Clinical Effectiveness of Family Therapeutic Interventions Embedded in General Pediatric Primary Care Settings for Parental Mental Health: A Systematic Review and Meta-analysis

Abstract

The aim of this systematic review and meta-analysis was to synthesize the available evidence on embedded family therapy interventions in pediatrics and impacts on parental mental health and family functioning outcomes. The Cochrane Collaboration guidelines for systematic reviews and meta-analysis were used for this study. Six electronic databases were searched for randomized controlled trials and cluster randomized trials. The Cochrane Collaboration's Risk of Bias Tool and GRADE system were used to rate the quality of evidence of the included studies. The primary outcomes included parental distress, parental depressive symptoms, and dysfunctional parent-child interaction. Fixed effects models showed statistically significant reductions in parental distress at 6-month and 12-month post-intervention in favor of the intervention group. Family therapy model, intervention level, delivery modality, and dosage moderated intervention impacts on parental distress. Fixed effects models showed statistically significant reductions in parental depressive symptoms and in dysfunctional parent-child interaction in favor of the intervention group. Family therapy interventions can be successfully embedded in general pediatric primary care, and intended outcomes are achieved in this setting. Recommendations for future research and implications for policy development are discussed.

An Australian adaptation of the Strengthening Families Program: Parent and child mental health outcomes from a pilot study

“…These findings reinforce the potential benefits of familybased interventions targeting CMH in improving PMH and wellbeing (Bertino et al, 2013;Cluxton-Keller et al, 2015;Poole et al, 2018), though further analysis is necessary to determine whether this extends to clinical levels of depression and anxiety in parents. These findings reinforce the potential benefits of familybased interventions targeting CMH in improving PMH and wellbeing (Bertino et al, 2013;Cluxton-Keller et al, 2015;Poole et al, 2018), though further analysis is necessary to determine whether this extends to clinical levels of depression and anxiety in parents.…”

“…In addition, results were also indicative of a significant reduction in parental psychological distress post-program and at follow-up; however, these effects did not maintain significance when comparing the 8-and 14-session SFC. These findings reinforce the potential benefits of familybased interventions targeting CMH in improving PMH and wellbeing (Bertino et al, 2013;Cluxton-Keller et al, 2015;Poole et al, 2018), though further analysis is necessary to determine whether this extends to clinical levels of depression and anxiety in parents.…”

“…Randomised controlled trials (RCTs) have found that family interventions targeting youth depression and anxiety symptoms significantly reduced parental anxiety (Bertino et al, 2013), stress and depressive symptoms (Poole et al, 2018), beyond parent or youth only treatment. A recent systematic review and metaanalysis also reported that family therapeutic interventions embedded within general paediatric care improved PMH (Cluxton-Keller et al, 2015). For example, parental psychological distress and depression were found to significantly decline after intervention with small to moderate effect sizes.…”

“…Child and parental mental health (PMH) problems can be reciprocal influences (Early, Gregoire, & McDonald, 2002) and are affected by family factors, including the parent-child relationship (Sander & McCarty, 2005). As such, familybased interventions have been promising for advancing both PMH and CMH (Cluxton-Keller, Riley, Noazin, & Umoren, 2015;Galbally & Lewis, 2017;Poole et al, 2018). Using a family systems approach, family interventions can address a range of risk factors that may reciprocally undermine family mental health (Carr, 2018;Kazdin, 2015), such as hostile parenting (e.g., Chang, Schwartz, Dodge, & McBride- Chang, 2003;Edwards & Maguire, 2011) and family conflict (e.g., Herrenkohl, Lee, Kosterman, & Hawkins, 2012;Lewis et al, 2015).…”

Consumo de psicofármacos por familiares cuidadores de pessoas com transtorno bipolar: fatores associados e significado do consumo

“…Há grande número de modalidades terapêuticas além do consumo de psicofármacos e o conhecimento e estudo de tais modalidades têm aumentado. É possível encontrar internacionalmente estudos recentes sobre essas práticas e a constatação científica de que algumas delas realmente podem trazer benefícios para as questões de saúde mental, como o yoga, mindfulness, psicoterapias, acupuntura, terapias familiares, entre outras (KINSER; ELSWICK; KORNSTEIN, 2014; SCHUVER; LEWIS,GOLDSTONE, 2017;FAN et al, 2016;CLUXTON- KELLER et al, 2015).Investir em saúde mental envolve investir na ampliação de possibilidades que promovam a expansão da compreensão de cuidado dos usuários com o seu corpo e sua mente. O conhecimento e a interação interior consigo mesmo possibilitam busca ativa, livre e consciente do cuidado em saúde que realmente convirja para as escolhas desses usuários.Resultado interessante encontrado no presente estudo foi a busca do consumo de classes de psicofármacos com eficácia para insônia.…”