针对高度焦虑父母的无指导模块化在线干预对预防子女焦虑的效果:平行小组随机对照试验

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES
Abby Dunn , James Alvarez , Amy Arbon , Stephen Bremner , Chloe Elsby-Pearson , Richard Emsley , Christopher Jones , Peter Lawrence , Kathryn J. Lester , Natalie Morson , Julia Simner , Abigail Thomson , Sam Cartwright-Hatton
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引用次数: 0

摘要

背景父母有焦虑问题的儿童自身患焦虑症的风险也会增加。父母的养育行为是导致焦虑症代代相传的一个因素。旨在限制导致焦虑的养育行为的干预措施已显示出减少后代焦虑的潜力,但并不普及。本预防试验旨在确定针对高度焦虑父母的非指导性模块化在线干预措施在预防子女焦虑方面的有效性。方法对非盲法参与者按 1:1 的比例进行平行分组、整群随机对照试验,以比较在线课程与无干预对照组的疗效。干预包括 8 个模块,每个模块大约 20 分钟,参与者按照自己的进度完成课程。这项研究完全通过网络进行,对象是英国社区中自我推荐的患有严重焦虑症的家长(孩子 2-11 岁)。主要结果是家长报告的儿童焦虑程度的变化,以斯彭斯儿童焦虑量表-家长报告(SCAS-P)或斯彭斯学前焦虑量表-家长报告(学前 SCAS)来衡量。次要结果是儿童内化、外化和注意力症状(儿科症状检查表)以及家长焦虑(SCARED-成人)。根据意向治疗原则进行的完整病例分析调查了 6 个月的干预效果(主要分析)以及 9 至 25 个月的随访效果。试验注册:ClinicalTrials.Gov NCT04755933,https://clinicaltrials.gov/ct2/show/NCT04755933.Findings1811 参与者(干预=900;对照=911;92.7%(1677/1810)为女性;85.3%(1535/1800)为英国白人;66.8%(1201/1799)受过大学教育)。T2 阶段(同意后 6 个月)的参与者保留率(基于主要结果完成情况)总体为 67.6%(n = 1224),干预组的保留率大幅降低,为 57.3%((516/900)对照组 = 77.8% (708/910))。在 6 个月的随访中,干预组儿童的焦虑程度低于对照组(调整后的效应估计值为-0.15(95% CI:-0.23 至-0.08,p <0.001)。有非常有力的证据表明,与对照组相比,干预组的儿童焦虑程度(标准化斯彭斯儿童焦虑评分)有所降低,效应大小(Cohen's d)为-0.16(95% CI:-0.23 至 -0.08,p < 0.001)。两组之间的标准化斯彭斯儿童焦虑量表得分差异为-0.15个标准差。在SCAS-P(0-114)和学龄前SCAS(0-112)的原始量表上,这相当于分别降低了-2.38(95% CI:-3.59至-1.16)和-2.68(95% CI:-4.05至-1.31)分。没有关于危害的报道。释义:一项针对焦虑程度较高的父母设计的、未获临床支持的在线干预措施,能够有效减轻孩子的焦虑和内化症状,同时也能减轻父母的焦虑。鉴于该干预措施的资源强度较低,且报告了积极效果,这些研究结果表明,该干预措施有望限制严重焦虑症的代际传播。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children: a parallel group randomised controlled trial

Background

Children whose parents have anxiety problems are at increased risk of developing anxiety themselves. Parenting behaviors are a contributing factor to intergenerational transmission. Interventions which seek to limit anxiogenic parenting behaviors have shown potential in reducing anxiety in offspring but are not widely accessible. This prevention trial aimed to establish the effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children.

Methods

A parallel group, block-randomised controlled trial of unblinded participants in a 1:1 ratio was conducted to compare efficacy of the online course compared to a no-intervention control. The intervention comprised 8 modules, of approximately 20 min each, and participants progressed through the course at their own pace. The study was conducted entirely online with a self-referred UK-based community sample of parents (child 2–11 years) with substantial anxiety. The primary outcome measure was change in parent-reported child anxiety, as measured by the Spence Children's Anxiety Scale–Parent Report (SCAS-P) or Spence Pre-School Anxiety Scale–Parent Report (Preschool SCAS). Secondary outcomes were child internalising, externalising, and attentional symptoms (Pediatric Symptom Checklist), and parent anxiety (SCARED-Adult). Analyses using complete case analysis following intention to treat principles investigated intervention effects at 6 months (primary analysis) and additionally at 9 to 25-months’ follow-up. Trial registration: ClinicalTrials.Gov NCT04755933, https://clinicaltrials.gov/ct2/show/NCT04755933.

Findings

1811 participants (intervention = 900; control = 911; 92.7% (1677/1810) female; 85.3% (1535/1800) White-British; 66.8% (1201/1799) university educated). Participant retention (based on primary outcome completion) at T2 (6-months post consent) was 67.6% overall (n = 1224) and substantially lower in the intervention arm 57.3% ((516/900) control = 77.8% (708/910)). Child anxiety was lower in the intervention group compared to control at 6-month follow-up (adjusted effect size estimate −0.15 (95% CI: −0.23 to −0.08, p < 0.001). There was very strong evidence that those in the intervention arm had lowered child anxiety (standardised SCAS score) compared to the control arm, with an effect size (Cohen's d) of −0.16 (95% CI: −0.23 to −0.08, p < 0.001). The difference in standardised Spence Child Anxiety Scale score between the arms was −0.15 standard deviations. On the original scales for SCAS-P (0–114) and Preschool SCAS (0–112), this corresponds to a reduction of −2.38 (95% CI: −3.59 to −1.16) and −2.68 (95% CI: −4.05 to −1.31), respectively. No reported harms.

Interpretation

A clinically unsupported online intervention designed for parents with high levels of anxiety is effective in reducing anxiety and internalising symptoms in their children, and also anxiety in parents. Given the low resource intensity of this intervention, and the positive effects reported here, these findings suggest it has promise in limiting the intergenerational transmission of severe anxiety.

Funding

This work was supported by Kavli Trust (grant 38/19).

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来源期刊
CiteScore
19.90
自引率
1.40%
发文量
260
审稿时长
9 weeks
期刊介绍: The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.
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