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针对面临失业的夫妻预防抑郁症干预措施效果的异质性:研究基线目标对影响的调节作用

Heterogeneity in the Effects of Interventions to Prevent Depression in Couples Facing Job Loss: Studying Baseline Target Moderation of Impact.

作者信息

Howe George W

机构信息

George Washington University, 2013 H Street NW, Washington, DC, 20052, USA.

出版信息

Prev Sci. 2023 Feb;24(2):271-285. doi: 10.1007/s11121-022-01410-3. Epub 2022 Jul 29.

Abstract

Couples' communication styles are associated with depression following job loss for both job seekers and their partners. The Couples Employment Program (CEP), an eight-session program for couples facing job loss, was developed to integrate job search strategies sessions from the JOBS program with couple communication sessions, targeting job search behavior, motivation, mastery, and couple communication. We hypothesized that CEP would have compensatory effects, such that those who began the program with lower job search behavior, lower motivation, less mastery, and more negative or less positive couple communication would make more gains on these targets, and this would mediate impact on reducing risk for depression. We conducted a randomized field trial of CEP with 1477 heterosexual couples facing recent unemployment. Baseline levels of job search behavior and motivation, but not mastery or depression, moderated the impact of intervention on job seeker depression slopes over 12 months; job seekers reporting less job search behavior and motivation at baseline benefited more. Male partners with higher baseline depression also benefited. Opposite to our hypothesis, baseline levels of couple's communication moderated the impact of intervention such that partners in couples with more negative and less positive communication showed iatrogenic effects. There was no evidence that baseline target levels moderated the impact of the intervention on any of these targets. We speculate that more intensive communication training may be necessary for positive impact.

摘要

夫妻的沟通方式与求职者及其伴侣失业后的抑郁情绪有关。夫妻就业计划(CEP)是一项为面临失业的夫妻设计的八节课程,旨在将就业机会与技能提升计划(JOBS计划)中的求职策略课程与夫妻沟通课程相结合,目标是求职行为、动机、掌控力和夫妻沟通。我们假设CEP会产生补偿效应,即那些在开始该计划时求职行为较少、动机较低、掌控力较弱且夫妻沟通更消极或更不积极的人,在这些目标上会有更大的收获,这将介导对降低抑郁风险的影响。我们对1477对面临近期失业的异性恋夫妻进行了CEP的随机现场试验。求职行为和动机的基线水平,但不是掌控力或抑郁,调节了干预对求职者12个月内抑郁斜率的影响;在基线时报告求职行为和动机较少的求职者受益更多。基线抑郁水平较高的男性伴侣也受益。与我们的假设相反,夫妻沟通的基线水平调节了干预的影响,使得沟通更消极和更不积极的夫妻中的伴侣表现出医源性效应。没有证据表明基线目标水平调节了干预对这些目标中任何一个的影响。我们推测可能需要更密集的沟通培训才能产生积极影响。

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