"Alone Again, Naturally": Mental Health Problems, Level of Personality Functioning, Social Withdrawal and Loneliness in Adolescents Admitted As Acute Inpatients in the Aftermath of the COVID-19 Pandemic

Overview

Journal Children (Basel)

Specialty Health Services

Date 2023 Nov 25

PMID 38002834

Authors

Johannes Boettcher

Dennis Radzuweit

Marie Mey

Philipp Rauch

Andreas Kogler

Claus Barkmann

Kirstin Goth

Sarah Hohmann

Carola Bindt

Ursula Voelker

Affiliations

Soon will be listed here.

Abstract

(1) Background: Adolescents admitted as acute inpatients belong to a particularly psychosocially vulnerable population. This study aimed to examine the clinical characteristics of an affected population in Germany using a theory-based approach. (2) Methods: We assessed the mental health problems, levels of personality functioning, and the severity of social withdrawal and loneliness in = 62 adolescents admitted to an acute psychiatric inpatient unit. Cases were investigated cross-sectionally utilizing standardized psychometric questionnaires from the perspective of the patients and clinical experts. (3) Results: Mental health, level of impaired personality functioning, social withdrawal, and loneliness were all positively associated with the need for acute admission. Further analyses revealed that the level of personality functioning fully mediated the positive association between social withdrawal and mental health problems. In contrast, level of personality functioning only partially mediated the positive association between loneliness and mental health problems. (4) Conclusions: Our results suggest that more impairment in personality functioning might lead to poorer mental health when adolescents socially withdraw in the aftermath of the COVID-19 pandemic. Loneliness, social withdrawal, and the level of personality functioning may help identifying essential characteristics of adolescents admitted to acute psychiatric inpatient units and guide the development of specific interventions.

References

Pirkis J, Burgess P, Kirk P, Dodson S, Coombs T, Williamson M . A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures. Health Qual Life Outcomes. 2005; 3:76. PMC: 1315350. DOI: 10.1186/1477-7525-3-76. View

Gander M, Buchheim A, Bock A, Steppan M, Sevecke K, Goth K . Unresolved Attachment Mediates the Relationship Between Childhood Trauma and Impaired Personality Functioning in Adolescence. J Pers Disord. 2020; 34(Suppl B):84-103. DOI: 10.1521/pedi_2020_34_468. View

Farrell A, Vitoroulis I, Eriksson M, Vaillancourt T . Loneliness and Well-Being in Children and Adolescents during the COVID-19 Pandemic: A Systematic Review. Children (Basel). 2023; 10(2). PMC: 9955087. DOI: 10.3390/children10020279. View

Hawkley L, Cacioppo J . Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med. 2010; 40(2):218-27. PMC: 3874845. DOI: 10.1007/s12160-010-9210-8. View

Ravens-Sieberer U, Devine J, Napp A, Kaman A, Saftig L, Gilbert M . Three years into the pandemic: results of the longitudinal German COPSY study on youth mental health and health-related quality of life. Front Public Health. 2023; 11:1129073. PMC: 10307958. DOI: 10.3389/fpubh.2023.1129073. View

Engel G . The clinical application of the biopsychosocial model. Am J Psychiatry. 1980; 137(5):535-44. DOI: 10.1176/ajp.137.5.535. View

Kusnanto H, Agustian D, Hilmanto D . Biopsychosocial model of illnesses in primary care: A hermeneutic literature review. J Family Med Prim Care. 2018; 7(3):497-500. PMC: 6069638. DOI: 10.4103/jfmpc.jfmpc_145_17. View

Xu J, Sun R, Li Y, Chen X, Yiu W, Zhou N . Subtypes of social withdrawal and mental health trajectories during COVID-19 pandemic. J Res Pers. 2022; 97:104203. PMC: 8828291. DOI: 10.1016/j.jrp.2022.104203. View

Kaman A, Erhart M, Devine J, Reiss F, Napp A, Simon A . Two Years of Pandemic: the Mental Health and Quality of Life of Children and Adolescents. Dtsch Arztebl Int. 2023; 120(15):269-270. PMC: 10366960. DOI: 10.3238/arztebl.m2023.0001. View

10.

Baumgardt J, Weinmann S . Using Crisis Theory in Dealing With Severe Mental Illness-A Step Toward Normalization?. Front Sociol. 2022; 7:805604. PMC: 9218753. DOI: 10.3389/fsoc.2022.805604. View

11.

Kristensen S, Urke H, Larsen T, Danielsen A . Hello Darkness, My Old Friend: Moderating a Random Intercept Cross-lagged Panel Model of Loneliness and Symptoms of Anxiety and Depression. Res Child Adolesc Psychopathol. 2022; 51(3):383-397. PMC: 9908696. DOI: 10.1007/s10802-022-00995-1. View

12.

Barzeva S, Meeus W, Oldehinkel A . Social Withdrawal in Adolescence and Early Adulthood: Measurement Issues, Normative Development, and Distinct Trajectories. J Abnorm Child Psychol. 2018; 47(5):865-879. PMC: 6469640. DOI: 10.1007/s10802-018-0497-4. View

13.

Wambua G, Kumar M, Falkenstrom F, Cuijpers P . Routine outcome measurement in adolescents seeking mental health services: standardization of HoNOSCA in Kenyan sample. BMC Psychiatry. 2021; 21(1):440. PMC: 8422761. DOI: 10.1186/s12888-021-03438-1. View

14.

Parmar M, Ma R, Attygalle S, Mueller C, Stubbs B, Stewart R . Associations between loneliness and acute hospitalisation outcomes among patients receiving mental healthcare in South London: a retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol. 2021; 57(2):397-410. PMC: 8784491. DOI: 10.1007/s00127-021-02079-9. View

15.

Hobbs M . Crisis intervention in theory and practice: a selective review. Br J Med Psychol. 1984; 57(1):23-34. DOI: 10.1111/j.2044-8341.1984.tb01577.x. View

16.

Bowers L . Reasons for admission and their implications for the nature of acute inpatient psychiatric nursing. J Psychiatr Ment Health Nurs. 2005; 12(2):231-6. DOI: 10.1111/j.1365-2850.2004.00825.x. View

17.

Sharp C, Miller J . Ten-year retrospective on the DSM-5 alternative model of personality disorder: Seeing the forest for the trees. Personal Disord. 2022; 13(4):301-304. DOI: 10.1037/per0000595. View

18.

von Wyl A, Toggweiler S, Zollinger R . HoNOSCA-D As a Measure of the Severity of Diagnosed Mental Disorders in Children and Adolescents-Psychometric Properties of the German Translation. Front Psychiatry. 2017; 8:186. PMC: 5625002. DOI: 10.3389/fpsyt.2017.00186. View

19.

Hayes C, Simmons M, Simons C, Hopwood M . Evaluating effectiveness in adolescent mental health inpatient units: A systematic review. Int J Ment Health Nurs. 2017; 27(2):498-513. DOI: 10.1111/inm.12418. View

20.

Levinson J, Kohl K, Baltag V, Ross D . Investigating the effectiveness of school health services delivered by a health provider: A systematic review of systematic reviews. PLoS One. 2019; 14(6):e0212603. PMC: 6561551. DOI: 10.1371/journal.pone.0212603. View