Jiang Yanping, Li Xiaoming, Harrison Sayward E, Zhang JiaJia, Qiao Shan, Decker Scott, Zhao Junfeng, Zhao Guoxiang
Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States.
Department of Psychology, Wayne State University, Detroit, Michigan, United States.
Child Youth Serv Rev. 2022 Feb;133. doi: 10.1016/j.childyouth.2021.106363. Epub 2022 Jan 5.
Resilience-based interventions have been suggested to improve mental health among children affected by parental HIV. Very few studies, however, have explicitly tested the mechanisms of change underlying the effects of resilience-based interventions on mental health among this group of children. The present study utilized a cluster randomized controlled trial to determine the effects of the (ChildCARE) intervention on mental health for children affected by parental HIV. Specifically, we examined the effects of the intervention on three mental health outcomes (i.e., depressive symptoms, school anxiety, loneliness) and whether emotion regulation and coping played mediating roles in the intervention's effectiveness. Child-caregiver dyads ( = 790) were randomly assigned by clusters to three intervention groups and a control group. Children reported on mental health outcomes for 36 months at 6-month intervals. Latent growth curve models showed that there were no direct impacts of the ChildCARE intervention on changes in mental health outcomes beyond 18-month follow-up. Mediation analyses showed that the ChildCARE intervention yielded significant improvements in positive coping, but not negative coping or emotion regulation at 18 months. Emotion regulation, positive coping, and negative coping were consistently associated with the intercepts (i.e., mean at 18 months) of mental health outcomes. Negative coping also significantly predicted the rates of change of mental health outcomes over time. Findings provide important implications for future resilience-based intervention development and highlight the promise of interventions that aim to strengthen emotion regulation and coping skills to improve mental health for children affected by parental HIV.
有人提出，基于复原力的干预措施可改善受父母感染艾滋病毒影响儿童的心理健康。然而，很少有研究明确检验基于复原力的干预措施对这类儿童心理健康产生影响的潜在变化机制。本研究采用整群随机对照试验，以确定（儿童关爱）干预措施对受父母感染艾滋病毒影响儿童心理健康的效果。具体而言，我们考察了该干预措施对三种心理健康结果（即抑郁症状、学校焦虑、孤独感）的影响，以及情绪调节和应对方式是否在干预效果中起中介作用。将儿童-照顾者二元组（=790）按整群随机分配到三个干预组和一个对照组。儿童每隔6个月报告一次为期36个月的心理健康结果。潜在增长曲线模型显示，在18个月的随访期之后，儿童关爱干预措施对心理健康结果的变化没有直接影响。中介分析表明，儿童关爱干预措施在18个月时使积极应对方式有显著改善，但消极应对方式或情绪调节没有显著改善。情绪调节、积极应对方式和消极应对方式始终与心理健康结果的截距（即18个月时的均值）相关。消极应对方式也显著预测了心理健康结果随时间的变化率。研究结果为未来基于复原力的干预措施发展提供了重要启示，并凸显了旨在加强情绪调节和应对技能以改善受父母感染艾滋病毒影响儿童心理健康的干预措施的前景。
