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Different dimensions of anxiety differentially predict binge drinking among juvenile offenders

Description
Although research has documented robust prospective relationships between externalizing symptomatology and subsequent binge drinking among adolescents, the extent to which internalizing symptoms increase risk for drinking remains controversial. In particular, the role of anxiety as a predictor of binge drinking remains unclear. Recent evidence suggests that one possible reason for…

Although research has documented robust prospective relationships between externalizing symptomatology and subsequent binge drinking among adolescents, the extent to which internalizing symptoms increase risk for drinking remains controversial. In particular, the role of anxiety as a predictor of binge drinking remains unclear. Recent evidence suggests that one possible reason for these mixed findings is that separate dimensions of anxiety may differentially confer risk for alcohol use. The present study tested two dimensions of anxiety - worry and physiological anxiety -- as predictors of binge drinking in a longitudinal study of juvenile delinquents. Overall, results indicate that worry and physiological anxiety showed differential relations with drinking behavior. In general, worry was protective against alcohol use, whereas physiological anxiety conferred risk for binge drinking, but both effects were conditional on levels of offending. Implications for future research examining the role of anxiety in predicting drinking behavior among youth are discussed.
ContributorsNichter, Brandon (Author) / Chassin, Laurie (Thesis advisor) / Barrera, Manuel (Committee member) / Presson, Clark (Committee member) / Arizona State University (Publisher)
Created2014
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The role of common and specific components of internalizing distress in predicting alcohol use among Mexican American adolescents

Description
Mexican American adolescents report high rates of internalizing symptomatology and alcohol use. However, very little research has explored to what extent internalizing distress may contribute to alcohol use among this population. The current study utilized longitudinal data from a community sample of Mexican American adolescents (n=626, 51% female) to test…

Mexican American adolescents report high rates of internalizing symptomatology and alcohol use. However, very little research has explored to what extent internalizing distress may contribute to alcohol use among this population. The current study utilized longitudinal data from a community sample of Mexican American adolescents (n=626, 51% female) to test a series of hypotheses about the role of internalizing distress on alcohol use and misuse. Specifically, this study used a bifactor modeling approach to investigate (1) whether different forms of internalizing distress are composed of common and unique components; (2) whether and to what extent such components confer risk for alcohol use; and (3) whether youth cultural orientation plays a role in these associations. Confirmatory factor analyses revealed that a bifactor model with a general factor and three specific factors (depressed mood, general worry, social anxiety) provided good fit to the data. The general distress factor was significantly associated with past month alcohol use but not binge drinking. However, these effects were conditional based on level of acculturation. Differential relations were found between the specific factors of internalizing distress and alcohol use. Depressed mood predicted past month alcohol use among girls; social anxiety negatively predicted past three month binge drinking among boys. Overall, results highlight the multidimensional nature of internalizing distress and suggest that both common and unique components of internalizing distress may be relevant to the etiology of alcohol use among Mexican-American adolescents. Findings underscore the importance of considering cultural orientation as a moderating factor when investigating substance use among Hispanic youth. Implications for future research examining the etiological relevance of the internalizing pathway to alcohol use among Hispanic adolescents are discussed.
ContributorsNichter, Brandon (Author) / Gonzales, Nancy (Thesis advisor) / Chassin, Laurie (Committee member) / Barrera, Manuel (Committee member) / Tein, Jenn (Committee member) / Arizona State University (Publisher)
Created2018
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Anxiety and Subjective Response to Alcohol: Moderating Effects of Drinking Context and Mediation by Cortisol Response to Alcohol

Description
Anxiety disorder diagnosis is a risk factor for alcohol use disorders (AUDs), but mechanisms of risk are not well understood. Studies show that anxious individuals receive greater negative reinforcement from alcohol when consumed prior to a stressor, but few studies have examined whether anxious individuals receive greater negative (or positive)…

Anxiety disorder diagnosis is a risk factor for alcohol use disorders (AUDs), but mechanisms of risk are not well understood. Studies show that anxious individuals receive greater negative reinforcement from alcohol when consumed prior to a stressor, but few studies have examined whether anxious individuals receive greater negative (or positive) reinforcement from alcohol in a general drinking context (i.e., no imminent stressor). Previous studies have also failed to examine possible moderating effects of specific drinking contexts (e.g., drinking in a group or alone). Finally, no studies have investigated mediating variables that might explain the relationship between anxiety and reinforcement from alcohol, such as physiological response to alcohol (e.g., cortisol response). Data for this study were drawn from a large alcohol administration study (N = 447) wherein participants were randomized to receive alcohol (target peak BAC: .08 g%) or placebo in one of four contexts: group simulated bar, solitary simulated bar, group sterile laboratory, solitary sterile laboratory. It was hypothesized that anxiety would be associated with positive subjective response (SR) under alcohol (above and beyond placebo), indicating stronger reinforcement from alcohol. It was also hypothesized that social and physical drinking context would moderate this relationship. Finally, it was hypothesized that anxiety would be associated with a blunted cortisol response to alcohol (compared to placebo) and this blunted cortisol response would be associated with stronger positive SR and weaker negative SR. Results showed that anxiety was not associated with positive SR in the full sample, but drinking context did moderate the anxiety/SR relationship in most cases (e.g., anxiety was significantly associated with positive SR (stimulation) under placebo in solitary contexts only). There was no evidence that cortisol response to alcohol mediated the relationship between anxiety and SR. This study provides evidence that anxious drinkers expect stronger positive reinforcement from alcohol in solitary contexts, which has implications for intervention (e.g., modification of existing interventions like expectancy challenge). Null findings regarding cortisol response suggest alcohol’s effect on cortisol response to stress (rather than cortisol response to alcohol consumption) may be more relevant for SR and drinking behavior among anxious individuals.
ContributorsMenary, Kyle Robert (Author) / Corbin, William (Thesis advisor) / Chassin, Laurie (Committee member) / Meier, Madeline (Committee member) / Grimm, Kevin (Committee member) / Arizona State University (Publisher)
Created2018
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Investigating adverse effects of adolescent group interventions

Description
This study examined an adverse effect of an adolescent group intervention. Group interventions represent one of the most economical, convenient, and common solution to adolescent behavior problems, although prior findings from program evaluation studies have suggested that these groups can unexpectedly increase the externalizing behaviors that they were designed to…

This study examined an adverse effect of an adolescent group intervention. Group interventions represent one of the most economical, convenient, and common solution to adolescent behavior problems, although prior findings from program evaluation studies have suggested that these groups can unexpectedly increase the externalizing behaviors that they were designed to reduce or prevent. The current study used data from a longitudinal, randomized controlled trial of the Bridges to High School / Puentes a La Secundaria Program, a multicomponent prevention program designed to reduce risk during the middle school transition, which has demonstrated positive effects across an array of outcomes. Data were collected at the beginning of 7th grade, with follow-up data collected at the end of the 7th, 8th, 9th, and 12th grade from a sample of Mexican American adolescents and their mothers. Analyses evaluated long-term effects on externalizing outcomes, trajectories of externalizing behaviors across adolescence, and potential mediators of observed effects. Results showed that the adverse effect that was originally observed based on adolescent self-report of externalizing symptoms at 1-year posttest among youth with high pretest externalizing symptoms was not maintained over time and was not reflected in changes in adolescents' trajectories of externalizing behaviors. Moreover, neither of the peer mediators that theory suggests would explain adverse effects were found to mediate the relationship between intervention status and externalizing symptoms at 1-year posttest. Finally, only beneficial effects were found on externalizing symptoms based on mother report. Together, these findings suggest that the Bridges intervention did not adversely affect adolescent problem behaviors and that future studies should use caution when interpreting unexpected adverse effects.
ContributorsWong, Jessie Jong-Chee (Author) / Gonzales, Nancy A. (Thesis advisor) / West, Stephen G. (Thesis advisor) / Chassin, Laurie (Committee member) / Dishion, Thomas (Committee member) / Arizona State University (Publisher)
Created2015
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Developmental changes in anxiety and social competence in early childhood: exploring growth and the roles of child temperament and gender

Description
This dissertation examined how anxiety levels and social competence change across the course of early elementary school, as well as how individual differences at the transition to kindergarten may influence these trajectories. Previous research has supported unidirectional relations among anxiety and social competence, but few studies explore how inter- and…

This dissertation examined how anxiety levels and social competence change across the course of early elementary school, as well as how individual differences at the transition to kindergarten may influence these trajectories. Previous research has supported unidirectional relations among anxiety and social competence, but few studies explore how inter- and intra-individual changes in social competence and anxiety may be related across time. From a developmental perspective, studying these trajectories following the transition to kindergarten is important, as cognitive and emotion regulation capacities increase markedly across kindergarten, and the relative success with which children navigate this transition can have a bearing on future social and emotional functioning across elementary school. In addition, given gender differences in anxiety manifestation and social competence development broadly, gender differences were also examined in an exploratory manner. Data from parent and teacher reports of a community sample of 291 children across kindergarten, 1st, and 2nd grades were analyzed. Results from bivariate growth models revealed steeper increases in anxiety, relative to peers in the sample, were associated with steeper decreases in social competence across time. This finding held after controlling for externalizing behavior problems at each time point, which suggests that relations among anxiety and social competence may be independent of other behavior problems commonly associated with poor social adjustment. Temperament variables were associated with changes in social competence, such that purportedly "risky" temperament traits of higher negative emotionality and lower attention control were associated with concurrently lower social competence in kindergarten, but with relatively steeper increases in social competence across time. Temperament variables in kindergarten were unrelated with changes in anxiety across time. Gender differences in relations among anxiety in kindergarten and growth in social competence also were revealed. Findings for teacher and parent reports of child behavior varied. Results are discussed with respect to contexts that may drive differences between parent and teacher reports of child behavior, as well as key developmental considerations that may help to explain why kindergarten temperament variables examined herein appear to predict changes in social competence but not changes in anxiety levels.
ContributorsParker, Julia Humphrey (Author) / Pina, Armando A. (Thesis advisor) / Grimm, Kevin (Committee member) / Doane, Leah D. (Committee member) / Valiente, Carlos (Committee member) / Arizona State University (Publisher)
Created2016
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The Intergenerational Transmission of Depressive and Anxiety Problems: Bidirectional Associations, Racial/Ethnic Differences, and the Mediating Role of Family Processes

Description
Depression and anxiety are among the most prevalent psychiatric disorders for adults and adolescents and can be intergenerationally transmitted from parents to their children. Moreover, depressive and anxiety disorders often develop during adolescence. Additionally, family environment and the parent-child relationship are significant predictors of mental health among adolescents. Yet, few…

Depression and anxiety are among the most prevalent psychiatric disorders for adults and adolescents and can be intergenerationally transmitted from parents to their children. Moreover, depressive and anxiety disorders often develop during adolescence. Additionally, family environment and the parent-child relationship are significant predictors of mental health among adolescents. Yet, few studies have considered how adolescent depression and anxiety problems may influence the family environment and mental health of parents. Moreover, even fewer studies have examined how depressive and anxious intergenerational pathways may vary by racial/ethnic status. As such, bidirectional effects of parent and adolescent depressive and anxiety problems were investigated using data from the Adolescent Brain and Cognitive Development (ABCD) study at Time 1 (T1)(Mage = 9.92, n=11,861), Time 2 (T2), and Time 3 (T3). Each follow-up was approximately one-year apart. Multiple path analysis models were used to examined bidirectional associations between parent and adolescent A) depressive problems B) anxiety problems and C) depressive and anxiety problems from T1 to T3 and how family conflict and adolescent-reported parental acceptance at T2 mediated these associations. Measurement invariance testing and multigroup analyses were conducted across non-Hispanic White, Hispanic, and non-Hispanic Black participants to examine if depressive and anxious pathways or measurement differed by racial-ethnic status. Findings revealed that both adolescent and parent depression problems at T1 predicted increases in depression at T3. Greater adolescent or parent anxiety problems at T1 predicted increases in adolescent and parent anxiety problems at T3. Greater family conflict and lower perceived parental acceptance at T2 predicted increases in adolescent depressive problems but did not predict adolescent anxiety problems over time. Parental depressive and anxiety problems at T1 did not predict adolescent-reported parental acceptance at T2 but did predict greater family conflict. Measurement noninvariance was found for family conflict and adolescent depressive problems. Multigroup analyses revealed that the association between both depressive and anxiety problems from T1 to T3 was weaker among Black adolescents compared to White and Hispanic adolescents. In summary, this research contributes valuable insights into the measurement of and relationship between parent and adolescent mental health, family dynamics, and adolescent perceived parental acceptance.
ContributorsJamil, Belal (Author) / Su, Jinni (Thesis advisor) / Doane, Leah (Committee member) / Grimm, Kevin (Committee member) / Arizona State University (Publisher)
Created2024
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Screening, Brief Intervention and Referral to Treatment (SBIRT): Implementation in the Adolescent Inpatient Psychiatric Setting

Description

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and nations. Screening, Brief Intervention (BI) and Referral to Treatment (SBIRT)…

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and nations. Screening, Brief Intervention (BI) and Referral to Treatment (SBIRT) provides an evidence-based (EB) framework to detect and treat SU. Evidence shows that mental health (MH) providers are not providing EB SU management. Federally grant-funded SBIRT demonstrated evidence of decreased SU and prevention of full disorders. Implementation outcomes in smaller-scale projects have included increased clinician knowledge, documentation and interdisciplinary teamwork.

Objective: To improve quality of care (QOC) for adolescents who use substances in the inpatient psychiatric setting by implementing EB SBIRT practices.

Methods: Research questions focused on whether the number of SBIRT notes documented (N=170 charts) increased and whether training of the interdisciplinary team (N=26 clinicians) increased SBIRT knowledge. Individualized interventions used existing processes, training and a new SBIRT Note template. An SBIRT knowledge survey was adapted from a similar study. A pre-and post-chart audit was conducted to show increase in SBIRT documentation. The rationale for the latter was not only for compliance, but also so that all team members can know the status of SBIRT services. Thus, increased interdisciplinary teamwork was an intentional, though indirect, outcome.

Results: A paired-samples t-test indicated clinician SBIRT knowledge significantly increased, with a large effect size. The results suggest that a short, 45-60-minute tailored education module can significantly increase clinician SBIRT knowledge. Auditing screening & BI notes both before and after the study period yielded important patient SU information and which types of SBIRT documentation increased post-implementation. The CRAFFT scores of the patients were quite high from a SU perspective, averaging over 3/6 both pre- and post-implementation, revealing over an 80% chance that the adolescent patient had a SU disorder. Most patients were positive for at least one substance (pre- = 47.1%; post- = 65.2%), with cannabis and alcohol being the most commonly used substances. Completed CRAFFT screenings increased from 62.5% to 72.7% of audited patients. Post-implementation, there were two types of BI notes: the preexisting Progress Note BI (PN BI) and the new Auto-Text BI (AT BI), part of the new SBIRT Note template introduced during implementation. The PN BIs not completed despite a positive screen increased from 79.6% to 83.7%. PN BIs increased 1%. The option for AT BI notes ameliorated this effect. Total BI notes completed for a patient positive for a substance increased from 20.4% to 32.6%, with 67.4% not receiving a documented BI. Total BIs completed for all patients was 21.2% post-implementation.

Conclusion: This project is scalable throughout the U.S. in MH settings and will provide crucial knowledge about positive and negative drivers in small-scale SBIRT implementations. The role of registered nurses (RNs), social workers and psychiatrists in providing SBIRT services as an interdisciplinary team will be enhanced. Likely conclusions are that short trainings can significantly increase clinician knowledge about SBIRT and compliance with standards. Consistent with prior evidence, significant management involvement, SBIRT champions, thought leaders and other consistent emphasis is necessary to continue improving SBIRT practice in the target setting.

Keywords: adolescents, teenagers, youth, alcohol, behavioral health, cannabis, crisis, documentation, drug use, epidemic, high-risk use, illicit drugs, implementation, mental health, opiates, opioid, pilot study, psychiatric inpatient hospital, quality improvement, SBIRT, Screening, Brief Intervention and Referral to Treatment, substance use, unhealthy alcohol use, use disorders
ContributorsMaixner, Roberta (Author) / Guthery, Ann (Thesis advisor) / Mensik, Jennifer (Thesis advisor) / Uriri-Glover, Johannah (Thesis advisor)
Created2019-05-02