Double Jeopardy: The Impact of Parental Psychopathology On Outcomes of a Family-Based HIV Prevention Intervention for Adolescents in Mental Health Treatment

Parents and families play an important role in insulating youth against high-risk sexual behavior (e.g., more partners, non-condom use) and have become an important focus of adolescent HIV prevention programs. Although adaptive parenting practices help protect youth, maladaptive practices may place them at greater risk. Parents with psychiatric disorders are more likely to display greater criticism and hostility in their communication and also display more disorganized parenting strategies with less parental monitoring.  These maladaptive behaviors suggest that parental psychopathology is an important background factor to consider when implementing family based prevention programs. Examining parental psychopathology is especially relevant given recent evidence from meta-analyses of general parenting interventions that suggests parents with mental health problems may not respond as well as their peers to parent-training interventions.

Strengthening Today’s Youth Life Experiences (Project STYLE) is an 11-hour family-based intervention (single day multi-family workshop and two booster sessions).  It was developed and evaluated through a large scale randomized clinical trial which recruited and intervened with 721 youth in mental health treatment and their caregivers and is based on the Social-Personal Framework. The current study examines the moderating influence of parent psychopathology on the Project STYLE family based intervention targets.  (e.g. parent-adolescent sexual communication, parent and adolescent HIV knowledge, parental monitoring and permissiveness). We hypothesized those parents with mental health problems would demonstrate less benefit from the family-based intervention.  Study hypotheses were tested using general linear models at the 3- and 6-month assessments controlling for baseline. Tests of moderation were conducted by modeling the interaction between treatment condition (family versus control) and parental psychopathology. There were significant interactions between treatment condition and parental psychopathology for parent report of sexual communication at 3 months (t(391) = 2.04; p =.04) and 6 months (t(369) = 2.24; p =.03), and for adolescent report of parental monitoring at 3 months (t(268) = 1.93; p =.05) and 6 months (t(300) = 1.95; p =.05). In both instances, parents with psychopathology responded better to the treatment condition than those without psychopathology. There were no differences in treatment response between parents with and without psychopathology on the other outcomes.

Contrary to our initial hypothesis, parents with psychiatric symptoms were either comparable to their peers without psychopathology (i.e., HIV knowledge and permissiveness) or demonstrated greater improvements (i.e., sexual communication and monitoring) following the family-based intervention. These results suggest that despite engaging in more maladaptive parenting practices, parents with mental health problems were responsive to a relatively brief but targeted intervention.