title: Correlates of Subjective Caregiver Strain in Caregivers of Youth Evaluated in a Pediatric Psychiatric Emergency Room.
abstract: BACKGROUND
  Although caregiver burden is relevant to the outcome for psychiatrically ill youth, most studies have focused on caregiver burden in the community or research settings. Therefore, we aimed at evaluating the subjective caregiver strain (SCS) at the time of presentation of youth to a pediatric psychiatric emergency room (PPER), assessing potential correlates to provide leads for improvements in formal support systems.
  
  
  METHODS
  In this retrospective cohort study, the internalized, externalized, and total SCS were assessed in caregivers of youth <18 years of age consecutively evaluated at a PPER during a 1 year period using the Caregiver Strain Questionnaire. Sociodemographic and a broad range of clinical data were collected during the PPER visit using a 12-page semistructured institutional evaluation form. The Appropriateness of Pediatric Psychiatric Emergency Room Contact scale, incorporating acuity, severity and harm potential, was used to rate appropriateness of the visit.
  
  
  RESULTS
  In caregivers of 444 youth, the internalized SCS was significantly higher than the externalized SCS (p < 0.001). Multivariable analyses indicated that higher total and externalized SCS were associated with disruptive behavior or substance abuse/dependent disorder diagnosis, presenting complaint of aggression, and discharge plan to the police. Higher total and internalized SCS were associated with lower child functioning, whereas total and internalized SCS were lower in adopted children. In addition, higher externalized SCS was associated with investigator-rated inappropriateness of the emergency visit, presenting complaint of defiance, and a lack of prior psychiatric ER visits.
  
  
  CONCLUSIONS
  High levels of CS in PPER highlight the necessity to adhere to existing guidelines regarding the inclusion of caregivers' perceptions into comprehensive psychiatric assessments. The particularly high strain in caregivers of children with externalizing disorders and in families with low-functioning youth may need to prompt PPER staff to provide efficient information on appropriate treatment options for these children and on support facilities for the parents.
authors.affiliation: 1 Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia , Pavia, Italy .|2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.
authors.forename: Silvia
authors.initials: S
authors.lastname: Molteni
authors.affiliation: 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.
authors.forename: Maren
authors.initials: M
authors.lastname: Carbon
authors.affiliation: 3 Department of Psychiatry, Maimonides Medical Center , Brooklyn, New York.
authors.forename: Johnny
authors.initials: J
authors.lastname: Lops
authors.affiliation: 4 Department of Psychiatry, Presbyterian Hospital, Columbia University , New York, New York.
authors.forename: Erin C
authors.initials: EC
authors.lastname: Soto
authors.affiliation: 5 Institute for Maternal and Child Health , Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS) "Burlo Garofolo," Trieste, Italy .|6 Paediatrics Department, University of Padua , Padua, Italy .
authors.forename: Chiara
authors.initials: C
authors.lastname: Cervesi
authors.affiliation: 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Sheridan
authors.affiliation: 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.
authors.forename: Britta
authors.initials: B
authors.lastname: Galling
authors.affiliation: 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.|7 Department of Psychiatry, Hofstra North Shore LIJ School of Medicine , Hempstead, New York.
authors.forename: Ema
authors.initials: E
authors.lastname: Saito
authors.affiliation: 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: Krakower
authors.affiliation: 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Dicker
authors.affiliation: 7 Department of Psychiatry, Hofstra North Shore LIJ School of Medicine , Hempstead, New York.
authors.forename: Carmel
authors.initials: C
authors.lastname: Foley
authors.affiliation: 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.|7 Department of Psychiatry, Hofstra North Shore LIJ School of Medicine , Hempstead, New York.
authors.forename: Victor
authors.initials: V
authors.lastname: Fornari
authors.affiliation: 1 Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia , Pavia, Italy .|8 Child Neuropsychiatry Unit, C. Mondino National Neurological Institute , Pavia, Italy .
authors.forename: Umberto
authors.initials: U
authors.lastname: Balottin
authors.affiliation: 2 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish (LIJ) Health System, Glen Oaks, New York.|7 Department of Psychiatry, Hofstra North Shore LIJ School of Medicine , Hempstead, New York.|9 The Feinstein Institute for Medical Research, Psychiatric Neuroscience Center of Excellence , Manhasset, New York.|10 Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine , Bronx, New York.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000293:Adolescent; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007389:Internal-External Control; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: adolescents; caregiver burden; children; disruptive behavior disorder; emergency room; psychiatric