 |
|
Remissions in Maternal Depression and Child Psychopathology
A STAR*D-Child Report
Myrna M. Weissman, PhD;
Daniel J. Pilowsky, MD, MPH;
Priya J. Wickramaratne, PhD;
Ardesheer Talati, PhD;
Stephen R. Wisniewski, PhD;
Maurizio Fava, MD;
Carroll W. Hughes, PhD;
Judy Garber, PhD;
Erin Malloy, MD;
Cheryl A. King, PhD;
Gabrielle Cerda, MD;
A. Bela Sood, MD;
Jonathan E. Alpert, MD, PhD;
Madhukar H. Trivedi, MD;
A. John Rush, MD; for the STAR*D-Child Team
JAMA. 2006;295:1389-1398.
Context Children of depressed parents have high rates of anxiety, disruptive, and depressive disorders that begin early, often continue into adulthood, and are impairing.
Objective To determine whether effective treatment with medication of women with major depression is associated with reduction of symptoms and diagnoses in their children.
Design Assessments of children whose depressed mothers were being treated with medication as part of the multicenter Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial conducted (between December 16, 2001 and April 24, 2004) in broadly representative primary and psychiatric outpatient practices. Children were assessed by a team of evaluators not involved in maternal treatment and unaware of maternal outcomes. Study is ongoing with cases followed at 3-month intervals.
Setting and Patients One hundred fifty-one mother-child pairs in 8 primary care and 11 psychiatric outpatient clinics across 7 regional centers in the United States. Children were aged 7 to 17 years.
Main Outcome Measures Child diagnoses based on the Kiddie Schedule for Affective Disorders and Schizophrenia; child symptoms based on the Child Behavior Checklist; child functioning based on the Child Global Assessment Scale in mothers whose depression with treatment remitted with a score of 7 or lower or whose depression did not remit with a score higher than 7 on the Hamilton Rating Scale for Depression.
Results Remission of maternal depression after 3 months of medication treatment was significantly associated with reductions in the children's diagnoses and symptoms. There was an overall 11% decrease in rates of diagnoses in children of mothers whose depression remitted compared with an approximate 8% increase in rates of diagnoses in children of mothers whose depression did not. This rate difference remained statistically significant after controlling for the child's age and sex, and possible confounding factors (P = .01). Of the children with a diagnosis at baseline, remission was reported in 33% of those whose mothers' depression remitted compared with only a 12% remission rate among children of mothers whose depression did not remit. All children of mothers whose depression remitted after treatment and who themselves had no baseline diagnosis for depression remained free of psychiatric diagnoses at 3 months, whereas 17% of the children whose mothers remained depressed acquired a diagnosis. Findings were similar using child symptoms as an outcome. Greater level of maternal response was associated with fewer current diagnoses and symptoms in the children, and a maternal response of at least 50% was required to detect an improvement in the child.
Conclusions Remission of maternal depression has a positive effect on both mothers and their children, whereas mothers who remain depressed may increase the rates of their children's disorders. These findings support the importance of vigorous treatment for depressed mothers in primary care or psychiatric clinics and suggest the utility of evaluating the children, especially children whose mothers continue to be depressed.
Author Affiliations: Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York (Drs Weissman, Pilowsky, and Wickramaratne) and Columbia University, New York (Dr Talati); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Drs Hughes, Rush, and Trivedi); Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn (Dr Garber); Department of Psychiatry, University of North Carolina, Chapel Hill (Dr Malloy); Department of Psychiatry, University of Michigan, Ann Arbor (Dr King); Department of Psychiatry, University of California at San Diego (Dr Cerda); Department of Psychiatry, Virginia Commonwealth University, Richmond (Dr Bela Sood); Department of Psychiatry, Harvard University, Boston, Mass (Drs Alpert and Fava); and Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Wisniewski).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Child Bipolar I Disorder: Prospective Continuity With Adult Bipolar I Disorder; Characteristics of Second and Third Episodes; Predictors of 8-Year Outcome
Geller et al.
Arch Gen Psychiatry 2008;65:1125-1133.
ABSTRACT
| FULL TEXT
Antidepressant Treatment of Caregivers of Children With Asthma
Brown et al.
Psychosomatics 2008;49:420-425.
ABSTRACT
| FULL TEXT
Depressed Mothers, Depressed Children
Markowitz
Am. J. Psychiatry 2008;165:1086-1088.
FULL TEXT
Children of Depressed Mothers 1 Year After the Initiation of Maternal Treatment: Findings From the STAR*D-Child Study
Pilowsky et al.
Am. J. Psychiatry 2008;165:1136-1147.
ABSTRACT
| FULL TEXT
Brief Interpersonal Psychotherapy for Depressed Mothers Whose Children Are Receiving Psychiatric Treatment
Swartz et al.
Am. J. Psychiatry 2008;165:1155-1162.
ABSTRACT
| FULL TEXT
An Adoption Study of Parental Depression as an Environmental Liability for Adolescent Depression and Childhood Disruptive Disorders
Tully et al.
Am. J. Psychiatry 2008;165:1148-1154.
ABSTRACT
| FULL TEXT
Identifying Postpartum Depression: Are 3 Questions as Good as 10?
Kabir et al.
Pediatrics 2008;122:e696-e702.
ABSTRACT
| FULL TEXT
Double Jeopardy: Depressive Symptoms and Rapid Subsequent Pregnancy in Adolescent Mothers
Barnet et al.
Arch Pediatr Adolesc Med 2008;162:246-252.
ABSTRACT
| FULL TEXT
Strategies for the Prevention and Treatment of Suicidal Behavior
Clayton and Auster
Focus 2008;6:15-21.
ABSTRACT
| FULL TEXT
Bibliography for Major Depressive Disorder and Suicide
Focus 2008;6:58-62.
FULL TEXT
Physician and Patient Characteristics Associated With Discussion of Psychosocial Health During Pediatric Primary Care Visits
Brown et al.
CLIN PEDIATR 2007;46:812-820.
ABSTRACT
Maternal depression, child behavior, and injury
Phelan et al.
Inj. Prev. 2007;13:403-408.
ABSTRACT
| FULL TEXT
Intimate Partner Violence and Health Care Costs and Utilization for Children Living in the Home
Rivara et al.
Pediatrics 2007;120:1270-1277.
ABSTRACT
| FULL TEXT
Reducing the Burden of Depression: Building Villages for Coordinated Care
Wells and Miranda
JAMA 2007;298:1451-1452.
FULL TEXT
Familial Pathways to Early-Onset Suicidal Behavior: Familial and Individual Antecedents of Suicidal Behavior
Melhem et al.
Am. J. Psychiatry 2007;164:1364-1370.
ABSTRACT
| FULL TEXT
Screening for Depression in an Urban Pediatric Primary Care Clinic
Dubowitz et al.
Pediatrics 2007;119:435-443.
ABSTRACT
| FULL TEXT
Conjoined Effects of Low Birth Weight and Childhood Abuse on Adaptation and Well-being in Adolescence and Adulthood
Nomura and Chemtob
Arch Pediatr Adolesc Med 2007;161:186-192.
ABSTRACT
| FULL TEXT
Externalizing and Attentional Behaviors in Children of Depressed Mothers Treated With a Selective Serotonin Reuptake Inhibitor Antidepressant During Pregnancy
Oberlander et al.
Arch Pediatr Adolesc Med 2007;161:22-29.
ABSTRACT
| FULL TEXT
Legal and Ethical Considerations: Risks and Benefits of Postpartum Depression Screening at Well-Child Visits
Chaudron et al.
Pediatrics 2007;119:123-128.
ABSTRACT
| FULL TEXT
Remission of maternal depression and children's psychopathology.
Michels
JAMA 2006;296:1232-1232.
FULL TEXT
Remission of maternal depression and children's psychopathology.
Kruszewksi et al.
JAMA 2006;296:1233-1233.
FULL TEXT
Remission of maternal depression and children's psychopathology.
Polanczyk and Rohde
JAMA 2006;296:1232-1233.
FULL TEXT
Helping Children by Helping Depressed Mothers
JWatch Psychiatry 2006;2006:3-3.
FULL TEXT
Treat Depressed Mothers; Help Two Generations
JWatch Women's Health 2006;2006:3-3.
FULL TEXT
What's new in the other general journals.
Tonks
BMJ 2006;332:781-782.
FULL TEXT
Depression in the Children of Depressed Mothers
JWatch General 2006;2006:6-6.
FULL TEXT
Women's Health--Advances in Knowledge and Understanding
DeAngelis and Glass
JAMA 2006;295:1448-1450.
FULL TEXT
|
