Stigma in relation to families living with parental mental illness: An integrative review

Abstract

Stigma is a pervasive social mechanism with negative ramifications for people who experience mental illness. Less is known about the stigma experiences of families where a parent has a mental illness. This review aims to identify and synthesize evidence on the concept of stigma and stigma-related experiences and outcomes reported by parents and children living with parental mental illness. An integrative review method was employed, with PRISMA (Preferred Reporting Items of Systematic Review and Meta-Analyses) guidelines to search and select literature and extract and analyse data. This approach allows for inclusion of theoretical and empirical literature and for concept definition. Fifty-eight papers, mostly from the USA, Australia, and the UK, met the inclusion criteria. Stigma was primarily conceptualized in families as a marked difference that was negatively appraised, and which could be internalized. Some articles examined how underpinning assumptions could shape the behaviour of individuals and groups and be embedded within social institutions and structures. For parents, mental illness stigma was interconnected with stigma relating to perceived violations of social and cultural norms related to parenting. Children's experience of stigma resulted in bullying, embarrassment, guilt and social isolation, and efforts to conceal their parent's mental illness. One outcome was that stigma prevented children and parents from seeking much needed supports. Public health policies and campaigns that focus exclusively on promoting open disclosure of mental illness to foster community education outcomes are unlikely to be effective without additional strategies aimed at preventing and redressing the structural impacts of stigma for all family members.

Parenting experiences of Chinese mothers living with a mental illness

“…Possibly because of public stigma, mothers in this study reported a lack of confidence in their parenting, and guilt about their children, consistent with other studies in the West and Japan [ 6 , 7 , 11 , 13 ]. Reupert et al [ 38 ] argued that the (in) ability of mothers to fulfil the socially standardized gender role and idealized parenting role underpins the stigmatization associated with being a mother with mental illness. The pervasive nature of stigma, described by the mothers in this study, poses a threat to their recovery and help-seeking [ 38 , 39 ].…”

“…Reupert et al [ 38 ] argued that the (in) ability of mothers to fulfil the socially standardized gender role and idealized parenting role underpins the stigmatization associated with being a mother with mental illness. The pervasive nature of stigma, described by the mothers in this study, poses a threat to their recovery and help-seeking [ 38 , 39 ]. It also may stop them from talking to children about their illness, as others have found [ 40 , 41 ].…”

“…Depending on their workplace, mental health professionals might need training in how to address clients’ common concerns about parenting, and their hereditary worries involving mental illness. Anti-stigma campaigns might be developed to address both public and self-stigma [ 38 ]. Such campaigns could include psychoeducational resources, and where mothers might be supported to talk to their children and other family members about their mental illness.…”

Expressed Emotion and Attributions in Parents With Schizophrenia

“…In families with a parent with a psychotic disorder, who are additionally disproportionately affected by parental unemployment, isolation and poverty ( 11 ) these impacts may be even greater. Psychosis has been found to interfere with the establishment and maintenance of important family routines ( 12 ) and stigmatization may serve to prevent help-seeking in families that are struggling ( 13 , 14 ). Ultimately, children of parents with schizophrenia and other psychotic disorders are more likely to be removed from their parents' care ( 15 , 16 ) with long term consequences for both parent and children's well-being and at significant economic cost for wider society.…”

The quality assessment of studies in integrative reviews: A commentary on Reupert et al. (2021)

“…

We read with great interest the article entitled 'Stigma in relation to families living with parental mental illness: An integrative review' by Reupert et al (2021). The authors used the integrative review method proposed by Whittemore and Knafl ( 2005), which emphasizes the importance of conducting a thorough quality appraisal of the included articles.

…”