Outcomes for Children of Depressed Parents

Recently, 3 reports that shed further light on the short- and long-term mental health consequences for children of depressed parents were published.

The first study focused on children of mothers who were depressed.¹ The mothers, who were participants in the sequenced treatment alternatives to relieve depression (STAR*D) multisite trial, had a current diagnosis of major depressive disorder and at least 1 child aged 7 to 17 years. A total of 151 mother-child pairs from primary care and psychiatric outpatient clinics were included in the study.

The mothers' mean age was 37 years. The ethnicity of the sample was as follows: white, 44%; black, 37%; Hispanic, 15%; and other, 4%. Forty-two percent of the mothers were married and 58% were single, divorced, or separated. A majority of the mothers (65%) were employed outside the home. Eighty-six percent of the mothers had completed a high school education or had obtained a college- or graduate-level education. Twenty-nine percent of the mothers were receiving public assistance.

The mothers were clinically rated to have severe (72%) or moderate (28%) depression. With regard to the children's demographic characteristics, the mean age was 11.5 years, and 48% of the sample were girls.

Approximately one third (34%) of the children of the depressed mothers were found to have a current psychiatric disorder, including disruptive behavior (22%), anxiety (16%), and depressive (10%) disorders. The children's lifetime prevalence of psychiatric disorders was 45% and similarly included disruptive behavior (29%), anxiety (20%), and depressive (19%) disorders.

The children's risk of having a depressive or anxiety disorder increased 3-fold if the mother had atypical depressive features. The risk of a child having a depressive disorder also increased substantially (3- to 8-fold) when the mother had a history of suicide attempts and concurrent comorbid panic disorder with agoraphobia. The onset of children's disruptive behavior and anxiety disorders tended to be before age 12. Slightly more than half of depressive disorders in children were diagnosed before adolescence.

Comorbid disorders were also common among children of depressed mothers. For example, 40% of the children with a depressive disorder had an anxiety disorder, and 58% of the children with an anxiety disorder had a disruptive behavior disorder.

The researchers in this study also conducted an investigation to determine whether treating the mothers who were depressed would reduce psychiatric symptoms in their children.² They found that it was necessary for the mother to have at least a 50% response to treatment in order for the researchers to detect any improvement in the children's symptoms. Moreover, the children's diagnoses and symptoms were significantly reduced when their mother's depression remitted after 3 months of medication treatment; there was an 11% decrease in diagnoses for these children. However, there was an 8% increase in the rate of psychiatric diagnoses in children with mothers whose depression did not remit after treatment.

Long-term effects
What happens to children of depressed parents over the long term? Weissman and colleagues³ followed the offspring of parents who were moderately to severely depressed over a 20-year period. This is the longest follow-up study of a high-risk group of offspring with researchers following up with patients into adulthood. The sample included 101 youths with either 1 or both parents with a major depressive disorder and a comparison group of 50 youths who did not have a parent with a major depressive disorder.

At 20-year follow-up, there were no demographic differences between the offspring of depressed parents and nondepressed parents, including gender, age, marital status, education, employment status, income, and mean number of children. However, the risks for major depression, anxiety disorders, and substance dependence were about 3 times as high in the offspring of parents with depression as in the offspring of parents who were not depressed. The peak age of incidence of major depressive disorder was between 15 and 20 years, particularly in females. This age of onset was earlier than in the offspring of parents who were not depressed.

It was also found that the offspring of depressed parents had greater impairment in work and family functioning. At about age 35, more medical illnesses-particularly cardiovascular problems-were found in the offspring of depressed parents than in the offspring of nondepressed parents. The offspring of parents who were depressed were twice as likely to have physical health problems as were the offspring of nondepressed parents. The mortality rate was also higher in the offspring of depressed parents when compared with nondepressed parents (4 deaths compared with 0 deaths; 3 of the deaths were attributable to suicide). Of note, more than 60% of the offspring of parents with depression did not receive any psychiatric treatment during the 20-year follow-up period.

Clinical implications
These studies have important clinical implications regarding depressed parents and their children. For clinicians who treat depressed parents, it is important to consider that their children may also have depression, anxiety, or disruptive behavior disorders. It is more likely that these disorders will occur in children if their parents' depression does not respond to treatment.

It may be helpful to inform parents with depression that their children are at risk for psychiatric disorders, and if the parent notices symptoms developing in his or her child, a psychiatric evaluation should be considered. Parents may benefit from knowing that there is now evidence that successfully treating their depression may result in a significant improvement in their children's psychiatric symptoms as well.

Dr Wagner is the Robert L Stubblefield Professor in the department of psychiatry and behavioral sciences and director of child and adolescent psychiatry at the University of Texas Medical Branch at Galveston.

References:

References1. Pilowsky DJ, Wickramaratne PJ, Rush AJ, et al. Children of currently depressed mothers: a STAR*D ancillary study. J Clin Psychiatry. 2006;67:126-136.
2. Weissman MM, Pilowsky DJ, Wickramaratne PJ, et al. Remissions in maternal depression and child psychopathology: a STAR*D-child report. JAMA. 2006;295: 1389-1398.
3. Weissman MM, Wickramaratne P, Nomura Y, et al. Offspring of depressed parents: 20 years later. Am J Psychiatry. 2006;163:1001-1008.