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Objective: Adverse childhood experiences (ACEs) and lifetime traumatic events are closely linked to development of comorbid psychiatric symptoms and substance use. Although research shows the risk for psychiatric and substance use comorbidity conferred by early adversity, most studies have not modeled multivariate symptom patterns that include posttraumatic stress disorder (PTSD) symptom criteria (i.e., re-experiencing, effortful avoidance, numbing, and hyperarousal). The aim of the present study was to model multivariate patterns of substance use and psychiatric symptoms, including PTSD criteria, and examine associations between these patterns and early adversity. Method: Latent profile analysis (LPA) was used in a large, nonclinical sample of community adults (N = 1,431). Relations between profile membership, cumulative ACEs, and demographic covariates were then evaluated. Results: Results indicated four distinct profiles of psychiatric symptom comorbidity (PSC): (a) PTSD dominant with elevated illicit drug and cannabis use; (b) anxiety and depression dominant with elevated use across substances; (c) avoidance dominant with low severity of all other psychiatric symptoms and substance use; and (d) psychiatrically healthy. Analyses identified significant associations between profile membership and cumulative ACEs and other traumatic events. Cumulative ACEs and traumatic events were highest among the PTSD dominant profile. Conclusions: A greater understanding of heterogeneous patterns of PSC may allow for future development of treatment care paths that correspond to standard criteria of symptom presentation and severity. [ABSTRACT FROM AUTHOR]

Background: Self-injurious thoughts and behaviors (SITBs) are increasing dramatically among children and adolescents. Crisis support is intended to provide immediate mental health care, risk mitigation, and intervention for those experiencing SITBs and acute mental health distress. Digital mental health interventions (DMHIs) have emerged as accessible and effective alternatives to in-person care; however, most do not provide crisis support or ongoing care for children and adolescents with SITBs., Objective: To inform the development of digital crisis support and mental health care for children and adolescents presenting with SITBs, this study aims to (1) characterize children and adolescents with SITBs who participate in a digital crisis response service, (2) compare anxiety and depressive symptoms of children and adolescents presenting with SITBs versus those without SITBs throughout care, and (3) suggest future steps for the implementation of digital crisis support and mental health care for children and adolescents presenting with SITBs., Methods: This retrospective study was conducted using data from children and adolescents (aged 1-17 y; N=2161) involved in a pediatric collaborative care DMHI. SITB prevalence was assessed during each live session. For children and adolescents who exhibited SITBs during live sessions, a rapid crisis support team provided evidence-based crisis support services. Assessments were completed approximately once a month to measure anxiety and depressive symptom severity. Demographics, mental health symptoms, and change in the mental health symptoms of children and adolescents presenting with SITBs (group with SITBs) were compared to those of children and adolescents with no SITBs (group without SITBs)., Results: Compared to the group without SITBs (1977/2161, 91.49%), the group with SITBs (184/2161, 8.51%) was mostly made up of adolescents (107/184, 58.2%) and female children and adolescents (118/184, 64.1%). At baseline, compared to the group without SITBs, the group with SITBs had more severe anxiety and depressive symptoms. From before to after mental health care with the DMHI, the 2 groups did not differ in the rate of children and adolescents with anxiety symptom improvement (group with SITBs: 54/70, 77% vs group without SITBs: 367/440, 83.4%; χ 2 1 =1.2; P=.32) as well as depressive symptom improvement (group with SITBs: 58/72, 81% vs group without SITBs: 255/313, 81.5%; χ 2 1 =0; P=.99). The 2 groups also did not differ in the amount of change in symptom severity during care with the DMHI for anxiety (t 80.20 =1.37; P=.28) and depressive (t 83.75 =-0.08; P=.99) symptoms., Conclusions: This study demonstrates that participation in a collaborative care DMHI is associated with improved mental health outcomes in children and adolescents experiencing SITBs. These results provide preliminary insights for the use of pediatric DMHIs in crisis support and mental health care for children and adolescents presenting with SITBs, thereby addressing the public health issue of acute mental health crisis in children and adolescents., (©Darian Lawrence-Sidebottom, Landry Goodgame Huffman, Aislinn Brenna Beam, Kelsey McAlister, Rachael Guerra, Amit Parikh, Monika Roots, Jennifer Huberty. Originally published in JMIR Formative Research (https://formative.jmir.org), 16.08.2024.)

Background: More than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths., Objective: This study aims to use retrospective data from youths participating in a DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non-posttraumatic DMHI is linked to reductions in PTS symptoms., Methods: This study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children's trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments., Results: Among eligible participants (n=966), 30.2% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73% (n=87) exhibited elevated anxiety symptoms and 50% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F 2,287 =26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96% (n=79) of participants showing symptom reductions., Conclusions: This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment., (©Darian Lawrence-Sidebottom, Landry Goodgame Huffman, Aislinn Brenna Beam, Rachael Guerra, Amit Parikh, Monika Roots, Jennifer Huberty. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org), 27.02.2024.)

Background: Rates of anxiety and depression have been increasing among children and adolescents for the past decade; however, many young people do not receive adequate mental health care. Digital mental health interventions (DMHIs) that include web-based behavioral health coaching are widely accessible and can confer significant improvements in youth anxiety and depressive symptoms. However, more research is necessary to determine the number of web-based coaching sessions that confer clinically significant improvements in anxiety and depressive symptoms in youth., Objective: This study uses data from a pediatric DMHI to explore the number of web-based coaching sessions required to confer symptom improvements among children and adolescents with moderate or moderately severe symptoms of anxiety and depression., Methods: We used retrospective data from a pediatric DMHI that offered web-based behavioral health coaching in tandem with self-guided access to asynchronous chat with practitioners, digital mental health resources, and web-based mental health symptom assessments. Children and adolescents who engaged in 3 or more sessions of exclusive behavioral health coaching for moderate to moderately severe symptoms of anxiety (n=66) and depression (n=59) were included in the analyses. Analyses explored whether participants showed reliable change (a decrease in symptom scores that exceeds a clinically established threshold) and stable reliable change (at least 2 successive assessments of reliable change). Kaplan-Meier survival analyses were performed to determine the median number of coaching sessions when the first reliable change and stable reliable change occurred for anxiety and depressive symptoms., Results: Reliable change in anxiety symptoms was observed after a median of 2 (95% CI 2-3) sessions, and stable reliable change in anxiety symptoms was observed after a median of 6 (95% CI 5-8) sessions. A reliable change in depressive symptoms was observed after a median of 2 (95% CI 1-3) sessions, and a stable reliable change in depressive symptoms was observed after a median of 6 (95% CI 5-7) sessions. Children improved 1-2 sessions earlier than adolescents., Conclusions: Findings from this study will inform caregivers and youth seeking mental health care by characterizing the typical time frame in which current participants show improvements in symptoms. Moreover, by suggesting that meaningful symptom improvement can occur within a relatively short time frame, these results bolster the growing body of research that indicates web-based behavioral health coaching is an effective form of mental health care for young people., (©Darian Lawrence-Sidebottom, Landry Goodgame Huffman, Aislinn Beam, Rachael Guerra, Amit Parikh, Monika Roots, Jennifer Huberty. Originally published in JMIR Formative Research (https://formative.jmir.org), 18.12.2023.)

Objective: Posttraumatic stress disorder (PTSD) has been associated with heightened impulsivity and risk-taking behaviors, including higher rates of substance use than individuals without PTSD. Although a number of studies suggest that impulsivity is associated with substance use in PTSD, the specific role of impulsivity in this common pattern of comorbidity remains unclear. The current study investigated associations between PTSD symptoms, substance use patterns, and impulsivity in a sample of adults., Method: A total of 2,967 participants were recruited online through Amazon's Mechanical Turk. Participants who did not report at least one Criterion A traumatic event on the Brief Trauma Questionnaire were excluded. The remaining 1,609 trauma-exposed individuals were placed into either the probable PTSD group (n = 406) or the trauma-exposed non-PTSD group (n = 1,203) based on their PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PCL-5) score. Impulsivity was assessed via a delay discounting measure and the brief UPPS-P (urgency, premeditation, perseverance, sensation seeking, and positive urgency) Impulsive Behavior Scale. Alcohol and cannabis were assessed using the Alcohol Use Disorders Identification Test (AUDIT) and Cannabis Use Disorders Identification Test (CUDIT-R) scales, respectively., Results: Probable PTSD participants exhibited steeper (more impulsive) delay discounting and endorsed more impulsive traits than participants in the trauma-exposed non-PTSD group. Moreover, the PTSD group reported significantly higher scores on both the AUDIT and CUDIT-R. Lastly, impulsive personality traits on the UPPS-P partially mediated the association between PTSD and both cannabis and alcohol use., Conclusions: These findings suggest that trauma-exposed individuals who exhibit elevated PTSD symptoms show heightened impulsivity. It also appears that lower levels of impulsivity may serve as a protective factor among trauma-exposed individuals resilient to the development of PTSD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).