Parental Remission from Depression and Child Psychopathology

描述（由申请人提供）：许多研究表明，父母患有抑郁症的孩子患抑郁症、焦虑症和行为障碍的比例很高。关于其预防和治疗仍有许多问题有待了解。我们假设成功治疗抑郁的父母可能会缓解后代的疾病。一项成人MDD治疗研究（星星 *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，成功地治疗母亲的抑郁症缓解与孩子的抑郁症和行为障碍在三个月内的显着减少有关。如果母亲没有缓解，孩子的症状就会加重。在一年的随访中，缓解母亲的孩子保持了他们的改善，他们的整体功能也得到了改善。这些调查结果需要推广。还有许多问题有待解决，我们将在新的拟议研究中予以跟进。1.星星 *D每个家庭只包括一个孩子。我们将研究每个家庭中7-17岁的所有儿童。2.星星 *D只包括母亲。我们将包括抑郁的父亲。3.星星 *D是一项有效性研究，限制了收集信息的数量和时间。我们将研究共同父母和照顾者，并将进行更频繁的评估，以便我们可以看到父母和孩子变化的时间和模式。4.星星 *D在前3个月是一项开放性试验，只有当患者在首次用药后没有改善时才进行随机分组。这项新的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可以加速缓解。我们的目标是抓住机会，在最近提交的成人研究中（“联合抗抑郁药加速抑郁症缓解”，PI Stewart和Blier）跟进和扩展我们在星星 *D儿童研究中的发现。成人试验将确定使用药物组合治疗成人MDD是否比单独使用任何一种药物更快缓解。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症父母和200名他们的孩子，以复制和完善我们以前的发现，即成功治疗抑郁症父母会改善他们的孩子。我们的发现，如果在这项拟议的研究中重复，将提供新的策略，帮助症状的儿童抑郁的父母。该项目的公共卫生意义是巨大的，因为它将为帮助抑郁父母的症状儿童提供新的策略。定义父母缓解抑郁症和儿童心理状态之间的关系提供了新的见解的因素，可能会改善儿童的精神病理学。在抑郁和焦虑儿童的治疗不确定的时候，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.