The negative effects on children of serious affective disorder in parents have been conclusively demonstrated. Strategies that can be used by a wide range of practitioners to assist families are needed. This application requests funds to test the effectiveness of one such strategy, a manual-based cognitive psychoeducational preventive intervention for families with a recent episode of parental affective disorder. The intervention is designed to: (1) teach recent findings about affective illness, (2) link this factual information to the family's own illness experience, (3) help families to enhance the resiliencies of their children, and (4) help families recognize and seek appropriate services for disorder in their children (in particular depression) when it develops. The intervention is designed to be used by family physicians, internists, and pediatricians, as well as mental health professionals. Pilot work has established the safety, feasibility, and standardization of the preventive intervention approach and of a design to examine its effectiveness. A pilot study of 40 families which uses the same random assignment design and assessment strategy as the proposed study is under way with support from the William T. Grant Foundation. In order to adequately test the intervention's prevention effects on children, a much larger sample, followed over several years, is needed. We propose to enroll an additional 100 families in which a parent has experienced recent affective disorder and in which at least one child is 9-14 years old. These families will be randomly assigned either to the clinician-based cognitive psychoeducational preventive intervention program (clinician intervention families) or to a series of lectures about affective illness in families (lecture families). The two groups will be followed longitudinally with assessments of both parents and children every six months for the length of the study, at least three years for all subjects. In addition, the 40 families already enrolled in the pilot will be followed throughout the study. Modelled on assessment strategies developed in studies of children at risk for affective disorder, proposed assessment includes standard diagnostic interview schedules for the parents (SADS-L, Schedule of Affective Disorder and Schizophrenia - Lifetime Version) and children (Kiddie-SADS- E-R), standard rating scales of child functioning (Child Behavior Checklist, Youth Self Report), standard ratings of marital functioning and communication (Spanier Dyadic Adjustment Scale(, and semistructured interviews about the illness experience, response to intervention and concerns about children. Children in clinician intervention families are expected to show primary (e.g., fewer cases of depression), secondary and tertiary prevention effects over time that exceed those in lecture families. The data set from the proposed study will be combined with the data from the pilot study to obtain a large enough sample followed for a sufficient period to test preventive intervention effects.
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