Periodic Reporting for period 4 - CAPRI (Children and Adolescents with PaRental mental Illness: Understanding the ‘who’ and ‘how’ of targeting interventions) Periodo di rendicontazione: 2021-04-01 al 2022-09-30 Sintesi del contesto e degli obiettivi generali del progetto 1 in 4 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, 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 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 (WA) and explore if their number has changed over time. We will investigate other environmental factors that contribute to CAPRI prevalence.2. Investigate the fertility of adults with mental illness exploring 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 illness6. For imaging analysis, 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 work packages(WP) will run in parallel. Robust population prevalence estimates will be detailed across countries by gender, age and time.By combining across the national cohorts, 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 whose data will be collected via the clinical cohort study. Lavoro eseguito dall’inizio del progetto fino alla fine del periodo coperto dalla relazione e principali risultati finora ottenuti WP 1 and main findings.Prevalence of CAPRI•1 in 4 children in the UK lives with a mother with a mental illness and 1 in 7 in Sweden lives with a mother or father with a severe mental illness. •Estimates are higher, providing further evidence of this public health priority. 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. 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 change from 1st to 2nd generation antipsychotics did not appear to improve fertility in women with psychosis. •Mental illness in general is associated with lower fertility, in teenagers it is associated with significantly higher fertility. Income inequality•Higher rates of mental illness observed in the UK cohort may be due to increased income inequality of the UK , but more likely an artefact of the type of healthcare data accessed.WP 2:Risks of CAPRI Physical Health•A systematic review of the association between parental mental illness and physical health in the offspring completed and shows 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. •Detailed analyses of injuries associated with parental mental illness in the Swedish registry data showed 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 UK and WA 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 £0.5billion annual excess to the NHS associated with CAPRI. •A study investigating the vaccination uptake in CAPRI reports that maternal mental illness contributes significantly to missed vaccinations in the UK. •In the UK we examined the association between CAPRI and atopy. This varied according to type of mental illness (common, serious, addiction) and atopy (asthma, eczema and allergy).•We examined the risk of childhood cancer among CAPRI.Adversity •In UK, Sweden and WA cohorts, we report a gradient of poverty, where children living in the poorest families were at highest risk of being CAPRI than children in the wealthiest families. •In the UK we were also able to look at the prevalence of self-harm in pregnancy among women, which is a potential risk factor for CAPRI.WP3: Vocal brain development of CAPRI (CAPRI-Voc)• Ethical Review Board convened which includes key independent experts in ethics, research and psychiatry.•Successful submissions to the relevant UK regulatory authorities are approved and study included within the NIHR Portfolio•16 NHS sites •Total recruitment up to 18/03/2020 reached 54 SMI and 29 control participants. Progressi oltre lo stato dell’arte e potenziale impatto previsto (incluso l’impatto socioeconomico e le implicazioni sociali più ampie del progetto fino ad ora) Expected results until the end of the project • A new data access agreement post Brexit is in plan to enable further work on risk and resilience analyses of CAPRI• We will also examine neuropsychiatric outcomes in CAPRI• We will investigate whether children with parental mental illness are less likely to achieve good outcomes at the end of their compulsory education•In WP3 The CAPRI-Voc study recruitment has now been paused and the study closed due to the COVID-19 pandemic. A proposed plan of work for an extension period is being submitted Centre for Women's Mental Health, University of Manchester Documenti correlati capri voc.jpg
