A Dimensional Model of Psychopathology Among Homeless Adolescents: Suicidality, Internalizing, and Externalizing Disorders

Abstract

The present study examined associations among dimensions of suicidality and psychopathology in a sample of 428 homeless adolescents (56.3% female). Confirmatory factor analysis results provided support for a three-factor model in which suicidality (measured with lifetime suicidal ideation and suicide attempts), internalizing disorders (assessed with lifetime diagnoses of major depressive episode and post-traumatic stress disorder), and externalizing disorders (indicated by lifetime diagnoses of conduct disorder, alcohol abuse, and drug abuse) were positively intercorrelated. The findings illustrate the utility of a dimensional approach that integrates suicidality and psychopathology into one model. KeywordsPsychopathology; Suicidality; Internalizing; Externalizing; Homeless adolescents Dimensions of adolescent suicidality and psychopathology are of increased concern to clinicians and researchers (Bridge et al. 2006;Verona et al. 2004). This interest can be attributed to the relatively high prevalence of adolescent suicidal ideation and suicide attempts (Evans et al. 2005) and to suicide being the third leading cause of death among youths ages 15-24 in the USA (Hoyert et al. 2006). Research also indicates both suicidal ideation and suicide attempts increase the risk for completed suicide (Brown et al. 2000). This pattern of increased liability for suicide risk has led to a broader conceptualization of a suicide spectrum ranging from suicidal ideation to attempted and completed suicide (Lewinsohn et al. 1996).Moreover, psychiatric disorders are among the strongest correlates of adolescent suicidality (Bridge et al. 2006). Mood disorders are robust correlates, but post-traumatic stress disorder, conduct disorder, and substance use disorders are also associated with suicidality (Bridge et al. 2006;Evans et al. 2004). Krueger (1999), informed by the work of Achenbach (Achenbach and McConaughy 1997), developed a dimensional model of psychopathology and clustered psychiatric diagnoses into internalizing and externalizing disorders. As specific psychiatric disorders from both clusters are related to suicidal ideation and attempts, there is interest in linking the suicide spectrum to these broader dimensions of psychopathology (Hills et al. 2005;Verona et al. 2004).Our study expands on this work by including the internalizing and externalizing dimensions of psychopathology in a structural model of adolescent suicidality using a sample of homeless adolescents. Suicidality is measured with lifetime suicidal ideation and suicide attempts, internalizing psychopathology with lifetime diagnoses of major depressive episode and posttraumatic stress disorder, and externalizing psychopathology with lifetime diagnoses of conduct disorder, alcohol abuse, and drug abuse. We use confirmatory factor analysis to examine covariances among dimensions of suicidality, internalizing, and externalizing disorders. Internalizing and Externalizing DisordersAchenbach used an empirical approach to derive two broad dimensions (internalizing...

Improving youth mental health through family-based prevention in family homeless shelters

“…While this number is lower than estimates found in existing studies of homeless adolescents (Rew et al, 2001; Yoder et al, 2008a; 2008b), a sizable number of youth reported psychological distress nonetheless. These findings confirm previous research involving homeless youth, and suggest there is a specific need for prevention and intervention efforts to target youth living with their families in temporary housing.…”

“…Thoughts of self-harm and suicidal acts are highly associated with mental health disorders including major depressive disorder, posttraumatic stress disorder, and substance abuse (Yoder, Longley, Whitbeck, & Hoyt, 2008b), and are the third cause of death among youth 12 to 18 years of age (National Center for Injury Prevention and Control, 2009). In fact, exposure to violence and victimization has been linked to an increased risk for suicidal ideation among adolescents (Chemtob et al, 2011; Turner et al, 2012; Wolitzky-Taylor et al, 2009), as has youth substance abuse (Gould et al, 1998; Vermeiren et al, 2003, Wolitzky-Taylor et al, 2009).…”

“…One recent study found over two-thirds of youth endorsed one or more indicators of intent to self-harm (Yoder et al, 2008a, 2008b), and a second study found approximately 35% of adolescents had thought seriously about suicide, with 12% attempting suicide on one or more occasions (Rew et al, 2001). However, there is little knowledge about suicide risk among sheltered youth living with their families, as the samples in these studies tend to be runaways, youth who were forced out of their homes, or who live on the streets.…”

“…While there has been an increased focus upon suicidal risk among homeless youth (Rew, Taylor-Seehafer, & Fitzgerald, 2001; Yoder, Whitbeck, & Hoyt, 2008a; Yoder, Longley, Whitbeck, & Hoyt, 2008b), research focusing on self-harm among youth living in family shelters is rare. Further, little is known about effective interventions to decrease thoughts of self-harm among this subpopulation of homeless youth.…”

Change in Parent- and Child-Reported Internalizing and Externalizing Behaviors Among Substance Abusing Runaways: The Effects of Family and Individual Treatments

“…Other studies of both street and shelter recruited youth up to age 19 report that three-quarters of runaway and homeless youth meet life-time criteria for conduct disorder (Yoder, Whitbeck, & Hoyt, 2008; Yu, North, LaVesser, Obsborne, & Spitznagel, 2008). Yoder, Longley, Whitbeck and Hoyt (2008) noted that internalizing and externalizing disorders could indicate suicidality, highlighting the importance of screening this high risk group of adolescents for intervention.…”