اثر محیط روانی در کودکانی که مادر مبتلا به اسکیزوفرنی دارند

The process of child׳s mental development depends heavily on the social interrelationship between the mother and her child. Schizophrenia in mothers potentially disrupts mother–infant relationship and adaptation to motherhood. Literature is limited on evaluating the emotional and behavioral problems of children of mother having schizophrenia with nearly none from the Indian subcontinent. The aim of the current study was to examine the effect of psychosocial environment in children of females with schizophrenia. Thirty children of mothers suffering with schizophrenia were evaluated with Child Behavior Checklist (CBCL) and Mini International Neuropsychiatric Interview for children and adolescents. The psychosocial environment was assessed using Parent Interview Schedule. Control group of 30 children were evaluated in the same way as the cases. The children of female patients with schizophrenia were found to score significantly higher on internalizing and externalizing behavioral problems on CBCL as compared to control group, along with significant differences in the psychosocial environment between the groups. We conclude that there is a need for screening and evaluation of children of mothers diagnosed with schizophrenia, for identifying and managing possible mental and behavioral problems in them, and to assess the psychosocial environment and provide interventions for issues related to it.

The process of child׳s mental development depends heavily on the social interrelationship between the mother and her child. Mothers are usually having a closer relationship to their children behaving as the more influential of the parent thus influencing majorly in this regard (Rothbaum and Weisz, 1994). Children devoid of such an inter-relationship because of diverse reasons are often at risk for development of emotional and behavioral problems (Vafaei and Seidy, 2003). Researchers have reported severe developmental retardation among those children who had been neglected and had not received proper attention and care (Kaplan and Sadock, 1998). Maternal mental illness is one such factor that may have potential deleterious effect on infant development. Vulnerability in such children may arise as a result of gene–environment interaction (Seeman, 2002). Literature associates maternal depression as a risk factor for development of childhood behavior problems with parenting and parent–child interaction playing major role (Cummings et al., 2005, Elgar et al., 2007, Foster et al., 2008 and Lunkenheimer et al., 2013). A poor child-rearing environment with low mother–child interaction has also been associated with maternal schizophrenia in various studies (Goodman, 1987, Niemi et al., 2003, Wan et al., 2008 and Gearing et al., 2012). Schizophrenia in mothers potentially disrupts mother–infant relationship and adaptation to motherhood. While positive symptoms lead to unwanted behaviors, negative symptoms tend to exert their influence through the absence of desirable behaviors. Besides the positive and negative symptoms of psychosis, women suffering from schizophrenia frequently experience problems of interpersonal, mood, cognitive, and behavior abnormalities that interfere with optimal parenting. The culminating parental discord, aggressive behavior, impaired maternal sensitivity and maladaptive bonding behavior adversely impact child rearing, compromising the value of family as an important component of a child׳s personality development (Reupert and Maybery, 2007). Performance deficits, low self esteem and severely debilitating social functioning further compounds the problem. A severe and long-standing illness in parent may increase the risk of psychological problems in their children (Willinger et al., 2002). The Stony Brook High Risk Study revealed greater marital discord and found the family environment to be unstable, disorganized and unpredictable in families with schizophrenia parent (Weintraub, 1987). Social isolation to the extent of minimal social contact was observed in 46% families consisting of women suffering from schizophrenia (Webster, 1992). Residential instability has been associated with patient׳s inability to care for their offspring (Caton et al., 1998). The Indian Council of Medical Research (ICMR) study revealed following psychosocial situations to be common in children with a psychiatric diagnosis; “living conditions that create a potentially hazardous psychosocial situation, physical abuse, parental mental disorder/deviance and intrafamilial discord” (Srinath et al., 2005). The Emory University Project reported that the overall environment provided by mothers with schizophrenia was poorest, consisting of less play stimulation, learning experiences, emotional and verbal involvement (Goodman, 1987). The possible protective factors in mothers identified in the project were of lesser severity of illness, older age, higher education, higher intelligence quotient, work experience, and the presence of spouse, boyfriend, or other relative to help in child care (Goodman, 1987). Several studies reported a kind of maladaptive bonding called “affectionless control” represented by less care and more overprotection in schizophrenic patients (Willinger et al., 2002). The disturbed family environment and poor parental emotional responses to children of affected parents spawn an increased risk of emotional and behavioral problems in such children. Literature is limited on evaluating the emotional and behavioral problems of children of mother having schizophrenia and nearly none from the Indian subcontinent. This study was carried out to explore for emotional and behavioral problems in such children in comparison with healthy controls from the community.

Families with schizophrenia need special concern in terms of focus on all members of the family. An assessment of the mother suffering from schizophrenia should also incorporate assessment of the children especially in terms of the nature and quality of their dyadic interactions as literature has shown that both nature and nurture play important roles in the genesis of mental disorders. There is a need for early detection of those mothers who are likely to have more disturbed relationship with their offspring, i.e. those with florid positive symptoms or those with prominent negative symptoms. Providers of mental health care should routinely gather information about the parental aspect of patients׳ lives and should intervene to ensure that offspring are adequately cared for during periods of crisis in the patients׳ illness. Integrated services also need to be positioned to take care of factors that are likely to influence mother–child interactions, like dysfunctional intrafamilial relationships. Also there is merit in screening and evaluation of the children of the mothers with schizophrenia for early identification and addressing of possible emotional and behavioral problems.