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More disengaged and withdrawn parenting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