Theory-based screening for prevention: focusing on mediating processes in children of divorce

Prevention programs in mental health theoretically can benefit from selecting participants who have a greater likelihood of developing psychological problems because of their exposure to the putative mediators targeted for change in an intervention. Screening on mediators may increase statistical power to detect program effects, enhance the cost-effectiveness of intervention trials, and decrease the possibility of iatrogenic effects. The circumstances that optimize the strategy of screening on the basis of mediating variables are discussed, and data are presented to illustrate the development of a mediational selection strategy to identify families who might best benefit from a preventive intervention for children of divorce. In addition, we present evidence that adjustment problems for children experiencing a divorce, as with most mental health problems, are not the result of one specific factor, but are jointly determined by several mediating processes that occur subsequent to the divorce. The mediational selection strategy developed illustrates the utility of measuring a set of mediational processes central to conferring risk for mental health problems to children of divorce.