Virginia Warner

Maternal smoking during pregnancy and psychopathology in offspring followed to adulthood.

OBJECTIVE To extend findings from several independent reports of an association between maternal smoking during pregnancy and attention-deficit hyperactivity disorder, conduct disorder, and substance abuse in the offspring. METHOD This is a 10-year longitudinal study of offspring assessed at 3 points in time into adulthood. Fifty offspring of mothers who reported smoking at least 10 cigarettes almost daily during pregnancy and 97 offspring of mothers who reported never smoking during pregnancy were studied. Psychiatric diagnosis in offspring was assessed blind to parental diagnosis. RESULTS There was a greater than 4-fold increased risk of prepubertal-onset conduct disorder in boys and a greater than 5-fold increased risk of adolescent-onset drug dependence in girls whose mothers smoked 10 or more cigarettes almost daily during pregnancy. These findings could not be explained by maternal substance abuse during pregnancy, parental psychiatric diagnosis, family risk factors, prenatal and early developmental history of offspring, postnatal maternal smoking, or smoking in the offspring. CONCLUSIONS Maternal smoking during pregnancy may have a long-term effect on specific psychopathology in offspring. The underlying pathophysiology of nicotine on the fetus requires study. The findings suggest the importance of programs aimed at smoking prevention and cessation in women during pregnancy.

Cortical thinning in persons at increased familial risk for major depression

The brain disturbances that place a person at risk for developing depression are unknown. We imaged the brains of 131 individuals, ages 6 to 54 years, who were biological descendants (children or grandchildren) of individuals identified as having either moderate to severe, recurrent, and functionally debilitating depression or as having no lifetime history of depression. We compared cortical thickness across high- and low-risk groups, detecting large expanses of cortical thinning across the lateral surface of the right cerebral hemisphere in persons at high risk. Thinning correlated with measures of current symptom severity, inattention, and visual memory for social and emotional stimuli. Mediator analyses indicated that cortical thickness mediated the associations of familial risk with inattention, visual memory, and clinical symptoms. These findings suggest that cortical thinning in the right hemisphere produces disturbances in arousal, attention, and memory for social stimuli, which in turn may increase the risk of developing depressive illness.

Diagnostic interviewing for family studies: Comparing telephone and face-to-face methods for the diagnosis of lifetime psychiatric disorders

Family studies require assessment of large numbers of family members, many of whom are geographically dispersed, live in different time zones, are not available during working hours, live in neighborhoods which are unsafe, or do not wish to have attention drawn to them by the presence of an interviewer in their home. For these reasons, telephone interviews are a potentially valuable and economical method. We present a comparison of results from telephone and face-to-face interviews conducted with 435 relatives of 193 probands from a family study. No significant differences were found between telephone versus face-to-face interviewed relatives in rates of RDC or of DSM-III-R diagnoses. Nor were differences found in the length of interviews; number of family history reports completed; or number of relatives requiring consensus diagnoses due to diagnostic disagreement. We conclude that telephone and face-to-face interviews yielded comparable diagnostic information in this family study and that telephone interviewing is an acceptable and valuable alternative method for the diagnosis of lifetime psychiatric disorder in relatives.

Early-onset major depression in parents and their children

In a study of 6-23-year-old offspring of depressed and of normal parents, an inverse relationship between the rates of major depression among the children and the age of onset of major depression in their proband parents was found. The children of parents who had an onset of major depression that was younger than age 20 years overall had the highest risk of major depression. There was specificity in the findings in that these higher rates were nearly all accounted for by prepubertal onsets of major depression in their children. There was a 14-fold increased risk of onset of depression before age 13 in the children of probands who had onset less than age 20. These results were not confounded by the current age of the proband or the children, by interview status (children were interviewed), by comorbidity in the parents or by assortative mating. Future family genetic studies should examine the rates and patterns of illness of the biological relatives of probands with prepubertal-onset major depression.

Religiosity and Depression: Ten-Year Follow-up of Depressed Mothers and Offspring

OBJECTIVE This study examines maternal religiosity as a protective factor against depression in offspring. METHOD Sixty mothers and 151 offspring were independently assessed over the course of a 10-year follow-up. Maternal and offspring religiosity were assessed on the basis of self-report of the importance of religion, the frequency of attendance of religious services, and religious denomination. Depression was assessed using the Schedule for Affective Disorders-Lifetime version. Maternal bonding style was assessed through offspring report on the Parental Bonding Instrument. A series of logistic regressions were run to predict offspring depression status, taking into account maternal religiosity, offspring religiosity, and mother-offspring concordance of religiosity. RESULTS Maternal religiosity and mother-offspring concordance of religiosity were shown to be protective against offspring depression, independent of maternal parental bonding, maternal social functioning, and maternal demographics. CONCLUSION Maternal religiosity and offspring concordance with it may protect against depression in offspring.

Electroencephalographic measures of regional hemispheric activity in offspring at risk for depressive disorders

BACKGROUND Electroencephalographic (EEG) studies have found abnormal regional hemispheric asymmetries in depressive disorders, which have been hypothesized to be vulnerability markers for depression. In a longitudinal high-risk study, resting EEG was measured in primarily adult offspring of depressed or nondepressed probands. METHODS Electroencephalograms from12 homologous sites over each hemisphere (digitally linked-ears reference) were analyzed in right-handed offspring for whom both parents (n = 18), one parent (n = 40), or neither parent (n = 29) had a major depressive disorder (MDD). RESULTS Offspring with both parents having MDD showed greater alpha asymmetry at medial sites, with relatively less activity (more alpha) over right central and parietal regions, compared with offspring having one or no parent with MDD. Relatively less left frontal activity at lateral sites was associated with lifetime MDD in offspring but not with parental MDD. Offspring with both parents having a MDD also showed markedly greater anterior-to- posterior increase in alpha with eyes closed compared with those with one or no parent with a MDD. CONCLUSIONS Alpha asymmetry indicative of right parietotemporal hypoactivity, previously reported for depressed adolescents and adults, and heightened anterior-to-posterior gradient of alpha are present in high-risk offspring having parents concordant for MDD.

Intergenerational Transmission of Parental Bonding Among Women

OBJECTIVE To examine the transmission of parental bonding style from mothers to daughters. METHOD Sixty mothers and their 69 daughters were independently assessed over the course of a 10-year follow-up. The Parental Bonding instrument was administered to both mothers and daughters to assess their own childhood parenting. Depression was assessed using the Schedule for Affective Disorders and Schizophrenia-Lifetime version. Temperament was assessed through self-report on the Dimensions of Temperament Survey. A series of logistic regressions were run to predict daughter report of maternal affectionless control, taking into account maternal and daughter depression status, temperament, and socioeconomic status. RESULTS The intergenerational transmission of parental bonding among women was shown to be independent of maternal depression, daughter depression, maternal temperament, daughter temperament, and socioeconomic status. CONCLUSION Given the previously established association between parental bonding style and depression in offspring, the sturdiness of the intergenerational transmission of parental bonding among women suggests the routine clinical assessment of maternal bonding style.

Applying Impairment Criteria to Children's Psychiatric Diagnosis

This paper examines the effect of applying impairment criteria using the Childrens Global Assessment Scale on rates, agreement between informants, and recall of diagnosis over 2 years in a sample of 220 offspring of depressed and nondepressed parents. The findings show that the offspring of depressed parents, compared with nondepressed parents, were more impaired overall. The rates of most psychiatric disorders in both groups of children were markedly reduced when impairment criteria were applied. The application of impairment criteria improved agreement between mother and child on many of the childrens diagnoses and also improved stability of recall of childs diagnosis at 2-year follow-up. Long-term follow-up studies are needed to determine the clinical consequences for children who meet diagnostic criteria for psychiatric disorder but who have minimal functional impairment.

Self-Esteem and Depression: ten year follow-up of mothers and offspring

OBJECTIVE The association between maternal bonding style, offspring low self-esteem and offspring depression status was assessed by maternal depression status. SUBJECTS Sixty mothers and 137 offspring were independently assessed over the course of a ten year follow-up study. METHOD Assessments included the Schedule for Affective Disorders and Schizophrenia (SADS-LA), Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS), the Coopersmith Self-Esteem Inventory (CSEI) and the Parental Bonding Instrument (PBI). RESULTS Among daughters of mothers with a history of depression, maternal affectionless-control was associated with daughter low self-esteem which was associated with daughter depression at ten year follow-up. Among daughters of mothers without a history of depression, maternal affectionless-control was not associated with daughter low self-esteem, which was not associated with daughter depression at ten year follow-up but which was associated with a history of childhood depression. None of these associations were found to be significant among sons. LIMITATIONS As self-esteem was not measured at ten year follow-up, among offspring the stability of self-esteem could not be assessed, nor could the association between adult self-esteem and adult depression. CONCLUSION Clinical presentation of low self-esteem in girls should be assessed in the context of maternal depression status.

Temperament among offspring at high and low risk for depression

The purpose of this study was to examine relationships between parental depression, offspring temperament, and offspring major depressive disorder (MDD), and to determine whether difficult temperament, as measured by the Dimensions of Temperament Survey (DOTS), mediates the relation between parental MDD and offspring MDD. Offspring (n=169) of depressed or never depressed parents were followed over approximately 20 years and were blindly assessed up to 4 times (Waves 1 to 4) using semi-structured interviews. Offspring completed the DOTS at the time of first or second assessment. The results showed: (1) high-risk offspring with one or more depressed parent were significantly more likely than offspring with neither parent depressed to have a difficult temperament; (2) offspring with a difficult temperament were more than twice as likely as those with an easy temperament to develop a MDD; and (3) difficult temperament explained more than 10% of the association between parental depression and new onsets of MDD in offspring. The findings suggest that offspring temperament is associated with development of MDD and that difficult temperament at least partially mediates the relationship between parental depression and offspring depression. When identifying those at greatest risk for MDD, measures of temperament could serve as a useful supplement to family psychiatric history of MDD.