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1.
Artigo em Inglês | MEDLINE | ID: mdl-33963489

RESUMO

Military-connected families face many challenges associated with military life transitions, including deployment separations. We report on a randomized controlled trial to evaluate the efficacy of Families OverComing Under Stress-Early Childhood (FOCUS-EC) delivered through an in-home, virtual telehealth platform. FOCUS-EC is a trauma-informed, family-centered preventive intervention designed to promote family resilience and well-being. Military-connected families with 3- to 6-year-old children (194 mothers; 155 fathers; 199 children) were randomized to FOCUS-EC or an online education condition. Parent psychological health symptoms, child behavior, parenting, and parent-child relationships were examined by parent-report and observed interaction tasks for up to 12 months. Longitudinal regression models indicated that FOCUS-EC families demonstrated significantly greater improvements than online education families in parent-reported and observational measures of child behavior, parenting practices, and parent-child interaction, as well as greater reductions in parent posttraumatic stress symptoms. Findings provide support for the benefit of a virtually-delivered preventive intervention for military-connected families.

2.
Acad Pediatr ; 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33582310

RESUMO

OBJECTIVE: To determine whether there are racial/ethnic differences in depression treatment for caregivers investigated by the US child welfare system. METHODS: This cross-sectional study used baseline data from the Second National Survey of Child and Adolescent Well-being, a nationally representative sample of children and caregivers investigated by US child welfare agencies (February 2008-April 2009). We included permanent caregivers who met criteria for major depression and had available covariate data (n = 908). In multivariable logistic regression models, we estimated the associations between caregiver race/ethnicity and past-year receipt of: any depression treatment, minimally adequate depression treatment, and depression treatment from 4 sectors (general medical, psychiatry, nonpsychiatry mental health, and human services). We controlled for clinical need and access variables according to the Institute of Medicine's definition of health care disparities. RESULTS: Black caregivers had the lowest rates of treatment receipt of any racial/ethnic group, with 42.2% receiving any depression treatment and 17.2% receiving minimally adequate depression treatment in the past year. In multivariable analyses controlling for clinical need and access variables, Black caregivers were less likely than White caregivers to receive any depression treatment (odds ratio [OR] = 0.49 [95% CI: 0.24-0.97]), minimally adequate depression treatment (OR = 0.37 [95% CI: 0.16-0.85]), and depression treatment from the general medical sector (OR = 0.40 [95% CI: 0.18-0.89]) in the past year (all P< .05). CONCLUSIONS: Future research should examine the underlying mechanisms of Black-White disparities in depression treatment for caregivers involved with the US child welfare system and develop targeted interventions to promote equitable mental health care for this highly vulnerable population.

3.
Int J Child Maltreat ; : 1-15, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33426476

RESUMO

Maltreatment of children continues to be a major public health concern, with high social, economic and health burdens. Rates vary by a number of factors that can be categorized into different levels of the social ecology. Research and theory in this field point to the importance of community-level factors that can contribute to either risk or prevention of child maltreatment. The COVID-19 pandemic context creates additional risks and concerns related to child maltreatment and exacerbates risk factors that existed before: e.g., families and communities are in much worsened states of poverty, unemployment, and food insecurity; losses and grief are affecting mental health; and limitations and safety concerns are affecting in-person child protection work and more. Central to recovery from this pandemic will be the mobilization of community-level resources and the building back up of the social fabric that can support vulnerable children and caregivers. Key to this mobilization will be a better intersectional understanding of structural inequities in the child welfare system and in our communities. Efforts to dismantle structural biases and discrimination are critical to provide safety and support for families and vital for effective child maltreatment prevention. In this context, we discuss the state of the science of community-level prevention of childhood maltreatment, highlighting evidence-based community-level prevention programs and how these types of efforts may be impacted by the current COVID-19 global pandemic.

4.
J Med Internet Res ; 22(10): e16802, 2020 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33112254

RESUMO

BACKGROUND: Adolescent depression carries a high burden of disease worldwide, but access to care for this population is limited. Prevention is one solution to curtail the negative consequences of adolescent depression. Internet interventions to prevent adolescent depression can overcome barriers to access, but few studies examine long-term outcomes. OBJECTIVE: This study compares CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training), an internet-based intervention, to a general health education active control for depression onset at 12 and 24 months in adolescents presenting to primary care settings. METHODS: A 2-site randomized trial, blinded to the principal investigators and assessors, was conducted comparing Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training to health education to prevent depressive episodes in 369 adolescents (193 youths were randomly assigned to Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training and 176 to health education) with subthreshold depressive symptoms or prior depressive episodes. Participants were recruited from primary care settings in the United States. The primary outcome was the occurrence of a depressive episode, determined by the Depression Symptom Rating. The secondary outcome was functioning, measured by the Global Assessment Scale. RESULTS: In intention-to-treat analyses, the adjusted hazard ratio favoring Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training for first depressive episode was not statistically significant at 12 months (hazard ratio 0.77, 95% CI 0.42-1.40, P=.39) and 24 months (hazard ratio 0.87, 95% CI 0.52-1.47, P=.61). Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training provided preventive benefit for first depressive episode for those with mild hopelessness or at least moderate paternal monitoring at baseline. Global Assessment Scale scores improved comparably in both groups (intention-to-treat). CONCLUSIONS: A technology-based intervention for adolescent depression prevention implemented in primary care did not have additional benefit at 12 or 24 months. Further research is necessary to determine whether internet interventions have long-term benefit. TRIAL REGISTRATION: ClinicalTrials.gov NCT01893749; http://clinicaltrials.gov/ct2/show/NCT01893749.

5.
J Fam Psychol ; 34(8): 927-937, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32658515

RESUMO

This study examined effects of an adolescent depression prevention program on maternal criticisms and positive remarks, whether the extent of adolescents' depression accounted for effects, and whether effects of the program on maternal criticisms and positive remarks differed by adolescents' gender. Participants were 298 adolescent (Mage = 14.79, SD = 1.36; 59% female) offspring of mothers with histories of depression; youth were randomized to either a cognitive-behavioral prevention (CBP) program or usual care (UC). At baseline and 9-month postintervention evaluations, mothers were administered the Five-Minute Speech Sample to measure number of criticisms and positive remarks made during an open-ended description of their child and their relationship. Adolescents' depression from pre- through postintervention was assessed with interviews. A hierarchical generalized linear model showed a significant condition-by-gender interaction, indicating that, controlling for baseline criticism, at postintervention mothers of girls in CBP made significantly more criticisms than did mothers of girls in UC, whereas mothers of boys in CBP made fewer criticisms than did mothers of boys in UC. The extent of adolescents' depression from pre- through postintervention partially mediated the relation between intervention condition and mothers' criticisms, for boys but not for girls. Second, controlling for preintervention positive remarks, at postintervention, mothers of youth in CBP made significantly more positive remarks about their child than did mothers of youth in UC, regardless of gender; this relation was not mediated by adolescent depression from pre- through postintervention. We suggest possible explanations for the observed effects of CBP on mothers' criticisms and positive remarks. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

6.
Addict Behav Rep ; 11: 100277, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32373707

RESUMO

Background: Antiretroviral therapy (ART) is publicly available in South Africa in response to the urgent need to address HIV and AIDS. Off-label use of ARV medication alone or in combination with other substances is known as "whoonga" and "nyaope" in South Africa. Diversion of ARVs for whoonga use is not well understood, especially among adolescents. This secondary analysis explores risk and protective factors for adolescent whoonga use in a community-based HIV endemic setting. Methods: Data on whoonga use were derived from a baseline survey of N = 200 adolescents recruited for participation in a randomized controlled trail to reduce adolescent HIV risk behaviors and depression. Risk and protective factors for adolescent whoonga use were explored using an ecological systems framework using one-way ANOVAs, chi-squared tests and hierarchical regression. Results: Individual level factors increased the odds of whoonga use or known use such as child age OR:1.22 (95% CI, 1.03-1.43), hazardous drug use OR:1.62 (95% CI, 1.02-2.59), and hazardous alcohol OR:1.80 (95% CI, 1.05-3.09). Food insecurity appears to have a slightly protective effect on the odds of whoonga use or reports of use among people adolescents knew OR:0.649 (95% CI, 0.541-0.779). Conclusions: Larger epidemiological studies should expand the surveillance of hazardous alcohol use and illicit drug use, specifically for recreational use of prescription medication. Granular data is warranted to characterize the patters of use, especially among highly vulnerable populations. Future surveillance studies that explore these multi-level relationships are warranted to further understand this phenomenon among teens in South Africa.

7.
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
8.
J Adolesc Health ; 66(3): 336-344, 2020 03.
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.

9.
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.


Assuntos
Adaptação Psicológica , Saúde do Adolescente , Cuidadores/psicologia , Crianças Órfãs/psicologia , Infecções por HIV/psicologia , Resiliência Psicológica , Adolescente , Comportamento do Adolescente , Proteção da Criança , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Humanos , Modelos Lineares , Masculino , Saúde Mental , Análise Multivariada , África do Sul , Inquéritos e Questionários
10.
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
11.
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
12.
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
13.
J Am Acad Child Adolesc Psychiatry ; 58(8): 759-767, 2019 08.
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.


Assuntos
Filho de Pais Incapacitados/psicologia , Depressão/prevenção & controle , Saúde da Família , Pais/psicologia , Educação de Pacientes como Assunto , Criança , Comportamento Infantil , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Relações Familiares , Feminino , Humanos , Masculino , Psicologia da Criança , Psicoterapia , Fatores de Risco
14.
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
15.
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.

16.
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
17.
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 , Proteção da Criança/estatística & dados numéricos , Estudos Transversais , Tomada de Decisões , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Encaminhamento e Consulta/estatística & dados numéricos
18.
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
19.
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
20.
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
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