(PS4-D78) Emotion Regulation Moderates Associations Between Adverse Childhood Experiences and Length of Stay for Psychiatrically Hospitalized Adolescents

The association between early childhood adversities and the onset of psychopathology is well documented. Adverse Childhood Experiences (ACEs) have negative consequences on neurological development and are associated with heightened emotion reactivity. Youth who experience ACEs also show deficits in emotion regulation, which is linked to anxiety, depression, and disruptive behaviors. Increased dysregulated behaviors and difficulty adjusting to acute stressors can contribute to poor clinical outcomes for adolescents receiving mental health treatment. Thus, there is a need for research to explore the relationships between ACEs, emotion regulation, and mental health treatment outcomes, particularly among adolescents in acute treatment settings, like inpatient psychiatric hospitals.

This study examined the relationship between ACEs and psychiatric inpatient length of stay as an indication of treatment outcomes for hospitalized adolescents, and whether this differed based on emotion regulation. The sample was comprised of psychiatrically hospitalized patients aged 12-18 (n = 427, M_age= 15.09, SD = 1.77). Patients completed the Difficulties in Emotion Regulation Scale (DERS-SF) with subscales (non-acceptance of emotion responses, difficulty in engaging in goal-directed behavior, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, lack of emotional clarity), Adverse Childhood Experiences Questionnaire (ACE-Q), and a demographic questionnaire following admission. Length of stay was retrospectively collected from patient medical records.

A series of regression models were run testing associations between ACEs and length of stay, as well as the moderating effect of emotion dysregulation, controlling for patient age, biological sex (p = .006), gender identity, sexual identity, and race identity. Results suggest no significant main effect of ACEs nor DERS subscales on inpatient length of stay. However, a significant interaction was revealed between ACEs and the DERS goal-directed behaviors subscale (p < .05). In adolescents who had greater difficulties with goal-directed emotion regulation behaviors, a greater number of ACEs was associated with longer length of stay. Further, consistent across all models, sex assigned at birth was a significant predictor of length of stay, such that males had longer lengths of stay than females.

These results suggest that utilizing skills in goal-directed emotion regulation might be protective for youth with ACEs. Implications for addressing goal-directed behavior to reduce psychiatric length of stay among youth who have experienced childhood adversity will be discussed.