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Preventive psychosocial parental and school programmes in a general population
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.ORCID iD: 0000-0003-2588-0780
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction Numerous preventive programmes have emerged, and need to be investigated to determine their effects on the normal population. Earlier studies have shown a decrease in depressive symptoms, positive effects on children’s disruptive behaviour problems, and an improvement in parental competence. About a fifth of the parents in previous studies had problem-oriented (targeted) reasons for enrolment, whereas the rest of the parents had general (universal) reasons. The results of those studies suggest that the programmes are cost effective in terms of Quality-Adjusted Life Years.

Aim Four sub-studies were performed, and their aims were to investigate the effect of parental training programmes (PTPs) in a naturalistic setting on parents’ mental health in the general population, to investigate how PTPs affect parents’ sense of parental competence, to investigate how PTPs affect parental stress and analyse the parents open questions about the PTPs, and to investigate the feasibility and to measure the effect on depression, anxiety, and social problems of two preventive school programmes for pupils in grade 7.

Method In a longitudinal quantitative study in a real-world setting, 279 parents from the general population in northern Sweden participated in five PTPs. A comparison group of 702 parents without intervention was included. Simultaneously, a community sample of 59 pupils in grade 7 participated in two preventive school programmes. Both studies were conducted from 2010 to 2013. Parents were assigned to professionally supported interventions that included 5-10 two-hour sessions. Respondents filled in a web-based questionnaire with the General Health Questionnaire (GHQ), the Parents Sense of Competence (PSOC) for parents who had children aged 0-17 years, and the Swedish Parenthood Stress Questionnaire (SPSQ) for parents who had children aged 0-10 years. The intervention groups’ results were compared to comparison group of 702 parents from northern Sweden that had not participated in any parental training programme. In the school study, one of the preventive programmes was an ongoing programme called “Life-Skills”, and the other was an implemented Canadian programme called “Choosing Healthy Actions and Thoughts” (CHAT). The pupils completed a test battery including the Sense of Coherence (SOC), the Children’s Depression Inventory (CDI), and the Youth Self-Report (YSR) instruments. Follow up of the parental programme study was done six months after the post-intervention measure, and follow up of the school study was at one year.

Results The improvements in GHQ were statistically significant for the mean of the 279 parents in the intervention group compared to the mean of a comparison group of the 702 parents who did not receive any intervention. This suggests that evidence-based PTPs enhance parental well-being even for parents without problems. The intervention group showed a statistically significant improvement in parental competence compared to the comparison group over time. The intervention itself had a significant effect on parental satisfaction, but the efficacy effect was not sustained when taking into account potential confounders. In the SPSQ, the intervention group was smaller due to the fact that the instrument was not validated for children over the age of 10 and one of the parental training groups was only for parents of teenagers. A reduction of stress in the sub-scale of health problems was detected, but no other subscale showed the intervention to have a significant effect when controlling for confounding variables. In the school study, both programmes had good feasibility according to the stake- holders and had several positive mental health outcomes over time. Compared to Life-Skills, CHAT had more significant positive effects on reducing anxious/depressive symptoms and girls experienced significant positive effects on reduced anxious/depressive behaviour, while boys reduced their aggressive behaviours.

Conclusions Earlier studies indicate that PTPs enhance perceived parental competence among referred parents. The present study shows that PTPs applied in the general population might also enhance perceived parental benefits such as improved health and satisfaction, suggesting that PTPs can be an important preventive strategy to enhance parenthood. The results suggest that parents who feel a need to increase their parenting competence might participate in PTPs based on lower scores than the comparison control group both before and after the intervention. The school-based programme shows that schools may be a suitable arena for preventive programmes because there was a significant short-term improvement in depression symptoms. Further studies need to explore how parents’ participation in PTPs affects children’s mental health in the general population in quantitative longitudinal studies in real-word settings. There is also a need for bigger studies and RCTs on school preventions and on how children’s health develops naturally in the population.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2017. , p. 63
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1922
Keywords [en]
Parental training program, parenting, universal prevention, parental stress, CHAT, Life-Skills, General Mental Health, Parental Sense of Competence, General Health Questionnaire, Swedish Parenthood Stress Questionnaire, Sense of Coherence, Children’s Depression Inventory, Youth Self-Report
National Category
Psychiatry
Research subject
Child and Youth Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-140737ISBN: 978-91-7601-779-1 (print)OAI: oai:DiVA.org:umu-140737DiVA, id: diva2:1150183
Public defence
2017-11-10, Sal A, byggnad 23, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish National Institute of Public Health, HFÅ2009/192Available from: 2017-10-20 Created: 2017-10-18 Last updated: 2018-06-09Bibliographically approved
List of papers
1. Healthier Parents: Effects of Parent Training Programs on Mental Health
Open this publication in new window or tab >>Healthier Parents: Effects of Parent Training Programs on Mental Health
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2017 (English)In: International Journal of Social Work and Human Services Practice, ISSN 2332-6832, E-ISSN 2332-6840, Vol. 5, no 2, p. 70-79Article in journal (Refereed) Published
Abstract [en]

The study aims to investigate the effects of Parent Training Programs on the mental health of parents with children aged between 1 and 17 in a universal preventive setting. The intervention group included 279 parents who were assigned to five professionally administered interventions, which included 5–10 two-hour sessions; they were then compared to 702 parents in the comparison group without intervention. The improvement in general mental health was statistically significant in the intervention group compared to the comparison group. The findings suggest that evidence-based parent training programs enhance well-being in parents without indicated problems. However further exploration of preventive training programs for parents are needed.

Keywords
Parental Training Program, Universal Interventions, General Mental Health, GHQ
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-136134 (URN)10.13189/ijrh.2017.050204 (DOI)
Available from: 2017-06-13 Created: 2017-06-13 Last updated: 2018-06-09Bibliographically approved
2. Effects of Parent Training Programmes on Parents' Sense of Competence in a General Population Sample
Open this publication in new window or tab >>Effects of Parent Training Programmes on Parents' Sense of Competence in a General Population Sample
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2017 (English)In: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 9, no 7, p. 24-34Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: This longitudinal case-controlled study examined the effects of universal parent-focused interventions on parents’ perceived competence in terms of parental efficacy and satisfaction.

METHOD: The study sample consisted of parents from northern Sweden in the general population who participated in parent training programmes from 2010 to 2013, and a matched-comparison group. All parents had children aged 0–17. Sense of competence was measured by the Parenting Sense of Competence Scale at pre- and post-intervention and six months after the intervention.

RESULTS: The intervention group showed a statistically significant improvement in parental competence compared to the comparison group over time. The intervention itself had a significant effect on parental satisfaction, but the efficacy effect was not sustained when taking into account potential confounders.

CONCLUSIONS: Earlier studies indicate that parent training programmes enhance perceived parental competence amongst referred parents. The present study shows that parent training programmes applied in the general population may also enhance perceived parental satisfaction, suggesting that parent training programmes can be an important preventive strategy to enhance parental feelings of satisfaction in the wider population. The results suggest that parents who participate in parent training programmes might have a need to increase parental competence, based on lower scores than the comparison group, both before and after the intervention.

Place, publisher, year, edition, pages
Canadian Center of Science and Education, 2017
Keywords
Parent training programme, parenting sense of competence, parental support, parenting, universal intervention
National Category
Public Health, Global Health, Social Medicine and Epidemiology Psychiatry
Identifiers
urn:nbn:se:umu:diva-130533 (URN)10.5539/gjhs.v9n7p24 (DOI)
Available from: 2017-01-23 Created: 2017-01-23 Last updated: 2018-06-09Bibliographically approved
3. Effects of Parent Training Programs on Parental Stress in a General Swedish Population Sample
Open this publication in new window or tab >>Effects of Parent Training Programs on Parental Stress in a General Swedish Population Sample
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2017 (English)In: Psychology, ISSN 2152-7180, E-ISSN 2152-7199, Vol. 8, no 5, p. 700-716, article id 75044Article in journal (Refereed) Published
Abstract [en]

This is a confirmatory study that assessed the effects of parent training programs on parental stress in a general population. There is a need to repeat and confirm earlier findings to acquire solid knowledge for policy stakeholders. In a quasi-experimental design, self-reported data were gathered at three occasions from 83 parents of children between the ages from one to ten years. These parents had responded to advertisements of parent training programs, and were matched to a comparison group of 83 parents chosen from a governmental database. Parent training program based upon behavioral, cognitive-behavioral, Adlerian and family system-theories. Parental stress due to incompetence, role restriction, social isolation, spousal relationship problems, and health problems were measured by the Swedish Parenthood Stress Ques- tionnaire that is based on the Parent Stress Index Scale. The data indicated a reduction of stress in the sub-scale of health problems among parents in the intervention group with an effect size of 0.33, however, no other subscale showed the intervention as a significant variable when controlling for confounding variables. This study adds on the accumulated knowledge of supporting interventions for parents. We conclude that parent training programs have a significant effect on the stress components of parental health when implemented in real-life settings. 

Keywords
Parental Training Program, Parental Stress, Universal Prevention, SPSQ
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-133099 (URN)10.4236/psych.2017.85045 (DOI)
Available from: 2017-03-31 Created: 2017-03-31 Last updated: 2018-06-09Bibliographically approved
4. First-level trial of two school-based prevention programmes for depression, anxiety and social problems in adolescents
Open this publication in new window or tab >>First-level trial of two school-based prevention programmes for depression, anxiety and social problems in adolescents
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Recognizing the positive mental health benefits of school-based interventions, the present study examined the effect of the preventive programmes. A small feasibility try-out turned out to have conclusive results worth reporting. Choosing Healthy Actions and Thoughts (CHAT) was examined and compared to Life-Skills, commonly used primary preventive method in Swedish schools that has been evaluated in research studies and showing effects on social skills. The aim was to determine if CHAT can be included in the school curriculum and result in positive mental health gains. A community sample of 59 pupils in grade 7 completed a test battery including the Sense of Coherence, the Children’s Depression Inventory, and the Youth Self Report instruments. Post intervention measures were performed at two time points, i.e., right after the intervention sessions and after 12 months follow-up. The two programmes aimed at improving mental health in schoolchildren and both are administered by teachers. The main result was improvement in self-reported depression symptoms for the CHAT programme and less social problems for the Life-Skill programme. There is however a dimension, attention problems, where the programmes had no effect. The feasibility was considered satisfactory. Educational and healthcare implications are discussed.

Keywords
CHAT, Life-Skills, Sense of Coherence, Children’s Depression Inventory, Youth Self Report
National Category
Psychiatry
Research subject
Child and Youth Psychiatry
Identifiers
urn:nbn:se:umu:diva-140702 (URN)
Available from: 2017-10-18 Created: 2017-10-18 Last updated: 2018-06-09

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