Severe mental illness such as major depressive disorder, bipolar disorder, and schizophrenia have a tremendous impact not only on the affected individual, but on their families. Children of parents with severe mental illness are also more likely to experience psychological and social adversity and academic problems, and they are at higher risk of developing severe mental illness themselves.

Genetic factors are part of the reason why, but they don't completely explain these outcomes. Rather, researchers point to a complex interplay between genetic predisposition and several psychosocial influences, including parent-child attachment, adverse childhood experiences, family dysfunction, and socioeconomic disadvantage.

Outcomes for familial at-risk children seem to depend on the point in development they've been exposed to adverse psychosocial and family factors and for how long. At the same time, mitigating influences also seem to play a role, such as the affected parent being in good remission, other healthy adult and peer relationships, and supportive extended family, community, and school life, also seem to play a role.

The good news is, many of these risk factors for children are modifiable or preventable. On the other hand, health services often focus on treatment rather than prevention, and look at patients individually rather than having a family-oriented approach.

"Children of a parent with severe mental illness are an overlooked high-risk group for whom mental health promotion and early intervention could have a profound impact," says Anne Duffy, a professor in the Department of Psychiatry. She recently led a review on this topic as part of an international collaborative paper, published in Nature Mental Health. The article recommends an evidence-based approach to proactively supporting these children and looks at specific challenges and needs related to different parental disorders.

For instance, children of parents with major depression are more susceptible to severe mental illness but also may live in home environments that are continually stressful. When major depression affects two generations, it is likely to onset at an even younger age.

Critical moments

The article reveals that the earlier a child is introduced to a stressor, the bigger the impact can be on their mental health. Even pre-natal and exposure during the first two years of life is associated with greater risk of mental disorders.

Research suggests that early childhood experiences are crucial for mental development, including the development of healthy social and emotional coping resources. This is particularly challenging in families where a parent has schizophrenia: evidence shows that their children often experience neurodevelopmental and social problems, not seen in children at risk for mood disorders. They are also at higher risk of burns, accidents, illnesses, and missing preventative health opportunities (vaccinations) during childhood, and are less likely to be successful in school.

Another crucial moment for healthy development is adolescence, a time where young people navigate external risks (e.g., substance use) and where parents usually play an important educational and support role—one that can be negatively impacted by parental mental illness.

A call to action

Further investigation into the biological, psychological, and social aspects of severe mental illnesses will allow researchers to establish staging models and risk assessment tools to guide prevention and early intervention opportunities. But the first step of preventing poor mental health and well-being in children is clear: ensuring parents suffering severe mental illness have access to treatment and support, including during pregnancy.

The researchers suggest that complementary strategies could include programs to promote healthy parent-child interactions, as well as education and training for parents with mental illnesses, teenagers, and health care providers.

"Parents play a vital role in the healthy development of their children, and when parents are struggling themselves with illness, families can pay a heavy price," says Dr. Duffy. "Our paper is a call to action and provides recommendations that could serve as a starting point in developing the tools and resources to proactively support parents with severe mental illness. These have the potential for enormous benefit—for children at familial risk, their parents, and for society at large."