Remissions in maternal depression and child psychopathology: A STAR*D-child report

Myrna M. Weissman, Daniel J. Pilowsky, Priya J. Wickramaratne, Ardesheer Talati, Stephen R. Wisniewski, Maurizio Fava, Carroll W. Hughes, Judy Garber, Erin Malloy, Cheryl A. King, Gabrielle Cerda, A. Bela Sood, Jonathan E. Alpert, Madhukar H. Trivedi, A. John Rush

Research output: Contribution to journalArticle

466 Citations (Scopus)

Abstract

Context: Children of depressed parents have high rates of anxiety, disruptive, and depressive disorders that begin early, often continue into adulthood, and are impairing. Objective: To determine whether effective treatment with medication of women with major depression is associated with reduction of symptoms and diagnoses in their children. Design: Assessments of children whose depressed mothers were being treated with medication as part of the multicenter Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial conducted (between December 16, 2001 and April 24, 2004) in broadly representative primary and psychiatric outpatient practices. Children were assessed by a team of evaluators not involved in maternal treatment and unaware of maternal outcomes. Study is ongoing with cases followed at 3-month intervals. Setting and Patients: One hundred fifty-one mother-child pairs in 8 primary care and 11 psychiatric outpatient clinics across 7 regional centers in the United States. Children were aged 7 to 17 years. Main Outcome Measures: Child diagnoses based on the Kiddie Schedule for Affective Disorders and Schizophrenia; child symptoms based on the Child Behavior Checklist; child functioning based on the Child Global Assessment Scale in mothers whose depression with treatment remitted with a score of 7 or lower or whose depression did not remit with a score higher than 7 on the Hamilton Rating Scale for Depression. Results Remission of maternal depression after 3 months of medication treatment was significantly associated with reductions in the children's diagnoses and symptoms. There was an overall 11% decrease in rates of diagnoses in children of mothers whose depression remitted compared with an approximate 8% increase in rates of diagnoses in children of mothers whose depression did not. This rate difference remained statistically significant after controlling for the child'sageandsex,andpossible confounding factors (P=.01). Of the children with a diagnosis at baseline, remission was reported in33%of those whose mothers' depression remitted compared with only a 12% remission rate among children of mothers whose depression did not remit. All children of mothers whose depression remitted after treatment and who themselves had no baseline diagnosis for depression remained free of psychiatric diagnoses at 3 months, whereas 17% of the children whose mothers remained depressed acquired a diagnosis. Findings were similar using child symptoms as an outcome. Greater level of maternal response was associated with fewer current diagnoses and symptoms in the children, and a maternal response of at least 50% was required to detect an improvement in the child. Conclusions: Remission of maternal depression has a positive effect on both mothers and their children, whereas mothers who remain depressed may increase the rates of their children's disorders. These findings support the importance of vigorous treatment for depressed mothers in primary care or psychiatric clinics and suggest the utility of evaluating the children, especially children whose mothers continue to be depressed.

Original languageEnglish (US)
Pages (from-to)1389-1398
Number of pages10
JournalJournal of the American Medical Association
Volume295
Issue number12
DOIs
StatePublished - Mar 22 2006
Externally publishedYes

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Psychopathology
Mothers
Depression
Therapeutics
Psychiatry
Primary Health Care

ASJC Scopus subject areas

  • Medicine(all)

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Weissman, M. M., Pilowsky, D. J., Wickramaratne, P. J., Talati, A., Wisniewski, S. R., Fava, M., ... Rush, A. J. (2006). Remissions in maternal depression and child psychopathology: A STAR*D-child report. Journal of the American Medical Association, 295(12), 1389-1398. https://doi.org/10.1001/jama.295.12.1389

Remissions in maternal depression and child psychopathology : A STAR*D-child report. / Weissman, Myrna M.; Pilowsky, Daniel J.; Wickramaratne, Priya J.; Talati, Ardesheer; Wisniewski, Stephen R.; Fava, Maurizio; Hughes, Carroll W.; Garber, Judy; Malloy, Erin; King, Cheryl A.; Cerda, Gabrielle; Sood, A. Bela; Alpert, Jonathan E.; Trivedi, Madhukar H.; Rush, A. John.

In: Journal of the American Medical Association, Vol. 295, No. 12, 22.03.2006, p. 1389-1398.

Research output: Contribution to journalArticle

Weissman, MM, Pilowsky, DJ, Wickramaratne, PJ, Talati, A, Wisniewski, SR, Fava, M, Hughes, CW, Garber, J, Malloy, E, King, CA, Cerda, G, Sood, AB, Alpert, JE, Trivedi, MH & Rush, AJ 2006, 'Remissions in maternal depression and child psychopathology: A STAR*D-child report', Journal of the American Medical Association, vol. 295, no. 12, pp. 1389-1398. https://doi.org/10.1001/jama.295.12.1389
Weissman MM, Pilowsky DJ, Wickramaratne PJ, Talati A, Wisniewski SR, Fava M et al. Remissions in maternal depression and child psychopathology: A STAR*D-child report. Journal of the American Medical Association. 2006 Mar 22;295(12):1389-1398. https://doi.org/10.1001/jama.295.12.1389
Weissman, Myrna M. ; Pilowsky, Daniel J. ; Wickramaratne, Priya J. ; Talati, Ardesheer ; Wisniewski, Stephen R. ; Fava, Maurizio ; Hughes, Carroll W. ; Garber, Judy ; Malloy, Erin ; King, Cheryl A. ; Cerda, Gabrielle ; Sood, A. Bela ; Alpert, Jonathan E. ; Trivedi, Madhukar H. ; Rush, A. John. / Remissions in maternal depression and child psychopathology : A STAR*D-child report. In: Journal of the American Medical Association. 2006 ; Vol. 295, No. 12. pp. 1389-1398.
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abstract = "Context: Children of depressed parents have high rates of anxiety, disruptive, and depressive disorders that begin early, often continue into adulthood, and are impairing. Objective: To determine whether effective treatment with medication of women with major depression is associated with reduction of symptoms and diagnoses in their children. Design: Assessments of children whose depressed mothers were being treated with medication as part of the multicenter Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial conducted (between December 16, 2001 and April 24, 2004) in broadly representative primary and psychiatric outpatient practices. Children were assessed by a team of evaluators not involved in maternal treatment and unaware of maternal outcomes. Study is ongoing with cases followed at 3-month intervals. Setting and Patients: One hundred fifty-one mother-child pairs in 8 primary care and 11 psychiatric outpatient clinics across 7 regional centers in the United States. Children were aged 7 to 17 years. Main Outcome Measures: Child diagnoses based on the Kiddie Schedule for Affective Disorders and Schizophrenia; child symptoms based on the Child Behavior Checklist; child functioning based on the Child Global Assessment Scale in mothers whose depression with treatment remitted with a score of 7 or lower or whose depression did not remit with a score higher than 7 on the Hamilton Rating Scale for Depression. Results Remission of maternal depression after 3 months of medication treatment was significantly associated with reductions in the children's diagnoses and symptoms. There was an overall 11{\%} decrease in rates of diagnoses in children of mothers whose depression remitted compared with an approximate 8{\%} increase in rates of diagnoses in children of mothers whose depression did not. This rate difference remained statistically significant after controlling for the child'sageandsex,andpossible confounding factors (P=.01). Of the children with a diagnosis at baseline, remission was reported in33{\%}of those whose mothers' depression remitted compared with only a 12{\%} remission rate among children of mothers whose depression did not remit. All children of mothers whose depression remitted after treatment and who themselves had no baseline diagnosis for depression remained free of psychiatric diagnoses at 3 months, whereas 17{\%} of the children whose mothers remained depressed acquired a diagnosis. Findings were similar using child symptoms as an outcome. Greater level of maternal response was associated with fewer current diagnoses and symptoms in the children, and a maternal response of at least 50{\%} was required to detect an improvement in the child. Conclusions: Remission of maternal depression has a positive effect on both mothers and their children, whereas mothers who remain depressed may increase the rates of their children's disorders. These findings support the importance of vigorous treatment for depressed mothers in primary care or psychiatric clinics and suggest the utility of evaluating the children, especially children whose mothers continue to be depressed.",
author = "Weissman, {Myrna M.} and Pilowsky, {Daniel J.} and Wickramaratne, {Priya J.} and Ardesheer Talati and Wisniewski, {Stephen R.} and Maurizio Fava and Hughes, {Carroll W.} and Judy Garber and Erin Malloy and King, {Cheryl A.} and Gabrielle Cerda and Sood, {A. Bela} and Alpert, {Jonathan E.} and Trivedi, {Madhukar H.} and Rush, {A. John}",
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T1 - Remissions in maternal depression and child psychopathology

T2 - A STAR*D-child report

AU - Weissman, Myrna M.

AU - Pilowsky, Daniel J.

AU - Wickramaratne, Priya J.

AU - Talati, Ardesheer

AU - Wisniewski, Stephen R.

AU - Fava, Maurizio

AU - Hughes, Carroll W.

AU - Garber, Judy

AU - Malloy, Erin

AU - King, Cheryl A.

AU - Cerda, Gabrielle

AU - Sood, A. Bela

AU - Alpert, Jonathan E.

AU - Trivedi, Madhukar H.

AU - Rush, A. John

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N2 - Context: Children of depressed parents have high rates of anxiety, disruptive, and depressive disorders that begin early, often continue into adulthood, and are impairing. Objective: To determine whether effective treatment with medication of women with major depression is associated with reduction of symptoms and diagnoses in their children. Design: Assessments of children whose depressed mothers were being treated with medication as part of the multicenter Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial conducted (between December 16, 2001 and April 24, 2004) in broadly representative primary and psychiatric outpatient practices. Children were assessed by a team of evaluators not involved in maternal treatment and unaware of maternal outcomes. Study is ongoing with cases followed at 3-month intervals. Setting and Patients: One hundred fifty-one mother-child pairs in 8 primary care and 11 psychiatric outpatient clinics across 7 regional centers in the United States. Children were aged 7 to 17 years. Main Outcome Measures: Child diagnoses based on the Kiddie Schedule for Affective Disorders and Schizophrenia; child symptoms based on the Child Behavior Checklist; child functioning based on the Child Global Assessment Scale in mothers whose depression with treatment remitted with a score of 7 or lower or whose depression did not remit with a score higher than 7 on the Hamilton Rating Scale for Depression. Results Remission of maternal depression after 3 months of medication treatment was significantly associated with reductions in the children's diagnoses and symptoms. There was an overall 11% decrease in rates of diagnoses in children of mothers whose depression remitted compared with an approximate 8% increase in rates of diagnoses in children of mothers whose depression did not. This rate difference remained statistically significant after controlling for the child'sageandsex,andpossible confounding factors (P=.01). Of the children with a diagnosis at baseline, remission was reported in33%of those whose mothers' depression remitted compared with only a 12% remission rate among children of mothers whose depression did not remit. All children of mothers whose depression remitted after treatment and who themselves had no baseline diagnosis for depression remained free of psychiatric diagnoses at 3 months, whereas 17% of the children whose mothers remained depressed acquired a diagnosis. Findings were similar using child symptoms as an outcome. Greater level of maternal response was associated with fewer current diagnoses and symptoms in the children, and a maternal response of at least 50% was required to detect an improvement in the child. Conclusions: Remission of maternal depression has a positive effect on both mothers and their children, whereas mothers who remain depressed may increase the rates of their children's disorders. These findings support the importance of vigorous treatment for depressed mothers in primary care or psychiatric clinics and suggest the utility of evaluating the children, especially children whose mothers continue to be depressed.

AB - Context: Children of depressed parents have high rates of anxiety, disruptive, and depressive disorders that begin early, often continue into adulthood, and are impairing. Objective: To determine whether effective treatment with medication of women with major depression is associated with reduction of symptoms and diagnoses in their children. Design: Assessments of children whose depressed mothers were being treated with medication as part of the multicenter Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial conducted (between December 16, 2001 and April 24, 2004) in broadly representative primary and psychiatric outpatient practices. Children were assessed by a team of evaluators not involved in maternal treatment and unaware of maternal outcomes. Study is ongoing with cases followed at 3-month intervals. Setting and Patients: One hundred fifty-one mother-child pairs in 8 primary care and 11 psychiatric outpatient clinics across 7 regional centers in the United States. Children were aged 7 to 17 years. Main Outcome Measures: Child diagnoses based on the Kiddie Schedule for Affective Disorders and Schizophrenia; child symptoms based on the Child Behavior Checklist; child functioning based on the Child Global Assessment Scale in mothers whose depression with treatment remitted with a score of 7 or lower or whose depression did not remit with a score higher than 7 on the Hamilton Rating Scale for Depression. Results Remission of maternal depression after 3 months of medication treatment was significantly associated with reductions in the children's diagnoses and symptoms. There was an overall 11% decrease in rates of diagnoses in children of mothers whose depression remitted compared with an approximate 8% increase in rates of diagnoses in children of mothers whose depression did not. This rate difference remained statistically significant after controlling for the child'sageandsex,andpossible confounding factors (P=.01). Of the children with a diagnosis at baseline, remission was reported in33%of those whose mothers' depression remitted compared with only a 12% remission rate among children of mothers whose depression did not remit. All children of mothers whose depression remitted after treatment and who themselves had no baseline diagnosis for depression remained free of psychiatric diagnoses at 3 months, whereas 17% of the children whose mothers remained depressed acquired a diagnosis. Findings were similar using child symptoms as an outcome. Greater level of maternal response was associated with fewer current diagnoses and symptoms in the children, and a maternal response of at least 50% was required to detect an improvement in the child. Conclusions: Remission of maternal depression has a positive effect on both mothers and their children, whereas mothers who remain depressed may increase the rates of their children's disorders. These findings support the importance of vigorous treatment for depressed mothers in primary care or psychiatric clinics and suggest the utility of evaluating the children, especially children whose mothers continue to be depressed.

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