Parenting and the emotional and behavioural adjustment of young children in families with a parent with bipolar disorder

CoDesign of a digital intervention for parents with bipolar disorder informed by integrated knowledge translation principles

OBJECTIVES

To provide detailed information on the codesign of a digital intervention to support parents with bipolar disorder (BD) who have young children. Each step of this process is reported, as well as a detailed description of the final version of the intervention in line with the TIDieR framework.

METHODS

Clinical experience and lived experience experts participated in online workshops, meetings, and remote feedback requests, informed by Integrated Knowledge Translation (IKT) principles. The IKT research group responded to each phase of recommendations from the knowledge users.

RESULTS

Five clinical experience experts and six lived experience experts engaged with the codesign process. Their recommendations for principles, content, look, and feel, and functionality of the digital intervention were structured over five iterative phases. This led to a final implemented design that was identified by the clinical and lived experience experts (referred to together as the knowledge users group) as genuinely reflecting their input.

CONCLUSIONS

The IKT principles offer an accessible structure for engaging with clinical and lived experience experts throughout a codesign process, in this case for a digital intervention for parents with BD. The resulting intervention is described in detail for transparency to aid further evaluation and development and to help other teams planning codesign approaches to intervention development.

The impact of treating parental bipolar disorder and schizophrenia on their children's mental health and wellbeing: an empty systematic review

Background

Parental psychosis (bipolar disorder and schizophrenia) are major risk factors for mental health problems in offspring. Although interventions that focus on parenting and the family environment have shown effectiveness in mitigating this risk, no systematic review has examined the impact of simply treating adult bipolar disorder or schizophrenia on their dependent children's outcomes.

Aims

To systematically review the effects (in randomized controlled trials) of adult-based interventions for bipolar disorder and schizophrenia, on offspring mental health and wellbeing.

Method

Eligibility criteria included randomized controlled trials that examined the treatment of adults with bipolar disorder and schizophrenia that also included child mental health and wellbeing outcomes. PubMed, Scopus, PsycINFO, and PsychArticles databases were searched.

Results

168,317 studies were reviewed; however, zero studies that met the inclusion criteria could be found.

Conclusions

The existing research aimed at treating adult bipolar disorder and schizophrenia has so far overlooked the potential advantages that these treatments could provide for their offspring. This is a missed opportunity to understand the mechanisms of intergenerational transmission. Researchers examining treatments for adults with bipolar disorder and schizophrenia should, where appropriate, consider including both adult and child mental health outcomes in their trials.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=431007, identifier CRD42023431007.

The perceived social support of parents having bipolar disorder impacts their children's mental health: a 10-year longitudinal study

BACKGROUND

The offspring of parents with bipolar disorder (OBD) are at higher risk of developing psychopathology than the offspring of parents with no affective disorder (control). In addition to genetic predisposition, childhood adversity and a stressful family environment are important risk factors for the OBD. Protective factors in parents, such as social support and coping strategies, may buffer the effects of stress on at-risk children. This study tested whether parents' social support and coping style attenuated the link between risk status (OBD vs. control) and psychopathology in offspring.

METHODS

During offspring's middle childhood, parents underwent a diagnostic interview and completed social support and coping style questionnaires. Sixty-nine OBD (39 female) and 69 control (29 female) offspring between ages 13 and 29 completed a diagnostic interview approximately 10 years later.

RESULTS

Parents' social support satisfaction moderated the link between offspring risk status and their development of substance use disorder (SUD) symptoms (F(1,131) = 5.90, p = .017). Parents' social network size moderated the link between offspring risk status and their development of anxiety and depression symptoms in an unexpected direction (F(1,131) = 5.07, p = .026). No effects of parents' coping style were found.

CONCLUSIONS

Among the OBD, having parents with greater social support satisfaction and, unexpectedly, a smaller social network buffered their development of SUD and depression and anxiety symptoms by early adulthood. Parents' social support may thus have a protective function for children in these high-risk families.

Family dysfunction, stressful life events, and mental health problems across development in the offspring of parents with an affective disorder

BACKGROUND

Offspring of parents with affective disorders (OAD) are at risk of developing a wide range of mental disorders. Deficits in the rearing environment and high levels of stress are well-known risk factors for negative outcomes in OAD. Building on prior research, we aim to examine the longitudinal relationships between family dysfunction, stressful life events, and mental health in OAD and control offspring of parents with no affective disorder. In the present study, we hypothesized that high levels of family dysfunction would be associated with more internalizing and externalizing problems across time in OAD than in controls, and that family dysfunction would mediate the relationship between stressful life events in adolescence and poor mental health in adulthood, particularly in OAD.

METHODS

As part of the TRacking Adolescents' Lives Survey (TRAILS), 2230 participants (51% female, Mage = 11.1 years, SD = 0.6, at baseline) and their parents completed measures across six time points, spanning 15 years. Mental health, family dysfunction, and stressful life events were assessed with the Youth and Adult Self-Report, Family Assessment Device, and an in-house measure, respectively.

RESULTS

Multi-group structured equation modeling revealed that family dysfunction was linked to internalizing and externalizing problems in OAD, but not controls, across time. Risk status did not moderate family dysfunction's mediation of the relationship between stressful life events and negative outcomes in adulthood.

CONCLUSIONS

OAD show high sensitivity to dysfunction in the rearing environment across childhood and adolescence, which supports the use of family based interventions to prevent the development of mental disorders in high-risk youth.

How Do Fathers Help? A Moderation Analysis of the Association between Adverse Childhood Experiences and Child Behavioral Health in Fragile Families

Existing research has built concrete links between trauma exposure and lifelong behavioral health outcomes. However, the ways by which father engagement buffers the detrimental effects of trauma on early childhood behavioral health remains unexplored. Using the data of 3001 mothers from the Fragile Families and Child Well-being Study, we conducted a moderation analysis to examine the associations between adverse childhood experiences (ACEs), child behavioral health, father engagement, and maternal education. We found that ACEs at child age three were positively associated with child externalizing and internalizing behaviors at child age five. Father engagement at child age one buffered the harmful effects of ACEs on child externalizing behaviors, but this effect was only significant for children living with mothers with an education level lower than high school. Child psychiatrists should view father engagement as a critical factor in fostering child resilience, particularly for children living in families with limited resources.

The changes of parental functioning of the patients with bipolar disorder and major depression since discharging from hospital: A longitudinal study

AIMS AND OBJECTIVES

This study examined the changes in patients' parental functioning and the associated factors, including manic, depressive symptoms and social support from before discharge to 6 months post-discharge.

BACKGROUND

For parents with bipolar disorder and major depression, parenting is a recovery factor for patients, but little research examines the dynamic parental functioning from acute hospitalisation to a remission stage.

DESIGN

A longitudinal design was used. The STROBE Checklist were used in presenting this research.

METHODS

Participants were inpatients with bipolar disorder or major depression (n = 33) recruited within one week before discharge from the acute psychiatric ward in Taiwan. Data on parental functioning was collected four times: before discharge (T1), the 1st (T2), the 3rd (T3) and the 6th (T4) months of post-discharge. Baseline parental functioning before admitting to the acute word was retrospectively assessed at T0. The questionnaires included positive and negative domains of parenting practice, hypomanic/manic symptoms, depressive symptoms and social support. Generalised estimating equations were applied for data analysis.

RESULTS

The negative parenting domains (poor monitoring, inconsistent discipline) decreased during hospitalisation but increased at one month post-discharge, except corporal punishment at 3-months discharge. The positive parenting domains (parental involvement and nurturance/responsiveness) did not recovery to baseline. While clinical symptoms remained stable during 6 months post-discharge, social support decreased at 3 and 6 months post-discharge. Higher depressive symptoms and low social support were associated with positive parenting domains but not related to negative parenting domains. Manic symptoms were not associated with positive or negative parenting domains.

CONCLUSIONS

Positive parenting domains did not fully return to the usual situation during 6 months post-discharge.

RELEVANCE TO CLINICAL PRACTICE

Parenting functioning recovery program targeting at the impacts of depressive symptoms on the parenting functioning and insufficient social support is needed from hospitalisation to post-discharge.

The role of tenacious versus flexible goal pursuit in the vulnerability to bipolar disorder

The vulnerability to bipolar disorder is characterized by dysregulated goal-related behavior, the setting of ambitious and extreme goals, and increases in goal approach behaviors. To date, no studies have investigated the nature of goal pursuit behaviors amongst individuals at a behavioral risk for bipolar disorder in terms of whether goal pursuit is characterized by a tenacious active striving for goals or a more flexible changeable focus on goals. A non-clinical sample of 168 participants completed online measures of mood, bipolar-vulnerability, reward sensitivity, goal-related perfectionist tendencies, tenacious goal pursuit and flexible goal adjustment behaviors. Our findings demonstrate that bipolar-vulnerability is characterized by the tenacious, not flexible, pursuit of goals, in combination with low regulation of goal behavior, and tendencies towards narcissistic and self-critical perfectionism indicative of setting high ambitious standards and making overly harsh self-judgments when such standards are not met. These findings are similar to those from clinical bipolar samples where there is evidence of prolonged symptom recoveries after the experience of goal frustrations and failures. Reducing the tenacious, active striving for goals amongst at-risk individuals may be a potential avenue for early intervention.

A Cross-Sectional Study on Internet Addiction Among Adolescent Children of Parents With Mental Illness

BACKGROUND

The internet can cause adverse psychological issues in children whose parents show less competence because of their mental illness. This study aims to find the level of internet addiction among adolescents who have a parent with psychiatric illness and its relationship to the type and duration of their parent's illness.

METHOD

This study was conducted among 283 adolescents whose parents suffered from mental illness. They were selected from the inpatient and outpatient services of a neuropsychiatric hospital in India. Informed written consent was obtained from the parent not suffering from psychiatric illness, and a semistructured interview accommodating various factors and statements from the internet addiction test was used to find the level of internet addiction.

RESULT

A total of 79.5% of adolescents showed scores indicative of internet addiction, with 14.5% of the participants having mild levels of addiction, 60.8% having moderate levels of addiction, and 4.2% having severe levels of addiction. There is a significant relationship between internet addiction scores and the type and duration of psychiatric illness in a parent.

CONCLUSION

The internet addiction scores in adolescents have a significant relationship to the various types of illnesses and the duration of illness of their parents.

Parental and partner role functioning and personal recovery in bipolar disorder

OBJECTIVES

Bipolar disorder research has primarily focused on clinical outcomes but there is increasing understanding of the importance of personal recovery. This study aimed to explore the relationship between functioning in key social roles including parenting and intimate relationships with personal recovery.

METHOD

Participants with bipolar disorder (N = 393) were recruited to participate in an online survey. Participants provided clinical information and completed measures of personal recovery, parental and intimate relationship functioning.

RESULTS

Parental functioning and intimate relationship functioning were found to be significantly associated with recovery scores with higher scores being associated with greater recovery. Parental functioning was also found to have a predictive effect, with higher parental functioning predicting greater recovery scores.

CONCLUSIONS

This study suggests that greater parental functioning may have an important role in the experience of personal recovery for people living with bipolar disorder. Future studies should further assess how supporting parenting may contribute recovery outcomes.

Improved Parent-Child Interactions Predict Reduced Internalizing Symptoms Among the Offspring of Parents with Bipolar Disorder Undergoing a Prevention Program: A Proof-of-Concept Study

The offspring of parents with bipolar disorder (OBD) exhibit elevated rates of psychopathology. However, preventative interventions are lacking. Using a quasi-experimental design with an assessment-only control group, we examined if a 12-week program (entitled Reducing Unwanted Stress in the Home, RUSH) decreases internalizing and externalizing symptoms in the OBD (aged 6-11 years) via intervention-related gains in parent-child interaction quality. Participants consisted of 55 offspring (26 OBD; 29 controls) and their parents. Assessments were conducted at four time points up to six months following the end of the RUSH program, during which parent and teacher ratings of child symptoms, and parent-child interaction quality (parental positivity and negativity, and dyadic mutuality) were measured. Multilevel modelling showed improved parental positivity and negativity, and dyadic mutuality among target dyads immediately and six months post-intervention. For the bootstrapping mediation analyses, intervention-related change in parental negativity fully mediated the relations between having participated in the RUSH program and lower parent-reported internalizing problems among the OBD six months later. These data provide evidence of the efficacy of the RUSH program for OBD who exhibited improved interactions with their parents post-intervention. Further investigation via a randomized controlled trial is warranted.

Emotion socialization in mothers with mood disorders: Affective modeling and recollected responses to childhood emotion

Growing evidence suggests that emotion socialization may be disrupted by maternal depression. However, little is known about emotion-related parenting by mothers with bipolar disorder or whether affective modeling in early childhood is linked to young adults' recollections of emotion socialization practices. The current study investigates emotion socialization by mothers with histories of major depression, bipolar disorder, or no mood disorder. Affective modeling was coded from parent-child interactions in early childhood and maternal responses to negative emotions were recollected by young adult offspring (n = 131, 59.5% female, M age = 22.16, SD = 2.58). Multilevel models revealed that maternal bipolar disorder was associated with more neglecting, punishing, and magnifying responses to children's emotions, whereas maternal major depression was associated with more magnifying responses; links between maternal diagnosis and magnifying responses were robust to covariates. Young adult recollections of maternal responses to emotion were predicted by affective modeling in early childhood, providing preliminary validity evidence for the Emotions as a Child Scale. Findings provide novel evidence that major depression and bipolar disorder are associated with altered emotion socialization and that maternal affective modeling in early childhood prospectively predicts young adults' recollections of emotion socialization in families with and without mood disorder.

The relationship between household chaos and child, parent, and family outcomes: a systematic scoping review

BACKGROUND

Household chaos, represented by the level of disorganisation or environmental confusion in the home, has been associated with a range of adverse child and family outcomes. This review aims to (1) identify how household chaos is measured, (2) chart study details of household chaos literature, and (3) map the existing literature with respect to the relationship between household chaos and child, parent, and family outcomes. We expect that this review will highlight the need to consider the importance of household chaos in child well-being research, particularly in those families where children may be more vulnerable to the adverse effects of household chaos.

METHODS

We searched five electronic databases (last updated September 1st 2018) in addition to Google Scholar, and identified publications via a 3-stage screening process, which was conducted by two researchers. Published studies were included if they investigated the association between household chaos and child, parent, or family outcomes. Research that investigated household chaos as a mediator or moderator, or that investigated how the relationship between household chaos and the outcome of interest was mediated or moderated, were also included.

RESULTS

One hundred twelve studies in 111 publications were included. The majority were conducted in the United States (n = 71), and used either cross-sectional (n = 60) or longitudinal (n = 49) study designs. Outcomes of interest were categorised into seven categories: (1) cognitive and academic (n = 16), (2) socio-emotional and behavioural (n = 60), (3) communication (n = 6), (4) parenting, family, and household functioning (n = 21), (5) parent outcomes (n = 6), (6) hormone (n = 8), and (7) physical health and health behaviours (n = 19). There was consistent evidence for significant correlations between household chaos and adverse outcomes across all seven categories in diverse populations with respect to age, disease status, and socio-economic status (SES).

CONCLUSION

There is consistent evidence for associations between household chaos and a number of adverse child, parent, and family-level outcomes. Household chaos may also help describe variations in outcomes between low SES and child development.

A prospective study of bipolar disorder vulnerability in relation to behavioural activation, behavioural inhibition and dysregulation of the Behavioural Activation System

Background:

The weak regulation, or “dysregulation”, of the Behavioural Activation System (BAS) is implicated in the development and recurrence of bipolar disorder. However, there has been a lack of prospective studies investigating the predictive role of BAS dysregulation in relation to bipolar-vulnerability. Furthermore, no studies have tested the prospective predictive utility of the DYS self-report measure of BAS dysregulation in an analogue sample. The goal of the current study was to redress this gap.

Methods:

Participants (n = 127) completed baseline self-report measures of mood symptoms (Internal States Scale [ISS]), the Hypomanic Personality Scale (HPS), behavioural activation, inhibition and dysregulation of BAS (BIS/BAS and DYS), and at six months, the Mood Disorders Questionnaire (MDQ).

Results:

Linear regression analysis indicated a significant main effect of BAS Dysregulation, and a significant interaction between BIS and BAS Fun Seeking, on prospective MDQ scores whilst controlling for baseline mood symptoms and HPS scores. The interaction effect indicated that the relationship between high BAS Fun Seeking and follow-up MDQ scores was strongest when BIS scores were high, whilst the lowest MDQ scores were observed for a combination of low BAS Fun Seeking and high BIS. However, DYS scores were the stronger predictor of MDQ scores compared to the BAS Fun Seeking and BIS interaction.

Conclusions:

Bipolar-vulnerability is prospectively associated with heightened BAS Dysregulation, as measured by the DYS subscale, similar to prior findings in clinical samples. Further research investigating the longer-term associations between BAS Dysregulation with the development of clinically significant bipolar mood symptoms is required.

Parenting practices in middle childhood mediate the relation between growing up with a parent having bipolar disorder and offspring psychopathology from childhood into early adulthood

The offspring of parents with bipolar disorder (OBD) are at high risk for developing mental disorders. In addition to genetic factors, environmental risk is purported to be associated with these negative outcomes. However, few studies have examined this relation. Using concurrent and longitudinal data, we examined if support, structure, and control provided by parents in middle childhood mediated the relation between having a parent with or without bipolar disorder, and offspring mental health. The sample included 145 offspring (77 OBD, 68 controls) aged 4 to 14 years and their parents. Parent and teacher ratings of child behavior were collected, and diagnostic assessments were conducted in offspring 12 years later (n = 101). Bootstrapping analyses showed that low levels of structure mediated the relation between having a parent with bipolar disorder and elevated internalizing and externalizing difficulties during middle childhood. For the longitudinal outcomes, parental control emerged as the strongest mediator of the relation between parents’ bipolar disorder and offspring psychopathology. Suboptimal childrearing may have different immediate and enduring consequences on mental health outcomes in the OBD. Parental structure has robust effects on emotional and behavioral problems in middle childhood, while levels of control promote psychological adjustment in the OBD as they mature.

Web-based integrated bipolar parenting intervention for parents with bipolar disorder: a randomised controlled pilot trial

BACKGROUND

People with bipolar disorder (BD) experience additional parenting challenges associated with mood driven fluctuations in communication, impulse control and motivation. This paper describes a novel web-based self-management approach (Integrated Bipolar Parenting Intervention; IBPI) to support parents with BD.

METHOD

Parents with BD with children aged 3-10 years randomised to IBPI plus treatment as usual (TAU) or waitlist control (WL). IBPI offered 16 weeks access to interactive self-management information concerning BD and parenting issues. Feasibility was through recruitment, retention and web usage. Clinical outcomes were assessed at baseline, 16, 24, 36 and 48 weeks.

TRIAL REGISTRATION NUMBER

ISRCTN75279027.

RESULTS

Ninety seven participants were recruited with 98% retention to end of intervention and 90% to final follow-up (56%-94% data analysed of retained participants; higher rates for observer measures). 77% of IBPI participants accessed the website (53% accessed parenting modules). Child behaviour, parenting sense of competence and parenting stress improved significantly in IBPI compared to WL to end of intervention, sustained to 48 weeks. Impacts of IBPI on family functioning, parent mood and time to mood relapse were not significant.

CONCLUSIONS

Online self-management support for parents with BD is feasible, with promising improvements in parenting and child behaviour outcomes. A definitive clinical and cost-effectiveness trial is required to confirm and extend these findings.

Paternal Mental Health: Why Is It Relevant?

Father's mental health is an emerging area of interest that is beginning to be recognized in research, and to a lesser extent in clinical practice and society. Fathers are part of a parenting dyad with 2 partners who are responsible for their children's emotional development. Similar to mothers, the risk for mental health problems increases once a male becomes a father, but there is limited research examining this issue. The purpose of this review is to present the available literature on father's mental health and its effect on child emotional health through various mechanisms. In general, father's mental health was found to be related to increased child internalizing and externalizing behaviors, but each disorder had different risk factors, and a unique effect on parenting behaviors and the child's emotional health. The most developed paternal mental health literature is focused on depression. However, key conceptual and methodological problems exist that may limit our understanding of paternal depression. Additionally, the focus on paternal depression may not accurately represent the largest risk for paternal psychopathology and the resultant child mental health outcomes because men have an increased likelihood of displaying externalizing behaviors. Implications for research, clinical practice, and policy are discussed.

Sexual Risk Behaviors in the Adolescent Offspring of Parents with Bipolar Disorder: Prospective Associations with Parents' Personality and Externalizing Behavior in Childhood

We recently reported that adolescent and young adult offspring of parents with bipolar disorder (OBD), relative to control offspring, were more likely to engage in sexual risk behaviors (SRBs). The present prospective study aimed to determine the contribution of parents' personality and offspring behaviour problems in middle childhood to offspring SRBs 10 years later. We hypothesized that offspring externalizing problems in childhood would mediate the relationship between parents' personality traits of neuroticism and agreeableness and adolescent SRBs. Furthermore, we expected these associations to be more robust among the OBD than controls. At baseline, 102 offspring (52 OBD and 50 controls) aged between 4 and 14 years were assessed along with their parents, who completed a self-report personality measure and child behavior rating. Behaviour ratings were also obtained from the children's teachers. Ten years later the offspring completed an interview assessing SRBs. Mediation analyses using bootstrapping revealed that, after controlling for age and presence of an affective disorder, externalizing behaviors served as a pathway through which high parental neuroticism, low parental agreeableness, and low parental extraversion were related to SRBs in offspring. Moderated mediation analyses revealed that the relationship between parental neuroticism and childhood externalizing problems was stronger for OBD than controls. These findings add to our previous results showing parents' personality contributes to intergenerational risk transfer through behavioral problems in middle childhood. These results carry implications for optimal timing of preventative interventions in the OBD.

Bipolar disorder and parental psychopathology

PURPOSE

Few population-based studies have examined the association between parental psychopathology and bipolar disorder (BPD) in offspring. One limitation is lack of control for potential confounding by indicators of parental socio-economic status or maternal smoking during pregnancy. Furthermore, none of them included analyses restricted to parental diagnoses received prior to the birth of the offspring. Associations could not be affected by child-related factors affecting the parent in such analyses. This study explores associations between those parental psychiatric disorders diagnosed at any point of time as well as those diagnosed before offspring birth, and BPD in offspring.

METHODS

In this nested case-control study, we identified 1,861 cases, age up to 25 years, 3,643 matched controls, and their parents from Finnish national registers. The associations were examined using conditional logistic regression, calculating odds ratios (OR) and adjusting for region of birth, parental age and education and mother's smoking during pregnancy.

RESULTS

Anytime diagnosed parental disorders associating with BPD in offspring (95% confidence interval) were BPD [OR (maternal) 5.2 (2.52-10.62); OR (paternal) 8.1 (3.77-17.26)], schizophrenia and related psychoses [OR (maternal) 3.1 (1.69-5.84); OR (paternal) 4.5 (1.97-10.27)], other affective disorders [OR (maternal) 3.0 (2.08-4.21); OR (paternal) 3.0 (1.97-4.47)] and maternal anxiety disorders OR 2.6 (1.08-6.42). Statistically significant associations were also found for parental schizophrenia and related psychoses, and other affective disorders, diagnosed before offspring birth.

CONCLUSIONS

BPD is associated with many parental psychiatric disorders, particularly BPD and schizophrenia and related psychoses. The associations must be partially due to child-independent factors. Covariate adjustments had only a minor impact on the associations.

Exploring psychosis and bipolar disorder in women: a critical review of the qualitative literature

BACKGROUND

The experiences of women with severe mental illness warrant particular consideration to identify the strategies they use to facilitate recovery. This review systematically examined women's experiences of psychosis and bipolar disorder.

METHODS

Following an extensive database search, 13 studies met inclusion criteria. Noblit and Hare's metasynthesis approach was used to synthesise these qualitative studies exploring the experiences of 250 women, of which 78 (31.2%) were also mothers.

RESULTS

Twelve sub-ordinate themes were identified and categorised into three overarching themes: 1) women's beliefs about illness, 2) perceived consequences of illness, and 3) strategies used to cope with illness. Contextual factors and spiritual beliefs were found to be important in these women's illness appraisals. Women incorporated diagnosis-related information into illness models if it was concordant with their existing beliefs.

CONCLUSIONS

Women reported negative illness consequences relating to stigma, loss of self-determination and changes to relationships. They employed various strategies in order to cope with illness. Barriers to strategy use and clinical recommendations are presented.

Parenting with bipolar disorder: coping with risk of mood disorders to children

Children of individuals with bipolar disorder (BPD) have increased risk for mood disorders and other adverse psychosocial outcomes due to genetic and environmental risk. Though parents with BPD are aware of increased risk to children, little is known about efforts undertaken in response or their perceived utility. Among parents who self-report with BPD, this study identifies key variables associated with parental coping with children's risk of mood disorders; and explores the relationship between monitoring children's moods and perceived coping efficacy. In this U.S. study, active parental coping with, and cognitive distancing from, child's risk were measured using novel scales. Parents (n = 266) who self-identified as having BPD completed a web-based survey. They had at least one unaffected child. Most participants endorsed monitoring their children's moods. Monitoring was associated with increased perceived control over the child's well-being (p < 0.005), but not feeling less worried. Active parental coping with risk to children was positively associated with active coping with own illness (β = 0.25, p = 0.001), family history (β = 0.24, p = 0.001), and self-report of current depression (β = 0.16, p = 0.037), explaining 13.8% of the variance (F = 8.81, p < 0.001). Cognitive distancing from the child's risk was positively associated with confidence in diagnosis (β = 0.25, p = 0.001), and negatively associated with self-report of current mania (β = -0.19, p = 0.007), perceiving BPD as genetic (β = -0.26, p < 0.001) and having more children (β = -0.20, p = 0.004); explaining 16.2% of the variance (F = 8.63, p < 0.001). Parents' adaptation to their own BPD was modestly correlated with active coping with child's risk (r = 0.15, p < 0.05) but not with cognitive distancing. The findings support the importance of understanding causal attributions and the value of genetic education and counseling for parents with BPD. Further research is necessary to elucidate the psychological benefits of active coping versus cognitive distancing from child's risk, and explore additional variables that predict parental coping with children's risk of mood disorders.