Effects of Adolescent Universal Substance Misuse Preventive Interventions on Young Adult Depression Symptoms: Mediational Modeling

Abstract

Depression symptoms are associated with impairments in functioning and have substantial health and economic consequences. Universal substance misuse prevention programs have shown effects on non-targeted mental health-related symptoms, but long-term effects are understudied. This cluster randomized controlled trial examined effects of both the LifeSkills Training (LST) and Strengthening Families Program: For Parents and Youth 10–14 (SFP 10–14) interventions, delivered during seventh grade, on age 22 young adult depression symptoms. The study was conducted in US rural Midwestern communities with a randomly-selected sample from a larger study (N= 670). Experimental conditions were LST+SFP 10–14, LST-only, and a control condition. Effects on age 22 depression symptoms were hypothesized as mediated through effects on age 21 relationship problems and illicit use of substances. Structural equation modeling with manifest and latent variables was conducted to test hypotheses; the intervention conditions were combined and compared with the control condition because analyses indicated a comparable pattern of effects between intervention conditions. Significant indirect intervention effects were found on age 22 depression symptoms via effects on the mediating variables (indirect effect: β=−0.06, 95 % CI [−0.10, −0.01], p=0.011). Effect sizes for the young adult variables were between d=0.17 and 0.29, which can be considered small, but nontrivial, especially in the context of public health benefits. Results support scaled-up implementation of school-based and family-focused universal substance misuse preventive interventions.

Reducing Internalizing Symptoms Among High-Risk, Hispanic Adolescents: Mediators of a Preventive Family Intervention

“…This is not the first study to find cascading effects of a preventive intervention on youth outcomes after the intervention ended (see Bonds et al 2010; Trudeau et al, 2015), but it lends support for the cascading effects of interventions that strengthen family factors (Sandler et al, 2014). The study adds to our intervention knowledge base by connecting reductions in externalizing problems to subsequent improvements in internalizing symptoms for youth with behavior problems, identifying an intervention that reduces both externalizing and internalizing symptoms in these vulnerable youth.…”

“…Previous studies have established that family-based preventive interventions for youth, such as Familias Unidas, can have noteworthy effects on youth across time (Bonds et al 2010; Connell & Dishion, 2008; NRC/ IOM, 2009; Perrino et al, 2015; Sandler, et al, 2014; Trudeau, et al, 2012; Trudeau et al, 2015). The current analyses add to this literature, showing that the Familias Unidas intervention reduced internalizing symptoms among Hispanic adolescents at risk due to having initially high levels of externalizing problems.…”

“…It may require the examination of multiple mediators across several time-points, sometimes across extended periods of time. Research has sometimes identified cascading effects of preventive interventions across long periods of time, important because the full effects of preventive interventions on youth outcomes may take time to become evident (Bonds et al, 2010; McClain et al, 2010; Trudeau, et al, 2015; VanRyzin & Dishion, 2012). …”

Effectiveness of Universal School‐Based Mental Health Awareness Programs Among Youth in the United States: A Systematic Review

“…After title/abstract review, 36 were selected for full article review. After full review of these articles, 25 were eliminated because they did not meet the inclusion criteria that had been established for this systematic review. After reference lists of relevant articles were searched, an additional 3 articles were selected to be part of the review.…”

PROSPER delivery of universal preventive interventions with young adolescents: long-term effects on emerging adult substance misuse and associated risk behaviors

“…To illustrate, the RRR for lifetime non-prescribed narcotics use (25.8%) suggests that, for every 100 general population young adults (i.e., from non-PROSPER communities/school districts) who have ever misused narcotics, approximately 74 young adults from PROSPER sites would have misused narcotics. The combination of positive outcomes and cost-efficiency of the PROSPER partnership model (Spoth & Greenberg, 2011; Crowley et al 2012) suggests its potential public health benefit, particularly in light of the likely long-term effects of reduced young adult substance misuse (e.g., Hawkins et al 2005, 2008 b ; Spoth et al 2014 a ;Trudeau et al 2016). The National Research Council and Institute of Medicine Report (2009) and the recent US Surgeon General Report (2016), along with other literature (Hawkins et al 2008 a; 2012), note the practical benefits of community-based prevention delivery systems for EBIs, particularly those embedded in national delivery systems and/or those supporting practitioner-scientist partnerships (Grumbach & Mold, 2009; Spoth & Greenberg, 2011).…”