Children whose parents have a mental illness: prevalence, need and treatment.

Up to one in five young people live in families with a parent who has a mental illness. There are various genetic, individual, family and environmental risk factors for children living in these families. Outcomes for children vary according to factors related to a parent's mental illness as well as certain environmental protective and risk factors, related to the family, social support and community. Health care workers need to acknowledge their patients' parenting roles and responsibilities and the needs of other family members, especially children.

Psychological factors associated with persistent postnatal depression: past and current relationships, defence styles and the mediating role of insecure attachment style.

BACKGROUND: This study prospectively investigated the factors underlying the maintenance and persistence of postnatal depression beyond the first year after birth. METHOD: One hundred primiparous women who were admitted to a parentcraft hospital for a week were assessed after discharge at 4 and 12 months postpartum. Various measures of mood, interpersonal relationships and defence styles were administered at 4 months and the relation between these measures and clinically elevated symptoms of depression at 12 months was examined. RESULTS: At 12 months, 30% of all mothers and 60% of those diagnosed depressed at 4 months continued to report clinically significant levels of depressive symptomatology. The strongest predictor of depression at 12 months was severity of symptoms at 4 months, and women from a non-English speaking background were significantly more likely to remain depressed. Reports of low maternal care in childhood, marital dissatisfaction at 4 months, an attachment style characterised by anxiety over relationships and immature defence styles were significant predictors of clinically elevated depression scale scores at 12 months. Furthermore, an insecure attachment style was shown to mediate the effect of low maternal care in childhood, while other cognitive and interpersonal factors appeared to contribute additively in maintaining depressive symptoms. LIMITATIONS: Self-report measures were used to measure insecure attachment styles and depression at 12 months. CONCLUSIONS: Findings demonstrate that both childhood and concurrent relationship difficulties contribute to the maintenance of postpartum depression. Interventions for persistent depression need to address relationship difficulties as well as depressive symptomatology.

Maternal attachment state of mind moderates the impact of postnatal depression on infant attachment.

BACKGROUND: Empirical studies have revealed a significant, but modest association between maternal depression and insecure mother-child attachment. Across studies, however, a substantial number of mothers with depression are able to provide a sensitive caretaking environment for their children. This paper aimed to explore whether a mother's own state of mind regarding attachment moderated the association between postpartum depression and insecure mother-child attachment. METHODS: Mothers (n = 111), mainly middle-class mothers, and their infants participated in a longitudinal study of postnatal depression, maternal attachment state of mind and child attachment. Depression was assessed using a diagnostic interview (at 4 and 12 months) and symptom checklists (at 4, 12 and 15 months). The Adult Attachment Interview was conducted at 12 months and the Strange Situation procedure at 15 months. RESULTS: Mothers diagnosed as depressed were more likely to have an insecure state of mind regarding attachment. Infants of chronically depressed mothers were more likely to be insecurely attached; however, the relationship between maternal depression and child attachment was moderated by maternal attachment state of mind. CONCLUSIONS: Results are discussed with reference to resiliency factors for women with postnatal depression and implications for intervention.