Lessons on targeting family mental health and improving outcomes for children of parents with a mental illness

Lessons on targeting family mental health and improving outcomes for children of parents with a mental illness

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ABSTRACT Children of parents with a mental illness (COPMI) are at risk of adverse outcomes, as well as of developing a mental illness themselves. Recognition of modifiable risk factors, along with targeted initiatives and interventions have the potential to improve their and their families’ strengths and resilience, and thus effectively interrupt this vicious circle of the transgenerational transmission of mental disorders. Although several international projects have been funded and implemented, their planning, implementation and translation are not free from problems and downsides, and the use of measures specifically targeting COPMI is not yet part of regular clinical practice. Here we illustrate four European projects targeting family mental health, addressing the main problems encountered and the principal focuses for future directions, as learned from live discussions between project team members, participating patients/parents and other stakeholders. Our goal was to summarize those as lessons learned and make them available to the public and research community. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 12 digital issues and online access to articles $79.00 per year only $6.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS THE WELL-BEING OF CHILDREN AT FAMILIAL RISK OF SEVERE MENTAL ILLNESS: AN OVERLOOKED YET CRUCIAL PREVENTION AND EARLY INTERVENTION OPPORTUNITY Article 20 July 2023 FAMILY MANAGEMENT STYLES OF FAMILIES OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES DURING THE COVID-19 PANDEMIC: A CROSS-SECTIONAL STUDY Article Open access 30 April 2025 PARENTAL CONCERN FOR CLINICALLY VULNERABLE CHILD DURING FIRST 18 MONTHS OF THE COVID PANDEMIC Article Open access 22 November 2022 REFERENCES * _Mental Disorders_ https://www.who.int/news-room/fact-sheets/detail/mental-disorders (World Health Organization, 2022). * McGrath, J. J. et al. Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries. _Lancet Psychiatry_ 10, 668–681 (2023). Article  PubMed  Google Scholar  * Kessler, R. C. et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. _Arch. Gen. Psychiatry_ 62, 593–602 (2005). Article  PubMed  Google Scholar  * Uher, R. et al. Transdiagnostic risk of mental disorders in offspring of affected parents: a meta-analysis of family high-risk and registry studies. _World Psychiatry_ 22, 433–448 (2023). Article  PubMed  PubMed Central  Google Scholar  * Leijdesdorff, S. et al. Prevalence of psychopathology in children of parents with mental illness and/or addiction: an up to date narrative review. _Curr. Opin. Psychiatry_ 30, 312–317 (2017). Article  PubMed  Google Scholar  * Schwenck, C., Christiansen, H. & Goetz, M. in _IACAPAP e-Textbook of Child and Adolescent Mental Health_ (eds Rey, J. M. & Martin. A.) Ch. J.13 (International Association for Child and Adolescent Psychiatry and Allied Professions, 2020). * Duffy, A. et al. The well-being of children at familial risk of severe mental illness: an overlooked yet crucial prevention and early intervention opportunity. _Nat. Mental Health_ 1, 534–541 (2023). Article  Google Scholar  * Hosman, C. M. H., van Doesum, K. T. M. & van Santvoort, F. Prevention of emotional problems and psychiatric risks in children of parents with a mental illness in the Netherlands: I. The scientific basis to a comprehensive approach. _AeJAMH_ 8, 250–263 (2009). Google Scholar  * Lannes, A. et al. Preventive interventions in offspring of parents with mental illness: a systematic review and meta-analysis of randomized controlled trials. _Psychol. Med._ 51, 2321–2336 (2021). Article  PubMed  Google Scholar  * Siegenthaler, E., Munder, T. & Egger, M. Effect of preventive interventions in mentally ill parents on the mental health of the offspring: systematic review and meta-analysis. _J. Am. Acad. Child Adolesc. Psychiatry_ 51, 8–17 (2012). Article  PubMed  Google Scholar  * Thanhäuser, M., Lemmer, G., de Girolamo, G. & Christiansen, H. Do preventive interventions for children of mentally ill parents work? Results of a systematic review and meta-analysis. _Curr. Opin. Psychiatry_ 30, 283–299 (2017). Article  PubMed  Google Scholar  * Baldwin, J. R. et al. A genetically informed Registered Report on adverse childhood experiences and mental health. _Nat. Hum. Behav._ 7, 269–290 (2023). Article  PubMed  Google Scholar  * Ranning, A. et al. Intergenerational transmission of suicide attempt in a cohort of 4.4 million children. _Psychol. Med._ 52, 3202–3209 (2022). Article  PubMed  Google Scholar  * Arango, C. et al. Preventive strategies for mental health. _Lancet Psychiatry_ 5, 591–604 (2018). Article  PubMed  Google Scholar  * Goodyear, M. et al. Development of an evidence-informed and codesigned model of support for children of parents with a mental illness- ‘it takes a village’ approach. _Front. Psychiatry_ 12, 806884 (2022). Article  PubMed  PubMed Central  Google Scholar  * Rosenbach, C. et al. Study protocol for a multi-center RCT testing a group-based parenting intervention tailored to mothers with borderline personality disorder against a waiting control group (ProChild*-SP1). _Trials_ 23, 589 (2022). Article  PubMed  PubMed Central  Google Scholar  * Christiansen, H. et al. Improving identification and child-focused collaborative care for children of parents with a mental illness in Tyrol, Austria. _Front. Psychiatry_ 10, 233 (2019). Article  PubMed  PubMed Central  Google Scholar  * Müller, A. D. et al. VIA Family—a family-based early intervention versus treatment as usual for familial high-risk children: a study protocol for a randomized clinical trial. _Trials_ 20, 112 (2019). Article  PubMed  PubMed Central  Google Scholar  * Nicholson, J., Paul, J. L., Riebschleger, J. & Wittkowski, A. Editorial: Parents with mental and/or substance use disorders and their children, volume II. _Front. Psychiatry_ 13, 1020660 (2022). Article  PubMed  PubMed Central  Google Scholar  * Reupert, A. et al. Editorial perspective: Prato Research Collaborative for change in parent and child mental health – principles and recommendations for working with children and parents living with parental mental illness. _J. Child. Psychol. Psychiatr._ 63, 350–353 (2022). Article  Google Scholar  * Stracke, M. et al. COMPARE Family (Children of Mentally Ill Parents at Risk Evaluation): a study protocol for a preventive intervention for children of mentally ill parents (Triple P, Evidence-Based Program That Enhances Parentings Skills, in Addition to Gold-Standard CBT With the Mentally Ill Parent) in a Multicenter RCT-Part II. _Front. Psychiatry_ 10, 54 (2019). Article  PubMed  PubMed Central  Google Scholar  * Heinrichs, N., Kliem, S. & Hahlweg, K. Four-year follow-up of a randomized controlled trial of Triple P group for parent and child outcomes. _Prev. Sci._ 15, 233–245 (2014). Article  PubMed  Google Scholar  * Sanders, M. R., Kirby, J. N., Tellegen, C. L. & Day, J. J. The Triple P-Positive Parenting Program: a systematic review and meta-analysis of a multi-level system of parenting support. _Clin. Psychol. Rev._ 34, 337–357 (2014). Article  PubMed  Google Scholar  * Wilson, P. et al. How evidence-based is an ‘evidence-based parenting program’? A PRISMA systematic review and meta-analysis of Triple P. _BMC Med._ 10, 130 (2012). Article  PubMed  PubMed Central  Google Scholar  * Christiansen, H. et al. Children of Mentally III Parents at Risk Evaluation (COMPARE): design and methods of a Randomized Controlled Multicenter Study-Part I. _Front. Psychiatry_ 10, 128 (2019). Article  PubMed  PubMed Central  Google Scholar  * Muller, A. D. et al. Family-based preventive intervention for children of parents with severe mental illness: a randomized clinical trial. _ICPP Adv._ 2024, e12216 (2024). Google Scholar  * Thorup, A. A. E. et al. The Danish High Risk and Resilience Study—VIA 7—a cohort study of 520 7-year-old children born of parents diagnosed with either schizophrenia, bipolar disorder or neither of these two mental disorders. _BMC Psychiatry_ 15, 233 (2015). Article  PubMed  PubMed Central  Google Scholar  * Zechmeister-Koss, I. et al. Practices to support co-design processes: a case-study of co-designing a program for children with parents with a mental health problem in the Austrian region of Tyrol. _Int. J. Mental Health Nurs._ 32, 223–235 (2023). Article  Google Scholar  * Bauer, A. et al. Acceptability, engagement and exploratory outcomes and costs of a co-designed intervention to support children of parents with a mental illness: mixed-methods evaluation and descriptive analysis. _Int. J. Ment. Health Nurs._ https://doi.org/10.1111/inm.13324 (2024). Article  PubMed  Google Scholar  * Goodyear, M. et al. _The ‘It Takes a Village’ Practice Manual_ (Monash Univ., 2023); https://doi.org/10.26180/22564960.v3 * Rosenbach, C., Buck-Horstkotte, S. & Renneberg, B. _Parenting Skills for Mothers with Borderline Personality Disorder—a group training_ (Freie Universität Berlin, 2020). * Rose, G. Strategy of prevention: lessons from cardiovascular disease. _Brit. Med. J._ 282, 1847–1851 (1981). Article  Google Scholar  * Rossow, I. & Romelsjö, A. The extent of the ‘prevention paradox’ in alcohol problems as a function of population drinking patterns. _Addiction_ 101, 84–90 (2006). Article  PubMed  Google Scholar  * Engelke, L. et al. Parental mental health and child maltreatment in the COVID-19 pandemic: the representativeness of the sample matters. Preprint at https://preprints.jmir.org/preprint/52043 (2023). * Meyer-Lindenberg, A. et al. The future German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit): a model for the co-creation of a national translational research structure. _Nat. Mental Health_ 1, 153–156 (2023). Article  Google Scholar  * Huhta, H. et al. _Expanding the understanding of low-threshold services for young people. Perspectives into topical issues in society and ways to support political decision making._ Policy Brief 2023:9 (Finnish Government, Prime Minister’s Office, 2023). * Dobener, L. M. et al. 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Economic evaluation of family-focused programs when parents have a mental health problem: methodological considerations. _Value Health_ 26, 704–711 (2023). Article  PubMed  Google Scholar  * Children displaced in a changing climate (UNICEF, 2023); https://www.unicef.org/media/145951/file/Climate%20displacement%20report%20 (English).pdf * Totzeck, C. et al. Systematic review: patient and public involvement of children and young people in mental health research. _Clin. Child. Fam. Psychol. Rev._ 27, 257–274 (2024). Article  PubMed  PubMed Central  Google Scholar  * Borntrager, C. & Lyon, A. R. Monitoring client progress and feedback in school-based mental health. _Cogn. Behav. Pract._ 22, 74–86 (2015). Article  PubMed  Google Scholar  * Brookman-Frazee, L. et al. Using survival analysis to understand patterns of sustainment within a system-driven implementation of multiple evidence-based practices for children’s mental health services. _Front. Public Health_ 6, 54 (2018). 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Propensity scores as a basis for equating groups: basic principles and application in clinical treatment outcome research. _J. Consult. Clin. Psychol._ 82, 906–919 (2014). Article  PubMed  Google Scholar  Download references ACKNOWLEDGEMENTS We wish to thank all families who participated in the projects. The study was funded by the German Federal Ministry of Education and Research (funding # 01GL1748B). AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany Elena Toffol, Markus Stracke, Kristin Gilbert & Hanna Christiansen * Department of Public Health, University of Helsinki, Helsinki, Finland Elena Toffol * German Center for Mental Health, Philipps University Marburg, Marburg, Germany Markus Stracke & Hanna Christiansen * German Language Atlas Research Center, Philipps University Marburg, Marburg, Germany Neele Harlos * Department of Children, Youth and Family, City of Marburg, Marburg, Germany Stefanie Lambrecht * IKK Südwest, Saarbücken, Germany Florian Brandt * Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany Sören Friedrich * Council of Affected Persons and Relatives, German Center for Mental Health, Philipps University Marburg, Marburg, Germany Sonja Kennard * Youth Council, German Center for Mental Health, Philipps University Marburg, Marburg, Germany Lasse Wenzel * IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy Giovanni de Girolamo * Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, Ludwig-Maximilians-University München, Munich, Germany Corinna Reck * Department of Social Psychology, Business and Methods, Philipps University Marburg, Marburg, Germany Kathleen Otto * Faculty of Educational Sciences and Psychology, Institute of Psychology, Technical University Dortmund, Dortmund, Germany Ricarda Steinmayr & Linda Wirthwein * Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany Babette Renneberg * Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria Jean L. Paul * Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria Jean L. Paul * Research Unit, Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark Anne A. E. Thorup * Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark Anne A. E. Thorup * Department of Clinical Child and Adolescent Psychology, Faculty of Psychology and Sports Science, Justus-Liebig-University Gießen, Giessen, Germany Christina Schwenck * Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany Anna-Lena Zietlow Authors * Elena Toffol View author publications You can also search for this author inPubMed Google Scholar * Markus Stracke View author publications You can also search for this author inPubMed Google Scholar * Neele Harlos View author publications You can also search for this author inPubMed Google Scholar * Stefanie Lambrecht View author publications You can also search for this author inPubMed Google Scholar * Florian Brandt View author publications You can also search for this author inPubMed Google Scholar * Sören Friedrich View author publications You can also search for this author inPubMed Google Scholar * Sonja Kennard View author publications You can also search for this author inPubMed Google Scholar * Lasse Wenzel View author publications You can also search for this author inPubMed Google Scholar * Giovanni de Girolamo View author publications You can also search for this author inPubMed Google Scholar * Kristin Gilbert View author publications You can also search for this author inPubMed Google Scholar * Corinna Reck View author publications You can also search for this author inPubMed Google Scholar * Kathleen Otto View author publications You can also search for this author inPubMed Google Scholar * Ricarda Steinmayr View author publications You can also search for this author inPubMed Google Scholar * Babette Renneberg View author publications You can also search for this author inPubMed Google Scholar * Jean L. Paul View author publications You can also search for this author inPubMed Google Scholar * Anne A. E. Thorup View author publications You can also search for this author inPubMed Google Scholar * Christina Schwenck View author publications You can also search for this author inPubMed Google Scholar * Anna-Lena Zietlow View author publications You can also search for this author inPubMed Google Scholar * Linda Wirthwein View author publications You can also search for this author inPubMed Google Scholar * Hanna Christiansen View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS E.T., M.S. and H.C. contributed to the conception of the work and wrote the initial draft of the manuscript. S.F., G.d.G., K.G., C.R., K.O., R.S., B.R., J.L.P. and A.A.E.T. critically reviewed the manuscript for intellectual content. All authors reviewed and edited subsequent drafts, and approved the final version. CORRESPONDING AUTHOR Correspondence to Elena Toffol. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. PEER REVIEW PEER REVIEW INFORMATION _Nature Mental Health_ thanks Katharina Kircanski and the other, anonymous, reviewers for their contribution to the peer review of this work. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. SUPPLEMENTARY INFORMATION SUPPLEMENTARY INFORMATION Supplementary Fig. 1. RIGHTS AND PERMISSIONS Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Toffol, E., Stracke, M., Harlos, N. _et al._ Lessons on targeting family mental health and improving outcomes for children of parents with a mental illness. _Nat. Mental Health_ 2, 893–900 (2024). https://doi.org/10.1038/s44220-024-00285-3 Download citation * Received: 22 January 2024 * Accepted: 13 June 2024 * Published: 01 August 2024 * Issue Date: August 2024 * DOI: https://doi.org/10.1038/s44220-024-00285-3 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative

ABSTRACT Children of parents with a mental illness (COPMI) are at risk of adverse outcomes, as well as of developing a mental illness themselves. Recognition of modifiable risk factors,


along with targeted initiatives and interventions have the potential to improve their and their families’ strengths and resilience, and thus effectively interrupt this vicious circle of the


transgenerational transmission of mental disorders. Although several international projects have been funded and implemented, their planning, implementation and translation are not free from


problems and downsides, and the use of measures specifically targeting COPMI is not yet part of regular clinical practice. Here we illustrate four European projects targeting family mental


health, addressing the main problems encountered and the principal focuses for future directions, as learned from live discussions between project team members, participating


patients/parents and other stakeholders. Our goal was to summarize those as lessons learned and make them available to the public and research community. Access through your institution Buy


or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 12 digital issues and


online access to articles $79.00 per year only $6.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to


local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT


BEING VIEWED BY OTHERS THE WELL-BEING OF CHILDREN AT FAMILIAL RISK OF SEVERE MENTAL ILLNESS: AN OVERLOOKED YET CRUCIAL PREVENTION AND EARLY INTERVENTION OPPORTUNITY Article 20 July 2023


FAMILY MANAGEMENT STYLES OF FAMILIES OF CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES DURING THE COVID-19 PANDEMIC: A CROSS-SECTIONAL STUDY Article Open access 30 April 2025


PARENTAL CONCERN FOR CLINICALLY VULNERABLE CHILD DURING FIRST 18 MONTHS OF THE COVID PANDEMIC Article Open access 22 November 2022 REFERENCES * _Mental Disorders_


https://www.who.int/news-room/fact-sheets/detail/mental-disorders (World Health Organization, 2022). * McGrath, J. J. et al. Age of onset and cumulative risk of mental disorders: a


cross-national analysis of population surveys from 29 countries. _Lancet Psychiatry_ 10, 668–681 (2023). Article  PubMed  Google Scholar  * Kessler, R. C. et al. Lifetime prevalence and


age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. _Arch. Gen. Psychiatry_ 62, 593–602 (2005). Article  PubMed  Google Scholar  * Uher, R. et al.


Transdiagnostic risk of mental disorders in offspring of affected parents: a meta-analysis of family high-risk and registry studies. _World Psychiatry_ 22, 433–448 (2023). Article  PubMed 


PubMed Central  Google Scholar  * Leijdesdorff, S. et al. Prevalence of psychopathology in children of parents with mental illness and/or addiction: an up to date narrative review. _Curr.


Opin. Psychiatry_ 30, 312–317 (2017). Article  PubMed  Google Scholar  * Schwenck, C., Christiansen, H. & Goetz, M. in _IACAPAP e-Textbook of Child and Adolescent Mental Health_ (eds


Rey, J. M. & Martin. A.) Ch. J.13 (International Association for Child and Adolescent Psychiatry and Allied Professions, 2020). * Duffy, A. et al. The well-being of children at familial


risk of severe mental illness: an overlooked yet crucial prevention and early intervention opportunity. _Nat. Mental Health_ 1, 534–541 (2023). Article  Google Scholar  * Hosman, C. M. H.,


van Doesum, K. T. M. & van Santvoort, F. Prevention of emotional problems and psychiatric risks in children of parents with a mental illness in the Netherlands: I. The scientific basis


to a comprehensive approach. _AeJAMH_ 8, 250–263 (2009). Google Scholar  * Lannes, A. et al. Preventive interventions in offspring of parents with mental illness: a systematic review and


meta-analysis of randomized controlled trials. _Psychol. Med._ 51, 2321–2336 (2021). Article  PubMed  Google Scholar  * Siegenthaler, E., Munder, T. & Egger, M. Effect of preventive


interventions in mentally ill parents on the mental health of the offspring: systematic review and meta-analysis. _J. Am. Acad. Child Adolesc. Psychiatry_ 51, 8–17 (2012). Article  PubMed 


Google Scholar  * Thanhäuser, M., Lemmer, G., de Girolamo, G. & Christiansen, H. Do preventive interventions for children of mentally ill parents work? Results of a systematic review and


meta-analysis. _Curr. Opin. Psychiatry_ 30, 283–299 (2017). Article  PubMed  Google Scholar  * Baldwin, J. R. et al. A genetically informed Registered Report on adverse childhood


experiences and mental health. _Nat. Hum. Behav._ 7, 269–290 (2023). Article  PubMed  Google Scholar  * Ranning, A. et al. Intergenerational transmission of suicide attempt in a cohort of


4.4 million children. _Psychol. Med._ 52, 3202–3209 (2022). Article  PubMed  Google Scholar  * Arango, C. et al. Preventive strategies for mental health. _Lancet Psychiatry_ 5, 591–604


(2018). Article  PubMed  Google Scholar  * Goodyear, M. et al. Development of an evidence-informed and codesigned model of support for children of parents with a mental illness- ‘it takes a


village’ approach. _Front. Psychiatry_ 12, 806884 (2022). Article  PubMed  PubMed Central  Google Scholar  * Rosenbach, C. et al. Study protocol for a multi-center RCT testing a group-based


parenting intervention tailored to mothers with borderline personality disorder against a waiting control group (ProChild*-SP1). _Trials_ 23, 589 (2022). Article  PubMed  PubMed Central 


Google Scholar  * Christiansen, H. et al. Improving identification and child-focused collaborative care for children of parents with a mental illness in Tyrol, Austria. _Front. Psychiatry_


10, 233 (2019). Article  PubMed  PubMed Central  Google Scholar  * Müller, A. D. et al. VIA Family—a family-based early intervention versus treatment as usual for familial high-risk


children: a study protocol for a randomized clinical trial. _Trials_ 20, 112 (2019). Article  PubMed  PubMed Central  Google Scholar  * Nicholson, J., Paul, J. L., Riebschleger, J. &


Wittkowski, A. Editorial: Parents with mental and/or substance use disorders and their children, volume II. _Front. Psychiatry_ 13, 1020660 (2022). Article  PubMed  PubMed Central  Google


Scholar  * Reupert, A. et al. Editorial perspective: Prato Research Collaborative for change in parent and child mental health – principles and recommendations for working with children and


parents living with parental mental illness. _J. Child. Psychol. Psychiatr._ 63, 350–353 (2022). Article  Google Scholar  * Stracke, M. et al. COMPARE Family (Children of Mentally Ill


Parents at Risk Evaluation): a study protocol for a preventive intervention for children of mentally ill parents (Triple P, Evidence-Based Program That Enhances Parentings Skills, in


Addition to Gold-Standard CBT With the Mentally Ill Parent) in a Multicenter RCT-Part II. _Front. Psychiatry_ 10, 54 (2019). Article  PubMed  PubMed Central  Google Scholar  * Heinrichs, N.,


Kliem, S. & Hahlweg, K. Four-year follow-up of a randomized controlled trial of Triple P group for parent and child outcomes. _Prev. Sci._ 15, 233–245 (2014). Article  PubMed  Google


Scholar  * Sanders, M. R., Kirby, J. N., Tellegen, C. L. & Day, J. J. The Triple P-Positive Parenting Program: a systematic review and meta-analysis of a multi-level system of parenting


support. _Clin. Psychol. Rev._ 34, 337–357 (2014). Article  PubMed  Google Scholar  * Wilson, P. et al. How evidence-based is an ‘evidence-based parenting program’? A PRISMA systematic


review and meta-analysis of Triple P. _BMC Med._ 10, 130 (2012). Article  PubMed  PubMed Central  Google Scholar  * Christiansen, H. et al. Children of Mentally III Parents at Risk


Evaluation (COMPARE): design and methods of a Randomized Controlled Multicenter Study-Part I. _Front. Psychiatry_ 10, 128 (2019). Article  PubMed  PubMed Central  Google Scholar  * Muller,


A. D. et al. Family-based preventive intervention for children of parents with severe mental illness: a randomized clinical trial. _ICPP Adv._ 2024, e12216 (2024). Google Scholar  * Thorup,


A. A. E. et al. The Danish High Risk and Resilience Study—VIA 7—a cohort study of 520 7-year-old children born of parents diagnosed with either schizophrenia, bipolar disorder or neither of


these two mental disorders. _BMC Psychiatry_ 15, 233 (2015). Article  PubMed  PubMed Central  Google Scholar  * Zechmeister-Koss, I. et al. Practices to support co-design processes: a


case-study of co-designing a program for children with parents with a mental health problem in the Austrian region of Tyrol. _Int. J. Mental Health Nurs._ 32, 223–235 (2023). Article  Google


Scholar  * Bauer, A. et al. Acceptability, engagement and exploratory outcomes and costs of a co-designed intervention to support children of parents with a mental illness: mixed-methods


evaluation and descriptive analysis. _Int. J. Ment. Health Nurs._ https://doi.org/10.1111/inm.13324 (2024). Article  PubMed  Google Scholar  * Goodyear, M. et al. _The ‘It Takes a Village’


Practice Manual_ (Monash Univ., 2023); https://doi.org/10.26180/22564960.v3 * Rosenbach, C., Buck-Horstkotte, S. & Renneberg, B. _Parenting Skills for Mothers with Borderline Personality


Disorder—a group training_ (Freie Universität Berlin, 2020). * Rose, G. Strategy of prevention: lessons from cardiovascular disease. _Brit. Med. J._ 282, 1847–1851 (1981). Article  Google


Scholar  * Rossow, I. & Romelsjö, A. The extent of the ‘prevention paradox’ in alcohol problems as a function of population drinking patterns. _Addiction_ 101, 84–90 (2006). Article 


PubMed  Google Scholar  * Engelke, L. et al. Parental mental health and child maltreatment in the COVID-19 pandemic: the representativeness of the sample matters. Preprint at


https://preprints.jmir.org/preprint/52043 (2023). * Meyer-Lindenberg, A. et al. The future German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit): a model for the


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Psychol._ 82, 906–919 (2014). Article  PubMed  Google Scholar  Download references ACKNOWLEDGEMENTS We wish to thank all families who participated in the projects. The study was funded by


the German Federal Ministry of Education and Research (funding # 01GL1748B). AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Clinical Child and Adolescent Psychology, Philipps


University Marburg, Marburg, Germany Elena Toffol, Markus Stracke, Kristin Gilbert & Hanna Christiansen * Department of Public Health, University of Helsinki, Helsinki, Finland Elena


Toffol * German Center for Mental Health, Philipps University Marburg, Marburg, Germany Markus Stracke & Hanna Christiansen * German Language Atlas Research Center, Philipps University


Marburg, Marburg, Germany Neele Harlos * Department of Children, Youth and Family, City of Marburg, Marburg, Germany Stefanie Lambrecht * IKK Südwest, Saarbücken, Germany Florian Brandt *


Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany Sören Friedrich * Council of Affected Persons and Relatives, German Center for


Mental Health, Philipps University Marburg, Marburg, Germany Sonja Kennard * Youth Council, German Center for Mental Health, Philipps University Marburg, Marburg, Germany Lasse Wenzel *


IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy Giovanni de Girolamo * Department of Clinical Child and Adolescent Psychology, Faculty of Psychology,


Ludwig-Maximilians-University München, Munich, Germany Corinna Reck * Department of Social Psychology, Business and Methods, Philipps University Marburg, Marburg, Germany Kathleen Otto *


Faculty of Educational Sciences and Psychology, Institute of Psychology, Technical University Dortmund, Dortmund, Germany Ricarda Steinmayr & Linda Wirthwein * Clinical Psychology and


Psychotherapy, Freie Universität Berlin, Berlin, Germany Babette Renneberg * Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria Jean L. Paul *


Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria Jean L. Paul * Research Unit,


Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark Anne A. E. Thorup * Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark


Anne A. E. Thorup * Department of Clinical Child and Adolescent Psychology, Faculty of Psychology and Sports Science, Justus-Liebig-University Gießen, Giessen, Germany Christina Schwenck *


Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany Anna-Lena Zietlow Authors * Elena Toffol View author publications You can also search for


this author inPubMed Google Scholar * Markus Stracke View author publications You can also search for this author inPubMed Google Scholar * Neele Harlos View author publications You can


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publications You can also search for this author inPubMed Google Scholar * Jean L. Paul View author publications You can also search for this author inPubMed Google Scholar * Anne A. E.


Thorup View author publications You can also search for this author inPubMed Google Scholar * Christina Schwenck View author publications You can also search for this author inPubMed Google


Scholar * Anna-Lena Zietlow View author publications You can also search for this author inPubMed Google Scholar * Linda Wirthwein View author publications You can also search for this


author inPubMed Google Scholar * Hanna Christiansen View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS E.T., M.S. and H.C. contributed to the


conception of the work and wrote the initial draft of the manuscript. S.F., G.d.G., K.G., C.R., K.O., R.S., B.R., J.L.P. and A.A.E.T. critically reviewed the manuscript for intellectual


content. All authors reviewed and edited subsequent drafts, and approved the final version. CORRESPONDING AUTHOR Correspondence to Elena Toffol. ETHICS DECLARATIONS COMPETING INTERESTS The


authors declare no competing interests. PEER REVIEW PEER REVIEW INFORMATION _Nature Mental Health_ thanks Katharina Kircanski and the other, anonymous, reviewers for their contribution to


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mental health and improving outcomes for children of parents with a mental illness. _Nat. Mental Health_ 2, 893–900 (2024). https://doi.org/10.1038/s44220-024-00285-3 Download citation *


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