Preventive Interventions Designed for Families with Parental Depression
Two preventive interventions are aimed at providing education and support to families facing depression, helping them understand the illness and the value of obtaining treatment, and improving their capacity to reflect and solve problems together. One intervention involves two lectures followed by a group discussion with parents only. The other—the Family Talk Intervention—is clinician-facilitated; it consists of five to seven sessions (clinician-centered) that include discussion of the history of the illness and psychoeducation for the parents, meeting with the children (ages 8-14 at the time of enrollment), a family meeting planned and conducted by parents with the clinician’s help, and follow-up over several years. In a randomized efficacy trial of these two interventions, significantly more children in the Family Talk group reported gaining a better understanding of parental affective illness as a result of their participation in the intervention. These results were sustained during the year following the intervention (Beardslee, Salt, et al., 1997; Beardslee, Versage, et al., 1997; Beardslee, Wright, et al., 1997). For long-term follow-up, the researchers followed 105 families. Analysis of the entire sample 2.5 years after enrollment showed sustained gains for both sets of intervention groups, with an increase in the main target of intervention—understanding in the children—as well as sustained changes in attitudes and behaviors in the parents; however, the improvement was significantly greater in the Family Talk group. There was an overall effect in both groups of a reduction in depressive symptomatology (Beardslee, Gladstone, et al., 2003). In the most recent follow-up, 4.5 years after enrollment, the same effects were found (Beardslee, Wright, et al., 2008). Also, both intervention groups showed an overall decline in depressive symptomatology, an increase in family functioning, and better recognition of when youngsters became depressed (Beardslee, Wright, et al., 2008).
In another trial, these interventions were adapted for use with inner-city single-parent minority families (Podorefsky, McDonald-Dowdell, and Beardslee, 2001). The intervention proved safe and feasible, and there was more change in the families receiving the clinician approach than the lecture approach, although both interventions showed gains. The interventions have also been adapted for use with Hispanic families, and an open trial has demonstrated that they are safe and feasible and lead to significant gains for both parents and children, with stronger effects in the parents (D’Angelo, Llerena-Quinn, et al., in press). Additionally, the principles of the Family Talk intervention have been applied in a program to help teachers develop skills to deal with depressed parents in Head Start and Early Head Start (Beardslee, Hosman, et al., 2005; Beardslee, Ayoub, et al., in press). Family Talk is now being used in a number of country-wide efforts to develop programs for children of the mentally ill (see Box 13-1 in Chapter 13).