(PS10-B39) Associations Between Perceived Parental Expressed Emotion-criticism and Internalizing Symptoms Including Indirect Effects via Loneliness in Youth

Parent-child interactions, including parents’ expressed emotion-criticism towards their child, adversely affect child and adolescent psychopathology, such as adolescents’ internalizing symptoms. Loneliness has also been shown to predict depression and anxiety in adolescents. As most studies examine the effects of parental expressed emotion-criticism (EE-criticism) and loneliness on youth’s internalizing symptoms within community samples, these relationships in clinical samples of youth remain to be further explored. Further, past research has not investigated how youth’s loneliness could indirectly play a role in the relationship between youth’s perceptions of their parents’ EE-criticism and their own internalizing symptoms. In this study, we examined the relationship between perceived parental EE-criticism and internalizing symptoms, with indirect effects via loneliness in a clinical sample of children and adolescents. We also investigated whether differences in parent-child ratings of parental EE-criticism were associated with youth’s internalizing symptoms.

Participants were children and adolescents aged 12-15 primarily recruited from the partial hospitalization program at a child mental health hospital (N = 33) as part of an ongoing study of self-referential processing. The data collection started in April of 2020 during the COVID-19 pandemic. Youth completed the Expressed Emotion Adjective Checklist, the Pediatric Symptoms Checklist, and the NIH Toolbox Loneliness.

Results showed that youth’s perceived parental EE-criticism was positively associated with youth’s internalizing symptoms (𝛽 = .544, p = .001). There was a significant indirect effect of youth’s perceived parental EE-criticism on their internalizing symptoms via youth’s loneliness, b = .0837, se = .0278, 95% CI [.0343, .1433], tested using PROCESS v4.0 macro (Model 4). Results also showed that greater differences in child vs. parent report of parents’ EE-criticism were linked to greater levels of youth’s internalizing symptoms (𝛽=.390, p=.025), suggesting that youth who report higher levels of parental EE-criticism than their parents may be more vulnerable to internalizing symptoms. These findings were maintained when we statistically adjusted for age, race/ethnicity minority status, gender identity minority status, and sex assigned at birth.

These preliminary findings suggest that youth’s perceptions of their parents’ criticism towards them may be linked to higher internalizing symptoms via increased sense of loneliness, highlighting the utility of assessing and targeting youth’s feelings of loneliness and perception of parental criticism in clinical settings. This approach may be especially critical following the COVID-19 pandemic when adolescents were socially isolated at home and were more greatly impacted by family relationships.