Should an adolescent receive individual or family therapy? It may depend on the level of their parents’ psychological distress

By Karla Rodriguez and Mei Yi Ng, Society for Research on Adolescence

Does a parent’s mental health affect how well an adolescent responds to psychological interventions?

Parents play an important role in their adolescents’ lives. When parents are suffering from their own mental health issues, their children suffer as well. For example, when parents experience psychiatric symptoms, their adolescent children are more likely to use substances or develop mood disorders. However, there is little research involving how parents’ mental health issues affect how well adolescents respond to psychological interventions, especially for interventions that target adolescents’ use of substances such as marijuana and alcohol, and their sexual risk behaviors such as engaging in unprotected sex. There is even less research of this type on adolescents involved in the juvenile justice system. Thus, the current study set out to fill these gaps in the literature.

In this study, adolescents who were charged in juvenile drug court for non-violent offenses and their parents participated in either one of two interventions intended to reduce substance use and prevent HIV. Each family had an equal chance of being assigned to Family-based Affect Management Intervention (FAMI) or Health Promotion Intervention (HPI). In FAMI, parents and adolescents participated in the intervention; they were introduced to strategies to handle their emotions in healthy ways and to help the adolescent build the motivation and skills to avoid using substances and practicing unsafe sex. FAMI included activities such as role-playing, family discussions, and tasks to be done at home to practice the skills learned in sessions. In HPI, only adolescents participated in the intervention; this was a health education program that gave the adolescent information about substances that are commonly abused, HIV and sexually transmitted infections (STIs), and health behaviors such as exercise and sleep. There was no role-playing, family discussions, or skills practice. Both interventions were five sessions long.

Parents completed a questionnaire about their psychological distress before the interventions. Adolescents completed questionnaires about their substance use, sexual risk behavior, and mental health before the interventions and then again three months after the intervention. The following results were obtained:

  1. Among the adolescents with highly distressed parents, those who participated in FAMI were less likely to use marijuana at all and those who used marijuana did so less frequently than those who participated in HPI.
  2. Among the adolescents with mildly distressed parents, those who participated in HPI were less likely to use alcohol than those who participated in FAMI. These first two findings suggest that family interventions have an advantage over adolescent-only interventions in reducing substance use for adolescents who have distressed parents. For example, family interventions may help distressed parents to handle their own emotions better and teach them skills to help their adolescents make choices to avoid using substances.
  3. Adolescents with highly distressed parents engaged in a larger number of unprotected sexual acts compared to adolescents with mildly distressed parents in both FAMI or HPI. This finding suggests that distressed parents may have difficulty supporting their adolescents in reducing sexual risk behaviors compared to parents experiencing little distress, regardless of what intervention they participated in. Distressed parents may have chosen to focus on applying the skills they learned in FAMI to the more pressing issue of substance use rather than sexual risk behaviors, given that many adolescents were charged for drug-related offenses. A brief family intervention like FAMI may be most helpful to distressed parent when it focuses only on one or two closely-related problems that are most pressing for the family
  4. Parent distress was not related to intervention effects on adolescent mental health problems, including depression and anxiety or behavior problems. This lack of a relationship may be because mental health problems were not the main focus of the interventions.

To summarize, the results showed that the adolescents’ response to the interventions depended on their parents’ level of psychological distress. These findings may help clinicians match adolescents with the intervention that is likely to benefit them the most, especially adolescents involved in the juvenile justice system,. Questionnaires or interviews that include questions about parents’ psychological distress may help clinicians to identify the type of intervention that may be most helpful to each adolescent. Adolescents with highly distressed parents do better with family interventions similar to FAMI, especially with regard to reducing marijuana use, whereas adolescents with mildly or not distressed parents may do better with adolescent-only interventions similar to HPI, especially with regard to alcohol use. This screening approach may help to personalize intervention to the needs of individual adolescents and improve behavioral health services for them.

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