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Remission of maternal depression and child symptoms among single mothers

A STAR*D-Child report

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An Erratum to this article was published on 29 November 2007

Abstract

Objective

Offspring of depressed parents are at increased risk for depressive and other disorders. We recently found that when depressed mothers reached full remission over 3 months of treatment, a significant improvement in the children’s disorders occurred. Since only a third of the mothers remitted, factors related to maternal remission rates, and thereby child outcomes, were important. This report examined the relationship of the presence of a father in the household to maternal depression remission and child outcomes.

Method

Maternal depression was measured using the 17-item Hamilton Rating Scale for Depression (HRSD17); social functioning was assessed using the Social Adjustment Scale-Self Report (SAS-SR). Children (age 7–17) were assessed independently, blind to maternal outcome, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL) and the Child Global Assessment Scale (C-GAS).

Results

Single mothers (n = 50), as compared to those in two-parent households (n = 61), were more likely to discontinue treatment (31% vs. 16%, P = 0.04), and less likely to remit if they remained in treatment (20% vs. 43%, P = 0.013). These differences remained significant after adjusting for socioeconomic status and potential confounders, but were partially explained by the mother’s pre-treatment social functioning. The reduction in child diagnoses following maternal remission was greater in two-parent than in single-parent households, although a formal test of interaction between the odds ratios was not significant.

Conclusion

Single depressed mothers are more likely to drop out of treatment, and less likely to reach remission if they stay in treatment. This high-risk group requires vigorous treatment approaches.

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References

  1. Agresti A (2002) Categorical data analysis, 2nd edn. John Wiley & Sons, Inc., New York, 120 pp

    Google Scholar 

  2. Ainsworth MS, Blehar MC, Waters E, Wall S (1978) Patters of attachment: a psychological study of the strange situation. Erlbaum, Hillsdale

    Google Scholar 

  3. Bartholomew K, Horowitz LM (1991) Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol 61(2):226–244

    Article  PubMed  CAS  Google Scholar 

  4. Bifulco A, Kwon J, Jacobs C, Moran PM, Bunn A, Beer N (2006) Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Soc Psychiatry Psychiatr Epidemiol 41(10):796–805

    Article  PubMed  Google Scholar 

  5. Bowlby J (1973) Attachment and loss, vol. II: separation: anxiety and anger. Basic Book, New York

    Google Scholar 

  6. Brennan PA, Hammen C, Katz AR, Le Brocque RM (2002) Maternal depression, paternal psychopathology, and adolescent diagnostic outcomes. J Consult Clin Psychol 70(5):1075–1085

    Article  PubMed  Google Scholar 

  7. Brooks-Gunn J, Duncan GJ (1997) The effects of poverty on children. Future Child 7(2):55–71 Review

    Article  PubMed  CAS  Google Scholar 

  8. Brown GW, Moran PM (1997) Single mothers, poverty and depression. Psychol Med 27(1):21–33

    Article  PubMed  CAS  Google Scholar 

  9. Cairney J, Boyle M, Offord DR, Racine Y (2003) Stress, social support and depression in single and married mothers. Soc Psychiatry Psychiatr Epidemiol 38(8):442–449

    Article  PubMed  Google Scholar 

  10. Caspi A, Moffitt TE (2006) Gene–environment interactions in psychiatry: joining forces with neuroscience. Nat Rev Neurosci 7(7):583–590

    Article  PubMed  CAS  Google Scholar 

  11. Ciechanowski P, Russo J, Katon W, Simon G, Ludman E, Von Korff M, Young B, Lin E (2006) Where is the patient? The association of psychosocial factors and missed primary care appointments in patients with diabetes. Gen Hosp Psychiatry 28(1):9–17

    Article  PubMed  Google Scholar 

  12. Ciechanowski P, Russo J, Katon W, Von Korff M, Ludman E, Lin E, Simon G, Bush T (2004) Influence of patient attachment style on self-care and outcomes in diabetes. Psychosom Med 66(5):720–728

    Article  PubMed  Google Scholar 

  13. Connell AM, Goodman SH (2002) The association between psychopathology in fathers versus mothers and children’s internalizing and externalizing behavior problems. Psychol Bull 128:746–773

    Article  PubMed  Google Scholar 

  14. Dierker LC, Merikangas KR, Szatmari P (1999) Influence of parental concordance for psychiatric disorders on psychopathology in offspring. J Am Acad Child Adolesc Psychiatry 38(3):280–288

    Article  PubMed  CAS  Google Scholar 

  15. Dodge KA, Pettit GS, Bates JE (1994) Socialization mediators of the relation between socioeconomic status and child conduct problems. Child Dev 65:649–665

    Article  PubMed  CAS  Google Scholar 

  16. Downey G, Coyne JC (1990) Children of depressed parents: an integrative review. Psychol Bull 108:50–76

    Article  PubMed  CAS  Google Scholar 

  17. Fava M, Rush AJ, Trivedi MH, Nierenberg AA, Thase ME, Sackeim HA, Quitkin FM, Wisniewski S, Lavori PW, Rosenbaum JF, Kupfer DJ (2003) Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study. Psychiatr Clin North Am 26:457–494

    Article  PubMed  Google Scholar 

  18. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    Article  PubMed  CAS  Google Scholar 

  19. Hammen C, Burge D, Burney E, Adrian C (1990) Longitudinal study of diagnoses in children of women with unipolar and bipolar affective disorder. Arch Gen Psychiatry 47:1112–1117

    PubMed  CAS  Google Scholar 

  20. Jablonska B, Lindberg L (2007) Risk behaviours, victimisation and mental distress among adolescents in different family structures. Soc Psychiatry Psychiatr Epidemiol (Epub ahead of print)

  21. Kafetsios K, Nezlek JB (2002) Attachment styles in everyday social interaction. Eur J Soc Psychol 32:719–735

    Article  Google Scholar 

  22. Kane P, Garber J (2004) The relations among depression in fathers, children’s psychopathology, and father–child conflict: a meta-analysis. Clin Psychol Rev 24(3):339–360

    Article  PubMed  Google Scholar 

  23. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective disorders and schizophrenia for school age children present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988

    Article  PubMed  CAS  Google Scholar 

  24. Kilbourne AM, McCarthy JF, Post EP, Welsh D, Blow FC (2007) Social support among veterans with serious mental illness. Soc Psychiatry Psychiatr Epidemiol (Epub ahead of print)

  25. Lieb R, Isensee B, Hofler M, Pfister H, Wittchen HU (2002) Parental major depression and the risk of depression and other mental disorders in offspring. Arch Gen Psychiatry 59:365–374

    Article  PubMed  Google Scholar 

  26. Lipman EL, Boyle MH (2005) Social support and education groups for single mothers: a randomized controlled trial of a community-based program. CMAJ 173(12):1451–1456

    PubMed  Google Scholar 

  27. Martins C, Gaffan EA (2000) Effects of early maternal depression on patterns of infant–mother attachment: a meta-analytic investigation. J Child Psychol Psychiatry 41(6):737–746

    Article  PubMed  CAS  Google Scholar 

  28. Miranda J, Chung JY, Green BL, Krupnick J, Siddique J, Revicki DA, Belin T (2003) Treating depression in predominantly low-income young minority women: a randomized controlled trial. JAMA 290(1):57–65

    Article  PubMed  Google Scholar 

  29. Olson SL, Ceballo R, Park C (2002) Early problem behavior among children from low-income, mother-headed families: a multiple risk perspective. J Clin Child Adolesc Psychol 31(4):419–430

    Article  PubMed  Google Scholar 

  30. Phares V, Compas BE (1992) The role of fathers in child and adolescent psychopathology: make room for daddy. Psychol Bull 111(3):387–412

    Article  PubMed  CAS  Google Scholar 

  31. Pilowsky DJ, Wickramaratne PJ, Rush AJ, Hughes CW, Garber J, Malloy E, King CA, Cerda G, Sood AB, Alpert JE, Wisniewski SR, Trivedi MH, Talati A, Carlson MM, Liu HH, Fava M, Weissman MM (2006) Children of currently depressed mothers: a STAR*D ancillary study. J Clin Psychiatry 67(1):126–136

    Article  PubMed  Google Scholar 

  32. Rush AJ, Bernstein IH, Trivedi MH, Carmody TJ, Wisniewski S, Mundt JC, Shores-Wilson K, Biggs MM, Woo A, Nierenberg AA, Fava M (2006) An evaluation of the quick inventory of depressive symptomatology and the hamilton rating scale for depression: a sequenced treatment alternatives to relieve depression trial report. Biol Psychiatry 59(6):493–501

    Article  PubMed  Google Scholar 

  33. Rush AJ, Fava M, Wisniewski SR, Lavori PW, Trivedi MH, Sackeim HA, Thase ME, Nierenberg AA, Quitkin FM, Kashner TM, Kupfer DJ, Rosenbaum JF, Alpert J, Stewart JW, McGrath PJ, Biggs MM, Shores-Wilson K, Lebowitz BD, Ritz L, Niederehe G (2004) Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design. Control Clin Trials 25:119–142

    Article  PubMed  Google Scholar 

  34. Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, Markowitz JC, Ninan PT, Kornstein S, Manber R, Thase ME, Kocsis JH, Keller MB (2003) The 16-item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry 54(5):573–583

    Article  PubMed  Google Scholar 

  35. Rush AJ, Trivedi MH, Wisniewski SR, Stewart JW, Nierenberg AA, Thase ME, Ritz L, Biggs MM, Warden D, Luther JF, Shores-Wilson K, Niederehe G, Fava M (2006) Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med 354(12):1231–1242

    Article  PubMed  CAS  Google Scholar 

  36. Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia S (1983) A children’s global assessment scale (CGAS). Arch Gen Psychiatry 40:228–231

    Google Scholar 

  37. Thase ME, Entsuah AR, Rudolph R (2001) Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry 78:234–241

    Article  Google Scholar 

  38. Trivedi MH, Fava M, Wisniewski SR, Thase ME, Quitkin F, Warden D, Ritz L, Nierenberg AA, Lebowitz BD, Biggs MM, Luther JF, Shores-Wilson K, Rush AJ (2006) Medication augmentation after the failure of SSRIs for depression. N Engl J Med 354(12):1243–1252

    Article  PubMed  CAS  Google Scholar 

  39. Trivedi MH, Rush AJ, Wisniewski SR, Nierenberg AA, Warden D, Ritz L, Norquist G, Howland RH, Lebowitz B, McGrath PJ, Shores-Wilson K, Biggs MM, Balasubramani GK, Fava M (2006) STAR*D Study Team. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 163(1):28–40

    Article  PubMed  Google Scholar 

  40. Wang JL (2004) The difference between single and married mothers in the 12-month prevalence of major depressive syndrome, associated factors and mental health service utilization. Soc Psychiatry Psychiatr Epidemiol 39(1):26–32

    Article  PubMed  Google Scholar 

  41. Weinraub M, Wolf BM (1983) Effects of stress and social supports on mother–child interactions in single- and two-parent families. Child Dev 54(5):1297–1311 Review

    Article  PubMed  CAS  Google Scholar 

  42. Weissman MM, Leaf PJ, Bruce ML (1987) Single parent women. A community study. Soc Psychiatry 22(1):29–36

    Article  PubMed  CAS  Google Scholar 

  43. Weissman MM, Olfson M, Gameroff MJ, Feder A, Fuentes M (2001) A comparison of three scales for assessing social functioning in primary care. Am J Psychiatry 158(3):460–466

    Article  PubMed  CAS  Google Scholar 

  44. Weissman MM, Pilowsky DJ, Wickramaratne PJ, Talati A, Wisniewski SR, Fava M, Hughes CW, Garber J, Malloy E, King CA, Cerda G, Sood AB, Alpert JE, Trivedi MH, Rush AJ (2006) STAR*D-Child Team. Remissions in maternal depression and child psychopathology: a STAR*D-child report. JAMA 295(12):1389–1398

    Article  PubMed  CAS  Google Scholar 

  45. Weissman MM, Wickramaratne P, Adams P, Wolk S, Verdeli H, Olfson M (2000) Brief screening for family psychiatric history: the family history screen. Arch Gen Psychiatry 57(7):675–682

    Article  PubMed  CAS  Google Scholar 

  46. Weissman MM, Wickramaratne P, Nomura Y, Warner V, Verdeli H, Pilowsky DJ, Grillon C, Bruder G (2005) Families at high and low risk for depression: a 3-generation study. Arch Gen Psychiatry 62(1):29–36

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by NIMH grant # R01MH063852 (MM Weissman, PI) and by an NIMH contract (#N01 MH90003) (A. John Rush, PI). Dr. Garber was supported in part by an Independent Scientist Award from NIMH (K02 MH66249). The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. Funding sources played no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review, or approval of the manuscript. We are grateful to the seven participating STAR*D Regional Centers: Massachusetts General Hospital, Boston, MA, Andrew Nierenberg, M.D.; University of California, San Diego, CA,: Sid Zisook, M.D., University of Michigan, Ann Arbor, MI, Elizabeth Young, M.D., University of North Carolina, Chapel Hill, NC, Bradley Gaynes, M.D., M.P.H.; University of Texas Southwestern Medical Center, Dallas, TX, Mustafa Husain, M.D., Vanderbilt University, Nashville, TN, Steven Hollon, Ph.D.; Virginia Commonwealth University, Richmond, VA, Susan Kornstein, M.D.

Author information

Authors and Affiliations

  1. Dept. of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA

    Ardesheer Talati Ph.D., Priya J. Wickramaratne Ph.D., Helen Verdeli Ph.D. & Myrna M. Weissman Ph.D.

  2. Dept. of Epidemiology and Psychiatry, Columbia University, New York, NY, USA

    Daniel J. Pilowsky M.D., M.P.H.

  3. Dept. of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Jonathan E. Alpert M.D., Ph.D.

  4. Dept. of Psychiatry, University of California at San Diego, San Diego, CA, USA

    Gabriele Cerda M.D.

  5. Dept. of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA

    Judy Garber Ph.D.

  6. Dept. of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Carroll W. Hughes Ph.D., Madhukar H. Trivedi M.D. & A. John Rush M.D.

  7. Depts. of Psychology and Psychiatry, University of Michigan, Ann Arbor, MI, USA

    Cheryl A. King Ph.D.

  8. Dept. of Psychiatry, University of North Carolina Medical Center, Chapel Hill, NC, USA

    Erin Malloy M.D.

  9. Dept. of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA

    A. Bela Sood

  10. Dept. of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA

    Helen Verdeli Ph.D.

Authors
  1. Ardesheer Talati Ph.D.
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  2. Priya J. Wickramaratne Ph.D.
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  6. Judy Garber Ph.D.
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  7. Carroll W. Hughes Ph.D.
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  8. Cheryl A. King Ph.D.
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  9. Erin Malloy M.D.
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  11. Helen Verdeli Ph.D.
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  12. Madhukar H. Trivedi M.D.
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  13. A. John Rush M.D.
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Corresponding author

Correspondence to Ardesheer Talati Ph.D..

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00127-007-0298-5.

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Talati, A., Wickramaratne, P.J., Pilowsky, D.J. et al. Remission of maternal depression and child symptoms among single mothers. Soc Psychiat Epidemiol 42, 962–971 (2007). https://doi.org/10.1007/s00127-007-0262-4

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