Children of Parents With Affective and Nonaffective Psychoses: A Longitudinal Study of Behavior Problems

Jo-Ann L. Donatelli, Ph.D., Larry J. Seidman, Ph.D., Jill M. Goldstein, Ph.D., Ming T. Tsuang, M.D., Ph.D., D.Sc., and Stephen L. Buka, Sc.D.
From the Department of Psychiatry, Community Health, Brown University, Providence, R.I.; the Department of Psychiatry, Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; the Departments of Psychiatry and Medicine, Connors Center for Women's Health and Gender Biology, Harvard Medical School at Brigham and Women's Hospital, Boston; and the Department of Psychiatry, Center for Behavior Genetics, University of California at San Diego, San Diego.
OBJECTIVE: It is generally accepted that children of parents with schizophrenia or other forms of psychosis are at heightened risk for a range of behavioral problems. However, it remains unclear whether offspring of parents with different forms of psychosis (e.g., schizophrenia, other nonaffective psychoses, and affective psychoses) have distinct forms of behavioral problems (i.e., internalizing and externalizing).
METHOD: Behavioral observations of children of parents with psychosis (N=281) and parents without psychosis (N=185) were conducted at ages 4 and 7 years.
RESULTS: There were no significant differences between groups in behavior observed at age 4 years. At age 7 years, compared with children of unaffected parents, children of parents with psychosis had an adjusted odds ratio of 2.8 (95% CI=1.5–5.6) for externalizing problems, in particular for children of parents with schizophrenia (adjusted odds ratio=4.4; 95% CI=1.7–12.5). This increase in risk for externalizing problems was observed for female children only (adjusted odds ratio=8.1; 95% CI=2.5–26.3). In contrast, male children were at increased risk for internalizing problems(adjusted odds ratio=3.6; 95% CI=1.6–8.3).
CONCLUSIONS: Children of parents with various forms of psychosis are at risk for internalizing and externalizing problems by age 7 years. This risk varies by gender of the offspring. Implications for treatment of parents with psychotic disorders and high-risk children are discussed.