Abstract
Parental depression can adversely affect parenting and children’s development. We adapted mindfulness-based cognitive therapy (MBCT) for parents (MBCT-P) with a history of depression and describe its development, feasibility, acceptability and preliminary estimates of efficacy. Manual development involved interviews with 12 parents who participated in MBCT groups or pilot MBCT-P groups. We subsequently randomised 38 parents of children aged between 2 and 6 years to MBCT-P plus usual care (n = 19) or usual care (n = 19). Parents were interviewed to assess the acceptability of MBCT-P. Preliminary estimates of efficacy in relation to parental depression and children’s behaviour were calculated at 4 and 9 months post-randomisation. Levels of parental stress, mindfulness and self-compassion were measured. Interviews confirmed the acceptability of MBCT-P; 78 % attended at least half the sessions. In the pilot randomised controlled trial (RCT), at 9 months, depressive symptoms in the MBCT-P arm were lower than in the usual care arm (adjusted mean difference = −7.0; 95 % confidence interval (CI) = −12.8 to −1.1; p = 0.02) and 11 participants (58 %) in the MBCT-P arm remained well compared to 6 (32 %) in the usual care arm (mean difference = 26 %; 95 % CI = −4 to 57 %; p = 0.02). Levels of mindfulness (p = 0.01) and self-compassion (p = 0.005) were higher in the MBCT-P arm, with no significant differences in parental stress (p = 0.2) or children’s behaviour (p = 0.2). Children’s behaviour problems were significantly lower in the MBCT-P arm at 4 months (p = 0.03). This study suggests MBCT-P is acceptable and feasible. A definitive trial is needed to test its efficacy and cost effectiveness.
Highlights
Between 10 and 15 % of adults experience depression during their lifetime (Lépine and Briley 2011)
In the manual development groups, attendance was high; one participant, respectively, attended 3, 4, 5 or 6 sessions whilst three attended 7 sessions and six attended all 8 available sessions. It was decided following a discussion with clinic staff, to include one parent who had two teenagers, the eldest being 14, in order to maximise the number of parents participating and ensure it was feasible for one of the mindfulness-based cognitive therapy (MBCT)-P groups to take place
All feedback was considered in the context of the group in which parents had participated (MBCT or MBCT-P) to allow changes to be made to the manual as appropriate
Summary
Between 10 and 15 % of adults experience depression during their lifetime (Lépine and Briley 2011). Estimates of disability-adjusted life years due to unipolar depression are highest among those aged between 15 and 49 (WHO 2015), which are typically the childbearing years. Parental depression has been associated with increased intrusiveness and reduced sensitivity in parent-child interactions (Lovejoy et al 2000) and with poorer outcomes for children, in terms of their emotional, behavioural, social (Davé et al 2008; Goodman et al 2011; Ramchandani et al 2005; Velders et al 2011) and cognitive development (Sharp et al 1995). There is evidence from the STAR*D trial that improving symptoms of parental depression can result in improvements in children’s behaviour (Weissman et al 2006)
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