Constance Hammen Depression Runs in Families The Social Context of Risk and Resilience in Children of Depressed Mothers Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Hong Kong Barcelona Constance Hammen Department of Psychology University of California Los Angeles, CA 90024-1563 USA Series Editor: Lauren B. Alloy Department of Psychology Temple University Philadelphia, PA 19122 USA With five illustrations. Library of Congress Cataloging-in-Publication Data Hammen, Constance L. Depression runs in families: The social context of risk and resilience in children of depressed mothers 1 Constance Hammen. p. cm. - (Series in psychopathology) Includes bibliographical references. ISBN-I3 978-1-4684-6412-2 e-ISBN-I3 978-1-4684-6410-8 DOL 10.1007/978-1-4684-6410-8 1. Children of depressed persons-Mental health. 2. Depression, Mental-Etiology. 3. Mother and child. 4. Depressed persons Family relationships. I. Title. II. Series. [DNLM: 1. Child of Impaired Parents. 2. Depressive Disorder. 3. Depressive Disorder-etiology. 4. Depressive Disorder-in infancy & childhood. 5. Family. 6. Parent-Child Relations. WM 171 H224d) RC537.H3 1991 616.85'27-dc20 DNLM/DLC for Library of Congress 90-10460 Printed on acid-free paper. © 1991 Springer-Verlag New York Inc. Softcover reprint of the hardcover 1s t edition 1991 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or here after developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. Typeset by Best-set Typesetter, Ltd., Hong Kong. 987654321 Series in Psychopathology Series Editor Lauren B. Alloy Series in Psychopathology Editor: Lauren B. Alloy Published Volumes: Depression Runs in Families: The Social Context of Risk and Resilience in Children of Depressed Mothers Forthcoming: Hopelessness Depression Neurobehavioral Systems, Personality, and Psychopathology Acknowledgments The research project that this book is based on came to be called the UCLA Family Stress Project. It began in the early 1980s as an attempt to study the childhood origins of depression. It was the collaborative effort of many people. It would not have been undertaken at all without the instigation, enthusiasm, and planning of then-graduate students David Gordon and Carol Jaenicke. Later, when the original enthusiasm gave way to the sheer amazement at the magnitude of the task we had undertaken, Dorli Burge and Cheri Adrian made it continue. Involved at every level of both tedium and excitement as the project matured, they were there through the last of the follow-ups. Their extraordinary talent and dedication were essential to the project. The enormous psychic rewards of an academic profession are nowhere more apparent than in the opportun ity to use the abilities entrusted to us to do meaningful work in the company of dedicated and enthusiastic students. It was a privilege for me to have this opportunity over the past few years. Jean Kaufman played a major part in keeping the ship afloat and everyone in good humor. Libbi Burney Hamilton was a mainstay in the follow-up stages, just as Brian Zupan was in the earlier phases. Carolyn Anderson and Marilyn Conrad contributed their interest, support, and good ideas, and early on we were glad to have the help of Pam Kimsey, Aimee Ellicott, Maren Jones, and other graduate students at UCLA. The countless administrative aspects of the study required the help of many, and over the years I was fortunate to have the assistance of Kelly Ellis, Memee Peggs, Tina Goodman-Brown, Robin Gilson, and Miki Carpenter. All of them have gone on to graduate studies in helping professions. There were many dedicated and talented undergraduates who played important roles in the project and who have now gone on to graduate programs and to their own projects. Although there are too many to mention all of them, a few deserve special recognition and good wishes for their own futures: Marie Martel, Nangel Lindberg, Lisa Harris, Naomi Oderberg, Michael Friedmann, Howard Fulfrost, Kirsten Fleming, and v vi Acknowledgments Debbi Stackman. The assistance of all the others is also gratefully acknowledged. Early in the project Donald Hiroto was helpful, and a grant to him from the Veterans Administration helped to get the study off the ground. Special thanks are owed to the William T. Grant Foundation for funding for most of the study. They showed faith in a newly forming developmental psychopathologist, and their support certainly opened new vistas in my career. Finally, the families who consented to participate in this study must be acknowledged. Their immeasurable contribution, the courage to reveal their most vulnerable experiences and the women's undeniable concerns about making the best family lives possible, earned our respect and gratitude. Although this report offers little to the women and children in return for their efforts, the work affirms our concern for their struggles and for finding solutions. Contents Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. v 1 Studies of Children of Depressed Parents . . . . . . . . . . . . . . . . 1 2 Methods ofthe Current Study ....................... 26 3 Diagnoses and Dysfunction in Children at Risk .. . . . . . . . . .. 54 4 Vulnerability to Depression: The Role of Children's Cognitions.. 80 5 Family Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 108 6 Parent-Child Relationships and Depression. . . . . . . . . . . . .. 140 7 Familial and Parental Clinical Characteristics. . . . . . . . . . . . .. 173 8 Risk and Resilience . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 201 9 Summary and Implications: Understanding Depression in Families at Risk ...................................... 227 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 250 vii 1 Studies of Children of Depressed Parents Depression runs in families. This simple conclusion has a far from simple explanation or meaning. Some would argue that in its severe or chronic forms, depression is a disease whose underlying pathophysiology is genetically transmitted. Others would argue that depression arises in a psychosocial context, and that its intergenerational patterns reflect maladaptive interpersonal, situational, and intrapsychic processes that are played out in family life and child socialization. Still others would emphasize the transactional nature of multiple processes, encompassing both biological and psychosocial factors unfolding in the family context. Not surprisingly, these three approaches to psychopathology represent competing perspectives on most forms of psychological disorder. The study of affective disorders offers an excellent opportunity to consider these models and their utility in explicating familial patterns of depression. There are several reasons for pursuing this goal in the context of depressive disorders: practical matters of the widespread incidence and pernicious consequences of mood disorders, and theoretical issues in which depress ion provides a lively forum for development of a variety of hypotheses. Mood Disorders: A Major Public Health Problem Nearly everyone experiences depression as part of living-it is a normal and usually brief reaction to the perils of existence, the failures, setbacks, disappointments, and losses that attend modern life. Depression can last a few hours, a few days, or even weeks, but for most individuals it is transitory and, however unpleasant it may feel, it does not impair functioning. Yet, for a substantial minority-and some would argue that this is a growing number-depression is a debilitating and even life threatening disorder. The constellation of mood and physical, behavioral, and psychological symptoms that comprise the syndrome of clinically significant depression 1 2 1. Studies of Children of Depressed Parents has been found to occur to between 4 and 8% of the adult population (Karno et aI., 1987). Earlier investigations using less stringent, reliable standards or including milder forms of depression estimated the rates to be even higher, up to 18% in various U.S. cities and Western nations (Boyd & Weissman, 1981). At any given moment, between 9 and 20% of the population will report some significant depression symptoms even if they do not meet formal diagnostic criteria for depression (e.g., Boyd & Weissman, 1981). The syndrome of manic depression, now termed bipolar disorder, is more rare, estimated to affect less than 1% of the population (Boyd & Weissman, 1981; Robins et aI., 1984). However, as criteria for identifying milder forms of bipolar disorder have improved, investigators have suggested that the rates of symptoms may be higher than originally suspected (Depue et aI., 1981). Moreover, these mild or even subsyndrom al forms of affective disorder may be early warning signs of later, full-scale major affective disorders. The sheer numbers of people with affective disorders marks them as our most common psychiatric problem. Yet the great majority of individuals, especially those with major or chronic unipolar depression, do not seek treatment. But even beyond the magnitude of the problem, there are three striking features of mood disorders. One is impairment, a second is recurrence and chronicity, and the third is the apparently increasing rates and shifting demographic patterns. Impairment of functioning due to moderate or severe affective disorder has a unique twist that separates such disorders from many other kinds of psychiatric conditions, all of which by definition involve impaired functioning. The low mood, apathy, lack of energy, loss of pleasure, negative outlook on the self and the future that typify depression, for instance, often seem "irrational" to others. Whereas psychotic or bizarre symptoms or behaviors of depression and mania may be detectable as illness, most of the less florid mood-related symptoms are often viewed as controllable. That is, people in this culture are typically held responsible for their own moods and expected to overcome dysphoric states by will, effort, and activity. Yet it is a major characteristic of clinical depression that mood affects the way people construe themselves and their worlds. Additionally, the bodily experiences of low energy, poor appetite, and sleep disturbances are part of the depression syndrome. Thus a depressed person may be entirely "capable" as a worker or parent but feel unable to perform the functions of these roles. An individual who is depressed may experience paralyzing doubts about her own worth as a person that exacerbate dysphoria and may heighten sensitivity to criticism or even lead to social withdrawal. Yet to an outsider, they may be unrealistic in terms of the person's skills, personal qualities, appearance, and desirability. Similarly, a man who has lost his job due to layoff may experience depression that affects his outlook, energy, and self-respect. When others