RCPsych: Severe mental illness in mothers can affect long-term development of children

Babies' early experiences with a mother suffering from severe mental illness, such as schizophrenia, other psychotic disorders, bipolar disorder or severe major depression disorder may affect their future health and development.

Dr. Susan Pawlby, of the Institute of Psychiatry in London, emphasises that complex issues surround the study of the impact of a mother's severe mental illness on her child. Among them are genetic risks, poor health practices, psychiatric medication, breast-feeding, and the physical and emotional care of the baby.

Infants are entirely dependent for their health and well-being on those who care for them, and those whose mothers suffer from mental illness are at risk if the care provided does not meet their developmental needs. In such instances, she warns, the long-term implications for the child are potentially devastating.

There is now a substantial body of research showing the adverse impact of maternal prenatal and postnatal depression on the child and into adolescence.

Evidence from longitudinal community studies shows that, compared to children of mothers who are healthy, children of mothers suffering from mild-to-moderate depression or anxiety in the period around birth are more likely to have increased behavioural, emotional, and/or cognitive difficulties. These, in turn, may have an adverse impact on the children's peer relationships and school attendance.

The outcome for babies whose mothers have severe mental illness is, surprisingly, less well studied. This may be because of lower fertility rates in this group of women, and also because many babies of mothers with severe mental illness are taken into care.

However, it is becoming increasingly clear that early mother-infant interaction plays a significant role in the outcome for the child. Observational studies show that women with severe mental illness often have problems in relating to their new babies.

They may appear indifferent, remote, intrusive, insensitive and self-absorbed. The babies, in turn, may react by protesting and crying excessively, or by becoming passive and avoidant.

Findings such as these suggest that early experiences with mothers suffering from severe mental illness may interfere with the infant's regulation of emotion and attention, with cognitive and memory function, with the ability to distinguish the self from other people, and with the security of his/her attachment relationship to the mother.

Without support, these experiences may continue to affect children's health and development over a decade later.

For further information contact Dr. Susan Pawlby.
Tel: 020 7848 0353/0212 (07736 406751)
E-mail: Susan.Pawlby@iop.kcl.ac.uk.