Treatment of depressed mothers of depressed children: pilot study of feasibility

Numerous studies have shown that depression is highly familial and impairing and that a history of depression in a parent is the strongest risk factor for depression in a child. Many of the parents in these studies have never received sustained treatment despite histories of recurrent depression. None of the studies have examined the effects of maternal symptom remission on offspring symptom or functioning. We sought to determine the feasibility of treating depressed mothers who brought an offspring for the treatment of depression and to examine the relationship between improved maternal depression and symptomatic improvement and social functioning in their offspring. Nine mothers bringing their offspring for treatment of depression, and who were evaluated and found to be currently depressed, completed a 12-week open trial of interpersonal psychotherapy. Mothers and their depressed offspring were assessed by independent evaluators at weeks 0, 6, and 12 for depressive symptomatology and social functioning. Although the rates of depression were high among the mothers, few eligible mothers agreed to participate. Of the 12 who entered treatment, 9 (75%) completed it. Mothers and offspring improved with regard to depressive symptomatology and global functioning over the course of the trial. Improvement in maternal depression was significantly associated with improvement in offspring functioning but not symptom reduction. Improvement of maternal depression may be associated with improved outcomes in depressed offspring. However, it is difficult to engage depressed mothers in treatment for themselves if they come to the clinic to bring their child for treatment of depression. It may be more feasible to study the effect of improved maternal depression on offspring by sampling depressed mothers coming for their own treatment and then assessing their children over the course of maternal treatment.     

Behavioral and emotional functioning in children of adolescent mothers

This study compared children of mothers in three age groups--15-17, 18-19, and 20-24 years--at the birth of their first child. Outcome measures were ratings of psychological functioning obtained at three time periods from multiple sources. Results, controlling for family structure and maternal education, indicate that children of adolescent mothers were generally not different from children of mothers in their early twenties with respect to behavioral and emotional functioning. Maternal education had a far greater effect on the outcome measures than did maternal age.     

Children of low‐income depressed mothers: psychiatric disorders and social adjustment

Background: Although several studies have documented a higher prevalence of psychiatric disorders in children of depressed than nondepressed parents, previous research was conducted in predominantly White, middle, or upper‐middle class populations. Only limited information is available on psychiatric disorders and psychosocial functioning in children of low‐income depressed mothers. Methods: We report the findings in children of mothers with and without a lifetime history of major depressive disorder, who were recruited from a large urban primary‐care practice. Bilingual clinical interviewers assessed 58 children with structured diagnostic interviews administered to most children (90%) and to their mothers as informants. Diagnostic assessments and best estimate diagnoses of the children were blind to the mothers' diagnostic status. Results: The families were poor and predominantly Hispanic, more than half of them headed by single mothers. After adjusting for child age and gender, and for any possible sibling correlation, children of depressed mothers had significantly higher rates of lifetime depressive, separation anxiety, oppositional defiant, and any psychiatric disorders than children of control mothers, with a lifetime prevalence of any psychiatric disorder of 84.6 versus 50.0%, respectively. Children of depressed mothers also reported significantly lower psychosocial functioning and had higher rates of psychiatric treatment. Conclusions: We conclude that the risk for psychiatric disorders may be particularly high in children of low‐income depressed mothers. The primary‐care setting offers a unique opportunity for early intervention with this underserved group. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

Deliberate emotional expressions of socially anxious children and their mothers

The aim of the present study was to investigate whether socially anxious children show deficits in their deliberate facial expression of emotions. To test for potential mother-child transmission effects, the mothers' facial expressions were also assessed. Fifty socially anxious and 25 socially nonanxious children (8-12 years) and their mothers participated in a facial expression posing task. The expressions produced were coded using Ekman and Friesen's (1978) Facial Action Coding System (FACS). In addition, naive raters rated their quality of emotion. FACS analyses indicated that socially anxious children show a reduced general facial activity, have a more restricted facial repertoire and differ qualitatively from controls in their facial expression of emotions. Similarly, the global ratings indicated that the socially anxious children's posed facial expressions are less accurate. For the mothers no differences between groups were found when global ratings were used. However, the FACS data demonstrate that the facial expressions of mothers of socially anxious children are less intense compared to controls. It is possible that the decreased intensity of the mothers' facial expressiveness makes it more difficult for the socially anxious children to learn adequate facial expressions.     

Behavioural and emotional problems in children of alcoholic mothers and fathers

 The Child Behavior Check List (CBCL) was used to compare a sample of 103 Danish children of alcoholics (CoA) to a Danish population-based sample (N = 780). The CoA had a significantly greater incidence of symptoms on 17 of the 118 CBCL items. Compared to the reference population, daughters of alcoholics were more impaired than sons of alcoholics on most CBCL measures. In families with maternal alcoholism daughters had higher internalising and depression scores than sons, and in families with paternal alcoholism, sons had higher internalising and depression scores than daughters. The CoA also had a significantly greater risk of scoring above the 95th percentile on internalising behaviour, depression symptoms and socially deviant behaviour. On all CBCL dimensions, almost half of the CoA samples functioned as well as the average of the reference population. The results from this study suggest that CoA should be regarded as a risk group but with very heterogeneous consequences in response to parental alcoholism. Accepted: 29 November 1999     

Psychosocial adjustment of poor Mexican mothers of disabled and nondisabled children

A comparison of 50 low-income Mexican mothers, 38 of whom had disabled and 22 nondisabled children, found significant differences in the areas of social support, child adjustment, perceived stress, and family functioning. Study findings point up the need for community-based education and support services.     

Play interactions and interviews of depressed and conduct disorder children and their mothers

Normal, depressed and conduct disorder children (M age=5 years) were interviewed (as were their mothers) and observed in free play and puzzle completion tasks both alone and together with their mothers to determine differences in temperament, behavior problems and play interaction behaviors. The depressed children reported more depressed feelings, lower self-esteem and more external locus of control, although their mothers were indistinguishable from mothers of normal children on interviews, and their dyadic play behavior together suggested less fantasy play and less involvement. The conduct disorder children's interview responses did not differ from their normal peers, although their mothers reported more self-depression, more external locus of control and less nurturant childrearing practices and rated their children as having more active temperaments. The conduct disorder children were more active motorically and less interactive during play sessions, and their mothers were less interactive and more disapproving than the other mothers. These results are discussed in the context of the literature on different behavior problems, self-concept, temperament and childrearing practices in these two groups of disturbed children.We would like to thank the children and mothers who participated in this study and the developmental follow-up clinic staff who made the referrals to the study. This research was supported by a NIMH research scientist development award #MH00331 to T.F. and by a postdoctoral fellowship from the Quebec Medical. Research Council to David Sandberg.     

Children of depressed and schizophrenic mothers

A sample of psychotic mothers and their children who were five years or younger when first recruited for our study of high risk children was followed up five years later. The current sample, obtained from our previous work, consisted of 18 schizophrenic, 12 depressed and psychotic, and 22 well mothers and their six to 12 year old children. The mothers were equated for education and age, and the children for sex and age. Cognitive style tests and interviews measuring social adjustment and functioning were given to both the parents and the children.Please enclose a self-addressed envelope. This research was supported in part by a grant from the Grant Foundation, New York, New York, and a grant from the Social Science Research Committee, the University of Chicago. The authors would like to thank David H. Gallant, Ph.D. for his many contributions to the design of the research.     

Psychological adjustment of relinquishing mothers before and after reunion with their children.

A main objective of this study was to compare the emotional well-being of mothers who had already experienced a reunion with children relinquished two to four decades ago, with that of mothers who were still awaiting the possibility of such re-contact. A nationwide postal survey was carried out in New Zealand of the relinquishment experiences and subsequent adjustment of 238 women who had been able to re-contact their children and of 206 women who had not as yet made contact. The two subgroups did not differ on two standardised measures of psychological well-being (GHQ-28 and global self esteem). However, the post-reunion women reported significantly greater improvements in their feelings connected with "adoption events", and also reported higher levels of perceived social support than did the pre-reunion women. Women who still lacked any information about their relinquished child showed significantly more negative affect and poorer psychological well-being than those who had at least obtained some non-identifying information.     

Clinical overview of children with mucopolysaccharidosis type III A and effect of Risperidone treatment on children and their mothers psychological status

Mucopolysaccharidosis IIIA (MPS IIIA) is a lysosomal storage disorder characterized by progressive mental deterioration and severe behavioral problems. We conducted an open-label, crossover study of the efficacy and safety of Risperidone on behavioral disorder in children with MPS IIIA. A total of 12 patients (5.5 ± 2.2 years) with enzymatic diagnosis of MPS IIIA were randomly assigned to receive Risperidone (0.125–2 mg/d) for 6 months. The hyperactivity and disruptive behavior level of children before and after treatment was evaluated regarding the scores from Turgay DSM IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S). Clinic Global Impression Scale – Severity (CGIS-S) was used for all cases for determining the psychiatric disorder severity. The anxiety and depression levels of mothers before and after treatment were evaluated using Hamilton Anxiety Scale (HAM-A) and Beck Depression Inventory (BDI). The adverse effects were evaluated by monitoring weight, serum prolactin, glucose and lipid levels. The response to the treatment was measured by decrease in values of CGI-S (from 6 ± 1.12 to 2.91 ± 0.66, p = 0.001). According to T-DSM-IV-S scores the best improvement was observed in hyperactivity scores (16.25 ± 8.57/11.58 ± 7.26, p = 0.001), followed by opposition/defiance (6.66 ± 5.92/5.08 ± 4.88, p = 0.032), and conduct disorder scores (1.00 ± 1.85/0.41 ± .99, p = 0.67). No clinically relevant elevations in weight and serum prolactin, glucose or lipid levels have been documented (p > 0.05). There was a significant decrease in anxiety and depression scores of mothers (HAM-A: 20.33 ± 8.28/17.91 ± 6.89, BDI: 23.58 ± 7.14/20.5 ± 5.93, p < 0.001). To our knowledge, research on the pharmacological treatment of MPS IIIA with Risperidone has not been reported. According to our data, Risperidone appeared to be safe and effective in MPS IIIA patients.     

Interpersonal impairment and the prediction of depressive symptoms in adolescent children of depressed and nondepressed mothers

OBJECTIVE: Different pathways to youth depression should be explored. Based on an interpersonal impairment perspective on depression, the currently depressed children of depressed mothers were hypothesized to differ in predictors of their depression compared with depressed children of nondepressed mothers. Chronic social difficulties were expected to be more predictive of depressive symptoms in offspring of depressed women, while recent stressful life events were expected to predict depression in offspring of never-depressed women. METHOD: A community sample of 812 fifteen-year-old children of depressed and nondepressed women was studied in Queensland, Australia, between 1996 and 1999; chronic and episodic stress in the past 6 to 12 months were examined in relation to current depressive disorders. RESULTS: Depressive states in children of depressed mothers were more associated with chronic interpersonal difficulties than were the depressions of children of nondepressed women, and the latter group had greater increases in depression level associated with episodic stressors than did children of depressed women. CONCLUSIONS: The results may reflect greater depression reactivity to chronic social difficulties among offspring of depressed mothers. Depressive experiences may have different predictors in subgroups of depressed youths and imply potentially different courses and needs for treatment.     

Suicidal ideation and attempts: a longitudinal investigation of children of depressed and well mothers.

OBJECTIVE: This study uses a prospective longitudinal design to examine suicidality (ideation, plans, attempts, and completions) in children and adolescents, to compare suicidality in the offspring of depressed and well mothers, and to identify correlates and predictors of suicidality. METHOD: Two children (n = 192) from each of the families in an ongoing longitudinal study of the offspring of mothers with major depressive disorder (n = 42), with bipolar disorder (n = 26), or without past or current psychiatric diagnosis (n = 30) were studied. Assessment of suicidality, based on diagnostic interviews, was made when the younger of the sibling pairs were approximately 6, 9, and 14 years of age and older siblings were approximately 6, 9, 13, and 18 years of age. RESULTS: Children of depressed mothers were more likely to report suicidal thoughts or behaviors than were children of well mothers (particularly the older sibling cohort). Developmental trajectories of suicidality differed for offspring of mothers with major depressive disorder and bipolar disorder. Links were found between lifetime reports of suicidality and the adolescent's mood problems (e.g., hypomanic behavior), coping strategies, and parental rejection. Also, child's and mother's suicidality were related. CONCLUSIONS: These findings have implications for planning interventions targeted at preventing suicide in youth.     

Clinical differences between suicidal and nonsuicidal depressed children and adolescents

OBJECTIVE: To examine the clinical symptoms and comorbid psychiatric disorders of depressed children and adolescents with and without clinically significant suicidal ideation. METHOD: Children and adolescents aged 7 to 17 years with current DSM-III-R major depressive disorder (MDD) (N = 135) were recruited between January 1987 and April 2002. Current MDD symptoms and lifetime comorbid psychiatric disorders were assessed using either a combination of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic and -Present Episode versions or the -Present Lifetime version. Thirty-two percent (N = 43) of the depressed subjects were classified as suicidal (at least suicidal ideation with a plan). RESULTS: Depressed suicidal youth presented with a more severe episode (p = .001) and a poorer functional status (p = .019), were more hopeless (p = .001), and presented more frequently with insomnia (p = .011). There was an interaction between suicide x sex x pubertal status for severity of MDD (p = .013), the presence of hopelessness (p < .001), poor functional status (p = .023), and comorbidity with a lifetime history of any disruptive behavior (p = .019). Among pre-pubertal depressed males, suicidal boys had significantly increased severity of MDD (p = .025) and poorer functional status (p = .044) than non-suicidal boys. Among postpubertal depressed females, suicidal girls were more frequently hopeless (p = .008) and presented an increased severity of MDD (p = .022) and more frequent lifetime history of any disruptive behavior (p = .03) when compared with nonsuicidal girls. CONCLUSION: There appears to be a sex difference for some clinical features, particularly hopelessness, among depressed suicidal children and adolescents. Whether hopelessness is a sex-specific characteristic of depressed suicidal children and adolescents requires further study.     

Amygdala and affective responses to infant pictures: Comparing depressed and non‐depressed mothers and non‐mothers

In many mammalian species, new mothers show heightened positive responsiveness to infants and their cues when they give birth. As is evident from non‐human and human studies, the amygdala is a brain region implicated in both the maternal and affective neural circuitry, and is involved in processing socioemotionally salient stimuli. In humans, infants are socially salient stimuli to women, and mothers in particular. Neuroimaging studies investigating the maternal response to infant cues have identified infant‐related amygdala function as an important factor in maternal anxiety/depression, in the quality of mothering and in individual differences in the motivation to mother. The present study investigated the effects of maternal status and depression on the subjective affective response and amygdala responsiveness to unfamiliar infants using functional magnetic resonance imaging. Smiling infant pictures were used in a 2 × 2 design comparing four groups of women: mothers and non‐mothers, with and without depression (total of 101 women: postpartum depression [PPD] = 32, non‐PPD = 25, major depression [MDD] = 15, non‐MDD = 29). We undertook an anatomically defined region of interest analysis of the amygdala response for a priori defined group comparisons. We found that mothers rated infants more positively than non‐mothers and non‐mothers rated non‐infant stimuli (scenery) more positively than mothers. In the amygdala, we found that depression elevated response to smiling unfamiliar infants in mothers but had no effect in non‐mothers. Within the depressed groups, mothers (PPD) showed an elevated amygdala response to unfamiliar smiling infants compared to depressed non‐mothers. Hence, our results indicate that women with PPD show an enhanced amygdala response to affectively positive infant pictures but not to affectively positive (but non‐salient) pictures of scenery. Women with depression outside of the postpartum period show no change in amygdala responsiveness to either stimulus categories.     

Emotional and cardiovascular reactivity to a child-focused interpersonal stressor among depressed mothers of psychiatrically ill children

Background: Impairment in maternal interpersonal function represents a risk factor for poor psychiatric outcomes among children of depressed mothers. However, the mechanisms by which this effect occurs have yet to be fully elucidated. Elevated levels of emotional or physiological reactivity to interpersonal stress may impact depressed mothers' ability to effectively negotiate child‐focused conflicts. This effect may become particularly pronounced when depressed mothers are parenting a psychiatrically ill child. Methods: The current feasibility study evaluated mothers' emotional and cardiovascular reactivity in response to an acute, child‐focused stress task. Twenty‐two depressed mothers of psychiatrically ill children were recruited from a larger clinical trial; half were randomly assigned to receive an adapted form of interpersonal psychotherapy (IPT‐MOMS), while the other half received treatment as usual (TAU). For comparison purposes, a matched sample of 22 nondepressed mothers of psychiatrically healthy children was also evaluated. Results: Depressed mothers receiving minimal‐treatment TAU displayed the greatest increases in depressed mood, heart rate, and diastolic blood pressure in response to the child‐focused stress task, and significantly differed from the relatively low levels of reactivity observed among nondepressed mothers of healthy children. In contrast, depressed mothers receiving IPT‐MOMS displayed patterns of reactivity that fell between these extreme groups. Maternal stress reactivity was associated not only with maternal psychiatric symptoms, but also with levels of chronic parental stress and maternal history of childhood emotional abuse. Conclusions: Future, more definitive research is needed to evaluate depressed mothers' interpersonal stress reactivity, its amenability to treatment, and its long‐term impact on child psychiatric outcomes. Depression and Anxiety, 2009. Published 2008 Wiley‐Liss, Inc.