An estimated 25% of children in Germany live with a parent who is affected by mental illness. These children are at a high risk of psychological and developmental disorders, including severe mental illness (SMI).1 Indeed, the trans-generational transmission of mental disorders (TTMD) seems to be a major risk factor for SMI development in children.2 Children of parents with a mental illness (COPMI) are thus likely to comprise the next generation of patients with a mental illness and represent a target high-risk group for prevention programs.
In 2009, Hosman et al., proposed a model to explain TTMD.3 By this model, TTMD comprises four major domains: the parent, family, child and social environment. These domains interact with their respective systems and are influenced by five transmission mechanisms: genetics, prenatal factors, parent-child interactions, family, and social factors. While much research has provided support for these individual domains and transmission mechanisms, research testing the TTMD model as a whole to explain SMI risk in affected children is lacking. Earlier this year, researchers in Germany announced the development of the randomized controlled multicenter study known as COMPARE — Children Of Mentally Ill Parents At Risk Evaluation. The study aims to test the components of the TTMD model and establish the efficacy and cost-effectiveness of a high-quality randomized controlled trial (RCT) that aims to interrupt TTMD in COPMI.
As can be found in their Clinical Study Protocol published in Frontiers in Psychiatry, Hanna Christiansen and colleagues will address five key sub-topics in the model-testing part of COMPARE. The first, known as COMPARE-family, will test the TTMD from parents to children. This sub-topic comprises the central RCT to COMPARE, testing the effects of high quality parental cognitive behavioural therapy (CBT) versus parental CBT plus Positive Parenting Program (CBT+PPP) on children. COMPARE-emotion will use behavioural measures, peripheral physiological markers and neuro-imaging techniques to assess emotion processing and regulation in COPMI and the impact on TTMD. COMPARE-interaction will investigate parent–infant interactions, and how maternal co-morbid depression and anxiety in the peri-partum period affects infant development. COMPARE-work will assess the working conditions of mentally ill parents compared to healthy parents and the effects that working conditions have on the family. Finally, COMPARE-school will investigate the effects of parental mental illness on youth academic achievement, psychosocial adjustment and child well-being.
The researchers hope that COMPARE will establish specific transmission profiles for a range of parental disorders with or without co-morbidities and will identify the risk profiles for children at high versus low risk. Gaining this information is anticipated to improve the development of targeted TTMD interventions.
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Christiansen, H., Reck, C., Zietlow, A-L., Otto, K., Steinmayr, R., Wirthwein, L., Weigelt, S., Stark, R., Ebert, D.D., Buntrock, C., Krisam, J., Klose, C., Kieser, M. & Schwenck, C. (2019), Children of Mentally III Parents at Risk Evaluation (COMPARE): Design and Methods of a Randomized Controlled Multicenter Study – Part I. Front. Psychiatry 10:128. doi:10.3389/fpsyt.2019.00128.
Stracke, M., Gilbert, K., Kieser, M., Klose, C., Krisam, J., Ebert, D.D., et al. (2019), COMPARE Family (Children of Mentally Ill Parents at Risk Evaluation): a study protocol for a preventive intervention for children of mentally Ill parents (triple P, evidence-based program that enhances parentings skills, in addition to gold-standard CBT with the mentally Ill parent) in a multicenter RCT–part II. Front. Psychiatry. 10:54. doi: 10.3389/fpsyt.2019.00054.
German Clinical Trials Register, Clinical Trial Registration: DRKS-ID: DRKS00013516. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013516.
1Wille, N., Bettge, S. & Ravens-Sieberer, U. (2008), Risk and protective factors for children’s and adolescents’ mental health: results of the BELLA study. Eur Child Adolescent Psychiatry. 17:133–47. doi: 10.1007/s00787-008-1015-y.
2van Santvoort, F., Hosman, C.M., Janssens, J.M., van Doesum, K.T., Reupert, A. & van Loon, L.M. (2015), The impact of various parental mental disorders on children’s diagnoses: a systematic review. Clin. Child Family Psychol. Rev. 18:281–99. doi: 10.1007/s10567-015-0191-9.
3Hosman, 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. Aust e-J Advancement Ment Health. 8:250–63. doi: 10.5172/jamh.8.3.250.