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Stitt N, Reupert A. Mothers with an eating disorder: 'food comes before anything'. J Psychiatr Ment Health Nurs 2014; 21:509-17. [PMID: 23869653 DOI: 10.1111/jpm.12104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 11/28/2022]
Abstract
There is little research that has presented the voices of mothers with an eating disorder (ED). The aim of this study was to clinicians present the experiences of mothers, drawn from the community, who have an ED and their perceptions regarding how their ED impacts on their children and parenting. Semi-structured, individual interviews were conducted with nine mothers with various EDs. Interpretative Phenomenological Analysis, alongside member checks and inter-rater reliability, was employed to analyze data. Six themes were identified: (1) the impact of an ED on children; (2) modelling disturbed eating behaviours; (3) prioritizing food before children's needs, or as described by one participant, 'food comes before anything'; (4) children motivate recovery; (5) secrecy within families; and (6) treatment needs. Overall, mothers juggled to balance the competing demands of an ED and the needs of their children. The need for clinicians to acknowledge and support a mother's role when treating EDs is highlighted.
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Affiliation(s)
- N Stitt
- Faculty of Education, Monash University, Clayton, Vic, Australia
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102
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Farrelly S, Clement S, Gabbidon J, Jeffery D, Dockery L, Lassman F, Brohan E, Henderson RC, Williams P, Howard LM, Thornicroft G. Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: a cross sectional study. BMC Psychiatry 2014; 14:157. [PMID: 24885144 PMCID: PMC4045950 DOI: 10.1186/1471-244x-14-157] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 05/15/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The unfair treatment of individuals with severe mental illness has been linked to poorer physical and mental health outcomes. Additionally, anticipation of discrimination may lead some individuals to avoid participation in particular life areas, leading to greater isolation and social marginalisation. This study aimed to establish the levels and clinical and socio-demographic associations of anticipated and experienced discrimination amongst those diagnosed with a schizophrenia and comparator severe mental illnesses (bipolar and major depressive disorders). METHODS This study was a cross-sectional analysis of anticipated and experienced discrimination from 202 individuals in South London (47% with schizophrenia, 32% with depression and 20% with bipolar disorder). RESULTS 93% of the sample anticipated discrimination and 87% of participants had experienced discrimination in at least one area of life in the previous year. There was a significant association between the anticipation and the experience of discrimination. Higher levels of experienced discrimination were reported by those of a mixed ethnicity, and those with higher levels of education. Women anticipated more discrimination than men. Neither diagnosis nor levels of functioning were associated with the extent of discrimination. Clinical symptoms of anxiety, depression and suspiciousness were associated with more experienced and anticipated discrimination respectively. CONCLUSIONS The unfair treatment of individuals with severe mental illnesses remains unacceptably common. Population level interventions are needed to reduce levels of discrimination and to safeguard individuals. Interventions are also required to assist those with severe mental illness to reduce internalised stigma and social avoidance.
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Affiliation(s)
- Simone Farrelly
- Section of Community Mental Health, Health Service and Population Research Department, King's College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK.
| | - Sarah Clement
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Jheanell Gabbidon
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Debra Jeffery
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Lisa Dockery
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Francesca Lassman
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Elaine Brohan
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK,Adelphi Values, Adelphi Mill, Grimshaw Lane, SK10 5JB Bollington, Cheshire, UK
| | - R Claire Henderson
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Paul Williams
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Louise M Howard
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Graham Thornicroft
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
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103
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Myors KA, Schmied V, Johnson M, Cleary M. Therapeutic interventions in perinatal and infant mental health services: a mixed methods inquiry. Issues Ment Health Nurs 2014; 35:372-85. [PMID: 24766172 DOI: 10.3109/01612840.2013.873100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Perinatal mental health disorders potentially have long-term negative sequelae for women, their infants and their families. Multidisciplinary perinatal and infant mental health (PIMH) services are an emerging specialty in mental health designed to improve mother-infant outcomes. This mixed methods study explored the characteristics of women referred to a specialist PIMH service and the therapeutic interventions that PIMH clinicians use. Women referred to the service were identified with multiple and complex risk factors. Perinatal and infant mental health clinicians use a range of interventions, dependent upon their training, such as family of origin work/genograms, non-directive counseling, and strategies to manage anxiety and depression. Clinicians also emphasized the therapeutic relationship and the interventions they use within an attachment-based framework, which warrants further research.
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104
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Peay HL, Rosenstein DL, Biesecker BB. Parenting with bipolar disorder: coping with risk of mood disorders to children. Soc Sci Med 2013; 104:194-200. [PMID: 24581078 DOI: 10.1016/j.socscimed.2013.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 08/12/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
Abstract
Children of individuals with bipolar disorder (BPD) have increased risk for mood disorders and other adverse psychosocial outcomes due to genetic and environmental risk. Though parents with BPD are aware of increased risk to children, little is known about efforts undertaken in response or their perceived utility. Among parents who self-report with BPD, this study identifies key variables associated with parental coping with children's risk of mood disorders; and explores the relationship between monitoring children's moods and perceived coping efficacy. In this U.S. study, active parental coping with, and cognitive distancing from, child's risk were measured using novel scales. Parents (n = 266) who self-identified as having BPD completed a web-based survey. They had at least one unaffected child. Most participants endorsed monitoring their children's moods. Monitoring was associated with increased perceived control over the child's well-being (p < 0.005), but not feeling less worried. Active parental coping with risk to children was positively associated with active coping with own illness (β = 0.25, p = 0.001), family history (β = 0.24, p = 0.001), and self-report of current depression (β = 0.16, p = 0.037), explaining 13.8% of the variance (F = 8.81, p < 0.001). Cognitive distancing from the child's risk was positively associated with confidence in diagnosis (β = 0.25, p = 0.001), and negatively associated with self-report of current mania (β = -0.19, p = 0.007), perceiving BPD as genetic (β = -0.26, p < 0.001) and having more children (β = -0.20, p = 0.004); explaining 16.2% of the variance (F = 8.63, p < 0.001). Parents' adaptation to their own BPD was modestly correlated with active coping with child's risk (r = 0.15, p < 0.05) but not with cognitive distancing. The findings support the importance of understanding causal attributions and the value of genetic education and counseling for parents with BPD. Further research is necessary to elucidate the psychological benefits of active coping versus cognitive distancing from child's risk, and explore additional variables that predict parental coping with children's risk of mood disorders.
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Affiliation(s)
- Holly Landrum Peay
- Social and Behavioral Research Branch, National Human Genome Research Institute, NHGRI Building 31, Room B1B36 31 Center Drive, MSC 2073, Bethesda, MD 20892, USA.
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina at Chapel Hill, Physicians Office Building, Room 3134 Chapel Hill, NC 27514, USA; Lineberger Comprehensive Cancer Center, School of Medicine, CB# 7295, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Barbara Bowles Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, NHGRI Building 31, Room B1B36 31 Center Drive, MSC 2073, Bethesda, MD 20892, USA.
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105
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Glangeaud-Freudenthal NMC, Howard LM, Sutter-Dallay AL. Treatment - mother-infant inpatient units. Best Pract Res Clin Obstet Gynaecol 2013; 28:147-57. [PMID: 24054169 DOI: 10.1016/j.bpobgyn.2013.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/02/2013] [Accepted: 08/22/2013] [Indexed: 11/27/2022]
Abstract
Infants of parents with psychiatric disorders may be particularly vulnerable and have a higher risk of developing psychiatric disorders in adulthood. Until the second half of the 20th century, women and infants were cared for separately. Today, hospitalisation of women with their babies in psychiatric mother-baby units enables psychiatric care of women and promotion of parent-infant interactions and child development. The distribution of psychiatric mother-baby units around the world, as well as within countries, varies strongly. Reasons for this may be related to the absence of national perinatal mental health policies related to psychiatric mother-baby unit location, differences in sources of referral for admission, and criteria for psychiatric mother-baby unit admission. Two principal national epidemiologic studies, in England and in France and Belgium, have described issues related to discharge from such care, as have smaller local studies, but no epidemiologic studies have yet demonstrated that joint inpatient psychiatric mother-baby unit care is cost-effective compared with separate care.
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Affiliation(s)
- Nine M C Glangeaud-Freudenthal
- INSERM, UMRS 953 Paris, Maternité Port Royal, 53 avenue de l'Observatoire, 75014 Paris, France; UPMC University Paris, Paris, France.
| | - Louise M Howard
- Section of Women's Mental Health and Women's Health Academic Centre, Institute of Psychiatry, King's College London, UK
| | - Anne-Laure Sutter-Dallay
- University of Bordeaux, Centre Hospitalier Charles Perrens, Bordeaux, France; INSERM, Centre Hospitalier Charles Perrens, Bordeaux, France
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106
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107
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Jeffery D, Clement S, Corker E, Howard LM, Murray J, Thornicroft G. Discrimination in relation to parenthood reported by community psychiatric service users in the UK: a framework analysis. BMC Psychiatry 2013; 13:120. [PMID: 23601350 PMCID: PMC3637460 DOI: 10.1186/1471-244x-13-120] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 04/15/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Experienced discrimination refers to an individual's perception that they have been treated unfairly due to an attribute and is an important recent focus within stigma research. A significant proportion of mental health service users report experiencing mental illness-based discrimination in relation to parenthood. Existing studies in this area have not gone beyond prevalence, therefore little is known about the nature of experienced discrimination in relation to parenthood, and how is it constituted. This study aims to generate a typology of community psychiatric service users' reports of mental illness-based discrimination in relation to becoming or being a parent. A secondary aim is to assess the prevalence of these types of experienced discrimination. METHODS In a telephone survey 2026 community psychiatric service users in ten UK Mental Health service provider organisations (Trusts) were asked about discrimination experienced in the previous 12 months using the Discrimination and Stigma Scale (DISC). The sample were asked if, due to their mental health problem, they had been treated unfairly in starting a family, or in their role as a parent, and gave examples of this. Prevalence is reported and the examples of experienced discrimination in relation to parenthood were analysed using the framework method of qualitative analysis. RESULTS Three hundred and four participants (73% female) reported experienced discrimination, with prevalences of 22.5% and 28.3% for starting a family and for the parenting role respectively. Participants gave 89 examples of discrimination about starting a family and 228 about parenting, and these occurred in social and professional contexts. Ten themes were identified. These related to being seen as an unfit parent; people not being understanding; being stopped from having children; not being allowed to see their children; not getting the support needed; children being affected; children avoiding their parents; children's difficulties being blamed on the parent's mental health problem; not being listened to; and being undermined as a parent. CONCLUSIONS This research highlights the need for: greater support for parents with mental illness, those wishing to have children, and those who lose access or custody; services to better meet the needs of children with a mentally ill parent; training about discrimination for professionals; and parenting issues to be included in anti-stigma programmes.
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Affiliation(s)
- Debra Jeffery
- Health Service and Population Research Department, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - Sarah Clement
- Health Service and Population Research Department, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK,Section of Community Mental Health, PO29, Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Elizabeth Corker
- Health Service and Population Research Department, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - Louise M Howard
- Health Service and Population Research Department, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - Joanna Murray
- Health Service and Population Research Department, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK
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