Sibling relations between individuation and attachment: attempt at a conceptualization

Although sibling relationships can be considered as one of the most durable and intensive relationships, not much research in developmental psychology and family research has been done on this issue. The strong focus on parents, more specifically on mothers, stood in the way of adequate conceptualization and understanding of the function and contribution of siblings to individual development and family interaction. In this contribution a conceptualization of sibling relationships is presented. Siblings as objects of aggressive and sexual feelings as well as the function of siblings in the family system, for example, as parentification and negative identity is emphasized. In addition, the different qualities of sibling relationships, for example, envy, rivalry, similarity, and difference, are emphasized. The function of siblings as love objects is stressed, and the role of siblings as support as well as teaching object is illustrated. Finally, it is emphasized that, similar to relationships between parents and child, the quality of sibling relationships changed over time and leads, for example, to a detachment between sibling relationships during adolescence.     

Family disruption in childhood and risk of adult depression

OBJECTIVE: The authors examined the risk that family disruption and low socioeconomic status in early childhood confer on the onset of major depression in adulthood. METHOD: Participants were 1,104 offspring of mothers enrolled during pregnancy in the Providence, R.I., site of the National Collaborative Perinatal Project. Measures of childhood family disruption and socioeconomic status were obtained before birth and at age 7. Structured diagnostic interviews were used to assess respondents' lifetime history of major depressive episode between the ages of 18 and 39. Survival analysis was used to identify childhood risks for depression onset. RESULTS: Parental divorce in early childhood was associated with a higher lifetime risk of depression among subjects whose mothers did not remarry as well as among subjects whose mothers remarried. These effects were more pronounced when accompanied by high levels of parental conflict. Independent of the respondents' adult socioeconomic status, low socioeconomic status in childhood predicted an elevated risk of depression. CONCLUSIONS: Family disruption and low socioeconomic status in early childhood increase the long-term risk for major depression. Reducing childhood disadvantages may be one avenue for prevention of depression. Identification of modifiable pathways linking aspects of the early childhood environment to adult mental health is needed to mitigate the long-term consequences of childhood disadvantage.     

Offspring of depressed parents: 20 years later

OBJECTIVE: This study was a 20-year follow-up of offspring of depressed and nondepressed parents to determine the magnitude and continuity of the risk of parental depression to the offspring. METHOD: The authors followed 151 offspring of moderately to severely depressed parents or nonpsychiatrically ill comparison subjects for about 20 years, to a mean age of 35 years. Four interviews and diagnostic assessments from childhood or adolescence to adulthood were conducted by assessors blind to the parents' clinical status or the offspring's previous history. Final best-estimate diagnoses were also made by blinded psychologists or psychiatrists. RESULTS: The risks for anxiety disorders, major depression, and substance dependence were approximately three times as high in the offspring of depressed parents as in the offspring of nondepressed parents. Social impairment was also greater. The period of highest incidence for major depressive disorder remained between ages 15 and 20 years, largely in females. The early onset of disorder seen in the high-risk group was not offset by a later onset in the low-risk group as they matured. Higher rates of medical problems and mortality in the offspring of depressed parents were beginning to emerge as the offspring entered middle age. CONCLUSIONS: The offspring of depressed parents constitute a high-risk group for psychiatric and medical problems, which begin early and continue through adulthood. Early detection seems warranted.     

Sibling relationships when a child has autism: marital stress and support coping

Family systems theory was employed to study sibling relationships in 50 families with a child with autism. Typically developing siblings expressed satisfaction with their sibling relationships. Parents were somewhat less positive about the sibling relationship than were the siblings themselves. As hypothesized, stress in the marital relationship was associated with compromised sibling relationships. Informal social support buffered the deleterious effects of marital stress on positive, but not negative, aspects of the sibling relationship. Contrary to predictions, families experiencing high marital stress who sought greater support from formal resources external to the family had typically developing siblings who reported a higher level of negative sibling behaviors than families who sought low levels of formal support. Findings reinforce the importance of considering family context as a contributor to the quality of the sibling relationship.     

Families of children with 5p- (cri du chat) syndrome: familial stress and sibling reactions

This research examined family stress and sibling reactions in families of children with 5p- (cri du chat) syndrome aged 1 to 18 years who were living at home. In Study 1,99 parents reported on themselves and their child with 5p-, as well as on family demographics, social supports, and stress. The best predictor of familial stress was the child's amount of maladaptive behavior, accounting for 12 to 38% of the variance across different stress measures. In Study 2, sibling concerns were examined in 44 unaffected siblings. The major finding was that parents and siblings disagreed on the extent of the siblings' interpersonal concerns. Parents reported that siblings felt ignored and misunderstood, whereas siblings themselves rated these concerns at much lower levels.     

Parent–youth conflict as a predictor of depression in adulthood: a 15-year follow-up of a community-based cohort

Experiencing conflictual relations with one’s parents while growing up has been linked to onset, recurrence, and worse treatment outcome of adolescent depression. While this suggests that significant problems in the parent–youth relationship make depressive disorders more relentless, it is not clear whether this effect lasts into adulthood. Our aim was to examine if major and minor conflict with parents while growing up predicts depression in adulthood in youth with and without a history of depression. We utilized data from the Uppsala Longitudinal Adolescent Depression Study. This community-based cohort was assessed with structured diagnostic interviews both at age 16–17 and at follow-up 15 years later. The analyses included 382 individuals (227 with a history of child or adolescent depression; 155 peers without such a history). Binary logistic regression was used, adjusting for sex, disruptive behavior disorders, and additional family-related adversities. Among individuals with adolescent depression, major conflict with parents was strongly associated with adult depression (adjusted OR 2.28, 95% CI 1.07–4.87). While major conflict with parents was rare among non-depressed controls, a non-significant association of similar magnitude was still observed. Minor conflict, on the other hand, was not significantly associated with adult depression. Overall, conflict with parents did not predict adult anxiety disorders, substance use, suicidal behavior, somatoform disorders, or psychotic disorders. In conclusion, major parent–youth conflict during upbringing seems to be linked with an increased risk of depression in adulthood. These findings underscore the need to consider contextual/familial factors in the prevention and clinical management of early-life depression.     

Childhood and adolescent predictors of major depression in the transition to adulthood

OBJECTIVE: The identification of predictors of major depression in the transition to adulthood has direct application to prevention and intervention efforts designed to forestall depression in this high-risk period. The current study identified childhood and adolescent familial and behavioral-emotional factors predicting depression during this critical developmental stage. METHOD: The 354 participants were part of a single-age cohort from a predominately Caucasian working-class community whose psychosocial development has been traced prospectively since age 5. In these analyses, data collected during childhood and adolescence were related to diagnoses of major depression at ages 18-26. RESULTS: During the transition to adulthood, 82 participants (23.2%) experienced major depression. Bivariate indicators of later depression included a family history of depression or substance use disorders, family composition, and childhood family environments perceived as violent and lacking cohesiveness. Also significant were self- and mother-reported internalizing behaviors, as well as self-rated anxiety and depressive symptoms. Multivariable analyses showed family violence, family composition, internalizing problems during adolescence, and low family cohesion to be the most salient factors. CONCLUSIONS: These results highlight familial and behavioral-emotional predictors of depression that can serve as foci for identifying youth in need of intervention.     

Psychosocial functioning in prepubertal major depressive disorders. I. Interpersonal relationships during the depressive episode

Psychosocial environment and relationships with parents, peers, and siblings of 115 prepubertal children were measured by interview with their parent(s) for the three-month period preceding the assessment. The children had a current diagnosis of major depression (52 children) or nondepressed neurotic disorder (23) or were assessed to be normal (40). Most aspects of psychosocial relationships were found to be significantly impaired in the psychiatric groups. This impairment was generally worse in the depressives and significantly worse for aspects of verbal and affective communication with parents and siblings. Prepubertal children with major depressive disorder regularly present social relation deficits in which two components can be distinguished: one general to childhood psychiatric disorder and another specific to major depression.     

Family discord, parental depression, and psychopathology in offspring: ten-year follow-up

OBJECTIVE: To determine the independent effects of parental depression and family discord on psychopathology in offspring at high and low risk for major depression. METHOD: One hundred eighty-two offspring of depressed or nondepressed parents were followed over 10 years. In direct interviews, parents' and offspring's psychopathology was evaluated by raters blind to parents' clinical status. Five dimensions of family discord-poor marital adjustment, parent-child discord, low family cohesion, affectionless control, and parental divorce-were assessed. RESULTS: Offspring exposed to either parental depression or family discord had higher rates of psychopathology than their counterparts. High-risk offspring had few family discord measures associated with their psychopathology; in low-risk offspring, family discord was associated with all offspring diagnoses. Between the two risk factors, parental depression proved a more important predictor for offspring major depressive disorder (MDD) and anxiety disorder, whereas family discord was a more important predictor for substance use disorder. CONCLUSIONS: Parental depression is a strong and consistent risk factor for offspring MDD and anxiety disorder. Without parental depression, offspring have less exposure to family discord and lower rates of psychopathology. In the presence of family discord, rates of MDD, anxiety disorder and substance use disorder increased. When offspring matured into young adulthood, effects of parental depression and family discord persisted.     

Attention deficit hyperactivity disorder in children is found to be related to the occurrence of ADHD in siblings and the male gender,but not to birth order,when compared to healthy controls

Objective. The aim of the present study was to explore the extent to which the prevalence of attention deficit hyperactivity disorder (ADHD) in childhood is associated with birth order and gender, and the prevalence of ADHD and mental retardation (MR) in siblings, as compared to healthy controls. Methods. Data from 200 children diagnosed with ADHD (mean age: 11.13 years; 10.5% females) were compared to data from 200 healthy controls (mean age: 11.0 years; 27.5% females). The data were related to symptoms of ADHD, birth order, gender, family size, and the occurrence of ADHD and MR in siblings. Results. Compared to controls, the occurrence of ADHD was found to be related to the male gender and to the occurrence of ADHD-related symptoms in siblings (odds ratio: 13.50). Birth order and MR were not associated with the occurrence of ADHD and ADHD-related symptoms. ADHD- related symptoms increased if a further sibling also suffered from ADHD. Conclusions. Among a sample of Iranian children suffering from ADHD, the ADHD and ADHD-related symptoms in childhood were found to be related to the male gender and to the occurrence of ADHD in siblings. Moreover, birth order was found to be unrelated. The fact that symptoms of ADHD-related symptoms increased if a further sibling was suffering from ADHD, and decreased if a further sibling was suffering from MR, is intriguing and needs further explanation.     

Characteristics of patients with major depression in combination with dysthymic or cyclothymic disorders. Childhood and precipitating events

The relationship between patients with acute major depression and chronic affective disorders was investigated in 298 nonpsychotic outpatients. The patients were categorized into 4 groups: major depression only, major depression with dysthymic or cyclothymic disorders, dysthymic or cyclothymic disorder without major depression and one group of other psychiatric disorders. The patients were interviewed about childhood losses, relationship to parents and siblings and family atmosphere, their personality characteristics as children, as well as precipitating events. The reports in the various diagnostic groups were compared. Patients in the mixed group reported somewhat more traumatic childhood experiences compared with patients in the pure major depression group and pure dysthymic-cyclothymic group, and much more traumatic childhood experiences compared with patients in the group of other disorders. Precipitating events among patients in the acute major depression group consisted of more acute external stressors compared with the events of the patients in the group of chronic affective disorders. Patients with major depression in combination with pure dysthymic-cyclothymic disorder generally remembered their childhood as having been more traumatic, with a less satisfying relationship to their parents.     

Attachment and loss experiences during childhood are associated with adult hostility, depression, and social support

OBJECTIVES: This study examined developmental antecedents to psychosocial traits in adulthood that have been linked in prior studies to increased risk of heart disease. The hypothesis was tested that early parental loss coupled with poor-quality family relationships (FR) during childhood would be associated with increased hostility and depression, and lower social support in adulthood. METHODS: Participants included 30 university students who experienced the death of one parent before the age of 16, and 31 control participants. Questionnaires were completed measuring current social support, hostility, depression, and the quality of FR. RESULTS: Multivariate analysis of variance (MANOVA) supported the hypothesis of maladaptive psychosocial characteristics in loss participants reporting poorer-quality FR. Significant interactions of loss and FR were found for individual variables of depressive symptoms, social support, and hostility. CONCLUSION: These results provide evidence that parental loss in childhood is associated with health-damaging psychosocial characteristics in adulthood only if the quality of the surviving FR is poor.     

Major depression, anxiety disorders and mixed conditions. Childhood and precipitating events

A consecutive sample of non-psychotic outpatients was divided into 4 groups: pure major depression, mixed major depression-anxiety disorder, pure anxiety disorder and a remaining group of other disorders. The patient reports of childhood losses, relation to parents, siblings and family climate, their own personality characteristics as children and precipitating events were compared in the various groups. On childhood experiences and precipitating events, it appears that the mixed group reported somewhat differently from the pure anxiety and the pure depression group, and very often differently from the group of other disorder. Patients with mixed major depression-anxiety disorder generally remembered their childhood as being more traumatic with a less satisfactory relationship to their parents. Prior to the onset of the disorder, they had more often experienced conflicts with partner, spouse or fiancé.     

Parental divorce and depression in young adulthood: adolescents' closeness to parents and self-esteem as mediating factor

Palosaari U, Aro H, Laippala P. Parental divorce and depression in young adulthood: adolescents' closeness to parents and self-esteem as mediating factor. Acta Psychiatr Scand 1996: 93: 20–26. © Munksgaard 1996. The mediating factors between childhood experience of parental divorce and subsequent depression in young adulthood were assessed in a follow-up study of one Finnish urban age cohort from the age of 16 to 22 (n = 1656). Depression was found to be more common among the offspring of divorced families. Low self-esteem at age 16 was an indicator of vulnerability to depression in young adulthood irrespective of family background or gender. Among girls the long-term impact of divorce was mediated via low self-esteem and lack of closeness to father. When the relationship with the father was close, no excess risk of depression was found among girls from divorced families. Conversely, in boys no statistical connection between low self-esteem or unsatisfactory relationship with parents and depression after parental divorce was found.     

The role of early adverse experience and adulthood stress in the prediction of neuroendocrine stress reactivity in women: a multiple regression analysis

Sensitization of stress-responsive neurobiological systems as a possible consequence of early adverse experience has been implicated in the pathophysiology of mood and anxiety disorders. In addition to early adversities, adulthood stressors are also known to precipitate the manifestation of these disorders. The present study sought to evaluate the relative role of early adverse experience vs. stress experiences in adulthood in the prediction of neuroendocrine stress reactivity in women. A total of 49 women (normal volunteers, depressed patients, and women with a history of early abuse) underwent a battery of interviews and completed dimensional rating scales on stress experiences and psychopathology, and were subsequently exposed to a standardized psychosocial laboratory stressor. Outcome measures were plasma adrenocorticotropin (ACTH) and cortisol responses to the stress test. Multiple linear regression analyses were performed to identify the impact of demographic variables, childhood abuse, adulthood trauma, major life events in the past year, and daily hassles in the past month, as well as psychopathology on hormonal stress responsiveness. Peak ACTH responses to psychosocial stress were predicted by a history of childhood abuse, the number of separate abuse events, the number of adulthood traumas, and the severity of depression. Similar predictors were identified for peak cortisol responses. Although abused women reported more severe negative life events in adulthood than controls, life events did not affect neuroendocrine reactivity. The regression model explained 35% of the variance of ACTH responses. The interaction of childhood abuse and adulthood trauma was the most powerful predictor of ACTH responsiveness. Our findings suggest that a history of childhood abuse per se is related to increased neuroendocrine stress reactivity, which is further enhanced when additional trauma is experienced in adulthood.     

Childhood adversities and quality of sleep in adulthood: A population-based study of 26,000 Finns

ObjectiveTo find out if childhood adversities predict poor sleep quality in working age.MethodsSurvey data from the Health and Social Support (HeSSup) study was used (N = 25,605, 59% women). Negative childhood adversities and quality of sleep in adulthood were assessed by the questionnaire in 1998. Multinomial regression models were used.ResultsA graded association between childhood adversities and the quality of sleep in adulthood was found. Odds ratio (OR) of poor quality of sleep for those with multiple childhood adversities (3–6) was 3.64 (95% CI 2.94–4.50). The association between childhood adversities and the quality of sleep remained significant after adjustments for work status, use of psychotropic drugs, health behaviours, recent life events and child–parent relationships. Poor quality of sleep was clearly increased among those with both poor child–mother (OR 10.4, 95% CI 6.73–16.07) or poor child–father (OR 5.4, 95% CI 3.89–7.50) relationships and multiple childhood adversities. In the analyses of specific childhood adversities, frequent fear of a family member and serious conflicts in the family showed the strongest associations.ConclusionsThe strong association between childhood adversities and the quality of sleep in adulthood highlights the importance of early life circumstances on adult health. Early stage recognition, prevention and supportive measures against childhood adversities and serious family conflicts should be promoted.     

A qualitative exploration of depression in emerging adulthood: disorder, development, and social context

OBJECTIVE: One in four emerging adults will experience a depressive episode between the ages of 18-25. We examined the lived experience of emerging adults with a focus on their treatment seeking, development and the social context of their illness. METHOD: In-depth interviews were conducted with 15 participants with major or minor depression. Interviews were recorded, transcribed verbatim and analyzed using established qualitative methods. RESULTS: Emerging adults reported dynamic and complex interactions within and between thematic areas including identification as an individual with depression, interactions with the healthcare system, relationships with friends and family, and role transitions from childhood to adulthood. Depressed mood, concerns about self-identifying one's self as being depressed, the complexity of seeking care often without insurance or financial support, alienation from peers and family, and a sense of failure to achieve expected developmental milestones appeared to interact and exacerbate functional impairment. CONCLUSIONS: Further research is needed to better understand and intervene upon pathways that lead to poor outcomes such as delayed milestones among emerging adults with depression. Health care providers should be conscious of the unique vulnerabilities posed by depressive disorders in this age group.     

Inner child of the past: long-term protective role of childhood relationships with mothers and fathers and maternal support for mental health in middle and late adulthood

Purpose

National longitudinal studies that investigate the long-term association between early family life and mental health in middle and older adulthood are limited. This study aims to fill the gap by examining the protective effect of positive childhood relationships with mothers and fathers and parental support against depression among women and men in middle and late adulthood.

Methods

The sample of 12,606 adults (7319 females; 5287 males) from the US Health and Retirement Study was nationally representative with the inclusion of 7 depression measures from 2008 to 2018. Two depression measures, CESD-8 scale and binary indicators of severe depressive symptoms, were used. Generalized estimation equations (GEE)-negative binomial models were estimated for CESD-8 and GEE-logit models were estimated for the binary indicator of severe depression. This study aimed to assess how positive parent–child relationships and maternal support protect the mental health of women and men in adulthood. Other risk and psychosocial factors, such as childhood depression, traumatic life events, stressful life events, marital status, and social support in adulthood were adjusted for.

Results

Positive childhood relationships with mothers, fathers, or both parents and increased maternal support were associated with a lower risk of depression among both females and males from middle to old age, even if they experienced trauma, stressful life events, divorce, singlehood, widowhood, or little social support. Females benefited more psychologically than males from positive mother–daughter relationships and high-quality relationships with both parents. However, compared to mother–child relationships, positive father–child relationships protected men better psychosocially than females.

Conclusion

Findings underscore the importance of fathers’ roles in promoting their children’s, especially sons’, emotional well-being. Interventions in early mother–child and father–child relationships and parental support are crucial for healthy aging in mental development.

     

The Maudsley long-term follow-up of child and adolescent depression

BACKGROUND: Little is known about the long-term economic impact of childhood depression. The aim of this study is to identify and examine the links between the characteristics of children with depression and the costs of services used in adulthood. METHODS: Subjects (N=149) who had attended psychiatric services in South London for depression were followed up on average 20.7 years later. Sociodemographic and illness characteristics were recorded in childhood and service use in adulthood was measured. Costs were calculated and multiple regression models were developed to explain variations in cost, with a comparison between ordinary least squares estimation and a generalised linear model. RESULTS: Service use and cost data were available on 140 subjects. The mean annual cost was 890 pounds Sterling (range 0 pounds Sterling-7532 pounds Sterling). Predictors of cost variations in both models were age at initial referral, level of childhood anxiety, and the presence of comorbid conduct disorder. In the ordinary least squares model, a family history of psychiatric illness was inversely related to cost, whilst in the generalised linear model there was an inverse link between peer/sibling relationship problems and costs. The models could explain 24 % and 20% of cost variation, respectively. CONCLUSIONS: It is possible to explain a reasonable amount of variation in adult service costs from factors describing the characteristics of children at the time of receiving care.     

Self‐esteem and symptoms of depression in children with seizures: Relationships with neuropsychological functioning and family variables over time

Purpose: To test over time the relationships of neuropsychological functioning to mental health in children following a first recognized seizure and, of primary importance, to determine if the strength of these relationships differs based on risk and protective factors. Methods: In a larger prospective study, 135 children with a first seizure (ages 8–14 years) and 73 healthy sibling controls completed neuropsychological testing at baseline and 36 months. Structured telephone interviews were used to obtain data from children on mental health and family environment; major caregiving parents provided data on demographic and family variables. Data analyses included correlation coefficients and linear regression models. Results: Children with seizures showed an overall trend for improvement in mental health. More children with seizures than siblings had declines in processing speed. Declines in neuropsychological functioning were correlated with worse mental health. With regard to risk and protective factors, higher parent education protected against decline in self‐esteem related to decline in processing speed. Better family functioning and greater parental support protected against decline in self‐esteem related to decrease in verbal memory and learning. Older child age protected against increase in depressive symptoms related to decline in processing speed. Discussion: Seizure onset had a negative impact on mental health in children with declines in cognitive functioning except for older children and those with more family resources. Children should be assessed for declines in processing speed and, if found, those subgroups of children with less educated or more anxious parents and those in less supportive families should be targeted for interventions.