Breaking the Intergenerational Cycle of Abuse: A Randomized Controlled Prevention Trial in Parents with Serious Mental Illness.

INTRODUCTION

Although children of parents with mental illness (MI) are at increased risk of adverse childhood experiences and parental maltreatment, prevention trials targeting parents with MI are scarce. In addition, meta-analyses highlight significant methodological shortcomings in the current research.

TRIAL

DESIGN

The aim of the study was to investigate real-world efficacy of a 12-h mentalization-based parenting counseling (MB-PC) program compared to a psychoeducation workshop (SCC+) as supplements to standard clinical care.

METHODS

This large-scale, cluster-randomized, open-label (partially observer-blind), active-controlled bicenter superiority trial was conducted at German psychiatric hospitals. It included 252 patients undergoing psychiatric treatment for various serious MIs. MB-PC subsumed five individual sessions including video feedback, five group sessions that guided parents to better understand and respond to their child's mental states, and two sessions of social counseling, all provided by an interprofessional hospital team of non-psychotherapists.

RESULTS

Patients in the MB-PC arm reported improved parenting practices - measured by the Alabama Parenting Questionnaire (APQ) total score as primary outcome - at post-intervention compared to those from the SSC+ arm (effect size [ES] = 0.43, 95% CI [0.13, 0.73], p = 0.004), but group difference decreased at 3-month follow-up (ES = 0.25, 95% CI [-0.04, 0.53], p = 0.085). All secondary outcomes were in favor of the MB-PC intervention, such as parental stress, child abuse potential, and child emotional well-being.

CONCLUSION

Implementing a mentalization-based parenting program in routine psychiatric hospital care may represent an important step forward in reducing the risk of child maltreatment and neglect among offspring of parents affected by severe mental disorders.