Family Conflict, Perceived Criticism, and Aggression in Symptomatic Offspring of Parents With Mood Disorders: Results From a Clinical Trial of Family-Focused Therapy

Objective

In offspring of parents with bipolar or major depressive disorder, we examined the longitudinal association between parents’ and youths’ ratings of family conflict and criticism and youths’ levels of impulsive aggression during a 6-month randomized trial of family intervention.

Method

Following a diagnostic evaluation, we offered adolescents (aged 13-19 years) and parents with mood disorders a 12-session, 18-week protocol of family-focused therapy, with random assignment to mobile applications that enabled mood tracking or encouraged practice of mood management and family communication skills, also with mood tracking. At pretreatment, 9 weeks, 18 weeks (posttreatment), and 27 weeks, parents completed measures of adolescent aggression and irritability, and parents/adolescents completed measures of dyadic conflict and perceived criticism.

Results

Parent- and youth-rated dyadic conflict scores and perceived criticism ratings were concurrently associated with youths’ composite aggression scores across the 4 timepoints. In lagged association analyses, parent-rated dyadic conflict scores in 1 9-week study interval predicted youths’ aggression scores in subsequent 9-week intervals (F_1,109 = 7.36, p = .008). In contrast, youths' aggression scores in 1 interval predicted youths’ ratings of dyadic conflict in subsequent intervals (F_1,107 = 8.16, p = .005). Levels of family conflict, perceived criticism, and youth aggression decreased over 6 months in both mobile app conditions.

Conclusion

In offspring of parents with mood disorders, levels of family conflict, criticism, and adolescent aggression are intercorrelated over time and suggest bidirectional, mutually influential processes within families. Aggression and its precipitants within family interactions should be a focus of interventions for youths with or at risk for mood disorders.

Plain language summary

The study’s purpose was to determine whether aggression in teenagers (aged 13-19 years) who had a biological parent with a mood disorder (major depression or bipolar disorder) was related to family conflict and parent/offspring criticism over 6 months. Adolescents and their parents received 12 telehealth family-focused therapy (FFT) sessions over 4 months and had access to either of 2 randomly assigned mobile phone applications. One enabled them to track their moods and the other to practice behavioral skills, such as mood management strategies or effective family communication between sessions. Family conflict and teen aggression were correlated in each of the study’s 9-week intervals, and parent-rated family conflict scores in one study interval predicted teens’ aggression scores in the next interval. Levels of family conflict, perceived criticism, and adolescents’ aggression decreased over 6 months in both FFT/mobile app conditions, suggesting that aggression within family interactions should be a significant focus of interventions for teens in the early stages of depression or bipolar disorder.

Clinical guidance

• In adolescent offspring of parents with mood disorders, levels of family conflict, adolescents’ perceptions of criticism, and aggression are intercorrelated over time.

• A 12-session course of family-focused therapy may positively impact these family processes.

• Mobile applications that emphasize mood tracking and family communication skills may enhance telehealth-based family interventions by encouraging skill practice between sessions.

Clinical trial registration information

Technology Enhanced Family Treatment; https://clinicaltrials.gov/; NCT03913013.

Diversity & Inclusion Statement

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.