Growing Up In Scotland: Maternal mental health and its impact on child behaviour and development

EXECUTIVE SUMMARY

Background

A mentally healthy childhood can be a precursor to a healthy and productive adulthood. Children's development can be affected by their socio-economic circumstances, but also by the emotional climate within the home, including the quality of relationships between a child's parents, the supports that are available to a family and by the health and well-being of the child's primary care-givers.

Longitudinal surveys afford a unique opportunity to study change over time for the same individuals and to explore the impact of prior circumstances on long-term outcomes. Using longitudinal data over four sweeps of the Growing Up in Scotland ( GUS) study, this report explores the impacts of poor maternal mental health on children's emotional, cognitive and behavioural development and on their relationships with peers at ages three to four.

Aims of the research

The overall aim of the research is to explore the impacts of poor maternal mental health on children's pre-school emotional, cognitive and behavioural development and considers:

• How many mothers in Scotland experience poor mental health in the first four years?
• What are the characteristics of these women?
• What are the longer-term impacts on child development and behaviour (at age 4) of a brief period of maternal emotional ill-health?
• What are the impacts on child development and behaviour of persistent (long-standing or repeated) exposure to maternal emotional ill-health?

Methods

This paper is based on data from natural mothers interviewed at the time of the first sweep of GUS undertaken in 2005/2006 when their baby was aged 10 months old and subsequently re-interviewed annually on three further occasions, until their children were almost four years old.

Maternal mental health was assessed at each interview and three categories of respondent were defined: those who were mentally well at each survey sweep; those who were classified as having poor mental health at one sweep only; and, finally, those mothers who were classified as having poor mental health at two or more survey sweeps. Child outcomes in relation to their emotional, behavioural and inter-personal relationships with peers were assessed at age 46 months, while cognitive development was assessed at 34 months. Standardised instruments were used throughout the survey.

We have used statistical techniques which allow us to look at the relationship between a mother's mental health and her child's development, but which control for other factors - such as the mother's age or marital status - which may affect both the mother's emotional health and the child's development.

Findings

The findings suggest that maternal mental health had a significant impact on their child's development by the age of four.

The incidence and prevalence of maternal mental health problems

• Almost a third of all of the GUS mothers interviewed experienced poor mental health at some point in the four years after the survey baby's birth
• At any one sweep, between 12 and 16% of the mothers was experiencing mental health difficulties
• One in 6 mothers had poor mental health recorded at one sweep only and 1 in 7 had poor mental well-being recorded on at least two occasions
• Poor mental health at the first sweep was a strong predictor of having poor mental health scores recorded at a subsequent sweep or sweeps: two-thirds (67%) who had poor mental health at Sweep 1 went on to have mental health problems at subsequent sweeps
• Mental health difficulties were associated with a mother's social circumstances: those who experienced poverty and those living in an area of deprivation were more likely to experience brief and repeated mental health problems
• Repeated mental health problems were additionally associated with reported relationship difficulties and with poor social support from friends, family or within the local community

Maternal mental health and child development outcomes

• Children's development was associated with a number of social factors, including maternal age and educational level, income, employment and family characteristics
• Maternal mental health was significantly associated with child development outcomes and there was evidence that the degree of a child's exposure to maternal mental
  ill-health affected child development outcomes
• Cognitive development at 34 months was not statistically associated with the mother's mental health
• Children whose mothers were emotionally well throughout the survey period had better social, behavioural and emotional development than those whose mothers had brief mental health problems and they, in turn, had better development than those whose mothers had repeated mental health problems
• The relationships between maternal mental health and children's social, emotional and behavioural development remained statistically significant, even after we took account of maternal family characteristics and socio-economic factors

Conclusions and implications

Maternal mental health is closely associated with socio-economic disadvantage and with deficits in relation to emotional and social support. Maternal mental health problems in the first year after a birth were often associated with further episodes of poor mental health and, to a large extent, predicted future difficulties. The Sweep 1 assessments took place when the survey baby was already 10 months old, beyond the immediate postnatal period often associated with maternal depression. By age four, children who experienced prolonged (repeated) exposure to a mother with mental health problems were particularly likely to have poor behavioural, emotional and social outcomes. At the point when they are about to start formal education, these early deficits may affect their transition to school and their subsequent development and attainment.

There were significant associations between brief exposure to maternal mental ill-health, but the outcomes for children were less marked than for those repeatedly exposed to a mother with mental health problems. This gradient in differences in outcome suggests that the impact of maternal mental health on children's development may be causal. It was not possible to explore how or why maternal mental health impacted on child outcomes, but we postulate that deficits in attachment may play a role by disrupting the mother-child relationship, inhibiting the nature and quality of their interactions.

Supporting mothers with mental health problems may have a direct impact on young children's development and well-being and could enhance children's early school experiences.