Brathwaite Rachel, Mutumba Massy, Ssewamala Fred M, Bahar Ozge Sensoy, Neilands Torsten B, Namatovu Phionah, McKay Mary M, Hoagwood Kimberly
International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, USA.
Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
SSM Ment Health. 2024 Dec;6. doi: 10.1016/j.ssmmh.2024.100338. Epub 2024 Jul 14.
Residing in poverty-impacted Ugandan communities and raising children with disruptive behavior disorders (DBDs) is associated with above heightened parenting stress. An evidence-based intervention designed to help parents tailor their parenting style to effectively manage children with DBDs was implemented in Uganda between 2017 and 2023. At the end of the intervention, caregivers displayed lower levels of parenting stress than controls, however the mechanisms by which stress reduction occurred is unknown. We investigated whether the intervention's effect on parenting stress was mediated by parenting practices, family cohesion, or mental health. Mediation was assessed using Mitchell and Maxwell's cross-lagged auto-regressive approach. Each mediation model regressed the outcome parenting stress score at each time point onto intervention group assignment (0 = Control; 1 = Multiple Family Group (MFG) intervention) and parenting stress score at the preceding time point. Each mediator was investigated one at a time and regressed onto intervention group assignment and the mediator score at the preceding time point. Parenting stress score was also regressed onto the preceding time point mediator score. The residuals for mediators and parenting stress were allowed to correlate at each time point. We included regression pathways from each covariate to the mediators and outcomes at subsequent waves and were included in the model as random variables. The findings show that the intervention had a significant direct effect on parenting stress at 16 weeks post intervention initiation and was partially mediated by parenting practices, caregiver mental health, and parenting stress at 8 weeks, but we found no evidence it was mediated by family cohesion, supporting two of our hypotheses. Equipping caregivers with parenting skills and strategies to improve mental health can go a long way in reducing overall parenting stress among caregivers with DBDs. Our findings could be leveraged to enhance stress reduction among caregivers of children with DBDs in the long-term.
生活在受贫困影响的乌干达社区并抚养患有破坏性行为障碍（DBD）的儿童与更高的育儿压力相关。2017年至2023年期间，乌干达实施了一项循证干预措施，旨在帮助父母调整育儿方式，以有效管理患有DBD的儿童。在干预结束时，照顾者的育儿压力水平低于对照组，然而压力减轻的机制尚不清楚。我们调查了干预对育儿压力的影响是否通过育儿实践、家庭凝聚力或心理健康来介导。使用米切尔和麦克斯韦的交叉滞后自回归方法评估中介作用。每个中介模型将每个时间点的育儿压力结果得分回归到干预组分配（0 = 对照组；1 = 多家庭小组（MFG）干预）和前一个时间点的育儿压力得分上。每次只研究一个中介变量，并将其回归到干预组分配和前一个时间点的中介变量得分上。育儿压力得分也回归到前一个时间点的中介变量得分上。允许中介变量和育儿压力的残差在每个时间点相关。我们纳入了从每个协变量到后续波次的中介变量和结果的回归路径，并将其作为随机变量纳入模型。研究结果表明，干预在干预开始后16周对育儿压力有显著的直接影响，并且部分由育儿实践、照顾者心理健康和8周时的育儿压力介导，但我们没有发现证据表明它由家庭凝聚力介导，支持了我们的两个假设。为照顾者提供育儿技能和策略以改善心理健康，对于减轻患有DBD的儿童照顾者的总体育儿压力大有帮助。我们的研究结果可用于长期提高患有DBD的儿童照顾者的压力减轻程度。
