European Child & Adolescent Psychiatry | 2019
Is children’s mental illness “a family affair”?
Abstract
Family characteristics, especially parental mental health, are among the strongest and best well-known determinants of emotional and behavioral difficulties in children and adolescents [1–3], 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 selfharm [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 * Maria Melchior [email protected]