Research reportOffspring of parents with recurrent depression: Which features of parent depression index risk for offspring psychopathology?
Introduction
Parental depression is one of the strongest identified risk factors for youth psychiatric disorder, with offspring of depressed parents consistently showing heightened rates of anxiety and disruptive behaviour disorders (Weissman et al., 2006) as well as a 2–3 fold increased risk for depressive disorders when compared with controls (Rice et al., 2002). Levels of depressive symptoms which fall short of diagnostic criteria are also elevated in offspring of depressed parents (Connell and Goodman, 2002). Adoption and twin designs suggest that both inherited and environmental factors contribute to this increased risk for offspring psychopathology, with non-inherited factors being particularly important in the intergenerational transmission of depression (Harold et al., 2010, Silberg et al., 2010, Tully et al., 2008).
Youth depression is associated with severe adverse consequences including psychosocial impairment and an increased risk for suicide and future medical problems (Birmaher et al., 1996, Fombonne et al., 2001b, Weissman et al., 1999). Furthermore, longitudinal follow-ups of clinical and community samples demonstrate that depression occurring early in life shows strong continuity into adulthood (Fombonne et al., 2001a, Harrington et al., 1990, Pine et al., 1998, Rao et al., 1995, Rutter et al., 2006) and recurrence rates of 60 to 70% (Birmaher et al., 1996). Depressive symptoms that fall below the diagnostic threshold are also often accompanied by impairment and predict escalation to full disorder (Angold et al., 1999, Fergusson et al., 2005, Lewinsohn et al., 2000, Pickles et al., 2001, Pine et al., 1999). The long-term morbidity associated with youth depression highlights it as a serious concern for health professionals and necessitates strategies for early evidence based intervention and prevention in those children who are at greatest risk.
Despite the robust association found between parental depression and offspring psychopathology, outcomes vary with not all children going on to experience problems. There is inherent heterogeneity within the depression construct meaning that parents meeting criteria for depressive disorder will differ on clinical variables such as episode severity and chronicity, and this may go some way to explaining differences in child outcomes. This possibility is however rarely considered, with most studies comparing child outcomes according to parental diagnostic status alone (e.g. depressed compared to non-depressed).
Several longitudinal population-based studies testing links between parent depression and child psychopathology have attempted to disaggregate associations with different depression features and suggest that children of parents who have experienced a more severe, chronic course of illness are at greater risk for psychopathology than children of parents who are less seriously affected. The number, severity and duration of parental depressive episodes as well as early age of depression onset (≤ 20) have all been associated with poorer child outcomes, including an increased risk for psychiatric disorder, higher levels of internalising and externalising symptoms and greater total behavioural problem scores (Brennan et al., 2000, Foster et al., 2008, Hammen and Brennan, 2003, Klein et al., 2005, Weissman et al., 1984).
Timing of parental depressive episodes may also differentially index risk in offspring. Many studies have focused on the post-natal period (with most assessing parental depression within 1 year of birth) as a time when depression exposure may be particularly harmful to children (Brand and Brennan, 2009, Murray et al., 1999, Murray et al., 2010, Murray et al., 2011). However other studies have failed to find associations with offspring depression once later maternal depressive episodes are taken into account (Halligan et al., 2007, Hay et al., 2008, Sutter-Dallay et al., 2010). These findings suggest that in addition to testing early associations between maternal depression and offspring outcomes, an important issue is how far depressive episodes occurring later in childhood and adolescence present a continuing index of risk for offspring as they grow older. This may be especially important in the transition to adolescence given that this is an important period for social and emotional development. A crucial question therefore is whether risk to older child and adolescent offspring can be usefully indexed by the presence of a recent episode of parental depression, and if so, whether this adds anything over and above risk associated with previous exposure.
The aim of the present study is to examine a group of parents with recurrent depression, and consider whether a recent episode of parental depression is associated with an increased risk of child psychopathology, over and above any risk associated with other depression characteristics such as past severity and chronicity.
Section snippets
Sample
This study utilised data from an ongoing high risk study of the offspring of recurrently depressed parents, the ‘Early Prediction of Adolescent Depression’ (EPAD) study. At baseline, participants included 339 parents, all of whom had a history of recurrent unipolar depression and their adolescent offspring (aged 9–17 years). The sample was recruited predominantly from general practices across South Wales (78%). Additional participants were community volunteers recruited into the study through a
Statistical analysis
Two child outcomes were analysed: Diagnosis of any DSM-IV psychiatric disorder and number of child-rated depression symptoms. The outcome diagnoses included all mood disorders, anxiety disorders, disruptive disorders (ODD and CD) and other disorders (eating disorders and adjustment disorders). In accordance with previous research on the offspring of depressed parents, specific phobias were not included as outcomes (Hammen and Brennan, 2003). Additionally, as ADHD is not assessed by the child
Results
Table 1 presents clinical information regarding the index parent's history of depression and the diagnoses in the children at the follow-up assessment. Rates of any DSM-IV disorder (parent and child disorder combined) were similar for boys and girls (28.7% vs. 27.3%, OR = 0.934, CI = 0.55, 1.58, p = 0.800), however girls experienced significantly higher rates of depressive disorders than boys (10.5% vs. 3.5%, OR = 3.24, CI = 1.07, 9.85, p = 0.038). Rates of disorder did not differ significantly between
Child diagnoses
A significant association was found between recent parental depression and child disorder (parent and child combined, Table 2). Children of parents who had recently experienced an episode of depression were significantly more likely to have a psychiatric disorder than children who had not been recently exposed (OR = 2.00, CI = 1.12, 3.56, p = 0.019).
When analyses excluded children with a psychiatric disorder at baseline, those children who had been recently exposed to a parental depressive episode
Other features of parent depression associated with child outcomes
Presence of a previous severe depressive episode in the parent was associated with both child disorder (OR = 1.81, CI = 1.01, 3.24, p = 0.047) and child depression symptoms (β = 0.19 CI = 0.04, 0.35, p = 0.015). Family history (β = 0.10 CI = 0.01, 0.19, p = 0.038) was also associated with number of child depression symptoms (Table 3). No associations were found between any of the other features of parental depression examined (postnatal depression, depression during pregnancy, average episode duration, frequent
Is recent parental depression associated with child outcomes when prior depression features are taken into consideration?
Of the parent depression features associated with child outcomes, only prior depression severity was also associated with recent parental depression (Table 4). Multiple regression analyses were therefore performed to assess the independent contributions of these two variables in predicting child outcomes (Table 5). Age and sex of child at follow-up, and their interaction were included as covariates.
Discussion
Parental depression is one of the best established risk factors for offspring psychopathology with studies repeatedly showing higher rates of psychiatric disorder in the children of depressed parents compared with non-depressed controls (Beardslee et al., 1998, Goodman and Gotlib, 1999, Weissman et al., 2006). Consistent with this previous research, high rates of psychopathology were found in the children in this sample, with over a quarter meeting criteria for a DSM-IV psychiatric disorder at
Role of funding source
Funding for this study was provided by the Sir Jules Thorn Medical Trust and the Waterloo Foundation; they had no further role in the study design, the collection, analysis and interpretation of data, the writing of the report, or in the decision to submit the paper for publication.
Conflict of interest
None of the authors have conflict of interest/financial disclosures, with the exception of Dr Daniel Smith who has received honoraria for speaking at educational meetings organised by AstraZeneca and Lilly.
Acknowledgments
Funding support: Sir Jules Thorn Medical Trust, Waterloo Foundation.
Thank you to: Michael, J. Owen, Ruth Sellers, Claire Delduca, Lynne Barry, Jennifer Hilgart, Eleni Kopsida, Olga Eyre, Sophie Thomas, Sophie Canton, Gemma Hammerton, Sophie Keates, Garret Coy, Rebecca Davis, Katie Lewis, Lucy Kift, Valerie Russell, Gemma Lewis.
References (54)
- et al.
The Child and Adolescent Psychiatric Assessment (CAPA)
Journal of the American Academy of Child and Adolescent Psychiatry
(2000) - et al.
Impaired but undiagnosed
Journal of the American Academy of Child and Adolescent Psychiatry
(1999) - et al.
Childhood and adolescent depression: a review of the past 10 years. Part I
Journal of the American Academy of Child and Adolescent Psychiatry
(1996) - et al.
Correspondence between adolescent report and parent report of psychiatric diagnostic data
Journal of the American Academy of Child and Adolescent Psychiatry
(1997) - et al.
Change in child psychopathology with improvement in parental depression: a systematic review
Journal of the American Academy of Child and Adolescent Psychiatry
(2008) - et al.
Maternal depression and psychiatric outcomes in adolescent offspring: a 13-year longitudinal study
Journal of Affective Disorders
(2007) - et al.
Change in adolescents' internalizing symptomatology as a function of sex and the timing of maternal depressive symptomatology
Journal of the American Academy of Child and Adolescent Psychiatry
(2008) - et al.
Maternal depression and parenting behavior: a meta-analytic review
Clinical Psychology Review
(2000) - et al.
Maternal postnatal depression and the development of depression in offspring up to 16 years of age
Journal of the American Academy of Child and Adolescent Psychiatry
(2011) - et al.
Unipolar depression in adolescents: clinical outcome in adulthood
Journal of the American Academy of Child and Adolescent Psychiatry
(1995)
Diagnostic and statistical manual of mental disorders
A test–retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C)
Psychological Medicine
Children of affectively ill parents: a review of the past 10 years
Journal of the American Academy of Child and Adolescent Psychiatry
The structure of autobiographical memory and the event history calendar: potential improvements in the quality of retrospective reports in surveys
Memory
Impact of antenatal and postpartum maternal mental illness: how are the children?
Clinical Obstetrics and Gynecology
Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5
Developmental Psychology
The life history calendar: a research and clinical assessment method for collecting retrospective event-history data
International Journal of Methods in Psychiatric Research
The association between psychopathology in fathers versus mothers and children's internalizing and externalizing behavior problems: a meta-analysis
Psychological Bulletin
Gender differences in the association between maternal depressed mood and child depressive phenomena from grade 3 through grade 10
Journal of Youth and Adolescence
Towards a family process model of maternal and paternal depressive symptoms: exploring multiple relations with child and family functioning
Journal of Child Psychology and Psychiatry, and Allied Disciplines
Gender-specific pathways between maternal depressive symptoms, family discord, and adolescent adjustment
Developmental Psychology
Maternal depressive symptoms and depressive symptoms in adolescents
Journal of Child Psychology and Psychiatry, and Allied Disciplines
Subthreshold depression in adolescence and mental health outcomes in adulthood
Archives of General Psychiatry
The Maudsley long-term follow-up of child and adolescent depression. 1. Psychiatric outcomes in adulthood
The British Journal of Psychiatry
The Maudsley long-term follow-up of child and adolescent depression. 2. Suicidality, criminality and social dysfunction in adulthood
The British Journal of Psychiatry
Course and severity of maternal depression: associations with family functioning and child adjustment
Journal of Youth and Adolescence
The life history calendar: a technique for collecting retrospective data
Sociological Methodology
Cited by (74)
Characterising depression trajectories in young people at high familial risk of depression
2023, Journal of Affective DisordersReinforcement-based responsiveness, depression, and anhedonia: A multi-method investigation of intergenerational risk
2023, Journal of Psychiatric ResearchADHD in adults with recurrent depression
2021, Journal of Affective DisordersRisk of conduct and oppositional defiant disorder symptoms in offspring of parents with mental health problems: Findings from the Raine Study
2021, Journal of Psychiatric ResearchThe risk of anxiety disorders in children of parents with severe psychiatric disorders: a systematic review and meta-analysis
2021, Journal of Affective DisordersCitation Excerpt :A total of 25 studies were included in this systematic review and meta-analysis. These studies were conducted in 8 countries: eleven studies (44%) were conducted in the USA (Glasheen et al., 2013, Henin et al., 2005, Nurnberger et al., 2011b, Radke-Yarrow et al., 1992, Biel et al., 2008, Weissman et al., 2006, Halligan et al., 2007, Johnson et al., 2006, Erlenmeyer-Kimling et al., 1997, Birmaher et al., 2009, Bella et al., 2011), three in Spain (12%) (Sanchez-Gistau et al., 2015, Lieb et al., 2002, Garcia-Amador et al., 2013), three in Sweden (12%) (Hirshfeld-Becker et al., 2006, Schubert and McNeil, 2003), three in the UK (12%) (Mars et al., 2012, Cooper et al., 2006, Murray et al., 2011), one in Switzerland (4%) (Vandeleur et al., 2012), one in Germany (4%) (Knappe et al., 2009b), one in Romania (4%) (Grigoroiu-Serbanescu et al., 1991), one in Denmark (4%) (Ellersgaard et al., 2018), and one in Israel (4%) (Hans et al., 2004). Of the 25 studies, fourteen studies included participants from the clinical setting (56%), ten studies from the general populations (40%), and one study used both clinical and community samples (4%).
Adolescent and adult differences in major depression symptom profiles
2019, Journal of Affective Disorders