James Jaccard’s research while affiliated with New York University and other places

We call for clinical trials researchers to carefully consider questions about use of intention-to-treat (ITT) analysis and per protocol analysis. We discuss how questions about efficacy and mechanisms of efficacy are appropriately answered through the application of per protocol analysis. ITT analysis is well-suited and appropriate for addressing questions related to treatment effectiveness, typically adherence to the treatment with respect to an outcome. While guided by admirable intentions, ITT analysis is often not guided by the right questions, leading to ITT misapplication. We address additional misconceptions that often lead to ITT misapplication, including issues relating to treatment noncompletion and violation of random assignment. We further highlight future directions and implications, particularly that future clinical child and adolescent research trial designs will be increasingly characterized by hybrid trials that combine elements of efficacy, effectiveness, and implementation research, where ITT and per protocol analysis will be appropriately applied to answer the right questions.

Among the many social determinants linked to adolescent alcohol use and depression, racial and ethnic discrimination is a prevalent determinant among Latinx adolescents and adults that is largely overlooked in preventive interventions. This study explored the influence of perceived racial and ethnic discrimination on depressive symptoms and alcohol use intentions among Latinx adolescents. Additionally, the study explored the cross-generational effects of how mothers’ perceived discrimination impacts the depressive symptoms and alcohol use of the adolescent. The study used a sample of 800 inner-city Dominican and Puerto Rican adolescent–mother dyads (adolescent mean age = 12.42 years, SD = 0.81; mother mean age = 40.55 years, SD = 8.70). Employing a five-wave panel design that followed adolescents from 8th grade to 10th grade, the study found statistically significant mediation pathways which showed that adolescents’ self-reported racial and ethnic discrimination experiences were associated with increases in their immediate and long-term depressive symptoms, which in turn were associated with stronger intentions to use alcohol in the future. Further, perceived racial and ethnic discrimination experienced by Latinx mothers was associated with increases in adolescents’ intentions to drink alcohol in the future, mediated by the mothers’ depressive symptoms and subsequently the adolescents’ depressive symptoms. As discussed, these findings have wide-ranging implications for alcohol use prevention programs targeting inner-city Latinx adolescents.

Background Depression continues to be an ongoing threat to adolescent well-being with Black adolescents being particularly vulnerable to greater burdens of depression as well as lower mental health service utilization. Black adolescents are likely to have untreated depression due to social network influences, varied perceptions of services and providers, or self-stigma associated with experiencing depressive symptoms. Furthermore, if or when treatment is initiated, low engagement and early termination are common. To address this gap, a trial is being conducted to preliminarily test the effectiveness of an engagement intervention targeting Black adolescents with depression in school mental health services in New York City. Methods A total of 60 Black middle and high school adolescents displaying depressive symptoms are equally randomized (based on school site) to the treatment arms. Both trial arms deliver Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), a time-limited, evidence-based treatment for depression. Additionally, one arm pairs IPT-A with a brief, multi-level engagement intervention, the Making Connections Intervention (MCI), involving adolescents, caregivers, and clinicians. Outcomes of interest are group differences in depression and suicide ideation, adolescent and caregiver engagement, and mental health service use. Discussion This trial will serve as an efficacy assessment of the MCI among a sample of Black adolescent students with depressive symptoms. Clinical and implementation results will be used to inform future research to further test the MCI intervention in a larger sample. Trial registration Registered by ClinicalTrials.gov on May 3, 2019, identifier: NCT03940508.

Using a stress process lens, this paper considers the interrelationship between individual and family‐level stress exposures and military spouse resources, including problem‐solving appraisals and problem‐solving support (PSS), and their associations with posttraumatic stress symptoms (PTSS) among both partners in military marital dyads. The study employs data from the Millennium Cohort Family Study, a longitudinal survey of married military dyads, with an initial panel of 9,872 spouses enroled from 2011 to 2013. A structural equation model explored the associations between service member and spouse childhood maltreatment exposure, nonmilitary and military stressors, as well as interactions with spouse resources on self‐reported PTSS among both service member (SM) and spouse (SP). Among our findings, spouse childhood maltreatment muted later self‐reported problem‐solving appraisal and support. Spouse resources, in turn, had both protective (problem‐solving appraisal) and promotive (problem‐solving support) effects on PTSS for both service members and spouses. These findings emphasise the central role of spouses in military families, as more psychological resources among spouses appeared to buffer against the deleterious effects of stress exposure on both their own and their partners mental health.

Extending a recent parent-mediation efficacy trial, we identified parent reinforcement and relationship behaviors as setting boundary conditions, or moderators, of youths’ anxiety outcome in 254 youths and their parents, who were randomized to (a) cognitive-behavioral treatment (CBT) with parent reinforcement-behavior training (CBT + Reinf), (b) CBT with parent relationship-behavior training (CBT + Relat), or (c) individual-youth CBT—a comparator control arm. Findings revealed that parents with high baseline negative-reinforcement levels and acceptance levels (i.e., above the mean) report their children as having lower anxiety at outcome when assigned to CBT + Reinf and CBT + Relat, respectively, versus CBT. No moderation effects were found for either parent positive reinforcement or parent psychological control. Implications for treating anxiety disorders and moving toward precision-treatment approaches in youths and the importance of research replication and extension are discussed.