The United States is in the midst of demographic transformation that will continue to diversify the cultural, ethnic, racial, and linguistic landscape of the country. Within the last decade, millions of immigrant families have emigrated to the U.S. to escape tremendous hardships in their native countries. These families are guided by the hope of creating a stable, safe, and comfortable environment for their children. Unfortunately, the pathway to citizenship and authorized entry into the U.S. is convoluted (Kremer, Moccio,& Hammell, 2009) and families are frequently assigned wait times that can last several years (U.S. Department of State, 2013). These very long wait times are an unfortunate reality for several families, which is one of the many reasons some families enter the U.S. without authorization. Upon arrival into the U.S., many immigrant families experience anti-immigrant attitudes, prejudicial law enforcement practices, and feel socially isolated. The U.S. born children of these immigrant families are at risk for being separated from their parents who lack authorized resident status. In this regard, over 100,000 parents of U.S. citizen children were deported between 1998 and 2007 (U.S. Department of Homeland Security, 2012). However, little is known about how these children cope with the loss of their parents. To date, no research has been conducted that measures the psychosocial impact of parental absence because of aggressive immigration enforcement. Thus, a patent need exists for research on the psychosocial implications of parental absence in a child's life because of deportation. This study addressed the psychosocial impact of parental loss because of aggressive immigration enforcement. All participants of this study completed a demographic questionnaire and two technically adequate standardized psychosocial assessments that measured emotional symptoms. A two-group independent samples design was employed that included a sample of youth who were homeless because their parents were impacted by immigration and customs enforcement and a sample of youth who were homeless for other reasons. The present study sought to answer the following questions: Are there significant differences in emotional symptoms between youth who are living on their own as a result of immigration enforcement in comparison to those youth who are living on their own for other reasons? Are there significant differences in emotional symptoms between U.S. citizen and non-U.S. citizen youth? Do significant differences exist in perceptions of school climate between youth who are living on their own as a result of immigration enforcement in comparison to those youth who are living on their own for other reasons? Is the quality of relationships with parents significantly different between youth who are living on their own as a result of immigration enforcement in comparison to those youth who are living on their own for other reasons? Do significant differences exist in emotional symptoms between youth whose parents have been impacted by immigration and customs enforcement (ICE; Impacted by ICE group) in comparison to youth whose parents have been impacted by immigration enforcement for other reasons (Homeless for Other Reasons group)? Lastly, are there significant differences in perception of school climate between U.S. citizen and non-U.S. citizen youth? Results of this study did not reveal significant differences in emotional symptoms between the Impacted by ICE group and the Homeless for Other Reasons group. However, in terms of how they perceived their relationships with their parents, the Impacted by Immigration group reported more positive relations with their parents. There were significant differences regarding perceptions of school climate between the Impacted by ICE and Homeless for Other Reasons groups. Intra-group analyses within the Impacted by Immigration group indicated significant differences in perceptions of school climate among authorized U.S. citizens and unauthorized non-U.S. citizens. Unauthorized non-U.S. citizens tended to perceive school climate more favorably than U.S. citizens.

Personality pathology, especially antisocial personality disorder (ASPD), often occurs in patients with methamphetamine use disorder (MAUD). However, little is known about potential risk factors for this dual diagnosis, and the impact of this comorbidity on both the severity of MAUD and levels of functional impairment. Casting light on such phenomena may aid in early identification of treatment targets, assist in the management of patients in this particular population, and contribute to development of treatment strategies. This crosssectional study described and compared sociodemographic, clinical and childhood trauma correlates in patients with a dual diagnosis of MAUD and ASPD (MAUD+ASPD) and those with MAUD without ASPD (MAUD-ASPD). The contribution of sociodemographic and childhood trauma variables in predicting membership of the MAUD+ASPD group was also investigated. A sample of 62 adult patients with a primary diagnosis of MAUD took part in the study. A sociodemographic questionnaire was completed and well established diagnostic measures of ASPD (The Mini-International Neuropsychiatric Interview; MINI) and MAUD (Structured Clinical Interview; SCID - 5) were used to determine diagnostic status. Illness severity was evaluated with the Yale-Brown Obsessive Compulsive scale (adapted for MAUD) (Y-BOCS-du) and functional impairment was assessed with the Sheehan Disability Scale (SDS). Histories of exposure and severity of childhood trauma (CT) were measured using the CTQ-SF. Of the 62 participants, 14 (23%) had MAUD and had MAUD+ASPD whereas 48 (77%) had MAUD without ASPD (MAUD-ASPD). Bivariate analyses found significant group differences in terms of gender (df =1) = 8.05; p =< 0.01), language (df = 2) = 7.12; p = 0.03), and level of physical neglect (F(1, 60) = 2.33; M = 9.85; SD = 4.23; p = 0.04). The MAUD+ASPD group members were mostly male (N = 9; 64%), English-speaking and with histories of increased physical neglect. Logistic regression suggested that male gender (beta = 1.08; OR = 8.65; p = 0.01) and English language (beta = 1.55; OR = 11.38; p = 0.03) significantly predicted ASPD comorbidity. There were no significant differences in clinical severity or functional impairment between the MAUD+ASPD and MAUD-ASPD groups. In conclusion, this study indicated that male gender and having English as a first language are associated with MAUD+ASPD but other sociodemographic variables, CT histories and clinical severity and impairment were not. Men who use MA are thus more prone to antisocial behaviour, which complicates their substance use condition. Treatment approaches for MAUD may benefit from developing adaptations that cater for challenges specific to comorbid ASPD. Additionally, the finding regarding first language warrants further investigation. Recommendations for future research are suggested.

Virtually nothing is known about the characteristics used to select foster families. This study examined if and how psychosocial problems, income, education, race and the supply of and demand for foster families are related to the approval of families to foster and the placement of children. Families who were approved and who had a child placed had fewer problems and higher incomes than families who were not approved and who did not have a child placed. Income moderated the effect of problems on placement. Race, education, and supply/demand were not related to approval or placement. In many respects results support the efficacy of the selection process.

Being the victim of school bullying is associated with many negative outcomes, including depression, anxiety, substance abuse, school refusal, and suicide. Peer bystanders are present in the majority of bullying situations and bystander intervention has been found to be very important in ending a bullying incident. However, most of the time bystanders do not step in to help the victim. The present study investigated the impact of parent and family influences on children’s bystander behavior. Seventy-three third- through sixth-grade students were given a questionnaire that asked about their behavior in bullying situations (engaging in bullying behavior, helping or encouraging the bully, defending the victim, or staying away from the situation altogether). Their mothers completed three questionnaires that evaluated symptoms of depression, quality of the parent-child relationship, and parent responses and experiences of anger. Key findings were: (a) parents who were more frustrated with their relationship with their children had children who were less likely to help their peers and were more likely to stay out of the incident. (b) children whose parents were less satisfied with their school were more likely to engage in bullying behavior; (c) the way parents expressed and controlled their own anger predicted whether or not their child would defend a peer; and (d) older children were both more likely to defend their peers and more likely remain uninvolved.

No description available.

Evidências sugerem o envolvimento de um estado de inflamação crônica de baixo grau na fisiopatologia do transtorno bipolar (TB). Os estudos apresentados nesta tese tiveram como objetivo explorar o papel da inflamação crônica nos mecanismos fisiopatológicos do TB através da avaliação dos níveis séricos de proteína C-reativa (PCR). A PCR é um marcador de inflamação sistêmica comumente utilizado na prática clínica, sendo considerado fator de risco para várias patologias, incluindo câncer e doença cardiovascular. O primeiro artigo, através de um estudo de meta-análise, teve como objetivo avaliar o tamanho de efeito da associação entre níveis de PCR em pacientes bipolares nas diferentes fases de humor (n=730) comparado a indivíduos controles (n=888). Pacientes bipolares apresentaram níveis de PCR significativamente elevados em comparação ao grupo controle, com moderado tamanho de efeito (effect size, ES = 0.39; 95% IC, 0.24 – 0.55; P < 0.0001). Níveis de PCR foram significativamente maiores em pacientes maníacos (ES = 0.73; 95% IC, 0.44 – 1.02; P < 0.001) e em eutímicos (ES = 0.26; 95% IC, 0.01 – 0.51; P = 0.04). O segundo artigo se propôs a revisar dados da literatura relacionados a biomarcadores periféricos potencialmente implicados na progressão do TB. Pacientes em diferentes estágios do TB apresentaram níveis alterados de marcadores de estresse oxidativo, neurotrofinas e de inflamação, incluindo a PCR, o que reforça a hipótese da inflamação crônica exercer um papel importante na fisiopatologia do TB. Em seguida, considerando a abordagem multidimensional no TB, o terceiro artigo avaliou a reatividade emocional como uma dimensão relevante para caracterizar pacientes bipolares apresentando sintomas subclínicos de humor durante a fase de remissão (N=613). Apesar de todos pacientes estarem em remissão, a maioria deles (68%) apresentou reatividade emocional anormal (hipo ou hiper-reatividade emocional). Esse estudo avaliou, também, o funcionamento psicossocial nesses pacientes e os níveis de PCR ultra-sensível como um possível marcador objetivo de hiper-reatividade emocional no TB. Os pacientes com hiper-reatividade emocional, em comparação aos pacientes com hipo- ou normal reatividade emocional, apresentaram prejuízo cognitivo e níveis de PCR significativamente mais elevados (P < 0.001). Esses resultados provêm de um estudo transversal e, portanto, conclusões sobre causalidade dessas associações não podem ser inferidas, já que outros fatores, além dos níveis de PCR, podem também contribuir para o estado inflamatório crônico observado nesses pacientes. Em suma, os resultados desta tese sugerem que a inflamação crônica de baixo grau, evidenciada pelas alterações nos níveis de PCR, parece estar implicada na fisiopatologia e na progressão do TB. Novas intervenções terapêuticas com alvo em mecanismos inflamatórios e na modulação dos níveis de PCR devem ser priorizados em estudos futuros. / Evidence suggests that chronic low-grade inflammation appears to be involved in the pathophysiology of bipolar disorder (BD). The studies presented in this thesis aimed at exploring the role of chronic inflammation in the BD pathophysiological mechanisms by assessing serum levels of C-reactive protein (CRP). CRP is a marker of low-grade inflammation widely used in clinical practice, and a risk factor for cardiovascular and malignant diseases. The first article, a meta-analysis, aimed at evaluating the effect size of the association between CRP levels in bipolar patients (n=730) compared to healthy subjects (n=888). Overall, CRP levels were significantly elevated in patients with BD versus controls (effect size, ES = 0.39; 95% CI, 0.24 to 0.55; P < .0001). CRP levels were significantly higher in manic (ES = 0.73; 95% CI, 0.44 to 1.02; P < 0.001) and euthymic (ES = 0.26; 95% CI, 0.01 to 0.51; P = 0.04). The second paper aimed at reviewing the scientific literature regarding peripheral biomarkers potentially implicated in the progression of BD. Bipolar patients within different disease’s stages presented altered levels of oxidative stress, neurotrophins and inflammatory markers, including PCR. These findings reinforce the hypothesis of the potential role of the chronic inflammation in BD pathophysiology. Regarding the multidimensional approach in BD, the third article assessed emotional reactivity as a major dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms (N=613). Although all patients were in remission, most of them (68%) showed abnormal emotional reactivity (hipo- or hyper-reactivity). In addition, this study assessed the psychosocial functioning in these patients as well as the levels of high-sensitivty PCR (hsCRP) as an objective marker of emotional hyper-reactivity in BD. Patients with emotional hyper-reactivity had higher levels of PCR and cognitive impairment compared to patients with emotional hypo or normal emotional reactivity (P < 0.001). This was a crosssectional study of emotional reactivity, hsCRP levels and functional status in remitted bipolar patients, and no conclusions regarding the causality of these associations can be substantiated. Others factors could also be contributing to the chronic inflammatory state in these patients. In conclusion, the results of this thesis suggest that low-grade chronic inflammation, as evidenced by alteration in CRP levels, may be implicated in the pathophysiology as well as in the BD progression. Novel therapeutic interventions targeting inflammatory mechanisms and the modulation of CRP levels should be prioritized in future studies.

No description available.

Evidências sugerem o envolvimento de um estado de inflamação crônica de baixo grau na fisiopatologia do transtorno bipolar (TB). Os estudos apresentados nesta tese tiveram como objetivo explorar o papel da inflamação crônica nos mecanismos fisiopatológicos do TB através da avaliação dos níveis séricos de proteína C-reativa (PCR). A PCR é um marcador de inflamação sistêmica comumente utilizado na prática clínica, sendo considerado fator de risco para várias patologias, incluindo câncer e doença cardiovascular. O primeiro artigo, através de um estudo de meta-análise, teve como objetivo avaliar o tamanho de efeito da associação entre níveis de PCR em pacientes bipolares nas diferentes fases de humor (n=730) comparado a indivíduos controles (n=888). Pacientes bipolares apresentaram níveis de PCR significativamente elevados em comparação ao grupo controle, com moderado tamanho de efeito (effect size, ES = 0.39; 95% IC, 0.24 – 0.55; P < 0.0001). Níveis de PCR foram significativamente maiores em pacientes maníacos (ES = 0.73; 95% IC, 0.44 – 1.02; P < 0.001) e em eutímicos (ES = 0.26; 95% IC, 0.01 – 0.51; P = 0.04). O segundo artigo se propôs a revisar dados da literatura relacionados a biomarcadores periféricos potencialmente implicados na progressão do TB. Pacientes em diferentes estágios do TB apresentaram níveis alterados de marcadores de estresse oxidativo, neurotrofinas e de inflamação, incluindo a PCR, o que reforça a hipótese da inflamação crônica exercer um papel importante na fisiopatologia do TB. Em seguida, considerando a abordagem multidimensional no TB, o terceiro artigo avaliou a reatividade emocional como uma dimensão relevante para caracterizar pacientes bipolares apresentando sintomas subclínicos de humor durante a fase de remissão (N=613). Apesar de todos pacientes estarem em remissão, a maioria deles (68%) apresentou reatividade emocional anormal (hipo ou hiper-reatividade emocional). Esse estudo avaliou, também, o funcionamento psicossocial nesses pacientes e os níveis de PCR ultra-sensível como um possível marcador objetivo de hiper-reatividade emocional no TB. Os pacientes com hiper-reatividade emocional, em comparação aos pacientes com hipo- ou normal reatividade emocional, apresentaram prejuízo cognitivo e níveis de PCR significativamente mais elevados (P < 0.001). Esses resultados provêm de um estudo transversal e, portanto, conclusões sobre causalidade dessas associações não podem ser inferidas, já que outros fatores, além dos níveis de PCR, podem também contribuir para o estado inflamatório crônico observado nesses pacientes. Em suma, os resultados desta tese sugerem que a inflamação crônica de baixo grau, evidenciada pelas alterações nos níveis de PCR, parece estar implicada na fisiopatologia e na progressão do TB. Novas intervenções terapêuticas com alvo em mecanismos inflamatórios e na modulação dos níveis de PCR devem ser priorizados em estudos futuros. / Evidence suggests that chronic low-grade inflammation appears to be involved in the pathophysiology of bipolar disorder (BD). The studies presented in this thesis aimed at exploring the role of chronic inflammation in the BD pathophysiological mechanisms by assessing serum levels of C-reactive protein (CRP). CRP is a marker of low-grade inflammation widely used in clinical practice, and a risk factor for cardiovascular and malignant diseases. The first article, a meta-analysis, aimed at evaluating the effect size of the association between CRP levels in bipolar patients (n=730) compared to healthy subjects (n=888). Overall, CRP levels were significantly elevated in patients with BD versus controls (effect size, ES = 0.39; 95% CI, 0.24 to 0.55; P < .0001). CRP levels were significantly higher in manic (ES = 0.73; 95% CI, 0.44 to 1.02; P < 0.001) and euthymic (ES = 0.26; 95% CI, 0.01 to 0.51; P = 0.04). The second paper aimed at reviewing the scientific literature regarding peripheral biomarkers potentially implicated in the progression of BD. Bipolar patients within different disease’s stages presented altered levels of oxidative stress, neurotrophins and inflammatory markers, including PCR. These findings reinforce the hypothesis of the potential role of the chronic inflammation in BD pathophysiology. Regarding the multidimensional approach in BD, the third article assessed emotional reactivity as a major dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms (N=613). Although all patients were in remission, most of them (68%) showed abnormal emotional reactivity (hipo- or hyper-reactivity). In addition, this study assessed the psychosocial functioning in these patients as well as the levels of high-sensitivty PCR (hsCRP) as an objective marker of emotional hyper-reactivity in BD. Patients with emotional hyper-reactivity had higher levels of PCR and cognitive impairment compared to patients with emotional hypo or normal emotional reactivity (P < 0.001). This was a crosssectional study of emotional reactivity, hsCRP levels and functional status in remitted bipolar patients, and no conclusions regarding the causality of these associations can be substantiated. Others factors could also be contributing to the chronic inflammatory state in these patients. In conclusion, the results of this thesis suggest that low-grade chronic inflammation, as evidenced by alteration in CRP levels, may be implicated in the pathophysiology as well as in the BD progression. Novel therapeutic interventions targeting inflammatory mechanisms and the modulation of CRP levels should be prioritized in future studies.

Evidências sugerem o envolvimento de um estado de inflamação crônica de baixo grau na fisiopatologia do transtorno bipolar (TB). Os estudos apresentados nesta tese tiveram como objetivo explorar o papel da inflamação crônica nos mecanismos fisiopatológicos do TB através da avaliação dos níveis séricos de proteína C-reativa (PCR). A PCR é um marcador de inflamação sistêmica comumente utilizado na prática clínica, sendo considerado fator de risco para várias patologias, incluindo câncer e doença cardiovascular. O primeiro artigo, através de um estudo de meta-análise, teve como objetivo avaliar o tamanho de efeito da associação entre níveis de PCR em pacientes bipolares nas diferentes fases de humor (n=730) comparado a indivíduos controles (n=888). Pacientes bipolares apresentaram níveis de PCR significativamente elevados em comparação ao grupo controle, com moderado tamanho de efeito (effect size, ES = 0.39; 95% IC, 0.24 – 0.55; P < 0.0001). Níveis de PCR foram significativamente maiores em pacientes maníacos (ES = 0.73; 95% IC, 0.44 – 1.02; P < 0.001) e em eutímicos (ES = 0.26; 95% IC, 0.01 – 0.51; P = 0.04). O segundo artigo se propôs a revisar dados da literatura relacionados a biomarcadores periféricos potencialmente implicados na progressão do TB. Pacientes em diferentes estágios do TB apresentaram níveis alterados de marcadores de estresse oxidativo, neurotrofinas e de inflamação, incluindo a PCR, o que reforça a hipótese da inflamação crônica exercer um papel importante na fisiopatologia do TB. Em seguida, considerando a abordagem multidimensional no TB, o terceiro artigo avaliou a reatividade emocional como uma dimensão relevante para caracterizar pacientes bipolares apresentando sintomas subclínicos de humor durante a fase de remissão (N=613). Apesar de todos pacientes estarem em remissão, a maioria deles (68%) apresentou reatividade emocional anormal (hipo ou hiper-reatividade emocional). Esse estudo avaliou, também, o funcionamento psicossocial nesses pacientes e os níveis de PCR ultra-sensível como um possível marcador objetivo de hiper-reatividade emocional no TB. Os pacientes com hiper-reatividade emocional, em comparação aos pacientes com hipo- ou normal reatividade emocional, apresentaram prejuízo cognitivo e níveis de PCR significativamente mais elevados (P < 0.001). Esses resultados provêm de um estudo transversal e, portanto, conclusões sobre causalidade dessas associações não podem ser inferidas, já que outros fatores, além dos níveis de PCR, podem também contribuir para o estado inflamatório crônico observado nesses pacientes. Em suma, os resultados desta tese sugerem que a inflamação crônica de baixo grau, evidenciada pelas alterações nos níveis de PCR, parece estar implicada na fisiopatologia e na progressão do TB. Novas intervenções terapêuticas com alvo em mecanismos inflamatórios e na modulação dos níveis de PCR devem ser priorizados em estudos futuros. / Evidence suggests that chronic low-grade inflammation appears to be involved in the pathophysiology of bipolar disorder (BD). The studies presented in this thesis aimed at exploring the role of chronic inflammation in the BD pathophysiological mechanisms by assessing serum levels of C-reactive protein (CRP). CRP is a marker of low-grade inflammation widely used in clinical practice, and a risk factor for cardiovascular and malignant diseases. The first article, a meta-analysis, aimed at evaluating the effect size of the association between CRP levels in bipolar patients (n=730) compared to healthy subjects (n=888). Overall, CRP levels were significantly elevated in patients with BD versus controls (effect size, ES = 0.39; 95% CI, 0.24 to 0.55; P < .0001). CRP levels were significantly higher in manic (ES = 0.73; 95% CI, 0.44 to 1.02; P < 0.001) and euthymic (ES = 0.26; 95% CI, 0.01 to 0.51; P = 0.04). The second paper aimed at reviewing the scientific literature regarding peripheral biomarkers potentially implicated in the progression of BD. Bipolar patients within different disease’s stages presented altered levels of oxidative stress, neurotrophins and inflammatory markers, including PCR. These findings reinforce the hypothesis of the potential role of the chronic inflammation in BD pathophysiology. Regarding the multidimensional approach in BD, the third article assessed emotional reactivity as a major dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms (N=613). Although all patients were in remission, most of them (68%) showed abnormal emotional reactivity (hipo- or hyper-reactivity). In addition, this study assessed the psychosocial functioning in these patients as well as the levels of high-sensitivty PCR (hsCRP) as an objective marker of emotional hyper-reactivity in BD. Patients with emotional hyper-reactivity had higher levels of PCR and cognitive impairment compared to patients with emotional hypo or normal emotional reactivity (P < 0.001). This was a crosssectional study of emotional reactivity, hsCRP levels and functional status in remitted bipolar patients, and no conclusions regarding the causality of these associations can be substantiated. Others factors could also be contributing to the chronic inflammatory state in these patients. In conclusion, the results of this thesis suggest that low-grade chronic inflammation, as evidenced by alteration in CRP levels, may be implicated in the pathophysiology as well as in the BD progression. Novel therapeutic interventions targeting inflammatory mechanisms and the modulation of CRP levels should be prioritized in future studies.

No description available.