Compare Strategic Family Therapy and Structural Family Therapy

Int J Environ Res Public Health. 2019 Apr; 16(vii): 1255.

Effectiveness of Structural–Strategic Family Therapy in the Treatment of Adolescents with Mental Wellness Problems and Their Families

Antonio León

²Kid and Adolescent Mental Wellness Unit, Virgen Macarena Infirmary, C/ Dr. Fedriani, 3, 41009 Seville, Espana

Received 2019 Mar viii; Accepted 2019 Apr 4.

Abstract

Mental wellness problems during boyhood constitute a major public health concern today for both families and stakeholders. Accordingly, dissimilar family-based interventions have emerged every bit an effective treatment for adolescents with sure disorders. Specifically, there is evidence of the effectiveness of concrete approaches of systemic family therapy on the symptoms of adolescents and family functioning in full general. All the same, few studies have examined the effectiveness of other relevant approaches, such every bit structural and strategic family therapy, incorporating parent–child or parental dyadic measurement. The purpose of this study was to test the effectiveness of a structural–strategic family therapy with adolescents involved in mental wellness services and their families. For this purpose, 41 parents and adolescents who participated in this handling were interviewed at pre-test and post-exam, providing information on adolescent behavior problems, parental sense of competence, parental practices, parenting alliance, and family functioning. Regardless of participants' gender, adolescents exhibited fewer internalizing and externalizing problems subsequently the treatment. Parents reported higher family cohesion, higher satisfaction and perceived efficacy as a parent, and healthier parental practices (less authoritarian and permissive practices, as well as more authoritative ones). An interaction effect betwixt parenting alliance and gender was constitute, with more favorable results for the mothers. In conclusion, this paper provides show of the usefulness of structural–strategic family therapy for improving family, dyadic, and individual facets in families with adolescents exhibiting mental health issues.

Keywords: family therapy, effectiveness, strategic therapy, structural therapy, family performance, parental competence, parenting brotherhood, behavior problems, mental wellness

one. Introduction

Mental health problems during adolescence constitute a major public wellness business organisation today for both families and stakeholders [1,2]. Epidemiological studies testify that mental health issues are the beginning nonfatal cause of illness [3], are in the top five causes of decease among adolescents [4], and represent 16% of the global health-related burden in young people [4,5]. In addition, mental health problems during adolescence are an important predictor of socialization difficulties and absenteeism at this developmental stage, as well as 1 of the almost significant predictors of adjustment problems and mental disorders in adulthood [6,7,8]. In order to accost these pressing issues, information technology is essential to have constructive intervention and prevention strategies that meet the specific needs of adolescents with mental health problems.

Adolescence is a challenging transitional period for both children and families. Information technology is a developmental stage characterized by normative physical, social, and psychological changes [9], some of which may be identified as potentially stressful among this population [ten]. Psychosocial stress in adolescents tin can be accentuated by the presence of stressful or agin life events (as maltreatment and violence, loss events, intrafamilial problems, school and interpersonal problems) that are associated with severe negative outcomes [11]. Although there are important inter-individual differences, the current homogenization of adolescents' daily experiences has contributed to the observation of fewer cross-cultural and gender differences during this stage [12]. Some of the normative developmental tasks that adolescents demand to undertake for a healthy development are the search for autonomy, identity, and independence [ix]. For families, this is a period characterized by the readjustment of family unit roles and norms, along with an increase in family unit conflicts [ix,13,14]. Families face the claiming of adjusting to these new demands and needs while trying to conserve family unity [9,13,xiv]. The inability to adjust to these new demands, together with inflexibility within the family over the negotiation of new norms and different solutions, are often related to mental health problems. Families with an adolescent with mental wellness problems take additional needs, demands, and difficulties stemming from the mental disorder [15]. Parents often face challenging behaviors and conflictive situations, having to manage symptoms and coordinate and engage with dissimilar service systems [16,17]. As they struggle to deal with these boosted demands, parents often observe their skills coming into question, and this can be accompanied past feelings of low competence, frustration, and powerlessness, together with increased isolation and contraction in their social network [xv,18].

There has been a proliferation of family-oriented and family-based interventions with adolescents with mental health difficulties; some of these are considered as evidence-based practices in the treatment of children and adolescents with certain disorders [19,20]. Previous research indicates that the incorporation of family members or family elements in therapy is either direct or indirectly an effective component of interventions that target adolescents with mental health issues [21,22,23]. On one hand, direct approaches (e.thousand., family-centered behavioral management or family therapy) involve a more immediate engagement with the family unit and usually include specific objectives that target families or family members. On the other paw, indirect approaches (due east.g., psychodynamic therapy or cerebral–behavioral therapy) incorporate the family context through reviews or reports, using them equally informants at some bespeak and by keeping the family unit elements in mind while intervening [22]. In sum, under the "family unit-based interventions" umbrella term, there are a wide range of qualitatively different interventions and approaches. The near widely used family-based interventions include psychoeducational approaches [24], behavioral interventions, and systemic family therapy [25]. The goal of the present study was to evaluate the efficacy of specific systemic family therapy approaches in families with an adolescent presenting a mental wellness problem.

From a systemic perspective, family is defined every bit a transactional system, where difficulties in any member accept an influence on every other member and on the whole family equally a unit. In plow, family processes accept an impact on every private member, likewise every bit on the different relationships embedded inside the family context [26]. This perspective shifts away from a linear consideration of family unit processes past recognizing the multiple recursive influences that shape family unit relationships and family operation, perceiving it as an ongoing procedure throughout the life bike [27]. Systemic family unit therapy has been shown to exist an efficacious intervention for families and adolescents with a wide range of mental wellness problems, such every bit drug use [19,28,29,xxx,31,32]), eating disorders [29,thirty] and both internalizing and externalizing disorders [19,29,30,31,33,34,35,36]. Despite these advances, near of the literature has focused on either systemic family therapy as a whole, without taking into business relationship the unlike approaches embedded within this framework, or on the effectiveness of more manualized approaches, such as multisystemic family unit therapy (eastward.chiliad., [37]) or functional family therapy (e.g., [34,38]). Few studies have examined the effectiveness of more than classical and widely used approaches, such as structural and strategic family therapy [39]. Hence, more than research is needed to be able to draw more definite conclusions regarding the use of these types of family therapy approaches.

Structural family therapy is one of the dominant approaches in systemic family unit intervention, originally created by Minuchin [40]. The focus of this approach is on achieving a salubrious hierarchical family organisation, where in that location are different subsystems with their limits and boundaries [27,41]. According to this approach, the difficulties expressed by the boyish are a reflection of: (ane) A family structural imbalance; (2) a dysfunctional hierarchy inside the family system, oftentimes characterized by difficulties in establishing boundaries between the parental and the kid subsystem; and (3) a maladaptive reaction to changing demands [27]. Therefore, the intervention focuses on reinforcing the parental subsystem, highlighting the demand to present a "united forepart", and clearly differentiating it from the parent–child subsystem [25,27,41,42]. It also emphasizes the need to conform the rigidity of the limits and the relationship between subsystems according to the moment of the life bicycle [42]. During boyhood, while authority withal relies on the parental subsystem, the manner it is exerted cannot be the same as in previous developmental stages, and the limits between the subsystems, while remaining clear, have to exist more flexible [25,27,42]. Although the cadre elements of this approach are well established and widely used among the clinical community [30,43], few studies take addressed the effectiveness of this approach for adolescents with mental health problems [39,44].

Strategic family unit therapy is purely embedded inside the systemic model and has a more directive impression [25,45]. From this approach, the symptom is considered every bit serving a function to the family, as well as reflecting a difficulty of the family unit to solve a trouble [25,27,45]. Co-ordinate to the strategic arroyo, when faced with a problem, families prefer solutions that have been useful to them in the past. However, symptoms such as behavioral or emotional difficulties or an increase in conflicts sally for which those solutions are no longer valid, and the family is unable to find and effectively use culling ones; thus, they become stuck in a symptom-maintaining sequence [27]. The objective of this therapy is for the family to initiate actions and solutions that are different to the ones previously attempted [27,45]. There is extensive testify about the effectiveness of the brief–strategic family therapy approach, which is a manualized and specific variant of the strategic approach, with different populations [46], including adolescents with mental health issues (eastward.k., [32,47,48]). Though structural and strategic family therapy are conceptually two unlike approaches within the systemic framework, they share certain core elements, and it is not rare to utilize them conjointly. Some illustrative examples are cursory–strategic family unit therapy and multisystemic therapy, both of which incorporate representative elements from both approaches.

In full general, literature has shown that systemic family therapy has a significant bear on by reducing internalizing and externalizing symptoms of adolescents, also as improving overall family functioning [35,36]. Nevertheless, in spite of the testify indicating gender differences in aligning problems, specially in internalizing symptoms, most available studies have not taken into account the boyish's gender when examining the impact of these interventions [49]. In addition, most studies accept focused on private outcomes or on family unit performance as a whole, rather than incorporating parent–child dyadic measures or parental dyadic measures. Inquiry has shown that some of these dyadic dimensions play an important role in families with adolescents with mental wellness problems; they should therefore exist incorporated in effectiveness evaluations. More specifically, coercive and permissive parenting practices [50,51,52] have generally been considered as 2 of the most of import predictors of internalizing and externalizing bug. Other parenting dimensions linked to kid psychopathology include: Depression sense of parental competence, defined as the perception parents accept of their own operation as parents [52,53,54], and high levels of interparental conflict [55]. Every bit a result, parental practices, sense of parental competence, and parenting brotherhood constitute intervention targets and should be included in effectiveness evaluations.

For some of these dimensions, the studies bachelor highlight the need to control gender differences. Specifically, there is prove of important differences in parenting practices betwixt mothers and fathers, with mothers scoring higher in communication and control dimensions [56,57,58]. In improver, there is show of gender differences in the perception of parenting alliance and co-parenting; more specifically, in parental back up and involvement dimensions. Thus, mothers are more likely to be involved in parental decision-making processes than fathers but also experience less supported in their parental role [59].

In this framework, the goal of this report was to evaluate the effectiveness of structural–strategic family therapy on different individual, dyadic, and family dimensions in families with an adolescent with a mental health problem; to do so, we conducted a comprehensive analysis and incorporated a gender perspective. According to previous evidence on systemic family unit therapy, we expected a reduction of internalizing and externalizing symptoms of adolescents, as well as an comeback in family performance. Due to their office in kid psychopathology, a reduction of coercive and permissive parenting practices besides as an increase in sense of parental competence and parenting brotherhood were hypothesized. Considering of an absence of previous studies, nosotros did not have expectations regarding the boyish's gender, although college improvements in mothers were expected in comparison to fathers.

2. Materials and Methods

ii.1. Study Design

This written report was part of a wider research projection assessing the effectiveness of a structural–strategic family therapy (SSFT) initiative run by mental health services in Southern Spain (Andalusia) for families with an adolescent with a mental health trouble. This initiative combined the theoretical principles and techniques of structural and strategic family therapy in order to reduce the adolescent'due south mental behavior problems and improve family relationships. The family therapy sessions initially focused on establishing a therapeutic alliance with all members of the family, providing them with a safety, nonjudging space where all of them felt understood. Subsequently, the objectives of the sessions were to set articulate boundaries between the subsystems, to strengthen the parental subsystem encouraging joint controlling and teamwork, to highlight and residuum parental authorization with the increasing need for autonomy from the adolescent, and to reframe the relationships within the family unit system. Both the referred adolescent with a mental wellness diagnosis and his/her parents participated in SSFT; whatever other significant family members were also asked to attend. The intervention was led by ii therapists trained in structural and strategic family therapy (a clinical psychologist and a psychiatrist). On average, the handling consisted of a one-hour session each month over a period of approximately x months [sixty].

For the purpose of the evaluation, a quasi-experimental design was followed, including a pre-exam versus post-test evaluation of the participants of an experimental group (EG). This EG consisted of the population of families receiving the SSFT intervention during the study (i.eastward., between 2009 and 2012).

two.2. Participants

The sample consisted of 41 participants (51.22% mothers, 48.78% fathers), whose adolescent children had been referred to mental health services in the Due south of Spain. The children's ages ranged between 10 and 17 (M = 14.12, SD = i.79), and at that place was a higher percentage of girls (73.17% girls and 26.83% boys). Most families were ii-parent (90.24%), with nearly all of them having iv members (M = 3.82, SD = 0.85) and an average of 2 children (M = i.80, SD = 0.51).

Post-obit ICD-10 criteria, behavioral disorders were the most mutual diagnoses (31.71%), followed by anxiety (29.27%), mood (17.07%), and eating disorders (17.07%). Other less frequent diagnoses included personality disorders (9.76%), psychotic disorders (9.76%), and pervasive developmental disorders (iv.88%). Approximately 20% of adolescents with one type of disorder met the criteria for some other grade of disorder (nineteen.51%), with half of the comorbidities between behavioral and anxiety disorders (9.76%) and the other half between feet and mood disorders (9.75%).

2.3. Measures

The report followed a multi-informant approach, collecting information from practitioners, caregivers, and target adolescents. In this paper, information provided by practitioners and caregivers is included. Practitioners provided information most adolescent and family sociodemographic profiles. Caregivers informed about the target adolescent behavior, as well as near their parental sense of competence, parental practices, perceived parenting alliance, and perceived family unit functioning. These measures are described beneath.

Sociodemographic profile: We compiled an ad-hoc questionnaire to collect sociodemographic data almost the target adolescent'southward age and gender (by measuring sexual activity) and the family unit structure (one/ii-parent structure) and composition (number of family members and children at dwelling).

Child behavior checklist for ages vi–eighteen [61]: This inventory provides information on kid and adolescent behaviors from the perspective of caregivers. It measures both positive competences and problem behaviors (internalizing and externalizing). A compilation of 113 items (ranging from 0 = not true to 2 = very true or oft truthful) measures internalizing (withdrawn/depressed, somatic complaints, and feet/low) and externalizing problems (rule-breaking and aggressive beliefs). Cronbach's alpha coefficients were α = 0.85 for internalizing problems and α = 0.89 for externalizing problems. Higher scores point greater beliefs bug. Hateful scores were computed.

Parental sense of competence [62]: This scale explores perceived competence as a parent. It consists of xvi items with responses on a six-point scale. Two subscales can exist computed, measuring efficacy and satisfaction in parenting. Cronbach's alpha coefficients were α = 0.75 for efficacy and α = 0.73 for satisfaction. For both subscales, mean scores were computed, with higher scores indicating greater parental sense of competence.

Parenting styles and dimensions questionnaire [63]: This 32-item instrument consists of three scales measuring authoritarian, administrative, and permissive parenting. The administrative items reverberate reasoning/induction, warmth and support, and democratic participation; the authoritarian items reflect exact hostility, physical compulsion, and nonreasoning/punitive strategies; and the permissive items reflect indulgence and failure to follow through. All items are answered on a five-point scale, with higher scores showing college authoritative/authoritarian/permissive practices. Internal consistency in this study was α = 0.81 for administrative practices, α = 0.79 for authoritarian practices, and α = 0.64 for permissive practices. Mean scores were computed.

Parenting alliance inventory [64]: This 20-particular scale assesses the degree of commitment and cooperation between hubby and wife in kid rearing. For each detail, parents respond on a 5-point scale. The total score revealed α = 0.94 in this study. We used the hateful score, with higher scores indicating stronger back up between partners as parents.

Family cohesion and adaptability scale [65]. Nosotros used the FACES-III, which evaluates emotional bonding between family unit members, every bit well as the adaptability of the family unit organisation. Information technology is ranked on a v-point scale. Different other versions, the scores assessed with FACES-III are interpreted in a linear manner, so the college the score, the greater the level of family cohesion and adjustability. Internal consistency in this research was α = 0.74 for cohesion and α = 0.56 for adaptability. Hateful scores were computed.

2.4. Procedure

Mental health practitioners referred the families for SSFT intervention. SSFT practitioners enrolled the families in SSFT if they met the post-obit criteria: (1) A child under 18 was being treated by the mental wellness service; (ii) the referred child met ICD-10 criteria for: Pervasive developmental disorders; behavioral and emotional disorders with an onset usually occurring in childhood and adolescence; neurotic, stress-related, and somatoform disorders; and if the previous criteria were not met, the child had to meet the requisites for an eating disorder process or severe mental illness; and (3) SSFT practitioners, based on their professional criteria through the observation and interviews with both the adolescent and the parents, considered that the kid's symptomatology could be related with a family dysfunction (east.g., the symptomatology was express to the family context, parental disagreement or dysfunctional communication patterns) or that the family dynamic was either being impacted past the symptomatology or maintaining it (eastward.g., difficulties in adjusting to changes due to adolescence or parental practices not coherent with the adolescent period, frequent or persistent family conflicts). If the intervention criteria were met, SSFT practitioners enrolled the family in the trial if they had an adolescent member (x years or older).

Two trained researchers, external to the SSFT, interviewed the caregivers and practitioners of each family and assessed the adolescents at the mental health service facilities. The pre-examination was completed before the first SSFT session, and the mail service-test in the concluding session (for those families that had attended at least 3 intervention sessions). The average length of fourth dimension between pre- and post-test assessment was 10 months, which corresponded approximately to the schoolhouse year. Every informant participated in the written report voluntarily, after signing an informed consent form in accordance with the Declaration of Helsinki. The aims of the research projection were explained, and all participants were assured that their anonymity would be protected. Ethics approving was obtained from the ethics committee of the Andalusian Health Services (code 22/0509). No monetary incentives were offered.

The flow of cases through the trial is shown in Figure 1. Patients were classified every bit dropouts if they did not complete Time 2 assessment protocols, despite beingness contacted at least three times past the research squad. The dropout rate at Time 2 was 42.25%.

Flowchart of participants through the report.

Dropouts and completers were compared in all pretreatment variables using one-mode ANOVAs for quantitative variables and Chi-square tests for qualitative ones. Partial eta squared and Cramer'due south V were computed as result-size indices. Partial eta squared was considered small if <0.01, medium if ≥0.06 and <0.14, or large if >0.xiv; Cramer'due south V was considered minor if <0.30, medium if >0.30 and <0.fifty, or high if >0.fifty [66]. Significant differences were not found in whatsoever variables, except for parenting alliance (see Tabular array 1).

Tabular array ane

Baseline characteristics for completers and dropouts.

	Completers %/M	Dropouts %/M	Differences χ2/F
Target adolescent
Girls	73.17%	56.67%	2.xi
Age	14.12	fourteen.14	0.01
Family
No. of family unit members	3.82	iv.04	0.83
No. of children	one.80	1.threescore	1.86
2-parent construction	90.24%	81.48%	one.09
Behavior problems
Internalizing	0.l	0.52	0.04
Externalizing	0.55	0.56	0.01
Parental competence
Efficacy	3.x	three.22	0.26
Satisfaction	3.77	3.88	0.32
Parental practices
Authoritative	3.65	three.67	0.02
Disciplinarian	1.84	1.83	0.02
Permissive	two.35	2.54	i.09
Parenting alliance	4.03	3.59	five.21* ηtwo fractional = 0.08
Family functioning
Cohesion	3.65	3.44	ii.00
Adjustability	two.64	two.76	1.16

2.five. Data Analyses

Statistical analyses were performed with SPSS v-18 (SPSS Inc., Chicago, IL, Us) [67]. Missing information at item level were extrapolated using the missing value analysis. When more than 10% of the items from a questionnaire were missing, the instance was excluded from the respective assay. If this were not the instance, we then practical the SEM procedure to impute the data, having previously checked that the data were missing at random using Little's MCAR test. We found less than 5% of missing information with an MCAR distribution.

Nosotros examined univariate and multivariate outliers using box plots and Mahalanobis' distance, respectively [68], finding two multivariate outliers which nosotros excluded from subsequent analyses. Other statistical assumptions for parametric tests were checked and confirmed following Hair, Anderson, Tatham, and Black's [69] recommendations (i.e., linearity, normality, homogeneity, and absence of multicollinearity and singularity). As an exception, high kurtosis for parental alliance required a reflected and logarithmic transformation.

We based statistical conclusions on event-size indices when statistical significance did not reach significance due to small sample size. We examined main and interaction furnishings from mixed factorial ANOVAs for the analyses of effectiveness, because the pre-postal service measures every bit within the subjects' cistron (modify) and informant's gender as between the subjects' gene. Nosotros used partial eta squared equally an effect-size index, with the conventional limits of 0.01, 0.06, and 0.fourteen for the small, medium, and large levels of effect size, respectively [66].

iii. Results

First of all, we examined the primary event of gender and found neither a significant effect nor a medium or large effect size. Equally Table 2 shows, after controlling for gender, the change betwixt pre- and postal service-measures was significant for several dependent variables. Thus, the adolescents exhibited fewer internalizing and externalizing problems in the post-test with a high effect size. In turn, parents reported higher satisfaction, likewise as fewer disciplinarian and permissive practices, also with a high outcome size. Moreover, higher efficacy as a parent and more authoritative practices were reported with a medium outcome size. Finally, the interaction between change and gender was meaning for the parenting alliance variable, with a high result size.

Table 2

Descriptives and inferential statistics for alter and modify * gender interaction of the mixed factorial ANOVAs for each dependent variable.

	Descriptives M (SD)		Change F (η2 partial)	Change × Gender F (ηtwo partial)
	Pre-Test	Post-Examination
Behavior problems
Internalizing	0.48 (0.21)	0.33 (0.19)	14.74*** (0.38)	0.02 (<0.01)
Externalizing	0.55 (0.26)	0.35 (0.21)	20.72*** (0.46)	0.47 (0.02)
Parental competence
Efficacy	3.14 (0.68)	three.32 (0.64)	four.04* (0.10)	0.88 (0.02)
Satisfaction	three.76 (0.70)	3.98 (0.81)	v.19* (0.xiv)	0.12 (<0.01)
Parental practices
Authoritative	3.61 (0.50)	3.75 (0.53)	4.25* (0.eleven)	0.21 (0.01)
Authoritarian	i.84 (0.46)	1.65 (0.40)	11.thirty** (0.25)	0.23 (0.01)
Permissive	2.31 (0.77)	2.05 (0.56)	5.44* (0.14)	two.08 (0.05)
Parenting alliance	4.03 (054)	4.xi (0.63)	0.89 (0.02)	ii.94 (0.08)
Family operation
Cohesion	iii.62 (0.44)	3.73 (0.45)	3.26 (0.08)	0.13 (<0.01)
Adaptability	2.65 (0.42)	2.73 (0.44)	0.91 (0.03)	0.39 (0.01)

The change * gender interaction is plotted in Figure 2, and it shows that mothers improved their parenting alliance afterwards intervention, while the opposite occurred with fathers. To investigate further into the interaction result, nosotros performed a simple repeated measures ANOVA for each gender. The results showed that mothers significantly improved their parenting alliance later on treatment with a high outcome size, F(1,xviii) = 4.54, p = 0.047, η² _partial = 0.20, merely no statistical difference was observed for fathers, F(1,18) = 0.24, p = 0.628, η² _partial = 0.01.

Interaction event of gender on parenting alliance.

four. Discussion

The results of this written report take shown a positive impact of a structural–strategic oriented family therapy on both the parents and adolescents in the family, dyadic, and individual-level dimensions. The improvement observed afterward the intervention was independent of the gender of both parents and adolescents, barring the parenting alliance variable.

The systemic approach understands the family every bit a whole, non equally a simple sum of individual members. Co-ordinate to this approach, a mutual objective in structural family therapy, regardless of clients' needs, consists of empowering and strengthening the family equally a organisation, favoring the persistence of these changes over time [38]. In consonance with previous empirical bear witness [35,36], this written report shows the touch on of this approach in the family sphere, particularly in terms of improving family cohesion. This event is particularly relevant with vulnerable families facing difficulties associated with the readjustment of family unit roles and norms, response to new demands and needs of family members [9,13,xiv]. This is the case of families with adolescents suffering from mental health problems, due to the existence of additional needs, demands, and difficulties linked to the presence of the mental disorders [15]. Still, despite the importance of the abovementioned results, no improvement was observed in family adjustability. Families in this state of affairs tend to carry inflexibly when negotiating and learning new ways of resolving parent–adolescent disharmonize [42]. An improvement in family adjustability in this population would accept been remarkable; the absence of changes in this dimension may be due to reliability issues when assessing with FACES [70].

At a dyadic level, authoritative parental practices increased subsequently the treatment, and both authoritarian and permissive practices decreased. Only a handful of studies had previously assessed the effectiveness of a systemic family approach on families whose adolescents presented mental health problems in dyadic dimensions [44]. Parenting training in childrearing practices constitutes a core component of near family unit interventions, particularly when child behavior problems exist [38]. Parental practices based on affect, dialogue, and reasoning are related to better family performance [71] and adolescent adjustment [6,72,73].

The structural–strategic therapy tested in this written report has also shown other dyadic effects. Participant mothers reported feeling more support from fathers in childrearing, although the opposite was non found (fathers feeling more than supported by mothers). This event is not surprising considering that mothers are usually involved more in childrearing than fathers and also feel less supported in their parenting role [59]. This difference in gender may also be explained considering mothers reported a lower level of parenting alliance before the intervention, and therefore had greater scope for subsequent improvement compared to fathers.

At an individual level, participating parents reported amend parental sense of competence after the therapy. Thus, both fathers and mothers reported higher perceived efficacy and satisfaction as a parent. Again, this result is particularly relevant every bit parents from these families presented loftier levels of difficulty in exerting their parental role [fifteen]. For example, there is testify of the being of additional parental stress on parents with adolescents presenting mental health bug, and the relationship between parental stress and less perceived efficacy and satisfaction as a parent [74]. Consequently, the increment observed in parental sense of competence could exist mirrored by a decrease in parenting stress. In whatsoever outcome, the comeback in parental sense of competence is positive not just for parents at an individual level, just likewise for the adolescents and the family every bit a whole [53,75,76].

Finally, this study has shown positive results in adolescent behavior, regardless of gender [19,33,34]. The reduction in adolescent problematic behavior both at external and internal level confirms the usefulness of structural–strategic therapy. This outcome can exist explained every bit a direct effect of the intervention or every bit an indirect effect of improvements in family functioning [35,36], parental practices [50,51,52], parental sense of competence [52,54], and parenting alliance [55]. As pointed out in the introduction, the absence of differences between boys and girls tin can be explained by the homogenization of adolescents' daily experiences in today's lodge [12].

This study has several limitations. Commencement, a chief shortcoming is the small sample of families recruited in the study. The high specialization and costs associated with SSFT together with the loftier-take a chance profile of these families help to understand this limitation. The latter, due to mental wellness bug and family dysfunction, can besides explain the loftier dropout rate reported in this study. Whatever the reason is, the statistical strength of the study could be improved with a college sample size, particularly if considering the statistical atmospheric condition of the longitudinal analyses [77]. Second, nosotros would have liked to take been able to conduct a long-term analysis to examine the persistence of treatment effects in the mid to long term. Third, the nigh important limitation of this written report was the absence of a comparison group to enable the states to corroborate that changes between pre-test and post-test were due to the therapy and not to other circumstances [78].

five. Conclusions

Despite the abovementioned limitations, this written report has fabricated some contributions. We drew on previous findings about the effectiveness of family-oriented and family-based interventions with adolescents with mental wellness difficulties [nineteen,twenty] from family unit systemic therapy arroyo [19,27,28,29,30,31]. While reaching the gold standard for effectiveness remains a distant goal for structural–strategic family unit therapy, this paper offers some evidences about its usefulness for improving private, dyadic, and family adjustment in families with adolescents with mental wellness difficulties [39].

In sum, this study has applied implications concerning the mode specialized services for children and adolescents with mental wellness problems have been traditionally organized, and regarding the core elements that need to be specifically targeted when working with these families. In full general, specialized mental health services for children and adolescents have traditionally focused on symptom reduction and "parental training", which have proven to be useful and essential interventions. However, our results back up the importance of incorporating complementary approaches targeting families as a whole in their regular services as to adequately accost the circuitous needs and difficulties of families of adolescents with mental wellness issues [23]. In add-on, this study highlights the need to directly target certain cadre elements related to the dyadic parental human relationship and the parent–child relationship when intervening with families of adolescents with mental health problems. Finally, gender-related results back up the idea of differentiated approaches when working at a dyadic parental level, such every bit co-parenting. Mothers and fathers seem to non simply experience co-parenting differently but likewise respond differently to interventions that directly target this core element [59]. Therefore, this study highlights the relevance of taking into account and incorporating gender-based strategies in interventions.

Acknowledgments

To Yard.J. Blanco, coordinator in charge of the Kid and Boyish Mental Health Unit, Virgen Macarena Hospital (Seville, Espana), for her technical support in data collection.

Author Contributions

Project administration, supervision and methodology: Fifty.J., A.50., and Five.H. Data curation: S.B., Fifty.J., and B.L. Resources: A.L. Conceptualization, formal analysis, and writing: 50.J., V.H., B.L., and S.B. All authors accept read and approved the final manuscript.

Funding

This study has been supported past the Research Project "Effectiveness of the family unit therapy treatment adult in mental health services. Analysis of effectiveness moderators". This work was also supported by the Spanish Authorities (MINECO, Ministry of Economics and Competitiveness). Projection reference: EDU2013-41441-P. In addition, the Ministry of Pedagogy, Civilization and Sports has funded the writer S.B. with a predoctoral grant (FPU 014/6751).

Conflicts of Interest

The authors declare no conflict of interest.

References

one. Lawrence D., Hakefost J., Johnson Southward.E., Saw S., Buckingham W.J., Sawyer M.Thou., Ainley J., Zubrick S.R. Key findings from the second Australian child and adolescent survey of mental health and wellbeing. Aust. N. Z. J. Psychiatry. 2016;l:876–886. doi: 10.1177/0004867415617836. [PubMed] [CrossRef] [Google Scholar]

2. Mehra S., Daral S., Sharma S. Investing in our adolescents: Assertions of the 11th Earth Congress on Adolescent Health. J. Adolesc. Health. 2018;63:ix–eleven. doi: x.1016/jadohealth.2018.05.005. [PubMed] [CrossRef] [Google Scholar]

three. Whiteford H.A., Degenhardt L., Rehm J., Baxter A.J., Ferrari A.J., Erskine H.E., Charlson F.J., Norman R.E., Flaxman A.D., Johns N., et al. Global brunt of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study 2010. Lancet. 2013;382:1575–1586. doi: 10.1016/S0140-6736(13)61611-6. [PubMed] [CrossRef] [Google Scholar]

5. Kieling C., Baker-Henningham H., Belfer K., Conti G., Ertem I., Omigbodun O., Rohde Fifty.A., Srinath S., Ulkuer N., Rahman A. Child and boyish mental health worldwide: Evidence for activeness. Lancet. 2011;378:1515–1525. doi: 10.1016/S0140-6736(xi)60827-1. [PubMed] [CrossRef] [Google Scholar]

vi. Carr A. The Handbook of Kid and Adolescent Clinical Psychology: A Contextual Approach. 3rd ed. Routledge; Abingdon, Britain: 2016. [Google Scholar]

7. Hofstra M.B., van der Ende J., Verhulst F.C. Child and adolescent issues predict DSM-4 disorders in machismo: A 14-year follow upwards of a Dutch epidemiological sample. J. Am. Acad. Kid Adolesc. Psychiatry. 2002;41:182–189. doi: 10.1097/00004583-200202000-00012. [PubMed] [CrossRef] [Google Scholar]

eight. Trentacosta C.J., Hyde Fifty.Westward., Goodlett B.D., Shaw D.S. Longitudinal prediction of disruptive behavior disorders in adolescent males from multiple hazard domains. Child Psychiatry Hum. Dev. 2013;44:561–572. doi: 10.1007/s10578-012-0349-3. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

9. Goossens L. Adolescent evolution: Putting Europe on the map. In: Jackson S., Goossens L., editors. Handbook of Adolescent Development. Psychology Press; New York, NY, United states of america: 2006. pp. 1–x. [Google Scholar]

10. Grant K.E., Compas B.E., Stuhlmacher A.F., Thurm A.Eastward., McMahon S.D., Halpert J.A. Stressors and child and boyish psychopathology: Moving from markers to mechanisms of risk. Psychol. Bull. 2003;129:447–466. doi: 10.1037/0033-2909.129.three.447. [PubMed] [CrossRef] [Google Scholar]

xi. Serafini G., Muzio C., Piccinini G., Flouri E., Ferrigno G., Pompili Grand., Girardi P., Amore Thou. Life adversities and suicidal behavior in young individuals: A systematic review. Eur. Child Adolesc. Psychiatry. 2015;24:1423–1446. doi: 10.1007/s00787-015-0760-y. [PubMed] [CrossRef] [Google Scholar]

12. Lannengrand-Willems L., Barbot B. Challenges of adolescent psychology in the European identity context. In: Grigorenko Due east.L., editor. The Global Context for New Directions for Child and Adolescent Development. Wiley Periodicals; Hoboken, NJ, Us: 2015. pp. 69–76. [PubMed] [Google Scholar]

13. Lubenko J., Sebre S. Longitudinal associations between adolescent behaviour bug and perceived family human relationship. Procedia Soc. Behav. Sci. 2010;5:785–790. doi: x.1016/j.sbspro.2010.07.185. [CrossRef] [Google Scholar]

14. Jaworska Northward., MacQueen Thousand. Adolescence as a unique developmental menses. J. Psychiatry Neurosci. 2015;40:291–293. doi: 10.1503/jpn.150268. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

15. Rodríguez-Meirinhos A., Antolín-Suárez L., Oliva A. Support needs of families of adolescents with mental illness: A systematic mixed studies review. Arch. Psychiatr. Nurs. 2018;32:152–163. doi: 10.1016/j.apnu.2017.09.004. [PubMed] [CrossRef] [Google Scholar]

16. Doornbos M.One thousand. The 24-7-52 job: Family unit caregiver for young adults with serious and persistent mental illness. J. Fam. Nurs. 2001;seven:328–344. doi: 10.1177/107484070100700402. [CrossRef] [Google Scholar]

17. Huang L., Stroul B., Friedman R., Mrazek-Rochester P., Friesen B., Pires S., Mayberg Due south. Transforming mental health treat children and their families. Am. Psychol. 2005;60:615–627. doi: x.1037/0003-066X.60.6.615. [PubMed] [CrossRef] [Google Scholar]

18. Lila M., van Aken Thou., Musitu G., Buelga Southward. Families and adolescents. In: Jackson Due south., Goossens L., editors. Handbook of Boyish Evolution. Psychology Press; New York, NY, USA: 2006. pp. 154–174. [Google Scholar]

19. Goorden M., Schawo S.J., Bouwmans-Frijters C.A.M., van der Schee Due east., Hendriks V.M., Hakkaart-van Roijen L. The cost-effectiveness of family unit/family unit-based therapy for treatment of externalizing disorders, substance utilise disorders and delinquency: A systematic review. BMC Psychiatry. 2016;xvi:237. doi: 10.1186/s12888-016-0949-8. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

20. Larner G. Family unit therapy with children and adolescents (Editorial) Aust. North. Z. J. Fam. Ther. 2016;37:439–442. doi: 10.1002/anzf.1194. [CrossRef] [Google Scholar]

21. Johnson Thou.H., George P., Armstrong Grand.I., Lyman D.R., Dougherty R.H., Daniels A.Due south., Ghose S.S., Delphin-Rittmon M.Eastward. Behavioral management for children and adolescents: Assessing the evidence. Psychiatr. Serv. 2014;65:580–590. doi: 10.1176/appi.ps.201300253. [PubMed] [CrossRef] [Google Scholar]

22. Karamat R. The parental couple human relationship in child and boyish mental health. Clin. Child Psychol. Psychiatry. 2015;20:169–172. doi: x.1177/1359104515571818. [PubMed] [CrossRef] [Google Scholar]

23. Oruche U.M., Draucker C., Alkhattab H., Knopf A., Mazurcyk J. Interventions for family members of adolescents with disruptive behavior disorders. J. Child Adolesc. Pyschiatr. Nurs. 2014;27:99–108. doi: 10.1111/jcap.12078. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

24. Fossum S., Handegård B.H., Martinussen M., Mørch W.T. Psychosocial interventions for disruptive and aggressive behaviour in children and adolescents: A meta-analysis. Eur. Child Adolesc. Psychiatry. 2008;17:438–451. doi: x.1007/s00787-008-0686-8. [PubMed] [CrossRef] [Google Scholar]

25. Lebow J.L., Stroud C.B. Family therapy. In: Norcross J.C., VandenBos G.R., Freedheim D.1000., Krishnamurthy R., editors. APA Handbook of Clinical Psychology: Applications and Methods. Volume three. American Psychological Association; New York, NY, USA: 2016. pp. 327–349. [Google Scholar]

26. Von Bertalanffy L. General System Theory: Foundations, Developments, Applications. Brazille; New York, NY, USA: 1968. [Google Scholar]

27. Walsh F. Clinical views of family unit normality, health and dysfunction: From a deficit to a strengths perspective. In: Walsh F., editor. Normal Family Processes: Growing Diversity and Complexity. The Guilford Press; New York, NY, USA: 2016. pp. 28–56. [Google Scholar]

28. Baldwin Southward.A., Christian S., Berkeljon A., Shadish W.R. The effects of family unit therapies for boyish malversation and substance abuse: A meta-analysis. J. Marital Fam. Ther. 2012;38:281–304. doi: x.1111/j.1752-0606.2011.00248.x. [PubMed] [CrossRef] [Google Scholar]

29. Carr A. The effectiveness of family therapy and systemic interventions for child-focused problems. J. Fam. Ther. 2009;31:3–45. doi: 10.1111/j.1467-6427.2008.00451.10. [CrossRef] [Google Scholar]

xxx. Cottrell D., Boston P. Practitioner review: The effectiveness of systemic family therapy for children and adolescents. J. Kid Psychol. Psychiatry. 2002;43:573–586. doi: 10.1111/1469-7610.00047. [PubMed] [CrossRef] [Google Scholar]

31. Riedinger V., Pinquart M., Teubert D. Effects of systemic therapy on mental health of children and adolescents: A meta-analysis. J. Clin. Child Adolesc. Psychol. 2017;46:880–894. doi: x.1080/15374416.2015.1063427. [PubMed] [CrossRef] [Google Scholar]

32. Robbins Yard.Southward., Feaster D.J., Horigian 5.Eastward., Rohrbaugh One thousand., Shoham V., Bachrach Yard., Miller M., Burlew K.A., Hodgkins C., Carrion I., et al. Brief Strategic Family Therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents. J. Consult. Clin. Psychol. 2011;79:713–727. doi: 10.1037/a0025477. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]

33. Cassells C., Carr A., Forrest M., Fry J., Beirne F., Casey T., Rooney B. Positive systemic practice: A controlled trial of family therapy for adolescent emotional and behavioural problems in Ireland. J. Fam. Ther. 2015;37:429–449. doi: 10.1111/1467-6427.12038. [CrossRef] [Google Scholar]

34. Hartnett D., Carr A., Sexton T. The effectiveness of Functional Family Therapy in reducing boyish mental health adventure and family adjustment difficulties in an Irish context. Fam. Process. 2016;55:287–304. doi: x.1111/famp.12195. [PubMed] [CrossRef] [Google Scholar]

35. Retzlaff R., von Sydow K., Haun M.W., Schweitzer J. The efficacy of systemic therapy for internalizing and other disorders of childhood and adolescence: A systematic review of 38 randomized trials. Fam. Process. 2013;52:619–652. doi: 10.1111/famp.12041. [PubMed] [CrossRef] [Google Scholar]

36. Von Sydow Yard., Retzlaff R., Beher South., Haun M.W., Schweitzer J. The efficacy of systemic therapy for childhood and adolescent externalizing disorders: A systematic review of 47 RCT. Fam. Procedure. 2013;52:576–618. doi: x.1111/famp.12047. [PubMed] [CrossRef] [Google Scholar]

37. Van der Stouwe T., Asscher J.J., Stams G.J., Dekovic 1000., van der Laan P.H. The effectiveness of Multisystemic Therapy (MST): A meta-analysis. Clin. Psychol. Rev. 2014;34:468–481. doi: 10.1016/j.cpr.2014.06.006. [PubMed] [CrossRef] [Google Scholar]

38. Sexton T. Functional Family Therapy in Clinical Practise: An Evidence-Based Treatment Model for Working with Troubled Adolescents. Routledge; New York, NY, USA: 2011. [Google Scholar]

39. Weaver A., Greeno C.Chiliad., Marcus Due south.C., Marcus S.C., Fusco R.A., Zimmerman T., Anderson C. Effects of structural family unit therapy on kid and maternal mental health symptomatology. Res. Soc. Work Pract. 2013;23:294–303. doi: 10.1177/1049731512470492. [CrossRef] [Google Scholar]

xl. Minuchin Due south. Families & Family Therapy. Harvard Academy Press; Cambridge, MA, USA: 1974. [Google Scholar]

41. Colapinto J. Structural family therapy. In: Horne A., Ohlsen M., editors. Family Counseling and Therapy. third ed. Peacock; Itasca, IL, USA: 1982. [Google Scholar]

42. Martínez One thousand.P. Terapia estructural. In: Moreno A., editor. Manual de Terapia Sistémica: Principios y Herramientas de Intervención. Editorial Desclée de Brouwer; Bilbao, Spain: 2014. pp. 263–296. [Google Scholar]

43. Szapocznik J., Rio A., Murray E., Cohen R., Scopetta M., Rivas-Vazquez A., Hervis O., Posada 5., Kurtines West. Structural family unit versus psychodynamic child therapy for problematic Hispanic boys. J. Consult. Clin. Psychol. 1989;57:571–578. doi: 10.1037/0022-006X.57.5.571. [PubMed] [CrossRef] [Google Scholar]

44. Barkley R.A., Guevremont D.C., Anastopoulos A.D., Fletcher Yard.Eastward. A comparing of 3 family therapy programs for treating family conflicts in adolescents with attention-deficit hyperactivity disorder. J. Consult. Clin. Psychol. 1992;60:450–462. doi: 10.1037/0022-006X.60.3.450. [PubMed] [CrossRef] [Google Scholar]

45. Styczynski L.E., Greenberg L.D. Terapia estratégica. In: Moreno A., editor. Transmission de Terapia Sistémica: Principios y Herramientas de Intervención. Editorial Desclée de Brouwer; Bilbao, Spain: 2014. pp. 377–412. [Google Scholar]

46. Szapocznik J., Schwartz Due south.J., Muir J.A., Dark-brown C.H. Cursory Strategic Family Therapy: An intervention to reduce adolescent risk beliefs. Couple Fam. Psychol. 2012;1:134–145. doi: 10.1037/a0029002. [PMC complimentary article] [PubMed] [CrossRef] [Google Scholar]

47. Robbins G.South., Horigian 5.Eastward., Szapocnik J. Brief Strategic Family unit Therapy: An empirically-validated intervention for reducing adolescent behavior problems. Praxis der Kinderpsychologie und Kinderpsychiatrie. 2008;57:381–400. doi: 10.13109/prkk.2008.57.v.381. [PubMed] [CrossRef] [Google Scholar]

48. Santisteban D.A., Perez-Vidal A., Coatsworth J.D., Kurtines W.M., Schwartz S.J., LaPerriere A., Szapocznik J. Efficacy of Cursory Strategic Family Therapy in modifying Hispanic adolescent behavior bug and substance apply. J. Fam. Psychol. 2003;17:121–133. doi: 10.1037/0893-3200.17.1.121. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

49. Hoffmann Yard.L., Powlishta K.Chiliad., White Yard.J. An test of gender differences in adolescent adjustment: The effect of competence on gender role differences in symptoms of psychopathology. Sex Roles. 2004;50:795–810. doi: 10.1023/B:SERS.0000029098.38706.b1. [CrossRef] [Google Scholar]

fifty. Enten R.S., Golan M. Parenting styles and eating disorder pathology. Appetite. 2009;52:784–787. doi: 10.1016/j.appet.2009.02.013. [PubMed] [CrossRef] [Google Scholar]

51. Kerig P., Ludlow A., Wenar C. Developmental Psychopathology: From Infancy through Adolescence. 6th ed. McGraw Hill; New York, NY, United states of america: 2012. [Google Scholar]

52. Sanders Grand.R., Woolley One thousand.L. The relationship between maternal cocky-efficacy and parenting practices: Implications for parent training. Child Care Health Dev. 2005;31:65–73. doi: x.1111/j.1365-2214.2005.00487.x. [PubMed] [CrossRef] [Google Scholar]

53. Coleman P.K., Karraker K.H. Parenting self-efficacy among mothers of school-historic period children: Conceptualization, measurement, and correlates. Fam. Relat. 2000;49:13–24. doi: 10.1111/j.1741-3729.2000.00013.x. [CrossRef] [Google Scholar]

54. Jones T.L., Prinz R.J. Potential roles of parental cocky-efficacy in parent and adjustment: A review. Clin. Psychol. Rev. 2005;25:341–363. doi: 10.1016/j.cpr.2004.12.004. [PubMed] [CrossRef] [Google Scholar]

55. Pinheiro C., Mena P. Parental relationships, self-esteem and depressive symptoms in young adults. Implications of interparental conflicts, coalition and triangulation. Univ. Psychol. 2014;xiii:907–922. doi: x.11144/Javeriana.UPSY13'3.rpas. [CrossRef] [Google Scholar]

56. Darling N., Steinberg L. Parenting style equally context: An integrative model. In: Zukauskiene R., editor. Interpersonal Development. Routledge; London, UK: 2017. pp. 225–235. [Google Scholar]

57. Laursen B., Collings Westward.A. Parent-child relationships during adolescence. In: Lerner R.Chiliad., Steinbergm L.D., editors. Handbook of Adolescent Psychology. Contextual Influences on Adolescent Development. Volume 2. John Wiley; Hoboken, NJ, Us: 2009. pp. iii–42. [Google Scholar]

58. MicKinney C., Renk K. Differential parenting betwixt mothers and fathers: Implications for tardily adolescents. J. Fam. Bug. 2008;29:806–827. doi: 10.1177/0192513X07311222. [CrossRef] [Google Scholar]

59. Irish potato S.E., Gallegos 1000.I., Jacobvitz D.B., Hazen Due north.Fifty. Coparenting dynamics: Mothers' and fathers' differential support and involvement. Pers. Relatsh. 2017;24:917–932. doi: 10.1111/pere.12221. [CrossRef] [Google Scholar]

60. León A., Hidalgo Five., Jiménez L., Lorence B. Estilos relacionales en terapia familiar. Necesidades de apoyo para el proceso de intervención. Mosaico. 2015;threescore:16–30. [Google Scholar]

61. Achenbach T.Grand., Rescorla 50.A. The Manual for the ASEBA School-Age Forms & Profiles. Enquiry Center for Children, Youth, and Families; Burlington, VT, The states: 2001. [Google Scholar]

62. Johnston C., Mash E.J. A measure out of parenting satisfaction and efficacy. J. Clin. Child Psychol. 1989;18:167–175. doi: 10.1207/s15374424jccp1802_8. [CrossRef] [Google Scholar]

63. Robinson C.C., Mandleco B., Olsen S.F., Hart C.H. The Parenting Styles and Dimensions Questionnaire (PSDQ) In: Perlmutter B.F., Touliatos J., Holden K.Due west., editors. Handbook of Family Measurement Techniques: Instruments and Index. Volume 3. Sage; Thousands Oaks, CA, U.s.a.: 2001. pp. 319–321. [Google Scholar]

64. Abidin R.R., Bruner J.F. Evolution of a Parenting Alliance Inventory. J. Clin. Child Psychol. 1995;24:31–forty. doi: 10.1207/s15374424jccp2401_4. [CrossRef] [Google Scholar]

65. Olson D.H., Portner J., Lavee Y. FACES Three. University of Minnesota; St. Paul, MN, The states: 1985.. [Google Scholar]

66. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2d ed. Erlbaum; Mahwah, NJ, The states: 1988. [Google Scholar]

67. IBM SPSS . IBM SPSS Statistics Base 18. SPSS; Chicago, IL, USA: 2010. [Google Scholar]

68. Tabachnik B.Grand., Fidell L.S. Using Multivariate Statistics. fifth ed. Pearson Instruction; Boston, MA, U.s.: 2007. [Google Scholar]

69. Hair J.F., Anderson R.East., Tatham R.Fifty., Black W.C. Multivariate Analysis. 5th ed. Pearson Prentice Hall; Upper Saddle River, NJ, U.s.: 2008. [Google Scholar]

70. Jiménez Fifty., Lorence B., Hidalgo V., Menéndez S. Factor analysis of FACES (Family Adaptability and Cohesion Evaluation Scales) with families at psychosocial risk. Universitas Psychologica. 2017;xvi:140–151. doi: 10.11144/Javeriana.upsy16-ii.afef. [CrossRef] [Google Scholar]

71. Matejevic Thou., Jovanovic D., Lazarevic V. Functionality of family unit relationships and parenting style in families of adolescents with substance abuse problems. Procedia Soc. Behav. Sci. 2014;128:281–287. doi: ten.1016/j.sbspro.2014.03.157. [CrossRef] [Google Scholar]

72. Militarist S.T., Hale W.W., Raaijmakers Q.A.Due west., Meeus W. Adolescents' perceptions of privacy invasion in reaction to parental solicitation and control. J. Early Adolesc. 2008;28:583–608. doi: 10.1177/0272431608317611. [CrossRef] [Google Scholar]

73. Ying L., Ma F., Huang H., Guo Ten., Chen C., Xu F. Parental monitoring, parent-boyish communication, and adolescents' trust in their parents in China. PLoS ONE. 2015;10:e134730. doi: 10.1371/journal.pone.0134730. [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]

74. Bloomfield L., Kendall S. Parenting self-efficacy, parenting stress and kid behavior before and after a parenting programme. Prim. Health Care Res. Dev. 2012;xiii:364–372. doi: 10.1017/S1463423612000060. [PubMed] [CrossRef] [Google Scholar]

75. Ardelt G., Eccles J.Due south. Effects of mothers' parental efficacy beliefs and promotive parenting strategies on innercity youth. J. Fam. Issues. 2001;22:944–972. doi: 10.1177/019251301022008001. [CrossRef] [Google Scholar]

76. Hill N.E., Bush K.R. Relationships between parenting surroundings and children'due south mental health among African American and European American mothers and children. J. Union Fam. 2001;63:954–966. doi: 10.1111/j.1741-3737.2001.00954.x. [CrossRef] [Google Scholar]

77. Bhaumik D.K., Roy A., Aryal South., Hur K., Duan Due north., Normand South.Fifty., Brown C.H., Gibbons R.D. Sample size determination for studies with repeated continuous outcomes. Psychiatr. Ann. 2008;38:765–771. doi: ten.3928/00485713-20081201-01. [PMC complimentary article] [PubMed] [CrossRef] [Google Scholar]

78. Hunter J.E., Jensen J.Fifty., Rodgers R. The control grouping and meta-assay. J. Methods Meas. Soc. Sci. 2014;5:3–21. doi: ten.2458/v5i1.18302. [CrossRef] [Google Scholar]

foleyeatinke.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479931/

Share this post