Parental affectionless control and suicidality

Objective

Although poor parental bonding is a known risk factor for suicidality, current literature is inconsistent about the relative role of low parental care and parental overprotection, as well as the combination of the two, termed “affectionless control”. This review presents the current state of knowledge of the relationship between suicidality and these two aspects of parental bonding.

Method

The computerized databases Medline, PubMed, PsychINFO, PsychLit, and Google Scholar were searched using combinations of the following keywords: suicidality, suicide, suicide attempt, suicidal behavior, parental bonding, and parental bonding instrument. Using the results, we reviewed the reports on the relationship between suicidality and parental bonding as measured by validated parental bonding instruments.

Results

Twelve papers were analyzed. All of them used the parental bonding instrument (PBI) and one used both the PBI and the object representation inventory (ORI). Most reports agreed that, in mothers, either lack of maternal care and/or overprotection was associated with an increase in suicidal behavior, while in fathers only low care was consistently associated with suicidality. This lack of constancy with regard to the effect of paternal overprotection appears to be due to cultural differences in fathers' role in child rearing. With these differences acknowledged, affectionless control in both parents emerges as the parenting style most strongly associated with suicidal behavior. Common methodological problems included low numbers of subjects, inconsistent control groups, and the lack of a uniform definition of suicidality.

Conclusion

Despite methodological limitations, current literature consistently indicates that parental affectionless control is associated with suicidal behavior. Recognizing affectionless control as a risk factor for suicide and developing early interventions aimed at modifying affectionless and overprotective parenting style in families with a history of affective disorders may be effective in reducing suicidal risk.     

Parental bonding and adult psychopathology: results from the US National Comorbidity Survey

BACKGROUND: Research using the parental bonding instrument (PBI) has suggested that lack of parental care and/or overprotection may be important risk factors for adult mental disorders. Much of this research, however, has relied on clinical populations with one or two disorders, or has used highly select community samples. METHOD: The association between parenting experiences and the occurrence of 13 common mental disorders in adulthood was evaluated in the US National Comorbidity Survey (N = 5877). The effect of sociodemographic variables (age, education, income) was statistically controlled and the effects of six parenting variables (maternal and paternal care, overprotection and authoritarianism) were examined simultaneously. The effects in men and women were examined separately. RESULTS: Lack of care was the parenting variable most consistently associated with adult psychopathology. Parenting experiences with one's mother were more consistently associated with adult mental disorders. In general the impact of parenting was diagnostically non-specific. However, there appeared to be some unique effects for externalizing disorders (substance use disorders and antisocial personality disorder) in males; paternal overprotection and authoritarianism conferred a reduced risk of externalizing disorders in adult males. The overall impact of parenting as assessed by the PBI was modest, accounting for about 1 to 5 % of the variance in the occurrence of adult mental disorders. CONCLUSION: Parenting experiences, particularly lack of care, are potentially causally related in a non-specific manner to a wide variety of forms of adult psychopathology in both men and women. The overall magnitude of the effect is small but statistically significant in a nationally representative US sample.     

Longitudinal relations between parental drinking problems, family functioning, and child adjustment

Relations between maternal and paternal problem drinking symptoms and destructive marital conflict, parenting problems, and children's internalizing and externalizing problems were investigated. Participants were community families with a child in kindergarten who completed questionnaire measures at baseline (N=235), 1 year later (N=227), and 2 years later (N=215). Structural equation modeling revealed that paternal problem drinking at Time 1 was associated with greater destructive marital conflict 1 year later. In turn, destructive marital conflict was related to decreased parental warmth and increased parental psychological control; these parenting problems were associated with greater child internalizing and externalizing problems at the third time point. Further analyses revealed that the indirect effects of paternal drinking on children's adjustment were significant, and that relations remained even after including autoregressive effects. Findings are discussed in terms of family process models for relations between parental drinking and child adjustment problems.     

Parental care and control during childhood: associations with maternal perinatal mood disturbance and parenting stress

This study examined the associations between perceived parental care and control in childhood and maternal anxiety, depression and parenting stress during the transition to parenthood. Eighty-eight women completed the Parental Bonding Instrument, self-report measures of anxiety and depression and a structured diagnostic interview (Mini-plus International Neuropsychiatric Interview) during the third trimester of pregnancy. The MINI-Plus and anxiety and depression measures were re-administered at 7 months postpartum. The Parenting Stress Index was also administered at this time. Significant associations were found between maternal 'affectionless control' and prenatal and postnatal symptom measures of anxiety and depression, p values <0.005. Compared to women who reported optimal parenting, women who recalled maternal 'affectionless control' were also six times more likely to be diagnosed with an anxiety disorder during pregnancy (OR = 6.1, 95% CI = 2.17-30.11) and seven times more likely to be diagnosed with postnatal major depression (OR = 6.8, 95% CI = 1.80-25.37). Paternal 'affectionless control' was associated with significantly higher scores on symptom measures of prenatal and postnatal anxiety, p values <0.005. This study suggests that assessing a woman's own parenting history is important in identifying and managing the risk of prenatal and postnatal affective disorders and parenting stress.     

Parental styles and long‐term outcome following treatment for anxiety disorders

Poor parenting has long been associated with the diagnosis of anxiety and mood disorders, but it is not clear whether perceived parenting can predict long‐term outcome following treatment. The shortened Parental Bonding Instrument (PBI) was examined in respect to outcome, 3–14 years after initial treatment, in a group of patients having an original diagnosis of generalized anxiety, panic or post‐traumatic stress disorder. All patients had been entered into one of six controlled clinical treatment trials between 1985 and 1999, which had compared cognitive behavioural therapy with other forms of treatment including psychotherapy, medication and placebo. Significantly lower levels of paternal care and higher levels of parental control were reported by patients still having a clinical diagnosis at long‐term follow‐up compared with those with no diagnosis. In addition, the parental style of ‘affectionless control’ (i.e. low care/high control) from either parent was over‐represented in those with a diagnosis at long‐term follow‐up. However, only maternal control was significant for male patients, whilst only paternal care and control were significant for females. Findings on a subgroup of patients, who completed the PBI both pre‐treatment and at long‐term follow‐up, suggest the results are not due to changes in clinical status affecting recall in the recovered patients. Copyright © 2004 John Wiley & Sons, Ltd.     

Influence of oxytocin on parenting behaviors and parent–child bonding: A systematic review

Oxytocin (OT) plays a pivotal role in early parent–child relationship formation and bonding that is critical for the social, cognitive, and emotional development of the child. Therefore, this systematic review aims to consolidate all available evidence regarding the associations of parental OT concentration levels with parenting behavior and bonding within the past 20 years. A systematic search was conducted in five databases from 2002 to May 2022, and 33 studies were finalized and included. Due to the heterogeneity of the data, findings were presented narratively based on the type of OT and parenting outcomes. Current evidence strongly suggests that parental OT levels are positively related to parental touch and parental gaze and affect synchrony and observer-coded parent–infant bonding. No gender difference in OT levels was observed between fathers and mothers, but OT strengthens affectionate parenting in mothers and stimulatory parenting in fathers. Child OT levels were also positively associated with parental OT levels. Family and healthcare providers could encourage more positive touch and interactive play between parent and child to strengthen parent–child relationships.     

Perceived parenting behavior in the childhood of cocaine users: relationship with genotype and personality traits.

Low parental care during childhood, a pattern characteristic of an "affectionless control" rearing style was frequently reported in the history of addicted individuals. Parents' childrearing regimes and children's genetic predispositions, with their own behavioral characteristics, have been seen to be closely interwoven, probably affecting children's development and addictive behavior susceptibility. In the present study, parents care perception, aggressive personality traits, and genotype (serotonin transporter promoter gene--5-HTTLPR) have been investigated in cocaine users and healthy control subjects. PBI scores (maternal and paternal care) were lower and BDHI scores (aggressiveness) higher in cocaine users in comparison with controls and significant differences in the perception of either paternal or maternal care were observed between cocaine users and non-users. The short-short (SS) genotype frequency was significantly higher among cocaine users compared with control subjects (P = 0.04). Logistic regression proves that persons bearing the SS genotype have a risk of becoming cocaine user almost three times higher than those having the LL genotype. Estimations of the effects of other factors potentially affecting the risk of being cocaine addicted clearly prove the significant impact of aggressiveness: the highest the score, the highest the risk of becoming cocaine user. Moreover, paternal and maternal care perception significantly improve the fit of the model (the log likelihood decreases passing from -105.9 to -89.8, LR test = 32.17, P-value = 0.0000). Each unit increase in the PBI score yields a significant 12% and 10% decrease of the risk of becoming cocaine user, respectively for paternal and maternal care. Interestingly, once controlled for the PBI score, the relative risk associated to the SS genotype drops strikingly and becomes no longer statistically significant. On the whole, our preliminary data suggest that the association between 5-HT transporter polymorphism and psycho-stimulant use may be mediated by mother-child relationship and parental attachment perception, both being environmental and genetic factors involved in the proneness to substance use disorders, particularly in aggressive-antisocial individuals.     

Familial risk factors to oppositional defiant disorder and conduct disorder: parental psychopathology and maternal parenting.

In a sample of 177 clinic-referred children aged 7-13, an association was found between a diagnosis of conduct disorder (CD) and several aspects of family functioning: maternal parenting (supervision and persistence in discipline) and parental adjustment (paternal antisocial personality disorder and paternal substance abuse). Children with oppositional defiant disorder (ODD) were intermediate to families of children with CD and clinic control children on all variables, but differed from control children only in having a higher rate of paternal substance abuse and paternal antisocial personality disorder (APD). When both parental APD and deviant maternal parenting were entered into 2 x 2 logit-model analyses predicting CD, only parental APD was significantly associated with CD, and no interactions between parental adjustment and maternal parenting were found. The importance of these findings for understanding the etiology of CD and for disentangling correlated risk factors in future studies is discussed.     

Changes in maternal distress and child-rearing strategies across treatment for pediatric cancer

OBJECTIVES: To examine longitudinal changes in perceived stress, affective distress, and self-reported parenting strategies among mothers of children with cancer over the initial 6 months of diagnosis and treatment, and to examine relationships between changes in distress and subsequent parenting strategies. METHOD: Questionnaire data were gathered regarding parental perceived stress, caregiver burden, affective distress, and parenting strategies from 65 mothers of children (mean age = 8.3 years) with cancer at 2-5, 12-14, and 22-24 weeks postdiagnosis. RESULTS: Consistent with other studies in the literature, maternal affective distress decreased over the time course of the study. Perceived stress also decreased, while caregiver burden remained relatively stable. Parental consistency fluctuated over the study period, while other parenting strategies (i.e., control, nurturance, and responsiveness) remained stable. CONCLUSIONS: Although maternal affective distress decreased following the initial diagnosis of cancer, sources of stress (e.g., caregiver burden) may remain stable, indicating the need for interventions to bolster parental coping resources.     

抑郁青少年父母亲职压力及其相关因素的研究

目的了解广州市在校抑郁青少年父母亲职压力情况,并探讨其亲职压力的影响因素。方法以贝克抑郁自评问卷（BDI）、亲职压力36项简表PSI-SF和家庭功能评定量表（FAD）为工具对220名中小学生及其父母进行调查。结果 1抑郁情绪组在亲职压力总分（F=5.63,P=0.004）及亲子互动失调（F=4.71,P=0.01）和困难孩子维度（F=7.24,P=0.001）的得分高于正常对照组;2单因素分析显示：家庭人均月收入少、父母受教育程度低的抑郁青少年,其父母亲职压力高（P〈0.01）;3抑郁青少年父母的亲职压力与家庭功能的角色（r=-0.572）、情感反应（r=-0.364）、情感介入（r=-0.549）、行为控制（r=-0.386）以及总功能（r=-0.292）均呈显著负相关（P〈0.01）;4多元回归分析结果显示：抑郁青少年的家庭功能的角色、情感介入、情感反应和家庭月均收入进入了亲职压力的回归方程,解释了总变异的49.6%。结论抑郁青少年父母普遍存在较高水平的亲职压力,其亲职压力受多种因素影响。     

The measurement of a major childhood risk for depression: comparison of the Parental Bonding Instrument (PBI) 'Parental Care' and the Childhood Experience of Care and Abuse (CECA) 'Parental Neglect'

BACKGROUND: Lack of adequate parental care is a consistent predictor of adult depression. Questionnaire measures that compare well with interviews are needed for large-scale studies of affective disorders in the general population. A widely used questionnaire, the Parental Bonding Instrument (PBI), was compared with a detailed standardized interview, the Childhood Experiences of Care and Abuse (CECA). METHODS: PBI ratings of maternal and paternal care were obtained from 192 women aged 25-36, identified from primary care lists. The women were interviewed for childhood neglect using the CECA, and ratings made blind to their PBI responses. RESULTS: The discriminative ability of PBI care scores to predict measures of neglect in the CECA were moderate to high, and the addition of paternal scores did not add to the prediction from maternal scores. Shortened forms of the PBI maternal care scales provided comparable predictions to those from the full scale, particularly three items from the maternal care scale, identified by logistic regression. LIMITATIONS: PBI and CECA measures on the women were retrospective. Low numbers in some of the subgroups of interest limited statistical power and is reflected in wider confidence intervals. The three maternal care items identified by logistic regression need to be confirmed in other samples as being as efficient as the combined maternal and paternal care scale scores. CONCLUSIONS: The maternal care scale of the PBI compares reasonably well as an index of overall neglect in childhood to that provided by the CECA.     

Parental child-rearing behavior as measured by the Parental Bonding Instrument in a Japanese population: factor structure and relationship to a lifetime history of depression

BACKGROUND: Recent factor analyses showed that the variance of the Parental Bonding Instrument (PBI) was more satisfactorily explained by the use of three factors (one factor corresponding to the original care factor and two factors derived from the original protection factor), casting doubt as to the accuracy of previous estimations regarding the associations between parental rearing behavior and depressive disorders. METHODS: 418 employed Japanese adults completed the PBI and the Inventory to Diagnose Depression, lifetime version. Associations of PBI scores with lifetime history of depression were explored by performing logistic regression analyses. The analyses were carried out using the original two PBI dimensions and the three new PBI dimensions validated in this sample. RESULTS: The results of the analyses using the three new dimensions did not differ markedly from those using the original two dimensions. Parental low care was always associated with having a lifetime history of depression. Analyses using the three new PBI dimensions provided some evidence that overprotective aspects of parenting may also be associated with a lifetime history of depression (a higher score on paternal denial of the psychological autonomy dimension predicted a lifetime history of depression in female subjects). LIMITATIONS: Subjects were Japanese adults, which may limit the validity of the conclusion to Western cultures. Data regarding both child-rearing behavior and lifetime major depression were obtained by self-rating instruments, which also may have influenced the results. CONCLUSION: Low parental care may be the most important factor associated with depression, even though the factor-analytically appropriate three PBI dimensions are used. Evidence for an association between overprotective aspects of child-rearing behavior and a lifetime history of depression can be newly recognized using the three new PBI dimensions.     

Behavioral family intervention for children with developmental disabilities and behavioral problems.

The outcomes of a randomized clinical trial of a new behavioral family intervention, Stepping Stones Triple P, for preschoolers with developmental and behavior problems are presented. Forty-eight children with developmental disabilities participated, 27 randomly allocated to an intervention group and 20 to a wait-list control group. Parents completed measures of parenting style and stress, and independent observers assessed parent-child interactions. The intervention was associated with fewer child behavior problems reported by mothers and independent observers, improved maternal and paternal parenting style, and decreased maternal stress. All effects were maintained at 6-month follow-up.     

Predictors of parenting behavior trajectories among families of young adolescents with and without spina bifida

OBJECTIVE: To evaluate the utility of familial and parental variables in predicting trajectories of parenting behaviors among families of young adolescents with and without spina bifida (SB). METHOD: Sixty-eight families with a child with SB and a demographically matched comparison group (CG) of 68 families of an able-bodied child participated. Observational and questionnaire assessments of parenting behavior were collected via home visits at three time points, as were reports of parent and family functioning. RESULTS: Family conflict was negatively associated with adaptive parenting behavior at Time 1 (T1), but positively associated with adaptive parenting change. Although the direction of this effect was the same across both groups, findings were more robust for the SB sample. Among fathers of children with SB, parenting stress was positively associated with adaptive parenting at T1 but negatively associated with adaptive parenting change. In contrast, within the CG, paternal parenting stress was negatively associated with adaptive parenting at T1 but showed no enduring negative effects in longitudinal analyses. CONCLUSIONS: Family conflict and parenting stress were significant predictors of parenting behaviors and longitudinal parenting change. Findings are interpreted within a developmental context such that variables associated with maladaptive (or adaptive) parenting in the short run, may facilitate adaptive (or maladaptive) parenting over time based on young adolescents' changing developmental needs.     

Child illness, the parenting alliance, and parenting stress

Assessed relationship between children's minor illnesses during the first 3 years of life and parenting stress in the 4th year. Also examined whether a good parenting alliance would compensate for or moderate this relationship. Parents of 56 3- to 4-year-olds completed parenting alliance and stress questionnaires. Child morbidity, assessed from medical records, was directly related to mothers' but not fathers' feelings of stress. The parenting alliance was more strongly related to parenting stress for fathers than for mothers. However, child morbidity and parenting alliance interacted in predicting child-related paternal stresses. While fathers in a poor alliance reported more stress, stress was unrelated to their children's illnesses; for fathers in a moderate to strong alliance, illness and stress were positively correlated. Even minor child illnesses appear to be a source of stress for parents.     

Perceived parenting pattern and response to antidepressants in patients with major depression.

BACKGROUND: No systematic study has been conducted to explore the relationship of dysfunctional parenting early in life, as measured by the Parental Bonding Instrument (PBI), to outcomes of depression, although a number of studies have related parenting behaviors to the development of depression in adulthood. METHODS: The relationship between PBI scores and 4-month outcomes after treatment with antidepressants was explored in 60 outpatients with major depression, controlling for potentially confounding factors. RESULTS: A multiple logistic regression analysis suggested that low levels of paternal care, unmarried condition, non-melancholic features, and a high isolation tendency were all factors that contributed to poor outcomes for depression. The predictive power of low paternal care was not influenced by levels of depression or neuroticism. LIMITATION: This study did not attempt to explore whether the effects of parenting of father and mother on outcomes for depression may differ between male and female subjects. CONCLUSION: The results suggest that low levels of paternal care may be an independent predictor of a poor response to treatment with adequate antidepressants.     

Possible role of imprinting in the Turner phenotype.

We have attempted to investigate the role of imprinting in the phenotype of Turner's syndrome. Sixty-three patients were investigated for parental origin of the retained normal X chromosome; 43 were found to retain the maternal X (XM) and 20 the paternal (XP). The relationship between a child's pretreatment height centile and parental height centiles was examined in 36 patients. No significant correlation was found between child and parental height centiles for XP or child and paternal height centiles for XM (p > 0.05) but a strong correlation was found between child's height centile and maternal height centile (p < 0.01) for XM. Using pooled data from this and other studies there was no significant correlation with renal anomalies but a strong correlation between cardiovascular abnormalities and XM (0.01 > p > 0.001) and neck webbing and XM (p < 0.05). We conclude that imprinting may play a part in the Turner's syndrome phenotype, especially with respect to pretreatment height, cardiovascular anomalies, and neck webbing.     

Mother–infant bonding impairment across the first 6 months postpartum: the primacy of psychopathology in women with childhood abuse and neglect histories

Our goal was to examine the trajectory of bonding impairment across the first 6 months postpartum in the context of maternal risk, including maternal history of childhood abuse and neglect and postpartum psychopathology, and to test the association between self-reported bonding impairment and observed positive parenting behaviors. In a sample of women with childhood abuse and neglect histories (CA+, n?=?97) and a healthy control comparison group (CA?, n?=?53), participants completed questionnaires related to bonding with their infants at 6 weeks, 4 months, and 6 months postpartum and psychopathology at 6 months postpartum. In addition, during a 6-month postpartum home visit, mothers and infants participated in a dyadic play interaction subsequently coded for positive parenting behaviors by blinded coders. We found that all women, independent of risk status, increased in bonding with their infant over the first 6 months postpartum; however, women with postpartum psychopathology (depression and posttraumatic stress disorder [PTSD]) showed consistently greater bonding impairment scores at all timepoints. Moreover, we found that, at the 6-month assessment, bonding impairment and observed parenting behaviors were significantly associated. These results highlight the adverse effects of maternal postpartum depression and PTSD on mother–infant bonding in early postpartum in women with child abuse and neglect histories. These findings also shed light on the critical need for early detection and effective treatment of postpartum mental illness in order to prevent problematic parenting and the development of disturbed mother–infant relationships. Results support the use of the Postpartum Bonding Questionnaire as a tool to assess parenting quality by its demonstrated association with observed parenting behaviors.     

Advanced parental age in maternal uniparental disomy (UPD): implications for the mechanism of formation

Uniparental disomy (UPD) describes the inheritance of a pair of chromosomes from only one parent. Meiotic nondisjunction followed by trisomy rescue is considered to be the major mechanism of formation. A literature search for cases with whole chromosome UPD other than UPD 15 was performed. Information on parental age was available in 111 cases with maternal UPD and in 34 cases with paternal UPD. In 52 out of 74 cases with maternal heterodisomy, information on the time of nondisjunction was also available. Around two-thirds of these cases were due to a maternal meiosis I error. Compared with the mean maternal age of 30.0 years in Bavarian mothers, in the year 2000 an advanced mean maternal age of 34.8 years was found in cases with maternal heterodisomy (n=74; P<0.0001). Almost no difference in the mean maternal age was observed between meiosis I errors (35.56 years; n=30) and meiosis II errors (35.78 years; n=14). The mean maternal age was 31.46 years in cases with maternal isodisomy and a normal karyotype (n=24), and the mean paternal age was 31.48 years in cases with paternal isodisomy (n=28). The various mean parental ages in heterodisomic and isodisomic cases are considered to reflect strongly the different mechanisms of formation: trisomy rescue or gamete complementation, which implies a meiotic nondisjunction in maternal heterodisomic UPD, and postzygotic somatic reduplication in cases with paternal and maternal isodisomic UPD.     

Patterns of maternal distress among children with cancer and their association with child emotional and somatic distress

OBJECTIVE: To identify patterns of distress among mothers of children with cancer over the initial 6 months of treatment and to examine these patterns as predictors of child somatic and emotional distress. METHOD: Data were gathered regarding maternal perceived stress and affective distress from mothers of children (N = 65, mean age = 8.3 years) with cancer at 2 to 5 weeks postdiagnosis, then at 12 to 14 weeks and 22 to 24 weeks. Mothers and nurses provided indexes of child somatic and emotional distress at these assessments. RESULTS: Hierarchical and k-means cluster analyses revealed four distinct patterns of maternal distress: high, moderate, declining, and low. The high maternal distress group reported higher child emotional distress at all three points but higher child somatic distress only at the final assessment. Maternal distress group was unrelated to nurse-reported child distress. CONCLUSIONS: The identification of four empirically derived patterns of maternal distress may explain some of the variance in the literature regarding parental distress vis-à-vis pediatric cancer treatment and may have relevance to intervention efforts. Differences in the relations between maternal distress groups and mother- and nurse-reported child distress underscore the importance of collecting child distress data from multiple sources.