Although rarely studied compared with studies of infants or young children, adolescents’ health care utilization also has been found to be associated with depression in parents. In one study at 10-year follow-up, the children of a depressed parent were more likely to have been hospitalized. However, only the subgroup of children who had themselves developed depression had more medical problems reported by their late teens to mid-20s (Kramer et al., 1998). Another report of these offspring after 20 years in middle age also showed an increase in the overall number of medical problems. Substance dependence was also more likely to develop during the adolescent years in this population (Weissman et al., 2006a).

An issue that emerges with adolescence is health risk behaviors, such as the use of tobacco, alcohol, and drugs. It is well known that adolescent health risk-taking behaviors are closely related to parental alcohol and tobacco use patterns. It was particularly informative to note that, in a German longitudinal community study from early adolescence into early adulthood, the odds of illicit drug use doubled if either parent had an affective disorder, even after controlling for parental use (Lieb et al., 2002). Rates did not increase further when both parents were affected—that is, even after accounting for parental use, an affective disorder in either the mother or father increased the likelihood of an adolescent’s beginning to use illicit drugs. Similarly, having a parent with depression was associated with a 40 percent increase in adolescents’ alcohol and nicotine dependence, even after controlling for parental anxiety and substance use (Lieb et al., 2002).

Overall, there is emerging evidence that depression, at least in mothers if not also in fathers, is related to the use of child health care services and adverse health outcomes in children, from infancy through adolescence. Moreover, the co-occurrence of maternal depression and a chronic health condition in the child places the child at additional risk of poor outcomes. Longitudinal studies that examine more closely the pathways by which depression influences health outcomes are needed to inform effective interventions.

Child Psychological Problems and Well-Being

Particular Aspects of Concern

Researchers have studied a range of aspects of child psychological problems and well-being. Typically, the choice of what to study in the children is justified as being important both in terms of theories and research suggesting (a) why these aspects of functioning are likely to be affected by depression in parents and (b) why these aspects of functioning, if af-

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