Home visits in the Danish High Risk and Resilience Study – <scp>VIA</scp> 7: assessment of the home environment of 508 7‐year‐old children born to parents diagnosed with schizophrenia or bipolar disorder

Gantriis, Ditte Lou; Thorup, Anne; Harder, Susanne; Greve, Aja; Henriksen, Maria Toft; Zahle, Kate Kold; Stadsgaard, Henriette; Ellersgaard, Ditte; Burton, Birgitte Klee; Christiani, Camilla Jerlang; Spang, Katrine Soeborg; Hemager, Nicoline; Uddin, Jamal; Jepsen, Jens Richardt Møllegaard; Plessen, Kerstin Jessica; Nordentoft, Merete; Mors, Ole; Bliksted, Vibeke

doi:10.1111/acps.13057

Cited by 27 publications

(25 citation statements)

References 35 publications

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“…Pregnancy and obstetric complications may be one such risk factor, which has been related to maternal SMI and adverse child outcomes 35 . Insufficient stimulation, 40 insensitive care, 27,28 and reduced mentalization 41 are examples of how parenting can be affected by active mental illness and parenting behavior may thus be another risk factor, which is also reflected in the high incidence of attachment disorders found in our study. Adverse childhood experiences are also a known risk factor of mental disorders that occur more frequently in dysfunctional families including families with parental SMI, which can be prevented by early supportive interventions.…”

Section: Discussionmentioning

confidence: 52%

Mental and pediatric disorders among children 0–6 years of parents with severe mental illness

Davidsen

Laursen

Foli‐Andersen³

et al. 2021

Acta Psychiatr Scand

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Objective Parental severe mental illness (SMI) increases the lifetime risk of mental and pediatric disorders in the offspring but little is known about specific disorders during early childhood. The primary aim was to investigate the incidence of mental and pediatric disorders among children 0–6 years old exposed to parental SMI, and secondarily to investigate the distribution of disorders on specific child age. Methods A nationwide, register‐based cohort study of 1,477,185 children born in Denmark between 1994.01.01 and 2016.12.31. Incidence rate ratios were calculated using Poisson regression analysis for any and specific mental and pediatric disorders. Results IRR for any psychiatric disorder was elevated by a factor 2–5 among SMI offspring. Maternal schizophrenia resulted in the highest IRR = 5.23 (4.80–5.69) of any child psychiatric disorder. The risk of anxiety/OCD and attachment disorder among offspring exposed to parental, and in particular maternal, SMI was markedly raised with IRRs for anxiety/OCD between 7.59 and 17.02 and attachment disorders between 6.26 and 15.40. IRRs of mental disorders were highest at age 0–1 year and declined with age. IRR for any pediatric disorder was also elevated with IRRs between 1.01 and 1.28. Disorders of the digestive system and ill‐defined symptoms were associated with the highest IRRs. Maternal (vs. paternal) SMI was associated with higher IRRs. IRRs declined slightly with child age. Conclusion Children exposed to parental SMI are at increased risk of mental and pediatric disorders during early childhood, particularly anxiety/OCD and attachment disorders. If associations are estimates of a modifiable causal relationship, our results indicate a need for early intervention to promote mental and pediatric health among SMI offspring.

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Section: Discussionmentioning

confidence: 52%

Mental and pediatric disorders among children 0–6 years of parents with severe mental illness

Davidsen

Laursen

Foli‐Andersen³

et al. 2021

Acta Psychiatr Scand

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“…Schizophrenia polygenic risk scores appear to mediate less than 20% of the effect of family history 229 . This is likely in part explained by the fact that particularly parental family history also reflects environmental influences, such as higher rates of birth and pregnancy complications 230,231 , growing up in an unfavorable home environment 232 , out-of-home placement 233 , elevated divorce rate, alterations in parental communication 234 , and poor school performance 235 . The sizeable impact of growing up with a parent with severe mental illness on psychological and social development has been recently reviewed 236 .…”

Section: Family Historymentioning

confidence: 99%

The clinical characterization of the patient with primary psychosis aimed at personalization of management

et al. 2021

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The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medication is prescribed, with second‐generation antipsychotics usually preferred to first‐generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence‐based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves “recovery‐oriented”, it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient’s needs in terms of employment, housing, self‐care, social relationships and education, and offers a focus on identity, meaning and resilience.

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“…We also investigated the potential predictors of a good home environment defined as a MC-MC-HOME Inventory cutoff score above 40 [ 21 ] ( N = 463 families, Table 2 S). The primary caregiver not being single had a positive influence on the home environment (ß = 0.07; 95% CI (0.01;0.14); p = 0.03) as did the social functioning of the primary caregiver (ß = 0.006; 95% CI (0.003;0.009); p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…In order to assess the association between various predictors from the primary caregiver and child and the MC-HOME Inventory total score multiple linear regression models were applied. Furthermore, we made a supplementary multiple logistic regression analysis to assess the association between a number of important predictors and having a poor home environment defined as a MC-HOME Inventory total score ≤ 40 [ 21 ]. The statistical analyses were performed using the statistical software Stata version 16.0.…”

Section: Methodsmentioning

confidence: 99%

“…Further, children with FHR are at an elevated risk of developing psychopathology [ 18 , 19 ] that is identifiable already at an early age and display higher rates of neurocognitive deficits [ 17 , 20 ]. In the Danish High Risk and Resilience study – VIA7, which is a familial high risk study based on a large sample of children ( N = 522), we found that a larger proportion of the children with a predisposition for schizophrenia also lived in a home environment that was estimated to be of poorer quality than in the population-based controls (PBC) [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Exploring protective and risk factors in the home environment in high-risk families – results from the Danish High Risk and Resilience Study—VIA 7

et al. 2022

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Background Exposure to inadequate home environment may put the healthy development of familial high-risk children at risk. This study aimed to investigate associations between risk factors and an adequate home environment of children having a parent diagnosed with schizophrenia or bipolar disorder. Methods From a cohort of 522 children, data from 463 7-year-old children was included. Of these 172 children had familial risk for schizophrenia, 109 children had familial risk for bipolar disorder, and 190 were population-based controls. As part of a comprehensive battery, all participants were assessed with the Middle Childhood-Home Observation for Measurement of the Environment Inventory (MC-HOME Inventory) measuring the quality of the home environment. Results When analyzing all families together, we found that having a parent diagnosed with schizophrenia would have a negative impact on the home environment (ß = -1.08; 95% CI (-2.16;-0.01); p = 0.05), while familial risk for bipolar disorder did not show significant predictive value. Being a single caregiver and child having experienced severe life events from ages 4 to 7 showed significant negative impact, while child having a mental illness diagnosis did not. Being a female caregiver, good social functioning of the caregiver, high child IQ and not being a single caregiver were found to predict positive values for the home environment. We found similar results when analyzing caregivers with and without a diagnosis separately. Conclusions Knowledge of what predicts good home environment should be used to inform development of early interventions for families at risk.

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Home visits in the Danish High Risk and Resilience Study – VIA 7: assessment of the home environment of 508 7‐year‐old children born to parents diagnosed with schizophrenia or bipolar disorder

Cited by 27 publications

References 35 publications

Mental and pediatric disorders among children 0–6 years of parents with severe mental illness

Mental and pediatric disorders among children 0–6 years of parents with severe mental illness

The clinical characterization of the patient with primary psychosis aimed at personalization of management

Exploring protective and risk factors in the home environment in high-risk families – results from the Danish High Risk and Resilience Study—VIA 7

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