Kinder psychisch erkrankter Eltern

Clinical- and Cost Effectiveness of a Guided Internet-Based Intervention for Children (12–18 Years) of Parents With Mental Disorders (iCHIMPS): Study Protocol of a Multicentered Cluster-Randomized Controlled Trial

Introduction

Children of parents with mental disorders have a high chance of developing a mental disorder themselves. However, this at-risk group is regularly overlooked and typically not seen by any mental health professionals. Internet- and mobile-based interventions (IMIs) can provide a means of promoting mental health for children of parents with mental disorders.

Objective

The introduced study will evaluate the clinical- and cost-effectiveness of the iCHIMPS IMI in promoting mental health for children of parents with mental disorders.

Methods

A two-armed multicentered cluster-randomized controlled trial (cRCT) comparing the clinical- and cost-effectiveness of the iCHIMPS IMI in the intervention group (IG) to a treatment-as-usual (TAU) control group will be conducted. Recruitment will be handled at currently 21 adult mental health clinics throughout Germany. Participating families will be randomly divided into the two groups until the final sample size of 306 participating adolescents (age 12–18) has been reached. The adolescents in the intervention group will receive access to the IMI and can take part in up to eight intervention modules. Assessment will be conducted during the recruitment (baseline), 1-month, 2-months, and 6-month post-inclusion. Primary outcome is the mental health of the participating adolescents at 6-months post-inclusion as measured by the Youth Self Report score. Secondary self-report outcomes are mental wellbeing, self-efficacy, coping strategies and negative effects as well as mental health of the adolescents as reported by their parent(s). Included moderators are sociodemographic characteristics, working alliance, social support and the mental health diagnoses of the parents. Statistical analyses will be conducted on the intention-to-treat principle as well as with additional per-protocol analyses. Additionally, the cost-effectiveness as well as qualitative data concerning the adherence, acceptance, and feasibility of the IMI will be analyzed.

Discussion

The iCHIMPS cRCT examines the clinical- as well as cost-effectiveness of the iCHIMPS mental health promotion IMI for children of parents with mental disorders. This provides the opportunity to gain insights into an innovative as well as time- and location-independent form of support for this often-overlooked at-risk group. Additionally, the larger CHIMPS-NET project allows comparisons between internet-based and face-to-face interventions for a similar target group.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier: DRKS00025158.

Parental mental illness and their offspring's mental health in Rwanda: neuropsychiatric hospital of Rwanda

BACKGROUND

Offspring of the parents with mental disorders are at higher risk to have the mental diseases throughout the world. This study examined the association between psychopathology of parents and the mental health of their offspring in Neuropsychiatric Hospital of Rwanda, Butare Branch.

METHODS

A cross-sectional study made up of case and control offspring was conducted on the case group made up of 80 offspring born to parents with mental diseases and a control group of 80 offspring from parents without mental disease. Hamilton Rating Scale for Depression (HRSD, α = 0.82), Posttraumatic stress disorders scale (PTSD, α = 0.73) and the Test of Psychological Problems (TPP, α = 0.93) were used. STATISTICA version 8 was used for statistical analysis.

RESULTS

Results indicated a significance difference between the two groups on depressive symptoms, psychological problems and PTSD symptomatology. The case group seemed to experience high level symptoms than the control group. Results indicated that, among the offspring born to parents with mental disease, there was a significant correlation between anxiety and depression symptoms (r = 0.71, p < .001), PTSD and eating disorder (r = 0.75, p < .001), domestic violence and PTSD (r = 0.78, p < .001), aggressive behavior and PTSD (r = 0.79, p < .001), somatoform disorders and PTSD (r = 0.98, p < .001). No significant association between the low self-esteem, depression, anxiety, mental disorders induced drug abuse and PTSD was found.

CONCLUSION

Offspring of the parents with mental disorders had higher risk to develop mental diseases than the offspring born to the parents without mental diseases. Taking into account the assessment of parents' mental illness when taking care of the offspring's psychological disorders is needed in the neuropsychiatric hospital.

[Preventive and therapeutic interventions for children of mentally ill parents]

Preventive and therapeutic interventions for children of mentally ill parents Abstract. The risk of developing mental disorders increases markedly in children of mentally ill parents. Several risk factors have been identified and become possible targets of preventive and therapeutic interventions. Numerous studies investigated the efficacy of these interventions, which are very heterogeneous regarding content and methodology. One part of these studies focuses on infants of depressed and substance-addicted mothers; the other part focuses on children and adolescents of parents suffering from various mental disorders. Today, we have several meta-analyses at our disposal which yielded small effect sizes concerning the development of psychological symptoms or disorders in these affected children. The current review reveals a lack of high-quality studies, and analyses on cost-effectiveness are also needed. The preventive and therapeutic interventions now available show inadequate efficacy to effectively improve the situation of these children and adolescents. Future research is needed to develop and implement cost-effective interventions as well as high-quality studies to investigate the efficacy of these interventions.

[Supporting Interventions for Families with Children of Mentally Ill Parents: An Overview of Family-Oriented Complex Interventions in German-Speaking Countries]

OBJECTIVE

The aim of the present review was to identify all outpatient, family-oriented complex interventions for children of mentally ill parents known in the German-speaking countries on the basis of defined minimum requirements and to give an overview of their structure, content and proof of effectiveness.

METHODOLOGY

The interventions were identified by means of internet and literature research. If the defined criteria were met, the providers were contacted and asked to participate in a written survey.

RESULTS

A total of 512 offers could be identified, 46 of which were to be classified as family-oriented complex interventions. Only a few interventions have been systematically evaluated so far.

CONCLUSION

There is a large number of interventions for the children of mentally ill parents, but family-oriented complex interventions are rare. There is also a considerable need for evaluation studies.

Risikofamilien

Zusammenfassung. Risikofamilien weisen häufig eine Vielzahl an Problemen, wie etwa Armut, einen geringen Bildungsstand, Paarkonflikte oder die Erkrankung eines Elternteils, auf, die in ihrer Kumulation und ihrer Wechselbeziehung eine hohe Belastung für alle Familienmitglieder darstellen. Kinder, die unter diesen schwierigen Lebensumständen aufwachsen, haben ein erhöhtes Risiko für Entwicklungs- und Verhaltensauffälligkeiten bzw. psychische Störungen. Entsprechend gilt es, Risiken innerhalb einer Familie frühzeitig zu erkennen. Die Kenntnis von familiären Ressourcen und ihre gezielte Stärkung sollten dabei ein unverzichtbarer Bestandteil der Intervention sein, um Familien bei der Bewältigung von Problemlagen zu unterstützen.

Tuning in to Kids

Zusammenfassung. Es wird eine deutsche Version des Elterntrainings Tuning in to Kids vorgestellt. Das Training zielt über die Förderung elterlicher Strategien zur Emotionssozialisation auf eine Verbesserung kindlicher emotionaler Kompetenzen ab und kombiniert kognitiv-verhaltenstherapeutische Prinzipien mit einem emotionsfokussierten Ansatz. In einer kontrollierten Pilotstudie mit Prä-Posttest-Design (TG: n = 41, KG: n = 30; Alter der Kinder: 3 – 6 Jahre) wurden durch das Training nicht-supportive emotionsbezogene Überzeugungen und Reaktionen auf kindliche Emotionen reduziert sowie supportive Überzeugungen und Reaktionen aufgebaut. Für verschiedene Maße des emotionalen Familienklimas zeigten sich tendenziell positive Effekte. Trotz der Vorläufigkeit der Befunde sprechen die Ergebnisse für eine gute Trainierbarkeit elterlicher Strategien zur Emotionssozialisation und einen stärkeren Einbezug in Prävention und Intervention.

Profitieren psychisch erkrankte Eltern und psychisch belastete Kinder von einer gemeinsamen Eltern-Kind-Behandlung?

Zusammenfassung. Es wird überprüft, ob die Teilnahme am Gruppenprogramm SEEK (Seelische Erkrankungen, Eltern und Kinder) für psychisch erkrankte Eltern im Rahmen einer stationären Eltern-Kind-Behandlung kurz- und längerfristige additive Behandlungseffekte erbringt hinsichtlich psychischer Symptome der Eltern (erfasst mit der Hopkins-Symptom-Checkliste-25; HSCL-25), der elterlichen Stressbelastung (erfasst mit dem Eltern-Belastungs-Inventar; EBI) sowie psychischer und körperlicher Symptome des Kindes (erfasst mit der Child Behavior Checklist; CBCL). Die Vergleichsgruppe (n = 11), die das übliche Behandlungsprogramm durchlief, und die Interventionsgruppe (n = 15), die zusätzlich an SEEK teilnahm, werden zu drei Messzeitpunkten (t1 bei Aufnahme, t2 bei Entlassung und t3 sechs Monate nach Entlassung) miteinander verglichen. Additive Effekte des Gruppenprogramms können bei dieser Untersuchung im umfangreichen stationären Behandlungssetting nicht belegt werden. Beide Gruppen erscheinen (mit Ausnahme zweier CBCL-Skalen im t1-t2-Vergleich) vergleichbar bezüglich ihres Behandlungserfolgs. Es zeigen sich sowohl kurzfristige Effekte als auch längerfristig stabile Effekte der stationären Eltern-Kind-Behandlung im 6-Monats-Follow-Up.

Secure attachment style appears to compensate for the effect of prenatal maternal distress regarding difficult infant temperament development

Objective: Secure attachment style is a known protective factor regarding psychopathological development. The infant's attachment style, which is developed during the first two years of life, is therefore considered a moderating factor on the association between prenatal maternal distress and child temperament development which has repeatedly been reported in previous studies. Method: In this longitudinal study on a new sample of 51 mother-child-dyads, reported maternal distress and maternal empathy were assessed during pregnancy. Infant temperament and motor development were assessed at 12 months, while additionally controlling for the infant's attachment style as a postnatal factor. Results: Infants with secure attachment style whose mothers had experienced higher prenatal distress showed slightly better gross motor development at the age of 12 months. No association could be found between prenatal maternal distress and infant temperament. Conclusions: The results support the view that secure attachment style in children is a protective factor and softens the effects of prenatal maternal distress on difficult temperament development.

Predictors of health-related quality of life in children with chronic heart disease

OBJECTIVE

Chronic paediatric heart disease is often associated with residual symptoms, persisting functional restrictions, and late sequelae for psychosocial development. It is, therefore, increasingly important to evaluate the health-related quality of life of children and adolescents with chronic heart disease. The aim of this study was to determine medical and socio-demographic variables affecting health-related quality of life in school-aged children and adolescents with chronic heart disease. Patients and methods The Pediatric Cardiac Quality of Life Inventory was administered to 375 children and adolescents and 386 parental caregivers. Medical information was obtained from the charts. The socio-demographic information was provided by the patients and caregivers.

RESULTS

Greater disease severity, low school attendance, current cardiac medication, current parental employment, uncertain or limited prognosis, history of connection to a heart-lung machine, number of nights spent in a hospital, and need for treatment in a paediatric aftercare clinic independently contributed to lower health-related quality of life (self-report: R2=0.41; proxy-report: R2=0.46). High correlations between self-reports and parent-proxy reports indicated concordance regarding the evaluation of a child's health-related quality of life.

CONCLUSIONS

Beyond medical treatment, integration into school is important to increase health-related quality of life in children and adolescents surviving with chronic heart disease. Regular screening of health-related quality of life is recommended to identify patients with special needs.

Elterliche Emotionsdysregulation als Risikofaktor für die kindliche Entwicklung

Zusammenfassung. Emotionsregulation ist eines der zentralen Themen der Entwicklungspsychopathologie. Der überwiegende Anteil an Forschungsarbeiten widmet sich der Frage zur Entwicklung von Emotionsregulation, welche als zentrale Entwicklungsaufgabe im Kindesalter erachtet wird. Die Herausbildung einer altersangemessenen Emotionsregulation besitzt eine entscheidende Bedeutung für die psychische Gesundheit und dem späteren Schulerfolg eines Kindes. Obwohl die elterliche Emotionsregulation als ein zentraler Aspekt des Erziehungsverhaltens verstanden wird, ist noch immer nicht hinreichend geklärt, wie Eltern ihre eigenen Gefühle im Erziehungskontext regulieren. Dieser Beitrag bietet einen Überblick zum aktuellen Forschungsstand zu den Auswirkungen einer elterlichen Emotions(dys)regulation auf familiäre Prozesse der kindlichen Emotionsregulation und den Entwicklungsergebnissen des Kindes. Empfehlungen für die klinische Praxis werden diskutiert.