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O’Hara KL, Wolchik SA, Rhodes CA, Uhlman RN, Sandler IN, Tein JY. Preventing Adverse Outcomes for Bereaved Youth: Indirect Effects From a Randomized Trial of the Family Bereavement Program on Fear of Abandonment, Grief, and Mental Health. J Pediatr Psychol 2024; 49:247-258. [PMID: 37654097 PMCID: PMC11019585 DOI: 10.1093/jpepsy/jsad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/23/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES We investigated whether the self-system belief of fear of abandonment mediated the effects of intervention-induced change in 2 protective factors-positive parenting and adaptive coping-and one risk factor-stressful events-on youth mental health problems and maladaptive grief. This study extends prior research on fear of abandonment in youth who experience parental death by examining pathways through which a program reduced fear of abandonment and, in turn, affected subsequent pathways to child mental health problems in the context of a randomized experiment. METHODS This is a secondary data analysis study. We used data from the 4-wave longitudinal 2-arm parallel randomized controlled trial of the Family Bereavement Program conducted between 1996 and 1999 in a large city in the Southwestern United States. The sample consisted of 244 offspring between 8 and 16 at the pretest. They were assessed again at posttest, 11-month follow-up, and 6-year follow-up. Offspring, caregivers, and teachers provided data. RESULTS Mediation analyses indicated that intervention-induced reductions in stressful events were prospectively associated with a lower fear of abandonment. For girls, fear of abandonment was related to self-reported maladaptive grief and teacher-reported internalizing problems 6 years later. CONCLUSIONS This study extends prior research on the relation between intervention-induced changes in risk and protective factors and improvements in outcomes of bereaved youth. The findings support the reduction of stressful events as a key proximal target of prevention programs for bereaved children.
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Rhodes CA, Wolchik SA, Uhlman RN, O'Hara KL, Sandler IN, Tein JY, Porter MM. Effects of a preventive parenting intervention for bereaved families on the intergenerational transmission of parenting attitudes: Mediating processes. Dev Psychopathol 2023; 35:2482-2498. [PMID: 37559382 PMCID: PMC10947508 DOI: 10.1017/s0954579423000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
This study evaluated whether the Family Bereavement Program (FBP), a prevention program for parentally bereaved families, improved parenting attitudes toward parental warmth and physical punishment in young adult offspring 15 years after participation and identified mediational cascade pathways. One hundred fifty-six parents and their 244 offspring participated. Data were collected at pretest (ages 8-16), posttest, and six- and 15-year follow-ups. Ethnicity of offspring was: 67% non-Hispanic Caucasian, 16% Hispanic, 7% African American, 3% Native American, 1% Asian or Pacific Islander, and 6% other; 54% were males. There was a direct effect of the FBP on attitudes toward physical punishment; offspring in the FBP had less favorable attitudes toward physical punishment. There were also indirect effects of the FBP on parenting attitudes. The results supported a cascade effects model in which intervention-induced improvements in parental warmth led to fewer externalizing problems in adolescence/emerging adulthood, which in turn led to less favorable attitudes toward physical punishment. In addition, intervention-induced improvements in parental warmth led to improvements in anxious romantic attachment in mid-to-late adolescence/emerging adulthood, which led to more favorable attitudes toward parental warmth in emerging/young adulthood. These findings suggest that the effects of relatively brief prevention programs may persist into subsequent generations.
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Herrero M, Roca P, Cormenzana S, Martínez-Pampliega A. The efficacy of postdivorce intervention programs for children: A meta-analytical review. FAMILY PROCESS 2023; 62:74-93. [PMID: 36054156 DOI: 10.1111/famp.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/10/2022] [Accepted: 07/02/2022] [Indexed: 06/15/2023]
Abstract
Preventive postdivorce interventions aim to help children cope with divorce and promote their adjustment. Nevertheless, questions remain regarding the concrete outcomes of these interventions and the intervention characteristics that influence them. This meta-analysis of 30 studies analyzes the efficacy of postdivorce interventions on children's symptomatology, personal resources, and adaptation to divorce. Likewise, it explores whether the intervention impacts the putative mediators from the family context and whether the characteristics of the studies themselves also influence the results. Using a data set of N = 4344 individuals, 258 effect sizes were calculated. Random effects analyses evidenced the impact of the interventions on specific variables instead of on children's global adjustment. There were no significant effects on children's mental health outcomes, and none of these effects were qualified by the moderators that were examined. Preventive postdivorce interventions had significant effects, specifically on children's divorce adjustment and self-esteem. The study of the moderators found that the interventions were generally homogeneous, and only one of the 20 moderators examined had a significant effect. Based on children's age, the interventions had an impact on family functioning only when they involved younger children, but this result should be interpreted with caution due to the small sample of studies. This meta-analysis provides evidence of the relevance of postdivorce interventions to critical variables as well as information about the role of the intervention characteristics in the effects and makes suggestions for future research on divorce interventions that encompass both practical and empirical developments.
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Affiliation(s)
- Marta Herrero
- Department of Social and Developmental Psychology, Deusto University, Bilbao, Spain
| | - Patricia Roca
- Department of Social and Developmental Psychology, Deusto University, Bilbao, Spain
| | - Susana Cormenzana
- Department of Social and Developmental Psychology, Deusto University, Bilbao, Spain
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Randomized Controlled Trial of a Program to Help Latina Mothers Help Their Children Cope with Stress: Effects on Parenting, Child Coping, and Adjustment. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1018-1028. [PMID: 35147825 DOI: 10.1007/s11121-022-01353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
"Madres Apoyando el Desarrollo Emocional de Sus Hijos" ("Mothers Supporting the Emotional Development of Their Children") is a parenting education program designed to help Latina mothers help their school-age children cope with stress. A previous randomized controlled trial, with a pre-post design, showed that the program had the predicted effects on mothers' knowledge, attitudes, and behavior. However, no data were collected from the children in that initial evaluation. The purpose of the present study was to determine if the program impacted children's coping and adjustment. One hundred twenty-two primarily first-generation Latina mothers from rural Washington State were randomly assigned to the intervention or to a no treatment control. Seven implementations of the program were conducted. Mothers and their 8- to 13-year-old children completed assessments 1 week before the program started, 1 week after its completion, and 3 months later. The results for maternal behavior were largely replicated: at posttest, intervention mothers, compared to controls, reported higher levels of emotion coaching, showed greater self-efficacy for helping their child cope with stress, and were more likely to report positive strategies for scaffolding their child's responses to stressful situations. Several maternal effects (e.g., emotion-coaching and maternal efficacy) continued at 3 months. Children of intervention mothers at posttest used more primary control coping strategies and reported fewer emotional symptoms; analyses of mothers' ratings of child adjustment replicated the posttest child effects for emotional symptoms, showed fewer other psychological problems at posttest, and showed greater child prosocial behavior at 3 months. The results further support the program's efficacy and provide the first evidence of its effects on child coping and adjustment.
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Elam KK, Johnson SL, Ruof A, Eisenberg DTA, Rej PH, Sandler I, Wolchik S. Examining the influence of adversity, family contexts, and a family-based intervention on parent and child telomere length. Eur J Psychotraumatol 2022; 13:2088935. [PMID: 35789082 PMCID: PMC9248961 DOI: 10.1080/20008198.2022.2088935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Background: Exposure to adversity, trauma, and negative family environments can prematurely shorten telomeres, the protective caps at the ends of chromosomes. Conversely, some evidence indicates that positive environments and psychosocial interventions can buffer the shortening of telomere length (TL). However, most work has examined individual aspects of the family environment as predictive of TL with little work investigating multiple risk and protective factors. Further, most research has not examined parent TL relative to child TL despite its heritability. Objective: In the current study, we examined interparental conflict, positive parenting, alcohol use, adverse childhood experiences (ACEs), and a family-based intervention as predictive of parent TL. We also examined interparental conflict, positive parenting, ACEs, and a family-based intervention as predictive of child TL. Method: Parents and adolescents from a sample of divorced families participated in either a 10-session family-based intervention, the New Beginnings Programme (NBP), or a 2-week active control condition. Approximately six years after the intervention, a subsample of parents (n = 45) and adolescents (n = 41) were assessed for TL. Parents reported on interparental conflict, ACEs, and alcohol use. Children reported on interparental conflict, positive parenting, and ACEs. In separate models, these constructs and the NBP intervention condition were examined as predictors of parent TL and child TL. Results: Findings indicated that the family-based intervention was associated with longer TL in parents. Also, positive parenting was associated with longer TL in children. Conclusions: These findings have important implications for the role of the family and family-based preventive interventions in buffering parent and child biological stress. HIGHLIGHTS Across multiple indices of psychosocial functioning, we found a family-based intervention associated with longer telomere length in parents and positive parenting associated with longer telomere length in children.
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Affiliation(s)
- Kit K Elam
- Department of Applied Health Science, Indiana University Bloomington, Bloomington, IN, USA
| | - Sarah Lindstrom Johnson
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - Ariana Ruof
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - Dan T A Eisenberg
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | - Peter H Rej
- Department of Psychology, Loyola Marymount University, Los Angeles, CA, USA
| | - Irwin Sandler
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Sharlene Wolchik
- Department of Psychology, Arizona State University, Tempe, AZ, USA
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O'Hara KL, Wolchik SA, Sandler IN. The Development, Evaluation, and Implementation of Parenting-focused Prevention Programs in Collaboration with Family Court. FAMILY COURT REVIEW 2021; 59:710-724. [PMID: 35832350 PMCID: PMC9272994 DOI: 10.1111/fcre.12604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Promoting the well-being and best interests of children in separated and divorcing families is a shared value among family court professionals and prevention scientists who develop and evaluate intervention programs. This article chronicles the development, evaluation, and implementation of two programs - the New Beginnings Program (NBP), a parenting intervention for separated/divorcing parents and the Family Transitions Guide (FTG), an intervention designed to motivate high conflict separated/divorcing parents to attend the NBP. The development and evaluation of these programs was facilitated by a long-standing collaboration with Maricopa Family Court. We discuss the process of developing these programs, their underlying small theories, and the evaluation of their effects in randomized trials. We also describe our collaboration with the family court and ways that the court promoted the development and evaluation of these programs. Finally, we summarize lessons learned and discuss future directions to bolster the public health impact of evidence-based programs for separated/divorcing families.
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Elam KK, Mun CJ, Kutzner J, Ha T. Polygenic Risk for Aggression Predicts Adult Substance Use Disorder Diagnoses via Substance Use Offending in Emerging Adulthood and is Moderated by a Family-Centered Intervention. Behav Genet 2021; 51:607-618. [PMID: 34117582 PMCID: PMC8404142 DOI: 10.1007/s10519-021-10070-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/28/2021] [Indexed: 12/31/2022]
Abstract
A substance use offense reflects an encounter with law enforcement and the court system in response to breaking the law which may increase risk for substance use problems later in life. Individuals may also be at risk for substance use offending and substance use problems based on genetic predisposition. We examined a mediation model in which polygenic risk for aggression predicted adult substance use disorder diagnoses (SUD) via substance use offending in emerging adulthood. In addition, we explored for potential attenuation of genetic influences on these outcomes by a family-based intervention, the Family Check-Up (FCU). Secondary data analyses based upon the Project Alliance 1 sample was conducted among those with genetic data (n = 631; 322 from control and 309 from FCU intervention). The sample was ethnically diverse (30% African American, 44% European American, 6% Latinx, 4% Asian American, 3% Native American, and 13% Other). Greater polygenic risk for aggression was found to increase risk for substance use violations (age 19-23), which in turn was associated with greater likelihood of being diagnosed with SUD at age 27. A gene-by-intervention effect was found in which individuals in the control group had greater risk for SUD with increasing polygenic risk for aggression. Some convergence in results was found when replicating analyses in African American and European American subgroups. Results imply that genetic predisposition may increase risk for problematic substance use later in life via antisocial behavior, such as substance use offending, and that this can be attenuated by a family-centered intervention.
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Affiliation(s)
- Kit K Elam
- Department of Applied Health Science, Indiana University, 1025 E. 7th St., Suite 116, Bloomington, IN, 47405, USA.
| | - Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, USA
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, USA
| | - Jodi Kutzner
- Department of Applied Health Science, Indiana University, 1025 E. 7th St., Suite 116, Bloomington, IN, 47405, USA
| | - Thao Ha
- Department of Psychology, Arizona State University, Tempe, USA
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Hagan M, Lara J, Montanes MC. Childhood adversity, socioemotional functioning and generalized anxiety in young adults from mixed immigration status families. CHILD ABUSE & NEGLECT 2021; 118:105128. [PMID: 34051486 DOI: 10.1016/j.chiabu.2021.105128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/16/2021] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The translation of research on adverse childhood experiences (ACEs) into effective prevention and treatment of psychopathology requires examination of how ACEs impact mental health. Moreover, increased attention to more marginalized populations, such as immigration-affected ethnic-minority young adults, is greatly needed. OBJECTIVE The current study tested the hypothesis that greater ACEs would be related to greater generalized anxiety symptoms directly and indirectly, via ACE-related deficits in coping efficacy, self-compassion, and perceived support, above and beyond immigration-related family stress. PARTICIPANTS AND SETTING Participants included ethnic minority young adults (n = 322) attending a public university who reported having at least one family member living in the United States without legal protection and/or being undocumented themselves. METHODS Data was collected online using validated measures of the primary study variables. Participants also completed a pilot measure of immigration-related stress in their family. A multiple mediation model was tested in a structural equation modeling framework. RESULTS A substantial percentage of young adults experienced 4 or more ACEs and clinically-significant generalized anxiety symptoms (38.5% and 20.5%, respectively); a greater number of ACEs were directly (β = 0.33, p < .001) and indirectly, via lower self-compassion (standardized indirect effect 95% CI: 0.04, 0.14), associated with significantly greater generalized anxiety symptoms, above and beyond immigration-related family stress and other indicators of socioemotional functioning. CONCLUSION Findings suggest that ACEs and generalized anxiety are prevalent in ethnic minority young adults from mixed legal status families and their association may be partially accounted for by ACE-related deficits in self-compassion.
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Affiliation(s)
- Melissa Hagan
- San Francisco State University, College of Science and Engineering, Department of Psychology, 1600 Holloway Avenue, San Francisco, CA 94132, USA.
| | - Jannet Lara
- San Francisco State University, College of Science and Engineering, Department of Psychology, 1600 Holloway Avenue, San Francisco, CA 94132, USA
| | - Ma Carla Montanes
- San Francisco State University, College of Science and Engineering, Department of Psychology, 1600 Holloway Avenue, San Francisco, CA 94132, USA
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Parrish KH, Thompson SF, Lengua LJ. Temperament as a moderator of the association of cumulative risk with preadolescent appraisal and coping style. ANXIETY STRESS AND COPING 2021; 34:513-529. [PMID: 33896289 DOI: 10.1080/10615806.2021.1918681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Children exposed to cumulative risk (CR) are more likely to have poor physical and psychological health across the lifespan. CR may contribute to children's adjustment, in part through its effects on appraisal and coping. Further, child temperament may alter the effects of CR on appraisal and coping. OBJECTIVE This study investigated the interactive and prospective effects of CR and temperament on children's appraisal and coping strategies. DESIGN AND METHOD In this secondary data analysis using a community sample (N=306) of preadolescents (M age = 9.5 at T1), structural equations models were conducted to examine temperament negative emotionality (NE) and effortful control (EC) as moderators of the effect of CR on both levels and proportional use of positive and threat appraisals, and active and avoidant coping. RESULTS Children higher in NE used more threat appraisal and avoidant coping, whereas children higher in EC used less threat appraisal concurrently and decreased in their use of threat appraisal across 1 year. Both NE and EC altered the prospective effect of CR on appraisal and coping. CONCLUSIONS Findings suggest temperament alters the effect of CR on appraisal and coping, implicating EC as a resource and NE as a vulnerability in changes in appraisal and coping during preadolescence.
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Affiliation(s)
- Krystal H Parrish
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Liliana J Lengua
- Department of Psychology, University of Washington, Seattle, WA, USA
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Power TG, Ramos GG, Guerrero YO, Martinez AD, Parker LA, Lee S. Evaluation of a Program to Help Low-Income, Latina Mothers Help Their Children Cope With Stress. J Prim Prev 2021; 42:257-277. [PMID: 33772710 DOI: 10.1007/s10935-021-00632-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
This paper describes the evaluation of a program that provides low-income Latina mothers with skills to help their children cope with stress. Based on focus groups with mothers and their school-aged children in two locations, we developed a five-week program for helping mothers identify signs of stress in their children, learn effective emotion-coaching skills, and learn how to effectively encourage their children to use coping strategies that match the controllability of the situation. We conducted a randomized controlled trial in an urban (n = 13) and rural (n = 78) location in which we randomly assigned mothers to either an intervention or a no-treatment control condition. We completed eight implementations of the program (2 in the urban sample and 6 in the rural one). To evaluate the program, we collected pre- and post-assessments of mothers' coping knowledge, emotion coaching, strategies for helping their children cope with stress, maternal self-efficacy in helping their children cope, general parenting practices, and general parenting self-efficacy. Observers assessed the fidelity of program delivery. Mothers who received the intervention, in contrast to those in the control condition, showed significant increases in their knowledge of strategies to help their children cope with stress, in reported emotion-coaching skills, and in the reported use of positive strategies for helping their children manage their behavior and emotions in stressful situations (i.e., helping their children relax and calm down, talking with their children about feelings, helping their children problem-solve, encouraging distraction, and helping their children improve their self-esteem). Post intervention, mothers reported increases in their efficacy for helping their children cope with stress. Analyses revealed no significant effects of the program on general parenting or general parenting self-efficacy, but did have the hypothesized effects on maternal knowledge, attitudes, and reported behavior. Subsequent research should examine the degree to which the program has effects over a longer time period and on children's approaches to coping with stress.
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Affiliation(s)
- Thomas G Power
- Department of Human Development, Washington State University, PO Box. 644852, Pullman, WA, 99164-4852, USA.
| | - Guadalupe G Ramos
- Department of Human Development, Washington State University, PO Box. 644852, Pullman, WA, 99164-4852, USA
| | - Yadira Olivera Guerrero
- Department of Human Development, Washington State University, PO Box. 644852, Pullman, WA, 99164-4852, USA
| | | | - Louise A Parker
- Department of Human Development, Washington State University, PO Box. 644852, Pullman, WA, 99164-4852, USA
| | - SuYeon Lee
- Department of Human Development, Washington State University Vancouver, 14204 NE Salmon Creek Avenue, Vancouver, WA, 98686, USA
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Gallo CG, Berkel C, Mauricio A, Sandler I, Wolchik S, Villamar JA, Mehrotra S, Brown CH. Implementation methodology from a social systems informatics and engineering perspective applied to a parenting training program. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2021; 39:7-18. [PMID: 34014726 PMCID: PMC8962635 DOI: 10.1037/fsh0000590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE For implementation of an evidence-based program to be effective, efficient, and equitable across diverse populations, we propose that researchers adopt a systems approach that is often absent in efficacy studies. To this end, we describe how a computer-based monitoring system can support the delivery of the New Beginnings Program (NBP), a parent-focused evidence-based prevention program for divorcing parents. METHOD We present NBP from a novel systems approach that incorporates social system informatics and engineering, both necessary when utilizing feedback loops, ubiquitous in implementation research and practice. Examples of two methodological challenges are presented: how to monitor implementation, and how to provide feedback by evaluating system-level changes due to implementation. RESULTS We introduce and relate systems concepts to these two methodologic issues that are at the center of implementation methods. We explore how these system-level feedback loops address effectiveness, efficiency, and equity principles. These key principles are provided for designing an automated, low-burden, low-intrusive measurement system to aid fidelity monitoring and feedback that can be used in practice. DISCUSSION As the COVID-19 pandemic now demands fewer face-to-face delivery systems, their replacement with more virtual systems for parent training interventions requires constructing new implementation measurement systems based on social system informatics approaches. These approaches include the automatic monitoring of quality and fidelity in parent training interventions. Finally, we present parallels of producing generalizable and local knowledge bridging systems science and engineering method. This comparison improves our understanding of system-level changes, facilitates a program's implementation, and produces knowledge for the field. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Carlos G Gallo
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Cady Berkel
- Integrated Behavior Health, College of Health Solutions, AZ State University
| | - Anne Mauricio
- REACH Institute, Department of Psychology, AZ State University
| | - Irwin Sandler
- REACH Institute, Department of Psychology, AZ State University
| | | | - Juan A Villamar
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Sanjay Mehrotra
- Department of Industrial Engineering and Management Sciences, Northwestern University
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
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Berkel C, Gallo CG, Sandler IN, Mauricio AM, Smith JD, Brown CH. Redesigning Implementation Measurement for Monitoring and Quality Improvement in Community Delivery Settings. J Prim Prev 2020; 40:111-127. [PMID: 30656517 DOI: 10.1007/s10935-018-00534-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The field of prevention has established the potential to promote child adjustment across a wide array of outcomes. However, when evidence-based prevention programs have been delivered at scale in community settings, declines in implementation and outcomes have resulted. Maintaining high quality implementation is a critical challenge for the field. We describe steps towards the development of a practical system to monitor and support the high-quality implementation of evidence-based prevention programs in community settings. Research on the implementation of an evidence-based parenting program for divorcing families called the "New Beginnings Program" serves as an illustration of the promise of such a system. As a first step, we describe a multidimensional theoretical model of implementation that links aspects of program delivery with improvements in participant outcomes. We then describe research on the measurement of each of these implementation dimensions and test their relations to intended program outcomes. As a third step, we develop approaches to the assessment of these implementation constructs that are feasible to use in community settings and to establish their reliability and validity. We focus on the application of machine learning algorithms and web-based data collection systems to assess implementation and provide support for high quality delivery and positive outcomes. Examples are presented to demonstrate that valid and reliable measures can be collected using these methods. Finally, we envision how these measures can be used to develop an unobtrusive system to monitor implementation and provide feedback and support in real time to maintain high quality implementation and program outcomes.
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Affiliation(s)
- Cady Berkel
- , 900 S McAllister Ave., Tempe, AZ, 85287, USA. .,REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ, USA.
| | - Carlos G Gallo
- Center for Prevention Implementation Methodology (Ce-PIM), Northwestern University, Chicago, IL, USA
| | - Irwin N Sandler
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Anne M Mauricio
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Justin D Smith
- Center for Prevention Implementation Methodology (Ce-PIM), Northwestern University, Chicago, IL, USA
| | - C Hendricks Brown
- Center for Prevention Implementation Methodology (Ce-PIM), Northwestern University, Chicago, IL, USA
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Developmental cascade effects of a parenting-focused program for divorced families on competence in emerging adulthood. Dev Psychopathol 2020; 33:201-215. [PMID: 32308168 DOI: 10.1017/s095457941900169x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This 15-year longitudinal follow-up of a randomized controlled trial of a parenting-focused preventive intervention for divorced families examined cascade models of program effects on offsprings' competence. It was hypothesized that intervention-induced improvements in parenting would lead to better academic, work, peer, and romantic competence in emerging adulthood through effects on behavior problems and competencies during adolescence. Families (N = 240) participated in the 11-session program or literature control condition when children were ages 9-12. Data were drawn from assessments at pretest, posttest, and follow-ups at 3 and 6 months and 6 and 15 years. Results showed that initial intervention effects of parenting on externalizing problems in adolescence cascaded to work outcomes in adulthood. Parenting effects also directly impacted work success. For work outcomes and peer competence, intervention effects were moderated by initial risk level; the program had greater effects on youths with higher risk at program entry. In addition, intervention effects on parenting led to fewer externalizing problems that in turn cascaded to better academic outcomes, which showed continuity into emerging adulthood. Results highlight the potential for intervention effects of the New Beginnings Program to cascade over time to affect adult competence in multiple domains, particularly for high-risk youths.
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The unique effects of maternal and paternal depressive symptoms on youth's symptomatology: Moderation by family ethnicity, family structure, and child gender. Dev Psychopathol 2020; 31:1213-1226. [PMID: 31478823 DOI: 10.1017/s0954579418000846] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Drawing on five waves of longitudinal data from 392 families (52% female; mean age of wave 1 [Mage_W1] = 12.89, standard deviation [SD] = .48; Mage_W5 = 21.95, SD = .77; 199 European American and 193 Mexican American families; 217 intact and 175 stepfather families), this study documented transactional relations of mothers' and fathers' depressive symptoms with youth's symptomatology from early adolescence to young adulthood. Trait and time-varying cross-lagged models revealed that both mothers' and fathers' between- and within-person differences in depressive symptoms were associated with youth's internalizing and externalizing symptoms. Whereas each parent's depressive symptoms uniquely contributed to youth's internalizing symptoms, however, only mothers' depressive symptoms influenced youth's externalizing symptoms. Although reciprocal effects of youth's internalizing symptoms on parents' depressive symptoms were not significant, youth's externalizing symptoms predicted changes in mothers' depressive symptoms over time. Moderation analyses revealed distinct transactional patterns by family ethnicity and child gender, but not by family structure. This study revealed dynamic transactions among family members' symptomatology that point to opportune times and targets for intervention efforts aimed at mitigating the negative impact of parents' depressive symptoms on youth's adjustment.
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O'Hara KL, Sandler IN, Wolchik SA, Tein JY. Coping in context: The effects of long-term relations between interparental conflict and coping on the development of child psychopathology following parental divorce. Dev Psychopathol 2019; 31:1695-1713. [PMID: 31535609 PMCID: PMC6854280 DOI: 10.1017/s0954579419000981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Exposure to high levels of postdivorce interparental conflict is a well-documented risk factor for the development of psychopathology, and there is strong evidence of a subpopulation of families for which conflict persists for many years after divorce. However, existing studies have not elucidated differential trajectories of conflict within families over time, nor have they assessed the risk posed by conflict trajectories for development of psychopathology or evaluated potential protective effects of children's coping to mitigate such risk. We used growth mixture modeling to identify longitudinal trajectories of child-reported conflict over a period of six to eight years following divorce in a sample of 240 children. We related the trajectories to children's mental health problems, substance use, and risky sexual behaviors and assessed how children's coping prospectively predicted psychopathology in the different conflict trajectories. We identified three distinct trajectories of conflict; youth in two high-conflict trajectories showed deleterious effects on measures of psychopathology at baseline and the six-year follow-up. We found both main effects of coping and coping by conflict trajectory interaction effects in predicting problem outcomes at the six-year follow-up. The study supports the notion that improving youth's general capacity to cope adaptively is a potentially modifiable protective factor for all children facing parental divorce and that children in families with high levels of postdivorce conflict are a particularly appropriate group to target for coping-focused preventive interventions.
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Affiliation(s)
- Karey L O'Hara
- REACH Institute, Arizona State University, Tempe, Arizona 85287, USA
| | - Irwin N Sandler
- REACH Institute, Arizona State University, Tempe, Arizona 85287, USA
| | | | - Jenn-Yun Tein
- REACH Institute, Arizona State University, Tempe, Arizona 85287, USA
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Mauricio AM, Mazza GL, Berkel C, Tein JY, Sandler IN, Wolchik SA, Winslow E. Attendance Trajectory Classes Among Divorced and Separated Mothers and Fathers in the New Beginnings Program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:620-629. [PMID: 28357550 DOI: 10.1007/s11121-017-0783-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined attendance trajectories among mothers and fathers in the effectiveness trial of the New Beginnings Program, a parenting-focused prevention program for divorced and separated parents. We also investigated attendance trajectory class differences on two sets of pretest covariates: one set previously linked to participation in programs not specifically targeting divorced parents (i.e., sociodemographics, perceived parenting skills, child problem behaviors, parent psychological distress) and another that might be particularly salient to participation in the context of divorce (i.e., interparental conflict, level of parent-child contact, previous marital status to the ex-spouse). For mothers and fathers, results supported four attendance trajectory classes: (1) non-attenders (NA), (2) early dropouts (ED), (3) declining attenders (DA), and (4) sustained attenders (SA). In the final model testing multiple covariates simultaneously, mothers who were EDs and DAs were more likely to be Latina than SAs, and EDs reported more interparental conflict than SAs. Mother trajectory groups did not differ on parenting skills, child problem behavior, or mother-child contact in the final or preliminary models. In the final model for fathers, EDs rated their children higher on externalizing than DAs, had less contact with their children than DAs and NAs, and reported less distress than SAs. Father trajectory groups did not differ on fathers' age, ethnicity, income, perceived parenting skills, or interparental conflict in the final or preliminary models. Results highlight qualitatively distinct latent classes of mothers and fathers who disengage from a parenting intervention at various points. We discuss implications for intervention engagement strategies and translational science.
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Affiliation(s)
- Anne M Mauricio
- Department of Psychology, REACH Institute, Arizona State University, P.O. Box 871104, Tempe, AZ, 85287-1104, USA.
| | - Gina L Mazza
- Department of Psychology, REACH Institute, Arizona State University, P.O. Box 871104, Tempe, AZ, 85287-1104, USA
| | - Cady Berkel
- Department of Psychology, REACH Institute, Arizona State University, P.O. Box 871104, Tempe, AZ, 85287-1104, USA
| | - Jenn-Yun Tein
- Department of Psychology, REACH Institute, Arizona State University, P.O. Box 871104, Tempe, AZ, 85287-1104, USA
| | - Irwin N Sandler
- Department of Psychology, REACH Institute, Arizona State University, P.O. Box 871104, Tempe, AZ, 85287-1104, USA
| | - Sharlene A Wolchik
- Department of Psychology, REACH Institute, Arizona State University, P.O. Box 871104, Tempe, AZ, 85287-1104, USA
| | - Emily Winslow
- Department of Psychology, REACH Institute, Arizona State University, P.O. Box 871104, Tempe, AZ, 85287-1104, USA
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Tyrell FA, Yates TM, Widaman KF, Reynolds CA, Fabricius WV. Data Harmonization: Establishing Measurement Invariance across Different Assessments of the Same Construct across Adolescence. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 48:555-567. [PMID: 31184494 DOI: 10.1080/15374416.2019.1622124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Longitudinal measurement invariance is a major concern for developmental scholars who seek to evaluate the same underlying construct across time. Unfortunately, discontinuities in the expression of various psychological constructs, as well as essential changes in measurement that are necessitated by shifting developmental capacities and practice effects over time, make the task of establishing longitudinal invariance extremely difficult. Drawing on 5 waves of longitudinal data from 392 families (52% female; Mage_W1 = 12.89, SD = .48; Mage_W5 = 21.95, SD = .77; 199 European American and 193 Mexican American families), the current investigation sought to establish measurement invariance across developmentally appropriate changes in measures of depressive symptomatology from early adolescence through early adulthood. Using a combination of item parceling and the common and unique items from 2 assessment instruments for depressive symptoms, the data supported strong factorial invariance in youth's depressive symptoms across 5 waves of measurement. Findings suggest that traditional invariance approaches can be adapted to determine whether the same construct underlies different measurement instruments across time. This analytic strategy can allow researchers and clinicians to use more sophisticated techniques to understand changes in symptomatology regardless of changes in measurement or developmental capacity. Applying this approach to model patterns of depressive symptomatology from early adolescence to early adulthood has important clinical implications for elucidating periods when youth experience elevations in depressive symptoms and heightened needs for intervention services.
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Affiliation(s)
- Fanita A Tyrell
- a Institute of Child Development , University of Minnesota Twin Cities
| | - Tuppett M Yates
- b Department of Psychology , University of California Riverside
| | - Keith F Widaman
- c Graduate School of Education , University of California Riverside
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18
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Murry VM, Berkel C, Inniss-Thompson MN, Debreaux ML. Pathways for African American Success: Results of Three-Arm Randomized Trial to Test the Effects of Technology-Based Delivery for Rural African American Families. J Pediatr Psychol 2019; 44:375-387. [PMID: 30865782 PMCID: PMC6657445 DOI: 10.1093/jpepsy/jsz001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The objective of this study was to test the effectiveness of a technology-based program to avert risky behaviors among rural African American youth. We hypothesized that the technology-based and group-based formats of the Pathways for African Americans Success (PAAS) program would lead to improvements in primary outcomes, and that the technology condition would perform at least as well as the group condition. METHODS A three-arm Randomized Control Trial (RCT) ([N = 141] technology-based delivery, [N = 141] small group delivery, and [N = 136] literature control) was conducted with 421 sixth graders and their caregivers, Summer 2009-Fall 2012. Families were recruited from five rural counties in Tennessee and completed baseline, posttest [M = 14.5 (4.4) months after pretest] and long-term follow-up [M = 22.6 (3.7) months after posttest]. Structural Equation Modeling (SEM) was used to test intervention-induced changes in both parents and youths' primary outcomes (pretest to posttest) and on secondary targeted outcome, youth sexual risk, and substance use patterns (pretest to follow-up). RESULTS Parents in the technology condition reported significant increases in strategies to reduce risk. Youth in the technology condition experienced a significant decline in intent to engage in risk behaviors and reduction in substance use and sexual risk behavior. Youth in the group condition experienced a significant increase in affiliation with deviant peers. CONCLUSIONS This study provides evidence of the ability of eHealth to improve parenting and reduce adolescent engagement in substance use and sexual risk behavior. Suggestions for dissemination in schools and health-care systems are offered.
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Affiliation(s)
- Velma McBride Murry
- Human and Organizational Development, Vanderbilt University Peabody College of Education and Human Development
| | - Cady Berkel
- REACH Institute, Arizona State University College of Liberal Arts and Sciences
| | - Misha N Inniss-Thompson
- Human and Organizational Development, Vanderbilt University Peabody College of Education and Human Development
| | - Marlena L Debreaux
- Human and Organizational Development, Vanderbilt University Peabody College of Education and Human Development
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19
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Mahrer NE, Holly LE, Luecken LJ, Wolchik SA, Fabricius W. Parenting Style, Familism, and Youth Adjustment in Mexican American and European American Families. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2019. [DOI: 10.1177/0022022119839153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Authoritative parenting is typically considered the gold-standard parenting approach based on studies with largely European American (EA) samples. The current study evaluated a novel, “no-nonsense” parenting style in Mexican American (MA) and EA families, not captured by traditional classifications. Parenting styles of mothers and fathers, cultural values, and youth internalizing and externalizing problems were assessed in 179 MA ( n = 84) and EA ( n = 95) parents and adolescents across 2 years (seventh to ninth grade). MA families showed a higher proportion of “no-nonsense” parenting, characterized by high levels of acceptance as well as harsh discipline and rejection, compared with EA families. Cultural values influenced the link between parenting styles and youth outcomes across ethnicity such that when parents endorsed low adherence to familismo values, authoritative parenting predicted lower youth internalizing and externalizing problems compared with the “no-nonsense” parenting. Yet when parents endorsed strong adherence to familismo values, the authoritative and no-nonsense parenting functioned similarly. Findings have implications for the development of culturally competent parenting interventions that may lead to positive outcomes in youth from diverse ethnic and cultural backgrounds.
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20
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Binge drinking in adolescence predicts an atypical cortisol stress response in young adulthood. Psychoneuroendocrinology 2019; 100:137-144. [PMID: 30326461 PMCID: PMC6333528 DOI: 10.1016/j.psyneuen.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 02/07/2023]
Abstract
Adolescence is a sensitive developmental period in which substance use can exert long-term effects on important biological systems. Emerging cross-sectional research indicates that problematic alcohol consumption may be associated with dysregulated neuroendocrine system functioning. The current study evaluated the prospective effects of binge drinking in adolescence on cortisol stress reactivity in young adulthood among individuals who had experienced parental divorce in childhood (N = 160; Mean age = 25.55, SD = 1.22; 46.9% Female; 88.8% White Non-Hispanic). Youth completed validated measures of problematic drinking during adolescence (aged 15-19) and participated in a standardized social stress task nine years later in young adulthood. Latent growth modeling was conducted within a structural equation modeling framework. Greater binge drinking during adolescence was associated with a significantly lower cortisol stress response in young adulthood, controlling for young adult drinking, sex, childhood externalizing problems, and socioeconomic status. Findings suggest problematic alcohol consumption during mid-to-late adolescence may have important effects on the neuroendocrine stress response system at subsequent developmental stages.
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21
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Sandler I, Wolchik S, Mazza G, Gunn H, Tein JY, Berkel C, Jones S, Porter M. Randomized Effectiveness Trial of the New Beginnings Program for Divorced Families with Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:60-78. [PMID: 30644774 DOI: 10.1080/15374416.2018.1540008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study presents findings from a randomized effectiveness trial of the New Beginnings Program (NBP), which has demonstrated efficacy in 2 prior randomized efficacy trials. Family courts in 4 counties facilitated recruitment of divorcing and separating parents, and providers in community agencies delivered the program. Participants were 830 parents of children ages 3-18 who were randomized to receive either the 10-session NBP or an active 2-session comparison condition in which parents learned about the same parenting skills but did not complete home practice of these skills. Parents were ethnically diverse (59.4% non-Hispanic White, 31.4% Hispanic, 9.2% other race or ethnicity). Multiple rater assessments of parenting, interparental conflict, and child mental health problems were conducted at pretest, posttest, and 10-month follow-up. The results indicated positive moderated effects of the NBP as compared with the active control condition to strengthen parenting at posttest and to reduce child mental health problems at posttest and 10 months. Many of these moderated effects showed positive benefits for non-Hispanic White families but not for Hispanic families. The findings indicate support for the effectiveness of the NBP when delivered by community-based agencies but also indicate the need for further adaptations to make the program effective for Hispanic parents.
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Affiliation(s)
- Irwin Sandler
- REACH Institute and Department of Psychology, Arizona State University
| | - Sharlene Wolchik
- REACH Institute and Department of Psychology, Arizona State University
| | - Gina Mazza
- REACH Institute and Department of Psychology, Arizona State University
| | - Heather Gunn
- REACH Institute and Department of Psychology, Arizona State University
| | - Jenn-Yun Tein
- REACH Institute and Department of Psychology, Arizona State University
| | - Cady Berkel
- REACH Institute and Department of Psychology, Arizona State University
| | - Sarah Jones
- REACH Institute and Department of Psychology, Arizona State University
| | - Michele Porter
- REACH Institute and Department of Psychology, Arizona State University
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22
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Howe GW, Ridenour TA. Bridging the Gap: Microtrials and Idiographic Designs for Translating Basic Science into Effective Prevention of Substance Use. ADVANCES IN PREVENTION SCIENCE 2019. [DOI: 10.1007/978-3-030-00627-3_22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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23
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Davis L, Barnes AJ, Gross AC, Ryder JR, Shlafer RJ. Adverse Childhood Experiences and Weight Status among Adolescents. J Pediatr 2019; 204:71-76.e1. [PMID: 30287067 DOI: 10.1016/j.jpeds.2018.08.071] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/30/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the relationship between adverse childhood experiences (ACEs) and weight status among adolescents. STUDY DESIGN Data were drawn from the Minnesota Student Survey, a large (n = 105 759), statewide, anonymous survey of public school students in eighth, ninth, and eleventh grades. Self-reported height and weight were used to calculate body mass index. Multinomial logistic regression was used to examine associations between self-reported ACEs and weight status, controlling for key sociodemographic characteristics. RESULTS ACEs were positively associated with weight status; adolescents with more ACEs were more likely to have overweight, obesity, and severe obesity than adolescents with no ACEs. Adolescents who reported an ACE were 1.2, 1.4, and 1.5 times as likely to have overweight, obesity, and severe obesity, respectively, compared with their peers with no ACEs. There was no relationship between ACEs and underweight. CONCLUSIONS The results of this large sample of adolescents with anonymous data support the hypothesis that ACEs and obesity are strongly associated. The directionality of this relationship needs to be understood. Moreover, these findings suggest that child health professionals may need to screen for ACEs as an important aspect of clinical weight management.
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Affiliation(s)
- Laurel Davis
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN.
| | - Andrew J Barnes
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Amy C Gross
- Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN; Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Justin R Ryder
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN; Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Rebecca J Shlafer
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
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24
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Wolchik S, Christopher C, Tein JY, Rhodes CA, Sandler IN. Long-term Effects of a Parenting Preventive Intervention on Young Adults' Attitudes Toward Divorce and Marriage. ACTA ACUST UNITED AC 2018; 60:283-300. [PMID: 31217674 DOI: 10.1080/10502556.2018.1528530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examined whether the New Beginnings Program (NBP), a parenting-focused preventive intervention designed to reduce children's post-divorce mental health problems, affected attitudes toward divorce and marriage in young adults whose mothers had participated 15 years earlier. Participants (M = 25.6 years; 50% female; 88% Caucasian) were from 240 families that had participated in a randomized experimental trial (NBP vs. literature control). Analyses of covariance showed that program effects on both types of attitudes were moderated by gender. Males in the NBP reported more positive attitudes toward marriage and less favorable attitudes toward divorce than males in the literature control.
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25
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Cardamone-Breen MC, Jorm AF, Lawrence KA, Rapee RM, Mackinnon AJ, Yap MBH. A Single-Session, Web-Based Parenting Intervention to Prevent Adolescent Depression and Anxiety Disorders: Randomized Controlled Trial. J Med Internet Res 2018; 20:e148. [PMID: 29699964 PMCID: PMC5945988 DOI: 10.2196/jmir.9499] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/19/2018] [Accepted: 03/08/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Depression and anxiety disorders are significant contributors to burden of disease in young people, highlighting the need to focus preventive efforts early in life. Despite substantial evidence for the role of parents in the prevention of adolescent depression and anxiety disorders, there remains a need for translation of this evidence into preventive parenting interventions. To address this gap, we developed a single-session, Web-based, tailored psychoeducation intervention that aims to improve parenting practices known to influence the development of adolescent depression and anxiety disorders. OBJECTIVE The aim of this study was to evaluate the short-term effects of the intervention on parenting risk and protective factors and symptoms of depression and anxiety in adolescent participants. METHODS We conducted a single-blind, parallel group, superiority randomized controlled trial comparing the intervention with a 3-month waitlist control. The intervention is fully automated and consists of two components: (1) completion of an online self-assessment of current parenting practices against evidence-based parenting recommendations for the prevention of adolescent depression and anxiety disorders and (2) an individually tailored feedback report highlighting each parent’s strengths and areas for improvement based on responses to the self-assessment. A community sample of 349 parents, together with 327 adolescents (aged 12-15 years), were randomized to either the intervention or waitlist control condition. Parents and adolescents completed online self-reported assessments of parenting and adolescent symptoms of depression and anxiety at baseline, 1-month (parent-report of parenting only), and 3-month follow-up. RESULTS Compared with controls, intervention group parents showed significantly greater improvement in parenting risk and protective factors from baseline to 1-month and 3-month follow-up (F2,331.22=16.36, P<.001), with a small to medium effect size at 3-month follow-up (d=0.33). There were no significant effects of the intervention on adolescent-report of parenting or symptoms of depression or anxiety in the adolescents (all P>.05). CONCLUSIONS Findings suggest that a single-session, individually tailored, Web-based parenting intervention can improve parenting factors that are known to influence the development of depression and anxiety in adolescents. However, our results do not support the effectiveness of the intervention in improving adolescent depression or anxiety symptoms in the short-term. Long-term studies are required to adequately assess the relationship between improving parenting factors and adolescent depression and anxiety outcomes. Nonetheless, this is a promising avenue for the translation of research into a low-cost, sustainable, universal prevention approach. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12615000247572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615000247572 (Archived by WebCite at http://www.webcitation.org/6v1ha19XG)
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Affiliation(s)
- Mairead C Cardamone-Breen
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Katherine A Lawrence
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
| | | | - Marie Bee Hui Yap
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Tein JY, Mazza GL, Gunn HJ, Kim H, Stuart EA, Sandler IN, Wolchik SA. Multigroup Propensity Score Approach to Evaluating an Effectiveness Trial of the New Beginnings Program. Eval Health Prof 2018; 41:290-320. [PMID: 29635949 DOI: 10.1177/0163278718763499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We used a multigroup propensity score approach to evaluate a randomized effectiveness trial of the New Beginnings Program (NBP), an intervention targeting divorced or separated families. Two features of effectiveness trials, high nonattendance rates and inclusion of an active control, make program effects harder to detect. To estimate program effects based on actual intervention participation, we created a synthetic inactive control comprised of nonattenders and assessed the impact of attending the NBP or active control relative to no intervention (inactive control). We estimated propensity scores using generalized boosted models and applied inverse probability of treatment weighting for the comparisons. Relative to the inactive control, NBP strengthened parenting quality as well as reduced child exposure to interparental conflict, parent psychological distress, and child internalizing problems. Some effects were moderated by parent gender, parent ethnicity, or child age. On the other hand, the effects of active versus inactive control were minimal for parenting and in the unexpected direction for child internalizing problems. Findings from the propensity score approach complement and enhance the interpretation of findings from the intention-to-treat approach.
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Affiliation(s)
- Jenn-Yun Tein
- 1 Department of Psychology, REACH Institute, Arizona State University, Tempe, AZ, USA
| | - Gina L Mazza
- 1 Department of Psychology, REACH Institute, Arizona State University, Tempe, AZ, USA
| | - Heather J Gunn
- 1 Department of Psychology, REACH Institute, Arizona State University, Tempe, AZ, USA
| | - Hanjoe Kim
- 2 University of Houston, Houston, TX, USA
| | | | - Irwin N Sandler
- 1 Department of Psychology, REACH Institute, Arizona State University, Tempe, AZ, USA
| | - Sharlene A Wolchik
- 1 Department of Psychology, REACH Institute, Arizona State University, Tempe, AZ, USA
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27
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Brown CH, Brincks A, Huang S, Perrino T, Cruden G, Pantin H, Howe G, Young JF, Beardslee W, Montag S, Sandler I. Two-Year Impact of Prevention Programs on Adolescent Depression: an Integrative Data Analysis Approach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 19:74-94. [PMID: 28013420 PMCID: PMC5483191 DOI: 10.1007/s11121-016-0737-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This paper presents the first findings of an integrative data analysis of individual-level data from 19 adolescent depression prevention trials (n = 5210) involving nine distinct interventions across 2 years post-randomization. In separate papers, several interventions have been found to decrease the risk of depressive disorders or elevated depressive/internalizing symptoms among youth. One type of intervention specifically targets youth without a depressive disorder who are at risk due to elevated depressive symptoms and/or having a parent with a depressive disorder. A second type of intervention targets two broad domains: prevention of problem behaviors, which we define as drug use/abuse, sexual risk behaviors, conduct disorder, or other externalizing problems, and general mental health. Most of these latter interventions improve parenting or family factors. We examined the shared and unique effects of these interventions by level of baseline youth depressive symptoms, sociodemographic characteristics of the youth (age, sex, parent education, and family income), type of intervention, and mode of intervention delivery to the youth, parent(s), or both. We harmonized eight different measures of depression utilized across these trials and used growth models to evaluate intervention impact over 2 years. We found a significant overall effect of these interventions on reducing depressive symptoms over 2 years and a stronger impact among those interventions that targeted depression specifically rather than problem behaviors or general mental health, especially when baseline symptoms were high. Implications for improving population-level impact are discussed.
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Affiliation(s)
- C Hendricks Brown
- Departments of Psychiatry and Behavioral Sciences, Preventive Medicine, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Ahnalee Brincks
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Tatiana Perrino
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gracelyn Cruden
- Departments of Psychiatry and Behavioral Sciences, Preventive Medicine, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hilda Pantin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - George Howe
- Departments of Psychology and Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Jami F Young
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA
| | | | - Samantha Montag
- Departments of Psychiatry and Behavioral Sciences, Preventive Medicine, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Irwin Sandler
- Department of Psychology, Arizona State University, Tempe, AZ, USA
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28
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Theunissen MHC, Klein Velderman M, Cloostermans APG, Reijneveld SA. Emotional and behavioural problems in young children with divorced parents. Eur J Public Health 2017; 27:840-845. [PMID: 28957475 DOI: 10.1093/eurpub/ckx056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background This study examines the link between divorce or separation and emotional and behavioural problems (EBP) in children aged 2-4 years. Methods We obtained cross-sectional data for a nationally representative Dutch sample of children aged 2-4 years within the setting of the national system of routine visits to well-child clinics. A total of 2600 children participated (response rate: 70%). Before the visit, parents completed the Child Behaviour Checklist and a questionnaire with questions about divorce or separation. We assessed the associations of children's EBP with a divorce either in the previous year or at any time in the past after adjustment for other child and family factors. Results Four percent of the children had parents who had divorced before the child reached the age of 2-4 years, and 3.4% of these parents had divorced in the previous year. EBP (and particularly behavioural problems) were more likely in children aged 2-4 years old in cases of lifetime divorce or separation. This association was weaker after adjustment for relevant child and family characteristics: it may be partly due to confounding factors such as paternal education level, ethnicity and family size. A divorce in the previous year was not linked to child EBP. Conclusions These findings show the importance of identifying care needs and providing care for pre-school children whose parents have divorced since they suggest that there may be negative effects in the longer term.
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Affiliation(s)
| | | | | | - Sijmen A Reijneveld
- TNO Child Health, Leiden, The Netherlands.,Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Christopher C, Wolchik S, Tein JY, Carr C, Mahrer NE, Sandler I. Long-term effects of a parenting preventive intervention on young adults' painful feelings about divorce. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2017; 31:799-809. [PMID: 28471208 PMCID: PMC5662483 DOI: 10.1037/fam0000325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examined whether the New Beginnings Program (NBP), a parenting preventive intervention for divorced mothers that was designed to reduce children's postdivorce mental health problems, reduced painful feelings about divorce in young adults whose families had participated 15 years earlier. This study also explored whether NBP participation reduced the relations between young adults' painful feelings about divorce and their concurrent internalizing, externalizing, and substance use problems. Participants (M = 25.6 years; 50% female; 88% Caucasian) were from 240 families that had been recruited into a randomized experimental trial (NBP vs. literature control). Data from the pretest and 15-year follow-up were used. NBP participants reported less feelings of seeing life through a filter of divorce (e.g., thinking about how the divorce causes continued struggles for them) than those in the control condition. Program effects on maternal blame and acceptance of the divorce were moderated by pretest risk, a composite of divorce-related stressors and externalizing problems. NBP participants with elevated risk at program entry had lower levels of maternal blame. Program participation was associated with higher acceptance for those with elevated risk at program entry but lower acceptance for those with low risk at program entry. Program participation decreased the relations between maternal blame, acceptance of the divorce and filter of divorce and some, but not all, of the adjustment outcomes. These findings suggest that programs designed to help families after divorce have benefits in terms of long-term feelings about parental divorce as well as their relations with adjustment problems. (PsycINFO Database Record
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Brummert Lennings HI, Bussey K. Personal agency in children. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2017. [DOI: 10.1177/0165025416635282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study is to develop a multidimensional measure for assessing children’s personal agency to handle parental conflict through their coping self-efficacy beliefs (Bandura, 1997). Coping self-efficacy beliefs are individuals’ perceived ability to motivate themselves, access cognitive resources, and perform the actions required to take control of stressful situations. This study examines the psychometric properties and validation of the newly created Parental Conflict Coping Self-Efficacy Scale (PCC-SES). The study was based on 663 children, in grades 5 and 7 and their mothers. An exploratory factor analysis and confirmatory factor analysis through structural equation modeling supported the structure of the PCC-SES. The PCC-SES’s structure was facilitated by three global strategies, namely Proactive Behavior (problem solving and seeking social support), Avoiding Maladaptive Cognitions (avoiding preoccupation, avoiding self-blame and distancing) and Avoiding Maladaptive Behavior (avoiding aggression and avoiding overinvolvement).
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Affiliation(s)
| | - Kay Bussey
- Department of Psychology, Macquarie University, Australia
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Bettis AH, Forehand R, Sterba SK, Preacher KJ, Compas BE. Anxiety and Depression in Children of Depressed Parents: Dynamics of Change in a Preventive Intervention. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 47:581-594. [PMID: 27768384 DOI: 10.1080/15374416.2016.1225503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current study examined effects of a preventive intervention on patterns of change in symptoms of anxiety and depression in a sample of children of depressed parents. Parents with a history of depression (N = 180) and their children (N = 242; 50% female; Mage = 11.38; 74% Euro-American) enrolled in an intervention to prevent psychopathology in youth. Families were randomized to a family group cognitive behavioral intervention (FGCB) or a written information (WI) control condition. Parents and youth completed the Child Behavior Checklist and Youth Self Report at baseline, 6-, 12-, 18-, and 24-month follow up. Youth in the FGCB intervention reported significantly greater declines in symptoms of both anxiety and depression at 6, 12, and 18 months compared to youth in the WI condition. Youth with higher baseline levels of each symptom (e.g., anxiety) reported greater declines in the other symptom (e.g., depression) from 0 to 6 months in the FGCB intervention only. Changes in anxiety symptoms from 0 to 6 months predicted different patterns of subsequent changes in depressive symptoms from 6 to 12 months for the two conditions, such that declines in anxiety preceded and predicted greater declines in depression for FGCB youth but lesser increases in depression for WI youth. Findings inform transdiagnostic approaches to preventive interventions for at-risk youth, suggesting that both initial symptom levels and initial magnitude of change in symptoms are important to understand subsequent patterns of change in response to intervention.
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Affiliation(s)
- Alexandra H Bettis
- a Department of Psychology and Human Development , Vanderbilt University
| | - Rex Forehand
- b Department of Psychology , University of Vermont
| | - Sonya K Sterba
- a Department of Psychology and Human Development , Vanderbilt University
| | | | - Bruce E Compas
- a Department of Psychology and Human Development , Vanderbilt University
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Yap MBH, Morgan AJ, Cairns K, Jorm AF, Hetrick SE, Merry S. Parents in prevention: A meta-analysis of randomized controlled trials of parenting interventions to prevent internalizing problems in children from birth to age 18. Clin Psychol Rev 2016; 50:138-158. [PMID: 27969003 DOI: 10.1016/j.cpr.2016.10.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/03/2016] [Accepted: 10/18/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE OF THE RESEARCH Burgeoning evidence that modifiable parental factors can influence children's and adolescents' risk for depression and anxiety indicates that parents can play a crucial role in prevention of these disorders in their children. However, it remains unclear whether preventive interventions that are directed primarily at the parent (i.e. where the parent receives more than half of the intervention) are effective in reducing child internalizing (including both depression and anxiety) problems in the longer term. PRINCIPAL RESULTS Compared to a range of comparison conditions, parenting interventions reduced child internalizing problems, at a minimum of 6months after the intervention was delivered. Mean effects were very small for measures of internalizing and depressive symptoms, and small for measures of anxiety symptoms. Pooled effects for anxiety diagnoses were significant and indicated a number needed to treat (NNT) of 10. Pooled effects for depression diagnoses approached significance but suggested a NNT of 11. These results were based on effects reported at the longest follow-up interval for each included study, which ranged from 6months up to 15years for internalizing measures, 5.5years for depressive measures, and 11years for anxiety measures. MAJOR CONCLUSIONS Our findings underscore the likely benefits of increasing parental involvement in preventing internalizing problems, particularly anxiety problems, in young people.
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Affiliation(s)
- Marie B H Yap
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Amy J Morgan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kathryn Cairns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Centre of Excellence in Youth Mental Health, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sally Merry
- School of Medicine, University of Auckland, New Zealand
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Hetrick SE, Cox GR, Witt KG, Bir JJ, Merry SN. Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents. Cochrane Database Syst Rev 2016; 2016:CD003380. [PMID: 27501438 PMCID: PMC8407360 DOI: 10.1002/14651858.cd003380.pub4] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Depression is common in young people. It has a marked negative impact and is associated with self-harm and suicide. Preventing its onset would be an important advance in public health. This is an update of a Cochrane review that was last updated in 2011. OBJECTIVES To determine whether evidence-based psychological interventions (including cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and third wave CBT)) are effective in preventing the onset of depressive disorder in children and adolescents. SEARCH METHODS We searched the specialised register of the Cochrane Common Mental Disorders Group (CCMDCTR to 11 September 2015), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched conference abstracts and reference lists of included trials and reviews, and contacted experts in the field. SELECTION CRITERIA We included randomised controlled trials of an evidence-based psychological prevention programme compared with any comparison control for young people aged 5 to 19 years, who did not currently meet diagnostic criteria for depression. DATA COLLECTION AND ANALYSIS Two authors independently assessed trials for inclusion and rated their risk of bias. We adjusted sample sizes to take account of cluster designs and multiple comparisons. We contacted trial authors for additional information where needed. We assessed the quality of evidence for the primary outcomes using GRADE. MAIN RESULTS We included 83 trials in this review. The majority of trials (67) were carried out in school settings with eight in colleges or universities, four in clinical settings, three in the community and four in mixed settings. Twenty-nine trials were carried out in unselected populations and 53 in targeted populations.For the primary outcome of depression diagnosis at medium-term follow-up (up to 12 months), there were 32 trials with 5965 participants and the risk of having a diagnosis of depression was reduced for participants receiving an intervention compared to those receiving no intervention (risk difference (RD) -0.03, 95% confidence interval (CI) -0.05 to -0.01; P value = 0.01). We rated this evidence as moderate quality according to the GRADE criteria. There were 70 trials (73 trial arms) with 13,829 participants that contributed to the analysis for the primary outcome of depression symptoms (self-rated) at the post-intervention time point, with results showing a small but statistically significant effect (standardised mean difference (SMD) -0.21, 95% CI -0.27 to -0.15; P value < 0.0001). This effect persisted to the short-term assessment point (up to three months) (SMD -0.31, 95% CI -0.45 to -0.17; P value < 0.0001; 16 studies; 1558 participants) and medium-term (4 to 12 months) assessment point (SMD -0.12, 95% CI -0.18 to -0.05; P value = 0.0002; 53 studies; 11,913 participants); however, the effect was no longer evident at the long-term follow-up. We rated this evidence as low to moderate quality according to the GRADE criteria.The evidence from this review is unclear with regard to whether the type of population modified the overall effects; there was statistically significant moderation of the overall effect for depression symptoms (P value = 0.0002), but not for depressive disorder (P value = 0.08). For trials implemented in universal populations there was no effect for depression diagnosis (RD -0.01, 95% CI -0.03 to 0.01) and a small effect for depression symptoms (SMD -0.11, 95% CI -0.17 to -0.05). For trials implemented in targeted populations there was a statistically significantly beneficial effect of intervention (depression diagnosis RD -0.04, 95% CI -0.07 to -0.01; depression symptoms SMD -0.32, 95% CI -0.42 to -0.23). Of note were the lack of attention placebo-controlled trials in targeted populations (none for depression diagnosis and four for depression symptoms). Among trials implemented in universal populations a number used an attention placebo comparison in which the intervention consistently showed no effect. AUTHORS' CONCLUSIONS Overall the results show small positive benefits of depression prevention, for both the primary outcomes of self-rated depressive symptoms post-intervention and depression diagnosis up to 12 months (but not beyond). Estimates of numbers needed to treat to benefit (NNTB = 11) compare well with other public health interventions. However, the evidence was of moderate to low quality using the GRADE framework and the results were heterogeneous. Prevention programmes delivered to universal populations showed a sobering lack of effect when compared with an attention placebo control. Interventions delivered to targeted populations, particularly those selected on the basis of depression symptoms, had larger effect sizes, but these seldom used an attention placebo comparison and there are practical difficulties inherent in the implementation of targeted programmes. We conclude that there is still not enough evidence to support the implementation of depression prevention programmes.Future research should focus on current gaps in our knowledge. Given the relative lack of evidence for universal interventions compared with attention placebo controls and the poor results from well-conducted effectiveness trials of universal interventions, in our opinion any future such trials should test a depression prevention programme in an indicated targeted population using a credible attention placebo comparison group. Depressive disorder as the primary outcome should be measured over the longer term, as well as clinician-rated depression. Such a trial should consider scalability as well as the potential for the intervention to do harm.
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Affiliation(s)
- Sarah E Hetrick
- The National Centre of Excellence in Youth Mental HealthOrygen35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Georgina R Cox
- The National Centre of Excellence in Youth Mental HealthOrygen35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | | | - Julliet J Bir
- University of AucklandDepartment of PsychiatryPrivate Bag 92109AucklandNew Zealand
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicinePrivate Bag 92019AucklandNew Zealand
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Wolchik SA, Tein JY, Sandler IN, Kim HJ. Developmental cascade models of a parenting-focused program for divorced families on mental health problems and substance use in emerging adulthood. Dev Psychopathol 2016; 28:869-88. [PMID: 27427811 PMCID: PMC5444389 DOI: 10.1017/s0954579416000365] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A developmental cascade model from functioning in adolescence to emerging adulthood was tested using data from a 15-year longitudinal follow-up of 240 emerging adults whose families participated in a randomized, experimental trial of a preventive program for divorced families. Families participated in the program or literature control condition when the offspring were ages 9-12. Short-term follow-ups were conducted 3 months and 6 months following completion of the program when the offspring were in late childhood/early adolescence. Long-term follow-ups were conducted 6 years and 15 years after program completion when the offspring were in middle to late adolescence and emerging adulthood, respectively. It was hypothesized that the impact of the program on mental health and substance use outcomes in emerging adulthood would be explained by developmental cascade effects of program effects in adolescence. The results provided support for a cascade effects model. Specifically, academic competence in adolescence had cross-domain effects on internalizing problems and externalizing problems in emerging adulthood. In addition, adaptive coping in adolescence was significantly, negatively related to binge drinking. It was unexpected that internalizing symptoms in adolescence were significantly negatively related to marijuana use and alcohol use. Gender differences occurred in the links between mental health problems and substance use in adolescence and mental health problems and substance use in emerging adulthood.
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Kuntsche S, Kuntsche E. Parent-based interventions for preventing or reducing adolescent substance use — A systematic literature review. Clin Psychol Rev 2016; 45:89-101. [DOI: 10.1016/j.cpr.2016.02.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 02/19/2016] [Accepted: 02/26/2016] [Indexed: 12/17/2022]
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Keating A, Sharry J, Murphy M, Rooney B, Carr A. An evaluation of the Parents Plus-Parenting When Separated programme. Clin Child Psychol Psychiatry 2016; 21:240-54. [PMID: 25911347 DOI: 10.1177/1359104515581717] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study evaluated the Parents Plus-Parenting when Separated Programme, an intervention specifically designed to address the needs of separated parents in an Irish context. In a randomized control trial, 82 separated parents with young children were assigned to the Parents Plus-Parenting when Separated Programme treatment group and 79 to a waiting-list control group. They were assessed on measures of client goals, parenting satisfaction, child and parental adjustment and interparental conflict at baseline (Time 1) and 6 weeks later (Time 2), after the treatment group completed the Parents Plus-Parenting when Separated Programme. From Time 1 to 2, significant goal attainment, increases in parenting satisfaction and decreases in child behaviour problems, parental adjustment problems and interparental conflict occurred in the Parents Plus-Parenting when Separated Programme group, but not in the control group. These results supported the effectiveness of Parents Plus-Parenting when Separated Programme, which should be made more widely available to separated parents.
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Affiliation(s)
- Adele Keating
- School of Psychology, University College Dublin, Ireland Lucena Child and Adolescent Mental Health Service, St John of Gods, Ireland
| | - John Sharry
- School of Psychology, University College Dublin, Ireland Parents Plus, Ireland
| | | | - Brendan Rooney
- School of Psychology, University College Dublin, Ireland
| | - Alan Carr
- School of Psychology, University College Dublin, Ireland
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A Longitudinal Study of the Effects of Child-Reported Maternal Warmth on Cortisol Stress Response 15 Years After Parental Divorce. Psychosom Med 2016; 78:163-70. [PMID: 26465217 PMCID: PMC4738014 DOI: 10.1097/psy.0000000000000251] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The experience of parental divorce during childhood is associated with an increased risk of behavioral and physical health problems. Alterations in adrenocortical activity may be a mechanism in this relation. Parent-child relationships have been linked to cortisol regulation in children exposed to adversity, but prospective research is lacking. We examined maternal warmth in adolescence as a predictor of young adults' cortisol stress response 15 years after parental divorce. METHODS Participants included 240 youth from recently divorced families. Mother and child reports of maternal warmth were assessed at 6 time points across childhood, adolescence, and young adulthood. Offspring salivary cortisol was measured in young adulthood before and after a social stress task. Structural equation modeling was used to predict cortisol response from maternal warmth across early and late adolescence. RESULTS Higher child-reported maternal warmth in early adolescence predicted higher child-reported maternal warmth in late adolescence (standardized regression = 0.45, standard error = 0.065, p < .01), which predicted lower cortisol response to a challenging interpersonal task in young adulthood (standardized regression = -0.20, standard error = 0.094, p = .031). Neither mother-reported warmth in early adolescence nor late adolescence was significantly related to offspring cortisol response in young adulthood. CONCLUSIONS Results suggest that for children from divorced families, a warm mother-child relationship after divorce and across development, as perceived by the child, may promote efficient biological regulation later in life. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01407120.
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Cost-benefit analysis of a preventive intervention for divorced families: reduction in mental health and justice system service use costs 15 years later. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 16:586-96. [PMID: 25382415 DOI: 10.1007/s11121-014-0527-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This cost-benefit analysis compared the costs of implementing the New Beginnings Program (NBP), a preventive intervention for divorced families to monetary benefits saved in mental healthcare service use and criminal justice system costs. NBP was delivered when the offspring were 9-12 years old. Benefits were assessed 15 years later when the offspring were young adults (ages 24-27). This study estimated the costs of delivering two versions of NBP, a single-component parenting-after-divorce program (Mother Program, MP) and a two-component parenting-after-divorce and child-coping program (Mother-Plus-Child Program, MPCP), to costs of a literature control (LC). Long-term monetary benefits were determined from actual expenditures from past-year mental healthcare service use for mothers and their young adult (YA) offspring and criminal justice system involvement for YAs. Data were gathered from 202 YAs and 194 mothers (75.4 % of families randomly assigned to condition). The benefits, as assessed in the 15th year after program completion, were $1630/family (discounted benefits $1077/family). These 1-year benefits, based on conservative assumptions, more than paid for the cost of MP and covered the majority of the cost of MPCP. Because the effects of MP versus MPCP on mental health and substance use problems have not been significantly different at short-term or long-term follow-up assessments, program managers would likely choose the lower-cost option. Given that this evaluation only calculated economic benefit at year 15 and not the previous 14 (nor future years), these findings suggest that, from a societal perspective, NBP more than pays for itself in future benefits.
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Elam KK, Sandler I, Wolchik S, Tein JY. Non-Residential Father-Child Involvement, Interparental Conflict and Mental Health of Children Following Divorce: A Person-Focused Approach. J Youth Adolesc 2015; 45:581-93. [PMID: 26692236 DOI: 10.1007/s10964-015-0399-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Abstract
Variable-centered research has found complex relationships between child well-being and two critical aspects of the post-divorce family environment: the level of non-residential father involvement (i.e., contact and supportive relationship) with their children and the level of conflict between the father and mother. However, these analyses fail to capture individual differences based on distinct patterns of interparental conflict, father support and father contact. Using a person-centered latent profile analysis, the present study examined (1) profiles of non-residential father contact, support, and interparental conflict in the 2 years following divorce (N = 240), when children (49 % female) were between 9 and 12 years of age and (2) differences across profiles in concurrent child adjustment outcomes as well as outcomes 6 years later. Four profiles of father involvement were identified: High Contact-Moderate Conflict-Moderate Support, Low Contact-Moderate Conflict-Low Support, High Conflict-Moderate Contact-Moderate Support, and Low Conflict-Moderate Contact-Moderate Support. Concurrently, children with fathers in the group with high conflict were found to have significantly greater internalizing and externalizing problems compared to all other groups. Six years later, children with fathers in the group with low contact and low support were found to have greater internalizing and externalizing problems compared to children with fathers in the high conflict group, and also greater internalizing problems compared to children with fathers in the low conflict group. These results provide insight into the complex relationship among non-residential fathers' conflict, contact, and support in child adjustment within divorcing families.
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Affiliation(s)
- Kit K Elam
- T. Denny Sanford School for Social and Family Dynamics, Arizona State University, 951 S Cady Mall, PO Box 873701, Tempe, AZ, 85287-3701, USA.
| | - Irwin Sandler
- Department of Psychology, REACH Institute, Arizona State University, PO Box 876005, Tempe, AZ, 85287-6005, USA.
| | - Sharlene Wolchik
- Department of Psychology, REACH Institute, Arizona State University, PO Box 876005, Tempe, AZ, 85287-6005, USA.
| | - Jenn-Yun Tein
- Department of Psychology, REACH Institute, Arizona State University, PO Box 876005, Tempe, AZ, 85287-6005, USA.
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Schoenfelder EN, Tein JY, Wolchik S, Sandler IN. Effects of the Family Bereavement Program on academic outcomes, educational expectations and job aspirations 6 years later: the mediating role of parenting and youth mental health problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 43:229-41. [PMID: 25052624 DOI: 10.1007/s10802-014-9905-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Experiencing the death of a parent during childhood is associated with a variety of difficulties, including lower academic achievement, that have implications for functioning in childhood and adulthood. This study examines effects of the Family Bereavement Program (FBP), a preventive intervention for parentally-bereaved youth and their caregivers, on grade point averages (GPA), educational expectations and job aspirations of youths 6 years after the intervention. A total of 244 bereaved youths ages 8-16 and their caregivers were randomized to either the FBP or a comparison group that received books about bereavement. Assessments occurred at pretest, post-test, and 11-month and 6-year follow-ups. Direct program effects on educational outcomes and job aspirations 6 years later were non-significant, although the program improved educational expectations for children with fewer behavior problems at program entry, and GPA for younger children. Mediational pathways for program effects on educational outcomes were also tested. Program-induced improvements in effective parenting at 11-month follow-up were associated with higher GPAs at 6-year follow-up for youth who were younger or for whom more time had passed since the loss. Program-induced improvements in parenting and teacher-rated youth mental health problems at the 6-year follow-up mediated program effects on youths' educational expectations for those with fewer behavior problems at program entry. The implications of these findings for understanding processes related to academic and educational outcomes following the death of a parent and for prevention efforts to help bereaved and other high-risk children succeed in school are discussed.
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Affiliation(s)
- Erin N Schoenfelder
- University of Washington Department of Psychiatry and Behavioral Sciences, Seattle Children's Hospital, 4800 Sandpoint Way NW, Seattle, WA, 98145, USA,
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Yap MBH, Fowler M, Reavley N, Jorm AF. Parenting strategies for reducing the risk of childhood depression and anxiety disorders: A Delphi consensus study. J Affect Disord 2015; 183:330-8. [PMID: 26047961 DOI: 10.1016/j.jad.2015.05.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/04/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Substantial evidence that some modifiable parental factors are associated with childhood depression and anxiety indicates that parents can play a crucial role in the prevention of these disorders in their children. However, more effective translation of research evidence is required. METHODS This study employed the Delphi methodology to establish expert consensus on parenting strategies that are important for preventing depression or anxiety disorders in children aged 5-11 years. A literature search identified 289 recommendations for parents. These were presented to a panel of 44 international experts over three survey rounds, who rated their preventive importance. RESULTS 171 strategies were endorsed as important or essential for preventing childhood depression or anxiety disorders by ≥90% of the panel. These were written into a parenting guidelines document, with 11 subheadings: Establish and maintain a good relationship with your child, Be involved and support increasing autonomy, Encourage supportive relationships, Establish family rules and consequences, Encourage good health habits, Minimise conflict in the home, Help your child to manage emotions, Help your child to set goals and solve problems, Support your child when something is bothering them, Help your child to manage anxiety, and Encourage professional help seeking when needed. LIMITATIONS This study relied on experts from Western countries; hence the strategies identified may not be relevant for all ethnic groups. CONCLUSIONS This study produced new parenting guidelines that are supported by research evidence and/or international experts, which can now be promoted in Western English-speaking communities to help parents protect their children from depression and anxiety disorders.
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Affiliation(s)
- Marie Bee Hui Yap
- School of Psychological Sciences, Monash University, Bld 17, 18 Innovation Walk, Clayton, Victoria 3800, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Michelle Fowler
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Nicola Reavley
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Anthony Francis Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Australia
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Luecken LJ, Hagan MJ, Sandler IN, Tein JY, Ayers TS, Wolchik SA. Longitudinal mediators of a randomized prevention program effect on cortisol for youth from parentally bereaved families. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 15:224-232. [PMID: 23529870 DOI: 10.1007/s11121-013-0385-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We recently reported that a randomized controlled trial of a family-focused intervention for parentally bereaved youth predicted higher cortisol output 6 years later relative to a control group of bereaved youth (Luecken et al., Psychoneuroendocrinology 35, 785-789, 2010). The current study evaluated longitudinal mediators of the intervention effect on cortisol 6 years later. Parentally bereaved children (N = 139; mean age, 11.4; SD = 2.4; age range = 8-16 years; male; 61% Caucasian, 17% Hispanic, 7% African American, and 15% other ethnicities) were randomly assigned to the 12-week preventive intervention (n = 78) or a self-study control (n = 61) condition. Six years later (mean age, 17.5; SD, 2.4), cortisol was sampled as youth participated in a parent-child conflict interaction task. Using four waves of data across the 6 years, longitudinal mediators of the program impact on cortisol were evaluated. Program-induced increases in positive parenting, decreases in child exposure to negative life events, and lower externalizing symptoms significantly mediated the intervention effect on cortisol 6 years later.
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Affiliation(s)
- Linda J Luecken
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA.
| | - Melissa J Hagan
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA
| | - Irwin N Sandler
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA
| | - Jenn-Yun Tein
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA
| | - Tim S Ayers
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA
| | - Sharlene A Wolchik
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA
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Sandler I, Ingram A, Wolchik S, Tein JY, Winslow E. Long-Term Effects of Parenting-Focused Preventive Interventions to Promote Resilience of Children and Adolescents. CHILD DEVELOPMENT PERSPECTIVES 2015; 9:164-171. [PMID: 30854024 DOI: 10.1111/cdep.12126] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In this article, we address three questions concerning the long-term effects of parenting-focused preventive interventions: 1) Do prevention programs promote effective parenting in families facing normative stressors as well as those facing frequent adversity? 2) Do parenting programs prevent children's long-term problems? 3) Do changes in parenting mediate long-term effects of programs? We address these questions by summarizing evidence from 22 programs with randomized trials and followups of three years or longer. We describe in more detail two interventions for divorced and bereaved families, suggesting that they prevent a range of problems and promote a range of developmental competencies over a prolonged period. Program effects to strengthen parenting mediated many of these long-term outcomes.
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Yap MBH, Jorm AF. Parental factors associated with childhood anxiety, depression, and internalizing problems: a systematic review and meta-analysis. J Affect Disord 2015; 175:424-40. [PMID: 25679197 DOI: 10.1016/j.jad.2015.01.050] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is a burgeoning and varied literature examining the associations between parental factors and depression or anxiety disorders in children. However, there is hitherto no systematic review of this complex literature with a focus on the 5-11 years age range, when there is a steep increase in onset of these disorders. Furthermore, to facilitate the application of the evidence in prevention, a focus on modifiable factors is required. METHODS Employing the PRISMA method, we conducted a systematic review of parental factors associated with anxiety, depression, and internalizing problems in children which parents can potentially modify. RESULTS We identified 141 articles altogether, with 53 examining anxiety, 50 examining depression, and 70 examining internalizing outcomes. Stouffer׳s method of combining p-values was used to determine whether associations between variables were reliable, and meta-analyses were conducted with a subset of eligible studies to estimate the mean effect sizes of associations between each parental factor and outcome. LIMITATIONS Limitations include sacrificing micro-level detail for a macro-level synthesis of the literature, the lack of generalizability across cultures, and the inability to conduct a meta-analysis on all included studies. CONCLUSIONS Parental factors with a sound evidence base indicating increased risk for both depression and internalizing problems include more inter-parental conflict and aversiveness; and for internalizing outcomes additionally, they include less warmth and more abusive parenting and over-involvement. No sound evidence linking any parental factor with anxiety outcomes was found.
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Affiliation(s)
- Marie Bee Hui Yap
- School of Psychological Sciences, Monash University, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Anthony Francis Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Australia
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Overbeek MM, De Schipper JC, Willemen AM, Lamers-Winkelman F, Schuengel C. Mediators and Treatment Factors in Intervention for Children Exposed to Interparental Violence. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 46:411-427. [PMID: 25751123 DOI: 10.1080/15374416.2015.1012720] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Changes in children's emotion differentiation, coping skills, parenting stress, parental psychopathology, and parent-child interaction were explored as mediators of treatment factors in two selective preventive group interventions for children exposed to interparental violence (IPV) and their parents. One hundred thirty-four IPV-exposed children (ages 6-12 years, 52% boys) and their parents were randomized to an IPV-focused or common factors community-based group intervention and completed baseline, posttest, and follow-up assessments for posttraumatic stress (PTS). A multilevel model tested mediators that included children's ability to differentiate emotions and coping skills, parenting stress, parental psychopathology, and parent-child interactions. In both conditions, exposure to nonspecific factors, specific factors unrelated to IPV and trauma-specific intervention factors was coded from videotaped child and parent sessions. Improved parental mental health mediated the link between greater exposure to nonspecific treatment factors and decreases in PTS symptoms. In addition, an increase in emotion differentiation and a decrease in parenting stress were associated with a decrease in PTS symptoms. Greater exposure to trauma-specific factors in child sessions was associated with a small decrease in emotion differentiation, an increase in coping skills, and a decrease in PTS symptoms over time. Greater exposure to nonspecific treatment factors in child and parent sessions was associated with more positive parent-child interaction. Parental mental health appears to be an important mechanism of change that can be promoted through exposure to nonspecific factors in parent intervention. For children, the effect of greater exposure to trauma-specific factors in intervention is less clear and may not have clear benefits.
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Affiliation(s)
- Mathilde M Overbeek
- a Department of Clinical Child and Family Studies and EMGO Institute for Health and Care Research , VU University
| | - J Clasien De Schipper
- a Department of Clinical Child and Family Studies and EMGO Institute for Health and Care Research , VU University
| | - Agnes M Willemen
- a Department of Clinical Child and Family Studies and EMGO Institute for Health and Care Research , VU University
| | - Francien Lamers-Winkelman
- a Department of Clinical Child and Family Studies and EMGO Institute for Health and Care Research , VU University
| | - Carlo Schuengel
- a Department of Clinical Child and Family Studies and EMGO Institute for Health and Care Research , VU University
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Luecken LJ, Hagan MJ, Mahrer NE, Wolchik SA, Sandler IN, Tein JY. Effects of a prevention program for divorced families on youth cortisol reactivity 15 years later. Psychol Health 2014; 30:751-69. [PMID: 25367835 PMCID: PMC4667557 DOI: 10.1080/08870446.2014.983924] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We examined whether an empirically based, randomised controlled trial of a preventive intervention for divorced mothers and children had a long-term impact on offspring cortisol regulation. DESIGN Divorced mothers and children (age 9-12) were randomly assigned to a literature control condition or the 11-week New Beginnings Program, a family-focused group preventive intervention for mothers and children in newly divorced families. MAIN OUTCOME MEASURES Fifteen years after the trial, offspring salivary cortisol (n = 161) was measured before and after a social stress task. RESULTS Multilevel mixed models were used to predict cortisol from internalizing symptoms, externalizing symptoms, group assignment and potential moderators of intervention effects. Across the sample, higher externalizing symptoms were associated with lower cortisol reactivity. There was a significant group-by-age interaction such that older offspring in the control group had higher reactivity relative to the intervention group, and younger offspring in the control group exhibited a decline across the task relative to younger offspring in the intervention group. CONCLUSIONS Preventive interventions for youth from divorced families may have a long-term impact on cortisol reactivity to stress. Results highlight the importance of examining moderators of program effects.
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Affiliation(s)
- Linda J Luecken
- a Department of Psychology , Arizona State University , Tempe , AZ , USA
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Programs for Prevention of Externalizing Problems in Children: Limited Evidence for Effect Beyond 6 Months Post Intervention. CHILD & YOUTH CARE FORUM 2014; 44:251-276. [PMID: 26696756 PMCID: PMC4676792 DOI: 10.1007/s10566-014-9281-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Preventing externalizing problems in children is a major societal concern, and a great number of intervention programs have been developed to this aim. To evaluate their preventive effects, well-controlled trials including follow-up assessments are necessary. Methods This is a systematic review of the effect of prevention programs targeting externalizing problems in children. The review covered peer reviewed publications in English, German, French, Spanish and Scandinavian languages. Experimental studies of standardized programs explicitly aiming at preventing externalizing mental ill-health in children (2–19 years), with outcome assessments at ≥6 months post intervention for both intervention and control groups, were included. We also included long-term trials with consecutive observations over several years, even in the absence of follow-up ≥6 months post intervention. Studies of clinical populations or children with impairments, which substantially increase the risk for mental disorders, were excluded. Results Thirty-eight controlled trials assessing 25 different programs met inclusion criteria. Only five programs were supported by scientific evidence, representing selective parent training (Incredible Years and Triple-P), indicated family support (Family Check-Up), and school-based programs (Good Behavior Game, universally delivered, and Coping Power, as an indicated intervention). With few exceptions, effects after 6–12 months were small. Long-term trials showed small and inconsistent effects. Conclusions Despite a vast literature, the evidence for preventive effects is meager, largely due to insufficient follow-up post intervention. Long-term follow up assessment and effectiveness studies should be given priority in future evaluations of interventions to prevent externalizing problems in children.
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Mahrer NE, Winslow E, Wolchik SA, Tein JY, Sandler IN. Effects of a preventive parenting intervention for divorced families on the intergenerational transmission of parenting attitudes in young adult offspring. Child Dev 2014; 85:2091-105. [PMID: 24916511 PMCID: PMC6112180 DOI: 10.1111/cdev.12258] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study evaluates whether the New Beginnings Program (NBP), a parenting intervention for divorced mothers, led to positive parenting attitudes in young adult offspring. Data were collected from 240 mothers (G1) and offspring (G2) at ages 9-12 and again in adolescence and young adulthood. Alternative theoretical models were tested to examine mediators of NBP effects on G2 parenting attitudes. Significant interactions between condition and baseline G1 parenting indicated that NBP improved G2's parenting attitudes for those exposed to poorer G1 parenting at program entry. Effects on G2 warm attitudes were partially mediated through program effects on G1 warm parenting. The implications of improving parenting attitudes in offspring who experience parental divorce on well-being in the next generation are discussed.
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Mahrer NE, Luecken LJ, Wolchik SA, Tein JY, Sandler IN. Exposure to maternal distress in childhood and cortisol activity in young adulthood. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2014. [DOI: 10.1177/0165025414537924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dysregulated cortisol is a risk factor for poor health outcomes. Children of distressed mothers exhibit dysregulated cortisol, yet it is unclear whether maternal distress predicts cortisol activity in later developmental stages. This longitudinal study examined the prospective relation between maternal distress during late childhood (9–12 years) and adolescence (15–19 years) and cortisol response in offspring in young adulthood (24–28 years). Data were collected from 51 recently divorced mothers and their children across 15 years. Higher maternal distress during late childhood was associated with lower total cortisol independent of levels of maternal distress in adolescence or young adulthood. Maternal distress during adolescence marginally predicted blunted cortisol when distress in childhood was low. Findings suggest that blunted cortisol activity in young adulthood may be a long-term consequence of exposure to maternal distress earlier in development.
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Caregiver responsiveness to the family bereavement program: what predicts responsiveness? What does responsiveness predict? PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2014; 14:545-56. [PMID: 23404661 DOI: 10.1007/s11121-012-0337-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The study developed a multidimensional measure to assess participant responsiveness to a preventive intervention and applied this measure to study how participant baseline characteristics predict responsiveness and how responsiveness predicts program outcomes. The study was conducted with caregivers who participated in the parenting-focused component of the Family Bereavement Program (FBP), a prevention program for families that have experienced parental death. The sample consisted of 89 caregivers assigned to the intervention condition in the efficacy trial of the FBP. Positive parenting, caregiver depression, and child externalizing problems at baseline were found to predict caregivers' use of program skills outside the group, and more child internalizing problems predicted more positive perceptions of the group environment. Higher levels of skill use during the program predicted increased positive parenting at the 11-month follow-up, whereas positive perceptions of the group environment predicted decreased caregiver depressive symptoms at follow-up. Caregiver skill use mediated the relation between baseline positive parenting and improvements in positive parenting at 11-month follow-up, and skill use and perceived group environment mediated changes in caregiver depression from baseline to 11-month follow-up.
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