Skip to main content Accessibility help
×
Home

Children of parents who have been hospitalised with psychiatric disorders are at risk of poor school readiness

  • M. F. Bell (a1) (a2), D.M. Bayliss (a2), R. Glauert (a1), A. Harrison (a3) and J.L. Ohan (a2)...

Abstract

Aims.

Children of parents with psychiatric disorders are at risk of poor outcomes. However, there is limited evidence regarding the relationship between parental psychiatric disorders and child school readiness, which is linked to later academic achievement. This study aims to investigate these relationships and broaden the evidence underlying the rationale for family-focused interventions for parental psychiatric disorders.

Method.

This study used linked administrative data. Children's school readiness in multiple developmental domains (physical, social, emotional, communicative, cognitive) was measured by the Australian Early Development Census (AEDC) for 19 071 Western Australian children (mean age 5.5 years). Children scoring in the bottom 25% on any AEDC domain were considered developmentally vulnerable, or at risk of vulnerability, on that domain. Biological child–parent pairs were identified using birth records. Parents with psychiatric disorders were identified from hospital records, which included information on diagnosis and frequency/duration of psychiatric admissions. Logistic regressions, adjusted for parent age, mother's marital status, child Aboriginality, child English language status, local community remoteness and socioeconomic index, estimated the odds of children being vulnerable/at-risk on each of the AEDC domains.

Results.

A total of 719 mothers and 417 fathers had a psychiatric hospitalisation during the study period (12 months prior to the child's birth, up to the end of 2009). Children whose parents had psychiatric disorders had increased odds of being classified as vulnerable/at-risk for school readiness. This increase in odds was evident for both maternal (adjusted odds ratio, aOR 1.37– 1.51) and paternal psychiatric disorders (aOR 1.38–1.50); and for a single admission of one day (aOR 1.32–1.59), a single admission of multiple days (aOR 1.30–1.47), and multiple admissions (aOR 1.35–1.63). Some variability in child outcome was found depending on the parents’ psychiatric diagnosis (mood, anxiety, substance abuse or comorbid disorder).

Conclusions.

Children of parents who have been hospitalised with psychiatric disorders are at risk for poor school readiness. These findings add support to recommendations that mental health professionals consider dependent children in discharge and treatment planning for adult psychiatric inpatients. It is also important to ensure that the impact of psychiatric illness in fathers is not overlooked in assessment and intervention. Family-based approaches to adult psychiatric care could meet the dual needs of intervention for parents and preventative measures for children. These findings can inform policy regarding the importance of integrating and coordinating services to meet the needs of families.

Copyright

Corresponding author

*Address for correspondence: M. F. Bell, Telethon Kids Institute, Linked Analytics and Social Policy, Perth, Western Australia, Australia. (Email: megan.bell@telethonkids.org.au)

References

Hide All
Afzelius, M, Östman, M, Råstam, M, Priebe, G (2017). Parents in adult psychiatric care and their children: a call for more interagency collaboration with social services and child and adolescent psychiatry. Nordic Journal of Psychiatry 18.
Anhalt, K, Telzrow, CH, Brown, CL (2007). Maternal stress and emotional status during the perinatal period and childhood adjustment. School Psychology Quarterly 22, 7490.
Avan, B, Richter, LM, Ramchandani, PG, Norris, SA, Stein, A (2010). Maternal postnatal depression and children's growth and behaviour during the early years of life: exploring the interaction between physical and mental health. Archives of Disease in Childhood 95, 690695.
Baker, CE, Iruka, IU (2013). Maternal psychological functioning and children's school readiness: the mediating role of home environments for African American children. Early Childhood Research Quarterly 28, 509519.
Barron, E, Sharma, A, Le Couteur, J, Rushton, S, Close, A, Kelly, T, Grunze, H, Ferrier, IN, Le Couteur, A (2014). Family environment of bipolar families: a UK study. Journal of Affective Disorders 152–154, 522525.
Bergman, K, Sarkar, P, O'Connor, TG, Modi, N, Glover, V (2007). Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. Journal of the American Academy of Child and Adolescent Psychiatry 46, 14541463.
Blanch, AK, Nicholson, J, Purcell, J (1994). Parents with severe mental illness and their children: the need for human services integration. The Journal of Mental Health Administration 21, 388396.
Boyle, MH, Georgiades, K, Racine, Y, Mustard, C (2007). Neighborhood and family influences on educational attainment: results from the Ontario child health study follow-Up 2001. Child Development 78, 168189.
Brennan, PA, Hammen, C, Adersen, MJ, Bor, W, Najman, JM, Williams, GM (2000). Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5. Developmental Psychology 36, 759766.
Brinkman, S, Silburn, S, Lawrence, D, Goldfeld, S, Sayers, M, Oberklaid, F (2007). Investigating the validity of the Australian early development index. Early Education & Development 18, 427451.
Brinkman, S, Gregory, T, Harris, J, Hart, B, Blackmore, S, Janus, M (2013). Associations between the early development instrument at age 5, and reading and numeracy skills at ages 8, 10 and 12: a prospective linked data study. Child Indicators Research 6, 695708.
Carter, AS, Garrity-Rokous, E, Chazan-Cohen, R, Little, C, Briggs-Gowan, MJ (2001). Maternal depression and comorbidity: predicting early parenting, attachment security, and toddler social-emotional problems and competencies. Journal of the American Academy of Child and Adolescent Psychiatry 40, 1826.
Chen, X, Wen, SW, Fleming, N, Demissie, K, Rhoads, GG, Walker, M (2007). Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. International Journal of Epidemiology 36, 368373.
Conners-Burrow, NA, Johnson, B, Whiteside-Mansell, L (2009). Maternal substance abuse and children's exposure to violence. Journal of Pediatric Nursing 24, 360386.
Cook, JA, Steigman, P (2000). Experiences of parents with mental illnesses and their service needs. The Journal of the California Alliance for the Mentally Ill 11, 2123.
Cooksey, EC (1997). Consequences of young mothers’ marital histories for children's cognitive development. Journal of Marriage and the Family 59, 245261.
Davé, S, Sherr, L, Senior, R, Nazareth, I (2008). Associations between paternal depression and behaviour problems in children of 4–6 years. European Child and Adolescent Psychiatry 17, 306315.
Davies, S, Janus, M, Duku, E, Gaskin, A (2016). Using the early development instrument to examine cognitive and non-cognitive school readiness and elementary student achievement. Early Childhood Research Quarterly 35, 6375.
De Maio, J, Zubrick, SR, Silburn, S, Lawrence, D, Mitrou, F, Dalby, R, Blair, EM, Griffin, J, Milroy, H, Cox, A (2005). The Western Australian Aboriginal Child Health Survey: Measuring the Social and Emotional Wellbeing of Aboriginal Children and the Intergenerational Effects of Forced Separation. Perth: Curtin University of Technology and Telethon Institute for Child Health Research.
Downey, G, Coyne, JC (1990). Children of depressed parents: an integrative review. Psychological Bulletin 108, 5076. http://dx.doi.org/10.1037/0033-2909.108.1.50
Duncan, GJ, Dowsett, CJ, Claessens, A, Magnuson, K, Huston, AC, Klebanov, P, Pagani, LS, Feinstein, L, Engel, M, Brooks-Gunn, J, Sexton, H, Duckworth, K, Japel, C (2007). School readiness and later achievement. Developmental Psychology 43, 14281446.
Falkov, A, Goodyear, M, Hosman, CMH, Biebel, K, Skogøy, BE, Kowalenko, N, Wolf, T, Re, E (2016). A systems approach to enhance global efforts to implement family-focused mental health interventions. Child & Youth Services 37, 175193.
Falloon, IRH (2003). Family interventions for mental disorders: efficacy and effectiveness. World Psychiatry 2, 2028.
Fihrer, I, McMahon, CA, Taylor, AJ (2009). The impact of postnatal and concurrent maternal depression on child behaviour during the early school years. Journal of Affective Disorders 119, 116123.
Fletcher, RJ, Feeman, E, Garfield, C, Vimpani, G (2011). The effects of early paternal depression on children's development. Medical Journal of Australia 195, 685689.
Forget-Dubois, N, Lemelin, J, Boivin, M, Dionne, G, Séguin, JR, Vitaro, F, Tremblay, RE (2007). Predicting early school achievement with the EDI: a longitudinal population-based study. Early Education & Development 18, 405426.
Foster, KP, Hills, D, Foster, KN (2017). Addressing the support needs of families during the acute hospitalization of a parent with mental illness: a narrative literature review. International Journal of Mental Health Nursing, advance online publication.
Fudge, E, Mason, P (2004). Consulting with young people about service guidelines relating to parental mental illness. Advances in Mental Health 3, 5058.
Gaetano, J (2013). Holm-Bonferroni sequential correction: An EXCEL calculator. http://www.researchgate.net/publication/236969037.
Garon, N, Bryson, SE, Smith, IM (2008). Executive function in preschoolers: a review using an integrative framework. Psychological Bulletin 134, 3160.
Gatsou, L, Yates, S, Goodrich, N, Pearson, D (2017). The challenges presented by parental mental illness and the potential of a whole-family intervention to improve outcomes for families. Child & Family Social Work 22, 388397.
Gilligan, R (2000). Adversity, resilience and young people: the protective value of positive school and spare time experiences. Children & Society 14, 3747.
Guhn, M, Gadermann, AM, Almas, A, Schonert-Reichl, KA, Hertzman, C (2016). Associations of teacher-rated social, emotional, and cognitive development in kindergarten to self-reported wellbeing, peer relations, and academic test scores in middle childhood. Early Childhood Research Quarterly 35, 7684.
Gupta, S, Ford-Jones, E (2014). Recognizing and responding to parental mental health needs. What can we do now? Paediatric Child Health 19, 357361.
Gutierrez-Galve, L, Stein, A, Hanington, L, Heron, J, Ramchandani, P (2015). Paternal depression in the postnatal period and child development: mediators and moderators. Pediatrics 135, e339e347.
Hammen, C, Brennan, PA (2003). Severity, chronicity, and timing of maternal depression and risk for adolescent offspring diagnoses in a community sample. Archives of General Psychiatry 60, 253258.
Handley, C, Farrell, GA, Josephs, A, Hanke, A, Hazelton, M (2001). The Tasmanian children's project: the needs of children with a parent/carer with a mental illness. The Australian and New Zealand Journal of Mental Health Nursing 10, 221228.
Hay, DF, Pawlby, S, Sharp, D, Asten, P, Mills, A, Kumar, R (2001). Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. Journal of Child Psychology and Psychiatry 42, 871889.
Hinshaw, SP (2005). The stigmatization of mental illness in children and parents: developmental issues, family concerns, and research needs. Journal of Child Psychology and Psychiatry 46, 714734.
Holm, S (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics 6, 6570.
Janus, M, Brinkman, S, Duku, EK, Hertzman, C, Santos, R, Sayers, M, Schroeder, J, Walsh, C (2007). The Early Development Instrument: A Population-Based Measure for Communities. A Handbook on Development, Properties and use. Ontario, Canada: Offord Centre for Child Studies, McMaster University.
Janus, M, Brinkman, S, Duku, EK (2011). Validity and psychometric properties of the early development instrument in Canada, Australia, United States, and Jamaica. Social Indicators Research 103, 283297.
Jones, M (2016). Working with service users who are parents: looking beyond risk. Journal of Psychiatric and Mental Health Nursing 23, 469470.
Kersten-Alvarez, LE, Hosman, CMH, Riksen-Walraven, JM, Van Doesum, KTM, Smeekens, S, Hoefnagels, C (2012). Early school outcomes for children of postpartum depressed mothers: comparison with a community sample. Child Psychiatry and Human Development 43, 201218.
Kingston, D, Tough, S (2014). Prenatal and postnatal maternal mental health and school-age child development: a systematic review. Maternal and Child Health Journal 18, 17281741.
Larsson, B, Knutsson-Medin, L, Sundelin, C, Von Werder, ACT (2000). Social competence and emotional/behavioural problems in children of psychiatric inpatients. European Child and Adolescent Psychiatry 9, 122128.
Loomans, EM, van der Stelt, O, van Eijsden, M, Gemke, RJBJ, Vrijkotte, T, Van den Bergh, BRH (2011). Antenatal maternal anxiety is associated with problem behaviour at age five. Early Human Development 87, 565570.
Luthar, SS, Sexton, CC (2007). Maternal drug abuse versus maternal depression: vulnerabiliy and resilience among school-age and adolescent offspring. Developmental Psychopathology 19, 205225.
Matheson, SL, Kariuki, M, Green, MJ, Dean, K, Harris, F, Tzoumakis, S, Tarren-Sweeney, M, Brinkman, S, Chilvers, M, Sprague, T, Carr, VJ, Laurens, KR (2016). Effects of maltreatment and parental schizophrenia spectrum disorders on early childhood social-emotional functioning: a population record linkage study. Epidemiology and Psychaitric Sciences 112.
Maybery, D, Reupert, A (2009). Parental mental illness: a review of barriers and issues for working with families and children. Journal of Psychiatric and Mental Health Nursing 16, 784791.
Maybery, D, Ling, L, Szakacs, E, Reupert, A (2005). Children of a parent with a mental illness: perspectives on need. Advances in Mental Health 4, 7888.
Mennes, M, Stiers, P, Lagae, L, Van den Bergh, B (2006). Long-term cognitive sequelae of antenatal maternal anxiety: involvement of the orbitofrontal cortex. Neuroscience & Biobehavioral Reviews 30, 10781086.
Mensah, FK, Kiernan, KE (2010). Parents’ mental health and children's cognitive and social development. Social Psychiatry and Psychiatric Epidemiology 45, 10231035.
Montgomery, P, Kirkpatrick, H (2002). Understanding those who seek frequent psychiatric hospitalizations. Archives of Psychiatric Nursing 16, 1624.
Mordoch, E, Hall, WA (2008). Children's perceptions of living with a parent with a mental illness: finding the rhythm and maintaining the frame. Qualitative Health Research 18, 11271144.
Morinis, J, Carson, C, Quigley, MA (2013). Effect of teenage motherhood on cognitive outcomes in children: a population-based cohort study. Archives of Disease in Childhood 98, 959964.
National Centre for Classification in Health (2004). The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM). Sydney, New South Wales: Faculty of Health Sciences, The University of Sydney.
Newson, RS, Karlsson, H, Tiemeier, H (2011). Epidemiological fallacies of modern psychiatric research. Nordic Journal of Psychiatry 65, 226237.
Nicholson, J, Geller, JL, Fisher, WH, Dion, GL (1993). State policies and programs that address the needs of mentally ill mothers in the public sector. Hospital & Community Psychiatry 44, 484489.
Nicholson, J, Biebel, K, Hinden, B, Henry, A, Stier, L (2001). Critical Issues for Parents with Mental Illness and Their Families. Rockville, MD: University of Massachusetts Medical School.
Parent, J, Forehand, R, Pomerantz, H, Peisch, V, Seehus, M (2017). Father participation in child psychopathology research. Journal of Abnormal Child Psychology 45, 12591270.
Pearson, RM, Bornstein, MH, Cordero, M, Scerif, G, Mahedy, L, Evans, J, Abioye, A, Stein, A (2016). Maternal perinatal mental health and offspring academic achievement at age 16: the mediating role of childhood executive function. Journal of Child Psychology and Psychiatry 57, 491501.
Pemberton, CK, Neiderhiser, JM, Leve, LD, Natsuaki, MN, Shaw, DS, Reiss, D, Ge, X (2010). Influence of parental depressive symptoms on adopted toddler behaviors: an emerging developmental cascade of genetic and environmental effects. Development and Psychopathology 22, 803818.
Pfeiffenberger, AS, D'Souza, AJ, Huthwaite, MA, Romans, SE (2016). The well-being of children of parents with a mental illness: the responsiveness of crisis mental health services in Wellington, New Zealand. Child & Family Social Work 21, 600607.
Power, J, Goodyear, M, Maybery, D, Reupert, A, O'Hanlon, B, Cuff, R, Perlesz, A (2016). Family resilience in families where a parent has a mental illness. Journal of Social Work 16, 6682.
Priest, N, Baxter, J, Hayes, L (2012). Social and emotional outcomes of Australian children from indigenous and culturally and linguistically diverse backgrounds. Australian and New Zealand Journal of Public Health 36, 183190.
Priest, N, Perry, R, Ferdinand, A, Paradies, Y, Kelaher, M (2014). Experiences of racism, racial/ethnic attitudes, motivated fairness and mental health outcomes among primary and secondary school students. Journal of Youth and Adolescence 43, 16721687.
Ramchandani, P, Psychogiou, L (2009). Paternal psychiatric disorders and children's psychosocial development. The Lancet 374, 646653.
Ranning, A, Laursen, TM, Thorup, A, Hjorthøj, C, Nordentoft, M (2015). Serious mental illness and disrupted caregiving for children: a nationwide, register-based cohort study. Journal of Clinical Psychiatry 76, e1006e1014.
Rasic, D, Hajek, T, Alda, M, Uher, R (2014). Risk of mental illness in offspring of parents with schizophrenia, bipolar disorder, and major depressive disorder: a meta-analysis of family high-risk studies. Schizophrenia Bulletin 40, 2838.
Reupert, A, Maybery, D (2007). Families affected by parental mental illness: a multiperspective account of issues and interventions. The American Journal of Orthopsychiatry 77, 362369.
Rutter, M, Quinton, D (1984). Parental psychiatric disorder: effects on children. Psychological Medicine 14, 853880.
SAS Institute Inc (2010). SAS System for Windows. Cary, North Carolina, USA.
Shen, H, Magnusson, C, Rai, D, Lundberg, M, Lê-Scherban, F, Dalman, C, Lee, BK (2016). Associations of parental depression with child school performance at age 16 years in Sweden. JAMA Psychiatry 73, 239246.
Sinclair, D, Murray, L (1998). Effects of postnatal depression on children's adjustment to school. British Journal of Psychiatry 172, 5863.
Taback, I, Zabłocka-Żytka, L, Ryan, P, Zanone Poma, S, Joronen, K, Viganὸ, G, Simpson, W, Paavilainen, E, Scherbaum, N, Smith, M, Dawson, I (2016). Needs, expectations and consequences for children growing up in a family where the parent has a mental illness. International Journal of Mental Health Nursing 25, 319329.
Thanhäuser, M, Lemmer, G, de Girolamo, G, Christiansen, H (2017). Do preventive interventions for children of mentally ill parents work? Results of a systematic review and meta-analysis. Current Opinion in Psychiatry 30, 283299.
Whitaker, RC, Orzol, SM, Kahn, RS (2006). Maternal mental health, substance use, and domestic violence in the year after delivery and subsequent behavior problems in children at age 3 years. Archives of General Psychiatry 63, 551560.
Williams, DR, Priest, N, Anderson, N (2016). Understanding associations among race, socioeconomic status, and health: patterns and prospects. Health Psychology 35, 407411.

Keywords

Type Description Title
WORD
Supplementary materials

Bell et al. supplementary material
Appendix

 Word (27 KB)
27 KB
WORD
Supplementary materials

Bell et al. supplementary material
Bell et al. supplementary material

 Word (15 KB)
15 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed