Impact of the Family Bereavement Program Fifteen Years Later

描述（由申请人提供）：拟议的竞争性更新是对156个家庭的244名年轻人进行15年的随访，他们参加了家庭丧亲计划（FBP）的实验性评估，这是一项针对父母丧亲儿童的预防性干预措施。FBP在儿童和青少年时期进行，随访将在青年期进行。家庭被随机分配到FBP或自学控制条件。FBP项目包括父母/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相关的多重中介，包括有效的养育和儿童的有效应对。事后测试和11个月的随访表明，该项目在改善父母教养和儿童应对方面有效，并减少了女孩的内化和外化问题。在为期6年的随访中，89.3%的儿童被随机分配到不同的条件下，发现项目的好处在于减少教师和自我报告的内在化和外在化问题，减少外在化障碍的诊断率，减少侵入性悲伤，改善HPA轴调节，平均成绩和自尊。在六年的随访中，FBP还降低了照顾者的抑郁水平，改善了养育子女的能力。几个项目对青少年的影响被儿童的年龄和测试前的问题水平所缓和。在6年的随访中，项目对青少年的影响是通过父母教养和父母抑郁症状的改善来调节的。该应用程序有五个具体目标：1。评估FBP在以下方面15年的效果：(a)精神健康问题和障碍(b)身体健康和健康风险行为以及(c)发展能力（如教育和职业成功）。2. 扩大对15年结果的评估，包括集中的、多方法的情绪调节技能评估（即注意力控制、积极应对、认知重新评估和社会支持的使用），通过自我报告调查、日常日记和对“实时”认知和人际压力任务的认知、行为和生理反应进行评估。3. 检查FBP的15年结果是否受到基线青年因素的影响，包括性别、年龄和干预前的社会心理风险。4. 评估纵向中介模型，假设干预对青年期的影响是由6年随访中对积极养育和青年期结局的项目诱导效应介导的。5. 对FBP在15年随访期间的影响进行经济分析。拟议的研究与NIMH战略计划是一致的，该计划评估干预对结果的广泛轨迹的影响，包括精神障碍、适应功能和对失去亲人的高风险儿童的神经生理反应的改善（NIMH, 2008）。

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).