Do Parental Psychiatric Symptoms Predict Outcome in Children With Psychiatric Disorders? A Naturalistic Clinical Study

Implementing an integrated family approach in mental health care for families experiencing complex and multiple problems: a case example in Amsterdam

For youth care professionals who work with families with complex needs, we implemented an interagency, family-focused approach involving child and adult mental health care services and child protection services. The primary objective of the collaboration was to minimize fragmentation in service delivery and to improve practitioners' self-efficacy in supporting families. A total of 50 families were enrolled between 2020 and 2023. Quantitative descriptive analysis was conducted to map the sample characteristics and the correlations between the practitioners' consultation requests and the recommendations they received. We evaluated the applicability of the model using semi-structured interviews. Results revealed the frequent socioeconomic and psychosocial challenges and co-current mental health issues faced by the families. As expected, practitioners who work with families experiencing complex and multiple problems encountered a range of difficulties in their service delivery. These related to barriers such as poor role demarcation between organizations, practitioners' unrealistic expectations of other services, the impact of multiple problems on family well-being, and complicated family dynamics. The interprofessional collaboration improved the practitioners' self-efficacy in supporting families. They also perceived improvements in child safety. The study emphasizes the need for clear pathways for youth care practitioners to obtain assistance from adult mental health services and to liaise with community support and services. It proposes including adults and young people with lived experiences in the interprofessional collaboration. The study data provides initial evidence that the interagency model has added value for youth care professionals who struggle with issues in family-focused care.

The Role of Maternal Anxiety in Treatment Response for Youth with ASD and Co-occurring Anxiety

Anxiety disorders occur at higher rates in youth with ASD than in neurotypical youth. Although the efficacy of CBT for anxiety in children with ASD is widely supported, factors that influence treatment outcomes are not well understood. This study examined the role of maternal anxiety in treatment outcomes for youth with ASD. Youth with ASD and anxiety (ages 8 to 14), along with their mothers (n = 87), participated in a group CBT intervention. Results indicated that maternal anxiety did not improve over the course of treatment. However, findings suggest that high levels of maternal anxiety at pre-treatment predicted higher levels of youth anxiety post-treatment. Importantly, the relationship between parent anxiety and youth outcomes was moderated by child age. The findings of the present study may provide initial insight into the role that maternal anxiety plays in treatment outcomes for children with ASD and co-occurring anxiety, particularly when considering child age.

Prospective Associations of Childhood Housing Insecurity With Anxiety and Depression Symptoms During Childhood and Adulthood

Importance

Childhood housing insecurity has dramatically increased in the US in recent decades, but whether an association with adverse mental health outcomes exists after adjusting for repeated measures of childhood poverty is unclear.

Objective

To test whether childhood housing insecurity is associated with later anxiety and depression symptoms after adjusting for time-varying measures of childhood poverty.

Design, Setting, and Participants

This prospective cohort study included individuals aged 9, 11, and 13 years at baseline from the Great Smoky Mountains Study in western North Carolina. Participants were assessed up to 11 times from January 1993 to December 2015. Data were analyzed from October 2021 to October 2022.

Exposure

Participants and their parents reported social factors annually when participants were 9 to 16 years of age. A comprehensive measure of childhood housing insecurity was constructed based on frequent residential moves, reduced standard of living, forced separation from home, and foster care status.

Main Outcomes and Measures

Between ages 9 and 16 years, the Child and Adolescent Psychiatric Assessment was used up to 7 times to evaluate childhood anxiety and depression symptoms. Adult anxiety and depression symptoms were assessed at ages 19, 21, 26, and 30 years using the Young Adult Psychiatric Assessment.

Results

Of the 1339 participants (mean [SD] age, 11.3 [1.63] years), 739 (55.2%; 51.1% weighted) were male; 1203 individuals assessed up to 30 years of age were included in the adulthood outcome analyses. Standardized mean (SD) baseline anxiety and depression symptom scores were higher among children who experienced housing insecurity than among those who never experienced housing insecurity (anxiety: 0.49 [1.15] vs 0.22 [1.02]; depression: 0.20 [1.08] vs -0.06 [0.82]). Individuals who experienced childhood housing insecurity had higher anxiety symptom scores (fixed effects: standardized mean difference [SMD], 0.21; 95% CI, 0.12-0.30; random effects: SMD, 0.25; 95% CI, 0.15-0.35) and higher depression symptom scores (fixed effects: SMD, 0.18; 95% CI, 0.09-0.28; random effects: SMD, 0.26; 95% CI, 0.14-0.37) during childhood. In adulthood, childhood housing insecurity was associated with higher depression symptom scores (SMD, 0.11; 95% CI, 0.00-0.21).

Conclusions and Relevance

In this cohort study, housing insecurity was associated with anxiety and depression during childhood and with depression during adulthood. Because housing insecurity is a modifiable, policy-relevant factor associated with psychopathology, these results suggest that social policies that support secure housing may be an important prevention strategy.

The impact of maternal depression on child mental health treatment and models for integrating care: a systematic review

Maternal depression negatively impacts child mental health and is a well-known risk factor for child psychopathology. However, maternal depression treatment and child mental health treatment are rarely integrated. The purpose of this review was to assess the impact of maternal depression on child mental health treatment, including (1) how treatment of maternal depression affects child mental health outcomes, (2) the impact of maternal depression on children receiving mental health care, and (3) emerging models that address maternal depression in primary-care pediatrics and child mental health settings. A systematic literature review was conducted using PubMed and PsycInfo. Initial search yielded 224 records, and after exclusion, 29 papers were reviewed. Effective treatment of maternal depression is associated with a significant decrease in child psychiatric symptoms. Maternal depression negatively affects child mental health treatment in that there is a high rate of untreated mental illness among mothers of psychiatrically ill children, and maternal depression impedes effective child mental health treatment. Current models to address maternal depression in child settings include screening in pediatric primary care, psychotherapy for depressed mothers of psychiatrically ill children, and emerging models that integrate maternal and child mental health treatment. Effective treatment of maternal depression significantly improves child mental health and should be better integrated into child treatment. Opportunities to improve care include more robust screening for parental mental illness, supports to refer parents to psychiatric care, and on-site services for parents. Such interventions hold promise, but require significant support from a multidisciplinary team.

Parent-to-Child Anxiety Transmission Through Dyadic Social Dynamics: A Dynamic Developmental Model

The intergenerational transmission of psychopathology is one of the strongest known risk factors for childhood disorder and may be a malleable target for prevention and intervention. Anxious parents have distinct parenting profiles that impact socioemotional development, and these parenting effects may result in broad alterations to the biological and cognitive functioning of their children. Better understanding the functional mechanisms by which parental risk is passed on to children can provide (1) novel markers of risk for socioemotional difficulties, (2) specific targets for intervention, and (3) behavioral and biological indices of treatment response. We propose a developmental model in which dyadic social dynamics serve as a key conduit in parent-to-child transmission of anxiety. Dyadic social dynamics capture the moment-to-moment interactions between parent and child that occur on a daily basis. In shaping the developmental trajectory from familial risk to actual symptoms, dyadic processes act on mechanisms of risk that are evident prior to, and in the absence of, any eventual disorder onset. First, we discuss dyadic synchrony or the moment-to-moment coordination between parent and child within different levels of analysis, including neural, autonomic, behavioral, and emotional processes. Second, we discuss how overt emotion modeling of distress is observed and internalized by children and later reflected in their own behavior. Thus, unlike synchrony, this is a more sequential process that cuts across levels of analysis. We also discuss maladaptive cognitive and affective processing that is often evident with increases in child anxiety symptoms. Finally, we discuss additional moderators (e.g., parent sex, child fearful temperament) that may impact dyadic processes. Our model is proposed as a conceptual framework for testing hypotheses regarding dynamic processes that may ultimately guide novel treatment approaches aimed at intervening on dyadically linked biobehavioral mechanisms before symptom onset.

Examining reciprocal associations between parent depressive symptoms and child internalizing symptoms on subsequent psychiatric disorders: An adoption study

INTRODUCTION

The dynamic interplay between parent depressive symptoms and child internalizing behavior over time is not well understood.

METHODS

We used data from a prospective parent-offspring adoption design (N = 561) to examine associations between adoptive parent depressive symptoms and child internalizing behavior when children were ages 18 months, 27 months, 4.5 years, and 6 years, and subsequent child psychiatric disorder symptoms when children were between the ages of 6-8 years. Models also accounted for the contributions of birth parent psychopathology, birth mother depressive symptoms during pregnancy, and infant negative emotionality. Bidirectional associations between adoptive parent depressive symptoms and child internalizing behavior were examined using a random-intercept cross-lagged panel model.

RESULTS

There was evidence for associations between child internalizing behavior and adoptive parent depressive symptoms over time, with mothers' depressive symptoms being a more salient risk factor for child internalizing behavior than fathers'. We found one significant cross-lagged association from adoptive mother depressive symptoms at child age 18 months to child internalizing behavior at age 27 months. Infant negative emotionality (i.e., emotional liability) at age 9 months predicted both child internalizing behavior and adoptive parent depressive symptoms.

CONCLUSION

Results suggest that postnatal maternal depressive symptoms confer specific risks for child internalizing behaviors in toddlerhood and childhood and depressive symptoms in childhood.

Emotional and Behavioral Problems in Children With a Cleft Lip With or Without Palate or an Infantile Hemangioma

OBJECTIVE

Life can be challenging for children with a visible difference due to a medical condition, and they might be at risk for emotional and behavioral problems. This study examines emotional and behavioral problems in children with a cleft lip with or without palate (CL ± P) or an infantile hemangioma (IH) in relation to the visibility of the condition, the presence of additional condition-related problems, and parental affect.

SETTING

This cross-sectional study took place in an academic medical hospital in the Erasmus MC Sophia Children's Hospital, the Netherlands.

PARTICIPANTS

A total of 309 parents (mean age = 40.34, 44.00% male) of 182 children with CL ± P and 48 parents (mean age = 39.21, 37.50% male) of 33 children with an IH completed questionnaires. Children were 1.5 to 12 years old.

RESULTS

Parents reported fewer child emotional and behavioral problems compared to normative data. Problems reported were mainly related to learning difficulties and parent gender, while visibility of the condition had no significant influence. Parental negative affect was related to child internalizing problems. Parental positive affect was not related to any of the outcome measures.

CONCLUSIONS

Parents reported fewer problems for their children compared to normative data. This is inconsistent with previous research, showing similar or worse scores for these children compared to peers. Our findings may be explained by a protective parenting style, a response shift in parents, or problems developing at a later point in life.

Prevalence of mental illness among parents of children receiving treatment within child and adolescent mental health services (CAMHS): a scoping review

People affected by mental illness often come from families with patterns of mental illness that span across generations. Hence, child and adolescent mental health services (CAMHS) likely provide treatment to many children with parents who also experience mental illness. The aim of this scoping review was to: (1) identify the prevalence of mental illness among parents of children in CAMHS; (2) identify and appraise the methodologies that have been implemented to assess the prevalence of parental mental illness in CAMHS; (3) identify additional circumstances associated with families where both parent and child experience mental illness; and (4) present recommendations that have been made for CAMHS practice based on these findings. English language, peer-reviewed studies (2010-2018) that had investigated the mental health of parents in CAMHS were included in the review. Literature searching yielded 18 studies which were found to have utilised diverse methodologies to assess parental mental health. Overall, reported prevalence of parental mental illness ranged from 16 to 79%; however, a single study that was deemed to be comprehensive reported prevalence rates of 36% for mothers and 33% for fathers. Across studies, parent and child mental illness was found to be associated with additional adversities impacting family functioning and wellbeing. For children who receive treatment for mental illness, having a parent who also experiences mental illness is a frequent family circumstance that has implications for their prospects for recovery. Accordingly, the mental health of parents should be an important consideration within the mental health care CAMHS provide to children.

Resemblance and clustering of mother's and father's psychopathology levels among Chinese parents of schoolchildren with psychiatric disorders

Background

Few studies have assessed the characteristics of spousal psychopathologies among parents of schoolchildren with and without psychological disorders (PD) in China.

Methods

Parental symptoms were measured using the General Health Questionnaire (GHQ) in 275 mothers and 278 fathers of 298 schoolchildren with PDs diagnosed in a population survey and in 825 mothers and 834 fathers of 894 schoolchildren without PDs as a 1:3 matched comparison group. Spousal GHQ scores were compared. Childhood PD type, presence of childhood comorbidities, and multiple parental and family characteristics were examined as predictors for parental GHQ scores by multiple linear regression analyses.

Results

The GHQ scores were significantly higher among mothers and fathers of children with any PD. Maternal GHQ scores were higher than paternal scores and significantly correlated with paternal GHQ scores in both groups. Spousal GHQ, personal PD history, and childhood PD comorbidity were significant independent predictors of both parents’ GHQ scores. There were also significant associations among parental chronic disease, low family income, and paternal and maternal GHQ score, as well as among low maternal education, less common disorder (LCD) prevalence in children and maternal GHQ score. The rate of GHQ score ≥3 for both parents was significantly higher in the study group than the control group (15.1 vs.7.0%).

Conclusions

Parents of children with any PD type demonstrate significantly elevated psychopathologies, and psychopathology tends to occur concomitantly and resemble that of the other spouse. Screening and treatment of parental psychiatric symptoms will benefit all family members.

Children With Early-Onset Disruptive Behavior: Parental Mental Disorders Predict Poor Psychosocial Functioning in Adolescence

OBJECTIVE

Parental mental disorders (MD) and child early-onset disruptive behavior (DB) are well-established risk factors for poor outcomes in adolescence. However, it is not clear whether parental MD increases risk of future maladjustment among children who already display DB.

METHOD

Parents of 9-year-old children reported on child DB, whereas a patient registry was used to determine parental MD. At follow-ups at ages 15 (n = 6,319) and 18 (n = 3,068) years, information about various problems were collected via registries, parent-, and self-reports.

RESULTS

In the total sample, child DB was related to all outcomes (mean odds ratio [OR] = 1.18; range = 1.07-1.51; p values < .01), paternal MD to criminality, aggression, truancy, poor school performance, and a cumulative risk index of poor functioning, and maternal MD to peer problems, rule breaking, and truancy (mean OR = 1.67; range = 1.19-2.71; p values < .05). In the subsample of children with DB, paternal MD predicted criminality, consequences of antisocial behavior, truancy, poor school performance, and cumulative risk, whereas maternal MD predicted peer problems (mean OR = 1.94; range = 1.30-2.40; p values < .05).

CONCLUSION

This study provides novel evidence that parental MD places 9-year-olds with DB at risk for negative outcomes in adolescence. In addition, paternal MD is a better predictor than maternal MD, regardless of child DB at age 9, suggesting that fathers should be given increased attention in future research. Treatment-as-usual of children with DB could be augmented with additional screening and, if necessary, treatment of mental health problems in their parents.

Parental Psychiatric Symptoms and Children's Outcomes: Toward Understanding and Responding to Intergenerational Risk in Child Psychiatry

Family history of psychiatric illness is a core feature of any competent clinical history taken in a child and adolescent psychiatry clinical setting, and this history is often limited to reviewing caregivers' reports of diagnosed or suspected mental disorders in biological parents and relatives across several generations. Less commonly included is a detailed inquiry into parents' and caregivers' current mental health, including psychiatric symptoms at the time that their child is presenting for evaluation. Recent evidence is a strong reminder that parental mental illness is an important adversity that critically affects lifelong mental well-being in offspring, and that maternal depression in particular is an established factor influencing offspring mental health.^1-3 In this issue of the Journal, Wesseldijk et al. present their article "Do Parental Psychiatric Symptoms Predict Outcome in Children With Psychiatric Disorders? A Naturalistic Clinical Study," an effort to examine relationships between parental psychiatric symptoms and clinical outcomes in child psychiatric patients.⁴ The study moves beyond a focus on maternal depression as a risk factor for offspring psychopathology to include a range of active psychiatric symptomatology in both mothers and fathers at the time that children are presenting for clinical evaluation, and again at follow-up over a year and a half later.