COPMI research news – February 2016

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Research news

Policy news

Research on children of parents with a mental illness

Research on child protection

Research on perinatal mental health

Monographs

 

Research news and articles

New international research project – The WARM Study

Researchers in Denmark and Scotland are collaborating on a new research project: Wellbeing and resilience: mechanisms of transmission of health and risk in parents with complex mental health problems and their offspring (The WARM Study). The WARM study is a longitudinal cohort study following infants of mothers with schizophrenia, bipolar disorder and depression. The control is set from pregnancy to infant one year of age, and researchers are currently establishing a cohort of pregnant women.

Factors in the parents, the infant and the social environment will be evaluated at one, four, 16 and 52 weeks in terms of evolution of very early indicators of developmental risk and resilience.

The aims of the WARM study are to:

  • identify very early risk markers for non-optimal development in infants of mothers with severe mental illness
  • explore transmission mechanisms of risk from parent to infant focusing especially on three possible mechanisms: stress, maternal caregiving-representation and mother-infant interaction

The researchers have recently published a study protocol in the journal BMC Psychiatry, which can be accessed
from the journal website.

Special issue of Advances in Mental Health

For those who missed it late last year, the journal ‘Advances in Mental Health’ published a special issue on ‘Prevention and early intervention for children and families where parents have mental illness’.

The special issue was guest edited by Professor Kim Foster and includes articles by COPMI staff.

Special issue of British Journal of Social Work

The Journal of Social Work recently published a special issue on ‘Social Work and Recovery’. This special issue includes a number of articles that may be relevant to COPMI researchers, including articles titled:

  • ‘Towards a Biopsychosociopolitical Frame for Recovery in the Context of Mental Illness’
  • ‘Exploring the Meaning of Recovery for Carers: Implications for Social Work Practice’
  • ‘Recovery-Promoters: Ways in which Children and Mothers Support One Another’s Recoveries from Domestic Violence;

For more information, see the journal website.

Policy news

Third action plan for the National Framework for Protection Australia’s Children

The Commonwealth Department of Social Services (DSS) has released the Third Action Plan (2015-2018) for the National Framework for Protecting Australia’s Children 2009-2020. The Third Action Plan comprises the following overarching strategies:

  • Strategy 1: Early intervention with a focus on the early years, particularly the first 1000 days for a child
  • Strategy 2: Helping young people in out-of-home care to thrive into adulthood
  • Strategy 3: Organisations responding better to children and young people to keep them safe
  • Strategy 4: Cross-cutting focus area: Aboriginal and Torres Strait Islander children and families

Parental mental health does not appear to be a priority in the Third Action Plan.

Research on children of parents with a mental illness

Mental health resilience in the adolescent offspring of parents with depression: A prospective longitudinal study

Background: Young people whose parents have depression have a greatly increased risk of developing a psychiatric disorder, but poor outcomes are not inevitable. Identification of the contributors to mental health resilience in young people at high familial risk is an internationally recognised priority. Our objectives were to identify protective factors that predict sustained good mental health in adolescents with a parent with depression and to test whether these contribute beyond what is explained by parent illness severity.

Methods: The Early Prediction of Adolescent Depression study (EPAD) is a prospective longitudinal study of offspring of parents with recurrent depression. Parents with recurrent major depressive disorder, co-parents, and offspring (aged 9–17 years at baseline) were assessed three times over 4 years in a community setting. Offspring outcomes were operationalised as absence of mental health disorder, subthreshold symptoms, or suicidality on all three study occasions (sustained good mental health); and better than expected mental health (mood and behavioural symptoms at follow-up lower than predicted given severity of parental depression). Family, social, cognitive, and health behaviour predictor variables were assessed using interview and questionnaire measures.

Findings: Between February and June, 2007, we screened 337 families at baseline, of which 331 were eligible. Of these, 262 completed the three assessments and were included in the data for sustained mental health. Adolescent mental health problems were common, but 53 (20%) of the 262 adolescents showed sustained good mental health. Index parent positive expressed emotion (odds ratio 1·91 [95% CI 1·31–2·79]; p=0·001), co-parent support (1·90 [1·38–2·62]; p<0·0001), good-quality social relationships (2·07 [1·35–3·18]; p=0·001), self-efficacy (1·49 [1·05–2·11]; p=0·03), and frequent exercise (2·96 [1·26–6·92]; p=0·01) were associated with sustained good mental health. Analyses accounting for parent depression severity were consistent, but frequent exercise only predicted better than expected mood-related mental health (β=–0·22; p=0·0004) not behavioural mental health, whereas index parents’ expression of positive emotions predicted better than expected behavioural mental health (β=–0·16; p=0·01) not mood-related mental health. Multiple protective factors were required for offspring to be free of mental health problems (zero or one protective factor, 4% sustained good mental health; two protective factors, 10%; three protective factors, 13%, four protective factors, 38%; five protective factors, 48%).

Interpretation: Adolescent mental health problems are common, but not inevitable, even when parental depression is severe and recurrent. These findings suggest that prevention programmes will need to enhance multiple protective factors across different domains of functioning.

Reference: Collishaw, S., et al. (2015). Mental health resilience in the adolescent offspring of parents with depression: a prospective longitudinal study, The Lancet Psychiatry, 3(1), 49-57.

Navigating in an unpredictable daily life: a metasynthesis on children’s experiences living with a parent with severe mental illness

A large group of individuals suffering from mental illness are parents living with their children. These children are invisible in the health care even though at risk for illhealth. The aim of this metasynthesis was to advance knowledge of how children of parents with mental illness experience their lives, thus contributing to the evidence of this phenomenon.

The metasynthesis is following Sandelowski and Barroso’s guidelines. Literature searches covering the years 2000 to 2013 resulted in 22 reports which were synthesised into the theme ‘navigating in an unpredictable everyday life’ and the metaphor compass.

Children of parents with mental illness irrespective of age are responsible, loving and worrying children who want to do everything to help and support. Children feel shame when the parent behaves differently, and they conceal their family life being afraid of stigmatisation and bullying. When their parent becomes ill, they distance to protect themselves. The children cope through information, knowledge, frankness and trustful relationships. These children need support from healthcare services because they subjugate own needs in favour of the parental needs, they should be encouraged to talk about their family situation, and especially, young children should to be child-like, playing and seeing friends.

Reference: Dam, K., & Hall, E., (2016). Navigating in an unpredictable daily life: a metasynthesis on children’s experiences living with a parent with severe mental illness. Scandinavian Journal of Caring Sciences, [Epub ahead of print]. doi: 10.1111/scs.12285

A fractured journey of growth: making meaning of a ‘broken’ childhood and parental mental ill-health (*Australian research*)

The psychopathological impact of parental mental ill-health on children is well known. However, little research
explores positive and negative interpretations of such exposure in childhood, from the adult child’s perspective. Using interpretative phenomenological analysis this study sought subjective interpretations of the ‘lived’
experiences of growing up in a family with parental mental ill-health.

A purposive sample of seven adult children provided data for analysis through semi-structured interviews. One superordinate theme: A fractured journey of growth to adulthood, overarched six subordinate themes. Four themes captured stigma, shame, social isolation and betrayal. Juxtaposed with this, two themes captured purposeful redefinition of self and psychological growth.

This study captures the chronicity of traumatic distress and sense of betrayal experienced by these participants in childhood through unrelenting exposure to parental mental ill-health. However, despite unpredictability, fear, and neglect in childhood, they identified the emergence of inner strengths in adult life: Unexpected growth in empathy and compassion, high resourcefulness, and personal authenticity through higher education.

Findings highlight that positively redefining ‘self’ in adult life is possible in the aftermath of childhood trauma associated with parental mental ill-health. Implications for therapy include: (a) moving forward from childhood trauma and (b) managing ongoing family dynamics in adult-life.

Reference: McCormack, L., White, S. & Cuenca, J. (2016). A fractured journey of growth: making meaning of a ‘Broken’ childhood and parental mental ill-health. Community, Work & Family, [Epub ahead of print]. doi: 10.1080/13668803.2015.1117418 
 

Research on child protection

Constructing Parental Problems: The Function of Mental Illness Discourses in a Child Welfare Context

Understanding how social workers and parental service users construct the meanings of parental problems in the child protection context is important, as ultimately this affects decision making. Using qualitative methods, this study elicited social workers’ and parental service users’ perceptions of decision-reasoning and analysed them from a discursive constructionist perspective.

By completing secondary analysis of social worker–parental service user pairs, this article describes patterns in how the causes of family problems were constructed by social workers and parental service users. It was found that explanations of poor mental health and lack of supports for initial family problems were used to emphasise a lack of parental culpability by both parties, particularly through a narrative of separating one’s ‘authentic self’ from the impacts of mental illness on parenting. This convergence of explanations helped to maintain fragile parental identities, assisted with relationship maintenance, and allowed both social workers and parents to acknowledge harm to children. However, an individualised view of problems promoted by mental illness discourses was unable to account for the impact of domestic violence and poverty on parental life experiences, and thus sometimes over-emphasised parental responsibility.

Reference: Keddell, E. (2015). Constructing Parental Problems: The Function of Mental
Illness Discourses in a Child Welfare Context. The British Journal of Social Work, [Epub ahead of print]. doi: 10.1093/bjsw/bcv096

Research on perinatal mental health

Perinatal mental health: Fathers – the (mostly) forgotten parent

Introduction: The importance of parental mental health as a determinant of infant and child outcomes is increasingly acknowledged. Yet, there is limited information regarding paternal mental health during the perinatal period. The aim of this review is to summarize existing clinical research regarding paternal mental health in the perinatal period in various contexts, and its possible impact on infant development.

Method: An electronic literature search was conducted using MEDLINE and PubMed databases. Key texts were used to cross-check for any further articles of interest.

Results: Men are at increased risk of mental health problems during the transition to fatherhood, as well as during the perinatal period. Paternal mental health during the perinatal period has been shown to impact on their child’s emotional and behavioral development. However, research addressing the needs of fathers with mental illness and the impact of their illness on their infant and family has been limited.

Conclusions: A paradigm shift is required, from a focus on women following childbirth and women with pre-existing psychiatric disorders, to a broader family perspective with the focus firmly on parent–infant relationships. This paradigm shift needs to involve greater research into the fathering role and paternal mental illness during the perinatal period, including further studies into risk factors, impact on the family system, and the most appropriate form of intervention and service provision.

Reference: Olivia, W., Nguyen T., Thomas, N., Thomson-Salo, F., Handrinos, D., & Judd, F. (2015).
Perinatal mental health: Fathers – the (mostly) forgotten parent. Asia-Pacific psychiatry, [Epub ahead of
print]. doi:10.1111/appy.12204.

A complex postnatal mental health intervention: Australian translational formative evaluation (*Australian research*)

Reducing the burden of postnatal maternal mental health problems is an international public health priority. We developed What Were We Thinking (WWWT), a psychoeducation programme for primary postnatal health care that addresses known but neglected risks. We then demonstrated evidence of its effects in a before-and-after controlled study in preventing maternal postnatal mental health problems among women without a psychiatric history participating in the intervention compared to usual care (AOR 0.43; 95% CI 0.21, 0.89) when conducted by specialist nurses. Testing its effectiveness when implemented in routine primary care requires changes at practitioner,organizational and health system levels. This paper describes a programme of translational formative evaluation to inform the protocol for a cluster RCT.

Following the UK Medical Research Council (MRC) Guidance for evaluating complex interventions, we conducted a translational formative evaluation using mixed methods. Collection and analysis of postnatal health service documents, semi-structured interviews, group discussions and an online survey were used to investigate service provision, consumers’ needs and expectations, clinicians’ attitudes and clinical practice, and the implications for health service delivery. Participants were expectant parents, health care providers, health service managers and government policy makers.

Results documented current clinical practice, staff training needs, necessary service modifications to standardize advice to parents and include fathers, key priorities and drivers of government health policy, and informed a model of costs and expected health and social outcomes. Implementation of WWWT into routine postnatal care requires adjustments to clinical practice. Staff training, modifications to service opening hours and economic implications for the health system also need to be considered.

The MRC Guidance for developing and evaluating complex interventions is a useful framework for conceptualizing and reporting translational formative evaluation, which is an essential step in the evidence trajectory. The results of the evaluation will inform the protocol for a cluster RCT of WWWT and associated health economic evaluation.

Reference: Rowe, H., Wynter, K., Burns, J., Fisher, J. (2016). A complex postnatal mental
health intervention: Australian translational formative evaluation. Health Promotion International, [Epub ahead of print].

Monographs

Joint Care of Parents and Infants in Perinatal Psychiatry

This book addresses key issues in perinatal mental health and discusses the different types of psychiatric care
that may be appropriate for pregnant women, parents and infants, with emphasis on the need for joint care. The wide range of preventive measures, mainly applicable in primary care and the various potential curative interventions are examined in detail, with coverage of ambulatory care, day care and the role of mother and baby units.

The importance of working in networks and joint decision-making strategies is explained. In addition, an overview of maternal perinatal psychopathology is provided and other relevant aspects are fully discussed, including the establishment of parent–infant interactions and the impacts of parental psychiatric illness on parenting skills and infant development.

The book will be invaluable for adult and child psychiatrists, psychologists, psychotherapists, midwives, nurses and all others involved in the provision of perinatal psychiatric care.

Reference: Sutter-Dallay, A., Glangeaud-Freudenthal, N., Guedeney, A., Riecher-Rössler, A. (2016). Joint Care of Parents and Infants in Perinatal Psychiatry. Springer international.

Parental Mental Health and Child Welfare Work Volume 1: A Pavilion Annual 2016

Research has established the potential direct and indirect impacts of mental illness on parenting, the parent-child relationship, and the child, and the extent to which this poses a public health challenge. Problems with how adult and children’s services understand and deliver support to parents with mental health problems and their children have also been identified. In contrast, far less is known about how parents with mental health difficulties and their children can be supported successfully.

The primary aim of Parental Mental Health and Child Welfare Work Volume 1: A Pavilion Annual 2016 is to begin to address this gap in research by capturing different perspectives (policy, research, professional and family) about what constitutes success and the contributions that lead to success. The annual will share this information, tools and resources, in ways that are accessible, useful, and usable by the broad range of professional groups involved in this complex area of practice.

Parental Mental Health and Child Welfare Work Volume 1: A Pavilion Annual 2016 forms the first volume of Pavilion’s new Annual series, which act as a yearly update on key research, policy developments and practice innovations, in the UK and elsewhere.

Reference: Diggins, M. (2016). Parental Mental Health and Child Welfare Work Volume 1: A Pavilion Annual 2016. Pavilion.

 

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