096 The Association Between Sleep Regularity Index and Self-Reported Behavioral and Emotional Symptoms in Adolescents

Abstract Introduction Among adolescents, sleep health has been associated with emotional and mood regulation, cognitive functioning, and behavior. Few studies, however, have examined the Sleep Regularity Index (SRI, Phillips et. al, 2017) and its associations with mental health and well-being in this age group. For this study, we examined whether SRI in 15-16-year-old adolescents would predict internalizing and externalizing symptoms as measured by Youth Self-Report (YSR) scores two years later. We hypothesized that a higher baseline sleep regularity would predict lower internalizing and externalizing YSR scores at the 2-year follow-up. Methods The sample included 32 adolescents (14 male) ages 15-16yr (mean = 15.6) at baseline and 2 years later (mean age = 17.7). Actigraphy data and YSR scores were collected at baseline, and YSR was examined at follow-up. Participant’s SRIs were calculated using 24-hour actigraphy data scored for sleep and wake. YSR T-scores of 60 or above indicate borderline clinical internalizing (n = 2) and externalizing (n = 4) symptoms at follow-up. We used linear regression modeling to determine whether baseline SRI predicted YSR scores 2 years later. Covariates included sleep start time, sleep duration, sex, and baseline YSR scores. Results At baseline, average SRI and YSR scores were not significantly correlated (internalizing: r = 0.10; externalizing: r = 0.24, p’s > 0.1). SRI score at baseline (mean = 80.5 ± 7.4) significantly predicted YSR internalizing scores (mean = 42 ± 9) at the 2-year follow up (t(26) = 2.57, p = 0.016) but not externalizing scores (mean = 44.8 ± 10.3, t(26) = .78, p = 0.44). Conclusion We observed that sleep regularity was associated with internalizing symptoms two years later; however, the association was not in the expected direction: higher SRI was correlated with increased YSR internalizing scores at the 2-year follow-up. As most participants were in a healthy range for YSR scores at both assessments, a possible explanation for this finding is that those with higher SRIs have greater self-awareness in assessing their internal feelings. Future work will examine SRI values and YSR in this sample across 6 assessments acquired at 6-month intervals. Support (if any) AA13252 (NIH)

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Exposure to Bullying and General Psychopathology: A Prospective, Longitudinal Study

Research on Child and Adolescent Psychopathology ◽

10.1007/s10802-020-00760-2 ◽

2021 ◽

Author(s):

Jolien Rijlaarsdam ◽

Charlotte A. M. Cecil ◽

J. Marieke Buil ◽

Pol A. C. van Lier ◽

Edward D. Barker

Keyword(s):

Longitudinal Study ◽

Child Psychopathology ◽

Well Being ◽

Self Report ◽

General Factor ◽

Prospective Longitudinal Study ◽

General Psychopathology ◽

Parents And Children ◽

Prospective Longitudinal ◽

Internalizing And Externalizing

AbstractAlthough there is mounting evidence that the experience of being bullied associates with both internalizing and externalizing symptoms, it is not known yet whether the identified associations are specific to these symptoms, or shared between them. The primary focus of this study is to assess the prospective associations of bullying exposure with both general and specific (i.e., internalizing, externalizing) factors of psychopathology. This study included data from 6,210 children participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). Child bullying was measured by self-report at ages 8 and 10 years. Child psychopathology symptoms were assessed by parent-interview, using the Development and Well-being Assessment (DAWBA) at ages 7 and 13 years. Bullying exposure significantly associated with the general psychopathology factor in early adolescence. In particular, chronically victimized youth exposed to multiple forms of bullying (i.e., both overt and relational) showed higher levels of general psychopathology. Bullying exposure also associated with both internalizing and externalizing factors from the correlated-factors model. However, the effect estimates for these factors decreased considerably in size and dropped to insignificant for the internalizing factor after extracting the shared variance that belongs to the general factor of psychopathology. Using an integrative longitudinal model, we found that higher levels of general psychopathology at age 7 also associated with bullying exposure at age 8 which, in turn, associated with general psychopathology at age 13 through its two-year continuity. Findings suggest that exposure to bullying is a risk factor for a more general vulnerability to psychopathology.

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As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

Frontiers in Neurology ◽

10.3389/fneur.2021.687740 ◽

2021 ◽

Vol 12 ◽

Author(s):

Linda Ewing-Cobbs ◽

Janelle J. Montroy ◽

Amy E. Clark ◽

Richard Holubkov ◽

Charles S. Cox ◽

...

Keyword(s):

Behavior Problems ◽

Conduct Problems ◽

Behavioral Problems ◽

Externalizing Behavior ◽

Executive Dysfunction ◽

Emotional Symptoms ◽

Factors Associated ◽

Severe Tbi ◽

Internalizing And Externalizing

Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes.Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from pre-injury to 12 months and from 12 to 36 months in children ages 4–15 years with mild to severe TBI relative to children with OI. A structural equation model framework incorporated injury characteristics, child demographic variables, as well as pre-injury child reserve and family attributes. Internalizing and externalizing behavior problems were indexed using the parent-rated Emotional Symptoms and Conduct Problems scales from the Strengths and Difficulties questionnaire.Results: The analysis cohort of 534 children [64% boys, M (SD) 8.8 (4.3) years of age] included 395 with mild to severe TBI and 139 with OI. Behavior ratings were higher after TBI than OI but did not differ by TBI severity. TBI, higher pre-injury executive dysfunction, and lower income predicted the level and trajectory of both Emotional Symptoms and Conduct Problems at 12 months. Female sex and poorer family functioning were vulnerability factors associated with greater increase and change in Emotional Symptoms by 12 months after injury; unique predictors of Conduct Problems included younger age and prior emotional/behavioral problems. Across the long-term follow-up from 12 to 36 months, Emotional Symptoms increased significantly and Conduct Problems stabilized. TBI was not a significant predictor of change during the chronic stage of recovery.Conclusions: After TBI, Emotional Symptoms and Conduct Problem scores were elevated, had different trajectories of change, increased or stayed elevated from 12 to 36 months after TBI, and did not return to pre-injury levels across the 3 year follow-up. These findings highlight the importance of addressing behavioral problems after TBI across an extended time frame.

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Personality traits and combat exposure as predictors of psychopathology over time

Psychological Medicine ◽

10.1017/s0033291715001798 ◽

2015 ◽

Vol 46 (1) ◽

pp. 209-220 ◽

Cited By ~ 11

Author(s):

E. Koffel ◽

M. D. Kramer ◽

P. A. Arbisi ◽

C. R. Erbes ◽

M. Kaler ◽

...

Keyword(s):

Personality Traits ◽

Indirect Effects ◽

Internalizing Symptoms ◽

Externalizing Symptoms ◽

Combat Exposure ◽

Self Report ◽

Equation Modeling ◽

Direct And Indirect Effects ◽

Internalizing And Externalizing ◽

Internalizing And Externalizing Symptoms

Background.Research suggests that personality traits have both direct and indirect effects on the development of psychological symptoms, with indirect effects mediated by stressful or traumatic events. This study models the direct influence of personality traits on residualized changes in internalizing and externalizing symptoms following a stressful and potentially traumatic deployment, as well as the indirect influence of personality on symptom levels mediated by combat exposure.Method.We utilized structural equation modeling with a longitudinal prospective study of 522 US National Guard soldiers deployed to Iraq. Analyses were based on self-report measures of personality, combat exposure, and internalizing and externalizing symptoms.Results.Both pre-deployment Disconstraint and externalizing symptoms predicted combat exposure, which in turn predicted internalizing and externalizing symptoms. There was a significant indirect effect for pre-deployment externalizing symptoms on post-deployment externalizing via combat exposure (p< 0.01). Negative Emotionality and pre-deployment internalizing symptoms directly predicted post-deployment internalizing symptoms, but both were unrelated to combat exposure. No direct effects of personality on residualized changes in externalizing symptoms were found.Conclusions.Baseline symptom dimensions had significant direct and indirect effects on post-deployment symptoms. Controlling for both pre-exposure personality and symptoms, combat experiences remained positively related to both internalizing and externalizing symptoms. Implications for diagnostic classification are discussed.

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Embedding palliative care into bone marrow transplantation clinic.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.157 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 157-157 ◽

Cited By ~ 1

Author(s):

Danielle M Noreika ◽

Brian Cassel ◽

Felicia Noland ◽

Egidio Del Fabbro

Keyword(s):

Bone Marrow ◽

Palliative Care ◽

Bone Marrow Transplantation ◽

Marrow Transplantation ◽

Intensive Therapy ◽

Well Being ◽

Initial Assessment ◽

Emotional Symptoms ◽

Goals Of Care

157 Background: Stem cell/bone marrow transplantation (SC/BMT) is intensive therapy that creates the potential for a number of physical and emotional symptoms. Despite the symptom burden and support needs of these patients there are no publications describing palliative care involvement in the course of treatment. Methods: Retrospective chart review was performed on 37 patients followed over a 6-month period by a palliative care service embedded within the SC/BMT clinic. Results: 37 patients were referred by SC/BMT clinic physicians or nurses to a palliative care team embedded within the clinic (including a physician, physical therapist, and psychologist). Almost all patients were referred for symptom management rather than goals of care; only three (9%) died during the review period and for none of them was the reason for consultation goals of care/hospice referral. Patients were seen between once and eight times during the six month period by various members of the team. Most (77%) were allogenic transplant patients and most were seen within 6 months of their transplantation. The most common reasons for referral were fatigue (57%), anorexia (27%), pain (38%) and depression and/or anxiety (35%). At initial assessment the highest-rated symptoms were lack of appetite (mean 4.78, SD 3.08), fatigue (4.51 [2.59]), and diminished feeling of well-being (4.16, [2.51]). At initial assessment, 73% of patients had 3 or more different symptoms that they rated at 4+; this dropped to 39.1% at follow-up (n = 23). Of the 9 symptoms assessed at both initial and follow-up visits, 7 decreased significantly (all but fatigue and dyspnea) and none increased. For example appetite improved from 5.52 (2.98) to 3.13 (2.96); pain improved from 3.52 (2.92) to 1.78 (1.88) (n = 23, p < .01). SC/BMT providers requested an expansion of the service after three months of experience. Conclusions: Patients who have undergone SC/BMT experience many physical and emotional symptoms. Palliative care embedded within the bone marrow transplant clinic can provide benefit by lessening the symptomatic burden of patients.

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Associations Between Physical Fitness and Children’s Psychological Well-Being

Journal of Clinical Sport Psychology ◽

10.1123/jcsp.2014-0053 ◽

2016 ◽

Vol 10 (1) ◽

pp. 32-47 ◽

Cited By ~ 7

Author(s):

Timothy LaVigne ◽

Betsy Hoza ◽

Alan L. Smith ◽

Erin K. Shoulberg ◽

William Bukowski

Keyword(s):

Depressive Symptoms ◽

Physical Fitness ◽

Internalizing Symptoms ◽

Adaptive Functioning ◽

Well Being ◽

Self Report ◽

Psychological Well Being ◽

Athletic Competence ◽

Self Worth ◽

Teacher Reports

We examined the relation between physical fitness and psychological well-being in children ages 10–14 years (N = 222), and the potential moderation of this relation by sex. Participants completed a physical fitness assessment comprised of seven tasks and a diverse set of self-report well-being measures assessing depressive symptoms, loneliness, and competence. Peers reported on social status and teachers rated adaptive functioning, internalizing symptoms, and externalizing symptoms. Multiple regression analyses indicated a significant association between physical fitness and psychological well-being for both boys and girls. Higher levels of physical fitness were associated with lower levels of peer dyadic loneliness and fewer depressive symptoms; greater cognitive, social, and athletic competence; greater feelings of self-worth; and better teacher reports of adaptive functioning. An interaction between internalizing and sex indicated a significant and negative association between physical fitness and internalizing symptoms for males only. No other moderation effects by sex were observed. Results suggest that physical fitness is associated with a range of well-being indicators for both boys and girls in this age group.

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Promoting treatment access following pediatric primary care depression screening: Randomized trial of web-based, single-session interventions for parents and youths

10.31219/osf.io/c639z ◽

2019 ◽

Cited By ~ 1

Author(s):

Jessica L. Schleider ◽

Mallory Dobias ◽

Susmita Pati

Keyword(s):

Mental Health ◽

Mental Health Treatment ◽

Internalizing Symptoms ◽

Low Cost ◽

Youth Mental Health ◽

Self Report ◽

Treatment Seeking ◽

Service Access ◽

Will Self

INTRODUCTION SUMMARY. Major depression in youth is a serious psychiatric illness with extensive acute and chronic morbidity and mortality. In 2018, the American Academy of Pediatrics released updated practice guidelines promoting screening of youth depression in primary care (PC) clinics across the country, representing a critical step towards increasing early depression detection. However, the challenge of bridging screening with service access remains. Even when diagnosed by PC providers, <50% of youth with elevated depressive symptoms access treatment of any kind. Thus, there is a need for interventions that are more feasible for youths and parents to access and complete—and that may strengthen parents’ likelihood of pursuing future, longer-term services for their child.Single-session interventions (SSIs) may offer a promising path toward these goals. SSIs include core elements of comprehensive, evidence-based treatments, but their brevity makes them easier to disseminate beyond traditional clinical settings. Indeed, SSIs can successfully treat youth psychopathology: In a meta-analysis of 50 randomized controlled trials, SSIs reduced youth mental health difficulties of multiple types (mean g=0.32). To date, one SSI has been shown to reduce youth depressive symptoms in multiple RCTs: the online “growth mindset” (GM) SSI, which teaches the belief that personal traits are malleable rather than fixed. As one example, a 30-minute GM-SSI led to significant 9-month MD symptom reductions in high-symptom youths ages 12-15 versus a supportive therapy control (N=96; ds=0.60, 0.32 per parent and youth reports). Thus, GM SSIs represents a scalable, evidence-based strategy for reducing youth depressive symptoms.GM-SSIs can also strengthen parent beliefs about the effectiveness of mental health treatment, which robustly predict whether youths ultimately access services. A recent RCT including 430 parents of youth ages 7-17 indicated that an online, 15-minute SSI teaching growth mindset of emotion (viewing emotions as malleable) significantly increased parents’ beliefs that psychotherapy could be effective, both for themselves (d=0.51) and their offspring (d=0.43), versus a psychoeducation control. By helping reverse parents’ low expectancies for treatment, this low-cost program may enhance parents’ odds of seeking services for children with mental health needs.Accordingly, this study will test whether empirically-supported GM-SSIs can help bridge the gap between PC-based depression screening and access to depression services for high-symptom youth. Youths reporting elevated internalizing symptoms at a PC visit will be randomly assigned to one of two conditions: Information, Psychoeducation, and Referral (IPR; i.e., usual care) or IPR enhanced with youth- and parent-directed online SSIs (IPR+SSI), designed to reduce youth internalizing symptoms and improve parents’ mental health treatment expectancies, respectively. We predict that (1) IPR+SSI will increase parents’ treatment-seeking behaviors, versus IPR alone, across 3-month follow-up; (2) IPR+SSI will reduce youth internalizing symptoms across 3-month follow-up versus IPR alone; (3) IPR+SSI will reduce parental stress and psychological distress across 3-month follow-up, versus IPR alone; (4) parents and youths will rate this service delivery model as acceptable.METHOD SUMMARY. Per youth-reported internalizing symptom elevations during a PC visit (score >=5 on the Pediatric Symptom Checklist internalizing subscale), eligible families (N=246; youth ages 11-16) will be invited to participate in the study. In online surveys, parents will self-report recent treatment-seeking behaviors, expectancies for psychotherapy, stress and psychological symptoms, and youth mental health problems, along with family and demographic information; youths will self-report symptom levels. Within the same survey, youths and parents will then be randomized (1:1 allocation ratio) to one of two experimental conditions (IPR+SSI or IPR alone); those assigned to IPR+SSI will complete an intervention feedback form immediately post-intervention. At 3-month follow-up, to assess SSI effects on parent treatment-seeking, parent stress and symptoms, and youth internalizing problems, participating youths and parents will complete the same questionnaires administered at baseline.SIGNIFICANCE. There is a need for novel, potent strategies to increase families’ access to youth mental health services following PC-based symptoms screening. Ideally, such strategies would be low-cost (e.g., those that do not require new staff); involve both parents and youths to address the myriad factors that may undermine service access; and impose minimal burdens on PC providers. Results will indicate whether one such strategy—providing online, low-cost SSIs to youths and parents—may help reduce youth internalizing symptoms and promote treatment-seeking in parents.

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Interactive Narrative Simulation as a Method for Preceptor Development

Pharmacy ◽

10.3390/pharmacy10010005 ◽

2021 ◽

Vol 10 (1) ◽

pp. 5

Author(s):

Charlene R. Williams ◽

Robert Hubal ◽

Michael D. Wolcott ◽

Abbey Kruse

Keyword(s):

Self Efficacy ◽

Well Being ◽

Cross Cultural ◽

Self Report ◽

Academic Learning ◽

Interactive Narrative ◽

Response Options ◽

Narrative Simulation ◽

Cultural Interactions

(1) Background: This proof-of-concept study assessed an interactive web-based tool simulating three challenging non-academic learning situations—student professionalism, cross-cultural interactions, and student well-being—as a means of preceptor development. (2) Methods: Three scripts focused on professionalism, cross-cultural interactions, and student well-being were developed and implemented using a commercial narrative tool with branching dialog. Delivered online, this tool presented each challenge to participants. Participants had up to four response options at each turn of the conversation; the choice of response influenced the subsequent conversation, including coaching provided at the resolution of the situation. Participants were invited to complete pre-activity, immediate post-activity, and one-month follow-up questionnaires to assess satisfaction, self-efficacy, engagement, and knowledge change with the tool. Knowledge was assessed through situational judgment tests (SJTs). (3) Results: Thirty-two pharmacist preceptors participated. The frequency of participants reflecting on challenging learning situations increased significantly one-month post-simulation. Participants affirmatively responded that the tool was time-efficient, represented similar challenges they encountered in precepting, was easily navigable, and resulted in learning. Self-efficacy with skills in managing challenging learning situations increased significantly immediately post-simulation and at a one-month follow-up. Knowledge as measured through SJTs was not significantly changed. (4) Conclusions: Preceptors found an interactive narrative simulation a relevant, time-efficient approach for preceptor development for challenging non-academic learning situations. Post-simulation, preceptors more frequently reflected on challenging learning situations, implying behavior change. Self-efficacy and self-report of knowledge increased. Future research is needed regarding knowledge assessments.

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Non-adherence to Immunosuppressant after Lung Transplantation – A Common Risk Behavior

The Open Nursing Journal ◽

10.2174/1874434601913010108 ◽

2019 ◽

Vol 13 (1) ◽

pp. 108-115 ◽

Cited By ~ 2

Author(s):

Lennerling Annette ◽

Kisch Annika ◽

Forsberg Anna

Keyword(s):

Lung Transplantation ◽

Immunosuppressive Treatment ◽

Graft Loss ◽

Symptom Burden ◽

Well Being ◽

Self Report ◽

Full Time ◽

Cross Sectional ◽

Immunosuppressive Medication

Background: After lung transplantation, life-long treatment with immunosuppressive medication is required to prevent rejection and graft loss but adherence to immunosuppressive treatment may be difficult for the lung recipient. Adherence is essential and non-adherence to immunosuppressive treatment can lead to graft loss and death. Objective: The aim of this cross-sectional study was to investigate the prevalence of non-adherence 1 to 5 years after lung transplantation in relation to symptom burden, health literacy, psychological well-being and relevant demographic variables. Methods: 117 adult lung recipients, due for their annual follow-up 1-5 years after lung transplantation, participated. Four self-report instruments were used for assessment: the Basel Assessment of Adherence with Immunosuppressive Medication Scale, the Newest Vital Sign, the Psychological General Well-Being and the Organ Transplant Symptom and Wellbeing Instrument. Statistical analysis was performed. Results: Thirty percent of the lung recipients were non-adherent. The most common non-adherence dimension was not taking a dose (43%) and not being punctual with the regimen (80%). Of those working full time or part time, 43% were non-adherent (p=.032). A higher level of non-adherence was reported a long time after LuTx with the highest level at the 3-year follow-up. Conclusion: The level of non-adherence among lung recipients was high. The highest levels were found among those who had returned to work. Non-adherence increased with time after lung transplantation.

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The Mental Health of Visitors of Web-Based Support Forums for Bereaved by Suicide

Crisis ◽

10.1027/0227-5910/a000281 ◽

2015 ◽

Vol 36 (1) ◽

pp. 38-45 ◽

Cited By ~ 17

Author(s):

Jeannet Kramer ◽

Brigitte Boon ◽

Marijke Schotanus-Dijkstra ◽

Wouter van Ballegooijen ◽

Ad Kerkhof ◽

...

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Repeated Measures ◽

Complicated Grief ◽

Well Being ◽

Self Report ◽

Online Support ◽

Mutual Support ◽

Web Based

Background: Persons bereaved by suicide are reluctant to ask for social support when they experience feelings of guilt and blame. A web-based peer forum may provide a safe and anonymous place for mutual support. Aims: This study examined the mental health changes of visitors of two online support forums for persons bereaved by suicide and their experiences with the forum over 1 year. Method: Visitors of two forums completed self-report measures at baseline and at 6 and 12 months' follow-up. Repeated measures analyses were used to study changes in well-being, depressive symptoms, and complicated grief. Additionally, participants were interviewed about their experiences with the forum. Results: The 270 participants were mostly female, low in well-being, with high levels of depressive symptoms and complicated grief. Suicidal risk was high for 5.9%. At 12 months, there were small to medium-sized significant improvements in well-being and depressive symptoms (p < .001) and nearly as much for grief (p = .08). About two thirds reported benefit from visiting the forum. Because of the pre–post design we cannot determine whether a causal relationship exists between the form and changes in mental health. Conclusion: After 1 year some positive changes but a large group was still struggling with their mental health. Interviews indicate that the forum was valued for finding recognition.

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Conceptualizations of the Family Context: New Insights Gained by Capturing Daily Variability in Cohesion and Conflict

10.31234/osf.io/zq35f ◽

2019 ◽

Author(s):

David M. Lydon-Staley ◽

Emily J. LoBraico ◽

Bethany C. Bray ◽

Gregory Fosco

Keyword(s):

Problem Behaviors ◽

Family Conflict ◽

Internalizing Symptoms ◽

Family Cohesion ◽

Latent Profile Analysis ◽

Profile Analysis ◽

Well Being ◽

Family Context ◽

The Family

In this study, we evaluate whether the use of dynamic characteristics of the family provides new and important information when conceptualizing the family context of adolescents. Using 21 days of daily diary data from adolescents (N=151; 61.59% female; mean age = 14.60 years) in two-caregiver households, we quantified between-family differences in the extent to which their experiences of family cohesion and conflict fluctuate from day to day. We included these estimates of consistency in family cohesion and conflict, along with traditional survey assessments of dispositional family cohesion and conflict, in a latent profile analysis to identify subgroups of families with distinct combinations of dispositional and consistency in family cohesion and conflict. We next assessed how these profiles were differentially associated with emotion regulation, internalizing symptoms, problem behaviors, and well-being at baseline and at a 12-month follow-up. Results revealed four distinct family profiles with unique associations with outcomes. By considering both dispositional and consistency in family cohesion and family conflict and how these four factors cluster within families to differing degrees, we better capture the richness of the family context and highlight the implications for understanding its role in adolescent well-being.

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