Effects of a nursing intervention program on the depression and perception of family functioning of mothers with intellectually disabled children

Psychological interventions for parents of children with intellectual disabilities to enhance child behavioral outcomes or parental well-being: A systematic review, content analysis and effects

The aim of this review was to identify the type, content, and effectiveness of psychological parenting interventions for parents of children with intellectual disabilities to enhance child behavior and/or parental well-being. A systematic search yielded 21 studies involving 1825 participants. Studies were evaluated according to intervention content, pre- and post-treatment and follow-up effect sizes, and risk of bias. We categorized the interventions into those targeting 'Child or interaction' (child behavior, interaction and learning, understanding disability), and those targeting 'Parent' (parental well-being) or both themes. All these interventions had positive effects on parental well-being or child behavior. Parental outcomes were improved by interventions targeting 'Parental well-being', as well as 'Child or interaction'. Child behavior showed improvements in programs focusing on 'Child or interaction', and in a mindfulness-based parental well-being program. During follow-up, most effects were sustained or further increased, but some studies showed no improvements over the control group.

Caregiver skills training for caregivers of individuals with neurodevelopmental disorders: A systematic review and meta-analysis

AIM

To systematically review the effectiveness of caregiver and parent skills training programs, including caregiver-mediated interventions, for caregivers of individuals with neurodevelopmental disorders.

METHOD

We conducted a systematic review with a random-effects meta-analysis. We searched 11 electronic databases through July 2021 and used a snowball methodology to locate relevant articles of randomized controlled trials. Effect size estimates were pooled using Hedges' g from data extracted from study reports and through author requests using random-effects meta-analyses for three child outcome categories (child development, adaptive behavior, and problem behavior) and three caregiver outcome categories (parenting skills and knowledge, psychological well-being, and interpersonal family relations).

RESULTS

We located 44 910 records, from which 75 randomized controlled trials involving 4746 individuals with neurodevelopmental disorders and their caregivers were included. Random-effects meta-analyses showed improvements in child development (g = 0.30; 99% confidence interval [CI] = 0.07-0.53) and reduction in reported problem behaviors (g = 0.41; 99% CI = 0.24-0.59), but not a statistically significant improvement in adaptive behavior (g = 0.28; 99% CI = -0.42 to 0.98). Caregivers showed improvements in parenting skills and knowledge (g = 0.72; 99% CI = 0.53-0.90), psychological well-being (g = 0.52; 99% CI = 0.34-0.71), and interpersonal family relations (g = 0.76; 99% CI = 0.32-1.20).

INTERPRETATION

Caregiver skills training programs benefit both caregivers and children with neurodevelopmental disorders. Skills training programs improve child development and behavior, improve parenting skills, reduce caregiver mental health issues, and improve family functioning. Programs using culturally appropriate training material to improve the development, functioning, and participation of children within families and communities should be considered when caring for children with neurodevelopmental disorders.

WHAT THIS PAPER ADDS

Caregiver skills training programs are effective interventions for both caregivers and children. Children with neurodevelopmental disorders benefit from improvements in development and reduction of problematic behaviors. Caregivers benefit from enhanced skills and psychological well-being. Improvements in interpersonal family relationships have also been documented.

Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries

BACKGROUND

Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries.  OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care.  SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019).   SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs.  PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs).  DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs).  Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes.  For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects.  Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention.  MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs).  Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination.  Intervention effects *Unless indicated, comparisons were usual care at T2.  "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence.   Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists);  g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death);  e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08);  b. may have uncertain effects on symptoms/functioning/SU/AEs.   Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and  functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11);  d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects.  Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11);  b. may have uncertain effects on symptoms/functioning/SU/AEs.  PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU.  Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13);  c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13);  c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs;  b. may have uncertain effects on recovery/symptoms(PTS)/functioning.

AUTHORS' CONCLUSIONS

PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.

Benefits and cultural adaptations of psychosocial interventions for parents and their children with intellectual disabilities in low-and middle-income countries: A systematic review

BACKGROUND

Evidence and awareness of the importance of culturally adapting psychosocial interventions is growing. The aim of this paper is to systematically review studies on cultural adaptations of psychosocial interventions for parents and their children with intellectual disabilities, in low- and middle-income countries.

METHODS

Studies were identified through electronic databases and searching bibliographies. The quality and cultural adaptations of thirteen studies focusing on parental trainings were analysed using standardised tools and frameworks.

RESULTS

Findings suggest interventions reduce the risk of depression and stress and increase coping strategies and positive perceptions of family functioning. Parenting skills training may improve parent-child interactions and child development. However, these benefits should be interpreted cautiously due to methodological shortcomings. Most studies described efforts to make appropriate cultural adaptations to the interventions, but these adaptations were not comprehensive.

CONCLUSION

High-quality cultural adaptations are crucial to providing meaningful interventions in different parts of the world.

Factors associated with the depression among people with disabilities: A cross-sectional study in Chinese communities of Shanghai

Depression has become a growing health issue in the world and is projected to become a leading cause of global burden. However, there is little scientific research on the factors associated with depression in people with disabilities in China. In this cross-sectional study, we aimed to explore the prevalence and related factors of depression among people with disabilities in communities in mainland China.Participants with disability certificates were recruited via face-to-face interviews to complete questionnaires. Contents include participants' demographic characteristics, the Modified Barthel Index (MBI), chronic medical history, and the Patient Health Questionnaire-9 (PHQ-9).A total of 1815 participants (M age = 60.35 ± 13.66) whose questionnaires are eligible were finally included. Among them the incidence rate of depressive symptoms was up to 39.9%. Multifactor regression analysis showed that grade I disability (odds ratio (OR) = 1.37, P < .05), impairment activities of daily living (OR = 3.23, P < .001), diabetes (OR = 1.43, P < .05), and hyperlipidemia (OR = 1.59, P < .001) were associated with depression in the disabled. However, intelligence disability is a protective factor of depression (OR = 0.69, P < .05).The data demonstrates that the depression of the disabled should arouse the attention of our society. Furthermore, the interventions to disability degree, impairment activities of daily living, diabetes, and hyperlipidemia may help to improve the mental health of the disabled people.

Chinese fathers of children with intellectual disabilities: their perceptions of the child, family functioning, and their own needs for emotional support

As more and more evidence accrues in support of family-centered approaches to disability services, parents' experiences raising children with disabilities is receiving increasing attention internationally. The literature on parents of children with disabilities, however-whether intellectual disability (ID) or other chronic health conditions (OCHC)-tends to focus on mothers as the primary research subject. To address the paucity of research focused on fathers' experiences of raising a child with disabilities, I surveyed over 4500 fathers of children with disabilities in Mainland China. The surveys focused on fathers' perceptions of their children, their perceptions of family functioning, and their perceptions of their own needs for emotional support. Results derived from statistical analyses of the data suggest that fathers tend to believe their children with ID are harder to raise than other children, and that they more often do things that irritate them and make them feel angry. Fathers of children with ID also tend to perceive their family functioning as somewhat problematic. Generally, these fathers are disinclined to seek emotional support from outside their families, although fathers from the majority Han population and fathers who have greater than high school education are more likely to seek support than are fathers from minority ethnic groups and fathers with lower educational background. Comparisons are made with fathers of children with OCHC. Implications of the findings are identified and lines of further research suggested.

Efficacy of a psychoeducational intervention in caregivers of people with intellectual disabilities: A randomized controlled trial (EDUCA-IV trial)

BACKGROUND

People with intellectual disabilities (ID) are usually cared for by their own parents, families or informal caregivers. Caring for a person with ID can have a negative impact on caregivers' mental health (burden, depression, anxiety). The main aim of the EDUCA-IV trial was testing the efficacy of a psychoeducational intervention program (PIP) versus standard practice and to see whether the PIP intervention would reduce the caregiver's burden at post-intervention (4 months) and at follow-up (8 months).

METHOD

This was a multi-centre randomised controlled trial including 194 caregivers (96 randomised to PIP, 98 to control condition). PIP intervention consists of 12 weekly group sessions. The control group received treatment as usual. Primary outcomes measured included the Zarit Burden Interview (ZBI). Secondary outcomes were caregivers' mental health (GHQ-28), anxiety (STAI) and depression (CES-D).

RESULTS

The decrease of ZBI scores was not significant at 4 months. There was significant decrease in the GHQ scores at 4 and 8 months. CES-D showed relevant results at follow-up. Intention to treat analyses showed similar results.

CONCLUSIONS

The PIP intervention seems not to be effective reducing burden, but appears to have a positive result on general mental health. The program was well received and valued by caregivers.

Parenting children with Down syndrome: Societal influences

Most studies of parenting children with Down syndrome (DS) have been conducted in industrialized countries. They suggest that sensitive communication on the part of professionals, and social support, can lead to acceptance and positive adjustments in the family. This study examined the impact of a diagnosis of DS on Ecuadorian families, in particular at how the diagnosis had been communicated and received, as well as the feelings and experiences which followed. Despite considerable progress in recent years, Ecuador is still marked by discriminatory attitudes which affect children with disabilities and their families, and by the persistence of widespread poverty. This qualitative study, conducted in Cuenca, Ecuador's third largest city, is based on a focus group discussion and four in-depth interviews with Ecuadorian parents of DS children attending a specialist center in the city. The study shows that, reflecting the effects of status differences and lack of appropriate training, professionals rarely communicate a DS diagnosis in an appropriate manner. Further, it is shown that lack of social support, and the widespread stigmatization confronting children with DS and their families, hinder development of positive and empowering adjustments that would best serve the child's and the family's interest.

The Effectiveness of Structured Supported Education Programs for Families With Intellectually Disabled Children: The Example of Turkey

This a quasi-experimental study that was conducted at a specialized education school in a city in Turkey for the purpose of evaluating the effectiveness of a structured supported education program for the parents of children with intellectual disability (ID). The education program was conducted with a total of 8 groups attending 3 sessions. 104 individuals completing the program sessions and comprised the sample. In a comparison of parents' levels of knowledge, the mean number of correct answers on the pretest was 15±3.75 and 19.25±2.88 on the posttest. Beck hopelessnes scores were 9.75±4.14 before the education and 6.25±4.77 after the education; this differences were statistically significant. It was found that the supported education of parents of individuals with ID made an impact on the family's knowledge and level of hopelessness.

Supporting Families of Children With Disabilities

Advanced technology combined with improvements in neonatal care have increased the survival rates of low-birth-weight infants and infants born with severe birth defects. These infants are at greater risk for long-term health and developmental problems. The effect of having a child with a disability on the family is described, and emerging interventions and resources available for these families are provided.

Multidisciplinary parent education for caregivers of children with autism spectrum disorders

This quasi-experimental study aimed to determine the effectiveness of a multidisciplinary parent education program focused on improving health-related quality of life (HRQOL) for caregivers of children with autism spectrum disorders (ASD). This study included 42 participants (22 intervention, 20 wait-list control) who were the main caregivers of children with ASD. Data were collected at baseline and post-intervention. At the end of the multidisciplinary parent education program, significant improvements were observed in the mental HRQOL, family functioning, self-efficacy and positive coping style. The results indicate that a multidisciplinary parent education program, designed for caregivers of children with ASD, may have positive effects on caregivers' mental health-related quality of life, while having little effect on their physical health-related quality of life.

Raising a child with disability and dealing with life events: a mother's journey

Intellectual disability services recognise people with intellectual disability as a family member and aim to provide effective support that facilitates family cohesion. However, the needs of families and individuals within the family should be addressed in a holistic manner to ensure a seamless service. This article outlines a mother's reflections on her experience of raising a child with autism spectrum disorder and its impact on her life. The article focuses on one mother's feelings, coping or lack of coping and growth during a time of sadness. This article written by a mother, nurse and academic through their shared interest in supporting families of children with a disability all came together to tell this story. It is hoped that this article will assist professionals understand a mother's perspective when raising a child with intellectual disability and support professionals to recognise the importance of listening, coordinated support and working in partnership.