4. Discussion and Implications
affective disorders, guilt, mental illness, mood disorders, affective illness, depressed, affective episodes, depression, deaths
EVENTS, STILL
The combined clinical and Likert-scale questionnaire data from the perspective of both young adults and their parents, in addition to qualitative responses from young adults, reveal insights into how parental depression may influence the transition to adulthood. Parents and their young adult children acknowledged that parental illness was an ongoing burden, as evidenced by 44% of parents experiencing affective episodes through T8. Although there are intervals in which some families reported no parental illness, it is remarkable how frequently affective illnesses recurred during the course of this study, regardless of whether the unit of analysis was the parent or the couple. Additionally, and in line with our first hypothesis, over half of the children also experienced affective illness over their lifetime, well above the prevalence rate of depression (17%) expected in the general population [Most parents and their children reported that the transition to young adulthood went reasonably well, in support of our third hypothesis. The young adults felt the transition went better and they had been more ready to leave home than their parents. Still, both parents and young adults reported some stress during this transition. Although depression is associated with, and often precipitated by, major life events, it is nonetheless striking that the majority of participants had experienced three or more major events in the previous year. In particular, the frequency with which participants reported deaths of loved ones suggests that particular attention to grieving, loss, and moving on is an important task in young adulthood complicated by growing up with a parent with depression. Both young adults and their parents were satisfied with the mental health care services youth currently received, but parents were much more concerned than their children about their children’s health insurance once the young adult left the parents’ insurance plan (a rating of, on average, 5.4 for parents versus 2.9 for young adults). The concern demonstrated by parents is well-founded given that the transition to adult care for both physical and mental health is often managed poorly and results in discontinuation of services [The qualitative data from the interviews with young adults did not vary by intervention condition. Both groups of young adults reported that families faced the continued presence of serious depression and other mood disorders in parents and that a number of young adults wrestled with depression themselves. It is clear that these young adults worry not only about their parents and leaving them, supporting our second hypothesis, but also about themselves. It is also clear that, for many, the presence of a parental mental illness heightened their awareness and compassion for that parent and for suffering in general. Many of these young adults report that their experience with a depressed parent led them to develop significant interpersonal empathy and awareness of the inner worlds of their parents, their friends, and their siblings. Interestingly, these reports contrast with the findings of Apter-Levy et al. (2013) in which young children of depressed mothers displayed decreased empathy compared to children of non-depressed mothers [In understanding the resilience of young people, a notable finding is the large role played by siblings in the context of parental depression. Many older siblings reported that they served as stand-in caregivers for their younger siblings. Others reported feeling guilt or concern over leaving their younger siblings in the home as they moved out or attended college. In a meta-synthesis on the experience of adult children of parents with mental illness, Murphy et al. (2011) also noted this theme of parentification, with older siblings having to take care of younger siblings [Given the significant number of young adults who, passing through an increased period of risk, developed affective disorders during this study, there are important public health implications for the mental health of emerging adults. Programs directed at at-risk offspring, whether they are primarily prevention, education, or treatment programs, must provide ways for young people to obtain treatment, when needed, quickly, adequately, and without barriers. Additionally, parents and young adults strongly endorsed the value of our two preventive intervention strategies even up to ten years after intervention, supporting the notion that preventive interventions delivered at one developmental epoch can have sustained effects. Taken together with our finding that parental depression continues to affect offspring into emerging adulthood, this information points to the delivery of preventive intervention strategies that provide families with skills that can be used over the long term (i.e., self-understanding, building relationships, being active, and accomplishing tasks), and should support parents in helping their children to acquire these skills.