A Multi-Method Investigation of Parental Burden Following Youth Discharge from Psychiatric Hospitalization

Katherine M. Harris

Advisor: Christianne Esposito-Smythers, PhD, Department of Psychology

Committee Members: Amanda Sanchez, Debora Goldberg

Off-Campus Location, Center for Evidence Based Behavioral Health Conference Room
April 11, 2025, 10:00 AM to 12:00 PM

Abstract:

Rates of suicide and poor mental health are high among adolescents, and psychiatric hospitalization for these reasons has increased significantly over the last decade. The year following youth psychiatric hospitalization is characterized by an increased risk for suicide attempts and rehospitalizations, which likely contributes to the high level of parental burden experienced during this time. This two-study dissertation explored factors related to parental burden following adolescent psychiatric hospitalization using a multi-method approach, with a focus on how income disparities may impact this experience. Both studies utilized a longitudinal, secondary dataset of 252 mothers with an adolescent recently discharged from psychiatric hospitalization. Mothers completed qualitative (i.e., semi-structured interviews) and quantitative measures at one month (M1), three months (M3), six months (M6) and twelve months (M12) following their adolescent’s discharge from psychiatric hospitalization. Using a cross-lagged autoregressive model, Study 1 investigated the bidirectional relations between parental burden (i.e., Child and Adolescent Impact Assessment; CAIA), youth externalizing symptoms (i.e., Achenbach Child Behavior Checklist; CBCL), and youth mental health service use (i.e., Child and Adolescent Services Assessment; CASA) at M1, M3, M6, and M12, and explored if relations were moderated by annual household income. Overall, results suggest that greater externalizing symptoms contribute to greater parental burden over time and lack of continuous follow-up with youth individual psychotherapy. Follow-up with youth individual psychotherapy at M3 predicted lower externalizing symptoms at M6, but not at other time points. Other longitudinal relations were not supported; hypotheses that relations differed by income were also not supported. Study 2 explored qualitative experiences of burden resulting from the mental health system (i.e., system-level burden), the year following adolescent psychiatric hospitalization. Specifically, 20 mothers from the secondary dataset were randomly selected from high (i.e., > $100,000) and low (i.e., < $25,000) annual household income groups, to compare how income may influence qualitative experiences of system-level burden. Semi-structured interviews were analyzed using an inductive and deductive coding approach and multi-cycle coding process. Three primary themes were found that persisted over time: (1) Difficulty accessing mental health services; (2) Dissatisfaction with mental health services; and (3) Frustration with medications. Nuanced differences between income groups, particularly as it related to dissatisfaction with services, were noted. Taken together, findings enhance our understanding of the experience of economically diverse youth and families following psychiatric hospitalization. Importantly, findings also contribute to knowledge of service use patterns following youth psychiatric hospitalization, which is sorely needed for youth safety. Recommendations for culturally responsive discharge practices and post-discharge care are discussed.