Brain Derived Neurotrophic Factor Moderates Associations Between Maternal Smoking During Pregnancy And Offspring Behavioral Disorders

Maternal smoking during pregnancy is associated with a number of adverse offspring outcomes. In the present study, based on 209 offspring from a 3-generation family study of depression, we show that the effects of prenatal exposure on offspring externalizing psychopathology (conduct, substance use disorder) is more pronounced in the presence of lower-expressing brain derived neurotrophic factor (BDNF) gene variants. BDNF plays an important role in the development and survival of neural circuits. Individuals with low-expressing variants who are further exposed to prenatal tobacco smoke may be most vulnerable to a spectrum of behavioral disorders that depend on these circuits

Effects of Serotonin Transporter Gene Variation on Impulsivity Mediated by Default Mode Network: A Family Study of Depression

Serotonergic neurotransmission, potentially through effects on the brain’s default mode network (DMN), may regulate aspects of attention including impulse control. Indeed, genetic variants of the serotonin transporter (5-HTT) have been implicated in impulsivity and related psychopathology. Yet it remains unclear the mechanism by which the 5-HTT genetic variants contribute to individual variability in impulse control. Here, we tested whether DMN connectivity mediates an association between the 5-HTT genetic variants and impulsivity. Participants (N = 92) were from a family cohort study of depression in which we have previously shown a broad distribution of 5-HTT variants. We genotyped for 5-HTTLPR and rs25531 (stratified by transcriptional efficiency: 8 low/low, 53 low/high, and 31 high/high), estimated DMN structural connectivity using diffusion probabilistic tractography, and assessed behavioral measures of impulsivity (from 12 low/low, 48 low/high, and 31 high/high) using the Continuous Performance Task. We found that low transcriptional efficiency genotypes were associated with decreased connection strength between the posterior DMN and the superior frontal gyrus (SFG). Path modeling demonstrated that decreased DMN–SFG connectivity mediated the association between low-efficiency genotypes and increased impulsivity. Taken together, this study suggests a gene-brain-behavior pathway that perhaps underlies the role of the serotonergic neuromodulation in impulse control

Religiosity And Major Depression In Adults At High Risk: A Ten-year Prospective Study

Objective: Previously the authors found that personal importance of religion or spirituality was associated with a lower risk for major depression in a study of adults with and without a history of depression. Here the authors examine the association of personal importance of religion or spirituality with major depression in the adult offspring of the original sample using a 10-year prospective longitudinal design. Method: Participants were 114 adult offspring of depressed and nondepressed parents, followed longitudinally. The analysis covers the period from the 10-year to the 20-year follow-up assessments. Diagnosis was assessed with the Schedule for Affective Disorders and Schizophrenia–Lifetime Version. Religiosity measures included personal importance of religion or spirituality, frequency of attendance at religious services, and denomination (all participants were Catholic or Protestant). In a logistic regression analysis, major depression at 20 years was used as the outcome measure and the three religiosity variables at 10 years as predictors. Results: Offspring who reported at year 10 that religion or spirituality was highly important to them had about one-fourth the risk of experiencing major depression between years 10 and 20 compared with other participants. Religious attendance and denomination did not significantly predict this outcome. The effect was most pronounced among offspring at high risk for depression by virtue of having a depressed parent; in this group, those who reported a high importance of religion or spirituality had about one-tenth the risk of experiencing major depression between years 10 and 20 compared with those who did not. The protective effect was found primarily against recurrence rather than onset of depression. Conclusions: A high self-report rating of the importance of religion or spirituality may have a protective effect against recurrence of depression, particularly in adults with a history of parental depression

Screening For Depression In African-american Churches

Introduction: Substantial racial/ethnic disparities exist in the identification and management of major depression. Faith-Based Health Promotion interventions reduce disparities in health screenings for numerous medical conditions. However, the feasibility of systematically screening for depression in faith-based settings has not been investigated. The purpose of this study was to assess the feasibility of using a validated instrument to screen for depression in African-American churches. Methods: Participants were recruited between October and November 2012 at three predominantly African-American churches in New York City. A participatory research approach was used to determine screening days. The Patient Health Questionnaire-9 (PHQ-9) was administered to 122 participants. Positive depression screen was defined as a PHQ-9 score Z10. Descriptive statistics were used to report sample characteristics, prevalence of participants who screened positive, and history of help seeking. Logistic regression analyses were conducted to determine the association of positive depression screen and sociodemographic characteristics. Initial analyses were conducted in 2013, with additional analyses in 2014. Results: The prevalence estimate for positive depression screen was 19.7%. More men (22.5%) screened positive than women (17.7%). Total household income was inversely related to positive depression screen. A similar percentage of respondents had previously sought help from primary care providers as from clergy. Conclusions: It was feasible to screen for depression with the PHQ-9 in African-American churches. The prevalence of positive depression screen was high, especially among black men. Churches may be an important setting in which to identify depressive symptoms in this underserved population

Offspring Of Depressed Parents: 30 Years Later

Objective: While the increased risk of psychopathology in the biological offspring of depressed parents has been widely replicated, the long-term outcome through their full age of risk is less known. The authors present a 30-year follow-up of biological offspring (mean age=47 years) of depressed (high-risk) and nondepressed (low-risk) parents. Method: One hundred forty-seven offspring of moderately to severely depressed or nondepressed parents selected from the same community were followed for up to 30 years. Diagnostic assessments were conducted blind to parents’ clinical status. Final diagnoses were made by a blinded M.D. or Ph.D. evaluator. Results: The risk for major depression was approximately three times as high in the high-risk offspring. The period of highest risk for first onset was between ages 15 and 25 in both groups. Prepubertal onsets were uncommon, but high-risk offspring had over 10-fold increased risk. The early onset of major depression seen in the offspring of depressed parents was not offset by later first onsets in the low-risk group as they matured. The increased rates of major depression in the high-risk group were largely accounted for by the early onsets, but later recurrences in the high-risk group were significantly increased. The high-risk offspring continue to have overall poorer functioning and receive more treatment for emotional problems. There was increased mortality in the high-risk group (5.5% compared with 2.5%) due to unnatural causes, with a nearly 8-year difference in the mean age at death (38.8 years compared with 46.5 years). Conclusions: The offspring of depressed parents remain at high risk for depression, morbidity, and mortality that persists into their middle years. While adolescence is the major period of onset for major depression in both risk groups, it is the offspring with family history who go on to have recurrences and a poor outcome as they mature. In the era of personalized medicine, until a more biologically based understanding of individual risk is found, a simple family history assessment of major depression as part of clinical care can be a predictor of individuals at long-term risk

Psychopathology And Functioning Among Children Of Treated Depressed Fathers And Mothers

Objective: Recent findings suggest that remissions of maternal depression are associated with decrease in offspring psychopathology. Little is known about the offspring effects of decrease in paternal depression. Method: The offspring of married fathers and married mothers were compared. The analysis was restricted to married parents to control for the confounding effect of single parenthood which was more prevalent among depressed mothers. At baseline all parents met criteria for major depressive disorder (MDD), and participated in a 3 month randomized controlled trial to treat depression with a 6 month follow-up. Married parents (N¼43) and their children aged 7–17 years (N¼78) were assessed independently through direct interviews of children and parents at baseline and followed for 9 months. Child assessors were blind to the clinical status of parents and uninvolved in their treatment. Results: At baseline, children of depressed fathers, compared to children of depressed mothers, had significantly fewer psychiatric disorders (11% vs. 37%; p¼ 0.012) and less impairment as measured by the Columbia Impairment Scale (6.5 vs. 11.6; p¼0.009). Over time, with treatment of parental depression, the prevalence of most child symptoms decreased among children of depressed mothers, but changed little among children of depressed fathers. Limitations: The main limitation of the study is the small number of fathers and their offspring included in the study. Conclusion: Maternal as compared to paternal depression had a greater impact on children. With treatment of parental depression the differential prevalence of child symptoms by parental gender narrowed over time. The clinical implication is that children may benefit from treatment of their depressed parents

Borderline Personality Disorder, Exposure To Interpersonal Trauma, And Psychiatric Comorbidity In Urban Primary Care Patients

Objective: Few data are available on interpersonal trauma as a risk factor for borderline personality disorder (BPD) and its psychiatric comorbidity in ethnic minority primary care populations. This study aimed to examine the relation between trauma exposure and BPD in low-income, predominantly Hispanic primary care patients. Method: Logistic regression was used to analyze data from structured clinical interviews and self-report measures (n = 474). BPD was assessed with the McLean screening scale. Trauma exposure was assessed with the Life Events Checklist (LEC); posttraumatic stress disorder (PTSD) was assessed with the Lifetime Composite International Diagnostic Interview, other psychiatric disorders with the SCID-I, and functional impairment with items from the Sheehan Disability Scale and Social Adjustment Scale Self-Report (SAS-SR). Results: Of the 57 (14%) patients screening positive for BPD, 83% reported a history of interpersonally traumatic events such as sexual and physical assault or abuse. While interpersonal trauma experienced during adulthood was as strongly associated with BPD as interpersonal trauma experienced during childhood, noninterpersonal trauma was associated with BPD only if it had occurred during childhood. The majority (91%) of patients screening positive for BPD met criteria for at least one current DSM-IV Axis I diagnosis and exhibited significant levels of functional impairment. Conclusion: Increased awareness of BPD in minority patients attending primary care clinics, high rates of exposure to interpersonal trauma, and elevated risk for psychiatric comorbidity in this population may enhance physicians' understanding, treatment, and referral of BPD patients

Adult Outcomes Of Childhood Disruptive Disorders In Offspring Of Depressed And Healthy Parents

Background: Longitudinal studies of children with disruptive disorders (DDs) have shown high rates of antisocial personality disorder (ASPD) and substance use in adulthood, but few have examined the contribution of parental disorders. We examine child-/adulthood outcomes of DDs in offspring, whose biological parents did not have a history of ASPD, bipolar disorder, or substance use disorders. Method: Offspring (N = 267) of parents with or without major depression (MDD), but no ASPD or bipolar disorders were followed longitudinally over 33 years, and associations between DDs and psychiatric and functional outcomes were tested. Results: Eighty-nine (33%) offspring had a DD. Those with, compared to without DDs, had higher rates of MDD (adjusted odds ratio, AOR = 3.42, p < 0.0001), bipolar disorder (AOR = 3.10, p = 0.03), and substance use disorders (AOR = 5.69, p < 0.0001) by age 18, as well as poorer school performance and global functioning. DDs continued to predict MDD and substance use outcomes in adulthood, even after accounting for presence of the corresponding disorder in childhood (MDD: hazards ratio, HR = 3.25, p < 0.0001; SUD, HR = 2.52, p < 0.0001). Associations were similar among the offspring of parents with and without major depression. DDs did not predict adulthood ASPD in either group. Limitations: Associations are largely accounted for by conduct disorder (CD), as there were few offspring with ADHD, and oppositional defiant disorder (ODD) was not diagnosed at the time this study began. Conclusion: If there is no familial risk for ASPD, bipolar disorder or substance use, childhood DDs do not lead to ASPD in adulthood; however, the children still have poorer prognosis into midlife. Early treatment of children with DD, particularly CD, while carefully considering familial risk for these disorders, may help mitigate later adversity

Treatment Of Maternal Depression In A Medication Clinical Trial And Its Effect On Children

Objective: Observational studies show that when a depressed mother’s symptoms remit, her children’s psychiatric symptoms decrease. Using randomized treatment assignment, the authors sought to determine the differential effects of a depressed mother’s treatment on her child. Method: The study was a randomized double-blind 12-week trial of escitalopram, bupropion, or the combination of the two in depressed mothers (N=76), with independent assessment of their children (N=135; ages 7–17 years). Results: There were no significant treatment differences in mothers’ depressive symptoms or remission. Children’s depressive symptoms and functioning improved significantly among those whose mothers were in the escitalopram group (compared with those whose mothers were in the bupropion and combination treatment groups). Only in the escitalopram group was significant improvement of mother’s depression associated with improvement in the child’s symptoms. Exploratory analyses suggested that this may be due to changes in parental functioning: Mothers in the escitalopram group reported significantly greater improvement, compared with the other groups, in their ability to listen and talk to their children, who as a group reported that their mothers were more caring over the 12 weeks. Maternal baseline negative affectivity appeared to moderate the effect of maternal treatment on children, although the effect was not statistically significant. Children of mothers with low negative affectivity improved in all treatment groups. Children of mothers with high negative affectivity improved significantly only for those whose mothers were in the escitalopram group. Conclusions: The effects of the depressed mother’s improvement on her children may depend on her type of treatment. Depressed mothers with high anxious distress and irritability may require medications that reduce these symptoms in order to show the effect of her remission on her children

Remission Of Maternal Depression And Child Symptoms Among Single Mothers: A Star*d-child Report

Objective: Offspring of depressed parents are at increased risk for depressive and other disorders. We recently found that when depressed mothers reached full remission over 3 months of treatment, a significant improvement in the children’s disorders occurred. Since only a third of the mothers remitted, factors related to maternal remission rates, and thereby child outcomes, were important. This report examined the relationship of the presence of a father in the household to maternal depression remission and child outcomes. Method: Maternal depression was measured using the 17-item Hamilton Rating Scale for Depression (HRSD17); social functioning was assessed using the Social Adjustment Scale-Self Report (SAS-SR). Children (age 7–17) were assessed independently, blind to maternal outcome, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL) and the Child Global Assessment Scale (C-GAS). Results: Single mothers (n = 50), as compared to those in two-parent households (n = 61), were more likely to discontinue treatment (31% vs. 16%, P = 0.04), and less likely to remit if they remained in treatment (20% vs. 43%, P = 0.013). These differences remained significant after adjusting for socioeconomic status and potential confounders, but were partially explained by the mother’s pre-treatment social functioning. The reduction in child diagnoses following maternal remission was greater in two-parent than in single-parent households, although a formal test of interaction between the odds ratios was not significant. Conclusion: Single depressed mothers are more likely to drop out of treatment, and less likely to reach remission if they stay in treatment. This high-risk group requires vigorous treatment approaches