Family functioning in adolescents at high and low risk for major depressive disorder

The reciprocal relationship between depression, social anxiety and aggression in Chinese adolescents: The moderating effects of family functioning

BACKGROUND

Depression, social anxiety, and aggression often co-occur in adolescents. Several theoretical models have been proposed to explain the temporal relationships of these symptoms, with relevant empirical evidence mixed. The role of environmental factors should be taken into consideration.

OBJECTIVES

To examine the temporal relationship between depression, social anxiety, and aggression in adolescents, and to extend previous work by exploring the moderating effects of family functioning.

METHOD

A total of 1947 Chinese adolescents completed the survey questionnaires at two time points: family functioning at baseline, and depression, social anxiety, and aggression at baseline and 6-month follow-up. Data was analyzed using a cross-lagged model.

RESULTS

Bidirectional positive association was found between depression and aggression. However, although social anxiety predicted subsequent depression and aggression, the opposite relationship was not found. Moreover, favorable family functioning alleviated depression and moderated the prediction of social anxiety to depression.

CONCLUSIONS

Findings suggested that clinicians should pay attention to the underlying depressive symptoms of adolescents with aggressive behaviors, and to the level of aggression of adolescents with depression. Interventions on social anxiety may prevent the transformation of social anxiety to depression and aggression. Adaptive family functioning may act as a protective factor for the comorbid depression in adolescents with social anxiety, which can be targeted by relevant interventions.

Characteristics and related factors of family functioning in Chinese families during early pregnancy

Introduction

Family functioning has been found to significantly impact each family member's health mentally, physically, and socially. A number of the research has focused on the impact of impaired family functioning in general, but limited studies explore family functioning in the vulnerable period, early pregnancy. Therefore, the study aimed to investigate the characteristics and related factors in Chinese females and partners during early pregnancy.

Methods

The cross-sectional study enrolled 226 pregnant women and 166 partners. Assessment tools included the McMaster Family Assessment Device (FAD), Edinburgh Postnatal Depression Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, Social Support Rating Scale, and Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form. Correlation analysis was applied to investigate the related factors.

Results

In the present study, FAD-Behavior Control (BC) was the only dysfunctional dimension and had the highest dysfunctional rates than other dimensions. Length of time living with a partner, depressive and anxious symptoms, and quality of life were all associated with the dysfunctional family functioning of BC.

Conclusions

The study reinforced the important clues of family functioning during early pregnancy. Also, it provided new entry points for the general population and healthcare providers to minimize the negative impact that impaired family function might bring to a family.

Symptom Checklist-90-Revised: A structural examination in relation to family functioning

The accurate assessment of psychopathological behaviours of adolescents and young adults is imperative. Symptom Checklist-90-Revised (SCL-90-R) is one of the most comprehensive and widely used scales addressing this purpose internationally. Interestingly, associations between the different SCL-90 symptoms and family functioning have been highlighted. Nevertheless, the scale’s factorial structure has often been challenged. To contribute in this area, this study scrutinizes the psychopathological dimensions of the Symptom Checklist-90-Revised (SCL-90-R) in a large cohort of high school students (Mean age = 16.16; SD = .911) from Greece. It addresses this aim by: a) using first order and bi-factor confirmatory factor analysis, and exploratory structural equation models and; b) investigating the factors’ associations with family functioning. A total of 2090 public Greek High School students completed the SCL-90-R and the Family Adaptability and Cohesion Scale IV (FACES-IV) covering family functioning, satisfaction and communication. Six different solutions, yielded by separate permutations of CFA, ESEM, and bifactor models, were evaluated. Based on global fit, the clarity, reliabilities and the family functioning links of the dimensions in the models, the ESEM oblique model with the theorized nine factors emerged as the optimum. This model had adequate fit, and symptom dimensions were well defined. Also six of the nine factors demonstrated external associations with family functioning, satisfaction and communication. The clinical assessment benefits of these results are discussed.

Family functioning and 1-year prognosis of first-episode major depressive disorder

This study aims at investigating the characteristics of family functioning in Chinese first-episode major depressive disorder (FE-MDD) patients and its relationship with major depressive episode (MDE) duration. We recruited 63 FE-MDD families and 59 healthy comparison (HC) families from WuHan Mental Health Center and its nearby communities from September 2014 to August 2016. Family functioning was assessed by the Chinese version of Family Assessment Device (FAD). After baseline assessment, MDD patients were followed-up monthly for one year. Independent t test and Pearson correlation analysis were respectively used to compare the family functioning of MDD and HC families and to assess the relationship between family functioning and MDE duration. Our results showed that MDD families exhibited family impairment in all the 7 sub-scales of FAD. MDD patients with "healthy family functioning" showed significantly shorter MDE duration than those with "unhealthy family functioning". MDE duration was positively correlated with the score of problem solving (PS), communication (CM) and general functioning (GF) subscales. These findings indicate that Chinese MDD families are associated with a wide range of family impairments and family functioning is linked to the MDE duration. Improvement of family functioning may be helpful for the recovery of MDD.

Family functioning as perceived by parents and young offspring at high and low risk for depression

BACKGROUND

Family dysfunction has been proposed as one of the environmental mechanisms whereby risk of depression is transmitted from mothers to their children. Using our sample of offspring at high and low familial risk for depression, we hypothesized that: a) high-risk offspring (n = 79) and their mothers will report more extensive family dysfunction than low-risk offspring (n = 82) and their mothers, b) family dysfunction will predict the extent of offspring's depressive symptoms, and c) family dysfunction will mediate the impact of mother's depression on offspring's depressive symptoms.

METHODS

The study enrolled 161 offspring of parents who, in a previous study, were ascertained to have either childhood onset mood disorder or no history of a major psychiatric disorder. Parents completed questionnaires and a clinical interview about themselves, their offspring, and the family, while offspring also completed questionnaires about themselves and the family.

RESULTS

We found support for all three hypotheses. The significant indirect effect between maternal depression and offspring depressive symptoms was driven primarily by offspring's, but not mothers', reports of family dysfunction.

LIMITATIONS

Although our assessment of mother's early history of depression was done in a previous study, it is important to note that our results do not inform about causality because of the present study's cross-sectional nature.

CONCLUSIONS

The results highlight the importance of detecting and treating family dysfunction, particularly via offspring report, as one way to lower the risk of depression transmission from mothers to their children.

Family and Individual Risk and Protective Factors of Depression among Chinese Migrant Children with Oppositional Defiant Disorder Symptoms

Migrant children reached 35.81 million in China and were vulnerable to serious emotional problems including depression. The present study aimed to identify the family and individual risk and protective factors for depression in an at-risk sample of Chinese migrant children. Participants were 368 children (9.47 ± 1.46 years old, 73.4% boys) who had at least one symptom of Oppositional Defiant Disorder symptoms (ODD) and their parents in Mainland China. Risk and protective factors within both family (i.e., family maltreatment and family functioning) and individual (i.e., automatic thoughts and resilience) perspectives. Family maltreatment and negative automatic thoughts served as risk factors in relation to children's depression. Further, automatic thoughts mediated the relationship between family maltreatment and children's depression. Family functioning (cohesion, but bot adaptability) and individual resilience could buffer the effects of risk factors in the Structure Emotion Model such that both cohesion and resilience moderated the relationship between family maltreatment and children's automatic thoughts only. Our findings highlighted the urgent need to decrease risk factors and increase protective factors of both family and child individual characteristics in prevention and intervention depression among migrant children with ODD symptoms in China.

Family functioning mediates the association between parental depression and low self-esteem in adolescents

BACKGROUND

The negative impact of parental depression on offsprings' development has been repeatedly documented. There is however little research on the potential pathways contributing to this association. The present study examined the relationship between parental depressive disorders, family functioning and adolescents' self-esteem.

METHODS

A community-based sample of 1040 participants aged 14-17 years and their parents was assessed including direct and indirect information on parental psychopathology based on the Munich-Composite International Diagnostic Interview (M-CIDI). Family functioning and youth self-esteem were assessed by self-report questionnaires using the McMaster Family Assessment Device (FAD) in parents and the "Aussagen-Liste zum Selbstwertgefühl" in adolescents.

RESULTS

Findings from multiple regression analyses indicated positive associations between parental depressive disorders and dimensions of dysfunctional family functioning as well as between dysfunctional familial affective involvement and youth's positive self-esteem. The relationship between parental depression and self-esteem was partly mediated by familial affective involvement.

LIMITATIONS

Associations may be underestimated, since incidence for depressive disorders spans to the third decade of life. Consensus diagnoses for parental depressive disorders were based on direct and indirect information for maximum use of available data, neglecting familial load, chronicity of parental depressive disorders or comorbid conditions. Thus, specificity of the findings for the family transmission of depressive disorders remains yet to be determined.

CONCLUSIONS

Findings contribute to understanding of the pathways on how parental depression impairs offsprings' view of themselves, and to consider family functioning as a possible target for preventive interventions.

Perceived family functioning, adolescent psychopathology and quality of life in the general population: a 6-month follow-up study

PURPOSE

The aim of the study was to investigate whether perceived family functioning of adolescent is moderating or mediating the longitudinal association of adolescent internalizing and externalizing psychopathology with quality of life (QoL) after 6 months in the general population.

METHODS

Using a cluster sampling technique in one Norwegian county 1331, 10- to 16-year-old students were included in the study (51 % girls). Parents completed the Child Behavior Checklist for the assessment of adolescent psychopathology at Time 1. The students completed the General Functioning Scale of the McMaster Family Assessment Device and the Inventory of Life Quality in Children and Adolescents at time 2 6 months later. Psychopathology, family functioning and QoL were treated as latent variables in a structural equation model adjusted for sex, age and parent education.

RESULTS

The regression coefficients for paths from psychopathology decreased (β = .199 for the internalizing and β = .102 for the externalizing model) in each case when including the indirect path via family functioning compared with the direct path from psychopathology to QoL. The sum of indirect effects on QoL via family functioning was significant for internalizing β = 0.093 (95 % CI 0.054-0.133) and externalizing β = 0.119 (95 % CI 0.076-0.162) psychopathology.

CONCLUSIONS

Family functioning significantly mediated the longitudinal association between psychopathology and QoL. Because the family remains an important social domain for adolescents, it must be an important consideration when attempting to reduce or alleviate psychopathology in youth and improve the quality of their life experience throughout this period.

The role of the mother-child relationship for anxiety disorders and depression: results from a prospective-longitudinal study in adolescents and their mothers

This study aims to examine whether (a) low child valence (emotional connectedness) within the mother-child relationship increases the risk for offspring depression, (b) low child potency (individual autonomy) increases the risk for offspring anxiety, and (c) maternal psychopathology pronounces these associations. We used data from a prospective-longitudinal study of adolescents (aged 14-17 at baseline) and their mothers (N = 1,015 mother-child dyads). Anxiety disorders and depression were assessed repeatedly over 10 years in adolescents (T0, T1, T2, T3) and their mothers (T1, T3) using the DSM-IV/M-CIDI. Valence and potency were assessed in mothers (T1) with the Subjective Family Image Questionnaire. Odds ratios (OR) from logistic regression were used to estimate associations between low child valence/potency and offspring psychopathology (cumulated lifetime incidences; adjusted for sex and age). In separate models (low valence or low potency as predictor), low child valence predicted offspring depression only (OR = 1.26 per SD), while low child potency predicted offspring anxiety (OR = 1.24) and depression (OR = 1.24). In multiple models (low valence and low potency as predictors), low child valence predicted offspring depression only (OR = 1.19), while low child potency predicted offspring anxiety only (OR = 1.22). Low child potency interacted with maternal anxiety on predicting offspring depression (OR = 1.49), i.e. low child potency predicted offspring depression only in the presence of maternal anxiety (OR = 1.33). These findings suggest that low child valence increases the risk for offspring depression, while low child potency increases the risk for offspring anxiety and depression and interacts with maternal psychopathology on predicting offspring depression.

Family functioning in depressed and non-clinical control families

BACKGROUND

Existing studies of depression and family functioning have used western samples to examine how depression and impaired family functioning are related, and to explore levels of discrepancy between depressed patients and their family members. The purpose of the current study is to explore these questions in a Chinese sample.

METHOD

This study examined the association between family functioning and depression in a Chinese sample of 60 depressed patients and their family members and 60 non-clinical controls and their family members. The study evaluated levels of agreement between family members on a self-report measure of family functioning (Family Assessment Device) using reliability statistics. It also compared families' self-reported family functioning to that of a trained observer using an observational rating scale (McMaster Clinical Rating Scale).

RESULTS RESULT

s indicate poorer family functioning among Chinese families with a depressed family member, high to moderate agreement between patients and family members, moderate to low agreement between non-clinical participants and their family members, and moderate correlations between subjective and objective ratings of family functioning in a mainland Chinese sample.

CONCLUSIONS

As in other cultures, depression is associated with impaired family functioning in Chinese families. There is good agreement between family members and a trained evaluator about the family impairments. The Family Assessment Device and the McMaster Clinical Rating Scale are useful for assessing family functioning in Chinese families.

Family functioning assessed by self-reported and observer-reported ratings of depressed patients and their partners

This study explored subjectively perceived and objectively rated family dysfunction using the self-report Family Assessment Device (FAD) and observer-rated McMaster Clinical Rating Scale (MCRS), respectively. Perceived differences in family functioning ratings between 86 depressed patients and their partners and the degree of agreement between the subjective and objective rating scales were analyzed. There were significant correlations for perceived family functioning between the patients and their partners. There were moderate to significant correlations between patients' perceptions on five of the seven dimensions of the FAD (excluding problem solving and roles) and those dimensions of the MCRS. Findings showed moderate to significant correlations between six dimensions of the FAD and MCRS, excluding problem solving. Results on the FAD and MCRS were significantly correlated and considered equivalent. This suggests that these two instruments can be used individually or in combination to provide a comprehensive understanding of family functioning of couples with a depressed partner.

Outcomes of a randomized study of a peer-taught Family-to-Family Education Program for mental illness

OBJECTIVE

The Family-to-Family Education Program (FTF) is a 12-week course offered by the National Alliance on Mental Illness (NAMI) for family members of adults with mental illness. This study evaluated the course's effectiveness.

METHODS

A total of 318 consenting participants in five Maryland counties were randomly assigned to take FTF immediately or to wait at least three months for the next available class with free use of any other NAMI supports or community or professional supports. Participants were interviewed at study enrollment and three months later (at course termination) regarding problem- and emotion-focused coping, subjective illness burden, and distress. A linear mixed-effects multilevel regression model tested for significant changes over time between intervention conditions.

RESULTS

FTF participants had significantly greater improvements in problem-focused coping as measured by empowerment and illness knowledge. Exploratory analyses revealed that FTF participants had significantly enhanced emotion-focused coping as measured by increased acceptance of their family member's illness, as well as reduced distress and improved problem solving. Subjective illness burden did not differ between groups.

CONCLUSIONS

This study provides evidence that FTF is effective for enhancing coping and empowerment of families of persons with mental illness, although not for reducing subjective burden. Other benefits for problem solving and reducing distress are suggested but require replication.

Outcome of adolescent depression: 6 months after treatment

OBJECTIVE

To evaluate the demographic and clinical factors that predicted depression in adolescents at 6 months after treatment.

METHOD

A total of 130 adolescents (aged 12 to 18 years) who had been clinically referred for treatment with a DSM-IV major depressive disorder, dysthymic disorder or minor depression were treated with either CBT, sertraline, their combination or supportive psychotherapy, in two randomized clinical trials using the same assessment instruments. Assessments in both studies were conducted at initial assessment, three months later at the conclusion of treatment, and at 6-month follow up. The data of these two trials were pooled. The primary outcome measures were the presence of a depressive disorder and the Reynolds Adolescent Depression Scale (RADS) score at 6-month follow up.

RESULTS

At baseline, only the Self Efficacy Questionnaire for Depressed Adolescents (SEQ-DA) predicted depression at 6-month follow up. Individual measures following 3 months of acute treatment that predicted depression at 6-month follow up were SEQ-DA, RADS, Revised Children's Manifest Anxiety Scale-total score, Global Assessment of Function, adolescent-rated Family Assessment Device General Functioning Subscale and adolescent-rated Visual Analogue Scores of mood states.

CONCLUSION

Clinical variables as reported by the adolescent and identified by the clinician at baseline assessment and following 3 months of treatment predicted depression at 6-month follow up. No demographic variables were predictive of depression at 6-month follow up.

Children's view of a major depression affecting a parent in the family

This study aims to elucidate, from the children's perspective, the meaning for family life of a parent suffering a major depression disorder. Eight children and young adults were interviewed. Phenomenological-hermeneutic analysis generated two themes: (1) "Being a rescuing observer" with the subthemes, "Being attentive" and "Being considerate," and (2) "Being a frustrated observer" with the subthemes, "feeling discomfort" and "being out of it." Children's lives alternate between responsibility and loneliness as they wait for reciprocity in family life to return to normal. Children need support in order to manage their sense of responsibility and loneliness adequately.

Familial risk factors in social anxiety disorder: calling for a family-oriented approach for targeted prevention and early intervention

Within the last decade, social anxiety disorder (SAD) has been identified as a highly prevalent and burdensome disorder. Both the characterization of its symptomatology and effective treatment options are widely documented. Studies particularly indicate that SAD aggregates in families and has its onset in early adolescence. Given the family as an important context for children's cognitive, emotional and behavioural development, familial risk factors could be expected to significantly contribute to the reliable detection of populations at risk for SAD. Reviewing studies on familial risk factors for SAD argues for the importance of parental psychopathology and unfavourable family environment, but also denotes to several shortcomings such as cross-sectional designs, short follow-up periods, diverging methodologies and the focus on isolated factors. Using a prospective longitudinal study that covers the high-risk period for SAD, including a broader spectrum of putative risk factors may help to overcome many of the methodological limitations. This review sets out to develop a more family-oriented approach for predicting the onset and maintenance of SAD that may be fruitful to derive targeted prevention and early intervention in SAD.

Psychosocial adjustment in siblings of young people with Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is a progressive, impairing, life-limiting disorder of childhood. Little is known about how siblings adapt to this. The aim of this study is to document psychosocial adjustment in siblings of patients with DMD. Healthy siblings (11-18 years old) of young people with DMD attending a specialist paediatric centre and their parent/main carer took part. Parents, siblings and teachers completed a battery of questionnaires: (i) to assess psychiatric risk the Strengths and Difficulties Questionnaire (SDQ), General Health Questionnaire (GHQ), Hospital Anxiety and Depression Scale (HADS); (ii) to measure general wellbeing: SF-36; (iii) to document DMD illness disability: Functional Disability Inventory (FDI); (iv) to assess family function and life stresses for the unaffected sibling: Family Assessment Device (FAD), Family Burden Interview Schedule and Life Events Checklist. Forty six/77 eligible siblings (24 females/22 males); (mean age 14 years (SD 2.3)) took part. Although their mean psychological functioning and wellbeing questionnaire scores were comparable to normative data, there was a trend for more siblings scoring at high-risk for psychological (mainly emotional) problems. Weak/moderate associations with psychological symptoms in siblings varied according to informant and included the following factors: closeness in age to the affected sibling; older sibling age; extent of wheelchair use, burden of illness on family interactions, and siblings reporting high impact of illness on their lives. Psychological symptoms were also associated with less sibling involvement in patient care, with broader psychosocial and family disadvantage and with life stresses. Siblings have an increased risk for emotional problems, which appears influenced by specific illness factors.

Prospective community study of family stress and anxiety in (pre)adolescents: the TRAILS study

For prevention of anxiety in children and adolescents, it is important to know whether family stress is a predictor of anxiety. We studied this in 1,875 adolescents from the Tracking Adolescents' Individual Lives Survey (TRAILS) who were followed up for 2 years, from age 10-12 to 12-14 years. Adolescents reported anxiety and depression symptoms at both assessments, and parents reported family stress (family dysfunction and parenting stress) at the first assessment. Family dysfunction was not associated with future anxiety, whereas high parenting stress was. Furthermore, family dysfunction was more strongly associated with anxiety than with depression, whereas parenting stress was more strongly associated with depression. Level of parental psychopathology explained part of the association of family stress with anxiety. The associations were modest and the understanding of the origins of adolescents' anxiety will require identifying other factors than family stress that account for more of the variance.

A Spanish version of the Family Assessment Device

INTRODUCTION

This paper presents the results of a study on the psychometric properties of an authorized Spanish version of the McMaster Family Assessment Device, a self-report measure of family functioning.

MATERIALS AND METHODS

The study sample comprised 60 psychiatric patients and their family member and 60 controls, without mental health problems, and their family member.

RESULTS

Compared to other studies, all subscales displayed adequate temporal stability and acceptable reliability. While the instrument discriminated well between the two groups of families on all subscales, the results nevertheless indicated limitations in the inter-item discriminant capacity of the "Roles" subscale. Factor analysis resulted in a three-factor model that does not coincide with the established structure of this instrument.

CONCLUSION

Proposals to improve and adapt questionnaire are discussed with a view to make it applicable to cultures other than the one it was developed. Theoretical models relating to psychosocial aspects such as family functioning, albeit compatible in some areas, should be viewed with caution in cultures different to that in which the model originates.

Do parental psychopathology and unfavorable family environment predict the persistence of social phobia?

Parental psychopathology and unfavorable family environment are established risk factors for onset of offspring social phobia (SP), but their associations with the further course, e.g., persistence of the disorder, remain understudied. A community cohort of 1395 adolescents and their parents was followed-up over almost 10 years using the DIA-X/M-CIDI. Parental diagnostic interviews were supplemented by family history data. Parental rearing was retrospectively assessed by the Questionnaire of Recalled Parental Rearing Behavior in offspring, and family functioning by the Family Assessment Device in parents. Persistence measures (proportion of years affected since onset) were derived from diagnostic interviews, using age of onset, age of recency, and course information. Lack of emotional warmth and dysfunctional family functioning characteristics were associated with higher SP persistence, particularly in interaction with parental psychopathology. Predictors for SP persistence differ from those predicting SP onset. Unfavorable family environment alone and in interaction with parental disorders predict higher SP persistence.

Effects of obesity and obesity-induced stress on depressive symptoms in Korean elementary school children

BACKGROUND

Obesity is becoming prevalent in Korean children. Because body image is becoming increasingly important, it is likely that obesity-induced stress has a significant effect on childhood depression.

AIMS

To examine the correlation between obesity-induced stress and depressive symptoms in Korean elementary school students.

METHODS

The study participants were 2,305 elementary school children and their parents in the districts of Jeju-si, Seogwipo-si, Namjeju-gun and Bukjeju-gun on Jeju Island, Korea, who completed questionnaires involving demographic information, an obesity-induced stress scale and the Korean form of Kovacs' Children's Depression Inventory (CDI) from September to December 2006.

RESULTS

After controlling for significant independent variables that are wellknown correlates of depressive symptoms in children (e.g. age, gender, residence, family monthly income, obesity status of both parents, family history of chronic illness, and time spent with mother), obesity-induced stress had an odds ratio of 1.128 (95% CI 1.111-1.146).

CONCLUSIONS

Reducing the prevalence of depressive symptoms in elementary school children in Jeju Island will require special attention, particularly the development of coping strategies to resolve obesity-induced stress in various areas including school, family and society.

Mother-child interactions in depressed children and children at high risk and low risk for future depression

OBJECTIVE

To compare mother-child interactions and parenting styles in families of children with major depressive disorder, youths at high risk for depression, and healthy controls.

METHOD

Currently depressed (n = 43), high-risk (n = 28), and healthy control (n = 41) youths and their mothers engaged in a standardized videotaped problem-solving interaction. Measures of affect and behavior for both mothers and children were obtained, in addition to global measures of parenting.

RESULTS

Depressed children demonstrated more negativity and less positivity in dyadic interactions than did children at high risk and control children. Mothers of depressed children were more disengaged than control mothers. Exploratory repeated-measures analyses in a subgroup of depressed children (n = 16) suggested mother-child interactions do not significantly change when children recover from depression. Children at high risk demonstrated less positivity in dyadic interactions than did controls. Mothers with a history of major depressive disorder and mothers with higher current depressive symptoms demonstrated patterns of disengagement and low control in interactions with children.

CONCLUSIONS

Mother-child interactions in depressed youths are marked by maternal disengagement and low child positivity that may not improve when children recover. The bidirectional effects of maternal disengagement and low levels of child positivity may precede onset of major depressive disorder in children and serve as risk factors for recurrent depression in youths.

Brief report: Development of a brief scale to assess family support function among Chinese high school students

PURPOSE

To develop a brief family support function scale for Chinese high school students (FSFS-CHSS).

METHODS

Standard procedures for scale development (identification of conceptual model, literature review, item selection and modification using consumer and expert panels and item reduction techniques) were used to develop a 17-item scale. Families of students in 96 high school classes in Hunan were used for item selection and validation. A subset of 4 out of 96 classes was selected as a test-retest sample.

RESULTS

A brief CHSS-FSFS with 17 items was found to have good test-retest and internal consistency reliability (Pearson correlation coefficient: 0.89, P<0.05; Cronbach's alpha coefficient was 0.87). Three factors were extracted using factor analysis, accounting for 48% of total variation. Comparison of CHSS-FSFS score between healthy and unhealthy families was statistically significant, t=7.58, P<0.01.

CONCLUSIONS

CHSS-FSFS is a reliable and valid tool for family support function assessment.

Practice parameter for the assessment of the family

The family assessment is one component of the comprehensive psychiatric assessment of the child or adolescent with a psychiatric disorder. This guideline reviews the basic principles in conducting a family interview that gathers history relevant to the child's disorder and observes family interaction associated with the child's disorder. It reviews basic information that must be covered in all evaluations and the information required in complex and specialized situations. The parameter emphasizes that all assessments should include a review of family strengths and resources.

Psychosocial functioning in youths at high risk to develop major depressive disorder

OBJECTIVE

To compare the psychosocial functioning of children and adolescents at high risk of major depressive disorder with youths with acute major depressive disorder and healthy controls.

METHOD

High-risk (n = 57), major depressive disorder (n = 71), and healthy control (n = 48) youths and their families were recruited from 1987 to 1996 and assessed for psychopathology using standardized instruments. Except for 16 children who had disruptive disorders, the high-risk children were free of psychopathology. A parent completed the Psychosocial Schedule to evaluate the mother-child, father-child, marital relationships, and child-friend relationships and the child's school performance.

RESULTS

Overall, high-risk and healthy controls had similar psychosocial functioning. Marital relationships were worse in the high-risk children with psychopathology. Youths with major depressive disorder had significantly more psychosocial problems and school difficulties than those at high risk and healthy controls in most domains measured. Controlling for age, pubertal stage, race, sex, family composition, current and lifetime parental depression, and current and lifetime parental nonmood psychopathology yielded similar results.

CONCLUSIONS

The family and peer interactions of high-risk youths were similar to the interactions of healthy controls. Although family dysfunctional patterns seem to mainly depend on the child's depressive symptoms, longitudinal studies are needed to establish causality.

The roots of depression in adolescent girls: is menarche the key?

Before adolescence, the rates of depression are similar in girls and boys (or are slightly higher in boys). Yet with the onset of puberty, the gender proportion of depression dramatically shifts to a two girls to one boy ratio. What, then, is the relationship between menarche and the onset of major depression in early adolescence? Recent literature intimates that vulnerability to depression may be rooted in an intricate meld of genetic traits, normal female hormonal maturational processes, and gender socialization. Information regarding gender differences in the presentation of depressive symptoms is provided along with biologic, psychologic, and sociologic factors contributing to depression in adolescent girls. The burden of illness associated with onset of depression after menarche reinforces the importance of prevention or else expeditious recognition and intervention.