Characteristics of depressed and nondepressed adult offspring of depressed and matched nondepressed parents

The high price of depression: Family members' health conditions and health care costs

OBJECTIVE

To compare the health conditions and health care costs of family members of patients diagnosed with a Major Depressive Disorder (MDD) to family members of patients without an MDD diagnosis.

METHODS

Using electronic health record data, we identified family members (n=201,914) of adult index patients (n=92,399) diagnosed with MDD between 2009 and 2014 and family members (n=187,011) of matched patients without MDD. Diagnoses, health care utilization and costs were extracted for each family member. Logistic regression and multivariate models were used to compare diagnosed health conditions, health services cost, and utilization of MDD and non-MDD family members. Analyses covered the 5years before and after the index patient's MDD diagnosis.

RESULTS

MDD family members were more likely than non-MDD family members to be diagnosed with mood disorders, anxiety, substance use disorder, and numerous other conditions. MDD family members had higher health care costs than non-MDD family members in every period analyzed, with the highest difference being in the year before the index patient's MDD diagnosis.

CONCLUSIONS

Family members of patients with MDD are more likely to have a number of health conditions compared to non-MDD family members, and to have higher health care cost and utilization.

A Couples' Based Self-Management Program for Heart Failure: Results of a Feasibility Study

Background

Heart failure (HF) is associated with frequent exacerbations and shortened lifespan. Informal caregivers such as significant others often support self-management in patients with HF. However, existing programs that aim to enhance self-management seldom engage informal caregivers or provide tools that can help alleviate caregiver burden or improve collaboration between patients and their informal caregivers.

Objective

To develop and pilot test a program targeting the needs of self-management support among HF patients as well as their significant others.

Methods

We developed the Dyadic Health Behavior Change model and conducted semi-structured interviews to determine barriers to self-management from various perspectives. Participants’ feedback was used to develop a family-centered self-management program called “SUCCEED: Self-management Using Couples’ Coping EnhancEment in Diseases.” The goals of this program are to improve HF self-management, quality of life, communication within couples, relationship quality, and stress and caregiver burden. We conducted a pilot study with 17 Veterans with HF and their significant others to determine acceptability of the program. We piloted psychosocial surveys at baseline and after participants’ program completion to evaluate change in depressive symptoms, caregiver burden, self-management of HF, communication, quality of relationship, relationship mutuality, and quality of life.

Results

Of the 17 couples, 14 completed at least 1 SUCCEED session. Results showed high acceptability for each of SUCCEED’s sessions. At baseline, patients reported poor quality of life, clinically significant depressive symptoms, and inadequate self-management of HF. After participating in SUCCEED, patients showed improvements in self-management of HF, communication, and relationship quality, while caregivers reported improvements in depressive symptoms and caregiver burden. Quality of life of both patients and significant others declined over time.

Conclusion

In this small pilot study, we showed positive trends with involving significant others in self-management. SUCCEED has the potential of addressing the growing public health problem of HF among patients who receive care from their significant other.

Childhood parental mental illness: living with fear and mistrust

This paper presents one major theme of findings from a doctorate study. The study used a narrative enquiry approach, to gather parenting narratives of adult children of parents with mental illness. A Partnership Model for a Reflexive Narrative for Participant and Researcher (Partnership Model) was used to invite participants into the study, while encouraging a space for reflection for both the adult children and researcher. In total, 13 adult children participants constructed their narratives of living with childhood parental mental illness, alongside their current parenting role. Their stories reflected childhood experiences of fear and emergence of mistrust of others, particularly their parent with mental illness. For some participants, fear and mistrust continued into adulthood. Many adult children reported their childhood experiences of feeling lonely and isolated. They felt unable to disclose their experiences of parental mental illness to others. In addition, participants were unable to access information about their parent's condition, leaving them feeling unprepared and unskilled, despite their childhood desire to help their parent. This furthermore, compounded their sense of fear and isolation. Early identification of children and families experiencing mental illness is important to facilitate dialogue, psychoeducation and support. Social and health professionals have an important opportunity to enhance the social integration and support for families experiencing parental mental illness, to reduce long-standing fear, isolation and mistrust.

A Dynamic Cycle of Familial Mental Illness

In this paper, we present A Dynamic Cycle of Familial Mental Illness; an innovative framework, which considers family members' experiences and responses to mental illness. There is an acknowledged discourse noting parental experiences of mental illness alongside a growing body of knowledge acknowledging children's needs while living with parental mental illness. However, there is a paucity of literature that makes reference to the concept of familial mental illness and the cyclic interface of parental and child distress and symptoms. The model is supported by published research studies from several differing disciplines to demonstrate the relationship between parent and child experiences and to synthesise the published short- and longer-term possible impact of familial mental illness. An extensive search of the literature using recognised search engines, keywords and phrases has been undertaken, to generate an appropriate literature base for this work. This literature demonstrates how a child's possible emotional distancing as a response to parental mental illness could increase parental distress. A Dynamic Cycle of Familial Mental Illness adopts the underpinning philosophy of a Stress Vulnerability Model of Mental Illness, which assumes that predisposing factors and increased stress for a parent may have possible links to exacerbation of parental mental distress and symptomology. We advocate for further research of familial mental illness, and argue for a family approach to mental health assessment and treatment in mainstream health and social care sectors.

Pain-related symptoms of temporomandibular disorders in the offspring of antenatally depressed mothers and depressed parents: a 31-year follow-up of the Northern Finland Birth Cohort 1966

BACKGROUND

Temporomandibular disorders (TMDs) are clinical problems involving the masticatory muscles and temporomandibular joints (TMJs). Aspects of the aetiology of TMD are controversial. Many studies have identified an association between depression and TMD. The aim of the study was to evaluate the association between both maternal antenatal depression and parental depression during the offspring's childhood with TMD symptoms of the offspring during adulthood and to evaluate the effect of the offspring's own depression on this association.

METHODS

In the general population-based Northern Finland Birth Cohort 1966 (NFBC 1966), mothers of 12,058 children were asked at mid-gestation at the antenatal clinic if they felt depressed. Of these offspring who had data available on TMD symptoms in the computer-aided inquiry at the 31-year field study, a final study data of 5541 subjects was compiled. The Finnish Hospital Discharge Register was used to identify depression in the parents between the years 1972 and 1984 (when offspring were 6-18 years old).

RESULTS

There were no statistically significant associations between TMD symptoms and maternal antenatal depressed mood. However, parental depression during the offspring's childhood associated significantly with facial pain [adjusted odds ratio (OR) = 1.64; 1.05-2.56] and with TMJ pain at jaw rest (OR = 1.81; 1.13-2.89), even after adjusting for gender, occupation of the father, family type at birth and the offspring's self-reported depression in adulthood.

CONCLUSION

The risk for TMD symptoms is not elevated in the offspring of antenatally depressed mothers. Parental depression during an offspring's childhood increases the risk of pain-related TMD symptoms in their early adulthood.

Psychometric assessment of the depressive cognition scale in women family members of adults with serious mental illness

Family members of persons with serious mental illness (SMI) are vulnerable to depression, and early identification of cognitive depressive symptoms is important to prevent it. The Depressive Cognition Scale (DCS) may be beneficial for early detection, but the scale's psychometrics have not been tested in family members of persons with SMI. In this study, 60 women relatives of adults with SMI completed the eight-item DCS and measures of caregiver burden, resourcefulness, sense of coherence, and quality of life. A Cronbach's alpha of .87 indicated internal consistency. Construct validity was supported by correlations with caregiver burden (.40), resourcefulness (-.65), sense of coherence (-.77), and quality of life (-.70). Confirmatory factor analysis produced a single factor with 48% of the variance explained and factor loadings >.45 for all items. The findings suggest the DCS is useful for early detection of depression in women relatives of adults with SMI.