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Is Caregiver Depression Associated with Children’s ADHD Symptoms and Overall Functioning?

Is Caregiver Depression Associated with Children’s ADHD Symptoms and Overall Functioning?

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Is Caregiver Depression Associated with Children’s ADHD Symptoms and Overall Functioning?

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  1. Is Caregiver Depression Associated with Children’s ADHD Symptoms and Overall Functioning? Randi Scott SUMR Final Presentation August 07, 2008

  2. Background • Depression is a mental health disorder characterized by depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration • Depression and depressive symptoms are among the most prevalent treatable mental health problems in the United States • 11.5 million Americans experience a depressive episode in a given year

  3. Background cont’d • Depressive symptoms are significantly more common in women than in men in both population and clinic-based studies • Being the mother of young children places a woman at increased risk for developing depression and depressive symptoms • 1 in 5 mothers screen positive for depressive symptoms in primary care settings

  4. Background cont’d • Children of depressed mothers show more behavioral problems than children whose mothers are not depressed • Treating maternal depression reduces children’s behavioral problems • Little data available on the effects of maternal depression on functioning of children with mental health disorders

  5. Study Aim • To determine whether children with ADHD who have depressed caregivers show greater ADHD symptom severity and functional impairment than children with ADHD whose caregivers are not depressed

  6. Study Design • Longitudinal 12 month cohort study • Enrolled urban, impoverished families • Conducted at a community mental health center (CMHC) in West Philadelphia

  7. Participants • Inclusion Criteria • 6-14 years old receiving services at a CMHC • ADHD Diagnosis from billing records • Exclusion Criteria • Foster care • Did not meet lifetime criteria for ADHD according to Diagnostic Interview Schedule for Children – Version 4.0 (DISC-IV) • Outside School District of Philadelphia • Suicidal, autistic symptoms, conduct disorder

  8. Study Procedures • Eligible children identified through administration files and permission for contact obtained • Contacted families by phone to clarify study procedures and assess for exclusion criteria • Eligible participants consented and enrolled • Completed three study visits over 12 months • School District data and CMHC mental health visit data obtained and merged with self report data

  9. Study Progress

  10. Study Instruments • Demographics • Diagnostic Interview Schedule for Children Version 4.0 (DISC-IV) • ADHD Rating Scale – IV (ADHD RS-IV) • Brief Impairment Scale (BIS) • Patient Health Questionnaire-9 (PHQ-9) • Social Skills Rating System (SSRS) • Family Apgar • Treatment Acceptability Questionnaire-Parent (TAQ-P) • Parenting Stress Index- Short Form (PSI-SF) • Experience of Care and Health Outcomes Survey (ECHO) • Services Assessment for Children and Adolescents (SACA)

  11. ADHD Rating Scale-IV • Caregiver ratings of child’s frequency of ADHD symptoms over the past 6 months. • 18 items to mirror 18 items on DSM-IV • Likert Scaled from Never to Very Often • Sample Question: “Fails to give close attention to details or makes careless mistakes in schoolwork.” • Score above 85th Percentile according to child’s age and gender indicates severe ADHD symptoms when both teacher and caregiver rating scales are ascertained.

  12. Brief Impairment Scale (BIS) • Brief Impairment Scale: • 23 Item Questionnaire examining child’s daily functioning in the following domains over the past 12 months: • Interpersonal • School • Self • Overall score of 14 or greater suggests impairment. • Sample Question: “How much of a problem has he had making friends?”

  13. Patient Health Questionnaire (PHQ-9) • Screening questionnaire for presence of depressive symptoms in caregivers over the last 2 weeks. • Sample Question: “Feeling down, depressed, or hopeless?” • 9 questions; each depressive symptom Likert scaled from not at all (0) to nearly every day (3) • A score in the range of 5 to 27 indicates the presence of mild to severe depression. • Depressed caregivers were referred to adult services at the CMHC for treatment

  14. Analysis • Main Predictor Variable • Caregiver depression (PHQ-9) • Outcome Variables of Interest Include: • ADHD Symptom Severity (Total ADHD RS-IV Score) • Overall Impaired Functioning (BIS Total Score) • School Performance (KIDS School District Data) • Social Skills (SSRS) • Family Functioning (Apgar) • Treatment Acceptability (TAQ-P) • Parenting Stress (PSI-SF) • Children’s Use of Mental Health Services (SACA)

  15. Analysis cont’d • Three main data sources • Self-reported scales and demographics • Service center at the CMHC • KIDS School District data • De-identified three data sources and merged them to create a single data source

  16. Analysis Cont’d • Data Cleaning • Checked data for incomplete, inaccurate, or irrelevant entries • Data Dictionary • Listed variable names, descriptions, and possible responses • Summary Statistics • Generated mean, value range for each variable • Bivariate Analysis • Relationship of caregiver depression with ADHD symptom severity and other outcome variables • Multivariate Analysis • Adjusted for outside variables (race, ethnicity, gender, mother’s education level, etc)

  17. Acknowledgments • Dr. James Guevara • Ankur Rustgi • Joanne, SUMR Staff • Fellow scholars