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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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