Table Of ContentConstance Hammen
Depression Runs in Families
The Social Context of Risk and Resilience in
Children of Depressed Mothers
Springer-Verlag
New York Berlin Heidelberg London
Paris Tokyo Hong Kong Barcelona
Constance Hammen
Department of Psychology
University of California
Los Angeles, CA 90024-1563
USA
Series Editor:
Lauren B. Alloy
Department of Psychology
Temple University
Philadelphia, PA 19122
USA
With five illustrations.
Library of Congress Cataloging-in-Publication Data
Hammen, Constance L.
Depression runs in families: The social context of risk and resilience in children of
depressed mothers 1 Constance Hammen.
p. cm. - (Series in psychopathology)
Includes bibliographical references.
ISBN-I3 978-1-4684-6412-2 e-ISBN-I3 978-1-4684-6410-8
DOL 10.1007/978-1-4684-6410-8
1. Children of depressed persons-Mental health. 2. Depression,
Mental-Etiology. 3. Mother and child. 4. Depressed persons
Family relationships. I. Title. II. Series.
[DNLM: 1. Child of Impaired Parents. 2. Depressive Disorder.
3. Depressive Disorder-etiology. 4. Depressive Disorder-in
infancy & childhood. 5. Family. 6. Parent-Child Relations. WM
171 H224d)
RC537.H3 1991
616.85'27-dc20
DNLM/DLC
for Library of Congress 90-10460
Printed on acid-free paper.
© 1991 Springer-Verlag New York Inc.
Softcover reprint of the hardcover 1s t edition 1991
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987654321
Series in Psychopathology
Series Editor
Lauren B. Alloy
Series in Psychopathology
Editor: Lauren B. Alloy
Published Volumes:
Depression Runs in Families: The Social Context of Risk and
Resilience in Children of Depressed Mothers
Forthcoming:
Hopelessness Depression
Neurobehavioral Systems, Personality, and Psychopathology
Acknowledgments
The research project that this book is based on came to be called the
UCLA Family Stress Project. It began in the early 1980s as an attempt to
study the childhood origins of depression. It was the collaborative effort of
many people. It would not have been undertaken at all without the
instigation, enthusiasm, and planning of then-graduate students David
Gordon and Carol Jaenicke. Later, when the original enthusiasm gave way
to the sheer amazement at the magnitude of the task we had undertaken,
Dorli Burge and Cheri Adrian made it continue. Involved at every level of
both tedium and excitement as the project matured, they were there
through the last of the follow-ups. Their extraordinary talent and
dedication were essential to the project. The enormous psychic rewards of
an academic profession are nowhere more apparent than in the opportun
ity to use the abilities entrusted to us to do meaningful work in the
company of dedicated and enthusiastic students. It was a privilege for me
to have this opportunity over the past few years.
Jean Kaufman played a major part in keeping the ship afloat and
everyone in good humor. Libbi Burney Hamilton was a mainstay in the
follow-up stages, just as Brian Zupan was in the earlier phases. Carolyn
Anderson and Marilyn Conrad contributed their interest, support, and
good ideas, and early on we were glad to have the help of Pam Kimsey,
Aimee Ellicott, Maren Jones, and other graduate students at UCLA.
The countless administrative aspects of the study required the help of
many, and over the years I was fortunate to have the assistance of Kelly
Ellis, Memee Peggs, Tina Goodman-Brown, Robin Gilson, and Miki
Carpenter. All of them have gone on to graduate studies in helping
professions. There were many dedicated and talented undergraduates who
played important roles in the project and who have now gone on to
graduate programs and to their own projects. Although there are too many
to mention all of them, a few deserve special recognition and good wishes
for their own futures: Marie Martel, Nangel Lindberg, Lisa Harris, Naomi
Oderberg, Michael Friedmann, Howard Fulfrost, Kirsten Fleming, and
v
vi Acknowledgments
Debbi Stackman. The assistance of all the others is also gratefully
acknowledged.
Early in the project Donald Hiroto was helpful, and a grant to him from
the Veterans Administration helped to get the study off the ground.
Special thanks are owed to the William T. Grant Foundation for funding
for most of the study. They showed faith in a newly forming developmental
psychopathologist, and their support certainly opened new vistas in my
career.
Finally, the families who consented to participate in this study must be
acknowledged. Their immeasurable contribution, the courage to reveal
their most vulnerable experiences and the women's undeniable concerns
about making the best family lives possible, earned our respect and
gratitude. Although this report offers little to the women and children in
return for their efforts, the work affirms our concern for their struggles and
for finding solutions.
Contents
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. v
1 Studies of Children of Depressed Parents . . . . . . . . . . . . . . . . 1
2 Methods ofthe Current Study ....................... 26
3 Diagnoses and Dysfunction in Children at Risk .. . . . . . . . . .. 54
4 Vulnerability to Depression: The Role of Children's Cognitions.. 80
5 Family Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 108
6 Parent-Child Relationships and Depression. . . . . . . . . . . . .. 140
7 Familial and Parental Clinical Characteristics. . . . . . . . . . . . .. 173
8 Risk and Resilience . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 201
9 Summary and Implications: Understanding Depression in Families
at Risk ...................................... 227
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 250
vii
1
Studies of Children of
Depressed Parents
Depression runs in families.
This simple conclusion has a far from simple explanation or meaning.
Some would argue that in its severe or chronic forms, depression is a
disease whose underlying pathophysiology is genetically transmitted.
Others would argue that depression arises in a psychosocial context,
and that its intergenerational patterns reflect maladaptive interpersonal,
situational, and intrapsychic processes that are played out in family life and
child socialization. Still others would emphasize the transactional nature of
multiple processes, encompassing both biological and psychosocial factors
unfolding in the family context.
Not surprisingly, these three approaches to psychopathology represent
competing perspectives on most forms of psychological disorder. The study
of affective disorders offers an excellent opportunity to consider these
models and their utility in explicating familial patterns of depression.
There are several reasons for pursuing this goal in the context of depressive
disorders: practical matters of the widespread incidence and pernicious
consequences of mood disorders, and theoretical issues in which depress
ion provides a lively forum for development of a variety of hypotheses.
Mood Disorders: A Major Public Health Problem
Nearly everyone experiences depression as part of living-it is a normal
and usually brief reaction to the perils of existence, the failures, setbacks,
disappointments, and losses that attend modern life. Depression can last
a few hours, a few days, or even weeks, but for most individuals it
is transitory and, however unpleasant it may feel, it does not impair
functioning. Yet, for a substantial minority-and some would argue that
this is a growing number-depression is a debilitating and even life
threatening disorder.
The constellation of mood and physical, behavioral, and psychological
symptoms that comprise the syndrome of clinically significant depression
1
2 1. Studies of Children of Depressed Parents
has been found to occur to between 4 and 8% of the adult population
(Karno et aI., 1987). Earlier investigations using less stringent, reliable
standards or including milder forms of depression estimated the rates to be
even higher, up to 18% in various U.S. cities and Western nations (Boyd
& Weissman, 1981). At any given moment, between 9 and 20% of the
population will report some significant depression symptoms even if they
do not meet formal diagnostic criteria for depression (e.g., Boyd &
Weissman, 1981).
The syndrome of manic depression, now termed bipolar disorder, is
more rare, estimated to affect less than 1% of the population (Boyd &
Weissman, 1981; Robins et aI., 1984). However, as criteria for identifying
milder forms of bipolar disorder have improved, investigators have
suggested that the rates of symptoms may be higher than originally
suspected (Depue et aI., 1981). Moreover, these mild or even subsyndrom
al forms of affective disorder may be early warning signs of later, full-scale
major affective disorders.
The sheer numbers of people with affective disorders marks them as our
most common psychiatric problem. Yet the great majority of individuals,
especially those with major or chronic unipolar depression, do not seek
treatment. But even beyond the magnitude of the problem, there are three
striking features of mood disorders. One is impairment, a second is
recurrence and chronicity, and the third is the apparently increasing rates
and shifting demographic patterns.
Impairment of functioning due to moderate or severe affective disorder
has a unique twist that separates such disorders from many other kinds
of psychiatric conditions, all of which by definition involve impaired
functioning. The low mood, apathy, lack of energy, loss of pleasure,
negative outlook on the self and the future that typify depression, for
instance, often seem "irrational" to others. Whereas psychotic or bizarre
symptoms or behaviors of depression and mania may be detectable as
illness, most of the less florid mood-related symptoms are often viewed as
controllable. That is, people in this culture are typically held responsible
for their own moods and expected to overcome dysphoric states by will,
effort, and activity. Yet it is a major characteristic of clinical depression
that mood affects the way people construe themselves and their worlds.
Additionally, the bodily experiences of low energy, poor appetite, and
sleep disturbances are part of the depression syndrome. Thus a depressed
person may be entirely "capable" as a worker or parent but feel unable to
perform the functions of these roles. An individual who is depressed may
experience paralyzing doubts about her own worth as a person that
exacerbate dysphoria and may heighten sensitivity to criticism or even lead
to social withdrawal. Yet to an outsider, they may be unrealistic in terms
of the person's skills, personal qualities, appearance, and desirability.
Similarly, a man who has lost his job due to layoff may experience
depression that affects his outlook, energy, and self-respect. When others
