Parents with Mental Illness : The Scope of the Issue

by SAMHSA

(Page 2 of 20)

There are no national data on the frequency with which adults with mental illness bear and care for children. Information on prevalence is drawn from existing data sets and is, therefore, limited by study rationale and methods. Large-scale descriptive data are not available on the characteristics of children whose parents have mental illness, such as where they are living or in whose custody or care.

Who are Parents with Mental Illness?

The number of parents living with mental illness is likely to be in the millions. Every year, 22% of the American population is affected by psychiatric disorder. About 3% of the adult population (approximately 5 million individuals in 1990) is diagnosed with severe psychiatric disorder, as indicated by diagnosis and disability (Goodwin et al., 1993). According to U.S. Census Bureau data, the majority of American women and men are parents (Bachu, 1995, 1996). The likelihood is high that many of the 5 million Americans diagnosed with severe mental illness each year, those most challenged by disability, already are or will become parents.

We reviewed findings from existing data sets, including the National Institute on Disability and Rehabilitation Research-funded National Survey of Parents with Disabilities, and the National Comorbidity Survey, to begin to address this question more carefully. These studies were not designed to describe the circumstances of families or characteristics of children in which parents have mental illness, and the usefulness of findings must be qualified.

The National Survey of Parents with Disabilities

Within populations of parents known to have disabilities, many identify themselves as having psychiatric disabilities alone, or in combination with other physical or medical disabilities (Barker & Maralani, 1997). In the National Institute on Disability and Rehabilitation Research (NIDRR)-funded Research and Training Center (RTC) National Survey of Parents with Disabilities, data from a convenience sample of over 1,200 adults with disabilities was supplemented by a secondary analysis of the 1993 U.S. Census Bureau Survey of Income and Program Participation (SIPP; Barker & Maralani). In the NIDRR/RTC study, one in seven parents with disabilities identified a psychiatric disability as the primary disability. According to SIPP data, about 7 million parents with children under the age of 18 have disabilities. Applying the NIDRR/RTC rate of one in seven to the SIPP data, it is possible to estimate that approximately one million parents of children under the age of 18 have psychiatric disabilities.

This, however, is a gross underestimate of all individuals with mental illness who are parents for several reasons. First, the RTC Survey focused on parents with mental illness who identify themselves as disabled as a consequence. Therefore, parents with mental illness who do not define themselves as "ill" or who do not view themselves as disabled are not represented in the study. In addition, minority populations are underrepresented in the RTC sample. The RTC survey was only distributed in English; data were not obtained in other languages. The RTC sample also had a higher percentage of female, white, highly educated respondents than the U.S. Census Bureau SIPP data. Finally, the data do not include information about parents who do not have custody, those with children who are adults themselves, or those with children living in alternative family situations.

Mothers with mental illness, more frequently studied than fathers, have numbers of children consistent with the general population (Caton, Cournos & Dominguez, 1999; Mowbray et al., 1995b; White, Nicholson, Fisher & Geller, 1995). Therefore, extrapolating from the NIDRR/RTC data convenience sample estimate of about one million parents with psychiatric disabilities whose children are under the age of 18, at least two to three million children in American have parents with self-reported psychiatric disabilities. In the NIDRR/RTC data, nearly half of the children of parents with psychiatric disabilities have disabilities themselves, underscoring the importance of supports for children as well as adults, and the potential impact of improving parents' skills on the lives of millions of children. These data highlight the significance of considering families, rather than individual adults or children, as the client "unit."

The National Comorbidity Survey

Recently, data from the National Comorbidity Survey (NCS) of the United States, a survey of a national probability sample of over 8,000 respondents carried out between 1990 and 1992 by Dr. Ronald Kessler and colleagues, have become available for analysis regarding parenting issues and mental illness (Kessler, 1994). Demographic data from these respondents have been shown to be comparable to U.S. Census distributions (Kessler), suggesting that conclusions drawn from NCS data are likely to be generalizable to the larger U.S. population. In Phase II of the NCS, interviews were administered to 5,877 respondents, and included items on parenting and children, allowing preliminary findings on the rates at which individuals with psychiatric and/or substance abuse disorders, in various diagnostic categories, become parents.

Recent preliminary analyses of National Comorbidity Survey data regarding the prevalence of mental illness and parenting indicate that about 31% of American women and about 17% of men have a 12-month prevalence of at least one psychiatric disorder (not including substance abuse), and significant percents of these individuals are mothers (65%) and fathers (52%) (Nicholson et al., 2001). The NCS data suggest that women and men with psychiatric disorders or with co-occurring psychiatric disorders and substance abuse may be at least as likely if not more likely to be parents than those who do not meet criteria for psychiatric disorder or substance abuse.

Among women in the NCS sample who are mothers, 25% meet criteria for diagnoses in the affective disorder category, including major depression, mania, bipolar disorder and dysthymia. Approximately one-third of the NCS women who are mothers have a lifetime prevalence of anxiety disorders. Slightly over 11 percent meet criteria for post traumatic stress disorder, and less than one percent for a nonaffective psychosis disorder diagnosis.

Among men in the NCS sample who are fathers, almost one-sixth have a lifetime prevalence of affective disorders. About one-fifth have anxiety disorders. Approximately six percent meet criteria for post traumatic stress disorder, and fewer than one percent have a lifetime prevalence of nonaffective psychosis.

Unfortunately, it is impossible to describe the current family circumstances of adults who participated in the NCS in detail, other than to know they have had children. Information about the prevalence of custody loss among parents with mental illness, the frequency with which children require alternative caregiving when parents' functioning is compromised by illness, or the percent of children relinquished for adoption or raised by others is not available.

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