Insight into mental illness and child maltreatment risk among mothers with major psychiatric disorders

OBJECTIVES: This study examined the relationship between insight into mental illness and current child maltreatment risk among mothers who had a major psychiatric disorder and who had lost custody of a child because of abuse, neglect, or having placed the child at risk of harm. Specifically, a measure of insight was examined in relation to systematically observed parenting behaviors known to be correlated with past child maltreatment and in relation to a comprehensive clinical determination of risk. METHODS: Forty-four mothers who had a major psychiatric disorder were independently rated for their insight into their illness, the quality of mother-child interaction, and the overall clinical risk of maltreatment. RESULTS: Better insight into mental illness was associated with more sensitive mothering behavior and with lower assessed clinical risk of maltreatment. The association remained when mothers with current psychotic symptoms were excluded from the analyses. Better insight did not appear to be associated with past psychotic symptoms, maternal psychiatric diagnosis, or the mother's level of education. CONCLUSIONS: Insight into mental illness may function as a protective factor that influences the risk of child maltreatment in mothers with mental illness. Measures of insight could be usefully incorporated into comprehensive parenting assessments for mothers with psychiatric disorders.     

Measuring child maltreatment: a comparison of prospective parent reports and retrospective adolescent reports

Using Lehigh Longitudinal Study data (N = 457), the authors compare prospective parent self-reports and retrospective adolescent reports of early childhood physical abuse, exploring their correspondence, predictive equivalence, and outcomes associated with conflicting reports. Correspondence between prospective and retrospective reports of child maltreatment was moderate (Phi = 0.27). Concurrence rates were similar for males and females. Analyses of the relative predictive capacity of prospective and retrospective measures revealed both to be significant predictors of key outcomes in adolescence. Findings support the predictive validity of both measures of childhood maltreatment and underscore the methodological challenges of measuring this important construct. Given the abundance and salience of research on the consequences of childhood maltreatment, greater attention to such measurement issues is due.     

Maternal stress and social support prospectively predict infant inflammation

Maternal stress has been suggested to be a risk factor for offspring health, while social support has been shown to be a protective factor for offspring functioning. Currently, research has yet to investigate how both of these factors may relate to infant inflammatory processes and associated biological aging in the first years of life. In 48 mother-infant dyads, we investigated whether maternal parenting stress and social support when infants were 12 and 18 months of age were cross-sectionally associated with infant salivary C-reactive protein (sCRP) during these times. In addition, we investigated whether parenting stress and social support were prospectively associated with later sCRP and changes in sCRP from 12 to 18 months of age, as well as whether those changes in sCRP were associated with subsequent infant salivary telomere length (sTL), a marker of biological aging. Analyses revealed that while there were no cross-sectional associations between maternal factors and infant sCRP, maternal parenting stress and social support when infants were 12 months of age predicted infant sCRP at 18 months of age. Further, maternal social support predicted changes in infant sCRP from 12 to 18 months of age. We observed a null association between infant sCRP and sTL. Implications for the ways that maternal mental health and social support may impact biological mechanisms related to disease processes in infants are discussed.     

Family burden,child disability,and the adjustment of mothers caring for children with epilepsy: Role of social support and coping

PurposeThis study was designed to contribute to the existing research on the coping behaviors, social support, and mental health outcomes in parents of children with epilepsy in the United States.MethodsParticipants included 152, predominantly Caucasian (89.5%), married (78.9%) women (95.4%). Via a web-based interface, mothers completed questionnaires assessing the impact of their child's disability on their family (i.e., severity of their child's disability, family burden, and personal stress), social resources (i.e., perceived social support), coping (i.e., emotion-focused and social support seeking), and adjustment (i.e., depression and anxiety).ResultsAfter controlling for demographic variables, mediational analysis revealed that mothers' perceptions of the severity of their child's disability were associated with decreased perceived social support, which was then related to higher reported levels of depression and anxiety. Similarly, low levels of perceived social support partially mediated the relation between family burden and depression, anxiety, and stress. Finally, mothers' perceptions of the severity of their children's disability and family burden were unrelated to their reports of emotion-focused or social support seeking coping. However, their use of emotion-focused and social support seeking behaviors was related to lower levels of depression.ConclusionLow levels of perceived social support may help to explain the mechanisms underlying the relation between mothers' perceptions of the severity of their child's disability and family burden on their mental health adjustment, such as depression and anxiety.     

Childhood maltreatment and antisocial behavior: comparison of self-reported and substantiated maltreatment

Although accurate assessment of maltreatment is critical to understanding and interrupting its impact on the life course, comparison of different measurement approaches is rare. The goal of this study is to compare maltreatment reports from official Child Protective Services (CPS) records with retrospectively self-reported measures. Research questions address the prevalence and concordance of each type of measure, their relationship to social disadvantage, and their prediction to four antisocial outcomes in adolescence and early adulthood including arrest, self-reported violence, general offending, and illegal drug use. Data to address this comparison come from the Rochester Youth Development Study (RYDS), a longitudinal panel study of 1,000 adolescents. Findings indicate that self-reported retrospective maltreatment is somewhat more prevalent (29%) than official substantiated maltreatment (21%). Among those with official reports, in young adulthood about half self-reported maltreatment, whereas 37% of those self-reporting have an official report. In general, both sources suggest that maltreatment is associated with a higher prevalence of antisocial behavior. It is not clear that combining sources of information improves prediction.     

Alcoholism and severe child maltreatment

A controlled study of the association between parental alcoholism and severe child maltreatment--i.e., physical abuse, sexual abuse, or neglect requiring court-ordered removal of the child from the home--reveals a significant overrepresentation of alcoholism in the parent population.     

Stress,social support and depression in single and married mothers

BACKGROUND: This study examined the effect of stress and social support on the relationship between single-parent status and depression. METHOD: A secondary data analysis of the 1994-95 National Population Health Survey was conducted. Single and married mothers who participated in the survey were derived from the general sample (N = 2,921). Logistic regression techniques were used to assess the mediating and moderating effects of stress and social support on the relationship between family structure and depression. RESULTS: Bivariate analyses showed that, compared to married mothers, single mothers were more likely to have suffered an episode of depression (12-month prevalence), to report higher levels of chronic stress, more recent life events and a greater number of childhood adversities. Single mothers also reported lower levels of perceived social support, social involvement and frequency of contact with friends and family than married mothers. The results of the multivariate analyses showed that, together, stress and social support account for almost 40% of the relationship between single- parent status and depression. We also found a conditional effect of stress on depression by family structure. Life events were more strongly related to depression in married than in single mothers. CONCLUSIONS: A substantial part of the association between single-parent status and depression can be accounted for by differences in exposure to stress and social support.Our results suggest that it is important to examine multiple sources of stress, as exposure to both distal and proximal stressors were higher among single mothers. Limitations and directions for future research are discussed.     

Hystersisters online: social support and social comparison among hysterectomy patients on the internet

Background: The Internet has become a popular source of health information for patients with a variety of medical concerns; however, research examining patient interactions on the Internet has been limited. Purpose: Four questions were examined in a survey study of hysterectomy patients who visited http://www.hystersisters.com: (a) Do hysterectomy patients use the support Web site because they perceive their proximal sources of social support to be inadequate? (b) What kinds of support do patients receive from the Web site? (c) What attributes characterize the “Hystersisters” that are perceived to be most helpful? (d) How do informational sources vary depending on the nature of the patient concern? Methods: Women (N = 137) responded to questions about social support, Web site use, and perceptions of other Web site users.Results: Participants reported high levels of perceived support and tangible assistance from their proximal social environment during recovery from surgery (93%–100%). Hystersisters who were perceived as helpful tended to share similar attributes, such as religion and children. On the Web site, information and advice (61%) was sought significantly more than emotional or esteem support (p < .01). For issues involving spiritual or partner matters versus factual issues connected to the hysterectomy, patients expressed greater interest in communicating with a patient who shared their values even if they were not more knowledgeable.Conclusions: This research contributes to our understanding of how patients utilize the Internet for health information. Longitudinal research is needed to evaluate causal relationships between Internet use and health outcomes.     

Lesbian mothers with planned families: a comparative study of internalized homophobia and social support

This study compared the perception of social support and the degree of internalized homophobia for two demographically similar groups: lesbians with planned families and lesbians who did not have children. Results found that lesbians with planned families perceived significantly less social support from friends overall, from gay men and lesbian friends specifically, and more support from their families-of-origin than lesbians who did not have children. Lesbians with planned families also reported significantly higher internalized homophobia specific to disclosure of sexual identification. The authors suggest that selective disclosure may be an adaptive response rather than a true measure of internalized homophobia.     

Mediating influences of social support: personal, family, and child outcomes

The mediating influences of social support were examined in a study of 137 parents of mentally retarded, physically impaired, and developmentally at-risk children. Social system theory was used as a conceptual framework for assessing the effects of social support on personal well-being, parental attitudes toward their child, family integrity, parental perceptions of child functioning, parent-child play opportunities, and child behavior and development. A series of hierarchical multiple regression analyses by sets, controlling for family SES and income, child sex and age, and child developmental quotient and diagnosis showed that both satisfaction with support and number of sources of support had main and/or interactive effects in all sets of outcome measures. More supportive social networks were associated with better personal well-being, more positive attitudes, and more positive influences on parent-child play opportunities and child behavior and development. Findings were discussed in terms of both methodological and conceptual contributions to understanding the broad-based influences of social support.     

Head Start as a social support for mothers: the psychological benefits of involvement

Parents' participation in Head Start activities was investigated for its possible effect on their psychological well-being. A pretest and posttest design was used. Results indicated a positive relationship: mothers who participated more reported fewer psychological symptoms, greater feelings of mastery, and greater current life satisfaction at the end of the program year. Implications for policy and research are discussed.     

Stress,social support and affective disorders in mothers of pre-school children — a test of the stress-buffering effect of social support

Summary The study attempted to assess the stress-buffering role of social support using data from a survey of 436 mothers from two semi-rural regions of Pennsylvania. Results indicated that women with less adequate social support were more at risk for psychiatric disorder following the Three Mile Island nuclear accident. However, contrary to earlier reports, the role of social support as a stress moderator was not substantiated vis-à-vis affective disorder.This research was supported in part by NIMH contract no. 278-79-0048 (SM).     

The effects of statutory requirements on child maltreatment reporting: a comparison of two state laws.

Two studies investigated the effects on reporting of child abuse by licensed psychologists from two states of a) different indicators of abuse and b) different state mandatory reporting requirements. Results of both studies showed an increased tendency to report with more available evidence of abuse. However, while both sets of mandatory requirements appeared to increase reporting in the first study scenario, they had divergent effects within the second study scenario.     

Maternal sensitivity and the empathic brain: Influences of early life maltreatment

One of the most striking characteristics of early life maltreatment (ELM) is the risk of transmission across generations, which could be linked to differences in maternal behavior. Maternal sensitivity includes appropriate and positive affective exchanges between mother and child. Mothers with a history of ELM have been found to show a lower sensitivity representing a significant risk factor for maltreating their own children. 25 mothers with and 28 mothers without sexual and/or physical childhood maltreatment (as assessed with the Childhood Experience of Care and Abuse interview) and their children participated in a standardized mother–child interaction task. Videotaped interactions were rated by two independent trained raters based on the Emotional Availability Scales. In addition, empathic capabilities were assessed with the Interpersonal Reactivity Index. High resolution structural magnetic resonance brain images of the mothers were analyzed with unbiased voxel-based morphometry and correlated with maternal sensitivity. Results indicate that mothers with ELM were less sensitive in the standardized interaction with their own child. In non-maltreated control mothers, maternal sensitivity was positively related to anterior insular grey matter volume, a region which is crucially involved in emotional empathy, while there was a positive association between maternal sensitivity and grey matter volume in parts of the cognitive empathy network such as the superior temporal sulcus and temporal pole region in mothers with ELM. These results implicate that neurostructural alterations associated with poor maternal sensitivity might be a sequelae of ELM and that mothers with ELM may try to compensate deficits in emotional empathy by recruiting brain regions involved in cognitive empathy when interacting with their child. Thus, findings suggest possible coping strategies of mother with ELM to prevent an intergenerational transmission of abuse.     

Parental substance use disorder and child abuse: risk factors for child maltreatment?

Although the literature consistently shows an association between parental substance use disorders (SUDs) and child abuse, it is unknown what factors discern non-abusive and abusive parents with SUDs. This study aims to investigate which specific risk factors are associated with child abuse in clinically treated parents with SUDs in the Netherlands. It examines two groups of parents with SUDs in a clinical setting, with and without known instances of child abuse. These groups were compared on SUD-related factors such as the type and severity of the SUDs, and variables addressing psychological disability such as comorbid diagnoses and quality of life. Other than a marginally significant difference in severity of addiction and a lower mean age of the parents in the child abuse group, no significant differences were found. The small sample size and the inherent difficulty of studying SUDs in a clinical sample is likely to have affected the results.     

Maternal stress and social support: effects on the mother-infant relationship from birth to eighteen months

Mothers' perceived stress and social support were found to be significant predictors of maternal attitudes and the quality of interaction with their infants, when measured concurrently across an 18-month period. However, long-term predictions were poor, as stability of maternal stress and support factors was only moderate. The quality of infants' interactive behavior was also affected by maternal stress and support, but only during the early measurement periods of one and four months.     

Long-term economic consequences of child maltreatment: a population-based study

Child maltreatment is prognostically associated with long-term detrimental consequences for mental health. These consequences are reflected in higher costs due to health service utilization and productivity losses in adulthood. An above-average sense of mastery can have protective effects in the pathogenesis of mental disorders and thus potentially cushion adverse impacts of maltreatment. This should be reflected in lower costs in individuals with a history of child maltreatment and a high sense of mastery. The aims of the study were to prognostically estimate the excess costs of health service uptake and productivity losses in adults with a history of child maltreatment and to evaluate how mastery may act as an effect modifier. Data were used on 5618 individuals participating in the Netherlands Mental Health Survey and Incidence Study (NEMESIS). We focussed on measures of child maltreatment (emotional neglect, physical, psychological and sexual abuse) and economic costs owing to health-care uptake and productivity losses when people with a history of abuse have grown into adulthood. We evaluated how mastery acted as an effect modifier. Estimates were adjusted for demographics and parental psychopathology. Post-stratification weights were used to account for initial non-response and dropout. Due to the non-normal distribution of the costs data, sample errors, 95 % confidence intervals, and p values were calculated using non-parametric bootstrapping (1000 replications). Exposure to child maltreatment occurs frequently (6.9–24.8 %) and is associated with substantial excess costs in adulthood. To illustrate, adjusted annual excess costs attributable to emotional neglect are €1,360 (95 % CI: 615–215) per adult. Mastery showed a significant effect on these figures: annual costs were €1,608 in those with a low sense of mastery, but only €474 in those with a firmer sense of mastery. Child maltreatment has profound mental health consequences and is associated with staggering long-term economic costs, rendering lack of action very costly. Our data lends credibility to the hypothesis that mastery may help to cushion the adverse consequences of child maltreatment. Further research on mastery may help to ameliorate individual burden and in addition offer some economic benefits.