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1.
OBJECTIVE: This study sought to determine the association between maternal schizophrenia and major affective disorders (serious mental illness) and child custody arrangements in a sample of Medicaid-eligible mothers. METHODS: Medicaid eligibility and claims data were merged with data from the child welfare system in Philadelphia for 1995 to 2000. The sample comprised 4,827 female residents of Philadelphia between the ages of 15 and 45 as of 1996, who were initially eligible for Medicaid through Aid to Families With Dependent Children between 1995 and 1996 and who had at least one family member younger than 18 years at the beginning of the study period. Logistic regression was used to determine association between maternal mental illness and involvement in the child welfare system. RESULTS: Among the 4,827 mothers, 7.2 percent had a serious mental illness and 4.4 percent had other psychiatric diagnoses. More than 14 percent of mothers with serious mental illness received child welfare services, compared with 10.8 percent of those with other psychiatric diagnoses, and 4.2 percent of those without a diagnosis. After the analyses adjusted for a past inpatient episode, race or ethnicity, and age, mothers with serious mental illness were almost three times as likely to have had involvement in the child welfare system or to have children who had an out-of-home placement. CONCLUSIONS: The results suggest the urgent need for increased planning and coordination between the child welfare and mental health systems, including provision of parenting support as part of mental health treatment for mothers.  相似文献   

2.
OBJECTIVE: Maternal psychiatric illness is a potent risk factor for child psychiatric disorders, but little is known about rates of psychiatric diagnoses among mothers who bring their children to pediatric mental health clinics. This study investigated rates of psychiatric disorders among mothers of children presenting for psychiatric evaluation and examined the relationship between maternal diagnosis and child psychopathology. METHODS: Interviewers conducted structured diagnostic interviews with nonpsychotic, school-age children and their mothers (N=222) and collected self-report measures of symptoms, functioning, and social support. RESULTS: One-hundred-thirty-five participating mothers (61 percent) met DSM-IV criteria for a current axis I disorder, most commonly depression (35 percent) and anxiety (42 percent). Children of mothers with a diagnosis met criteria for significantly more diagnoses on the Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Lifetime version and had significantly higher scores on measures of internalizing and externalizing symptoms than children of mothers without a diagnosis. Two-thirds of mothers with a diagnosis were not receiving psychiatric treatment. CONCLUSIONS: More than half the mothers who brought their children for psychiatric treatment were themselves suffering from a psychiatric disorder. Maternal psychiatric illness was, in turn, associated with greater occurrence of psychopathology among offspring, underscoring the importance of developing interventions that address the needs of both children with psychiatric disorders and their at-risk mothers.  相似文献   

3.
Parents, especially mothers, have a critical role in initiating psychiatric treatment for their child with first-episode schizophrenia. Knowledge of attitudes of mothers towards the illness of their child prior to psychiatric treatment and towards the start of treatment is essential for the development of interventions for reducing duration of untreated psychosis (DUP). In the present study, mothers (n = 61) of consecutively admitted patients with recent-onset schizophrenic disorders were interviewed about: their views on the nature of the symptoms at first occurrence of psychotic symptoms in their child and views on the main reason for psychiatric treatment; their perception of problems in initiating psychiatric treatment; and suggestions they might have for getting treatment started at an earlier point in time. About 57% of the mothers did not think that their child had a psychosis at first occurrence of psychotic symptoms. Most of the mothers who immediately thought that their child suffered from a psychotic disorder supposed that this disorder was caused by use of street drugs. About one-third (32.8%) of the mothers thought that the reluctance of patients to acknowledge that they needed help was the major obstacle in initiating psychiatric treatment. More than half of the mothers perceived factors related to the delivery of professional care as problems in initiating psychiatric treatment. Given the reluctance of patients to accept treatment, these problems further complicate the initiating of treatment. Mothers emphasize that a more active approach by professional caregivers could reduce treatment delay.  相似文献   

4.
5.
OBJECTIVE: To investigate the psychosocial outcome of pregnancies in women with a history of psychotic disorder in an epidemiologically representative sample and to determine the predictors of having a baby looked after by social services in the first year of life. METHOD: Historical matched controlled cohort study and nested case control study using the General Practice Research Database (GPRD), an anonymised primary care database, in women with a history of psychotic disorders who gave birth in 1996-1998 (199 cases and 787 controls). RESULTS: Twenty-seven percent of cases had a psychotic episode and a further 38% had nonpsychotic depression in the first year after birth. Women with nonaffective psychoses were at a significantly higher risk of postnatal depression compared with controls (adjusted rate ratio 2.07, 95% CI 1.45-2.96, p<0.001). Cases were well supported with 72% in a cohabiting relationship and only 38% on benefits. The only significant predictor of parenting difficulties was recent contact with psychiatric services. CONCLUSIONS: Women with a history of psychotic disorder are at high risk of psychiatric illness postpartum, particularly a twofold risk of postnatal depression, even if they have not been in contact with psychiatric services during pregnancy. However, this epidemiologically representative sample has better parenting outcomes than has been previously reported for specialist treated cases. Liaison between all professionals involved in the care of mothers with psychotic disorders during and after pregnancy is essential to optimise care for them and their families.  相似文献   

6.
ObjectivesParenthood of mothers with a psychotic disorder has become a growing social reality that requires specific care. This study was carried out to shed light on an understudied topic that raises a number of ethical questions. The purpose of this study was to explore the point of view of healthcare professionals working in psychiatry services about parenthood of psychotic mothers and what they are offered in terms of support and care.MethodsSixteen health professionals working in psychiatry services responded to a semi-directive interview. They were recruited on a voluntary basis. Anonymity was ensured and all professionals gave their written informed consent to participate in the study. Interview's content was transcribed verbatim then examined through a qualitative thematic analysis.ResultsThe interviews highlighted contrasting representations of these mothers’ parenthood. Whilst the weaknesses and difficulties in parenting and education were predominantly mentioned, mothers’ resources and skills were hardly acknowledged. Although attachment to the child was one of the few resources noticed, the professionals named 25 items relating to parenting problems. The main ones related to the impact on the child of the symptoms of the maternal mental disorder, and to difficulties in coping with daily tasks. A lack of empathy was also observed in these mothers. The parent's difficulties appeared to be more significant depending on the child's developmental stage. Family support was described as essential in helping these mothers with parenting. However, parenting issues seem to be very seldom taken into account by adult psychiatric services, as most health professionals believe these questions do not fall within their field of activity. A lack of training and information on this issue is seen as one of the main barriers regarding this topic. Besides, the organization of psychiatric services in France, with its child and adult sectors, appears to be a barrier to a joint work of child psychiatry and adult psychiatry. However, for these professionals, psychiatry in general remained the place where the issue of parenthood should be addressed. Children of psychotic mothers were perceived as suffering from the parent's difficulties, yet reporting situations where the children were in danger remained an unusual practice in adult psychiatry. This was considered as belonging to the realm of other institutions, or of child psychiatry. Lack of knowledge about existing procedures and partners appeared to limit assessments of situations of concern that should be reported. These results invite to discuss on models of support, for instance based on empowerment and recovery approaches. These models build on the strengths and resources of people who are seen as stakeholders in their own care journey. Given the impact of parenting on the mental health of these mothers, implementing recovery programs that focus on sexuality and parenthood could be effective. Providing health professionals with information might raise their awareness of their role in taking charge of the patients in a comprehensive perspective that includes parenthood issues. Professionals’ practices seemed to be more focused on the patient and his symptoms rather than on all aspects of their personal life (family, children, work). Finally, some ethical issues are discussed. Parenthood of psychotic mothers deserves a global approach, including work in partnership. Although the law lays down the principle of shared secrecy, some professionals still remain reserved about sharing relevant information, given the medical confidentiality principle. These issues also appear to be an argument for refusing to report a child as requiring a child protection intervention.ConclusionAlthough its limitations, in particular the low number of professionals who agreed to participate, this study sheds new light on a scarcely studied issue that deserves more attention given the increasing number of patients with children who are cared in psychiatric services.  相似文献   

7.
OBJECTIVE: Maternal filicide is not an isolated phenomenon. When a mother kills her child, she may be affected by many factors and confronted with different problems based on the child's developmental stage. In this study in Japan, a judicial sample of 96 adult women, convicted in their first trial for the murder or attempted murder of their children, was divided into four groups of mothers according to the age of the victim (25 women killed neonates, 22 women infants, 27 women preschool children, and 22 women schoolchildren and/or teenagers) in order to identify the factors that have a major impact on filicide in each group. METHODS: The socio-demographic, clinical, forensic, circumstantial, and offense characteristics, and legal disposition of 96 cases drawn from judicial records were compared among the four groups using the Kruskal-Wallis test; comparison of two groups was conducted using the Mann-Whitney test. RESULTS: Neonaticide cases were distinguished from the other three groups by marked differences: a significantly higher rate of unmarried mothers, financial difficulties, absence of mental illness, and admission of not wanting an illegitimate child. In the other groups, mental disorders were frequent; in particular, post-partum depression was the primary cause of infanticide. For the two groups of cases involving a child older than one year, filicidal mothers were more affected by circumstantial factors such as health problems of the child or severe marital discord. These problems may then have caused a reactive mental disorder among these mothers. The risk of fatal abuse or neglect was higher for handicapped preschool children. Filicide-suicide was most frequently seen among school-aged children and/or teenagers who had serious behavioral problems, and these children often had a mental disorder. CONCLUSIONS: The classification of maternal filicide by age of the child demonstrated that there are specific issues for each group. Based on these findings, future directions for prevention include: appropriate sex education for youths to avoid unwanted pregnancy; organization of specialized mental health services for mothers with post-partum mental disorder; careful psychiatric risk assessment of mentally ill mothers; and development of diversified social support measures for child-bearing parents, especially those with identifiable financial or social difficulties.  相似文献   

8.
The timing of mental illness onset in relationship to birth of children was explored as a possible indicator of the extent to which mothers experienced difficulties in parenting and functioning. Analyses employed data from a longitudinal study of urban-based, primarily minority mothers with mental illness (N = 379) who had parenting responsibility for their minor children. We found that women who were parents first and experienced mental illness onset after the birth of all their children showed the most positive trajectories over the study course. Mothers whose mental illness onset occurred before the birth of any of their children also showed improvements in functioning and symptomatology over time. In contrast, mothers whose mental illness onset had occurred in temporal proximity to the birth of a child showed little improvement. They also were younger, on average, at first birth, and had the largest number of children. Thus, timing of mental illness onset and childbirth may be predictive of longer-term maternal functioning and therefore may be useful in clinical assessment and treatment.  相似文献   

9.
OBJECTIVE: To compare the cognitive, social cognitive, behavioural, emotional and attachment security outcomes of children whose mothers were admitted to a psychiatric mother and baby unit (MBU) with those of offspring of mothers not admitted and with standardized norms. METHOD: Children aged 4-6 years of mothers admitted (following childbirth) to the dedicated psychiatric MBUs in Manchester, and still living with their mother, were traced for recruitment. Observational and multi-informant measures of developmental functioning were administered during a home visit. RESULTS: From 94 consecutive admissions, 16 children participated and showed no poorer developmental outcomes than comparison children or standardized child norms. Girls, securely attached children and children of mothers with no current mental illness tended to show the most positive outcomes. CONCLUSION: Possible reasons for low participant recruitment are discussed. Our provisional findings suggest that interventions should focus on improving infant attachment security, targeted at women with psychotic and chronic illness, who have no partner and/or who have a male child.  相似文献   

10.
This study compared the mental and physical health of two groups of black mothers aged 55 years and older: those who were providing care for their adult child with schizophrenia or schizoaffective disorder (N=30) and those who did not have a child with mental illness (N=263). The only demographic variable that was found to differ between the two groups was that the women who were providing care for their adult child with mental illness had more children than the women in the comparison group. Both groups of women had similar mental health status. However, the mothers who were providing care for their adult children with mental illness had higher rates of chronic health conditions, such as high blood pressure, arthritis, and eye problems.  相似文献   

11.
OBJECTIVE: The study investigated histories of child maltreatment and psychiatric disorder in a high-risk sample of pregnant adolescents. METHOD: Cross-sectional data were obtained for 252 pregnant adolescents from high school, hospital, and group home settings in Montreal (Canada). Adolescents completed a child maltreatment questionnaire and a psychiatric interview on lifetime conduct and major depressive disorders. Latent class analysis was used to model the association between child maltreatment and psychiatric disorder. RESULTS: Analyses indicated two latent classes: pregnant adolescents with no reported child maltreatment history (79%) and those with multiple forms of maltreatment (21%). There was no association between the child maltreatment latent variable and major depressive disorder. Rather, depression was related specifically to one form of maltreatment (i.e., sexual abuse, odds ratio = 2.60). Depression also showed a significant relationship with conduct disorder (odds ratio = 3.70). Pregnant adolescents with multiple forms of child maltreatment had a fourfold risk of also having conduct disorder, compared with nonmaltreated adolescents. CONCLUSIONS: In this sample of pregnant adolescents, prior experience of multiple forms of child maltreatment was prevalent, as were depression and conduct disorder. Clinicians need to screen for histories of child maltreatment and psychiatric disorder and to introduce effective interventions for pregnant adolescents and their children.  相似文献   

12.
BACKGROUND: There is insufficient information on the predictors of parenting difficulties in mothers with severe mental illness. Using data from mother and baby units in the UK we aimed to examine the social and clinical characteristics of mothers whose babies were supervised by social services on discharge. METHOD: A case-control study was carried out using data from mother and baby units and facilities entered onto the Marce database. RESULTS: Of 1197 mothers, 23% were discharged with their babies under some form of social services supervision. Factors independently associated with an increased risk of supervision included social class (OR 3.16, 95% CI 1.99-5.03), single marital status (OR 2.10, 95% CI 1.38-3.20), behavioural disturbance (OR 1.69, 95% CI 1.08-2.65) and psychiatric illness in the partner (OR 2.67, 95% CI 1.59-4.49). The diagnostic groups independently associated with the highest risk of having a supervised baby were schizophrenia (OR 5.16, 95% CI 2.61-10.21) and personality disorder (OR 9.29, 95% CI 3.46-24.91). CONCLUSIONS: Mothers with schizophrenia are at particularly high risk of having their baby supervised by social services. Preventative interventions should be targeted at socio-economic difficulties, early detection of psychiatric disorders postpartum and treatment of perinatal mental illness in the context of the whole family.  相似文献   

13.
The medical charts of 150 consecutive admissions of dually diagnosed substance abusing adolescents admitted to a psychiatric hospital were examined to determine the extent and characteristics of maltreatment. Results indicated that 61% of the sample experienced or had a history that warranted suspicion of past and/or current maltreatment. Physical abuse was the most frequent form of maltreatment, followed by sexual abuse and neglect. Thirty-seven percent of patients experienced multiple forms of maltreatment. Maltreated patients had significantly more hospitalizations than their nonmaltreated counterparts on the same unit. Moreover, the age of maltreated patients was significantly lower than nonmaltreated patients, perhaps indicating an earlier age of onset of psychiatric illness and/or substance abuse. Analyses of parental substance abuse and psychiatric history among the maltreated and nonmaltreated groups revealed no significant findings. Results are discussed in terms of the following: (1) increased risk of subsequent substance abuse in maltreated children; (2) need for systematic assessment of child maltreatment in psychological or psychiatric evaluations; and (3) importance of treatment to deal with abuse or neglect as part of a comprehensive substance abuse intervention strategy.  相似文献   

14.
BACKGROUND: The majority of women with severe mental illness are mothers. Little is known about their experiences and the extent to which their needs are met. METHODS: Semi-structured interviews were carried out with 22 women with schizophrenia, bipolar affective disorder or severe depression with psychotic symptoms in Inner London. Participants' experiences, views about services and needs for support in parenting were discussed. Interviews were transcribed verbatim and qualitative thematic analysis carried out. RESULTS: Most participants who looked after their children described motherhood as rewarding and central to their lives. However, they described the demands associated with parenting and at the same time coping with severe mental illness as considerable, and some feared that their children would be adversely affected by their illnesses. Parenting responsibilities created practical impediments to engaging with mental health services. Fear of losing custody or access to children dominated interactions with mental health and social services, making most participants reluctant to disclose difficulties in parenting to professionals. A widespread assumption that mentally ill women are inherently poor parents, regardless of the facts of individual cases, was described, and stigma was seen as affecting children as well as mothers. Services were perceived as offering little continuing support in relation to parenting, intervening only in crises. CONCLUSION: Little attention has so far been paid in research and service development to the fact that the majority of mentally ill women are mothers. Strategies for assessing and meeting the resulting unmet needs should be developed and evaluated.  相似文献   

15.
PURPOSE: To investigate the prevalence rate and risk factors of psychiatric disorders among new referrals for epilepsy, a multicenter study was conducted by using the International League Against Epilepsy (ILAE) criteria for epilepsy and the ICD-10 criteria for psychiatric disorders. METHODS: From April 2000 to March 2001, 398 patients with epilepsy, who were referred to nine neuropsychiatric outpatient clinics specialized for epilepsy in the Tokyo metropolitan area, were evaluated by using a newly developed five-axis classification scheme. RESULTS: Forty-two percent of the subjects showed a psychiatric disorder. Twenty-four percent of the total showed psychiatric disorders, including neurotic disorders in 8%, psychotic disorders in 7%, and affective disorders in 1%. In addition, 23% of the total showed mental retardation, and 18% showed personality disorders. A logistic regression analysis revealed that the three risk factors for a psychiatric disorder were mental retardation, temporal lobe epilepsy (as opposed to other subtypes), and a high seizure frequency. CONCLUSIONS: The presence of mental retardation was the primary risk factor for developing a psychiatric disorder, especially a schizophrenia-spectrum disorder. The type of epilepsy alone is not a strong predictor of psychiatric illness, and intractable temporal lobe epilepsy with a high seizure frequency is accountable for the link between the epilepsy and the psychiatric illness.  相似文献   

16.
OBJECTIVE: This article reviews findings in preclinical research on the adverse impact of parental depression on the development of offspring, with emphasis on the relevance of this research for the psychiatric care of depressed parents. METHOD: The authors reviewed literature from the last 40 years reporting laboratory animal studies pertaining to the persistent effects of parental stress and parenting deficits on neurobehavioral and neurobiological development in offspring. RESULTS: Animal studies indicate that disrupted parenting produces a persistent, deleterious biobehavioral impact on offspring. Stressors, including maternal separation, variable foraging, and a variety of prenatal maternal challenges, produce offspring behaviors reminiscent of the cardinal features of anxiety and affective disorders. The stress paradigms also uniformly produce persistent hyperresponsivity in hypothalamic-pituitary-adrenal axis activity secondary to hypersecretion of corticotropin-releasing hormone. These findings bear striking similarities to findings for stress-related illnesses in humans, including major depression. CONCLUSIONS: Data from research on animal parenting reinforce the idea that parental mental illness may pose the first adverse life event for a child. A thorough risk-benefit assessment for the psychiatric care of parents of young children must consider the impact on the infant of exposure both to treatment and to parental illness. Preclinical data regarding the risk to offspring posed by untreated parental mental illness should be incorporated into clinical decision making in the treatment of parents with mental illness.  相似文献   

17.
OBJECTIVE: Identification of the genetically related disorders in the putative schizophrenia spectrum is an unresolved problem. Data from the Finnish Adoptive Family Study of Schizophrenia, which was designed to disentangle genetic and environmental factors influencing risk for schizophrenia, were used to examine clinical phenotypes of schizophrenia spectrum disorders in adopted-away offspring of mothers with schizophrenia spectrum disorders. METHOD: Subjects were 190 adoptees at broadly defined genetic high risk who had biological mothers with schizophrenia spectrum disorders, including a subgroup of 137 adoptees at narrowly defined high risk whose mothers had DSM-III-R schizophrenia. These high-risk groups, followed to a median age of 44 years, were compared diagnostically with 192 low-risk adoptees whose biological mothers had either a non-schizophrenia-spectrum diagnosis or no lifetime psychiatric diagnosis. RESULTS: In adoptees whose mothers had schizophrenia, the mean lifetime, age-corrected morbid risk for narrowly defined schizophrenia was 5.34% (SE=1.97%), compared to 1.74% (SE=1.00%) for low-risk adoptees, a marginally nonsignificant difference. In adoptees whose mothers had schizophrenia spectrum disorders, the mean age-corrected morbid risk for a schizophrenia spectrum disorder was 22.46% (SE=3.56%), compared with 4.36% (SE=1.51%) for low-risk adoptees, a significant difference. Within the comprehensive array of schizophrenia spectrum disorders, schizotypal personality disorder was found significantly more often in high-risk than in low-risk adoptees. The frequency of the group of nonschizophrenic nonaffective psychoses collectively differentiated high-risk and low-risk adoptees, but the frequencies of the separate disorders within this category did not. The two groups were not differentiated by the prevalence of paranoid personality disorder and of affective disorders with psychotic features. CONCLUSIONS: In adopted-away offspring of mothers with schizophrenia spectrum disorders, the genetic liability for schizophrenia-related illness (with the rearing contributions of the biological mothers disentangled) is broadly dispersed. Genetically oriented studies of schizophrenia-related disorders and studies of genotype-environment interaction should consider not only narrowly defined, typical schizophrenia but also schizotypal and schizoid personality disorders and nonschizophrenic nonaffective psychoses.  相似文献   

18.
OBJECTIVE: To provide an overview of the literature relevant to, and describing, parenting programs for women with mental illness who have young children. METHOD: A literature search was undertaken, including MEDLINE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews and EMBASE: Psychiatry. Searches were limited to English journals and books and to the last five years in the first instance, with earlier literature considered where appropriate. RESULTS: Maternal mental illness can impact negatively on a child's life, especially where an insecure attachment is formed between mother and baby during the important early developmental years. The potential sequelae of maternal mental illness for children include impaired cognitive development, behavioural difficulties and increased risk of psychiatric disorder. Effective parenting skills are suggested to be a protective factor against these sequelae. However, the effects of parenting programs for women with mental illness have not been empirically tested, so that the potential long-term benefits of such interventions are not known. CONCLUSIONS: Parenting skills training for women with mental illness may be a useful selective preventive intervention. It is unlikely generic programs will be suitable. Rather, interventions for women with a mental illness will need to address the commonly experienced parenting problems as well as the more specific needs of women with mental illness.  相似文献   

19.
Objectives: There are limited studies on the factors that can predict the presence of impaired clinical insight specifically in an Emergency Room (ER) psychiatric patient population. The objective of this study is to examine the factors that can predict the likelihood that a patient presenting to the ER will have impaired clinical insight. Methods: Nineteen independent demographic and clinical factors contained on data assessment tools for 337 patients assessed by the crisis team in the ER over 6 months were compiled and analysed using SPSS Version 20 with univariate analyses and logistic regression. Results: Patients who were unemployed or had a history of self-harm or had psychotic symptoms on mental state examination were about two, three and six times, respectively, more likely to have impaired clinical insight compared with those who were employed, had no history of self-harm or had no psychotic symptoms on mental state examination, controlling for other factors in the logistic regression model. Conclusion: Patients who are unemployed, have a history of self-harm or have psychotic symptoms following as psychiatric assessment in the ER may benefit from an insight-oriented psychotherapy.  相似文献   

20.
Mothers of a child with intellectual disability (ID) have more psychiatric disorders after the birth of their child than other mothers. However, it is unclear if this is because they have more psychiatric disorders before the birth or if the increase is related to the burden of caring for the child. We aimed to calculate the rate of new psychiatric disorders in mothers after the birth of their eldest child with ID born between 1983 and 2005 and to compare these with rates in women with a child with no ID or autism spectrum disorder (ASD) born during the same period. By linking data from Western Australian population-based registries, we selected women with no psychiatric history who survived the birth of their live-born child (N = 277,559) and compared rates of psychiatric disorders for women with a child with ID and women without a child with or ASD. Negative binomial regression with STATA 12 was used for all analyses. Mothers of children with mild–moderate ID of unknown cause had around two to three and a half times the rate of psychiatric disorders of mothers of children without ID or ASD. Mothers of children with Down syndrome and no pre-existing psychiatric disorder showed resilience and had no impairments in their mental health. Interventions and services are needed for mothers of other children with ID to improve their mental health. Further research is implicated to explore the mental health of mothers of children with ID and a pre-existing psychiatric disorder.  相似文献   

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