Preventing Youth Internalizing Symptoms Through the Familias Unidas Intervention: Examining Variation in Response
- 390 Downloads
Prevention programs that strengthen parenting and family functioning have been found to reduce poor behavioral outcomes in adolescents, including substance use, HIV risk, externalizing and internalizing problems. However, there is evidence that not all youth benefit similarly from these programs. Familias Unidas is a family-focused intervention designed to prevent substance use and sexual risk among Hispanic youth and has recently demonstrated unanticipated reductions in internalizing symptoms for some youth. This paper examines variation in intervention response for internalizing symptoms using individual-level data pooled across four distinct Familias Unidas trials: (1) 266 eighth grade students recruited from the general school population; (2) 160 ninth grade students from the general school population; (3) 213 adolescents with conduct, aggression, and/or attention problems; and (4) 242 adolescents with a delinquency history. Causal inference growth mixture modeling suggests a three-class model. The two largest classes represent youth with low (60 %) and medium (27 %) internalizing symptoms at baseline, and both intervention and control participants show reductions in internalizing symptoms. The third class (13 %) represents youth with high levels of baseline internalizing symptoms who remain at steady levels of internalizing symptoms when exposed to the intervention, but who experience an increase in symptoms under the control condition. Female gender, low baseline levels of parent–adolescent communication, and older age were associated with membership in the high-risk class. These synthesis analyses involving a large sample of youth with varying initial risk levels represent a further step toward strengthening our knowledge of preventive intervention response and improving preventive interventions.
KeywordsAdolescent Internalizing symptoms Variation in response Hispanic Family Prevention Integrative data analyses (IDA)
Compliance with Ethical Standards
This work was supported by the following grants: National Institute of Mental Health Grant No. R01MH040859 (C. Hendricks Brown, PI); National Institute of Mental Health Grant No. R01MH61143 (Jose Szapocznik, PI); National Institute on Drug Abuse Grant No. R01DA017462 (Hilda Pantin, PI); National Institute on Drug Abuse Grant No. R01DA025894 (Guillermo Prado, PI); Centers for Disease Control and Prevention Grant No. U01PS000671 (Guillermo, Prado, PI).
Conflicts of Interest
The authors declare that they have no conflict of interest.
Statement of Human Rights
All procedures performed in the original studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, synthesizing data across multiple, completed randomized clinical trials, formal consent is not required.
- Biglan, A., Flay, B. R., Embry, D. D., & Sandler, I. N. (2012). The critical role of nurturing environments for promoting human well-being. American Psychologist, 67, 257-71.Google Scholar
- Brown, C. H., Sloboda, Z., Faggiano, F., Teasdale, B., Keller, F., Burkhart, G., Vigna-Tagliant, F., Howe, G., Masyn, K., Wang, W., Muthén, B., Stephens, P., Grey, S., & Perrino, T. (2013). Methods for synthesizing findings on moderation effects across multiple randomized trials. Prevention Science, 14, 144–156.CrossRefPubMedPubMedCentralGoogle Scholar
- Estrada, Y., Rosen, A., Huang, S., Tapia, M., Sutton, M., Willis, L., et al. (2015). Efficacy of a brief intervention to reduce substance use and Human Immunodeficiency Virus infection risk among Latino youth. Journal of Adolescent Health, 57(6), 651–657.Google Scholar
- Greenbaum, P. E., Wang, W., Henderson, C. E., Kan, L., Hall, K., Dakof, G. A., & Liddle, H. A. (2015). Gender and Ethnicity as Moderators: Integrative Data Analysis of Multidimensional Family Therapy Randomized Clinical Trials. Journal of Family Psychology. Advance online publication. http://dx.doi.org/ 10.1037/fam0000127.
- Ingoldsby, E. M., Kohl, G. O., McMahon, R. J., Lengua, L., & the Conduct Disorders Prevention Research Group. (2006). Conduct problems, depressive symptomatology and their co-occurring presentation in childhood as predictors of adjustment in early adolescence. Journal of Abnormal Psychology, 34, 603–21.Google Scholar
- Merry, S. N., Hetrick, S. E., Cox, G. R., Brudevold-Iversen, T., Bir, J. J., & McDowell, H. (2011). Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database Systematic Reviews, 12. doi: 10.1002/14651858.CD003380.pub3.
- Muthén, B., Brown, H., Leuchter, A., & Hunter, A. (2008). General approaches to analysis of course: Applying growth mixture modeling to randomized trials of depression medication. In P. E. Shrout (Ed.), Causality and psychopathology: Finding the determinants of disorders and their cures. Washington, DC: American Psychiatric Publishing.Google Scholar
- Neumark-Sztainer, D., Larson, N. I., Fulkerson, J. A., Eisenberg, M. E., & Story, M. (2010). Family meals and adolescents: what have we learned from Project EAT (Eating Among Teens)? Public health nutrition, 13, 1113–1121.Google Scholar
- NRC/IOM- National Research Council/Institute of Medicine. (2009). Committee on the Prevention of Mental Disorders and Substance Abuse among Children. In M. O’Connell, T. Boat, & K. Warner (Eds.), Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: National Academies Press.Google Scholar
- Perrino, T., Brincks, A., Howe, G., Brown, C. H., Prado, G., & Pantin, H. (2016). Reducing internalizing symptoms among high-risk, Hispanic adolescents: Mediators of a family intervention. Prevention Science, 17, 595–605.Google Scholar
- Perrino, T., Pantin, H., Prado, G., Huang, S., Brincks, A., Howe, G., & Brown, C. H. (2014). Preventing internalizing symptoms among Hispanic adolescents: A synthesis across Familias Unidas trials. Prevention Science. Epub ahead of print.Google Scholar
- Prado, G., Pantin, H., Briones, E., Schwartz, S. J., Feaster, D., Huang, S., & Szapocznik, J. (2007). A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents. Journal of Consulting and Clinical Psychology, 75, 914–26.CrossRefPubMedPubMedCentralGoogle Scholar
- Prado, G., Pantin, H., Huang, S., Cordova, D., Tapia, M. I., Velazquez, M. R., & Estrada, Y. (2012). Effects of a family intervention in reducing HIV risk behaviors among high-risk Hispanic adolescents: A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 166, 127–133.CrossRefGoogle Scholar
- Quay, H. C., & Peterson, D. R. (1993). The Revised Behavior Problem Checklist: Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
- Sandler, I., Wolchik, S. A., Cruden, G., Mahrer, N. E., Ahn, S., Brincks, A., & Brown, C. H. (2014). Overview of meta-analyses of the prevention of mental health, substance use, and conduct problems. Annual Review of Clinical Psychology. Epub ahead of Print.Google Scholar
- Schafer, J. L. (1997). Analysis of incomplete multivariate data. Boca Raton: CRC press.Google Scholar
- Stice, E., Shaw, H., Bohon, C., Marti, C. N., & Rohde, P. (2009). A meta-analytic review of depression prevention programs for children and adolescents: Factors that predict magnitude of intervention effects. Journal of Consulting and Clinical Psychology, 77, 486–503.CrossRefPubMedPubMedCentralGoogle Scholar