Martha C. Tompson

FAMILY-FOCUSED TREATMENT VERSUS INDIVIDUAL TREATMENT FOR BIPOLAR DISORDER: RESULTS OF A RANDOMIZED CLINICAL TRIAL

Recently hospitalized bipolar, manic patients (N = 53) were randomly assigned to a 9-month, manual-based, family-focused psychoeducational therapy (n = 28) or to an individually focused patient treatment (n = 25). All patients received concurrent treatment with mood-stabilizing medications. Structured follow-up assessments were conducted at 3-month intervals for a 1-year period ofactive treatment and a 1-year period of posttreatment follow-up. Compared with patients in individual therapy, those in family-focused treatment were less likely to be rehospitalized during the 2-year study period. Patients in family treatment also experienced fewer mood disorder relapses over the 2 years, although they did not differ from patients in individual treatment in their likelihood of a first relapse. Results suggest that family psychoeducational treatment is a useful adjunct to pharmacotherapy in decreasing the risk of relapse and hospitalization frequently associated with bipolar disorder.

Family-expressed emotion, childhood-onset depression, and childhood-onset schizophrenia spectrum disorders: Is expressed emotion a nonspecific correlate of child psychopathology or a specific risk factor for depression?

Expressed emotion (EE) was examined, using the brief Five Minute Speech Sample measure, in families of (1) children with depressive disorders, (2) children with schizophrenia spectrum disorders, and (3) normal controls screened for the absence of psychiatric disorder. Consistent with the hypothesis of some specificity in the association between EE and the form of child disorder, rates of EE were significantly higher among families of depressed children compared to families of normal controls and families of children with schizophrenia spectrum disorders. Within the depressed group, the presence of a comorbid disruptive behavior disorder was associated with high levels of critical EE, underscoring the need to attend to comorbid patterns and subtypes of EE in future research.

Depression in youth: psychosocial interventions.

Witnessed over the past 20 years are major advances in knowledge regarding depression in children and adolescents. Although additional research is needed, clinicians can now turn to treatment strategies with demonstrated efficacy. In this article we review the literature on psychosocial interventions for depression in youth and offer a working model to guide the treatment of depressed youth. We begin with a brief overview of the model, followed by a review of the treatment efficacy and prevention literatures. We offer some caveats that impact the ability to move from this treatment literature to the real world of clinical practice. We conclude by considering how extant research can inform treatment decisions and highlight critical questions that need to be addressed through future research.

Maternal Depression, Maternal Expressed Emotion, and Youth Psychopathology

Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two predictors–maternal depression within the child’s lifetime and maternal EE–in a study of children at risk for depression. One hundred and seventy-one youth, ages 8–12, and their mothers participated. To assess maternal and youth psychopathology, dyads were administered structured diagnostic assessments, and mothers and children completed self-report measures of their own depressive symptoms. In addition, mothers completed the Achenbach Child Behavior Checklist–Parent Report Version (CBCL) for their children. Maternal EE was assessed based on the Five Minute Speech Sample. History of maternal depression was associated with high maternal EE, and the combination of maternal depression history and maternal EE was associated with children’s own reports of higher depressive symptoms. Current maternal depressive symptoms were associated with mothers’ reports of children’s Internalizing scores on the CBCL, and maternal depression history, current maternal depressive symptoms, and maternal EE were strongly associated with mothers’ reports of children’s Externalizing and Total Problem scores on the CBCL. History of maternal depression and a rating of high or borderline Critical EE (characterized by maternal critical comments and/or reports of a negative relationship) were independently associated with children’s depression diagnoses.

Social, academic, and behavioral competence of depressed children : Relationship to diagnostic status and family interaction style

This study compared the social adjustment and academic performance of 15 psychiatrically hospitalized children with depression to 14 children with schizophrenia spectrum disorders and 20 normal community children, ages 7–14. The relationship between childrens interpersonal and academic competence and the quality of direct family interactions was also examined. Analyses revealed an association between childrens adaptive functioning and both diagnostic status and family transactional processes, as assessed by two 10-minute conflict-solving tasks. Major findings were as follows: (a) depressed children and children with schizophrenia spectrum disorders received similarly low ratings of social competence in comparison to normal controls; (b) academic performance of depressed children was similar to normal controls and better than children with schizophrenia spectrum disorders; and (c) children with poorer social competence and more behavioral problems were more likely to have parents who showed negative affect during family problem-solving tasks. The implications of these results for understanding the relationship between psychiatric impairment and childrens social and academic development were discussed.

Enhancing the Developmental Appropriateness of Treatment for Depression in Youth: Integrating the Family in Treatment

Treatment models for youth depression that emphasize interpersonal functioning, particularly family relationships, may be particularly promising. This article first reviews the current state of knowledge on the efficacy of psychosocial treatments for depression in youth, with an emphasis on family involvement in treatment. It then discusses developmental factors that may impact the applicability and structure of family-focused treatment models for preadolescent and adolescent youth. Finally, two family-based treatment models that are currently being evaluated in randomized clinical trials are described: one focusing on preadolescent depressed youth and the other on adolescents who have made a recent suicide attempt.

Parental expressed emotion toward children: Prediction from early family functioning.

Expressed emotion (EE), an index of family member criticism and emotional overinvolvement, predicts outcome among adults and children with mental disorders. However, limited research exists on factors contributing to EE. Aims of the current study were to (a) examine EE in mothers of young children; (b) assess relationships between demographic factors and EE in a diverse sample; and (c) investigate whether family stress and functioning, including quality of marital relationship, life events, maternal stress, and family environment, predict EE. In the current study, 276 mothers completed questionnaires when their children were between 1 and 3 years of age and a measure of EE when their children were in kindergarten. Results indicated that family expressiveness was the most consistent predictor of EE. Further research seems warranted to better delineate associations between family functioning and EE.

Enhancing Maternal Depression Recognition in Health Care Settings: A Review of Strategies to Improve Detection, Reduce Barriers, and Reach Mothers in Need

Maternal depression is a major public health concern in the United States affecting mothers, children, and families. Many mothers experience depression, and exposure to maternal depression can put children at increased risk for psychopathology and poor psychosocial development. Early recognition of maternal depression is a critical step in promoting healthy development and preventing adverse outcomes in children and families. In this review, we examine some of the major barriers that mothers face in seeking help for depression; discuss optimal settings in which to implement maternal depression screening; review available depression screening tools for identifying mothers in need of care; discuss steps providers can take after screening; examine barriers to screening; and present information about promising initiatives developed to address these barriers.

Childhood-onset schizophrenia: a follow-up study.

This paper presents results from the UCLA Follow-Up Study of Childhood-Onset Schizophrenia Spectrum Disorders. Eighteen children with schizophrenia (SZ) were assessed 1 to 7 years following initial project intake. Results demonstrated significant continuity between SZ spectrum disorders in childhood and adolescence. Although not all children who presented initially with SZ continued to meet criteria for SZ spectrum disorder as they progressed through the follow-up period, rates of SZ spectrum disorders ranged from 78–89% across the first three follow-up years. Rates of continuing SZ ranged from 67% to 78% across the three follow-up years and rates of schizoaffective disorder ranged from 11% to 13% across the three follow-up years. Variability in levels of functioning were observed with 45% of the sample showing deteriorating course or minimal improvement and 55% of the sample showing moderate improvement or good outcomes. This variability in outcome is comparable to that seen in adults with SZ, suggesting that with current treatments childhoodonset does not ensure a more severe disorder.

Longitudinal Associations Between Depression and Problematic Substance Use in the Youth Partners in Care Study

Large-scale treatment studies suggest that effective depression treatment and reduced depression are associated with improved substance use outcomes. Yet information is limited regarding the longitudinal association between depressive symptoms and problematic substance use and its predictors, particularly in real-world practice settings. Using latent growth modeling, we examined the (a) longitudinal association between depressive symptoms and problematic substance use, (b) impact of depressive symptoms on problematic substance use, (c) impact of problematic substance use on depressive symptoms, and (d) role of co-occurring symptoms on depression and problematic substance use. Participants were part of the Youth Partners in Care study, an effectiveness trial evaluating a quality improvement intervention for youth depression through primary care. This ethnically diverse sample included youths aged 13 to 21 years screening positive for depression from 5 health care organizations. Participants were followed 4 times over an 18-month period and assessed for both depressive symptoms and problematic substance use. Both depressive symptoms and problematic substance use declined over time. Higher baseline depressive symptoms predicted a slower decline in problematic substance use, but baseline problematic substance use did not predict changes in depressive symptoms. These prospective associations remained robust controlling for co-occurring symptoms. Results support prior large-scale depression studies indicating depression burden negatively impacts substance use outcome and extends these findings to real-world practice settings. Findings underscore the importance of addressing depression severity in youth with concurrent substance use problems, even in the context of comorbid symptoms of anxiety, delinquency, and aggression.