Mechanisms By Which the Familias Unidas Intervention Influences Adolescent Internalizing Symptoms

Introduction: Familias Unidas is a family-focused, evidence-based preventive intervention that has been found to reduce drug use, sexual risk behaviors and externalizing behaviors among Hispanic adolescents. Recent analyses have also documented the efficacy of Familias Unidas in reducing adolescent internalizing symptoms (i.e., depressive and anxiety symptoms) even though this intervention did not specifically target internalizing symptoms. This study examines potential mechanisms of action by which Familias Unidas influences internalizing symptoms, specifically the role of intervention-targeted improvements in parent-adolescent communication and reductions in youth externalizing behaviors.

Methods: 213 Hispanic eighth grade students with a history of externalizing behavior problems and their primary caregivers were recruited from the public school system. Participants, 36% female with a mean age of 13.8 years, were randomized into either the Familias Unidas intervention or a Community Practice control condition. Participants were assessed at Baseline, 6-months (post-intervention), 18-months and 30-months post-baseline. The outcome variable examined was parent reports of adolescent internalizing symptoms (i.e., anxiety and anxiety symptoms), assessed at 30-months post-baseline. Parent reports of parent-adolescent communication at 6-months and youth externalizing problems at 18-months post-baseline were also assessed. We tested a cascading mediation model in which the Familias Unidas intervention was hypothesized to decrease distal internalizing levels through two mediators: increases in parent-adolescent communication at 6-months, leading to decreases in externalizing behaviors at 18-months post-baseline.

Results: The Familias Unidas intervention demonstrated significant direct and indirect effects on youth internalizing symptoms at 30-months post-baseline.  The cascading mediator model showed significant improvement by the intervention on parent-adolescent communication at 6-months, which significantly decreased externalizing behaviors at 18-months, which in turn reduced internalizing symptoms at 30-months post-baseline.

Conclusions: Findings suggest a cascading model in which the Familias Unidas intervention improves parent-adolescent communication leading to reductions in youth externalizing symptoms and subsequent reductions in youth internalizing symptoms. Implications of these findings for the prevention of youth internalizing problems (i.e., anxiety and depressive disorders) will be addressed.