A B S T R A C TThe children of seriously ill parents are at risk for emotional disturbances. This review covers five former reviews, three theoretical articles, five case studies and 39 sample studies from the last 15 years. Methodological problems and shortcomings of previously published studies are discussed in detail. Based on former reviews and theoretical approaches, a developmental framework for children's adaptation processes is elaborated. Empirical studies are analysed with a differentiation of how various results were correlated with the types of parental diseases and children's age groups studied, as well as with various methodological designs and instruments applied. It appeared evident that children of seriously ill parents had higher scores on symptom scales than did controls, with a tendency towards internalizing symptomatology. In several studies, adolescent daughters of ill mothers appeared to be at highest risk for maladjustment. Ill parents' subjective perception of their impairment predicted children's symptoms better than the objective degree of severity of their disease. Although subgroups of children adjusted well, covariant protective mechanisms could not be clearly identified. In conclusion, suggestions for further research include ethical standards, a profound theoretical framework for any hypothesis to be tested, a combination of qualitative and quantitative methodology, the integration of the child's subjective dimension by semi-structured or open interviews, and the consideration of coping as a process through longitudinal designs.K E Y W O R D S children at psychiatric (or mental health) risk, child of impaired parents, mental health prevention (in children), psychological family medicine, psychotraumatology

Background: The impact of road traffic accidents (RTAs) on the physical health of children is well recognized, but their psychological consequences have only recently become a topic of research. While other traumatic experiences in childhood are well studied, this kind of trauma has been poorly investigated to date. Sampling and Methods: A prospective cohort study was conducted of 8- to 18-year-old children and adolescents who were involved in RTAs in a large urban area during a 6-month period. The children and adolescents were interviewed within 1 week after the accident and, again, 3 months later. In total, 72 children and adolescents took part in the study. Symptoms of posttraumatic stress, depression and anxiety were assessed by a structured clinical interview and standardized questionnaires. Results: One week after the accident, 11% of the children met the diagnostic criteria for posttraumatic stress disorder (PTSD) according to ICD-10 and a further 13% met the criteria for ‘subsyndromal PTSD’. Complex syndromes consisting of subsyndromal posttraumatic stress, (separation) anxiety and depression were common among those children. Isolated cases of anxiety and depression symptoms were also observed but rarely reached an impairing level. Three months after the accident, 25% of the children reported persistence of the PTSD symptoms (measured by the Impact of Event Scale – Revised). The strongest predictor of the extent of posttraumatic stress after 3 months was proven to be the initial level of PTSD symptoms. This predictor alone accounted for 38% of its variance. Conclusions: Our results provide evidence that even after ‘everyday’ RTAs, psychological consequences are common. Special attention should be paid to the common occurrence of subsyndromal psychological disturbances and more complex syndromes. The results further indicate the limitations of the PTSD concept in the assessment of posttraumatic disturbances in childhood and adolescence.

Results of this study suggest a strong longitudinal inter-relatedness between social functioning and negative symptoms in this age group. An integrative treatment approach including family interventions, social skills training, long-term specialized work/school rehabilitation, and adequate antipsychotic treatment is warranted to improve both, social functioning and negative symptoms.

Die Kinder psychisch kranker Eltern sind als Hochrisikogruppe für die Entwicklung psychischer Störungen bekannt, wobei die Zahlen betroffener Kinder in verschiedenen Studien schwanken. Bei der Frage, ob die Kinder später selbst erkranken, spielen Risiko- und Schutzfaktoren eine entscheidende Rolle. Im Rahmen einer Elternbefragung wurden psychopathologische Auffälligkeiten von Kindern psychisch kranker Eltern untersucht (n = 62). Kinder psychisch kranker Eltern weisen drei- bis zu siebenfach erhöhte Auffälligkeitsraten gegenüber der Allgemeinbevölkerung auf. Die Auffälligkeiten der Kinder stehen im Zusammenhang mit der subjektiv erlebten elterlichen Beeinträchtigung durch die Erkrankung. Die Ergebnisse geben deutliche Hinweise darauf, dass die Entwicklung geeigneter präventiver Maßnahmen sinnvoll und notwendig erscheint.

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