Outcomes of parental mental illness on children: a qualitative study from Iran

Children of parents with mental illness are a substantial, yet marginalized group. This study, as part of a more extensive research project, used grounded theory to explore the outcomes of parental mental illness on their children. Seventeen informants were interviewed at a mental hospital in the city of Qazvin, Iran. The participants were selected using purposeful and theoretical sampling. Interviews were analyzed using Strauss and Corbin's method. It was revealed that parental mental illness leads to five major outcomes that involve communication, mental, educational, economic, and extra roles factors. As such, it is suggested that these children should be considered within health care plans and that policy makers, nurses, and other health care providers use these findings for preventive and educational purposes.     

Male gamblers – suicide victims and living controls: comparison of adversity over the life course

The objective of this research is to investigate the possible difference in accumulation of adversity over the life course among decedent gamblers and living control gamblers in the province of Quebec, Canada. A sample of 90 adult men, 41 living participants and 49 suicide decedents, met the criteria for at-risk and problem gambling over the last five years. Data were obtained from informants in the case of suicide and directly from living controls during semi-structured face-to-face interviews using SCID I and II, SOGS, Module K and a recount of life trajectories methodology. The results showed a high level of adversity throughout the life trajectories of both groups. However, the living gamblers faced more difficulties during their lifespan than the suicide victims. In the last six months before their death, suicide victims had a significantly higher number of mental health disorders, especially co-morbid mental health disorders and anxiety, compared to the living controls. We also observed a rapid escalation of difficulties, more life events and more psychological distress in the last six months of their lives among the suicide decedents. Suicidal behaviour needs to be carefully investigated by medical staff and mental health practitioners, especially when gamblers demonstrate evidence of mental health disorders or financial difficulties.     

Screening for trauma exposure, and posttraumatic stress disorder and depression symptoms among mothers receiving child welfare preventive services

The role of parental trauma exposure and related mental health symptoms as risk factors for child maltreatment for parents involved with the child welfare (CW) system has received limited attention. In particular, little is known about the extent to which mothers receiving CW services to prevent maltreatment have experienced trauma and suffered trauma-related psychopathology. This study examined screening data collected from 127 mothers receiving CW preventive services. There were high levels of trauma exposure among screened mothers and their young children. Among mothers, 91.6% experienced at least one traumatic event (M = 2.60) and 92.2% reported their children had been exposed to one or more traumas (M = 4.85). Mothers reported high levels of trauma-related symptoms: 54.3% met probable criteria for posttraumatic stress disorder (PTSD) or depression (61.7%). Nearly half (48.8%) met criteria for co-morbid PTSD and depression. The large majority of the clients with trauma-related disorders were not receiving mental health services. Latina women had significantly more severe PTSD symptoms than African American women. Case planners reported that the screening process was useful and feasible. These findings underscore the feasibility and importance of trauma screening among parents receiving CW preventive services.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Mental health and substance use disorders among foster youth transitioning to adulthood: Past research and future directions

At a time when there is increasing attention being given to systematically integrating the well-being of children with the goals of safety and permanence in child welfare, little is known about the psychosocial functioning of foster youth transitioning to adulthood from substitute care. This article systematically reviews 16 peer-reviewed articles and/or research reports to identify lifetime and past year prevalence rates of mental health disorders and service utilization. At ages 17 or 18, foster youth are 2 to 4 times more likely to suffer from lifetime and/or past year mental health disorders compared to transition aged youth in the general population. Findings show that mental health service use declines at ages when the prevalence rate of mental health disorders is peaking. The findings of this review suggest the need to focus future efforts in three main areas: 1) setting a common research agenda for the study of mental health and service use; 2) routine screening and empirically supported treatments; and 3) integration and planning between child and adult mental health service systems.     

Gambling problems seldom come alone: prevalence and temporal relationships of mental health problems in casino excluders

ABSTRACT

To estimate the effectiveness of gambling exclusion programmes, previous research focused on changes in gambling behaviour post-exclusion. Although other mental health problems, especially co-morbid mental disorders, may be crucial for relapse and recovery of gambling-related problems, these factors have rarely been studied in excluders. Therefore, this study aimed to assess a comprehensive mental health status of excluders using well-validated diagnostic instruments. Fifty-eight casino excluders participated in face-to-face diagnostic interviews and completed several validated questionnaires (e.g. Stinchfield Questionnaire, Brief Symptom Inventory). Retrospective temporal sequences of diagnosed mental disorders, help-seeking behaviour and exclusion were examined. The majority of excluders reported impairments in mental health aspects. About three-quarters met criteria of lifetime gambling disorder, more than half in the last 12 months whereby screening and diagnostic measures correlated moderately. Other mental disorders were frequent, especially affective and substance-related disorders and typically preceded the onset of gambling disorder. Six years passed between self-awareness of gambling problems and help-seeking. Two more years passed until exclusion. Frequent mental health problems suggest the need for individually tailored support beyond exclusion programmes (e.g. psychotherapy, pharmacotherapy, counselling services). Late help-seeking and exclusion entry claim for improved early detection and intervention concepts that consider underlying mental disorders.     

Children’s Mental Health Providers’ Perceptions of Mental Health Literacy Among Parents and Caregivers

Mental health disorders are prevalent among children, yet many do not receive treatment. Parents and caregivers play a vital role in recognizing mental health disorders in children and accessing treatment. But a substantial number of parents lack essential knowledge of children’s mental health disorders, including risk factors, symptom recognition, and treatment options. Little focus has been given to parents in the children’s mental health literacy literature. The purpose of this article is to begin filling that gap by using a survey to describe the perceptions of child and family mental health providers’ perceptions regarding the amount, accuracy, and origin of mental health literacy in the parents of the children they treat. The impact of those perceptions on the work of providers is also explored. Eighty-seven mental health providers completed a survey to assess their perceptions of parent mental health literacy in the area of children’s mental health. Providers perceived parent mental health literacy as low, inaccurate, and inconsistent. In addition, providers indicated that parents rely on informal sources of support, such as friends and family for information about children’s mental health. Implications for social work researchers, practitioners, and the children and families they serve are discussed.     

Do male and female gamblers have the same burden of adversity over their life course?

The objective of this research is to investigate gender difference and the burden of adversity during the life course of people who develop gambling problems. A sample of 86 adult participants met the criteria for at-risk problem gambling over the last 5 years. Data were obtained from informants during semi-structured face-to-face interviews, using SCID I and II, SOGS, Module K and a recount of life trajectories methodology. The results showed a high level of adversity throughout the life trajectories of the men and women studied. The results indicated that the major load of mental health disorders, the presence of anxiety disorders and co-morbid mental health disorders are more significant among women. Results also indicated a significant presence of violence in the lives of both men and women during early childhood and adolescence. During adulthood, women are more likely to be victims of intimate partner or marital violence whereas men tended to cumulate difficulties in social fields and especially in their professional lives. This significant burden of adversity creates a number of difficulties which makes it complicated to isolate gambling activities. Clinicians might have difficulty detecting female gamblers during consultation, especially when they present with co-morbid mental health disorders and violence issues.     

Youth with Serious Mental Health Disorders: Wraparound as a Promising Intervention in New Zealand

Youth with serious mental health disorders present with a complexity of challenges for the mental health system, schools, youth justice, care and protection, and their communities. Research shows their needs are best achieved by providing coordinated intensive, multidisciplinary, and individualised services. This article outlines the prevalence and characteristics of youth with serious mental health disorders. It also discusses community‐based interventions used in New Zealand and their limitations. It introduces Wraparound, an intensive individualised coordination and care planning process as a promising practice for youth with serious mental health disorders and their families. Key principles and phases underpinning the Wraparound process are presented along with a case vignette to exemplify the process. Its theory of change, the challenges experienced in practice, and a brief overview of the evidence‐base are also discussed.     

Examining Outpatient Treatment Dropout in Adolescents: A Literature Review

This literature review explores the research to date on adolescent mental health treatment drop out. As many as one in five adolescents in the United States has been diagnosed with an Axis-I psychiatric disorder. Adolescents with Axis-I psychiatric disorders face significant short- and long-term consequences if they do not obtain mental health treatment. However, treatment dropout research has focused on child and adult populations with little focus on the unique issues that are likely to impact adolescents. The theoretical underpinnings for understanding adolescent mental health treatment are explored in relation to adolescent psychological development and the therapeutic alliance. The review concludes with suggestions for future research to extend our understanding of adolescent treatment drop out.     

A Theory of Mental Health and Optimal Service Delivery for Homeless Children

Homeless children are a vulnerable group with high risk for developing mental health disorders. The pathways to disorders among homeless children have not been fully elucidated, with significant logistical and measurement issues challenging accurate and thorough assessment of need. The environments of homeless children are uniquely chaotic, marked by frequent moves, family structure changes, household and neighborhood disorder, parenting distress, and lack of continuous services. Despite high rates of service use, mental health outcomes remain poor. This paper reviews the literature on homeless children’s mental health, as well as prior theoretical explorations. Finally, the paper proposes a theoretical model that explains elevated rates of mental health problems among homeless children as consequences of harmful stress reactions triggered by chronic household instability along with repeated service disruptions. This model draws upon existing conceptual frameworks of child development, family poverty, health services utilization, and the biology of stress to clarify the role of environmental chaos in the development of child emotional and behavioral problems. Potential strategies to mitigate the risk for mental health disorders among homeless children and future research directions are discussed.     

The labeling paradox: stigma, the sick role, and social networks in mental illness

Although research supports the stigma and labeling perspective, empirical evidence also indicates that a social safety net remains intact for those with mental illness, recalling the classic "sick role" concept. Here, insights from social networks theory are offered as explanation for these discrepant findings. Using data from individuals experiencing their first contact with the mental health treatment system, the effects of diagnosis and symptoms on social networks and stigma experiences are examined. The findings suggest that relative to those with less severe affective disorders, individuals with severe diagnoses and more visible symptoms of mental illness have larger, more broadly functional networks, as well as more supporters who are aware of and sympathetic toward the illness situation. However, those with more severe diagnoses are also vulnerable to rejection and discrimination by acquaintances and strangers. These findings suggest that being formally labeled with a mental illness may present a paradox, simultaneously initiating beneficial social processes within core networks and detrimental ones among peripheral ties.     

Serving the needs of immigrant families of children with autism

The growing influx of immigrant families into the USA necessitates an understanding of how these families manage mental health disorders. Few studies have documented the ways in which autism spectrum disorders (ASD) are understood across different immigrant groups. This lack of knowledge creates barriers for practitioners who are encountering immigrant families in their practice. The present paper provides a conceptual framework of how cultural values and beliefs shape the way diagnosis, etiology and treatment of ASD is perceived by both immigrant families and western practitioners and how differences in perspectives may create obstacles in treatment planning. A review of the literature describing practical and cultural barriers to mental health access and research among immigrant populations is also presented. Finally, recommendations are offered to practitioners, families and individuals with ASD to aid in increasing understanding and collaboration among these populations when designing and implementing treatment interventions.     

Multiple Co-occurring Behaviours among Gamblers in Treatment: Implications and Assessment

A substantial portion of gamblers in treatment may have co-occurring mental health disorders including substance use disorders, especially alcohol dependency, personality disorders, affective disorders, anxiety disorders and impulse control disorders. Co-occurring mental health disorders affect treatment seeking, the treatment process and its outcome, quality of life and functioning in many mental health disorders. Participants in this study were 78 adults enrolled in state-supported out-patient services for pathological gambling and current Gamblers Anonymous attendees. The majority of participants (76.6%) had co-occurring behaviours; 55.8% had multiple co-occurring behaviours. Participants with multiple co-occurring behaviours were more likely to report that a co-occurring behaviour increased the severity of their gambling symptoms. A dose/response relationship between number of co-occurring behaviours and severity of gambling problems was found. Co-occurring behaviours can interact with gambling behaviour. Brief, validated screening instruments are available for screening and diagnosing co-occurring behaviours among gamblers presenting for treatment.     

Negotiating narratives surrounding children's mental health diagnoses: Children and their contribution to the discourse

Despite increasing numbers of children diagnosed with mental health disorders, there is limited research on how children come to understand these diagnoses in childhood. This study examines the retrospective accounts of emerging adults who were diagnosed with mental health disorders in childhood to better understand how they made sense of their diagnoses over time. In-depth, semi-structured interviews were conducted with 42 emerging adults (ages 18 to 22) who were diagnosed with attention deficit hyperactivity disorder (ADHD), depression, generalized anxiety disorder (GAD), and/or bipolar disorder in childhood. Interviews elicited participants' experiences learning about their diagnoses and suggestions for how diagnoses should best be explained to children. Findings demonstrate that participants actively sought and obtained information about their diagnoses over time. They negotiated narratives from several sources, including parents, teachers, mental health professionals, peers, siblings, the media, reading materials, and the Internet. Many of those who embraced medical accounts of their diagnoses did so as they obtained in-depth medical information over time. Meanwhile, those whose parents were open and communicative without using medical narratives suggest it is possible to share information with children without utilizing the terminology of “disorder.” Participants emphasize the importance of being open with children and providing them assurances, explaining that their problems are legitimate, common, and “not their fault.” Implications for social work practice are discussed.     

The Current State of Mental Health Research on Asian Americans

Summary

A review of research reveals that the prevalence rates of depression, somatization, and posttraumatic stress disorder among Asian Americans are at least as high as those for White Americans, and, in many cases, higher rates are exhibited. Findings with respect to anxiety have been equivocal. The conclusion that is best supported by research at this time is that Asian Americans are not extraordinarily well adjusted, in contrast to their stereotype as a model ethnic minority group. What has hindered researchers in determining the rates and distributions of mental disorders among Asian Americans has been methodological and conceptual problems. These problems involve (a) making cross-cultural comparisons using assessment instruments that have been standardized on one group and applied to another and (b) phenomena unique to Asian Americans, including their population size, heterogeneity, and rapid demographic changes. Suggestions for research directions are given.     

“A lot of work needs to be done”—Service provider perspectives of mental health services available to Croatia- and Bosnia-born migrants

Research suggests that migrants have higher rates of mental health disorders but are less likely to access mental health services, which highlights both their vulnerability to mental illness and inequity in service provision. Despite being large and established culturally similar migrant cohorts in Australia, Croatians and Bosnians are invisible in mental health research. This qualitative study collected practice-based evidence from eight mental health service providers who have had direct professional contact with these communities, in order to understand how they engage with services, barriers to uptake and provide suggestions for service improvements. Thematic analysis was used to identify themes across interviews, which were then compared against Yang and Hwang's Migrant Mental Health Service Utilisation Model. The study identified unique factors specific to Croatia- and Bosnia-born migrants that impact how they engage with services, including mandated/prescribed services, religious resources, knowledge resources, referral pathways and procedures, and service provider competencies. This study will promote a better understanding of the limitations of the current mental health service offerings for Croatia- and Bosnia-born migrants, making it significant to practitioners, mental health organizations, policymakers and the general public.     

The history, economics, and financing of mental health care. Part 1: 17th to 19th centuries

Families in colonial times cared for their mentally ill members at home, with little assistance from their communities. Community treatment is an old idea, not a new one. Early laws about containing the disturbances created by individuals with mental illness made no mention of clinical dimensions. The focus was strictly on the social and economic consequences of the mental disorders. Legislation about public mental hospitals in the mid-19th century was hardly enlightened. There were no particular plans, other than not to expend more dollars than actually necessary.     

Psychiatric comorbidity in women with a history of childhood sexual abuse

Childhood sexual abuse (CSA) is associated with the development of numerous adult mental disorders. Women with a history of CSA were surveyed concerning their abuse experience and prevalence of DSM-IV mental disorders. The 63 women in the low morbidity cluster had a mean of 1.02 disorders. The 11 women in the moderate morbidity cluster had a mean of 2.36 disorders. The 16 women in the severe morbidity cluster had a mean of 4.75 disorders. Childhood family environment and CSA during preschool years were important predictors of morbidity cluster membership.