Prevention Science

, Volume 19, Supplement 1, pp 49–59 | Cite as

Preventing Youth Internalizing Symptoms Through the Familias Unidas Intervention: Examining Variation in Response

  • Ahnalee BrincksEmail author
  • Tatiana Perrino
  • George Howe
  • Hilda Pantin
  • Guillermo Prado
  • Shi Huang
  • Gracelyn Cruden
  • C. Hendricks Brown


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.


Adolescent 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.

Supplementary material

11121_2016_666_MOESM1_ESM.docx (34 kb)
ESM 1 (DOCX 34 kb)
11121_2016_666_MOESM2_ESM.docx (34 kb)
ESM 1 (DOCX 34 kb)


  1. Adams, R. N., Mosher, C. E., Blair, C. K., Snyder, D. C., Sloane, R., & Demark‐Wahnefried, W. (2015). Cancer survivors’ uptake and adherence in diet and exercise intervention trials: An integrative data analysis. Cancer, 121, 77–83.CrossRefPubMedGoogle Scholar
  2. Avenevoli, S., Swendsen, J., He, J. P., Burstein, M., & Merikangas, K. R. (2015). Major depression in the National Comorbidity Survey- Adolescent Supplement: Prevalence, correlates, and treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 54, 37–44.CrossRefGoogle Scholar
  3. Barnes, H. L., & Olson, D. H. (1985). Parent-adolescent communication and the circumplex model. Child Development, 56, 438–447.CrossRefGoogle Scholar
  4. 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
  5. 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
  6. Cervantes, R. C., Padilla, A. M., & Salgado de Snyder, N. (1991). The Hispanic Stress Inventory: A culturally relevant approach to psychosocial assessment. Psychological Assessment, 3, 438–447.CrossRefGoogle Scholar
  7. Curran, P. J., & Hussong, A. M. (2009). Integrative data analysis: The simultaneous analysis of multiple data sets. Psychological Methods, 14, 81.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 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
  9. Garber, J. (2006). Depression in children and adolescents: Linking risk research and prevention. American Journal of Preventive Medicine, 31, 104–125.CrossRefGoogle Scholar
  10. 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. 10.1037/fam0000127.
  11. Horowitz, J. L., & Garber, J. (2006). The prevention of depressive symptoms in children and adolescents: A meta-analytic review. Journal of Consulting and Clinical Psychology, 74, 401–15.CrossRefPubMedGoogle Scholar
  12. Horwood, L. J., Fergusson, D. M., Coffey, C., Patton, G. C., Tait, R., Smart, D., & Hutchinson, D. M. (2012). Cannabis and depression: An integrative data analysis of four Australasian cohorts. Drug and alcohol dependence, 126, 369–378.CrossRefPubMedGoogle Scholar
  13. Hovey, J. D., & King, C. A. (1996). Acculturative stress, depression, and suicidal ideation among immigrant and second-generation Latino adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 35, 1183–1192.CrossRefGoogle Scholar
  14. Hussong, A. M., Curran, P. J., & Bauer, D. J. (2013). Integrative data analysis in clinical psychology research. Annual Review of Clinical Psychology, 9, 61.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 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
  16. Jo, B., Wang, C. P., & Ialongo, N. S. (2009). Using latent outcome trajectory classes in causal inference. Statistics and Its Interface, 2, 403–12.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Kessler, R. C., Avenevoli, S., Costello, J., Green, J. G., Gruber, M. J., McLaughlin, K. A., & Merikangas, K. R. (2012). Severity and 12-month DSM-IV disorders in the National Comorbidity Survey-Adolescent Supplement. Archives of General Psychiarty, 69, 381–9.CrossRefGoogle Scholar
  18. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.CrossRefPubMedGoogle Scholar
  19. 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.
  20. Mun, E. Y., de la Torre, J., Atkins, D. C., White, H. R., Ray, A. E., Kim, S. Y., & Huh, D. (2014). Project INTEGRATE: An integrative study of brief alcohol interventions for college students. Psychology of Addictive Behaviors, 29, 34–48.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Muthén, B., & Brown, C. H. (2009). Estimating drug effects in the presence of placebo response: Causal inferences using growth mixture modeling. Statistics in Medicine, 28, 3363–3385.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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
  23. 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
  24. 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
  25. Pantin, H., Prado, G., Lopez, B., Huang, S., Tapia, M. I., Schwartz, S. J., & Branchini, J. (2009). A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems. Psychosomatic Medicine, 71, 987–95.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 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
  27. 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
  28. 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
  29. 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
  30. Quay, H. C., & Peterson, D. R. (1993). The Revised Behavior Problem Checklist: Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  31. Restifo, K., & Bögels, S. (2009). Family processes in the development of youth depression: Translating the evidence to treatment. Clinical Psychology Review, 29, 294–316.CrossRefPubMedGoogle Scholar
  32. Rueter, M. A., Scaramella, L., Wallace, L. E., & Conger, R. D. (1999). First onset of depressive or anxiety disorders predicted by longitudinal course of internalizing symptoms and parent-adolescent disagreements. Archives of General Psychiatry, 56, 726–32.CrossRefPubMedGoogle Scholar
  33. Saluja, G., Iachan, R., Scheidt, P. C., Overpeck, M. D., Sun, W., & Giedd, J. N. (2004). Prevalence of and risk factors for depressive symptoms among young adolescents. Archives of Pediatric & Adolescent Medicine, 158, 760–5.CrossRefGoogle Scholar
  34. Sandler, I., Schoenfelder, E., Wolchik, S., & MacKinnon, D. (2011). Long-term impact of prevention programs to promote effective parenting: Lasting effects but uncertain processes. Annual Review of Psychology, 62, 299–329.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 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
  36. Schafer, J. L. (1997). Analysis of incomplete multivariate data. Boca Raton: CRC press.Google Scholar
  37. 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
  38. 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, 617–24.CrossRefPubMedGoogle Scholar
  39. Thomas, A., Forehand, R., Armistead, L., Wierson, M., & Fauber, R. (1990). Cross-informant consistency in externalizing and internalizing problems in early adolescence. Journal of Psychopathology and Behavioral Assessment, 12, 255–62.CrossRefGoogle Scholar
  40. Trudeau, L., Spoth, R., Randall, G. K., Mason, W. A., & Shin, C. (2012). Internalizing symptoms: Effects of a preventive intervention on developmental pathways from early adolescence to young adulthood. Journal of Youth and Adolescence, 41, 788–801.CrossRefPubMedGoogle Scholar
  41. Wang, C. P., Brown, C. H., & Bandeen-Roche, K. (2005). Residual diagnostics for growth mixture models: Examining the impact of a preventive intervention on multiple trajectories of aggressive behavior. Journal of the American Statistical Association, 100, 1054–76.CrossRefGoogle Scholar
  42. Wesselhoeft, R., Sørensen, M. J., Heiervang, E. R., & Bilenberg, N. (2013). Subthreshold depression in children and adolescents–a systematic review. Journal of Affective Disorders, 151, 7–22.CrossRefPubMedGoogle Scholar
  43. Wolffe, J. C., & Ollendick, T. H. (2006). The comorbidity of conduct problems and depression in childhood and adolescence. Clinical Child and Family Psychology Review, 9, 201–20.CrossRefGoogle Scholar
  44. Zahn-Waxler, C., Klimes-Dougan, B., & Slattery, M. J. (2000). Internalizing problems of childhood and adolescence: Prospects, pitfalls, and progress in understanding the development of anxiety and depression. Development & Psychopathology, 12, 443–66.CrossRefGoogle Scholar

Copyright information

© Society for Prevention Research 2016

Authors and Affiliations

  • Ahnalee Brincks
    • 1
    Email author
  • Tatiana Perrino
    • 1
  • George Howe
    • 2
  • Hilda Pantin
    • 1
  • Guillermo Prado
    • 1
  • Shi Huang
    • 1
  • Gracelyn Cruden
    • 3
  • C. Hendricks Brown
    • 3
  1. 1.Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.George Washington UniversityWashingtonUSA
  3. 3.Feinberg School of Medicine, Northwestern UniversityChicagoUSA

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