Young women's experiences of psychotic illness: a systematic review of qualitative research.

BACKGROUND: The relationship between young adulthood, women and psychosis was the focus for this systematic review. Age and gender are factors that can influence responses to illness. Research indicates that there are differences in how young men and women are affected biologically and psychosocially, including the presentation of a constellation of symptoms, response to anti-psychotic medications and how they assess their life circumstances. Yet in literature that examines experiences of young people with psychosis, the specific needs of young women are usually not presented separately. To better understand and address young adult women's healthcare and social service needs, a synthesis of evidence addressing the relationship between young adulthood, women and psychosis is needed. OBJECTIVES: The aim of this systematic review was to synthesize the best available evidence on the experiences of young adult women (aged 18-35 years) living with a psychotic illness in the community. Specifically, the review question was:What are the experiences of young adult women living with a psychotic illness? INCLUSION CRITERIA TYPES OF PARTICIPANTS: Participants were young women between 18 and 35 years of age who were living with a psychotic illness in the community. PHENOMENA OF INTEREST: The phenomenon of interest was the experiences of living with a psychotic illness of women aged 18-35 years in the community. Experiences were defined broadly as and inclusive of perceptions and experiences with health and social systems. CONTEXT: The context for this review was the community setting. TYPES OF STUDIES: The current review included studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, feminist research and the qualitative component of mixed methods studies. SEARCH STRATEGY: A three-step search strategy was used to locate both published and unpublished studies. The search was limited to studies published from 1995 to the search date of May 13, 2015. METHODOLOGICAL QUALITY: Two reviewers independently appraised the nine included studies using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) assessment tool. DATA EXTRACTION: Data were extracted from included papers using the standardized data extraction tool from JBI-QARI. DATA SYNTHESIS: Two reviewers independently reviewed the extracted findings to identify potential categories to pool similar findings. A third member of the team met with the reviewers to collaboratively review these derived categories to create a meta-synthesis that reflected a comprehensive set of synthesized findings. RESULTS: Based on the thematic findings from nine qualitative studies, two synthesized findings were identified: (1) the complexity of living with psychosis and finding health, and (2) the presence of harming and healing relationships in young women's lives. The included studies explored a range of experiences relevant for women within the broader phenomenon of experiences of living with a psychotic illness, including experiences within healthcare and social systems. CONCLUSION: The systematic exploration of the literature resulted in identification of nine studies of moderate-to-high methodological quality that met the inclusion criteria. The ConQual evaluation of the level of evidence resulted in synthesized finding 1 (the complexity of living with psychosis and finding health) rated as moderate and synthesized finding 2 (the presence of harming and healing relationships in young women's lives) rated as low. Practitioners can use these findings to guide practice. Further research exploring other experiences relevant for this population is needed.

The Wellness Planner: empowerment, quality of life, and continuity of care in mental illness.

Coordination of mental health services has often been a challenge from the user's point of view. Resulting gaps in care can lead to increased use of crisis services, more frequent hospitalization, and impaired quality of life. This study examined an innovative approach to building an individual's self-care capacities by testing the use of a wellness intervention: an adaptation of a client-held medical record/crisis plan in booklet form. Fifty individuals using community mental health services were recruited. Using a pretest-posttest design, participants completed measures of empowerment, continuity of care, quality of life, and satisfaction with services at the start of and again following 3 months of using the booklet. The booklet, referred to as the Wellness Planner, included components that have been empirically demonstrated as effective, such as crisis planning, goal setting, and resource planning. For the 42 individuals who completed the study, statistically significant increases were seen in empowerment, continuity of care, and satisfaction with services after 3 months of using the Wellness Planner. Qualitative data further demonstrated positive acceptance of the booklet by the users. Findings of the study suggest that the use of such a booklet could not only have a positive impact on the recovery of individuals but could also have utility within the mental health system. Since the completion of this study, the Winnipeg Regional Health Authority has adopted the booklet for use within all its adult mental health programs. Future research will focus on the impact of the booklet on system-wide indicators such as service utilization and readmission rates.

Relationship-based support for women living with serious mental illness.

Relationships are critical to a woman's growth and development, yet when living with serious mental illness, developing and nurturing connections can be challenging. This qualitative study explored the nature and quality of support provided within relationships for 14 women with schizophrenia. Families were key supporters. Female friends with mental illness often provided a meaningful source of connection for participants. Problematic relationships, losses over time, and living in poverty were among the barriers to receiving needed support. Participants conveyed a sense of wanting relational reciprocity as they talked about their relationships and place within the community.