Transmission and prevention of depression in the offspring of parents with depression

According to the World Health Organisation, depression is one of the most common psychiatric disorders - affecting around 350 million people across all age groups worldwide. Suffering from major depression not only causes great personal burden for the affected person, but also for their family, society and economy. The later the disease is recognized, the worse is the prognosis, going along with higher treatment costs. Consequently, an early identification of risk factors for depression is necessary to prevent these high personal and economic costs. One of the groups at greatest risk of developing depression is the offspring of parents suffering from depression. Their risk of developing depression is estimated to be three to four times higher during childhood and adolescence alone, and do even persist into adulthood. Since the transmission of depression from parent to child may result from numerous risk and protective factors and their interaction, the high risk for developing a depression is not understood well yet. Furthermore, although evidence-based treatment interventions for depression have been developed and implemented into practice, few prevention programs for the children of depressed parents have been developed, with heterogeneous findings. In the first part of the thesis, I provide a theoretical framework for the trans-generational transmission of depression based on the existing literature. In addition, prevention approaches and their efficiency in reducing the risk for depression are discussed. In the second and empirical part two studies referring to the transmission and prevention of depression in the offspring of depressed parents are reported. In study I, a high-risk group (HR, n = 74) children of parents with depression is compared to a low-risk group (LR, n = 38) consisting of the offspring of parents without depression. The goal of the study was to i) replicate findings of the increased risk in youth that is associated with parental depression and ii) identify most prevalent risk factors in order to explore possible mechanisms of the trans-generational transmission of depression. Therefore, the HR and LR were compared in general psychopathology (self-rated depressive and psychopathology symptoms; parent-rated psychopathology) and the mediators (emotion regulation, attributional style) and moderators (life events). In addition, the role of parental depression and its impact and association on the children’s depressive symptoms is investigated. The data supported earlier findings of increased risk for depression for the HR, since the HR showed significantly increased psychopathology and depressive symptoms with a big effect size (d = 1.75). Thereby, the parental depression was associated significantly with children’s depression severity. In addition, the data provided strong evidence for group differences in adaptive emotion regulation strategies, positive and negative attributional style and the number of positive life events. Against expectations, groups did not differ in maladaptive emotion regulation strategies and the number of negative life events. Maladaptive emotion regulation strategies, negative life events and parental depression were the strongest predictors of children’s depressive symptoms, together accounting for 30.8 % of the variance. These results suggest practical implications for prevention interventions for depression like increasing emotional and cognitive coping strategies and positive life events. Longitudinal highly-powered studies are necessary in future research. In study II, preliminary results of an ongoing randomized controlled trial of one of the most promising prevention programs for the offspring of depressed parents (replicated here for the first time outside of the research group) are presented. Data from n = 61 families who reached post-assessment are provided. It was hypothesized that children in the experimental group (EG) would show decreased symptoms of psychopathology and depression compared to the control group (CG) over time. In addition, mediating factors such as emotion regulation strategies and attributional style were expected to improve within the EG over time. Rating of treatment fidelity was very high, indicating good reliability of the intervention. The acceptance of families of the program was excellent; children and parents gave a very positive feedback about the intervention and their personal benefit of participating. Results indicate significant reduction of self-reported psychopathological symptoms between groups over time favouring a positive intervention effect. In addition, parent-rated psychopathology symptoms also showed significant decreases from baseline to post-assessment. Against expectations, both groups showed significant lower depression. There was a significant interaction effect of time and group indicating less maladaptive emotion regulation strategies and a more positive internal attributional style in the intervention group compared to the control group over time. Both groups showed improved adaptive emotion regulation strategies but a more negative attributional style over the study period. In contrast to predictions, there was a significant interaction effect of time and group in the negative internal attributional style scale, indicating a more negative attributional style of children in the EG over time. The benefits of the CG are interpreted as general activation for this high risk group for seeking information help. Together these findings are promising, although the results are preliminary and a bigger sample is necessary for more confident interpretations. There is a lack of evidence and number of prevention programs for this high-risk group, especially in Germany. Since effect sizes of prevention interventions were found to be small and diminish over time, further research is needed to identify relevant mediators and moderators in order to increase efficacy. In sum, this thesis supports previous findings about the increased risk of depression for the offspring of parents suffering from depression and the association of parental and youth depression. In addition, it provides novel information about particular risk factors for children of depressed parents. Moreover, results of the first replication of a promising prevention intervention in Germany suggest that it is possible to modify some of these risk factors (maladaptive emotion regulation strategies and positive internal attributional style) and that doing so has positive effects on reducing self-reported psychopathology in children at risk

A randomised controlled trial of a family-group cognitive-behavioural (FGCB) preventive intervention for the children of parents with depression: short-term effects on symptoms and possible mechanisms

OBJECTIVE Parental depression is one of the biggest risk factors for youth depression. This parallel randomized controlled trial evaluates the effectiveness of the German version of the family-group-cognitive-behavioral (FGCB) preventive intervention for children of depressed parents. METHODS Families with (i) a parent who has experienced depression and (ii) a healthy child aged 8-17~years (mean = 11.63; 53% female) were randomly allocated (blockwise; stratified by child age and parental depression) to the 12-session intervention (EG; n = 50) or no intervention (CG; usual care; n = 50). Self-reported (unblinded) outcomes were assessed immediately after the intervention (6~months). We hypothesized that CG children would show a greater increase in self-reported symptoms of depression (DIKJ) and internalising/externalising disorder (YSR/CBCL) over time compared to the EG. Intervention effects on secondary outcome variables emotion regulation (FEEL-KJ), attributional style (ASF-KJ), knowledge of depression and parenting style (ESI) were also expected. Study protocol (Belinda Platt, Pietsch, Krick, Oort, & Schulte-Körne, 2014) and trial registration (NCT02115880) reported elsewhere. RESULTS We found significant intervention effects on self-reported internalising (Formula: see text = 0.05) and externalising (Formula: see text = 0.08) symptoms but did not detect depressive symptoms or parent-reported psychopathology. Parental depression severity did not modify these effects. Both groups showed equally improved knowledge of depression (Formula: see text = 0.06). There were no intervention effects on emotion regulation, attributional style or parenting style. CONCLUSION The German version of the FGCB intervention is effective in reducing symptoms of general psychopathology. There was no evidence that the mechanisms targeted in the intervention changed within the intervention period

Transmission and prevention of depression in the offspring of parents with depression

According to the World Health Organisation, depression is one of the most common psychiatric disorders - affecting around 350 million people across all age groups worldwide. Suffering from major depression not only causes great personal burden for the affected person, but also for their family, society and economy. The later the disease is recognized, the worse is the prognosis, going along with higher treatment costs. Consequently, an early identification of risk factors for depression is necessary to prevent these high personal and economic costs. One of the groups at greatest risk of developing depression is the offspring of parents suffering from depression. Their risk of developing depression is estimated to be three to four times higher during childhood and adolescence alone, and do even persist into adulthood. Since the transmission of depression from parent to child may result from numerous risk and protective factors and their interaction, the high risk for developing a depression is not understood well yet. Furthermore, although evidence-based treatment interventions for depression have been developed and implemented into practice, few prevention programs for the children of depressed parents have been developed, with heterogeneous findings. In the first part of the thesis, I provide a theoretical framework for the trans-generational transmission of depression based on the existing literature. In addition, prevention approaches and their efficiency in reducing the risk for depression are discussed. In the second and empirical part two studies referring to the transmission and prevention of depression in the offspring of depressed parents are reported. In study I, a high-risk group (HR, n = 74) children of parents with depression is compared to a low-risk group (LR, n = 38) consisting of the offspring of parents without depression. The goal of the study was to i) replicate findings of the increased risk in youth that is associated with parental depression and ii) identify most prevalent risk factors in order to explore possible mechanisms of the trans-generational transmission of depression. Therefore, the HR and LR were compared in general psychopathology (self-rated depressive and psychopathology symptoms; parent-rated psychopathology) and the mediators (emotion regulation, attributional style) and moderators (life events). In addition, the role of parental depression and its impact and association on the children’s depressive symptoms is investigated. The data supported earlier findings of increased risk for depression for the HR, since the HR showed significantly increased psychopathology and depressive symptoms with a big effect size (d = 1.75). Thereby, the parental depression was associated significantly with children’s depression severity. In addition, the data provided strong evidence for group differences in adaptive emotion regulation strategies, positive and negative attributional style and the number of positive life events. Against expectations, groups did not differ in maladaptive emotion regulation strategies and the number of negative life events. Maladaptive emotion regulation strategies, negative life events and parental depression were the strongest predictors of children’s depressive symptoms, together accounting for 30.8 % of the variance. These results suggest practical implications for prevention interventions for depression like increasing emotional and cognitive coping strategies and positive life events. Longitudinal highly-powered studies are necessary in future research. In study II, preliminary results of an ongoing randomized controlled trial of one of the most promising prevention programs for the offspring of depressed parents (replicated here for the first time outside of the research group) are presented. Data from n = 61 families who reached post-assessment are provided. It was hypothesized that children in the experimental group (EG) would show decreased symptoms of psychopathology and depression compared to the control group (CG) over time. In addition, mediating factors such as emotion regulation strategies and attributional style were expected to improve within the EG over time. Rating of treatment fidelity was very high, indicating good reliability of the intervention. The acceptance of families of the program was excellent; children and parents gave a very positive feedback about the intervention and their personal benefit of participating. Results indicate significant reduction of self-reported psychopathological symptoms between groups over time favouring a positive intervention effect. In addition, parent-rated psychopathology symptoms also showed significant decreases from baseline to post-assessment. Against expectations, both groups showed significant lower depression. There was a significant interaction effect of time and group indicating less maladaptive emotion regulation strategies and a more positive internal attributional style in the intervention group compared to the control group over time. Both groups showed improved adaptive emotion regulation strategies but a more negative attributional style over the study period. In contrast to predictions, there was a significant interaction effect of time and group in the negative internal attributional style scale, indicating a more negative attributional style of children in the EG over time. The benefits of the CG are interpreted as general activation for this high risk group for seeking information help. Together these findings are promising, although the results are preliminary and a bigger sample is necessary for more confident interpretations. There is a lack of evidence and number of prevention programs for this high-risk group, especially in Germany. Since effect sizes of prevention interventions were found to be small and diminish over time, further research is needed to identify relevant mediators and moderators in order to increase efficacy. In sum, this thesis supports previous findings about the increased risk of depression for the offspring of parents suffering from depression and the association of parental and youth depression. In addition, it provides novel information about particular risk factors for children of depressed parents. Moreover, results of the first replication of a promising prevention intervention in Germany suggest that it is possible to modify some of these risk factors (maladaptive emotion regulation strategies and positive internal attributional style) and that doing so has positive effects on reducing self-reported psychopathology in children at risk

The role of cognitive biases and negative life events in predicting later depressive symptoms in children and adolescents

Aims Cognitive models propose that negative cognitive biases in attention (AB) and interpretation (IB) contribute to the onset of depression. This is the first prospective study to test this hypothesis in a sample of youth with no mental disorder. Methods Participants were 61 youth aged 9–14 years with no mental disorder. At baseline (T1) we measured AB (passive-viewing task), IB (scrambled sentences task) and self-report depressive symptoms. Thirty months later (T2) we measured onset of mental disorder, depressive symptoms and life events (parent- and child-report). The sample included children of parents with ( n = 31) and without ( n = 30) parental depression. Results Symptoms of depression at T2 were predicted by IB ( ß = .35, p = .01) but not AB ( ß = .05, p = .72) at T1. This effect was strongest for children who experienced multiple negative life events (F 2,48 = 6.0, p = .018, ΔR 2 = .08). IB did not predict depressive symptoms at T2 over-and-above the effect of depressive symptoms at T1 ( ß = .21, p = .13). Discussion These findings suggest that IB (but not AB) plays an important role in the aetiology of depression. Modifying IB may have a preventive effect on youth depression, particularly for youth who experience negative life events. This prospective study provides important foundations for future experimental studies

Fostering resilience and well-being in emerging adults with adverse childhood experiences: study protocol for a randomized controlled trial to evaluate the FACE self-help app

Abstract Background Adverse childhood experiences (ACE) are linked to an increased risk of psychological disorders and lower psychosocial functioning throughout life. This study aims to evaluate the FACE self-help app, designed to promote resilience and well-being in emerging adults with a history of ACE. The app is based on cognitive-behavioural principles and consists of two thematic components: (1) self- and emotion regulation (SER) and (2) social skills and biases in social information processing (SSIP). Methods The efficacy of the app will be tested through a single-centre, two-arm randomized controlled trial, comparing an active intervention group against a waiting list control group. The active group is divided into two subgroups, in which the two components are delivered in a different order to investigate differential effects in a crossover design. Up to 250 emerging adults aged 18 to 25 years with a history of ACE from a general population cohort study will be recruited. The primary objective is to test the efficacy of the app in improving resilience (primary outcome) and well-being (co-primary outcome) compared to a waiting list control group and to examine the stability of these effects. The secondary objectives include testing the efficacy of the app in improving the secondary outcomes, i.e., self-efficacy in managing emotions, problem solving, fear of evaluation, social avoidance, and self-esteem; examining the differential effects of the two components; and assessing the effect of the app on real-life data on resilience, affective states, distress in social interactions and coping strategies. Furthermore, the study will investigate potential moderators (e.g. ACE severity) and mediators of intervention outcomes (e.g. self-efficacy in managing emotions). Discussion The results will provide insights into the efficacy of the self-help intervention as well as mediators and moderators of outcomes. Furthermore, results will extend the existing knowledge by testing the differential effects of the SER and SSIP component on the outcomes. Findings can inform improvements to the FACE app and the development of other interventions for this target group and assess its potential as a scalable, low-threshold intervention to support emerging adults with a history of ACE in their transition to adulthood. Trial registration number: NCT05824182

How are families in Germany doing in 2022? Study protocol of a nationally representative, cross-sectional study of parents with children aged 0-3 years.

BackgroundIn order for Early Childhood Intervention (ECI) to be effective, data-based information on families' resources, burden and current use of support services for families with young children, as well as on children's health and development is needed. The study Kinder in Deutschland [Children in Germany]-KiD 0-3 2022 aims at providing these data to help us understand families' situation and needs in Germany now, including families' experience of the COVID-19 pandemic.MethodThe study will recruit up to 300 pediatricians who will invite parents of children aged up to 48 months to participate in the study during a well-child visit. Parents (goal N = 8,000) will complete an online-questionnaire with their own web-enabled device. Pediatricians will complete a short questionnaire about each participating family. The questionnaires cover family psychosocial burden and resources, child health and development, use of family support services, as well as the families' experiences of the COVID-19 pandemic. Data will be analyzed to assess patterns of families´ psychosocial burdens and resources, use of support services for families with young children, and children´s health and development. Concordance between parent and pediatrician report will be assessed and comparisons with the predecessor study of 2015 will be drawn.DisseminationFindings will be disseminated through scientific conferences, open access peer-reviewed journals, and dissemination channels of the National Centre for Early Prevention.DiscussionThe present study will provide parent and pediatrician reports on how families with young children are doing in Germany. These data will be used to inform Germany's early childhood intervention (ECI) program ("Frühe Hilfen") on current needs of families with young children

Computational charisma—A brick by brick blueprint for building charismatic artificial intelligence

Charisma is considered as one's ability to attract and potentially influence others. Clearly, there can be considerable interest from an artificial intelligence's (AI) perspective to provide it with such skill. Beyond, a plethora of use cases opens up for computational measurement of human charisma, such as for tutoring humans in the acquisition of charisma, mediating human-to-human conversation, or identifying charismatic individuals in big social data. While charisma is a subject of research in its own right, a number of models exist that base it on various “pillars,” that is, dimensions, often following the idea that charisma is given if someone could and would help others. Examples of such pillars, therefore, include influence (could help) and affability (would help) in scientific studies, or power (could help), presence, and warmth (both would help) as a popular concept. Modeling high levels in these dimensions, i. e., high influence and high affability, or high power, presence, and warmth for charismatic AI of the future, e. g., for humanoid robots or virtual agents, seems accomplishable. Beyond, also automatic measurement appears quite feasible with the recent advances in the related fields of Affective Computing and Social Signal Processing. Here, we therefore present a brick by brick blueprint for building machines that can appear charismatic, but also analyse the charisma of others. We first approach the topic very broadly and discuss how the foundation of charisma is defined from a psychological perspective. Throughout the manuscript, the building blocks (bricks) then become more specific and provide concrete groundwork for capturing charisma through artificial intelligence (AI). Following the introduction of the concept of charisma, we switch to charisma in spoken language as an exemplary modality that is essential for human-human and human-computer conversations. The computational perspective then deals with the recognition and generation of charismatic behavior by AI. This includes an overview of the state of play in the field and the aforementioned blueprint. We then list exemplary use cases of computational charismatic skills. The building blocks of application domains and ethics conclude the article

Recommendations for the Development of Family-Based Interventions Aiming to Prevent Unhealthy Changes in Energy Balance-Related Behavior during the Transition to Parenthood: A Focus Group Study

Feasible interventions addressing unhealthy changes in energy balance-related behavior (EBRB) during pregnancy and early postpartum are needed. This study identified the needs and wishes of expecting and first-time parents concerning EBRB interventions during the transition to parenthood. Thirteen focus group discussions (n = 74) were conducted. Couples provided information about whether an intervention targeting unhealthy EBRB changes during pregnancy and postpartum would be acceptable, how such an intervention should look like, and in which way and during which period they needed support. Guided by the TiDIER checklist, all quotes were divided into five main categories (i.e., ‘what’, ‘how’, ‘when and how much’, ‘where’, ‘for and from whom’). Interventions should aim for changes at the individual, social, environmental and policy levels. The accessibility and approach (indirect or face-to-face) together with communicational aspects should be taken into account. A focus should go to delivering reliable and personalized information and improving self-regulation skills. Interventions should be couple-or family-based. Authorities, healthcare professionals, the partner and peers are important sources for intervention delivery and support. In the prevention of unhealthy EBRB changes around childbirth, the involvement of both parents is needed, while health care professionals play an important role in providing personalized advice