On Mothers with Schizophrenia: Assessment of Early Infant Caregiving Capacity & the Contribution of Cognitive Deficits

Abstract

An Australian national research priority is a healthy start to life, requiring a good-enough nurturing environment in infancy. Mothers with schizophrenia are a group who struggle to provide this early foundation, with up to 50% of their infants removed from their care. There are major limitations to our service provision and the state of our knowledge regarding the impact of schizophrenia upon early parenting. Regarding service provision, there is currently no instrument to validly assess the parenting of mothers with schizophrenia. Treatment approaches and decisions regarding custody are presently guided by parenting assessments that are not appropriate nor specific to this cohort. Regarding the state of our knowledge, it is still not known what it is about schizophrenia that interferes with the ability to parent. The current literature demonstrates that symptomatology and psychosocial variables do not adequately explain the extent of dysfunction that is seen in this parenting group. In an attempt to address the above limitations, the following study aimed to develop and validate a measure of infant parenting that is appropriate for use in schizophrenia. The second aim of the study was to compare the infant caregiving of mothers with schizophrenia to that of clinical and healthy postpartum controls. It was hypothesised that schizophrenia-associated cognitive deficits would account for a significant proportion of the difficulty experienced by mothers with schizophrenia. Fifty one postpartum mothers participated in the study. The sample comprised a schizophrenia group (n=13), a clinical control group (mothers with a mood disorder; n=13), and a healthy control group (n=25). The psychometric properties of the Infant Caregiving Assessment Scales (INCAS) were examined using a 12-month prospective longitudinal design. A cross-sectional design was concurrently used to determine the extent to which schizophrenia-associated cognitive deficits affect the capacity to care for a new infant, relative to symptoms and psychosocial variables. Early findings suggest that the INCAS is reliable and valid for use in the postpartum schizophrenia population. Compared to the clinical and healthy control groups, mothers with schizophrenia exhibited specific impairments to their infant caregiving in the dimensions of empathy, adaptability, protection and provision. A significant relationship between caregiving capacity and schizophrenia-associated cognitive deficits was found in the study at hand. Through regression analyses, it was shown that the total neurocognition and processing speed variables were significant predictors of caregiving capacity (as measured by the INCAS). When clinical and psychosocial variables were included in the model however, these relationships were no longer significant. These findings suggest that there is not a direct relationship between neurocognition and infant caregiving, or alternatively, that the relationship is only slight. Regarding social cognitions, facial affect recognition and attributional style retained significance as predictors of infant caregiving capacity when other variables were added to the model. Using path analyses, it was clarified that although the neurocognitive deficits did not directly impair the maternal role functioning of women with schizophrenia, they impaired it indirectly through their negative impact upon social cognition. A major limitation was the very small sample size. Within the context of only 51 participants, the findings should be viewed as preliminary. Further studies that replicate these findings in larger samples are required. This important and innovative research project has introduced an evidence-based caregiving assessment for mothers with schizophrenia. The INCAS has the potential to help this group provide a healthy start to life to their infants by assisting in the careful examination and identification of problems early in the caregiving relationship. While still only in the early stages of validating this scale, the INCAS has helped to provide an early indication of the caregiving dimensions affected by schizophrenia, together with the cognitive aspects of the illness that may be responsible for this specific area of functional impairment. With the feasibility of this research established in the current thesis, the way is paved for future research to go forth.