Research focusing on parenting as perceived by children and adolescents shows that youths with depressive symptoms feel less loved and more criticized by their parents as compared to their peers without depression. However, the personal experience can substantially differ from objectively measurable parenting behavior (see this blog). Based on research so far, we can thus only draw conclusions about the importance of perceived parenting in the context of depression, not about more concrete parenting behavior. For the purpose of interventions it is also important to know whether observed parenting behavior relates to childhood and adolescent. We examined this research aim.

Meta-analysis
At the department of Clinical Psychology at Leiden University, my colleagues and I therefore combined all existing research on observed parent-child interactions (as scored by independent coders) and childhood and adolescent depression in a meta-analysis, we included a total of ninety studies. A substantial amount of research has thus been done on this topic, but the overall effect is still unknown. We included observed behavior of parent as well as child.

Observed parenting behavior
The meta-analysis showed that less observed parental warmth/support and more observed parental control/criticism related to more depression in children and adolescents at the same timepoint and at a later timepoint (e.g. half a year after the assessment of parenting behavior). Observed parental autonomy granting, guidance/structure, and observed depressed affect of parents did not relate to childhood and adolescent depression.

The relations of warmth/support and control/criticism with depression at the same timepoint and at a later timepoint were significant, but the effect size was small. Less parental warmth and more parental criticism thereby seem to form risk factor to childhood and adolescent depression, but this is clearly not an one-to-one relation. Previously our qualitative research also showed that adolescents with a depression and their parents perceive multiple factors as causes of the adolescent’s depression (see this blog).

Further, there were clear differences between studies and families. We found, amongst others, that the impact of criticism is stronger when this is observed in a positive interaction context. The effect of observed warmth/support and control/criticism that we found was smaller than the effect of perceived parenting that was found in previous meta-analyses. In other words, a lack of warmth and the presence of criticism can play a role in the development and maintenance of depression, but ‘one size does not fit all’. We cannot simply translate these findings to the family dynamics of individual families.

Observed behavior of children and adolescent
Children and adolescents are not passive recipients of parenting behavior, but form an essential part of the interactions. We therefore also examined observed behavior of children and adolescents with a depression. Our meta-analysis indicated that children and adolescents with (clinical) depressive symptoms showed more negative affect (e.g. anxiety, agitation), less autonomy (self-employed decision-making and functioning), and they were less involved in the task during interactions with their parent. These associations again were significant with a small effect size, but did seem to hold for children and adolescents from different families and in different contexts. We found limited evidence for lower positive affect (smiling, friendliness) and more depressed affect (sadness, dysphoria) and no evidence for more withdrawal (avoidance, distancing). Together, these results align previous research indicating that depression in childhood and adolescence is characterized by an irritable/hostile rather than a melancholic profile.

What do we learn from this for clinical practice?

1. Strengthening parental warmth and support is an important target in preventing depression. Psychoeducation and interventions should incorporate how parents can strengthen these behaviors. Specifically in the case of depressive symptoms among younger children (school-aged) we found lowered parental warmth and support over time (e.g. half a year after assessing the child’s depression). This phenomena is known as warmth/support-erosion. It highlights the importance to support parents in increasing or retaining their warmth and support when their child struggles with depressive symptoms.
2. Parental criticism and control also is an important target in preventing and intervening on childhood and adolescent depression. It is particularly important to limit parental criticism and control in positive interaction contexts. We found a stronger association of this parenting behavior with depression at a later timepoint (e.g. half a year) in the context of positive interaction tasks (e.g. planning a weekend trip) than in the context of negative interaction tasks (e.g. discussing conflicts). It is therefore important to keep positive interactions free from criticism and control.
3. Lastly, we found that childhood and adolescent depression is characterized by an irritable/hostile profile rather than a melancholic profile in parent-child interactions. Higher negative affect, lower autonomy, and lower task-engagement are more visible behaviors that can possibly help in signaling depressive symptoms. Further, these behaviors can form a challenge to children, parents, and the family dynamics. Family interventions should aim to validate these challenges and support family members in dealing with them.

About the study
The current study is part of the NWO Vici-project RE-PAIR of the department Clinical Psychology of Leiden University, led by prof. dr. Bernet Elzinga. The full, peer-reviewed paper has been published open access at the scientific journal Clinical Child and Family Psychology Review. Information about and publication of RE-PAIR can be found here.