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Hansen HG, Gjøde ICT, Starzer M, Ranning A, Hjorthøj C, Albert N, Nordentoft M, Thorup AAE. Clinical illness course and family-related outcomes among parents with a first episode of schizophrenia spectrum disorder: a 20-year follow-up of the OPUS trial. Psychol Med 2024:1-10. [PMID: 38563286 DOI: 10.1017/s0033291724000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Studies investigating parenthood and how it affects long-term outcomes are lacking among individuals with schizophrenia spectrum disorders. This study aimed to examine the life of participants 20 years after their first diagnosis with a special focus on parenthood, clinical illness course, and family-related outcomes. METHODS Among 578 individuals diagnosed with first-episode schizophrenia spectrum disorder between 1998 and 2000, a sample of 174 participants was reassessed at the 20-year follow-up. We compared symptom severity, remission, clinical recovery, and global functioning between 75 parents and 99 non-parents. Also, family functioning scored on the family assessment device, and the children's mental health was reported. We collected longitudinal data on psychiatric admission, supported housing, and work status via the Danish registers. RESULTS Participants with offspring had significantly lower psychotic (mean (s.d.) of 0.89 (1.46) v. 1.37 (1.44), p = 0.031) negative (mean [s.d.] of 1.13 [1.16] v. 1.91 [1.07], p < 0.001) and disorganized symptom scores (mean [s.d.] of 0.46 [0.80] v. 0.85 [0.95], p = 0.005) and more were in remission (59.5% v. 22.4%, p < 0.001) and in clinical recovery (29.7% v. 11.1%, p = 0.002) compared to non-parents. When investigating global functioning over 20 years, individuals becoming parents after their first diagnosis scored higher than individuals becoming parents before their first diagnosis and non-parents. Regarding family-related outcomes, 28.6% reported unhealthy family functioning, and 10% of the children experienced daily life difficulties. CONCLUSIONS Overall, parents have more favorable long-term outcomes than non-parents. Still, parents experience possible challenges regarding family functioning, and a minority of their children face difficulties in daily life.
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Affiliation(s)
- Helene Gjervig Hansen
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ida Christine Tholstrup Gjøde
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Research Unit - Child and Adolescent Mental Health Centre, The Capital Region, Copenhagen, Denmark
| | - Marie Starzer
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Ranning
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Amager, Copenhagen University Hospital, Digevej 110, 2300 Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- Copenhagen Research Centre for Mental Health - Core, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Research Unit - Child and Adolescent Mental Health Centre, The Capital Region, Copenhagen, Denmark
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Ribette C, Rosenthal L, Raynaud JP, Franchitto L, Revet A. Primary care physicians' experience of caring for children with parents with mental health illness: a qualitative study among French general practitioners and paediatricians. BMC PRIMARY CARE 2023; 24:190. [PMID: 37718455 PMCID: PMC10506299 DOI: 10.1186/s12875-023-02145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Parental psychiatric disorders can have a significant impact on child development and the parent-infant bond, with a high risk of attachment disorders. Early identification of difficulties in the parent-child relationship is essential to prevent consequences for the child. Childcare practitioners have a major role to play in this early detection process, through regular mandatory consultations during the first two years of a child's life. Thus, the aim of this study was to collect the experience of private practitioners in their care of children of parents with a mental health illness. METHOD This is a cross-sectional, observational, qualitative study. Data were collected by means of semi-structured interviews with eleven general practitioners and private paediatricians between February and July 2021 in Toulouse and its suburbs. We only included practitioners who had followed children of parents with a mental health illness. The interviews were recorded with the agreement of the participants, before being transcribed anonymously. The data were analysed with NVivo software using interpretative phenomenological analysis. RESULTS Three main themes emerged from the results, which were further divided into several sub-themes. Addressing psychiatric disorders presents a risk for the therapeutic relationship. Practitioners express a need to preserve this relationship with the parent in joint care. Care is difficult and is permeated by the parents' emotional issues. Furthermore, practitioners face a conflict between their concerns for the parent-child bond and their desire not to stigmatise these families. They express a feeling of isolation in these follow-ups. This stressful care has a significant emotional impact on the doctors. Access to psychiatric training and multidisciplinary collaboration seem to be essential to improve the follow-up experience for practitioners, as these factors strengthen inter-professional connections. CONCLUSION Practitioners describe a parent-doctor relationship at risk, which is underpinned by the fear of care placement. This study illustrates the need to strengthen multidisciplinary work by promoting interprofessional exchanges, in order to improve the experience of practitioners in this care process. Addressing practitioners' fear of discussing parental psychiatric illness is very important, so as not to delay the implementation of preventive actions that are likely to improve the developmental prognosis for children.
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Affiliation(s)
- Cécile Ribette
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France.
| | - Lucie Rosenthal
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
| | - Jean-Philippe Raynaud
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
- CERPOP, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Ludivine Franchitto
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
| | - Alexis Revet
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
- CERPOP, University of Toulouse, Inserm, UPS, Toulouse, France
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Rohd SB, Hjorthøj C, Ohland J, Gregersen M, Hemager N, Søndergaard A, Christiani CA, Spang KS, Ellersgaard D, Burton BK, Melau M, Greve A, Gantriis DL, Jepsen JRM, Plessen KJ, Mors O, Nordentoft M, Harder S, Thorup AAE. Experiences of helplessness and fear among caregivers diagnosed with severe mental illness and co-caregivers: The Danish High Risk and Resilience Study - VIA 7. Dev Psychopathol 2023; 35:1540-1551. [PMID: 35659307 DOI: 10.1017/s0954579422000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study investigates indicators of disorganized caregiving among caregivers of children who have a familial predisposition of schizophrenia spectrum psychosis (SZ) or bipolar disorder (BP), and whether indicators of disorganized caregiving are associated with the caregivers' and children's level of functioning as well as the children's internalizing and externalizing behavior problems. Indicators of disorganized caregiving were assessed with the Caregiving Helplessness Questionnaire (CHQ). Level of functioning was evaluated using the Children's Global Assessment Scale and the Personal and Social Performance Scale, while dimensional psychopathology were measured with the Child Behavior Checklist. 185 caregivers belonging to a SZ combined group (i.e., SZ-I + SZ co-caregiver), 110 caregivers to a BP combined group (i.e., BP-I + BP co-caregiver), and 184 caregivers to a population-based control group provided data on CHQ. Having a history of SZ or BP or being a co-caregiver to a parent with SZ or BP was associated with higher levels of experiences of helplessness and fear. Higher scores on helplessness were associated with lower level of functioning among caregivers and children and with children having externalizing/internalizing behavior problems. These results emphasize the need for interventions addressing indicators of disorganized caregiving in families with SZ or BP.
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Affiliation(s)
- Sinnika Birkehøj Rohd
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- University of Copenhagen, Department of Public Health, Section of Epidemiology, 1014Copenhagen K, Denmark
| | - Jessica Ohland
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
| | - Maja Gregersen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
| | - Nicoline Hemager
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Søndergaard
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
| | - Camilla Austa Christiani
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- University of Copenhagen, Department of Public Health, Section of Epidemiology, 1014Copenhagen K, Denmark
| | - Katrine Soeborg Spang
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- University of Copenhagen, Department of Public Health, Section of Epidemiology, 1014Copenhagen K, Denmark
| | - Ditte Ellersgaard
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200Copenhagen, Denmark
| | - Marianne Melau
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
| | - Aja Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, DK-8200Aarhus, Denmark
| | - Ditte Lou Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, DK-8200Aarhus, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, University Medical Center, University of Lausanne, Lausanne, Switzerland
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, DK-8200Aarhus, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200Copenhagen, Denmark
| | - Susanne Harder
- Department of Psychology, University of Copenhagen, 1353, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, DK-2900Copenhagen, Capital Region of Denmark, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), DK-8210Aarhus, Denmark
- Child and Adolescent Mental Health Center, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200Copenhagen, Denmark
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González-Rodríguez A, Natividad M, Seeman MV, Paolini JP, Balagué A, Román E, Izquierdo E, Pérez A, Vallet A, Salvador M, Monreal JA. Schizophrenia: A Review of Social Risk Factors That Affect Women. Behav Sci (Basel) 2023; 13:581. [PMID: 37504028 PMCID: PMC10376000 DOI: 10.3390/bs13070581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
Social risk factors are long-term or repeated environmental exposures in childhood and youth that change the brain and may, via epigenetic effects, change gene expression. They thus have the power to initiate or aggravate mental disorders. Because these effects can be mediated via hormonal or immune/inflammatory pathways that differ between men and women, their influence is often sex-specific. The goal of this narrative review is to explore the literature on social risk factors as they affect women with schizophrenia. We searched the PubMed and Scopus databases from 2000 to May 2023 using terms referring to the various social determinants of health in conjunction with "women" and with "schizophrenia". A total of 57 studies fulfilled the inclusion criteria. In the domains of childhood and adult abuse or trauma, victimization, stigma, housing, and socioeconomics, women with schizophrenia showed greater probability than their male peers of suffering negative consequences. Interventions targeting appropriate housing, income support, social and parenting support, protection from abuse, violence, and mothering-directed stigma have, to different degrees, yielded success in reducing stress levels and alleviating the many burdens of schizophrenia in women.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 5 Dr. Robert Square, 08221 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 08221 Terrassa, Spain
| | - Mentxu Natividad
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 5 Dr. Robert Square, 08221 Terrassa, Spain
| | - Mary V Seeman
- Department of Psychiatry, University of Toronto, 605 260 Heath Street West, Toronto, ON M5P 3L6, Canada
| | - Jennipher Paola Paolini
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 5 Dr. Robert Square, 08221 Terrassa, Spain
| | - Ariadna Balagué
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 5 Dr. Robert Square, 08221 Terrassa, Spain
| | - Eloïsa Román
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 5 Dr. Robert Square, 08221 Terrassa, Spain
| | - Eduard Izquierdo
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 5 Dr. Robert Square, 08221 Terrassa, Spain
| | - Anabel Pérez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 5 Dr. Robert Square, 08221 Terrassa, Spain
| | - Anna Vallet
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 5 Dr. Robert Square, 08221 Terrassa, Spain
| | - Mireia Salvador
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 5 Dr. Robert Square, 08221 Terrassa, Spain
| | - José Antonio Monreal
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 5 Dr. Robert Square, 08221 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 08221 Terrassa, Spain
- Institut de Neurociències, Universitat Autònoma de Barcelona (UAB), 08221 Terrassa, Spain
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Tuck M, Wittkowski A, Gregg L. A Balancing Act: A Systematic Review and Metasynthesis of Family-Focused Practice in Adult Mental Health Services. Clin Child Fam Psychol Rev 2023; 26:190-211. [PMID: 36318397 PMCID: PMC9879847 DOI: 10.1007/s10567-022-00418-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 01/28/2023]
Abstract
Parental mental illness is a major international public health concern given its implications for whole families, including children. Family-focused practice (FFP), an approach that emphasises a "whole-family" approach to care, provides an opportunity to mitigate the significant risks associated with parental mental health difficulties. The positive benefits associated with FFP have led to a shift in policy and practice towards prioritising FFP within adult mental health services. However, evidence suggests that FFP remains scarce and is not routine. Research has identified the important role of practitioners in facilitating FFP. The current review identified, synthesised and appraised the international qualitative literature examining adult mental health practitioners' implementation experiences of FFP. It aimed to provide an evidence-informed account of practitioner experiences of FFP delivery and to identify key recommendations to enhance future FFP outcomes in AMHS. Ovid Medline, PsycInfo, CINAHL plus, EMBASE and Web of Science Core Collection were searched systematically, in line with PRISMA guidance, up to January 2022. The Critical Appraisal Skills Programme (CASP) was used to undertake the quality appraisal prior to a thematic synthesis being conducted. The review was registered on PROSPERO. Nineteen papers, spanning 17 years of research with 469 practitioners, were included. Three main themes and 14 subthemes were developed, representing different aspects of practitioner experiences of FFP delivery. Practitioners' approach to FFP was variable and influenced by their beliefs about FFP, perceived roles and responsibilities, competence, service setting, and personal parenting status. Practitioners engaged in a balancing act to maintain a dual focus on their service-users and their children, to navigate powerful emotions, and consider multiple perspectives in a biomedical organisational structure that advocates individualised treatment. Although working together unified teams, a greater need for external interagency collaboration was identified. The use of strength-based approaches with clients and dedicated staff resources, within clear guidelines and frameworks, was reported to be necessary to maximise FFP delivery. This review proposes a complex FFP dynamic whereby practitioners engage in a constant balancing act between FFP stakeholders to achieve meaningful FFP outcomes for service-users and their families. Service recommendations are provided.
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Affiliation(s)
- M Tuck
- School of Health Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - A Wittkowski
- School of Health Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - L Gregg
- School of Health Sciences, The University of Manchester, Manchester, UK.
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
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6
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Chen W, Wang X, Zhou T, Wen L, Yang X, Chen B, Zhang T, Zhang C, Hua J, Tang Q, Hong X, Liu W, Du C, Xie C, Ma H, Yu X, Guan L. Childhood experiences and needs of offspring living with paternal and maternal severe mental illness: A retrospective study in China. Asian J Psychiatr 2023; 81:103449. [PMID: 36641966 DOI: 10.1016/j.ajp.2023.103449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Parental mental illness is considered one of the strongest risk factors for the development of children. This study aimed to describe the adverse childhood experiences and needs of offspring living with parental severe mental illness (SMI) in China and to compare the differences in needs between offspring living with maternal SMI and those living with paternal SMI. METHOD Overall, 381 participants, including 76 living with paternal SMI, 104 living with maternal SMI, and 201 living without parental mental illness, were enrolled. Data were collected using questionnaires from five sites in China. Differences among the three groups were compared using analysis of variance and chi-square test. Factors were extracted using exploratory factor analysis, and differences in factor scores between the paternal and maternal SMI groups were compared using the rank sum test. RESULTS The percentages of poverty, family care, and housework were significantly higher in the paternal SMI group and maternal SMI group, compared with the control group, and those of school dropout and relationship with friends were significantly higher in the maternal SMI group (p < 0.0167). The need for stigma reduction in the maternal SMI group was significantly higher than that in the paternal SMI group (p = 0.015). CONCLUSION Our findings highlight the importance of considering the impact of maternal and paternal SMI on child development. There is an urgent need to develop a national program to assist families with mentally ill parents to provide services for children living with parental SMI.
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Affiliation(s)
- Weiran Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xun Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tianhang Zhou
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Liping Wen
- The Fifth People's Hospital of Zigong, Zigong, China
| | - Xianmei Yang
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | | | - Tao Zhang
- Taiyuan Psychiatric Hospital, Shanxi Mental Health Center, Taiyuan, China
| | | | - Juan Hua
- Yantan Mental Health Center, Zigong, China
| | - Qi Tang
- Jiangyou Psychiatric Hospital, Jiangyou, China
| | - Xu Hong
- Xiamen Xianyue Hospital, Xiamen, China
| | - Wenhui Liu
- Taiyuan Psychiatric Hospital, Shanxi Mental Health Center, Taiyuan, China
| | - Chunyu Du
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chenmei Xie
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hong Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xin Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Lili Guan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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7
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Kageyama M, Koide K, Saita R, Iwasaki-Motegi R, Ichihashi K, Nemoto K, Sakae S, Yokoyama K. A randomized controlled study of an e-learning program (YURAIKU-PRO) for public health nurses to support parents with severe and persistent mental illness and their family members. BMC Nurs 2022; 21:342. [PMID: 36471361 PMCID: PMC9720938 DOI: 10.1186/s12912-022-01129-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/29/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Supporting parents with severe and persistent mental illness (SPMI) requires knowledge, skills, and a positive attitude toward parenthood. We developed a Japanese e-learning program for public health nurses (PHNs) to enable them to support parents with SPMI and their family members. This study aimed to evaluate the effectiveness of the program in improving the knowledge, skills, attitudes, and self-efficacy of PHNs in supporting them. METHODS A three-hour video-based e-learning program was developed. A randomized controlled trial was conducted with 176 PHNs responsible for maternal and child health in Japan. The outcome measures included the Sense of Coping Difficulty/Possibility Scale, skills to support people with SPMI, and achievement of program goals. Outcome data were collected at three time points during the study: baseline (T1), post-intervention (T2), and one month after T2 (T3) using self-administered electronic questionnaires. Outcome measures were assessed by comparing the two groups at the endpoint (T3) using t-tests and ANOVA. Effectiveness over time was assessed using a mixed model for repeated measures, with group and time interactions as fixed effects. RESULTS The study participants were randomly allocated to two groups:89 in the intervention group, and 87 in the control group. The total score and the scores in the two subscales of the Sense of Coping Difficulty/Possibility Scale in the intervention group at T3 were significantly higher than those in the control group, as shown by the t-test and ANOVA (all p<0.001). The Sense of Coping Difficulty subscale had a large effect size (Cohen's d=1.27). The analysis of the results of a mixed model for repeated measures showed that the group and time interactions on all outcome measures were not significantly different at T1 but were significantly different at T2 and T3. CONCLUSIONS The program was effective one month after its completion, particularly in reducing PHNs' difficulties in supporting parents with SPMI. TRIAL REGISTRATION UMIN000045765, November 1, 2021.
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Affiliation(s)
- Masako Kageyama
- grid.136593.b0000 0004 0373 3971Osaka University Institute of Advanced Co-Creation Studies, 1-7 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Keiko Koide
- grid.136593.b0000 0004 0373 3971Department of Health Promotion Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Ryotaro Saita
- grid.412398.50000 0004 0403 4283Department of Medical Innovation, Osaka University Hospital, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Riho Iwasaki-Motegi
- grid.415776.60000 0001 2037 6433Section of Public Health Nursing Research Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami Wako, Saitama, 351-0197 Japan
| | - Kayo Ichihashi
- grid.412708.80000 0004 1764 7572Department of Neuropsychiatry, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655 Japan
| | - Kiyotaka Nemoto
- grid.20515.330000 0001 2369 4728Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai Tsukuba, Ibaraki, 305-8575 Japan
| | - Setsuko Sakae
- grid.444005.10000 0001 2112 2435Department of Social Design, Faculty of Sociology, St. Andrew’s University, 1-1 Manabino, Izumi, Osaka 594-1198 Japan
| | - Keiko Yokoyama
- grid.469307.f0000 0004 0619 0749Department of Nursing, Faculty of Nursing, Yokohama Soei University, 1Miho-cho, Yokohama City, Kanagawa, 226-0015 Japan
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8
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Garosi A, Sunhary de Verville PL, Etchecopar-Etchart D, Richieri R, Godin O, Schürhoff F, Berna F, Aouizerate B, Capdevielle D, Chereau I, Clauss-Kobayashi J, Dorey JM, Dubertret C, Coulon N, Leignier S, Mallet J, Misdrahi D, Passerieux C, Rey R, Szoke A, Urbach M, Leboyer M, Llorca PM, Lançon C, Boyer L, Fond G, Andrieu-Haller C, Aouizerate B, Berna F, Blanc O, Bourguignon E, Capdevielle D, Chereau-Boudet I, Clauss-Kobayashi J, Coulon N, Dassing R, Dorey JM, Dubertret C, Esselin A, Fond G, Gabayet F, Jarroir M, Lacelle D, Leboyer M, Leignier S, Llorca PM, Mallet J, Metairie E, Michel T, Misdrahi D, Passerieux C, Petrucci J, Pignon B, Peri P, Portalier C, Rey R, Roman C, Schorr B, Schürhoff F, Szöke A, Tessier A, Urbach M, Wachiche G, Zinetti-Bertschy A. The impact of parent history of severe mental illness on schizophrenia outcomes: results from the real-world FACE-SZ cohort. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01449-x. [PMID: 35852617 DOI: 10.1007/s00406-022-01449-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/12/2022] [Indexed: 11/27/2022]
Abstract
Parent history of severe mental illness (PHSMI) may have long-term consequences in adult offspring due to genetic and early environmental factors in preliminary studies. To compare the outcomes associated in subjects with PHSMI to those in patients without PHSMI. The participants with schizophrenia and schizoaffective disorders were recruited in the ongoing FACE-SZ cohort at a national level (10 expert centers) and evaluated with a 1-day-long standardized battery of clinician-rated scales and patient-reported outcomes. PHSMI was defined as history of schizophrenia or bipolar disorders in at least one parent and was included as explanatory variable in multivariate models. Of the 724 included patients, 78 (10.7%) subjects were classified in the PHSMI group. In multivariate analyses, PHSMI patients had a better insight into schizophrenia and the need for treatment and reported more often childhood trauma history compared to patients without PHSMI. More specifically, those with paternal history of SMI reported more severe outcomes (increased childhood physical and emotional abuses, comorbid major depression and psychiatric hospitalizations). PHSMI is associated with increased risk of childhood trauma, major depressive disorder and psychiatric hospitalization and better insight in individuals with schizophrenia. Specific public health prevention programs for parents with SMI should be developed to help protect children from pejorative psychiatric outcomes. PHSMI may also explain in part the association between better insight and increased depression in schizophrenia.
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Affiliation(s)
- A Garosi
- Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - P L Sunhary de Verville
- Fondation FondaMental, Créteil, France.,Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, 94010, Creteil, France.,Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.,Centre Hospitalier Charles Perrens, Université de Bordeaux, 33076, Bordeaux, France.,INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, 63003, Clermont-Ferrand, France.,INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier le Vinatier, Pole Est, 95 Bd Pinel, BP 30039, 69678, Bron, France.,Department of Psychiatry, Faculté de Médecine, AP-HP, Louis Mourier Hospital, Université Paris Diderot, Sorbonne Paris Cité, Inserm U894, Colombes, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France.,Centre Hospitalier de Versailles, Service de psychiatrie et d'addictologie adulte, le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone veil, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France.,INRA, NutriNeuro, University of Bordeaux, U1286, 33076, Bordeaux, France.,CNRS UMR 5287-INCIA, Pessac, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France
| | - D Etchecopar-Etchart
- Fondation FondaMental, Créteil, France.,Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - R Richieri
- Fondation FondaMental, Créteil, France.,Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - O Godin
- Fondation FondaMental, Créteil, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France.,Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, 94010, Creteil, France
| | - F Berna
- Fondation FondaMental, Créteil, France.,INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France.,Centre Hospitalier Charles Perrens, Université de Bordeaux, 33076, Bordeaux, France.,INRA, NutriNeuro, University of Bordeaux, U1286, 33076, Bordeaux, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - I Chereau
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, 63003, Clermont-Ferrand, France
| | - J Clauss-Kobayashi
- INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - J M Dorey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier le Vinatier, Pole Est, 95 Bd Pinel, BP 30039, 69678, Bron, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Faculté de Médecine, AP-HP, Louis Mourier Hospital, Université Paris Diderot, Sorbonne Paris Cité, Inserm U894, Colombes, France
| | - N Coulon
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - S Leignier
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - J Mallet
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Faculté de Médecine, AP-HP, Louis Mourier Hospital, Université Paris Diderot, Sorbonne Paris Cité, Inserm U894, Colombes, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France.,Centre Hospitalier Charles Perrens, Université de Bordeaux, 33076, Bordeaux, France.,CNRS UMR 5287-INCIA, Pessac, France
| | - C Passerieux
- Fondation FondaMental, Créteil, France.,Centre Hospitalier de Versailles, Service de psychiatrie et d'addictologie adulte, le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone veil, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - R Rey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier le Vinatier, Pole Est, 95 Bd Pinel, BP 30039, 69678, Bron, France
| | - A Szoke
- Fondation FondaMental, Créteil, France.,Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, 94010, Creteil, France
| | - M Urbach
- Fondation FondaMental, Créteil, France.,Centre Hospitalier de Versailles, Service de psychiatrie et d'addictologie adulte, le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone veil, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France.,Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, 94010, Creteil, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, 63003, Clermont-Ferrand, France
| | - C Lançon
- Fondation FondaMental, Créteil, France.,Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - L Boyer
- Fondation FondaMental, Créteil, France.,Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - G Fond
- Fondation FondaMental, Créteil, France. .,Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.
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9
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Morán-Kneer J, Ríos U, Costa-Cordella S, Barría C, Carvajal V, Valenzuela K, Wasserman D. Childhood Trauma and Social Cognition in participants with Bipolar Disorder: The Moderating Role of Attachment. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Stolper H, van Doesum K, Steketee M. Integrated Family Approach in Mental Health Care by Professionals From Adult and Child Mental Health Services: A Qualitative Study. Front Psychiatry 2022; 13:781556. [PMID: 35573344 PMCID: PMC9096092 DOI: 10.3389/fpsyt.2022.781556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/28/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE A multiple case-study in which each case was evaluated by adult and child mental health professionals who used an integrated family approach in their treatments. In this approach, treatment focuses on the mental disorders of the parents as well as on the development of the young child and family relationships. This study evaluated the experiences of professionals from adult and child mental health services using this approach. The aim of the study is identifying key elements of this approach, processes involved in treatment, and barriers to its success, with the aim of contributing to the development of practice based integrated mental health care for the whole family. BACKGROUND Parental mental disorders have an impact on parenting and child development. To stop detrimental cascade effects and prevent parent and child from being caught up in the intergenerational transmission of psychopathology, an integrated family approach in mental health care is needed. Methods: A qualitative case study design using a grounded theory approach. Data were collected through 19 group interviews of professionals (N = 37) from adult and infant mental health teams who worked together in the treatment of a family. RESULTS Professionals from the two services were comfortable coping with complexity and felt supported to perform their treatments by staying in touch with each other in multi-disciplinary consultations. They indicated that by attuning the treatment components to each other and tailoring them to the capabilities of the family, their treatments had more impact. A flexible attitude of all involved professionals and commitment to the interest of all family members was essential. CONCLUSION According to professionals, treatment with an integrated family approach in mental health care is of value for families by addressing the distinct roles, positions and relationships, by implementing a flexible complementary treatment plan, and by empowering professionals by multi-disciplinary consultations.
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Affiliation(s)
- Hanna Stolper
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Karin van Doesum
- Department of Clinical Psychology, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Majone Steketee
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
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11
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Stolper H, van Doesum K, Steketee M. How to Support Parents of Infants and Young Children in Mental Health Care: A Narrative Review. Front Psychol 2021; 12:745800. [PMID: 34867627 PMCID: PMC8634941 DOI: 10.3389/fpsyg.2021.745800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/15/2021] [Indexed: 01/30/2023] Open
Abstract
Objective: The aim of this narrative review is to gain insight into the appropriate intervention targets when parents of infants and young children suffer from psychopathology. Background: Psychopathology in parents is a risk factor for maladaptive parenting and is strongly related to negative cascade effects on parent-child interactions and relations in the short and long term. Children in their first years of life are especially at risk. However, in adult mental health care, this knowledge is rarely translated into practice, which is a missed opportunity for prevention. Methods: Electronic databases were searched for reviews and meta-analysis. In addition, sources were obtained via manual search, reference mining, expert opinion, and communications from conferences. In total, 56 papers, whereof 23 reviews and 12 meta-analyses were included. Results: Findings regarding targets of intervention were identified in different interacting domains, namely the parental, family, child, and environmental domains as well as the developing parent-child relationship. A "one size fits all" intervention is not appropriate. A flexible, tailored, resource-oriented intervention program, multi-faceted in addressing all modifiable risk factors and using different methods (individual, dyadic, group), seems to provide the best results. Conclusion: To address the risk factors in different domains, adult and child mental health care providers should work together in close collaboration to treat the whole family including mental disorders, relational, and contextual problems. A multi-agency approach that includes social services is needed.
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Affiliation(s)
- Hanna Stolper
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Karin van Doesum
- Department of Clinical Psychology, Radboud University, Nijmegen, Netherlands
| | - Majone Steketee
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
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12
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Gregg L, Adderley H, Calam R, Wittkowski A. The implementation of family-focused practice in adult mental health services: A systematic review exploring the influence of practitioner and workplace factors. Int J Ment Health Nurs 2021; 30:885-906. [PMID: 33792149 DOI: 10.1111/inm.12837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/03/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
There is increased recognition of the need for greater and more appropriate support to be offered to families in which a parent experiences mental illness and has dependent children. One way of meeting this need is for adult mental health services to take a more family-focused approach. However, there are recognized difficulties in facilitating family-focused practice (FFP). The current review systematically synthesized quantitative and qualitative literature of practitioner perspectives and experiences of FFP in adult mental health settings to identify modifiable factors associated with its successful implementation. Five databases were searched systematically leading to the inclusion and quality assessment of 19 papers, ten of which were quantitative and nine qualitative. Analysis was guided by a narrative synthesis approach. Factors shown to influence FFP functioned at both practitioner and workplace levels and included personal attitudes, beliefs about job role, and perceptions of workplace support. Practitioners who felt that a family-focussed approach was inappropriate or detrimental to service users or outside of their remit as mental health professionals were less likely to adopt this approach. For those who saw the potential benefits of FFP, lack of confidence in their ability to deliver such an approach and lack of training can be barriers, as can lack of support and resources within services. This review highlights the need for actions to boost the awareness of adult mental health practitioners working with parents and to increase their confidence. It also makes the case for broader organizational support if family-focussed practice is to be implemented successfully.
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Affiliation(s)
| | | | | | - Anja Wittkowski
- University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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13
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A Systematic Review Focusing on Psychotherapeutic Interventions that Impact Parental Psychopathology, Child Psychopathology and Parenting Behavior. Clin Child Fam Psychol Rev 2021; 24:579-598. [PMID: 34254219 DOI: 10.1007/s10567-021-00355-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
Given the high rates of co-occurrence of psychopathology within families, it is important to identify and characterize interventions that simultaneously reduce both parent and child symptoms, and improve parenting quality. This is needed as intervention development is increasingly moving toward integrated interventions that target some combination of parent and child mental health, and parenting behavior. Even so, much remains unknown regarding which treatment components provide maximum benefit for parent symptoms, child symptoms, and parenting behavior. This systematic review identified and characterized psychotherapeutic interventions that report improvements in each of three outcomes: parent symptoms, child symptoms and parenting behavior. Fifty-six unique interventions were eligible for review, of which 25 reported improvements in all three outcomes. All 25 of these interventions directly intervened on parenting behavior, often as the sole target of the intervention. Few interventions improved all three outcomes in samples in which parents, children or both met clinical-level thresholds of psychopathology. Additional research is needed to better understand the bi-directional and transactional influences of treatment on family members, and to better inform the development of interventions for dually disordered parent-child dyads across a range of diagnostic profiles.
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14
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Furlong M, McGilloway S, Mulligan C, McGuinness C, Whelan N. Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness (PRIMERA-Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children): study protocol for a randomised controlled trial. Trials 2021; 22:243. [PMID: 33794971 PMCID: PMC8015312 DOI: 10.1186/s13063-021-05199-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Parental mental illness is common and can lead to dependent children incurring a high risk of developing mental disorders, physical illness, and impaired educational and occupational outcomes. Family Talk is one of the better known interventions designed to prevent the intergenerational transmission of mental illness. However, its evidence base is small, with few robust independent randomised controlled trials, and no associated process or cost evaluations. The PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children) research programme involves a mixed method evaluation of Family Talk which is being delivered in mental health settings in Ireland to improve child and family psychosocial functioning in families with parental mental illness. METHODS The study comprises a multi-centre, randomised controlled trial (RCT), with nested economic and process evaluations, to assess the clinical and cost-effectiveness and implementation mechanisms of Family Talk compared to usual services. The study is being conducted in 15 adult and child mental health settings in Ireland. Families with a parent with mental illness, and children aged 5-18 years (n = 144 families) will be randomised to either the 7-session Family Talk programme (n = 96) or to standard care (n = 48) using a 2:1 allocation ratio. The primary outcomes are child psychosocial functioning and family functioning. Secondary outcomes are as follows: understanding and experience of parental mental illness, parental mental health, child and parental resilience, partner wellbeing and service utilisation. Blind assessments will take place at pre-intervention and at 6- and 12-month follow-up. DISCUSSION Given the prevalence and burden of intergenerational mental illness, it is imperative that prevention through evidence-based interventions becomes a public health priority. The current study will provide an important contribution to the international evidence base for Family Talk whilst also helping to identify key implementation lessons in the scaling up of Family Talk, and other similar interventions, within routine mental health settings. TRIAL REGISTRATION ISRCTN Registry, ISRCTN13365858 . Registered 5th February 2019.
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Affiliation(s)
- Mairead Furlong
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Co. Kildare Ireland
| | - Sinead McGilloway
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Co. Kildare Ireland
| | - Christine Mulligan
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Co. Kildare Ireland
| | - Colm McGuinness
- Department of Business, Technological University Dublin, Blanchardstown Campus, Dublin, Ireland
| | - Nuala Whelan
- Department of Sociology, Maynooth University, Maynooth, Co. Kildare Ireland
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15
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Butler J, Gregg L, Calam R, Wittkowski A. Exploring Staff Implementation of a Self-directed Parenting Intervention for Parents with Mental Health Difficulties. Community Ment Health J 2021; 57:247-261. [PMID: 32445074 PMCID: PMC7835308 DOI: 10.1007/s10597-020-00642-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 05/18/2020] [Indexed: 12/02/2022]
Abstract
Parents with mental health difficulties face significant barriers in accessing evidence-based parenting interventions. Self-directed approaches may be a destigmatising, accessible alternative. Evidence has suggested that Triple P Positive Parenting Programme's self-directed format is as effective as more time- and cost-intensive delivery methods. The aim of the current study was to establish whether staff were able to use this intervention with parents with mental health difficulties and to explore staff experiences of implementation. Triple P self-help workbooks were provided to practitioners across three teams. Data were collected regarding workbook uptake and use. Interviews with staff exploring their experiences of implementation were analysed using thematic analysis. Overall, 41 participants were recruited, of which 12 (29.27%) also consented to interviews. Overall, six practitioners (14.63%) reported that they utilised the workbook. Uptake and utilisation were varied, but practitioners who used the workbook reported positive outcomes. Interviews revealed themes regarding practitioner concerns, views of the intervention and implementation issues. Self-directed Triple remains a promising intervention but its feasibility is dependent on addressing barriers to implementation and facilitating a family-focused approach to meet the needs of these parents and their children.
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Affiliation(s)
- J Butler
- School of Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - L Gregg
- School of Health Sciences, University of Manchester, Manchester, UK
| | - R Calam
- School of Health Sciences, University of Manchester, Manchester, UK
| | - A Wittkowski
- School of Health Sciences, University of Manchester, Manchester, UK. .,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK. .,Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, England, UK.
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16
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Radley J, Sivarajah N, Moltrecht B, Klampe ML, Hudson F, Delahay R, Barlow J, Johns LC. A Scoping Review of Interventions Designed to Support Parents With Mental Illness That Would Be Appropriate for Parents With Psychosis. Front Psychiatry 2021; 12:787166. [PMID: 35153857 PMCID: PMC8828543 DOI: 10.3389/fpsyt.2021.787166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022] Open
Abstract
The experience of psychosis can present additional difficulties for parents, over and above the normal challenges of parenting. Although there is evidence about parenting interventions specifically targeted at parents with affective disorders, anxiety, and borderline personality disorder, there is currently limited evidence for parents with psychotic disorders. It is not yet known what, if any, interventions exist for this population, or what kinds of evaluations have been conducted. To address this, we conducted a scoping review to determine (1) what parenting interventions have been developed for parents with psychosis (either specifically for, or accessible by, this client group), (2) what components these interventions contain, and (3) what kinds of evaluations have been conducted. The eligibility criteria were broad; we included any report of an intervention for parents with a mental health diagnosis, in which parents with psychosis were eligible to take part, that had been published within the last 20 years. Two reviewers screened reports and extracted the data from the included reports. Thirty-eight studies of 34 interventions were included. The findings show that most interventions have been designed either for parents with any mental illness or parents with severe mental illness, and only two interventions were trialed with a group of parents with psychosis. After noting clusters of intervention components, five groups were formed focused on: (1) talking about parental mental illness, (2) improving parenting skills, (3) long-term tailored support for the whole family, (4) groups for parents with mental illness, and (5) family therapy. Twenty-three quantitative evaluations and 13 qualitative evaluations had been conducted but only eight interventions have or are being evaluated using a randomized controlled trial (RCT). More RCTs of these interventions are needed, in addition to further analysis of the components that are the most effective in changing outcomes for both the parent and their children, in order to support parents with psychosis and their families.
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Affiliation(s)
- Jessica Radley
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Bettina Moltrecht
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Marie-Louise Klampe
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Felicity Hudson
- School of Psychological Science, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Rachel Delahay
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Louise C Johns
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Adderley H, Wittkowski A, Calam R, Gregg L. Adult mental health practitioner beliefs about psychosis, parenting, and the role of the practitioner: A Q methodological investigation. Psychol Psychother 2020; 93:657-673. [PMID: 31448869 PMCID: PMC7687147 DOI: 10.1111/papt.12249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/27/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES There is a lack of research into parenting interventions for families which include a parent experiencing psychosis or other serious mental illness (SMI). Preliminary findings highlight the potential benefits of adult mental health practitioners supporting parents experiencing SMI by using self-directed parenting interventions. This study explored beliefs relating to parenting and psychosis held by practitioners working in adult mental health settings, specifically examining their beliefs about the parenting needs of adults experiencing psychosis who have dependent children, as well as their role as adult mental health practitioners. DESIGN This study used Q methodology to explore the beliefs of mental health practitioners on psychosis and parenting. METHODS Twenty-one adult mental health practitioners ranked 58 items according to how much they agreed with the belief statement presented. Participants also provided additional written information and interviews to contextualize the Q methodology data. RESULTS Three factors emerged representing three groups of practitioners with similar beliefs around psychosis and parenting. Factors were labelled: 'Parenting interventions are worthwhile, and I'd deliver them', 'Parenting interventions are worthwhile, but I'm not confident to deliver them', and 'Parenting interventions might be worthwhile, but it's not my responsibility'. CONCLUSION Using parenting interventions as part of their clinical work was acceptable to most practitioners; however, some lacked confidence in their ability to work in a family-focused way. Efforts now need to focus on enhancing practitioners' skill, knowledge, and confidence in family-focused approaches to provide increased and improved support to families which include a parent experiencing psychosis or other SMI. PRACTITIONER POINTS Parenting interventions need to be made more available and accessible to parents experiencing serious mental illness (SMI), such as psychosis. Adult mental health practitioners are willing to incorporate parenting interventions into their work with parents accessing their services, but some lack confidence to do this. These results highlight the importance of equipping practitioners with the skill, knowledge, and confidence to engage in family-focused approaches. Further research needs to involve parents experiencing SMI as well practitioners working in adult mental health services.
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Affiliation(s)
| | | | - Rachel Calam
- School of Health SciencesUniversity of ManchesterUK
| | - Lynsey Gregg
- School of Health SciencesUniversity of ManchesterUK
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18
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Strand J, Rudolfsson L. Mental Health Professionals' Perceptions of Parenting by Service Users with Psychosis. Community Ment Health J 2020; 56:1014-1022. [PMID: 31925655 PMCID: PMC7289771 DOI: 10.1007/s10597-020-00548-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/02/2020] [Indexed: 12/29/2022]
Abstract
Despite extensive needs, interventions for parents with psychosis are rarely offered, poorly described, and vary between offering instrumental and emotional support. To improve the design of interventions offered to families with parental psychosis, more knowledge is needed. The aim of this study was to gain knowledge about mental health professionals' perceptions of parenting by patients with psychosis. Eleven mental health professionals educated in family interventions were interviewed using a semi-structured interview guide and the material underwent inductive thematic analysis. Results showed that the professionals described the patients parenting as characterized by difficulties in providing security and predictability, taking part in and organizing family life, and to focus on the child's needs. The difficulties were described as related to specific symptoms such as voice hearing, cognitive impairments, anxiety, and paranoia. As a vast amount of research stresses the psychosocial basis of psychosis and the interpersonal causes of its symptoms, parenting difficulties in people with psychosis could benefit from being addressed from a relational perspective. Accordingly, parents with psychosis should be offered interventions that enable them to create positive parental role models, develop reflective functioning, and identify situations in which their symptoms might hinder positive parenting. Many of these needs are unmet by interventions offered in adult psychosis services today.
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Affiliation(s)
- Jennifer Strand
- Department of Psychology, University of Gothenburg, Box 500, 405 30, Göteborg, Sweden.
| | - Lisa Rudolfsson
- Gothenburg Research Institute, University of Gothenburg, Box 603, 405 30, Göteborg, Sweden
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Hefti S, Pérez T, Fürstenau U, Rhiner B, Swenson CC, Schmid M. Multisystemic Therapy for Child Abuse and Neglect: Do Parents Show Improvement in Parental Mental Health Problems and Parental Stress? JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:95-109. [PMID: 30516844 DOI: 10.1111/jmft.12367] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) is an evidence-based program for families with children who experience maltreatment. This clinical trial is the first evaluation of MST-CAN in a German-speaking area. Parental psychological problems and parental stress have been shown to be risk factors for child abuse and neglect. By the end of treatment, parents reported significantly less psychological distress than before the start of MST-CAN. Six months after treatment, this reduction was still evident. However, parents did not report any significant reduction of parental stress at any of the three time points. MST-CAN is an effective intervention for child maltreatment that not only combats child abuse and neglect but also has the potential to alleviate parental psychological distress.
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20
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Cai C, Zhang X, Sheng Q, Ding L. Affiliate Stigma and Psychosocial Adaption Among Adolescents Who Have a Parent With Serious Mental Illness: Mediation Role of Family Cohesion. J Psychosoc Nurs Ment Health Serv 2019; 57:39-47. [PMID: 31566703 DOI: 10.3928/02793695-20190920-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/29/2019] [Indexed: 11/20/2022]
Abstract
The current cross-sectional study examined the relationship between affiliate stigma and externalizing and internalizing problems by investigating the role of family cohesion among adolescents having a parent with serious mental illness (SMI). One hundred sixty-four adolescents were recruited from two community mental health centers. Family cohesion, affiliate stigma, and adolescent internalizing and externalizing problems were assessed. A significant relationship was found between adolescent externalizing and internalizing problems and family cohesion (r = -0.462, p < 0.01 and r = -0.534, p < 0.001, respectively) and affiliate stigma (r = 0.512, p < 0.01 and r = 0.656, p < 0.001, respectively). Family cohesion partially mediated the relation between affiliate stigma and externalizing problems (Z = -4.97, p < 0.001) and fully mediated the relation between affiliate stigma and internalizing problems (Z = -5.18, p < 0.001). The current study highlights the need for effective interventions aimed at families to support parents with SMI in their parenting role and enhance family cohesion. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 39-47.].
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21
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Isaacs AN, Beauchamp A, Sutton K, Maybery D. Unmet needs of persons with a severe and persistent mental illness and their relationship to unmet accommodation needs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e246-e256. [PMID: 30848020 DOI: 10.1111/hsc.12729] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
This is a cross-sectional study of unmet needs of persons enrolled in Australia's Partners in Recovery (PIR) initiative. It aimed to explore the unmet needs reported by persons with a severe and persistent mental illness (SPMI) and to examine the associations between unmet accommodation needs and other unmet needs. The study was undertaken in the Gippsland region of Victoria from February to May 2015. Data were collected from the administrative database for the PIR initiative in Gippsland, which was held by the Gippsland Primary Health Network. Data on unmet needs, as measured by the Camberwell Assessment of Needs Short Appraisal Schedule, were analysed using proportions and logistic regression. Psychological distress, daytime activities, company/someone to spend time with and employment and volunteering were the most commonly reported unmet needs. Participants with unmet accommodation needs were less likely to receive information on their condition or access other services. They also had unmet needs relating to food, money, transport, childcare, looking after home, physical health, psychological distress and self-care. Supported accommodation may not be enough for persons with SPMI who have poor functioning skills and are incapable of looking after themselves. Services such as Housing First that have shown promising results need to be part of a comprehensive strategy to care for persons with severe and enduring mental illness.
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Affiliation(s)
- Anton N Isaacs
- School of Rural Health, (Traralgon and West Gippsland), Monash University, Traralgon, Vic., Australia
| | - Alison Beauchamp
- School of Rural Health (UDRH), Monash University, Moe, Vic., Australia
| | - Keith Sutton
- School of Rural Health (UDRH), Monash University, Moe, Vic., Australia
| | - Darryl Maybery
- School of Rural Health (UDRH), Monash University, Moe, Vic., Australia
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22
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Chan SYY, Ho GWK, Bressington D. Experiences of self-stigmatization and parenting in Chinese mothers with severe mental illness. Int J Ment Health Nurs 2019; 28:527-537. [PMID: 30575250 DOI: 10.1111/inm.12558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 12/16/2022]
Abstract
Mental health stigma has serious ramifications on people with a severe mental illness (SMI). Stigma damages self-esteem, recovery outcomes, family relationships, socialization abilities, access to housing, and career prospects. The cultural tendencies of Chinese people have been shown to be associated with particularly high levels of stigmatization. These cultural tenets can result in high levels of self-stigma due to experiencing shame and a perceived need to keep mental illness a secret. Although there is a lack of existing evidence, it is possible that such experiences present unique challenges to Chinese mothers diagnosed with SMI when they parent their children. Therefore, this qualitative study explored the experiences of parenting and self-stigmatization of Chinese mothers with SMI. Individual semi-structured interviews were conducted with 15 mothers who were direct carers of their children aged under 18 and who were receiving community-based care in Hong Kong. Manual inductive thematic analysis was used to analyse the interview data. Three main themes related to self-stigmatization emerged from the interviews: (i) distancing and being distanced; (ii) doubting myself; and (iii) struggling for control. The experiences of self-stigmatization appeared to damage these mothers' self-efficacy, which may negatively affect their parenting self-esteem, tendency to seek professional help, and ability to manage their own mental health. Strategies to improve self-efficacy, including psychoeducation, and additional childcare support/resources are required for mothers with SMI so they can better manage and balance the demands of motherhood and their mental healthcare needs.
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Affiliation(s)
| | - Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China SAR
| | - Daniel Bressington
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China SAR
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23
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Reedtz C, van Doesum K, Signorini G, Lauritzen C, van Amelsvoort T, van Santvoort F, Young AH, Conus P, Musil R, Schulze T, Berk M, Stringaris A, Piché G, de Girolamo G. Promotion of Wellbeing for Children of Parents With Mental Illness: A Model Protocol for Research and Intervention. Front Psychiatry 2019; 10:606. [PMID: 31572227 PMCID: PMC6752481 DOI: 10.3389/fpsyt.2019.00606] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/30/2019] [Indexed: 12/27/2022] Open
Abstract
Background: The main objective of this project is to create a research and intervention model to promote large-scale implementation and evaluations of generic very brief interventions for children of parents with mental disorders (COPMI). Feasible interventions for COPMI aged 0-18 years are highly needed, as this is a large high-risk group in society. Reducing behavioral problems and enhancing wellbeing for families with parents affected by any mental disorder are important preventive initiatives. One key prevention strategy is to reduce the risk and expression of psychopathology in children and to promote wellbeing. The present model protocol offers an intervention for children of parents with mental disorders internationally based on a model already implemented in the Netherlands and Norway. Methods: Participants will be parents receiving treatment in mental health services in participating countries and their minor children aged 6-18 years. Participants should be randomized into an intervention group or control group. Data should be retrieved from electronic patient journals (demographics, DSM 5/ICD-10, SCID, MINI) as well as from assessment measures administered at baseline and follow-up, including the KIDSCREEN-27, Strengths and Difficulties Questionnaire (SDQ), Parents' Evaluations of Developmental Status (PEDS), Parenting Sense of Competence (PSOC), Resilience Scale for Adolescence (READ), Guilt and Shame Questionnaire for Adolescents of Parents with Mental Illness (GSQ-APMI), Mental Health Literacy Scale, and Parent-Child Communication Scale. Results: The hypothesis is that there will be improvements of child behavioral and emotional problems, and outcomes in the project will be reported in terms of parent´s diagnosis, child behavioral and emotional problems, child wellbeing, family communication and functioning, as well as participants' satisfaction. Discussion: This multi-site international protocol will focus the attention of European scientific and policy makers toward COPMI. This young segment of the population is presently almost completely neglected in most European health policies, despite having a large burden of disability and being at risk of transgenerational transmission of psychopathology. We will further discuss the feasibility of a very brief intervention aiming at preventing mental disorders in young people.
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Affiliation(s)
- Charlotte Reedtz
- RKBU North, Faculty of Health, UiT - Arctic University of Norway, Tromsø, Norway
| | - Karin van Doesum
- RKBU North, Faculty of Health, UiT - Arctic University of Norway, Tromsø, Norway.,Team Preventie, Onderzoeker Mindfit, Nijmegen, Netherlands
| | - Giulia Signorini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Camilla Lauritzen
- RKBU North, Faculty of Health, UiT - Arctic University of Norway, Tromsø, Norway
| | | | | | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Philippe Conus
- Service de Psychiatrie Générale, Dép. de Psychiatrie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Richard Musil
- Bipolar Disorders and Borderline Personality Disorders Unit, Clinic for Psychiatry and Psychotherapy, LMU Klinikum der Universität München, München, Germany
| | - Thomas Schulze
- Institute for Psychiatric Phenomics and Genomics (IPPG), Klinikum der Universität München, München, Germany
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Melbourne, VIC, Australia.,Orygen Youth Health Research Centre and the Centre of Youth Mental Health, The Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Argyris Stringaris
- Mood and Development Laboratory, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Geneviève Piché
- Psychoeducation and Psychology Department, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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24
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Reinaldo AMDS, Pereira MO, Tavares MLDO, Henriques BD. Parents and children suffering from mental distress: coping mechanisms, understanding and fear of the future. CIENCIA & SAUDE COLETIVA 2018; 23:2363-2371. [PMID: 30020388 DOI: 10.1590/1413-81232018237.16332016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 08/04/2016] [Indexed: 11/22/2022] Open
Abstract
The aim of the study was to learn about the parents' coping experiences regarding the mental suffering of their children. This is an ethnographic study. Data was analyzed through content analysis. Three categories have been identified: 1. Coping with everyday situations 2. Understanding of mental suffering as a life situation; 3. Fear of the future, feeling of social and governmental helplessness. Mental suffering imposes situations that need to be quickly resolved on families and arrangements in an attempt to balance the family system; family members coexist with mental suffering in the perspective of a chronic illness, and seek coping mechanisms for day-to-day situations; lastly they fear the future of their sick relatives and feel helpless due to public policies. Research is needed in the area to assess the impact of this issue on the lives of families, institutions and public policies.
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Affiliation(s)
- Amanda Márcia Dos Santos Reinaldo
- Departamento Enfermagem Aplicada, Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Maria Odete Pereira
- Departamento Enfermagem Aplicada, Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | | | - Bruno David Henriques
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa. Viçosa MG Brasil
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Lauritzen C, Kolmannskog AB, Iversen AC. Family assessment conversations as a tool to support families affected by parental mental illness: a retrospective review of electronic patient journals. Int J Ment Health Syst 2018; 12:18. [PMID: 29760769 PMCID: PMC5937825 DOI: 10.1186/s13033-018-0199-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/09/2018] [Indexed: 01/05/2023] Open
Abstract
Background Previous research has shown a link between parental mental illness and adverse development in their offspring. In Norway, it is mandatory for health professionals to identify if patients in adult mental health services have children, and subsequently to provide support for the children. An important tool to detect if families are affected by parental mental illness and to assess if there is a need for further intervention is the Family Assessment Conversation. Family Assessment Conversations is potentially a powerful tool for communication with families affected by parental mental illness because it facilitates early identification of children at risk of various adversities due to the family situation. Additionally the tool may initiate processes that enable children and parents to cope with the situation when a parent becomes seriously ill. Little is however known about how the mental health practitioners use the family assessment form in conversations, and to what extent they record relevant information in the electronic patient journals. Methods The main aim of the study was to provide information about the existing practice within mental health services for adults in terms of parental mental illness and family assessment conversations. The project is a retrospective journal review. The data base consists of relevant journal data from 734 patients aged 20-60 years admitted. In total, 159 recordings of family assessment conversations were discovered. Results The main result in this study was that many of the questions in the family assessment form lacked documented responses and assessments from the healthcare professionals. Only 17% of the participants had been assessed with the total family assessment form. Additionally, there was a lack of documentation about whether or not the children had been informed in a large proportion of the assessment forms (31%). A total of 55% say that the child has not been informed. This implies that there is still a long way to go in order to make sure that children of parents with a mental illness are given relevant information and support. Conclusions The documentation and family assessment frequency is low and reflects the challenges healthcare professionals and patient experience when the child's situation becomes the topic of assessment. There is a need to further investigate the challenges of changing the mental health systems to incorporate the children and families of patients. More research should promote knowledge on what may facilitate family assessment dialogue.
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Affiliation(s)
- Camilla Lauritzen
- 1Regional Center for Child and Youth Mental Health & Child Welfare (RKBU North), UiT- Arctic University of Norway, 9037 Tromsø, Norway
| | - Anne Berit Kolmannskog
- 2Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Anette Christine Iversen
- 2Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
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Afzelius M, Plantin L, Östman M. Families living with parental mental illness and their experiences of family interventions. J Psychiatr Ment Health Nurs 2018; 25:69-77. [PMID: 28906576 DOI: 10.1111/jpm.12433] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Coping with parental mental illness in families can be challenging for both children and parents. Providing evidence-based family interventions to families where a parent has a mental illness can enhance the relationships in the family. Although psychiatric research has shown that evidence-based family interventions may improve the communication and understanding of parental mental illness, there is a lack in this area of research from an everyday clinical context. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Our study reinforces the fact that parents with mental illnesses are searching for support from psychiatric services in order to talk to their children about their illness. The finding that under-age children comply when they are told by their parents to join an intervention in psychiatric services supporting the family is something not observed earlier in research. This study once more illuminates the fact that partners of a person with parental mental illness are seldom, in an obvious way, included in family support interventions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychiatric services, and especially mental health nurses, have an important task in providing families with parental mental illness with support concerning communication with their children and in including the "healthy" partner in family support interventions. ABSTRACT Introduction Although research has shown that evidence-based family interventions in research settings improve the communication and understanding of parental mental illness, there is a lack of knowledge about interventions in an everyday clinical context. Aim This study explores how families with parental mental illness experience family interventions in a natural clinical context in psychiatric services. Method Five families with children aged 10-12 were recruited from psychiatric services in southern Sweden and interviewed in a manner inspired by naturalistic inquiry and content analysis. Both family and individual interviews were performed. Results In striving to lead an ordinary life while coping with the parental mental illness, these families sought the support of the psychiatric services, especially in order to inform their children about the mental illness. Despite different family interventions, the family members felt supported and reported that the number of conflicts in the family had decreased. The parents were appreciative of help with child-rearing questions, and the children experienced a calmer family atmosphere. However, the partner of the person with mental illness experienced being left without support. Implications for practice Our study shows that psychiatric services, and especially mental health nurses, are in a position to more regularly offer family interventions in supporting the children and the healthy partners.
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Affiliation(s)
- M Afzelius
- Faculty of Health and Society, Department of Social Work, Malmö University, Malmö, Sweden
| | - L Plantin
- Faculty of Health and Society, Department of Social Work, Malmö University, Malmö, Sweden
| | - M Östman
- Faculty of Health and Society, Department of Social Work, Malmö University, Malmö, Sweden
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27
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Jones SH, Jovanoska J, Calam R, Wainwright LD, Vincent H, Asar O, Diggle PJ, Parker R, Long R, Sanders M, Lobban F. Web-based integrated bipolar parenting intervention for parents with bipolar disorder: a randomised controlled pilot trial. J Child Psychol Psychiatry 2017; 58:1033-1041. [PMID: 28512921 PMCID: PMC5573909 DOI: 10.1111/jcpp.12745] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND People with bipolar disorder (BD) experience additional parenting challenges associated with mood driven fluctuations in communication, impulse control and motivation. This paper describes a novel web-based self-management approach (Integrated Bipolar Parenting Intervention; IBPI) to support parents with BD. METHOD Parents with BD with children aged 3-10 years randomised to IBPI plus treatment as usual (TAU) or waitlist control (WL). IBPI offered 16 weeks access to interactive self-management information concerning BD and parenting issues. Feasibility was through recruitment, retention and web usage. Clinical outcomes were assessed at baseline, 16, 24, 36 and 48 weeks. TRIAL REGISTRATION NUMBER ISRCTN75279027. RESULTS Ninety seven participants were recruited with 98% retention to end of intervention and 90% to final follow-up (56%-94% data analysed of retained participants; higher rates for observer measures). 77% of IBPI participants accessed the website (53% accessed parenting modules). Child behaviour, parenting sense of competence and parenting stress improved significantly in IBPI compared to WL to end of intervention, sustained to 48 weeks. Impacts of IBPI on family functioning, parent mood and time to mood relapse were not significant. CONCLUSIONS Online self-management support for parents with BD is feasible, with promising improvements in parenting and child behaviour outcomes. A definitive clinical and cost-effectiveness trial is required to confirm and extend these findings.
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Affiliation(s)
- Steven H. Jones
- Spectrum Centre for Mental Health ResearchFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - Jelena Jovanoska
- Spectrum Centre for Mental Health ResearchFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - Rachel Calam
- Division of Psychology and Mental HealthThe University of ManchesterManchesterUK
| | - Laura D. Wainwright
- Division of Psychology and Mental HealthThe University of ManchesterManchesterUK
| | - Helen Vincent
- Spectrum Centre for Mental Health ResearchFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - Ozgur Asar
- Department of Biostatistics and Medical InformaticsAcibadem UniversityIstanbulTurkey
| | - Peter J. Diggle
- CHICASFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - Rob Parker
- Spectrum Centre for Mental Health ResearchFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - Rita Long
- Spectrum Centre for Mental Health ResearchFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - Matthew Sanders
- Parenting and Family Support CentreUniversity of QueenslandBrisbaneQldAustralia
| | - Fiona Lobban
- Spectrum Centre for Mental Health ResearchFaculty of Health and MedicineLancaster UniversityLancasterUK
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Strand J, Rudolfsson L. A qualitative evaluation of professionals’ experiences of conducting Beardslee’s family intervention in families with parental psychosis. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2017. [DOI: 10.1080/14623730.2017.1345690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Jennifer Strand
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Lisa Rudolfsson
- Department of Literature, History of Ideas, and Religion, University of Gothenburg, Gothenburg, Sweden
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Nicholson J, Albert K, Gershenson B, Williams V, Biebel K. Developing Family Options: Outcomes for mothers with severe mental illness at twelve months of participation. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016. [DOI: 10.1080/15487768.2016.1231639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Joanne Nicholson
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Karen Albert
- Systems and Psychosocial Advances Research Center, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bernice Gershenson
- Systems and Psychosocial Advances Research Center, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Valerie Williams
- Systems and Psychosocial Advances Research Center, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kathleen Biebel
- Systems and Psychosocial Advances Research Center, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Gullbrå F, Smith-Sivertsen T, Rortveit G, Anderssen N, Hafting M. Ill and substance-abusing parents: how can the general practitioner help their children? A qualitative study. BMC FAMILY PRACTICE 2016; 17:154. [PMID: 27821069 PMCID: PMC5100102 DOI: 10.1186/s12875-016-0553-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/29/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Severe illness among parents may interfere with their parenting. Children having ill or substance-abusing parents are at risk of own health problems and psychosocial difficulties. The health care system should identify families in need of help and provide the help needed. For ill parents, it can be difficult to seek help and advices for their parenting. The aim of this study was to identify important factors for the general practitioner (GP) to bear in mind during encounters with ill and substance-abusing parents, to enable the GP to provide appropriate support for the children. METHOD A qualitative approach was chosen and the data material was semi-structured individual interviews with 12 parents with mental illness, substance abuse or severe somatic illness. The participants were recruited through GPs in Norway, and the interviews were performed in 2014. We used systematic text condensation for analysis. RESULTS It was important for the participants that the GP was oriented about their family and children's situation. They wanted to be regarded as competent parents in ordinary families; however, they were aware that their illness affected their parenting. They expressed a need for advice about how to inform the children of their illness and talk to them about their challenges, and, if necessary, utilize helpers who could inform the children and talk to them directly. There were often many agencies involved, and it was important that the helpers cooperated and shared information. In addition, the parents were in need of information about support services. CONCLUSION Ill parents in this study conveyed a double message to their helpers. They wanted to be considered as responsible and well-intended parents who wished the best for their children. At the same time they needed support in parenting. The GP should take the time to listen to the parents' first spontaneous description about an ordinary daily life (while realising that it may not necessarily be an accurate report), then explore their worries and needs of support.
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Affiliation(s)
- Frøydis Gullbrå
- Research Unit for General Practice, Uni Research Health, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | | | - Guri Rortveit
- Research Unit for General Practice, Uni Research Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Norman Anderssen
- Research Unit for General Practice, Uni Research Health, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Marit Hafting
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
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Ranning A, Munk Laursen T, Thorup A, Hjorthøj C, Nordentoft M. Children of Parents With Serious Mental Illness: With Whom Do They Grow Up? A Prospective, Population-Based Study. J Am Acad Child Adolesc Psychiatry 2016; 55:953-961. [PMID: 27806863 DOI: 10.1016/j.jaac.2016.07.776] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 06/27/2016] [Accepted: 08/30/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide an overview of living arrangements during childhood for children of parents with schizophrenia, bipolar disorder, and depression. METHOD Information was obtained from Danish registers on children's addresses and used to calculate the proportion living in different household living arrangements. The study was conducted as a prospective, register-based cohort study covering all children in the entire Danish population born after 1982 (N = 1,823,625) and their parents with a diagnosis of schizophrenia, bipolar disorder, depression, or none of these disorders. Regression analyses were performed assessing the risk of dissolution of the conjugal family. RESULTS Children's living arrangements were characterized by fewer nuclear families and more single-parent-headed households when parents had serious mental illness (SMI). From birth, 15% to 20% of children lived with a single mother with SMI. Conjugal families were dissolved at higher rates if a parent had SMI, especially if the mother (incidence rate ratio 2.98; 95% CI 2.80-3.17) or the father (incidence rate ratio 2.60; 95% CI 2.47-2.74) had schizophrenia. Risks for family dissolution varied greatly with parents' socioeconomic position in all diagnostic groups. CONCLUSION Parents' SMI affects children's family living arrangements because fewer children live with both parents and more children live with a single parent or are separated from both parents. Family cohesion seems especially difficult to maintain when parents have schizophrenia.
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Affiliation(s)
- Anne Ranning
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark.
| | - Thomas Munk Laursen
- Aarhus University, the National Center for Register-based Research, Aarhus, Denmark, and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH
| | - Anne Thorup
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark; Center for Child and Adolescent Psychiatry Capital Region, Copenhagen
| | - Carsten Hjorthøj
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Mental Health Services, Capital Region of Denmark, and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
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van der Ende PC, van Busschbach JT, Nicholson J, Korevaar EL, van Weeghel J. Strategies for parenting by mothers and fathers with a mental illness. J Psychiatr Ment Health Nurs 2016; 23:86-97. [PMID: 26868044 DOI: 10.1111/jpm.12283] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: The combination of coping with their mental health problems and caring for children makes parents vulnerable. Family-centred practice can help to maintain and strengthen important family relationships, and to identify and enhance the strengths of a parent with a mental illness, all contributing to the recovery of the person with the mental illness. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: Taking the strength and the opportunities formulated by parents themselves as a starting point is fairly new. Parents with severe mental illness find strength for parenting in several ways. They feel responsible, and this helps them to stay alert while parenting, whereas parenthood also offers a basis for social participation through school contacts and the child's friendships. Dedication to the parent role provides a focus; parents develop strengths and skills as they find a balance between attending to their own lives and caring for their children; and parenting prompts them to find adequate sources of social support. In this study these strategies were found to be the fundamentals of recovery related to parenting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can support and coach patients who are identified as parents, and self-chosen parenting related goals are set and addressed. A family-focused approach by nurses can be used to prevent problems for children and their families, identify their strengths as well as vulnerabilities, and address the challenges to build resilience. INTRODUCTION Understanding of the problems of parents with mental illness is growing. Gaining insight into strategies for parenting, while taking the opportunities formulated by these parents themselves as a starting point is fairly new. QUESTION What are the strategies of parents with a mental illness to be successful? METHOD Experiences of 19 mothers and eight fathers with a mental illness were explored with in-depth interviews. Data were content analysed, using qualitative methods. RESULTS Next to feelings of inadequacy, interviewees also describe how children enrich and structure their lives and are not only a burden but serve as distraction from problems. Developing activities that interest both child and parent provides avenues for emerging strength. Mental illness constrains fathers, but also gives opportunities to develop a meaningful relation with their children. DISCUSSION Strategies like being fully dedicated to the parental role, finding a balance between attention for one's own life and parenting and finding adequate sources of support are found to be fundamental for recovery in the parent role. Implications for practice Peer groups can be of valuable help and mental health workers can support parents to set self-chosen parenting related goals.
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Affiliation(s)
- P C van der Ende
- Hanze University of Applied Sciences, Groningen, The Netherlands
| | - J T van Busschbach
- Department of Psychiatry and Rob Giel Research Centre, University Medical Centre, Groningen, The Netherlands.,Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - J Nicholson
- Dartmouth Psychiatric Research Center, The Geisel School of Medicine, Dartmouth, Lebanon, NH, USA
| | - E L Korevaar
- Hanze University of Applied Sciences, Groningen, The Netherlands
| | - J van Weeghel
- Department of Social and Behavioral Science, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands.,Phrenos Centre of Expertise on Severe Mental Illness, Utrecht, The Netherlands.,Research and Development, Dijk en Duin Mental Health Centre, Castricum, The Netherlands
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