Transdiagnostic risk of mental disorders in offspring of affected parents: a meta‐analysis of family high‐risk and registry studies

Abstract

The offspring of parents with mental disorders are at increased risk for developing mental disorders themselves. The risk to offspring may extend transdiagnostically to disorders other than those present in the parents. The literature on this topic is vast but mixed. To inform targeted prevention and genetic counseling, we performed a comprehensive, PRISMA 2020‐compliant meta‐analysis. We systematically searched the literature published up to September 2022 to retrieve original family high‐risk and registry studies reporting on the risk of mental disorders in offspring of parents with any type of mental disorder. We performed random‐effects meta‐analyses of the relative risk (risk ratio, RR) and absolute risk (lifetime, up to the age at assessment) of mental disorders, defined according to the ICD or DSM. Cumulative incidence by offspring age was determined using meta‐analytic Kaplan‐Meier curves. We measured heterogeneity with the I2 statistic, and risk of bias with the Quality In Prognosis Studies (QUIPS) tool. Sensitivity analyses addressed the impact of study design (family high‐risk vs. registry) and specific vs. transdiagnostic risks. Transdiagnosticity was appraised with the TRANSD criteria. We identified 211 independent studies that reported data on 3,172,115 offspring of parents with psychotic, bipolar, depressive, disruptive, attention‐deficit/hyperactivity, anxiety, substance use, eating, obsessive‐compulsive, and borderline personality disorders, and 20,428,575 control offspring. The RR and lifetime risk of developing any mental disorder were 3.0 and 55% in offspring of parents with anxiety disorders; 2.6 and 17% in offspring of those with psychosis; 2.1 and 55% in offspring of those with bipolar disorder; 1.9 and 51% in offspring of those with depressive disorders; and 1.5 and 38% in offspring of those with substance use disorders. The offspring's RR and lifetime risk of developing the same mental disorder diagnosed in their parent were 8.4 and 32% for attention‐deficit/hyperactivity disorder; 5.8 and 8% for psychosis; 5.1 and 5% for bipolar disorder; 2.8 and 9% for substance use disorders; 2.3 and 14% for depressive disorders; 2.3 and 1% for eating disorders; and 2.2 and 31% for anxiety disorders. There were 37 significant transdiagnostic associations between parental mental disorders and the RR of developing a different mental disorder in the offspring. In offspring of parents with psychosis, bipolar and depressive disorder, the risk of the same disorder onset emerged at 16, 5 and 6 years, and cumulated to 3%, 19% and 24% by age 18; and to 8%, 36% and 46% by age 28. Heterogeneity ranged from 0 to 0.98, and 96% of studies were at high risk of bias. Sensitivity analyses restricted to prospective family high‐risk studies confirmed the pattern of findings with similar RR, but with greater absolute risks compared to analyses of all study types. This study demonstrates at a global, meta‐analytic level that offspring of affected parents have strongly elevated RR and lifetime risk of developing any mental disorder as well as the same mental disorder diagnosed in the parent. The transdiagnostic risks suggest that offspring of parents with a range of mental disorders should be considered as candidates for targeted primary prevention.

Intracortical Myelin in Youths at Risk for Depression

“…We selected the 9 to 16 years age range to encompass youths who had not yet reached the typical age of depression onset ( 86 ). However, some studies have shown that high-risk youths may experience earlier onset of psychopathology than control offspring ( 36 , 38 ). By selecting asymptomatic youths, we might have missed some of the high-risk sample that had already developed depression.…”

“…Reduction of white matter integrity has also been observed in high-risk offspring in the cingulum, corpus callosum, and uncinate fasciculus, with reduced fractional anisotropy in the cingulum being related to elevated depression scores ( 34 , 35 ). Compared to the general population, high-risk youths have an increased probability of mood disorder onset due to their genetic and environmental relationships with family member(s) who have a severe mental disorder ( 36 , 37 , 38 ). Familial risk is known from birth or an early age, making it possible to study development in individuals who are at risk at a time when they have not experienced depression.…”

Duration of Untreated Illness in Patients with Obsessive–Compulsive Disorder and Its Impact on Long-Term Outcome: A Systematic Review

“…Multicomponent and multilevel interventions should include informative campaigns for young people to be disseminated in schools, the promotion of antistigma campaigns through the use of social media on the importance of early referral to specialistic care and help-seeking [38], and the establishment of non-stigmatizing mental health care facilities dedicated to young people needs, in order to facilitate access and appropriate mental health care [39][40][41][42][43][44][45][46].…”

Children of parents with a mental illness – stigma questionnaire: validation and revision

“…Children and adolescents who grow up with a parent with a mental illness are a particularly vulnerable group to develop a mental disorder themselves ( 25 – 28 ). A recent large meta-analysis reported a lifetime risk of 55% among those children and adolescents to develop any mental disorder ( 27 ), whereby subclinical symptoms occur more often and earlier in life ( 29 ). Due to their close and dependent relationship to their parents, these children and adolescents are also considered to be particularly affected by SBA ( 21 , 30 ) and stigmatization has been identified as a potential social mechanism in the transgenerational transmission of mental disorders (TTMD) ( 29 ).…”