Maternal depression is a significant risk factor for psychiatric illness in youth: offspring of depressed mothers have a two- to five-fold increased risk of experiencing a psychiatric illness relative to offspring of unaffected parents. Simply treating psychiatrically ill offspring does not address the problem: maternal depressive symptoms have been shown to moderate child treatment outcomes such that even when treated, children who suffer from depressive or anxiety disorders do not improve while their mothers remain depressed. By contrast, when maternal depression is effectively treated, data suggest their offspring will do better as well. Maladaptive maternal interpersonal functioning has been implicated as an important mediator of psychiatric risk in offspring of depressed mothers, suggesting that directly targeting this area of dysfunction may lead to better outcomes in children. Despite the clear link between maternal depression and poor child outcomes and an increased understanding of mechanisms of illness transmission, no attempts have been made to translate this information into treatments that alleviate suffering in both mothers and children. Thus, there is an urgent public health need to evaluate treatments that, if proven efficacious, have the potential to confer direct benefit to both affected generations. The current application is a randomized, controlled, clinical trial to evaluate the intergenerational impact of treating depressed mothers whose children suffer from psychiatric disorders. It will compare a psychotherapy for mothers that targets factors known to be associated with the intergenerational transmission of psychiatric disorders (IPT-MOMS) to a nonspecific psychotherapeutic control condition (Brief Supportive Psychotherapy), evaluating outcomes in both mothers and their offspring, age 7-17, who suffer from a depressive or anxiety disorder. A modified form of interpersonal psychotherapy for depression, IPT-MOMS, specifically addresses maternal depressive symptoms, interpersonal functioning, and mother-child communication, all factors that contribute to psychiatric illness in youth. This application proposes to recruit mother-child dyads, both of whom suffer from psychiatric illness, randomly assign mothers to 9 sessions over a 3-month period of either IPT-MOMS (N=105) or Brief Supportive Psychotherapy (N=105), and evaluate the impact of acute maternal treatment on child and maternal symptomatic and functional outcomes at 3, 6, 9, and 12 month follow-up. Exploratory aims are to evaluate potential moderators and mediators of child outcomes such as early maternal exposure to trauma, family socioeconomic status, current level of domestic conflict, maternal parenting style, and maternal interpersonal functioning. Findings from this trial have the potential to inform treatment strategies for depressed mothers and their psychiatrically ill offspring, a high risk population whose improved mental health would contribute to significant reductions in public health burden.
When psychiatrically ill children have mothers who suffer from depression, they do not recover from their own illnesses. Thus, the public health consequences of maternal depression are enormous not only for the mothers themselves, but also for their psychiatrically ill offspring. We will test a psychotherapy for maternal depression that directly targets factors that have been implicated in transmitting psychiatric illness risk to children-specifically, poor maternal functioning in interpersonal relationships and poor mother-child communication. We will compare the effects of this psychotherapy with a non-specific psychotherapy (supportive psychotherapy) on psychiatric outcomes in children and their mothers.
|Phillips, Mary L; Swartz, Holly A (2014) A critical appraisal of neuroimaging studies of bipolar disorder: toward a new conceptualization of underlying neural circuitry and a road map for future research. Am J Psychiatry 171:829-43|
|Salsman, John M; Butt, Zeeshan; Pilkonis, Paul A et al. (2013) Emotion assessment using the NIH Toolbox. Neurology 80:S76-86|
|Zalewski, Maureen; Cyranowski, Jill M; Cheng, Yu et al. (2013) Role of maternal childhood trauma on parenting among depressed mothers of psychiatrically ill children. Depress Anxiety 30:792-9|