*1.4.1 Aims*

*Quality of Life - Biopsychosocial Perspectives*

tive impacts on the psychosocial well-being of offspring.

negative impacts on the psychosocial well-being of offspring [45].

and heritability of schizophrenia and symptoms involved.

be put in place to aid the HR offspring [12].

**1.4 The current review**

Furthermore, extending beyond the idea that environmental factors elevate the risk for developing psychological difficulties, much research has been conducted within this area exploring other factors. This includes factors such as unemployment and socio-economic disadvantage [12], childhood sexual abuse [34], marital conflict amongst the parents of HR offspring [46], poor upbringing due to hospitalisation of parents or neglect [47], inadequate parental care [48] and other stressful life events such as loss and traumatic events [49, 50]. Stressful life events have the potential to trigger the onset of symptoms of schizophrenia and other disorders [51]. Such studies, highlighting upon the environmental factors involved in the developmental trajectory of schizophrenia, strengthen the proposed diathesisstress model explaining why negative outcomes occur in HR offspring. This is by demonstrating that the environment acts as a stressor in increasing the genetic risk

This systematic review is exploring the following psychosocial aspects influencing the well-being of HR offspring: social skills and functioning, self-concept, quality of life, employment situation and the prevalence of disorders and emotional/behavioural symptoms. Regarding the term 'social skills and functioning', this includes self-esteem and self-concept. Due to the limited amount of research within these domains, it would be worthy to investigate and obtain insightful formulations. A review is needed with recent studies that build upon the HR research but also focus on the psychosocial impacts signifying a diathesis-stress model, linking parental schizophrenia and negative impacts on HR offspring. This is because awareness can be raised and possible support can be given to HR offspring as a preventative technique regarding the prevention of negative psychosocial impacts. Current interventions focus on aiding the parent with schizophrenia but should also

develop schizophrenia, if they had a biological parent suffering from schizophrenia, in comparison to those that did not [43]. This supports the idea that schizophrenia is genetically transmitted strengthening the notion that neurological pathways are distorted amongst HR offspring as with the parents. Therefore, this indicates that not only is there a genetic influence but there is also an environmental influence, suggesting a gene-environment interaction arising from the development of nega-

Moreover, another method to explore the HR perspective is by exploring HR offspring that are twins in studies. This allows an enhanced perspective regarding genetic and environmental influences to be considered. Twin and adoption studies found that the risk of HR individuals developing schizophrenia was 9% for siblings, 13% for HR offspring with one parent suffering from schizophrenia and 46% for HR offspring with two parents [44]. As there was found to be a genetic risk amongst twin and adoption studies for HR offspring, these findings also display an environmental influence as the genetic risk is not 100%. Therefore, there must be other factors within the offspring's environment involved in the development of schizophrenia suggesting a possible diathesis-stress model of schizophrenia. The diathesis-stress model is the idea that mental illnesses are developed from a genetic or biological component of a particular illness (i.e. schizophrenia) which is combined with stressful environmental factors, which all influence the vulnerability for a mental illness. In this particular instance, this involves negative environmental factors interacting with the genetic vulnerability for schizophrenia amongst HR offspring, resulting in an elevation of risk and heritability in the development of

**164**

To identify the impact of parental schizophrenia on the psychosocial well-being of HR offspring.

To explore the likelihood that HR offspring will develop schizophrenia or other psychiatric conditions.
