Abstract
This study presents an analysis of mediation of the effects of the Family Bereavement Program (FBP) to improve mental health outcomes of girls at 11 months following program participation. The FBP was designed based on a theory that program-induced change in multiple child and family level mediators would lead to reductions in children’s mental health problems. Mediational models were tested using a three wave and a two wave longitudinal design. Using a three wave longitudinal design, FBP effects on three variables at T2 (increased positive parenting, decreased negative events, and decreased inhibition of emotional expression) were found to mediate the effects of the FBP on mental health problems at 11-month follow-up. Using a two-wave longitudinal design, support was found for FBP effects on three additional variables at 11-month follow-up (increased positive coping, decreased negative thoughts about stressors, and decreased unknown control beliefs) to mediate program effects to reduce mental health problems at 11-month follow-up. The discussion focuses on theoretical explanations for the mediational effects and on implications for identifying “core components” of the FBP that are responsible for its effects to reduce mental health problems of girls.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Randomized trials have demonstrated efficacy for prevention programs for specialized populations of bereaved children such as AIDS orphans (Rotheram-Borus et al., 2001).
Although mediational analysis allows us to rule out some alternative explanations of the relations between the risk factor and the mental health outcomes (e.g., third variable explanations such as genes as a shared common cause) it does not prove causality because the effect of the mediator on the outcome is still a correlational rather than experimental effect and alternative explanations for this effect may still be plausible (e.g., an unmeasured variable that is correlated with the measured mediator and is also affected by the intervention may be the true cause of the program induced change in outcomes).
A full list of eligibility requirements and the procedure for random assignment is provided in Sandler et al., 2003.
The computation of the weighted alpha coefficients excluded the two observation variables.
The findings from the program effect on the mediators may not be consistent with those in the outcome evaluation presented in Sandler et al. (2003). This is because in the analyses conducted in the Sandler et al. (2003) study, both boys and girls were included in the analyses. Also, in the mediation models, not only T1 mediator but also T1 symptom scores (i.e., baseline internalizing or externalizing problems) were controlled for when examining the program effect on T2 mediators and T3 outcomes. In the Sandler et al. (2003) outcome evaluation, only the respective T1 variable was controlled for in evaluating the intervention effect on each of the mediator or the symptom measures at T2 or T3.
To reflect the findings that T3 negative thought about stressful events had mediation effects only if children had high levels of negative thoughts, following the procedures outlined by Tein et al. (2004) and Aiken and West (1991), the scores on the negative thought about stressful events were recalibrated so that the mean of the new scores were one standard deviation below the mean from the original scores.
References
Achenbach, T. M. (1991a). Manual for the child behavior checklist/4-18 and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.
Achenbach, T. M. (1991b). Manual for the teacher’s report form and 1991 profile. Burlington, VT: University of Vermont, Department of Psychology.
Achenbach, T. M. (1991c). Manual for the youth self-report and 1991 profile. Burlington, VT: University of Vermont, Department of Psychology.
Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA, US: Sage Publications, Inc.
Aroian, L. A. (1947). The probability function of the product of two normally distributed variables. Annals of Mathematical Statistics, 18, 165–271.
Aroian, L. A., Taneja, V. S., & Cornwell, L. W. (1978). Mathematical forms of the distribution of the product of two normal variables. Mathematical forms of the distribution of the product of two normal variables, A7, 165–172.
Ayers, T. S., Kennedy, C. L., Sandler, I. N., & Stokes, J. (2003). Bereavement, Adolescence. In T. P. Gullotta & M. Bloom (Eds.), Encyclopedia of primary prevention and health promotion (pp. 221–229). New York: Kluwer Academic/Plenum Publishers.
Ayers, T. S., Kwok, O.-M., Sandler, I. N., Haine, R. A., & Wolchik, S. A. (2005). Three perspectives on emotional expression and their relations to mental health problems of bereaved children. Unpublished manuscript.
Ayers, T. S., & Sandler, I. N. (2003). Bereavement, Childhood. In T. P. Gullotta & M. Bloom (Eds.), Encyclopedia of primary prevention and health promotion (pp. 213–220). New York: Kluwer Academic/Plenum Publishers.
Ayers, T. S., Sandler, I. N., Twohey, J. L., & Haine, R. A. (1998). Three views of emotional expression in parentally bereaved children. Poster presented at the 106th Annual Convention of the American Psychological Association, San Francisco.
Ayers, T. S., Sandler, I. N., West, S. G., & Roosa, M. W. (1996). A dispositional and situational assessment of children’s coping: Testing alternative models of coping. Journal of Personality, 64(4), 923–958.
Ayers, T. S., Sandler, I. N., Wolchik, S. A., & Haine, R. A. (2000). Emotional expression and mental health problems of bereaved children. Poster presented at the Eighth Annual Meeting of the Society for Prevention Research, Montreal, Canada.
Ayers, T. S., Twohey, J. L., Sandler, I. N., Wolchik, S. A., Lutzke, J. R., Padgett-Jones, S., Weiss, L., Cole, E., & Kriege, G. (2006). The Family Bereavement Program: Description of a theory-based prevention program for parentally-bereaved children and adolescents. Unpublished manuscript, Tempe, AZ.
Barrera, M., Jr., Hageman, D. N., & Gonzales, N. A. (2004). Revisiting Hispanic adolescents’ resilience to the effects of parental problem drinking and life stress. American Journal of Community Psychology, 34(1–2), 83–94.
Beck, A. T., & Steer, R. A. (1984). Internal consistencies of the original and revised Beck Depression Inventory. Journal of Clinical Psychology, 40, 1365–1367.
Brown, A., Sandler, I. N., Liu, X., Haine, R. A., & Tein, J. Y. (2005). Interventions for survivors of suicide: Current status and a model for child survivors of parental suicide.
Cole, D. A., & Maxwell, S. E. (2003). Testing mediational models with longitudinal data: Questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112(4), 558–577.
Connell, J. P. (1985). A new multidimensional measure of children’s perceptions of control. Child Development, 56(4), 1018–1041.
DeGarmo, D. S., Patterson, G. R., & Forgatch, M. S. (2004). How do outcomes in a specified parent training intervention maintain or wane over time? Prevention Science, 5(2), 73–89.
Dohrenwend, B. P., Shrout, P. E., Ergi, G., & Mendelsohn, F. S. (1980). Non-specific psychological distress and other dimensions of psychopathology. Archives of General Psychology, 39, 1229–1236.
Duncan, O. D. (1975). Introduction to structural equation models. New York, NY: Academic Press.
Gollob, H. F., & Reichardt, C. S. (1987). Taking account of time lags in causal models. Child Development, 58, 80–92.
Gottman, J. M., Katz, L. F., & Hooven, C. (1997). Meta-emotion: How families communicate emotionally. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Grant, K. E., & Compas, B. E. (1995). Stress and anxious-depressed symptoms among adolescents: Searching for mechanisms of risk. Journal of Consulting and Clinical Psychology, 63(6), 1015–1021.
Griffin, W. A., & Decker, A. A. (1996). Family Bereavement Program parent/child interaction code scheme. Prevention Research Center, Observational Coding Lab, Arizona State University. 900 S. McAllister Ave. Room 205, P.O. Box 876005, Tempe, AZ 85287-6005.
Gross, J. J., & Levenson, R. W. (1997). Hiding feelings: The acute effects of inhibiting negative and positive emotion. Journal of Abnormal Psychology, 106(1), 95–103.
Haine, R. A., Ayers, T. S., Sandler, I. N., Wolchik, S. A., & Weyer, J. L. (2003). Locus of control and self-esteem as stress-moderators or stress-mediators in parentally bereaved children. Death Studies, 27, 619–640.
Harris, T., Brown, G. W., & Bifulco, A. T. (1990). Loss of parent in childhood and adult psychiatric disorder: A tentative overall model. Development and Psychopathology, 2(3), 311–328.
Harter, S. (1982). The perceived competence scale for children. Child Development, 53, 87–97.
Hazzard, A., Christensen, A., & Margolin, G. (1983). Children’s perception of parental behaviors. Journal of Abnormal Clinical Psychology, 11, 49–60.
Howe, G. W., Reiss, D., & Yuh, J. (2002). Can prevention trials test theories of etiology? Development and Psychopathology, 14(4), 673–694.
Jordan, J. R. (2001). Is suicide bereavement different? A reassessment of the literature. Suicide and Life-Threatening Behavior, 31(1), 91–102.
Kim, L. S., Sandler, I. N., & Tein, J. Y. (1997). Locus of control as a stress moderator and mediator in children of divorce. Journal of Abnormal Child Psychology, 25(2), 145–155.
Kovacs, M. (1981). Rating scales to assess depression in school aged children. Acta Paedopsychiatry, 46, 305–315.
Kraemer, H. C., Kazdin, A. E., Offord, D. R., Kessler, R. C., & et al. (1997). Coming to terms with the terms of risk. Archives of General Psychiatry, 54(4), 337–343.
Kreamer, H. C., Stice, E., Kazdin, A., Offord, D., & Kupfer, D. (2001). How do risk factors work together? Mediators, moderators, and independent, overlapping and proxy risk factors. American Journal of Psychiatry, 158, 848–883.
Kwok, O.-M., Haine, R. A., Sandler, I. N., Ayers, T. S., Wolchik, S. A., & Tein, J.-Y. (2005). Positive parenting as a mediator of the relations between parental psychological distress and mental health problems of parentally bereaved children. Journal of Clinical Child and Adolescent Psychology, 34(2), 260–271.
Lord, F. M., & Novick, M. R. (1968). Statistical theories of mental test scoring. Reading, MA: Addison-Wesley.
Lutzke, J. R., Ayers, T. S., Sandler, I. N., & Barr, A. (1997). Risks and interventions for the parentally bereaved child. In S. A. Wolchik & I. N. Sandler (Eds.), Handbook of children’s coping with common life stressors: Linking theory, research and interventions (pp. 215–243). New York: Plenum.
MacKinnon, D. P. (1994). Analysis of mediating variables in prevention and intervention research. National Institute on Drug Abuse Research Monograph Series, 139, 127–153.
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7(1), 83–104.
MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39(1), 99–128.
MacKinnon, D. P., Warsi, G., & Dwyer, J. H. (1995). A simulation study of mediated effect measures. Multivariate Behavioral Research, 30(1), 41–62.
Martinez, C. R., Jr., & Forgatch, M. S. (2001). Preventing problems with boys’ noncompliance: Effects of a parent training intervention for divorcing mothers. Journal of Consulting and Clinical Psychology, 69(3), 416–428.
Meeker, W. Q., Cornwell, L. W., & Aroian, L. A. (1981). Selected tables in mathematical statistics, Volume VII: The product of two normally distributed random variables. Providence, RI: American Mathematical Society.
Muthén, L. K., & Muthén, L. K. (2003). Version 3 Mplus user’s guide. Los Angeles, CA: Muthen & Muthen.
Oregon Social Learning Center. (1991). LIFT Parent Interview. Unpublished Manual.
Partridge, S., & Kotler, T. (1987). Self-esteem and adjustment in adolescents from bereaved, divorced, and intact families: Family type versus family environment. Australian Journal of Psychology, 39(2), 223–234.
Pillow, D. R., Sandler, I. N., Braver, S. L., Wolchik, S. A., & Gersten, J. C. (1991). Theory-based screening for prevention: Focusing on mediating processes in children of divorce. American Journal of Community Psychology, 19(6), 809–836.
Pitts, S. C., West, S. G., & Tein, J. Y. (1996). Longitudinal measurement models in evaluation research: Examining stability and change. Evaluation and Program Planning, 19(4), 333–350.
Price, R. H., Cowen, E. L., Lorion, R. P., & Ramos McKay, J. (1989). The search for effective prevention programs: What we learned along the way. American Journal of Orthopsychiatry, 59(1), 49–58.
Price, R. H., & Lorion, R. P. (1989). Prevention programming as organizational reinvention: From research to implementation. In D. Shaffer & I. Philips & N. B. Enzer (Eds.), Prevention of mental disorders, alcohol, and other drug use in children and adolescents (pp. 97–123). Rockville, MD: Office for Substance Abuse Prevention.
Program for Prevention Research. (1999). Manual for the Children’s Coping Strategies Checklist and the How I Coped Under Pressure Scale. Prevention Research Center, Arizona State University. 900 S. McAllister Ave. Room 205, P.O. Box 876005, Tempe, AZ 85287-6005.
Raveis, V. H., Siegel, K., & Karus, D. (1999). Children’s psychological distress following the death of a parent. Journal of Youth and Adolescence, 28(2), 165–180.
Reinherz, H. Z., Giaconia, R. M., Hauf, A. M. C., Wasserman, M. S., & Silverman, A. B. (1999). Major depression in the transition to adulthood: Risks and impairments. Journal of Abnormal Psychology, 108(3), 500–510.
Reynolds, C. R., & Richmond, B. O. (1978). What I Think and Feel: A Revised Measure of Children’s Manifest Anxiety. Journal of Abnormal Child Psychology, 6, 271–280.
Rotheram-Borus, M. J., Stein, J. A., & Lin, Y.-Y. (2001). Impact of parent death and intervention on the adjustment of adolescents whose parents have HIV/AIDS. Journal of Consulting and Clinical Psychology, 69(5), 763–773.
Rutter, M., Pickles, A., Murray, R., & Eaves, L. (2001). Testing hypotheses on specific environmental causal effects on behavior. Psychological Bulletin, 127(3), 291–324.
Sandler, I. N., Ayers, T. S., Wolchik, S. A., Tein, J.-Y., Kwok, O.-M., Haine, R. A., Twohey, J. L., Suter, J., Lin, K., Padgett-Jones, S., Weyer, J. L., Cole, E., Kriege, G., & Griffin, W. A. (2003). The Family Bereavement Program: Efficacy evaluation of a theory-based prevention program for parentally-bereaved children and adolescents. Journal of Consulting and Clinical Psychology, 71(3), 587–600.
Sandler, I., Wolchik, S., Braver, S., & Fogas, B. (1991). Stability and quality of life events and psychological symptomatology in children of divorce. American Journal of Community Psychology, 19(4), 501–520.
Sandler, I. N., & Guenther, R. T. (1985). Assessment of life stress events. In P. Karoly (Ed.), Measurement strategies in health psychology (pp. 555–600). New York: Wiley.
Sandler, I. N., Ramirez, R., & Reynolds, K. D. (1986). Life stress for children of divorce, bereaved and asthmatic children. Paper presented at the American Psychological Association Convention, Washington, DC.
Sandler, I. N., Tein, J. Y., Mehta, P., Wolchik, S., & Ayers, T. (2000). Coping efficacy and psychological problems of children of divorce. Child Development, 71(4), 1099–1118.
Sandler, I. N., Tein, J. Y., & West, S. G. (1994). Coping, stress, and the psychological symptoms of children of divorce: A cross-sectional and longitudinal study. Child Development, 65(6), 1744–1763.
Sandler, I. N., West, S. G., Baca, L., Pillow, D. R., Gersten, J., Rogosch, F., Virdin, L., Beals, J., Reynolds, K., Kallgren, C., Tein, J., Krieg, G., Cole, E., & Ramirez, R. (1992). Linking empirically based theory and evaluation: The Family Bereavement Program. American Journal of Community Psychology, 20(4), 491–521.
Schaefer, E. S. (1965). Children’s report of parental behavior: An inventory. Child Development, 36, 413–424.
Schmiege, S. J., Khoo, S. T., Sandler, I. N., Ayers, T., & Wolchick, S. A. (in press). Impact of intervention and gender on recovery curves of child mental health problems following parental bereavement. American Journal of Preventive Medicine.
Sheets, V., Sandler, I., & West, S. G. (1996). Appraisals of negative events by preadolescent children of divorce. Child Development, 67(5), 2166–2182.
Silverman, P. R. (2000). Never too young to know: Death in children’s lives. Oxford, NY: Oxford University Press.
Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structure equation models. In S. Leinhardt (Ed.), Social Methodology (pp. 290–312). San Francisco: Jossey Bass.
Sobel, M. E. (1986). Some new results in indirect effects and their standard errors in covariance structure models. Sociological Methodology, 16, 159–186.
Sobel, M. E. (1990). Effect analysis and causation in linear structural equation models. Psychometrika, 55, 495–515.
Stroebe, M. (2001). Gender differences in adjustment to bereavement: An empirical and theoretical review. Review of General Psychology, 5(1), 62–83.
Taborga, M. P. (2000). Effect size in mediation models. Unpublished Masters Thesis, Arizona State University, Tempe, AZ.
Tein, J. Y., Sandler, I. N., MacKinnon, D. P., & Wolchik, S. A. (2004). How did it work? Who did it work for? Mediation in the context of a moderated prevention effect for children of divorce. Journal of Consulting and Clinical Psychology, 72(4), 617–624.
Thompson, M. P., Kaslow, N. J., Price, A. W., Williams, K., & Kingree, J. B. (1998). Role of secondary stressors in the parental death-child distress relation. Journal of Abnormal Child Psychology, 26(5), 357–366.
Tremblay, G. C., & Israel, A. C. (1998). Children’s adjustment to parental death. Clinical Psychology: Science and Practice, 5(4), 424–438.
West, S. G., Sandler, I., Pillow, D. R., Baca, L., & Gersten, J. C. (1991). The use of structural equation modeling in generative research: Toward the design of a preventive intervention for bereaved children. Special Issue: Preventive Intervention Research Centers. American Journal of Community Psychology, 19(4), 459–480.
Wolchik, S. A., Tein, J. Y., Sandler, I. N., & Ayers, T. S. (2005). Self-system beliefs as mediators of the relations of stressors and caregiver–child relationship quality with children’s adjustment problems after parental death. Unpublished manuscript.
Wolchik, S. A., Tein, J. Y., Sandler, I. N., & Doyle, K. W. (2002). Fear of abandonment as a mediator of the relations between divorce stressors and mother-child relationship quality and children’s adjustment problems. Journal of Abnormal Child Psychology, 30(4), 401–418.
Wolchik, S. A., West, S. G., Westover, S., Sandler, I. N., Martin, A., Lustig, J., Tein, J. -Y., & Fisher, J. (1993). The Children of Divorce Intervention Project: Outcome Evaluation of an Empirically Based Parenting Program. American Journal of Community Psychology, 21(3), 293–331.
Wolchik, S. A., Wilcox, K. L., Tein, J. -Y., & Sandler, I. N. (2000). Maternal acceptance and consistency of discipline as buffers of divorce stressors on children’s psychological adjustment problems. Journal of Abnormal Child Psychology, 28(1), 87–102.
Worden, J. W. (1996). Children and grief: When a parent dies. New York: Guilford.
Worden, J. W., & Silverman, P. R. (1996). Parental death and the adjustment of school-age children. Omega Journal of Death and Dying, 33, 91–102.
Wyman, P. A., Sandler, I., Wolchik, S., & Nelson, K. (2000). Resilience as cumulative competence promotion and stress protection: Theory and intervention. In D. Cicchetti, J. Rappaport, R. P. Weissberg & I. N. Sandler (Eds.), The promotion of wellness in children and adolescents (pp. 133–184). Washington, DC, US: Child Welfare League of America, Inc.
Acknowledgements
Support for this research was provided by the National Institute of Mental Health Grant R01 MH49155-05 to evaluate the Family Bereavement Program and P30 MH068685 to fund the Advanced Center for Intervention and Services Research (ACISR) at Arizona State University. We are grateful to multiple people for their help in conducting this study including Laura Legge, Sonia Krainz, Diane Mignella, all of our dedicated interviewers, and the children and parents who participated in this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tein, JY., Sandler, I.N., Ayers, T.S. et al. Mediation of the Effects of the Family Bereavement Program on Mental Health Problems of Bereaved Children and Adolescents. Prev Sci 7, 179–195 (2006). https://doi.org/10.1007/s11121-006-0037-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-006-0037-2