Baseline differences and intervention effects of the “Gesund und Glücklich Aufwachsen (GUG-Auf)” prevention program for children of depressed parents

Since children with a parent suffering from depression are at heightened risk of developing psychiatric disorders themselves, they are a target group for preventive interventions and as such a major public health priority. The cognitive-behavioural, family-, and group-based prevention program “Raising Healthy Children” (RHC) has shown promising findings in reducing the prevalence of depression and general psychopathology in a sample of children of depressed parents in the United States of America. The overarching aim of the current thesis is the evaluation of a German adaption of RHC prevention program. The current study is in this form unique, because the program was not evaluated yet outside the research group on an international level. In the first step I investigated whether the psychopathology of children of depressed parents is associated with parental depression (number of symptoms, number of depressive episodes), number of stressful experiences the child experienced and the parental socio-economic status (SES). For baseline differences, data of 77 families (who took part in an intervention study) were available, which were included in the analyses. There was no evidence that children of depressed parents differ at baseline in depressive symptoms in relation to parent depression severity, number of depressive episodes, the number of stressful experiences or the SES. But evidence emerged that offspring’s externalising problem behaviour is related to the number of parental depressive episodes, and offspring’s general psychopathology is related to the number of stressful life events. No relation between SES and offspring’s mental health could be demonstrated. In a second step, I examined whether the prevention program is effective in reducing child’s depression in the short-term (six months after baseline). By investigating preliminary data on incidence of depression at 15 months after baseline, I also investigated the extent to which the intervention prevented depression in the long-term. Further key aims were to see whether the program is effective in reducing child’s general psychopathology, and whether the program is effective in enhancing child’s knowledge of depression as well as whether it is effective in changing the parenting style in a positive direction in the short- and medium-term (six and nine months after baseline). The study was conducted as randomised controlled trial. The 77 families were randomised to receive the twelve session intervention vs. waiting list. Intervention outcomes suggested that the program has positive effects from child’s perspective on child’s internalising and mixed psychopathological symptoms. However, the parental view did not confirm these findings. Parent reports indicate that independent of group (intervention vs. waiting list) both symptom scales improved over a period of nine months. No evidence was found that the program shows benefits on child’s depression, knowledge of depression or child’s perception of parenting style. The knowledge of depression rather enhanced in short-term independent of participation. A feedback evaluation suggested that the general acceptability of the prevention program is high. The baseline findings indicate that the psychopathology of children of depressed parents is influenced by some, but not all, parental factors. Although I could not demonstrate the prevention effect of the program for depression prevention, I could show that some general psychopathological symptoms of children can be reduced by the program. The study provides an important step in the development of more effective prevention, which is exigently required

Baseline differences and intervention effects of the “Gesund und Glücklich Aufwachsen (GUG-Auf)” prevention program for children of depressed parents

Since children with a parent suffering from depression are at heightened risk of developing psychiatric disorders themselves, they are a target group for preventive interventions and as such a major public health priority. The cognitive-behavioural, family-, and group-based prevention program “Raising Healthy Children” (RHC) has shown promising findings in reducing the prevalence of depression and general psychopathology in a sample of children of depressed parents in the United States of America. The overarching aim of the current thesis is the evaluation of a German adaption of RHC prevention program. The current study is in this form unique, because the program was not evaluated yet outside the research group on an international level. In the first step I investigated whether the psychopathology of children of depressed parents is associated with parental depression (number of symptoms, number of depressive episodes), number of stressful experiences the child experienced and the parental socio-economic status (SES). For baseline differences, data of 77 families (who took part in an intervention study) were available, which were included in the analyses. There was no evidence that children of depressed parents differ at baseline in depressive symptoms in relation to parent depression severity, number of depressive episodes, the number of stressful experiences or the SES. But evidence emerged that offspring’s externalising problem behaviour is related to the number of parental depressive episodes, and offspring’s general psychopathology is related to the number of stressful life events. No relation between SES and offspring’s mental health could be demonstrated. In a second step, I examined whether the prevention program is effective in reducing child’s depression in the short-term (six months after baseline). By investigating preliminary data on incidence of depression at 15 months after baseline, I also investigated the extent to which the intervention prevented depression in the long-term. Further key aims were to see whether the program is effective in reducing child’s general psychopathology, and whether the program is effective in enhancing child’s knowledge of depression as well as whether it is effective in changing the parenting style in a positive direction in the short- and medium-term (six and nine months after baseline). The study was conducted as randomised controlled trial. The 77 families were randomised to receive the twelve session intervention vs. waiting list. Intervention outcomes suggested that the program has positive effects from child’s perspective on child’s internalising and mixed psychopathological symptoms. However, the parental view did not confirm these findings. Parent reports indicate that independent of group (intervention vs. waiting list) both symptom scales improved over a period of nine months. No evidence was found that the program shows benefits on child’s depression, knowledge of depression or child’s perception of parenting style. The knowledge of depression rather enhanced in short-term independent of participation. A feedback evaluation suggested that the general acceptability of the prevention program is high. The baseline findings indicate that the psychopathology of children of depressed parents is influenced by some, but not all, parental factors. Although I could not demonstrate the prevention effect of the program for depression prevention, I could show that some general psychopathological symptoms of children can be reduced by the program. The study provides an important step in the development of more effective prevention, which is exigently required

Biased Maintenance of Attention on Sad Faces in Clinically Depressed Youth: An Eye-Tracking Study

The role of negative attention biases (AB), central to cognitive models of adult depression, is yet unclear in youth depression. We investigated negative AB in depressed compared to healthy youth and tested whether AB are more pronounced in depressed than at-risk youth. Negative AB was assessed for sad and angry faces with an eye-tracking paradigm Passive Viewing Task (PVT) and a behavioural task Visual Search Task (VST), comparing three groups of 9-14-year-olds: youth with major depression (MD; n = 32), youth with depressed parents (high-risk; HR; n = 49) and youth with healthy parents (low-risk; LR; n = 42). The PVT revealed MD participants to maintain attention longer on sad faces compared to HR, but not LR participants. This AB correlated positively with depressive symptoms. The VST revealed no group differences. Our results provide preliminary evidence for a negative AB in maintenance of attention on disorder-specific emotional information in depressed compared to at-risk youth

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

Qualitative evaluation of a preventive intervention for the offspring of parents with a history of depression

Background: Meta-analyses of randomised controlled trials suggest that psychological interventions to reduce children’s risk of depression are effective. Nevertheless, these effects are modest and diminish over time. The Medical Research Council recommends a mixed-methods approach to the evaluation of complex interventions. By gaining a more thorough understanding of participants’ perspectives, qualitative evaluations of preventive interventions could improve their efficacy, longevity and transfer into clinical practice. Methods: 18 parents and 22 children who had received a 12-session family- and group-based cognitivebehavioural intervention to prevent youth depression as part of a randomised controlled trial took part in semistructured interviews or a focus group about aspects which had been perceived as helpful, elements they were still using after the intervention had ended, and suggestions they had for improving the intervention. Results: The chance to openly share and discuss their experiences of depression within and between families was considered helpful by both children and parents. Children benefitted the most from learning coping strategies for dealing with stress and many still used them in everyday life. Parents profited mostly from increasing positive family time, but noted that maintaining new routines after the end of the intervention proved difficult. Participants were generally content with the intervention but commented on how tiring and time consuming it was. Conclusions: Managing parents’ expectations of family-based interventions in terms of their own mental health needs (versus those of their children) and leaving more room for open discussions may result in interventions which are more appealing to participating families. Increasing intervals between sessions may be one means of improving the longevity of interventions. Trial registration: The original RCT this evaluation is a part of was registered under NCT02115880

A randomized controlled trial of a preventive intervention for the children of parents with depression: mid-term effects, mediators and moderators

Abstract Background In a parallel randomized controlled trial the effectiveness of the family- and group-based cognitive-behavioural “Gug-Auf” intervention in preventing depression in children of depressed parents was evaluated. We hypothesized that the intervention would be associated with reduced incidence of depression at 15 months as well as with reduced symptom severity at 6, 9, and 15 months. We also explored the role of a number of mediators and moderators. Methods Families were included if a parent (n = 100, mean age = 46.06, 61% female) had experienced depression and children (n = 135, aged 8–17 years, 53% female) had no mental illness. Families (91.5% German) were randomly allocated (50:50 block-wise; stratified by child age and parental depression) to the 12-session “GuG-Auf” intervention or no intervention. Outcomes were assessed (on an intention-to-treat basis) at 0-(T1), 6-(T2), 9-(T3) and 15-months (T4) after baseline. Primary outcome (onset of depression; T4) was assessed with standardized (blinded) clinical interviews. Secondary (unblinded) outcome was risk of depression (at T2-T4) indicated by self- and parent-reported symptoms of internalizing, externalizing and depressive disorder. Potential mediators were emotion regulation, attributional style, knowledge of depression and parenting style. Potential moderators were parental depression severity and negative life events. Results None of the children who received the intervention developed depression, whereas two of those in the control group did. The intervention significantly reduced depression risk (indicated by severity of self-reported internalizing symptoms) at T3 (p = .027, d = -0.45) and T4 (p = .035, d = -0.44). Both groups showed reduced depressive symptoms (p = .029, d = -0.44). Cognitive problem-solving and negative parenting emerged as mediators. There was no evidence that the intervention was associated with parent-reported internalizing symptoms or externalizing symptoms. No adverse events were observed. Conclusions Children of parents with depression showed an increase in self-reported (but not parent-reported) internalizing symptoms over time. This increase was not present in children who received the GuG-Auf intervention. The intervention was not associated with changes in externalizing symptoms. Conclusions regarding prevention of the onset of depression were not possible. Despite some limitations in the generalizability, these findings contribute to reducing the burden of youth depression. Registration The trial was registered on 16/04/2014 at ClinicalTrials.gov ( NCT02115880 ) and study protocol published in BMC Psychiatry ( https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-014-0263-2 )