Impact of Youth Strengths and Objective Strain on the Experiences of Subjective Strain Among Caregivers of Youth with Behavioral Health Conditions

Caregivers of youth with behavioral health conditions often experience significant and chronic caregiving strain. Caregiving strain is thought to consist of three dimensions: objective strain (observable negative events), subjective internalized strain (negative feelings directed inwardly), and subjective externalized strain (negative feelings directed outwardly). Based on a modified stress process model, the aims of this study were to: (1) examine whether the association between youth emotional-behavioral problem severity (measured with the Child Behavior Checklist/6–18) and subjective internalized and subjective externalized caregiving strain is mediated by objective strain for caregivers, and; (2) identify other predictors of subjective internalized and subjective externalized strain, particularly related to youth emotional-behavioral strengths as measured by the Behavioral and Emotional Rating Scale-Parent Rating Scale. We also explored the extent to which the association between youth emotional-behavioral problem severity and subjective internalized and subjective externalized strain may be moderated by perceived youth emotional-behavioral strengths. One-hundred and eighty-five (N = 185) caregivers of youth served by a community-based system of care participated in structured survey interviews at program enrollment. Regression analyses indicated that objective strain was found to fully mediate the association between youth emotional-behavioral problem severity and subjective externalized strain. Greater youth strengths related to family involvement were also associated with lower subjective externalized strain. Higher caregiver age, lower education, biological parent relationship to youth, greater youth emotional-behavioral problem severity, higher objective strain, and lower youth strengths related to school functioning were associated with higher subjective internalized strain. A significant interaction was found between youth problem severity, youth affective strengths, and subjective internalized strain such that caregivers who reported higher levels of youth affective strengths experienced stronger effects from youth emotional-behavioral problem severity on subjective internalized strain. These findings shed light upon the complex set of circumstances that may lead caregivers of youth with behavioral health conditions to experience subjective internalized and subjective externalized strain.