Adaptation and evaluation of a digital dialectical behaviour therapy for youth at clinical high risk for psychosis: A protocol for a feasibility randomized controlled trial

by Thea Lynne Hedemann, Yun Lu, Sofia Campitelli, Lisa D. Hawke, Nelson Shen, Sarah Saperia, Brett D. M. Jones, Gillian Strudwick, Chelsey R. Wilks, Wei Wang, Marco Solmi, Michael Grossman, Muhammad Ishrat Husain, Nicole Kozloff, George Foussias, Muhammad Omair Husain

Youth at clinical high risk (CHR) for psychosis often experience emotional dysregulation, psychiatric symptoms, substance use, suicidality, and functional impairment. Dialectical behaviour therapy (DBT) is an evidence-based intervention that improves emotion regulation, clinical outcomes, and functioning across psychiatric populations. Digital adaptations (d-DBT) may enhance accessibility and engagement for CHR youth, but acceptability and potential benefits in this group are unknown.

To adapt d-DBT for CHR youth and evaluate the acceptability of delivering it to this population, as well as the feasibility of a larger-scale clinical trial.

This mixed-methods clinical trial has two phases. In Phase 1, d-DBT will be adapted for CHR youth in collaboration with a lived-experience youth advisory group. In Phase 2, an assessor-masked randomized controlled trial will compare d-DBT (n = 30) with treatment as usual (n = 30). The intervention consists of eight weekly modules, with primary outcomes assessing acceptability, usability, and trial feasibility. Secondary outcomes include changes in emotional dysregulation, psychiatric symptoms, substance use, suicidality, and functioning.

We anticipate that d-DBT will be acceptable to CHR youth and that conducting a larger trial will be feasible. Preliminary findings may demonstrate improvements in emotion regulation, psychiatric symptoms, suicidality, and functioning. Results will guide further refinement of the intervention and inform the design of a confirmatory clinical trial.

ClinicalTrials.gov #NCT06928935

Patterns of Intergenerational co‐Parenting Relationships in Chinese Families With Infants and Toddlers: A Latent Profile Analysis

ABSTRACT

Background

Within the context of limited childcare resources and a high prevalence of multigenerational co-residence in China, grandparents play a pivotal role in the caregiving of infants and toddlers. However, discrepancies in parenting philosophies across generations may lead to conflict, thereby impacting maternal psychological well-being and parenting experiences. Identifying the typologies of intergenerational co-parenting relationships is therefore essential for informing targeted health interventions.

Aim

This study aimed to identify latent profiles of mother–grandparent intergenerational co-parenting relationships in families with infants and toddlers in Shenzhen, China, using the Grandparent-Parent Co-parenting Relationship Scale (GPCRS) dimensions. It further sought to examine how maternal psychosocial factors (parenting stress, perceived stress, depressive symptoms, sleep quality), the quality of spousal co-parenting relationships and intergenerational caregiving role arrangements are associated with profile membership.

Design

A cross-sectional survey study.

Methods

A total of 366 mothers with children aged 0–3 years was recruited from maternity and child healthcare institutions in Shenzhen, China, between January 2023 and May 2024. Validated scales were used to assess intergenerational and spousal co-parenting, parenting stress, parenting sense of competence, perceived stress and depressive symptoms. Latent profile analysis was employed to identify patterns of intergenerational co-parenting relationships, and multinomial logistic regression was conducted to examine the associated predictors.

Results

Three distinct intergenerational co-parenting profiles were identified: the Discordant Group (29.2%), the Balanced Group (46.7%) and the Harmonious Group (24.0%). Higher spousal co-parenting scores were positively associated with more harmonious profiles. Lower levels of parenting stress, perceived stress and depressive symptoms, as well as higher sleep quality and grandparental involvement in caregiving were all associated with more positive relationship profiles. However, higher maternal parenting competence was paradoxically linked to greater intergenerational conflict.

Conclusion

Mothers in the Discordant Group, marked by low agreement/support and high conflict, reported the highest stress and depressive symptoms, whereas those in the Harmonious Group showed the most favourable psychosocial outcomes, with the Balanced Group in between. Stronger spousal co-parenting, better sleep quality and grandparental caregiving were associated with membership in the Harmonious class. These findings underscore the importance of fostering harmonious co-parenting across spousal and intergenerational subsystems to enhance maternal well-being and family functioning in early childhood.

Implications for the Profession and/or Patient Care

Nurses and healthcare professionals could implement family-based interventions tailored to identified profile characteristics, thereby more effectively supporting maternal mental health and fostering greater harmony in intergenerational co-parenting families.