Children of Depressed Mothers: a STAR*D Ancillary Study

总体目的是研究减轻母亲抑郁症状对儿童精神症状和社会功能的影响，作为缓解抑郁的多位点测序治疗方案研究（STAR D）的辅助研究。STAR - D着眼于常见的临床问题，即当患者对标准治疗试验没有反应时，下一步该做什么，旨在确定哪些后续治疗策略是可接受的，并提供最佳的临床结果。这项拟议的辅助研究（STAR D-Child）利用了一个独特的机会，跟踪了一大批不同文化背景的抑郁母亲样本，这些母亲将接受治疗、评估和前瞻性随访，以确定对她们孩子的影响。拟议的儿童研究与STAR D的启动时间一致，并已得到其附属研究委员会的批准。先前的研究表明，患有抑郁症的母亲的孩子患严重和持久问题的风险增加了3到5倍。关于母亲抑郁症的缓解对其后代的影响，人们知之甚少。在接受各种治疗后，母亲抑郁症状缓解的8至16岁儿童的结果将与母亲在接受治疗后仍然抑郁的儿童的结果进行比较。将对参加STAR D方案的母亲的子女进行盲基线和后续评估，并对六个地点的327名母亲和327名儿童进行育儿和家庭功能评估。评估将按基线进行，每三个月进行一次。在母亲完成治疗后，孩子们将被随访12个月。主要的假设是，在随访期间，治疗反应者的孩子比治疗抵抗者的孩子有更少的精神症状和更好的社会功能。抑郁母亲的孩子在抑郁缓解的随访间隔中花费更多的时间，他们的症状会更少，功能水平也会比抑郁母亲的孩子高。父母教养和家庭功能的改变将调解母亲抑郁缓解的影响；人口统计、家庭构成等因素会起到缓和作用。如果成功治疗母亲抑郁症与降低后代患抑郁症的风险有关，这一发现将具有广泛的公共卫生意义。

The overall aim is to study the impact of a reduction of maternal depressive symptoms on children's psychiatric symptoms and social functioning, as an ancillary study to the multisite Sequenced Treatment Alternatives to Relieve Depression study (STAR D). Focusing on the common clinical question of what to do next when patients fail to respond to a standard trial of treatment, STAR D aims at defining which subsequent treatment strategies are acceptable and provide the best clinical results. This proposed ancillary study (STAR D-Child) takes advantage of a unique opportunity to follow a large culturally diverse sample of depressed mothers who will be treated, assessed and followed prospectively to determine the impact on their children. The proposed Child study is timed to coincide with the initiation of STAR D and has been approved by their ancillary studies committee. Previous studies have demonstrated that children of depressed mothers have over three-to five fivefold increased risk of serious and enduring problems. Little is known about the impact of remission of maternal depression on their offspring. The outcomes in the 8 to 16 year old children of mothers who experience a remission of their depression following exposure to a variety of treatments will be compared to children of mothers who remain depressed following exposure to treatment/s. Blind baseline and follow-up evaluations of children of mothers participating in the STAR D protocol and assessments of parenting and family functioning will be conducted in 327 mothers and 327 children in six sites. Assessments will be carried out a baseline and every three months. Children will be followed for 12 months after their mothers complete treatment. The main hypotheses are that children of treatment-responders will have fewer psychiatric symptoms and better social functioning than children of treatment-resistant mothers during the follow-up. Children of depressed mothers who spend a greater proportion of time during the follow-up interval in depression-remission will experience less symptoms and a higher level of functioning than children of mothers who remain depressed. Changes in parenting and family functioning will mediate the impact of maternal depression-remission; demographic, family composition, etc. will moderate the effect. If it is shown that successfully treating maternal depression is associated with diminished risk in offspring, the finding would have wide ranging public health implications.