Penny Bee|Peter Bower|Sarah Byford|Rachel Churchill|Rachel Calam|Paul Stallard|Steven Pryjmachuk|Kathryn Berzins|Maria Cary|Ming Wai Wan|Kathryn M. Abel
The clinical effectiveness, cost-effectiveness and acceptability of community-based interventions aimed at improving or maintaining quality of life in children of parents with serious mental illness: a systematic review
University of Manchester|Manchester Academic Health Science Centre|University of Manchester|King's College London|Centre for Mental Health|University of Bristol|University of Manchester|University of Bath|University of Manchester|University of Manchester|King's College London|University of Manchester|University of Manchester
serious parental mental illness poses challenge quality life qol substantial number children adolescents improving lives children political public health concernto conduct evidence synthesis clinical effectiveness costeffectiveness acceptability communitybased interventions improving qol children parents serious mental illness sminineteen health allied health educational databases searched database inception may 2012 supplemented hand searches reference checking searches grey literature dissertations ongoing research registers forward citation tracking key author contactinclusion criteria required50 parents smi severe depression confirmed clinical diagnosis baseline symptoms children 18 years age communitybased interventions included nonresidential psychologicalpsychosocial intervention involving parents children purposes improving health wellbeing intervention comparators predefined primary outcomes validated measures childrens qol emotional health secondary outcomes derived uk policy stakeholder consultation data extracted independently two reviewers study quality assessed via cochrane criteria randomisednonrandomised designs critical appraisal skills programme casp qualitative criteria standard checklist economic evaluations separate syntheses conducted smi severe depression standardised effect size es trials pooled using randomeffects modelling sufficient data available economic data summarised acceptability data synthesised via textual narrative approachthree trials targeted mothersthe children mothers psychotic symptoms children 12 years age primary qol emotional health outcomes reported insufficient secondary outcome data prevented pooling eligible economic evaluations found twentysix trials targeted parentschildren parents severe depression 18 recruited mothers infants25 years age data pooling suggested significant shortterm effect childrens emotional health standardised es 006 95 confidence interval ci 020 033 social function standardised es 023 95 ci 000 046 medium large effects observed parents depressive symptoms standardised es 073 95 ci 051 094 parenting behaviours standardised es 067 95 ci 032 102 one nonrandomised economic evaluation found intervention uptake adherence inconsistently reported incomplete evidence highlighted potential barriers child custody losses conflicting life circumstances qualitative data suggesting interventions overcome social isolation stigma well received parents limited data suggested children may value peer interactions normalising activitiesincluded trials poor unclear quality inadequate randomisation allocation concealment possible attrition biases incomplete outcome reporting meaningful analysis challenged clinical methodological heterogeneity insufficient data subgroup comparisons childrens selfreports lacking evidence effect remains biased towards parentbased interventions severely depressed mothers infants generalisability diagnoses older children children fathers smi unclear lack highquality economic data prevented economic modellingevidence communitybased interventions enhance qol children smi parents lacking capacity recommend evidencebased approaches limited rigorous development work needed establish feasible acceptable child familybased interventions prior evaluating clinical effectiveness costeffectiveness via randomised controlled trial rct substantial programme pilot work recommended underpin development feasible acceptable interventions population evaluations incorporate validated childcentred qol outcome measures highquality cost data nested indepth acceptability studies new ageappropriate instruments better reflect life priorities unique challenges faced children parents smi may need developedthis report commissioned nhs rd health technology assessment programme funded national institute health research health technology assessment programme