Top

Published in:

Open Access 01-12-2019 | Affective Disorder | Research article

Qualitative evaluation of a preventive intervention for the offspring of parents with a history of depression

Authors: Nathalie Claus, Lisa Marzano, Johanna Loechner, Kornelija Starman, Alessandra Voggt, Fabian Loy, Inga Wermuth, Stephanie Haemmerle, Lina Engelmann, Mirjam Bley, Gerd Schulte-Koerne, Belinda Platt

Published in: BMC Psychiatry | Issue 1/2019

Abstract

Background

Meta-analyses of randomised controlled trials suggest that psychological interventions to reduce children’s risk of depression are effective. Nevertheless, these effects are modest and diminish over time. The Medical Research Council recommends a mixed-methods approach to the evaluation of complex interventions. By gaining a more thorough understanding of participants’ perspectives, qualitative evaluations of preventive interventions could improve their efficacy, longevity and transfer into clinical practice.

Methods

18 parents and 22 children who had received a 12-session family- and group-based cognitive-behavioural intervention to prevent youth depression as part of a randomised controlled trial took part in semi-structured interviews or a focus group about aspects which had been perceived as helpful, elements they were still using after the intervention had ended, and suggestions they had for improving the intervention.

Results

The chance to openly share and discuss their experiences of depression within and between families was considered helpful by both children and parents. Children benefitted the most from learning coping strategies for dealing with stress and many still used them in everyday life. Parents profited mostly from increasing positive family time, but noted that maintaining new routines after the end of the intervention proved difficult. Participants were generally content with the intervention but commented on how tiring and time consuming it was.

Conclusions

Managing parents’ expectations of family-based interventions in terms of their own mental health needs (versus those of their children) and leaving more room for open discussions may result in interventions which are more appealing to participating families. Increasing intervals between sessions may be one means of improving the longevity of interventions.

Trial registration

The original RCT this evaluation is a part of was registered under NCT02115880.

Available only for authorised users

At the time the intervention was referred to as “PRODO” (the time of the study trial) rather than “GuG auf”.

World Health Organisation. Prevention of Mental Disorders: Effective Interventions and Policy Options. Summary Report. Geneva: Prevention Research Centre of the Universities of Nijmegen and Maastricht; 2004.

Weissman MM, Wickramaratne PJ, Nomura Y, Warner V, Pilowsky D, Verdeli H. Offspring of depressed parents: 20 years later. Am J Psychiatry. 2006;163:1001–8.CrossRef

Downey G, Coyne JC. Children of depressed parents: an integrative review. Psychol Bull. 1990;108:50–76.CrossRef

Hammen C, Burge D, Burney E, Adrian C. Longitudinal study of diagnoses in children of women with unipolar and bipolar affective disorder. Arch Gen Psychiatry. 1990;47:1112–7.CrossRef

Klein DN, Lewinsohn PM, Seeley JR, Rohde P. A family study of major depressive disorder in a community sample of adolescents. Arch Gen Psychiatry. 2001;58:13–20.CrossRef

Kovacs M, Devlin B, Pollock M, Richards C, Mukerji P. A controlled family history study of childhood-onset depressive disorder. Arch Gen Psychiatry. 1997;54:613–23.CrossRef

Lieb R, Isensee B, Höfler M, Pfister H, Wittchen H-U. Parental major depression and the risk of depression and other mental disorders in offspring: a prospective-longitudinal community study. Arch Gen Psychiatry. 2002;59:365–74.CrossRef

Orvaschel H, Walsh-Allis G, Ye W. Psychopathology in children of parents with recurrent depression. J Abnorm Child Psychol. 1988;16:17–28.CrossRef

Williamson DE, Birmaher B, Axelson DA, Ryan ND, Dahl RE. First episode of depression in children at low and high familial risk for depression. J Am Acad Child Adolesc Psychiatry. 2004;43:291–7. https://doi.org/10.1097/00004583-200403000-00010.CrossRefPubMed

10.

Rasic D, Hajek T, Alda M, Uher R. Risk of mental illness in offspring of parents with schizophrenia, bipolar disorder, and major depressive disorder: a meta-analysis of family high-risk studies. Schizophr Bull. 2014;40:28–38.CrossRef

11.

Beardslee WR, Podorefsky D. Resilient adolescents whose parents have serious affective and other psychiatric disorders: importance of self-understanding and relationships. Am J Psychiatry. 1988;145:63–9.CrossRef

12.

Beardslee WR, Versage E, Giadstone T. Children of affectively ill parents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1998;37:1134–41.CrossRef

13.

Mattejat F. Kinder depressiver Eltern. In: Braun-Scharm H, editor. Depressionen bei Kindern und Jugendlichen. Stuttgart: Wissenschaftliche Verlagsgesellschaft mbH; 2002. p. 231–45.

14.

Robins LN, Regier DA. Psychiatric disorders in America. New York: Free Press; 1991.

15.

Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J, Dahl RE, et al. Childhood and adolescent depression: a review of the past 10 years. Part I. J Am Acad Child Adolesc Psychiatry. 1996;35:1427–39. https://doi.org/10.1097/00004583-199611000-00011.CrossRefPubMed

16.

Rudolph KD, Klein DN. Exploring depressive personality traits in youth: Origins, correlates, and developmental consequences. Dev Psychopathol. 2009;21:1155–80. https://doi.org/10.1017/S0954579409990095.CrossRefPubMedPubMedCentral

17.

Zhou X, Hetrick SE, Cuijpers P, Qin B, Barth J, Whittington CJ, et al. Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: a systematic review and network meta-analysis. World Psychiatry. 2015;14:207–22. https://doi.org/10.1002/wps.20217.CrossRefPubMedPubMedCentral

18.

Mathers C, Fat DM, Boerma JT. The global burden of disease: 2004 update: World Health Organization; 2008.

19.

Hetrick SE, Cox GR, Witt KG, Bir JJ, Merry SN. Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents. Cochrane Database Syst Rev. 2016;8:CD003380. https://doi.org/10.1002/14651858.CD003380.pub4.

20.

Stockings EA, Degenhardt L, Dobbins T, Lee YY, Erskine HE, Whiteford HA, et al. Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention. Psychol Med. 2016;46:11–26. https://doi.org/10.1017/S0033291715001725.CrossRefPubMed

21.

Loechner J, Starman K, Galuschka K, Tamm J, Schulte-Körne G, Rubel J, et al. Preventing depression in the offspring of parents with depression: A systematic review and meta-analysis of randomized controlled trials. Clin Psychol Rev. 2017;:In press. https://doi.org/10.1016/j.cpr.2017.11.009.CrossRef

22.

Goodman SH, Gotlib IH. Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev. 1999;106:458–90.CrossRef

23.

Beardslee WR, Versage E, Wright EJ, Salt P, Rothberg PC, Drezner K, et al. Examination of preventive interventions for families with depression: evidence of change. Dev Psychopathol. 1997;9:109–30 https://www.cambridge.org/core/article/div-class-title-examination-of-preventive-interventions-for-families-with-depression-evidence-of-change-div/A98F5AF5D489CA8FD63F7160C67D8C09.CrossRef

24.

Compas BE, Forehand R, Keller G, Champion JE, Rakow A, Reeslund KL, et al. Randomized controlled trial of a family cognitive-behavioral preventive intervention for children of depressed parents. J Consult Clin Psychol. 2009;77:1007–20.CrossRef

25.

Garber J, Clarke GN, Weersing VR, Beardslee WR, Brent DA, Gladstone TRG, et al. Prevention of depression in at-risk adolescents: a randomized controlled trial. JAMA Psychiatry. 2009;301:2215–24.

26.

Mason WA, Haggerty KP, Fleming AP, Casey-Goldtein M. Family intervention to prevent depression and substance use among adolescents of depressed parents. J Child Fam Stud. 2012;21:891–905.CrossRef

27.

Sanford M, Byrne C, Williams S, Atley S, Ridley T, Miller J, et al. A pilot study of a parent-education Group for Families Affected by depression. Can J Psychiatry. 2003;48:78–86. https://doi.org/10.1177/070674370304800203.CrossRefPubMed

28.

Compas BE, Forehand R, Thigpen JC, Keller G, Hardcastle EJ, Cole DA, et al. Family group cognitive–behavioral preventive intervention for families of depressed parents: 18- and 24-month outcomes. J Consult Clin Psychol. 2011;79:488–99.CrossRef

29.

Platt B, Pietsch K, Krick K, Oort F, Schulte-Körne G. Study protocol for a randomised controlled trial of a cognitive-behavioural prevention programme for the children of parents with depression: the PRODO trial. BMC Psychiatry. 2014;14:263.CrossRef

30.

Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. Br Med J. 2001;323:334–6.CrossRef

31.

Kaptchuk TJ. The double-blind, randomized, placebo-controlled trial: gold standard or golden calf? J Clin Epidemiol. 2001;54:541–9. https://doi.org/10.1016/S0895-4356(00)00347-4.CrossRefPubMed

32.

Midgley N, Ansaldo F, Target M. The meaningful assessment of therapy outcomes: incorporating a qualitative study into a randomized controlled trial evaluating the treatment of adolescent depression. Psychotherapy. 2014;51:128–37.CrossRef

33.

Blackwood B, O’Halloran P, Porter S. On the problems of mixing RCTs with qualitative research: the case of the MRC framework for the evaluation of complex healthcare interventions. J Res Nurs. 2010;15:511–21. https://doi.org/10.1177/1744987110373860.CrossRef

34.

Spillane JP, Pareja AS, Dorner L, Barnes C, May H, Huff J, et al. Mixing methods in randomized controlled trials (RCTs): validation, contextualization, triangulation, and control. Educ Assess Eval Account. 2010;22:5–28. https://doi.org/10.1007/s11092-009-9089-8.CrossRef

35.

McLeod J. The role of qualitative methods in outcome research. In: McLeod J, editor. Qualitative research in counselling and psychotherapy. 2nd ed. London: SAGE Publications; 2011. p. 161–80.

36.

Hollon SD. Randomized clinical trials. In: Norcross JC, Beutler LE, Levant RF, editors. Evidence-based practices in mental health: debate and dialogue on the fundamental questions. Washington, DC: American Psychological Association; 2006. p. 96–105.

37.

Stiles WB, Hurst RM, Nelson-Gray R, Hill CE, Greenberg LS, Watson JC, et al. What qualifies as research on which to judge effective practice? In: Norcross JC, Beutler LE, Levant RF, editors. Evidence-based practices in mental health: debate and dialogue on the fundamental questions. Washington, DC: American Psychological Association; 2006. p. 56–130.CrossRef

38.

Dures E, Rumsey N, Morris M, Gleeson K. Mixed methods in Health Psychology. J Health Psychol. 2010;16:332–41. https://doi.org/10.1177/1359105310377537.CrossRefPubMed

39.

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions. 2019. www.mrc.ac.uk/complexinterventionsguidance.

40.

Down R, Willner P, Watts L, Griffiths J. Anger management groups for adolescents: a mixed-methods study of efficacy and treatment preferences. Clin Child Psychol Psychiatry. 2010;16:33–52. https://doi.org/10.1177/1359104509341448.CrossRefPubMed

41.

Richards A, Ospina-Duque J, Barrera-Valencia M, Escobar-Rincón J, Ardila-Gutiérrez M, Metzler T, et al. Posttraumatic stress disorder, anxiety and depression symptoms, and psychosocial treatment needs in Colombians internally displaced by armed conflict: a mixed-method evaluation. Psychol Trauma Theory Res Pract Policy. 2011;3:384–93.CrossRef

42.

Davidson L, Ridgway P, Kidd S, Topor A, Borg M. Using qualitative research to inform mental health policy. Can J Psychiatr. 2008;53:137–44. https://doi.org/10.1177/070674370805300303.CrossRef

43.

Barnes M, Sherlock S, Thomas L, Kessler D, Kuyken W, Owen-Smith A, et al. No pain, no gain: depressed clients’ experiences of cognitive behavioural therapy. Br J Clin Psychol. 2013;52:347–64. https://doi.org/10.1111/bjc.12021.CrossRefPubMed

44.

Buus N, Johannessen H, Stage KB. Explanatory models of depression and treatment adherence to antidepressant medication: a qualitative interview study. Int J Nurs Stud. 2012;49:1220–9. https://doi.org/10.1016/j.ijnurstu.2012.04.012.CrossRefPubMed

45.

Cramer H, Salisbury C, Conrad J, Eldred J, Araya R. Group cognitive behavioural therapy for women with depression: pilot and feasibility study for a randomised controlled trial using mixed methods. BMC Psychiatry. 2011;11:82. https://doi.org/10.1186/1471-244X-11-82.CrossRefPubMedPubMedCentral

46.

Nakimuli-Mpungu E, Wamala K, Okello J, Ndyanabangi S, Kanters S, Mojtabai R, et al. Process evaluation of a randomized controlled trial of group support psychotherapy for depression treatment among people with HIV/Aids in Northern Uganda. Community Ment Health J. 2017;53:1–14. https://doi.org/10.1007/s10597-017-0129-4.CrossRef

47.

Renner W, Platz T, Esmann H, Mills S. Evaluation eines psychologischen Präventionsprogramms zur betrieblichen Gesundheitsförderung: quantitative und qualitative Ergebnisse. Prax Klin Verhal und Rehabil. 2000;13:67–75.

48.

Bühler A, Schröder E, Silbereisen RK. Welche Lebensfertigkeiten fördert ein suchtpräventives Lebenskompetenzprogramm? Quantitative und qualitative Ergebnisse einer schulbasierten Interventionsstudie. Zeitschrift für Gesundheitspsychologie. 2007;15:1–13.CrossRef

49.

Skryabina E, Morris J, Byrne D, Harkin N, Rook S, Stallard P. Child, teacher and parent perceptions of the FRIENDS classroom-based universal anxiety prevention Programme: a qualitative study. School Ment Health. 2016;8:486–98. https://doi.org/10.1007/s12310-016-9187-y.CrossRefPubMedPubMedCentral

50.

Scope A, Booth A, Morrell CJ, Sutcliffe P, Cantrell A. Perceptions and experiences of interventions to prevent postnatal depression. A systematic review and qualitative evidence synthesis. J Affect Disord. 2017;210:100–10. https://doi.org/10.1016/j.jad.2016.12.017.CrossRefPubMed

51.

Rubin H, Rubin I. Qualitative interviewing: the art of hearing data. Thousand Oaks: SAGE Publications; 1995.

52.

Smith JA. Qualitative methodology: analysing participants’ perspectives. Curr Opin Psychiatry. 1996;9:417–21.CrossRef

53.

Pihkala H, Johansson EE. Longing and fearing for dialogue with children: depressed parents’ way into Beardslee’s preventive family intervention. Nord J Psychiatry. 2008;62:399–404.CrossRef

54.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Heal Care. 2007;19:349–57.CrossRef

55.

Guest G, Bunce A, Johnson L. How many interviews are enough? Field Methods. 2006;18:59–82. https://doi.org/10.1177/1525822X05279903.CrossRef

56.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. IV-TR. Washington, D.C.: Author; 2000.

57.

Schneider S, Margraf J. Diagnostic Interview for Psychiatric Disorders [Diagnostisches Interview bei psychischen Störungen]. Berlin: Springer; 2011.

58.

Unnewehr S, Schneider S, Margraf J. Kinder-DIPS: Diagnostisches Interview bei Psychischen Störungen im Kindes- und Jugendalter. Heidelberg: Springer Medizin; 2008.

59.

Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62:107–15. https://doi.org/10.1111/j.1365-2648.2007.04569.x.CrossRef

60.

Polit DF, Beck CT. Nursing Research: Principles and Methods. Philadelphia: Lippincott Williams and Wilkins; 2004.

61.

Patton MQ. Qualitative evaluation and research methods. Newbury Park: SAGE Publications; 1990.

62.

Sandelowski M. Qualitative analysis: what it is and how to begin. Res Nurs Health. 1995;18:371–5. https://doi.org/10.1002/nur.4770180411.CrossRef

63.

QSR International Pty Ltd. NVivo qualitative data analysis software. 2012. http://www.qsrinternational.com/nvivo-product.

64.

Graneheim U, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24:105–12. https://doi.org/10.1016/J.NEDT.2003.10.001.CrossRef

65.

Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358:483–8. https://doi.org/10.1016/S0140-6736(01)05627-6.CrossRefPubMed

66.

Gartstein MA, Bridgett DJ, Dishion TJ, Kaufman NK. Depressed mood and maternal report of child behavior problems: another look at the depression–distortion hypothesis. J Appl Dev Psychol. 2009;30:149–60. https://doi.org/10.1016/j.appdev.2008.12.001.CrossRefPubMedPubMedCentral

67.

Beardslee WR, Wright EJ, Gladstone TRG, Forbes P. Long-term effects from a randomized trial of two public health preventive interventions for parental depression. J Fam Psychol. 2007;21:703–13.CrossRef

68.

Beardslee WR, Gladstone TRG, Wright EJ, Cooper AB. A Family-Based Approach to the Prevention of Depressive Symptoms in Children at Risk: Evidence of Parental and Child Change. Pediatrics. 2003;112:e119 LP–e131 http://pediatrics.aappublications.org/content/112/2/e119.abstract.CrossRef

69.

Focht-Birkerts L, Beardslee WR. A Child’s experience of parental depression: encouraging relational resilience in families with affective illness*. Fam Process. 2000;39:417–34. https://doi.org/10.1111/j.1545-5300.2000.39403.x.CrossRefPubMed

70.

Festen H, Schipper K, de Vries SO, Reichart CG, Abma TA, Nauta MH. Parents’ perceptions on offspring risk and prevention of anxiety and depression: a qualitative study. BMC Psychol. 2014;2:17. https://doi.org/10.1186/2050-7283-2-17.CrossRefPubMedPubMedCentral

71.

Stallard P, Norman P, Huline-Dickens S, Salter E, Cribb J. The effects of parental mental illness upon children: a descriptive study of the views of parents and children. Clin Child Psychol Psychiatry. 2004;9:39–52. https://doi.org/10.1177/1359104504039767.CrossRef

72.

Britten N. Qualitative research and the take-up of evidence-based practice. J Res Nurs. 2010;15:537–44. https://doi.org/10.1177/1744987110380611.CrossRef

73.

Compas BE, Forehand R, Thigpen JC, Hardcastle EJ, Garai E, McKee LG, et al. Efficacy and moderators of a family group cognitive–behavioral preventive intervention for children of parents with depression. J Consult Clin Psychol. 2015;83:541–53.CrossRef

74.

Weersing VR, Shamseddeen W, Garber J, Hollon SD, Clarke GN, Beardslee WR, et al. Prevention of depression in at-risk adolescents: predictors and moderators of acute effects. J Am Acad Child Adolesc Psychiatry. 2016;55:219–26.CrossRef

75.

Perrino T, Beardslee W, Bernal G, Brincks A, Cruden G, Howe G, et al. Toward scientific equity for the prevention of depression and depressive symptoms in vulnerable youth. Prev Sci. 2015;16:642–51.CrossRef

Title: Qualitative evaluation of a preventive intervention for the offspring of parents with a history of depression
Authors: Nathalie Claus
Lisa Marzano
Johanna Loechner
Kornelija Starman
Alessandra Voggt
Fabian Loy
Inga Wermuth
Stephanie Haemmerle
Lina Engelmann
Mirjam Bley
Gerd Schulte-Koerne
Belinda Platt
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Affective Disorder
Affective Disorder
Published in: BMC Psychiatry / Issue 1/2019
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-019-2273-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Qualitative evaluation of a preventive intervention for the offspring of parents with a history of depression

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2019

Psychiatric symptoms and risk factors in adults born preterm with very low birthweight or born small for gestational age at term

Clinical effects and treatment outcomes of long-term compulsory in-patient treatment of treatment-resistant patients with severe mental illness and substance-use disorder

A German climbing study on depression: a bouldering psychotherapeutic group intervention in outpatients compared with state-of-the-art cognitive behavioural group therapy and physical activation – study protocol for a multicentre randomised controlled trial

The validity of the patient health Questionnaire-9 to screen for depression in patients with type-2 diabetes mellitus in non-communicable diseases clinics in Malawi

Hazardous alcohol use in a sample of first episode psychosis patients in Singapore

Suicidal plan, attempt, and associated factors among patients with diabetes in Felegehiwot referral hospital, Bahirdar, Ethiopia: cross-sectional study