产妇精神疾病与受虐儿童的安全和稳定。
Maternal mental illness and the safety and stability of maltreated children.
机构信息
Brown Center for Injury and Violence Prevention, George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA.
出版信息
Child Abuse Negl. 2011 May;35(5):309-18. doi: 10.1016/j.chiabu.2011.01.006.
OBJECTIVE
Children of mothers with mental illness are at risk for multiple untoward outcomes, including child maltreatment and foster care placement. The purpose of this analysis was to determine the association between maternal mental illness and children's long term safety and stability.
METHODS
A multi-sector administrative dataset from the Department of Social Services (DSS) and Department of Mental Health (DMH) was analyzed. The sample was 4,895 low income families (mother and child dyads) first reported to child welfare in 1993 or 1994. Families were followed until March of 2009. Dates of new report and foster care placement were obtained from DSS data. ICD-09 or ICD-10 diagnostic codes were obtained from Department of Mental Health data. Schizophrenic disorders, episodic mood disorders, anxiety disorders and personality disorders were examined.
RESULTS
New reports were more likely for children of mothers with mental illness, regardless of diagnosis. While overall 67% of children had a new report over the course of their childhood, rates ranged from 80 to 90% for children of mothers with mental illness and occurred within a shorter time frame than for other children. In the multivariate models, mood (HR=1.41, p<.001) and anxiety disorders (HR=1.32, p<.05) placed children at greater risk for new reports. The proportion of children with foster placements was more than double for children of mothers with mental illness than for other children. In the multivariate model, anxiety disorders were strongly associated with the risk of placement (HR=1.75, p<.001).
CONCLUSIONS AND PRACTICE IMPLICATIONS
Important differences in safety and stability were found between children of mothers with and without mental illnesses, as well as some variability across diagnoses. Since these mothers had already received services our findings suggest that access is not enough. The services they are receiving or have received may be an ineffective approach to helping them parent safely.
目的
患有精神疾病的母亲的孩子面临多种不良后果的风险，包括儿童虐待和寄养安置。本分析的目的是确定母亲的精神疾病与儿童长期安全和稳定之间的关联。
方法
分析了来自社会服务部（DSS）和心理健康部（DMH）的多部门行政数据集。该样本包括 1993 年或 1994 年首次向儿童福利机构报告的 4895 个低收入家庭（母亲和孩子对子）。家庭一直随访到 2009 年 3 月。从 DSS 数据中获得新报告和寄养安置的日期。从心理健康部的数据中获得 ICD-09 或 ICD-10 诊断代码。检查了精神分裂症、发作性情绪障碍、焦虑障碍和人格障碍。
结果
患有精神疾病的母亲的孩子更有可能出现新的报告，无论诊断如何。虽然总体上 67%的儿童在其童年期间有新的报告，但患有精神疾病母亲的孩子的比例从 80%到 90%不等，并且发生的时间框架比其他儿童更短。在多变量模型中，情绪障碍（HR=1.41，p<.001）和焦虑障碍（HR=1.32，p<.05）使儿童面临新报告的风险增加。患有精神疾病母亲的孩子被安置在寄养家庭的比例是其他孩子的两倍多。在多变量模型中，焦虑障碍与安置风险密切相关（HR=1.75，p<.001）。
结论和实践意义
患有和不患有精神疾病的母亲的孩子在安全性和稳定性方面存在显著差异，并且在各种诊断之间存在一定的差异。由于这些母亲已经接受了服务，我们的发现表明获得服务是不够的。他们正在接受或已经接受的服务可能是帮助他们安全育儿的无效方法。
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