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doi:10.1111/j.1365-2206.2012.00874.x

Parenting style, competence, social network and

attachment in mothers with mental illness cfs_874 1..8

Marc Gelkopf and Suzy Ella Jabotaro

Department of Community Mental Health, University of Haifa, Haifa, Israel

Correspondence: A B S T R AC T
Suzy Ella Jabotaro,
Department of Community Severe mental illnesses (SMIs) can affect parents’ ability to provide an
Mental Health, adequate environment for their children. Little has been written
University of Haifa, about the different factors that affect these abilities in individuals
Bialik St. 13/1, with SMI. In this study, we explored a number of relationships that
Tel-Aviv, have been found in the literature to be related to parenting styles. Our
Israel main hypotheses were that the participants’ secure attachment with
E-mail: suzyella@gmail.com their parents is positively correlated with high levels of social support;
social support is positively correlated with the experience of having
Keywords: attachment, mental good parental competency; lack of parental competency is negatively
illness, parental competence,
correlated with problematic parenting styles. This correlational and
parenting style, social network
cross-sectional study was conducted with 60 mothers with SMI.
Accepted for publication: March 2012 Results suggest a strong relationship between parental style, sense of
parental competency, social support and attachment style of the
parent. Negative parental styles were found to be negatively corre-
lated with parental competence. Overactive and hostile parenting
styles were found to be correlated with the interviewees’ parental
overprotecting attachment style. Positive correlations were found
between parental competence and high social support. The results of
the study may help in developing future multidimensional interven-
tions for parents with SMI, to improve their parenting skills and
reduce any negative influence on their offspring.

with some level of mental illness (Maybery et al. 2009),

INTRODUCTION
Psychiatric deinstitutionalization has transferred the
focus of treatment of mental illness to the community.
One little recognized outcome of this change in policy
has been the increased opportunity for the population
with mental illness to experience parenthood. As the
majority of adults with severe and ongoing mental
illness spend most of their time in the community,
many of them aspire to normal adult roles, including
involvement in intimate relationships and childbear-
ing (Apfel & Handel 1993). Recent evaluations show
that the probability of childbearing for women with
mental illness is equal to that of women in the general
population, and most are also capable of parenting
their children (Oyserman et al. 2005).
As a result of this, as well as due to the fact that
significant numbers of children might have a parent
there is an urgent need to assist those parents whose
children might be at developmental, cognitive, emo-
tional or social risk (Smith 2004). Nevertheless, it is
important to emphasize that parents with a mental
illness are not a homogenous group; not all parents will
have their parenting compromised, and therefore, not
all children will be affected by their parents’ illness.
Many people with mental illness parent their children
well, and their children do not suffer any of the effects
mentioned above. Still, women with mental illness
might encounter parenting problems as a result of their
primary and secondary symptoms, their lack of knowl-
edge or the absence of social support, and may need
help in coping both with their mental illness and the
motherhood experience (Brunette & Dean 2002).
Therefore, researching the processes that contribute
to the different aspects of parenthood among mothers

1 Child and Family Social Work 2012 © 2012 Blackwell Publishing Ltd
 Parenting styles of mothers with SMI M Gelkopf and S E Jabotaro
with mental illness may help to develop insight into
the factors that influence their adjustment to the
parenting role and therefore may procure a better
understanding of the kind of services that may be
provided to these mothers. In this study, we focus on
four main areas, whose influence on parenting and
its outcomes has considerable significance among
parents in general, namely the mother’s parenting
styles, parenting competence, the social network at the
mother’s disposal, and the parent–child attachment
style that the mother herself experienced during her
childhood.
The parenting style that a mother adopts is of major
importance in childrearing. Indeed, not only have
studies consistently shown that a permissive parenting
style has a negative influence on children (Baumrind
1991), it has also been suggested that mothers with
mental illness tend to use problematic parenting styles
(Oyserman et al. 2005). Furthermore, Berg-Nielsen &
Vikan (2002), reviewing parenting studies in families
with either a parent or a child with mental illness, also
noted that the two main parental dysfunctionalities in
those families were parental negativity as well as inef-
fective parental discipline.
Another factor that might have a negative impact
on childrearing is a lack of parenting confidence,
which includes low parenting sense of competence
and satisfaction (Oyserman & Bybee 2004; Oyser-
man et al. 2005). Mothers with mental illness may
feel that they are not able to be good mothers, or
that they are lacking the parenting skills to provide a
suitable environment in which to raise children, not
because they are incapable, but because of a reduced
sense of parenting competence and sense of parent-
ing self-efficacy, which affects the ability to succeed
in applying their parenting knowledge (Oyserman
et al. 2005). Indeed, studies have suggested that
although mothers with mental illness considered par-
enthood as central to their lives, they also considered
it as a burden and were troubled about their degree
of competence in the parenting role (Oyserman &
Bybee 2004). Thus, the way mothers conceive of
their parental role can affect the quality of the
parenting, especially in times of stress (Raver &
Leadbeater 1999).
A further factor of importance for parenting is the
social networks to which mothers belong and the
social support received. These are significant, not
only as related to the childrearing process, but also
regarding the ongoing psychological adjustment
every mother has to undergo during childrearing. A
supportive social framework affects parenting in
2 Child and Family Social Work 2012
many ways. It can provide parenting models, it can
encourage or suppress certain types of behaviours by
sharing experiences and knowledge, e.g. regarding
where to set limits for the child, as well as providing
access to emotional support, a circle of friends and
genuine help to cope with the inevitable fears,
doubts and frustrations of parenthood. All these
aspects of social support and network should raise
the mother’s self-esteem and increase her ability to
respond to her children’s needs, while reducing the
stress of the caregiver role (Rogosch et al. 1992).
Studies have indeed shown a connection between
social support and better parental coping with crises
(Ackerson 2003), a positive correlation between low
levels of social support and low levels of parental
care (Parker & Barnett 1988), and a main positive
effect of social support on parenting stress (Ostberg
& Hagekull 2000).
Interestingly, it was found that the extent and sig-
nificance of the social support that individuals
received was related to the nature of the attachment
and parental experiences in early childhood (Crock-
enberg 1981). Therefore, the bonding experience of
mothers during their childhood might be another
important factor that can indirectly affect the quality
of the parenting. Indeed, it was found that adults, who
experienced a secure attachment in their childhood,
tended to be warmer, more sensitive and more
involved as parents as opposed to adults who experi-
enced an insecure attachment (Green et al. 2007).
According to attachment theory, these primary social
interactions, the most fundamental and essential of
which is the relationship that develops between
parents and children in the earliest years, will influ-
ence not only the nature and extent of social interac-
tions that form throughout their lives, but also how
adults function as parents.
In light of this short review of the literature, we
hypothesize that:
1. The greater the participant’s parenting compe-
tence, the more appropriate will be her parenting
style.
2. The wider and more established the social
network, the greater the parenting competence and
the more adequate the parenting style.
3. The more beneficial the participant’s attachment
to her own parents during childhood, the wider and
more established her adult social attachments.
4. The more beneficial the participant’s attachment
(to her own parents) during childhood, the higher the
parental competence and the more adequate the
parenting style.
© 2012 Blackwell Publishing Ltd
 Parenting styles of mothers with SMI M Gelkopf and S E Jabotaro
METHODS
Study participants
The study population comprised 60 mothers who
were diagnosed with severe mental illness (SMI) and
were treated in psychiatric departments.
Study procedure
After the study was approved by the local Helsinki
Committee, it was presented to caregiver staff and
psychiatrists, who were requested to locate mothers
with children under the age of 18, who would be
willing to participate in a study on parenting. Those
who signed the informed consent in the presence of
their clinicians were contacted by the researchers.
Only four of the potential participants preferred not to
participate in the study (94% participation rate).
Tools
The participants were invited to provide demographic
data, such as age, place of birth, family status, educa-
tion level, current place of residence, with whom they
lived, income and type of income, number of children
and whether their children currently lived with them.
Clinical information taken from the medical files
included major diagnosis, entitlement to the rehabili-
tation services package from the Israeli Ministry of
Health (Roe et al. 2010), age at first hospitalization,
number of hospitalizations, occurrence of the last hos-
pitalization and whether first hospitalization was prior
to or after giving birth.
Parenting style was measured using the Parenting
Scale (Arnold et al. 1993). This 30-item self-report
questionnaire, which measures dysfunctional disci-
pline styles, invites participants to answer questions
regarding their typical reactions to a variety of pre-
sented situations (Karazsia et al. 2008). There are
three factors, namely the permissive, hyperactive and
hostile parenting styles. In the present study, Cron-
bach’s alpha for the entire questionnaire was found to
be 0.69, for the permissive parenting style 0.73, for
hyperactive parenting 0.64 and hostile parenting 0.67.
Parenting competence was measured using the
17-item Parenting Sense of Competence scale
(Johnston & Mash 1989). This self-report question-
naire has two factors: efficacy and satisfaction. In the
present study, Cronbach’s alpha reliability for the sub-
scales of satisfaction and efficacy was 0.65 and 0.76,
respectively.
3 Child and Family Social Work 2012
Familial social network was measured using the
20-item Family Support Scale (Dunst et al. 1984). In
this self-report questionnaire, the participants were
invited to answer questions regarding the degree to
which various social resources had helped them in
raising their children over the last 3–6 months. In the
present study, Cronbach’s alpha reliability was 0.69.
The participants’ attachment style in childhood was
measured using the Parental Bonding Instrument
(Parker et al. 1979). The participants were invited to
respond to the self-report questionnaire by answering
questions regarding their parents’ behaviour towards
them during the first 16 years of life. The question-
naire’s 25 items measure behaviour patterns on two
subscales: the parental care scale and the parental
overprotection scale. In the present study, Cronbach’s
alpha was found to be 0.92 for the parental care and
0.85 for the parental overprotection scale.
Analyses
Univariate statistics were used in all analyses followed
by three linear regression analyses as dependent
variables: parenting confidence, satisfaction and
competence.
R E S U LT S
Description of the population
Characteristics of the study population are presented
in Table 1. Most participants were found to have been
born in Israel and to have grown up in their parents’
homes, and were currently living in their own homes.
Almost half of them were married and had been
through high school. A considerable percentage had
received higher education. Over half of them were
living mainly off stipends. Their average number of
children was three, and most participants were raising
their children at home.
An examination of the study participants’ clinical
data is presented in Table 2 and shows an almost
equal distribution of types of major diagnoses, with a
slight tendency towards Axis I diagnoses rather than
personality disorders. Most of the participants were
hospitalized for the first time after bearing a child.The
average age at this hospitalization was approximately
30, and the last hospitalization of over half of the
participants had occurred more than a year before.
Study outcomes
The hypothesis that the greater the participants’
parenting competence, the more appropriate their
© 2012 Blackwell Publishing Ltd
 Parenting styles of mothers with SMI M Gelkopf and S E Jabotaro

Table 1 Demographic data (n = 60) Table 2 Clinical data (n = 60)

n (SD) % Variable n (SD) %

Age, mean (SD) 41.1 (7.2) Major psychiatric diagnosis

Place of birth Schizophrenia 15 25
Israel 40 66.7 Bipolar disorder 14 23.3
Europe 12 20 Clinical depression 19 31.7
Africa 5 8.3 Personality disorder 12 20
Other 3 5 National Insurance Institute Disability
Family status percentage
Married 27 45 Entitled to basket of rehabilitation 39 65
Divorced 27 45 services
Single 4 6.7 Not entitled to basket of 21 35
Widowed 2 3.3 rehabilitation services
Education Age at first hospitalization, mean (SD) 29.55 (10.5)
Elementary school 9 15 First hospitalization
High school 31 51.7 Prior to first birth 13 21.7
Higher education 20 33.3 After giving birth 32 53.3
Main place of residence during childhood Number of hospitalizations
Parental home 49 81.7 0–2 27 45
Outside of parental home 11 18.3 3–5 16 26.7
Current type of residence 6–10 8 13.3
Independent 51 85 10 or more 9 15
Not independent (with family/hostel) 9 15 Last hospitalization
Currently living with: Currently hospitalized/in the last 19 31.7
Children and children’s father 25 41.7 year
Children and different partner 5 8.3 More than a year ago 30 50
Children and other/s 8 13.3 Unknown 11 18.2
Children only 21 35
Alone 1 1.7
Type of income SD, standard deviation.
Stipends 39 65
Stipends and employment 8 13.3
Employment 12 20
members and parenting competence (rp = 0.37,
Monthly income
Less than NIS 2000 1 1.7 P < 0.01) and efficacy (rp = 0.33, P < 0.05).
NIS 2000–NIS 3000 16 26.7 No significant correlation was found between the
NIS 3000–NIS 4000 25 41.7
participants’ social network and their parenting styles
Over NIS 4000 16 26.7
Number of children, mean (SD) 2.72 (1.4) or between bonding experiences in childhood and
Children’s main place of residence social relationships.
With the mother 53 88.3
The hypothesis that the more secure the partici-
Not with the mother 7 11.7
pant’s parent–child relationship in childhood, the
greater would be their parenting competence (effi-
SD, standard deviation.
cacy), was confirmed (rp = 0.39, P < 0.01), and a
significant negative correlation was found between
parental overprotection experienced by the partici-
parenting style would be, was partially confirmed. It pants in childhood and parenting satisfaction
was found that the lower the participants’ parenting (rp = -0.31, P < 0.05).
satisfaction (as a subcategory of parenting compe- The hypothesis that the more secure the parent–
tence), the more dominant their problematic parent- child attachment had been in the participants’ child-
ing style would be, whether this was permissive hood, the more appropriate their parenting style
(rp = -0.44, P < 0.001), hyperactive (rp = -0.29, would be, was partially confirmed. Significant corre-
P < 0.05) or hostile (rp = -0.29, P < 0.05). lations were found between parental overprotection
We found that the wider and more established the (in childhood), and hyperactive (rp = 0.28, P < 0.05)
social network, the greater the parenting competence. and hostile parenting (rp = 0.37, P < 0.01) but not
Significant correlations were found both between the between parental overprotection and permissive
extent of social support and parenting competence parenting, nor between parental care and the different
(rp = 0.31, P < 0.05), and satisfaction (rp = 0.43, parenting styles. All correlations are presented in
P < 0.001), as well as between support from family Table 3.

4 Child and Family Social Work 2012 © 2012 Blackwell Publishing Ltd
 Parenting styles of mothers with SMI M Gelkopf and S E Jabotaro

We further ran three linear regressions to predict

Efficacy
(PSOC)

0.25
-0.04
-0.00
permissive, hyperactive and hostile parenting styles.

1
The independent variables that were entered stepwise
were parental care, parental overprotection, social
support, parental competence, satisfaction and effi-
Satisfaction cacy. The final regression models show hyperactive

-0.44***
(PSOC)

-0.29*
-0.29*
parenting to be predicted solely by a lack of satisfac-

0.08
1
tion; hostile parenting to be predicted by overprotec-
tive parenting when the mothers were children; and
permissive parenting to be predicted by a lack of sat-
isfaction and a positive relation with parenting com-
Parenting competence

petence. Results are presented in Table 4.

0.67***
(PSOC)

0.79**

DISCUSSION
-0.18
-0.24
-0.22
1

In this study, we focused on several of the processes

that contribute to parenting in mothers with mental
FSS, Family Support Scale; PBI, Parental Bonding Instrument; PS, Parenting Scale; PSOC, Parenting Sense of Competence. illness. The four areas studied were the parenting
style that the mothers applied to their children, their
parenting competence, the social network at the
Social support
amounts (FSS)

mothers’ disposal, and the nature of the parent–child

0.26**

attachment during the mothers’ own childhood.

0.25
0.13
-0.12
0.01
0.09

Regarding the hypothesis that the greater the

1

parenting competence, the more appropriate the

parenting style will be, it was found that as parenting
satisfaction was lower, permissive, hyperactive or
hostile parenting styles tended to be more dominant.
Parental overprotection

This matches previous findings in the literature, sug-

gesting that the greater the parenting confidence, the
0.37**

better the mother–child interaction, while at the same

-0.31*

0.28*
(PBI)

-0.04
-0.24

-0.01
0.24

time, parenting errors were found to be related to a

1

low sense of parenting competence (Oyserman &

Bybee 2004).
The hypothesis that the broader the social network,
the greater the parenting competence would be, was
confirmed. This finding is in keeping with the litera-
Parental care

ture that shows that social networks can help individu-

-0.41***

0.39**

als create new, more adaptive behavioural parenting

(PBI)

-0.02
0.18
-0.09

0.06
-0.02
-0.08

patterns of parents living in different social circum-

1

stances. This is a subject of great importance due to

the fact that mothers with schizophrenia are more
Table 3 Correlation table (n = 60)

likely to be exposed to lack of social support and to

*P < 0.05, **P < 0.01, ***P < 0.001.

be socially isolated (Wan et al. 2008). According to

Hyperactive parenting style (PS)
Parenting competence (PSOC)

Permissive parenting style (PS)

Cochran & Brassard’s (1979) literature review, when

Social support amounts (FSS)
Parental overprotection (PBI)

Hostile parenting style (PS)

parents’ social environment was loving and relatively

stable and included a social network that provided a
Satisfaction (PSOC)

source that helps dealing with doubts and frustrations,

Parental care (PBI)

they were able to be more sensitive to their children’s

Efficacy (PSOC)

needs. Therefore, those findings are in accordance

Variables

with the recognition that intimate and steady contact

with relatives, neighbours and friends may increase
parental competence (Mercer & Ferketich 1994;

5 Child and Family Social Work 2012 © 2012 Blackwell Publishing Ltd
 Parenting styles of mothers with SMI M Gelkopf and S E Jabotaro
Parental styles
Permissive
B (SE)
Satisfaction -0.43 (0.10)***
Efficacy 0.32 (0.13)**
Overprotective parenting as a child
*P < 0.05, **P < 0.01, ***P < 0.001.
SE, standard error.
Pridham & Chang 1992). Nevertheless, these sugges-
tions should be taken with some reserve, as our study
was correlational, and it is also possible that it is the
competence of parents that enhances social networks
and not the other way around. Further long-term
studies should be undertaken before we can assume
causality.
No confirmation was found for the existence of a
correlation between the nature of the attachment in
childhood and social relationships in the present
study. Bowlby has claimed that lifetime development
is not only a product of the attachment patterns in
early developmental history but also of current cir-
cumstances, genetic factors, life experiences, continu-
ity and adjustment, as shaped by the person (Sroufe
et al. 1990). In other words, although attachment pat-
terns during early childhood are important, they are
not the only factor that influences our social relation-
ships as adults. Therefore, there is room for further,
more focused study of this field.
In addition, the hypothesis that the more secure
the participant’s parental attachment in childhood,
the greater her parenting competence would be, was
confirmed. This finding matches previous studies on
attachment, supporting Bowlby’s view that attach-
ment is central to emotional adjustment (Berant et al.
2001). Indeed, studies have shown that people who
display highly anxious or avoidant attachment styles
tend to evaluate themselves, as well as stressful
events, in negative terms, tend to avoid seeking help,
and report high levels of distress under stressful con-
ditions (Mikulincer & Florian 1998). All these out-
comes can lead to a diminished sense of parenting
competence.
Partially confirmed was the hypothesis that the
more secure the participant’s attachment to her
parents in childhood, the more appropriate her
parenting style will be. Parental overprotection during
the mother’s childhood was found to be highly related
6 Child and Family Social Work 2012
Table 4 Final stage of three
linear regressions predicting
three parental styles
Hyperactive Hostile
B (SE) B (SE)
-0.22 (0.10)*
0.10 (0.06)*
to current hyperactive and hostile parenting styles.
Only the relationship with hostile parenting was con-
firmed by the regression analysis. Bowlby’s (1977)
attachment theory indicates that the early relationship
between infants and their caregivers shapes emotional
representation, which will outline their future relation-
ships, including future parenthood. An infant whose
needs are constantly met learns to feel deserving of
love, trust and security; whereas a neglected infant,
who experiences abuse or unstable parenting, will
bring a lack of self-confidence into future relation-
ships, especially parenthood. Following from this, it is
logical to conclude that inadequate attachment in
childhood could become a mechanism through which
uncompromising parenting or defective treatment of
children might be passed down to generations. Nev-
ertheless, it should be noted that there are exceptions,
and many people who experienced abuse in childhood
behave very differently towards their own children.
Indeed, studies have shown that some people with
insecure parental attachment during childhood will
provide their children with a secure attachment
(Travis & Combs-Orme 2007). Therefore, parental
influences are just one of many mechanisms that can
affect how parents will raise their children. Hosman
et al.’s (2009) developmental model includes genetic,
parental influences, parent–child interactions, family
processes and conditions, as well as social influences
such as major risk and protective factors for the trans-
generation transmission of psychopathology.
To conclude, during the inquiry process, many of
the participants expressed their agreement to partici-
pate in the study out of a hope that the study’s results
could influence future policy-making. Indeed, many
of the mothers expressed the need for assistance,
which would take into consideration both their mental
illness and their parental functioning.
The study results underscore the importance of
providing the necessary assistance for mothers with
© 2012 Blackwell Publishing Ltd
 Parenting styles of mothers with SMI M Gelkopf and S E Jabotaro
mental illness to cope with parenthood. This can be
achieved through providing tools and professional
direction to expand and stabilize social networks and
to improve parenting confidence.
Our results show that the greater the parenting
competence, the more appropriate the parenting style
and the wider and more established the social
network. This suggests that parental assistance needs
to focus on parental empowerment, while imparting
tools and direction to improve existing social support
and networks. Indeed, this might enhance parenting
competence, which has a critical influence on the
parenting style. In addition, the results regarding the
positive connection between a secure attachment
during childhood to both greater parenting compe-
tence and a more appropriate parenting style in
adulthood, lead us to consider the need for providing
therapeutic interventions aimed at resolving thera-
peutic issues surrounding the nature of the attach-
ment of individuals with mental illness to their own
parents. The need to help those parents can be met,
e.g. by parent education and psychotherapy in
group interventions, as suggested by Marvin et al.
(2002). By providing this type of assistance, we might
empower and implicitly recognize the natural right of
people with mental illness to act as parents to their
children, as well as our obligation, as professionals,
to help them fulfil their parenting role in the best
possible way.
There are four main limitations regarding the
present study that imply the need for further research.
The first is its relatively small sample recruited in a
specific environment, which limits the generalization
of the findings to the general population of mothers
with SMI.The second is that the study was conducted
at only one point in time, so that there is room for a
longitudinal study, to enable the evaluation of caus-
ative factors. Our third limitation lies in it being a
correlational study, and therefore limits us in our
ability to assume causality, especially concerning the
relation between mothers’ social support and confi-
dence.The fourth limitation relates to the study popu-
lation. Our participants had only four major
diagnoses, and it is possible that women with different
kinds of diagnoses will have different kinds of parent-
ing as well as parenthood experiences.
Because of the fact that most recent studies deal
with the general implications of parenting with a
mental illness, other more specific factors affecting
parenting should be researched, such as parents’ cog-
nitive functioning, their management of symptoms,
accessibility to community resources and awareness of
7 Child and Family Social Work 2012
the illness itself, all of which may affect parenting
styles and processes and, ultimately, child well-being.
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