The overall mental health and wellbeing of mothers has a significant impact on their pregnancies, their children, their families and their communities.  Although the general prevalence of mental disorders between men and women is similar, women are at an increased likelihood of experiencing certain disorders that have a direct effect on their health and wellness, and on the care they are able to provide for their children.¹

Impact

A child’s mental health is often related to that of their caregivers, especially during the younger years of life.  Research studies have found that infants of depressed mothers display negative behavioral symptoms as early as 6 weeks of age, when compared with their peers.  A 2006 study found that children of mothers who had been successfully treated for depression were 11 percent less likely to be diagnosed with depression themselves.  Children whose mothers were not symptom-free were 8 percent more likely to be diagnosed.²

Although a mental health diagnosis in no way necessitates inadequacies in parenting, stressors undeniably impact the family system.  The threat of child abuse and neglect is by far the most severe risk to children of parents with mental health issues.  Mental illness can also negatively impact the family system by affecting parental employment, the quality of living situations, family relationships and resources, healthy interpersonal interactions, and child development.

Risk & Protective Factors

Discussions about the impact and outcome of parental mental illness involve “risk and protective factors” – characteristics of a child, family, or community that increase or decrease the likelihood of certain outcomes.

Risk Factors include:

• poverty
• parent does not receive treatment or receives ineffective treatment
• high severity of mental illness and high impact on the family system
• multiple family members affected by mental illness
• inadequate community and neighborhood supports
• lack of public awareness and available community resources
• “dual diagnosis,” the co-occurrence of substance abuse and mental health disorders

Protective Factors include:

• stable home environment
• knowledge that their parent(s) is ill and that they are not to blame
• help from outside of the family (e.g. marital psychotherapy or parenting classes)
• strong relationship with a healthy adult
• healthy interests and experiences outside of the home (e.g. at school or other activities)

Mental Health Issues

There are a spectrum of specific mental health issues that are more common among pregnant women, mothers and caregivers.  There are pregnancy-related issues that affect the emotional and physical health of the mother and baby in the perinatal period – these issues tend to be more acute in nature.  Secondly, there are caregiver-related issues that can occur at any point in the family timeline – these can be either acute or chronic.  Any of these issues can register in severity from a mild stressor to a severe family crisis.

Pregnancy-Related Issues

• The safe treatment of existing mental health disorders throughout pregnancy and breast-feeding.
• Psychiatric disorders that may develop during pregnancy (predominantly mood and anxiety disorders)
• Postpartum Psychiatric Disorders, including postpartum “blues,” postpartum depression (PPD), and postpartum psychosis
• Substance abuse during pregnancy, drug-exposed infants, and resulting child disorders and impairment
• Adjustment disorders relating to giving birth, adopting a child or becoming a foster parent.

Caregiver-Related Issues

• Untreated mental illness of a parent or caregiver
• Substance abuse of a parent or caregiver
• Stress on the caregiver, especially among single parents, grandparents as the primary caregiver, parents of special needs children, families in which one member has special health issues or medical needs, and parents in the “sandwich generation”  – those simultaneously caring for small children and for aging parents.

In St. Louis

Locally, there are nationally-ranked mental health treatment facilities and services available to individuals and families, but community-wide organization and targeted, strategic planning around the issue is limited.  While there are many organizations that deal with related issues (for example, general mental health, substance abuse, postpartum depression, family strengthening, or crisis intervention) fewer organizations specifically target mental health as it relates to pregnant mothers and caregivers.

Among local organizations that provide services and coordinate local activities around this issue Nurses for Newborns, and the Maternal, Child & Family Health Coalition are the most specifically targeted.  The local Children’s Divisions and court systems coordinate local services to children and families within the child welfare field.  The MO Dept. of Mental Health operates “CSTAR” programs (Comprehensive Substance Treatment and Rehabilitation programs) which are the only MO HealthNet (Medicaid) funded substance abuse treatment programs in MO.  East St. Louis, IL houses several behavioral health service organizations.  Although the metro area has many quality mental health treatment providers there is little incentive to accept Medicaid clients.

¹World Health Organization (WHO). (2010). Maternal Mental Health & Child Health and Development.

²Weissman MM, Pilowsky DJ, et al.  (2006). Remissions in Maternal Depression and Child Psychopathology: A STAR*D-Child Report.

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