The overall aim is to study the impact of a reduction of maternal depressive symptoms on children's psychiatric symptoms and social functioning, as an ancillary study to the multisite Sequenced Treatment Alternatives to Relieve Depression study (STAR D). Focusing on the common clinical question of what to do next when patients fail to respond to a standard trial of treatment, STAR D aims at defining which subsequent treatment strategies are acceptable and provide the best clinical results. This proposed ancillary study (STAR D-Child) takes advantage of a unique opportunity to follow a large culturally diverse sample of depressed mothers who will be treated, assessed and followed prospectively to determine the impact on their children. The proposed Child study is timed to coincide with the initiation of STAR D and has been approved by their ancillary studies committee. Previous studies have demonstrated that children of depressed mothers have over three-to five fivefold increased risk of serious and enduring problems. Little is known about the impact of remission of maternal depression on their offspring. The outcomes in the 8 to 16 year old children of mothers who experience a remission of their depression following exposure to a variety of treatments will be compared to children of mothers who remain depressed following exposure to treatment/s. Blind baseline and follow-up evaluations of children of mothers participating in the STAR D protocol and assessments of parenting and family functioning will be conducted in 327 mothers and 327 children in six sites. Assessments will be carried out a baseline and every three months. Children will be followed for 12 months after their mothers complete treatment. The main hypotheses are that children of treatment-responders will have fewer psychiatric symptoms and better social functioning than children of treatment-resistant mothers during the follow-up. Children of depressed mothers who spend a greater proportion of time during the follow-up interval in depression-remission will experience less symptoms and a higher level of functioning than children of mothers who remain depressed. Changes in parenting and family functioning will mediate the impact of maternal depression-remission; demographic, family composition, etc. will moderate the effect. If it is shown that successfully treating maternal depression is associated with diminished risk in offspring, the finding would have wide ranging public health implications.
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