Journal of Child Psychology and Psychiatry 45:2 (2004), pp 377386

Major depression and conduct disorder in youth: associations with parental psychopathology and parent^child conict
Naomi R. Marmorstein1 and William G. Iacono2
1

Rutgers University, USA; 2University of Minnesota, USA

Background: This study examined conduct disorder (CD) and major depression (MDD) in adolescents in relationship to parentchild conict and psychopathology in their parents. Method: Participants were drawn from a population-based sample of twins and their families. Affected participants had lifetime diagnoses of CD and/or MDD; controls had no history of either disorder. Results: The presence of CD or MDD in an adolescent was related to increased rates of maternal MDD and paternal antisocial behavior. Both CD and MDD in adolescents were directly associated with high parentchild conict. This association appeared unrelated to whether the father had a history of antisocial behavior; however, the association between motherchild conict and psychopathology in the child was related to the mother having a history of MDD as well. Conclusion: The implications of these ndings for the complex relationship between parental diagnoses, child diagnoses, and parentchild conict are discussed. Keywords: Adolescence, conduct disorder, depression, parentchild interaction. Abbreviations: MTFS: Minnesota Twin Family Study; PEQ: Prenatal Environment Questionnaire; SCID: Structured Clinical interview for DSM-III-R; DICA: Diagnostic Interview for Children and Adolescents.

Research has clearly demonstrated that the families of youth with a wide variety of forms of psychopathology tend to be disturbed. These disturbances include problems in interactions among family members and psychopathology in the parents. It is also clear that youth who have one disorder often have one or more co-occurring disorders as well. Unfortunately, research to date on family correlates of child and adolescent psychopathology has largely focused on single conditions, either by excluding potential participants who have other forms of psychopathology or by ignoring potential co-occurring conditions. At times, researchers have examined family factors in relation to co-occurring internalizing or externalizing disorders (e.g., depression and anxiety, or oppositional deant disorder and conduct disorder); rarely, however, have the family characteristics associated with both an internalizing disorder and an externalizing disorder been studied. In addition, it is relatively rare for a single study of child psychopathology to examine both parental diagnoses and family interaction patterns. The present study aimed to address this situation by examining the families of youth with conduct disorder and depression. Studies examining associations between parent and offspring disorders sometimes begin by identifying a parental proband and proceed to examine offspring for potential psychopathology; other studies begin by identifying a child with particular disorders and proceed to examine his or her parents for potential psychopathology. Both types of studies are useful in identifying links between parent and child diagnoses. Both lines of research have shown that

parents of depressed youth often have depression (reviewed in Neuman, Geller, Rice, & Todd, 1997) and parents of conduct-disordered youth often evidence antisocial behavior (e.g., Frick, Lahey, Loeber, & Stouthamer-Loeber, 1992). Available evidence indicates that these ndings are at least partially due to genetic inuences (e.g., Slutske et al., 1997; Thapar & McGufn, 1994; Wierzbicki, 1987). In addition to these associations, maternal depression has been found to be associated with a wide range of behavioral problems in youth, including disruptive behavior (reviewed in Goodman & Gotlib, 1999). The link between paternal depression and offspring problems has been less well-studied. Based on both theoretical considerations (Goodman & Gotlib, 1999) and indirect empirical evidence (Foley et al., 2001; Shiner & Marmorstein, 1998), it appears that paternal depression may be less strongly associated with offspring depression, compared to maternal depression. A few studies have examined the relationship between the co-occurrence of conduct disorder and depression in youth and psychopathology among their family members. Puig-Antich et al. (1989) found that depressed children with low familial rates of depression were more likely to exhibit comorbid conduct disorder than were depressed children with high familial rates of depression. Williamson et al. (1995) found that the rate of antisocial personality disorder among relatives of youth with depression and conduct disorder was elevated compared with the rate among relatives of youth with depression only. In addition to the likelihood that parents of these youth may have forms of psychopathology that are

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similar to those of their children, the social interactions of these families appear to be disturbed. The family environments of children exhibiting delinquent behavior have been shown to be less warm and affectionate, less accepting, less emotionally supportive, and including less supervision than those of non-disordered children (e.g., Frick et al., 1992; Slee, 1996; Vostanis, Nicholls, & Harrington, 1994). Parents of conduct-disordered youth tend not to clearly set out expectations regarding acceptable and unacceptable behavior, not to provide consistent discipline following antisocial behavior, to inadequately monitor and supervise their children, and to use ineffective family problem-solving strategies (see review by Hemphill, 1996; Patterson, DeBaryshe, & Ramsey, 1989). The families of depressed youth also appear to be disturbed in a variety of ways. Numerous studies have found that families of depressed adolescents tend to be less cohesive, secure, communicative, warm, and supportive and more tense, antagonistic, and critical, relative to families of non-depressed youth (reviewed by Kaslow, Deering, & Racusin, 1994). This appears to be the case in both clinical and community samples and before, during, and subsequent to major depressive episodes (Garrison et al., 1997; Lewinsohn et al., 1994; Reinherz et al., 1993). Two observational studies have examined the social interactions within families of children with both depression and conduct disorder. During a laboratory-based family problem-solving task, children with conduct disorder only and those with both conduct disorder and depression and their mothers displayed lower levels of positive solutions and more aversive content than did depressed-only and non-psychiatric control children and their mothers (Sanders, Dadds, Johnston, & Cash, 1992). During an in-home observation, children with conduct disorder only expressed high levels of aversive behavior and anger and their family systems were characterized by conict and aggression; in contrast, depressed-only and depressed and conduct-disordered children did not show evidence of elevated anger or aversive behavior, despite being exposed to maternal aversiveness (Dadds, Sanders, Morrison, & Rebgetz, 1992). Thus, based on the limited evidence available, children with both depression and conduct disorder appear to have families that in some ways are similar to those of conduct-disordered children and in other ways are similar to those of depressed children. It is not known whether these patterns differ for males and females nor how these brief observational measures relate to family members perceptions of their relationship qualities. The potential link between parental psychopathology and increased conict in families merits study. Based on the review above, it is clear that both family conict and parental psychopathology are associated with disorders in children; however, few studies have attempted to describe the potential

connection between these domains. Those that have attempted to clarify these relationships have not pointed to clear, consistent conclusions. Not surprisingly, family risk factors (including conict) are more common among families in which the parents evidence pathology, compared to families in which the parents do not evidence pathology (Fendrich, Warner, & Weissman, 1990). Despite the frequent co-occurrence of conict and parental psychopathology, Fendrich et al. found that parental depression was more important than family risk factors (such as parental divorce and low family cohesion) in predicting offspring depression. In contrast, both parental depression and family risk factors were important in predicting conduct disorder (Fendrich et al.). However, the ndings of Frick et al. (1992) somewhat contradict this nding. Frick et al. reported that both parental antisocial personality disorder and deviant maternal parenting were associated with offspring conduct disorder; however, when both of these factors were entered together into a model predicting offspring conduct disorder, only parental antisocial personality disorder remained signicantly associated with conduct disorder. In a related study examining depression in adolescents in relationship to depression in mothers and family environment factors, Shiner and Marmorstein (1998) found that depressed adolescents with depressed mothers reported poorer family functioning than depressed adolescents without depressed mothers and control adolescents. In a study examining the offspring of depressed parents, Warner, Mufson, and Weissman (1995) found that the association between parental depression and panic spectrum disorder (e.g., isolated panic attacks) in offspring was accounted for by family environment factors. Thus, the relationships among parental psychopathology, disturbed family environment, and offspring psychopathology remain unclear. These associations may differ according to parental disorder, offspring disorder, or the specic family environment factors examined; in addition, it is possible that which parent (the mother or the father) is affected by a given disorder may be a relevant consideration. With the overarching aim of better understanding the families of conduct-disordered and depressed youth, this study had three specic primary goals. First, it examined the occurrence of depression and antisocial behavior in the parents of conduct-disordered and depressed youth. Based on the previous research reviewed above, it was expected that maternal depression would be associated with both depression and conduct disorder in youth. Paternal depression was also expected to be associated with offspring depression, although less strongly than maternal depression, due to the empirical and theoretical considerations discussed above. Because of a lack of previous research, no prediction was made regarding whether paternal depression would be associated with offspring conduct disorder. Both

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maternal and paternal antisocial behavior were expected to be associated with offspring conduct disorder; no association with offspring depression was predicted. The second goal of this study was to examine the level of parentchild conict within families of depressed and conduct-disordered youth. Based on previous research, it was expected that both adolescent depression and adolescent conduct disorder would be associated with higher parentchild conict in these families. Third, this study aimed to elucidate the potential links between these two domains. That is, if parental psychopathology was associated with offspring disorder (as predicted), was the hypothesized association between offspring disorder and parentchild conict only present when the parent(s) evidenced disorder(s) as well? It was hypothesized that when there were signicant associations found between a particular parental disorder and a particular offspring disorder, any elevation in conict with that parent that had been found in the entire sample would not be present when only parents without the particular disorder were included. Stated another way, it was expected that the link between offspring disorders and parentchild conict would only be present when families in which the parent was affected by psychopathology (of whatever form they were at-risk for, given the diagnosis of the child) were included in the sample. Results supporting this hypothesis would be consistent with a model stating that the potentially harmful effects of a bad family environment on children are dependent on the parent(s) having psychopathology of some sort. This would be consistent with a broader model of psychopathology in which genetic and environmental factors are proposed to interact. This could occur in any of a number of ways: perhaps both a genetic liability and a conictual family environment are necessary for the development of psychopathology; it is also possible that children with a genetic liability for psychopathology are more sensitive to the deleterious effects of parentchild conict. Results that do not support this hypothesis would be consistent with a model stating that having a bad family environment is associated with child psychopathology, regardless of the mental health (or lack thereof) of parents. In addition to these primary goals, this study examined whether the sex of the child interacted with either depression or conduct disorder. Previous research had not comprehensively addressed this issue; due to the lack of clear evidence pointing toward a sex difference, no sex differences were predicted.

Methods
Participants
Participants were drawn from the larger sample of the Minnesota Twin Family Study (MTFS), an epidemiolo-

gical study of twins and their parents. A populationbased twin ascertainment method was used, in which all twins who were born in the state of Minnesota during specied years were identied from public birth records. Of those families who were eligible for the study, 17.3% declined participation. There were no signicant occupational differences between families who participated and those who refused to participate. After twins who were not suitable for the study (for example, they had mental retardation or were adopted) were excluded, the nal sample included 337 families of female twins and 289 families of male twins from around the state. The twins were recruited to be approximately age 17 at the time of their familys assessment. At the beginning of the visit, the study was explained to participants and written informed assent/consent was obtained from parents and their children as appropriate. For details regarding the design of this epidemiological study, see Iacono, Carlson, Taylor, Elkins, & McGue (1999). Participants for the current report were selected from the larger MTFS sample based on their having a lifetime diagnosis of major depressive disorder (MDD) and/or conduct disorder (CD) at the denite (meeting all DSMIII-R [American Psychiatric Association, 1987] criteria for the disorder) or probable (exhibiting all except one symptom for a DSM-III-R diagnosis) level. The use of probable diagnoses allowed for faulty recollection of symptoms in individuals with a past episode of disorder who were not currently symptomatic. A diagnosis was considered present if either the participant or his or her mother reported that the adolescent had experienced enough symptoms. Assessments of MDD were completed by administering the Structured Clinical Interview for DSM-III-R (SCID; Spitzer, Williams, & Gibbon, 1987) to the adolescents and a modied version of the Diagnostic Interview for Children and Adolescents Parents version (DICA-P; Reich & Welner, 1988) to the mothers. Assessments of CD were completed by administering an MTFS interview that asks about DSM-III-R symptoms of CD to the adolescents and the DICA-P to the mothers. Interviewers received intensive training in diagnostic interviewing and had bachelors or masters degrees in psychology or related elds. The diagnostic interviews were then reviewed by teams of advanced clinical psychology doctoral students, who coded the presence or absence of each symptom based on written notes and audiotapes of the interviews. Kappa reliabilities for the diagnoses were: SCID MDD, k .89; DICA-P MDD, k .91; MTFS interview CD, k .85; and DICA-P CD, k .75. Approximately 28% of males (162/578) and 7% of females (47/674) in the entire sample met these initial criteria for CD but not MDD; 2% of males (13/578) and 13% of females (87/674) met criteria for MDD but not CD, and 6% of males (36/578) and 3% of females (21/ 674) met criteria for both disorders. When both twins in a family fell into a given diagnostic category (CD-only, MDD-only, or CD + MDD), one twin was randomly selected for inclusion in the study. Only one twin from each family was included due to this studys consideration of family factors; the inclusion of two children from a single family could have potentially biased the results to reect more strongly the characteristics of families with two included offspring. When one twin was affected by one disorder and

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the other twin was affected by both disorders, the twin with both disorders was included. When one twin had CD only and the other had MDD only, both twins were excluded (eliminating 7 families). Control participants were selected by identifying all families in which neither twin had symptoms of either target disorder, then randomly selecting one twin from each of these families. This resulted in the nal inclusion of 109 males and 26 females with CD only, 12 males and 67 females with MDD only, 28 males and 16 females with both CD and MDD, and 50 male and 134 female control participants. Primary analyses included only biological parents. Data regarding biological mothers were available for all families; data regarding biological fathers were available for 88% of families. To determine if the results applied to two-parent families generally rather than only those in which biological parents were raising the children, the analyses were repeated including families with stepfathers (n 41). The biological parents were divorced in 11% of families. Divorce occurred more frequently in the families of depressed (20%; v2 11.12, df 1, p < .01) and conduct-disordered (16%; v2 5.62, df 1, p < .05) youth than in families of control youth (4%). Participants were primarily Caucasian (98.6%), reecting the demographic makeup of Minnesota at the time they were born (there were no signicant group differences on this variable, v2 3.01, df 3, p > .05). Participants ages did not differ across groups (mean 17.5 years; F3,437 .96, p > .05). Parental socioeconomic status, as measured by the Hollingshead Four Factor Index of Social Status (Hollingshead, 1975), did not differ across groups (F3,812 .94; p > .05). The average Hollingshead score (3.80) corresponded to occupations such as clerical and sales workers, technicians, and small business owners.

and their parents to measure perceptions of the motheradolescent and fatheradolescent relationships. The PEQ was developed for use in this epidemiological study and has been factor-analyzed and shown to reliably assess parentchild relationships (Elkins, McGue, & Iacono, 1997). The conict scale of this measure consists of items such as My parent and I often get into arguments that are rated on a 4-point scale (from definitely true to denitely false) and has an alpha reliability in the larger sample of MTFS participants of .88. The adolescents rated their relationships with their mothers and their fathers or stepfathers; the parents rated their own relationships with the adolescent, as well as their spouses (or ex-spouses) relationship with the adolescent. As expected based on previous research (e.g., Achenbach, McConaughy, & Howell, 1987), agreement among the three informants for each relationship (motherchild and fatherchild) was moderate (Pearson correlations ranging from r .41 to r .50). The ratings of each family member were averaged to yield one overall conict with mother score and one overall conict with father score (e.g., the conict with mother overall score was an average of the childs report of his/her conict with the mother, the mothers report of her conict with this child, and the fathers report of the mothers conict with this child).

Statistical analyses
Analyses of variance (ANOVAs) were conducted for continuous dependent variables in order to assess main effects (of each disorder and sex) and interaction effects. For dichotomous dependent variables (presence or absence of each diagnosis in each parent), hierarchical logit analyses were conducted. A separate logit analysis was computed for each dependent variable. First, a model without the 3-way interaction was compared to the saturated model; next, models without each 2-way interaction were examined; nally, models without main effects were examined in order to determine the importance of each diagnosis and potential interaction in accounting for variance in the dependent variable. All analyses were conducted rst using only families without stepfathers (i.e., all fathers who were included were biological fathers; all mothers in the study are biological mothers). Subsequently, analyses were repeated using all families including those with stepfathers.

Measures Parental diagnoses. To assess past and present symptoms of antisocial behavior in the parents, an MTFS interview that asks about each DSM-III-R antisocial personality disorder criterion C symptom contributing to a diagnosis of antisocial personality disorder in adulthood (adult antisocial behavior, or AAB) was administered to mothers and fathers. To assess past and present symptoms of major depression, the SCID (Spitzer et al., 1987) was used. A different interviewer interviewed each family member. After the interviews, mothers and fathers interviews were reviewed and coded in the same manner as the adolescents interviews. Parents were categorized as having each diagnosis (MDD or AAB) if they received a lifetime diagnosis at a denite or probable level. Diagnostic reliability of the AAB and MDD diagnoses using the kappa statistic were .95 and .89, respectively. Diagnoses in mothers and fathers were considered separately. Therefore, the following parental disorders were each examined for potential associations with offspring disorders: maternal MDD, maternal AAB, paternal MDD, and paternal AAB. Parentchild conict. The Parental Environment Questionnaire (PEQ) was administered to adolescents

Results
Main effects of adolescent sex
Examining main effects of the adolescents sex was not a primary goal of this study. However, because interaction effects of each of the disorders with the adolescents sex were examined, it was important rst to determine if main effects were present. No main effects of adolescent sex were found to be associated with any parental diagnosis or the level of fatheradolescent conict. However, a main effect of adolescent sex was found to be associated with the

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level of motheradolescent conict. Female adolescents tended to have higher levels of conict with their mothers (F1,424 5.63, p < .05). This nding appears to be related to the differential prevalence of MDD in male and female youth (v2 10.89, df 1, p < .01), with more females having MDD. When the contributions of Sex and MDD were examined in a multiple regression predicting conict with mother, the independent contribution of Sex of adolescent was non-signicant (b .24, t 4.87, p < .001 for MDD; b .00, t ).02, p > .05 for Sex).

Parentchild conict
Conict with mother and conict with father were examined for the entire sample, without reference to parental psychopathology. The descriptive statistics summarizing the level of parentchild conict in the biological families as a function of child psychopathology are presented in the two rows labeled entire sample in Table 2. These ndings were evaluated using two three-factor ANOVAs, one for conict with mother and one for conict with father. Each of these ANOVAs revealed a signicant main effect for CD (F1,394 11.44, p < .01, and F1,392 11.59, p < .01, for conict with mother and father, respectively), a main effect for MDD (F1,394 11.83, p < .01, and F1,392 5.16, p < .05, for conict with mother and father, respectively), and a CD Sex interaction (F1,394 4.14, p < .05, and F1,392 6.63, p < .05, for conict with mother and father, respectively). The main effect results indicated that conict with each parent was elevated if the adolescent had either MDD or CD (see Table 2). The CD Sex interaction, as can be seen from Figures 1 and 2, indicated that females with CD had particularly high levels of conict with both parents. For both ANOVAs, the CD MDD (F1,394 .47, p > .05, and F1,392 3.17, p > .05, for conict with mother and father, respectively), MDD Sex (F1,394 .00, p > .05, and F1,392 .03, p > .05, for conict with mother and father, respectively), and three-way interactions (F1,394 .02, p > .05, and F1,392 .00, p > .05, for conict with mother and father, respectively) failed to attain signicance. These analyses were repeated using families with stepfathers, with all but one of the effects observed with the biological fathers remaining the same. The one exception was the CD Sex interaction effect for maternal conict, which was reduced to a trend effect (F1,424 3.31, p .07).

Parental diagnoses
Rates of parental psychopathology, split by the diagnostic group of the adolescents, are reported in Table 1. Also included in this table are odds ratios indicating the increased odds of a particular disorder occurring in the parent if the child has (versus does not have) a particular disorder, along with adjusted chi-square values for each corresponding logit analysis. Results of logit analyses indicated that main effects of adolescent MDD and adolescent CD were associated with rates of maternal MDD. Each disorder in adolescents was associated with increased rates of MDD in mothers. Main effects of both adolescent CD and adolescent MDD were also associated with rates of paternal AAB. Each disorder in adolescents was associated with increased rates of AAB in fathers. No interaction effects were found for maternal MDD or paternal AAB. No signicant associations between offspring disorders and maternal AAB or paternal MDD were found. Thus, both maternal MDD and paternal AAB were associated with both adolescent CD and adolescent MDD. However, paternal MDD and maternal AAB were not signicantly associated with offspring disorder.

Table 1 Prevalence of MDD and AAB among parents of youth with and without MDD and CD % of mothers (N 438) with disorder if child: Parental and child disorders Parental AAB: Child CD Child MDD Parental MDD: Child CD Child MDD Has disorder 5.14% 5.69% 34.29% 46.34% Does not have disorder 1.90% 2.22% 27.76% 24.13% OR (CI)a 2.80 (.928.49) 2.66 (.917.73) 1.36 (.902.05) 2.72 (1.754.21) Adjustedb v2 3.12 3.67 4.76* 19.20*** % of fathers (N 385) with disorder if child: Has disorder 26.53% 36.27% 15.65% 14.71% Does not have disorder 17.23% 15.19% 13.03% 13.78% OR (CI)a 1.74 (1.062.85) 3.18 (1.895.33) 1.24 (.692.22) 1.07 (.572.05) Adjustedb v2 6.30* 19.62*** .52 .05

*p < .05; ***p < .001 for a main effect of this disorder (from hierarchical logit analyses analyzing the relationship between the parental disorder and the child disorder). a OR odds ratio; computed based on the odds the parent has the indicated disorder if the child has the indicated disorder, relative to the odds the parent has the indicated disorder if the child does not have the indicated disorder. These gures are based on the raw percentages presented in this table (and therefore do not have interaction effects statistically removed, as do the chi-square values). CI 95% condence interval for the odds ratio. b Chi-square values computed from hierarchical logit analyses, conducted as described in the Statistical analyses section. These values represent main effects of child disorder when accounting for variance in parental disorder; interaction effects of the two disorders (MDD and CD) and the Sex of the adolescent have been removed.

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Table 2 Family relationships in families of youth with CD, MDD, CD and MDD, and neither diagnosisa Adolescents diagnostic groupb CD + MDD T-scores:c Conict with mother: Entire sample (n 394) Maternal MDD absentd (n 280) Maternal MDD presentd (n 114) Conict with Father: Entire sample (n 393) Paternal AAB absentd (n 316) Paternal AAB presentd (n 77)
a

CD-only (n 115120) 54.19x (10.96) 53.80x (9.46) 55.41 (16.24) 56.44y (13.23) 54.41x (11.16) 58.59 (11.46)

MDD-only (n 7071) 56.41y (12.24) 56.15y (12.33) 56.25 (13.55) 56.42z (11.81) 55.98y (11.63) 55.72 (9.70)

Control (n 178) 50.00x,y (10.00) 50.00x,y (10.00) 50.00x (10.00) 50.00x,y,z (10.00) 50.00x,y 10.00) 50.00 (10.00)

(n 3335) 59.96x (13.63) 54.38 (10.32) 63.88x (16.63) 59.35x (14.69) 57.36 (14.56) 58.00 (11.87)

Values in this table are the results of analyses using biological parents only. When families with stepfathers were included, no differences in the pattern of group differences emerged. b Groups with the same subscript are signicantly different from each other (p <. 05, based on post-hoc multiple comparison tests using the Bonferroni correction). c Values are T-scores derived from the control participants, who had a mean of 50 and a standard deviation of 10. d Includes only those families in which the indicated parental diagnosis is present or absent, as indicated. Ns represent the total number of families included (in all diagnostic groups and the control group) in the table row.

Thus, MDD and CD were both directly related to high parentchild conict. In addition, females with CD had particularly high levels of conict with their parents.

Relationship between parentchild conict and parental psychopathology

As Table 1 and the associated analyses revealed, both CD and MDD in the adolescents were associated with maternal MDD and paternal AAB. To explore how maternal MDD and paternal AAB related to family conict, two sets of analyses were carried out, one for mothers and the other for fathers. For each set of analyses, families were split into two

groups, those with and those without an affected parent, and ANOVAs were carried out to determine if the presence of adolescent CD or MDD was associated with elevated conict independent of the affected status of the parent. Means and standard deviations summarizing the results of these analyses are presented in Table 2 when maternal MDD was absent or present, and when paternal AAB was absent or present. Because earlier analyses indicated that ndings with stepfathers differed little from those with only biological fathers, stepfathers were not considered in these analyses. Turning to the effects of maternal depression, there were 280 families in which the mother was not depressed (with 56 youth with MDD and 99 youth

60 58 56 T-score 54 52
T-score

62 60 58 56 54 52

50 48 46 CD absent Sex of Participant is Male Sex of Participant is Female CD present

50 48 46 CD absent Sex of Participant is Male Sex of Participant is Female CD present

Figure 1 Level of conict with mother as a function of the presence or absence of CD and the sex of the participant. Scores are presented as T-scores, with a mean of 50 corresponding to the level of conict with mother among control participants

Figure 2 Level of conict with father as a function of the presence or absence of CD and the sex of the participant. Scores are presented as T-scores, with a mean of 50 corresponding to the level of conict with father among control participants

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with CD) and 114 in which she was depressed (with 47 youth with MDD and 48 youth with CD). In the absence of maternal depression, results of ANOVAs indicated that neither child diagnosis was associated with the motherchild conict score (MDD: F1,280 .99, p > .05; CD: F1,280 1.37, p > .05). In addition, the CD Sex interaction effect found for the entire sample and illustrated in Figure 1 was not present when mothers with histories of MDD were not in the sample (F1,280 .01, p > .05). When the mother was depressed, a main effect of child MDD (F1,114 5.93, p < .05) and an interaction effect of child CD Sex (F1,114 6.27, p < .05) were found, while the main effect of child CD found for the entire sample was reduced to a trend level (F1,114 3.74, p .06). These results indicate that motherchild conict was signicantly elevated only when the family included a depressed mother. Turning to the effects of paternal AAB, there were 316 families in which the fathers did not have AAB (with 72 youth with MDD and 111 youth with CD) and 77 in which the father had AAB (with 43 youth with MDD and 39 youth with CD). For families with a father without AAB, results of ANOVAs indicated that main effects of MDD and CD, as well as a CD Sex interaction effect (plotted for the entire sample in Figure 2), were found to relate to the fatherchild conict score (MDD main effect: F1,316 6.81, p < .05; CD main effect: F1,316 4.67, p < .05; CD Sex interaction effect: F1,316 4.82, p < .05). When the father had AAB, a main effect of child CD (F1,77 4.10, p < .05) and an interaction effect of child CD Sex (F1,77 4.55, p < .05) were found. However, the main effect of child MDD found for the entire sample and for families with fathers without AAB was not present (F1,77 .16, p > .05), and an additional signicant CD MDD interaction effect (F1,77 6.73, p < .05) was found. This interaction effect indicates that in families where the father has AAB, adolescent MDD is only associated with fatherchild conict when it is found in combination with adolescent CD. These ndings generally indicate that, unlike the situation for maternal depression, MDD and CD in youth are associated with elevated rates of fatherchild conict whether or not the father has AAB. Because paternal MDD and maternal AAB were not found to signicantly relate to offspring disorders in this sample, analogous analyses were not planned for these parental disorders. However, because the odds ratios shown in Table 1 indicate a possible relationship between maternal AAB and offspring disorders (though this did not reach statistical signicance), analogous exploratory analyses were conducted using only families in which mothers did not evidence antisocial behavior. Results were quite similar to those using the entire sample; the only difference was that the CD Sex interaction effect was reduced to the trend level (F1,386 2.83, p .09). Thus, despite the potential increased

prevalence of antisocial behavior among mothers of youth with CD and/or MDD, the results relating to levels of adolescentmother conict do not seem to be due to the presence of maternal antisocial behavior. To summarize, the parentchild conict results reported above were in some cases dependent on the psychological status of the parent. Specically, ndings indicating that levels of conict with mother were associated with child MDD and CD (as well as associated with the interaction of CD and Sex) were contingent upon mothers with histories of MDD being in the sample. In contrast, the nding that levels of conict with father were associated with direct effects of MDD and CD, as well as a CD Sex interaction, remained similar when fathers with antisocial behavior were removed from the sample, indicating that these fathers did not signicantly inuence the results.

Discussion
The ndings of this study facilitate understanding of the nature of the family disturbances associated with adolescent depression and conduct disorder. These family problems were evident in both parental psychopathology and family interactions. Consistent with expectations, both offspring depression and offspring conduct disorder were associated with maternal depression. Also consistent with expectations, offspring conduct disorder (in addition to offspring depression, a nding that was not predicted) was associated with paternal antisocial behavior. However, some hypotheses regarding parental diagnoses were not supported. Offspring conduct disorder was not found to be signicantly associated with maternal antisocial behavior. In addition, neither depression nor conduct disorder in offspring were associated with paternal depression. These main effects indicate two things. First, both offspring depression and conduct disorder are associated with both depression and antisocial behavior in parents. Thus, families of depressed youth have an increased likelihood of having parents who are depressed and/or evidence antisocial behavior; the same holds true for families of conduct-disordered youth. Second, the specic associations between offspring and parent disorders differ across parents. That is, maternal depression is strongly associated with these offspring disorders while paternal depression is not; conversely, paternal antisocial behavior is strongly associated with these offspring disorders while maternal antisocial behavior may not be. Though the nding that paternal depression is less strongly associated with offspring depression than is maternal depression does not contradict previous research (Foley et al., 2001; Shiner & Marmorstein, 1998), it remains unclear why adolescent depression would be associated with

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maternal but not paternal depression. It is possible that mothers generally greater role in child-rearing means that any form of maternal impairment, including depression, has a greater impact on the child. Alternatively, in a family in which several members have some liability to depression, it is possible that mothers generally greater investment in their role as caretaker causes them to become more upset, and potentially even depressed, as a result of seeing their child struggle with a problem such as depression. A similar question arises regarding the nding that maternal antisocial behavior was not signicantly associated with conduct disorder (or depression) in offspring. It is unclear why this may be the case, but as the elevated odds ratios in Table 1 indicate, the relationship between maternal antisocial behavior and disorders in the offspring approached statistical signicance. Although our community-based sample was large by most standards, maternal AAB was uncommon, limiting power to detect group differences. Hence, additional research with larger samples is needed before rm conclusions can be reached regarding associations with maternal AAB. The primary hypotheses regarding family relationships were supported: main effects of both conduct disorder and depression were found to be associated with high levels of conict with both parents. The two disorders did not interact in these areas. Because of a lack of previous research in the area, it was unclear whether the sex of the adolescent should have been expected to interact with the presence of either disorder in any area; therefore, it had been predicted that no sex differences would be found. However, the sex of the adolescent was found to interact with the presence of conduct disorder to be associated with particularly high levels of parent child conict in families with conduct-disordered females. This may be due to parents relatively greater acceptance of conduct-disordered behaviors in male adolescents than in female adolescents. Research has shown that parents tend to be less accepting of mild antisocial behavior among girls, compared to boys (as reviewed in Zahn-Waxler, 1993). It is possible that a young girl who exhibits even mild antisocial behavior could elicit a strong negative response from her parents, which then could be followed by protestations from the girl, leading to a cycle of conict and disobedient behavior. It is also possible that female adolescents are more sensitive to parentchild conict and are more likely to act out as a result of such conict. Alternatively, this nding could be a result of reporting biases. That is, parents (as well as the youth themselves) may have different standards for girl versus parent conict and boy versus parent conict. So, a certain amount of conict between adolescent boys and their parents might be expected and therefore not reported in response to questions such as My

parent and I often get into arguments; in contrast, adolescent females may be expected to be more compliant and therefore even a relatively minor amount of arguing might be reported in response to a questionnaire item such as that. Observational studies could clarify this issue. This study was unique in its ability to address the relationship between parental psychopathology and family interaction patterns. Whenever a parental disorder was found to be associated with psychopathology in the child, analyses examining the level of conict with that parent were repeated using both families in which the parent did and families in which the parent did not have the disorder in question. The fatherchild conict ndings remained the same for families in which the fathers did not have histories of antisocial behavior, indicating that the elevated levels of fatherchild conict in these families were unrelated to the potential presence of paternal antisocial behavior. However, in families in which the mother did not have a history of depression, there was no association between motherchild conict and either depression or conduct disorder in the child. Thus, it appears that the elevated levels of conict with mother among depressed and/or conduct-disordered youth may be dependent on a history of depression in the mother; in the absence of this maternal psychopathology, motherchild conict does not appear elevated. It is unlikely that this nding was due to potential reporting biases among depressed mothers, because measures of parent child conict were based on a combination of maternal, paternal, and child reports. There could be several reasons for this nding. It seems most likely that having two people with histories of depression in the home would lead to conict perhaps due to the irritability that sometimes occurs with depression. It is also possible that there is more than one type of depression and that those depressions that relate to genetic factors (in this case, those in families in which both the mother and the child were depressed) are somehow also more likely to relate to high levels of conict. It is possible that there are multiple pathways to the development of depression and conduct disorder in youth, with some youth developing psychopathology primarily due to extremely pathogenic family environments, some youth developing psychopathology primarily due to extreme parental pathology, and some youth requiring a combination of these factors in order to develop a given disorder. Future research following youth with each of these sets of characteristics (i.e., extremely pathogenic family environments but no parental pathology, extreme parental pathology but average family environments, and youth with both sets of risk factors perhaps at more moderate levels) over time would shed light on this possibility. Several limitations of this study should be noted. First, participants in this study had histories of these

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disorders; they did not necessarily have the disorders at the time of the assessment, nor did they necessarily have both disorders at the same time. Second, because participants from this study were selected from an epidemiological sample of adolescents, their cases of conduct disorder and/or depression may have been less severe than cases of these disorders found in clinic settings. In addition, the use of both denite and probable cases, though common in epidemiological studies that use retrospective reporting, may have resulted in the inclusion of participants with sub-clinical cases of the disorders. Participants were primarily Caucasian; although this reects the demographic makeup of Minnesota at the time they were born, it may limit the applicability of these ndings to other groups. It should also be noted that measures of family interaction patterns were based on family members own reports; it is not known how an outside observers ratings would compare to those of the adolescent and his or her parents. In addition, this study did not address the possibility that different types of conict may characterize families in which different forms of psychopathology are present.

Acknowledgments
This work was supported by grants AA09367 from the National Institute on Alcohol Abuse and Alcoholism and DA05147 from the National Institute of Drug Abuse.

Correspondence to
Naomi R. Marmorstein, Department of Psychology, Rutgers University, Camden, 311 North 5th Street, Camden, NJ 0810, USA; Email marmorst@camden. rutgers.edu

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