Text messaging improves medication adherence and parental depression is bad for kids in so many ways.  This is Healthcare Triage News.  

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We've talked about individual trials involving text messaging before, but a meta-analysis was just published.  Our first story, mobile telephone text messaging for medication adherence and chronic disease.  Researchers looked at all randomized controlled trials examining a mobile text messaging system to improve medication adherence in adults with chronic disorders.  The main outcomes of interest were odds ratios of adherence.  

They identified 16 randomized controlled trials.  Five of them involved personalized messages, half of them used two-way communication, and half sent a text message every day.  Half the interventions were 12 weeks or more.  The pooled analysis found that text messaging significantly improved medication adherence, with an odds ratio of 2.1.  The effect wasn't different based on study characteristics or text messaging characteristics.  Even after an adjustment for potential publication bias, the results were still statistically significant.  These are relative improvements, of course, but the authors cite literature that finds that baseline adherence rates in developing countries of people with chronic disease are about 50%.  Using the odds ratio found in this study means that text messaging could be expected to increase this adherence rate to about 68% or an absolute rate increase of about 18%.  That's pretty stunning.

Now, there's still short term results.  Many of them rely on self-reported adherence measures, but still!  This is pretty impressive.  In the 11 studies that reported on text messaging acceptability, most showed moderate to high levels of satisfaction with the programs.  The study that used twice daily text messaging found that only 6% of participants said the messages were intrusive and inconvenient.

This stuff works.  It's not expensive and people like it.  Why aren't we trying this more in system across the country?  

Our second study comes from JAMA Psychiatry, "Associations of parental depression with child school performance at age 16 years in Sweden."  Depression continues to be a terrible, terrible thing.  Besides its devastating consequences to people who themselves are depressed, it also impairs their children.  Prior work has shown that parental depression is associated with many detrimental consequences in early childhood, from the behavioral, social, and emotional standpoint.  Long-term outcomes are less well understood.

This study sought to investigate the relationship between parental depression and school performance at 16 years of age in Sweden.  Researchers examined a cohort of more than 1.1 million children born between 1984 and 1994.  They gathered data from medical records from 1969 onward to see if their parents had a diagnosis of depression.  

The main outcome of interest was the decile of school grades, 1-10, at the end of compulsory education at about age 16.  They controlled for many things, like child characteristics, including sex, birth year, birth order, and whether the child was part of a multiple birth.  They accounted for pregnancy characteristics, including maternal and paternal age, and maternal smoking during pregnancy.  Family characteristics controlled for included parental education, disposable family income, parental region of birth, and parental alcohol abuse.  

Both maternal and paternal depression at any time before the final compulsory school year were associated with worse school performance, even after adjusting for all those co-variates, depression was associated with a reduction of almost half a decile, and the effect was greater for girls than for boys.  

There are limitations, of course.  Depression that's never diagnosed is gonna be missed.  This is an epidemiological study, so causation is not assured, and other unmeasured confounding could be important.  We also don't know whether the lower school performance is because children were affected by their parents' depression or because they themselves have problems because of genetic or familial predispositions.  

Regardless, this study shows that parental depression is linked to long-term effects in education in children.  Even depression when kids are young appears to be associated with worse school performance many years later.  There are so many reasons to diagnose and treat depression, in both adults and children.  This just might be one more.

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