Which family factors predict children's externalizing behaviors following discharge from psychiatric inpatient treatment?
Which family factors predict children's externalizing behaviors following discharge from psychiatric inpatient treatment?
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DOI：
10.1111/j.1469-7610.2006.01651.x
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发表时间：
2006-11-01
影响因子：
7.6
通讯作者：
Blader, Joseph C.
中科院分区：
文献类型：
--
作者：
Blader, Joseph C.
背景：父母的行为管理方式、父母的压力和家庭环境与儿童的行为问题密切相关。青少年精神疾病住院通常是由于严重的行为问题引起的，因此家庭相关变量与出院后功能的关系值得研究。这项研究通过a)入院时测量的预测因素，b)与结果同时测量的预测因素，以及c)从入院到随访期间预测数值的变化，研究了出院后的临床病程和选择的家庭因素来模拟结果。方法：在一项对107名儿童精神科住院患者的前瞻性随访中，照顾者完成了关于他们孩子的行为、养育方式、父母压力、照顾者压力以及他们在入院时、出院后3个月、6个月和12个月时的心理困扰的评定量表。结果：在入院和随访期间，父母养育压力的减轻程度与外化行为的改善有最强的关系。外化行为下降幅度最大、持续时间最长的是那些父母报告入院时父母压力较大、出院后父母压力较低的青少年。相比之下，父母在入院和随访时报告父母压力较低的孩子在出院后的改善明显较小。育儿压力的变化与行为症状的变化无关。育儿压力使行为管理实践和孩子结果之间的关系黯然失色，这表明育儿压力可能起到了中介作用。结论：在随访一年中，较高的初始育儿压力倾向于更好的结果。持续的低压力预示着更少的进步。入院时较高的压力可能意味着更有利的亲子关系或随后坚持治疗的动机。缓解高压力的干预措施可能值得进一步研究。较低的育儿压力可能意味着脱离，或者，一些慢性受损儿童的父母对行为问题的波动变得相当习惯。如果得到证实，似乎有必要对这些和其他关于低育儿压力和次优子女结果之间关系的解释进行进一步检查。
Background: Parents' behavior management practices, parental stress, and family environment are highly pertinent to children's conduct problems. Preadolescents' psychiatric hospitalization usually arises because of severe conduct problems, so the relationships of family-related variables to postdischarge functioning warrant investigation. This study examined postdischarge clinical course and select family factors to model outcomes via a) predictors measured at admission, b) predictors measured concurrently with outcome, and c) changes in predictor values from admission through follow-up. Method: In a prospective follow-up of 107 child psychiatry inpatients, caregivers completed rating scales pertaining to their child's behavior, parenting practices, parenting stress, caregiver strain, and their own psychological distress at admission and three, six, and 12 months after discharge. Results: The magnitude of reductions in parenting stress between admission and follow-up bore the strongest relationship to improvements in externalizing behavior. The largest and most sustained decreases in externalizing behavior arose among youngsters whose parents reported high parenting stress at admission and low parenting stress after discharge. By contrast, children whose parents reported low parenting stress at admission and follow-up showed significantly less postdischarge improvement. Parenting stress changes were not attributable to changes in behavioral symptoms. Parenting stress eclipsed relationships between behavior management practices and child outcomes, suggesting that parenting stress might have a mediational role. Conclusion: High initial parenting stress disposed to better outcomes over the year of follow-up. Consistently low stress predicted less improvement. Higher stress at admission may imply more advantageous parent-child relationships or motivation for subsequent persistence with treatment. Interventions that ameliorate high stress may warrant further study. Low parenting stress might signify disengagement, or, alternatively, that parents of some chronically impaired children become rather inured to fluctuations in behavioral problems. If confirmed, further examination of these and other accounts for a relationship between low parenting stress and suboptimal child outcome seems warranted.