The Demand for Psychological and Social Services Related to COVID-19 Pandemic in Families of Patients With Severe Mental Disorders
Conditions: Schizophrenia and Schizoaffective Disorder, Bipolar Disorder (BD)
Sponsor: Peking University

I. Research Title: Survey on the Reproductive and Child-Rearing Situations of Patients 
with Severe Mental Disorders 
II. Summary of the Research Plan 
1. Background 
The intergenerational impact of severe mental illness constitutes a critical public health 
challenge. In Australia, 23.3% of children have at least one parent with mental illness [1], while 
China's national registry currently documents over 6 million cases of severe mental disorders, with 
60% of affected individuals being married or previously married. This suggests a substantial 
population of children raised by parents with mental illness nationwide. 
Existing evidence demonstrates that parental mental disorders exert multidimensional burdens 
across social, familial, and psychological domains [2]. Developmental outcomes for these children 
show increased vulnerability to both physical and mental health complications compared to peers 
[2]. Adolescence represents a particularly critical period, as emerging psychosocial engagement 
coincides with heightened risk for psychological distress [3]. Comparative studies indicate these 
children exhibit poorer coping strategies, lower self-esteem, and greater internalizing/externalizing 
behaviors than controls [4], underscoring their need for targeted support systems. 
The transition to adulthood presents additional challenges, as this developmental stage 
coincides with typical onset periods for mental disorders. Longitudinal data reveal alarmingly high 
heritability risks (41-77%) among offspring of affected parents [2]. Adult children of depressed 
parents demonstrate elevated rates of depressive symptomatology, somatic complaints, stress 
reactivity [5], and functional impairment [6,7]. 
Despite these documented risks, China lacks systematic data regarding family formation 

patterns and child-rearing circumstances among mentally ill populations. This epidemiological 
survey will establish foundational data to inform national mental health service planning and policy 
development. 
2. Research Objectives 
This multicenter study aims to: 
Characterize reproductive histories, child-rearing practices, and socioeconomic conditions 
among patients with severe mental disorders; 
Identify demographic and clinical correlates of family formation patterns; 
Provide empirical evidence to guide mental health service policy formulation. 
3. Methodology 
3.1 Study Design: 
Multicenter cross-sectional survey 
3.2 Study Population: 
Registered patients (N=100,000-200,000) aged 18-60 years with: 
Diagnoses of schizophrenia, bipolar disorder, paranoid disorder, schizoaffective disorder, 
epilepsy-related mental disorders, or intellectual disability with mental disorders; 
Documented reproductive history (including live births, miscarriages, or preterm deliveries); 
Residence in 10 representative regions (Shenyang, Changchun, Wuhan, Zigong, Mianyang, 
Suzhou, Beijing Haidian/Fangshan, Taiyuan, Xiamen). 
3.3 Data Collection: 
Electronic medical record extraction from national mental health registry 
Community-based assessments via 686 Program network: 

        Household visits/telephone interviews conducted by trained mental health workers; 
        Structured questionnaire covering: 
            Marital/reproductive history, 
            Child developmental status, 
            Household socioeconomic indicators. 
4. Data Analysis 
4.1Statistical Approach: 
    Primary analysis: Descriptive statistics (SPSS 24.0) 
    Continuous variables: Mean (SD) or median (IQR) as appropriate 
    Categorical variables: Frequency distributions (%) 
4.2 Data Management: 
    Secure EDC system with role-based access 
    AES-256 encryption for all electronic records 
5. Ethical Protections 
5.1 Confidentiality Measures: 
    De-identified data storage, 
    Restricted access to research team members, 
    Publication protocols excluding identifiable information. 
5.2Participant Safeguards: 
    Voluntary participation with withdrawal option, 
    Dedicated research contacts for concerns, 
    Referral pathways for requested support services. 

5.3 Special Population Protections: 
    Dual consent process for minor participants (assent + guardian consent), 
    Age-appropriate communication protocols. 
III. Participant Recruitment 
Sample Size: 
100,000-200,000 eligible households nationwide. 
Timeline: 
Projected commencement: February 2021 
Procedures: 
    Registry-based identification via national mental health management system; 
    Community outreach through 686 Program infrastructure. 
Inclusion Criteria 
Patients diagnosed with schizophrenia, bipolar disorder, paranoid disorder, schizoaffective 
disorder, epilepsy-related mental disorders, or mental retardation with associated mental disorders, 
who are registered in the severe mental disorder management system, aged 18-60 years, and have a 
history of childbirth (including miscarriage, preterm birth, and full-term birth). 
Exclusion Criteria 
Those who do not agree to participate in the survey. 
IV. Risk-Benefit Assessment 
Potential Benefits: 
    Contribution to evidence-based policy development. 
    Foundation for future intervention studies. 

Potential Risks: 
    Minimal psychological discomfort during survey. 
    Mitigation: 
    Real-time withdrawal option, 
    Embedded support service referrals. 
Risk-Benefit Conclusion: 
Study procedures present minimal risk with significant potential to advance mental health 
service equity for vulnerable families. 
Reference: 
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problems and psychiatric risks in children of parents with a mental illness in the Netherlands: I. The 
scientific basis to a comprehensive approach[J]. Australian e-Journal for the Advancement of 
Mental Health, 2009,8(3 
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[3] GRABER J A. Internalizing problems during adolescence[J]. Handbook of adolescent 
psychology, 2004,2: 587-626. 
[4] Van LOON L M A, Van De VEN M O M, Van DOESUM K T M, et al. Factors Promoting 
Mental Health of Adolescents Who Have a Parent with Mental Illness: A Longitudinal Study[J]. 
Child & Youth Care Forum, 2015,44(6): 777-799. 
[5] TIMKO C, CRONKITE R C, SWINDLE R, et al. Functioning status of adult children of 

depressed parents: a 23-year follow-up[J]. Psychological Medicine, 2008,38(3 
): 343-353. 
[6] WEISSMAN M M, WICKRAMARATNE P, NOMURA Y, et al. Offspring of depressed 
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[7] WEISSMAN M M, WICKRAMARATNE P, GAMEROFF M J, et al. Offspring of 
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