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Parental Mental Health and Children’s Functioning

There is a substantial association between parental and,in particular,maternal mental health and children’s adjustment. Perinatal mental illness has been shown to have potential long-term negative developmental consequences for infants and children, especially in combination with other risk factors (Goodman & Gotlib, 2002; Murray, Cooper,Wilson,& Romaniuk, 2003; Radke-Yarrow & Klimes-Dougan, 2002).

Refugee populations have a high prevalence of posttraumatic stress disorder (PTSD) compared with nonrefugee populations, and exposure to trauma and mass violence increase risk for depressive and anxiety disorders (Bruce, 2003).There is also evidence of the adverse impact of maternal mental health on children’s functioning,both in situations of war trauma (Qouta, Runamäki,& Eyad, 2005; Smith, Perrin, Yule,& Rabe-Hesketh, 2001), while seeking asylum (Mares & Jureidini, 2004; Mares, Newman, Dudley,& Gale, 2002; Steel et al., 2004), and following resettlement (Almquist & Broberg, 1999).

The following vignette demonstrates the interactions between symptoms of psychosis and PTSD, cultural difference and upheaval in a family and the difficulties in formulating an appropriate clinical understanding of these factors. Ms M and her four children fromSomaliawere referred for psychiatric assessment after the children were removed from her care under child protection legislation 18 months after the family were resettled in ruralAustraliaunder the UNHCR humanitarian program.

They had endured 2 years in the Kakuma refugee camp inKenya, where they had experienced significant trauma, including sexual violence. The family had moved seven times since arriving inAustralia, resulting in school disruption for the older children and loss of any developing social networks. Each move was preceded by Ms M’s belief that people were either not giving her what she was entitled to, or were in fact stealing her money and possessions. When child protection services became involved, the family was barricaded in a hotel room, because Ms M believed she and her children were being poisoned.

The youngest child, aged 2 years, was breastfeeding. Her removal particularly distressed Ms M, adding to her sense of persecution and risk. Her husband had been killed 3½ years earlier. Despite this she related that all the children, including the youngest, were her husband’s, and that the baby had ‘stayed in my womb until it was safe to be born’.

This could be considered a delusional belief, but it seemed more appropriately understood as protective for mother and child in current circumstances. Trusting no-one and remaining hypervigilant had been necessary and had served her and her children well prior to arriving inAustralia. Her experience of ongoing persecution and insecurity, and her inability to accept available services and help needed a contextual understanding. A psychiatric diagnosis was appropriate but insufficient.

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