Mom’s Depression can put kids at same risk

TUESDAY, March 22, The children of mothers who are successfully treated for depression have a markedly reduced risk of developing psychiatric disorders themselves. But if a mother’s depression continues, her children face an increased risk of also having such problems, a new study showed. The message is clear.

JAMA. (Journal of the American Medical Association) 2006;295:1389-1398. Effective Treatment of a Mother’s Depression Reduces Risk of Psychiatric Disorders in Her Children

NEW YORK, N.Y. — March 22, 2006 — Remission of a mother’s depression within the first three months of treatment decreases the likelihood of her children having psychiatric disorders, such as mood or disruptive behavior disorders, within the same time period. Mothers who remain depressed increase the risk of her children having these disorders, according to a study in the March 22/29 issue of the Journal of the American Medical Association (JAMA), a theme issue on women’s health.

Lead author Myrna M. Weissman, PhD, of Columbia University Medical Center and the New York State Psychiatric Institute, New York, presented the findings of the study today at a JAMA media briefing on women’s health in New York.

Parental depression is among the most consistent risk factors for childhood anxiety and disruptive behavior disorders and for major depression, with more than a 2- to 3-fold increased risk in offspring of depressed parents compared with controls, according to background information in the article. These offspring problems often begin before puberty, continue into adolescence and adulthood, and can be transmitted to the next generation. The long-term effects include impaired social and occupational functioning and increased risk of medical problems.

Although early onset major depression is highly familial and has a strong genetic component, environmental factors, such as disrupted parent-child attachment and poor parent-child bonding may affect the impact of parental depression on children’s symptoms.

Dr. Weissman and colleagues examined whether effective treatment of a mother’s depression with medication is associated with reduction of psychopathological symptoms and disorders in their children. The study included 151 mother-child pairs in 8 primary care and 11 psychiatric outpatient clinics who were part of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, which was conducted between December 2001 and April 2004. The mothers in the trial were treated with medication for depression. The children, aged 7 to 17 years, were assessed by a team of evaluators not involved in maternal treatment and unaware of maternal outcomes.

The researchers found that after 3 months of medication treatment there was an overall 11% decrease in rates of diagnoses (from 35% to 24%) in children of mothers in remission vs. an 8% increase (from 35% to 43%) in children of mothers with continuing depression. Of the offspring who had psychiatric diagnoses at baseline and whose mother’s depression remitted, 33% of the children’s own diagnoses had remitted, whereas only 12% of the children of women whose depression remained lost their diagnosis. Of the children who had no psychiatric disorder at baseline, all remained free of psychiatric disorders at the 3-month follow-up if the maternal depression remitted, whereas 17% of children of mothers who remained depressed had an onset or relapse over this period

“To our knowledge, this is the first published study to document prospectively the relation between remission of a mother’s depression and her child’s clinical state. These findings are intriguing because they suggest that an environmental influence (i.e., the impact of maternal depression remission) had a measurable impact on the child’s psychopathology,” the authors write. “Our studies 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, although we have not genotyped the children in the study.”

“From a clinical vantage point, our findings suggest that vigorous treatment of depressed mothers to achieve remission is associated with positive outcomes in their children as well, whereas failure to treat depressed mothers may increase the burden of illness in their children. At a time when there are many questions about the appropriate and safe treatment of psychiatric disorders in children, these findings suggest that it is important to provide vigorous treatment to mothers if they are depressed,” the researchers conclude.

SOURCE: American Medical Association