Yap Marie Bee Hui, Mahtani Shireen, Rapee Ronald M, Nicolas Claire, Lawrence Katherine A, Mackinnon Andrew, Jorm Anthony F
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Australia.
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
J Med Internet Res. 2018 Jan 19;20(1):e17. doi: 10.2196/jmir.9139.
Depression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking.
This study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms.
A two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to target parenting factors associated with adolescents' risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent's strengths and areas for improvement, followed by a set of interactive modules (up to nine) that is specifically recommended for the parent based on individually identified areas for improvement. Parents in the active-control condition received a standardized package of five Web-based factsheets about adolescent development and well-being. Parents in both conditions received a 5-min weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at postintervention was parent-reported changes in parenting risk and protective factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children's Anxiety Scale (anxiety symptoms).
Parents in the intervention condition completed a mean of 73.7% of their intended personalized PiP program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed the postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between conditions were found at postintervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to postintervention in both conditions.
The fully automated PiP intervention showed promising short-term effects on parenting behaviors that are associated with adolescents' risk for depression and anxiety. Long-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents' mental health.
Australia New Zealand Clinical Trials Registry: ACTRN12615000328572; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx? id=368274 (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj).
青少年的抑郁和焦虑症是一个全球关注的健康问题。父母在降低这些疾病的风险方面起着重要作用，但缺乏可广泛传播的、具有成本效益且基于证据的针对父母的干预措施。
本研究旨在探讨“育儿伙伴”（PiP）项目干预后对青少年抑郁和焦虑的育儿风险及保护因素，以及青少年抑郁和焦虑症状的影响。
对359对亲子进行了双臂随机对照试验，主要通过澳大利亚各地的学校招募。在基线和3个月后（干预后）对父母和青少年进行评估。干预组的父母接受PiP项目，这是一种基于网络的量身定制的育儿干预措施，根据说服系统设计（PSD）原则设计，旨在针对与青少年抑郁和焦虑问题风险相关的育儿因素。PiP包括一份量身定制的反馈报告，突出每位父母的优势和改进领域，随后是一组根据个体确定的改进领域专门为父母推荐的互动模块（最多九个）。积极对照组的父母收到一套关于青少年发展和幸福的五份基于网络的资料手册。两组的父母每周都会接到一个5分钟的电话，以鼓励他们完成分配的项目。两个项目均通过试验网站每周提供。干预后的主要结局指标是父母报告的育儿风险和保护因素的变化，使用“降低青少年抑郁和焦虑的育儿量表”（PRADAS）进行测量。次要结局指标是青少年报告的PRADAS、父母和儿童报告的“简短情绪和情感问卷”（抑郁症状）以及父母和儿童报告的“斯宾斯儿童焦虑量表”（焦虑症状）。
干预组的父母平均完成了其预定的个性化PiP项目的73.7%。共有318名父母（88.6%，318/359）和308名青少年（92.8%，308/332）完成了干预后的评估。使用重复测量方差分析的混合模型处理失访情况。正如所假设的，我们在PRADAS上发现了显著的条件×时间交互作用，效应量中等，科恩d = 0.57，95% CI 0.34 - 0.79。在干预后，在任何次要结局指标上，两组之间均未发现显著差异，在两种情况下，青少年抑郁（仅父母报告）和焦虑（父母和青少年报告）症状从基线到干预后均显著降低。
全自动的PiP干预对与青少年抑郁和焦虑风险相关的育儿行为显示出有希望的短期效果。需要进行长期随访以确定这些效果是否能转化为青少年抑郁和焦虑问题的减少。该干预措施作为一种低成本的通用公共卫生项目，可能有助于增加被认为有益于青少年心理健康的育儿行为。
澳大利亚新西兰临床试验注册中心：ACTRN12615000328572；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368274（由WebCite存档于http://www.webcitation.org/6qgsZ3Aqj）。
