The Relation between Familial Risk Factors, Maltreatment Types, and Mental Health Diagnoses Among Youth in Psychiatric Residential Treatment

Background/Purpose: Many children in residential care have experienced maltreatment and present with severe mental and/or behavioral health needs. Children who experienced maltreatment are more likely to exhibit externalizing and internalizing behavior problems (Brack et al., 2012; Mills et al., 2013) and to be diagnosed with mental health disorders (Petrenko et al., 2012). Children who experience maltreatment often have adverse family backgrounds driven by high rates of exposure to familial risk factors. Exposure to family risk factors increases the risk of poor mental health outcomes (Tonmyr et al., 2011). This study aims to examine the relation between familial risk factors and maltreatment types with different mental health diagnoses among youth in residential care.

Methods: Data and Sample: Data was obtained from a larger study of youth in a psychiatric residential treatment facility (n=447; Boel-Studt, 2017). The study sample included 430 youth in two Midwestern psychiatric residential treatment programs between 2007 and 2012.

Measures: Adolescent demographics included gender, age and race. Maltreatment was measured using the Maltreatment Checklist to assess subtypes of maltreatment that included neglect, sexual abuse, physical abuse, and emotional abuse{\displaystyle \alpha }. Family risk factors were measured utilizing the Checklist of Family Problems. {\displaystyle \alpha }Diagnoses were completed by psychiatrists utilizing the Diagnostic and Statistical Manual of Mental Disorders classification system (American Psychiatric Association, 2000).

Results: Six separate hierarchical logistic regression models were specified using family risk factors and maltreatment type to predict risk for attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), reactive attachment disorder (RAD), and depressive disorder. Gender was the strongest predictor of whether a youth in PRT would be diagnosed with ADHD. Age, gender, and race were all predictive of a CD diagnosis. Age and gender were predictive of a GAD diagnosis. Gender and having a history of sexual abuse were predictive of a PTSD diagnosis. Age, race, and history of neglect were predictive of having a RAD diagnosis. Exposure to domestic violence was associated with decreased odds of a RAD diagnosis. Age and being female were predictive of a depressive disorder diagnosis.

Conclusions: The results show that, overall, demographic characteristics are more predictive of diagnoses compared to that of family risk factors and maltreatment for this population. Specifically, gender was the most consistent predictor with significant associations found with five out of six diagnoses. This was followed by age which significantly predicted four out of the six diagnoses. Findings from this study suggest residential treatment programs should include person-centered treatment plans considering gender, race, and age. Moreover, maltreatment types are associated with certain diagnoses, and therefore, should also be considered when designing and implementing a treatment plan for a child presenting with PTSD or RAD. Familial risk factors, while predictive of mental health diagnoses, should continue to be explored for indirect impacts in the manifestation of mental health and the role familial risk factors play in the placement of children in psychiatric residential treatment.