[Show abstract][Hide abstract] ABSTRACT: Young people whose parents have depression have a greatly increased risk of developing a psychiatric disorder, but poor outcomes are not inevitable. Identification of the contributors to mental health resilience in young people at high familial risk is an internationally recognised priority. Our objectives were to identify protective factors that predict sustained good mental health in adolescents with a parent with depression and to test whether these contribute beyond what is explained by parent illness severity.
Full-text · Article · Dec 2015 · The Lancet Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Background
Very little is known about the extent to which eleven-year olds might consider a career in medicine. This exploratory study therefore asked children and their parents about medicine as a possible career, looking also at the relationship to a range of background measures.
A longitudinal, three-wave, questionnaire study of students transferring from primary to secondary school (STARS), with data collection at primary school (wave 1; mean age 11.3 yrs), in the first months of secondary school (wave 2; mean age 11.7 yrs) and at the end of the first year of secondary school (wave 3; mean age 12.3 yrs). Parents/carers also completed questionnaires. Children were entering ten large comprehensive secondary schools in the south-east of England; 46.3 % were female, 15.6 % receiving free-school meals, 39.8 % were Black or Minority Ethnic and 28.8 % had a first language which was not English. Of 2287 children in the study, 1936 children (84.5 %) completed at least one questionnaire of the three waves (waves 1, 2 and 3). The main outcome measures were an open-ended question in each wave, “What job would you like to do when you grow up?”, and a more detailed questionnaire in wave 3 asking about 33 different jobs.
9.9 % of children spontaneously mentioned medicine as a career on at least one occasion. For the specific jobs, would-be doctors particularly preferred Hospital Medicine, followed by Surgery, General Practice and then Psychiatry. Would-be doctors were also more interested in careers such as Nurse, Archaeologist, Lawyer and Teacher, and less interested in careers such as Shopkeeper, Sportsperson, or Actor/dancer/singer/musician. Would-be doctors were less Neurotic, more Open to Experience, more Conscientious, and preferred higher prestige occupations. Those interested in medicine did not score more highly on Key Stage 2 attainment tests or Cognitive Abilities Test, did not have a higher family income or greater parental/carer education, and did not have more experience of illness or deaths among family and friends.
An interest in a medical career, unlike high prestige jobs in general, is not associated with higher educational attainment or cognitive ability, and it is likely that only one in ten of the children interested in medical careers will have sufficient educational attainment at GCSE or A-level to be able to enter medical school.
[Show abstract][Hide abstract] ABSTRACT: Background:
Depression is typically more common in females and rates rise around puberty. However, studies of children and adolescents suggest that depression accompanied by conduct problems may represent a different subtype not characterised by a female preponderance, with differing risk factors and genetic architecture compared to pure-depression. This study aimed to identify aetiologically distinct profiles of depressive symptoms, distinguished by the presence or absence of co-occurring conduct problems.
Latent profile analysis was conducted on a school sample of 1648 children (11-12 years) and replicated in a sample of 2006 twins (8-17 years).
In both samples pure-depressive and conduct-depressive profiles were identified. The pure-depressive profile was associated with female gender, while the conduct-depressive profile was associated with lower cognitive ability but not with gender. Twin analyses indicated possible differences in genetic aetiology.
There was evidence for aetiologically heterogeneous depression symptom profiles based on the presence or absence of co-occurring conduct problems.
Full-text · Article · Sep 2015 · Journal of Child Psychology and Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Stress has been shown to have a causal effect on risk for depression. We investigated the role of cognitive ability as a moderator of the effect of stressful life events on depressive symptoms and whether this varied by gender. Data were analyzed in two adolescent data sets: one representative community sample aged 11-12 years (n = 460) and one at increased familial risk of depression aged 9-17 years (n = 335). In both data sets, a three-way interaction was found whereby for girls, but not boys, higher cognitive ability buffered the association between stress and greater depressive symptoms. The interaction was replicated when the outcome was a diagnosis of major depressive disorder. This buffering effect in girls was not attributable to coping efficacy. However, a small proportion of the variance was accounted for by sensitivity to environmental stressors. Results suggest that this moderating effect of cognitive ability in girls is largely attributable to greater available resources for cognitive operations that offer protection against stress-induced reductions in cognitive processing and cognitive control which in turn reduces the likelihood of depressive symptomatology.
No preview · Article · Mar 2015 · Development and Psychopathology
[Show abstract][Hide abstract] ABSTRACT: Background
Adolescence is associated with developments in the reward system and increased rates of emotional disorders. Familial risk for depression may be associated with disruptions in the reward system. However, it is unclear how symptoms of depression and anxiety influence the development of reward-processing over adolescence and whether variation in the severity of parental depression is associated with hyposensitivity to reward in a high-risk sample. Methods
We focused on risk-adjustment (adjusting decisions about reward according to the probability of obtaining reward) as this was hypothesized to improve over adolescence. In a one-year longitudinal sample (N=197) of adolescent offspring of depressed parents, we examined how symptoms of depression and anxiety (generalized anxiety and social anxiety) influenced the development of risk-adjustment. We also examined how parental depression severity influenced adolescent risk-adjustment. ResultsRisk-adjustment improved over the course of the study indicating improved adjustment of reward-seeking to shifting contingencies. Depressive symptoms were associated with decreases in risk-adjustment over time while social anxiety symptoms were associated with increases in risk-adjustment over time. Specifically, depression was associated with reductions in reward-seeking at favourable reward probabilities only, whereas social anxiety (but not generalized anxiety) led to reductions in reward-seeking at low reward probabilities only. Parent depression severity was associated with lowered risk-adjustment in offspring and also influenced the longitudinal relationship between risk-adjustment and offspring depression. Conclusions
Anxiety and depression distinctly alter the pattern of longitudinal change in reward-processing. Severity of parent depression was associated with alterations in adolescent offspring reward-processing in a high-risk sample.
Full-text · Article · Jun 2014 · Journal of Child Psychology and Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Aims and method To determine rates of parent-reported child awareness of parental depression, examine characteristics of parents, children and families according to child awareness, and explore whether child awareness is associated with child psychopathology. Data were available from 271 families participating in the Early Prediction of Adolescent Depression (EPAD) study, a longitudinal study of offspring of parents with recurrent depression.
Results Seventy-three per cent of participating children were perceived as being aware of their parent’s depression. Older children, and children of parents who experienced more severe depression, were more likely to be aware. Awareness was not associated with child psychopathology.
Clinical implications Considering children in the context of parental depression is important. Child awareness may influence their access to early intervention and prevention programmes. Further research is needed to understand the impact of awareness on the child.
Full-text · Article · Jun 2014 · Psychiatric Bulletin
[Show abstract][Hide abstract] ABSTRACT: Longitudinal studies have provided mixed findings regarding the relationship between emotional problems and subsequent poor school attainment. A meta-analysis of 26 community-based studies of children and adolescents was performed. Results revealed a prospective association between emotional problems and poor school attainment. More consistent associations were found for depression than anxiety. Moderator analyses indicated that some of the heterogeneity between studies may be due to age and gender, with reduced heterogeneity particularly notable for school grades during early adolescence and for anxiety by gender. Findings suggest that early identification and provision of support for young people with emotional problems may be helpful for improving academic outcomes such as school attainment.
No preview · Article · Jun 2014 · Journal of Adolescence
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND Major depressive disorder (MDD) is often a chronic disorder with relapses usually detected and managed in primary care using a validated depression symptom questionnaire. However, for individuals with recurrent depression the choice of which questionnaire to use and whether a shorter measure could suffice is not established. AIM To compare the nine-item Patient Health Questionnaire (PHQ-9), the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale against shorter PHQ-derived measures for detecting episodes of DSM-IV major depression in primary care patients with recurrent MDD. DESIGN AND SETTING Diagnostic accuracy study of adults with recurrent depression in primary care predominantly from Wales METHOD Scores on each of the depression questionnaire measures were compared with the results of a semi-structured clinical diagnostic interview using Receiver Operating Characteristic curve analysis for 337 adults with recurrent MDD. RESULTS Concurrent questionnaire and interview data were available for 272 participants. The one-month prevalence rate of depression was 22.2%. The area under the curve (AUC) and positive predictive value (PPV) at the derived optimal cut-off value for the three longer questionnaires were comparable (AUC = 0.86-0.90, PPV = 49.4-58.4%) but the AUC for the PHQ-9 was significantly greater than for the PHQ-2. However, by supplementing the PHQ-2 score with items on problems concentrating and feeling slowed down or restless, the AUC (0.91) and the PPV (55.3%) were comparable with those for the PHQ-9. CONCLUSION A novel four-item PHQ-based questionnaire measure of depression performs equivalently to three longer depression questionnaires in identifying depression relapse in patients with recurrent MDD.
No preview · Article · Feb 2014 · British Journal of General Practice
[Show abstract][Hide abstract] ABSTRACT: Children of depressed parents are at increased risk of developing mood disorders but mechanisms of intrafamilial transmission are currently unclear. One rarely investigated area is the impact of depression on a parent's everyday functioning. Currently there are no validated assessments of depression-specific parental impairment. The creation of such a measure would complement depression symptom counts, providing a more comprehensive account of the parent's depression. We therefore aimed to develop a valid and reliable measure of impairment specifically associated with parental depression. In a longitudinal study of parents with recurrent unipolar depression and their offspring, we collected data from 337 parents. These participants completed the Depression Impairment Scale for Parents (DISP), a questionnaire assessing depression-associated impairment in multiple domains of functioning. Factor analysis revealed that this measure consisted of two factors - impairment in routine tasks/activities and impairment in family functioning - that together accounted for 51.04% of variance. The scale evidenced good internal consistency (Cronbach's alpha=0.82). The DISP also displayed good construct and criterion validity as evidenced by significant associations with established measures of depression severity and global impairment. These results demonstrate that the DISP is a valid and reliable measure of depression-associated impairment in parents.
[Show abstract][Hide abstract] ABSTRACT: To disaggregate the depression construct and investigate whether specific depression symptoms in parents with a history of recurrent depression are clinical risk markers for future depression in their high-risk offspring. Our hypothesis was that parental symptoms of the type that might impact offspring would most likely be of greatest importance.
Data were drawn from a longitudinal high-risk family study. Families were mainly recruited from primary care and included 337 parent-child dyads. Parents had a history of recurrent DSM-IV unipolar depression and were aged 26-55 years. Their offspring (197 female and 140 male) were aged 9-17 years. Three assessments were conducted between April 2007 and April 2011. Ninety-one percent of families (n = 305) provided full interview data at baseline and at least 1 follow-up, of which 291 were included in the primary analysis. The main outcome measure was new-onset DSM-IV mood disorder in the offspring, which was assessed using the Child and Adolescent Psychiatric Assessment.
Of the 9 DSM-IV depression symptoms, parental change in appetite or weight, specifically loss of appetite or weight, most strongly predicted new-onset mood disorder (odds ratio [OR] = 4.47; 95% CI, 2.04-9.79; P < .001) and future depression symptoms in the offspring (β = 0.12; B = 0.21; 95% CI, 0.00-0.42; P = .050). The cross-generational association was not accounted for by measures of parental depression severity (total depression symptom score, episode recurrence, age at onset, and past impairment or hospitalization) or other potential confounds (parent physical health, eating disorder, or medication).
Findings from this study suggest that loss of appetite or weight in parents with a history of recurrent depression is a marker of risk for depression in their offspring. The findings highlight the importance of examining depression heterogeneity. The biological and environmental mechanisms underlying this finding require investigation.
No preview · Article · Sep 2013 · The Journal of Clinical Psychiatry
[Show abstract][Hide abstract] ABSTRACT: An enduring tendency towards negative thinking is thought to increase vulnerability for future depression. However, it has not been possible to assess this tendency in non-depressed mood states. We examined if response latency to endorse dysfunctional attitudes is associated with depressive outcomes in a longitudinal study. A sample of young people at familial risk of depression (N = 252, aged 10-19, 56.3 % female) completed a computer-administered dysfunctional attitude scale. The main outcome measure was the difference in reaction time to agree versus disagree with dysfunctional attitudes. Cross-sectional differences between current and previous depression and no psychiatric disorder groups as well as longitudinal associations with depressive symptoms were examined. Young people with current and previous depression were quicker to agree with dysfunctional attitudes than those without disorder. In young people free from depressive disorder, faster agreements with dysfunctional attitudes were specifically associated with increased depressive symptoms over time. Self-reported dysfunctional attitudes did not differentiate the formerly depressed and no disorder groups and showed a longitudinal association with depressive symptoms for older adolescents only. Reaction time to endorse dysfunctional attitudes may indicate changes in affective processing that represent an early risk for future depression that is not indexed by self-report measures of negative thought.
Full-text · Article · May 2013 · Journal of Abnormal Child Psychology
[Show abstract][Hide abstract] ABSTRACT: This longitudinal study of adolescents in the first year of secondary school, examined the relationship between psychological functioning at the beginning of year 7 (mean age 11.25 years) with attainment at the end of year 7 (mean age 11.78 years). Depressive symptoms, school liking and conduct problems predicted lower attainment across time having controlled for the temporal stability in psychological functioning and attainment. School concerns predicted lower attainment for boys only, and the effects of depressive symptoms on later attainment were significantly stronger for boys compared to girls. School liking - and school concerns for boys - remained significant predictors of attainment when controlling for conduct problems. The transition to secondary school may represent a window of opportunity for developing interventions aimed at improving both pupil psychological functioning and attainment.
No preview · Article · Apr 2013 · Journal of Adolescence
[Show abstract][Hide abstract] ABSTRACT: Parental depression is associated with disruptions in the parent-child relationship, exposure to stressful family life events, and offspring depressive symptoms. Evidence suggests that intergenerational transmission of depression involves environmental and inherited contributions. We sought to evaluate the role of passive gene-environment correlation (rGE) in relation to depression, family life events that were due to parental behavior, and parental positivity in a sample where children varied in genetic relatedness to their rearing parents. Our study included 865 families with children born through assisted conception (444 related to both parents, 210 related to the mother only, 175 related to the father only, and 36 related to neither parent). Consistent with previous studies, the intergenerational transmission of depressive symptoms was largely due to environmental factors, although parent and child gender influenced results. Maternal and paternal depressive symptoms were associated with reduced positivity and increased parentally imposed life events regardless of parent-child relatedness. Results of path analysis were consistent with passive rGE for both maternal and paternal positivity in that positivity partially mediated the link between maternal/paternal depression and child depression only in genetically related parent-child pairs. Results also suggested passive rGE involving parentally imposed life events for mothers and fathers although passive rGE effects were smaller than for positivity.
No preview · Article · Feb 2013 · Development and Psychopathology
[Show abstract][Hide abstract] ABSTRACT: The way people look at faces is thought to be consistent across the non-clinical population and stable over time. We tested this hypothesis, tracking the gaze of 160 visitors to the London Science Museum as they saw movies and pictures of faces, one of which was their own. Afterwards they answered mood and personality questionnaires. We found a network of relationships linking individual differences to the duration of looks to the eyes and mouths of others and the self. Women looked more at other people's eyes than their own, whereas men behaved in the opposite way. Looks to the mouth, for example, were influenced by an interaction between mood and emotional regulation. Later experiments manipulated either mood or emotional regulation and produced consistent patterns of eye movements. Against the prevailing view, we show that the way that people look at faces is subtly determined by personality, goals and emotions.
[Show abstract][Hide abstract] ABSTRACT: Past research has linked interparental conflict, parent psychopathology, hostile parenting, and externalizing behavior problems in childhood. However, few studies have examined these relationships while simultaneously allowing the contribution of common genetic factors underlying associations between family- and parent-level variables on child psychopathology to be controlled. Using the attributes of a genetically sensitive in vitro fertilization research design, the present study examined associations among interparental conflict, parents' antisocial behavior problems, parents' anxiety symptoms, and hostile parenting on children's antisocial behavior problems among genetically related and genetically unrelated mother-child and father-child groupings. Path analyses revealed that for genetically related mothers, interparental conflict and maternal antisocial behavior indirectly influenced child antisocial behavior through mother-to-child hostility. For genetically unrelated mothers, effects were apparent only for maternal antisocial behavior on child antisocial behavior through mother-to-child hostility. For both genetically related and genetically unrelated fathers and children, interparental conflict and paternal antisocial behavior influenced child antisocial behavior through father-to-child hostility. Effects of parental anxiety symptoms on child antisocial behavior were apparent only for genetically related mothers and children. Results are discussed with respect to the relative role of passive genotype-environment correlation as a possible confounding factor underlying family process influences on childhood psychopathology.
No preview · Article · Nov 2012 · Development and Psychopathology
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Offspring of mothers with depression are at heightened risk of psychiatric disorder. Many mothers with depression have comorbid psychopathology. How these co-occurring problems affect child outcomes has rarely been considered. AIMS: To consider whether the overall burden of co-occurring psychopathology in mothers with recurrent depression predicts new-onset psychopathology in offspring. METHOD: Mothers with recurrent depression and their adolescent offspring (9-17 years at baseline) were assessed in 2007 and on two further occasions up to 2011. Mothers completed questionnaires assessing depression severity, anxiety, alcohol problems and antisocial behaviour. Psychiatric disorder in offspring was assessed using the Child and Adolescent Psychiatric Assessment. RESULTS: The number of co-occurring problems in mothers (0, 1 or 2+) predicted new-onset offspring disorder (odds ratio (OR) = 1.80, 95% CI 1.17-2.77, P = 0.007). Rates varied from 15.7 to 34.8% depending on the number of co-occurring clinical problems. This remained significant after controlling for maternal depression severity (OR = 1.73, 95% CI 1.03-2.89, P = 0.040). CONCLUSIONS: The burden of co-occurring psychopathology among mothers with recurrent depression indexes increased risk of future onset of psychiatric disorder for offspring. This knowledge can be used in targeting preventive measures in children at high risk of psychiatric disorder.
No preview · Article · Oct 2012 · The British journal of psychiatry: the journal of mental science