1. Introduction
An extensive body of evidence supports the role of family processes
in the development, course and maintenance of depression in
children and adolescents (Sander & McCarty, 2005). Family
environment, marital and family relationships (Cummings, Keller, &
Davies, 2005), parenting behavior (Alloy, Abramson, Smith, Gibb, &
Neeren, 2006) and attachment (Sexson, Glanville, & Kaslow, 2001)
have been related to the development and maintenance of
childhood and adolescent depressive symptoms and disorders, as
well as treatment response and relapse among depressed
adolescents (Birmaher et al., 2000). This evidence comes from
diverse research traditions and populations, employing diverse
methodologies, and
examining varying aspects of family relationships (Goodman &
Gotlib, 1999; Sander & McCarty, 2005; Sheeber, Hops, & Davis,
2001). Surprisingly, the direct translation of these research fndings
into specifc techniques for treatment of depressive disorders has
been limited (Davies & Cummings, 2006). Few treatment studies of
youth depression include family-based interventions; those that do
target only a few of the specifc family risk factors identifed in the
research literature (Sander & McCarty, 2005; Weisz, McCarty, &
Valeri, 2006).
Furthermore, the evidence for effcacy of current treatments for
youth depression may not be as strong as it once appeared
(Weersing &
Brent, 2006). In a recent meta-analysis of treatments for youth
depression,Weisz et al. (2006) reported a modest overall effect size
for
current treatments for youth depression, which was considerably
lower than effect sizes found for treatments of other child and
adolescent disorders. Cognitively based treatments, which make up
the majority of empirically tested treatments, were not signifcantly
better than non-cognitively based treatments. Taken together, these
fndings suggest not only that there is considerable room for
improvement in the treatment of youth depression, but also the
possibility that treatment effects could be increased by also
targeting
non-cognitive risk factors. Family factors would seem to be an
obvious candidate, given the strong evidence for family factors in
depression.
Despite this, few treatment studies of youth depression have
included family interventions which target the wide variety of family
risk factors for youth depression (Sander& McCarty, 2005;Weisz et
al., 2006). This is in contrast to clinical trials research on
externalizing disorders, substance abuse and eating disorders, in
which effcacy of family interventions has been demonstrated
(Diamond & Josephson, 2005). The aim of this review is to address
the gap in the translation of research fndings on family processes in
depression and treatment of youth depression. The frst goal is to
examine the empirical evidence on family risk factors and
mechanisms in the development of youth
depression, in order to identify potential targets for treatment. The
second goal is to examine the extent to which these family risk
factors have been targeted in randomized controlled psychotherapy
trials for youth depression. The third goal is to provide a road map
for the development of family-based treatments for youth
depression to target the broad array of family risk factors identifed
in the empirical literature.