Prevention of Depression in Children and Adolescents of Parents with Depression: a Randomized Controlled Trial

• In Event: Dual-Generation Treatments: Addressing Parent Mental Health in Parenting and Child-Focused Prevention and Intervention Programs

Abstract

Objective: Major depressive disorder (MDD) is one of the most common mental health illnesses worldwide with a lifetime prevalence of around 8-12%. Children of parents with depression are three to six times more likely to develop depression themselves, associated with a high likelihood of chronicity and other adverse outcomes later in life. However, only a small number of depression prevention programs was conducted and evaluated in the past, showing small to moderate effect sizes in prevention of depression the offspring of parents with depression. In a parallel randomized controlled trial the effectiveness of a family- and group-based cognitive-behavioral intervention in preventing depression in children of depressed parents – the “GuG-Auf”-program – was evaluated. This manuscript concerns mid-term effects, mediators and moderators.

Method: N=100 Families were included if i) a parent (n = 100, mean age = 46.06, 61 % female) had experienced depression and ii) children (n = 135, aged 8-17 years, 53% female) were not affected by a mental illness. Families (91.5% German) were randomly allocated (50:50 blockwise; stratified by child age and parental depression) to the 12-session “GuG-Auf” intervention or no intervention. The group sessions were conducted in group of 3-4 families by two group leaders (clinically trained psychologists and psychiatrists) at the department of child and adolescent psychiatry of the university hospital of the Ludwig-Maximilians-University, Munich (Germany). Outcomes were assessed (on an intention-to-treat basis) at 0-(T1), 6-(T2), 12-(T3) and 15-months(T4) after baseline. Primary outcome (onset of depression; T4) was assessed with standardized (blinded) clinical interviews. Secondary (unblinded) outcome was risk of depression (at T2-T4) indicated by internalizing, externalizing and symptoms of depression. Potential mediators were emotion regulation, attributional style, knowledge of depression and parenting style. Potential moderators were parental depression severity and negative life events.

Results: None of the children who received the intervention developed depression, whereas two of those in the control group did. The intervention significantly reduced internalizing symptoms at T3 (p = .027, d = -0.45) and T4 (p =.035, d=-0.44). Both groups showed reduced depressive symptoms (p = .029, d = -0.44). Cognitive problem-solving and negative parenting emerged as mediators. No adverse events were observed.

Conclusions: GuG-Auf is effective in reducing children’s risk of depression and provided evidence for effective preventive mechanisms at both the parent and child levels. Since the sample was characterized by a high socio-economic status and low incidence rates of mental illness, further research is need to replicate the effects on families that face higher psychosocial burden. However, even this selective sample reported high burden due to the parental depression and were struggling to manage the study participation (indicated by a high number if missing data in the follow-up assessments). Despite these limitations in the generalizability, these findings contribute substantially to reducing the burden of youth depression. Further research is needed to determine how to reach and support highly stressed families with greater psychosocial burden.

Authors

• Johanna Löchner
  Presenting Author

• Belinda Platt

• Kornelija Starman-Wöhrle

• Keisuke Takano

• Lina Engelmann

• Alessandra Voggt

• Fabian Loy

• Mirjam Bley

• Dana Winogradow

• Stephanie Hämmerle

• Esther Neumeier

• Inga Wermuth

• Katharina Schmitt

• Frans Oort, University of Amsterdam

• Gerd Schulte-Körne