidity and its relationship to severity of ideation for a nonpsychiatric sample of chronic and severe suicide ideators

This study examined the relationships of frequency and type of psychiatric diagnosis to suicidality within a sample of chronically and severely ideating college-aged students (N=78). The most common diagnoses were the depressive disorders, comprising 43% of all diagnoses, followed by anxiety disorders, comprising 17% of all diagnoses. Retrospective reports of childhood diagnoses were also quite common, comprising 38% of all diagnoses. Number of psychiatric diagnoses was significantly correlated with severity of suicidal ideation (r=.27,p<.02). Hierarchical regression analyses revealed that retrospective childhood diagnoses of attention deficit hyperactivity disorder (ADHD) and separation anxiety disorder significantly predicted 19% of the variance in severity of suicidal ideation after controlling for current diagnoses of major depression and PTSD. When entry of childhood and current diagnoses were reversed, PTSD significantly predicted 4% of the variance in severity of suicidal ideation, while major depression was rendered nonsignificant. Severe suicide ideation, therefore, may be a product of early psychological problems as well as the number of such problems.     

Evaluating panic-specific factors in the relationship between suicide and panic disorder

Work during the past decade has suggested an association between panic disorder and suicide (i.e., suicidal ideation and suicide attempts) that cannot simply be accounted for by co-occurring depression symptoms. To clarify the linkage between panic disorder and suicide, the association between panic-specific clinical and cognitive variables and suicide indicators were evaluated in patients with panic disorder (N=146). Analyses predicting the presence of suicidal ideation (positive, negative) after covarying the effects of a current mood disorder diagnosis and depression symptoms indicated a number of significant predictors including: (1) overall anxiety symptoms; (2) level of anticipatory anxiety; (3) avoidance of bodily sensations; (4) attentional vigilance toward bodily perturbations; and (5) phrenophobia (i.e., fear of cognitive incapacitation). Anxiety-specific variables did not account for unique variance in predicting prior history of suicide attempts.     

Association between loneliness and suicidality during middle childhood and adolescence: longitudinal effects and the role of demographic characteristics

The association between loneliness and suicidality has been documented in many studies, but these studies have been limited by cross-sectional designs and the use of adult-only populations. The purpose of the current study was to overcome these limitations by (a) investigating whether the link between loneliness and suicidal thoughts and behaviors occurs cross-sectionally, longitudinally, or both and (b) investigating how the link between loneliness and suicidality might be influenced by different demographic variables, including gender, ethnicity, and socioeconomic status. Logistic regression analyses were used to analyze data from a large sample (N = 937) of youth from the NICHD Study of Early Child Care. Results indicated that loneliness at age 15 years was concurrently associated with both suicidal ideation and suicidal behavior at age 15 years. Loneliness in middle childhood was longitudinally associated with suicidal behaviors at age 15 years, but not with suicidal ideation at age 15 years. None of the demographic characteristics influenced these associations.     

Suicidal Ideation in Elderly Bereaved: The Role of Complicated Grief

This study examined whether symptoms of complicated grief at baseline predicted suicidal ideation during a depressive episode in elderly bereaved individuals. Over a 17-month period, serial ratings of suicidal ideation, hopelessness, and symptoms of depression, anxiety, and complicated grief were obtained from 130 elderly participants who had lost their spouses within the past 2 years. Groups of active and passive suicidal ideators, as well as nonideator controls, were compared via analysis of variance (ANOVA) with respect to levels of complicated grief, depression, and anxiety. Elderly bereaved with both active and passive suicidal ideation were found to have higher symptomatic levels of depression, hopelessness, complicated grief, and anxiety, as well as lower levels of perceived social support, than nonideators at study entry. Fifty-seven percent of the patients with high complicated grief scores were found to be ideators during the follow-up versus 24% of the patients with low complicated grief scores. Patients with any suicidal ideation had higher symptom levels of depression, anxiety, and complicated grief when they were ideators as compared with periods when they denied ideation. Fifteen out of the 39 ideators had recurrent depressive episodes versus 5 of the 91 nonideators. Patients with a history of suicide attempts were more likely to be ideators after loss than other bereaved. Thus, the condition of having high levels of complicated grief symptoms and depressive symptoms appears to make bereaved individuals vulnerable to suicidal ideation. Detection of high levels of complicated grief could help clinicians identify patients who may be at heightened risk for suicide.     

Childhood Social Withdrawal,Interpersonal Impairment,and Young Adult Depression: A Mediational Model

Building on interpersonal theories of depression, the current study sought to explore whether early childhood social withdrawal serves as a risk factor for depressive symptoms and diagnoses in young adulthood. The researchers hypothesized that social impairment at age 15 would mediate the association between social withdrawal at age 5 and depression by age 20. This mediational model was tested in a community sample of 702 Australian youth followed from mother’s pregnancy to youth age 20. Structural equation modeling analyses found support for a model in which childhood social withdrawal predicted adolescent social impairment, which, in turn, predicted depression in young adulthood. Additionally, gender was found to moderate the relationship between adolescent social impairment and depression in early adulthood, with females exhibiting a stronger association between social functioning and depression at the symptom and diagnostic level. This study illuminates one potential pathway from early developing social difficulties to later depressive symptoms and disorders.     

Pathways to suicidal behaviors in childhood

Path analyses were applied to test a model that includes internalizing and externalizing behavior problems as predictors of suicidal behaviors in children. Parents of an inpatient sample of boys (N=87; M age=9.81 years) rated the frequency of suicidal ideation and completed standardized measures of behavior problems. Blind raters rated the severity of the children's suicidal behaviors. Results revealed a significant direct effect for suicidal ideation on suicide attempt and for depressive symptoms on suicidal ideation. There was also a significant indirect path from impulsivity to suicidal ideation through aggressive and depressive symptoms. Clinical implications are discussed.     

Increased Risk of Suicidal Ideation in Smokers and Former Smokers Compared to Never Smokers: Evidence from the Baltimore ECA Follow‐Up Study

The incidence rate of suicidal ideation among current and former smokers versus never smokers is not known. In this study, the age‐adjusted incidence of suicidal ideation was highest among current smokers, followed by former, then never smokers. The adjusted hazard for suicide ideation was 2.22 (95%CI = 1.48, 3.33) and 1.19 (95%CI = 0.78, 1.82) for current and former smokers, respectively, compared to never smokers. Results indicate that current smokers have increased risks of suicidal ideation above and beyond the risk for never and former smokers regardless of age, gender, history of depressive disorder or anxiety symptoms, and alcohol abuse/dependence. Smoking cessation might be beneficial for some suicide prevention efforts.     

Naturalistic evaluation of suicidal ideation: variability and relation to attempt status

Suicidal ideation has been thought to have a relatively stable course across weeks and months. However, daily changes in levels of ideation have not been adequately examined despite the importance of potential variability clinically and conceptually. For example, it has been suggested that variability in suicidal ideation may become less closely tied to variability in other mood symptoms (e.g., depression, hopelessness) among individuals with multiple suicide attempts. The present report had two related goals: (1) to prospectively evaluate suicidal ideation and related mood symptoms, and (2) to determine whether suicide attempt status predicted a decreased association between ideation and other mood symptoms. Non-clinical participants (N=108) with varying levels of suicidal ideation and number of previous suicide attempts completed the beck hopelessness scale (BHS), beck depression inventory (BDI), and suicide probability scale (SPS) every day for 4 weeks. Findings suggested considerable variability in suicidal ideation, especially for multiple attempters. Multiple attempt status predicted a decreased association between suicidal ideation and depression, although the results were only marginally significant. These findings have implications for conceptual models of suicide risk as well as assessment and treatment of suicidal individuals.     

The relationship between automatic thoughts and negative emotions in children and adolescents: a test of the cognitive content-specificity hypothesis

The aim of this study was to test the cognitive content-specificity hypothesis in children and adolescents aged 7-16 years. Participants consisted of a community sample of 200 youth and a clinical sample of 160 youth with anxiety, depressive, or disruptive behavior disorders. Participants completed several self-report measures assessing a wide range of negative beliefs and symptoms of internalizing and externalizing problems. Multivariate analyses examining the interrelationships between beliefs and noncognitive symptoms revealed that thoughts on loss or personal failure were the strongest predictors of depressive symptoms, thoughts on social threat were the strongest predictors of anxiety symptoms, and thoughts on hostility or revenge were the strongest predictors of aggression. Results showed clear evidence of cognitive-affective specificity across both internalizing and externalizing problems in youth.     

Do close supportive relationships moderate the effect of depressive symptoms on suicidal ideation?

Depressive symptoms, a lack of close supportive relationships and suicidal ideation are important risk factors for suicidal acts. Previous studies have primarily focused on the additive effects of close relationships and depressive symptoms on suicide risk. Here we explored whether, in addition, close relationships moderated the impact of depressive symptoms on suicidal ideation. An analysis of pre-existing data from 319 attendees at a student counselling service using moderated regression models indicated that when the student has close supportive relationships, the association between depressive symptoms and suicidal ideation is weaker than when he/she feels an absence of close relationships. This confirms the need to include enquiries about the presence of close relationships and depression as part of any suicide risk assessment.     

Suicidal ideation in Hispanic and mixed-ancestry adolescents.

This survey examined differences in suicidal ideation, depressive symptomatology, acculturation, and coping strategies based on ethnicity. The author gathered data from a self-report questionnaire administered to students in an ethnically diverse middle school (grades 6-8, N= 158). Hispanic (predominantly Mexican American) and mixed-ancestry adolescents displayed significantly higher risk of suicidal ideation compared to Anglo peers, even when socioeconomic status, age, and gender were controlled for. Suicidal ideation was associated with depressive symptoms, family problems, lower levels of acculturation, and various coping strategies. Using multivariate analysis, Hispanic ancestry, depressive symptoms, family problems, and the use of social coping remained in the model.