THE FAMILY AND PSYCHOSOCIAL BACKGROUND OF CHILDREN WITH ENDOGEN DEPRESSIVE PARENTS

ABSTRACT:

Objective

This study aims the evaluation of 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 schizophrenical parent Material and methods

Three standardized instruments were applied 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 (V^th)axeResults

Through the CBCL application we obtained the fact all the children registered high scores at the items for depression, hyper­activity and aggressivity.

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 V^th axe application, the psychosocial pression 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 distorsioned in the families with a depressive parent. The abnormal psychosocial conditions are more numerous in the families with an endogen depressive parent.

INTRODUCTION

Tne risk of developing depressive disorders has been estimated for the children of parents with en­dogenous depression at a value of 15-45%.

Tne children of parents with endogenous depres­sion present high risk nut only in developing depres­sion but also anxiety disorders and disruptive disor­ders. There are needed some environmental stressors in order to develop those disorders. Tne presentation of psychopathology at offspring has its roots in the individual genetic – biochemical structures but also in the interaction phenomena with the environment.

It is naturally for us to ask ourselves the following questions:

• What particularly is a determinant for the genetic predisposition to validate?
• What kind of specific environmental factor does interact with the genetic predisposition for the phenotypic expression?
• Which are the psychosocial risk factors which facilitate the apparition of the psychopathological disorder at the offspring?

Tne clinical reality proved the fact that some chil­dren present a “resilience mechanism” and can through this mechanism rescue themselves from the psycho-pathological influences of the parents, through the projection on real or imaginary coordinations, which are different from those of his disorder parent.

We tried to identify some parental attributes, especially concerning the communication deviance and the affective styles. Tne communication deviance mirrors the parental inability in stabilizing and keep­ing a relation with the child. In most cases we found negative, critical, intrusive, guilt-inducting attitudes. Early installation and the recurrence of depression at parents are major risk factors for the children to de­velop depression.

Tne pathological communication pattern will be determinant for the deviant development of the com­munication style, but also for the capacity of the child of understanding the surrounding reality.

Tne analysis of the context has shown the fact that the effects on the children are deeper, when those are involved in the symptoms of the disordered parent.

Tne study proposes itself the evaluation of extrinsic predictive risk factors(variables of the environment) and of the interactive factors(interrelation between child-parents, family, communication deviances).

OBJECTIVES

Through our study we provide a research on a “high risk” children group, from families with a par­ent suffering with endogenous depression.

We followed a retrospective study but also a pro­spective research on the “high risk” children group. We 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 schizophrenically parent.

MATERIAL AND METHODS

Tne study was performed between 2000-2006 in the Clinic of Psychiatry and Neurology for Children and Adolescents Timisoara.

We applied the research instruments (CBCL-Chil-dren Behavioral Checklist, PIF- Family Identification Probe, the Vth Axe DSMIV) on a group of 23 children.

Those three standardized instruments were ap­plied on the 52 children control group, composed by children from families with one parent suffering from schizophrenia, as well.

The 1st step of the study included the search in the Clinic of Psychiatry “Eduard Pamfil”Timisoara in or­der to identify the families, in which exists a member suffering from major endogenous depression.

The 2nd step of the study was composed of the identification of children and adolescents, which needed ambulatory consultations or were inpatients of the Clinic of Psychiatry and Neurology of Chil­dren and Adolescents Timişoara in the period begin­ning with the year 2000.

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 endogenous depression.

Our control group is composed of 52 “high risk” chil­dren of families with one parent with schizophrenia.

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 psychopathological parental models, the eva­luation of the spécifie psycho-social conditions of each family from the studied group and the control group.

We applied the three standardized instruments:

• CBCL (Child Behavior Checklist) elaborated by Achenbach includes 112 items referring to behavioral and social competence problems, evaluated by parents.

This instrument doesn’t have a diagnostic func­tion, but it evaluates the modality through which the parents do perceive their child.

• PIF (Family Identification Probe) utilized for the study of the intra-familial relations, we tried a quantification of these relations.

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. We used 12 cards on which are written different adjectives, through which the child is characterizing first his pa­rents and then himself.The 12 adjectives respect a hie­rarchy, the most proper one being head of the column, at the end being the most inadequate adjective.

The order of completing for the child is: real my­self/ ideal myself/ the real portrait of the mother/ the ideal portrait of the mother/real portrait of the father/ ideal portrait of the father.

• The V-th Axe of DSM IV. describes methodi­cally those aspects of the psycho-social situation of the child, which present a significant deviance from the normal conditions concerning the developmental grade, the knowledge acquirements and the socio-cultural conditions. The categories included in this axe, have been chosen, knowing the fact that they can represent significant risk factors:

0 – there don’t exist significant déviances of the

psycho-social conditions.

1  – abnormal intra-familial relations

2  – psychical disorder, abnormal behavior or han-

dicap in the family

3 – inadequate or distorted intra-familial commu-

nication

4  – abnormal educational conditions

5  – abnormal ambiance, environment

6  – acute, traumatizing life events

7  – social traumatizing factors

8  – chronical traumatizing factors, of inter-human

type, concerning school or work

9 – traumatizing events or situations in relation

with the behavioral disturbances or with the handicap of the child

RESULTS

Through the CBCL application on depressive parents, respectively schizophrenic parents of children from our group and the control group, our study led to the following observations concerning the sex of the child:

• All the children registered high scores at the items for depression, hyperactivity and aggressive, in­dependently from the sex of the child or the disorder of the parent- depression or schizophrenia.
• 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 are higher for boys than for girls
• 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 high vulnerability of the boys from the families with a depressive parent.

The scores obtained with CBCL from girls and boys, 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 effectuated by the psychotically parent is distortion, existing an exacerbation of the symptoms or the complete igno­ring of the child’s symptoms.

In the families with an endogenous depressive pa­rent, from the 23 parents with endogenous depression, just one parent caught with accuracy the problematic of the child in conformity with the clinical diagnostic (Table 2, Table 3).

The results obtained through PIF on the target group and on the control group

• Tne intra-familial relations have been studied, try­ing their quantification through PIF, which focuses on the identification process of the child with his parents.

Through this probe are researched the familial re­lations, the way they are perceived by the child.

As a measure of the similitude of the children’s characterizations, we utilized correlation rang bet­ween the different items (Table 4).

There can be calculated 6 correlation coefficients as it follows:

• The medium correlation rang for the child’s self-evaluation, the evaluation of the disturbed parent, the evaluation of the healthy parent reflects the identifi­cation process of the children. Significant factors are as well the sex of the patient and of the disturbed pa­rent as well as the age of the child. Table 5.
• For the identification of the influences of those factors we utilized the multi-variance analysis ANO-VA / MANOVA in which the “dependent” variables are represented in function of the parent (mother or father) and the “independent” variables which are represented by the disturbed parent. Table 6,7.
• 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 parents, healthy parent is generally low, has a great significance.
• 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.

The Spearman correlation rang (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 8.

DISCUSSIONS

• Tne effect of the “disturbance type” factor at all the variables (I-F, I-M, R-F, R-M) – the medial val­ues in the families with a depressive parent are higher than those in the families with a schizophrenic par­ent. Tne 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.
• Tne 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. Tne real hypoth­esis would be that in the families with a depressive parent, the centripetal forces, the familial cohesion and the identification tendencies are higher.

Those results confirm us that:

• Tne identification of the children with their par­ents is diminished through a psychotic disorder in the family, independently if the mother or the father are disturbed.
• Tne identification capacity of the child with the parent is especially diminished when we are dealing with a schizophrenic disorder.
• Tne identification of the child with his parents is diminished especially for the cases where the mother is disturbed, independently if she suffers from a de­pression or from schizophrenia.

Results obtained through the Vth Axe Interview application on the target and control group:

• Tne psycho-social pressing 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.

DISCUSSIONS (THE V^th AXE)

Tne number and the gravity of the abnormal psy­chosocial conditions are significantly higher in the cas­es of children from families with a depressive parent.

Tne research of the familial environment showed some specifically modifications through the appea­rance of the depressive symptoms. We must highlight a supplementary pressing if the mother is disturbed, with a weak affective, verbal and educational stimulation.

Another variable is the relation between the sex of the parent-patient and the disorder of the child. Tne 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 schizophrenically parent we can notice the poor social status, the stigmatization of the child and of the family and in some situations the institutionalization.

CONCLUSIONS

Through the application of the three standar­dized instruments of evaluation of the children from the studied group (children with depressive parents) and the control group (children with schizophrenic parents) we noticed that:

• The child’s perception made by the disordered parent is more distortion in the family with a depres­sive parent than in those with a schizophrenic one.
• The identification of the child with the disor­dered parent and as well with the healthy one is very low in the families with a schizophrenic parent, most­ly then when the mother has the disorder.
• The abnormal psychosocial conditions for the children are more accentuated seen in the families with a depressive parent, this fact becoming a supli-mentary pression for the psychological development and the prognosis of the disorder of the child.

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