Incorporating family factors into treatment planning for adolescent depression: Perceived parental criticism predicts longitudinal symptom trajectory in the Youth Partners in Care trial

Abstract

BackgroundThis study aimed to clarify the predictive significance of youth perceptions of parental criticism assessed using a brief measure designed to enhance clinical utility. We hypothesized that high perceived parental criticism would be associated with more severe depression over 18-months of follow-up. MethodsThe study involved secondary analyses from the Youth Partners in Care trial, which demonstrated that a quality improvement intervention aimed at increasing access to evidence-based depression treatment in primary care led to improved depression outcomes at post-treatment compared to usual care enhanced by provider education regarding depression evaluation/management. Patients (N = 418; ages 13–21) were assessed at four time points: baseline; post-treatment (six-month follow-up); 12- and 18-month follow-ups. The primary analysis estimated the effect of perceived parental criticism on likelihood of severe depression (i.e., Center for Epidemiological Studies-Depression Scale ≥ 24) over post-intervention follow-ups using a repeated-measures logistic regression model. Secondarily, a linear mixed-effects growth model examined symptom trajectories from baseline through 18-months using the Mental Health Index-5, a measure of emotional distress available at all time-points. ResultsHigh perceived parental criticism emerged as a robust predictor of clinically-elevated depression (OR=1.66, p=.02) and a more pernicious symptom trajectory over 18-months (β =-1.89, p<.0001). LimitationsThe association between the self-report perceived criticism and traditional expressed emotion measures derived from verbal and nonverbal parental behaviors was not evaluated. ConclusionsResults support perceived parental criticism as a predictor of youth depression outcomes over 18-months. This brief measure can be feasibly integrated within clinical assessment to assist clinicians in optimizing treatment benefits.