Building Regulation in Dual-Generations Program (BRIDGE): A Novel Parenting Program for Depressed Mothers of Preschoolers

• In Event: Integration of Dialectical Behavior Therapy and Parent Training: Results From Three New Dual-Generation Treatment Studies

Abstract

Background
Early exposure to maternal depression is a risk factor for the emergence of children’s own mental health problems, given the primary role of caregivers to child well-being and shared heritability components (Rasic, 2014; Denham, 2002). However, there are limited programs that effectively support both maternal and child mental health to prevent intergenerational transmission of mental illness (Goodman, 2011; Vostanis et al., 2006). The BRIDGE “Building Regulation in Dual GEnerations” Program was designed to prevent child MI by treating maternal MI using Dialectical Behavior Therapy skills (DBT), improving child self-regulation and the parent-child relationship (Figure 1). This is achieved through promoting non-reactive parenting that scaffolds children’s ability to understand emotions, regulate arousal, and reduce aggressive or defiant behaviour.
Methods
The pilot feasibility trial (Clin Trials Reg #: NCT04347707) included 28 mothers and their 2.5 to 5-year-old children. Mothers were eligible to participate if they met the criteria for a Major Depressive Episode (MINI psychodiagnostic interview Sheehan et al., 1998). The sample had considerable adversity with a median household income of 20-30K and over 50% of mothers reporting > 4 adverse child experiences. The 20-week BRIDGE program was completed in a group-based format across in person and telehealth techniques, due to COVD-19. Mixed methods of standardized questionnaires and qualitative interviews investigated program feasibility and efficacy across intergenerational mental health and parenting stress outcomes.
Results
Feasibility indicators suggest high acceptability (86% retention) and alignment of program strategies with clients’ reasons for joining. Efficacy results indicated consistent improvements across program targets and outcomes with largest effect-sizes for changes in maternal depression (t(25) = -5.08, p < .001, d = 1.02) and child mental health problems (t(25) = -5.42, p < .001, d = 1.08). This included clinically significant symptom reductions for 85 % of clients. Qualitative results related to parenting highlighted program efficacy in supporting positive parent-child relationships, rewarding parenting experiences, parenting competence, and child development (Table 1). Preliminary investigations indicate the program was particularly effective for reducing parenting stress in mothers with greater adversity exposure r = -.49, p <.01.
Discussion
Results indicate high BRIDGE program feasibility in recruitment and retention with participants highlighting accessibility considerations (e.g. childcare, meals) and the group-based context as important for addressing their specific needs. There is also mixed-methods evidence for client satisfaction with the program material and increases in both DBT skills and parenting skills from pre to post program. Furthermore, efficacy results on key program outcomes suggest clinically significant reductions in mother maternal MI and child MI symptoms. All results should be considered in light of limitations of the feasibility trial design. Future research will include observational assessments of parent-child interactions and examine mechanisms of change across parenting skills and child self-regulation (i.e. emotional, behavioral, physiological domains. e BRIDGE holds substantial promise for offering a single-program approach to preventing child MI in families of preschool aged children at risk for intergenerational transmission. Delivering BRIDGE in an accessible group format has potential for scalability with transdiagnostic relevance in promoting family well-being, child mental health, and development.

Authors

• Leslie E. Roos, University of Manitoba
  Presenting Author

• Lauren Kaminski, University of Manitoba
  Non-Presenting Author

• Shaelyn Stienwandt, University of Manitoba
  Non-Presenting Author

• Sandra Hunter, University of Manitoba
  Non-Presenting Author

• Ryan Giuliano, University of Manitoba
  Non-Presenting Author

• Natalie Mota, University of Manitoba
  Non-Presenting Author

• Laurence Katz, Health Sciences Centre
  Non-Presenting Author

• Maureen Zalewski, University of Oregon
  Non-Presenting Author