Key takeaways:

• A family bereavement program for children lowered the prevalence of major depression years later.
• The findings stress the value of parenting and coping in children’s depression development.

The prevalence of major depression was lower among bereaved children 15 years after participating in a family bereavement program compared with children who did not partake in the program, data showed.

“Although studies have reported positive effects of programs to prevent depression and anxiety research has not yet demonstrated that programs in childhood and adolescence prevent depression and anxiety disorders in adulthood, or identified the pathways that account for these long-term preventive effects,” Irwin Sandler, PhD, a Regents Professor Emeritus and research professor in the department of psychology at Arizona State University, and colleagues wrote in the Journal of the American Academy of Child & Adolescent Psychiatry.

Sandler and colleagues analyzed data from a randomized controlled trial assessing the family bereavement program in 135 children aged 8 to 16 years whose parent had died within the past 3 to 30 months. Outcomes in these children were compared with 109 controls documented in literature. Children underwent evaluation for major depression and generalized anxiety at the pre-test and post-test, as well as at follow-ups at 11 months, 6 years and 15 years.

For the family bereavement program, caregivers, children aged 8 to 11 years and adolescents aged 12 to 16 years attended 12 separate sessions. Caregivers learned about positive parenting, understanding their children’s grief and how to reduce children’s exposure to stressful events. The sessions for children and adolescents focused on coping and emotional regulation.

At 15 years, children who went through the family bereavement program were less likely to have major depression compared with controls (OR = 0.332; 95% CI, 0.13-0.84). Generalized anxiety disorder at 15 years occurred marginally less frequently among children in the bereavement program (OR = 0.353; 90% CI, 0.35-0.96).

“Prior mediation analyses with this sample found that family bereavement program effects to strengthen positive parenting immediately after the program mediated its effects to reduce 6-year internalizing symptoms and aversive self-views,” Sandler and colleagues wrote. “The current study found that youth positive coping, active inhibition of emotional expression and intrusive grief thoughts also mediated family bereavement program effects on 6-year internalizing problems and aversive self-views, which in turn mediated program effects to reduce major depressive disorder in adulthood.”

Moving forward, work is needed to move the program from an experimental to a community resource phase, as well as make the program more efficient, according to the researchers.