Remissions in maternal depression and child psychopathology: a STAR*D-child report.
BACKGROUND
Children of depressed parents have high rates of anxiety, disruptive, and depressive disorders that begin early, often continue into adulthood, and are impairing.


OBJECTIVE
To determine whether effective treatment with medication of women with major depression is associated with reduction of symptoms and diagnoses in their children.


METHODS
Assessments of children whose depressed mothers were being treated with medication as part of the multicenter Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial conducted (between December 16, 2001 and April 24, 2004) in broadly representative primary and psychiatric outpatient practices. Children were assessed by a team of evaluators not involved in maternal treatment and unaware of maternal outcomes. Study is ongoing with cases followed at 3-month intervals.


METHODS
One hundred fifty-one mother-child pairs in 8 primary care and 11 psychiatric outpatient clinics across 7 regional centers in the United States. Children were aged 7 to 17 years.


METHODS
Child diagnoses based on the Kiddie Schedule for Affective Disorders and Schizophrenia; child symptoms based on the Child Behavior Checklist; child functioning based on the Child Global Assessment Scale in mothers whose depression with treatment remitted with a score of 7 or lower or whose depression did not remit with a score higher than 7 on the Hamilton Rating Scale for Depression.


RESULTS
Remission of maternal depression after 3 months of medication treatment was significantly associated with reductions in the children's diagnoses and symptoms. There was an overall 11% decrease in rates of diagnoses in children of mothers whose depression remitted compared with an approximate 8% increase in rates of diagnoses in children of mothers whose depression did not. This rate difference remained statistically significant after controlling for the child's age and sex, and possible confounding factors (P = .01). Of the children with a diagnosis at baseline, remission was reported in 33% of those whose mothers' depression remitted compared with only a 12% remission rate among children of mothers whose depression did not remit. All children of mothers whose depression remitted after treatment and who themselves had no baseline diagnosis for depression remained free of psychiatric diagnoses at 3 months, whereas 17% of the children whose mothers remained depressed acquired a diagnosis. Findings were similar using child symptoms as an outcome. Greater level of maternal response was associated with fewer current diagnoses and symptoms in the children, and a maternal response of at least 50% was required to detect an improvement in the child.


CONCLUSIONS
Remission of maternal depression has a positive effect on both mothers and their children, whereas mothers who remain depressed may increase the rates of their children's disorders. These findings support the importance of vigorous treatment for depressed mothers in primary care or psychiatric clinics and suggest the utility of evaluating the children, especially children whose mothers continue to be depressed.
Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York 10032, USA. mmw3@columbia.edu
Myrna M
MM
Weissman
Daniel J
DJ
Pilowsky
Priya J
PJ
Wickramaratne
Ardesheer
A
Talati
Stephen R
SR
Wisniewski
Maurizio
M
Fava
Carroll W
CW
Hughes
Judy
J
Garber
Erin
E
Malloy
Cheryl A
CA
King
Gabrielle
G
Cerda
A Bela
AB
Sood
Jonathan E
JE
Alpert
Madhukar H
MH
Trivedi
A John
AJ
Rush
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D011581:Psychological Tests; D012074:Remission Induction; D012931:Social Environment
D000928:Antidepressive Agents