This study examined how sibling relationships influence child outcomes in families where a parent has depression. The researchers found that among 316 adolescents aged 13-17 with a depressed parent, those who reported warmer sibling relationships were less vulnerable to the negative effects of parental criticism and hostility. Specifically, warmer sibling bonds moderated the relationship between expressed parental emotion/behaviors and adolescent symptoms of anxiety and depression. The results suggest promoting positive sibling relationships may help buffer children from difficulties associated with parental depression.

1. Sibling Relationships in
Children of Depressed Parents
Tracy R. G. Gladstone, Alice Frye, William R. Beardslee,
V. Robin Weersing, Judy Garber, Greg Clarke, David
Brent and Eugene D’Angelo
November 2, 2010
Oslo, Norway
1

2. Parental Depression
 Strongest risk factor for the development of
depression in children
 Children have two- to four-fold increased risk of
developing depression
 Children have more internalizing and externalizing
disorders, cognitive delays, academic and social
difficulties
 Effects of maternal depression have been found
from infancy through adolescence
2

3. Interpersonal Effects of
Parental Depression
 Negative, hostile and irritable towards
children
 More disengaged and withdrawn parenting
 More parent-child conflict
 More marital conflict
3

4. Positive Sibling Relationships
 Better social-cognitive skills
 Positive peer relationships
 Better perspective-taking skills
 Better self-control
 Decreased depressive symptoms
 Fewer externalizing problems
 Better coping skills
4

5. Negative Sibling Relationships
 Aggressive behaviors
 Poor peer relationships
 Academic difficulties
 Feelings of inadequacy
 Hostility
 Early substance abuse and sexual
behaviors
5

6. California Children of Divorce
Project (Wallerstein, 1985)
 Began in 1971
 Nonclinical sample – 60 families, 131
children, aged 2-18 at time of divorce
 Assessed at time of separation, 18
months, 5 years and 10 years post-
separation
 10-year follow-up of young adults who
were 9+ at time of separation (N=40)
6

7. Sibling Effects
 ―My brother and I are unusually close…I don’t
know what I would have done without him.‖
 ―Divorce forced my brother and me to grow up
and to be close to each other.‖
 ―My relationship with my sister has been the
saving of our emotional and physical
selves…without the other our chances of turning
out how we are would have been very different.
If I’d been an only child, I might have lost my
sanity.‖
7

8. Wallerstein (1985) Findings
 Siblings helped one another manage the
stress of parental divorce.
 Sibling relationships were protective.
8

9. Study Goal
 To examine the effects of sibling
relationships on child outcome in families
with depressed parents
 In families with a depressed parent, do
strong sibling relationships buffer teens
from the effects of negative parenting
behaviors that are associated with
parental depression?
9

10. Adolescent Eligibility Requirements
 Teen aged 13-17
 Parent with history of depression
AND
 Teen with history of depression OR
current depressive symptoms
* Teens with current depressive disorder
were NOT eligible for this study
10

11. Full Sample Description (N=316)
Characteristic
Child Age M=14.79 Range: 13-17
years
Child Sex 185 Girls 131 Boys
Child Race White: 80% Black: 13% Other: 7%
Child Ethnicity Non-Latino: 93% Latino: 7%
Parents’ Marital
Status
60% Married
Mother in Home 93%
Family Income Median: 60-70,000
Parent Education Mean: Some
College
11

12. Measures
 Adolescent Symptomatology
 Center for Epidemiologic Studies – Depression Scale
(CES-D)
 Screen for Anxiety Related Emotional Disorders
(SCARED)
 Patient Health Questionnaire (PHQ) - GAD
 Parental Behaviors
 Five Minute Speech Sample Task (FMSS)
 Conflict Behavior Questionnaire (CBQ)
 Child’s Report of Parental Behavior Inventory (CRPBI)
 Sibling Relationships
 Sibling Relationships Questionnaire (SRQ)
12

13. Measures of Adolescents’
Symptoms – CES-D
 20 items
 Symptoms over past 1 week
 Sample items:
 ―I did not feel like eating, my appetite was
poor‖
 ―I thought my life had been a failure‖
 ―I had crying spells‖
13

14. Measures of Adolescents’
Symptoms - SCARED
 41 items
 Symptoms over past 3 months
 Sample items
 ―I get stomachaches at school.‖
 ―When I get frightened, my heart beats fast.‖
 ―I don’t like to be with people I don’t know
well.‖
14

15. Measures of Adolescents’
Anxiety Diagnosis - PHQ
 26 items (related to anxiety)
 Symptoms over past 6 months
 Sample items
 ―In the last 6 months, have you had an
anxiety attack, when you suddenly felt fear or
panic for no apparent reason?‖
 ―In the last 6 months, have you felt nervous,
anxious, or on edge, or have you worried a lot
on more than half the days?‖
15

16. Measures of Parenting Behaviors -
FMSS
 ―Please tell me what kind of person your
child is, and how the two of you get along
together‖
 Parents talk for 5 minutes without
interruption
 Rated for expressed emotion
16

17. Measures of Parenting Behaviors -
CBQ
 Parent- and child-rated versions
 20 items
 Negative communication and conflict over
past 2 weeks
 Sample items:
 ―My child is easy to get along with.‖
 ―My child tells me he/she thinks I am unfair.‖
 ―My child acts impatient when I talk.‖
17

18. Measures of Parenting Behaviors -
CRPBI
 Parent- and child-rated versions
 23 items, scores on parental
warmth/acceptance, psychological control
and monitoring
 Sample items:
 ―You give your child a lot of care and
attention.‖
 ―You often interrupt your child.‖
18

19. Measure of Sibling Relationship
Quality - SRQ
 6 items assessing sibling intimacy and prosocial
behaviors
 Completed for sibling who is ―the most
important in your life‖
 Sample items:
 ―How much do you and this sibling share with each
other?‖
 ―Some siblings cooperate a lot, whereas other siblings
cooperate a little. How much do you and this sibling
cooperate with each other?‖
19

20. Measures: Descriptive Statistics
Measure Mean (Standard Deviation)
CRPBI-Acceptance, Mother on Child 26.06 (3.62)
CRPBI-Acceptance, Child on Mother 23.89 (4.84)
Five Minute Speech Sample—EE
Subgroup
3.39 (2.55)
CBQ-Parent 6.81 (5.74)
CBQ-Child 5.68 (5.35)
SRQ Total 1.64 (1.00)
CES-D Child 15.69 (9.69)
CES-D Parent 19.22 (12.26)
SCAA-Child 22.57 (12.18) 20

21. Sibling Related Characteristics from SRQ
(N=233)
Had a Sibling 91%
Age Range Difference 0 – 22 years, M=4.28
% Sibling Older than Target Child 47%
Gender of sibling 53% female
% Sibling full or half sibling 90%
21

22. What is Moderation?
 A moderator is a variable that influences
the strength of the relationship between
two other variables.
 When the level of the moderator is higher
or lower, the degree of relationship
between the other variables changes
 Cross sectional moderation does not imply
causality.
22

23. Analyses
 Conducted in M-Plus
 Moderation using linear regression
 Moderation using logistic regression
 Missing data estimated using Full
Information Maximum Likelihood
 Results similar for models with missing
and non-missing data
23

24. Sibling Relationship Quality as a
Moderator of Parental Expressed
Emotion and Child Outcome
Predictor SCAA GAD
Beta R2 Odds Ratio Confidence
Interval
Adolescent
Age
-.14 .01 .60 .32—1.11
Parental EE .55** .01 1.95* 1.04—3.55
SRQ .37* .01 2.28 .51—8.89
SRQ X EE -.72** .07* .63* .41--.97
24
* p<.05; ** p<.01

25. Sibling Relationship Quality as a
Moderator of Parent Expressed Emotion
and Child Anxiety Symptoms
0,00
10,00
20,00
30,00
40,00
50,00
60,00
0 1 2 3 4 5 6 7 8
ChildAnxiety
Parent Expressed Emotion
High
Low
Sibling
Relationship
Quality
25

26. Sibling Relationship Quality as a
Moderator of Parent Expressed Emotion
and Child Anxiety Diagnosis
0,00
0,10
0,20
0,30
0,40
0,50
0,60
0,70
0,80
0,90
1,00
0 1 2 3 4 5 6 7 8
PredictedProbabilityofDiagnosis
Parental Expressed Emotion
High
Low
Sibling
Relationship
Quality
26

27. Sibling Relationship Quality as a
Moderator of Parent Reported
Psychological Control and Child
Outcome
Predictor GAD
Odds Ratio Confidence Interval
Adolescent
Age
.69 .41--1.73
Psych
Control
1.95 .94--2.83
SRQ 142.06* 1.32—***
SRQ X
Control
.54* .34--.90
27*p<.05; **p<.01; ***p<.001

28. Sibling Relationship Quality as a
Moderator of Parent Reported
Psychological Control and Child Anxiety
Diagnosis
0,00
0,10
0,20
0,30
0,40
0,50
0,60
0,70
0,80
0,90
1,00
0 4 8 12 16 20 24
PredictedProbabilityofDiagnosis
Parental Psychological Control
High
Low
Sibling
Relationship
Quality
28

29. Sibling Relationship Quality as a
Moderator of Parent Reported
Negative Interactions and Child
Outcome
Predictor SCAA CES-D, Adolescent
Beta R2 Beta R2
Child Age -.06 .02 -.03 .01
Negative
Interactions
.69** .02 .72** .05
SRQ .41** .02 .29* .06
SRQ X Negative
Interactions
-.85** .14 -.77** .16
*=p<.05; **=p<.01 29

30. Sibling Relationship Quality as a Moderator of
Parent Reported Negative Behaviors and Child
Depressive Symptoms
0,00
10,00
20,00
30,00
40,00
50,00
0 4 8 12 16 20
ChildDepressiveSymptoms
Parent Reported Negative Behaviors
High
Low
Sibling
Relationship
Quality
30

31. Sibling Relationship Quality as a Moderator of
Parent Reported Negative Behaviors and Child
Anxiety Symptoms
0,00
5,00
10,00
15,00
20,00
25,00
30,00
35,00
40,00
0 4 8 12 16 20
ChildAnxietySymptoms
Parent Reported Negative Behaviors
High
Low
31

32. Sibling Relationship Quality as a
Moderator of Child Reported Maternal
Acceptance and Child Outcome
Predictor CES-D Adolescent
Beta R2
Child Age -.07 .01
Maternal
Acceptance
-.64** .03
SRQ -1.11** .06
SRQ X Maternal
Acceptance
1.12* .09
*=p<.05; **=p<.01 32

33. Sibling Relationship Quality as a Moderator of Child
Reported Maternal Acceptance and Child
Depressive Symptoms
0,00
5,00
10,00
15,00
20,00
25,00
30,00
35,00
40,00
45,00
0 5 10 15 20 25 30
ChildDepressiveSymptoms
Child Reported Maternal Acceptance
High
Low
Sibling
Relationship
Quality
33

34. Sibling Relationship Quality as a
Moderator of Parent Reported Parental
Acceptance and Child Outcome
Predictor SCAA CES-D, Adolescent
Beta R2 Beta R2
Child Age -.08 .02 -.06 .01
Acceptance -.51** .02 -.53** .02
SRQ -1.63** .02 -1.65* .02
SRQ X
Acceptance
1.68** .07 1.64** .06
*=p<.05; **=p<.01 34

35. Sibling Relationship Quality as a Moderator of
Parent Reported Parental Acceptance and Child
Depressive Symptoms
0,00
10,00
20,00
30,00
40,00
50,00
60,00
0 5 10 15 20 25 30
ChildDepressiveSymptoms
Parent Reported Parental Acceptance
High
Low
Sibling
Relationship
Quality
35

36. Sibling Relationship Quality as a Moderator of
Parent Reported Parental Acceptance and Child
Anxiety Symptoms
0,00
10,00
20,00
30,00
40,00
50,00
60,00
0 5 10 15 20 25 30
ChildAnxietySymptoms
Parent Reported Parental Acceptance
High
Low
Sibling
Relationship
Quality
36

37. Limitations
 High risk sample
 Female respondents only
 Not enough fathers to analyze separately
 Sibling relationships account for 5-10% of
variance
37

38. Conclusions
 Multi-method, multi-informant study with
consistent findings:
 In sibling pairs containing at least one girl,
when sibling relationships are warm and
supportive, girls are less vulnerable to the
negative effects of maternal criticism and
negative parenting behaviors
 Supports family-based approach to
preventing depression in children of
depressed parents
 Implications for prevention and
intervention 38

39. Next Steps
 Need to replicate findings with sibling data
from a larger sample
 Include additional measures of sibling
relationships
 Observational measures
 Reports from both siblings
 Parent reports
 Include gender-neutral measures
 Include more fathers
 Longitudinal design 39

40. Sibling-Based Intervention
Key Components
(Kramer, 2010)
▪ Positive engagement
▪ Cohesion
▪ Shared experiences that build support
▪ Perspective taking
▪ Emotion regulation
▪ Behavioral control
▪ Forming neutral or positive attributions
▪ Problem solving/managing conflicts
▪ Evaluating parental differential treatment 40

41. Sibling Intervention for Families
with Parental Depression
 Short, structured
 Focus on promoting sibling warmth rather
than reducing sibling conflict
 Include significant psychoeducational and
training component for parents
 Include direct session with siblings
41

42. Prevention of Depression
in
At-Risk Adolescents
Judy Garber, Vanderbilt University
David Brent, University of Pittsburgh
Greg Clarke, Kaiser Permanente Center for Health Research
William Beardslee, Harvard University
V. Robin Weersing, SDSU/UCSD
Tracy Gladstone, Wellesley College
Steven D. Hollon, Vanderbilt University
Lynn Debar, Kaiser Permanente Center for Health Research
Eugene D'Angelo, Harvard University
42

43. END
43

44. Sample Description for SRQ, n=233
Characteristic
Child Age M=14.79 Range: 13-17
years
Child Sex 133 Girls 100 Boys
Child Race White: 81% Black: 10.4% Other: 7%
Child Ethnicity Non-Latino: 93% Latino: 7%
Parents’ Marital
Status
68% married
Mother in Home 94%
Family Income Median: 60-70,000
Parent Education Mean: Some
college
44

45. Associations Between Measures
(girls analysis sample only)
Measure 2. 3. 4. 5. 6. 7. 8. 9. 10.
1. Age -.11 -.14 .14 .10 .00 -.07 .04 -.09 -.05
2. CESD
Child
-- .65*
*
.34** -.10 -.21* -.05 .11 .21* .16
3. SCAA -- -- .11 -.04 -.14 .03 .03 .14 .04
4. CESD-
Parent
-- -- -- .16 -.10 -.34. .16 -.04 .32**
5. SRQ -- -- -- -- -.01 -.03 .18 -.02 .06
6. CRPBI-
Child
-- -- -- -- -- .28** -.20* -.80 -.33**
7. CRPBI-
Parent
-- -- -- -- -- -- -.17 -.21* -.39**
8. FMSS-
EE
-- -- -- -- -- -- -- .22* .35**
9. CBQ-
Parent
-- -- -- -- -- -- -- -- .37**
*=p<.05; **=p<.01
45

46. Measures: Descriptive Statistics
Measure Mean (Standard
Deviation)
Community Norms
Mean (Standard
Deviation)
CRPBI-Acceptance,
Mother on Child
26.06 (3.62) 25.43 (2.71)
CRPBI-Acceptance,
Child on Mother
23.89 (4.84) 24.15 (4.02)
Five Minute Speech
Sample—EE
Subgroup
3.39 (2.55) No comparison, different
metric used
CBQ-Parent 6.81 (5.74) 6.96 (6.02)
CBQ-Child 5.68 (5.35) 7.20 (5.61)
SRQ Total 1.64 (1.00) 2.40 (.31)
CES-D Child 15.69 (9.69) 15.6 (9.7)
CES-D Parent 19.22 (12.26) Generally 9-10
SCAA-Child 22.57 (12.18) 37.30 (18.97) 46

47. Current Sample vs. Community Norms
 Current Sample
 Higher self-reported depressive symptoms in
parent
 Parent is observed to be more critical
regarding child
 Teens rate parent as more negative in
interactions
 Teens report fewer symptoms of anxiety
 Teens report less warmth and closeness
toward siblings 47