risk for depression compared with children whose mothers were not at risk (Administration for Children and Families, 2002). Early Head Start had no effect on maternal depression 1 year after enrollment, but, after 3–5 years, depressive symptoms were reduced. The earlier impacts on child outcomes mediated this effect on maternal depression (Chazan-Cohen et al., 2007).

Given the high prevalence of maternal depression in early childhood programs such as Early Head Start, these programs offer an opportunity to deliver interventions to address maternal depression. Therefore, as with home visitation programs, one promising approach may be to embed ways to recognize parental depression in existing early childhood programs and to enrich these programs with parenting interventions specifically for depressed parents and referral for mental health services. In addition, because the combination of multiple risk factors was associated with worse outcomes, program enhancements to address other family needs, for example, income and educational needs, may also be warranted in order to maximize program outcomes.

Interventions for Children of Depressed Parents in Childhood and Adolescence

Clarke and colleagues have developed a cognitive-behavioral preventive intervention for youth at high risk of depression and have evaluated it specifically in children of depressed parents (Clarke et al., 1995, 2001). Adolescent youth with subdiagnostic depressive symptoms whose parents were being treated for depression received 15 1-hour group sessions or usual care (Clarke et al., 2001). Adolescents in the intervention reported significantly fewer symptoms of depression at postintervention and 12-month follow-up and a significantly lower rate of newly diagnosed major depressive episodes at 12-month follow-up. This trial has recently been replicated in a larger, four-site randomized trial (Garber et al., 2007, 2009). In this case, the participants had current depressive symptoms or a history of depression or both and also had a parent with a current or past episode of major depression. At 8 months after enrollment, a significant preventive effect was found, but this was moderated by parental depression at enrollment. For adolescents with parents with a history of depression but not currently depressed at baseline, the intervention led to reduced onset of depression. However, when the adolescents in the intervention group had a parent with current depression at enrollment, the rates of new depression posttreatment were not significantly different.

Depression is one of the major adverse outcomes for children of depressed parents, and this intervention demonstrates that it is possible to prevent episodes of major depression in these children. However, the importance of the current status of the parent’s depression in the expanded rep-



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