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个家庭中的244名年轻人进行的15年随访，他们参加了对家庭丧亲计划（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。在儿童和青少年时期提供FBP，并将在成年早期进行随访。家庭被随机分配到FBP或自学控制条件。FBP方案包括一个针对父母/照顾者和儿童的组成部分，旨在改变与丧亲儿童的心理健康和调整结果相关的多种介质，包括有效的养育和儿童的有效应对。后测试和11个月的随访表明，该计划的效力，以改善父母和儿童的应对，并减少内化和外化的问题，女孩。6年的随访，其中包括89.3%的儿童谁被随机分配到条件，发现程序的好处，以减少教师和自我报告的内化和外化问题，降低诊断的外化障碍率，减少侵入性悲伤，并改善HPA轴调节，平均成绩和自尊。在6年的随访中，FBP还降低了照顾者抑郁的水平，改善了养育子女的情况。在青春期的几个程序的影响，在预测试的问题，儿童的年龄和水平进行了调节。在六年的随访中，项目对青少年的影响是通过父母养育方式的改善和父母在后测中的抑郁症状来调节的。该应用程序有五个具体目标：1。评价FBP在以下方面的15年疗效：（a）心理健康问题和障碍（B）身体健康和健康风险行为以及（c）发展能力（例如，教育和职业成功）。2.扩大对15年结果的评估，以包括对情绪调节技能的重点、多方法评估（即，注意力控制、积极应对、认知再评价和社会支持的使用），通过自我报告调查、每日日记以及对“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调节，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，假设在年轻的成年干预效果是介导的程序诱导的影响，积极的父母和青年的结果，在6年的随访。5.在15年的随访期内对FBP的影响进行经济分析。拟议的研究与NIMH战略计划一致，以评估干预措施对广泛结果的影响，包括精神障碍，适应功能和对丧亲儿童高风险样本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).