ArticleLiterature Review

Children living with a parent who has a mental illness: A critical analysis of the literature and research implications

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Abstract

This article provides an analysis and assessment of the literature that deals with children of a parent who has a mental illness. It argues that children's perspectives about living with a parent who has a mental illness have not been taken into consideration. A survey of the literature indicates that it can be divided into sections that include: the family context of the child, risks associated with the child's stage of growth and development, characteristics associated with resilience, and existing interventions. In general, research studies have examined factors that are associated with the presence or absence of children's pathology and have relied on researchers' normative judgments to denote narrow views of pathology, and diagnostic and behavioral measures. The article will propose a program of research that addresses the issues raised in our analysis.

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... Studier i USA och Storbritannien uppskattar att åtminstone 20 %, och i vissa fall upp till 50 %, av de vuxna som är kända av den psykiatriska vården är föräldrar (Fudge et al., 2004). I USA bedöms hälften av befolkningen någon gång drabbas av psykisk sjukdom eller störning, varav två tredjedelar av kvinnorna är mödrar och hälften av männen är fäder (Mordoch & Hall, 2002). 26 % av de kvinnor som får diagnosen schizofreni lever med barn som är yngre än 16 år; var tionde till var tjugonde kvinna drabbas av postpartum depression (Mordoch & Hall, 2002). ...
... I USA bedöms hälften av befolkningen någon gång drabbas av psykisk sjukdom eller störning, varav två tredjedelar av kvinnorna är mödrar och hälften av männen är fäder (Mordoch & Hall, 2002). 26 % av de kvinnor som får diagnosen schizofreni lever med barn som är yngre än 16 år; var tionde till var tjugonde kvinna drabbas av postpartum depression (Mordoch & Hall, 2002). I en studie från Sverige med ett material på 137 patienter inom psykiatrisk vård, var 36 % föräldrar till minderåriga barn (Ostman & Eidevall, 2005). ...
... Vidare har dessa barn sämre möjligheter än andra barn att få skolgången att fungera (Farahati et al., 2003). Ett centralt tema i många studier handlar om hur barn blir utsatta i samband med det sociala stigma och den skam som ofta förknippas med psykisk ohälsa (Bassett, Lampe, & Lloyd, 1999;Diaz-Caneja & Johnson, 2004;Hinshaw, 2005;Mordoch & Hall, 2002;Ostman & Hansson, 2002;Ostman & Kjellin, 2002;Tanner, 2000). ...
... Yet, research does suggest that children may 46 feel reassured by a visit to their parent, particularly if 47 they receive a welcoming approach from ward personnel 48 and if the visit is in the context of 49 an organised intervention (Poehlmann et al. 2010). (Rutter, 1966;Meadus & Johnston, 2000;Handley 66 et al. 2001;Mordoch & Hall, 2002;Riebschleger, 2004). 67 Other studies highlight the impacts of parental illness 68 on children's schooling and friendships, as well as the 69 continuous frustration experienced by children due to 70 lack of information or involvement (Garley et al. 1997; 71 Meadus & Johnston, 2000;Mordoch & Hall, 2002;Scott 72 et al. 2007). ...
... (Rutter, 1966;Meadus & Johnston, 2000;Handley 66 et al. 2001;Mordoch & Hall, 2002;Riebschleger, 2004). 67 Other studies highlight the impacts of parental illness 68 on children's schooling and friendships, as well as the 69 continuous frustration experienced by children due to 70 lack of information or involvement (Garley et al. 1997; 71 Meadus & Johnston, 2000;Mordoch & Hall, 2002;Scott 72 et al. 2007). For children whose parent has been 73 hospitalised, this may be experienced as a painful 74 and emotional time, especially if it is a first separation 75 (Rutter, 1966;Meadus & Johnston, 2000;Handley et al. 76 2001;Mordoch & Hall, 2002;Riebschleger, 2004). ...
... 67 Other studies highlight the impacts of parental illness 68 on children's schooling and friendships, as well as the 69 continuous frustration experienced by children due to 70 lack of information or involvement (Garley et al. 1997; 71 Meadus & Johnston, 2000;Mordoch & Hall, 2002;Scott 72 et al. 2007). For children whose parent has been 73 hospitalised, this may be experienced as a painful 74 and emotional time, especially if it is a first separation 75 (Rutter, 1966;Meadus & Johnston, 2000;Handley et al. 76 2001;Mordoch & Hall, 2002;Riebschleger, 2004). 77 The stigma and secrecy that surround mental health 78 problems may make it difficult for the child to seek 79 assistance (Riebschleger, 2004). ...
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Background: The provision of care for children of parents with a mental health problem is an area that is frequently neglected by health-care practitioners. Objectives: The aim of the overall study was to explore psychiatric nurses' knowledge of, attitudes and practice towards the support needs of children whose parent has a mental health problem. This paper specifically addresses the views of psychiatric nurses towards children visiting their parent in a mental health inpatient facility. Method: This study employed a self-completion survey design with a sample of 114 registered psychiatric nurses from one integrated mental health service in Ireland. Results: The majority of participants were in favour of children visiting their parent when in hospital, but were of the view that the visiting areas should be away from the main ward location and designed to be child-friendly. Many expressed concerns about the standard of visiting facilities and worried about the potentially negative impact of a visit on the child's well-being. In relation to education on child-care issues, a significant majority of the participants reported not having received any education in the child-care issues identified and, as a likely consequence, rated their knowledge as insufficient. Conclusions: This study highlights the need for further work in the areas of practitioner education, child-friendly visiting facilities, and the development of policy and practice guidelines around children whose parents experience a mental health problem.
... The impetus for this study derives from communicating with mental health nurses about feeling of incompetence caring for children to hospitalised parents. Healthcare researchers emphasise the need to make the children of parents with mental illnesses more visible (2)(3)(4). The children are at risk to develop mental illness. ...
... The children are at risk to develop mental illness. They are, however, competent individuals who take actions when needed and able to account for their experiences in own words (2)(3)(4). ...
... Children easily can be engulfed by their parents' illness resulting in poor relations in the family and among friends and schoolmates (3,13), and they handle this threat differently to preserve themselves (2,10). Aldridge and Becker (14), in a study involving parents', staff's and children's experiences when a parent has mental illness, concluded that children often subjugated own needs in favour of the needs of their ill parent. ...
Article
A large group of individuals suffering from mental illness are parents living with their children. These children are invisible in the health care even though at risk for illhealth. The aim of this metasynthesis was to advance knowledge of how children of parents with mental illness experience their lives, thus contributing to the evidence of this phenomenon. The metasynthesis is following Sandelowski and Barroso's guidelines. Literature searches covering the years 2000 to 2013 resulted in 22 reports which were synthesised into the theme 'navigating in an unpredictable everyday life' and the metaphor compass. Children of parents with mental illness irrespective of age are responsible, loving and worrying children who want to do everything to help and support. Children feel shame when the parent behaves differently, and they conceal their family life being afraid of stigmatisation and bullying. When their parent becomes ill, they distance to protect themselves. The children cope through information, knowledge, frankness and trustful relationships. These children need support from healthcare services because they subjugate own needs in favour of the parental needs, they should be encouraged to talk about their family situation, and especially, young children should to be child-like, playing and seeing friends.
... In a longitudinal study of over 4000 Australian children, Bayer et al. (2008) identified the family context as an important predictor of developing mental health problems in child and adulthood. Research has repeatedly shown that children exposed to the genetic and environmental risks associated with parental mental illness have an increased chance of experiencing adverse outcomes in their social, emotional and cognitive development across their lifespan, compared to other children in the community (Goodman et al. 2011;Hosman et al. 2009;Mordoch and Hall 2002;Mowbray et al. 2004;Solantaus et al. 2009;van Doesum and Hosman 2009). Similarly, other literature has confirmed that children exposed to various risk factors such as parental mental illness, have an increased chance of developing their own mental health problems later in life, compared to other children. ...
... Programs that target mental health literacy of staff who work in schools and early childhood settings can potentially mitigate stigma's adverse impact on parents seeking support and care (Neil 2007;Whitley et al. 2013). Many studies have identified that parents who have a mental illness may develop a sense of hopelessness linked to feelings of incompetence, in addition to the stigma they may experience in the community (Mordoch and Hall 2002;Oyserman et al. 2000;Stepp et al. 2012). ...
... This is perhaps not surprising given contemporary ecological understandings of child development incorporated in formal and informal training of staff working in this sector. Bronfenbrenner's ecological systems model is also emphasised in numerous ECEC policy documents (ACECQA 2014;AICAFMHA 2001) and in theoretical models developed by international researchers in the mental health field (Falkov 2012;Goodman et al. 2011;Hosman et al. 2009;Mordoch and Hall 2002;Nicholson and Henry 2003). Given this, the findings of the present study suggest that those surveyed are making important links between their practice and national guidelines. ...
Article
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During the preschool years (3–5 years), children living with parental mental illness are more at risk of various adverse developmental outcomes, compared to other children. Early childhood services are opportune settings for prevention and early intervention strategies that may support preschool children living with parental mental illness. However, there is limited research examining how the early childhood sector supports the child, parent and family. The aim of the study was to explore family focused practices within the early childhood sector in terms of the level of self-perceived knowledge, skill and confidence; and compare the self-perceived knowledge, skill and confidence between preschool teachers and childcare workers. A sample of 40 preschool teachers and 39 childcare providers rated themselves across eight domains that describe their knowledge, confidence and skill using the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Overall, the sample rated themselves positively across all domains. In a cross-sectional analysis, a t-statistic comparison of preschool teachers and childcare providers showed that childcare providers scored significantly higher than preschool teachers in parenting support, referrals and assessing the impact of parental illness on the child. Future studies might identify the barriers and enablers for Family Focus Practice (FFP) across different groups of workers in the early childhood sector.
... Since the early 2000's, parental mental illness and the impact on children is a phenomenon that has attracted much attention around the world (Mordoch and Hall 2002;Oyserman et al. 2000). Prevalence studies have identified that there is a high proportion of children in the population living with a parent with a diagnosed mental health disorder, namely mood and personality disorders. ...
... It is also important to note here, however, that PMI intervention research highlights that there is no single risk factor on its own that may have a significant effect on the child (Mordoch and Hall 2002). Rather, there are several interacting factors that can elevate exposure to risk and strongly influence negative outcomes for children living with a parent affected by mental illness. ...
Article
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Children exposed to the risk factors associated with parental mental illness are seen to be at risk of developing cognitive, emotional, and behavioural difficulties in preschool and later in life. Given that educational settings are seen as optimal for early intervention, preschool teachers have an important role to play in identifying and responding to the needs of these vulnerable children at a critical period of their development. The aim of this study was to explore the experiences of preschool teachers who have taught, or currently teach, preschool aged children (4–6 years) affected by a parent’s mental illness. Seven university qualified preschool teachers were interviewed about their experiences and reflected on their practices, specifically those practices that seemed to help support the child and those that did not. The findings highlighted that preschool teachers are knowledgeable and have the skills to identify warning signs and risk factors for young children, however this knowledge was limited in the context of parental mental illness and associated risks for preschool children. As such, the present study highlighted the need for targeted and specialized training and resources designed for the needs of preschool teachers. Several implications were discussed.
... Mental disorders are among the common problems in societies (1). According to the statistics, it is predicted that half of the population in the United States experience some forms of mental disorders in a period of their lives (2). In Europe, mental disorders are estimated to be present among 27% of the population (3). ...
... It is also of prime importance to notice the needs of these children to improve and enhance their normal development and growth (13). Unfortunately, there are only a limited number of plans assigned to these children (2). ...
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Background: In the families of patients with mental disorder, children are in a critical situation since they are faced with several problems that may not be efficiently noticed. Objectives: The purpose of this study was to explore the challenges concerning the marriage of children of parent with mental illness in Iran. Patients and Methods: This study was a part of more comprehensive study conducted using qualitative method. It was conducted in a mental hospital Qazvin City, Iran. In the present research, semi-structured interviews were performed with 17 participants, selected based on purposeful sampling. The obtained data were analyzed using constant comparison analysis. Results: According to the findings, main theme of “Gloomy Horizon” with subthemes of premarriage and postmarriage issues was emerged. People were unwilling to marry these children. In addition, these children considered marriage as a challenging issue, due to their fear of genetic transferability of their parents’ illnesses and incidence of having problems with their spouses’ families. Conclusions: Regarding the challenges opposed to the marriage of these children, allocation of necessary actions within their care services as well as offering educational programs seems to be of prime importance for the society. Keywords: Child; Qualitative Research; Marriage; Mental Disorders; Parents
... One possibility is living in a household with a mentally ill or suicidal adult (which demonstrated good homogeneity and separation in the highly dysfunctional and abusive class). Previous research has shown that, in such households, primary caregivers may be unavailable psychologically and emotionally, are likely to be faced with additional losses, and children are sometimes forced to make other sacrifices such as parenting themselves, caring for parents, and residing in deprived environments (Mordoch & Hall, 2002). Moreover, these losses have been shown to be accompanied by both short-and longterm effects that may go unrecognized in the lives of children living with mentally ill persons (Mordoch & Hall, 2002). ...
... Previous research has shown that, in such households, primary caregivers may be unavailable psychologically and emotionally, are likely to be faced with additional losses, and children are sometimes forced to make other sacrifices such as parenting themselves, caring for parents, and residing in deprived environments (Mordoch & Hall, 2002). Moreover, these losses have been shown to be accompanied by both short-and longterm effects that may go unrecognized in the lives of children living with mentally ill persons (Mordoch & Hall, 2002). From the standpoint of intervention and prevention, future research should seek to clarify the dynamics associated with clinically significant heightened depressive symptoms and probable MDD by incorporating contexts characterized by chronic loss and alienation that children may experience when living with a mentally ill adult. ...
Article
Studies of adverse childhood experiences (ACEs) have gauged severity using a cumulative risk (CR) index. Few studies have focused on the nature of the context of adversity and their association with psychosocial outcomes. The objective of this study was to examine the patterning of ACEs and to explore the resultant patterns' association with HIV risk-taking, problem drinking, and depressive symptoms in adulthood. Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive "classes" of 11 of the most commonly used ACEs. The LCA resulted in four high-risk profiles and one low-risk profile, which were labeled: (1) highly abusive and dysfunctional (3.3%; n ¼ 1,983), (2) emotionally abusive alcoholic with parental conflict (6%, n ¼ 3,303), (3) sexual abuse only (4.3%, n ¼ 2,260), (4) emotionally abusive and alcoholic (30.3%, n ¼ 17,460), and (5) normative, low risk (56.3%, n ¼ 32,950). Compared to the low-risk class, each high-risk profile was differentially associated with adult psychosocial outcomes even when the conditional CR within that class was similar. The results further our understanding about the pattern of ACEs and the unique pathways to poor health. Implications for child welfare systems when dealing with individuals who have experienced multiple forms of early childhood maltreatment and/or household dysfunction are discussed.
... Esta es entendida como la capacidad de un sujeto o colectivo para desarrollarse adecuadamente y articular un proyecto de vida, a pesar de adversidades y acontecimientos traumáticos 20 . En esta línea se ha encontrado, que no obstante la presencia de emociones negativas y de haber vivido en familias caóticas e imprevisibles, los(as) hijos(as) lograban darle sentido a sus experiencias y elaborarlas, lo que les permitió crecer personalmente 21 . ...
... La vivencia de tener un padre/madre con un TMS afecta a los hijos(as) de manera diferenciada según la etapa del ciclo vital que cursen, sin embargo, es transversal el experimentar emociones aflictivas de tristeza, culpa y rabia 21,30 . Investigaciones previas destacan la niñez como etapa clave pues en ella se configuran los aspectos psicopatológicos ligados al riesgo en la salud mental de la descendencia 14,24,31 . ...
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Introduction: The experience of living with people who present a Severe Mental Disorder (SMD) is hard for the families, especially for children who have been less studied. This research was aimed to know how the experience of having lived with a parent with severe mental disorder influenced on childhood, adolescence and young adulthood of their children. Method: The experience of coexistence with a parent with SMD in 10 children (6 men and 4 women) aged between 18 and 29 years was analyzed through individual semi-structured interviews and a group interview. The sample was obtained by convenience and all participants lived at least two continuous years during their childhood with a parent who presented SMD. Regarding the diagnoses, four parents suffered schizophrenia and six, bipolar disorder. The study is qualitative, exploratory and of descriptive type. An analysis of content and thematic of the corpuses was performed. Results: Show that by coexisting with a parent with SMD have negative as well as positive consequences. Among the negative consequences the following can be mentioned: distressing feelings, family burden and the delay of stages in the vital cycle. On the other hand, the positive consequences are related to the development of strengths in the offspring. Conclusions: These findings may provide inputs to be focused on the work with children of people affected by SMD.
... In the context of parental mental illness, research has repeatedly demonstrated the potential psychological vulnerability and unique emotional needs of children exposed to the various risk factors associated with living with a parent who has a mental illness (Beardslee, Solantaus, Morgan, Gladstone, & Kowalenko, 2012;Hosman, van Doesum, & van Santvoort, 2009). While not all children living with parental mental illness will experience problems (Gladstone, Boydell, Seeman, & McKeever, 2011), evidence suggests that some may experience behavioral and/or emotional difficulties in school, or later in life (Mordoch & Hall, 2002). However, many parents who have a mental illness are reluctant to seek support for their children because they fear judgment about their parenting and competence, judgements fueled by the stigmatized attitudes and prejudice associated with mental illness within the community (Angermeyer & Matschinger, 2003). ...
... According to Rouse (2012), the relational and participatory behaviors that underpin trusting and respectful relationships are also fundamental to the notion of family empowerment. This is important as parents living with adversity may feel disempowered and develop a sense of hopelessness that is linked to feelings of incompetence in their parenting skills (Hinshaw, 2005;Mordoch & Hall, 2002). Additionally, evidence suggests that many parents who have a mental illness are reluctant to seek support for their children because they fear the judgements fueled by the stigmatized attitudes and prejudice associated with mental illness within the community (Clement et al., 2015;Hinshaw, 2005). ...
Article
The prevalence of developmentally vulnerable children living with parental mental illness has been well documented; however due to stigmatised attitudes and prejudice these children may be ‘hidden’ and not identified as requiring additional assistance in early childhood settings. The aim of the present study was to explore the experiences and workforce needs of centre-based child care staff working with children and families living with parental mental illness. Eight staff (four child care workers and four child care directors) who worked in centre-based child care were interviewed using a semi-structured interviews. The data were analysed using an Interpretative Phenomenology Analysis framework. The findings of the present study highlighted four central themes from the data collected: child development issues; tension around referral and worker anxiety and; inadequate knowledge and training about parental mental illness and sensitivity when working with families. While these participants knowingly prioritized the importance of working with families in their daily work, these participants described feeling stressed and anxious about discussing referral options with these parents, and often worried about ‘making things worse’ for the child and the parent. The present study has contributed knowledge in regard to an important segment of the early childhood workforce; such information can inform the development of tailored professional training and resources that provide information about referral procedures and support programs for these families.
... Other factors that complicate the identification of BD risk factors in OBP are that prodromal symptoms of BD, including non-BD disorders, in OBP often overlap with those in offspring at risk of other psychiatric disorders, due to OBP having parents with these other disorders [20,21]. Furthermore, living with a parent with any psychiatric disorder also likely affects the offspring's development and general well-being [22][23][24]. More recent BIOS studies [25,26] have therefore included offspring of comparison parents with non-BD psychopathology (OCP) and healthy offspring of healthy parents, to differentiate neuroimaging abnormalities common to OBP and OCP that are more likely to be associated with risk for non-BD disorders from those that are specific to OBP, and thus more likely to be associated with risk for BD. ...
Article
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Bipolar disorder (BD) is highly heritable. Identifying objective biomarkers reflecting pathophysiological processes predisposing to, versus protecting against BD, can help identify BD risk in offspring of BD parents. We recruited 21 BD participants with a first-degree relative with BD, 25 offspring of BD parents, 27 offspring of comparison parents with non-BD psychiatric disorders, and 32 healthy offspring of healthy parents. In at-risk groups, 23 had non-BD diagnoses and 29, no Axis-I diagnoses(healthy). Five at-risk offspring who developed BD post scan(Converters) were included. Diffusion imaging(dMRI) analysis with tract segmentation identified between-group differences in the microstructure of prefrontal tracts supporting emotional regulation relevant to BD: forceps minor, anterior thalamic radiation(ATR), cingulum bundle(CB), and uncinate fasciculus(UF). BD participants showed lower fractional anisotropy (FA) in the right CB (anterior portion) than other groups (q < 0.05); and in bilateral ATR (posterior portion) versus at-risk groups (q < 0.001). Healthy, but not non-BD, at-risk participants showed significantly higher FA in bilateral ATR clusters than healthy controls (qs < 0.05). At-risk groups showed higher FA in these clusters than BD participants (qs < 0.05). Non-BD versus healthy at-risk participants, and Converters versus offspring of BD parents, showed lower FA in the right ATR cluster (qs < 0.05). Low anterior right CB FA in BD participants versus other groups might result from having BD. High bilateral ATR FA in at-risk groups, and in healthy at-risk participants, versus healthy controls might protect against BD/other psychiatric disorders. Absence of elevated right ATR FA in non-BD versus healthy at-risk participants, and in Converters versus non-converter offspring of BD parents, might lower protection against BD in at-risk groups. Neuropsychopharmacology; https://doi.
... The present study was consistent with many prior findings that parents of depressed adolescents often experience their own psychological distress (Mordoch and Hall 2002;Vostanis et al. 2006). In our trial, at baseline, parents in both treatment arms reported moderate levels of depressive symptoms and mild levels of stress. ...
Article
Objective: This paper presents findings from a multi-centre, double-blind, randomized controlled trial that tested the hypothesis that parent and youth mental health improvements would be superior in a family-based intervention for adolescent depression (BEST MOOD) compared to a treatment-as-usual supportive parenting program (PAST). Method: Eligible participants were families with a young person aged between 12 and 18 years who met diagnostic criteria for a depressive disorder (major, minor or dysthymic). Participating families (N = 64) were recruited in Victoria, Australia and allocated to treatment condition using a block randomization procedure (parallel design) with two levels of blinding. This paper reports on the trial’s secondary outcomes on youth and parent mental health. Results: Data were analyzed according to the as-received principle; 27 families were analyzed in BEST MOOD, and 26 families in PAST. Using mixed model analyses, parents in the BEST MOOD group experienced significantly greater reductions in stress and depressive symptoms than parents in the PAST group at 3-month follow-up. A greater reduction in parental anxiety was observed in the BEST MOOD group (d = 0.35) compared with PAST (d = 0.02), although the between-group difference was not significant. Both groups of youth showed similar levels of improvement in depressive symptoms at post-treatment (d=.83 and .80 respectively) which were largely sustained at a 3-month follow-up. Conclusion: The family-based BEST MOOD intervention appeared superior to treatment-as-usual (PAST) in demonstrating greater reductions in parental stress and depression. Both BEST-Mood and an active control group of parent support produced large reductions in youth depressive symptoms. Clinical trial registration information—Engaging youth with high prevalence mental health problems using family based interventions; http://www.anzctr.org.au; ACTRN12612000398808.
... I en artikel av Stallard et al (2004) refererar författarna till Creswell & Brereton som funnit att 15-30 % av patienter inom vuxenpsykiatrin är föräldrar. Andra undersökningar som refereras i Mordoch & Hall (2002) har funnit ett uppseendeväckande resultat, att i vissa fall 50 % av patienter inom vuxenpsykiatrin är föräldrar. Att så många psykiskt sjuka är föräldrar är alarmerande. ...
... Developmental researchers have increasingly recognized the associations between parental psychopathological symptoms and a range of adverse child behavioral and emotional outcomes (e.g. Connell & Goodman, 2002;Mordoch & Hall, 2002). Such intergenerational transmission has been demonstrated in both clinical (e.g. ...
Background: Parental psychopathological symptoms have been associated with a number of child psychological problems, yet little research has examined the role of parental emotion dysregulation on the intergenerational transmission of psychopathological symptoms. This study aims to examine the relationship between parents' and children's psychopathological symptoms with a focus on the mediating mechanism of parental emotion dysregulation on these relationships. Methods: Eighty-nine Chinese parents and their school-age children between the ages of 7 and 12 (49 males, M age = 8.79, SD = 1.81) participated in the study. In the initial phase of the study, parents filled out a series of questionnaires reporting their own psychopathological symptoms via SCL-90 and difficulties with emotion regulation via Difficulties in Emotion Regulation Scale. After 9 months, the parents reported their children's internalizing and externalizing problems via Child Behavior Checklist, and the children self-reported anxiety symptoms via Screen for Child Anxiety Related Emotional Disorders in the second phase of the study. Results: The results showed that parental emotion dysregulation played an important role as a mediator of the relationship between parental psychopathological symptoms and child internalizing problems and separation anxiety, which indicates that parents' mental health problems were significantly associated with their difficulties with emotion regulation, which in turn led to more internalizing problems and separation anxiety in their children. However, we did not find a mediating effect of parental emotion dysregulation on the links between parent psychopathology and child externalizing problems or other types of self-reported anxiety symptoms. Conclusions: Our findings highlighted the importance of implementing more psycho-education programs that specifically target parents' emotion regulation abilities in both community and clinical settings to ameliorate the intergenerational transmission of psychopathological symptoms between generations.
... [1,4] An expanding body of literature now also documents the difficulties encountered by children growing up with parents who are mentally ill, citing poor physical and psychological outcomes for children as they move into adulthood. [6,7,8,9] There is however a paucity of research examining the experiences of adult children who care for an elderly parent with a psychiatric illness, in spite of the numbers of children engaged in parental care. With better treatment and support, people with mental illness are living longer. ...
Article
Introduction: This research contrasts the experiences of long-term carers of elderly parents who have had a long-standing mental illness and first-time carers of parents who have become mentally unwell in old age. It was hypothesized that the children of elderly parents with a long-standing mental illness have differing needs when faced with the caring role compared to first-time carers of elderly mentally ill patients. Method: Using a qualitative research methodology and interpretive perspective, eight carers were interviewed using a standardized questionnaire from which salient issues were drawn and analyzed. Results: Long-term carers faced issues including a longer duration of care-giver stress, early entry into adult responsibilities of caring, frustrations concerning lack of recognition from mental health services and cumulative stress affecting long-term carers significant relationships and health. First-time carers sought earlier access to mental health services, specialist information about mental health issues and coping strategies for the care-giving role. Conclusion: It was found that both sets of carers (long-term and first-time), irrespective of the duration of their caring experiences, shared complex and competing demands on their physical and emotional resources. All carers were able to identify ways to improve support to improve support to children caring for ageing mentally ill parents.
... [1] It is estimated that in Australia, one of every five people experiences serious mental problems. [2] Moreover, about half of American people experience some forms of mental disorders during their lives [3] so much so that 40 million people are affected by mental illnesses each year. [4] In Europe, mental disorders have been also estimated to affect about 27% of the total population. ...
Article
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Context: There is considerable empirical evidence about the psychosocial vulnerability of children of parents with mental illness (COPMI). Nonetheless, these children's experiences and needs have still known poorly. Aims: This study was conducted to explore the mental health needs of COPMI. Settings and Design: The grounded theory approach was deployed. Material and Methods: Semi-structured interviews were held with 17 participants who had been recruited purposively and theoretically from a psychiatric teaching hospital located in Qazvin, Iran 2008–2010. Statistical Analysis Used: The data were analyzed using Strauss and Corbin method (1998). Results: After relating the main concepts of the study, the “COPMI need theory” was formulated. This theory explains children's needs, changes of needs in the cycle of parents' illness, the process of fulfilling the needs, and outcomes-driven from need fulfillment. Conclusions: Based on findings, recommendations were provided to mental health professionals who for dealing with families and children of patients with mental disorders. Keywords: Children, Family, Grounded theory, Mental disorder, Parents
... [7][8][9][10] Moreover, when children are identified as 'at risk', this status follows them into adulthood and the strategies they use to manage everyday life may have ongoing negative social consequences. 11,12 The direct effects of parental mental illness seem to be less detrimental to children than the social adversity that accompanies such illness. 3,13 Although a significant genetic contribution to such illness in children is widely acknowledged, family context and social circumstances (e.g. ...
... On the other hand, stigma that involves their parents' mental illness can create negative feelings, such as shame and guilt. Because of that, these children tend to not communicate about their emotional experiences at home (17). ...
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Background: Children of parents with mental illness (COPMI) are a high-risk group. There is a strong association between parents’ psychiatric disorders and the incidence of psychopathology in their children. These children need to be identified and supported by mental health workers early, and hence, clinical practice in adult mental health services needs to change from a focus on individual patients to a more systemic family focus. “Semente,” a mental health promotion program developed by the Psychiatry Service of Fernando Fonseca hospital (Lisbon, Portugal), had been established to identify these children and families and promote their mental health, by decreasing the impact of risk factors and promoting protective factors. The program included preventive COPMI interventions and implementation of activities offered to families with children in the mental health care. The aim of the present study was to evaluate changes in mental health care after the training in “Child Talks” intervention (two to three psycho-educational meetings with parents and children) and implementation of the “Semente” program. Methods: Participants (N = 51) were all professionals from Psychiatric Service of Fernando Fonseca Hospital who received Child Talks training. The Family-Focused Mental Health Practice Questionnaire (FFMPQ) was used to measure change in professionals’ attitudes, knowledge, confidence, and organizational structure in working with these families. All participants filled in the questionnaire before training and 10 months later. Results: The results showed that, from pre- to post-measurement, the professionals changed clinical practice significantly. The largest changes were visible in the improved provision of support at the workplace for family-focused practice and the clarity and availability of the policies and procedures. Furthermore, the skill and knowledge of the mental health workers showed significant improvement at posttest. Conclusion: The positive results of this study were not unexpected; the training, implementation of routines, and procedures as well as workplace support were aims of the “Semente” program. Interpretation of the results should be taken with caution because of the small sample and the lower reliability of some of scales of the FFMPQ. The results indicate that professionals moved from patient focus to family focus during the implementation of the “Semente” program.
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This chapter revisits a challenge to expand the conceptual repertoire for thinking about Children's experiences of parental mentalillnesses beyond risk and resilience (Gladstone et al., 2006). I begin with a brief literature review of children's subjective experiencesof everyday life (Gladstone et al., 2011), followed by a research exemplar illustrating one young participant's response to his parent's illness (Gladstone et al., 2014). I reflect on these analyses as a shift in thinking about children as individuals with “lived experience(s)” of parental illnesses. This also requires us to consider children's interactions with others and how they participate in all aspects of social life, ascribing meaning to behavior and things, and to interpret how they see themselves, events, environments, and others (Gladstone et al., 2014). Children's behaviours are seen as competent, rational, purposeful, and practical achievements of social interaction, albeit contained, shaped, and bounded by the contexts in which they live(Hutchby and Moran Ellis, 1998). I conclude with commentary on conceptual progress in the field, to reflect on the potential for analyzing children's social participation from the standpoint of child/adult interdependency and intergenerational dialog and practice (Ulvik, 2014; Wyness, 2012).
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The mental health professional who undertakes an assessment of a parent and family for court purposes invariably takes on a somewhat different perspective than that of a clinician. It has been argued that the two tasks (clinical and court) should not normally be combined for a number of reasons (Iverson, 2000):
Book
Full-text available
This book has been written for practitioners who work with children, parents, and families as well as for those who design and conduct applied research in the area of parental mental illness. The first and second editions chronicled the development of research, policy, and practice in this field across various countries. The third edition is completely rewritten, reflecting recent research developments as well as policy and practice changes. These reflect the greater specificity we now know in terms of what, when, and how family life is impacted by parental mental illness. Additionally, recently developed programs and interventions for children, parents, and families are showcased in this edition. These interventions provide the latest research evidence and concrete guidance to practitioners in terms of formal and informal approaches for different family members. What is especially heartening are the various workforce approaches to professional development as well as collaborative models for intervention.
Chapter
Full-text available
Major depressive disorder (MDD) is a highly prevalent and disabling mental illness. It is estimated to affect 17% of the US population within their lifetime, and is the leading cause of disability in the USA for ages 15–44 (Kessler et al., 2005; WHO, 2008). Of particular significance is the widespread occurrence of MDD in parents. Parental depression is associated with a number of impaired parenting behaviors, and is a risk factor for a range of poor outcomes in children, including academic and social problems, medical difficulties, and internalizing and externalizing disorders (England and Sim, 2009; Lovejoy et al., 2000). This is particularly concerning, given that at least 15 million children are living with a depressed parent (England and Sim, 2009). What follows is a discussion of the impact of parental depression on children and families, the factors that contribute to this relation, and clinical implications for working with families with depressed parents.The impact of parental depression on children Academic and social outcomes Parental depression has been associated with a number of poor outcomes in children across a variety of important domains. Current and past depression in parents is associated with lower cognitive and academic performance and poorer interpersonal functioning in off-spring (England and Sim, 2009; Goodman and Tully, 2006). Infants of depressed mothers have been found to exhibit more withdrawn behaviors, insecure attachment, negative affect with nondepressed adults, and lower cognitive performance than other infants (Canadian Paediatric Society, 2004). Toddlers of depressed mothers also have higher rates of insecure attachment (England and Sim, 2009), and exhibit less interaction with other children, less creative play, and lower cognitive-linguistic skills than their peers (Canadian Paediatric Society, 2004). School-age children have been found to have significantly higher rates of low social competence if their mothers were currently or postnatally depressed, compared with children of nondepressed mothers (Luoma et al., 2001). Children whose mothers were depressed during the postpartum period also have been found to have lower average IQ scores, more difficulties in mathematical reasoning, and more special education needs by the time they reach school age, independently of the current status of parental depression (Hay et al., 2001).
Article
Objectives Children growing up in military families are naturally exposed to certain elements of the military family lifestyle, which has been characterized by a unique triad of mobility, family separation, and risk. The extent to which this lifestyle may affect mental health across developmental phases among those children is unclear. The purpose of this scoping review was to identify and describe the mental health of children growing up in military-connected families across development. Methods This scoping review of the available literature was conducted using the Arksey and O’Malley’s five-step structured process. Results A total of 3278 articles were found from databases searched (PsycInfo, CINAHL, EMBASE, ERIC, and Medline). A total of 86 were selected for inclusion. Most research was produced in the United States of America (n = 74). Findings endorsed that children’s mental health may be impacted directly and indirectly by the family separation, mobility, and risk associated with the military lifestyle. Conclusions The majority of studies examining mental health impacts of family separation and deployment indicate significant deleterious effects on children. Studies examining the impact of mobility indicate mixed findings related to mental health impact, and those investigating risk related to parental injury, PTSD, and civilian parent mental health suggest a negative impact on child mental health.
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In this final chapter, we highlight the various conceptual frameworks presented in Chapter 1 and outline the gaps in knowledge that have emerged from this work.
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Multiple international studies indicate that very few family members including children receive interventions or support when their relative with mental illness is receiving treatment (e.g., Rummel-Kluge et al., 2006). This chapter focuses upon workforce issues, particularly how the psychiatric workforce can be supported to be family focused. Initially, the chapter outlines what we mean by family approaches and then overviews our conception of a continuum of family-focused care and expectations for psychiatric agencies and workers. A brief theoretical review of family-focused care is then outlined followed by information about barriers and enablers to family-focused practice. The chapter ends with reflections from multiple countries regarding the current state of family-focused practice and potential ways forward in each country. As outlined throughout this book, mental illness can be disabling, but when such patients are parents their children can also be adversely affected. Having such parents significantly increases the likelihood of children developing a mental disorder themselves compared to other children in the community (Hosman et al., 2009) along with a multitude of associated risks (e.g., emotional, school, and relationship problems) (Reupert and Maybery, 2007). At the same time, research has clearly demonstrated the benefits of family-focused practice to parents, as well as their children and other family members (Siegenthaler et al., 2012). However, throughout the world, the psychiatric workforce rarely seems to respond to children and families where a parent has a mental illness. Children living in such families have been described as “hidden” because workers are often unaware that service users are parents with dependent children (Fudge and Mason, 2004). A study of German, Austrian, and Swiss psychiatric institutions found that only 2% of family members received any form of psychoeducation (Rummel-Kluge et al., 2006). That means 98% of family members received no information about mental illness from these psychiatric institutions.
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This chapter discusses the fact that too many women with mental illness lose custody of their children unnecessarily. Solutions need to be found that keep children safe and allow them to flourish within the parental home. The extended family as well as teachers, neighbours, peers, and community members can all contribute but mental health workers, child and adult, probably bear the greatest responsibility to ensure that families are kept together whenever possible. They need to know how to provide parents with the skills and information that parents need to protect themselves and their children against unnecessary family separation.
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This chapter is intended for patients, family members, mental health professionals and, especially for prescribers of psychotherapeutic drugs to women who are pregnant and/or breast feeding. Prescribing drugs for a woman who is pregnant or already a mother means taking into account the potential effects of the drug not only on the woman, but also on her developing offspring. Whereas drugs can have both beneficial and undesirable effects on adults and children, fetuses and infants are especially vulnerable to the adverse effects of drugs during the development of their organs, their cognitive abilities, and their personalities. At the same time, their physical and psychological health depends, to a large extent, on the health of their mother.
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Grandparents worldwide are increasingly becoming primary caregivers of children because of parental mental and substance use problems, and also because of a growing preference for kinship care. Many more grandparents act in this capacity than is generally known. Out of loyalty to cultural traditions, fear of stigma, or concern about involvement of statutory authorities, some grandparents choose not to identify themselves as custodial parents. When parents suffer from mental illnesses, the grandparental caregiving role poses particularly complex challenges that require a coordinated therapeutic approach. That is the subject of this chapter, which draws on available research relating to grandparent care generally, as this is more available than research specific to grandparent care when a parent has a mental illness. The ‘hidden’ nature of this care contributes to the paucity of research.
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This paper presents one major theme of findings from a doctorate study. The study used a narrative enquiry approach, to gather parenting narratives of adult children of parents with mental illness. A Partnership Model for a Reflexive Narrative for Participant and Researcher (Partnership Model) was used to invite participants into the study, while encouraging a space for reflection for both the adult children and researcher. In total, 13 adult children participants constructed their narratives of living with childhood parental mental illness, alongside their current parenting role. Their stories reflected childhood experiences of fear and emergence of mistrust of others, particularly their parent with mental illness. For some participants, fear and mistrust continued into adulthood. Many adult children reported their childhood experiences of feeling lonely and isolated. They felt unable to disclose their experiences of parental mental illness to others. In addition, participants were unable to access information about their parent's condition, leaving them feeling unprepared and unskilled, despite their childhood desire to help their parent. This furthermore, compounded their sense of fear and isolation. Early identification of children and families experiencing mental illness is important to facilitate dialogue, psychoeducation and support. Social and health professionals have an important opportunity to enhance the social integration and support for families experiencing parental mental illness, to reduce long-standing fear, isolation and mistrust.
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A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy, Dalla Lana School of Public Health, University of Toronto, 2010
Article
Zusammenfassung. Theoretischer Hintergrund: In der Risikogruppe Kinder psychisch kranker Eltern werden Zusammenhange zwischen elterlicher Krankheitsbewaltigung und psychischer Gesundheit der Kinder vermutet, die nicht empirisch untersucht sind. Fragestellung: In einer Stichprobe psychisch kranker Eltern (N = 62) wird gepruft, ob zwischen individueller und familiarer Krankheitsbewaltigung und psychischer Gesundheit der Kinder Zusammenhange bestehen. Methode: Art und Angemessenheit der Krankheitsbewaltigung (KB) werden mit FKV-LIS (Elternsicht), PANSS-Item (Arzturteil) und Spontanangabe des Arztes, familiare KB aus Elternsicht und psychische Gesundheit der Kinder mit Child Behavior Checklist (CBCL/4-18, Ellternsicht) gemessen. Ergebnisse: Es finden sich Zusammenhange zwischen spezifischen Bewaltigungsstrategien des erkrankten Elternteiles und psychischer Gesundheit der Kinder. Zwischen Angemessenheit der KB und Auffalligkeit der Kinder ist der Zusammenhang unerwartet gegenlaufig: Je geringer die Krankheitse...
Article
The aim of this study was to identify how daughters or sons to parents suffering from mental illness perceive their situation. The objective was to provide new knowledge based on what they communicate on open Internet forums. The sample consisted of forum posts written by individuals who reported that they had mentally ill parents. Data collection comprised 301 comments from 35 forum threads on 5 different Swedish Internet forums, and predetermined inclusion criteria were used. Data were analyzed qualitatively using thematic analysis. The analysis generated four themes: "Caregiver burden," "Knowledge seeking," "Support from the forum," and "Frustration and powerlessness over health care." The results showed that parents' mental illness affected the forum writers on several levels, and they often felt stigmatized. The writers often lacked knowledge of their parents' mental illness and sought out Internet forums for information and support from peers in similar situations. The psychiatric care given to the parents was a source of dissatisfaction among the forum writers, who often felt that their parents did not receive adequate care. This study shows that fear of stigmatization and perceived lack of care and support caused forum writers to anonymously seek out Internet forums for information and support from others with similar experiences. The role of social support and the attractiveness of anonymity and availability typical for open Internet forums ought to be considered by health care professionals and researchers when developing new ways for providing support for children or adolescents with a mentally ill parent.
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This chapter talks about parenting in the context of the most severe of mental illnesses, schizophrenia. It underscores the reality that schizophrenia, when treated, need not necessarily interfere with effective parenting, but that mothers who are ill with schizophrenia need extensive support, for themselves and for their children and for the family unit. Services need to be multifaceted and the whole family needs to be included. Intervention should begin as early as possible; it needs to address service users in a respectful way and to pay attention to their points of view. Most important is tight liaison and good communication among all service providers.
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How psychiatrists who care for adult patients with a chronic mental disorder deal with the difficulties of patients’s children under 18: preliminary study Background: to assess how psychiatrists caring for adult patients deal with the difficulties of children under 18 with a parent presenting a chronic mental disorder. Method: exploratory and qualitative study based on an in-depth evaluation of interviews. Study population: twelve psychiatrists treating patients with chronic psychiatric disorders. Results: there are diversified practices in managing issues of the patient’s parenthood, child-parent relationships, and difficulties for the child. However, the child’s difficulties are not specifically approached. Representations among many clinicians of the parenting function, as well as the needs and the difficulties of the child are seldom used in working with the patient. Patient-centred care appears at odds with meeting the needs of the patient’s children and their specific difficulties. The seriousness of the mental pathologies, their chronic nature, and the fact that they can affect the patient in their parental functioning and concerns, appear as one of the factors for the reluctance of clinicians to consider the problem. The other reasons are lack of familiarity with issues relating to childhood, and the feeling of entering into a private and intimate sphere. Moreover, the representations of clinicians with regard to parenthood, parent-child relations, needs and difficulties of children, are often not integrated into the corpus of knowledge. These issues are more often aspects of clinicians’ own experience. Conclusion: the conflict of values and the embarrassment of the clinicians require the practical thinking of ethical groups as well as Balint groups.
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A focus on individuals within a family context highlights the diversity of need and the inevitable requirement for better collaboration and support within and between services and agencies. No single service can meet the needs of all family members. The essential feature of focusing on families is the requirement for collaboration. Regardless of training, work setting, ideology or resource constraints, all clinicians, frontline staff and managers must work better together. All staff therefore have responsibilities for and contributions to make in undertaking better assessments of need, delivering more effective interventions and establishing more successful partnerships and networks. Falkov, 2012 The opening chapter of this book summarizes several conceptual frameworks.to assist in understanding the impact of parental mental illness on families. This chapter takes one conceptual framework, The Family Model (TFM), and outlines how this might inform practice change. The development of the conceptual framework is initially outlined along with its core components. This is followed by discussion of how the translation of the framework might be undertaken in practice along with how the strategies for implementing the protocols might occur. This includes an emphasis upon how training and support for staff in making practice change might be undertaken. The chapter will also outline the difficulties and challenges that might arise when trying to implement such a framework or approach. A family focus for mental health and children's services TFM formed the key conceptual framework underpinning the Crossing Bridges program, commissioned by the Department of Health (UK), and entitled “The Impact of Parental Mental Illness on Children” (Falkov, 1998; Mayes et al., 1998). This consisted of a comprehensive set of training materials designed to enhance practice and improve services for families in which mentally ill parents and carers live with dependent children. Since then TFM has been adapted and used in individual work with families, as a framework for training and to inform research and policy (Mainstone, 2014; www.thefamilymodel.com).
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Some clinicians consider children whose parents have a mental illness to be a relatively homogeneous group, with the same needs and issues (Steer et al., 2011). The consequence of such an assumption is that youth are then grouped together and provided with the same intervention, such as peer support groups (Reupert et al., 2012). Grouping children together for the purposes of intervention may or may not be appropriate. However, we know that the risk exposure for children is not uniform; instead there are multiple influences that affect children’s developmental outcomes, influences from within them, and from their parents, their family, and the community in which they live and the services they have access to. This chapter will consider whether, and in what way, a parent’s mental illness diagnosis may affect children’s well-being and mental health. Such information is important to identify the children at greatest risk of adverse outcomes, ensure that intervention goals meet the needs of participants, and ensure that appropriate participants are selected for different interventions. Moreover, such information may also allow us to consider whether a public health approach is needed for all children whose parents have a mental illness and whether specific programs are needed for different groups of children, using a specific eligibility criterion such as their parent’s mental illness diagnosis
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People who have a mental illness have to manage not only their mental health symptoms but also the sometimes judgmental attitudes and discriminatory behaviors of others. Some people report that stigma is as distressing as the symptoms themselves (Phelan, 2005). At the same time, stigma not only affects the person with the mental illness; family members might also be adversely affected because of their association with someone with a mental illness. While stigma research has an extensive history, this chapter will synthesize previous research and apply this specifically to families where a parent has a mental illness. A discussion of anti-stigma strategies at the individual, family, and community level will conclude this chapter. Stigma defined. Hinshaw (2007, p. 23) defines stigma as a pervasive “global devaluation of certain individuals on the basis of some characteristic they possess, related to membership in a group that is disfavoured, devalued, or disgraced by the general society.” Link and Phelan (2001, p. 367) add to this definition when they point out the power imbalance implicit in stigma: “stigma exists when elements of labelling, stereotyping, separation, status loss and discrimination co-occur in a power situation that allows these processes to unfold.” Mental illness is one of the most highly stigmatized attributes an individual might possess, as many in the community perceive those with a mental illness as deviant, incompetent, different, dangerous, or undesirable (Phelan, 2005). In sum, stigma is a process of “othering” whereby a clear distinction is made between “them” and “us.”. There are many spheres in which stigmatization may occur, including the language used to describe mental illness – for example, “crazy” or “mad” (Hinshaw, 2007). Another sphere is the media (internet, television, cinema, advertising, and so on), where, for example, those with a mental illness are often portrayed as violent (Anderson, 2003). The attitudes and practices of mental health professionals are another way in which people may be stigmatized. Finally, policies and laws that affect housing, employment, insurance, funding, and custody are all potential sources of stigma. For example, in the UK, mental illness receives only 13% of health expenditure, while accounting for 23% of the total burden of disease (London School of Economics and Political Science, 2012).
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This book has been written for practitioners who work with children, parents, and families as well as for those who design and conduct applied research in the area of parental mental illness. The first and second editions chronicled the development of research, policy, and practice in this field across various countries. The third edition is completely rewritten, reflecting recent research developments as well as policy and practice changes. These reflect the greater specificity we now know in terms of what, when, and how family life is impacted by parental mental illness. Additionally, recently developed programs and interventions for children, parents, and families are showcased in this edition. These interventions provide the latest research evidence and concrete guidance to practitioners in terms of formal and informal approaches for different family members. What is especially heartening are the various workforce approaches to professional development as well as collaborative models for intervention.
Chapter
In order to ensure the optimal care of children, this chapter presents a framework for assessing capacity for effective parenting in the context of mental illness. The chapter will (1) outline the principles of ethical assessment practice, (2) provide a multidimensional and practical template for a comprehensive assessment, and (3) offer an example of a functional formulation following from a parenting assessment. The term “parent” may refer to anyone functioning in a parenting role.There are wide regional disparities in the conduct of family assessments that depend on available resources, predominant philosophies, tradition and culture, and service structure. We will outline practice principles relevant to practitioners from diverse contexts. This is important because a good clinical formulation of a parent provides the essential foundation for all subsequent treatment interventions, be they with the parent, child, or family (Diggins, 2011). In most resource-rich countries, assessments are multidisciplinary, with Children's social workers retaining responsibility for coordinating multiagency perspectives and ensuring child safety. All mental health professionals have responsibility for developing meaningful mental health formulations that address the needs of all family members, and this includes highlighting potential risks. Principles of ethical assessment practice Health service cultures worldwide have adopted the four Hippocratic principles of beneficence, nonmaleficence, autonomy, and fairness. We have tried to adapt them here for the practice of parenting assessment, which fundamentally involves the responsibility for the welfare of child and parent. Ethically, this means that the needs of family members should not be assessed unless a service to meet such need can be provided. Commitment to the parental role and the parent–child relationship. The literature focuses on the needs of and risks to the child because children are more vulnerable than adults. But mentally ill parents are vulnerable as well. The separation of child and adult services makes it hard to simultaneously encompass the needs of both. In some countries, policies have been developed to help overcome this dilemma; for example, in the UK, guidance on this issue is now available from the Social Care Institute of Excellence (Diggins, 2011). However, in most contexts, services are not designed nor are professionals trained to address the mental health needs of both parent and child.
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The purpose of this chapter is to outline the impact of trauma and migration on the mentalhealth of parents in refugee families, and to conclude with service recommendations. The published and gray literature on asylum seeking in the UK over the last ten years (2005–14) were reviewed and integrated with the author's own clinical experience. Asylum seekers who are parents flee their home countries mainly because of fear for the survival of their children: Fear of physical attack, chemical warfare, rape, torture, and ethnic cleansing, all of which are considered normal means of war in many parts of the world. Persecutors know that attacking children is the surest way to inflict pain on parents. In seeking refuge, personal possessions, familiar surroundings, and the lives of loved ones are lost, and, as a consequence, such parents develop a variety of medical and psychological disorders (Pfortmueller et al., 2013). This is probably especially true for mothers, themselves the targets of sexual violence and torture (Keygnaert et al., 2014), and witnesses to the murder of family members. The UN High Commissioner for Refugees (UNHCR) reports that, in 2010, 47% of the world's 15.4 million refugees were women and girls (UNHCR, 2011). Who is a refugee? Refugees arriving in a host country differ from immigrants in that they have not been able to plan their displacement ahead of time, often leaving behind aging parents, children, or domestic partners. Refugees do not choose where to go. Host countries vary in their willingness to accept refugees and in their desirability as refugee destinations (Table 18.1). There are no specific statistics on asylum seekers who are parents; however, there is information on dependants, by age, for 2012 in the UK (Refugee Council, 2012). That year, there was a total of 4,128 asylum seekers between 5 and 17 years old, with no indication of how many came alone or accompanied by a parent.
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Children and young people want professionals to listen to them and to talk to them; above all, they want to be recognized as important to the parent they live with. Barnardos Action with Young Carers (AWYC) is located in Liverpool and supports young caregivers who reside in that city. Barnardos is a children's charity that has services and projects across the UK and internationally. All of the statements reported in this chapter are from Liverpool young people. In November 1999 a small group of young people involved with Barnardos AWYC were invited to take part in a conference launching the report Keeping the Family in Mind (Göpfert et al., 1999). This project, like other AWYC projects, provides a service for children and young people who live with someone with a mental health problem, and many of whom take on caring roles and responsibilities. All of the young people who participated care for a parent with mental ill health and receive support from staff at the AWYC project. We know from research and consultations with children and young people that they value being listened to and drawing upon their own experiences.They have some very important messages for professionals and policymakers.
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The Family Options psychiatric rehabilitation intervention targets families where a parent is living with or in recovery from a serious mental illness (e.g., major depression, bipolar disorder, schizophrenia and other psychotic disorders). The Family Options intervention grew out of the efforts of providers, researchers, and parents themselves to provide supports to parents and their family members at Employment Options, Inc., a community-based, recovery-oriented agency located in Marlborough, Massachusetts, USA. The aim of the intervention is to support family members in achieving their desired level of well-being and functioning, and to enhance their social supports and resources, both formal and informal. This chapter will provide (1) our rationale for intervention development; (2) an overview of the Family Options model; (3) a description of services provided; (4) a perspective on the roles of key players, including parent peers, in meeting families' needs; (5) steps in the intervention; and (6) preliminary data regarding outcomes. We conclude with a discussion of the implications of this work for providers, administrators, and policymakers.
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It can be challenging to talk to children about a sensitive topic such as their parent's mental health difficulties. Nonetheless, it is essential that children be informed about their parent's mental illness and given the opportunity to express how their parent's health issues might be affecting them. This chapter will explore some of the issues related to having conversations with rather than to young people and, similarly, to “opening up” a discussion rather than “imposing” information. In this chapter, the term “children” refers to the offspring of those with a mental difficulty, illness, or disorder, and includes adolescents as well as younger children. It is our belief that supporting parents to hold conversations about their mental illness with their children, in an age-appropriate and sensitive manner, can empower parents by acknowledging their critical role within the family setting (Marston et al., 2014). In this way, parents are reinstated as the experts in their children's lives, often at times when they are feeling disempowered by the course of the illness and treatments. Acquiring and applying these skills is not necessarily easy, however. Within this context, it might be helpful to consider what it is like for parents to discuss with their children other sensitive or personal topics such as sex, divorce, death, or a physical illness and the skills that parents might need to do this, and issues or problems parents and children might encounter during and after such discussions. Thus, the skills used to discuss parental mental illness could well be generalized into other family conversations. A parent's mental illness is often the “elephant in the room” or the shameful secret that everyone knows is there but no one talks about. Mental illness is likely to affect the parent's behavior, which the child might notice but not always understand. Within these families' systems, children need to be provided with a framework for understanding what is happening in their family and given permission to talk and ask questions. Moreover, strategies are required to counterbalance the pervasive negative stereotypes and stigma often associated with mental illness within and outside the family.
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The various e-learning resources for professional development in the area of parental mental illness will be presented and critically reviewed in this chapter. We define professional development (sometimes referred to as in-service training, continuing education, or retraining; Lyon et al., 2011), as the process by which professionals acquire new skills for the workplace. The advantages, primarily around the flexibility that e-learning resources offer, along with some of the problems associated with their uptake and use, will be presented. A newly developed, four-tiered, professional development framework for those working with parents and children where a parent has a mental illness will conclude this chapter. What is e-learning?, E-learning can take various forms, from reading papers or listening to podcasts online, to multimedia modules or courses using text, sound, animation, video, links to other websites, and a variety of interactive elements including a final assessment (Hare, 2009). Various terms have been used to refer to e-learning, including computer-delivered, computer-assis ted, online learning, virtual learning environment, web course tools, and learning management systems (Hare, 2009). While often sourced from a personal computer, other electronic equipment such as MP3 players and mobile phones can also be used. E-learning is increasingly considered to be an efficient way to deliver professional development programs, with some 80% of 642 companies reporting that e-learning is the most popular form of learning technology (Jeske and Stamov-Roßnagel, 2012). Moreover, the internet is becoming the first place that both clients and professionals turn to for information about mental health (Powell and Clarke, 2006). E-learning in its various guises is increasingly used in medical and allied health education (Cook et al., 2009) and is considered by many to be comparable and in some ways superior to face-to-face training. For example, in a study on community education in mental health first aid, Jorm and colleagues (2010) randomly assigned participants to (1) an e-learning CD, (2) a mental health first aid manual, or (3) a wait-list control group. Both the e-learning and the printed manual groups demonstrated increased knowledge and confidence and reduced stigma, compared to the wait-list group. However, those exposed to the e-learning CD held less stigmatizing attitudes to mental illness than those who had been through the printed manual.
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Throughout the world, societal mores place paramount value in the institution of the family and confer significant authority on the adult parents who are usually at its head. As a result, parents generally are supposed to have unfettered rights to raise children in a manner consistent with their beliefs and personal preferences. Social systems such as the law, then, should enshrine that value we bestow upon parenting by ensuring parents' right to raise their child without undue interference from the state or other parties, actual harm to a child being absent. In practice, though, most legal systems routinely deny such protection to a significant subset of parents: Those who experience mental illness. And while nothing should necessarily prevent people who have experienced mental illness from caring for their children, these particular parents are frequently singled out for scrutiny rather than the protection promised to most citizens by their state. They are, often unfairly, presumed incapable of parenting. Yet data suggest that over half of all adults with mental illness do become parents (Nicholson et al., 2001). This chapter used the United States of America (USA) as an example of a system that has failed to progress as far as possible in recognizing the importance of allowing all people to enjoy their right to parent their children. But it also aims to show that something can be done to remedy the grave shortcomings of the state, and that reparative action need not be bound by national borders. The Clubhouse Family Legal Support Project has worked to cultivate a refuge for parents with mental illness in this otherwise barren patch of the American social and legal services landscape. The project takes a holistic approach, combining the support services of a clubhouse with the advocacy of an attorney who specializes in the intersection of mental health and family law. The goal is to help clients overcome the significant legal obstacles they encounter in raising children, particularly in the face of family breakup or state-initiated intervention.
Article
Background As well as having a higher genetic vulnerability to psychiatric problems, children of a parent with schizophrenia suffer a significantly poorer quality of life than those with healthy parents. In mental healthcare settings, the well-being of these children is still overlooked. It is crucial to develop child-centered interventions for them. This scoping review focuses specifically on children of a parent with schizophrenia to identify the likely impacts on their life and development, the factors and strategies that may alleviate negative impacts, and available interventions. Methods We applied a systematic approach to search the following databases: PsycINFO, MEDLINE, Embase, Google Scholar, CNKI and CEPS to identify relevant English and Chinese publications focusing on children. Quality assessments of quantitative and qualitative studies were undertaken, using the Downs and Black instrument and the CASP Checklist respectively. Results After screening, thirty-three studies were included for review. The existing evidence indicates that children of a parent with schizophrenia experience multiple deficits. Although various factors have been identified that can potentially alleviate their negative experiences, few are well supported with solid empirical evidence that confirm causal effects. The needs of these children are commonly neglected: little professional support has been provided, and the usefulness of the available support has yet to be determined. Conclusions Based on the review, we argue that effective means should be implemented so that children of a parent with schizophrenia needing help can be identified and experts can overcome barriers to providing help. The potential modifiable factors that can alleviate the negative impacts of having a parent with schizophrenia on youngsters need to be tested and confirmed. Interventions should be evidence-based, schizophrenia-specific, and child-centered.
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Obwohl schon lange bekannt war, welche große Bedeutung Angehörigen psychisch Kranker für den Verlauf der Erkrankung zukommt, sind diese erst spät in das Blickfeld der Psychiatrie getreten. Nachdem dann zunächst vor allem die pathogenen Einflussfaktoren der Familie auf die Entstehung von psychischen Erkrankungen und deren Verlauf betrachtet wurden, hat sich die Perspektive in den letzten Jahren umgekehrt zu der Frage, welche Auswirkungen psychische Erkrankungen auf die Familie und die einzelnen Familienmitglieder haben. Damit rückten einerseits Fragen der Belastung von Angehörigen und daraus resultierende Beeinträchtigungen, andererseits ihre Unterstützungsfunktion, die Bedeutung familiärer Interaktionen und erst in jüngster Zeit auch die Kinder als wichtige Angehörige ins Zentrum der Aufmerksamkeit.
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In recent years, models of borderline personality disorder (BPD) have changed from an almost exclusive focus on the internal characteristics of a person to an emphasis on the developmental context. Research suggests that the majority of people diagnosed with BPD are characterized by insecure or disorganized states of mind with respect to attachment, as well as by unresolved trauma (Fonagy et al., 1996). Thus, individuals with BPD have usually themselves experienced early relational trauma and adverse childhood experiences. The long-term psychological sequelae of childhood trauma are profound and include difficulties in affect regulation and interpersonal relationships and failure of the capacity to conceive of how others think or feel – or to realize that people's behavior is driven by emotional and psychological factors (mentalization). From this perspective, relationships, including the relationship with a child, are complex and compromised. This chapter will briefly outline the characteristics and etiology of BPD with a particular focus on attachment theory and the construct of mentalization (Fonagy et al., 2004). We will outline the impact of BPD on parenting and children development in this context. Drawing on clinical material, we will conclude the chapter by discussing the implications for clinicians working with these families. BPD – characteristics BPD is characterized by significant difficulties in maintaining stable attachment relationships and in the regulation of affect, self-image, and impulses. The cluster and behaviour associated with borderline personality include fluctuations from periods of self-confidence and buoyancy to periods of absolute despair, unstable self-image, rapid changes in mood, fears of abandonment and rejection, and a tendency towards suicidal thinking and self-harm. Transient psychotic symptoms may also be present. The DSM-5 classification system describes the interpersonal relationships of individuals with BPD as swinging between poles of idealization and devaluation, stressing the individual's often unrealistic expectations of the other in a relationship and coexisting anxieties in closer interactions. This is a pattern of “oscillating” attachments with the individual experiencing difficulties in maintaining an appropriate “distance” in relationships.
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“Anxiety disorders” (ADs) are a broad category of psychiatric disorders characterized by excessive fear, worry, or anxiety which cause significant distress or impairment in everyday life. They are among the most common psychiatric disorders, affecting over a quarter of people during their lifetime (Kessler et al., 2005). This chapter reviews the evidence concerning the psychological mechanisms by which ADs affect parenting and adjustment in children and young people, in order to guide further research in this area and inform clinical practice. Most research in this field has focused on the impact of maternal ADs on parenting and Children's development, largely because women are at higher risk of ADs than men (Kessler et al., 2005) and tend to be the primary caregivers of children in Western cultures. Nevertheless, recent studies including fathers with ADs have found similar associations between parenting and child adjustment to those found with mothers with ADs (Aktar et al., 2013, 2014). Thus, in the absence of evidence to the contrary, it would be prudent to assume that studies of “mothers” may well provide evidence relating to “parents”. However, we also consider potential gender-specific associations with parenting and child adjustment when appropriate. Outcomes for children of parents with Ads Offspring of parents with ADs are at increased risk of psychiatric disorders (e.g., Beidel and Turner, 1997; Merikangas et al., 1999). Specifically, these offspring have a fourfold higher risk of AD than offspring of parents with no psychiatric diagnoses, and a twofold higher risk than offspring of parents with other psychiatric (nonanxiety) disorders (Micco et al., 2009). Offspring of parents with AD may also be at somewhat increased risk of mood disorders, particularly where parents have comorbid mood disorders (Micco et al., 2009).
Article
How psychiatrists who care for adult patients with a chronic mental disorder deal with the difficulties of patients's children under 18: Preliminary study. Background: To assess how psychiatrists caring for adult patients deal with the difficulties of children under 18 with a parent presenting a chronic mental disorder. Method: Exploratory and qualitative study based on an in-depth evaluation of interviews. Study population: Twelve psychiatrists treating patients with chronic psychiatric disorders. Results: There are diversified practices in managing issues of the patient's parenthood, child-parent relationships, and difficulties for the child. However, the child's difficulties are not specifically approached. Representations among many clinicians of the parenting function, as well as the needs and the difficulties of the child are seldom used in working with the patient. Patient-centred care appears at odds with meeting the needs of the patient's children and their specific difficulties. The seriousness of the mental pathologies, their chronic nature, and the fact that they can affect the patient in their parental functioning and concerns, appear as one of the factors for the reluctance of clinicians to consider the problem. The other reasons are lack of familiarity with issues relating to childhood, and the feeling of entering into a private and intimate sphere. Moreover, the representations of clinicians with regard to parenthood, parent-child relations, needs and difficulties of children, are often not integrated into the corpus of knowledge. These issues are more often aspects of clinicians' own experience. Conclusion: the conflict of values and the embarrassment of the clinicians require the practical thinking of ethical groups as well as Balint groups.
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Individuals implementing interventions for families living with parental mental illness must be aware of and responsive to the environmental and contextual landscape in which they operate. Shifting the intervention paradigm (i.e., the conceptual framework reflecting the embraced model of change and guiding interactions with patients, clients, or consumers) from treating individuals with mental illness to working together with whole families requires consideration of the community, agency, and practice contexts in which the intervention is embedded. The realities and constraints, as well as the opportunities, are unique when implementing an intervention for families rather than individuals and, specifically, for families living with parental mental illness (Nicholson et al., 2014). Families themselves are complex systems. Families, in turn, live in communities, which may offer varying opportunities for integration, participation in local life, and access to resources to support children and parents. Organizations and agencies, most notably human service entities, sit within these communities as well. Human service entities have their own organizational cultures, which are influenced by their funding streams, and the characteristics and competencies of the workforce. They tend to be driven by a stated mission and values (explicit and implicit) that reflect, at best, the characteristics and needs of the individuals, families, and communities they serve. To be effective, any sustained shift in treatment paradigm requires changes at all levels – community, organizational, and practice – to enhance the likelihood of positive change for families, parents, and children. This chapter includes: (1) a theoretical background for considering intervention implementation; (2) a description of our efforts to develop, test, and sustain interventions, and to contribute to the evidence base at the community, organizational, and practice levels; and (3) recommendations for action drawn from both (1) and (2) to shift the paradigm from working with individuals to working with families. We provide details regarding specific strategies and potential pitfalls, to explore and create community, organizational, and practice level capacity to implement interventions serving families living with parental mental illness.
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Citation: Nicholson, J., Biebel, K., Hinden, B., Henry, A. & Stier, L. (2001) Critical issues for parents with mental illness and their families. Rockville, MD: Center for Mental Health Services/Substance Abuse and Mental Health Services Administration. This report discusses the outcomes of a study that investigated the impact of parents who have mental illness on children and families. The report discusses the scope of the issue and the experiences of parents with mental illness, federal and State policies impacting policies and practices relating to parents with mental illness, current programs for parents with mental illness and their families, and recommended steps for improving and expanding services. Prepared for the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, MD.
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It is indisputable that mental illness in a parent has serious and often adverse effects on the child, a fact that is not always reflected in systems of health care A team of international experts reviews interventions from a practical point of view - essential reading for all professionals dealing with adult mental illness and child-care. https://books.google.ca/books/about/Parental_Psychiatric_Disorder.html?id=2zjjCQAAQBAJ&printsec=frontcover&source=kp_read_button&redir_esc=y#v=onepage&q&f=false
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Examined the functioning of casework that was performed by social agencies in Denmark to assist the children of 11 child–schizophrenic mother pairs. The group as a whole was characterized by a number of features that make the risk of developmental deviance in the child especially high: the mother as the only permanent caregiver, unstable relations of the mother to her spouse and family, onset of maternal illness at the time of the child's birth, chronic damage to the mother's ability to care for her self, and a maternal system of delusions involving the infant. It is concluded that the risk of developmental deviance in the children might have been avoided had a careful assessment been made at the beginning of casework. Such an assessment would integrate the aforementioned risk factors with knowledge about the early establishment of deviant attachment patterns.
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Meaningful family rituals have been associated with positive outcomes for families and children. No studies, however, have investigated predictors of family ritual quality, the identification of which would be important for understanding why some families create and enact meaningful family rituals while others lack rituals or have problematic rituals. We propose that adult attachment security may be an important predictor of family ritual quality because family rituals may provide a sense of stability and cohesiveness for the family. The purpose of this study was to examine relationships between adult attachment representations and the quality of family rituals, using a prospective, longitudinal design. Prior to the birth of their first child, 125 couples completed the Adult Attachment Interview, and a subsample of 70 mothers and 62 fathers completed the Family Rituals Questionnaire when their first child was 7 years old. Different patterns of relationships between attachment representations and family rituals were found for mothers and fathers. Maternal Insecure Attachment was associated with higher routinization of family rituals. Being in a couple with mixed attachment classifications (e.g., one Secure partner and one Insecure partner) was related to a pattern of low routinization and low meaning for family rituals. The results of this study are interpreted in terms of two patterns of rituals that have been described by clinicians-rigid ritualization and underritualization, and suggestions for working with these ritual patterns in families with Insecure attachment are provided.
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It was found that emotional disorders, conduct disorders and specific reading retardation were all twice as common in ten-year-old children attending schools in an inner London borough as in children of the same age on the Isle of Wight. The correlates of these disorders in the two areas were investigated in order to explore possible reasons for these differences in prevalence. It was possible to identify four sets of variables (family discord, parental deviance, social disadvantage and certain school characteristics) which were associated with child disorder and deviance within both the two areas. As in almost all cases these same adverse factors were more commonly found in London, it may be concluded that the high rates of psychiatric disorder and specific reading retardation in London ten-year-olds are due in part to the fact that a relatively high proportion of London families experience marital discord and disruption, that many of the parents show mental disorder and antisocial behaviour, that families often live in poor social circumstances, and that the schools are more often characterized by a high rate of turnover in staff and pupils. The evidence suggests that these problems stemmed from living in an inner London borough, but further research is required to identify what it is about life in a metropolitan area that predisposes to the development of disorder and deviance.
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The 2-year course, first onset (incidence), recurrence, and recovery of major depression in 174 offspring at high and low risk for major depression were studied. A variety of predictors of course were examined, including parental diagnosis, demographic and clinical characteristics of the family and offspring, comorbidity and social functioning in offspring, and family risk factors. The 2-year incidence rate was 8.5%. All of the incident cases of major depression occurred in offspring of depressed parents. Additional predictors of incidence were a preceding diagnosis of conduct disorder and subclinical symptoms of depression. The recurrence rate results are tentative because of the small sample. The 2-year recurrence rate was 16.1%. Predictors of recurrence were a previous comorbid diagnosis of dysthymia or problems in social functioning. By the end of 2 years, the majority of offspring (87%) had recovered. The mean number of weeks to recovery was 54 in the offspring of depressed parents and 23 in the offspring of nondepressed parents. Offspring with an onset of major depression at age 13 years or younger, who were exposed to divorce in the family or who had been exposed to more than one parental depressive episode, had significantly more protracted times to recovery. We conclude that there are different predictors of incidence of major depression, its recurrence, and time to recovery in offspring, and that parental depression has an impact on the course in offspring.
Article
There have been strong critiques of the notion that environmental influences can have an important effect on psychological functioning. The substance of these criticisms is considered in order to infer the methodological challenges that have to be met. Concepts of cause and of the testing of causal effects are discussed with a particular focus on the need to consider sample selection and the value (and limitations) of longitudinal data. The designs that may be used to test hypotheses on specific environmental risk mechanisms for psychopathology are discussed in relation to a range of adoption strategies, twin designs, various types of "natural experiments," migration designs, the study of secular change, and intervention designs. In each case, consideration is given to the need for samples that "pull-apart" variables that ordinarily go together, specific hypotheses on possible causal processes, and the specification and testing of key assumptions. It is concluded that environmental risk hypotheses can be (and have been) put to the test but that it is usually necessary to use a combination of research strategies.
Article
The monograph series reports work carried out in the Institute and in the associated Hospital. This book gives an account of work that formed the subject of an M.D. thesis submitted to the University of Birmingham. Not only may a study of interactions between illnesses in the parent and the child improve understanding of the role of the environment in the aetiology of child psychiatric disorders, and of ways in which the family and social setting may determine the form of a disorder but there are also public health considerations. Treatment of adult illness involves decisions as to whether the patient should remain at home, be admitted to hospital or receive care elsewhere, and these must take into account not only what is best for the individual, but also the effects on the family. The effect upon children of a mentally ill parent in the home is particularly pertinent in view of recent trends towards community care of psychiatric patients.
Article
In response to A. Anastasi's (1958) long-standing challenge, the authors propose an empirically testable theoretical model that (1) goes beyond and qualifies the established behavioral genetics paradigm by allowing for nonadditive synergistic effects, direct measures of the environment, and mechanisms of organism–environment interaction, called proximal processes, through which genotypes are transformed into phenotypes; (2) hypothesizes that estimates of heritability (e.g., h–2) increase markedly with the magnitude of proximal processes; (3) demonstrates that heritability measures the proportion of variation in individual differences attributable only to actualized genetic potential, with the degree of nonactualized potential remaining unknown; and (4) proposes that, by enhancing proximal processes and environments, it is possible to increase the extent of actualized genetic potentials for developmental competence. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Special concerns of mothers who suffer from schizophrenia.
Article
Reviews research on the influence of external environments on the functioning of families as contexts of human development. Investigations of the interaction of genetics and environment in family processes; transitions and linkages between the family and other major settings influencing development, such as hospitals, daycare, peer groups, school, social networks, the world of work (both for parents and children), and neighborhoods and communities; and public policies affecting families and children are included. A 2nd major focus is on the patterning of environmental events and transitions over the life course as these affect and are affected by intrafamilial processes. External systems affecting the family are categorized as meso-, exo-, and chronosystem models. Identified as areas for future research are ecological variations in the expression of genotypes, relations between the family and other child settings, relations between family processes and parental participation in other settings of adult life, and families in broader social contexts. (4 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Reviews the literature on the concept of resilience in children. The topic of individual resilience is one of considerable importance with respect to public policies focused on the prevention of either mental disorders or developmental impairment in young people. In planning preventive policies, it is important ot ask whether it is more useful to focus on the risks that render children vulnerable to psychopathology or on the protective factors that provide for resilience in the face of adversity. Topics covered include methodological considerations in the study of resilience, studies directly focusing on resilience, processes associated with resilience, and associated policy implications. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Associations between parents' poor marital adjustment, parent–child discord, affectionless control, low family cohesion, and parental divorce and Diagnostic and Statistical Manual of Mental Disorders (DSM-III) diagnoses were explored in a study of 220 offspring of parents with and without major depression. Family risk factors were more prevalent among offspring of depressed parents. Risk factors were associated with major depression and any diagnosis for children of nondepressed parents; they were associated with conduct disorder for both groups. Parental depression was more important than family risk factors in models predicting major depression, anxiety disorders, and any diagnosis. Both parental depression and family risk factors were significant predictors of conduct disorder. Implications for the etiology of psychopathology and for analytic strategies are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
It [this book] is written for the two million American families whose lives are currently touched by schizophrenia. . . . The book provides a scientific framework for understanding its symptoms, causes, and treatment and suggests how familes can come to terms with the disease. Above all the book tries to dispel the multitude of myths and alleviate the millstone of guilt which families have been condemned to carry by mental health professionals. . . . (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Examined coping skills, needs, and self-perceived strengths gathered through subjective interview data with 10 adult offspring and 10 adult siblings (all Ss aged 27–56 yrs) of people with mental illness (schizophrenia, bipolar disorder, or major depression). Distinctions were made between positive and negative coping skills, and several themes in coping skills were reported, including constructive escape, seeking support, objectifying the illness, acquiring information, spiritual faith, internalization of emotions, self-censoring behavior, and self-isolation. Four themes also emerged from interview data regarding needs: information or explanation, support groups, individual attention and attention to emotions, and inclusion in the treatment process. All Ss had perceived themselves to have grown in a positive way from their experiences, despite the adversities they had endured. Self-perceived strengths reported include independence or self-reliance, ability to create, empathy, resiliency, assertiveness, and spiritual and life perspective. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
[examine] the impact of social disadvantage, particularly low SES and poverty, on the mental health of children / [examine] aspects of the family structure that may represent risk factors for child psychopathology / review studies assessing the impact of parental divorce, single-parent families, and early parental loss on child mental health / [examine] the effects on children's psychosocial functioning of specific types of parental disturbance / review studies assessing the impact of parental depression, schizophrenia, and alcoholism / examine a number of common processes that might mediate this impact family milieu and child psychopathology [social disadvantage and child psychopathology, family structure and child psychopathology] / parental psychiatric disturbance and child psychopathology [children of depressed parents, children of schizophrenic parents, children of alcoholic parents] / common processes [marital/family discord, parental emotional unavailability] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
focuses on the likely operation of interactions of various sorts, including the possibility that individuals differ in their susceptibility to specific environmental factors / such interactions are widespread in biology and medicine . . . , and they are likely to be so in psychological development, although so far there have been few investigations using methods likely to reveal them / however, a further essential part of the ecological concept as applied to the process of development concerns the influence of transactions between persons and their environments / that is, not only are individuals shaped by their environments, but so, too, are environments shaped by the individuals within them / the findings from many well-planned investigations which used a range of research strategies, provide convincing evidence that enviromental-risk mechanisms do indeed play a role in the etiology of psychiatric disorders in both childhood and adult life (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Family members now seek help, instead of bearing the weight of problems related to mental illness of a sibling or parent alone. "Troubled Journey" is written specifically for this audience, as readers are led through the essential stages of recovery, from revisiting childhood to revising their family legacy, and ultimately to reclaiming their life. The authors illustrate how to: recognize the imprint of childhood experiences on adult life; deal effectively with the mental health system; improve family relationships and reach out to others; and reclaim self-esteem and build coping skills. Included also are the voices of family members who have made this journey before. From their example, readers learn not only that acceptance and healing are possible, but more important, that they are not alone. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This article reports the qualitative findings of a multimethod study of the homeless population in Toronto, Canada. The qualitative component sought to identify how people become homeless and why some individuals remain homeless for an extended period of time or cycle in and out of homelessness (the chronically homeless). In-depth, semistructured interviews were conducted with 29 homeless adults. The findings suggest that people both become and remain homeless due to a combination of macro level factors (poverty, lack of employment, low welfare wages, lack of affordable housing) and personal vulnerability (childhood abuse or neglect, mental health symptoms, impoverished support networks, substance abuse). Chronically homeless individuals often reported experiences of severe childhood trauma and tended to attribute their continued homelessness to a substance abuse problem. It is concluded that both macro and individual level factors must be considered in planning programs and services to address the issue of homelessness in Canada.
Article
This paper describes a growing understanding of one adolescent boy’s experience of living with a parent with a chronic mental illness. The way in which services were organized and delivered to address the needs of either adults or children made it difficult to comprehend the impact of parental psychiatric disorder on the family as a whole. The case study illustrates the problems for the ‘not-noticed child’, the process of internalization and enmeshment that affected his internal world, his relationships with others, and his development in adolescence. The need for all professionals to focus on interactive processes both within the family and in the professional network is emphasized, as is the importance of collaborative work.
Article
The association between parental mental health problems and negative outcomes for children has been long known. This paper addresses three issues in relation to this. First, the scale of the problem is outlined, in terms of both the prevalence of mental health problems in parents and the likelihood of children exhibiting negative outcomes in these circumstances. Secondly, the specificity, or lack of it, of particular outcomes in the child in relation to different parental mental health problems is explored. Thirdly, the paper focuses on the importance of disruptions to parenting as a mechanism in the transmission of mental health problems to negative impacts on the child. Examples are given of how parenting is disrupted in non-clinical community populations, and the subsequent impacts on the child. The case is made for the preventative importance of parenting and family support in mediating between parental mental health problems and negative impacts on the child.
Article
Maternal role performance was examined in a group of acutely depressed women and compared with matched normal controls. The depressed women were significantly more impaired mothers. Their impairments with the children included diminished emotional involvement, impaired communication, disaffection, increased hostility and resentment. These disturbances were examined clinically within the context of the family life cycle from post partum to the "empty nest". The specific problems between mother and children were found to vary with the stages of the life cycle. Depressed mothers of infants were helpless in caring for the children, over concerned or directly hostile, laying the ground work for future problems with the child. Mothers of school age children were irritable, uninvolved and intolerant of the children's noise and activity. Most school age children, however, did not develop overt psychological symptoms. The most severe problems occurred with the adolescents who reacted to the mothers hostility and withdrawal with serious deviant behavior. While conflict existed between the depressed mothers and the children leaving home, most children were able to make the physical break from home. These findings are discussed in light of scattered reports about the effect of maternal depression on children. Early and intensive treatment of the depressed mother can facilitate major preventive work for the entire family.
Article
Objective: To examine long-term effects of two forms of preventive intervention designed to increase families' understanding of parental affective disorder and to prevent depression in children. Method: Thirty-six families who had a nondepressed child between ages 8 and 15 years and a parent who had experienced affective disorder were enrolled and randomly assigned to either a clinician-facilitated intervention or a lecture discussion group. Each parent and child were assessed prior to randomization, after intervention, and approximately 1 1/2 years after enrollment. Assessments included standard diagnostic interviews, measures of child and family functioning, and interviews about experience of parental affective disorder and intervention effects. Results: Children in the clinician-facilitated group reported greater understanding of parental affective disorder, as rated by self-report, rater-generated scales, and parent report, and had better adaptive functioning after intervention. Parents in the clinician-facilitated intervention group reported significantly more change. Conclusion: Findings from both interventions support the value of a future-oriented resiliency-based approach. The greater effects of the clinician-facilitated intervention support the need for linking cognitive information to families' life experience and involving children directly in order to achieve long-term effects.
Book
Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In The Discovery of Grounded Theory, Barney Glaser and Anselm Strauss address the equally Important enterprise of how the discovery of theory from data--systematically obtained and analyzed in social research--can be furthered. The discovery of theory from data--grounded theory--is a major task confronting sociology, for such a theory fits empirical situations, and is understandable to sociologists and laymen alike. Most important, it provides relevant predictions, explanations, interpretations, and applications. In Part I of the book, "Generation Theory by Comparative Analysis," the authors present a strategy whereby sociologists can facilitate the discovery of grounded theory, both substantive and formal. This strategy involves the systematic choice and study of several comparison groups. In Part II, The Flexible Use of Data," the generation of theory from qualitative, especially documentary, and quantitative data Is considered. In Part III, "Implications of Grounded Theory," Glaser and Strauss examine the credibility of grounded theory. The Discovery of Grounded Theory is directed toward improving social scientists' capacity for generating theory that will be relevant to their research. While aimed primarily at sociologists, it will be useful to anyone Interested In studying social phenomena--political, educational, economic, industrial-- especially If their studies are based on qualitative data.
Article
In a follow-up study of children of psychotic mothers, the authors examined a subgroup of outstandingly talented, colorful, and competent "high-risk" children. These children and their mothers were given a variety of psychological tests and were interviewed individually. They were then compared with a control group of children whose mothers had no psychiatric illness. The 6 most socially and intellectually competent high-risk children were strikingly more competent, colorful, creative, and talented than the 6 highest functioning control children. They more often reported having a best friend and had extensive and positive contact with an extrafamilial adult. Another important variable in the prediction of high social competence among children at high risk is a warm relationship with the mother.
Article
Research reports the uncertain outcome of variables affecting the life of a child of an MI parent. Nurses must avoid stereotyping children before assessment; they are to be in the forefront in assessing self-care skills and deficits to guide planning individual interventions for children and MI parents. Long-term research theory-based interventions will enhance mental health in high-risk children and families.
Article
This study examines the prevalence of psychiatric dysfunction in the children of parents diagnosed with affective disorders. Sixty children from 37 proband families were compared to 43 children from 26 families obtained from matched controls as well as 20 children from 13 medically ill families. Group differences in diagnosable childhood disorders and familial characteristics are investigated. Significantly more disorders and symptoms were noted in the children with psychiatrically ill parents as compared to children from matched controls and medically ill parents. Using logistic and Cox survival analyses, correlates for the risk of affective disorder, attention deficit and conduct disorder in the children were examined. Maternal depression and paternal alcoholism were related to the risk for depression in the child. The child's sex and the presence of affective disorders in the father were significantly related to the risk for attention deficit disorder. Maternal alcoholism, parental divorce and the type of subject (proband or control family) were significantly related to the risk for conduct disorder. The findings are discussed relative to results from earlier studies on rates of disorder in the offspring of depressed parents.
Article
The evolution of an ongoing research study into stress-resistant factors in children is traced from the early work on adult schizophrenia through the identification of risk factors in children vulnerable to stress. Future directions for the research are explored, including the necessity for defenses against possible politicization of the findings.
Article
Eighteen young men and women whose parents had major affective disorders, often in combination with other serious psychiatric disorders, were selected from a larger sample on the basis of their good behavioral functioning as adolescents at initial assessment. When they were reassessed an average of 2 1/2 years later, 15 of the 18 were still functioning well. Considerable self-understanding, a deep commitment to relationships, and the ability to think and act separately from their parents characterized these young people. Many of them were taking care of their ill parents. The implications of these findings for preventive and clinical intervention are discussed.
Article
We studied the six-month prevalence of four child psychiatric disorders (conduct disorder, hyperactivity, emotional disorder, and somatization) and patterns of service utilization for mental health and social services, ambulatory medical care and special education by different regions of Ontario, urban-rural residence, and age and sex groupings. Among children 4 to 16 years of age, the overall six-month prevalence rate of one or more of these disorders was 18.1%. The prevalences of hyperactivity and one or more disorders were significantly higher in urban areas than rural areas. The utilization data indicated that children with these psychiatric disorders, compared with children without these disorders, were almost four times more likely to have received mental health or social services in the six months preceding this study. However, five of six of these children had not received these specialized services in the previous six-month period. Over 50% of the children in the province had received ambulatory medical care in the last six months. Over 15% of the children in the province had received special education services at some time thus far in their school careers. Implications of these findings, especially for the provision of child mental health services, are discussed.
Article
Indications for preventive intervention with children of hospitalized psychiatric patients are discussed and the clinical findings of a pilot study are presented. Reactive disorders are examined and two profiles of vulnerability proposed. Findings underscore the need to integrate preventive intervention with these children into routine hospital practice.
Article
Almost since the beginnings of psychiatric practice, there has been a recognition that negative life experiences and stressful happenings may serve to precipitate mental disorders (Garmezy & Rutter, 1985). Nearly 200 years ago, Pinel wrote about the psychiatric risks associated with unexpected reverses or adverse circumstances, and it is reported that his initial question to newly admitted psychiatric patients was: “Have you suffered vexation, grief or reverse of fortune?” Nevertheless, although an appreciation that a variety of stressors may play a role in the genesis of psychiatric disorder has a long history, the systematic study of such effects is much more recent.