Mitigating risk from macroeconomic stress on child mental health: Exploring protective effects of universal preventive intervention

这项研究的广泛目标是加强我们对健康的社会决定因素的理解， 具体地说，可以缓解社会经济状况和相关的压力源，以改善儿童的心理 在预防性干预的背景下的健康。社会经济状况和相关的压力源 对一生中的心理健康产生重大影响(《健康人2020》，美国卫生部和 人类服务，2019年)。国家贫困中心最近的估计表明，在美国，40%的儿童 美国生活在贫困线的200%以下，21%的儿童生活在贫困中。来自弱势群体的儿童 与更有优势的同龄人相比，有背景的人出现心理健康问题的可能性是后者的2-3倍。 解决社会经济压力和儿童结果之间联系的一个关键理论观点是 家庭压力模型(FSM)，认为社会经济压力对父母的幸福感产生负面影响 和养育子女，导致儿童心理健康状况较差的风险。ParentCorps是一个普遍的以家庭为中心的组织 作为对参加高贫困儿童的学前教育方案的加强而提供的预防性干预 学校。干预措施包括教师的专业发展和为所有学龄前儿童提供的课程 家人。ParentCorps的两项随机对照研究发现，对父母养育和儿童自我调节有影响，并持续 对二年级儿童心理健康(情绪和行为问题)的影响。当ParentCorps 已经证明了在集中的环境中支持父母和孩子的福祉的潜力 尽管这是一种不利因素，但它可以在多大程度上减轻宏观经济压力带来的风险仍不清楚。 来自大衰退(GR)的宏观经济压力被证明会增加儿童的风险 心理健康问题，有证据表明，不太理想的父母教养和父母幸福会产生间接影响。 鉴于ParentCorps支持育儿和儿童心理健康，它也可能保护儿童免受 宏观经济压力的压力。该项目寻求利用ParentCorps RCT的时机， 2005年至2012年对1,050个家庭(4组学龄前儿童)进行了评估 (GR之前、期间和之后)。通过将现有的RCT数据与时间匹配的宏观经济数据联系起来，这 项目利用随机对照试验中的“自然实验”来解决两个具体目标：(1)评估 哪些ParentCorps降低了与宏观经济压力相关的儿童心理健康问题的风险，以及 (2)通过审查以下各项之间的联系，探索可通过哪些机制进行缓解 宏观经济压力、父母幸福和育儿，与密克罗尼西亚联邦一致。分析探索节制 通过混合效应模型将宏观经济压力与干预状况的结果联系起来，例如 随机化是在学校层面进行的。该项目符合NIMH的战略目标3，以审问推定的 通过对“干预目标和机制”的二次分析，提出了预防性干预措施。调查结果显示 为修改健康的社会决定因素以降低精神健康问题风险的方法提供信息的可能性。

The broad goals of this study are to strengthen our understanding of how social determinants of health, specifically socioeconomic conditions and associated stressors, can be mitigated to improve child mental health within the context of a preventive intervention. Socioeconomic conditions and associated stressors have significant impact on mental health across the lifespan (Healthy People 2020, U.S. Department of Health and Human Services, 2019). Recent estimates from the National Center on Poverty suggest that 40% of children in the US live below 200% of the poverty line, with 21% of children living in poverty. Children from disadvantaged backgrounds are 2-3 times as likely to exhibit mental health problems compared to more advantaged peers. One key theoretical perspective addressing the link between socioeconomic stress and child outcomes is the Family Stress Model (FSM), which suggests that socioeconomic stress negatively affects parental well-being and parenting, leading to risk for poorer child mental health. ParentCorps is a universal family-centered preventive intervention delivered as an enhancement to Pre-K programs for children attending high-poverty schools. Intervention includes professional development for teachers and a program offered to all Pre-K families. Two cluster RCTs of ParentCorps found impacts on parenting and child self-regulation, with sustained effects on child mental health (both emotional and behavior problems) in second grade. While ParentCorps has demonstrated the potential to bolster parent and child well-being in the context of concentrated disadvantage, the extent to which it may mitigate risk stemming from macroeconomic stress remains unclear. Macroeconomic stress stemming from the Great Recession (GR) has been shown to increase risk for child mental health problems, with evidence of indirect effects through less optimal parenting and parent well-being. Given that ParentCorps supports parenting and child mental health, it may also protect against the added strain of macroeconomic stress. This project seeks to capitalize on the timing of an RCT of ParentCorps which involved assessments with 1,050 families (4 cohorts of Pre-K children) that occurred from 2005 to 2012 (before, during, and after the GR). By linking existing RCT data with time-matched macroeconomic data, this project utilizes a “natural experiment” within an RCT to address two specific aims: (1) to evaluate the extent to which ParentCorps mitigates risk for child mental health problems associated with macroeconomic stress, and (2) to explore mechanisms through which such mitigation may occur by examining links between macroeconomic stress and parent well-being and parenting, in line with the FSM. Analyses explore moderation of links between macroeconomic stress and outcomes by intervention status through mixed-effects models, as randomization was at the school-level. The project fits NIMH’s Strategic Objective 3 “to interrogate putative intervention targets and mechanisms” through secondary analysis of a preventive intervention. Findings have the potential to inform ways to modify social determinants of health to reduce risk for mental health problems.