How Do Children Make Sense of their Parent’s Mental Health Difficulties: A Meta-Synthesis

Abstract

Children of parents who experience mental health difficulties (COPE-MHD) consistently demonstrate numerous negative outcomes, including risks of intergenerational continuity of mental health difficulties (MHD). Numerous studies have analysed the experiences and understanding of parents’ MHD from the perspective of COPE-MHD. This metasynthesis aims to capture, across available literature, the way in which COPE-MHD make sense of their parent’s MHD and how this perception impacts their life. For inclusion in the review, research articles were required to be published in peer-reviewed journals, apply qualitative methods of data collection and analysis and report on the direct accounts of COPE-MHD regarding their understanding or experience of their parents’ MHD. Five electronic databases were used; Academic Search Complete, CINAHL, MEDLINE, PsycINFO and Child Development and Adolescent Studies. Fourteen studies were included. Analysis produced three overarching themes. The findings illustrate children’s sophisticated biopsychosocial conceptualisation of the cause and process of their parent’s MHD. It also highlights how they utilise this understanding to manage the day-to-day concerns associated with their parent’s experience of MHD. Clinical implications highlight a need for services working with children, parents and families to more frequently enquire about parents’ MHD and to consider the outcomes of such enquiry in the psychological formulation of children and young peoples’ mental health and development. Limitations and recommendations for future research are presented.

To build a home: A phenomenological approach of reconstructing “feeling-at-home” among children living in households with parents exhibiting depressive symptoms

“…Our findings also echo existing literature, wherein the depressed parent is no longer who they once were, and the child must endure the emotional turmoils that accompany that change, while making sense of what it means to still have a family (Dam & Hall, 2016; Simpson-Adkins & Daiches, 2018). Specifically, the experiences of emotional struggle closely resonate with the concept of ambiguous loss in the context of trauma and complicated grief in the family (Boss, 2007, 2010).…”

“…Furthermore, only high functioning participants are included in the current study, which is why they were able to fully articulate difficult experiences at home. Although our sampling criteria did not include a formal diagnosis of clinical depression, our findings still validated the effects of parents with mental health difficulties on the family (e.g., see recent review of Simpson-Adkins & Daiches, 2018). Unlike the current study (i.e., formal diagnosis was difficult to confirm in recruitment because of the pervasive stigma associated with mental health conditions), we recommend future studies to specify, if ethically possible, formal clinical diagnosis of depression or other mental health conditions in order to stay closer to the particularity of the case.…”

“…They experience confusion and a sense of loss at home as their parent becomes emotionally and physically distant or unavailable altogether (Murphy et al, 2011). Since depression is often linked to suicide, some children may live in fear of the possibility of parental suicide and tread cautiously around their parents so as not to cause any unwanted distress (Simpson-Adkins & Daiches, 2018). Because of the unpredictability of their parent’s emotional state and their constantly shifting behavior, these children must remain vigilant and adapt to their parent’s condition, which adds to the stress of living in an already volatile home environment (Dam & Hall, 2016).…”

A child’s perspective of bidirectional impacts of mental illness in families: “It’s like a cold it goes from one of us to the next”

“…The current literature indicates child psychological difficulties result from exposure to parental mental illness. [36] Uncertainty increases children's anxiety and impacts on their own mental illness, invariably exacerbating their mood or other symptoms. Confusion over parents' symptoms and presentation adds to children's anxiety.…”

Childhood experiences pursue adulthood for better and worse: a qualitative study of adults' experiences after growing up with a severely mentally ill parent in a small-scale society

“…Research has demonstrated that growing up with a mentally ill parent is both different and difficult for children (Dam and Hall, 2016; Dam et al., 2018; Gladstone et al., 2011; Simpson-Adkins and Daiches, 2018). Painful experiences linger in the adult children, resulting in ambivalent, strained and confusing relationships (Foster, 2010; Murphy et al., 2011; O'Connell, 2008).…”