Sibling Relationships in Children of Depressed Parents

Tracy R. G. Gladstone, Alice Frye, William R. Beardslee, V. Robin Weersing, Judy Garber, Greg Clarke, David

Brent and Eugene D’AngeloNovember 2, 2010

Oslo, Norway

1

Parental Depression

Strongest risk factor for the development of

depression in children

Children have two- to four-fold increased risk of

developing depression

Children have more internalizing and externalizing

disorders, cognitive delays, academic and social

difficulties

Effects of maternal depression have been found

from infancy through adolescence

2

Interpersonal Effects ofParental Depression

Negative, hostile and irritable towards children

More disengaged and withdrawn parenting

More parent-child conflict

More marital conflict

3

Positive Sibling Relationships

Better social-cognitive skills

Positive peer relationships

Better perspective-taking skills

Better self-control

Decreased depressive symptoms

Fewer externalizing problems

Better coping skills

4

Negative Sibling Relationships

Aggressive behaviors

Poor peer relationships

Academic difficulties

Feelings of inadequacy

Hostility

Early substance abuse and sexual behaviors

5

California Children of Divorce Project (Wallerstein, 1985)

Began in 1971

Nonclinical sample – 60 families, 131 children, aged 2-18 at time of divorce

Assessed at time of separation, 18 months, 5 years and 10 years post-separation

10-year follow-up of young adults who were 9+ at time of separation (N=40)

6

Sibling Effects

―My brother and I are unusually close…I don’t know what I would have done without him.‖

―Divorce forced my brother and me to grow up and to be close to each other.‖

―My relationship with my sister has been the saving of our emotional and physical selves…without the other our chances of turning out how we are would have been very different. If I’d been an only child, I might have lost my sanity.‖

7

Wallerstein (1985) Findings

Siblings helped one another manage the stress of parental divorce.

Sibling relationships were protective.

8

Study Goal

To examine the effects of sibling relationships on child outcome in families with depressed parents

In families with a depressed parent, do strong sibling relationships buffer teens from the effects of negative parenting behaviors that are associated with parental depression?

9

Adolescent Eligibility Requirements

Teen aged 13-17

Parent with history of depression

AND

Teen with history of depression ORcurrent depressive symptoms

* Teens with current depressive disorder were NOT eligible for this study

10

Full Sample Description (N=316)

Characteristic

Child Age M=14.79 Range: 13-17 years

Child Sex 185 Girls 131 Boys

Child Race White: 80% Black: 13% Other: 7%

Child Ethnicity Non-Latino: 93% Latino: 7%

Parents’ Marital Status

60% Married

Mother in Home 93%

Family Income Median: 60-70,000

Parent Education Mean: Some College

11

Measures

Adolescent Symptomatology Center for Epidemiologic Studies – Depression Scale

(CES-D) Screen for Anxiety Related Emotional Disorders

(SCARED) Patient Health Questionnaire (PHQ) - GAD

Parental Behaviors Five Minute Speech Sample Task (FMSS) Conflict Behavior Questionnaire (CBQ) Child’s Report of Parental Behavior Inventory (CRPBI)

Sibling Relationships Sibling Relationships Questionnaire (SRQ)

12

Measures of Adolescents’ Symptoms – CES-D

20 items

Symptoms over past 1 week

Sample items:

―I did not feel like eating, my appetite was poor‖

―I thought my life had been a failure‖

―I had crying spells‖

13

Measures of Adolescents’ Symptoms - SCARED

41 items

Symptoms over past 3 months

Sample items

―I get stomachaches at school.‖

―When I get frightened, my heart beats fast.‖

―I don’t like to be with people I don’t know well.‖

14

Measures of Adolescents’ Anxiety Diagnosis - PHQ

26 items (related to anxiety)

Symptoms over past 6 months

Sample items

―In the last 6 months, have you had an anxiety attack, when you suddenly felt fear or panic for no apparent reason?‖

―In the last 6 months, have you felt nervous, anxious, or on edge, or have you worried a lot on more than half the days?‖

15

Measures of Parenting Behaviors -FMSS

―Please tell me what kind of person your child is, and how the two of you get along together‖

Parents talk for 5 minutes without interruption

Rated for expressed emotion

16

Measures of Parenting Behaviors -CBQ

Parent- and child-rated versions

20 items

Negative communication and conflict over past 2 weeks

Sample items: ―My child is easy to get along with.‖

―My child tells me he/she thinks I am unfair.‖

―My child acts impatient when I talk.‖

17

Measures of Parenting Behaviors -CRPBI

Parent- and child-rated versions

23 items, scores on parental warmth/acceptance, psychological control and monitoring

Sample items: ―You give your child a lot of care and

attention.‖

―You often interrupt your child.‖

18

Measure of Sibling Relationship Quality - SRQ

6 items assessing sibling intimacy and prosocial behaviors

Completed for sibling who is ―the most important in your life‖

Sample items: ―How much do you and this sibling share with each

other?‖

―Some siblings cooperate a lot, whereas other siblings cooperate a little. How much do you and this sibling cooperate with each other?‖

19

Measures: Descriptive StatisticsMeasure Mean (Standard Deviation)

CRPBI-Acceptance, Mother on Child 26.06 (3.62)

CRPBI-Acceptance, Child on Mother 23.89 (4.84)

Five Minute Speech Sample—EE Subgroup

3.39 (2.55)

CBQ-Parent 6.81 (5.74)

CBQ-Child 5.68 (5.35)

SRQ Total 1.64 (1.00)

CES-D Child 15.69 (9.69)

CES-D Parent 19.22 (12.26)

SCAA-Child 22.57 (12.18) 20

Sibling Related Characteristics from SRQ

(N=233)

Had a Sibling 91%

Age Range Difference 0 – 22 years, M=4.28

% Sibling Older than Target Child 47%

Gender of sibling 53% female

% Sibling full or half sibling 90%

21

What is Moderation?

A moderator is a variable that influences the strength of the relationship between two other variables.

When the level of the moderator is higher or lower, the degree of relationship between the other variables changes

Cross sectional moderation does not imply causality.

22

Analyses

Conducted in M-Plus

Moderation using linear regression

Moderation using logistic regression

Missing data estimated using Full Information Maximum Likelihood

Results similar for models with missing and non-missing data

23

Sibling Relationship Quality as a Moderator of Parental Expressed

Emotion and Child Outcome

Predictor SCAA GAD

Beta R2 Odds Ratio Confidence Interval

Adolescent Age

-.14 .01 .60 .32—1.11

Parental EE .55** .01 1.95* 1.04—3.55

SRQ .37* .01 2.28 .51—8.89

SRQ X EE -.72** .07* .63* .41--.97

24

* p<.05; ** p<.01

Sibling Relationship Quality as a Moderator of Parent Expressed Emotion

and Child Anxiety Symptoms

0,00

10,00

20,00

30,00

40,00

50,00

60,00

0 1 2 3 4 5 6 7 8

Ch

ild

An

xie

ty

Parent Expressed Emotion

High

Low

Sibling RelationshipQuality

25

Sibling Relationship Quality as a Moderator of Parent Expressed Emotion

and Child Anxiety Diagnosis

0,00

0,10

0,20

0,30

0,40

0,50

0,60

0,70

0,80

0,90

1,00

0 1 2 3 4 5 6 7 8

Pre

dic

ted

Pro

ba

bil

ity o

f D

iag

no

sis

Parental Expressed Emotion

High

Low

Sibling RelationshipQuality

26

Sibling Relationship Quality as a Moderator of Parent Reported Psychological Control and Child

OutcomePredictor GAD

Odds Ratio Confidence Interval

Adolescent Age

.69 .41--1.73

Psych Control

1.95 .94--2.83

SRQ 142.06* 1.32—***

SRQ X Control

.54* .34--.90

27*p<.05; **p<.01; ***p<.001

Sibling Relationship Quality as a Moderator of Parent Reported

Psychological Control and Child Anxiety Diagnosis

0,00

0,10

0,20

0,30

0,40

0,50

0,60

0,70

0,80

0,90

1,00

0 4 8 12 16 20 24

Pre

dic

ted

Pro

ba

bil

ity o

f D

iag

no

sis

Parental Psychological Control

High

Low

Sibling RelationshipQuality

28

Sibling Relationship Quality as a Moderator of Parent Reported

Negative Interactions and Child Outcome

Predictor SCAA CES-D, Adolescent

Beta R2 Beta R2

Child Age -.06 .02 -.03 .01

Negative Interactions

.69** .02 .72** .05

SRQ .41** .02 .29* .06

SRQ X Negative Interactions

-.85** .14 -.77** .16

*=p<.05; **=p<.01 29

Sibling Relationship Quality as a Moderator of Parent Reported Negative Behaviors and Child

Depressive Symptoms

0,00

10,00

20,00

30,00

40,00

50,00

0 4 8 12 16 20

Ch

ild

De

pre

ssiv

e S

ym

pto

ms

Parent Reported Negative Behaviors

High

Low

Sibling RelationshipQuality

30

Sibling Relationship Quality as a Moderator of Parent Reported Negative Behaviors and Child

Anxiety Symptoms

0,00

5,00

10,00

15,00

20,00

25,00

30,00

35,00

40,00

0 4 8 12 16 20

Ch

ild

An

xie

ty S

ym

pto

ms

Parent Reported Negative Behaviors

High

Low

31

Sibling Relationship Quality as a Moderator of Child Reported Maternal

Acceptance and Child Outcome

Predictor CES-D Adolescent

Beta R2

Child Age -.07 .01

MaternalAcceptance

-.64** .03

SRQ -1.11** .06

SRQ X Maternal Acceptance

1.12* .09

*=p<.05; **=p<.01 32

Sibling Relationship Quality as a Moderator of Child Reported Maternal Acceptance and Child

Depressive Symptoms

0,00

5,00

10,00

15,00

20,00

25,00

30,00

35,00

40,00

45,00

0 5 10 15 20 25 30

Ch

ild

De

pre

ssiv

e S

ym

pto

ms

Child Reported Maternal Acceptance

High

Low

Sibling RelationshipQuality

33

Sibling Relationship Quality as a Moderator of Parent Reported Parental

Acceptance and Child Outcome

Predictor SCAA CES-D, Adolescent

Beta R2 Beta R2

Child Age -.08 .02 -.06 .01

Acceptance -.51** .02 -.53** .02

SRQ -1.63** .02 -1.65* .02

SRQ X Acceptance

1.68** .07 1.64** .06

*=p<.05; **=p<.01 34

Sibling Relationship Quality as a Moderator of Parent Reported Parental Acceptance and Child

Depressive Symptoms

0,00

10,00

20,00

30,00

40,00

50,00

60,00

0 5 10 15 20 25 30

Ch

ild

De

pre

ssiv

e S

ym

pto

ms

Parent Reported Parental Acceptance

High

Low

Sibling RelationshipQuality

35

Sibling Relationship Quality as a Moderator of Parent Reported Parental Acceptance and Child

Anxiety Symptoms

0,00

10,00

20,00

30,00

40,00

50,00

60,00

0 5 10 15 20 25 30

Ch

ild

An

xie

ty S

ym

pto

ms

Parent Reported Parental Acceptance

High

Low

Sibling RelationshipQuality

36

Limitations

High risk sample

Female respondents only

Not enough fathers to analyze separately

Sibling relationships account for 5-10% of variance

37

Conclusions Multi-method, multi-informant study with

consistent findings:

In sibling pairs containing at least one girl, when sibling relationships are warm and supportive, girls are less vulnerable to the negative effects of maternal criticism and negative parenting behaviors

Supports family-based approach to preventing depression in children of depressed parents

Implications for prevention and intervention 38

Next Steps

Need to replicate findings with sibling data from a larger sample

Include additional measures of sibling relationships

Observational measures

Reports from both siblings

Parent reports

Include gender-neutral measures

Include more fathers

Longitudinal design 39

Sibling-Based InterventionKey Components

(Kramer, 2010)

▪ Positive engagement

▪ Cohesion

▪ Shared experiences that build support

▪ Perspective taking

▪ Emotion regulation

▪ Behavioral control

▪ Forming neutral or positive attributions

▪ Problem solving/managing conflicts

▪ Evaluating parental differential treatment40

Sibling Intervention for Families with Parental Depression

Short, structured

Focus on promoting sibling warmth rather than reducing sibling conflict

Include significant psychoeducational and training component for parents

Include direct session with siblings

41

Prevention of Depressionin

At-Risk Adolescents

Judy Garber, Vanderbilt University

David Brent, University of Pittsburgh

Greg Clarke, Kaiser Permanente Center for Health Research

William Beardslee, Harvard University

V. Robin Weersing, SDSU/UCSD

Tracy Gladstone, Wellesley College

Steven D. Hollon, Vanderbilt University

Lynn Debar, Kaiser Permanente Center for Health Research

Eugene D'Angelo, Harvard University42

END

43

Sample Description for SRQ, n=233

Characteristic

Child Age M=14.79 Range: 13-17 years

Child Sex 133 Girls 100 Boys

Child Race White: 81% Black: 10.4% Other: 7%

Child Ethnicity Non-Latino: 93% Latino: 7%

Parents’ Marital Status

68% married

Mother in Home 94%

Family Income Median: 60-70,000

Parent Education Mean: Some college

44

Associations Between Measures(girls analysis sample only)

Measure 2. 3. 4. 5. 6. 7. 8. 9. 10.

1. Age -.11 -.14 .14 .10 .00 -.07 .04 -.09 -.05

2. CESDChild

-- .65**

.34** -.10 -.21* -.05 .11 .21* .16

3. SCAA -- -- .11 -.04 -.14 .03 .03 .14 .04

4. CESD-Parent

-- -- -- .16 -.10 -.34. .16 -.04 .32**

5. SRQ -- -- -- -- -.01 -.03 .18 -.02 .06

6. CRPBI-Child

-- -- -- -- -- .28** -.20* -.80 -.33**

7. CRPBI-Parent

-- -- -- -- -- -- -.17 -.21* -.39**

8. FMSS-EE

-- -- -- -- -- -- -- .22* .35**

9. CBQ-Parent

-- -- -- -- -- -- -- -- .37**

*=p<.05; **=p<.0145

Measures: Descriptive StatisticsMeasure Mean (Standard

Deviation)Community NormsMean (Standard Deviation)

CRPBI-Acceptance, Mother on Child

26.06 (3.62) 25.43 (2.71)

CRPBI-Acceptance, Child on Mother

23.89 (4.84) 24.15 (4.02)

Five Minute Speech Sample—EE Subgroup

3.39 (2.55) No comparison, different metric used

CBQ-Parent 6.81 (5.74) 6.96 (6.02)

CBQ-Child 5.68 (5.35) 7.20 (5.61)

SRQ Total 1.64 (1.00) 2.40 (.31)

CES-D Child 15.69 (9.69) 15.6 (9.7)

CES-D Parent 19.22 (12.26) Generally 9-10

SCAA-Child 22.57 (12.18) 37.30 (18.97) 46

Current Sample vs. Community Norms

Current Sample

Higher self-reported depressive symptoms in parent

Parent is observed to be more critical regarding child

Teens rate parent as more negative in interactions

Teens report fewer symptoms of anxiety

Teens report less warmth and closeness toward siblings

47