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No previous studies have examined suicide risk among Central American immigrants. The present study explored the relationship between acculturative stress, depression, and suicidal ideation among Central American immigrants. Also examined were variables that predict depression and suicidal ideation. Elevated levels of acculturative stress were significantly correlated with high levels of depression and suicidal ideation. Family dysfunction, ineffective social support, nonpositive expectations concerning the future, low levels of religiosity, low levels of education and income, and lack of agreement with the decision to immigrate were significantly associated with high levels of depression and suicidal ideation. The overall findings suggest that Central American immigrants who experience elevated levels of acculturative stress may be at risk for experiencing heightened levels of depression and suicidal ideation. The findings highlight the importance of using culturally relevant clinical methods when assessing and treating depressed and potentially suicidal acculturating individuals.
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PMID:Acculturative stress, depression, and suicidal ideation among Central American immigrants. 1088 53

The present study investigated the relationship between stress and depression associated with acculturation among Central American immigrants (64 women, 14 men) and identified the best predictors of depression among Central American immigrants. Elevated acculturative stress was significantly associated with higher depression. Family dysfunction, ineffective social support, lack of hopefulness toward the future, and low socioeconomic status were also significantly associated with high depression. The overall findings suggest that Central American immigrants who report high acculturative stress may be "at risk" for experiencing depression and that effective family and social support, hopefulness toward the future, and socioeconomic status may serve to protect against depression during acculturation.
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PMID:Psychosocial predictors of depression among Central American immigrants. 1093 88

The specificity of cognitive and family therapies, and potential treatment mediators and moderators, was examined in a randomized clinical trial for adolescent depression. After acute treatment, cognitive-behavioral therapy (CBT) exerted specific effects on cognitive distortions relative to either systemic-behavioral family therapy (SBFT) or nondirective supportive therapy (NST). At 2-year follow-up, SBFT was found to impact family conflict and parent-child relationship problems more than CBT; NST and CBT tended to show a greater reduction in anxiety symptoms than SBFT. Nonspecific therapist variables qualified few outcome analyses. No measures of cognitive distortion or family dysfunction mediated or moderated treatment outcome. As in adult studies, relatively few areas of treatment specificity or mediation were identified. The implications of these findings for clinical treatment and research in adolescent depression are discussed.
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PMID:Cognitive and family therapies for adolescent depression: treatment specificity, mediation, and moderation. 1096 36

Examined models of suicidal ideation severity that include two psychosocial risk factors (i.e., peer and family functioning) and four domains of psychological symptoms (i.e., generalized anxiety, depression, conduct problems, and substance abuse/dependence). Participants were 96 psychiatric inpatients (32 boys, 64 girls), ages 12 to 17, who were hospitalized because of concerns of suicidality. Adolescents completed a structured diagnostic interview, measures of suicidal ideation, and several dimensions of family and peer functioning. Results supported a model in which greater levels of perceived peer rejection and lower levels of close friendship support were associated directly with more severe suicidal ideation. In addition, indirect pathways included deviant peer affiliation and global family dysfunction related to suicidal ideation via substance use and depression symptoms. The results are among the first to demonstrate relations between suicidal ideation and several areas of adolescent peer functioning, as well as divergent processes for peer and family predictors of suicidal ideation.
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PMID:Peer functioning, family dysfunction, and psychological symptoms in a risk factor model for adolescent inpatients' suicidal ideation severity. 1096 23

Baseline data from the Canadian National Longitudinal Survey of Children and Youth were used to evaluate the associations between child care arrangement and poor developmental attainment (PDA). A weighted total of 521,800 children aged 2 to 3 years were studied (N = 2,709). PDA was assessed by age-standardized motor and social development score. Children were grouped by the predominant type of arrangement: care by someone in the child's own home, in another home (family child care), at a child care centre, or none (child care exclusive to parents). Controlling for socioeconomic status, biological factors and maternal immigration, family dysfunction, hostile parenting and low neighbourhood safety were correlated with PDA and positive parent-child interaction decreased the odds of PDA. Whereas centre child care arrangements were beneficial to development overall (OR = 0.41, 99% CI = 0.18, 0.93), an interaction existed between type of child care and maternal depression; among children with depressed mothers, centre child care was associated with increased odds of PDA. Findings suggest that the associations between child care arrangement and child development involve interactions of factors that influence a child's home environment. Future child development studies exploring these interactions are warranted.
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PMID:Child care arrangement and preschool development. 1120 Jul 30

This study examined the association between suicidality, family factors, and clinical and diagnostic variables in depressed adult inpatients. The subjects were 121 depressed adult inpatients living with a family member or significant other. Demographic, clinical, and diagnostic information about the patient, and subjective and observer ratings of family functioning were obtained. Trained interviewers rated families of suicidal depressed patients as more dysfunctional than families of patients with no history of attempted suicide. In a logistic regression model, earlier age of depression onset, number of psychiatric hospitalizations, and objectively rated poorer family communication were associated with a history of a prior suicide attempt. Also, modest evidence suggested that patients with a prior suicide attempt perceived their families as more dysfunctional than did their respective family members. Variations in family functioning are associated with different degrees of suicidality. However, prospective longitudinal designs would elucidate the causal relation between family dysfunction and suicidal behavior.
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PMID:Family functioning and suicidality in depressed adults. 1124 44

Low levels of parental skill and cooperation are the prominent roots of arrested socialization, and a lack of appreciation for intimate and gratifying human relationships is evident in children with CD. The relational problems are exaggerated further by the child's observation of chronic parental discord and internalization of a family image constructed around intrafamilial conflict and isolation. Skills deficits in parental and marital communication and problem solving and conflicts in these relationships play significant roles in producing family dysfunction. The low level of parental differentiation and identity formation plays a fundamental role in family dysfunction by interfering with the development of an adequate self-image, self-esteem, and internal codes of behavior in the child. The transmission of parental antisocial tendencies to their children is facilitated by the low level of differentiation between parent and child. Family treatment should focus on enhancing cooperation between parents and children and between parents as co-parents and as a couple. Enhancing parent management skills can undermine the use of coercive, punitive, and impulsive interactions in the families. The higher divorce rate in parents of children with CD should be addressed with parents directly and early in treatment with the hope of mobilizing the rehabilitative and cooperative marital forces. In terms of future directions, family studies should address and incorporate the expanding knowledge of biologic and psychologic characteristics of children with CD and the possible impact of such characteristics in undermining family development and integrity. Such investigations should include the following information: The role of sustained and intense aggression in some children on family functioning and development. The possible role of diminished response to punishment and excessive search for gratification in children with CD. The role of the child with CD in promoting marital and family discord and divorce. The role of neurotransmitters (such as serotonin) in the production of irritability, provocativeness, coercive family processes, and subsequent depression in the caregiver or the child. Effective models of intervention with children with CD in hospitals and residential treatment centers.
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PMID:Family therapy for conduct disorders. 1144 9

Four hundred eighty-two adolescents who were diagnosed with at least one mental disorder were studied to determine the predictors of suicidal ideation and suicide attempts. Major depression was predictive of suicidal ideation and suicide attempts for both genders. Chronic stress was found predictive of male suicidal ideation, while low self-esteem and high family dysfunction were found to be predictive of suicidal ideation in females. Statistical trends suggest that females with comorbid alcohol use/conduct disorder were approximately three times more likely to have attempted suicide than those with only one of these conditions. Clinicians working with adolescents should be aware that, while depression remains the number one clinical risk forsuicidal behavior, risk factors for suicidal ideation may be different than those for attempted suicide and may vary by gender.
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PMID:Alcohol use disorders and risk factor interactions for adolescent suicidal ideation and attempts. 1145 50

Cystic fibrosis and asthma have many psychosocial implications for patients and their relatives. These can stem from parental adaptational problems following diagnosis, negative illness perceptions, feeling 'different' and other associated developmental intrusions. In asthma, psychological factors arising from a variety of sources are known to 'trigger' attacks. For adolescents, psychological problems are hallmarked by loss (e.g. of identity, independence and peers) which results in re-appraisals of self-worth, depression and anxiety. Early intervention strategies and screening are crucial in ameliorating unsuccessful emotional adaptation and preventing chronic psychological morbidity. Behavioural and cognitive-behavioural interventions are particularly effective for both treatment-related behavioural problems (e.g. procedural distress, and poor feeding behaviour) and some psychological disorders (e.g. anxiety and depression). However, outcome depends on patients' motivation to change and willingness to collaborate. Where this is absent, less directive, but nonetheless effective, psychotherapies are utilised. Family therapy is also considered useful in addressing family dysfunction when thought to be intrinsic to the emotional problems.
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PMID:Psychological interventions in cystic fibrosis and asthma. 1205 7

Depression in children and adolescents is associated with poor psychosocial functioning, high psychiatric comorbidity, risk of recurrent episodes or onset of bipolar disorder. These findings emphasize the importance of early identification of children and adolescents having elevated risk for future depression and further development, evaluation and greater availability of prevention strategies. Our review aims an update about depressive vulnerability in children and adolescents in the perspective of better identification of at-risk populations and targeting of prevention programs. Psychopathology, in particular anxiety and disruptive disorders are well identified risk-factors for later depression. Subclinical depressive symptomatology, also termed "demoralization", also identifies high-risk populations, likely to become incident cases of depression. It is still unclear whether this condition is prodromal depression, a specific clinical entity or the expression of biological and/or cognitive vulnerability. Familial risk for depressive disorders involves both genetic and psychosocial factors. Marital discord, poor communication and dysfunctional parenting practices are often present in families with affective disorders and can be implicated in increased depressive vulnerability in the offspring. Research on individual vulnerability in children and adolescents has focused on temperamental and cognitive characteristics. Temperament traits describe individual differences in reactivity and behavior. High emotionality, defined as the tendency to become upset easily and intensely has been associated with an increased risk for subsequent major depression. However, as the majority of high scorers will not become depressive cases, emotionality should not be the only criterion for selection of at-risk populations. Cognitive style including poor self esteem, low social competence and negative attributions are also associated with increased likelihood of depressive symptoms, but their predictive value for the onset of clinical depressive episodes needs further investigation. Familial and individual vulnerability is likely to heighten the depressogenic impact of life events and psycho-social adversity. Prevention interventions have been developed in the United States for children and adolescents at-risk for depression. In France, clinicians witness growing demands from families with affective illness concerned with risk of parent-child transmission of depressive vulnerability, prevention and early identification of symptoms. To meet this kind of emerging needs and to prevent family dysfunction, a preventive program targets offspring of depressed parents and uses clinician-based family approaches. Family and individual sessions aim a better understanding of illness experience and encourage the parents to identify and foster resilience in their children. Another type of preventive intervention focuses on children and adolescents with subclinical depressive symptoms, eventually associated with behavioral problems ou high level of parental conflict, recruited in school settings. These school-based interventions combine cognitive and social problem-solving techniques. Both familial and school-based preventive interventions have proven applicable and promising in high-risk children and adolescents. Perspectives are more systematic identification of risk groups, including youngsters with past or current non affective symptoms who might benefit from depression prevention, long-term evaluation and cross-cultural applications of prevention programs.
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PMID:[Vulnerability to depression in children and adolescents: update and perspectives]. 1209 84


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