Boyd Rhonda C, Gerdes Marsha, Rothman Brooke, Dougherty Susan L, Localio Russell, Guevara James P
Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, 3440 Market Street, 2nd Floor, Philadelphia, PA, 19104, USA.
Policylab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Prim Prev. 2017 Oct;38(5):465-480. doi: 10.1007/s10935-017-0481-8.
Caregiver depression impacts parenting behaviors and has deleterious effects on child behavior. Evidence-based interventions to address parenting have not been adapted for use with depressed caregivers in pediatric primary care settings. Our study examined the feasibility and explored outcomes of an evidence-based parenting program implemented in primary care and adapted for caregivers with depressive symptoms caring for toddlers. We conducted a randomized controlled trial with a wait-list control. Participants were caregivers who screened positive for depressive symptoms in pediatric settings with a toddler. Our study was implemented from July 2011 to June 2012. We adapted the Incredible Years Parents, Babies and Toddlers program with the addition of depression psychoeducation (12 weekly sessions), and assessed caregivers at baseline and immediately post-intervention. We assessed participation rates, depressive symptoms, parenting discipline practices, social support, and parenting stress. Our results revealed that 32 caregivers participating in the intervention group had significantly greater improvement in self-reported parenting discipline practices compared to the 29 wait-list control group caregivers. We found no differences between groups in depressive symptoms, social support, or parenting stress. Our study demonstrated that the average attendance was poor (mean attendance = 3.7 sessions). We adapted an evidence-based parenting intervention for caregivers with depressive symptoms and toddlers in primary care; however, participation was challenging. Alternative intervention strategies are needed to reach and retain low-income caregivers with depression symptoms as they face multiple barriers to participation in groups within center-based services. Trial Registration Clinical Trials.gov identifier NCT01464619.
照顾者抑郁会影响养育行为，并对儿童行为产生有害影响。针对养育问题的循证干预措施尚未适用于儿科初级保健环境中患有抑郁症的照顾者。我们的研究检验了一项在初级保健中实施并适用于照顾患有抑郁症的幼儿的照顾者的循证养育项目的可行性，并探索了其效果。我们进行了一项设有等待名单对照组的随机对照试验。参与者是在儿科环境中筛查出患有抑郁症且家中有幼儿的照顾者。我们的研究于2011年7月至2012年6月实施。我们对“不可思议的岁月家长、婴儿和幼儿项目”进行了改编，增加了抑郁症心理教育内容（每周12节课程），并在基线和干预后立即对照顾者进行评估。我们评估了参与率、抑郁症状、养育管教方式、社会支持和养育压力。我们的结果显示，与29名等待名单对照组的照顾者相比，32名参与干预组的照顾者在自我报告的养育管教方式上有显著更大的改善。我们发现两组在抑郁症状、社会支持或养育压力方面没有差异。我们的研究表明平均出勤率很低（平均出勤 = 3.7节课程）。我们为初级保健中患有抑郁症的照顾者及其幼儿改编了一项循证养育干预措施；然而，参与情况具有挑战性。由于低收入且有抑郁症状的照顾者在参与基于中心的服务中的团体时面临多重障碍，因此需要替代干预策略来接触并留住他们。试验注册ClinicalTrials.gov标识符NCT01464619。
