Satisfaction with Life Scale (SWLS) in Caregivers of Clinically-Referred Youth: Psychometric Properties and Mediation Analysis

This paper presents the psychometric evaluation of the Satisfaction with Life Scale (SWLS; Diener et al. in J Personal Assess 49:71-75, 1985) used with a large sample (N = 610) of caregivers for youth receiving mental health services. Methods from classical test theory, factor analysis, and item response theory were utilized. Additionally, this paper investigated whether caregiver strain mediates the effect of youth symptom severity on caregiver life satisfaction (N = 356). Bootstrapped confidence intervals were used to determine the significance of the mediated effects. Results indicated that the SWLS is a psychometrically sound instrument to be used with caregivers of clinically-referred youth. Mediation analyses found that the effect of youth symptom severity on caregiver life satisfaction was mediated by caregiver strain but that the mediation effect differed based on the type of youth symptoms: caregiver strain was a partial mediator when externalizing symptoms were measured and a full mediator when internalizing symptoms were measured. Implications for future research and clinical practice are discussed.     

Quality of life and burden in caregivers of youth with obsessive-compulsive disorder presenting for intensive treatment

BackgroundPediatric obsessive-compulsive disorder (OCD) is associated with deleterious familial effects; caregivers are often enmeshed in the disorder and can experience considerable burden and decreased quality of life (QoL). Consequently, this study examined burden and QoL in caregivers of youth with OCD enrolled in an intensive outpatient or partial hospitalization program.MethodThe relationships between caregiver QoL and burden and the following variables were investigated: OCD symptom severity, functioning (youth functional impairment, general family functioning), family (family accommodation, parental relationship satisfaction, positive aspects of caregiving), and comorbid psychopathology (caregiver anxiety and depressive symptoms, youth internalizing and externalizing behaviors). Seventy-two child and caregiver dyads completed clinician- and self-rated questionnaires.ResultsComponents of caregiver QoL correlated with caregiver-rated functional impairment, family accommodation, youth externalizing behaviors, and caregiver psychopathology. Aspects of caregiver burden correlated with child OCD symptom severity, functional impairment related to OCD, as well as caregiver and child comorbid psychopathology. Caregiver depressive symptoms predicted caregiver QoL, and caregiver depressive symptoms and child externalizing symptoms both predicted caregiver burden. Caregiver burden did not mediate the relationship between obsessive-compulsive symptom severity and caregiver QoL.ConclusionUltimately, elucidating factors associated with increased caregiver burden and poorer QoL is pertinent for identifying at-risk families and developing targeted interventions.     

Validation and use of the Children’s Hope Scale-Revised PTPB Edition (CHS-PTPB): High Initial Youth Hope and Elevated Baseline Symptomatology Predict Poor Treatment Outcomes

The present study examined the relationship between initial youth hope, measured within the first 4 weeks of mental health treatment, and treatment progress over time (self-, caregiver-, and clinician-report of symptom severity) in a clinical sample of youth ages 11-18 years (N = 356). The psychometric properties of the CHS-PTPB, a revised version of the Children's Hope Scale, are also presented. Results indicate the CHS-PTPB is a psychometrically sound measure for use in this population. Additionally, results found that while higher levels of hope were associated with lower levels of symptom severity at baseline, initial level of hope was not significantly related to symptom improvement over time as reported by the youth and caregiver. Surprisingly, higher initial hope predicted slower treatment progress as rated by clinicians. According to clinician-rated symptom severity, youth with high initial hope and high baseline symptom severity show the poorest predicted clinical outcome. Implications, future directions, and limitations of the study are discussed.     

Witnessed violence and youth behavior problems: a multi-informant study

Witnessed violence has significant negative consequences for youth behavior and mental health. However, many findings on the impact of witnessed violence have been based on a single informant. There is a general lack of consistency between caregiver and youth reports on both witnessed violence and behavioral problems. This study included data from both caregivers and youth and incorporated a multisource analytic approach to simultaneously examine the association between youth witnessed violence and externalizing and internalizing behavior problems. Data from 875 caregivers and 812 youth were collected as part of the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Findings showed that youth reported more witnessed violence than did their caregivers, and caregivers reported more externalizing and internalizing behavior problems than did youth. Further, the source of information had a significant impact on the association between witnessed violence and internalizing behaviors. These findings highlight the need to incorporate multiple sources and multi-informant analytic techniques to eliminate methodological limitations to understanding the effect of witnessed violence on youth behavioral problems.     

Psychosocial consequences of caregiver transitions for maltreated youth entering foster care: the moderating impact of community violence exposure

Youth who experience a greater number of caregiver transitions during childhood are at risk for developing a host of psychosocial problems. Although researchers have examined individual-level factors that may moderate this association, no known studies have examined the impact of community-level factors. The current study investigated whether community violence exposure (CVE) moderated the association between number of prior caregiver transitions and increases in levels of externalizing and internalizing problems for a sample of youth entering foster care. Participants included 156 youth (aged 9-11 at first assessment) removed from their homes because of maltreatment. Youth provided reports of caregiver transitions and CVE at baseline, and caregivers, teachers, and youth reported on externalizing and internalizing problems 18-22 months later. Results from hierarchical multiple regression analyses indicated that youth with a greater number of caregiver transitions and higher levels of CVE evidenced significant increases in levels of psychosocial problems. The results of the study are discussed in terms of their implications for child welfare services.     

Parent attitudes and parent adolescent interaction in families of youth at risk for psychosis and with recent-onset psychotic symptoms

Aim: This study investigated the behavioural correlates of caregiver attitudes among parents of youth at risk for psychosis and with recent‐onset psychotic symptoms. Methods: Forty adolescents identified as ultra‐high‐risk (UHR) for psychosis using the Structured Interview for Prodromal Syndromes, and their primary caregivers, participated in the Family Interaction Task (FIT), a 10‐minute discussion of meaningful shared experiences that allowed families to demonstrate supportive as well as conflict‐engaging behaviour. At the same assessment, caregivers were administered the Camberwell Family Interview (CFI). We examined cross‐sectional relationships between these measures, as well as their association with youth symptom severity and functioning at 4‐month follow‐up. Results: As predicted, caregivers who provided more positive remarks regarding their UHR and recent‐onset adolescents during the CFI were also more likely to exhibit constructive behaviour during the FIT. Similarly, CFI critical comments were positively associated with caregivers' conflict‐engaging behaviour during the FIT. Parents' positive remarks predicted a decrease in negative symptoms, and parent warmth predicted an increase in social functioning at follow‐up assessment. Conclusions: The ability to maintain a constructive attitude and approach towards youth predicted symptomatic and functional improvement, and may be a teachable skill.     

The relationships among caregiver and adolescent identity status, identity distress and psychological adjustment

The present study addresses the relationships of caregiver identity status on their adolescent children's identity distress and psychological symptom severity among a sample of adolescents (age 12-19) in treatment at a community mental health center (N?=?60 caregiver-child dyads). A significant proportion of caregivers (10%) and their adolescent children (21.7%) met DSM-IV criteria for Identity Problem. Caregiver identity commitment, significantly predicted adolescent identity distress over and above the adolescents' identity variables, while caregiver identity exploration significantly predicted adolescent psychological symptom severity. These findings and implications are discussed in further detail.     

Brief Multidimensional Students’ Life Satisfaction Scale—PTPB Version (BMSLSS-PTPB): Psychometric Properties and Relationship with Mental Health Symptom Severity Over Time

Youth life satisfaction is a component of subjective well-being, an important part of a strengths-based approach to treatment. This study establishes the psychometric properties of the Brief Multidimensional Students' Life Satisfaction Scale-PTPB Version (BMSLSS-PTPB). The BMSLSS-PTPB showed evidence of construct validity with significant correlations as expected to measures of youth hope and youth symptom severity, and no relationship as expected to youth treatment outcome expectations. A longitudinal analysis was conducted examining the relationship between youth-reported life satisfaction and mental health symptom severity (youth-, caregiver-, and clinician-report) for 334 youth (aged 11-18 years) receiving in-home treatment. Results indicated that life satisfaction consistently increased over the course of treatment but increased faster in youth whose symptom severity, as rated by all reporters, decreased over the course of treatment. Implications, future directions, and limitations of the study are discussed.     

Preliminary study of family accommodation in youth with autism spectrum disorders and anxiety: Incidence,clinical correlates,and behavioral treatment response

Anxiety symptoms are common in youth with autism spectrum disorders (ASD) and directly associated with symptom severity and functional impairment. Family accommodation occurs frequently among individuals with obsessive-compulsive and anxiety disorders; to date, no data exist on the nature and correlates of family accommodation in youth with ASD and anxiety, as well as its relationship to cognitive-behavioral therapy outcome. Forty children with ASD and a comorbid anxiety disorder participated. Clinicians administered measures of ASD and anxiety disorder caseness, anxiety symptom severity, and family accommodation; parents completed questionnaires assessing social responsiveness, internalizing and externalizing behaviors, and functional impairment. A subsample of youth (n = 24) completed a course of cognitive-behavioral therapy. Family accommodation was common and positively correlated with anxiety symptom severity, but not functional impairment, general internalizing symptoms, externalizing behavior, or social responsiveness. Family accommodation decreased following cognitive-behavioral therapy with decreases in family accommodation being associated with decreases in anxiety levels. Treatment responders reported lower family accommodation frequency and lower parent impact relative to non-responders. Clinical implications of this study in assessing and psychotherapeutically treating youth with ASD and comorbid anxiety are discussed.     

A randomized, controlled study of an Alzheimer's caregiver skills training program

This study was an attempt to improve the quality of the relationship between dementia caregivers and their loved ones by decreasing the gap between caregivers' expectations and patients' actual functional abilities and by teaching supportive skills. Although a group of 49 caregiver-patient dyads were recruited, the outcome measures of only those dyads (47) that completed the week seven session were used for analysis. Half of the dyads were randomized to an intervention group and the other half to a waiting list. The intervention group (N = 24) completed a four-session caregiver training program in which caregivers first watched investigators administering to their loved ones the Texas Functional Living Scale and later progressed to helping their loved ones by appropriate cueing to perform the tasks involved. Comparisons were made between baseline scores, scores at seven weeks, and scores at the end of 17 weeks on the congruence between caregiver estimates and patients' actual performance on the Independent Living Scale and measures of cognition, function, preillness quality of relationship, caregiver mood, feeling of self-efficacy, and several other measures. We were not able to increase the congruence between caregiver estimates and patients' actual performance and found no change in any other measure. We didfind the expected relationship between depression and caregiver sense of self-efficacy.     

Investigating treatment characteristics and first-session relationship variables as predictors of dropout in the treatment of traumatized youth

Objective: Attrition is a common problem in youth trauma treatment, but there is currently little knowledge of why so many youths drop out. In this study, treatment variables (caregiver attendance in the first session and exposure vs. non-exposure-based treatment) and first-session process variables (the therapeutic alliance and youths’ perceptions of parental treatment approval) were investigated as predictors of dropout. Method: Participants (N?=?156, mean age?=?15.1) were randomly assigned to trauma-focused cognitive behavioral therapy or therapy as usual in a community trial. Results: Dropout (n?=?39, 25.0%) was predicted by a lack of caregiver attendance, lower rates of youth-perceived parental treatment approval, and weaker therapist-rated youth alliance. Neither type of treatment, youth-rated alliance or caregiver alliance, predicted dropout. Conclusions: The findings indicate that in addition to caregivers’ actual participation in the first session, youths’ perception of their parents’ approval of treatment seems to influence treatment attendance. This finding implies that therapists should engage caregivers in therapy and address possible discordance in treatment goals and tasks. Furthermore, consistent with adult studies, exposure-based treatments do not appear to increase dropout rates.     

The Relationship Between Change in Therapeutic Alliance Ratings and Improvement in Youth Symptom Severity: Whose Ratings Matter the Most?

This paper presents the psychometric evaluation of brief measures of therapeutic alliance (TA) for youths, clinicians and caregivers and a longitudinal analysis of relationships between changes in TA and changes in youth symptom and functioning severity. Psychometric analyses using methods from Classical Test Theory, Item Response Theory, and Factor Analysis indicate that the measures of TA used in this study offer something new for both practice and research. The measures have variability, sensitivity to change over time, brevity and can be used with multiple parties through parallel forms. The longitudinal analyses, employing hierarchical linear modeling with time-varying covariates, found that TA ratings of the clinician correlated with symptom improvement as rated by the clinician, caregiver and youth. Additional analyses showed that decreases in clinician-rated youth TA was most important in predicting a lower rate of youth improvement. Implications for future research and clinical practice are discussed.     

Development and Psychometric Evaluation of the Youth and Caregiver Service Satisfaction Scale

There is widespread need for the inclusion of service satisfaction measures in mental health services evaluation. The current paper introduces the Service Satisfaction Scale (SSS), a practical and freely available measure of global youth and adult caregiver service satisfaction. The development process, as well as results from a comprehensive psychometric evaluation in a large sample of clinically referred youth (N = 490) receiving home-based care, and their caregivers (N = 383), are presented. Multiple models for psychometric analyses were used including classical test theory, item response theory, and confirmatory factor analysis. As expected, SSS total scores were negatively skewed but the measure displayed otherwise adequate scale characteristics for both the youth and caregiver versions. Thus, the SSS is a brief and psychometrically sound instrument for measuring global satisfaction in home-based mental health service settings. It has several advantages compared to existing measures including brevity, parallel youth and caregiver forms, availability at no cost, and its development on a large sample of youth and caregivers with rigorous psychometric methodology.     

Relationship Between Caregiver Hopefulness and Satisfaction with their Children’s Mental Health Services

Relationships among the Youth Services Survey for Families (YSSF) Indicators, selected demographic and clinical variables, and caregiver-rated hopefulness and children’s problem severity were examined in a random sample of 1,500 caregivers of Medicaid-enrolled youth in a satisfaction study with Kentucky’s 14 community mental health centers. Multiple linear regressions revealed that caregiver services and caregiver hopefulness were excellent predictors of two and three YSSF Indicators, respectively. Providers need to respond to caregiver concerns when developing support services and understand the mechanisms associated with these services’ effectiveness. Tracking changes in caregiver and youth hopefulness during treatment may improve services and retention and bridge the gap between research and the important construct of hope.     

Relations among co-occurring psychopathology in youth with autism spectrum disorder,family resilience,and caregiver coping

BackgroundCo-occurring mental health problems are common in youth with autism spectrum disorder (ASD) and are associated with greater caregiver stress; however, it is not known whether such challenges overwhelm caregivers’ ability to cope. Research has demonstrated that families of children with ASD are able to demonstrate resilience; yet, whether family resilience functions as a compensatory or protective factor in ASD families has not been investigated. This study aimed to examine the relations among family resilience, co-occurring psychopathology in youth with ASD, and caregiver coping.MethodData from this study were obtained from the 2016–2018 National Survey of Children’s Health (NSCH). Multiple binary logistic regression was run to examine the associations among commonly co-occurring psychiatric disorders in youth with ASD (i.e., anxiety, depression, attention-deficit/hyperactivity disorder, and behavioral/conduct problems) and caregiver coping. Another multiple binary logistic regression was run to examine whether family resilience moderates the aforementioned relationships.ResultsYouth with ASD and co-occurring conduct problems or depression were significantly more likely to be cared for by adults who were not coping well. High family resilience was directly associated with lower odds of poor parental coping; nonetheless, co-occurring conduct problems and depression were still associated with worse coping of caregivers after accounting for family resilience.ConclusionsFindings indicate that co-occurring depression and conduct problems in ASD youth may overwhelm their caregivers’ coping resources. Results also suggest that interventions targeting family resilience may improve the coping of adults caring for children and adolescents with ASD.     

Caregiver causal attributions in youth psychosis

Aim: Caregiver causal attributions influence patient and caregiver reactions to psychosis. The current study describes common caregiver causal attributions about psychosis onset in youth, including a subset of first‐episode psychosis patients, and the patient and caregiver characteristics that influence these attributions. It also examines if caregiver views are affected by contact with youth mental health services. Methods: Fifty‐one caregivers of 50 youth patients with a diagnosed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) psychotic disorder were interviewed about their causal attributions. Patient and caregiver demographic and clinical predictors were also collected. Results: Caregivers most highly endorsed substance use, genetics, negative peer influences and school stress as individual causes. These findings were consistent across the total sample. Principal components analysis derived three causal categories. Caregivers most frequently endorsed a biological and substance use lifestyle causal category, followed by psychological vulnerability and stress‐reactivity causal categories. There was evidence that caregiver and patient factors, as well as contact with youth mental health services, influenced the causal attributions caregivers made about the onset of psychosis. Conclusion: Caregivers of youth with psychosis are making causal attributions that are consistent with current aetiological theories of psychosis in youth. The study showed that caregivers are particularly cognizant of genetic and substance use factors in the development and maintenance of psychosis. However, youth mental health services may need to particularly focus on increasing caregiver understanding of the dynamics of stress factors as symptoms, and not causes, of psychosis early in the illness course.     

Co-Occurring Posttraumatic Stress Disorder and Depression Among Young Children

The purpose of this study was to examine differences in: (1) mental health emotional and behavioral problems between young children experiencing PTSD with and without MDD; (2) the incidence of caregiver PTSD and MDD between children with PTSD?±?MDD; and (3) the number of traumatic events and interpersonal versus non-interpersonal nature of trauma events among children whose parents sought child trauma-focused treatment. Sixty-six caregivers of children aged 3–7 with PTSD completed semi-structured interviews regarding caregiver and child diagnoses, and caregivers completed self-report measures regarding child symptomatology. Results indicated that young children with PTSD?+?MDD had significantly higher internalizing symptoms, dissociative symptoms, and posttraumatic stress severity than those without comorbid MDD. There were no significant group differences in the incidence of caregiver PTSD or MDD, or the number or types of traumatic events. Future research to understand the unique contributors to the etiology of MDD in the context of PTSD among young children is needed.     

Self-efficacy for seizure management and youth depressive symptoms: caregiver and youth perspectives

The aims of this study were to (1) compare caregiver and youth measures of self-efficacy for seizure management (SESM), as well as report of depressive symptoms and suicidal ideation in youth with epilepsy (YWE) and (2) examine the potential relationship between caregiver SESM and caregiver report of depressive symptoms in YWE. Seventy-seven YWE ages 9-17 completed the Children's Depression Inventory (CDI) and the Seizure Self-Efficacy Scale for Children with Epilepsy (SSES-C). Sixty-five caregivers completed the Behavior Assessment System for Children (BASC-II) and the Epilepsy Self-Efficacy Scale (ESES). Results showed no agreement between youth and caregiver self-efficacy scores. However, there was low to modest agreement in published classifications of depressive symptoms between youth and caregiver ratings of depressive symptoms in youth, with caregivers reporting higher levels of symptoms than the youth reported. Twenty-seven percent of YWE endorsed suicidal ideation. When caregiver report of their own self-efficacy towards their child's seizures and their assessment of their child's depressive symptoms were compared, there was a significant inverse relationship. These findings suggest a multi-informant approach to assessment of depressive symptoms in YWE, the importance of including self-efficacy for seizure management in assessment and treatment of YWE, and provide support for transactional patterns of psychosocial adjustment.     

Reduction of subjective distress in CBT for childhood OCD: Nature of change,predictors, and relation to treatment outcome

Little research has investigated changes in subjective distress during cognitive-behavioral therapy (CBT) for anxiety disorders in youth. In the current study, 40 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age = 11.9 years, 60% male, 80% Caucasian) and 36 parent informants completed separate weekly ratings of child distress for each OC symptom during a 12-session course of CBT. Between-session changes in distress were calculated at the start of, on average throughout, and at the end of treatment. On average throughout treatment, child- and parent-reported decreases in child distress were significant. Baseline OCD severity, functional impairment, and internalizing symptoms predicted degree of change in child distress. Additionally, greater decreases in child distress were predictive of more improved clinical outcomes. Findings advance our understanding of the strengths and limitations of this clinical tool. Future studies should examine youth distress change between and within CBT sessions across both subjective and psychophysiological levels of analysis.