Interventions Aim To Prevent Depression in High-Risk Children

Children whose parents have been diagnosed with affective disorders are far more likely to be diagnosed with a mental illness-especially affective disorder-than their peers whose parents do not have mood disorders (Beardslee, 1998; Burge and Hammen, 1991; Downey and Coyne, 1990). Unhappy with these odds, Boston researcher William R. Beardslee, M.D., has developed two promising short-term interventions that aim to prevent depression in this at-risk population.

Both interventions-a two-session psychoeducational lecture series as well as a series of four to eight clinician-centered interventions-have resulted in long-term improvement in family functioning, according to Beardslee, professor of psychiatry at Harvard University and psychiatrist-in-chief at Boston's Children's Hospital and the Judge Baker Children's Center. Specifically, comparisons of detailed parent and child assessments done in randomized, longitudinal studies have indicated increased resilience on the part of at-risk children as well as improved family communication overall. Children in the study reported an increase in coping skills and an improved ability to make sense of their internal and external environments (Beardslee et al., 1998).

Beardslee is confident that changes in family functioning brought about by the interventions have been robust and valuable for families. "Whether this study will demonstrate definitive prevention of depression in kids," he said, "is a separate question." Beardslee added that the next phase of research will focus on achieving a better understanding of the mechanics of the interventions: how they effect change as well as who most benefits from them.

"We see this as very important and promising," said Peter Jensen, M.D., associate director for child and adolescent research at the National Institute for Mental Health. He added, "These are the kinds of tools we need." Jensen said Beardslee's study is the first to compare two behavioral interventions in a specific population with younger children. If these findings are replicated in subsequent studies, such interventions could offer a valuable nonpharmacological alternative to children for whom medication is not effective or acceptable, Jensen said. He added that the next challenge would be to determine when interventions are most valuable for at-risk youngsters.

Over 100 families have been followed in the study, which began in 1989 and was expanded in 1991 with a grant from the NIMH. Children whose families were chosen to participate in the study were between the ages of 8 and 14.

Familial acceptance in the study was contingent upon the absence of frank psychosis, active chemical dependency, and/or active and acrimonious divorce proceedings between the parents. Acceptance criteria for children included the absence of profound mental retardation or a diagnosis of acute depression. All families in the study have had at least one affectively disordered parent.

Beardslee said the idea for the project originated in part from an unrelated research study of patients who had been hospitalized for depression. During clinical interviews, patients spontaneously and repeatedly voiced concern that their children had been irrevocably damaged by their illness. Further, they felt that health care professionals did not take their concerns seriously, something Beardslee believes not only compounded patients' suffering but also led to missed important opportunities to study the relationship between parental affective disorder and child outcome.

"What surprised me is that no one was asking that question and there were no programs to address this issue," said Beardslee, who remembers the days when intake interviews didn't even include questions, much less discussion, about patients' children. At the same time, Beardslee's work with severely depressed and suicidal children in the emergency room of a large city hospital reinforced his sense that early intervention was necessary to foster optimal development and functioning.