Adolescent offspring of endogenous unipolar depressive parents and of normal parents

doi:10.1016/0165-0327(91)90039-U

Journal of Affective Disorders

Volume 21, Issue 3, March 1991, Pages 185-198

https://doi.org/10.1016/0165-0327(91)90039-U Get rights and content

Abstract

Ninety-six children aged 10–17 of unipolar endogenous depressive proband parents and 96 matched control children of well parents were investigated using DSM-IIIR diagnostic criteria. Both sets of parents were also studied. Although the rate of psychopathology was significantly higher in proband than in control children, adaptive functioning as a measure of the severity of the psychopathology did not differentiate the two groups of choldren. Among factors related to the mental status of the children were: severity and onset under 30 years of age of the parental depression and lifelong association of parental anxiety with depression. Personality measurements performed in children showed different personality structures in proband offspring. Data on adolescent psychopathology and personality showed little evidence of a homotypic relationship with the adult affective disorders.

References (55)

H.S. Akiskal et al.
Bipolar outcome in the course of depressive illness
J. Affect. Disord.
(1983)
L. Cytryn et al.
Offspring of patients with affective disorders. II.
J. Am. Acad. Child Psychiatry
(1982)
J.H. Kashani et al.
Differential effect of subtype of parental major affective disorder on children
Psychiatr. Res.
(1985)
K.R. Merikangas et al.
Parental concordance for affective disorders: psychopathology in offspring
J. Affect. Disord.
(1988)
I.W. Miller et al.
The Modified Hamilton Rating Scale for Depression: reliability and validity
Psychiatr. Res.
(1985)
T. Reich et al.
The familial transmission of primary major depressive disorder
J. Psychiatr. Res.
(1987)
D. Von Zerssen
Premorbid personality and affective psychoses
D. Von Zerssen et al.
The premorbid personality of patients with different subtypes of an affective illness
J. Affect. Disord.
(1990)
M.M. Weissman et al.
Psychopathology in the children (ages 6–18) of depressed and normal parents
J. Am. Acad. Child Psychiatry
(1984)
M.M. Weissman et al.
Early-onset major depression in parents and their children
J. Affect. Disord.
(1988)

Z. Welner et al.

School-aged children of depressed parents: a blind and controlled study

J. Affect. Disord.

(1988)

H.S. Akiskal

The interface of chronic depression with personality and anxiety disorders

Psychopharmacol. Bull.

(1984)

H.S. Akiskal

Affective disorders in referred children and younger siblings of manic-depressives

Arch. Gen. Psychiatry

(1985)

H.S. Akiskal et al.

The relationship of personality to affective disorders

Arch. Gen. Psychiatry

(1983)

R. Alnaes et al.

Personality and personality disorders among patients with major depression in combination with dysthymic or cyclothymic disorders

Acta Psychiatr. Scand.

(1989)

American Psychiatric Association

Diagnostic and Statistical Manual of Mental Disorders

(1987)

N.C. Andreasen et al.

The validation of the concept of endogenous depression

Arch. Gen. Psychiatry

(1986)

J. Biederman et al.

High rate of affective disorders in probands with attention deficit disorder and in their relatives: a controlled family study

Am. J. Psychiatry

(1987)

R.J. Cadoret et al.

Depressive disease: personality factors in patients and their relatives

Biol. Psychiatry

(1971)

G.A. Carlson et al.

Unmasking masked depression in children and adolescents

Am. J. Psychiatry

(1980)

M.W.P. Carney et al.

The diagnosis of depressive syndromes and the prediction of ECT response

Br. J. Psychiatry

(1965)

M.W.P. Carney et al.

Prediction of outcome in depressive illness by the Newcastle diagnostic scale

Br. J. Psychiatry

(1986)

C.K. Conners et al.

Children of parents with affective illness

J. Am. Acad. Child Psychiatry

(1979)

J. Davidson et al.

Comparative diagnostic criteria for melancholia and endogenous depression

Arch. Gen. Psychiatry

(1984)

J. Davidson et al.

Validation of four definitions of melancholia by the dexamethasone suppression test

Am. J. Psychiatry

(1984)

N. El-Guebaly et al.

Psychosocial adjustment of offspring of psychiatric inpatients: the effect of alcoholic, depressive and schizophrenic parentage

Can. Psychiatr. Ass. J.

(1978)

E.S. Gershon et al.

A family study of schizoaffective, bipolar I, bipolar II, unipolar and normal control probands

Arch. Gen. Psychiatry

(1982)

Cited by (27)

The risk of anxiety disorders in children of parents with severe psychiatric disorders: a systematic review and meta-analysis
2021, Journal of Affective Disorders
Citation Excerpt :
A total of 25 studies were included in this systematic review and meta-analysis. These studies were conducted in 8 countries: eleven studies (44%) were conducted in the USA (Glasheen et al., 2013, Henin et al., 2005, Nurnberger et al., 2011b, Radke-Yarrow et al., 1992, Biel et al., 2008, Weissman et al., 2006, Halligan et al., 2007, Johnson et al., 2006, Erlenmeyer-Kimling et al., 1997, Birmaher et al., 2009, Bella et al., 2011), three in Spain (12%) (Sanchez-Gistau et al., 2015, Lieb et al., 2002, Garcia-Amador et al., 2013), three in Sweden (12%) (Hirshfeld-Becker et al., 2006, Schubert and McNeil, 2003), three in the UK (12%) (Mars et al., 2012, Cooper et al., 2006, Murray et al., 2011), one in Switzerland (4%) (Vandeleur et al., 2012), one in Germany (4%) (Knappe et al., 2009b), one in Romania (4%) (Grigoroiu-Serbanescu et al., 1991), one in Denmark (4%) (Ellersgaard et al., 2018), and one in Israel (4%) (Hans et al., 2004). Of the 25 studies, fourteen studies included participants from the clinical setting (56%), ten studies from the general populations (40%), and one study used both clinical and community samples (4%).
Several studies have investigated the association between parental severe psychiatric disorders and anxiety disorder risk in offspring, but the findings across these studies have been inconsistent.
Using the PRISMA guideline, a rigorous electronic and manual search was conducted in four electronic databases EMBASE, PubMed, PsychINFO, and Scopus to identify relevant studies. All observation studies (cohort and case-control studies) that examined the association between parental severe psychiatric disorders and the risk of offspring anxiety disorders were identified. Summary risk ratios (RRs) and 95% confidence intervals (95%CI) were synthesized using a fixed and random effect meta-analysis.
Twenty-five studies were included in the final analysis (14 cohort and 11 case-control studies). The meta-analysis showed that parental severe psychiatric disorder was associated with a higher risk of social phobia, panic, obsessive-compulsive, post-traumatic stress, separation anxiety, and generalized anxiety disorders in the offspring. When considering specific severe psychiatric disorders in parents as exposure, parental bipolar disorder was associated with an increased risk of obsessive-compulsive and generalized anxiety disorders in the offspring, whereas parental depressive disorder was associated with an increased risk of social phobia, separation anxiety, and generalized anxiety disorders in the offspring. Conversely, parental schizophrenia was not associated with offspring anxiety disorder
This review suggests that the offspring of parents with severe psychiatric, bipolar, and depressive disorders are at an increased risk of developing a range of anxiety disorders. These findings suggest that targeted early screening and intervention programs are imperative in exposed offspring.
Predictive power of the ADHD GWAS 2019 polygenic risk scores in independent samples of bipolar patients with childhood ADHD
2020, Journal of Affective Disorders
Citation Excerpt :
Family and high risk studies have observed an increased frequency of attention deficit/ hyperactivity disorder (ADHD) in the offspring of parents with major psychiatric disorders (Rieder and Nichols, 1979; Decina et al., 1983; Gershon et al., 1985; Erlenmeyer-Kimling and Cornblatt, 1987; Grigoroiu-Serbanescu et al., 1989; 1991) suggesting that childhood ADHD (cADHD) may be an unspecified precursor of the adult psychoses.
Although there is evidence of genetic correlation between bipolar disorder (BP) and ADHD, the extent of the shared genetic risk and whether childhood ADHD (cADHD) influences the characteristics of the adult BP remain unclear. Our objectives were: (i) to test the ability of polygenic risk scores (PRS) derived from the latest PGC ADHD-GWAS (Demontis et al., 2019) to predict the presence of cADHD in BP patients; (ii) to examine the hypothesis that BP preceded by cADHD is a BP subtype with particular clinical traits and (iii) partially shares its molecular basis with ADHD.
PRS derived from the ADHD-GWAS-2019 were tested in BP patients (N = 942) assessed for cADHD with the Wender Utah Rating Scale and in controls from Romania and UK (N = 1616).
The ADHD-PRS differentiated BP cases with cADHD from controls. Proband sex and BP age-of-onset significantly influenced the discriminative power of the ADHD-PRS. The ADHD-PRS predicted the cADHD score only in males and in BP cases with early age-of-onset (≤21 years). Bipolar patients with cADHD had a younger age-of-onset of mania/depression than patients without cADHD. The ADHD-PRS predicted the BP-affection status in the comparison of early-onset BP cases with controls suggesting a partial molecular overlap between early-onset BP and ADHD.
Retrospective diagnosis of cADHD, small sample size.
The PRS-analysis indicated an acceptable predictive ability of the ADHD-SNP-set 2019 in independent BP samples. The best prediction of both cADHD and BP-affection status was found in the early-onset BP cases. The results may have impact on the individual disease monitoring.
The co-occurrence of attention-deficit/hyperactivity disorder and unipolar depression in children and adolescents: A meta-analytic review
2014, Clinical Psychology Review
Citation Excerpt :
Similarly Neuman et al. (2001) found that genetic factors partially explained the presence versus absence of ADHD co-occurrence patterns using latent class analysis with a large sample of female twins. Several other studies have indicated that higher rates of depression are seen in parents of children with ADHD than in parents of children without ADHD (Bhatia, Nigam, Bohra, & Malik, 1991; Biederman, Faraone, Keenan, Knee, & Tsuang, 1990; Biederman et al., 1992; Faraone, Biederman, Keenan, & Tsuang, 1991) and that higher rates of ADHD are seen in children of depressed parents than in children of non-depressed parents (Grigoroiu-Serbanescu et al., 1991; Orvaschel, Walsh-Allis, & Ye, 1988; Weissman et al., 1984). Thus, initial evidence suggests that shared genetic factors may play a role in the co-occurrence of ADHD and depression, although additional research is necessary before conclusions are drawn.
This paper reviews the empirical literature on the association between attention-deficit/hyperactivity disorder (ADHD) and depression (i.e., unipolar depressive disorders and symptoms) among children and adolescents. Findings from cross-sectional and longitudinal studies published on the co-occurrence of ADHD and depression were summarized and subjected to a meta-analysis. Results (k = 29, N = 8755; rbar = 0.22) indicated that ADHD and depression were positively related, but substantial variability existed across the studies. Subgroup analyses indicated medium positive effects for cross-sectional studies, studies that operationalized ADHD based on DSM-III or DSM-IV diagnostic criteria, and studies that did not include teacher report in the assessment of ADHD. Subgroup analyses showed a large positive effect for studies that operationalized ADHD based on DSM-III-R criteria and studies using clinic referred samples. In contrast, subgroup analyses indicated a small negative and/or unreliable association between ADHD and depression for longitudinal studies, studies using DSM-II diagnostic criteria for hyperkinetic reaction of childhood or used a dichotomous motor hyperactivity criterion, studies that used nonreferred samples, and studies including teacher report in the assessment of ADHD. When studies that used DSM-II diagnostic criteria were removed, a reliable medium effect was found for studies that included teacher report. Similarly when the study that used idiosyncratic methods of diagnosing ADHD was excluded, a reliable medium effect was found for studies that used nonreferred samples. Potential explanations for the findings are discussed, including explanations based on sampling and base rates, artifacts of diagnostic criteria, inaccurate diagnostic boundaries, and etiological relationships. Directions for future research and clinical implications are discussed.
Children of a cohort of depressed patients 25 years later: Psychopathology and relationships
2004, Journal of Affective Disorders
Background: While many studies have examined cross-sectional or short-term effects of parental depression on children, few have studied such children many years later when they reach adulthood. It was hypothesised that children of patients hospitalised for depression 25 years ago would have more psychological morbidity and relationship difficulties than children of a surgical comparison group. Method: Children (n=94) of depressed patients and a surgical control group (n=31) admitted to a teaching hospital 25 years ago were compared on measures of psychiatric morbidity, personality, marital and family relationships. Results: Compared with control children, children of depressed patients demonstrated trends for higher rates of non-phobic anxiety and substance disorders, but neither psychological morbidity overall nor affective disorder specifically. Compared with control children, children of depressed patients rated their relationships with fathers who were spouses of female patients more negatively. Having consciously tried to make their own intimate relationships different from that of their parents, children of depressed patients and their partners reported significantly more caring in their relationships compared with control children and their partners. Conclusion: In this study of the effects of parental depression on children 25 years on, adult children of depressed patients demonstrated significant resilience as evidenced by similar rates of overall psychiatric morbidity and quality of intimate relationships to controls. They may be at risk for specific disorders such as anxiety and substance disorder and have problematic relationships with the “well” spouses of depressed patients particularly if the “well” spouse is their father.
First episode of depression in children at low and high familial risk for depression
2004, Journal of the American Academy of Child and Adolescent Psychiatry
To examine the development of first-onset major depressive disorder (MDD) in children at high and low familial risk for depression in a prospective study.
High-risk children (n = 76) who were free of any lifetime affective disorder and had at least one first-degree and one second-degree relative with a lifetime history of childhood-onset, recurrent, bipolar, or psychotic depression were included. Low-risk children (n = 63) were included if they were free of any lifetime psychiatric disorder and had no first-degree relatives and fewer than 20% of their second-degree relatives with a lifetime affective disorder. Children and their parents were assessed in a prospective design using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic version (K-SADS-E). The average interval between follow-up interviews was 18 months, and the average follow-up period was 6 years.
High-risk children had approximately a threefold increased risk of developing first-onset MDD compared with low-risk children (odds ratio = 3.21). The average age of new-onset MDD was 14.0 ± 2.9 years (range 9.5–19.5 years). Above and beyond the familial loading for MDD, mother's lifetime anxiety disorder (odds ratio = 2.84) and lifetime behavioral disorder (odds ratio = 3.25) in the child significantly added to the risk of developing a first-onset MDD.
Having high familial loading for affective disorders, a mother with and anxiety disorder, and a behavioral disorder in the child all significantly contributed to the risk of developing depression.
Prevention of childhood depression: Recent findings and future prospects
2001, Biological Psychiatry
Citation Excerpt :
These qualities are important targets for preventive intervention programs in the future. Numerous studies have reported increased rates of psychiatric disorders in children from homes with affectively ill parents relative to children with parents who are not ill (Beardslee et al 1998; Grigoroiu-Serbanescu et al 1991). Rates of observed disorder have varied greatly, with estimates as low as 8% to as high as 74% reported in the children of unipolar depressed parents (Lavoie and Hodgins 1994) and from 23 to 92% in the children of bipolar parents (Radke-Yarrow et al 1992).
Traditionally, research on childhood mood disorders has focused on clinical trials and longitudinal course and outcome studies, rather than on prevention. Recently, however, advances in the design, methodology, and evaluation of prevention approaches and progress in understanding what factors predispose children to depression have made possible the development of theoretically driven, empirically justified approaches to the prevention of depression in youngsters who are at high risk, either because of elevated symptom levels or parental mood disorder. In this review, we outline recent empirical findings on risk factors for depression in nonreferred samples of youngsters and also in children of depressed parents. Additionally, we review three trials of preventive interventions for childhood depression that yield promising initial findings. We emphasize the need to understand both risks for depression and factors that protect youngsters at risk from succumbing to depression in guiding the development of prevention programs. We also argue that consideration of prevention of depression requires addressing broader social adversity influences that lead to poor mental health outcomes in children, even beyond the effects of parental mood disorder. We conclude with an emphasis on the importance of a developmental-transactional perspective that highlights opportunities for intervention at different points across the lifespan.

View all citing articles on Scopus

View full text

Adolescent offspring of endogenous unipolar depressive parents and of normal parents

Abstract

J. Affect. Disord.

J. Am. Acad. Child Psychiatry

Psychiatr. Res.

J. Affect. Disord.

Psychiatr. Res.

J. Psychiatr. Res.

J. Affect. Disord.

J. Am. Acad. Child Psychiatry

J. Affect. Disord.

J. Affect. Disord.

The interface of chronic depression with personality and anxiety disorders

Psychopharmacol. Bull.

Affective disorders in referred children and younger siblings of manic-depressives

Arch. Gen. Psychiatry

The relationship of personality to affective disorders

Arch. Gen. Psychiatry

Personality and personality disorders among patients with major depression in combination with dysthymic or cyclothymic disorders

Acta Psychiatr. Scand.

Diagnostic and Statistical Manual of Mental Disorders

The validation of the concept of endogenous depression

Arch. Gen. Psychiatry

High rate of affective disorders in probands with attention deficit disorder and in their relatives: a controlled family study

Am. J. Psychiatry

Depressive disease: personality factors in patients and their relatives

Biol. Psychiatry

Unmasking masked depression in children and adolescents

Am. J. Psychiatry

The diagnosis of depressive syndromes and the prediction of ECT response

Br. J. Psychiatry

Prediction of outcome in depressive illness by the Newcastle diagnostic scale

Br. J. Psychiatry

Children of parents with affective illness

J. Am. Acad. Child Psychiatry

Comparative diagnostic criteria for melancholia and endogenous depression

Arch. Gen. Psychiatry

Validation of four definitions of melancholia by the dexamethasone suppression test

Am. J. Psychiatry

Psychosocial adjustment of offspring of psychiatric inpatients: the effect of alcoholic, depressive and schizophrenic parentage

Can. Psychiatr. Ass. J.

A family study of schizoaffective, bipolar I, bipolar II, unipolar and normal control probands

Arch. Gen. Psychiatry