Parental Illness Research Articles

The University Teachers’ Perceptions of their Family Illness Affect Students’ Motivation and Interest in their Studies

This research delves into the intricate interplay between parents' illness and its impact on the well-being and academic interests of their children. As health is a cornerstone of family dynamics, understanding the consequences of parental illness on students becomes imperative. The study employs a mixed-methods approach, combining surveys and qualitative interviews to gather comprehensive insights. The research examines the psychological and emotional dimensions of students facing parental illness, investigating the potential correlations with changes in academic motivation and engagement. Through a diverse sample representing various socio-economic backgrounds and educational levels, the study aims to provide a nuance understanding of the multifaceted aspects of this phenomenon. Additionally, the research explores the support mechanisms available to students coping with parental illness, both within and outside the educational context. Identifying coping strategies and resilience factors becomes crucial in formulating recommendations for educators, policymakers, and healthcare professionals to enhance the overall well-being and academic performance of students in these challenging circumstances. The findings of this study contribute to the growing body of literature on the intersectionality of health, family, and education. By shedding light on the often-overlooked consequences of parental illness on student life, this research seeks to inform interventions and support systems that can mitigate the negative effects and foster a conducive learning environment for students facing such challenges. Ultimately, this exploration aims to promote a holistic approach to education that recognizes and addresses the diverse needs of students navigating the complexities of familial health crises.

Factors affecting caregiver burden among parents of children with cancer: A path analysis.

To investigate the relationships between parental resilience, illness perception and pain catastrophizing as factors affecting caregiver burden among parents of children with cancer, based on the Transactional Model of Stress and Coping. Parents, as the primary caregivers of children with cancer, often face universal challenges. These include adverse health impacts, work, financial disruptions, strained social and family relationships, and the need for specialised support and intervention. A cross-sectional design using path analysis. The STROBE guidelines for cross-sectional studies were followed. An online questionnaire was distributed through Facebook pages operated by various organisations that support parents of children with cancer, such as 'The Israel Cancer Association', 'Giving Hope' and 'Hayim Association' from October 2021 to February 2022. The participants completed a questionnaire about demographic and child-related characteristics, resilience, illness perception, pain catastrophizing, social support and caregiver burden. Associations between the variables were explored using Pearson's correlations and path analyses. The study included 67 parents of children with cancer with an average age of 41.79 (SD = 6.31). The majority were mothers (n = 54, 80.6%) with a steady partner (n = 62, 92.5%). The level of caregiver burden was M (SD) = 25.00 (7.15) out of 48 possible, indicating a high burden level. Illness perception was directly positively associated with caregiver burden (β = .280, p = .017) and pain catastrophizing (β = .340, p < .01), and directly negatively with resilience (β = -.318, p < .01). Illness perception and pain catastrophizing serially mediated the relationship between resilience and caregiver burden among parents of children with cancer (β = -.190, p = .001). This study found that both illness perception and pain catastrophizing serially mediated the relationship between personal resilience and caregiver burden. To ease caregiver burden for parents of children with cancer, programmes should address their psychological and emotional needs, including managing perceptions of illness and coping with pain-related distress.

From climatic to international shocks: Where does the evidence stand on income changes and child labor

AbstractChildren in developing countries are vulnerable to shocks and adversities and child labor is often seen as a direct consequence of poverty and economic downturns. While such univocal causality may appear obvious, its empirical basis has not been systematically evaluated. To understand the linkages between shocks, changes in the economic situation of families and child labor, we therefore conduct a systematic literature review on the impact of income‐related shocks on child labor. We evaluate empirical studies of weather events and natural disasters, agricultural shocks such as crop failures, family shocks like parental illness, price shocks and transnational shocks through trade, migration, and remittances. Focusing on the literature that identifies causal effects, we find that the relationship between shocks and child labor is far from univocal. While in most cases adverse shocks increase child labor, we find that favorable shocks that improve earning opportunities may also cause more child labor. Policies to tackle child labor should therefore develop safety nets that minimize the probability of children being used as buffers in adverse economic downturns, but also consider the risk that positive economic shocks may attract children into labor due to changes to the value of children's time spent working.

Empathy and psychopathology in children and adolescents: the role of parental mental illness and emotion regulation.

Although empathy is known to be a strength, recent studies suggest that empathy can be a risk factor for psychopathology under certain conditions in children. This study examines parental mental illness as such a condition. Further, it aims to investigate whether maladaptive emotion regulation (ER) mediates the relationship between empathy and psychopathological symptoms of children. Participants were 100 children of parents with a mental illness (55% female) and 87 children of parents without a mental illness (50% female) aged 6 - 16 years and their parents. Greater cognitive empathy was related to more psychopathological symptoms in COPMI, but not in COPWMI. In addition, in COPMI maladaptive ER mediated this relationship. In contrast, greater affective empathy was associated with more psychopathological symptoms regardless of whether parents had a mental illness. Our findings highlight the importance of implementing preventive programs for COPMI that specifically target the reduction of maladaptive ER.

Trauma in the lives of parents experiencing severe perinatal mental illness.

The perinatal period is a time of 'high risk' for new and recurrent episodes of mental illness with 0.1-0.2% of birthing parents requiring admission to specialist mental health units in the months after birth. The prevalence and role of trauma in the lives of birthing parents (most commonly mothers) experiencing severe perinatal mental illness is not well known. In a new perinatal mental health unit in Sydney Australia, a retrospective audit of trauma prevalence was undertaken using patient completed questionnaires and electronic medical record data. Descriptive analysis was undertaken. Prevalence of trauma in the lives of mothers with severe mental illness was found to be higher than that reported in general or community mental health settings, with 76% of mothers reporting lifetime trauma exposure and 24% meeting criteria for complex PTSD. The majority reported trauma experiences likely to impact attachment and also reported difficulties in responding to their infants' cues and needs. The findings suggest a need for more research, awareness, and consideration of the role of trauma in experiences of perinatal mental illness, with implications for developing trauma informed models for responding to parental mental illness.

Associations between psychiatric diagnoses in parents and psychiatric, behavioral, psychosocial outcomes in their offspring: a Swedish population-based register study

IntroductionChildren with parents with psychiatric diagnoses have an increased probability for not only the same condition as their parent, but also for other conditions and behavioral and psychosocial problems. Whereas many studies have focused on parental severe mental illness due to their significant impairment, less attention has been paid to more common disorders despite their higher prevalence. In addition, because most past research only included one exposure or one outcome at a time, it remains difficult to examine and compare broad patterns of intergenerational transmission.ObjectivesTo examine associations between six parental psychiatric diagnoses in parents, and a broad range of psychiatric diagnoses, psychotropic medications, criminality, suicide, violent victimization, accidents, and school and labor performance in their offspring.MethodsBased on Swedish national registers, we linked all individuals born in Sweden between 1970 and 2000 to their biological parents (N = 3 286 293). We used a matched cohort design, analyzed with stratified Cox regression and conditional logistic regressions to examine associations between six psychiatric diagnoses in the parents, and 32 outcomes in their offspring. All exposed and unexposed children were followed from their date of birth to the date of emigration from Sweden, the death, or 31 December 2013 when the offspring were 14-44 years old.ResultsIn terms of absolute risk, most children who had parents with psychiatric diagnoses were not diagnosed in specialist care themselves, as the proportion of having any of the 16 types of psychiatric conditions ranged from 22.17% (exposed to parental depression) to 25.05% (exposed to parental drug-related disorders) at the end of follow-up. Nevertheless, in terms of relative risk, all six parental psychiatric diagnoses increased the probability of all 32 outcomes in their offspring, with the Hazard Ratio ranging from 1.04 to 8.91 for time-to-event outcomes, and the Odds Ratio ranging from 1.29 to 3.36 for binary outcomes. Some specificities were observed for parental psychotic and substance misuse diagnoses, which strongly predicted offspring psychotic-like and externalizing-related outcomes, respectively.ConclusionsThe intergenerational transmission of parental psychiatric conditions appeared largely transdiagnostic, even for non-psychiatric outcomes in offspring. Given the broad spectrum of associations with the outcomes, service providers (e.g., psychiatrists, teachers, and social workers) should consider clients’ broader psychiatric family history when predicting prognosis and planning interventions/treatment.Disclosure of InterestNone Declared

Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness: a randomised controlled trial and cost analysis.

Parental mental illness (PMI) is common and places children at high risk of developing psychological disorders. Family Talk (FT) is a well-known, whole-family, 7-session intervention designed to reduce the risk of transgenerational psychopathology. However, very few larger-scale evaluations of FT (across only a limited number of settings) have been conducted to date while there have been no cost analyses. This study aimed to assess the effectiveness and costs of delivering FT in improving child and family psychosocial functioning in families with PMI within routine mental health settings. A total of 83 families with PMI, with children aged 5-18 years, were randomly assigned on a 2:1 ratio to receive either the FT intervention (n=55 families) or usual services (n=28 families) across 10 adult, child and primary care mental health sites in Ireland. Parental disorders included anxiety/depression (57%), Bipolar Disorder (20%), Borderline Personality Disorder (12%), Post-Traumatic Stress Disorder (8%) and psychosis (2%). Detailed assessments with parents were conducted at baseline and 6-month follow up. FT led to significant improvements in family functioning and child behaviour at 6-month follow up when compared to usual services, with medium effect sizes indicated. Parent participants with lower mental health literacy at baseline also showed significant post-intervention improvements. Those parents with less severe mental illness at baseline, and families with more partner and economic supports, reported additional significant post-intervention improvements in child depression/anxiety and parental mental health symptoms. The cost of FT amounted to €761.50 per family, although this decreased to €415.31 when recurring costs only were included. The findings from this study, which was conducted within the context of a national programme to introduce family-focused practice in Ireland, demonstrate that FT is a low-cost intervention that improved child and family psychosocial functioning across different mental health disorders within routine adult, child and primary care mental health services. The findings contribute to the growing evidence base for FT, and provide a robust basis to inform practice and policy development for families with parental mental illness both in Ireland and elsewhere. https://www.isrctn.com/ISRCTN13365858, identifier ISRCTN13365858.

Modelling social networks for children of parents with severe and enduring mental illness: an evidence based modification to the network episode model.

The Network Episode Model (NEM) is a well utilised model conceptualising how social networks, valuable resources which can positively impact wellbeing and functional outcomes, are responsive to the needs of people with physical and mental health difficulties. Children of parents with severe and enduring mental illness (COPMI) are impacted by these illnesses through the intersecting roles of kin relation, informal carer, and dependent. However, it is not clear that social networks effectively respond in kind to the child's episodic need.We draw upon qualitative data to propose a new multi-factorial conceptual model (COPMI-NEM), triangulating parental mental illness, child's developmental stage and social ties to theorise how social networks do respond and adapt to children's needs.The model illustrates how networks are typically flexible and responsive to visible age-related needs, but less reactive to more obscured needs. Successful network navigation and negotiation of support relies on multiple factors including the child's ability to successfully activate social ties and the availability of formal networks. We propose a new theoretically and empirically informed NEM model also available for testing, refinement and validation in other young carer populations exposed to episodic parental health needs. Findings from this study could be used to generate network informed interventions for this and comparable populations.

Lived experiences of mental health nurses who care for clients who are parents: An approximation of Tronto's definition of care.

Adult psychiatric services typically focus on the mental health needs of the client but they do not support his or her parenting role. Many authors highlight the importance of a non-judgmental approach when providing support and care to clients with mental illness who are parents. Assessments frequently focus on the negative aspects while the strengths of these families were often overlooked. There is a lack of scientific literature exploring nurses' experiences when caring for parents with mental illness and their families. Trust is the basis that helps clients to be open to receiving care and answering parenting-related questions. Therefore, without adequate professional-client trust, some care and interventions addressed to parents with mental illness could be poorly received by the client. Tronto's phases of care facilitated the collection of data and exploration of mental health nurses' experiences of care. Mental health nurses should be aware of the potential needs of these families, as described in the scientific literature, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique. Mental health nurses must take the person's environment into account (family, social and political aspects and different forms of stigma) since all these factors may influence how parents with mental illness receive and provide care. Introduction Many authors highlight the importance of a non-judgmental approach when providing care to parents with mental illness. However, assessments frequently focus on the negative aspects while the strengths of such families were often overlooked. Aim To explore the lived experiences of mental health nurses who care for clients who are parents. Method We conducted a qualitative phenomenological study. The main data collection technique was in-depth interviews. Data were analysed according to Colaizzi model, subsequently, the main categories that arised were compared and related to the five phases of Tronto's care. Results The main categories identified from the analysis of the interviews were: (1) individualized care, (2) continuity of care, (3) psychoeducation and counselling, (4) trust and (5) context of the client. Discussion Trust is the basis that helps parents with mental illness to be open to receiving care and answering parenting-related questions. Without trust, some interventions could be poorly received by the client. Implications for Practice Mental health nurses should be aware of the potential needs of these families, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique.

Structural disadvantages to the kin network from intergenerational racial health inequities.

This article utilizes the Panel Study of Income Dynamics to demonstrate how disadvantages in healthy life expectancies accumulated across generations create disparate kin structures among African American families in the United States. The analysis quantifies the overlap in parents' healthy years with their adult children's healthy life expectancies and examines how much the overlap coincides with the adult children's childrearing years. Non-Hispanic Black adults experienced parental illness and death sooner than non-Hispanic White adults, and their parents' poor health coincided longer with their own health declines. Non-Hispanic White adults, on the other hand, enjoyed more years in good health with two healthy parents. The intergenerational accumulation of unequal healthy life expectancies directly translated into unequal kin structures for the subsequent third generation. Race inequities in the intergenerational kin structure and health were greater among women than among men, and non-Hispanic Black women spent the most years raising children in poor health with unhealthy or deceased parents. Disparities in the intergenerational tempos of fertility, mortality, and morbidity are building profound structural racial inequities within a fundamental social institution-the family.

Trajectories of illness perceptions in paediatric cancer patients and their parents and associations with health-related quality of life: Results of a prospective-longitudinal study.

In paediatric oncology, little is known about trajectories of illness perceptions and their longitudinal associations with health-related quality of life (HRQoL). Therefore, the aim of this study was to investigate changes in illness perceptions in children and parents over a one-year-period and to investigate predictive value of child's and parent's illness perceptions during acute treatment for child's HRQoL 1year later. N=65 child-parent-dyads participated in a longitudinal study (retention rate: 80.2%). Children were 4-18years of age and underwent acute cancer treatment at baseline. Children and parents reported on their own illness perceptions (Illness-Perception-Questionnaire-Revised), as well as on the child's HRQoL (KINDL-R) at baseline and one-year-follow-up. Paired-samples t-tests were calculated to investigate changes over time. A hierarchical multiple regression analysis was performed to investigate predictive value of child's and parent's illness perceptions for child's HRQoL. Child's HRQoL t(63)=-6.73, p<0.001, their perceptions of coherence (i.e. understanding; t(54)=-2.36, p=0.022) and consequences of their illness (t(54)=2.86, p=0.006), and parent's perception of cyclical trajectory (t(61)=2.06, p=0.044) improved from baseline to 1-year-follow-up. All other illness perceptions remained stable. Exploratory post-hoc analyses showed differences in the pattern of change in age-, gender-, and diagnosis-specific subgroups. After controlling for baseline levels of HRQoL, child's perceptions of symptoms and consequences were independent predictors of their HRQoL 1year later (R2=0.396, F(2,52)=10.782, p<0.001), whereas no parent's illness perceptions added predictive value. In paediatrics, child's and parent's illness perceptions should be assessed. Our findings highlight the importance of illness perceptions as potential modifiable variables in interventions to improve child's HRQoL.

Whole-family programmes for families living with parental mental illness: a systematic review and meta-analysis

Several interventions have been developed to support families living with parental mental illness (PMI). Recent evidence suggests that programmes with whole-family components may have greater positive effects for families, thereby also reducing costs to health and social care systems. This review aimed to identify whole-family interventions, their common characteristics, effectiveness and acceptability. A systematic review was conducted according to PRISMA 2020 guidelines. A literature search was conducted in ASSIA, CINAHL, Embase, Medline, and PsycINFO in January 2021 and updated in August 2022. We double screened 3914 abstracts and 212 papers according to pre-set inclusion and exclusion criteria. The Mixed Methods Appraisal Tool was used for quality assessment. Quantitative and qualitative data were extracted and synthesised. Randomised-control trial data on child and parent mental health outcomes were analysed separately in random-effects meta-analyses. The protocol, extracted data, and meta-data are accessible via the Open Science Framework (https://osf.io/9uxgp/). Data from 66 reports—based on 41 independent studies and referring to 30 different interventions—were included. Findings indicated small intervention effects for all outcomes including children’s and parents’ mental health (dc = −0.017, −027; dp = −0.14, −0.16) and family outcomes. Qualitative evidence suggested that most families experienced whole-family interventions as positive, highlighting specific components as helpful, including whole-family components, speaking about mental illness, and the benefits of group settings. Our findings highlight the lack of high-quality studies. The present review fills an important gap in the literature by summarising the evidence for whole-family interventions. There is a lack of robust evidence coupled with a great need in families affected by PMI which could be addressed by whole-family interventions. We recommend the involvement of families in the further development of these interventions and their evaluation.

Paternal Orphanhood, Parental Illness, and Child’s Biological Relationship to Household Head: Their Impact on Child Health in Nigeria

Abstract This research fills a hole in the literature by investigating whether, in Nigeria, differences exist in the health of paternal orphans or vulnerable children depending on whether they have a close biological relationship with the household head compared to a distant relationship when health is measured through diarrhea, fever, and cough. The research analyzes the 2013 Nigeria Demographic and Health Survey Data and employs a multi-level logistic regression as the model estimation technique. The results show that, regardless of the measure of child health, among paternal orphans or vulnerable children there is no significant difference in the health of grandchildren or children who are relatives/non-relatives of their household head in contrast to biological children of the household head. Further, results indicate that, among non-orphans or non-vulnerable children, there is a positive and statistically significant difference only in the odds of diarrhea for grandchildren compared to biological children. The devotion of foreign aid in social and health services in 2011–2013 from the United States Agency for International Development (USAID) for only orphans and vulnerable children, alongside contributions from the Nigeria government and other organizations, alleviated poor health status among said children.

Early Childhood Teachers’ Relationships with Families When Children Experience Adversity

ABSTRACT Quality relationships among families and teachers in early care and education (ECE) hold promise to nurture resilience among children impacted by adversity. However, little is known about how adverse childhood experiences (ACEs) may affect the interactions between families and teachers. This study uses quantitative survey data from families (N = 235) and qualitative interview data from teachers (N = 13) to examine the link between children’s adversity and family-teacher relationship quality (knowledge, attitudes, practices) in ECE. Quantitative results indicate that when a child has experienced more of the ACEs conventionally studied (e.g. maltreatment, parent substance abuse or mental illness), parents are more likely to perceive lower quality practices with teachers, but when a child has experienced more ACEs on an extended measure (e.g., bullying, discrimination), parents are more likely to perceive higher quality practices with teachers. Qualitative results indicate that teachers report challenges in relationships with families when children experience trauma or adversity, but that ACEs also can present an opportunity to strengthen family-teacher relationships. Findings can inform professional development for teachers focused on strategies to work with families facing adversity, as well as policies related to program standards (e.g., family engagement) and interventions to improve family-teacher relationships quality.

Parental Mental Illness and the Likelihood of Child Out-of-Home Care: A Cohort Study.

To detail the relationship between parental mental illness and the likelihood of out-of-home care (OHC) among their children, and to identify factors which modify this relationship. Using Swedish national registers, children born in 2000 to 2011 (n = 1 249 463) were linked to their parents. Time-dependent parental mental illness (nonaffective and affective psychosis, substance misuse, depression, anxiety and stress, eating disorders, personality disorders, attention deficit hyperactivity disorder, autism, and intellectual disability), was identified through International Classification of Diseases codes. After adjustment for socioeconomic factors, children living with mentally ill parents were 4 times as likely to be placed in OHC than children without (95% confidence interval [CI] 4.24-4.61). The highest hazard ratio (HR) was in the youngest children aged 0 to 1 year (5.77, 95% CI 5.42-6.14), exposed to maternal illness (HR 4.56, 95% CI 4.37-4.76), and parental intellectual disability (HR 4.73, 95% CI 4.09-5.46). Children with parental mental illness with multiple risk factors were at particularly high risk. Compared with children without parental mental illness, and those with university-educated parents, children whose parents had mental illness and only had education to age 16 had a 15 times higher risk of OHC (95% CI 13.75-16.54). Children with parental mental illness are considerably more likely to be removed from home into care during childhood, particularly during the first year of life and if they are from socially disadvantaged families. Greater knowledge of these risks should lead to increased support for vulnerable new families.

Social-ecological perspective on the suicidal behaviour factors of early adolescents in China: a network analysis

BackgroundIn early adolescence, youth are highly prone to suicidal behaviours. Identifying modifiable risk factors during this critical phase is a priority to inform effective suicide prevention strategies.AimsTo explore the risk...

Association of parental mental illness with anxiety and depression in adulthood: The role of potentially contributing factors

ObjectiveChildren of parents with a mental illness (COPMI) are at risk of developing mental disorders in adulthood, especially anxiety disorders and depression. The role of the family environment and demographic factors as related to adult anxiety and depression is insufficiently understood. We examined potentially contributing factors in the associations between a COPMI background with anxiety and depressive symptoms in adulthood. MethodCross-sectional general population-based study. Instruments were the General Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9) and a questionnaire to evaluate self-reported history of a COPMI background and family-related experiences (CEPMIF). Multiple regression analyses were used to examine the role of demographic and family-related factors in the association of a self-reported COPMI background with the level of anxiety and depressive symptoms. ResultsOf the 942 participants (mean age 48.1 (SD = 16.2) years; 53.7 % women), 116 (12.3 %) had a COPMI background. A COPMI background was associated with higher levels of anxiety and depressive symptoms. Within individuals with a COPMI background, relationship problems within the family were associated with elevated levels of anxiety and depression. LimitationsThe cross-sectional design does not allow for causal inferences, COPMI background was based on participant's self-report, and the type of parental mental disorder was not considered. ConclusionsAdults with a COPMI background have higher levels of anxiety and depressive symptoms. Dysfunctional family relationships during childhood were associated with the severity of mental health problems of adults who grew up with a mentally ill parent. There is a need for targeted interventions for adult COPMI.

The urgent need for greater parent support and better health system experiences to enhance outcomes for pediatric anorexia nervosa: A Commentary on Marchetti & Sawrikar (2023).

Marchetti and Sawrikar's (2024) systematic review of parent illness representations of their child's anorexia nervosa provides a valuable synthesis of 32 qualitative studies. The key themes that emerge paint a concerning picture of parents' perceptions of AN as: difficult to identify and understand; of chronic duration; uncontrollable; severe; and associated with serious consequences. A sense of hopelessness and low-parental self-efficacy was identified. This Commentary explores the key findings of this review in four areas: AN treatment and recovery (control/cure); emotional representations of the illness; parent understanding of the illness (coherence) and its causes; and consequences of the AN. These illness perceptions are discussed along with relevant quantitative investigations of parent experiences, with a view to suggesting how the toll on parents might be reduced and how reducing burdens on parents might also lead to improved timely treatment outcomes. It is proposed that two broad features are needed: improved help-seeking experiences in the health care system; and, more parent-focussed support.

Impact of early risk factors on schizophrenia risk and age of diagnosis: A Danish population-based register study.

While several risk factors for schizophrenia have been identified, their individual impacts are rather small. The relative independent and cumulative impacts of multiple risk factors on disease risk and age of onset warrant further investigation. We conducted a register-based case-control study including all individuals receiving a schizophrenia spectrum disorder in Denmark from 1973 to 2018 (N=29,142), and a healthy control sample matched 5:1 on age, sex, and parental socioeconomic status (N=136,387). Register data included parental history of psychiatric illness, birth weight, gestational age, season of birth, population density of birthplace, immigration, paternal age, and Apgar scores. Data were analysed using logistic regression and machine learning. Parental history of psychiatric illness (OR=2.32 [95%CI 2.21-2.43]), high paternal age (OR=1.30 [1.16-1.45]), and low birth weight (OR=1.28 [1.16-1.41]) increased the odds of belonging to the patient group. In contrast, being a second-generation immigrant (OR=0.65 [0.61-0.69]) and high population density of the birthplace (OR=0.92 [0.89-0.96]) decreased the odds. The findings were supported by a decision tree analysis where parental history, paternal age, and birth weight contributed most to diagnostic classification (ACCtest=0.69, AUCtest=0.59, p<0.001). Twenty percent of patients were child-onset cases. Here, female sex (OR=1.82 [1.69-1.97]) and parental psychiatric illness (OR=1.62 [1.49-1.77]) increased the odds of receiving the diagnosis <18years. Multiple early factors contribute independently to a higher psychosis risk, suggesting cumulative effects leading to symptom onset. Routine assessments of the most influential risk factors could be incorporated into clinical practise. Being female increased the risk of diagnosis during childhood, suggesting sex differences in the developmental trajectories of the disorder.

Common caregiver illness representations in the context of family-based treatment: Commentary on Marchetti and Sawrikar (2023).

In their systematic review on parent illness representations in their children with anorexia nervosa (AN), Marchetti and Sawrikar (International Journal of Eating Disorders, 2023) integrate past research on the parental experience of the illness, investigating whether the Common Sense Model of Self-Regulation (CSM) is a useful framework for understanding parental responses to AN. Given that family-based treatment (FBT) is a first-line treatment for adolescents with eating disorders and is based upon integrating parents into the treatment process, it is especially relevant to explore how parent illness representations may impact FBT. In this commentary, we describe how FBT is designed to support parents and address many of the common unhelpful beliefs and emotions associated with parenting an adolescent with AN. We include specific examples of how parents can be supported within FBT as manualized. We also examine parental representations that may not be addressed by FBT, and how these may impact treatment outcomes in FBT, possibly via the impact of expressed emotion. Future research is needed to determine if modifications to FBT are required to address parental representations of the illness. We end by expanding upon Marchetti and Sawrikar's suggestions on how treatment could be extended to better support parents as necessary.