Psych · Child and adolescent psychiatry — family and prevention
Children of parents with mental illness
Also known as COPMI · CPMI · Children of parents with mental illness · Offspring of parents with mental illness · Parental mental illness and child outcomes · Family-focused practice adult mental health
Exam-exhaustive fellowship reference on children of parents with mental illness — epidemiology, multi-pathway risk transmission, assessment of parenting capacity, dual loyalty and child-protection interface, STAR*D-child parental remission effects, Beardslee-style preventive family intervention, and multi-agency care. FRANZCP-primary, globally tagged.
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Red flags
- Dependent child cannot safely remain with caregivers tonight because of parental psychosis, mania, severe neglect, or violence — escalate emergency protection and do not discharge to unresolved danger
- Adult mental health admission with no named care plan for dependent children
- Adolescent young carer with self-harm, food insecurity, or covering for parental illness without support
- Reasonable suspicion of significant harm or emotional abuse — multi-agency report principles apply despite dual loyalty to the parent-patient
- Infant with failure to thrive or unsupervised care during parental acute illness
- Collusion with family secrecy that leaves siblings unassessed after one child discloses risk
Meet the patient
Your adult inpatient is a 34-year-old woman, day three of an admission for a depressive episode with psychotic features. She is improving. The discharge summary is drafted and the bed is needed.[1][6]
Nowhere in three days of notes does anyone record that she has an eight-year-old son and a fourteen-year-old daughter, that the daughter has been getting her brother to school, or that nobody has asked who is doing that tonight.[1][7]
Two questions decide this discharge: who is caring for those children right now? and is treating this woman's illness the most effective child mental health intervention available to you today? The answer to the second is often yes.[1][6]
References16ShowHide
- [1]Reupert AE, J Maybery D, Kowalenko NM Children whose parents have a mental illness: prevalence, need and treatment Med J Aust, 2013.PMID 25369850
- [2]Rasic D, Hajek T, Alda M, Uher R Risk of mental illness in offspring of parents with schizophrenia, bipolar disorder, and major depressive disorder: a meta-analysis of family high-risk studies Schizophr Bull, 2014.PMID 23960245
- [3]Uher R, Pavlova B, Radua J, et al. Transdiagnostic risk of mental disorders in offspring of affected parents: a meta-analysis of family high-risk and registry studies World Psychiatry, 2023.PMID 37713573
- [4]Dean K, Stevens H, Mortensen PB, et al. Full spectrum of psychiatric outcomes among offspring with parental history of mental disorder Arch Gen Psychiatry, 2010.PMID 20679590
- [5]Goodman SH, Gotlib IH Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission Psychol Rev, 1999.PMID 10467895
- [6]Weissman MM, Pilowsky DJ, Wickramaratne PJ, et al. Remissions in maternal depression and child psychopathology: a STAR*D-child report JAMA, 2006.PMID 16551710
- [7]Beardslee WR, Gladstone TR, Wright EJ, Cooper AB A family-based approach to the prevention of depressive symptoms in children at risk: evidence of parental and child change Pediatrics, 2003.PMID 12897317
- [8]Siegenthaler E, Munder T, Egger M Effect of preventive interventions in mentally ill parents on the mental health of the offspring: systematic review and meta-analysis J Am Acad Child Adolesc Psychiatry, 2012.PMID 22176935
- [9]Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study Am J Prev Med, 1998.PMID 9635069
- [10]Gilbert R, Widom CS, Browne K, et al. Burden and consequences of child maltreatment in high-income countries Lancet, 2009.PMID 19056114
- [11]Weissman MM, Berry OO, Warner V, et al. A 30-year study of 3 generations at high risk and low risk for depression JAMA Psychiatry, 2016.PMID 27532344
- [12]Teicher MH, Samson JA Annual Research Review: Enduring neurobiological effects of childhood abuse and neglect J Child Psychol Psychiatry, 2016.PMID 26831814
- [13]Cohen JA, Mannarino AP, Kliethermes M, Murray LA Trauma-focused CBT for youth with complex trauma Child Abuse Negl, 2012.PMID 22749612
- [14]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292
- [15]Olds DL, Eckenrode J, Henderson CR Jr, et al. Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial JAMA, 1997.PMID 9272895
- [16]Glaser D Emotional abuse and neglect (psychological maltreatment): a conceptual framework Child Abuse Negl, 2002.PMID 12201163