Familial transmission of depression and antisocial behavior symptoms: disentangling the contribution of inherited and environmental factors and testing the mediating role of parenting

Family dysfunction, stressful life events, and mental health problems across development in the offspring of parents with an affective disorder

BACKGROUND

Offspring of parents with affective disorders (OAD) are at risk of developing a wide range of mental disorders. Deficits in the rearing environment and high levels of stress are well-known risk factors for negative outcomes in OAD. Building on prior research, we aim to examine the longitudinal relationships between family dysfunction, stressful life events, and mental health in OAD and control offspring of parents with no affective disorder. In the present study, we hypothesized that high levels of family dysfunction would be associated with more internalizing and externalizing problems across time in OAD than in controls, and that family dysfunction would mediate the relationship between stressful life events in adolescence and poor mental health in adulthood, particularly in OAD.

METHODS

As part of the TRacking Adolescents' Lives Survey (TRAILS), 2230 participants (51% female, Mage = 11.1 years, SD = 0.6, at baseline) and their parents completed measures across six time points, spanning 15 years. Mental health, family dysfunction, and stressful life events were assessed with the Youth and Adult Self-Report, Family Assessment Device, and an in-house measure, respectively.

RESULTS

Multi-group structured equation modeling revealed that family dysfunction was linked to internalizing and externalizing problems in OAD, but not controls, across time. Risk status did not moderate family dysfunction's mediation of the relationship between stressful life events and negative outcomes in adulthood.

CONCLUSIONS

OAD show high sensitivity to dysfunction in the rearing environment across childhood and adolescence, which supports the use of family based interventions to prevent the development of mental disorders in high-risk youth.

Adult mental healthcare professionals' experiences of family centred conversations with patients who are parents: a qualitative study

Background

Many parents with a mental illness report a desire for both recognition of their parental role and support for themselves and their children. However, parents are often fearful of negative judgements from professionals about their ability to be a parent, which inhibits raising concerns about their children with clinical teams. Consequently, an essential first step to supporting families is for professionals to proactively identify which patients are parents, although evidence indicates this is not consistently part of services. Professionals could play a pivotal role in guiding parents about how to talk to their children about their mental illness; this in turn can facilitate family functioning and enable children to access evidence-based interventions. This approach is crucial for mitigating the well-documented intergenerational risk of poorer outcomes and mental illness in children of affected parents. This study aimed to explore adult mental healthcare professionals' beliefs and experiences of talking with patients about: i) their role as parents ii) communication with their children about mental illness.

Methods

Semi-structured qualitative interviews were conducted with 19 adult mental healthcare professionals with 4-30 years' experience of working with adult patients under the care of NHS adult mental healthcare services in England. Audio recordings were transcribed verbatim and analysed using an inductive coding approach following the principles of thematic analysis.

Result

All participants recognised their responsibility to identify patients' children through routine safeguarding protocols, but supporting patients around telling their children the diagnosis was less common. Many participants expressed concerns that raising the topic of children with patients could conflict with other parts of their professional role or would not be welcomed. Obstacles to these conversations were identified, across individual, environmental and organisational factors. Potential facilitators included specific staff training and resources for clinical teams and families around how to tell children about mental illness.

Conclusion

Adult mental healthcare professionals would benefit from enhanced training on the importance and methods of guiding parents to communicate with their children about mental illness. This should include routine identification of which patients are parents and recognition of the impact of an adult's mental illness on the wider family system.

Intergenerational transmission of depressive symptoms: Maternal socialization of infant positive affect as a mediator

Parenting behaviors play an important role in the transmission of depressive symptoms from mothers to children. Although reduced positive affect is a central feature of depression, models of intergenerational transmission have neglected maternal socialization of positive affect as a mediating mechanism. This study investigated whether maternal responses to infant positive affect mediate the link between mothers' and toddlers' depressive symptoms. A community sample of 128 mothers (58% White) and their infants (Mage = 6.65 months, SD = 0.53 at first visit) participated in 3 assessments over a 1-year period. Assessments included self-reports of postpartum depressive symptoms, observational measures of maternal responses to infant positive affect and maternal sensitivity, and mother report of toddlers' depressive problems. Mediation analyses revealed that mothers with elevated postpartum depressive symptoms displayed fewer supportive responses to their infants' positive affect. In turn, infants who received fewer supportive responses had more depressive problems in toddlerhood. The indirect effect of postpartum depressive symptoms on toddlers' depressive problems via maternal supportive responses remained significant after controlling for maternal sensitivity. Findings suggest that maternal responses to infant positive affect play a unique role in the intergenerational transmission of depressive symptoms. The theoretical and practical implications of these findings are discussed.

Familial genetic and environmental transmission of depression: A multi-informant twin family study

The phenomenon of familial clustering in depression is well established, yet the mechanisms by which depression is transmitted within families remain poorly understood. In the current study, we investigate the familial genetic and environmental transmission of depression by incorporating data from both adolescent twins and their parents. A total of 987 twin families were recruited from the Beijing Twin Study. Depression assessments were conducted for both adolescents and their parents. Twins' depression was assessed through reports from both the twins themselves and their parents, while parental depression was assessed by parental self-report. We employed a nuclear twin family model to examine genetic and environmental influences on adolescent depression. Our results, based on both self- and parent-report, demonstrate significant additive and dominant genetic influences on depression. We also found mild yet significant sibling environmental influences, while familial environmental influences were absent. Notably, parent-reported depression showed higher heritability but lower unique environmental influences compared with self-reported depression. These results highlight the important role of genetic transmission and sibling environmental transmission in explaining depression. Our study delineates the underlying mechanism of familial transmission in depression and can inform early treatments to halt transmission during adolescence.

Estimating the impact of transmitted and non-transmitted psychiatric and neurodevelopmental polygenic scores on youth emotional problems

Anxiety and depression (emotional disorders) are familial and heritable, especially when onset is early. However, other cross-generational studies suggest transmission of youth emotional problems is explained by mainly environmental risks. We set out to test the contribution of parental non-transmitted genetic liability, as indexed by psychiatric/neurodevelopmental common polygenic liability, to youth emotional problems using a UK population-based cohort: the Millennium Cohort Study. European (N = 6328) and South Asian (N = 814) ancestries were included, as well as a subset with genomic data from both parents (European: N = 2809; South Asian: N = 254). We examined the association of transmitted (PGST) and non-transmitted polygenic scores (PGSNT) for anxiety, depression, bipolar disorder and neurodevelopmental disorders (attention-deficit/hyperactivity disorder [ADHD], autism spectrum disorder [ASD], schizophrenia) with youth emotional disorder and symptom scores, measured using the parent- and self-reported Strengths and Difficulties Questionnaire emotional subscale at 6 timepoints between ages 3-17 years. In the European sample, PGST for anxiety and depression, but not bipolar disorder, were associated with emotional disorder and symptom scores across all ages, except age 3, with strongest association in adolescence. ADHD and ASD PGST also showed association across ages 11-17 years. In the South Asian sample, evidence for associations between all PGST and outcome measures were weaker. There was weak evidence of association between PGSNT for anxiety and depression and age 17 symptom scores in the South Asian sample, but not in the European sample for any outcome. Overall, PGST for depression, anxiety, ADHD and ASD contributed to youth emotional problems, with stronger associations in adolescence. There was limited support for non-transmitted genetic effects: these findings do not support the hypothesis that parental polygenic psychiatric/neurodevelopmental liability confer risk to offspring emotional problems through non-transmitted rearing/nurture effects.

Differential Associations of Adversity Profiles with Adolescent Cognitive Control and Psychopathology

Adverse childhood experiences are common and have long-term consequences for biological and psychosocial adjustment. We used a person-centered approach to characterize distinct profiles of adversity in early adolescence and examined associations with later cognitive control and psychopathology. The sample included 167 adolescents (47% female) and their primary caregivers who participated in a longitudinal study across four time points (approximately one year between assessments). At Time 1 (Mage = 14 years), we measured seven indicators of adversity: socioeconomic disadvantage, abuse, neglect, household chaos, parent substance use, parent depression, and negative life events. At Times 2-4, adolescents' behavioral performance and functional activation during a cognitive control task were measured. At Time 5, adolescents and their caregiver reported on adolescent internalizing and externalizing symptomatology. Using latent profile analysis, we identified four distinct adversity subgroups: a low exposure group, a neglect group, a household instability group, and a poly-adversity group. These groups significantly differed on subsequent levels of psychopathology, but not cognitive control. Specifically, the poly-adversity group reported significantly higher levels of both internalizing and externalizing symptomatology relative to the low exposure group, and the household instability group demonstrated elevated risk for externalizing symptomatology. When using a cumulative risk approach, higher levels of adversity exposure were associated with significantly worse cognitive control performance (but not neural activation). These results suggest that psychopathology outcomes may be differentially predicted by distinct patterns of risk, and that cognitive control impairment may be more strongly predicted by cumulative risk.

Nutritional considerations in major depressive disorder: current evidence and functional testing for clinical practice

Depression is a multifaceted condition with diverse underlying causes. Several contributing and inter-related factors such as genetic, nutritional, neurological, physiological, gut-brain-axis, metabolic and psychological stress factors play a role in the pathophysiology of depression. This review aims to highlight the role that nutritional factors play in the aetiology of depression. Secondly, we discuss the biomedical and functional pathology tests which measure these factors, and the current evidence supporting their use. Lastly, we make recommendations on how practitioners can incorporate the latest evidence-based research findings into clinical practice. This review highlights that diet and nutrition greatly affect the pathophysiology of depression. Nutrients influence gene expression, with folate and vitamin B12 playing vital roles in methylation reactions and homocysteine regulation. Nutrients are also involved in the tryptophan/kynurenine pathway and the expression of brain-derived neurotrophic factor (BDNF). Additionally, diet influences the hypothalamic-pituitary-adrenal (HPA) response and the composition and diversity of the gut microbiome, both of which have been implicated in depression. A comprehensive dietary assessment, combined with appropriate evaluation of biochemistry and blood pathology, may help uncover contributing factors to depressive symptoms. By employing such an approach, a more targeted and personalised treatment strategy can be devised, ultimately leading to improved patient outcomes.

Socioeconomic disadvantage and parental mood/affective problems links negative parenting and executive dysfunction in children born very preterm

Poverty increases the risk of poorer executive function (EF) in children born full-term (FT). Stressors associated with poverty, including variability in parenting behavior, may explain links between poverty and poorer EF, but this remains unclear for children born very preterm (VPT). We examine socioeconomic and parental psychosocial adversity on parenting behavior, and whether these factors independently or jointly influence EF in children born VPT. At age five years, 154 children (VPT = 88, FT = 66) completed parent-child interaction and EF tasks. Parental sensitivity, intrusiveness, cognitive stimulation, and positive and negative regard were coded with the Parent-Child Interaction Rating Scale. Socioeconomic adversity spanned maternal demographic stressors, Income-to-Needs ratio, and Area Deprivation Index. Parents completed measures of depression, anxiety, inattention/hyperactivity, parenting stress, and social-communication interaction (SCI) problems. Parental SCI problems were associated with parenting behavior in parents of children born VPT, whereas socioeconomic adversity was significant in parents of FT children. Negative parenting behaviors, but not positive parenting behaviors, were related to child EF. This association was explained by parental depression/anxiety symptoms and socioeconomic adversity. Results persisted after adjustment for parent and child IQ. Findings may inform research on dyadic interventions that embed treatment for parental mood/affective symptoms and SCI problems to improve childhood EF.

Experiences of eating difficulties in siblings of people with anorexia nervosa: a reflexive thematic analysis

BACKGROUND

Siblings of people with anorexia nervosa (AN) have been found to experience strong emotions, changing family roles and poorer wellbeing as a consequence of experiencing the effects of the illness on their sibling and family system. These factors, combined with genetic influences, may put siblings at an increased risk of developing eating disorder psychopathology in addition to other mental health issues. This research aims to explore the experiences of siblings of people with AN who have had eating difficulties themselves and investigate issues that may be important to the development and prevention of eating difficulties in this population.

METHODS

This qualitative study used a reflexive thematic analysis approach. Ten adults who had witnessed a sibling with AN and experienced eating difficulties themselves participated in semi-structured interviews.

ANALYSIS

Participants' own eating difficulties were affected by the specific experience of witnessing a sibling with AN through mealtimes becoming emotionally charged, an increased focus on body size and diet, and comparisons with their sibling. Difficult experiences, such as marital discord amongst parents were common, as was a difficulty in managing emotions. The onset of AN within the family caused participants to take on caring responsibilities for their sibling and to hide their own difficulties for fear of adding additional burden to their parents. This reduced their perceived ability to access support and for some increased a desire to restrict as a coping mechanism for the stress they were experiencing. Systemic beliefs regarding the value of thinness were prevalent and influential. Protective factors, such as not wanting to become as unwell as a sibling with AN and an understanding of the negative consequences of AN, aided recovery.

CONCLUSIONS

Eating difficulties in siblings of people with AN may be influenced by competition for slimness, increased focus on diet and body size, and a need to manage difficult emotions. The disruption to social connections and a difficulty finding emotional support that may be experienced by people when a sibling develops AN may further influence susceptibility to eating difficulties. Further research is needed into the best ways to support siblings of people with AN.

The Contagion of Psychopathology across Different Psychiatric Disorders: A Comparative Theoretical Analysis

Psychopathology is often studied and treated from an individual-centered approach. However, studies have shown that psychological distress is often best understood from a contextual, environmental perspective. This paper explores the literature on emotional contagion and symptom transmission in psychopathology, i.e., the complex ways in which one person's psychological distress may yield symptoms among others in his/her close environment. We argue that emotions, cognitions, and behaviors often do not stay within the borders of the individual, but rather represent intricate dynamic experiences that are shared by individuals, as well as transmitted between them. While this claim was comprehensively studied in the context of some disorders (e.g., secondary traumatization and the "mimicking" of symptoms among those close to a trauma survivor), it was very scarcely examined in the context of others. We aim to bridge this gap in knowledge by examining the literature on symptom transmission across four distinct psychiatric disorders: PTSD, major depression, OCD, and psychosis. We first review the literature on emotional contagion in each disorder separately, and then we subsequently conduct a comparative analysis highlighting the shared and differential mechanisms underlying these processes in all four disorders. In this era of transdiagnostic conceptualizations of psychopathology, such an examination is timely, and it may carry important clinical implications.

Examining reciprocal associations between parent depressive symptoms and child internalizing symptoms on subsequent psychiatric disorders: An adoption study

INTRODUCTION

The dynamic interplay between parent depressive symptoms and child internalizing behavior over time is not well understood.

METHODS

We used data from a prospective parent-offspring adoption design (N = 561) to examine associations between adoptive parent depressive symptoms and child internalizing behavior when children were ages 18 months, 27 months, 4.5 years, and 6 years, and subsequent child psychiatric disorder symptoms when children were between the ages of 6-8 years. Models also accounted for the contributions of birth parent psychopathology, birth mother depressive symptoms during pregnancy, and infant negative emotionality. Bidirectional associations between adoptive parent depressive symptoms and child internalizing behavior were examined using a random-intercept cross-lagged panel model.

RESULTS

There was evidence for associations between child internalizing behavior and adoptive parent depressive symptoms over time, with mothers' depressive symptoms being a more salient risk factor for child internalizing behavior than fathers'. We found one significant cross-lagged association from adoptive mother depressive symptoms at child age 18 months to child internalizing behavior at age 27 months. Infant negative emotionality (i.e., emotional liability) at age 9 months predicted both child internalizing behavior and adoptive parent depressive symptoms.

CONCLUSION

Results suggest that postnatal maternal depressive symptoms confer specific risks for child internalizing behaviors in toddlerhood and childhood and depressive symptoms in childhood.

Longitudinal Coupling of Depression in Parent-Adolescent Dyads: Within- and Between-Dyad Effects Over Time

The present work evaluated reciprocal, within-dyad associations between parent-adolescent depressive symptoms across two independent samples (N=327 and N=435 dyads, respectively; approximately 85% biological mothers) assessed every three months for two (Study 1) to three (Study 2) years. Results of random intercept cross-lagged panel models converged to support positive contemporaneous patterns of co-fluctuation in parent and adolescent depression, such that within-person deviations in parental depression were associated with same direction within-person deviations in adolescent depression at the same timepoint. In contrast, within-person fluctuations in parent depression did not predict prospective within-person fluctuations in adolescent depression, or vice versa, across the follow-up period. Results held across boys and girls, as well as dyads with and without a parental history of depressive disorder. Overall, findings advance knowledge by demonstrating that, after accounting for between-person/dyad variance, parent and adolescent depression demonstrate contemporaneous co-fluctuations, but do not demonstrate within-dyad reciprocity over time.

Association of parenting with suicidal ideation and attempts in children and youth: protocol for a systematic review and meta-analysis of observational studies

BACKGROUND

Suicide is a leading cause of death in children and youth, with suicidal thoughts and suicide attempts (referred to as non-fatal suicidal behaviors (NFSB)) being among its strongest predictors. Positive parenting (e.g., warmth, responsiveness), negative parenting (e.g., control, hostility), and parent-child relationship quality (e.g., trust, communication) have been reported to be associated with differences in NFSB in this population. To date, no comprehensive systematic review has considered together the wide range of parenting factors studied in relation to NFSB, and no meta-analysis of existing findings has been conducted. The present study will critically appraise and synthesize the existing evidence from observational studies that examine the relationships between parenting factors and (i) suicidal ideation and (ii) suicide attempt in children and youth.

METHODS

Studies will be retrieved from APA PsycInfo, MEDLINE, CINAHL, Embase, Scopus, and the Cochrane Library databases. Retrospective, cross-sectional, and longitudinal studies, conducted in clinical and population settings, among youth aged less than 25 years and published as articles and dissertations in English or French will be eligible. Two reviewers will select articles using the Covidence Software after title and abstract screening and full-text assessment, will extract information using double data entry, and will appraise studies' quality using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Any disagreements will be discussed with a third reviewer. Publication bias will be evaluated using funnel plots and Egger's test. In addition to a narrative summary of results, meta-analyses will be conducted using results from at least three studies. Three-level random effect models will allow to derive pooled estimates from dependent effect sizes (from the same sample or study). In case of significant heterogeneity, moderation analyses will be performed considering participants' characteristics and methodological aspects of studies. The results will be reported according to the PRISMA guidelines, and the certainty of evidence will be assessed using the GRADE approach.

DISCUSSION

In highlighting parenting factors associated with NFSB and in estimating the overall strength of these associations in children and youth, our results will inform further intervention and prevention strategies designed for young people experiencing NFSB and their families.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020165345.

The Premise and Promise of Activation Parenting for Fathers: A Review and Integration of Extant Literature

Although research on fathers tends to focus on mother-derived conceptualizations of caregiving, such as sensitivity, it has been theorized that fathers play a unique role in opening their children to the world by encouraging exploration and risk-taking. However, extant research on these forms of paternal caregiving is scattered across multiple related but distinct domains, namely rough-and-tumble play, challenging parenting behavior, and the activation relationship. Based on the overlap in theory and operationalizations of these domains, the present review aimed to define and operationalize a new caregiving construct: activation parenting (AP). Fathers who exhibit frequent and high-quality AP behaviors encourage children to take risks, challenge children physically and socioemotionally, and set appropriate limits during stimulating interactions to ensure safety and prevent over-arousal. Using Belsky's (1984) process of parenting model as a foundation, associations between paternal AP and characteristics of the father, his environment, and his child are reviewed, with a focus on early childhood (i.e., ages 0-5 years). The present review found some support for paternal AP occurring more frequently, but not necessarily with higher quality, when fathers had children older than one years old. Unexpectedly, the frequency and quality of paternal AP did not differ much by paternal age or indicators of socioeconomic status, or by child age or gender. In line with underlying theories, higher quality paternal AP in early childhood has been found to be associated with children's self-regulation skills and lower levels of internalizing and externalizing problems. Limitations of the current paternal AP literature are discussed and future directions for research, policy, and clinical work are proposed.

Disentangling nature from nurture in examining the interplay between parent-child relationships, ADHD, and early academic attainment

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is highly heritable and is associated with lower educational attainment. ADHD is linked to family adversity, including hostile parenting. Questions remain regarding the role of genetic and environmental factors underlying processes through which ADHD symptoms develop and influence academic attainment.

METHOD

This study employed a parent-offspring adoption design (N = 345) to examine the interplay between genetic susceptibility to child attention problems (birth mother ADHD symptoms) and adoptive parent (mother and father) hostility on child lower academic outcomes, via child ADHD symptoms. Questionnaires assessed birth mother ADHD symptoms, adoptive parent (mother and father) hostility to child, early child impulsivity/activation, and child ADHD symptoms. The Woodcock-Johnson test was used to examine child reading and math aptitude.

RESULTS

Building on a previous study (Harold et al., 2013, Journal of Child Psychology and Psychiatry, 54(10), 1038-1046), heritable influences were found: birth mother ADHD symptoms predicted child impulsivity/activation. In turn, child impulsivity/activation (4.5 years) evoked maternal and paternal hostility, which was associated with children's ADHD continuity (6 years). Both maternal and paternal hostility (4.5 years) contributed to impairments in math but not reading (7 years), via impacts on ADHD symptoms (6 years).

CONCLUSION

Findings highlight the importance of early child behavior dysregulation evoking parent hostility in both mothers and fathers, with maternal and paternal hostility contributing to the continuation of ADHD symptoms and lower levels of later math ability. Early interventions may be important for the promotion of child math skills in those with ADHD symptoms, especially where children have high levels of early behavior dysregulation.

Family-Based Designs that Disentangle Inherited Factors from Pre- and Postnatal Environmental Exposures: In Vitro Fertilization, Discordant Sibling Pairs, Maternal versus Paternal Comparisons, and Adoption Designs

Identifying environmental risk and protective exposures that have causal effects on health is an important scientific goal. Many environmental exposures are nonrandomly allocated and influenced by dispositional factors including inherited ones. We review family-based designs that can separate the influence of environmental exposures from inherited influences shared between parent and offspring. We focus on prenatal exposures. We highlight that the family-based designs that can separate the prenatal environment from inherited confounds are different to those that are able to pull apart later-life environmental exposures from inherited confounds. We provide a brief review of the literature on maternal smoking during pregnancy and offspring attention-deficit/hyperactivity disorder (ADHD) and conduct problems; these inconsistencies in the literature make a review useful and this illustrates that results of family-based genetically informed studies are inconsistent with a causal interpretation for this exposure and these two offspring outcomes.

Polygenic Risk for Major Depression Interacts with Parental Criticism in Predicting Adolescent Depressive Symptom Development

Research has focused more and more on the interplay between genetics and environment in predicting different forms of psychopathology, including depressive symptoms. While the polygenic nature of depressive symptoms is increasingly recognized, only few studies have applied a polygenic approach in gene-by-environment interaction (G × E) studies. Furthermore, longitudinal G × E studies on developmental psychopathological properties of depression are scarce. Therefore, this 6-year longitudinal community study examined the interaction between genetic risk for major depression and a multi-informant longitudinal index of critical parenting in relation to depressive symptom development from early to late adolescence. The sample consisted of 327 Dutch adolescents of European descent (56% boys; M_age T₁ = 13.00, SD_age T₁ = 0.44). Polygenic risk for major depression was based on the Hyde et al. (Nature Genetics, 48, 1031–1036, 2016) meta-analysis and genetic sensitivity analyses were based on the 23andMe discovery dataset. Latent Growth Models suggested that polygenic risk score for major depression was associated with higher depressive symptoms across adolescence (significant main effect), particularly for those experiencing elevated levels of critical parenting (significant G × E). These findings highlight how polygenic risk for major depression in combination with a general environmental factor impacts depressive symptom development from early to late adolescence.

The Transactional Relationship between Parental and Adolescent Depressive Symptoms: The Mediating Effect of Nurturant-Involved Parenting

Sameroff's transactional theory emphasizes a bidirectional process between parents and offspring. The present study explored the reciprocal relationships between parental and adolescent depressive symptoms using a cross-lagged model and examined the mediating effect of nurturant-involved parenting on the relationship between them. Data for the present study were collected from a longitudinal study, and a total of 1644 adolescents and their mothers and fathers participated in the present study. The results revealed a reciprocal relationship between maternal and adolescent depressive symptoms, and the child-driven effect was more robust than the mother-driven effect. Adolescent depressive symptoms significantly predicted paternal depressive symptoms, but not vice versa. In addition, adolescent depressive symptoms indirectly predicted maternal and paternal depressive symptoms by deteriorating nurturant-involved parenting. These findings highlight a child-driven effect on parents' psychopathology, which may shed light on the mechanism underlying depression transmission between parents and adolescents.

Parenting and Youth Onset of Depression Across Three Years: Examining the Influence of Observed Parenting on Child and Adolescent Depressive Outcomes

Concurrent associations between parenting behaviors and youth depression are well established. A smaller body of work has demonstrated longitudinal associations between aspects of parenting and youth risk for depression; however, this limited longitudinal work has predominantly relied upon self- and parent-report questionnaire measures and is thus affected by biases related to retrospective recall and common method variance. The present study used behavioral observation measures of parenting and clinical interview measures of youth depression to examine prospective relationships between observed parental support, responsiveness, criticism, and conflict and youths' onset of a depressive episode in a 3-year longitudinal design. Participants included 585 community youth age 8-16 (M = 11.92, SD = 2.39, 56.6% female) and a participating caregiver. Parental behavior was coded by trained observers in the context of a 5-min conflict resolution discussion at the baseline assessment. Youth onset of depression was subsequently assessed every 6 months for a period of 3 years using the Schedule for Affective Disorders and Schizophrenia for School Aged Children (KSADS) to ascertain whether youth experienced onset of depressive episode over the follow-up. Logistic regression analyses indicated that greater parental conflict at baseline predicted higher odds of youth experiencing a depressive onset across the 3-year follow up period, even after controlling for youth and caregiver history of depression at baseline. Findings suggest that parental conflict is particularly influential in youth vulnerability to depression.

Siblings of Individuals With Eating Disorders: A Review of the Literature

Eating disorders (EDs) are serious psychopathologies characterized by a persistent disturbance in eating or eating-related behavior. Studies have shown EDs' detrimental consequences not only for patients, but also for their families. Nevertheless, a specific group that has so far been neglected, in both the research and clinical fields, are siblings of individuals with EDs. In an effort to identify this population's needs, and to facilitate effective prevention and treatment, this paper aims to review the existing literature on the subject, and examine siblings' personal experience, ways of coping, and levels of psychopathology. PubMed and PsycNet databases were searched with no publication date restrictions, yielding 26 relevant papers. Studies were categorized according to common themes they addressed, and subsequently summarized by highlighting common features, as well as information unique to each study. Several themes emerged, including emotional well-being, psychopathology, social consequences, family dynamics, and coping strategies. Results show that EDs experienced by one individual have significant effects on one's siblings, such as a decrease in quality of life, social isolation, and elevated familial strain. In several studies siblings were found to have elevated levels of psychopathology and EDs related symptoms. Nevertheless, findings' nature and magnitude were highly varied. The review indicates the need for further studies that will examine possible intra- and interpersonal moderating factors for EDs' impact on well-being among siblings, and take into consideration the substantial heterogeneity in studies conducted thus far. Additionally, this review highlights the need for novel and effective interventions, specifically targeting this at-risk group.

The intergenerational transmission of suicidal behavior: an offspring of siblings study

We examined the extent to which genetic factors shared across generations, measured covariates, and environmental factors associated with parental suicidal behavior (suicide attempt or suicide) account for the association between parental and offspring suicidal behavior. We used a Swedish cohort of 2,762,883 offspring born 1973-2001. We conducted two sets of analyses with offspring of half- and full-siblings: (1) quantitative behavior genetic models analyzing maternal suicidal behavior and (2) fixed-effects Cox proportional hazard models analyzing maternal and paternal suicidal behavior. The analyses also adjusted for numerous measured covariates (e.g., parental severe mental illness). Quantitative behavior genetic analyses found that 29.2% (95% confidence interval [CI], 5.29, 53.12%) of the intergenerational association was due to environmental factors associated with exposure to maternal suicidal behavior, with the remainder due to genetic factors. Statistical adjustment for parental behavioral health problems partially attenuated the environmental association; however, the results were no longer statistically significant. Cox hazard models similarly found that offspring were at a 2.74-fold increased risk [95% CI, 2.67, 2.83]) of suicidal behavior if their mothers attempted/died by suicide. After adjustment for familial factors and measured covariates, associations attenuated but remained elevated for offspring of discordant half-siblings (HR, 1.57 [95% CI, 1.45, 1.71]) and full-siblings (HR, 1.62 [95% CI, 1.57, 1.67]). Cox hazard models demonstrated a similar pattern between paternal and offspring suicidal behavior. This study found that the intergenerational transmission of suicidal behavior is largely due to shared genetic factors, as well as factors associated with parental behavioral health problems and environmental factors associated with parental suicidal behavior.

Effects of Maternal Depression and Mother-Child Relationship Quality in Early Childhood on Neural Reactivity to Rejection and Peer Stress in Adolescence: A 9-Year Longitudinal Study

Problems in mother-child relationships are thought to be key to intergenerational transmission of depression. To evaluate neural and behavioral processes involved in these pathways, we tested effects of maternal depression and maternal-child relationship quality in early childhood on neural and interviewer-based indicators of social processes in adolescence. At age 3, children and mothers (N=332) completed an observational parenting measure and diagnostic interviews with mothers. At age 12, adolescents completed a task in which event-related potentials (ERPs) were recorded to peer acceptance and rejection feedback and interviews to assess peer stress. Lower mother-child relationship quality at age 3 was associated with enhanced reactivity to rejection, as measured by N1, and greater peer stress at age 12. Indirect effects of maternal depression through mother-child relationship quality were observed for N1 and peer stress. Findings inform understanding of disruptions in social functioning that are likely relevant to the intergenerational transmission of depression.

The Rearing Environment and Risk for Major Depression: A Swedish National High-Risk Home-Reared and Adopted-Away Co-Sibling Control Study

OBJECTIVE

The authors sought to clarify the role of rearing environment in the etiology of major depression.

METHODS

Defining high risk as having at least one biological parent with major depression, the authors identified a Swedish National Sample of 666 high-risk full sibships and 2,596 high-risk half sibships containing at least one home-reared and one adopted-away sibling. Major depression was assessed from national medical registries.

RESULTS

Controlling for sex, parental age at birth, and, for half siblings, history of major depression in the nonshared parent, the risk for major depression in the matched adopted compared with home-reared full and half siblings was reduced by 23% (95% CI=7-36) and by 19% (95% CI=10-38), respectively. This protective rearing effect was not influenced by the relative educational status of the biological and adoptive parents. However, in both full and half sibships, the protective effect of adoption disappeared when an adoptive parent or stepsibling had major depression or the adoptive home was disrupted by parental death or divorce.

CONCLUSIONS

In matched full and half sibships at high risk for major depression, compared with individuals raised in their home environment, those reared in adoptive homes (homes selected in Sweden for their high-quality rearing environment) had a significantly reduced risk for major depression. This protective effect disappeared if an adoptive parent had major depression or if the adoptive home experienced parental death or divorce during childhood/adolescence. The rearing environment has a meaningful impact on risk for major depression, and this effect is likely mediated both by parental depression and the continuity or disruption of the home environment.

Utilising Genetically-Informed Research Designs to Better Understand Family Processes and Child Development: Implications for Adoption and Foster Care Focused Interventions

Understanding the interplay between genetic factors and family environmental processes (e.g., inter-parental relationship quality, positive versus negative parenting practices) and children's mental health (e.g., anxiety, depression, conduct problems, ADHD) in the contexts of adoption and foster-care research and practice is critical for effective prevention and intervention programme development. Whilst evidence highlights the importance of family environmental processes for the mental health and well-being of children in adoption and foster care, there is relatively limited evidence of effective interventions specifically for these families. Additionally, family-based interventions not specific to the context of adoption and foster-care typically show small to medium effects, and even where interventions are efficacious, not all children benefit. One explanation for why interventions may not work well for some is that responses to intervention may be influenced by an individual's genetic make-up. This paper summarises how genetically-informed research designs can help disentangle genetic from environmental processes underlying psychopathology outcomes for children, and how this evidence can provide improved insights into the development of more effective preventative intervention targets for adoption and foster-care families. We discuss current difficulties in translating behavioural genetics research to prevention science, and provide recommendations to bridge the gap between behavioural genetics research and prevention science, with lessons for adoption and foster-care research and practice.

Epilepsy, language, and social skills

Language and social skills are essential for intrapersonal and interpersonal functioning and quality of life. Since epilepsy impacts these important domains of individuals' functioning, understanding the psychosocial and biological factors involved in the relationship among epilepsy, language, and social skills has important theoretical and clinical implications. This review first describes the psychosocial and biological factors involved in the association between language and social behavior in children and in adults and their relevance for epilepsy. It reviews the findings of studies of social skills and the few studies conducted on the inter-relationship of language and social skills in pediatric and adult epilepsy. The paper concludes with suggested future research and clinical directions that will enhance early identification and treatment of epilepsy patients at risk for impaired language and social skills.

A Prospective Test of the Family Stress Model with Mexican-origin Adolescent Mothers

The current six-wave longitudinal study tested the Family Stress Model among 204 Mexican-origin families in which an adolescent pregnancy had occurred. Wave 1 (W1) occurred when adolescents (M age = 16.80 years; SD = 1.00) were pregnant, and the last wave (W6) occurred when children were 5 years of age. In the current study, the Family Stress Model was expanded to include parenting relations among adolescent mothers and fathers, and among adolescent mothers and grandmothers. In support of the Family Stress Model, findings indicated that W1 family income was negatively associated with W6 child internalizing and externalizing problem behaviors via increased W2 economic pressure, increased W3 maternal depressive symptoms, increased W4 mother-grandmother coparenting conflict, and increased W5 maternal parenting hassles. Additionally, W4 mother-father coparenting conflict was positively associated with W6 child internalizing and externalizing problem behaviors via W5 maternal parenting hassles. Findings are discussed with attention to the processes by which family income informs child problem behaviors over time. El presente estudio longitudinal de seis años analizó el Family Stress Model con una muestra de 204 familias de origen mexicano en las cuales había ocurrido un embarazo durante la adolescencia. La primera fase (W1) del estudio se llevó a cabo cuando las adolescentes (M edad= 16.80 años; DE= 1.00) estaban embarazadas, y la última fase (W6) ocurrió cuando sus niños tenían cinco años. En el presente estudio, el Family Stress Model se amplió para incluir variables sobre la co-paternidad entre las madres adolescentes y los padres, y entre las madres adolescentes y las abuelas. Los resultados apoyaron las ideas del Family Stress Model; ingreso familiar en W1 mostró un efecto negativo con problemas de comportamiento y problemas de internalización de los niños en W6 a través del aumento de la presión económica en W2, el aumento de síntomas de depresión maternos en W3, el aumento del conflicto de la co-paternidad entre madre y abuela en W4, y el aumento de problemas de crianza maternas en W5. Adicionalmente, conflicto de la co-paternidad entre la madre y el padre mostró un efecto positivo con problemas de comportamiento y problemas de internalización de los niños en W6 a través de problemas de crianza maternas en W5. Varias ideas se presentan en la Discusión sobre como el ingreso familiar informa el comportamiento problemático en niños a largo plazo.

Do natural experiments have an important future in the study of mental disorders?

There is an enormous interest in identifying the causes of psychiatric disorders but there are considerable challenges in identifying which risks are genuinely causal. Traditionally risk factors have been inferred from observational designs. However, association with psychiatric outcome does not equate to causation. There are a number of threats that clinicians and researchers face in making causal inferences from traditional observational designs because adversities or exposures are not randomly allocated to individuals. Natural experiments provide an alternative strategy to randomized controlled trials as they take advantage of situations whereby links between exposure and other variables are separated by naturally occurring events or situations. In this review, we describe a growing range of different types of natural experiment and highlight that there is a greater confidence about findings where there is a convergence of findings across different designs. For example, exposure to hostile parenting is consistently found to be associated with conduct problems using different natural experiment designs providing support for this being a causal risk factor. Different genetically informative designs have repeatedly found that exposure to negative life events and being bullied are linked to later depression. However, for exposure to prenatal cigarette smoking, while findings from natural experiment designs are consistent with a causal effect on offspring lower birth weight, they do not support the hypothesis that intra-uterine cigarette smoking has a causal effect on attention-deficit/hyperactivity disorder and conduct problems and emerging findings highlight caution about inferring causal effects on bipolar disorder and schizophrenia.

Genetic moderation of the effects of the Family Check-Up intervention on children's internalizing symptoms: A longitudinal study with a racially/ethnically diverse sample

Development involves synergistic interplay among genotypes and the physical and cultural environments, and integrating genetics into experimental designs that manipulate the environment can improve understanding of developmental psychopathology and intervention efficacy. Consistent with differential susceptibility theory, individuals can vary in their sensitivity to environmental conditions including intervention for reasons including their genotype. As a consequence, understanding genetic influences on intervention response is critical. Empirically, we tested an interaction between a genetic index representing sensitivity to the environment and the Family Check-Up intervention. Participants were drawn from the Early Steps Multisite randomized prevention trial that included a low-income and racially/ethnically diverse sample of children and their families followed longitudinally (n = 515). As hypothesized, polygenic sensitivity to the environment moderated the effects of the intervention on 10-year-old children's symptoms of internalizing psychopathology, such that children who were genetically sensitive and were randomly assigned to the intervention had fewer symptoms of child psychopathology than genetically sensitive children assigned to the control condition. A significant difference in internalizing symptoms assessed with a clinical interview emerged between the intervention and control groups for those 0.493 SD above the mean on polygenic sensitivity, or 25% of the sample. Similar to personalized medicine, it is time to understand individual and sociocultural differences in treatment response and individualize psychosocial interventions to reduce the burden of child psychopathology and maximize well-being for children growing up in a wide range of physical environments and cultures.

The Impact of the "Semente" Program on the Family-Focused Practice of Mental Health Professionals in Portugal

Background: Children of parents with mental illness (COPMI) are a high-risk group. There is a strong association between parents' psychiatric disorders and the incidence of psychopathology in their children. These children need to be identified and supported by mental health workers early, and hence, clinical practice in adult mental health services needs to change from a focus on individual patients to a more systemic family focus. "Semente," a mental health promotion program developed by the Psychiatry Service of Fernando Fonseca hospital (Lisbon, Portugal), had been established to identify these children and families and promote their mental health, by decreasing the impact of risk factors and promoting protective factors. The program included preventive COPMI interventions and implementation of activities offered to families with children in the mental health care. The aim of the present study was to evaluate changes in mental health care after the training in "Child Talks" intervention (two to three psycho-educational meetings with parents and children) and implementation of the "Semente" program. Methods: Participants (N = 51) were all professionals from Psychiatric Service of Fernando Fonseca Hospital who received Child Talks training. The Family-Focused Mental Health Practice Questionnaire (FFMPQ) was used to measure change in professionals' attitudes, knowledge, confidence, and organizational structure in working with these families. All participants filled in the questionnaire before training and 10 months later. Results: The results showed that, from pre- to post-measurement, the professionals changed clinical practice significantly. The largest changes were visible in the improved provision of support at the workplace for family-focused practice and the clarity and availability of the policies and procedures. Furthermore, the skill and knowledge of the mental health workers showed significant improvement at posttest. Conclusion: The positive results of this study were not unexpected; the training, implementation of routines, and procedures as well as workplace support were aims of the "Semente" program. Interpretation of the results should be taken with caution because of the small sample and the lower reliability of some of scales of the FFMPQ. The results indicate that professionals moved from patient focus to family focus during the implementation of the "Semente" program.

The Relationship Between Parental Affective Temperament Traits and Disruptive Behavior Disorders Symptoms in Children With ADHD

OBJECTIVE

This study investigated the relationship between parental affective temperaments and the oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms of children with ADHD.

METHOD

The sample consisted of 542 treatment-naive children with ADHD and their biological parents. Children were assessed via both parent- and teacher-rated behavioral disorder scales. Parental affective temperament and ADHD symptoms were measured by self-report inventories. The relationships between psychiatric variables were evaluated using structural equation modeling.

RESULTS

According to parent-rated behavioral disorder scales, paternal cyclothymic and maternal irritable temperaments were associated with ODD scores, and maternal depressive temperament was associated with CD scores. In terms of teacher-rated behavioral disorder scales, maternal anxious temperament was associated with ODD scores, and paternal cyclothymic and maternal depressive temperaments were associated with CD scores.

CONCLUSION

These results suggest that certain parental affective temperaments are related to an increase in symptoms of disruptive behavioral disorders in children with ADHD.

Adult mental health clinicians' perspectives of parents with a mental illness and their children: single and dual focus approaches

BACKGROUND

When clinicians in the adult mental health sector work with clients who are parents with dependent children, it is critical they are able to acknowledge and respond to the needs of the parents and their children. However, little is known about clinicians' personal perspectives and reactions towards these parents and children or if/how they balance the needs of both.

METHODS

Semi structured interviews were conducted with eleven clinicians from adult mental health services in Australia. Interviews focused on clinicians' experiences when working with parents who have mental illness. Transcripts were analysed within an Interpretative Phenomenological Analysis framework to examine participants' perspectives and personal reactions to parents and children.

RESULTS

There was considerable divergence in participants' reactions towards parents and children and the focus of their perspectives when working with parental mental illness. Feelings of sympathy and responsibility made it difficult for some participants to maintain a dual focus on parents and children and contributed to some adopting practices that focused on the needs of parents (n = 3) or children (n = 1) exclusively. Other participants (n = 7) described strategies and supports that allowed them to manage these feelings and sustain a dual focus that incorporated the experiences and needs of both parents and children.

CONCLUSIONS

It is difficult for some mental health clinicians to maintain a dual focus that incorporates the needs and experiences of parents and their children. However, findings suggest that the challenges of a dual focus may be mitigated through adequate workplace support and a strengths-based practice framework that emphasises parental empowerment.

Using an adoption-biological family design to examine associations between maternal trauma, maternal depressive symptoms, and child internalizing and externalizing behaviors

Maternal trauma is a complex risk factor that has been linked to adverse child outcomes, yet the mechanisms underlying this association are not well understood. This study, which included adoptive and biological families, examined the heritable and environmental mechanisms by which maternal trauma and associated depressive symptoms are linked to child internalizing and externalizing behaviors. Path analyses were used to analyze data from 541 adoptive mother-adopted child (AM-AC) dyads and 126 biological mother-biological child (BM-BC) dyads; the two family types were linked through the same biological mother. Rearing mother's trauma was associated with child internalizing and externalizing behaviors in AM-AC and BM-BC dyads, and this association was mediated by rearing mothers' depressive symptoms, with the exception of biological child externalizing behavior, for which biological mother trauma had a direct influence only. Significant associations between maternal trauma and child behavior in dyads that share only environment (i.e., AM-AC dyads) suggest an environmental mechanism of influence for maternal trauma. Significant associations were also observed between maternal depressive symptoms and child internalizing and externalizing behavior in dyads that were only genetically related, with no shared environment (i.e., BM-AC dyads), suggesting a heritable pathway of influence via maternal depressive symptoms.

Shared genetic influences do not explain the association between parent-offspring relationship quality and offspring internalizing problems: results from a Children-of-Twins study

BACKGROUND

Associations between parenting and child outcomes are often interpreted as reflecting causal, social influences. However, such associations may be confounded by genes common to children and their biological parents. To the extent that these shared genes influence behaviours in both generations, a passive genetic mechanism may explain links between them. Here we aim to quantify the relative importance of passive genetic v. social mechanisms in the intergenerational association between parent-offspring relationship quality and offspring internalizing problems in adolescence.

METHODS

We used a Children-of-Twins (CoT) design with data from the parent-based Twin and Offspring Study of Sweden (TOSS) sample [909 adult twin pairs and their offspring; offspring mean age 15.75 (2.42) years], and the child-based Swedish Twin Study of CHild and Adolescent Development (TCHAD) sample [1120 adolescent twin pairs; mean age 13.67 (0.47) years]. A composite of parent-report measures (closeness, conflict, disagreements, expressions of affection) indexed parent-offspring relationship quality in TOSS, and offspring self-reported internalizing symptoms were assessed using the Child Behavior Checklist (CBCL) in both samples.

RESULTS

A social transmission mechanism explained the intergenerational association [r = 0.21 (0.16-0.25)] in our best-fitting model. A passive genetic transmission pathway was not found to be significant, indicating that parental genetic influences on parent-offspring relationship quality and offspring genetic influences on their internalizing problems were non-overlapping.

CONCLUSION

These results indicate that this intergenerational association is a product of social interactions between children and parents, within which bidirectional effects are highly plausible. Results from genetically informative studies of parenting-related effects should be used to help refine early parenting interventions aimed at reducing risk for psychopathology.

Sources of Parent-Offspring Resemblance for Major Depression in a National Swedish Extended Adoption Study

IMPORTANCE

Twin studies have assessed sibling resemblance for major depression (MD) but cannot address sources of resemblance across generations.

OBJECTIVE

To clarify the relative importance of genetic and rearing effects on the parent-offspring resemblance for MD.

DESIGN

This Swedish population register-based study examined parents and children from the following 5 family types: intact (2 041 816 offspring), adoptive (14 104 offspring), not-lived-with (NLW) father (116 601 offspring), stepfather (67 826 offspring), and triparental (29 205 offspring). The 5 family types permitted quantification of parent-offspring resemblance for genes plus rearing, genes-only, and rearing-only associations. Treated MD was assessed from national primary care, specialist care, and inpatient registries. Data were collected from January 1, 1960, through December 31, 2016.

EXPOSURE

Diagnosis of MD vs no diagnosis in parents.

MAIN OUTCOMES AND MEASURES

Registration for MD.

RESULTS

The study population included 2 269 552 offspring (51.5% male and 48.5% female; median age, 42; range, 26-56 years). The weighted tetrachoric correlations for MD across family types and across mothers and fathers were r = 0.17 (95% CI, 0.16-0.17) for genes plus rearing, r = 0.08 (95% CI, 0.06-0.09) for genes-only, and r = 0.08 (95% CI, 0.07-0.09) for rearing-only parent-child associations. Only the genes plus rearing association differed significantly between mothers (weighted tetrachoric correlation, r = 0.18; 95% CI, 0.18-0.18) and fathers (weighted tetrachoric correlation, r = 0.15; 95% CI, 0.15-0.16). In triparental families, the parent-offspring correlations for MD were estimated at r = 0.19 (95% CI, 0.17-0.22) for mothers in the genes plus rearing association, r = 0.10 (95% CI, 0.07-0.13) for NLW fathers in the genes-only association, and r = 0.08 (95% CI, 0.05-0.11) for stepfathers in the rearing-only association. In adoptive families, the effect of affected biological and affected adoptive parents on adoptee risk for MD was additive. In intact families, parental MD diagnosed by specialists in hospital or outpatient settings and primary care physicians affected equally the risk for MD in offspring.

CONCLUSIONS AND RELEVANCE

The parent-offspring resemblance for treated MD arises from genetic factors and rearing experiences to an approximately equal extent. Both forms of cross-generational transmission act additively on the risk for MD in the offspring.

Naturalistic Experimental Designs as Tools for Understanding the Role of Genes and the Environment in Prevention Research

Before genetic approaches were applied in experimental studies with human populations, they were used by animal and plant breeders to observe, and experimentally manipulate, the role of genes and environment on specific phenotypic or behavioral outcomes. For obvious ethical reasons, the same level of experimental control is not possible in human populations. Nonetheless, there are natural experimental designs in human populations that can serve as logical extensions of the rigorous quantitative genetic experimental designs used by animal and plant researchers. Applying concepts such as cross-fostering and common garden rearing approaches from the life science discipline, we describe human designs that can serve as naturalistic proxies for the controlled quantitative genetic experiments facilitated in life sciences research. We present the prevention relevance of three such human designs: (1) children adopted at birth by parents to whom they are not genetically related (common garden approach); (2) sibling designs where one sibling is reared from birth with unrelated adoptive parents and the other sibling is reared from birth by the biological mother of the sibling pair (cross-fostering approach); and (3) in vitro fertilization designs, including egg donation, sperm donation, embryo donation, and surrogacy (prenatal cross-fostering approach). Each of these designs allows for differentiation of the effects of the prenatal and/or postnatal rearing environment from effects of genes shared between parent and child in naturalistic ways that can inform prevention efforts. Example findings from each design type are provided and conclusions drawn about the relevance of naturalistic genetic designs to prevention science.

A longitudinal study of families formed through reproductive donation: Parent-adolescent relationships and adolescent adjustment at age 14

The aim of the 6th phase of this longitudinal study was to establish whether children born through assisted reproduction involving reproductive donation were at risk for psychological problems following the transition to adolescence at age 14 and, if so, to examine the nature of these problems and the mechanisms involved. Eighty-seven families formed through reproductive donation, including 32 donor insemination families, 27 egg donation families, and 28 surrogacy families, were compared with 54 natural conception families. Standardized interviews, questionnaires, and observational assessments of the quality of parent-adolescent relationships and adolescent adjustment were administered to mothers, adolescents, and teachers. The mothers in surrogacy families showed less negative parenting and reported greater acceptance of their adolescent children and fewer problems in family relationships as a whole compared with gamete donation mothers. In addition, less positive relationships were found between mothers and adolescents in egg donation families than in donor insemination families as rated by both mothers and adolescents. There were no differences between family types for the adolescents themselves in terms of adjustment problems, psychological well-being, and self-esteem. Longitudinal analyses showed no differences between family types in negative parenting from age 7 to age 14, and a weaker association between negative parenting and adjustment difficulties for gamete donation than natural conception and surrogacy families. The findings suggest that the absence of a genetic link between mothers and their children is associated with less positive mother-adolescent relationships whereas the absence of a gestational link does not have an adverse effect.

Parental depressive history, parenting styles, and child psychopathology over 6 years: The contribution of each parent's depressive history to the other's parenting styles

The link between parental depressive history and parenting styles is well established, as is the association of parenting with child psychopathology. However, little research has examined whether a depressive history in one parent predicts the parenting style of the other parent. As well, relatively little research has tested transactional models of the parenting-child psychopathology relationship in the context of parents' depressive histories. In this study, mothers and fathers of 392 children were assessed for a lifetime history of major depression when their children were 3 years old. They then completed measures of permissiveness and authoritarianism and their child's internalizing and externalizing symptoms when children were 3, 6, and 9 years old. The results showed that a depressive history in one parent predicted the other parent's permissiveness. Analyses then showed that child externalizing symptoms at age 3 predicted maternal permissiveness and authoritarianism and paternal permissiveness at age 6. Maternal permissiveness at age 6 predicted child externalizing symptoms at age 9. No relationships in either direction were found between parenting styles and child internalizing symptoms. The results highlight the importance of considering both parents' depressive histories when understanding parenting styles, and support transactional models of parenting styles and child externalizing symptoms.

Annual Research Review: An expanded account of information-processing mechanisms in risk for child and adolescent anxiety and depression

BACKGROUND

Anxiety and depression occurring during childhood and adolescence are common and costly. While early-emerging anxiety and depression can arise through a complex interplay of 'distal' factors such as genetic and environmental influences, temperamental characteristics and brain circuitry, the more proximal mechanisms that transfer risks on symptoms are poorly delineated. Information-processing biases, which differentiate youth with and without anxiety and/or depression, could act as proximal mechanisms that mediate more distal risks on symptoms. This article reviews the literature on information-processing biases, their associations with anxiety and depression symptoms in youth and with other distal risk factors, to provide direction for further research.

METHODS

Based on strategic searches of the literature, we consider how youth with and without anxiety and/or depression vary in how they deploy attention to social-affective stimuli, discriminate between threat and safety cues, retain memories of negative events and appraise ambiguous information. We discuss how these information-processing biases are similarly or differentially expressed on anxiety and depression and whether these biases are linked to genetic and environmental factors, temperamental characteristics and patterns of brain circuitry functioning implicated in anxiety and depression.

FINDINGS

Biases in attention and appraisal characterise both youth anxiety and depression but with some differences in how these are expressed for each symptom type. Difficulties in threat-safety cue discrimination characterise anxiety and are understudied in depression, while biases in the retrieval of negative and overgeneral memories have been observed in depression but are understudied in anxiety. Information-processing biases have been studied in relation to some distal factors but not systematically, so relationships remain inconclusive.

CONCLUSIONS

Biases in attention, threat-safety cue discrimination, memory and appraisal may characterise anxiety and/or depression risk. We discuss future research directions that can more systematically test whether these biases act as proximal mechanisms that mediate other distal risk factors.

The Impact of Single Mothers' Health Insurance Coverage on Behavioral Health Services Utilization by Their Adolescent Children

Adolescents living in single-mother households are more likely to have behavioral health conditions, but are less likely to utilize any behavioral health services. Using nationally representative mother-child pair data pooled over 6 years from the National Survey on Drug Use and Health, the study finds that when single mothers were uninsured, their adolescent children were less likely to utilize any behavioral health services, even when the children themselves were covered by insurance. The extension of health coverage under the Affordable Care Act (ACA) to uninsured single mothers could improve the behavioral health of the adolescent population.

Associations of Perceived Parental Psychopathology with Mental Health Burden and Lifetime Drug Use in Gay, Bisexual, and other YMSM: The P18 Cohort Study

Parental mental health may be a critical component in understanding the overlapping health burdens of mental health symptomatology and drug use in young men who have sex with men (YMSM), yet studies of YMSM have not fully examined these associations. To understand these relationships, data drawn from a study of gay, bisexual, and other YMSM were used to examine associations between perceived parental psychopathology and the health of YMSM. Findings suggest that YMSM reporting at least one parent with perceived depression, manic depression, schizophrenia, or antisocial behavior anytime during their childhoods were more likely to report higher levels of both depressive symptomatology and post-traumatic stress disorder (PTSD) than those reporting no perception of any of these psychopathologies in their parents. Number of different drugs used in one's life were higher among participants who perceived at least one parent as depressed. Mediation analyses indicated that the relationship between perceived parental depression and lifetime drug use of YMSM was mediated both by YMSM depression and YMSM PTSD. These results suggest that parental psychopathology plays an important role in the health of sexual minority men, a population with elevated levels of mental health burden and drug use across the lifespan.

Behavioral Problems and Childhood Epilepsy: Parent vs Child Perspectives

OBJECTIVE

To test whether the reported association between pediatric epilepsy and behavioral problems may be distorted by the use of parental proxy report instruments.

STUDY DESIGN

Children in the Connecticut Study of Epilepsy were assessed 8-9 years after their epilepsy diagnosis (time-1) with the parent-proxy Child Behavior Check List (CBCL) (ages 6-18 years) or the Young Adult Self-Report (≥18 years of age). For children <18 years of age, parents also completed the Child Health Questionnaire, which contains scales for impact of child's illness on the parents. The same study subjects completed the Adult Self-Report 6-8 years later (time-2). Sibling controls were also tested. Case-control differences were examined for evidence suggesting more behavioral problems in cases with epilepsy than in controls based on proxy- vs self-report measures.

RESULTS

At time-1, parent-proxy CBCL scores were significantly higher (worse) for cases than controls (n = 140 matched pairs). After adjustment for Child Health Questionnaire scales reflecting parent emotional and time impact, only 1 case-control difference on the CBCL remained significant. Self-reported Young Adult Self-Report scores did not differ between cases and controls (n = 42 pairs). At time-2, there were no significant self-reported case-control differences on the Adult Self-Report (n = 105 pairs).

CONCLUSIONS

Parent-proxy behavior measures appear to be influenced by the emotional impact of epilepsy on parents. This may contribute to apparent associations between behavioral problems and childhood epilepsy. Self-report measures in older adolescents (>18 years of age) and young adults do not confirm parental perceptions. Evidence suggesting more behavioral problems in children with epilepsy should be interpreted in light of the source of information.

Verhaltens- und emotionale Probleme bei Vorschulkindern im Kontext der Mutter-Kind-Interaktion

Zusammenfassung. Theoretischer Hintergrund: Frühe Interaktionserfahrungen zwischen Eltern und ihren Kindern wirken sich langfristig auf deren psychische Entwicklung aus. Jedoch können verschiedenen psychosoziale Risikofaktoren, insbesondere mütterliche psychische Erkrankungen, die Qualität solcher Interaktionen verändern und sich damit ungünstig auf die psychische Gesundheit von Kindern auswirken. Fragestellung: In der vorliegenden Untersuchung wurde deshalb geprüft, ob sich psychische Probleme von Müttern auf ihr Interaktionsverhalten auswirken und ob dieses wiederum mit Verhaltensproblemen bei Vorschulkindern assoziiert ist. Methode: Es wurden insgesamt 63 Mutter-Kind-Paare untersucht. Die psychische Gesundheit der Mütter wurde mit Hilfe des Brief Symptom Inventory (BSI), Verhaltensprobleme der Kinder mittels der CBCL erfasst. Die Mutter-Kind-Interaktion wurde während einer standardisierten Verhaltensbeobachtung videographiert und von zwei blinden Ratern ausgewertet. Ergebnisse: Multiple Regressionsanalysen zeigen, dass die globale psychische Belastung von Müttern 13 % der Varianz externalisierender und 14.5 % der Varianz internalisierender Symptome bei Vorschulkindern aufklärt. Weiterhin wurde deutlich, dass nur bei den internalisierenden Störungen die Qualität der Mutter-Kind-Interaktion einen Effekt auf die Ausprägung kindlicher Symptome hatte. Außerdem fanden wir einen Mediatoreffekt für mütterliche Intrusivität. Diskussion: Die Befunde der vorliegenden Studie ermöglichen somit ein besseres Verständnis der Entstehung von Verhaltensauffälligkeiten im Vorschulalter, da sie spezifische Interaktionsmerkmale als Risikofaktoren für internalisierende Probleme identifizieren konnten und die Bedeutung der psychischen Gesundheit der Mutter unterstreichen. Daraus kann abgeleitet werden, dass bei einer psychotherapeutischen Behandlung von Vorschulkindern, neben der symptomorientierten Therapie, eine Entlastung der Mütter und eine Verbesserung der Mutter-Kind-Interaktion von großer Relevanz ist.

[Recognition of facial expressions of emotions by 3-year-olds depending on sleep and risk of depression]

INTRODUCTION

The emotional process is characterized by a negative bias in depression, thus it was legitimate to establish if they same is true in very young at-risk children. Furthermore, sleep, also proposed as a marker of the depression risk, is closely linked in adults and adolescents with emotions. That is why we wanted first to better describe the characteristics of emotional recognition by 3-year-olds and their links with sleep. Secondly we observed, if found at this young age, an emotional recognition pattern indicating a vulnerability to depression.

MATERIAL AND METHOD

We studied, in 133 children aged 36 months from the AuBE cohort, the number of correct answers to the task of recognition of facial emotions (joy, anger and sadness). Cognitive functions were also assessed by the WPPSI III at 3 years old, and the different sleep parameters (time of light off and light on, sleep times, difficulty to go to sleep and number of parents' awakes per night) were described by questionnaires filled out by mothers at 6, 12, 18, 24 and 36 months after birth. Of these 133 children, 21 children whose mothers had at least one history of depression (13 boys) were the high-risk group and 19 children (8 boys) born to women with no history of depression were the low-risk group (or control group).

RESULTS

Overall, 133 children by the age of 36 months recognize significantly better happiness than other emotions (P=0.000) with a better global recognition higher in girls (M=8.8) than boys (M=7.8) (P=0.013) and a positive correlation between global recognition ability and verbal IQ (P=0.000). Children who have less daytime sleep at 18 months and those who sleep less at 24 months show a better recognition of sadness (P=0.043 and P=0.042); those with difficulties at bedtime at 18 months recognize less happiness (P=0.043), and those who awaken earlier at 24 months have a better global recognition of emotions (P=0.015). Finally, the boys of the high-risk group recognize sadness better than boys in the control group (P=0.015).

CONCLUSION

This study confirms that the recognition of emotion is related to development with a female advantage and a link with the language skills at 36 months of life. More importantly, we found a relationship between sleep characteristics and emotional recognition ability and a negative bias in emotional recognition in young males at risk for depression.

The relationship between parental mental illness and/or substance use disorder on adolescent substance use disorder: Results from a nationally representative survey

This study examines the relationship between parental comorbid mental illness and substance use disorder (SUD) and adolescent SUD. Nationally representative parent-child data pooled over six years from the National Survey on Drug Use and Health (NSDUH) was utilized in this study. Multivariable regression analysis was conducted to determine whether adolescents living with parents who have mental health disorders and/or substance use disorder are themselves more likely to have SUD while controlling for potential confounding variables. The results show that comorbid AMI-SUD in mothers is significantly associated with adolescent SUD after controlling for potential confounders. However, comorbid AMI-SUD in fathers is not associated with adolescent SUD when other controls are included in the model. The association of parental comorbid AMI-SUD with adolescent SUD indicates that parental behavioral health treatment may be a preventive measure to protect their children and may function as an important deterrent to adolescent SUD.

Genes, environments and depressions in young people

Among the common mental illnesses in childhood and adolescence, the unipolar depressions are the most concerning. These mental illnesses are aetiologically and clinically heterogeneous and little is known about their pathophysiology. This selected review considers the contribution of genetic and environmental factors in the emergence of these illnesses in the second decade of life.

Brain Reward Pathway Dysfunction in Maternal Depression and Addiction: A Present and Future Transgenerational Risk

Two research areas that could benefit from a greater focus on the role of the reward pathway are maternal depression and maternal addiction. Both depression and addiction in mothers are mediated by deficiencies in the reward pathway and represent substantial risks to the health of offspring and future generations. This targeted review discusses maternal reward deficits in depressed and addicted mothers, neural, genetic, and epigenetic mechanisms, and the transgenerational transmission of these deficits from mother to offspring. Postpartum depression and drug use disorders may entail alterations in the reward pathway, particularly in striatal and prefrontal areas, which may affect maternal attachment to offspring and heighten the risk of transgenerational effects on the oxytocin and dopamine systems. Alterations may involve neural circuitry changes, genetic factors that impact monoaminergic neurotransmission, as well as growth factors such as BDNF and stress-associated signaling in the brain. Improved maternal reward-based preventative measures and treatments may be specifically effective for mothers and their offspring suffering from depression and/or addiction.

Raised by depressed parents: is it an environmental risk?

The mechanisms explaining how parental depression compromises healthy child development are complex and multifaceted, with genetic and environmental pathways intertwined. Reexamination of whether and how maternal and paternal depression serve as environmental risk factors is important because such an investigation can be helpful to identify modifiable mechanisms that are accessible to interventions. We review studies that have employed designs that isolate the effects of the environment from genetic influences, including adoption studies and children of twins studies. Findings indicate that maternal depression is an environmental risk factor for the emotional, behavioral, and neurobiological development of children. Although more studies are needed, preliminary findings suggest that paternal depression appears to be a weaker environmental risk as compared to maternal depression, at least during infancy and toddlerhood. Implications for theory and future research are discussed.