Correlates of Subjective Caregiver Strain in Caregivers of Youth Evaluated in a Pediatric Psychiatric Emergency Room

Silvia Molteni, Maren Carbon, Johnny Lops, Erin C Soto, Chiara Cervesi, Eva M Sheridan, Britta Galling, Ema Saito, Scott Krakower, Robert Dicker, Carmel Foley, Victor Fornari, Umberto Balottin, Christoph U Correll

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Although caregiver burden is relevant to the outcome for psychiatrically ill youth, most studies have focused on caregiver burden in the community or research settings. Therefore, we aimed at evaluating the subjective caregiver strain (SCS) at the time of presentation of youth to a pediatric psychiatric emergency room (PPER), assessing potential correlates to provide leads for improvements in formal support systems.

METHODS: In this retrospective cohort study, the internalized, externalized, and total SCS were assessed in caregivers of youth <18 years of age consecutively evaluated at a PPER during a 1 year period using the Caregiver Strain Questionnaire. Sociodemographic and a broad range of clinical data were collected during the PPER visit using a 12-page semistructured institutional evaluation form. The Appropriateness of Pediatric Psychiatric Emergency Room Contact scale, incorporating acuity, severity and harm potential, was used to rate appropriateness of the visit.

RESULTS: In caregivers of 444 youth, the internalized SCS was significantly higher than the externalized SCS (p < 0.001). Multivariable analyses indicated that higher total and externalized SCS were associated with disruptive behavior or substance abuse/dependent disorder diagnosis, presenting complaint of aggression, and discharge plan to the police. Higher total and internalized SCS were associated with lower child functioning, whereas total and internalized SCS were lower in adopted children. In addition, higher externalized SCS was associated with investigator-rated inappropriateness of the emergency visit, presenting complaint of defiance, and a lack of prior psychiatric ER visits.

CONCLUSIONS: High levels of CS in PPER highlight the necessity to adhere to existing guidelines regarding the inclusion of caregivers' perceptions into comprehensive psychiatric assessments. The particularly high strain in caregivers of children with externalizing disorders and in families with low-functioning youth may need to prompt PPER staff to provide efficient information on appropriate treatment options for these children and on support facilities for the parents.

Original languageEnglish
Pages (from-to)451-461
Number of pages11
JournalJournal of Child and Adolescent Psychopharmacology
Volume27
Issue number5
DOIs
Publication statusPublished - Jun 2017

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Caregivers
Psychiatry
Hospital Emergency Service
Pediatrics
Police
Aggression
Substance-Related Disorders
Emergencies
Cohort Studies
Retrospective Studies
Parents
Research Personnel
Guidelines

Keywords

  • Journal Article

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Correlates of Subjective Caregiver Strain in Caregivers of Youth Evaluated in a Pediatric Psychiatric Emergency Room. / Molteni, Silvia; Carbon, Maren; Lops, Johnny; Soto, Erin C; Cervesi, Chiara; Sheridan, Eva M; Galling, Britta; Saito, Ema; Krakower, Scott; Dicker, Robert; Foley, Carmel; Fornari, Victor; Balottin, Umberto; Correll, Christoph U.

In: Journal of Child and Adolescent Psychopharmacology, Vol. 27, No. 5, 06.2017, p. 451-461.

Research output: Contribution to journalArticle

Molteni, S, Carbon, M, Lops, J, Soto, EC, Cervesi, C, Sheridan, EM, Galling, B, Saito, E, Krakower, S, Dicker, R, Foley, C, Fornari, V, Balottin, U & Correll, CU 2017, 'Correlates of Subjective Caregiver Strain in Caregivers of Youth Evaluated in a Pediatric Psychiatric Emergency Room', Journal of Child and Adolescent Psychopharmacology, vol. 27, no. 5, pp. 451-461. https://doi.org/10.1089/cap.2015.0028
Molteni, Silvia ; Carbon, Maren ; Lops, Johnny ; Soto, Erin C ; Cervesi, Chiara ; Sheridan, Eva M ; Galling, Britta ; Saito, Ema ; Krakower, Scott ; Dicker, Robert ; Foley, Carmel ; Fornari, Victor ; Balottin, Umberto ; Correll, Christoph U. / Correlates of Subjective Caregiver Strain in Caregivers of Youth Evaluated in a Pediatric Psychiatric Emergency Room. In: Journal of Child and Adolescent Psychopharmacology. 2017 ; Vol. 27, No. 5. pp. 451-461.
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T1 - Correlates of Subjective Caregiver Strain in Caregivers of Youth Evaluated in a Pediatric Psychiatric Emergency Room

AU - Molteni, Silvia

AU - Carbon, Maren

AU - Lops, Johnny

AU - Soto, Erin C

AU - Cervesi, Chiara

AU - Sheridan, Eva M

AU - Galling, Britta

AU - Saito, Ema

AU - Krakower, Scott

AU - Dicker, Robert

AU - Foley, Carmel

AU - Fornari, Victor

AU - Balottin, Umberto

AU - Correll, Christoph U

PY - 2017/6

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N2 - BACKGROUND: Although caregiver burden is relevant to the outcome for psychiatrically ill youth, most studies have focused on caregiver burden in the community or research settings. Therefore, we aimed at evaluating the subjective caregiver strain (SCS) at the time of presentation of youth to a pediatric psychiatric emergency room (PPER), assessing potential correlates to provide leads for improvements in formal support systems.METHODS: In this retrospective cohort study, the internalized, externalized, and total SCS were assessed in caregivers of youth <18 years of age consecutively evaluated at a PPER during a 1 year period using the Caregiver Strain Questionnaire. Sociodemographic and a broad range of clinical data were collected during the PPER visit using a 12-page semistructured institutional evaluation form. The Appropriateness of Pediatric Psychiatric Emergency Room Contact scale, incorporating acuity, severity and harm potential, was used to rate appropriateness of the visit.RESULTS: In caregivers of 444 youth, the internalized SCS was significantly higher than the externalized SCS (p < 0.001). Multivariable analyses indicated that higher total and externalized SCS were associated with disruptive behavior or substance abuse/dependent disorder diagnosis, presenting complaint of aggression, and discharge plan to the police. Higher total and internalized SCS were associated with lower child functioning, whereas total and internalized SCS were lower in adopted children. In addition, higher externalized SCS was associated with investigator-rated inappropriateness of the emergency visit, presenting complaint of defiance, and a lack of prior psychiatric ER visits.CONCLUSIONS: High levels of CS in PPER highlight the necessity to adhere to existing guidelines regarding the inclusion of caregivers' perceptions into comprehensive psychiatric assessments. The particularly high strain in caregivers of children with externalizing disorders and in families with low-functioning youth may need to prompt PPER staff to provide efficient information on appropriate treatment options for these children and on support facilities for the parents.

AB - BACKGROUND: Although caregiver burden is relevant to the outcome for psychiatrically ill youth, most studies have focused on caregiver burden in the community or research settings. Therefore, we aimed at evaluating the subjective caregiver strain (SCS) at the time of presentation of youth to a pediatric psychiatric emergency room (PPER), assessing potential correlates to provide leads for improvements in formal support systems.METHODS: In this retrospective cohort study, the internalized, externalized, and total SCS were assessed in caregivers of youth <18 years of age consecutively evaluated at a PPER during a 1 year period using the Caregiver Strain Questionnaire. Sociodemographic and a broad range of clinical data were collected during the PPER visit using a 12-page semistructured institutional evaluation form. The Appropriateness of Pediatric Psychiatric Emergency Room Contact scale, incorporating acuity, severity and harm potential, was used to rate appropriateness of the visit.RESULTS: In caregivers of 444 youth, the internalized SCS was significantly higher than the externalized SCS (p < 0.001). Multivariable analyses indicated that higher total and externalized SCS were associated with disruptive behavior or substance abuse/dependent disorder diagnosis, presenting complaint of aggression, and discharge plan to the police. Higher total and internalized SCS were associated with lower child functioning, whereas total and internalized SCS were lower in adopted children. In addition, higher externalized SCS was associated with investigator-rated inappropriateness of the emergency visit, presenting complaint of defiance, and a lack of prior psychiatric ER visits.CONCLUSIONS: High levels of CS in PPER highlight the necessity to adhere to existing guidelines regarding the inclusion of caregivers' perceptions into comprehensive psychiatric assessments. The particularly high strain in caregivers of children with externalizing disorders and in families with low-functioning youth may need to prompt PPER staff to provide efficient information on appropriate treatment options for these children and on support facilities for the parents.

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U2 - 10.1089/cap.2015.0028

DO - 10.1089/cap.2015.0028

M3 - Article

C2 - 26978127

VL - 27

SP - 451

EP - 461

JO - Journal of Child and Adolescent Psychopharmacology

JF - Journal of Child and Adolescent Psychopharmacology

SN - 1044-5463

IS - 5

ER -