A family history of severe mental illness (i.e. major depression, bipolar disorder or schizophrenia) is an important risk factor for developing mental health problems. Over 50% of children with a parent with severe mental illness will develop a mental disorder by early adulthood, demonstrating a tangible transfer of risk from affected parents to offspring, referred to as the intergenerational transmission of risk for mental illness.
The intergenerational transmission of risk for mental illness in offspring of patients is insufficiently considered in clinical practice. Healthcare systems do not sufficiently utilise (and in most cases substantially neglect) family history of mental illness into diagnostics and care of offspring of parents with a mental health disorder. This may lead to delays in diagnosing young offspring and missing opportunities for protective actions and resilience strengthening. Currently, healthcare professionals are in need for tools or guidelines, or even a change in the system, to pay adequate consideration to a more family-based approach.
Research in family members has shown that the onset of mental illness is governed by a complex interplay between genetic factors and environmental factors. Biological mechanisms, like epigenetic processes and brain development, may explain some of the relationship between genetic and environmental factors, and how they ultimately materialise into mental disorders along the lifespan. Importantly, the increased familial risk of mental illness can be dampened by resilience factors, including supportive parenting style or social support, that themselves can be of genetic or environmental origin (or both).
Despite ample evidence that mental illness runs in families, how and when risk for mental illness is passed from parents to offspring is still poorly understood. Therefore, FAMILY aims 1) to advance our understanding of the aetiology of familial risk for and resilience to mental illness, thereby providing new targets for prevention and intervention studies and 2) to construct a prediction model to predict who is at the highest risk to develop mental health problems later in life, using environmental, clinical, behavioural information, and biological information of parents and offspring.
Individually predicting the risk for mental disorders in children of affected parents would radically change the clinical approach to mental illness. Critically, ethical and social consequences need careful attention and appraisal, such as the right not to know or the risk of stigma. Therefore, our third aim is to provide insights into social and ethical issues related to risk prediction to inform guidelines.
