Family Functioning in Adolescents with Major Depressive Disorder
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Poor family functioning is common among children and adolescents with Major Depressive Disorder (MDD). Previous research suggests that depressed children describe their families as less cohesive, supportive, communicative, and as more conflictual than do their nondepressed peers. The present study examined the relationship between family functioning and severity of child/adolescent and parental depressive illness at baseline, whether the presence of healthier family functioning at baseline predicted a differential response to acute treatment with fluoxetine, and whether self-report measures were a better predictor of outcome than clinician or observer rated measures. The family functioning of 168 depressed children and adolescents (ages 8 to 17) and one or both parent(s), and treatment response from the 12-week acute treatment phase of an NIMH-funded study of discontinuation phase treatment for MDD were examined. At study entry and exit, information was collected about the severity of MDD, parental affective symptomatology, and self-reported, clinician reported, and observationally reported family functioning. Participants received 12 weeks of open treatment with fluoxetine, using flexible dosing (10mg-40mg) in order to maximize treatment response. Results indicate a robust treatment response for depressive symptoms across all participants, with an overall response rate of 77% and a remission rate of 66%. There were no significant differences in severity of depression and initial family functioning. Maternal depression was found to be significantly correlated or approaching significance for all five global measures of family functioning examined in this study (including self report, clinician report, and observational report). There were no significant associations found between family functioning at baseline and symptom improvement, although children/adolescents who responded early to treatment had reported significantly healthier family cohesion than late responders to treatment. There were no significant differences in outcome of depressive symptoms based on baseline family functioning. As parents rated their family's health competence functioning in the healthy direction, so did clinicians. Our findings suggest that it is very important to include families in the treatment process for depressed patients, including assessing and addressing parental psychopathology.