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Background: Therapeutic alliance and decreases in negative cognitions may play an important role in the outcomes of child trauma-focused cognitive behavioral therapy. However, understanding alliance from multiple perspectives (i.e., therapist, parent, and child) and if changes in negative cognitions differ by type of delivery is limited. Objective: The current study examined therapist, parent and child therapeutic alliance and child negative cognition changes over time and as potential mediators of outcomes between Step One, a parent-led therapist-assisted cognitive behavioral therapy (CBT), and therapist-led Trauma-Focused CBT (TF-CBT). Methods: Therapist, parent and child therapeutic alliance, child negative cognitions, child posttraumatic stress symptoms (PTSS) and impairment were assessed at the first session, mid-treatment and near the end of treatment among child-parent dyads in Step One (n = 43) and TF-CBT (n = 71). Child PTSS and impairment were also assessed at post-treatment. Results: The rate of change in therapist and parent therapeutic alliance within Step One and TF-CBT did not significantly differ. Changes over time in child alliance ratings differed with a convex curve for Step One and a concave curve for TF-CBT children. Similar decreases in negative cognitions in Step One and TF-CBT children occurred. Neither therapeutic alliance (therapist, parent, and child) nor negative cognitions were mediators of PTSS and impairment outcomes. Therapist therapeutic alliance over time, across treatments was a predictor of child PTSS. Conclusions: Change rates in child therapeutic alliance differs with a parent-led therapist-assisted treatment versus TF-CBT. Therapist alliance may influence child PTSS outcomes in a parent-led and therapist-led CBT treatment. Clinical Trial Registration Information: Stepped Care for Children after Trauma: Optimizing Treatment: https://clinicaltrials.gov: NCT02537678. [ABSTRACT FROM AUTHOR]

Purpose: Adolescent suicide ideation (SI) often portends more grievous suicidal behavior; yet, long-term studies of what risk factors predict SI are limited. We employ a multi-wave longitudinal design to investigate the impact of earlier social contexts on change in SI.Method: A community sample of 748 youths drawn from the Children in the Community (CIC) study was first assessed with the CIC Youth SI Scale at mean age 13.7 (range 9-18) (baseline) and in two follow-ups over 10 years. GEE Poisson Regression was used to estimate SI between ages 10 and 25 (intercept set at age midpoint of 17), and to examine associations between baseline measures of parent, peer, and school social contexts and subsequent change in SI. Analyses were controlled for demographic characteristics and known risks for SI: sexual or physical abuse before age 18 (obtained by official reports) and major depressive disorder (MDD, diagnosed by psychiatric interview at baseline and follow-ups).Results: SI declined significantly by age 17 with greater mother affection (β = - 0.091, SE = 0.037), peer friendship quality (β = - 0.115, SE = 0.034), peer social support (β = - 0.116, SE = 0.042), and school engagement (β = - 0.083, SE = 0.045, trend), but increased significantly with more parent punishment (β = 0.143, SE = 0.045) and school conflict (β = 0.168, SE = 0.042). SI associations with sexual or physical abuse (β = 0.299, SE = 0.137) and MDD (β = 0.777, SE = 0.130) were independent of other effects.Conclusions: Earlier social contexts influence change in SI independent of each other and of known risks for SI in community youths, and may be a resource for intervention efforts to deter future SI. [ABSTRACT FROM AUTHOR]

Purpose: Flexible fiber-optic bronchoscope-guided orotracheal intubation is a valuable technique with demonstrated benefits in the management of difficult airways. Despite its popularity with anesthesia providers, the technique is not fail-safe and airway-related complications secondary to failed intubation attempts remain an important problem. We sought to determine the effect of incorporating lingual traction on the success rate of fiber-optic bronchoscope-guided intubation in patients with anticipated difficult airways. Methods: In this prospective, randomized, cohort study, we enrolled 91 adult patients with anticipated difficult airways scheduled for elective surgery to undergo fiber-optic bronchoscope-guided orotracheal intubation alone or with lingual traction by an individual anesthesiologist after induction of general anesthesia and neuromuscular blockade. A total of 78 patients were randomized: 39 patients to the fiber-optic bronchoscope-guided intubation with lingual traction group and 39 patients to the fiber-optic bronchoscope-guided intubation alone group. The primary endpoint was the rate of successful first attempt intubations. The secondary outcome was sore throat grade on post-operative day 1. Results: Fiber-optic intubation with lingual traction compared to fiber-optic intubation alone resulted in a higher success rate (92.3 vs. 74.4 %, χ = 4.523, p = 0.033) and greater odds for successful first attempt intubation (OR 4.138, 95 % CI 1.041-16.444, p = 0.044). Sore throat severity on post-operative day 1 was not significantly different but trended towards worsening grades with lingual traction. Conclusions: In this study, lingual traction was shown to be a valuable maneuver for facilitating fiber-optic bronchoscope-guided intubation in the management of patients with anticipated difficult airways. [ABSTRACT FROM AUTHOR]

Purpose: To examine whether religiosity may help people ward off depression, we investigated the association between religious service attendance and depressive symptom scores in a community-based 30-year follow-up longitudinal study. Methods: This study used data on 754 subjects followed over 30 years and evaluated at four time points. Linear mixed effects models were used to assess the association between religious service attendance and depressive symptoms development; frequency of attendance and age also were used as predictors. Demographic factors, life-time trauma, family socioeconomic status, and recent negative events were considered as control variables. Results: Depressive symptom scores were reduced by an average of 0.518 units (95 % CI from −0.855 to −0.180, p < 0.005) each year in subjects who attended religious services as compared with subjects who did not. The more frequent the religious service attendance, the stronger the influence on depressive symptoms when compared with non-attendance. Yearly, monthly, and weekly religious service attendance reduced depression scores by 0.474 (95 % CI from −0.841 to −0.106, p < 0.01), 0.495 (95 % CI from −0.933 to −0.057, p < 0.05) and 0.634 (95 % CI from −1.056 to −0.212, p < 0.005) units on average, respectively, when compared with non-attendance after controlling for other covariates. Conclusion: Religious service attendance may reduce depressive symptoms significantly, with more frequent attendance having an increasingly greater impact on symptom reduction in this 30-year community-based longitudinal study. [ABSTRACT FROM AUTHOR]

Previous research is inconsistent about the effects of prenatal famine exposure on risk of adult hypertension. Follow-up of persons exposed to the 1959-1961 Chinese famine, the largest in human history, provides an opportunity to examine the long-term impact of prenatal famine exposure on adult cardiovascular disease (CVD). We investigated the effects of fetal-infant exposure to the famine on risk of hypertension in adulthood. We included 1,415 participants from the 2009 China Health and Nutrition Survey born September 1, 1956-December 31, 1964. Blood pressure (BP) measurements, self-reported previous diagnosis of hypertension and current anti-hypertension drug use were obtained from the survey. Differences in mean BP and risk of adult hypertension by famine exposure status were determined using linear and logistic regression analyses, after adjusting for confounders. Women with fetal-infant exposure to famine had higher mean systolic blood pressure (4.24 mmHg; 95 % confidence interval (CI) 1.50-6.98) than those unexposed. They also had increased odds of a prior diagnosis of hypertension (odds ratio (OR) 2.16; 95 % CI 1.16-4.02), and were more likely to be currently taking anti-hypertensive medications (OR 2.81; 95 % CI 1.32-5.97) than unexposed women after adjusting for covariates. No statistically significant increases in mean BP or hypertension were seen among men. Exposure to famine during the fetal-infant period or early childhood has deleterious effects on adult health, but the effects may be greater for women. Gender-specific intervention strategies for CVD may be warranted for populations exposed to under-nutrition during critical time periods of fetal development. [ABSTRACT FROM AUTHOR]

Past research on idioms of distress among U.S. Latinos has revealed that ataque de nervios and altered perceptions, such as hearing and seeing things when alone, are independent markers of higher morbidity and mental health utilization despite having no one-to-one relationships with any single psychiatric diagnosis. It has been proposed that the idioms exert this effect because they are signs of distressing dissociative capacity associated with traumatic exposure. This study examines the relationships in an ethnically diverse Latino psychiatric outpatient sample ( N = 230) among interpersonal trauma, posttraumatic stress disorder (PTSD), major depressive disorder, dissociative capacity and four cultural idioms of distress associated with the popular overall category of nervios. We particularly explore how these relationships change with varied measures of traumatic exposure, including trauma severity and timing or persistence of trauma. A series of adjusted bivariate regressions assessed the matrix of associations between the idioms and the clinical variables. In this highly traumatized population, we identified a strong ‘nexus’ of associations between dissociation and three of the idioms: currently being ill with nerves, ataque de nervios and altered perceptions. These idioms were largely independent from PTSD and depression and were associated with trauma persistence and severity. A fourth idiom, being nervous since childhood, was not associated with any other variable and may represent a personality trait rather than a diagnosable condition. Our results validate the clinical utility of the construct of nervios as a set of specific idioms associated with dissociation that are useful markers of mental health need among Latinos independently of their association with clinical diagnoses. [ABSTRACT FROM AUTHOR]

To investigate normative patterns of peer relationships from ages 17 to 27, and to examine the impact of adolescent psychiatric disorders on peer relationships. Psychiatric disorders were measured at a mean age 16 years. At mean age 29, 200 participants completed detailed narrative interviews about their transition to adulthood. Monthly contact and conflict with peers were described in narratives covering ages 17–27. Adolescent psychiatric disorders did not predict the frequency of peer contact in the young adult period. However, adolescent disruptive disorders predicted greater peer conflict regardless of contact frequency. Adolescents with major depressive or substance abuse disorders and subsequent high frequency of peer contact reported elevated peer conflict during the transition to adulthood. In contrast, among study participants with frequent peer contact during this period, those with adolescent anxiety disorders reported less peer conflict than did those without such a diagnostic history. Adolescents with major depressive, disruptive, and substance abuse disorders may be at risk for long-term negative peer relationships, whereas those with anxiety disorders may subsequently avoid peer conflict. [ABSTRACT FROM AUTHOR]

We investigated age-based changes in mothers’ complaints about offspring behavioral opposition, and offspring reports of opposition in a prospective longitudinal design ( N = 821). Maternal complaints declined from pre-adolescence to early adulthood, but more slowly in low socioeconomic status (SES) and single-parent families. Mothers complained more about first- than later-born children, but showed no average differences for offspring gender, race, SES, or single parent status. Complaints covaried with youth-reported opposition, but effects involving SES, single-parent status, and birth order remained significant after opposition was controlled; this finding is interpreted to reflect social contextual differences in maternal beliefs. Youth opposition was stable to age 16, then decreased; higher levels were associated with earlier birth order and low SES among European-Americans. Our results have implications for parenting interventions, indicating that parents may benefit from education about the normative, gradual increase in concordance between their own expectations and their child’s behavior from early to late adolescence. Further, parenting interventions may be strengthened by actively attending to social contextual factors that shape parental belief systems and values. [ABSTRACT FROM AUTHOR]

Emerging adulthood is a period in which profound role changes take place across a number of life domains including finance, romance, and residence. On the basis of dynamic systems theory, change in one domain should be related to change in another domain, because the concept of development according to this approach is a relational one. To evaluate this hypothesis dynamic systems analysis was applied to data from narrative interviews of 200 respondents covering the years between 17 and 27 to examine how change in one domain affects change in another domain. In each dyad, the fit of the model significantly deteriorated when the coupling between domains was removed providing support for the assumption of interdependency. On average, assuming greater responsibility in one domain was associated with assuming greater responsibility in the other domain. However, imbalances were also observed in which role assumption in one domain far exceeded role assumption in another domain. These imbalances can have detrimental effects and indicate the utility of a balanced approach to development. The findings underscore the importance of studying the relational unit between domains, which is critical to understanding development over time within domains. [ABSTRACT FROM AUTHOR]

Background: The most recent wave of interviews in a longitudinal study spanned the terrorist attacks of September 11, 2001. This unintended "natural experiment" allows examination of effects of traumatic events in ways impossible in studies conducted solely after the event and in populations not previously studied.Methods: Participants were 610 members of the randomly selected Children in the Community cohort studied longitudinally for over 25 years and between ages 27 and 38 at the time of the current in-home interviews. Symptoms of generalized anxiety, post-traumatic stress disorder, panic disorder, agoraphobia, dissociation, and depression were assessed with an adaptation of the Structured Clinical Interview for Diagnosis. Changes in self-reported symptoms from an assessment 10 years earlier were related to the date of interview between 7/2001 and 12/2003 by polynomial regression methods, including demographic and design controls. Diagnoses based on clinical follow-up were also examined.Results: In contrast to other data on this cohort where timing effects were absent, levels of symptoms were related to time of interview. The months following 9/11/2001 and the two anniversary periods in 2002 and 2003 showed significant elevation in anxiety symptoms (t = 2.50, df = 608, P = 0.013) with some evidence of elevated anxiety disorder as well (Fisher's exact test P = 0.096). Similar patterns were seen for specific anxiety and depressive symptom groups. Effects of religious participation, patriotism, having offspring, and media exposure on anxiety symptoms tended to differ by season, but the effect of community involvement did not. Proximity to New York City was not significantly related to symptoms.Conclusions: Study findings suggest that young Americans showed symptomatic and, possibly, diagnostic anxiety reactions to the events of 9/11 that persisted in response to heightened awareness of ongoing threat during anniversary periods. [ABSTRACT FROM AUTHOR]

Background: Rising depression rates in more recent cohorts of women have been attributed in part to their increased participation in dual family and work roles.Method: This study examined associations among depressive symptoms, age, and work and marital status in two cohorts of women, all mothers, born between 1931 and 1944 (preboomers) or between 1945 and 1958 (baby boomers), assessed at comparable ages.Results: Being married (vs. divorced) was related to less depression within and across cohorts, whereas working was related to more depression in preboomers only. Moreover, divorced working preboomers were significantly more depressed than women in most other role status groups within and across cohorts. Depression scores declined across age among working women in the combined cohorts; however, that association held only for baby boomers when cohorts were analyzed separately. Among divorced working women, that decline was significantly greater in baby boomers than preboomers.Conclusions: These cohort differences support a call for new social policies that address the mental health needs of women and their children. [ABSTRACT FROM AUTHOR]

Assessment of quality of life (QOL) in young adults has become an increasingly important field of research as information on the QOL of children and adults accumulates. The purpose of this study is to report on the development of the Young Adult Quality Of Life (YAQOL) instrument, a measure of QOL for young adults aged 18-25. The YAQOL, which is comprised of 14 multi-item scales that assess physical health and aspects of psychological well-being, social relationships, role function, and environmental context, was administered to a general population sample of 751 young adults. Scale structure was confirmed by item-internal consistency, item discriminant validity, and inter-scale correlations. Reliability coefficients ranged from 0.88 to 0.63 across scales (mean = 0.73). Eight YAQOL scales discriminated clearly between young adults with and without chronic physical conditions, 12 scales discriminated between young adults with and without personality disorder, and negative associations were demonstrated between YAQOL scale scores and psychiatric disorder symptoms. Demographic differences in the YAQOL scales were consistent with theoretical expectations and previous empirical work. Overall, findings support the reliability and utility of the YAQOL as a measure of QOL in young adults in the general population. Additional psychometric properties will continue to be evaluated as more data become available. [ABSTRACT FROM AUTHOR]

This article focuses on the multilevel analyses for predicting sequence effects of financial and employment problems on the probability of arrest. The narrative in this study covers five domains of the person's life--residence, financial support, career, romantic relationships, and family formation. The interview begins with establishing the dwelling setting and behavior of the respondent within that setting with regard to concrete aspects including other occupants, routine chores, and responsibilities for household tasks. We have found that having the respondent describe and date changes over the study period one domain at a time usually works best. It also allows the interviewer to check the various dates of change in one domain against dates provided for other domains to make sure that they are consistent. Often these checks help the respondent to sort out uncertainties about the dates. In this study the researches dated changes in study variables only to the month in which they occurred. When there were multiple changes within a month the coders attributed the changes to multiple months, making sure to retain the sequence indicted by the respondent.