Belinda Platt So, my name’s Belinda Platt,  and today I’d like to talk to you about the   prevention of mental illness in children of  parents with depression. My talk’s split up   into three parts. I’ll start by telling  you about why parental depression is a   risk factor for child mental illness. I’ll  then go on to talk about the evidence base   for preventive interventions for  this target group, and, at the end,   I’ll talk about some of the hurdles that we face  when we’re trying to implement prevention into   practice, and I hope you’ll stay until the end,  because I’ve got a good news story to tell you. So, you might have heard that depression runs  in families, and this study, which you can see   on the left-hand side, followed around 200  children over nearly 40 years of their life,   and measured the onset at which they  experienced an episode of depression.   And as you can see from the red line, children  who had a parent with depression were around   twice as likely during adolescence to  experience an episode of depression,   compared the children who didn’t  have a parent with mental illness. And we know that this is due to a range  of factors, so it’s partly to do with   biology and environment, but it’s also  to do with the way that parents behave,   the exposure that their children have to their  thoughts and their feelings. But it’s not all   doom and gloom because, as we know, these  factors, the majority of them at least,   are modifiable, and it’s important to note,  as well, that the majority of children with   a parent with mental illness do not go  on to develop mental illness themselves. Nevertheless, in 2012, the World Health  Organization identified the implementation   of evidence-based prevention for the children of  depressed parents as a public health priority. In   2018, we conducted an international review  of the literature. We found seven trials,   including 935 children, looking at the  effectiveness of psychological interventions   for this target group. We found a wide range  of interventions. The interventions varied,   whether they included children, or just parents,  whether they were family based, how many sessions   they involved, and what the contents of those  sessions were. But, on the whole, on average,   these interventions are effective, at least in  the short to midterm. And so, you can see in the   green box at the bottom that children who didn’t  receive an intervention were around twice as   likely as those who did to experience an episode  of depression across a two to three year period. And you might be wondering what  these interventions look like. So,   here’s one intervention, the “Family  and Group-Based Cognitive Behavioural   Intervention” developed by Bruce Compas and  his colleagues at Vanderbilt University. The   programme’s split up into three parts, and  involves in – sessions as well for parents   as well as their children. In the first  few sessions, the families are altogether,   they learn what about depression is, why it  runs in families, and what we can do about it. In other sessions, children are alone with  one Group Leader, where they learn various   evidence-based coping strategies for dealing  with stress. Parents go into a separate room   with another Group Leader, and learn how to  provide structure and warmth during episodes of   depression. They also learn about the importance  of getting support so that they can also support   and provide for their children. On average, Bruce  Compas and his colleagues found this intervention   roughly halved the risk of depression in children  of parents with depression across two years. As you may know, many of the interventions  to prevent mental ep – illness in children   of depressed parents have been developed and  evaluated in the USA. And so one thing we   wanted to do was to take this intervention,  which had been found to be effective there,   adapt it to German language and culture, and  re-evaluate it. We did this across five years,   with 135 children from 100 families, and  the families were split into two groups.   They either received our intervention, or they  received no intervention, treatment as usual. I should say in advance that the intervention  was widely accepted by families. So although   we found diff – we found it difficult to recruit  families in the first place, once they took part   in the intervention, they generally stayed until  the end. And here you can see some data on the   effectiveness of the intervention in our study.  On the left-hand side, you can see that children   who didn’t receive any intervention during the  15 month period much more frequently experience   mental illness than children who did take part  in the intervention. Although these numbers,   the absolute numbers, are relatively small, so  we’re reluctant to conduct statistical analyses. On the right-hand side, you can see data we  collected from the children themselves on the   severity of their internalising symptoms. That  means in symptoms of depression and anxiety. And,   as you can see, in the blue line, the  in – the risk of depression increased   across time for children who didn’t  receive the intervention, whereas,   those who did receive our intervention showed  a slight reduction in their symptomology. And the longer I’ve been  in this field of research,   the more I’ve realised that what we know works  in the lab is rarely implemented in practice,   and so I’ve been more increasingly interested  in understanding what those barriers are,   so that we can develop more interventions  that are implemented into practice. My first   encounter with implementation research was  when we complemented the quantitative data   we collected in the randomised control study with  qualitative analysis of semi-structured interviews   and pilot group studies that we conducted with  families who took part in our intervention. We asked them what they found particularly  helpful, what they put into practice afterwards,   and what was more difficult for them. And, as you  can see from the quotes, there were several themes   that emerged. Children found the coping strategies  we taught them to be particularly helpful,   and they were putting those into practice long  after we finished the intervention. Parents   reported it was particularly helpful to have  the experience to meet other parents who are   affected and share their experiences with each  other. What was difficult? Alongside the time   commitment that was required for the intervention,  some parents reported that they would have rather   taken the – part in the intervention once  their depression had been more stabilised. So, taking account into the – taking these  factors into account, and due to the corona   pandemic in 2020, we were forced to take our  intervention online. We’d already digitalised   some of the contents that participants completed  between sessions, but due to the pandemic,   we also conducted the intervention  sessions themselves online. In total,   we took 37 families into the study  and we split them into two groups,   those who received the intervention,  and those who didn’t. And in this slide,   you can see the various different constellations  and families that we had in our five groups in   total. We were particularly pleased that we had  a number of single parent families who took part. We’re still analysing the effectiveness data from  this study, but what we do have is a number of   implementation outcomes that are quite valuable  and important to take in consideration. So,   one interesting finding was that very few of  our families came to us through colleagues,   through Clinicians, through  clinical services. Rather,   the majority of people found out about the study  via public advertisements and newspaper articles,   and one thing that we’ve experienced during  the study is the value of publishing newspaper   articles that destigmatise the issue of  seeking help for parental mental illness. So, because we’d had some difficulties  recruiting families to our intervention,   we also decided to conduct an online survey  with these families who didn’t feel able to   take part. In total, there were 247 of them, and  we found several themes that emerged that were   particularly important. Firstly, many families  felt overburdened, either by their depression   or by the pandemic, and this was one thing  that stopped them from wanting to take part. Secondly, many families encountered feelings of  guilt or shame, they might have been embarrassed   about their depression, or they didn’t want to  open up in front of other families. Thirdly,   many of the families felt that taking part  in the intervention would remind them about   previous episodes of depression,  and that was what held them back. So, I promised you I was going to share a  success story, and here it goes. In German law,   there were some changes recently, so that public  health insurance companies are forced to provide   preventive financial support for their clients.  And we applied last year to have our programme,   an adapted version of it at least, certified  by the governing body, and in July 2024,   we were successful in our certification. So,  we’re currently running a group for families   affected by depression and looking forward  to evaluating its implementation in practice. I want to finish my talk by say – take –  summarising some key takeaway messages.   Parental depression can have a significant  impact on children’s risk of mental illness,   but I hope I’ve been able to persuade you that  evidence-based interventions are effective,   at least in the short-term.  However, the implementation   of evidence-based interventions into  practice depends on several things   the availability of financial resources,  the availability of appropriate structures,   and the extent to which service users are  involved in the development and implementation. Thank you for taking the time to listen to  my presentation, and if you have an interest   in my research group and the things we are  doing, please don’t hesitate to contact me.