Parental eating disorder

Four reviews on parental eating disorders and child outcomes were found (Astrachian-Fletcher et al., 2008; Coulthard et al., 2004; Park et al., 2003; Patel et al., 2002). Young children present with growth and feeding problems and attachment and behavioral problems while older child report with concerns about shape and weight, and mental health problems including eating problems. In comparison to boys, girls with a mother with an eating disorder have a higher risk of developing eating problems. These studies offer some proof of transgenerational concordance in adolescent girls (i.e., where the risk in children is mainly restricted to developing the same disorder as the parent), but the concept of transgenerational multifinality fits best for the diverse outcomes of children (a wide range of negative child outcomes). There is evidence that parental eating disorder increases the risk of parenting difficulties and adverse outcomes for children. There is genetic risk vulnerability for children. Other risk factors for children include family problems, marital difficulties, disturbed parenting behavior towards children’s weight and shape, and the parent’s own eating behaviors. The gender of the child (where girls are more at risk than boys), low birth weight, and not being breastfed are other variables associated with risk to children. Finally, there is more risk to children when there is an accumulation of risk factors.

Parental substance-use disorder

Five review studies describe the outcomes of children of parents with a substance-use disorder. There is some proof of concordance for sons of fathers with alcohol-abuse disorder (where sons develop the same disorder as their father). Family history of alcohol abuse is linked to early onset and heavy use of alcohol in adolescence (Leonard et al., 2007). However, these children also present with various internalizing and externalizing problems. Peleg-Oren and Teichman (2008) did not find evidence of concordance, possibly because of the wide age range of the children involved in the study (4–18 years, where very young children do not use alcohol). All reviewed studies found more evidence for transgenerational multifinality than for concordance. This means that the children of alcohol- or substance-abusing parents may develop psychosocial, behavioral, and attachment problems as well as poor academic functioning (Magura et al., 1996; Steinhausen et al., 1995). Harter et al. (2000) found no difference in the development of problems in adult children of alcoholics compared to other high-risk populations (children of parents with other mental illnesses, survivors of childhood abuse or trauma, and persons from other dysfunctional family environments). Both groups had a higher level of psychosocial problems and psychopathology (e.g., depression and anxiety) than the rest of the population.

A wide range of risk factors was found for families with parental substance abuse including one or more of the following: prenatal exposure (fetal drug exposure), comorbidity of personality disorder, severity of the substance-use disorder, two parents with substance-use disorder, parental discord, deficits in parenting, disrupted family life, economic difficulties, exposure to anger and aggression, multiple foster care placements, and early psychopathology in children. Peleg-Oren and Teichman (2008) indicated that the availability of support systems and maintenance of family routines were protective factors for such families.

Parental anxiety disorders

Two meta-analytic/systematic review studies were included on parental anxiety disorders (Ding et al., 2014; Glasheen et al., 2010), and one systematic review assessed anxiety disorders as well as other parental disorders (van Santvoort et al., 2013). Since the two reviews focused on parental anxiety disorders but not on whether children developed an anxiety disorder themselves, no conclusions regarding concordance can be drawn, though some evidence was found for multifinality. Ding et al. (2014) found that children of anxious mothers have a lower birth weight and are more likely to be born preterm than children of nonanxious women. Glasheen et al. (2010) found that anxiety in mothers is related to children having more somatic complaints, such as colic and recurrent abdominal pain, a more difficult temperament, more delays in social and cognitive development, and more behavioral problems and psychopathology than other children. At the same time, Glasheen et al. (2010) highlighted other studies which do not show significant differences in outcomes between children of mothers with anxiety and mothers without anxiety. Similarly, van Santvoort et al. (2013) failed to show evidence of multifinality and instead concluded that the majority of the studies on children of anxious parents showed that these children more often had anxiety disorders themselves than children of nonanxious parents (concordance).

Risk factors found to increase the risk of children of anxious mothers include the mother not receiving psychological/medication treatment for her disorder, living in an area with limited resources, poor maternal physical health, the presence of medical or obstetric risks, maternal comorbidity, and stressful life events.

Parental bipolar disorder

Three systematic review studies on parental bipolar disorder were included (DelBello and Geller, 2001; Duffy et al., 2011; Narayan et al., 2013) and one systematic review which assessed bipolar disorders as well as other parental disorders (van Santvoort et al., 2013). Duffy et al. (2011) focused on psychopathology and bipolar disorders in offspring and found evidence for concordance: that is, children of parents with bipolar disorder were mainly at risk of developing bipolar disorder themselves (a wide range of negative child outcomes – multifinality – was only shown in children of parents with comorbidity).

The three other review studies focused on other child diagnoses and outcomes, finding evidence of transgenerational multifinality (Delbello and Geller, 2001; Narayan et al., 2013; van Santvoort et al., 2013). For example, children of parents with bipolar disorder demonstrated elevated rates of depressive, substance-use, conduct, oppositional-defiant, and anxiety disorders; problems with cognitive functioning (executive functioning problems and poorer performance IQ) and neurobiological functioning (e.g., enlarged hippocampal volumes); and disturbances in reality testing (psychotic symptoms, cognitive disruptions, and thought problems).

All reviews found that children with low socioeconomic backgrounds, those who had parents with comorbidity issues, and those whose other parent also had a psychiatric disorder had the highest risk of developing problems themselves. Other potential risk factors involved the type and severity of parental bipolar disorder, concurrent parental impairment, presence of psychotic features, gender of affected parent, and age of onset of the parental disorder. Specific protective factors included having leisure time, engaging in social activities, and the presence of a healthy father.

Parental depression

Five studies on children of parents with unipolar depression were included (two meta-analyses: Goodman et al., 2011; Grote et al., 2010; two systematic reviews: Gunlicks and Weissman, 2008; Mendes et al., 2012; one narrative literature review: Beardslee et al., 2011; and one systematic review that assessed children of parents with unipolar depression as well as children of parents with other disorders: van Santvoort et al., 2013). The five review studies that assessed multiple child outcomes all found evidence of multifinality (Beardslee et al., 2011; Goodman et al., 2011; Grote et al., 2010; Gunlicks and Weissman, 2008; van Santvoort et al., 2013). Children of depressed parents had higher rates of internalizing problems/disorders, externalizing problems/disorders, general psychopathology, depression, anxiety disorders, negative emotion/behavior, cognitive delays, academic and social failure, physical problems, preterm birth and low birth weight, and lower rates of positive emotion/behavior. Moreover, reduction or remission of parental depressive symptoms was related to reductions in child symptoms such as emotional and behavioral problems, psychiatric diagnoses, academic and global functioning, and mother–child relation/interaction problems. Mendes et al. (2012) assessed the association between depression in parents and children, which was present, but could not draw conclusions on the presence of concordance since no other child outcomes were studied.

Evidence of various risk factors was found, influencing the strength of the relationship between depression in parents and various child outcomes including low family income, belonging to an ethnic minority population, marital conflict, child abuse, severity and chronicity of parents’ depression, comorbidity issues in a parent, a parent receiving no treatment, difficult child temperament, and vulnerabilities in the child such as poor interpersonal functioning, depressogenic cognitive style, and high negative affect.

Child age, child gender, and parent gender appeared to affect various child outcomes differently. Moreover, these factors seemed to interact with each other, though the results were far from conclusive. Goodman et al. (2011) found that girls of depressed mothers were more susceptible to developing internalizing problems than boys, and Mendes et al. (2012) found that older girls especially were at risk of developing depression. Beardslee et al. (2011) reported a trend for boys of depressed parents to be more likely to develop externalizing problems, though this was not found by Goodman et al. (2011), who instead reported a similar risk of externalizing and internalizing problems in boys and girls. Mendes et al. (2012) suggested that externalizing problems in children were more related to family dysfunction than to parental depression. Connell and Goodman (2002) found that depression in mothers was more related to internalizing problems in children than depression in fathers, a relationship that appeared to be moderated by the child’s age: younger children of depressed mothers were more at risk of developing problems than older children.

Children of parents with various types of psychopathology

Rasic et al. (2014) compared outcomes in offspring of parents with severe mental illnesses, including schizophrenia, bipolar disorder, and major depressive disorder. Children of parents with severe mental illness had a probability of 32% to develop severe mental illness themselves. While they showed a higher risk of developing the same disorder present in their parent, they also presented with other types of mental disorders. Offspring of parents with schizophrenia had increased rates of mood disorders; the risk of schizophrenia was significantly increased in children of parents with bipolar disorder but not in children of parents with depression. Hence, the results fit with the concepts of both transgenerational concordance and transgenerational multifinality.

Connell and Goodman (2002) found some evidence for multifinality: children of parents with various disorders (alcohol or substance abuse, depression, anxiety disorders, schizophrenia, antisocial personality disorder, and bipolar disorder) showed increased rates of internalizing as well as externalizing problems. At the same time, evidence was found of equifinality, as all parental disorders except bipolar disorder had elevated correlations with internalizing problems in children, and all parental disorders except bipolar and schizophrenia had high correlations with externalizing problems in children.

Van Santvoort et al. (2013) also found evidence of multifinality in children of parents with unipolar depression and bipolar disorder. For children of parents with anxiety disorder, more evidence was found of transgenerational concordance: children had high rates of anxiety disorders but not of other negative outcomes. Evidence of equifinality was found as well: children of depressed, bipolar, and anxious parents all showed elevated rates of anxiety disorders. Moreover, unipolar depression, conduct disorders and ADHD, affective disorders, and mental disorders in general were more evident in children of depressed parents as well as in children of bipolar parents.