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Journal of Experimental Medical & Surgical Research
Cercetãri Experimentale & Medico-Chirurgicale
Year XVII · Nr.4/2010 · Pag.311 - 315
JOURNAL of
Experimental
Medical
Surgical
R E S E A R C H
THE FAMILY AND PSYCHOSOCIAL BACKGROUND OF
CHILDREN WITH ENDOGEN DEPRESSIVE PARENTS
L.A. Nussbaum1,
L.M. Nussbaum2,
T. Mircea1
SUMMARY:
Objectives: This study aims to evaluate the ways in which the “high risk” children from
parents with endogen depression perceive their parents, the way in which parents with
endogen depression evaluate their children, in comparison with those in the families with a
schizophrenic parent. Material and Methods: We applied three standardized instruments on
the studied “high risk” group of 23 children from parents with depression and on the control
group of 52 children from parents with schizophrenia: Children Behavioral Checklist (CBCL),
The Family Identification Probe (PIF), The Fifth (Vth) Axis. Results: Through the CBCL
application we obtained that all the children registered high scores at the items for
depression, hyperactivity and aggressiveness.Through the PIF application, utilizing the
Spearman’s correlation ranks (R) and the multi-variant analysis ANOVA/ MANOVA, we
obtained a quantification of the child’s identification with his parents. So that, the effect of
the “disorder” factor in all the variables, is higher in the “depressive families” than that in
the “schizophrenic families”. Through the Vth Axe application, the psychosocial burden to
which a child is exposed in a family with a major depressive member is much higher than in
the families with a schizophrenic parent.
Conclusions: The perception of the child by the disordered parent is more distorted in the
families with a depressive parent. The abnormal psychosocial conditions are more
numerous in the families with an endogen depressive parent.
Key-words: high risk, endogen depression, identification, abnormal conditions
FUNDALUL FAMILIAL ªI PSIHOSOCIAL AL COPIILOR CU PÃRINÞI ENDOGEN
DEPRESIVI
Received for publication: 04.09.2010
Revised: 21.10.2010
REZUMAT:
Obiective: Studiul urmãreºte evaluarea modului în care copiii “high risk” ai pãrinþilor cu
depresie endogenã îºi percep pãrinþii, modul în care pãrinþii cu depresie endogenã îºi
evalueazã copiii, în comparaþie cu cei din familiile cu un pãrinte schizofren.Material ºi
Metode: Am aplicat trei instrumente standardizate la lotul studiat, format din 23 copii, grup
“high risk” din familii cu un pãrinte cu depresie endogenã ºi la lotul control format din 52
copii din familii cu un pãrinte schizofren : CBCL, PIF, Axa V. Rezultate: Prin aplicarea CBCL,
toþi copiii au înregistrat scoruri înalte la itemii pentru depresie, hiperactivitate ºi agresivitate.
Prin aplicarea PIF, utilizând rangurile de corelaþie Spearman (R) ºi analiza multivariantã
ANOVA/MANOVA, am obþinut o cuantificare a identificãrii copilului cu pãrinþii. Efectul
factorului tip îmbolnãvire pe toate variabilele, este mai puternic în familiile depresivilor
decât în cele ale schizofrenilor. Prin aplicarea axei V, presiunea psihosocialã la care este
expus un copil dintr-o familie cu un membru depresiv major este mai mare decât în familiile
cu un pãrinte schizofren. Concluzii: Percepþia copilului de cãtre pãrintele bolnav este mai
distorsionatã în familiile cu un pãrinte depresiv. Condiþiile psihosociale abnorme în care
trãiesc copiii sunt mai numeroase în familiile cu un pãrinte cu depresie endogenã.
Cuvinte cheie: înalt grad de risc, depresie endogenã, identificare, condiþii abnorme.
1 – University of Medicine and Pharmacy “V.Babeº”-Timiºoara, Department of Child and Adolescent Psychiatry
2 – Department of Mental Health for Children and Adolescents, Timiºoara
Correspondence to: Laura Nussbaum, MD, Department of Psychiatry for Children and Adolescents Timisoara, UMF
“V.Babes” Timisoara, 2 E.Murgu Sq. , 300041 Timisoara, RO, Tel:40744767343; Email: [email protected]
311
INTRODUCTION
The risk of developing depressive disorders, for the
children of parents with endogenous depression has
been estimated at a value of 15-45%.The children of
parents with endogenous depression present high risk
not only in developing depression but also anxiety
disorders and disruptive disorders. There are needed
some environmental stressors in order to develop those
disorders. The manifestation of psychopathology in
offspring has its roots in the individual geneticbiochemical structures but also in the interaction
phenomenon with the environment.
The clinical reality proved the fact that some children
present a “resilience mechanism” and can rescue
themselves from the psychopathological influences of
the parents, through the projection on real or imaginary
coordinates, which are different from those of the
parenþ’s disorder (Kaplan and Sadock, 1998, Lãzãrescu,
1994).Early installation and the recurrence of depression
in parents are major risk factors for the children to
develop depression.
OBJECTIVES
Through our study we provide a research on a “high
risk” children group, from families with a parent suffering
with endogenous depression.
We aimed a retrospective study but also a prospective
research on the “high risk” children group. We also aimed
the evaluation of the predictive factors for the children to
develop psychopathology. We tried to study the
similarities or differences between the two “high risk”
children groups, those from families with a depressive,
respectively a schizophrenic parent (Mircea Tiberiu,
2004).
MATERIAL AND METHODS
The study was performed in the Clinic of Psychiatry
and Neurology for Children and Adolescents, Timiºoara,
between the years 2005-2010 (Nussbaum Liliana, 2000).
We applied the three standardized research
instruments (CBCL-Children Behavioral Checklist, PIFFamily Identification Probe, the DSM IV Vth Axis ) on the
study group of 23 “high risk” children with endogen
depressive parents and on the control group of 52
children, composed by children from families with one
parent suffering from schizophrenia, as well.
The Ist step of the study included the research in the
Clinic of Psychiatry “Eduard Pamfil” Timiºoara, in order to
identify the families, with a member suffering from major
312
depression. The 2nd step of the study consisted in the
identification of children and adolescents, who needed
ambulatory consultations or were inpatients of the Clinic
of Psychiatry and Neurology of Children and Adolescents
Timiºoara in that period. For the selection of the cases,
we took as inclusion criteria the accessibility of children
and families in order to apply our instruments and also the
presence of one parent suffering from endogen
depression. Our practical study consists in: the research
of the way through which the depressive and the
schizophrenic parents do perceive their children, the
modality of identification or non-identification of the
children with the psychopathologic parental models, the
evaluation of the specific psycho-social conditions of
each family from the studied group and the control group
(Oates, 1997). We applied the three standardized
instruments:
n CBCL (Child Behavior Checklist) elaborated by
Achenbach includes 112 items referring to behavioral
and social competence problems, evaluated by
parents (Achenbach, T.& Edelbrock, 1983).
n This instrument doesn’t have a diagnostic function,
but it evaluates the modality through which the
parents do perceive their child.
n PIF (Family Identification Probe) utilized for the study
of the intra-familial relations.
n This probe implies the identification process of the
child with his parents. The identification concept is
referring as well, to individual aspects - the self image
of the child and to interactional aspects.
n The DSM IV V-th Axis describes methodologically
those aspects of the psycho-social situation of the
child, concerning the developmental grade, the
knowledge acquirements and the socio-cultural
conditions which present a significant deviance from
the normal conditions. The categories included in this
axis, have been chosen, knowing the fact that they
can represent significant risk factors (Remschmidt
1997, 1998).
RESULTS
Through the CBCL application on depressive parents,
respectively schizophrenic parents of children from our
study and control group, our study led to the following
observations concerning the variables - sex of the child
and the parent’s disorder:
n All the children registered high scores at the items for
depression, hyperactivity and aggressiveness,
independently from the sex of the child or the disorder
of the parent- depression or schizophrenia.
Table 1. Scores obtained at CBCL for girls and boys appreciated by the depressive, respectively the schizophrenic parent.
Table 2. Scores on the three subscales of competence and on the total scale of social competence.
Table 3. Internalization / externalization behavior of the two groups.
In the group of children with schizophrenic parents,
the boys and the girls registered similar scores at the
internalization items (depressed, avoidant, somatic
complaints, schizoid-obsessive) and at those of
externalization (hyperactive, delinquent, aggressive)
the scores were higher for boys than for girls
n In the studied target group- children with depressive
parents, the boys obtained high scores at the items
for depression and avoidant behavior, higher than
those obtained by the girls, which indicates a higher
vulnerability for the boys from the families with a
depressive parent.
The scores obtained through the CBCL application,
appreciated by the depressive respectively by the
schizophrenic parent are presented in the table 1.
Through the correlation of the scores obtained through
the CBCL application with the clinical diagnostic, we
noticed that the evaluation made by the psychotic parent
is distorted, by the exacerbation of the symptoms or the
complete ignoring of the child’s symptoms.
n
In the families with an endogen depressive parent,
from the 23 parents with endogen depression, just one
parent caught with accuracy the problematic of the child
in conformity with the clinical diagnostic (table 2, 3).
The results obtained through the PIF application on the
target group and on the control group mirrored the
identification process of the child with his parents
(Poustka, 1997). As a measure of the similitude of the
children’s characterizations, we utilized correlation ranks
between the different items .
Six correlation coefficients can be calculated as it
follows:
n The medium correlation rang for the child’s
self-evaluation, the evaluation of the disturbed parent
and of the healthy parent reflects the identification
process of the child. Significant factors are the sex of
the patient and of the disturbed parent as well as the
age of the child .
n For the identification of the influences of those factors
we utilized the multi-variance analysis ANOVA /
313
Table 4. Multi-variance analysis MANOVA.
MANOVA in which the “dependent” variables are
represented in function of the parent (mother or
father) and the “independent” variables are
represented by the disturbed parent ( table 4).
n The fact that in the families with a schizophrenic
parent not only the identification with the disturbed
parent is low, but also the identification tendency
with the healthy parent is generally low, has a great
significance.
n If we think that the identification with the parents has
a central significance for the development of the
child’s personality, this fact supposes that these
children present a partial developmental process of
the identity (Remschmidt,1993, Rutter,1990,1996).
n The Spearman correlation ranks (r) that were
obtained, represent a measure of the way the patient
perceives himself similar or different from one of the
parents, with which of them he does identify himself
and finally how pleased the child with himself is and
his self-critical tendencies (table 5).
The results obtained through the Vth Axis application
on the target and control group showed that:
n The psycho-social burden to which a child is exposed
in a family with a major depressive member is
significantly higher than in the families with a
schizophrenic parent.
n The number and the gravity of the abnormal
psychosocial conditions are significantly higher in the
cases of children from families with a depressive
parent.
n The research of the family environment showed some
specific modifications through the appearance of the
depressive symptoms. We must highlight a
supplementary burden if the mother is disturbed, with
a weak affective, verbal and educational stimulation.
314
Another variable was the relation between the sex of
the parent-patient and the disorder of the child. The
boys presented more frequently symptoms if the
fathers have been the patients and the girls if the
mothers. We noticed this fact through the PIF
application, too. This shows an association between
the same sex. In the families with a schizophrenic
parent we could notice the poor social status, the
stigmatization of the child and of the family and in
some situations the institutionalization.
The effect of the “disturbance type” factor at all the
variables (I-F, I-M, R-F, R-M) – the median values in the
families with a depressive parent are higher than those in
the families with a schizophrenic parent. The significant
difference proves to be especially concerning the variable
“ideal identification with the father”, so that in the
families with a depressive parent exists a significantly
higher ideal identification with the father in comparison
with the children from families with a schizophrenic
parent. This indicates the fact that a disorder from the
schizophrenia spectrum has a more significant, stronger
influence on the relation parent-child than a depressive
disorder of one parent has.Generally the psychotic
disorder of the mother is more important for the child than
that of the father and the influence of this disorder has a
direct, stigmatizing effect on the child.The absolute
frequency and model of the identification values in the
families with a depressive parent resembles more to the
normality than those in the families with a schizophrenic
parent. The real hypothesis would be that in the families
with a depressive parent, the centripetal forces, the
familial cohesion and the identification tendencies are
higher (Rutter, 1998). Those results confirm us that:
n The identification of the children with their parents is
diminished through a psychotic disorder in the family,
n
Table 5. Spearman correlations transformed z.
independently if the mother or the father is disturbed depressive parents) and the control group (children with
(Mc Gorry, 2004).
schizophrenic parents) we noticed that:
n The identification capacity of the child with the parent
n The child’s perception made by the disordered parent
is especially diminished when we are dealing with a
is more distorted in the family with a depressive
schizophrenic disorder.
parent than in those with a schizophrenic one.
n The identification of the child with his parents is
n The identification of the child with the disordered
diminished especially for the cases where the mother
parent and as well with the healthy one is very low in
is disturbed, independently if she suffers from a
the families with a schizophrenic parent, mostly then
depression or from schizophrenia.
when the mother has the disorder.
n The abnormal psychosocial conditions for the children
CONCLUSIONS
are higher in the families with a depressive parent,
this fact becoming a suplimentary burden for the
Through the application of the three standardized
psychological development and the prognosis of the
instruments on the studied group (children with
disorder of the child.
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