Levels of family assessment: II. Impact of maternal psychopathology on family functioning.

Abstract

The association of maternal and contextual risk factors with whole-family, marital, and parent-child levels of family functioning was examined. Maternal mental illness and multiple contextual risk best predicted whole-family functioning, but each was related to marital and parent-child levels as well Nonspecific indicators of maternal illness, rather than diagnostic category, were the better predictors of family functioning. The multiple contextual risk index was the variable most associated with all levels of family functioning, more so than any indicator of maternal illness. These results indicate (a) that maternal mental illness and family functioning are strongly associated and (b) that variation in the conceptualization and measurement strategy for risk and family functioning affects the conclusions of research. The importance of clear conceptualization of family levels and psychopathology risk in families of young children is discussed.Psychopathology is a family matter. There illness runs in families, and many researchers now exists considerable evidence that mental are investigating the mechanisms by which psychopathology is transmitted to the next generation. Conceptual models have been formu-Susan Dickstein, Ronald Seifer, lisa C. Hayden, ] a ted to explain parenting strategies and child Masha Schiller, and Karin Dodge Magee, Bradley developmental outcomes that emerge in the Hosratal,EastProvia^,RhodeIsland,ar^ context of adversity in ^ form of mat ernal of Psychify and HuinanBehavior, Brown University psychopathology . j^ modeIs ^^y focus School of Medicine; Arnold J. Sameroff, Center for ^ J . * , e/ . _ .

Does the portal of entry determine our view? Interfaces between dyadic and three‐way assessment of a clinical family transitioning to parenthood

“…Similarly, Seifer and Dickstein (2000) and Dickstein et al (1998) explored the integration of different levels of family assessment, including individual psychopathology, into our understanding of clinical outcome in infancy. Linked to this is Emde's (2005) proposal to add a Family Axis to the already existing Axis II: Parent-Infant Relationship in the next DC: 0-3 classification.…”

“…Alternatively, one might choose to begin with the most challenging context. On the basis of their findings with the families of psychiatrically impaired mothers, Dickstein et al (1998) recommend intervention aimed at the family unit, as they found it to be the most effected by the mother's mental illness and by marital discord; however, they warned that disparities in measurement techniques may have accounted for some of these differences. Fivaz-Depeursinge and colleagues (e.g., FivazDepeursinge, Corboz-Warnery, & Keren, 2004) developed their therapeutic consultations by aiming their interventions at the family system while also moving more organically between the family as a whole and the various dyads.…”

“…In a sense, the pattern we have observed here is a variant of this decreased sensitivity described by McHale (1995;Lauretti & McHale, 1997). Alternatively, Dickstein et al (1998) described "subsystem strengths." In other words, in their study of psychiatrically impaired mothers, they found a relative sparing of maternal competencies in dyadic play alone, with greater disruption observed in family-level functioning.…”

“…Seifer and Dickstein (2000) noted that in families where one parent has a mental illness, the child's outcome appears to be more dependent on the family level of functioning than on the quality of the dyadic interaction with the ill parent. Furthermore, Dickstein et al (1998) proposed that one significant mediator in the outcomes of children exposed to maternal psychopathology may be the health of family functioning.…”

“…To date, there have been very few attempts to integrate different levels of assessment in clinical infancy literature (Dickstein et al, 1998). The goal of this interface was for three independent clinicians to observe dyadic and three-way interactions in a family referred for consultation.…”