University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
Chatham University, Pittsburgh, PA, United States of America.
Compr Psychiatry. 2018 Oct;86:123-130. doi: 10.1016/j.comppsych.2018.08.001. Epub 2018 Aug 3.
Treatment of maternal depression with psychotherapy has been shown to confer indirect benefits to school-age offspring with psychiatric disorders. The current study sought to understand mechanisms by which improvement in depressed mothers, with and without histories of trauma and treated with psychotherapy, produce changes in children who struggle with psychiatric illnesses themselves. We hypothesized that maternal history of childhood trauma would moderate the relationship between maternal and child outcomes and that increased positive and decreased negative parenting behaviors would mediate the relationship between maternal and child outcomes. We also examined whether maternal history of trauma would moderate the mediational effects of parenting behaviors.
Participants were dyads (n = 62) of mothers with major depressive disorder and their children, ages 7-18, with at least one internalizing disorder. Mothers were treated with nine sessions of psychotherapy and children were treated openly in the community. Dyads were evaluated every three months over one year.
Maternal improvement in depressive symptoms was associated, in a lagged fashion, with child improvement in functioning six months later. There was a significant interaction of time and change in maternal symptoms [F(1, 45) = 5.84, p = 0.02], where change in maternal depressive symptoms from baseline to six months was robustly associated with change in child functioning from baseline to 12 months (β = 0.49, p = 0.0002). Maternal history of childhood sexual abuse moderated the association between change in maternal and child depressive symptoms [F(1,87) = 5.8, p = 0.02], and maternal history of physical neglect moderated the relationship between improvement in maternal depression and improvement in child functioning [F(1,36) = 4.34, p = 0.04], where significant associations between maternal and child outcomes were only found in mothers without histories of sexual abuse or physical neglect. Increase in positive parenting strategies (acceptance) by mothers mediated 6-month lagged associations between maternal and child outcomes, but reduction in negative parenting strategies (psychological control) did not. Maternal history of childhood emotional neglect moderated the mediational model, such that improved positive parenting did not explain lagged improvement in child depression among the subset of mothers with childhood histories of emotional neglect.
In dyads comprised of depressed mothers and school-age children with internalizing disorders, children improved when mothers improved, but not among those whose mothers who had histories of sexual abuse or physical neglect. Increased use of positive parenting strategies among mothers accounted for lagged relationships between improvement in maternal depressive symptoms and improvement in child functioning. This pattern was not, however, observed among mothers with childhood histories of emotional neglect. Interventions that directly enhance positive parenting and more rapidly change these behaviors may hasten improvement in offspring. Offspring of depressed mothers with histories of early trauma are at high risk for poor outcomes, even when their mothers receive depression treatment.
心理疗法治疗产妇抑郁症已被证明可间接使患有精神疾病的学龄期后代受益。本研究旨在了解改善患有创伤史和接受心理治疗的抑郁母亲的机制，这些母亲如何使本身患有精神疾病的孩子发生变化。我们假设母亲的童年创伤史会调节母亲和孩子结果之间的关系，并且增加积极的育儿行为和减少消极的育儿行为将调解母亲和孩子结果之间的关系。我们还检查了母亲的创伤史是否会调节育儿行为的中介作用。
参与者为患有重度抑郁症的母亲及其 7-18 岁至少患有一种内在障碍的孩子的母子二人（n=62）。母亲接受了九次心理治疗，而孩子则在社区中公开接受治疗。在一年中，每三个月对母子二人进行一次评估。
母亲抑郁症状的改善与六个月后孩子功能的改善呈滞后关系。母亲症状变化的时间和变化之间存在显著的交互作用[F（1,45）=5.84，p=0.02]，从基线到六个月时母亲抑郁症状的变化与从基线到 12 个月时孩子功能的变化密切相关（β=0.49，p=0.0002）。母亲童年性虐待史调节了母亲和孩子抑郁症状变化之间的关系[F（1,87）=5.8，p=0.02]，母亲童年身体忽视史调节了母亲抑郁改善与孩子功能改善之间的关系[F（1,36）=4.34，p=0.04]，仅在没有性虐待或身体忽视史的母亲中发现了母亲和孩子结局之间的显著关系。母亲积极育儿策略（接受）的增加介导了母亲和孩子结局之间 6 个月的滞后关系，但减少消极育儿策略（心理控制）并没有。母亲童年情感忽视史调节了中介模型，因此，在童年有情感忽视史的母亲中，改善的积极育儿并不能解释孩子抑郁的滞后改善。
在由患有内在障碍的抑郁母亲和学龄期孩子组成的母子二人中，当母亲改善时，孩子也会改善，但在那些母亲有性虐待或身体忽视史的孩子中则不会。母亲更频繁地使用积极的育儿策略可以解释母亲抑郁症状改善与孩子功能改善之间的滞后关系。然而，在母亲有童年情感忽视史的情况下，并没有观察到这种模式。直接增强积极育儿并更快速地改变这些行为的干预措施可能会加速后代的改善。患有早期创伤史的抑郁母亲的后代即使接受母亲的抑郁治疗，也面临着不良后果的高风险。
