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Gammage RJ, Nolte L. Talking and making meaning about parental mental health problems: The role of children's family caregivers. JOURNAL OF MARITAL AND FAMILY THERAPY 2024; 50:5-27. [PMID: 37641434 DOI: 10.1111/jmft.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
When a parent is less able to meet their children's needs due to a severe and enduring mental health problem (MHP), other adult family members often help with childcare. We present a Grounded Theory of how children's family caregivers construct meaning about the parental MHP and communicate about it with children. Nineteen caregivers participated in qualitative interviews. Each supported at least one related child aged 4-17 years with a parent with MHPs. We found that caregivers engaged in a Core Social Process of providing protection in uncertainty. This comprised three categories as follows: shaping the interactional space, communicating through the developmental process, and engendering a sense of safety. Caregivers appeared to act from a Key Social Positioning of developing a caregiver identity. The findings implicate family-focused provision of mental health and social care. Clinical recommendations are made for whole-family interventions and the role of marital and family therapists.
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Affiliation(s)
- Rebecca J Gammage
- NHS Greater Glasgow and Clyde in Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Lizette Nolte
- Department of Psychology and Sport Science, University of Hertfordshire, Hatfield, UK
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Khanijahani A, Sualp K. Adverse Childhood Experiences, Neighborhood Support, and Internalizing and Externalizing Mental Disorders among 6-17 years old US Children: Evidence from a Population-Based Study. Community Ment Health J 2022; 58:166-178. [PMID: 33709281 DOI: 10.1007/s10597-021-00808-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 02/23/2021] [Indexed: 11/24/2022]
Abstract
We pooled data from four years (2016-2019) of the National Survey of Children's Health (NSCH) and included a nationally representative sample of 6 to 17 years old US children (N = 94,369; Mean age = 11.53 years, Standard Deviation [SD] = 3.53). Among 6-17-year-old US children, about 48% had a lifelong exposure to at least one of nine Adverse Childhood Experiences (ACEs), and 18.7% had a current diagnosis of at least one of four mental disorders. We examined the association between ACEs, neighborhood support, and mental disorders using several logistic regression models. More types of lifelong ACEs and lower neighborhood support were associated with a higher diagnosis of internalizing (anxiety/depression) and externalizing (ADHD/behavior problems) mental disorders (odds ratio [OR] > 1, and p < .001 for all relationships). After controlling for neighborhood support in the models, the odds ratios for ACEs attenuated but remained significant in all models regardless of mental disorder type or age group. However, the odds ratios for neighborhood support were larger for the association with ADHD/behavior problems than anxiety/depression. Moreover, odds ratios for neighborhood support levels were higher for older children (12-17 years old) compared to younger (6-11 years old) children. Higher neighborhood support appears to mitigate the adverse effects of ACEs on mental disorders, especially externalizing mental disorders (anxiety/depression) among adolescents (12-17 years old).
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Affiliation(s)
- Ahmad Khanijahani
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
| | - Kenan Sualp
- Department of Public Affairs, University of Central Florida, Orlando, FL, USA
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Kang E, Omigbodun O, Oduguwa A, Kim W, Qin L, Ogunmola O, Akinkuotu F, Derenoncourt M, Abdurahman H, Adejumo O, Lawal K, Bella-Awusah T. If we build it, they will come: Caregiver decision to use an accessible outpatient psychiatric service for children and adolescents in Nigeria. Soc Sci Med 2021; 279:113972. [PMID: 33990075 DOI: 10.1016/j.socscimed.2021.113972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/05/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE If child and adolescent psychiatric (CAP) services were accessible in lower-middle-income countries (LMIC) such as Nigeria, what individual and socio-cultural factors would influence caregivers' willingness to use these services when they are needed? METHODS To address this question, we conducted structured interviews with a stratified random sampling of 442 adult caregivers of children aged 5 to 19-years who lived within 10 km of an established CAP outpatient service in Ibadan, Nigeria. RESULTS Based on structural equation modeling, our cross-sectional findings indicated that caregivers were generally willing to use the accessible outpatient CAP service for a narrow range of overtly disruptive and developmentally atypical child behavior. However, their decisions were not influenced by their recognition of child and adolescent mental health (CAMH) conditions, competing life stressors, caregiver wellness, nor stigma as we had initially hypothesized. Rather caregivers pragmatically considered a range of approaches to address CAMH concerns. Post-hoc hypotheses confirmed that caregivers' beliefs about etiology and treatment effectiveness for CAMH conditions shaped their help-seeking decisions and stigmatization of CAP services. Specifically, caregivers who attributed CAMH conditions to physical causes regarded biomedical interventions as the most effective treatment while spiritual interventions were deemed to be the least effective. CONCLUSIONS Taken together our results suggested that caregivers were receptive and willing to use outpatient psychiatric services for their children. However, their beliefs about the etiology and treatment effectiveness of CAMH conditions shaped how they intended to engage the services. These findings underscored the importance of scaling up a broader spectrum of accessible complementary CAMH intervention and prevention services in Nigeria that extend beyond indigenous or biomedical models. In doing so caregivers will come.
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Affiliation(s)
- Ezer Kang
- Howard University, Department of Psychology, Washington, DC, USA.
| | - Olayinka Omigbodun
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria; University College Hospital, Department of Child & Adolescent Psychiatry, Ibadan, Nigeria.
| | - Adeola Oduguwa
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria
| | - Woojae Kim
- Howard University, Department of Psychology, Washington, DC, USA
| | - Lu Qin
- Howard University, Department of Psychology, Washington, DC, USA
| | - Olusegun Ogunmola
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria
| | | | | | - Haleem Abdurahman
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria; University College Hospital, Department of Child & Adolescent Psychiatry, Ibadan, Nigeria
| | - Olurotimi Adejumo
- University College Hospital, Department of Child & Adolescent Psychiatry, Ibadan, Nigeria; Hertfordshire Partnership, University NHS Foundation Trust, UK
| | - Kehinde Lawal
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria; University College Hospital, Department of Child & Adolescent Psychiatry, Ibadan, Nigeria
| | - Tolulope Bella-Awusah
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria; University College Hospital, Department of Child & Adolescent Psychiatry, Ibadan, Nigeria
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Plass-Christl A, Ravens-Sieberer U, Hölling H, Otto C. Trajectories of health-related quality of life in children of parents with mental health problems: results of the BELLA study. Qual Life Res 2021; 30:1841-1852. [PMID: 33651276 DOI: 10.1007/s11136-021-02783-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Children of parents with mental health problems (CPM) have an increased risk for impaired health-related quality of life (HRQoL). This study aims at investigating the age- and gender-specific course of HRQoL and at exploring predictors of HRQoL in CPM based on longitudinal data (baseline, 1-year and 2-year follow-up) of a German population-based sample. METHODS Longitudinal data from the German BELLA study was analyzed (n = 1429; aged 11 to 17 years at baseline). The SCL-S-9 in combination with the cutoff for the General Severity Index (GSI) from the longer SCL-90-R served to identify CPM (n = 312). At first, we compared domain-specific HRQoL according to the KIDSCREEN-27 in CPM versus Non-CPM. Focusing on CPM, we used individual growth modeling to investigate the age and gender-specific course, and to explore effects of risk and (personal, familial and social) resource factors on self-reported HRQoL in CPM. RESULTS Self-reported HRQoL was reduced in CPM compared to Non-CPM in all domains, but in social support & peers. However, a minimal important difference was only reached in girls for the domain autonomy & parent relation. Internalizing and externalizing mental health problems were associated with impaired HRQoL in CPM. Self-efficacy, social support and family climate were identified as significant resources, but parental mental health problems over time were not associated with any investigated domain of HRQoL in CPM. CONCLUSIONS Adolescent female CPM may be especially at risk for reduced HRQoL. When developing support programs for CPM, self-efficacy, social support and family climate should be considered, HRQoL and mental health problems in CPM should be addressed.
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Affiliation(s)
- Angela Plass-Christl
- Evangelical Hospital Alsterdorf Hamburg, Hamburg, Germany.
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Child Public Health, Hamburg, Germany.
| | - Ulrike Ravens-Sieberer
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Child Public Health, Hamburg, Germany.
| | - Heike Hölling
- Robert Koch Institute, Department of Epidemiology and Health Reporting, Berlin, Germany
| | - Christiane Otto
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Child Public Health, Hamburg, Germany
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