Sustaining efforts to improve family well-being with parents with mental ill health and substance (mis)use

Research conducted over the past 30 years has developed an extensive body of knowledge on families where parents experience mental ill health and/or substance (mis)use, and interventions that are effective in improving their outcomes. A more recent focus has also explored the importance and nuance of implementation. This perspective article reflects on the concept and practice of sustainability within this body of work and considers underlying assumptions in the field about the goal and direction of interventions that make clarity about sustainability difficult. We identify challenges for understanding sustainability, relating to how and who defines it, what is measured and the impact of context. We conclude by considering how we might be better able to plan and design for sustainability within this field.

Acceptability, engagement and exploratory outcomes and costs of a co-designed intervention to support children of parents with a mental illness: Mixed-methods evaluation and descriptive analysis

Children whose parents have a mental illness are much more likely to experience mental health problems and other adverse long-term impacts. Child-centred psychosocial interventions can be effective, but not much is known about how to design and implement them in different settings. A pre-post, mixed methods, single-arm evaluation of a co-designed social support intervention with parents and children (4-18 years) measured parents' mental health (PHQ-9), perceived social support (ENRICHD), parental self-efficacy (PSAM) and children's mental health (SDQ), quality of life (Kidscreen-27), and child service use (CAMHSRI-EU) at baseline and 6 months. Qualitative data were gathered at 6 months to explore parents' and children's experience with the intervention. Twenty-nine parents and 21 children completed baseline and follow-up questionnaires; 22 parents and 17 children participated in interviews. Parents' depression (MD -1.36, SD 8.08), perceived social support (MD 1, SD 5.91), and children's mental health potentially improved, and children's service use and costs potentially reduced (€224.6 vs. €122.2, MD 112.4). Parental self-efficacy was potentially reduced (MD -0.11, SD 3.33). The sample was too small to perform statistical analysis. Favourable themes emerged describing the high satisfaction with the intervention, parents' improved understanding of the impact of their mental health problems on children, and improvements in parent-child relationships. This study contributes to an emerging evidence base for co-designed child-centred interventions to prevent the transgenerational transmission of poor mental health.

Disentangling the trajectories of maternal depressive symptoms and partnership problems in the transition to parenthood and their impact on child adjustment difficulties

Maternal perinatal depression (PND) and partnership problems have been identified to influence the development of later child adjustment difficulties. However, PND and partnership problems are closely linked which makes it difficult to draw conclusions about the exact transmission pathways. The aim of the present study was to investigate to what extent PND symptoms and partnership problems influence each other longitudinally and to examine the influence of their trajectories on child adjustment difficulties at the age of three. Analyses were based on publicly available data from the German family panel "pairfam". N = 354 mothers were surveyed on depressive symptoms and partnership problems annually from pregnancy (T0) until child age three (T4). Child adjustment difficulties were assessed at age three. Results of latent change score modeling showed that partnership problems predicted change in PND symptoms at T0 and T3 while PND symptoms did not predict change in partnership problems. Child adjustment difficulties at age three were predicted by PND symptoms, but not by partnership problems. Partnership problems predicted externalizing, but not internalizing symptoms. Results underline the effects of family factors for the development of child adjustment difficulties and emphasize the importance of early interventions from pregnancy onwards.

Family dynamics, trauma, and child-related characteristics: examining factors associated with co-occurring mental health problems in clinically-referred children with and without an intellectual (and developmental) disability

Psychiatric disorders are common in youth with intellectual and developmental disabilities. This is a vulnerable group of children whose behavioural problems often have more complicated care needs than other children, which can place a great deal of stress on their families. However, the association of family mental health issues, level of intellectual ability, and diagnostic co-morbidity in children is relatively under-studied. In the present study, we investigated the relationship among child diagnoses, family mental health problems, risk for self-injury, and disruption in care among children with (N = 517) and without (N = 517) intellectual and developmental disabilities. A negative binomial regression showed that mental health problems in multiple family members, self-injurious behaviour, and self-reported abuse/trauma was related to greater likelihood of provisional diagnoses of co-occurring psychiatric disorders in both a clinically referred sample and a sample with IDD. Implications for care-planning are discussed.

The Long-Term Impact of Maternal Anxiety and Depression Postpartum and in Early Childhood on Child and Paternal Mental Health at 11-12 Years Follow-Up

BACKGROUND

Postpartum maternal anxiety and depression can affect child development and family functioning. However, the long-term impact of postpartum maternal anxiety and depression on child and paternal mental health is understudied. The present large-scale prospective cohort study is one of the first to investigate whether maternal anxiety and depressive symptoms postpartum and at child age 5-6 years separately and synergistically increase paternal anxiety and depressive symptoms and child emotional problems in early adolescence at age 11-12 years. Secondly, we investigated whether concurrent paternal anxiety and depressive symptoms at child age 11-12 years moderated the association between maternal anxiety and depressive symptoms in the postpartum period and at child age 5-6 years with child emotional problems at age 11-12 years.

METHODS

This study is part of the Amsterdam Born Children and Development (ABCD) cohort study, the Netherlands (N = 2.298). Maternal postpartum anxiety and depressive symptoms were assessed using the State-Trait Anxiety Inventory (STAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) at 13 weeks postpartum. Maternal anxiety and depressive symptoms at child age 5-6 years and parental anxiety and depressive symptoms at 11-12 years were assessed using the Depression Anxiety Stress Scale (DASS-21). Child emotional problems were reported by the child and a teacher using the Strengths and Difficulties Questionnaire (SDQ). Multivariable linear regression was conducted, adjusted for demographic, perinatal/obstetric confounders, and affective symptoms of the other family members at 11-12 years.

RESULTS

Neither maternal anxiety nor depressive symptoms were related to paternal depressive symptoms at child age 11-12 years, while maternal postpartum depressive symptoms, depressive symptoms at 5-6 years and maternal anxiety at 5-6 years were positively related to paternal anxiety at 11-12 years. However, effect sizes were small. Only maternal postpartum depression was positively but weakly associated with more child emotional problems at 11-12 years. Although paternal concurrent affective symptoms were positively related to more child emotional problems in early adolescence, they did not moderate the association between maternal symptoms and child emotional problems.

CONCLUSIONS

Our results indicate that fathers and children seem to be affected only to a small extent by maternal postpartum anxiety or depression.

A Narrative Inquiry Into Global Systems Change to Support Families When a Parent Has a Mental Illness

The issues that confront families when a parent experiences mental illness are complex. This often means that multiple service systems must be engaged to meet families' needs, including those related to intergenerational experiences of mental health and illness. A multisystem approach to public mental health care is widely recommended as a form of preventative intervention to address the effects of mental illness and its social, psychological, and economic impact upon parents, children, and families. Globally, a multisystemic approach to care requires a change in the way systems are currently organized to support families, as well as the way systems are interacting with families, and with each other. This qualitative secondary analysis emerged from a primary study examining global systems change efforts to support families, including components of change that were common and considered successful in different countries. A narrative inquiry method was used to re-analyze the data by compiling the stories of change described by individuals from participant countries. The data were interrogated to ask questions about story content, and to identify who was telling the story and how they described important changes across different geographical and cultural contexts. The individual stories of 89 systems change experts from 16 countries were then compiled into a shared global narrative to demonstrate international progress that has occurred over time, toward multisystemic change to support families where parents experience mental illness. While the global narrative demonstrates considerable overlap between pathways toward change, it is also important to document individual stories, as change pertains differently in different contexts. The individual stories and the global narrative illustrate how countries begin a journey toward change at different time points and may have various outcomes in mind when they commence. Study findings raise questions about the extent to which systems change can be standardized across countries that have unique social, cultural, political, and economic features. This study provides several potential points of reference for countries considering, or currently undertaking systems change to support families where a parent has a mental illness. It also provides an important story about international efforts undertaken to improve outcomes for families.