Trajectories of parent criticism across treatment for youth self‐harm

BACKGROUND: Criticism from parents is a risk factor for poor youth mental health, including self-harm and limited response to psychosocial interventions. We identified trajectories of change in parent criticism across treatment for youth self-harm (suicide attempts and non-suicidal self-injury) and compared these trajectories on treatment outcomes. METHODS: This is a preregistered secondary analysis of data from the Self-harm Intervention: Family Therapy trial. Participants (N = 831, 11-17 years; 89% girls, 11% boys; 84% White) were clinically referred for self-harm and randomly assigned to family therapy or usual care. A growth mixture model identified trajectories of parent self-reported criticism across baseline, 3, and 6 months. Trajectories were compared on youth self-harm, suicidal ideation, depression, and hopelessness, and parent mental distress (baseline, and change from baseline to 12 and 12-18 months). RESULTS: Four trajectories of parent criticism were identified: High and remaining elevated despite a small decrease (51.6%); sharply decreasing (7.6%); low/stable (37.2%); and increasing (3.6%). Youth with parents in the high with small decrease class had more severe baseline suicidal behavior. Treatment type was not related to criticism trajectory. Parent mental distress increased in the increasing criticism class. Youth with parents in the increasing class showed less improvement in suicidal ideation at 12-month follow-up compared to the high with small decrease and sharply decreasing classes. CONCLUSIONS: Current treatments for youth self-harm may not reduce parent criticism to subclinical levels. Increasing parent criticism may forecast poorer response to a range of treatments for youth self-harm and be indicative of increases in parent mental distress.