Children Benefit When Moms Get Depression Treatment

Successful treatment of maternal depression may have benefits that extend to the youngest family members, according to data posted online in the June 16 AJP in Advance. (The report will appear in print in the September American Journal of Psychiatry.)

Findings captured in the Sequenced Treatment Alternatives to Relieve Depression-Child (STAR*D-Child) study showed that among children of depressed mothers, psychiatric symptoms decreased significantly when mothers' depression symptoms lifted. “Clinicians who treat depressed mothers may want to inform them about the potential benefits of remission for their children,” Myrna Weissman, Ph.D., one of the study's authors, told Psychiatric News. “For clinicians treating children with certain psychiatric disorders, they may want to inquire about the mental health of the parents,” she noted, because there is a possibility that parental mental health treatment may be beneficial for the children's mental health.

Weissman is a professor of epidemiology and psychiatry at Columbia University. She and her colleague examined 123 of the original 151 mothers with depression enrolled in the STAR*D study and one child of these women enrolled in the STAR*D-Child study.

The STAR*D study was a large, multicenter clinical trial funded by the National Institute of Mental Health and conducted between December 2001 and April 2004. In the study, adults with major depression went through a stepwise treatment algorithm: those who did not reach remission on citalopram after up to 14 weeks were treated with two additional steps using options that included switching to another antidepressant, switching to cognitive therapy, and continuing with citalopram augmented with bupropion, buspirone, or cognitive therapy (see Algorithm Aids Depression Care).

The ancillary STAR*D-Child study was launched about a year later. It examined at least one child of the depressed mothers at baseline and involved follow-up exams every three months for one year after the initiation of treatment for mothers. In all, there were 123 mother-child pairs studied.

As part of the study, researchers used the Hamilton Depression Rating Scale (HAM-D) to assess the severity of depression in mothers aged 25 to 60. After the initiation of treatment, mothers with a score of 7 or less were considered to be “remitters.”

Children and adolescents aged 7 to 17 were assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Life-time Version (K-SADS-PL) for affective, anxiety, and disruptive behavior disorders. Children's functioning was assessed using the Children's Global Assessment Scale (C-GAS).

The timing of the change in mothers' depressive symptoms and the psychiatric symptoms of their children were also assessed by examining whether the prior three-month assessments of the mothers' HAM-D scores were associated with children's symptoms between three and 12 months after the initiation of maternal treatment.

Researchers found that 70 of the 123 mothers experienced remission during the study period, and the proportion of children with one or more diagnoses as measured by the K-SADS-PL also decreased after maternal treatment. Mothers who did not experience remission were more likely to have higher HAM-D scores at baseline, have lower annual incomes, and be single as compared with those who did experience remission.

During the one-year study period, there was a significant decrease in the number of symptoms among children of mothers who experienced a remission of depressive symptoms. C-GAS scores also improved moderately during the first six months after treatment of mothers began among those who remitted, according to the results (p<.001).

Among mothers whose depressive symptoms did not remit, the number of child-reported symptoms did not change significantly during the one-year study period.

When researchers examined time trends among a subsample of 60 children with baseline psychiatric symptoms, they found a significant decrease in psychiatric symptoms among children of mothers whose symptoms remitted within three months of initial treatment (p=0.003). Decreases were not significant for children of mothers whose symptoms remitted after that three-month period, however, or among mothers whose symptoms did not remit during the study period.

Children did not receive treatment as part of the STAR*D-Child study, but researchers provided information about psychiatric treatment to parents of children with a psychiatric diagnosis (as indicated by the K-SADS-PL). There were no statistically significant differences in the proportion of children receiving treatment by maternal remission status, according to the report.

Weissman emphasized that there also was no significant association between child symptoms during the previous three months and current maternal depression severity, meaning that the mothers' decreasing depression scores were likely not due to any improvement in the children's mental health.

Weissman commented that “this study left some questions unanswered,” such as whether successful treatment of fathers' depression may have a similar impact on children's mental health.

She also noted that the current study did not permit researchers to explore the mechanisms that linked improved maternal mental health to improved mental health of children.

So that she can better answer these questions, Weissman is leading a new study involving depressed parents and their children. Clinicians in the New York City metro area may refer adult parents with depression for free evaluation and treatment as part of the study by calling the New York State Psychiatric Institute at (212) 543-5734.

The article, “Children of Depressed Mothers 1 Year After the Initiation of Maternal Treatment: Findings From the STAR*D Child Study” is posted at<http://ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2008.07081286v1>.▪