Research report
Offspring of parents with recurrent depression: Which features of parent depression index risk for offspring psychopathology?

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Abstract

Background

Parental depression is associated with an increased risk of psychiatric disorder in offspring, although outcomes vary. At present relatively little is known about how differences in episode timing, severity, and course of recurrent depression relate to risk in children. The aim of this study was to consider the offspring of parents with recurrent depression and examine whether a recent episode of parental depression indexes risk for offspring psychopathology over and above these other parental depression features.

Methods

Three hundred and thirty seven recurrently depressed parents and their offspring (aged 9–17) were interviewed as part of an ongoing study, the ‘Early Prediction of Adolescent Depression Study’. The Child and Adolescent Psychiatric Assessment was used to assess two child outcomes; presence of a DSM-IV psychiatric disorder and number of DSM-IV child-rated depression symptoms.

Results

Children whose parents had experienced a recent episode of depression reported significantly more depression symptoms, and odds of child psychiatric disorder were doubled relative to children whose parents had not experienced a recent episode of depression. Past severity of parental depression was also significantly associated with child depression symptoms.

Limitations

Statistical analyses preclude causal conclusions pertaining to parental depression influences on offspring psychopathology; several features of parental depression were recalled retrospectively.

Conclusions

This study suggests that particular features of parental depression, specifically past depression severity and presence of a recent episode, may be important indicators of risk for child psychiatric disorder and depressive symptoms.

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.

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