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

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

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

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

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

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

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

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

Study Progress

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)

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 85 th Percentile according to child’s age and gender indicates severe ADHD symptoms when both teacher and caregiver rating scales are ascertained.

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?”

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

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)

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

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)

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