Linking empirically based theory and evaluation: the Family Bereavement Program.

Evaluated the effects of a theoretically derived program to prevent mental health problems in children who had experienced the death of a parent. The program was designed to improve variables in the family environment which were specified as mediators of the effects of parental death on child mental health. The evaluation design involved the random assignment of families to either an intervention or control group. The program led to parental ratings of increased warmth in their relationships with their children, increased satisfaction with their social support, and the maintenance of family discussion of grief-related issues. The program also led to parent ratings of decreased conduct disorder and depression problems and overall problems in older children. Significant correlations between the family environment variables and child mental health problems provided further empirical support for the theory underlying the program. Implications for program redesign were derived by reconsidering the adequacy of the program components to change theoretically mediating variables.

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.

Small theory and the strategic choices of prevention research.

Our comments on the discussion of mediational screening for prevention research highlight two issues: (a) There are advantages to giving a high priority to theory in a strategic sequence of prevention research studies. (b) Screening to identify a subgroup that is experiencing problems on processes the program is designed to change may be useful in accomplishing specific goals within an overall strategy of prevention research studies.

The use of structural equation modeling in generative research: toward the design of a preventive intervention for bereaved children.

Describes a generative study of processes which may lead to symptomatology in children who have experienced the death of a parent. Based on existing literature, four putative mediating variables were identified: parental demoralization, family warmth, negative family events, and positive stable family events. Structural equation modeling techniques were used to compare several potential causal models involving these variables. The results were most consistent with a model in which bereavement was not directly related to the child symptomatology, but rather its effects were transmitted through these four mediational mechanisms. The implications of the results of the structural modeling for the design and evaluation of preventive interventions are discussed briefly.

Epidemiology and preventive interventions: parental death in childhood as a case example.

Illustrates how standard epidemiologic principles form the knowledge base to justify a preventive intervention for an at-risk population. These principles were applied to a sample of 92 from the population of children aged 8 to 15 at alleged risk for mental health disorders because a parent died. Prior work on this alleged risk population is sparse and flawed. Validly determining the population effect of an alleged risk factor requires assessing the influence of sampling bias. The bias found, underrepresentation of deaths of a mother, did not influence the relations among death of a parent and children's depression and conduct disorder, and the modifiable mediators of risk to be changed by the preventive intervention. The epidemiologic measure of effect indicated that death of a parent is a risk factor for major depression but not for conduct disorder among youth. Families recruited for the preventive intervention by epidemiologic methods (ES families) did not differ significantly from the earlier families on whom the knowledge base was formed. Families referred to the intervention by self or others significantly differed from the ES families in two ways that constituted serious biases. The implications of these biases for prevention were discussed.

Transfer factor is ineffective in amyotrophic lateral sclerosis.

Sixty-six patients with amyotrophic lateral sclerosis (ALS) participated in a double-blind, placebo-controlled study of transfer factor. A structured rating score of neurological function was recorded after each monthly administration of transfer factor or placebo. Statistical analysis of mean scores for all patients and for those with specific clinical abnormalities showed no significant difference between the two groups. There was no evidence of therapeutic value for transfer factor. During the observation period of nearly one year, more than two-thirds of the deterioration occurred in the first six months. Meaningful clinical trials of other potential therapeutic agents could probably be conducted within six months in double-blind crossover trials.

A behavioral classification of welfare children from survey data.

From survey data on 1000 urban Welfare AFDC children aged six to eighteen, a hierarchical cluster analysis yielded six distinct behavioral types of Welfare children. Characteristics of each type, and its relationship to treatment, ethnicity, and other variables are discussed. Advantages of this system of behavioral classification for research and population assessment are outlined.

Life dissatisfactions, job dissatisfaction and illness of married men over time.

This study examines the degree to which job and marital satisfaction and participation in leisure activities could predict concurrent and future health status relative to ethnicity, class and occupational factors, and mental health. Data were obtained from a longitudinal study of a random sample of 1034 Manhattan families with at least one child 6 to 18 years of age. The wives in these families were interviewed twice at 5-year intervals. Multiple regression analyses, using variables abstracted from the records of 640 wives of working husbands, indicated that husbands' health status at Time I (R = .33) and Time II, 5 years later (R = .28) was significantly predicted by the Time I assessments on 12 independent variables. The largest single unique contributor, i.e. net of all other independent variables, to concurrent husband's health was job dissatisfaction (partial r = .15), followed by husband's institutionalization for mental illness (r = .14), being Spanish (r = .10), and the factor of Unhappy Marriage (r = .09). This preliminary investigation indicated that uncertain life satisfactions were important predictors for either concurrent or future health status which operated across class, ethnic, occupational and mental health factors. These findings tend to support models which postulate stressful psychosocial conditions as potential etiologic agents in the development of illness.