Children of Parents With Mental Illness: An Investigation of Intervention and Resilience

Eliza Fraser (). Children of Parents With Mental Illness: An Investigation of Intervention and Resilience Professional Doctorate, School of Psychology, The University of Queensland.

       
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Author Eliza Fraser
Thesis Title Children of Parents With Mental Illness: An Investigation of Intervention and Resilience
School, Centre or Institute School of Psychology
Institution The University of Queensland
Thesis type Professional Doctorate
Supervisor Associate Professor Kenneth Pakenham
Total pages 207
Abstract/Summary There are an estimated one million children living in Australia who have a parent with a mental illness (Maybery, Reupert, Patrick, Goodyear, & Crase, 2005). These children are more likely than their peers with ‘healthy’ parents to experience poorer outcomes in a variety of domains (Australian Infant, Child, Adolescent and Family Mental Health Association [AICAFMHA], 2001), and may be presented with the unique experiences and challenges of performing within a caregiving role for their parent (Aldridge & Becker, 1993). The observation that not all children in this situation are adversely affected by parental mental illness (Silverman, 1989) led to the application of resilience theory to this group, and the identification of risk and protective factors related to the individual, the parent’s illness, the family environment, and social circumstances. While a great amount of research has focused on the relationships between resilience factors and adjustment outcomes, there has been almost no research published regarding resilience and caregiving experiences. The dominance of resilience theory in this area has guided the development of interventions for children who have a parent with a mental illness. Reviews of interventions for children of parents with mental illness indicate the need for evidence-based practice, including the development of theoretical foundations for intervention design and the implementation of formally evaluated interventions (Davis, Martin, Kosky, & O’Hanlon, 2000; Fraser, James, Anderson, Lloyd, & Judd, 2006). The present research aimed to partially meet this need by providing an in-depth review of the theoretical basis and design of a psychoeducative peer support group intervention for young people aged 12 to 18 years who are affected by parental mental illness and conducting an empirical evaluation of the effectiveness of this intervention. In addition, the present research explored the relationship between resilience factors and both adjustment outcomes and caregiving experiences of children of parents with mental illness. The intervention utilised within this research was the Koping Adolescent Program (KAP), facilitated in Brisbane by the Child and Youth Mental Health Service within the Royal Children’s Hospital and Health Service District of Queensland Health. An in-depth review of KAP was conducted according to recommendations regarding the design, development, and evaluation of interventions arising from reviews of interventions for children of parents with mental illness (Fraser et al., 2006) and for children and young people in general (Davis et al., 2000). It was demonstrated that the main theoretical bases for KAP were the resilience model and a model of early and preventative intervention, both of which are supported via the use of a peer support format. The goals of KAP were clarified as: increased mental health literacy, social connectedness, and repertoire of coping strategies; and intervention content was reviewed in consideration of these. Consultation regarding the design and implementation of KAP was sought from previous facilitators and participants of the intervention. A trial of the revised KAP was conducted with 6 participants, resulting in some additional minor modifications to the intervention. Review of KAP lead to the redevelopment of a theoretically sound intervention, provided scope for the creation of a formalised manual for KAP, and prepared KAP for an evaluation of the effectiveness of the intervention. The effectiveness of KAP was evaluated using a treatment (pre-, post-, and 8 week follow-up phase) and waitlist control (pre- and post-phase) design. The treatment (n = 27) and control (n = 17) groups were compared on three groups of dependent variables: intervention targets (mental health literacy, social connectedness, and coping strategies), adjustment outcomes (depressive symptomatology, life satisfaction, prosocial behaviour, and emotional/behavioural difficulties), and caregiving experiences. Group comparisons failed to show statistically significant intervention effects. However, reliable clinical change analyses suggested that compared to the control group, more intervention participants demonstrated clinically significant improvements in mental health literacy, depressive symptomatology, and life satisfaction. These treatment gains were maintained 8 weeks after the conclusion of treatment. The feedback collected from participant satisfaction data supported these treatment gains. Given the study limitations and the modest support for intervention effectiveness, the findings of this study highlight the necessity that this and other similar interventions continue to be revised and undergo rigorous evaluation. A short-term (4 weeks) longitudinal study was used to examine the relationships between Time 1 (n = 44) resilience factors (mental health literacy, social connectedness, and coping strategies) and Time 2 (n = 40) adjustment outcomes (depressive symptomatology, life satisfaction, prosocial behaviour, and emotional/behavioural difficulties), controlling for corresponding Time 1 adjustment outcomes. The relationships between resilience and caregiving experiences were similarly examined. It was predicted that greater mental health literacy, social connectedness, and reliance on voluntary engagement coping strategies, and less reliance on disengagement and involuntary coping strategies would be associated with better adjustment outcomes and with less adverse caregiving experiences. Overall, there was weak support for the predicted beneficial effects of mental health literacy on adjustment, stronger support for the existence of beneficial relationships between social connectedness and caregiving experiences, and strong support for the adverse effects of disengagement and involuntary coping strategies with respect to adjustment. There was no support for predictions regarding the relationships between disengagement and involuntary coping strategies and caregiving experiences, or the relationships between voluntary engagement coping and adjustment. Finally, there was mixed evidence of associations between voluntary engagement coping and less adverse caregiving experiences. The findings of the study raise implications regarding the actual relationships between adjustment outcomes and commonly promoted resilience factors, and the need for further research into resilience and caregiving experiences. Strengths, limitations, and implications of the research are discussed, and suggestions for future directions in this area are provided, with emphasis on the need for further research in relation to the resilience of children of parents with mental illness and the subsequent development and evaluation of interventions for this group.
Keyword parental mental illness
Children & Adolescents
young caregivers
Resilience
intervention

 
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Created: Thu, 02 Apr 2009, 23:26:48 EST by Ms Eliza Fraser