When a mother's depression remits, her child's clinical state also improves, and children of mothers who remain depressed are likely to deteriorate, reported Myrna M. Weissman, Ph.D., and her associates in the pediatric portion of the Sequenced Treatment Alternative to Relieve Depression study.
Maternal depression is one of the most consistent risk factors for childhood anxiety, depression, and disruptive behavior disorders. However, the researchers said, to their knowledge, this is the first published study documenting prospectively the relationship between the remission of a mother's depression and a child's clinical state.
“These findings are intriguing because they suggest that an environmental influence … had a measurable impact on the child's psychopathology,” the investigators noted.
The Sequenced Treatment Alternative to Relieve Depression (STAR
In the ancillary pediatric study, Dr. Weissman and her associates assessed 114 mother-child pairs. This report details their findings at baseline and at the first of several planned follow-up evaluations (JAMA 2006;295:1389–98).
All the mothers were initially treated with citalopram (Celexa). Those who did not respond or did not tolerate the antidepressant went on to be randomly assigned to subsequent steps in treatment, said Dr. Weissman, of Columbia University and the New York State Psychiatric Institute, New York, and her associates.
Many of the children, aged 7–17 years, were acutely symptomatic at baseline. “Over a third had a current psychiatric disorder including anxiety (16%), depressive (10%), or disruptive behavior disorders (22%); almost half had a past psychiatric disorder. These high rates are consistent with findings from numerous studies of children with depressed parents,” the investigators said.
The maternal remission rate at 3 months was 33%. At that time, children of the 34 mothers who remitted showed an 11% decline in rates of those diagnoses, from 35% (12 of 34 children) at baseline to 24% (8 of 34). In contrast, there was an 8% increase in diagnoses among children of mothers with continuing depression, from 35% (25 of 71 children) to 43% (30 of 71 children) during that interval.
There were 68 children who had no psychiatric disorder at baseline. All of those in whom maternal depression remitted remained free of psychiatric disorders at the 3-month follow-up. In contrast, 17% (8 of 46) of the children of mothers who remained depressed developed an onset or a relapse of psychiatric disorders by the 3-month follow-up.
The change in rates of child diagnoses was inversely related to the magnitude of the mother's response to treatment. An improvement of at least 50% was necessary before any improvement could be discerned in the children. After that threshold was reached, greater maternal improvements had a direct linear association with decreases in child diagnoses. Conversely, children of mothers who responded at a rate of less than 50% showed an increase in psychiatric diagnoses at 3 months.
It is important to note that although many of the children in this study had a current or past psychiatric disorder, they showed improvement in a relatively short time (3 months)–even though most of them were not receiving direct treatment–simply because their mothers improved.
“Even more interesting” was the finding of a possible preventive effect of maternal improvement: None of the children of remitting mothers had any onset or recurrence of psychiatric symptoms, the researchers noted.
These results suggest that “a reduction in stress associated with maternal remission may reverse the long-standing symptoms in children who are likely to be genetically vulnerable,” they added.
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