the role of parents in adolescent mental health: they
TRANSCRIPT
The role of parents in adolescent mental health: They matter more than we thought..
The Cornell Research Program on Self-Injurious Behavior in Adolescents and
Young Adults (CRPSIB)
Presented by: Janis Whitlock
www.crpsib.com
Adolescent and young adult mental health!
Reflection question!How is growing up now different than it was when you were young? What is similar and
what has changed?
How I came to be here
“I think my greatest fear is to be forgotten. A teacher I had last year doesn’t even remember my name -- it makes me think that no one remembers me. How do I know I exist? At least I know I exist when I cut”
-‐-‐ Self-‐Injury Message Board Post
It’s tough to be a teen anytime, but particularly in the contemporary era..!
THE ADOLESCENT MENTAL HEALTH LANDSCAPE!
The health paradox of adolescence
• Adolescence is (physically) the healthiest period of the lifespan: prior to adult declines; beyond the frailties of infancy and childhood:
• Yet: overall morbidity and mortality rates increase 200% from childhood to late adolescence
• Individuals are at greater risk of mental health challenges during adolescence than any other time
• Primary sources of death/disability are related to problems with control of behavior and emotion 0
0.02
0.04
0.06
0.08
0.1
0.12
0 10 20 30 40 50 60 70Age
femalemale
Kids are also at high risk for mental health issues
u Rates of mental health challenges high and appear to be increasing
u Age of onset for most mental disorders is 18-24 but symptoms often begin earlier (most common are depression and anxiety)
u On any given day in the U.S., an estimated 6-8 million children(8%-10% of the 0-18 population) take medications for what are classified as mental health problems.
u The proportion of U.S. office visits that resulted in the prescription of a psychotropic medication among adolescents increased 250% from 1994 to 2001: The largest increase was for SSRIs and stimulants
u 13.9% of students have been diagnosed with a DSM IV classifiable disorder (29.3% believe they have struggled with a DSMIV disorder)
Thomas, C., et. al., “Trends in the Use of psychotropic Medica9ons Among Adolescents, 1994 to 2001,” Psychiatric Services, January 2006, 57(1): 63-‐9.
Changes in depression scores in college students by year
(Twenge, et.al, 2010)
Any MI (%) Any MI (%)
US
Netherlands
Columbia Spain
Mexico Ukraine
Belgium Lebanon
France Nigeria
Germany Japan
Italy China (Beijing)
China (Shanghai)
JAMA, June 2, 2004—Vol 291, No. 21
Global comparisons of rates of mental illness: The World Health Organization Study
Results Any MI (%) Any MI (%)
US
26.4 Netherlands 14.9
Columbia 17.8 Spain 9.2
Mexico 12.2 Ukraine 20.5
Belgium 12.0 Lebanon 16.9
France 18.4 Nigeria 4.7
Germany 9.1 Japan 8.8
Italy 8.2 China (Beijing)
9.1
China (Shanghai) 4.3
Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-‐developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Even some of our most privileged youth are struggling..
(average =5.88)
And growing up is increasingly complicated
" Reaching adulthood takes longer (“maturity gap”)
" Lines between adolescence and adulthood blurry
" Acquiring all skills required to be an adult is more difficult than ever
" We are living in exponential times: Living in Exponential times
" Net result: The process of navigating the many developmental tasks associated with moving into adulthood is increasingly complicated
Where do parents fit in?!
We all instinctively know that parents matter
Particularly in childhood
But a teenager’s job is to begin moving out into the world, so how much do parents matter
then? Especially when we consider the myriad other influences that affect youth func9oning, growth, and wellbeing…
We did not set out to study parents: Study of Self-Injurious Behaviors in Adolescents and
Young Adults
Establishing Baseline Epidemiology Basic characteris9cs, risk and protec9ve factors, comorbidity, disclosure & help-‐seeking, iden9fica9on of sources of contagion
EffecLve outreach and prevenLon Development of strength-‐based, par9cipatory approaches to
NSSI assessment, interven9on, and preven9on
Recovery and trajectories Factors contribu9ng to recovery, evolu9on of using NSSI over 9me,
contribu9on of NSSI to wellbeing perspec9ves
But that changed over time…!A few key findings!
Objectives: To assess student mental health and wellbeing with particular focus on non-suicidal self-injury, suicide, wellbeing, risk and protective factors, and help seeking in a community population of young adults
Methods: • Cross-sectional survey administered in 8 universities (Cornell, Princeton,
Harvard, Columbia, U. North Dakota, Youngstown State, MIT, U of Rochester) (total n=14,372)
• Simple random sample of 10,655 Cornell graduate and undergraduate students;
4,150 participated (RR= 38.9%) • Administered via web-based survey in 2006-2007 academic year • Representative of all known population parameters, with the exception of more
female than male respondents.
• All analysis conducted controlling for design effects
Study 1: The 8 college study (2006 Survey of student wellbeing; SSWB)
We found that parents were present even when not present..
25.8 27.3 28.9 26.6
5.5 12
0%
20%
40%
60%
80%
100%
1st year 2nd year 3rd year 4th year 5th year graduate
at least once a dayfew times a weekonce a weekfew times a moonce a mo< 1 per mo
That parents are primary sources for advice and comfort when students are sad, depressed, or
anxious
70.2 66.461.7
43.3 40.1 39.9
17.3 13.88.2 11.1
5.49.6 6.2 4.0 4.8 4.6 4.1 2.8
7.1
01020304050607080
Friend
s at s
choo
l
Friend
s away
Parents
Sibling
s
Romati
c part
ner
Rommate
Other re
lative
s
Spiritu
al ad
visor
Secon
dary
scho
ol as
socia
te
Therap
ist on
campu
s
Therap
ist at
home
Reside
nt Adv
isor
Facult
y mem
ber
MD at ho
me
MD at sc
hool
No one
Coach
at sc
hool
Virtual
friend
Other
Friend Family Non-‐ mental health
professional Mental health professional
No one Other
That parents are the most helpful people to talk to about serious mental health issues, such as self-injury(n=833):
42.3
21.7 22.5 30.6
21.4
40
20.5
24.6 27.9
20.1
28.6
12
37.2
53.7 49.5 49.3 50.7 48
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
parents friends partners therapist teachers physician
not sure
not helpful
helpful
That most teens from whom self-injury is silent want to talk to their parents..
12.8 13.2 13.9 20
12
23.5 36.8
20.8 11.4
44
63.8 50
65.3 68.6
44
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
friend partner parent sibling teacher
wishes to talk
not sure they want to talk
do not want to talk
Parents emerged as so important from this study that we concluded:
• Educa9on and outreach is warranted for social network gatekeepers, namely parents and peers. Focus should include enhancing links with ins9tu9onal gatekeepers
Objectives: To longitudinally investigate the relationship between NSSI and suicidality in a young adult sample
To longitudinally assess psychological distress trajectories over time and to identify key contributors to the onset of distress in a young adult sample
Methods: • Simple random sample of undergraduate and graduate students drawn from 8
universities (n=14,372; overall response rate of 38.9%) using measures from the
Survey of Student Wellbeing administered via web-based survey in 2006-2007
academic year.
• Longitudinal study in 5 of 8 original schools (3 private, 2 public). Wave I-III data
on 1, 466 individuals (2006-2009)
Study 2: Longitudinal study in 5 colleges (SSWH 2006 – 2009)
Suicide (kessler et. al., 2005)
Self injury (NSSI-AT; Whitlock &
Purington, 2010)
Global psychological distress (K-6;
Kessler, 2002) • Captures DSMIV classifiable
anxiety and distress in past 30 days
Key Measures Demographics
• Sex
• Sexual orientation
• Ethnicity / race
• SES
Psychological traits
• Optimistic or pessimistic cog style
• Emotion regulation
• Sense of presence of meaning in life
• Endorsement of aggression
• Life satisfaction History of trauma or abuse (emo, phys, sex) History of mental illness
• Subjective and diagnosed (self)
• Parental diagnosed
Social connectedness
• Number of confidants
• Category of confidant
• Perceived peer connectedness
Mental health treatment
• History of MH treatment
• Attitudes toward treatment (stigma)
NSSI Any Suic psych Distress
0
5
10
15
20
Wave I Wave II Wave III
13.7
18.9 19.7
9.7 11.9 13.1
5.9 8.3
10.3 NSSI
Any Suic
psych Distress
NSSI incidence: Wave 2: n=77 (5.2%) Wave 3 n= 11 (.8%) SI/SA incidence:
Wave 2: n=32 (2.2%) Wave 3 n= 18 (1.2%)
Psychological distress: Wave 2: n=57 (3.9%) Wave 3 n= 53 (3.6%)
Accumulation of NSSI, suicide, and psych distress over time
Trajectories over time using NSSI, SI/SA, and K-6 (PD)
28.7% of all students at time 1 had a history of PD or experienced onset of PD over the subsequent 2 years
10.5% students are adding some form of PD within a 2 year period
When restricted to <20 yo at T1
31.7% of all students at time 1 had a history of PD or experienced onset of PD over the subsequent 2 years
12.4% students are adding some form of PD in a two year period
Progress to SI/SA from NSSI
Mother history of MI Presence of meaning in life (.7)
NSSI life9me frequency (>20,
3.9)
Perceived social isola9on
Confidant categories
Psychological distress
Pessimis9c cogni9ve style
History of MH treatment
(2.2)
Personal history of MI
Emo9onal regula9on and processing
No one Peers only (1.0) Peers and adult professionals (1.0) Peers, professionals, and informal adults (.7) Parents (.3)
What differentiates individuals with NSSI history who do and do not progress onto SI/SA? (adjusted logistic regression analysis)
Progress from no PD at 9me 1 to PD by T3 (ROC curve analysis classifying 58%-‐75% of individuals who
convert)
Percep9ons of therapy
Presence of meaning in life
History of physical abuse
Confidant categories
Pessimis9c cogni9ve style (this alone correctly categorizes 70% of individuals in the risk condi9on)
History of MH treatment
Endorsement of aggression Emo9onal
regula9on and processing
No one Peers only Peers and adult professionals Peers, professionals, and informal adults Parents
When we asked a similar question to determine what predicts who is at risk for later psychological distress (as measure by NSSI, suicidality, and global
psychological distress) parents again emerge as key factors..
SES Number of
traumas reported
Life sa9sfac9on
Model iden9fied would correctly predict 84 of every 100 people at risk for conversion
Our current study: The role of parents in NSSI recovery!
Why study parental roles in NSSI recovery?
Theoretical reasons: " Parental contributions to etiology of
maladaptive behaviors is well documented " Parental contributions to recovery less
well understood and studied
" Parent-child interactions are important after disclosure/discovery : " Indirect modeling of communication
styles and emotion regulation, expressivity, and cognitions
" Directly through response to and regulation of child behavior
The Current Study Objectives:
" To identify key processes and turning points in recovery from youth and parent perspectives " To identify key dynamic processes in family and parent-child interaction patterns
Sample and procedure: " Recruit 35 families (dyads or triads):
" Youth with NSSI experience and their parents
" On-line survey assessing family interaction style, emotion acceptance and regulation, communication styles, and family warmth
" Interviews: key events, turning points, processes, and exchange patterns " 9 parent and 11 youth interviews complete; 7 family units (2 with 3 members)
Key findings so far
" Parents and children may identify very different events as key
" When an event is characterized as key by both parent and child, the meaning may vary dramatically
" Disclosure/discovery moment provides a window of opportunity for parental knowledge gain which may shut without vigilance " There is low correspondence between parent and child in stage of the process (youth are in middle or end when parents are beginning) " Parents are often ill equipped to respond effectively and this is complicated by developmental issues also occurring " Therapy plays a different role for youth and parents
Our future work: !!!
• Development of programs which capitalize on parental influence!
• Development of interventions for parents of youth who injure and young adults in general aimed at building their own capacity
for emotion regulation and positive communication (this is currently an SBIR under review)!
• Development of a series of trainings for parents and those who work with parents on use of mindfulness principles and
practices in parenting !!
Reflection question!
What do you take away from this? What should we be looking at that I have not
mentioned?
Thank you!!