(PS3-C61) A Multi-method Assessment of Emotional Processes in Relation to Anxiety Symptom Trajectories Post-discharge in Psychiatrically Hospitalized Youth

Anxiety disorders are the most common psychiatric disorders among adolescents, with a lifetime prevalence of 31.9%. Processing of emotions – including emotion recognition, emotion reactivity, and emotion regulation (ER) – play an important role in both the development and maintenance of anxiety disorders. Further, symptoms of anxiety have been associated with poorer ER in adolescents. However, only a few studies have explored this relationship using trajectory analyses, identifying subgroups in terms of symptom course and predictors of these trajectories. Moreover, there is a lack of research specifically focused on adolescents in the post-discharge period, which is a particularly vulnerable period of transition. The current study uses a novel approach to examine emotional processes as prospective predictors of anxiety symptom trajectories in the 18 months post-discharge in psychiatrically hospitalized youth via a comprehensive and multi-method evaluation. Participants were 180 adolescents (M_age = 14.89; SD = 1.35; 71.7% female; 78.9% White; 55.0% heterosexual) recruited from a psychiatric inpatient unit. The Screen for Child Anxiety Related Disorders (SCARED) was administered as a measure of anxiety at baseline and 3-, 6-, 12-, and 18-months post-discharge. At baseline, candidate predictors included: (i) a computer-based assessment of facial emotion recognition ability with youth and adult facial stimuli; (ii) a self-reported measure of emotional sensitivity, intensity, and persistence; and (iii) a self-report measure of multiple facets of ER. Latent growth curve analysis was conducted to identify subgroups of individuals based upon their trajectory of anxiety symptoms across the 18-month follow-up period. Then, ANOVAs were used to examine subgroup differences in emotion processing variables. Three distinct trajectories were identified, a group characterized by relatively stable low-to-moderate anxiety throughout the study period, a stable moderate-to-high anxiety group, and a group with moderate-to-high anxiety at index hospitalization with symptom improvement over time. After correcting for multiple comparisons, the two initially moderate-to-high anxiety groups generally scored higher for emotion dysregulation and emotion reactivity at baseline compared to the low-to-moderate anxiety group (all ps < .05). ER difficulties relating to goal-directed behaviors and impulsivity when experiencing negative emotions were higher (ps < .05) for the stable moderate-to-high anxiety group than for the moderate-to-high anxiety group that experience symptom improvement over time. The three groups did not differ for facial emotion recognition. Results support the growing evidence of the relationship between emotion dysregulation and anxiety. These findings may have clinical implications for discharge planning, as adolescents with different anxiety trajectories may benefit from different treatment strategies. Future studies should explore ER with a focus on goal-directed behaviors and impulsivity as a potential target of intervention for high-risk adolescents with anxiety.