One of the adverse factors that, even when no longer current, continues to exert effects on children, especially on internalising conditions such as anxiety and depression, is past parental psychiatric illness (Cohen et al 1990). Ongoing mental illness, however, seems likely to be more indirect in its consequences. That there are effects is not in dispute: three times as many children attending a Child Guidance Clinic w ith neurotic or behavioural problems as control children attending a dental clinic had a psychiatrically ill parent (Herbert 1974). Nevertheless, although an association has been uncovered between parental depression and depressive symptoms in
children, depressive mood in parents putting children at a significantly greater risk of psychiatric symptomatology (Bond and McMahon 1984), few specific outcomes have been found for other diagnostic categories, including
personality disorders (Quinton et al 1990). In an initial study looking at the effects on children of parents' psychiatric profiles, Rutter and Quinton (1984) concluded that, 'parental diagnosis carried little risk for children under 16 in the absence of famiiy discord and disruption" (italics added).
The italicised caveat probably explains discrepant findings in the area.
Parental mental illness is almost certain to bring in its wake a fair measure of disturbance in the home and, therefore, indirectly to lead to more vulnerable children. This supports the conclusion reached by Bond and McMahon, mentioned above, that anxious and depressed mothers find it more difficult to be adequate caretakers of their children and are also more likely to be maritally distressed. Forehand et al confirmed that mothers' depression occurs in parallel w ith perceptions of child maladjustment and w ith less-than-
optimal parenting. Depressed mothers issue more 'beta' commands - described by Forehand as 'vague or interrupted commands w ith which the child cannot comply' (Forehand et al 1986) - which, by definition, lead to greater noncompliance from the child and, thus, to parental perceptions of child oppositional behaviour^\
Even more likely to lead to domestic disruption is the observation that
psychiatric disorder in one parent tends to be associated w ith disorder in the other parent as well (Rutter and Quinton 1984)^®. The tw o most obvious explanations for this finding are 'assertive mating' - like marrying like - and 'contagion' theory which is the better supported by the evidence. As we have already seen, parental diagnoses are not specially 'contagious' for the children except in the case of major depression (op cit), but many more marriages fail or are disharmonious when mental illness is present in one or both partner and this certainly results in the sort of 'fam ily discord and disruption' that Rutter and Quinton identified as necessary for gross adverse effects on the children.
In looking for explanations for observed associations between psychiatric disorder in parents and that in their children, Rutter and Quinton reject not only theories of genetic transmission, but also that child disturbances occur as either a direct effect of the parents' pathology (children as targets for parental aggression or neglect) or as an indirect effect (such as the child being taken into care). They opt for the decisive rôle played by the correlates of mental disorder and, in particular, that of marital disharmony. This, they believe, accounts almost entirely for why children of psychiatric patients run a greater risk of being psychologically disturbed themselves than do other
These perceptions need not, logically, be distorted, Conrad and Hammen (1989) found depressed mothers perceived their child's behaviour more accurately than did non-depressed mothers. Clinical research on attributional styles also show depressed inferences to be well- grounded in reality (Alloy and Abraham 1979, Lewinsohn et al 1980).
Husbands of women patients have an excess of personality disorders; wives of male patients tend towards affective disorders. This is in agreement with epidemiological figures which consist ently report neurosis as a primarily female preserve while men have the greater share of personality disorders (Dohrenwend and Dohrenwend 1974).
children. Above all, there is an excess of conduct disorders, especially among boys, in this group. This may be an inevitable development from the
'noncompliance' noted by Forehand et al (1986). Rutter and Quinton reach this conclusion on the basis of their 'family adversity index'. The rate of child emotional and behavioural dysfunction (in the school setting, at least,) is directly proportional to the number of family adversity factors (psychiatric disorder, criminality, overcrowding, 4 or more children at home etc)
experienced. Children of psychiatric patients show no increase in disturbance once the family adversity factors have been controlled for. It is the
combination and accumulation of psychosocial difficulties that co-exist w ith psychiatric illness that cause difficulties for the child (Rutter and Quinton 1984).
Boys run a particularly increased risk of becoming disturbed if either parent, but especially the father, is hostile towards them as a result of mental illness (Rutter and Quinton 1984). Seventy-one per cent of boys had emotional and/or behavioural problems in the presence of paternal illness; the figure dropped to 40% if only the mother was affected and father remained well. These results appear to conflict w ith the work of Shepherd et al who found childhood problems to have a greater association w ith psychiatric illness in mother than in father (1971) but become more consistent when the
consequences for girls are added. For them, significant risk is only present when exposed to a high level of maternal hostility. 36% of girls showed disturbance when mother was herself disturbed and acting in a hostile manner; no girl was affected if only the father was disturbed provided that mother stayed relatively unimpaired.