Special to The Los Angeles Times
March 15, 2010
Gary McMane, 50, of Fontana, California, is convinced that his own depression has taken a toll on the three children he adores. "They're all good kids, and good in school, but I know it's had a terrible effect on them."
His 22-year-old daughter hangs on to her high school boyfriend as a security blanket, he says, and his 17-year-old son seems seriously depressed. Further, he adds, the 13-year-old boy is overly sensitive, feeling compelled to "rescue" anyone who is hurt. Granted, such perceptions are filtered through McMane's own feelings of guilt and responsibility — and his kids might not agree — but he's right to worry.
Although their father's depression may not be the cause of all these qualities, evidence is mounting that growing up with a depressed parent increases a child's risk for mental health problems, cognitive difficulties and troubled social relationships. The research on how a depressed parent affects kids has slowly accumulated for about 20 years, "but it's really taken off in the last few years," says Vanderbilt University psychologist Bruce Compas.
The harmful effects on children were summed up last year in a report by the National Research Council and Institute of Medicine. Problems begin early, as the infants of depressed mothers cry more than other babies. They have greater fear of strangers and less tolerance for frustration, according to the report. Starting in preschool, kids with depressed parents are more likely than classmates to have attention deficit hyperactivity disorder. Across all stages of childhood, they have more behavior problems at school and higher rates of depression and anxiety disorders.
By adolescence, children with depressed parents have poorer social relations than the teens of parents who aren't depressed, and they're more likely to be dependent on alcohol and drugs, the federal report indicates. Depression in parents also is linked to poorer academic performance, according to studies in the report.
And some harmful effects of growing up with a depressed parent appear to linger well into adulthood. A 20-year study following the children of depressed parents and a comparison sample of kids whose parents had no mental disorders found that those with depressed parents suffered about triple the rate of anxiety disorders and depression by their 30s, were in poorer health than peers and much more likely to be dependent on drugs and alcohol. The study, believed to be the longest ever done on kids of depressed parents, was published in the American Journal of Psychiatry in 2006.
These effects may not only be long-lasting but also far-reaching. Serious depression affects about one in five American parents, and 15.6 million children live with an adult who has had major depression in the last year, according to government data.
But as knowledge about the effects of parental depression has grown, so too has research into how to combat those effects. Studies suggest, for example, that changing destructive parenting practices and teaching children good coping strategies can make a big, positive difference in kids.
"We can reverse the effects of parental depression," says William Beardslee, a professor of child psychiatry at Harvard Medical School. He's also chief of a Boston Children's Hospital program on preventing depression in families and co-wrote the National Research Council report.
Depression can hamper parenting in two key ways, that report says.
Adults may withdraw from their children, not interacting with them much because their own suffering is so acute. Some of these kids may be subjected to true neglect if a parent is very withdrawn and there are no other adults around to be there for the kids. At the opposite extreme, depressed parents can become overly intrusive or authoritarian, trying to control everything about their child. They may even lash out harshly, possibly becoming child abusers.
Parents who can change these destructive patterns may ultimately prevent their children from continuing a negative cycle with yet another generation.
Trouble Starts Early
Adult depression can have an effect even before active parenting begins.
Depressed pregnant women smoke and drink more than pregnant women who aren't depressed, research has shown, increasing health risks for the developing fetus. They're also in poorer health, seek less prenatal care and produce more stress chemicals that reduce fetal growth. Even controlling for other factors linked to premature birth, depressed women are almost twice as likely as others to deliver a premature baby, and this risk increases with the severity of depression symptoms.
Then comes the effect on newborns.
About one in 11 infants has a mother with major depression, according to a research update report last December by Harvard University's Center on the Developing Child. Healthy emotional and brain development depends on a "serve and return" interaction, just like a tennis game. Tots engage parents' attention, prompting parents to respond with words or facial expressions, which stimulate more infant communication.
If caregivers are withdrawn or hostile, this shuts down the game and may even alter the architecture of the child's brain.
EEG brain scans show the children of depressed moms have patterns of brain activity similar to those found in adults with depression. Among these children, the patterns are most pervasive if the depressed mother was withdrawn from her infant and also if she was seriously depressed in the child's second and third year, when the brain systems that generate these waves are developing rapidly. That means the child of a depressed parent may become vulnerable to depression very early in life, at least in part through how parenting affects the brain.
Although most research on parental depression has focused on mothers, newer studies are looking at fathers and finding similar effects for children.
"Depression is just wicked. It takes away the enthusiasm and energy you need to be a good parent. And on top of that, it distorts your thinking," says Diana Barnes, a Tarzana psychotherapist who treats parents with postpartum depression.
Babies clamor for a parent's attention and, when parents don't respond, they'll mimic the flat adult expression they see before them as a way to engage, Barnes notes. "Then a mom will say, ‘The baby doesn't like me' — I hear it all the time. Or they'll see normal infant behavior as ‘difficult' or ‘fussy' and see the baby as a problem child."
Many women with postpartum depression have grappled with mental health problems earlier in life. That was true for 42-year-old Walker Karraa of Sherman Oaks, who had been on and off depression medications for years. She struggled through severe, untreated depression during pregnancy and the first three months with her now 9-year-old son, Ziggy. Then she got treatment and began to improve.
Karraa had a "do over" opportunity with 6-year-old Miles, her daughter, but this time she was receiving treatment — therapy and antidepressants. "I felt normal; it was totally different than the first time. I was able to sleep and eat and experience joy ...
"To this day, I see differences in my kids' personalities. My son is a lot more prone to worry and anxiety. He struggles with big, big feelings. He feels things on a very deep, empathetic level and is so affected by the feelings of others." Ziggy has tested as highly gifted, is well liked and healthy, says Karraa. But she still worries about him. "There is more lightness to Miles, more joy."
Karraa says she still has some rough days. There are times when she needs to adjust her medicine, and often she can't face social encounters, especially crowds in close quarters. Tony Karraa, Walker's husband, takes Miles to ballet class and frequently ferries the youngsters to birthday parties.
Managing the Effects
Both parents openly discuss Walker's depression with their children. "I've started to look at it like diabetes, a medical condition I need to manage," she says, adding that she and her husband emphasize to the kids that they're not to blame for their mother's periodic sadness and that Walker has great doctors helping her. "They've asked, ‘Am I going to get it?' and I tell them, ‘Probably not. But if it happens, people will be there to help you,' " Walker says.
This "we can master things" attitude is the opposite of the helplessness message many kids get from depressed parents, says Kitty Walker, a Santa Monica psychotherapist. "Part of depression is feeling, ‘No matter what I do, I can't make things better.' This is learned helplessness. Kids model on it, and it can program them to become pessimists who feel helpless and eventually depressed themselves."
Not only do children fare better if they are taught not to blame themselves for a parent's depression, they also flourish when caregivers can give them plenty of attention, says Beardslee.
Effects on kids tend to be more damaging if the family is poor, if there's marital conflict or if a depressed mother is the sole parent, according to the federal report. Financial strain can prevent parents from getting treatment, and the other family stressors add to the strain children may feel.
Even when parents are mindful of how their emotional problems may affect children, it can be hard to maintain consistent expectations and discipline as symptoms fluctuate from day to day. "It's important to have this consistency, this sticking to your guns, being firm and loving at the same time," says Beardslee.
Ruth Hollman, 53, of Los Angeles, has struggled against depression most of her life but feels she has her symptoms under reasonably good control now. "I do have bad days, though, and there's no question I'm inconsistent with the kids. On bad days I'll ignore something they're not supposed to be doing. On better days there's a different rule. Of course I'm concerned. I have tremendous worry that they're going to turn out to be not OK kids."
Her 11-year-old son is in therapy because he has trouble controlling impulses and can be defiant about rules at home. He's been diagnosed with attention deficit disorder and is improving with medication and therapy. "My younger daughter is just blossoming all over the place, but, still, you worry because you don't want your troubles to harm them."
Gary McMane, the Fontana father who believes his depression has hurt his three kids, feels he avoided inflicting serious harm for years by letting them know he needed more alone time on some days. That worked when their mother lived with the children. But when she left the home five years ago after a 20-year marriage, McMane plunged into a black hole. The kids — 9, 12 and 17 at the time — lived with him. "For days I would lie in bed and cry. They kept trying to console me; they just didn't see this coming. For a couple of months I was just disabled."
McMane took a leave from his job as a social worker and joined a men's therapy group that he credits with gradually bringing him back to mental health. "It ‘parentified' my older daughter, though. She felt she had to take care of the younger kids, and to this day she still kind of feels that way," he says. McMane talks with his children openly about what's happened.
He hopes that sensitive parenting — and seeing how he's turned his life around — will help them in the long run.
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