When Depression Is a Family Matter

When a parent suffers from depression, the whole family suffers.

A depressed mom or dad who is normally loving and communicative can become short-tempered with family members, averse to talking and doing activities together, says Anne Riley an associate professor of Health Policy and Management (HPM). Kids often respond by feeling rejected and anxious, which can lead to problems with their behavior and school performance—further exacerbating the depressed parent's guilt and stress.

But, though more than half of those adults in treatment for depression have children at home, the illness's effects on family members are not often addressed, says Riley, PhD.

She and others are hoping to change that through the "Keeping Families Strong" program, developed by Carmen Valdez, PhD, and Sandra Barrueco, PhD, both former postdoctoral fellows at the School, with input from mental health clinicians and other School faculty. "Keeping Families Strong" works with entire families in the mental health clinic where the parent is getting treatment. The goal: to inform parents and children about the effects of depression and teach coping and communication skills.

The 10-week program starts with separate sessions for parents and children (who must be 8 or older to participate). In the parents' class, clinicians encourage the adults to share their stories of depression and examine ways to improve their parenting skills, says Carrie Mills, senior research program coordinator in HPM. Parents discuss positive ways of communicating. If their despondency leaves them without the desire to talk, for instance, they learn to tell their children that they will make time to chat with them later. 

Meanwhile, clinicians work with the kids to discuss coping methods, teach problem-solving strategies and build communication skills. The children discuss the reasons why a depressed parent may not want to talk to them, for instance, so that kids aren't just left assuming, "Mom's mad at me."

Kids of depressed parents often try to take on extra household responsibilities, or be "extra good," in an effort to "fix" things, Mills has found. Such was the case with Stacia, the youngest daughter in one of the first families to go through the program.

Stacia had watched as her mother, Priscilla, quit her job and remained in her house for almost three years, spending much of that time in bed. Stacia's stepsister repeatedly acted out, making an already stressful situation even worse. But Stacia worked hard to stay out of trouble, thinking: "As long as I take care of myself, it's one less thing for my mother to worry about."

Like other families who go through the program, Priscilla's family came together in week eight, to share concerns and talk through their feelings. The content of the family session varies from family to family depending on the severity of depression, particular family issues and the ages of children involved. The common objective of these sessions is to practice skills learned by parents and children in their individual group meetings so that they take root at home.

"By creating a shared understanding," says Mills, "families are in a much better place to begin to address problems within the family context."

Priscilla praises the program for bringing her family together. She says she learned to listen to her children and be mindful of how she talks to them. She joined a gym, socializes more often and is now eager to find a job.

Currently, "Keeping Families Strong" sessions are offered at two clinics: Johns Hopkins Bayview Medical Center's Community Psychiatry Program and Sheppard Pratt in Howard County. Plans are currently under way to conduct a large-scale study to test the program in multiple sites across the region, says Riley.

"We want to get clinicians to realize that if parents are ill, then children are affected. Clinicians have to ask after the whole family," she says.