Parental expressed emotion, family conflict, and symptom severity in adolescent offspring of parents with mood disorders.

BACKGROUND

Levels of expressed emotion (EE) in caregivers are associated with recurrence risk in individuals with mood disorders. In adolescent offspring of parents with mood disorders, we examined the longitudinal associations between parental EE, family conflict and youths' mood states during a trial of family-focused therapy (FFT).

METHODS

Participants (N = 62; mean 15.7 yrs. ± 1.6) had current depressed mood, mood instability, and a parent with a history of depression or bipolar disorder. Families received 12 sessions of videoconference-based FFT (psychoeducation, communication, and problem-solving) over 18 weeks, with random assignment to one of two mobile apps. Levels of EE based on five-minute speech samples were obtained from parents at pretreatment and every 9 weeks over 27 weeks. At each 9-week interval, independent evaluators rated youths' mood symptoms and adolescents/parents rated family conflict and mood instability.

RESULTS

Levels of EE were stable from baseline to post-treatment in 70.4 % of parents. Over 27 weeks, youth in low-EE families showed greater improvements in depressive symptoms and mood lability compared to those in high-EE families. Parents who were high-EE in one study interval reported higher parent/offspring conflict in the next interval. The association between parental EE and youths' mood symptoms was partially mediated by family conflict. Findings were unaffected by type of mobile app assigned to families.

LIMITATIONS

Despite its prognostic significance, we cannot draw conclusions about the causal role of parental EE in youths' mood fluctuations.

CONCLUSIONS

The pathways from parental EE to family conflict and youths' mood fluctuations suggest strategies for early intervention.

CLINICAL TRIAL REGISTRATION INFORMATION

Technology Enhanced Family Treatment; https://clinicaltrials.gov/NCT03913013.