Depression in Parents, Parenting, and Children Opportunities to Improve Identification, Treatment, and Prevention (2009) / Chapter Skim
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2 Approach to Research and Its Evaluation
2 Approach to Research and Its Evaluation
Pages 43-72
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From page 43... ...
the definition and measurement of depression and parenting, the etiology of depression, timing and use of appropriate screening interventions, the process of risk and resilience in children of depressed parents, correlates of depression, and developmental processes and time points.
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From page 44... ...
For example, in the section on research challenges, we show that a conceptual framework relating to the effects of parental depression on families should be guided by a developmental psychopathology perspective. Later, in the section on research standards, we mention what the literature has shown in this regard and that research relating to any psychopathology should address questions "across generations and across time" (Hinshaw, 2008)
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From page 45... ...
the need to acknowledge the presence of the constellation of risk factors, context, and correlates of parental depression. Each of these is discussed in turn.
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Similarly, addressing the public health problem of parental depression requires multiple points of access for delivery of services and multiple types of intervention and care. On the other hand, the challenges presented by the integration of these widely varied disciplines are enormous.
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Establishing links between research and practice involves the interactions among the full range of health care services and family and community support systems that may intervene with depressed parents or their children. A Two-Generation Approach The evidence of the effects of depression on the parents' parenting skills and on their children's health and development makes a compelling case for fostering this integration through such a two-generation approach (parent and child)
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From page 48... ...
In addition, interventions with good evidence for improving child outcomes rarely consider the influence of parental depression on their effectiveness and even more rarely examine the potential effects of including program components that identify and refer or treat parents with depression. When this has been done, improvements in effectiveness have been noted, such as in the work of Kazdin and Sanders and colleagues (Kazdin, 2005; Sanders et al., 2000)
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From page 49... ...
A Developmental Framework The implementation of a two-generation approach involves many challenges. Childhood is a period of rapid change and development, and the presence or absence of supportive parental behaviors can have lasting effects if they interfere with the children getting their stage-salient needs met.
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. Understanding the mechanisms of risk in children of depressed parents requires understanding the processes underlying individual patterns of adaptation and the consequences of the individual patterns for the development of depression or other problems.
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. Those risk factors may be essential to understanding the problems in children of depressed parents.
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This report shows that the comorbidities, correlates, and contexts may function as independent risk factors for adverse child outcomes or as modifying factors, which exacerbate the effects of parental depression. Yet research on the effects of parental depression on parenting or child functioning rarely provides adequate tests of the role of co-occurring conditions.
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From page 53... ...
Although current research has not yet covered the specific topic of parental depression among vulnerable populations -- with the exception of a few qualitative studies (e.g., Lazear et al., 2008) -- for the purpose of this report it is important to point to major studies of mental illness in specific racial and ethnic populations that may provide significant insights into prevalence rate differences, help-seeking behaviors, and patterns of use of mental health services.
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Yet given the number and multiplicity of depressive disorders' comorbid mental and physical health problems (e.g., substance abuse, chronic pain) , impairment (e.g., problems getting to work)
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ISSUES CONSIDERED IN SEARCHING THE LITERATURE To fully understand the linkages among depression, parenting, and children's development, we considered a wide range of research. This includes research on but not limited to the definition and measurement of depression and parenting practices, the etiology of depression, timing and use of appropriate screening interventions, the processes of risk and resilience in children of depressed parents, correlates of depression, and developmental processes and time points.
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Perinatal depression is not a separate diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association, 1994)
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From page 57... ...
Similarly, the use of symptom levels without an assessment of functional impact is likely to overestimate the occurrence of maternal depression. The development of a specific screening tool for the postpartum period, the Edinburgh Postpartum Depression Scale, has promoted screening of women in the perinatal period.
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Risk factors, however, do not explain the processes through which these factors influence the likelihood of an undesirable outcome. In contrast, risk mechanisms or processes describe the intervening paths that connect risk conditions with specific dysfunctional outcomes (Garber, 2006)
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Even in the face of significant risk, not all individuals do poorly -- not all children and adolescents of depressed parents develop psychopathology. Although children and adolescents of affectively ill parents are at an increased risk for depression and other forms of psychopathology, a number of studies have demonstrated that many of them actually do quite well.
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Overall, both depressive disorder and depressive symptoms in parents are accompanied by comorbid disorders, problems in families and communities, and disruptions in work, marital relationships, and parenting. Developmental Approach We take an explicitly developmental approach in our perspective on parental depression.
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Thus, we examined evidence that the associations researchers have found between depression in parents and adverse outcomes in children are at least partially explained by parenting practices. Third, to take into consideration other possible mediators of associations between parents' depression and child outcomes, in addition to parenting practices, we noted studies of the effects of depression in parents on the children that also considered the potential role of marital relationships.
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For example, not accounting for the effects of parental substance abuse, violence, and depression or other psychiatric distress in families may result in an overestimation of the individual effects of these factors on the development of the child. The relative lack of generalizable, integrative research and interventions on the scope and nature of the prob
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From page 63... ...
For example, assuming that risk factors have effects or interventions that work the same among families with infants and toddlers, school-age children, adolescents, and young adults ignores the vast evidence in the area of child development. A recent editorial by Hinshaw (2008)
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Examples of such studies can be found in many socalled complex sample surveys funded by the federal government, such as the National Comorbidity Survey (see http://www.icpsr.umich.edu/CPES/)
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In the area of parental depression, the relative lack of randomized studies can be explained by the difficulty of implementation because of ethical issues, such as withholding a potentially effective treatment, or scientific concerns, such as avoiding contamination of intervention groups in behavioral studies. However, randomized clinical trials represent the optimal design for evaluating the efficacy of interventions to prevent adverse outcomes in children of depressed parents.
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Assessment of Effect-Modifying Factors In many studies in the area of parental depression as a risk factor, moderators of effect have not been measured, such as exposure to violence. We would expect that when the constellation of factors associated with depression in a parent are measured, effects for the subgroup with multiple risk factors, such as depression and violence exposure, could be significantly higher than for those who have depression and no other factors.
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Developmental models of psychopathology emphasize the importance of cumulative risk or multiple risk factors (Rutter, 2000; Rutter et al., 2001)
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Four themes emerge from the committee's approach: (1) the integration of knowledge regarding the dynamics of parental depression, parenting practices, and child outcomes; (2)
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From page 69... ...
Journal of Abnormal Child Psychology, 35, 627–639. Egeland, B., and Farber, E.A.
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Journal of Abnormal Child Psychology, 36, 567–589. Kazdin, A.E.
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From page 71... ...
Journal of Abnormal Child Psychology, 18, 105–117. Romeo, R.D., and McEwen, B.S.
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From page 72... ...
Child Development, 55, 17–29. Tronick, E.Z., and Gianino, A.F.
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