Course:SOWK551/2021/Impact and Outcomes to Children Due to Parental Mental Health Challenges
Literature review of the impacts and outcomes of parental mental health challenges on child developmental wellbeing.
Author: Manpreet Kaur
Date: December 11/2022
As society becomes more aware of mental health impacts (Renwick et al., 2022), the dialogue needs to include families in mental health treatment plans, including children (Perocier, 2022). Although it is widely known abuse and neglect can negatively impact children (Scully & McLaughlin & Fitzgerald, 2020), little is discussed on parental mental health, and how this impacts children. Studies have shown that transgenerational transmission of parents' mental illnesses can increase the risk factors for children (Christiansen et al., 2015). The implications of this directly impact children's development, and also continues on into adulthood (Laletas & Reupert & Goodyear, 2020). Understanding the impact to children's mental health can support health prevention, and increased initiatives in this sector (Renwick et al., 2022).
This literature review will synthesize the literature of the outcomes to children with parental mental health challenges. Peer-reviewed articles were gathered from the dates 2000-2003 to more recent literature dated 2015-2022. Sources were found on google scholar and UBC Library databases. The keywords “outcomes to children with parental mental illness”, “Interventions for children with parental illness”, “impact on children's mental health”, were used interchangeably to gather relevant literature on the topic. Three main themes/patterns arised from the literature highlighting how children are impacted by parental mental health: 1) interaction of genetic and environmental factors, 2) mental health, behavioral, and emotional challenges, and 3) the need and outcomes of interventions. This paper will also highlight limitations of the literature, and conclude with application to Social Work practice.
Interaction of Genetics and Environmental Factors
Research has shown that there is an interaction between genetics and environmental factors that impact the vulnerability of a child’s developmental wellbeing (Yin, 2016). Studies have indicated if a parent has a mental illness, the child may also inherit the same mental health illness through genetic transmission, or develop other challenges (Barnes & Stein, 2000). In recent literature, a study was conducted to find psychiatric associations using genetics, clinical diagnosis and brain imaging; which found that 5 major mental illnesses had a single gene polymorphism: schizophrenia, bipolar disorder, major depressive disorder, autism and attention deficit hyperactivity disorder (Su & Chen & Tu, 2022). Recognizing that genes play a vital role in pre-determining children's likelihood of developing a mental illness, can support communities implementing more services for this population, especially for more common diagnosis.
Regardless of gene transmission, the environment plays an influential factor in a child developing a mental illness. It is important to also recognize that although data has shown that boys have a higher risk for externalizing, while girls have higher chance of internalizing problems (Barnes & Stein, 2000), the research is limited in its findings of those that identify as non-binary or trans. There are a number of factors that can offset children's risk and wellbeing, such as family dynamics, parental substance use, parental divorce, housing/location, culture/ethnicity, violence and socio-economic levels (Renwick et al., 2022; Varnaite & Sambaras & Lesinskiene, 2022). For example, research has shown that if a child is socio-economically disadvantaged, along with a parent who has a mental illness, they are more likely to be at risk (Barnes & Stein, 2000). Studies have also found that risk factors such as abuse and neglect in a family with sociocultural factors, can increase the chances of a child developing a personality disorder (Orme & Fowler & Oldham, 2022).
Research has indicated that parental mental illness is a risk factor for children developing mental illnesses (Sameroff & Seifer, 2021). Parental mental illness was also associated with children having internalized and externalized mental health problems, which could also predict the child’s depression over time (Scully & Mclaughlin & Fitzgerald, 2020). A link was also found between parental mental illness with higher rates of mortality in children (Varnaite & Sambaras & Lesinskiene, 2022). The results of the largest longitudinal study indicated that children of parents with major depressive disorder had an increased chance of developing panic disorder, phobias, substance dependency, and social impairment (Barnes & Stein, 2000). Research also found that fathers who had PTSD, resulted in children having greater risk of poor family functioning (Scully & Mclaughlin & Fitzgerald, 2020). There was also a study that suggested mothers with borderline personality disorder (BPD) had increased chances of their child developing BPD symptoms (Orme & Fowler & Oldham, 2022). Additionally, parents with mental illnesses that had over-barring personality traits when it came to parenting (i.e. over-controlling, lack of warmth, harsh punishments, over-involvement), increased the chances of children developing personality disorders (Orme & Fowler & Oldham, 2022). It appears through the many studies conducted, depending on the diagnosis and environmental factors, researchers can pre-determine if a child will face challenges. Understanding these risk factors, can predisposition a worker to providing additional support to these families.
Secondly, children are more prone to behavioral health problems in the core stages of child and adolescence development (Washington et al., 2022). Studies have shown that if there is healthy parenting and family functioning in the household, and children do not experience maltreatment, children have less behavioral challenges (Washington et al., 2018). However, due to parental mental illnesses, it can influence parenting characteristics, cause parenting challenges, and impact parent-child interactions; for example, a parent that is withdrawn, may be unable to give the child appropriate level of attention, which can lead the child developing behavior issues (Barnes & Stein, 2000). Additionally, parental mental illness can also lead to parents modeling negative behavior, thus causing the child to imitate this as well (Scully & Mclaughlin & Fitzgerald, 2020). In contrast, another study found that a parent's mental illness had limited effect on child’s behavior during early childhood; however when observing the mothers with severe mental illnesses, the child's behavior was impacted during early years (i.e. lower developmental score) (Sameroff & Seifer, 2021). Although this study found that low-income households had lower child development when compared to higher socioeconomic households (Sameroff & Seifer, 2021), its research had limitations as it only used single mothers for participants, and not fathers. This limitation is critiqued as more fathers are becoming sole caregivers, thus should be included more in research. The study also poses a discrepancy if negative parenting and lack of affection is solely due to the mental illness, or mainly due to social factors. Additionally, although literature is limited in discussing race, it is important to acknowledge the role that race plays on children's life experiences, that also impacts their behavior and mental wellbeing (Washington et al., 2018; Scully & Mclaughlin & Fitzgerald, 2020).
Thirdly, historical evidence has shown that infants and children need strong attachments with their caregivers in order to develop secure emotional bonds (Orme & Fowler & Oldham, 2022). However, what happens when a parent has a mental illness? Parental mental health challenges negatively impact children's emotional health (Varnaite & Sambaras & Lesinskiene, 2022). For example, parents may struggle to develop emotional attachments with their child due to having depressive symptoms (Scully & Mclaughlin & Fitzgerald, 2020), which can later lead to emotional challenges (Barnes & Stein, 2000). Research also revealed that if a parent has a personality disorder, then it can impact the parents ability to role model emotional regulation to the child (Seeger, 2022). Additional studies also showed that mothers who develop postnatal depression, the child is more likely to struggle with cognitive tasks (Barnes & Stein, 2000). However it is important to also recognize that limited research has been done when it comes to fathers and their role in attachment and mental health. Ultimately, these findings reveal that parents who struggle with forming attachments with their child, may require more support from the community.
Need and Outcomes of Interventions
Negative mental health outcomes are lessened when there is improvement in the child's environment; therefore it is important to understand which psychosocial factors need to be targeted in the intervention, as this supports healthier outcomes for children (Washington et al., 2018). Research found that if family members are included, the treatment results are beneficial to both family and individual (Overbeek et al., 2022). Many parents want to support their children about their illness (Afzelius & Plantin & Ostman, 2018), however there are only a few evidence-based interventions for this population (Christiansen et al., 2015). That being said, there is also a lack of regard for including children in treatment approaches (Maybery & Reupert & Goodyear, 2015). When children do not comprehend or understand their parents' mental illness, it can lead to them feeling confused, left out and attributing the family conflict to themselves (Barnes & Stein, 2000). In addition, since children may not ask for help, they do not get access to professional help that could support them with parental mental illness (Varnaite & Sambaras & Lesinskiene, 2022). Adu (2022) study revealed that due to familial mental health stigma, education and training should be provided to families, and that individuals with mental illness should be involved. This echoes Perocier (2022) study that discussed how patients are prone to be in repeat treatments with limited results, as families are not included in the intervention. Perocier (2022) also states that mental health treatment should take an ecological and systemic approach as an essential way for clients to not have to repeatedly re-enter treatment.
Family, Psychoeducation Intervention
Furthermore, evidence-based practices of the use of psychosocial interventions are best supported with the inclusion of family and psychoeducation intervention (Torrey et al., 2022) . Implementing evidence-based family interventions can positively impact family relationships (i.e. lessen family conflict, children living in calmer atmospheres), regardless of the type of family intervention (Afzelius & Plantin & Ostman, 2018). A common evidence-based practice is family psycho-education intervention, which has a wide framework that includes: family psychoeducation, individual consultation, various forms of family therapy, short-term family education programs, and support classes/groups (Dixon et al., 2001). Christiansen et al (2015) study found that psycho-education such as, ‘Family Talk Interventions’, resulted in children becoming more knowledgeable on their parents' mental illness post intervention; while parents also exhibited positive changes in reducing their externalizing symptoms.
However, family and psychoeducation interventions are rarely used in healthcare services, especially with early interventions (Malla & McGorry 2019). Although these interventions support family communication, and children becoming educated on parental mental health, there is limited studies done on implementing these interventions in the day to day clinical context (Afzelius & Plantin & Ostman, 2018). Additionally, the challenges occur when children and parents goals conflict with each other, for example if the parents treatment goal requires respite from the child, but child requires more attention from the parent (Maybery & Reupert & Goodyear, 2015). Lastly, interventions solely do not reduce relapse rates of individuals becoming hospitalized again, however by continuing ongoing skills training, having support about managing the mental illness, and providing emotional support to families, this can positively impact individuals and families (Dixon et al., 2001).
Additional Limitations to Literature
It is relevant to acknowledge that most literature defines mental illnesses as a separate entity, like for example parents who have depression or parents who have schizophrenia. There was limited discussion of dual mental illnesses, and focused on singular mental illnesses. Although literature touched base on demographics and environmental factors, it was limited in its discussion on various intersectionality's connected to children and parents. More research is needed to discuss how intersectionality and multiple mental illness diagnoses impact the well-being of children. This will create more inclusiveness for a wider range of interventions and treatment. Additionally, it is equally important to acknowledge that many children are resilient, and the onset of genetics or environmental factors do not necessarily claim that children will develop mental illnesses (Barnes & Stein, 2000). However, the literature was very limited on discussing the resilience and strength of children. As such, further research is needed in focusing on strengths and resilience of children of parental mental illness in order to develop more holistic and broadened interventions. Furthermore, there are limitations in the research regarding how to implement these interventions in direct practice, or on a mezzo community level within the healthcare sector. Lastly, the literature did not touch base on the barriers that healthcare professionals face that make it difficult to practice or implement these types of interventions.
Application to Social Work
Healthcare Social Workers already take on a vital role in recognizing various risk factors such as environmental factors when they complete psychosocial assessments, with the use of a person-in-the-environment perspective. By including children in their parents mental health treatment plan, it can positively impact children's mental health, behavioral and emotional well-being. However, there is a lack of inclusion of children in treatment planning, which is where Social Workers can fill in that gap. Using the information of this literature review, Social Workers can take preventative measures such as implementing family and psychoeducation interventions. Recognizing the consequences to children, Social Workers should advocate to health teams to also incorporate educating children on their parents' mental illness; especially as parental mental illness can increase children's likelihood of developing a mental illness or other challenges. Although this may not be at the forefront of the team's agenda, research reveals that by incorporating education to children, it can positively impact their developmental wellbeing, and family functioning. Patient-centered care should include having stable environments (i.e. family), which can greatly influence the wellbeing of parents and their children.
Additionally, as the literature tends to limit its discussion on the strengths and resiliency of families, Social Workers should also aim to shed light on the resilience and value that children bring to parental well being as well. Lastly, since the environment is a key factor that impacts children, it is equally important for Social Workers to take a social justice lens, and advocate for more accessible services. This will promote mental wellbeing in children, especially those that come from lower socioeconomic families. Social Workers can reveal findings in this literature review as a way to change the discourse of treatment planning when it comes to parental mental illnesses, and child wellbeing.
In conclusion, children are impacted by parental mental illness by genetic and environmental risk factors that influence their mental health, behavioral and emotional developmental wellbeing. Current literature recognizes that these issues still challenge children, and that is why it is crucial for the healthcare sector to take a vital role of implementing evidence-based interventions, such as psychoeducation intervention as a way to support the child, parent and family. Social Workers have the privilege of beginning these conversations, and implementing interventions. Social Workers also have the unique role and discipline where they can advocate for change on the mezzo and macro levels.
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