Table 1 Overview of longitudinal clinical high-risk studies studying the role of environmental risk factors in the parent–child transmission of mood disorders
Article, country, name of study | BPD parent type | Parent, type of control | Age range offspring | Diagnostic and environmental measures | Environmental factors | Offspring of parent with BPD | Control offspring | Main findings | ||
|---|---|---|---|---|---|---|---|---|---|---|
n (% female) | Mean age ± SD | n (% female) | Mean age ± SD | |||||||
Koenders et al. (2020), The Netherlands, “The Dutch Bipolar Offspring Study” | I, II | – | 12–21 | DSM-IV K-SADS-PL QFP CTQ | Childhood trauma Family functioning | 102 (46) | 16.0 ± 2.7 | – | – | Among offspring of parents with BPD, emotional maltreatment (abuse and neglect) was significantly associated with mood disorder development. Due to very low variance on the physical trauma and sexual abuse scales, these were not incorporated in the analyses No association was found with the family functioning total score nor its subscales |
Shalev et al. (2019), USA, “The Pittsburgh Bipolar Offspring Study” | I, II | w/o BPD dx or w/o any Psychiatric Dx (HC) | 7–18 | DSM-IV K-SADS-PL K-SADS-MRS K-SADS-P FACES II CBQ | Family functioning Family conflict | 481 (50) | 15.4 ± 2.6 | Offspring of parents w/o BPD dx 162 (51.2) Offspring of HC parents 175 (52) | Offspring of parents w/o BPD dx 15.5 ± 2.4 Offspring of HC parents 15.5 ± 2.2 | Families of parents with BPD and those of parents with non-BPD psychopathology showed lower cohesion and adaptability and higher conflict compared with HC families. There were no significant differences in cohesion and adaptability scores between families of parents with BPD and families of parents with non-BPD psychopathology In all 3 groups, parent-reported family conflict was significantly higher than child-reported conflict |
Iacono et al. (2017), Quebec, Canada | I, II | w/o any psychiatric Dx, no lifetime mood Dx | 4–21 | SCID-I K-SADS-PL PDI CBCL TRF | Parenting practices (support, structure, control) | 77 (NR) | 8.4 ± 2.5 | 68 (NR) | 12.4 ± 3.2 | Parents with BPD showed impairment in parenting practices compared to controls in terms of less support, structure and control to their offspring in middle childhood. Low levels of structure mediated the relation between parental BPD and internalizing and externalizing difficulties during middle childhood. However, low parental control in middle childhood emerged as the strongest mediator of the relation between parental BPD and offspring psychopathology in late adolescence and early adulthood, in terms of substance misuse and depressive disorders among the offspring 12 years later |
Kemner et al. (2015), The Netherlands, “The Dutch Bipolar Offspring Study” | I, II | – | 12–21 | DSM-IV K-SADS-PL LEDS TCI UCL Short-EMBU | Stressful life events Passive coping style Harm-avoidance temperament | 140 (49) | 16.0 ± 2.7 | – | – | Among offspring of parents with BPD, stressful life events were a risk factor for the onset and recurrence of mood disorders. Passive coping style increased the risk of mood episode onset and recurrent episodes, but also altered the effect of life events on the onset of mood disorders by more than 10%, suggesting that having more passive reacting coping-style features enhanced the risk of mood episode onset. The impact of life-events was most pronounced in the early stages of mood disorders. Harm-avoidance temperament also increased the risk of subsequent mood episodes in offspring |
Doucette et al. (2016), Canada, “The Canadian Flourish high-risk offspring cohort study” | I, II | – | 16–23 | DSM-IV K-SADS-PL CECA.Q EAS LEQ Hollingshead SES Scale Self-report measures of temperament and early adversities | Early childhood adversity Emotionality Exposure to parental BPD Stressful life events | 233 (59.7) | 16.6 ± 5.6 | – | – | In offspring of parents with BPD, perceived maternal neglect was a significant early predictor of mood disorders, even after adjusting for further factors, such as exposure to parental BPD. In addition, high offspring emotionality appeared to be associated with the development of mood disorders, also being the possible mediator of the relationship between maternal neglect and the development of mood disorders |
Hillegers et al. (2004), The Netherlands, “The Dutch Bipolar Offspring Study” | I, II | – | 12–21 | DSM-IV K-SADS-PL FH-RDC K-LEDS FH-RDC Life event load (time-dependent variable) | Stressful life events | 140 (49) | 16.0 ± 2.7 | – | – | Among offspring of parents with BPD, stressful life events increased the liability to mood disorders independently of the familial loading, but the effects slowly diminished over time |