PDF herunterladen
Psychiatr Prax 2011; 38(1): 8-15
DOI: 10.1055/s-0030-1265976
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Hilfebedarfe von Eltern mit psychischen Erkrankungen – eine Literaturübersicht

The Needs of Mentally Ill Parents – A Review of the LiteratureLouise  M.  Howard1 , Helen  Underdown1
  • 1Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College London / United Kingdom
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
22. Dezember 2010 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Anliegen Bei etwa 10 % aller Frauen und 6 % aller Männer kommt es im Rahmen ihrer Elternschaft zu teilweise erheblichen psychischen Störungen. Zum Hilfebedarf psychisch kranker Eltern liegen vereinzelte Befunde vor. Methode Literaturübersicht. Ergebnisse/Fazit Psychisch kranke Frauen weisen sowohl hinsichtlich des peri- und postpartalen Verlaufs als auch in ihrer Elternrolle einen gesundheitlichen und sozialen Hilfe- und Unterstützungsbedarf auf. Psychisch kranke Väter benötigen Unterstützung in der Ausübung ihrer Elternrolle. Zu den Problemen zählen auch Stigmatisierung und die Angst vor Sorgerechtsverlust. Psychisch kranke Eltern können die Aufgaben einer Elternschaft häufig bewältigen, wenn geeignete Hilfen zur Verfügung stehen.

Abstract

Background Approximately 10 % of women and 6 % of men who become parents will experience mental health problems and a significant proportion of these have a severe psychiatric illness. PurposeThis paper provides a literature review of the needs of parents with severe mental illness. Methods Literature review. Results Mothers with severe mental illness have a wide range of complex health and social care needs in addition to their parenting needs, which must be addressed by services in pregnancy and postpartum to optimise outcomes. There is limited evidence on the needs of fathers with severe mental illness but they may have a greater number of needs than women, and a greater need for training in parenting skills than women suffering from severe mental illness. Parents with severe mental illness may experience stigma and discrimination, and fear accessing services due to fears of losing custody of their child. Conclusions Although a significant proportion of parents with severe mental illness do lose custody, many can successfully parent if adequate support is available and needs are assessed and managed by a multi-disciplinary team.

Schlüsselwörter

psychotische Störungen - Schizophrenie - Eltern - Mütter - Väter

Keywords

psychotic disorder - schizophrenia - parents - mothers - fathers

Literatur

  • 1 Parker G, Beresford B, Clarke S. et al .Research Reviews on Prevalence, Detection and Interventions in Parental Mental Health and Child Welfare: summary report. University of York: Social Policy Research Unit; 2009
    Google Scholar
  • 2 Howard L M, Kumar R, Thornicroft G. Psychosocial characteristics and needs of mothers with psychotic disorders.  Br J Psychiatry. 2001;  178 427-432
    CrossrefPubMedGoogle Scholar
  • 3 McGrath J, Hearle J, Jenner L. et al . The fertility and fecundity of patients with psychoses.  Acta Psychiatr Scand. 1999;  99 441-446
    CrossrefPubMedGoogle Scholar
  • 4 Department of Health .Mental Health National Service Framework. TSO (The Stationary Office); 1999
    Google Scholar
  • 5 World Health Organization .The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: WHO; 1993
    Google Scholar
  • 6 Maslow A. Motivation and Personality, Third Edition. New York: Harper and Row; 1987
    Google Scholar
  • 7 Slade M, Glover G. The needs of people with mental disorders.. In: Thornicroft G, Szmukler G, eds Textbook of Community Psychiatry.. Oxford: Oxford University Press; 2001: 117-127
    Google Scholar
  • 8 Bradshaw J. A taxonomy of social need.. In: McLaughlan J, eds Problem and Progress in Medical Care: Essays on Current Research.. Oxford: Oxford University Press; 1972: 69-82
    Google Scholar
  • 9 Howard L M, Leese M, Kumar C. et al . The general fertility rate in women with psychotic disorders.  Am J Psychiatry. 2002;  159 991-997
    CrossrefPubMedGoogle Scholar
  • 10 Laursen T M, Munk-Olsen T. Reproductive patterns in psychotic patients.  Schizophr Res. 2010;  121 234-240
    CrossrefPubMedGoogle Scholar
  • 11 Howard L M. Fertility and pregnancy in women with psychotic disorders.  Eur J Obstet Gynecol Reprod Biol. 2005;  119 3-10
    CrossrefPubMedGoogle Scholar
  • 12 Miller L, Finnerty M. Sexuality, pregnancy, and childbearing among women with schizophrenia-spectrum disorders.  Psychiatr Serv. 1996;  47 502-505
    PubMedGoogle Scholar
  • 13 Mowbray C, Oyserman D, Zemencuk J. et al . Motherhood for women with serious mental illness.  Am J Orthopsychiatry. 1995;  65 21-38
    CrossrefPubMedGoogle Scholar
  • 14 Howard L M, Goss C, Leese M. et al . The medical outcome of pregnancy in women with psychotic disorders and their infants after birth.  Br J Psychiatry. 2003;  182 63-67
    CrossrefPubMedGoogle Scholar
  • 15 Rudolph B, Larson G, Sweeney S. et al . Hospitalized pregnant women: characteristics and treatment issues.  Hosp Community Psychiatry. 1990;  41 159-163
    PubMedGoogle Scholar
  • 16 Coverdale J, Aruffo J. Family planning needs of female chronic psychiatric patients.  Am J Psychiatry. 1989;  146 1489-1491
    PubMedGoogle Scholar
  • 17 National Institute for Health and Clinical Excellence .Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance. Leicester: The British Psychological Society and London:. London: The Royal College of Psychiatrists; 2007
    Google Scholar
  • 18 Goodman S, Emory E. Perinatal complications in births to low socio-economic status schizophrenic and depressed women.  J Abnorm Psychol. 1992;  101 225-229
    CrossrefPubMedGoogle Scholar
  • 19 Kelly R, Danielsen B, Zatrick D. et al . Chart-recorded psychiatric diagnoses in women giving birth in California in 1992.  Am J Psychiatry. 1999;  156 955-957
    PubMedGoogle Scholar
  • 20 Alder J, Fink N, Bitzer J. et al . Depression and anxiety during pregnancy: a risk factor for obstetric, foetal and neonatal outcome? A critical review of the literature.  J Matern Fetal Neonatal Med. 2007;  20 189-209
    CrossrefPubMedGoogle Scholar
  • 21 Bennedsen R, Mortensen P, Olsen A. Preterm birth and intra-uterine growth retardation among children of women with schizophrenia.  Br J Psychiatry. 1999;  175 239-245
    CrossrefPubMedGoogle Scholar
  • 22 Bennedsen B, Mortensen P, Olsen A. et al . Congenital malformations, stillbirths and infant deaths among children of women with schizophrenia.  Arch Gen Psychiatry. 2001;  58 674-679
    CrossrefPubMedGoogle Scholar
  • 23 Jablensky A, Morgan V, Zubrick S. et al . Pregnancy, delivery and neonatal complications in a population cohort of women with schizophrenia and major affective disorders.  Am J Psychiatry. 2005;  162 79-91
    CrossrefPubMedGoogle Scholar
  • 24 Webb R, Abel K, Pickles A. et al . Mortality in offspring in parents with psychotic disorders: a critical review and meta-analysis.  Am J Psychiatry. 2005;  162 1045-1056
    CrossrefPubMedGoogle Scholar
  • 25 Webb R, Abel K, Pickles A. et al . Mortality risk among offspring of psychiatric inpatients: a population based follow-up to early adulthood.  Am J Psychiatry. 2006;  163 2170-2177
    CrossrefPubMedGoogle Scholar
  • 26 Webb R T, Wicks S, Dalman C. et al . Influence of environmental factors in higher risk of sudden infant death syndrome linked with parental mental illness.  Arch Gen Psychiatry. 2010;  67 69-77
    CrossrefPubMedGoogle Scholar
  • 27 Howard L M, Hannam S. Sudden Infant Death Syndrome and Psychiatric Disorders.  Br J Psychiatry. 2003;  182 379-380
    CrossrefPubMedGoogle Scholar
  • 28 McCreadie R G, Kelly C, Connolly M. et al . Dietary improvement in people with schizophrenia: randomised controlled trial.  Br J Psychiatry. 2005;  187 346-351
    CrossrefPubMedGoogle Scholar
  • 29 Luppino F, de Wit L, Bouvy P. et al . Overweight, Obesity, and Depression: A Systematic Review and Meta-analysis of Longitudinal Studies.  Arch Gen Psychiatry. 2010;  67 220-229
    Google Scholar
  • 30 Shah N, Howard L. Screening for smoking and substance misuse in pregnant women with mental illness.  Psychiatr Bull R Coll Psychiatr. 2006;  30 294-297
    CrossrefPubMedGoogle Scholar
  • 31 Lo W Y, Friedman J M. Teratogenicity of recently introduced medications in human pregnancy.  Obstet Gynecol. 2002;  100 465-473
    CrossrefPubMedGoogle Scholar
  • 32 Cohen L, Rosenbaum J. Psychotropic drug use during pregnancy: weighing the risks.  J Clin Psychiatry. 1998;  59 18-28
    PubMedGoogle Scholar
  • 33 Howard L, O’Keane V. The needs of women with mental health problems during pregnancy and the postnatal period.. In: Howard L, Hunt K, Slade M, O’Keane V, Seneviratne T, Leese M, Thornicroft G, Wiseman M CAN-M: Camberwell Assessment of Need for Mothers.. London: The Royal College of Psychiatrists; 2008: 8-13
    Google Scholar
  • 34 Austin M P, Kildea S, Sullivan E. Maternal mortality and psychiatric morbidity in the perinatal period: challenges and opportunities for prevention in the Australian setting.  Med J Austr. 2007;  186 364-367
    PubMedGoogle Scholar
  • 35 Lewis G. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer – 2003–2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH; 2007
    Google Scholar
  • 36 Meador K, Reynolds M W, Crean S. et al . Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts.  Epilepsy Res. 2008;  81 1-13
    CrossrefPubMedGoogle Scholar
  • 37 Meador K J, Baker G A, Browning N. et al . NEAD Study Group Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs.  N Engl J Med. 2009;  360 1597-1605
    CrossrefPubMedGoogle Scholar
  • 38 Webb R T, Howard L, Abel K M. Antipsychotic drugs for non-affective psychosis during pregnancy and postpartum.  Cochr Data Syst Rev. 2004;  (2) CD004411
    PubMedGoogle Scholar
  • 39 Altshuler L L, Cohen L, Szuba M P. et al . Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines.  Am J Psychiatry. 1996;  153 592-606
    CrossrefPubMedGoogle Scholar
  • 40 Reis M, Källén B. Maternal use of antipsychotics in early pregnancy and delivery outcome.  J Clin Psychopharmacol. 2008;  28 279-288
    CrossrefPubMedGoogle Scholar
  • 41 Howard L, Webb R, Abel K. Safety of antipsychotic drugs for pregnant and breastfeeding women with non-affective psychosis.  BMJ. 2004;  329 933-934
    CrossrefPubMedGoogle Scholar
  • 42 Friedman S H, Loue S. Incidence and prevalence of intimate partner violence by and against women with severe mental illness.  J Womens Health. 2007;  16 471-480
    CrossrefPubMedGoogle Scholar
  • 43 Howard L, Trevillion K, Khalifeh H. et al . Domestic violence and severe psychiatric disorders: prevalence and interventions.  Psychol Med. 2010;  40 881-893
    CrossrefPubMedGoogle Scholar
  • 44 Gazmararian J, Lazorick S, Spitz A. et al . Prevalence of violence against pregnant women.  JAMA. 1996;  275 1915-1920
    CrossrefPubMedGoogle Scholar
  • 45 Golding M J. Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-Analysis.  J Fam Violence. 1999;  14 99-132
    CrossrefPubMedGoogle Scholar
  • 46 Neria Y, Bromet E J, Carlson G A. et al . Assaultive trauma and illness course in psychotic bipolar disorder: findings from the Suffolk county mental health project.  Acta Psychiatr Scand. 2005;  111 380-383
    CrossrefPubMedGoogle Scholar
  • 47 Department of Health .Refocusing the Care Programme Approach: Policy and Positive Practice Guidance. March 2008 Retrieved on Nov 3rd 2010 from http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_083649.pdf
    Google Scholar
  • 48 Hegarty K, Taft A, Feder G. Violence between intimate partners: working with the whole family.  BMJ. 2008;  337 DOI: 10.1136/bmj.a839
    PubMedGoogle Scholar
  • 49 Cantwell R, Cox J L. Psychiatric disorders in pregnancy and the puerperium.  Curr Obst Gyn. 2006;  16 14-20
    PubMedGoogle Scholar
  • 50 Solari H, Dickson K, Miller L. Understanding and Treating Women with Schizophrenia during pregnancy and Postpartum.  Can J Clin Pharmacol. 2009;  16 23-32
    PubMedGoogle Scholar
  • 51 Miller L J. Psychotic denial of pregnancy: phenomenology and clinical management.  Hosp Comm Psychiatr. 1990;  41 1233-1237
    PubMedGoogle Scholar
  • 52 Apfel R, Handel H. Madness and Loss of Motherhood. Sexuality, Reproduction and Long-Term Mental illness. Washington: American Psychiatric Press; 1993
    Google Scholar
  • 53 Howard L M, Goss C, Leese M. et al . The Psychosocial outcome of pregnancy in women with psychotic disorders.  Schizophr Res. 2004;  71 49-60
    CrossrefPubMedGoogle Scholar
  • 54 Krumm S, Becker T. Subjective views of motherhood in women with mental illness – a sociological perspective.  J Ment Health. 2006;  15 449-460
    CrossrefPubMedGoogle Scholar
  • 55 White C, Nicholson J, Fisher W. et al . Mothers with severe mental illness caring for children.  J Nerv Ment Dis. 1995;  183 398-403
    PubMedGoogle Scholar
  • 56 Hollingsworth L D. Child Custody Loss among Women with Persistent Severe Mental Illness.  Soc Work Res. 2004;  28 199-209
    CrossrefPubMedGoogle Scholar
  • 57 Kumar R, Marks M, Platz C. et al . Clinical survey of a psychiatric mother and baby unit: characteristics of 100 consecutive admissions.  J Affect Disord. 1995;  33 11-22
    CrossrefPubMedGoogle Scholar
  • 58 Howard L M, Thornicroft G, Salmon M. et al . Predictors of parenting outcome in women with psychotic disorders discharged from mother and baby units.  Acta Psychiatr Scand. 2004;  110 347-355
    CrossrefPubMedGoogle Scholar
  • 59 Cuyahoga County Department of Child and Family Services .Disproportionality and what the data tells us. Ohio; 2004 Retrieved on November 1st 2010 from http://cfs.cuyahogacounty.us/pdf_cfs/en-US/disproportionality.pdf
    Google Scholar
  • 60 Park J, Solomon P, Mandell D. Involvement in the child welfare system among mothers with serious mental illness.  Psychiatr Serv. 2006;  57 493-497
    CrossrefPubMedGoogle Scholar
  • 61 Brockington I. Motherhood and Mental Health. Oxford: Oxford University Press; 1996
    Google Scholar
  • 62 Diaz-Caneja A, Johnson S. The views and experiences of severely mentally ill mothers – a qualitative study.  Soc Psychiatry Psychiatr Epidemiol. 2004;  39 472-482
    PubMedGoogle Scholar
  • 63 Thornicroft G. Shunned. Discrimination against people with mental illness. Oxford: Oxford University Press; 2006
    Google Scholar
  • 64 Ackerson B J. Coping with the dual demands of severe mental illness and parenting: the Parent’s perspective.  Fam Soc. 2003;  84 109-118
    PubMedGoogle Scholar
  • 65 Nicholson J, Sweeney E M, Geller J L. Mothers with mental illness: The competing demands of parenting and living with mental illness.  Psychiatr Serv. 1998;  49 635-642
    PubMedGoogle Scholar
  • 66 Nicholson J, Sweeney E M, Geller J L. Mothers with mental illness: II. Family relationships and the context of parenting.  Psychiatr Serv. 1998;  49 643-649
    PubMedGoogle Scholar
  • 67 Nicholson J, Geller J L, Fisher W H. „Sylvia Frumkin” has a baby: a case study for policymakers.  Psychiatr Serv. 1996;  47 497-501
    PubMedGoogle Scholar
  • 68 Göpfert M, Webster J, Seeman M. et al .Parental Psychiatric Disorder, Distressed Parents and their Families: Second Edition. Cambridge: Cambridge University Press; 2004
    Google Scholar
  • 69 Department of Health .Women’s Mental Health: Into the Mainstream: Strategic Development of Mental Health Care for Women. 2002
    Google Scholar
  • 70 Department of Health .Mainstreaming Gender and Women’s Mental Health: Implementation Guidance. 2003
    Google Scholar
  • 71 Kahng S K, Oyserman D, Bybee D. et al . Mothers with serious mental illness: when symptoms decline does parenting improve?.  J Fam Psychol. 2008;  22 162-166
    CrossrefPubMedGoogle Scholar
  • 72 Howard L, Hunt K, Slade M. et al . Assessing the needs of pregnant women and mothers with severe mental illness: the psychometric properties of the Camberwell Assessment of Need – Mothers (CAN-M).  Int J Methods Psychiatr Res. 2007;  16 177-185
    CrossrefPubMedGoogle Scholar
  • 73 Howard L M, Hunt K. The needs of mothers with severe mental illness: a comparison of assessments of needs by staff and patients.  Arch Womens Ment Health. 2008;  11 131-136
    CrossrefPubMedGoogle Scholar
  • 74 Munk-Olsen T, Laursen T M, Pedersen C B. et al . New parents and mental disorders: a population-based register study.  JAMA. 2006;  296 2582-2589
    CrossrefPubMedGoogle Scholar
  • 75 Joy C B, Saylan M. Mother and baby units for schizophrenia.  Cochr Data Syst Rev. 2007;  (1) CD006333
    PubMedGoogle Scholar
  • 76 Elkin A, Gilburt H, Slade M. et al . A National Survey of Psychiatric Mother and Baby Units in England.  Psych Serv. 2009;  60 629-633
    CrossrefPubMedGoogle Scholar
  • 77 Howard L M, Flach C, Leese M. et al . The effectiveness and cost effectiveness of admissions to women’s crisis houses compared with traditional psychiatric wards – a pilot patient preference randomized controlled trial.  Br J Psychiatry. 2010;  197 s32-s40 DOI: 10.1192/bjp.bp.110.081083
    CrossrefPubMedGoogle Scholar
  • 78 Bassett H, Lampe J, Lloyd C. Parenting: experiences and feelings of parents with mental illness.  J Ment Health. 1999;  8 597-604
    CrossrefPubMedGoogle Scholar
  • 79 Khalifeh H, Murgatroyd C, Freeman M. et al . Home Treatment as an alternative to Hospital Admission for Mothers in a Mental Health Crisis: A Qualitative Study.  Psychiatr Serv. 2009;  60 634-639
    CrossrefPubMedGoogle Scholar
  • 80 Riordan D, Appleby L, Faragher B. Mother-infant interaction in post-partum women with schizophrenia and affective disorders.  Psychol Med. 1999;  29 991-995
    Google Scholar
  • 81 Wan M W, Salmon M, Riordan D. et al . What predicts poor mother-infant interaction in schizophrenia?.  Psychol Med. 2007;  37 537-546
    CrossrefPubMedGoogle Scholar
  • 82 Wan M W, Moulton S, Abel K. The service needs of mothers with schizophrenia: a qualitative study of perinatal psychiatric and anetenal workers.  Gen Hosp Psychiatry. 2008;  30 177-184
    CrossrefPubMedGoogle Scholar
  • 83 Pawlby S, Fernyhough C, Meins E. et al . Mind-mindedness and maternal responsiveness in infant-mother interactions in mothers with severe mental illness.  Psychol Med. 2010;  40 1861-1869
    CrossrefPubMedGoogle Scholar
  • 84 Savvidou I, Bozikas V P, Hatzigeleki S. et al . Narratives about their children by mothers hospitalized on a psychiatric unit.  Fam Process. 2003;  42 391-402
    CrossrefPubMedGoogle Scholar
  • 85 Sommer R, Zoller P, Felder W. Elternschaft und psychiatrische Hospitalisation.  Prax Kinderpsychol Kinderpsychiat. 2001;  50 498-512
    PubMedGoogle Scholar
  • 86 Streeruwitz A, Iversen A C, Woodall A. et al .Service needs of mothers while they are inpatients in acute psychiatric units. Annual Meeting. London: Royal College of Psychiatrists Faculty of General and Community Psychiatry; 2010
    Google Scholar
  • 87 Brunette M, Dean W. Community Mental Health Care for Women with Severe Mental Illness Who Are Parents.  Comm Ment Health J. 2002;  38 153-165
    CrossrefPubMedGoogle Scholar
  • 88 Nicholson J, Biebel K. Commentary on „Community Mental Health Care for Women with Severe Mental Illness Who Are Parents” – The Tragedy of Missed Opportunities: What Providers Can Do.  Comm Ment Health J. 2002;  38 167-172
    CrossrefPubMedGoogle Scholar
  • 89 Irving C B, Saylan M. Mother and baby units for schizophrenia.  Cochr Data Syst Rev. 2007;  (1) CD006333 DOI: 10.1002 / 14 651 858.CD006333
    PubMedGoogle Scholar
  • 90 Shinkwin L, Thompson P eds. Quality Network for Perinatal Mental Health Services: Standards for Mother and Baby Inpatient units. Second Edition. The Royal College of Psychiatrists; 2008 http://www.rcpsych.ac.uk/perinatal-network
    Google Scholar
  • 91 Singh S, Paul M, Ford T. et al . Process, outcome and experience of transition from child and adult mental healthcare: multiperspective study.  Br J Psychiatry. 2010;  197 305-312
    CrossrefPubMedGoogle Scholar
  • 92 Grube M, Dorn A. Parenthood and mental illness.  Psychiat Prax. 2007;  34 66-71
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 93 Coverdale J, Schotte D, Ruiz P. et al . Family Planning Needs of Male Chronic Mental Patients in the General Hospital Psychiatry Clinic.  Gen Hosp Psychiatry. 1994;  16 38-41
    CrossrefPubMedGoogle Scholar
  • 94 Nicholson J, Nason M W, Calabresi A O. et al . Fathers with severe mental illness: characteristics and comparisons.  Am J Orthopsychiatry. 1999;  69 134-141
    CrossrefPubMedGoogle Scholar
  • 95 Thornicroft G, Leese M, Tansella M. et al . Gender differences in living with schizophrenia: A cross-sectional European multi-site study.  Schizophr Res. 2002;  57 191-200
    CrossrefPubMedGoogle Scholar
  • 96 Jungbauer J, Stelling K, Kuhn J. et al . Wie erleben schizophren erkrankte Mütter und Väter ihre Elternschaft? Ergebnisse einer qualitativen Interviewstudie.  Psychiat Prax. 2010;  37 233-239
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 97 Borbé R, Flammer E, Borbé S. et al . Sozialpsychiatrische Forschung – Entwicklung über die letzten 10 Jahre im Spiegel deutschsprachiger Zeitschriften.  Psychiat Prax. 2009;  2 362-367
    PubMedGoogle Scholar

Prof. Louise M. Howard

Professor in Women's Mental Health & Head of Section of Women's Mental Health, Honorary Consultant Psychiatrist, Health Service and Population Research Department, PO31 Institute of Psychiatry, King's College London

De Crespigny Park

SE5 8AF London, United Kingdom

eMail: louise.howard@kcl.ac.uk