title: Parenting stress predicts depressive symptoms in adolescents with inflammatory bowel disease.
abstract: OBJECTIVE
  Adolescents with inflammatory bowel disease (IBD) are at an increased risk for depression and poor IBD management. Although depression and family factors have been associated in cross-sectional analyses, their casual association over time has not been studied. The primary objective of this study was to assess the temporal association between parenting stress and adolescent depressive symptoms in IBD.
  
  
  METHODS
  Along with a primary parent, adolescents [Mage(years)=15.5±1.4] with a confirmed diagnosis of Crohn's disease or ulcerative colitis and prescribed a treatment regimen of a 5-ASA medication and/or 6-MP/azathioprine were recruited from routine gastroenterology clinic visits at two pediatric medical centers. The current study was nested in a larger IBD self-management trial. Adolescents completed the Children's Depression Inventory. Parents completed a sociodemographic questionnaire and the Pediatric Inventory for Parents. Gastroenterologists provided disease severity assessments on the basis of the clinic appointment corresponding to the study visit or the most recent clinic appointment. Questionnaires were readministered ∼6 months after the initial visit.
  
  
  RESULTS
  Participants include 93 families at baseline and 65 at follow-up (69.8% retention; N=65). A cross-lagged panel analysis was used to detect causal directionality and change in adolescent depression and parenting stress over 6 months. Baseline parenting stress accounted for a significant amount of the variance in depressive symptoms at follow-up [R-change=0.03, F(1,58)=35.6, P<0.05].
  
  
  CONCLUSIONS
  Parenting stress impacts adolescent depressive symptoms in IBD. Identification of parenting stress and adolescent depression should occur early and possibly in the context of routine clinic visits.
authors.affiliation: aCincinnati Children's Hospital Medical Center, Division of Behavioral Medicine & Clinical Psychology, Cincinnati, Ohio bDepartment of Psychology, Auburn University, Auburn, Alabama cChildren's Mercy Hospitals & Clinics, Division of Clinical Psychology, Developmental & Behavioral Medicine, Kansas City, Missouri, USA.
authors.forename: Shanna M
authors.initials: SM
authors.lastname: Guilfoyle
authors.forename: Wendy N
authors.initials: WN
authors.lastname: Gray
authors.forename: Michele
authors.initials: M
authors.lastname: Herzer-Maddux
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Hommel
mesh_terms: D000293:Adolescent; D000328:Adult; D016241:Child of Impaired Parents / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016487:Parenting / Q000523:psychology*; D010290:Parents / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology; D014481:United States / Q000453:epidemiology