People who have experienced mental illness and those whose prospective partners have family history of mental illness are often worried about the illness affecting their families. They worry that there is a high chance for their future children to be affected with the same illness.

Affected individuals may choose not to have children either because of the fear of being inadequate parents or the fear of bringing up children with a mental illness.  Running through their mind are usually questions such as: Would I be able to take care of my children?

What will happen if my mental sickness became uncontrollable? How would it be to watch my own children struggle with a mental illness? Other fears are often related to the question of disclosure to a potential partner who desires to have children.  Is this fear always warranted? This article discusses the role of genetic counselling in mental illness.

What is genetic counselling?

Genetic counselling is a process where information about the causes of an illness and about the chances for members of families with these illnesses to become similarly affected is provided in a supportive environment by a specially trained healthcare professional.

Genetic counsellors are involved in evaluating the risk of getting the illness, recurrence, educating patients about risks and providing information on various options. Genetic counselling may be given to a woman during prenatal screening or after the birth of a child with a birth defect or a genetic condition.

Some people may see a genetic counsellor before deciding to get married to a person with genetically influenced or determined disorder or one who has a family history of such a disorder. In Uganda genetic counselling is often offered by the attending clinician or health worker.

Determining genetic vulnerability for mental illness:

Mental disorders such as Schizophrenia, Bipolar disorder and major Depression are relatively highly inheritable and thus tend to run in families; however there is enormous variation in the rates of illness manifesting among family members because of the complex interactions between genetic risk and environmental factors in determining illness expression.

In addition, the genes for these major mental illnesses remain largely unidentified and unstudied. Therefore, counsellors do not have the kind of data or information that allows for more exact predictions in terms of risk to the unborn baby which may not be the case in other genetic illnesses. There is however, valuable data that allows clinicians to help educate concerned patients who wonder what vulnerabilities they may be passing on to their children.

In order to determine whether mental illness runs in one’s family or whether you are genetically predisposed to it, involves collecting information about the family members such as grandparents, parents, siblings, children and other close relatives. Information on cousins, nephews and nieces may also be collected but tends to be unreliable.

Information on the causes of death for a family member such as suicide, unexplained disappearance from home, abandoning work for a long period of time influenced or constantly switching jobs, jumping from one relationship to another, drug abuse and excessive use of alcohol, having a nervous breakdown and ever being frequently admitted to a psychiatric hospital may point to a generically recurring mental illness.  The above features may suggest increased future vulnerability for you and the offspring particularly when those affected are very close to you.

Dr.  Fred Kigozi is a Senior Consultant Psychiatrist, Executive director Butabika Hospital

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