Children of Parents with Mood Disorders: Opportunities for Prevention
Having a parent with a serious mood disorder is the single largest risk factor for initial onset of depression in childhood and adolescence and, because it involves both genetic and psychosocial risk factors, is among the largest risk factors for depression across the life span. A brief review of the literature on children of parents with depression is in order both to look at how this risk factor operates and to illuminate opportunities for prevention.
Documentation of the Risk Factor
For decades, it has been well established that severe mental disorder in parents is associated with increased rates of mental disorder in offspring. Recently, a series of rigorous empirical studies have been conducted using standard diagnostic instruments with the children of parents with serious mood disorders (Beardslee and Wheelock, in press; Downey and Coyne, 1990). The majority of these studies focused on parental major depression, but some focused on bipolar disorder, and therefore the more inclusive term mood disorder is used here. These studies are the result both of the recognition of childhood depression as a discrete entity and of the awareness that such children are themselves at heightened risk, particularly for depression. There is a clear consensus in the empirical research literature that children of parents with mood disorders fare much more poorly than subjects in comparison samples. A series of studies conducted by different investigators in different sites, but with similar designs, have conclusively established that the rates of adolescent depression in offspring of parents with mood disorders are at least several times higher than in children of parents with no disorder. These rates often reach 30 percent by the end of adolescence (Downey and Coyne, 1990). Children in these families also manifest impairments in adaptive and social functioning, as well as school and medical problems. Moreover, youngsters who experience depression or other serious psychopathology are largely unrecognized and untreated (Keller, Lavori, Beardslee, Wunder, and Ryan, 1991). These findings parallel findings of underrecognition and undertreatment of childhood disorders in epidemiological studies and studies of pediatric practice (Beardslee, Salt, Porterfield, Rothberg, van DeVelde, Swatling et al., 1993b). They also parallel the corresponding finding in adults that depression is underrecognized and undertreated. There is also substantial literature to indicate that children of parents with severe mood disorder are at considerable risk for a variety of poor developmental outcomes from birth to age five (Beardslee and Wheelock, in press; Downey and Coyne, 1990).
Most of the studies of the impact of parental mood disorder on children have been conducted using clinically referred parents. Extension of studies to nonreferred samples has demonstrated the same powerful effect of parental mood disorder on child outcome (Beardslee, Keller, Lavori, Staley, and Sacks, 1993a).