Psychiatric disorders are increasing and significantly affecting the public health all over the world . These disorders usually occur with psychological and behavioral manifestations which lead to significant functional deficiencies. Among the psychiatric disorders, schizophrenia, bipolar disorder, and depression are particularly important with the highest bed occupancy rates in psychiatric wards. Schizophrenia is a severe psychiatric disorder involving delusions and hallucinations. Depression is characterized by feeling sad, anhedonia, guilt, and suicidal thoughts, and bipolar is defined as periods of depression, elevated mood, over activity, reduced need for sleep, and pressured speech . There are 20 million people with schizophrenia, about 45 million cases of bipolar disorder, and 264 million people with major depression around the world . In Iran, demographic studies have reported the prevalence of these three disorders to be 25–31% .
Such diseases entail serious ramifications for patients and affect their interpersonal relationships and personal and social performance. Feelings of helplessness, hopelessness, worthlessness, stigma, fear, vulnerability, and low quality of life are among such consequences . Various biological, familial, psychosocial, and spiritual factors are involved in the etiology of these disorders. These factors can be considered as predisposing, precipitating, and perpetuating factors . Family, as one the most important factors, could impact the mental health of the members . In Iran, the recent socio-economic changes, advances in technology, fading family traditions, more women’s social activities, and employment of both parents outside home have led to the investigation of the role of family, especially parents, in the development of children's mental health.
Over the past decade, some studies have reported that the quality of life is lower in patients with mental disorders than the general public . These investigations have raised questions led to further research on relationships among family members and its effects on children’s mental health. Accordingly, the available scientific evidence has hypothesized that family or parents can have critical parts in the occurrence of certain mental disorders. The theory of schizophrenogenic mothers and learned helplessness theory have raised hypotheses as to the role of family in shaping the context for schizophrenia and depression, respectively. On this account, family relationships, particularly parents' roles in the family and children's mental development, can be considered and studied as strong variables influencing the children’s future mental health [8, 9].
In this regard, the concept of parental bonding has been specifically taken into consideration by researchers worldwide . For instance, according to Bowlby’s theory of attachment, parents who are unable to either establish warm, loving, and close relationships with their children or provide the necessary environment for their children’s independent development, raise their children in an atmosphere of anxiety, leading to psychological disorders . The concept of parental bonding also focuses on the quality of the relationship between parents and offspring throughout their life. A warm relationship with adequate parental care and control (optimum parental bonding) plays an important role in the development children’s mental health. On the contrary, dysfunctional parenting leads to problems in interpersonal relationships and psychiatric disorders caused by the cold relationship between parents and children, inadequate care, and excessive control or rejection of children . As a leading researcher in this field, Parker has introduced the dual styles of parental bonding in a continuum. The first style, "caring parental bonding", reflects a warm, close, and empathetic relationship as opposed to a cold, rejecting, and neglecting relationship. The second style is the "over protection" or "control parental bonding" which involves parents' severe control and protection over their children, leading to the non-completion of independence in the children .
Studies focusing on the concept of parental bonding have examined the effects of parental styles on children’s mental health [14, 15]. For instance, a study in Brazil compared the parental bonding styles of parents of schizophrenic and bipolar patients. Based on their results, there were significant differences between parental bonding styles in these two diseases, especially among the maternal bonding styles . Another study was conducted to determine the relationship between parental bonding and attitudes toward suicide in medical students in Japan. The researchers concluded that high levels of maternal care ensured reduced suicidal ideation . In Iran, results of a cross-sectional study on university students showed that the students who experienced a less caring parental bonding style, had significantly higher psychological symptoms, particularly depression, anxiety, and paranoia . In this study, researchers investigated the healthy dormitory students of a university in Iran. On the contrary, the results of another study in Iran revealed that depression and lack of self-confidence rates in children significantly increased in parenting styles in which parents exaggerated in caring for or controlling their children .
Health care providers should target both patients and their families, necessitating an accurate evaluation of family performance . A review of the related literature also indicates that relatively few studies have addressed psychiatric patients, and most have mainly focused on samples other than psychiatric patients. This research gap is more evident in Iran. Due to the increasing prevalence of psychiatric disorders and the undeniable role of family in the development of children's mental health, there is an urgent need for more detailed studies in this field.
This study aimed to evaluate and compare parental bonding styles in patients with schizophrenia, depression, and bipolar disorders in Bushehr, Iran.