Parental Remission from Depression and Child Psychopathology

描述（由申请人提供）：大量研究表明，抑郁父母的孩子有很高的抑郁、焦虑和行为障碍的比例。关于它们的预防和治疗，还有许多有待了解的地方。我们假设成功治疗抑郁的父母可能会导致后代疾病的缓解。一项成人重度抑郁症的治疗研究STAR*D为我们提供了一个独特的机会，通过对患者儿童的辅助研究来检验这一假设。我们发现，成功治疗母亲的抑郁症缓解与三个月后孩子的抑郁症和行为障碍的显著减少有关。如果母亲不赦免，孩子的症状就会恶化。在一年的随访中，汇款母亲的子女继续得到改善，其整体功能也有所改善。这些发现需要重复。许多问题仍然存在，我们将在新提出的研究中进行后续研究。1. STAR*D只包括每个家庭的一个孩子。我们将研究每个家庭7-17岁的所有儿童。2. STAR*D只包括母亲。我们将包括抑郁的父亲。3. STAR*D是一项有效性研究，限制了收集信息的数量和时间。我们会研究共同父母和照顾者，并会进行更频繁的评估，这样我们就能看到父母和孩子变化的时间和模式。4. STAR*D是前3个月的一项开放试验，只有在第一次用药没有改善的情况下，患者才被随机化。这项新研究将成年人随机分为3个治疗组，其中一个治疗组被假设能加速缓解。我们的目标是抓住机会，在最近提交的一项成人研究中跟进和扩展我们在STAR*D儿童研究中的发现（“联合抗抑郁药加速抑郁症缓解”PIs Stewart和Blier）。成人试验将确定使用药物联合治疗成年重度抑郁症是否比单独使用任何一种药物缓解更快。我们对儿童的研究将与成人研究的开始同时进行。我们将独立研究100名正在接受治疗的抑郁父母和200名他们的孩子，以重复和完善我们之前的发现，即成功治疗抑郁父母会导致孩子的改善。我们的发现，如果在这个提议的研究中得到重复，将为帮助父母有抑郁症状的孩子提供新的策略。这个项目的公共卫生意义是巨大的，因为它将为帮助父母有抑郁症状的儿童提供新的策略。明确父母抑郁缓解与儿童心理状态之间的关系，为改善儿童精神病理的因素提供了新的见解。在治疗抑郁和焦虑儿童的方法不确定的时候，需要新的策略。

DESCRIPTION (provided by applicant): Numerous studies have shown that children of depressed parents have high rates of depression, anxiety and conduct disorders. Much remains to be understood about their prevention and treatment. We hypothesized that successful treatment of a depressed parent may lead to a remission of the offspring's disorders. A treatment study of adults with MDD, STAR*D, provided us with a unique opportunity to test this hypothesis via an ancillary study of the patient's children. We found that successful treatment of the mother's depression to remission was associated with a significant reduction in the child's depression and conduct disorder at three months. If the mother did not remit, the child's symptoms worsened. At one year follow-up, the children of remitting mothers, maintained their improvement and their overall functioning also improved. These findings require replication. Many questions remain which we will follow-up in the new proposed study. 1. STAR*D only included one child per family. We will study all children age 7-17 years in each family. 2. STAR*D only included mothers. We will include depressed fathers. 3. The STAR*D was an effectiveness study and limited the amount and timing of information collected. We will study the co-parent, and care takers and will have more frequent assessment so we can see the timing and pattern of change in parent and child. 4. STAR*D was an open trial in the first 3 months and patients were randomized only if they did not improve on the first medication. The new study has adults randomized into 3 treatment groups at entrance, one of which is hypothesized to speed up remission. Our aim is to capture the opportunity to follow up and extend our findings from the STAR*D Child study in a recently submitted adult study ("Combining Antidepressants to Hasten Remission from Depression" PIs Stewart and Blier). The adult trial will determine if treating adults with MDD using a drug combination results in faster remission than using either drug alone. Our study of children will coincide with the initiation of the adult study. We will independently study 100 depressed parents undergoing treatment and 200 of their children to replicate and refine our previous findings that successful treatment of a depressed parent leads to improvement in their children. Our findings, if replicated in this proposed study, will provide new strategies for helping symptomatic children of depressed parents. The public health significance of this project is enormous as it will indicate new strategies for helping symptomatic children of depressed parents. Defining the relationship between parental remission of depression and child psychological status provides new insight into factors which may ameliorate child psychopathology. At a time when the treatment of depressed and anxious children is uncertain, new strategies are needed.