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Sex Differences in Effects of a Depression Prevention Program on Parental Criticism and Positive Remarks

Thu, March 21, 2:15 to 3:45pm, Hilton Baltimore, Floor: Level 2, Key 9

Integrative Statement

Background. Parental depression is associated with increased risk of depression in offspring (Beardslee et al., 2001), and more negative parental expressed emotion (EE) – high levels of criticism and low levels of positive remarks (Marshall et al., 1990). In a transactional way, child behaviors also have been shown to predict parental criticism (Rueter & Conger, 1998). The present study examined whether a depression prevention program for at-risk youth affected the number of criticisms and positive remarks made by parents, and whether this varied by child sex.
Method. Participants were 316 adolescents (Mage=14.79, SD=1.37) and one parent (88% mothers) who had a history of depression in the child’s life. Youth had either current subsyndromal depressive symptoms (CES-D > 20) or a prior depressive episode. Adolescents were randomized to either a cognitive behavioral prevention program (CBP; n=159) or usual care (UC; n=157). The CBP intervention taught cognitive restructuring, problem solving, behavioral activation, and assertiveness in 8-weekly and 6-monthly 90-minute sessions.
Parental criticisms and positive remarks were assessed using a five-minute speech sample (FMSS; Magana et al., 1986) completed at baseline and post-intervention (month 9). The FMSS instructs parents to talk for five minutes about their child and their relationship. Independent coders unaware of intervention condition rated the number of criticisms and positive remarks.
Results. Previously, we have reported that youth in CBP had significantly fewer onsets of depressive episodes than those in UC through the 9-month assessment. To examine change in parental EE, we ran hierarchical generalized linear models, for count variables that follow a Poisson distribution, which use the log link function. There was a significant condition by sex interaction predicting the number of parental criticisms at month 9, controlling for baseline criticisms. Parents of boys in CBP made significantly fewer criticisms (.12 criticisms, CI: .05-.27) than did parents of boys in UC (.19 criticisms, CI: .12-.31). In contrast, parents of girls in CBP made significantly more critical comments (.26 criticisms, CI: .16-.42) than did parents of girls in UC (.08 criticisms, CI: .04-.13) (see Figure 1).
Results from the model examining parental positive remarks revealed a significant main effect of condition in predicting the number of parental positive remarks at month 9. Parents of children in CBP made significantly more positive remarks (3.35 remarks, CI: 2.83-3.97) than did parents of children in UC (2.52 remarks, CI: 2.10-3.02), controlling for number of parental positive remarks at baseline. Adolescents’ age, sex, and concurrent depression symptoms were not significant predictors of parental positive remarks.
Conclusion. The significantly more parental criticisms of girls in CBP vs. UC might reflect an increase in assertiveness in the girls. The significantly fewer parental criticisms for boys in CBP might indicate improved interpersonal functioning, not seen for boys in UC. These results highlight the possible need to include parents in programs for preventing depression, particularly for girls.

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