Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-26T14:52:57.120Z Has data issue: false hasContentIssue false
  • English
  • Français

Preventive interventions in offspring of parents with mental illness: a systematic review and meta-analysis of randomized controlled trials

Published online by Cambridge University Press:  26 August 2021

Alice Lannes Open the ORCID record for Alice Lannes [Opens in a new window] ,
Eric Bui Open the ORCID record for Eric Bui [Opens in a new window] ,
Catherine Arnaud Open the ORCID record for Catherine Arnaud [Opens in a new window] ,
Jean-Philippe Raynaud Open the ORCID record for Jean-Philippe Raynaud [Opens in a new window]  and
Alexis Revet Open the ORCID record for Alexis Revet [Opens in a new window]
Alice Lannes*
Affiliation:
Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
Eric Bui
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA University of Caen Normandy & Caen University Hospital, Caen, France
Catherine Arnaud
Affiliation:
CERPOP, UMR 1295, Inserm, University Paul Sabatier Toulouse, Toulouse, France Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
Jean-Philippe Raynaud
Affiliation:
Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France CERPOP, UMR 1295, Inserm, University Paul Sabatier Toulouse, Toulouse, France
Alexis Revet
Affiliation:
Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France CERPOP, UMR 1295, Inserm, University Paul Sabatier Toulouse, Toulouse, France CIC 1436, Team PEPSS, « Pharmacologie En Population cohorteS et biobanqueS », Toulouse University Hospital, Toulouse, France
*
Author for correspondence: Alice Lannes, E-mail: [email protected]; [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Children with parents suffering from a psychiatric disorder are at higher risk for developing a mental disorder themselves. This systematic review and meta-analysis of randomized controlled trials aims to evaluate the efficacy of psychosocial interventions to prevent negative mental health outcomes in the offspring of parents with mental illness. Eight electronic databases, grey literature and a journal hand-search identified 14 095 randomized controlled trials with no backward limit to June 2021. Outcomes in children included incidence of mental disorders (same or different from parental ones) and internalizing and externalizing symptoms at post-test, short-term and long-term follow-up. Relative risks and standardized mean differences (SMD) for symptom severity were generated using random-effect meta-analyses. Twenty trials were selected (pooled n = 2689 children). The main therapeutic approaches found were cognitive-behavioural therapy and psychoeducation. A significant effect of interventions on the incidence of mental disorders in children was found with a risk reduction of almost 50% [combined relative risk = 0.53, 95% confidence interval (CI) 0.34–0.84]. Interventions also had a small but significant effect on internalizing symptoms at post-test (SMD = −0.25, 95% CI −0.37 to −0.14) and short-term follow-up (−0.20, 95% CI −0.37 to −0.03). For externalizing symptoms, a decreasing slope was observed at post-test follow-up, without reaching the significance level (−0.11, 95% CI −0.27 to 0.04). Preventive interventions targeting the offspring of parents with mental disorders showed not only a significant reduction of the incidence of mental illness in children, but also a diminution of internalizing symptoms in the year following the intervention.

Keywords

Meta-analysispreventive interventionmentally ill parentsoffspringinternalizing and externalizing symptoms
Type
Review Article
Information
Psychological Medicine , Volume 51 , Issue 14 , October 2021 , pp. 2321 - 2336
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.Google Scholar
Achenbach, T. M. (1991). Manual for the child behaviour checklist/4–18 and 1991 profile. Burlington: University of Vermont Department of Psychiatry.Google Scholar
Apter, G., Bobin, A., Genet, M. C., Gratier, M., & Devouche, E. (2017). Update on mental health of infants and children of parents affected with mental health issues. Current Psychiatry Reports, 19, 72. doi: 10.1007/s11920-017-0820-8CrossRefGoogle ScholarPubMed
Arango, C., Díaz-Caneja, C. M., McGorry, P. D., Rapoport, J., Sommer, I. E., Vorstman, J. A., … Carpenter, W. (2018). Preventive strategies for mental health. The Lancet. Psychiatry, 5, 591–604. doi: 10.1016/S2215-0366(18)30057-9CrossRefGoogle ScholarPubMed
Beardslee, W. R., Brent, D. A., Weersing, V. R., Clarke, G. N., Porta, G., Hollon, S. D., … Garber, J. (2013). Prevention of depression in at-risk adolescents: Longer-term effects. JAMA Psychiatry, 70, 1161–1170. doi: 10.1001/jamapsychiatry.2013.295CrossRefGoogle ScholarPubMed
Bella, T., Goldstein, T., Axelson, D., Obreja, M., Monk, K., Hickey, M. B., … Birmaher, B. (2011). Psychosocial functioning in offspring of parents with bipolar disorder. Journal of Affective Disorders, 133, 204–211. doi: 10.1016/j.jad.2011.03.022CrossRefGoogle ScholarPubMed
Brent, D. A., Brunwasser, S. M., Hollon, S. D., Weersing, V. R., Clarke, G. N., Dickerson, J. F., … Garber, J. (2015). Effect of a cognitive-behavioural prevention program on depression 6 years after implementation among at-risk adolescents: A randomized clinical trial. JAMA Psychiatry, 72, 1110. doi: 10.1001/jamapsychiatry.2015.1559CrossRefGoogle Scholar
Catalano, R. F., Gainey, R. R., Fleming, C. B., Haggerty, K. P., & Johnson, N. O. (1999). An experimental intervention with families of substance abusers: One-year follow-up of the focus on families project. Addiction, 94, 241–254. doi: 10.1046/j.1360-0443.1999.9422418.xCrossRefGoogle ScholarPubMed
Clarke, G. N., Hornbrook, M., Lynch, F., Polen, M., Gale, J., Beardslee, W. R., … Seeley, J. (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry, 58, 1127–1134. doi: 10.1001/archpsyc.58.12.1127CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Coiro, M. J., Riley, A., Broitman, M., & Miranda, J. (2012). Effects on children of treating their mothers’ depression: Results of a 12-month follow-up. Psychiatric Services, 63, 357–363. doi: 10.1176/appi.ps.201100126CrossRefGoogle ScholarPubMed
Compas, B. E., Champion, J. E., Forehand, R., Cole, D. A., Reeslund, K. L., Fear, J., … Roberts, L. (2010). Coping and parenting: Mediators of 12-month outcomes of a family group cognitive behavioural preventive intervention with families of depressed parents. Journal of Consulting and Clinical Psychology, 78, 623–634. doi: 10.1037/a0020459CrossRefGoogle Scholar
Compas, B. E., Forehand, R., Keller, G., Champion, J. E., Rakow, A., Reeslund, K. L., … Cole, D. A. (2009). Randomized controlled trial of a family cognitive behavioural preventive intervention for children of depressed parents. Journal of Consulting and Clinical Psychology, 77, 1007–1020. doi: 10.1037/a0016930CrossRefGoogle ScholarPubMed
Compas, B. E., Forehand, R., Thigpen, J., Hardcastle, E. J., Garay, E., McKee, L., … Sterba, S. (2015). Efficacy and moderators of a family group cognitive–behavioural preventive intervention for children of parents with depression. Journal of Consulting and Clinical Psychology, 83, 541–553. doi: 10.1037/a0039053CrossRefGoogle Scholar
Compas, B. E., Forehand, R., Thigpen, J. C., Keller, G., Hardcastle, E. J., Cole, D. A., … Roberts, L. (2011). Family group cognitive–behavioural preventive intervention for families of depressed parents: 18- and 24-month outcomes. Journal of Consulting and Clinical Psychology, 79, 488–499. doi: 10.1037/a0024254CrossRefGoogle Scholar
Connell, A. M., & Goodman, S. H. (2002). The association between psychopathology in fathers versus mothers and children's internalizing and externalizing behaviour problems: A meta-analysis. Psychological Bulletin, 128, 746–773. doi: 10.1037/00332909.128.5.746CrossRefGoogle Scholar
Dodge, K. A., Bates, J. E., & Pettit, G. S. (1990). Mechanisms in the cycle of violence. Science (New York, N.Y.), 250, 1678–1683. doi: 10.1126/science.2270481CrossRefGoogle ScholarPubMed
Eyberg, S., & Pincus, D. (1999). Eyberg child behaviour inventory & Sutter-Eyberg student behaviour inventory-revised: Professional manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Forman, D. R., O'Hara, M. W., Stuart, S., Gorman, L. L., Larsen, K. E., & Coy, K. C. (2007). Effective treatment for postpartum depression is not sufficient to improve the developing mother–child relationship. Development and Psychopathology, 19, 585–602. doi: 10.1017/S0954579407070289CrossRefGoogle Scholar
Garber, J., Clarke, G. N., Weersing, V. R., Beardslee, W. R., Brent, D. A., Gladstone, T. R. G., … Iyengar, S. (2009). Prevention of depression in at-risk adolescents: A randomized controlled trial. JAMA Psychiatry, 301, 2215–2224. doi: 10.1001/jama.2009.788Google ScholarPubMed
Giannakopoulos, G., Solantaus, T., Tzavara, C., & Kolaitis, G. (2021). Mental health promotion and prevention interventions in families with parental depression: A randomized controlled trial. Journal of Affective Disorders, 278, 114–121. doi: 10.1016/J.JAD.2020.09.070CrossRefGoogle ScholarPubMed
Ginsburg, G. S. (2009). The child anxiety prevention study: Intervention model and primary outcomes. Journal of Consulting and Clinical Psychology, 77, 580–587. doi: 10.1037/a0014486CrossRefGoogle ScholarPubMed
Ginsburg, G. S., Drake, K. L., Tein, J. Y., Teetsel, R., & Riddle, M. A. (2015). Preventing onset of anxiety disorders in offspring of anxious parents: A randomized controlled trial of a family-based intervention. The American Journal of Psychiatry, 172, 1207–1214. doi: 10.1176/appi.ajp.2015.14091178CrossRefGoogle ScholarPubMed
Ginsburg, G. S., Tein, J. Y., & Riddle, M. A. (2020). Preventing the onset of anxiety disorders in offspring of anxious parents: A six-year follow-up. Child Psychiatry & Human Development, 52, 751–760. doi: 10.1007/s10578-020-01080-8CrossRefGoogle ScholarPubMed
Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1337–1345. doi: 10.1097/00004583-200111000-00015CrossRefGoogle ScholarPubMed
Haggerty, K. P., Skinner, M., Fleming, C. B., Gainey, R. R., & Catalano, R. F. (2008). Long-term effects of the focus on families project on substance use disorders among children of parents in methadone treatment. Addiction, 103, 2008–2016. doi: 10.1111/j.1360-0443.2008.02360.xCrossRefGoogle ScholarPubMed
Hay, D. F., Pawlby, S., Sharp, D., Asten, P., Mills, A., & Kumar, R. (2001). Intellectual problems shown by 11 year-old children whose mothers had postnatal depression. Journal of Child Psychology and Psychiatry, 42, 871–889. doi: 10.1111/1469-7610.00784CrossRefGoogle ScholarPubMed
Hazell, P., O'Connell, D., Heathcote, D., & Henry, D. (2002). Tricyclic drugs for depression in children and adolescents. The Cochrane Database of Systematic Reviews, 2(6), Art. No.: CD002317. doi: 10.1002/14651858.CD002317.pub2Google Scholar
Higgins, J. P. T., & Green, S. (2011). Cochrane handbook for systematic reviews of interventions (Vol. 4). West Sussex, England: John Wiley & Sons.Google Scholar
Hoffmann, T., Glasziou, P., Boutron, I., Milne, R., Perera, R., Moher, D., … Michie, S. (2014). Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. British Medical Journal, 348, 1687. doi: 10.1136/bmj.g1687CrossRefGoogle ScholarPubMed
Hosman, C. M. H., van Doesum, K. T. M., & van Santvoort, F. (2009). Prevention of emotional problems and psychiatric risks in children of parents with a mental illness in the Netherlands: I. The scientific basis to a comprehensive approach. Australian e-Journal for the Advancement of Mental Health, 8, 250–263. doi: 10.5172/jamh.8.3.250CrossRefGoogle Scholar
Ingoldsby, E. M. (2010). Review of interventions to improve family engagement and retention in parent and child mental health programs. Journal of Child and Family Studies, 19, 629–645. doi: 10.1007/s10826-009-9350-2CrossRefGoogle ScholarPubMed
Jones, S. H., Jovanoska, J., Calam, R., Wainwright, L. D., Vincent, H., Asar, O., … Lobban, F. (2017). Web-based integrated bipolar parenting intervention for parents with bipolar disorder: A randomised controlled pilot trial. Journal of Child Psychology and Psychiatry, 58, 1033–1041. doi: 10.1111/jcpp.12745CrossRefGoogle ScholarPubMed
Kelley, M. L., & Fals-Stewart, W. (2002). Couples- versus individual-based therapy for alcohol and drug abuse: Effects on children's psychosocial functioning. Journal of Consulting and Clinical Psychology, 70, 417–427. doi: 10.1037//0022-006x.70.2.417CrossRefGoogle ScholarPubMed
Kersten-Alvarez, L. E., Hosman, C. M. H., Riksen-Walraven, J. M., Van Doesum, K. T. M., & Hoefnagels, C. (2010). Long-term effects of a home-visiting intervention for depressed mothers and their infants: Long-term effects of an early intervention. Journal of Child Psychology and Psychiatry, 51, 1160–1170. doi: 10.1111/j.1469-7610.2010.02268.xCrossRefGoogle Scholar
Kmet, L. M., Lee, R. C., & Cook, L. S. (2004). Standard quality assessment criteria for evaluating primary research papers from a variety of fields. Alberta Heritage Foundation for Medical Research. doi:10.7939/R37M04F16.CrossRefGoogle Scholar
Knapp, M., McDaid, D., & Parsonage, M. (2011). Mental health promotion and mental illness prevention: The economic case. Report published by the Department of Health, London. Available at: https://www.gov.uk/government/publications/mental-health-promotion-and-mental-illness-prevention-the-economic-case.Google Scholar
Lam, W. K., Fals-Stewart, W., & Kelley, M. L. (2008). Effects of parent skills training with behavioural couples therapy for alcoholism on children: A randomized clinical pilot trial. Addictive Behaviours, 33, 1076–1080. doi: 10.1016/j.addbeh.2008.04.002CrossRefGoogle ScholarPubMed
Larsson, B., Knutsson-Medin, L., Sundelin, C., & Trost von Werder, A. C. (2000). Social competence and emotional/behavioural problems in children of psychiatric inpatients. European Child & Adolescent Psychiatry, 9, 122–128. doi: 10.1007/PL00010708CrossRefGoogle ScholarPubMed
Lenze, S. N., Potts, M. A., Rodgers, J., & Luby, J. (2020). Lessons learned from a pilot randomized controlled trial of dyadic interpersonal psychotherapy for perinatal depression in a low-income population. Journal of Affective Disorders, 271, 286–292. doi: 10.1016/J.JAD.2020.03.084CrossRefGoogle Scholar
Loechner, J., Starman, K., Galuschka, K., Tamm, J., Schulte-Körne, G., Rubel, J., & Platt, B. (2018). Preventing depression in the offspring of parents with depression: A systematic review and meta-analysis of randomized controlled trials. Clinical Psychology Review, 60, 1–14. doi: 10.1016/j.cpr.2017.11.009CrossRefGoogle ScholarPubMed
Mattejat, F., & Remschmidt, H. (2008). The children of mentally Ill parents. Deutsches Arzteblatt International, 105, 413–418. doi: 10.3238/arztebl.2008.0413Google ScholarPubMed
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Clinical Epidemiology, 62, 1006–1012. doi: 10.1371/journal.pmed.1000097CrossRefGoogle ScholarPubMed
Murray, L., Cooper, P. J., Wilson, A., & Romaniuk, H. (2003). Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression. British Journal of Psychiatry, 182, 420–427.CrossRefGoogle Scholar
O'Donnell, M., Maclean, M. J., Sims, S., Morgan, V. A., Leonard, H., & Stanley, F. J. (2015). Maternal mental health and risk of child protection involvement: Mental health diagnoses associated with increased risk. Journal of Epidemiology and Community Health, 69, 1175–1183. doi: 10.1136/jech-2014-205240CrossRefGoogle ScholarPubMed
Pella, J. E., Drake, K. L., Tein, J. Y., & Ginsburg, G. S. (2017). Child anxiety prevention study: Impact on functional outcomes. Child Psychiatry and Human Development, 48, 400–410. doi: 10.1007/s10578-016-0667-yCrossRefGoogle ScholarPubMed
Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M. R., & Rahman, A. (2007). No health without mental health. Lancet (London, England), 370, 859–877. doi: 10.1016/S0140-6736(07)61238-0CrossRefGoogle ScholarPubMed
Punamäki, R. L., Paavonen, J., Toikka, S., & Solantaus, T. (2013). Effectiveness of preventive family intervention in improving cognitive attributions among children of depressed parents: A randomized study. Journal of Family Psychology, 27, 683–690. doi: 10.1037/a0033466CrossRefGoogle ScholarPubMed
Rasic, D., Hajek, T., Alda, M., & Uher, R. (2014). Risk of mental illness in offspring of parents with schizophrenia, bipolar disorder, and major depressive disorder: A meta-analysis of family high-risk studies. Schizophrenia Bulletin, 40, 28–38. doi: 10.1093/schbul/sbt114CrossRefGoogle ScholarPubMed
Reupert, A. E., Cuff, R., Drost, L., Foster, K., Van Doesum, K. T. M., & Van Santvoort, F. (2012). Intervention programs for children whose parents have a mental illness: A review. The Medical Journal of Australia, 199(Supplement 1), 18–22. doi: 10.5694/mja11.11145Google Scholar
Siegenthaler, E., Munder, T., & Egger, M. (2012). Effect of preventive interventions in mentally ill parents on the mental health of the offspring: Systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 8–17. doi: 10.1016/j.jaac.2011.10.018CrossRefGoogle ScholarPubMed
Solantaus, T., Paavonen, E. J., Toikka, S., & Punamäki, R. L. (2010). Preventive interventions in families with parental depression: Children's psychosocial symptoms and prosocial behaviour. European Child & Adolescent Psychiatry, 19, 883–892. doi: 10.1007/s00787-010-0135-3CrossRefGoogle ScholarPubMed
Stanger, C., Ryan, S. R., Fu, H., & Budney, A. J. (2011). Parent training plus contingency management for substance abusing families: A complier average causal effects (CACE) analysis. Drug and Alcohol Dependence, 118, 119–126. doi: 10.1016/j.drugalcdep.2011.03.007CrossRefGoogle ScholarPubMed
Stein, A., Netsi, E., Lawrence, P. J., Granger, C., Kempton, C., Craske, M. G., … Murray, L. (2018). Mitigating the effect of persistent postnatal depression on child outcomes through an intervention to treat depression and improve parenting: A randomised controlled trial. The Lancet. Psychiatry, 5, 134–144. doi: 10.1016/S2215-0366(18)30006-3CrossRefGoogle ScholarPubMed
Stuart, E. A., Bradshaw, C. P., & Leaf, P. J. (2015). Assessing the generalizability of randomized trial. Results to target populations. Prevention Science, 16, 475–485. doi: 10.1007/s11121-014-0513-zCrossRefGoogle ScholarPubMed
Sue, S., Zane, N., Nagayama Hall, G. C., & Berger, L. K. (2009). The case for cultural competency in psychotherapeutic interventions. Annual Review of Psychology, 60, 525–548. doi: 10.1146/annurev.psych.60.110707.163651CrossRefGoogle ScholarPubMed
Thanhäuser, M., Lemmer, G., de Girolamo, G., & Christiansen, H. (2017). Do preventive interventions for children of mentally ill parents work? Results of a systematic review and meta-analysis. Current Opinion in Psychiatry, 30, 283–299. doi: 10.1097/YCO.0000000000000342CrossRefGoogle ScholarPubMed
Van Doesum, K. T. M., Riksen-Walraven, J. M., Hosman, C. M. H., & Hoefnagels, C. (2008). A randomized controlled trial of a home-visiting intervention aimed at preventing relationship problems in depressed mothers and their infants. Child Development, 79, 547–561. doi: 10.1111/j.1467-8624.2008.01142.xCrossRefGoogle ScholarPubMed
Van Santvoort, F., Hosman, C. M. H., Janssens, J. M. A. M., van Doesum, K. T. M., Reupert, A., & van Loon, L. M. A. (2015). The impact of various parental mental disorders on children's diagnoses: A systematic review. Clinical Child and Family Psychology Review, 18, 281–299. doi: 10.1007/s10567-015-0191-9CrossRefGoogle ScholarPubMed
Van Santvoort, F., Hosman, C. M. H., van Doesum, K. T. M., & Janssens, J. M. A. M. (2014). Effectiveness of preventive support groups for children of mentally ill or addicted parents: A randomized controlled trial. European Child & Adolescent Psychiatry, 23, 473–484. doi: 10.1007/s00787-013-0476-9CrossRefGoogle ScholarPubMed
Verduyn, C., Barrowclough, C., Roberts, J., Tarrier, N., & Harrington, R. (2003). Maternal depression and child behaviour problems: Randomised placebo-controlled trial of a cognitive-behavioural group intervention. British Journal of Psychiatry, 183, 342–348. doi: 10.1192/bjp.183.4.342CrossRefGoogle ScholarPubMed
Weissman, M. M., Wickramaratne, P., Nomura, Y., Warner, V., Pilowsky, D., & Verdeli, H. (2006). Offspring of depressed parents: 20 years later. The American Journal of Psychiatry, 163, 1001–1008. doi: 10.1176/ajp.2006.163.6.1001CrossRefGoogle ScholarPubMed
Wille, N., Bettge, S., & Ravens-Sieberer, U. (2008). Risk and protective factors for children's and adolescents’ mental health: Results of the BELLA study. European Child & Adolescent Psychiatry, 17, 133–147. doi: 10.1007/s00787-008-1015-yCrossRefGoogle ScholarPubMed
World Health Organization (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.Google Scholar
Zhang, J., Slesnick, N., & Feng, X. (2018). Co-occurring trajectory of mothers’ substance use and psychological control and children's behaviour problems: The effects of a family systems intervention. Family Process, 57, 211–225. doi: 10.1111/famp.12279CrossRefGoogle ScholarPubMed
Zotero software [computer program]. Corporation for digital scholarship. Virginia, USA. Retrieved from https://www.zotero.org/.Google Scholar
Supplementary material: File

Lannes et al. supplementary material

Lannes et al. supplementary material

Download Lannes et al. supplementary material(File)
File 769.8 KB