Trying to comfort the parent: a qualitative study of children dealing with parental depression

Roles of physical functioning and comorbid mental illness of chronically ill parents and their spouses' health status in adolescent functioning

INTRODUCTION

Emerging research suggests that physically ill parents' psychological adjustment to illness and emotional well-being may affect adolescents' psychosocial functioning. As people with chronic medical conditions often develop mental disorders, it is important to examine the influence of comorbidity of parental physical and mental health conditions on adolescents' functioning. In addition, the physical and mental health status of the spouses/partners of chronically ill parents needs to be explored to further understand the potential impact of parental chronic illness on adolescents' psychological distress and academic performance.

METHODS

Cross-sectional data from 164 parent-adolescent pairs were collected through online surveys in the United States between 2018 and 2019. Parent participants (Mage  = 42.69, SD = 5.96) included parents who had been diagnosed with a chronic physical illness (e.g., multiple sclerosis, diabetes, chronic pain, cancer). Adolescent participants were middle- and high-school-aged children who lived with their physically ill parents (Mage  = 14.34, SD = 2.07).

RESULTS

Hierarchical regression analyses indicated that comorbid mental illness of parental chronic illness and spousal mental health status were associated with adolescents' distress. The level of physical functioning of chronically ill parents was related to adolescents' academic performance.

CONCLUSION

Parental chronic illness appears to affect adolescents' psychological and academic outcomes through distinct pathways. It is important to examine the comorbid mental health status of chronically ill parents and their spouses'/partners' mental health conditions to better understand the impact of parental chronic illness on adolescents' psychological adjustment.

Talking and making meaning about parental mental health problems: The role of children's family caregivers

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.

The Transition to Adulthood in Children of Depressed Parents: Long-Term Follow-Up Data from the Family Talk Preventive Intervention Project

Little is known about the effects of parental depression on offspring as they transition to adulthood-a challenging time developmentally, when late adolescents must separate from home, achieve intimate relationships, and develop a sense of identity. We present long-term quantitative and qualitative data from early adolescents with a depressed parent who were randomized to one of two family-based preventive interventions and followed over time, across the transition to young adulthood. Specifically, we present clinical measures of psychopathology and Likert-scale questionnaire data from young adults and their parents regarding the transition to adulthood and perceptions of the interventions. We also report in-depth qualitative interview data from young adults about the effects of parental depression on their transition to adulthood. Findings suggest that leaving home, establishing relationships, and coping with stressors may be challenging for emerging adults. Furthermore, the interviews highlight the importance of siblings, the burden of parental depression, and the development of self-understanding and empathy in young adults who grew up with a depressed parent. Data suggest that clinicians, policy makers, educators, and employers must address the preventive and clinical needs of young people and their families as they transition to young adulthood after growing up with depressed parents.

Maternal Depressive Symptoms and Preschoolers' Helping, Sharing, and Comforting: The Moderating Role of Child Attachment

Maternal depressive symptoms (MDS) are inconsistently associated with lower rates of child prosocial behavior. Studies typically examine prosocial behavior as a unitary construct rather than examining its multiple dimensions, and rarely consider how the quality of the parent-child relationship could influence this association.Objective: The current study examines whether the security of the parent-child attachment relationship moderates the association between MDS and children's helping, sharing, and comforting behaviors.Method: Participants were 164 low-income, majority African American mothers and their preschool-aged children recruited from Head Start centers. Mothers reported the frequency of depressive symptoms at baseline; child attachment security and helping, sharing, and comforting behavior were observationally assessed 5 to 8 months later.Results: Moderation analyses revealed a positive main effect of security (but not MDS) on children's comforting behavior, a main effect of MDS on sharing, and no main effects of MDS or security on children's helping behaviors. Significant interactions between MDS and security predicted comforting and (marginally) helping behaviors, such that MDS were associated with both more helping and more comforting behavior only when children were more secure. No such interaction was observed for sharing.Conclusions: These findings suggest that children may adapt to maternal depressive symptoms in prosocial ways, but that this depends at least in part on the quality of the parent-child relationship, underscoring the importance of examining attachment quality as a moderator of parental influences on children's social-emotional development. We discuss potential explanations for these findings, as well as their implications for intervention.

Living with parental mental illness is like a roller coaster: Reflections on children's lifeworld in the family setting

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.

Vo J, Dionne-Odom JN, Bakitas MA. Parentification Among Young Carers: A Concept Analysis

There are approximately 1.4 million young carers in the United States alone. Being a young carer can result in parentification, a type of role reversal that occurs when children take on the roles and responsibilities of the adult. The purpose of this concept analysis is to provide a better understanding of the phenomenon of parentification among young carers through a description of its antecedents, attributes, and consequences using the steps of Rodgers' evolutionary method. The databases CINAHL, PubMed, PsycINFO, and Scopus were searched to identify 25 articles. The antecedents of the concept include the dependency of the care receiver and the child's adoption of a caregiving role. The attributes include fairness, obligation, resiliency, individuation, confidence in performing care tasks, cultural normalcy, family system functioning, support system, family resources, caregiver-care receiver relationship, and awareness of the child's needs. Parentification has both positive and negative consequences that impact the young carer. The antecedents, consequences, and identifiable attributes of the concept are presented through this work to provide a comprehensive picture of parentification among young carers. These findings showcase the multidimensional nature of parentification and the broad impact that it can have on young carers. While these findings do provide greater insight into young carers, the fact remains that little is known about this underserved and underacknowledged population. This concept analysis provides a foundation of understanding that specifies potential targets for intervention development, as well as modifiable outcomes, that can be explored through future research and intervention work.

Family understanding and communication about an adult relative's mental health problem: A systematic narrative review

WHAT IS KNOWN ON THE SUBJECT?: Adults who support an adult family member with a severe and enduring mental health problem often experience carer burden. Over time, this often negatively affects their mental and physical health and social well-being. Understanding and communicating about mental health problems in families can help to improve resilience and coping among both adults and children. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: We conducted a review of studies looking at how adult relatives understand and communicate about an adult family member's mental health problem. The findings highlight that how relatives make sense of MHP is related to historical family relationships, their mental health literacy and whether they see themselves as a "carer" or not. The findings also show that little research to date has explored how adult relatives talk with children about their parent's difficulties, and how the adults' understanding might affect what children learn about the MHP. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a research gap to be addressed regarding family communication with children about parental mental health problems. This knowledge gap likely impacts family-focused mental health nursing and therapy provision. Mental health nursing, therapeutic and support workers and advocates are ideally positioned to assist relatives with improving their mental health literacy and confidence communicating about mental health, and to promote inclusion of relatives and children in interventions. ABSTRACT: Introduction Relatives are profoundly affected by an adult family member's severe and enduring mental health problem (MHP). The burdens of caring impact on adult relatives' emotional, physical and social well-being. How relatives make meaning and communicate about the MHP is thought to affect family talk about mental health, and this can impact family coping and well-being. Aim No review has yet drawn together research about how adult relatives of people with severe and enduring MHP make meaning and communicate about their relatives' difficulties. We aimed to address this gap. Method We conducted a systematic review of peer-reviewed primary research. SCOPUS, PubMed, Psychnet, SCIE, Cochrane and CINAHL+ databases were searched. Results Nineteen papers qualified for inclusion. Findings are organized under four themes: making meaning about the MHP and affected individual; conceptualizing the self in the presence of the MHP; meaning-making processes underlying relatives' well-being outcomes; and relatives' perspectives on family talk about the MHP. Discussion Historical relationships, caregiver identity and mental health literacy moderate relatives' understanding and talk about the MHP. Implications for practice Psychoeducation and communication support for relatives should be provided by mental health practitioners. Future research should address familial communication about MHP, including with children.

Strengthening Connectedness in Close Relationships: A Model for Applying Contextual Therapy

This article presents a model for conducting contextual therapy with the aim of contributing to the further development of contextual therapy. Its founder, Ivan Boszormenyi-Nagy, introduced the core of this approach, relational ethics, as a new paradigm for family therapy, which has been received well. The authors presume that the training of (upcoming) contextual therapists and conducting contextual therapy itself can benefit from more concrete guidelines and a phased structure. It can also enhance the further development, research, and accountability of this approach. Therefore, using a design-oriented method, the authors developed a model that helps to shape a contextual therapy process and the applicable contextual interventions. It is based on strengthening connectedness in close relationships, using relational ethics as its compass. The framework of the model consists of three phases: exploring connectedness in close relationships, modifying connectedness in close relationships, and reinforcing connectedness in close relationships, whereby the goals of each of these phases are defined as process elements and expanded into guidelines for 19 interventions. The ingredients for these interventions are derived from two recent studies on the practice of Nagy and on the practice of current contextual therapists. The model is explained and substantiated based on contextual theory and therapy. Final remarks are presented in the conclusion.

Children of Parents with Mental Illness: The Need for Family Focussed Interventions in India

Family interventions have been an integral part of mental healthcare in India for several decades. This paper highlights the need for an emerging change in the nature of family interventions in India-from generic interventions for heterogeneous caregiver groups to interventions addressing particular needs based on family stages and structures. It makes a case for recognizing the experiences and needs of one such group, that is, families affected by parental mental illness with children in their care and summarizes the current status of research on this topic in the Indian and global context. It presents implications for future research in India and discusses preliminary ideas for professionals working in adult mental health settings to address the needs of children and families affected by parental mental illness.

Talking to children about parental mental illness: The experiences of well parents

BACKGROUND

Children of parents with mental illness are not routinely included in psychoeducational and supportive family interventions provided by adult mental health systems. The family, therefore, is an important and, sometimes, the only source of information and support for them.

AIM

To understand the experiences of well parents in talking to their children about parental mental illness.

METHOD

This article presents the findings of a qualitative study of the experiences of well parents in talking to their children about parental mental illness. Ten well parents whose spouses were diagnosed with a severe mental illness participated in the study. Socio-demographic information, family details and history of the spouse's mental illness along with their experiences of talking to children about parental mental illness, the perceived risks and benefits, challenges they faced and the role of others in the process were recorded. Qualitative data were analysed using interpretative phenomenological analysis.

FINDINGS

The themes of 'distancing children from parental mental illness', 'avoiding conversations about the illness', 'giving and receiving emotional support', 'providing explanations of the illness' and 'regulating other sources of information' show the complex ways in which well parents influence their children's understanding of parental mental illness. The findings are examined in the background of what is known about this topic from the perspective of children or of the parent with illness. Possible ways to support well parents in families affected by parental mental illness are discussed.

CONCLUSION

This study is a step forward in the understanding of how families talk to children about parental mental illness and provides the perspective of the well parent.

Children's experiences of living with a parent with mental illness: A systematic review of qualitative studies using thematic analysis

WHAT IS KNOWN ABOUT THE SUBJECT?: There are many qualitative studies that explore what it is like for children who live with a parent who has a mental illness. These studies are sometimes criticized because they have small sample sizes which limits their application. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We conducted a systematic review of qualitative papers with an aim to strengthening our understanding of what it is like for children who live with a parent who has a mental illness. We used stringent criteria to make sure that only the voices of children affected by parental mental illness were included in the review. In addition, the paper presents a timely update on previous reviews completed in this area. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings of this review highlight the impact that parental mental illness has on children and the important role that mental health nurses can play in maximizing opportunities for building resilience in affected children. Mental health nurses are in a key position to provide timely and age-appropriate information and support to both parents and children to assist in the development of appropriate coping and support mechanisms.

ABSTRACT

Introduction This paper brings together what is known about what it is like for children who live with a parent with a mental illness with a view to strengthening our understanding of their experiences. This paper presents an update on previous reviews that were completed in this area and used a systematic approach and stringent inclusion/exclusion criteria to ensure that the voices of children were central in the included papers. A systematic review of this nature could not be located in the literature. Aims This paper presents the findings of a systematic review which explored the experiences of children who were affected by parental mental illness. Methods CINAHL, PubMed, PsychINFO, Pubmesh and EMBASE were searched for qualitative studies which explored children's experiences, and eight studies were included following review and quality appraisal. Pertinent data were extracted, coded and analysed using a thematic approach. Results Four themes emerged from the analytic process which described the children's understanding of mental illness, their relationship with their parents, their coping strategies and their social connections. Implications for Practice Mental health nurses need to recognize the psychosocial needs of children, and to acknowledge, the wider impact mental illness has of the family.

How Do Children Make Sense of their Parent's Mental Health Difficulties: A Meta-Synthesis

Children of parents who experience mental health difficulties (COPE-MHD) consistently demonstrate numerous negative outcomes, including risks of intergenerational continuity of mental health difficulties (MHD). Numerous studies have analysed the experiences and understanding of parents' MHD from the perspective of COPE-MHD. This metasynthesis aims to capture, across available literature, the way in which COPE-MHD make sense of their parent's MHD and how this perception impacts their life. For inclusion in the review, research articles were required to be published in peer-reviewed journals, apply qualitative methods of data collection and analysis and report on the direct accounts of COPE-MHD regarding their understanding or experience of their parents' MHD. Five electronic databases were used; Academic Search Complete, CINAHL, MEDLINE, PsycINFO and Child Development and Adolescent Studies. Fourteen studies were included. Analysis produced three overarching themes. The findings illustrate children's sophisticated biopsychosocial conceptualisation of the cause and process of their parent's MHD. It also highlights how they utilise this understanding to manage the day-to-day concerns associated with their parent's experience of MHD. Clinical implications highlight a need for services working with children, parents and families to more frequently enquire about parents' MHD and to consider the outcomes of such enquiry in the psychological formulation of children and young peoples' mental health and development. Limitations and recommendations for future research are presented.

Talking or Keeping Silent About Parental Mental Health Problems-A Grounded Theory of Parents' Decision Making and Experiences with Their Children

This grounded theory study explored parents' experiences of responding to their children's need for understanding parental mental health concerns. Fifteen parents with severe and enduring mental health difficulties participated in the study. The findings suggest four main social processes that influence parents' talk with their children about parental mental health issues, namely "Protecting and being protected," "Responding to children's search for understanding," "Prioritizing family life," and "Relating to others." Implications of the findings for clinical practice and future research are considered. In particular, the need for more family-orientated services where parents experience parental mental health problems is highlighted.

Self-expressed strengths and resources of children of parents with a mental illness: A systematic review

The aim of the present study was to explore the strengths children reported to have acquired while coping with their parents illness, and the external factors these children indicated had facilitated their coping process. A systematic literature search was conducted of peer-reviewed papers that focused on self-reported experiences of children with parents who had mental illness, and revealed their strengths and resources. The search included the following databases: MEDLINE, PsycINFO, and CINAHL. Results were filtered according to whether search terms appeared in the title or abstract. Fifty-seven full-text papers were reviewed; 26 of them met the inclusion criteria and were included in the review. The statements were analysed using content analysis. The search identified 160 relevant statements, 38 (24%) of which could be described as self-reported strengths, and 122 (76%) as self-reported resources. According to these statements, the children described themselves as more mature, independent, and empathic than their peers who did not have a parent with a mental illness, and as having acquired several abilities. The statements about resources indicated that the children regarded social support, information, and particularly the support of mental health-care professionals as helpful when living with a parent with a mental illness. Recommendations for nursing actions to support children's ability to cope with their parents' illness are outlined.

Navigating in an unpredictable daily life: a metasynthesis on children's experiences living with a parent with severe mental illness

A large group of individuals suffering from mental illness are parents living with their children. These children are invisible in the health care even though at risk for illhealth. The aim of this metasynthesis was to advance knowledge of how children of parents with mental illness experience their lives, thus contributing to the evidence of this phenomenon. The metasynthesis is following Sandelowski and Barroso's guidelines. Literature searches covering the years 2000 to 2013 resulted in 22 reports which were synthesised into the theme 'navigating in an unpredictable everyday life' and the metaphor compass. Children of parents with mental illness irrespective of age are responsible, loving and worrying children who want to do everything to help and support. Children feel shame when the parent behaves differently, and they conceal their family life being afraid of stigmatisation and bullying. When their parent becomes ill, they distance to protect themselves. The children cope through information, knowledge, frankness and trustful relationships. These children need support from healthcare services because they subjugate own needs in favour of the parental needs, they should be encouraged to talk about their family situation, and especially, young children should to be child-like, playing and seeing friends.

Toward Understanding the Child's Experience in the Process of Parentification: Young Adults' Reflections on Growing up With a Depressed Parent

This article reports on a qualitative study with 21 young adults who grew up with a depressed parent. We examined how young adults make sense of their childhood experiences of parental depression and how their retrospective reflections help us to understand the experiences of children and the processes of parentification. Participants recounted that their childhood consisted mainly of actions in the service of family well-being. At that time, they reflected on their own experiences only rarely. In adolescence, there was an evolution toward a greater consideration for oneself and a repositioning within the family. In the discussion, we explore the therapeutic implications of this study--and in particular--the meaningfulness of silence in the family process of parentification.

Analysis of a support group for children of parents with mental illnesses: managing stressful situations

We report an ethnographic analysis of a psycho-education and peer-support program for school-aged children of parents with mental illnesses. We conducted a critical discourse analysis of the program manual and observed group interactions to understand whether children shared program goals predetermined by adults, and how, or if, the intervention was responsive to their needs. Children were expected to learn mental illness information because "knowledge is power," and to express difficult feelings about being a child of a mentally ill parent that was risky. Participants used humor to manage group expectations, revealing how they made sense of their parents' problems, as well as their own. Suggestions are made for determining good mental health literacy based on children's preferences for explaining circumstances in ways they find relevant, and for supporting children's competencies to manage relationships that are important to them.