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Díaz-Pons A, Soler-Andrés M, Ortiz-García de la Foz V, Murillo-García N, Yorca-Ruiz A, Magdaleno Herrero R, Castaño-Castaño S, González-Rodríguez A, Setién-Suero E, Ayesa-Arriola R. Exploring parenthood in first episode of psychosis: the potential role of the offspring in the outcome of women. Arch Womens Ment Health 2024; 27:693-703. [PMID: 38512467 DOI: 10.1007/s00737-024-01457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE The study aimed to explore the role of parenthood at first episode of psychosis (FEP) on recovery, with a focus on potential sex differences. METHODS Sociodemographic, clinical, and neurocognitive information was considered on 610 FEP patients form the PAFIP cohort (Spain). Baseline and three-year follow-up comparisons were carried out. Chi-square tests and ANCOVA analysis were performed controlling for the effect of age and years of education. RESULTS Men comprised 57.54% of the sample, with only 5.41% having offspring when compared to 36.29% of women. Parenthood was related to shorter duration of untreated illness (DUI) in women with children (12.08 months mothers vs. 27.61 months no mothers), showing mothers better premorbid adjustment as well. Childless men presented the worst premorbid adjustment and the highest cannabis and tobacco consumption rates. Mothers presented better global cognitive function, particularly in attention, motor dexterity and executive function at three-year follow-up. CONCLUSIONS Diminished parental rates among FEP men could be suggested as a consequence of a younger age of illness onset. Sex roles in caregiving may explain the potential role of parenthood on premorbid phase, with a better and heathier profile, and a more favorable long-term outcome in women. These characteristics may be relevant when adjusting treatment specific needs in men and women with and without offspring.
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Affiliation(s)
- Alexandre Díaz-Pons
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Department of Medicine and Health Sciences, Faculty of Medicine, University of Cantabria (UC), 39011, Santander, Spain
- Faculty of Psychology, National University of Distance Education (UNED), 28015, Madrid, Spain
- Department of Psychology, Faculty of Health Sciences, European University of the Atlantic (UNEAT), 39011, Santander, Spain
| | - Marina Soler-Andrés
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Department of Psychology, Faculty of Health Sciences, European University of the Atlantic (UNEAT), 39011, Santander, Spain
- Faculty of Psychology, University of Oviedo (UO), 33003, Oviedo, Spain
| | | | - Nancy Murillo-García
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Department of Molecular Biology, Faculty of Medicine, University of Cantabria (UC), 39011, Santander, Spain
| | - Angel Yorca-Ruiz
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Department of Psychology, Faculty of Health Sciences, European University of the Atlantic (UNEAT), 39011, Santander, Spain
- Department of Molecular Biology, Faculty of Medicine, University of Cantabria (UC), 39011, Santander, Spain
| | - Rebeca Magdaleno Herrero
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Department of Psychology, Faculty of Health Sciences, European University of the Atlantic (UNEAT), 39011, Santander, Spain
- Department of Molecular Biology, Faculty of Medicine, University of Cantabria (UC), 39011, Santander, Spain
| | - Sergio Castaño-Castaño
- Department of Psychobiology, Faculty of Psychology, University of Oviedo (UO), 33003, Oviedo, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 08221, Terrassa, Spain
- Biomedical Research Center in Mental Health Network (CIBERSAM), Health Institute Carlos III, 28029, Madrid, Spain
| | - Esther Setién-Suero
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Faculty of Psychology, National University of Distance Education (UNED), 28015, Madrid, Spain
- Department of Psychology, Faculty of Health Sciences, European University of the Atlantic (UNEAT), 39011, Santander, Spain
| | - Rosa Ayesa-Arriola
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain.
- Department of Medicine and Health Sciences, Faculty of Medicine, University of Cantabria (UC), 39011, Santander, Spain.
- Faculty of Psychology, National University of Distance Education (UNED), 28015, Madrid, Spain.
- Biomedical Research Center in Mental Health Network (CIBERSAM), Health Institute Carlos III, 28029, Madrid, Spain.
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Havelková A, Havelka D, Koros Bartošová K. Prevalence of parenthood among hospitalized adult patients with severe mental illness: a quantitative data analysis. Front Psychiatry 2024; 15:1386842. [PMID: 39081533 PMCID: PMC11287770 DOI: 10.3389/fpsyt.2024.1386842] [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: 02/16/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction In the Western world, more than one-third of the patients of productive age hospitalized for severe mental illness (SMI) are parents. Each of their offspring is exposed to several stressors related to their parent's illness and hospitalization, which puts them at an increased risk of developing mental health problems. In the Czech Republic, no statistics are currently available about the families of patients with SMI, inpatients who are parents, or data about their children (ages ≤18 years). Therefore, our research aim was to describe the prevalence of parenthood among hospitalized patients with SMI, assess the number of children and determine the extent to which offspring information was present in medical records. Methods Quantitative data from medical records (2,768 patients, aged 18-63 years, hospitalized for SMI between 2017 and 2020) from two large inpatient psychiatric facilities were examined. Parental information, demographic characteristics, number of children, and other available data were collected. Results The prevalence of parenthood among inpatients with SMI was 34.6%. Parenthood was most prevalent among female patients and patients with recurrent depressive and bipolar disorders. The total number of offspring in 957 patient-parents was 1781 (41.7% minors under the age of 18). Information on parenthood was available in 99.7% of cases; information on the age of offspring, custody, and sociodemographic situation varies, being included in 73% to 89.7% of the medical records (some details were more frequently recorded than others). Discussion The data obtained may help to better understand and address the specifics of these families and thus serve as a basis for the development of prevention programs.
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Affiliation(s)
- Anna Havelková
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - David Havelka
- Children’s Psychiatric Hospital Opařany, Opařany, Czechia
- Department of Psychology, Faculty of Education, Masaryk University, Brno, Czechia
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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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Oakes L, Wolfenden L, Drake RJ, Calam R, Gregg L. Health and social care professionals' views and experiences of supporting parents with serious mental illness. Front Psychiatry 2023; 14:1284712. [PMID: 38161725 PMCID: PMC10756684 DOI: 10.3389/fpsyt.2023.1284712] [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: 08/29/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction A significant number of individuals with a serious mental illness (SMI) such as schizophrenia or bipolar disorder are also parents of dependent children. Despite the risk of adverse psychological, behavioral, and social outcomes their needs often go unmet. To better understand the needs of parents with SMI and their children it is necessary to gain insight into the perspectives and experiences of the professionals in adult mental health and children's services who work with them, and who, ultimately, are best placed to meet those needs. Aims To explore the views and experiences of health and social care professionals working with parents with SMI to understand the needs of, and their role supporting, parents with SMI and their children. Methods Semi-structured interviews were conducted with seventeen professionals from six NHS and Local Authority settings in England, UK. Participants were included if they were employed in adult mental health or local authority children's services and had experience of working with parents with SMI. Sampling was purposive, including a wide range of professions in these settings. Interview data were analyzed using template analysis taking a critical realist perspective. Results Three top-level themes were generated: (1) Impact of parental SMI on the child, (2) Accessing support from services, (3) Role of professionals working with parents with SMI. Themes highlight diverse, wide-ranging effects of SMI on the child and a reluctance from parents to seek help due to stigma and fear. Available services are reported to be inaccessible and unacceptable to parents with SMI and practitioners experience conflict when balancing the needs of the parent and child. A whole-family approach facilitated by improved communication between services is advocated. Conclusion Participants believed that parents with SMI experience complex parenting challenges over and above other parents, describing a largely detrimental impact on the child. Support services were deemed inadequate, and participants stressed the need to develop specialist services tailored toward the needs of parents with SMI and their children. Although participants endorsed joined up working across health and social care settings to facilitate a whole family approach, they required greater service knowledge and training in parental SMI.
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Affiliation(s)
- Lucy Oakes
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Lauren Wolfenden
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Richard J. Drake
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Rachel Calam
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Lynsey Gregg
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Seeman MV. Grappling with Issues of Motherhood for Women with Schizophrenia. Healthcare (Basel) 2023; 11:2882. [PMID: 37958026 PMCID: PMC10650198 DOI: 10.3390/healthcare11212882] [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: 10/06/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Despite the fact that most persons with schizophrenia find steady employment difficult to sustain, many women with this diagnosis embrace and fulfill the most difficult task of all-motherhood. The aim of this paper is to specify the challenges of motherhood in this population and review the treatment strategies needed to keep mothers and children safe, protecting health and fostering growth. The review addresses concerns that had been brought to the author's earlier attention during her clinical involvement with an outpatient clinic for women with psychosis. It is, thus, a non-systematic, narrative review of topic areas subjectively assessed as essential to "good enough" mothering in the context of schizophrenia. Questions explored are the stigma against motherhood in this population, mothers' painful choices, issues of contraception, abortion, child custody, foster care and kin placement of children, the effects of antipsychotics, specific perinatal delusional syndromes, and, finally, the availability of parental support. This review is intended for clinicians. Recommendations are that care providers work collaboratively with mothers, take note of their strengths as well as their failings, offer a wide array of family services, monitor households closely for safety and for treatment adherence, appreciating the many challenges women with schizophrenia face daily.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
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Tuck M, Wittkowski A, Allott R, Gregg L. What about the children? Adult mental health practitioners' experiences and views of family-focused practice in Early Intervention Services. Psychol Psychother 2023; 96:697-715. [PMID: 37017306 DOI: 10.1111/papt.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND There is a significant risk of negative outcomes for families when a parent experiences serious mental illness. Family-focused practice (FFP) emphasises the "whole family" as the unit of care and has been found to improve outcomes for service users and their families. Despite its benefits, FFP is not routinely implemented in UK adult mental health services. This study explores adult mental health practitioners' experiences and views of FFP within Early Intervention Psychosis Services in the UK. METHODS Sixteen adult mental health practitioners employed in three Early Intervention Psychosis teams in the Northwest of England were interviewed. Interview data were analysed using thematic analysis. RESULTS Five core themes were generated: (1) A limited understanding of FFP, (2) Our practitioners, (3) Our approach, (4) Our families and (5) Our services. Practitioners' understanding of FFP was limited and typically excluded dependent children. Practitioners' age, professional and personal experience, and preconceptions of families influenced delivery, and in turn, the engagement approach they adopted impacted families' responsiveness. The diversity and dynamics of service user families such as age, socioeconomic status, culture and stigma impacted FFP. An operational context characterised by insufficient resources reduced FFP; however, organisational structures such as leadership, clinical supervision and multi-disciplinary teams facilitated FFP. CONCLUSIONS FFP is not yet embedded within Early Intervention Services. Practice recommendations include agreeing on a formal definition of FFP and its scope; the development of FFP policy; clarity in relation to staff responsibilities and identities; the adoption of a collaborative approach which encourages service user choice and for time to be ring-fenced to prioritise FFP. Future research should ascertain service user and family views on the facilitators and barriers to engaging with FFP in Early Intervention Services.
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Affiliation(s)
- Molly Tuck
- School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anja Wittkowski
- School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rory Allott
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lynsey Gregg
- School of Health Sciences, University of Manchester, Manchester, UK
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Radley J, Barlow J, Johns LC. A family perspective on parental psychosis: An interpretative phenomenological analysis study. Psychol Psychother 2022; 96:347-363. [PMID: 36463435 DOI: 10.1111/papt.12443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES While one third of people with a psychotic disorder are a parent, there has been little research to date examining the consequences of this from a whole family perspective. This study investigates families where a parent has experienced an episode of psychosis and compares and contrasts the family members' perspectives. DESIGN This study was rooted in phenomenology and data were derived from in-depth semi-structured interviews. METHODS Parents with a psychotic disorder who had a child aged between 3 and 11 in a UK NHS Trust were invited to take part in the study. Semi-structured interviews were conducted with these parents, with their child (if they were between the ages of 8 and 11), and with their partner or another close family member. Data were analysed using multiperspectival interpretive phenomenological analysis (m-IPA). RESULTS Thirteen participants took part comprising of five parents, four children, three partners and one grandmother. Four themes were developed using m-IPA: (1) Parental psychosis impacts the whole family, (2) Psychosis and my role as a parent, (3) Secrecy and concealment surrounding parental psychosis, and (4) Pressures and vulnerabilities within the family system. CONCLUSION Psychosis had a negative impact on all family members and secrecy existed between family members. The children in particular only had partial information about their parent's mental illness, which left them worried and confused. More work is needed to support these families to explain psychosis to the children.
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Affiliation(s)
- Jessica Radley
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Louise C Johns
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Radley J, Barlow J, Johns LC. Parenting and psychosis: An experience sampling methodology study investigating the inter-relationship between stress from parenting and positive psychotic symptoms. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1236-1258. [PMID: 35938517 PMCID: PMC9804428 DOI: 10.1111/bjc.12389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES There is a strong association between stress and psychotic symptoms, and this study examined the bidirectional nature of this relationship in parents with psychosis, with negative affect as a mediator and a range of other psychosocial factors included as covariates. It also examined whether stress from parenting had a larger impact on psychosis than non-parenting stress. DESIGN The study used a within-participants repeated measures design, using experience sampling methodology (ESM). ESM is a self-report surveying technique completed over an intensive longitudinal period. Participants completed six surveys a day, for 10 days. METHODS Thirty-five participants with psychosis who were a parent to a child between the ages of 2 and 16 took part. Study phones alerted participants to complete surveys by beeping at semi-random intervals over 10 days. Multi-level modelling was used with surveys at Level-1 and participants at Level-2. Predictor variables were time-lagged in order to infer directionality. RESULTS Parenting stress was found to predict psychotic symptoms, and this relationship was mediated by negative affect. The reverse direction was also confirmed. Few of the additional psychosocial factors were found to have a significant impact on the models' estimations. Parenting stress was not found to have a larger impact on psychosis than other sources of stress. CONCLUSIONS This study provides further evidence of the bidirectional relationship between stress and psychosis in the context of parenting. Further research should explore if parenting stress plays a unique role in predicting psychotic symptoms by comparing parents and non-parents with psychosis.
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Affiliation(s)
- Jessica Radley
- Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK
| | - Jane Barlow
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Louise C. Johns
- Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK
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Radley J, Barlow J, Johns LC. Sociodemographic characteristics associated with parenthood amongst patients with a psychotic diagnosis: a cross-sectional study using patient clinical records. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1897-1906. [PMID: 35445841 PMCID: PMC9375763 DOI: 10.1007/s00127-022-02279-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/31/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Estimates of parenthood in individuals with psychosis range from 27 to 63%. This number has likely increased due to the introduction of newer anti-psychotics and shorter hospital stays. The problems of psychosis can affect patients' capacity to offer the consistent, responsive care required for healthy child development. The following research questions were assessed: (1) what proportion of these patients have their children correctly recorded in their clinical notes, (2) what proportion of patients in secondary care with a psychotic diagnosis have children, and (3) what sociodemographic characteristics are associated with parenthood in this population. METHODS This study used CRIS (Clinical Record Interactive Search) to search for patients with a diagnosis of non-affective or affective psychosis (F20-29, F31.2 or F31.5) within a UK NHS Trust. A binomial regression model was fitted to identify the variables associated with parenthood. RESULTS Fewer than half of the parents in the sample had their children recorded in the correct field in their clinical notes. Of 5173 patients with psychosis, 2006 (38.8%) were parents. Characteristics associated with parenthood included being female, older age, higher socioeconomic status, renting or owning, having ever been married, being unemployed, not being White (British) and not having a diagnosis of schizophrenia. CONCLUSION Over one-third of patients with psychosis were parents, and the study indicates that not all NHS Trusts are recording dependants accurately. Many variables were strongly associated with parenthood and these findings may help target interventions for this population.
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Affiliation(s)
- Jessica Radley
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
| | - Jane Barlow
- grid.4991.50000 0004 1936 8948Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER UK
| | - Louise C. Johns
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX UK
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Gregg L, Calam R, Drake RJ, Wolfenden L. Expressed Emotion and Attributions in Parents With Schizophrenia. Front Psychiatry 2021; 12:799626. [PMID: 34966315 PMCID: PMC8710699 DOI: 10.3389/fpsyt.2021.799626] [Citation(s) in RCA: 3] [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: 10/21/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022] Open
Abstract
We examined expressed emotion (EE) and attributions in parents with schizophrenia and compared them to parents without serious mental illness (SMI) in order to better understand the emotional climate of families in which a parent has schizophrenia. Parenting practices and parental reports of child behavior were also compared between the two groups. The relationship of EE to attributions was examined in each group separately. Relationships between parental mental health, EE, and attributions were explored in the parents with schizophrenia only. The Camberwell Family Interview was used to determine both EE and attributions in 20 parents with schizophrenia and 20 parents without SMI. We found that more parents with schizophrenia were rated as high EE than those without (60 and 35%, respectively) although this was not a statistically significant difference. Parents with schizophrenia demonstrated significantly more hostility and criticism toward their children than those without SMI and made more child-blaming attributions. Blame was associated with increased hostility, less warmth, and fewer positive remarks. Parental warmth was related to greater parenting self-efficacy, less harsh parenting practices, better child behavior, and a more positive parent-child relationship. We conclude that EE and attributions are potential explanatory variables to be considered in the development of preventative and early intervention strategies for families with a parent with schizophrenia or other psychotic disorder. Blame and warmth are modifiable factors that could be targeted within family and parenting interventions.
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Affiliation(s)
- Lynsey Gregg
- 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, Manchester, United Kingdom
| | - Rachel Calam
- 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, Manchester, United Kingdom
| | - Richard J. Drake
- 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, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Lauren Wolfenden
- 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, Manchester, United Kingdom
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Radley J, Grant C, Barlow J, Johns L. Parenting interventions for people with schizophrenia or related serious mental illness. Cochrane Database Syst Rev 2021; 10:CD013536. [PMID: 34666417 PMCID: PMC8526162 DOI: 10.1002/14651858.cd013536.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Around a third of people with schizophrenia or related serious mental illness will be a parent. Both the parents and the children in this population are at increased risk of adverse outcomes due to parental mental illness. Parenting interventions are known to improve parenting skills and decrease child disruptive behaviour. This systematic review aimed to synthesise the evidence base for parenting interventions designed specifically for parents who have schizophrenia or related serious mental illness. OBJECTIVES To assess the effects of parenting interventions for people with schizophrenia or related serious mental illness. SEARCH METHODS On 10 February 2021 we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on the following: Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.Gov, Embase, International Standard Randomised Controlled Trial Number (ISRCTN), MEDLINE, PsycINFO, PubMed, and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs) that compared parenting interventions with a control condition for people with schizophrenia or related serious mental illness with a child between the ages of 0 and 18 years. DATA COLLECTION AND ANALYSIS We independently inspected citations, selected studies, extracted data and appraised study quality. We assessed risk of bias for included studies. MAIN RESULTS We only included one trial (n = 50), and it was not possible to extract any data because the authors did not provide any means and standard deviations for our outcomes of interest; they only reported whether outcomes were significant or not at the 0.05 level. Three domains of the trial were rated as having a high risk of bias. AUTHORS' CONCLUSIONS The only included trial provided inconclusive evidence. There is insufficient evidence to make recommendations to people with schizophrenia (or related serious mental illness) or clinicians, or for policy changes. Although there is no RCT evidence, parenting interventions for people with schizophrenia or related serious mental illness have been developed. Future research should test these in RCTs in order to improve the evidence base for this population.
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Affiliation(s)
- Jessica Radley
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Claire Grant
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Louise Johns
- Department of Psychiatry, University of Oxford, Oxford, UK
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Dubreucq M, Plasse J, Gabayet F, Blanc O, Chereau I, Cervello S, Couhet G, Demily C, Guillard-Bouhet N, Gouache B, Jaafari N, Legrand G, Legros-Lafarge E, Mora G, Pommier R, Quilès C, Verdoux H, Massoubre C, Franck N, Dubreucq J. Being parent is associated with suicidal history in people with serious mental illness enrolled in psychiatric rehabilitation. J Psychiatr Res 2021; 140:395-408. [PMID: 34144443 DOI: 10.1016/j.jpsychires.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Parenting is a central life experience that could promote recovery in people with Serious Mental Illness (SMI). It could also be challenging for parents with SMI and result in poor recovery-related outcomes. Parenting is often overlooked in psychiatric rehabilitation. The objectives of the present study were to identify the characteristics and needs for care of mothers and fathers with SMI enrolled in a multicentric non-selected psychiatric rehabilitation SMI sample. We consecutively recruited 1436 outpatients from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). The evaluation included standardized scales for clinical severity, psychosocial function, quality of life and satisfaction with life, wellbeing, personal recovery and a broad cognitive battery. We found that parenting was associated to suicidal history in mothers and fathers with SMI. In the multivariate analysis, being mother was best explained by insight (p < 0.015, adjusted OR = 0.76 [0.59-0.90]), current age (p < 0.001, aOR = 1.13 [1.07-1.21]), education level (p = 0.008; aOR = 0.12 [0.02-0.53]) and family accommodation (p = 0.046, aOR = 0.19 [0.03-0.84]). Being father was best explained by suicidal history (p = 0.005, aOR = 3.85 [1.51-10.10]), marital status (in relationship, p < 0.001; aOR = 7.81 [2.73-23.84]), satisfaction with family relationships (p = 0.032, aOR = 1.22 [1.02-1.47]) and current age (p < 0.001, aOR = 1.16 [1.10-1.23]). In short, parenting was associated to increased history of suicide attempt in mothers and fathers with SMI. Mothers and fathers with SMI may have unique treatment needs relating to parenting and recovery-related outcomes. The implementation of interventions supporting the needs of parents with SMI in psychiatric rehabilitation services could improve parent and children outcomes.
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Affiliation(s)
- M Dubreucq
- Centre Référent de Réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France; Fondation FondaMental, Créteil, France.
| | - J Plasse
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France; Pôle Centre, centre hospitalier Le Vinatier, Lyon, France
| | - F Gabayet
- Centre Référent de Réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France; Fondation FondaMental, Créteil, France
| | - O Blanc
- CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - S Cervello
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon, France; Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France; Pôle Centre, centre hospitalier Le Vinatier, Lyon, France
| | - G Couhet
- Centre référent de réhabilitation psychosociale C2RP Nouvelle-Aquitaine Sud, Pôle de réhabilitation psychosociale, Centre de la Tour de Gassies, Bruges, France
| | - C Demily
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon, France; Centre de référence maladies rares Génopsy, pôle ADIS, centre hospitalier Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France
| | | | - B Gouache
- Centre Référent de Réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
| | - N Jaafari
- CREATIV & URC Pierre Deniker, CH Laborit, Poitiers, France
| | - G Legrand
- Association Hospitalière Sainte Marie, Centre Hospitalier Sainte Marie de Clermont Ferrand, 33 rue Gabriel Péri, CS 9912, 63037, Clermont-Ferrand Cedex 1, France
| | - E Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges C2RL, CH Esquirol, Limoges, France
| | - G Mora
- Association Hospitalière Sainte Marie, Centre Hospitalier Sainte Marie de Clermont Ferrand, 33 rue Gabriel Péri, CS 9912, 63037, Clermont-Ferrand Cedex 1, France
| | - R Pommier
- REHALise, CHU de Saint-Etienne, France
| | - C Quilès
- Centre référent de réhabilitation psychosociale C2RP Nouvelle Aquitaine Sud, Pôle universitaire de psychiatrie adulte, centre hospitalier Charles Perrens, Bordeaux, Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000, Bordeaux, France
| | - H Verdoux
- Centre référent de réhabilitation psychosociale C2RP Nouvelle Aquitaine Sud, Pôle universitaire de psychiatrie adulte, centre hospitalier Charles Perrens, Bordeaux, Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000, Bordeaux, France
| | | | | | - N Franck
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon, France; Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France; Pôle Centre, centre hospitalier Le Vinatier, Lyon, France
| | - J Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon, France; Centre Référent de Réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France; Fondation FondaMental, Créteil, France; Réseau Handicap Psychique, Grenoble, France
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13
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Rabha A, Padhy SK, Grover S. Parenting skills of patients with chronic schizophrenia. Indian J Psychiatry 2021; 63:58-65. [PMID: 34083821 PMCID: PMC8106422 DOI: 10.4103/psychiatry.indianjpsychiatry_107_20] [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: 02/09/2020] [Revised: 03/15/2020] [Accepted: 04/10/2020] [Indexed: 11/14/2022] Open
Abstract
AIM OF THE STUDY This study aims to evaluate the parenting skills of patients with schizophrenia as perceived by themselves and their children and compare the same with a matched healthy control group of parents and their children. MATERIALS AND METHODS Fifty-one patients with schizophrenia and their 51 children were assessed on the Alabama Parenting Scale. A healthy control group of 51 parents and their children were also assessed for parenting. RESULTS The mean age of parents with schizophrenia was 45.23 years. Compared to the parents in the healthy control group, patients with schizophrenia reported deficits in the domains of positive involvement, positive parenting; more often report poor monitoring/supervision, and inconsistent discipline. When the children of patients with schizophrenia and children of healthy parents were compared, children of healthy control parents reported higher positive involvement, positive parenting; and lower corporal punishment and inconsistent discipline. Except for few associations, parenting was not affected by demographic and clinical profile of the patients with schizophrenia. CONCLUSION The present study suggests that patients with schizophrenia have deficits in parenting and there is a need to improve the parenting skills of the patients with schizophrenia.
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Affiliation(s)
- Anjumoni Rabha
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Susanta Kumar Padhy
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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14
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Chen J, Chen X, Leung SS, Tsang HW. Potential impacts, alleviating factors, and interventions for children of a parent with schizophrenia: A scoping review. CHILDREN AND YOUTH SERVICES REVIEW 2021. [DOI: 10.1016/j.childyouth.2020.105751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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15
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Boström PK, Strand J. Children and parents with psychosis-Balancing between relational attunement and protection from parental illness. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 34:68-76. [PMID: 33285033 PMCID: PMC7898685 DOI: 10.1111/jcap.12302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 11/28/2022]
Abstract
Background Few studies have explored the experiences of young children and their parents with psychosis. The aim of the present study was to explore parent and child mental health and the parent–child relationship from the perspectives of children and their parents with psychosis. Methods The present study had a multiperspectival qualitative design. Seven children (aged 8–15 years) and their six parents with psychosis were interviewed individually. Data were analyzed according to interpretative phenomenological analysis. Results Children were found to have a limited understanding of the parent's illness. While both parents and children described the illness as part of ordinary life and focused on improvements, there was incoherence both within and between interviews. Parent–child relationships appeared to be nonhierarchical and to vary in terms of attunement and distance, which in turn seemed to be associated with the child's well‐being. Conclusion The findings contribute multiperspectival insights into lived experiences of young children and parents with psychosis. Nurses are in a key position to recognize the children's needs for continuous adult support and to promote communication about the illness.
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Affiliation(s)
| | - Jennifer Strand
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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Strand J, Meyersson N. Parents with psychosis and their children: experiences of Beardslee's intervention. Int J Ment Health Nurs 2020; 29:908-920. [PMID: 32304272 DOI: 10.1111/inm.12725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 11/28/2022]
Abstract
To meet children's needs for information and support when a parent has a mental illness, Beardslee's family intervention was implemented in Swedish psychosis care. The present study aimed to gain understanding of how parents' with psychosis and their children experienced having taken part in Beardslee's family intervention. The study followed COREQ guidelines. Semi-structured interviews were conducted with 15 participants (8 parents with psychosis and 7 children) who had participated in the family intervention. Data were analysed with content analysis. Results showed that the parents perceived that the intervention had contributed to improved illness knowledge, communication, and understanding in the family. They also appreciated receiving support in finding an age-adapted way of explaining their illness, but asked for structured follow-ups in order to maintain communication. However, comparing parents' and children's interviews led to discrepancies in perceptions of the overall benefits of the intervention. In conclusion, parents with psychosis need continual support in talking to their children about their illness. Furthermore, discrepancies between parents' and children's interviews show the importance of multi-perspective data collection when studying intervention effects.
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Affiliation(s)
- Jennifer Strand
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Meyersson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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17
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[Mental Disorders and Parenting: Challenges and Opportunities for Adult Mental Health Services]. Prax Kinderpsychol Kinderpsychiatr 2020; 69:463-480. [PMID: 32886047 DOI: 10.13109/prkk.2020.69.5.463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mental Disorders and Parenting: Challenges and Opportunities for Adult Mental Health Services Parenting can be a key element in the psychiatric rehabilitation process, but it may come with many challenges for parents with mental health problems. Illness symptoms, together with social and sociocultural factors, can have adverse effects on family life or parenting behaviors and entail severe consequences for a child's psychosocial development. Bidirectional interactions can increase parental burden and thus worsen a parent's course of illness. This vicious circle can be broken by the provision of early and adequate support of mothers and fathers with mental health problems. Adult mental health services can make an important yet often underestimated contribution here. This article refers to parents' resources and needs and introduces both opportunities and challenges for adult mental health services when it comes to dealing with parenting needs. Mental health professionals are in a pivotal position for extending adequate support to clients on their parental needs. These professionals' skills and knowledge regarding parenting are essential for the successful implementation of family-focused practices in adult mental health services. Beyond the individual level, there is a need for policies and guidelines stipulating the integration of family and child perspectives in adult mental health services. In a broader view, a program from Finland shows how mental health professionals as well as peers can support parents and their families during the treatment process.
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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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19
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Radley J, Grant C, Barlow J, Johns L. Parenting interventions for people with schizophrenia or related serious mental illness. Hippokratia 2020. [DOI: 10.1002/14651858.cd013536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica Radley
- University of Oxford; Department of Psychiatry; Warneford Hospital Warneford Lane Oxford UK OX3 7JX
| | - Claire Grant
- King's College London; Department of Child & Adolescent Psychiatry; Room D1.05, Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience DeCrespigny Park London UK SE5 8AF
| | - Jane Barlow
- University of Oxford; Department of Social Policy and Intervention; Barnett House 32 Wellington Square Oxford UK OX1 2ER
| | - Louise Johns
- University of Oxford; Department of Psychiatry; Warneford Hospital Warneford Lane Oxford UK OX3 7JX
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20
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Malagón-Amor Á, Martín-López LM, Córcoles D, González A, Bellsolà M, Teo AR, Bulbena A, Pérez V, Bergé D. Family Features of Social Withdrawal Syndrome (Hikikomori). Front Psychiatry 2020; 11:138. [PMID: 32194459 PMCID: PMC7061609 DOI: 10.3389/fpsyt.2020.00138] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Family may play an important role in the origin, maintenance, and treatment of people with social withdrawal. The aim of this study is to analyze family factors related to social withdrawal syndrome. Methods: Socio-demographic, clinical, and family data, including family psychiatric history, dysfunctional family dynamics, and history of family abuse were analyzed in 190 cases of social withdrawal with a minimum duration of 6 months that started an at-home treatment program. Data were analyzed at baseline and at 12 months. Results: In 36 cases (18%) neither the patient nor the family allowed at home evaluation and treatment by the Crisis Resolution Home Treatment (CRHT) team. Patients had high rates of dysfunctional family dynamics (n = 115, 61.5%), and family psychiatric history (n = 113, 59.3%), especially maternal affective (n = 22, 42.9%), and anxiety disorders (n = 11 20.4%). There was a non-negligible percentage of family maltreatment in childhood (n = 35, 20.7%) and single-parent families (n = 66, 37.8%). Most of the cases lived with their families (n = 135, 86%), had higher family collaboration in the therapeutic plan (n = 97, 51.9%) and families were the ones to detect patient isolation and call for help (n = 140, 73.7%). Higher social withdrawal severity (as defined by at least one of: early age of onset, no family collaboration, lack of insight, higher CGSI score, and higher Zarit score), was associated with family psychiatric history, dysfunctional family dynamics, and family abuse history. All of these predictive variables were highly correlated one to each other. Conclusions: There is a high frequency of family psychiatric history, dysfunctional family dynamics, and traumatic events in childhood (family maltreatment), and these factors are closely interrelated, highlighting the potential role of family in the development and maintenance of social withdrawal.
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Affiliation(s)
- Ángeles Malagón-Amor
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Luis Miguel Martín-López
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - David Córcoles
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Madrid, Spain
| | - Anna González
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
| | - Magda Bellsolà
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
| | - Alan R Teo
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States.,Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, OR, United States.,School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, United States
| | - Antoni Bulbena
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Víctor Pérez
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Daniel Bergé
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
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Ueno R, Osada H, Solantaus T, Murakoshi A, Inoue T. Safety, Feasibility, Fidelity, and Perceived Benefits of an Intervention for Parents with Mood Disorders and Their Children — “Let’s Talk About Children” in Japan. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/08975353.2019.1678092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Rie Ueno
- Department of Psychiatric and Mental Health Nursing, School of Nursing, Tokyo Medical University, Tokyo, Japan
| | - Hirokazu Osada
- Department of Psychology, School of Human Sciences, Senshu University, Kawasaki, Japan
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Tytti Solantaus
- The Finnish Association for Mental Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Akiko Murakoshi
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
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Poon AWC, Hayes L, Harvey C. Care-giving by people with psychotic disorders in the second Australian prevalence study of psychosis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1042-1052. [PMID: 30723953 DOI: 10.1111/hsc.12721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/12/2018] [Accepted: 12/29/2018] [Indexed: 06/09/2023]
Abstract
Increasing numbers of people living with psychosis are providing care for others, although the associated benefits and impacts are poorly understood. This innovative quantitative study investigated this life role using a population-based framework aiming to compare the mental health and functioning of those providing care to and/or receiving care from others. Care-giving provided by people with psychosis was examined using data from the second Australian prevalence survey of psychosis. This epidemiologically based sample (n = 1,822) was divided into four subgroups based on providing and/or receiving care from others. Independent functioning, cognitive functioning, social functioning, social connection and mental health were compared between the four subgroups. One in seven participants were providing care to others. The majority of carers were female and half were living with the care recipients. Caregivers were more likely to experience better illness course and were more commonly diagnosed with bipolar disorder. Almost one-third of caregivers reported that caring adversely affected their lives a great deal. Functioning and social connection were better in caregivers compared to non-caregivers, although cognitive functioning did not differ. People with psychosis who were neither providing nor receiving care were more likely to be single and perceive less warmth in their relationships. As expected, those only in receipt of care were living with greater disability and poorer illness course. It is relatively common to encounter people with psychosis who provide care to others in clinical settings, and women in particular combine care-giving with multiple other roles. Despite most experiencing some negative emotional impact, care-giving is associated with enhanced social relationships which may provide meaning and purpose for recovery. Care-giving roles should be addressed in recovery and care planning so as to provide people with psychosis with adequate information and support to fulfil these potentially important life roles.
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Affiliation(s)
| | - Laura Hayes
- Parenting Research Centre, East Melbourne, Vic., Australia
| | - Carol Harvey
- Department of Psychiatry, University of Melbourne and North Western Mental Health, Melbourne, Vic., Australia
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Ruud T, Maybery D, Reupert A, Weimand B, Foster K, Grant A, Skogøy BE, Ose SO. Adult Mental Health Outpatients Who Have Minor Children: Prevalence of Parents, Referrals of Their Children, and Patient Characteristics. Front Psychiatry 2019; 10:163. [PMID: 31001149 PMCID: PMC6456127 DOI: 10.3389/fpsyt.2019.00163] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background: A strong connection exists between parental mental illness and lifetime mental health risk for their children. Thus, it is important to determine, when parents attend for treatment for their illness, the prevalence and characteristics of parents with a mental illness and identify referral actions for their children. Previous studies indicate that 12-45% of adult mental health service patients are parents with minor children. There is a need for studies with larger sample sizes that investigate the prevalence and characteristics of parents, and factors associated with referral actions for their children. Method: Data on 23,167 outpatients was drawn from a national census study across 107 Norwegian adult mental health outpatient clinics during 2 weeks in April 2013. Clinicians identified various socio-demographic characteristics of patients who were parents and referral actions for their children. Results: Eight thousand thirty-five (36%) of outpatients had children under 18 years. Thirty-one percent were provided with referrals for their children and 58% were reported to have children with no need for referral. Three percent were reported to have children with unmet needs who were not referred. There were missing data on children's needs and referral actions for 8% of parents. Patients who care for minor children were more likely to be refugees, and less likely to be single, male, not own a house/apartment, and have a schizophrenia spectrum illness or substance use disorder. Children were more likely to be referred when their parent was single, with no income from paid work, low education, not owning house/apartment, poor family network, long outpatient treatment, and an individual care plan; and less likely for men with a moderate or less severe mental illness. Children were referred to child protection agencies, child and adolescent mental health services and school psychological/pedagogic services. Discussion: The prevalence of outpatients with children is similar to other studies. Referrals were made for children of one third of outpatients with minor children. Needs and referrals of children was unknown for one in ten outpatients. Mental health outpatient clinics must improve procedures to identify parenting status and ascertain and act on children's needs.
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Affiliation(s)
- Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Darryl Maybery
- School of Rural Health, Monash University, Moe, VIC, Australia
| | - Andrea Reupert
- Faculty of Education, Monash University, Clayton, VIC, Australia
| | - Bente Weimand
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia.,NorthWestern Mental Health, Parkville, VIC, Australia
| | - Anne Grant
- School of Nursing and Midwifery, Queens University Belfast, Belfast, United Kingdom
| | - Bjørg Eva Skogøy
- Nordland Hospital Trust, Bodø, Norway.,Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Johnson SE, Lawrence D, Perales F, Baxter J, Zubrick SR. Prevalence of Mental Disorders Among Children and Adolescents of Parents with Self-Reported Mental Health Problems. Community Ment Health J 2018; 54:884-897. [PMID: 29289984 DOI: 10.1007/s10597-017-0217-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
This paper provides Australian population-level estimates of the prevalence of parental self-reported lifetime mental disorders and past 12 month mental disorders in their children. It leverages unique data from the 2013-2014 Australian Child and Adolescent Survey of Mental Health and Wellbeing (Young Minds Matter) (n = 6310). Mental disorders were assessed in 4-17 year-olds using the Diagnostic Interview Schedule for Children Version IV. Primary carer (PC) and secondary carer mental health was based on PC-reported lifetime diagnoses. Over one-third of 4-17 year-olds had a PC with a lifetime diagnosis. The prevalence of all disorders was significantly higher amongst these children than children whose PC reported no diagnoses, and highest when the PC had comorbid and more severe disorders. Assessing mental health needs at a family level is important to identify children who are particularly vulnerable to developing mental disorders, to develop targeted interventions, and to understand the intergenerational transmission of risk.
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Affiliation(s)
- Sarah E Johnson
- ARC Centre of Excellence for Children and Families over the Life Course, Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, WA, 6008, Australia.
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Crawley, Perth, WA, 6009, Australia
| | - Francisco Perales
- ARC Centre of Excellence for Children and Families over the Life Course, Institute for Social Science Research, The University of Queensland, Long Pocket Precinct, 80 Meiers Rd, Building C, Indooroopilly, Brisbane, QLD, 4068, Australia
| | - Janeen Baxter
- ARC Centre of Excellence for Children and Families over the Life Course, Institute for Social Science Research, The University of Queensland, Long Pocket Precinct, 80 Meiers Rd, Building C, Indooroopilly, Brisbane, QLD, 4068, Australia
| | - Stephen R Zubrick
- ARC Centre of Excellence for Children and Families over the Life Course, Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, WA, 6008, Australia.,Graduate School of Education, The University of Western Australia, Crawley, Perth, WA, 6009, Australia
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25
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Campbell LE, Hanlon MC, Galletly CA, Harvey C, Stain H, Cohen M, van Ravenzwaaij D, Brown S. Severity of illness and adaptive functioning predict quality of care of children among parents with psychosis: A confirmatory factor analysis. Aust N Z J Psychiatry 2018; 52:435-445. [PMID: 29103308 DOI: 10.1177/0004867417731526] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Parenthood is central to the personal and social identity of many people. For individuals with psychotic disorders, parenthood is often associated with formidable challenges. We aimed to identify predictors of adequate parenting among parents with psychotic disorders. METHODS Data pertaining to 234 parents with psychotic disorders living with dependent children were extracted from a population-based prevalence study, the 2010 second Australian national survey of psychosis, and analysed using confirmatory factor analysis. Parenting outcome was defined as quality of care of children, based on participant report and interviewer enquiry/exploration, and included level of participation, interest and competence in childcare during the last 12 months. RESULTS Five hypothesis-driven latent variables were constructed and labelled psychosocial support, illness severity, substance abuse/dependence, adaptive functioning and parenting role. Importantly, 75% of participants were not identified to have any dysfunction in the quality of care provided to their child(ren). Severity of illness and adaptive functioning were reliably associated with quality of childcare. Psychosocial support, substance abuse/dependence and parenting role had an indirect relationship to the outcome variable via their association with either severity of illness and/or adaptive functioning. CONCLUSION The majority of parents in the current sample provided adequate parenting. However, greater symptom severity and poorer adaptive functioning ultimately leave parents with significant difficulties and in need of assistance to manage their parenting obligations. As symptoms and functioning can change episodically for people with psychotic illness, provision of targeted and flexible support that can deliver temporary assistance during times of need is necessary. This would maximise the quality of care provided to vulnerable children, with potential long-term benefits.
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Affiliation(s)
| | | | - Cherrie A Galletly
- 2 School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,3 Discipline of Psychiatry, University of Adelaide Ramsay Health Care (SA) Mental Health Services Northern Adelaide Local Health Network, South Australia
| | - Carol Harvey
- 4 Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Helen Stain
- 5 School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | - Martin Cohen
- 1 The University of Newcastle, Newcastle, NSW, Australia
| | | | - Scott Brown
- 1 The University of Newcastle, Newcastle, NSW, Australia
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Hanlon MC, Campbell LE, Single N, Coleman C, Morgan VA, Cotton SM, Stain HJ, Castle DJ. Men and women with psychosis and the impact of illness-duration on sex-differences: The second Australian national survey of psychosis. Psychiatry Res 2017. [PMID: 28633054 DOI: 10.1016/j.psychres.2017.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We aimed to examine and compare sex-differences in people receiving treatment for psychotic illnesses in community settings, based on long or short duration of illness; expecting association between longer illness-duration and worse outcomes in women and men. Clinical, demographic and service-use data from the Survey of High Impact Psychosis were analysed by sex and duration of illness (≤5 years; ≥6 years), using independent t-tests, chi-square tests, one-way ANOVA, and Cramer's V. Of the 1825 participants, 47% had schizophrenia, 17.5% bipolar and 16.1% schizo-affective disorders. More women than men had undertaken post-school education, maintained relationships, and been living in their own homes. Women with a shorter-illness-duration showed social functioning equivalent to non-ill women in the general population. Men tended to have an early illness onset, show premorbid dysfunction, be single, show severe disability, and to use illicit substances. Men with a longer-illness-duration were very socially disadvantaged and isolated, often experiencing homelessness and substance use. Men with a short-illness-duration were most likely to be in paid employment, but two-thirds earned less than $AUD500 per fortnight. Men with longer-illness-duration showed most disability, socially and globally. Interventions should be guided by diagnosis, but also by a person's sex and duration of illness.
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Affiliation(s)
- Mary-Claire Hanlon
- The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, NSW, Australia; Calvary Mater Newcastle, Waratah, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Linda E Campbell
- The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Priority Research Centre GrowUpWell and the School of Psychology, University of Newcastle, Australia
| | | | | | - Vera A Morgan
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, WA, Australia; North Metropolitan Health Service Mental Health, Perth, WA, Australia
| | - Susan M Cotton
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Helen J Stain
- Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, NSW, Australia; School of Social and Health Sciences, Leeds Trinity University, Horsforth, Leeds, UK
| | - David J Castle
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
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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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28
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Wahl P, Bruland D, Bauer U, Okan O, Lenz A. What are the family needs when a parent has mental health problems? Evidence from a systematic literature review. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2017; 30:54-66. [DOI: 10.1111/jcap.12171] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Patricia Wahl
- Institute for Health Research and Social Psychiatry; Catholic University of Applied Sciences North Rhine-Westphalia; Paderborn Germany
| | - Dirk Bruland
- Centre for Prevention and Intervention in Childhood and Adolescence; Bielefeld University; Bielefeld Germany
| | - Ullrich Bauer
- Centre for Prevention and Intervention in Childhood and Adolescence; Bielefeld University; Bielefeld Germany
| | - Orkan Okan
- Centre for Prevention and Intervention in Childhood and Adolescence; Bielefeld University; Bielefeld Germany
| | - Albert Lenz
- Institute for Health Research and Social Psychiatry; Catholic University of Applied Sciences North Rhine-Westphalia; Paderborn Germany
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29
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Morgan VA, Waterreus A, Carr V, Castle D, Cohen M, Harvey C, Galletly C, Mackinnon A, McGorry P, McGrath JJ, Neil AL, Saw S, Badcock JC, Foley DL, Waghorn G, Coker S, Jablensky A. Responding to challenges for people with psychotic illness: Updated evidence from the Survey of High Impact Psychosis. Aust N Z J Psychiatry 2017; 51:124-140. [PMID: 27913580 DOI: 10.1177/0004867416679738] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective is to summarise recent findings from the 2010 Australian Survey of High Impact Psychosis (SHIP) and examine their implications for future policy and planning to improve mental health, physical health and other circumstances of people with a psychotic disorder. METHODS Survey of High Impact Psychosis collected nationally representative data on 1825 people with psychotic illness. Over 60 papers have been published covering key challenges reported by participants: financial problems, loneliness and social isolation, unemployment, poor physical health, uncontrolled symptoms of mental illness, and lack of stable, suitable housing. Findings are summarised under the rubric of participant-ranked top challenges. RESULTS The main income source for the majority (85%) of participants was a government benefit. Only one-third was employed, and the most appropriate employment services for this group were under-utilised. High rates of loneliness and social isolation impacted mental and physical health. The rate of cardiometabolic disease was well above the general population rate, and associated risk factors were present from a very young age. Childhood abuse (30.6%), adult violent victimisation (16.4%) and alcohol and substance abuse/dependence (lifetime rates of 50.5% and 54.5%, respectively) complicated the clinical profile. Treatment with medication was suboptimal, with physical health conditions undertreated, a high rate of psychotropic polypharmacy and underutilisation of clozapine in chronic persistent psychotic illness. Only 38.6% received evidence-based psychosocial therapies. In the previous year, 27.4% had changed housing and 12.8% had been homeless, on average for 155 days. CONCLUSION Money, social engagement and employment are the most important challenges for people with psychotic illness, as well as good physical and mental health. An integrated approach to recovery is needed to optimise service delivery and augment evidence-based clinical practice with measures to improve physical health and social circumstances. Meeting these challenges has the potential to reduce costs to government and society, as well as promote recovery.
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Affiliation(s)
- Vera A Morgan
- 1 Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.,2 Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - Anna Waterreus
- 1 Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - Vaughan Carr
- 3 Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,4 Schizophrenia Research Institute and Neuroscience Research Australia, Sydney, NSW, Australia.,5 Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - David Castle
- 6 St Vincent's Hospital, Melbourne, VIC, Australia.,7 Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Martin Cohen
- 8 Hunter New England Mental Health, Newcastle, NSW, Australia.,9 The University of Newcastle, Newcastle, NSW, Australia
| | - Carol Harvey
- 7 Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Cherrie Galletly
- 10 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,11 Ramsay Health Care, Mental Health Services, Adelaide, SA, Australia.,12 Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Andrew Mackinnon
- 13 Black Dog Institute and University of New South Wales, Sydney, NSW Australia.,14 Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Patrick McGorry
- 15 Orygen Youth Health Research Centre, Melbourne, VIC, Australia
| | - John J McGrath
- 16 Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia.,17 Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Amanda L Neil
- 18 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Suzy Saw
- 19 Health Data Analysis Pty Ltd, Canberra, ACT, Australia
| | - Johanna C Badcock
- 2 Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.,20 Cooperative Research Centre-Mental Health, Carlton, VIC, Australia
| | - Debra L Foley
- 21 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Geoff Waghorn
- 17 Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Sarah Coker
- 22 SANE Australia, Melbourne, VIC, Australia
| | - Assen Jablensky
- 2 Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.,20 Cooperative Research Centre-Mental Health, Carlton, VIC, Australia
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Wong O, Nguyen T, Thomas N, Thomson-Salo F, Handrinos D, Judd F. Perinatal mental health: Fathers - the (mostly) forgotten parent. Asia Pac Psychiatry 2016; 8:247-255. [PMID: 26293755 DOI: 10.1111/appy.12204] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/07/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The importance of parental mental health as a determinant of infant and child outcomes is increasingly acknowledged. Yet, there is limited information regarding paternal mental health during the perinatal period. The aim of this review is to summarize existing clinical research regarding paternal mental health in the perinatal period in various contexts, and its possible impact on infant development. METHOD An electronic literature search was conducted using MEDLINE and PubMed databases. Key texts were used to cross-check for any further articles of interest. RESULTS Men are at increased risk of mental health problems during the transition to fatherhood, as well as during the perinatal period. Paternal mental health during the perinatal period has been shown to impact on their child's emotional and behavioral development. However, research addressing the needs of fathers with mental illness and the impact of their illness on their infant and family has been limited. CONCLUSIONS A paradigm shift is required, from a focus on women following childbirth and women with pre-existing psychiatric disorders, to a broader family perspective with the focus firmly on parent-infant relationships. This paradigm shift needs to involve greater research into the fathering role and paternal mental illness during the perinatal period, including further studies into risk factors, impact on the family system, and the most appropriate form of intervention and service provision.
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Affiliation(s)
- Olivia Wong
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia.
| | - Tram Nguyen
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Naomi Thomas
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia
| | - Frances Thomson-Salo
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Dennis Handrinos
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia
| | - Fiona Judd
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia
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Finzi-Dottan R, Dayan-Gazith E, Borosh T, Golubchik P. Involvement and Warmth of Fathers with Mental Illness: The Role of the Caregiving System, Parental Self-Efficacy, Social Support and Child Characteristics. Community Ment Health J 2016; 52:972-982. [PMID: 27137508 DOI: 10.1007/s10597-016-0011-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 04/28/2016] [Indexed: 12/01/2022]
Abstract
This study compares the levels and predictors of paternal warmth and involvement of 69 fathers with serious mental illness (SMI) and 69 matched non-clinical (NC) fathers in Israel. Findings show that the NC fathers were more involved with their children, whereas the SMI fathers reported more warmth and perceived their children as less difficult. The interactions that were found in the regression analyses highlight the differences between the two groups. Among the SMI fathers, but not the NC fathers, higher paternal self-efficacy was associated with increased father involvement, and lower family support was associated with decreased warmth.
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Affiliation(s)
- Ricky Finzi-Dottan
- School of Social Work, Bar Ilan University, 529002, Ramat Gan, Israel. .,Child and Adolescence Outpatient Clinic, Geha Mental Health Center, P.O.B. 102, 49100, Petah Tiqva, Israel.
| | | | - Tali Borosh
- School of Social Work, Bar Ilan University, 529002, Ramat Gan, Israel
| | - Pavel Golubchik
- Child and Adolescence Outpatient Clinic, Geha Mental Health Center, P.O.B. 102, 49100, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
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Nguyen T, Brooks J, Frayne J, Watt F, Fisher J. The preconception needs of women with severe mental illness: a consecutive clinical case series. J Psychosom Obstet Gynaecol 2016; 36:87-93. [PMID: 25830510 DOI: 10.3109/0167482x.2015.1029448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Women with severe mental illness (SMI) are having babies at an increasing rate, but continue to face many challenges across the perinatal period. There is little research into the preconception needs of women with SMI and the aim of this study was to investigate the social circumstances, general health, mental health and reproductive health care needs in these at risk women. METHOD Women with SMI referred for specialist preconception counselling at a tertiary obstetric hospital in 2012 were eligible to participate. The data source was a semi-structured study-specific interview schedule with open-ended questions incorporated into the routine assessment protocol. RESULTS In a one-year period, 23 women were referred to the service and 22 consented to data from the interview being pooled for the study. All women were taking at least one psychotropic medication at the time of referral. Overall, 40% (n = 9) were aged at least 35 years, 36% (n = 8) smoked cigarettes daily and over half (54.5% n = 12) reported their body mass index as being in the overweight or obese range. Thematic analysis revealed the importance of maternal desire, and concerns relating to age and biological time pressure, the impact of the illness and medication on pregnancy and motherhood. CONCLUSION Our data indicate that preconception counselling should be routine in the care of women with SMI of reproductive age, and should take into account the potential centrality of motherhood in the woman's rehabilitation, as well as the complex appraisals of risks, general health and support.
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Affiliation(s)
- Thinh Nguyen
- a School of Psychiatry and Clinical Neurosciences, University of Western Australia , Australia .,b Peel and Rockingham Kwinana Mental Health Services , Australia
| | - Janette Brooks
- c Women and Newborn Health Service , Western Australia , Australia .,d School of Women and Infant Health, University of Western Australia , Australia
| | - Jacqueline Frayne
- c Women and Newborn Health Service , Western Australia , Australia .,e School of Primary, Aboriginal and Rural Health Care, The University of Western Australia , Australia , and
| | - Felice Watt
- c Women and Newborn Health Service , Western Australia , Australia
| | - Jane Fisher
- f Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Australia
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Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, Kulkarni J, McGorry P, Nielssen O, Tran N. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 2016; 50:410-72. [PMID: 27106681 DOI: 10.1177/0004867416641195] [Citation(s) in RCA: 519] [Impact Index Per Article: 64.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. METHODS The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. RESULTS The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. CONCLUSIONS This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges.
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Affiliation(s)
- Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, SA, Australia Ramsay Health Care (SA) Mental Health, Adelaide, SA, Australia Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - David Castle
- Department of Psychiatry, St Vincent's Health and The University of Melbourne, Melbourne, VIC, Australia
| | - Frances Dark
- Rehabilitation Services, Metro South Mental Health Service, Brisbane, QLD, Australia
| | - Verity Humberstone
- Mental Health and Addiction Services, Northland District Health Board, Whangarei, New Zealand
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia (UWA), Crawley, WA, Australia
| | - Eóin Killackey
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- The Alfred Hospital and Monash University, Clayton, VIC, Australia Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia Board of the National Youth Mental Health Foundation (headspace), Parkville, VIC, Australia
| | - Olav Nielssen
- Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Nga Tran
- St Vincent's Mental Health, Melbourne, VIC, Australia Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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[Subjective Needs of Support in Families with a Mentally Ill Parent – A Literature Review]. Prax Kinderpsychol Kinderpsychiatr 2016; 65:231-48. [PMID: 27027215 DOI: 10.13109/prkk.2016.65.4.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mentally ill parents are often sceptical about professional help for their children although these children face an increased risk to develop a mental disease themselves. To get a better understanding of needs and help-seeking behaviour in those families a systematic literature review was conducted. Four databases (FIS, PsycINFO, PSYNDEX, PubPsych) were scanned for international and national research literature. Out of 18,057 articles 56 were included which report quantitative or qualitative studies taking the children's and parents' perspectives into account. A thematic synthesis was done to categorize the needs. Results concerning the help-seeking behaviour and the influence of demographic variables were extracted and summarized. Our results were limited by the aspect that no evaluation of study quality had been made and influences on the categorizing process by the authors' subjective perceptions are likely. There were a lot of hints regarding the needs of the families, but little report was found about help-seeking behaviour and demographic variables. The "health literacy" concept was discussed as a basis for further research in this area.
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How to support patients with severe mental illness in their parenting role with children aged over 1 year? A systematic review of interventions. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1765-83. [PMID: 26091723 DOI: 10.1007/s00127-015-1069-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 05/13/2015] [Indexed: 01/26/2023]
Abstract
PURPOSE There are well-established risks for parents with severe mental illness (i.e. psychotic and bipolar disorders), both for their children and themselves. Interventions to help parents fulfil their role should therefore be a public health objective, but their implementation needs to be underpinned by research evidence. This systematic review determines what is known about the nature and effectiveness of interventions for parents with severe mental illness. METHODS We conducted a narrative synthesis of controlled and uncontrolled studies reporting interventions for this patient group after the post-natal period (i.e. after the child has turned 1 year old). RESULTS Eighteen publications reported data from 15 studies. All but two studies were rated as low quality studies. Interventions included home visiting programmes, complex community programmes, residential treatments, and online interventions. Interventions targeted diverse areas, with parenting skills and understanding the impact of mental illness on parenting most frequently addressed. Both parent and child-related outcomes improved, but children were only assessed via observers and follow-up times were short. CONCLUSIONS Interventions were diverse with respect to their nature and effectiveness. Future interventions should combine different intervention strategies to target multiple areas in a flexible manner. The addition of positively focussed and resource-oriented components should be investigated. Trials should include direct assessments of both parents and children, outcomes that are relevant from a public health perspective, and establish the long-term effects ideally until children have reached 18 years of age.
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Lacey M, Paolini S, Hanlon MC, Melville J, Galletly C, Campbell LE. Parents with serious mental illness: differences in internalised and externalised mental illness stigma and gender stigma between mothers and fathers. Psychiatry Res 2015; 225:723-33. [PMID: 25524813 DOI: 10.1016/j.psychres.2014.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/17/2014] [Accepted: 09/16/2014] [Indexed: 11/18/2022]
Abstract
Research demonstrates that people living with serious mental illness (SMI) contend with widespread public stigma; however, little is known about the specific experiences of stigma that mothers, and in particular fathers, with SMI encounter as parents. This study aimed to explore and compare the experiences of stigma for mothers and fathers with SMI inferred not only by living with a mental illness but also potential compounding gender effects, and the associated impact of stigma on parenting. Telephone surveys were conducted with 93 participants with SMI who previously identified as parents in the Second Australian National Survey of Psychosis. Results indicated that mothers were more likely than fathers to perceive and internalise stigma associated with their mental illness. Conversely, fathers were more inclined to perceive stigma relating to their gender and to hold stigmatising attitudes towards others. Mental illness and gender stigma predicted poorer self-reported parenting experiences for both mothers and fathers. These findings may assist in tailoring interventions for mothers and fathers with SMI.
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Affiliation(s)
- Melanie Lacey
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Callaghan, NSW, Australia
| | - Stefania Paolini
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Callaghan, NSW, Australia; School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Ourimbah, NSW, Australia; Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia
| | - Mary-Claire Hanlon
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia; Department of Radiation Oncology, Calvary Mater Hospital, Waratah, NSW, Australia; Hunter Cancer Research Alliance, Newcastle, NSW, Australia; Schizophrenia Research Institute, Darlinghurst, NSW, Australia
| | - Jessica Melville
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Ourimbah, NSW, Australia; Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, VIC, Australia; Northern Adelaide Local Health Network, Adelaide, VIC, Australia
| | - Linda E Campbell
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Ourimbah, NSW, Australia; Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia.
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Mehta UM, Bhagyavathi HD, Kumar CN, Thirthalli J, Gangadhar BN. Cognitive deconstruction of parenting in schizophrenia: the role of theory of mind. Aust N Z J Psychiatry 2014; 48:249-58. [PMID: 23928275 DOI: 10.1177/0004867413500350] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Schizophrenia patients experience impairments across various functional roles. Emotional unresponsiveness and an inability to foster intimacy and display affection may lead to impairments in parenting. A comprehensive cognitive understanding of parenting abilities in schizophrenia has the potential to guide newer treatment strategies. As part of a larger study on functional ability in schizophrenia patients, we attempted a cognitive deconstruction of their parenting ability. METHODS Sixty-nine of the 170 patients who participated in a study on social cognition in remitted schizophrenia were parents (mean age of their children: 11.8 ± 6.2 years). They underwent comprehensive assessments for neurocognition, social cognition (theory of mind, emotion processing, social perception and attributional bias), motivation and insight. A rater blind to their cognitive status assessed their social functioning using the Groningen Social Disabilities Schedule. We examined the association of their functional ability (active involvement and affective relationship) in the parental role with their cognitive performance as well as with their level of insight and motivation. RESULTS Deficits in first- and second-order theory of mind (t = 2.57, p = 0.01; t = 3.2, p = 0.002, respectively), speed of processing (t = 2.37, p = 0.02), cognitive flexibility (t = 2.26, p = 0.02) and motivation (t = 2.64, p = 0.01) had significant association with parental role dysfunction. On logistic regression, second-order theory of mind emerged as a specific predictor of parental role, even after controlling for overall functioning scores sans parental role. CONCLUSIONS Second-order theory of mind deficits are specifically associated with parental role dysfunction of patients with schizophrenia. Novel treatment strategies targeting theory of mind may improve parenting abilities in individuals with schizophrenia.
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Affiliation(s)
- Urvakhsh M Mehta
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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The comprehensive management of pregnant women with major mood disorders: a case study involving phenelzine, lithium, and quetiapine. Arch Womens Ment Health 2014; 17:73-5. [PMID: 24196828 DOI: 10.1007/s00737-013-0386-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 10/20/2013] [Indexed: 10/26/2022]
Abstract
Pregnancy in women with severe mental illness (SMI) often bring added dimensions of complexity; considering that this group of women are choosing to have children at increasing rates, more highly complex cases will require management. A 31-year-old primigravida with a diagnosis of bipolar affective disorder was treated with an antidepressant, mood stabiliser and antipsychotic. This case discusses preconception counselling, pregnancy and labour management that resulted in the delivery of a 4,200 g baby at 39 weeks by emergency caesarian section. This case highlights the collaborative approach to care that is needed in this group of women and the need for increasing awareness and knowledge in health professionals. It follows the management from preconception through to the postpartum period.
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Affiliation(s)
- Michael Berk
- School of Medicine, Deakin University, Geelong, Australia.
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Carr VJ, Whiteford H, Groves A, McGorry P, Shepherd AM. Policy and service development implications of the second Australian National Survey of High Impact Psychosis (SHIP). Aust N Z J Psychiatry 2012; 46:708-18. [PMID: 22563037 DOI: 10.1177/0004867412446488] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We consider insights from the second Australian National Survey of High Impact Psychosis (2010) in order to identify the key policy and service development implications. METHOD The Survey of High Impact Psychosis (SHIP) provides an updated description of the experiences of people living with psychosis in Australia. We discuss the SHIP survey participants' greatest challenges for the future in light of the strength of existing literature, highlighting prospective opportunities for policy and service planning. RESULTS Targets for future policy development and service initiatives are informed by the survey participants' leading challenges: financial difficulties, social isolation, lack of employment, physical and mental ill health, accommodation, and access to services. CONCLUSIONS Many of the areas of need identified by survey participants are supported by quality research that may be more widely translated into effective services. For areas of need where the evidence is lacking, more clinical research is urgently needed. A targeted approach is vital to secure necessary investment in the wider dissemination of efficacious interventions and their systematic evaluation in ordinary clinical practice, enabled by both research investment and active integration of the research effort within ordinary clinical settings.
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Affiliation(s)
- Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, Australia.
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