Interventions Aim To Prevent Depression in High-Risk Children

Beardslee feels strongly that preventive interventions must be family-based since depression is an illness that can derail marital and parental functioning. Citing statistics asserting that 10% to 20% of adults will experience an episode of depression during their lifetime, Beardslee is concerned that several million children are growing up in families with severe affective illness; this underscores the need for proactive intervention.

Like others in the field, Beardslee believes that the development of affective disorders is likely based on a complex interplay of biological/genetic forces and developmental transactions between children, family members and the outside world (Beardslee, 1998). Some children manage to survive and even flourish under the most difficult circumstances, while others flounder under the same conditions.

Factors such as presence of comorbid diagnoses, chronicity of parental illness and previous history of disorder in a child have been found to be among those factors resulting in poor child outcomes. Conversely, increased resilience has been observed to have significant protective value (Beardslee, 1998).

Beardslee's earlier research on American civil rights workers provided him with important clues about the building blocks of resilience. Interviewees attributed their ability to thrive, despite significant and ongoing adversity, to several core factors. Primary among them were the ability to form strong relationships, an action-oriented outlook, and a keen and cohesive sense of identity.

These characteristics have been observed in subsequent studies of children who had survived cancer or were coping with parental affective disorder. Beardslee has come to believe that these traits are of universal value in terms of individuals' ability to cope with adversity. Beardslee and his colleagues have found that those children of affectively ill parents who had the most promising diagnostic outcomes had a clear understanding that they were not responsible for their parents' illness (Beardslee, 1998). Further, these children had active lives outside the home and a strong sense of self-understanding.

Beardslee said that both interventions have been designed to combat cognitive distortions often held by depressed individuals and their families concerning the symptoms and treatment of their illness. Families also are educated about the risk factors for depression in children and indicators of children's resilience. The psychoeducational lectures attended by parents only are designed to foster an improved understanding of affective illness. Parents are invited to contact program facilitators as the need arises for help with ongoing concerns.

Beardslee said that gains were particularly strong and long-lived in the clinician-centered intervention, which includes separate meetings for parents and children as well as family sessions. A core feature of this intervention is the active discussion of affective disorder as it relates to the specific functioning of the family. This process, said Beardslee, gives family members permission to openly discuss parental illness and can serve as an important model for families with generalized communication problems. Clinicians contact families periodically to check on their progress following the conclusion of the program. In addition, participants in both interventions receive detailed assessments over the course of the study.

"If you've undergone terrible adversity in your family and it's not discussed and you're part of it, finding a way to discuss it safely lets people make sense of it and move on," Beardslee said. The Boston researcher said comparisons of longitudinal assessments indicate that this can be an especially powerful and corrective intervention for children, whose insight broadens and deepens as they move into adolescence and beyond. "The understanding that worked for them when they were 12 doesn't work for them when they're 19," he added.

As for those children who do develop depression, Beardslee believes that the interventions will sensitize families to the importance of early diagnosis and treatment. He said that manual-based interventions could be used by pediatricians and primary care physicians as easily and as effectively as by mental health professionals.