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Beardslees preventiva familjeintervention för barn till föräldrar med psykisk sjukdom. Svenska familjers erfarenheter
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
2011 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

It has been known for many years that the children of parents with mental illness run a high risk of developing psychiatric and other problems both during their childhood and later in adulthood. Meeting and providing support for the patients’ children has, however, been a neglected area in adult psychiatry until today. Recent supplementary legislation in the Nordic countries obligates the professionals in health services to take account of the needs for information and support of the children and their families when a parent suffers from a serious illness. Beardslee’s preventive family intervention (FI) is the first family-based and structured method used in psychiatric services in Sweden. The method has some evidence of positive long-term effects for the children and families with parental depression.

The purpose of this thesis was to investigate the FIs safety and feasibility in Sweden (paper I), its’ perceived impact for the families (papers I, III and IV) and also to examine the process of the FI from the perspective of the ill parent, the other parent and the children (papers II, III and IV). The studies were conducted in naturalistic settings.

The data in paper I was collected by using a questionnaire to parents and children (117 parents and 89 children responded) one month after an FI. Paper II comprises interviews with ten parents, suffering from depression, about their decision process for participation in an FI. In papers III and IV the data from 25 interviews with parents and 14 interviews with children about the experiences of the FI is presented. Seventy five professionals from 29 psychiatric units had conducted the FIs for the families that participated in the studies. The data was analyzed by descriptive statistics and chi2 (I), Grounded theory (II and III) and Qualitative content analysis (IV).

The results in paper I showed that the overall satisfaction with the FI was high for both parents and children. Ninety three percent of the answers from parents to questions concerning the satisfaction with the FI were positive, and 71 % of the answers from the children. The reported perceived impact of the FI was also predominantly positive. Feelings of guilt decreased for 89 % of the children who had had feelings of guilt towards the parent prior to the FI. Knowledge about the parent’s illness was perceived to increase for 74 % of the children. There were a few negative answers about the impact of FI from the children; five children experienced increased concerns about the parent and three children reported a lower level of well-being after the FI.

In paper II the interviews with the depressed parents revealed ambivalence in the decision to participate in an FI. The parents longed for knowing how their children were feeling, how they thought about the illness and if it had harmed them. On the other hand, the parents were anxious about hearing the answers to their questions, as feelings of shame and guilt were associated with these. Exposure to outside opinion was also both relieving and scaring. The examination of the parents’ experiences continued in paper III. The process of opening up the dialogue about the illness with the children was demanding. To listen to the children’s experiences, to find the words to speak about the illness to the children and finally to be able to start to talk about it in the family session required a solid base of confidence and security in the professionals and in the method. The FI as a method seemed to provide favorable conditions for an establishment of an alliance with the parents. The children’s experiences of the FI are presented in paper IV. Most of the children described a sense of relief because of better knowledge about the parent’s illness and increased communication in the family and thus they also felt released from some worry for the parent. They could spend more time with their friends and did not need to take so much responsibility at home. Parents and children in the same families described the changes in similar ways, indicating mutual understanding in the families. The parents experienced themselves as stronger in their roles as parents and less ashamed.

In summary, the families are satisfied with their participation in FI, they report a positive impact and the number of perceived negative effects is low. The children describe a sense of relief from concerns about the parent’s illness.

Place, publisher, year, edition, pages
Umeå: Print och Media , 2011. , 64 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1403
Keyword [sv]
barn till föräldrar med psykisk sjukdom, prevention, intervention, kvalitativ analys, Beardslees familjeintervention
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-40700ISBN: 978-91-7459-146-0OAI: oai:DiVA.org:umu-40700DiVA: diva2:402600
Public defence
2011-04-08, Tandläkarhögskolan, 9 tr, sal B, Norrlands Universitets Sjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-03-09 Created: 2011-03-07 Last updated: 2011-03-18Bibliographically approved
List of papers
1. Beardslee's preventive family intervention for children of mentally ill parents: a Swedish national survey
Open this publication in new window or tab >>Beardslee's preventive family intervention for children of mentally ill parents: a Swedish national survey
2010 (English)In: International Journal of Mental Health Promotion, ISSN 1462-3730, Vol. 12, no 1, 29-38 p.Article in journal (Refereed) Published
Abstract [en]

Beardslee’s family intervention (FI) is a preventive method for children of depressed parents and included among evidence-based methods in the US. In Finland and Sweden the FI has been used in families with varying parental diagnosis, whereas research is lacking for other parental diagnoses than depression. The aim of this questionnaire study is to investigate the introduction and implementation of the FI in Sweden, its safety and its feasibility in clinical services. Professionals in adult psychiatry using FI recruited 103 families, who had participated in FI during 2007, regardless of parents’ diagnosis. Children between ages of 8 and 18 years were included. Parents and children were generally satisfied with FI and predominantly reported a positive impact of FI. No differences in responses were found between different diagnostic groups. The present study lends support to the assumption that FI is safe and feasible to use in general psychiatric populations.

Keyword
parental mental illness, intervention, prevention, implementation
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-40697 (URN)
Available from: 2011-03-06 Created: 2011-03-06 Last updated: 2012-10-10Bibliographically approved
2. Longing and fearing for dialogue with children: depressed parents' way into Beardslee's preventive family intervention
Open this publication in new window or tab >>Longing and fearing for dialogue with children: depressed parents' way into Beardslee's preventive family intervention
2008 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 5, 399-404 p.Article in journal (Refereed) Published
Abstract [en]

Background: There is a growing interest in prevention of mental disorders in children of mentally ill parents. Beardslee’s preventive family intervention is a method recently introduced into Sweden. When asking parents to participate in this intervention it has become evident how sensitive the issue of parenthood is to our patients.

Aim: The study aims at exploring what depressed parents considered as obstacles and facilitating factors for accepting Beardslee’s family intervention.

Methods: Ten parents from two psychiatric clinics and one primary health care centre in northern Sweden were interviewed by semi-structured technique. Nine of these parents had accepted and participated in Beardslee’s family intervention, one parent had been offered but refused participation. Data were analysed according to grounded theory.

Results: The main reason for taking part was the lack of dialogue these parents perceived with their children. There were difficulties in talking about and finding words to explain the depression. The parents were worried about their children, wishing to know how the children were actually feeling, and wanting the professionals to take a look at them. To open up was both frightening and tempting. It implied the consideration of many aspects: the right timing, shame and guilt, the partner’s interest, the children’s willingness and the involvement of professionals.

Conclusion: The findings show the delicacy of the issue of children’s well-being when a parent is depressed and they highlight some important topics to discuss with the parents when preventive interventions are offered.

Keyword
Beardslee's family intervention, parental mental illness, prevention, qualitative analysis
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-40696 (URN)10.1080/08039480801984800 (DOI)
Available from: 2011-03-06 Created: 2011-03-06 Last updated: 2011-03-18Bibliographically approved
3. Initiating communication about parental mental illness in families: an issue of confidence and security
Open this publication in new window or tab >>Initiating communication about parental mental illness in families: an issue of confidence and security
(English)In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854Article in journal (Refereed) Accepted
Abstract [en]

Background: Beardslee’s family intervention (FI) is a family-based intervention to prevent psychiatric problems for children of mentally ill parents. The parents’ experiences are of importance in family-based interventions.

Material: Twenty-five parents were interviewed about their experiences of the FI. Data was analysed by qualitative methods.

Discussion: Confidence and security in the professionals and in the FI as a method were prerequisites for initiating communication about the parent’s mental illness with the children.

Conclusions: The FI provides a solid base for an alliance with the parents and might be a practicable method when parenthood and children are discussed with psychiatric patients.

Keyword
parental mental illness, Beardslee’s family intervention, therapeutic alliance, qualitative analysis.
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-40698 (URN)
Available from: 2011-03-06 Created: 2011-03-06 Last updated: 2011-03-18Bibliographically approved
4. Children in Beardslee's family intervention: relieved by understanding of the parents' mental illness
Open this publication in new window or tab >>Children in Beardslee's family intervention: relieved by understanding of the parents' mental illness
(English)Article in journal (Other academic) Submitted
Abstract [en]

Background: Beardslee’s family intervention (FI), which is a family-based preventive method for children of mentally ill parents, has been implemented on a national level in Sweden.

Material: Fourteen children from nine families and their parents were interviewed about how the FI was for the children. Data was analyzed by Qualitative content analysis.

Discussion: A central finding was the children’s sense of relief and release from worry because of more knowledge and openness about the parent’s illness in the family.

Conclusion: The results indicating relief for the children are encouraging.

Keyword
Beardslee’s preventive family intervention, children, parental mental illness, qualitative analysis.
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-40699 (URN)
Available from: 2011-03-06 Created: 2011-03-06 Last updated: 2011-03-18Bibliographically approved

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