Reducing major depression in children at high risk: opportunities for prevention.

OBJECTIVE

The profound negative impact of a parent's Major Depressive Disorder (MDD) on his or her children is of increasing concern to public health and mental health professionals. Children of a depressed parent have a markedly elevated risk for psychiatric illness, including a fourfold increased risk for MDD. The objective is to examine the scientific literature for ways to reduce this high risk to the offspring. First, we consider the relation between effective treatment of a parent's depression and reduced risk to the offspring, and review the effectiveness of treatments for adult M1DD. We then review emerging evidence that risk for psychopathology can be reduced in children of depressed parents by preventive intervention, including targeting two pathways hypothesized as links between parental MDD and offspring psychopathology: parenting skills and child coping.

DATA SOURCES

Three 5-year PubMed searches, and a Cochrane Database search, and one Medline and two PsycLit searches (to 1970) were completed (search words in combinations included: depression, prevention, treatments, depression in families, family interaction, adolescents).

STUDY SELECTION

Randomized controlled studies are included, and review studies and meta-analyses are highlighted to provide a critical overview of the considerable scientific literatures for specific steps that can be taken to reduce the high risk of depression to the offspring of parents with MDD.

RESULTS

A deliberate clinical focus on better treatment of MDD in parents is clearly needed and has the potential additional benefit of reducing psychopathology in their children. Altering clinical treatment to address MDD "co-occurring" in both parent and child is supported by the scientific literature. There is also good evidence that preventive intervention with high-risk adolescents reduces the incidence of MDD. Targeting parenting skills and teaching children how to better cope with a parent's illness that they cannot control, appears to reduce MDD in the offspring.