Functional family therapy for adolescent disruptive behavior in Norway: Results from a randomized controlled trial.

Disruptive behavior during adolescence is linked to severe problems for the youths later in life and poses challenges to the families, schools, and treatment systems these youths meet. This randomized controlled trial was conducted to examine the short- and long-term effectiveness of functional family therapy (FFT) for adolescents aged 11-17 referred for disruptive behavior to Child Welfare Services in Norway. One hundred sixty-one youths (Mage = 14.7, 45.9% female) were randomly assigned to FFT (n = 88) or treatment as usual (TAU, n = 73). Primary outcomes were parent- and teacher-reported youth aggressive behavior, rule-breaking behavior, internalizing problems, and social skills; youth self-reported delinquency (SRD) and negative peer involvement; and teacher-reported academic performance and adaptive functioning. Outcomes were collected before treatment (pretest), 6 months after pretest (posttest), and 18 months after pretest (follow-up). The results showed no intervention effect for FFT compared to TAU between pretest and posttest (p > .05). Significant improvements between pretest and posttest were found for youth receiving both FFT and TAU on parent-reported aggressive and rule-breaking behavior, internalizing problems, and social skills (ranging from d = 0.56 to -0.45) and youth SRD (d = 0.29). Between posttest and follow-up, however, a significant intervention effect in favor of TAU was found for parent-reported youth internalizing (d = 0.27). Significant improvements between posttest and follow-up were also found for youth receiving both FFT and TAU on parent- and teacher-reported aggressive behavior. Findings did not support the hypothesized superiority of FFT over TAU. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Subjective Well-Being Among Unaccompanied Refugee Youth: Longitudinal Associations With Discrimination and Ethnic Identity Crisis.

Unaccompanied refugee youth (URY), who as children fled their countries to seek asylum in a foreign country without the company of an adult legal caretaker are described as being in a vulnerable situation. Many of them struggle with mental reactions to traumatic events experienced pre-migration, and to the daily hassles they face after being granted asylum and residence. Despite continuous high levels of mental health problems URY demonstrate remarkable agency and social mobility in the years after being granted asylum in their destination countries. A sense of subjective well-being (SWB) may enable resilient outcomes in people exposed to past or ongoing adversities. To fill the gap in the research literature about positive psychological outcomes among URY, the overall aim of this study was to explore the longitudinal associations between SWB and two taxing acculturation hassles: perceived discrimination and ethnic identity crisis. Three annual waves of self-report questionnaire data were collected from a population-based sample of URY; n = 581, M age = 20.01(SD = 2.40), M length of stay = 4.63 (SD = 4.40), 82 % male, mainly from Afghanistan, Somalia, Iraq, and Sri Lanka. The longitudinal associations between SWB, perceived discrimination and ethnic identity crisis across time were analyzed using auto-regressive cross-lagged modeling. The results revealed that perceived discrimination, but not ethnic identity crisis, negatively predicted subsequent levels of SWB. More importantly, high levels of SWB at one timepoint predicted decreases in both discrimination and ethnic identity crisis at subsequent timepoints. Further, increases in SWB from one timepoint to the next was associated with significant co-occurring decreases in both discrimination and ethnic identity crisis, and vice versa. Despite the negative effect of perceived discrimination on SWB, promoting SWB in URY can protect them from future hazards of acculturation hassles in complex ways. We underscore the need for more research on SWB among URY and other refugee youth. We further discuss the potential of SWB to foster resilient outcomes in young refugees and suggest that interventions to strengthen SWB among them should consider their transnational and multicultural realities and experiences.

Identification of Multisystemic Therapy (MST) Subgroups with Distinct Trajectories on Ultimate Outcomes in Norway.

The effect of Multisystemic Therapy (MST) treatment for serious behavior problems among adolescents has been established through multiple studies. However, variations across individuals should also be examined to better understand how MST works or for whom. In this study, we explored and identified subgroups of youth with serious problems in Norway regarding their responses to MST in terms of ultimate MST outcomes (e.g., living at home, abstaining from violence) over time. We further explored whether immigrant background, in addition to gender and age of the youth at intake, predicted belonging to the subgroups. Data came from 1674 adolescents (MeanAge = 14.55, SDAge = 1.58; 60.7% boys) and their families referred to MST treatment by the municipal Child Welfare Services for serious and persistent antisocial behavior. The outcomes were assessed at five time-points from intake to 18-months after discharge for youth and families who completed the treatment. Latent class growth analyses revealed heterogeneous trajectories regarding youths' responses to MST. Results indicated a high and sustained degree of improvement across the ultimate outcomes for the vast majority of the youths. However, there was still variation in the groups, with improvement and deterioration trajectories for various outcomes. Most of these trajectories were predicted by gender and youth's age at intake, but not by immigrant status. Not every youth-at-risk responds similarly to MST, and more studies examining heterogeneity will help us to identify factors to be targeted to better tailor the MST interventions for youth with serious problems.

Six- and Twelve-Month Follow-up Results of a Cluster Randomized Controlled Trial of a CBT-Based Group Course.

In the current study, we examined the durability of intervention gains over a 6- and 12-month follow-up period after the implementation of a CBT-based group intervention "Adolescent Coping with Depression Course" (ACDC) for adolescents with subclinical or mild-to-moderate depression. Data were collected from 228 youth, 133 of whom were allocated to the 14-week ACDC intervention and 95 to the usual care (UC) control condition. Analyses for the main outcome variable of depressive symptoms were performed using a random effects repeated measures piecewise growth model to estimate trajectory shape over time on an intention-to-treat basis. Results revealed that the reduction in depressive symptoms achieved during the intervention phase continued across the follow-up period for both ACDC and UC (i.e., depressive symptoms showed a significantly decreasing trend in both groups in intervention and follow-up phases); however, no differential effects between conditions were found during the follow-up phase. The direct and indirect effects of the intervention on the other outcome variables' follow-up results were also presented. ISRCTN registry ISRCTN19700389. Registered 6 October 2015. https://doi.org/10.1186/ISRCTN19700389 . Full Protocol: https://doi.org/10.1186/s12888-016-0954-y.

Culture competence and mental health across different immigrant and refugee groups.

BACKGROUND: Over the last decades, due to high rates of immigration, many high-income countries have witnessed demographic shifts towards more cultural diversity in the population. Socio-economic deprivation and traumatic experiences pre-migration contribute to a high risk for mental health problems among immigrant background youth. Moreover, when adapting to the multi-cultural contexts of the resettlement countries they face several acculturation demands, which may also affect their mental health in adaptive or hazardous ways. One of these acculturation tasks involves developing the cultural competence necessary to thrive and participate socially within the heritage and the majority cultural domains. From a public mental health perspective, it is important to have thorough knowledge about acculturation-related risk and protective factors. However, this responsibility has been challenged by a lack of acculturation measures that are theoretically linked to mental health, and target the cultural competencies of immigrant background youth. Therefore, the current study aimed at examining if a construct of peer-related culture competence, operationalized in the Youth Culture Competence Scale (YCCS), captured the same competence-phenomenon across different language, age, and immigrant groups in two immigrant-receiving countries. The scale includes two dimensions: one of heritage, and one of majority peer-related culture competence. METHODS: Self-report questionnaire data were collected from 895 unaccompanied refugees and 591 immigrant background high school students in Norway, and from 321 immigrant university students in the United States. To examine if the measure assessed the same phenomenon of peer-related culture competence across these three multi-ethnic samples with an age range from 13 to 28, we examined its measurement equivalence. Additionally, we examined if the association between peer-related culture competence and depressive symptoms was similar in these groups. RESULTS: Confirmatory factor analyses supported the proposed two factor structure of the YCCS across the three samples. The structural equation model assessing the effects of heritage and majority culture competence on depressive symptoms confirmed that each culture competence dimension had a unique association with depressive symptoms across the samples. CONCLUSIONS: We conclude that the YCCS is a robust acculturation measure that may be included in public health studies of mental health among multi-ethnic refugee and immigrant samples of varied ages.

The relation between behavioral problems and social competence: A correlational Meta-analysis.

BACKGROUND: Previous studies have shown that children who display behavioral problems also tend to display low social competence. The relation does however vary according to type of behavior being measured, as well as demographic characteristics of the respondent. The present meta-analysis examined the correlation between different types of behavioral problems and social competence among children aged 3-13, and investigated possible moderators in this relation. METHODS: A systematic literature search was conducted for English language studies from January 2008 to January 2018 that reported correlations between three types of behavioral problems (i.e., externalizing behaviors, conduct problems, or aggression) and two types of social competence (i.e., social competence or social skills). The studies included reports from parents and teachers, or both as a dyad. The review included data from 54 independent studies and a total of 46,828 participants. Effect sizes were estimated using a random effects approach and moderator analyses between subsets of categorical variables were tested by the significant Q test. RESULTS: Results showed an overall correlation between behavioral problems and social competence of medium effect size (r = -.42, p < .01). Moderation analyses indicated no significant differences for different types of behavioral problems or social competence. However, a significant difference was found with regard to type of respondent; the correlation was significantly higher when both measures were reported by the same respondent (teacher or parent) compared to when measures were reported by parent-teacher as a dyad. CONCLUSIONS: Findings summarized and quantified a robust negative correlation between behavioral problems and social competence. The results indicate that intervention programs targeting problem behaviors in children would benefit from reducing behavioral problems and in concert, increase social competence to help children with emerging or present problem behaviors.

Cognitive behavioral treatment for depressed adolescents: results from a cluster randomized controlled trial of a group course.

BACKGROUND: The group-based CBT intervention, the Adolescent Coping with Depression Course (ACDC), has previously been evaluated within a quasi-experimental design, showing reduction in depressive symptoms compared to a benchmark of similar studies. The aim of our study was to investigate the effectiveness of ACDC within a randomized controlled (RCT) design. METHOD: Thirty-five course/control leaders randomly assigned to provide ACDC or usual care (UC) recruited 133 adolescents allocated to ACDC and 95 to UC. ACDC participants received eight weekly sessions and two follow-up sessions about 3 and 6 weeks after the last session. UC participants received usual care as implemented at the different sites. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale for adolescents (CES-D), perfectionism with the revised version of the Dysfunctional Attitude Scale (DAS), and rumination with the revised version of the Ruminative Responses Scale (RRS). Attrition was considered missing at random (MAR) and handled with a full information maximum likelihood (FIML) procedure. RESULTS: Intention to treat analysis (ITT), including baseline scores and predictors of missing data as control or auxiliary variables, showed a small to medium reduction in depressive symptoms for the ACDC group compared to UC (d = -.31). Changes in perfectionism and rumination in favor of the intervention were also significant. Sensitivity analyses confirmed the findings from the ITT analyses. CONCLUSIONS: The current study supports the effectiveness of this group-based CBT intervention. The intervention can hopefully result in clinically significant reductions in symptoms associated with depression among adolescents. TRIAL REGISTRATION: ISRCTN registry ISRCTN19700389 . Registered 6 October 2015.

A meta-analysis of group Cognitive Behavioral Therapy (CBT) interventions for adolescents with depression.

The aim of this meta-analysis was to systematically examine the short- and long-term effects of group Cognitive Behavioral Therapy (CBT) for adolescent depression and to examine the role of various moderators of the reported effect sizes. A comprehensive literature search of relevant randomized-controlled trials identified 23 studies containing 49 post-intervention and 56 follow-up comparisons. Standardized mean differences (SMD) were calculated both for post-intervention and follow-up. A three-level random effects approach was used to model the dependent effect sizes. Group CBT was more efficacious than control conditions both at post-intervention (SMD = -0.28, 95% CI [-0.36, -0.19]) and at follow-up (SMD = -0.21, 95% CI [-0.30, -0.11]). Having an inactive control group was associated with a larger post-intervention effect size, while having a longer follow-up duration was associated with a smaller follow-up effect size. Even though the effect sizes are low, research suggests that group CBT is a significant treatment for adolescent depression.

The longitudinal association between internalizing symptoms and academic achievement among immigrant and non-immigrant children in Norway.

The aim of this study was to explore the longitudinal relation between internalizing symptoms and academic achievement, as two processes of children and youth development, among children in Norway, and whether having an immigrant background moderated this association. Data collected from 4,458 students in Norway in four waves over three years were analyzed with multi-group latent growth curve modeling (LGM). Results showed that internalizing symptoms level remained unchanged over time both for immigrant and non-immigrant children, while levels of academic achievement increased only for children of immigrants with both parents born outside of Norway. Further analyses supported a reciprocal relation between internalizing symptoms and academic achievement and revealed that the initial level of academic achievement predicted the rate of change in internalizing symptoms over time, but not vice versa. Moreover, immigrant background did not moderate the associations in the model, however, children of immigrants with both parents born abroad initially had lower levels of academic achievement, but showed an increase in academic achievement, compared to their non-immigrant peers as well as to peers with one native-born parent after controlling for gender and their grade at the first observation. The implications for policy and practice were discussed.

The Longitudinal Relation between Daily Hassles and Depressive Symptoms among Unaccompanied Refugees in Norway.

The aim of the present longitudinal study is to understand the longitudinal relation between depressive symptoms and daily hassles (i.e., general and acculturation hassles) in a high-risk population of unaccompanied refugees. We investigated the validity of three stress-mental health models: the stress exposure model, the stress generation model, and the reciprocal model. Data were collected from 918 unaccompanied refugees in Norway in three waves. Of the initial sample, the majority (82.1%) were male (M age = 19.01 years, SD = 2.54 years). The data were analyzed with auto-regressive cross-lagged modeling and latent growth curve modeling. The results supported the stress exposure model for the relation between depressive symptoms and acculturation hassles, indicating that acculturation hassles predicted the subsequent levels of depressive symptoms rather than vice versa. On the other hand, the reciprocal model was supported for the relation between depressive symptoms and general hassles indicating a bidirectional, mutual relation. Unconditional latent growth models further showed that depression level remained unchanged over time, while levels of acculturation and general hassles decreased. The implications for clinical practice and immigration policy are discussed.

Study protocol for a randomized controlled trial of a group cognitive-behavioral course for depressed adolescents.

BACKGROUND: School dropout is considered a serious problem in high schools in Norway. Despite studies which emphasize the importance of mental health as a unique risk factor for dropout, interventions have only taken this into account to a limited extent. Depression is one of the most prevalent mental health issues. Here we report the study protocol of a cluster randomized controlled trial of a group-CBT intervention, "Adolescent Coping with Depression Course" (ACDC) for depressed adolescents in upper secondary school. METHOD: The aim of this study is to investigate the extent to which ACDC can reduce depressive symptoms, prevent dropout and improve academic and social functioning among adolescents in upper secondary school. This study investigates the effectiveness of ACDC through a cluster randomized trial, in which course leaders are randomized to experimental or control conditions where the control groups receive usual care. DISCUSSION: The intervention is expected to reduce depressive symptoms among adolescents. The study will further investigate whether the intervention can prevent dropout and improve academic and social functioning among adolescents in upper secondary school. TRIAL REGISTRATION: ISRCTN registry ISRCTN19700389 . Registered 6 October 2015.

Depression among unaccompanied minor refugees: the relative contribution of general and acculturation-specific daily hassles.

OBJECTIVES: This study is designed to provide an empirical conceptualization of daily hassles among unaccompanied refugees, and whether they might affect mental health of young refugees after resettlement. First, we examined the underlying structure of daily hassles conceptualized as measuring general and acculturation-specific hassles. Second, we examined whether these two distinct categories of daily hassles significantly contribute to depression above and beyond the impact of premigration trauma. DESIGN: The study was based on self-report questionnaire data collected from 895 unaccompanied refugees who had been granted residence in Norway. RESULTS: Using structural equation modeling, the results confirmed the grouping of hassles in two general categories, which explained 43% of the variance in depression. CONCLUSION: The findings underscore the importance of current life conditions for unaccompanied refugees' mental health.