Association of parental depression with psychiatric course from adolescence to young adulthood among formerly depressed individuals

Understanding and Addressing Male Postpartum Depression: Incidence, Causes, Diagnosis, and Management Strategies

Pregnancy-related stress affects not only the woman but also her partner. The issue of postpartum depression in women is increasingly discussed, apart from its occurrence in men, which can develop up to 12 months after giving birth. Risk factors for depression in young fathers are numerous and include hormonal fluctuations, socioeconomic conditions, and co-occurrence of other diseases. Emerging depressive symptoms are nonspecific and can be missed even by experienced medical personnel. Currently, screening tests use questionnaires that do not consider male risk factors. Perhaps the development of more personalized diagnostic methods would enable early identification of men at risk and include preventive measures. The proposed treatment methods of postpartum depression, such as sertraline or cognitive-behavioral therapy, enable patients to recover and provide appropriate support. The disease can cause long-term consequences that negatively affect the development and functioning of the child's psyche. Behavioral disorders and emotional problems are observed in children whose fathers had postpartum depression. Moreover, partner relationships deteriorate and the father-child bond is impaired. Further research should focus on identifying risk factors in men from different social classes, considering environmental, personal, and ethnic characteristics, and on the effectiveness of postpartum depression treatment in men. This article aims to review the incidence, causes, diagnosis, and management of male postpartum depression.

A Potential Role for MAGI-1 in the Bi-Directional Relationship Between Major Depressive Disorder and Cardiovascular Disease

PURPOSE OF REVIEW

Major Depressive Disorder (MDD) is characterized by persistent symptoms such as fatigue, loss of interest in activities, feelings of sadness and worthlessness. MDD often coexist with cardiovascular disease (CVD), yet the precise link between these conditions remains unclear. This review explores factors underlying the development of MDD and CVD, including genetic, epigenetic, platelet activation, inflammation, hypothalamic-pituitary-adrenal (HPA) axis activation, endothelial cell (EC) dysfunction, and blood-brain barrier (BBB) disruption.

RECENT FINDINGS

Single nucleotide polymorphisms (SNPs) in the membrane-associated guanylate kinase WW and PDZ domain-containing protein 1 (MAGI-1) are associated with neuroticism and psychiatric disorders including MDD. SNPs in MAGI-1 are also linked to chronic inflammatory disorders such as spontaneous glomerulosclerosis, celiac disease, ulcerative colitis, and Crohn's disease. Increased MAGI-1 expression has been observed in colonic epithelial samples from Crohn's disease and ulcerative colitis patients. MAGI-1 also plays a role in regulating EC activation and atherogenesis in mice and is essential for Influenza A virus (IAV) infection, endoplasmic reticulum stress-induced EC apoptosis, and thrombin-induced EC permeability. Despite being understudied in human disease; evidence suggests that MAGI-1 may play a role in linking CVD and MDD. Therefore, further investigation of MAG-1 could be warranted to elucidate its potential involvement in these conditions.

Reciprocal associations between parental depression and child cognition: Pathways to children's internalizing and externalizing symptoms

Parental depression is a risk factor for children's cognitive and psychological development. Literature has found reciprocal relations between parental depression and child psychopathology and effects of parental depression on children's cognition. The present study is the first to examine reciprocity among parental depression and child cognition, and pathways to child psychopathology. Structural equation models were conducted using data from the Early Head Start Research and Evaluation Project, a nationally representative sample of 3,001 economically marginalized families. Measures were collected in four waves from 14 months to 10-11 years. Reciprocal associations emerged between maternal and paternal depression at from 14 months to 5 years. Reciprocal parental depression was associated with greater psychopathology at age 10-11. Maternal depression predicted poorer child cognition, which indirectly predicted increased depression in mothers of children aged 3-5 through paternal depression, and in fathers at age 3, through earlier paternal depression. This study was unable to parse within- and between-person effects. Additionally, data for paternal depression was limited to ages 2 and 3. Findings emphasize the transactional nature of child cognition and child and parent psychopathology, supporting family focused intervention and prevention efforts that target parent psychopathology and child cognition.

Paternal peripartum depression: emerging issues and questions on prevention, diagnosis and treatment. A consensus report from the cost action Riseup-PPD

INTRODUCTION

Paternal peripartum depression (P-PPD) is a serious and understudied public health problem associated with impaired family functioning and child development. The lack of recognition of P-PPD may result in limited access to both information and professional help.

OBJECTIVE

The aim of the study was to review studies on paternal peripartum depression and to identify issues and questions where future research and theory formation are needed.

METHODS

A literature search for systematic reviews, meta-analyses and primary studies was conducted using PubMed, Web of Science, Embase, Scopus, Medline, PsychInfo and Informit databases. Key results within the retrieved articles were summarised and integrated to address the review objectives.

RESULTS

Based on the literature, the knowledge related to prevalence, screening, risk factorsunique to fathers, management strategies and outcomes of P-PPD is lacking. Currently, there is no consensual understanding of the definition of P-PPD and recommendations for dealing with P-PPD. Limited data were available regarding the barriers preventing fathers from accessing support systems.

CONCLUSION

Emerging issues that need to be addressed in future research include: P-PPD definition and pathogenetic pathways; prevention strategies and assessment tools; self-help seeking and engagement with interventions; the cost-effectiveness of P-PPD management; needs of health professionals; effect on child development, and public awareness. Future studies and clinical practice should account the complexities that may arise from the father's perceptions of health care services. Results from this review highlights the critical issues on how to plan, provide and resource health services, to meet the health needs of fathers.

Paternal Depression and Risk of Depression Among Offspring: A Systematic Review and Meta-Analysis

Importance

Existing epidemiological evidence is equivocal as to whether paternal depression poses a consequent risk of depression in offspring; meta-analysis of findings can help inform preventative intervention efforts.

Objective

To conduct a systematic review and meta-analysis of observational studies examining the association between paternal and offspring depression.

Data Sources

Embase, PubMed, PsycINFO, Scopus, and Web of Science databases were searched between inception and December 2022.

Study Selection

The review included all observational studies that investigated the association between paternal and offspring depression and 10 606 studies were initially identified.

Data Extraction and Synthesis

This systematic review and meta-analysis was performed following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The review protocol was prospectively registered in PROSPERO. Summary odds ratios (ORs) and 95% CIs were pooled using inverse variance weighted random effect meta-analysis. Subgroup and sensitivity analyses were performed.

Main Outcomes and Measures

The main outcome of interest was offspring depression measured using recognized depression assessment tools.

Results

Sixteen observational studies published between 2002 and 2021 were included, with a combined sample of 7 153 723 father-child dyads. A meta-analysis of these studies showed that paternal depression was associated with an increased risk of depression in offspring (OR, 1.42; 95% CI, 1.17-1.71). The risk was higher among offspring exposed to paternal depressive disorders (OR, 1.65; 95% CI, 1.28-2.12) than those exposed to depression as defined by a nonclinical symptom scale (OR, 1.12; 95% CI, 1.06-1.19). Sensitivity analysis revealed consistent pooled estimates ranging from 1.35 (95% CI, 1.12-1.62) to 1.45 (95% CI, 1.18-1.78).

Conclusions and Relevance

Paternal depression was associated with subsequent offspring depression. This finding shows the intergenerational transmission of mental health problems and suggests that mental health interventions benefit not only the patient but also the family as a whole, including both parents.

When Fathers Begin to Falter: A Comprehensive Review on Paternal Perinatal Depression

The transition to parenthood is considered to be a major life transition that can increase the vulnerability to parental depressive disorders, including paternal perinatal depression (PPND). Although it is known that many fathers experience anxiety and depression during the perinatal period, PPND is a recent diagnostic entity and there are not enough published studies on it. Accordingly, its prevalence and epidemiology are still not well defined, although the majority of studies agree that PPND is less frequent than maternal perinatal depression and postpartum depression. Nevertheless, PPND is different from maternal perinatal mental health disorders, usually, fathers have less severe symptoms, and mood alterations are often in comorbidity with other affective disorders. Despite the absence of DSM-5 diagnostic criteria and the fluctuation of prevalence rates, clinical symptoms have been defined. The main symptoms are mood alterations and anxiety, followed by behavioral disturbances and concerns about the progress of pregnancy and the child’s health. Moreover, PPND negatively impacts on family functioning, on couples’ relationships, and on family members’ well-being. The aim of this paper is to present an overview of the current understandings on PPND and the potential screening, prevention, and treatment options.

The unique effects of maternal and paternal depressive symptoms on youth's symptomatology: Moderation by family ethnicity, family structure, and child gender

Drawing on five waves of longitudinal data from 392 families (52% female; mean age of wave 1 [Mage_W1] = 12.89, standard deviation [SD] = .48; Mage_W5 = 21.95, SD = .77; 199 European American and 193 Mexican American families; 217 intact and 175 stepfather families), this study documented transactional relations of mothers' and fathers' depressive symptoms with youth's symptomatology from early adolescence to young adulthood. Trait and time-varying cross-lagged models revealed that both mothers' and fathers' between- and within-person differences in depressive symptoms were associated with youth's internalizing and externalizing symptoms. Whereas each parent's depressive symptoms uniquely contributed to youth's internalizing symptoms, however, only mothers' depressive symptoms influenced youth's externalizing symptoms. Although reciprocal effects of youth's internalizing symptoms on parents' depressive symptoms were not significant, youth's externalizing symptoms predicted changes in mothers' depressive symptoms over time. Moderation analyses revealed distinct transactional patterns by family ethnicity and child gender, but not by family structure. This study revealed dynamic transactions among family members' symptomatology that point to opportune times and targets for intervention efforts aimed at mitigating the negative impact of parents' depressive symptoms on youth's adjustment.

The impact of pre- and perinatal factors on psychopathology in adulthood

BACKGROUND

There is considerable evidence that pre- and post-natal factors are associated with a wide range of psychopathology in offspring during childhood and adolescence.

OBJECTIVE

The main aims of the present study were to examine the associations between pre- and perinatal factors and psychopathology in offspring during adulthood, and to explore whether family factors (i.e., family cohesion, mother's social support, and father's social support) mediate these relationships.

METHOD

Information on pre- and perinatal events was collected from biological mothers of the participants (N = 315) when they were between 14 and 18 years who were then followed up until they reached age 30.

RESULTS

Maternal obstetric history and illness during first year were significant predictors of offspring anxiety disorder. Maternal emotional health predicted offspring affective disorder. Difficult delivery and breast feeding predicted disruptive disorder. The relationship between maternal obstetric history/emotional health and anxiety/affective disorder was no longer significant after controlling for family cohesion.

LIMITATIONS

The information was based on maternal recall when their offspring were between 14 and 18 years which may be subjected to recall bias.

CONCLUSION

The association between pre- and postnatal factors and psychopathology of offspring during adulthood is mediated by familial factors.

Offspring of depressed and anxious patients: Help-seeking after first onset of a mood and/or anxiety disorder

BACKGROUND

Offspring of patients with depressive and/or anxiety disorders are at high risk of developing a similar disorder themselves. Early recognition and treatment may have substantial effects on prognosis. The main aim of this study was to examine the time to initial help-seeking and its determinants in offspring after the first onset of a mood and/or anxiety disorder.

METHODS

Data are presented of 215 offspring with a mood and/or anxiety disorder participating in a cohort study with 10 year follow-up. We determined age of disorder onset and age of initial help-seeking. Offspring characteristics (gender, IQ, age of onset, disorder type, suicidal ideation) and family characteristics (socioeconomic status, family functioning) were investigated as potential predictors of the time to initial help-seeking.

RESULTS

The estimated overall proportion of offspring of depressed/anxious patients who eventually seek help after onset of a mood and/or anxiety disorder was 91.9%. The time to initial help-seeking was more than two years in 39.6% of the offspring. Being female, having a mood disorder or comorbid mood and anxiety disorder (relative to anxiety) and a disorder onset in adolescence or adulthood (relative to childhood) predicted a shorter time to initial help-seeking.

LIMITATIONS

Baseline information relied on retrospective reports. Age of onsets and age of initial help-seeking may therefore be subject to recall bias.

CONCLUSION

Although most offspring eventually seek help after onset of a mood/anxiety disorder, delays in help-seeking were common, especially in specific subgroups of patients. This information may help to develop targeted strategies to reduce help-seeking delays.

A longitudinal study of Latino and non-Hispanic mothers' and fathers' depressive symptoms and its association with parent-child communication

BACKGROUND

Roughly 8% of the U.S. population report moderate or severe depression for two or more weeks and Latinos (3.7%) report higher rates of severe depression compared to non-Hispanic whites (2.6%) (Pratt and Brody, 2014). As the Latino population continues to grow in the U.S., there is little research on the manifestations for depression, and how this affects the family system longitudinally.

METHODS

Based on data from the Fragile Families and Child Wellbeing Study, a 3-step latent class analysis examined the association of self-reported parental depressive symptoms and their children's perceived levels of closeness and openness to communicate with their parents over 9 years (N=3956 families).

RESULTS

Latino parents reported four different depressive patterns, while non-Hispanic parents were more diversified and had six patterns in terms of latent class analysis. Latinos reported episodic symptoms, while NH parents were more likely to report chronic depressive symptoms over time. Regardless of race/ethnicity, parental depressive symptoms negatively affected their children's reported level of parental closeness and openness to communicate with mothers and fathers.

LIMITATIONS

As with any self-report data, the risk of social desirability bias is likely still present. Additionally, these results cannot be generalized to the broader U.S.

CONCLUSIONS

Due to the different mental health presentations over 9 years, and following the federal initiatives (National Institute of Mental Health, 2015) of early and consistent surveillance, we advise that clinicians and primary care physicians screen for depressive symptoms at least yearly.

The association between paternal and adolescent depressive symptoms: evidence from two population-based cohorts

BACKGROUND

Incidence of depression increases markedly around age 13 years, and nearly three-quarters of adults report that their mental health problems started in adolescence. Although maternal depression is a risk factor for adolescent depression, evidence about the association between paternal and adolescent depression is inconclusive, and many studies have methodological limitations. We aimed to assess the association between paternal and adolescent depressive symptoms in two large population-based cohort studies.

METHODS

We used data for two-parent families from two representative prospective cohorts in Ireland (Growing up in Ireland [GUI]) and the UK (Millennium Cohort Study [MCS]). Parental depressive symptoms were measured with the Centre for Epidemiological Studies Depression Scale in the GUI cohort when children were 9 years old, and the Kessler six-item psychological distress scale in the MCS cohort when children were 7 years old. Adolescent depressive symptoms were measured with the Short Mood and Feelings Questionnaire (SMFQ) at age 13 years in the GUI cohort and age 14 years in the MCS cohort. We analysed data using linear regression models, before and after adjustment for confounders, in both multiply imputed and complete case samples.

FINDINGS

There were 6070 families in GUI and 7768 in MCS. After all adjustments, a 1 SD (three-point) increase in paternal depressive symptoms was associated with an increase of 0·24 SMFQ points (95% CI 0·03-0·45; p=0·023) in the GUI cohort and 0·18 SMFQ points (0·01-0·36; p=0·041) in the MCS cohort. This association was independent of, and not different in magnitude to, the association between maternal and adolescent depressive symptoms (Wald test p=0·435 in the GUI cohort and 0·470 in the MCS cohort).

INTERPRETATION

Our results show an association between depressive symptoms in fathers and depressive symptoms in their adolescent offspring. These findings support the involvement of fathers as well as mothers in early interventions to reduce the prevalence of adolescent depression, and highlight the importance of treating depression in both parents.

FUNDING

Department of Children and Youth Affairs and Economic and Social Research Council.

Maternal depression and trajectories of adolescent depression: The role of stress responses in youth risk and resilience

This study examined the independent and interactive contributions of maternal depression and youth stress responses to trajectories of youth depression in adolescence. Youths (n = 165, M age = 12.43, SD = 1.18) and their maternal caregivers participated in a 4-year longitudinal study. Mothers and youths were administered diagnostic interviews assessing depression, and youths provided reports of their responses to peer stress. Consistent with an interactive model, adaptive responses to stress (high effortful engagement and low involuntary disengagement) buffered the effect of maternal depression on initial levels and trajectories of youth depression, with gender differences emerging. Consistent with a dual-risk model, maternal depression and maladaptive responses to stress (high effortful disengagement and involuntary engagement) contributed additive risks such that youths displayed the highest levels of depression when they were exposed to maternal depression and showed maladaptive stress responses. This research provides novel evidence that responses to stress contribute to individual differences in depression among offspring of depressed mothers, and suggests that responses to stress are an important target for efforts to promote resilience in at-risk youth.

Self-Rated Depression Severity Relative to Clinician-Rated Depression Severity: Trait Stability and Potential Role in Familial Transmission of Suicidal Behavior

Self-rated depression and hopelessness severity are predictors of suicide attempt in major depression. This study evaluated whether: (1) greater self-rated distress relative to severity of clinician-rated depression is a trait; (2) that trait is familial; and (3) that trait is linked to familial transmission of suicidal behavior. A total of 285 mood disorder probands and 457 offspring were assessed twice, at least 1 year apart. Family and subject intra-class correlations for self-report depression and hopelessness, controlling for clinician-rated depression severity, were computed. Mixed general linear models determined offspring-proband correlations. Within-individual intra-class correlation (ICC) for depression-hopelessness was 37.8% (bootstrap 95% CI: 31.0-46.3%). Parent-offspring ICC was 10.7% (bootstrap 95% CI: 3.5-17.8%). Suicide attempt concordant parent-offspring correlation for subjective depression was positive, but negative for attempter parent and nonattempter offspring (p = .0213 for slope interaction). Pessimism was greater in proband or offspring attempters than proband or offspring nonattempters (p < .05). Self-reported hopelessness is partly trait-dependent, and there is modest familial transmission of self-reported depression linked to suicidal behavior that may partly explain familial transmission of suicidal behavior.

Sexual intercourse among adolescent daughters of mothers with depressive symptoms from minority families

This study investigated the association between maternal depressive symptoms and adolescent engagement in sexual intercourse in a non-clinical sample of mothers and their adolescent daughters from minority families. The current study explores ways in which maternal depression, family factors, and adolescent sex interact. Data were from a cross-sectional study of 176 mother-daughter dyads, including a subset of mothers with HIV. Logistic regression analyses revealed that among mothers who were not current marijuana users, more maternal depressive symptoms was associated with daughters' engagement in sexual intercourse. Neither parent-child conflict nor parental involvement significantly mediated the relationship between maternal depressive symptoms and adolescent sex. This study provides the first empirical evidence that non-clinical depressive symptoms in mothers are associated with adolescent engagement in sexual intercourse.

Transgenerational effects of maternal depression on affect recognition in children

BACKGROUND

The association between maternal depression and adverse emotional and behavioral outcomes in children is well established. One associated factor might be altered affect recognition which may be transmitted transgenerationally. Individuals with history of depression show biased recognition of sadness. Our aim was to investigate parallels in maternal and children's affect recognition with remitted depressed mothers.

METHODS

60 Mother-child dyads completed an affect recognition morphing task. We examined two groups of remitted depressed mothers, with and without history of physical or sexual abuse, and a group of healthy mothers without history of physical or sexual abuse. Children were between 5 and 12 years old.

RESULTS

Across groups, mothers identified happy faces fastest. Mothers with remitted depression showed a higher accuracy and response bias for sadness. We found corresponding results in their children. Maternal and children's bias and accuracy for sadness were positively correlated. Effects of remitted depression were found independent of maternal history of physical or sexual abuse.

LIMITATIONS

Our sample size was relatively small and further longitudinal research is needed to investigate how maternal and children's affect recognition are associated with behavioral and emotional outcomes in the long term.

CONCLUSIONS

Our data suggest a negative processing bias in mothers with remitted depression which might represent both the perpetuation of and vulnerability to depression. Children of remitted depressed mothers appear to be exposed to this processing bias outside acute depressive episodes. This may promote the development of a corresponding processing bias in the children and could make children of depressed mothers more vulnerable to depressive disorders themselves.

Affective modulation of the startle response among children at high and low risk for anxiety disorders

BACKGROUND

Identifying early markers of risk for anxiety disorders in children may aid in understanding underlying mechanisms and informing prevention efforts. Affective modulation of the startle response indexes sensitivity to pleasant and unpleasant environmental contexts and has been shown to relate to anxiety, yet the extent to which abnormalities in affect-modulated startle reflect vulnerability for anxiety disorders in children has yet to be examined. The current study assessed the effects of parental psychopathology on affective modulation of startle in offspring.

METHOD

Nine-year-old children (n = 144) with no history of anxiety or depressive disorders completed a passive picture viewing task in which eye-blink startle responses were measured during the presentation of pleasant, neutral, and unpleasant images.

RESULTS

Maternal anxiety was associated with distinct patterns of affective modulation of startle in offspring, such that children with maternal histories of anxiety showed potentiation of the startle response while viewing unpleasant images, but not attenuation during pleasant images, whereas children with no maternal history of anxiety exhibited attenuation of the startle response during pleasant images, but did not exhibit unpleasant potentiation - even when controlling for child symptoms of anxiety and depression. No effects of maternal depression or paternal psychopathology were observed.

CONCLUSIONS

These findings suggest that both enhanced startle responses in unpleasant conditions and failure to inhibit startle responses in pleasant conditions may reflect early emerging vulnerabilities that contribute to the later development of anxiety disorders.

Long-term Effects of Fathers' Depressed Mood on Youth Internalizing Symptoms in Early Adulthood

While an accumulating body of research has documented increased risk for psychopathology among children of depressed fathers, most studies have used cross-sectional design and little is known about offspring outcomes beyond childhood. Using prospective data from a community sample (N = 395), we found that paternal depressive symptoms when children were in early adolescence (age 13) predicted offspring depressive and anxiety symptoms at age 21, controlling for baseline youth symptoms, maternal depressive symptoms, and other known correlates of internalizing problems in early adulthood. Associations were not moderated by maternal depressive symptoms or child gender. These results suggest that the unique and long-term effects of paternal depression on children's risk for mood disorders may persist into adulthood.

Family patterns of psychopathology in psychiatric disorders

OBJECTIVE

Familial loading and crucial outcomes of family history of psychopathology in psychiatric disorders have long been recognized. There has been ample literature providing convincing evidence for the importance of family psychopathology in development of emotional disturbances in children as well as worse outcomes in the course of psychiatric disorders. More often, maternal psychopathology seems to have been an issue of interest rather than paternal psychopathology while effects of second-degree familiality have received almost no attention. In this study, we addressed the relations between affected first- and second-degree relatives of probands and categories of psychiatric disorders.

METHOD

Subjects were 350 hospitalized psychiatric inpatients, consecutively admitted to psychiatry clinics in Van, Turkey. Mean age was 34.16 (SD±12) and 51.4% of the sample consisted of male patients. Assessment of psychopathology in psychiatric probands was conducted based on DSM-IV TR. Familial loading of psychiatric disorders amongst first- and second-degree relatives of patients were initially noted primarily relying on patients' retrospective reports, and confirmed by both phone call and following official health records via the Medical Knowledge System. We analyzed the data using latent class analysis approach.

RESULTS

We found four patterns of familial psychopathology. Latent homogeneous subsets of patients due to familial characteristics were as paternal kinship psychopathology with schizophrenia, paternal kinship psychopathology with mood disorders, maternal kinship psychopathology and core family psychopathology.

CONCLUSION

Family patterns were critical to exerting variation in psychiatric disorders of probands and affected relatives. Probands with a core family pattern of psychopathology exhibited the most colorful clinical presentations in terms of variation in psychopathology. We observed a specificity of intergenerational transmission of psychiatric disorders when family patterns of psychopathology were taken into consideration, even second-degree relatives of psychiatric probands.

PROGRESS ON THE PATERNAL BRAIN: THEORY, ANIMAL MODELS, HUMAN BRAIN RESEARCH, AND MENTAL HEALTH IMPLICATIONS

With a secure foundation in basic research across mammalian species in which fathers participate in the raising of young, novel brain-imaging approaches are outlining a set of consistent brain circuits that regulate paternal thoughts and behaviors in humans. The newest experimental paradigms include increasingly realistic baby-stimuli to provoke paternal cognitions and behaviors with coordinated hormone measures to outline brain networks that regulate motivation, reflexive caring, emotion regulation, and social brain networks with differences and similarities to those found in mothers. In this article, on the father brain, we review all brain-imaging studies on PubMed to date on the human father brain and introduce the topic with a selection of theoretical models and foundational neurohormonal research on animal models in support of the human work. We discuss potentially translatable models for the identification and treatment of paternal mood and father-child relational problems, which could improve infant mental health and developmental trajectories with potentially broad public health importance.

Exposure to maternal distress in childhood and cortisol activity in young adulthood

Dysregulated cortisol is a risk factor for poor health outcomes. Children of distressed mothers exhibit dysregulated cortisol, yet it is unclear whether maternal distress predicts cortisol activity in later developmental stages. This longitudinal study examined the prospective relation between maternal distress during late childhood (9–12 years) and adolescence (15–19 years) and cortisol response in offspring in young adulthood (24–28 years). Data were collected from 51 recently divorced mothers and their children across 15 years. Higher maternal distress during late childhood was associated with lower total cortisol independent of levels of maternal distress in adolescence or young adulthood. Maternal distress during adolescence marginally predicted blunted cortisol when distress in childhood was low. Findings suggest that blunted cortisol activity in young adulthood may be a long-term consequence of exposure to maternal distress earlier in development.

Key Characteristics of Major Depressive Disorder Occurring in Childhood, Adolescence, Emerging Adulthood, Adulthood

This paper summarizes characteristics of major depressive disorder (MDD) in the Oregon Adolescent Depression Project, using data from 816 participants (56% female; 89% White). Contrasting four developmental periods (Childhood [5-12.9], Adolescence [13-17.9], Emerging Adulthood [18-23.9], Adulthood [24-30]), we examine MDD incidence/recurrence, gender, comorbidity, duration, and suicide attempts across periods. MDD first incidence was lower in Childhood compared to subsequent periods, and higher in Emerging Adulthood than Adulthood. Cumulative incidence was 51%. Recurrence was lower during Childhood than remaining periods, which were comparable. Female gender predicted first incident MDD in all four periods but was unassociated with recurrence. Comorbidity rates were comparable across periods. MDD duration was greater in Childhood than remaining periods. Suicide attempt rates were significantly higher during Adolescence than either Emerging Adulthood or Adulthood. Depression research should focus on MDD during Emerging Adulthood, adolescent suicidal behavior, the continuing role of gender into adulthood, and the ubiquity of MDD.

Can father inclusive practice reduce paternal postnatal anxiety? A repeated measures cohort study using the Hospital Anxiety and Depression Scale

Background

Perinatal research on anxiety and depression has primarily focused on mothers. We have limited knowledge of fathers’ anxiety during the perinatal period yet there is evidence that the parenting capacity of a person can be compromised by anxiety and depression. The purpose of this paper is to identify the impact of a father inclusive intervention on perinatal anxiety and depression. The prime focus of the intervention was to provide education and support to fathers of breastfeeding partners with the aim of increasing both initiation and duration of breastfeeding.

Methods

A repeated measures cohort study was conducted during a RCT that was implemented across eight public maternity hospitals in Perth, Western Australia between May 2008 and June 2009. A baseline questionnaire which included the Hospital Anxiety and Depression Scale (HADS) was administered to all participants on the first night of their hospital based antenatal education program and was repeated at six weeks postnatal. SPSS version 17 was used for reporting descriptive results.

Results

The mean anxiety levels at baseline for the fathers in the intervention group (n=289) and control group (n=244) were 4.58 and 4.22 respectively. At 6 weeks postnatal (only matched pairs), intervention and control group were 3.93 and 3.79. More intervention group fathers self-rated less anxiety compared to the fathers in the control group from baseline to post test (p=0.048). Depression scores for intervention fathers at baseline (mean =1.09) and at six weeks (mean=1.09) were very similar to fathers in the control group at baseline (mean=1.11) and at six weeks (mean =1.07) with no significant changes.

Conclusions

Both intervention and control group fathers experienced some anxiety prior to the birth of their baby, but this was rapidly reduced at six weeks. Paternal anxiety is common to new fathers and providing them with information and strategies for problem-solving can increase their knowledge and potentially lower the risk of postnatal anxiety.

Trial registration

(Australian New Zealand Clinical Trials Registry ACTRN12609000667213)

The Moderating Effects of Mother-Adolescent Relations on the Longitudinal Association between Father and Offspring Depressive Symptoms

Little theoretical or empirical attention has been given to factors associated with better or worse outcomes in offspring of depressed fathers. Drawing from interpersonal models of intergenerational depression transmission in children of depressed mothers, the present investigation of adolescents and their families (N = 424) examined maternal warmth and hostility as moderators of the longitudinal association between paternal and adolescent depressive symptoms. Controlling for family demographic variables, previous adolescent depressive symptoms, and maternal depressive symptoms, fathers' depressive symptoms predicted offspring depressive symptoms among adolescents experiencing low maternal warmth or high maternal hostility. Adolescent girls reporting adversity in their relationships with their mothers were the most vulnerable to risk associated with paternal depressive symptoms. These findings highlight the implications of fathers' mental health for adolescent psychological well-being and add to the growing evidence that family relationships play a crucial role in the transmission of depression from one generation to the next.

Dynamic associations between maternal depressive symptoms and adolescents' depressive and externalizing symptoms

The current prospective study investigated transactional relations between maternal depressive symptoms and children's depressive and externalizing symptoms. Participants included 240 children (M age = 11.86 years, SD = 0.56; 53.9% female) and their mothers who were part of a 6-year longitudinal study. Measures of maternal depression (Beck Depression Inventory), child depression (Children's Depression Inventory), and children's externalizing symptoms (Youth Self-Report Form) were assessed annually. Data analyses using dynamic latent difference score structural equation models indicated that the observed relations between mothers' and adolescents' symptoms were stable across the 6 years. Higher levels of maternal depressive symptoms predicted subsequent elevations in children's depressive symptoms and in their externalizing problems over time. Among mothers with high initial levels of depression, children's depressive symptoms predicted subsequent declines in mothers' depressive symptoms. Children's externalizing problems were not related to subsequent change in maternal symptoms.

Intergenerational transmission of psychopathology: minor versus major parental depression

This study used data from the National Comorbidity Survey to investigate associations between: (1) maternal and paternal depression and young adult offspring psychopathology, and (2) major and minor parental depression and offspring psychopathology. Offspring of a depressed parent were significantly more likely to experience a psychiatric disorder by young adulthood than offspring of nondepressed parents. Major and minor maternal and paternal depression were associated with comparable increases in risk for offspring 12-month mood, anxiety, and substance use disorders and lifetime substance use disorder. However, maternal major depression was associated with a greater risk for offspring lifetime mood and anxiety disorder than maternal minor depression. Risk for lifetime mood and anxiety disorder did not differ by severity of paternal depression. These findings suggest that parental depressive symptoms that do not meet major depressive disorder criteria may nevertheless have significant adverse associations with offspring mental health.

Effects of paternal depression on fathers' parenting behaviors: a meta-analytic review

One possible mechanism for the familial transmission of depression is through its negative effects on parenting and the parent-child relationship. Although previous research indicates that depression is associated with parenting impairment for mothers, no quantitative synthesis of the empirical literature on the effects of paternal depression on fathers' parenting has been conducted. The present meta-analysis examined the effects of paternal depression on fathers' positive and negative parenting behaviors. The mean effect sizes, computed using 40 independent effect sizes derived from 28 published and unpublished studies, indicated that paternal depression has significant, though small, effects on parenting, with depressed fathers demonstrating decreased positive and increased negative parenting behaviors. Several moderating effects were found, including child and father age, and sample race/ethnicity, and effects were comparable for studies that used self-report measures and observational methods to assess fathers' parenting behaviors. Moreover, effect sizes for the relationship between paternal depression and fathers' parenting behaviors were comparable to those found for mothers. The present findings indicate that paternal depression has a significant and deleterious effect on parenting behaviors by fathers, and speak to the importance of continuing to include fathers in research on child development and the family environment.

The Relation of Parental Guilt Induction to Child Internalizing Problems When a Caregiver Has a History of Depression

The purpose of this study was to examine the relation between parental guilt induction and child internalizing problems in families where a caregiver had experienced depression. A total of 107 families, including 146 children (age 9-15), participated. Child-reported parental guilt induction, as well as three more traditionally studied parenting behaviors (warmth/involvement, monitoring, and discipline), were assessed, as was parent-report of child internalizing problem behavior. Linear Mixed Models Analysis indicated parental guilt induction was positively related to child internalizing problems in the context of the remaining three parenting behaviors. Implications of the findings for prevention and intervention parenting programs are considered.

Risk of emotional disorder in offspring of depressed parents: gender differences in the effect of a second emotionally affected parent

In offspring of depressed parents a second parent with emotional problems is likely to increase risk of emotional disorder. This effect may however differ between sons and daughters and between offspring of depressed fathers and offspring of depressed mothers. In adolescent and young-adult offspring of parents with major depressive disorder, this study examined the effects of a second affected parent, offspring gender, gender of the depressed parent and their interactions on risk of depression and anxiety disorder. We found that daughters had a higher risk of depression and anxiety than sons and that offspring of depressed mothers had a higher risk of anxiety than offspring of depressed fathers. In addition to these main effects, we found an interaction between parent and offspring gender inasmuch that sons of depressed fathers had the lowest risk of depression and anxiety relative to the other groups. A second affected parent tended to increase risk of depression and significantly increased risk of anxiety. However, this effect of a second affected parent on offspring anxiety was most prominent in daughters when the second affected parent was the father, whereas risk in sons did not increase if the father was affected as well. Our results indicate that paternal and maternal depression similarly and additively increase daughters' risk of emotional disorder, but that sons' risk only increases with maternal depression. Intergenerational transmission of emotional disorder seems strongest when the female gender is involved, either in the form of a daughter or a depressed mother.

The long-term course of depression: development of an empirical index and identification of early adult outcomes

BACKGROUND

Research on the long-term course of major depressive disorder (MDD) is hindered by the absence of established course criteria and by idiosyncratic definitions of chronicity. The aims of this study were to derive an empirical index of MDD course, to examine its predictive validity, and to identify the adulthood outcomes associated with a chronic course.

METHOD

Indicators for a MDD course factor were rationally selected and subjected to principal components (PCA) and confirmatory factor analyses (CFA) among 426 subjects with a lifetime history of MDD by age 30. Scores on the index prior to age 19 were examined as predictors of course from age 19 to 30. Associations between the index and outcomes of interest at age 30 were examined.

RESULTS

Three indicators loaded highly on a chronic course index and displayed adequate internal consistency: early onset age, number of episodes, and duration of ill time. Predictive validity of the index was supported. A more chronic course was associated with greater symptom severity, greater likelihood of treatment utilization, and greater psychosocial impairment in multiple domains. Treatment utilization interacted with chronicity to predict relatively few outcomes and did not reduce the negative impact of a chronic course.

CONCLUSIONS

The course of MDD through early adulthood is best represented by a composite of early onset age, number of episodes, and duration of ill time. A chronic course through early adulthood is associated with numerous indicators of psychosocial impairment. Mental health treatment utilization in a naturalistic setting does not appear to reduce the negative impact of chronic MDD.

Intergenerational transmission of internalizing problems: effects of parental and grandparental major depressive disorder on child behavior

Effects of lifetime histories of grandparental (G1) and parental (G2) major depressive disorder (MDD) on children's (G3) internalizing problems were investigated among 267 G3 children (ages 2-18 years) who received Child Behavior Checklist (CBCL) ratings and had diagnostic data available on 267 biological G2 parents and 527 biological G1 grandparents. Results indicated that G1 MDD conferred risk for G2 MDD, but not for G3 CBCL scores. G2 MDD predicted higher G3 Internalizing and Anxious/Depressed scores. Also, there was an interaction between G1 MDD and G2 MDD in predicting higher G3 Anxious/Depressed scores such that scores were highest among children with both depressed parents and grandparents. These effects were robust to statistical adjustments for status variables and parental relationship measures but not to adjustment for concurrent parental depressive symptoms.

Patterns of adolescent depression to age 20: the role of maternal depression and youth interpersonal dysfunction

Considerable research has focused on youth depression, but further information is needed to characterize different patterns of onset and recurrence during adolescence. Four outcome groups by age 20 were defined (early onset-recurrent, early-onset-desisting, later-onset, never depressed) and compared on three variables predictive of youth depression: gender, maternal depression, and interpersonal functioning. Further, it was hypothesized that the association between maternal depression and youth depression between 15 and 20 is mediated by early-onset depression and interpersonal dysfunction by age 15. Eight hundred sixteen community youth selected for depression risk by history (or absence) of maternal depression were interviewed at age 15, and 699 were included in the 5-year follow-up. Controlling for gender, early onset and interpersonal dysfunction mediated the link between maternal depression and late adolescent major depression. Different patterns for males and females were observed. For males maternal depression's effect was mediated by early onset but not interpersonal difficulties, while for females maternal depression's effect was mediated by interpersonal difficulties but not early onset. Maternal depression did not predict first onset of major depression after age 15. The results suggest the need for targeting the impact of maternal depression's gender-specific effects on early youth outcomes, and also highlight the different patterns of major depression in youth and their likely implications for future course of depression.

Parental mental illness: the effects on children and their needs

Parental mental health problems can have a major impact on children and studies indicate that they increase the risk of children developing behavioural, social, emotional and educational problems (Royal College of Psychiatrists, 2004). While this impact has been acknowledged for some time, there appear to be few interventions in the UK to help reduce the effect that parental mental illness has on children. This article discusses the impact of parental mental illness on children and gives examples of interventions that have been found to be useful in other countries. Potential interventions that mental health services in the UK could adopt are also discussed.

Sad dads: paternal postpartum depression

The postpartum period is associated with many adjustments to fathers that pose risks for depression. Estimates of the prevalence of paternal postpartum depression (PPD) in the first two months postpartum vary in the postpartum period from 4 to 25 percent. Paternal PPD has high comorbidity with maternal PPD and might also be associated with other postpartum psychiatric disorders. Studies so far have only used diagnostic criteria for maternal PPD to investigate paternal PPD, so there is an urgent need to study the validity of these scales for men and develop accurate diagnostic tools for paternal PPD. Paternal PPD has negative impacts on family, including increasing emotional and behavioral problems among their children (either directly or through the mother) and increasing conflicts in the marital relationship. Changes in hormones, including testosterone, estrogen, cortisol, vasopressin, and prolactin, during the postpartum period in fathers may be biological risk factors in paternal PPD. Fathers who have ecological risk factors, such as excessive stress from becoming a parent, lack of social supports for parenting, and feeling excluded from mother-infant bonding, may be more likely to develop paternal PPD. Support from their partner, educational programs, policy for paid paternal leave, as well as consideration of psychiatric care may help fathers cope with stressful experiences during the postpartum period.

The role of psychosocial stress in the onset and progression of bipolar disorder and its comorbidities: The need for earlier and alternative modes of therapeutic intervention

Psychosocial stress plays an important role at multiple junctures in the onset and course of bipolar disorder. Childhood adversity may be a risk factor for vulnerability to early onset illness, and an array of stressors may be relevant not only to the onset, recurrence, and progression of affective episodes, but the highly prevalent substance abuse comorbidities as well. A substantial group of controlled studies indicate that various cognitive behavioral psychotherapies and psychoeducational approaches may yield better outcomes in bipolar disorder than treatment as usual. Yet these approaches do not appear to be frequently or systematically employed in clinical practice, and this may contribute to the considerable residual morbidity and mortality associated with conventional treatment. Possible practical approaches to reducing this deficit (in an illness that is already underdiagnosed and undertreated even with routine medications) are offered. Without the mobilization of new clinical and public health approaches to earlier and more effective treatment and supportive interventions, bipolar illness will continue to have grave implications for many patients' long-term well being.

Parent-child connectedness and behavioral and emotional health among adolescents

BACKGROUND

This study sought to examine teen perceptions of mother-child and father-child connectedness, with focus on valuing parental opinions and perception of parental communication and caring, and associations with behavioral and emotional health.

METHODS

A population-based sample of 4746 students in public schools completed the 2001 Project EAT (Eating Among Teens) survey.

RESULTS

Overall, the majority of girls and boys reported valuing their parents' opinion when making serious decisions and believing that their parents cared about them. Yet, one fourth of girls and boys felt unable to talk to their mother about problems, and over half of girls and one third of boys felt unable to talk to their father. Valuing friends' opinions over parents' opinions, and perceiving low parental communication and caring were associated with unhealthy weight control, substance use, suicide attempts, body dissatisfaction, depression, and low self-esteem. Of significant concern, compared to their peers who reported feeling that their mother cared quite a bit or very much, youths who reported feeling as though their mother cared very little or not at all about them reported particularly high prevalence rates of unhealthy weight control behaviors (63.49% girls, 25.45% boys); suicide attempts (33.51% girls, 21.28% boys); low self-esteem (47.15% girls, 24.56% boys); and depression (63.52% girls, 33.35% boys).

CONCLUSIONS

Adolescents' perceptions of low parental caring, difficulty talking to their parents about problems, and valuing their friends' opinions for serious decisions were significantly associated with compromised behavioral and emotional health. Interventions aimed at improving the parent-child relationship may provide an avenue toward preventing health risk behaviors in youth.