CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 45PARENTINGJOANNE NICHOLSONLAURA MILLEREPIDEMIOLOGY AND SOCIAL CONTEXTParenthood is a desired life goal and meaningful role for many adults with schizophrenia.An analysis of national prevalence data indicated that 62% of women and 55% of menwith schizophrenia spectrum disorders are parents. Parents with schizophrenia spectrumdisorders have their first children, on average, at about age 20, with up to 35% experiencingtheir first episode of psychosis before becoming parents.Systematic data on the parenting experiences of individuals with schizophrenia aresparse, and most studies to date do not fully take into account the influence of gender, onsetand course of illness, extent and domain of disability, family and community resourcesand supports, and access to effective treatment and rehabilitation on parents’ experiences.Some studies have shown that individuals with schizophrenia who become parentstend to have had better premorbid social adjustment. Women with mental illness who becomemothers are more likely to have been married than are women with mental illnesswho do not become mothers. However, women with schizophrenia, compared withwomen without mental illness, are less likely to have a current partner and have a highernumber of lifetime sexual partners.Fathers with serious mental illness (SMI) are significantly more likely than motherswith SMI to be younger and to abuse substances. Fathers with schizophrenia tend to besocially isolated. In one study, for example, fewer than 20% of fathers with schizophreniawere married, and fewer than 30% lived with their children.Many parents with SMI lack material and emotional supports. They report that theirmental illnesses limit their social networks and contribute to poverty, joblessness, homelessness,and lack of transportation. They may have limited ability to supply children’snecessities. Whereas relationships with adult family members can be an important sourceof support in some cases, they can undermine parents’ abilities and efforts, and contributeto their stress in other cases.Comorbid substance abuse may contribute to poor overall functioning and impairedparenting. Medical comorbidity, including higher rates of hypertension, diabetes, and471