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Randomized Controlled Trial
. 2018 Jan 19;20(1):e17.
doi: 10.2196/jmir.9139.

A Tailored Web-Based Intervention to Improve Parenting Risk and Protective Factors for Adolescent Depression and Anxiety Problems: Postintervention Findings From a Randomized Controlled Trial

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Free PMC article
Randomized Controlled Trial

A Tailored Web-Based Intervention to Improve Parenting Risk and Protective Factors for Adolescent Depression and Anxiety Problems: Postintervention Findings From a Randomized Controlled Trial

Marie Bee Hui Yap et al. J Med Internet Res. .
Free PMC article

Abstract

Background: Depression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking.

Objective: This study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms.

Methods: A two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to target parenting factors associated with adolescents' risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent's strengths and areas for improvement, followed by a set of interactive modules (up to nine) that is specifically recommended for the parent based on individually identified areas for improvement. Parents in the active-control condition received a standardized package of five Web-based factsheets about adolescent development and well-being. Parents in both conditions received a 5-min weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at postintervention was parent-reported changes in parenting risk and protective factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children's Anxiety Scale (anxiety symptoms).

Results: Parents in the intervention condition completed a mean of 73.7% of their intended personalized PiP program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed the postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between conditions were found at postintervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to postintervention in both conditions.

Conclusions: The fully automated PiP intervention showed promising short-term effects on parenting behaviors that are associated with adolescents' risk for depression and anxiety. Long-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents' mental health.

Trial registration: Australia New Zealand Clinical Trials Registry: ACTRN12615000328572; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx? id=368274 (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj).

Keywords: Internet; adolescent; anxiety; depression; family; mental health; parenting; preventive health services.

Conflict of interest statement

Conflicts of Interest: MBHY, AFJ, and KAL are codevelopers of the PiP intervention, and MBHY and AFJ are cofounders of the broader Parenting Strategies online platform of parenting interventions, including PiP. None of these authors derives a personal financial benefit from these online interventions.

Figures

Figure 1
Figure 1
Participant flow diagram. ITT=Intention-to-treat analyses. Parent or dyad remain enrolled in study unless indicated that they had opted out. aIncludes complete dyads opted out; badolescent opted out of study at 3-month follow-up; cof these, 2 adolescent participants had opted out before completing adolescent baseline survey and, one adolescent’s 3-month follow-up was also missed because of a technical error; dadolescent participant(s) opted out before completing adolescent baseline survey; eadolescent participant opted out of completing 3-month follow-up survey; and fadolescent participant completed 3-month follow-up.
Figure 2
Figure 2
Graphs of estimated marginal means of primary and secondary outcomes for each intervention condition and occasion of measurement. Error bars represent standard error. Square=control, triangle=intervention.

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