Study Review

Child mental illness prevention

Interventions for children whose parents have mental health problems, to help prevent them from experiencing problems themselves

Outcome	Overall effectiveness This rating shows how effective the intervention is at achieving the evaluated outcome. Click here for information about how effectiveness ratings are applied.	Strength of evidence This rating shows how confident we can be about a finding, based on how the research was designed and carried out.
Children's mental health	Overall effectiveness: 1 (maximum 2)	Strength of evidence : 2 (maximum 3)
Children's internalising behaviours	Overall effectiveness: 1 (maximum 2)	Strength of evidence : 2 (maximum 3)
Children's externalising behaviours	Overall effectiveness: 0 (maximum 2)	Strength of evidence : 2 (maximum 3)

Headline points

This summary comes from the original systematic review: Siegenthaler, E., Munder, T., & Egger, M. (2012). Effect of preventive interventions in mentally ill parents on the mental health of the offspring: systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 8-17
Positive effects on children’s mental health
Positive effects on internalising behaviours
Evidence was of a moderate strength

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What is this?

Children of parents who have mental health problems have an elevated risk of experiencing mental health problems themselves. In 2017-18, 43 per cent of children’s social care assessments in England identified concerns about mental health in the family. A variety of interventions have been developed to help the children of parents who have mental health problems (such as depression or anxiety disorders), to help prevent them from experiencing these problems themselves. These interventions tend to be based on cognitive, behavioural and psycho-educational principles and are delivered either in group sessions or 1:1. In some cases interventions targeted parental substance misuse problems. They are variously delivered by a range of different professional groups, including social workers, therapists, clinical psychologists and nursery nurses.

How is it meant to work?

The interventions included in the review involved a variety of strategies for improving parent and child participants’ mental health. These included:

Psychoeducation (e.g. providing information about child development, mental health disorders, the impact of poor mental health on individual functioning, and its impact on the family)
Skills training to improve problem solving, positive communication, relationships or parenting, or to reduce conflict and aggression
Techniques for self-management of symptoms, including relaxation, cognitive restructuring and identifying risk factors
Help to strengthen partner relationships, build support networks, increase positive activities and increase resilience in children
Support to remain abstinent from drugs and alcohol.

What are the evaluated outcomes?

Children's mental health
Children's internalising behaviours
Children's externalising behaviours

How effective is it?

This review summarises findings from 13 randomised controlled trials (RCTs) of a range of interventions that were designed to prevent children from experiencing the same mental health problems as their parents. The following specific outcomes were considered:

Children’s mental health

Overall, the preventative interventions tended to show a positive effect on children’s mental health. The interventions reduced the risk of a child developing the same mental health condition as their parent by 40 per cent. The length of the follow-up period varied between six months and 15 years. This finding is based on moderate strength evidence from six research trials involving 919 participants.

Children’s internalising behaviours

Overall, the preventative interventions tended to show a positive effect on children’s internalising behaviours, such as symptoms of negative emotions, depression or anxiety. Children who received an intervention had significantly lower scores for internalising symptoms than children allocated to a control group. This is based on moderate strength evidence from seven research trials involving 750 children.

Children’s externalising behaviours

Overall, the preventative interventions had no effect on externalising behaviours, such as hyperactivity, aggression or problem behaviours. Children in the intervention groups did not have significantly different scores from those allocated to a control group. This is based on moderate strength evidence from seven research trials involving 543 children.

Where has it been studied?

The review included 17 studies of 13 different research trials. Of these, nine were carried out in the USA, two in Canada, one in Finland and one in the UK.

Who does it work for?

This review did not carry out sub-group analysis to identify which groups of people were particularly likely to benefit. Participants in the research trials had the following characteristics:

Children were aged between newborn and 18 years. Individual studies addressed varying age ranges, with the smallest age range targeting only newborn babies and the largest age range spanning 11 years.
Parent mental health disorders included depression, anxiety, alcohol dependence, drug dependence and varied affective disorders.

In some cases eligibility for the study required that the parent had recently had an episode of poor mental health; lived in a specific area; was aged over 18; was taking drug replacement therapy or was abstinent from drugs or alcohol; was married or lived with a partner; or was English speaking. In some cases parents were excluded from the study if they had certain mental disorders, if their partner was abusive, if they were taking certain medication or if they had a substance misuse problem.

When, where and how does it work?

This review focused on the overall relationship between preventative interventions and mental health outcomes but not on the particular techniques or circumstances that affect them. The authors of the review noted that there was little evidence of variation between the interventions in relation to the mental health outcome and the internalising behaviour outcomes. It was hypothesised that the programmes might have been successful due to common factors (such as the empathy shown by professionals) rather than specific techniques. Further research could carry out a more detailed analysis of the techniques used in each programme and their relationship to particular outcomes.

What are the costs and benefits?

There is no information on the cost-benefit of this intervention.

How is it implemented?

There was considerable variation in how the 13 interventions included within this review were implemented. Some of the key features of implementation are set out below.

How is it delivered?

The number of sessions varied between 6 and 33. Where stated, individual sessions ranged between 1 hour and 2 hours in length.
Sessions took place over a period of time that ranged from one month to one year.
Some interventions were delivered with the individual mother, couple or family, some with groups of parents, some with family groups and some with groups of adolescents.

Who can deliver it?

The interventions were delivered by therapists with a range of professional backgrounds:

Clinical psychologists working with social workers
Clinical psychologists (with support from nursery nurses running separate children’s play sessions)
Master’s level therapists (some with additional addiction expertise)
Social workers working with psychologists
Nurses working with social workers and psychologists
Clinicians.

What supports good implementation?

In four of the research trials included in the review, the fidelity of the intervention was supported by the use of a manual or guidelines. In six other studies, methods for testing fidelity were used such as audio taping and rating sessions, or providing supervision to those delivering the intervention. In three of the trials, methods for maintaining fidelity were unclear.

Case study

The UK-based intervention included in this review, which was studied in the Manchester area, was a cognitive–behavioural therapy (CBT) group for mothers with depression. Groups of 6-8 mothers received 16 sessions of support, each session lasting for 1.5 hours, over a period of 16 weeks. The CBT groups were run by clinical psychologists who had been qualified for at least 5 years.

The mothers’ transport costs were covered to support their attendance. While the mothers took part in the CBT group, their children (aged between 2 and a half and 4 years old) attended play sessions staffed by nursery nurses.

The quality of the intervention was monitored through weekly supervision by an experienced clinical psychologist experienced in CBT supervision.

In summary...

Overall the interventions appeared to have a positive effect in preventing children from developing the same mental health condition as their parent, with the period of follow-up lasting between six months and 15 years
Overall the interventions also had a positive effect on reducing internalising behaviours (e.g. symptoms of depression or anxiety)
Findings from 13 separate trials were included in the review and they were implemented in varied ways. It is not clear whether the effectiveness of the interventions was influenced by the type of mental health condition, the types of techniques used or the intensity of the programme.
Only one of the studies included was carried out in the UK. This means that the overall findings may not be replicated in a UK context.
Future research should consider the cost of the programmes and whether they provide value for money.

Further resources

This summary comes from an original systematic review called: Effect of preventive interventions in mentally ill parents on the mental health of the offspring: systematic review and meta-analysis (Siegenthaler, E., Munder, T., & Egger, M.) Published 2012.