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.

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Correspondence to Maria Melchior.

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Melchior, M. Is children’s mental illness “a family affair”?. Eur Child Adolesc Psychiatry 28, 875–876 (2019). https://doi.org/10.1007/s00787-019-01366-w

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