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Recent research: mothers, children & depression

Here are five recent papers on mothers, families, children and depression.  The first is a freely viewable editorial by Markowitz which begins with a quote from the Aeneid "I cannot bear a mother's tears".  Markowitz looks at evidence demonstrating the importance of both nature (genetic risk) and nurture (effects of the mother-child relationship and other environmental factors) on psychological outcomes.  The second paper is a good overview of postnatal depression by Musters et al.  Unfortunately the full text is only viewable if you are a BMJ subscriber or if you pay for the article (or contact the authors).  The third study looks at the benefits for children of effective treatment for maternal depression.  The fourth paper - a freely viewable editorial by Reiss - looks both at the effects of maternal depression on children and the effects of children's psychological symptoms on mothers.  The fifth study is unusual and interesting as it compares the effects of parental depression on both nonadopted and on adopted children.

Markowitz, J. C. (2008). "Depressed Mothers, Depressed Children." Am J Psychiatry 165(9): 1086-1088. [Free Full Text]
This free full text editorial states "As neuropsychiatric basic science research has grown increasingly sophisticated, the pendulum has been swinging toward nature and away from nurture. This shift risks the neglect of psychiatry's old home base, the dynamics of the nuclear family. Three excellent articles in this issue indicate, however, that nurture plays a crucial role for mothers with major depressive disorder and the effect of their depression on their children."  The editorial goes on to discuss this field interestingly and helpfully.

Musters, C., E. McDonald, et al. (2008). "Management of postnatal depression." BMJ 337(aug08_1): a736-.  [Extract/Full Text]
Summary points: 1.) Postnatal depression occurs after 13% of births. 2.) A previous history of postnatal depression or of any mental illness, poor social support, and depression during the pregnancy all increase the risk of developing the illness. 3.) Postnatal depression needs to be identified and treated promptly and adequately because it can result in a range of lasting adverse outcomes for mother and child. 4.) A range of psychological therapies is effective in treating postnatal depression. 5.) Drugs are also effective and some antidepressants are thought to be safer in breastfeeding mothers than others. 6.) Drugs are recommended for women who decline psychological therapy, or for whom there would be an unacceptable delay in providing non-pharmacological measures

Pilowsky, D. J., P. Wickramaratne, et al. (2008). "Children of Depressed Mothers 1 Year After the Initiation of Maternal Treatment: Findings From the STAR*D-Child Study." Am J Psychiatry 165(9): 1136-1147. [Abstract/Full Text]
OBJECTIVE: Maternal depression is a consistent and well-replicated risk factor for child psychopathology. The authors examined the changes in psychiatric symptoms and global functioning in children of depressed women 1 year following the initiation of treatment for maternal major depressive disorder. METHOD: Participants were 1) 151 women with maternal major depression who were enrolled in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study and 2) their eligible offspring who, along with the mother, participated in the child STAR*D (STAR*D-Child) study (mother-child pairs: N=151). The STAR*D study was a multisite study designed to determine the comparative effectiveness and acceptability of various treatment options for adult outpatients with nonpsychotic major depressive disorder. The STAR*D-Child study examined children of depressed women at baseline and involved periodic follow-ups for 1 year after the initiation of treatment for maternal major depressive disorder to ascertain the following data: 1) whether changes in children's psychiatric symptoms were associated with changes in the severity of maternal depression and 2) whether outcomes differed among the offspring of women who did and did not remit (mother-child pairs with follow-up data: N=123). Children's psychiatric symptoms in the STAR*D-Child study were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children--Present and Lifetime Version (K-SADS-PL), and maternal depression severity in the STAR*D study was assessed by an independent clinician, using the 17-item Hamilton Depression Rating Scale (HAM-D). RESULTS: During the year following the initiation of treatment, maternal depression severity and children's psychiatric symptoms continued to decrease over time. Decreases in the number of children's psychiatric symptoms were significantly associated with decreases in maternal depression severity. When children's outcomes were examined separately, a statistically significant decrease in symptoms was evident in the offspring of women who remitted early (i.e., within the first 3 months after the initiation of treatment for maternal depression) or late (i.e., over the 1-year follow-up interval) but not in the offspring of nonremitting women. CONCLUSIONS: Continued efforts to treat maternal depression until remission is achieved are associated with decreased psychiatric symptoms and improved functioning in the offspring.

Reiss, D. (2008). "Transmission and Treatment of Depression." Am J Psychiatry 165(9): 1083-1085.  [Free Full Text
This interesting free full text editorial discusses current understanding of the effects of maternal depression on children (and the effects of child psychopathology on parents).  A good overview.

Tully, E. C., W. G. Iacono, et al. (2008). "An Adoption Study of Parental Depression as an Environmental Liability for Adolescent Depression and Childhood Disruptive Disorders." Am J Psychiatry 165(9): 1148-1154.  [Abstract/Full Text]
OBJECTIVE: The authors used an adoption study design to investigate environmental influences on risk for psychopathology in adolescents with depressed parents. METHOD: Participants were 568 adopted adolescents ascertained through large adoption agencies, 416 nonadopted adolescents ascertained through birth records, and their parents. Clinical interviews with parents and adolescents were used to determine lifetime DSM-IV-TR diagnoses of major depressive disorder, oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder (ADHD), and substance use disorders in adolescents and major depression in mothers and fathers. Effects of parental depression (either parent with major depression, maternal major depression, and paternal major depression) on adolescent psychopathology were tested in nonadopted and adopted adolescents separately, and interactive effects of parental depression and adoption status were tested. RESULTS: Either parent having major depression and a mother having major depression were associated with a significantly greater risk for major depression and disruptive behavior disorders in both nonadopted and adopted adolescents. Paternal depression did not have a main effect on any psychiatric disorder in adolescents and, with one exception (ADHD in adopted adolescents), did not predict significantly greater likelihoods of disorders in either nonadopted or adopted adolescents. CONCLUSIONS: Maternal depression was an environmental liability for lifetime diagnoses of major depression and disruptive disorders in adolescents. Paternal depression was not associated with an increased risk for psychopathology in adolescents.


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