Featured Article
Article Title
Family Functioning, Maternal Depression, and Adolescent Cognitive Flexibility and Its Associations with Adolescent Depression: A Cross-Sectional Study
Authors
- Justyna Urbańska-Grosz - Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland; Laboratory of Clinical Neuropsychology, Neurolinguistics and Neuropsychotherapy, Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-952 Gdansk, Poland
- Emilia J. Sitek - Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland; Laboratory of Clinical Neuropsychology, Neurolinguistics and Neuropsychotherapy, Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-952 Gdansk, Poland; Department of Neurology, St. Adalbert Hospital, Copernicus PL, 80-462 Gdansk, Poland
- Anna Pakalska - Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland
- Bożena Pietraszczyk-Kędziora - Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland
- Kalina Skwarska - Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland
- Maciej Walkiewicz - Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland; Division of Quality of Life Research, Department of Psychology, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland
Abstract
Background: This study explores family functioning and its associations with adolescent major depressive disorder (MDD), comparing its dynamics with healthy counterparts. Family functioning (cohesion, flexibility, communication, and satisfaction), maternal depressive symptoms, postpartum depression history, parental divorce, parental alcohol abuse, and the adolescents’ cognitive flexibility, are examined. The research incorporates the perspectives of both adolescents and mothers. Methods: The sample includes 63 mother-teenager dyads in the clinical group and 43 in the control group. Instruments encompass the Family Adaptability and Cohesion Evaluation Scales (FACES IV), Children’s Depression Inventory (CDI-2), Beck Depression Inventory (BDI-II), The Brixton Spatial Anticipation Test, and structured interviews. Results: Families of adolescents with MDD exhibit lower flexibility, cohesion, communication, and overall satisfaction. Depressed adolescents display reduced cognitive flexibility. Discrepancies were observed between adolescents’ and mothers’ perspectives as associated with adolescents’ MDD. Teenagers emphasized the severity of maternal depressive symptoms, while mothers highlighted the importance of family cohesion and flexibility. Conclusions: This study emphasizes a holistic strategy in addressing adolescent depression, including family-based assessment and therapy. Screening for maternal depressive symptoms is identified as valuable. Cognitive flexibility also needs to be addressed during therapy for depression in adolescence.
Keywords
depression; adolescents; family; mothers; mother-child relations; family cohesion
Summary of Research
“Family systems theory provides a framework for understanding the influence of family dynamics on adolescent depression. This approach highlights how families function as interconnected wholes, where each member’s behaviour affects the others… [It] views the family as a complex social network with reciprocal interactions that significantly impact both individual and collective well-being… The family systems theory implies that understanding and improving [family interactions] can lead to better mental health outcomes for adolescents” (p. 1- 2).
“...Family systems [rates] along three fundamental dimensions: cohesion, flexibility, and communication. Cohesion involves fostering strong emotional bonds between family members… Flexibility is the measure of the family system balance between stability and change... [and] Effective family communication serves to reduce conflict and increase adaptability and cohesion… Children born to depressed mothers tend to exhibit deficits in social, psychological, and cognitive domains, thereby encountering an elevated susceptibility to depression and other mental health disorders” (p. 2).
“[This study] consisted of … 63 teenagers diagnosed with major depressive disorder (MDD)... and 63 mothers…, plus a matched control group of 43 healthy [mother-teenager dyads]… All adolescents with MDD were outpatients at the Mental Health Clinic or Psychiatric Day Unit for Children and Adolescents of the Gda´nsk Health Centre, Gda´nsk, Poland. Youth from the control group were students at the Maritime School Complex in Gda´nsk (Poland)” (p. 3).
“... Teenagers diagnosed with MDD… assessed general family functioning as worse, with less favourable ratings pertaining to flexibility, cohesion, family communication, and overall satisfaction with family life… The maternal counterparts of these adolescents exhibited a heightened prevalence of depressive symptoms in comparison to the mothers of their healthy peers… From the mothers’ perspective, the most important factors related to children’s depression are the low level of family cohesion, the severity of maternal depressive symptoms, low levels of family flexibility, adolescents’ cognitive flexibility, and satisfaction with family life. However, from the point of view of teenagers, the most important link with their depression is the severity of depressive symptoms in the mother, the presence of which in our model significantly increased the likelihood of depression in an adolescent” (p. 9).
“...Current maternal depressive symptoms were more important than a history of postpartum depression… We assume that it may be related to the developmental phase in which adolescents experience a pronounced inclination to gradually distance themselves from their familial units, intensifying their focus on peer relationships… adolescents desire independence; however, from their perspective, maternal depression symptoms may hinder this process…
This situation can elicit a myriad of emotional responses, including sentiments of guilt for seemingly “abandoning” depressive mothers. Conversely, the mother may attribute her child’s depression to the perception that the teenager is “growing apart” from the family unit… this is in line with the clinical observations of how when faced with their teenagers’ depressive symptoms, mothers as their primary response frequently seek to foster familial togetherness. This inclination to define the adolescent’s emotional detachment from the family as the root cause of depression leads them to believe that nurturing emotional closeness represents the optimal means of supporting their children.
This approach, however, appears counterproductive when viewed within the context of the natural developmental needs of adolescents… mothers, conceivably burdened by guilt associated with perceiving a growing familial rift, regard this natural developmental trajectory as an aberration and strive, albeit unsuccessfully, to counteract it, experiencing depressive reactions” (p. 10).
“Families of adolescents with MDD were found to exhibit lower levels of flexibility, cohesion, family communication, and overall satisfaction with family life compared to healthy adolescents. Adolescents with MDD showed reduced cognitive flexibility. Mothers of adolescents with depressive symptoms reported higher levels of depressive symptoms compared to mothers of healthy adolescents. Quality of family functioning, maternal depressive symptoms, and adolescent cognitive flexibility were identified as important factors associated with adolescent depression. Discrepancies were observed between the perspectives of adolescents and their mothers: teenagers emphasized the severity of maternal depressive symptoms, while mothers highlighted the importance of family cohesion and flexibility” (p. 13).
Translating Research into Practice
Applying Systemic Theory in Clinical Approach
“Within the framework of systemic theory, a foundational assumption lies in the recognition that family members can potentially disrupt the trajectory of adolescent independence. This interference, it is posited, emanates from the perceived threat it poses to the equilibrium, or homeostasis, of the family system. The systemic approach seeks to identify the origins of disorders not within the individual but within the realm of family interactions… In essence, the systemic approach refutes the notion of individual pathology, instead positing that interdependent (and potentially atypical) family interactions may serve as a pathogenic element in the emergence of disorders within one or more family members” (p. 12).
Efficacity of Family-Based Interventions
“... Family factors have a crucial importance for adolescent depression, and thus a systemic approach to treatment seems optimal… Until now, however, the literature on the efficacity of family-based interventions is scarce, and only a small positive effect of involving family/caregivers in the therapy was proven… most of the studies documenting the effects of family-based interventions used cognitive-behavioural therapy approaches, while attachment-based interventions show particular promise in repairing parent-child communication” (p. 12).
Screening for Depression and Cognitive Flexibility
“... Screening for maternal depressive symptoms emerges as a potentially valuable component of this approach. Another notable facet pertains to the heightened significance of emphasizing cognitive flexibility in the treatment efforts aimed at adolescents with depression… it holds considerable promise in mitigating the potential progression of depressive symptoms in this population. These findings not only underscore the necessity for multifaceted therapeutic interventions, but also argue for the integration of familial and individual-level assessments in clinical and preventive mental health paradigms” (p. 13).
Other Interesting Tidbits for Researchers and Clinicians
“To fully appreciate the emergence of cognitive flexibility deficits and their neurobiological and/or familial origin in adolescents with MDD, a prospective study would be needed, starting from a large population-based neuropsychological and neuroimaging study and then comparing the subset of adolescents who developed MDD and those who did not… While teenagers’ cognitive functioning, encompassing cognitive flexibility, might not intuitively appear closely related to family dynamics or maternal depression, our study’s findings suggest its considerable predictive potential. This dimension of cognitive flexibility could be instrumental in shaping perceptions of family functioning and might indirectly account for the disparities in the assessment of factors related to depressive disorders between mothers and adolescents” (p. 11).
“This study contributes to the burgeoning body of knowledge surrounding adolescent mental health, shedding light on the intricate interplay between familial dynamics, maternal mental health, and neurocognitive factors in the aetiology of depressive disorders. The results emphasize the need for a holistic strategy when addressing adolescent depression. It underscores the importance of conducting assessment and therapy that encompasses the entire family system” (p. 13).
Additional Resources/Programs
As always, please feel free to check out the resources below and comment to add more to the discussion!
