Objectives Approximately 17–28% of families worldwide include a parent with mental health symptoms; their children are at elevated risk of psychopathology. The additional demands involved in caring for children with mental health disorders can influence parents’ mental health, but less is known about this association. The aim of this work was to investigate the association between children’s psychiatric disorder and parent mental health in a population-based probability sample of children in England and the factors that may have influenced this relationship. A better understanding of these relationships may yield insights relevant to education, clinical practice, and policymaking.

Methods Secondary analysis of the Survey of Mental Health in Children and Young People in England 2017 which included 9117 children aged 2–19 years. Multivariate logistic regression models tested for effects, mediation, and moderation. Children were diagnosed with a psychiatric disorder using the Development and Well-being Assessment [1] which includes highly structured questions about mental health conditions based on the Diagnostic and Statistical Manual 5^th edition. The 12-item General Health Questionnaire (GHQ) [2] was used to assess parents’ mental health.

Results More children with a psychiatric disorder had a parent in poor mental health (GHQ score of 4 or more) compared to children with no disorder. More parents in poor mental health had a child with a psychiatric disorder compared to parents in good mental health. This bidirectional relationship persisted for emotional disorders only. Significant correlates for both parent and child psychopathology were parents’ Strengths & Difficulties Questionnaire (SDQ) impact score, whether three or more stressful life events had affected them and unhealthy family functioning. There were significantly greater odds of a child being diagnosed with an emotional disorder if they had low self-esteem (adjusted odds ratio, aOR: 8.21, 95% Confidence Interval, CI: 5.51 – 12.24, p<0.001) and a neurodevelopmental disorder if they had special educational needs (aOR: 21.72, 95% CI: 8.29 – 56.92, p<0.001). There were significantly greater odds of a parent being in poor mental health if they were unemployed (aOR: 1.94, 95% CI: 1.53 – 2.46, p<0.001) and had a low household income (less than or equal to £15,205) (aOR: 1.31, 95% CI: 1.10 – 1.54, p=0.002).

Conclusions We found evidence for a bidirectional relationship between child and parent mental health, particularly emotional disorders. Parent SDQ impact score has powerful predictive ability in identifying children and parents who may be struggling. Mental health should also be screened for when a child is in contact with child and adolescent mental health services. Family-based interventions are necessary to improve family functioning and mitigate adverse life events, which can have beneficial effects for both members of the dyad.

References

1. Goldberg D. et al. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 1997;27(1): 191–197.

2. Goodman R. et al. The development and well-being assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. Journal of Child Psychology and Psychiatry, 2000;41(5): 645–655.