Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; National Institute of Mental Health, Bethesda, MD, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Psychiatr Res. 2019 Jul;114:153-160. doi: 10.1016/j.jpsychires.2019.05.003. Epub 2019 May 3.
Children's perceptions are important to understanding family environment in the bipolar disorder (BD) high-risk context. Our objectives were to empirically derive patterns of offspring-perceived family environment, and to test the association of family environment with maternal or paternal BD accounting for offspring BD and demographic characteristics. Participants aged 12-21 years (266 offspring of a parent with BD, 175 offspring of a parent with no psychiatric history) were recruited in the US and Australia. We modeled family environment using latent profile analysis based on offspring reports on the Conflict Behavior Questionnaire, Family Adaptability and Cohesion Evaluation Scales, and Home Environment Interview for Children. Parent diagnoses were based on the Diagnostic Interview for Genetic Studies and offspring diagnoses were based on the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Latent class regression was used to test associations of diagnosis and family environment. Two-thirds of all offspring perceived well-functioning family environment, characterized by nurturance, flexibility, and low conflict. Two 'conflict classes' perceived family environments low in flexibility and cohesion, with substantial separation based on high conflict with the father (High Paternal Conflict), or very high conflict and rigidity and low warmth with the mother (High Maternal Conflict). Maternal BD was associated with offspring perceiving High Maternal Conflict (OR 2.8, p = 0.025). Clinical care and psychosocial supports for mothers with BD should address family functioning, with attention to offspring perceptions of their wellbeing. More research is needed on the effect of paternal BD on offspring and family dynamics.
儿童的认知对于理解双相障碍（BD）高危环境中的家庭环境很重要。我们的目标是从经验上得出子女感知家庭环境的模式，并检验家庭环境与父母的 BD 之间的关联，同时考虑子女的 BD 和人口统计学特征。参与者年龄在 12-21 岁之间（266 名父母中有一名患有 BD 的子女，175 名父母中无精神病史的子女），在美国和澳大利亚招募。我们使用基于子女对冲突行为问卷、家庭适应性和凝聚力评估量表以及儿童家庭环境访谈报告的潜在剖面分析来构建家庭环境。父母的诊断基于遗传研究诊断访谈，子女的诊断基于儿童情感障碍和精神分裂症诊断访谈。潜在类别回归用于检验诊断和家庭环境之间的关联。三分之二的子女感知到功能良好的家庭环境，其特征是养育、灵活性和低冲突。有两个“冲突类别”感知到家庭环境缺乏灵活性和凝聚力，与父亲的冲突很大（高父亲冲突），或者与母亲的冲突非常大且僵硬且温暖度低（高母亲冲突）。母亲的 BD 与子女感知到高母亲冲突相关（OR 2.8，p=0.025）。为患有 BD 的母亲提供临床护理和心理社会支持应解决家庭功能问题，并关注子女对其幸福感的感知。需要更多关于父亲的 BD 对子女和家庭动态影响的研究。
