Report

Teaser, summary, work performed and final results

Periodic Reporting for period 2 - CAPRI (Children and Adolescents with PaRental mental Illness: Understanding the ‘who’ and ‘how’ of targeting interventions)

Teaser

One in four children lives with a parent with a mental illness. Family, educational and social lives of children and adolescents with parental mental illness (CAPRI) are disrupted by deprivation and repeated parental hospitalisations. This is an urgent political and public...

Summary

One in four children lives with a parent with a mental illness. Family, educational and social lives of children and adolescents with parental mental illness (CAPRI) are disrupted by deprivation and repeated parental hospitalisations. This is an urgent political and public health concern. The Child and Adolescent Mental Health in Europe (CAMHEE) report urges us ‘to acknowledge and attend to the needs of children and families with parental mental health. ’ recommending better information on CAPRI risks and resilience so interventions can target those at highest risk. This ground-breaking interdisciplinary programme exploits expertise in epidemiology and neuroscience to deliver on CAMHEE objectives for CAPRI.
Previous work focuses on these ‘high risk’ children primarily to examine mental illness heritability. In a crucial departure from this, our programme of work brings in collaborations in Sweden and Australia to create unique linkage across 3 population datasets. This work will detail CAPRI numbers and a broad range of life outcomes disentangling effects of social adversity over time. But population epidemiology alone cannot reveal how risk creates effects in individuals. To understand ‘how’ to identify ‘who’ we target for costly interventions, our work links the epidemiology with powerful neuroimaging (functional near infrared spectroscopy fNIRS) to discover which at-risk infants of mothers with severe mental illness show abnormal cognitive development at the level of individual brains.
Our broad objectives are thus to:
1. Estimate the numbers of CAPRI in Sweden, UK and Western Australia and explore if their number has changed over time. In addition we will investigate other environmental factors that contribute to CAPRI prevalence.
2. Investigate the fertility of adults with mental illness and explore if changes to therapies and care mean fertility is increasing.
3. Quantify the extent to which CAPRI are at risk (and are resilient to) physical health, social and economic adverse outcomes; and to explore factors that may confer additional risk and resilience.
4. Use information routinely captured during clinical care, to test if we can identify those CAPRI at greatest risk.
5. Measure vocal brain development in the infants of mothers with serious mental illness through the CAPRI-Voc Study.
6. For imaging analysis purposes, infants will be stratified into ‘highest’ and ‘lowest’ risk within the risk-subset using the clinical-risk algorithm derived epidemiologically from population data captured via objectives 3 and 4.
7. Comparing highest and lowest risk children, we shall validate our clinical algorithm by determining if the risk sets from epidemiological measures predict early language development assessed using fNIRS and Bayley’s assessments.
Three complementary work packages will run in parallel. Robust population prevalence estimates will be detailed across countries by gender, age and time (Work Package (WP) 1). By combining across the national cohorts (WP2), we can then understand ‘Who’ is resilient and ‘Who’ is at risk across their lives. We will also identify the most pertinent predictors of resilience or risk with which to develop a risk model for 3 clusters of outcome: cognitive and neuropsychiatric; social and health care utilisation; and social and criminal justice. These measures will then be used to predict risk status for mothers in WP3 whose data will be collected via the clinical cohort study.

Work performed

Workpackage (WP) 1:
We are pleased to announce the completion of WP 1 and these are the main findings.

Prevalence of CAPRI
• Almost 1 in 4 children in the UK lives with a mother with a mental illness and 1 in 7 children in Sweden lives with a mother or father with a severe mental illness.
• These estimates are higher than previously thought, providing further evidence of the public health priority of this group. In both datasets we show that the proportion of CAPRI is higher in adolescence and we provide evidence that the proportion is increasing over time.
• These children are more likely to live in deprivation and to teenage parents.
• Children with a parent with a mental illness are almost three times more likely to be in a household where both parents are unemployed and 21% live in families in the lowest quintile of income in the population.
• The effect that becoming a mother has on mental illness is much stronger for teenagers than older women. This means that teenage mothers should be targeted for interventions aimed at reducing post-natal mental illness.

Mental illness and fertility
• People with mental disorder have significantly fewer children than healthy adults.
• In the UK we found (counter to our initial hypothesis) that the change from first to second generation antipsychotics did not appear to improve fertility in women with psychosis.
• Whilst mental illness in general is associated with lower fertility, in teenagers it is associated with significantly higher fertility. This has important consequences because teenage parents with mental illness are likely at significantly higher risk of worsening symptoms. Also the children of mentally ill, teenage parents are likely to be a vulnerable group, in need of significant support.

WP 2:
We have made significant progress with WP 2 and here are our main findings to date:

Risks of CAPRI

Physical Health

• A systematic review investigating the association between parental mental illness and physical health in the offspring has been completed.
• This has found evidence of an increased risk associated with parental mental illness of atopic disorders, infections, injuries and, in studies conducted in lower and middle income countries, diarrhoea and vomiting.
• The review also revealed significant gaps in the literature: it was noted that the literature focuses almost exclusively on common mental disorders and particularly on maternal (not paternal) exposures.
• Detailed analyses of injuries associated with parental mental illness in the Swedish registry data has been conducted. This shows a significant increase in the risk of injuries, particularly in the early years and more so for common, rather than severe, parental mental illness.
• Parallel papers from the UK and Western Australia demonstrate healthcare use associated with parental mental illness. CAPRI are seen in general, specialist and acute care more frequently than children of well mothers.
• In the UK, every healthcare contact has been costed and it is estimated that there is a half a billion pounds annual excess cost to the National Health Service associated with CAPRI.
• A study investigating the vaccination uptake in CAPRI has been undertaken and reports that maternal mental illness contributes significantly to missed vaccinations in the UK.

WP3: Vocal brain development of CAPRI (CAPRI-Voc)

The clinical cohort study ‘CAPRI-Voc’ is fully underway which aims to recruit women with serious mental illness and their infants in order to measure the children\'s vocal brain development. Key achievements to date are highlighted below.


• The CAPRI-Voc Ethical Review Board has been convened with membership from key independent experts in ethics, research and psychiatry, overseeing the ethical aspects of the CAPRI-Voc Study ensuring the highest standards are maintained throughout.
• Successful submissions to the relevant UK regulatory authorities, including

Final results

Expected results until the end of the project
• An analysis is planned of UK primary care data to quantify the risk of atopic disease for CAPRI.
• Furthermore analysis using Swedish data will investigate other physical diseases: cancers, auto-immune diseases and infections.
• An investigation in to the poverty associated with CAPRI and school grades, socioeconomic and social outcomes amongst CAPRI will take place
• CAPRI-Voc study recruitment will complete and will enable full analysis of the data collected