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A Randomized Comparative Effectiveness Trial of Family-Problem-Solving Treatment for Adolescent Brain Injury: Parent
Shari L Wade1, Amy E Cassedy, Kelly A McNally
1Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center and Departments of Pediatrics and Psychology, University of Cincinnati, Cincinnati, Ohio (Dr Wade); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Cassedy); Division of Psychiatry and Behavioral Health, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio (Dr McNally); Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, and Departments of Pediatrics, Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio (Dr Kurowski); Department of Rehabilitation Psychology/Neuropsychology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado (Dr Kirkwood); Department of Psychiatry, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio (Dr Stancin); Center for Biobehavioral Health, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University, Columbus, Ohio (Dr Taylor); and Division of Developmental/Behavioral Pediatrics and Psychology, Case Western Reserve University and Rainbow Babies & Children's University Hospital Cleveland Medical Center, Cleveland, Ohio (Dr Taylor).
Objective:
To examine changes in depression and distress in parents of adolescents receiving family-problem-solving therapy (F-PST) following traumatic brain injury.
Method:
Families of adolescents hospitalized for moderate to severe traumatic brain injury were randomized to face-to-face F-PST (34), therapist-guided online F-PST (56), or self-guided online F-PST (60). Outcomes were assessed pretreatment and 6 and 9 months later. Parents rated depression and distress on the Center for Epidemiological Studies Depression Scale and the Brief Symptom Inventory, respectively. Mixed modeling was used to examine changes over time and treatment moderators.
Results:
The therapist-guided online group had significant reductions in parental depression over time. Analyses of slopes of recovery revealed differential improvement on the Center for Epidemiological Studies Depression Scale between the 2 online groups, with no significant change in depressive symptoms following self-guided F-PST. On the Brief Symptom Inventory Global Severity Index, the therapist-guided online group reported significant improvement from baseline to 6 months that was maintained at 9 months. The face-to-face and self-guided online groups reported significant reductions in distress between 6 and 9 months with corresponding large effect sizes. Differences on the Center for Epidemiological Studies Depression Scale between therapist-guided and self-guided online groups at the 9-month follow-up were more pronounced in families of lower socioeconomic status, t103 = -2.87; P = .005.
Conclusions:
Findings provide further support for the utility of therapist-guided online F-PST in reducing parental depression and distress following pediatric traumatic brain injury and offer limited evidence of the efficacy of self-guided online treatment for these outcomes. Families of lower socioeconomic status may benefit more from therapist involvement.
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