Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS, 96020-220, Brazil.
Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
BMC Psychiatry. 2020 Jul 15;20(1):370. doi: 10.1186/s12888-020-02777-9.
Nurturing care, in which children are raised in engaging and safe environments, may reduce child stress and shape hypothalamic-pituitary-adrenal axis functioning. Hence, parent-training programs may impact child cortisol levels, as well as behavioral, social and health outcomes. We conducted a systematic review of the impact of parent-training interventions on children's and caregivers' cortisol levels, and meta-analyzed the results.
In January 2020, searches in PubMed, LILACS, ERIC, Web of Science, Scielo, Scopus, PsycNET and POPLINE databases were conducted, and two independent researchers screened the results for eligible studies - randomized trials that assessed the impact of parent-training interventions on child or caregiver cortisol levels. Random effects were used to pool the estimates, separately for children and caregivers, and for children's morning and evening cortisol levels, as well as change across the day.
A total of 27 eligible studies were found. Data from 19 studies were extracted and included in the meta-analyses, with 18 estimates of child cortisol levels and 5 estimates for caregiver cortisol levels. The pooled effect size (standardized mean difference) for the effects of parent training programs on morning child cortisol was 0.01 (95%CI: - 0.14 to 0.16; I: 47.5%), and for caregivers it was 0.04 (95%CI: - 0.22 to 0.30; I: 0.0%). Similar null results were observed for child evening cortisol and for the slope between morning and evening child cortisol. No evidence of publication bias was found.
Existing evidence shows no effect of parent-training interventions on child or caregiver post-intervention cortisol. Researchers are encouraged to adopt standardized protocols to improve evaluation standards, to test for intervention effects on psychosocial outcomes that are theorized to mediate the effects on biomarkers, and to use additional biomarkers for chronic stress.
在充满趣味和安全的环境中养育孩子，可能会减轻孩子的压力并影响下丘脑-垂体-肾上腺轴的功能。因此，家长培训计划可能会影响孩子的皮质醇水平以及行为、社会和健康结果。我们系统地回顾了家长培训干预对儿童和照顾者皮质醇水平的影响，并对结果进行了荟萃分析。
2020 年 1 月，我们在 PubMed、LILACS、ERIC、Web of Science、Scielo、Scopus、PsycNET 和 POPLINE 数据库中进行了检索，并由两名独立的研究人员筛选出符合条件的研究——评估家长培训干预对儿童或照顾者皮质醇水平影响的随机试验。我们分别使用随机效应来汇总儿童和照顾者的估计值，以及儿童的早晨和傍晚皮质醇水平以及全天的变化。
共发现 27 项符合条件的研究。从 19 项研究中提取并纳入荟萃分析的数据，其中包括 18 项儿童皮质醇水平的估计值和 5 项照顾者皮质醇水平的估计值。家长培训计划对儿童早晨皮质醇影响的汇总效应大小（标准化均数差）为 0.01（95%CI：-0.14 至 0.16；I²：47.5%），对照顾者的皮质醇水平为 0.04（95%CI：-0.22 至 0.30；I²：0.0%）。对于儿童傍晚皮质醇和儿童早晨和傍晚皮质醇之间的斜率，也观察到类似的无效结果。未发现发表偏倚的证据。
现有证据表明，家长培训干预对儿童或照顾者干预后皮质醇水平没有影响。研究人员应采用标准化方案来提高评估标准，测试干预对心理社会结果的影响，这些结果被认为可以介导对生物标志物的影响，并使用额外的生物标志物来评估慢性应激。
