Sample and procedure
Youth experiencing their first psychiatric hospitalization were recruited from inpatient services at a regional hospital in Ontario, Canada between January and February 2020. Eligibility criteria for this study were youth aged 10-16 years who had adequate English skills to complete the in-person interview and mail questionnaires. Youth were excluded if their mental health prevented participation (e.g., risk for harm to others, lack of capacity to consent). In consultation with the clinical manager of the child and adolescent psychiatry inpatient unit, nurses identified eligible youth, introduced the study, and invited youth interested in participating in the study to speak with research staff. Research staff then described the study to youth, obtained informed consent (including an assessment of their decisional capacity) , and sought permission from youth to contact their parents/guardians for participation. Youth were eligible to participate without parental participation. Youth and parent-reported data were collected with researcher-led structured interviews and self-reported questionnaires using lightweight tablets in the hospital. Follow-up included data collection at three, six, and 12-months post-discharge whereby structured interviews were conducted by phone and questionnaires by mail. Readmission was defined as a hospital admission to any psychiatric inpatient unit or a psychiatric assessment unit in an emergency department during the 12-month follow-up.
The Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) is a validated diagnostic interview for mental illness in youth aged 6-17 years [13-15] which was administered by trained research staff to youth. It is aligned with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and International Statistical Classification of Diseases and Related Health Problems (ICD-10). The most common mental illnesses affecting youth were assessed .
The Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) is a validated 52-item self-reported checklist measuring youth psychopathology [16, 17]. Items are scored on a three-point response scale, which are summed to total, internalizing, externalizing, and illness-specific scores. Higher scores indicate greater frequency of symptoms.
Youth health-related quality of life (HRQL) was measured using the self-reported KIDSCREEN-27 . KIDSCREEN-27 is a validated scale scored using a five-point Likert scale to assess HRQL across five domains: physical well-being, psychological well-being, autonomy & parent relations, social support & peers, and school environment [19-24]. T-scores (mean 50, standard deviation 10) are computed with higher scores indicating better HRQL.
The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a standardized self-reported instrument for measuring disability , which includes 12 items scored using a five-point response scale. Scores are summed with higher scores indicating lower functioning/greater disability. The WHODAS 2.0 has excellent psychometric properties [26, 27].
The 10-item Perceived Stress Scale (PSS) assesses the extent to which an individual perceives aspects of their life as uncontrollable, unpredictable, and overloading . Responses to each item, which target thoughts and feelings from the past month, are based on a five-point Likert scale, with higher scores indicating elevated levels of perceived psychological stress.
Family environment was measured using two scales. The 10-item, self-reported Adverse Childhood Experience Questionnaire (ACE) was used to measure exposure to maltreatment/abuse and household dysfunction in childhood [29-31]. Responses are binary (no/yes) and higher sum scores suggest greater frequency of previous adverse experiences. Current family functioning was measured using the General Functioning subscale of the McMaster Family Assessment Device (FAD) [32, 33]. The 12 items are based on four-point response scale, which were summed to a total score. Higher scores indicating better overall family functioning.
Summary statistics were used to describe the sample and outcomes using youth and parent reports. Complete case analysis was conducted on six youth-parent dyads (those that completed all four assessments). Repeated measures ANOVA was performed to assess changes in youth mental and psychosocial outcomes from baseline to 12 months (normality assumption was satisfied and results were consistent with the non-parametric Friedman test). Analyses were performed using IBM SPSS version 28.0 (Armonk, NY: IBM Corp). Hypothesis tests were two-sided and given that this was a feasibility study, type one error was set at α=0.10.