Theses, Dissertations, and Doctoral Papers
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Browsing Theses, Dissertations, and Doctoral Papers by Author "Aalsma, Matthew C."
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Item Daily Experiences of Racial Microaggressions and Health Outcomes Among Black Adolescents: A Daily Diary Study(2023-08) Clifton, Richelle Lee; Zapolski, Tamika C. B.; Stewart, Jesse C.; Johnson, India R.; Aalsma, Matthew C.Racial microaggressions are associated with multiple negative health outcomes, including increased distress, anxiety (Blume et al., 2012; Schoulte et al., 2011), and substance use (Su et al., 2019). The negative effects of racial microaggressions have been observed through daily assessments (Burrow & Ong, 2010; Ong et al., 2009; Swim et al., 2003). However, these studies have been conducted almost exclusively among Black adults. Thus, the first aim of the current study is to examine the impact of daily experiences of racial microaggressions on health outcomes among Black adolescents. Further, it is also important to examine factors that might influence the relationship between racial microaggressions and health outcomes. One factor that has received a considerable amount of attention is racial identity, with more recent studies examining the impact of racial identity profiles. Thus, the second aim of the current study was to explore variability in these risk pathways based on racial identity profiles. Participants were Black adolescents (N = 48; 79.2% girls; Mage=17.13). Respondents completed measures of racial identity at baseline and daily diary measures of racial microaggressions, depression, anxiety, aggression, and substance use for 14 days. Participants reported an average of 5.56 experiences of racial microaggressions per day. Neither concurrent or lagged-day associations between racial microaggressions and symptoms of depression or symptoms of anxiety were significant. Concurrent analyses indicated that the between-person effect of racial microaggressions on aggression was significant (estimate=0.345, SE=0.138, t=2.495, p=0.016), and that effect was still evident one day later (estimate=0.107, SE=0.040, t=2.686, p=0.007). The concurrent, within-person effect of racial microaggressions on cannabis use was also significant (OR=1.524, 95%CI[0.103, 0.740], p=0.010). Four racial identity profiles were identified (labeled race- focused, undifferentiated, integrationist, and multiculturalist) and a number of effects were significant within profiles. This study further highlighted that Black youth are experiencing an overwhelming number of racial microaggressions on a daily basis. Additionally, this project represents a crucial step in advancing our understanding of how racial microaggressions operate to influence health outcomes among Black adolescents on the daily level and highlights several areas for needed study and intervention.Item Deliberate Self-Harm in Young Children(2020-08) Lewis, Lisa McConnell; Adamek, Margaret E.; Vernon, Robert; Aalsma, Matthew C.; Walton, BettyWhile deliberate self-harm (DSH) in adolescents and adults has been established as a reliable predictor of future suicidal behavior and attempts, whether the same is true for younger children has rarely been studied. Two separate articles will address issues regarding intentional self-injury in young children. The first identified describes the demographic profile of young children who engage in NSSI and evaluated whether predictors of adolescent NSSI are also associated with NSSI in children. The second manuscript analyzed NSSI behaviors to see if they can be correctly predicted from knowledge of a child's history of maltreatment to identify which trauma variables are central in prediction of NSSI status. A Chi-square and logistic regression were run on data from 16,271 records of children ages 5-9 years who received services from the IDMHA in 2018. NSSI was significantly (p < .000) associated with trauma history (x2 = 75.54, df = 1), anxiety (x2 = 107.59, df = 1), depression (x2 = 217.011, df = 1), suicide risk (x2= 993, df = 1), and impulsivity (x2 = 122.49, df = 1. Presence of a caregiver mental health problem (x2 =38.29, df = 1), age (x2 = 14.18, df = 4), being male (x2 = 11.59, df = 1), and being Caucasian (x2 = 23.29, df = 6) at p < .05. Regression results indicated the overall model of seven predictors (sexual abuse [OR 1.14], physical abuse [OR 1.26], emotional abuse [OR1.3], neglect [OR .895], medical trauma [OR 1.34], exposure to natural disaster [OR 1.81] and victim of a crime [1.14] was statistically reliable in distinguishing between children who self-injure and those who do not. [-2 Log Likelihood = 6228.78, x2(6) = 105.416, p < .000]. NSSI does occur in preadolescent children and while there is some indication that the risk factors and co-variates are like those of adolescents, there are some differences which need further study. Training clinicians to inquire about self-injury during assessment of younger children is a simple step. The variables of age and sex throughout development as well as identifying protective as well as risk factors with children should be studied.Item Mental health and substance-related treatment utilization, dropout, and continuity of care among detained adolescents: a 14-year longitudinal study(2015-07-07) White, Laura Morgan; McGrew, John H.; Aalsma, Matthew C.; McGuire, Alan B.; Salyers, Michelle P.Although approximately 60%-80% of detained adolescents have a psychiatric disorder, little is known about their utilization of mental health and substance-related treatment services upon release from detention. Given that treatment can potentially reduce symptomology and recidivism, the study examined detained adolescents’ post-detention treatment utilization and longitudinal patterns of use. Data were abstracted from the electronic juvenile justice records and medical records of 9664 detained adolescents (62.7% male; 34.8% White, 65.2% Black; 72.6% with disorder) with Medicaid coverage held in a Midwestern detention center at some time during 1998-2011. A series of statistical tests (e.g., chi-square, ANOVA, logistic regression, Kaplan-Meier survival analyses, Cox regression) were conducted to identify group differences in treatment utilization during the 14-year follow-up period. Following detention release, approximately 66.2% of adolescents were re-arrested and 54.9% were re-detained/incarcerated. Treatment utilization within two years post-detention was 36.7%; 31.4% obtained mental health treatment, 10.4% obtained substance-related treatment, 36.0% obtained outpatient treatment, and 6.2% obtained non-outpatient treatment. Among treatment users, 22.5% dropped out of treatment within 1-3 sessions and 40.6% experienced gaps (>45 days) between treatment services. Treatment utilization was significantly higher among males, White (vs. Black) adolescents, younger adolescents, violent (vs. non-violent) offenders, recidivists (vs. non-recidivists), and adolescents with mental disorders (vs. substance-related disorders). Variables associated with increased likelihood of post-detention treatment included: male gender, psychiatric disorder(s), pre-detention arrest(s), charge severity, violent offender, incarceration, and pre-detention treatment; age and Black race were associated with decreased likelihood of treatment. As one of the only longitudinal studies to examine treatment utilization among detained adolescents upon community reentry, findings suggest limited service utilization, as well as treatment gaps and disparities. Future research should focus on the treatment needs of detained adolescents, factors associated with disparities, and programs/policies to ensure consistent identification, referral, and connection to care for detained adolescents.Item TRAJECTORIES OF PARENTS’ EXPERIENCES IN DISCOVERING, REPORTING, AND LIVING WITH THE AFTERMATH OF MIDDLE SCHOOL BULLYING(2010-06-01T16:49:47Z) Brown, James Roger; Adamek, Margaret E.; Chang, Valerie Nash; Chism, Nancy; Sloan, Rebecca S.; Blackman, Lorraine; Aalsma, Matthew C.Bully victimization takes place within a social context of youths’ parents, peers, teachers, school administrators, and community. Victims often rely on parents, educators, or peers for support. However, there is a gap in the literature in understanding parents’ experiences of what occurs before, during, and after reporting bullying to school officials. Therefore, this dissertation study examined parents’ experiences in discovering, reporting, and living through the aftermath of their child being bullied. This study used a purposeful sample that was criterion-based. Nine mothers and one mother/father pair were tape-recorded using face-to-face semi-structured interviews. Follow-up phone interviews followed. Key themes and patterns were analyzed using the philosophical method of interpretive phenomenology based on Heidegger’s philosophy of being. Exemplars were used to illuminate several themes. Results suggest three unique stages. In the first stage, discovery, parents often noticed psychosocial changes in their child related to bullying. Parents often responded initially by providing advice to their children. When signs of their schoolchildren being bullied persisted, parents decided to report the incidents to school officials. Nine parents reported incomplete interventions that let their youths’ victimization continue. One parent, a paradigm case, shared understandings of how her son’s school official provided a full intervention that was restorative. However, all other parents who received an incomplete intervention found themselves rethinking how to protect their children from bullying. In this aftermath, several parents moved their children out of the school into a new district or began to home school. However, half the parents were left unable to move their child and therefore could not provide protection. Indiana’s anti-bullying law was unknown to eight parents and was unsuccessful in leveraging protection for one parent who used it with school officials as a threat. School official’s responses to bullying were incongruent with student handbook procedures. Recommendations from a parent’s perspective indicate school officials must: 1) have a clear process in place for parents to report, 2) follow through by calling parents back with results from investigating and procedures that will be taken to intervene, and 3) call the bullies’ and victims’ parents to notify what has occurred and what will be done to ensure safety. Discussed are implications for school officials, including social workers, and state policymakers. There is a proposed intervention model (Appendix J) that addresses how parents can respond to school officials who are hesitant to provide bullied youth protection.Item The unfolding depressive symptoms, disease self-management, and treatment utilization for Latina adolescents(2018-06-18) Stafford, Allison McCord; Draucker, Claire Burke; Aalsma, Matthew C.; Bigatti, Silvia M.; Oruche, UkamakaLatina adolescents are more likely to suffer from depressive symptoms and less likely to receive mental health services for depression than their White peers, and this mental health disparity is poorly understood. The purpose of this dissertation study is to describe how Latina adolescents experience and seek mental health services for their depressive symptoms. The dissertation includes three components. The first is an integrative literature review to determine which cultural stressors are associated with depressive symptoms among Latino/a youth. The results indicate that discrimination, family culture conflict, acculturative and bicultural stress, intragroup rejection, immigration stress, and context of reception are associated with depressive symptoms in this population. The second and third components were based on interviews with 25 Latinas (ages 13-20) who experienced depressive symptoms during adolescence. In the second component, a content analysis was conducted to determine cultural stressors experienced by contemporary Latinas living in a tumultuous sociopolitical climate in the United States. The stressors included (a) pressure to succeed, (b) parental oversight, (c) being treated differently, and (d) fears of deportation. In the third component, grounded theory methods were used to develop a theoretical framework to describe the process by which Latina adolescents self-managed and sought treatment for depressive symptoms. In this framework, participants shared a psychosocial problem labeled Being Overburdened and Becoming Depressed. They responded to this problem through the psychosocial process labeled Getting a Grip on My Depression, which consisted of five phases: 1) hiding my depression, 2) keeping my depression under control, 3) having my depression revealed, 4) skirting treatment for my depression, and 5) deciding to move on from depression. The Latino family, peer groups, and mainstream authorities influenced the participants’ experiences. The process of experiencing, self-managing, and seeking treatment for depressive symptoms for Latina adolescents is both similar to and unique from the processes by which other groups of adolescents experience depressive symptoms. These results will contribute to the development of culturally-sensitive strategies to prevent, identify, and treat depressive symptoms in Latina adolescents.