The experiences of family resilience from the view of the adult children of parents with bipolar disorder in Chinese society

Individual Resilience among Adult Children of Parents with Bipolar Disorder in Chinese Society: An Inductive and Deductive Content Analysis Approach

INTRODUCTION

Nurses can help children of parents with mental illness discover their resilience. However, previous studies have focused on their experience in Western settings and have limited understanding of a Chinese cultural context. This study aims to explore individual resilience emerging from adult children's experience of living with parents with bipolar disorder in Chinese society within the framework of character strengths and possible cultural components.

METHODOLOGY

A content analysis with both inductive and deductive approaches. Twenty adults participated in this study. Interviews were conducted while the participants' parents were hospitalized in an acute psychiatric hospital ward.

RESULTS

The framework of character strengths confirmed five emergent themes of individual resilience in this study: courage, temperance, humanity, knowledge and wisdom, and transcendence.

DISCUSSION

Character strengths are an adequate framework for understanding of individual resilience. Chinese adult children develop resilience by regulating their emotions, respecting their parents, engaging in self-discipline, and positively interpreting adversity.

Resiliency process in the family after childhood leukaemia diagnosis: A longitudinal qualitative study

AIMS

To construct a conceptual framework on the process of family resilience during the first year following childhood leukaemia diagnosis.

DESIGN

A longitudinal qualitative interview study.

METHODS

A longitudinal qualitative study following a grounded theory methodology was employed. Semi-structured interviews were conducted with parents of children with leukaemia in a general hospital. The participants were recruited through purposive and theoretical sampling and longitudinal engagement was achieved by conducting interviews at 1, 3, 6, and 12 months after the leukaemia diagnosis. The core category and categories were saturated following the enrolment of parents of children with leukaemia. Data collection and analyses were performed simultaneously.

RESULTS

Sixteen parents of children with leukaemia participated. The core category of 'families living with childhood leukaemia' refers to the process of family resilience during the first year following childhood leukaemia diagnosis, which includes three phases: (1) destruction and resiliency period; (2) adjustment and consolidation period; and (3) growth and planning period.

CONCLUSION

This study explored the dynamic, complex and continuous processes of resilience among families coping with childhood leukaemia during the first year following diagnosis. Further research should design tailored family interventions that characterise the different phases of family resilience, aiming to support family well-being, integrity and functioning.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Both families and healthcare professionals must create an enabling environment that supports families coping with difficulties. Understanding the different phases of family resilience allows healthcare professionals to provide holistic care that meets the demands of families with childhood leukaemia.

IMPACT

Unique knowledge emerged about the family's resiliency process when facing childhood leukaemia, suggesting a family-led revolution in understanding and managing childhood leukaemia. Therefore, the development of phased, resilience-based family interventions is imperative.

REPORTING METHOD

This study was reported using the COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

Patients contributed via study participation.

Parenting Experiences in the Context of Parental Bipolar Disorder: A Systematic Review and Meta-Synthesis of the Qualitative Literature

Parental bipolar disorder (BD) is associated with an increased risk of mental health problems in children. Despite the urgent need for clear guidance on how best to support parents with BD, current research lacks a unified analysis of the challenges and needs faced by these parents and their children. This review aims to explore the impact of BD on experiences of parent-child interactions or relationships to inform effective policies and interventions. Following a preregistered PROSPERO protocol, we searched Medline, Embase, PsycINFO, SCOPUS, and CINAHL for qualitative studies on parents with BD and their children (under 19 years) published since 1994. Each study was independently screened and jointly assessed for quality using the Critical Appraisal Skills Program. Our thematic synthesis entailed coding in NVivo, followed by collaborative theme generation on the Miro platform. We reviewed 19 studies, of which 9 studies reported on parents, 8 on children, and 2 on both parents and children. Our analysis generated four themes: (1) "The multifaceted landscape of parenting with BD," which outlines how mood swings affect parenting in diverse ways; (2) "The evolving dynamic of child-parent relationship amidst parental BD," including how children adapt and grow in understanding and responsibility in response to their parent's BD; (3) "The dual nature of childcare for parents with BD," which explores how childcare impacts parents' emotions and motivations, bringing both uplifting and challenging effects; (4) "Navigating parental challenges in the context of BD," highlighting the importance of open communication, self-reflection, and timely, unbiased support to mitigate challenges associated with parental BD. This qualitative synthesis focuses specifically on the parenting experiences of families affected by parental BD. It highlights the complex, dynamic impact of BD on parenting behaviors and children's coping mechanisms, calling for tailored therapeutic interventions that benefit both parents and children. The scope of our study is limited by factors such as a predominance of Western perspectives and an underrepresentation of fathers' experiences, highlighting the need for more diverse research in this area.

The effects of maternal health literacy, family functioning and self-efficacy on antepartum depression in pregnant women in China: a moderated mediation model

BACKGROUND

Antepartum depression (AD) is associated with a greater risk of adverse outcomes for both mothers and fetuses. Maternal health literacy (MHL), family functioning (FF), and self-efficacy (SE) are important factors affecting antepartum depression (AD) in pregnant women. Therefore, this study aimed to explore the associations between these factors and whether MHL and SE mediate the relationship between FF and AD.

METHODS

This cross-sectional study included 1392 pregnant women from 6 hospitals in Chongqing, China. Data were collected via structured scales, including the Edinburgh Postpartum Depression Scale, the APGAR Family Care Index Scale, the Maternal Health Literacy Scale and the General Self-Efficacy Scale (GSES). Structural equation modeling(SEM) was used to test the hypothesized relationships among the variables.

RESULTS

In our survey, 31.90% participants had depression symptoms. Correlation analysis revealed that all the variables were significantly correlated with AD (p < 0.01). The model indicated that FF had the strongest correlation with AD (β = -0.276, p < 0.01), followed by MHL (β = -0.248, p < 0.01) and self-efficacy (SE) (β = -0.222, p < 0.01). SE fully mediated the relationship between FF and AD and mediated the relationship between MHL and AD. There was no evidence of a mediating effect of MHL on the relationship between FF and AD.

CONCLUSIONS

AD is correlated with MHL, SE and FF. MHL and FF can directly affect AD and mediate AD through SE. Future programs should consider MHL promotion, FF improvement and SE strengthening as breakthrough points when planning educational programs.

Children's Perceptions and Experiences of Their Involvement in Their Parents' Mental Health Care - A Qualitative Literature Review

This systematic review aims to synthesise the research on children's perceptions and experiences of their involvement in a parent's mental health care. After an extensive search and quality appraisal, 22 articles remained and were included in the review. The results show that children-although resourceful and with good intentions-frequently felt excluded. They hungered for information and felt their questions were abandoned. They also felt caught in a tumultuous life situation and struggled for support. Finally, they expressed the need to be seen and ultimately did not feel involved in their parent's mental health care.

Family Resilience Progress from the Perspective of Parents of Adolescents with Depression: An Interpretative Phenomenological Analysis

Family resilience plays an important role in the healthy family development of adolescents with depression, but few studies have explored the specific process of family resilience. This study aims to explore the dynamic processes of family resilience from parents of adolescents with depression. Data were collected from 14 Chinese parents of adolescents with depression by interpretative phenomenological analysis method. Four themes and 12 sub-themes emerged: (1) decompensation phase: (i) misinterpretations of illness, (ii) heavy psychological burden, (iii) chaotic rhythms in family; (2) launch phase: (i) potential influences of labeling, (ii) we must cure my child anyway, (iii) begin adjusting to family roles; (3) recovery phase: (i) family reflection, (ii) subsequent reorganization of family resources, (iii) ultimately establishing a new balance; (4) normality phase: (i) adaption for medical seeking process, (ii) actively lower expectations, (iii) concerns of future needs. Mental health professionals could provide targeted suggestions to help the parents achieve family resilience by assessing its different phases.

Living with parental mental illness is like a roller coaster: Reflections on children's lifeworld in the family setting

AIMS AND OBJECTIVES

To explore what it is like for children in the family setting to live with parental mental illness.

BACKGROUND

There are reported risks of negative social and behavioural outcomes among children living with parental mental illness such as poor school performance, isolation and poor mental health. There is yet more to know about how children's interactions with significant members of the family shape their experiences.

DESIGN

A phenomenological design following Husserl's concepts of lifeworld and inter-subjectivity was adapted for the study.

METHOD

Twenty-one children (ages 10-17) who lived with a parent with mental illness were interviewed. The data were analysed to attain the essential features of the phenomenon. The study followed the COREQ checklist for qualitative studies.

FINDINGS

The essence of the phenomenon 'living with parental mental illness' in the family setting comprises strain, sadness and some happy moments. Living with parental mental illness can produce unpredictable life situations for children as relationships and interactions in the family setting can be chaotic and confusing. The ups and downs define their lifeworld as a roller coaster. Strenuous family environment, sibling interaction, navigating separate living arrangements and there are good days were specific themes that clarified the children's lives as a roller coaster.

CONCLUSION

A concept called the 'parent paradox' is coined to reflect how children are torn between what their living situation looks like comparing the parent with mental illness and the other without mental illness. The paradox is founded on children's loyalty towards their parents.

RELEVANCE TO CLINICAL PRACTICE

To break the unhealthy cycle created by the parent paradox, mental health nurses should ensure that children are well informed about the parent's mental condition including information about treatment procedures and recovery. Child's psychological distress may be reduced when they are informed.