Objective:Data on sexual violence perpetration among adolescents has not been widely available in South Africa. This paper characterizes sexual violence perpetration and identifies factors associated with perpetration. Method:Data were derived from a secondary analysis of N=879, 14-16 year old adolescents with elevated risk for depression, and recruited via house-to-house community sampling for participation in a randomized controlled trial testing the efficacy of a behavioral intervention for prevention of HIV, STIs, and depression. Data were collected from 2018-2023 in South Africa. Results:Nearly half of participants (45.8%) attempted and/or completed one or more acts of sexual violence perpetration. The most common act of completed perpetration was coerced touching (30.5%), followed by oral sex (18.2%), vaginal sex (12.1%), and anal sex (11.9%). The most common act of attempted perpetration was oral sex (15.5%) followed by vaginal sex (11.2%) and anal sex (10.6%). Boys engaged in more violent perpetration than girls. Regression analysis adjusted for age and gender showed that having more sexual partners (p<0.001), drug use (p<0.001), and less parental monitoring (p=0.057) remained independent risk factors. Conclusions:Public health intervention is urgently needed to address sexual violence perpetration among adolescents. Future interventions should be timed for early adolescence, and should develop adolescents' understanding of rape, assault, and gaining sexual consent for a range of sexual touching, not just penetrative sex. Interventions to address violence should concurrently address sexual and reproductive health risk behaviors as well as substance use.

Socio-ecological contexts shape trauma and recovery after sexual abuse, but little is known about these contexts, particularly for racial and ethnic minority families. We aimed to describe contextual stressors for Black and Latino families after child sexual abuse. We interviewed 30 Black and Latino, English and Spanish-speaking caregivers of children who were sexually abused. Interviews were analyzed using thematic analysis. Caregivers (87% mothers) reported two sociocultural stressors: (1) beliefs about sexual abuse (patriarchy and stigma) and (2) beliefs about help-seeking (trust in family advice and mistrust of mental health care). Caregivers reported one main systems stressor: sexual abuse evaluation, investigation, and legal processes. They described how experiences with multidisciplinary systems can lead to child re-traumatization, caregiver blame and powerlessness, and family and community identity-based stress. Our findings highlight areas of intervention to strengthen and uplift communities, improve child protection systems, and promote child and family well-being after sexual abuse.

OBJECTIVE:Child sexual abuse is associated with mental health (MH) challenges across the lifespan. Black and Latino children are less likely to receive MH services than children of other backgrounds. We aimed to identify facilitators and barriers to MH services for Black and Latino children after sexual abuse. METHODS:We conducted semistructured interviews with 30 Black and Latino, English- and Spanish-speaking caregivers of children who have experienced sexual abuse. Interviews were completed in caregivers' preferred language and modality (phone, video conferencing, or in person). Caregivers were asked about their opinions and experiences with initiating child MH services after sexual abuse. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS:Caregivers (27% Black, 47% Latino, 27% Black and Latino) were mostly biological mothers (87%). Half were born outside the United States. Caregivers reported 3 facilitators to MH services after sexual abuse: 1) perceived benefits of MH services; 2) trust in MH providers; and 3) support from frontline professionals and systems. Caregivers reported timely support when there was cross-system care coordination. Caregivers described 5 barriers to MH services after sexual abuse: 1) perceived harms of MH services; 2) concerns about misjudgment and discrimination by MH providers; 3) stigma of sexual abuse; 4) youth's lack of engagement in MH services; and 5) structural obstacles to MH services. CONCLUSIONS:Black and Latino caregivers identified multiple facilitators and barriers to MH services after sexual abuse. Our findings can inform the development and testing of evidence-based strategies to improve MH engagement and outcomes after sexual abuse.

Background Resettled refugee families face elevated mental health risks, compounded by structural and cultural barriers. The Family Strengthening Intervention for Resettlement (FSIR), co-developed with resettled refugee communities, aims to improve family functioning and child mental health. This study evaluated FSI-R in Somali Bantu and Bhutanese communities in New England during COVID-19 using a Hybrid Type II Implementation-Effectiveness Trial guided by the EPIS framework.Methods Linear mixed modeling assessed changes in family functioning and child mental health. A process evaluation identified implementation barriers and informed adaptations. Activities were registered under Clinical Registry #NCT03796065.Results Bhutanese families receiving FSI-R showed greater improvements in parental supervision compared to usual care. Process evaluation highlighted that responsiveness to community needs supported successful implementation despite pandemic stressors. Somali Bantu interventionists reported stronger emotional connection with families during in-person delivery.Conclusions Findings support the utility of hybrid trials in assessing both effectiveness and implementation of preventive interventions with resettling families. Despite contextual disruptions, attention to community needs and delivery flexibility enabled successful implementation. This study underscores the importance of context-informed strategies to sustain core elements of evidence-based interventions in dynamic settings.

The current study estimated effects of intervention dose (attendance) of a cognitive behavioral prevention (CBP) program on depression-free days (DFDs) in adolescent offspring of parents with a history of depression. As part of secondary analyses of a multisite randomized controlled trial, we analyzed the complete intention-to-treat sample of 316 at-risk adolescents ages 13 to 17 years. Youth were randomly assigned to the CBP program plus usual care (n = 159) or to usual care alone (n = 157). The CBP program involved 8 weekly acute sessions and 6 monthly continuation sessions. Results showed that higher CBP program dose predicted more DFDs, with a key threshold of approximately 75% of a full dose in analyses employing instrumental variable methodology to control multiple channels of bias. Specifically, attending at more than 75% of acute phase sessions led to 45.3 more DFDs over the 9-month period after randomization, which accounted for over 12% of the total follow-up days. Instrument sets were informed by study variables and external data, including weather and travel burden. In contrast, conventional analysis methods failed to find a significant dose-outcome relation. Application of the instrumental variable approach, which better controls the influence of confounding, demonstrated that higher CBP program dose resulted in more DFDs. This article is part of a Special Collection on Mental Health.

On the 100th birthday of the Global Alliance for Behavioral Health and Social Justice, it is appropriate to reflect on the evolution of thought on depression prevention research, as seen through a historical perspective, to note how the field has grown and how it can address the issues of today. This article is a personal reflection on one practitioner's evolution of thought on resilience and preventive intervention, starting with interviewing civil rights workers, to conceptualizing self-understanding as an essential component of resilience, to the development of a family-based preventive intervention for parental depression, which was disseminated, adapted, and incorporated into a growing body of prevention research. Consensus statements on mental health prevention from the National Academies are reviewed, and the importance of a social justice perspective is highlighted throughout. The article concludes with principles for developing effective preventive interventions to promote mental health today, and in the future. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Youth internalizing symptoms (i.e., depression and anxiety), suicide ideation and attempts have been rising in recent years, including among Hispanics. Disparities in mental healthcare are concerning and require intervention, ideally prevention or early intervention. Familias Unidas is a culturally-syntonic, family-centered intervention effective in reducing youth drug use and sexual risk, with evidence of unanticipated effects on internalizing symptoms. This paper describes the systematic process used to adapt the eHealth version of the Familias Unidas intervention to more directly address internalizing symptoms and suicide risk in preparation for an effectiveness-implementation hybrid trial for youth with elevated internalizing symptoms, a history of suicide ideation/attempts, or poor parent-youth communication. The resulting eHealth Familias Unidas Mental Health intervention is described. Guided by a 4-phase framework, the steps in the adaptation process involved: assessment of the community and intervention delivery setting (pediatric primary care clinics); integration of previous intervention research, including intervention mechanisms of action; and expert and community consultation via focus groups. Focus group analyses showed that youth and parents perceived that the intervention was helpful. Their feedback was categorized into themes that were used to directly target mental health by addressing technology use, parent mental health, and social support. Effective and scalable preventive interventions are needed to address mental health disparities. The systematic adaptation process described in this paper is an efficient approach to expanding interventions while maintaining known, empirical and theoretical mechanisms of action. Findings from the ongoing effectiveness-implementation trial will be critical.

The historic momentum from national conversations on the roots and current impacts of racism in the USA presents an incredible window of opportunity for prevention scientists to revisit how common theories, measurement tools, methodologies, and interventions can be radically re-envisioned, retooled, and rebuilt to dismantle racism and promote equitable health for minoritized communities. Recognizing this opportunity, the NIH-funded Prevention Science and Methodology Group (PSMG) launched a series of presentations focused on the role of Prevention Science to address racism and discrimination guided by a commitment to social justice and health equity. The current manuscript aims to advance the field of Prevention Science by summarizing key issues raised during the series’ presentations and proposing concrete research priorities and steps that hold promise for promoting health equity by addressing systemic racism. Being anti-racist is an active practice for all of us, whether we identify as methodologists, interventionists, practitioners, funders, community members, or an intersection of these identities. We implore prevention scientists and methodologists to take on these conversations with us to promote science and practice that offers every life the right to live in a just and equitable world.

Informed by models of resilience in military families, we explored factors theorized to be associated with social-emotional resilience and risk among young military-connected children. Our secondary analysis of cross-sectional data from 199 military-connected families (n = 346 parents) with at least one preschool-age child in the home (n = 199) led to the empirical identification of two distinct clusters: families with children demonstrating healthy social-emotional functioning and those showing indicators of poor social-emotional functioning. We then identified factors associated with membership in each cluster to determine which deployment and parental wellbeing variables were salient for young child adjustment. Parent psychological health symptoms, parenting, child behavior, and parent-child relationships were measured by parent report and observed interaction. Children with healthier social-emotional functioning were found to be residing with families experiencing less stress and distress. The importance of maternal trauma history is highlighted in our study, as elevated maternal symptoms across all three posttraumatic stress disorder symptom domains were associated with child social-emotional risk. Basic family demographic characteristics did not contribute significantly to the cluster distinctions, nor did military service factors such as active duty, reserve or veteran status, military rank or parent deployment history. These findings are important as the results deemphasize the importance of military service characteristics and highlight the importance of parent wellbeing when considering social-emotional risk and resilience of young children within military families.

Major depressive disorder (MDD) is highly prevalent in youth and generally characterized by psychiatric comorbidities. Secular trends in co-occurring diagnoses remain unclear, especially in healthcare settings. Using large-scale electronic health records data from a major U.S. healthcare system, we examined the prevalence of MDD diagnoses and co-occurring psychiatric conditions during adolescence (12-18 years; N = 133,753) across four generations (birth years spanning 1985 to 2002) and by sex. Then using a phenome-wide association analysis, we explored which of 67 psychiatric conditions were associated with adolescent MDD diagnosis in earlier versus recent generations. Adolescent MDD diagnosis prevalence increased (8.9 to 11.4%) over time. Over 60% with an MDD diagnosis had co-occurring psychiatric diagnoses, especially neurodevelopmental and anxiety disorders. Co-occurring diagnoses generally increased over time, especially for anxiety disorders (14 to 50%) and suicidal behaviors (6 to 23%), across both sexes. Eight comorbidities interacted with generation, showing stronger associations with MDD diagnosis in earlier (e.g., conduct disorder) versus more recent (e.g., suicidal ideation and behaviors) generations. The findings underscore the importance of assessing psychiatric complexity in adolescents diagnosed with MDD, applying transdiagnostic approaches to address co-occurring presentations, and further investigating potential causes for generational increases.

Since its founding, American Orthopsychiatric Association (AOA) has been at the forefront of working at the intersection of mental health and social justice. In Mental Health and Social Change: 50 Years of Orthopsychiatry (Shore & Mannino, 1975), former organization president and journal editor Milton Shore and Fortune Mannino wrote that the association had consistently held a philosophy that included (a) a commitment to an interdisciplinary approach in the study of mental health problems and the development of mental health programs; (b) an emphasis on prevention as well as treatment; (c) the integration of the clinical and the social; (d) a major focus on the social scene and its interweaving with mental health problems in individuals within society; and (e) an avoidance of dilettantism, superficiality, and well-meaning generalizations through a commitment to high-quality research, thoughtful analysis of mental health issues, and high professional standards of practice in all areas of mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Depression is highly prevalent and a major cause of disability, decreased quality of life, and premature mortality. Indicated prevention of depressive disorders is a major opportunity to improve population behavioral health. Offspring of adults who have experienced depression are at high risk of depression, and Family Talk is a family-based intervention that has shown remarkable and persistent improvement in RCTs. Implementation of Family Talk has been successfully accomplished in multiple settings in the United States and internationally, including racial and socioeconomic disparities. Description and discussion of this successful implementation will be of use to others in roles of clinical and public policy leadership, and with other disorders and interventions. This experience will be discussed in the context of other interventions on this program and the increasing body of evidence that effective prevention is feasible. The development, testing, and implementation of Family Talk will be discussed. Challenges in the process of implementation and effective navigation through them are discussed, for consideration with other opportunities for prevention. Issues include engagement of families in difficult conversations, training of the clinical workforce, and moving beyond stigma. Family Talk has been demonstrated to be effective and has been implemented successfully in multiple settings. Lessons learned can be useful in the implementation of other innovative prevention strategies. Preventive interventions are feasible and can be successfully implemented at a scale sufficient to realize their promise to improve population behavioral health. Increased investment in prevention is sound public policy.

Background Children of parents with mental illness have an increased risk of developing mental illness themselves throughout their lifespan. This is due to genetic factors but also environmental disadvantages during childhood associated with parental mental illness. Selective primary preventive interventions for the children are recommended to mitigate risk factors and strengthen protective factors, but large-scale, longitudinal studies are needed. This study aims to investigate the effect of the Family Talk Preventive Intervention in a cohort of children and their parents with mental illness. Methods The study is a randomized controlled trial with 286 planned families with at least one parent with any mental illness and at least one child aged 7 to 17 years. It will be carried out in the mental healthcare system in the Capital Region of Denmark. Families will be referred from hospitals and municipalities. The children and parents will be assessed at baseline and then randomized and allocated to either the Family Talk Preventive Intervention or service as usual. The intervention group will be assigned to Family Talk Preventive Intervention, a manualized programme consisting of ~ seven sessions for the family, including psychoeducation about parental mental illness and resilience in children, stimulating dialogue between family members and creating a common family narrative. The study period for both groups will be 12 months. Follow-up assessments will be conducted after 4 months and 12 months. The primary outcomes are the children’s level of functioning, parental sense of competence and family functioning. Discussion Given the prevalence of transgenerational transmission of mental illness, a systematic approach to prevention is needed in the mental healthcare setting. This study provides valuable knowledge on the Family Talk Preventive Intervention with a large sample size, inclusion of any parental mental illness and examination of the primary outcomes. Trial registration ClinicalTrials.gov NCT05615324. Registered on 26 October 2022. Retrospectively registered.

This article focuses on the rationale, design and methods of an effectiveness-implementation hybrid type I randomized trial of eHealth Familias Unidas Mental Health, a family-based, online delivered intervention for Hispanic families to prevent/reduce depressive and anxious symptoms, suicide ideation/behaviors, and drug use in Hispanic youth. Utilizing a rollout design with 18 pediatric primary care clinics and 468 families, this study addresses intervention effectiveness, implementation research questions, and intervention sustainment, to begin bridging the gap between research and practice in eliminating mental health and drug use disparities among Hispanic youth. Further, we will examine whether intervention effects are partially mediated by improved family communication and reduced externalizing behaviors, including drug use, and moderated by parental depression. Finally, we will explore whether the intervention's impact on mental health and drug use, as well as sustainment of the intervention in clinics, varies by quality of implementation at clinic and clinician levels. Trail registration: ClinicalTrials.gov Identifier: NCT05426057, First posted June 21, 2022.

Little is known about the effects of parental depression on offspring as they transition to adulthood-a challenging time developmentally, when late adolescents must separate from home, achieve intimate relationships, and develop a sense of identity. We present long-term quantitative and qualitative data from early adolescents with a depressed parent who were randomized to one of two family-based preventive interventions and followed over time, across the transition to young adulthood. Specifically, we present clinical measures of psychopathology and Likert-scale questionnaire data from young adults and their parents regarding the transition to adulthood and perceptions of the interventions. We also report in-depth qualitative interview data from young adults about the effects of parental depression on their transition to adulthood. Findings suggest that leaving home, establishing relationships, and coping with stressors may be challenging for emerging adults. Furthermore, the interviews highlight the importance of siblings, the burden of parental depression, and the development of self-understanding and empathy in young adults who grew up with a depressed parent. Data suggest that clinicians, policy makers, educators, and employers must address the preventive and clinical needs of young people and their families as they transition to young adulthood after growing up with depressed parents.

Les enfants vivant avec un parent atteint d'un trouble dépressif majeur sont à plus haut risque de vivre des difficultés sociales, scolaires et émotionnelles (Reupert et al., 2012). Ils se retrouvent également très souvent à avoir un rôle de proche aidant auprès de leur parent (Cooklin, 2010). À l'étranger, entre autres aux États-Unis, en Europe et en Australie, plusieurs interventions ont été développées pour ces enfants et leurs familles dans le but de favoriser leur résilience. Au Québec, le programme FAMILLE+, une intervention préventive ciblée pour les enfants et les familles vivant avec un parent ayant un trouble dépressif, a été développé en 2018. Le contenu du programme, notamment les objectifs, la structure générale, les activités d'apprentissage et les outils novateurs proposés seront détaillés. Puis, les auteurs présenteront les résultats d'une étude pilote de la fidélité de la mise en oeuvre du programme, les principaux facteurs facilitant et entravant l'implantation, ainsi que les retombées perçues par les participants (enfants, parents) et les animateurs. Finalement, les implications pour la pratique seront abordées.

Evidence-based interventions to prevent child maltreatment among individuals and families are being implemented across wide areas of the U.S. Often focused on high-risk families such as teenage parents, single parents, or families living in poverty, these approaches are typically focused on giving parents skills, knowledge, and sometimes assistance with multiple needs that enable them to safely parent their young children. This chapter describes a much newer area of inquiry, that is how community-level approaches to child maltreatment prevention, typically evaluated on their ability to both change environments and to improve population rates of maltreatment, can augment these individual and family-focused efforts. We describe the development of these interventions and how it follows an emerging body of research on both neighborhood structural factors such as poverty and segregation, and potentially modifiable social processes, such as collective efficacy, each of which are associated with fluctuations in maltreatment rates in expected directions. A number of existing community-level prevention programs will be described. We will discuss different definitions of community-level programs for child maltreatment prevention; strategies for building relationships with communities; working with culturally diverse communities; overcoming barriers to implementation; and planning for sustainability. Recommendations for moving community-level child maltreatment programs forward are provided.

Transnational migration of refugees is associated with poor mental health, particularly among children. We conducted a pilot trial of the Family Strengthening Intervention for Refugees (FSI-R), using a community-based participatory research (CBPR) approach to deliver a home-based intervention "for refugees by refugees" to improve family functioning and child mental health. N = 80 refugee families in the Greater Boston area participated in the study (n = 40 Somali Bantu families; n = 40 Bhutanese families) with n = 41 families randomized to care-as-usual. Of the 39 families who received FSI-R, n = 36 caregivers and children completed qualitative exit interviews. We present findings from these interviews to identify the mechanisms through which a family-strengthening intervention for refugees can be acceptable, feasible, and effective at improving family functioning and children's mental health outcomes. Authors applied Grounded Theory to code interview transcripts and detailed field notes and used an iterative process to arrive at final codes, themes, and a theoretical framework. The greatest contributors to acceptability and feasibility included flexibility in scheduling intervention sessions, the interventionist being a community member, and improvements to family communication and time spent together. All of these factors were made possible by the CBPR approach. Our findings suggest that given the socio-political context within the U.S. and the economic challenges faced by refugee families, the successful implementation of such interventions hinges on culturally-grounding the intervention design process, drawing heavily on community input, and prioritizing community members as interventionists.

The Biden/Harris Administration faces many challenges, from systems and policies that do not work for or benefit all Americans to stark social and political divisions. Multiple courses of action will be necessary, and there must be commitment and investment for the long haul. When considering the nation's challenges, overarching themes emerge that must be addressed. For instance, recommendations for justice reform cannot be followed without significant focus on race and equity. This focus will also be needed in considering solutions to affordable housing shortages, economic crises, and social and economic immobility concerns. In a similar vein, if the interests and rights of our nation's children are not recognized now, the social consequences will impact every aspect of their livelihoods-and those of future generations. The recommendations put forward by the Global Alliance are bold and will take time to fully implement. The implementation of these recommendations will challenge our systems and our policymakers to acknowledge our past and reenvision the future-and they will help address the multifaceted behavioral health and well-being needs of our nation, its communities, and its people. (PsycInfo Database Record (c) 2021 APA, all rights reserved).