Diagnosed in 10-15% of children worldwide, childhood mental illness [MI] remains a
prominent public health concern. Early exposure to maternal depression is a notable risk
factor for the development of childhood MI. Maternal depression is most common in the
first few years following childbirth, and clinically significant depressive symptoms are
on the rise, with recent estimates at 26.9% for mothers worldwide. This increase
highlights the current and critical need for interventions to address maternal depression
and the prevention of childhood MI concurrently.
To simultaneously address maternal and child MI, the Building Regulation in Dual
Generations (BRIDGE) group-based intervention was created. BRIDGE aims to increase
intergenerational emotion regulation by pairing Dialectical Behaviour Therapy (DBT)
skills training with a theoretically aligned parenting skills program. DBT has been shown
to be a propitious transdiagnostic treatment for underlying mechanisms of
psychopathology, including emotion regulation difficulties common in depression, anxiety,
and traumatic stress.
Developmentally supportive parenting requires mothers to have the ability to regulate
emotions effectively; in so doing, a mother can simultaneously limit over-reactive
responses within themselves and towards their child, as well as teach their child about
emotions. These objectives map nicely to the skills being learned in DBT. Within BRIDGE,
the aligned parenting content also includes best-practice behaviour management training
techniques, such as creating positive family routines and using positive reinforcement,
framed within the context of DBT skills. The integration of DBT with parenting programs
in BRIDGE is a promising approach for addressing intergenerational needs.
The current study will expand on previous evaluations of BRIDGE by conducting a
randomized controlled trial (RCT) comparing (1) BRIDGE (DBT skills training + Parenting
Skills), (2) DBT (DBT skills training only), and (3) services as usual (SAU). Our primary
aim is to examine the effects of BRIDGE on maternal depression and child MI symptoms. We
hypothesize that participants who receive the BRIDGE and DBT interventions will report
fewer depressive symptoms than participants in the SAU group. Participants who receive
the BRIDGE intervention are hypothesized to report fewer child MI symptoms than those in
the DBT and SAU groups.
A secondary aim of this study is to evaluate the efficacy of BRIDGE in reducing parenting
stress and harsh parenting. Participants who receive the BRIDGE intervention are
hypothesized to show lower levels of parenting stress and harsh parenting than those in
the DBT and SAU groups.
Interim analyses of primary and secondary outcomes will be conducted at the mid-way point
of the RCT, when approximately 90 participants have completed the post-intervention
questionnaires (T2). Minor changes in intervention delivery (e.g., offering optional
in-person group therapy, updating DBT homework, changing video production) may be made
based on results from interim analyses. Any changes to intervention delivery will be
documented in a protocol deviation document.
Additional aims of the RCT are to examine the effects of BRIDGE and DBT on family
relationships, other service use (e.g., hospital visits, interactions with police), and
maternal psychopathology symptoms. The investigators hypothesize that mothers who receive
the BRIDGE or DBT intervention will report lower psychopathology symptoms, reduced
service use, and improved family relationship quality. The investigators will also assess
participants' engagement in each intervention.
Exploratory outcomes of observed maternal sensitivity and child emotion regulation will
also be examined via remote Zoom assessments. The investigators hypothesize that mothers
in the BRIDGE group will show greater maternal sensitivity and that their children will
demonstrate improved emotion regulation, more than those in the DBT or SAU groups.
Additional exploratory outcomes will come from physiological feedback and coparent
participation. Physiological indices of wellbeing (e.g., sleep and daily activity) will
be measured via Fitbits that mothers will wear during the program. The investigators
hypothesize that participants who receive the BRIDGE or DBT interventions will display
improved sleep quality and reduced sedentary behaviour.
The investigators will invite participants' co-parents to complete questionnaires on
their own mental health and family relationships. Inviting co-parents to complete
questionnaires during this trial is exploratory and will allow us to evaluate the
feasibility of including assessments of co-parents in future trials. The investigators
hypothesize that some spill-over effects of the BRIDGE and DBT interventions may occur,
such that co-parents of participants in either intervention group will show fewer MI
symptoms and improved family relationship quality.
