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

养育孩子对每个父母来说都是一个挑战，对于患有双相障碍的父母来说，情绪和压力的起伏会增加这一挑战的规模(3)。双相障碍患者通常会经历情绪高涨（狂躁）和情绪低落（抑郁）的时期，这与他们平时的情绪明显不同。沟通、冲动控制和动机都受到双相障碍的影响，这使得始终如一的养育方式更加困难（3,8）。父母患有双相障碍（CPB）的孩子患多种行为和情绪疾病的风险显著增加，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，与普通人群相比，双相障碍的发病率也更高（4,5,9）。如果不及时治疗，父母患有双相障碍的孩子的行为和情绪问题会增加他们未来精神健康问题的风险（2,3,10）。对基于社区的育儿支持有很高的需求，但很少有基于证据的育儿干预（11,12）。对于双相障碍的心理支持也有很高的需求（13），正如英国社区精神卫生团队因双相障碍而产生的巨大年度成本所证明的那样（14）。然而，传统的育儿干预并不能解决双相障碍患者的特殊需求，心理干预也不一定关注育儿技巧。我们的目标是同时解决这两个问题与一个综合的双相父母干预。我们计划对文献中对有心理健康问题的父母进行干预的有效性进行回顾。我们将利用我们在制定和评估BD干预措施方面的专业知识，为BD开发一揽子支持材料。这些材料将与我们的服务用户焦点小组（FG）合作进行审查。我们将把这些信息与以证据为基础的三重P-Positive Parenting Program（15）结合起来，这是一种旨在在家庭中建立积极关系并管理儿童行为问题的育儿干预。3p在线治疗是新推出的，将及时为大量的人提供服务，而且比面对面的治疗更便宜。我们的目标是确定将3p在线应用于双相障碍的育儿是否有用，这有可能降低CPB未来情感问题的风险。目前的研究建立在我们团队进行的试点工作的基础上(6)，该工作发现，与对照组相比，接受3p在线教育的双相障碍家庭的儿童行为和养育方式都有显著改善。该试点有一些明显的局限性，包括1)有大量的退出（22/54参与者），部分原因可能是没有额外提供支持使用网络材料，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效果或对父母心理健康的影响；3）.年龄下限（2岁）太小，无法有效使用关键结果测量指标——力量和困难问卷（SDQ:16）。我们打算解决上述局限性，并探索一种综合双相父母干预（IBPI）。我们将邀请50位患有双相障碍的父母（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，为期4个月。我们将获得有关有多少人使用本网站、他们如何使用本网站以及他们使用本网站的体验的信息。在使用IBPI之前、之后以及6个月、9个月和12个月之后，家长将完成关于育儿问题、育儿压力和儿童行为问题的问卷调查。他们的回答将与那些没有访问网站的人（TAU: n=50）进行比较。我们将询问参与者样本（n=10）关于他们使用干预的经历，以及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.