Web-based Integrated Bipolar Parenting Intervention (IBPI) for Bipolar Parents of Young Children

养育子女对每个父母来说都是一个挑战，对于患有BD的父母来说，情绪和压力的唐斯会增加这一挑战的规模（3）。患有BD的个体特征性地经历与他们平常的情绪明显不同的高情绪（躁狂）和低情绪（抑郁）时期。沟通，冲动控制和动机都受到BD的影响，使始终如一的养育变得更加困难（3，8）。父母患有BD（CPB）的儿童出现各种行为和情绪状况的风险显著增加，包括注意缺陷多动障碍（ADHD）、焦虑、抑郁、物质使用和睡眠障碍，此外，与一般人群相比，BD的发病率更高（4、5、9）。如果父母患有BD，其子女的行为和情绪问题未经治疗，可能会增加其未来出现心理健康问题的风险（2，3，10）。有一个基于社区的育儿支持的需求很高，但很少有证据为基础的育儿干预（11，12）。也有高需求的心理支持BD（13），证明了显着的BD归因于社区心理健康团队在英国的年度成本（14）。然而，传统的育儿干预措施并不能满足BD患者的特殊需求，心理干预措施也不一定侧重于育儿技能。我们的目标是同时解决这两个问题与综合双相育儿干预。我们计划在文献中对有心理健康问题的父母进行干预的有效性进行审查。我们将利用我们开发和评估BD干预措施的专业知识，为BD开发一套支持材料。这些材料将与我们的服务用户（SU）焦点小组（FG）合作进行审查。我们将把这些信息与以证据为基础的Triple P-Positive Parenting Program（15）相结合，Triple P-Positive Parenting Program是一种旨在建立家庭内积极关系和管理儿童行为问题的育儿干预措施。Triple P Online是新推出的，将及时向大量人群开放，并且比面对面治疗更便宜。我们的目的是确定适应三P在线与BD养育，这有可能降低未来的CPB情绪问题的风险的有用性。目前的研究建立在我们团队进行的试点工作的基础上（6），该研究发现，与对照组相比，接受Triple P Online的BD家庭的儿童行为和养育方式都有显着改善。飞行员有一些重大的模仿，包括1）有显着辍学（22/54名参与者）可能部分原因是没有为使用网络材料提供额外的支持，这已被证明可以提高参与度（7）; 2）我们无法正式评估干预的长期影响或对父母心理健康的影响; 3）.年龄下限（2岁）太小，不能有效地使用关键结果测量，优势和困难问卷（SDQ：16）。我们打算解决上述局限性，并探索综合双相父母干预（IBPI）。我们将要求50名患有BD的父母（他们至少有一个3-10岁的孩子，平均每周与孩子面对面接触至少10小时）使用IBPI四个月。我们将收集有多少人使用该网站，他们如何使用它，以及他们使用它的经验。父母将在使用IBPI之前和之后，以及在6个月，9个月和12个月后完成关于育儿问题，育儿压力和儿童行为问题的问卷。他们的回答将与那些没有访问网站的人进行比较（TAU：n=50）。我们将询问参与者样本（n=10）关于他们使用干预措施的经验，并询问父母参与者的孩子样本（n=15）关于干预前后的家庭生活。

Parenting can be a challenge for every parent, and for parents with BD, the ups and downs of mood and stress can add to the scale of this challenge(3). Individuals with BD characteristically experience periods of high mood (mania) and low mood (depression) that are noticeably different from their usual mood. Communication, impulse control and motivation are all affected by BD, making the delivery of consistent parenting more difficult(3,8). Children of parents with BD (CPB) are at significantly increased risk of a wide range of behavioural and emotional conditions including Attention Deficit Hyperactivity Disorder (ADHD), anxiety, depression, substance use, and sleep disorders, in addition to higher rates of BD compared to the general population(4,5,9). Left untreated, behavioural and emotional problems in children of parents with BD can increase their risk of future mental health problems(2,3, 10). There is a high demand for community based parenting support, yet there are few evidence-based parenting interventions(11,12).There is also high demand for psychological support for BD(13), as evidenced by the significant BD-attributed annual costs to community mental health teams in the UK(14). However, traditional parenting interventions do not address the particular needs of people with BD, and psychological interventions do not necessarily focus on parenting skills. We aim to tackle both issues simultaneously with an integrated bipolar parenting intervention. We plan to conduct a review of the effectiveness of interventions for parents with mental health problems in the literature. We will develop a package of support materials for BD drawing on our expertise of developing and evaluating interventions for BD. These materials will be reviewed in collaboration with our Service User (SU) Focus Group (FG). We will integrate this information with the evidence-based Triple P-Positive Parenting Program(15), which is a parenting intervention that aims to build positive relationships within families and manage behaviour problems in children. Triple P Online is newly available, will be accessible to large numbers of people in time, and is less expensive than face-to-face therapy. We aim to determine the usefulness of adapting Triple P Online to parenting with BD, which has the potential to reduce risk of future emotional problems for CPB. The current study builds on pilot work conducted by our team(6) which found significant improvements in both child behaviour and parenting for families with BD for those who received a Triple P Online compared to controls. The pilot had some significant imitations, including 1) There was significant drop-out (22/54 participants) possibly partly because there was no additional provision of support for use of the web materials, which has been shown to enhance engagement(7); 2) We were not able to formally evaluate longer-term effects of the intervention or impact on parental mental health; 3).The lower age limit (2 years) was too young for effective use with the key outcome measure, the Strength and Difficulties Questionnaire (SDQ:16). We intend to address the above limitations and explore an Integrated Bipolar Parenting Intervention (IBPI). We will ask 50 parents with BD (who have at least one child aged 3-10 years and at least 10 hours of face-to-face contact with their child per week on average) to use IBPI for four months. We will obtain information on how many use the website, how they used it, and their experiences of using it. Parents will complete questionnaires about parenting problems, parenting stress, and child behaviour problems before and after using IBPI, and after 6, 9 and 12 months. Their responses will be compared to those who did not have access to the website (TAU: n=50). We will ask a sample of participants (n=10) about their experience using the intervention and a sample of children of parent participants (n=15) about family life before and after the intervention.