Parenthood and severe mental illness: relationships with recovery

Optimism in dire times: The buffering role of optimism in the relationship between food insecurity and mental health during the COVID-19 pandemic

Considering the need to gain a deeper understanding of the protective factors associated with coping with food insecurity, specifically in times of severe prolonged stress, the current longitudinal study seeks to examine the role of optimism in the relationship between food insecurity and adverse mental health outcomes during the COVID-19 pandemic. A three-wave longitudinal study involving 1921 Israeli adults was performed during the COVID-19 pandemic. Participants completed questionnaires assessing food insecurity, anxiety, depression, optimism, and socio-demographic characteristics. To explore the relationship between food insecurity and symptoms of anxiety and depression, as well as the moderating role of optimism in this relationship, we employed a set of panel regression models with individual fixed effects. Our results indicate that the degree and change in food insecurity over time were positively associated with both anxiety and depression symptoms, whereas the degree and change in optimism were negatively correlated. Optimism was found to moderate the association between food insecurity and anxiety symptoms over time, but not the association between food insecurity and depression symptoms. A subgroup analysis revealed that optimism moderated the relationship between food insecurity and anxiety and depression for women, but not for men; for married/coupled individuals but not for singles; for non-parents with regard to anxiety, and for parents with regard to depression. Our results highlight the need to practice and enhance optimism in times of great despair, uncertainty, and hardship, especially in situations of food insecurity where tangible change may take time.

Mental health professionals' awareness of the parental functioning of persons with severe mental disorders: a retrospective chart study

Background:

The proportion of persons with severe mental illness (SMI) who are parents has increased in recent decades. Children of parents with SMI are at increased risk for medical, behavioral, emotional, developmental, academic, and social problems. They also have an increased risk for injuries, accidents, and mortality, addictions, and various psychiatric disorders compared to children of parents with no such diagnoses. We aimed to examine the extent to which mental health professionals (MHPs) who treat adult patients with SMI in ambulatory settings are aware of these individuals’ functioning in three parenting domains: parental functioning, familial support system and children’s conditions. We also compared psychiatrists’ awareness with that of psychologists and social workers.

Methods:

In this retrospective practice-oriented study, we reviewed 80 clinical files of individuals diagnosed with schizophrenia, affective disorder or personality disorder treated in a mental health outpatient clinic, using the Awareness of Family’s Mental Health Checklist (AFMHC) developed for this study. Thus, awareness was determined on the basis of what was recorded in the patient file.

Results:

Almost half of the MHPs were unaware to their patients’ parental functioning as only 44% of files contained records relating to this issue. Awareness to other domains was even lower: 24% of files contained information on patient’s support system and 12% had information about their children’s mental and/or physical health. No statistically significant differences between psychiatrists and other MHPs were found with regards to awareness to the various domains. Positive correlations were found among MHP’s for awareness in the three domains.

Conclusion:

Lack of awareness among MHPs to their patients’ parental functioning is not specific to a certain profession and may be attributed to patients (e.g., reluctance to disclose relevant information) or to MHPs (e.g., lack of training). Awareness of family and parental functioning by MHPs working with persons with SMI should be part of a standard procedure, integrated into policy and training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13584-022-00547-4.

How psychosis interrupts the lives of women and men differently: a qualitative comparison

PURPOSE

Psychosis disrupts how persons experience themselves and their lives. Despite knowledge that gender differences have been noted in presentation and course of psychosis symptoms, little is known about differences in how men and women experience these disruptions.

METHOD

The narratives of 26 men and 27 women diagnosed with psychosis, matched on age, education, and race, of the impact of psychosis on one's life, were compared. Using secondary data from semi-structured interviews, themes were identified using inductive, phenomenological qualitative analyses.

RESULTS

Women and men discussed psychosis-related interruptions to the roles and relationships that shape their identity. Both genders discussed the impact of psychosis on their sense of self, work, and relationships. Nuanced gender differences emerged, informing unique areas of challenge related to (1) parenting and loss of parenting roles, (2) work and loss or changes in work trajectories, (3) isolation and strain on interpersonal relationships, and (4) manifestations of stigma.

CONCLUSIONS

Psychosis may disrupt distinct aspects of life for men and women. Each gender faces the intersection of socially informed expectations that impact one's experiences of stigma, expectations of others, and manifestations of losses felt in one's role and sense of identity. Findings inform important considerations for therapy and other services.

PRACTITIONER POINTS

Gender-based socialized expectations, losses, and challenges that accompany psychosis are important areas for therapeutic consideration. Current treatments may neglect challenges that are more commonly experienced by women with psychosis.

Being parent is associated with suicidal history in people with serious mental illness enrolled in psychiatric rehabilitation

Parenting is a central life experience that could promote recovery in people with Serious Mental Illness (SMI). It could also be challenging for parents with SMI and result in poor recovery-related outcomes. Parenting is often overlooked in psychiatric rehabilitation. The objectives of the present study were to identify the characteristics and needs for care of mothers and fathers with SMI enrolled in a multicentric non-selected psychiatric rehabilitation SMI sample. We consecutively recruited 1436 outpatients from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). The evaluation included standardized scales for clinical severity, psychosocial function, quality of life and satisfaction with life, wellbeing, personal recovery and a broad cognitive battery. We found that parenting was associated to suicidal history in mothers and fathers with SMI. In the multivariate analysis, being mother was best explained by insight (p < 0.015, adjusted OR = 0.76 [0.59-0.90]), current age (p < 0.001, aOR = 1.13 [1.07-1.21]), education level (p = 0.008; aOR = 0.12 [0.02-0.53]) and family accommodation (p = 0.046, aOR = 0.19 [0.03-0.84]). Being father was best explained by suicidal history (p = 0.005, aOR = 3.85 [1.51-10.10]), marital status (in relationship, p < 0.001; aOR = 7.81 [2.73-23.84]), satisfaction with family relationships (p = 0.032, aOR = 1.22 [1.02-1.47]) and current age (p < 0.001, aOR = 1.16 [1.10-1.23]). In short, parenting was associated to increased history of suicide attempt in mothers and fathers with SMI. Mothers and fathers with SMI may have unique treatment needs relating to parenting and recovery-related outcomes. The implementation of interventions supporting the needs of parents with SMI in psychiatric rehabilitation services could improve parent and children outcomes.

Essential Elements That Contribute to the Recovery of Persons With Severe Mental Illness: A Systematic Scoping Study

Introduction: There is an increasing emphasis on recovery-oriented care in the design and delivery of mental health services. Research has demonstrated that recovery-oriented services are understood differently depending on the stakeholders involved. Variations in interpretations of recovery lead to challenges in creating systematically organized environments that deliver a consistent recovery-oriented approach to care. The existing evidence on recovery-oriented practice is scattered and difficult to apply. Through this systematic scoping study, we aim to identify and map the essential elements that contribute to recovery outcomes for persons living with severe mental illness. Methods: We used the Arksey & O'Malley framework as our guiding approach. Seven key databases (MEDLINE, PubMed, CINAHL/EBSCO, EMBASE, ProQuest, PsycINFO, and Google Scholar) were searched using index terms and keywords relating to recovery and severe mental illness. To be included, studies had to be peer-reviewed, published after 1988, had persons with severe mental illness as the focal population, and have used recovery in the context of mental health. The search was conducted in August 2018 and last updated in February 2020. Results: Out of 4,496 sources identified, sixty (n = 60) sources were included that met all of the selection criteria. Three major elements of recovery that emerged from the synthesis (n = 60) include relationships, sense of meaning, and participation. Some sources (n = 20) highlighted specific elements such as hope, resilience, self-efficacy, spirituality, social support, empowerment, race/ethnicity etc. and their association with the processes underpinning recovery. Discussion: The findings of this study enable mental health professionals to incorporate the identified key elements into strategic interventions to facilitate recovery for clients with severe mental illness, and thereby facilitate recovery-oriented practice. The review also documents important gaps in knowledge related to the elements of recovery and identifies a critical need for future studies to address this issue.

Towards relational recovery: Nurses' practices with consumers and families with dependent children in mental health inpatient units

Facilitating parent-child and family connections during parental hospitalization provides important opportunities for mental health services to support individual and family recovery. Nurses are often the primary point of contact for families in the inpatient context. They play an integral role in the care provision of consumers and families and in supporting consumers' recovery. The aim of the present qualitative study was to explore nurses' practice with families in inpatient mental health settings in the context of designated family rooms. Three themes were derived from the thematic analysis of semistructured interviews with 20 nurses from four mental health inpatient units. Nurses experienced tensions within their roles in balancing safety and risk, a lack of confidence in family-focused practices in relation to role expectations, and challenges in juggling nursing care ideals with the contemporary realities of inpatient practice. A family-centred relational recovery approach is recommended for mental health services, which is underpinned by family-focused policies and processes, and supported at an organizational, managerial, and local-unit level. At an individual level, nurses need professional development on the models of care they practice in, explicit role clarity on their practice with families, and education on evidence-based brief family interventions.

Clinical Considerations When Treating Adults Who Are Parents

When providing mental health services to adults, we are often treating individuals who, among their other roles, are also parents. The goal of this article was to provide practitioners with the state of the science about both the impact of parental psychopathology on children and the role that children's well-being has in parental psychopathology. We discuss the benefits of integrated care for adult clients who are parents, as well as the barriers to providing integrated care for both parents and children in psychotherapy, and provide recommendations for practice. With this information, practitioners will gain greater awareness of their opportunities to treat adults in their parenting roles as well as to contribute to prevention of mental disorders in children.

Language and hope in schizophrenia-spectrum disorders

Hope is integral to recovery for those with schizophrenia. Considering recent advancements in the examination of clients' lexical qualities, we were interested in how clients' words reflect hope. Using computerized lexical analysis, we examined social, emotion, and future words' relations to hope and its pathways and agency components. Forty-five clients provided detailed narratives about their life and mental illness. Transcripts were analyzed using the Linguistic Inquiry and Word Count program (LIWC), which assigns words to categories (e.g., "anxiety") based on a pre-existing dictionary. Correlations and linear multiple regression were used to examine relationships between lexical qualities and hope. Hope and its subcomponents had significant or trending bivariate correlations in expected directions with several emotion-related word categories (anger and sadness) but were not associated with expected categories such as social words, positive emotions, optimism, achievement, and future words. In linear multiple regressions, no LIWC variable significantly predicted hope agency, but anger words significantly predicted both total hope and hope pathways. Our findings indicate lexical analysis tools can be used to investigate recovery-oriented concepts such as hope, and results may inform clinical practice. Future research should aim to replicate our findings in larger samples.

Strategies for parenting by mothers and fathers with a mental illness

WHAT IS KNOWN ON THE SUBJECT?: The combination of coping with their mental health problems and caring for children makes parents vulnerable. Family-centred practice can help to maintain and strengthen important family relationships, and to identify and enhance the strengths of a parent with a mental illness, all contributing to the recovery of the person with the mental illness. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: Taking the strength and the opportunities formulated by parents themselves as a starting point is fairly new. Parents with severe mental illness find strength for parenting in several ways. They feel responsible, and this helps them to stay alert while parenting, whereas parenthood also offers a basis for social participation through school contacts and the child's friendships. Dedication to the parent role provides a focus; parents develop strengths and skills as they find a balance between attending to their own lives and caring for their children; and parenting prompts them to find adequate sources of social support. In this study these strategies were found to be the fundamentals of recovery related to parenting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can support and coach patients who are identified as parents, and self-chosen parenting related goals are set and addressed. A family-focused approach by nurses can be used to prevent problems for children and their families, identify their strengths as well as vulnerabilities, and address the challenges to build resilience.

INTRODUCTION

Understanding of the problems of parents with mental illness is growing. Gaining insight into strategies for parenting, while taking the opportunities formulated by these parents themselves as a starting point is fairly new.

QUESTION

What are the strategies of parents with a mental illness to be successful?

METHOD

Experiences of 19 mothers and eight fathers with a mental illness were explored with in-depth interviews. Data were content analysed, using qualitative methods.

RESULTS

Next to feelings of inadequacy, interviewees also describe how children enrich and structure their lives and are not only a burden but serve as distraction from problems. Developing activities that interest both child and parent provides avenues for emerging strength. Mental illness constrains fathers, but also gives opportunities to develop a meaningful relation with their children.

DISCUSSION

Strategies like being fully dedicated to the parental role, finding a balance between attention for one's own life and parenting and finding adequate sources of support are found to be fundamental for recovery in the parent role. Implications for practice Peer groups can be of valuable help and mental health workers can support parents to set self-chosen parenting related goals.

Factor structure of the autonomy preference index in people with severe mental illness

People vary in the amount of control they want to exercise over decisions about their healthcare. Given the importance of patient-centered care, accurate measurement of these autonomy preferences is critical. This study aimed to assess the factor structure of the Autonomy Preference Index (API), used widely in general healthcare, in individuals with severe mental illness. Data came from two studies of people with severe mental illness (N=293) who were receiving mental health and/or primary care/integrated care services. Autonomy preferences were assessed with the API regarding both psychiatric and primary care services. Confirmatory factor analysis was used to evaluate fit of the hypothesized two-factor structure of the API (decision-making autonomy and information-seeking autonomy). Results indicated the hypothesized structure for the API did not adequately fit the data for either psychiatric or primary care services. Three problematic items were dropped, resulting in adequate fit for both types of treatment. These results suggest that with relatively minor modifications the API has an acceptable factor structure when asking people with severe mental illness about their preferences to be involved in decision-making. The modified API has clinical and research utility for this population in the burgeoning field of autonomy in patient-centered healthcare.