1
|
Janssen-de Ruijter EAW, Mulder EA, Bongers IL, Omlo L, van Nieuwenhuizen C. Looking into the crystal ball: quality of life, delinquency, and problems experienced by young male adults after discharge from a secure residential care setting in the Netherlands. Child Adolesc Psychiatry Ment Health 2019; 13:45. [PMID: 31832091 PMCID: PMC6859618 DOI: 10.1186/s13034-019-0305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents in residential care are a vulnerable population with many problems in several life areas. For most of these adolescents, these problems persist after discharge and into adulthood. Since an accumulation of risk factors in multiple domains increases the likelihood of future adverse outcomes, it would be valuable to investigate whether there are differences in life after residential care between subgroups based on multiple co-occurring risk factors. AIMS AND HYPOTHESIS The aim of this exploratory follow-up study is to explore differences between young adults-classified in four risk profiles-in relation to life after discharge from a secure residential care setting. It is hypothesised that young adults with a profile with many risks in multiple domains will experience more problems after discharge, such as (persistent) delinquency, compared to young adults with a profile with lower risks. METHODS Follow-up data were collected from 46 former patients of a hospital for youth forensic psychiatry and orthopsychiatry in the Netherlands. In order to illustrate these young adults' life after discharge, self-reported outcome measures divided into five domains (i.e., quality of life, daily life, social life, problems, and delinquency) were used. Differences between four classes based on pre-admission risk factors, which were identified in a previous study by latent class analysis, were explored by three (non-)parametric statistical tests. RESULTS Life after discharge for most young adults was characterised by close friends and a high quality of life, but also by substance abuse, professional support, debts, and delinquency. Only a few significant differences between the classes were found, primarily between young adults with risk factors in the individual, family, school, and peer domains and young adults in the other three classes. CONCLUSIONS Young adults experience a high quality of life after discharge from secure residential care, despite the presence of persistent problems. Some indications have been found that young adults with risk factors in four domains are at greatest risk for persistent problems in young adulthood. Because of the high amount of persistent problems, residential treatment and aftercare should focus more on patients' long-term needs.
Collapse
Affiliation(s)
- E. A. W. Janssen-de Ruijter
- GGzE Centre for Child & Adolescent Psychiatry, PO BOX 909 (DP 8001), 5600 AX Eindhoven, The Netherlands ,0000 0001 0943 3265grid.12295.3dTilburg University, Scientific Center for Care & Wellbeing (Tranzo), Tilburg, The Netherlands
| | - E. A. Mulder
- 0000000089452978grid.10419.3dLeiden University Medical Center, Leiden, The Netherlands ,Intermetzo-Pluryn, Nijmegen, The Netherlands
| | - I. L. Bongers
- GGzE Centre for Child & Adolescent Psychiatry, PO BOX 909 (DP 8001), 5600 AX Eindhoven, The Netherlands ,0000 0001 0943 3265grid.12295.3dTilburg University, Scientific Center for Care & Wellbeing (Tranzo), Tilburg, The Netherlands
| | - L. Omlo
- GGzE Centre for Child & Adolescent Psychiatry, PO BOX 909 (DP 8001), 5600 AX Eindhoven, The Netherlands
| | - Ch. van Nieuwenhuizen
- GGzE Centre for Child & Adolescent Psychiatry, PO BOX 909 (DP 8001), 5600 AX Eindhoven, The Netherlands ,0000 0001 0943 3265grid.12295.3dTilburg University, Scientific Center for Care & Wellbeing (Tranzo), Tilburg, The Netherlands
| |
Collapse
|
2
|
Vismara L, Presaghi F, Bocchia M, Ricci RV, Ammaniti M. Attachment Patterns in Subjects Diagnosed With a Substance Use Disorder: A Comparison of Patients in Outpatient Treatment and Patients in Therapeutic Communities. Front Psychiatry 2019; 10:807. [PMID: 31780968 PMCID: PMC6851193 DOI: 10.3389/fpsyt.2019.00807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/11/2019] [Indexed: 11/29/2022] Open
Abstract
The purpose of the present study is to analyze the quality of attachment in substance abuse patients in outpatient treatment vs. patients in therapeutic communities in order to identify the role of attachment insecurity in choosing a care system. The sample consisted of 127 subjects (107 males and 20 females); 97 were outpatients (83 males) and 30 therapeutic community patients (24 males). Attachment with respect to current, significant relationships was assessed using the Relationship Questionnaire. In the outpatient subgroup, the prevailing attachment style was preoccupied; for the therapeutic community patients, the prevailing attachment style was dismissive. The dimensions of care (how the caregiver is perceived as loving and caring) and overprotection (how the caregiver is perceived as intrusive and interfering)-evaluated by means of the Parent Bonding Instrument-were higher in the outpatient subgroup. Scores were higher with respect to maternal subscales regardless of treatment modality. No differences emerged with respect to self-perceived symptoms (SCL-90-R) between the subgroups; however, fearful-avoidant and dismissive-avoidant individuals reported higher self-perceived symptom regardless of treatment modality. Understanding the distribution of different attachment patterns with respect to the treatment modality may improve efficacious interventions, attuning them to the individual and his or her developmental environment.
Collapse
Affiliation(s)
- Laura Vismara
- Department of Educational Sciences, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Fabio Presaghi
- Department of Psychology of Development and Socialization Processes, Sapienza University of Rome, Rome, Italy
| | - Maria Bocchia
- Department of Mental Health (DSM), SERT, Local Health Service of Sarzana DSS 17, Sarzana, Italy
| | - Rosolino Vico Ricci
- Department of Mental Health (DSM), SERT, Local Health Service of Sarzana DSS 17, Sarzana, Italy
| | - Massimo Ammaniti
- Department of Psychology of Development and Socialization Processes, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
3
|
Rytilä-Manninen M, Fröjd S, Haravuori H, Lindberg N, Marttunen M, Kettunen K, Therman S. Psychometric properties of the Symptom Checklist-90 in adolescent psychiatric inpatients and age- and gender-matched community youth. Child Adolesc Psychiatry Ment Health 2016; 10:23. [PMID: 27429645 PMCID: PMC4946097 DOI: 10.1186/s13034-016-0111-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 06/29/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Symptom Checklist-90 (SCL-90) is a questionnaire that is widely used to measure subjective psychopathology. In this study we investigated the psychometric properties of the SCL-90 among adolescent inpatients and community youth matched on age and gender. METHODS The final SCL-90 respondents comprised three subsets: 201 inpatients at admission, of whom 152 also completed the instrument at discharge, and 197 controls. The mean age at baseline was 15.0 years (SD 1.2), and 73 % were female. Differential SCL-90 item functioning between the three subsets was assessed with an iterative algorithm, and the presence of multidimensionality was assessed with a number of methods. Confirmatory factor analyses for ordinal items compared three latent factor models: one dimension, nine correlated dimensions, and a one-plus-nine bifactor model. Sensitivity to change was assessed with the bifactor model's general factor scores at admission and discharge. The accuracy of this factor in detecting the need for treatment used, as a gold standard, psychiatric diagnoses based on clinical records and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) interview. RESULTS Item measurement properties were largely invariant across subsets under the unidimensional model, with standardized factor scores at admission being 0.04 higher than at discharge and 0.06 higher than those of controls. Determination of the empirical number of factors was inconclusive, reflecting a strong main factor and some multidimensionality. The unidimensional factor model had very good fit, but the bifactor model offered an overall improvement, though subfactors accounted for little item variance. The SCL-90s ability to identify those with and without a psychiatric disorder was good (AUC = 83 %, Glass's Δ = 1.4, Cohen's d = 1.1, diagnostic odds ratio 12.5). Scores were also fairly sensitive to change between admission and discharge (AUC 72 %, Cohen's d = 0.8). CONCLUSIONS The SCL-90 proved mostly unidimensional and showed sufficient item measurement invariance, and is thus a useful tool for screening overall psychopathology in adolescents. It is also applicable as an outcome measure for adolescent psychiatric patients. SCL-90 revealed significant gender differences in subjective psychopathology among both inpatients and community youth.
Collapse
Affiliation(s)
- Minna Rytilä-Manninen
- Hospital District of Helsinki and Uusimaa, Kellokoski Hospital, 04500 Kellokoski, Finland ,Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sari Fröjd
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Henna Haravuori
- Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland ,Department of Health, Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Nina Lindberg
- Forensic Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mauri Marttunen
- Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland ,Department of Health, Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Kirsi Kettunen
- Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sebastian Therman
- Department of Health, Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
4
|
de Boer SBB, Boon AE, Verheij F, Donker MCH, Vermeiren R. Treatment Outcome of Adolescent Inpatients With Early-Onset and Adolescent-Onset Disruptive Behavior. J Clin Psychol 2016; 73:466-478. [PMID: 27391037 DOI: 10.1002/jclp.22341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Unlike adolescents with adolescent-onset (AO) disruptive behavior, adolescents with early-onset (EO) disruptive behavior may not benefit from treatment. METHOD Using Symptom Checklist (SCL-90-R) ratings at admission and discharge of adolescent inpatients with EO (n = 85) and AO (n = 60) disruptive behavior treatment outcome was determined by (a) a change in mean scores and (b) the Reliable Change Index. For a subgroup, ratings on the Satisfaction Questionnaire Residential Youth Care for Parents (n = 83) were used to verify the treatment outcome. RESULTS Inpatients with EO disruptive behavior had a higher risk of dropout (44.4%) from treatment than the AO group (24.7%). Among the treatment completers, both onset groups reported improvements on the SCL-90-R, with 26.9% recovering and 31.7% improving. Inpatients who reported improvement were mostly rated as improved by their parents (r = .33). CONCLUSION As EO inpatients are more likely to drop out, interventions should aim at motivating youngsters to continue treatment, particularly given the poor outcome in this group. Treatment may benefit both groups because those EO youths who stayed in treatment improved to the same extent as AO inpatients.
Collapse
Affiliation(s)
- Sjoukje Berdina Beike de Boer
- De Fjord, Center of Orthopsychiatry and Forensic Youth Psychiatry.,De Jutters, Center of Youth Mental Healthcare Haaglanden
| | - Albert Eduard Boon
- De Fjord, Center of Orthopsychiatry and Forensic Youth Psychiatry.,Lucertis, Child and Adolescent Psychiatry.,Curium-Leiden University Medical Center
| | - Fop Verheij
- Erasmus MC-Sophia (Sophia Children's Hospital).,Erasmus MC University Medical Center
| | | | - Robert Vermeiren
- Curium-Leiden University Medical Center.,VU University Medical Center
| |
Collapse
|
5
|
Brown RA, Abrantes AM, Minami H, Prince MA, Bloom EL, Apodaca TR, Strong DR, Picotte DM, Monti PM, MacPherson L, Matsko SV, Hunt JI. Motivational Interviewing to Reduce Substance Use in Adolescents with Psychiatric Comorbidity. J Subst Abuse Treat 2015; 59:20-9. [PMID: 26362000 DOI: 10.1016/j.jsat.2015.06.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 11/16/2022]
Abstract
Substance use among adolescents with one or more psychiatric disorders is a significant public health concern. In this study, 151 psychiatrically hospitalized adolescents, ages 13-17 with comorbid psychiatric and substance use disorders, were randomized to a two-session Motivational Interviewing intervention to reduce substance use plus treatment as usual (MI) vs. treatment as usual only (TAU). Results indicated that the MI group had a longer latency to first use of any substance following hospital discharge relative to TAU (36 days versus 11 days). Adolescents who received MI also reported less total use of substances and less use of marijuana during the first 6 months post-discharge, although this effect was not significant across 12 months. Finally, MI was associated with a significant reduction in rule-breaking behaviors at 6-month follow-up. Future directions are discussed, including means of extending effects beyond 6 months and dissemination of the intervention to community-based settings.
Collapse
Affiliation(s)
- Richard A Brown
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI.
| | - Ana M Abrantes
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | - Haruka Minami
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | - Mark A Prince
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | - Erika Litvin Bloom
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | | | | | - Dawn M Picotte
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | - Peter M Monti
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | | | | | - Jeffrey I Hunt
- Alpert Medical School of Brown University, Providence, RI; Bradley Hospital, East Providence, RI
| |
Collapse
|