Is children’s mental illness “a family affair”?

“It’s a family affair

It’s a family affair

It’s a family affair

It’s a family affair

One child grows up to be

Somebody that just loves to learn

And another child grows up to be

Somebody you’d just love to burn

Mom loves the both of them

You see, it’s in the blood

Both kids are good to mom

Blood’s thicker than the mud”

Family Affair, Sly and the Family Stone, 1971

Family characteristics, especially parental mental health, are among the strongest and best well-known determinants of emotional and behavioral difficulties in children and adolescents [1,2,3], including in situations when children are exposed to other sources of adversity [4]. In particular, extensive research shows the impact of maternal depression and substance use—including alcohol use disorder—on the onset and course of offspring externalizing disorders [5] such as ADHD [6, 7], adolescent depression [8] and self-harm [9].

While genetic and epigenetic factors certainly contribute to the intergenerational transmission of mental illness [10, 11], parents’ behavior plays an essential role, too. Parents who have mental health problems may lack parenting self-efficacy, which leads to difficulties in finding adequate resources and skills to address the child’s needs [8]. For instance, parents who are anxious appear particularly fearful of holding and stroking their baby, which can lead to insufficient reassurance and contribute to an excess risk of internalizing and externalizing symptoms later in childhood [12]. Parents who have mental health problems also appear at increased risk of hostility towards their children [13], which can be detrimental to their psychosocial development.

This issue of European Child and Adolescent Psychiatry presents original research which broadens the spectrum of thinking in this area in at least three ways. First, a study conducted by Mulraney et al. [13] indicates that offspring outcomes are deteriorated not only in case of severe mental illness but also in case of psychological distress, which is relatively frequent and may go undetected by health professionals. Similarly, the study conducted by Vergunst et al. [14] indicates that maternal symptoms of depression are predictive of offspring trajectories of hyperactivity–impulsivity and inattention through age 17 years. Additionally, the study conducted by Raitasalo et al. [15] shows that prenatal alcohol abuse—even if it is not considered severe—is also predictive of offspring mental and behavioral disorders. This is consistent with other research [5] and suggests that at the population level, a majority of cases of mental illness occur among children who are not in high-risk groups. This finding calls for wide-spectrum efforts to prevent depression at the population level and screen for parental psychological difficulties. For instance, each contact young parents have with the health care system (e.g., during the course of perinatal care and preparation for parenthood, in well-baby clinics, in case of the child’s required medical check-ups) should be used as an opportunity to screen for psychological distress and to propose adequate referral if necessary. Second, a systematic review and meta-analysis conducted by Lei et al. [16] reports an association between parental body mass index and autism spectrum disorder in the offspring. While the mechanisms underlying this association are yet unclear, the most likely one, and which may additionally contribute to other child mental health problems such as ADHD [17], is excess inflammation prenatally, which may influence neurogenesis. Importantly, only maternal, and not paternal, body mass index seems a source of risk for the offspring, strengthening the biological interpretation of this association. Third, studies in this issue of ECAP consider not only maternal but also paternal mental health and behavior as a possible source of risk. While neither paternal alcohol abuse nor body mass index appears to be related to offspring mental health [13, 16], other research has shown that paternal depression predicts behavioral and emotional problems [18,19,20], especially in boys [21]. Moreover, paternal parenting style may also be a key risk factor of children’s long-term behavioral and emotional difficulties [22]. Hence, it is important to evaluate fathers’, as well as mothers’, mental health to identify youths at risk of mental health problems and include fathers in efforts aiming to support parents.

The finding that parental mental health difficulties influence children’s mental health is not new. However, research published in this month’s European Child and Adolescent Psychiatry refines this observation, by showing that (a) this association goes beyond children of persons with severe mental illness and (b) involves the fathers’, as well as the mothers’, mental health. Moreover, parents’ physical weight also appears to influence the risk of child mental health difficulties. Additional research on the mechanisms of intergenerational transmission of mental health problems as well as effective ways of limiting the impact of parental psychological difficulties on their children is warranted.


  1. 1.

    Feder A, Alonso A, Tang M, Liriano W, Warner V, Pilowsky D et al (2009) Children of low-income depressed mothers: psychiatric disorders and social adjustment. Depress Anxiety 26(6):513–520

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M et al (2014) Effects of perinatal mental disorders on the fetus and child. Lancet 384(9956):1800–1819

    Article  Google Scholar 

  3. 3.

    Weissman MM, Berry OO, Warner V, Gameroff MJ, Skipper J, Talati A et al (2016) A 30-year study of 3 generations at high risk and low risk for depression. JAMA Psychiatry 73(9):970–977

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Eruyar S, Maltby J, Vostanis P (2018) Mental health problems of Syrian refugee children: the role of parental factors. Eur Child Adolesc Psychiatry 27(4):401–409

    Article  PubMed  Google Scholar 

  5. 5.

    van der Waerden J, Galera C, Larroque B, Saurel-Cubizolles M-J, Sutter-Dallay A-L, Melchior M (2015) Trajectories of maternal depression and children’s behavior at age five: the EDEN birth cohort study. J Pediatr 166(6):1440–1448

    Article  PubMed  Google Scholar 

  6. 6.

    Agha SS, Zammit S, Thapar A, Langley K (2017) Maternal psychopathology and offspring clinical outcome: a four-year follow-up of boys with ADHD. Eur Child Adolesc Psychiatry 26(2):253–262

    Article  PubMed  Google Scholar 

  7. 7.

    O’Connor C, Reulbach U, Gavin B, McNicholas F (2018) A prospective longitudinal investigation of the (dis)continuity of mental health difficulties between mid- to late-childhood and the predictive role of familial factors. Eur Child Adolesc Psychiatry 27(3):289–300

    Article  PubMed  Google Scholar 

  8. 8.

    Ahun MN, Consoli A, Pingault JB, Falissard B, Battaglia M, Boivin M et al (2018) Maternal depression symptoms and internalising problems in the offspring: the role of maternal and family factors. Eur Child Adolesc Psychiatry 27(7):921–932

    Article  PubMed  Google Scholar 

  9. 9.

    Hu N, Li J, Glauert RA, Taylor CL (2017) Influence of exposure to perinatal risk factors and parental mental health related hospital admission on adolescent deliberate self-harm risk. Eur Child Adolesc Psychiatry 26:791–803

    Article  PubMed  Google Scholar 

  10. 10.

    Kim-Cohen J, Moffitt TE, Taylor A, Pawlby SJ, Caspi A (2005) Maternal depression and children’s antisocial behavior: nature and nurture effects. Arch Gen Psychiatry 62(2):173–181

    Article  PubMed  Google Scholar 

  11. 11.

    Monk C, Spicer J, Champagne FA (2012) Linking prenatal maternal adversity to developmental outcomes in infants: the role of epigenetic pathways. Dev Psychopathol 24(4):1361–1376

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Pickles A, Sharp H, Hellier J, Hill J (2017) Prenatal anxiety, maternal stroking in infancy, and symptoms of emotional and behavioral disorders at 3.5 years. Eur Child Adolesc Psychiatry 26(3):325–334

    Article  PubMed  Google Scholar 

  13. 13.

    Mulraney M, Giallo R, Efron D, Brown S, Nicholson JM, Sciberras E (2019) Maternal postnatal mental health and offspring symptoms of ADHD at 8–9 years: pathways via parenting behavior. Eur Child Adolesc Psychiatry 54:1038–1046

    Google Scholar 

  14. 14.

    Vergunst F, Tremblay RE, Galéra C, Nagin D, Vitaro F, Boivin M et al (2018) Multi-rater developmental trajectories of hyperactivity-impulsivity and inattention symptoms from 1.5 to 17 years: a population-based birth cohort study. Eur Child Adolesc Psychiatry.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Raitasalo K, Holmila M, Jääskeläinen M, Santalahti P (2018) The effect of the severity of parental alcohol abuse on mental and behavioural disorders in children. Eur Child Adolesc Psychiatry.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Lei XY, Li YJ, Ou JJ, Li YM (2018) Association between parental body mass index and autism spectrum disorder: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry.

    Article  PubMed  Google Scholar 

  17. 17.

    Andersen CH, Thomsen PH, Nohr EA, Lemcke S (2018) Maternal body mass index before pregnancy as a risk factor for ADHD and autism in children. Eur Child Adolesc Psychiatry 27(2):139–148

    Article  PubMed  Google Scholar 

  18. 18.

    Ramchandani PG, Stein A, O’Connor TG, Heron J, Murray L, Evans J (2008) Depression in men in the postnatal period and later child psychopathology: a population cohort study. J Am Acad Child Adolesc Psychiatry 47(4):390–398

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Kvalevaag AL, Ramchandani P, Hove O, Assmus J, Eberhard-Gran M, Biringer E (2013) Paternal mental health and socioemotional and behavioral development in their children. Pediatrics 131(2):e463–e469

    Article  PubMed  Google Scholar 

  20. 20.

    Liskola K, Raaska H, Lapinleimu H, Elovainio M (2018) Parental depressive symptoms as a risk factor for child depressive symptoms; testing the social mediators in internationally adopted children. Eur Child Adolesc Psychiatry 27(12):1585–1593

    Article  PubMed  Google Scholar 

  21. 21.

    Andreas A, White LO, Sierau S, Perren S, von Klitzing K, Klein AM (2018) Like mother like daughter, like father like son? Intergenerational transmission of internalizing symptoms at early school age: a longitudinal study. Eur Child Adolesc Psychiatry 27(8):985–995

    Article  PubMed  Google Scholar 

  22. 22.

    Ong MY, Eilander J, Saw SM, Xie Y, Meaney MJ, Broekman BFP (2018) The influence of perceived parenting styles on socio-emotional development from pre-puberty into puberty. Eur Child Adolesc Psychiatry 27(1):37–46

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Maria Melchior.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Melchior, M. Is children’s mental illness “a family affair”?. Eur Child Adolesc Psychiatry 28, 875–876 (2019).

Download citation