Antenatal caregiving representations among expectant mothers with severe mental illness: a cross-sectional study

ABSTRACT

Objective: The study explores predictors of antenatal caregiving representations among mothers with a history of severe mental illness (SMI).

Background: Attachment research has demonstrated that multifactorial assessment of antenatal caregiving representations predicts later maternal behaviour and child attachment. However, the field lacks research among clinical groups. Knowledge of factors influencing caregiving representations during pregnancy can contribute to our understanding of caregiving risk among SMI-mothers and inform intervention decisions.

Method: The current study is a cross-sectional subsample of the WARM study. Participants were 65 Danish or Scottish pregnant women with a history of either schizophrenia, bipolar disorder, moderate–severe depression, or non-clinical controls. Caregiving representations, adverse childhood experiences, social support and current symptom severity were assessed during pregnancy.

Results: Symptom severity was associated with more non-optimal caregiving representations expecting less parental enjoyment, more difficulties separating from the child, and more feelings of caregiving helplessness. Lack of social support and adverse childhood experiences served as independent predictors of caregiving representations. Parental mental illness during own childhood predicted role reversed expectations.

Conclusion: Antenatal caregiving representations can be assessed with a time-efficient self-report measure that assesses caregiving as a multidimensional construct. Prenatal treatment planning should target individual difficulties in undertaking transformation of the caregiving system.

KEYWORDS:

• Caregiving system
• expectant mothers
• severe mental illness (SMI)
• psychosis
• adverse childhood experiences (ACEs)

Acknowledgments

The authors would like to thank Jenna-Marie Lundy, Jacqueline McTaggart, Emilie Nayberg and Christopher Høier Trier for recruiting participants and collecting data to the study in both Scotland and Denmark.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

The WARM study has been approved by The Committees of Health Research Ethics in the Capital Region of Denmark (Protocol no: H-2-014-024) and by the West of Scotland Research Ethics Service and the NHS GG&C Board Approval (REC Reference 14/WS/1051) in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Funding

The WARM study received funding from the FKK Danish Council for Independent Research | Humanities (Grant Reference No: DFF – 1319–00103); Psychiatric Research Foundation in the Region of Southern Denmark; Health Foundation of Region Zealand, and was supported by NHS Research Scotland (NRS), through NHS Greater Glasgow & Clyde (NHSGG&C) and of the Scottish Mental Health Research Network (SMHRN).