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Sibling relationships among offspring of depressed parents

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Children’s wellbeing by PhD Tracy Gladstone. The conference Developing Strength and Resilience in Children 1-2 Nov. 2010 in Oslo.

Children’s wellbeing by PhD Tracy Gladstone. The conference Developing Strength and Resilience in Children 1-2 Nov. 2010 in Oslo.

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    Sibling relationships among offspring of depressed parents Sibling relationships among offspring of depressed parents Presentation Transcript

    • Sibling Relationships in Children of Depressed Parents Tracy R. G. Gladstone, Alice Frye, William R. Beardslee, V. Robin Weersing, Judy Garber, Greg Clarke, David Brent and Eugene D’Angelo November 2, 2010 Oslo, Norway 1
    • Parental Depression  Strongest risk factor for the development of depression in children  Children have two- to four-fold increased risk of developing depression  Children have more internalizing and externalizing disorders, cognitive delays, academic and social difficulties  Effects of maternal depression have been found from infancy through adolescence 2
    • Interpersonal Effects of Parental Depression  Negative, hostile and irritable towards children  More disengaged and withdrawn parenting  More parent-child conflict  More marital conflict 3
    • Positive Sibling Relationships  Better social-cognitive skills  Positive peer relationships  Better perspective-taking skills  Better self-control  Decreased depressive symptoms  Fewer externalizing problems  Better coping skills 4
    • Negative Sibling Relationships  Aggressive behaviors  Poor peer relationships  Academic difficulties  Feelings of inadequacy  Hostility  Early substance abuse and sexual behaviors 5
    • California Children of Divorce Project (Wallerstein, 1985)  Began in 1971  Nonclinical sample – 60 families, 131 children, aged 2-18 at time of divorce  Assessed at time of separation, 18 months, 5 years and 10 years post- separation  10-year follow-up of young adults who were 9+ at time of separation (N=40) 6
    • Sibling Effects  ―My brother and I are unusually close…I don’t know what I would have done without him.‖  ―Divorce forced my brother and me to grow up and to be close to each other.‖  ―My relationship with my sister has been the saving of our emotional and physical selves…without the other our chances of turning out how we are would have been very different. If I’d been an only child, I might have lost my sanity.‖ 7
    • Wallerstein (1985) Findings  Siblings helped one another manage the stress of parental divorce.  Sibling relationships were protective. 8
    • Study Goal  To examine the effects of sibling relationships on child outcome in families with depressed parents  In families with a depressed parent, do strong sibling relationships buffer teens from the effects of negative parenting behaviors that are associated with parental depression? 9
    • Adolescent Eligibility Requirements  Teen aged 13-17  Parent with history of depression AND  Teen with history of depression OR current depressive symptoms * Teens with current depressive disorder were NOT eligible for this study 10
    • Full Sample Description (N=316) Characteristic Child Age M=14.79 Range: 13-17 years Child Sex 185 Girls 131 Boys Child Race White: 80% Black: 13% Other: 7% Child Ethnicity Non-Latino: 93% Latino: 7% Parents’ Marital 60% Married Status Mother in Home 93% Family Income Median: 60-70,000 Parent Education Mean: Some College 11
    • Measures  Adolescent Symptomatology  Center for Epidemiologic Studies – Depression Scale (CES-D)  Screen for Anxiety Related Emotional Disorders (SCARED)  Patient Health Questionnaire (PHQ) - GAD  Parental Behaviors  Five Minute Speech Sample Task (FMSS)  Conflict Behavior Questionnaire (CBQ)  Child’s Report of Parental Behavior Inventory (CRPBI)  Sibling Relationships  Sibling Relationships Questionnaire (SRQ) 12
    • Measures of Adolescents’ Symptoms – CES-D  20 items  Symptoms over past 1 week  Sample items:  ―I did not feel like eating, my appetite was poor‖  ―I thought my life had been a failure‖  ―I had crying spells‖ 13
    • Measures of Adolescents’ Symptoms - SCARED  41 items  Symptoms over past 3 months  Sample items  ―I get stomachaches at school.‖  ―When I get frightened, my heart beats fast.‖  ―I don’t like to be with people I don’t know well.‖ 14
    • Measures of Adolescents’ Anxiety Diagnosis - PHQ  26 items (related to anxiety)  Symptoms over past 6 months  Sample items  ―In the last 6 months, have you had an anxiety attack, when you suddenly felt fear or panic for no apparent reason?‖  ―In the last 6 months, have you felt nervous, anxious, or on edge, or have you worried a lot on more than half the days?‖ 15
    • Measures of Parenting Behaviors - FMSS  ―Please tell me what kind of person your child is, and how the two of you get along together‖  Parents talk for 5 minutes without interruption  Rated for expressed emotion 16
    • Measures of Parenting Behaviors - CBQ  Parent- and child-rated versions  20 items  Negative communication and conflict over past 2 weeks  Sample items:  ―My child is easy to get along with.‖  ―My child tells me he/she thinks I am unfair.‖  ―My child acts impatient when I talk.‖ 17
    • Measures of Parenting Behaviors - CRPBI  Parent- and child-rated versions  23 items, scores on parental warmth/acceptance, psychological control and monitoring  Sample items:  ―You give your child a lot of care and attention.‖  ―You often interrupt your child.‖ 18
    • Measure of Sibling Relationship Quality - SRQ  6 items assessing sibling intimacy and prosocial behaviors  Completed for sibling who is ―the most important in your life‖  Sample items:  ―How much do you and this sibling share with each other?‖  ―Some siblings cooperate a lot, whereas other siblings cooperate a little. How much do you and this sibling cooperate with each other?‖ 19
    • Measures: Descriptive Statistics Measure Mean (Standard Deviation) CRPBI-Acceptance, Mother on Child 26.06 (3.62) CRPBI-Acceptance, Child on Mother 23.89 (4.84) Five Minute Speech Sample—EE 3.39 (2.55) Subgroup CBQ-Parent 6.81 (5.74) CBQ-Child 5.68 (5.35) SRQ Total 1.64 (1.00) CES-D Child 15.69 (9.69) CES-D Parent 19.22 (12.26) SCAA-Child 22.57 (12.18) 20
    • Sibling Related Characteristics from SRQ (N=233) Had a Sibling 91% Age Range Difference 0 – 22 years, M=4.28 % Sibling Older than Target Child 47% Gender of sibling 53% female % Sibling full or half sibling 90% 21
    • What is Moderation?  A moderator is a variable that influences the strength of the relationship between two other variables.  When the level of the moderator is higher or lower, the degree of relationship between the other variables changes  Cross sectional moderation does not imply causality. 22
    • Analyses  Conducted in M-Plus  Moderation using linear regression  Moderation using logistic regression  Missing data estimated using Full Information Maximum Likelihood  Results similar for models with missing and non-missing data 23
    • Sibling Relationship Quality as a Moderator of Parental Expressed Emotion and Child Outcome Predictor SCAA GAD Beta R2 Odds Ratio Confidence Interval Adolescent -.14 .01 .60 .32—1.11 Age Parental EE .55** .01 1.95* 1.04—3.55 SRQ .37* .01 2.28 .51—8.89 SRQ X EE -.72** .07* .63* .41--.97 * p<.05; ** p<.01 24
    • Sibling Relationship Quality as a Moderator of Parent Expressed Emotion and Child Anxiety Symptoms 60,00 50,00 40,00 Sibling Relationship Child Anxiety Quality 30,00 High Low 20,00 10,00 0,00 0 1 2 3 4 5 6 7 8 Parent Expressed Emotion 25
    • Sibling Relationship Quality as a Moderator of Parent Expressed Emotion and Child Anxiety Diagnosis 1,00 0,90 0,80 Predicted Probability of Diagnosis 0,70 0,60 Sibling Relationship 0,50 Quality High 0,40 Low 0,30 0,20 0,10 0,00 0 1 2 3 4 5 6 7 8 Parental Expressed Emotion 26
    • Sibling Relationship Quality as a Moderator of Parent Reported Psychological Control and Child Outcome Predictor GAD Odds Ratio Confidence Interval Adolescent .69 .41--1.73 Age Psych 1.95 .94--2.83 Control SRQ 142.06* 1.32—*** SRQ X .54* .34--.90 Control *p<.05; **p<.01; ***p<.001 27
    • Sibling Relationship Quality as a Moderator of Parent Reported Psychological Control and Child Anxiety Diagnosis 1,00 0,90 0,80 Predicted Probability of Diagnosis 0,70 Sibling Relationship 0,60 Quality High 0,50 Low 0,40 0,30 0,20 0,10 0,00 0 4 8 12 16 20 24 Parental Psychological Control 28
    • Sibling Relationship Quality as a Moderator of Parent Reported Negative Interactions and Child Outcome Predictor SCAA CES-D, Adolescent Beta R2 Beta R2 Child Age -.06 .02 -.03 .01 Negative .69** .02 .72** .05 Interactions SRQ .41** .02 .29* .06 SRQ X Negative -.85** .14 -.77** .16 Interactions *=p<.05; **=p<.01 29
    • Sibling Relationship Quality as a Moderator of Parent Reported Negative Behaviors and Child Depressive Symptoms 50,00 40,00 Child Depressive Symptoms Sibling Relationship 30,00 Quality High 20,00 Low 10,00 0,00 0 4 8 12 16 20 Parent Reported Negative Behaviors 30
    • Sibling Relationship Quality as a Moderator of Parent Reported Negative Behaviors and Child Anxiety Symptoms 40,00 35,00 30,00 Child Anxiety Symptoms 25,00 20,00 High Low 15,00 10,00 5,00 0,00 0 4 8 12 16 20 Parent Reported Negative Behaviors 31
    • Sibling Relationship Quality as a Moderator of Child Reported Maternal Acceptance and Child Outcome Predictor CES-D Adolescent Beta R2 Child Age -.07 .01 Maternal -.64** .03 Acceptance SRQ -1.11** .06 SRQ X Maternal 1.12* .09 Acceptance *=p<.05; **=p<.01 32
    • Sibling Relationship Quality as a Moderator of Child Reported Maternal Acceptance and Child Depressive Symptoms 45,00 40,00 35,00 Sibling Relationship Child Depressive Symptoms Quality 30,00 25,00 20,00 High Low 15,00 10,00 5,00 0,00 0 5 10 15 20 25 30 Child Reported Maternal Acceptance 33
    • Sibling Relationship Quality as a Moderator of Parent Reported Parental Acceptance and Child Outcome Predictor SCAA CES-D, Adolescent Beta R2 Beta R2 Child Age -.08 .02 -.06 .01 Acceptance -.51** .02 -.53** .02 SRQ -1.63** .02 -1.65* .02 SRQ X 1.68** .07 1.64** .06 Acceptance *=p<.05; **=p<.01 34
    • Sibling Relationship Quality as a Moderator of Parent Reported Parental Acceptance and Child Depressive Symptoms 60,00 50,00 Child Depressive Symptoms 40,00 Sibling Relationship Quality 30,00 High Low 20,00 10,00 0,00 0 5 10 15 20 25 30 Parent Reported Parental Acceptance 35
    • Sibling Relationship Quality as a Moderator of Parent Reported Parental Acceptance and Child Anxiety Symptoms 60,00 50,00 Child Anxiety Symptoms Sibling 40,00 Relationship Quality 30,00 High Low 20,00 10,00 0,00 0 5 10 15 20 25 30 Parent Reported Parental Acceptance 36
    • Limitations  High risk sample  Female respondents only  Not enough fathers to analyze separately  Sibling relationships account for 5-10% of variance 37
    • Conclusions  Multi-method, multi-informant study with consistent findings:  In sibling pairs containing at least one girl, when sibling relationships are warm and supportive, girls are less vulnerable to the negative effects of maternal criticism and negative parenting behaviors  Supports family-based approach to preventing depression in children of depressed parents  Implications for prevention and intervention 38
    • Next Steps  Need to replicate findings with sibling data from a larger sample  Include additional measures of sibling relationships  Observational measures  Reports from both siblings  Parent reports  Include gender-neutral measures  Include more fathers  Longitudinal design 39
    • Sibling-Based Intervention Key Components (Kramer, 2010) ▪ Positive engagement ▪ Cohesion ▪ Shared experiences that build support ▪ Perspective taking ▪ Emotion regulation ▪ Behavioral control ▪ Forming neutral or positive attributions ▪ Problem solving/managing conflicts ▪ Evaluating parental differential treatment 40
    • Sibling Intervention for Families with Parental Depression  Short, structured  Focus on promoting sibling warmth rather than reducing sibling conflict  Include significant psychoeducational and training component for parents  Include direct session with siblings 41
    • Prevention of Depression in At-Risk Adolescents Judy Garber, Vanderbilt University David Brent, University of Pittsburgh Greg Clarke, Kaiser Permanente Center for Health Research William Beardslee, Harvard University V. Robin Weersing, SDSU/UCSD Tracy Gladstone, Wellesley College Steven D. Hollon, Vanderbilt University Lynn Debar, Kaiser Permanente Center for Health Research Eugene D'Angelo, Harvard University 42
    • END 43
    • Sample Description for SRQ, n=233 Characteristic Child Age M=14.79 Range: 13-17 years Child Sex 133 Girls 100 Boys Child Race White: 81% Black: 10.4% Other: 7% Child Ethnicity Non-Latino: 93% Latino: 7% Parents’ Marital 68% married Status Mother in Home 94% Family Income Median: 60-70,000 Parent Education Mean: Some college 44
    • Associations Between Measures (girls analysis sample only) Measure 2. 3. 4. 5. 6. 7. 8. 9. 10. 1. Age -.11 -.14 .14 .10 .00 -.07 .04 -.09 -.05 2. CESD -- .65* .34** -.10 -.21* -.05 .11 .21* .16 Child * 3. SCAA -- -- .11 -.04 -.14 .03 .03 .14 .04 4. CESD- -- -- -- .16 -.10 -.34. .16 -.04 .32** Parent 5. SRQ -- -- -- -- -.01 -.03 .18 -.02 .06 6. CRPBI- -- -- -- -- -- .28** -.20* -.80 -.33** Child 7. CRPBI- -- -- -- -- -- -- -.17 -.21* -.39** Parent 8. FMSS- -- -- -- -- -- -- -- .22* .35** EE 9. CBQ- -- -- -- -- -- -- -- -- .37** Parent 45 *=p<.05; **=p<.01
    • Measures: Descriptive Statistics Measure Mean (Standard Community Norms Deviation) Mean (Standard Deviation) CRPBI-Acceptance, 26.06 (3.62) 25.43 (2.71) Mother on Child CRPBI-Acceptance, 23.89 (4.84) 24.15 (4.02) Child on Mother Five Minute Speech 3.39 (2.55) No comparison, different Sample—EE metric used Subgroup CBQ-Parent 6.81 (5.74) 6.96 (6.02) CBQ-Child 5.68 (5.35) 7.20 (5.61) SRQ Total 1.64 (1.00) 2.40 (.31) CES-D Child 15.69 (9.69) 15.6 (9.7) CES-D Parent 19.22 (12.26) Generally 9-10 SCAA-Child 22.57 (12.18) 37.30 (18.97) 46
    • Current Sample vs. Community Norms  Current Sample  Higher self-reported depressive symptoms in parent  Parent is observed to be more critical regarding child  Teens rate parent as more negative in interactions  Teens report fewer symptoms of anxiety  Teens report less warmth and closeness toward siblings 47