Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland at College Park, Biology/Psychology Building, Room 3123K, College Park, MD, 20742, USA.
Department of Psychiatry and Behavioral Science, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center (Level 12), Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA.
J Abnorm Child Psychol. 2019 Oct;47(10):1677-1689. doi: 10.1007/s10802-019-00540-7.
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; M = 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.
与彼此相比，多个报告者对青少年内化问题的报告通常显示出较低的一致性。这给临床服务的提供带来了挑战，尤其是对于与内化问题相关的严重后果，即自杀意念和行为。临床医生将受益于有助于解释多报告者报告的方法，尤其是在以高成本护理和高风险决策为特征的住院环境中。765 名青少年住院患者（70.3%为女性；M=14.7）及其父母完成了青少年内化问题的测量。我们从电子病历中获得了基线临床和治疗特征。潜在类别分析显示出四种报告模式：父母-青少年低（LL；49.0%）、父母低-青少年高（PL-AH；11.5%）、父母高-青少年低（PH-AL；21.8%）、父母-青少年高（HH；17.6%）。与 LL 类相比，PH-AL 和 PL-AH 类的青少年更有可能因自杀意念而入院。就治疗特征而言，与 LL 类相比，HH 和 PH-AL 青少年更有可能接受常规抗精神病药物治疗，PH-AL 青少年更有可能被隔离，HH 青少年的住院时间更长。在出院时，与 LL 类相比，HH、PH-AL 和 PL-AH 青少年更有可能被诊断为焦虑障碍。此外，与 LL 类相比，HH、PH-AL 和 PL-AH 青少年在住院治疗后更有可能接受部分住院治疗或在其他限制环境中接受治疗。这项自然主义研究通过帮助我们理解多报告者报告如何促进对青少年临床表现的解释以及对治疗特征的预测，为临床决策提供信息。
