title: Preventing internalizing symptoms among Hispanic adolescents: a synthesis across Familias Unidas trials.
abstract: Studies document that there are efficacious interventions to prevent adolescent depression and internalizing symptoms, including several family-focused interventions. Questions remain about for whom interventions work (moderation) and by what mechanisms they work (mediation) to prevent internalizing symptoms. Unfortunately, single trials are often underpowered to address moderation and mediation, an issue addressed in this paper. This synthesis study combined individual-level, longitudinal data from 721 adolescents across 3 randomized clinical trials of Familias Unidas, a family-focused prevention intervention for Hispanic youth. Using integrative data analysis (IDA) methods applied to trials, the study examined intervention moderation and mediation effects on internalizing symptoms. Baseline internalizing symptoms were a significant moderator of the intervention's effects on internalizing symptoms, while baseline externalizing symptoms did not moderate intervention effects. Baseline parent-adolescent communication, a modifiable risk factor and hypothesized mechanism by which the intervention works, significantly moderated the intervention's effects. Specifically, the intervention was more efficacious in its impact on internalizing symptoms for youth with lower initial levels of parent-adolescent communication compared to those with higher communication levels. Moderated mediation analyses showed that parent-adolescent communication changes mediated the intervention's effects on internalizing symptoms, with stronger effects for those with poorer baseline communication. Results suggest a potential benefit of identifying youth risks prior to interventions, and targeting specific modifiable mediators that lead to reductions of internalizing problems of adolescents. Findings also highlight advantages of utilizing data from combined trials and IDA for examining intervention moderators and mediators.
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, 1425 NW 10th Avenue, #307F (R-669), Miami, FL, 33136, USA, tperrino@med.miami.edu.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Perrino
authors.forename: Hilda
authors.initials: H
authors.lastname: Pantin
authors.forename: Guillermo
authors.initials: G
authors.lastname: Prado
authors.forename: Shi
authors.initials: S
authors.lastname: Huang
authors.forename: Ahnalee
authors.initials: A
authors.lastname: Brincks
authors.forename: George
authors.initials: G
authors.lastname: Howe
authors.forename: William
authors.initials: W
authors.lastname: Beardslee
authors.forename: Irwin
authors.initials: I
authors.lastname: Sandler
authors.forename: C Hendricks
authors.initials: CH
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D057189:Checklist; D003627:Data Interpretation, Statistical; D003863:Depression / Q000208:ethnology* / Q000517:prevention & control; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010287:Parent-Child Relations / Q000208:ethnology*; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis