Systematic Review: Patient Outcomes in Transdiagnostic Adolescent Partial Hospitalization Programs.

OBJECTIVE: Partial hospitalization programs (PHPs) are designed to help stabilize patients with acute mental health problems and are considered more cost-effective than inpatient care for patients who do not require 24-hour monitoring. Many PHPs treat transdiagnostic adolescents to reduce suicidality, self-harm, and other high-risk behaviors; however, the effectiveness of such programs is unknown. We aimed to review the existing evidence for the effects of PHPs on adolescent mental health symptoms and functioning. METHOD: We retrieved peer-reviewed evaluations of PHPs treating adolescents with a range of disorders that reported quantitative clinical outcomes. We followed PRISMA guidelines for systematic reviews and included studies published since 2000. RESULTS: Fifteen studies of 10 PHPs in North America, Europe, Asia, and Australia met inclusion criteria, 5 of which used comparison groups. Most participants were White and female with depressive disorders. All studies found improvements in adolescents' functioning and mental health from admission to discharge; however, only 1 study tested PHP relative to other levels of care, and only 1 study included follow-up data. Dialectical behavior therapy (DBT) may be an effective theoretical orientation for PHP settings, but evidence is limited. CONCLUSION: Evidence for effectiveness of PHPs relative to other models is limited. Currently available research suggests that many high-risk transdiagnostic adolescents tend to improve during PHP treatment; however, controlled studies with follow-up data are needed to determine whether partial hospitalization is effective and, if so, how effective, and whether treatment gains persist after discharge.

A unique model of care for youth in crisis: A pilot open trial.

Suicide is the second leading cause of death for those ages 10-24 years in the United States, and emergency department (ED) visits due to youth self-injurious thoughts and behaviors (SITB) and increased substantially between 2016 and 2021. Although ED services are essential for an effective system of care, the ED setting is typically not well-suited for the comprehensive, collaborative, and therapeutic evaluation of SITB; treatment planning; and care coordination that youth in a suicidal crisis need. As a result, an urgent care model for mental health designed to provide comprehensive crisis triage and intervention services is needed within outpatient psychiatry. This pilot trial examined the feasibility, acceptability, and preliminary clinical outcomes of a brief, urgent care model, the Behavioral Health Crisis Care Clinic (CCC), designed to provide comprehensive outpatient triage and intervention services aimed at reducing suicide risk for youth in crisis. Participants were 189 youth (ages 10-20; 62.4% females; 58% Caucasian) who had past-week suicidal ideation or behavior and their caregivers. The results demonstrated the CCC model exceeded feasibility and acceptability benchmarks based on the Service Satisfaction Scale (M score > 3.00). CCC care was associated with significant decreases in self-reported suicide risk based on the Collaborative Assessment and Management of Suicidality Suicide Status Form with low levels of ED usage during CCC care (7.7%) and 1-month posttreatment (11.8%). Over 88% of patients without established outpatient care at the time of referral were connected to care during CCC treatment, almost all of whom (95%) continued with ongoing mental health care 1 month after ending CCC care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A systematic review of dialectical behavior therapy mobile apps for content and usability.

BACKGROUND: The gap between treatment need and treatment availability is particularly wide for individuals seeking Dialectical Behavior Therapy (DBT), and mobile apps based on DBT may be useful in increasing access to care and augmenting in-person DBT. This review examines DBT based apps, with a specific focus on content quality and usability. METHODS: All apps referring to DBT were identified in Google Play and iOS app stores and were systematically reviewed for app content and quality. The Mobile App Rating Scale (MARS) was used to evaluate app usability and engagement. RESULTS: A total of 21 free to download apps were identified. The majority of apps (71%) included a component of skills training, five apps included a diary card feature. Most (76.19%) apps were designed to function without help from a therapist. The average user "star" rating was 4.39 out of 5. The mean overall MARS score was 3.41, with a range of 2.15 to 4.59, and 71.43% were considered minimally 'acceptable,' as defined by a score of 3 or higher. The average star rating was correlated with the total MARS score (r = .51, p = .02). Estimates of app usage differed substantially between popular and unpopular apps, with the three most popular apps accounting for 89.3% of monthly active users. CONCLUSIONS: While the present study identified many usable and engaging apps in app stores designed based on DBT, there are limited apps for clinicians. DBT based mobile apps should be carefully developed and clinically evaluated.

Stress and psychological adjustment in caregivers of children with cancer.

OBJECTIVE: To examine effects of stress on caregiver psychological adjustment during the first year of pediatric cancer. METHOD: Caregivers (N = 159) of children with cancer completed monthly questionnaires assessing domains of caregiver psychological adjustment (depression, anxiety, and posttraumatic stress symptoms) and stress (general life stress, treatment-related stress, caregiver perceptions of treatment intensity and life threat). Effects of stress were assessed at two levels to examine whether within-person changes in stress predicted concurrent changes in caregiver adjustment and whether average stress was associated with between-person differences in caregiver adjustment trajectories. RESULTS: Overall, higher levels of stress factors were associated with poorer caregiver adjustment at both the between- and within-person levels, with high average levels of treatment-related stress and general life stress emerging as leading predictors of worse adjustment. CONCLUSIONS: Both types of stressors, those directly related as well as unrelated to a child's cancer, contribute uniquely to caregiver distress. Caregiver distress is impacted by both overall levels of stress over time as well as month-to-month changes in stress. Implications for informing care for at-risk caregivers are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An emotion coaching parenting intervention for families exposed to intimate partner violence.

The current study describes a promising new emotion coaching (EC) parenting intervention for survivors of intimate partner violence (IPV) targeting emotion regulation (ER) and parent-child relationships. We discuss the development of an EC parenting intervention, outline its key elements, and use preliminary pilot data to illustrate how such a behavioral intervention can yield improvements in behavioral and physiological indices of ER (i.e., respiratory sinus arrhythmia [RSA]) and parent-child relationships and reductions in mental health difficulties in IPV-exposed mothers and their children. A 12-week skills-based EC parenting program was developed and administered in groups. Fifty mothers were assigned to intervention or waitlist groups. Physiological, observational, and questionnaire data were obtained pre- and postintervention. Because of the small sample size, effect sizes were examined for illustrative purposes of potential effects of the EC intervention. Relative to mothers in waitlist group, mothers in the intervention group showed (a) improvements in emotion awareness and coaching, (b) increases in ER as assessed by baseline RSA, (c) increased use of validation and decreased use of sermonizing/lecturing/scolding during parent-child interaction, and (d) increased sense of parenting competence. Relative to children of mothers in the waitlist group, children of mothers in the intervention group showed (a) increases in ER as measured by parent-report and baseline RSA, (b) decreases in negativity during parent-child interaction, and (c) decreases in depressive symptoms. Discussion highlights potential usefulness of an EC parenting intervention for populations at risk for ER and parenting difficulties. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Post-Traumatic Stress, Mother's Emotion Regulation, and Parenting in Survivors of Intimate Partner Violence.

Post-traumatic stress symptoms (PTSS) are high among female survivors of intimate partner violence (IPV), and children of parents experiencing PTSS are at heightened risk for a wide range of emotional and behavioral problems. Parenting has significant influence on child adjustment, and although links have been found between parental psychopathology and maladaptive parenting, little is known about the factors that may explain this relation. The current study examines mother's emotion regulation (ER) as a factor influencing the relation between mother PTSS and parenting around children's emotions in a study sample of sixty-four female survivors of IPV and their 6- to 12-year-old children. Mothers reported on their own PTSS and their parenting. Respiratory sinus arrhythmia (RSA) was used as a psychophysiological index of mother's ER. Experiential components of mother's ER was also measured by observer coding of the Meta-Emotion Interview, a structured assessment that asks parents about their attitudes toward and experiences with emotions, including their regulation of emotions. Mother's RSA reactivity moderated the relation between PTSS and negative parenting. There was also a significant indirect relation between mothers' PTSS symptom severity and supportive parenting reactions through mothers' self-report of ER. Results suggest that mother's ER abilities represent factors that significantly affect associations between maternal PTSS and parent's emotion socialization practices. Implications for assessment and intervention with families exposed to the stress of IPV are discussed.

Trajectories of child and caregiver psychological adjustment in families of children with cancer.

OBJECTIVE: To describe the trajectory of patient and caregiver mental health from diagnosis through the first year of treatment for pediatric cancer and assess whether rates of clinically relevant symptoms were elevated compared with norms. We examined mean levels of internalizing and externalizing symptoms and posttraumatic stress symptoms (PTSS) in children with cancer, and depression, anxiety, and PTSS in caregivers during the first year of treatment; the proportion of patients and caregivers that scored in the clinical range at each time point; and the typical trajectory of symptoms in patients and caregivers and whether trajectories differed between individuals. METHOD: Families (N = 159) of children newly diagnosed with cancer (Mage = 5.6 years; range = 2-18 years) participated in a short-term prospective study. Primary caregivers provided monthly reports of their own and their children's psychological adjustment. RESULTS: On average, children were well-adjusted. However, compared with norms, there was a higher than expected proportion of children with clinically relevant internalizing symptoms around the time of diagnosis. On average children's symptoms declined over time, though variability was observed. Caregivers were less well-adjusted on average, with a high proportion reporting clinically relevant symptoms over time for depression and anxiety. Caregiver symptoms also declined over time, though considerable variability was observed. CONCLUSION: Although most children remain well-adjusted during the first year of treatment, many caregivers experience clinically relevant symptoms of psychological distress. Implications for development of interventions targeting at-risk patients and caregivers are discussed. Identifying processes that predict between-family variability in trajectories of psychopathology is an important next step. (PsycINFO Database Record

Trajectories of marital, parent-child, and sibling conflict during pediatric cancer treatment.

OBJECTIVE: The stress of having a child with cancer can impact the quality of relationships within the family. The current study describes the longitudinal trajectory of marital, parent-child, and sibling conflict beginning around the time of diagnosis through the first year of treatment. We examined the average level of marital, parent-child, and sibling conflict at each monthly time point in the first year of treatment; the proportion of families that fall into the distressed range of marital, parent-child, and sibling conflict at each time point; the typical trajectory of conflict during the first year of treatment and whether there are differences in trajectories across families. METHOD: A total of 160 families of children newly diagnosed with cancer (Mage = 5.6 years; range = 2-18 years) participated in a short-term prospective longitudinal study. Primary caregivers provided monthly reports of marital, parent-child, and sibling conflict. RESULTS: Using multilevel modeling (MLM), most families showed stability in quality of family relationships, although considerable between-family variability was observed. For married couples, 25-36% of couples were in the distressed range at one time point over the first year of treatment. For married couples, more distress occurred at earlier months, particularly month 3. For parent-child and sibling dyads, the most difficult time periods were during later months. CONCLUSION: Implications for development of interventions that target at-risk family relationships are discussed. Identifying processes that predict between-family variability in trajectories of family relationships is an important next step, particularly for the marital relationship. (PsycINFO Database Record

Patterns of Spillover Between Marital Adjustment and Parent-Child Conflict During Pediatric Cancer Treatment.

Objective: When a child is diagnosed with cancer, problems may arise in family relationships and negatively affect child adjustment. The current study examined patterns of spillover between marital and parent-child relationships to identify targets for intervention aimed at ameliorating family conflict. Method: Families (N = 117) were recruited from two US children's hospitals within 2-week postdiagnosis to participate in a short-term prospective longitudinal study. Children with cancer were 2-10 years old (M = 5.42 years, SD = 2.59). Primary caregivers provided reports of marital and parent-child conflict at 1-, 6-, and 12-month postdiagnosis. Results: Results indicated that a unidirectional model of spillover from the marital to the parent-child relationship best explained the data. In terms of specific temporal patterns, lower marital adjustment soon after diagnosis was associated with an increase in parent-child conflict 6 months later, though this pattern was not repeated in the latter 6 months of treatment. Conclusion: Targeting problems in marital relationships soon after diagnosis may prevent conflict from developing in the parent-child relationship.

Featured Article: Caregiver Perceptions of Stress and Sibling Conflict During Pediatric Cancer Treatment.

Objective: The current study examined the effect of stress on sibling conflict during the first year of pediatric cancer treatment. Method: Families (N = 103) included a child with cancer (aged 2-17 years, Mage = 6.46, SD = 3.52) and at least one sibling aged <5 years of the child with cancer (Mage = 8.34, SD = 5.61). Primary caregivers completed monthly questionnaires throughout the first year of treatment assessing five sources of stress (i.e., general life, cancer-related, financial, perceived treatment intensity, and life threat) and level of sibling conflict. Using multilevel modeling, we explored the effects of these stressors on conflict both at the within- and between-family levels to examine if changes in stress resulted in concurrent changes in conflict within an individual family, and whether greater average stress affected the trajectory of conflict between families, respectively. Results: At the between-family level, higher average levels of cancer-related stress, general life stress, and financial stress were associated with higher sibling conflict at the end of the first year of treatment. Perceived treatment intensity and life threat were not associated with conflict. No stressors were associated with conflict at the within-family level. Conclusions: During pediatric cancer treatment, some stressors may spill over into family relationships and contribute to increases in sibling conflict.

Stress and marital adjustment in families of children with cancer.

OBJECTIVE: Pediatric cancer is highly stressful for parents. The current prospective study examines the impact of several stressors (financial strain, life threat, treatment intensity, treatment-related events, and negative life events) on the trajectory of marital adjustment across the first year following diagnosis. We examined whether average level of stressors across the year was related to (1) levels of marital adjustment at the end of the first year of treatment and () the rate of change in marital adjustment. METHOD: One hundred and thirty families of children newly diagnosed with cancer (M age = 6.33 years, SD = 3.61) participated. Primary caregivers provided 12 monthly reports on marital adjustment and stressors. RESULTS: Multilevel models indicated that although marital adjustment was stable across the first year on average, random effect estimates suggested that this was the result of differing trajectories between families (eg, some increasing and others decreasing). Five individual stress constructs and a cumulative stress composite were then used to predict this variability. Higher average economic strain was related to consistently poorer marital adjustment across time. Higher average frequency of treatment-related events and negative life events were associated with decreasing adjustment over time and lower adjustment at the end of the first year of treatment. Perception of life threat and treatment intensity were not associated with final levels or trajectory of adjustment. Finally, higher cumulative stress was associated with consistently poorer marital adjustment across time. CONCLUSION: Implications for identification of at-risk families are discussed, and importance of delivering tailored interventions for this population.

Posttraumatic stress and emotion regulation in survivors of intimate partner violence.

Rates of posttraumatic stress symptoms (PTSS) are high among female survivors of intimate partner violence (IPV), and children of parents experiencing PTSS are at increased risk for emotional and behavioral problems. However, little is known about the factors that may explain this relation. We examined child's emotion regulation as a moderator and mother's emotion regulation as a mediator of the relation between mother PTSS and child adjustment. Sixty-four female survivors of IPV and their 6-12-year-old children participated. Mothers reported their own PTSS and their children's adjustment. Child emotion regulation was measured using respiratory sinus arrhythmia, a physiological index of emotion regulation. Mother's emotion regulation was measured from observer coding of the Parent Meta-Emotion Interview (Katz & Gottman, 1986), which asked mothers about their awareness and regulation of emotion. Child emotion regulation moderated the relation between mother's PTSS and child depression and child PTSS. Mothers' total trauma symptom severity showed significant indirect effects on children's internalizing, externalizing, and total problems via mothers' emotion regulation. Results suggest that children's as well as mothers' emotion-regulation abilities represent factors that affect associations between maternal PTSS and child adjustment in families exposed to IPV.