Prevalence and correlates of adolescent self-injurious thoughts and behaviors: A population-based study in Burkina Faso

Self-injurious thoughts and behaviors (SITBs) are a growing concern among youth in sub-Saharan Africa, but their prevalence and correlates in this region are poorly understood. We therefore examined self-reported SITBs in a population-representative sample of youth in rural Burkina Faso. We used interviews from 1,538 adolescents aged 12 to 20 years living in 10 villages and 1 town in northwestern Burkina Faso. Adolescents were asked about their experiences with suicidal and nonsuicidal SITBs, adverse environmental factors, psychiatric symptoms, and interpersonal-social experiences. SITBs included lifetime prevalence of life is not worth living, passive suicide ideation, active suicide ideation, and nonsuicidal self-injury (NSSI). After describing SITB prevalence, we ran logistic and negative binomial regression models to predict SITBs. Weighted lifetime SITB prevalence estimates were: 15.6% (95% confidence interval [CI]: 13.7-18.0) for NSSI; 15.1% (95% CI: [13.2, 17.0]) for life is not worth living; 5.0% (95% CI [3.9, 6.0]) for passive suicide ideation; and 2.3% (95% CI [1.6, 3.0]) for active suicide ideation. Prevalence of life is not worth living increased with age. All four SITBs were significantly positively associated with mental health symptoms (depression symptoms, probable posttraumatic stress disorder) and interpersonal-social experiences (peer and social connectedness, physical assault, sexual assault and unwanted sexual experiences). Females were significantly more likely to report that their life was not worth living compared to males (aOR = 0.68; 95% CI [0.48, 0.96]). There is a high prevalence of SITBs among youth in rural Burkina Faso, most notably NSSI and life is not worth living, with interpersonal-social factors being the strongest predictors. Our results highlight the need for longitudinal SITB assessment to understand how risk for SITBs operates in resource-constrained settings, and to design interventions to mitigate risk. Given low school enrollment in rural Burkina Faso, it will be important to consider youth suicide prevention and mental health initiatives that are not school-based

Within Person Associations of Thought Uncontrollability and Negative Valence with Anxiety Symptoms: A Daily Diary Investigation

Background: Perseverative thought (PT) is a cognitive process involving marked repetitive and uncontrollable mental activity centered on a particular theme. Recently, research investigating the characteristics of PT that vary within person has identified thought uncontrollability and negative valence as characteristics of PT that are strongly related to anxiety-related disorders at the between-person level. Despite findings that thought uncontrollability and negative valence are dissociable dimensional features of PT, no studies have looked at their concurrent or prospective within-person associations with anxiety. This research gap is important to address because major psychological theories of PT propose a specific role for uncontrollability, above and beyond negative valence, in contributing to the adverse effects of PT. Thus, this study uses a prospective longitudinal daily diary design to investigate the independent and incremental within-person associations of thought uncontrollability and negative valence with anxiety symptoms. Method: Prospective daily-diary measures of thought uncontrollability (hard-to-stop, intrusive, repetitive), negative valence (happy [reversed scored], nervous), and anxiety symptoms were completed by 200 undergraduate students for 15 days. Six multilevel models were conducted to examine the within person associations of thought uncontrollability and negative valence with anxiety symptoms. Two sensitivity analyses examined whether greater thought uncontrollability was differentially associated with specific facets of anxiety (anxious arousal and anxious apprehension). Results: Uncontrollability and negative valence were positively associated with same-day anxiety symptoms. Furthermore, uncontrollability was incrementally positively associated with same-day anxiety symptoms beyond negative valence. However, greater uncontrollability did not predict next-day anxiety symptoms. Unexpectedly, greater uncontrollability was related to both higher anxious arousal and higher anxious apprehension within person. Conclusion: This study suggests that negative valence and uncontrollability are transdiagnostic characteristics of PT that relate to anxiety, but may not prospectively predict anxiety, within person. Future research should directly explore the temporal specificity of how these dimensions of PT relate to anxiety over time

National implementation of a trauma-informed intervention for intimate partner violence in the Department of Veterans Affairs: first year outcomes

Abstract Background The U.S. Department of Veterans Affairs (VA) has recently implemented a comprehensive national program to help veterans who use or experience intimate partner violence (IPV). One important component of this plan is to implement Strength at Home (SAH), a 12-week cognitive-behavioral and trauma-informed group treatment designed to reduce and end IPV use among military and veteran populations. Method The present study describes initial patient and clinician findings from the first year of a training program tasked with implementing SAH at 10 VA medical centers. Results Results from 51 veterans who completed both pre- and post-treatment assessments indicate SAH was associated with significant pre- to post-treatment reductions in the proportion of veterans who reported using physical and psychological IPV toward a partner, the types of IPV used, and posttraumatic stress disorder symptoms. Overall, veterans reported high satisfaction with the quality and nature of services received, and with the program materials. In addition, 70% of sites and 34% of the 79 clinicians trained were successful in launching the program in the first year. The mean number of days between site training and initiation of the first group session was 135.86 (SD = 63.16, range 72–252). Conclusions Results suggest that the training and implementation program was successful overall. However, average length of time between in-person training and initiation of group services was longer than desired and there were three sites that did not successfully implement the program within the first year, suggesting a need to reduce implementation barriers and enhance institutional support

Does trauma event type matter in the assessment of traumatic load?

Conrad D, Wilker S, Pfeiffer A, et al. Does trauma event type matter in the assessment of traumatic load? European Journal of Psychotraumatology. 2017;8(1): 1344079

Brain structural correlates of upward social mobility in ethnic minority individuals

Purpose!#!Perigenual anterior cingulate cortex (pACC) is a neural convergence site for social stress-related risk factors for mental health, including ethnic minority status. Current social status, a strong predictor of mental and somatic health, has been related to gray matter volume in this region, but the effects of social mobility over the lifespan are unknown and may differ in minorities. Recent studies suggest a diminished health return of upward social mobility for ethnic minority individuals, potentially due to sustained stress-associated experiences and subsequent activation of the neural stress response system.!##!Methods!#!To address this issue, we studied an ethnic minority sample with strong upward social mobility. In a cross-sectional design, we examined 64 young adult native German and 76 ethnic minority individuals with comparable sociodemographic attributes using whole-brain structural magnetic resonance imaging.!##!Results!#!Results showed a significant group-dependent interaction between perceived upward social mobility and pACC gray matter volume, with a significant negative association in the ethnic minority individuals. Post-hoc analysis showed a significant mediation of the relationship between perceived upward social mobility and pACC volume by perceived chronic stress, a variable that was significantly correlated with perceived discrimination in our ethnic minority group.!##!Conclusion!#!Our findings extend prior work by pointing to a biological signature of the 'allostatic costs' of socioeconomic attainment in socially disadvantaged upwardly mobile individuals in a key neural node implicated in the regulation of stress and negative affect