As a multidimensional and universal stressor, the COVID-19 pandemic negatively affected the mental health of children, adolescents, and adults worldwide. In particular, families faced numerous restrictions and challenges. From the literature, it is well known that parental mental health problems and child mental health outcomes are associated. Hence, this review aims to summarize the current research on the associations of parental mental health symptoms and child mental health outcomes during the COVID-19 pandemic. We conducted a systematic literature search in Web of Science (all databases) and identified 431 records, of which 83 articles with data of over 80,000 families were included in 38 meta-analyses. A total of 25 meta-analyses resulted in significant small to medium associations between parental mental health symptoms and child mental health outcomes (r = 0.19 to 0.46, p < 0.05). The largest effects were observed for the associations of parenting stress and child mental health outcomes. A dysfunctional parent–child interaction has been identified as a key mechanism for the transmission of mental disorders. Thus, specific parenting interventions are needed to foster healthy parent–child interactions, to promote the mental health of families, and to reduce the negative impacts of the COVID-19 pandemic.

Children born to parents with a severe mental illness, like schizophrenia, bipolar disorder, or major recurrent depression, have an increased risk of developing a mental illness themselves during life. These children are also more likely to have developmental delays, cognitive disabilities, or social problems, and they may have a higher risk than the background population of experiencing adverse life events. This is due to both genetic and environmental factors, but despite the well-documented increased risk for children with a familial high risk, no family-based early intervention has been developed for them. This study aims to investigate the effect of an early intervention that focuses on reducing risk and increasing resilience for children in families where at least one parent has a severe mental illness. The study is a randomized clinical trial with 100 children aged 6–12 with familial high risk. It is performed in the context of the Danish health-care system. Families will be recruited from registers or be referred from the primary sector or hospitals. The children and their parents will be assessed at baseline and thereafter randomized and allocated to either treatment as usual or VIA Family. The intervention group will be assigned to a multidisciplinary team of specialists from adult mental health services, child and adolescent mental health services, and social services. This team will provide the basic treatment elements: case management, psychoeducation for the whole family, parental training, a safety plan, and potentially an early intervention if the child has mental problems. The study period is 18 months for both groups, and all participants will be assessed at baseline and after 18 months. The primary outcome measure will be daily functioning of the child, and the secondary measures are the psychopathology of the child, days of absence from school, family functioning, child’s home environment, and parental stress. This study is to our knowledge the first to explore the effects of a multidisciplinary team intervention that provides an intensive and flexible support to match the families’ needs for children with a familial high risk for severe mental illness. The study will provide important knowledge about the potential for increasing resilience and reducing risk for children by supporting the whole family. However, a longer follow-up period may be needed. ClinicalTrials.gov, NCT03497663 . Registered on 13 April 2018.

Background: Children of parents with a severe mental illness have an increased risk of developing a lifetime mental illness. We aimed to compare the effects of a preventive family‐based intervention, VIA Family, with treatment as usual (TAU) on these children's global functioning.Methods: Between 2017 and 2021, we conducted a pragmatic, rater‐blinded, two‐arm parallel‐group superiority trial in Denmark. Families with at least one child aged 6–12 years and at least one biological parent with schizophrenia spectrum disorder, bipolar disorder, or recurrent major or moderate depression were included. We randomly allocated 95 families with their 113 children to VIA Family or TAU (ratio 1:1). VIA Family was individually tailored and based on case management. The intervention included options for psychoeducation, parental support, and treatment for emerging child psychiatric symptoms. Blinded raters assessed children and their families at baseline and after 18 months. The primary outcome was the difference in change between groups at end‐of‐treatment in daily global functioning measured with the Children's Global Assessment Scale. Secondary outcomes were emotional and behavioral problems and days absent from school. We analyzed data blinded to allocation.Results: At post‐intervention, differences in mean change from baseline between VIA Family and TAU were non‐significant (CGAS: −1.20, 95% CI = −6.61; 4.21, p = 0.66), as were the differences on the secondary and exploratory outcomes.Conclusion: Contrary to our hypothesis, we did not find a superior effect of VIA Family compared with TAU. The short follow‐up period and large sample heterogeneity might explain the null findings. Therefore, a possible long‐term, preventive treatment effect has yet to be explored.

Selective preventive interventions aim to reduce mental illness in high-risk populations, yet the reasons why some children benefit while others do not remain unclear. This study explores participants’ perceptions of mechanisms contributing to change in a family-based preventive intervention for children of parents with severe mental illness. Using an exploratory sequential mixed methods approach, we conducted an abductive qualitative analysis of focus groups (eight parents, eight children) to identify narratives of mechanisms contributing to change. The qualitative findings informed a subgrouping variable for a quantitative post hoc exploratory subgroup analysis of secondary data from the VIA Family trial (N = 110). The qualitative findings indicate that child mental health problems, parents’ personal unmet needs from childhood, children’s relatedness to peers and family, and contextual family-focused activities contribute to change within selective prevention. Quantitative results indicated that parents motivated by a need for support at baseline exhibited meaningful improvements in the home environment upon enrollment in the experimental preventive intervention compared with families motivated to support science (mean change: 5.07, 95% CI 2.11 to 8.03). However, no significant subgroup differences were observed in changes in children’s global functioning between the allocation groups. Parents’ perceived need for support facilitated engagement and home improvements, while children’s relatedness to peers and family contributed to their intervention experiences. These findings emphasize the importance of motivation and social connections in intervention outcomes, contributing to the growing field of precision prevention. Future research should explore these mechanisms as potential mediators or mechanisms of action for selective prevention. ClinicalTrial.gov Identifier: NCT03497663.

Objectives: To examine labour market outcomes among spouses of individuals with a hospital‐recorded diagnosis of a mental disorder living with dependent children, compared with matched controls, and to assess whether these associations differ by sex. Methods: We conducted a nationwide, register‐based matched cohort study using data from Danish population registers from 2010 to 2022. Cases were spouses cohabiting with an individual diagnosed with a mental disorder and with at least one child aged 0–17 years living at home at the index date. Controls were matched 1:10 on age, sex, and cohabitation status and had no partner with a registered mental disorder at the index date. Outcomes were taxable income, degree of employment (percentage of full‐time employment), and receipt of sickness benefits, assessed from 5 years before to 5 years after the index date. Analyses used fixed‐effects linear models and conditional fixed‐effects logistic regression with both unadjusted and covariate‐adjusted estimates, and sex‐by‐case status interactions were examined. Results: The study included 54,080 cases and 468,541 matched controls. Across the observation period, spouses of individuals with mental illness had persistently lower income and degree of employment and higher odds of receiving sickness benefits than controls. Five years after the index date, cases had a 16% lower annual income and a 12 percentage point lower degree of employment compared with controls. Odds of receiving sickness benefits increased markedly in the year following the partner's diagnosis. Sex‐specific analyses showed that male spouses experienced larger relative income loss, whereas female spouses exhibited greater reductions in degree of employment and higher absolute levels of sickness benefit receipt. Conclusions: Spousal mental illness is associated with substantial and sustained labour market disadvantages in families with dependent children, even within a universal welfare system. The observed sex‐specific patterns suggest that caregiving‐related economic consequences are structured along sex‐specific divisions of labour. These findings highlight the need to consider spouses in policy responses to mental illness.

Background: Children of parents with severe mental illness are at markedly increased risk of developing psychiatric disorders themselves. Interventions that target family‐related risk and protective factors may represent a promising approach in preventive psychiatry. This study evaluated the long‐term effects of the VIA Family intervention, a family‐based program designed for children at familial risk of severe mental illness and their families. Methods: We conducted a 2.5‐year follow‐up of a randomized clinical trial comparing the VIA Family intervention with treatment as usual (TAU). Eligible participants were families with children aged 6–12 years at baseline and at least one biological parent with a current or past severe mental illness. Families in the intervention arm participated in VIA Family for 1.5 years. The primary outcome was child mental health, assessed with the Strengths and Difficulties Questionnaire (SDQ). Secondary outcomes were child global functioning and the quality of the home environment (support and stimulation). Trial registration: clinicaltrials.gov (NCT06218693). Results: At follow‐up, 65 out of 95 families (68% retention) participated, including 77 children. The estimated treatment difference for SDQ was −0.23 (95% CI: −3.11 to 2.66), indicating no measurable long‐term impact of the intervention on child mental health compared to TAU. No significant differences emerged between intervention and TAU groups for the secondary outcomes, changes in global functioning and home environment quality. Conclusion: Our findings highlight the challenges of achieving significant and specific impacts with interventions for families with children at familial risk for the development of mental illnesses. The results emphasize the need for further research to optimize family‐based programs for familial high‐risk populations.