Dunn Abby, Alvarez James, Arbon Amy, Bremner Stephen, Elsby-Pearson Chloe, Emsley Richard, Jones Christopher, Lawrence Peter, Lester Kathryn J, Morson Natalie, Simner Julia, Thomson Abigail, Cartwright-Hatton Sam
University of Sussex, Falmer, United Kingdom.
University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom.
Lancet Reg Health Eur. 2024 Sep 4;45:101038. doi: 10.1016/j.lanepe.2024.101038. eCollection 2024 Oct.
Children whose parents have anxiety problems are at increased risk of developing anxiety themselves. Parenting behaviors are a contributing factor to intergenerational transmission. Interventions which seek to limit anxiogenic parenting behaviors have shown potential in reducing anxiety in offspring but are not widely accessible. This prevention trial aimed to establish the effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children.
A parallel group, block-randomised controlled trial of unblinded participants in a 1:1 ratio was conducted to compare efficacy of the online course compared to a no-intervention control. The intervention comprised 8 modules, of approximately 20 min each, and participants progressed through the course at their own pace. The study was conducted entirely online with a self-referred UK-based community sample of parents (child 2-11 years) with substantial anxiety. The primary outcome measure was change in parent-reported child anxiety, as measured by the Spence Children's Anxiety Scale-Parent Report (SCAS-P) or Spence Pre-School Anxiety Scale-Parent Report (Preschool SCAS). Secondary outcomes were child internalising, externalising, and attentional symptoms (Pediatric Symptom Checklist), and parent anxiety (SCARED-Adult). Analyses using complete case analysis following intention to treat principles investigated intervention effects at 6 months (primary analysis) and additionally at 9 to 25-months' follow-up. Trial registration: ClinicalTrials.GovNCT04755933, https://clinicaltrials.gov/ct2/show/NCT04755933.
1811 participants (intervention = 900; control = 911; 92.7% (1677/1810) female; 85.3% (1535/1800) White-British; 66.8% (1201/1799) university educated). Participant retention (based on primary outcome completion) at T2 (6-months post consent) was 67.6% overall (n = 1224) and substantially lower in the intervention arm 57.3% ((516/900) control = 77.8% (708/910)). Child anxiety was lower in the intervention group compared to control at 6-month follow-up (adjusted effect size estimate -0.15 (95% CI: -0.23 to -0.08, p < 0.001). There was very strong evidence that those in the intervention arm had lowered child anxiety (standardised SCAS score) compared to the control arm, with an effect size (Cohen's d) of -0.16 (95% CI: -0.23 to -0.08, p < 0.001). The difference in standardised Spence Child Anxiety Scale score between the arms was -0.15 standard deviations. On the original scales for SCAS-P (0-114) and Preschool SCAS (0-112), this corresponds to a reduction of -2.38 (95% CI: -3.59 to -1.16) and -2.68 (95% CI: -4.05 to -1.31), respectively. No reported harms.
A clinically unsupported online intervention designed for parents with high levels of anxiety is effective in reducing anxiety and internalising symptoms in their children, and also anxiety in parents. Given the low resource intensity of this intervention, and the positive effects reported here, these findings suggest it has promise in limiting the intergenerational transmission of severe anxiety.
This work was supported by Kavli Trust (grant 38/19).
父母有焦虑问题的孩子自身患焦虑症的风险更高。养育行为是代际传播的一个促成因素。旨在限制产生焦虑的养育行为的干预措施已显示出在降低后代焦虑方面的潜力，但尚未广泛普及。这项预防试验旨在确定一种针对高度焦虑父母的无指导模块化在线干预措施在预防其子女焦虑方面的有效性。
进行了一项平行组、整群随机对照试验，参与者不设盲，按1:1比例进行分组，以比较在线课程与无干预对照组的疗效。干预包括8个模块，每个模块约20分钟，参与者可按照自己的节奏完成课程。该研究完全在线进行，样本为来自英国的自我推荐的有严重焦虑情绪的父母群体（孩子年龄在2至11岁）。主要结局指标是父母报告的孩子焦虑程度的变化，通过斯宾斯儿童焦虑量表父母报告版（SCAS-P）或斯宾斯学前焦虑量表父母报告版（学前SCAS）进行测量。次要结局指标包括孩子的内化、外化和注意力症状（儿童症状清单）以及父母的焦虑程度（SCARED成人版）。按照意向性分析原则，采用完全病例分析方法，在6个月时（主要分析）以及9至25个月的随访中调查干预效果。试验注册：ClinicalTrials.GovNCT04755933，https://clinicaltrials.gov/ct2/show/NCT04755933。
1811名参与者（干预组 = 900人；对照组 = 911人；92.7%（1677/1810）为女性；85.3%（1535/1800）为英国白人；66.8%（1201/1799）受过大学教育）。在T2（同意后6个月）时，基于主要结局指标完成情况的参与者留存率总体为67.6%（n = 1224），干预组的留存率显著较低，为57.3%（（516/900），对照组为77.8%（708/910））。在6个月的随访中，干预组孩子的焦虑程度低于对照组（调整后的效应量估计值为 -0.15（95%置信区间：-0.23至 -0.08，p < 0.001））。有非常有力的证据表明，与对照组相比，干预组孩子的焦虑程度（标准化SCAS评分）有所降低，效应量（科恩d值）为 -0.16（95%置信区间：-0.23至 -0.08，p < 0.001）。两组之间标准化斯宾斯儿童焦虑量表评分的差异为 -0.15个标准差。在SCAS-P（0 - 114）和学前SCAS（0 - 112）的原始量表上，这分别相当于降低了 -2.38（95%置信区间：-3.59至 -1.16）和 -2.68（95%置信区间：-4.05至 -1.31）。未报告有不良事件。
一种为焦虑程度高的父母设计的未经临床验证的在线干预措施，在降低其子女的焦虑和内化症状以及父母自身的焦虑方面是有效的。鉴于该干预措施资源投入低，且报告了积极效果，这些发现表明它在限制严重焦虑的代际传播方面具有前景。
这项工作得到了卡弗里信托基金（拨款38/19）的支持。
