What’s A Family?

Weissman, Myrna M.

Interest in the family of a child has a long and critical history in child psychiatry. In modern psychiatric research, at least 3 concepts of family can be identified: the environmental family, that is, the biological and nonbiological relatives a child lives with; the biological family who carry the child’s genes; and the caretaking family, who can be all of the above. Although these overlapping concepts can be identified and studied, clinical care requires attention to all 3. An extraordinary article by Ranning et al. in this issue of the Journal draws attention to these models and provides the most comprehensive data ever available on the first model: who the child lives with.

The article includes the largest (nearly 2 million), prospective (28 years), population-based (Danish register) data on every child born since 1982 and their parents and describes the living arrangements of children whose parents have a serious mental illness (SMI), specifically depression, schizophrenia, or bipolar disorder. The prospective design allowed the investigators to examine changes in living arrangements. They concluded that fewer children of parents with SMI compared with children of parents without live with both parents. They also found that more of these children live with a single parent or are separated from both parents and that more marriages of parents with SMI dissolved during the study period. The effects were somewhat stronger in families in which the parent had schizophrenia. Although these findings are not surprising, they have never been documented before with such a large sample and a prospective design. However, the demographic characterization does not tell us about all possible effects on the child. For example, a divorce from a hostile marriage might calm rather than upset the family environment.


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Journal of the American Academy of Child & Adolescent Psychiatry

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February 1, 2022

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What’s A Family?