Introduction. Adolescent interpersonal violence is a global public health problem, yet gaps remain in the epidemiologic literature on adolescent violence in low- and middle-income countries (LMIC). Prevalence rates and risk and protective factors reported in high-income countries may be different from those reported in LMICs. Culturally-relevant epidemiologic data is important in efforts aimed at addressing adolescent interpersonal violence in these countries.Methods. A cross-sectional study of Egyptian adolescent involvement in violent behavior was conducted. Data collected from a 2006 school-based survey initiative were used; participants were adolescents aged 11–17 (N = 5, 249). Some participants were excluded from the dataset due to incomplete data (N = 111) resulting in a final sample of 5,138. Bivariate and logistic regression analyses were run to determine demographic and social variables associated with participation in physical fighting.Results. Thirty-one percent of adolescents reported being involved in a physical fight. Previously reported risk factors for violent behavior among adolescents such as depressive symptoms (OR = 1.29; CI = 1.11–1.50) and bullying victimization (OR = 2.44; CI = 2.12–2.83) were positively associated with violent behavior in the present study, while the more novel factor of sedentary behavior was also observed as having a positive association with violent behavior (OR = 1.43; CI = 1.21–1.69). Known protective factors such as helpful peers (OR = 0.75; CI = 0.62–0.90) and understanding parents (OR = 0.67; CI = 0.56–0.81) were found to have negative associations with violent behavior in the present study, in addition to the counterintuitive protective effect of having fewer friends (OR = 0.75; CI = 0.60–0.92).Conclusions. Prevalence rates of adolescent interpersonal violence in Egypt are similar to rates in other LMICs. The high reported rates of depressive symptomatology and bully victimization along with their positive association with physical fighting suggest that interventions aimed at treating and preventing these problems may help mitigate the likelihood of adolescents engaging in violent behavior; involvement in appropriate physical activity in a safe environment may be beneficial as well. More research is needed to understand the observed protective factor of having fewer friends.

We examined the effectiveness of Dialectical Behavior Therapy (DBT) training in community-based agencies. Data were gathered at four time points over a two-year period from front-line mental health therapists (N = 64) from 10 community-based agencies that participated in a DBT implementation initiative. We examined change on therapist attitudes towards consumers with Borderline Personality Disorder (BPD), confidence in the effectiveness of DBT, and use of DBT model components. All measures were self-report. Participating in DBT training resulted in positive changes over time, including improved therapist attitudes toward consumers with BPD, improved confidence in the effectiveness of DBT, and increased use of DBT components. Therapists who had the lowest baseline scores on the study outcomes had the greatest self-reported positive change in outcomes over time. Moreover, there were notable positive correlations in therapist characteristics; therapists who had the lowest baseline attitudes towards individuals with BPD, confidence in the effectiveness of DBT, or who were least likely to use DBT modes and components were the therapists who had the greatest reported increase over time in each respective area. DBT training with ongoing support resulted in changes not commonly observed in standard training approaches typically used in community settings. It is encouraging to observe positive outcomes in therapist self-reported skill, perceived self-efficacy and DBT component use, all of which are important to evidence-based treatment (EBT) implementation. Our results underscore the importance to recognize and target therapist diversity of learning levels, experience, and expertise in EBT implementation.

In this study, key informant interviews were conducted with 13 administrators from nine community-based mental health agencies implementing dialectical behavior therapy in order to assess their perspectives on implementation. Four major themes were identified. They include opinions about dialectical behavior therapy and its fit with existing practices, resource concerns (for example, reimbursement issues, time commitment, and staff training), staff selection for training and staff turnover, and ongoing client referrals. Understanding agency administrators' unique perspectives and addressing their concerns is critical to treatment implementation given administrators' role in determining whether and how a treatment will be implemented. Better understanding of the fit between dialectical behavior therapy and existing service structures, the impact of staff turnover on implementation, and the resources required for implementation are all needed to ensure successful implementation and sustainability.

BackgroundSuicide is among the top causes of adolescent mortality worldwide. While correlates of suicidal behavior are better understood and delineated in upper-income countries, epidemiologic knowledge of suicidal behavior in low-income countries remains scant, particularly in the African continent. The present study sought to add to the epidemiologic literature on suicidal behavior in Africa by examining the behavioral correlates of suicide attempts among Malawi adolescents.MethodsA cross-sectional study using a nationally-representative sample extracted from publically-available data was conducted. Bivariate and multivariate analyses were performed to discern associations between suicide attempts and a host of behavioral variables. 2225 records were included in the study.ResultsAt the multivariate level, suicide attempters had significantly higher odds of being anxious, being physically bullied, having sustained a serious injury and having a greater number of lifetime sexual partners. Alcohol use (at an early age and within the past 30 days) was also associated with suicide attempts.ConclusionsThese findings have the potential to guide public health interventions geared toward suicide prevention in Africa and other, similar regions, as well as provide the impetus for future epidemiologic studies on suicidal behavior in low-income countries.

Background: Adolescent physical fighting is a problem of public health importance, with varied consequences in the form of school absenteeism, injury, and, in some cases, death. Although research on risk and protective factors exists, most has been conducted in high-income countries. Methods: The 2009 Pakistan Global School-based Health Survey (GSHS) data were used. Logistic regression models were used to determine the associations. Five independent variables were investigated at the individual level (anxiety, suicide planning, truancy, physical activity, and bullying victimization) and four independent variables at the social level (presence of supportive parental figures, presence of helpful peers, extent of social network, and food insecurity). Results: Among adolescents in this study (N = 5177), 20% reported being involved in two or more physical fights, most of whom were males (79.9%). The factors associated with physical fighting were: being male (OR = 2.78); bullying victimization (OR = 3.14); truancy (OR = 1.63), loneliness (OR = 1.44); and suicidality, as evidenced by having a suicide plan (OR = 1.75). Having few close friends (0–2) as opposed to more (>3) was found to be protective against engaging in physical fighting. Conclusion: Risk factors for physical fighting among adolescents in South Asia seem to corroborate with previously-identified risk factors using samples in high-income countries, while protective factors seemed to differ. More research needs to be conducted to understand why certain factors do not have the same protective effect among South Asian adolescents. Aim: The aim of this study was to examine demographic and contextual factors associated with physical fighting among a nationally representative sample in a rapidly developing South Asian context.