What happens to children of depressed parents over the long term? Weissman and colleagues3 followed the offspring of parents who were moderately to severely depressed over a 20-year period. This is the longest follow-up study of a high-risk group of offspring with researchers following up with patients into adulthood. The sample included 101 youths with either 1 or both parents with a major depressive disorder and a comparison group of 50 youths who did not have a parent with a major depressive disorder.
At 20-year follow-up, there were no demographic differences between the offspring of depressed parents and nondepressed parents, including gender, age, marital status, education, employment status, income, and mean number of children. However, the risks for major depression, anxiety disorders, and substance dependence were about 3 times as high in the offspring of parents with depression as in the offspring of parents who were not depressed. The peak age of incidence of major depressive disorder was between 15 and 20 years, particularly in females. This age of onset was earlier than in the offspring of parents who were not depressed.
It was also found that the offspring of depressed parents had greater impairment in work and family functioning. At about age 35, more medical illnesses—particularly cardiovascular problems—were found in the offspring of depressed parents than in the offspring of nondepressed parents. The offspring of parents who were depressed were twice as likely to have physical health problems as were the offspring of nondepressed parents. The mortality rate was also higher in the offspring of depressed parents when compared with nondepressed parents (4 deaths compared with 0 deaths; 3 of the deaths were attributable to suicide). Of note, more than 60% of the offspring of parents with depression did not receive any psychiatric treatment during the 20-year follow-up period.
These studies have important clinical implications regarding depressed parents and their children. For clinicians who treat depressed parents, it is important to consider that their children may also have depression, anxiety, or disruptive behavior disorders. It is more likely that these disorders will occur in children if their parents' depression does not respond to treatment.
It may be helpful to inform parents with depression that their children are at risk for psychiatric disorders, and if the parent notices symptoms developing in his or her child, a psychiatric evaluation should be considered. Parents may benefit from knowing that there is now evidence that successfully treating their depression may result in a significant improvement in their children's psychiatric symptoms as well.
Dr Wagner is the Robert L Stubblefield Professor in the department of psychiatry and behavioral sciences and director of child and adolescent psychiatry at the University of Texas Medical Branch at Galveston.