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Numerous studies report that some first-time parents experience a decline in relationship quality and an increase in conflict after the birth of a first baby. Inter-parental discord that is frequent, intense, and poorly resolved increases the likelihood of relationship breakdown and adversely impacts child development. We investigated the feasibility of a brief preventative couple-focused psychotherapeutic intervention in the perinatal period in a general population sample. Sixty couples expecting their first baby were recruited from the Royal Free Hospital, London. Thirty were randomly assigned to treatment (TMT, a newly developed five-session couple-focused intervention), and 30 to usual care (TAU). Outcomes were collected at 28 weeks into pregnancy, 6–8 weeks after birth, and when the baby was 6 months old. The intervention was feasible and acceptable, evidenced by 100% attendance. However, no change in relationship quality or inter-parental discord was detected in either TMT or TAU groups across the transition to parenthood. The intervention did not improve outcomes vs. TAU. Depression assessed by the Hospital Anxiety and Depression Scale increased across the cohort and mood symptoms assessed by the Edinburgh Postnatal Depression Scale decreased in mothers but not fathers. The absence of a decline in relationship quality could reflect sample attributes: couples were older than average UK first-time parents, had high levels of educational qualifications, and low discord. Even in this low-risk sample, only 20 out of 30 TAU couples completed all three assessments, vs. 29 out of 30 TMT couples. Larger-scale RCTs of perinatal couple-focused psychosocial interventions may be hampered by selection effects and attrition. They may benefit from co-design with stakeholders and active control conditions. Trial registration: ISRCTN12258825; 1st May 2020 (retrospectively registered).

Background Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD. Aims To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility of conducting a randomised controlled trial (RCT) of the modified intervention. Method The intervention was modified with expert input and tested on a case series. A feasibility and pilot RCT compared the new intervention with usual care. Foster carers and children in their care aged ≤6 years were recruited across nine local authorities, with 1:1 allocation and blind post-treatment assessments. The modified intervention was delivered in-home by trained mental health professionals over 4–6 months. Children were assessed for RAD symptoms, attachment quality and emotional/behavioural difficulties, and foster carers were assessed for sensitivity and stress. Results Minimal changes to the intervention programme were necessary, and focused on improving its suitability for the UK foster care context. Recruitment was challenging, and remained below target despite modifications to the protocol and the inclusion of additional sites. Thirty families were recruited to the RCT; 15 were allocated to each group. Most other feasibility outcomes were favourable, particularly high numbers of data and treatment completeness. The revised intervention was positively received by practitioners and foster carers. Conclusions A large-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended.

Numerous studies report that some first-time parents experience a decline in relationship quality and an increase in conflict after the birth of a first baby. Inter-parental discord that is frequent, intense, and poorly resolved increases the likelihood of relationship breakdown and adversely impacts child development. We investigated the feasibility of a brief preventative couple-focused psychotherapeutic intervention in the perinatal period in a general population sample. Sixty couples expecting their first baby were recruited from the Royal Free Hospital, London. Thirty were randomly assigned to treatment (TMT, a newly developed five-session couple-focused intervention), and 30 to usual care (TAU). Outcomes were collected at 28 weeks into pregnancy, 6-8 weeks after birth, and when the baby was 6 months old. The intervention was feasible and acceptable, evidenced by 100% attendance. However, no change in relationship quality or inter-parental discord was detected in either TMT or TAU groups across the transition to parenthood. The intervention did not improve outcomes vs. TAU. Depression assessed by the Hospital Anxiety and Depression Scale increased across the cohort and mood symptoms assessed by the Edinburgh Postnatal Depression Scale decreased in mothers but not fathers. The absence of a decline in relationship quality could reflect sample attributes: couples were older than average UK first-time parents, had high levels of educational qualifications, and low discord. Even in this low-risk sample, only 20 out of 30 TAU couples completed all three assessments, vs. 29 out of 30 TMT couples. Larger-scale RCTs of perinatal couple-focused psychosocial interventions may be hampered by selection effects and attrition. They may benefit from co-design with stakeholders and active control conditions.Trial registration: ISRCTN12258825; 1st May 2020 (retrospectively registered).

Background Parenting programmes aim to alleviate behavioural problems in children, including conduct disorder. This study was part of a multi-phase mixed-methods project seeking to extend the reach of parenting programmes for the treatment of conduct problems through developing an evidence base to inform a personalised approach. It explored the narratives of parents of children with behavioural and conduct problems about parenting programmes to identify how such programmes could be personalised in order to extend their reach to parents and children who do not currently benefit. Methods Face-to-face semi-structured interviews with a purposive sample of 42 parents, who had different experiences of parenting programmes. Interviews were conversational and informed by a topic guide. Analysis of transcripts of audio-recorded interviews drew on inductive thematic approaches and was framed largely within a phenomenological perspective. Results Parents’ accounts demonstrated three themes: 1) a personalised approach needs to include the child; 2) a supportive school matters; and, 3) the programme needs to feel personal. Parents were more likely to have a positive experience at a parenting programme, and for their child to demonstrate positive behavioural changes, when they felt their concerns were validated within the group and they also felt supported by the child’s teachers. Parents whose children had been assessed prior to undertaking the programme were also more likely to perceive the programme to be beneficial, compared to parents who felt their child’s individual issues were never considered. Conclusions Our findings point to the potential for personalised approaches to extend the reach of parenting programmes to parents and children who do not currently benefit from such programmes. Important in personalising parenting programmes is assessing children before parents are referred, to directly work with children as well as parents, and to work collaboratively with parents and children to identify which families are most suited to group support or one-to-one support and how this may change depending on circumstances.

Objective: Identify the core ‘interaction structures’ between therapists and depressed adolescents within and across two common forms of psychotherapy. Method: A total of 70 audio-recorded psychotherapy sessions representing short-term psychoanalytic psychotherapy (STPP) and cognitive behavioural therapy (CBT) with youth aged 12–18 years old were coded with the Adolescent Psychotherapy Q-set (APQ), a newly developed instrument. Data included different therapist-patient dyads and stages in treatment and were analysed with cluster analysis. Results: Three distinct interaction structures between therapists and depressed adolescents: two influenced by the therapists’ techniques and one more influenced by the young people’s attitude to therapy. Conclusion: When there is a collaborative working relationship between therapists and depressed young people, the therapy process is influenced by the therapists’ techniques; while when there is a poor working relationship, the techniques used by therapists of different theoretical orientation become more similar with the aim of engaging the young person in the process.

BACKGROUND: Psychological treatments for adolescents with unipolar major depressive disorder are associated with diagnostic remission within 28 weeks in 65-70% of patients. We aimed to assess the medium-term effects and costs of psychological therapies on maintenance of reduced depression symptoms 12 months after treatment. METHODS: We did this multicentre, pragmatic, observer-blind, randomised controlled superiority trial (IMPACT) at 15 National Health Service child and adolescent mental health service (CAMHS) clinics in three regions in England. Adolescent patients (aged 11-17 years) with a diagnosis of DSM IV major depressive disorder were randomly assigned (1:1:1), via a web-based randomisation service, to receive cognitive behavioural therapy (CBT) or short-term psychoanalytical therapy versus a reference brief psychological intervention. Randomisation was stochastically minimised by age, sex, self-reported depression sum score, and region. Patients and clinicians were aware of group allocation, but allocation was concealed from outcome assessors. Patients were followed up and reassessed at weeks 6, 12, 36, 52, and 86 post-randomisation. The primary outcome was self-reported depression symptoms at weeks 36, 52, and 86, as measured with the self-reported Mood and Feelings Questionnaire (MFQ). Because our aim was to compare the two psychological therapies with the brief psychosocial intervention, we first established whether CBT was inferior to short-term psychoanalytical psychotherapy for the same outcome. Primary analysis was by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN83033550. FINDINGS: Between June 29, 2010, and Jan 17, 2013, we randomly assigned 470 patients to receive the brief psychosocial intervention (n=158), CBT (n=155), or short-term psychoanalytical therapy (n=157); 465 patients comprised the intention-to-treat population. 392 (84%) patients had available data for primary analysis by the end of follow-up. Treatment fidelity and differentiation were established between the three interventions. The median number of treatment sessions differed significantly between patients in the brief psychosocial intervention group (n=6 [IQR 4-11]), CBT group (n=9 [5-14]), and short-term psychoanalytical therapy group (n=11 [5-23]; p

OBJECTIVE: High therapy dropout rates among adolescents have been reported, but little is known about whether dropout is associated with poor outcomes. This study aimed to examine clinical outcomes in adolescents with depression who dropped out of psychological therapy and to determine whether this varied by treatment type. \ud \ud METHOD: Data were drawn from the Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT) study, a randomized controlled trial, comparing a brief psychosocial intervention, cognitive-behavioral therapy, and short-term psychoanalytic psychotherapy in the treatment of adolescent major depression. The sample comprised 406 adolescents with a diagnosis of major depression, 169 of whom dropped out of treatment before the planned end of therapy. Primary outcome was self-report Mood and Feelings Questionnaire (MFQ); secondary outcomes were Health of the Nation Outcome Scale for Children and Adolescents, Revised Children's Manifest Anxiety Scale, Modified Leyton Obsessional Inventory, and clinical diagnosis. \ud \ud RESULTS: During follow-up, there was a nonsignificant trend for dropouts to report higher depressive symptoms than completers. However, modeling showed insufficient evidence for an association between dropout and outcomes. \ud \ud CONCLUSION: In contrast to studies of adult therapy, there was no strong evidence that adolescent patients who dropped out had poorer clinical outcomes compared with those who completed therapy, when dropout was defined as ending treatment without agreement of the therapist. This challenges us to understand why adolescents stop going to therapy, how dropout should be defined, and whether what is prescribed is what is always needed. \ud \ud CLINICAL TRIAL REGISTRATION INFORMATION: Improving Mood and Preventing Relapse With Psychoanalytic Psychotherapy and Cognitive Behavior Therapy; http://www.isrctn.com/; 83033550.

BackgroundAlthough there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years.ObjectiveTo determine whether or not either of two specialist psychological treatments, cognitive–behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief psychosocial intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment.DesignObserver-blind, parallel-group, pragmatic superiority randomised controlled trial.SettingA total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London.ParticipantsAdolescents aged 11–17 years withDiagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses.InterventionsIn total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up.Main outcome measuresMean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation.ResultsThere were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = –0.578, 95% confidence interval (CI) –2.948 to 4.104;p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = –1.898, 95% CI –4.922 to 1.126;p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49–52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome.ConclusionsThe three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings.LimitationsNeither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data.Trial registrationCurrent Controlled Trials ISRCTN83033550.FundingThis project was funded by the National Institute for Heath Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 12. See the National Institute for Heath Research Journals Library website for further project information. Funding was also provided by the Department of Health. The funders had no role in the study design, patient recruitment, data collection, analysis or writing of the study, any aspect pertinent to the study or the decision to submit toThe Lancet.

There is good evidence that children of parents with psychiatric disorders are at increased risk of disturbances in their development. There is considerable research on disorders such as depression and alcohol abuse, but research on the children of parents with eating disorders has only recently emerged. This paper reviews evidence in a number of domains, including genetic factors; pregnancy; the perinatal and postpartum period; followed by infancy, and the early years, focusing on feeding and mealtimes, general parenting functions and growth. Psychopathology in the children, parental attitudes to children's weight and shape, and adolescence are then considered. While numerous case reports and series have been published, there are very few systematic controlled studies, and virtually no reports of the influence of fathers with eating disorders or the male partners of mothers with eating disorders. The available evidence suggests that children of mothers with eating disorders are themselves at increased risk of disturbance in a variety of domains. This risk depends on a range of factors, and it should be noted that difficulties in the offspring of mothers with an eating disorder are far from invariable. Finally, based on current evidence, five types of mechanisms by which eating disturbance in parents can influence child development are summarised.

Social domains are classes of interpersonal processes each with distinct procedural rules underpinning mutual understanding, emotion regulation and action. We describe the features of three domains of family life – safety, attachment and discipline/expectation – and contrast them with exploratory processes in terms of the emotions expressed, the role of certainty versus uncertainty, and the degree of hierarchy in an interaction. We argue that everything that people say and do in family life carries information about the type of interaction they are engaged in – that is, the domain. However, sometimes what they say or how they behave does not make the domain clear, or participants in the social interactions are not in the same domain (there is a domain mismatch). This may result in misunderstandings, irresolvable arguments or distress. We describe how it is possible to identify domains and judge whether they are clear and unclear, and matched and mismatched, in observed family interactions and in accounts of family processes. This then provides a focus for treatment and helps to define criteria for evaluating outcomes.

Background Maternal depression can be detrimental to infant development. Structured home visiting initiated either in pregnancy or soon after the birth by a professional has led to better outcomes for mothers and their children but some vulnerable families may respond more favourably to a local volunteer. The value of volunteer support provided in the UK by Home-Start for maternal well-being is noted in qualitative studies, but there is no evidence of its impact from trials. The support is not structured and both the frequency and content of visits may vary. Methods A cluster randomized study allocated Home-Start local schemes to intervention or control conditions. Mothers in all areas were screened at routine health checks in late pregnancy. In intervention areas names of those scoring 9+ on the Social Disadvantage Screening Index were passed to Home-Start to be offered a volunteer. Not all those offered the support accepted the offer. In control areas no support was offered. Research assessments were conducted at 2 and 12 months. The outcomes were major or minor depression occurring between 2 and 12 months (Structured Clinical Interview for Diagnostic and Statistical Manual – Third Edition – Revised) and depression symptoms at 12 months (Edinburgh Postnatal Depression Scale). Three groups were compared: supported, case-matched controls and those offered but not receiving support. Results Almost one-third experienced depression during the time period. Volunteer support had no identifiable impact on the emergence of maternal depression from 2 to 12 months or on depression symptoms when infants were 12 months. The major predictor of both was depression identified at 2 months. Conclusions It was not found that informal support initiated following screening for disadvantage in pregnancy reduced the likelihood of depression for mothers with infants.

Background It is well established that maternal depression is associated with enhanced child consultation for developmental and behaviour problems, but there is a dearth of research on paternal depression and child outcome. Aim To assess the association of major paternal depressed mood and child consultation for developmental and behaviour problems. Design of study Cross-sectional study. Setting General practices in London and Hertfordshire, UK. Method Fathers of children aged 4–6 years were recruited via 13 general practices. A sample of 248 biological father and mother dyads completed measures on depressive syndrome (Patient Health Questionnaire), child consultations with health professionals for developmental and behaviour problems, fathering, couple relationship quality, alcohol misuse, other psychiatric impairment, and sociodemographic factors. Results Eight out of 248 fathers (3%) had a major depressive syndrome. Sixty-five out of 247 (26%) fathers reported they were responsible for taking their child to see the doctor at least half the time compared with mothers. Children of fathers with a major depressive syndrome were almost nine times more likely to have consulted a health professional for speech and language problems (adjusted odds ratio [OR] = 8.67, 95% confidence interval [CI] = 1.99 to 37.67, P = 0.004) and seven times more likely to have consulted for externalising behaviour problems (adjusted OR = 6.98, 95% CI = 1.00 to 48.76, P = 0.05). Conclusion Children of fathers with major depression were more likely to consult for speech and language problems and externalising behaviour problems. A longitudinal study is recommended to identify causal mechanisms.

To date there has been no comparison of father and mother report on the Strengths and Difficulties Questionnaire (SDQ), a standardised measure of child behaviour used widely in the UK in clinical practice and research. The objectives of the study were to investigate differences and agreement between parents on the various SDQ domains of child behaviour. Parents of 4-6 years olds were recruited via 13 UK general practices, and completed the SDQ and measures on depression, parenting, couple relationship, alcohol use and demographics. Parental SDQ ratings were compared. The SDQ was completed by 248 parent dyads. Mother and father ratings were correlated, however fathers reported higher mean scores than mothers for externalising behaviours. Higher reporting by fathers was related to alcohol misuse, the couple relationship, fathering, and father employment. Fathers did not report significantly more abnormal behaviours than mothers except for hyperactivity. There was high interparental agreement on normal/borderline behaviours (94.8-98.3% agreement), but lower agreement on abnormal behaviours (7.7-37.9%). There was higher interparental agreement on male rather than female children, but fathers were four times more likely to report hyperactivity among their boys compared with girls. Using combined parental reports in clinical settings would enhance the sensitivity of identifying children requiring clinical attention for their problem behaviours.

The study reported here aimed to evaluate the impact on parenting and the home environment of community volunteer home visiting offered during or soon after pregnancy to potentially vulnerable mothers. A cluster‐randomised study allocated Home‐Start schemes to intervention or comparison (existing services) conditions. Mothers were screened at routine health checks. Families in intervention and comparison areas were assessed at two and 12 months. The results showed that comparing families receiving support and those in comparison areas, there were few differences. There was a greater reduction in parent‐child relationship difficulties for supported families, but they offered their children fewer healthy foods. There was no evidence of enhanced parenting, organisation of the home environment or more appropriate use of health services. Comparing families receiving support with a second comparison group, living in intervention areas but not receiving support, no differences were found. The article concludes that a more structured approach may be required to make changes in parenting behaviour and the home environment.

This study investigated the characteristics of families with a new baby, screened to identify families with vulnerability, who did not take up the offer of home-visiting support from a community volunteer. Using logistic regression, background factors were compared with those families receiving support. Those not receiving support, 59.1% of those referred, were more socially, educationally and economically disadvantaged, living in more disadvantaged neighbourhoods. Those who received support were more likely to have larger families, no local support network, or had family members with health or mental health problems. One in nine families referred had not been reached by the support service. In brief qualitative telephone interviews, mothers who did not take up the offer of support reported changing their mind, wanting to cope without help and in some cases feeling that the support offered did not meet their specific needs. Policy implications are suggested, in particular offering support to new parents thought to be vulnerable within a statutory framework, with sufficient infrastructure and resources to conduct outreach work. Research implications include making a concerted effort to find out about families who decide not to take part in service evaluation studies, or who drop out after initial agreement.

Fathers are underrepresented in research on mental health and child outcome. We tested a range of methods of recruitment of fathers to establish feasibility and recruitment rates to obtain a sample for a study on paternal depression and child development. The study took place in North London. Fathers of children aged 6 years and under were approached via: general practice surgeries by post and by face-to-face contact with attendees; child health surveillance clinics face-to-face or via their partners and via hospital postnatal wards face-to-face or by post. Researcher time and associated costs were monitored for each method, and symptoms of depression and anxiety measured using the Hospital Anxiety and Depression Scale (HADS). Face-to-face recruitment of fathers on the postnatal ward generated the highest return rate of HADS (28/37; 76%), followed by postal recruitment through general practice (41%;124/303). Lower response rates were observed with postal recruitment via postnatal wards (31%), recruitment in child health surveillance clinics (20%) and approaching attendees in general practice (16%). Twelve percent (23/194) and 30% (58/194) of fathers respectively reported depression and anxiety above the cut-off for case-definition. Costs were calculated on pro-rata researcher time. Costs of recruiting one participant ranged from 3 pounds sterling (general practice postal) to 11.75 pounds sterling (child health surveillance clinics), however the general practice attender method was disproportionately expensive (52.50 pounds sterling). This feasibility study shows that it is possible to recruit fathers to mental health studies and provides clear guidance on planning, costing and the expected levels of recruitment for future studies on fathers of young children.

Maternal depression is associated with adverse child development, but little is known about the effects of paternal depression. This pilot study estimated the prevalence of paternal depression and mood state, and assessed the relationship between paternal mood and infant temperament. The participants in the study were 98 fathers of newborn babies. Fathers were initially screened for depressed mood (Hospital anxiety and depression scale, and Edinburgh postnatal depression scale), and at 6 months parental mood, infant temperament, couple relationship quality, alcohol use, adverse life events, parenting, and demographics were recorded. Infant fussiness was analysed in relation to paternal mood and other contextual factors using multiple regression. Of the 98 fathers, 48 (49%) completed depression-screening measures. Of these 48 fathers, 4 (8%) reported depressive symptoms above the cut-off for case definition. A total of 48% (N=19) completed measures at follow-up. In the adjusted model, higher paternal depression scores, more traditional attitudes towards fathering, and increased recent life events were related to higher infant fussiness scores; and better couple relationship quality was related to lower fussiness scores. This study showed that 1 in 12 fathers had depressed mood, and lower mood was associated with negative infant temperament. Since the findings of this feasibility study were based on a small sample size the association of paternal mood and child development merits further study using a larger sample of fathers.

The NHS has emphasised the need for rigorous evaluations of preventative home-visiting support (Bull and others, 2004) in building a public health evidence base. Interdisciplinary studies involving the NHS in any capacity are subject to ethical review by NHS Research Ethics Committees. However, the current process of ethical review does not respond flexibly to research conducted by non-NHS organisations. Through documentary analysis, this paper describes the experience of a non-clinical research evaluation of a family support service offered during pregnancy and the difficulties encountered in gaining ethical approval. Implications for social science research with minimal NHS involvement are discussed and recommendations for improvements suggested.

Wolpert and colleagues highlight the limitations of the current evidence base for treatment in child mental health.1 That child mental health is “everybody’s business”2 has long been the mantra of clinicians working in the field, so recognising the pivotal role of the wider community in children’s wellbeing is uncontroversial, but we must also focus on increasing …

Clinical and empirical methods are commonly considered to be complementary activities. However, many people in the fields of mental health and social welfare espouse a strong adherence to experimental, scientific methods for the evolution of theory and practice and consider only that which has been experimentally tested as ‘really true’. Others would propose the clinical method as the main source of useful knowledge and are suspicious of enumeration and quantification as sources of useful information. Formal, empirical methodology is well and extensively described whilst there is less systematic exposition of the clinical method. Family therapy evolved in a context in which activity was visible and the emerging discipline was propelled by a theoretical framework with strongly scientific origins that was critical of the exclusive clinical method of pre-existing psychotherapies. This paper describes some of the clinically based contributions to the family therapy of anorexia nervosa and compares this information with that which comes out of the Maudsley trials of psychotherapies in anorexia nervosa.

General practice is an obvious but relatively untried context within which to practise family therapy. This paper describes the development of a family therapy clinic within a group general practice and considers the influence of the practice setting on the practical style and theoretical approach of the family therapy team. The influence of the clinic on the referring habits and on the consulting style of the GPs is also considered in the context of the changes taking place in the organization of general practice.

Maternal depression is associated with adverse child development, however little is known about paternal depression and child outcome. The aim of this study was to estimate the prevalence of paternal depression and assess its association with abnormal child behaviours among 4- 6-year-olds. Parents of 4- 6-years-olds were recruited via general practices and completed measures on child behaviour (Strengths and Difficulties Questionnaire), depression (Patient Health Questionnaire), and other covariates. The association of major and other paternal depressive syndrome with mother reported child behaviour was analysed. Eight percent (29/365) of fathers had depression (3.3 and 4.77% a major and other depressive syndrome, respectively). Major but not other paternal depressive syndrome was associated with an 8 and 36 times greater likelihood of child prosocial behaviour problems and peer problems respectively.