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1.
AIDS Educ Prev ; 32(1): 67-81, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32202920

RESUMO

We tested the acceptability, feasibility, and preliminary efficacy of Our Family Our Future, a resilience-oriented intervention engaging families in prevention of adolescent HIV and depression. South African adolescents, 13-15 years of age, with mild depressive symptoms, were randomized to intervention or wait-list using parallel assignment in a single-blind trial. HIV risk behavior and depression were evaluated at baseline, 1, and 3 months. We examined intervention satisfaction, fidelity, trial retention, and preliminary efficacy. One hundred-ninety-six adolescent-parent dyads completed eligibility screening and baseline, and n = 73 dyads were randomized. All families ranked intervention quality as good or excellent. Over 90% were satisfied with content. Facilitators were adherent to intervention protocol. All families were retained in post-intervention assessments. Intervention recipients reported diminished depressive symptoms, inconsistent condom use, and sexual activity, as well as increased HIV testing. Our Family Our Future is highly acceptable and feasible and should be tested in a future efficacy trial.


Assuntos
Depressão/prevenção & controle , Infecções por HIV/prevenção & controle , Programas de Rastreamento/métodos , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Resiliência Psicológica , Adolescente , Comportamento do Adolescente , Depressão/psicologia , Estudos de Viabilidade , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Projetos Piloto , Sexo Seguro , Comportamento Sexual , Método Simples-Cego , África do Sul
2.
J Adolesc Health ; 66(3): 336-344, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31699604

RESUMO

PURPOSE: There are disparities in mental health of refugee youth compared with the general U.S. POPULATION: We conducted a pilot feasibility and acceptability trial of the home-visiting Family Strengthening Intervention for refugees (FSI-R) using a community-based participatory research approach. The FSI-R aims to promote youth mental health and family relationships. We hypothesized that FSI-R families would have better psychosocial outcomes and family functioning postintervention compared with care-as-usual (CAU) families. We hypothesized that FSI-R would be feasible to implement and accepted by communities. METHODS: A total of 40 Somali Bantu (n = 103 children, 58.40% female; n = 43 caregivers, 79.00% female) and 40 Bhutanese (n = 49 children, 55.30% female; n = 62 caregivers, 54.00% female) families were randomized to receive FSI-R or CAU. Refugee research assistants conducted psychosocial assessments pre- and post-intervention, and home visitors delivered the preventive intervention. Multilevel modeling assessed the effects of FSI-R. Feasibility was measured from retention, and acceptability was measured from satisfaction surveys. RESULTS: The retention rate of 82.50% indicates high feasibility, and high reports of satisfaction (81.50%) indicate community acceptance. Across communities, FSI-R children reported reduced traumatic stress reactions, and caregivers reported fewer child depression symptoms compared with CAU families (ß = -.42; p = .03; ß = -.34; p = .001). Bhutanese FSI-R children reported reduced family arguing (ß = -1.32; p = .04) and showed fewer depression symptoms and conduct problems by parent report (ß = -9.20; p = .04; ß = -.92; p = .01) compared with CAU. There were no significant differences by group on other measures. CONCLUSIONS: A family-based home-visiting preventive intervention can be feasible and acceptable and has promise for promoting mental health and family functioning among refugees.

3.
AIDS ; 33 Suppl 1: S29-S34, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31397720

RESUMO

OBJECTIVE: In South Africa, adolescents account for the largest share of new HIV infections. Given the scale of the epidemic, millions of adolescents cope with familial HIV illness and AIDS orphanhood. Developing an understanding of adolescent resilience is vital for informing HIV and mental health prevention efforts. DESIGN: A cross-sectional survey of N = 195 South African adolescents, 13-15 years, and living in communities with high prevalence of HIV and poor mental health, was used to gather data on resilience, psychosocial factors, and mental health. METHODS: Participants were recruited through systematic community-based household sampling. Analysis was conducted on a subsample of adolescents identified as potentially vulnerable (n = 82); potential vulnerability was defined as adolescents living with HIV, residing with parents or caregivers living with HIV, or experiencing orphanhood. Differences on behavioral and psychosocial outcomes in those with higher and lower resilience were evaluated using SPSS software. RESULTS: Among adolescents identified as potentially vulnerable (n = 82), those with higher resilience scores reported significantly lower behavioral problems using the total difficulties Strength and Difficulties Questionnaire score (P < 0.01) with a mean score difference of 2.76 (standard error = 1.02). Multivariate linear regressions were conducted with total difficulties Strength and Difficulties Questionnaire score as the dependent variable. Higher resilience among vulnerable youth was significantly associated with fewer behavioral problems (ß = -0.229, P < 0.05), even after adjusting for variables that could also contribute to poor behavioral outcomes. CONCLUSION: Resilience is related to the behavioral health of vulnerable HIV-affected adolescents. Resilience-focused interventions hold promise for improving the behavioral health of adolescents living in high HIV prevalence settings.

4.
Psychol Assess ; 31(9): 1154-1167, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31259571

RESUMO

Construct equivalence of measures across studies is necessary for synthesizing results when combining data in meta-analysis or integrative data analysis. We discuss several assumptions required for construct equivalence, and review methods using individual-level data and item response theory (IRT) analysis for detecting or adjusting for violations of these assumptions. We apply IRT to data from 7 measures of depressive symptoms for 4,283 youth from 16 randomized prevention trials. Findings indicate that these data violate assumptions of conditional independence. Bifactor IRT models find that depression measures contain substantial reporter variance, and indicate that a single common factor model would be substantially biased. Separate analyses of ratings by youth find stronger evidence for construct equivalence, but factor invariance across sex and age does not hold. We conclude that data synthesis studies employing measures of youth depression should analyze results separately by reporter, explore more complex approaches to integrate these different perspectives, and explore methods that adjust for sex and age differences in item functioning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Depressão/diagnóstico , Escalas de Graduação Psiquiátrica , Projetos de Pesquisa , Adolescente , Interpretação Estatística de Dados , Humanos , Modelos Teóricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes
5.
Harv Rev Psychiatry ; 27(4): 241-253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31219883

RESUMO

Recent studies suggest that parental depressive symptoms may affect a child's ability to benefit from interventions for anxiety and depression. This article reviews the current literature, suggesting that, when parents experience current depressive symptoms, children are less likely to benefit from psychosocial interventions for anxiety and depression. Opportunities for future research are discussed, including moderators and mechanisms of the association between parental depressive symptoms and child intervention outcomes.


Assuntos
Ansiedade/epidemiologia , Filho de Pais Incapacitados/psicologia , Depressão/epidemiologia , Pais/psicologia , Psicologia da Criança/estatística & dados numéricos , Adulto , Ansiedade/prevenção & controle , Criança , Depressão/prevenção & controle , Relações Familiares , Humanos , Psicoterapia
6.
Psychiatr Serv ; 70(4): 279-286, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30929618

RESUMO

OBJECTIVE: Youth depression can be prevented, yet few programs are offered. Decision makers lack cost information. This study evaluated the cost-effectiveness of a cognitive-behavioral prevention program (CBP) versus usual care. METHODS: A cost-effectiveness analysis was conducted with data from a randomized controlled trial of 316 youths, ages 13-17, randomly assigned to CBP or usual care. Youths were at risk of depression because of a prior depressive disorder or subthreshold depressive symptoms, or both, and had parents with a prior or current depressive disorder. Outcomes included depression-free days (DFDs), quality-adjusted life years (QALYs), and costs. RESULTS: Nine months after baseline assessment, youths in CBP experienced 12 more DFDs (p=.020) and .018 more QALYs (p=.007), compared with youths in usual care, with an incremental cost-effectiveness ratio (ICER) of $24,558 per QALY. For youths whose parents were not depressed at baseline, CBP youths had 26 more DFDs (p=.001), compared with those in usual care (ICER=$10,498 per QALY). At 33 months postbaseline, youths in CBP had 40 more DFDs (p=.05) (ICER=$12,787 per QALY). At 33 months, CBP youths whose parents were not depressed at baseline had 91 more DFDs (p=.001) (ICER=$13,620 per QALY). For youths with a currently depressed parent at baseline, CBP was not significantly more effective than usual care at either 9 or 33 months, and costs were higher. CONCLUSIONS: CBP produced significantly better outcomes than usual care and was particularly cost-effective for youths whose parents were not depressed at baseline. Depression prevention programs could improve youths' health at a reasonable cost; services to treat depressed parents may also be warranted.


Assuntos
Filho de Pais Incapacitados/psicologia , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/prevenção & controle , Pais/psicologia , Adolescente , Terapia Cognitivo-Comportamental/economia , Análise Custo-Benefício , Transtorno Depressivo/economia , Feminino , Seguimentos , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Análise de Regressão , Risco , Estados Unidos
7.
J Am Acad Child Adolesc Psychiatry ; 58(8): 759-767, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30794948

RESUMO

The study of parental depression in families with children who are depressed and the development of appropriate family prevention strategies to assist families with parents who are depressed have expanded and improved significantly over the past 30 years. This article highlights an evidence-informed approach for clinicians dealing with parents who are depressed in different settings, addressing when a parent presents with depression, and when parental depression is encountered in treating a child with behavior health concerns. Some reflections on key contextual, policy, and systems issues are offered, because these so often determine what is and is not possible in a clinical encounter.

8.
Transcult Psychiatry ; 56(1): 187-212, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30289374

RESUMO

Depression contributes significantly to the global burden of disease in low- and middle-income countries. In South Africa, individuals may be at elevated risk for depression due to HIV and AIDS, violence, and poverty. For adolescents, resilience-focused prevention strategies have the potential to reduce onset of depression. Involving families in promoting adolescent mental health is developmentally appropriate, but few existing interventions take a family approach to prevention of adolescent depression. We conducted a qualitative investigation from 2013-2015 to inform the development of a family intervention to prevent adolescent depression in South Africa among families infected or at risk for HIV. Using focus groups with adolescents and parents (eight groups, n = 57), and interviews (n = 25) with clinicians, researchers, and others providing mental health and related services, we identified context-specific factors related to risk for family depression, and explored family interactions around mental health more broadly as well as depression specifically. Findings indicate that HIV and poverty are important risk factors for depression. Future interventions must address linguistic complexities in describing and discussing depression, and engage with the social interpretations and meanings placed upon depression in the South African context, including bewitchment and deviations from prescribed social roles. Participants identified family meetings as a context-appropriate prevention strategy. Family meetings offer opportunities to practice family problem solving, involve other family members in communal parenting during periods of parental depression, and serve as forums for building Xhosa-specific interpretations of resilience. This study will guide the development of Our Family Our Future, a resilience-focused family intervention to prevent adolescent depression (ClinicalTrials.gov #NCT02432352).


Assuntos
Transtorno Depressivo/prevenção & controle , Saúde da Família , Infecções por HIV/prevenção & controle , Poder Familiar/psicologia , Resiliência Psicológica , Adolescente , Adulto , Idoso , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pobreza , Fatores de Risco , Apoio Social , África do Sul , Adulto Jovem
9.
JAMA Netw Open ; 1(7)2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30533601

RESUMO

Importance: Although 13-20% of American adolescents experience a depressive episode annually, no scalable primary care model for adolescent depression prevention is currently available. Objective: To study whether CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training) reduces the hazard for depression in at-risk adolescents identified in primary care, as compared to a general health education attention control (HE). Design: The Promoting AdolescenT Health (PATH) study compares CATCH-IT and HE in a phase 3 single-blind multicenter randomized attention control trial. Participants were enrolled from 2012 to 2016 and assessed at 2, 6, 12, 18, and 24 months post-randomization. Setting: Primary care. Participants: Eligible adolescents were 13-18 years with subsyndromal depression and/or history of depression and no current depression diagnosis or treatment. Of 2,250 adolescents screened for eligibility, 446 participants completed the baseline interview and 369 were randomized into CATCH-IT (n=193) and HE (n=176). Interventions: CATCH-IT is a 20-module (15 adolescent modules, 5 parent modules) online psychoeducation course that includes a parent program, supported by three motivational interviews. Main Outcomes and Measures: Time-to-event for depressive episode; depressive symptoms at 6 months. Results: Mean age was 15.4 years, and 68% were female; 28% had both a past episode and subsyndromal depression; 12% had a past episode only, 59% had subsyndromal depression only, and 1% had borderline subsyndromal depression. The outcome of time-to-event favored CATCH-IT but was not significant with intention-to-treat analyses (N=369; unadjusted HR=0.59; 95% CI 0.27, 1.29; p=0.18; adjusted HR=0.53; 95% CI 0.23, 1.23, p=0.14). Adolescents with higher baseline CES-D10 scores showed a significantly stronger effect of CATCH-IT on time-to-event relative to those with lower baseline scores (p=0.04). For example, for a CES-D10 score of 15 (significant sub-syndromal depression), HR=0.20 (95% CI 0.05, 0.77), compared to CES-D10 of 5 (no sub-syndromal depression), HR=1.44 (95% CI, 0.41, 5.03). In both CATCH-IT and HE groups, depression symptoms declined and functional scores increased. Conclusions and Relevance: CATCH-IT may be better than HE for preventing depressive episodes for at-risk adolescents with sub-syndromal depression. CATCH-IT may be a scalable approach to prevent depressive episodes in adolescents in primary care.

10.
Psychiatr Serv ; 69(11): 1175-1180, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30256184

RESUMO

OBJECTIVE: The authors sought to determine whether a multicomponent, community-based program for preventing maternal depression also promotes engagement with mental health services for individuals with persistent symptoms. METHODS: Mothers of children enrolled in Head Start were randomly assigned between February 2011 and May 2016 to Problem-Solving Education (PSE) (N=111) or usual services (N=119) and assessed every two months for 12 months. RESULTS: Among 230 participants, 66% were Hispanic; 223 participants were included in the analysis. For all PSE participants, engagement with specialty mental health services increased from approximately 10% to 21% between two and 12 months. The PSE group was more likely than the control group to be engaged in specialty services at 12 months (adjusted odds ratio [AOR]=2.36, 95% confidence interval [CI]=1.07-5.20), and the rate of engagement with specialty services over time (treatment × time interaction) favored PSE (p=.016). Among PSE participants with persistent depressive symptoms over the follow-up period, engagement with specialty services increased from 12% (two months) to approximately 46% (12 months), whereas among control group participants, engagement fluctuated between 24% and 33%, without a clear trajectory pattern. At 12 months, PSE participants with persistent symptoms were more likely to engage with specialty care compared with their counterparts in the control group (AOR=6.95, CI=1.50-32.19). The treatment × time interaction was significant for the persistently symptomatic subgroup (p=.029) but not for the episodically symptomatic or the asymptomatic subgroups. CONCLUSIONS: Embedding mental health programs in Head Start is a promising strategy to engage parents with depressive symptoms in care, especially those with persistent symptoms.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Transtorno Depressivo Maior/terapia , Intervenção Educacional Precoce/organização & administração , Mães , Avaliação de Processos e Resultados em Cuidados de Saúde , Adulto , Boston , Pré-Escolar , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Transtorno Depressivo Maior/prevenção & controle , Intervenção Educacional Precoce/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Lactente , Adulto Jovem
11.
Child Abuse Negl ; 79: 401-412, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29529594

RESUMO

Although child welfare caseworkers are responsible for facilitating mental health services access for maltreated children, little is known about caseworkers' decisions to refer children to services. We aimed to identify factors associated with caseworker referral of children to mental health services after a maltreatment investigation. We analyzed data from 1956 children 2-17 years old from the Second National Survey of Child and Adolescent Well-being. We examined associations of children's predisposing, enabling, and need-related factors and caseworkers' work environment characteristics with referral to mental health services. Caseworkers referred 21.0% of children to mental health services. In multivariable analyses controlling for potential covariates, factors associated with increased odds of caseworker referral included: older child age; child sexual abuse (versus neglect); child out-of-home placement; caregiver mental health problems; prior maltreatment reports; clinically significant child behavioral problems; and child welfare agency collaborative ties with mental health providers (all p < .05). Factors associated with decreased odds of caseworker referral included child Black race (versus White race) and lack of insurance (versus Private insurance) (all p < .05). In summary, children's need for mental health services was positively associated with caseworker referral to services but certain predisposing and enabling factors and caseworker work environment characteristics also correlated with services referral. Interventions to reduce disparities in services referral by race and insurance type are critically needed. These may include child welfare agency implementation of policies for mental health screening, assessment, and services referral based on clinical need and establishment of child welfare-mental health agency collaborative ties.


Assuntos
Maus-Tratos Infantis/psicologia , Serviços de Proteção Infantil/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Abuso Sexual na Infância/psicologia , Abuso Sexual na Infância/estatística & dados numéricos , Bem-Estar da Criança/estatística & dados numéricos , Estudos Transversais , Tomada de Decisões , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Encaminhamento e Consulta/estatística & dados numéricos
12.
JAMA Netw Open ; 1(2): e180334, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30646083

RESUMO

Importance: Although problem solving has been an important component of successful depression prevention and treatment interventions, evidence to support problem solving's mechanism of action is sparse. Objective: To understand the mechanism of an efficacious depression prevention intervention, problem-solving education (PSE). Design, Setting, and Participants: A multivariate path analysis was embedded within a randomized efficacy trial (February 15, 2011, to May 9, 2016). Participants were mothers with depressed mood, anhedonia, or depression history (but not in current major depressive episode) at 1 of 6 Head Start agencies. Participants were followed up for 12 months with serial assessments of potential intervention mediators and depressive symptoms. Interventions: Problem-solving education (n = 111) and usual Head Start services (n = 119). Main Outcomes and Measures: Primary outcomes were depressive symptom elevations, which were measured bimonthly. Eight plausible intervention mediators were assessed: problem-solving ability; mastery; self-esteem; perceived stress; behavioral activation; and avoidant, problem-focused, and social coping. Results: Among 230 participants, 152 (66.1%) were Hispanic; mean (SD) age was 31.4 (7.3) years. Based on associations with either PSE participation or depressive symptom outcomes, problem-solving ability, perceived stress, behavioral activation, and problem-focused coping were included in a parsimonious, multivariate path model. In this model, only perceived stress was associated with both PSE participation and depressive symptoms. Participants in the PSE group had adjusted standardized perceived stress change scores that were 11% lower than controls (95% CI, -0.19 to -0.03), and improvement in perceived stress generated an adjusted rate ratio (aRR) of 0.42 (95% CI, 0.33-0.53) for depressive symptom elevations. Participants in the intervention group also had standardized behavioral activation change scores 15% greater than controls (95% CI, 0.01-0.30) and problem-focused coping change scores 17% greater than controls (95% CI, 0.03-0.31); however, changes in these constructs were not associated with a differential rate of depressive symptom elevations. The direct effect of PSE on depressive symptom elevations (aRR, 0.72; 95% CI, 0.52-0.97) was greater than the mediated effect explained by improvement in perceived stress (aRR, 0.91; 95% CI, 0.85-0.98). Conclusions and Relevance: Problem-solving education is efficacious in preventing depressive symptoms and appears to work by decreasing perceived stress; however, the mechanism for much of PSE's impact on depression remains unexplained. These results can be used to simplify the intervention model in preparation for effectiveness testing. Trial Registration: ClinicalTrials.gov Identifier: NCT01298804.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Depressão/prevenção & controle , Depressão/terapia , Hispano-Americanos/psicologia , Mães/psicologia , Resolução de Problemas , Estresse Psicológico/psicologia , Adulto , Feminino , Humanos , Análise de Intenção de Tratamento , Pessoa de Meia-Idade , Análise Multivariada , Pobreza , Escalas de Graduação Psiquiátrica , Autoimagem , Estresse Psicológico/terapia , Estados Unidos , Adulto Jovem
13.
Prev Sci ; 19(Suppl 1): 74-94, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28013420

RESUMO

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.


Assuntos
Depressão/prevenção & controle , Promoção da Saúde , Adolescente , Terapia Cognitivo-Comportamental , Análise de Dados , Depressão/fisiopatologia , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Poder Familiar , Pais/educação
14.
Obesity (Silver Spring) ; 25(10): 1802-1808, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28834373

RESUMO

OBJECTIVE: This study examined relationships between attention-deficit/hyperactivity disorder (ADHD), stimulant use, and BMI change in a nationally representative cohort of children as well as differences in diet and physical activity that may mediate associations between stimulant use and BMI change. METHODS: By using the Early Childhood Longitudinal Study-Kindergarten Cohort 1998-1999 (N = 8,250), we modeled BMI and z score change by ADHD and stimulant start time, examined the odds of unhealthy diet and physical activity predicted by ADHD and stimulant use, and performed mediation analysis assessing indirect effects of health behaviors. RESULTS: Early stimulant use predicted short-term BMI reductions, but any stimulant use predicted increased BMI growth between fifth grade (mean age = 11.2 years) and eighth grade (mean age = 14.3 years). Children with ADHD had higher odds of poor diet regardless of medication. Health behaviors were not associated with BMI change after controlling for medication use. CONCLUSIONS: Stimulant use predicted higher BMI trajectory between fifth and eighth grade but did not affect dietary or physical activity patterns. Future research should explore potential mechanisms by which early and long-term stimulant use may affect metabolism, while clinicians should initiate nutrition counseling with families of children with ADHD, regardless of medication prescription, at or shortly after diagnosis.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Exercício Físico/fisiologia , Índice de Massa Corporal , Criança , Estudos de Coortes , Dieta , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos
15.
JAMA Psychiatry ; 74(8): 781-789, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28614554

RESUMO

Importance: Low-income and minority mothers experience a disproportionate incidence of depression and lack access to treatment services. Development of prevention strategies in accessible community-based venues is a potentially important public health strategy. Objective: To determine the efficacy of a depression prevention strategy embedded in Head Start. Design, Setting, and Participants: This randomized clinical trial was performed from February 15, 2011, through May 9, 2016, at 6 Head Start agencies serving families at or below the federal poverty level. Participants included mothers with depressed mood, anhedonia, or depression history but who were not in a current major depressive episode. Participants were followed up for 12 months with masked outcome assessments. Final follow-up was completed on May 9, 2016. Interventions: Participants were randomized to a problem-solving education (PSE) intervention (n = 111) or usual Head Start services (n = 119). Main Outcomes and Measures: Primary outcomes were problem-solving skills and depressive symptoms. To capture the chronicity and intensity of symptoms, the Quick Inventory of Depressive Symptoms was administered bimonthly, and rates of clinically significant symptom elevations were compared across groups. Secondarily, the presence of a major depressive episode was assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Results: Among the 230 participants, 152 (66.1%) were Hispanic, with a mean (SD) age of 31.4 (7.3) years. An intention-to-treat analysis among 223 participants contributing follow-up data found no differences in problem-solving skills across groups. The mean (SD) number of depressive symptom elevations among the PSE participants was 0.84 (1.39) compared with 1.12 (1.47) among the usual service participants (adjusted incident rate ratio [aIRR], 0.60; 95% CI, 0.41-0.90). In analyses stratified according to baseline depressive symptoms, PSE exerted a preventive effect among those with lower-level baseline symptoms, with a mean (SD) of 0.39 (0.84) elevations among PSE participants compared with 0.88 (1.37) among usual service participants (aIRR, 0.39; 95% CI, 0.21-0.75). However, no difference was observed among those with higher-level baseline symptoms (mean [SD] elevations, 2.06 [1.92] for PSE and 2.00 [1.91] for usual service; aIRR, 1.10; 95% CI, 0.67-1.80). Analysis of symptom scores followed the same pattern, with an adjusted mean reduction of 1.33 (95% CI, 0.36-2.29) among participants with lower-level baseline symptoms. Conclusions and Relevance: The PSE intervention is efficacious in preventing depressive symptom episodes and performs optimally among those with initial low-level symptoms. Additional effectiveness studies in Head Start are necessary to develop meaningful public health programs. Trial Registration: clinicaltrials.gov Identifier: NCT01298804.


Assuntos
Depressão/prevenção & controle , Intervenção Educacional Precoce , Mães/psicologia , Resolução de Problemas , Adulto , Feminino , Humanos , Educação de Pacientes como Assunto , Resultado do Tratamento , Adulto Jovem
16.
J Child Psychol Psychiatry ; 58(8): 922-930, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28504307

RESUMO

BACKGROUND: Children affected by HIV are at risk for poor mental health. We conducted a pilot randomized controlled trial (RCT) of the Family Strengthening Intervention (FSI-HIV), a family home-visiting intervention to promote mental health and improve parent-child relationships in families with caregivers living with HIV, hypothesizing that child and family outcomes would be superior to usual care social work services. METHODS: Eighty two families (N = 170 children, 48.24% female; N = 123 caregivers, 68.29% female) with at least one HIV-positive caregiver (n = 103, 83.74%) and school-aged child (ages 7-17) (HIV+ n = 21, 12.35%) were randomized to receive FSI-HIV or treatment-as-usual (TAU). Local research assistants blind to treatment conducted assessments of child mental health, parenting practices, and family functioning at baseline, post-intervention, and 3-month follow-up. Multilevel modeling assessed effects of FSI-HIV on outcomes across three time points. TRIAL REGISTRATION: NCT01509573, 'Pilot Feasibility Trial of the Family Strengthening Intervention in Rwanda (FSI-HIV-R).' https://clinicaltrials.gov/ct2/show/;NCT01509573?term=Pilot+Feasibility+Trial+of+the+Family+Strengthening+Intervention+in+Rwanda+%28FSI-HIV-R%29&rank=1. RESULTS: At 3-month follow-up, children in FSI-HIV showed fewer symptoms of depression compared to TAU by both self-report (ß = -.246; p = .009) and parent report (ß = -.174; p = .035) but there were no significant differences by group on conduct problems, functional impairment, family connectedness, or parenting. CONCLUSIONS: Family-based prevention has promise for reducing depression symptoms in children affected by HIV. Future trials should examine the effects of FSI-HIV over time in trials powered to examine treatment mediators.


Assuntos
Filho de Pais Incapacitados/psicologia , Depressão/psicologia , Relações Familiares/psicologia , Terapia Familiar/métodos , Infecções por HIV/psicologia , Promoção da Saúde/métodos , Comportamento Problema/psicologia , Adolescente , Adulto , Criança , Depressão/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Relações Pais-Filho , Poder Familiar/psicologia , Projetos Piloto , Método Simples-Cego , Resultado do Tratamento
17.
Pediatrics ; 139(2)2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28069663

RESUMO

BACKGROUND AND OBJECTIVES: Exercise is linked with improved cognition and behavior in children in clinical and experimental settings. This translational study examined if an aerobic cybercycling intervention integrated into physical education (PE) resulted in improvements in behavioral self-regulation and classroom functioning among children with mental health disabilities attending a therapeutic day school. METHODS: Using a 14-week crossover design, students (N = 103) were randomly assigned by classroom (k = 14) to receive the 7-week aerobic cybercycling PE curriculum during fall 2014 or spring 2015. During the intervention, children used the bikes 2 times per week during 30- to 40-minute PE classes. During the control period, children participated in standard nonaerobic PE. Mixed effects logistic regression was used to assess relationships between intervention exposures and clinical thresholds of behavioral outcomes, accounting for both individual and classroom random effects. RESULTS: Children experienced 32% to 51% lower odds of poor self-regulation and learning-inhibiting disciplinary time out of class when participating in the intervention; this result is both clinically and statistically significant. Effects were appreciably more pronounced on days that children participated in the aerobic exercise, but carryover effects were also observed. CONCLUSIONS: Aerobic cybercycling PE shows promise for improving self-regulation and classroom functioning among children with complex behavioral health disorders. This school-based exercise intervention may significantly improve child behavioral health without increasing parental burden or health care costs, or disrupting academic schedules.


Assuntos
Transtornos do Comportamento Infantil/psicologia , Transtornos do Comportamento Infantil/terapia , Exercício Físico , Deficiências da Aprendizagem/psicologia , Deficiências da Aprendizagem/terapia , Educação Física e Treinamento , Interface Usuário-Computador , Adolescente , Criança , Estudos Cross-Over , Currículo , Hospital Dia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Autocontrole/psicologia , Pesquisa Médica Translacional
18.
Trauma Violence Abuse ; 17(4): 387-97, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27580664

RESUMO

Often the focus of the field of child maltreatment has concentrated on identifying and intervening on risk and protective factors at the individual and family levels; however, since the 1970s, the important roles that communities play in both exacerbating and preventing child maltreatment have received attention as well. This article outlines the development of this area of scientific inquiry, describes the theoretical frameworks utilized by existing programs, and describes several community-level programs aimed at preventing child maltreatment that show promise as scalable strategies to enhance individual and family strengths and reduce caregiver stress. Challenges inherent in community-level programming in increasingly diverse environments and in building/maintaining political will for sustainability of evidence-based efforts are discussed as well. A multilevel, holistic approach that takes into account developmental changes and needs of individuals as well as their environments is likely to bring about more sustainable change in protecting children from abuse and neglect than efforts focused solely on individuals.


Assuntos
Maus-Tratos Infantis/prevenção & controle , Serviços de Saúde Comunitária/métodos , Avaliação de Programas e Projetos de Saúde , Criança , Pré-Escolar , Humanos , Lactente , Fatores de Risco
20.
Am J Prev Med ; 51(4 Suppl 2): S106-18, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27498167

RESUMO

Family-focused prevention programs have been shown to effectively reduce a range of negative behavioral health outcomes but have had limited reach. Three key barriers must be overcome to expand the reach of family-focused prevention programs and thereby achieve a significant public health impact. These barriers are (1) current social norms and perceptions of parenting programs; (2) concerns about the expertise and legitimacy of sponsoring organizations to offer parenting advice; and (3) a paucity of stable, sustainable funding mechanisms. Primary healthcare settings are well positioned to overcome these barriers. Recent changes within health care make primary care settings an increasingly favorable home for family-focused prevention and suggest possibilities for sustainable funding of family-focused prevention programs. This paper discusses the existing advantages of primary care settings and lays out a plan to move toward realizing the potential public health impact of family-focused prevention through widespread implementation in primary healthcare settings.


Assuntos
Terapia Familiar/métodos , Conhecimentos, Atitudes e Prática em Saúde , Serviços Preventivos de Saúde/economia , Atenção Primária à Saúde/tendências , Humanos , Poder Familiar , Patient Protection and Affordable Care Act , Normas Sociais , Estados Unidos
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