Psychological interventions for depression and anxiety in pregnant Latina and Black women in the United States: A systematic review

Black women and Latinas have more symptoms of depression and anxiety during pregnancy than do their non‐Latina White counterparts. Although effective interventions targeting internalizing disorders in pregnancy are available, they are primarily tested with White women. This article reviews randomized controlled trials and non‐randomized studies to better understand the effectiveness of psychological interventions for anxiety and depression during pregnancy in Latinas and Black women. Additionally, this review summarizes important characteristics of interventions such as intervention format, treatment modality, and the use of cultural adaptations. Literature searches of relevant research citation databases produced 68 studies; 13 of which were included in the final review. Most studies were excluded because their samples were not majority Latina or Black women or because they did not test an intervention. Of the included studies, three interventions outperformed a control group condition and showed statistically significant reductions in depressive symptoms. An additional two studies showed reductions in depressive symptoms from pretreatment to post‐treatment using non‐controlled designs. The remaining eight studies (seven randomized and one non‐randomized) did not show significant intervention effects. Cognitive behavioral therapy was the modality with most evidence for reducing depressive symptoms in pregnant Black and Latina women. No intervention was found to reduce anxiety symptoms, although only two of the 13 measured anxiety as an outcome. Five studies made cultural adaptations to their treatment protocols. Future studies should strive to better understand the importance of cultural modifications to improve engagement and clinical outcomes with pregnant women receiving treatment for anxiety and depression.     

Periodic Prompts and Reminders in Health Promotion and Health Behavior Interventions: Systematic Review

Background

Health behavior interventions using periodic prompts have utilized technology, such as the Internet, that allows messages to be sent to participants in cost-effective ways. To our knowledge, no comprehensive evidence review has been performed specifically to evaluate the effectiveness of communicating regular messages and to examine how characteristics of the prompts change the effectiveness of programs aimed at reminding people to adopt healthy behaviors, maintain those they already practice, and cease unhealthy behaviors.

Objective

A systematic literature review was performed to investigate the effectiveness of limited contact interventions targeting weight loss, physical activity, and/or diet that provided periodic prompts regarding behavior change for health promotion. The review sought to identify specific characteristics of these interventions that may be associated with superior results.

Methods

Electronic literature searches were performed between February and April, 2008. Articles were included if periodic prompts were used as an intervention or a component of an intervention, a behavioral or biological outcome measure was used, and an ongoing health promotion behavior was targeted. A rating system was applied to each study to provide a quantitative representation of the quality of the evidence provided by each article.

Results

There were 19 articles with a combined sample size of 15,655 that met the inclusion criteria, and 11 studies reported positive findings regarding the utility of periodic prompts. Several articles showed enhanced effectiveness when prompts were frequent and personal contact with a counselor was included. Long-term behavior change and health improvements were not examined by this review because of a lack of long-term follow-up in the literature.

Conclusions

In light of promising results of most studies, additional research on limited contact interventions targeting health behaviors including weight loss, physical activity, and/or diet is merited that utilizes rigorous methods including control groups; follow-up data collection; and testing of prompt frequencies, specific intervention components, or prompt characteristics. Future research would be especially valuable if it improves understanding of the most effective types of periodic prompts for fostering long-term behavior change in order to maximize use of this tool in limited contact health promotion programs. Specifically, various types of communication technology should be used and evaluated to expand and refine their use.     

Effects of Social Problem-Solving Training and Self-Instruction Training With Aggressive Boys

Twenty aggressive boys received either an 18-session anger coping intervention (AC) or an 18-session intervention in which anger coping was preceded by self-instruction training on impersonal problem solving and academic tasks (AC-SIT). Anger coping emphasized training in interpersonal cognitive problem-solving skills. Although, contrary to the hypothesis, there were no significant differences between the two conditions in their abilities to reduce passive off-task classroom behavior, the AC-SIT groups did tend to produce stronger reductions in this behavior. The AC groups were significantly more effective in reducing disruptive-aggressive off-task classroom behavior than were the AC-SIT groups. Both forms of cognitive behavioral treatment produced significant increases in on-task classroom behavior, reductions in parents' ratings of boys' aggression, and increases in boys' self-esteem.     

Magnesium deficiency alters aggressive behavior and catecholamine function

Magnesium is an abundant mineral in the brain and is important for monoamine neurotransmitter synthesis and receptor binding. It should, therefore, have behavior-altering effects. Three experiments were conducted to determine the influence of magnesium deficiencies on aggressive behavior and catecholamine function in mice. There were concentration- and time-dependent reductions in offensive aggressive behavior with magnesium deficiencies. Defensive behavior was affected in a manner opposite to that of offensive behavior. Upon administration of low doses of apomorphine and l-amphetamine, less dopamine- and norepinephrine-related behavior occurred with less magnesium in the diet. These reductions also showed a time dependency. These data demonstrate that magnesium has an influence on aggressive behavior in mice. Also, a magnesium deficiency is capable of altering the potency of catecholamine stimulating drugs.     

Video feedback in widescreen: a meta-analysis of family programs

A meta-analysis of 29 studies (n=1844 families) shows statistically significant positive effects of video feedback interventions on the parenting behavior and attitude of parents and the development of the child. Parents become more skilled in interacting with their young child and experience fewer problems and gain more pleasure from their role as parent. Shorter programs appeared to be more effective in improving parenting skills. The intervention effects were smaller for the attitude domain at parent level. The experimental outcomes were smaller at child level if the parents belonged to a high-risk group.     

Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics

The effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use was evaluated in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites.     

Dynamic Change of Aggressive Behavior and Victimization Among Adolescents: Effectiveness of the ViSC Program

The present study reports a high-quality evaluation of the ViSC Social Competence Program, which was implemented large scale in Austria. A rigorous test of program effectiveness has been performed to investigate the dynamic change of aggressive behavior and victimization and to ensure a high level of statistical conclusion validity. A cluster randomized control study was applied to examine program effectiveness regarding aggressive behavior and victimization. In sum, 1,377 adolescents (48.5% girls, M_age = 11.7) enrolled in 13 schools participated in the program; 665 adolescents (45.2% girls, M_age = 11.6) enrolled in 5 schools were in the control group. Data were collected with Internet-based questionnaires at pre- and posttest with several validated scales to capture the full range of the two constructs. To ensure construct validity, a series of invariance tests of the second-order factor models were performed. To test program effectiveness, a multiple group bivariate latent change score model was applied. Evidence for a dynamic change of aggressive behavior and victimization was found. As predicted, the pretest levels and the change scores of aggressive behavior and victimization were associated. Moreover, higher levels of pretest values predicted more change. The program was effective in reducing victimization but not aggressive behavior. Gender did not moderate the results. Results are important for national rollout and cross-national dissemination of the program. However, further research is needed to investigate the underlying mechanisms of the intervention effects.     

Effectiveness of the Incredible Years parent training to modify disruptive and prosocial child behavior: A meta-analytic review

The present meta-analytic review examined effectiveness of the Incredible Years parent training (IYPT) regarding disruptive and prosocial child behavior, and aimed to explain variability in intervention outcomes. Fifty studies, in which an intervention group receiving the IYPT was compared to a comparison group immediately after intervention, were included in the analyses. Results showed that the IYPT is an effective intervention. Positive effects for distinct outcomes and distinct informants were found, including a mean effect size of d = .27 concerning disruptive child behavior across informants. For parental report, treatment studies were associated with larger effects (d = .50) than indicated (d = .20) and selective (d = .13) prevention studies. Furthermore, initial severity of child behavior revealed to be the strongest predictor of intervention effects, with larger effects for studies including more severe cases. Findings indicate that the IYPT is successful in improving child behavior in a diverse range of families, and that the parent program may be considered well-established.     

Adverse school context moderates the outcomes of selective interventions for aggressive children

Drawing on social ecological theory and empirical studies on the role of school context in aggression, the authors argue that school adversity is an important consideration in choosing selective interventions for aggressive children. The moderating role of school adversity on intervention effectiveness is illustrated with data from a randomized clinical trial study investigating 2 selective interventions administered to 86 aggressive 2nd and 3rd graders. The authors expected that PrimeTime, an intervention targeting child competencies, would be more effective in low-adversity schools, whereas Lunch Buddy, an intervention targeting peer ecology, would be more effective in high-adversity schools. Hierarchical linear regression analyses showed significant posttreatment effects on composite measures of aggression and achievement for the interaction between the level of school adversity and treatment condition.     

Evaluation of a voluntary, military-style residential treatment program for adolescents with academic and conduct problems.

This study evaluated the effectiveness of a military-style residential treatment program for adolescents with academic and conduct problems. Two hundred twelve referred adolescents were separated into 3 groups for analyses: (a) adolescents who completed the 22-week program, (b) adolescents who prematurely withdrew, and (c) wait-list controls. Adolescents' socioemotional and behavioral functioning were measured at baseline and 6 months after treatment. Results showed statistically and clinically significant reductions in externalizing symptoms and increases in adaptive behavior associated with treatment. Treatment was also associated with increased likelihood of high school completion or employment and decreased likelihood of alcohol or drug problems and arrest. The relation between treatment participation and outcomes was moderated by adolescents' living environments after treatment, but it was not moderated by age of symptom onset. The benefits of treatment may be partially attributable to the voluntary nature of the intervention.     

Evaluation of a Voluntary,Military-Style Residential Treatment Program for Adolescents With Academic and Conduct Problems

This study evaluated the effectiveness of a military-style residential treatment program for adolescents with academic and conduct problems. Two hundred twelve referred adolescents were separated into 3 groups for analyses: (a) adolescents who completed the 22-week program, (b) adolescents who prematurely withdrew, and (c) wait-list controls. Adolescents' socioemotional and behavioral functioning were measured at baseline and 6 months after treatment. Results showed statistically and clinically significant reductions in externalizing symptoms and increases in adaptive behavior associated with treatment. Treatment was also associated with increased likelihood of high school completion or employment and decreased likelihood of alcohol or drug problems and arrest. The relation between treatment participation and outcomes was moderated by adolescents' living environments after treatment, but it was not moderated by age of symptom onset. The benefits of treatment may be partially attributable to the voluntary nature of the intervention.     

The effectiveness of two universal preventive interventions in reducing children's externalizing behavior: a cluster randomized controlled trial

This article reports the effectiveness of two universal prevention programs in reducing externalizing behavior in elementary school children. A sample of 1,675 first graders in 56 Swiss elementary schools was randomly assigned to a school-based social competence intervention, a parental training intervention, both, or control. Externalizing psychopathology and social competence ratings were provided by the children, primary caregivers, and teachers at the beginning and end of the 2-year program, with a follow-up 2 years later. Intention-to-treat analyses revealed that long-term effects on teacher- and parent-rated externalizing behavior were greater for the social competence intervention than for the control. However, for most outcomes, no statistically significant positive effects were observed.     

Developing and evaluating a smoking cessation program combined with an Internet-assisted instruction program for adolescents with smoking

OBJECTIVE: The purpose of this study was to develop a smoking cessation program combined with an Internet-assisted instruction (IAI) program to help youth smokers quit smoking, and to evaluate the effectiveness of the program in changing youth's attitudes toward smoking, smoking behavior, and self-efficacy for smoking cessation. METHODS: To achieve this goal, a comparative study of 77 senior high students divided into two groups was conducted. One group, designated as the experimental group, accepted a 6-week smoking cessation program plus an IAI program and the other group did not receive any intervention as the comparison group. All participants completed questionnaires before and after the program. RESULTS: The results showed that the strategy of combining the smoking cessation program and an IAI program was highly effective in terms of effects upon the youth's attitude towards smoking, smoking behavior, and self-efficacy. There was a highly positive correlation between the participants' attitude toward smoking and self-efficacy. In contrast, cigarette consumption was in a strongly negative correlation with self-efficacy. CONCLUSION: Most of all participants in the experimental group recognized the effectiveness of the program, and thought the smoking cessation program with an IAI program was helpful and welcomed by youth. This study can serve as reference for future design and implementation of IAI programs for youth smoking cessation.     

Building friendships and combating bullying: effectiveness of S.S.GRIN at one-year follow-up.

This study tested the long-term effectiveness of a social-skills program for peer-rejected, victimized, and socially anxious children. Third-grade children with peer problems were randomly assigned to treatment (TX; n=187) or no-treatment control (CO; n=194) groups. One year after the intervention, the pattern of findings was similar to that at postintervention; however, several new group differences emerged. Additional positive treatment effects were found, including higher social acceptance and self-esteem and lower depression and anxiety. Lower aggressive behavior was found, particularly for initially more aggressive children. Several gender differences emerged where treatment effects were present for girls but not boys. The demonstrated value of teaching social skills to children experiencing peer problems is discussed and suggestions for future research are offered.     

Building Friendships and Combating Bullying: Effectiveness of S.S.GRIN at One-Year Follow-Up

This study tested the long-term effectiveness of a social-skills program for peer-rejected, victimized, and socially anxious children. Third-grade children with peer problems were randomly assigned to treatment (TX; n = 187) or no-treatment control (CO; n = 194) groups. One year after the intervention, the pattern of findings was similar to that at postintervention; however, several new group differences emerged. Additional positive treatment effects were found, including higher social acceptance and self-esteem and lower depression and anxiety. Lower aggressive behavior was found, particularly for initially more aggressive children. Several gender differences emerged where treatment effects were present for girls but not boys. The demonstrated value of teaching social skills to children experiencing peer problems is discussed and suggestions for future research are offered.     

Institutionahzation and parole behavior: Assessing the influence of individual and family characteristics

Using statistical controls for selection bias, the present study evaluates the relative impact of institutional and noninstitutional programs on two indicators of parole behavior, parole maladjustment and parole violations. Multiple regression models assessing program effects included individual and family predictors of parole behavior identified in previous literature. Placement in alternative programs was inversely associated with both parole outcomes; larger effects for program placement were observed for models predicting parole violations. Nonprogram variables, including younger commitment age, lower IQ, and more family problems, were consistently associated with adverse parole outcomes. Significant interaction effects suggested that the effect of programs on parole behavior depends on a youth's age and level of family problems. The family problems index was the single most important predictor of parole behavior. Despite specific differences, there was considerable overlap between models explaining the two parole outcome measures. Implications for research and intervention are discussed.     

An integrated components preventive intervention for aggressive elementary school children: the early risers program

The Early Risers prevention program aims to alter the developmental trajectory of children with early onset aggressive behavior. The program features 4 CORE components: (a) an annual 6-week summer school program, (b) a teacher consultation and student mentoring program, (c) child social skills groups, and (d) parent education and skills-training groups, all delivered in tandem with a FLEX family support program individually tailored to address the unique needs of families. At baseline, the mean age of the sample was 6.6 years. Following 2 years of intervention, program children showed significant improvement relative to controls in academic achievement and school behaviors. Change on behavioral self-regulation was moderated by level of child aggression, with intervention effects found for only the most severely aggressive children. Parents with high program attendance rates showed improvement in discipline methods.     

Generalizability and durability of treatment effects in an intervention program for coronary-prone (type A) managers

To test the reliability and durability of positive treatment effects obtained in a type A intervention project for healthy managers, the analysis was extended to data available from a third treatment group (a special behavior therapy group for participants eliminated from the main sample because of manifestations of clinical CHD) and to measures obtained 6 months following the end of treatment. Immediately after treatment all three groups showed a similar pattern of improvement, although the two behavior therapy groups did show a greater decrease in serum cholesterol levels. Six months after treatment the sample as a whole showed good maintenance of treatment effects, but the differences between groups had become somewhat sharper, with the special behavior therapy group faring best, the regular behavior therapy group intermediate, and the psychotherapy group worst. The logical consistency of these findings increases our confidence in the initial treatment results, as well as permitting cautious optimism concerning the possibility of developing effective intervention programs for coronary-prone (type A) behavior.     

Socioeconomic status mediates the genetic contribution of the dopamine receptor D4 and serotonin transporter linked promoter region repeat polymorphisms to externalization in preadolescence

The impact of socioeconomic status (SES) and genetic polymorphisms on individual differences for externalized behaviors have often been investigated separately in studies of children and adults. In a general population sample of 607 Italian preadolescents, we examined the independent and joint effects of SES and the dopamine receptor D4 (DRD4) and serotonin transporter linked promoter region (5-HTTLPR) polymorphisms upon rule-breaking and aggressive behaviors measured with the Child Behavior CheckList/6-18. We found evidence, which was based on both one locus and two-loci genotype analyses, that low SES and DRD4 long and 5-HTTLPR long alleles, both alone and in interaction, are associated with higher aggressive behavior scores. The effects were similar but more modest and limited to one locus genotype analyses for rule-breaking behavior. Consistent with studies that showed the effects of societal moderators on the heritability of externalized behaviors across different segments of the population, we suggest that diminished social constraints associated with low parental SES may act as enhancers of the genetic influence of specific DRD4 and 5-HTTLPR alleles over aggressive behaviors in preadolescence.