Associations between adolescent depression and parental mental health, before and after treatment of adolescent depression

Parental education level and adolescent depression: A multi-country meta-analysis

Adolescent depression, as a common problem, has always been the focus of attention and research. However, no consistent conclusion has been drawn on its relationship with parental education level. Therefore, this study used meta-analysis and dose-response analysis techniques to explore the overall relationship between the two, and further explore the moderating factors affecting the relationship between the two through subgroup analysis and meta-regression analysis. After a literature search and screening, a total of 22 literatures were included, including 634,821 adolescents aged 9-25, distributed in 10 countries. The results showed that: (1) Overall parental education level was negatively correlated with adolescent depressive symptoms (RR = 0.88. p < 0.001), and there was a dose-response relationship between the two. (2) Geographical location (p = 0.002 < 0.05) and national economic development (p = 0.03 < 0.05) significantly moderated and affected the association between parental education level and adolescent depression, thus presenting a global inconsistency. The results of this study provide a more accurate conclusion on the relationship between parental education and adolescent depression to some extent, highlight the importance and necessity of considering family, economic and cultural factors when studying and solving adolescent depression problems, and guide us to pay more attention to the cross-regional and cross-cultural differences in adolescent depression problems.

The relationship between family communication and family resilience in Chinese parents of depressed adolescents: a serial multiple mediation of social support and psychological resilience

BACKGROUND

Family resilience plays a crucial role in helping depressed adolescents overcome challenges. However, studies examining family resilience in depressed adolescents are currently scarce. This study, guided by the family resilience framework, aimed to investigate the serial-multiple mediation of social support and psychological resilience between family communication and family resilience in Chinese families of depressed adolescents.

METHODS

In 229 parents of adolescents with major depressive disorder, 20.1% comprises of fathers, while 79.9% comprises of mothers. The mean age of depressed adolescents was 14.84 (±1.76) years, and the mean age of parents of these depressed adolescents was 43.24 (±4.67) years. The Family Resilience Assessment Scale (FRAS), the Psychological Resilience of Parents of Special Children Questionnaire, and the Social Support Rating Scale, Family Assessment Device (FAD) were used to collected data. Descriptive, univariate, and Pearson correlation analyses were used in preliminary analyses. To explore mediation, we employed a serial-multiple mediation model (PROCESS model 6).

RESULTS

Family communication was positively correlated with family resilience, social support, and psychological resilience. Mediation analysis revealed indirect effects of family communication on family resilience, which were mediated solely by either social support or psychological resilience, or through multiple mediation pathways involving both social support and psychological resilience.

CONCLUSIONS

Family communication positively and directly affects the family resilience of depressed adolescents, and a higher level of social support and psychological resilience can help improve family resilience. These findings not only provide empirical evidence supporting the family resilience framework but also have practical implications for future family interventions targeting depressed adolescents.

Childhood abuse as a mediator of the relationship between early family socio-economic status and geriatric depression: A population-based study in China

Previous studies have suggested that childhood socioeconomic status (SES) is linked to geriatric depressive symptoms in many developed countries. However, the potential pathways of the relationship between childhood SES and geriatric depressive symptoms need to be further explored. This study aimed to assess the mediating effect of being abused during childhood on the association between childhood SES and geriatric depressive symptoms, using evidence from a longitudinal study in China. The study cohort included 8137 individuals. Childhood abuse was defined as experiences related to parental violence, sibling abuse, school violence, community violence, and parental quarrel. Results indicated poor childhood SES was associated significantly with geriatric depressive symptoms. The indirect effect of poor childhood SES to high geriatric depressive risk through community violence, sibling abuse, school violence, and parental quarrel were 0.02, 0.01, 0.02, and 0.01, respectively. Our findings shed new light on the literature regarding the impact of childhood SES on elderly depressive symptoms. Furthermore, childhood SES demonstrated a significant correlation with geriatric depressive symptoms through bullying behaviors. The findings highlight the need to promote both childhood social welfare and psychological well-being within the elderly population.

The complexities of suicide: a multilevel survival analysis examining individual, familial and neighbourhood determinants of suicide risk using Danish register-based data

BACKGROUND

Suicide risk is complex and nuanced, and how place impacts suicide risk when considered alongside detailed individual risk factors remains uncertain. We aimed to examine suicide risk in Denmark with both individual and neighbourhood level risk factors.

METHODS

We used Danish register-based data to identify individuals born in Denmark from 1972, with full parental information and psychiatric diagnosis history. We fitted a two-level survival model to estimate individual and neighbourhood determinants on suicide risk.

RESULTS

We identified 1723 cases of suicide in Denmark during the follow-up period from 1982 to 2015. Suicide risk was explained mainly by individual determinants. Parental comorbidities, particularly maternal schizophrenia [incidence rate ratio (IRR): 2.29, 95% CI 1.56-3.16] and paternal death (2.29, 95% CI 1.31-3.72) partly explained suicide risk when adjusted for all other determinants. The general contextual effect of suicide risk across neighbourhoods showed a median incidence rate ratio (MRR) of 1.13 (1.01-1.28), which was further reduced with full adjustment. Suicide risk increased in neighbourhoods with a higher proportion of manual workers (IRR: 1.08; 1.03-1.14), and decreased with a higher population density (IRR: 0.89; 0.83-0.96).

CONCLUSION

Suicide risk varies mainly between individuals, with parental comorbidities having the largest effect on suicide risk. Suicide risk was less impacted by neighbourhood, though, albeit to a lesser extent than individual determinants, some characteristics were associated with suicide risk. Suicide prevention policies might consider targeting interventions towards individuals more vulnerable due to particular parental comorbidities, whilst taking into account that some neighbourhood characteristics might exacerbate this risk further.

Association of maternal mental health and drinking/smoking with adolescents' mental health based on the Korea National Health and Nutrition Examination Survey

Introduction

Depression is one of the major concerns in adolescence, with a global prevalence of approximately 5%. Diverse environmental factors can affect the development of depression depending on the individual developmental stage.

Methods

Using data from the Korea National Health and Nutrition Examination Survey (KNHANES), we aimed to investigate the association between socioeconomic factors and mental health in a population of non-clinically ill adolescents in Korea totaling 6,261 adolescents aged 12-18 years.

Results

Drinking, smoking, stress, depressed mood, suicidal ideation in adolescents, and stress, depressed mood, and suicidal ideation in mothers were identified as factors associated with adolescent depression. In addition to depressed mood and suicidal ideation, the higher perception of stress in mothers was related to higher stress perception, depressed mood, and suicidal ideation in adolescents. The association of adolescents' mental health with fathers' mental health was weaker than that with mothers' mental health. Additionally, increased smoking and drinking were commonly reported in adolescents with higher stress perception, depressed mood, and suicidal ideation.

Discussion

We conclude that close monitoring of mental health is required for adolescents with drinking and smoking habits and mothers with mental health problems.

Longitudinal relationship between maternal distress and pediatric mood symptoms in youth with mood disorders

Parents of a child with a mood disorder report significant levels of distress and burden from caregiving. This study examined whether maternal distress varies over time with levels of mood symptoms in youth with mood disorders, and whether expressed emotion (EE) and family functioning moderate these associations. We recruited youth (ages 9-17 years) with mood disorders and familial risk for bipolar disorder (BD) for a randomized trial of family-focused therapy compared to standard psychoeducation. Participants were assessed every 4-6 months for up to 4 years. Using repeated-measures mixed effects modeling, we examined the longitudinal effects of youths' mood symptoms and maternal distress concurrently, as well as whether each variable predicted the other in successive study intervals. Secondary analyses examined the moderating effects of EE and ratings of family cohesion and adaptability on maternal distress. In sample of 118 youth-mother dyads, levels of self-reported parental distress decreased over time, with no differences between treatment conditions. Youths' depressive symptoms and, most strongly, mood lability were associated with greater maternal distress longitudinally; however, maternal distress did not predict youths' mood symptoms or lability. The effect of youth symptoms on maternal distress was greater among mothers who were high EE. Family cohesion was associated with reduced concurrent ratings of maternal distress, whereas family adaptability was associated with reduced maternal distress at successive follow-ups. While maternal distress decreases over time as youths' symptoms decrease, mothers of youth with mood disorders experience significant distress that is directly linked to the youths' depressive symptom severity and lability. Improved family functioning appears to be an important mechanism by which to intervene.

Systematically Defined Informative Priors in Bayesian Estimation: An Empirical Application on the Transmission of Internalizing Symptoms Through Mother-Adolescent Interaction Behavior

BACKGROUND

Bayesian estimation with informative priors permits updating previous findings with new data, thus generating cumulative knowledge. To reduce subjectivity in the process, the present study emphasizes how to systematically weigh and specify informative priors and highlights the use of different aggregation methods using an empirical example that examined whether observed mother-adolescent positive and negative interaction behavior mediate the associations between maternal and adolescent internalizing symptoms across early to mid-adolescence in a 3-year longitudinal multi-method design.

METHODS

The sample consisted of 102 mother-adolescent dyads (39.2% girls, M age T1 = 13.0). Mothers and adolescents reported on their internalizing symptoms and their interaction behaviors were observed during a conflict task. We systematically searched for previous studies and used an expert-informed weighting system to account for their relevance. Subsequently, we aggregated the (power) priors using three methods: linear pooling, logarithmic pooling, and fitting a normal distribution to the linear pool by means of maximum likelihood estimation. We compared the impact of the three differently specified informative priors and default priors on the prior predictive distribution, shrinkage, and the posterior estimates.

RESULTS

The prior predictive distributions for the three informative priors were quite similar and centered around the observed data mean. The shrinkage results showed that the logarithmic pooled priors were least affected by the data. Most posterior estimates were similar across the different priors. Some previous studies contained extremely specific information, resulting in bimodal posterior distributions for the analyses with linear pooled prior distributions. The posteriors following the fitted normal priors and default priors were very similar. Overall, we found that maternal, but not adolescent, internalizing symptoms predicted subsequent mother-adolescent interaction behavior, whereas negative interaction behavior seemed to predict subsequent internalizing symptoms. Evidence regarding mediation effects remained limited.

CONCLUSION

A systematic search for previous information and an expert-built weighting system contribute to a clear specification of power priors. How information from multiple previous studies should be included in the prior depends on theoretical considerations (e.g., the prior is an updated Bayesian distribution), and may also be affected by pragmatic considerations regarding the impact of the previous results at hand (e.g., extremely specific previous results).

Presence of Older Adolescents in the Household is Associated with Depressive Symptoms Among Women Living with HIV in Kenya

The objective of this study was to determine the association between the number of adolescents in a household and depressive symptoms among adult caregivers living with HIV. We examined cross-sectional baseline data among adults enrolled in the Shamba Maisha multisectoral agricultural intervention (n = 705) in the Nyanza region of Kenya (NCT02815579). Each additional adolescent 15-19 years in a household was associated with a 1.35 (95% CI 1.06-1.71) higher odds of depressive symptoms among women, but not men, adjusting for potential confounders. Interventions to support the mental health of adults living with HIV may target women caring for dependent adolescents 15-19 years.

Impact of parental mental illness on children's HoNOSCA results in a regional child and adolescent mental health service

Use of routine outcome measures are frequently used to ascertain improvement in children's symptomology, this study examined whether living with a parent with a mental illness impacted outcome measures. The study examined 134 children attending a Child and Adolescent Mental Health Service (CAMHS). The majority lived with a parent reporting mental illness. Routine HoNOSCA and CGAS outcome measures were collected over a 6-month period. Children of parents with a mental illness scored higher on most outcome measures. All children improved on most variables over the 6 months of CAMHS intervention with children of parents with mental illness showing greater improvement compared to other children on behaviour but less improvement on all other variables. They did not, however, improve as much on education-related factors and showed lower improvement in overall functioning. Younger children with a parent with a mental illness improved least in the area of behaviour. This study highlighted the need for greater use and integration of measures where children live with a parent who has a mental illness. Findings suggest parental mental illness impacted on overall child outcomes, and this influence remained irrespective of clinical intervention. The common occurrence of parental mental illness, where children also have a mental illness, indicates focusing on a wider set of outcome measures for more effective intervention. Analysis of a larger cohort sample is warranted.

Trajectories of change in maternal and adolescent depressive symptoms in the depression prevention initiative

BACKGROUND

Given the prevalence and consequences of adolescent depression, depression prevention has become an important area of research. While prevention programs like Interpersonal Psychotherapy - Adolescent Skills Training (IPT-AST) have demonstrated effectiveness, little research to date has studied the relationship between maternal depression and adolescent outcomes in these programs.

METHOD

The current study investigated the relationship between maternal and adolescent depressive symptoms in 167 mother-adolescent dyads who were enrolled in the Depression Prevention Initiative (DPI), a randomized controlled trial that compared IPT-AST to group counseling (GC). First, the study examined the relationship between initial levels of adolescent and maternal depressive symptoms. The study then investigated whether maternal depressive symptoms improved over the two-year study period. Finally, the study assessed whether maternal and adolescent symptoms changed concurrently across time.

RESULTS

Results indicated that initial levels of maternal and adolescent symptoms were positively associated. Additionally, maternal symptoms improved across the two-year period. Maternal and adolescent outcomes were related across time: as adolescents improved in our study, their mothers also improved.

LIMITATIONS

The study utilized self-report data only and did not allow for the testing of causality in the relationship between mother-youth depression.

CONCLUSIONS

These findings add to the literature demonstrating that as one part of the mother-child dyad improves, the other improves as well. These findings extend the current understanding of the relationship between maternal and adolescent depressive symptom outcomes, and have important implications for the prevention and treatment of depression.

Correlations between caregiver psychiatric symptoms and offspring psychopathology in a low-resource setting

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The relationship between parental depressive symptoms and offspring psychopathology: evidence from a children-of-twins study and an adoption study

BACKGROUND

Parental depressive symptoms are associated with emotional and behavioural problems in offspring. However, genetically informative studies are needed to distinguish potential causal effects from genetic confounds, and longitudinal studies are required to distinguish parent-to-child effects from child-to-parent effects.

METHOD

We conducted cross-sectional analyses on a sample of Swedish twins and their adolescent offspring (n = 876 twin families), and longitudinal analyses on a US sample of children adopted at birth, their adoptive parents, and their birth mothers (n = 361 adoptive families). Depressive symptoms were measured in parents, and externalizing and internalizing problems measured in offspring. Structural equation models were fitted to the data.

RESULTS

Results of model fitting suggest that associations between parental depressive symptoms and offspring internalizing and externalizing problems remain after accounting for genes shared between parent and child. Genetic transmission was not evident in the twin study but was evident in the adoption study. In the longitudinal adoption study child-to-parent effects were evident.

CONCLUSIONS

We interpret the results as demonstrating that associations between parental depressive symptoms and offspring emotional and behavioural problems are not solely attributable to shared genes, and that bidirectional effects may be present in intergenerational associations.

Family support programs and adolescent mental health: review of evidence

Family support programs aim to improve parent wellbeing and parenting as well as adolescent mental and behavioral health by addressing the needs of parents of adolescents experiencing or at risk for mental health problems. Family support programs can be part of the treatment for adolescents diagnosed with mental or behavioral health problems, or family support programs can be delivered as prevention programs designed to prevent the onset or escalation of mental or behavioral health problems. This review discusses the rationale for family support programs and describes the range of services provided by family support programs. The primary focus of the review is on evaluating the effectiveness of family support programs as treatments or prevention efforts delivered by clinicians or peers. Two main themes emerged from the review. First, family support programs that included more forms of support evidenced higher levels of effectiveness than family support programs that provided fewer forms of support. Discussion of this theme focuses on individual differences in client needs and program adaptions that may facilitate meeting diverse needs. Second, family support prevention programs appear to be most effective when serving individuals more in need of mental and behavioral health services. Discussion of this theme focuses on the intensity versus breadth of the services provided in prevention programs. More rigorous evaluations of family support programs are needed, especially for peer-delivered family support treatments.