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Symptoms characteristic of autism spectrum disorder were initially believed to protect individuals with autism spectrum disorder from developing substance abuse. However, recent studies suggest that up to 36% of individuals with autism spectrum disorder may have a co-occurring issue with substance abuse. In addition, substance abuse may worsen the difficulties with daily functioning some individuals with autism spectrum disorder experience. It is important to understand occurrence rates, and risk, protective and positive treatment factors of co-occurring autism spectrum disorder and substance abuse in order to promote the best possible support for this special population. This review aimed to find and synthesize evidence regarding risk, protective and treatment factors, and determine a general prevalence rate of co-occurring autism spectrum disorder and substance abuse from all studies on substance use and abuse in individuals with autism spectrum disorder. The review also aimed to assess study quality and identify a diagnostic measure for substance abuse in individuals with autism spectrum disorder. Twenty-six studies on substance use and abuse in autism spectrum disorder were included in the review. The rates of substance abuse among those with autism spectrum disorder identified by included studies ranged from 1.3% to 36%, but due to large differences in study methods, a general prevalence rate could not be determined. Risk and protective factors, recognized in the general population, such as familial substance abuse and co-occurring mental health issues, and factors which may be more likely to occur in individuals with autism spectrum disorder, such as limited social resources and low sensation-seeking, were identified. No diagnostic measures specific to individuals with autism spectrum disorder and substance abuse were identified. This review identified only one exploratory study on an adapted intervention for co-occurring autism spectrum disorder and substance abuse. However, there were many methodological challenges in this study that limit the conclusions that can be drawn from the data. More research, using consistent methods, is needed to understand risk and protective factors and to determine the prevalence of substance abuse among individuals with autism spectrum disorder. The potential for co-occurring autism spectrum disorder and substance abuse should be considered by professional working in both autism spectrum disorder and substance abuse services, as finding suggests substance abuse is possible among individuals with autism spectrum disorder and may occur more frequently than previously believed. In addition, autism spectrum disorder and substance abuse service providers should be sensitive to specific risk and protective factors identified by the review that may impact substance abuse course and outcomes.

Since the 1970s, suicide has been a major public health issue in Greenland. The World Health Organization has emphasised the importance of the identification of both risk and protective factors in relation to suicide. The aim of this paper was to identify scientific literature on risk and protective factors for suicide and suicidal behaviour among Greenland Inuit. Searches in PubMed and PsycInfo resulted in 420 studies that were screened by three of the authors. After screening, the authors included 15 studies that were subject to quality assessment and data extraction. All 15 studies reported on risk factors, and only three mentioned protective factors. Most reported risk factors were on an individual level and were related to socioeconomic status, mental health, alcohol and substance use, and life stress. Risk factors related to the family mainly related to adverse childhood experiences, while the community level concerned access to education, work, and conflicts. The results indicate a large knowledge gap about protective factors for suicide and suicidal behaviour. The few protective factors reported were related to men having a family, high socioeconomic status, and being born between 1901 and 1950.

Letter to editor

• The risk factors for suicidal behaviours in military aligned with the social-ecological model. • Adverse military experiences were the most important factors associated with suicidality. • The most feasible factors for Defence to address were clustered as workplace culture. • Concept mapping is a novel approach in suicidology overcoming limitations of a Delphi study. There are increasing efforts to better understand suicidal behaviour among current and former military personnel in Australia. More research using innovative methodologies is needed to identify risk and protective factors that could be addressed within the military. To better understand perceived risk and protective factors associated with suicidal behaviour within the military context. Three groups of stakeholders were recruited: people with lived experience of suicide in a military context, military mental health clinicians, and researchers with expertise in suicide in a military context. Using concept mapping, participants individually generated risk and/or protective factors for suicidal behaviour in a military context, before organising and rating all statements. Data were collected, analysed, and visually represented using the GroupWisdom platform. In total, 57 stakeholders participated in at least one stage of the study (i.e., brainstorming, sorting and/or rating). Brainstorming generated 97 perceived risk-factors and 63 perceived protective factors, which were thematically grouped by participants. A multidimensional scaling and hierarchical cluster analysis generated a 7-cluster solution for risk factors and a 5-cluster solution for protective factors. Most of the risk and protective factors rated highly both in terms of importance and feasibility for the military to address were from workplace-related clusters. The risk and protective factors for suicidal behaviours within a military context were identified on three social-ecological levels: workplace (community), relational, and individual. The results of this study may inform future suicide research and prevention activities targeted to military personnel.

Youth violence: opportunities for intervention

Sexual violence (SV) among adolescents continues to be a major public health concern with numerous consequences. Research, predominantly with male collegiate samples, has suggested an association between sports participation and SV perpetration, and has included other important risk factors such as substance use and attitudes. However, more research is needed in this area among adolescents. The current study uses latent class analysis (LCA) to examine data- driven classes of high school student athletes (N = 665) engaged in three risk factor areas for SV: sport contact level, likelihood of substance use, and attitudes dismissive of SV. Once classes were enumerated and fit separately for male and female samples, pairwise comparisons were conducted on scores on two forms of SV (perpetration of sexual harassment and unwanted sexual contact) as a function of class membership. A 5-class solution was retained for both males and females. In the female sample, regarding SV-harassment, those most likely to perpetrate sexual harassment were those characterized by high likelihood of use of cigarettes, marijuana, alcohol, vape products, and those who played any type of sport. Too few females endorsed perpetration of unwanted sexual contact for pairwise comparisons to be conducted. For males, the classes most likely to perpetrate both forms of SV were those who were likely to endorse high likelihood to use of cigarettes, marijuana, alcohol, vape products, endorse attitudes dismissive of SV, and play any type of sport but especially high contact sports. These findings implicate high school athletic spaces as important venues for sexual violence prevention efforts.

Social Ecological Determinants of Substance Use Treatment Entry Among Serious Juvenile Offenders From Adolescence Through Emerging Adulthood

The main goal of the study was to analyze youth's externalizing problem behaviors based on a risk and protective factors framework in two different cultural settings. Data were collected among secondary school students in Szeged, Hungary (N=1240) and in Birmingham, AL, USA (N=1538). The self-administered questionnaires contained items on youth's externalizing problem behaviors as well as risk and protective factors. In both samples, first year students in secondary (high) schools and boys reported greater levels of problem behaviors. Multiple regression analyses revealed that substance use, gang membership and low academic achievement were consistent risk factors and associated with higher reporting levels of problem behaviors in both cultures. Parental monitoring served as an important protective factor in both samples, while school protective factors were only significant for American students. Findings draw attention to similar structures of certain risk and protective factors of youth's externalizing problem behaviors in different cultural settings. While there are universal risk factors (e. g., substance use, gang membership and low academic achievement), parental monitoring seems to be a universal protective factor against youth's externalizing problem behavior. An important difference is that the school domain seems to act as more important protection for American youth.

PurposeTo describe the psychosocial protective and risk factors for perinatal mental health identified in a sample of Aboriginal women’s Kimberley Mum’s Mood Scale (KMMS) assessments and explore the role of these factors in their screening assessment and diagnostic outcome.MethodsWe used a mixed methods approach to retrospectively analyse a cross-sectional study dataset of 91 completed KMMS assessments. This included: categorising the clinical notes from the KMMS psychosocial yarn into ‘risk’ and ‘protective’ factors and describing these categories, describing the number and type of risk and protective factors associated with different KMMS risk assessment categories (no, low, medium, high), and exploring relationships between these risk and protective factors and diagnosis of perinatal depression and/or anxiety.ResultsProtective factors were recorded for the vast majority of the women; the most prominent was positive family relationships. When protective and risk factors were stratified by KMMS risk category, women in the higher risk group less commonly had specific protective factors (11–33% high vs 61–100% no risk) and more commonly had risk factors (22–67% high vs 6–28% no risk) than women with lower KMMS assessed risk. The average number of protective factors decreased with increasing KMMS risk category (4.9 ± 1.1 to 1.6 ± 1.3), with the inverse pattern for risk factors (1.1 ± 1.1 to 3.8 ± 1.0). Having protective factors also appeared to reduce the risk of developing clinical depression or anxiety.ConclusionAssessing protective factors in mental health screening for perinatal Aboriginal women increases the effectiveness of screening and provides a foundation for the delivery of local structured psychosocial care.

Research on juvenile justice aims to identify profiles of risk and protective factors in juvenile offenders. This paper presents a study of profiles of risk factors that influence young offenders toward committing sanctionable antisocial behavior (S-ASB). Decision tree analysis is used as a multivariate approach to the phenomenon of repeated sanctionable antisocial behavior in juvenile offenders in Spain. The study sample was made up of the set of juveniles who were charged in a court case in the Juvenile Court of Almeria (Spain). The period of study of recidivism was two years from the baseline. The object of study is presented, through the implementation of a decision tree. Two profiles of risk and protective factors are found. Risk factors associated with higher rates of recidivism are antisocial peers, age at baseline S-ASB, problems in school and criminality in family members.

This thesis had two major aims: the first was aimed to test the efficacy of an Individual Cognitive Behavior Therapy for treatment of unipolar mood disorders with suicidal behavior and the second was to evaluate the risk and protective factors for suicidal behavior among patients with unipolar mood disorders in Malaysia. A review of literature on suicidal behavior in Malaysia suggested that lack of suicidal behavior-related measurements has been hindrance in identification of the risk and protective factors for suicidal behaviors. In addition, the investigation of variables that predicts treatment outcomes for patients with unipolar mood disorders with suicidal behavior has also beenhampered. This review chapter (Chapter 2; parts of them have been published in Comprehensive Psychiatry, 2014 and The Scientific World Journal, 2014) sets the scene for the following empirical chapters.Since most of the instruments used are not validated in Malaysia, thus the next 4 chapters validated two measuring instruments of risk factors and two measuring instruments for protective factors for suicidal behavior (other fours measures were not included as chapters due to limitation in words allowed in this thesis). The validated instruments and other measures were used to identify the risk and protective factors for suicidal behavior as well as to test the efficacy of Individual Cognitive Behavior Therapy (ICBT) for patients with unipolar mood disorders with suicidal behavior.Chapter 3, on Positive and Negative Suicide Ideation (PANSI) Inventory (submitted for publication), Chapter 4, on Beck Hopelessness Scale (BHS), Chapter 5, on Satisfaction With Life Scale (SWLS; published in Comprehensive Psychiatry, 2014), and Chapter 6, is on Reasons For Living Inventory (RFL; published in Comprehensive Psychiatry, 2014). The Exploratory and Confirmatory Factor Analyses were used to examine the psychometric properties and to establish the reliability and validity of these instruments. These measures were validated using the sample size of 483 from both medical and psychiatry patients. All the measures were found to have good reliability and validity using the exploratory and confirmatory factor analyses.Chapter 7 compared the two groups and the results showed that psychiatry patients had significantly higher mean scores on risk factors (hopelessness, psychological distress, depressive, anxiety and stress symptoms) and lower mean scores on protective factors (reasons for living, self esteem, hopefulness, satisfaction with life and social support) for suicidal behavior as compared to medical patients. In addition, patients with suicidal ideation had significantly higher mean scores on risk factors and lower mean scores on protective factors for suicidal behavior as compared to patients without suicidal ideation. And finally, there was a significant interaction between diagnosis (psychiatry patients with suicidal ideation, psychiatry patients without suicidal ideation, medical patients with suicidal ideation and medical patients without suicidal ideation) and suicidal behavior (suicidal ideation).Chapter 8 is a controlled trial comparing the Treatment As Usual (TAU) (N=36) with TAU + Individual Cognitive Behavior Therapy (ICBT) (TAU+ICBT) (N=36) groups. All the outpatients were diagnosed as suffering from unipolar mood disorders with suicidal ideation according to DSM IV-TR criteria. Eight sessions of manualised ICBT were given and each session lasted for 90 minutes. The measures of depressive symptoms (BDI-T and DASS-D), measures of suicidal ideation symptoms (PANSI-T and BSS-T), measures of risk factors for suicidal behavior (DASS-T, DASS-D, BHS-T, DASS-A, DASS-S) and measures of protective factors for suicidal behavior (RFL-T, RSE-T, AHTS-T, PRS-T, SWLS-T, PSR-FR, PSR-FM, SCB, MO, RF, FS, FSD, and CC) were administered at pre, mid, post, 3 months follow-up and 6 months follow-up for both groups. The TAU groups received outpatient treatment as usual by the psychiatrists of the hospital. The results showed that the TAU+ICBT groups consistently and significantly scored better on most of measures when compared to the TAU group. In addition, the TAU+ICBT group improved at earlier stage and the rate of improvement was significantly faster than the TAU group. The TAU group had significant improvement on seven dependent measures only. Thus the addition of the ICBT to TAU produced a more generalized and significant improvement on all the measures of depressive symptoms, measures of suicide ideation symptoms, measures of risk and protective factors of unipolar mood disordered with suicidal ideation patients.The general discussion of the whole thesis was presented in chapter 9, which ties together all the major significant findings from the previous chapters in the general context. The first empirical chapters on assessments were discussed and provided the base for discussions of chapter seven on psychopathology of mood disordered patients with suicidal behavior. Following that the findings of controlled trial on Individual Cognitive Behavioral Therapy of unipolar mood disorders with suicidal ideation in Malaysia was discussed and put in the general context of literature. The discussions were concluded with several strengths of this thesis, limitations of the studies and directions for future research.

Understanding patient experiences with opioid substitution treatment (OST) is critical to developing more personalized and responsive care strategies. This study employed latent class analysis (LCA) to: (1) identify subgroups of patients based on their perceptions and satisfaction with OST; (2) examine differences across subgroups in clinical outcomes and interest in novel formulations (methadone tablets, weekly/monthly buprenorphine depot, buprenorphine implant); (3) assess associations with individual and treatment-related factors; and (4) explore class-specific risk and protective factors. A total of 280 individuals (79% male; mean age=46.9years) receiving OST (methadone syrup=78%; sublingual buprenorphine tablets=22%) at six public addiction services in Italy completed an anonymous questionnaire. The survey assessed sociodemographics, current OST type and adherence, treatment perceptions and overall satisfaction, treatment duration, recent substance use and OST misuse, interest in novel formulations, motives for switching, and recovery capital (BARC-10). LCA identified three subgroups: Satisfied yet burdened, Satisfied and engaged, and Not experiencing benefit. The Not experiencing benefit class showed low satisfaction and limited perceived effectiveness with OST, high recent heroin and cocaine use, shorter treatment duration, and lowest recovery capital, with living alone emerging as a key risk factor. The Satisfied yet burdened class reported high satisfaction with OST but significant stigma and burden; recovery capital was positively linked to age and employment; living alone and higher education were associated with cocaine use; heroin use was higher among those receiving methadone syrup. The Satisfied and engaged class showed the highest satisfaction with OST, longer treatment, and appreciation for clinical contact; living alone remained the main risk factor, associated with heroin use. Methadone tablets were preferred by those on methadone syrup across all classes. Interest in monthly buprenorphine depot was highest in the Satisfied yet burdened class, especially among women and those on sublingual buprenorphine. The implant was favored in the Satisfied and engaged class by men with higher education. Individuals living alone in the Not experiencing benefit class showed the lowest interest in long-acting options. Findings highlight the importance of tailoring OST delivery to distinct patient profiles to enhance engagement, reduce unmet needs, and support long-term recovery.

Committee on Science and the Arts

This chapter begins by defining risk and protective factors, with a focus on their use in the context of nonsuicidal self-injury (NSSI). Theoretically, risk factor constructs should both be observable prior to the onset of NSSI and differentiate those who do and do not develop NSSI over time. Whereas risk factors are constructs that increase risk, protective factors are those that decrease risk. There are several additional critical considerations when reviewing risk factors, such as the variation of risk factor potency across populations and the implications of different types of risk factors (fixed risk factors, variable risk factors, and causal risk factors). The chapter then describes the barriers to research on NSSI risk and protective factors; among the most critical includes NSSI measurement. Risk factor research requires that the outcome of interest can be defined and measured clearly and consistently. Unfortunately, definitions and measures of NSSI vary widely across researchers. The chapter also summarizes the current state of research on intrapersonal (i.e., factors that occur within someone) NSSI risk and protective factors.

The influence of family-based risk and protective factors on adolescent substance use was examined in this study. Parental education level, ethnic background, religious affiliation, sibling substance use, family conflict, and family involvement were the specific risk and protective factors examined. Five thousand and nine adolescents in the state of Utah were randomly sampled and completed the survey. Responses of 4,983 adolescents were included in the data analysis. High parental education level, religiously affiliated, and family involvement are protective factors for adolescent substance use. Ethnic minority background, sibling substance use, and family conflict are risk factors for adolescent substance use. Future implications for intervention and research in relation to family-based risk and protective factors are discussed.