Family Structure

Family circumstances during childhood and adolescence may affect the chances of children developing mental health issues later in life.1,2,3,4 Aspects of parenting, family dynamics and parent-child bonding can influence the risk of a child developing mental health issues. For example, substantial changes to family life have created changes to children’s experiences of daily family life. There are fewer nuclear families and new family forms are emerging, with rises in divorce, children born out of wedlock and single parents. Transitions in family structure can significantly affect a child’s emotional and psychological development.5

Research suggests that, on average, children from divorced, never married, and remarried or cohabiting couples are more likely to have emotional problems than children from nuclear families,6,7 which in turn increases the chances of children having emotional and psychological distress later in life. These differences are perceived to be because children living with both biological parents tend to have a higher standard of living, receive more effective parenting and have stronger emotional attachment to parents with fewer stressful life circumstances.8  In addition, families are often now more widely dispersed, meaning expectant mothers may have less ‘hands-on’ experience of babies, fewer role models and less nearby help from other family members.

Fortunately, as explained below, there are now a range of resources to assist parents who aren’t in traditional families and/or who have no family members living nearby to support them.

The importance of early child-parent bonding

What can happen in the absence of early child-parent bonding was revealed in a study of Romanian orphans9. This found that infants who spent more than 6 months in the institution (thereby deprived of early child-parent bonding) were more likely to have mental health issues later in life. An older study suggested that the trauma of abuse (presumably in the absence of or disrupting child-parent bonding) induces a cascade of effects, including changes in hormones and neurotransmitters that impact on the development of vulnerable brain regions, leaving those abused more vulnerable to mental disorders.10

Parental Mental Health

The overall mental health of a child’s mother can also have a major influence on the chances of their child developing mental instabilities, shown from significant research around mothers who suffer from postnatal depression11,12. It is believed that the mother’s state of mind will affect how well she bonds with her child. The children of women who suffer from postnatal depression have been found to have poorer cognitive outcomes at aged 18 months compared to those of women who did not suffer from postnatal depression.13 This can thus affect child development and lead to mental health issues later in life. It is further suggested that mothers who return to work within the first year of their child’s life hinder the cognitive and behavioural development of their child14, also associated with the mother and child attachment. Where it is necessary for a mother to return to work early this suggests the value of employers adopting family friendly policies, particularly during this first year.

The respective influence of mothers and fathers

Research has tended to focus on the influence of mothers on their children’s mental health, rather than the influence of fathers. While both parents can increase the risk of mental illness in their children (for instance through genetic inheritance or dysfunctional behaviour), there are both biological and social factors which suggest the importance of mothers in particular. These include the importance of the intrauterine environment and antenatal exposure during pregnancy and the fact that mothers tend to be the primary or sole carers of babies (with men unable to breast feed, with paternity leave much less generous than maternity leave, and with not all mothers having partners).

However, several studies have suggested that fathers also have influence. One 2017 study showed the positive effect fathers have on their infants when they engage in Kangaroo Care (skin-to-skin contact or SSC), which lowered rates of anxiety around parenting and led to more positive behaviours between infant and father.15 Previous studies have shown that when SSC is performed, oxytocin levels increase in both parent and infant, which reduces the stress-hormone cortisol, leading to a reduction in stress and anxiety, promoting security and calmness, and enhancing the bonding experience. Another study suggested that the children of single fathers do as well as the children of married couples as regards mental health.16

Resources available to help parents

From the cases explored, it appears that two key indicators of a child developing mental health issues come from the family environment and level of bonding and attachment created with their parents, in particular their mother. Fortunately there are many resources available to parents which promote family bonding and aim to reduce the amount of stress experienced within the family home, which can both help to reduce the risk of a child developing mental health difficulties later in life. For example:

• Parents of children who live in stressful environments, experiencing parental separation and divorce, can get guidance from the NSPCC to help their children feel as relaxed as possible during a distressing time. They suggest reminding the children that they are loved by both parents and they are not to blame for family difficulties, and suggest attempting to continue daily routines as normal as possible but being honest with them about the changes they are experiencing.17
• The charity Action for Children also provides advice to parents on how to raise confident children,18 such as allowing children to make decisions for themselves, showing an interest in what the children do, giving praise and encouragement which boosts motivations and helps them recognise their strengths, showing the children affection, being open and approachable for children to discuss any problems or concerns without feeling judged and setting out clear boundaries to give a sense of stability. All of the suggestions noted above are believed to help children feel comfortable and confident which may reduce the risk of them developing mental health difficulties later in life.
• The National Childbirth Trust (NCT) gives a wide range of information on child birth and parental support for new parents,19 including information on improving maternal mood and steps to help those suffering from postnatal depression. It is noted that there needs to be more research on how to treat postnatal depression to reduce long term negative outcomes. However it appears that support groups and community networks can have a positive effect on raising the maternal mood and helping mother and child to bond effectively. Research has suggested that pyscho-educational group and cognitive behaviour therapy can help mothers suffering from postnatal depression bond with their child .
• The children’s charity Barnado’s offers a range of parenting support including the Five to Thrive, campaign which saw parents educated in the importance of five key activities- respond, cuddle, relax, play and talk, which were seen as the ‘building blocks for a healthy brain’20 One way in which this was implemented was through a seven-week course for new parents covering all aspects of the Thrive to Five campaign which saw parents feeling empowered and enjoying being able to talk to other parents about the realities of parenting.

Experts confirm the value of programmes for parents

NHS Education for Scotland’s publication ‘Infant Mental Health: Developing Positive Early Attachments’21 notes that parental mental health, maternal and neonatal physical health and family and social context can all affect the quality of early relationships and thus mental health in the infant later in life. NHS Education for Scotland suggests that activities such as observing the infant’s behaviour, being aware of their state and signs of distress, making eye contact with the child as well as talking to them and singing to them and creating physical contact can all help parents bond with their child and reduce the chances of mental disturbance later in life.

The National Children’s Bureau found that group-based parenting programmes which aim to support, educate and train carers to fulfil their parenting potential, can be effective in improving the behaviour of children from high-risk backgrounds.22 The parenting groups helped to improve the children’s relationship with their parents which aided their development. The study concluded that group-based parenting support was cost effective and had long term positive impacts on the prevention of children developing behaviour disorders.

Another study looked at an 8-week Cognitive Behavioural prevention program for adolescents whose parents suffered from depression, which aimed to provide problem-solving skills and “cognitive restructuring techniques” to help identify and challenge irrational and negative thought patterns. It reported, ‘Significant decrease in depressive episodes and self-reported depressive symptoms in adolescents with high familial and individual risk for depression23

From the evidence explored it appears that group based parental education could be a wise step to help parents who have a higher risk of their child developing mental health issues. On a wider scale, there is a range of information available online for parents to advise them how to raise healthy and confident children, who feel self-assured and safe, which will help them to maintain a positive mental state throughout childhood into adulthood.

Elizabeth Walters and Alice Gough September 2018

 

References

[1] Melchoir, M and van der Waerden, J ‘Parental Influences on children’s mental health: the bad and the good sides of it’, Eur Child Adolesc Psychiatry, (2016) 25: 805-807

[1] Lee D and McLanahan S ‘Family Structure Transitions and Child Development: Instability, Selection, and Population Heterogenity’ American Sociological Review, 80.4 (2015) 738-763, http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=1&sid=2a490126-cda8-4936-a718-6683c6554a4a%40sessionmgr4006

[1] Baydar N. and Brooks-Gunn J. ‘Effects of maternal employment and child-care arrangements on preschoolers’ cognitive and behavioural outcomes: Evidence from the Children of the National Longitudinal Survey of Youth’ Developmental Psychology, 27.6 (1991) 932-945 http://psycnet.apa.org/buy/1992-08554-001

[1] McLeod, J D. and Shanahan M J. ‘Poverty, Parenting, and Children’s Mental Health’ American Sociological Review, 58 (1993) 351-366

[1] Lee D and McLanahan S ‘Family Structure Transitions and Child Development: Instability, Selection, and Population Heterogenity’ American Sociological Review, 80.4 (2015) 738-763, http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=1&sid=2a490126-cda8-4936-a718-6683c6554a4a%40sessionmgr4006

[1] Amato, P, R. ‘The Impact of Family Formational on the Cognitive Social, and Emotional Well-Being of the next Geeration’ The Future of Children, 15.2 (2005) 75-96 https://www.jstor.org/stable/3556564?seq=1#page_scan_tab_contents

[1] Turner H A, Finkelhor D, Hamby, S and Shattuck, A ‘Family Structure, victimisation, and child mental health in a nationally representative sample’ Aocial Science and Medicine, 87 (2013) 35-51 https://www.sciencedirect.com/science/article/pii/S0277953613001275

[1] Amato, P, R. ‘The Impact of Family Formational on the Cognitive Social, and Emotional Well-Being of the next Generation’ The Future of Children, 15.2 (2005) 75-96 https://www.jstor.org/stable/3556564?seq=1#page_scan_tab_contents

9 Sonuga-Barke EJS, Kennedy M, Kumsta R et al. Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study The Lancet 2017 Vol 389 Issue 10078, 1539-1548

10 Teicher M. Wounds That Won’t Heal: The Neurobiology of Child Abuse Cerebrum Available online at: http://www.dana.org/Cerebrum/2000/Wounds_That_Time_Won%E2%80%99t_Heal__The_Neurobiology_of_Child_Abuse/

11 Murray et al. ‘The Impact of Postnatal Depression and Associated Adversity on Early Mother-Infant Interactions and Later Infant Outcome’ Child Development, 76.5 (1996) 2512-2526 https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-8624.1996.tb01871.x

12 NHS Education for Scotland ‘Infant Mental Health: Developing Positive Early Attachments’ (2016) https://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/maternity-care/about-us/current-projects/infant-mental-health.aspx

13 Murray et al. ‘The Impact of Postnatal Depression and Associated Adversity on Early Mother-Infant Interactions and Later Infant Outcome’ Child Development, 76.5 (1996) 2512-2526 https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-8624.1996.tb01871.x

14 Baydar N. and Brooks-Gunn J. ‘Effects of maternal employment and child-care arrangements on preschoolers’ cognitive and behavioural outcomes: Evidence from the Children of the National Longitudinal Survey of Youth’ Developmental Psychology, 27.6 (1991) 932-945 http://psycnet.apa.org/buy/1992-08554-001

15 Er-MeiChenMeei-Ling GauChieh-YuLiu. Effects of Father-Neonate Skin-to-Skin Contact on Attachment: A Randomized Controlled Trial Nursing Research and Practice Volume 2017, Article ID 8612024

16 Bramlett MD and Blumberg SJ. Family Structure and Children’s Physical And Mental Health Health Affairs March/April 2007. Available online at https://www.healthaffairs.org/doi/full/10.1377/hlthaff.26.2.549

17 NSPCC, Separation, divorce and contact, https://www.nspcc.org.uk/preventing-abuse/keeping-children-safe/separation-divorce-and-contact/

18 Action for Children, Strategies for raising confident children, https://www.actionforchildren.org.uk/news-and-blogs/parenting-tips/2017/january/strategies-for-raising-confident-children/

19 National Childbirth Trust, ‘Postnatal depression- the impact for women and children and interventions to enhance the mother-infant relationship’ Perspective- NCT’s journal on preparing parents for birth and early parenthood (2011) 16- 20, https://www.nct.org.uk/sites/default/files/related_documents/Tsivos%20et%20al.%20Postnatal%20depression%2016-20_1.pdf

20 Barnardo’s, ‘Bringing Five to Thrive Alive: Two approaches to implementing Five to Thrive with Barnardo’s’ (2015) http://www.barnardos.org.uk/five-to-thrive-evaluation-report.pdf

21 NHS Education for Scotland ‘Infant Mental Health: Developing Positive Early Attachments’ (2016) https://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/maternity-care/about-us/current-projects/infant-mental-health.aspx

22 National Children’s Bureau, ‘Highlight no.211: Group-based parenting programmes and reducing children’s behaviour problems’ (2004) http://www.barnardos.org.uk/group-based_parenting.pdf

23 Garber JClarke GNWeersing VR, Prevention of Depression in At-Risk Adolescents JAMA 2009 Jun 3;301(21):2215-24.