Parental Illness Research Articles

Using State Administrative Data to Identify Social Complexity Risk Factors for Children.

Screening for social determinants of health is challenging but critically important for optimizing child health outcomes. We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to emergency department (ED) use. We conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367). We linked child and parent administrative data for this cohort to identify a set of social complexity risk factors, such as poverty and parent mental illness, that have either a known or hypothesized association with suboptimal health care use. Using multivariate analyses, we examined associations of each risk factor and of number of risk factors with the rate of ED use. Nine of 11 identifiable social complexity risk factors were associated with a higher rate of ED use. Additionally, the rate increased as the number of risk factors increased from 0 to 5 or more, reaching approximately twice the rate when 5 or more risk factors were present in children aged younger than 5 years (incidence rate ratio = 1.92; 95% CI, 1.85-2.00) and in children aged 5 to 17 years (incidence rate ratio = 2.06; 95% CI, 1.99-2.14). State administrative data can be used to identify social complexity risk factors associated with higher rates of ED use among Medicaid-insured children. State agencies could give primary care medical homes a social risk flag or score to facilitate targeted screening and identification of needed resources, potentially preventing future unnecessary ED use in this vulnerable population of children.

Population attributable fractions of psychopathology and suicidal behaviour associated with childhood adversities in Northern Ireland

Childhood adversities are strong predictors of psychopathology and suicidality. However, specific adversities are associated with different outcomes, with cross-national variations reported. The current study examined rates of adversities reported in Northern Ireland (NI), and associations between adverse childhood experiences and psychopathology and suicidal behaviour were explored. Data was obtained from the Northern Ireland Study of Health and Stress (NISHS), conducted as part of the World Mental Health (WMH) survey initiative (2004–2008); response rate 68.4% (n = 1,986). The on-line survey used, the WHO Composite International Diagnostic Interview (CIDI) to examine psychopathology and associated risk factors in the NI population. Prevalence rates of retrospectively reported childhood adversities were calculated, with gender and age variations explored. Females were more likely to experience sexual abuse. Individuals who grew up during the worst years of the civil conflict in NI experienced elevated levels of childhood adversities. Participants who endured childhood adversities were more likely to have mental health problems but variations in risk factors were found for different disorders. Parental mental illness was associated with all disorders however, with ORs ranging from 2.20 for mood disorders to 4.07 for anxiety disorders. Population attributable fractions (PAF) estimated the reduction in psychopathology and suicidal behaviour in the population if exposure to adverse childhood events had not occurred. The highest PAF values were revealed for parental mental illness and sexual abuse. The findings indicate that a substantial proportion of psychopathology and suicide risk in NI are attributable to childhood adversities, providing support for early intervention and prevention initiatives.

Parental Mental Illness: Cross-Sectional Analysis Of Family Focused Practice within the Early Childhood Sector

During the preschool years (3–5 years), children living with parental mental illness are more at risk of various adverse developmental outcomes, compared to other children. Early childhood services are opportune settings for prevention and early intervention strategies that may support preschool children living with parental mental illness. However, there is limited research examining how the early childhood sector supports the child, parent and family. The aim of the study was to explore family focused practices within the early childhood sector in terms of the level of self-perceived knowledge, skill and confidence; and compare the self-perceived knowledge, skill and confidence between preschool teachers and childcare workers. A sample of 40 preschool teachers and 39 childcare providers rated themselves across eight domains that describe their knowledge, confidence and skill using the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Overall, the sample rated themselves positively across all domains. In a cross-sectional analysis, a t-statistic comparison of preschool teachers and childcare providers showed that childcare providers scored significantly higher than preschool teachers in parenting support, referrals and assessing the impact of parental illness on the child. Future studies might identify the barriers and enablers for Family Focus Practice (FFP) across different groups of workers in the early childhood sector.

Coping with Parental Mental Illness – An Everyday Battle

Coping with Parental Mental Illness – An Everyday Battle

School performance from primary education in the adolescent offspring of parents with schizophrenia and bipolar disorder- a national, register-based study.

Schizophrenia (SZ) and bipolar disorder (BP) are causes of severe disability worldwide and parents' severe mental illness (SMI) is associated with childhood adversity, and socio-emotional and cognitive problems in children. Yet, how parental BP and SZ affect educational attainment in offspring is still unclear. We included all children (N = 684.248) born and living in Denmark between 1986 and 1996 and their parents. Our follow-up lasted from 1986 until children's graduation in 2014. The main outcome variable was their school grades following their primary education. School outcomes were divided into four categories: not graduated, low-grade point average (GPA), medium GPA and high GPA. We then performed a multiple logistic regression with medium GPA as the reference category, with the children of parents without SZ or BP as the reference group. Children of parents with SZ faced higher odds than their peers of not graduating primary education (OR 2.6), along with low GPA (odds ratios (OR) 1.6) and lower odds for a high GPA (OR 0.7). Moreover, it was the children of mothers rather than fathers with BP who had higher odds of not graduating primary education (OR 1.6). Lastly, child placement was associated with lower grades and lower graduation rates, and outcomes for children of parents with SMI were favorable compared with other children placed in care. For children, parental SZ is associated with lower grades and lower chances for graduating primary education. In contrast, the children of parents with BP were indistinguishable from the reference group regarding school grades. This signifies that specificity of parental severe mental illness is important in relation to educational achievement of children.

Adult children of parents with mental illness: Dehumanization of a parent - 'She wasn't the wreck in those years that she was to become later'.

Children who have lived with parental mental illness experience long-standing reduced health and social outcomes, alongside ongoing personal distress. While there has been some dialogue regarding interventions to support children who are living with parental mental illness, there remains a paucity of knowledge regarding adult children's experiences and potential needs. Given this, the aim of the present study was to establish parenting narratives of adult children who had experienced childhood parental mental illness. This included their experiences of being parented alongside their own subsequent parenting roles. Three men and 10 women, ranging from 30 to 78years old, met individually with a researcher to tell their stories. Narratives were thematically analysed to establish themes. The findings of the study demonstrated that individuals who have lived with childhood parental mental illness dehumanized their parent with mental illness. The authors argue that all mental health services should be underpinned with a whole of family assessment and care philosophy. There is also a need for all mental health services to consider how policies and procedures might inadvertently dehumanize clients who are parents, which could contribute to familial dehumanization. This could prevent the dehumanization of parents who experience mental illness to preserve parental and child relationships.

How do Australian adult mental health clinicians manage the challenges of working with parental mental illness? A phenomenological study

AbstractAdult mental health clinicians face a range of challenges that hinder their use of family‐focused practices when working with consumers who are parents. The purpose of this study was (a) to examine clinicians' experiences when working with parents and (b) identify strategies they found to be effective when working with parents. Eleven Australian mental health clinicians were recruited who regularly worked with consumers who are parents. Semistructured interviews were conducted within a qualitative paradigm and analysed using interpretative phenomenological analysis. Themes were identified which related to (a) managing sensitive parenting conversations, (b) making decisions about child safety in unclear or unpredictable situations, and (c) working with child protection services. Participants had developed strategies for managing the challenges of the first two practice issues and suggested organizational changes that could facilitate collaboration with child protection services. The findings highlight that the challenges of working with parents with mental health issues cannot be addressed with a one‐size‐fits‐all approach. Initiatives to facilitate the effective support of parents and their children need to be informed by contextual factors, including clinical practice.

Enhancing Family Communication in Families Where a Parent has a Mental Illness

In this brief we will discuss the <strong>Think Family-Whole Family Programme</strong>, which differs from other interventions by putting a central focus on fostering effective communication within families. This can enhance families’ understanding of parental mental illness (PMI) and how it affects behavior and relationships, help families jointly set goals for recovery, and enable more supportive interactions among family members. A Spanish translation of this publication is available to download under "Additional Files".

Adverse life events increase risk for postpartum psychiatric episodes: A population-based epidemiologic study.

Trauma histories may increase risk of perinatal psychiatric episodes. We designed an epidemiological population-based cohort study to explore if adverse childhood experiences (ACE) in girls increases risk of later postpartum psychiatric episodes. Using Danish registers, we identified women born in Denmark between January 1980 and December 1998 (129,439 childbirths). Exposure variables were ACE between ages 0 and 15 including: (1) family disruption, (2) parental somatic illness, (3) parental labor market exclusion, (4) parental criminality, (5) parental death, (6) placement in out-of-home care, (7) parental psychopathology excluding substance use, and (8) parental substance use disorder. Primary outcome was first occurrence of in- or outpatient contact 0-6 months postpartum at a psychiatric treatment facility with any psychiatric diagnoses, ICD-10, F00-F99 (N = 651). We conducted survival analyses using Cox proportional hazard regressions of postpartum psychiatric episodes. Approximately 52% of the sample experienced ACE, significantly increasing risk of any postpartum psychiatric diagnosis. Highest risks were observed among women who experienced out-of-home placement, hazard ratio (HR) 2.57 (95% CI: 1.90-3.48). Women experiencing two adverse life events had higher risks of postpartum psychiatric diagnosis HR: 1.88 (95% CI: 1.51-2.36), compared to those with one ACE, HR: 1.24 (95% CI: 1.03-49) and no ACE, HR: 1.00 (reference group). ACE primarily due to parental psychopathology and disability contributes to increased risk of postpartum psychiatric episodes; and greater numbers of ACE increases risk for postpartum psychiatric illness with an observed dose-response effect. Future work should explore genetic and environmental factors that increase risk and/or confer resilience.

Latent profiles of early developmental vulnerabilities in a New South Wales child population at age 5 years.

Detecting the early emergence of childhood risk for adult mental disorders may lead to interventions for reducing subsequent burden of these disorders. We set out to determine classes of children who may be at risk for later mental disorder on the basis of early patterns of development in a population cohort, and associated exposures gleaned from linked administrative records obtained within the New South Wales Child Development Study. Intergenerational records from government departments of health, education, justice and child protection were linked with the Australian Early Development Census for a state population cohort of 67,353 children approximately 5 years of age. We used binary data from 16 subdomains of the Australian Early Development Census to determine classes of children with shared patterns of Australian Early Development Census-defined vulnerability using latent class analysis. Covariates, which included demographic features (sex, socioeconomic status) and exposure to child maltreatment, parental mental illness, parental criminal offending and perinatal adversities (i.e. birth complications, smoking during pregnancy, low birth weight), were examined hierarchically within latent class analysis models. Four classes were identified, reflecting putative risk states for mental disorders: (1) disrespectful and aggressive/hyperactive behaviour, labelled 'misconduct risk' ( N = 4368; 6.5%); (2) 'pervasive risk' ( N = 2668; 4.0%); (3) 'mild generalised risk' ( N = 7822; 11.6%); and (4) 'no risk' ( N = 52,495; 77.9%). The odds of membership in putative risk groups (relative to the no risk group) were greater among children from backgrounds of child maltreatment, parental history of mental illness, parental history of criminal offending, socioeconomic disadvantage and perinatal adversities, with distinguishable patterns of association for some covariates. Patterns of early childhood developmental vulnerabilities may provide useful indicators for particular mental disorder outcomes in later life, although their predictive utility in this respect remains to be established in longitudinal follow-up of the cohort.

Early childhood adversities and risk of eating disorders in women: A Danish register-based cohort study.

Previous studies evaluating the association between early childhood adversities and eating disorders have yielded conflicting results. The aim of this study is to examine the association between a range of adversities and risk of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) in 495,244 women. In this nationwide, register-based cohort study, nine types of early childhood adversity (family disruption, residential instability, placement in out-of-home care, familial death, parental somatic illness, parental psychiatric illness, parental disability, severe parental criminality, and parental substance use disorder) were defined and exposure during the first 6years of life was determined. Hazard ratios for eating disorders were calculated using Cox regression. Few adversities were significantly associated with AN, and for each, the presence of the adversity was associated with lower risk for AN. BN, and EDNOS were positively associated with several types of adversities. AN rates were unchanged or reduced by up to 54% by adversities, whereas rates of BN and EDNOS were unchanged or increased by adversities by up to 49 and 89%, respectively. Our findings indicate that childhood adversities appear to be associated with an increased risk of BN and in particular EDNOS, whereas they seem to be either unassociated or associated with a decreased risk of AN.

Associations of adversity in childhood and risk factors for cardiovascular disease in mid-adulthood

Studies assessing associations of childhood psychosocial adversity (e.g. sexual abuse, physical neglect, parental death), as opposed to socioeconomic adversity, with cardiovascular disease (CVD) risk factors in adulthood are scarce. The aim of this study is to assess associations of various types of psychosocial adversity and cumulative adversity in childhood, with multiple CVD risk factors in mid-life. At study enrolment, women from the Avon Longitudinal Study of Parents and Children (N=3612) retrospectively reported: lack of maternal care, maternal overprotection, parental mental illness, household dysfunction, sexual abuse, physical and emotional abuse, and neglect in childhood. Approximately 23 years later, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, plasma glucose, insulin, triglycerides, low and high density lipoprotein cholesterol, C-reactive protein, carotid intima-media thickness (cIMT) and arterial distensibility were assessed (mean age 51 years). We examined associations of each specific type of psychosocial adversity and cumulative adversity with CVD risk factors. No specific type of psychosocial adversity was consistently associated with the CVD risk factors. There was evidence that a one standard deviation greater cumulative psychosocial adversity was associated with 0.51cm greater waist circumference (95% confidence interval [CI]: 0.02cm, 1.00cm, p=0.04) and a lower arterial distensibility, even after adjustment for age, ethnicity and childhood and adult socioeconomic position. We found no consistent evidence that any specific type of psychosocial adversity, or cumulative psychosocial adversity in childhood, is associated with CVD risk factors in adult women.

Maternal Mental Health Disorders and Reports to Child Protective Services: A Birth Cohort Study.

Background. Existing literature has documented a strong relationship between parental mental illness and child maltreatment, but little is known about the prevalence of mental illness among childbearing women. In the present study, linked administrative records were used to identify the prevalence of maternal mental health (MH) disorders documented at birth and determine the associated likelihood of maltreatment reports during infancy. Materials and Methods. Vital records for California’s 2006 birth cohort were linked to hospital discharge and Child Protective Services (CPS) records. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) billing codes from the mother’s delivery hospitalization were used to determine diagnosed maternal MH disorders for 551,232 infants born in 2006, and reports of alleged maltreatment were documented from CPS records. Vital birth records were used to control for sociodemographic factors. Finally, the associated risk of reported maltreatment during the first year of life was examined using generalized linear models. Results. Among infants in this statewide birth cohort, 2.8% were born to a mother with a documented MH disorder, of which 41.3% had documented maternal substance abuse issues versus less than 0.5% of infants born to mothers without a diagnosed MH disorder. Further, 34.6% of infants born to mothers with a MH disorder were reported to CPS within one year, and a majority of those reports were made within the first month of life (77.2%). In contrast, among children born to mothers without a MH disorder, 4.4% were reported to CPS during infancy. After controlling for sociodemographic factors, the rate of CPS reports during infancy for infants born to mothers with a MH disorder but no substance use disorder was 2.6 times that of infants born to mothers without a MH disorder (95% CI = 2.47, 2.73). Among infants born to mothers with MH and substance use disorders, the rate of CPS reports during infancy was 5.69 times that of infants born to mothers without a MH disorder (95% CI = 5.51, 5.87). Conclusions. Administrative records provide a method for identifying infants born to mothers with MH disorders, enabling researchers to track rates over time and generate population-level data to inform policy development and improve service delivery.

The Nonpecuniary Costs of Adult Morbidity: Evidence from Children in Indonesia

Using two waves (2007, 2014) of Indonesian Family Life Survey data, this paper investigates the effects of parental chronic illness on educational attainment of children in Indonesia. Studies on this nonpecuniary cost of adult morbidity are rare in the literature despite its significance in future wellbeing of people in developing countries. This paper is distinguished from existing studies in that it accounts for the duration of illness in the estimation of effects. The results show that girls with one additional year of paternal chronic illness achieve approximately 2.5 months lower educational levels than the mean educational level of their same age cohort between 2007 and 2014. In contrast, boys are unaffected by the father’s duration of chronic illness. Furthermore, this paper finds no evidence that mother’s duration of chronic illness affects educational attainment of children in Indonesia.

Adverse childhood experiences, non-response and loss to follow-up: Findings from a prospective birth cohort and recommendations for addressing missing data

Adverse childhood experiences have wide-ranging impacts on population health but are inherently difficult to study. Retrospective self-report is commonly used to identify exposure but adult population samples may be biased by non-response and loss to follow-up. We explored the implications of missing data for research on child abuse and neglect, domestic violence, parental mental illness and parental substance use. Using 15 waves of data collected over 28 years in a population-based birth cohort, the Australian Temperament Project, we examined the relationship between retrospective self-reports of adverse childhood experiences and parent- and cohort-responsiveness at other time points. We then compared prevalence estimates under complete case analysis, inverse probability-weighting using baseline auxiliary variables, multiple imputation using baseline auxiliary variables, multiple imputation using auxiliary variables from all waves, and multiple imputation using additional measures of participant responsiveness. Retrospective self-reports of adverse childhood experiences were strongly associated with non-response by both parents and cohort members at all observable time points. Biases in complete case estimates appeared large and inverse probability-weighting did not reduce them. Multiple imputation increased the estimated prevalence of any adverse childhood experiences from 30.0% to 36.9% with only baseline auxiliary variables, 39.7% with a larger set of auxiliary variables and 44.0% when measures of responsiveness were added. Close attention must be paid to missing data and non-response in research on adverse childhood experiences as data are unlikely to be missing at random. Common approaches may greatly underestimate their prevalence and compromise analysis of their causes and consequences. Sophisticated techniques using a wide range of auxiliary variables are critical in this field of research, including, where possible, measures of participant responsiveness.

Mental Health Literacy Content for Children of Parents with a Mental Illness: Thematic Analysis of a Literature Review.

Millions of children have a parent with a mental illness (COPMI). These children are at higher risk of acquiring behavioural, developmental and emotional difficulties. Most children, including COPMI, have low levels of mental health literacy (MHL), meaning they do not have accurate, non-stigmatized information. There is limited knowledge about what kind of MHL content should be delivered to children. The aim of this exploratory study is to identify the knowledge content needed for general population children and COPMI to increase their MHL. A second aim is to explore content for emerging children’s MHL scales. Researchers created and analyzed a literature review database. Thematic analysis yielded five main mental health knowledge themes for children: (1) attaining an overview of mental illness and recovery; (2) reducing mental health stigma; (3) building developmental resiliencies; (4) increasing help-seeking capacities; and (5) identifying risk factors for mental illness. COPMI appeared to need the same kind of MHL knowledge content, but with extra family-contextual content such as dealing with stigma experiences, managing stress, and communicating about parental mental illness. There is a need for MHL programs, validated scales, and research on what works for prevention and early intervention with COPMI children.

The perspective of families affected by parental mental illness on stigma and help-seeking

The perspective of families affected by parental mental illness on stigma and help-seeking

Social Networks of Children with Mentally Ill Parents

Social Networks of Children with Mentally Ill Parents Mental illness of parents can be a load situation for children. Supporting social relations might be an important source in such a situation. Social relations can be shown by social network analysis. Studies about social networks and mental health indicate differences regarding structure and potential for support when compared with social networks of healthy individuals. If and how mental illness of parents has an impact on their children's network is widely unknown. This systematic review shows methods and results of studies about social networks of children with mentally ill parents. By systematic search in electronic databases as well as manual search, two studies were found who met the target criteria. Both studies were conducted in the USA. Results of studies indicate that parental mental illness affects the state of mental health and social networks of children. Symptomatology of children changed due to perceived social support of network contacts. Impact of social support and strong network contacts seems to depend on age of children and the family situation. That's why support offers should be adapt to children's age. Focusing on social networks as potential resource for support and needs of the family affected seems appropriate during treatment.

Moving the field forward: Developing online interventions for children of parents with a mental illness

Parental mental illness has the potential to affect children adversely. These children report a higher risk of developing a mental illness than other children. At the same time, some young people are resilient in the face of adverse situations arising from their parent's illness, especially when appropriate interventions are provided. While there are several interventions available to support young people with parents with a mental illness, there are few online interventions. Additionally, much of the previous work in this area, including intervention development and evaluation, has not included the child's point of view about what they want. Clearly, there is a gap in current research regarding the development of interventions that are available online and are informed by children. This research note aims to further the argument for developing online interventions for children of parents with a mental illness.

Families living with parental mental illness and their experiences of family interventions.

Introduction Although research has shown that evidence-based family interventions in research settings improve the communication and understanding of parental mental illness, there is a lack of knowledge about interventions in an everyday clinical context. Aim This study explores how families with parental mental illness experience family interventions in a natural clinical context in psychiatric services. Method Five families with children aged 10-12 were recruited from psychiatric services in southern Sweden and interviewed in a manner inspired by naturalistic inquiry and content analysis. Both family and individual interviews were performed. Results In striving to lead an ordinary life while coping with the parental mental illness, these families sought the support of the psychiatric services, especially in order to inform their children about the mental illness. Despite different family interventions, the family members felt supported and reported that the number of conflicts in the family had decreased. The parents were appreciative of help with child-rearing questions, and the children experienced a calmer family atmosphere. However, the partner of the person with mental illness experienced being left without support. Implications for practice Our study shows that psychiatric services, and especially mental health nurses, are in a position to more regularly offer family interventions in supporting the children and the healthy partners.