Maternal Attachment in Infancy and Adult Mental Health

There’s an interesting article by Angela Fan et al, in Comprehensive Psychiatry, October 28, 2013.  It’s titled Association between maternal behavior in infancy and adult mental health: A 30-year prospective study.  The data for this investigation were gathered as part of a wider longitudinal study.

PROCEDURE

Participants in the study were 1,752 babies born between 1960 and 1965.  The babies received medical examinations at 4 and 8 months with their mothers present.  During the 8-month examination, the mothers’ interactions with the babies were observed and rated on the following dimensions:

(1) mother’s expression of affection;
(2) mother’s verbal evaluation of the child;
(3) mother’s physical handling of the child;
(4) mother’s management of the child during the testing;
(5) mother’s reaction to the child’s needs;
(6) mother’s reaction to the child’s test performance;
(7) mother’s focus of attention during the examination.

These ratings were analyzed statistically, and yielded the two following factors:

  • Low attachment, characterized by indifference, rough handling, and criticism of the baby.
  • Overly involved, characterized by excessive pride, caution, and affection. 

Between 1992 and 1994, when the children had reached the age of about 30 (actual range 27-33), they were contacted and interviewed.  They were asked to complete the General Health Questionnaire, and were also asked about their present mental/emotional health status.

The earlier and later data were combined to see if the maternal behavior in the 60’s correlated with the interview data from the adult children in the 90’s.

RESULTS

The primary finding was that:

“Mothers of subjects who reported poor adult mental health were significantly more likely to exhibit ‘Low Attachment’ behaviors at the 8-month exam than mothers of subjects with normal adult mental health (p = 0.040).”

There was no correlation between the maternal “over-involvement” in the 60’s and subsequent mental health of the adult child.

The components of the Low Maternal Attachment factor that were significantly associated with poorer subsequent mental health were:

  • Harsh and negative expression
  • Made no effort to facilitate the testing
  • Inconsiderate in handling the child 

The main findings are set out in the table below:

Low Maternal Attachment Measures Yes/No N %age Poor Mental Health Relative Risk P
Harsh and negative expression yes
no
128 1485 21.9%
15.4%
1.42 0.04
Made no effort to facilitate testing yes
no
146 1471 22.6%
15.4%
1.47 0.02
Inconsiderate in handlng the child yes
no
59 1556 25.4%
15.6%
1.63 0.04

 

As can be seen from the table, each low-attachment variable is associated with an increased percentage of poor mental health in adulthood (e.g. 21.9% vs 15.4% for the first variable – Harsh and negative expression).  The relative risk is the ratio between these two percentages:  21.9 ÷ 15.4 = 1.42, etc…

It is important to note that, as in most research of this kind, the correlation is not perfect.  For instance, although 1485 (92%) of the mothers were rated as not harsh and negative during the infant examination, nevertheless 15.4% of their children reported poor mental health in adulthood.  And conversely, of the 128 mothers who scored yes on this variable, only 21.9% of their children reported poor subsequent mental health.  The point being that low maternal attachment during infancy is only one of the factors that contribute to a person developing “mental health” problems in later life.

The authors concluded that:

“Infants who experience unsupportive maternal behavior at 8 months have an increased risk for developing psychological sequelae later in life.”

. . . . . . . . . . . . . . . . 

DISCUSSION

In recent decades it has become increasingly difficult to discuss the impact of parenting styles on subsequent behavioral/emotional problems in the adult child.  Any such attempt has been condemned by psychiatry – or at least some segments of psychiatry – as unwarranted blaming of the parent.  For psychiatry, problems of thinking, feeling, and/or behaving are illnesses caused by genetic and/or neurological factors, with little or no causal link to parenting behavior.

But the notion that what we do or don’t do to our children when they are young has a profound effect on how they function in adult life is obvious, and has been obvious throughout recorded history. 

Hopefully the publication of the Fan et al study might go some way to bringing this topic back into focus.

In the parenting arena, we all make mistakes.  Sometimes the mistakes are minor.  Other times they are more serious.  But we will do our species no service if we fail to learn from those mistakes, and if we fail to pass on the lessons learned to future generations.

  • Stefan Björk

    Although I do appreciate the move away from medicalisation (that is, treating a problem as a purely medical problem although it is not), I must admit that the tendency of “mother blaming” concerns me. This was, and still is, a major criticism of psychoanalytic developmental theories.

    I have not read the article you review, and perhaps the answers to my questions can be found there. Anyway: (1) Are we sure that it is mother-child attachment (measured by Mary Ainsworth’s procedure, I presume)? Can we exclude class, ethnicity and other “environmental” factors? Psychological distress tend to run in families, not because of genetics, but because lack of positive experiences as a child does not prepare well for parenthood. (2) Although two factors, separated by 30 years in time, are correlated, it does not mean they are causally correlated. I guess the authors are careful with their language. Yet, this is too easily understood as causality.

    Sorry for a short post; at a conference and need to run.

  • Francesca Allan

    I’m with you, Stefan. I had hoped the refrigerator mother theory of schizophrenia had been long buried.

  • Francesca Allan

    I’m with you, Stefan. I had hoped the refrigerator mother of schizophrenia was long buried. And if schizophrenia as a category is rubbery, then what the hell are we going to say about maternal attachment?

  • Francesca Allan

    That was, of course, supposed to be “refrigerator mother theory ….”

  • Stefan Björk

    I don’t mind attachment theory, but I note that only mother-child attachment (not father-child or any-significant-other-child attachment) was assessed. If you use theories, do it properly! 🙂

  • Phil_Hickey

    Stefan,

    You’ve opened a huge and very important subject. Rather than trying to respond here, I’m writing a new post. Should be up by tomorrow. Thanks for your input.

    Best wishes.

  • Phil_Hickey

    Francesca,

    See my apply to Stefan above.

  • Stefan Björk

    Thank you, Phil. Looking forward to that post!

  • ssenerch

    I think there is a lot to attachment theory as well, but similarly I wonder if the mother-child relationship is too narrow a focus…

  • Phil_Hickey

    ssenerch,

    You’re correct. It’s one small piece of a very big puzzle.

  • ssenerch

    Although, I don’t know. I mean, we can easily look to other social species to see the importance of the mother-child bond and the quality of the parenting. We can see how offspring fail to thrive or survive when there is a problem with the mothering/parenting. Why can’t we look to our own species and see the same? Maybe, since humans are such a social and group-oriented species, the focus on mothers and even parents is just a little too narrow, since tight-knit, functioning groups/communities can act as surrogate parents… the “it takes a village” idea…. Of course that’s IF we have tight-knit, well-functioning groups/communities, which is a very big IF.

  • ssenerch

    One of my favorite psychologist/authors on this subject, Dr. Faye Snyder, explains it this way – every child needs a “mother” – the “mother” doesn’t necessarily have to be the female parent, although due to biology that’s generally the most natural candidate – but they need an adult who is loving and attentive to them, whom they can attach securely to and who looks out for & guides them. Without that kind of secure, attentive attachment, yes I definitely believe major problems result. Dr. Faye has organized the problems that result down to a pretty exact science…. see for example http://www.thecausaltheory.com/assets/tct/pdf/PreventiveDiagnosisCheatSheet.pdf. I think there is so much to this theory. I highly recommend Dr. Faye’s books on the subject.

  • ssenerch

    So Francesca, what do you think the ramifications, if any, of having a “refrigerator parent” would be for a child or grown child?

  • ssenerch

    Correct me if I’m wrong. It seems like the “refrigerator parent” theory was retired not because it was invalid, but because parents didn’t want to hear it. That would be typical MO for this field. According to Wiki (yes, the only source I’ve read about it thus far), the refrigerator theory was applied to both SZ and autism, and yet the only reason it lists for its having fallen out of favor is that “The modern consensus is that autism has a strong genetic basis, although the genetics of autism are complex and are not well understood.” (Sound familiar??) “Although recent studies have indicated that maternal warmth, praise, and
    quality of relationship are associated with reductions of behavior
    problems in adolescents and adults with autism, and that maternal
    criticisms are associated with maladaptive behaviors and symptoms, these
    ideas are distinct from the refrigerator mother hypothesis.” Really?, they don’t sound all that distinct to me. Warmth makes things better, and coldness makes them worse…. Seems like a very weak refutation of the refrigerator theory.

  • Phil_Hickey

    ssenerch,

    I agree, it doesn’t have to be the mother, or even a female. But babies need cuddling and cossetting.

  • ssenerch

    Yes, and not only that – they need consistent, attuned responsiveness – to themselves, their needs and concerns.

  • ssenerch

    A term that could be used perhaps instead of “mother” is “primary caregiver.”