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Parental Mental Health Concerns (MHCs), including affective disorders, impact each family member, making this "... a family experience - shared together but suffered separately" (Marshall, Bell, & Moules, 2010, p.197). When a parent has a MHC, their partner and children may be impacted in terms of their adjustment, mental health, social, emotional and academic development and life satisfaction. Parental MHCs hold further implications for the ways in which family members may interact and relate to each other. Alongside concerns regarding deleterious long term outcomes for families there is however, also the potential for resilience, bravery and possibilities that allow families to grow together and thrive. Accordingly, a family focussed approach is important in understanding the perspective of different members, without overlaying deficit laden expectations, frameworks or language. The required supports of each family member should also be determined, along with the subsequent interventions that might assist families to manage potential difficulties. To this end, this thesis poses the following three research questions: 1. What is the experience of families where a parent has an affective disorder? 2. What intervention components help families with parental MHCs? 3. How do families respond to the design and development of a new parent-initiated and family-focussed resource? Four studies have been conducted to seek answers to these research questions. The first study explored the experience of parental affective disorders using a family functioning model to guide interviews with parents who have depression and / or anxiety. Parents in study one described how their parenting and their way of interacting with family members changed from times when they were ill, compared to times when they were not experiencing mental health symptoms. These changes were most pertinent when performing their parenting role and remaining involved with their family. Parents perceived that changes to functioning influenced the subsequent behaviours of other family members, e.g., increased uncertainty and neediness in children. In addition, when ill, parents noted that communication within the family was less frequent, more negative and more hostile and that other family members might avoid talking altogether or use communication more cautiously. Finally, parents indicated that their partner assumed extra family tasks and duties when they were ill. Collectively, the results highlight possible intervention targets including family interactions, communication and functioning, alongside various family roles. Studies two and three employed a content analysis approach and the interviewing of experts to identify the core components of family-focussed interventions targeting families where a parent has a MHC. In study two, the focus was on identifying core components incorporated in available interventions. In study three the focus was on considering what ideally might be included in formal intervention supports, and who should deliver these. The importance of psycho-education was emphasized with a particular focus on knowledge provision to each family member about the impact of parental mental health on child development and wellbeing. Other intervention elements included improving family communication, and teaching skills such as positive parenting behaviours. Interestingly, results also indicated that parents who receive interventions are supported to actively change the ways their family interact and understand parental MHCs while children often receive coping strategies such as cognitive restructuring, to help them manage or adapt, but not influence the family milieu. Additionally, experts from study three did not rate skills training (such as coping skills) for children to be as essential or important as other core components such as changes to the environment including their role in the family. In terms of interventions, these results highlight a missed opportunity for family focussed interventions that might service the needs of children in an inclusive and empowering fashion. Moreover, study three found that, according to experts, clinicians’ supportive stance was essential for family engagement and outcomes. Study four extended the results of the previous studies by evaluating a particular resource, a DVD, designed by consumers, and delivered to families in a matter congruent with their needs and wishes. Consumers were able to assist in each step of the production of this resource, which meant that parents contributed to the knowledge on the DVD and ensured it was authentic and accurate. The DVD was evaluated using a mixed methods approach. Quantitative data indicated the DVD significantly changed parents’ understanding of how depression and / or anxiety can affect family members. Qualitative data from parent interviews provided an in-depth account of the experience of watching this resource, and of family outcomes which included holding discussions about parental MHCs with children. Most parents were overwhelmingly positive about the resource, and emphasized the importance of having support to talk about their MHCs with their family. The thesis provides important information about the family experience of parental mental health, and how functioning may fluctuate alongside mental health symptoms. Information about how parents perceive these changes to affect each family member can be used to identify specific areas for inclusion in psycho education, and for intervention. Ultimately, results collected across the four studies convey hope by finding that family functioning is dynamic rather than rigid, which indicates that positive family adaption to parental MHCs is feasible. These results highlight the value of delivering support for family knowledge, communication, skills training for parents in particular, as well as illuminating possible areas of opportunity for intervention with children, and of service development and provision that is consumer driven. A key message emanating from all studies includes the necessity of ensuring that support is strengths-based and enables families to manage their family's parental MHCs while feeling valued, validated and hopeful. In this way, parental MHCs may be regarded as a family experience - shared together and from which members can grow. |
