School of Psychology, Griffith University, Brisbane, Australia.
School of Criminology and Criminal Justice, Griffith University, Brisbane, Australia.
Addiction. 2021 Nov;116(11):3206-3218. doi: 10.1111/add.15579. Epub 2021 Jun 7.
Family-focused interventions can improve family functioning when parents have substance use problems. However, there has been little focus upon potential predictors of change and analysis of mechanisms of change. This study aims to identify mediators and moderators of change in a pragmatic, multi-site, randomized controlled trial of the Parents under Pressure (PuP) programme, a family-focused intervention for parents with substance use and other problems, and treatment-as-usual (TAU).
Secondary analysis of data: multi-level modelling was used to investigate moderators of treatment outcome; mediation was tested with cross-lagged models.
Community-based family support services in the United Kingdom.
Parents (n = 100) attending community-based addiction services with children aged 2.5 years or younger.
Predictors of the primary outcome, child abuse potential, were: baseline child age and gender, composite family risk score, parental substance use and parental emotional dysregulation. Mediation was tested across three time-points with the observed variables parental emotion dysregulation and child abuse potential.
Increased child age [Z = 2.14, 95% confidence interval (CI) = 0.01, 0.33] at baseline was associated with greater reductions in child abuse potential for PuP programme participants compared with TAU. Poorer parental emotional regulation (Z = 2.48, 95% CI = -2.76, -0.32) was associated with greater reductions in child abuse potential for all participants. Parental substance use (either recent use or primary substance of concern) did not alter any treatment effects on child abuse potential. The mediation analysis showed that PuP produced greater improvements in emotional regulation at post-treatment (P < 0.001) compared with TAU, which predicted lower child abuse potential at 6-month follow up (P < 0.05).
For UK parents enrolled in a family-focused intervention, baseline measurements of higher child age appear to be associated with greater reductions in child abuse potential at 6-month follow-up in PuP participants compared with treatment as usual (TAU). Poorer parental emotional regulation and, potentially, higher family risk, appears to be associated with greater reductions in child abuse potential at 6-month follow-up in PuP and TAU. Emotional regulation appeared to act as a mediator as improvements in parental emotional regulation post-treatment appeared to be associated with greater reductions in child abuse potential at 6-month follow up. Notably, participation in the PuP programme led to better parental emotional regulation compared with TAU.
当父母有药物使用问题时，以家庭为中心的干预可以改善家庭功能。然而，对于变化的潜在预测因素和变化机制的分析关注甚少。本研究旨在识别父母压力计划（PuP）的一个实用、多地点、随机对照试验中的中介和调节因素，PuP 是一种针对有药物使用和其他问题的父母的以家庭为中心的干预措施，以及常规治疗（TAU）。
数据的二次分析：使用多层次模型来研究治疗结果的调节因素；使用交叉滞后模型测试中介。
英国基于社区的家庭支持服务。
参加有 2.5 岁或以下儿童的社区成瘾服务的父母（n=100）。
儿童虐待倾向的主要结果的预测因子为：基线儿童年龄和性别、综合家庭风险评分、父母药物使用和父母情绪失调。在三个时间点上用观察到的变量父母情绪失调和儿童虐待倾向来测试中介。
基线时儿童年龄增加[Z=2.14，95%置信区间（CI）=0.01，0.33]与 PuP 项目参与者相比，TAU 参与者的儿童虐待倾向降低幅度更大。较差的父母情绪调节（Z=2.48，95%CI=-2.76，-0.32）与所有参与者的儿童虐待倾向降低幅度更大有关。父母药物使用（最近使用或主要关注的物质）并未改变药物使用对儿童虐待倾向的任何治疗效果。中介分析表明，PuP 在治疗后（P<0.001）产生了更大的情绪调节改善，而 TAU 则预测了 6 个月随访时较低的儿童虐待倾向（P<0.05）。
对于参加以家庭为中心的干预的英国父母来说，与 TAU 相比，PuP 参与者在 6 个月随访时，较高的基线儿童年龄似乎与较低的儿童虐待倾向有关。较差的父母情绪调节和（可能）较高的家庭风险与 PuP 和 TAU 中 6 个月随访时儿童虐待倾向的降低有关。情绪调节似乎起中介作用，因为治疗后父母情绪调节的改善与 6 个月随访时儿童虐待倾向的降低有关。值得注意的是，与 TAU 相比，PuP 计划的参与导致了更好的父母情绪调节。
