Introduction
Methods
Search Strategy
1. | S-ample | (Parent* or Mother* or Father* or Caregiv* Guardian* or Carer* or Kinship or Stepparent* or foster parent*) |
2. | PI-phenomenon of Interest | (Serious Mental Illness* or SMI or Severe Mental Illness* or Enduring Mental Illness* or Serious Mental Health Difficult* or Serious Mental Health Problem* or Psychos* or Schizophr* or Mental Health or Mental Illness* or Persistent Mental Illness* or Bipolar* Disorder* or Bipolar*) |
3. | D-design | (interview*, focus group*, case stud* or observ*) |
4. | E-evaluation | (view* or experience* or opinion* or attitude* or perce* or belie* or feel* or know* or understand* or Perspective*) |
5. | R-research type | (Qualitative* or mixed method* or IPA or Grounded Theory or Thematic Analys* or Narrative*) |
6. | 1 AND 2 | |
7. | 3 OR 4 | |
8. | 5 AND 6 AND 7 |
Inclusion and Exclusion Criteria
Methodological Quality and Risk of Bias Assessment
Data Extraction and Analysis
Reflexivity Statement
Results
Study Characteristics
Study: Authors, Year, Location | Study Aim | Sample Description | Verification of diagnosis | Recruitment method | Data collectiona/analysis | Main theme titles | |||
---|---|---|---|---|---|---|---|---|---|
Parental mental health difficulty | Other socio-demographical information | Child information | |||||||
1. | Radley et al., (2022a), UK | To understand the needs and experiences of parents with psychosis | Psychosis (n = 12; 100%) | Mothers (n = 10) and fathers (n = 2) Marital status: married (n = 6), divorced (n = 1), separated (n = 1), single (n = 4) Ethnicity: White British (n = 7), White(other) (n = 1), Black British (n = 3), Asian British-Pakistani (n = 1) Age (years): 20–29 (n = 1), 30–39 (n = 5), 40–49 (n = 4), 50–59 (n = 2) Years since first psychotic episode ranged from 0 to 33 No. of hospital admissions due to psychosis ranged from 0 to 4 Setting: community | No. of children: 1 (n = 6) 2 (n = 3) 3 (n = 3) Child genders: M (16), F(5) | Not stated | Early Intervention in Psychosis services and Adult mental health teams | Semi-structured interviews / Reflexive TA (Braun & Clarke, 2006, 2020) | - The impact of psychosis on parenting - The need to protect their child - The need to feel normal - The impact of parenting stress on psychosis |
2. | Sabella et al. (2022), USA | To understand the experiences of young adult parents with SMI | Anxiety (n = 15; 28%), MDD (n = 13; 24%), PTSD (n = 9; 17%), BD (n = 9; 17%), schizophrenia (n = 1; < 1%), schizoaffective disorder (n = 1; < 1%), ED (n = 5; 9%), BPD (n = 1; < 1%) | Mothers (n = 15) and fathers (n = 3) Age (years): Mean age 26 Ethnicity: non-Hispanic white (n = 10), non-Hispanic black (n = 2), Hispanic (n = 3), mixed/other (n = 3) Relationship status: married/ cohabiting (n = 5), divorced/separated (n = 3), never married (n = 10) Living: independently (n = 9), with own parents (n = 6), homeless shelter/group home (n = 3) Income: average income < $10,000 Education: high school (n = 8), college (n = 7), degree (n = 3) Setting: community | Number of children: 1 (n = 9), 2 (n = 7), 3 (n = 1), 4 (n = 1). Ages ranged from “several weeks” to 12 years | Unclear | Community centres, social services, homeless shelters, and social media advertisement | Semi-structured interviews / GT (Strauss & Corbin, 1998) | - Managing symptomatology whilst parenting - Children as sources of motivation and recovery - Experiences of discrimination and feelings of stigma |
3. | Chen et al., (2021b), China | Explore the experiences of family life and parenting of Chinese mothers, in the context of mental illness | Schizophrenia (n = 1; 7%), BD (n = 3; 21%), Anxiety (n = 2; 14%), MDD (n = 4; 28%), PND (n = 3; 21%), Anxiety and Depression (n = 1; 7%) | Mothers (N = 14) Age (years): 20–29 (n = 1), 3–39 (n = 8), 40–49 (n = 5) Relationship status: Married (n = 12), divorced (n = 1), new relationship (n = 1) Employment: employed (n = 11), part-time (n = 1), freelance (n = 1), housewife (n = 1) Ethnicity: Chinese (n = 14) SES status: not reported Setting: outpatient | Number of children: 1 (n = 9), 2 (n = 5) Aged 1–6 (n = 5), 7–12 (n = 10), 13–18 (n = 4) | Self-report | Social media | Semi-structured interviews / IPA (Smith et al., 2009) | - Motherhood as central identity - The stigma associated with being a mother with MI - The impact of MI on parenting - Perceptions about the impact of MI on children - Experience of talking to children about MI - How having children impacts mothers’ MI and their recovery - Support obtained and needed |
4. | Mulvey et al. (2021), USA | To explore how mothers involved in the criminal justice system with significant and long-term mental illness describe their experience of mothering | Bipolar/depression type disorder (n = 31; 65%), psychotic disorder (n = 14; 29%) and anxiety type disorder (n = 3; 6%) | Mothers (N = 48) Age (years): Mean age 40 Ethnicity: from white (n = 30), black (n = 10), Hispanic (n = 4), or other (n = 4) backgrounds Custody: never lost custody (n = 18), partial/family custody (n = 11), and lost custody at some point (n = 19) SES: not reported Setting: community | The number of children participants had 1 (n = 12), 2 (n = 13), 3 (n = 10), or 4 or more (n = 13) | DSM-IV-TR diagnoses | SMI probation caseloads within the criminal justice system | Semi-structured interviews / Unspecified inductive approach inspired by GT | - “Normative” Mothering - Aspiring to Break the Cycle - Constrained Mothering - “Failure” and State Intervention - Children as Parents - Children as Catalyst for Change |
5. | Boström and Strand (2021), Sweden | To explore parent–infant relationships and parent and child mental health perceptions | Schizoaffective disorder (n = 4; 67%) and schizophrenia (n = 2; 33%) | Mothers (n = 4) and fathers (n = 2) Age (years): 38–47 Family environment: cohabiting with other parent (n = 2), single parent (n = 1), shared custody (n = 2), child in foster care (n = 1) Ethnicity and SES: not reported Setting: community | Children: five girls and two boys aged 8–15 | Not stated | Four outpatient services for people who experience psychosis | Semi-structured interviews / IPA (Smith et al., 2009) | - An unclear image - An incoherent story - Illness as part of ordinary life - A non-hierarchical parent–child relationship - Attunement of the parent–child relationship and child well-being |
6. | Strand et al. (2020), Sweden | To explore parents’ experiences of how psychosis affects their parenting | Schizoaffective disorder (n = 8; 53%), schizophrenia (n = 2; 13%), psychotic disorder (n = 3; 20%) and MDD with psychotic episodes (n = 2; 13%) | Mothers (n = 10) and fathers (n = 5) Age (years): 36–56 (M = 42) Relationship status: married/cohabiting (n = 8), single, divorced (n = 7) Employment: employed (n = 2), parental leave (n = 1), sick leave (n = 12) Custody status: lived with child/ren (n = 10), joint custody (n = 3), access rights (n = 2). Ethnicity and SES: not reported Setting: community | Participants had 17 children between them (11 boys and 6 girls), aged 3–16 (M = 10) | Not stated | Psychosis outpatient clinics | Semi-structured interviews / TA (Braun & Clarke, 2006) | - Protection - Reciprocity - Control - Guided learning - Group participation - Unpredictable absences |
7. | Chan et al. (2019), Hong Kong | To explore the experiences of parenting and self-stigmatisation of Chinese mothers with SMI | MDD (n = 11; 73%) or a schizophrenia-spectrum disorder (n = 4; 27%) | Mothers (N = 15) Age (years): 26—50 Relationship status: divorced (n = 8), married (n = 5), windowed (n = 2) Employment status: unemployed (n = 10), part-time (n = 4), full-time (n = 1) Ethnicity and SES not reported Setting: community | Participants had between 1 and 6 children between them, aged between two and 22 years | Not stated | Two mental health support centres | Semi-structured interviews / TA (Braun & Clarke, 2006) | - Distancing and being distanced - Doubting myself - Struggling for control |
8. | Awram et al. (2017), Australia | To understand the strategies women with mental illness use to balance the demands of mothering with mental health recovery | Depression (n = 6; 29%), BD (n = 3; 14%), schizoaffective disorder (n = 2), PND (n = 1; 10%), post-natal psychosis (n = 1; 5%), anxiety (n = 4; 20%), PTSD (n = 3; 14%), OCD (n = 1; 5%) | Mothers (N = 10) Relationship status: separated (n = 4) living with partner (n = 6), Childcare arrangements: children in mothers’ full-time care (n = 6), part-time care (n = 3), or both (n = 1) Ethnicity and SES status not reported Setting: community | Mothers had between 1 and 4 children aged 2–25 years (M = 12) | Not stated | Three community mental health organisations | Semi-structured interviews / GT and constant comparison (Charmaz, 2014) | - Recovery and motherhood intertwined - Seeing the bigger picture - Strategies of balancing mothering and recovery - Supports and resources |
9. | Klausen et al. (2016), Norway | To understand mothers’ stories about motherhood in relation to being admitted as mental health service users | Psychosis (n = 2; 20%), suicidality (n = 2; 20%), somatic illness (n = 1; 10%), overdose (n = 1; 10%), depression (n = 1; 10%), “request from doctor” (n = 1; 10%), not disclosed (n = 2; 10%) | Mothers (N = 10) Age (years): 31–70 Relationship status: single (n = 3), married (n = 3), had a partner (n = 4) Ethnicity and SES not reported Setting: community perspective on inpatient admission | The number of children participants had 2 (n = 5), 3 (n = 3), 4 (n = 1), and 6 (n = 1). Age of children not specified | Unclear | Psychiatric hospital services | Semi-structured interviews / TA (Riessman, 2008) | - Being able to put oneself in the child’s shoes - The emotional impact of being admitted - Being open with the children about the admission - Being an emotionally available and present mother |
10. | van der Ende et al. (2016), Netherlands | To understand the successful strategies of parents with mental illness | Mood disorder (n = 9; 33%), anxiety (n = 1; 4%), psychotic disorder (n = 6; 22%), addiction (n = 2; 7%), PD (n = 7; 26%), and ADHD (n = 2; 7%) | Mothers (n = 19) and fathers (n = 8) Age (years): 19–59 Relationship status: married/ relationship (n = 14), divorced/ widowed (n = 5), unmarried (n = 8) Living arrangements: independent living (n = 21), sheltered/supported accommodation (n = 6) Employment status: employed or had “regular daytime activity” (n = 14). SES and ethnicity not reported Setting: community | Participants youngest children were aged between 6 months and 18 years old 18 had 1–2 children and 9 had 3–6 children | Not stated | Expert by experience groups, providers of mental health services, and volunteers | “open-ended” interviews / TA (Miles & Huberman, 1994) | - Effects of MI on parenting—mothers - Effects of MI on parenting—fathers - Strategies for successful parenting |
11. | Parrott et al. (2015), UK | To understand experiences of parents parenting roles maintained during admission to a secure forensic hospital | Of the total secure hospital population: schizophrenia (n = 100), PD (n = 7), Affective disorder (n = 4), unconfirmed (n = 4). Not possible to determine percentage of population by diagnosis | Mothers (n = 8) and fathers (n = 10) Living arrangements: medium secure hospital without children (n = 18) Other demographical information from the qualitative study was not provided Setting: inpatient | Fathers had 41 children between them (range = 1–5; median = 1). Mothers had 20 children between them (range = 1–3; (M = 2) | Not stated | Ward staff | - Parenthood and self-identity - Impact of MI on parenting - Parental concepts of offending and risk - Parenting from within the unit-maintaining relationships - Explaining MI and detention to children | |
12. | Rampou et al. (2015), South Africa | To explore and describe the parenting experiences of mothers with a chronic mental illness | Schizophrenia (n = 4; 40%), BD (n = 4; 40%), and MDD (n = 2; 20%) | Mothers (N = 10) Age (years): 40–49, (n = 6), 30–39 (n = 3), and 20–29 (n = 1) Relationship status: single, separated or widowed (n = 8), unknown (n = 2) Employment: employed (n = 1), unknown (n = 9). SES and ethnicity not reported Setting: community | Number and ages of children were not supplied | Not stated | Outpatient mental healthcare treatment and rehabilitation services | Individual interviews / Tesch’s descriptive method (Creswell, 2009) | - Challenges for mothers with regard to caring for their children - Family support needs |
13. | Perera et al. (2014), Australia | To explore positive and challenging experiences of mothers with MI, from perspectives of mothers and HCPs | Primary diagnoses: schizophrenia (n = 5; 63%), MDD with psychotic symptoms (n = 2; 25%), BD (n = 1; 13%) | Mothers (N = 8) Relationship status: in relationship (n = 5), single (n = 3) Background: “Various cultural backgrounds including Polynesian and Indigenous Australian”. Ethnicity and SES not reported Setting: community | Mothers had a total of 20 children between them, aged 1–24 years 13 children were under the age of 10 | Not stated | Adult public mental health service | Semi-structured interviews / GT (Charmaz, 2006) | - Positive aspects of motherhood for women living with MI - Challenging aspects of motherhood |
14. | Tjoflåt and Ramvi (2013), Norway | To understand parenting with bipolar disorder | BD (N = 6; 100%) | Mothers (n = 5) and fathers (n = 1) Age (years): 31–50 (M = 41) Relationship status: married and shared parental responsibility (n = 3) divorced (n = 3) Employment: employed full- or part-time (n = 3), “national insurance” (n = 3). Living arrangements: renting (n = 3) own home (n = 3) Ethnicity and SES not reported Setting: community | Parents had 11 children between them, aged 1–18 years. Parents had between 1 and 3 children each | Not stated | Community mental health centres | Semi-structured interviews/IPA (Smith & Osborn, 2003) | - Balancing bipolar disorder and parenting - The need for support versus perceiving stigma - Dependence on their children - Change and growth |
15. | Jungbauer et al. (2011), Germany | Explore the impact of parental schizophrenia on family members | Schizophrenia (N = 57; 100%) | Mothers (n = 40) and fathers (n = 17) Age (years): 19 – 54 (M = 38.3) Living arrangements: same household as child/ren (n = 36), separated from children (n = 18) Ethnicity and SES not reported Setting: inpatient and community | 38 children took part aged 7 – 18 (M = 12; 19 males, 19 females) | ICD-10 | Inpatient and outpatient psychiatric care facilities | Semi-structured interviews/GT and CA (Mayring, 2010) | - Everyday family life between crisis and normalisation - The perspective of sick parents - Effects on the couple relationship - Coping with stress and the consequences of stress in children - Family constellations |
16. | Montgomery et al. (2011), Canada | To explore the experience of “hitting bottom” from the perspectives of mothers with SMI | Diagnoses were not detailed. The most common diagnosis was MDD | Mothers (N = 37) Age (years): 19–38 Living arrangements: lived with child/ren (n = 22), separated from child/ren (n = 10), unspecified (n = 5) Ethnicity and SES not reported Setting: inpatient and community | Children were aged 2–15 | Not stated | N/A—secondary qualitative analysis | Semi-structured interviews/Narrative Analysis (Riessman, 2008) | - Storytellers - Stories of bottom |
17. | Jungbauer et al. (2010), Germany | To investigate the experience of parenthood in parents with schizophrenia with young children and their needs for assistance | Schizophrenia (n = 17; 65%) and schizoaffective disorder (n = 9; 35%) | Mothers (n = 21) and fathers (n = 5) Mean age (years): 39.7 Living arrangements: lived with child/ren (n = 15), separated from children (n = 11), Employment: employed (n = 6), part-time (n = 5) Income: disability benefits (n = 13), unemployment benefit (n = 5), child-raising allowance (n = 1), no income (n = 1) Ethnicity not reported Setting: inpatient and community | Parents had an average of 1.8 children between the ages of 1 and 30 (M = 12.8) | ICD-10 | Inpatient, semi-inpatient, and outpatient psychiatric facilities | - Positive aspects/resources in the perception of parenthood - Negative aspects/burdens in the perception of parenthood - Support requests regarding parenting/upbringing | |
18. | Khalifeh et al. (2009), UK | To explore experiences, treatment preferences, and needs of mothers who were treated at home as an alternative to hospital admission for an acute severe mental health crisis | MDD (n = 10; 56%), BD (n = 6; 33%) and Schizophrenia (n = 2; 11%) | Mothers (N = 18) Age (years): 21–30 (n = 1), 31–40 (n = 9), 41–50 (n = 7), and 51–60 (n = 1) Ethnicity: White (n = 12), Black (n = 3) or Asian (n = 3) Living arrangements: alone (n = 9), with the child’s father (n = 8), with another male (n = 1) 5 children aged 12–18 also participated SES not reported Setting: community | Mothers had 1 (n = 6), 2 (n = 3), 3 (n = 5), or 4 (n = 4) children aged 0–1 (n = 3), 2–5 (n = 8), 6–11 (n = 13), 12–18 (n = 16), or > 18 (n = 3) | Not stated | Crisis resolution team | Semi-structured interviews/TA (Braun & Clarke, 2006) | - Mothers’ experiences: advantages and disadvantages - Child experiences |
19. | Wilson and Crowe (2009), New Zealand | To explore how parents with bipolar disorder construct their role as parent, and how bipolar disorder is constructed in texts | BD (N = 6; 100%) | Mothers (n = 5), fathers (n = 1) No other socio-demographical details provided Ethnicity and SES not reported Setting: unclear | “Young children” (ages not reported) Number of children not reported | Self-identified diagnosis | Unclear | Semi-structured interviews/Critical discourse analysis (Titscher et al., 2000) | - Monitoring and Emotional Regulation |
20. | Ueno and Kamibeppu (2008), Japan | To understand mothers’ perceptions of what experiences influence them or their parenting practices | Schizophrenia (n = 13; 65%) and mood disorders (n = 7; 35%) | Mothers (N = 20) Mean age (years) = 43 Relationship status: married (n = 14), separated or divorced (n = 4), widow (n = 1), never married (n = 1) Living arrangements: with children (n = 20) Ethnicity and SES not reported Setting: community | Mothers had between 1 and 3 children, ranging from 3 to 20 years old | DSM-IV-TR diagnosis | One psychiatric hospital and two psychiatric clinics | Semi-structured interviews/Modified GT (Kinoshita, 2003) | - Parenting whilst performing self-care - Balancing responsibilities - Feeling of affection for the child - Frustration with poor parenting - Feeling the child’s compassion |
21. | Evenson et al. (2008), UK | To explore the experiences of fathers with psychosis | Schizophrenia (n = 7; 70%), schizoaffective disorder (n = 2; 20%), and delusional disorder (n = 1; 10%) | Fathers (N = 10) Age (years): 34–67 (M = 51) Relationship status: married (n = 5), cohabiting (N = 2), divorced (n = 1), single (n = 2) Ethnicity: “white” Living arrangements: with child/ren (n = 6), with partner/wife without child/ren (n = 2), alone (n = 2) SES not reported Setting: community | Participants had 21 children between them (7 girls, 14 boys aged 1–44 years) | Not stated | CMHTs | Semi-structured interviews/IPA (Smith & Osborn, 2003) | - Psychosis undermines the father–child relationship and the work of parenting - Pre-fatherhood aspirations - Fears for the children - Impact of psychosis on fathers |
22. | Venkataraman and Ackerson (2008), USA | To understand the strengths, challenges, and service needs of mothers with BD | Bipolar-I disorder (n = 8; 80%) and Bipolar-II disorder (n = 2; 20%) | Mothers (N = 10) Age (years): 21–49 Relationship/living status: never married (n = 4), divorced (n = 1), widowed (n = 1), married/cohabiting (n = 4) Employment status: unemployed (n = 2), “lower level” jobs (n = 4), “higher level” jobs (n = 2), “a couple” were students SES: “low” (n = 7), “middle” (n = 3) Ethnicity: “white” (n = 10) Setting: community | The number of children in each family ranged from 1 to 4. Children were aged 1–30 | Not stated | Community mental health centres and support groups | Semi-structured interviews/GT (Strauss, 1987) | - Strengths in Parenting - Challenges in Parenting - Service Needs |
23. | Montgomery et al. (2006), Canada | To describe experiences of mothers with SMI and how they manage their mothering circumstance | Schizophrenia (n = 3; 15%), BD (n = 4; 20%), MDD (n = 9; 45%), and unspecified (n = 4; 20%) | Mothers (N = 20) Age (years): “early 20 s to late 30 s” All had contact with their children and 16 were living with their children Ethnicity and SES not reported Setting: inpatient and community | 39 children between mothers, aged 2–15 years. Mothers had between one and four children | Self-identified | Referred by psychiatrists or “designate” | Unstructured formal interviews/GT (Glaser, 1998) | - Core category: appearing normal, creating security, being responsible - Keeping close: masking, censoring speech, doing mother work, seeking help |
24. | Diaz-Caneja and Johnson (2004), UK | To understand the experiences of mothers with SMI and their views of the services they receive | Schizophrenia (n = 8; 36%) BD (n = 10; 45%) and severe depression with psychotic symptoms (n = 4; 18%) | Mothers (N = 22) Age (years): 20–29 (n = 2), 30–39 (n = 9), 40 + (n = 11) Ethnicity: White (n = 13), White European or South American (n = 3), Black UK (n = 1), Black Caribbean (n = 1), Black African (n = 1), Asian (n = 2), Mixed (n = 1) Relationship status: married/ cohabiting (n = 3), previously married and living alone (n = 11), widow (n = 1), never married (n = 7). Living arrangements: local authority (n = 21), privately renting (n = 1). Employment: part-time (n = 1), unspecified (n = 22). SES not reported Setting: community | Mothers had a total of 41 children 9 mothers had child/ren aged under 9 and 17 had child/ren aged 10–17 Child living arrangements: both parents (n = 2), mother only, (n = 9), father only (n = 4), other family member (n = 2), foster care (n = 4), adopted (n = 1) | Not stated | CMHT | Face-to-face semi-structured interviews/TA (Richards & Richards, 1998) | - Positive aspects of motherhood - Difficulties associated with motherhood - Effect of MI on children - Stigma - Views about services |
25. | Savvidou et al. (2003), Greece | To explore the influence of the diagnosis of SMI on mother’s lives and relationships for mothers hospitalised on a psychiatric unit | Schizophrenia (n = 10; 50%), delusional disorder (n = 1; 5%), BD (n = 1; 5%), MDD (n = 3; 15%), and BPD (n = 2; 10%) | Mothers (N = 20) Age (years): 28–53 Living arrangements: hospitalised (n = 20); with child/ren (n = 13), without child/ren (n = 7) Relationship status: divorced (n = 10), unspecified (n = 10) Custody: lost custody (n = 10), regular contact (n = 1), full custody (n = 9) Ethnicity and SES not reported Setting: inpatient | Mothers had a total of 32 children between them, aged 3.5–18 years | DSM-IV diagnosis | Unclear | - The discourse of “parenthood” - The discourses of “Mental Illness” and “Mentally Ill” parent - Relationship with partner, family, and social environment - MI and parenthood | |
26. | Ackerson (2003), USA | Explore how parents coped with the dual demands of parenthood and experiencing SMI | “Severe and persistent mental illness” (psychotic disorder or severe mood disorder); diagnostic information was not supplied | Mothers (n = 12), fathers (n = 1) Relationship status: married (n = 3), separated, widowed, or divorced (n = 10) Ethnicity and SES not reported Setting: community | Children’s ages were not stated | Self-identified or ‘documented’ diagnosis | Community mental health centres or mental health consumer groups | 1:1 semi-structured / structured interviews/Guided by GT (Glaser & Strauss, 1967) | - Problems with diagnosis and treatment - Stigma and discrimination - Chaotic interpersonal relationships - The strain of single parenthood - Custody issues - Relationship with children: discipline, boundary issues, role reversal - Social support - Pride in being a parent |
27. | Thomas and Kalucy(2002), Australia | To explore the views of parents and their families about the impact of mental illness on their families, especially their children | BD (n = 11; 31%), MDD (n = 10; 29%), schizoaffective disorder (n = 8; 23%), schizophrenia (n = 3; 9%), PD (n = 2; 6%), or PND (n = 1; 3%) | Mothers (n = 28) and fathers (n = 7) Age (years): 30–67 (M = 44.6) Living arrangements: separated from child/ren completely (n = 12), lived with some of their child/ren (n = 4) Ethnicity and SES not reported Setting: inpatient and community | Parents had 88 children between them (48 daughters and 40 sons) aged 2–36 years | Not stated | Inpatient and outpatient mental health services and consumer groups | Semi-structured interviews/Unspecified qualitative methodology | - Impact on daily life - Family concerns - Hospitalisation - Ongoing management - Participant recommendations |
28. | Nicholson et al. (1998), USA | Understand the parenting experiences of women with mental illness from the perspectives of mothers and case managers | Affective disorder (n = 23; 55%), psychotic disorder (n = 8; 19%), anxiety disorder (n = 6; 14%), or “other/don’t know” (n = 5; 12%) | Mothers (N = 42) Age (years): 22–48 (M = 35) Relationship status: married/ cohabiting (n = 19), previously married (n = 20), never married (n = 3) Living arrangements: private home (n = 34), group care (n = 4), family home (n = 3), hospital (n = 1) Ethnicity: Caucasian (n = 35), African American (n = 5), Hispanic/Latina (n = 1), Native American (n = 1) Setting: community | 97 children between mothers with an average of 2.2 children per family Living: with mother/ mother and partner (n = 38), with father (n = 18), foster care (n = 6), adopted (n = 10), with relatives (n = 10), independently (n = 5) | Not stated | Case management services/ Unspecified thematic analysis | Face-to-face focus groups / Unspecified TA | - The stigma of MI - Day-to-day parenting - Managing MI - Custody of and contact with children |
29. | Sands (1995), USA | To examine mothers’ perceptions of themselves as mothers and persons with mental illness, their psychosocial issues, and their receptivity to support programmes | Schizophrenia (n = 6; 60%), schizotypal personality disorder (n = 1; 10%), MDD (n = 1; 10%), BD (n = 1; 10%) and unknown (n = 1; 10%) | Mothers (N = 10) Age (years): 21–37 (M = 27) SES: low-income (n = 10) Living arrangements: community supervised apartment (n = 10). Mothers’ children were living with them (n = 5) or in foster care or with a relative (n = 5) Ethnicity: African American (n = 7) or White (n = 3) 8 mothers without SMI were included as a comparison group Setting: community | Ages and number of children not specified | Not stated | Support services | Informal conversations and semi-structured interviews/Unspecified TA | - Experience of motherhood and MI - Programme demands - Psychosocial issues |
Methodological Quality of Included Studies
Study: Authors and year | Was there a clear statement of the aims of the research | Is a qualitative methodology appropriate | Was the research design appropriate to address the aims of the research | Was the recruitment strategy appropriate to the aims of the research | Was the data collected in a way that addressed the research issue | Has the relationship between researcher and participants been adequately considered | Have ethical issues been taken into consideration | Was the data analysis sufficiently rigorous | Is there a clear statement of findings | How valuable is the research | Quality Appraisal (total score) | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Radley et al. (2022a) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9.5) |
2 | Sabella et al. (2022) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9.5) |
3 | Chen et al. (2021b) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9.5) |
4 | Mulvey et al. (2021) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | Yes (1) | No (0) | PA (0.5) | PA (0.5) | Yes (1) | Yes (1) | Moderate (7.5) |
5 | Boström and Strand (2021) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
6 | Strand et al. (2020) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
7 | Chan et al. (2019) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (10) |
8 | Awram et al. (2017) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
9 | Klausen et al. (2016) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | PA (0.5) | No (0) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Moderate (7.5) |
10 | van der Ende et al. (2016) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Moderate (8.5) |
11 | Parrott et al. (2015) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
12 | Rampou et al. (2015) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
13 | Perera et al. (2014) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Moderate (8.5) |
14 | Tjoflåt and Ramvi (2013) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
15 | Jungbauer et al. (2011) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
16 | Montgomery et al. (2011) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | No (0) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Moderate (8) |
17 | Jungbauer et al. (2010) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | No (0) | Yes (1) | Yes (1) | Yes (1) | Moderate (8) |
18 | Khalifeh et al. (2009) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Moderate (8.5) |
19 | Wilson and Crowe (2009) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | PA (0.5) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Moderate (8) |
20 | Ueno and Kamibeppu (2008) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Moderate (8.5) |
21 | Evenson et al. (2008) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Moderate (8) |
22 | Venkataraman and Ackerson (2008) | Yes (1) | Yes (1) | PA (0.5) | PA (0.5) | Yes (1) | PA (0.5) | No (0) | PA (0.5) | Yes (1) | Yes (1) | Moderate (7) |
23 | Montgomery et al. (2006) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9.5) |
24 | Diaz-Caneja and Johnson (2004) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
25 | Savvidou et al. (2003) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | PA (0.5) | PA (0.5) | Yes (1) | Yes (1) | Moderate (8) |
26 | Ackerson (2003) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | No (0) | No (0) | Yes (1) | Yes (1) | Yes (1) | Moderate (7.5) |
27 | Thomas and Kalucy (2002) | Yes (1) | Yes (1) | PA (0.5) | PA (0.5) | Yes (1) | No (0) | No (0) | PA (0.5) | Yes (1) | Yes (1) | Moderate (6.5) |
28 | Nicholson et al. (1998) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | PA (0.5) | PA (0.5) | Yes (1) | Yes (1) | Moderate (8) |
29 | Sands (1995) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | PA (0.5) | No (0) | No (0) | PA (0.5) | Yes (1) | PA (0.5) | Moderate (6) |
Percentage of studies rated ‘Yes’ (1) | 96.6% | 100% | 75% | 79.3% | 86.2% | 3.4% | 55.2% | 79.3% | 100% | 96.6% |
Thematic Synthesis
Study: Authors and year | Theme 1: The constrained Parent | Theme 2: Parenting Difficulties | Theme 3: The Strained Child: Role Reversal and the Perceived Impact | Theme 4: Inescapable Threat | Theme 5: Combatting Threat: Holding Hope, Goals and Aspirations | Theme 6: Wrap-around Support Needs | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Perfect Parenting Standards | Emotion Regulation Difficulties | Fears of Repeating History | Avoidance and Masking | Struggling for Control | Balancing Needs | Amplification of Struggle due to Symptoms and Medication | Connection to Child | Loss and Separation Fears | Stigma and Fears of Rejection | Inappropriate Support | System-wide Compassion and Understanding | Connection to support | ||||
1 | Radley et al. (2022a ) | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ |
2 | Sabella et al. (2022) | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | – |
3 | Chen et al. ( 2021b) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ |
4 | Mulvey et al. (2021) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
5 | Boström and Strand (2021) | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ | – | – | – | ✓ | – | ✓ |
6 | Strand et al. (2020) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
7 | Chan et al. (2019) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ | – | ✓ | ✓ |
8 | Awram et al. (2017) | ✓ | – | – | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ |
9 | Klausen et al. (2016) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ |
10 | van der Ende et al. (2016) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | – | ✓ | ✓ | ✓ | ✓ | ✓ |
11 | Parrott et al. (2015) | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
12 | Rampou et al. (2015) | ✓ | ✓ | – | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ |
13 | Perera et al. (2014) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ |
14 | Tjoflåt and Ramvi (2013) | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ |
15 | Jungbauer et al. (2011) | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | – | ✓ | ✓ |
16 | Montgomery et al. (2011) | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | – | ✓ | ✓ |
17 | Jungbauer et al. (2010) | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
18 | Khalifeh et al. (2009) | ✓ | ✓ | – | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ |
19 | Wilson and Crowe (2009) | ✓ | ✓ | – | ✓ | – | ✓ | ✓ | – | – | – | ✓ | ✓ | – | – | – |
20 | Ueno and Kamibeppu (2008) | – | ✓ | – | ✓ | – | ✓ | ✓ | ✓ | ✓ | – | ✓ | – | ✓ | – | – |
21 | Evenson et al. (2008) | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | – |
22 | Venkataraman and Ackerson (2008) | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ |
23 | Montgomery et al. (2006) | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | – | ✓ | ✓ | ✓ | ✓ |
24 | Diaz-Caneja and Johnson (2004) | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
25 | Savvidou et al. (2003) | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
26 | Ackerson (2003) | ✓ | ✓ | – | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
27 | Thomas and Kalucy (2002) | – | ✓ | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | – | ✓ | – | ✓ | ✓ |
28 | Nicholson et al. (1998) | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ | ✓ | – | ✓ | ✓ | ✓ | – | – | – |
29 | Sands (1995) | ✓ | ✓ | – | – | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
Theme 1: The Constrained Parent
Subtheme 1.1: “Perfect” Parenting Standards
“When I was psychotic, I stayed away for long periods. I didn’t want her [child] to see me in such bad shape” (Strand et al., 2020, p. 623).
Subtheme 1.2: Emotion Regulation Difficulties
“When my first son was 1 year old, I was suicidal. I felt bad as a parent. I could not fulfil the mother role” (van der Ende et al., 2016, p. 90).
Subtheme 1.3: Fears of Repeating History
“…It [childhood home] was just not a safe place…so for [daughter], I have tried to provide her with like a really safe place to be that is clean and I am always there” (Venkataraman & Ackerson, 2008, p. 395).
Subtheme 1.4: Avoidance and Masking
“…I was depressed enough so that I just kind of went through life. I didn’t feel anything, I just, you know, did the grocery shopping, did the cooking, took care of their needs, but I wasn’t happy…” (Venkataraman & Ackerson, 2008, p. 397).
Theme 2: Parenting Difficulties
Subtheme 2.1: Struggling for Control
Subtheme 2.2: Balancing Needs
“I try to keep my balance, for when I am terribly tired and feel bad, I push myself as much as I can, and I feel bad, it hurts not to have enough strength for my children…” (Tjoflåt & Ramvi, 2013, p. 82).
Subtheme 2.3: Amplification of the Struggle due to Symptoms and Medication
“…regardless of how I loved my [child] I had thoughts of hurting her, so I have to put her down and I couldn’t understand why I had these thoughts” (Montgomery et al., 2006, p. 24).
“…I was hallucinating that there was demons inside of him so I took a knife sharpener and just pressed it on his chest…So I didn’t really attack him, in my mind I was protecting myself” (Mulvey et al., 2021, p. 14).
Subtheme 2.4: Connection to Child
“…it is as if we are somehow not together; you know, it is as if I am in my own world, pondering on things and then the children wonder why you are so distant” (Tjoflåt & Ramvi, 2013, p. 82).
“They don’t really understand my illness, and I don’t understand my illness either, so it’s so hard to talk about it...” (Khalifeh et al., 2009, p. 637).
Theme 3: The Strained Child
“I’m reliant on him physically to go to bed, physically to get up, emotionally because he’s my one and only contact. And it’s almost like sometimes I am the child, and he’s the parent” (Khalifeh et al., 2009, p. 636).
“…my daughter got herself a little job, she left school ... she was like running the show, being the mum, and I was just like a puppet” (Perera et al., 2014, p. 175).
“She [daughter] felt like she was living on an island. She missed the support she needed from me, during my depression” (van der Ende et al., 2016, p. 90).
“…Because he has been depressed, down in the dumps. He got hold of knife two weeks ago and had it close to his wrist and ready to cut himself and I asked him why he did it ‘I don’t know mommy’” (Venkataraman & Ackerson, 2008, p. 402).
Theme 4: Inescapable Threat
Subtheme 4.1: Loss and Separation Fears
“I didn’t want to go to a psychiatrist because I thought he would lock me up and I wanted to raise my kids” (Ackerson, 2003, p. 112).
Subtheme 4.2: Stigma and Fears of Rejection
“If other mothers knew I had a mental illness, they might not allow their children to play with mine” (Diaz-Caneja & Johnson, 2004, p. 477).
Subtheme 4.3: Inappropriate Support
“…Then they would say ‘Your case does not fit,’ why should I keep trying?” (Chan et al., 2019, p. 532).
Theme 5: Combatting Threat: Holding Hopes, Goals, and Aspirations
Theme 6: Wrap-Around Support Needs
“Mental health professionals and the children and family social services department have to be more incorporated. They have to become more of a joint body and have some kind of co-ordination and co-operation going fully” (Diaz-Caneja & Johnson, 2004, p. 479).
Subtheme 6.1: System-Wide Compassion and Understanding
“If you talked in a group setting with other parents, where they understood what psychosis was, and you could share different experiences, and then maybe share things that have worked, and then also it’s then sociable as well, and you may gain, sort of, friends out of it” (Radley et al., 2022a, p. 8).
“So once I learnt that, that made a huge...like light bulb moment so that I knew ‘ok if I start looking after me and my mental health and my physical health then I’ll be able to look after my family” (Awram et al., 2017, p. 152).
“Let’s say I get angry at my child...how can I manage that with my child? Or is it okay if I don’t deal with it? If I need to deal with it, then what should I do?” (Chen et al., 2021b, p. 7).
Subtheme 6.2: Connection to Support
“If it was possible that when you are admitted at the hospital and your child doesn’t have anybody to take care of him/her, they should allow us to sleep with them in the hospital until we are discharged” (Rampou et al., 2015, p. 124).
“I think there needs to be like a place where we could take our kids to take them somewhere because we need time to ourselves but I mean for just bipolar, you know” (Venkataraman & Ackerson, 2008, p. 404).
“As much as I have to go to a psychiatrist or a psychologist and chat, the kids have to be allowed to go...they’ve got so many thoughts in their heads” (Klausen et al., 2016, p. 112).
Discussion
Clinical Implications
Area of the system | Recommendation |
---|---|
Parents | • Psychoeducation should be provided to normalise parents’ experiences, reduce guilt and stigma, promote integration with community networks, support system-wide conversations about mental health, and support parent–child attachment relationships • Parents should be supported to access peer networks to tackle parental isolation • Parents’ psychological and practical support needs should be considered from an early stage to avoid crisis escalation and restrictive interventions. A strengths-based approach could support parental hope and goal-based parenting outcomes • Longer-term psychological support could support parents to make sense of experiences of threat, supporting parents to re-gain their sense of control and connection with their children, families, and wider networks • Emotion regulation support should be considered, if necessary, to support parent–child relationships by reducing shame and self-defeating behaviours by supporting parental recognition and management of their own and their children’s emotional needs • Practical parenting support and respite care should be considered, particularly for parents without system supports. Practical factors should be considered, including childcare provision and flexible service access arrangements |
Children and family | • Consideration should be given to providing respite care for children, particularly children who have been identified as experiencing increased responsibility to care for their parent(s). Community support groups could also provide connection and containment for these children and other family members • Child and family well-being should be monitored to promote signposting and joined up support to appropriate healthcare and community services • Psychological support for children should be considered, providing opportunities for safe and supportive exploration, sense making, and management of psychosocial difficulties |
Healthcare services | • Specialist training, support, and supervision should be offered across parent and child services to ensure that necessary knowledge, skills, confidence, competence, and compassion underpins service delivery. This could help reduce practitioner fear- and risk-orientated responses, in turn fostering parental hope and trust in services • HCPs should hold in mind the centrality of parenting identity in the lives of people who experience SMI. Parenting status should be asked about and considered by all HCPs • Consideration should be given to socio-cultural and political contexts within which parents live, promoting a cultural fit of service delivery • Sensitivity to parental distress and fears of social service involvement is required. Services should address parental concerns to alleviate fears and promote engagement |
Policy and legislation | • Services and communities should be adequately funded to ensure suitable provision of staff, training, and resources to meet parents needs as outlined above • Public awareness of experiences of SMI should be increased to target stigma and promote non-judgmental, compassionate, and connected system-wide support • Socio-economic disadvantage, adversity, and wider systemic influences should be accounted for |