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Use the Advanced search for more specific terms. Volume Issue 3 Suppl. Supporting families of parents with mental illness in general practice. Med J Aust ; 3 Suppl: Summary The general-practice setting provides a unique opportunity to positively influence the impact of mental illness on individuals and families.
Intervention can begin from the moment an individual seeks professional help. This is a republished version of an article previously published in MJA Open C hildren of parents with mental illness have an elevated risk of psychological problems. Case study 1 Rob is a year-old man. Case study 2 Diane is worried about her year-old son Adam because he is too unwell to go to school several times a week. What can the GP do?
Cambridge University Press; Nicholson J, Claylield JC. The longer the mother experienced depression, the more likely the child was to develop ASB at seven years of age 8. Br J Psychiatry Suppl ; Australian Bureau of Statistics. She recognized mental illness made her mother different from other mothers.
Enhance insight without increasing stigma Better outcomes for the child begin with assisting parents to understand the impact of their mental health on their parenting, and the impact of parenting on their mental health. This can neutralise parental self-blame and promote a more objective approach; and maintain awareness that the GP does not hold all the answers and that ideas developed by the patient and the family themselves can be the most powerful and long-lasting.
New parents, new challenges Exploring mental health issues in the perinatal period, and providing quality advice and care if problems are detected, can reap long-term benefits for children and their families. Time to talk Family psychoeducational interventions and appropriate family communication about parental mental illness can reduce psychological symptoms and improve family functioning.
Stories, play and role models as tools GPs can encourage parents to talk with their child about parental mental illness and highlight opportunities for communication and reflection that are present in everyday activities, such as storytelling and play. Some examples GPs can share with parents include: Conclusion The general-practice setting provides opportunities to identify and support families when a parent has a mental illness.
Commissioned; externally peer reviewed. Falkov A, Lindsey C, editors. Royal College of Psychiatrists, Parenting is a mental health issue. Australas Psychiatry ; Prevalence of parental mental illness in Australian families. The Psychiatrist ; Australian Bureau of Statistics. National Survey of Mental Health and Wellbeing: Summary of results, Psychiatric illness and family stigma.
Schizophr Bull ; How children with parents suffering from mental health dis and avoid stigma. To be or not to be Thomas L, Kalucy R. Parents with mental illness: Int J Ment Health Nurs ; Australian Institute of Health and Welfare. Mental health services in Australia — Risk for psychopathology in the children of depressed mothers: Psychol Rev ; Br J Psychiatry Suppl ; Interactive use of genograms and ecomaps in family caregiving research.
J Fam Nurs ; From cognitive information to shared meaning: Nicholson J, Claylield JC. Responding to depression in parents. Pediatr Nurs ; Safety, feasibility and family experiences of preventive interventions for children and families with parental depression. Int J Ment Health Promotion ; Psychol Bull ; Preventive interventions in families with parental depression: Eur Child Adolesc Psychiatry ; Long-term effects from a randomized trial of two public health preventive interventions for parental depression.
J Fam Psychol ; Goal setting within family care planning: Children of depressed mothers had lower IQ scores than those of nondepressed mothers at 42 months of age 7. This was mediated by a decrease in responsiveness among mothers.
These children also had lower scores on the Early Screening Profiles, which are designed to measure cognitive and language development in young children 7. The effects of maternal depression have also been studied in relation to children developing antisocial behaviour ASB 8. It was found that children were more likely to develop ASB at seven years of age if they had a mother who was depressed during the first four years of their life.
The longer the mother experienced depression, the more likely the child was to develop ASB at seven years of age 8. This was consistent when controlling for child sex, as well as for maternal and paternal antisocial personality disorder. Genetic factors influenced the association between maternal depression and childhood ASB symptoms. The authors emphasized the possibility that depressed mothers are more likely to have poor-quality interactions with their children, and the children are more likely to grow up in stressful family environments. This may promote behavioural troubles in children later in their lives 8.
The Family Model: Managing the Impact of Parental Mental Health on Children [ Adrian Falkov] on www.farmersmarketmusic.com *FREE* shipping on qualifying offers. Adrian Falkov author of The Family Model Handbook Dr Adrian Falkov is a child and adolescent psychiatrist who trained and practised in London before moving.
Depression among fathers has also been shown to negatively affect child development. Specifically, paternal depression during the postnatal period is associated with behavioural and emotional problems in children 9.
This is maintained later in life because adolescents of depressed fathers have increased rates of depression and suicidal behaviour 9. Children who had a depressed father were more likely to exhibit conduct problems and hyperactivity at 3. This correlation remained even after maternal depression was controlled for. Depressed fathers spend less time with their children than fathers who are not depressed 9.
The quality of this time is less positive, with fewer activities such as reading, singing and hugging. Furthermore, paternal depression can increase maternal conflict. The risk of marital conflict is heightened, and this stressful environment can result in behavioural problems in the child They may be the only health care provider with whom parents have contact It is important that physicians assess for depression among the parents and know the appropriate steps to take.
This is especially true when parents raise concerns about the behavioural or cognitive development of their child because parental depression may be an underlying cause or an exacerbating factor It is important to understand the financial backgrounds of the families in the office because it will help the physician to determine appropriate and beneficial resources for them Poverty creates an environment of material deprivation and stress for the parent These economic hardships and the pressure of providing for a family can lead to depression.
Single-parent households are a risk factor for parental depression. However, this relationship is partly mediated through the poverty associated with single-parent households When focusing on single-mother households, mothers living below the threshold poverty line were more likely to experience depression The combination of depression and poverty also increased the level of physical punishment on the child, with physical punishment being associated with emotional difficulties in children This interperson effect was shown by following the economic status and depressive symptoms as measured by Center for Epidemiological Studies Depression Scale of mothers for three years after childbirth.
There are two patterns of maternal-infant interactions among depressed mothers: In an intrusive interaction, a mother will be hostile and overbearing.
The infant will respond in anger, and will be more likely to develop an internalized and shielding coping style A withdrawn mother is disengaged and will not take great measures to support her infant. The infant will be passive and withdrawn A physician can look for these patterns in an office setting.
Postpartum depression is defined as depressive symptoms persisting beyond the first two weeks after birth What distinguishes postpartum depression from the normal stress of pregnancy and delivery is symptom severity and timing The symptoms of postpartum depression can be severe enough to impair a woman from performing her daily tasks As well, symptoms persist much longer than a few weeks after delivery Women experiencing postpartum depression will experience at least five of the symptoms presented in Table 1 If many symptoms are present, the likelihood of postpartum depression is increased.
Adapted from reference As mentioned above, poverty is a major risk factor for depression among parents. It is important that the physician performs an initial assessment of the socioeconomic status of the child and the family. Poverty assessment tools have been developed for the Ontario region for primary care and paediatric use, which include questions assessing financial background, along with resources available if concerns are raised Comprehensive development of these adapted poverty tools is underway in Manitoba and under consideration in at least two other provinces personal communication, Dr Sharon Macdonald and Dr Noralou Rous, University of Manitoba, Winnipeg, Manitoba.
Various tools have been used to study the effect of screening. For example, the Patient Health Questionnaire 2: It asks about the two cardinal features of depression: One study involved asking mothers to complete a paper version of the questionnaire in the waiting room, with a follow-up discussion for positive results The study showed promising results, with A maximum of 3 points is given for each question, with a maximum of 6 points for the overall scale. However, screening comes with the burden of false positives, and it is important to ensure that our screening tools have a measured benefit When considering the postpartum period, some argue that there is insufficient evidence to mandate screening for maternal depression This is due to a lack of consensus on the criteria to screen for major versus major and minor depression and the screening tool to use Although there is evidence that screening improves maternal outcomes, this benefit is dependent on resources available in the community.
As well, the long-term sustainability of this improvement, as well as improvement in the well-being of the child, is not clear Therefore, it may be too early to implement screening in the postpartum period. The Canadian Paediatric Society recommends that physicians stay alert to the signs of mother-child interaction difficulties and behavioural or developmental problems in children.
Currently, there is insufficient evidence to recommend national screening specifically for paternal depression However, screening is proposed by some authors to be important in fathers because they are less likely to come forward on their own with mental health concerns They should acknowledge feelings of self-blame, reassure parents and outline further avenues of help Such avenues include referrals to adult primary care physicians, adult mental health professionals or accessing various local community supports 23 , Paediatricians have also found it helpful to have educational pamphlets to hand to parents that review the effects of parental depression, and self-help techniques that may reduce the impact of depression on their child Clinician home visiting involves multiple sessions in which parents are taught parenting skills and positive ways to think about their child.
This has been shown to be beneficial during the infant stage in the setting of maternal depression. Sessions improved maternal sensitivity to their children, infant attachment to the mother, infant initiation of interactions with the mother and maternal structuring of interactions Public health early visiting programs are offered in every province and territory in Canada. A Canadian study following children born in Quebec showed that having a child engaged in a form of child care appeared to lessen the effect of maternal depression This was especially true for children enrolled in group-based child care The group setting gives the child structure and allows him or her to interact with other children Furthermore, care is provided by a trained professional.
Best Start is a helpful resource designed for health care providers across Ontario, and is universally available to all health care providers through their website It supports these providers as they work to better the health of expectant and new parents, newborns and young children One service that Best Start provides among many is a readily accessible workshop providers can work through specific to parental depression. There are case-based formulas that educate providers on the impact of parental mental health on children, strategies to help parents who are experiencing a mental health crisis, tools to support parents experiencing mental health problems, and links for education and support This number connects callers with information and contacts for local social, health and government services.
Of the many services offered, some include child care resources, child and family services, financial assistance and health care services Physicians should direct families to telephone a help line should they stand to benefit from the offered services. The effect of poverty on a parent-child interaction is an area that can be further addressed in future research.
In this way, physicians can understand how financial barriers can specifically hinder families and children, and how to appropriately tailor their management.
Furthermore, research showing that screening for parental depression improves child development is insufficient or unavailable. Also, while screening will identify more mothers at risk of depression, it is important to ensure that the benefit to the mother has long-term sustainability. The amount of research investigating paternal depression pales in comparison with maternal depression.
More research should be performed addressing depression in fathers to further our understanding of how to identify and address the issue. Finally, considering the significant delays in accessing psychiatric care, there is a need to explore optimal management of a patient during these wait times, as well as possible prenatal preventive strategies that a physician could offer. Depression among parents has serious developmental consequences for the child. While the majority of depressed parents may not be living in poverty, a major risk factor for depression among parents is poverty.
Raising income could dramatically increase health for mothers and infants