Rob Senior

The offspring of mothers with eating disorders

Abstract. There is good evidence that children of parents with psychiatric disorders are at increased risk of disturbances in their development. There is considerable research on disorders such as depression and alcohol abuse, but research on the children of parents with eating disorders has only recently emerged. This paper reviews evidence in a number of domains, including genetic factors; pregnancy; the perinatal and postpartum period; followed by infancy, and the early years, focusing on feeding and mealtimes, general parenting functions and growth. Psychopathology in the children, parental attitudes to childrens weight and shape, and adolescence are then considered.While numerous case reports and series have been published, there are very few systematic controlled studies, and virtually no reports of the influence of fathers with eating disorders or the male partners of mothers with eating disorders. The available evidence suggests that children of mothers with eating disorders are themselves at increased risk of disturbance in a variety of domains. This risk depends on a range of factors, and it should be noted that difficulties in the offspring of mothers with an eating disorder are far from invariable. Finally, based on current evidence, five types of mechanisms by which eating disturbance in parents can influence child development are summarised.

A Comparison of Father and Mother Report of Child Behaviour on the Strengths and Difficulties Questionnaire

To date there has been no comparison of father and mother report on the Strengths and Difficulties Questionnaire (SDQ), a standardised measure of child behaviour used widely in the UK in clinical practice and research. The objectives of the study were to investigate differences and agreement between parents on the various SDQ domains of child behaviour. Parents of 4–6 years olds were recruited via 13 UK general practices, and completed the SDQ and measures on depression, parenting, couple relationship, alcohol use and demographics. Parental SDQ ratings were compared. The SDQ was completed by 248 parent dyads. Mother and father ratings were correlated, however fathers reported higher mean scores than mothers for externalising behaviours. Higher reporting by fathers was related to alcohol misuse, the couple relationship, fathering, and father employment. Fathers did not report significantly more abnormal behaviours than mothers except for hyperactivity. There was high interparental agreement on normal/borderline behaviours (94.8–98.3% agreement), but lower agreement on abnormal behaviours (7.7–37.9%). There was higher interparental agreement on male rather than female children, but fathers were four times more likely to report hyperactivity among their boys compared with girls. Using combined parental reports in clinical settings would enhance the sensitivity of identifying children requiring clinical attention for their problem behaviours.

Associations between paternal depression and behaviour problems in children of 4–6 years

Maternal depression is associated with adverse child development, however little is known about paternal depression and child outcome. The aim of this study was to estimate the prevalence of paternal depression and assess its association with abnormal child behaviours among 4–6 year olds. Parents of 4–6 years olds were recruited via general practices and completed measures on child behaviour (Strengths and Difficulties Questionnaire), depression (Patient Health Questionnaire), and other covariates. The association of major and other paternal depressive syndrome with mother reported child behaviour was analysed. Eight percent (29/365) of fathers had depression (3.3 and 4.77% a major and other depressive syndrome, respectively). Major but not other paternal depressive syndrome was associated with an 8 and 36 times greater likelihood of child prosocial behaviour problems and peer problems respectively.

The utility of volunteer home‐visiting support to prevent maternal depression in the first year of life

BACKGROUND Maternal depression can be detrimental to infant development. Structured home visiting initiated either in pregnancy or soon after the birth by a professional has led to better outcomes for mothers and their children but some vulnerable families may respond more favourably to a local volunteer. The value of volunteer support provided in the UK by Home-Start for maternal well-being is noted in qualitative studies, but there is no evidence of its impact from trials. The support is not structured and both the frequency and content of visits may vary. METHODS A cluster randomized study allocated Home-Start local schemes to intervention or control conditions. Mothers in all areas were screened at routine health checks in late pregnancy. In intervention areas names of those scoring 9+ on the Social Disadvantage Screening Index were passed to Home-Start to be offered a volunteer. Not all those offered the support accepted the offer. In control areas no support was offered. Research assessments were conducted at 2 and 12 months. The outcomes were major or minor depression occurring between 2 and 12 months (Structured Clinical Interview for Diagnostic and Statistical Manual - Third Edition - Revised) and depression symptoms at 12 months (Edinburgh Postnatal Depression Scale). Three groups were compared: supported, case-matched controls and those offered but not receiving support. RESULTS Almost one-third experienced depression during the time period. Volunteer support had no identifiable impact on the emergence of maternal depression from 2 to 12 months or on depression symptoms when infants were 12 months. The major predictor of both was depression identified at 2 months. CONCLUSIONS It was not found that informal support initiated following screening for disadvantage in pregnancy reduced the likelihood of depression for mothers with infants.

The Association of Paternal Mood and Infant Temperament: A Pilot Study.

Maternal depression is associated with adverse child development, but little is known about the effects of paternal depression. This pilot study estimated the prevalence of paternal depression and mood state, and assessed the relationship between paternal mood and infant temperament. The participants in the study were 98 fathers of newborn babies. Fathers were initially screened for depressed mood (Hospital anxiety and depression scale, and Edinburgh postnatal depression scale), and at 6 months parental mood, infant temperament, couple relationship quality, alcohol use, adverse life events, parenting, and demographics were recorded. Infant fussiness was analysed in relation to paternal mood and other contextual factors using multiple regression. Of the 98 fathers, 48 (49%) completed depression-screening measures. Of these 48 fathers, 4 (8%) reported depressive symptoms above the cut-off for case definition. A total of 48% (N=19) completed measures at follow-up. In the adjusted model, higher paternal depression scores, more traditional attitudes towards fathering, and increased recent life events were related to higher infant fussiness scores; and better couple relationship quality was related to lower fussiness scores. This study showed that 1 in 12 fathers had depressed mood, and lower mood was associated with negative infant temperament. Since the findings of this feasibility study were based on a small sample size the association of paternal mood and child development merits further study using a larger sample of fathers.

The impact on parenting and the home environment of early support to mothers with new babies

The study reported here aimed to evaluate the impact on parenting and the home environment of community volunteer home visiting offered during or soon after pregnancy to potentially vulnerable mothers. A cluster‐randomised study allocated Home‐Start schemes to intervention or comparison (existing services) conditions. Mothers were screened at routine health checks. Families in intervention and comparison areas were assessed at two and 12 months. The results showed that comparing families receiving support and those in comparison areas, there were few differences. There was a greater reduction in parent‐child relationship difficulties for supported families, but they offered their children fewer healthy foods. There was no evidence of enhanced parenting, organisation of the home environment or more appropriate use of health services. Comparing families receiving support with a second comparison group, living in intervention areas but not receiving support, no differences were found. The article concludes that a more structured approach may be required to make changes in parenting behaviour and the home environment.

Major paternal depression and child consultation for developmental and behavioural problems

BACKGROUND It is well established that maternal depression is associated with enhanced child consultation for developmental and behaviour problems, but there is a dearth of research on paternal depression and child outcome. AIM To assess the association of major paternal depressed mood and child consultation for developmental and behaviour problems. DESIGN OF STUDY Cross-sectional study. SETTING General practices in London and Hertfordshire, UK. METHOD Fathers of children aged 4-6 years were recruited via 13 general practices. A sample of 248 biological father and mother dyads completed measures on depressive syndrome (Patient Health Questionnaire), child consultations with health professionals for developmental and behaviour problems, fathering, couple relationship quality, alcohol misuse, other psychiatric impairment, and sociodemographic factors. RESULTS Eight out of 248 fathers (3%) had a major depressive syndrome. Sixty-five out of 247 (26%) fathers reported they were responsible for taking their child to see the doctor at least half the time compared with mothers. Children of fathers with a major depressive syndrome were almost nine times more likely to have consulted a health professional for speech and language problems (adjusted odds ratio [OR] = 8.67, 95% confidence interval [CI] = 1.99 to 37.67, P = 0.004) and seven times more likely to have consulted for externalising behaviour problems (adjusted OR = 6.98, 95% CI = 1.00 to 48.76, P = 0.05). CONCLUSION Children of fathers with major depression were more likely to consult for speech and language problems and externalising behaviour problems. A longitudinal study is recommended to identify causal mechanisms.