Having a Parent with Mental Illness

by SAMHSA

(Page 9 of 20)

Research indicates that children who have a parent with mental illness are more likely to develop psychosocial difficulties. Studies, however, have focused primarily on elaborating sources of risk, rather than identifying sources of resilience. Mental illness in parents interacts with, or is associated with many variables and processes that can confer risk upon or enhance the resilience of children. No attention has been paid to children's subjective experiences or reports of what is useful to them in coping with their families' circumstances.

Research on Outcomes for Children

Two decades of research have unequivocally indicated that children who have a parent with mental illness are at significantly greater risk for multiple psychosocial problems. Studies have noted rates of child psychiatric diagnosis among offspring ranging from approximately 30% to 50%, as compared to an estimated rate of 20% among the general child population. These same children are more likely to show developmental delays, lower academic competence, and difficulty with social relationships. Despite these risks, many children of parents with mental illness are resilient and appear to "avoid" significant problems.

Why do some children exposed to parental illness do well while others struggle? Active research in the area has revealed that mental illness itself does not guarantee poor outcomes. Instead, mental illness in parents interacts with, or is associated with many variables and processes that can enhance resilience or confer risk upon children. Thus, there are many potential avenues for intervention, and research is beginning to turn its attention to these important issues.

It is important to note that the research on child outcomes has been limited in several ways. The majority of studies have focused on white, middle-class families in which the mother has an affective disorder diagnosis. Thus, our understanding of the processes of risk and resilience, and appropriate related interventions, is limited with respect to other diagnoses, among more diverse families. Similarly, little is known about cultural and ethnic differences in the relationship of parental mental illness and child outcomes.

Pathways of Influence

In a recent review of the literature on the risk for psychopathology among children of depressed mothers, Goodman and Gotlib (1999) define a model that provides a useful framework for the current discussion. Although their model focuses on "risk" for poor outcomes, i.e., psychopathology, it provides a framework for discussing both risk and resilience among children who have a parent with mental illness.

Based on existing data, Goodman and Gotlib (1999) identify pathways between parent diagnosis of depression and child outcomes that involve multiple mediating and moderating processes. Mediators explain why, or through what mechanisms, parental mental illness is related to child outcomes, while moderators influence the quality of the relationship, or to what degree parental mental illness impacts child outcomes. Specifically, Goodman and Gotlib (1999) propose that parental depression is related to several "mechanisms of risk" (i.e., mediators) that result from parental depression. These confer vulnerability on the child that ultimately leads to psychopathology. In addition to these mediating factors, the authors list moderating factors that interact with mediating variables to increase risk for child vulnerability and negative outcomes. Moderators distinguish between different subgroups of families in which a parent has a mental illness. For example, availability of a father without mental illness in the context of maternal mental illness can enhance child outcomes, such that families with a second parent do better, and single-parent families do worse. Availability moderates the relationship of parental mental illness and child outcomes.

Mediators of the Relationship of Parental Mental Illness and Child Outcomes

Genetic Influences. Research clearly indicates that certain mental illnesses run in families. This is true whether studies begin with a cohort of adults with psychiatric diagnoses and examine rates of diagnosis among their children; or with a cohort of children with diagnoses and examine rates of mental illness or symptomotology among parents. There may also be specificity for transmission of diagnosis from parents to children. Children of parents with affective disorders are more likely to manifest affective disorders than other disorders, children of parents with an anxiety disorder are more likely to manifest anxiety disorders, and children of parents with both depression and anxiety are more likely to manifest similar comorbidity.

The strong evidence for increased prevalence of diagnosis within families does not however, "prove" heredity of mental illness. It is difficult to tease out genetic from environmental influences in families where both genes and environment are shared. Risk for diagnosis among children may result from the stressful and disruptive environment potentially created by a parent's illness, a child's illness, or the multiple stressors (e.g., family disruption) that co-occur with psychiatric diagnoses for both adults and children. Thus, research strategies that can distinguish between genetic and environmental influences are necessary to understand the relative role of these two factors. Recent research has begun to employ such strategies.

Twin and adoption studies are generally considered the "gold standard" in genetic research. Both have supported a unique role for heredity in the transmission of mental illness from parent to child. Twin studies have shown that monozygotic twins who share identical genetic structure, show significantly higher concordance rates for schizophrenia and anxiety than dizygotic twins, who share no more genetic similarity than any siblings. Adoption studies further reveal that adopted-away children of parents with schizophrenia and anti-social personality disorder are at greater risk for these or related diagnoses, respectively, than adopted-away children whose parents did not have these diagnoses. However, a large study of adopted children in Finland showed that risk for schizophrenia may result from an interaction between genetic predisposition and difficult adopted-family environment.

Using a complementary strategy of investigation, Todd et al. have examined extended families of adults with affective illnesses. They found that risk for diagnosis was greater among first-degree relatives and offspring, compared to second and lesser degree relatives. In addition, they found that bipolar disorder showed stronger heritability than unipolar depression.

About the Author

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