The aim of this randomised clinical trial is to evaluate the short and longterm effects of a transdiagnostic mentalization-based intervention (Lighthouse MBT Parenting Program) compared to care as usal (CAU) for parents with a mental disorder in adult mental health service.
According to the World Health Organization (WHO), 970 million people worldwide suffer from mental disorders, many of whom are parents. Cross-sectional studies indicate that between 15-55% of the patients attending adult mental health service (AMHS) are parents. In Denmark, about 430.000 children have at least one parent with a mental disorder. Parental mental health problems have a detrimental impact on parenting, leading to long-term negative consequences for their children. Robust evidence shows that children of parents with mental disorders have an elevated risk of various adverse outcomes and events, such as developing a mental disorder themselves and exposure to child maltreatment, compared to children of healthy unaffected parents, suggesting an intergenerational transmission of adversity from parent to child. Mental disorders in parents thus leaves deep traces throughout their children's' lives and entails major socio-economic consequences. Given the high prevalence and substantial burden of parental mental disorders, there is an urgent need for evidence-based interventions targeting the specific needs of this population to prevent the adverse impact on their children. Despite this, the existing services in AMHS for parents with mental disorders are insufficient, and not evidence based. The present trial seeks to fill in this gap. This is an investigator-initiated single-center, two-arm, parallel group randomized clinical trial testing for superiority of a transdiagnostic mentalization-based intervention (Lighthouse MBT Parenting Program) versus care as usual in 170 parents with various mental disorders. The experimental intervention and active control group intervention are delivered as an add-on to the participants' outpatient treatment. Participants will be recruited from the outpatient clinics at Psychotherapy Centre Stolpegaard (PCS), Capital Region of Denmark. Participants will be included if they comply with the eligibility criteria. Participants will be assessed at baseline, and at 6, 12, and 24 months follow-up after randomization.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
170
The experimental group is a manualized transdiagnostic mentalization-based parenting intervention (Lighthouse MBT Parenting Program). This is a 12-week parenting group intervention (weekly session of 2 hours) with one preperatory initial individual session (1 hour) before the group commence.
1-2 next of kin sessions (called 'Familiesamtale') is considered the care as usual offered to parents in adult mental health service in the Capital Region of Denmark. Parents are offered the possibility of bringing their spouse or offspring to one of the sessions.
Psychotherapeutic Centre Stolpegaard
Gentofte Municipality, Capital Region, Denmark
RECRUITINGPsychotherapeutic Centre Stolpegård
Gentofte Municipality, Denmark
RECRUITINGParenting stress assessed with Parenting Stress Index - Short Form (PSI-4-SF)
PSI-4-SF is a 36-item questionnaire assessing self-reported levels of parenting stress. The PSI-4-SF consists of three subscales: Parental Distress (PD), Parent-Child Dysfunctional Interaction (P-CDI), and Difficult Child (DC). A total stress score indicates the overall level of parenting stress as experienced by the parent. Parents rate the degree to which they agree with each statement (SA: Strongly agree, A: Agree, NS: Not sure; D: Disagree, SD: Strongly Disagree). Range: 36-180 with higher scores indicating higher levels of parenting stress.
Time frame: Baseline, and at 6, 12, and 24 months post randomization
Psychological adjustment in children assessed with the Strenght and Difficulties Questionnaire - Extended version (SDQ)
SDQ is a 25-item questionnaire assessing parent-reported child emotional and behavioural problems. The SDQ has five scales (scored 0-10); emotional problems, conduct problems, hyperactivity, peer problems and pro-social scale. The scales are combined (excluding the pro-social scale) into a 'total difficulties' score (Range: 0-40, with higher scores indicating more problems). The items on the overall distress and impairment can be summed to generate an impact score (Range: 0-10), indicating the need for assessment and possible intervention. Parents rate the degree to which they agree with each statement (NT: Not true, ST: Somewhat true, CT: Certainly true). Higher scores indicate more problems or more functional impairment.
Time frame: Baseline, and at 6, 12, and 24 months post randomization
Quality of life in parents assessed with the World Health Organization Questionnaire of Life - BREF (WHOQL-BREF)
WHOQL-BREF is a 26-item questionnaire assessing self-reported quality of life. The instrument measures an individual's overall quality of life and general health and four health dimensions: Physical health, psychological, social relationships, and environment. The domain scores are scaled in a positive direction with higher scores indicating a higher quality of life. The two domains assessing psychological health (6 items) and social relationsships (3-items) and the measure of the overall quality of life and general health (2 items) will be used.
Time frame: Baseline, and at 6, 12, and 24 months post randomization
Family functioning assessed with the McMaster Family Assessment Device - General Functioning Scale (FAD-GF).
The FAD is a questionnaire assessing self-reported perceptions of the parent's current family relationships. It consists of five subscales: problem solving, communication, roles, affective responsiveness, affective involvement, behavior control, and general functioning. Parents rate each statement on a 4-point scale (SA: Strongly agree, A: Agree, D: Disagree, SD: Strongly Disagree). Only the general functioning (6-items) subscale will be used.Range: 6-24, with higher scores indicating more functional impairment.
Time frame: Baseline, and at 6, 12, and 24 months post randomization
Childhood adversity in children assessed with the Adverse Child Experciences Questionnaire (ACE) extended version developed by the Center for Youth Wellness (CYW)
ACE CYW is questionnaire assessing parent-reported childhood adversity in children and adolescents. The instrument is comprised of two sections: Section 1 consists of the traditional ten ACEs covering exposure to childhood psychological, physical, and sexual abuse as well as household dysfunction, including domestic violence, substance use, and incarceration. Section 2 includes seven (CYW ACE-Q Child) or nine (CYW ACE-Q Teen) items assessing for exposure to additional early life stressors, including involvement in the Foster Care system, bullying, loss of parent or guardian due to death, deportation or migration, medical trauma, exposure to community violence, and discrimination. Parents are asked to how many categories apply to their child (i.e. they do not specificy which categories applies). Parents tally the number for each section, and report the total number, thus resulting in two total scores. Higher scores indicates exposure to more adverse events.
Time frame: Baseline, and at 6, 12, and 24 months post randomization
Parenting competence assessed with the Parenting Sense of Competence (PSOC)
PSOC is a 16-item questionnaire assessing self-reported parenting competence It consists of 2 subscales: Parental satisfaction and parental self-efficacy. Parents rate each item on a 6-point scale.ossible scores range from 10 to 60 for Efficacy and 6 to 36 for Satisfaction. Lower scores may indicate a parent's uncertainty about whether they have the knowledge or skills required to be an effective parent.
Time frame: Baseline, and at 6, 12, and 24 months post randomization
Psychiatric symptom severity in parents assessed with the Brief Symptom Inventory (BSI)
BSI is a 53-item questionnaire assessing self-reported severity of psychiatric symptoms adapted from the Symptom Checlist Revised (SCL-90-R). it covers 9 symptom dimensions: Somatization, Obsession-Compulsion, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation and Psychoticism; and three global indices of distress: Global Severity Index, Positive Symptom Distress Index, and Positive Symptom Total. The global indices measure current or past level of symptomatology, intensity of symptoms, and number of reported symptoms, respectively. Parents rate each statement on a 5-point scale ranging from 0 (not at all ) to 4 (extremely). Range: 0-212, with higher scores indicating higher symptom severity
Time frame: Baseline, and at 6, 12, and 24 months post randomization
Health related quality of life and functioning in parents assessed with the European Quality of life - 5 Dimensions (EQ-5D)
EQ-5D is a 5-item questionnaire assessing health related quality of life and level of functioning. Parents select one out of three statements within each of five domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Higher scores indicates better quality of life. The statements are complemented by a visual analog scale in which parents are asked to rate the health ranging form 0 (worst imaginable health) to 100 (best imaginale health)
Time frame: Baseline, and at 6, 12, and 24 months post randomization
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