A range of risk factors lead to opioid use and substance-related problems (SRP) including childhood maltreatment, elevated impulsivity, and psychopathology. These constructs are highly interrelated such that childhood maltreatment is associated with elevated impulsivity and traumarelated psychopathology such as posttraumatic stress disorder (PTSD), and impulsivity—particularly urgency—and PTSD are related. Prior work has examined the association between these constructs and substance-related problems independently and it is unclear how these multifaceted constructs (i.e., maltreatment types and positive and negative urgency) are associated with one another and SRP. The current study used structural equation modeling (SEM) to examine the relations among childhood maltreatment, trait urgency, PTSD symptoms, and SRP in a sample of individuals with a history of opioid use. An initial model that included paths from each type of childhood maltreatment, positive and negative urgency, PTSD and SRP did not fit the data well. A pruned model with excellent fit was identified that suggested emotional abuse, positive urgency, and negative urgency were directly related to PTSD symptoms and only PTSD symptoms were directly related to SRP. Furthermore, significant indirect effects suggested that emotional abuse and negative urgency were related to SRP via PTSD symptom severity. These results suggest that PTSD plays an important role in the severity of SRP.
Co-occurring adversities are common for young children with child protective services (CPS) involvement, with high rates of intimate partner violence (IPV) exposure in this population. Despite extensive research linking childhood IPV exposure to later psychopathology, fewer studies have examined the prospective associations between IPV exposure and psychopathology using a dimensional approach. Here, we conducted secondary analyses of data from a randomized controlled trial of a parenting intervention for CPS-involved children, examining the associations between early childhood IPV exposure (i.e., threat), co-occurring deprivation, and middle childhood internalizing and externalizing symptoms. Adversity variables were coded from data collected when children were infants ( N = 249, M age = 7.97 months) through 48-month assessments; internalizing and externalizing psychopathology were modeled as latent variables reflecting the mean of data from yearly assessments between ages 8 to 10. Results of our structural equation model demonstrated that, accounting for the effects of co-occurring deprivation, IPV exposure was significantly associated with both internalizing, β = .38, p = .001, and externalizing, β = .26, p = .019, symptoms. Results suggest links between early childhood IPV exposure (i.e., threat) and later psychopathology. Findings support screening and intervention efforts to mitigate the developmental sequelae of IPV exposure among CPS-involved children.
Internalizing problems are common in adolescence and increased substantially during the COVID-19 pandemic. Leveraging data from a U.S. nationally diverse sample of 2,954 adolescents (ages 13-16), we examined the associations between factors at multiple levels of youths’ ecologies – spanning indicators of threat and deprivation – and their depression and anxiety symptoms during the COVID-19 pandemic. Furthermore, we examined how these associations differed by adolescents’ racial/ethnic groups. Consistent with socio-ecological models, we found that indicators of threat and deprivation at the adolescents’ immediate home, and more distal neighborhood environments were associated with their depression and anxiety symptoms. The patterns of associations were similar across racial/ethnic groups in multigroup structural equation models. Additionally, we found that mean levels of internalizing symptoms and socio-ecological predictors significantly differed across racial/ethnic groups. These findings have important implications for understanding multi-level contributors to mental health among adolescents which may inform research, practice, and policy.
Background: Therapists must dedicate considerable time to session plan to implement evidence-based practices (EBPs) flexibly and with fidelity. It is unclear whether public mental health settings offer the structural and organizational support for therapists to engage in session planning or whether public mental health therapists have received session planning training.Methods: In Fall 2022, 18 therapists working in public mental health settings in New York City were recruited through snowball sampling to participate in 90-minute semi-structured qualitative interviews. Therapists were prompted to review their session planning practices using a chart-stimulated recall strategy; to describe structural, organizational, and individual barriers and facilitators to session planning; and, to generate implementation strategies to support their session planning. Qualitative data were analyzed using reflexive thematic analysis. Results: A diverse group of therapists participated in the study—22% identified as Black; 22% as Asian; and 11% as Hispanic/Latinx. Seventy-eight percent of therapists were social workers; and they had on average 6.18 (SD = 5.70) years of clinical experience. The research team identified four multilevel session planning barriers and three multilevel session planning facilitators. Therapists proposed seven multilevel implementation strategies to support their session planning. Overall, therapists indicated that managing high productivity standards, severe clinical presentations, and clients’ social needs often prevent them from having time to plan for sessions and, in turn, to implement EBPs.Conclusion: Efforts to implement EBPs in public mental health settings cannot neglect the structural realities faced by agencies, therapists, and clients. Multilevel strategies to support therapists’ session planning are necessary.
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