1
|
Furlong M, McGuinness C, Mulligan CM, McGarr SL, McGilloway S. Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness: a randomised controlled trial and cost analysis. Front Psychiatry 2024; 15:1287378. [PMID: 38606410 PMCID: PMC11007704 DOI: 10.3389/fpsyt.2024.1287378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/31/2024] [Indexed: 04/13/2024] Open
Abstract
Background Parental mental illness (PMI) is common and places children at high risk of developing psychological disorders. Family Talk (FT) is a well-known, whole-family, 7-session intervention designed to reduce the risk of transgenerational psychopathology. However, very few larger-scale evaluations of FT (across only a limited number of settings) have been conducted to date while there have been no cost analyses. This study aimed to assess the effectiveness and costs of delivering FT in improving child and family psychosocial functioning in families with PMI within routine mental health settings. Methods A total of 83 families with PMI, with children aged 5-18 years, were randomly assigned on a 2:1 ratio to receive either the FT intervention (n=55 families) or usual services (n=28 families) across 10 adult, child and primary care mental health sites in Ireland. Parental disorders included anxiety/depression (57%), Bipolar Disorder (20%), Borderline Personality Disorder (12%), Post-Traumatic Stress Disorder (8%) and psychosis (2%). Detailed assessments with parents were conducted at baseline and 6-month follow up. Results FT led to significant improvements in family functioning and child behaviour at 6-month follow up when compared to usual services, with medium effect sizes indicated. Parent participants with lower mental health literacy at baseline also showed significant post-intervention improvements. Those parents with less severe mental illness at baseline, and families with more partner and economic supports, reported additional significant post-intervention improvements in child depression/anxiety and parental mental health symptoms. The cost of FT amounted to €761.50 per family, although this decreased to €415.31 when recurring costs only were included. Conclusion The findings from this study, which was conducted within the context of a national programme to introduce family-focused practice in Ireland, demonstrate that FT is a low-cost intervention that improved child and family psychosocial functioning across different mental health disorders within routine adult, child and primary care mental health services. The findings contribute to the growing evidence base for FT, and provide a robust basis to inform practice and policy development for families with parental mental illness both in Ireland and elsewhere. Clinical trial registration https://www.isrctn.com/ISRCTN13365858, identifier ISRCTN13365858.
Collapse
Affiliation(s)
- Mairead Furlong
- Centre for Mental Health and Community Research, Maynooth University Department of Psychology and Social Sciences Institute, Maynooth, Ireland
| | | | - Christine Marie Mulligan
- Centre for Mental Health and Community Research, Maynooth University Department of Psychology and Social Sciences Institute, Maynooth, Ireland
| | - Sharon Lisa McGarr
- Centre for Mental Health and Community Research, Maynooth University Department of Psychology and Social Sciences Institute, Maynooth, Ireland
| | - Sinead McGilloway
- Centre for Mental Health and Community Research, Maynooth University Department of Psychology and Social Sciences Institute, Maynooth, Ireland
| |
Collapse
|
2
|
Ochoa S, Espinosa V, López-Carrilero R, Martinez I, Barrera ADH, Birulés I, Barajas A, Pélaez T, Díaz-Cutraro L, Coromina M, González-Rodríguez A, Verdaguer-Rodríguez M, Gutiérrez-Zotes A, Palma-Sevillano C, Montes C, Gallego J, Paya B, Casanovas F, Roldán M, Noval E, Varela Casals P, Salas-Sender M, Aznar A, Ayesa-Arriola R, Pousa E, Canal-Rivero M, Garrido-Torres N, Montserrat C, Muñoz-Lorenzo L, Crosas JM. Effectiveness of family metacognitive training in mothers with psychosis and their adolescent children: a multicenter study protocol. Front Psychol 2024; 15:1359693. [PMID: 38586292 PMCID: PMC10997187 DOI: 10.3389/fpsyg.2024.1359693] [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: 12/21/2023] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Background More than half of women with psychosis take care of their children despite the difficulties caused by the disease. Additionally, these kids have a higher risk of developing a mental health disorder. However, no interventions have been developed to meet these needs. Metacognitive Training (MCT) is a psychological intervention that has demonstrated its efficacy in improving cognitive insight, symptom management and social cognition in people with first-episode psychosis (FEP). Additionally, MCT has shown better results in women than men with FEP. This study aims to adapt and evaluate the efficacy of MCT-F in mothers and adolescent children in an online group context with the main purpose of improving family relationships, cognitive awareness and symptoms in women with psychosis and increase their children's knowledge of the disease and their functioning. As secondary objectives, it also aims to evaluate improvements in metacognition, social cognition, symptoms, protective factors and self-perception of stigma. Materials and methods A quasi-experimental design with participants acting as their own control will be carried out. Forty-eight mothers with psychosis and their adolescent children (between 12 and 20 years old) recruited from a total of 11 adult mental health care centers will receive MCT-F. Participants will be evaluated 11 weeks before the intervention (T1), at baseline (T2), and post-intervention (T3) with a cognitive insight scale, as a primary outcome. Measures of metacognitive and social cognition, symptoms, cognitive functioning, family and social functioning, protective factors (self-esteem, resilience, and coping strategies) and self-perceived stigma will be addressed as secondary outcomes. Assessment will also address trauma and attachment in mothers and, lastly, the feasibility and acceptability of MCT-F in both participant groups. Discussion This will be the first investigation of the efficacy, acceptability, and viability of the implementation of MCT-F. The results of this study may have clinical implications, contributing to improving mothers' with psychosis and adolescents' functioning and better understanding of the disease, in addition to the possible protective and preventive effect in adolescents, who are known to be at higher risk of developing severe mental disorders.Clinical trial registration:https://clinicaltrials.gov/, identifier [NCT05358457].
Collapse
Affiliation(s)
- Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Victoria Espinosa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Irene Martinez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Irene Birulés
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Facultat de Psicologia Departament de Cognició, Desenvolupament i Psicologia de l'Educació, Universistat de Barcelona, Barcelona, Spain
| | - Ana Barajas
- Departament de Psicologia, Facultat de Psicologia Clínica I de la Salut. Serra Húnter Programme, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Trinidad Pélaez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Luciana Díaz-Cutraro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Department of Psychology, FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Marta Coromina
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, CIBERSAM, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, Terrassa, Spain
| | - Marina Verdaguer-Rodríguez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitari Institut Pere Mata, Institut d’Investigació Sanitària Pere Virgili-CERCA, Universitat Rovira i Virgili, Reus, Spain
| | - Carolina Palma-Sevillano
- Department of Psychology, FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain
| | - Cristian Montes
- Virgen del Rocío University Hospital, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Biomedicine of Seville (IBiS), First-episode Psychosis Research Network of Andalusia (Red PEPSur), University of Seville, Seville, Spain
| | | | - Beatriz Paya
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | - Francesc Casanovas
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Barcelona, Spain
| | - María Roldán
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Barcelona, Spain
| | - Emma Noval
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | | | | | - Ana Aznar
- Centre d’Higiene Mental Les Corts, Barcelona, Spain
| | - Rosa Ayesa-Arriola
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | - Esther Pousa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Manuel Canal-Rivero
- Virgen del Rocío University Hospital, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Biomedicine of Seville (IBiS), First-episode Psychosis Research Network of Andalusia (Red PEPSur), University of Seville, Seville, Spain
| | - Nathalia Garrido-Torres
- Virgen del Rocío University Hospital, Network Centre for Biomedical Research in Mental Health (CIBERSAM), Institute of Biomedicine of Seville (IBiS), First-episode Psychosis Research Network of Andalusia (Red PEPSur), University of Seville, Seville, Spain
| | - Clara Montserrat
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Josep María Crosas
- Department of Mental Health, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain
| |
Collapse
|
3
|
Espinosa V, Arin-González P, Jiménez-Lafuente A, Pardo N, López-Carrilero R, Birulés I, Barajas A, Pélaez T, Díaz-Cutraro L, Verdaguer-Rodríguez M, Gutiérrez-Zotes A, Palma-Sevillano C, Varela-Casals P, Salas-Sender M, Aznar A, Ayesa-Arriola R, Pousa E, Canal-Rivero M, Garrido-Torres N, Montserrat C, Muñoz-Lorenzo L, Crosas JM, Ochoa S. Family Metacognitive Training (MCT-F): Adapting MCT to Mothers with Psychosis and Their Adolescent Children. Behav Sci (Basel) 2024; 14:97. [PMID: 38392450 PMCID: PMC10885955 DOI: 10.3390/bs14020097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Over half of women with psychosis are mothers. Research suggests that mothers with psychosis face unique challenges affecting both their mental health prognosis and their relationship with their children. Moreover, those children have a higher risk of developing a mental disorder. Notwithstanding, interventions specifically tailored to these families remain largely uncovered. Metacognitive Training (MCT) has demonstrated its efficacy in improving cognitive insight, symptom management, and social cognition in people with psychosis. However, there is no evidence of the efficacy of MCT in a family setting (MCT-F). This study describes the first adaptation of MCT for mothers with psychosis and their adolescent children in an online group setting. The phases (assessment, decision, adaptation, production, topical experts' integration) of the ADAPT-ITT model were systematically applied through a participatory approach (n = 22), including a first-person perspective and involving qualitative (e.g., topical expert literature review and consensus groups, interviews, thematic analyses) and quantitative methods. While MCT's core components were retained, participants guided adaptations both in content and delivery. The findings suggest the importance of community engagement and sharing decision-making processes to demonstrate the acceptability and feasibility of the adapted intervention. Employing a structured approach such as the ADAPT-ITT model ensures readiness of the new training for efficacy trials.
Collapse
Affiliation(s)
- Victoria Espinosa
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
| | | | | | - Nerea Pardo
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Irene Birulés
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Department of Social and Quantitative Psychology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain
| | - Ana Barajas
- Departament de Psicologia, Facultat de Psicologia Clínica I de la Salut. Serra Húnter Programme, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
| | - Trinidad Pélaez
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luciana Díaz-Cutraro
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, 08022 Barcelona, Spain
| | - Marina Verdaguer-Rodríguez
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
| | - Alfonso Gutiérrez-Zotes
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili-CERCA, Universitat Rovira i Virgili, 43206 Reus, Spain
| | - Carolina Palma-Sevillano
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, 08022 Barcelona, Spain
- Hospital de Mataró, Consorci Sanitari del Maresme, 08301 Mataró, Spain
| | | | | | - Ana Aznar
- Centre d'Higiene Mental Les Corts, 08035 Barcelona, Spain
| | - Rosa Ayesa-Arriola
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, 39008 Santander, Spain
| | - Esther Pousa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), 08041 Barcelona, Spain
| | - Manuel Canal-Rivero
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS), University of Seville, First-Episode Psychosis Research Network of Andalusia (Red PEPSur), 41013 Sevilla, Spain
| | - Nathalia Garrido-Torres
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS), University of Seville, First-Episode Psychosis Research Network of Andalusia (Red PEPSur), 41013 Sevilla, Spain
| | - Clara Montserrat
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, 08003 Barcelona, Spain
| | - Laura Muñoz-Lorenzo
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Josep Maria Crosas
- Department of Mental Health, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
4
|
Budden T, Hafizuddin A, Dimmock JA, Law KH, Furzer BJ, Jackson B. Support needs and experiences of young people living in families with mental illness. J Adolesc 2023. [PMID: 36808749 DOI: 10.1002/jad.12153] [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: 10/11/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Children and adolescents living in families affected by mental illness are at elevated risk of developing mental health problems. A range of interventions have been designed to help these young people; however, the effectiveness of these programs is, in some cases, mixed. Our aim was to understand in detail the support needs and experiences of a group of Australian children and adolescents living in families with mental illness. METHODS Our study is a qualitative in nature. In 2020-2021, we interviewed 25 Australian young people (Mage = 13.60, SD = 2.26, 20 females and 5 males) living with family members affected by mental illness to understand their (the young people's) experiences, and to identify the types of support that these young people considered important or effective. We conducted reflexive thematic analyses of interview data, underpinned by interpretivist assumptions. RESULTS We identified seven themes within two higher-order categories reflecting our aims to understand (1) lived experiences within families affected by mental illness (i.e., increased responsibilities, missing out, and stigmatization), and (2) support experiences, needs, and preferences (i.e., respite, shared experiences with like-minded others, education, and flexibility). CONCLUSIONS Our findings hold substantial practical value by informing services, interventions, and conversations that better support young people living in families affected by mental illness.
Collapse
Affiliation(s)
- Timothy Budden
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Australia
| | - Ahmad Hafizuddin
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Australia
| | - James A Dimmock
- Department of Psychology, College of Healthcare Services, James Cook University, Townsville, Australia
| | - Kwok Hong Law
- Department of Psychology, College of Healthcare Services, James Cook University, Townsville, Australia
| | - Bonnie J Furzer
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Australia
| | - Ben Jackson
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| |
Collapse
|
5
|
Bell MF, Glauert R, Roos LL, Wall-Wieler E. Examining the relationship between maternal mental health-related hospital admissions and childhood developmental vulnerability at school entry in Canada and Australia. BJPsych Open 2023; 9:e29. [PMID: 36715086 PMCID: PMC9970171 DOI: 10.1192/bjo.2022.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND It is well established that maternal mental illness is associated with an increased risk of poor development for children. However, inconsistencies in findings regarding the nature of the difficulties children experience may be explained by methodological or geographical differences. AIMS We used a common methodological approach to compare developmental vulnerability for children whose mothers did and did not have a psychiatric hospital admission between conception and school entry in Manitoba, Canada, and Western Australia, Australia. We aimed to determine if there are common patterns to the type and timing of developmental difficulties across the two settings. METHOD Participants included children who were assessed with the Early Development Instrument in Manitoba, Canada (n = 69 785), and Western Australia, Australia (n = 19 529). We examined any maternal psychiatric hospital admission (obtained from administrative data) between conception and child's school entry, as well as at specific time points (pregnancy and each year until school entry). RESULTS Log-binomial regressions modelled the risk of children of mothers with psychiatric hospital admissions being developmentally vulnerable. In both Manitoba and Western Australia, an increased risk of developmental vulnerability on all domains was found. Children had an increased risk of developmental vulnerability regardless of their age at the time their mother was admitted to hospital. CONCLUSIONS This cross-national comparison provides further evidence of an increased risk of developmental vulnerability for children whose mothers experience severe mental health difficulties. Provision of preventative services during early childhood to children whose mothers experience mental ill health may help to mitigate developmental difficulties at school entry.
Collapse
Affiliation(s)
- Megan F Bell
- School of Population and Global Health, University of Western Australia, Western Australia; School of Psychological Science, University of Western Australia, Western Australia; and Telethon Kids Institute, University of Western Australia, Western Australia
| | - Rebecca Glauert
- School of Population and Global Health, University of Western Australia, Western Australia; and Telethon Kids Institute, University of Western Australia, Western Australia
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Canada
| | | |
Collapse
|
6
|
Wirehag Nordh EL, Grip K, Thorvaldsson V, Priebe G, Afzelius M, Axberg U. Preventive interventions for children of parents with depression, anxiety, or bipolar disorder: A quasi-experimental clinical trial. Acta Paediatr 2023; 112:132-142. [PMID: 36169579 PMCID: PMC10092553 DOI: 10.1111/apa.16555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/06/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022]
Abstract
AIM To investigate the effectiveness of preventive interventions for 8-17-year-old children of patients diagnosed with depression, anxiety, or bipolar disorder. METHODS Sixty-two families including 89 children received either the more extensive Family Talk Intervention (FTI; n = 35), the brief Let's Talk about Children (LTC; n = 16), or Interventions as Usual (IAU; n = 38) in routine care in adult psychiatry. Parent-rated questionnaire data were collected at baseline, after 6 and 12 months. We used growth curve models to investigate the effect of intervention on child mental health problems (SDQ-P Total Difficulties) and perceived parental control of child behaviour (PLOC-PPC). RESULTS Parents in the FTI and LTC groups, versus the IAU group, reported more favourable development in terms of preventing increase in child mental health problems with standardised intervention effects of d = -0.86 and -0.88 respectively, by study end, and reported improved perceived parental control, d = 1.08 and 0.71, respectively, by study end. No significant differences in effect were found when FTI and LTC were compared. CONCLUSIONS The results support continued use of FTI and LTC in adult psychiatry, and since LTC is a brief intervention, it might be useful as a minimum-level preventive intervention.
Collapse
Affiliation(s)
| | - Karin Grip
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | | | - Gisela Priebe
- Department of Social and Psychological Studies and CBU, Centre for Research on the Mental Health and Life Circumstances of Children and Youth, Karlstad University, Karlstad, Sweden
| | - Maria Afzelius
- Department of Social Work, Malmo University, Malmo, Sweden
| | - Ulf Axberg
- Faculty of Social Studies, VID Specialized University, Oslo, Norway
| |
Collapse
|
7
|
Farářová A, Papežová H, Gricová J, Štěpánková T, Čapek V, Reedtz C, Lauritzen C, van Doesum K. ChildTalks+: a study protocol of a pre-post controlled, paired design study on the use of preventive intervention for children of parents with a mental illness with focus on eating disorders. BMC Psychiatry 2022; 22:715. [PMID: 36384579 PMCID: PMC9670502 DOI: 10.1186/s12888-022-04349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Children of parents with a mental illness are at high risk of developing a mental disorder as a result of transgenerational transmission. Without effective intervention, they could form the next generation of psychiatric patients. ChildTalks+ is a preventive intervention involving four structured psychoeducational sessions designed for parents affected by a mental disorder and their children. Its aim is to reduce the risk of mental disorders in children of parents with mental illness. This study draws on our clinical practice and involves a group of patients with eating disorders. The aim of the project, which will run in the Czech Republic, is to evaluate the effectiveness of ChildTalks+ methodology. METHODS ChildTalks+ therapists (professionals from health, social, and educational facilities) will recruit 66 families where a parent is treated for a mental disorder and the family includes children aged 6-18. Paired allocation into an intervention group (N = 33) and a control group (N = 33) will be based on the number of risk factors identified in the family. Both groups will complete questionnaires at the baseline, post-test, and follow-up assessments after six and 12 months. The intervention group will receive the ChildTalks+ intervention within 2 months of the baseline assessment; the control group after the last assessment. Questionnaires will be completed by parents and children aged 12+ and, in two cases, 15+ years. Quantitative data will be supplemented with qualitative data from ChildTalks+ therapists working with patients with eating disorders. DISCUSSION The ChildTalks+ intervention is expected to strengthen parenting competencies and family protective factors, improve family communication, increase awareness of parental mental health issues, and improve the wellbeing of children of parents with mental illness with long-term sustainable outcomes. The study should contribute to the evidence base for the ChildTalks+ program and help identify key themes in the implementation of similar preventive interventions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05554458. Registered 26 September 2022. Retrospectively registered.
Collapse
Affiliation(s)
- Adéla Farářová
- First Faculty of Medicine, Charles University, Prague, Czech Republic. .,Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Hana Papežová
- grid.4491.80000 0004 1937 116XFirst Faculty of Medicine, Charles University, Prague, Czech Republic ,grid.411798.20000 0000 9100 9940Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jana Gricová
- grid.4491.80000 0004 1937 116XFirst Faculty of Medicine, Charles University, Prague, Czech Republic ,grid.411798.20000 0000 9100 9940Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tereza Štěpánková
- grid.4491.80000 0004 1937 116XFirst Faculty of Medicine, Charles University, Prague, Czech Republic ,grid.411798.20000 0000 9100 9940Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Václav Čapek
- grid.4491.80000 0004 1937 116XFirst Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Charlotte Reedtz
- grid.10919.300000000122595234RKBU North, Faculty of Health, UiT – Arctic University of Norway, Tromsø, Norway
| | - Camilla Lauritzen
- grid.10919.300000000122595234RKBU North, Faculty of Health, UiT – Arctic University of Norway, Tromsø, Norway
| | - Karin van Doesum
- grid.5590.90000000122931605Department of Clinical Psychology, Radboud University, Nijmegen, Netherlands
| |
Collapse
|
8
|
Cudjoe E, Tam CHL, Effah D, Amegashie EF, Tweneboah AO. Living with parental mental illness is like a roller coaster: Reflections on children's lifeworld in the family setting. J Clin Nurs 2022. [PMID: 35733326 DOI: 10.1111/jocn.16417] [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: 04/12/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore what it is like for children in the family setting to live with parental mental illness. BACKGROUND There are reported risks of negative social and behavioural outcomes among children living with parental mental illness such as poor school performance, isolation and poor mental health. There is yet more to know about how children's interactions with significant members of the family shape their experiences. DESIGN A phenomenological design following Husserl's concepts of lifeworld and inter-subjectivity was adapted for the study. METHOD Twenty-one children (ages 10-17) who lived with a parent with mental illness were interviewed. The data were analysed to attain the essential features of the phenomenon. The study followed the COREQ checklist for qualitative studies. FINDINGS The essence of the phenomenon 'living with parental mental illness' in the family setting comprises strain, sadness and some happy moments. Living with parental mental illness can produce unpredictable life situations for children as relationships and interactions in the family setting can be chaotic and confusing. The ups and downs define their lifeworld as a roller coaster. Strenuous family environment, sibling interaction, navigating separate living arrangements and there are good days were specific themes that clarified the children's lives as a roller coaster. CONCLUSION A concept called the 'parent paradox' is coined to reflect how children are torn between what their living situation looks like comparing the parent with mental illness and the other without mental illness. The paradox is founded on children's loyalty towards their parents. RELEVANCE TO CLINICAL PRACTICE To break the unhealthy cycle created by the parent paradox, mental health nurses should ensure that children are well informed about the parent's mental condition including information about treatment procedures and recovery. Child's psychological distress may be reduced when they are informed.
Collapse
Affiliation(s)
- Ebenezer Cudjoe
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Cherry Hau Lin Tam
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Deborah Effah
- Kokompe Health Nurse. Black Belt Ghana Foundation, Takoradi, Ghana
| | - Elorm Faith Amegashie
- Community Psychiatric Unit, Effia Nkwanta Regional Hospital, Sekondi-Takoradi, Ghana
| | | |
Collapse
|
9
|
Goodyear M, Zechmeister-Koss I, Bauer A, Christiansen H, Glatz-Grugger M, Paul JL. Development of an Evidence-Informed and Codesigned Model of Support for Children of Parents With a Mental Illness- "It Takes a Village" Approach. Front Psychiatry 2022; 12:806884. [PMID: 35173638 PMCID: PMC8841827 DOI: 10.3389/fpsyt.2021.806884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Providing support to parents and their children to help address the cycle of intergenerational impacts of mental illness and reduce the negative consequences for children is a key focus of selective prevention approaches in public mental health. However, a key issue for children of parents with a mental illness is the lack of access to early intervention and prevention support when needed. They are not easily identifiable (until presenting with significant mental health issues of their own) and not easily accessing the necessary support that address the complex interplay of parental mental illness within families. There are significant barriers to the early identification of these children, particularly for mental health care. Furthermore, there is a lack of collaborative care that might enhance identification as well as offer services and support for these families. The "It takes a Village" project seeks to improve mental health outcomes for children through the co-development, implementation and evaluation of an approach to collaborative practice concerned with the identification of families where a parent has a mental illness, and establishing a service model to promote child-focused support networks in Austria. Here we describe the development of service delivery approach for the "It takes a Village" project that aims to improve identification and support of these children within enhancements of the existing service systems and informal supports. The paper describes the use of codesign and other implementation strategies, applied to a research setting, with the aim of impacting the sustainability of workforce reform to achieve lasting social impact. Results highlight the steps involved in translating evidence-based components, local practice wisdom and lived experience into the "It takes a Village" practice model for Tyrol, Austria. We highlight through this paper how regional context-specific solutions are essential in the redesign of care models that meet the complex needs of children of parents with a mental illness. Service system and policy formation with local and experienced stakeholders are also vital to ensure the solutions are implementation-ready, particularly when introducing new practice models that rely on organizational change and new ways of practice with vulnerable families. This also creates a solid foundation for the evaluation of the "It take a Village" approach for children of parents with a mental illness in Austria.
Collapse
Affiliation(s)
- Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, VIC, Australia
- Emerging Minds, National Workforce Centre for Child Mental Health, Hilton, SA, Australia
| | | | - Annette Bauer
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Hanna Christiansen
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Martina Glatz-Grugger
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria
| | - Jean Lillian Paul
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
10
|
Everts S, van Amelsvoort T, Leijdesdorff S. Mandatory Check for COPMI in Adult Mental Healthcare Services in the Netherlands-A Quantitative and Qualitative Evaluation. Front Psychiatry 2022; 13:807251. [PMID: 35370848 PMCID: PMC8971626 DOI: 10.3389/fpsyt.2022.807251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children of parents with a mental disorder and/or addiction (COPMI) are at increased risk of developing a mental disorder. In spite of preventive interventions that can decrease the risk of problem development, COPMI are not automatically offered help. In 2013, a mandatory COPMI check was implemented in the Netherlands, requiring every mental health care professional to check whether their adult patients have children and to assess these children's safety and needs. Earlier research has shown that a gap between these regulations and the actual integration in clinical practice is not uncommon. METHOD In the current study, we evaluated the implementation of the mandatory COPMI check in the Netherlands, using quantitative as well as qualitative data from a large mental healthcare organization in the Netherlands that offers both Child and Adolescent Mental Health and Adult Mental Healthcare. RESULTS Files from 14,469 patients were analyzed quantitatively and a sample of 150 files was further analyzed in depth. Findings were refined through 4 focus groups with adult mental healthcare professionals. It was found that while there are examples of the tool leading to interventions for COPMI, the tool is often not used, and when used tends to direct the focus away from COPMI needs and organizing help toward the more narrow and problematic focus on safety and reporting to child abuse authorities. CONCLUSION The potential of the COPMI check is currently not fully realized. Strategies to improve its effectiveness in clinical practice are needed to improve access to interventions for COPMI.
Collapse
Affiliation(s)
- Saskia Everts
- Division Child and Adolescent Mental Health, Mondriaan Mental Health Center, Maastricht, Netherlands
| | - Therese van Amelsvoort
- Division Child and Adolescent Mental Health, Mondriaan Mental Health Center, Maastricht, Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Sophie Leijdesdorff
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
11
|
Vetri K, Piché G, Villatte A. An Evaluation of the Acceptability, Appropriateness, and Utility of a Bibliotherapy for Children of Parents With a Mental Illness. Front Psychiatry 2022; 13:815873. [PMID: 35492703 PMCID: PMC9046907 DOI: 10.3389/fpsyt.2022.815873] [Citation(s) in RCA: 1] [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: 11/15/2021] [Accepted: 03/14/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Children of parents with a mental illness are at higher risk for various psychiatric problems and adaptive difficulties compared to those of parents without mental health problems. Certain preventive psychoeducational interventions target these children to promote their well-being and resilience and prevent the emergence of adaptive difficulties. However, few such interventions have been developed and evaluated specifically for elementary school-aged children of parents with a mental illness. OBJECTIVES This study aims to evaluate an interpersonal psychotherapy-based book targeting children living with a parent with a mental illness. METHODS The study examines children, parents and psychosocial workers' perception of the acceptability, appropriateness and utility of the book. In total, 22 participants answered online open-ended questions after reading the book. RESULTS The book was highly appreciated and positively perceived by the families and psychosocial workers. Results suggest that children, parents and psychosocial workers viewed it as an appropriate and useful tool for supporting children with a parent with a mental illness. The present study reveals that the bibliotherapy appears well adapted to the developmental level of school-age children. DISCUSSION This study presents a book that shows promise for supporting the resilience of elementary school-aged children having a parent with a mental illness. Results highlight the importance of tailoring the content and modalities of interventions to the developmental level, needs and preferences of elementary school-aged children. The relevance of a collaborative method is also discussed, thus providing knowledge regarding this type of approach for the development of interventions targeting children.
Collapse
Affiliation(s)
- Kelly Vetri
- Laboratory LaPProche, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada.,Centre de recherche universitaire sur les jeunes et les familles (CRUJEF), Québec, QC, Canada.,Réseau de recherche en santé des populations du Québec (RRSPQ), Montréal, QC, Canada.,Réseau Intersectoriel de Recherche en Santé de l'Université du Québec (RISUQ), Québec, QC, Canada
| | - Geneviève Piché
- Laboratory LaPProche, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada.,Centre de recherche universitaire sur les jeunes et les familles (CRUJEF), Québec, QC, Canada.,Réseau de recherche en santé des populations du Québec (RRSPQ), Montréal, QC, Canada.,Réseau Intersectoriel de Recherche en Santé de l'Université du Québec (RISUQ), Québec, QC, Canada
| | - Aude Villatte
- Laboratory LaPProche, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada.,Centre de recherche universitaire sur les jeunes et les familles (CRUJEF), Québec, QC, Canada.,Réseau de recherche en santé des populations du Québec (RRSPQ), Montréal, QC, Canada.,Réseau Intersectoriel de Recherche en Santé de l'Université du Québec (RISUQ), Québec, QC, Canada
| |
Collapse
|