There is substantial evidence for the association between parent psychological distress and adolescent substance use, risky sexual behavior , delinquency, and mental health. Parental psychopathology is associated with adolescent substance use , RSB and mood disorders . Furthermore, parents’ own substance use—likely correlated with overall parent distress—is associated with adolescent substance use and depression . Some of these associations are mediated by less parental monitoring and poor adolescent–parent communication . Research with justice-involved youth—an adolescent population with elevated substance use, RSB, and mental health problems—has documented a negative relationship between severity of parental distress and quality of family functioning and parental monitoring . Family-based interventions are the empirical gold standard for adolescent substance use and delinquency . Evidence suggests that family-based interventions are more effective than adolescent-only interventions in reducing delinquency and substance use among youth in general ; however, a review indicated that both types of interventions have similarly modest effects with juvenile offenders . Moreover, plant grow table adolescent-only health promotion has been shown to reduce RSB, including substance use during sex, among justice-involved youth .
Family based interventions focus on intrafamilial relationships and their influence on peer, school, and justice systems that contribute to substance use and RSB; they foster effective communication, conflict-resolution, and parental monitoring to reduce problematic adolescent behavior . In contrast, adolescentonly interventions, target the youth’s individual attitudes and behaviors contributing to substance use and RSB through psychoeducation and skills training for making healthy decisions that directly applies to the youth rather than to their family system . There is a dearth of research on how parent distress may impact intervention effects on substance use, RSB, and delinquency, especially among justice-involved adolescents. Research has linked the effects of youth mental health interventions to parent distress, but studies are focused on youth with anxiety, depression, or disruptive behavior—all in non-justice contexts. Additionally, findings are mixed as to how family- and youth-focused intervention effects may depend on the severity of parent distress. Bodden et al. reported that youth whose parents had anxiety disorders were less likely to experience normal-range symptoms after receiving family-focused cognitive behavioral therapy versus child-focused CBT; the reverse occurred among youth whose parents had no anxiety disorders. However, youth whose parents had anxiety disorders were more likely to retain their diagnosis regardless of treatment. Conversely, Cobham, Dadds, and Spence demonstrated that anxious youth with high-anxious parents had higher remission rates after CBT plus parent anxiety management than after CBT only, and those with low-anxious parents had comparable remission rates across treatments.
Dietz et al. reported similar findings with depressed adolescents: higher maternal depressive symptomatology predicted lack of improvement in problem-solving, a skill associated with remission, in youth-focused CBT but not in systemic behavior family therapy. Finally, maternal psychopathology was associated with reduced effects of adolescent-focused CBT for depression and parent training for disruptive behavior , respectively. These findings support the link between parent distress and attenuated youth response. We sought to fill a gap in the literature by examining how pre-existing parent distress might relate to justice-involved adolescents’ response on multiple behavioral health outcomes in a pilot randomized controlled trial . In this RCT, family-based intervention for adolescent substance use and HIV prevention led to greater reductions in marijuana use and unprotected sex compared to adolescent-only intervention . No differences in alcohol use were found and mental health problems were not included in primary outcome analyses. In this study, we considered three hypotheses: higher-level parent distress may predict worse outcomes for both interventions because mental health issues may limit parents’ ability to support their children’s intervention goals; higher level parent distress may predict worse outcomes for family-based intervention versus adolescent-only intervention because engagement may be more challenging for parents experiencing severe mental health symptoms, and higher-level parent distress may predict either better or equivalent outcomes for family based intervention versus adolescent-only intervention because family-based intervention may help parents with more severe psychopathology to build skills to support their children’s intervention goals.
Our findings may indicate whether family-based or adolescentonly interventions may be more helpful to justice-involved adolescents, depending on the level of parent distress, thereby improving services for this underserved adolescent population.Parent–adolescent dyads were recruited from a juvenile drug court in the northeastern United States—a diversionary program for first-time or repeat nonviolent offenders. All adolescents reported active substance use but were not necessarily charged with drug-related crimes. The case manager or presiding judge referred families to research staff who obtained informed consent and assent. Study methods were approved by the Institutional Review Board of the primary investigator . Of 283 referred families, 233 were eligible, 60 consented and were randomized, and the 47 who received any intervention were included in this study. Table 1 displays participant characteristics .We modeled each outcome at post intervention, entering intervention condition, baseline parent distress, and their interaction as predictors, and baseline levels of the outcome as covariates. For each YSR outcome, we covaried both baseline internalizing and externalizing problems scores . We modeled the post intervention substance use and RSB outcomes as dichotomous variables and as count variables because we wanted to examine whether parent distress and its interaction with intervention impacted whether adolescents engaged in the behavior, and how much they did so, respectively. We analyzed the baseline values of those outcomes as counts to maximize comparability between models. We modeled dichotomous outcomes using logistic regression. We found no fit or assumption violations with the Hosmer–Lemeshow goodness of-fit test and the Box–Tidwell approach to test the linearity of the logit . We modeled count outcomes using generalized linear models with negative binomial distribution and log link function. We used linear regression for mental health outcomes because their distributions showed no significant departures from normality.Significance level was set at α= .05 for each model. Finally, we probed significant interactions using the Johnson–Neyman technique, which identifies the range of parent GSI values for which FAMI and HPI significantly differed on dichotomous or continuous outcomes—”the “region of significance.” Three families missed the post intervention assessment and one adolescent did not complete post intervention YSR. We imputed baseline values for missing post intervention outcomes, consistent with primary outcome analyses . YSR analyses excluded data from two adolescents who completed insufficient YSR items at baseline to generate scale scores and RSB analyses excluded data from one adolescent who skipped relevant questions at baseline. These six participants reported significantly fewer baseline days of marijuana use than the remaining participants; they did not differ on other characteristics. Analyses were conducted using SPSS Version 25, with Hayes’ PROCESS macro to identify the region of significance.The intervention × baseline parent distress interaction was significant for whether adolescents used marijuana and alcohol at post intervention. Table 2 displays model parameters and statistics. At low-level parent distress, the odds of using marijuana, and of using alcohol, were higher among FAMI adolescents than among HPI adolescents, whereas at high-level parent distress, the odds of using marijuana, and of using alcohol, were higher among HPI adolescents than among FAMI adolescents. However, hydroponic table the region of significance differed between the two outcomes. The odds of marijuana use were significantly higher among HPI adolescents than FAMI adolescents only when parent GSI score exceeded 0.86 ; whereas the odds of alcohol use were significantly higher among FAMI adolescents than HPI adolescents only when parent GSI score fell under 0.58 . The interaction was also significant for number of days of marijuana use, but not for number of days of alcohol use . Figure 1 illustrates the significant crossover interactions.In this pilot efficacy trial, parents’ pre-existing distress had differential impact across interventions on justice-involved adolescents’ marijuana and alcohol use at 3 months post intervention, controlling for adolescents’ baseline substance use. When parents experienced greater distress, family affect management intervention outperformed adolescent-only psychoeducation in preventing adolescent marijuana use and reducing days of marijuana use, and did as well as adolescent-only psychoeducation in preventing alcohol use.
But when parents experienced less distress, adolescent-only psychoeducation was superior to family intervention in preventing adolescent alcohol use, and had similar effects as family intervention on preventing and reducing days of adolescent marijuana use. Although the interaction was not significant for reducing days of alcohol use, the substance use models mostly support the third hypothesis—distressed parents may benefit more from family based intervention than from adolescent-only intervention, compared to their less distressed counterparts. On the other hand, the RSB model for reducing number of risky sexual acts supports the first hypothesis—that adolescents with distressed parents engage in more risky sex following both interventions. None of the hypotheses were supported by the mental health models—parent distress had no impact on those outcomes, either alone or in combination with intervention. Our substance use findings add to a small evidence base suggesting that family-based intervention may be especially beneficial to youth whose parents have mental health concerns. This pattern has emerged with anxious and depressed youth, and is consistent with results from two RCTs of Multidimensional Family Therapy , which included many justice-involved adolescents. In both RCTs, adolescents with greater symptom severity and comorbidity displayed greater improvement in substance use after receiving MDFT relative to other adolescent-focused interventions . MDFT also significantly reduced RSB relative to enhanced usual services at one of two study sites, where adolescents had greater number of lifetime arrests, substance dependence, and comorbid psychiatric diagnoses, and higher rates of family substance use and criminality . Research suggests that the effects of MDFT on adolescent abstinence from substance use are mediated by improvement in parent monitoring of adolescents’ activities and peers . Moreover, parents with clinically elevated psychopathology showed greater improvement on parental monitoring and adolescent–parent sexual communication than parents without elevated psychopathology after receiving family-based HIV prevention compared to adolescent-only intervention . Therefore, family-based interventions may offer greater benefit to adolescents whose parents experience greater mental and behavioral health concerns because they may help parents build monitoring and communication skills needed to support their children’s treatment goals. Identifying parent distress as a moderator of adolescent substance use suggests the possibility of matching interventions to families, yet the lack of moderation of other outcomes require discussion. Mental health was not a primary intervention target, thus effects on those outcomes may have been smaller, and the modest sample size may have constrained power to detect significant effects. In contrast, RSB was a primary intervention target and was significantly predicted by greater parent distress—thus low power is unlikely to explain the absence of moderation. Key differences between our study and the MDFT trial showing moderation of RSB offer possible explanations for our failure to find moderation of RSB. First, our adolescent participants were not detained and engaged in minor forms of delinquency, whereas the MDFT sample included detained youth with more severe delinquency. Second, our interventions lasted only 2 months compared to 4 to 6 months in the MDFT trial . Third, as an evidence-based treatment for adolescent substance use , MDFT is far more developed and intensive than FAMI and it is tailored to individual families and targets multiple systems beyond the family. Distressed parents in our study who became involved with the legal system related to their youth’s own drug involvement might understandably focus on applying their skills to the more pressing issue of youth substance use than RSB during a brief intervention, whereas families with greater psychopathology and substance use in the MDFT trial have more time and guidance to address multiple risk behaviors. A clinical implication of our findings is that adolescents with distressed parents may be better served by a brief intervention that focuses on one or two closely related problems most salient to the family; multiple outcomes might require greater duration and intensity of treatment. Our study had several limitations. Our small sample of nonviolent offenders constrained power and may not generalize to severe offenders. We were unable to collect information about eligible families who did not consent for participation, which precluded examining differences between families who consented and those who did not. Additionally, the low participation rate of male caregivers precluded comparisons of the impact of fathers versus mothers on intervention response. We did not assess parent-report or objective outcomes, nor did we examine outcomes beyond 3 months post intervention. Moreover, other parent variables , were not assessed— these plausible moderators should be tested in future studies. Importantly, it remains unknown whether changes in parental behaviors, including improvement in parent distress, parental monitoring, adolescent–parent communication, drove the interaction we found.