Expressed Emotion and Attributions in Parents With Schizophrenia

The Parenting Practices of Parents with Psychosis: A Systematic Integrative Review

Parental psychosis has been reliably associated with adverse outcomes for both parents and children. Despite this, support for these families remains limited. Understanding the everyday parenting practices of parents with psychosis, and whether they differ from parents without psychosis is crucial for developing suitable, evidence-based interventions. We therefore aimed to synthesise quantitative and qualitative research to answer two research questions: (1) 'What are the parenting practices of parents who experience psychosis?' and (2) 'Are the parenting practices of parents who experience psychosis the same as the parenting practices of parents without serious mental illness (SMI)?' Five databases were searched for terms associated with parenting, psychosis and parenting practices, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The Mixed Methods Appraisal Tool was used for quality appraisal prior to an integrative narrative synthesis being conducted. Twelve studies (n = 9 quantitative; n = 3 qualitative) containing 1115 parents with psychosis were included. The synthesis revealed that parents with psychosis frequently use positive authoritative parenting strategies, but sometimes this can be difficult to sustain, with parents resorting to permissive and inconsistent parenting practices. They appear to do so more frequently than parents without SMI but because only four studies utilised a control group, more comparative research is needed. The review recommends further support, and use of parenting interventions for parents with psychosis, alongside systemic practice change initiatives within adult mental health services.

Expressed emotion of caregivers to children at familial high risk of schizophrenia or bipolar disorder: The Danish High Risk and Resilience Study - VIA 11

A high level of parental expressed emotion is thought to play an important role in the development and course of mental disorders in offspring. This study investigates expressed emotion among primary caregivers to 11-year-old children at familial high risk of schizophrenia or bipolar disorder and population-based controls, and whether potential differences in expressed emotion are related to child psychopathology. Expressed emotion was assessed with the Five-Minute Speech Sample and a total of 440 audio files from primary caregivers were collected. Child psychopathology was assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children. Primary caregivers from families with a parental diagnosis of schizophrenia spectrum disorder or bipolar disorder were classified as high on expressed emotion significantly more often than population-based controls. Between-group differences remained significant after adjusting for any current axis I child diagnosis indicating that high expressed emotion is not solely attributable to the presence of child psychopathology. These findings underline the importance of assessing the emotional climate in families with parental schizophrenia and bipolar disorder.

A family dynamics theory perspective on parenting styles and children's aggressive behavior

BACKGROUND

Children's mental health and behavioral habits are crucial to social development. Previous studies have focused on social learning theory and Baumrind's parenting style theory to explain the impact of parenting style on children's aggressive behavior, but findings have been inconsistent. This paper introduces family dynamics theory in order to further elucidate the complexities surrounding the relationship between parenting styles and child aggression, with the aim of informing interventions to reduce child aggression and promote child behavioral health.

METHODS

Questionnaire method was used in the study. Simplified Parenting Style Scale, Aggression Questionnaire, Questionnaire of Systemic Family Dynamics were used to measure psychological condition of 455 primary school children.

RESULTS

Findings indicate that parental rejection, overprotection, and system logic positively predict aggressive behavior, whereas emotional warmth and family climate negatively predict it. Notably, family climate and system logic mediate the relationship between parenting styles and children's aggressive behavior.

CONCLUSION

These results underscore the importance of positive parenting practices, a nurturing family environment, and the cultivation of diverse cognitive skills in mitigating children's aggressive tendencies.

Clinical illness course and family-related outcomes among parents with a first episode of schizophrenia spectrum disorder: a 20-year follow-up of the OPUS trial

BACKGROUND

Studies investigating parenthood and how it affects long-term outcomes are lacking among individuals with schizophrenia spectrum disorders. This study aimed to examine the life of participants 20 years after their first diagnosis with a special focus on parenthood, clinical illness course, and family-related outcomes.

METHODS

Among 578 individuals diagnosed with first-episode schizophrenia spectrum disorder between 1998 and 2000, a sample of 174 participants was reassessed at the 20-year follow-up. We compared symptom severity, remission, clinical recovery, and global functioning between 75 parents and 99 non-parents. Also, family functioning scored on the family assessment device, and the children's mental health was reported. We collected longitudinal data on psychiatric admission, supported housing, and work status via the Danish registers.

RESULTS

Participants with offspring had significantly lower psychotic (mean (s.d.) of 0.89 (1.46) v. 1.37 (1.44), p = 0.031) negative (mean [s.d.] of 1.13 [1.16] v. 1.91 [1.07], p < 0.001) and disorganized symptom scores (mean [s.d.] of 0.46 [0.80] v. 0.85 [0.95], p = 0.005) and more were in remission (59.5% v. 22.4%, p < 0.001) and in clinical recovery (29.7% v. 11.1%, p = 0.002) compared to non-parents. When investigating global functioning over 20 years, individuals becoming parents after their first diagnosis scored higher than individuals becoming parents before their first diagnosis and non-parents. Regarding family-related outcomes, 28.6% reported unhealthy family functioning, and 10% of the children experienced daily life difficulties.

CONCLUSIONS

Overall, parents have more favorable long-term outcomes than non-parents. Still, parents experience possible challenges regarding family functioning, and a minority of their children face difficulties in daily life.

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.

Recovery journey of people with a lived experience of schizophrenia: a qualitative study of experiences

BACKGROUND

Mental health recovery involves an integration of clinical and psychosocial frameworks. The recovery journey of individuals diagnosed with schizophrenia and the factors that influence it have been extensively studied. Because the recovery journey is culturally influenced, we examined the recovery process expriences of individuals diagnosed with schizophrenia in China, focusing on the influence of a Confucian-dominated collectivist and family-centred culture.

METHODS

An Interpretive Phenomenological Analysis (IPA) study was conducted; data were gathered through in-depth interviews with 11 individuals with lived experience of schizophrenia.

RESULTS

Four themes were identified in this study: traumatic illness experiences, influence of the family, motives for recovery, and posttraumatic growth, comprising ten subthemes. "For the family" and "relying on oneself" are the main drivers of recovery for individuals with a Chinese cultural background. Some people believe that taking care of themselves is an important way to ease the burden on their families and treat them well. There is a link between 'for the family' and 'relying on oneself.

CONCLUSIONS

Individuals living with schizophrenia in China have undergone significant traumatic experiences and have profound interactions with their families. Post-traumatic growth reflects an increase in the individual's connection to others and individual agency. It also suggests that the individual is not receiving enough support outside of the family. The impact of individual agency and family relationships should be considered in services that promote recovery, and clinic staff should enhance support outside the home to the individuals.

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.

The impact of parent history of severe mental illness on schizophrenia outcomes: results from the real-world FACE-SZ cohort

Parent history of severe mental illness (PHSMI) may have long-term consequences in adult offspring due to genetic and early environmental factors in preliminary studies. To compare the outcomes associated in subjects with PHSMI to those in patients without PHSMI. The participants with schizophrenia and schizoaffective disorders were recruited in the ongoing FACE-SZ cohort at a national level (10 expert centers) and evaluated with a 1-day-long standardized battery of clinician-rated scales and patient-reported outcomes. PHSMI was defined as history of schizophrenia or bipolar disorders in at least one parent and was included as explanatory variable in multivariate models. Of the 724 included patients, 78 (10.7%) subjects were classified in the PHSMI group. In multivariate analyses, PHSMI patients had a better insight into schizophrenia and the need for treatment and reported more often childhood trauma history compared to patients without PHSMI. More specifically, those with paternal history of SMI reported more severe outcomes (increased childhood physical and emotional abuses, comorbid major depression and psychiatric hospitalizations). PHSMI is associated with increased risk of childhood trauma, major depressive disorder and psychiatric hospitalization and better insight in individuals with schizophrenia. Specific public health prevention programs for parents with SMI should be developed to help protect children from pejorative psychiatric outcomes. PHSMI may also explain in part the association between better insight and increased depression in schizophrenia.