Life trajectories in offspring of parents with psychiatric diagnoses: A population-based register study

Research problem and specific questions: About one quarter of all children have parents with mental health problems. These children are at increased risk for a wide range of adverse outcomes.

Nevertheless, despite the importance of reducing this form of inequality, research on the intergenerational transmission of mental health problems is plagued by three important limitations.

These include an overreliance on small samples and retrospective (biased) reports; a failure to address psychiatric comorbidity; and inadequate control of unmeasured confounding.

The aim of this project is to answer three research questions: 1) What are the associations between psychiatric diagnoses in parents and adverse outcomes in their children? 2) Can these be attributed to broad comorbidity? 3) Does treatment of the parents’ psychiatric disorders reduce the risk of adverse outcomes in children?Data and method: We will include all individuals born in Sweden between 1970 and 2000 (N = 2 797 086).

The exposures are 6 psychiatric diagnoses in their parents, and the outcomes are 34 adverse events in the offspring recorded until the end of 2019 (e.g., psychiatric disorders, psychotropic medications, criminality, school and employment problems, etc.).

We will estimate associations between the exposures and outcomes; adjust for comorbidity using multiple regression and a general factor model; and apply causal inference techniques to control for unmeasured confounding.Plan for project realisation: We will hire a PhD student and a postdoc to complete the project.

The PI, along with experts in epidemiology and psychiatry, will provide support.Relevance: Our project will contribute to the study of intergenerational transmission of mental health problems in three important ways.

First, because psychiatric treatment resources are becoming increasingly scarce as more individuals seek help, parental psychiatric history can help guide treatment allocation by identifying those at higher risk and by screening out low risk persons.

Second, we will highlight the importance of focusing on parental comorbidity, which will guide clinicians to additionally focus on the number of parental diagnoses (rather than only type) when predicting patient prognosis.

Third, if a parental psychiatric diagnosis appears causally related to an outcome, then it would be beneficial to develop a policy for child and adolescent mental health providers to recommend that the parent also seek treatment.