Promotion of Wellbeing for Children of Parents With Mental Illness: A Model Protocol for Research and Intervention

Abstract

Background: The main objective of this project is to create a research and intervention model to promote large-scale implementation and evaluations of generic very brief interventions for children of parents with mental disorders (COPMI). Feasible interventions for COPMI aged 0–18 years are highly needed, as this is a large high-risk group in society. Reducing behavioral problems and enhancing wellbeing for families with parents affected by any mental disorder are important preventive initiatives. One key prevention strategy is to reduce the risk and expression of psychopathology in children and to promote wellbeing. The present model protocol offers an intervention for children of parents with mental disorders internationally based on a model already implemented in the Netherlands and Norway. Methods: Participants will be parents receiving treatment in mental health services in participating countries and their minor children aged 6–18 years. Participants should be randomized into an intervention group or control group. Data should be retrieved from electronic patient journals (demographics, DSM 5/ICD-10, SCID, MINI) as well as from assessment measures administered at baseline and follow-up, including the KIDSCREEN-27, Strengths and Difficulties Questionnaire (SDQ), Parents’ Evaluations of Developmental Status (PEDS), Parenting Sense of Competence (PSOC), Resilience Scale for Adolescence (READ), Guilt and Shame Questionnaire for Adolescents of Parents with Mental Illness (GSQ-APMI), Mental Health Literacy Scale, and Parent–Child Communication Scale. Results: The hypothesis is that there will be improvements of child behavioral and emotional problems, and outcomes in the project will be reported in terms of parent´s diagnosis, child behavioral and emotional problems, child wellbeing, family communication and functioning, as well as participants’ satisfaction. Discussion: This multi-site international protocol will focus the attention of European scientific and policy makers toward COPMI. This young segment of the population is presently almost completely neglected in most European health policies, despite having a large burden of disability and being at risk of transgenerational transmission of psychopathology. We will further discuss the feasibility of a very brief intervention aiming at preventing mental disorders in young people.

Editorial: Children, Adolescents and Families With Severe Mental Illness: Toward a Comprehensive Early Identification of Risk

“…Furthermore, having a family member suffering from SMI profoundly affects family dynamics, e.g., by increasing expressed emotions, or by decreasing the patient's ability to support other family members while simultaneously increasing his or her need for their support (8,9). On a converging line, it has been recently confirmed that, for example, preventive interventions targeting the offspring of parents with SMI have tangible prognostic impact both in terms of reduced incidence of mental illness in children and attenuation of internalizing symptoms (10,11). However, within the framework of the early detection of psychosis, a positive family history of psychosis even in combination with a recent drop in functioning was an insufficient predictor of a conversion to first-episode psychosis by itself when compared to symptom-based risk criteria (12)(13)(14).…”

“…Thus, contemporary clinical applied research on the early detection of SMI, even in its most developmentally-oriented branches, typically emphasizes an indicated approach based on subtle psychopathological antecedents (e.g., attenuated positive symptoms and basic symptoms [BS] as included in Clinical High Risk [CHR] criteria, anomalous subjective experiences, and schizotypal traits) (15) while the best strategy to incorporate evidence-based, transgenerational familial risk features still warrants more research (14,16). Therefore, addressing the need of care and developing suitable early identification strategies for familial or genetic high-risk, and other young vulnerable groups is essential (11,(16)(17)(18)(19)(20)(21)(22)(23).…”

Looking at Intergenerational Risk Factors in Schizophrenia Spectrum Disorders: New Frontiers for Early Vulnerability Identification?

“…While respectable, such debate seems to elude an obvious medical fact, that is, although not necessarily transitioning to psychosis, UHR helpseekers usually have a lower level of functioning, poorer quality of life, and a higher proclivity for an array of other mental health disorders. On this background it is crucial to highlight the problem of unmet needs and insufficient managing of early signatures of risk of mental illness in offspring of parents with SMI (102).…”

A Family-Focused Intervention for Parental Mental Illness: A Practitioner Perspective

“…Ireland lags behind most European countries and also Australia, in its lack of legislation and/or a national "think family" policy/practise guidance to support families with PMI (24,26,(33)(34)(35)(36). Moreover, mental health provision in Ireland is severely underfunded when compared with European counterparts, with services operating at between two-thirds to three quarters of recommended staffing levels (37,38).…”