Preventive interventions for children of parents with a mental disorder:
a multicomponent approach
Children of parents with a mental disorder are at high risk for developing psychiatric problems, especially children of parents with unipolar depression. Studies point at a risk between 30 and 70%. In addition, a fast majority of the children in psychiatric treatment have parents with psychiatric problems. Although there is a tendency for depressed parents to have children with an increased risk at affective disorders, in general the type of disorders in the children is not strictly related to the type of parental disorders. Children of schizophrenic parents have an increased risk at a diversity of disorders. Likewise, children of depressed parents have also an increased risk at attention-deficit disorders, conduct disorders and the use of drugs. This high risk for transgenerational transfer of psychiatric disorders calls for a significant investment in the development of effective prevention.
Besides the role of genetic factors research in the last 15 years has offered repeated clinical and empirical evidence for the impact of malleable psychological and social risk factors mediating or moderating the effects of parental psychopathology. For example, research on outcomes of marital depression points at the significant mediating risk factors, such as obstetric complications, the severity and chronicity of parental symptomatology, disturbed parental behavior, problems in the child-parent interaction, the lack of positive responsiveness by the parent, insecure attachment parental discord, low intrafamilial and extrafamilial support, lack of knowledge about the parental disease, guilt feeling in the child and parentification. Especially the interaction of multiple risk factors enhances a dowward spiral and increases the risk of the children.
However, not all of these children show evidence of later dysfunction. A range of protective factors are identified which decrease the risk even under adverse circumstances. At higher level of intelligence, availability of cognitive and social skills, adequate social support and positive school experiences seem to have a protective influence, reducing the risk.
C. M.H. Hosman (1), K. van Doesum (2)
(1) Professor of Mental Health Promotion and Prevention of Mental Disorders
Department of Health Education, Maastrich University
(2) Researcher at the Research Group Prevention and Psychopathology
University of Nijmegen
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