Motherhood and Childhood in the Context of Mental Illness: A Narrative Review

Abstract

Maternal mental illness significantly impacts caregiving, influencing both mothers and their children. This narrative review examines the challenges faced by mothers with conditions such as depression, anxiety, bipolar disorder, and schizophrenia, which often disrupt caregiving routines, emotional stability, and social integration. These difficulties can hinder secure attachments and contribute to adverse developmental outcomes in children, including heightened risks of anxiety, depression, behavioral issues, and cognitive impairments. Children of mothers with mental illnesses are 1.8 times more likely to develop emotional or behavioral problems and face a 2.7 times higher risk of suicidal ideation during adolescence. Intergenerational transmission of mental illness is also prevalent, with affected children showing a 2.5 times greater likelihood of developing mental illnesses in adulthood. Effective interventions include cognitive behavioral therapy (CBT), family-based approaches, and community programs integrating parenting education and mental health resources. These strategies have demonstrated improvements in maternal well-being and child resilience. The review highlights the need for comprehensive policies addressing maternal mental health, early intervention for children, and culturally sensitive support systems to break cycles of intergenerational mental illness. Future research should prioritize evaluating long-term intervention effectiveness and exploring innovative tools like digital mental illnesses solutions to support affected families.

1. Introduction

Motherhood is a demanding role that requires emotional stability, resilience, and consistent caregiving. For mothers experiencing mental illnesses, these demands can become significantly more challenging [1]. Mental illnesses such as depression, anxiety, bipolar disorder, and schizophrenia can interfere with a mother’s ability to provide stable and nurturing care [2]. These challenges may lead to difficulties in forming secure attachments, maintaining routine caregiving tasks, and managing stress, which can, in turn, impact the child’s emotional and cognitive development [3]. Moreover, societal stigma and lack of adequate support further exacerbate the struggles faced by these mothers [4].

Children and adolescents raised by parents with mental illnesses often face unique adversities. The instability that can accompany parental mental illness may lead to increased exposure to stress, neglect, and even trauma [5]. Studies indicate that children of parents with mental health conditions are at a higher risk for developing emotional, behavioral, and cognitive difficulties themselves [6]. These children may struggle with identity formation, social relationships, and academic performance, potentially leading to long-term psychological effects [7]. Additionally, they may take on caregiving responsibilities at a young age, which can impact their own well-being and development [8].

Generally, studies have revealed a high correlation between children’s behavioral disorders and parents’ mental illnesses [6], mothers’ mental stress [9,10], mothers’ poor mental health [6,9] mothers’ irrational beliefs [6], parenting stress [11,12], poor child–parent interaction [13], depression [14,15,16,17] caused by economic problems, social [18] and cultural [19] pressures, and parenting styles [20]. Therefore, environmental stress factors (in parents) can create psychological disorders and many other complications for children.

When these two challenges—maternal mental illness and its impact on child development—are combined, the effects can be particularly profound. The interplay between a mother’s mental illness and her child’s upbringing creates a dynamic that may perpetuate cycles of mental health issues across generations [21,22]. Family environments characterized by unpredictability, emotional distress, and inadequate coping mechanisms can hinder the child’s ability to develop resilience [21,23,24]. Furthermore, the lack of appropriate social and healthcare support can leave both mothers and their children vulnerable to persistent difficulties [25,26,27].

Despite the growing body of literature on maternal mental disorders and their impact on children, important gaps remain. These include a limited focus on how maternal psychopathology specifically affects child cognitive development, a lack of integration between clinical and social frameworks in the analysis, and insufficient attention to resilience mechanisms that might protect against intergenerational transmission of mental health problems. Addressing these gaps is essential to designing more holistic and effective support strategies for affected families.

This narrative review aims to explore the dual challenge of maternity with a mental illness and its impact on children and adolescents. By synthesizing the existing literature, this review will highlight the primary difficulties faced by mothers with mental illnesses, the challenges encountered by their children, and the broader implications of these intersecting experiences. Additionally, it will discuss available support mechanisms and potential interventions to mitigate these difficulties [28]. Understanding these complex dynamics is essential for developing effective policies and programs that support affected families and promote better mental health outcomes for both mothers and their children [29].

2. Results

This review included a total of 18 studies published between 2009 and 2024, covering a range of research methodologies such as longitudinal cohort studies, cross-sectional surveys, and randomized controlled trials. These studies were identified through a literature search conducted in PubMed, PsycINFO, and Google Scholar. Keywords included “maternal mental illness”, “parenting and mental health”, “children of parents with mental disorders”, and “adolescent psychological development”. The analysis revealed key findings related to maternal challenges, child and adolescent impact, cognitive deficits, suicide risks, intergenerational transmission of mental illness, and intervention strategies; these concepts are defined in

Table 1. Key concepts in the review results.

Concepts	Definition
Maternal Challenges	Difficulties maintaining care routines, symptoms of depression and anxiety, emotional overload, social isolation, and dual role as caregiver and patient.
Child and Adolescent Impact	Increased risk of anxiety, depression, behavioral problems (aggression, withdrawal), difficulties in social relationships, and poor school performance.
Cognitive Deficits in Offspring	Problems with memory, attention, executive functions, and language from an early age, persisting into adolescence.
Suicide Risks and Self-Harm	Adolescence with a higher probability of suicidal ideation, self-harming behaviors and difficulties in regulating emotions in context of family instability.
Intergenerational Transmission	Greater likelihood of developing mental illness in adulthood, with genetic, epigenetic, and family environment influencing future mental health.
Intervention and Support Systems	Strategies such as cognitive behavioral therapy, family interventions, community programs, and parental education help to reduce distress and increase resilience.

.

Maternal Challenges: A significant proportion (approximately 68%) of mothers with a diagnosed mental illness reported difficulties in maintaining consistent caregiving routines. Mothers with severe mental illnesses, such as schizophrenia and bipolar disorder, were more likely to experience social isolation and lack of support compared to those with mild to moderate conditions [30,31].

Child and Adolescent Impact: Children of mothers with mental illness exhibited a 1.8 times higher likelihood of developing anxiety and depression compared to those with mentally healthy mothers [32]. Behavioral issues, including aggression and social withdrawal, were reported in 35% of cases [33,34]. Additionally, increased stress and self-blame were identified as common experiences among these children [35,36].

Cognitive Deficits in Offspring: Several studies identified cognitive impairments in children of mothers with mental illnesses, particularly in executive functioning, memory, and attention. These deficits were observed as early as preschool age and persisted into adolescence, potentially affecting academic performance and social integration [37,38]. Deficits in problem-solving abilities and verbal fluency were also common, highlighting the need for early cognitive interventions to support affected children. The evidence suggests that children exposed to more severe or psychotic parental psychopathology may present broader and more persistent impairments across multiple cognitive domains, reinforcing the need for early neurodevelopmental screening and intervention [39].

Suicide Risks and Self-Harm: Adolescents raised by mothers with mental illness were at an increased risk of suicidal ideation and self-harm behaviors. The suicide risk was approximately 2.7 times higher compared to peers with mentally healthy mothers [40,41]. Factors such as emotional neglect, familial instability, and a lack of coping mechanisms contributed to this elevated risk. Early screening and psychological support for at-risk adolescents are critical in mitigating these dangers.

Intergenerational Transmission: Studies revealed that children raised in households with maternal mental illness had a 2.5 times greater risk of experiencing mental illness in adulthood. These children also demonstrated lower academic performance and increased school dropout rates. Emotional dysregulation and attachment issues in early life were identified as mediators in the persistence of mental illness across generations [42,43,44]. This risk often extended beyond the specific diagnostic category of the parent, indicating a transdiagnostic vulnerability that includes both affective and psychotic disorders [45].

Intervention and Support Systems: Psychological interventions, such as cognitive behavioral therapy (CBT) and parental support groups, were found to be effective in mitigating negative outcomes. Family-based interventions showed a 40% improvement in child well-being and a 30% reduction in maternal stress levels [46,47]. Community support programs that integrated parenting education and mental health resources demonstrated promising results in improving long-term outcomes for both mothers and children [31].

Overall, the results highlight the significant challenges faced by mothers with mental disorders and their children. The findings emphasize the need for targeted interventions aimed at reducing psychological distress and breaking the intergenerational cycle of mental illness. Future research should focus on evaluating the long-term effectiveness of intervention programs and developing culturally sensitive approaches to supporting affected families.

Table 2. Main results of the selected articles in the narrative review.

Author	Maternal Diagnosis	Results in Mothers	Results in Children	Mediating/Moderating Factors	Interventions/Key Considerations
Seeman [30]	Schizophrenia	High frequency of external custody; difficulties in ongoing parenting; sedative effects of antipsychotics; institutional and societal stigma	Frequent separations at birth or infancy; risk of genetic and environmental transmission; development rarely monitored	Severity and chronicity; social/familial support; adherence to treatment; stigma	Need for social support, family monitoring, and comprehensive services
Tuncer et al. [31]	Severe mental illness	Domestic violence; dual role as caregiver and patient; stigmatization; limited coping strategies; stigmatization; limited coping strategies	Not directly specified in the study	Gender roles; social inequality; lack of family and community support	Need for psychosocial support programs, intervention against domestic violence, stigma reduction and strengthening of support networks for women with severe mental illness
Barker et al. [32]	Perinatal depression and anxiety	Difficulties in parenting; exposure to environmental and familial risk factors	Increased internalizing and externalizing disorders in infancy	Accumulation of environmental, family, and lifestyle risks	Intervention must address environmental risks in addition to maternal depression
Kim et al. [33]	Postpartum depression	Maternal depressive symptoms associated with lower maternal responsiveness	Increased risk of attachment problems and alterations in socioemotional development in infants	Quality of mother-child relationship; social support	Parenting support and early detection programs
Nordh et al. [34]	Bipolar disorder	Increased risk of postpartum psychiatric hospitalization; difficulties in maternal-infant bonding	Increased behavioral and emotional problems in young children	Severity of bipolar episode; family support	Intensive psychiatric follow-up and postpartum family support
Gillen et al. [35]	History of child abuse + depression	Increased prevalence of maternal depression; difficulties in emotional regulation	Increased vulnerability to emotional and attachment problems in children	Maternal history of child abuse; presence of support network	Trauma-focused interventions and parenting strengthening
Stein et al. [36]	Depression, anxiety, psychosis, BDD, bipolar	Increased risk of premature delivery and low birth weight; postnatal depressive and anxious symptoms	Emotional and behavioral problems from infancy to adolescence; cognitive and attachment deficits	Quality of parenting; social/material support; duration and severity of the disorder	Family and parenting interventions; emphasis on early identification and support
Rodrigues et al. [37]	Perinatal depression	Persistence of depressive symptoms throughout the first year postpartum	Delayed language development and behavioral problems in young children	Persistence of maternal depression; socioeconomic status	Perinatal mental health interventions and home visits
MacKenzie et al. [39]	Generalized anxiety	Maternal anxiety associated with difficulties in emotional regulation	Higher incidence of anxiety and behavioral problems in preschool-age children	Severity of maternal anxiety; presence of social support	Emotional regulation and psychological support interventions
di Giacomo et al. [40]	Schizophrenia	Increased frequency of hospitalization and separation of children	Increased prevalence of cognitive and emotional difficulties in children	Severity of the disorder; access to mental health services	Comprehensive family support programs
Goldstein et al. [41]	Maternal mental illness and suicide	High risk of maternal suicidal behavior; impact on family dynamics	Increased risk of suicidal ideation and emotional problems in adolescent children	Presence of maternal suicidal behaviors; family support	Suicide prevention and family psychosocial support interventions
Labriola et al. [43]	Parental mental illness (ICD-10 and adolescent self-report)	Parental mental illness associated with poorer self-perceived health; higher risk with low work integration	Worse self-perceived health in adolescents; OR 1.2–1.8 depending on diagnostic source	Parental diagnosis, work integration, previous adolescent disorders, parental education	Public interventions targeting vulnerable adolescents and families with intergenerational problems
Sunde et al. [44] (pre-print)	Parental income range	Lower parental income linked to higher prevalence of psychiatric disorders in parents	Increased prevalence of psychiatric disorders in offspring, especially in adolescence; association decreases in adulthood	Direct parental effect (social causation) in adolescence; shared factors (social selection) in adulthood	Social policies more effective in adolescence; distinguish mechanisms by age group
Bertolín-Guillén et al. [42]	Parental SMI, genetic/epigenetic transmission	Heritable vulnerability and epigenetic marks influence transmission	Higher risk of mental illness across generations; fetal programming and prenatal stress impact neurodevelopment	Genetic, epigenetic, prenatal stress; environmental factors	Need for more research; intergenerational programs still limited
Rasic et al. [45]	Schizophrenia, bipolar disorder, or major depression in parents	Increased risk of SMI transmission to offspring; risk higher if parental diagnosis is schizophrenia or bipolar	32% of offspring develop SMI by age 20 (vs. 14% in controls); RR for SMI: 2.52; risk is both diagnosis-specific and transdiagnostic	Offspring age, parental diagnosis type, diagnostic method, comorbidity in the other parent	Family information and early preventive monitoring in high-risk offspring
McFarlane et al. [46]	Parental psychosis	More parenting difficulties, higher stress, less social support	Increased behavioral and school problems in children	Severity of parental disorder, social support, family stability	Psychoeducational and social support interventions
Wadephul et al. [47]	Perinatal depression/ anxiety	Higher parental stress, difficulties in mother–infant bonding	More emotional and developmental problems in young children	Social support, severity, and duration of maternal disorder	Early intervention and parental support programs
Wang et al. [38]	Maternal mental illness and family adversity	More family adversity and parenting difficulties	Increased risk of psychiatric disorders and poor academic performance in children	Environmental factors, access to community resources	Comprehensive family and community interventions

presents a critical analysis of these studies.

3. Discussion

The findings of this review emphasize the significant challenges faced by mothers with mental illnesses and their children, highlighting the need for targeted interventions to break the cycle of intergenerational mental illness. The combination of maternal mental illness and the developmental impact on children creates a complex dynamic that requires multifaceted approaches for intervention and support.

Summary of Results: The reviewed studies confirm that maternal mental illness is strongly associated with difficulties in caregiving, affecting child emotional and cognitive development. Findings show that children of affected mothers have a higher prevalence of anxiety, depression, and behavioral disorders [32], with cognitive deficits observed as early as preschool age [36,37,39]. Adolescents from such backgrounds experience an increased risk of self-harm and suicidal ideation [40,41]. Additionally, intergenerational studies highlight the role of parental mental health in shaping adolescent outcomes [42,43,45]. Wang et al. (2024) further link early psychiatric symptoms to transdiagnostic cognitive impairments in at-risk youth [38]. These outcomes indicate that maternal mental health significantly influences the psychological resilience and social adaptation of children, reinforcing the need for early interventions.

Although clinical aspects are addressed throughout the following recommendations, we now highlight more explicitly the clinical implications of our findings. Several of the reviewed studies support the importance of the early identification of cognitive and emotional difficulties in children of mothers with mental illnesses, as well as the implementation of integrated care programs that combine maternal mental health treatment with pediatric follow-up. Interventions such as cognitive behavioral therapy and family-based programs not only improve maternal functioning but also reduce risk factors in children. These findings reinforce the need for multidisciplinary clinical approaches in primary care, perinatal services, and child mental health systems.

Recommendations for Mothers: Addressing maternal mental health is crucial in mitigating its impact on child development. Providing accessible maternal healthcare, integrating mental health services into prenatal and postnatal care, and promoting community-based support networks can improve maternal well-being and caregiving quality [31]. Cognitive behavioral therapy (CBT) and peer-support groups have shown effectiveness in reducing stress and improving maternal mental health outcomes [31]. Wadephul et al. (2016) highlight the benefits of antenatal psychological group interventions for improving maternal psychological well-being [47]. Reducing the stigma surrounding maternal mental illness is also essential in encouraging mothers to seek help without fear of judgment [30].

Recommendations for Children and Adolescents: Children of mothers with mental illnesses require targeted psychological support to mitigate their increased risk for emotional and cognitive impairments. School-based mental health programs, peer mentoring, and community outreach initiatives can provide stability and structured support [34]. Engaging children in structured activities such as arts, sports, and counseling programs can strengthen resilience and social skills, reducing the long-term effects of parental mental illness [33]. Educational initiatives that teach emotional regulation and problem-solving skills can empower children to manage stress more effectively. Intergenerational trauma studies also emphasize the importance of addressing resilience mechanisms to break cycles of adversity [35].

Recommendations for Family-Based Interventions: Family-based interventions that address both maternal and child mental health are essential. Joint therapy sessions, attachment-based interventions, and parental training programs can improve parent–child relationships and emotional co-regulation [37]. Establishing multidisciplinary support networks, including healthcare providers, educators, and social workers, can ensure that affected families receive comprehensive care tailored to their specific needs [34]. Addressing family-level stressors such as financial insecurity, housing instability, and lack of social support is also crucial in improving outcomes for both mothers and children [31].

Future Directions and Research Needs: Future research should focus on evaluating the long-term effectiveness of existing interventions and exploring culturally sensitive approaches that cater to diverse populations. More longitudinal studies are needed to understand the trajectory of children raised by mothers with mental illnesses, examining resilience factors that may mitigate adverse outcomes [43]. Sunde et al. (2024)—in their pre-print—highlight how socioeconomic differences influence mental illness across generations, suggesting that addressing these disparities is key to breaking intergenerational cycles of poor mental health [44]. Additionally, policymakers should consider integrating mental health support into primary healthcare systems to enable early detection and intervention. The growing field of digital mental health interventions should also be explored as a potential tool for reaching mothers and children who may have limited access to traditional mental health services [38].

Strengths and limitations: This narrative review methodology presents both strengths and limitations. Among its strengths are the breadth of databases consulted and the inclusion of diverse study types addressing both clinical and psychosocial dimensions. The thematic synthesis approach allowed for the integration of heterogeneous findings in a coherent and structured manner. However, the absence of a predefined systematic protocol may reduce reproducibility, and the article selection process—though carefully executed—may still be influenced by subjective interpretation. These methodological considerations should be taken into account when interpreting and applying the findings of this review. Although this review covers a wide range of social and contextual stressors, we identified a lack of studies specifically addressing single motherhood. This is a relevant omission, given the potential compounding effects of parenting, economic hardship, and reduced social support on maternal and child mental health. Future research should explore how single motherhood intersects with mental illness and influences caregiving, child outcomes, and access to services.

4. Materials and Methods

This narrative review was conducted through a comprehensive literature search in major electronic databases, including PubMed, PsycINFO, and Google Scholar. The search targeted peer-reviewed studies published between January 2005 and March 2025, addressing the challenges of motherhood in the context of mental illness and the developmental impact on children and adolescents. The search was limited to articles published in English, with full-text availability, and focused on populations ranging from birth to 18 years of age. Keywords included “maternal mental illness”, “parenting and mental health”, “children of parents with mental disorders”, and “adolescent psychological development”. Boolean operators and controlled vocabulary were used when applicable to optimize the search process. In addition, quality gray studies, such as doctoral theses [48], were considered when they provided relevant evidence not available in peer-reviewed articles. These documents were identified and marked as gray literature. The study selection process is illustrated in the flow diagram presented in Figure 1.

Studies were selected based on their thematic relevance, methodological rigor, and overall contribution to understanding the psychological, cognitive, and social implications of parental mental illness. Priority was given to empirical research involving children or adolescents exposed to maternal psychopathology, including both observational and interventional designs. In addition, studies exploring protective factors, support systems, and resilience-enhancing strategies were included to provide a holistic perspective on potential outcomes and interventions.

The review employed a thematic synthesis approach, organizing the findings into core categories: maternal caregiving challenges, emotional and behavioral outcomes in children and adolescents, cognitive impairments, intergenerational transmission of mental illness, suicide risk, and intervention frameworks. This allowed for the integration of findings across diverse methodologies while maintaining conceptual coherence. The gray literature—including health organization reports and policy guidelines—was incorporated when relevant to broaden the practical and contextual understanding of the topic.

The initial identification of the articles, including the selection of titles and abstracts to determine their relevance, was carried out by the first author. The second author independently reviewed the selected articles for relevance and methodological quality. Discrepancies were discussed until a consensus was reached. Articles that met the full-text inclusion criteria were then retrieved and assessed for eligibility. Additional references were located by manually searching the bibliographies of the included studies.

Only publicly accessible, peer-reviewed, and ethically approved studies were included. Ethical considerations were respected by excluding any research that did not clearly report ethical compliance.

Table 3. Summary of reviewed studies.

Author(s)	Year	Study Design	Key Findings
Barker et al. [32]	2012	Longitudinal observational	Maternal depression and associated risk factors significantly increase the risk of both internalizing and externalizing psychopathology in offspring.
Bertolín-Guillén [42]	2023	Narrative review	Intergenerational transmission of mental illness is mediated by early emotional dysregulation and attachment issues, highlighting the need for preventive family interventions.
di Giacomo et al. [40]	2024	Cohort	Increased risk of self-threatening behaviors in adolescents of parents with mental illness.
Gillen et al. [35]	2024	Qualitative	Intergenerational trauma impacts child mental health in immigrant families.
Goldstein et al. [41]	2009	Cross-sectional	Offspring of parents with bipolar disorder have a substantially elevated risk of suicidal ideation compared to peers with mentally healthy parents.
Kim et al. [33]	2024	Cross-sectional	Parental depression associated with adolescent psychological well-being and health behaviors.
Labriola et al. [43]	2024	Intergenerational	Mental health issues persist across generations of parents and adolescents.
MacKenzie et al. [39]	2020	Cognitive testing cohort	Found widespread cognitive deficits (attention, working memory, processing speed) in offspring of parents with psychotic but not in those with non-psychotic disorders.
McFarlane et al. [46]	2017	Randomized trial	CBT enhancement is effective in addressing maternal distress.
Nordh et al. [34]	2024	Observational	Parental mental illness affects family functioning and involvement in child mental health services.
Rasic et al. [45]	2014	Meta-analysis	Estimated a 32% lifetime risk of SMI in offspring of parents with schizophrenia, bipolar, or depression, 2.5× higher than controls.
Rodrigues et al. [37]	2024	Systematic Review	Maternal depressive symptoms impact offspring’s executive functions.
Seeman [30]	2023	Review	Women with schizophrenia face unique challenges in motherhood.
Stein et al. [36]	2014	Review	Perinatal mental illness in mothers is linked to a wide range of adverse developmental, emotional, and behavioral outcomes in children from infancy through adolescence.
Sunde [44]	2024	Cohort (gray literature)	Socioeconomic differences influence mental health across generations.
Tuncer et al. [31]	2024	Qualitative	Women with severe mental illness face significant domestic difficulties
Wadephul et al. [47]	2016	Systematic Review	Antenatal psychological interventions improve maternal well-being.
Wang et al. [38]	2024	Cohort	Early psychiatric symptoms linked to cognitive impairments in at-risk youth.

provides a structured overview of the key studies analyzed in this review, ensuring clarity and comprehensiveness in presenting the research findings. Further details on the characteristics of each article—including objectives, methodology, sample, data collection, main findings, robustness, contributions, and limitations—can be found in Supplementary Material Table S1, which expands on the critical analysis of the studies.

5. Conclusions

The interplay between maternal mental illness and child development presents significant challenges that require a comprehensive and multi-tiered approach to intervention. Providing accessible maternal mental healthcare, enhancing child support systems, and implementing family-focused interventions are critical steps toward breaking the intergenerational transmission of mental illness. Limitations of the review include potential publication bias and the exclusion of non-English language studies, which may have led to the omission of relevant research from different cultural contexts. Future studies should continue to explore innovative intervention strategies and policies that support affected families, ensuring better mental health outcomes for both mothers and their children.