Parental depression and child conduct problems: evaluation of parental service use and associated costs after attending the Incredible Years Basic Parenting Programme

A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme

BACKGROUND

This study assessed whether a relatively newly developed Parent and Infant (PIN) parenting support programme was cost-effective when compared to services as usual (SAU).

METHODS

The cost-effectiveness of the PIN programme versus SAU was assessed from an Irish health and social care perspective over a 24-month timeframe and within the context of a non-randomised, controlled before-and-after trial. In total, 163 parent-infant dyads were included in the study (86 intervention, 77 control). The primary outcome measure for the economic evaluation was the Parenting Sense of Competence Scale (PSOC).

RESULTS

The average cost of the PIN programme was €647 per dyad. The mean (SE) cost (including programme costs) was €7,027 (SE €1,345) compared to €4,811 (SE €593) in the control arm, generating a (non-significant) mean cost difference of €2,216 (bootstrap 95% CI -€665 to €5,096; p = 0.14). The mean incremental cost-effectiveness of the PIN service was €614 per PSOC unit gained (bootstrap 95% CI €54 to €1,481). The probability that the PIN programme was cost-effective, was 87% at a willingness-to-pay of €1,000 per one unit change in the PSOC.

CONCLUSIONS

Our findings suggest that the PIN programme was cost-effective at a relatively low willingness-to-pay threshold when compared to SAU. This study addresses a significant knowledge gap in the field of early intervention by providing important real world evidence on the implementation costs and cost-effectiveness of a universal early years parenting programme. The challenges involved in assessing the cost-effectiveness of preventative interventions for very young children and their parents are also discussed.

TRIAL REGISTRATION

ISRCTN17488830 (Date of registration: 27/11/15). This trial was retrospectively registered.

Longitudinal Outcomes of Child Parent Psychotherapy: Response to Commentaries

In response to the commentaries provided by Chu et al. (2020), Harmon et al. (2020), and McMahon & Maxwell (2020) on our longitudinal follow-up of Child-Parent Psychotherapy (CPP) with mothers with depression and their children, we focus on two domains: accessibility and scalability of CPP and identifying empirically supported mechanisms of change in attachment intervention research. In considering the accessibility and scalability of CPP, we discuss issues related to attrition, length of intervention, and implementation with caregivers with depression. Our discussion of mechanisms of change in attachment interventions explores active comparison conditions, theorized mediators, intervention modalities, assessment methods, and longitudinal research designs. This conversation is intended to highlight important areas for future research in the field of attachment interventions, with the goal of informing clinical and systems-level policies and practices.

The Relationship Between Parental Affective Temperament Traits and Disruptive Behavior Disorders Symptoms in Children With ADHD

OBJECTIVE

This study investigated the relationship between parental affective temperaments and the oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms of children with ADHD.

METHOD

The sample consisted of 542 treatment-naive children with ADHD and their biological parents. Children were assessed via both parent- and teacher-rated behavioral disorder scales. Parental affective temperament and ADHD symptoms were measured by self-report inventories. The relationships between psychiatric variables were evaluated using structural equation modeling.

RESULTS

According to parent-rated behavioral disorder scales, paternal cyclothymic and maternal irritable temperaments were associated with ODD scores, and maternal depressive temperament was associated with CD scores. In terms of teacher-rated behavioral disorder scales, maternal anxious temperament was associated with ODD scores, and paternal cyclothymic and maternal depressive temperaments were associated with CD scores.

CONCLUSION

These results suggest that certain parental affective temperaments are related to an increase in symptoms of disruptive behavioral disorders in children with ADHD.

Multiple family group service delivery model for children with disruptive behavior disorders: Impact on caregiver stress and depressive symptoms

Disproportionately high rates of caregiver stress and depression are found among poverty-impacted communities, with high levels of caregiver stress and depression putting youth at heightened risk for the onset and perpetuation of disruptive behavior disorders. The purpose of this study was to examine the effects of a behavioral parent training program called the 4Rs and 2Ss for Strengthening Families Program (4R2S) on caregiver stress and depressive symptoms among 320 youth aged seven to 11 and their families assigned to either the 4R2S or services as usual (SAU) condition. Among caregivers with clinically significant scores at baseline, 4R2S participants manifested significantly reduced scores on the stress and depressive symptom scores to SAU participants at 6-month follow-up. Findings suggest that 4R2S may reduce caregiver stress and depressive symptoms among those caregivers initially manifesting clinically significant levels of stress or depressive symptoms.

Family hostility and depressive symptoms in middle-aged couples: Moderating effect of marital integration

This study examined (a) the associations between family hostility (husband-wife marital hostility and child hostility) and middle-aged husbands' and wives' depressive symptoms over an 11-year time period and (b) the moderating influence of couples' marital integration on these associations as measured by their joint activity. Higher order family-level latent constructs captured chronic husband-wife (marital) hostility using husbands' and wives' reports of chronic hostile interactions from 1990 to 1992, while a higher order latent construct of chronic child hostility toward parents was measured using parental reports of children's hostile behaviors from 1990 to 1992. Structural equation modeling with data from 370 families depicted the longitudinal impact of family hostility on depressive symptoms of both husbands and wives in 2001 after accounting for earlier levels of depressive symptoms in 1991. Separate models were fit for couples with high and low levels of marital integration. For couples who experienced low levels of marital integration, chronic marital hostility and child hostility were related to depressive symptoms in husbands and wives. However, for those with high marital integration, these influences were largely diminished. (PsycINFO Database Record