Effectiveness of family-based therapy for depressive symptoms in children and adolescents: A systematic review and meta-analysis.

Early-onset depression contributes significantly to the global health burden and has long-term negative effects. This meta-analysis collates and examines the effectiveness of family-based interventions, where family members are involved in the treatment of depression in children and adolescents. A literature search was performed up to 8th March 2023. Randomised controlled trials of family-based interventions were included for participants aged 3-18 years with a diagnosis of major depressive disorder or dysthymia, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) or with a score above a cut-off on a standardised self-report depression measure. The overall effect size for treatment versus active control was g = 0.22 (95% confidence interval [CI]: -0.05-0.50) (nine studies; 659 participants), and for treatment versus non-active control it was g = 0.46 (95% CI: -0.09-1.01) (four studies; 385 participants). Effect sizes were not statistically significant, and heterogeneity was high, ranging between I2 = 64.3-81.1%. Subgroup analysis comparing attachment-based family therapy with family therapy using other theoretical frameworks did not yield a significant difference between the two. The effects of family-based therapies were larger than those in the comparison groups, but family-based therapy did not demonstrate a significant treatment benefit compared to the controls. More randomised controlled trials are warranted, considering that evidence for other psychotherapies for depression in children and adolescents, indicates modest effects. Family-based therapy may be an alternative for children and adolescents whose needs are not addressed by these treatments.

Attachment and the Development of Depressive Symptoms in Adolescence: The Role of Regulating Positive and Negative Affect.

Although widely accepted, attachment theory's hypothesis that insecure attachment is associated with the development of depressive symptoms through emotion regulation strategies has never been longitudinally tested in adolescence. Additionally, previous research only focused on strategies for regulating negative affect, whereas strategies for regulating positive affect may also serve as a mechanism linking insecure attachment to depressive symptoms. This study aimed to fill these research gaps by testing whether the association between attachment and change in depressive symptoms over time is explained by strategies for regulating negative and positive affect in adolescence. Adolescents (N = 1706; 53% girls; Mage = 12.78 years, SDage = 1.54 at Time 1) were tested three times, with a 1-year interval between measurement times. They reported on their attachment anxiety and avoidance at Time 1, depressive symptoms at Times 1 and 3, and regulation of negative affect (brooding and dampening) and positive affect (focusing and reflection) at Time 2. The results from multiple mediation analyses showed that more anxiously attached adolescents developed more depressive symptoms via increased brooding and dampening. More avoidantly attached adolescents developed more depressive symptoms via decreased focusing. These findings provide longitudinal support for attachment theory's emotion regulation hypothesis, and show that the regulation of both negative and positive affect is important.

Epigenetics in Families: Covariance between Mother and Child Methylation Patterns.

Theory and research both point at epigenetic processes affecting both parenting behavior and child functioning. However, little is known about the convergence of mother and child's epigenetic patterns in families. Therefore, the current study investigated epigenetic covariance in mother-child dyads' methylation levels regarding four stress-regulation related genes (5HTT, NR3C1, FKBP5, and BDNF). Covariance was tested in a general population sample, consisting of early adolescents (Mage = 11.63, SDage = 2.3) and mothers (N = 160 dyads). Results showed that mother and offspring 5HTT and NR3C1 methylation patterns correlated. Furthermore, when averaged across genes, methylation levels strongly correlated. These findings partially supported that child and parent methylation levels covary. It might be important to consider this covariance to understand maladaptive parent-child relationships.