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Mom’s Depression Remits, Kids’ Behavior Problems Improve

When a mother’s depression remits, behavioral problems and symptoms in her children significantly improve over the year following remission, new research shows. The latest findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Child study show that remission of maternal major depressive disorder (MDD) significantly reduced psychopathology in their children, while psychopathology in children of mothers with nonremitting depression increase

 June 16, 2011 — When a mother’s depression remits, behavioral problems and symptoms in her children significantly improve over the year following remission, new research shows.

The latest findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Child study show that remission of maternal major depressive disorder (MDD) significantly reduced psychopathology in their children, while psychopathology in children of mothers with nonremitting depression increased.

“Our findings…indicate that remission of depression in mothers is associated with positive outcomes in their children. Continuing the mother’s treatment until remission is achieved may be warranted, as even later remission of maternal depression was associated with decreases in children’s symptoms,” the investigators, led by Priya Wickramaratne, PhD, write.

The study is published in the June issue of the American Journal of Psychiatry.

Treat Until Remission

Previous research by the STAR*D group of investigators showed maternal MDD is an established risk factor for child psychopathology and that 1 year after initiation of treatment, children of mothers whose depression remitted had significantly improved functioning and psychiatric symptoms.

The primary goal of the current study was to extend these findings and examine the relationship between the mother’s remission and child outcomes in the first year after remission.

The study included 80 women with MDD who remitted in the first 3 months (n = 36) or late remitters who experienced remission after 3 months, but before 12 months (n = 28), and a comparison group (n = 16) of nonremitters who experienced no remission after 1 year. Remission was defined as having a score on the Hamilton Depression Rating Scale below 7. The researchers compared outcomes in children of the 3 maternal groups.

The authors evaluated threshold or subthreshold psychiatric symptoms in the 80 children who were between the ages of 7 and 17 years. Children were assessed at baseline and at 3-month intervals using the Schedule for Affective Disorders and Schizophrenia for School-Age children-Present and Lifetime version, the Child Behavior Checklist, and the Children’s Global Assessment Scale for 1 year after their mothers’ remission or for 2 years if the mothers did not remit.

The researchers found that there “were statistically significant decreases over time in the number of symptoms among children of both early- and late-remitting mothers…but not in children of non-remitting mothers.”

The investigators also report that Child Behavior Checklist total problem scores for children of early- and late-remitting mothers decreased over time, but only the decrease in mothers with early remission was statistically significant.

Similarly, Child Behavior Checklist externalizing problem scores mirrored the patterns of change in total problem scores, with decreases in scores in children of early- and late-remitting mothers; however, only decreases in children of early-remitting mothers were statistically significant.

These findings suggest “there may be benefit to the child in having the mother remain in treatment even if she does not achieve full remission immediately.”

However, the authors note that there are barriers to providing continuous care of depressed patients until remission. These include access to treatment and retention of patients as well as financial barriers.

Vicious Circle

In an accompanying editorial, Boris Birmaher, MD, University of Pittsburgh School of Medicine in Pennsylvania, notes that facilitating treatment of mothers (and possibly fathers) is a critical step in the prevention of the generational transmission of mental illness.

Furthermore, writes Dr. Birmaher, clinicians who work with depressed patients, as well as those who work with children, need to be aware of the importance of early diagnosis and treatment of parental depression and its potential deleterious effect on children. They must also ask about the mental health status of both.

“This approach not only may increase the likelihood that the child’s psychopathology will be identified and successfully treated, but may even prevent the development of psychopathology in the child,” he notes.

“This is particularly important in light of evidence that depressed mothers do not seek treatment or delay their own treatment until after the treatment of their children. This creates a vicious circle in which the mothers’ untreated symptoms and consequent impairment in functioning negative affect their children,” Dr. Birmaher writes.

Dr. Wickramaratne has disclosed no relevant financial relationships. The disclosures of the other authors can be found in the original paper. Dr. Birmaher reports that he is a consultant for Schering Plough, has participated in forums sponsored by Dey Pharma, and receives royalties from Random House and Lippincott Williams & Wilkins.

Am J Psychiatry. 2011;168:593-602. Abstract

Authors and Disclosures

Journalist

Caroline Cassels

A veteran health and medical journalist, Caroline is the News Editor for Medscape Psychiatry. During her career she has edited and written for publications aimed at both physician and consumer audiences. She helped launch, and was the Editor of Health Digest, a national, award-winning Canadian consumer health publication. She was also National Editor of the Heart & Stroke Foundation of Canada’s Web site before joining Medscape Medical News in 2005. She is the recipient of the 2008 American Academy of Neurology Journalism Fellowship Award and the 2010 National Press Foundation Alzheimer’s Disease Fellowship.

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