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Caiada M, Felix S, Guionnet S, Valery KM, Bonilla-Guerrero J, Destaillats JM, Prouteau A. Promoting Intimate Relationships in Mental Illness: A Systematic Review of Interventions. Community Ment Health J 2024; 60:536-551. [PMID: 38015269 DOI: 10.1007/s10597-023-01204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
Although persons with Serious Mental Illness (SMI) express a need for intimate relations with others, they still suffer from a severe lack of social participation in this domain. However, these unmet needs have received little attention until recently. This study reviews interventions that aim to facilitate the development and the maintenance of intimate relationships (IR) of persons with schizophrenia, bipolar disorder and major depression. A systematic review following PRISMA guidelines was conducted. Studies published in Scopus, PubMed, EBSCO (Psych INFO, Psych ARTICLES, Psychology and Behavioral Sciences Collection) from January 1, 2000, to December, 2021, were screened. The search using terms referring to "schizophrenia", "bipolar disorder", "major depression", "IR" and "interventions" revealed 11 studies. Among them, 10 reported interventions for persons with depression, including 9 for couple therapy. Most interventions targeted satisfaction with couple relationships as the main therapeutic objective. Heterogeneity in study design precludes any firm conclusions about their efficacy. Interestingly, only one intervention focused on single persons interested in developing IR. The results highlight the lack of interventions: (i) aimed at promoting IR, (ii) designed for single persons, and (iii) targeting persons with psychotic disorders. This result may reflect the persisting stigmatization of persons with psychotic disorders, and the taboo associated with the IR and sexuality of persons with mental illness. Further studies are needed to develop inclusive interventions promoting the development of IR in persons with mental illness.
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Affiliation(s)
- Meryl Caiada
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France.
| | - Simon Felix
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
| | - Sarah Guionnet
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
| | - Kevin-Marc Valery
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
| | | | | | - Antoinette Prouteau
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
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Van Schoors M, Van Lierde E, Steeman K, Verhofstadt LL, Lemmens GMD. Protective factors enhancing resilience in children of parents with a mental illness: a systematic review. Front Psychol 2023; 14:1243784. [PMID: 38192397 PMCID: PMC10773682 DOI: 10.3389/fpsyg.2023.1243784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024] Open
Abstract
Objectives A systematic review was conducted to (1) investigate protective factors enhancing resilience in children of parents with a mental illness (COPMI), and (2) examine theoretical and methodological issues in the existing literature. Method Following guidelines for systematic reviews, searches were performed using Web of Science, Pubmed and Embase. After screening 5,073 articles 37 fulfilled inclusion criteria and were extracted for review. Results of the present review indicate that there are several ways to help build resilience in COPMI. More specifically, five protective factors emerged from the reviewed literature: Information, Support, Family functioning and Connectedness, Child coping, and Parenting. Discussion Research on protective factors in children confronted with parental mental illness is still scarce and for some factors no clear conclusions can be drawn based on the available evidence. To further our understanding of the building blocks and underlying mechanisms of resilience in COPMI, additional rigorously designed studies are needed.
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Affiliation(s)
| | | | | | - Lesley L. Verhofstadt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Gilbert M. D. Lemmens
- Department of Head and Skin – Psychiatry, Ghent University, Ghent, Belgium
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
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Levine MP, Sadeh-Sharvit S. Preventing eating disorders and disordered eating in genetically vulnerable, high-risk families. Int J Eat Disord 2023; 56:523-534. [PMID: 36579440 DOI: 10.1002/eat.23887] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To close the chasm between theory about families containing a parent with an eating disorders (EDs) history and lack of selective or indicated prevention programming for such families with an older child or adolescent who is, genetically, at high risk. METHOD A search of four major databases for January 2000 through September 2022 yielded no publications that (a) identified genetically high-risk families with offspring ages 10 through 18; (b) devised a prevention program for the family; and (c) evaluated program effects on risk/protective factors. To rectify this gap, research on three lines of family-based prevention is reviewed: (1) programs for adolescents at genetic risk for depression or anxiety; (2) the Stanford-Dresden project for adolescents at high risk for anorexia nervosa; and (3) Sadeh-Sharvit et al.'s work concerning the Parent-Based Prevention program for mothers with an EDs history and a child under age 5. RESULTS The significant challenges for innovative prevention programming should be addressed by experts in effective EDs, depression, and anxiety prevention, and in family-based treatment (FBT) for EDs, collaborating with people from genetically vulnerable families. Innovative programming should focus on robust risk factors for EDs, adaptive expression of non-specific risk factors (e.g., temperament), and strengthening family functioning. DISCUSSION The field is overdue for development of prevention programs designed for older children or adolescents who are at risk because a parent has an ED. Evidence-based prevention programs for EDs and for depression and anxiety, as well as parent-based prevention informed by FBT, provide a springboard for addressing this gap. PUBLIC SIGNIFICANCE The foundation of theory and research is available for stakeholders to develop prevention programming that closes the huge gap between theory and research about families that are genetically vulnerable for eating disorders versus the complete lack of prevention programming for such families that have an older child or adolescent at high risk.
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Eklund R, Lövgren M. The Family Talk Intervention in Pediatric Oncology: Ill Children's Descriptions of Feasibility and Potential Effects. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:143-154. [PMID: 35467434 DOI: 10.1177/27527530221068423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: There are few scientifically evaluated psychosocial interventions in pediatric oncology, despite the needs for families. The family-based psychosocial intervention "The Family Talk Intervention" (FTI) has shown promising results in other care contexts and was therefore pilot-tested in pediatric oncology. In this study, we examined the experiences of participating in FTI from ill children's perspectives regarding feasibility and potential effects. Methods: This pilot study involved 26 families in pediatric oncology that had participated in FTI. The paper is focused on those ill children who answered surveys (n = 19) and/or participated in interviews (n = 11) when FTI had ended. Data were analyzed with descriptive statistics and thematic analysis. Results: For most ill children, FTI came at the right time, included a reasonable number of meetings, and the length of the meetings was appropriate. The children felt listened to and understood by the interventionists and almost all children reported that FTI had helped them in some way. The children's perceptions indicated that FTI improved communication within the family and strengthened family relations. Children reported that the parents and their siblings seemed to feel better after participation and became more understanding. Discussion: The findings of this pilot study indicated that a full-scale study could be valuable from the ill children's perspective, as FTI was reported as feasible and had positive effects. The findings showed that FTI gave families an opportunity to open up communication about the illness, adjust their behaviors, and strengthen family relationships. Trial registration: ClinicalTrials.gov Identifier NCT03650530.
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Affiliation(s)
- Rakel Eklund
- 7643Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, Stockholm, Sweden
- Department of Neuroscience, National Centre for Disaster Psychiatry, 8097Uppsala University, Uppsala, Sweden
| | - Malin Lövgren
- 7643Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, Stockholm, Sweden
- Advanced Pediatric Home Care, Astrid Lindgren Children's Hospital, 59562Karolinska University Hospital, Stockholm, Sweden
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Allchin B, Solantaus T. An Evidence-Based Practice Developed in-situ: Let's Talk About Children and a Consolidation of Its Evidence Base. Front Psychiatry 2022; 13:824241. [PMID: 35237194 PMCID: PMC8882815 DOI: 10.3389/fpsyt.2022.824241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Traditional models of evidence-based practice assume knowledge is developed in research settings before being installed in practice settings. The role practice settings can play in enhancing effectiveness and enabling sustainability is not therefore acknowledged. Developing interventions in-situ alongside developing their evidence base, provides another pathway to evidence-based practice. One example is Let's Talk about Children (LTC), a brief family-focused intervention that promotes parent, family and child wellbeing. Let's Talk about Children has been developed and adapted to respond to the context into which it has been established, leading to different descriptions reported in its 20 year collection of evidence. Collating the diverse literature on LTC, this paper showcases an evidence-based practice developed in-situ in order to guide future innovation. METHOD Using an integrative review, key literature using LTC were identified through electronic databases and snowballing techniques. Constant comparison analysis synthesized the data to develop patterns and themes. FINDINGS From the 26 records, three forms of LTC were identified and outcomes related to parents, family and child wellbeing, implementation and sustainability were collated. Consolidated outcomes show overall agreement in effectiveness and acceptability outcomes across different settings and populations. Implementation and sustainability impacts are entwined with the context, and influenced by its development in-situ. CONCLUSIONS The study documents that the in-situ model is effective at developing sustainable evidence-based practice. In consolidating the evidence, the review clarified LTC's forms and outcomes, and draws attention to the importance of research on mechanisms of change.
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Affiliation(s)
- Becca Allchin
- Eastern Health, Mental Health Program, Melbourne, VIC, Australia.,School of Rural Health, Monash University, Melbourne, VIC, Australia
| | - Tytti Solantaus
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Breaking the silence about illness and death: Potential effects of a pilot study of the family talk intervention when a parent with dependent children receives specialized palliative home care. Palliat Support Care 2021; 20:512-518. [DOI: 10.1017/s1478951521001322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective
The entire family is affected when a parent is severely ill. Parents often need and appreciate professional support when talking to children about illness and death. The family talk intervention (FTI) is family-centered and intends to promote communication about the illness and its consequences, support parenting to enhance family coping and help family members share experiences with each other to create a shared family history. This study aimed to explore potential effects of FTI in specialized palliative home care, as reported by parents.
Method
This pre-post test intervention pilot was conducted in specialized palliative home care. A convergent mixed-method design was used to analyze interview and questionnaire data. Twenty families with dependent children were recruited from two specialized palliative home care units in Stockholm, Sweden.
Results
Parents reported that family communication improved after participation in FTI as family members learned communication strategies that facilitated open sharing of thoughts and feelings. Increased open communication helped family members gain a better understanding of each other's perspectives. Parents reported that relationships with their partner and children had improved as they now shared several strategies for maintaining family relationships. Parents were also less worried following participation in FTI. The ill parents stated that they gained a sense of security and were less worried about the future.
Significance of results
This study adds to the evidence that FTI may be a useful intervention for families with dependent children and an ill parent in a palliative care setting. This trial is registered at ClinicalTrials.gov Identifier NCT03119545.
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Eklund R, Jalmsell L, Kreicbergs U, Alvariza A, Lövgren M. Children's experiences of the family talk intervention when a parent is cared for in palliative home care-A feasibility study. DEATH STUDIES 2020; 46:1655-1666. [PMID: 33054633 DOI: 10.1080/07481187.2020.1829747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to explore the feasibility of the family talk intervention (FTI) and its acceptability to dependent children when a parent is cared for in palliative home care. The main goal of FTI is to increase family communication about the illness. The present paper derives from a pilot study and is based on 25 children's reports, involving both questionnaires and interviews, after participation. A majority of the children appreciated the structure and content of FTI. They felt seen, heard, and acknowledged by the interventionists and recommended FTI to other children in similar situations.
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Affiliation(s)
- Rakel Eklund
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, National Centre for Disaster Psychiatry, Uppsala University, Uppsala, Sweden
| | - Li Jalmsell
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Breast cancer, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institute, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institute, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
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Eklund R, Kreicbergs U, Alvariza A, Lövgren M. Children's Views Are Not Taken Into Account in Accordance With Article 12 of the United Nations Convention on the Rights of the Child in the Family Talk Intervention When a Parent Is Cared for in Palliative Care. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:126-154. [PMID: 32659170 DOI: 10.1177/0030222820941283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Having a parent with a life-threatening illness is challenging throughout the illness trajectory, and for some also in bereavement. Article 12 of the United Nations Convention on the Rights of the Child states a child's right to express their opinion and have it respected in processes that affect them. The aims of this paper were to explore the child's active participation in a family support programme, the Family Talk Intervention, in accordance with Article 12, when having a parent cared for in palliative care. Twenty families with 50 children participated. Fieldnotes were taken during the programme and later analysed with interpretive descriptions. The study shows that all children were listened to, but only a quarter reached the minimum point required in Article 12, where their views were taken into account. The Family Talk Intervention in palliative care would benefit from implementing a child-centred approach in order for all children to be active participants.
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Affiliation(s)
- Rakel Eklund
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,The Department of Women's and Children's Health, Paediatric Oncology and Haematology, Karolinska Institutet, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,The Department of Women's and Children's Health, Paediatric Oncology and Haematology, Karolinska Institutet, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
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9
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Eklund R, Alvariza A, Kreicbergs U, Jalmsell L, Lövgren M. The family talk intervention for families when a parent is cared for in palliative care - potential effects from minor children's perspectives. BMC Palliat Care 2020; 19:50. [PMID: 32299420 PMCID: PMC7164202 DOI: 10.1186/s12904-020-00551-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children show long-term psychological distress if family communication and illness-related information are poor during and after a parent's illness and death. Few psychosocial interventions for families with minor children living with a parent who has a life-threatening illness have been evaluated rigorously. Even fewer interventions have been family-centered. One exception is the Family Talk Intervention (FTI), which has shown promising results regarding increased illness-related knowledge and improved family communication. However, FTI has not yet been evaluated in palliative care. This study therefore aimed to explore the potential effects of FTI from the perspectives of minor children whose parent is cared for in specialized palliative home care. METHODS This pilot intervention study involves questionnaire and interview data collected from children after participation in FTI. Families were recruited from two specialized palliative home care units. To be included, families must include one parent with life-threatening illness, at least one child aged 6-19 years, and understand and speak Swedish. Twenty families with a total of 34 children participated in FTI; 23 children answered the questionnaire, and 22 were interviewed after participation. RESULTS The children reported that FTI increased their knowledge about their parents' illness. They said the interventionist helped them to handle school-related problems, establish professional counselling, and find strength to maintain everyday life. Children aged 8-12 reported that talking with their parents became easier after FTI, whereas communication was unchanged for teenagers and between siblings. Children also reported having been helped to prepare for the future, and that they benefitted from advice about how to maintain everyday life and minimize conflicts within the family. CONCLUSIONS Children who participated in FTI reported that it was helpful in many ways, providing illness-related information and improving family communication when a parent has a life-threatening illness. Other potential positive effects reported by the children were that FTI facilitated their preparation for the future, decreased family conflicts, and started to build up resilience. TRIAL REGISTRATION ClinicalTrials.gov, Identifier NCT03119545, retrospectively registered 18 April 2017.
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Affiliation(s)
- Rakel Eklund
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden.
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, 121 87, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden
- The Department of Women's and Children's Health, Paediatric Oncology and Haematology, Karolinska Institutet, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Childhood Cancer Research Unit, 177 77, Stockholm, Sweden
| | - Li Jalmsell
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden
- Department of Breast Cancer, Endocrine Tumours and Sarcoma, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden
- The Department of Women's and Children's Health, Paediatric Oncology and Haematology, Karolinska Institutet, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Childhood Cancer Research Unit, 177 77, Stockholm, Sweden
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Mohammadi MR, Alavi SS, Ahmadi N, Khaleghi A, Kamali K, Ahmadi A, Hooshyari Z, Mohamadian F, Jaberghaderi N, Nazaribadie M, Sajedi Z, Farshidfar Z, Kaviani N, Davasazirani R, Shahbakhsh AJ, Rad MR, Shahbazi K, Khodaverdloo RR, Tehrani LN, Nasiri M, Naderi F, Kiani A, Chegeni M, Hashemi Nasab SM, Ghaneian M, Parsamehr H, Nilforoushan N, Amiri S, Fooladi MF, Mohammadzadeh S, Ahmadipour A, Sarraf N, Hojjat SK, Nadermohammadi M, Mostafavi SA, Zarafshan H, Salmanian M, Shakiba A, Ashoori S. The prevalence, comorbidity and socio-demographic factors of depressive disorder among Iranian children and adolescents: To identify the main predictors of depression. J Affect Disord 2019; 247:1-10. [PMID: 30640024 DOI: 10.1016/j.jad.2019.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 12/23/2018] [Accepted: 01/04/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depressive disorders are a major public health problem in developed and developing countries. Recently, several risk factors have been described for depressive disorders in children and adolescents. The aim of the present study was to identify the main risk factors that can affect the incidence of depression in Iranian children and adolescents. METHODS A total of 30,546 children and adolescents (between 6 and 18 years of age) participated in a cross-sectional study to identify the predictors of depressive disorders. Depressive disorders were assessed using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). In addition, a demographic characteristics questionnaire was completed by parents of the participants. The data was analyzed using the SPSS22 software via performing the descriptive analysis and the multiple logistic regression analysis methods. P-values less than 0.05 were considered statistically significant. RESULTS Results showed that a higher age (15-18), being female, and the father's unemployment were associated with an increased odds ratio for depressive disorders. The age of 10-14 (OR = 2.1; 95% CI, 1.57-2.81), the age of 15-18 (OR = 4.44; 95% CI, 3.38-5.83), female gender (OR = 1.44; 95% CI, 1.2-1.73) and the father's unemployment (OR = 1.59; 95% CI, 1.01-2.5) were significant positive predictors, whereas, the mother's job (as a housewife) (OR = 0.66; 95% CI, 0.45-0.96) and a history of psychiatric hospitalization of the father and mother (OR = 0.34; 95% CI, 0.15-0.78 and OR = 0.34; 95% CI, 0.14-0.84) were negative predictors for depressive symptoms. CONCLUSION Depressive symptoms are common in children and adolescents and are correlated with age and gender. The assessment of the prevalence of psychiatric disorders, especially the depressive disorders and their comorbidities, may help to prevent mood disorders in children and adolescents.
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Affiliation(s)
- Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyyed Salman Alavi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nastran Ahmadi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Ali Khaleghi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Koorosh Kamali
- Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Ameneh Ahmadi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Hooshyari
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Fathola Mohamadian
- Department of Psychology, Psychosocial Injuries Research Center, Ilam University of Medical Science, Ilam, Iran.
| | - Nasrin Jaberghaderi
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Marzieh Nazaribadie
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Zahra Sajedi
- Faculty of Psychology and Educational Sciences, University of Semnan, Semnan, Iran.
| | | | - Nahid Kaviani
- Health Deputy, Kerman University of Medical Sciences, Kerman, Iran.
| | - Reza Davasazirani
- Community Mental Health and Addiction Health Department of Khuzestan Province, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | | | | | | | | | | | | | - Fatemeh Naderi
- Hormozgan University of Medical Sciences, Hormozgan, Iran.
| | - Arezou Kiani
- Urmia University of Medical Sciences, Urmia, Iran.
| | | | | | - Mahnaz Ghaneian
- Department of Psychology, Islamic Azad University, Najafabad Branch, Najafabad, Iran.
| | - Hosein Parsamehr
- Lorestan University of Medical Sciences, Imam Reza Psychiatric Hospital, Khorramabad, Iran.
| | | | - Shahrokh Amiri
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mahbod Fadaei Fooladi
- Department of Psychology and Educational Sciences, Allameh Tabatabai University, Tehran, Iran.
| | - Soleiman Mohammadzadeh
- Department of Psychiatry, Neuroscience Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Ahmad Ahmadipour
- Department of Psychiatry, Booshehr University of Medical Sciences, Khalij-E Fars Hospital. Booshehr, Iran.
| | - Nasrin Sarraf
- Department of Child and Adolescents Psychiatry, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Seyed Kaveh Hojjat
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran.
| | | | - Seyed-Ali Mostafavi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hadi Zarafshan
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Salmanian
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Alia Shakiba
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Simin Ashoori
- Mashhad University of Medical Sciences, Mashhad, Iran.
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Karacetin G, Arman AR, Fis NP, Demirci E, Ozmen S, Hesapcioglu ST, Oztop D, Tufan AE, Tural U, Aktepe E, Aksu H, Ardic UA, Basgul S, Bilac O, Coskun M, Celik GG, Demirkaya SK, Dursun OB, Durukan I, Fidan T, Gencoglan S, Gokcen C, Gokten ES, Gorker I, Gormez V, Gundogdu OY, Gurkan CK, Herguner S, Kandemir H, Kilic BG, Kilincaslan A, Mutluer T, Nasiroglu S, Ozcan OO, Ozturk M, Sapmaz SY, Suren S, Sahin N, Tahiroglu AY, Toros F, Unal F, Vural P, Yazici IP, Yazici KU, Yildirim V, Yulaf Y, Yuce M, Yuksel T, Akdemir D, Altun H, Ayik B, Bilgic A, Bozkurt OH, Cakir ED, Ceri V, Demir NU, Dinc G, Irmak MY, Karaman D, Kinik MF, Mazlum B, Memik NC, Ozdemir DF, Sinir H, Tasdelen BI, Taskin B, Ugur C, Uran P, Uysal T, Uneri OS, Yilmaz S, Yilmaz SS, Acikel B, Aktas H, Alaca R, Alic BG, Almbaidheen M, Ari FP, Aslan C, Atabay E, Ay MG, Aydemir H, Ayranci G, Babadagi Z, Bayar H, Bayhan PC, Bayram O, Bektas ND, Berberoglu KK, Bostan R, Cakan Y, Canli MA, Cansiz MA, Ceylan C, Coskun N, Coskun S, Demir I, Demir N, Demirdogen EY, Dogan B, Donmez YE, Donder F, Efe A, Eray S, Erbilgin S, Erden S, Ersoy EG, Eseroglu T, Firat SK, Gok EE, Goksoy SC, Guler G, Gules Z, Gunay G, Gunes S, Gunes A, Guven G, Horozcu H, Irmak A, Isik U, Kahraman O, Kalayci BM, Karaaslan U, Karadag M, Kilic HT, Kilicaslan F, Kinay D, Koc EB, Kocael O, Mutlu RK, San Z, Nalbant K, Okumus N, Ozbek F, Ozdemir FA, Ozdemir H, Ozgur BG, Ozkan S, Ozyurt EY, Polat B, Polat H, Sekmen E, Sertcelik M, Sevgen FH, Sevince O, Shamkhalova U, Suleyman F, Simsek NE, Tanir Y, Tekden M, Temtek S, Topal M, Topal Z, Turk T, Ucar HN, Ucar F, Uygun D, Uzun N, Vatansever Z, Yazgili NG, Yildiz DM, Yildiz N, Ercan ES. Prevalence of Childhood Affective disorders in Turkey: An epidemiological study. J Affect Disord 2018; 238:513-521. [PMID: 29936389 DOI: 10.1016/j.jad.2018.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/24/2018] [Accepted: 05/13/2018] [Indexed: 12/17/2022]
Abstract
AIM To determine the prevalence of affective disorders in Turkey among a representative sample of Turkish population. METHODS This study was conducted as a part of the "The Epidemiology of Childhood Psychopathology in Turkey" (EPICPAT-T) Study, which was designed by the Turkish Association of Child and Adolescent Mental Health. The inclusion criterion was being a student between the second and fourth grades in the schools assigned as study centers. The assessment tools used were the K-SADS-PL, and a sociodemographic form that was designed by the authors. Impairment was assessed via a 3 point-Likert type scale independently rated by a parent and a teacher. RESULTS A total of 5842 participants were included in the analyses. The prevalence of affective disorders was 2.5 % without considering impairment and 1.6 % when impairment was taken into account. In our sample, the diagnosis of bipolar disorder was lacking, thus depressive disorders constituted all the cases. Among depressive disorders with impairment, major depressive disorder (MDD) (prevalence of 1.06%) was the most common, followed by dysthymia (prevalence of 0.2%), adjustment disorder with depressive features (prevalence of 0.17%), and depressive disorder-NOS (prevalence of 0.14%). There were no statistically significant gender differences for depression. Maternal psychopathology and paternal physical illness were predictors of affective disorders with pervasive impairment. CONCLUSION MDD was the most common depressive disorder among Turkish children in this nationwide epidemiological study. This highlights the severe nature of depression and the importance of early interventions. Populations with maternal psychopathology and paternal physical illness may be the most appropriate targets for interventions to prevent and treat depression in children and adolescents.
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Affiliation(s)
- Gul Karacetin
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Ayse Rodopman Arman
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Nese Perdahli Fis
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Esra Demirci
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Sevgi Ozmen
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Selma Tural Hesapcioglu
- Karadeniz Technical University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Trabzon, Turkey.
| | - Didem Oztop
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Ali Evren Tufan
- Abant Izzet Baysal University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu, Turkey.
| | - Umit Tural
- Kocaeli University, Department of Psychiatry, Kocaeli, Turkey.
| | - Evrim Aktepe
- Suleyman Demirel University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Isparta, Turkey.
| | - Hatice Aksu
- Adnan Menderes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Aydin, Turkey.
| | - Ulku Akyol Ardic
- Denizli State Hospital, Child and Adolescent Psychiatry, Denizli, Turkey.
| | - Senem Basgul
- Hasan Kalyoncu University, Department of Psychology, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Oznur Bilac
- Manisa Mental Health and Diseases Hospital Child and Adolescent Psychiatry, Manisa, Turkey.
| | - Murat Coskun
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Gonca Gul Celik
- Cukurova University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adana, Turkey.
| | - Sevcan Karakoc Demirkaya
- Adnan Menderes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Aydin, Turkey.
| | - Onur Burak Dursun
- Ataturk University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Erzurum, Turkey.
| | - Ibrahim Durukan
- University of Health Sciences Gulhane Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Tulin Fidan
- Osmangazi University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Eskisehir, Turkey.
| | - Salih Gencoglan
- Yuzuncu Yil University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Van, Turkey.
| | - Cem Gokcen
- Gaziantep University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Gaziantep, Turkey.
| | - Emel Sari Gokten
- University of Health Sciences, Bursa Yuksek Ihtisas Hospital, Child and Adolescent Psychiatry, Bursa, Turkey.
| | - Isık Gorker
- Trakya University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Edirne, Turkey.
| | - Vahdet Gormez
- Istanbul Medeniyet University, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Ozlem Yildiz Gundogdu
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Cihat Kagan Gurkan
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Sabri Herguner
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Hasan Kandemir
- Harran University Faculty of Medicine, Child and Adolescent Psychiatry Department, Sanliurfa, Turkey.
| | - Birim Gunay Kilic
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Ayse Kilincaslan
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Tuba Mutluer
- Van Training and Research Hospital, Department of Child and Adolescent Psychiatry, Van, Turkey.
| | - Serhat Nasiroglu
- Sakarya University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Sakarya, Turkey.
| | - Ozlem Ozel Ozcan
- Inonu University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Malatya, Turkey.
| | - Mucahit Ozturk
- Hasan Kalyoncu University, Department of Psychology, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Sermin Yalin Sapmaz
- Celal Bayar University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Manisa, Turkey.
| | - Serkan Suren
- Samsun Medical Park Hospital, Child and Adolescent Psychiatry, Samsun, Turkey.
| | - Nilfer Sahin
- Mugla Sitki Kocman University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mugla, Turkey.
| | - Aysegul Yolga Tahiroglu
- Cukurova University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adana, Turkey.
| | - Fevziye Toros
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Fatih Unal
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Pinar Vural
- Uludag University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa, Turkey.
| | | | - Kemal Utku Yazici
- Firat University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Elazig, Turkey.
| | - Veli Yildirim
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Yasemin Yulaf
- Private Practice, Child and Adolescent Psychiatry, Tekirdag, Turkey.
| | - Murat Yuce
- Ondokuz Mayis University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Samsun, Turkey.
| | - Tugba Yuksel
- Dicle University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey.
| | - Devrim Akdemir
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Hatice Altun
- Kahramanmaras Sutcu Imam University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kahramanmaras, Turkey..
| | - Basak Ayik
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Ayhan Bilgic
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Ozlem Hekim Bozkurt
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Emine Demirbas Cakir
- Abant Izzet Baysal University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu, Turkey.
| | - Veysi Ceri
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Nagehan Ucok Demir
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Gulser Dinc
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mustafa Yasin Irmak
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Dursun Karaman
- University of Health Sciences Gulhane Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mehmet Fatih Kinik
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Betul Mazlum
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Nursu Cakin Memik
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Dilsad Foto Ozdemir
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Hayati Sinir
- Kahramanmaras Sutcu Imam University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kahramanmaras, Turkey..
| | - Bedia Ince Tasdelen
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Beril Taskin
- Private Doctor, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Cagatay Ugur
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Pınar Uran
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Taciser Uysal
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey.
| | - Ozden Sukran Uneri
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Savas Yilmaz
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Sultan Seval Yilmaz
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Burak Acikel
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Huseyin Aktas
- Dicle University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey.
| | - Rumeysa Alaca
- Dicle University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey.
| | - Betul Gul Alic
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mahmoud Almbaidheen
- University of Health Sciences Gulhane Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Fatma Pinar Ari
- Osmangazi University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Eskisehir, Turkey.
| | - Cihan Aslan
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Ender Atabay
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Merve Gunay Ay
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Hilal Aydemir
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Gülseda Ayranci
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Zehra Babadagi
- Ondokuz Mayis University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Samsun, Turkey.
| | - Hasan Bayar
- Gaziantep University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Gaziantep, Turkey.
| | - Pelin Con Bayhan
- Inonu University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Malatya, Turkey.
| | - Ozlem Bayram
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Nese Dikmeer Bektas
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Kivanc Kudret Berberoglu
- Trakya University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Edirne, Turkey.
| | - Recep Bostan
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Yasemin Cakan
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Merve Arici Canli
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mehmet Akif Cansiz
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Cansin Ceylan
- Trakya University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Edirne, Turkey.
| | - Nese Coskun
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Seyma Coskun
- Gaziantep University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Gaziantep, Turkey.
| | - Ibrahim Demir
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Nuran Demir
- Abant Izzet Baysal University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu, Turkey.
| | - Esen Yildirim Demirdogen
- Ataturk University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Erzurum, Turkey.
| | - Busra Dogan
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Yunus Emre Donmez
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Funda Donder
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Aysegul Efe
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Safak Eray
- Uludag University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa, Turkey.
| | - Seda Erbilgin
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Semih Erden
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Elif Gokce Ersoy
- Osmangazi University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Eskisehir, Turkey.
| | - Tugba Eseroglu
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Sumeyra Kina Firat
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Ezgi Eynalli Gok
- Cukurova University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adana, Turkey.
| | - Seyda Celik Goksoy
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Gulen Guler
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Zafer Gules
- Adnan Menderes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Aydin, Turkey.
| | - Gulay Gunay
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Serkan Gunes
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Adem Gunes
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Gokcen Guven
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Havvana Horozcu
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Ayse Irmak
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Umit Isik
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Ozlem Kahraman
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Bilge Merve Kalayci
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Umut Karaaslan
- Dicle University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey.
| | - Mehmet Karadag
- Gaziantep University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Gaziantep, Turkey.
| | - Hilal Tugba Kilic
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Fethiye Kilicaslan
- Harran University Faculty of Medicine, Child and Adolescent Psychiatry Department, Sanliurfa, Turkey.
| | - Duygu Kinay
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Esra Bulanik Koc
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Omer Kocael
- Uludag University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa, Turkey.
| | - Rahime Kadir Mutlu
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Zejnep San
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Kevser Nalbant
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Nilufer Okumus
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Fatih Ozbek
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Fatma Akkus Ozdemir
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Hanife Ozdemir
- Marmara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Borte Gurbuz Ozgur
- Adnan Menderes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Aydin, Turkey.
| | - Selcuk Ozkan
- University of Health Sciences Gulhane Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Esra Yildirim Ozyurt
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Berna Polat
- Mersin University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
| | - Hatice Polat
- Erciyes University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kayseri, Turkey.
| | - Ebru Sekmen
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mehmet Sertcelik
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Feyza Hatice Sevgen
- Kahramanmaras Sutcu Imam University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kahramanmaras, Turkey..
| | - Oguz Sevince
- Cukurova University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adana, Turkey.
| | - Ulker Shamkhalova
- Cukurova University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adana, Turkey.
| | - Funda Suleyman
- Istanbul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Nurcan Eren Simsek
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Yasar Tanir
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Mehmet Tekden
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Seyhan Temtek
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Melike Topal
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Zehra Topal
- Abant Izzet Baysal University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bolu, Turkey.
| | - Tugba Turk
- University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Child and Adolescent Psychiatry, Istanbul, Turkey.
| | - Halit Necmi Ucar
- Uludag University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa, Turkey.
| | - Filiz Ucar
- Ondokuz Mayis University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Samsun, Turkey.
| | - Duygu Uygun
- University of Health Sciences, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Necati Uzun
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Konya, Turkey.
| | - Zeynep Vatansever
- Kocaeli University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli, Turkey.
| | - Neslihan Gokce Yazgili
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Dilsad Miniksar Yildiz
- Inonu University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Malatya, Turkey.
| | - Nazike Yildiz
- Trakya University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Edirne, Turkey.
| | - Eyup Sabri Ercan
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey.
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de Angel V, Prieto F, Gladstone TRG, Beardslee WR, Irarrázaval M. The feasibility and acceptability of a preventive intervention programme for children with depressed parents: study protocol for a randomised controlled trial. Trials 2016; 17:237. [PMID: 27153835 PMCID: PMC4859948 DOI: 10.1186/s13063-016-1348-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background One of the most important risk factors for childhood depression is being the child of a depressed parent. These at-risk children have two to four times the probability of having an affective episode compared with their peers. Preventive interventions such as Beardslee’s Preventive Intervention Program (PIP) that are targeted at children of depressed parents have proven effective in many countries. The PIP is a family-based approach that works by promoting resilience in children and increasing positive interactions within the family. In this pilot randomised controlled trial (RCT), we will determine the acceptability and feasibility of an adapted version of this intervention in Chile. Methods/design We are conducting a pilot RCT with a manualized intervention. The intervention will be delivered in seven weekly sessions at the family home. It is targeted mostly at parents but will also measure outcomes among the children. Control subjects will follow their treatment as usual. Feasibility and acceptability will be assessed by recruitment, adherence, dropout and level of missing data, as well as the burden of scales and measurement tools. Families will be followed for 11 months. Discussion Given the negative lifelong consequences of depression and the burden they represent, preventive programmes are not only feasible but necessary. Despite the successful implementation of this intervention in different countries, an adaptation to the Chilean reality will be prerequisite. The results of this pilot study will inform a definitive trial that will make the case for its national implementation. Trial registration Clinicaltrials.gov trial identifier: NCT02593266. Registration date: 30 Octo 2015.
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Affiliation(s)
- Valeria de Angel
- Department of Psychiatry, Hospital Clínico University of Chile Medical School, Avenida La Paz, Recoleta, Santiago, 1003, Chile
| | - Fernanda Prieto
- Department of Psychiatry, Hospital Clínico University of Chile Medical School, Avenida La Paz, Recoleta, Santiago, 1003, Chile.,Millennium Institute for Research in Depression and Personality, Avda. Vicuña Mackenna, Macul, Santiago, 1003, Chile
| | | | - William R Beardslee
- Department of Psychiatry, Baer Prevention Initiatives, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Matías Irarrázaval
- Department of Psychiatry, Hospital Clínico University of Chile Medical School, Avenida La Paz, Recoleta, Santiago, 1003, Chile. .,Millennium Institute for Research in Depression and Personality, Avda. Vicuña Mackenna, Macul, Santiago, 1003, Chile.
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How to support patients with severe mental illness in their parenting role with children aged over 1 year? A systematic review of interventions. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1765-83. [PMID: 26091723 DOI: 10.1007/s00127-015-1069-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 05/13/2015] [Indexed: 01/26/2023]
Abstract
PURPOSE There are well-established risks for parents with severe mental illness (i.e. psychotic and bipolar disorders), both for their children and themselves. Interventions to help parents fulfil their role should therefore be a public health objective, but their implementation needs to be underpinned by research evidence. This systematic review determines what is known about the nature and effectiveness of interventions for parents with severe mental illness. METHODS We conducted a narrative synthesis of controlled and uncontrolled studies reporting interventions for this patient group after the post-natal period (i.e. after the child has turned 1 year old). RESULTS Eighteen publications reported data from 15 studies. All but two studies were rated as low quality studies. Interventions included home visiting programmes, complex community programmes, residential treatments, and online interventions. Interventions targeted diverse areas, with parenting skills and understanding the impact of mental illness on parenting most frequently addressed. Both parent and child-related outcomes improved, but children were only assessed via observers and follow-up times were short. CONCLUSIONS Interventions were diverse with respect to their nature and effectiveness. Future interventions should combine different intervention strategies to target multiple areas in a flexible manner. The addition of positively focussed and resource-oriented components should be investigated. Trials should include direct assessments of both parents and children, outcomes that are relevant from a public health perspective, and establish the long-term effects ideally until children have reached 18 years of age.
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Marcotte D, Lemieux A. [The trajectory of depressive symptoms from childhood to adolescence and targets for preventive intervention]. CIENCIA & SAUDE COLETIVA 2015; 19:785-96. [PMID: 24714893 DOI: 10.1590/1413-81232014193.16072013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/26/2013] [Indexed: 11/21/2022] Open
Abstract
Cette étude longitudinale s'intéresse à la trajectoire développementale des symptômes de dépression sur une période de cinq ans entre l'enfance et l'adolescence ainsi qu'à ses facteurs associés. À partir de l'analyse de courbes de croissance latente (Latent Growth Model-LGM), les résultats indiquent que les symptômes de dépression augmentent entre l'âge de 11-12 ans et 15-16 ans chez les filles, mais non chez les garçons. Cependant, pour chacun des sexes, la variance de la pente de la trajectoire reflète l'hétérogénéité des sous-groupes, révélant que les trajectoires varient chez les individus. Parmi les facteurs mesurés au temps 1 de l'étude, ceux qui sont le plus étroitement associés à la variation longitudinale des symptômes dépressifs sont le soutien des amis pour les deux genres et l'âge pour les filles. Plusieurs facteurs sont également associés à la présence de dépression au temps initial. Les cibles d'intervention pour une prévention universelle de la dépression chez les jeunes sont ensuite discutées et un programme visant le développement de facteurs de protection chez les adolescents est présenté
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Depression, Alcohol Abuse, and Alcoholism in One versus Two Parents and the Implications for Child Attachment and Self-Regulation in Infancy through Adolescence. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2015; 2015:275649. [PMID: 27347512 PMCID: PMC4897137 DOI: 10.1155/2015/275649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 02/17/2015] [Indexed: 11/18/2022]
Abstract
This study's purpose was to determine whether the influence of combined parental disorders can cause greater frequency in the occurrence of insecure child attachment and dysfunctions in self-regulation as opposed to the influence of one parent having a disorder. The research design is a quantitative meta-analysis that combined effects from 10 studies to establish differences in the frequency of occurrence for insecure child attachment and dysfunctions in self-regulation through an examination of Cohen's d. Global analysis of Cohen's effect (d) indicated that children being reared by two disordered parents had higher frequency in occurrence of insecure attachment and self-regulation dysfunction than those children reared by only one disordered parent. By addressing the issues surrounding the child population where both parents are disordered, children would have a better chance at healthy development by way of interventions that minimize the occurrence of child psychopathology and foster improvements in the social and overall human condition.
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Cohen S, Daniel O'Leary K, Foran HM, Kliem S. Mechanisms of change in brief couple therapy for depression. Behav Ther 2014; 45:402-17. [PMID: 24680234 DOI: 10.1016/j.beth.2014.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 12/05/2013] [Accepted: 01/07/2014] [Indexed: 11/25/2022]
Abstract
The goal of the present study was to investigate potential mechanisms of previously documented treatment effects for a brief, 5-session, problem-focused couple therapy for depression in a sample of 35 depressed women and their nondepressed husbands. The primary treatment effects were reducing women's depressive symptoms and their husbands' psychological distress and depression-specific burden. Secondarily, treatment resulted in increased relationship satisfaction for both partners. Given these significant treatment changes observed in 5 sessions, we sought to examine the mechanisms of change by testing the following three factors as potential mediators: (a) negative behaviors and attitudes toward depression, (b) support provision, and (c) empathic communication towards the depressed female partners. Women's depression and husbands' depression-specific burden were alleviated by positive changes in their illness-related attitudes and behaviors. Improvements in women's marital satisfaction were also mediated by positive change in their illness-related attitudes and behaviors, along with perceptions of increased positivity and support from their husbands. Findings highlight the importance of targeting specific treatment agents in a brief couple therapy for depression such as psychoeducation about depression and support-building to increase partners' understanding and acceptance of the illness, and teaching communication skills to reduce negative behaviors and criticism that are replaced by more empathic communication towards the depressed individual.
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Affiliation(s)
- Shiri Cohen
- Harvard Medical School/Massachusetts General Hospital.
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17
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Chen HJ. Robust protective factors for Africa American youths who have a parent with depression. SOCIAL WORK RESEARCH 2013; 37:121-134. [PMID: 23869162 PMCID: PMC3711815 DOI: 10.1093/swr/svs026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 07/20/2011] [Accepted: 08/16/2011] [Indexed: 05/22/2023]
Abstract
A considerable body of literature suggests that children of a parent with depression are at heightened risk of developing maladjustments. Few studies, however, have examined protective mechanisms for this population, particularly for African American youths. Based on theoretical and empirical studies of risk and protective factors for offspring of a parent with mental illness, this study examined four adjustment outcomes associated with six protective factors among African American youths in poor communities with a primary caregiver who had depression. Families (N = 126) were drawn from an ongoing panel study, the Family and Community Health Study. Hierarchical regression analyses showed that most protective factors operated only for specific adjustment outcomes; only parental monitoring functioned across behavioral and academic domains of youth adjustment. The findings suggested that the improvement of parental monitoring skills could be essential for interventions designed to prevent multiple adjustment problems among these youths, particularly in behavioral and academic domains. Moreover, because many protective factors across different systems are likely to affect youth resilience, collaborative multisystem programs are needed to targets all of these factors.
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Mason WA, Haggerty KP, Fleming AP, Casey-Goldstein M. Family Intervention to Prevent Depression and Substance Use Among Adolescents of Depressed Parents. JOURNAL OF CHILD AND FAMILY STUDIES 2012; 21:891-905. [PMID: 23798891 PMCID: PMC3689227 DOI: 10.1007/s10826-011-9549-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Parental depression places offspring at elevated risk for multiple, co-occurring problems. The purpose of this study was to develop and preliminarily evaluate Project Hope, a family intervention for the prevention of both depression and substance use among adolescent-aged children (M = 13.9 years) of depressed parents. The program was created by blending two empirically supported interventions: one for depression and another for substance use. Thirty families were randomly assigned to either Project Hope (n = 16) or a wait-list control condition (n = 14). Pretests, posttests (n = 29), and 5-month follow-ups (n = 28) were conducted separately with parents and youth via phone interviews. Questions asked about the family depression experience, family interactions, family management, coping, adolescent substance use beliefs and refusal skills, adolescent depression, and adolescent substance use. Project Hope was fully developed, manualized, and implemented with a small sample of targeted families. Engagement in the program was relatively high. Preliminary outcome analyses were conducted using 2 (Group) ×3 (Time) analyses of covariance. Results provided some evidence for significant improvements among intervention compared to control participants in indicators of the family depression experience, family management, and coping, and a statistically significant decrease from pretest to posttest in alcohol quantity for intervention compared to control youth. Next steps for this program of research are discussed.
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Affiliation(s)
- W Alex Mason
- National Research Institute for Child and Family Studies, Boys Town, NE 68010, USA
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Depressive disorders in school children of suburban India: an epidemiological study. Soc Psychiatry Psychiatr Epidemiol 2012; 47:783-8. [PMID: 21533600 DOI: 10.1007/s00127-011-0383-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Accepted: 04/10/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE There is a dearth of research on the prevalence of depressive disorders in children from suburban and rural areas in the Indian subcontinent. Therefore, the present study was aimed at assessing the prevalence of depressive disorders and the associated risk factors in the primary and secondary school children in suburban India. METHODS This was a cross-sectional, school-based epidemiological study involving 1,851 children from standard I to VII age group. Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS-PL), a semi-structured interview was used to diagnose depression in this sample. RESULTS Using K-SADS-PL, prevalence of depressive disorder was 3.13% (n = 58); major depressive disorder was diagnosed in 15 (0.81%), dysthymia in 28 (1.51%) and depressive disorder NOS in 15 (0.81%). Age (OR 1.396, CI 1.121-1.738), class attendance (OR 0.251, CI 0.103-0.613), family history of psychiatric illness (OR 0.204, CI 0.069-0.605) and birth complications (OR 0.128, CI 0.029-0.558) emerged as significant predictors of depression; the model explained 24.1-32.3% of the variance in this sample. CONCLUSION The present study confirms the findings from previous studies that childhood depression is a distinct diagnostic entity affecting a significant number of children and adolescents.
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Nauta MH, Festen H, Reichart CG, Nolen WA, Stant AD, Bockting CLH, van der Wee NJA, Beekman A, Doreleijers TAH, Hartman CA, de Jong PJ, de Vries SO. Preventing mood and anxiety disorders in youth: a multi-centre RCT in the high risk offspring of depressed and anxious patients. BMC Psychiatry 2012; 12:31. [PMID: 22510426 PMCID: PMC3403886 DOI: 10.1186/1471-244x-12-31] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/17/2012] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Anxiety and mood disorders are highly prevalent and pose a huge burden on patients. Their offspring is at increased risk of developing these disorders as well, indicating a clear need for prevention of psychopathology in this group. Given high comorbidity and non-specificity of intergenerational transmission of disorders, prevention programs should target both anxiety and depression. Further, while the indication for preventive interventions is often elevated symptoms, offspring with other high risk profiles may also benefit from resilience-based prevention programs. METHOD/DESIGN The current STERK-study (Screening and Training: Enhancing Resilience in Kids) is a randomized controlled clinical trial combining selected and indicated prevention: it is targeted at both high risk individuals without symptoms and at those with subsyndromal symptoms. Individuals without symptoms meet two of three criteria of the High Risk Index (HRI; female gender, both parents affected, history of a parental suicide (attempt). This index was developed in an earlier study and corresponds with elevated risk in offspring of depressed patients. Children aged 8-17 years (n = 204) with subthreshold symptoms or meeting the criteria on the HRI are randomised to one of two treatment conditions, namely (a) 10 weekly individual child CBT sessions and 2 parent sessions or (b) minimal information. Assessments are held at pre-test, post-test and at 12 and 24 months follow-up. Primary outcome is the time to onset of a mood or anxiety disorder in the offspring. Secondary outcome measures include number of days with depression or anxiety, child and parent symptom levels, quality of life, and cost-effectiveness. Based on models of aetiology of mood and anxiety disorders as well as mechanisms of change during interventions, we selected potential mediators and moderators of treatment outcome, namely coping, parent-child interaction, self-associations, optimism/pessimism, temperament, and emotion processing. DISCUSSION The current intervention trial aims to significantly reduce the risk of intergenerational transmission of mood and anxiety disorders with a short and well targeted intervention that is directed at strengthening the resilience in potentially vulnerable children. We plan to evaluate the effectiveness and cost-effectiveness of such an intervention and to identify mechanisms of change. TRIAL REGISTRATION NTR2888.
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Affiliation(s)
- Maaike H Nauta
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Helma Festen
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Catrien G Reichart
- Curium/Leiden University Medical Center, Endegeesterstraatweg 27, 2342 AK, Oegstgeest, The Netherlands
| | - Willem A Nolen
- Department of Psychiatry/Interdisciplinary Center of Pathology of Emotion, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - A Dennis Stant
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Claudi LH Bockting
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Nic JA van der Wee
- Department of Psychiatry and Leiden Institute for Brain and Cognition, Leiden University Medical Center, Albinusfreef 2, 2333 ZA, Leiden, The Netherlands
| | - Aartjan Beekman
- Department of Psychiatry and EMGO institute, VU University Medical Center/GGZ inGeest, A.J. Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands
| | - Theo AH Doreleijers
- de Bascule/Academic Medical Center Amsterdam, p/a Postbus 303, 1115 ZG, Duivendrecht, the Netherlands
| | - Catharina A Hartman
- Department of Psychiatry/Interdisciplinary Center of Pathology of Emotion, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Sybolt O de Vries
- Department of Psychiatry/Interdisciplinary Center of Pathology of Emotion, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
- Mental Health Care Friesland (GGz Friesland), Borniastraat 34B, 8934 AD, Leeuwarden, The Netherlands
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Tompson MC, Boger KD, Asarnow JR. Enhancing the developmental appropriateness of treatment for depression in youth: integrating the family in treatment. Child Adolesc Psychiatr Clin N Am 2012; 21:345-84. [PMID: 22537731 PMCID: PMC4808580 DOI: 10.1016/j.chc.2012.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Treatment models for youth depression that emphasize interpersonal functioning, particularly family relationships, may be particularly promising. This article first reviews the current state of knowledge on the efficacy of psychosocial treatments for depression in youth, with an emphasis on family involvement in treatment. It then discusses developmental factors that may impact the applicability and structure of family-focused treatment models for preadolescent and adolescent youth. Finally, two family-based treatment models that are currently being evaluated in randomized clinical trials are described: one focusing on preadolescent depressed youth and the other on adolescents who have made a recent suicide attempt.
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Affiliation(s)
- Martha C Tompson
- Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02215, USA.
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Rooney R, Roberts C, Kane R, Pike L, Winsor A, White J, Brown A. The Prevention of Depression in 8- to 9-Year-Old Children: A Pilot Study. ACTA ACUST UNITED AC 2012. [DOI: 10.1375/ajgc.16.1.76] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe outcomes of a new universal program aimed at preventing depressive symptoms and disorders in 8- to 9-year-old children are presented. The Positive Thinking Program is a mental health promotion program based on cognitive and behavioural strategies. It is designed to meet the developmental needs of children in the middle primary school Years 4 and 5. Four state primary schools were randomly assigned to receive the program implemented by psychologists or to a control condition involving their regular Health Education curriculum. Seventy-two children participated in the intervention condition and 48 children in the control condition. Children completed measures of depressive and anxiety symptomatology, depressive disorders, and attribution style. The intervention was associated with reductions in depressive symptoms and more positive attributions at post-intervention. Compared to the control group, there was a lower prevalence of depressive disorders at posttest and fewer intervention group children developed a depressive disorder at a 9-month follow-up.
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Alasuutari M, Järvi A. “My Dad Got Depression, or Something”: How Do Children Talk about Parental Mental Disorder? QUALITATIVE RESEARCH IN PSYCHOLOGY 2012. [DOI: 10.1080/14780880903414250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fraser C, James EL, Anderson K, Lloyd D, Judd F. Intervention Programs for Children of Parents with a Mental Illness: A Critical Review. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2006.9721897] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rishel CW. Pathways to prevention for children of depressed mothers: a review of the literature and recommendations for practice. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:313689. [PMID: 22454768 PMCID: PMC3290810 DOI: 10.1155/2012/313689] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 10/07/2011] [Accepted: 10/24/2011] [Indexed: 11/18/2022]
Abstract
Maternal depression is one of the most well-documented risk factors for child and adolescent depression, but little work has focused on how to reduce this risk. Although a few interventions have been developed and tested, implementing targeted prevention efforts with depressed mothers and their children is not common practice. The increased risk of depression for children of depressed mothers is so clear, however, professionals can no longer "sit on the sidelines" without initiating specific prevention efforts with this population. To do so requires a paradigm shift-moving from a focus on individual treatment to a prevention approach that engages the entire family as the unit of care. The purpose of this paper is to draw on existing literature to highlight potential "pathways to prevention" for children of depressed mothers. Recommendations for initiating these pathways based on family lifecycle stage, point of contact, and service setting are presented and discussed.
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Affiliation(s)
- Carrie W. Rishel
- Division of Social Work, West Virginia University, P.O. Box 6830, Morgantown, WV 26506, USA
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Solantaus T, Toikka S. The Effective Family Programme: Preventative Services for the Children of Mentally Ill Parents in Finland. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2006.9721744] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Siegenthaler E, Munder T, Egger M. Effect of preventive interventions in mentally ill parents on the mental health of the offspring: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 2012; 51:8-17.e8. [PMID: 22176935 DOI: 10.1016/j.jaac.2011.10.018] [Citation(s) in RCA: 272] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 10/26/2011] [Accepted: 10/28/2011] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Mental illness in parents affects the mental health of their children. A systematic review and a meta-analysis of the effectiveness of interventions to prevent mental disorders or psychological symptoms in the offspring were performed. METHOD The Cochrane, MEDLINE, EMBASE, and PsycINFO databases were searched for randomized controlled trials of interventions in parents with mental disorders. Outcomes in the child included incident mental disorders of the same nature and internalizing (negative emotions, depressive symptoms, anxiety) or externalizing (hyperactivity, aggressiveness, behavioral problems) symptoms. Relative risks and standardized mean differences in symptom scores were combined in random-effects meta-analysis. RESULTS Thirteen trials including 1,490 children were analyzed. Interventions included cognitive, behavioral, or psychoeducational components. Seven trials assessed the incidence of mental disorders and seven trials assessed symptoms. In total 161 new diagnoses of mental illness were recorded, with interventions decreasing the risk by 40% (combined relative risk 0.60, 95% CI 0.45-0.79). Symptom scores were lower in the intervention groups: standardized mean differences were -0.22 (95% CI -0.37 to -0.08) for internalizing symptoms (p = .003) and -0.16 (95% confidence interval -0.36 to 0.04) for externalizing symptoms (p = .12). CONCLUSIONS Interventions to prevent mental disorders and psychological symptoms in the offspring of parents with mental disorders appear to be effective.
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McLaughlin KA. The public health impact of major depression: a call for interdisciplinary prevention efforts. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2011; 12:361-71. [PMID: 21732121 PMCID: PMC3219837 DOI: 10.1007/s11121-011-0231-8] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Major depression is a consequential public health problem in the United States. Depression has long been recognized as an important target of intervention in psychology and psychiatry, but these fields have focused efforts primarily on treatment rather than prevention. Although effective preventive interventions targeting high-risk groups have been developed, they have thus far had poor reach and sustainability in the community. The development of sustainable preventive interventions that have the potential to impact population health represents a critical goal for the field. To this end, a research agenda incorporating the perspectives of both mental health disciplines and public health is proposed as a guide for future depression prevention research. Increased interdisciplinary collaboration between mental health disciplines and public health is recommended to develop, enact, and evaluate multilevel preventive interventions aimed at reducing the population health burden of major depression.
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Affiliation(s)
- Katie A McLaughlin
- Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Valdez CR, Mills CL, Barrueco S, Leis J, Riley AW. A Pilot Study of a Family-Focused Intervention for Children and Families Affected by Maternal Depression. JOURNAL OF FAMILY THERAPY 2011; 33:3-19. [PMID: 23420650 PMCID: PMC3572863 DOI: 10.1111/j.1467-6427.2010.00529.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A non-experimental pilot study examined child, mother, and family outcomes of a 10-session multi-family group intervention designed to reduce risk and promote resilience for mothers with depression and their families. Positive changes following the Keeping Families Strong intervention included mother-reported decreases in child behavior and emotional problems, improvements in the quality of family interactions and routines, and improvements in their own well being and support from others. Children (9-16 years) reported decreased internalizing symptoms, improved coping, increased maternal warmth and acceptance, and decreased stressful family events. Attendance and mother-reported satisfaction were high, indicating the perceived value of the intervention.
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Affiliation(s)
- Carmen R Valdez
- Department of Counseling Psychology, University of Wisconsin at Madison
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Cohen S, O’Leary KD, Foran H. A randomized clinical trial of a brief, problem-focused couple therapy for depression. Behav Ther 2010; 41:433-46. [PMID: 21035609 PMCID: PMC3536531 DOI: 10.1016/j.beth.2009.11.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 11/16/2009] [Accepted: 11/29/2009] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate a brief couple therapy for depression targeted for mildly discordant or nondiscordant couples struggling with the negative impact of depression. Subjects included women with major depression or dysthymia who had husbands without clinical depression. Thirty-five couples were randomly assigned to the 5-week intervention (n=18) or a waitlist control group (n=17), and followed up 1 and 3 months later. Results showed a significant effect of treatment in reducing women's depressive symptoms, with 67% of women improved and 40% to 47% recovered at follow-up, compared to only 17% improved and 8% recovered among women in the control group. Treatment was also effective in secondarily improving women's marital satisfaction, reducing husbands' levels of psychological distress and depression-specific burden, and improving both partners' understanding and acceptance of depression. The treatment was implemented in five 2-hour sessions, representing an efficient, cost-effective approach. Findings support the growing utility of brief, problem-focused couple interventions that simultaneously target depression, relational functioning, and psychological distress experienced by the loved ones of depressed persons.
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Affiliation(s)
- Shiri Cohen
- Department of Psychiatry, Harvard Medical School, Brigham & Women's Hospital, 1249 Boylston Street, Boston, MA 02215, USA.
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Boyd RC, Gillham JE. Review of Interventions for Parental Depression from Toddlerhood to Adolescence. ACTA ACUST UNITED AC 2009; 5:226-235. [PMID: 20824114 DOI: 10.2174/157340009789542123] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Because of the recurrent course, significant burden, and intergenerational impact of depression, there is a great need for interventions for depressed parents and their children. This article reviews eight interventions that 1) aim to impact the functioning and well-being of 18-month to 18-year old children of depressed parents and 2) have been evaluated in controlled studies. The interventions are described and the empirical evidence of their efficacy is reviewed and critiqued. Existing research points to several promising intervention strategies, such as psychoeducation about parental depression, addressing parenting in adult depression treatment, promoting positive parent-child interactions, and teaching coping skills to children. Common limitations of the research in this area are small sample sizes, homogenous samples, and lack of replication. Implementation problems within the mental healthcare system are highlighted. Multi-component interventions seem to be a promising approach to address the complex impact parental depression has on children and the parent-child relationship. This review illustrates the need for more research on intervention models that can be implemented with children at various developmental levels.
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Affiliation(s)
- Rhonda C Boyd
- Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA
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Development of a family-based program to reduce risk and promote resilience among families affected by maternal depression: theoretical basis and program description. Clin Child Fam Psychol Rev 2008; 11:12-29. [PMID: 18360775 DOI: 10.1007/s10567-008-0030-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Depression is a family matter. It not only diminishes the quality-of-life of the depressed person, but also strains the resources of the family unit and increases the children's risk of developing significant problems that start early and persist into adulthood. Although treatment of a parent's depression is critical, many families also need professional intervention to reduce children's risk. This article reviews the evidence on needs of these families and shows that the theoretical and clinical evidence exists to support the design of interventions for families affected by maternal depression. A preventive intervention developed from this foundation is described, the Keeping Families Strong (KFS) program, that is designed to promote resilience and reduce the risk for psychological disorders in children of parents with depression. The pilot study on the KFS program, conducted in adult mental health outpatient settings, is described. Families participate in 10 meetings 90 min each, with a group for parents and for children (10 years and older) conducted concurrently. The program structure and content are described, the challenges of implementing a family preventive intervention in actual clinical settings are discussed, and a case example is provided, as well as preliminary outcome data on ten families. In sum, we provide a strong rationale for the potential of preventive interventions for families affected by maternal depression.
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Korhonen T, Vehviläinen-Julkunen K, Pietilä AM. Implementing child-focused family nursing into routine adult psychiatric practice: hindering factors evaluated by nurses. J Clin Nurs 2008; 17:499-508. [DOI: 10.1111/j.1365-2702.2007.02008.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schmitt F, Santalahti P, Saarelainen S, Savonlahti E, Romer G, Piha J. Cancer families with children: factors associated with family functioning—a comparative study in Finland. Psychooncology 2008; 17:363-72. [PMID: 17614096 DOI: 10.1002/pon.1241] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective is to examine the factors associated with family functioning in families with children where a parent has cancer in comparison to families without cancer. SAMPLE AND METHODS Eighty-five families including 85 cancer patients, 61 healthy spouses and 68 children between 11 and 17 years of age, and a control group of 59 families including 105 adults and 65 children were given a set of questionnaires including a background variable questionnaire, the Family Assessment Device, the Beck Depression Inventory and the Sense of Coherence (SOC). A statistical multilevel model allowing the use of data from several informants belonging to the same family was constructed for the analysis of associations between variables. RESULTS Maternal depression and SOC of family members were associated with family functioning; maternal depression impaired family functioning and family members' SOC improved it. No difference was found between the clinical group and the control group. CONCLUSION In clinical work with cancer families with children, maternal depression and SOC should be focused on.
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Affiliation(s)
- F Schmitt
- Child Psychiatry Clinic, Turku University Hospital, Finland.
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Barrera AZ, Torres LD, Muñoz RF. Prevention of depression: the state of the science at the beginning of the 21st Century. Int Rev Psychiatry 2007; 19:655-70. [PMID: 18092243 DOI: 10.1080/09540260701797894] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Major depression is one of the most prevalent mental disorders and the number one cause of disability worldwide. Once a person experiences a major depressive episode (MDE), the likelihood of recurrence is very high. The prevention of first onset, as well as the protection against recurrence after recovery, are therefore essential goals for the mental health field. By the end of the 20th century, however, most depression research efforts had focused on either acute or prophylactic treatment. In this article, we review USA and international studies that have attempted to reduce incidence of MDE, either 1) to prevent onset in populations of children and adults (including women during the postpartum period) not currently meeting diagnostic criteria for depression, or 2) to prevent a new episode in individuals who have recovered after treatment through protective, but not prophylactic interventions. We identified twelve randomized controlled trials focused on preventing the onset of major depression (both MDE and postpartum depression (PPD)), five randomized controlled trials focusing on preventing relapse, and no randomized controlled trials focused exclusively on preventing recurrent episodes through protective interventions. The review is limited in scope given that depression prevention trials focused on infants, young children, and older adults were not included in the review. The research to date suggests that the prevention of major depression is a feasible goal for the 21st century. If depression prevention interventions become a standard part of mental health services, unnecessary suffering due to depression will be greatly reduced. This review concludes with suggestions for the future direction of depression prevention research.
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Affiliation(s)
- Alinne Z Barrera
- University of California, San Francisco and San Francisco General Hospital, San Francisco, CA 94110, USA.
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Abstract
BACKGROUND People with depression often experience interpersonal problems. Family therapy for depression is a widely used intervention, but it is unclear whether this is an effective therapy for the treatment of depression. OBJECTIVES To assess the efficacy of family therapy for depression. SEARCH STRATEGY The following electronic databases were searched using a specific search strategy: CCDANCTR-Studies and CCDANCTR-References searched on 21/10/2005, The Cochrane Central Register of Controlled Trials, Medline (1966 to January 2005), EMBASE (1980 to January 2005), Psycinfo (1974 to January 2005). Reference lists of articles were also searched. Handsearches of relevant journals and bibliographies were conducted and first authors of included studies and experts in the field were contacted for further information. SELECTION CRITERIA Included studies were randomised controlled and controlled clinical trials comparing family therapy with no intervention or an alternative intervention in which depression symptomatology was a main outcome measure. DATA COLLECTION AND ANALYSIS Methodological quality was independently assessed by two review authors using the Maastricht-Amsterdam Criteria List. The qualitative and quantitative characteristics of the selected trials were independently extracted by three review authors using a standardised data extraction form. Levels of evidence were used to determine the strength of the evidence available. It was not possible to perform meta-analyses because of the heterogeneity of the selected studies. MAIN RESULTS Three high-quality and three low-quality studies, involving 519 people with depression, were identified. The studies were very heterogeneous in terms of interventions, participants, and measuring instruments. Despite fairly good methodological quality and positive findings of some studies, evidence for the effectiveness of family therapy for depression did not exceed level 3 (limited or conflicting evidence), except for moderate evidence (level 2), based on the non-combined findings from three studies, indicating that family therapy is more effective than no treatment or waiting list condition on decreasing depression, and on increasing family functioning. AUTHORS' CONCLUSIONS The current evidence base is too heterogeneous and sparse to draw conclusions on the overall effectiveness of family therapy in the treatment of depression. At this point, use of psychological interventions for the treatment of depression for which there is already an evidence-base would seem to be preferable to family therapy. Further high quality trials examining the effectiveness and comparative effectiveness of explicitly defined forms of family therapy are required.
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Affiliation(s)
- H T Henken
- Maastricht University, Department of Medical, Clinical & Experimental Psychology, Duitse Poort 15, 6221 VA, Maastricht, Netherlands.
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Steck B, Amsler F, Grether A, Dillier AS, Baldus C, Haagen M, Diareme L, Tsiantis J, Kappos L, Bürgin D, Romer G. Mental health problems in children of somatically ill parents, e.g. multiple sclerosis. Eur Child Adolesc Psychiatry 2007; 16:199-207. [PMID: 17136500 DOI: 10.1007/s00787-006-0589-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2006] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Based on the investigation of 144 families (144 patients affected by Multiple Sclerosis (MS), 109 partners, and 192 children) examined in three different European child and adolescent psychiatric University centres by means of questionnaires, we evaluated the prevalence of psychological symptoms in the offspring and associated risk factors such as duration and severity of the disease as well as depression of the ill and the healthy parent. RESULTS Indicate that the severe disease of MS is associated with depression of the ill and healthy parent. Ill parents, especially ill mothers, as well as depressed ill, or depressed healthy parents evaluate their children's mental health problems with a higher prevalence within the internalizing spectrum. Healthy parents report normal psychological adjustment of their children. If two parents present a depressive state, the prevalence of relevant psychological internalizing symptoms is twice or three times as high as the age norms. CONCLUSION Children in families with a parent affected by MS and associated depression of the parental couple are at high risk of mental health problems, especially internalizing disorders. In focusing on the mental health of children one must also be aware of the potential opportunities to address the parents' own psychological needs.
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Affiliation(s)
- Barbara Steck
- Child and Adolescent Psychiatry, University of Basel, Schaffhauserrheinweg 55, 4058 Basel, Switzerland
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Abstract
Whether one takes a biological, psychological, or psychosocial perspective, depression in mothers raises concerns about risks for the development of psychopathology in the children. This review addresses the complexity of that risk and the essential role of development in a model that explains processes of transmission. This article addresses the following aims: (a) to provide convincing evidence that depression in mothers is an important topic for clinical psychologists; (b) to summarize current theoretical models of mechanisms of risk for the development of psychopathology in children of depressed mothers and the status of empirical support for those models; (c) to examine the theoretical bases and current status of evidence for moderators of this risk; (d) to argue for the advantages to be gained from a developmental psychopathology perspective on this topic; and (e) to point to future directions for theory, research, and practice.
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Morriss RK, Faizal MA, Jones AP, Williamson PR, Bolton C, McCarthy JP. Interventions for helping people recognise early signs of recurrence in bipolar disorder. Cochrane Database Syst Rev 2007; 2007:CD004854. [PMID: 17253526 PMCID: PMC6544804 DOI: 10.1002/14651858.cd004854.pub2] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recurrence rates for bipolar disorder are high despite effective treatments with mood stabiliser drugs. Self-help treatments and psychological treatments that teach patients to recognise and manage early warning symptoms and signs (EWS) of impending manic or depressive episodes are popular with patients. The main aim of such interventions is to intervene early and prevent bipolar episodes, thereby increasing the time to the next recurrence and preventing hospitalisation. OBJECTIVES To compare the effectiveness of an EWS intervention plus treatment as usual (TAU ) versus TAU (involving and not involving a psychological therapy) on time to manic, depressive and all bipolar episodes (the primary outcome), hospitalisation, functioning, depressive and manic symptoms. SEARCH STRATEGY Relevant studies identified by searching Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References - searched on 20/10/2005), supplemented with hand searching the journal Bipolar Disorders, searching the UK National Research Register, checking reference lists of included studies and contacting authors. SELECTION CRITERIA Only randomised controlled trials (RCTs) were included. Participants were adults with a diagnosis of bipolar disorder based on standardised psychiatric criteria. DATA COLLECTION AND ANALYSIS Two reviewers independently rated trials for inclusion. Data were extracted from included trials by reviewers using a data extraction sheet. Authors of all the included studies were contacted for any additional information required. Time to recurrence data was summarised as log hazard ratios, dichotomous data as relative risk and continuous data as weighted mean difference, using random effects models to calculate effect size only when there was heterogeneity in the data. MAIN RESULTS Eleven RCTs were identified, but only six provided primary outcome data. All six RCTs were of high quality. Time to first recurrence of any type (RE, hazards ratio 0.57, 95% CI 0.39 to 0.82), time to manic/hypomanic episode, time to depressive episode, and percentage of people hospitalised and functioning favoured the intervention group. Neither depressive nor hypomanic symptoms differed between intervention and control groups. AUTHORS' CONCLUSIONS This review shows a beneficial effect of EWS in time to recurrence, percentage of people hospitalised and functioning in people with bipolar disorder. However, the absence of data on the primary outcome measure in so many included studies is a source of concern and a potential source of bias. Mental health services should consider routinely providing EWS interventions to adults with bipolar disorder, as they appear to reduce hospitalisation and therefore may be cost-effective.
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Affiliation(s)
- R K Morriss
- University of Nottingham, Psychiatry, A Floor, South Block, Nottingham, UK, NG7 2UH.
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Abstract
General psychiatrists frequently treat adult patients with Major Depressive Disorder. Ordinarily, these psychiatrists focus solely on the treatment of their adult patients. However, new data suggest that treatment efforts might be doubly rewarded if psychiatrists tended to the children of these patients as well. This article reviews the literature on children whose parents have Major Depressive Disorder, and on preventive interventions for their children. We also review challenges to funding interventions of this sort based on systematic interviews of public and private insurance providers. We suggest a new standard of care for depressed patients: reliable screening of the patients' children for both risk of disorder and resilience as well as referral of these children, where indicated, for prevention services. We review obstacles to this standard of care: the professional reluctance of general psychiatrists to work with children and the lack of screening and preventive services for these children in most practice settings.
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Affiliation(s)
- Jongil Yuh
- Center for Family Research, George Washington University Medical Center, Washington, DC 20037, USA.
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Davey M, Gulish L, Askew J, Godette K, Childs N. Adolescents coping with mom's breast cancer: developing family intervention programs. JOURNAL OF MARITAL AND FAMILY THERAPY 2005; 31:247-58. [PMID: 15974061 DOI: 10.1111/j.1752-0606.2005.tb01558.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The purpose of this pilot study was to gain a deeper understanding of how adolescents are affected by their mothers' breast cancer and to discover their opinions about how future intervention programs should be designed. Three focus groups were conducted with a total of 10 adolescents. Findings indicate that adolescents' lives had been complicated by their mothers' illness, as they often felt burdened with additional roles and responsibilities. Adolescents suggested that future intervention programs should have the following elements: Adolescent group comprised of boys and girls within 4 months of cancer diagnosis; psychoeducation; target coping skills sensitive to girls and boys of different ethnic and racial backgrounds; and after the adolescent groups, have multiple-family therapy groups that promote shared family understanding and open communication between parents and adolescents.
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Affiliation(s)
- Maureen Davey
- PATH, 8220 Castor Avenue, Philadelphia, Pennsylvania 19152, USA.
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Van Doesum KT, Hosman CM, Riksen-Walraven JM. A model-based intervention for depressed mothers and their infants. Infant Ment Health J 2005; 26:157-176. [DOI: 10.1002/imhj.20037] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ihle W, Ahle ME, Jahnke D, Esser G. Leitlinien zur Diagnostik und Psychotherapie von depressiven Störungen im Kindes- und Jugendalter: Ein evidenzbasierter Diskussionsvorschlag. KINDHEIT UND ENTWICKLUNG 2004. [DOI: 10.1026/0942-5403.13.2.64] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Ein Entwurf evidenzbasierter Leitlinien zur Diagnostik und Psychotherapie von depressiven Störungen im Kindes- und Jugendalter wird vorgestellt. Für die Diagnosestellung depressiver Störungen im Kindes- und Jugendalter müssen die gleichen diagnostischen Kriterien nach ICD-10 erfüllt sein wie für Erwachsene. Allerdings kann das klinische Bild einer Depression in verschiedenen Altersgruppen deutlich variieren. Depressive Störungen sind vor allem im Jugendalter häufig, chronische Verläufe und Rückfälle treten auf und sie gehen oft mit komorbiden Störungen wie Angststörungen, Störungen des Sozialverhaltens und Störungen durch Substanzgebrauch einher. Wirksame Interventionsansätze zur Prävention depressiver Störungen und zur Akutbehandlung bei leichten und mittelschweren depressiven Störungen stehen zur Verfügung. Die psychotherapeutischen Interventionen der Wahl stellen derzeit kognitiv-verhaltenstherapeutische Ansätze (KVT) und die interpersonale Therapie (IPT) dar. Die Antidepressiva der Wahl sind derzeit selektive Serotoninwiederaufnahmehemmer (SSRI). Weitere Studien, vor allem hinsichtlich Rückfallprophylaxe und der Evaluation der Wirksamkeit einer Kombinationsbehandlung von Psychotherapie mit antidepressiver Medikation stehen noch aus.
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Affiliation(s)
- Wolfgang Ihle
- Institut für Psychologie und Akademie für Psychotherapie und Interventionsforschung an der Universität Potsdam
| | - Maria Elisabeth Ahle
- Institut für Psychologie und Akademie für Psychotherapie und Interventionsforschung an der Universität Potsdam
| | - Dörte Jahnke
- Institut für Psychologie und Akademie für Psychotherapie und Interventionsforschung an der Universität Potsdam
| | - Günter Esser
- Institut für Psychologie und Akademie für Psychotherapie und Interventionsforschung an der Universität Potsdam
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Lustig SL, Weine SM, Saxe GN, Beardslee WR. Testimonial psychotherapy for adolescent refugees: a case series. Transcult Psychiatry 2004; 41:31-45. [PMID: 15171205 DOI: 10.1177/1363461504041352] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescent refugees are a traumatized, vulnerable group of arrivals to America who lack experience with or interest in psychiatric care. Testimonial psychotherapy's unique focus on transcribing personal, traumatic events for the altruistic purpose of education and advocacy make it an acceptable interaction by which to bridge the cultural gap that prevents young refugees from seeking psychiatric care. The theoretical basis for testimony is discussed. Testimonial psychotherapy has been used with adult refugees, but not with adolescents. This article describes the testimonial process with three Sudanese adolescents (the so-called 'Lost Boys'), which appeared feasible and safe. An efficacy study is underway.
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Merry S, McDowell H, Hetrick S, Bir J, Muller N. Psychological and/or educational interventions for the prevention of depression in children and adolescents. Cochrane Database Syst Rev 2004:CD003380. [PMID: 14974014 DOI: 10.1002/14651858.cd003380.pub2] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Depression is the fourth most important disease in the estimation of the burden of disease Murray 1996 and is a common problem with prevalence rates estimated to be as high as 8% in young people. Depression in young people is associated with poor academic performance, social dysfunction, substance abuse, suicide attempts, and completed suicide (NHMRC 1997). This has precipitated the development of programmes aimed at preventing the onset of depression. This review evaluates evidence for the effectiveness of these prevention programmes. OBJECTIVES To determine whether psychological and/or educational interventions (both universal and targeted) are effective in reducing risk of depressive disorder by reducing depressive symptoms immediately after intervention or by preventing the onset of depressive disorder in children and adolescents over the next one to three years. SEARCH STRATEGY The Cochrane Depression, Anxiety and Neurosis Group trials register (August 2002), MEDLINE (1966 to December Week 3 2002), EMBASE (1980 to January Week 2 2003), PsychInfo (1886 to January Week 2 2003) and ERIC (1985 to December 2002) were searched. In addition, conference abstracts, the reference lists of included studies, and other reviews were searched and experts in the field were contacted. SELECTION CRITERIA Each identified study was assessed for possible inclusion by two independent reviewers based on the methods sections. The determinants for inclusion were that the trial include a psychological and/or educational prevention programme for young people aged 5 to 19 years-old, who did not meet DSM or ICD criteria for depression and/or did not fall into the clinical range on standardised, validated, and reliable rating scales of depression. DATA COLLECTION AND ANALYSIS The methodological quality of the included trials was assessed by two independent reviewers according to a list of pre-determined criteria, which were based on quality ratings devised by Moncrieff and colleagues (Moncrieff 2001). Outcome data was extracted and entered into Revman 4.2. Means and standard deviations for continuous outcomes and number of events for dichotomous outcomes were extracted where available. For trials where the required data were not reported or could not be calculated, further details were requested from first authors. If no further details were provided, the trial was included in the review and described, but not included in the meta-analysis. Results were presented for each type of intervention: targeted or universal interventions; and educational or psychological interventions and if data were provided, by gender. Where possible data were combined in meta-analyses to give a treatment effect across all trials. Sensitivity analysis were conducted on studies rated as "adequate" or "high" quality, that is with a score over 22, based on the scale by Moncrieff et al (Moncrieff 2001). The presence of publication bias was assessed using funnel plots. MAIN RESULTS Studies were divided into those that compared intervention with an active comparison or placebo (i.e. a control condition that resembles the intervention being investigated but which lacks the elements thought to be active in preventing depression) and those that used a "wait-list" or no intervention comparison group. Only two studies fell into the former category and neither showed effectiveness although one study was inadequately powered to show a difference and in the other the "placebo" contained active therapeutic elements, reducing the ability to demonstrate a difference from intervention. Psychological interventions were effective compared with non-intervention immediately after the programmes were delivered with a significant reduction in scores on depression rating scales for targeted (standardised mean difference (SMD) of -0.26 and a 95% confidence interval (CI) of -0.40 to -0.13 ) but not universal interventions (SMD -0.21, 95% CI -0.48, 0.06), with a significant effect maintained on pooling data (SMD -0.26, 95% CI -0.36, -0.15). While small effect sizes were reported, these were associated with a significant reduction in depressive episodes. The overall risk difference after intervention translates to "numbers needed to treat" (NNT) of 10. The most effective study is the targeted programme by Clarke (Clarke 2001) where the initial effect size of -0.46 is associated with an initial risk difference of -0.22 and NNT 5. There was no evidence of effectiveness for educational interventions. Reports of effectiveness for boys and girls were contradictory. The quality of many studies was poor, and only two studies made allocation concealment explicit. Sensitivity analysis of only high quality studies did not alter the results significantly. The only analysis in which there was significant statistical heterogeneity was the sub-group analysis by gender where there was variability in the response to different programmes for both girls and boys. For the most part funnel plots indicate findings are robust for short term effects with no publication bias evident. There are too few studies to comment on whether there is publication bias for studies reporting long-term (12-36 month) follow-up. REVIEWER'S CONCLUSIONS Although there is insufficient evidence to warrant the introduction of depression prevention programmes currently, results to date indicate that further study would be worthwhile. There is a need to compare interventions with a placebo or some sort of active comparison so that study participants do not know whether they are in the intervention group or not, to investigate the impact of booster sessions to see if effectiveness immediately after intervention can be prolonged, ideally for a year or longer, and to consider practical implementation of prevention programmes when choosing target populations. Until now most studies have focussed on psychological interventions. The potential effectiveness of educational interventions has not been fully investigated. Given the gender differences in prevalence, and the change in these that occurs in adolescence with a disproportionate increase in prevalence rates for girls, it is likely that girls and boys will respond differently to interventions. Although differences have been reported in studies in this review the findings are contradictory and a more definitive delineation of gender specific responses to interventions would be helpful.
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Affiliation(s)
- S Merry
- Department of Psychiatry, University of Auckland, Private Bag 92019, Auckland, New Zealand
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Ginsburg GS. Anxiety prevention programs for youth: Practical and theoretical considerations. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2004. [DOI: 10.1093/clipsy.bph100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Beardslee WR, Gladstone TRG, Wright EJ, Cooper AB. A family-based approach to the prevention of depressive symptoms in children at risk: evidence of parental and child change. Pediatrics 2003; 112:e119-31. [PMID: 12897317 DOI: 10.1542/peds.112.2.e119] [Citation(s) in RCA: 289] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Depression in parents is a prevalent and impairing illness that is encountered frequently in medical practice. Children of depressed parents are at risk for psychopathology and other difficulties. A series of recent national reports have recommended the development of prevention efforts targeting children of depressed parents. Yet, to date, few controlled prevention studies of depression in children and adolescents have been conducted. In this study, we report the evaluation of 2 preventive intervention strategies that target children living in homes with depressed parents. Both are public health approaches that were designed to be used by a wide range of practitioners from a variety of disciplines, including pediatricians, internists, school counselors, nurses, and mental health practitioners. We adopted a developmental perspective and intervened with families when children were entering the age of highest risk for depression onset (ie, adolescence). We chose a family-based approach to prevention and sought to reduce risk factors and enhance protective factors for early adolescents by increasing positive interactions between parents and children, and by increasing understanding of the illness for everyone in the family. Our prevention approaches were designed to provide information about mood disorders to parents, to equip parents with the skills they need to communicate information to their children, and to open a dialogue with their children about the effects of parental depression. We hypothesized that participation in these prevention programs would result in parental change in child-related behaviors and attitudes about depression and its impact on the family. In addition, we hypothesized that this parental change would produce change in children's self-understanding, and in children's depressive symptomatology. METHODS We conducted a large-scale efficacy trial of 2 manual-based preventive intervention programs that were designed to be used widely in public health settings. These interventions target the relatively healthy children (ages 8-15) of parents with mood disorder. Ninety-three families (88.5% of our initial sample), including 121 children, participated in this study through the fourth assessment point. These families were assigned randomly to either a lecture or a clinician-facilitated intervention. Both interventions were specified in manuals. The lecture condition consisted of 2 separate meetings delivered in a group format without children present. The clinician-facilitated condition consisted of 6 to 11 sessions, including separate meetings with parents and children, and a family meeting in which the parents led a discussion of the illness and of positive steps that can be taken to promote healthy functioning in the children. In addition, telephone contacts or refresher meetings were conducted at 6- to 9-month intervals. In both conditions, psychoeducational material about mood disorders, risk, and resilience was presented and efforts were made to decrease feelings of guilt and blame in children. Parents were helped to build resilience in their children through encouraging their friendships, their success outside of the home, and their understanding of parental illness and of themselves. In addition, in the clinician-facilitated condition, efforts were made to link the psychoeducational material presented to the family's own unique illness experience. To address directly how their lives had changed, all family members in both conditions were assessed for psychopathology and for overall functioning at intake, and for psychopathology, functioning, and response to intervention immediately postintervention, approximately 1 year postintervention, and again approximately 2.5 years postintervention. RESULTS We examined the outcomes of child understanding and internalizing symptomatology, and a number of predictor variables, using repeated measures analyses with generalized estimating equations. We found that parents in both conditions reported significant change in child-related behaviors and and attitudes, and that the amount of change reported increased over time from time 3 to time 4 (chi2(1) = 18.1). Moreover, relative to parents in the lecture program (mean number of changes = 6.3), parents in the clinician-facilitated program reported more change in child-related behaviors and attitudes (mean number of changes = 9.8). Children in both conditions reported increased understanding of parental illness attributable to participation in our intervention programs. There was a positive association between the amount of change children reported in their understanding of parental illness and the number of changes couples reported in child-related behaviors/attitudes (chi2(1) = 37.3; ie, parents who had changed the most in response to intervention had children who also changed the most). Finally, internalizing scores for all children decreased with increased time since intervention (chi2(1) = 7.3). In addition, females had higher internalizing scores than males (chi2(1) = 5.3). There was no significant effect of group on children's change in internalizing symptomatology (chi2(1) = 0.2). CONCLUSIONS We enrolled families with relatively healthy children, administered carefully designed preventive interventions that are manual-based and relatively brief, and found that these programs do have long-standing positive effects in how families problem solve around parental illness. Our results show significant benefits from both interventions. Moreover, changes in parents' perceptions translated directly into changes in children's own understanding of parental illness. Parental behavior and attitude changes and their connection to child changes in understanding identify an important mediating variable: family change. By increasing children's understanding of parental mood disorder, our interventions were found to promote resilience-related qualities in these children at risk. This presentation represents the first and only longitudinal primary prevention study of relatively healthy children at risk for psychopathology attributable to parental mood disorder and demonstrates a significant reduction in risk factors and increase in protective factors in these families over a long time interval--2(1/2) years. Our results provide support for a family-based approach to preventive intervention.
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Timko C, Cronkite RC, Berg EA, Moos RH. Children of parents with unipolar depression: a comparison of stably remitted, partially remitted, and nonremitted parents and nondepressed controls. Child Psychiatry Hum Dev 2002; 32:165-85. [PMID: 11893169 DOI: 10.1023/a:1017924421229] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study reports on 122 families with a depressed parent at baseline and matched nondepressed control families. The 10-year course of depression in parents was characterized as stably-, partially-, or non-remitted. At the 10-year follow-up, children of stably-remitted parents had more psychological distress, physical problems, and disturbance than children of controls. Unexpectedly, children of stably-remitted parents had as much distress and disturbance as children of partially- or non-remitted parents. Stably-remitted families emphasized independence less, and organization more, in comparison to controls at 10 years; partially- and non-remitted families were less cohesive and more conflicted than controls. More severe initial or current parental depression was associated with poorer child adaptation, and family functioning explained children's outcomes above and beyond parents' depression. Children living with parents treated for depression are at risk for problems irrespective of the parent's course, perhaps due to poor family functioning.
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Affiliation(s)
- Christine Timko
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System, Menlo Park, CA 94025, USA.
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Solantaus-Simula T, Punamäki RL, Beardslee WR. Children's responses to low parental mood. I: Balancing between active empathy, overinvolvement, indifference, and avoidance. J Am Acad Child Adolesc Psychiatry 2002; 41:278-86. [PMID: 11886022 DOI: 10.1097/00004583-200203000-00007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims were to study children's behavioral and emotional responses to parental low mood, and the associations of these responses with parental depressive symptoms and the children's own mental distress. METHOD The community sample consists of 990 twelve-year-old Finnish children and their mothers (843) and fathers (573). The children's responses were elicited by inquiring about their behaviors and feelings when their mothers and their fathers were feeling down. RESULTS Cluster analysis identified four response patterns: the Active Empathy, Emotional Overinvolvement, Indifference and Avoidance. The Emotional Overinvolvement and the Avoidance groups reported more depressive and externalizing symptoms than the other two groups. The patterns did not vary on the basis of variation in the level of parental depressive symptoms. CONCLUSIONS Children are sensitive members of their families and feel for their parents. Their responses can reflect both adaptive and nonadaptive patterns.
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Affiliation(s)
- Tytti Solantaus-Simula
- National Research and Development Centre and Helsinki University Hospital for Children and Adolescents, Finland.
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