Incredible Years - Parent Training

项目概要/摘要 自杀是美国5-11岁儿童死亡的第八大原因。2012-2017年，青年 自杀率每年以惊人的14.7%的速度增长。在此期间，5至18岁的急诊室就诊人数增加了92%， 112万人--这些访问中几乎有一半涉及5至11岁的儿童。然而，迄今为止， 关于儿童自杀和自杀行为（SB）的研究有限，没有经验支持 尽管NIMH承认预防青少年自杀应该是国家的优先事项。 一个特别脆弱的群体是父母有自杀企图史的儿童（PH+）。PH+儿童 4- 6倍更有可能从事SB比他们的同龄人，并显示出特别早的发病年龄-通常在10岁之前。 在本提案中，我们针对特定的父母和儿童层面的脆弱性/风险因素， 家庭虽然自杀风险是遗传的，但现有的研究表明：（1）共同的家庭环境对 SB和自杀，超过和以上的遗传影响;和（2）特定的家庭环境机制， 导致SB和自杀。这些机制还包括严厉、无效和低热情的养育方式 父母与孩子之间的沟通受损，父母对孩子的行为监控不力。这些育儿 这种做法会强化情绪不稳定和情绪失调，这对父母双方都很常见， 危险家庭中的儿童。在我们之前的研究（R21 MH 116206）中，PH+儿童，6-9岁，报告较少 家庭凝聚力，PH+父母报告更多的宽容养育，这与严厉同时发生， 敌意和情绪失调针对这些育儿做法的有效干预措施， 父母和孩子的情绪调节（ER）可能会降低青少年SB的风险，但尚未在PH+中进行测试 家庭我们将比较Incredible Years®父母培训（IY-PT）的虚拟版本和增强型家庭护理 （EUC）。IY-PT降低了父母的情绪反应，并教会他们有效地“指导”孩子 成功的ER。IY-PT在增加父母的积极育儿和提高父母双方的ER技能方面是有效的， 儿童，在1年和2年随访时保持较大的效应量。我们将（1）测试可接受性， 从父母和临床医生的角度来看，虚拟IY-PT对该人群的可行性;（2）确定是否 IY-PT可有效降低PH+青少年的自杀风险;（3）探讨IY-PT作为 PH+状态与父母和孩子结局之间的潜在调节因素。ER和养育是主要的 结果和NSSI、SI和抑郁症状是次要结果。措施包括面谈， 直接观察和自我报告。参与者包括100个PH+家庭，他们将完成基线， 随机分配至虚拟IY-PT或EUC，并完成干预后1个月、3个月和6个月的重新评估。这 有效性-实施混合模型设计I，以PRISM实施科学框架为指导， 可能对预防高危青年中迫在眉睫的公共卫生问题产生重大影响。

Project Summary/Abstract Suicide is the eighth leading cause of death among U.S. children ages 5-11 years. From 2012-2017, youth suicides increased at an alarming 14.7% annually. During this time, ER visits increased 92% among 5- to 18- year-olds—to 1.12 million. Almost half of these visits involved a 5- to 11-year-old child. To date, however, limited research on child suicide and suicidal behavior (SB) exists, and there are no empirically supported prevention programs despite recognition by NIMH that youth suicide prevention should be a national priority. One especially vulnerable group is children with a parental history of suicide attempts (PH+). PH+ children are 4-6x more likely to engage in SB than their peers and show especially early age of onset—often before age 10. In this proposal, we target specific parent- and child-level vulnerabilities/risk factors for SB among these families. Although suicide risk is heritable, existing research shows (1) effects of shared family environment on SB and suicide, over-and-above genetic influences; and (2) specific family environment mechanisms that contribute to SB and suicide. Such mechanisms include harsh, invalidating, and low-warmth parenting, as well as impaired parent-child communication and poor parental monitoring of children’s behavior. These parenting practices reinforce emotional lability and emotion dysregulation, which are common to both parents and children in at-risk families. In our previous study (R21MH116206), PH+ children, ages 6-9 years, reported less family cohesion, and PH+ parents reported more permissive parenting, which co-occurs with harshness, hostility, and emotion dysregulation. Effective interventions that target these parenting practices and improve parent and child emotion regulation (ER) may reduce risk for youth SB but have not been tested in PH+ families. We will compare a virtual version of Incredible Years® parent training (IY-PT) to Enhanced Usual Care (EUC). IY-PT decreases parents’ emotional reactivity and teaches them to effectively “coach” their children on successful ER. IY-PT is effective in increasing positive parenting and improving ER skills of both parents and children, with large effect sizes that maintain at 1- and 2-year follow-ups. We will (1) test acceptability and feasibility of virtual IY-PT for this population from both parent and clinician perspectives; (2) determine whether IY-PT is effective in decreasing suicide risk among PH+ youth; and (3) explore acceptability and feasibility as potential moderators between PH+ status and parent and child outcome. ER and parenting are primary outcomes and NSSI, SI, and depressive symptoms are secondary outcomes. Measures include interviews, direct observations, and self-reports. Participants include 100 PH+ families who will complete a baseline, be randomized to virtual IY-PT or EUC, and complete 1-,3-, and 6-month reassessments post-intervention. This effectiveness-implementation hybrid model design I, guided by PRISM Implementation Science Framework, could have major implications for preventing an imminent public health concern among at-risk youth.