RESUMO
The posthospitalization period following a youth's psychiatric emergency is characterized by marked risk for suicide attempts and rehospitalization. Parental anxiety and uncertainty about parenting strategies may become particularly salient during this period due to fear of youth relapse. These parental factors, then, may negatively impact family functioning, a factor known to mitigate suicide risk. The present study tested a theoretical model to elucidate the relationship between parenting factors and family functioning during this transition period, specifically, whether parental anxiety symptoms and parenting confidence are related and contribute to family functioning longitudinally following youth psychiatric hospitalization. The sample included 147 adolescents and a primary caregiver enrolled in a clinical trial. At baseline (BL) and 6 months (M6), caregivers completed measures of global anxiety symptoms (Brief Symptom Inventory) and parenting confidence (Parenting Relationship Questionnaire). Observer-rated family problem solving and limit setting were assessed (Family Assessment Task) at BL and 12 months (M12). These two measures of family functioning were included in separate path analyses that examined the temporal relations between constructs. After accounting for demographics, BL levels of parenting variables, BL youth functioning, and the presence or absence of youth suicide attempts during follow-up, BL parenting confidence negatively predicted M6 parent anxiety in both models. Additionally, M6 parenting confidence positively predicted M12 problem solving and limit setting. Bidirectional relations between parenting confidence and global anxiety were not supported, nor did global anxiety predict family functioning. Findings suggest that specifically addressing parenting confidence in youth treatment may be beneficial to support family adjustment, particularly following crises. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
RESUMO
BACKGROUND: Traumatic experiences are common in youth and can be classified as acute (one incident or short-term) or complex (chronic exposure to multiple traumas) experiences. Posttraumatic stress disorder (PTSD) is a common response to trauma, often co-occurring with other mental health symptoms. According to the International Classification of Diseases, 11th Edition (World Health Organization, 2018), complex PTSD includes difficulties with affect regulation, interpersonal relationships, and self-blame. OBJECTIVE: The aims of this study were to evaluate trauma chronicity and PTSD presentation as moderators of outcomes of trauma-focused cognitive behavior therapy (TF-CBT). PARTICIPANTS AND SETTING: Participants included 176 youth and caregiver dyads who were participants in an ongoing effectiveness study of TF-CBT at a community-based clinic in NYC. METHODS: Multilevel modeling was used to examine longitudinal, within-subject variability. Moderation analyses were used to assess the role of trauma chronicity and levels of PTSD on change in the outcomes. RESULTS: There were no baseline differences between youth with acute versus chronic trauma. At baseline, participants who had PTSD plus 2 or 3 of the ICD-11 Complex PTSD symptom domains had significantly worse functioning than those with simple PTSD. We found significant improvement on most measures of PTSD and complex PTSD domains. Level of improvement was found to vary based on PTSD presentation at baseline. CONCLUSIONS: This is the first study to evaluate both trauma chronicity and PTSD presentation in the context of evidence-based treatment, and findings support the effectiveness of TF-CBT for simple and complex PTSD for youth who have experienced acute and chronic trauma.