Competence and Coping in the Family Group Cognitive Behavioral (FGCB) Preventive Intervention: A Moderated Mediation Model in Youth at Risk for Depression

Abstract

Adolescents exposed to parental depression are at increased risk of developing internalizing and externalizing disorders. The Family Group Cognitive Behavioral (FGCB) intervention (Compas et al., 2015) is an evidence-based prevention program designed to reduce this risk by enhancing youth coping skills. However, it remains unclear which youth benefit most from this intervention. Competence, an indicator of youth resilience, may help identify those most likely to respond. This randomized controlled trial examined whether baseline youth competence moderated the effect of FGCB on coping at 6-month follow-up and whether improved coping subsequently mediated reductions in anxiety and depression symptoms at 12 months. Participants included 180 youth (ages 9–15; M = 11.46 years, SD = 2.00) and their parents with a history of depression, randomly assigned to either the FGCB intervention or a written information control condition. Moderated mediation analyses revealed that FGCB significantly improved coping only among youth with average to high levels of competence. In turn, coping predicted lower internalizing symptoms. Findings highlight competence as a key factor shaping intervention response and emphasize the need for tailored prevention efforts to support at-risk youth.

Psychopathology often emerges during adolescence and can persist into adulthood, leading to long-term impairments in functioning and well-being (Copeland et al., 2015; Costello et al., 2011; Dalsgaard et al., 2020; Hofstra et al., 2002; Merikangas et al., 2010). Preventive interventions that reduce symptoms before the onset of clinical disorders are essential for altering these adverse developmental trajectories (Cuijpers et al., 2008). Children of parents with depression are at a particularly elevated risk of developing emotional and behavioral problems, as well as related academic and social difficulties (Beardslee et al., 2011; Goodman et al., 2011). Targeted interventions for this high-risk group are therefore critical to disrupt the intergenerational transmission of psychopathology (Gladstone et al., 2011; Horowitz & Garber, 2006).

The Family Group Cognitive Behavioral (FGCB) intervention is one such program designed to lower the risk of psychopathology in families with a history of parental depression. FGCB targets both parenting strategies and youth coping skills, and has demonstrated sustained effects on internalizing and externalizing symptoms, as well as the occurrence of depressive episodes, in youth up to two years post-intervention (Ciriegio et al., 2025; Compas et al., 2015; Löchner et al., 2023). The primary mechanism underlying FGCB’s efficacy is improvement in youth coping skills (Ciriegio et al., 2025; Compas et al., 2010). By strengthening these skills, the intervention helps youth manage uncontrollable stressors commonly associated with parental depression, ultimately reducing symptoms of psychopathology.

Despite FGCB’s overall efficacy, not all youth may benefit equally from this preventive intervention (Howe & Leijten, 2023). Although prior research has found limited evidence for moderators of FGCB’s effects on youth outcomes (Compas et al., 2015), no studies have examined whether individual differences in resilience, particularly competence, might influence how youth respond to the intervention. Understanding whether competence affects youths' use of and benefit from coping-focused content can help clarify for whom FGCB is most effective.

Competence, defined as the ability to meet age-appropriate developmental tasks, is a core construct in resilience theory (Masten & Coatsworth, 1995). It reflects youths’ adaptation to developmental expectations across key domains, including engagement in activities and hobbies, supportive peer and social relationships, and academic performance (Achenbach & Rescorla, 2001), with the salience of these domains varying by cultural and contextual factors (Masten et al., 2021). Early competence has been linked to reduced psychopathology risk and improved functioning into adulthood (Burt et al., 2008; Burt & Roisman, 2010; Masten et al., 2010), as well as cascading positive outcomes following intervention (Sorensen et al., 2016; Wolchik et al., 2021). Although competence has been associated with intervention-related changes in developmental trajectories, relatively few studies have examined whether baseline competence shapes differential response to intervention (e.g., Reinke et al., 2018).

Among youth exposed to parental depression, higher competence is associated with improved functioning, fewer internalizing symptoms, and more effective coping strategies (Eichler et al., 2017; Garber & Little, 1999; Goodman et al., 1993; Korhonen et al., 2014; Pargas et al., 2010). These links suggest that competence may influence how effectively youth engage with and benefit from coping-focused content. Youth with higher competence may be better equipped to acquire and implement coping strategies, particularly amidst ongoing emotional challenges associated with parental depression. Nevertheless, competence has not yet been explored as a potential moderator of intervention mechanisms within FGCB.

The current study aimed to examine whether baseline competence influences how youth benefit from the FGCB preventive intervention. Prior work from this trial has established secondary control coping as a salient mediator of FGCB intervention effects (Ciriegio et al., 2025; Compas et al., 2010). Therefore, we extend this work by testing a moderated mediation model in which competence was hypothesized to moderate the effect of intervention condition on secondary control coping skill use, which in turn was hypothesized to mediate intervention effects on youth anxiety and depression symptoms. We hypothesized that higher baseline competence would be associated with improvements in coping and subsequent symptoms among youth receiving FGCB. By clarifying the role of competence in intervention response, this work can inform the design and delivery of more tailored and impactful interventions for youth at highest risk.

Method

Participants

The screening and enrollment flowchart for this randomized controlled trial was previously published (Compas et al., 2015). Participants included 180 parents with current or past Major Depressive Disorder (MDD) or Dysthymic disorder (DY) during the lifetime of their child(ren), as well as 242 of their offspring, recruited from two metropolitan areas in the United States. Parents with a history of MDD or DY included 160 mothers (M = 41.16 years, SD = 7.17) and 20 fathers (M = 48.30 years, SD = 7.50). Parents’ education level included less than high school (6%), completion of high school (9%), some college (30%), college degree (32%), and graduate education (23%). The majority of parents were White (82%), with the remainder identifying as African American (12%), Hispanic (2%), Asian (1%), Native American (1%), or mixed ethnicity (2%). The racial and ethnic compositions of the samples were representative of the regions from which they were recruited, based on 2000 U.S. Census data. Annual family income ranged from less than $5,000 to more than $180,000, with a median between $40,000 and $ 60,000. Regarding marital status, 62% of parents were married/partnered, 22% were divorced, 5% were separated, 10% had never married, and 1% were widowed. Families randomized to FGCB and the written information (WI) control condition did not differ significantly on any of these demographic variables. At baseline, 48 parents (27%) were in a current depressive episode, while 132 parents (73%) were not. Most parents (82%) reported experiencing multiple depressive episodes during their child’s life (median = 3), 15% reported a single episode, and 2.7% reported dysthymic disorder (one parent’s episode history was unknown).

Although multiple children from the same family could participate in the trial, one child per family was randomly selected for the present analyses to maintain independence of observations given shared family-level nesting, resulting in a final offspring sample of 180. Youth ranged from 9 to 15 years old (M = 11.46 years, SD = 2.00) and included 91 males and 89 females. Children were selected within this age range to intervene prior to the increased risk for depression onset in early- to mid-adolescence (Hankin et al., 1998) and to ensure youth were developmentally capable of learning the cognitive coping skills taught in the intervention. Parents and children could access other mental health treatments during the study. Over the 2-year study period, 76% of parents and 23% of children received either psychological or pharmacological treatment. Treatment rates did not differ between the FGCB and WI conditions.

Screening and Procedures

Families were recruited through mental health clinics, family/general medical practices, and media outlets to capture both treatment-seeking and non-treatment-seeking parents with a history of depression. Screening occurred by telephone and required parents to meet criteria for current or lifetime MDD or DY during their child’s life. Additional inclusion/exclusion criteria ensured that parents did not have bipolar I, schizophrenia, or schizoaffective disorder, and that children did not have autism spectrum disorder, intellectual disability, bipolar I disorder, or schizophrenia. Children were also excluded if they currently met criteria for conduct disorder or substance/alcohol use disorder, potentially under-representing families with these conditions.

The Institutional Review Boards approved all procedures at the study sites. Families were randomized in blocks of eight to either FGCB (90 families) or WI (90 families) conditions using a random number generator and sealed envelopes. Assessments and intervention sessions took place at the university’s psychology department. Structured diagnostic interviews were administered by doctoral students and staff research assistants who were blind to the condition and had received extensive training in the protocols. Intervention groups were co-facilitated by clinical social workers and doctoral students, who completed approximately 30 hours of manual review, role-play, and supervision. Ongoing supervision was provided on a weekly basis by two licensed clinical psychologists.

Measures

Adolescent Competence.

Youth-reported competence was assessed using the Youth Self-Report (YSR; Achenbach & Rescorla, 2001). The YSR competency scales evaluate engagement in activities (e.g., sports, jobs), social functioning (e.g., friendships, peer contact), and academic performance. Age- and gender-normed T scores from the total competence scale at baseline were used in the analyses. The YSR competency scales has demonstrated good test-retest reliability and validity (Achenbach et al., 2002; Achenbach & Rescorla, 2001). Internal consistency for the total competence scale in the current sample was α = .74.

Adolescent Coping.

Coping with parental depression was assessed using the Parental Depression version of the Responses to Stress Questionnaire (RSQ; Connor-Smith et al., 2000; Jaser et al., 2005, 2008). Youth rated how often they used various coping strategies in response to specific stressors (e.g., “My mom seems to be sad or cries a lot of the time”) on a 4-point Likert scale (1 = not at all; 4 = a lot). The RSQ includes three coping domains: primary control engagement, secondary control engagement, and disengagement coping (Connor-Smith et al., 2000). Proportion scores were calculated to account for individual differences in response tendencies (Vitaliano et al., 1987). This study focused on secondary control coping (acceptance, positive thinking, cognitive restructuring, distraction) assessed at the 6-month follow-up, as these strategies were central to the FGCB intervention. The RSQ has demonstrated excellent validity and reliability in adolescent samples (Connor-Smith et al., 2000; Wadsworth et al., 2004). Internal consistency for secondary control coping in the current sample was α = .79.

Adolescent Psychopathology Symptoms.

Youth emotional and behavioral problems were assessed using the Youth Self-Report (YSR; Achenbach & Rescorla, 2001), a 118-item instrument that covers a broad range of psychological difficulties over the past six months. The anxious/depressed scale at 12-month follow-up was used as the primary outcome due to its established relevance in youth exposed to parental depression. The YSR has demonstrated strong reliability and validity across diverse youth samples (Achenbach & Rescorla, 2001; Ivanova et al., 2007), and internal consistency for anxious/depressed symptoms was α = .83 in the current sample.

Data Analytic Plan

All analyses were completed in R (R Core Team, 2024) using the lavaan package (Rosseel, 2012). A moderated mediation model (Preacher et al., 2007) was specified to examine whether the indirect effect of intervention condition (X) on youth anxious/depressed symptoms at 12-month follow-up (Y), via secondary control coping at 6-month follow-up (M), varied as a function of baseline youth competence (W). Competence was mean-centered and modeled as a moderator of the path from intervention to coping (path a). Moderation was specified on this pathway because competence was conceptualized as influencing youths’ acquisition of coping skills taught by the intervention. Covariates included baseline anxious/depressed symptoms and secondary control coping. Models were estimated using maximum likelihood estimation and full information maximum likelihood (FIML) to account for missing data. Bootstrap confidence intervals (based on 5,000 resamples) were used to test the significance of indirect effects and interaction terms. Conditional indirect effects were computed at low (−1 SD), mean, and high (+1 SD) levels of competence (Aiken & West, 1991).

Results

Descriptive statistics for all primary study variables are presented in Table 1. No significant baseline differences were found between intervention and control groups on demographic or key study variables. The structure of the moderated mediation model is illustrated in Figure 1.

Table 1.

Sample descriptive characteristics

	Total (N=180)	FGCB (N=90)	Written Control (N=90)	p
Age (M ± SD)	11.46 ± 2.00	11.41 ± 2.03	11.51 ± 1.98	.74
Total Competence Baseline	21.19 ± 4.73	21.23 ± 4.85	21.15 ± 4.64	.92
Coping 6-months	0.25 ± 0.05	0.27 ± 0.04	0.24 ± 0.05	<.001***
Anxious/Depressed 12-months	4.05 ± 4.16	2.89 ± 2.89	5.31 ± 4.93	.001**
Race, %				.73
White	74.4	73.3	75.6
Black or African American	12.8	13.3	12.2
Asian	3.3	2.2	4.4
Latino or Hispanic	1.7	2.2	1.1
American Indian or Alaska Native	0.6	0.0	1.1
Multiple	7.2	8.9	5.6
Sex, %				.88
Male	50.6	50.0	51.1
Female	49.4	50.0	48.9

p represents group comparison. p < .05*, p < .01**, p < .001***.

Fig. 1. Significant moderated mediation model.

Note. Baseline youth competence moderated the effect of intervention condition on 6-month secondary control coping (path a), which in turn mediated the effect of condition on 12-month anxious/depressed symptoms (path b). The model controlled for baseline levels of secondary control coping and anxious/depressed symptoms. Values shown are unstandardized path coefficients. p < .05*, p < .01**, p < .001***

The overall model predicting 12-month anxious/depressed symptoms was significant, R² = .28, F(4, 135) = 13.15, p < .001, reflecting a main effect of intervention condition with youth in the FGCB condition reporting lower anxious/depression symptoms than those in the control condition. Similarly, the model predicting 6-month secondary control coping was significant, R² = .20, F(5, 134) = 6.69, p < .001, indicating an overall intervention effect on coping. A significant interaction emerged between the intervention condition and youth competence in predicting coping (b = −0.002, SE = .001, p = .002), indicating that the positive effect of the intervention on coping increased with higher levels of competence. As shown in Figure 2, youth in the FGCB condition demonstrated significantly greater use of secondary control coping at average (b = −.03, SE = .01, p < .001) and high (+1 SD) levels of competence, but not at low competence (−1 SD).

Fig. 2. Interaction between intervention condition and baseline youth competence predicting secondary control coping at 6-month follow-up.

Note. Higher baseline competence strengthened the positive effect of the FGCB intervention on youth coping. Predicted secondary control coping was significantly higher for youth with average and high competence, but not for those with low competence

Increased use of 6-month secondary control coping predicted significantly lower anxious/depressed symptoms at 12 months (b = −42.56, SE = 12.83, p = .001). The direct effect of intervention condition on 12-month symptom levels remained significant after accounting for coping (b = 2.79, SE = 1.01, p = .01). The indirect effect of the intervention on symptoms through coping was significant at the mean level of competence (indirect effect = 1.26, SE = 0.55, 95% CI [0.36, 2.49]). Conditional indirect effects were significant at average (effect = 1.28) and high competence (effect = 2.25), but not at low competence (effect = 0.30). The index of moderated mediation was statistically significant (index = 0.09, 95% CI [0.03, 0.18]), confirming that the strength of the indirect effect was contingent on baseline levels of competence.

Discussion

Coping is a well-established mechanism through which the FGCB intervention reduces risk for psychopathology among adolescents exposed to parental depression. However, the present findings suggest that not all youth benefit equally from this approach. Notably, baseline levels of youth competence moderated the intervention’s effect on coping, such that FGCB improved coping only among those with average or above-average competence. This pattern highlights the importance of competence in shaping intervention response and identifying youth who may require additional supports.

Youth with higher competence may possess the developmental capacities, including cognitive, emotional, and behavioral skills, needed to engage effectively with coping-focused interventions. This aligns with developmental cascade models (Burt & Roisman, 2010; Masten & Cicchetti, 2010; Obradovic et al., 2010), which describe how strengths in one domain can promote positive adaptation in others over time. While such cascades often occur naturally, preventive interventions like FGCB may also initiate or strengthen these processes (Hinshaw, 2002), especially among youth with sufficient competence to benefit. In this way, competence may function not only as a marker of resilience but also as an active facilitator of adaptive change.

Although FGCB has demonstrated efficacy across trials (Compas et al., 2015; Löchner et al., 2023), the present findings provide greater insight into which youth may benefit most from the intervention. In particular, results suggest that baseline competence may shape youths’ ability to acquire and apply coping skills targeted in FGCB. These findings have implications for more personalized and developmentally tailored intervention strategies. For example, youth with lower competence may benefit from the inclusion of additional competence-building supports prior to beginning FGCB. Alternatively, modifying the delivery of FGCB, such as through digital formats, enhanced scaffolding, or increased opportunities for practice and repetition, may improve outcomes for these youth. These results are also consistent with the “rich-get-richer” patterns observed in prevention science (Howe & Leijten, 2023), whereby youth with greater initial strengths tend to gain more from intervention. As such, early efforts to build competence are vital for supporting youth at greatest risk.

The study’s strengths include its randomized controlled trial design, longitudinal follow-up, and use of validated measures. However, several limitations should be noted. First, competence was assessed using youth self-report across three domains (activities, social, and school), which may not fully capture cultural or contextual factors that shape access to and salience of these opportunities. Second, the sample lacked racial and ethnic diversity, which may limit the generalizability of findings to more diverse populations. Third, all data were collected from a single informant, so shared method variance might have influenced observed associations. Finally, while FGCB has demonstrated efficacy in research settings, additional research is needed to assess whether these moderation effects extend to real-world implementation.

Beyond implications for FGCB specifically, the present findings have implications for coping-focused prevention programs more broadly. Many prevention programs prioritize youth at highest risk, as intervention effects are often strongest among youth with greater room to benefit (Conduct Problems Prevention Research Group, 2007; Sandler et al., 2003; Wolchik et al., 2021). The current findings suggest similar value in considering developmental strengths when determining which youth benefit most from intervention. Coping skill use integrates emotional, attentional, and behavioral processes (Skinner & Zimmer-Gembeck, 2007), and these capacities vary widely across childhood and adolescence. Despite this variability, few prior coping-focused preventive interventions have examined competence as a moderator of intervention response, and existing research in this area has primarily focused on younger samples and classroom-level interventions. Indeed, one prior study identified a different pattern than the current study, as youth with lower levels of competence demonstrated greater benefit from intervention (Reinke et al., 2018). Although additional research is needed to characterize how competence shapes coping-focused intervention response across developmental stages and settings, these findings highlight the importance of supporting competence development as a potential pathway for enhancing preventive intervention outcomes.

Current findings also suggest several promising directions for future research. First, studies should examine whether competence similarly moderates responses to other coping-focused interventions across diverse approaches, populations, and contexts. This would help determine whether the role of competence generalizes across coping-focused interventions or is specific to FGCB. These considerations are especially important among youth experiencing multiple levels of psychosocial stress or structural inequities, which can shape opportunities for competence development and coping skill use. In these contexts, future interventions may benefit from integrating coping-focused content with individual and family resilience interventions (Jolie et al., 2021). Second, future work should investigate the mechanisms underlying competence-related moderation effects, including whether youth with higher competence had a better understanding of intervention material, used more skills at home between sessions, or were more engaged during intervention sessions. While this study did not include measures of these variables, given the robust and long-term effects observed in FGCB (Ciriegio et al., 2025; Löchner et al., 2023), as well as the significant link between homework adherence and treatment outcomes (Kazantzis et al., 2010), identifying these modifiable processes may point to additional opportunities to enhance intervention effects. Finally, future research might explore whether resilience-building programs (e.g., Greenberg, 2006) implemented prior to or alongside FGCB could help prepare youth with lower competence to benefit. Collectively, this work advances understanding of how and for whom coping-focused preventive interventions are most effective, laying the foundation for more targeted strategies to foster resilience among at-risk youth.

Data, Material, or Code Availability:

De-identified datasets may be made available upon reasonable request by contacting the principal investigators.