Parental Remission from Depression and Child Psychopathology

DESCRIPTION (provided by applicant): Numerous studies have shown that children of depressed parents have high rates of depression, anxiety and conduct disorders. Much remains to be understood about their prevention and treatment. We hypothesized that successful treatment of a depressed parent may lead to a remission of the offspring's disorders. A treatment study of adults with MDD, STAR*D, provided us with a unique opportunity to test this hypothesis via an ancillary study of the patient's children. We found that successful treatment of the mother's depression to remission was associated with a significant reduction in the child's depression and conduct disorder at three months. If the mother did not remit, the child's symptoms worsened. At one year follow-up, the children of remitting mothers, maintained their improvement and their overall functioning also improved. These findings require replication. Many questions remain which we will follow-up in the new proposed study. 1. STAR*D only included one child per family. We will study all children age 7-17 years in each family. 2. STAR*D only included mothers. We will include depressed fathers. 3. The STAR*D was an effectiveness study and limited the amount and timing of information collected. We will study the co-parent, and care takers and will have more frequent assessment so we can see the timing and pattern of change in parent and child. 4. STAR*D was an open trial in the first 3 months and patients were randomized only if they did not improve on the first medication. The new study has adults randomized into 3 treatment groups at entrance, one of which is hypothesized to speed up remission. Our aim is to capture the opportunity to follow up and extend our findings from the STAR*D Child study in a recently submitted adult study ("Combining Antidepressants to Hasten Remission from Depression" PIs Stewart and Blier). The adult trial will determine if treating adults with MDD using a drug combination results in faster remission than using either drug alone. Our study of children will coincide with the initiation of the adult study. We will independently study 100 depressed parents undergoing treatment and 200 of their children to replicate and refine our previous findings that successful treatment of a depressed parent leads to improvement in their children. Our findings, if replicated in this proposed study, will provide new strategies for helping symptomatic children of depressed parents. The public health significance of this project is enormous as it will indicate new strategies for helping symptomatic children of depressed parents. Defining the relationship between parental remission of depression and child psychological status provides new insight into factors which may ameliorate child psychopathology. At a time when the treatment of depressed and anxious children is uncertain, new strategies are needed.