Publications

2015
Humphreys, K. L., McGoron, L., Sheridan, M. A., McLaughlin, K. A., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2015). High-Quality Foster Care Mitigates Callous-Unemotional Traits Following Early Deprivation in Boys: A Randomized Controlled Trial. Journal of the American Academy of Child and Adolescent Psychiatry , 54 (12), 977–983.Abstract
OBJECTIVE: Callous-unemotional (CU) traits in childhood are a developmental precursor to psychopathy, yet the origins and etiology of CU traits are not known. We examined CU traits among 12-year-old children exposed to severe early deprivation and evaluated whether a high-quality foster care intervention mitigated the development of high levels of CU traits. METHOD: Participants were from the Bucharest Early Intervention Project, a randomized controlled trial of foster care for children in institutions. Children were recruited from institutions in Bucharest, Romania, along with age- and sex-matched children who were never institutionalized. Children raised in institutional settings were randomized (mean age = 22 months) to either a foster care group (n = 68) or a care-as-usual group (n = 68). CU traits were assessed at age 12.75 years in available participants from the randomized trial (n = 95) and children who were never institutionalized (n = 50). RESULTS: Children who experienced institutional rearing as young children had significantly higher levels of CU traits in early adolescence compared to children who were never institutionalized. Intent-to-treat analysis indicated that, among boys, CU traits were significantly lower among those who received the foster care intervention compared to those randomized to care as usual. Caregiver responsiveness to distress, but not caregiver warmth, mediated the intervention effect on CU traits in boys. CONCLUSION: These findings provide the first evidence to date that psychosocial intervention can prevent the onset of CU traits. Although severe early deprivation predicted higher levels of CU traits, high-quality foster care that emphasized responsive caregiving reduced the impact of deprivation on CU trait development for boys. CLINICAL TRIAL REGISTRATION INFORMATION: The Bucharest Early Intervention Project; http://clinicaltrials.gov; NCT00747396.
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McLaughlin, K. A., Rith-Najarian, L., Dirks, M. A., & Sheridan, M. A. (2015). Low vagal tone magnifies the association between psychosocial stress exposure and internalizing psychopathology in adolescents. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 , 44 (2), 314–328.Abstract
Vagal tone is a measure of cardiovascular function that facilitates adaptive responses to environmental challenge. Low vagal tone is associated with poor emotional and attentional regulation in children and has been conceptualized as a marker of sensitivity to stress. We investigated whether the associations of a wide range of psychosocial stressors with internalizing and externalizing psychopathology were magnified in adolescents with low vagal tone. Resting heart period data were collected from a diverse community sample of adolescents (ages 13-17; N = 168). Adolescents completed measures assessing internalizing and externalizing psychopathology and exposure to stressors occurring in family, peer, and community contexts. Respiratory sinus arrhythmia (RSA) was calculated from the interbeat interval time series. We estimated interactions between RSA and stress exposure in predicting internalizing and externalizing symptoms and evaluated whether interactions differed by gender. Exposure to psychosocial stressors was associated strongly with psychopathology. RSA was unrelated to internalizing or externalizing problems. Significant interactions were observed between RSA and child abuse, community violence, peer victimization, and traumatic events in predicting internalizing but not externalizing symptoms. Stressors were positively associated with internalizing symptoms in adolescents with low RSA but not in those with high RSA. Similar patterns were observed for anxiety and depression. These interactions were more consistently observed for male than female individuals. Low vagal tone is associated with internalizing psychopathology in adolescents exposed to high levels of stressors. Measurement of vagal tone in clinical settings might provide useful information about sensitivity to stress in child and adolescent clients.
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Roberts, A. L., Chen, Y., Slopen, N., McLaughlin, K. A., Koenen, K. C., & Austin, S. B. (2015). Maternal experience of abuse in childhood and depressive symptoms in adolescent and adult offspring: A 21-year longitudinal study. Depression and Anxiety , 32 (10), 709–719.Abstract
BACKGROUND: Intergenerational effects of child abuse have been documented, but it is unknown whether maternal childhood abuse influences offspring mental health in adolescence or adulthood. METHODS: To examine whether maternal experience of childhood abuse is associated with depressive symptoms in adolescent and young adult offspring, we linked data from two large longitudinal cohorts of women (N = 8,882) and their offspring (N = 11,402), and we examined three possible pathways by which maternal experience of abuse might be associated with offspring depressive symptoms: maternal mental health, family characteristics, and offspring's own experience of abuse. RESULTS: Offspring of women who experienced severe versus no childhood abuse had greater likelihood of high depressive symptoms (RR = 1.78, 95% CI = 1.47, 2.16) and persistent high depressive symptoms (RR = 2.47, 95% CI = 1.37, 4.44). Maternal mental health accounted for 20.9% and offspring's exposure to abuse accounted for 30.3% of the elevated risk of high depressive symptoms. Disparities in offspring depressive symptoms by maternal abuse exposure were evident at age 12 years and persisted through age 31 years. CONCLUSIONS: Findings provide evidence that childhood abuse adversely affects the mental health of the victim's offspring well into adulthood. As offspring exposure to abuse and maternal mental health accounted for more than 50% of the elevated risk of high depressive symptoms among offspring of women who experienced abuse, improving maternal mental health and parenting practices may reduce offspring risk for depressive symptoms in these families.
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Green, J. G., Alegría, M., Kessler, R. C., McLaughlin, K. A., Gruber, M. J., Sampson, N. A., & Zaslavsky, A. M. (2015). Neighborhood sociodemographic predictors of Serious Emotional Disturbance (SED) in schools: demonstrating a small area estimation method in the National Comorbidity Survey (NCS-A) Adolescent Supplement. Administration and Policy in Mental Health , 42 (1), 111–120.Abstract
We evaluate the precision of a model estimating school prevalence of SED using a small area estimation method based on readily-available predictors from area-level census block data and school principal questionnaires. Adolescents at 314 schools participated in the National Comorbidity Supplement, a national survey of DSM-IV disorders among adolescents. A multilevel model indicated that predictors accounted for under half of the variance in school-level SED and even less when considering block-group predictors or principal report alone. While Census measures and principal questionnaires are significant predictors of individual-level SED, associations are too weak to generate precise school-level predictions of SED prevalence.
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Hatzenbuehler, M. L., McLaughlin, K. A., & Xuan, Z. (2015). Social networks and sexual orientation disparities in tobacco and alcohol use. Journal of Studies on Alcohol and Drugs , 76 (1), 117–126.Abstract
OBJECTIVE: The purpose of this study was to examine whether the composition of social networks contributes to sexual orientation disparities in substance use and misuse. METHOD: Data were obtained from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative cohort study of adolescents (N = 20,745). Wave 1 collected extensive information about the social networks of participants through peer nomination inventories. RESULTS: Same- and both-sex-attracted youths had higher frequency/quantity of tobacco use in their peer networks than did opposite-sex-attracted youths, and both-sex-attracted youths had higher frequency/quantity of alcohol use and misuse in their peer networks than opposite-sex-attracted youths. Among same- and both-sex-attracted youths, greater frequency/quantity of tobacco use in one's social network predicted greater use of cigarettes. In addition, greater frequency/quantity of peers' drinking and drinking to intoxication predicted more alcohol use and alcohol misuse in the both-sex-attracted group. These social network factors mediated sexual orientation-related disparities in tobacco use for both- and same-sex-attracted youths. Moreover, sexual orientation disparities in alcohol misuse were mediated by social network characteristics for the same-sex and both-sex-attracted youths. Importantly, sexual minority adolescents were no more likely to have other sexual minorities in their social networks than were sexual majority youths, ruling out an alternative explanation for our results. CONCLUSIONS: These findings highlight the importance of social networks as correlates of substance use behaviors among sexual minority youths and as potential pathways explaining sexual orientation disparities in substance use outcomes.
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McLaughlin, K. A., Koenen, K. C., Friedman, M. J., Ruscio, A. M., Karam, E. G., Shahly, V., Stein, D. J., et al. (2015). Subthreshold posttraumatic stress disorder in the world health organization world mental health surveys. Biological Psychiatry , 77 (4), 375–384.Abstract
BACKGROUND: Although only a few people exposed to a traumatic event (TE) develop posttraumatic stress disorder (PTSD), symptoms that do not meet full PTSD criteria are common and often clinically significant. Individuals with these symptoms sometimes have been characterized as having subthreshold PTSD, but no consensus exists on the optimal definition of this term. Data from a large cross-national epidemiologic survey are used in this study to provide a principled basis for such a definition. METHODS: The World Health Organization World Mental Health Surveys administered fully structured psychiatric diagnostic interviews to community samples in 13 countries containing assessments of PTSD associated with randomly selected TEs. Focusing on the 23,936 respondents reporting lifetime TE exposure, associations of approximated DSM-5 PTSD symptom profiles with six outcomes (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate implications of different subthreshold definitions. RESULTS: Although consistently highest outcomes for distress-impairment, suicidality, comorbidity, and PTSD symptom duration were observed among the 3.0% of respondents with DSM-5 PTSD rather than other symptom profiles, the additional 3.6% of respondents meeting two or three of DSM-5 criteria B-E also had significantly elevated scores for most outcomes. The proportion of cases with threshold versus subthreshold PTSD varied depending on TE type, with threshold PTSD more common following interpersonal violence and subthreshold PTSD more common following events happening to loved ones. CONCLUSIONS: Subthreshold DSM-5 PTSD is most usefully defined as meeting two or three of DSM-5 criteria B-E. Use of a consistent definition is critical to advance understanding of the prevalence, predictors, and clinical significance of subthreshold PTSD.
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Jenness, J. L., & McLaughlin, K. A. (2015). Towards a person-centered approach to the developmental psychopathology of trauma. Social Psychiatry and Psychiatric Epidemiology , 50 (8), 1219–1221. PDF
Sumner, J. A., Sheridan, M. A., Drury, S. S., Esteves, K. C., Walsh, K., Koenen, K. C., & McLaughlin, K. A. (2015). Variation in CACNA1C is Associated with Amygdala Structure and Function in Adolescents. Journal of Child and Adolescent Psychopharmacology , 25 (9), 701–710.Abstract
{OBJECTIVE: Genome-wide association studies have identified allelic variation in CACNA1C as a risk factor for multiple psychiatric disorders associated with limbic system dysfunction, including bipolar disorder, schizophrenia, and depression. The CACNA1C gene codes for a subunit of L-type voltage-gated calcium channels, which modulate amygdala function. Although CACNA1C genotype appears to be associated with amygdala morphology and function in adults with and without psychopathology, whether genetic variation influences amygdala structure and function earlier in development has not been examined. METHODS: In this first investigation of the neural correlates of CACNA1C in young individuals, we examined associations between two single nucleotide polymorphisms in CACNA1C (rs1006737 and rs4765914) with amygdala volume and activation during an emotional processing task in 58 adolescents and young adults 13-20 years of age. RESULTS: Minor (T) allele carriers of rs4765914 exhibited smaller amygdala volume than major (C) allele homozygotes ($\beta$=-0.33
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McLaughlin, K. A., Garrad, M. C., & Somerville, L. H. (2015). What develops during emotional development? A component process approach to identifying sources of psychopathology risk in adolescence. Dialogues in Clinical Neuroscience , 17 (4), 403–410.Abstract
Adolescence is a phase of the lifespan associated with widespread changes in emotional behavior thought to reflect both changing environments and stressors, and psychological and neurobiological development. However, emotions themselves are complex phenomena that are composed of multiple subprocesses. In this paper, we argue that examining emotional development from a process-level perspective facilitates important insights into the mechanisms that underlie adolescents' shifting emotions and intensified risk for psychopathology. Contrasting the developmental progressions for the antecedents to emotion, physiological reactivity to emotion, emotional regulation capacity, and motivation to experience particular affective states reveals complex trajectories that intersect in a unique way during adolescence. We consider the implications of these intersecting trajectories for negative outcomes such as psychopathology, as well as positive outcomes for adolescent social bonds.
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Gooding, H. C., Milliren, C., Austin, S. B., Sheridan, M. A., & McLaughlin, K. A. (2015). Exposure to violence in childhood is associated with higher body mass index in adolescence. Child Abuse & Neglect , 50, 151–158. Publisher's VersionAbstract
To determine whether different types of childhood adversity are associated with body mass index (BMI) in adolescence, we studied 147 adolescents aged 13–17 years, 41% of whom reported exposure to at least one adversity (maltreatment, abuse, peer victimization, or witness to community or domestic violence). We examined associations between adversity type and age- and sex-specific BMI z-scores using linear regression and overweight and obese status using logistic regression. We adjusted for potential socio-demographic, behavioral, and psychological confounders and tested for effect modification by gender. Adolescents with a history of sexual abuse, emotional abuse, or peer victimization did not have significantly different BMI z-scores than those without exposure (p\textgreater0.05 for all comparisons). BMI z-scores were higher in adolescents who had experienced physical abuse ($\beta$=0.50, 95% CI 0.12–0.91) or witnessed domestic violence ($\beta$=0.85, 95% CI 0.30–1.40). Participants who witnessed domestic violence had almost 6 times the odds of being overweight or obese (95% CI: 1.09–30.7), even after adjustment for potential confounders. No gender-by-adversity interactions were found. Exposure to violence in childhood is associated with higher adolescent BMI. This finding highlights the importance of screening for violence in pediatric practice and providing obesity prevention counseling for youth.
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2014
Mclaughlin, K. (2014). Developmental Epidemiology. In M. Lewis & K. D. Rudolph (Ed.), Handbook of Developmental Psychopathology (3rd ed. pp. 87-107) . Springer. PDF
Keyes, K. M., Shmulewitz, D., Greenstein, E., McLaughlin, K., Wall, M., Aharonovich, E., Weizman, A., et al. (2014). Exposure to the Lebanon War of 2006 and effects on alcohol use disorders: The moderating role of childhood maltreatment. Drug and Alcohol Dependence , 134, 296–303. Publisher's VersionAbstract
{Background Civilian populations now comprise the majority of casualties in modern warfare, but effects of war exposure on alcohol disorders in the general population are largely unexplored. Accumulating literature indicates that adverse experiences early in life sensitize individuals to increased alcohol problems after adult stressful experiences. However, child and adult stressful experiences can be correlated, limiting interpretation. We examine risk for alcohol disorders among Israelis after the 2006 Lebanon War, a fateful event outside the control of civilian individuals and uncorrelated with childhood experiences. Further, we test whether those with a history of maltreatment are at greater risk for an alcohol use disorder after war exposure compared to those without such a history. Methods Adult household residents selected from the Israeli population register were assessed with a psychiatric structured interview; the analyzed sample included 1306 respondents. War measures included self-reported days in an exposed region. Results Among those with a history of maltreatment, those in a war-exposed region for 30+ days had 5.3 times the odds of subsequent alcohol disorders compared to those exposed 0 days (95%C.I. 1.01–27.76), controlled for relevant confounders; the odds ratio for those without this history was 0.5 (95%C.I. 0.25–1.01); test for interaction: X2=5.28
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Kessler, R. C., Adler, L. A., Berglund, P., Green, J. G., McLaughlin, K. A., Fayyad, J., Russo, L. J., et al. (2014). The effects of temporally secondary co-morbid mental disorders on the associations of DSM-IV ADHD with adverse outcomes in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Psychological Medicine , 44 (08), 1779–1792. Publisher's VersionAbstract
Background. Although DSM-IV attention deficit hyperactivity disorder (ADHD) is known to be associated with numerous adverse outcomes, uncertainties exist about how much these associations are mediated temporally by secondary comorbid disorders. Method. The US National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a national survey of adolescents aged 13–17 years (n = 6483 adolescent–parent pairs), assessed DSM-IV disorders with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Statistical decomposition was used to compare direct effects of ADHD with indirect effects of ADHD through temporally secondary mental disorders (anxiety, mood, disruptive behavior, substance disorders) in predicting poor educational performance (suspension, repeating a grade, below-average grades), suicidality (ideation, plans, attempts) and parent perceptions of adolescent functioning (physical and mental health, interference with role functioning and distress due to emotional problems). Results. ADHD had significant gross associations with all outcomes. Direct effects of ADHD explained most (51.9–67.6%) of these associations with repeating a grade in school, perceived physical and mental health (only girls), interference with role functioning and distress, and significant components (34.5–44.6%) of the associations with school suspension and perceived mental health (only boys). Indirect effects of ADHD on educational outcomes were predominantly through disruptive behavior disorders (26.9–52.5%) whereas indirect effects on suicidality were predominantly through mood disorders (42.8–59.1%). Indirect effects on most other outcomes were through both mood (19.8–31.2%) and disruptive behavior (20.1–24.5%) disorders, with anxiety and substance disorders less consistently important. Most associations were comparable for girls and boys. Conclusions. Interventions aimed at reducing the adverse effects of ADHD might profitably target prevention or treatment of temporally secondary co-morbid disorders.
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Keyes, K. M., Shmulewitz, D., Greenstein, E., McLaughlin, K., Wall, M., Aharonovich, E., Weizman, A., et al. (2014). Exposure to the Lebanon War of 2006 and effects on alcohol use disorders: The moderating role of childhood maltreatment. Drug and Alcohol Dependence , 134, 296–303. Publisher's VersionAbstract
{Background Civilian populations now comprise the majority of casualties in modern warfare, but effects of war exposure on alcohol disorders in the general population are largely unexplored. Accumulating literature indicates that adverse experiences early in life sensitize individuals to increased alcohol problems after adult stressful experiences. However, child and adult stressful experiences can be correlated, limiting interpretation. We examine risk for alcohol disorders among Israelis after the 2006 Lebanon War, a fateful event outside the control of civilian individuals and uncorrelated with childhood experiences. Further, we test whether those with a history of maltreatment are at greater risk for an alcohol use disorder after war exposure compared to those without such a history. Methods Adult household residents selected from the Israeli population register were assessed with a psychiatric structured interview; the analyzed sample included 1306 respondents. War measures included self-reported days in an exposed region. Results Among those with a history of maltreatment, those in a war-exposed region for 30+ days had 5.3 times the odds of subsequent alcohol disorders compared to those exposed 0 days (95%C.I. 1.01–27.76), controlled for relevant confounders; the odds ratio for those without this history was 0.5 (95%C.I. 0.25–1.01); test for interaction: X2=5.28
McLaughlin, K. A., Busso, D. S., Duys, A., Green, J. G., Alves, S., Way, M., & Sheridan, M. A. (2014). Amygdala response to negative stimuli predicts PTSD symptom onset following a terrorist attack. Depression and Anxiety , 31 (10), 834–842.Abstract
OBJECTIVE: Individuals with posttraumatic stress disorder (PTSD) exhibit heightened amygdala reactivity and atypical activation patterns in the medial prefrontal cortex (mPFC) in response to negative emotional information. It is unknown whether these aspects of neural function are risk factors for PTSD or consequences of either trauma exposure or onset of the disorder. We had a unique opportunity to investigate this issue following the terrorist attacks at the 2013 Boston Marathon and the ensuing manhunt and shelter in place order. We examined associations of neural function measured prior to the attack with PTSD symptom onset related to these events. METHODS: A sample of 15 adolescents (mean age = 16.5 years) who previously participated in a neuroimaging study completed a survey assessing posttraumatic symptoms related to the terrorist attack. We examined blood oxygen level dependent (BOLD) response to viewing and actively down-regulating emotional responses to negative stimuli in regions previously associated with PTSD, including the amygdala, hippocampus, and mPFC, as prospective predictors of posttraumatic symptom onset. RESULTS: Increased BOLD signal to negative emotional stimuli in the left amygdala was strongly associated with posttraumatic symptoms following the attack. Reduced bilateral hippocampal activation during effortful attempts to down-regulate emotional responses to negative stimuli was also associated with greater posttraumatic symptoms. Associations of amygdala reactivity with posttraumatic symptoms were robust to controls for pre-existing depression, anxiety, and PTSD symptoms and prior exposure to violence. CONCLUSIONS: Amygdala reactivity to negative emotional information might represent a neurobiological marker of vulnerability to traumatic stress and, potentially, a risk factor for PTSD.
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Myers, B., McLaughlin, K. A., Wang, S., Blanco, C., & Stein, D. J. (2014). Associations between childhood adversity, adult stressful life events, and past-year drug use disorders in the National Epidemiological Study of Alcohol and Related Conditions (NESARC). Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors , 28 (4), 1117–1126.Abstract
Stress sensitization, whereby CA lowers tolerance to later stressors, has been proposed as a potential mechanism explaining the association between exposure to childhood adversities (CA) and drug use disorders in adulthood. However, this mechanism remains untested. This paper begins to address this gap through exploring associations between CA exposure and stressful events in adulthood for predicting drug use disorders. We used data drawn from Wave 2 of the U.S. National Epidemiological Survey of Alcohol and Related Conditions (n = 34,653) to explore whether the association between past-year stressful life events and the 12-month prevalence of disordered cannabis, stimulant, and opiate use varied by the number of types of CA that an individual was exposed to. Past-year stressful life events were associated with an increased risk of cannabis, stimulant, and opiate use disorders among men and women. Exposure to CA was associated with increased risk for disordered cannabis use among men and women and opiate use among men only. Finally, we found significant associations between exposure to CA and past-year stressful life events in predicting disordered drug use, but only for women in relation to disordered stimulant and opiate use. Findings are suggestive of possible stress sensitization effects in predicting disordered stimulant and opiate use among women. Implications of these findings for the prevention and treatment of drug use disorders and for future research are discussed.
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Iverson, K. M., McLaughlin, K. A., Adair, K. C., & Monson, C. M. (2014). Anger-related dysregulation as a factor linking childhood physical abuse and interparental violence to intimate partner violence experiences. Violence and Victims , 29 (4), 564–578.Abstract
OBJECTIVE: Childhood family violence exposure is associated with increased risk for experiencing intimate partner violence (IPV) in adulthood, but the mechanisms underlying this relationship remain inadequately understood. Difficulties with emotion regulation may be one factor that helps to explain this relationship. METHOD: Childhood physical abuse and interparental violence, as well as subsequent IPV experiences, were assessed in a large sample of young adults (N = 670). Several indicators of anger-related dysregulation were also assessed. Structural equation modeling was used to create a latent variable of anger-related dysregulation, which was examined as a potential mediator of the associations between childhood family violence exposure and IPV. RESULTS: Childhood physical abuse and interparental violence were associated with greater physical, sexual, and emotional IPV victimization. Childhood physical abuse and interparental violence were also associated with anger-related dysregulation, which was positively associated with all three types of IPV experiences. Anger-related dysregulation fully mediated the association between witnessing interparental violence and physical IPV. Anger-related dysregulation partially mediated the association between witnessing interparental violence and psychological IPV and the associations of childhood physical abuse with all three forms of IPV. These associations were consistent across gender. CONCLUSIONS: Interventions aimed at reducing IPV risk among survivors of childhood family violence may benefit from including techniques to target anger-related emotion regulation skills.
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Rith-Najarian, L. R., McLaughlin, K. A., Sheridan, M. A., & Nock, M. K. (2014). The biopsychosocial model of stress in adolescence: self-awareness of performance versus stress reactivity. Stress (Amsterdam, Netherlands) , 17 (2), 193–203.Abstract
Extensive research among adults supports the biopsychosocial (BPS) model of challenge and threat, which describes relationships among stress appraisals, physiological stress reactivity, and performance; however, no previous studies have examined these relationships in adolescents. Perceptions of stressors as well as physiological reactivity to stress increase during adolescence, highlighting the importance of understanding the relationships among stress appraisals, physiological reactivity, and performance during this developmental period. In this study, 79 adolescent participants reported on stress appraisals before and after a Trier Social Stress Test in which they performed a speech task. Physiological stress reactivity was defined by changes in cardiac output and total peripheral resistance from a baseline rest period to the speech task, and performance on the speech was coded using an objective rating system. We observed in adolescents only two relationships found in past adult research on the BPS model variables: (1) pre-task stress appraisal predicted post-task stress appraisal and (2) performance predicted post-task stress appraisal. Physiological reactivity during the speech was unrelated to pre- and post-task stress appraisals and to performance. We conclude that the lack of association between post-task stress appraisal and physiological stress reactivity suggests that adolescents might have low self-awareness of physiological emotional arousal. Our findings further suggest that adolescent stress appraisals are based largely on their performance during stressful situations. Developmental implications of this potential lack of awareness of one's physiological and emotional state during adolescence are discussed.
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Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K. (2014). The burden of loss: unexpected death of a loved one and psychiatric disorders across the life course in a national study. The American Journal of Psychiatry , 171 (8), 864–871.Abstract
OBJECTIVE: Unexpected death of a loved one is common and associated with subsequent elevations in symptoms of multiple forms of psychopathology. Determining whether this experience predicts novel onset of psychiatric disorders and whether these associations vary across the life course has important clinical implications. The authors examined associations of a loved one's unexpected death with first onset of common anxiety, mood, and substance use disorders in a population-based sample. METHOD: The relation between unexpected death of a loved one and first onset of lifetime DSM-IV disorders was estimated by using a structured interview of adults in the U.S. general population (analytic sample size=27,534). Models controlled for prior occurrence of any disorder, other traumatic experiences, and demographic variables. RESULTS: Unexpected death of a loved one was the most common traumatic experience and most likely to be rated as the respondent's worst, regardless of other traumatic experiences. Increased incidence after unexpected death was observed at nearly every point across the life course for major depressive episode, panic disorder, and posttraumatic stress disorder. Increased incidence was clustered in later adult age groups for manic episode, phobias, alcohol use disorders, and generalized anxiety disorder. CONCLUSIONS: The bereavement period is associated with elevated risk for the onset of multiple psychiatric disorders, consistently across the life course and coincident with the experience of the loved one's death. Novel associations between unexpected death and onset of several disorders, including mania, confirm multiple case reports and results of small studies and suggest an important emerging area for clinical research and practice.
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McLaughlin, K. A., Sheridan, M. A., Alves, S., & Mendes, W. B. (2014). Child maltreatment and autonomic nervous system reactivity: identifying dysregulated stress reactivity patterns by using the biopsychosocial model of challenge and threat. Psychosomatic Medicine , 76 (7), 538–546.Abstract
{OBJECTIVE: Disruptions in stress response system development have been posited as mechanisms linking child maltreatment (CM) to psychopathology. Existing theories predict elevated sympathetic nervous system reactivity after CM, but evidence for this is inconsistent. We present a novel framework for conceptualizing stress reactivity after CM that uses the biopsychosocial model of challenge and threat. We predicted that in the context of a social-evaluative stressor, maltreated adolescents would exhibit a threat pattern of reactivity, involving sympathetic nervous system activation paired with elevated vascular resistance and blunted cardiac output (CO) reactivity. METHODS: A sample of 168 adolescents (mean age =14.9 years) participated. Recruitment targeted maltreated adolescents; 38.2% were maltreated. Electrocardiogram, impedance cardiography, and blood pressure were acquired at rest and during an evaluated social stressor (Trier Social Stress Test). Pre-ejection period (PEP), CO, and total peripheral resistance reactivity were computed during task preparation, speech delivery, and verbal mental arithmetic. Internalizing and externalizing symptoms were assessed. RESULTS: Maltreatment was unrelated to PEP reactivity during preparation or speech, but maltreated adolescents had reduced PEP reactivity during math. Maltreatment exposure (F(1,145) = 3.8-9.4
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