Concurrent trajectories of change in adolescent and maternal depressive symptoms in the TORDIA study

Abstract

Depression has a heightened prevalence in adolescence, with approximately 15 % of adolescents experiencing a major depressive episode by age 18. Depression in adolescence also poses a risk for future distress and impairment. Despite treatment advances, many adolescents relapse after initial remission. Family context may be an important factor in the developmental trajectory of adolescent depression, and thus in enhancing treatment. This study examined concurrent change over time in adolescent and maternal depressive symptoms in the context of the Treatment of Resistant Depression in Adolescents study. Participants were 334 adolescents (mean age: 16; SD: 1.6; 70 % female, 84 % Caucasian), and their mothers (n = 241). All adolescents were clinically depressed when they entered the study and had received previous selective serotonin reuptake inhibitor (SSRI) treatment. Adolescents received acute treatment for 12 weeks and additional treatment for 12 more weeks. Adolescent depression and suicidal ideation were assessed at 0, 6, 12, 24, 48 and 72 weeks, while maternal depressive symptoms were assessed at 0, 12, 24, 48 and 72 weeks. Latent basis growth curve analyses showed a significant correlation over 72 weeks between trajectories of maternal and adolescent depressive symptoms, supporting the hypothesis of concurrent patterns of change in these variables. The trajectories were correlated more strongly in a subsample that included only dyads in which mothers reported at least one depressive symptom at baseline. Results did not show a correlation between trajectories of maternal depressive symptoms and adolescent suicidal ideation. These findings suggest that adolescent and maternal depressive symptoms change in tandem, and that treatment for adolescent depression can benefit the wider family system. Notably, most mothers in this sample had subclinical depressive symptoms. Future research might explore these trajectories in dyads with more severely depressed mothers.

Trial registration: ClinicalTrials.gov NCT00018902.

Figures

Fig. 1

Latent growth model of maternal depression and adolescent depression. A simplified depiction of the structural equation model used to estimate latent basis growth curves of maternal depression (MD) via BDI-II and adolescent depression (AD) via CDRS-R. The intercept path was constrained to 1 in all cases. The slope of each variable was constrained to 0 at 0 weeks and 72 at 72 weeks. Interim time points were estimated. Though not depicted, analyses controlled for gender and CBT condition on the latent intercepts and slopes. The error structure is not shown

Fig. 2

Trajectories of growth over time in maternal depression, adolescent depression and adolescent suicidal ideation. Clockwise from top-left, the trajectories of decline over 72 weeks in adolescent depressive symptoms, adolescent suicidal ideation and maternal depressive symptoms. For all three variables, the rate of decline was steepest during the initial 12 weeks of treatment. Adolescent depression and suicidal ideation, which were also measured after 6 weeks, showed even faster decline during these initial 6 weeks