Mental health difficulties in children and young people are a significant public health issue, requiring urgent attention to alleviate potential life-long impacts. Around one in five children and young people are thought to experience mental health difficulties, impacting on day-to-day functioning and potential longer-term outcomes (NHS Digital, 2023; Sacco et al., 2024; Su, 2025).
When a young person suffers with a mental health difficulty, significant stress can be placed on the wider system, including parents or caregivers, family, friends and any networks of professionals involved. It can be devastating to watch a young person suffer, witnessing emotional turmoil, potential challenges with education or in the school environment, difficulties with friends and social situations, and struggles engaging with day-to-day life. As a parent or caregiver this can be especially painful, witnessing children living a very different life to the one hoped for.
Research has focused on understanding the factors that increase vulnerability, and how we can improve outcomes for young people (e.g. Cumber, 2024; Essex et al., 2006; UCL Psychiatry MSc). This has included exploration of the roles that parental mental health difficulties and parenting behaviours play as risk factors for children’s wellbeing (Zecchinato, 2023).
However, a group of Finnish and Danish researchers have flipped the focus, and instead explored population-level associations between children’s mental disorders and subsequent parental mental health.
Chicken or egg? Do parental mental health difficulties increase the risk of mental health problems in children, or can children’s mental health challenges affect their parents’ wellbeing?
Methods
Using nationwide register data, the authors included a vast sample of over 1.6 million parents of children born in Finland or Denmark between 1990–2010. Parental exposure was recorded as the time of a child’s diagnosis, from as early as one year of age up to age twenty-five. The ‘follow-up’ point ended either when a parent received a diagnosis of a mental health disorder, at the end of 2019 (the ‘end’ of the study), or if a parent had died or emigrated. Importantly, parents with a history of mental health difficulties were excluded, to focus on new onset.
The authors used a statistical approach called Cox proportional hazards, to develop models looking at the likelihood of parental mental health diagnosis based on time of exposure. If a child had experienced more than one diagnosis (e.g. an episode of depression and a later episode of substance abuse), each ‘category’ of mental disorder was considered within the analyses. Where a parent had multiple children with recorded mental disorders, the earliest onset date recorded for any child was considered the exposure point. The only other factors considered were parents’ gender, age at birth of their first child, and their educational level.
Results
Over 248,000 women and 250,000 men were recorded to have at least one child with a diagnosed mental disorder. The paper predominantly focuses on discussing the combined results for parental outcomes following any childhood mental disorder, but a substantial amount of additional data, including hazard ratios for specific childhood disorders, are included in the supplementary material.
Overall, parents who had a child with any mental disorder between the ages of one to twenty-five were at greater risk of subsequently being diagnosed with a mental health disorder themselves. For both men and women, the likelihood (or risk) was highest in the first six months following the child’s diagnosis, which then declined over time (Hazard Ratios: Finland: women = 2.29, men = 1.75; Denmark: women = 2.54; men = 2.04). There were some nuances in the data once models were broken down to look at parent gender and the different childhood mental health disorders, as well as differences between Danish and Finnish families. Women were most at risk overall, with men’s data showing less consistent associations.
Amongst a large sample of Danish and Finnish families, an association was found between children’s mental health and subsequent parental mental health. This was particularly high in the first six months following the child’s diagnosis.
Conclusions
So, what does this really tell us? Even when ruling out parents with a previous mental health difficulty, there appears to be a greater risk for parental mental health difficulties in Danish and Finnish families following childhood mental health diagnosis. We could suggest that this appears to tell us something about the causal direction of the association. That is, that childhood mental health difficulties significantly raise the risk for parents’ mental wellbeing.
However, we know very little about the families involved, and what other factors may play a role in these associations. For example, is the association telling us something about elevated genetic risk within families, or about psychosocial risk factors, such as shared life experiences, adversity, socioeconomic factors, social support, physical health, parenting practices, etc. We don’t know if these families actually lived together at the time of the childhood diagnosis and whether the parents were the primary caregiver/s for the child. Importantly, we don’t know what mental health difficulties the parents were diagnosed with, or anything about onset, severity or duration of the difficulties in the children or parents. Both the children and parents could have been struggling for some time before the diagnosis was made. The list of unknowns could go on. And so caution must be applied in drawing conclusions about what this data set can really tell us.
We must be cautious in inferring that parental mental health disorders were caused by offspring mental health difficulties.
Strengths and limitations
This study has many strengths, the first of which is that it tells an important story about family functioning which needs to be seriously considered to support family wellbeing and long-term outcomes. The incredibly large sample size was collected across two Nordic countries, spanning a large time-period, offering the opportunity to provide robust insight into family mental health experiences.
However, the methodology entirely relies on data having been accurately recorded to tell us a true story. Presence of a mental health disorder will only be recorded for individuals who either sought or were referred for help. Likewise, whilst it’s helpful that parents with a history of mental health difficulties were excluded, this again relies on accurate recording. Many individuals don’t seek help meaning that the sample is likely to have included parents with prior or co-existing mental health difficulties, which will somewhat confound the picture. During the study period these families will undoubtedly have experienced numerous life events (both positive and negative), which will have buffered and exacerbated mental health and wellbeing in parents and children. The only covariates considered were parents’ age at the birth of their first child and education level. Whilst the models might therefore tell us about associations between some important factors, they simplify the complexity of real-life. Importantly we don’t know details about participants’ identities, including demographics. Given that individuals from marginalised backgrounds, including minoritised ethnicities, are at higher risk of mental health difficulties understanding risk ratios for families facing inequalities may be of particular importance (Kings Fund, 2024).
To some degree, the paper explored parental outcomes based on different childhood mental health disorders, but by largely combining childhood disorders together to provide an overall picture, some important nuance is lost. The most important clinical stories may lie in understanding the picture for different types of childhood experiences faced by children and their caregivers. For example, along with disorders such as childhood anxiety and depression, the authors also included diagnoses of childhood developmental disorders and intellectual disability. For parents and children these are likely to have very different impacts on wellbeing.
The study tells us an important story about relationships between mental health difficulties within families. However, the limited information known about the families misses the multitude of factors that will influence this association.
Implications for practice
The main take-home message is the interconnected nature of mental health within families, and the need to support those families at risk. This isn’t surprising information. As Bronfenbrenner’s (1979) ecological systems theory proposed, the relationships, wellbeing and functioning between a child and their caregiver (as well as their wider network) are bidirectional; when one person is struggling, those around them will be affected too, and vice-versa. However, the scale of the study tells us we need to pay attention to this. Particularly given that the associations held despite us knowing very little about the families.
The study doesn’t tell us why childhood mental health diagnoses increased risk for parental mental health. However, there already exists a wealth of evidence to help us understand this further, including the role of shared genes and environment, and wide-ranging psychosocial factors, including the stressors experienced when caring for a child with mental health difficulties (e.g. Cham et al., 2026; Chegeni et al., 2026; Martin et al., 2024; Martin et al., 2025). So, attention now really needs to turn to support and prevention; how can we break this pattern?
We could start by offering more support to children and young people; if we reduce their mental health struggles, logic tells us parents will be exposed to less parenting and familial stress, thereby reducing their own risk. However, this solution really only tackles one part of the picture. To really make a difference to family functioning, we need to focus on prevention, offering support that enables families to thrive right from the very earliest points in a child’s life (Guo & Higson-Sweeney, 2025; Leadsom et al., 2016; Department of Health and Social Care, 2025). Positive family outcomes need to be promoted via support and intervention from pre-conception planning onwards, continuing into the early years and adolescence. We need to seriously consider inequalities families face when accessing support, making services equitable and accessible, including to those often facing the highest levels of marginalisation. Only by taking a systems-level approach to family functioning can we really start to find ways to prevent these familial cycles of distress and look at breaking the associations found in this study.
Support needs to be available to families at the earliest possible points, aiming for prevention of familial cycles of distress, rather than offering support only at times of crisis.
Statement of interests
I am not aware of any direct conflict of interest I hold with this study. However, it’s important to note that I view this work through the lens of a clinician and researcher focusing on perinatal mental health, early years parenting, and advocating for supporting the whole family to promote positive outcomes. This will undoubtedly have influenced the conclusions I’ve drawn and the perspective I take on where changes need to be made to support families during the critical years of a child’s life. I am also a parent to two children and will inevitably be influenced by these experiences. – Jane Iles
Editor
Edited by Laura Hemming.
Links
Primary paper
Christian Hakulinen, Mai Gutvilig, Ripsa Niemi, Natalie C Momen, Laura Pulkki-Råback, Petri Böckerman, Oleguer Plana-Ripoll, Kaisla Komulainen, Marko Elovainio (2026). Associations of mental disorders in children with parents’ subsequent mental disorders: nationwide cohort study from Finland and Denmark. The British Journal of Psychiatry, 228(1), 10-17.
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