青少年脑损伤家庭问题解决治疗的随机对照有效性试验：通过问题解决应对头部损伤（CHIPS）研究的家长结果

A Randomized Comparative Effectiveness Trial of Family-Problem-Solving Treatment for Adolescent Brain Injury: Parent Outcomes From the Coping with Head Injury through Problem Solving (CHIPS) Study.

作者信息

Wade Shari L, Cassedy Amy E, McNally Kelly A, Kurowski Brad G, Kirkwood Michael W, Stancin Terry, Taylor H Gerry

机构信息

Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center and Departments of Pediatrics and Psychology, University of Cincinnati, Cincinnati, Ohio (Dr Wade); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Cassedy); Division of Psychiatry and Behavioral Health, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio (Dr McNally); Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, and Departments of Pediatrics, Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio (Dr Kurowski); Department of Rehabilitation Psychology/Neuropsychology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado (Dr Kirkwood); Department of Psychiatry, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio (Dr Stancin); Center for Biobehavioral Health, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University, Columbus, Ohio (Dr Taylor); and Division of Developmental/Behavioral Pediatrics and Psychology, Case Western Reserve University and Rainbow Babies & Children's University Hospital Cleveland Medical Center, Cleveland, Ohio (Dr Taylor).

出版信息

J Head Trauma Rehabil. 2019 Nov/Dec;34(6):E1-E9. doi: 10.1097/HTR.0000000000000487.

DOI:10.1097/HTR.0000000000000487

PMID:31033747

Abstract

OBJECTIVE

To examine changes in depression and distress in parents of adolescents receiving family-problem-solving therapy (F-PST) following traumatic brain injury.

METHOD

Families of adolescents hospitalized for moderate to severe traumatic brain injury were randomized to face-to-face F-PST (34), therapist-guided online F-PST (56), or self-guided online F-PST (60). Outcomes were assessed pretreatment and 6 and 9 months later. Parents rated depression and distress on the Center for Epidemiological Studies Depression Scale and the Brief Symptom Inventory, respectively. Mixed modeling was used to examine changes over time and treatment moderators.

RESULTS

The therapist-guided online group had significant reductions in parental depression over time. Analyses of slopes of recovery revealed differential improvement on the Center for Epidemiological Studies Depression Scale between the 2 online groups, with no significant change in depressive symptoms following self-guided F-PST. On the Brief Symptom Inventory Global Severity Index, the therapist-guided online group reported significant improvement from baseline to 6 months that was maintained at 9 months. The face-to-face and self-guided online groups reported significant reductions in distress between 6 and 9 months with corresponding large effect sizes. Differences on the Center for Epidemiological Studies Depression Scale between therapist-guided and self-guided online groups at the 9-month follow-up were more pronounced in families of lower socioeconomic status, t103 = -2.87; P = .005.

CONCLUSIONS

Findings provide further support for the utility of therapist-guided online F-PST in reducing parental depression and distress following pediatric traumatic brain injury and offer limited evidence of the efficacy of self-guided online treatment for these outcomes. Families of lower socioeconomic status may benefit more from therapist involvement.

摘要

目的

研究接受家庭问题解决疗法（F-PST）的青少年创伤性脑损伤后其父母抑郁和痛苦情绪的变化。

方法

因中度至重度创伤性脑损伤住院的青少年家庭被随机分为面对面F-PST组（34个家庭）、治疗师指导的在线F-PST组（56个家庭）或自我指导的在线F-PST组（60个家庭）。在治疗前、治疗6个月和9个月后评估结果。父母分别在流行病学研究中心抑郁量表和简明症状量表上对抑郁和痛苦进行评分。采用混合模型来研究随时间的变化以及治疗调节因素。

结果

治疗师指导的在线组父母的抑郁情绪随时间有显著降低。恢复斜率分析显示，两个在线组在流行病学研究中心抑郁量表上的改善存在差异，自我指导的F-PST后抑郁症状无显著变化。在简明症状量表总体严重程度指数上，治疗师指导的在线组从基线到6个月有显著改善，并在9个月时保持。面对面组和自我指导的在线组在6至9个月之间痛苦显著降低，且效应量相应较大。在9个月随访时，治疗师指导的在线组和自我指导的在线组在流行病学研究中心抑郁量表上的差异在社会经济地位较低的家庭中更为明显，t103 = -2.87；P = 0.005。