A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: Results of the Pleasant Events Program (PEP)

Dementia caregiving is associated with elevations in depressive symptoms and increased risk for cardiovascular diseases (CVD). This study evaluated the efficacy of the Pleasant Events Program (PEP), a 6-week Behavioral Activation intervention designed to reduce CVD risk and depressive symptoms in caregivers. One hundred dementia family caregivers were randomized to either the 6-week PEP intervention (N = 49) or a time-equivalent Information-Support (IS) control condition (N = 51). Assessments were completed pre- and post-intervention and at 1-year follow-up. Biological assessments included CVD risk markers Interleukin-6 (IL-6) and D-dimer. Psychosocial outcomes included depressive symptoms, positive affect, and negative affect. Participants receiving the PEP intervention had significantly greater reductions in IL-6 (p = .040), depressive symptoms (p = .039), and negative affect (p = .021) from pre- to post-treatment. For IL-6, clinically significant improvement was observed in 20.0% of PEP participants and 6.5% of IS participants. For depressive symptoms, clinically significant improvement was found for 32.7% of PEP vs 11.8% of IS participants. Group differences in change from baseline to 1-year follow-up were non-significant for all outcomes. The PEP program decreased depression and improved a measure of physiological health in older dementia caregivers. Future research should examine the efficacy of PEP for improving other CVD biomarkers and seek to sustain the intervention's effects.     

Feasibility,Acceptability, and Preliminary Outcomes of the Fortalezas Familiares Intervention for Latino Families Facing Maternal Depression

This pilot study examined the feasibility, acceptability, and preliminary outcomes of a linguistically and culturally adapted intervention for immigrant Latina mothers with depression and their families. Fortalezas Familiares (Family Strengths) is a community‐based, 12‐week, multifamily group intervention that aims to increase communication about family processes leading up to and affected by the mother's depression, build child coping and efficacy, enhance parenting competence and skills, and promote cultural and social assets within the family. In terms of feasibility, of 16 families who enrolled and participated in the intervention, 13 families attended more than 90% of meetings and completed the intervention. Posttests reported positive changes following the intervention, including improved psychological functioning, increased family and marital support, and enhanced family functioning, as reported by mothers and other caregivers. Mothers also reported decreased conduct and hyperactivity problems among their children. Children reported positive changes in their psychological functioning and coping, parenting warmth and acceptance, and overall family functioning. Postintervention focus groups and surveys measuring acceptability revealed families' satisfaction with the intervention and suggested areas of improvement. We discuss similarities and differences in outcomes between the adapted intervention, Fortalezas Familiares, and the original intervention, Keeping Families Strong, and propose future areas of intervention adaptation and development.     

Recensement des actions évaluées à destination des enfants exposés à la violence conjugale

Knowledge relating to actions for children exposed to marital violence appears still limited, whereas in France many efforts are deployed to develop them. This field of intervention is recent and the actors of child welfare and those of the associative sector wishing to set up specific actions to help the child, often encounter a lack of knowledge about this type of intervention. This article proposes to make known actions carried out in this context over Atlantic by the analysis of six programs and the results of their evaluation.     

A longitudinal experimental study comparing the effectiveness of happiness-enhancing strategies in Anglo Americans and Asian Americans

Growing evidence suggests that well-being interventions can be effective. However, it is unclear whether happiness-increasing practices are equally effective for individuals from different cultural backgrounds. To investigate this question, Anglo Americans and predominantly foreign-born Asian Americans were randomly assigned to express optimism, convey gratitude, or list their past experiences (control group). Multilevel analyses indicated that participants in the optimism and gratitude conditions reported enhanced life satisfaction relative to those in the control condition. However, Anglo Americans in the treatment conditions demonstrated larger increases in life satisfaction relative to Asian Americans, while both cultural groups in the control condition showed the least improvement. These results are consistent with the idea that the value individualist cultures place on self-improvement and personal agency bolsters the efforts of Anglo Americans to become more satisfied, whereas collectivist cultures’ de-emphasis of self-focus and individual goals interferes with the efforts of Asian Americans to pursue enhanced well-being.     

Developing a family-based depression prevention program in urban community mental health clinics: a qualitative investigation

Extensive research documents that children of depressed mothers are at a significantly higher risk for developing a variety of socioemotional difficulties than children of nondepressed mothers. Yet, little prevention research has been conducted for this population, and low-income, minority, and urban families are rarely included. To address this deficit, we are developing the Protecting Families Program (PFP), a family-based multicomponent depression prevention program for mothers in treatment at urban community mental health agencies and their school-aged children. To inform intervention development and begin relationship building with the agencies, patient and staff focus groups were conducted in the participating agencies. Eighteen mothers with depression participated, and eight major themes were identified: (1) depression symptoms, (2) generational legacy, (3) parenting difficulties, (4) child problems, (5) social support, (6) stressful life events, (7) therapy and other helpful activities, and (8) desired treatment. In the focus groups with 10 mental health providers, the five major themes identified were parenting difficulties, lack of social support, life stress, current mental health practices, and intervention development. The findings support the multicomponent design of PFP, which focuses on increasing knowledge of depression, enhancing social support, and improving parenting skills. The study helped clarify many of the challenges of conducting research in a community mental health system.     

The development of a systemic school-based intervention: Marte Meo and coordination meetings

Antisocial behavior is often persistent, and in addition to causing suffering to children and their families, it also poses considerable costs for society. Children who display externalizing behavior in their early years run a high risk of having severe problems later in life. There is a need for treatment methods that may be used in various settings because these children constitute a group that is hard to reach with conventional treatment methods. In addition, the dropout rate from ordinary treatment is often high. In the present study, a systemic school-based model for early detection and intervention among 4-12-year-old children who displayed externalizing behavior problems was developed and examined in a nonrandomized study in the county of Skaraborg in Sweden. The intervention was collaborative and included a combination of the Marte Meo model and coordination meetings based on systemic theory and practice. Treatment effects in the group who had received the intervention were compared with a group who had received treatment as usual in their ordinary school setting. Assessments were carried out before, and 2 years after, the intervention. For the intervention group (N = 33), there was a significant decrease in the children's reported symptoms in school and in the home. No decrease in externalizing behavior was found in the comparison group (N = 16). There were no dropouts in the intervention group after the intervention had begun. The results are promising; the study demonstrates that it is possible to work effectively with many children who display externalizing behavior problems in a nonclinical setting.     

Joint attention in term and preterm infants at 12 months corrected age: the significance of gender and intervention based on a randomized controlled trial

This study tested the effects of optimized neonatal mother–infant transactions on joint attention performance at 12 months. Surviving infants <2000 g from a geographically defined area were randomly assigned to a preterm intervention (n = 71) or preterm control group (n = 69). Comparisons were made between preterm groups, secondary with a term group (n = 75). Joint attention was measured using the Early Social Communication Scales. Preterm intervention infants scored significantly higher than preterm control infants on elements Initiating Joint Attention (p < 0.05), Initiating Object Requests (p < 0.05), and Responding to Social Interaction (p < 0.0005). Intervention was not associated with performance on elements Responding to Joint Attention, or on Responding to Requests. ELBW infants scored significantly lower than VLBW and LBW infants on imperative functions. Girls outperformed boys on all communication elements. An intervention implemented during the neonatal period can be of advantage for certain aspects of joint attention performance in preterm infants.     

Effects of a physical education intervention programme for ninth-graders on physical activity-related health competence: Findings from the GEKOS cluster randomised controlled trial

The main purpose of this cluster randomised controlled trial was to investigate the effects of a physical education (PE) intervention programme combining theoretical and practical components on students' knowledge, skills, abilities and motivation related to competence for a healthy active lifestyle. The intervention used learning tasks to combine theory on health and physical fitness with either running/jumping activities or small-sided ball games and was compared to regular PE classes. Forty-eight PE classes were randomly assigned to intervention (IG-run, IG-game play; 27 classes) and control (CG-run, CG-game play; 21 classes) groups. Overall, 841 ninth-graders (51.1% girls, M_age = 14.20, SD = 0.51) were tested before and after the six-week intervention and in an eight-to-twelve-week follow-up. Students completed a health-related fitness knowledge test, questionnaires on control competence for physical training, health- and fitness-related interest and attitudes, and physical fitness tests. Regressions in structural equation models revealed positive treatment effects of the game play intervention on students' knowledge (β_StdY = 0.33, 99.6% CI [0.12, 0.55]) and control competence for physical training (β_StdY = 0.26, 99.6% CI [0.02, 0.50]) at the post-test. No significant effects were found at the follow-up test. Treatment effects were independent of gender. The results indicate the short-term effectiveness of learning tasks combining theory with ball games in order to develop knowledge and control competence for physical training in PE. Further studies have to clarify how to sustain effects over time and address students' physical fitness and health- and fitness-related interest and attitudes in interventions combining theory and practice.Trial registrationThis study was retrospectively registered with the German Clinical Trials Register (DRKS), DRKS-ID: DRKS00016349.     

Identifying factors for traffic safety support in older drivers

The present study aimed at identifying factors for traffic safety support in older drivers. This was achieved by studying the co-operation between older drivers and their ordinary front seat passenger (co-driver). The knowledge emerging from such study can enhance the understanding of what kind of support an older driver needs and also help facilitate proper design of in-vehicle support systems and intervention training programs for older drivers. A within group field study was carried out, using a mixed-methods evaluation design. Four elderly couples participated in the study. The drivers included in the study requested and received on-going directional support, traffic -and driving strategic help, help with look-out and reminding of current speed limit. It was evident from comparisons between interview data and field data that how the participants themselves described their need of support differed from what support they requested (drivers) and gave (co-drivers) in real driving. Furthermore, data revealed that three out of four drivers were given a score of 2 in the Useful Field Of View test (UFOV). It was evident that there are areas in which older drivers need and request support. The results from the present study could be used in the design process, and in evaluation of, in-vehicle support systems as well as in developing intervention training programs customised for older drivers.