Children's Psychiatric Symptoms Ease When Mom's Depression Lifts

Megan Brooks

March 15, 2011

March 15, 2011 — Effective treatment of women with major depressive disorder can ease problem behaviors and psychiatric symptoms in their children, new research confirms.

Taken together with other recent studies, these latest findings "indicate that remission of depression in mothers is associated with positive outcomes in their children," study investigator Mryna M. Weissman, PhD, of Columbia University and New York Psychiatric Institute in New York City, and colleagues conclude.

"Vigorous treatment of the parent to remission" is important, Dr. Weissman told Medscape Medical News. "If you are treating a depressed child, see if the mother is depressed because that might be another venue for helping both mother and child," she added.

The study is published online March 15 in the American Journal of Psychiatry.

A Family Affair

Gabrielle Shapiro, MD, associate clinical professor of psychiatry, Mount Sinai School of Medicine, in New York City, who was not involved in the study, agrees. When looking at a child's behavioral or mental health picture, it's important to take "the psychiatric picture of the parents" into consideration, she said an interview.

"Having a depressed, or anxious, or substance-abusing, or traumatized primary care taker or primary attachment figure" can spark problems in children, added Dr. Shapiro, secretary treasurer of the Assembly of the American Academy of Child and Adolescent Psychiatry.

"This study shows that the earlier we intervene with parents — in this case mothers — the better we are going to serve the children," she said, adding that it's also important to consider the mental health of fathers.

Dr. Weissman and colleagues prospectively followed up 80 mothers and their children who participated in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. As part of the study, the women were initially treated with citalopram, followed by other antidepressants, cognitive-behavioral therapy, or a combination of treatments, as needed.

At 3-month intervals during the year after remission of maternal depression, the researchers examined changes in psychiatric symptoms, behavioral problems, and functioning among their school-aged children.

They compared child outcomes by time of remission of maternal depression, adjusting for the child's age, sex, baseline psychiatric status, and treatment; household income; and mother's baseline Hamilton Depression Score, presence of an anxiety disorder at baseline, and marital status.

Of the 80 mothers studied, 36 were "early remitters," achieving remission from their depression in the first 3 months of treatment; 12 were "late remitters," experiencing remission 3 to 12 months after treatment; and the remaining 28 were "nonremitters."

During the year-long period after the women's remission, children of early- and late-remitting mothers showed a significant decrease in psychiatric symptoms and problem behaviors based on standard assessments.

However, psychosocial functioning improved only in children of early-remitting mothers. The fact that these women were less depressed at baseline and remained depressed for a shorter time suggests "early remission, lower illness severity, and shorter duration of maternal depressive episodes may be important in relation to their children's adaptation."

Lingering Depression Hard on Kids

Dr. Weissman and her team failed to see any marked changes in psychiatric symptoms or behavior among the children of nonremitting mothers, with the exception of externalizing behavioral problems, which increased in children of nonremitting mothers.

It's possible, note the researchers, that women who stayed in remission in the first year did so because their children continued to improve. In mothers who did not remit, their children's continued behavioral problems may have contributed to maternal depressive symptoms.

There were too few mothers who relapsed to adequately assess this possibility. However, in a previous analysis of the STAR*D Child study cohort, the researchers report they found little evidence that mothers became less depressed in reaction to positive changes seen in their children.

The study was funded by the National Institute of Mental Health. Financial disclosures reported by the STAR*D Child study team are listed with the original article.

Am J Psychiatry. Published online March 15, 2011.

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