Tally Moses

This study examines the relative risk for suicide attempts (SA) among high-school students self-identifying with one or more disability classifications (nine); assesses the extent to which youth with disabilities are disproportionately vulnerable to risk factors that predict suicidal behavior among all adolescents; and explores whether disability status adds to risk for SA after accounting for a comprehensive set of known risk and protective factors for SA. Analyses using Wisconsin’s 2012 Dane County Youth Assessment Survey data found that youth in each disability category were 3–9 times more likely to report suicide attempt(s) relative to peers, and the endorsement of multiple disabilities tripled the risk SA relative to youth reporting a single disability. Some disability sub-groups, including youth reporting autism spectrum disorder, hearing, and vision impairments reported surprisingly high rates of SA. While youth with disabilities reported disproportionate exposure to adversity in every life domain examined, similar to youth reporting SA, disability status added unique risk for suicidal behavior. This suggests that disability may be a ‘fundamental cause’ of suicidal behavior, a question that requires further investigation.

Background: Better understanding of the individual and environmental factors that promote adolescents’ use of more or less adaptive coping strategies with mental illness stigma would inform interventions designed to bolster youth resilience. Aims: This cross-sectional study draws on data from research on adolescents’ well-being after discharge from a first psychiatric hospitalization to explore the relationships between anticipated coping in reaction to a hypothetical social stigma scenario, and various factors conceptualized as ‘coping resource’ and ‘coping vulnerability’ factors. Focusing on coping strategies also identified in the companion article, we hypothesize that primary and secondary control engagement coping would relate to more coping resource and less coping vulnerability factors, and the opposite would be true for disengagement, aggression/confrontation and efforts to disconfirm stereotypes. Methods: Data were elicited from interviews with 102 adolescents within 7 days of discharge. Hypothesized coping resource factors included social resources, optimistic illness perceptions, better hospital experiences and higher self-esteem. Vulnerability factors included more previous stigma experiences, desire for concealment of treatment, more contingent self-worth, higher symptom levels and higher anticipated stress. Multivariate ordinary least squares (OLS) regression was used to analyze associations between coping strategy endorsement and correlates. Results: Although some coping correlates ‘behaved’ contrary to expectations, for the most part, our hypotheses were confirmed. As expected, youth anticipating reacting to the stigmatizing situation with greater disengagement, aggression/confrontation or efforts to disconfirm stenotypes rated significantly lower on ‘coping resources’ such as self-esteem and higher on vulnerability factors such as symptom severity. The opposite was true for youth who anticipated exercising more primary and secondary control engagement coping. Conclusions: This study begins to identify factors that promote more and less adaptive coping strategies among youth at high risk for social stigma. Some factors that can be modified in the shorter term point to useful directions for clinical interventions.

Background: The effects of mental illness stigma on adolescents receiving psychiatric treatment may largely be determined by their coping strategies. Yet, little is known about adolescents’ use of stigma-coping strategies, or how helpful these are for addressing stigma-related stress. Aims: This study explores how adolescents discharged from psychiatric hospitalization anticipate coping with a hypothetical social stigma event related to hospitalization. We examine how well anticipated coping strategies predict adolescents’ self-stigma ratings following 6 months. To evaluate the direction of causality, the reverse order of effects, the influence of self-stigma on coping strategies, is also assessed. Methods: A voluntary sample of 80 adolescents participated in two face-to-face interviews that assessed coping and self-stigma. Anticipated (baseline) and actual (follow-up) coping strategies were measured with a modified Response to Stress Questionnaire (primary and secondary control engagement coping, disengagement) and two stigma-specific strategies developed for this study (disconfirming stereotypes and aggression/confrontation). Relationships between anticipated coping strategies and self-stigma were assessed with ordinary least squares (OLS) regression; multivariate general linear modeling (GLM) and structural equation modeling (SEM) explored the reverse associations. Results: Youth reporting higher self-stigma ratings at follow-up anticipated using more disengagement and effort to disconfirm stereotypes and less secondary control engagement coping at baseline. Anticipated use of secondary control engagement coping was uniquely significant in predicting participants’ self-stigma when controlling for baseline self-stigma. At the same time, higher baseline self-stigma ratings predicted less adaptive coping (disengagement and effort to disconfirm stereotypes) at follow-up. Conclusions: The results point to the particular importance of secondary control engagement coping for helping to mitigate the impact of peer prejudice or discrimination on self-stigma among youth receiving psychiatric services. At the same time, higher initial levels of self-stigma likely drive less adaptive coping with peer stigma. These bidirectional influences point to a vicious cycle between internalizing negative stereotypes and coping in ways that perpetuate negative outcomes.

This study explores stigma apprehension (fear of being devalued or rejected) and its correlates among 102 adolescents, interviewed within 7 days of discharge from their first psychiatric hospitalization. Components of the Model of Stigma-Induced Identity Threat by Major and O'Brien (Annu Rev Psychol 56:393-421, 2005) comprise the study model, including collective stigma representations and group and domain identification; additional clinical, personal, and contextual characteristics such as social affiliation, interpersonal support, self-identification as having a mental disorder, and perceived need for others' approval were added to the model. We found that, on average, the participants reported "a little" stigma apprehension, and 21% reported substantial stigma apprehension. Multivariate analysis demonstrated that higher stigma apprehension was most associated with the female sex, younger age at initiation of mental health treatment, lower self-esteem, greater need for others' approval, more experiences with personal stigmatization, and not identifying or affiliating with peers who have mental health or behavior challenges. These factors collectively accounted for 46% of the variance. The study's findings particularly highlight the role of social context and external contingencies of self-worth in determining adolescents' perceptions of stigma-related threat.

This mixed-method study examines (1) the extent to which fifty adolescents receiving wraparound treatment and prescribed psychotropic medication for various psychiatric disorders report that they would continue taking medication if the decision was entirely their own (termed “medication commitment”); (2) their general subjective experiences with medication; and (3) which medication experiences and clinical, social, and demographic factors are associated with greater medication commitment. We found that most adolescents (62%) would discontinue treatment; these “less committed” youth were more likely to report various negative medication perceptions and experiences in open-ended questions, relative to “committed” youth. Multivariate analysis indicated that significant correlates of commitment to medication were: taking antipsychotic medication, greater perceived family support, and lack of perceived coercion to take the medication; clinical or demographic factors were not significantly related to medication commitment. The results reinforce the importance of addressing youths’ concerns about medication and maximizing their participation in treatment decision-making.

Significant numbers of adolescents receive inpatient psychiatric services, yet we know little about their experiences: what about hospitalization is perceived as helpful and what is counter-productive or even harmful? In this study, eighty adolescents hospitalized for the first time in a psychiatric program were interviewed within a week of discharge (using a semi-structured interview format), and asked to describe what did and did not help them. Multiple themes emerged relating to helpful experiences and these were grouped in three categories: interpersonal support, therapy and psycho-education, and environment; Unhelpful/harmful experiences were classified in four categories: rigidity and confinement, lack of treatment responsiveness, frightening/anxiety-provoking experiences, and other. Participants provided rich feedback that both reinforces existing practices and offers ways for programs to change practices to better meet adolescents’ developmental needs. Some factors noted as key therapeutic ingredients, especially the helpful role of peers, have not previously been included in hospital satisfaction surveys.

Currently, little is known about adolescents' self‐stigma experiences as mental health (MH) treatment recipients. Hence, this study addresses the following two questions: (a) what are adolescents' and parents' perceptions of stigma and perceptions of the cause, controllability, and anticipated outcome (illness perceptions) of adolescents' MH problems? (b) to what extent do illness perceptions (adolescents and parents) and parents' own stigma experiences relate to adolescents' self‐stigmatization? The results, based on data from separate interviews with a voluntary sample of 60 adolescent–parent dyads, clients of MH wraparound services, suggest that approximately 20% of adolescents and parents reported significant concerns related to self‐stigmatization. Using multivariate analyses, we found that the three most prominent factors associated with adolescents' self‐stigma ratings included adolescents' perceptions of social skill deficits and trauma as causal factors pertaining to their mental health challenges, as well as parents' inclination to conceal their child's MH problems from others.