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Parental Depressive Symptoms as a Predictor of Outcome in the Treatment of Child Internalizing and Externalizing Problems

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Abstract

Child internalizing and externalizing problems have been identified as high priority intervention targets by the World Health Organization. Parental depression is a risk factor for development of these childhood problems and may negatively influence intervention outcomes; however, studies have rarely assessed its influence on these outcomes. The present study assessed whether baseline parental depressive symptoms predicted psychotherapy outcomes among children treated for clinically significant internalizing and externalizing problems. The sample included 142 children (79 with primary internalizing problems, 63 with primary externalizing problems). Children were aged 7–13, 67.6% boys, and race included Caucasian (46.5%), African-American (9.9%), Latino (5.6%), Asian (1.4%), and multi-racial (32.4%). Analyses focused on child- and parent-reported weekly trajectories of change and post-treatment symptoms among children treated for internalizing and externalizing problems whose parents did (N = 28 and 25) and did not (N = 51 and 38) have elevated depressive symptoms. For children with internalizing problems, growth curve analyses showed markedly different trajectories, by child- and parent-report: children with less depressed parents showed significantly steeper symptom declines than did children with more depressed parents, who showed an increase in symptoms. ANCOVAs showed marginally lower post-treatment symptoms for children of less depressed versus more depressed parents (p = 0.064 by child-report). For children with externalizing problems, growth curve analyses showed trajectories in the opposite direction, by child- and parent-report; however, ANCOVAs showed no group differences at post-treatment. These findings suggest that it may be important to consider the impact of parental depressive symptoms when treating child internalizing and externalizing problems.

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Acknowledgments

This research was supported by grant K23MH093491 (D. Eckshtain, P.I.) from the National Institute of Mental Health, and the parent study was supported by the John D. and Catherine T. MacArthur Foundation and the Norlien Foundation.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Boston, MA, 02114, USA

    Dikla Eckshtain

  2. Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge St, Cambridge, MA, 02139, USA

    Lauren Krumholz Marchette

  3. Department of Psychology, Harvard University, 1032 William James Hall, 33 Kirkland Street, Cambridge, MA, 02138, USA

    Jessica Schleider, Spencer Evans & John R. Weisz

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  1. Dikla Eckshtain
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Correspondence to Dikla Eckshtain.

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John Weisz receives royalties for some of the work cited in this paper, including the MATCH-ADTC treatment manual used in the study. All other co-authors declare they have no conflict of interest.

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All study procedures were approved by the institutional review boards of Judge Baker Children’s Center, Harvard Medical School, and the University of Hawaii at Manoa.

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Eckshtain, D., Marchette, L.K., Schleider, J. et al. Parental Depressive Symptoms as a Predictor of Outcome in the Treatment of Child Internalizing and Externalizing Problems. J Abnorm Child Psychol 47, 459–474 (2019). https://doi.org/10.1007/s10802-018-0446-2

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