Fifteen-Year Follow-Up of a Randomized Trial of a Preventive Intervention for Divorced Families: Effects on Mental Health and
Substance Use Outcomes in Young Adulthood
Sharlene A. Wolchik, Irwin N. Sandler, Jenn-Yun Tein, Nicole E. Mahrer, Roger E. Millsap, Emily Winslow, Clorinda Vélez, Michele M. Porter, Linda J. Luecken, and Amanda Reed
Arizona State University
Objective: This 15-year follow-up assessed the effects of a preventive intervention for divorced families, the New Beginnings Program (NBP), versus a literature control condition (LC). Method: Mothers and their 9- to 12-year-olds (N � 240 families) participated in the trial. Young adults (YAs) reported on their mental health and substance-related disorders, mental health and substance use problems, and substance use. Mothers reported on YA’s mental health and substance use problems. Disorders were assessed over the past 9 years (since previous follow-up) and 15 years (since program entry). Alcohol and marijuana use, other substance use and polydrug use, and mental health problems and substance use problems were assessed over the past month, past year, and past 6 months, respectively. Results: YAs in NBP had a lower incidence of internalizing disorders in the past 9 years (7.55% vs. 24.4%; odds ratio [OR] � .26) and 15 years (15.52% vs. 34.62%; OR � .34) and had a slower rate of onset of internalizing symptoms associated with disorder in the past 9 years (hazard ratio [HR] � .28) and 15 years (HR � .46). NBP males had a lower number of substance-related disorders in the past 9 years (d � 0.40), less polydrug (d � 0.55) and other drug use (d � 0.61) in the past year, and fewer substance use problems (d � 0.50) in the past 6 months than LC males. NBP females used more alcohol in the past month (d � 0.44) than LC females. Conclusions: NBP reduced the incidence of internalizing disorders for females and males and substance-related disorders and substance use for males.
Keywords: divorce, prevention, young adults, mental health, substance use
Although the rate of divorce in the United States has stabi- lized or decreased somewhat since the 1970s (Bramlett & Mosher, 2002; U.S. Census Bureau, 2005), it is estimated that
30%–50% of youths in the United States will experience pa- rental divorce in childhood or adolescence (National Center for Health Statistics, 2008). Although most youths do not experi- ence significant adjustment problems after parental divorce (e.g., Amato, 2001; Hetherington, 1999), there is compelling evidence demonstrating that divorce confers increased risk for multiple problems in childhood and adolescence, including mental health problems and disorders (e.g., Amato, 2001; Fer- gusson, Horwood, & Lynskey, 1994), elevations in substance use (e.g., Eitle, 2006; Paxton, Valois, & Drane, 2007), early onset of sexual activity (Hetherington, 1999), and physical health problems (Troxel & Matthews, 2004). For a sizeable subgroup, the negative effects of parental divorce continue into adulthood. Multiple prospective studies with epidemiologic samples have shown that parental divorce is associated with substantial increases in clinical levels of mental health prob- lems, substance abuse, mental health service use, and psychi- atric hospitalization in adulthood (e.g., Afifi, Boman, Fleisher, & Sareen, 2009; Kessler, Davis, & Kendler, 1997). Illustra- tively, in the National Comorbidity Study, Kessler et al. (1997) found that parental divorce was related to elevated rates of multiple mental (odds ratio [OR] range � 1.39 –2.61) and substance-related (OR range � 1.46 –2.38) disorders, control- ling for demographics including age, sex, race, and family socioeconomic status (SES). Similarly, Chase-Lansdale, Cher- lin, and Kiernan (1995) reported a 39% increase in the odds of being above the clinical cut-point on mental health problems at
This article was published Online First June 10, 2013. Sharlene A. Wolchik, Irwin N. Sandler, Jenn-Yun Tein, Nicole E.
Mahrer, Roger E. Millsap, Emily Winslow, Clorinda Vélez, Michele M. Porter, Linda J. Luecken, and Amanda Reed, Department of Psychology, Arizona State University.
Clorinda Vélez is now at the Department of Psychology, Swarthmore College.
Sharlene A. Wolchik, Irwin N. Sandler, and Michele M. Porter declare the following competing financial interest: Partnership in Family Transi- tions—Programs That Work LLC, which trains and supports providers to deliver the New Beginnings Program. This research was funded by National Institute of Mental Health Grants 5R01MH071707, 5P30MH068685, and 5P30MH039246 (Trial Registration: clinicaltrials .gov; Identifier: NCT01407120). We thank Philip G. Poirier and Linda Sandler for their support throughout this project; the mothers and young adults for their participation; Monique Nuno, Toni Genalo, and Michele McConnaughay for their assistance with data collection and management; the interviewers for their commitment and dedication to this project; and Janna LeRoy for her technical assistance. We also thank the group leaders and graduate students for their assistance with implementing the programs.
Correspondence concerning this article should be addressed to Sharlene A. Wolchik, Prevention Research Center, Department of Psychology, Arizona State University, P.O. Box 876005, Tempe, AZ 85287-6005. E-mail: email@example.com