Gaps in Knowledge About Effects of Parental Depression on Children Reflect Need for Change in U.S. Healthcare System

A recent report from the Institute of Medicine found that while parental depression is widespread in the U.S., there is a notable lack of strategy in the healthcare system for treating the depressed adults along with preventing problems in their children. The report found little systematic examination of depression in parents, noting that most existing research focuses on the role of the mother, with little data available regarding fathers.

The Institute estimates that there are 7.5 million parents in the U.S. suffering from depression. These depressed parents, furthermore, are responsible for taking care of approximately 16 million children under the age of 18.

Depression is usually addressed as a disorder affecting individuals, but little attention is paid to how depression affects the family and family interactions, particularly if the depressed individual is a parent. “Parental depression can result in a withdrawn, detached parenting style that interferes with attachment and harms the child's physical, psychological, and social development. It can also disrupt the structure and routine that provide a framework for young lives and is associated with poorer physical health in children. Depression is often accompanied by other physical or psychological comorbidities, most prominently anxiety or substance abuse, often worsening outcomes for affected families,” says Mary Jane England, former president of the American Psychological Association.

England proposes that “the remedy lies in comprehensive, multigenerational, family-centered care that will not only identify and treat parents with depression, but also help them improve their parenting skills, and provide support for their children.”

This will take time to implement, given current healthcare policy. Many restrictions in Medicaid exist that deter depressed parents from seeking and receiving appropriate treatment for their condition, such as low reimbursement rates and a restricted range of eligible providers. Widespread change is necessary, from wider recognition of the problem, to increased research into risk and protective factors, to collaborative training programs for healthcare professionals to create better family-oriented service.

For the full article, please visit http://pn.psychiatryonline.org/cgi/content/full/44/13/1-a

This Independence day celebrate your kids' independence...

...it may help protect them from depression in adulthood. Studies have found that overprotective parenting is associated with depression in adulthood (Parker, 1979, Oakly-Browne, Joyce, Wells, Bushnell, & Hornblow, 1995; Rey, 1995 cited in Yoshizumi et al., 2007 http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V9F-4N27631-2&_user=18704&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=946509490&_rerunOrigin=google&_acct=C000002018&_version=1&_urlVersion=0&_userid=18704&md5=cc79797f5eccfefb499bb3ef52248e93).
It seems a perfect endorsement of the values espoused by the founders of this nation, who when asserting our independence 233 years ago this July 4th, were quick to link it with the pursuit of happiness. (Photo below taken from http://www.cincinnatichildrens.org/assets/0/78/315/355/455/457/469/473/5c50b94f-999b-4e72-b3d1-15b165c10c57.jpg)

Clues About My Parent's Blues: A New Book to Help Kids Understand Their Parent's Depression

It's hard to talk to your kids about your depression. Will they understand? Will it scare them? Will they be angry? Will it make them depressed? These concerns are just a brief sampling of the many that parents have when they consider discussing their depression with their kids. Many parents prefer their kids just don't know they're depressed or seeking treatment and the confidentiality of the docotor-patient relationship and the researcher-participant relationship guarantees that this is a decision each parent makes him or herself. This being said, most kids know when their parents are sad and are affected by it whether or not it's openly acknowledged. You could say, parental depression is shared by the family before it is discussed. Perhaps with this in mind, a recently published book, Why Are You So Sad? by Beth Andrews, aims to ameliorate the challenges of talking with kids about parental depression.

The book goes beyond explaining parental depression, however. It's a forum for kids and parents to explore how kids feel about mom and/or dad's sadness and how to deal with those feelings in an adpative way. Learning to identify and deal with feelings may be protective for the children of depressed parents, who are at heightened risk of developing emotional and behavioral disorders.

For more on Why Are you So Sad? go to http://www.maginationpress.com/4418870.html.

Child Study Team

Hello! We are the faces of the Child Study team. From the left is Mariely (Ellie) Hernandez, M.A., Myrna Weissman, PhD., Monica Alvarez-Goldman, B.A., Daniel Pilowsky, M.D., MPH, and Jennifer Dev. We would love to hear from you and are willing to answer any questions regarding our study on Parental Depression and Child Psychopathology.

Another reason it's important to invesitgate whether parents' recovery from depression helps kids...

Parents worry about pursuing mental health treatment for their children for many reasons: it may be dangerous, it may affect their growth, other kids may tease them if they find out, teachers may think differently of them, maybe it will negatively impact them when they apply for college or jobs. The APA recently addressed this issue and highlighted research that suggested many Americans hold opionions that make the decision of whether or not to treat their kids very difficult (http://www.apa.org/monitor/2009/06/dilemma.html). In this piece, Jane McLeod, PhD, co-acuthor of the paper discussed, said, "Whether because of the symptoms of the disorders themselves, or because of the stigmatizing responses of others, children with emotional and behavioral problems have a lot of trouble as they transition into adulthood. (Monitor on PsychologyVolume 40, No. 6 June 2009)"



It may be that one thing parents of children with emotional and behavioral problems can do to help their kids is to seek treatment for themselves if they're depressed. Previous research supports this statement for the kids of depressed moms (Weissman, et al. 2006) and the current further explores it for both moms and dads (see "Study Details" posted on 6/17/09 for a study that investigates this issue).

Treatment Goal: Getting People Better Faster

One of the questions in depression research is how to help people recover faster from depression. This is desirable not only for the obvious reason (we want to minimize suffering), but also because people may get discouraged when they're in treatment but not experienceing relief. They may even decide to discontinue treatment for this reason. Dr Pierre Blier, a leading Canadian psychopharmacologist, has done research on the way antidepressants work for close to 30 years and suggests that this is the key to figuring out which treatments will help people feel better faster.

In a 2004 interview with Medscape CME (http://cme.medscape.com), Dr. Blier discussed his research noting that he is interested in improving the speed and quality of antidepressants "in the long run"(Medscape Psychiatry & Mental Health. 2004;9(1), http://cme.medscape.com/viewarticle/475413). With this goal Dr. Blier and his team began looking at two systems in the brain. "Initially," he explained, "we focused on the serotonin system because we thought it was a major mechanism by which all these antidepressants could work. In recent years, we have concentrated on the norepinephrine system because it is also important in mediating the antidepressant response, and now we are at the point where we are looking at the interactions of the two systems." These two systems are targeted by two types of antidepressants, selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs). These medications also reduce symptoms of anxiety and, as Dr. Blier noted in the interview with Medscape CME, "Eighty percent of depressed patients will have significant levels of anxiety -- it is part of the syndrome."

The take-home message about antidepressant research is one of hope. "It has always been our goal in the treatment of depression to get people better faster. I think this is an achievable goal by really trying to clarify how medications work. Once we know exactly how they work, the goal is to achieve the same pharmacologic end point faster through different tools." Dr. Blier is the prinical investigator at the Canadian site of the studies described on this blog (see post, "Study Details" on June 17, 2009), one of which investigates a possible road to the end point of recovery from depression, whether 2 antidepressants together lead to faster recovery from depression than either one alone.

Focus on Fathers

Every year on Father's Day we take time to thank the men who guided us as children and those who are our partners in raising children. Part of appreciating the dads in our lives is considering the challenges they face. While the current economic downturn has put pressure on families as a whole, it presents some specific struggles for men. These struggles can be overwhelming for some men. Research supports a link between low socioeconomic status (SES) and adult depression (Lorant et al, 2003, http://dx.doi.org/10.1034/j.1600-0447.2003.00071.x ), as well as job loss and depression (Price, Choi, & Vinokur 2002, http://dx.doi.org/10.1037/1076-8998.7.4.302). In the spirit of supporting and understanding dads on Father's Day, the American Psychological Association (APA) recently asked an evolutionary biologist a few questions about how the economic downturn effects men. Click here to read more http://www.apa.org/releases/kruger.html.