Impact of the Family Bereavement Program Fifteen Years Later

描述(由申请人提供)：拟议的竞争性续签是对156个家庭的244名年轻人进行的15年跟踪调查，这些人参与了家庭丧亲计划(FBP)的实验性评估，这是一项针对失去父母的儿童的预防性干预措施。FBP在儿童和青春期提供，后续将在青壮年进行。家庭被随机分配到FBP或自学对照条件下。FBP计划包括一个针对父母/照顾者和儿童的组成部分，旨在改变与失去亲人的儿童的心理健康和适应结果有关的多个中介，包括有效的父母养育和儿童的有效应对。测试后和11个月的随访表明，该计划有效地改善了父母教养方式和儿童的应对方式，减少了女孩的内化和外化问题。经过6年的随访，89.3%的儿童被随机分配到不同的条件下，发现计划的好处是减少教师和自我报告的内化和外化问题，降低被诊断为外化障碍的比率，减少侵入性悲伤，并改善HPA轴调节、平均成绩和自尊。在六年的随访中，FBP还降低了照顾者抑郁的水平，并改善了父母养育方式。青春期的几个项目的效果受到儿童年龄和预试问题水平的影响。在六年的跟踪调查中，项目对青少年的影响是通过父母教养方式的改善和父母在测试后的抑郁症状来调节的。这项申请有五个具体目标：1.评估FBP在以下方面的15年效果：(A)精神健康问题和障碍(B)身体健康和健康危险行为以及(C)发展能力(例如，教育和职业成功)。2.扩大对15年结果的评估，包括对情绪调节技能(即注意力控制、积极应对、认知重新评估和社会支持的使用)的重点、多方法评估，通过自我报告调查、日常日记以及对认知和人际压力任务的认知、行为和生理反应进行评估。3.审查FBP的15年结果是否受到基线青年因素的影响，包括性别、年龄和干预前的心理社会风险。4.评估一个纵向中介模型，该模型假设青年期的干预效果是通过项目诱导对积极父母教育的影响和6年随访的青少年结果来中介的。5.对FBP在15年后续期间的影响进行经济分析。这项拟议的研究与NIMH战略计划是一致的，该战略计划评估对高风险丧亲儿童样本的干预效果，包括精神障碍、适应功能和对压力的神经生理反应的改善(NIMH，2008)。 与公共卫生相关：虽然父母的死亡是一种创伤性事件，会增加儿童患多种心理健康问题和障碍的风险，但几乎没有证据支持对这一群体进行干预的有效性。目前的应用是对家庭丧亲计划的长期效果进行评估，这是为数不多的针对丧亲儿童的预防性干预措施之一，在严格的随机实验试验中显示出有效的证据。这项跟踪调查具有重大的公共卫生意义，可以展示该计划在儿童成年后的潜在影响，评估干预措施的成本效益，并更好地确定谁最有可能从该计划中受益。

DESCRIPTION (provided by applicant): The proposed competing renewal is a 15-year follow-up of 244 young adults, in 156 families, who participated in an experimental evaluation of the Family Bereavement Program (FBP), a preventive intervention for parentally-bereaved children. The FBP was provided in childhood and adolescence and the follow-up will occur in young adulthood. Families were randomly assigned to the FBP or a self-study control condition. The FBP program includes a component for parents/caregivers and children and was designed to change multiple mediators that are associated with mental health and adjustment outcomes of bereaved children, including effective parenting and children's effective coping. The post-test and 11-month follow-up indicated program efficacy to improve parenting and children's coping, and to reduce internalizing and externalizing problems for girls. The 6-year follow-up, which included 89.3% of the children who were randomly assigned to conditions, found program benefits to reduce teacher and self-reported internalizing and externalizing problems, reduce rates of diagnosed externalizing disorders, reduce intrusive grief, and improve HPA axis regulation, grade point average and self-esteem. FBP also reduced levels of caregiver depression and improved parenting at six-year follow-up. Several program effects in adolescence were moderated by age of child and level of problems at pre-test. Program effects on adolescents at six year follow-up were mediated by improvements in parenting and parents' depressive symptoms at post-test. This application has five specific aims: 1. Evaluate the 15-year efficacy of the FBP on: (a) mental health problems and disorders (b) physical health and health risk behaviors and (c) developmental competencies (e.g., educational and vocational success). 2. Expand the evaluation of 15-year outcomes to include focused, multi-method evaluation of emotion regulation skills (i.e., attentional control, active coping, cognitive reappraisal, and use of social support), assessed through self-report surveys, daily diaries, and cognitive, behavioral, and physiological responses to "real-time" cognitively and interpersonally stressful tasks. 3. Examine whether the 15-year outcomes of the FBP are moderated by baseline youth factors, including gender, age, and pre-intervention psychosocial risk. 4. Evaluate a longitudinal mediation model hypothesizing that intervention effects in young adulthood are mediated by program-induced effects on positive parenting and youth outcomes at 6-year follow-up. 5. Conduct an economic analysis of FBP's impact over the 15-year follow-up period. The proposed research is consistent with the NIMH strategic plan to assess intervention effects on a broad trajectory of outcomes including mental disorder, adaptive functioning and improvements in neurophysiological response to stress in a high risk sample of bereaved children (NIMH, 2008). PUBLIC HEALTH RELEVANCE: While the death of a parent is a traumatic event that elevates children's risk for multiple mental health problems and disorders, there is little evidence to support the effectiveness of interventions with this population. The current application is an evaluation of the long-term effects of the Family Bereavement Program, one of the very few preventive interventions with bereaved children that have shown evidence of effectiveness in a rigorous randomized experimental trial. The follow-up has great public health significance to demonstrate the potential impact of the program as children reach young adulthood, to assess the cost-effectiveness of the intervention and to better identify who is most likely to benefit from the program.