Neighborhood Disadvantage as a Moderator of Children’s Response to a Dyadic Positive Affect Intervention for Children of Mothers with Depressive Symptoms

Abstract

Background:

Family promoting positive emotions (FPPE) is a dyadic, positive affect-focused preventive intervention shown to reduce perceived stress and emotional symptoms among children of mothers with elevated depressive symptoms, a population at heightened risk for psychopathology. Emerging evidence suggests that contextual disadvantages (e.g., socioeconomic, neighborhood) may shape vulnerability for major depressive disorder in children. The present study examined whether family- and neighborhood-level disadvantage moderated children’s response to FPPE relative to a psychoeducation comparison condition, with the goal of informing precision prevention efforts for high-risk families.

Methods:

Participants included 74 children (ages 8–12 years; 46.3% female) and their biological mothers with elevated depressive symptoms (i.e., Patient Health Questionnaire scores ≥ 8). Following random assignment, 47 dyads were assigned to FPPE, and 27 dyads were assigned to a written information psychoeducation condition. Neighborhood and family-level disadvantage was assessed using the Child Opportunity Index (COI) scores and family-level income-to-needs ratio (INR), respectively. Parent-reported child perceived stress and emotional distress (depressive, anxiety, and anger symptoms) were assessed pre- and post-intervention using the Perceived Stress Scale and Patient-Reported Outcomes Measurement Information System Emotional Distress Scales.

Results:

Family-level INR did not moderate intervention effects. Results revealed a significant time × group × COI interaction for child-perceived stress, such that greater neighborhood disadvantage was associated with a larger reduction in child-perceived stress pre-to-post intervention in the FPPE but not the written information group. No other significant effects emerged.

Conclusions:

FPPE was most effective in reducing perceived stress among children of mothers with elevated depression symptoms exposed to greater neighborhood-level disadvantage, suggesting that a positive valence system (PVS) may be a particularly sensitive and proximal preventive intervention target through which downstream reductions in stress occur. These findings suggest that youth facing both intergenerational and environmental risk may benefit the most from dyadic, positive affect-focused interventions to reduce stress. Research should test downstream effects of FPPE on clinical symptoms emerging over longer periods.