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Children of Currently Depressed Mothers: A STAR*D Ancillary Study

Daniel J. Pilowsky, M.D., M.P.H.; Priya J. Wickramaratne, Ph.D.; A. John Rush, M.D.; Carroll W. Hughes, Ph.D.; Judy Garber, Ph.D.; Erin Malloy, M.D.; Cheryl A. King, Ph.D.; Gabrielle Cerda, M.D.; A. Bela Sood, M.D.; Jonathan E. Alpert, M.D., Ph.D.; Stephen R. Wisniewski, Ph.D.; Madhukar H. Trivedi, M.D.; Ardesheer Talati, Ph.D.; Marlene M. Carlson, M.P.H.; Harry Hong Liu, Ph.D.; Maurizio Fava, M.D.; and Myrna M. Weissman, Ph.D.

Objective: To assess the current and lifetime prevalence of psychiatric disorders among children of currently depressed mothers and to assess the association of clinical features of maternal depression (i.e., severity, chronicity, and clinical features) with child psychopathology. Mothers were participants in the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) multisite trial, designed to compare effectiveness and acceptability of different treatment options for outpatients with nonpsychotic major depressive disorder (MDD).

Method: Treatment-seeking mothers with a current DSM-IV diagnosis of MDD and with at least 1 child 7 to 17 years old were assessed during a major depressive episode (MDE). For each mother, 1 child was assessed (if a mother had more than 1 child, 1 was randomly selected). Maternal features assessed for this study were history of MDEs, severity of current MDE, comorbid conditions, depressive symptom features, and social functioning. Children were assessed for selected psychiatric diagnoses (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version [K-SADS-PL]), psychopathologic symptoms and social functioning (Child Behavior Checklist), and global functioning (Children's Global Assessment Scale). Data were gathered from December 2001 to April 2004.

Results: A large proportion (72%) of mothers were severely depressed (17-item Hamilton Rating Scale for Depression score > = 22). About a third (34%) of children had a current psychiatric disorder, including disruptive behavior (22%), anxiety (16%), and depressive (10%) disorders. Nearly half (45%) had a lifetime psychiatric disorder, including disruptive behavior (29%), anxiety (20%), and depressive (19%) disorders. Atypical depressive features in the mother were associated with a 3-fold increase in the odds of having a child with depressive (OR = 3.3 [95% CI = 1.2 to 9.5]; p = .02) or anxiety (OR = 2.6 [95% CI = 1.1 to 6.9]; p = .03) disorders. A history of maternal suicide attempts and the presence of comorbid panic disorder with agoraphobia were associated with a 3-fold increase and an 8-fold increase in the odds of depressive disorders in the offspring, respectively. The final model showed significant associations (p < =.05) between the following characteristics of maternal depression and offspring disorders: maternal comorbid panic disorder with agoraphobia and offspring depressive and anxiety disorders, maternal irritable depression and offspring disruptive behavior disorders and any disorder, and maternal substance use disorders and any disorder.

Conclusions: Children of mothers in the midst of a current MDE are at high risk for disruptive behavior and anxiety disorders. The elevated risk of psychopathology among children of depressed mothers may recommend assessment of these children when clinically suggested. Children of depressed mothers with comorbid panic disorder with agoraphobia are at high risk for depressive and anxiety disorders and deserve special attention from clinicians.

(J Clin Psychiatry 2006;67:126-136)

Received July 19, 2005; accepted Oct. 17, 2005. From Columbia University and the New York State Psychiatric Institute, New York (Drs. Pilowsky, Wickramaratne, and Weissman); University of Texas Southwestern Medical Center, Dallas (Drs. Rush, Hughes, and Trivedi); Vanderbilt University, Nashville, Tenn. (Dr. Garber); University of North Carolina, Chapel Hill (Dr. Malloy); University of Michigan, Ann Arbor (Dr. King); University of California at San Diego, San Diego (Dr. Cerda); Virginia Commonwealth University, Richmond (Dr. Sood); Harvard University, Boston, Mass. (Drs. Alpert and Fava); University of Pittsburgh, Pittsburgh, Pa. (Dr. Wisniewski); and Columbia University, New York, N.Y. (Drs. Talati and Liu and Ms. Carlson).

This study was supported by grant # R01MH063852 (Dr. Weissman, principal investigator) and contract #N01 MH90003 (Dr. Rush, principal investigator) from the National Institute of Mental Health, Bethesda, Md.

Financial disclosure appears at the end of the article.

Acknowledgments are listed at the end of the article.

The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

Corresponding author and reprints: Daniel J. Pilowsky, M.D., New York State Psychiatric Institute, Unit 24, 1051 Riverside Dr., New York, NY 10032 (e-mail: