Academic literature on the topic 'Pre-existing vulnerabilities, internalizing symptom'

AimsComplex traumas are traumatic experiences that involve multiple interpersonal threats during childhood or adolescence, such as repeated abuse. This type of trauma is hypothesized to lead to more severe psychopathology and poorer cognitive function than other non-complex traumas, such as road traffic accidents. However, empirical testing of this hypothesis has been limited to clinical or convenience samples and cross-sectional designs. To better understand this topic, we aimed to investigate psychopathology and cognitive function in young people exposed to complex, non-complex, or no trauma from a population-representative longitudinal cohort, and to consider the role of pre-existing vulnerabilities.MethodParticipants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a population-representative birth-cohort of 2,232 children born in England and Wales in 1994-95. At age 18 years (93% participation), we assessed lifetime exposure to complex and non-complex trauma. We also assessed past-year psychopathology including general psychopathology ‘p’ and several psychiatric disorders, as well as current cognitive function including IQ, executive function, and processing speed. Additionally, we prospectively assessed early childhood vulnerabilities including internalizing and externalizing symptoms at age 5, IQ at age 5, family history of mental illness, family socioeconomic status, and sex.ResultWe found that participants who had been exposed to complex trauma had more severe psychopathology and poorer cognitive function across wide-ranging measures at age 18, compared to both trauma-unexposed participants and those exposed to non-complex trauma. Early childhood vulnerabilities had an important role in these presentations, as they predicted risk of later complex trauma exposure, and largely explained associations of complex trauma with cognitive deficits, but not with psychopathology.ConclusionBy conflating complex and non-complex traumas, current research and clinical practice under-estimate the severity of psychopathology and cognitive deficits linked with complex trauma, as well as the role of pre-existing vulnerabilities. A better understanding of the mental health needs of people exposed to complex trauma and underlying mechanisms could inform the development of new effective interventions.

Background: The study aimed at assessing the emotional and behavioral difficulties in adolescents using the Strengths and Difficulties questionnaire. The challenges brought forth due to the COVID-19 shut down of educational institutions has created additional distress due to a lack of routine and separation from one’s peer group. Being closeted with a family for prolonged duration can exacerbate pre-existing vulnerabilities of conflict and mental health issues. Method: Both males and females were selected for the study. The age of the participants was 16-18 years. The total sample size was 140 (mean age 17.5, SD 2.5), with 70 males (mean age- 17, SD 1.5) and 70 females (mean age - 16.5, SD 2.8). The Strengths and Difficulties Questionnaire by Goodman et al. (1998) was used, as also a detailed clinical case study was taken to identify pertinent issues and concerns. Result: The study found significant gender differences in prosocial behavior and peer relationships in adolescents, and we assume that a role parity and empathy may be the linking factor between prosocial behavior and peer relationships. A case study is also discussed from the practitioner’s perspective that brings into focus the increased consultations due to the stressful times. Findings also bring out a need for inculcating life skills in adolescents for recognizing and managing their stressors; incorporating a balance between internalizing and sharing their feelings. Conclusion: Interventions such as yoga, physical activities that maintain distance such as aerobics to mediate stress under lockdown can be undertaken at community level. The study showed that correlations may be present between conduct problems and emotional behaviors due to similar causal factors but more research is needed in the said field.

AbstractFor many adolescents, the COVID-19 pandemic represents a uniquely challenging period, and concerns have been raised about whether COVID-19-related stress may increase the risk for self-injurious behaviors among adolescents. This study examined the impact of pre-existing vulnerabilities on the occurrence and frequency of Non-Suicidal Self-Injury (NSSI) through COVID-19-related stress, and whether the impact of COVID-19-related stress on NSSI was buffered by the perceived social support during the pandemic. Participants were 1061 adolescents (52.40% females; Mage = 15.49 years, SD = 0.76) from a two-wave longitudinal study, which included assessments before the COVID-19 onset and one year later the declaration of the pandemic. Path analyses showed that adolescents with a prior history of NSSI, higher levels of internalizing symptoms, and poor regulatory emotional self-efficacy before the COVID-19 pandemic reported higher levels of COVID-19-related stress which in turn increased their risk to engage in NSSI. Besides, the findings did not support the role of social support as a moderator of the association between COVID-19 related stress and the occurrence/frequency of NSSI. These findings suggest that enhanced stress perception may serve as a key pathway for the continuation and development of NSSI among vulnerable adolescents facing adverse life events.

Abstract Background Concerns have been raised that the COVID-19 pandemic could increase risk for adverse mental health outcomes, especially in young adults, a vulnerable age group. We investigated changes in depression and anxiety symptoms (overall and severe) from before to during the pandemic, as well as whether these changes are linked to COVID-19-related stressors and pre-existing vulnerabilities in young adults followed in the context of a population-based cohort. Method Participants (n = 1039) from the Quebec Longitudinal Study of Child Development reported on their depression (Centre for Epidemiological Studies Depression Scale, short form) and anxiety (General Anxiety Disorder-7 Scale) symptoms and completed a COVID-19 questionnaire during the first wave of the COVID-19 pandemic in the summer of 2020 (age 22 years). Assessments at age 20 (2018) were used to estimate pre-pandemic depression and anxiety symptom severity. Results While mean levels of depression and anxiety symptoms did not change from before to during the first wave of the COVID-19 pandemic (e.g., the mean of depressive symptoms was 9.30 in 2018 and 9.59 in 2020), we observed a slight increase in rates of severe depression (scores ≥ 21) from before (6.1%) to during (8.2%) the pandemic. Most COVID-19-related variables (e.g., loss of education/occupation, frequent news-seeking) – except living alone – and most pre-existing vulnerabilities (e.g., low SES, low social support) were not associated with changes in depression or anxiety symptoms. However, results varied as a function of pre-pandemic levels of depression and anxiety: depression and anxiety symptoms increased among adults with the lowest levels of symptoms before the pandemic, while they decreased among those with the highest levels of symptoms, possibly reflecting a regression to the mean. Conclusions Depression and anxiety symptoms in young adults from Québec in Summer 2020 were mostly comparable to symptoms reported in 2018. Most COVID-19-related stressors and pre-existing vulnerabilities were not associated with changes in symptoms, except living alone and pre-existing symptoms of depression and anxiety. However, the increased rate of severe depression warrants further investigation.

Abstract Background Adolescence can be difficult to navigate and the post-conflict environment in Jaffna Province, Sri Lanka compounds existing issues for adolescents. Conduct problems, hyperactivity along with emotional problems are challenges faced by adolescents, particularly in fragile, post-conflict settings. This study was a non-randomized controlled trial carried out in 4 educational zones over 6 months. The study implemented a yoga-based intervention package: two types of slow breathing for 5-6 min, Surya-namaskaram for 6-8 min, and mindfulness meditation for 5-6 min. Pre/post quantitative assessments were conducted with intervention and control groups. A focus group was conducted with the intervention group. The aim was to evaluate. Effectiveness of implementing a yoga-based intervention package in grade 8 school children (early adolescents) to address behavioural problems. Results Paired t-test and independent t-tests were completed for both arms using statistical product and service solutions (SPSS21). Parents’ assessments of emotional issues reduced for the intervention group (n = 584) [t(584) = 11.41, p = 0.001] along with reduction of the total difficulty score [t(584) = 28.12, p = 0.001]. Teachers’ assessments indicated prosocial scores improved in the intervention group [t(584) = − 28.5, p = 0.001]. Students’ self-assessments in the intervention group indicate a reduction in emotional problems [t(584) = 6.4, p = 0.001], and reduction in problems with peers [t(584) = 14.4, p = 0.001]. Within the control group (n = 499), teachers’ assessments indicated emotional problems increased [t(499) = − 9.5, p = 0.001] and prosocial scores reduced [t(499) = 13.5, p = 0.001]. Students’ self-assessments in the control group indicated emotional problems increased [t(499) = − 27.1, p = 0.001]. A comparison of post-test scores revealed a statistically significant difference between groups. Focus group results indicate students felt the intervention had an overall positive effect on school achievements, family dynamics and individual health. Conclusions This yoga-based intervention package appeared to be effective in reducing both externalizing and internalizing symptoms in adolescents. Practicing Surya-namaskaram, breathing control techniques and mindfulness meditation significantly reduced both externalizing symptoms (conduct problems and hyperactivity) as well as internalizing symptom (emotional problem and peer problems). It is recommended this intervention be scaled up across Sri Lanka and other similar post-conflict regions.

Abstract Background Based on the current state of research regarding the treatment in pediatric obsessive–compulsive disorder (OCD), cognitive behavioral therapy (CBT) (in severe cases with additional pharmacotherapy) is considered as the first-line treatment according to internationally recognized guidelines. Research is mostly based on randomized controlled trials (RCTs; efficacy research). Thus, examined treatment conditions, especially the treatment duration, and patients’ characteristics do not necessarily correspond to those found within routine care. Studies showed CBT packages as a whole to be efficacious, but less is known about the effects of individual CBT components. Furthermore, effects on comorbid symptoms or psychosocial impairment have been often neglected and different rater perspectives have been hardly considered in previous research. Methods This effectiveness study aimed to examine the effects of multimodal CBT in children, adolescents, and young adults (age 6–20 years) with OCD (n = 38) within routine care. Effects on obsessive–compulsive and co-existing symptoms were evaluated in a within-subject design by comparing changes during the assessment phase with 12-week standard treatment and with individually tailored extended treatment. Additionally, within the standard treatment, non-exposure treatment was compared to exposure treatment. Multi-informant assessment was applied, and the analyses included multilevel modeling and t-tests for pre-post comparisons. Results During the standard treatment and extended treatment, obsessive–compulsive symptoms, strain, and functional impairment significantly decreased. Moreover, a significant reduction of overall comorbid symptoms emerged, particularly regarding internalizing symptoms, including anxiety and depression. Comparisons of treatment components indicated that adding exposure with response prevention (ERP) has an additional positive effect. Clinical improvement and remission rates increased considerably when more treatment sessions were provided. Conclusions These results suggest that improvement after an initial 12-week course of treatment may not allow for the prediction of non-responders/non-remitters and for the termination of treatment. Overall, the findings show that results from randomized controlled trials are transferrable to routine care. Trial registration number This study was registered retrospectively at the German Clinical Trials Register (https://drks.de/search/de/trial/DRKS00030050).

The present dissertation aims to improve our knowledge on the longitudinal development of Non-Suicidal Self-Injury (NSSI) and the role of interpersonal and intrapersonal risk factors associated with it. Non-Suicidal Self-injury (NSSI), defined as the direct and deliberate self-inflicted damage of body tissue without suicidal intent, is a serious public health concern worldwide (Kiekens et al., 2018). Adolescents are the most at-risk group, given that the transition into adolescence may represent a critical vulnerability period for the onset of NSSI behaviors (Lloyd-Richardson, 2008). This phenomenon requires attention not only because of its heavy impact in terms of public health and the high incidence within the population, but also for the consequences that engagement in NSSI entails. The long-term effects of self-injurious behavior can be destructive, with consequences for emotional and cognitive development (Baetens et al., 2011). NSSI is used as a maladaptive means of coping with intense emotions. Both interpersonal (e.g., social interaction with peers and family; Brausch & Gutierrez, 2010) and intrapersonal factors (e.g., emotion regulation, self-efficacy, and self-esteem; Baetens et al., 2011) can serve to initiate and maintain NSSI (Nock, 2009; Nock & Prinstein, 2004; Zetterqvist et al., 2013). In the last ten years, the attention given to this issue has become increasingly important. Most of the existing literature has examined this behavior (e.g., prevalence, risks factors) at the cross-sectional level, while few studies have explored the longitudinal development of NSSI, and the role played by interpersonal and intrapersonal factors at the longitudinal level. For these reasons, the general aim of the present dissertation is to analyze the longitudinal development of NSSI and the association with interpersonal and intrapersonal risk factors. Three empirical studies are presented. They cover three main issues: 1) a meta-analysis on the longitudinal development of NSSI; 2) the reciprocal associations between peer problems and NSSI; 3) the mediational role of Covid-19 related stress in the association between pre-existing vulnerabilities and NSSI. In the first study (Chapter 1), we presented a meta-analysis on the development of NSSI from childhood to young adulthood, using a Bayesian approach. The aim was to examine both the occurrence and the frequency of NSSI over time, considering all studies published up until November 2020. Subsequently, we examined the role of possible moderators, such as gender, mean age during the first wave of data collection, and number of months covered by the assessment. The results show the important role of gender (i.e., females) and age in the explanation of the expected proportion and mean changes of NSSI over time. Specifically, what emerges from the findings is how being female represents an important risk factor for the occurrence of this behavior. As for the frequency of this behavior, a higher percentage of females are associated with higher severity of NSSI, but it tends to decrease over time. The results show that mid-adolescence (i.e., 14/15 years) appears to be the period of highest risk for the occurrence of NSSI over time. Instead, over time, findings suggest that the frequency of this behavior is higher in adolescence, at a mean age of 15-16 years of age, and it decreases in late adolescence (e.g., Plener et al., 2015). In the second study (Chapter 2), we investigated the reciprocal associations between peer problems (e.g., peer victimization, friendship stress, and loneliness) and NSSI throughout adolescence, distinguishing between- and within-person effects. Participants were 866 adolescents (54.5% females; Mage = 13.12 years, SD = 0.78), who took part in six waves of data collection. Random Intercept Cross-Lagged Panel Models (RI-CLPM) were used to estimate within-person cross-lagged effects between each peer problem and NSSI from Grade 7 to 12. After accounting for between-person associations between peer problems and NSSI, results indicated that higher-than-usual levels of NSSI predicted higher-than-usual levels of adolescents’ own friendship stress, loneliness, and peer victimization at the subsequent time point. Yet, sensitivity analyses revealed that most of these effects were strongly attenuated and explained by within-person fluctuations in depressive symptoms. No within-person cross-lagged effects from peer problems to NSSI were found. In the third study (Chapter 3), we examined the role of Covid-19 related stress in the association between pre-existing vulnerabilities and the engagement in NSSI during the pandemic. Specifically, the study aimed to examine if adolescents with pre-existing vulnerabilities, including a prior history of NSSI, higher levels of internalizing symptoms, and poorer regulatory emotional self-efficacy, were more likely to show increases in NSSI across the pandemic period through higher levels of Covid-19 related stress. The analysis was conducted on 1061 adolescents (52.4% females; Mage = 15.49 years, SD = 0.76), enrolled in the 9th and 10th grade in Tuscany, Italy, who took part in two waves of data collection. Results showed that adolescents with pre-existing vulnerabilities were at higher risk of engaging in NSSI through the role of Covid-19 related stress. Specifically, adolescents with a prior history of NSSI, higher levels of anxious and depressive symptoms, and poorer regulatory emotional self-efficacy showed a higher level of Covid-19 related stress, which in turn it was associated with an increased risk of occurrence of NSSI. In the final chapter (Chapter 4), the results of the previous three studies have been discussed highlighting their contribution to the literature on the longitudinal development of NSSI, strengths and limitations, and the implications for future studies.