Parental Expressed Emotion during Family-Focused Treatment for Childhood Depression: Prediction and Change

• In Event: 1-158 - Randomized Controlled Trials for the Treatment and Prevention of Depressive Disorders: Effects on the Family

Integrative Statement

Background: Depression during childhood may be powerfully influenced by numerous family relational characteristics. For example, parental Expressed Emotion (EE), an index of criticism and emotional overinvolvement, predicts more negative course and greater likelihood of relapse among youth with mood disorders. Family-Focused Treatment for Childhood Depression (FFT-CD) was developed to treat depression during middle childhood through early adolescence and specifically targets parental criticism, family conflict and support. Using the concept of emotional spirals, families are introduced to the idea that interpersonal processes are related to mood, providing a rationale for the family approach. Utilizing an interpersonal model, FFT-CD includes psychoeducation about depression, communication training, pleasant activities scheduling and problem-solving. In this presentation we describe FFT-CD and discuss findings from a large 2-site randomized clinical trial comparing it to individual supportive psychotherapy (IP). We provide data on (a) clinical response, (b) parental EE as a predictor of treatment outcome, and (c) change in EE across the treatment phase.
Method: Youth with a diagnosis of major depressive disorder, dysthymic disorder, or depressive disorder NOS (n=134, ages 7-14 years) were recruited in two large urban areas. Following baseline assessment, youth were randomly assigned to 15 sessions of FFT-CD or IP; youth and families were re-evaluated at post-treatment. Ratings of audiotaped treatment sessions demonstrated high adherence to and differentiation between treatments. Parental EE was assessed using the Five Minute Speech Sample (FMSS). As some families included two parents, we used a Family EE rating whereby if either parent was rated high EE, the family was considered high EE. Using the interviewer-rated Children’s Depression Rating Scale-Revised (CDRS-R), we rated both adequate clinical depression response (> 50% reduction on CDRS-R) and clinical remission (< 28 on CDRS-R).
Results: Most participants (74%) completed >10 treatment sessions with no group differences in sessions. Regarding response to treatment, FFT-CD youth showed higher rates of adequate clinical depression response than did IP youth in completer (OR=2.64, p=.02, 79.6% vs. 59.7%) and ITT analyses (OR=2.29, p=.05, estimated 77.7% vs. 59.9%) (see Figure 1). Second, baseline EE did not predict adequate clinical response, remission or total CDRS-R change. Third, we examined change in EE. At baseline, at least one parent was high EE in 36.4% of the sample (25.7% for criticism; 15.9% for emotional overinvolvement); at follow-up; and rates did not differ for the treatment groups at baseline or follow-up. For cases with FMSS at both time points, treatment groups did not differ in likelihood of change in EE (see Figure 2).
Conclusion: Although youth in both treatments improved, FFT-CD youth were more likely to show an adequate clinical response and remission than were IP youth. However, family EE did not predict outcome nor significantly change as a function of treatment. Although correlated with other family functioning measures, the FMSS may lack sensitivity to treatment effects. There is a need to develop brief, dimensional measures of EE constructs.

Authors

• Martha Tompson, Boston University
  Presenting Author

• Gail Kemp, University of Scranton
  Non-Presenting Author

• Erin O’Connor, Brown University
  Non-Presenting Author

• Joan Asarnow, UCLA
  Non-Presenting Author