A multidimensional approach to assessing six-year trajectories of outcomes of bereaved children, the effects of the FBP to modify trajectories and mediation of effects 15 years later

摘要 父母的死亡是童年时期压力最大的事件之一，并与患心脏病风险增加有关 儿童和儿童时期的多重心理健康问题以及发展能力受损 成人期。这项研究使用了一项为期15年的纵向研究的二级数据分析，该研究是对一项关于 家庭丧亲计划(FBP)描述问题和问题的发展轨迹 六年来丧失亲人儿童的能力；研究FBP对减少问题的效果 并研究这些轨迹的改变如何解释FBP对青少年精神障碍的影响 15年后，他成年了。这项研究建立在评估个体差异的研究进展的基础上 丧失亲人等潜在创伤性事件后，结果随时间的变化轨迹。多项研究 使用这种方法得出的结论是，绝大多数儿童和成年人的问题水平较低 随着时间的推移，可以被认为是有弹性的。目前的研究对这一结论提出了质疑，这一结论是基于 对单一结果轨迹的评估(一维方法)，而不考虑 在遭遇逆境之后，不同的人可能会以不同的方式经历问题。关于丧亲的最新研究 成年人采用了一种多维方法来评估五种结果的轨迹，并发现很少有 成年人(只有8%)在所有结果中的问题水平都很低。目前研究采用了这种多维的 评估悲伤轨迹、精神健康问题、能力、风险和保护因素的方法 对失去亲人的儿童进行了为期六年的二次数据分析，这些数据来自于 FBP。这是第一项应用多维方法评估四个个体轨迹的研究 结果领域(悲伤、心理健康问题、发展能力、风险和保护 儿童在经历任何重大逆境后的影响因素)。这些发现对理解 这失去了可以从循证服务中受益的儿童。这项研究将应用 多维方法评估FBP对问题和能力发展轨迹的影响 六年来的结果以及有针对性的风险和保护因素。它还将评估 FBP以改善跨结果的问题轨迹的总数。FBP为其提供服务的个人 减少一个或多个问题轨迹可被视为计划的响应者。这项研究还将 评估六年来在问题、能力或风险和保护因素方面不断变化的轨迹 儿童期和青春期调节FBP效应以减少精神障碍、自杀念头/行为或 九年后，当参与者是年轻人时，使用心理健康服务。这些分析的发现 对以调解人为目标的《外交政策框架》各部分的有效传播具有行动意义 通过该计划成功地改变了这些问题，并调解了FBP对成人心理健康问题的影响。

Abstract Parental death is one of the most stressful events of childhood and is associated with increased risk for multiple mental health problems as well as impairments in developmental competencies in childhood and adulthood. This study uses a secondary data analysis of a 15-year longitudinal study of a randomized trial of the Family Bereavement Program (FBP) to characterize the developmental trajectories of problems and competencies of bereaved children over six years; to study the effects of the FBP to reduce problem trajectories; and to study how changing these trajectories account for FBP effects on mental disorder in young adulthood 15 years later. The study builds on a major advance in research to assess individual differences in trajectories of outcomes over time following potentially traumatic events such as bereavement. Multiple studies using this method have concluded that the great majority of children and adults have low levels of problems over time and can be considered to be resilient. The current study questions this conclusion which is based on the assessment of trajectories of single outcomes (a unidimensional approach) and does not consider that different people may experience problems in different ways following adversity. Recent research with bereaved adults adapted a multidimensional approach to assess trajectories across five outcomes and found that few adults (only 8%) had low levels of problems across outcomes. The current study adapt this multidimensional approach to assess trajectories of grief, mental health problems, competencies and risk and protective factors over a six year period for bereaved children in a secondary analysis of data from the longitudinal study of the FBP. This is the first study to apply a multidimensional approach to assess individual trajectories of four domains of outcomes (grief, mental health problems, developmental competencies and risk and protective factors) of children following any major adversity. The findings have significant implications for understanding which bereaved children who could benefit from evidence-based services. The study will apply the multidimensional approach to assess the effects of the FBP on trajectories of problem and competence outcomes as well as targeted risk and protective factors over six years. It will also assess the effects of the FBP to improve the aggregate number of problem trajectories across outcomes. Individuals for whom the FBP reduces one or more problem trajectories can be considered responders to the program. The study will also assess how changing trajectories in problems, competencies or risk and protective factors across six years in childhood and adolescence mediate FBP effects to reduce mental disorder, suicidal ideation/behavior or mental health service use nine years later when participants are young adults. Findings from these analyses have action implications to optimize effective dissemination of components of the FBP that target mediators that are successfully changed by the program and that mediate FBP effects on adult mental health problems.