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The Effect of Parental Mental Illness on the Child

Essentials

  • Parental mental illness may have an impact on child's mental health through genetic factors, the overall situation during pregnancy, as well as the direct and indirect effects of the illness and its consequences. The risk of a child developing mental health problems increases as problems accumulate if the parent's ability to notice and respond to the child's needs deteriorates as their consequence.
  • In addition to the mental illness, the parent may have an alcohol or drug problem, be suicidal or violent, and further, the other parent may also have mental health problems, there may be marital problems, family violence Children and Domestic Violence or financial difficulties.
  • Efficient delivery of psychiatric treatment to the affected parent is crucial and, in the context of small children, the mental health of the parent as well as the mental images held regarding the unborn infant during pregnancy should be considered by consulting a health care worker well acquainted with questions of mental health in small children.
  • The interaction between the parents and the infant/small child should be assessed because the interaction between an infant or small child and his/her parents is developmentally significant especially for the development of the child's emotional life. The parent's mental image of the infant acts as a guide for the parent-child interaction. When parent-child interaction is clinically assessed, the parent's ability to notice the child's needs and to respond to them in a timely and correct manner is considered. Also the situation of the older children in the family and the family's possible need for assistance should be investigated.
  • Family-centred intervention and provision of sufficient social support preventatively against parental mood disorder may improve the function of a family unit in the long run and reduce the child's risk of developing mental health problems. The severity of the parent's depression and anxiety can be assessed by using forms.
  • Crisis assistance should be offered also to the children whenever a parent is undergoing a severe psychiatric crisis.
  • The children of psychotic mothers have a heightened risk of developing a wide range of severe mental health problems. The risk of a child developing mental health problems may be reduced by family-centred intervention with emphasis on child-protective measures and the reduction of risk factors. Further, the child should be given information about the parent's illness and the matter discussed from the child's point of view.
  • Children of psychotic parents feel their parent's illness has a significant impact on their lives.
  • The evaluation of a child's mental wellbeing requires the co-operation of a network of professionals. Relevant information must also be gathered from the personnel at day care facilities and school.

The effect of maternal mental illness on an infant

  • The biological development of an infant's brain continues after birth and is dependent on the quality of early interaction. According to the contemporary view this early interaction is based on interpersonal neurobiology.
  • Serious and recurrent maternal depression and the mother's significantly diminished psychological presence and reduced functional capacity are significant risks factors for the child, especially during the child's early years. The Edinburgh Postnatal Depression Scale (EPDS) Edinburgh Postnatal Depression Scale (Epds) is a useful tool for the identification of maternal depression. Both the mother and the infant should be referred to the nearest infant psychiatric treatment unit for the planning and implementation of the necessary treatment. If no intervention is introduced, the effects may in the long run manifest themselves as serious symptoms in the child.
  • Psychotic mothers have been found to be more nervous and less attentive than mentally healthy mothers in their early interaction with their infant Monitoring a Child's Psychological Development at Child Health Clinics. They also smile and make eye and other contact less frequently when playing with the child, and they are less sensitive to the infant's needs.
  • Respectively, the infants of psychotic mothers have been found both to smile and vocalise less. These infants also make less social and eye contact with their mother.
  • The absence of stranger anxiety in an infant of a psychotic mother may relate to the mother's nervousness or insecurity, discordant feeding situations or the crying of the baby.
  • Mothers who bring their children for evaluation of depression are often themselves depressed or have other, often untreated, mental health problems Depression in Mothers Bringing Their Offspring for Evaluation or Treatment of Depression.
  • Mothers with an eating disorder feed their children differently from healthy mothers. The abnormal eating habits are thought to contribute towards later eating disorders, particularly in the female offspring Influence of Eating-Disordered Mothers on Their Children.

Assessment and treatment

  • The quality of interaction between a mother with mental health problems and her infant as well as the overall situation in the family should always be assessed using appropriate methods. Help should be offered when needed in the form of, for example, psychoeducative counselling, psychiatric outpatient services, parent-child psychotherapy, possibly introducing a family support worker, and subsequent close monitoring.
  • The parent-child pair in need of hospital care can be admitted to an assessment unit in a psychiatric hospital, or they can be met by an outpatient team specialising in infant psychiatry, or domiciliary visits may be offered. If necessary, residential replacement may be considered for the infant and the parent involved in intensive daily interaction therapy.
  • The other parent should also be encouraged to take the responsibility of childcare, and the mentally ill parent should be allocated a contact person in the primary care (e.g. a therapist who specialises in families with children) who can be contacted whenever needed.
  • A qualified professional should assess whether the parenting capabilities of a parent are sufficient to safeguard the mental development of the child and in cooperation with family-targeted social services provide sufficient supportive measures on an outpatient basis or with the means of child protection.

Immediate intervention is necessary if

  • the infant is withdrawn, not sufficiently interested in interaction or does not make sufficient contact
    • The parent(s)-child interaction must be assessed and treatment arranged as deemed necessary.
  • the infant appears depressed, apathetic, cries a great deal or looks neglected
    • An appropriate network of professionals should establish the parent's/parents' psychiatric background and the reasons for lack of interaction, followed by the introduction of suitable treatment.
  • the physical health and development of the infant is at risk
    • A paediatrician, a team specialising in family work, a social services or child protection employee, and if necessary a psychiatric team must all be involved.
  • the parent's/parents' parental capabilities are not sufficient at the functional level
    • Based on an evaluation carried out in co-operation with the afore-mentioned professionals, either intensive therapeutic support together with family-targeted social services should be introduced or child protection support measures put in place.
  • the attitude of a parent towards the child is hostile, and he/she expresses thought patterns that may endanger the safety of the child.
    • A psychiatric team, a child protection worker and a team specialising in family work should be involved in the care. In order to understand the parent's thought patterns it will be necessary to explore both the parent's past and present life experiences, at the same time taking care of the safety and welfare of the infant.

The impact of parental mental illness on the child is increased if

  • the parent(s) show(s) diminished ability to interact with the child, feel empathy and recognise the child's needs
  • the parent(s) harboured negative or abnormal mental images of the child during pregnancy
  • the parent(s) show(s) is/are repeatedly admitted to hospital for psychiatric reasons during the child's early years
  • residential rather than foster home placement is chosen for the child during parent's hospitalisation
  • the parent with mental health problems has no supportive network
  • the symptoms of the parental illness directly affect the child
  • the relationship with the ill parent is entangled or too involved; the child starts to share the mental world of the parent
  • the relationship between the parents is problematic or there are other family-related problems
  • the basic strengths of the child are weakened
  • the child lacks the presence of another close adult or a sufficient supportive network
  • the child needs to take on too much responsibility in the family and has no emotional support.

Assessment of the preschool and and school-age child

Referral for treatment

  • The family of a psychiatric patient should undergo a child-orientated assessment with the focus on the situation of the child within the family unit, the parental capabilities and the child's need for help.
    • Children from families with parental depression may be involved in a structured Beardslee prevention programme where the child's progress is discussed with the family members, the parent is encouraged to step into the child's shoes, the child is encouraged to express his/her experiences and the parent is shown how to support and understand the child.
    • The family may also be admitted to a psychiatric family ward, or the child may be referred to the care of a child psychiatrist or child psychiatry team.
  • If the child shares the parent's world of delusions, intensive treatment intervention is warranted, and in difficult cases physical separation of the child and parent is necessary.
  • The parents' illness should be explained to the child, an attempt should be made to lessen the guilt of family members, the parentification of the child should be addressed and the close social network should be activated to support the child. Information given to the family and child regarding the parent's psychiatric illness, taking into account the viewpoints of both the family and the child, will prevent mental health problems in the child.
  • It is recommended that the EPDS is used in antenatal clinics. Local treatment chains should be developed in order to facilitate both the delivery of interaction therapy (for depressed mothers and their infants) and the referral of a parent for psychiatric treatment. Further, it is recommended that the antenatal clinic personnel seek help for a mother whose pregnancy is characterised by disturbed feelings or mental images.
  • See also article Psychiatric evaluation and referral to treatment of adolescents Psychiatric Evaluation and Referral to Treatment of Adolescents.

Social services support

  • Find out about local regulations and availability of relevant social services and provide information on these to the child and family at an early stage, so that they receive appropriate support, as necessary.
  • The physician in charge of the parent's care may be legally obliged to inform the child protection services.

References

  • Gluschkoff K, Keltikangas-Järvinen L, Pulkki-Råback L et al. Hostile parenting, parental psychopathology, and depressive symptoms in the offspring: a 32-year follow-up in the Young Finns study. J Affect Disord 2017;208:436-442. [PubMed]
  • Mentjox R, van Houten CA, Kooiman CG. Induced psychotic disorder: clinical aspects, theoretical considerations, and some guidelines for treatment. Compr Psychiatry 1993 Mar-Apr;34(2):120-6. [PubMed]
  • Cummings EM, Davies PT. Maternal depression and child development. J Child Psychol Psychiatry 1994 Jan;35(1):73-112. [PubMed]
  • Niemi LT, Suvisaari JM, Haukka JK, Wrede G, Lönnqvist JK. Cumulative incidence of mental disorders among offspring of mothers with psychotic disorder. Results from the Helsinki High-Risk Study. Br J Psychiatry 2004 Jul;185():11-7. [PubMed]
  • Valiakalayil A, Paulson LA, Tibbo P. Burden in adolescent children of parents with schizophrenia. The Edmonton High Risk Project. Soc Psychiatry Psychiatr Epidemiol 2004 Jul;39(7):528-35. [PubMed]
  • Siegel DJ. Towards an interpersonal neurobiology of the developing mind: attachment relationships, ”mindsight”, and neural integration. Infant Ment Healt Journal 2001;22:67-94
  • Luoma I, Kaukonen P, Mäntymaa M, Puura K, Tamminen T, Salmelin R. A longitudinal study of maternal depressive symptoms, negative expectations and perceptions of child problems. Child Psychiatry Hum Dev 2004 Fall;35(1):37-53. [PubMed]
  • Kim-Cohen J, Moffitt TE, Taylor A, Pawlby SJ, Caspi A. Maternal depression and children's antisocial behavior: nature and nurture effects. Arch Gen Psychiatry 2005 Feb;62(2):173-81. [PubMed]