Childhood Trauma, Resilience and Adult Outcomes in SMI Families
Key Takeaways
- Among adults who grew up with a parent meeting the study definition of severe mental illness, higher self-efficacy and resilience and lower morbidity were independently associated with better quality of life in the adjusted model
- Poorer adult social functioning was independently associated with greater childhood trauma and parental overprotection
- Childhood trauma predicted higher morbidity in adulthood
In the cross-sectional quantitative Journal of Nursing Scholarship analysis of adult outcomes after growing up with a parent with severe mental illness, participants were Hebrew-speaking adults residing in Israel who had grown up before age 18 with a parent whose severe mental illness was defined by participant-reported formal psychiatric diagnosis plus at least two psychiatric hospitalizations during childhood. The cohort had a mean age of 36.33 years, 53.7% were female, 64.7% were partnered, and 74.7% were employed. The analysis used validated measures for quality of life, resilience, self-efficacy, childhood trauma, social functioning, and parental bonding, alongside EUROHIS-adapted checklists for morbidity and healthcare utilization. This design framed adult outcomes across psychological, social, and health domains within a single sample.
After adjustment, greater childhood trauma and higher parental overprotection aligned with poorer social functioning, while parental care did not add unique variance once the other variables were considered. In the count models, childhood trauma predicted higher morbidity, and greater morbidity aligned with higher healthcare utilization. The authors assessed healthcare utilization with an 11-item adapted EUROHIS instrument covering multiple service types, including mental health service contacts, with outpatient visits captured over the previous 4 weeks and hospitalizations over the previous year. These findings linked early adversity to both social and health burden in adulthood.
The correlation pattern broadly matched the adjusted models, with better quality of life aligning most closely with resilience and self-efficacy and poorer health and functioning clustering with greater trauma exposure and morbidity. In PROCESS analyses, the trauma-by-resilience interaction was not significant for morbidity, with b = −0.001 and p = 0.199, or for social functioning, with b = 0.000 and p = 0.924. The authors described resilience as an independent contributor rather than a buffer in this sample, while noting that the cross-sectional design, convenience and snowball sampling in Hebrew-speaking adults in Israel, self-reported measures including parental severe mental illness classification and morbidity and utilization checklists, and possible ceiling effects or restriction of range may have affected interpretation. These moderation findings were therefore reported within the confines of this sample and design.
Clinician Questions
How was parental severe mental illness defined in this Israeli adult cohort?
In this cohort of Hebrew-speaking adults in Israel who had grown up before age 18 with a parent with severe mental illness, parental severe mental illness was defined by participant self-report of a formal psychiatric diagnosis plus at least two psychiatric hospitalizations during the participant’s childhood.
What independently predicted quality of life in adults who grew up with a parent with severe mental illness?
In adults who grew up with a parent with severe mental illness, the adjusted quality-of-life model showed that self-efficacy β = 0.238 (p < 0.001), resilience β = 0.191 (p = 0.008), and lower morbidity β = −0.119 (p = 0.005) were independently associated with better quality of life, with final model R2 = 0.738 after demographic adjustment.
What predicted healthcare utilization among adults raised by a parent with severe mental illness?
Among adults raised by a parent with severe mental illness, morbidity predicted healthcare utilization in the adjusted negative binomial model, with B = 0.111, Exp(B) = 1.117, and p = 0.004, meaning each additional morbidity condition was associated with an 11.7% increase in expected healthcare utilization count; the study measured utilization with an 11-item, EUROHIS-adapted composite that summed multiple service types, including outpatient visits over the past 4 weeks and hospitalizations over the past year, along with additional mental health service items.
Did resilience buffer childhood trauma-related morbidity or social functioning in adults with parental severe mental illness?
In adults with parental severe mental illness, the moderation analyses did not show a significant trauma-by-resilience interaction for morbidity, with b = −0.001 and p = 0.199, or for social functioning, with b = 0.000 and p = 0.924; the authors described resilience as an independent contributor rather than a buffer in this sample and noted that ceiling effects or restriction of range may have limited power to detect interaction effects.