RESUMO
The relation between maternal depressive symptoms and children's mental health problems has been well established. However, prior studies have predominantly focused on maternal reports of children's mental health problems and on parenting behavior, as a broad and unilateral concept. This cross-sectional study examined specific observed mother-child interaction behaviors through which maternal depressive symptoms are assumed to affect children's mental health problems. We expected higher rates of maternal depressive symptoms to predict higher rates of children's mental health problems, and we expected this relation to be mediated by low maternal warmth and high maternal psychological control. The sample consisted of 111 mother-child dyads referred for treatment. The mother-child interaction behaviors were coded according to the observed mother-child interaction tasks. Children's mental health problems were assessed using both maternal reports and children's self-reports. As expected, the results showed that maternal depressive symptoms were strongly related to maternal reports of children's internalizing and externalizing mental health problems. Surprisingly, maternal depressive symptoms were unrelated to children's self-reported depressive symptoms. Furthermore, mother-child interactions did not mediate the relation between maternal depressive symptoms and child mental health problems. Maternal depressive symptoms were associated with high maternal warmth, and high psychological control was associated with high levels of mother-reported externalizing mental health problems in children. These results partially replicate previous findings but add to these by using observational methods and multi-informant data. The importance of using a multi-informant and multi-method approach in assessing children's mental health problems in clinical practice and research are discussed.
RESUMO
BACKGROUND: In the Netherlands, the prevalence of anxiety disorders is 20%; and children with anxiety are at increased risk for psychopathology throughout adulthood. Recently, a revised version of a cognitive behavioral therapy manualized program called 'Thinking + Doing = Daring' (TDD) was developed for children between 8 and 12 years old with an anxiety disorder. The main aim of this project is to conduct a Randomized Controlled Trial (RCT) to evaluate the effectiveness of TDD. METHODS/DESIGN: The CBT program will be tested with a RCT with 120 clinically anxious children (8-12 years old) referred to one of three mental health care agencies. Children will be randomly assigned to the experimental (N = 60, TDD) or to the control condition (N = 60, treatment as usual). The primary outcome measure will be the child's anxiety symptoms level. Secondary outcome measures will be externalizing (e.g. aggression) and internalizing problems (e.g. depression). Two potential mediators of change will be examined in the current study: therapeutic alliance and parenting. Mother and child in both the experimental and control condition will be surveyed at baseline, post treatment and after 6 and 12 months (follow-up). It is hypothesized that children in the experimental condition will show a stronger decrease in anxiety symptoms compared to children that receive treatment as usual. Moreover, we expect that a strong therapeutic alliance and decreases in parental control and rejection will contribute to treatment success. DISCUSSION: Early treatment for anxiety problems has the potential to not only result in anxiety reductions, but also to prevent future problems such as substance abuse and psychopathology throughout adulthood. Our results will be immediately relevant to practice, since we are partnering with 'real world' community agencies. If the CBT program proves more effective than treatment as usual, it could be implemented in community mental health care agencies across the Netherlands and beyond. Moreover, it has the potential to make treatment in these community settings shorter, more efficient and therefore cost-effective. TRIAL REGISTRATION: Nederlands Trial Register NTR2967.
