(PS3-C51) Perceived Criticism from Parents as Rated by Adolescents at High Risk for Mood Disorders

Family stress has been found to be a predictor of mood relapse across major depressive and bipolar disorders (Miklowitz & Johnson, 2006). Perceived criticism (PC), a self-report measure of how critical a caregiving family member is towards a person with psychiatric disorder, is an indicator of risk for relapse (Masland & Hooley, 2015). However, little is known about the psychiatric correlates of PC, as well as how PC changes over the course of treatment. The goal of this study was to examine how levels of PC fluctuate with the severity of mood symptoms among youth with or at high risk for major depression or bipolar disorder. 

Youth participants (N = 65) were recruited for a clinical trial of family-focused therapy (FFT), an evidence-based treatment for youth with mood disorders. FFT lasts for 4 months and comprises three core modules: psychoeducation, communication skills, and problem-solving. All youth received up to 12 sessions of FFT, with half also receiving a mobile app that reminded them to use illness management and communication skills between sessions. Youth completed assessments at baseline, mid-treatment, post-treatment and at 27-week follow-up. Symptom assessments covered depressive, manic, and anxiety symptoms and degree of mood variability. Ratings of perceived criticism from parents (“how critical was [your parent] to you?” rated on a 1-10 scale) were collected. A series of correlations, ANOVAs, and mixed effects linear regression models were conducted to examine the relationships between PC and symptom measures at baseline and longitudinally over 27 weeks.  

There was a moderate positive relationship between baseline PC and measures of mood lability (r = .39, p < .01) and anxiety (r = .32, p < .01), but not depressive or manic symptoms. A repeated-measures ANOVA revealed that overall, PC decreased over time (F(3, 156) = 3.22, p < .05), especially from baseline to post-treatment (6.25 to 5.30, respectively). However, perceptions of criticism were higher among youth with more severe mood lability (F(1, 224) = 27.64, p < .001], anxiety [F(1, 204) = 16.96, p < .001)], and depression [F(1, 213) = 8.88, p < .01)] increased. These results were independent of assessment timepoint.  

Symptom reduction may affect youths’ perceptions of criticism. It is also possible that when families begin to use FFT communication skills, youths perceive lower levels of criticism from parents. Future studies should examine whether changes in PC precede or follow changes in symptoms. This will allow us to better understand the mechanisms by which symptoms and perceptions of family criticism influence each other. Additionally, future studies should examine whether changes in perceptions of criticism align with observer-rated changes in criticism.