Family Stress Moderates Emotional and Behavioral Symptoms in a Child Partial Hospital Setting
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Partial hospitalization programs are an increasingly utilized, multidisciplinary treatment for children with social, emotional, and behavioral needs. Although previous work suggests these programs improve children’s mental health functioning, outcomes research has been limited. This study examines moderators of emotional and behavioral outcomes in children with serious mental illness, with particular focus on demographic (age, race, insurance type, and gender) and family (stressors and supports) factors.
The study includes 287 children ages 7–13. Children completed standardized questionnaires at admission and discharge including the Behavior Assessment System for Children-2 the Child Depression Inventory 2, and the Screen for Child Anxiety Related Disorders while caregivers completed the Strengths and Difficulties Questionnaire.
Results indicate improvements in children’s anxiety, depressive symptoms, psychological adjustment, and emotional symptoms. Furthermore, children with private insurance reported significant decreases in depressive (p < 0.001) and emotional symptoms (p< 0.001) compared to children with state funded insurance. Females reported sharper decreases in depressive symptoms (p< 0.001) compared to males (p= 0.019). Finally, children in families with no stressors in the past month demonstrated sharper declines in depressive symptoms (p< 0.001) compared to children in families with one or more stressors in the past month (p= 0.001). Family support did not moderate these outcomes.
This study suggests partial hospitalization programs may be effective in improving emotional and behavioral problems. This study suggests family stressors are important to consider and emphasize in treatment.
KeywordsPartial hospitalization Treatment outcomes Child psychology Family stressors
We are grateful to the children and families who have participated in our program. We would also like to thank the clinical team for their dedication and service to our patients.
This study was conducted without external grant funding.
MY: developed research question, created database, conducted data analyses, wrote the paper. TP: collaborated with the design, writing, and data analysis of the study. KM: assisted with the creation of the database, assisted with data collection for record review, reviewed and provided feedback on manuscript and revisions. SP: assisted with the database, assisted with conducting data analyses, provided edits on the manuscript and revisions SU: assisted with literature review, assisted with analysis and interpretation of data associated with measures. AW: collaborated with the design of the study, provided edits on the manuscript and revisions.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of institutional and/or national research committee through Lifespan- Rhode Island Hospital IRB, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.
- Bennett, D. S., Macri, M. T., Creed, T. A., Isom, J. A. (2001). Predictors of treatment response in a child day treatment program. Residential Treatment for Children & Youth, 19, 59–72.Google Scholar
- Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1230–1236.CrossRefPubMedGoogle Scholar
- Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., & Neer, S. M. (1997). The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 545–553. https://doi.org/10.1097/00004583-199704000-00018.CrossRefGoogle Scholar
- Boekamp, J. R., Liu, R. T., Martin, S. E., Mernick, L. R., DeMarco, M., & Spirito, A. (2018). Predictors of partial hospital readmission for young children with oppositional defiant disorder. Child Psychiatry and Human Development, 49, 505–511. https://doi.org/10.1007/s10578-017-0770-8.CrossRefPubMedGoogle Scholar
- Canals, J., Hernandez-Martinez, C., Cosi, S., & Domenech, E. (2012). Examination of a cutoff score of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a non-clinical Spanish population. Journal of Anxiety Disorders, 26, 785–791. https://doi.org/10.1016/j.janxdis.2012.07.008.CrossRefPubMedGoogle Scholar
- Dishion, T. J., Brennan, L. M., Shaw, D. S., McEachern, A. D., Wilson, M. N., & Jo, B. (2014). Prevention of problem behavior through annual Family Check-Ups in early childhood: Intervention effects from home to early elementary school. Journal of Abnormal Child Psychology, 42, 343–354. https://doi.org/10.1007/s10802-013-9768-2.
- Dishion, T. J., & Stormshak, E. A. (2007). Intervening in children’s lives: An ecological, family-centered approach to mental health care. Washington, DC: American Psychological Association. https://doi.org/10.1037/11485-000.
- Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42, 377–381.CrossRefGoogle Scholar
- Mansur, R. B., Cunha, G. R., Asevedo, E., Zugman, A., Zeni-Graiff, M., Rios, A. C., & Brietzke, E. (2016). Socioeconomic disadvantage moderates the association between peripheral biomarkers and childhood psychopathology. PLoS ONE, 11, 1–14. https://doi.org/10.1371/journal.pone.0160455.CrossRefGoogle Scholar
- Martin, S. E., McConville, D. W., Williamson, L. R., Feldman, G., & Boekamp, J. R. (2013). Partial hospitalization treatment for preschoolers with severe behavior problems: Child age and maternal functioning as predictors of outcome. Child and Adolescent Mental Health, 18, 24–32.CrossRefGoogle Scholar
- Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., & Swendsen, J. (2010). Lifetime Prevalence of Mental Disorders in US Adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49, 980–989.CrossRefPubMedPubMedCentralGoogle Scholar
- Milin, R., Coupland, K., Walker, S., & Fisher-Bloom, E. (2000). Outcome and follow-up study of an adolescent psychiatric day treatment school program. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 320–328. https://doi.org/10.1097/00004583-2000030000-00014.CrossRefPubMedGoogle Scholar
- Muller, J. M., Averbeck-Holocher, M., Romer, G., Furniss, T., Archtergarde, S., & Postert, C. (2015). Psychiatric treatment outcomes of preschool children in a family day hospital. Child Psychiatry and Human Development, 46, 257–269. https://doi.org/10.1007/s10578-014-0465-3.CrossRefPubMedGoogle Scholar
- National Alliance on Mental Illness. Mental Health Facts Children and Teens. Retrieved from http://www.nami.org/NAMI/media/NAMI-Media/Infographics/Children-MH-Facts-NAMI.pdf.
- Nilsen, T. S., Eisemann, M., & Kvernmo, S. (2013). Predictors and moderators of outcome in child and adolescent anxiety and depression: a systematic review of psychological treatment studies. European Child & Adolescent Psychiatry, 22, 69–87. https://doi.org/10.1007/s00787-012-0316-3.CrossRefGoogle Scholar
- Perou, R., Bitsko, R. H., Blumberg, S. J., Pastor, P., Ghandour, R. M., Gfroerer, J. C., & Huang, L. N. (2013). Mental health surveillance among children: United States, 2005-2011. Morbidity and Mortality Weekly Report, 62, 1–35 http://www.cdc.gov/mmwr/preview/mmwrhtml/su6202a1.htm Retrieved from.
- Reynolds, C. R., & Kamphaus, R. W. (2004). BASC-2: Behavior assessment system for children, second edition manual. Circle Pines, MN: American Guidance Service.Google Scholar
- Reynolds, C. R., & Kamphaus, R. W. (2010). BASC-2: Behavior Assessment System for Children Second Edition: Manual Supplement for the Clinical Report. Bloomington, MN: NCS Pearson, Inc.Google Scholar
- Steele, H., Bate, J., Steele, M., Dube, S. R., Danskin, K., Knafo, H., Nikitiades, A., Bonuck, K., Meissner, P., & Murphy, A. (2016). Adverse childhood experiences, poverty, and parenting stress. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 48, 32.CrossRefGoogle Scholar
- Webster-Stratton, C. (2005). The incredible years: A trouble-shooting guide for parents of children 2–8 years (2nd ed.). Seattle, WA: Incredible Years.Google Scholar
- Webster-Stratton, C., & Reid, M. J. (2010). The Incredible Years parents, teachers and children training series: A multifaceted treatment approach for young children with conduct problems. In J. Weisz & A. Kazdin (Eds), Evidence-based psychotherapies for children and adolescents (194-210). New York: Guilford Publications.Google Scholar
- Zahn-Waxler, C., Shirtcliff, E. A., & Marceau, K. (2008). Disorders of childhood and adolescence: Gender and psychopathology. Annual Review of Clinical Psychology, 4, 275–303. https://doi.org/10.1146/annurev.clinpsy.3.022806.091358.CrossRefPubMedGoogle Scholar