**3.4 Assessment of quality**

Overall, the majority of studies used a clearly defined inclusion and exclusion criteria similar to that of this review. Also, the diagnoses of parents with schizophrenia were clearly established using reliable and valid methods amongst all studies (**Tables 3** and **4**).

**169**

**Article**

[7] [55]

Psychiatric disorder and level of social functioning in offspring and cultural comparison

Longitudinal study

Questionnaires and demographic information

51 HR offspring

HR offspring

No control

[56] [57]

New York High-Risk

Longitudinal

Child and parent report

150 offspring

HR

subjects

and counting broad smiles

assessed via interviews

cohort study

Project, social competence

and affective deficits

amongst offspring

[58] [59] [60]

Psychosocial effects in

Crosssectional

Questionnaires and

60 offspring

HR

HC group

individuals

interviews

study

offspring

Prevalence of emotional

Crosssectional

study

and behavioural disorders

Symptoms in offspring

Longitudinal

Records collected (1991–

116 adolescents

HR

HC group and OHR group

Greater prevalence of

disorders in HR group,

greater for males

offspring

from 61

families

150 offspring

HR

HC group and OHR group

Higher prevalence

of emotional and

behavioural symptoms

in HR group

HR group significantly

scored greater

on internalising/

externalising

behavioural problems

offspring

1995) and structured clinical

interviews

cohort study

Social functioning levels in HR individuals

Cross- sectional study

Questionnaires

244 participants

HR offspring

HC, offspring experiencing first episode of psychosis (FE), offspring experiencing multi-episode psychosis (ME)

Significant deficits for HR in social functioning long before onset of potential psychosis

HC and OHR group

HR adolescents the

greatest social and

affective deficits

Quality of life in HR offspring

**Aims/objectives**

**Design** Cross- sectional study

Questionnaires

**Measures**

**Population** 61 offspring

HR offspring

HC group

**Exposure**

**Comparator**

**Outcomes** Lowered quality of life and negative emotions in HR

Incidence of SZ was 13.7%

*The Impacts of Parental Schizophrenia on the Psychosocial Well-Being of Offspring:…*

*DOI: http://dx.doi.org/10.5772/intechopen.91658*

HR did not significantly affect the risk in Japanese offspring and social functioning


#### *The Impacts of Parental Schizophrenia on the Psychosocial Well-Being of Offspring:… DOI: http://dx.doi.org/10.5772/intechopen.91658*

*Quality of Life - Biopsychosocial Perspectives*

**size**

[60] 60 5–16 years (HR

[61] 52 5–19 years

[62] 157 9–21 years

[63] 90 13–26 years (HR

[64] 60 18+ (HR

[65] 431 18+

**Article Sample** 

**168**

**3.2 Comparators**

*Participant characteristics.*

**Table 1.**

were not 100%.

**3.4 Assessment of quality**

studies (**Tables 3** and **4**).

other than schizophrenia (OHR).

**3.3 Effect size and mean differences**

The comparator in all studies included used healthy controls (HC) with the exception of [55], whereby in this study, a control is not stated (see **Table 2**). Some of the studies [56–59] used a comparison of offspring of those with a mental illness

**Age Group of** 

mean = 11, HC mean = 10)

(mean = 12)

(mean = 16)

mean = 19, HC mean = 18)

mean = 21.5, HC mean = 20.7)

(mean = 27.6)

**interest**

HR = 30 (male = 13, female = 17)

High-risk offspring n = 17 (male = 7, female = 10)

HR = 75 (male = 34, female = 41)

HR = 35 (male = 16, females = 19)

HR = 30 (male = 21, female = 9)

HR = 431 (male = 233, female = 198)

[66] 341 Not known HR = 155 HC = 186 Data collected

**Comparator Ethnicity**

Obtained from New Delhi, India

HC = 22% non-white, HR = 41% non-white

Data collected in Western Pennsylvania, Pittsburgh

White >50% African American <20% Hispanic <23% Asian <9% other 3%

Obtained from Bangalore, South India

Data collected in Cuiaba, Brazil

in Finland

HC = 30 (male = 14, female = 16)

Healthy control n = 35 (male = 13, female = 22)

HC = 82 (male = 40, female = 42)

HC = 55 (males = 24, females = 31)

HC = 30 (male = 21, female = 9)

No control group

Across all studies within the HR, HC and OHR groups, the mean incidence ratings/scores and effect sizes were similar to that of the control group and also

Overall, the majority of studies used a clearly defined inclusion and exclusion criteria similar to that of this review. Also, the diagnoses of parents with schizophrenia were clearly established using reliable and valid methods amongst all



**Table 2.** *Data extraction table.*

**171**

*The Impacts of Parental Schizophrenia on the Psychosocial Well-Being of Offspring:…*

**Article Outcome 1 Outcome 2 Effect size/mean difference**

Lower levels of family functioning, greater resource loss and lower resource gains

Social functioning not significantly impacted by parental schizophrenia

HR group scored higher for quality of life in comparison to ME and FE group

Poorer social competence, affective flattening and reduced smiling per minute. Higher scores for social competence and affective flattening reflect greater pathology

Highest prevalence in males

No significant difference in gender and age distribution, family income, education levels and socioeconomic status in HR group

No significant differences in education, religion, employment, monthly income and gender

Mean scores: quality of life score HR = 2.85, HC = 3.42 Negative emotions: HR = 2.56, HC = 3.35 Positive emotions: HR = 3.22, HC = 3.8

Incidence for schizophrenia amongst Japanese offspring

Mean scores of social functioning

HR = 125.29, FE = 129.14, ME = 136.53, HC = 161.65

Mean incidence of social/ affective deficits: social competence child HR = 0.17, adolescent HR = 0.49, child OHR = 0, adolescent OHR = −0.06, child HC = −0.11, adolescent

HC = −0.19 Affective flattening Child HR = 0.42, adolescent HR = 1.1, child OHR = 0.38, adolescent HR = 0.62, child HC =0.46, Adolescent HC = −0.68 Smiling Child HR = 0.58, adolescent HR = 0.49, child OHR = 0.63, adolescent OHR = 0.93, child HC = 0.72, adolescent HC

0.97

HC = 2.8%

OHR = 0.71

Mean incidence of internalising/externalising behavioural problems: HR = 39.13, HC = 31.53

Incidence of disorders: HR = 17.1%, OHR = 7.7%,

Incidence of emotional/ behavioural symptoms (standardised means-effect size): HR = 1.33, HC = 0.43,

was 13.7%

*DOI: http://dx.doi.org/10.5772/intechopen.91658*

[7] HR group had significantly lower

[55] Psychiatric disorder prevalent amongst HR offspring

[56] Deficits in social functioning prior

[57] Greater social and affective deficits amongst HR group

[58] HR at highest prevalence disorders amongst the schizophrenia spectrum, avoidant personality disorder and anxiety

[59] HR group displayed significantly

group (p < 0.01)

[60] Highest prevalence of

group

greater prevalence of emotional and behavioural symptoms in HR

internalising/externalising behavioural problems for HR

to onset of psychosis in HR group

quality of life and greater negative emotions than positive emotions


*The Impacts of Parental Schizophrenia on the Psychosocial Well-Being of Offspring:… DOI: http://dx.doi.org/10.5772/intechopen.91658*

*Quality of Life - Biopsychosocial Perspectives*

**170**

**Article**

[61] [62]

Prevalence of

psychopathology in HR

offspring

[63]

Social development (i.e.

Longitudinal

Seven tests and

90 offspring

HR

HC group

subjects

questionnaires assessing

psychopathology, personality

traits and social development

study

personality traits) and

psychopathology amongst

HR individuals

[64] [65] [66]

Prevalence of

Crosssectional

Interview and questionnaires

341 offspring

HR

HC group

given up for

offspring

adoption

psychopathology in

adopted offspring

**Table 2.** *Data extraction table.*

study

Social impacts in HR

offspring

Self-concept in HR

Crosssectional

Questionnaires

60 subjects

HR group

HC group

study

Crosssectional

Questionnaires

431 offspring

HR

No control group

HC—poor

employment situations

and lowered marriage

rates

HR has a higher

percentage of

psychiatric disorders

individuals

study

offspring

study

**Aims/objectives**

Social deficits amongst

high-risk offspring

**Design** Crosssectional

Questionnaires and

interviews

study

Crosssectional

Interviews

157 offspring

HR

HC group

individuals

**Measures**

**Population** 52 offspring

HR

HC group

offspring

**Exposure**

**Comparator**

**Outcomes**

The HR had worse

social skills, assertion

and empathy outcomes

HR offspring had

increased risk for one

or more psychiatric

disorders (60%)

HR displayed less

positive involvement,

poor physical

anhedonia and less

cooperation

Poorer self-concept

in HR


#### **Table 3.**

*Summary of outcomes.*


**173**

*The Impacts of Parental Schizophrenia on the Psychosocial Well-Being of Offspring:…*

**Article Outcome 1 Outcome 2 Effect size**

Psychiatric disorder occurred in disturbed familial environments No diagnosis: HR = 51%,

Personality disorder: HR = 19.4%,

Psychosis: HR = 8.4%, HC = 0.5% Schizophrenia: HR = 5.2%,

HC = 57%

HC = 13.4%

HR = 0.5%

This review presented evidence for the impacts of parental schizophrenia on the psychosocial well-being of offspring. There appears to be many similarities across the studies such as similar negative outcomes, i.e. the greater incidence of psychiatric conditions amongst HR offspring in comparison to controls. The findings identified the negative impacts of parental schizophrenia on the psychosocial well-being of offspring highlighting upon the heritability of schizophrenia, extending beyond

A preliminary synthesis of the research found that HR offspring had a greater prevalence of behavioural and emotional disorders in comparison to those without a parent with schizophrenia. It was also found there to be a greater prevalence of psychiatric disorders amongst HR offspring; for example, it was found there to be a 13.7% prevalence of psychiatric disorders amongst HR offspring [55]. Furthermore, HR offspring are at greater risk in developing at least one or more psychiatric conditions. It appeared that the greatest prevalence was for personality disorders amongst HR offspring. This signifies the negative impact parental schizophrenia has on the psychosocial well-being of HR offspring, regarding the development of a

Research identifies a negative influence of parental schizophrenia on HR offspring, arising deficits in social skills in the domains of social competence, reduced smiling, affective flattening, assertion, empathy, cooperation, positive involvement, physical anhedonia, self-esteem, self-confidence, social adjustment and employment situation. This emphasises upon the debilitating negative impacts of parental

Furthermore, it was found there to be a greater prevalence of internalising and externalising behavioural problems amongst HR offspring in which the incidence was greater for the HR group than the HC group [60]. HR offspring were also found to have *fewer positive emotions*, *greater negative emotions and reduced quality of life*, all of which differed from the HC group in mean scores [7]. This highlights upon the behavioural issues experienced for HR offspring further indicating a negative

schizophrenia on the psychosocial well-being of offspring.

**4.3 Internalising and externalising behavioural problems**

impact on the psychosocial well-being of HR offspring.

*DOI: http://dx.doi.org/10.5772/intechopen.91658*

had a greater prevalence of psychiatric disorders than HC

group

[66] HR group

**4. Discussion**

*Summary of outcomes.*

**Table 4.**

those that are clinically diagnosed.

**4.1 Prevalence of disorders**

psychiatric disorder.

**4.2 Social skills**


*The Impacts of Parental Schizophrenia on the Psychosocial Well-Being of Offspring:… DOI: http://dx.doi.org/10.5772/intechopen.91658*

#### **Table 4.**

*Quality of Life - Biopsychosocial Perspectives*

[61] HR group scored worse on social

and empathy

**Table 3.**

*Summary of outcomes.*

[62] Greater risk for

[63] Lowered positive

[64] HR group had

one or more psychiatric disorders amongst HR group

involvement, poor physical anhedonia and less cooperation in HR offspring

lower scores on self-concept indicting poorer self-esteem and self-confidence in comparison to HC

group Positive correlation between duration of parent illness and self-esteem in HR group

[65] Offspring had

poor employment situations indicating poorer social adjustment HR offspring

adjustment across all periods of development. HR group had poorer social skills than HC group Majority of social skills deficits were within domain of assertion

**Article Outcome 1 Outcome 2 Effect size**

No significant difference amongst age or gender

HR offspring 17 years and above displayed poor physical anhedonia and positive involvement whereas older HR displayed

less cooperation

Duration of illness of parent was 11.67 years. Early-onset subjects (<10 years of age) showered lower scores on self-esteem than late-onset subjects (>10 years of age). Mean age of onset 10.6 years

24.8% of male offspring had a reported mental disorder, and 16% of female offspring had a reported mental

disorder

**Article Outcome 1 Outcome 2 Effect size/mean difference**

Anomalous findings were that eight subjects in HR group displayed excellent social skills and nine subjects in HR group displayed below normative scores with none in the mid-range No differences observed in age, education and occupation level

Mean score for social skills: HC = 109.5, HR = 99.2 Lower scores represent poorer social skills

Incidence of psychopathology;

Social difficulties = 0.88

Physical anhedonia = 0.66

Cooperativeness = −0.57

Positive involvement = −0.69

Personal self-esteem: HR = 64.43,

Self-confidence: HR = 66.07,

HR = 60%

Cohen's d:

(HR > HC)

(HR > HC)

(HR < HC)

(HR < HC)

HC = 75.3

HC = 76.03

Mean self-concept:

Employment: 66.7% Married = 61.4% Mental disorder = 21%

**172**

*Summary of outcomes.*
