Parent-Youth Divergence (and Convergence) in Reports of Youth Internalizing Problems in Psychiatric Inpatient Care
When compared to one another, multiple informants’ reports of adolescent internalizing problems often reveal low convergence. This creates challenges in the delivery of clinical services, particularly for severe outcomes linked to internalizing problems, namely suicidal thoughts and behaviors. Clinicians would benefit from methods that facilitate interpretation of multi-informant reports, particularly in inpatient settings typified by high-cost care and high-stakes decision-making. 765 adolescent inpatients (70.3% female; Mage = 14.7) and their parents completed measures of adolescent internalizing problems. We obtained baseline clinical and treatment characteristics from electronic medical records. Latent class analysis revealed four reporting patterns: Parent-Adolescent Low (LL; 49.0%), Parent Low-Adolescent High (PL-AH; 11.5%), Parent High-Adolescent Low (PH-AL; 21.8%), Parent-Adolescent High (HH; 17.6%). Relative to the LL class, adolescents in the PH-AL and PL-AH classes were more likely to be admitted with suicidality. In terms of treatment characteristics and relative to the LL class, HH and PH-AL adolescents were more likely to receive standing antipsychotics, PH-AL adolescents were more likely to be in seclusion, and HH adolescents had longer hospital stays. At discharge and relative to the LL class, HH, PH-AL, and PL-AH adolescents were more likely to receive an anxiety disorder diagnosis. Further, HH, PH-AL, and PL-AH adolescents were more likely to receive partial hospitalization or care in another restrictive environment after inpatient treatment, relative to the LL class. This naturalistic study informs clinical decision-making by aiding our understanding of how multi-informant reports facilitate interpretations of adolescents’ clinical presentations as well as predictions about treatment characteristics.
KeywordsInpatient Assessment Multi-informant Internalizing problems Clinical utility
The research reported here was supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R324A180032 to University of Maryland at College Park. The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Education.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed were in accordance with the ethical standards of the institutional research committees and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study formal consent is not required.
- Beidas, R. S., Stewart, R. E., Walsh, L., Lucas, S., Downey, M. M., Jackson, K., Fernandez, T., & Mandell, D. S. (2015). Free, brief, and validated: Standardized instruments for low-resource mental health settings. Cognitive and Behavioral Practice, 22(1), 5–19. https://doi.org/10.1016/j.cbpra.2014.02.002.Google Scholar
- Brent, D. A., Greenhill, L. L., Compton, S., Emslie, G., Wells, K., Walkup, J. T., et al. (2009). The treatment of adolescent suicide attempters study (TASA): Predictors of suicidal events in an open treatment trial. Journal of the American Academy of Child & Adolescent Psychiatry, 48(10), 987–996. https://doi.org/10.1097/CHI.0b013e3181b5dbe4.Google Scholar
- Burnham, K. P., & Anderson, D. R. (2004). Multimodel inference: Understanding AIC and BIC in model selection. Sociological Methods & Research, 33(2), 261-304. https://doi.org/10.1177/0049124104268644
- Capron, D. W., Allan, N. P., Ialongo, N. S., Leen-Feldner, E., & Schmidt, N. B. (2015). The depression distress amplification model in adolescents: A longitudinal examination of anxiety sensitivity cognitive concerns, depression and suicidal ideation. Journal of Adolescence, 41, 17–24. https://doi.org/10.1016/j.adolescence.2015.02.001.Google Scholar
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Mahwah: Erlbaum.Google Scholar
- Crawford, E. A., Burke, T. A., Siegel, D., Jager-Hyman, S., Alloy, L. B., & Kendall, P. C. (2019). Somatic symptoms of anxiety and suicide ideation among treatment-seeking youth with anxiety disorders. Suicide and Life-Threatening Behavior. Advance online publication. https://doi.org/10.1111/sltb.12479
- De Los Reyes, A., Thomas, S. A., Goodman, K. L., & Kundey, S. M. A. (2013). Principles underlying the use of multiple informants’ reports. Annual Review of Clinical Psychology, 9, 123–149. https://doi.org/10.1146/annurev-clinpsy-050212-185617.Google Scholar
- De Los Reyes, A., Augenstein, T. M., Wang, M., Thomas, S. A., Drabick, D. G., Burgers, D. E., & Rabinowitz, J. (2015). The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin, 141(4), 858–900. https://doi.org/10.1037/a0038498.Google Scholar
- De Los Reyes, A., Alfano, C. A., Lau, S., Augenstein, T. M., & Borelli, J. L. (2016). Can we use convergence between caregiver reports of adolescent mental health to index severity of adolescent mental health concerns? Journal of Child and Family Studies, 25(1), 109–123. https://doi.org/10.1007/s10826-015-0216-5.Google Scholar
- Deros, D. E., Racz, S. J., Lipton, M. F., Augenstein, T. M., Karp, J. N., Keeley, L. M., ... & De Los Reyes, A. (2018). Multi-informant assessments of adolescent social anxiety: Adding clarity by leveraging reports from unfamiliar peer confederates. Behavior Therapy, 49(1), 84–98. https://doi.org/10.1016/j.beth.2017.05.001.
- Friedman, B., Berdahl, T., Simpson, L. A., McCormick, M. C., Owens, P. L., Andrews, R., & Romano, P. S. (2011). Annual report on health care for children and youth in the United States: Focus on trends in hospital use and quality. Academic Pediatrics, 11(4), 263–279. https://doi.org/10.1016/j.acap.2011.04.002.Google Scholar
- James, S., Charlemagne, S. J., Gilman, A. B., Alemi, Q., Smith, R. L., Tharayil, P. R., & Freeman, K. (2010). Post-discharge services and psychiatric rehospitalization among children and youth. Administration and Policy in Mental Health and Mental Health Services Research, 37(5), 433–445. https://doi.org/10.1007/s10488-009-0263-6.Google Scholar
- Jensen, P. S., Rubio-Stipec, M., Canino, G., Bird, H. R., Dulcan, M. K., Schwab-Stone, M. E., & Lahey, B. B. (1999). Parent and child contributions to diagnosis of mental disorder: Are both informants always necessary? Journal of the American Academy of Child & Adolescent Psychiatry, 38(12), 1569–1579. https://doi.org/10.1097/00004583-199912000-00019.Google Scholar
- Kraemer, H. C., Measelle, J. R., Ablow, J. C., Essex, M. J., Boyce, W. T., & Kupfer, D. J. (2003). A new approach to integrating data from multiple informants in psychiatric assessment and research: Mixing and matching contexts and perspectives. American Journal of Psychiatry, 160(9), 1566–1577. https://doi.org/10.1176/appi.ajp.160.9.1566.Google Scholar
- Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.Google Scholar
- Muthén, B., & Muthén, L. (2013). Mplus 7.1. Los Angeles: Muthén & Muthén.Google Scholar
- Nagin, D. S. (2006). Group-based modeling of development. Cambridge: Harvard University Press.Google Scholar
- Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry, 70(3), 300–310. https://doi.org/10.1001/2013.jamapsychiatry.55.Google Scholar
- Prinstein, M. J., Nock, M. K., Spirito, A., & Grapentine, W. L. (2001). Multimethod assessment of suicidality in adolescent psychiatric inpatients: Preliminary results. Journal of the American Academy of Child & Adolescent Psychiatry, 40(9), 1053–1061. https://doi.org/10.1097/00004583-200109000-00014.Google Scholar
- Prinstein, M. J., Nock, M. K., Simon, V., Aikins, J. W., Cheah, C. L., & Spirito, A. (2008). Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization. Journal of Consulting and Clinical Psychology, 76(1), 92–103. https://doi.org/10.1037/0022-006X.76.1.92.Google Scholar
- Reynolds, C. R., & Kamphaus, R. W. (2004). Behavior assessment system for children (2nd ed.). Circle Pines: American Guidance Service.Google Scholar
- Reynolds, E. K., Grados, M. A., Praglowski, N., Hankinson, J. C., Deboard-Lucas, R., Goldstein, L., Perry-Parrish, C. K., Specht, M. W., & Ostrander, R. (2016). Use of modified positive behavioral interventions and supports in a psychiatric inpatient unit for high-risk youths. Psychiatric Services, 67(5), 570–573. https://doi.org/10.1176/appi.ps.201500039.Google Scholar
- Reynolds, E. K., Silver, A. A., Morris, A., Hankinson, J. C., Perry-Parish, C., Specht, M. W., & Ostrander, R. (2018). Factors associated with length of youth inpatient psychiatric hospitalization. Adolescent Psychiatric, 8(20), 111–120. https://doi.org/10.2174/2210676608666180508125157.Google Scholar
- Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., & Aluwahlia, S. (1983). A children's global assessment scale (CGAS). Archives of General Psychiatry, 40(11), 1228–1231.Google Scholar
- Sullivan, E. M., Annest, J. L., Simon, T. R., Luo, F., & Dahlberg, L. L. (2015). Suicide trends among persons aged 10-24 years-United States, 1994-2012. Morbidity and Mortality Weekly Report, 64(8), 201–205.Google Scholar
- Thompson, R., Dubowitz, H., English, D. J., Nooner, K. B., Wike, T., Bangdiwala, S. I., Runyan, D. K., & Briggs, E. C. (2006). Parents’ and teachers’ concordance with children’s self-ratings of suicidality: Findings from a high-risk sample. Suicide and Life-threatening Behavior, 36(2), 167–181. https://doi.org/10.1521/suli.2006.36.2.167.Google Scholar
- Torio, C. M., Encinosa, W., Berdahl, T., McCormick, M. C., & Simpson, L. A. (2015). Annual report on health care for children and youth in the United States: National estimates of cost, utilization and expenditures for children with mental health conditions. Academic Pediatrics, 15(1), 19–35. https://doi.org/10.1016/j.acap.2014.07.007.Google Scholar