Obstacles and Facilitators to Communicating with Children About Their Parents' Mental Illness: a Qualitative Study in a Sub-district of Mpumalanga, South Africa

Overview

Journal BMC Psychiatry

Publisher Biomed Central

Specialty Psychiatry

Date 2023 Jan 28

PMID 36707793

Authors

Lucy Dean

Hadassah Buechner

Bianca Moffett

Meriam Maritze

Louise J Dalton

Jeffrey R Hanna

Elizabeth Rapa

Alan Stein

Stephen Tollman

Kathleen Kahn

Affiliations

Soon will be listed here.

Abstract

Background: Given that common mental disorders are one of the leading causes of disease burden worldwide, it is likely that many children are growing up with a parent or other adult within their family who has anxiety or depression. Parents with a mental illness may not consider it appropriate to discuss their illness with their child, and consequently an absence of communication may lead to stigmatization, shame, misunderstanding their parents' symptoms, and even blaming themselves. There is a scarcity of research exploring the experiences and perceptions of healthcare professionals about communication with children of parents with mental illness in low-resource and African contexts.

Methods: A qualitative study using semi-structured interviews with healthcare professionals (n = 15) was conducted within the Bushbuckridge sub-district of Mpumalanga Province, South Africa. Data were analysed using Thematic Analysis.

Results: Four themes were identified relating to the obstacles around communication with children. These included: (1) finding an appropriate language to describe mental illness, as well as the prevailing cultural explanations of mental illness (2) the stigma associated with mental illness (3) the perceived role of children in society and (4) mental health services and staff skills. Two themes that addressed facilitators of communication about parental mental illness were identified: (1) the potential to increase mental health awareness amongst the broader community through social media, the internet, and general psychoeducation (2) healthcare professionals' concerns for the wellbeing and future mental health of patients' children, as well as their hopes for increased mental health awareness amongst future generations.

Conclusions: This study provides insight into healthcare professionals' attitudes and perceptions about talking to patients and families within their community about mental illness. The results provide recommendations about possible ways to promote sharing information about a parent's mental illness with children at an individual and community level. Future research should focus on the collaborative creation of culturally sensitive psychoeducational resources and evidence-based guidelines. This must be supported by systemic and organisational change in order for professionals to successfully facilitate conversations with patients who are parents, and their children.

References

Egbe C . Experiences and effects of psychiatric stigma: Monologues of the stigmatizers and the stigmatized in an African setting. Int J Qual Stud Health Well-being. 2015; 10:27954. PMC: 4472553. DOI: 10.3402/qhw.v10.27954. View

Reupert A, Gladstone B, Hine R, Yates S, McGaw V, Charles G . Stigma in relation to families living with parental mental illness: An integrative review. Int J Ment Health Nurs. 2020; 30(1):6-26. DOI: 10.1111/inm.12820. View

Williams D, Herman A, Stein D, Heeringa S, Jackson P, Moomal H . Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study. Psychol Med. 2007; 38(2):211-20. PMC: 2718686. DOI: 10.1017/S0033291707001420. View

Rochat T, Stein A, Cortina-Borja M, Tanser F, Bland R . The Amagugu intervention for disclosure of maternal HIV to uninfected primary school-aged children in South Africa: a randomised controlled trial. Lancet HIV. 2017; 4(12):e566-e576. DOI: 10.1016/S2352-3018(17)30133-9. View

Lambert J, Holzer J, Hasbun A . Association between parents' PTSD severity and children's psychological distress: a meta-analysis. J Trauma Stress. 2014; 27(1):9-17. DOI: 10.1002/jts.21891. View

Monnapula-Mazabane P, Petersen I . Mental health stigma experiences among caregivers and service users in South Africa: a qualitative investigation. Curr Psychol. 2021; 42(11):9427-9439. PMC: 8396139. DOI: 10.1007/s12144-021-02236-y. View

. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022; 9(2):137-150. PMC: 8776563. DOI: 10.1016/S2215-0366(21)00395-3. View

Ballal D, Navaneetham J . Talking to children about parental mental illness: The experiences of well parents. Int J Soc Psychiatry. 2018; 64(4):367-373. DOI: 10.1177/0020764018763687. View

Ostman M, Afzelius M . Children's representatives in psychiatric services: what is the outcome?. Int J Soc Psychiatry. 2009; 57(2):144-52. DOI: 10.1177/0020764008100605. View

10.

Grant A, Reupert A, Maybery D, Goodyear M . Predictors and enablers of mental health nurses' family-focused practice. Int J Ment Health Nurs. 2018; 28(1):140-151. DOI: 10.1111/inm.12503. View

11.

Audet C, Ngobeni S, Graves E, Wagner R . Mixed methods inquiry into traditional healers' treatment of mental, neurological and substance abuse disorders in rural South Africa. PLoS One. 2017; 12(12):e0188433. PMC: 5736181. DOI: 10.1371/journal.pone.0188433. View

12.

Botha U, Koen L, Niehaus D . Perceptions of a South African schizophrenia population with regards to community attitudes towards their illness. Soc Psychiatry Psychiatr Epidemiol. 2006; 41(8):619-23. DOI: 10.1007/s00127-006-0071-1. View

13.

Schierenbeck I, Johansson P, Andersson L, Krantz G, Ntaganira J . Collaboration or renunciation? The role of traditional medicine in mental health care in Rwanda and Eastern Cape Province, South Africa. Glob Public Health. 2016; 13(2):159-172. DOI: 10.1080/17441692.2016.1239269. View

14.

Davies G, Deane F, Williams V, Giles C . Barriers, facilitators and interventions to support help-seeking amongst young people living in families impacted by parental mental illness: A systematized review. Early Interv Psychiatry. 2021; 16(5):469-480. DOI: 10.1111/eip.13194. View

15.

Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J . Barriers to improvement of mental health services in low-income and middle-income countries. Lancet. 2007; 370(9593):1164-74. DOI: 10.1016/S0140-6736(07)61263-X. View

16.

Abel K, Hope H, Faulds A, Pierce M . Promoting resilience in children and adolescents living with parental mental illness (CAPRI): children are key to identifying solutions. Br J Psychiatry. 2019; 215(3):513-515. DOI: 10.1192/bjp.2019.118. View

17.

Brooke-Sumner C, Lund C, Petersen I . Perceptions of psychosocial disability amongst psychiatric service users and caregivers in South Africa. Afr J Disabil. 2017; 3(1):146. PMC: 5443050. DOI: 10.4102/ajod.v3i1.146. View

18.

Maybery D, Reupert A . Parental mental illness: a review of barriers and issues for working with families and children. J Psychiatr Ment Health Nurs. 2009; 16(9):784-91. DOI: 10.1111/j.1365-2850.2009.01456.x. View

19.

Ganasen K, Parker S, Hugo C, Stein D, Emsley R, Seedat S . Mental health literacy: focus on developing countries. Afr J Psychiatry (Johannesbg). 2009; 11(1):23-8. DOI: 10.4314/ajpsy.v11i1.30251. View

20.

Bryant R, Edwards B, Creamer M, ODonnell M, Forbes D, Felmingham K . The effect of post-traumatic stress disorder on refugees' parenting and their children's mental health: a cohort study. Lancet Public Health. 2018; 3(5):e249-e258. DOI: 10.1016/S2468-2667(18)30051-3. View