Predictors of parenting stress among Malaysian mothers of children with Down syndrome

Background Having children with intellectual disability can be stressful for most parents. Currently there are very few studies focusing on parenting stress among mothers of children with Down syndrome (DS) in Asia. The present study examined the level of parenting stress experienced by Malaysian mothers of children with DS and evaluated the child and maternal factors that contributed to parenting stress based on Hill's ABC‐X Model (Hill 1949). Methods We conducted a cross‐sectional study of mothers of children with DS between the ages of 2–12 years during February–June 2008 in Kedah, a state in Peninsular Malaysia. We used self‐administered questionnaires to gather data on parenting stress, child's birth history and current behavioural problems, as well as the maternal sociodemographic characteristics, coping styles and psychological well‐being. Parental Stress Scale (PSS) was used to assess parenting stress. Measures of child's behavioural problem using Pediatric Symptom Checklist, mother's coping style using Carver et al. (1989 ) COPE inventory and their psychological well‐being using Lovibond and Lovibond (1995 ) DASS21, a scale assessing depression, anxiety and stress were also carried out. Results The 147 mothers who participated in the study had an average age of 43.1 years (SD = 7.6 years), of whom 94.6% were married, 57.1% had secondary level education and 28.6% were working outside their home. Based on PSS, mean parenting stress was 37.6 (SD = 8.1). Parenting stress was significantly higher among mothers who reported having children with behavioural problems. However, parenting stress was modified by positive coping styles and negative maternal psychological well‐being. The final model based on hierarchical regression analysis identified maternal depression and lack of acceptance as significant predictors of parenting stress rather than child's behavioural problems. Conclusion Mean parenting stress among mothers of children with DS significantly differed by behavioural problems in their children. Parenting stress is also significantly correlated with frequent use of acceptance, religious and optimist coping styles, and presence of maternal depressive, anxiety and stress symptoms. However, hierarchical regression analysis identified maternal depression and lack of acceptance of having a child with DS as the most significant predictors of parenting stress in these mothers.     

Early childhood predictors of mothers' and fathers' relationships with adolescents with developmental disabilities

Background The importance of positive parent–adolescent relationships is stressed in research on adolescents, although very little is known about this relationship when a teen has developmental disabilities (DD). We investigated the relationships of adolescents with disabilities with their mothers and their fathers in order to answer a number of questions regarding these relationships. In particular, we asked: are there differences in the relationships of mothers and fathers with their adolescent with DD? Are there early childhood predictors of the parent–teen relationship and are those based on variables that are amenable to intervention? Finally, do these predictors differ for mothers and fathers? Methods This study focused on the relationships of 72 mothers and 53 fathers with their 15‐year‐old teens with DD and their predictors from the early childhood years. Data were collected from parents through interviews and self‐administered questionnaires, and from their children with disabilities through structured assessment when children were age 3 years and again at age 15 years. Results Analyses indicated that both mother–teen and father–teen relationships were predicted by earlier parenting stress. The father–teen relationship was also predicted by early behaviour problems, but this relation was mediated by parenting stress. Socio‐economic status, type of disability and the child's level of functioning were not predictive of later relationships between parents and teens. Mothers and fathers did not differ significantly in their reports of perceived positive relationships with their teens. Conclusions The findings from this study suggest two important points of potential intervention during the early intervention years. First, parenting assistance and support to reduce stress during the early childhood years can benefit both mothers and fathers. Second, helping families and children cope with and diminish problem behaviours is likely to yield multiple advantages for parents and children and deserves emphasis in early intervention and pre‐school programmes.     

Raising trophy kids: The role of mothers' contingent self-esteem in maternal promotion of extrinsic goals

This study examined the role of mothers' child-invested contingent self-esteem, that is, their tendency to hinge their self-worth on their child's achievements, in maternal promotion of extrinsic goals, as perceived by adolescents. It was also examined whether maternal promotion of extrinsic goals would, in turn, relate to adolescents' Social Dominance Orientation (SDO). Participants were 184 mothers and their adolescent children (66% female). Maternal child-invested contingent self-esteem predicted adolescent-perceived maternal promotion of extrinsic goals, even when taking into account the variance shared between the promotion of extrinsic goals and mothers' use of a controlling parenting style. Maternal child-invested contingent self-esteem also moderated associations between mothers' personal pursuit of extrinsic goals and their promotion of those goals, such that the association between mothers' own extrinsic goals and their promotion of those goals was significant only among mothers high on child-invested contingent self-esteem. Maternal promotion of extrinsic goals was, in turn, related to adolescent SDO, suggesting that the dynamics examined in this study ultimately relate to adolescents' social and ideological development.     

Psychological variables as correlates of adjustment in mothers of children with intellectual disabilities: cross-sectional and longitudinal relationships

Background Existing research studies suggest that parenting a child with intellectual disabilities (ID) can be a stressful experience. However, there are few data addressing the question of how or why parents might experience considerable distress. In the present study, psychological variables (acceptance, mindfulness, avoidant coping) are explored that may explain some variance in maternal distress. Method Questionnaire data were gathered from mothers of children attending special schools at two time points, 18 months apart (n = 91 at Time 1; n = 57 at Time 2). In addition to measures of the child's functioning, the questionnaire pack included: a measure of acceptance of unwanted thoughts/feelings; a measure of attention to the present (mindfulness); a measure of active avoidance coping; measures of maternal anxiety, depression and stress; and a measure of mothers' positive perceptions of their child. Results In cross‐sectional analysis, acceptance was negatively associated with maternal anxiety, depression and stress, such that mothers who were generally more accepting reported fewer psychological adjustment problems. Longitudinal analysis showed that acceptance is bidirectionally related to anxiety and depression. Mindfulness was not significantly related to maternal distress, and avoidance coping was positively cross‐sectionally associated with depression only. There were no associations between psychological variables and maternal positive perceptions. Conclusions These data suggest that acceptance, in particular, may be a construct that explains some variance in maternal distress. Further research could focus on the utility of acceptance‐based interventions (e.g. Acceptance and Commitment Therapy) in the support of families with a child with ID.     

Hope as a psychological resilience factor in mothers and fathers of children with intellectual disabilities

Background Positive psychology is an area gaining credence within the field of intellectual disability (ID). Hope is one facet of positive psychology that is relatively unstudied in parents of children with ID. In the present study, we explore hope and its relationships with parental well‐being in parents of school‐aged children with ID. Method A total of 138 mothers and 58 fathers of children with ID took part in a questionnaire‐based study. Parents reported on their feelings of hope and positive affect, other dimensions of psychological well‐being (anxiety, depression and stress), and on their child's behaviour. For this study, hope was measured as a goal driven behaviour comprising two components: agency (the perception that one can reach his/her goals) and pathways (the perception that one can find alternative routes to reach these goals should the need arise). Results For mothers, regression analyses revealed that lower levels of hope (agency and pathways) and more child behaviour problems predicted maternal depression. Positive affect was predicted by less problematic child behaviour and by higher levels of hope agency. For fathers, anxiety and depression were predicted by low hope agency and positive affect was predicted by high hope agency. Hope pathways was not a significant predictor of paternal well‐being. Hope agency and pathways interacted in the prediction of maternal depression such that mothers reporting high levels of both hope dimensions reported the lowest levels of depressive symptoms. Conclusions Hope is a construct that merits further investigation within families research, and is potentially a factor that could be utilised in intervention to help increase familial well‐being.     

Coping strategies,caregiving burden,and depressive symptoms of Taiwanese mothers of adolescents with autism spectrum disorder

Little research focuses on the caregiving experiences of Taiwanese mothers of adolescents with autism spectrum disorder (ASD). The effects of the caregiving burden and coping strategies on the depressive symptoms of 60 of these mothers were examined. The adolescents they cared for ranged from 10 to 19 years old (mean age: 14.7 years). Mothers completed self-report written questionnaires. Findings indicated that greater use of problem-focused rather than emotion-focused coping was generally associated with lower levels of caregiver burden and fewer depressive symptoms. Problem-focused coping acted as a buffer when caregiving burdens were high. Specifically, actively confronting, planning, and suppressing competing activities as coping strategies moderated the effect of the caregiving burden on the depressive symptoms of these mothers. This significant buffering effect reflected adaptation to the caregiving burden. Awareness of the effects of coping strategies on maternal well-being could serve as a valuable guide for practitioners.     

Coping,distress, and well-being in mothers of children with autism

As is the case in stress research generally, studies examining the relationship between coping and mental health outcomes in parents of children with autism frequently classify parental coping methods as being either problem- or emotion-focused. We argue that this dichotomization of coping strategies oversimplifies the way parents respond to their child's autism. In the present study, the coping methods employed by 113 mothers of children with autism were investigated using the Brief COPE (Carver et al., 1989). Exploratory factor analysis of Brief COPE subscales identified four reliable coping dimensions: engagement coping, distraction coping, disengagement coping, and cognitive reframing coping. In addition, using multiple regression, we examined the relationship of coping strategies to negative and positive maternal outcomes (depression, anger, and well-being). In general, maternal use of avoidant coping (distraction and disengagement) was found to be associated with increased levels of maternal depression and anger, while use of cognitive reframing was associated with higher levels of maternal well-being. In several instances, child characteristics, particularly severity of child maladaptive behavior, moderated the effect of coping on maternal outcomes. Study findings are discussed in light of previous research in the area; in addition, study limitations and clinical implications are highlighted.     

Fathers' and mothers' perceptions of their child and maternal depressive symptoms

Fathers' reports concerning their children have seldom been considered in the previous studies on maternal depression and child development. The literature on parental reports in general suggests that discrepancies in mothers' and fathers' perceptions are associated with the psychological state of the parent and the gender of the child. As part of a prospective follow-up study, fathers' and mothers' perceptions of children's social competence and behavioural/ emotional problems were assessed by the Child Behavior Checklists (CBCLs) when the firstborn children were 8–9 years old. The depressive symptoms of the mothers were screened by the Edinburgh Postnatal Depression Scale (EPDS) at the same time point. The level of children's social competence and behavioural/emotional problems reported by the fathers were analysed by background factors. The reports of both parents were explored by the gender of the child and by the presence of maternal depressive symptoms. The concordance of parental reports concerning child's social competence was high, but fathers usually reported lower problem levels than mothers, particularly for boys' problems. The presence of maternal depressive symptoms was associated with child's high problem levels from both fathers' and mothers' perspective. Parental ratings of children's externalizing problems in particular were associated with high maternal depressive symptom level.     

Theory-driven development of a mobile phone supported intervention for adolescents with perinatal depression

Purpose

This paper describes the design of a theory-informed pragmatic intervention for adolescent perinatal depression in primary care in Nigeria.

Methods

We conducted Focus Group Discussions (FGDs) among 17 adolescent mothers and 25 maternal health care providers with experience in the receipt and provision of care for perinatal depression. The Consolidated Framework for Implementation Research (CFIR) was used to systematically examine the barriers and facilitators affecting adolescent mothers' use of an existing intervention package for depression. The Theoretical Domain Framework (TDF) and the Capability, Opportunity, Motivation, Behaviour (COM-B) model were used to analyze the results of the data across the five CFIR domains.

Results

FGD analysis revealed that care providers lacked knowledge on approaches to engage young mothers in treatment. Young mothers had poor treatment engagement, low social support, and little interest in parenting. A main characteristic of the newly designed intervention is the inclusion of age-appropriate psychoeducation supported with weekly mobile phone calls, to address treatment engagement and parenting behaviours of young mothers. Also in the outer setting, low social support from relatives was addressed with education, “as need arises” phone calls, and the involvement of "neighborhood mothers”. In the inner settings, care providers’ behaviour is addressed with training to increase their capacity to engage young mothers in treatment.

Conclusion

A theory-based approach helped develop an age-appropriate intervention package targeting depression and parenting skills deficit among perinatal adolescents in primary maternal care and in which a pragmatic use of mobile phone was key.

     

Maternal parenting styles and mother–child relationship among adolescents with and without persistent attention-deficit/hyperactivity disorder

We investigated mothering and mother–child interactions in adolescents with and without persistent attention-deficit/hyperactivity disorder (ADHD) in a sample of 190 adolescents with persistent DSM-IV ADHD, 147 without persistent ADHD, and 223 without ADHD. Both participants and their mothers received psychiatric interviews for diagnosis of ADHD and other mental disorders; and reported on the Parental Bonding Instrument about mother's parenting style, the Social Adjustment Inventory for Children and Adolescents for interactions with mothers and home behavioral problems. The mothers also reported on their ADHD and neurotic/depressive symptoms. Our results based on both informants showed that both ADHD groups obtained less affection/care and more overprotection and control from the mothers, and perceived less family support than those without ADHD. Child's inattention and comorbidity, and maternal depression were significantly correlated with decreased maternal affection/care and increased maternal controls; child's hyperactivity–impulsivity and maternal neurotic trait were significantly correlated with maternal overprotection; and child's inattention and comorbidity, and maternal neurotic/depressive symptoms were significantly correlated with impaired mother–child interactions and less family support. Our findings suggested that, regardless of persistence, childhood ADHD diagnosis, particularly inattention symptoms and comorbidity, combining with maternal neurotic/depressive symptoms was associated with impaired maternal process.     

Paternal versus maternal coping styles with child diagnosis of developmental delay

Parents of children with disabilities vary in their reaction to their children's diagnosis. The current study focused on fathers in addition to mothers and examined their resolution and coping styles when having children diagnosed with developmental delay (DD). Sixty-five fathers and 71 mothers were interviewed using the reaction to the diagnosis interview (RDI; Pianta & Marvin, 1992a). Results indicated that the majority of parents were unresolved with their child's diagnosis, with no differences found between fathers’ and mothers’ rates of resolution. Furthermore, both parents of children that were diagnosed at a later age and parents that were less educated tended to be unresolved, as did fathers of a lower socioeconomic status. Older age of both children and mothers was related to maternal lack of resolution. Finally, an in-depth examination revealed significant differences in the manner in which fathers and mothers cope with their children's diagnosis: whereas mothers were more prone to using an emotional coping style, fathers tended to use a cognitive coping style. The clinical implications of paternal versus maternal coping styles are discussed.     

The well-being of mothers of adolescents with developmental disabilities in relation to medical care utilization and satisfaction with health care

Parents of children with disabilities have been found to be more likely to experience stress and depressive symptoms than parents of typically developing children as a result of the increased challenges inherent in their parenting role. This study investigated the utilization of and satisfaction with adolescent health care services reported by mothers and their relation to maternal well-being. Participants included 73 mothers and their adolescents with developmental disabilities who had been recruited as infants and toddlers from early intervention programs to participate in a longitudinal investigation, the Early Intervention Collaborative Study. Data were collected through parent reports and structured assessments with adolescents. Regression analyses were conducted to test whether utilization and maternal satisfaction with care related to maternal depressive symptoms or parenting stress after controlling for child and family characteristics. The results demonstrated that both utilization and maternal satisfaction with health care added unique variance in predicting lower levels of maternal stress and depressive symptoms.     

Family burden,child disability,and the adjustment of mothers caring for children with epilepsy: Role of social support and coping

PurposeThis study was designed to contribute to the existing research on the coping behaviors, social support, and mental health outcomes in parents of children with epilepsy in the United States.MethodsParticipants included 152, predominantly Caucasian (89.5%), married (78.9%) women (95.4%). Via a web-based interface, mothers completed questionnaires assessing the impact of their child's disability on their family (i.e., severity of their child's disability, family burden, and personal stress), social resources (i.e., perceived social support), coping (i.e., emotion-focused and social support seeking), and adjustment (i.e., depression and anxiety).ResultsAfter controlling for demographic variables, mediational analysis revealed that mothers' perceptions of the severity of their child's disability were associated with decreased perceived social support, which was then related to higher reported levels of depression and anxiety. Similarly, low levels of perceived social support partially mediated the relation between family burden and depression, anxiety, and stress. Finally, mothers' perceptions of the severity of their children's disability and family burden were unrelated to their reports of emotion-focused or social support seeking coping. However, their use of emotion-focused and social support seeking behaviors was related to lower levels of depression.ConclusionLow levels of perceived social support may help to explain the mechanisms underlying the relation between mothers' perceptions of the severity of their child's disability and family burden on their mental health adjustment, such as depression and anxiety.     

Applied behaviour analysis: does intervention intensity relate to family stressors and maternal well‐being?

Background Interventions based on applied behaviour analysis (ABA) are commonly recommended for children with an autism spectrum disorder (ASD); however, few studies address how this intervention model impacts families. The intense requirements that ABA programmes place on children and families are often cited as a critique of the programme, although little evidence is available to support this claim. Using Pearlin's (1999) stress process model, this study assessed: (1) whether mothers of children participating in a home‐based ABA programme reported elevated depressive symptoms; and (2) whether ABA intensity related to unmet family needs and maternal feelings of depression, personal strain and mastery. Method Forty‐one mothers of children diagnosed with an ASD participated in this study by completing questionnaires about their child's ASD behaviours, unmet family needs, and maternal feelings of depression, personal strain and mastery. Additionally, mothers provided information about their child's intervention programme and their own level of involvement in the programme. At the time of data collection, all families had been running a home‐based ABA programme for at least 6 months. Results Single‐sample t‐tests and multiple regression analyses were used to test the proposed hypotheses. Mothers of children participating in a home‐based ABA programme reported more depressive symptoms than mothers of children with other developmental disabilities. Comparisons revealed comparable depressive symptoms between the mothers of the present sample and those in other ASD samples. When considering weekly ABA intensity, mothers reported fewer depressive symptoms when their child was older and when their child participated in more ABA therapy hours. Conversely, mothers who were more involved in their child's ABA programme reported more personal strain. Conclusions The findings of this study supported the hypothesis that families participating in ABA experienced elevated depressive symptoms, much like any family raising a child with an ASD, suggesting a potential area for family‐level intervention. Additionally, ABA intensity related to maternal depression and personal strain, and therefore deserves continued attention. Future studies should attempt to replicate these findings with a larger and more representative sample and seek to identify mechanisms through which ABA intensity may influence maternal and family well‐being.     

Predictors of depressive symptoms in primary caregivers of young children with or at risk for developmental delay

Background Despite extensive research with families raising children with or at risk for developmental delay (DD), it is not clear whether primary caregivers of these children are at increased risk for depressive symptoms. Discrepant findings in the literature may be owing to heterogeneity of child problems. More research is needed on child, parent and family variables that may increase risk for, or resilience to, caregiver depressive symptoms. Some studies have found that parental resources (e.g. social support and coping strategies) may buffer the effects of parental distress, while other studies have highlighted the role of parental self‐efficacy. Methods We examined Beck Depression Inventory (BDI) scores in 178 primary caregivers (mainly biological mothers) who had 2‐year‐old children with or at risk for DD owing to: (a) low birthweight, prematurity or multiple birth (n = 58), (b) other known reasons (e.g. Down syndrome, spina bifida) (n = 67), or (c) unknown reasons (n = 69). Results We found that 20% (n = 35) of the caregivers scored above the BDI clinical cut‐off for depression. Analysis of variance revealed that caregivers with elevated BDI scores had higher child behaviour problem and escape‐avoidance coping scores, and lower social support and parent self‐efficacy, compared with caregivers without depressive symptoms. Caregivers with children who had DD for unknown reasons had higher BDI scores than caregivers of the other two groups of children. Regression analyses showed that child behaviour problems, escape‐avoidance coping strategies and social support predicted caregiver BDI scores, but caregiver self‐efficacy only did so when entered independently of social support. Only social support mediated and (marginally) moderated the relationship between child behaviour problems and caregiver depressive symptoms. Conclusions These findings suggest that early intervention programmes should carefully consider the interaction of child characteristics (e.g. Diagnosis and behaviour problems), caregiver resources (e.g. coping strategies and social support), and parental mental health and mood when planning and tailoring services for families of children with or at risk for DD.     

Resilience and the course of daily parenting stress in families of young children with intellectual disabilities

Background Parenting stresses have consistently been found to be higher in parents of children with intellectual disabilities (ID); yet, some families are able to be resilient and thrive in the face of these challenges. Despite the considerable research on stress in families of ID, there is still little known about the stability and compensatory factors associated with everyday parenting stresses. Methods Trajectories of daily parenting stress were studied for both mothers and fathers of children with ID across child ages 36–60 months, as were specific familial risk and resilience factors that affect these trajectories, including psychological well‐being of each parent, marital adjustment and positive parent–child relationships. Results Mothers' daily parenting stress significantly increased over time, while fathers' daily parenting stress remained more constant. Decreases in mothers' daily parenting stress trajectory were associated with both mother and father's well‐being and perceived marital adjustment, as well as a positive father–child relationship. However, decreases in fathers' daily parenting stress trajectory were only affected by mother's well‐being and both parents' perceived marital adjustment. Conclusions Parenting stress processes are not shared entirely across the preschool period in parents of children with ID. Although individual parent characteristics and high‐quality dyadic relationships contribute to emerging resilience in parents of children with ID, parents also affect each others' more resilient adaptations in ways that have not been previously considered.     

It takes two! Exploring sex differences in parenting neurobiology and behaviour

Parents lay the foundation for their children's socio‐emotional experiences by sensitively responding to their needs. The hormonal and neurobiological changes that occur during the transition to parenthood importantly contribute to the parents’ caregiving behaviour toward their children. Much research has emphasised the relationship between the mother, who is most often the primary caregiver, and her infant, with less focus on the role of fathers in child development. However, recent accounts have suggested that fathers also play an important role in promoting the health, development and psychosocial wellbeing of their children. Evidence from the behavioural literature has indicated that there are significant differences between typical mother‐infant versus father‐infant interactions. The current review aims to outline differences between maternal and paternal caregiving by discussing the differences in their biological mechanisms. First, we focus on the different hormones that are correlated with sensitive parenting behaviours in mothers and fathers. Next, we discuss the differences between neural bases of motherhood and fatherhood. Lastly, we discuss ways in which parental hormones, parental brain and parental exposure to infant cues interact to shape parental caregiving behaviour. In summary, this review highlights the distinct but complementary nature of maternal and paternal caregiving.     

The role of meta-cognition and parenting in adolescent worry

In the meta-cognitive model of worry, positive, and negative beliefs about worry interact to make worry problematic. These beliefs have been found to be associated with anxiety in adolescents, but it is unknown whether they are associated with worry. Furthermore, it may be via cognitive mechanisms such as these, or directly through behavior, that parents influence their child's worry. The current study aimed to explore whether adolescent meta-cognition and parenting behaviors and meta-cognitions were associated with adolescent worry. Results indicated that meta-cognitions were specifically associated with worry in adolescents, but there was little evidence that parenting was. Parental worry on the other hand was associated with both parent and child reported parenting. It is concluded that the meta-cognitive model of worry may be relevant in adolescents, but that further research is required to explore how parents influence adolescent worry.     

Personality, coping style and well-being of parents rearing children with developmental disabilities

Background Parents with children with developmental disabilities (DD) encounter a variety of stressors associated with rearing their children and must develop effective coping mechanisms in order to adapt successfully to these challenges. Previous research has failed to establish the role of parental individual differences in the reported use of different coping strategies. The current study explores parental personality and whether children with DD were adopted or born into the families and their influence on the coping strategies used by mothers and fathers. Methods A total of 97 mother–father dyads rearing at least one child with DD were participants. They narrated stressful situations related to their child and completed the Ways of Coping Questionnaire twice. Data were also collected with regard to personality, depression and subjective well‐being (SWB). Results Both adoptive and birth mothers and fathers used more problem‐focused than emotion‐focused strategies. Personality factors, Neuroticism especially, were predictive of coping strategy use. Higher levels of Positive Reappraisal were associated with higher levels of SWB, whereas higher levels of Escape‐Avoidance were associated with lower levels of SWB, but only for mothers. Results were consistent with a dispositional model of strategy use in that frequency of use was associated with personality characteristics, was consistent over time, and for different children in the same families. Future research should focus on the persistence of the associations between strategy use and well‐being and whether they hold true at different stages of the lifespan when coping contexts may change quite dramatically.     

Associations between adolescent depression and parental mental health, before and after treatment of adolescent depression

The negative impacts of parental mental health problems on children and adolescents are well known, but the relationship between a child’s depression and their parents’ health is not so well understood. Being a carer/parent of someone with mental illness can be associated with negative outcomes for the caregiver. This paper reports the associations between the mental health of adolescents with major depression and their parents, before and after treatment of the adolescent’s depression. Data were collected as part of the Adolescent Depression Antidepressants and Psychotherapy Trial, a randomised controlled trial of selective serotonin reuptake inhibitors with and without cognitive behaviour therapy in 208 clinic-recruited adolescents with major depression. The baseline severity of depression in the adolescent was significantly associated with both maternal and paternal mental health (as rated by the General Health Questionnaire). This effect was not confounded by other psychiatric symptoms. The degree of improvement in parental and child mental health was positively correlated across time. Our results support the hypothesis that there is a significant association between parental mental health and adolescent depressive symptoms. This study was not able to establish the direction of this association. In clinical practice, the findings demonstrate the importance of considering the mental health of the parents when treating depressed adolescents.