Living arrangements and social support: effects on the well-being of mothers with mental illness.

Author:Mowbray, Carol T.
 
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This article examines the effects of living arrangements on the well-being of mothers with a serious mental illness. Analyses of data from a National Institute of Mental Health-funded study of an urban, primarily African American sample of 379 mothers with mental illness revealed few differences in parenting or social functioning between mothers living with their children and a spouse or partner and those living with their children only. However, mothers living with their children and extended family had significantly better outcomes than women in the other two living arrangements. Structural equation modeling analyses indicated that living with relatives significantly related to mothers' well-being (social functioning and parenting) above and beyond relatives' provision of social support. Multilevel modeling revealed racial differences in the effects of living with relatives on functioning and parenting stress: Effects were positive for African American mothers but mixed for white American mothers.

KEY WORDS: extended family; mental illness; mothers; psychiatric disabilities; social support

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Motherhood is an important role for many women--one associated with numerous rewards and positive experiences, as well as arduous responsibilities and stresses, in that mothers often maintain the primary responsibility for their children (Larson & Richards, 1994). However, fathers and other relatives can and do play significant roles in children's lives and in alleviating mothers' duties and pressures. Indeed, living arrangements and marital status are key predictors of mothers' well-being, with many studies concluding that married mothers are better off than their single counterparts (Coombs, 1991; Davies, Avison, & McAlpine, 1997). However, other researchers have concluded that the aloneness of mother (that is, absence of supportive adults), more than particular family structure or living situation, is associated with reduced global well-being (Demo & Acock, 1996). Living with relatives may promote the well-being of mothers through provision of increased support; for example, mothers who receive more emotional support have been found to be more nurturing in their parenting (Weinraub & Wolf, 1983). Living with extended family appears to have especially positive effects for some sub-populations; for example, in black families, kin networks have heightened importance (Stack, 1974). Living arrangements and family support can also be significant for mothers who are at risk of problems in parenting or well-being.

Women with mental illnesses who are mothers are at risk of parenting and other functioning problems (see review by Oyserman, Mowbray, Allen-Meares, & Firminger, 2000). However, most of this research has focused on clinical variables as predictors, such as diagnosis, chronicity, and age of onset. Very little research has investigated the contributions of contextual features, such as living arrangements, which may be more malleable and subject to intervention than clinical history. In mental health services, clients' living arrangements are seen as important factors in recovery, evidenced by supported housing initiatives (Carling, 1995).

However, living arrangements are often confounded with family support (both positive and negative) and differ for African American and white families; therefore, analyses of living arrangements of mothers with mental illness must also attend to the effects of race and social support. Because research focused specifically on mothers with a mental illness is sparse, our literature review includes research on the effects of living arrangements and social support on the well-being of other groups of at-risk mothers as well.

THE EFFECTS OF LIVING ARRANGEMENTS

For adolescent mothers, policymakers have presumed that coresidence with family is beneficial, as evidenced by the requirements of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (EL. 104-193), but research results are mixed. One study found that for low-income teenage mothers, living with biological parents was associated with having congruent expectations and aspirations (Hellenga, Aber, & Rhodes, 2002). Others have reported no effects (Kalil, Spencer, Spieker, & Gilchrist, 1998) or negative effects of coresidence (Caldwell, Antonucci, Jackson, Wolford, & Osofsky, 1997; Chase-Lansdale, Brooks-Gunn, & Zamsky, 1994; Nitz, Ketterlinus, & Brandt, 1995).

Mothers with mental illness are often single, living alone with their children, and in poverty--all of which can exacerbate symptoms (Rogler, 1996) and be risk factors for child outcomes (McLoyd & Wilson, 1990).Thus, mothers with mental illness who are single parents could be expected to function less well than their married counterparts because of role overload, financial problems, and so forth. Living with extended family has not been studied for mothers with mental illness--a significant gap, given that these women may be more likely to live with their families due to lower marriage rates and higher divorce rates (Goldman, 1982; Lehman, Ward, & Linn, 1982). Research on single adults with mental illness who live at home suggests that their family environments often differ significantly. In families with a member who has a mental illness, "expressed emotion" (critical or hostile comments or emotional over-involvement) predicted relapse in schizophrenia and mood disorders (Butzlaff & Hooley, 1998).Thus, we might expect that living with extended families would have some negative effects on mothers with mental illness.

THE BENEFITS OF SOCIAL SUPPORT

For low-income single mothers, social support reportedly reduces the impact of stressful life events, like poverty, on psychological adjustment (Goodman & Johnson, 1986; Kessler & McLeod, 1985). For teenage mothers, consistently significant positive relationships have been found between family social support and outcomes, whereas lack of family support (Turner, Grindstaff, & Phillips, 1990; Unger & Cooley, 1992; Voran & Phillips, 1993) and conflictual family relationships (Thompson & Peebles-Wilkins, 1992) relate to poor adjustment (Barth & Schinke, 1983; Nitz et al., 1995). However, social support can be either positive (supporting) or negative (stressing) (Belle, 1982).

Many married women with mental illness report high levels of marital conflict and family strife (Mowbray et al., 2000; Ritsher, Coursey, & Farrell, 1997) and may have spouses with psychiatric disorders (Miller, 1997) that could exacerbate their own functioning problems. Thus, the relationship between living with a spouse or partner and social support cannot be assumed for women with mental illness. Salokangas (1997) found that for men with schizophrenia, living with a spouse or parents contributed positively to outcomes, but the reverse was true for female patients. Furthermore, it is reportedly difficult for many women with mental illness to sustain family relationships (Nicholson & Blanch, 1994; Ritsher et al.). Because mothers with mental illness often experience greater family conflict and social isolation (Downey & Coyne, 1990), they may receive less social support from family members even when they are living with them than is the case for other mothers (Caron, Tempier, Mercier, & Leouffre, 1998; Puckering, 1989).

Extended family support for parenting has not been studied in mothers with mental illness, nor has its effects on functioning or well-being. An exception is qualitative research by Nicholson, Sweeney, and Geller (1998), who found that positive family support is an asset for mothers with mental illness (and lack of support a liability), especially for those living in poverty, but that there is often conflict with family members, particularly over the parenting role.

RELATIONSHIP BETWEEN SOCIAL SUPPORT AND LIVING ARRANGEMENTS

Although research has examined the impact of social support or living relationships on the outcomes for at-risk mothers, the relationship between the two constructs has not been examined, with some exceptions. Both Chase-Lansdale and colleagues (1994) and Nitz and colleagues (1995) reported that parental support positively affected teenage mothers' parenting and reduced stress levels, but only when parents and teenage mothers did not coreside. Henly (1997) studied adolescent mothers and the reciprocal relationships between living arrangements and various types of support. She concluded that, for these young mothers, living arrangements were less important to psychological adjustment than were emotional and material support. Henly's study did not examine the role of negative support, which, in many studies, has been found to have an even greater impact on well-being than positive support (Rook, 1984; Todd & Worell, 2000; Vinokur & van Ryn, 1993).

DIFFERENTIAL EFFECTS OF RACE AND ETHNICITY

Living arrangements and family support may have qualitatively different influences in the lives of mothers from different racial or ethnic groups. For the most part, research suggests more benefits of coresidence in African American than in white American households, because the former emphasize cooperation among family members and involvement in decision making in times of distress (Finley, 1998). Congruent with this evidence, African American compared with white American adolescent mothers reported less conflict with their parents (Caldwell et al., 1997); for white American (but not African American) adolescent mothers, living with mothers related to more stress and worse parenting outcomes (Spieker & Bensley, 1994; Unger & Cooley, 1992), with some exceptions (Caldwell, Antonucci, & Jackson, 1998). Henly (1997) also found that the effects of specific types of family support differ by race.

In populations with mental illness, it appears that African Americans with mental illness, compared with non-Hispanic white Americans, are more likely to live with extended family and to rely on informal networks for...

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