Understanding how family processes affect children's mental health: Implementing an international and interdisciplinary programme of research

Lead Research Organisation: University of Sussex
Department Name: Sch of Psychology

Abstract

Mental health problems among youth in the UK are steadily on the increase. Family relationship experiences and parent mental health symptoms have been identified as factors that may underlie individual differences in children's symptoms of psychopathology. Yet questions remain as to the relative role of family level influences on children's mental health problems and the factors that may mediate and/or moderate these associations. The proposed programme of research will employ four complementary datasets that together will advance understanding of the interplay between family interaction patterns, parent mental health problems and child symptoms of psychopathology (e.g., depression, conduct problems). These datasets include a longitudinal US adoption-at-birth sample (N>500), a UK sample of children conceived through in vitro fertilization (IVF, N>1000), a UK longitudinal sample of adolescent children at familial risk for depression (N>300), and a cohort longitudinal study of children followed from birth to present age 38+ years (N>900, living in New Zealand). The proposed programme of research will advance three core objectives: (1) to substantively improve understanding of how family relationship processes and parent mental health problems affect mental health outcomes for children and adolescents, and to identify factors that mediate and moderate pathways, (2) to implement a mentorship model that will help develop world-class methodological and knowledge-transfer skills that will promote prospects for a sustainable career of international standing in the future, while also contributing to the promotion of transferable skills for UK social science, and (3) to facilitate engagement with relevant practice and policy agencies to promote knowledge transfer and implementation of findings in order to advance the next generation of intervention and prevention programmes with the objective of improving outcomes for children and families in the UK (and internationally). Collectively, a central objective of the proposed programme of research is to facilitate advanced training in two primary areas. First, training in the application of advanced multivariate statistics and the analysis of longitudinal data will be emphasised throughout the training/fellowship period. Second, training will be directed toward promoting skills development that facilitate engagement with practice and policy agencies in relation to dissemination and impact related activities specific to the programme of research outlined. Mentorship, training and support in these areas will allow the applicant to compete at an international level in relation to emerging knowledge and skills in this area in the future, and also contribute to the development of a recognised skills deficit in the UK in the area of advanced multivariate statistics, thereby improving the knowledge base in this area and increasing the prospect of knowledge transfer for future UK social scientists. Principal mentorship support will be provided by Professor Gordon Harold (University of Sussex) within the research environment provided by the School of Psychology and the Rudd Centre for Adoption Research and Practice. This Centre is a newly established centre of excellence for the study of family processes and child development and the utilisation of large-scale data resources with the expressed purpose of generating evidence-led knowledge for the development of intervention-prevention programmes and working with practice and policy agencies in the UK and internationally. Collectively, the proposed programme of research, mentorship model, and access to practice and policy partners will help locate the applicant as a future world leader in the field of child and adolescent mental health, an area of recognised critical social, clinical and policy relevance to the UK.

Planned Impact

The proposed programme of research linked to this fellowship application will offer benefits in the short and long-term to academic, child and family policy, practitioner, and advocacy agencies working to help promote positive outcomes for children and families in the UK and internationally. In addition, advanced training in multivariate statistics and the analysis of longitudinal data will be provided for the applicant that will both promote the prospects of an independent academic career and help consolidate an emerging reputation as a researcher of international standing. As outlined in the proposed programme of research, the project will utilise a longitudinal US adoption-at-birth sample (N>500), a UK sample of children conceived through in vitro fertilization (IVF, N>1000), a UK longitudinal sample of adolescents at familial risk for depression (N>300), and a cohort longitudinal study of children followed from birth to present age 38+ years (N>900, living in New Zealand). Across the complementary research design attributes that these national and international data resources represent, the project will advance three core objectives: (1) to substantively advance understanding of how family relationship processes and parent mental health problems influence adverse mental health outcomes for children and adolescents, and to identify factors that mediate and moderate pathways, (2) to implement a mentorship model that will help develop world-class methodological and knowledge-transfer skills that will promote prospects for a sustainable career of international standing in the future, while also contributing to the promotion of skills in this area for UK social science, and (3) to facilitate engagement with relevant practice and policy agencies in the UK and internationally to promote knowledge transfer and implementation of findings to advance the next generation of intervention and prevention programmes with the objective of improving outcomes for children and families in the UK (and internationally). While findings derived from the proposed programme of research will retain relevance to promoting new knowledge relating to family process influences on child and adolescent mental health among biologically related parents and children (as has been the predominant focus of past research in this area), the project also offers unique opportunity to advance knowledge and understanding of these questions and related processes specific to children and parents who are not fully genetically related to each other (e.g. adoption, foster-care, assisted reproduction). Practice and policy based partnerships already established through the Rudd Centre for Adoption Research and Practice will facilitate impacts of benefit to children, parents and families in the UK (and internationally), as represented by core study objectives and proposed pathways to impact. In addition, training and dissemination activities linked specifically to the application of advanced statistical methods to the analysis of longitudinal data will be a core focus of project linked impact activities. Utilisation of secondary data resources (both nationally and internationally) requires the application of state-of-the-art data analytic approaches if these resources are to be fully maximised and if the UK is to retain capacity at an international level in this area of expanding interest (e.g., utilising existing UK and international cohort studies). Training in the application, interpretation and implementation of research findings to relevant practice and policy domains using advanced statistical methods, as well as dissemination of knowledge to other UK social scientists using these approaches will serve as a centrepiece of the proposed programme of research.

Publications

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Collishaw S (2019) Brief report: A comparison of child mental health inequalities in three UK population cohorts in European Child and Adolescent Psychiatry

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Harold GT (2018) Annual Research Review: Interparental conflict and youth psychopathology: an evidence review and practice focused update. in Journal of child psychology and psychiatry, and allied disciplines

 
Description Evidence from several key papers sourced from this grant (Harold, Leve, Sellers, 2017, Child Development; Sellers et al., 2019, in press, Adoption and Fostering) demonstrates robust associations between the inter-parental relationship, parenting and risk for child mental health difficulties using biosocial research designs (such research designs aim to understand the interplay between biology, experiences and behaviours over time and thus enable our understanding of the complex pathways and mechanisms that impact on child mental health). Interventions targeting the inter-parental relationship and parenting processes show significant intervention related reductions in child internalizing and externalizing problems. However, most evidence-based parenting and couple-focused interventions result in small to medium effects on children's emotional and behaviour problems. Findings from this research proposes that there is opportunity to improve upon these interventions through incorporation of knowledge from genetically sensitive research designs. Three core recommendations are provided for practitioners engaging in intervention work with children and families. These recommendations are contextualized relative to what genetically sensitive research designs can tell us about the role of the inter-parental relationship and parenting behaviours on child outcomes (Harold et al, 2017).

In addition, I contributed to an annual review paper (Harold & Sellers, 2018 Journal of Child Psychology and Psychiatry). This reviews evidence and presents a theoretical model highlighting how children can be affected by inter-parental conflict whether parents are living together or not (e.g., context of separation or divorce) and whether parents are biologically related to their child or not (e.g., context of adoption, foster care, step parents). We also review the evidence base of effect intervention and prevention program development and policy implications of the research. This represents a comprehensive review of the most-up-to-date evidence in this area.

In addition to comprehensive reviews of the current evidence, there are a number of specific research findings from this project that have examined how family processes (e.g. parent-child relationships; inter-parental relationships) and parent mental health can impact on child outcomes (including emotional problems, disruptive behaviours, inattention problems, peer problems and academic outcomes). These are outlined briefly below:

(i) We have examined a cascade model of family processes on child development and mental health employing general population cohorts (Millennium cohort Study, MCS; Growing up in Ireland, GUI), with a view to employ cost-benefit approaches to case models. This research found that, across both datasets, parent depression was associated with lower inter-parental relationship quality, which in turn was associated with increased hostility in the parent-child relationship. This was linked to early child emotional dysregulation. Both parent-child relationship quality and early child emotional dysregulation were linked to a range of later child outcomes (emotional problems, behavioural problems, hyperactivity problems, peer problems, and academic problems).
(ii) We have examined inter-generational processes using a longitudinal cohort (Christchurch Health and development Study), examining bidirectional/reciprocal processes in a general population cohort (Christchurch Health and Development Study; CHDS). We identified reciprocal processes between maternal depression symptoms and child conduct problems across late childhood to early adolescence. Further collaborative work is ongoing to examine the role of genetic risk (e.g., Polygenic Risk Scores) for child mental health (using CHDS).

(iii) We have examined the directional of associations between parenting and child psychopathology (depression and aggression) in a longitudinal high-risk sample of parents with recurrent depression and their adolescent offspring (Early Prediction of Adolescent Depression; EPAD). We found that maternal hostility was associated with an increase in adolescence aggression symptoms (boys and girls). In addition, for boys, aggression symptoms predicted change in maternal hostility. Maternal hostility and warmth were not related to change in offspring depression symptoms or vice versa. Findings suggest different risk pathways to depression and aggression in offspring of depressed parents.

Together these studies suggest a cascade of risk such that family processes (parent mental health, inter-parental conflict; parenting) can impact on a range of child outcomes. In addition, child mental health can also impact on parents (both in terms of their mental health and parenting) highlighting the importance of holistic supports within families.

(iv) We have also examined trends in mental health using a range of UK cohort studies to further-develop understanding of risk processes for child mental health (National Child Development Study, NCDS; Avon Longitudinal Study of Parents and Children, ALSPAC; British Child and Adolescent Mental Health Surveys, BCAMHS; Millennium Cohort Study, MCS). These studies suggested that (a) Child mental health problems have become more strongly associated with negative social, educational and mental health outcomes in recent generations and (b) that marked child mental health inequalities exist. The mental health gap between advantaged and disadvantaged children has not reduced over the last 20 years and may be getting worse. These two studies are both currently 'in press'.
(v) Additional work employing this (cross-cohort comparison) approach examines the role of maternal smoking in pregnancy on child development. The study examined associations in two cohorts 40 years apart: cross-cohort designs can aid causal inference through comparison of associations across populations with different confounding structures. The study finds that maternal smoking in pregnancy was less common and more strongly associated with social disadvantage in the more recent cohort. Maternal smoking in pregnancy was robustly and equivalently associated with infant low birth weight (LBW) in both cohorts. In contrast, maternal smoking was more strongly associated with conduct problems, hyperactivity and reading in the more recent cohort. Evidence therefore supports a causal link between maternal smoking and child birth weight, but links between maternal smoking and child conduct problems, hyperactivity and reading are likely influenced by residual confounding. This study provides proof of principle that the cross-cohort comparison design works as expected and is a useful complement to other research designs testing causal explanations.

(vi) We have examined a range of family processes on child development in families who were not genetically related (Early Growth and Development Study: Adoption-at-birth design) to examine environmental processes for the inter-generational processes of mental health. We focus on both maternal and paternal mental health, maternal and paternal parenting, as mediating and moderating processes for the development and child depression and aggression. Ongoing work also examines the role of maternal and paternal positive parenting.

These findings have been presented at a range of conferences and are in the process of being submitted to journal. Further work in this area and further outputs are pending.
Exploitation Route These findings highlight the importance of family factors for the development of child mental health. This work has already been taken forward, with evidence used in policy (see Harold et al., 2016; Acquah, Sellers, Stock & Harold 2017). In addition, this work has led to ongoing collaborative efforts with staff at the Department for Work & Pensions (DWP) to assist in screening and measuring inter-parental conflict with the aim to target supports for families and improve outcomes for children. Further work in this area is on-going.
Sectors Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice

 
Description This work has been taken forward and used in policy: research has informed a report for the Department for Work and Pensions, examining family processes, specifically inter-parental conflict on child mental health outcomes (see Harold et al., 2016). This has also informed further work with the Department for Work and Pensions and the Early Intervention Foundation. This work examines the inter-parental relationship quality for child mental health outcomes in the context of poverty (see Acquah, Sellers, Stock & Harold 2017) and examines cost-benefit analyses to reduce societal costs of inter-parental conflict (Harold, Chowdry et al., 2017). The works has provided an evidence base to inform policy and identify how to train frontline practitioners in these key areas to identify risk processes.
First Year Of Impact 2016
Sector Communities and Social Services/Policy,Government, Democracy and Justice
Impact Types Policy & public services

 
Description Assisted in the development of an evidence resource for Department for Work and Pensions which accompanies a policy document to assist with knowledge tranfser to practitioners
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
Impact The evidence resource accompanies a policy document (Helping Workless Families) and has led to government announcements on the importance of investing in inter-parental relationship support regardless of whether parents are living together or not to help remediate risks for children. This represents a fundamental shift in policy which has previously focused on marital status. This has led to on-going discussions with the Department for Work and Pensions (DWP) to assist in appropriate recognition of adults with high levels of inter-parental conflict.
URL https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/605988/evidence-resource-i...
 
Description Government Internal working document: Reducing Societal Costs of Inter-Parental Conflict: Introducing a Cascade Model to Estimate Cumulative Cost Benefit Analysis (CBA): see publications section
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description Inter-parental conflict and outcomes for children in the contexts of poverty and economic stress: Implications aimed at improving outcomes for children (see publications section)
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
Impact The evidence resource accompanies a policy document (Helping Workless Families) and has led to government announcements on the importance of investing in inter-parental relationship support regardless of whether parents are living together or not to help remediate risks for children, with a particular focus on workless families. This represents a fundamental shift in policy which has previously focused on marital status. This has led to on-going discussions with the Department for Work and Pensions (DWP) to assist in appropriate recognition of adults with high levels of inter-parental conflict.
 
Description NSPCC Roundtable on Mental Health Support for Abused and Neglected Children, Conservative Party Conference October 2016
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description Review: What Works to Enhance Inter-parental Relations
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
Impact The Review: 'WHAT WORKS TO ENHANCE INTER-PARENTAL RELATIONSHIPS AND IMPROVE OUTCOMES FOR CHILDREN' outlines key evidence on the relevance of inter-parental relationships for child outcomes for children, as well as evaluating intervention evidence. This evidence has led to a shift in policy thinking with evidence included in a forthcoming government policy statements. It has also prompted additional work of policy relevance with the Department for Work and Pensions to focus on specific vulnerable groups.
 
Description work contributed to the development of UK government policy document (Helping Workless Families)
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
Impact The evidence resource (see relevant policy impact sections) accompanies this specified policy document (Helping Workless Families) and has led to government announcements on the importance of investing in inter-parental relationship support regardless of whether parents are living together or not to help remediate risks for children. This represents a fundamental shift in policy which has previously focused on marital status. This has led to on-going discussions with the Department for Work and Pensions (DWP) to assist in appropriate recognition of adults with high levels of inter-parental conflict - this involves training the workforce in understanding the implementation of standardized assessments, as well as understanding the importance of inter-parental conflict for youth mental health .
URL https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/621364/improving-lives-hel...
 
Description Funding to examine the added value of Child Contact Centres in Wales
Amount £4,999 (GBP)
Organisation Welsh Assembly 
Sector Public
Country United Kingdom
Start 06/2016 
End 09/2016
 
Description Access to Christchurch Health and Development data set 
Organisation University of Otago
Country New Zealand 
Sector Academic/University 
PI Contribution Have begun conducting analyses with the data set.
Collaborator Contribution Provided access to the data and contributed to scientific papers for publication. Collaboration as part of this Fellowship also will provide additional data access and statistical training.
Impact Data analysis and preparation for publication is ongoing during the life of this grant. Therefore it is too early to report outputs specific to this grant.
Start Year 2016
 
Description Cardiff University 
Organisation Cardiff University
Country United Kingdom 
Sector Academic/University 
PI Contribution Attend regular meetings at Cardiff University to contribute to scientific discussions. Have contributed to research papers. I also contribute to teaching
Collaborator Contribution Part of the collaboration is to access data.
Impact Relevant papers have been included in the publication section. This collaboration is multi-disciplinary spanning developmental psychology, psychiatry and genetics. My Fellowship is in collaboration with researchers at Cardiff University.
Start Year 2016
 
Description Oregon collaboration and data access 
Organisation University of Oregon
Department Oregon Social Learning Centre
Country United States 
Sector Academic/University 
PI Contribution Writing papers and presenting at conferences the findings
Collaborator Contribution Providing data access and contributing to writing papers for publication
Impact Two poster presentations have been accepted at SRCD. Several papers are currently under review by the team before submitting for publication. The fellowship is in collaboration with Oregon and visits to their site to develop skills in data analyses are planned as part of the fellowship.
Start Year 2016
 
Description Attend Parliamentary event hosted by Caroline Lucas 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Attended parliamentary event at the House of Comments, November 2017. This involved discussions with policy makers, practitioners and third sector organizations. Discussions focused on the importance of youth mental health, and the relevance of intervention and preventions strategies across child development. The discussions outlined the importance of considering multiple factors that can impact on youth mental, and discussed the utility of the evidence resource (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/605988/evidence-resource-improving-lives-helping-workless-families-web-version.pdf ; see other entry in policy impact section) for all practitioners working with adults or children with an interest in promoting positive youth mental health. Discussions with members of ACAMHS (Association for Child and Adolescent Mental Health Services) have led discussions of potential opportunities (either via blog posts or video links) to help promote research in this area, with a key focus on translating research into practice, and promoting the evidence tool as an important and relevant resource.
Year(s) Of Engagement Activity 2017
 
Description Blog post for Capita One following keynote presentation at Youth Justice Convention 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Third sector organisations
Results and Impact The blog post outlined the evidence for the importance of the inter-parental relationship for child outcomes, specifically in the context of Youth Justice Services. The piece also outlined policy and practice implications of the evidence as well as providing recommendations and areas for future research (Family Relationship Influences on Youth Mental Health: Moving from Evidence to Implementation. Blog post, Capita One. https://www.capita-one.co.uk/resources/blog/family-relationship-influences-on-youth-mental-health-moving-from-evidence-to)
Year(s) Of Engagement Activity 2018
URL https://www.capita-one.co.uk/resources/blog/family-relationship-influences-on-youth-mental-health-mo...
 
Description Deliver presentation at Council conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Delivering presentation to Hertfordshire Council regarding the importance of inter-parental relationship for child mental health. This presentation outlines recent research evidence and policy and practice implications.
Year(s) Of Engagement Activity 2017
 
Description Edinburgh University Network Event 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact The aim was to discuss intersections of violence in childhood, learning outcomes and educational practices to help develop a new conceptual model. The working group discussed key research areas that would be relevant to a new conceptual model. Some members of the group were organising travel to a range of different countries e.g. war torn countries and areas where domestic abuse is common to conduct focus groups.
Year(s) Of Engagement Activity 2016
 
Description Presentation to Brighton & Sussex Medical School (BSMS) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Presented initial research findings to researchers and practitioners at Presentation to Brighton & Sussex Medical School (October 2017). The presentation examined the interplay between parent - child mental health, considering an intergenerational transmission framework. The presentation involved outlining complex statistics and research designs to address specific research questions to a non-specialist audience. Discussions following the presentation involved requests for further information and discussions around future inter-disciplinary research projects.
Year(s) Of Engagement Activity 2016
 
Description Presentation to Practitioners regarding the Evaluation of the AdOpt parenting programme 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Outlined an evaluation of the AdOpt parenting programme to practitioners who delivered the AdOpt parenting programme across the UK
Year(s) Of Engagement Activity 2016
 
Description Presentation to genetic counselling students (annually) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact A lecture on genetics of child and adolescent depression. This involved outlining existing and on-going research including a discussion on the environmental risks and gene environment interplay.
Year(s) Of Engagement Activity 2016,2017,2018
 
Description Think Piece for Action for Children 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Think piece for Action for Children written outlining the evidence for the importance of the inter-parental relationships for child positive outcomes. The piece also outlined policy and practice implications of the evidence as well as providing recommendations and areas for future research.
(What Role does the Inter-parental Relationship play in Supporting Positive Child Development in the Early Years and Enhancing Outcomes in Later Life? Think Piece, Action for Children. https://www.actionforchildren.org.uk/media/8960/think-piece_inter-parental-relationships.pdf)
Year(s) Of Engagement Activity 2017
 
Description Training to Barnardos (Wales) Practitioners 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Developed and trained Barnardo's (Wales) workers in delivery and interpretation of an assessment tool that increases understanding of child mental health outcomes following exposure to inter-parental conflict
Year(s) Of Engagement Activity 2016,2017
 
Description presentation & school visit (Supporting Student Mental Health: Understanding Risk and Resilience Processes) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Presented to all school staff at a secondary school for CPD training. Presented research evidence regarding risk factors and processes for the development of mental health problems. This led to a discussion regarding identification of mental health problems and the importance of mental health training and awareness. Met with all senior leadership team, as well as support staff. This has led to a subsequent invitation from the school to discuss mental health with school pupils, and discussions regarding assisting with the identification of mental health difficulties in students
Year(s) Of Engagement Activity 2019
 
Description presentation to aid collaboration with University of Otago 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Invited presentation (Examining the interplay between parent-child mental health: Revisiting an Inter-generational transmission framework) of research profile and ongoing research proposals to aid collaborations with University of Otago. This led to the discussion of the importance of environmental processes for child development and mental health, as well as considering child-effects on parents in relation to inter-generational transmission processes. Some practitioners reported a change of opinion and a reduction of negative attitudes towards some of the parents they worked with to support children. Audience members requested further information, and links to published works from the research group to use evidence in teaching and practice.
Year(s) Of Engagement Activity 2018