In this Papers Podcast, Dr. Vicky Powell discusses her JCPP Advances paper ‘Following the children of depressed parents from childhood to adult life: A focus on mood and anxiety disorders’ (https://doi.org/10.1002/jcv2.12182). Vicky is the first author of the paper.
There is an overview of the paper, methodology, key findings, and implications for practice.
Discussion points include:
- The gaps in the research that this study aimed to address.
- Details about the cohort used (The Early Prediction of Adolescent Depression Study).
- The implications of the findings.
- Insight into trials looking into early intervention and prevention.
- The SWELL study and how to take part.
In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.
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Vicky completed her PhD at Cardiff University and works as a postdoctoral research associate at the Wolfson Centre for Young People’s Mental Health, based at Cardiff University. Vicky’s PhD work focussed on investigating the link between ADHD and depression, and her work now centres on prevention of depression in young people. Vicky is a senior researcher on the Skills for Adolescent WELLbeing (SWELL) study, working as part of a team running a clinical trial of a group wellbeing program aimed at preventing depression in young people who have a parent with a history of depression.
[00:00:00.290] Mark Tebbs: Hello, and welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Mark Tebbs, and I’m a Freelance Consultant. In this series, we speak to the authors of papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances. If you’re a fan of one of our Papers Podcast Series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues.
Today, I’m delighted to be interviewing Dr. Vicky Powell, who is the first author of a paper entitled, “Following the Children of Depressed Parents from Childhood to Adult Life: A Focus on Mood and Anxiety Disorders.” Vicky is a Research Associate based at the Wolfson Centre for Young People’s Mental Health at Cardiff University. Vicky’s research field is developmental psychology and her work focuses, broadly, on youth depression. Vicky, thank you for joining me, I’m really looking forward to our conversation today.
[00:01:07.049] Dr. Vicky Powell: Me too, thank you very much for having me.
[00:01:08.049] Mark Tebbs: So, let’s start with some introductions, could you tell us a little bit about who you are and maybe a little bit about your career today?
[00:01:13.590] Dr. Vicky Powell: So, I am a Postdoctoral Research Associate based at the Wolfson Centre for Young People’s Mental Health, as you just mentioned. And my work broadly focuses on depression in young people using a developmental approach. So, looking across ages and life stages. My PhD focused on investigating the link between ADHD and depression. So, looking at factors that might explain the increased risk of depression that’s observed in young people with ADHD. And currently, I work on a project called the SWELL Study, and this is a clinical trial looking at whether a CBT, so cognitive behavioural therapy-based intervention can prevent depression in young people who are at an increased risk of depression, through having a parent with a history of depression.
[00:01:58.530] Mark Tebbs: Thank you for that introduction. Could we turn to the paper, just a brief overview of the paper?
[00:02:05.080] Dr. Vicky Powell: Yeah, sure, so, unlike to the clinical trial I just mentioned, the study population for this paper was the offspring of depressed parents. So, to give you some background on this, we know that the risk of psychiatric disorder, especially the mood anxiety disorder, is increased in young people who have a depressed parent. And we also know in the general population, that the transition period from adolescence to adulthood is a key risk period for the emergence of psychiatric disorders in a time where there are lots of changes happening socially. So, for example, going from school to university or work.
However, there are a few studies looking at this risk period in the offspring of depressed parents, that track them over this time period using a multiple assessment timepoint. So, our aim was to look at the prevalence and cause of mood and anxiety disorders in the offspring of depressed parents, from childhood all the way through to adulthood, including that transition period. And looking at things like age of onset of these disorders, recurrence, and comorbidity with other disorders. And to also have a look at the social outcomes for these young people in their early adulthood, as well.
[00:03:12.209] Mark Tebbs: Great. I’m just wondering, were there any particular gaps in the research field that you were hoping that this kind of work was going to address? I’m just wondering about, sort of, taking us back to that original research questions, and what shaped your motivation for the work?
[00:03:26.849] Dr. Vicky Powell: There are, as I mentioned, sort of, relatively few studies that have looked at this transition from adolescence to adulthood in the offspring of depressed parents. The notable exception are the Offspring Study, led by Weissman and colleagues, over in the US, which followed the offspring of depressed parents, recruited back in the 80s. We know that the prevalence of mood or anxiety disorder has been increasing in recent decades, and so, there is a need to investigate outcomes in the offspring of depressed parents in a more modern cohort, who are recruited and followed concurrently with these increases.
So, the study sample used this paper is a cohort of depressed parents who were recruited in the early Noughties. So, they were followed from 2007 all the way through to 2020, and there are also subtle differences in the ways we collected the data, compared to previous studies, of the offspring of depressed parents. So, we followed the offspring and their parents over four prospective assessment timepoints spread over 13 years. And at each of these four timepoints where we assessed them, we looked at current disorders.
So, we’ve assessed, kind of, current disorder prevalence, which is slightly different to other studies that have looked at lifetime prevalence of disorders, so ever having had these disorders over a longer time period. So, there are advantages to looking at both, of course, but in this study we looked at current prevalence, and the advantage of this is that you can look, in detail, at the course of these disorders over time and how it changes over time as well.
[00:04:54.120] Mark Tebbs: Could you tell us a little bit more about the cohort and how the study was conducted?
[00:05:00.479] Dr. Vicky Powell: The cohort I mentioned, just now, that we used for this paper is called, “The Early Prediction of Adolescent Depression Study,” or the EPAD Study, and this is based at Cardiff University. And, as far as we’re aware, it’s the largest longitudinal study of the offspring of parents with major depression. And it started back in 2007, with 337 parents who had experienced recurrent depression and their offspring, who were aged between nine and 17-years-old. And we followed them over four assessment timepoints, and these consisted of questionnaires and interviews for the offspring and their parent, and this spanned 13 years in total. And for this paper, we restructured the data, so, even though the data was collected in these four timepoints that I’ve talked about, we looked at data by age and year.
So, looked at the prevalence of disorders by age and years, rather than by assessment timepoints, to allow us to look at prevalence by developmental stage. So, we looked at childhood, so age nine to 11, early adolescence, which is age 12 to 14, late adolescence, age 15 to 17, transition to adulthood, this important period that we wanted to focus on, which is age 18 to 22, and then the mid to late 20s, so age 23 to 28. And we, sort of, accounted for this change in the data structure in our analyses.
So, we did something called clustering, so, we clustered our analyses on participant ID to account for offspring who may have been included in the same age group more than once, and this is because we collected the data not, sort of, with everybody being the same age at the start, but there was a range of ages. So, you could have a scenario where a child is included in the childhood group because they were still a child at wave one and wave two, for example, so, we made sure to account for that.
[00:06:47.410] Mark Tebbs: And what were the key findings from the paper? Were there any things that, maybe, surprised you or stood out?
[00:06:53.110] Dr. Vicky Powell: Yeah, so the key findings really were that – so as we’d expect from the previous literature, we see a really high rate of mood and anxiety disorders in the offspring of depressed parents. So, 25% met diagnostic criteria for a mood disorder, at least once during the course of the study, and 33% met diagnostic criteria for an anxiety disorder, at least once during the study. But what we also found was that comorbidity, so having another disorder concurrently at the same time as the mood and anxiety disorder was really common in this group.
So, around 70% of those with a mood disorder experienced another disorder at the same time. And of those with an anxiety disorder, around 60% of those experienced another disorder at the same time. The age, at first diagnosis of the mood and anxiety disorders, was really varied, including some very early ages, at first diagnosis being observed. So, for example, the youngest age, at first diagnosis, we observed for major depression was just ten-years-old, which is much younger than we would, you know, expect to see, normally, in the general population. And even though the offspring in the study was still quite young at the final assessment point, so aged 18 to 28, at their final assessment wave, 7% of the young people had already experienced more than one depressive episode across the study period, and 13% had experienced anxiety disorder more than once, as well.
Another key finding was that this transition period from adolescence to adulthood was a key risk period for mood and anxiety disorders, particularly in males. So, while mood and anxiety disorders started to increase in prevalence in the female offspring during adolescence, this rise in prevalence was not observed in the male offspring until a little bit later, at the transition to adulthood. And even though, as we know, sort of from previous literature from the general population, that there’s typically a female preponderance of depression from puberty onwards, which we did see here.
When we got to early adulthood, the prevalence of mood and anxiety disorders in males seemed to be similar to females, if not even a little higher. But, of course, I’m just describing patterns here, we didn’t really have the power to statistically test these gender differences within this paper. And though the transition period stood out as a period when prevalence was very high, it’s important to note that the risk period was really very prolonged in these offspring. So, we were seeing offspring meeting criteria for these disorders from childhood all the way through to adulthood. So, at all of the age groups we looked at, the prevalence for these offspring of mood and anxiety disorders was higher than what has been reported in the same age groups in the general population.
[00:09:32.820] Mark Tebbs: So, what are the potential implications of those findings?
[00:09:36.470] Dr. Vicky Powell: So, firstly, these findings build on previous findings, highlighting the offspring of depressed parents, as a group that elevated risk for mood and anxiety disorders. And it also aligns with the recommendations by the World Health Organization, and others, highlighting the offspring of depressed parents as an important group for prevention and early intervention programmes.
What this research announces, that such interventions may need to be considered or delivered over prolonged periods and the need for prolonged vigilance in this group. And it also highlights the importance of considering family history of depression clinically, when young people are transitioning into adulthood, particularly, perhaps, in males.
[00:10:15.390] Mark Tebbs: You mentioned there about the importance of early intervention and prevention, are there any trials or studies looking at the best way to do this?
[00:10:24.690] Dr. Vicky Powell: Yes, so there have been various studies looking into this, and one study that’s shown particular promise, in terms of prevention of depression in young people, is a randomised controlled trial by Garber and colleagues, in the US, who tested the effectiveness of a group CBT intervention for preventing depression in young people at increased risk, due to having a parent with a history of depression. And they found that this intervention was effective in preventing depression episodes in these young people, but there was a caveat that if the parent was currently depressed at the start of the study, in this scenario, the intervention didn’t seem to be effective for these young people.
So, that brings me really on to what I’m working on now. So, I’m working as part of the team based at the Wolfson Centre at Cardiff University, who are running a clinical trial called the SWELL Study, as I mentioned earlier, or the Skills for Adolescent Wellbeing Study. And this is a randomised controlled trial testing whether an updated version of this group CBT programme, trialled in the US by Garber and colleagues, is effective in preventing depression in young people with a parent, with a history of depression. And it also incorporates a parent depression treatment phase at the start of the study, where, essentially, we’re trying to get the parent into the best place we can do at the beginning of the study before the young people receive the group CBT. And we hope that this will address this issue that Garber and colleagues found, whereby the intervention was effective at preventing depression in young people, but not for those young people whose parent was currently depressed at the start of the study.
[00:11:59.950] Mark Tebbs: From my understanding, the Garber trial was face-to-face, does your study replicate that?
[00:12:06.899] Dr. Vicky Powell: No, so, we’re going to be conducting them online, actually, so via, sort of, video call. So, the intervention that we’ve developed is replicating Garber’s work, but what we’ve done is, we, sort of, updated it to fit with a modern UK, NHS context. So, the sessions have been streamlined and shortened, so the intervention is shorter overall, and also, it will be delivered over a video call with the other young people and their Therapist as well. So, what we’re hoping, really, is that if we do find it to be effective at preventing depression in these young people that, hopefully, we will be able to roll out this intervention across the UK, perhaps, in future.
[00:12:46.170] Mark Tebbs: That sounds really interesting, the work you’re doing on the trial, could you tell us a little bit more about that?
[00:12:51.350] Dr. Vicky Powell: Yeah, of course, so the SWELL Study is, as I said, a randomised controlled trial and we’re aiming to test whether this group CBT intervention that teaches skills for wellbeing can prevent depression happening in young people, or reduce depression symptoms in young people who have a parent with a history of depression. So, we’ve actually, very recently, opened for recruitment, which is very exciting, so we’re looking for parents with a history of depression and a child aged 13 to 17-years-old to take part in this study.
I suppose to give you a kind of overview of what the study involves, first, for those parents and young people who are eligible to take part, we will screen the parents to see what their depression symptoms are like at the moment, and if we find that they are currently depressed, they will go into this 12 week long depression treatment phase I mentioned earlier, where they’ll meet with one of our Child Psychiatrists for a consultation, and they might recommend various things, including lifestyle changes, completing some internet CBT, also, recommending some medication changes, if needed, to their GP. And then once this 12-week treatment is completed, or straightaway, if the parent isn’t currently depressed, the young person will be randomly assigned, like the toss of a coin, so 50/50, to either receive this group CBT programme or to continue with any treatment they’d usually receive.
So, all young people and their parents, who participate in the study, will be asked to complete some kind of questionnaires and interviews at the start of the study, three months into the study and nine months into the study, which will allow us to test whether this group CBT programme, that teaches a skills wellbeing works in preventing depression and, if so, how it might work.
[00:14:27.820] Mark Tebbs: So, where could people find out more?
[00:14:30.290] Dr. Vicky Powell: So, if you want to find out more about the trial, or you’re interested in taking part, or know somebody else who might be interested, please do visit our website for more information. So, the link for that is bit.ly/wcSWELL, so that’s S-W-E-L-L, and we’re due to be open for recruitment until late 2024 to, kind of, very early 2025.
[00:14:55.579] Mark Tebbs: Brilliant, thank you so much. For more details on Dr Vicky Power, please visit the ACAMH website, www.acamh.org, and Twitter @acamh. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.