Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Psychiatr Res. 2021 Dec;144:353-359. doi: 10.1016/j.jpsychires.2021.10.041. Epub 2021 Oct 26.
Parents of a child with a mood disorder report significant levels of distress and burden from caregiving. This study examined whether maternal distress varies over time with levels of mood symptoms in youth with mood disorders, and whether expressed emotion (EE) and family functioning moderate these associations. We recruited youth (ages 9-17 years) with mood disorders and familial risk for bipolar disorder (BD) for a randomized trial of family-focused therapy compared to standard psychoeducation. Participants were assessed every 4-6 months for up to 4 years. Using repeated-measures mixed effects modeling, we examined the longitudinal effects of youths' mood symptoms and maternal distress concurrently, as well as whether each variable predicted the other in successive study intervals. Secondary analyses examined the moderating effects of EE and ratings of family cohesion and adaptability on maternal distress. In sample of 118 youth-mother dyads, levels of self-reported parental distress decreased over time, with no differences between treatment conditions. Youths' depressive symptoms and, most strongly, mood lability were associated with greater maternal distress longitudinally; however, maternal distress did not predict youths' mood symptoms or lability. The effect of youth symptoms on maternal distress was greater among mothers who were high EE. Family cohesion was associated with reduced concurrent ratings of maternal distress, whereas family adaptability was associated with reduced maternal distress at successive follow-ups. While maternal distress decreases over time as youths' symptoms decrease, mothers of youth with mood disorders experience significant distress that is directly linked to the youths' depressive symptom severity and lability. Improved family functioning appears to be an important mechanism by which to intervene.
患有情绪障碍的儿童的父母报告称，他们在照顾孩子方面承受着巨大的痛苦和负担。本研究探讨了青少年情绪障碍患者的情绪症状水平是否会随着时间的推移而导致母亲的痛苦程度发生变化，以及表达情感（EE）和家庭功能是否会调节这些关联。我们招募了患有情绪障碍且具有双相情感障碍（BD）家族风险的青少年（9-17 岁），并对其进行家庭为中心的治疗与标准心理教育的随机试验。参与者每 4-6 个月接受一次评估，最长为期 4 年。使用重复测量混合效应模型，我们同时检查了青少年情绪症状和母亲痛苦的纵向影响，以及每个变量在连续的研究间隔中是否预测另一个变量。二次分析检验了 EE 和家庭凝聚力与适应性评分对母亲痛苦的调节作用。在 118 个青少年-母亲对子样本中，自我报告的父母痛苦水平随时间逐渐降低，治疗条件之间没有差异。青少年的抑郁症状，尤其是情绪不稳定性，与母亲痛苦呈纵向相关；然而，母亲痛苦并没有预测青少年的情绪症状或不稳定性。青少年症状对母亲痛苦的影响在 EE 较高的母亲中更大。家庭凝聚力与同时评估的母亲痛苦程度降低有关，而家庭适应性与后续随访时的母亲痛苦程度降低有关。尽管随着青少年症状的减轻，母亲的痛苦程度会随时间逐渐减轻，但患有情绪障碍的青少年的母亲会经历严重的痛苦，这与青少年的抑郁症状严重程度和不稳定性直接相关。改善家庭功能似乎是一种重要的干预机制。
