Children with depressed parents at risk of major depression in adulthood
The offspring of depressed parents are significantly more likely to have depression and disability as adults.
A longitudinal cohort study from the US has followed up the adult children of depressed parents and a matched control group 23 years after recruitment.
Questionnaires were sent to 215 adult children of depressed parents, of whom 143 (67%) responded. The results were compared with those from 177 (68%) responders in the control group.
The prevalence of depression symptoms was measured using two psychometric tools based on the DSM-IV criteria: the DSSI and the PHQ-9. The two groups were also compared across a number of domains, including other psychiatric problems, physical symptoms, disability, social functioning and use of antidepressants.
Children of depressed parents were significantly more likely to be classified as depressed: 8.1% met the PHQ-9 criteria for major depression compared with 3.0% of controls (P= 0.049). This increased risk was restricted to those children whose parents' depression followed a nonremitting or relapsing-remitting course.
Children of depressed parents were also significantly more likely to have been kept in bed by physical or emotional problems (26.4% compared with 16.9% of controls, P=0.046) and to have sought help from a mental health professional within the past year. Across all the other domains, the two groups were comparable.
The children of depressed parents are known to be at increased risk of childhood anxiety, adolescent depression or substance misuse, poor social functioning and school problems.1 This may be because of genetic factors, family circumstances or exposure to negative parental thinking, behaviour and mood:2 we learn to see the world through our parents' eyes.
This is the third study that has followed up children of depressed parents into adulthood. One of the previous studies found an increase in anxiety and substance misuse, but not depression;3 the other found a threefold increase in both anxiety and depression.4
Weissman et al used diagnostic interviews administered by trained mental health professionals, whereas this study relied on self-completed questionnaires, with no external corroboration. The use of cut-off scores to diagnose depression is arbitrary and may lead to overdiagnosis.5
The construction of family trees can help to reveal transgenerational patterns of illness and problem behaviours.6
Depressed parents may model styles of thinking, such as negative expectancy, that predispose to depression. They may also interact with their children in harmful ways, for example by withdrawing when confronted by a resistant child.7 It is interesting to speculate whether the participants in this study who took to their beds had learnt this form of withdrawal behaviour from their parents.
The use of CBT, either alone or with antidepressant treatment, may not only help patients to change their harmful modes of thought and behaviour, but also help to prevent them teaching them to their children.
Timko C, Cronkite RC, Swindle R et al. Functioning status of adult children of depressed parents: a 23-year follow-up. Psychol Med 2008;38:343-52Reviewer
Dr Phillip Bland