Differences in Internalizing Symptoms Across Specific Ethnic Minority Groups: An Analysis Across Chinese American,Filipino American,Japanese American,Native Hawaiian,and White Youth

Research to date on child and adolescent anxiety and depression have focused predominantly on major ethnic groups. Very few studies to date have been conducted on specific ethnic minority groups and the relatively few studies on these ethnic minority samples have produced mixed findings. The following question therefore still remains: Do specific ethnic subgroups differ with respect to their expression of anxiety and depression? And do these differences differ as a function of reporter type (i.e., youth versus parent)? If the expression of internalizing symptoms differs across specific ethnic subgroups, these differences could inform approaches to assessing and treating these populations. In the current study, we therefore examined ethnic differences in anxiety and depression symptoms in ethnic subgroups. A total of 629 children and adolescents from various public and private schools, aged 8–18 years (M = 12.37, SD = 2.8) and their caregivers completed anxiety and depression scales. Multiple indicators, multiple causes confirmatory factor analysis revealed that the following specific ethic subgroups were associated with significantly greater anxiety and depression relative to Caucasian youth: Chinese American, Filipino American, Japanese American, and Native Hawaiian. These results were found only among parent (but not youth) reports. Age and low SES status was also associated with more internalizing problems among Chinese, Filipino, and Japanese American youth. Implications related to ethnic minority subgroup differences and the role of multi-informant reports in understanding the relationship between anxiety, depression and ethnic minority subgroups are discussed.     

Parent and Family Characteristics and Their Associates in a Follow-Up of Outpatient Children with ADHD

We examined associations between child symptoms, demographic variables, parent and family characteristics in a long-term follow-up study of 214 outpatient children with attention-deficit/hyperactivity disorder (ADHD). The children’s mean age was 12.6 (SD = 2.1) years, and the mean interval from diagnosis to follow-up was 3.7 (SD = 2.2) years. We compared the characteristics of the clinical group with a community group (n = 110) recruited from the same catchment area. Parents filled out questionnaires on child symptoms, parent characteristics, and family functioning. The results showed that parents of young boys (<13 years) experienced more parenting stressors than those of adolescent boys (≥13 years), but the opposite was true for parents of girls. Parents of children with both ADHD and oppositional defiant disorder symptoms in the clinical range experienced significantly more parent and family dysfunctions than those of children with ADHD only (even after controlling for levels of ADHD symptoms in the child). Parents of children in the community group experienced significantly less parent and family dysfunctions than those of children with ADHD. Partial correlations between parent characteristics and child symptoms showed that oppositional symptoms were most strongly associated with parent and family dysfunction. Fathers experienced significantly less parenting stress, parental efficacy, and child involvement than mothers. We conclude that parents of children with ADHD experienced considerable strain related to a broad range of parent and family characteristics. Assessment of such characteristics should be part of routine assessment procedures and a prerequisite for family-focused treatment of children with ADHD.     

The Association of Parent Mindfulness with Parenting and Youth Psychopathology Across Three Developmental Stages

The primary purpose of the current study was to test a model examining the process by which parent dispositional mindfulness relates to youth psychopathology through mindful parenting and parenting practices. The universality of the model across youth at three developmental stages was examined: young childhood (3–7 years; n?=?210), middle childhood (8–12 years; n?=?200), and adolescence (13–17 years; n?=?205). Overall, participants were 615 parents (55 % female) and one of their 3-to-17 year old children (45 % female). Parents reported on their dispositional mindfulness, mindful parenting, positive and negative parenting practices and their child’s or adolescent’s internalizing and externalizing problems. Consistent findings across all three developmental stages indicated that higher levels of parent dispositional mindfulness were indirectly related to lower levels of youth internalizing and externalizing problems through higher levels of mindful parenting and lower levels of negative parenting practices. Replication of these findings across families with children at different developmental stages lends support to the generalizability of the model.     

Made in America: Perspectives on Friendship in West African Immigrant Families

This qualitative study compared West African immigrant parents’ and adolescents’ perspectives on parental monitoring of adolescents’ peer groups. Parents (n = 31) and adolescent children (n = 25) were interviewed using focus groups and individual interviews, and data were analyzed using a grounded theory approach. Parents expressed a general concern about external influences on their children, particularly their mistrust of their children’s friends. Adolescents reported that they were aware of their parents’ fears and described their attempts to manage their parents’ concerns while simultaneously maintaining friendships with same-ethnic and other-ethnic peers. This study offers both parent and adolescent perspectives in an effort to better understand adolescents’ peer socialization and parental monitoring among West African immigrant families, one of the fastest growing demographic groups in the United States. Recommendations for mental health professions are discussed.     

<Emphasis Type="Italic">DSM-5</Emphasis> Posttraumatic Stress Disorder Symptom Structure in Disaster-Exposed Adolescents: Stability across Gender and Relation to Behavioral Problems

Given the significant modifications to posttraumatic stress disorder (PTSD) symptom criteria from DSM-IV to DSM-5, a better understanding of the dimensionality underlying DSM-5 PTSD symptoms among adolescents is needed. However, to date, whether gender moderates the latent structure of DSM-5 PTSD symptoms in youth remains unclear. Meanwhile, little is known about how distinct PTSD dimensions relate to adolescent behavioral problems. The aim of this study was to fill these gaps. A sample of 1184 disaster-exposed Chinese adolescents (53.8 % girls) with age ranging from 13 to 17 years (M = 14.3, SD = 0.8) completed the PTSD Checklist for DSM-5, and the Withdrawn, Aggressive Behavior, and Delinquent Behavior subscales of the Youth Self-Report. Confirmatory factor analyses revealed that the seven-factor hybrid PTSD model provided the best fit to the data for both girls and boys. Measurement equivalence of this model held across gender, although girls had higher mean scores than boys on some factors. Differential patterns of associations emerged between PTSD dimensions and behavioral problems, with anhedonia symptoms most strongly relating to social withdrawal, and externalizing behavior symptoms most strongly relating to aggression and delinquency. These findings further support the gender invariance and external criterion validity of the newly refined hybrid model that best represents DSM-5 PTSD symptom structure in youth, and carry implications for accurate assessment, diagnosis, and gender comparison of DSM-5 PTSD symptomatology, and potential symptom targets for PTSD intervention among adolescent disaster survivors.     

Cyber Victimization and Internalizing Difficulties: The Mediating Roles of Coping Self-Efficacy and Emotion Dysregulation

Cyber victimization has consistently been associated with internalizing difficulties in adolescents. However, the underlying psychological mechanisms linking this relationship have not been adequately examined. The present study aimed to investigate the mediational roles of coping self-efficacy and emotion dysregulation in the relationships between cyber victimization with depression and social anxiety. Participants were 459 students (199 girls) from independent middle-class schools in grades 8 (M _age ?=?13 years 9 months) and 10 (M _age ?=?15 years 7 months). They completed a self-report questionnaire about cyberbullying participation, internalizing symptoms, coping self-efficacy, and emotion dysregulation. Structural equation modeling revealed that most domains of coping self-efficacy and emotion dysregulation partially mediated the relationship between cyber victimization and depression, and fully mediated the relationship between cyber victimization and social anxiety. The results highlight the importance of targeting these mediating factors in intervention programs to reduce the negative impact of cyber victimization on adolescents.     

Parenting Behaviors of Mothers and Fathers of Preschool Age Children with Internalizing Disorders

This study investigated parenting behaviors of mothers and fathers of clinically anxious preschool children (with or without depressive comorbidity) and healthy comparison children. Studies assessing children from early school age onwards have found that parental control, rejection, and inconsistent discipline are associated with the presence of children’s internalizing symptoms/disorders. Despite the scarcity of studies investigating these associations at preschool age, we assumed that findings with older children would also apply to children in this age group. In a cross-sectional study we assessed N = 176 children of preschool age (M = 5; 2 years) and both of their parents. A diagnostic interview (Preschool Age Psychiatric Assessment) was conducted to determine children’s psychiatric diagnoses, yielding the following results: a group of n = 67 children with pure anxiety disorders (AD group), a group of n = 38 children with anxiety disorders with depressive comorbidity (AD/DC group), and a comparison group of n = 71 children without psychiatric disorders. Both parents completed the German extended version of the Alabama Parenting Questionnaire. We evaluated maternal depressive symptoms and children’s temperament as further correlates. All variables that differed significantly between groups were entered into multinomial logistic regression analyses to test which variables predict group membership. When comparing each of the two anxiety groups with the comparison group we obtained the following results: (1) Inconsistent paternal discipline and maternal depressive symptoms increased and children’s positive affectivity decreased the probability of children of being in the AD group rather than in the comparison group. (2) Maternal overinvolvement, maternal depressive symptoms and children’s negative affectivity increased and children’s positive affectivity decreased the probability of children of belonging to the AD/DC group rather than to the comparison group. When comparing the two anxiety groups with each other, we found that inconsistent paternal discipline increased and children’s negative affectivity decreased the probability of children of being in the AD group rather than in the AD/DC group. The results suggest that paternal parenting behaviors show different associations with internalizing disorders at preschool age than maternal parenting behaviors. This underlines the importance of including fathers in the prevention and treatment of internalizing disorders at preschool age.     

Depressive Symptoms in Mothers and Daughters: Attachment Style Moderates Reporter Agreement

Parents and adolescents show only modest agreement when reporting on depressive symptoms. Drawing from attachment theory and previous research on informant discrepancies, we tested hypotheses about how adolescent attachment style may impact reporting agreement in a sample of 184 low-income mother-adolescent daughter dyads (adolescent mean age = 15.4 (SD = 1.05), maternal mean age = 41.4 (SD = 7.60); 58 % Latina, 26 % African-American/Black, 16 % as non-Hispanic, White). Mothers and adolescents reported on their own and each others’ depressive symptoms and adolescents reported on attachment style. Using a moderated Actor Partner Interdependence Model (APIM) to calculate reporter bias and accuracy estimates, we tested whether attachment style moderated maternal and adolescent accuracy in theoretically consistent ways. Mothers and adolescents showed similar levels of accuracy and bias when reporting on each other. Consistent with hypotheses, we found that adolescents who reported high levels of preoccupation were less accurate when reporting on their mothers because they tended to observe symptoms that their mothers did not endorse. Conversely, mothers were the most accurate in these dyads, potentially because preoccupied adolescents tend to elevate displays of emotional distress. Reporting accuracy was not affected by a dismissive style. These results add to literature indicating that parent-child reporting discrepancies often reflect meaningful information about relationships, and highlight the need to consider different sources of reporting bias and accuracy in assessment and treatment.     

Mental Health Symptoms and Parenting Stress of Parents of Court-Involved Youth

Youth involved in the juvenile justice system are at risk for emotional and behavioral problems. However, research with court-involved adolescents has neglected to examine the mental health of their parents, who may also have significant personal and parenting stress. This sample consisted of 144 parent–adolescent dyads. Adolescents (aged 11–17 years) identified by court officials were referred to the study to receive mental health treatment. Parents and adolescents completed surveys about their mental health diagnoses, treatment, and family relationships. Using the clinical cut-off for the global severity index of the Symptom Checklist-90-Revised, bivariate and multiple logistic regression analyses were performed to examine group differences between parents with and without significant mental health symptoms. Results indicated that 35% of parents endorsed clinically significant mental health symptoms. Parents with clinically significant symptoms, compared to those without, reported significantly greater parenting stress (p?<?.05), and were more likely to have received prior mental health treatment (54 vs. 25%; p?<?.05) and a psychiatric diagnosis (52 vs. 19%; p?<?.05). Our findings revealed that more than one in three parents of court-involved adolescents are currently experiencing significant mental health symptoms. Improved mental health screening and intervention that incorporates the unique needs of families is recommended, including the possible use of family-based approaches as well as individualized treatment for the parents of court-involved youth.     

Behavioral Problems Reported by Adolescents and Parents from HIV Affected Families in China

This study examined the influence of various factors on the behavioral problems of adolescents affected by HIV while considering the agreement between adolescent and parent reports on problem behaviors. A total of 136 families each with one parent living with HIV (PLH) and one child aged 13–18 were included. Structural equation modeling was used to explore relationships between selected family measures and adolescent’s problem behaviors. The correlation between the PLH and adolescent-reported behavioral problem measures was low (β?=?0.11). PLH-reported adolescent problem behaviors were negatively related to PLH-reported parental bonding (β?=??0.39), family routines (β?=??0.26), and positively associated with family conflict (β?=?0.21). Adolescent-reported family participation was associated with self-reported problem behaviors (β?=??0.35). Our study reported discrete perceptions of adolescent problem behaviors from parents’ and adolescents’ points of view. Future intervention efforts should emphasize family contextual factors to improve behavioral outcomes in adolescents affected by HIV.     

Maltreated Children in Out-of-Home Care: The Relation between Attachment Quality and Internalizing Symptoms

Maltreated children in out-of-home care are at high risk for poor relationships with caregivers (i.e., biological parents and substitute caregivers) and high levels of internalizing symptoms. It is unclear if these poor relationships are related to, and account for a large portion of the variance in maltreated children’s internalizing symptoms, above and beyond maltreatment type and out-of-home care factors. This study examined the relation between attachment quality with both biological parents and substitute caregivers and children’s internalizing symptoms within a sample of 493 maltreated children (aged 9–11; 51.0?% male) recently placed in out-of-home care. A series of hierarchical regression models indicated that greater child-reported attachment quality with both biological parents and substitute caregivers was associated with fewer child-reported anxiety (β?=??.15, p?<?.01; β?=??.29, p?<?.001, respectively) and depression symptoms (β?=??.14, p?<?.01; β?=??.28, p?<?.001, respectively) as well as fewer child internalizing symptoms (β?=??.12, p?<?.05; β?=??.14, p?<?.01, respectively). Attachment quality with the biological parent and substitute caregiver each explained a significant proportion of the variance in children’s internalizing symptoms, above and beyond child demographics, maltreatment type, and out-of-home care variables. The study also examined whether children’s attachment with substitute caregivers moderated the relationship between children’s attachment with biological parents and children’s internalizing symptoms. No statistically significant moderation effects were found. Future clinical work should focus on enhancing attachment quality between children and both biological parents and substitute caregivers, as these relationships appear to individually relate to the children’s internalizing symptomology.     

Parental Depressive Symptoms as a Predictor of Outcome in the Treatment of Child Depression

Child depression is an impairing condition for which psychotherapies have shown modest effects. Parental depression is a risk factor for development of child depression and might also be negatively associated with child depression treatment outcomes. To explore this possibility, we analyzed data from a study in which children were treated for depression after parental depressive symptoms had been assessed at baseline. Among children treated for depression in a randomized controlled trial, we identified 31 who had child- and parent-report pre- and post-treatment data on child symptoms and parent-report of pre-treatment parental depressive symptoms. Children were aged 8–13, 77% boys, and 52% Caucasian, 13% African-American, 6% Latino, and 29% multi-racial. Analyses focused on differences in trajectories of change (across weekly measurements), and post-treatment symptoms among children whose parents did (n = 12) versus did not (n = 19) have elevated depressive symptoms at baseline. Growth curve analyses showed markedly different trajectories of change for the two groups, by both child-report (p = 0.03) and parent-report (p = 0.03) measures: children of parents with less severe depression showed steep symptom declines, but children of parents with more severe depression showed flat trajectories with little change in symptoms over time. ANCOVAs showed lower post-treatment child symptoms for children of parents with less severe depression versus parents with more severe depression (p = 0.05 by child report, p = 0.01 by parent report). Parental depressive symptoms predict child symptom trajectories and poorer child treatment response, and may need to be addressed in treatment.     

Adolescent Cell Phone Communications with Mothers and Fathers: Content,Patterns, and Preferences

Adolescents participated in qualitative interviews (N?=?40) and permitted researchers to check their cell phone histories (N?=?35) for the content and frequency of text and call communications with parents. Communications focused predominantly on day-to-day “managerial” aspects of parent–child relationships but also facilitated emotional connections between adolescents and parents. Adolescents preferred to use texts to engage in managerial communications and calls to connect emotionally, but logistical constraints resulted in most cell phone communications between adolescents and parents involving calls. Participants communicated more with mothers than fathers, regardless of communication content or medium. This was true regardless of family structure, although gender-of-parent differences were accentuated for adolescents in mother-only households. This pattern was explained by both greater maternal accessibility and adolescent preferences for communication with mothers. Communications with fathers tended to occur either when mothers were not available or when the communication was focused on a highly specific set of stereotypically masculine content areas.     

Siblings’ Perceptions of Differential Treatment,Fairness, and Jealousy and Adolescent Adjustment: A Moderated Indirect Effects Model

Youth’s perception of parents’ differential treatment (PDT) are associated with maladjustment during adolescence. Although the direct relations between PDT and youth’s maladjustment have been well established, the mechanisms underlying these associations remain unclear. We addressed this gap by examining whether sibling jealousy accounted for the links between PDT and youth’s depressive symptoms, self-worth, and risky behaviors. Additionally, we examined whether youth’s perceptions of fairness regarding their treatment as well as the gender constellation of the dyad moderated these indirect relations (i.e., moderated-indirect effects). Participants were first- and second-born adolescent siblings (M = 15.96, SD = .72 years for older siblings, M = 13.48, SD = 1.02 years for younger siblings) and their parents from 197 working and middle class European American families. Data were collected via home interviews. A series of Conditional Process Analyses revealed significant indirect effects of PDT through sibling jealousy to all three adjustment outcomes. Furthermore, perceptions of fairness moderated the relations between PDT and jealousy, such that the indirect effects were only significant at low (?1 SD) and average levels of fairness. At high levels of fairness (+1 SD) there was no association between PDT, jealousy, and youth adjustment. Taken together, results indicate that youth and parents would benefit from engaging in clear communication regarding the reasoning for the occurrence of differential treatment, likely maximizing youth and parent perceptions of that treatment as being fair and in turn mitigating sibling jealousy and maladjustment.     

Interactive Effects of Psychosocial Stress and Early Pubertal Timing on Youth Depression and Anxiety: Contextual Amplification in Family and Peer Environments

While off-time pubertal development has emerged as a potential risk factor for both symptoms of depression and anxiety in youth, the literature is mixed and inconsistent as to (1) how early versus late pubertal timing confers risk for both boys and girls, (2) if the conferred risk is distinct between symptoms of anxiety and depression, and (3) under what social contexts (e.g., family environment, peer relationships) off-time pubertal development may emerge as a potent risk factor for these symptoms. The present study examined the impact of perceived pubertal timing on symptoms of anxiety and depression in two distinct psychosocial contexts: parent’s perceptions of their own harsh parenting and parent’s perceptions of their child’s peer problems. The sample consisted of 412 parents (M = 38.6 years old, SD = 7.8, 60.4 % mothers) of children between the ages of 8 and 17 (M = 12.13, SD = 2.97, 45.4 % girls). All constructs were assessed by parent reports. Linear multiple regression analyses revealed that the interaction between earlier pubertal timing and greater peer problems was significantly related to higher youth depressive and anxiety symptoms. The interaction between earlier pubertal timing and greater harsh discipline was significantly related to higher youth anxiety but not depressive symptoms. Youth gender did not qualify findings. Results suggest that the contextual amplification process of early pubertal timing may occur in both high stress family and peer environments and impact both girls and boys.     

Distress Tolerance and Social Support in Adolescence: Predicting Risk for Internalizing and Externalizing Symptoms Following a Natural Disaster

The purpose of the multi-measure, multi-wave, longitudinal study was to examine the interactive relation between behavioral distress tolerance (DT) and perceived social support (PSS) in 352 tornado-exposed adolescents aged 12–17 years (M = 14.44; SD = 1.74). At baseline, adolescents completed a computer-based task for DT, and self-report measures of PSS, depressed mood, posttraumatic stress disorder (PTSD), substance use, and interpersonal conflict. Symptoms also were assessed 4 and 12 months after baseline. Findings showed that lower levels of DT together with lower levels of PSS conferred risk for elevated symptoms of prospective depression (t(262) = ?2.04, p = .04; r_{effect size} = 0.13) and PTSD (t(195) = ?2.08, p = .04; r_{effect size} = 0.15) following a tornado. However, only PSS was significant in substance use t(139) = 2.20, p = .03; r_{effect size=}0.18) and conflict (t(138) = ?4.05, p < .0001; r_{effect size=}0.33) in our sample. Implications regarding adolescent DT, the transdiagnostic nature of PSS, and the clinical applications of our findings in the aftermath of a natural disaster are discussed.     

Longitudinal Associations between Depression and Aggression in Children and Adolescents

Due to the longstanding and detrimental effects of engaging in aggressive behaviour and of experiencing symptoms of internalizing problems in children and adolescents, there is an increasing interest in identifying the temporal sequence between these 2 problems with previous research yielding inconsistent findings. Therefore, the longitudinal links between relational aggression, physical aggression, and depression were examined across 7 years in a sample of 643 children (54 % girls) aged 10 at Time 1. Three models were compared— (1) the failure model, in which aggression predicted depression, (2) the acting out model, in which depression predicted aggression, and (3) a reciprocal model, in which both aggression and depression shared a reciprocal relation over time. Cross-lagged path analyses using structural equation modeling supported the failure model (i.e., engaging in relational and physical aggression predicts subsequent depressive symptoms). Findings were similar for boys and girls. These findings add to the literature suggesting that externalizing problems precede internalizing problems.     

Impaired Fear Recognition and Social Anxiety Symptoms in Adolescence

This study represents the first examination of adolescent anxiety in relation to peer emotion recognition, rather than adult emotion recognition. Additionally, we examine potential mechanisms for the development of social anxiety in females. Facial emotion recognition (FER) is important for accurate social cognition, which is impaired in individuals with various disorders, including anxiety disorders. Social anxiety often onsets during adolescence, is observed more commonly in females, and is often associated with FER difficulties. Given the importance of peer interaction during adolescence, and some evidence that FER may differ as a function of the stimuli (adolescent or adult faces), we sought to study FER in relation to social anxiety symptoms using stimuli portraying adolescent faces. Male and female adolescents (N = 64) completed an online survey in which they rated 257 child and adolescent emotional faces and completed a self-report measure of social anxiety symptoms. We examined differences in emotion recognition (e.g., fear, anger, sadness) between individuals with high and low levels of social anxiety symptoms. Adolescents with high social anxiety symptoms were more likely to have problems correctly identifying fearful expressions (90.55 % accuracy) compared to adolescents with low social anxiety symptoms (96.00 % accuracy; t = 2.375, p = .021, d = 0.594), and this effect was observed exclusively in female adolescents. The observed sex difference in accurate identification of fearful faces in relation to social anxiety could suggest a potential mechanism for social anxiety development in adolescent females.     

Interplay between Attachment to Peers and Parents in Korean Adolescents’ Behavior Problems

The present study investigated the relative contribution of style of peer attachment (secure, anxious, avoidant) and quality of attachment to parents on behavior problems in Korean adolescents. In addition, we examined the role of paternal and maternal attachment separately as a potential moderator in the relationship between style of peer attachment and internalizing and externalizing behavior problems. Middle school students (245 males, 209 females) completed the Korean version of the Adolescent Friendship Attachment Scale, Inventory of Parental and Peer Attachment-Revised, and Youth Self-Report. Attachment to peers and parents as predictors of behavior problems were tested via hierarchical multiple regression analyses. Results revealed that anxious peer attachment remained the strongest predictor of behavior problems among adolescents (internalizing behavior problems β?=?.18, p?<?.01; externalizing behavior problems β?=?.21, p? <?.001), indicating the relative importance of peer relationship compared to attachment to parents. Paternal attachment significantly moderated the relationship between avoidant peer attachment and externalizing behavior problems (β?=?.15, p?<?.05), even when the main effect of avoidant peer attachment on externalizing behavior problems was not significant. Results highlight the role of both attachments to peers and parents on adolescents’ psychological adjustment.     

A Randomized Controlled Trial of the Impact of a Family-Based Adolescent Depression Intervention on both Youth and Parent Mental Health Outcomes

This paper presents findings from a multi-centre, double-blind, randomized controlled trial that tested the hypothesis that parent and youth mental health improvements would be superior in a family-based intervention for adolescent depression (BEST MOOD) compared to a treatment-as-usual supportive parenting program (PAST). Eligible participants were families with a young person aged between 12 and 18 years who met diagnostic criteria for a depressive disorder (major, minor or dysthymic). Participating families (N = 64; 73.4% of youth were female) were recruited in Victoria, Australia and allocated to treatment condition using a block randomization procedure (parallel design) with two levels of blinding. This paper reports on the trial’s secondary outcomes on youth and parent mental health. General linear mixed models were used to examine the longitudinal effect of treatment group on outcome. Data were analyzed according to intention-to-treat; 31 families were analyzed in BEST MOOD, and 33 families in PAST. Parents in the BEST MOOD group experienced significantly greater reductions in stress and depressive symptoms than parents in the PAST group at 3-month follow-up. A greater reduction in parental anxiety was observed in the BEST MOOD group (d = 0.35) compared with PAST (d = 0.02), although the between-group difference was not significant. Both groups of youth showed similar levels of improvement in depressive symptoms at post-treatment (d = 0.83 and 0.80 respectively), which were largely sustained at a 3-month follow-up. The family-based BEST MOOD intervention appeared superior to treatment-as-usual (PAST) in demonstrating greater reductions in parental stress and depression. Both interventions produced large reductions in youth depressive symptoms.