Case Western Reserve University, Cleveland, USA.
University of Oregon, Eugene, USA.
Prev Sci. 2023 Nov;24(8):1523-1534. doi: 10.1007/s11121-022-01471-4. Epub 2022 Dec 31.
Maternal depression is a well-established risk factor for the development of depression in offspring. As such, reducing maternal depression may be key to effective prevention efforts to reduce offspring's depression. Based on the broad risk represented by maternal depression, examining cross-over effects of parent-focused interventions on maternal depression is important. The present study examined improvements in maternal depression as a mediator of the long-term effects of the Family Check-Up (FCU) prevention program on youth depression across three randomized controlled trials. The FCU is a family-focused intervention originally designed to reduce youth problem behaviors, particularly conduct problems and substance use, but has also been found to have cross-over effects on other youth problem behaviors, including internalizing symptoms. We utilized integrative data analysis that allows for powerful tests of prevention effects across trials, specifically moderated nonlinear factor analysis, to integrate data across three trials: one trial initiated in early childhood and two in early adolescence. Using a latent growth modeling approach, we first examined direct effects of the FCU on changes in maternal depression. Then we examined the mediating effect of maternal depression on changes in both parent and youth reports of youth depression. A significant intervention effect on maternal depression was observed across the three trials, with the FCU predicting improvements in maternal depression. In turn, such improvements predicted a reduction in the growth in both parent and youth reports of youth depressive symptoms across 10 years post baseline. These results demonstrate the utility in addressing cross-over effects of family-focused interventions in reducing the long-term development of depression in youth through mediating pathways.
母亲抑郁是子女抑郁发展的一个既定风险因素。因此,减少母亲抑郁可能是有效预防子女抑郁的关键。鉴于母亲抑郁带来的广泛风险,研究以父母为焦点的干预措施对母亲抑郁的交叉影响非常重要。本研究通过三项随机对照试验,检验了家庭检查(FCU)预防计划对青少年抑郁的长期影响中,母亲抑郁改善作为中介的作用。FCU 是一种以家庭为中心的干预措施,最初旨在减少青少年的问题行为,特别是行为问题和药物使用,但也被发现对其他青少年问题行为(包括内化症状)具有交叉影响。我们利用综合数据分析,对跨试验的预防效果进行了有力的测试,特别是调节非线性因素分析,整合了三项试验的数据:一项试验在幼儿期开始,两项在青少年早期开始。我们采用潜在增长模型方法,首先检验了 FCU 对母亲抑郁变化的直接影响。然后,我们检验了母亲抑郁对父母和青少年报告的青少年抑郁变化的中介效应。在三项试验中都观察到了 FCU 对母亲抑郁的显著干预效果,FCU 预测了母亲抑郁的改善。反过来,这种改善预测了在基线后 10 年内,父母和青少年报告的青少年抑郁症状的增长速度都会降低。这些结果表明,通过中介途径,解决以家庭为中心的干预措施的交叉影响,对于减少青少年抑郁的长期发展是有效的。