Based on studies they conducted in the 1980s, Dr. Beardslee has identified core characteristics of resilient youth: a desire to accomplish developmental tasks outside the home, such as doing well in school or in sports; a commitment to relationships with friends, siblings, and parents; and an understanding that they are not to blame for a parent's illness.
Giving depressed parents the tools to build resilience in their children is central to the Prevention Intervention Project. The manualized, stepwise therapeutic strategy teaches parents to encourage children to pursue interests, relationships, and activities outside the home and to talk about the illness in a productive way.
The intervention is designed for use by physicians, school counselors, nurses, and mental health professionals.
Two models—one lecture based, the other clinician led—have been tested with promising results. In the lecture-based model, parents attend two group meetings without their children. In the clinician-led version, parents and children attend a series of 6-11 meetings facilitated by a clinician, as well as a family meeting led by the parents during which the illness is discussed.
Participants in both interventions receive information about mood disorders, risk, and resilience, and both interventions focus on removing misunderstanding, guilt, and blame.
In the clinician-led intervention, cognitive information is linked specifically to the individual's life and family experiences, while the lecture intervention presents that information in a group format with opportunity for discussion. Unlike in the clinician model, children of families receiving the lecture intervention are not seen directly; parents are encouraged to talk with their children.
In an examination of the efficacy of the programs at 1 year and 2 ½ years post intervention among 100 families randomly assigned to one of the two intervention models, parents in both conditions reported significant change in child-related behaviors and attitudes, and the amount of change increased over time. Children in both conditions reported increased understanding of parental illness, and internalizing scores for all of the children decreased (Pediatrics 2003;112:e119-31).
Although more change was seen in the clinician-led group, the long-standing positive effects of both interventions suggest that interventions built around family involvement, even if brief, “translate into significant mental health gains for children and families,” Dr. Beardslee said.
Perspective
By CARL C. BELL, M.D., president and CEO of Community Mental Health Council Inc. Chicago, and director of public and community psychiatry, University of Illinois at Chicago.
We live in a society that believes in “better living through chemistry.” Fortunately, there are those who rail against the trend of taking a pill for everything that ails us. But in the treatment of mental illness, hard work is critical to helping patients achieve health and well-being.
In my research, I have uncovered several key principles necessary to cultivate resilience and resistance in individuals so they won't need pills to manage clinical illness. We need to:
▸ Create a social fabric around individuals.
▸ Establish systems that promote interpersonal connectedness as a way to facilitate health behavior change.
▸ Develop infrastructures that promote social skills, personal value, and empowerment.
▸ Provide children with an adult protective shield to increase protective factors and decrease risk factors.
▸ Strive to minimize the experience and impact of trauma.
▸ Support quality psychosocial research at the level we have been supporting biomedical research.
Validated programs that incorporate these principles, such as the Preventive Intervention Project, need to be aggressively marketed. For example, people are more hyped about preventing maternal transmission of HIV than preventing parental transmission of depression because of the availability of clear-cut, proven, hard biologic interventions for HIV. To encourage a paradigm shift in mental illness, science needs to show equally strong evidence for psychosocial interventions, along with a strong advocacy campaign to convince people that psychosocial interventions are as valuable as biological ones.
Another obstacle is our couch-potato society's shortsighted preoccupation with how long something takes.
Some would argue that 6-11 manualized, evidence-based sessions aimed at helping a child keep from getting depressed is a significant time commitment, but consider the possible depression-related outcomes without such efforts: school failure, substance abuse, hopelessness, and suicide attempts. How can an individual or a society not make such a time investment?
It boils down to paying now or paying much, much more later, akin to the old Chinese proverb: “You are a fool if you wait until you are thirsty before you start digging your well.