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Cited by 530Child and Adolescent Psychosocial and Emotional DevelopmentFamily Support in IllnessMental Health Treatment and Access

A family-based approach to the prevention of depressive symptoms in children at risk: evidence of parental and child change

Beardslee, William R., Gladstone, Tracy R. G., Wright, Ellen J., Cooper, Andrew B.·2003·Pediatrics
DOI 10.1542/peds.112.2.e119
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Abstract

OBJECTIVE: Depression in parents is a prevalent and impairing illness that is encountered frequently in medical practice. Children of depressed parents are at risk for psychopathology and other difficulties. A series of recent national reports have recommended the development of prevention efforts targeting children of depressed parents. Yet, to date, few controlled prevention studies of depression in children and adolescents have been conducted. In this study, we report the evaluation of 2 preventive intervention strategies that target children living in homes with depressed parents. Both are public health approaches that were designed to be used by a wide range of practitioners from a variety of disciplines, including pediatricians, internists, school counselors, nurses, and mental health practitioners. We adopted a developmental perspective and intervened with families when children were entering the age of highest risk for depression onset (ie, adolescence). We chose a family-based approach to prevention and sought to reduce risk factors and enhance protective factors for early adolescents by increasing positive interactions between parents and children, and by increasing understanding of the illness for everyone in the family. Our prevention approaches were designed to provide information about mood disorders to parents, to equip parents with the skills they need to communicate information to their children, and to open a dialogue with their children about the effects of parental depression. We hypothesized that participation in these prevention programs would result in parental change in child-related behaviors and attitudes about depression and its impact on the family. In addition, we hypothesized that this parental change would produce change in children's self-understanding, and in children's depressive symptomatology. METHODS: We conducted a large-scale efficacy trial of 2 manual-based preventive intervention programs that were designed to be used widely in public health settings. These interventions target the relatively healthy children (ages 8-15) of parents with mood disorder. Ninety-three families (88.5% of our initial sample), including 121 children, participated in this study through the fourth assessment point. These families were assigned randomly to either a lecture or a clinician-facilitated intervention. Both interventions were specified in manuals. The lecture condition consisted of 2 separate meetings delivered in a group format without children present. The clinician-facilitated condition consisted of 6 to 11 sessions, including separate meetings with parents and children, and a family meeting in which the parents led a discussion of the illness and of positive steps that can be taken to promote healthy functioning in the children. In addition, telephone contacts or refresher meetings were conducted at 6- to 9-month intervals. In both conditions, psychoeducational material about mood disorders, risk, and resilience was presented and efforts were made to decrease feelings of guilt and blame in children. Parents were helped to build resilience in their children through encouraging their friendships, their success outside of the home, and their understanding of parental illness and of themselves. In addition, in the clinician-facilitated condition, efforts were made to link the psychoeducational material presented to the family's own unique illness experience. To address directly how their lives had changed, all family members in both conditions were assessed for psychopathology and for overall functioning at intake, and for psychopathology, functioning, and response to intervention immediately postintervention, approximately 1 year postintervention, and again approximately 2.5 years postintervention. RESULTS: We examined the outcomes of child understanding and internalizing symptomatology, and a number of predictor variables, using repeated measures analyses with generalized estimating equations. We found that parents in both conditions reported significant change in child-related behaviors and and attitudes, and that the amount of change reported increased over time from time 3 to time 4 (chi2(1) = 18.1). Moreover, relative to parents in the lecture program (mean number of changes = 6.3), parents in the clinician-facilitated program reported more change in child-related behaviors and attitudes (mean number of changes = 9.8). Children in both conditions reported increased understanding of parental illness attributable to participation in our intervention programs. There was a positive association between the amount of change children reported in their understanding of parental illness and the number of changes couples reported in child-related behaviors/attitudes (chi2(1) = 37.3; ie, parents who had changed the most in response to intervention had children who also changed the most). Finally, internalizing scores for all children decreased with increased time since intervention (chi2

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Authors
Beardslee, W. R., Gladstone, T. R. G., Wright, E. J., & Cooper, A. B.
Affiliations
  • Boston Children's Hospital (US)
  • Judge Baker Children's Center (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2003-08-01
Volume
112
Issue
2
Pages
e119-e131
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.112.2.e119
OpenAlex
W2147472234
Cited by
530
References
70
Citations by year
2026: 9 · 2025: 13 · 2024: 12 · 2023: 14 · 2022: 14 · 2021: 18 · 2020: 21 · 2019: 20 · 2018: 22 · 2017: 26 · 2016: 25 · 2015: 41 · 2014: 28 · 2013: 28 · 2012: 33
FWCI
17.08
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • William T. Grant Foundation
  • National Institutes of Health (5r01mh048696-10)
  • National Institute of Mental Health (R01-MH48696)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Sociology and Political Science › Family Support in Illness
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
parental depression, children of depressed parents, family intervention, mood disorders, adolescent depression, parent-child communication, psychoeducation, resilience, protective factors, risk factors, child depressive symptoms, family functioning, early adolescence, telephone follow-up, school-based prevention
MeSH terms
Adolescent, Child, Child Behavior, Psychology, Child, Depression, Depressive Disorder, Family, Family Relations, Female, Follow-Up Studies, Humans, Male, Parents, Patient Education as Topic, Psychotherapy, Risk Factors, Child of Impaired Parents, Mood Disorders

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