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PSYCHOPATHOLOGICAL CORRELATES OF RISK FOR ADOLESCENTS IN SECURE TREATMENT ©ARIANA MCCULLOCH B.A., University of Lethbridge, 1998 A Thesis Submitted to the School of Graduate Studies of the University of Lethbridge In Partial Fulfillment of the Requirements for the Degree MASTER OF EDUCATION COUNSELLING PSYCHOLOGY FACULTY OF EDUCATION LETHBRIDGE, ALBERTA March 2005 ABSTRACT This research utilized data concerning adolescents at imminent risk for harm confined to the Edmonton and Lethbridge secure treatment centres in Alberta. Once screened for inclusion criteria in a single stage, non-random convenience sampling protocol, 210 files were included in the study. From these files, the adolescents' psychopathological diagnoses, Suicide Probability Scale (SPS) scores as well as other demographic data (including age, gender, ethnicity and previous suicide attempts) were recorded. This research was designed to delineate the characteristics of adolescents admitted to secure treatment, examine the overall suicide risk in this sample, investigate the relationship between study variables via crosstabulation and chi-square analysis, and to determine which independent variable/s best predicted suicide risk via ANOVA and multiple linear regression analysis. Analysis results indicated that the sample was predominantly comprised of female adolescents, Caucasian ethnicity and was aged between 13 and 15 years. The majority of adolescents with suicide history information available in their file had previously attempted suicide. Youth demonstrated an average of 2.7 psychopathological diagnoses, the most frequent of which were conduct disorder, substance abuse, depression, adjustment disorder and parent child relational disorder. The majority of youth were in the moderate suicide risk category from SPS scores. Multiple linear regression analysis determined that the diagnoses of adjustment disorder and depression were found to be predictive of increased suicide risk scores, as was gender (females had higher risk scores), age (younger adolescents had higher risk scores) and previous suicide attempts. Those in the "other" ethnicity category demonstrated lower suicide risk scores. iii ACKNOWLEDGEMENTS A major undertaking such as this cannot be made solely via the endeavours of one individual. I have been blessed with support from many different people through the years that I have been working on my degree and thesis. First and foremost, this thesis is dedicated to my husband, Stewart. Despite the trials of separation for the duration of my degree and the ensuing difficulties, his support and understanding has never wavered. I could never have undertaken something of this magnitude without him being there for me. My gratitude cannot be fully expressed in words and so I simply say thank you. Thanks also go out to my friends and in-laws for their support, understanding and patience while I was working on my thesis. Thank you to my Mom for consistently asserting that I could achieve anything. My Grandmother provided the impetus from when I was a child to further my education and her support has never wavered. For their aid and support throughout our years together, thank you to my classmates and confidants Deb, Kim, Norma and Terra. I cannot begin to put words together to express my gratitude for helping me maintain clarity and focus. Thank you also to Kris Magnusson for his support. Many thanks go to my dear friend Trudy who has shown me the meaning of friendship and support throughout not only this thesis but my entire degree. Thank you very much to committee member, Mike Basil, for his assistance in this process, especially statistical analysis, and for making himself available to me for bouncing off ideas and answering questions. There is no doubt in my mind that he made the process a lot less stressful for me than it would have been without his support and assistance. iv I must also give my thanks to Kerry Bernes in his role as supervisor for this thesis, for his assistance in getting funding for this study, for his guidance in presenting it nationally and for his patience with the time it took me to complete it all though he was on sabbatical. Thanks to Joy Mueller at the Edmonton Secure Treatment Centre who aided in gathering data from Edmonton and was very supportive of my endeavours and interested in the results. My gratitude also goes out to all other staff at this centre who enthusiastically gave me time and space despite the inconvenience of the many days that I was in the way gathering data. Thanks also to Kerry and Jenn Bernes for assistance with files from the Lethbridge Secure Treatment Centre and for providing the time and space to review these files as well. Thanks to Clarence Carter of the CCA for allowing me to present my preliminary results at the CCA National Conference. This venue was an amazing opportunity for me to receive feedback on my preliminary results and therefore strengthen my thesis. Finally, this study was funded by the REE and the SSHRC, which made it possible for me to gather data in Edmonton and present preliminary results in Halifax. It would not have been financially feasible for me to do this otherwise and as such I am extremely appreciative for the receipt of this funding. v TABLE OF CONTENTS APPROVAL PAGE ii ABSTRACT iii ACKNOWLEDGEMENTS iv TABLE OF CONTENTS vi LIST OF TABLES x LIST OF FIGURES xi CHAPTER 1: INTRODUCTION 1 CHAPTER 2: LITERATURE REVIEW 6 Adolescent Risk 6 Psychopathology 10 Psychopathological Diagnoses Definitions Relevant to Current Study 14 Theoretical Basis 17 Aggression 19 Epidemiology 21 Prevalence 21 Gender 22 Ethnicity 23 Theoretical Basis 24 Risk Factors 30 Suicide 31 vi Firearms. 31 Abuse/Neglect 32 Psychopathology 33 Substance Abuse 34 Screening Methods 35 Structured Assessment of Violence Risk in Youth 38 Reliability and validity 42 Critical summary 44 Treatment 46 Medication 46 Cognitive Behavioral Therapy 47 Family Therapy 48 Massage Therapy 49 Suicide 51 Epidemiology 52 Prevalence 53 Gender 57 Ethnicity 59 Theoretical Basis 60 Risk Factors 69 Aggression 69 Firearms 70 Life Stressors 72 vii Sexual Orientation 73 Previous Suicide Attempts 75 Psychopathology 78 Screening Methods 82 Suicide Probability Scale 86 Standardization 89 Theoretical basis 90 Reliability 91 Validity 92 Literature review 94 Critical summary 95 Treatment 99 Cognitive Behavioral Therapy 102 Family Therapy 103 Supportive Therapy 104 Medication 105 Secure Treatment 108 Summary 112 Research Goals 114 Hypotheses 115 CHAPTER 3: METHOD 117 Research Design 117 Sample 117 viii Data Collection 118 Data Analysis 119 Limitations 121 CHAPTER 4: RESULTS 123 Descriptive Statistics 124 Relationship between Study Variables and Risk 133 Multiple Regression Analysis 141 Summary 143 CHAPTER 5: DISCUSSION 146 Results Summary 147 Limitations 154 Implications for Psychological Practice 156 Recommendations for Future Research 160 Conclusion 162 REFERENCES 164 APPENDICES 187 A: Ethics Approval University of Lethbridge 187 B: Ethics Approval Edmonton Secure Treatment 188 C: Ethics Approval Lethbridge Secure Treatment 191 D: Sworn Statement Province of Alberta; Researcher 192 E: Sworn Statement Province of Alberta; Research Assistant 193 ix LIST OF TABLES 1. 1998 Canadian Suicide Statistics by Age 2. 2000 Alberta Suicide by Age 3. Demographic Characteristics of Sample 4. Number and Percentage of Diagnoses per Youth 5. Frequency and Percentage of Reported Psychopathologies 6. SPS Score Means, Standard Deviations and Score Ranges 7. Frequency and Percentages of Risk Scores 8. Diagnosis by Gender Crosstabulation Analysis 9. Diagnosis by Ethnicity Crosstabulation Analysis 10. Diagnosis by Age Crosstabulation Analysis 11. Crosstabulation Analysis of Previous Suicide Attempts by Age, Gender and Ethnicity 12. Crosstabulation Analysis of Low Risk Scores by Disorder 13. Study Variables by SPS T Score ANOVA 14. Multiple Linear Regression Analysis LIST OF FIGURES 1. Frequency of Ten Most Frequently Diagnosed Psychopathologies 127 2. Frequency Histogram of SPS Total Weighted Scores 131 3. Frequency Histogram of SPS T Scores 132 4. Frequency of Diagnosis of Substance Abuse 137 5. Frequency of Diagnosis of Parent Child Relational Disorder 137 xi CHAPTER 1 INTRODUCTION Adolescence is widely regarded as a time of increased risk. Youth perform many risk taking behaviours, some of which contribute to the major causes of mortality in adolescents, namely, vehicular accidents, accidents, homicide and suicide (Grunbaum et al., 2002). Despite gains made via research and through prevention programmes, increasing numbers of adolescent lives are being lost to violence and suicide. The tragedy of the loss of young lives calls for further investigation of adolescent violence and suicide in an effort to decrease future losses through better understanding of the causes behind these destructive acts. Aggressive behaviours perpetrated by youth have shown dramatic increases (Moeller, 2001). There has been a corresponding resurgence of media attention to adolescents at risk of hurting other youth, especially since the school shooting tragedies at both Columbine High School in Littleton, Colorado, and W. R. Myers high school in Taber, Alberta. The escalation of violence is reflected in the increasing diagnosis of aggressive psychopathology among youth, including conduct disorder and oppositional defiant disorder (Grisso, 2003). According to Grunbaum et al. (2002), homicide is the ultimate violent act against another person, and ranks among the top four causes of youth mortality.
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