Family therapy for childhood depression: researching significant moments

This paper is a qualitative family therapy process study which is part of a larger European-based outcome study comparing family therapy to child psychotherapy plus parent support for depressed children and their families. The family therapists and two clinical supervisors from the original study formed themselves into a research team to study the process of therapy with twelve families. Therapists selected the significant moments from fifty-nine sessions, and were then interviewed by the research team using a standard protocol to investigate the therapists' own thinking about the significant moments. Applying a thematic analysis, the significant moments were clustered into eleven themes. The paper discusses the rationale for this model of research, which is well suited for clinical teams, and the application of the themes to therapeutic work with depressed children and their families.     

Family interaction and caregivers of Alzheimer's disease patients: correlates of depression.

Depression is ubiquitous in primary family caregivers of Alzheimer's Disease (AD) patients, but its relationship to the overall behavior patterns of these families has received little attention thus far. The focus of the exploratory study reported here was on one aspect of this issue — affective responses between caregiver and other family members as they relate to level of depressive symptoms in the primary caregivers. Family affective responses, especially negative responses, have proven of particular salience in studies of major psychiatric disorders. Would they be equally salient in a study of depressive symptoms in primary caregivers of Alzheimer's patients? Apparently so. Thirty caregivers and extended family members participated in problem-solving family interaction tasks that were videotaped, transcribed, and coded on affect. Two variables representing angry and sad responses of extended family members to the caregiver accounted for over 44% of the variance in caregiver depressive symptoms. The relevance of these findings for treatment approaches and future research efforts are discussed.     

Marital interaction and depression

In this article, patterns of marital interaction as a function of depression and marital satisfaction are examined. The purpose of the study was to separate dysfunctional marital interaction patterns that were unique to depression from those that were associated with marital distress. The presence or absence of a depressed wife was crossed with level of marital satisfaction (distressed or nondistressed) to produce four groups of subject couples. Couples in which the wife was depressed exhibited more depressive behavior than did nondepressed couples, but only during discussion of a high conflict (as opposed to neutral) topic. Sex X Depression Level X Marital Satisfaction interactions were found for aggressive behavior: Depressed women in nondistressed relationships exhibited behavior that was characteristic of maritally distressed couples (high rates of aggression). In contrast, the husbands of these women exhibited behavior that one would expect in happily married couples (low rates of aggression). We failed to replicate previous findings that depressive behavior served a coercive function, although distressed couples, regardless of depression status, exhibited all the usual signs of negative dysfunctional interaction. In general, the findings suggested that marital distress rather than depression per se may be responsible for the dysfunctional interaction patterns frequently observed in depressed couples.     

Continuity in childhood depression

It is only in recent years that childhood depression has received widespread attention from mental health specialists. Its status as a clinical syndrome of childhood remains unclear. Many controversies surround various facets of this condition, foremost among these are questions relating to the duration of depressive disorders, the likelihood of recurrence, and the long-term outcome of depressed children. In the course of addressing these issues, attention is devoted to the outcomes as well as the advantages and disadvantages of commonly used research designs (prospective, retrospective, and catch-up prospective), the level of diagnosis used (symptom, syndrome, disorder), the significance of the age of onset on severity, and specific areas in need of further research. Among the tentative conclusions, it is asserted that many depressive symptoms are transient, diminishing or disappearing with age and/or changing environmental circumstances, but that severe depressive disorders do persist, with periods of remission, at least into the early adult years.     

Family factors in childhood obesity

Abstract

Childhood obesity is reaching epidemic proportions in the United States today. Children become its victims and often carry obesity-producing habits into adulthood. Much research has been reported on obesity, but little has touched on how family dynamics affect childhood obesity. This article explores the family dynamics of childhood obesity, and presents evidence supporting the need for a family-based treatment model.     

Family management of childhood diabetes

This paper reviews the available literature on family management of childhood diabetes and highlights gaps in the current knowledge base. Four aspects of family management of childhood diabetes are discussed: coping (how the family adjusts to living with a child who has diabetes), compliance (how the family manages the child's diabetes on a daily basis), communication (how the family learns from interactions with the health provider), and context (how the family environment sets the stage for managing diabetes).     

Family and childhood adjustment in cystic fibrosis

Family adaptation has been commonly associated with the psychological adjustment of chronically ill children. However, few studies have attempted to systematically evaluate this association and its relationship to illness severity. We studied 44 children ages 7 to 15 and their families at a large cystic fibrosis center and obtained measures of 1) impact of illness on the family; 2) family functioning; 3) behavioral adjustment; 4) social competence; 5) ratings of anxiety, depressive, and eating disorder symptoms; and 6) ratings of illness severity and duration. Impact of illness on the family and overall family dysfunction were significantly correlated with illness severity, but not duration. However, impact of illness on the family was significantly correlated with internalizing behavioral symptoms, while family dysfunction was correlated with depressive symptomatology. These findings suggest that illness-related stress is primarily reflected in general emotional and behavioral symptoms, with familial adaptation either ameliorating or exacerbating their development into depressive symptomatology.     

Self-efficacy pathways to childhood depression

This prospective research analyzed how different facets of perceived self-efficacy operate in concert within a network of sociocognitive influences in childhood depression. Perceived social and academic inefficacy contributed to concurrent and subsequent depression both directly and through their impact on academic achievement, prosocialness, and problem behaviors. In the shorter run, children were depressed over beliefs in their academic inefficacy rather than over their actual academic performances. In the longer run, the impact of a low sense of academic efficacy on depression was mediated through academic achievement, problem behavior, and prior depression. Perceived social inefficacy had a heavier impact on depression in girls than in boys in the longer term. Depression was also more strongly linked over time for girls than for boys.     

Family climate of routine asthma care: associating perceived burden and mother-child interaction patterns to child well-being

This preliminary report links the literatures on family asthma management practices and on the characteristics of family interaction patterns thought to influence children's adjustment to a chronic physical illness. Specifically, this study of 60 families with a child with asthma examined the extent to which perceived burden of routine asthma care affected child mental health via its influence on parent-child interaction patterns. Mothers completed a measure of asthma management routine burden, mother and child were observed in a 15-minute interaction task, and children completed measures of child anxiety and asthma quality of life (QOL). Perceived routine burden significantly predicted child anxiety and QOL through its effect on mother-child rejection/criticism. The same pattern did not hold for mother intrusiveness/control. The results are discussed in terms of how overall family climate and regulation of routines affects child well-being. Implications for clinical practice and limitations of the study are provided.     

Predicting depression using earliest childhood memories

In order to investigate the utility of earliest childhood memories (EMs) in clinical assessment, this study investigated the value of EMs in predicting naturally occurring depressive mood states. Of interest were those features of EMs that discriminate depressed from nondepressed individuals. Subjects were 212 undergraduate volunteers who completed the Beck Depression Inventory, the Profile of Mood States, and a self-administered EM questionnaire. Utilizing thematic predictors derived from cognitive and psychodynamic theories of depression, depressed subjects were differentiated from nondepressed subjects at a rate significantly greater than chance, p less than .001, with a highly respectable estimate of cross-validation shrinkage. The findings demonstrate the phenomenon of mood dependent recall in autobiographical memory, namely, that memory attributes are strongly influenced by current mood state. Consistent with psychodynamic theories of depression and in contrast to cognitive theory, depressive mood states appear to facilitate retrieval of memory schemas involving deprivation and disturbing human interaction. Schemas involving loss of control, failure, or reactions to noncontingent reinforcement (perceptions of the self as agent) appear less salient than relationship schemas (perceptions of the self as related) in depressive experience.     

Childhood depression and conduct disorder: II. An analysis of family interaction patterns in the home.

Few researchers have assessed family interaction patterns associated with childhood depression, especially using observations in natural settings. We directly sampled the interaction patterns of families with depressed, conduct-disordered, mixed depressed-conduct-disordered, and comparison children ages 7-14 years in their homes during the evening meal. Observational measures were taken of positive and aversive behaviors and affect expression for both parents, the referred children, and their siblings. Results replicated previous research showing that conduct-disordered children express high levels of aversive behavior and anger and are part of a family system marked by conflict and aggression. The depressed children were exposed to maternal aversiveness but did not show any evidence of elevated levels of anger or aversiveness in their own behavior. Surprisingly, this was also true for the mixed-disorder children. High levels of depression in both groups of depressed children were associated with low levels of conflict and anger in family members. Overall, siblings showed very similar patterns of behavior, and were exposed to similar patterns of parental behavior, as the referred children. Results are discussed in terms of family models that emphasize the function of aggression and depression in the maintenance of child psychopathology.     

Family predictors of moral internalization in childhood

This study aimed to analyze the relationship between parents' affection, acceptance, emotional communication, the transmission of values and moral intervention, on the one hand, and children's moral emotions and behaviors on the other (empathy, guilt, internalized behavior and reparation). It also aimed to identify the family variables that influence moral internalization in children. The sample comprised 485 children (244 boys and 241 girls) aged between 6 and 8. The results showed that the principal variable to predict internalized behavior in girls was maternal affection, whereas for boys, the principal variables were maternal emotional communication and transmission of values. The family variables that explain moral internalization in extreme groups of children are basically parents' affection, emotional communication, the transmission of values and moral intervention.     

The relationship of anxiety to childhood depression

In order to investigate the relationship between anxiety and depression in emotionally disturbed children, 30 hospitalized inpatient children were individually administered the Children's Depression Inventory (CDI), the Children's Manifest Anxiety Scale-Revised (CMAS-R), and the State-Trait Anxiety Inventory for Children (STAIC). Results indicated a significant relationship between CDI scores, the CMAS-R and its factors, and the STAIC. Correlations between the various factors of anxiety and depression suggest a complex relationship between the two constructs. Stepwise regression analyses indicated further the complexity of this relationship. Results were discussed in terms of the possible differential role which the different anxiety factors play in depression.     

Family interaction and outcome IQ in high-risk boys

This study examined the relationship between measures of family interaction and outcome for 97 boys at risk for psychopathology from having one parent previously hospitalized for psychiatric illness. Measures of communication deviance and of activity, balance and warmth, derived from two family activities, correlated significantly with 3-yr. follow-up adaptive functioning, measured by IQ. Poor family interaction, in previous studies associated with schizophrenic symptomatology, was here correlated with poor cognitive/social/emotional functioning, suggesting that family interaction may be a broad predictor of adequacy of functioning.