Factors associated with mental health resilience in the child, adolescent and adult offspring of depressed parents: A systematic literature review

Offspring of depressed parents are at high risk for mental health problems. Nevertheless, some of them do not develop mental health difficulties or do so only temporarily, implying that certain modifiable protective factors could buffer parental-depression-related effects. This systematic review aimed to 1) review the evidence for protective factors enhancing mental health resilience in the offspring of depressed parents; 2) identify outcome-, developmental-stage, and sex-specific protective factors; and 3) summarise conceptual and operational definitions of mental health resilience. We searched PsycINFO, Embase, MEDLINE, Web of Science Core Collection, and Cochrane Library in March 2021. Two reviewers blinded to each other's decisions independently screened abstracts and full texts against pre-determined eligibility criteria, extracted data, and performed risk of bias assessments. Sixty studies (<i>N</i> = 52,966 offspring) examining 70 protective factors were included. Most studies were from high-earning countries (97 %), defined resilience as the absence of psychopathology (90 %), and considered protective factors before young adulthood (97 %) - the peak age for common mental health problems. Most protective factors were examined in only one study (56 %). We observed limited evidence for 10 demographic, parenting, individual, and social protective factors, of which parent-child relationships, co-parent support, and parental positivity were supported across mental health outcomes, and parental positivity was supported across developmental stages. Findings for sex-specific protective factors were inconsistent. Future studies should build further evidence for the protective factors examined and investigate if these associations are causal.