Kristen L. Reeslund

Randomized controlled trial of a family cognitive-behavioral preventive intervention for children of depressed parents.

A family cognitive-behavioral preventive intervention for parents with a history of depression and their 9-15-year-old children was compared with a self-study written information condition in a randomized clinical trial (n = 111 families). Outcomes were assessed at postintervention (2 months), after completion of 4 monthly booster sessions (6 months), and at 12-month follow-up. Children were assessed by child reports on depressive symptoms, internalizing problems, and externalizing problems; by parent reports on internalizing and externalizing problems; and by child and parent reports on a standardized diagnostic interview. Parent depressive symptoms and parent episodes of major depression also were assessed. Evidence emerged for significant differences favoring the family group intervention on both child and parent outcomes; strongest effects for child outcomes were found at the 12-month assessment with medium effect sizes on most measures. Implications for the prevention of adverse outcomes in children of depressed parents are highlighted.

Coping and Parenting: Mediators of 12-Month Outcomes of a Family Group Cognitive-Behavioral Preventive Intervention with Families of Depressed Parents.

OBJECTIVEnIn a randomized clinical trial with 111 families of parents with a history of major depressive disorder (86% mothers, 14% fathers; 86% Caucasian, 5% African-American, 3% Hispanic, 1% American Indian or Alaska Native, 4% mixed ethnicity), changes in adolescents (mean age = 11 years; 42% female, 58% male) coping and parents parenting skills were examined as mediators of the effects of a family group cognitive-behavioral preventive intervention on adolescents internalizing and externalizing symptoms.nnnMETHODnChanges in hypothesized mediators were assessed at 6 months, and changes in adolescents symptoms were measured at a 12-month follow-up.nnnRESULTSnSignificant differences favoring the family intervention compared with a written information comparison condition were found for changes in composite measures of parent-adolescent reports of adolescents use of secondary control coping skills and direct observations of parents positive parenting skills. Changes in adolescents secondary control coping and positive parenting mediated the effects of the intervention on depressive, internalizing, and externalizing symptoms, accounting for approximately half of the effect of the intervention on the outcomes. Further, reciprocal relations between childrens internalizing symptoms and parenting were found from baseline to 6-month follow-up.nnnCONCLUSIONnThe present study provides the first evidence for specific mediators of a family group cognitive-behavioral preventive intervention for families of parents with a history of major depressive disorder. The identification of both coping and parenting as mediators of childrens mental health outcomes suggests that these variables are important active ingredients in the prevention of mental health problems in children of depressed parents.

Coping With the Stress of Parental Depression II: Adolescent and Parent Reports of Coping and Adjustment

This study examined associations between adolescents self-reports and parents reports of adolescents exposure to family stress, coping, and symptoms of anxiety/depression and aggression in a sample of 78 adolescent offspring of depressed parents. Significant cross-informant correlations were found between adolescents reports of family stress, their stress responses, and their coping and parents reports of adolescents symptoms of anxiety/depression and aggression, but not between parents reports of adolescents stress and coping and adolescents self-reported symptoms. Adolescents reports of secondary control engagement coping and involuntary engagement stress responses mediated the relation between adolescents reports of parental stress and parents reports of adolescents anxiety/depression symptoms. Moderate levels of correspondence were found in the correlations between parent and adolescent reports of adolescents exposure to stress, coping, stress responses, and symptoms even after controlling for parents current depressive symptoms. However, depressed parents reported higher levels of symptoms of anxiety/depression and aggression and more family stress than did their adolescent offspring. Implications for future research on coping and adjustment in offspring of depressed parents are highlighted.

Family Group Cognitive-Behavioral Preventive Intervention for Families of Depressed Parents: 18- and 24-Month Outcomes

OBJECTIVEnIn a long-term follow-up of a randomized controlled trial (Compas et al., 2009) to examine the effects at 18- and 24-month follow-ups of a family group cognitive-behavioral (FGCB) preventive intervention for mental health outcomes for children and parents from families (N = 111) of parents with a history of major depressive disorder (MDD).nnnMETHODnParents with a history of MDD and their 9- to 15-year-old children were randomly assigned to a FGCB intervention or a written information comparison condition. Childrens internalizing, externalizing, anxiety/depression, and depressive symptoms; episodes of MDD and other psychiatric diagnoses; and parents depressive symptoms and episodes of MDD were assessed at 18 and 24 months after randomization.nnnRESULTSnChildren in the FGCB condition were significantly lower in self-reports of anxiety/depression and internalizing symptoms at 18 months and were significantly lower in self-reports of externalizing symptoms at 18 and 24 months. Rates of MDD were significantly lower for children in the FGCB intervention over the 24-month follow-up (odds ratio = 2.91). Marginal effects were found for parents symptoms of depression at 18 and 24 months but not for episodes of MDD.nnnCONCLUSIONSnSupport was found for a FGCB preventive intervention for children of parents with a history of MDD significantly reducing childrens episodes of MDD over a period of 2 years. Significant effects for the FGCB intervention were also found on internalizing and externalizing symptoms, with stronger effects at 18- than at 24-month follow-up.

Maternal Sadness and Adolescents' Responses to Stress in Offspring of Mothers with and Without a History of Depression

This study examined maternal sadness and adolescents responses to stress in the offspring (n = 72) of mothers with and without a history of depression. Mothers with a history of depression reported higher levels of current depressive symptoms and exhibited greater sadness during interactions with their adolescent children (ages 11–14) than mothers without a history of depression. Similarly, adolescent children of mothers with a history of depression experienced higher rates of internalizing and externalizing symptoms than adolescents of mothers without a history of depression. Regression analyses indicated that adolescents use of secondary control coping mediated the relationship between observed maternal sadness and adolescents internalizing and externalizing symptoms, in that higher levels of secondary control coping (e.g., cognitive reframing) were related to fewer symptoms.

Caretaking Behaviors by Adolescent Children of Mothers With and Without a History of Depression

In a sample of 72 mothers with and without a history of depression and their adolescent children, maternal depression history, current maternal depressive symptoms, intrusive and withdrawn parental behavior, and adolescent caretaking behaviors were examined as predictors of adjustment in these youth. Two types of caretaking behaviors were examined: emotional (e.g., caring for a parents emotional distress) and instrumental (e.g., looking after younger siblings). Although adolescents of mothers with and without a history of depression were comparable on levels of both types of caretaking, caretaking was associated with adolescents reports of anxiety-depression and mothers reports of social competence only for adolescents of mothers with a history of depression. Moreover, regression models showed that among children of mothers with a history of depression, emotional, but not instrumental, caretaking was related to adolescents anxiety-depression symptoms and social competence after controlling for current parental depressive symptoms and stressful parenting behaviors. Theoretical and clinical implications are discussed.

Parental depression and interparental conflict: children and adolescents' self-blame and coping responses.

The present study examined the role of children and adolescents perceptions of self-blame specific to interparental conflict and children and adolescents coping behaviors in the context of parental depression as predictors of internalizing and externalizing symptoms in a sample of 108 youth (age 9-15 years old) of parents with a history of depression. Higher levels of current depressive symptoms in parents were associated with higher levels of interparental conflict and higher levels of internalizing symptoms in children and adolescents, and interparental conflict was positively associated with both internalizing and externalizing symptoms in children/adolescents. Consistent across a series of multiple regression models, children and adolescents perceptions of self-blame and use of secondary control coping (acceptance, distraction, cognitive restructuring, positive thinking) were significant, independent predictors of both internalizing and externalizing symptoms.

Parenting specificity: an examination of the relation between three parenting behaviors and child problem behaviors in the context of a history of caregiver depression.

The aim of this study was to advance our understanding of the relations between three specific parenting behaviors (warmth, monitoring, and discipline) and two child outcomes (internalizing and externalizing problems) within the context of parental depression. Using an approach recommended by A. Caron, B. Weiss, V. Harris, and T. Carron (2006), unique and differential specificity were examined. Ninety-seven parents with a history of depression and 136 of their 9- to 15-year-old children served as participants. Children reported parenting behaviors and parents reported child problem behaviors. The findings indicated that warmth/involvement, but not monitoring or discipline, was uniquely related to externalizing problems and differentially related to internalizing and externalizing problems. The findings suggest that parental warmth has implications for interventions conducted with children living in families with a history of parental depression.

The Relation of Maternal Sensitivity to Children’s Internalizing and Externalizing Problems Within the Context of Maternal Depressive Symptoms

Maternal depression has been linked to deficits in parenting that contribute to youth’s development of externalizing and/or internalizing problems. Maternal sensitivity has been implicated within the infant literature as a foundational aspect of parenting contributing to a child’s adjustment. This study examines the main and moderating effects of a construct labeled maternal sensitivity, within the context of depressive symptoms, on youth externalizing and internalizing problems in a sample of 65 mothers with a history of depression and their 84 children ages 9-15 years. Sensitivity was related to child externalizing problems. Although two-way interactions were not significant, exploratory moderation analyses indicated a significant three-way interaction among maternal depressive symptoms, maternal sensitivity, and youth gender for internalizing problems: among girls only, high depressive symptoms, low sensitivity, and the combination of these two variables were each associated with high levels of internalizing problems.

Neurocognitive deficits in children with chronic health conditions.

Over 4 million children in the United States suffer from chronic health conditions, including cancer, sickle cell disease, and diabetes. Because of major advances in the early identification and treatment of these conditions, survival rates for these children continue to rise, and the majority now lives into adulthood. However, increases in survival have come with costs related to long-term effects of disease processes and treatments. Foremost among these consequences is impairment in brain development and neurocognitive function that may affect a substantial portion of children with chronic health conditions and follow many into adulthood. Impaired cognitive function may contribute to impairment in educational and occupational attainment, mental health, and quality of life for children with chronic conditions. Despite the significance and scope of this problem, advances in the identification and understanding of neurocognitive problems and the delivery of effective clinical care have been hindered in part because research has been “siloed”—conducted on each chronic condition in isolation. This review examines, for the first time, neurocognitive problems in a selected set of 6 chronic pediatric health conditions—leukemia, brain tumors, sickle cell disease, congenital heart disease, Type 1 diabetes, and traumatic brain injury—to define the magnitude of the problem and identify directions for future research and clinical care. Psychologists from many areas of specialization, including pediatric psychology, educational and school psychology, neuropsychology, behavioral medicine, and adult primary care, are uniquely positioned to contribute to every phase of this work, including research, identification, and intervention.