Effectsofparentalmentalillnessonsphysicalhealthsystematicreviewandmet - PDF document

Effectsofparentalmentalillnessonsphysicalhealth:systematicreviewandmeta-analysisMatthiasPierce,HollyF.Hope,AdekeyeKolade,JudithGellatly,CemreSuOsam,ReenaPerchard,KyriakiKosidou,ChristinaDalman,VeraMorgan,PatriciaDiPrinzioandKathrynM.AbelBackgroundChildrenofparentswithmentaldisorderfacemultiplechallenges.Tosummariseevidenceaboutparentalmentaldisorderandchildphysicalhealth.Wesearchedsevendatabasesforcohortorcasecontrolstudiesquantifyingassociationsbetweenparentalmentaldisorders(substanceuse,psychotic,mood,anxiety,obsessivesive,post-traumaticstressandeating)andoffspringphysical TheBritishJournalofPsychiatry217,354363.doi:10.1192/bjp.2019.216 KWWSVGRLRUJEMS 3XEOLVKHGRQOLQHE\&DPEULGJH8QLYHUVLW\3UHVV anddefinitionsofexposureandoutcome,thestudywiththelargestsamplewaschosen.Wespecifiedaprioriparentalmentaldisordersthatwereofinterest:substanceusedisorders(ICD-10category:F1019);schizo-phrenia,schizotypalanddelusionaldisorders(F2029);mooddis-orders(F3039);anxietydisorders(F4041);obsessivecompulsivedisorders(F42);post-traumaticstressdisorder(F43.1);andeatingdisorders(F50).Weincludedstudieswhere:mentalillnesswasdefinedbyaclinicaldiagnosis,usingICDorDSMcriteria;mentalillnesswasmeasuredusingapeer-reviewedinstrument;orwheretheparentreceivedtreatmentforamentalWeincludedstudiesreportinganyphysicaldiseaseintheoff-spring,clinicallydiagnosedandintheWorldHealthICD-10framework.Thisexcludedpsychologicalorneurobehaviouraldisorders(i.e.chapterVofICD-10)andanydis-ordercategorisedinICD-10chapterVIII:Symptoms,signsandabnormalclinicalandlaboratoryfindings,notelsewhereclassifiedSearchstrategyWesearchedthefollowingdatabasesforpublishedpapers,reports,conferenceabstractsandtheses:MEDLINE;PsycINFO;PsycARTICLES;Embase;WebofScience;ProQuestASSIA.Weincludedstudiespublishedwithinthedates1January1970tothesearchdate(21September2017),anddidnotinitiallyincludelan-guagerestrictions.Wesearchedusingthefollowinggeneralterms:(children)AND(parent)AND(mentalillness)AND(physicaldisease)AND(casecontrolORcohortstudy).Weincludedtermsforthespecificmentalillnessesand,forthepurposesofconductingthesearch,anapriorilistofcommondiseasesofchildhoodthatwasdevelopedbyclinicalcollaborators(R.P.andK.M.A.).WeincludedMESHtermsandincludedvariantsandsynonymsusingtruncationsandwildcardswherehelpful.Thefullsearchstrategycanbefoundinsupplemen-taryAppendixAavailableathttps://doi.org/10.1192/bjp.2019.216Followingscreening,wesoughttoidentifyfurtherstudiesbyhand-searchingreviewpapersarisingfromoursearches.Wealsoconductedhand-searchesofreferencelistsofidentifiedpapersandweconductedacited-referencesearchusingWebofScience.Duplicateswereremovedandthentworeviewers(M.P.andA.K.)screenedtitlesandabstracts,initiallypiloting250paperstoensurethatconsistentfeatureswereselected.Allstudiescategorisedasforinclusionwereextractedforfulltextscreening.Afull-textscreeningtoolwaspilotedbythreereviewers(M.P.,A.K.andJ.G.)using30papersandthenthesamethreereviewersdividedallfull-textpapersbetweenthemsothateachpaperwasscreenedtwice.Disagreementsandambiguitieswereresolvedinagroupdis-cussion,callingonafourthreviewer(K.M.A.)asnecessary.LackofresourcesmeantthatweexcludedpapersthatwerenotinEnglish.DataextractionandanalysisDataextractionwascarriedoutbytworeviewers(M.P.andA.K.),extractingdataon:outcometype,exposuretype;assessmentinstru-mentused;timingofexposureandoutcome;samplesize;studysetting;statisticalmodel;variablesusedinadjustment;andeffectsize.StudyqualitywasassessedusingtheNationalInstitutesofHealth(NIH)QualityAssessmentToolsusingchecklistsdevelopedforcohortandcasecontrolstudies.Whenstudiesusedmultipleadjustedmodels,wereportfromthemodelwiththemostcovariates,unlesswejudgedthatanyoftheextravariableswereonthecausalpathwaybetweenexposureandoutcome.Whenstudiespresentedmultipleeffectsizesfrommultipleexposureswereportonlythoseexposuresconsideredbythestudiesauthorstobethemostsevereandmostchronic.AllextractedeffectsizesarepresentedinsupplementaryAppendixB.Formeta-analysis,whenastudyreportedmultipleoutcomesweselectedthemostfrequentandwhenstudiesreportedtheeffectofmaternalandpaternalexposureweselectedestimatesasso-ciatedwithmaternalexposure.Forevidencesynthesis,studiesweregroupedaccordingtooutcometype.Foreachgrouping,estimateswereconvertedintooddsratios(wherepossible)andpooledoddsratioswereestimatedusingrandom-effectsmeta-analyses.Between-studyheterogeneitywasestimatedusingthestatistic.Twosensitivityanalyseswereconducted.First,wedeterminedthero

bustnessofthemeta-analysestoremovingstudiesthatwererankedpoorquality.Second,whereappropriatewecomparedestimatesbytypeofstudy(caseversuscohortdesign).AnalysesweredoneusingStata14forWindowsusingtheThedatabasesearchesyielded15945non-duplicatestudies(Fig.1Ofthese,251wereconsideredforfull-textscreeningand221wereexcluded(94failedtheoutcomecriteria;37failedtheexposurecri-teria;36werenon-relevantstudydesigns;12werereviews;12selectedadiseased-onlycohort;7wereinalanguageotherthanEnglish;7didnotreportsufficientdata;6wereoutsidetheagerange;4hadexposuresubsequenttodisease;2werenestedwithinalargerstudy;andwewereunabletolocatethefulltextfor4).Thisresultedin30studiesforinclusion.Afteradditionalsearches,afurther11studieswereincluded(5fromotherreviews,5fromref-erencelistsofincludedpapersand1fromthecitedreferencesearch),givingafinaltotalof41studies.OverviewofincludedstudiesThevastmajorityofincludedstudies(31/41)investigatedexposuretoparentaldepression;7investigatedanxiety,5substancemisuseand1psychoticdisorder(Table1).Onestudydefinedexposureaspsychiatricmorbidity,anotherascommonmentaldisorderanotherconsideredtheeffectofpost-traumaticstressdisorder.Noneinvestigatedtheeffectofparentaleating,bipolarorobses-compulsivedisorders.Allstudiesexaminedmaternalmentaldisorder;17%(7/41)alsoexaminedexposuretopaternalmentaldis-order.Forty-twopercentofstudies(17/41)measuredexposureonlyduringtheperinatalperiod,definedhereasfromthestartofpreg-nancyto1yearafterthebirth.Themedianageatthelastfollow-upwas5years(interquartilerangeIQR=27.5)andthemediansamplesizewas1696(IQR=29412618).Themajority(26)wereprospectivecohortstudies;8wereretro-spectivecohortstudiesand7werecasecontrolstudies.Thirty-ninepercent(16)camefromEurope(halfofwhichwerefromScandinavia)and29%(12)werefromNorthAmerica.Sixty-eightpercent(28)werecarriedoutafter2010andtheearlieststudywasfrom1981.Studiesweregroupedintothecategoriesaccordingtotheirout-comes:accidentsandinjuries(=10);asthma(=8);otheratopicdiseases(=3);overweightandobesity(=10).Theremainingstudiesweresplitbetweenthosefromalow-andmiddle-incomecountry(LMIC)setting(=8)(mainlyconsistingofstudiesexam-iningdiarrhoeaormalnutrition)andthosefromahigh-incomecountrysetting(=2).Effectsofparentalmentalillnessonchildrensphysicalhealth KWWSVGRLRUJEMS 3XEOLVKHGRQOLQHE\&DPEULGJH8QLYHUVLW\3UHVV Accidentsorinjuries(tenstudies)Ofthetenstudiesthatreportedaccidentsandinjuries,andacombinedsampleof314132childrenwereincludedinthepooledanalysisforaccidentsandinjuries(Fig.2).Thisrevealeda15%increaseinthelikelihoodofachildhavinganaccidentorinjuryiftheywereexposedtoparentalmentalillness(OR1.15,95%CI1.04=76.4%).Fiveofthesixstudiesthatconsideredtheriskofoffspringacci-dentsorinjuriesassociatedwithmaternaldepressionfoundapositiveassociationandonestudy,whichwasthesmallestandtheonlyonetoexaminepaternalaswellasmaternaldepression,didnotfindaneffectTable2).Moststudiesexaminedoutcomesinthefirst5years;however,onestudyofabirthcohortof1265foundaneffectofmaternaldepressionontraumaticbraininjuriesuptoage15.ThreestudiesexaminedparentalsubstanceusedisorderandOnereportedadoublingintheriskoftraumaticbraininjuryifeitherparenthadmisusedalcoholandanothersmallstudy(=125)estimatedasimilareffectofmaternalsub-stancemisuse,althoughthelowerconfidenceintervalincludedanulleffect.AlargeretrospectivecohortstudyfromFinland(113813)didnotfindaneffectofmaternalorpaternalsubstancemisuseonriskofinjuriesinthefirst6years.Onestudyexaminedaccidentsinthefirstyearoflifefor199childrenwithmaternalpsychoticdisordermatchedto787childrenTheydidnotfindanincreasedriskofaccidentsasso-ciatedwithmaternalexposure.Asthma(eightstudies)Fromeightstudiesandacombinedsampleof450202children,weestimateda19%increaseintheoddsofchildhoodasthmaforchildrenexposedtoparentalmentalillness(OR=1.19,95%CI=77.0%).Sixoftheeightstudiesfoundapositiveassociationbetweenmaternaldepressionoranxietyandchildhoodasthma.remainingtwostudiesalsohadeffectsizesindicatingapositiverela-tionship,albeitwithconfidenceintervalsthatincludeanullThreeofthesestudiesalsoreportedonexposuretopater-nalmentaldisorderbutonlyonedetectedaneffect.thatinvestigatedshort-termversuschronicdepressionfoundagreatereffectofthelatter.Onestudythatlookedatdepressionexposureduringpregnancyversusexposurepostnatallydidnotfindadifference.Otheratopicdiseases(threestudies)Inthepooledanalysis,usingthreestudiesand23471children,therewasinconclusiveevidenceforanassociationbetweenparentalmentalillnessandchildhood

atopy(OR=1.36,95%CI0.91=92.9%).However,alargecohortstudyfromTaiwanreportedapositiveeffectofmaternaldepressiononriskofinfanteczemainthefirst6monthsoflife.Onestudyreportedanassociationbetweenatopicdermatitisandmaternalanxiety,butnotmaternaldepressionanotherreportedanassociationwithmaternal(butnotpaternal)depressionforinhalant(butnotfood)allergies.Overweightorobesity(tenstudies)Thepooledanalysisfortheeffectofparentalmentalillnessandbeingoverweightorobeseinchildhoodincludedsevenstudiesand36309children.Tofacilitatepooling,overweightwasselectedinthemeta-analysis.Thepooledestimateshowedborderline databases = 25168IdentiÞed from otherReview papers = 5Reference lists = 5Cited papers = 1In foreign language = 7Could not locate full text = 4Was a review = 12Outcome criteria not met = 94Exposure criteria not met = 37Study design criteria not met = 36Out of age range = 6InsufÞcient data reported = 7Selected on basis of disease = 12Outcome prior to exposure = 4Nested within a larger study = 2screened = 15945Included in review = 41Included in meta-analysis = 35Excluded = 15694 Fig.1Flowdiagramforstudiesincludedinsystematicreview.Pierceetal KWWSVGRLRUJEMS 3XEOLVKHGRQOLQHE\&DPEULGJH8QLYHUVLW\3UHVV evidencetoconcludeapositiveassociation(ORpool=1.16,95%CI0.971.39,=55.0%).Thethreestudiesunsuitableforpoolingreportedequivocalresults.Oftheninestudiesthatexaminedchildhoodobesityanditsassociationwithmaternaldepressionoranxiety,onesmallcohortstudy(=160)estimatedapositiveassociation,sevenwereandonereportedanegativeeffect.Ofthethreestudiesthatexamineddurationofmaternaldepressivedisorder,twofoundanincreasedriskassociatedwithcumulativeexposuretodepression,butnotofexposuretoperiodicdepression.Twolargeprospectivecohortstudies,basedinTheNetherlandsandtheUSA,indicatedaneffectofmaternaldepressiononchildhoodoverweightintheirunadjustedanalyses,butwhenadjustedforpotentialconfounders(includingmaternal/paternalbodymassindex)thiseffectdisappeared.OneFinnishstudyof4525teenagersthatexaminedtheassoci-ationbetweenparentalharmfuldrinkingandoffspringobesitydidnotfindaneffect.Otherstudiesfromlow-andmiddle-incomecountries(eightstudies)FivestudiesfromLMICswithacombinedsampleof851childreninvestigatedtheeffectofmaternalmentalillnessonchildhoodmal-Thepooledriskofmalnutritionwasmorethandoubleforexposedcomparedwithunexposedchildren(OR2.55,95%CI1.74=0.0%).Threestudiesand13430childrenwerepooledtoinvestigatethelinkbetweenperinatalmaternaldepressionanddiarrhoeaorgastrointestinalinfectionand,similarly,theoddsofdiarrhoeadoubledforexposedchildren(OR=2.16,95%CI1.65=52.0%).Otherstudiesfromhigh-incomecountries(twostudies)Oneretrospectivecohortstudyof107587childrenintheUKreportedanassociationbetweenmaternalperinataldepressionandoffspringgastrointestinalinfectionandrespiratorytractinfec-Anotherretrospectivecohortstudyof2552childrenofmotherswithalcoholorsubstanceusedisorderinFinlandfoundamarginaleffectondiseasesoftheeye,earandmastoidprocess.StudyqualityOverall,10studiesweregraded,19studieswereand12studiesweregraded(supplementaryAppendixC).Particularmethodologicalproblemswerethelackofclarityregardingsampleselectionandthemeasurementsused,andoverlappingtimingofexposureandoutcome.Removingstudiesthatweregraded(supplementaryAppendixD)madelittledifferencetothepooledestimates.Also,forthetwometa-analysesthatincludedcasecontrolstudies,theresultswereconsistentbytypeofstudydesign(supplementaryAppendixE).SummaryoffindingsForthefirsttime,thissystematicreviewsummarisescurrentevi-denceonriskforpoorphysicalhealthinoffspringofparentswithmentaldisorder.Overall,thisdetailedevidencesynthesispaintsapictureofrelativelypoorphysicalhealthinthechildrenofparentswithmentaldisorder,withpooledeffectestimatesrevealinganincreasedriskofinjuries,asthma,malnutritionanddiarrhoea.However,wehighlightstrikinggapsintheevidence:overthree-quartersofthestudiesfocusedexclusivelyonmaternaldepressionand,ofthose,halfonpostnataldepression;thereislittleinformationaboutchildrenofparentswithmentaldisordersotherthandepres-sionoranxiety;andfewstudiesinvestigatedtheimpactofpaternalmentaldisorder.Intotal,63%ofstudies(26/41)reportedaneffectofparentalmentaldisorderonphysicalhealthoutcomesintheoffspring.Afurther17%ofstudies(7/41)estimatedapositiveassociation,albeitwith95%confidenceintervalsthatincludeanulleffect.Mostoftheidentifiedstudiesexaminedtherelationshipbetweenexposuretoparentalmentalillness(predominantlymaternalpost-nataldepression)andriskofchildhoo

dinjuries(=10),obesity=10)orasthma(=8).Ofnote,noeligiblestudiesassessedriskofchildhoodcancers,diabetes,epilepsyormigraineandonlyoneassessedtheimpactofseriousmentaldisorderssuchasschizo-phreniaorbipolardisorderonchildhoodphysicalhealth.Similarly,nostudiesassessedeffectsofdualdiagnosis,maternalorpaternalpersonalitydisorderoreatingdisorders.ResearchincontextWeidentifiedevidenceofanincreasedriskofchildhoodaccidentsorinjuriesassociatedwithparentalmentalillness(OR=1.15,95%CI1.04Self-reporteddatahaveshownthatperiodsofdepressionaffectamothersabilitytosuperviseherSubstancemisuse,particularlyalcoholdependence,isasso-ciatedwithviolentbehaviour,whichmayconferadditionalriskofinjurytothechild.Theonestudythatexaminedtheeffectofpsych-osisonriskofchildhoodaccidentsdidnotfindaneffect,althoughtheconfidenceintervalsindicatethatitwasunderpoweredtodetect Table1Descriptivesummaryofthe41studiesincludedinthesystematicreviewStudydesigncontrolstudy7(17.1)Cohortstudy34(82.9)Prospective26(63.4)Retrospective8(19.5)OriginofsampleAfrica4(9.8)Australasia2(4.9)Asia4(9.8)Europe16(39.0)NorthAmerica12(29.3)SouthAmerica3(7.3)YearstudypublishedBefore20002(4.9)20044(9.8)20097(17.1)201415(36.6)After201513(31.7)Accidents/injuries10(24.4)Asthma8(19.5)Otheratopicdiseases3(7.3)Overweight/obesity10(24.4)Malnutrition5(12.2)Diarrhoea3(7.3)Other2(4.9)MentaldisorderDepression31(75.6)Anxiety7(17.1)Substancemisuse5(12.2)Other4(9.8)ParentinwhommentaldisorderwasmeasuredMothers41(100.0)Fathers7(17.1)a.Thesecategoriesnotmutuallyexclusive.Effectsofparentalmentalillnessonchildrensphysicalhealth KWWSVGRLRUJEMS 3XEOLVKHGRQOLQHE\&DPEULGJH8QLYHUVLW\3UHVV lessthanadoublingintherateofaccidents.Allbuttwoofthesestudiesonaccidentandinjuryfollowedchildreninthefirst6yearsoflifeandthereforewedonotknowwhethertheriskisame-lioratedbyschoolentrance.Wehighlightevidencetoofanincreasedriskofchildhoodasthmaassociatedwithparentalmentalillness(OR=1.26,95%CI1.121.26)andsomeevidencetosuggestanincreasedriskofotheratopicdisorders(OR=1.36,95%CI0.912.03).Theassociationwasobservedmoststronglyinstudiesinwhichtheexposurewascategorisedassevereorchronic.Priorresearchhasreportedpsychosisandatopicdisordersclusteringinindivi-andfamilies.Thefamiliallinkbetweenmentalandatopicdisorderscouldariseasaresultofsharedaetiologicalfactorsbutalsoasaresultoftheeffectsofadversity.Parentalmentaldisorderincreasesrisksforarangeofadversitiesduringchildhood,suchaspovertyandtrauma.Exposuretoadversityandstresscanalterachildsimmuneresponse,whichinturnincreasestheriskforatopy.Yet,thelinkbetweenmentaldisordersandatopyislikelycomplexandmightincludecombinationsofdirectandindirecteffectsofparentaldisorder,aswellassharedenvironmentalfactors(suchassmoking).Theevidenceforalinkbetweenparentalmentalillnessandchildhoodoverweightorobesityisinconclusive.Priorreviewsthatincludedcross-sectionalstudiesdidreportacorrelationbetweenmaternaldepressionoranxietyandchildhoodanotherthatincludedonlyprospectivedesignsfound OR (95% Cl)InjuriesWilson et al (1981)et al (2003)et al (2007)et al (2010)et al (2010)Myhre et al (2012)et al (2012)et al (2017)et al (2017)1.90 (0.80Ð4.54)0.98 (0.55Ð1.74)1.09 (1.03Ð1.16)1.06 (0.93Ð1.20)AsthmaKlinnert et al (2001)Kozyrskyj et al (2008)et al (2009)et al (2010)et al (2015)Kozyrskyj et al (2017)et al (2017)Brew et al (2018)1.41 (0.98Ð2.03)1.25 (1.01Ð1.37)1.15 (0.85Ð1.56)1.19 (1.09Ð1.30)1.44 (1.34Ð1.56)1.26 (1.12Ð 1.41)Other atopic disorderset al (2016)et al (2017)Elbert et al (2017)1.42 (1.21Ð1.66)0.93 (0.82Ð1.05)1.36 (0.91Ð2.03)Overweightet al (2010)et al (2010)et al (2011)Guxens et al (2013)et al (2013)et al (2016)et al (2017)1.01 (0.96Ð1.07)1.60 (1.00Ð2.60)0.28 (0.03Ð0.92)1.09 (0.92Ð1.30)1.50 (0.96Ð2.33)2.40 (1.10Ð5.60)1.00 (0.61Ð2.02)1.16 (0.97Ð1.39)LMIC setting-malnutritionDe Miranda et al (1996)et al (2004)et al (2008)et al (2011)et al (2015)LMIC setting-diarrhoeaRahman et al (2004)et al (2015)et al (2012)2.90 (1.20Ð6.90)7.40 (1.60Ð38.50)2.84 (0.98Ð8.24)2.04 (1.10Ð3.782.40 (1.11Ð5.18)2.40 (1.70Ð3.30)1.80 (1.45Ð2.14)2.16 (1.65Ð2.84)ExposureSubstance misusePsychosisDepressionDepression/anxietyDepressionDepressionDepression/anxietyDepressionDepression/anxietyDepressionDepressionDepressionDepressionAlcohol misuseMental disorderDepressionDepressionDepressionDepressionDepressionOutcomeAccidentsAccidentsInjuries FracturesAsthmaAsthmaAsthmaAsthmaAtopic dermatitis Atopic dermatitis Inhalant allergyOverweightOverweightOverweightOverweightOver

weightMalnutritionMalnutritionMalnutritionMalnutritionDiarrhoeaDiarrhoeaDiarrhoea 0.30.5124 Fig.2ForestplotdisplayingestimatesandpooledestimatesoftheeffectofchildhoodexposuretoparentalmentalillnessonchildhoodPierceetal KWWSVGRLRUJEMS 3XEOLVKHGRQOLQHE\&DPEULGJH8QLYHUVLW\3UHVV Table2SummaryofanalysesfromstudiesincludedinthesystematicreviewStudyDesign,country,Exposure(agemeasured)Outcome(agemeasured)Effectmeasure:estimate(95%CI)Wilson1981Prosp.matchedcohort,USA,125Substancemisuse(8wksgest.tobirth)Accidents(01y)OR:1.90(0.80Howard2003Retro.matchedcohort,UK,986Psychosis(2ypriortobirth)Accidents(01y)OR:0.98(0.55Phelan2007Prosp.cohort,USA,1106Unitincreaseindepressionscore(06y)Injuries(06y)OR:1.04(1.01Winqvist2007Retro.cohortFinland,12058Maternalorpaternalalcoholmisuse(014y)Traumaticbraininjury(014y)aRR:1.99(1.19McKinlay2010Prosp.cohort,NZ,1265Depression(613y)Traumaticbraininjury(015y)HR:1.49(1.0Schwebel2010Prosp.cohort,USA,584Depression(56y)Injuries(711y)ORMaternal:1.00(0.98Paternal:1.00(0.97Myhre2012Prosp.cohort,Norway,26087Distress(1.5y)Injuries(1.53y)OR:1.09(1.03Orton2012Matchednestedcasecontrolstudy,UK,104512Depression(pregnancyto6m)Typesofinjuries(05y)aORPoisonings:1.45(1.24ORFractures:1.06(0.93aORThermalinjuries:1.15(1.02Baker2017Retro.cohort,UK,54702Depressionoranxiety(6mbeforepregnancyto5y)Typesofinjuries(05y)aIRRPoisonings:2.30(1.93Fractures:1.24(1.06Burns:1.53(1.29Seriousinjuries:0.95(0.60Raitasalo2017Retro.cohort,Finland,113813Substancemisuse(4ybeforebirthto6y)Injuries(06y)aORMaternal:1.12(0.84Paternal:1.03(0.86Klinnert2001Prosp.cohort,USA,133Depression(6y)Asthma(68y)OR:1.41(0.98Kozyrskyj2008Retro.cohort,Canada,13907Long-termmoodoranxietydisorder(06y)Asthma(7y)aOR:1.25(1.01Cookson2009Prosp.cohort,UK,5810Anxiety(32wkspregnancyand8wks)Asthma(7.5y)aOR32wks:1.03(0.868wks:1.12(0.84Lange2010Prosp.twincohort,PuertoRico,339Depressionsymptoms(01y)Asthma(3y)aOR:1.13(1.01Giallo2015Prosp.cohort,Australia,4165Persistentandhighdepressionsymptoms(3mto7y)Asthma(67y)aOR:2.70(1.59Kozyrskyj2017Prosp.cohort,Canada,1696Depression(018m)Asthma(10y)aOR:1.15(0.85Magnus2017Prosp.cohort,Norway,63626Majordepression(18wkspregnancy)Asthma(7y)aORMaternal:1.19(1.09Paternal:0.95(0.81Brew2018Retro.cohort,Sweden,360526Depressionoranxiety(continuouslythroughpreconception,pregnancyandpostnatally)Asthma(5y)aORMaternal:1.44(1.34Paternal:1.11(1.01OtheratopicdiseasesWang2016Prosp.cohort,Taiwan,18024Depression(6m)Atopicdermatitis(3y)aOR:1.42(1.21Letourneau2017Prosp.cohort,Canada,242Depressionoranxiety(3m)Atopicdermatitis(18m)aOR:0.93(0.82Elbert2017Prosp.cohort,Netherlands,5205Depression(2ndtrimesterand3y)Allergy(910y)aORMaternal/inhalant:2.07(1.43Maternal/food:0.75(0.29Paternal/inhalant:1.58(0.89Paternal/food:0.87(0.18Bronte-Tinkew2007Prosp.cohort,USA,8693Depression(9m)Overweight(2y)Pathcoefficient:0.025,=0.29DeSousa2009control,India,160Depressionscore(mean:9.53y)ObesityWeight,mean(s.d.),kg:Normal3.69(2.95),Obese:7.75=0.29Ajslev2010Prosp.cohort,Denmark,21121Distress(6m)Overweight(7y)aOR:1.01(0.96Santos2010Prosp.cohort,Brazil,3792Depression(3,12,24,48m)Overweight(04y)aOR:1.6(1.0Wojcicki2011Prosp.cohort,US,166Depression(2ndtrimesterand46wks)Overweight(6m2y)aOR:0.28(0.03Effectsofparentalmentalillnessonchildrensphysicalhealth KWWSVGRLRUJEMS 3XEOLVKHGRQOLQHE\&DPEULGJH8QLYHUVLW\3UHVV Table2StudyDesign,country,Exposure(agemeasured)Outcome(agemeasured)Effectmeasure:estimate(95%CI)Guxens2013Prosp.cohort,Netherlands,5283Depression(20wks)Overweight(3m4y)aORMaternal:1.09(0.92Paternal:0.71(0.46Wang2013Prosp.cohort,USA,1090Depression(1,24and36m)Overweight(24m12y)aOR:1.50(0.96Audelo2016Prosp.cohort,USA,332Depression(1,3.5and7yObesity(7y)aOR:2.4(1.1Blanco2017Matchedcasecontrol,Spain,100Depressionscore(812y)Obesity(812y)Weight,mean(s.d.),kg:Normal7.28(5.57),Obese:9.56=0.086Figueiredo2017Prosp.cohort,Finland,4525Alcoholmisuse(914y)Overweight(914y)aRR:1.00(0.81Otherstudiesfromlowandmiddle-incomecountriesDeMiranda1996control,Brazil,105Mentaldisorder(02y)malnutrition(02y)aOR2.9(1.2Anoop2004Matchedcasecontrol,India,144Depression(1m)Malnutrition(612m)aOR:7.4(1.6Rahman2004Prosp.cohort,Pakistan,320Depression(3rdtrimesterand2,6,and12m)DiarrhoeaOR2.4(1.7Adewuya2008Prosp.matchedcohort,Nigeria,142Depression(6m)Malnutrition(9m)OR:2.84(0.98Santos2011Matchedcasecontrol,Brazil,294Commonmentaldi

sorder(05y)Malnutrition(05y)aOR:2.04(1.10Okronipa2012Prosp.cohort,Ghana,492Depression(050days)Diarrhoea(03m)aOR:2.89(1.71Ashaba2015Matchedcasecontrol,Uganda,166Depression(15y)Malnutrition(15y)OR:2.4(1.11Weobong2015Prosp.cohort,Ghana,12618Depression(412wks)Diarrhoea(01y)aOR:1.80(1.45Otherstudiesfromhigh-incomeBan2010Retro.cohort,UK,107587Depression(pregnancyto6m)Infection(04y)RR:GI1.40(1.37LRTI1.27(1.22Sarkola2011Retro.matchedcohort,Finland,2552Alcoholorsubstancemisuse(pregnancy)Diseasesoftheeye,earormastoidprocess(05y)OR:1.34(1.03Prosp.,prospective;retro.,retrospective;gest.,gestation;a,adjustedanalyses;HR,hazardratio;IRR,incidencerateratio;OR,oddsratio;RR,riskratio;m,month;y,year;wks,weeks;GI,gastrointestinalinfection;LRTI,lowerrespiratorytractinfection.a.Fromthemostsevereandchronicexposuresreportedineachstudy.OtherrelevantanalysesarereportedinsupplementaryAppendixB.Pierceetal KWWSVGRLRUJEMS 3XEOLVKHGRQOLQHE\&DPEULGJH8QLYHUVLW\3UHVV alinkwithchronic,butnotwithepisodic(mostlypostnatal),mater-naldepression.Allofthestudiesweidentifiedthatinvestigatedthisrelationshipusedprospectivecohortorcasecontroldesigns,whichgenerallyhadsmallersamplesthanstudiesthatusedregis-try-basedcohorts.Therefore,thelackofdefinitivefindingsmaybeduetolackofpowerofindividualstudies.AllthestudiesfromLMICsreportedapositiveassociationbetweenmaternaldepressionandoffspringmalnutritionordiar-rhoea.Halfoftheseexclusivelyexaminedtheeffectofpostnataldepressioninthefirstyearafterbirth.RecentreviewshavereportedratesofmaternalpostnataldepressioninLMICsofaround20%,considerablyhigherthanthe6.512.9%seeninaffluentWesternEvidencealsosuggeststhatmaternalmentalillhealthisassociatedwithbothpoorfetalandchildgrowth.Therefore,maternalmentalhealthhasbeenhighlightedasaprioritytargetforscreeningmothersinthesesettings.StrengthsandlimitationsThereviewhighlightshowchildrenofparentswithmentalillnesshavemultiplephysicalhealthchallenges,ontopofpreviouslyidentifiedmortalityandneurodevelopmentalrisks.strengthsofourreviewreinforcethefindings.First,althoughthedifferentoutcomesunderconsiderationprecludedirectcompari-sonofestimates,thereisgeneralconsistencyintheeffectsizesesti-mated,lendingweighttotheevidence.Also,weusestrictdefinitionsofstudydesign;thismeansthattheestimatesarebetterapproximationsofeffectsizesthanifweakerstudydesignswereused:i.e.cross-sectionalstudies.Therefore,weindi-catewherepotentialmechanisticexplanationsshouldbeexplored,sothatmodifiablefactorsmightbeidentifiedtohelpthisvulner-ablegroup.Theincludedstudiescomefromheterogeneoussamples,countries,settings,measuresanddesigns.Thisstrength-enstheconclusionsofthereviewbecause,astheresultsgenerallyshowconsistency,wecanassumethatthefindingsareindepend-entofthesefactors.Todate,thisisthemostcomprehensivereviewandmeta-ana-lysisoftheassociationsbetweenparentalmentalillnessandoff-springphysicalillnessduringchildhood,howeverthereareanumberoflimitations.Fewstudiesinvestigatedtheeffectofbothmaternalandpaternalmentalillnessand,generally,theynotedweakereffectsforpaternalexposure.Thisindicatesthatmaternalconditionplaysamoreimportantroleintheriskofoff-springphysicalillhealth,eitherasaresultofintrauterineexposures,orthroughearlychildhoodexperiencesorboth;italsoprovidessomeevidenceagainstapurelygeneticcausefortheserelationships.Alltheidentifiedstudiescomefromobservationalsettingsandarethereforesubjecttoconfoundingbias.Mostattemptedtoaccountforthisbias,primarilyusingregressionadjustment.Notably,mostoftheadjustedanalyseswereclosertoanulleffectsize.Thisindicatesthat,overall,factorsthatincreasetheriskofpar-entalmentalillnessarealsolikelytoincreasetheriskofpoorphys-icalhealthinoffspring(andviceversa).Oneobviouscandidateforavariableofthiskindissocioeconomicormultipledeprivation,inex-tricablylinkedwithparentalmentalillhealthandpoorchildphys-icalhealth.Despiteadjustmentforconfounders,wemustbecautiousbeforeattributingthecausesofpoorchildphysicalhealthtoparentalmentaldisorders.First,notallthepotentialconfoundersarelikelytobeidentifiedandmeasuredindataavailabletoresearchers.Twoofthemorerecentstudiestriedtoaccountforresidualcon-foundingfromfamilialfactorsbyinvestigatingwhetherassociationsstillpersistusingsiblingorcousinanalysisorwheninvestigat-ingpaternalexposure.Second,somestudiesmaybesubjecttooveradjustment,whereanalysesadjustforvariablesonthepathwaybetweentheexposureandtheoutcome.Forexample,poorfetalgrowthisassociatedwithbothprenatalmaternalmentaldisorderaswell

asmanyhealthoutcomes.Therefore,thismightbethemechanismbywhichprenatalmaternalmentaldisorderinfluenceschildhealthandstudiesthatadjustforthismightbeunderestimatingtheeffectofmaternalmentalillnessonchildhealth.Third,althoughweexcludedstudiesinwhichitwasclearthattheoutcomewasmeasuredbeforetheexposureoccurred,formanystudiesthiswasunclear.Therefore,wecannotruleoutthatatleastsomeportionoftheresultswerebecausepoorchildhealthaffectsparentalmentalillnessandnotviceversa.Fourth,althoughweactivelytriedtoincludeunpublishedresearch,alltheidentifiedstudieswerefromthepublishedliterature.Therefore,itmightwellbethatsomepositivefindingsaretheresultofpublicationbias.ImplicationsforfutureresearchandpolicyThissystematicreviewshinesastarklightonthegapsinourknowl-edgeaboutthephysicalhealthofchildrenwhoseparentshavementalillness,andhighlightsaneedtoshiftthefocusofresearchtowardsparentalmentaldisordersotherthanmaternalpostnataldepression.Futurestudiesshouldinterrogatetheextenttowhichantenatal,perinatalandpostnatalexposureshavedifferentialeffectsonoffspringsriskofphysicalillness.Also,maternalmentaldisordermayposemorerisktochildphysicalhealththanpaternaldisorderbutthereisastrongneedforfuturestudiestoincludepaternalexposurewherepossibleifwearetounderstandthemechanismsbehindtheseeffectsinparticularoutcomes.Thischimeswellwithrecentcallsforresearchandpolicytoplaceagreateremphasisontheroleoffathersinchildrenslives.Futureresearchshouldinterrogatetheassociationshighlightedheretoexplorebehavioural,environmentalandgeneticcauses.Todothiswehighlightaneedtodevelopfreshapproachestounderstand-ingthelinksbetweenchildphysicalhealthandparentalmentalhealth.Theseincludethenecessityofaccountingforkeyconfoundersandtoconsidertheuseofalternativedesignstrategies,includingnegativecontrols,siblingorquasi-experimentaldesigns.Iffutureresearchistobeabletodeepenourunderstandingofwhenandhowthesevul-nerablechildrenareatriskofpreventableillnesses,largehigh-qualitycohortsmustbeidentified.Forexample,toinvestigatemechanismsofchildhoodasthma(stillthemostcommonchildhoodillness)weneedtolookateffectsofdifferentparentalillnessesandeffectsofmaternalversuspaternalmentaldisorder.Combiningdataacrosssuchcohortsfromdifferentcountriesmayoffersuchanopportunity.Finally,fromapolicyperspective,suchapproachescanofferthedetailneededtoplanresourceallocationanddevelopnewserviceprovision.Studiesdescribingpatternsofhealthcareutilisationbythesechildrenandparentsmaybeparticularlyvaluableforthis.MatthiasPierce ,PhD,ResearchFellow,CentreforWomensMentalHealth,DivisionofPsychologyandMentalHealth,FacultyofBiology,MedicineandHealth,UniversityofManchester,UK;HollyF.Hope ,PhD,ResearchAssociate,CentreforWomenMentalHealth,DivisionofPsychologyandMentalHealth,FacultyofBiology,MedicineandHealth,UniversityofManchester,UK;AdekeyeKolade,MRes,ResearchAssistant,CentreforWomensMentalHealth,DivisionofPsychologyandMentalHealth,FacultyofBiology,MedicineandHealth,UniversityofManchester,UK;JudithGellatly,PhD,ResearchFellow,CentreforWomensMentalHealth,DivisionofPsychologyandMentalHealth,FacultyofBiology,MedicineandHealth,UniversityofManchester,UK;CemreSuOsam,MSc,PhDStudent,CentreforWomensMentalHealth,DivisionofPsychologyandMentalHealth,FacultyofBiology,MedicineandHealth,UniversityofManchester,UK;ReenaPerchard,MBChB,MRCPCH,ClinicalResearchFellow,DivisionofDevelopmentalBiology&Medicine,FacultyofBiology,MedicineandHealth,UniversityofManchester,UK;KyriakiKosidou,MD,PhD,SeniorConsultant,DepartmentofPublicHealthSciences,DivisionPublicHealthEpidemiology,KarolinskaInstitutet,Stockholm;andCentreforEpidemiologyandCommunityMedicine,StockholmCountyCouncil,ChristinaDalman,MD,PhD,ProfessorofPsychiatricEpidemiologyandResearchGroupLeader,DepartmentofPublicHealthSciences,DivisionPublicHealthEpidemiology,KarolinskaInstitutet,Stockholm;andCentreforEpidemiologyandCommunityMedicine,StockholmCountyCouncil,Sweden;VeraMorgan,MSocSc,PhD,WinthropProfessorandHead,NeuropsychiatricEpidemiologyResearchUnit,DivisionofPsychiatry,UniversityofWesternAustralia,Australia;PatriciaDiPrinzio,BSc,MBiostat,ResearchFellow,NeuropsychiatricEpidemiologyResearchUnit,DivisionofPsychiatry,Effectsofparentalmentalillnessonchildrensphysicalhealth KWWSVGRLRUJEMS 3XEOLVKHGRQOLQHE\&DPEULGJH8QLYHUVLW\3UHVV UniversityofWesternAustralia,Australia;KathrynM.Abel,MBBS,FRCP,FRCPsych,PhD,ProfessorofPsychologicalMedicineandDirector,CentreforWomensMentalHealth,DivisionofPsychologyandMentalHealth,FacultyofBi

ology,MedicineandHealth,UniversityofManchester,UKMatthiasPierce,CentreforWomensMentalHealth,Room3.320,JeanMcFarlaneBuilding,OxfordRoad,ManchesterM139PL,UK.Email:Firstreceived11May2018,finalrevision19Aug2019,accepted7Sep2019ThisprojecthasreceivedfundingfromtheEuropeanResearchCouncil(ERC)undertheEuropeanUnionsHorizon2020researchandinnovationprogramme(grantagreementno.GA682741)andtheNationalInstituteforHealthResearchGrant(grantreference111905). SupplementarymaterialSupplementarymaterialisavailableonlineathttps://doi.org/10.1192/bjp.2019.216BassaniDG,PadoinCV,PhilippD,VeldhuizenS.EstimatingthenumberofchildrenexposedtoparentalpsychiatricdisordersthroughanationalhealthChildAdolescPsychiatryMentHealth:6.MayberyDJ,ReupertAE,PatrickK,GoodyearM,CraseL.Prevalenceofpar-entalmentalillnessinAustralianfamilies.:22AbelKM,HopeH,SwiftE,ParisiR,AshcroftDM,KosidouK,etal.PrevalenceofmaternalmentalillnessamongchildrenandadolescentsintheUKbetween2005and2017:anationalretrospectivecohortanalysis.LancetPublicHealth:e291PurasD,KolaitisG,TsiantisJ.ChildandadolescentmentalhealthintheenlargedEuropeanUnion:overviewoftheCAMHEEproject.IntJMentHealthDigginsM,ChildT,ParentT.ThinkFamily:AGuidetoParentalMentalHealthandChildWelfare.SCIE,2011.AbelKM,HopeH,FauldsA,PierceM.Promotingresilienceinchildrenandadolescentslivingwithparentalmentalillness(CAPRI):childrenarekeytoidentifyingsolutions.BrJPsychiatry2019:1RasicD,HajekT,AldaM,UherR.Riskofmentalillnessinoffspringofparentswithschizophrenia,bipolardisorder,andmajordepressivedisorder:ameta-analysisoffamilyhigh-riskstudies.SchizophrBull:28FairthorneJ,DeKN,LeonardH.Therelationshipbetweenmaternalpsychiatricdisorder,autismspectrumdisorderandintellectualdisabilityinthechild:acompositepicture.JAutism:2.ShenH,MagnussonC,RaiD,LundbergM,Lê-ScherbanF,DalmanC,etal.Associationsofparentaldepressionwithchildschoolperformanceatage16yearsinSweden.JAMAPsychiatry:239BergL,BackK,VinnerljungB,HjernA.Parentalalcohol-relateddisordersandschoolperformancein16-year-olds:aSwedishnationalcohortstudy.:1795WebbRT,PicklesAR,King-HeleSA,ApplebyL,MortensenPB,AbelKM.Parentalmentalillnessandfatalbirthdefectsinanationalbirthcohort.:1495SteinA,PearsonRM,GoodmanSH,RapaE,RahmanA,McCallumM,etal.Effectsofperinatalmentaldisordersonthefetusandchild.WebbR,AbelK,PicklesA,ApplebyL.Mortalityinoffspringofparentswithpsychoticdisorders:acriticalreviewandmeta-analysis.AmJPsychiatry:1045WebbRT,ScM,AbelKM,ApplebyL,King-HeleSA,MortensenPB.Mortalityriskamongoffspringofpsychiatricinpatients:apopulation-basedfollow-uptoearlyadulthood.AmJPsychiatry:2170MeijerSA,SinnemaG,BijstraJO,MellenberghGJ,WoltersWHG.Socialfunc-tioninginchildrenwithachronicillness.JChildPsycholPsychiatryThiesKM.IdentifyingtheeducationalimplicationsofchronicillnessinschoolJSchHealth:392CurrieJ.Healthy,wealthy,andwise:socioeconomicstatus,poorhealthinchildhoodandhumancapitaldevelopment.JEconLit:87RoughE,GoldblattP,MarmotM,NathansonV.Inequalitiesinchildhealth.GrowingUpintheUK:EnsuringaHealthFutureforOurChildren(edsAMansfield,GFoyle,VNathanson):3756.BMABoardofScience,2013.MilgromJ,SkouterisH,WorotniukT,HenwoodA,BruceL.Theassociationbetweenante-andpostnataldepressivesymptomsandobesityinbothmotherandchild:asystematicreviewoftheliterature.WomensHealthIssues:e319LampardAM,FranckleRL,DavisonKK.Maternaldepressionandchildhoodobesity:asystematicreview.PrevMed:60BentonPM,SkouterisH,HaydenM.Doesmaternalpsychopathologyincreasetheriskofpre-schoolerobesity?Asystematicreview.:259EasterG,SharpeL,HuntCJ.Systematicreviewandmeta-analysisofanxiousanddepressivesymptomsincaregiversofchildrenwithasthma.JPediatr:623vandeLooKFE,vanGelderMMHJ,RoukemaJ,RoeleveldN,MerkusPJFM,VerhaakCM.Prenatalmaternalpsychologicalstressandchildhoodasthmaandwheezing:ameta-analysis.EurRespirJ:133AnderssonNW,HansenMV,LarsenAD,HougaardKS,KolstadHA,SchlünssenV.Prenatalmaternalstressandatopicdiseasesinthechild:asystematicreviewofobservationalhumanstudies.TacconelliE.Systematicreviews:CRDsguidanceforundertakingreviewsinhealthcare.LancetInfectDis:226.NationalHeart,LungandBloodInstitute.StudyQualityAssessmentTools.NationalInstitutesofHealth(https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools).Accessed14February2018.PhelanK,KhouryJ,AthertonH,KahnRS.Maternaldepression,childbehavior,andinjury.InjPrev:403McKinlayA,KyonkaEGE,GraceRC,HorwoodLJ,FergussonDM,MacFarlaneMR.Aninvestigationofthepre-injuryriskfactorsassociatedwithchildrenwhoexperiencetraumaticbraininjury.InjPrev:31MyhreMC,ThoresenS,GrogaardJB,DybG.Familialfactorsandchildchar-acteristicsaspredictorsofinju

riesintoddlers:aprospectivecohortstudy.:e000740.OrtonE,KendrickD,WestJ,TataLJ.Independentriskfactorsforinjuryinpre-schoolchildren:threepopulation-basednestedcasecontrolstudiesusingroutineprimarycaredata.PLoSOne(4):e35193.BakerR,KendrickD,TataLJ,OrtonE.Associationbetweenmaternaldepres-sionandanxietyepisodesandratesofchildhoodinjuries:acohortstudyfromInjPrev:396SchwebelDC,BrezausekCM.Howdomothersandfathersinfluencepediatricinjuryriskinmiddlechildhood?JPediatrPsychol:806WinqvistS,JokelainenJ,LuukinenH,HillbomM.Parentalalcoholmisuseisapowerfulpredictorfortheriskoftraumaticbraininjuryinchildhood.BrainInj:1079WilsonGS,DesmondMM,WaitRB.Follow-upofmethadone-treatedanduntreatednarcotic-dependentwomenandtheirinfants:health,developmen-tal,andsocialimplications.JPediatr:716RaitasaloK,HolmilaM.Parentalsubstanceabuseandriskstochildrensafety,healthandpsychologicaldevelopment.DrugsEducPrevPolicy2017;22.HowardLM,GossC,LeeseM,ThornicroftG.Medicaloutcomeofpregnancyinwomenwithpsychoticdisordersandtheirinfantsinthefirstyearafterbirth.JPsychiatry:63CooksonH,GranellR,JoinsonC,Ben-ShlomoY,HendersonAJ.Mothersanxietyduringpregnancyisassociatedwithasthmaintheirchildren.JAllergyClinImmunol:847GialloR,BahreinianS,BrownS,CooklinA,KingstonD,KozyrskyjA.Maternaldepressivesymptomsacrossearlychildhoodandasthmainschoolchildren:findingsfromalongitudinalAustralianpopulationbasedstudy.PLoSOne(3):e0121459.LangeNE,BunyavanichS,SilbergJL,CaninoG,RosnerBA,CeledónJC.ParentalpsychosocialstressandasthmamorbidityinPuertoRicantwins.JAllergyClin:734BrewBK,LundholmC,ViktorinA,LichtensteinP,LarssonH,AlmqvistC.Longitudinaldepressionoranxietyinmothersandoffspringasthma:aSwedishpopulation-basedstudy.IntJEpidemiol:166MagnusMC,WrightRJ,RøysambE,ParrC,KarlstadØ,PageC,etal.AssociationofmaternalpsychosocialstresswithincreasedriskofasthmadevelopmentinAmJEpidemiol:1199Pierceetal KWWSVGRLRUJEMS 3XEOLVKHGRQOLQHE\&DPEULGJH8QLYHUVLW\3UHVV KlinnertMD,NelsonHS,PriceMR,AdinoffAD,LeungDYM,MrazekDA.Onsetandpersistenceofchildhoodasthma:predictorsfrominfancy.:e69.KozyrskyjAL,LetourneauNL,KangLJ,SalmaniM.AssociationsbetweenpostpartumdepressivesymptomsandchildhoodasthmadiminishwithchildClinExpAllergy:324KozyrskyjAL,MaiX-M,McGrathP,HayGlassKT,BeckerAB,MacNeilB.Continuedexposuretomaternaldistressinearlylifeisassociatedwithanincreasedriskofchildhoodasthma.AmJRespirCritCareMed2008;:142WangIJ,WenHJ,ChiangTL,LinSJ,GuoYL.Maternalpsychologicproblemsincreasedtheriskofchildhoodatopicdermatitis.PediatrAllergyImmunol:169LetourneauNL,KozyrskyjAL,CosicN,NtandaHN,AnisL,HartMJ,etal.MaternalsensitivityandsocialsupportprotectagainstchildhoodatopicAllergyAsthmaClinImmunol:26.ElbertNJ,DuijtsL,denDekkerHT,deJongNW,NijstenTE,JaddoeVW,etal.MaternalpsychiatricsymptomsduringpregnancyandriskofchildhoodatopicClinExpAllergy:509DeSousaA.Maternal,childandfamilyfactorsinchildhoodobesity.IntJDiabetesMetab:111Bronte-TinkewJ,ZaslowM,CappsR,HorowitzA,McNamaraM.Foodinse-curityworksthroughdepression,parenting,andinfantfeedingtoinfluenceoverweightandhealthintoddlers.JNutr:2160AjslevTA,AndersenCS,IngstrupKG,NohrEA,SørensenTIA.Maternalpost-partumdistressandchildhoodoverweight.PLoSOne(6):e11136.SantosIS,MatijasevichA,DominguesMR,BarrosAJD,BarrosFCF.Long-lastingmaternaldepressionandchildgrowthat4yearsofage:acohortstudy.:401GuxensM,TiemeierH,JansenPW,RaatH,HofmanA,SunyerJ,etal.Parentalpsychologicaldistressduringpregnancyandearlygrowthinpreschoolchil-dren:ThegenerationRstudy.AmJEpidemiol:538WangL,AndersonJL,DaltonIIIWT,WuT,LiuX,ZhengS,etal.Maternaldepressivesymptomsandtheriskofoverweightintheirchildren.MaternChildHealthJ:940AudeloJ,KogutK,HarleyKG,RosasLG,SteinL,EskenaziB.Maternaldepres-sionandchildhoodoverweightintheCHAMACOSstudyofMexican-AmericanMaternChildHealthJ:1405BlancoM,SepulvedaAR,LacruzT,ParksM,RealB,Martin-PeinadorY,etal.Examiningmaternalpsychopathology,familyfunctioningandcopingskillsinchildhoodobesity:acasecontrolstudy.EurEatDisordRev:359WojcickiJM,HolbrookK,LustigRH,EpelE,CaugheyAB,MuñozRF,etal.ChronicmaternaldepressionisassociatedwithreducedweightgaininLatinoinfantsfrombirthto2yearsofage.PLoSOne(2):e16737.FigueiredoRdO,RoosE,ErikssonJG,Simola-StrömS,WeiderpassE.Maternalalcoholandtobaccoconsumptionandtheassociationwiththeir9to14-year-oldchildrensbodymassindex.ScandJPublicHealth:503deMirandaCT,TureckiG,deJesusMariJ,AndreoliSB,MarcolimMA,GoihmanS,etal.Mentalhealthofthemothersofmalnourishedchildren.IntJ:128AnoopS.Maternaldepressionandlow

maternalintelligenceasriskfactorsformalnutritioninchildren:acommunitybasedcase-controlstudyfromSouthArchDisChild:325AdewuyaAO,OlaBO,AlobaOO,MapayiBM,OkeniyiJAO.ImpactofpostnataldepressiononinfantsgrowthinNigeria.JAffectDisord:191SantosDS,SantosDN,DeCássiaRibeiroSilvaR,HasselmannMH,BarretoML.Maternalcommonmentaldisordersandmalnutritioninchildren:acase-con-trolstudy.SocPsychiatryPsychiatrEpidemiol:543AshabaS,RukundoGZ,BeinempakaF,NtaroM,LeBlancJC.MaternaldepressionandmalnutritioninchildreninsouthwestUganda:acasecontrolBMCPublicHealth:1303.RahmanA,IqbalZ,BunnJ,LovelH,HarringtonR.Impactofmaternaldepressiononinfantnutritionalstatusandillness.ArchGenPsychiatry2004;:94652.OkronipaH,MarquisG,LarteyA,BrakohiapaL,Perez-EscamillaR,MazurRE.PostnataldepressionsymptomsareassociatedwithincreaseddiarrheaamonginfantsofHIV-positiveGhanaianmothers.AIDSBehav2012;:221625.WeobongB,tenAsbroekAHA,SoremekunS,GramL,Amenga-EtegoS,DansoS,etal.Associationbetweenprobablepostnataldepressionandincreasedinfantmortalityandmorbidity:findingsfromtheDONpopulation-basedcohortstudyinruralGhana.BMJOpen(8):e006509.BanL,GibsonJE,WestJ,TataLJ.Associationbetweenperinataldepressioninmothersandtheriskofchildhoodinfectionsinoffspring:apopulation-basedcohortstudy.BMCPublicHealth:799.SarkolaT,GisslerM,KahilaH,Autti-RämöI,HalmesmäkiE.Earlyhealthcareutilizationandwelfareinterventionsamongchildrenofmotherswithalcoholandsubstanceabuse:aretrospectivecohortstudy.ActaPaediatrPhelanKJ,MorrongielloBA,KhouryJC,XuY,LiddyS,LanphearB.Maternalsupervisionofchildrenduringtheirfirst3yearsoflife:theinfluenceofmaternaldepressionandchildgender.JPediatrPsychol:349CleaverH,NicholsonD,TarrS,CleaverD.ChildProtection,DomesticViolenceandParentalSubstanceMisuse:FamilyExperiencesandEffectivePracticeJessicaKingsley,2007.ChenYH,LeeHC,LinHC.Prevalenceandriskofatopicdisordersamongschizophreniapatients:anationwidepopulationbasedstudy.SchizophrRes:191PedersenMS,BenrosME,AgerboE,BørglumAD,MortensenPB.Schizophreniainpatientswithatopicdisorderswithparticularemphasisonasthma:aDanishpopulation-basedstudy.SchizophrRes:58FitzsimonsE,GoodmanA,KellyE,SmithJP.Povertydynamicsandparentalmentalhealth:determinantsofchildhoodmentalhealthintheUK.SocSciMed:43WickhamS,WhiteheadM,Taylor-RobinsonD,BarrB.Theeffectofatransitionintopovertyonchildandmaternalmentalhealth:alongitudinalanalysisoftheUKMillenniumCohortStudy.LancetPublicHeal:e141BjörkenstamC,KosidouK,BjörkenstamE.Childhoodadversityandriskofsuicide:cohortstudyof548721adolescentsandyoungadultsinSweden.:j1334.FagundesCP,Kiecolt-glaserJK.StressfulearlylifeexperiencesandimmuneBrainBehavImmunSternthalMJ,EnlowMB,CohenS,CannerMJ,StaudenmayerJ,TsangK,etal.MaternalinterpersonaltraumaandcordbloodIgElevelsinaninner-citycohort:alife-courseperspective.JAllergyClinImmunol:954FisherJ,CabraldeMelloM,PatelV,RahmanA,TranT,HoltonS,etal.Prevalenceanddeterminantsofcommonperinatalmentaldisordersinwomeninlow-andlower-middle-incomecountries:asystematicreview.WorldHealthOrgan:139GavinNI,GaynesB,LohrKN,Meltzer-BrodyS,GartlehnerG,SwinsonT.Perinataldepression:asystematicreviewofprevalenceandincidence.:1071GelayeB,RondonM,ArayaR,WilliamsMA.Epidemiologyofmaternaldepression,riskfactors,andchildoutcomesinlow-incomeandmiddle-incomecountries.LancetPsychiatry:973SurkanPJ,KennedyCE,HurleyKM,BlackMM.Maternaldepressionandearlychildhoodgrowthindevelopingcountries:systematicreviewandmeta-ana-BullWorldHealthOrgan:608WalkerSP,WachsTD,MeeksGardnerJ,LozoffB,WassermanGA,PollittE,etal.Childdevelopment:riskfactorsforadverseoutcomesindevelopingcountries.:145ElliottI.PovertyandMentalHealth:AReviewtoInformtheJosephRowntreesAnti-PovertyStrategy.MentalHealthFoundation,2016.BradleyRH,CorwynRF.Socioeconomicstatusandchilddevelopment.RevPsychol:371LewisAJ,AustinE,GalballyM.Prenatalmaternalmentalhealthandfetalgrowthrestriction:asystematicreview.JDevOrigHealthDis:416King-HeleS,WebbRT,MortensenPB,ApplebyL,PicklesA,AbelKM.Riskofstillbirthandneonataldeathlinkedwithmaternalmentalillness:anationalcohortstudy.ObstetGynecolSurv:439SteinA,PearsonRM,GoodmanSH,RapaE,RahmanA,McCallumM,etal.Effectsofperinatalmentaldisordersonthefetusandchild.ClaptonG.DadMatters:WhyFathersShouldFigureinYourWork.FathersNetworkScotland,2014(http://www.fathersnetworkscotland.org.uk/archive/LawlorDA,TillingK,SmithGD.Triangulationinaetiologicalepidemiology.IntJ:1866 Effectsofparentalmentalillnessonchildrensphysicalhealth KWWSVGRLRUJEMS 3XEOLVKHGRQOLQHE\&DPEULGJH8QLYHUVLW\3