Author
BLEGEN Nina E.; HUMMELVOLL Jan K.; SEVERINSSON Elisabeth
Mothers with mental health problems: a systematic review.
Journal citation/publication details
Nursing and Health Sciences, 12(4), December 2010, pp.519-528.
Summary
Three major themes were examined in the 19 studies included in the review: the vulnerability of mothers with mental health problems, fears of not being considered a good enough mother, and concern that the children might develop mental health problems. The tendency to view the mothers in medical terms rather than as women with their own voices is identified as a barrier to providing help and support to mothers with mental health problems. The need for further research on lived experiences and existential concerns of the mothers is stressed.
Context
The mental health of mothers is associated with the mental health of their children and is therefore an important public health issue. Research has found that many mothers with poor mental health live alone with their children and experience a range of social and financial difficulties. ‘The aim of this study was to create a synthesis of the previous research on mothers with MHPs (mental health problems) and the challenges they face’, and to identify gaps in the current knowledge base.
Methods
What sources were searched?
Electronic searches were carried out on EBSCOhost, Academic Search Premier, Science Direct, and ProQuest between January 1988 and April 2009. Relevant papers were hand searched for additional references.
What search terms/strategies were used?
The following keywords were combined: ‘experiences’, mental health’, ‘mental illness’, ‘mothering’, ‘mothers’, ‘women’ and ‘parenting’. Specific search strategies are not presented.
What criteria were used to decide on which studies to include?
Quantitative and qualitative studies on mothers with mental health problems and/or their children were eligible for inclusion. Studies focusing on parental mental illness and mental health problems in families were excluded.
Who decided on their relevance and quality?
Details of the selection process are not included and there is no indication that study quality was formally assessed.
How many studies were included and where were they from?
A total of 1,181 articles was identified from the search; 174 were screened in full nineteen of which were selected for inclusion. Twelve studies were from the USA, four were from the UK and there was one each from Australia, Canada, and Denmark.
How were the study findings combined?
The findings were synthesised according to the guidelines for conducting critical appraisals of quantitative and qualitative research by Burns and Grove, 2009. The results are presented according to the three themes that emerged: the vulnerability of mothers with MHPs; the fear of being perceived as not good enough as a mother, and; concern that the children might develop mental health problems.Findings of the review
Ten quantitative studies, seven qualitative studies and two studies using mixed-methods were included in the review. Sample size ranged from six in the smallest UK study to over two million in the Danish study. A range of diagnostic instruments and other measurement scales were used in the studies.
The vulnerability of mothers with MHPs
Vulnerability was linked to physical health, poverty, abuse and violence, problems related to pregnancy and childbirth, and experiences of separation and loss. Symptoms of mental illness and the effects of medication were reported to affect mothers’ ability to function effectively and in several studies competing demands were described as leading to additional stress. But, although some mothers reported parenting to be a burden, many indicated that their children provided an opportunity for personal growth and an incentive to get better.
Fear of being perceived as not good enough as a mother
The contradiction between the demands of mothering and the challenges of living with mental health problems was identified as a concern. Several studies identified a lack of understanding of the distress of mothers with mental health problems and the experience of being thought of as not being good enough mothers. Negative attitudes from professionals were reported in some studies and in one only half of the women interviewed mentioned a professional as a source of support on being a mother. Other problems included the feeling of being constantly monitored, and difficulty in managing their dual identity as a mother and a woman with a mental health problem.
Concern that the children might develop mental health problems
Studies examined a wide range of factors including the effect of symptoms of the mother’s psychiatric diagnoses, life situations, parenting styles, and societal attitudes that could present a risk to the children’s health and development.
Authors' conclusions
‘There has been a shift from studying the mothers’ clinical symptoms and medical diagnoses as individual problems to a broader context that also takes into consideration’ other economic, relationship, and environmental factors that impact on the mothers’ mental health. The challenges they faced ‘included being seen as an individual and as having an independent relationship with their children’.
Implications for policy or practice
None are discussed.