Experiences of self-stigmatization and parenting in Chinese mothers with severe mental illness

Implementation of the modified NAVIGATE program for early schizophrenia in Shanghai through the specialized hospital and community integration: A comparative study

BACKGROUND

The modified NAVIGATE program for early schizophrenia, called the Recovery program, was implemented in the Minhang district of Shanghai, China, with a population of approximately 2.7 million, representing 11% of the city's population of about 24 million. The specialized hospital and communities integrated to form multidisciplinary treatment teams to provide multi-component treatment and services, and to receive group training and supervision together. The aim of the study is to evaluate and compare the effects of the Recovery program with conventional care on psychiatric symptoms and social functioning.

METHOD

A total of 128 participants with a diagnosis of schizophrenia, aged 15 to 40 years, and illness duration ⩽5 years were enrolled. Patients living in the Minhang district were assigned to the Recovery program, and those living in other districts of Shanghai received the conventional care. Patients were followed up at baseline and after 2, 4, 6, 8, 10, and 12 months with assessments of symptoms, social functioning, treatment adherence, relapse, community activities, and school/work attendance using the Positive and Negative Symptom Scale (PANSS), the Clinical Global Impression Scale (CGI), and the Personal Social Functioning Scale (PSP).

RESULTS

Sixty-three participants receiving the Recovery program care showed greater improvement in psychotic symptoms and social functioning than 65 participants receiving conventional care. Participants in the Recovery program had lower rates of missed psychiatric visits >2 months (3.2% vs. 49.2%), antipsychotic discontinuation (7.9% vs. 36.9%), and relapse (4.8% vs. 26.2%) compared with conventional care.

CONCLUSIONS

The modified NAVIGATE program can be implemented in the Minhang district of Shanghai, China, through the integration of the specialized hospital and community, and improves clinical outcomes for patients with early schizophrenia compared to conventional care. It has great potential for implementation in other districts in China.

Anxiety and depression as potential risk factors for limited pain management in patients with elderly knee osteoarthritis: a cross-lagged study

BACKGROUND

Pain management for knee osteoarthritis (KOA) patients is challenging. Pain arises from both physiological and psychological interactions, with anxiety and depression potentially contributing as risk factors that hinder effective pain management in KOA patients.

METHODS

Before treatment(T1), A total of 206 elderly inpatients with KOA were enrolled based on initial screening criteria. After treatment (T2), patients were selected based on inclusion and exclusion criteria, and completed follow-up through phone or online questionnaires. The interval between T1 and T2 was three months. Outcome measures included the Visual Analogue Scale (VAS) for pain intensity, Beck Anxiety Inventory (BAI) for anxiety, and Geriatric Depression Scale (GDS) for depression. Descriptive and bivariate analyses were used to evaluate the pain, anxiety and depression of the participants. A cross-lagged model was used to examine the temporal and causal associations among pain, anxiety, and depression.

RESULTS

91% of elderly patients with KOA experienced at least mild depression. Furthermore, 31% of patients reported mild or higher levels of anxiety. At the same time, pain, depression, and anxiety were significantly correlated and mutually predictive(all p < 0.01). Across the different time points, Depression and anxiety at T1 positively predicted pain at T2,with correlation coefficients of 0.19 (p < 0.05) and 0.07 (p < 0.05), respectively.

CONCLUSIONS

Anxiety and depression may be potential risk factors limiting the effectiveness of pain management in KOA patients. Clinical treatment should regularly evaluate anxiety and depression levels and integration of psychological interventions or appropriate antianxiety and antidepressant medications.

CLINICAL TRIAL NUMBER

Not applicable, for the investigative research nature of the study.

Deconstructing stigmatising narratives: a qualitative analysis of contrast devices in interviews with mothers with a mental illness

BACKGROUND

In the context of stigma and mental health research, limited empirical studies examine stigma through the positioning of individuals within interview contexts. This study addresses this gap by investigating the positioning processes in interviews with mothers with a mental illness, with a specific focus on the use of contrast devices as a strategy identified through analysis. By analysing how mothers position themselves through contrast devices and to which discourses they refer, this study provides insights into how stigmatising discourses are evident in the narratives of mothers with a mental illness.

METHODS

This study is based on 20 semi-narrative interviews with mothers with a mental illness who participated in the Village Project (a pilot project co-created for children of parents with mental illness in Tyrol, Austria). Our analysis focuses on identifying stigmatising discourses related to motherhood and mental illness by examining the use of contrast devices in their accounts.

RESULTS

The analysis shows insights into mothers' efforts to distance themselves from labels such as 'bad mother', 'not normal/crazy women' and 'weak person'. These positions often carry a gendered dimension, with motherhood emerging as a central position. Our study highlights the challenges mothers with a mental illness face in navigating societal norms and expectations related to motherhood during research interviews.

CONCLUSION

The research contributes to a deeper understanding of mental health stigma in the context of motherhood, emphasising the importance of considering gendered dynamics and societal expectations in mental health research.

Parenting and family life experiences of mothers diagnosed with schizophrenia within Chinese cultural context

WHAT IS KNOWN ON THE SUBJECT?: Parenting experiences are a great challenge but also a meaningful achievement for mothers diagnosed with schizophrenia (MDWSs). Most previous studies focused on the parenting experiences of Chinese mothers diagnosed with depression rather than those diagnosed with schizophrenia, who usually experience psychiatric symptoms. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Unlike in Western society, Chinese society is characterised by a family-centred culture. This study insightfully explores MDWSs' parenting and family life experiences addressing their intrapersonal mindsets, interpersonal connections with family members across generations and extrapersonal roles such as traditional social expectations as a mother, wife and daughter-in-law. While Western studies have mainly focused on MDWSs' personal resilience, this study insightfully explored MDWSs' resilient dimensions including their personal, familial and cultural issues within the Chinese society. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study develops a comprehensive and professional understanding of the parenting experiences and family interactions of MDWSs who struggle to achieve their motherly role and re-establish connections with intimate family members. The findings highlight the following important considerations when offering family-based nursing cares: (1) assess power relationships, familial dynamics and cultural influences between MDWSs and their family members; (2) extend family members' involvement, such as parents-in-law, while offering psychoeducation to MDWSs and their family members. ABSTRACT: Introduction In Chinese culture, raising the next generation is recognised as a crucial family matter involving intergenerational participation. Mothers diagnosed with schizophrenia (MDWSs) usually experience high stress due to psychiatric symptoms, different parenting values across generations and traditional expectations associated with motherly roles. MDWSs need urgent professional assistance. Aim To explore MDWSs' parenting experiences and family life in Chinese cultural contexts. Method In-depth interviews were conducted with 20 MDWSs. Data were analysed using interpretative phenomenological analyses. Results The superordinate theme was identified as 'You are not a qualified mother'. Three major themes were elicited: experiencing crises in parenting, family life and self-stability; striving to be a good mother and wife under humiliation; and developing wisdom and courage to move forward. Discussion A dehumanised attitude of family members in a paternalistic culture was found. While Western society focuses on personal resilience and family-based nursing care for nuclear families, Chinese society intensively focuses on MDWSs' relationship with nuclear family members as well as extended family members such as parents-in-law. Implications for Practice The results highlighted the significance of culturally sensitive nursing care for MDWSs and family-centred psychoeducation that clarifies familial dynamics and improves effective communication between MDWSs and their family members.

Primary care physicians' experience of caring for children with parents with mental health illness: a qualitative study among French general practitioners and paediatricians

BACKGROUND

Parental psychiatric disorders can have a significant impact on child development and the parent-infant bond, with a high risk of attachment disorders. Early identification of difficulties in the parent-child relationship is essential to prevent consequences for the child. Childcare practitioners have a major role to play in this early detection process, through regular mandatory consultations during the first two years of a child's life. Thus, the aim of this study was to collect the experience of private practitioners in their care of children of parents with a mental health illness.

METHOD

This is a cross-sectional, observational, qualitative study. Data were collected by means of semi-structured interviews with eleven general practitioners and private paediatricians between February and July 2021 in Toulouse and its suburbs. We only included practitioners who had followed children of parents with a mental health illness. The interviews were recorded with the agreement of the participants, before being transcribed anonymously. The data were analysed with NVivo software using interpretative phenomenological analysis.

RESULTS

Three main themes emerged from the results, which were further divided into several sub-themes. Addressing psychiatric disorders presents a risk for the therapeutic relationship. Practitioners express a need to preserve this relationship with the parent in joint care. Care is difficult and is permeated by the parents' emotional issues. Furthermore, practitioners face a conflict between their concerns for the parent-child bond and their desire not to stigmatise these families. They express a feeling of isolation in these follow-ups. This stressful care has a significant emotional impact on the doctors. Access to psychiatric training and multidisciplinary collaboration seem to be essential to improve the follow-up experience for practitioners, as these factors strengthen inter-professional connections.

CONCLUSION

Practitioners describe a parent-doctor relationship at risk, which is underpinned by the fear of care placement. This study illustrates the need to strengthen multidisciplinary work by promoting interprofessional exchanges, in order to improve the experience of practitioners in this care process. Addressing practitioners' fear of discussing parental psychiatric illness is very important, so as not to delay the implementation of preventive actions that are likely to improve the developmental prognosis for children.

Parents who experience psychosis: A qualitative exploration

OBJECTIVES

Psychosis can present parents with complex parenting challenges and significant adverse outcomes for parents and their children have been reported. However, remarkably little is known about how parenting is experienced by these parents. Therefore, this qualitative study aimed to understand the lived experiences of parents with psychosis, including how parenting support was experienced.

DESIGN AND METHODS

Using interpretative phenomenological analysis (IPA), eight biological parents (five mothers and three fathers) with psychosis were recruited and interviewed from early intervention in psychosis services in the Northwest of England.

RESULTS

Three superordinate themes and seven subordinate themes were identified. Theme 1 'Living with the Struggle: Painfully Disconnected' captured a persistent parenting struggle that distanced parents from their children and support due to all-consuming experiences of psychosis, fear and risk-focused service support. Theme 2 'Desired and Vulnerable Position: Comfortably Connected' captured parental experiences of symptom relief through connection with their children, alongside parental need to be integrated with the systems around them. Theme 3 'Exposed: Parenting Under a Spotlight' represented parental experiences of inescapable observation and judgement from the systems around them.

CONCLUSIONS

Novel insights into the role of misaligned parent and service priorities in parental perceptions of powerlessness, shame and disconnection from their children, valued parenting identities, and system supports are presented. Systemic interventions that target stigma, provide system-wide psychoeducation and promote person-centred, compassionate and meaningful connections between parents and the systems they live within are needed to promote better parenting outcomes.

Schizophrenia in Women: Clinical Considerations

Men and women, for biologic and sociocultural reasons, differ in the nature of their risks for schizophrenia and also in their care needs. Women with schizophrenia have several reproduction-associated risks and care needs that require special clinical consideration. They also have several specific risks related to antipsychotics and gender-associated needs not necessarily related to biology. These require clinicians' diagnostic acumen, treatment skills, cultural sensitivity, and advocacy know-how. Although this does not pertain to everyone, awareness on the part of clinicians is essential. This article addresses the current evidence for difference.

Parenting and Serious Mental Illness (SMI): A Systematic Review and Metasynthesis

The consequences of Serious Mental Illness (SMI) on parent and child outcomes can be profound. Supporting parents to manage their caregiving roles alongside parental SMI successfully has been recognised as a public health priority. To meet this priority and develop effective and acceptable interventions, it is imperative that parents' experiences and support needs are understood. This systematic review aimed to synthesise qualitative research that explored parents' experiences and perceptions of the impact of SMI on their parenting and their corresponding support needs. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. Five databases were searched for terms associated with SMI, parenting, and qualitative research. Twenty-nine studies involving 562 parents who experienced SMI met inclusion criteria, and the methodological quality of included studies was appraised using the Critical Appraisal Skills Programme. After findings were synthesised using thematic synthesis, six themes were identified: (1) The constrained parent, (2) parenting difficulties, (3) the strained child, (4) inescapable threat, (5) combatting threat, and (6) wrap-around support needs. Novel insights into the centrality of SMI-related parenting difficulties and threat perceptions across parent, family, healthcare, and wider social systems on strained parent-child and distanced parent-support relationships were highlighted. Systemic practice change initiatives via compassionate and inclusive system-wide support were recommended.

Stigmatized experience is associated with exacerbated pain perception in depressed patients

Patients with depression not only have to cope with depressive and physical symptoms but also face stigmatization due to mental illness. Pain is a clinical symptom of many patients with depression. However, it is unclear whether stigmatized experience associated with mental illness directly affects depressed patients' pain perception. Here, using the event reflection task, Study 1 (N = 95) examined whether stigmatized experiences due to depression would affect patients' self-reported pain assessment. Study 2 (N = 43) further employed thermal stimuli at different intensities to examine whether stigmatization would affect patients' evoked pain. We found that patients with depression who experienced stigmatization based on mental illness reported higher pain catastrophizing and performed increased pain perception for noxious stimuli than those who did not. Our studies provide first-hand experimental evidence of the effect of stigmatized experiences on depressed patients' pain perception. The findings contribute insights for improving clinical treatment, suggesting that interventions should minimize stigmatization associated with mental illness to help patients maintain healthier physical and psychological states.

Parenting experiences of Chinese mothers living with a mental illness

BACKGROUND

Although the experiences of mothers with mental illness are well researched in Western countries, little is known about the experiences of Chinese mothers. This study aims to explore the experiences of family life and parenting of Chinese mothers, in the context of their mental illness.

METHODS

Fourteen Chinese mothers with mental illness undertook in-depth, semi-structured interviews. Interpretative Phenomenological Analysis was employed to guide the data analysis.

RESULTS

Seven themes were identified: motherhood as a central identity, the stigma associated with being a mother with mental illness, participants' perceptions about the impact of mental illness on parenting and their children, experiences of talking to children about mental illness, how having children impacts mothers' illness and recovery, and support obtained and needed. Similar to Western mothers, Chinese mothers experienced stigma and fluctuating mental illness symptoms which impacted on parenting. Unlike mothers based in Western countries, the mothers interviewed in this study highlighted complicated co-caring relationships with parents-in-law and did not raise child custody concerns.

CONCLUSIONS

Mental health professionals need to have the skills to identify and recognize the mothering role of their clients. Culturally sensitive interventions are required to assist Chinese families where mothers have a mental illness. Future research is required to investigate family experiences of parental mental illness from the perspectives of children, partners, and mental health professionals.

Effectiveness of digital psychotherapeutic intervention among perinatal women: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The perinatal period is a challenging time of substantial emotional, physiological, social, and relational changes. Depression, anxiety, and stress symptoms are common, and co-exist in the perinatal period. Digital technology continues to grow at an unprecedented pace with wide application, including psychotherapeutic intervention. A growing number of meta-analyses supported the application of digital psychotherapeutic intervention across different populations, but relatively few meta- and meta-regression analyses have concentrated on perinatal women.

AIM

To evaluate the effectiveness of digital psychotherapeutic intervention on improving psychological outcomes among perinatal women and identify its essential features.

METHODS

Randomized controlled trials (RCTs) were obtained from eight databases, including Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, Scopus, PsycINFO, PubMed, Web of Science, and ProQuest Dissertation and Theses from inception up until November 24, 2020. Comprehensive Meta-analysis 3.0 software was used to conduct meta- and meta-regression analyses. The Cochrane risk-of-bias tool and the Grading of the Recommendation, Assessment, Development, and Evaluation system were adopted to assess the individual and overall qualities of the evidence, respectively.

RESULTS

A total of 25 RCTs that included 3239 women were identified. Meta-analyses revealed that intervention significantly improved depression (Hedges's g = 0.49), anxiety (g = 0.25), and stress (g = 0.47) symptoms compared to the control. Subgroup analyses demonstrated that a website platform with ≥ eight therapist-guided sessions using the theoretical principle of cognitive behavioral therapy was more effective than other treatments in improving depression symptoms in postnatal women. Meta-regression analyses observed that the age of perinatal women and the type of psychotherapy also had statistically significant effects on depression symptoms. Egger's regression asymmetry tests suggested that no publication biases occurred, but the overall quality of the evidence was very low.

CONCLUSION

This review suggests that digital psychotherapeutic intervention may be a potential solution to reduce psychological problems in perinatal women. Further high-quality RCTs with large sample sizes are needed.

Chinese mothers' experiences of family life when they have a mental illness: A qualitative systematic review

The challenges experienced by families in western countries, where a parent has a mental illness, are well established. However, research documenting the experiences of Chinese families with parental mental illness appears limited. This study aimed to systematically review qualitative research about the experiences of families, living in mainland China, Hong Kong, Macao, and Taiwan, where parents have a mental illness. Eight databases were comprehensively searched, along with manual search of reference lists. The identified studies were critically appraised and analysed using a thematic synthesis approach. Ten papers were identified, with nine investigating mothers' experiences, one focusing on children's experiences, and none reporting on fathers' experiences. Subsequently, only papers presenting mothers' experiences were included for thematic synthesis. Five primary themes were identified including managing parenting in the context of mental illness; failure to meet one's expectations of motherhood; being burdened by others' expectations; stigma from self, others and service providers; and support obtained and needed. Similar to western mothers, Chinese mothers struggled to balance the demands of parenting and their illness, and experienced stigma associated with being a parent with a mental illness. Western and Chinese mothers' experiences differ in regard to the influence of parents-in-law and the division of domestic labour. Future research might investigate Chinese mothers with various mental health diagnoses, the perspectives of Chinese fathers with a mental illness, and the children in these families.

Stigma in relation to families living with parental mental illness: An integrative review

Stigma is a pervasive social mechanism with negative ramifications for people who experience mental illness. Less is known about the stigma experiences of families where a parent has a mental illness. This review aims to identify and synthesize evidence on the concept of stigma and stigma-related experiences and outcomes reported by parents and children living with parental mental illness. An integrative review method was employed, with PRISMA (Preferred Reporting Items of Systematic Review and Meta-Analyses) guidelines to search and select literature and extract and analyse data. This approach allows for inclusion of theoretical and empirical literature and for concept definition. Fifty-eight papers, mostly from the USA, Australia, and the UK, met the inclusion criteria. Stigma was primarily conceptualized in families as a marked difference that was negatively appraised, and which could be internalized. Some articles examined how underpinning assumptions could shape the behaviour of individuals and groups and be embedded within social institutions and structures. For parents, mental illness stigma was interconnected with stigma relating to perceived violations of social and cultural norms related to parenting. Children's experience of stigma resulted in bullying, embarrassment, guilt and social isolation, and efforts to conceal their parent's mental illness. One outcome was that stigma prevented children and parents from seeking much needed supports. Public health policies and campaigns that focus exclusively on promoting open disclosure of mental illness to foster community education outcomes are unlikely to be effective without additional strategies aimed at preventing and redressing the structural impacts of stigma for all family members.