Silvia Molteni1,2, Maren Carbon2, Johnny Lops3, Erin C Soto4, Chiara Cervesi5,6, Eva M Sheridan2, Britta Galling2, Ema Saito2,7, Scott Krakower2, Robert Dicker2, Carmel Foley7, Victor Fornari2,7, Umberto Balottin1,8, Christoph U Correll2,7,9,10. 1. 1 Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia , Pavia, Italy . 2. 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York. 3. 3 Department of Psychiatry, Maimonides Medical Center , Brooklyn, New York. 4. 4 Department of Psychiatry, Presbyterian Hospital, Columbia University , New York, New York. 5. 5 Institute for Maternal and Child Health , Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS) "Burlo Garofolo," Trieste, Italy . 6. 6 Paediatrics Department, University of Padua , Padua, Italy . 7. 7 Department of Psychiatry, Hofstra North Shore LIJ School of Medicine , Hempstead, New York. 8. 8 Child Neuropsychiatry Unit, C. Mondino National Neurological Institute , Pavia, Italy . 9. 9 The Feinstein Institute for Medical Research, Psychiatric Neuroscience Center of Excellence , Manhasset, New York. 10. 10 Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine , Bronx, New York.
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.
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.