Older age mothers (1995-9)
The lifetime experiences of an older age group of mothers was examined
to look both at experiences of a previous cohort of mothers, for
example those born before the second world war, but also to examine
the experience of mothers whose daughters had proved high risk for
depression in midlife. Establishing how risk may have been transmitted
intergenerationally for this age group would add to the lifespan
models developed. Such investigation is of course dependent upon
good retrospective measures, and since the CECa and ALPHI interview
had proved so robust on midlife women, it was hoped that the same
would hold for an even older age group. In addition, social isolation
has been identified as a risk in older persons for depression and
anxiety orders. ‘Disengagement’ has been viewed as a
characteristic of older life stages and explained in terms of loss
of close others with low opportunity for increasing attachment.
Therefore attachment style in older persons, specifically
around avoidance, was examined as a theoretical framework for exploring
isolation in relation to disorder.
Aim
To look at lifetime psychosocial risk for disorder in an older group
of mothers aged 50-85. To test the same model as in midlife women,
investigating childhood experience, adult adversity, attachment
style and self-esteem. Also, to compare risk in these mothers and
their midlife daughters to look for mechanisms of intergenerational
transmission.
The sample
81
women aged between 50 and 75 were selected for interview. These
comprised three groups:
•
Intergenerational high-risk series
- 33 mothers of midlife women already studied who had been selected
on the basis of GP screening in 1990-5 as vulnerable to depression.
The daughters all had psychosocial risks in terms of either childhood
neglect or abuse, or poor adult relationships. This included a
series of sisters.
• Intergenerational comparison
series - 23 mothers of midlife comparison women
who were selected consecutively from GP surgery records and studied
in 1990-5. Each mother had two daughters in the study.
• New series
- 25 newly selected women from GP lists, all of whom had a midlife
daughter in Islington in common with the other two groups.
9%
of the older mothers directly refused the interview and 11% of midlife
daughters refused to contact their mothers for the study. A further
20% were either too ill (7%) or had died (13%) since the original
study. 13% of either midlife daughters or their mothers proved unobtainable
at the follow-up of the original study (eg having moved away). 13%
of mothers were not contacted because they did not bring up the
daughter. This resulted in 34% of the original mothers identified
being interviewed.
Of
the newly selected series: 108 women were screened by questionnaire
through GP surgery listings. 9% refused to be interviewed, 7% proved
unobtainable, 22% were unsuitable having no midlife daughter in
Islington and 23% were interviewed.
For
other analyses midlife daughter and older mothers were paired to
look at intergenerational transmission. For this analysis all 81
women were analysed as a single group to examine inter-respondent
risks for disorder and social support.
There
were no significant differences between the three groups in demographic
or disorder variables.
Method
The 81 community-based mothers aged between 50 and 75 (average age
64) were selected for interview. All women were contacted for interview
in their own homes, wherever they lived in the UK. The ‘mini-mental’
test was used to screen out women over 65 with cognitive deficit
or signs of dementia. A lifespan interview covering childhood and
adult adversity, current support and attachment style and lifetime
episodes of depression and anxiety was conducted.
Measures used
Results
Disorder:
24%
of women experienced case of depression or anxiety in the 12 months
before interview and 17% had chronic or recurrent episodes during
their lifetime. This was a lower rate than shown by their daughters
who had been studied, and substantially lower than the adolescents
studied.
Attachment
style: Three-quarters
of the women were judged to have highly insecure attachment style,
of which ‘Withdrawn’ was the most common. Insecure attachment
style was significantly related to social isolation, marked loneliness
and history of poor partner relationships. However, consistent with
other analyses, Withdrawn style was unrelated to affective disorder,
Fearful or Angry-Dismissive styles had the highest rates of disorder.
Childhood neglect/abuse and adult adversity were associated with
increased rates of such insecure attachment. Attachment style is
an important aspect of older life experience and can denote isolation,
loneliness and poor support. This needs to be understood in treating
older persons at risk for affective disorder. Attachment style proved
to be associated with disorder as in all series including the elderly.
Rates of insecure were high in the elderly due mainly to paucity
of close relationships with the most common attitudes denoting 'withdrawn
avoidance' indicating high self-reliance and attitudinal constraints
on closeness and help-seeking.
Lifetime
psychosocial risk in
the form of childhood neglect/abuse, adult attachment style and
chronic adversity are associated with affective disorder in this
series as in all the three generations. These replicate previous
findings on the mid-life series studied in the last programme. Associations
with childhood experience were however, weakest in the elderly series.
This maybe due to the weakening influence of childhood with the
passage of time, or may be due to a different environmental impact
and sensitivity on an earlier cohort. These alternative explanations
require further analysis. Young daughters were found to have significantly
more adult life phases and change points than women in their grandmothers'
generation, implying an acceleration of pace of life in terms of
change of partners, living place and major roles. Where such change
is associated with premature embarkation into adult roles this may
account for some of the increase in risk. Further analysis of adversity
and change will be made to test such hypotheses.
Inter-generational
analysis: Characteristics
of older age mothers and their midlife daughters was examined in
terms of two outcomes in the offspring: neglect/abuse in childhood
and lifetime recurrent disorder. Mothers insecure attachment at
interview was highly related to disorder in her daughter at follow-up.
There was however no relationship between mothers depression (either
in 12 months before last contact or lifetime recurrent disorder),
or fathers lifetime disorder and the daughters disorder. Mother's
own neglect or abuse in childhood was unrelated to her daughter's
neglect/abuse in this high risk series although it was significant
at the 5% level in the comparison series. Mothers, but not fathers,
lifetime chronic or recurrent disorder was significantly associated
with her daughters experience of neglect/abuse Logistic regression
showed that daughters neglect/abuse and mothers vulnerability were
required to model daughters disorder. Lifetime disorder of either
mother or father did not add to the model.Logistic regression showed
that daughter's neglect/abuse in addition to mothers non-standard
attachment style was required to model daughters disorder.
