Parenting of mothers with a serious mental illness: Differential effects of diagnosis, clinical history, and other mental health variables

This study examined the effects of mental illness on parenting in a large urban-based sample of women with serious mental illness. Seventy percent of the sample were women from ethnic minority groups, average age mid-30s; all had care responsibility for at least one minor child. Diagnostic Interview Schedule modules were administered; the women were interviewed to obtain information on parenting, clinical history, and current functioning. Diagnosis had a small but significant negative effect on parenting attitudes and behaviors, and there were race-by-diagnosis interactions. However, current symptoms mediated the effects of diagnosis and chronicity on parenting stress, and current symptomatology and community functioning partially mediated the effects of diagnosis on parenting satisfaction. Researchers--practitioners need to assess the status of mothers with mental illness rather than assuming problems or intervention needs. Key words: diagnosis; mental illness; mothers; parenting; symptomotology ********** Maternal mental illness is clearly a risk factor for children. Children whose mothers have long-term, serious mental illness are at increased risk of being placed in alternative settings such as foster care (for example, Oyserman, Benbenishty, & Ben Rabi, 1992). Furthermore, in their lifetimes, from one-third to more than one-half of these children will themselves have a DSM diagnosable disorder (Amminger et al., 1999; Jacobsen, Miller, & Kirkwood, 1997; Waters & Marchenko-Bouer, 1980). Some of the association between mother and child diagnosis may reflect the heritability (that is, estimated proportion of the phenotypic variance that is genetically determined) of major mental illnesses--estimated at 80 percent for bipolar disorder, from 34 percent to 48 percent for depression, and 75 percent for schizophrenia (Rutter, Silberg, O'Connor, & Simonoff, 1999). Children's increased risks of mental health and behavioral problems have also been related to the parenting provided by their mothers with mental illness (Masten, Best, & Garmezy, 1990). A recent review of the empirical literature on the influence of serious mental illness on parenting concluded that these mothers have significantly less adequate parenting skills and behaviors than mothers who do not have a mental illness (Oyserman, Mowbray, Allen-Meares, & Firminger, 2000). Specifically, in parenting their children from preschool age through adolescence, mothers with a serious mental illness have been found to be less emotionally available, less reciprocal, less involved, and less positive (Cohler, Gallant, Grunebaum, Weiss, G Cohler & Musick, 1983; Klehr, Cohler, & Musick, 1983; Musick, Stott, Spencer, Goldman, & Cohler, 1984; Stott, Musick, Clark, & Cohler, 1983; Stott et al., 1984). They are also less encouraging (Scherer, Melloh, Buyck, Anderson, & Foster, 1996); less affectionate and responsive (Goodman & Brumley, 1990); and less able to differentiate their own needs from those of their children (Cohler et al., 1980) than are mothers who do not have an illness. Sandler (2001) has presented a conceptual model of the aspects of adversity that contribute to problem outcomes in childhood; they include threats to satisfying basic needs for safety and biological integrity, self-worth, sense of personal control, social relatedness, and attaining developmental competencies. Masten et al. (1990) described how living with parents with mental illness might affect the physical and emotional care provided to children and therefore increase the likelihood that these children experience the stated aspects of adversity. Furthermore, Oyserman et al. (2000) summarized empirical support for a mediational model wherein maternal diagnosis and symptoms affect positive parenting attitudes that then affect children's behavior (for example, aggressive behavior, Hops et al. …