Psychiatr News April 21, 2006
Volume 41, Number 8, page 44
© 2006 American Psychiatric Association
Child's Symptoms Abate When Mother's Depression Remits
Eve Bender
Children experienced vicarious clinical improvement when their depressed
mothers improved during three months of treatment.
Children benefited from successful depression treatment of a group of
mothers who experienced remission within several months of treatment, a new
study has found. Moreover, children of mothers who remained depressed actually
developed new psychiatric problems in some cases.
"These findings are intriguing because they suggest that an
environmental influence had a measurable impact on the child's
psychopathology," the authors wrote in the March 22/29 Journal of
the American Medical Association.
Researchers speculated that maternal depression contributes to a stressful
home environment, which can increase the rates of depression and other
disorders in children who may already be genetically vulnerable to developing
mental health problems.
Lead author Myrna Weissman, Ph.D., and colleagues found an overall 11
percent decrease in rates of psychiatric disorders in children of mothers who
experienced remission after treatment. Weissman is a professor of epidemiology
and psychiatry at Columbia University Medical Center and chief of the
Department of Clinical-Genetic Epidemiology at New York State Psychiatric
Institute.
In contrast, there was an 8 percent increase in rates of psychiatric
diagnoses for children whose mothers continued to experience depressive
symptoms.
Weissman told Psychiatric News that she has long been interested
in studying the effects of parental depression on children.
"Children of depressed parents have very high rates of depression and
other mental health problems," which continue into adulthood, she noted.
"If you can impact the child by treating the parent, you'd have a
twofer."
Weissman chose to study mothers with depression instead of fathers because
depression is more prevalent among women, and more women seek treatment, but
she emphasized that either parent's depression can negatively impact
children.
She studied 151 mother-child pairs who were part of the Sequenced Treatment
Alternatives to Relieve Depression (STAR*D) trial, which was conducted between
December 2001 and April 2004 among more than 4,000 people in primary care and
outpatient psychiatric settings at a number of sites across the country (see
page 42).
The mothers who agreed to be part of Weissman's study had children between
the ages of 7 and 17 and received three months of treatment with citalopram at
eight primary care and 11 psychiatric clinics across the country. Researchers
earlier established a diagnosis of depression using a symptom checklist based
on DSM-IV and measured the severity of mothers' depression using the
Hamilton Depression Rating Scale (HAM-D).
Children in the study were evaluated for psychiatric disorders at the
beginning of the study and after their mothers took citalopram for three
months. Researchers used the Kiddie Schedule for Affective Disorders and
Schizophrenia–Present and Lifetime Version, the Child Behavioral
Checklist (parent report), and the Child Global Assessment Scale to assess
psychiatric illness and functioning in children.
At baseline, 37 of the 151 children had a psychiatric disorder, such as
depression (10 percent), anxiety (16 percent), or a disruptive behavior
disorder (22 percent).
Of the 114 mothers who were assessed after three months of treatment with
citalopram, 33 percent (38) met remission criteria and 47 percent (54)
responded to treatment, defined as a 50 percent or greater reduction of
symptoms as measured by the HAM-D.
Among children whose mothers' depression remitted, one-third of the
children experienced remission during the three-month study period.
Weissman found an 11 percent drop in the rates of psychiatric disorders
among children of mothers who experienced remission from depression. At
baseline, 35 percent (12) of the children had a psychiatric diagnosis, and
after three months 24 percent (eight) of children did.
Among children of mothers who experienced continuing depression, the rate
of psychiatric disorders increased from 35 percent to 43 percent.
According to the article, 68 of the children had no psychiatric diagnosis
at baseline. Among children with no baseline diagnosis with mothers who
remitted (22), all remained diagnosis free at the three-month assessment.
However, among children with no baseline diagnosis but with mothers who did
not remit, 17 percent (eight) developed a new psychiatric disorder or
experienced a recurrence of symptoms from a previously diagnosed disorder.
Weissman found mothers' depressive symptoms had to decrease by at least 50
percent for there to be a reduction in children's psychiatric symptoms.
There are a few limitations to the study. "The use of a single
antidepressant in an open-trial design without a placebo control did not allow
us to rule out that maternal remission was due to nonspecific treatment
effects," the authors wrote, "or whether the relation of maternal
remission to children's outcomes may have been different if another medication
or psychotherapy had been used."
In regard to the association between maternal remission from depression and
reduced child psychopathology, Weissman speculated that the mothers' remission
from depression brought about improvement in children that, in turn, further
impacted the mothers in a positive way.
The study's findings add a new urgency to the importance of finding
depression treatments that work, according to experts.
"One of the most creative aspects of this study is the assessment of
the impact of a remission of depression in mothers on the mental health of
their children," Darrel Regier, M.D., M.P.H., told Psychiatric
News. "It brings home the enormous public health impact of
successful treatment for this illness." Regier is director of the
American Psychiatric Institute for Research and Education and APA's Division
of Research.
Weissman is currently following the sample to track clinical outcomes in
children of mothers who achieve remission after three months of treatment.
The study was funded by the National Institute of Mental Health.
An abstract of "Remissions in Maternal Depression and Child
Psychopathology" is posted at
<http://jama.ama-assn.org/cgi/content/short/295/12/1389>.
JAMA 2005 295 1389
Related Article:
-
For Nonremitting Depression, Add Rather Than Switch
- Jim Rosack
Psychiatr News 2006 41: 42-56.
[Full Text]
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