Depressed mothers as informants in family history research--are they accurate?

Trajectory of maternal depression and parasomnias

Maternal depressive symptoms are associated with poorer sleep quality in their children. Although parasomnias can occur at any age, this group of sleep disorders is more common in children. The aim of this study was to assess whether maternal depression trajectories predict parasomnias at the age of 11 years. Data were from a Birth Cohort of 4231 individuals followed in the city of Pelotas, Brazil. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at 12, 24, and 48 months, and 6 and 11 years postpartum. Maternal depression trajectories were calculated using a group-based modelling approach. Information on any parasomnias (confused arousals, sleepwalking, night terrors, and nightmares) was provided by the mother. Five trajectories of maternal depressive symptoms were identified: chronic-low (34.9%), chronic-moderate (41.4%), increasing (10.3%), decreasing (8.9%), and chronic-high (4.4%). The prevalence of any parasomnia at the age of 11 years was 16.8% (95% confidence interval [CI] 15.6%-18.1%). Confusional arousal was the most prevalent type of parasomnia (14.5%) and varied from 8.7% to 14.7%, 22.9%, 20.3%, and 27.5% among children of mothers at chronic-low, moderate-low, increasing, decreasing, and chronic-high trajectories, respectively (p < 0.001). Compared to children from mothers in the chronic-low trajectory, the adjusted prevalence ratio for any parasomnia was 1.58 (95% CI 1.29-1.94), 2.34 (95% CI 1.83-2.98), 2.15 (95% CI 1.65-2.81), and 3.07 (95% CI 2.31-4.07) among those from mothers in the moderate-low, increasing, decreasing, and chronic-high trajectory groups, respectively (p < 0.001). In conclusion, parasomnias were more prevalent among children of mothers with chronic symptoms of depression.

Parent-adolescent informant discrepancy on the Strengths and Difficulties Questionnaire in the UK Millennium Cohort Study

BACKGROUND

Developmental researchers often use a multi-informant approach to measure adolescent behaviour and adjustment, but informant discrepancies are common. In general population samples, it is often found that parents report more positive and less negative outcomes than adolescents themselves. This study aimed to investigate factors associated with informant discrepancy, including adolescent sex, and parental level of psychological distress and education.

METHODS

Informant discrepancy on the Strengths and Difficulties Questionnaire was investigated using a Latent Difference Score (LDS) approach, which estimates the true difference between parent and adolescent reports in a structural equation model. The sample were parent-adolescent dyads from the seventh wave of the UK Millennium Cohort Study (N = 6947, 49.3% female, aged 17 years).

RESULTS

Parents reported lower levels of difficulties (emotion symptoms, peer problems, conduct problems), and higher levels of pro-social behaviour than adolescents themselves. Conditional effects were found, as discrepancy was greater amongst parent-daughter dyads for emotion and peer problems, and greater amongst parent-son dyads for conduct problems and pro-social behaviour. Parent-adolescent discrepancy was also greater generally if parents had a lower level of psychological distress or a higher level of education.

CONCLUSIONS

In a large general population sample from the UK, it was found that adolescents tended to report more negative and less positive outcomes than parents reported about them. Conditional effects were found at the parent and adolescent level suggesting that specific informant biases are likely to impact the measurement of adolescent behaviour and adjustment across reporters.

Parent-youth agreement on psychiatric diagnoses and symptoms: results from an adolescent outpatient clinical sample

OBJECTIVE

Previous research suggests that agreement, between youths and their parents, regarding assessment of youth psychiatric problems is limited. Due to this discrepancy, a multi-informant, multimethod approach is recommended when gathering psychopathological information. This study examines parent-youth agreement regarding youth psychiatric problems. It does so at a diagnostic level and at a symptom level, as well as studying the influence of age, gender, depressive disorder, anxiety disorder and attention-deficit/hyperactivity disorder (ADHD) as potential moderators of agreement.

METHODS

The participants in this study were 61 adolescents aged 12-18 years and their parents. The K-SADS-PL DSM-5 was administered in two outpatient units, with adolescents and their parents interviewed separately. Participants also rated symptoms using a broad rating scale (Child Behavior Checklist and the Youth Self-Report) prior to being interviewed.

RESULTS

Parent-youth agreement at a diagnostic level ranged from fair to excellent. Agreement at a symptom level was lower than that at a diagnostic level, ranging from poor to fair. These results indicate that parent-youth agreement regarding diagnosis and symptoms is higher than in most previous studies. The results also suggest that some variables, such as age, gender, depressive disorders, and ADHD, potentially influence agreement on symptoms.

CONCLUSION

These findings support the importance of gathering information from both children and parents, and that clinicians should consider moderating factors when integrating data from multiple informants.

Maternal prenatal stress and postnatal depressive symptoms: discrepancy between mother and teacher reports of toddler psychological problems

PURPOSE

Maternal prenatal stress and postnatal depression are reported to increase the risk for early offspring psychological problems. We examined whether these two stressors predicted toddler emotional or behavioral problems based on the mother and teacher reports, respectively.

METHODS

A longitudinal study within the Odense Child Cohort (OCC). Prenatal stress was assessed (gestation week 28) using Cohen's Perceived Stress Scale (PSS). Depressive symptoms were assessed (3 months after birth) using the Edinburgh Postnatal Depression Scale (EPDS). Behavioral and emotional problems were assessed by mothers using the preschool version of Child Behaviour Checklist (CBCL) and by teachers using the caregiver-teacher report form (CTR-F).

RESULTS

N = 1302 mother-child dyads were included. CBCL (N = 1302) was collected at 29 months (SD 5.3) and C-TRF (N = 989) at 32.6 months (SD 6.9). N = 70 mothers (5.4%) were at high risk for postnatal depression (EPDS score > 12). Generalized additive models showed that prenatal stress (increase of + 1 on PSS-10 total score) predicted an increase in CBCL (+ 0.011) and C-TRF (+ 0.015) total scores. Postnatal depressive symptoms (increase of + 1 on EPDS total score) only predicted an increase in CBCL total score (+ 0.026).

CONCLUSION

Prenatal maternal stress was a significant predictor of both mother and teacher reported toddler emotional and behavioral problems, although effect sizes were small. Postnatal depressive symptoms were associated with increased maternal (but not teacher) reporting of toddler problems. Mothers reported more toddler psychological problems than teachers, and the mother-teacher discrepancy was positively correlated to maternal postnatal depressive symptoms.

Family income, maternal psychological distress and child socio-emotional behaviour: Longitudinal findings from the UK Millennium Cohort Study

The association between low family income and socio-emotional behaviour problems in early childhood has been well-documented, and maternal psychological distress is highlighted as central in mediating this relationship. However, whether this relationship holds for older children, and the precise mechanisms by which income may influence child behaviour is unclear. This study investigated the relationship between family income and child socio-emotional behaviour at 11 years of age, and examined the mediating role of maternal psychological distress over time using the UK Millennium Cohort Study. The primary outcome was parent-reported behavioural problems, as captured by the Total Difficulties Score (TDS), derived from the Strengths and Difficulties Questionnaire (SDQ). Secondary outcomes were the emotional, peer-related, conduct, and hyperactivity/inattention problems subscales of the SDQ; and teacher-reported TDS. Permanent family income was the primary exposure variable; frequency of poverty up to age 11 years was the secondary exposure variable. Maternal psychological distress was operationalised to reflect the trajectory from child birth to age 11. Multivariable logistic regression models were used to estimate the effect of permanent family income on child behaviour at age 11, controlling for maternal psychological distress and other relevant covariates. Results showed a statistically significant protective effect of increased permanent family income on the likelihood of behavioural problems at age 11. This finding was consistent for all SDQ subscales apart from emotional problems, and was strongest for teacher-reported behavioural problems. Maternal distress was an important mediator in the income-child behaviour relationship for parent-reported, but not teacher-reported, behavioural problems. The results of this study strengthen empirical evidence that the child behaviour-income gradient is maintained in older childhood. Mother's psychological distress, particularly longstanding or recurrent, appears to contribute to this relationship. These findings may validate calls for psychosocial and financial supports for families affected by parental mental health issues.

Parent-child discrepancies in the report of adolescent emotional and behavioral problems in Taiwan

The majority of studies on parent-child discrepancies in the assessment of adolescent emotional and behavioral problems have been conducted in Western countries. It is believed that parent-adolescent agreement would be higher in societies with a strong culture of familism. We examined whether parent-adolescent discrepancies in the rating of adolescent emotional and behavioral problems are related to parental and family factors in Taiwan. Participants included 1,421 child-parent pairs of 7^th-grade students from 12 middle schools in Northern Taiwan and their parents. We calculated Pearson’s correlation coefficients to assess the relationship between parental (Child Behavior Checklist, CBCL) and adolescent (Youth Self Report, YSR) report of emotional/behavioral problem syndromes. Regression models were used to assess parent-adolescent differences in relation to parental psychopathology and family factors. We found that parent-adolescent agreement was moderate (r = 0.37). Adolescents reported higher symptom scores than their parents (Mean Total Problem Score: CBCL: 20.79, YSR: 33.14). Parental psychopathology was related to higher parental ratings and better informant agreement. Parents with higher socioeconomic status (SES) tended to report lower scores for adolescent problem syndromes, resulting in higher levels of disagreement. Greater maternal care was related to higher parent-adolescent agreement. Based on our study findings, we conclude that familism values do not seem to improve parent-child agreement in the assessment of adolescent problem syndromes. The finding that higher SES was related to increased discrepancies speaks to the need to explore the culture-specific mechanisms giving rise to informant discrepancies.

U.S. Caregivers with Mental Health Problems: Parenting Experiences and Children's Functioning

The 2007 National Survey of Children's Health was used to determine the prevalence of poor mental health among U.S. mothers, fathers, and guardians, specific parenting experiences and children's functioning. More guardians (13.7%) reported poor mental health compared to mothers (7.7%) and fathers (5.3%), generalizing to 4.6 million U.S. caregivers with poor mental health. Caregivers with poor mental health were at least 3 times more likely to report children's problematic functioning after accounting for sociodemographic factors and parenting stress and experiences. Research and clinical activities should recognize poor caregiver mental health as a condition that affects parenting and children's functioning.

Trajectories of maternal depression and offspring psychopathology at 6 years: 2004 Pelotas cohort study

BACKGROUND

Few studies have addressed the course and severity of maternal depression and its effects on child psychiatric disorders from a longitudinal perspective. This study aimed to identify longitudinal patterns of maternal depression and to evaluate whether distinct depression trajectories predict particular psychiatric disorders in offspring.

METHODS

Cohort of 4231 births followed-up in the city of Pelotas, Brazil. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at 3, 12, 24 and 48 months and 6 years after delivery. Psychiatric disorders in 6-year-old children were evaluated through the development and well-being assessment (DAWBA) instrument. Trajectories of maternal depression were calculated using a group-based modelling approach.

RESULTS

We identified five trajectories of maternal depressive symptoms: a "low" trajectory (34.8%), a "moderate low" (40.9%), a "increasing" (9.0%), a "decreasing" (9.9%), and a "high-chronic" trajectory (5.4%). The probability of children having any psychiatric disorder, as well as both internalizing and externalizing problems, increased as we moved from the "low" to the "high-chronic" trajectory. These differences were not explained by maternal and child characteristics examined in multivariate analyses.

LIMITATIONS

Data on maternal depression at 3-months was available on only a sub-sample. In addition, we had to rely on maternal report of child's behavior alone.

CONCLUSIONS

The study revealed an additive effect on child outcome of maternal depression over time. We identified a group of mothers with chronic and severe symptoms of depression throughout the first six years of the child life and for this group child psychiatric outcome was particularly compromised.

Differential Reporting of Adolescent Stress as a Function of Maternal Depression History

The depression-distortion hypothesis posits that depressed mothers report child characteristics in a negatively-biased manner, motivating research on discrepant reporting between depressed mothers and their children. However, the literature has predominately focused on report discrepancies of youth psychopathological and behavioral outcomes, with limited focus on youth stress despite the marked increase of stressful events during adolescence. The current study investigated whether the presence versus absence of a maternal history of major depressive disorder differentially influenced reporting of adolescent stress when compared to her child's report, utilizing a community sample of diverse adolescents. As hypothesized, mothers with a history of depression were more likely to report more youth stress than their children reported. Specifically, mothers with a history of depression were more likely than nondepressed mothers to report more familial, social, and youth-dependent stressors relative to their children; nondepressed mothers were more likely to report less independent stressors than their children.

Correlates of parent-youth discordance about youth-witnessed violence: a brief report

Studies have consistently demonstrated a lack of agreement between youth and parent reports regarding youth-witnessed violence (YWV). However, little empirical investigation has been conducted on the correlates of disagreement. Concordance between youth and parents about YWV was examined in 766 parent-youth dyads from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Results showed that significantly more youth (42%) than parents (15%) reported YWV. Among the dyads in which at least one informant reported YWV (N = 344), we assessed whether youth delinquency, parental monitoring, parent-child relationship quality, history of child maltreatment, income, and parental depression were predictive of parent-youth concordance. Findings indicated that youth engagement in delinquent activities was higher in the groups in which the youth reported violence exposure. More empirical study is needed to assess correlates of agreement in high-risk youth to better inform associations found between exposures and outcomes as well as practice and policy for violence exposed youth.

A comparison of levels and predictors of emotional problems among preadolescent Ethiopians in Addis Ababa, Ethiopia, and Toronto, Canada

According to a literature of theory and advocacy, immigration and resettlement jeopardize the mental health of children and youth, largely because of factors such as intergenerational tensions arising from conflicts about the retention of traditional values, and experiences of prejudice and discrimination. The current study examines the specificity of these putative mental health risks to the immigration experience. The level and predictors of emotional problems among preadolescent Ethiopians living in immigrant families in Toronto, Canada, were compared with a matched sample of Ethiopian youngsters in Addis Ababa, Ethiopia. Data came from structured interviews with the person most knowledgeable about the family (usually a parent), as well as from the children themselves. Youth reported higher levels of emotional problems (EP) than their parents. Predictors differed for parent and child ratings. In both the Toronto and Addis Ababa samples, parental mental health predicted parent-rated, but not self-rated EP. Contrary to immigration stress theory, parental perceptions of prejudice predicted EP in Addis Ababa, but not Toronto, and parent-child discordance regarding ethnic adherence were predictors of self-rated emotional problems in Ethiopia, but not in Canada. Perceived discrimination was a significant predictor of self-rated emotional problems in both settings. Implications for theory and further research are discussed.

A three-generational study of risk factors for childhood externalizing behavior among African Americans and Puerto Ricans

This is the first prospective study to examine the precursors of child externalizing behavior across three generations of African Americans and Puerto Ricans. Participants comprised a community cohort of male and female African Americans and Puerto Ricans (N = 366, X⁻ age = 29.4 years), who are part of an ongoing study of drug use and problem behaviors, and who had a child. Data were collected at four time waves, spanning the participants' adolescence to adulthood. Questionnaires were initially self-administered in schools in East Harlem, NY, USA (time 1). Subsequently, structured interviews were conducted by trained interviewers (times 2 and 3), and self-administered via mail (time 4). The independent variables consisted of the participants' prospective reports of their (a) relationships with their parents during adolescence, (b) depressive mood and drug use (adolescence to adulthood), (c) relationship with their oldest child between the ages of 6-13, and (d) perceptions of neighborhood crime and deterioration (in adulthood). The dependent variable was externalizing behavior in the participant's oldest child (X⁻ age = 9.6 years; SD = 2.0). Structural equation modeling showed that the parent-child relationship during participants' adolescence was linked with the participants' depressive mood and drug use which, in turn, were associated with the participants' relationship with their own child, as well as with neighborhood crime and deterioration when participants were adults. The participants' depressive mood, and relationship with their own child, as well as neighborhood crime and deterioration, each had a direct pathway to externalizing behavior in the participant's child. Findings suggest that intervention programs and public policy should address parental attributes, neighborhood factors, and, especially, parenting skills, to reduce risk factors for the intergenerational transmission of externalizing behavior.

Impact of maternal posttraumatic stress disorder and depression following exposure to the September 11 attacks on preschool children's behavior

To evaluate whether conjoined maternal posttraumatic stress disorder (PTSD) and depression are associated with increased behavioral problems among terrorism-exposed preschool children (N = 116; 18-54 months), this study compared clinically significant child behavioral problem rates among the preschool children of mothers with PTSD and depression, depression alone, and neither disorder. Behavioral problems were independently rated by mothers and preschool teachers. Maternal depression and PTSD, relative to maternal depression alone, and to neither disorder, were associated with substantially increased child problems. Notably, maternal depression and PTSD were associated with increased emotional reactivity (relative risk [RR] = 5.9 by mother's and 3.4 by teacher's reports) and aggressive behavior problems (RR = 11.0 by mother's and RR = 5.9 by teacher's reports). This was corroborated by teacher ratings. Implications for intervening with terrorism-exposed preschool children are discussed.

The Ages & Stages Questionnaire: Social-Emotional: A validation study of a mother-report questionnaire on a clinical mother-infant sample

Mother-report questionnaires of infant socioemotional functioning are increasingly used to screen for clinical referral to infant mental health services. The validity of the Ages & Stages Questionnaire: Social Emotional (ASQ:SE; J. Squires, D. Bricker, K. Heo, & E. Twombly, 2002) was investigated in a sample of help-seeking mothers with young infants. It was compared with independent observer-rated dyadic interactions, and the quality of dyadic relationships was rated by expert clinicians. The ASQ:SE ratings also were compared with questionnaires on maternal psychological stress and distress. The ASQ:SE did not correlate significantly with either external ratings of dyadic interaction or clinically assessed relationship qualities, though the latter two were strongly associated with each other. In contrast, ASQ:SE scores were associated with questionnaires relating to maternal psychological distress. This was especially true for mothers classified as depressed. Furthermore, reports on the ASQ:SE were strongly predicted by maternal stress. The study points to some problems with the concurrent validity of the ASQ:SE in clinical samples. It also demonstrates a close link between mothers' psychological distress and their ratings of infant social and emotional functioning. Further research should investigate the extent to which the ASQ:SE specifically measures infant functioning or maternal distress, and how it functions in clinical versus nonclinical samples.

Maternal depression, maternal expressed emotion, and youth psychopathology

Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two predictors-maternal depression within the child's lifetime and maternal EE-in a study of children at risk for depression. One hundred and seventy-one youth, ages 8-12, and their mothers participated. To assess maternal and youth psychopathology, dyads were administered structured diagnostic assessments, and mothers and children completed self-report measures of their own depressive symptoms. In addition, mothers completed the Achenbach Child Behavior Checklist-Parent Report Version (CBCL) for their children. Maternal EE was assessed based on the Five Minute Speech Sample. History of maternal depression was associated with high maternal EE, and the combination of maternal depression history and maternal EE was associated with children's own reports of higher depressive symptoms. Current maternal depressive symptoms were associated with mothers' reports of children's Internalizing scores on the CBCL, and maternal depression history, current maternal depressive symptoms, and maternal EE were strongly associated with mothers' reports of children's Externalizing and Total Problem scores on the CBCL. History of maternal depression and a rating of high or borderline Critical EE (characterized by maternal critical comments and/or reports of a negative relationship) were independently associated with children's depression diagnoses.

The persistence of maternal distress and symptoms of distress in adult offspring

This study examined the influence of maternal psychological distress symptoms during offspring's preschool, middle childhood, and adolescent years on the distress symptoms of offspring in adulthood. Data were derived from the British Cohort Study, a longitudinal study of children born in a one-week period in 1970. Results indicated that greater symptoms of maternal distress that persisted over multiple stages of offspring development were generally associated with greater symptoms of distress in adult offspring. The effect of greater maternal distress symptoms that persisted across preschool, middle childhood, and adolescence on adult offspring, however, was not significantly different from the long term effects of a single, but early, exposure to maternal distress once offspring's psychosocial adjustment during adolescence was considered. The relationship between mother and offspring distress symptoms did not vary for male and female offspring. The results provide general support for a cumulative effect perspective in that continuous exposure to maternal distress symptoms had negative consequences in adulthood, and that the adult effect of exposure in early or middle childhood was explained by adolescent adjustment.

Parent-child agreement and prevalence estimates of diagnoses in childhood: direct interview versus family history method

Diagnostic information on children is typically elicited from both children and their parents. The aims of the present paper were to: (1) compare prevalence estimates according to maternal reports, paternal reports and direct interviews of children [major depressive disorder (MDD), anxiety and attention-deficit and disruptive behavioural disorders]; (2) assess mother-child, father-child and inter-parental agreement for these disorders; (3) determine the association between several child, parent and familial characteristics and the degree of diagnostic agreement or the likelihood of parental reporting; (4) determine the predictive validity of diagnostic information provided by parents and children. Analyses were based on 235 mother-offspring, 189 father-offspring and 128 mother-father pairs. Diagnostic assessment included the Kiddie-schedule for Affective Disorders and Schizophrenia (K-SADS) (offspring) and the Diagnostic Interview for Genetic Studies (DIGS) (parents and offspring at follow-up) interviews. Parental reports were collected using the Family History - Research Diagnostic Criteria (FH-RDC). Analyses revealed: (1) prevalence estimates for internalizing disorders were generally lower according to parental information than according to the K-SADS; (2) mother-child and father-child agreement was poor and within similar ranges; (3) parents with a history of MDD or attention deficit hyperactivity disorder (ADHD) reported these disorders in their children more frequently; (4) in a sub-sample followed-up into adulthood, diagnoses of MDD, separation anxiety and conduct disorder at baseline concurred with the corresponding lifetime diagnosis at age 19 according to the child rather than according to the parents. In conclusion, our findings support large discrepancies of diagnostic information provided by parents and children with generally lower reporting of internalizing disorders by parents, and differential reporting of depression and ADHD by parental disease status. Follow-up data also supports the validity of information provided by adolescent offspring.

Depressed Mood and Maternal Report of Child Behavior Problems: Another Look at the Depression-Distortion Hypothesis

Caregiver depression has been described as leading to overreport of child behavior problems. This study examines this "depression-distortion" hypothesis in terms of high-risk families of young adolescents. Questionnaire and diagnostic interview data were collected from mothers, teachers, and fathers, and self-report information was obtained from youth between ages 10 and 14 years. First, convergent and discriminant validity were demonstrated for internalizing and externalizing multiagent constructs. Second, the depression-distortion hypothesis was examined, revealing a modest effect of maternal depression, leading to the inflation of reported son externalizing and daughter internalizing problems. The data suggest the need to consider multiple influences on parental perceptions of child behavior and psychopathology in research and clinical settings.

The influence of caregiver depressive symptoms on proxy report of youth depressive symptoms: a test of the depression-distortion hypothesis in pediatric type 1 diabetes

OBJECTIVE

To test the depression-distortion hypothesis in pediatric type 1 diabetes.

METHODS

In a sample of 187 youth with type 1 diabetes, caregivers completed the Center for Epidemiologic Studies Depression (CES-D) scale and the Children's Depression Inventory (CDI): parent proxy report. Youth completed the CDI. To test whether caregiver depressive symptoms (CES-D) moderated the proxy report of youth depressive symptoms (CDI:P), the CDI, CES-D, and their interactions were entered as predictors in to a regression analysis.

RESULTS

The regression was significant, F (8,178) = 9.26, p <.0001, R(2) =.29, and all three variables were significant predictors. Post-hoc probing of the interaction showed that caregivers with high CES-D scores reported high levels of youth depressive symptoms at both high and low levels of youth-reported depressive symptoms. In contrast, caregivers with low CES-D scores reported similar levels as the youth.

CONCLUSIONS

These results support the depression-distortion hypothesis in a pediatric chronic disease sample.

Factors influencing mother-child reports of depressive symptoms and agreement among clinically referred depressed youngsters in Hungary

BACKGROUND

Psychiatric assessments of children typically involve two informants, the child and the parent. Understanding discordance in their reports has been of interest to clinicians and researchers. We examine differences between mothers' and children's report of children's depressive symptom severity, and factors that may influence their reports and level of agreement. We hypothesized that agreement between mother and child would improve if (1) the mother is depressed, due to improved recall of mood congruent symptoms, (2) the child is older, due to better social-cognitive and communication skills, and (3) the child is a female.

METHODS

Subjects were 354 children (158 girls; mean age 11.69 years, SD: 2.05 years) with Major Depressive Disorder. Depressive symptoms were evaluated by a semi-structured interview separately with the mother and the child. Agreement on symptom severity was based on concordance of the presence and extent of symptoms.

RESULTS

Maternal reports were significantly higher than their son's but not daughters'. Girls, particularly with increasing age, reported higher levels of symptoms; however mothers' reports were not affected by child sex or age. Maternal depression predicted more severe symptom reports for both children and mothers. Agreement between the mother and the child increased as children got older.

LIMITATIONS

The same clinician interviewed the mother and the child, which might inflate rates of agreement. However, this method mirrors clinical evaluation.

CONCLUSION

During a clinical interview one must consider the age and sex of the child and the depressive state of the mother in assimilating information about the child.

Predicting school dropout and adolescent sexual behavior in offspring of depressed and nondepressed mothers

OBJECTIVE

To examine predictors of school dropout and adolescent sexual behavior in offspring of depressed and nondepressed mothers. Possible moderators of the relation between maternal depression and these outcomes also were explored.

METHOD

Participants were 240 mothers and adolescents assessed annually from 6th through 12th grade. Interviews and questionnaires measured the chronicity and severity of the mother's depressive episodes, the mother's educational attainment, socioeconomic status, the presence of a father, the adolescent's IQ, externalizing behaviors, and substance use disorders.

RESULTS

Substance use disorders before ninth grade significantly predicted higher rates of both school dropout and adolescent sexual behavior. Lower levels of mother's educational attainment and higher rates of adolescent's externalizing behaviors in grades 6 through 8 predicted higher school dropout. Higher IQ was associated with a lower likelihood of dropping out among offspring of never or moderately depressed mothers, but not for offspring of chronic/severely depressed mothers. Among offspring of never or moderately depressed mothers, the presence of a male head of household was associated with lower rates of adolescent sexual behavior, but not among offspring of chronically/severely depressed mothers.

CONCLUSIONS

These findings have implications for the development of programs aimed at preventing behavior problems in high-risk adolescents.

Family cohesion and children's behavior problems: a longitudinal investigation

We examine the association of family cohesion and conflict with childhood behavior problems. A stratified random sample of 823 children was evaluated at ages 6 and 11 years. Mothers rated the family environment at age 6 using the Family Environment Scale. Mothers and teachers rated children's behavior problems at ages 6 and 11, using the Child Behavior Checklist and the Teacher Report Form, respectively. Multiple regression analysis, applying generalized estimating equations, was used. Although results varied between mothers' and teachers' data, they converged in identifying family cohesion as a factor in children's mental health. Family cohesion, as rated by mothers, had a beneficial effect on children's internalizing and attention problems, as rated by both mothers and teachers, that was stable over time. The study highlights an important relationship between family cohesion and children's internalizing and attention problems.

The development of an observation tool for use with parents with psychiatric disability and their preschool children

Community-based treatment and care of people with psychiatric disabilities has meant that they are now more likely to engage in the parenting role. This has led to the development of programs designed to enhance the parenting skills of people with psychiatric disabilities. Evaluation of these programs has been hampered by a paucity of evaluation tools. This study's aim was to develop and trial a tool that examined the parent-child interaction within a group setting, was functional and easy to use, required minimum training and equipment, and had acceptable levels of reliability and validity. The revised tool yielded a single scale with acceptable reliability. It had discriminative validity and concurrent validity with non-independent global ratings of parenting. Sensitivity to change was not investigated. The findings suggest that this method of evaluating parenting is likely to have both clinical and research utility and further investigation of the psychometric properties of the tool is warranted.

Effects of psychotherapy for depression in children and adolescents: a meta-analysis

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability.

Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study

Discrepancies often exist among different informants' (e.g., parents, children, teachers) ratings of child psychopathology. Informant discrepancies have an impact on the assessment, classification, and treatment of childhood psychopathology. Empirical work has identified informant characteristics that may influence informant discrepancies. Limitations of previous work include inconsistent measurement of informant discrepancies and, perhaps most importantly, the absence of a theoretical framework to guide research. In this article, the authors present a theoretical framework (the Attribution Bias Context Model) to guide research and theory examining informant discrepancies in the clinic setting. Needed directions for future research and theory include theoretically driven attention to conceptualizing informant discrepancies across informant pairs (e.g., parent-teacher, mother-father, parent-child, teacher-child) as well as developing experimental approaches to decrease informant discrepancies in the clinic setting.

Families at high and low risk for depression: a three-generation startle study

BACKGROUND

Anxiety symptoms might be a vulnerability factor for the development of major depressive disorder (MDD). Because elevated startle magnitude in threatening contexts is a marker for anxiety disorder, the present study investigated the hypothesis that enhanced startle reactivity would also be found in children and grandchildren of individuals with MDD.

METHODS

The magnitude of startle was investigated in two tests (anticipation of an unpleasant blast of air and during darkness) in children (second generation) and grandchildren (third generation) of probands with (high risk) or without (low risk) MDD (first generation).

RESULTS

Startle discriminated between the low- and high-risk groups. In the probands' children, the high-risk group showed increased startle magnitude throughout the fear-potentiated startle test. In the probands' grandchildren, a gender-specific abnormality was found in the high-risk group with high-risk girls, but not boys, exhibiting elevated startle magnitude throughout the procedure.

CONCLUSIONS

Increased startle reactivity in threatening contexts, previously found in patients with anxiety disorder and in children of parents with an anxiety disorder, might also constitute a vulnerability marker for MDD. These findings suggest that there might be common biologic diatheses underlying depression and anxiety.

Behavior problems in New York City's children after the September 11, 2001, terrorist attacks

Children's behavior was assessed with 3 cross-sectional random-digit-dial telephone surveys conducted 11 months before, 4 months after, and 6 months after September 11, 2001. Parents reported fewer behavior problems in children 4 months after the attacks compared with the pre-September 11 baseline. However, 6 months after the attacks, parents' reporting of behavior problems was comparable to pre-September 11 levels. In the 1st few months after a disaster, the identification of children who need mental health treatment may be complicated by a dampened behavioral response or by a decreased sensitivity of parental assessment to behavioral problems.

Genetic and environmental mechanisms underlying stability and change in problem behaviors at ages 3, 7, 10, and 12

Maternal ratings on internalizing (INT) and externalizing (EXT) behaviors were collected in a large, population-based longitudinal sample. The numbers of participating twin pairs at ages 3, 7, 10, and 12 were 5,602, 5,115, 2,956, and 1,481, respectively. Stability in both behaviors was accounted for by genetic and shared environmental influences. The genetic contribution to stability (INT: 43%; EXT: 60%) resulted from the fact that a subset of genes expressed at an earlier age was still active at the next time point. A common set of shared environmental factors operated at all ages (INT: 47%; EXT: 34%). The modest contribution of nonshared environmental factors (INT: 10%; EXT: 6%) could not be captured by a simple model. Significant age-specific influences were found for all components, indicating that genetic and environmental factors also contributed to changes in problem behavior.

Retrospective reports of college students' childhood problems

College students and a subsample of their mothers and fathers participated in a study examining their retrospective reports of childhood emotional and behavioral problems experienced by college students. College students and their mothers and fathers exhibited moderate correspondence in their recollection of internalizing and externalizing problems that college students experienced during their childhood. In contrast, college students tended to endorse significantly greater levels of both internalizing and externalizing problems relative to their mothers and fathers. Current psychological symptoms predicted the greater endorsement of childhood internalizing and externalizing problems by college students and the greater endorsement of college students' childhood internalizing problems by their mothers. Further, college students' current perceptions of their parents predicted their endorsement of childhood internalizing problems, and college students' current masculinity and femininity predicted their endorsement of childhood externalizing problems. Results of this study emphasized the importance of noting factors that may be related to retrospective reports.

A psychometric evaluation of the parent report form of the State-Trait Anxiety Inventory for Children--Trait Version

We examined the psychometric characteristics of the State-Trait Anxiety Inventory for Children-Parent Report-Trait Version (STAIC-P-T) [Strauss, C. (1987). Modification of trait portion of State-Trait Anxiety Inventory for Children-Parent Form. Gainesville, FL: University of Florida], a brief, parent report paper-and-pencil measure of child chronic anxiety, in a large clinic-referred sample. Internal consistency coefficients were high and retest reliability coefficients were in the moderate range. Convergent validity evidence was mixed in its support for the measure, with evidence most supportive within reporter and within parental dyad. Divergent validity evidence provided less support for the measure, but was largely consistent with past research. Regression analyses indicated that parent reports on the STAIC-P-T were not significantly related to a parent's own level of symptomatology. Overall, the study provides mixed support for the psychometrics of the STAIC-P-T.

Bias in Parental Reports?

Summary: In clinical practice, child psychologists' case formulations are often based on parental reports. In this study, we examined whether mothers' reports of internalizing and externalizing behavior problems in their children might be biased by maternal psychopathology. The target child sample consisted of 68 boys aged 6-12 years who were receiving treatment. Mothers' reports were compared with the reports of both teachers and group care workers as criterion ratings. After controlling for variance shared with the independent raters, multiple regression analysis indicated substantial partial correlations between various types of maternal psychopathology and the reporting of internalizing child behavior problems. Only small to insignificant partial correlations were found in the case of externalizing behavior problems. This finding is consistent with the social attribution theory that predicts greater distortion when observing more ambiguous stimuli.

The association between psychopathology in fathers versus mothers and children's internalizing and externalizing behavior problems: a meta-analysis

In light of the selective focus on maternal (vs. paternal) psychopathology as a risk factor for child development, this meta-analysis examines the relative strength of the association between psychopathology in mothers versus fathers and the presence of internalizing and externalizing disorders in children. Associations were stronger between maternal than paternal psychopathology and the presence of internalizing (but not externalizing) problems in children, with all average effect sizes being small in magnitude. Relations were moderated by variables that highlight theoretically relevant differences between psychopathology in mothers versus fathers (e.g., age of children studied, type of parental psychopathology) and by variables related to methodological differences across studies (e.g., method of assessing psychopathology in parents and children, type of sample recruited, familial composition).

Issues in parent-child agreement: the case of structured diagnostic interviews

There are three primary purposes of this review. First, the review distinguishes among three types of reliability and describes the importance of evaluating the reliability of child psychopathology assessment instruments for clinical practice and research. Second, parent-child reliability findings from 5 of the more carefully studied and frequently used Structured (semi and highly) diagnostic interviews (The Schedule for Affective Disorders and Schizophrenia for School-age Children, The Child Assessment Scale, The Anxiety Disorders Interview Schedule for Children. The Diagnostic Interview for Children and Adolescents, and the Diagnostic Interview Schedule for Children) are examined. Finally, this review explores factors that have been implicated in terms of their potential effect on parent-child agreement. In addition, future directions for research and clinical practice within this area are identified and potential resolutions to the conundrum of parent-child discordance are discussed.

Developmental trajectories of adolescents' depressive symptoms: predictors of change

In a sample of 240 adolescents assessed annually in Grades 6 through 11, the developmental trajectories of their depressive symptoms were examined using latent factor growth modeling. Growth in mother-reported adolescent depressive symptoms was quadratic; growth in adolescent-reported symptoms was linear. In the model with gender and maternal depression, girls reported a greater increase in depressive symptoms over time than boys, and adolescents of mothers with histories of mood disorders had higher initial levels of depressive symptoms than offspring of never-depressed mothers. After gender and maternal depression were controlled, initial levels of negative attributions and stressors significantly predicted initial levels of adolescent- and mother-reported depressive symptoms. Attributional styles that were increasingly negative across time were associated with significantly higher initial levels (mother reported) and increasing growth (adolescent reported) of depressive symptoms. Reciprocal models in which development of depressive symptoms predicted the development of attributions and stress also were examined.

Revisiting the accuracy hypothesis in families of young children with conduct problems

Revisited the accuracy hypothesis in an examination of the relation between maternal depressive symptomatology and child conduct problems. All data were gathered as part of the pretreatment assessment in an outcome study of families with clinic-referred children with conduct problems (age 3 to 6). The mothers varied in their depressive symptomatology, from not at all symptomatic to severely symptomatic. Correlations indicated that with increasing depressive symptomatology, mothers (N = 97) displayed a higher rate of physical negative behaviors towards their child and reported more child conduct problems. Regression analyses revealed that at the lowest levels of maternal depressive symptomatology there was a discrepancy between mothers' reports of child behavior problems and child deviant behaviors observed during mother-child interaction. In contrast, at higher levels of depression, mothers' reports of child behavior were consistent with laboratory observations of their child's behavior. These findings provide evidence to support the accuracy hypothesis in reference to mothers who display a high degree of depressive symptomatology, but the results also call into question the validity of maternal report in families with children with conduct problems.

Symptoms of anxiety and depression among mothers of pre-school children: effect of chronic strain related to children and child care-taking

BACKGROUND

Factors that affect maternal mental health were studied when the children were 30 and 50 months old, and changes in the importance of these factors over time were analyzed. A specific aim was to elucidate the role of chronic strain related to children and child care-taking. This study follows up previous work on the influence of social class, strain and social support on maternal mental distress when the children were 18 months old.

METHODS

The sample is population based, and 1,081 parents were invited to fill out questionnaires. Maternal mental distress was measured by the Hopkins Symptom Checklist (SCL-25). Multiple regression analyses were conducted at each time point and chi-square tests were used to analyze the changes between the estimated regression coefficients over time.

RESULTS

Chronic strain related to children and child care-taking consistently predicted maternal mental distress. Among the specific child related strains, problems with child care-taking were significantly associated with maternal symptom levels at all time points. The importance of two specific child problem behaviors (activity level and the child being a worrier) on maternal mental health changed over time.

LIMITATIONS

Conclusions about causality can not be drawn based on cross-sectional analyses. The self-report measures used here may be biased by the current mood state.

CONCLUSIONS

Problems with child care arrangements and combining work and child care-taking are predictive of maternal mental health when the children are 18, 30 and 50 months old. The risk and protective factors found here may have implications for prevention and intervention.

Maternal depression and child behaviour problems: a meta-analysis

Children of depressed mothers are not only at risk for the development of psychopathology, but also for behaviour problems. A meta-analysis of 33 studies was conducted to determine the magnitude of the relationship between maternal depression and behaviour problems in children 1 year of age and older. Substantive, methodological, and miscellaneous variables were extracted and coded by both the researcher and a research assistant. The initial inter-rater agreement reached in coding these variables ranged from 85% to 100%. Effect sizes were calculated in three ways: unweighted, weighted by sample size, and weighted by quality index score. The mean effect size for the r index ranged from 0.29 when weighted by sample size to 0.35 when unweighted, indicating a moderate relationship between maternal depression and child behaviour problems. Children between the ages of 1-18 whose mothers were depressed displayed more conduct behaviour problems than children whose mothers were not depressed. The magnitude of this relationship covaried significantly with the predictors of sample size and quality index scores. Implications for future research are addressed.

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.

Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: results from a community-based survey

OBJECTIVE

Health problems of gay, lesbian, and bisexual (GLB) youth are reported as differing from those of heterosexual youth. Increased depression, suicide, substance use, homelessness, and school dropout have been reported. Most studies of GLB youth use clinical or convenience samples. The authors conducted a community school-based health survey that included an opportunity to self-identify as GLB.

METHOD

An anonymous self-report health care questionnaire was used during a community-based survey in 2 high schools in an upper middle class district.

RESULTS

Significantly increased health risks for self-identified GLB youth were found in mental health, sexual risk-taking, and general health risks compared with self-identified heterosexuals, but not in health domains associated with substance abuse, homelessness, or truancy.

CONCLUSIONS

Self-identified GLB youth in community settings are at greater risk for mental health, sexual risk-taking, and poorer general health maintenance than their heterosexual peers.

The influence of distress on mothers' and fathers' reports of childhood emotional and behavioral problems

This study examined the effect of parental distress on mothers' and fathers' reports of children's emotional and behavioral problems. The subjects were the parents of 696 children aged 10 to 11 or 14 to 15 years living in two-parent families in the community. The study utilized an extended version of the model previously employed by Fergusson, Lynskey, and Horwood (1993) to examine the impact of maternal depression on mothers' reports of children's behavior. In the present study, the extended model was used to assess the impact of distress on reports of childhood externalizing and internalizing problems obtained from both mothers and fathers. The results suggested that distress had little influence on mothers' or fathers' reports of childhood behavior problems. It is concluded that in community studies the size of any bias in mothers' and fathers' reports of childhood behavior problems due to parental distress is likely to be very small and of little clinical significance.

Adolescent depression. Epidemiology, nosology, life stress and social network. Minireview based on a doctoral thesis

The study engaged a total population of 16-17-year-old urban high-school students and 2300 (93%) were screened for depression and previous suicide attempts. Adolescents with high depression scores in self-evaluation (12.3%) or reporting previous suicide attempts (2.4%) were diagnostically interviewed together with one control for each, matched for gender and educational program. After the interview self-ratings were completed regarding social network, family climate, and life events. Major depression was prevalent during the last year in 5.8% and during life time in 11.4%, 4 girls for every boy. A depression with remaining symptoms for a year or more was the most common type. Dysthymia without major depressive episodes was diagnosed in 1.1%, two girls for every boy. Short hypomanic episodes had been experienced by 13.2% of those with major depressive disorder. Anxiety disorder was comorbid to depression in one half and conduct disorder in one forth of the depressed adolescents. Alcohol was abused by 6.5% and used regularly by another 12%. Other drugs were used by 6.5% of depressed adolescents and not at all by controls. The depressed used tobacco twice as frequently as non-depressed. Social network and family climate were compared within the originally matched pairs. Adolescents with long-lasting depressions had a smaller and unsatisfying social network. They also had experienced many stressful life events related to family adversities, while those with shorter depressive episodes had stress related to the peer group. Depressed adolescents with comorbid conduct disorder reported insufficient support from the close network and a more negative family climate.

Mother-child agreement on self-report of anxiety in abused children

This study investigates the lack of agreement in maternal and child report of child anxiety with a sample of abused and nonabused clinic-referred children. Based on the literature, it was predicted that nonabused clinic-referred children would report more symptoms of anxiety than their mothers would report for them. It was also predicted that mothers of abused children would report greater anxiety symptoms for their children than the children's self-report. Finally, it was predicted that maternal psychopathology, specifically anxiety, would increase the probability that mothers would overreport their children's anxiety. Mother-child agreement based on anxiety symptoms assessed by the Quay Behavior Problem Checklist and the Revised-Children's Manifest Anxiety Scale was obtained on 54 male and female outpatients, 5 to 16 years of age. Overall, mothers reported significantly more anxiety for their children, than the children's own self-report, irrespective of abuse history. The implications of the findings are discussed with respect to the validity of maternal and child report. Directions for future research are also offered.

Subject and informant variables affecting family history diagnoses of depression and dementia

The aim of the present study was to evaluate subject and informant factors affecting the validity of the family history for dementia and depression. Relatives of patients and control subjects (n = 531) were interviewed directly. At least one 'significant' other provided family history information on every interviewed relative. The detection of dementia or depression based on the family history increased with the severity of the respective disorder. The likelihood of detecting dementia based on the family history increased in proportion to the subject's age. A lifetime diagnosis of depression in the informant improved the detection of this disorder in a relative. The presence of another psychiatric disorder in either the interviewed relative or the informant significantly increased the risk for false-positive diagnoses of depression. The present results demonstrate that family history information on depression and dementia is influenced by different proband and informant variables. On the basis of these results, we cannot recommend reducing thresholds for family history diagnoses.

In the eye of the beholder? Parental ratings of externalizing and internalizing symptoms

Variations in ratings of externalizing and internalizing symptoms may contain a trait (i.e., shared view) component when behavioral symptoms that generalize across context are perceived and an individual view component when they are misperceived of when each informant has access to different symptoms. Using a LISREL model, we estimated that the trait and the important-specific, individual view components in parental ratings of externalizing and internalizing symptoms of adolescent siblings. This model demonstrated that mothers' and fathers' ratings contained a substantial individual view component (from 21% to 50% of total rating variance, depending on rater and trait). Except for fathers' ratings of internalizing symptoms (13%), parental ratings also contained a substantial trait component (42% to 58%). Mother's, fathers', and child's ratings may be averaged to estimate a trait of externalizing. To estimate an internalizing trait, it may be best to combine just the mother's rating with the child's self-rating.

Does psychiatric history bias mothers' reports? An application of a new analytic approach

OBJECTIVE

To evaluate whether mothers' psychiatric history biases reports of their children's behavior problems, mothers' and teachers' reports of children's behavior problems were compared using a recently developed statistical approach.

METHOD

Child Behavior Checklists and Teacher's Report Forms were completed by mothers and teachers, respectively, about 801 six-year-old children. Mother's history of major depression, anxiety disorders, and substance use disorder was assessed by using the National Institute of Mental Health Diagnostic Interview Schedule. Generalized estimating equations were used for data analysis.

RESULTS

According to both teachers and mothers, maternal history of major depression was associated with more internalizing problems; the association was significantly stronger when mothers were the informants. Mothers with history of any psychiatric disorder reported more externalizing problems in their children than expected, whereas teachers' reports of externalizing behaviors were unrelated to maternal psychiatric history. These findings could not be explained by variations in children's behaviors across settings.

CONCLUSION

The generalized estimating equation models enabled simultaneous examination of whether children of depressed mothers have excess behavior problems and whether depressed mothers overreport behavior problems in their children. The results indicate that children of depressed mothers have more internalizing problems. In addition, depressed mothers overstate and overgeneralize their offspring's behavior problems. This study broadens the concerns with reporting bias beyond maternal depression to include other psychiatric problems. The results emphasize the potential for bias in family history studies that rely on informants.

At risk for anxiety: I. Psychopathology in the offspring of anxious parents

OBJECTIVE AND METHOD

Children of parents with anxiety disorders, depressive disorders, mixed anxiety/depressive disorders, and no psychiatric disorder were assessed with semistructured interviews to determine rates of overall psychopathology and to determine specifically the presence of anxiety disorders.

RESULTS

Children of the three "high-risk" groups were significantly more likely to have a diagnosable disorder (including anxiety disorders) than offspring of normal parents, but there were no differences among the children from the three parental diagnostic groups. However, when examined specifically for anxiety disorders, offspring of anxious parents were significantly more likely to have only anxiety disorders. Offspring of depressed or mixed anxious/depressed parents had a broader range of disorders and more comorbid disorders. Family socioeconomic status was related to the probability that a child would have a disorder.

CONCLUSIONS

Anxiety disorders are common among offspring of anxious and depressed parents. However, when a parent has depression, children exhibit a broader range of psychopathology than when a parent has an anxiety disorder alone.