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Bruce E. Compas, PhD, Vanderbilt

Helping family members cope when a parent suffers from depression is the goal of a study being conducted collaboratively by Vanderbilt University and the University of Vermont in Burlington. Both sites are actively recruiting families to participate.

"Children whose parents are depressed are at extraordinary risk for depression, but also anxiety and other kinds of behavior problems," says Vanderbilt's Bruce E. Compas, PhD, who is the study's principal investigator and the Patricia and Rodes Hart Professor of Psychology and Human Development. "Extensive research says that part of that link is perhaps genetic, but a lot of that link is also what happens in a family when they struggle with depression in a parent. Although there's a biological component, there's a large psychological and interpersonal component as well."

The randomized clinical trial is called Raising Healthy Children and is funded by the National Institute of Mental Health. The study follows each participating family for a minimum of two years. The families receive one of two treatments, either educational information or counseling, to determine which works better.

"Any participating family will go into an active arm of the study. They will get something that we believe will be helpful to them. I think it's going to be pretty obvious which we think is potentially the most helpful," Compas says.

The families that receive printed educational materials on coping get three packages over eight weeks with information targeting all the family members. Researchers stay in touch with the families and seek feedback.

Families in the second group are divided into four-family units that come together for eight consecutive weeks and then for an additional four weeks of sessions once a month. They receive group counseling that includes parenting skills and skills to help children cope. "We teach core parenting skills to help the parents offset the effects of depression. We focus on structure, work, being responsive to their children while also setting good limits," Compas explains. "At the same time, we teach the children skills to cope with depression in their parent. We help kids to understand that children don't cause depression in their parent, and depression has a nasty habit of recurring. We teach them ways to handle the stress that occurs when a parent is in an episode of depression." The sessions also bring the families together to learn how to deal with depression as a family, he adds.

Emily Hardcastle, the project coordinator and one of the therapists who works with families, says parents are "very thankful" and welcome the parenting advice. "They come knowing that this is about parenting," she says. In fact, most families become involved in the study motivated by worry and guilt that their depression is having a negative effect on their children. She says the first counseling session is usually "a very destigmatizing experience" because they meet others with the same challenges, fears and concerns.

"We're very open about depression," Hardcastle says. "We put it right out there at the very beginning. We define what it is. We explain it. It's not anyone's fault. The kids haven't done anything wrong. The parents haven't done anything wrong."

Hardcastle adds that the families involved with the self-study intervention rather than counseling are receiving something beneficial as well. "We don't want to downplay the readings at all. I have to say that we made our jobs a lot harder by having what we call the Family Readings Program (rather than a control group that receives no support). It just means that our counseling intervention has to be even better. If we show that it was effective, if we show that it was good, it means it was really good because we didn't just beat nothing. We beat something that we think actually has some value."

Adds Compas, "We don't think it's ethical to randomize families to receive nothing. In fact, long ago, in the very first phase of the work on this, we did try to run a trial in which we had a true no-treatment control group, and families didn't want to participate in that."

Compas began this work in 2000 while a faculty member with the University of Vermont and brought the project to Nashville when he moved to the city in 2002. While Compas is a nationally recognized authority on coping and stress, his counterpart in Vermont, Rex Forehand, is an expert and author on parenting. Thus, the pair brings complementary expertise to the project. At the two sites, nearly 500 families have been screened as potential participants, with more than 80 families enrolled so far. Before the current funded study, Compas and Forehand conducted a pilot study with about 50 families "that showed very beneficial effects in which we reduced depressive symptoms in the parents who participated in the group; we enhanced better coping in the kids; and we reduced emotional and behavioral problems in the kids," he says, adding that the pilot data was "promising enough" to purse the randomized clinical trial.

The study is recruiting participants where adults are being treated for depression, either at mental health organizations or medical facilities, as well as through community health centers and by advertising in some local publications. Compas says practitioners should be assured that participation in the study by their patients would only augment the treatment they give their patients, not replace or compete with it.

"The goal is that, as much as two years out, the children who have been in the groups are going to experience lower rates of depression, anxiety and other behavior problems than the children in the comparison condition," he says.

For more information, contact Hardcastle at 615-322-4081.

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