The perceived social support of parents having bipolar disorder impacts their children's mental health: a 10-year longitudinal study.

BACKGROUND: The offspring of parents with bipolar disorder (OBD) are at higher risk of developing psychopathology than the offspring of parents with no affective disorder (control). In addition to genetic predisposition, childhood adversity and a stressful family environment are important risk factors for the OBD. Protective factors in parents, such as social support and coping strategies, may buffer the effects of stress on at-risk children. This study tested whether parents' social support and coping style attenuated the link between risk status (OBD vs. control) and psychopathology in offspring. METHODS: During offspring's middle childhood, parents underwent a diagnostic interview and completed social support and coping style questionnaires. Sixty-nine OBD (39 female) and 69 control (29 female) offspring between ages 13 and 29 completed a diagnostic interview approximately 10 years later. RESULTS: Parents' social support satisfaction moderated the link between offspring risk status and their development of substance use disorder (SUD) symptoms (F(1,131) = 5.90, p = .017). Parents' social network size moderated the link between offspring risk status and their development of anxiety and depression symptoms in an unexpected direction (F(1,131) = 5.07, p = .026). No effects of parents' coping style were found. CONCLUSIONS: Among the OBD, having parents with greater social support satisfaction and, unexpectedly, a smaller social network buffered their development of SUD and depression and anxiety symptoms by early adulthood. Parents' social support may thus have a protective function for children in these high-risk families.

The effects of intranasal oxytocin on the efficacy of psychotherapy for major depressive disorder: a pilot randomized controlled trial.

BACKGROUND: Although both pharmacotherapy and psychological treatments are considered to be efficacious in the treatment of major depressive disorder (MDD), one third of patients do not respond to treatment and many experience residual symptoms post-treatment. In this double-blind placebo-controlled randomized control trial (RCT), we assessed whether intranasal oxytocin (OT) augments the therapeutic efficacy of psychotherapy for MDD and improves the therapeutic alliance. METHODS: Twenty-three volunteers (12 female) with MDD underwent 16 sessions of interpersonal therapy. Prior to each session, volunteers self-administered 24 International Units of intranasal OT (n = 12; Syntocinon) or placebo (n = 11). Depressive symptoms were assessed with the Inventory of Depressive Symptomatology at pre- and post-treatment, and at a six month follow-up. RESULTS: Multilevel modeling found a significant effect of OT on the negative slope of depressive symptoms over time (p < 0.05), with medium-large effect sizes at post-treatment (Cohen's d = 0.75) and follow-up (Cohen's d = 0.82). Drug intervention also predicted the intercept when examining the weekly ratings of the therapeutic alliance (p < 0.05), such that volunteers receiving OT, relative to placebo, reported improved therapeutic alliance at session 1. The agreement of goals between therapists and participants, a facet of the therapeutic alliance, mediated the relationship between drug intervention and clinical outcome. CONCLUSION: In this pilot study, the administration of intranasal OT, relative to placebo, improved the therapeutic alliance at the beginning of therapy and therapeutic efficacy of psychotherapy in persons with MDD. Future RCTs should attempt to replicate these findings in larger samples with different therapeutic modalities (ClinicalTrials.gov: NCT02405715).

Reduced parenting stress following a prevention program decreases internalizing and externalizing symptoms in the offspring of parents with bipolar disorder.

BACKGROUND: Offspring of parents with bipolar disorder (OBD) are at risk for developing mental disorders, and the literature suggests that parenting stress may represent an important risk factor linking parental psychopathology to offspring psychopathology. We aimed to investigate whether improvements in parenting stress mediated the relationship between participation in a prevention program and offspring internalizing and externalizing symptoms at follow-up. METHODS: Families having a parent with BD (N = 25) underwent a 12-week prevention program. Assessments were conducted at pre-intervention, post-intervention, and at 3- and 6-month follow-ups. Families of parents with no affective disorders (i.e., control families) served as a comparison sample (N = 28). The Reducing Unwanted Stress in the Home (RUSH) program aimed to teach communication, problem-solving, and organization skills to improve the rearing environment. Measures included the Parenting Stress Index-4th Edition, the Behaviour Assessment Scales for Children-2nd Edition, and the UCLA Life Stress Interview. RESULTS: Families having a parent with BD reported more parenting stress at pre-intervention, and more change across time, than control families. Improvements in parenting stress mediated the relationship between participation in the intervention and reduced offspring internalizing and externalizing symptoms. While families having a parent with BD reported more chronic interpersonal stress at pre-intervention, no intervention effects were found. CONCLUSIONS: The findings demonstrate that a preventative intervention targeting parenting stress in families may serve to prevent the development of mental disorders in at-risk children.

Improved Parent-Child Interactions Predict Reduced Internalizing Symptoms Among the Offspring of Parents with Bipolar Disorder Undergoing a Prevention Program: A Proof-of-Concept Study.

The offspring of parents with bipolar disorder (OBD) exhibit elevated rates of psychopathology. However, preventative interventions are lacking. Using a quasi-experimental design with an assessment-only control group, we examined if a 12-week program (entitled Reducing Unwanted Stress in the Home, RUSH) decreases internalizing and externalizing symptoms in the OBD (aged 6-11 years) via intervention-related gains in parent-child interaction quality. Participants consisted of 55 offspring (26 OBD; 29 controls) and their parents. Assessments were conducted at four time points up to six months following the end of the RUSH program, during which parent and teacher ratings of child symptoms, and parent-child interaction quality (parental positivity and negativity, and dyadic mutuality) were measured. Multilevel modelling showed improved parental positivity and negativity, and dyadic mutuality among target dyads immediately and six months post-intervention. For the bootstrapping mediation analyses, intervention-related change in parental negativity fully mediated the relations between having participated in the RUSH program and lower parent-reported internalizing problems among the OBD six months later. These data provide evidence of the efficacy of the RUSH program for OBD who exhibited improved interactions with their parents post-intervention. Further investigation via a randomized controlled trial is warranted.

Predicting Interpersonal Outcomes From Information Processing Tasks Using Personally Relevant and Generic Stimuli: A Methodology Study.

Despite evidence of differential processing of personally relevant stimuli (PR), most studies investigating attentional biases in processing emotional content use generic stimuli. We sought to examine differences in the processing of PR, relative to generic, stimuli across information processing tasks and to validate their use in predicting concurrent interpersonal functioning. Fifty participants (25 female) viewed generic and PR (i.e., their intimate partner's face) emotional stimuli during tasks assessing selective attention (using a modified version of the Spatial Cueing Task) and inhibition (using the Negative Affective Priming task) of emotional content. Ratings of relationship quality were also collected. Evidence of increased selective attention during controlled and greater avoidance during automatic stages of processing emerged when viewing PR, relative to generic, emotional faces. We also found greater inhibition of PR sad faces. Finally, male, but not female, participants who displayed greater difficulty disengaging from the sad face of their partner reported more conflict in their relationships. Taken together, findings from information processing studies using generic emotional stimuli may not be representative of how we process PR stimuli in naturalistic settings.

A comprehensive assessment of personality traits and psychosocial functioning in parents with bipolar disorder and their intimate partners.

BACKGROUND: Individuals with bipolar disorder (BD) often possess maladaptive traits and present with various difficulties in psychosocial functioning. However, little is known about the intimate partners of adults with bipolar disorder (BD) and how mental illnesses other than BD within couples may further complicate the picture. Such knowledge is needed to inform both couple and family interventions. METHODS: Participants were parents whose children were enrolled in a prospective study: 55 with BD and their partners, and 47 healthy control couples. All completed diagnostic interviews, and questionnaires describing personality traits, negative life events, coping skills, social support, marital adjustment and inter-partner verbal aggression. Parents with BD and healthy control parents were compared, as were the intimate partners. A series of exploratory analyses focused on the average measures within couples, with and without BD, and took account of comorbid personality disorders among those with BD and major depressive disorder among their partners. RESULTS: Intimate partners of adults with BD, relative to healthy control partners, presented with more mental disorders, higher neuroticism, lower extraversion, more emotion-focused coping, smaller social networks, less satisfaction with their social networks, and little, satisfying social contact. Additionally, they reported less consensus and satisfaction in their marital relationships, and engaged in more verbal aggression towards their partners. Participants with BD showed similar, more extreme, characteristics. Marital distress and verbal aggression were greatest among couples with an adult having BD and a comorbid personality disorder or a partner with major depressive disorder. CONCLUSION: This study contributes to the literature by demonstrating that both parents with BD and their intimate partners exhibit high levels of mental illness, maladaptive personality traits and psychosocial difficulties, thus limiting their partners' ability to provide support and stability in the these high risk families. Moreover, mental illnesses other than BD may contribute to marital problems within couples. Some statistical analyses, particularly those involving comorbid conditions, were under-powered in this study. As clinical implications, the current study suggests that both individuals with BD and their partners could benefit from interventions aimed at lowering emotionality and verbal aggression, and increasing social support and effective coping skills.

Oxytocin and social context moderate social support seeking in women during negative memory recall.

BACKGROUND: Oxytocin is theorized to promote social support seeking under stress- an alternate biobehavioural response to challenge known as the tend-and-befriend response. These effects may be context dependent, however, and no study has evaluated this effect in the presence and absence of social support. The aim of this study was to evaluate the effects of oxytocin on the experience of recalling emotional autobiographical memories in two contexts-with and without social contact with an experimenter. METHOD: Sixty-three individuals (32 female) participated in this randomized, double-blind, placebo-controlled, and within-subject study. RESULTS: During recall of negative memories in the absence of social contact, oxytocin decreased perceived emotional support relative to placebo F(1,62)=10.75, p=0.002. In this same context, women who were motivated to affiliate with the experimenter following oxytocin administration showed this effect in greater magnitude t(57)=-2.04, p=0.047, but showed the reverse effect (i.e. increased perceived support in response to oxytocin) when social contact with the experimenter was available t(57)=2.78, p=0.007. Male participants did not evidence this pattern. CONCLUSION: These findings support the role of oxytocin in social support seeking in distressed women, and highlight the negative consequences of increasing oxytocin bioavailability in the absence of social support. Supportive relationships may be necessary to elicit the prosocial effects oxytocin.

Stress-induced negative mood moderates the relation between oxytocin administration and trust: evidence for the tend-and-befriend response to stress?

INTRODUCTION: Recent evidence suggests that oxytocin, a nonapeptide posited to underlie the affiliation-related "tend-and-befriend" behavioral response to stress (Taylor et al., 2000), may improve interpersonal functioning by facilitating the acquisition of social support during times of distress. The assertion, however, has not been explicitly tested in humans. Thus, we examined whether the effect of oxytocin on self-perceived trust is magnified in individuals who experienced higher ratings of negative mood following social rejection. METHOD: In a double-blind experiment, 100 students (50 ♀) were subject to a live social rejection paradigm following random assignment to either a 24 IU intranasal oxytocin or placebo administration. Mood and self-perceived trust were measured following social rejection. RESULTS: Multiple regression and simple slope analysis revealed that oxytocin administration increased self-perceived trust relative to placebo in participants reporting a negative mood response following social rejection [b=4.245, t(96)=3.10, p=.003], but not in those whose mood state was euthymic. CONCLUSION: These results demonstrate that oxytocin may promote the acquisition of social support in times of distress by increasing self-perceived trust. The findings provide empirical support that oxytocin promotes an affiliation-related behavioral response to stress, consistent with the tend-and-befriend theory.