Children of parents with psychiatric disorder in the community

Helping Teachers to Help Children Living with a Mentally Ill Parent

The material presented here is based on a pilot European project (Daphne Project, 2000/EU funding, collaboration of Greece and England) regarding parental mental illness and children‘s welfare and needs1.The presentation focuses upon the responses of a group of teachers working in primary education in relation to identi-.cation issues and assessment needs regarding children who live with a mentally ill parent. The results showed that although the teachers are able to identify risks and protective factors in the cases of a parental mental illness, there is a lack of early identi.cation mechanisms in the school setting and an absence of a shared understanding of relevant issues across services and agencies. The results are discussed in relation to school-based prevention initiatives that empower teachers to feel that they contribute to change in their schools as well as in their own practice in the classroom.

Family community integration and maternal mental health

While the majority of women with mental health problems (MHPs) are mothers, little is known about the community integration (CI) of these women and their children. Given that poorer mental health status has been linked with lower CI, CI has become a long standing goal of mental health policy. Data from a national survey examined the association of maternal mental health status with the physical, social, and psychological integration of families. After adjusting for sociodemographics, mothers with MHPs reported similar physical integration but less social and psychological integration. Interventions focused on improving social networks, scarce resources, and neighborhood safety are needed for families impacted by maternal MHPs.

Links between maternal and child psychopathology symptoms: mediation through child emotion regulation and moderation through maternal behavior

This study examined the intergenerational transmission of psychopathology symptoms with 7-12 year-old children (N = 97; 44 boys, 53 girls, M age = 9.14, SD = 1.38) and their mothers (M age = 38.46, SD = 6.86). Child emotion regulation mediated the links between maternal psychopathology and child internalizing and externalizing symptoms. In turn, the indirect effect was dependent on the level of maternal support in response to youth's expressions of negative emotions when considering particular constellations of maternal reactions and type of psychopathology symptoms. The findings indicate that the relations between maternal and child psychopathology symptoms and child emotion regulation are complex and vary by context. Regardless of the complexity, however, for both internalizing and externalizing symptoms in youth, the results suggest that building adaptive emotion regulation skills is an important target for prevention among children who are at risk for problems due to exposure to maternal psychopathology.

Child and family psychiatric and psychological factors associated with child physical health problems: results from the Boricua youth study

To examine associations among Puerto Rican children's physical health problems and children's internalizing disorders, parental psychopathology and acculturative stress, and family factors. A population-based probability sample of 2491 Puerto Rican children, aged between 5 and 13 years, and caregivers from the South Bronx and the U.S. Commonwealth of Puerto Rico participated in this study. The parent version of the Diagnostic Interview Schedule for Children-IV was used to assess children's internalizing disorders. Children's anxiety disorders, parental psychopathology, and acculturative stress were associated with childhood asthma, abdominal pain, and headaches. Children's depressive disorders, maternal acceptance, and family functioning were associated with abdominal pain and headaches. Parents of children living in Puerto Rico were more likely to report physical health problems in their children than in the Bronx. Children's internalizing disorders, parental psychopathology, and acculturative stress may be important areas to target among Puerto Rican children with physical health problems.

Preventive child-focused family work: development of instrument in adult psychiatry

It is well-known that a parent's mental disorder has a significant psychosocial influence on the development of her or his children. This study reports the development process and psychometric testing of the preventive child-focused family work (PCF-FW) questionnaire in adult psychiatric settings. The PCF-FW instrument was developed to measure support for parenting, dependent children and family relationships in order to promote child development and mental health in adult psychiatry. A 133-item PCF-FW questionnaire was developed; the content validity, construct validity and reliability of the instrument were ensured by expert review, pilot test and internal consistency. The final instrument was distributed to all nurses (n= 608), including registered nurses (n= 373) and practical mental health nurses (n= 235), working in 45 adult psychiatric units in five university hospitals in Finland. Some 51% of all nurses responded. Correlation variables in each subscale varied between 0.1 and 0.8. Cronbach's alpha coefficients were 0.55-0.95 in each subscale, demonstrating the moderate to excellent internal consistency of the instrument. The Cronbach's alpha coefficient for the entire instrument was 0.94. In spite of some caveats, such as possible response biases, the present study suggests that the PCF-FW instrument is a valid and reliable tool for studying preventive child-focused family working in adult psychiatry.

Maternal mental health and pediatric health care use among a national sample of Medicaid- and SCHIP-insured children

While the literature has shown that health care use is associated with mental health status, little is known about the relationship between a mother's mental health status and her children's health care use. This study examined the association of maternal mental health status and pediatric health care for their children in a nationally representative sample of 17,830 women parenting children ages 0-17 insured through Medicaid or a State Children's Health Insurance Program (SCHIP). Mothers with a mental health problem were significantly more likely to be poorer, single parents, with lower levels of education, fewer parenting supports, and greater difficulty coping with parenting than mothers without a mental health problem; however, they reported comparable receipt of pediatric health care for their children, indicating their resilience as caretakers. The findings also suggest that all Medicaid- or SCHIP-eligible families could benefit from targeted engagement strategies linking them with consistent and appropriate sources of pediatric health care.

Serious psychological distress among parenting and nonparenting adults

OBJECTIVES

We compared the prevalence of serious psychological distress among parenting adults with the prevalence among nonparenting adults and the sociodemographic correlates of serious psychological distress between these 2 populations.

METHODS

We drew data from 14240 parenting adults and 19224 nonparenting adults who responded to the 2002 National Survey on Drug Use and Health. We used logistic regression procedures in our analysis.

RESULTS

An estimated 8.9% of parenting adults had serious psychological distress in the prior year compared with 12.0% of nonparenting adults of similar age. In both groups, the adjusted odds of having serious psychological distress were higher among adults who were women, younger (between the ages of 18 and 44 years), low income, or receiving Medicaid. We found some differences in the correlates of serious psychological distress between parenting adults and nonparenting adults. The odds of having serious psychological distress were lower among parenting adults after we controlled for demographic characteristics.

CONCLUSIONS

Serious psychological distress is fairly prevalent among parenting adults, and high-risk sociodemographic groups of parenting adults should be targeted to ensure access to coordination of services.

Clients with mental illness and their children: implications for clinical practice

The problem of adults with severe mental illness parenting minor children is a growing concern. These clients suffer from concerns that negatively affect them and their children. This study showed many clients seeking services at public mental health agencies are parents of minor children and have had a history of family dysfunction. Prevalence rates, demographic characteristics, types of mental illness diagnoses, family background variables, and some current issues regarding these clients were examined. The study concludes with clinical implications for clients and their families and calls for a family focused approach.

Helping Parents with Mental Illnesses and their Children: A Call for Family-Focused Mental Health Care

1. Large numbers of individuals with mental illnesses are parents to minor children. 2. Recommendations to improve services suggest that services provided by the adult mental health system and child service agencies be coordinated. 3. Nursing care intersects both the adult and child systems, and nurses have the expertise to offer a variety of services. 4. There is an urgent need to improve family-focused mental health nursing care to benefit parents with mental illnesses, their children and families, and the overall community and society.

Relationship between parental psychopathology, parenting strategies and child mental health--findings from the GB national study

BACKGROUND

Parental and child psychiatric disorders have been found to be associated, and this association can be mediated by other psychosocial variables, including parenting attitudes and strategies. As most previous studies included clinical samples, the purpose of this study was to establish the relationship between parental psychopathology and parenting strategies with child psychiatric disorders in a national survey population.

METHODS

The sample included 10,438 children of 5-15 years and their parents, from representative UK households. Families were assessed on child psychiatric diagnosis, parental psychopathology, family functioning, and socioeconomic status. Parenting strategies included using rewards, physical and non-physical punishments towards their child.

FINDINGS

Parental psychopathology scores (OR 3.99, 95% CI 3.13-5.09) and non-physical punishment (OR 1.50, 95% CI 1.27-1.76) were associated with child psychiatric disorders. This association was particularly prominent among children with conduct disorders: parental psychopathology scores (OR 3.13, 95% CI 2.28-4.30) and non-physical punishment (OR 3.19, 95% CI 2.55-3.97). Absence of child psychopathology was associated with a combination of rewarding and non-punitive parenting strategies.

CONCLUSIONS

Although parents in the general population may be using less physical strategies than in the past, non-physical punishment is strongly related to mental health problems in children. Enhancement of positive parenting through universal and targeted interventions is an important preventive strategy.

The premature demise of public child and adolescent inpatient psychiatric beds : Part II: challenges and implications

Psychiatric disorders are the leading reason for hospitalization among 5-19 year olds. Current data, however, suggest there are fewer than necessary available services for children and adolescents requiring intensive, inpatient psychiatric care. Children and adolescents with behavioral health problems, the majority of whom do not receive appropriate treatment, have increased risk of school failure, family disruption, out-of-home placements, poor employment opportunities, and poverty in adulthood. This paper will examine the challenges inherent in serving children and adolescents with serious emotional disturbances, avenues of financing for treatment and services, and various loci of intervention for high-risk children, including inpatient settings and systems of care. The goals of this paper are to illustrate the complexities of working with children and adolescents most in need of intensive psychiatric services, to explore how inpatient services "fit" into existing treatment approaches, and to discuss the efficacy of downsizing or closing inpatient psychiatric units for this population.

Are ataques de nervios in Puerto Rican children associated with psychiatric disorder?

OBJECTIVE

To provide the first empirical analysis of a cultural syndrome in children by examining the prevalence and psychiatric correlates of ataques de nervios in an epidemiological study of the mental health of children in Puerto Rico.

METHOD

Probability samples of caretakers of children 4-17 years old in the community (N = 1,892; response rate: 90%) and in clinical services (N = 761; response rate 72%) were administered structured interviews to assess the presence and correlates of ataques de nervios.

RESULTS

Nine percent of children in the community sample and 26% of children in the clinical sample had a reported history of an ataque de nervios. In contrast to the overall community and clinical samples, which had more boys in them, the ataque de nervios groups in both samples had more girls in them. Family history of ataques de nervios was associated with ataques de nervios in children in both samples. Across a wide range of depression, anxiety, and disruptive disorders, children who reported an ataque de nervios were more likely to meet research criteria for psychiatric disorder in both samples.

CONCLUSIONS

Ataques de nervios are a frequently reported cultural syndrome among children in Puerto Rico. Adolescent girls are more likely to report this experience. Ataques de nervios have a significant relationship with psychiatric disorder and impairment in Puerto Rican children.

Elterliche psychische Belastung, konflikthafte Paarbeziehung und Verhaltensregulation dreijähriger Kinder

Zusammenfassung. Anhand einer Stichprobe von 69 Familien mit Kindern im Alter von 3 bis 3.5 Jahren wurde die Bedeutung mütterlicher und väterlicher psychischer Belastung und konflikthafter Paarbeziehung der Eltern für die kindliche Verhaltensregulation überprüft. Das elterliche Interaktionsverhalten mit dem Kind wurde als mögliche Vermittlungsvariable einbezogen. Die Verhaltensregulation des Kindes wurde mittels eines Elterninterviews (RABI) und eines Elternfragebogens (CBCL/2 - 3) erhoben. Zur Erfassung der psychischen Belastung der Eltern und der Qualität der Paarbeziehung wurden Fragebogen verwendet (SCL-90-R, PFB). Die Einschätzung des elterlichen Interaktionsverhaltens beruht auf einer Eltern-Kind-Spielsequenz (FEAS). Unsere Resultate erbrachten deutliche Zusammenhänge zwischen der mütterlichen psychischen Belastung sowie der konflikthaften Paarbeziehung und der Verhaltensregulation der dreijährigen Kinder, sowohl bezüglich der sozialen Kompetenz als auch bezüglich der Verhaltensprobleme. Das elterliche Interaktionsverhalten im Spiel mit dem Kind erwies sich als unabhängiger Prädiktor für die kindliche Verhaltensregulation und nicht als Vermittlungsvariable im Zusammenspiel von mütterlicher psychischer Belastung, Paarkonflikten und kindlicher Verhaltensregulation.

Predictors of self-reported problem behaviours in Turkish immigrant and Dutch adolescents in the Netherlands

BACKGROUND

Although many studies have compared psychopathology in different cultures, not much is known about factors that contribute to the observed differences.

METHODS

We compared self-reported emotional and behavioural problems in 363 Turkish immigrant and 1098 Dutch adolescents in the Netherlands and we evaluated the contribution of adolescent, parent, family and stress-related factors to the observed ethnic differences. Data were drawn from the Dutch version of the Youth Self-Report (YSR), as well as from Dutch and Turkish parental questionnaires.

RESULTS

Turkish girls scored higher on four of the eight YSR syndrome-scales, on the Internalising broadband scale and on total problems than Dutch girls. Turkish boys scored higher on three syndrome scales and on the Internalising scale, but scored less on Delinquent Behaviour than their Dutch peers. Ethnic differences for both sexes were most pronounced on the Withdrawn and Anxious/Depressed scales. Socio-economic measures, in particular education of the parents, contributed most to the explanation of ethnic differences on the Somatic Complaints scale for girls and Social Problem and Internalising scales for boys. On most scales, however, ethnic differences could not be explained by other factors. The distribution of some factors appeared to be more favourable (i.e., less frequent) for Turkish than for Dutch youths, such as referral of family members to mental health services.

CONCLUSIONS

Low educational levels of the parents play an important, yet not an exclusive role in explaining cross-cultural differences in emotional and behavioural problems in adolescents. In particular, differences in Withdrawn and Anxious/Depressed behaviour could not be explained by non-cultural factors. This study offers starting-points for future research on cultural-specific predictors of psychopathology in immigrants.

Commentary on "Community mental health care for women with severe mental illness who are parents" - The tragedy of missed opportunities: of missed opportunities: What providers can do

Women and men who meet criteria for psychiatric disorder are likely to be parents. Many go undiagnosed and untreated, putting themselves and their children at risk of poor outcomes. Adults with mental illness may fear disclosing their status as parents; providers may not ask. Practices can be modified to promote the well being of parents with mental illness and their children.

Advocacy and leadership when parental rights and child welfare collide: the role of the advanced practice nurse

This article describes the experience of an advanced practice nurse in a challenging clinical situation. A mother with mental illness and mental retardation seeks to retain parental rights and care for her newborn with cystic fibrosis. The nurse provides leadership to the hospital team and serves as an advocate throughout legal proceedings. A systematic, nonjudgmental, and empathic approach to gathering information, working with the family, welfare, and legal representatives is described. Enacting a complex and court-mandated homecare education regimen to the disabled mother is discussed. Preparation to testify in a termination of parental rights proceeding is outlined and a summary description of the testimony provided.

Children's emotional and behavioural well-being and the family environment: findings from the Health Survey for England

Recent trends towards diversity in family structure have posed important challenges for traditional social theories on the family. This critical debate has not, however, had much influence on policy discussions of the impact of diverse family structures on children's psychological health, where two-parent families are presumed ideal. In 1997, the annual Health Survey for England focussed on the health of children and young people. The Strengths and Difficulties Questionnaire (SDQ), used to assess children's psychological health, was administered to the parents of 5705 children aged 4-15 using a self-completion booklet. The effect of family structure, socio-economic indicators, parental working status and parental psychological status on children's psychological health was explored using multi-variate logistic regression models. Findings indicated that the high prevalence of psychological morbidity among children of lone-mothers was a consequence of socio-economic effects. disappearing when benefits receipt, housing tenure and maternal education were taken into account. Socio-economic factors did not, however, explain the higher proportion of psychological morbidity among children with stepparents, or the strong relationship between parents' and children's psychological morbidity.

Affective disorders in children and adolescents: addressing unmet need in primary care settings

Affective disorders are common among children and adolescents but may often remain untreated. Primary care providers could help fill this gap because most children have primary care. Yet rates of detection and treatment for mental disorders generally are low in general health settings, owing to multiple child and family, clinician, practice, and healthcare system factors. Potential solutions may involve 1) more systematic implementation of programs that offer coverage for uninsured children; 2) tougher parity laws that offer equity in defined benefits and application of managed care strategies across physical and mental disorders; and 3) widespread implementation of quality improvement programs within primary care settings that enhance specialty/primary care collaboration, support use of care managers to coordinate care, and provide clinician training in clinically and developmentally appropriate principles of care for affective disorders. Research is needed to support development of these solutions and evaluation of their impacts.

Predicting developmental outcomes at school entry using a multiple-risk model: four American communities. The Conduct Problems Prevention Research Group

The contributions of different risk factors in predicting children's psychological and academic outcomes at the end of 1st grade were examined. Using a regression model, levels of ecobehavioral risk were assessed in the following order: specific demographics, broad demographics, family psychosocial status, mother's depressive symptoms, and neighborhood quality. Participants were 337 families from 4 American communities. Predictor variables were assessed in kindergarten, and teacher, parent, and child outcomes (behavioral and academic) were assessed at the end of 1st grade. Results indicated that (a) each level of analysis contributed to prediction of most outcomes, (b) 18%-29% of the variance was predicted in outcomes, (c) a common set of predictors predicted numerous outcomes, (d) ethnicity showed little unique prediction, and (e) the quality of the neighborhood showed small but unique prediction to externalizing problems.

Children of parents with mental illness. I: An overview from a nursing perspective

This paper explores the psychosocial consequences of parental mental illness for child mental health and the implications for mental health nursing. The literature on risk and vulnerability to psychosocial disorder, resilience, child protection, disorder prevention and epidemiological data are reviewed. Based upon a health promotion approach, a model for mental health nursing advocacy for families of adult consumers is proposed as an effective means of preventing disorder in subsequent generations.

Acceptability of the Conners Parent Rating Scale and Child Behavior Checklist to Dakotan/Lakotan parents

OBJECTIVE

The objective of this pilot study was to determine how Dakotan/Lakotan parents view the Conners Parent Rating Scale (CPRS) and Child Behavior Checklist (CBCL).

METHOD

Using a focus group methodology, four discussion groups were held in different sites across South Dakota where the CPRS and CBCL were in clinical use.

RESULTS

Only two questions on each form were incomprehensible to these Dakotan/Lakotan parents. Other questions were hard to answer because certain questions contained implicit dominant cultural values that did not take into account Dakotan/Lakotan cultural values or traditions, or the questions were hard to answer because Dakotan/Lakotan believed their responses could or would be misunderstood by members of the dominant culture who did not understand Dakotan/Lakotan style or customs.

CONCLUSIONS

The CPRS and CBCL were generally acceptable to Dakotan/Lakotan parents. Clinicians could make several statements to Native parents that would improve cultural acceptability.

Parental mental disorder and early child development

In a prospective longitudinal study of 354 parents and their first-born infants the association between parental psychopathology and risk for maladjustment in the offspring was investigated. At age two infants of disturbed parents displayed significantly poorer language performance and had higher scores of behaviour problems as compared to infants of healthy parents. While maternal disorder affected both cognitive and social-emotional outcome, the impact of paternal disorder was confined to cognitive functioning. The poorest outcome was found in infants of mothers with a personality disorder or with alcohol abuse. The relationship was maintained even after accounting for a number of family risk factors associated with parental psychopathology. One mediating factor between maternal disorder and infant maladjustment was found in disturbed mother-infant interaction. Maternal mental health did not only affect infant outcome, but was itself influenced by infant adaptation.

Have the invisible children become visible?

Over the past 30 years much information has been collected on children whose parents suffer from psychiatric illness. Research has shown that many of these children are at high risk for significant psychopathology but there have been few investigations examining whether or not they are being identified and are receiving mental health care. The purpose of this pilot study was to investigate to what extent the children of psychiatrically ill adult patients are identified and referred to the mental health services. Results of structured interviews with the patients indicate that a considerable number had school-aged children and that in many instances no inquiry had been made concerning the children's psychological health. Although some of the children were reported to have received treatment, few had been referred by their parent's psychiatrists. Recommendations to improve the identification and treatment of such children are outlined in this study.

The psychological adjustment of offspring of adults with obsessive-compulsive disorder: a brief report

This study describes the prevalence of emotional and behavioural problems in the offspring of parents who are members of the Obsessive-Compulsive Neurosis Support Group in South Australia. The results suggest that the offspring of adults with obsessive-compulsive disorder do not have more problems than other children and adolescents in the community. The study also highlights potential benefits of collaborative research conducted by research groups and self-help organisations.