Effects of a prevention program for divorced families on youth cortisol reactivity 15 years later

Restoration of typical HPA-SAM co-activation following psychosocial intervention among preadolescent youth living in poverty

Despite the added value of multisystem (relative to traditional single-system) approaches for characterizing biological processes linked to risk for psychopathology (e.g., neuroendocrine stress responsivity; Buss et al., 2019; Quas et al., 2014), no study to date has evaluated whether multisystem processes may serve as viable biological targets of intervention. Utilizing a multiple-levels-of-analysis approach (Cicchetti & Dawson, 2002), this person-centered study examined whether stress-adapted patterns of hypothalamus-pituitary-adrenal (HPA) axis and sympathetic-adrenomedullary (SAM) system co-activation were amenable to change following the Building a Strong Identity and Coping Skills intervention (BaSICS; Wadsworth et al., 2022). Preadolescents exposed to concentrated poverty (n = 112, M age = 11.78 years, 57.1% female, 54% assigned to intervention; 40% Hispanic, 63% Black, 20% White) completed questionnaires and the Trier Social Stress Test at both pre- and posttest. Multitrajectory modeling of cortisol and alpha-amylase levels identified four pretest and posttest HPA-SAM co-activation profiles. At pretest, youth exhibiting Asymmetric Nos. 1 & 2 HPA-SAM co-activation reported greater maladjustment relative to youth with Symmetric Nos. 1 & 2 co-activation. Youth exhibiting Asymmetric No. 1 co-activation at pretest were more likely to exhibit Symmetric No. 1 co-activation following BaSICS relative to control. Findings highlight the potential of BaSICS to restore neuroendocrine stress response function in impoverished youth, pointing to HPA-SAM co-activation as a potential biological target of preventive intervention in this population.

Familiäre Gesundheitsförderung bei Alleinerziehenden und ihren Kindern

Hintergrund

Die Lebenslage von Alleinerziehenden und ihren Kindern geht oft mit besonderen Herausforderungen einher, die in Folge gesundheitliche Beeinträchtigungen mit sich bringen können. Es ist daher von Relevanz, für diese Zielgruppe wirksame Maßnahmen der Gesundheitsförderung zu identifizieren.

Ziel der Arbeit

Die vorliegende Arbeit gibt einen aktuellen Überblick zu Ansätzen der Gesundheitsförderung/Prävention bei Alleinerziehenden und ihren Kindern sowie deren Wirksamkeit.

Methode

Es erfolgte eine systematische Recherche in relevanten Datenbanken mit anschließendem mehrschrittigen Screeningprozess und einer narrativen Ergebnissynthese.

Ergebnisse

Es wurden 27 Studien eingeschlossen, in denen 22 Interventionsprogramme evaluiert wurden. Die Studienlage ist verhaltenspräventiv geprägt, die Evidenzlage ist heterogen. Es zeigen sich eingeschränkte Wirksamkeitsnachweise von Workshop-Formaten, Bildungsangeboten und Kompetenztrainings mit dem Ziel der psychosozialen Ressourcenstärkung bei Alleinerziehenden und ihren Kindern.

Schlussfolgerung

Die Belastbarkeit der Ergebnisse wird durch die mäßige methodische Qualität der Studien relativiert. Durch die Suchstrategie, die auf Studien mit Outcomes für Alleinerziehende fokussiert war, sowie die Methodik des systematischen Reviews wurden fast ausschließlich Angebote der Verhaltensprävention identifiziert. Für verhältnispräventive Interventionen liegen nur selten Studien vor, die explizit Auskunft zur Wirksamkeit bei Alleinerziehenden geben. Das gewählte Vorgehen war somit nur begrenzt in der Lage, das Handlungsfeld umfassend abzubilden. Das Review liefert dennoch einen Baustein eines evidenzbasierten Vorgehens in der Gesundheitsförderung für Alleinerziehende und ihre Kinder.

Effects of parenting interventions on child and caregiver cortisol levels: systematic review and meta-analysis

BACKGROUND

Nurturing care, in which children are raised in engaging and safe environments, may reduce child stress and shape hypothalamic-pituitary-adrenal axis functioning. Hence, parent-training programs may impact child cortisol levels, as well as behavioral, social and health outcomes. We conducted a systematic review of the impact of parent-training interventions on children's and caregivers' cortisol levels, and meta-analyzed the results.

METHODS

In January 2020, searches in PubMed, LILACS, ERIC, Web of Science, Scielo, Scopus, PsycNET and POPLINE databases were conducted, and two independent researchers screened the results for eligible studies - randomized trials that assessed the impact of parent-training interventions on child or caregiver cortisol levels. Random effects were used to pool the estimates, separately for children and caregivers, and for children's morning and evening cortisol levels, as well as change across the day.

RESULTS

A total of 27 eligible studies were found. Data from 19 studies were extracted and included in the meta-analyses, with 18 estimates of child cortisol levels and 5 estimates for caregiver cortisol levels. The pooled effect size (standardized mean difference) for the effects of parent training programs on morning child cortisol was 0.01 (95%CI: - 0.14 to 0.16; I2: 47.5%), and for caregivers it was 0.04 (95%CI: - 0.22 to 0.30; I2: 0.0%). Similar null results were observed for child evening cortisol and for the slope between morning and evening child cortisol. No evidence of publication bias was found.

CONCLUSION

Existing evidence shows no effect of parent-training interventions on child or caregiver post-intervention cortisol. Researchers are encouraged to adopt standardized protocols to improve evaluation standards, to test for intervention effects on psychosocial outcomes that are theorized to mediate the effects on biomarkers, and to use additional biomarkers for chronic stress.

Binge drinking in adolescence predicts an atypical cortisol stress response in young adulthood

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.

Ameliorating the biological impacts of childhood adversity: A review of intervention programs

Childhood adversity negatively impacts the biological development of children and has been linked to poor health outcomes across the life course. The purpose of this literature review is to explore and evaluate the effectiveness of interventions that have addressed an array of biological markers and physical health outcomes in children and adolescents affected by adversity. PubMed, CINAHL, PsychInfo, Sociological Abstracts databases and additional sources (Cochrane, WHO, NIH trial registries) were searched for English language studies published between January 2007 and September 2017. Articles with a childhood adversity exposure, biological health outcome, and evaluation of intervention using a randomized controlled trial study design were selected. The resulting 40 intervention studies addressed cortisol outcomes (n = 20) and a range of neurological, epigenetic, immune, and other outcomes (n = 22). Across institutional, foster care, and community settings, intervention programs demonstrated success overall for improving or normalizing morning and diurnal cortisol levels, and ameliorating the impacts of adversity on brain development, epigenetic regulation, and additional outcomes in children. Factors such as earlier timing of intervention, high quality and nurturant parenting traits, and greater intervention engagement played a role in intervention success. This study underlines progress and promise in addressing the health impacts of adversity in children. Ongoing research efforts should collect baseline data, improve retention, replicate studies in additional samples and settings, and evaluate additional variables, resilience factors, mediators, and long-term implications of results. Clinicians should integrate lessons from the intervention sciences for preventing and treating the health effects of adversity in children and adolescents.

Childhood close family relationships and health

Emerging data suggest that during childhood, close family relationships can ameliorate the impact that adversity has on life span physical health. To explain this phenomenon, a developmental stress buffering model is proposed in which characteristics of family relationships including support, conflict, obligation, and parenting behaviors evolve and change from childhood to adolescence. Together, these characteristics govern whether childhood family relationships are on balance positive enough to fill a moderating role in which they mitigate the effects that childhood adversities have on physical health. The benefits of some family relationship characteristics are hypothesized to stay the same across childhood and adolescence (e.g., the importance of comfort and warmth from family relationships) whereas the benefits of other characteristics are hypothesized to change from childhood to adolescence (e.g., from a need for physical proximity to parents in early childhood to a need for parental availability in adolescence). In turn, close, positive family relationships in childhood operate via a variety of pathways, such as by reducing the impact that childhood stressors have on biological processes (e.g., inflammation) and on health behaviors that in turn can shape physical health over a lifetime. (PsycINFO Database Record

Childhood negative emotionality predicts biobehavioral dysregulation fifteen years later

The temperamental trait of negative emotionality (NE) plays an important role in maladaptation among adults experiencing significant life stress. However, the prospective relation between childhood NE and subsequent interrelated behavioral, emotional, and biological dysregulation in later life has not yet been established among children who experience early adversity. Using a longitudinal sample of youth who experienced parental divorce during childhood (N = 160; 53% male; 83% White), we tested the hypothesis that childhood NE would predict physiological, emotional, and behavioral dysregulation 15 years later. NE was assessed by maternal report when youth were between 9 and 12 years old. Fifteen years later, young adults (mean age = 25.55 years) participated in a psychosocial stress task to assess cortisol reactivity and reported on internalizing symptoms and problematic alcohol use. Structural equation modeling revealed that higher childhood NE predicted significantly greater alcohol use, internalizing symptoms, and total cortisol output during a stress task 15 years later. Importantly, these findings held after adjusting for childhood internalizing symptoms. In addition, problematic alcohol use was associated with greater cortisol reactivity and internalizing symptoms. Findings suggest that childhood NE is a critical risk marker for interrelated forms of dysregulation in young adulthood among at-risk youth. (PsycINFO Database Record

Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents

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.

A Longitudinal Study of the Effects of Child-Reported Maternal Warmth on Cortisol Stress Response 15 Years After Parental Divorce

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.

Long-Term Effects of Parenting-Focused Preventive Interventions to Promote Resilience of Children and Adolescents

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.