Signe Heuckendorff

Children of parents with mental illness face significant increased risks of developing mental health problems and experiencing developmental delays or other negative life outcomes due to genetic and environmental factors. Parental symptoms often disrupt caregiving, leading to family stress, inadequate routines, and insufficient stimulation and support in the home. Research, including findings from the Danish High Risk and Resilience Study, the VIA cohort, has shown substantial developmental, social, and cognitive challenges in these children. This study aims to evaluate the efficacy of a team-based, multidisciplinary preventive intervention compared with standard treatment for families with recent parental mental illness via a series of predefined outcome measures. This randomized controlled trial, VIA Family 2.0, includes 304 children aged 3-17 years and 128 children aged 0-2 years with a parent with a psychiatric diagnosis and having received treatment within the past three years. The families will be assessed at baseline and thereafter randomized to either treatment as usual or VIA Family 2.0 intervention. The intervention group will be assigned to a multidisciplinary team with expertise from municipal services, child and adolescent psychiatry, and adult psychiatry. A case manager coordinates all the elements and supports the family with their challenges, on the basis of their own motivation. The study period is 24 months, and all participants will be assessed at baseline and after 24 months. The primary outcomes are cognitive, language and motor development for infants and toddlers aged 0-2 years (Bayley-4, Bayley Scales of Infant and Toddler Development), well-being and behavioral and social development for children aged 3-17 years (the Strengths and Difficulties Questionnaire (SDQ)), perceived parental stress for parents (Parental Stress Scale, PSS), and family functioning for the family (Family Assessment Device, FAD). This study examines the impact of a cross-sectoral intervention that integrates expertise across sectors. This study contributes critical knowledge about whether improving family resilience, supporting children's development, and reducing risk loads through holistic family support is possible. This research highlights the potential of preventive public health initiatives to promote well-being and reduce long-term adverse outcomes in a high-risk group of children and adolescents. The study is registered at ClinicalTrials.Gov (NCT06312410) on March 15, 2024.

Introduction: Children of parents with mental illness face heightened risks of adverse health, social, and educational outcomes. Yet, families affected by parental mental illness are often overlooked in mental health and social care systems. Identifying parents in psychiatric care enables targeted interventions to mitigate intergenerational risks. This study aims to estimate the prevalence and describe the sociodemographic characteristics of patients in psychiatric hospital services in Denmark who are parents, with particular focus on those living with minor children, to inform future preventive support strategies.Methods: Using Danish nationwide register data from 2020-2022, we identified individuals with at least one adult psychiatric hospital contact. Parenthood was determined through linkage to the Civil Registration System, including children aged 0–29 years. Diagnoses, socioeconomic status, and living arrangements were described, and associations between parental characteristics and co-residence with a minor child were described using crude relative risks.Results: Among 164,223 patients in psychiatric hospital services, 24% had at least one minor child (aged 0–17 years), and 8% had only adult children (aged 18–29 years). The most common diagnoses among parents with minor children were neurotic and stress-related disorders (31%) and affective disorders (25%). Geographic and diagnostic variation in the prevalence of parents was observed, and parent patients generally had higher socioeconomic status than non-parent patients. Among parent patients, those with a partner, higher education, and labor market affiliation were more likely to live with their child.Conclusions: One in four Danish psychiatric hospital patients have minor children, highlighting the need for systematic identification and tailored services. The findings underscore the importance of integrating family-focused approaches within psychiatric care to reduce the long-term burden on children and break cycles of mental illness.

Aim: The aim of this study is to investigate associations between attending routine preventive child health examinations in general practice and the risk of obesity and overweight at age six, focusing on psychosocial risk factors. Methods: Data from nationwide Danish registers on 725 926 children born between 2000 and 2012 were analysed. Information on examination attendance and BMI was obtained. Regression analyses assessed the association between examination attendance and obesity or overweight risk. Results: Non‐attendance in preventive child health examinations was associated with a risk of obesity of 18%–31% at age six. The highest risk was observed in children of parents with low educational attainment who missed all examinations, a four‐ to five‐fold increase compared to children of parents with high educational attainment who attended all or missed only one exam. A smaller association of one to 2% was found between missing examinations and risk of overweight in the general population. However, children of parents with low educational attainment who did not attend were 8%–9% more likely to have overweight. Conclusion: Associations were found between obesity and overweight and not attending preventive child health examinations in general practice. Further research is needed to understand the mechanisms and develop targeted interventions to address health disparities in childhood obesity.

Objective: This study aims to investigate the association between attendance at routine preventive child health examinations in general practice and the risk of overweight and obesity in Danish children at age six, with a specific focus on children of parents with psychosocial risk factors. Methods: Utilizing nationwide Danish registers, a population-based birth cohort of 725 926 children born between 2000-2012 was analyzed. Information on preventive health examination attendance and BMI data were obtained. Statistical analyses, including modified Poisson regression, were conducted to assess the relationship between examination attendance and overweight/obesity risk. Results: The study found no significant association between attending these examinations and a reduced risk of overweight at age six in the overall population. In the subgroup of children of parents having 10 years of education of less, non-attendance was associated with a slightly increased risk of overweight, ranging from eight to nine percent. Regarding obesity risk, a dose-response correlation was observed, indicating that missing examinations increased the risk of obesity. Children of parents with psychosocial risk factors, particularly those with parents of low educational attainment, faced increased obesity risks, with the highest risk observed in children of parents with 10 years of education or less who missed all examinations, showing a four- to five-fold increase compared to children of parents with 14 years of the education or more attending all or missing only one exam (reference). Conclusion: Although routine preventive child health examinations may not directly reduce the risk of overweight, they could potentially mitigate obesity risk, especially in vulnerable populations. Further research is warranted to understand the underlying mechanisms and to develop targeted interventions to address health disparities in childhood obesity.

Background: The obligation to pay for asthma medication in a country with universal healthcare might lead to increased asthma exacerbations and inequitable healthcare access for children from low-income households. Thus, the aim of this study was to examine the association between household income and childhood/preschool asthma regarding hospitalization and medication receipt. Methods: In this nationwide register-based cohort study, we encompassed all 3-year-old children residing in Denmark, born between 2000 and 2014, along with their linked parents and followed them until their sixth birthday. Household income was divided into quartiles. Asthma was categorized in two mutually exclusive groups as either the redemption of two prescriptions for asthma medication or receiving a hospital diagnosis. We utilized Poisson regression to estimate the risk ratio (RR). Results: The analysis included 834 422 preschool children. The prevalence of asthma dependent on medication alone was 7.3%, while 1.8% of children necessitated asthma-related hospitalization. Income inequality was evident across all income quartiles. Notably, children from the lowest income quartile had a RR of 0.95 (95% CI: 0.92–0.98) of redeeming asthma medication and conversely a RR of 1.18 (95% CI: 1.14–1.23) of asthma-related hospitalization. Conclusions: Despite universal healthcare, income inequality has a dual impact on children from low-income households. They face a diminished risk of redeeming asthma medication and a higher susceptibility to asthma-related hospitalizations indicating an unequal access to healthcare. Prioritizing efforts to reduce childhood health inequalities is crucial. However, further research, particularly qualitative studies, is needed to better comprehend the underlying mechanisms to address the complexities of income inequality.

Background: Children with the most severe parental mental health conditions have an elevated risk of numerous adversities including somatic morbidity. However, there is no knowledge concerning physical health in most children affected by parental mental health conditions. Therefore, the aim was to examine the association between different severities of parental mental health conditions and somatic morbidity in children of different age-groups and further explore the combinations of maternal and paternal mental health conditions on child somatic morbidity. Methods: In this register-based cohort study, we included all children born in Denmark between 2000–2016 and linked parents. Parental mental health conditions were categorised into four severity groups (no, minor, moderate, and severe). Somatic morbidity in offspring was categorised into broad disease categories corresponding to the International Classification of Diseases. We estimated the risk ratio (RR) using Poisson regression, of the first registered diagnosis in different age-groups. Results: Of the around 1 million children in the study > 14.5% were exposed to minor parental mental health conditions and < 2.3% were exposed to severe parental mental health conditions. Overall, the analyses revealed a higher risk of morbidity in exposed children across all disease categories. The strongest association was observed for digestive diseases in children aged < 1 year exposed to severe parental mental health conditions (RR: 1.87 (95% CI: 1.74–2.00). Generally, the risk of somatic morbidity increased the more severe the parental mental health conditions. Both paternal and especially maternal mental health conditions were associated with a higher risk of somatic morbidity. The associations were strongest if both parents had a mental health condition. Conclusion: Children with different severities of parental mental health conditions experience a higher risk of somatic morbidity. Although children with severe parental mental health conditions had the highest risk, children with minor parental mental health conditions should not be neglected as more children are exposed. Children with both parents having a mental health condition were the most vulnerable to somatic morbidity and maternal mental health conditions were more strongly associated with somatic morbidity than paternal. More support and awareness of families with parental mental health conditions is highly needed.

Background: The prevalence of children with overweight and obesity is increasing. General practitioners in Denmark follow children throughout early childhood via the preventive child health examinations. These examinations are offered to all children from birth to the age of five. Thus, the general practitioners have a unique opportunity for early tracing and identification of overweight and obesity, but the impact of the examinations are not examined. Therefore, the aim of this study was to examine the association between attending preventive child health examinations and the risk of overweight and obesity at the age of six both for the total pediatric population and within groups of vulnerable children such as children of parents with low educational level or low household income. Methods: A population-based birth cohort study was conducted including all Danish children born from 2000-2012 using the Danish nationwide registers. Data included information on child participation in preventive health examinations at general practice, height and weight at the age of six, and parental information on socioeconomic factors. Results: The analyses included 801,444 children. Attending preventive child health examinations were not associated with a lower risk of overweight at the age of six. A lower risk of obesity was seen in children attending the examinations, both in the general population (RR 0.71, 95% CI 0.66-0.76) and within vulnerable groups (low level of maternal education: RR 0.80, 95% CI 0.72-0.89), low household income (RR 0.79, 95% CI 0.72-0.87). The risk of obesity was greater in the vulnerable groups than in the not-vulnerable groups. Conclusions: Attending preventive child health examinations were associated with a lower risk of obesity at the age of six, but not overweight. This was seen for both the general pediatric population and within vulnerable groups. The lowest risk of obesity was seen in the not-vulnerable groups. Key messages: • The results indicated that attending preventive child health examinations in general practice reduced the risk of obesity at the age of six, but not the risk of overweight. • The lowest risk of obesity was seen in the not-vulnerable groups attending the preventive child health examinations in general practice.

Aim: This study examined any associations between parents' mental health conditions and hospital diagnoses of functional gastrointestinal disorders (FGIDs) in offspring at the age of six. We also examined any associations between children who met these criteria and attended routine Danish preventive child health appointments.Methods: Nationwide registers identified all children born in Denmark from 2000 to 2011 and parents' mental health conditions. Negative binomial regression analyses estimated the incidence rate ratios (IRRs) with 95% confidence intervals (CIs) of children receiving their first hospital diagnosis for an FGID at the age of six.Results: We identified 750,379 children and 38% had at least one parent with a mental health condition: 24% were minor, 12% were moderate, and 2% were severe. These children faced a higher risk of an FGID diagnosis than children whose parents did not have mental health conditions. The IRRs were highest for maternal exposure: minor (1.35, 95% CI 1.29–1.42), moderate (1.58, 95% CI 1.48–1.67) and severe (1.58, 95% CI 1.38–1.81). Attending routine preventive child health examinations was associated with a higher risk of FGIDs associated with parents' mental health conditions.Conclusion: Paediatric FGIDs were associated with parents' mental health conditions, especially mothers, and attending routine preventive child health examinations.

Background: Parental mental illness affects child health. However, less is known about the impact of different severities of maternal depression and anxiety as well as other mental health conditions. The objective of this study was to examine the impact of different severities of maternal and paternal mental health conditions on child asthma.Methods: This nationwide, register-based cohort study included all children in Denmark born from 2000 to 2014. Exposure was parental mental health conditions categorized in three severities: minor (treated at primary care settings), moderate (all ICD-10 F-diagnoses given at psychiatric hospital) and severe (diagnoses of severe mental illness). The children were followed from their third to sixth birthday. Child asthma was identified by prescribed medication and hospital-based diagnoses. Incidence rate ratios were calculated using negative binomial regression analyses.Results: The analyses included 925 288 children; 26% of the mothers and 16% of the fathers were classified with a mental health condition. Exposed children were more likely to have asthma (10.6–12.0%) compared with unexposed children (8.5–9.0%). The three severities of mental health conditions of the mother and the father increased the risk of child asthma, most evident for maternal exposure. Additive interaction between maternal mental health conditions and disadvantaged socioeconomic position was found.Conclusion: We found an increased risk of asthma in exposed children, highest for maternal exposure. Not only moderate and severe, but also minor mental health conditions increased the risk of child asthma. The combination of mental health condition and disadvantaged socioeconomic position for mothers revealed a relative excess risk.