Summarising Quantitative Outcomes in Parental Mental Illness Research.

A quarter of all children grow up in a family where a parent experiences a mental illness (FaPMI). Research activity in this area is growing rapidly and it is now critical to better understand the extant knowledge in the field. This scoping review of quantitative FaPMI literature parallels a qualitative literature review and a series of Delphi studies with key stakeholders (e.g. lived experience and clinicians), that is part of a larger program of research to achieve consensus regarding the direction of FaPMI research; including making recommendations about outcomes and measures. The programme of research aims to promote and facilitate greater comparison and learning across studies and settings. Initially this scoping review summarises the quality and focus (e.g. country and sampling) of 50 quantitative studies from 2000 to 2023 and then classifies studies according to outcomes for parents, children and families. Six to eleven years were the most common child sample group and girls were slightly underrepresented (49/51) and parents were 88% mothers. Analogous parent and child outcomes were; mental illness/psychopathology, wellbeing, mental health literacy, trauma and stressful experiences, coping, help seeking/service need, within family relationships and supports, outside family relationships and supports. Additional outcomes for parents were; parenting skills, parent competence and parenting stress and for children in relation to their; cognitive functioning and caregiving. The family related outcomes were the within and outside family relationships and supports. Since 2000 there have been 136 different survey instruments employed with approximately 80% used in only one study. This suggests that the broader goals of the program of research are warranted as there is a need for less heterogeneity in measures used. Suggested areas for future research include a sampling focus on fathers, economic evaluations of programs, parent mental health literacy, trauma, genetics and integrating well-being concepts into research designs. Child research should focus on mental health literacy, the level and impact of caring responsibilities, assessing past trauma and the roles of close family and external supports.

Predictors of family-focused practices among mental health workers in Quebec.

Context: Engaging family members in the ongoing care of individuals with mental illness is a practice known to bolster the client's recovery journey and enhance the overall wellbeing of both children and families involved. Despite its potential benefits, there remains a dearth of understanding surrounding the implementation of family-focused practices (FFP) by mental health professionals serving adults, as well as the factors that could either promote or hinder such practices. This knowledge gap is particularly pronounced within North American settings. Goal: The goal of this study was to identify potential hindering and enabling factors of FFP used in adult mental health services. Methods: A sample of 512 professionals working with adult mental health clients, from all regions of Quebec, Canada, with a variety of disciplinary backgrounds and working in different work settings, completed the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Multinominal logistic regression analysis was performed to assess the impact of several factors - organizational, professional, and personal - on the degree of family-based practices of mental health workers. Results and discussion: Findings of this study show that the strongest predictors for the adoption of higher FFP levels among adult mental health professionals in Quebec, are being employed on a full-time basis, perceiving a higher level of skills, knowledge, and confidence toward FFP, and having a supportive workplace environment. Results underscore the need to address both organizational and worker-related aspects to effectively promote better FFP in mental health services.

Children and adolescents' mental health in pandemics and confinement: A scoping review of vulnerability factors and repercussions.

Children and adolescents are a population at particular risk of experiencing adverse mental health repercussions related to pandemics. To understand vulnerability factors and repercussions of pandemics and related sanitary measures on children and adolescents' mental health, we performed a scoping review to examine and synthesize literature. In total, 66 articles were included. Results present: (1) factors that increase vulnerability to adverse mental health repercussions (e.g., having a pre-existing mental health condition, social isolation, low socio-economic status, parental distress, and overexposure to media content) and (2) specific mental health repercussions (e.g., anxiety, fear, depression, and externalizing behaviors). Addressing concerns underlined in this review could contribute to preventing further negative mental health repercussions of pandemics for children and adolescents and better prepare governments and professionals to address these highly challenging situations. Recommendations for practice include enhancing healthcare professionals' awareness about possible detrimental repercussions pandemics and sanitary measures have on children and adolescents' mental health, assessing changes for those with pre-existing mental health conditions, allocating funding for telehealth research, and providing greater support to healthcare providers.

Children and adolescents' mental health during the COVID-19 pandemic: A qualitative study of their experiences.

TOPIC: Public health measures implemented in response to the COVID-19 pandemic severely disrupted children and adolescents' (C&A) lives, affecting their sense of structure, predictability, and security. PURPOSE: To examine C&A' experiences during the COVID-19 pandemic to better understand how this context and its associated public health measures affected them and their mental health, and to identify helpful coping strategies. SOURCES USED: The study was guided by a participatory hermeneutic framework. Semistructured interviews were conducted with 25 C&A aged 6-17 years during the first and second pandemic waves. Participants' interviews were analyzed following a narrative synthesis approach, through which C&A' experiences were contrasted and contextualized to highlight relevant themes. CONCLUSIONS: Participants described a distinct pattern related to their mental health as the pandemic unfolded, which followed the severity of the pandemic in the province. Negative repercussions on their mental health were linked to the loss of social activities, imposed public health measures, transition to online learning, and challenges with family relationships. Certain youth shared positive societal and moral reflections triggered by the pandemic context. Coping strategies reported include: having a variety of hobbies; expressing their emotions; and accessing financial and material resources. This study highlights the importance of supporting C&A' mental health during crisis situations such as a pandemic. Their perspectives are vital for clinical practice and policy improvement, particularly to find means for social engagement while maintaining safety.

[Family-focused practices among adult mental health professionals: A portrait of the situation in Quebec]. / Pratiques centrées sur la famille chez les professionnels en santé mentale adulte : un portrait de la situation au Québec.

Context Children living with a mentally ill parent are a vulnerable population, at higher risk of various psychosocial and mental health problems. They are overrepresented in youth mental health and child protection services. Adult mental health services that treat parents have the opportunity to identify and support children in these families. However, to date, there is still little knowledge on the extent of family-centered practices offered by professionals from different disciplinary fields in Quebec. Objective This study aims to document the family-focused practices of adult mental health professionals according to different disciplines (social work, nursing, psychoeducation, psychology, and special education). Method A total of 524 participants, from all regions of Quebec and working with adult mental health clients, responded to an online provincial survey. A subsample of 380 participants, members of a professional order or association, was retained for the present study. These come from five discipline: social work (n=127), nursing (n=99), psychoeducation (n=57), psychology (n=56) and special education (n=41) A MANCOVA analysis was performed to compare groups on the five subscales of the French version of the Family Focused Mental Health Practice (FFMHPQ-FR, Piché et al., in press), controlling for gender, years of experience working in mental health services and estimated proportion of clients with a parental role. Results Significant differences were found between social workers and psychologists in reported family-focused practices. Participants also reported very different levels of facilitating factors such as workplace support, openness to training, perceived knowledge and skills, and attitudes towards these practices. Discussion This study helps to increase knowledge on the use of family-focused practices by professionals from different disciplinary fields, in the context of adult mental health services in Quebec. The results allow to better support the adoption of such practices in mental health services.

An Evaluation of the Acceptability, Appropriateness, and Utility of a Bibliotherapy for Children of Parents With a Mental Illness.

Background: Children of parents with a mental illness are at higher risk for various psychiatric problems and adaptive difficulties compared to those of parents without mental health problems. Certain preventive psychoeducational interventions target these children to promote their well-being and resilience and prevent the emergence of adaptive difficulties. However, few such interventions have been developed and evaluated specifically for elementary school-aged children of parents with a mental illness. Objectives: This study aims to evaluate an interpersonal psychotherapy-based book targeting children living with a parent with a mental illness. Methods: The study examines children, parents and psychosocial workers' perception of the acceptability, appropriateness and utility of the book. In total, 22 participants answered online open-ended questions after reading the book. Results: The book was highly appreciated and positively perceived by the families and psychosocial workers. Results suggest that children, parents and psychosocial workers viewed it as an appropriate and useful tool for supporting children with a parent with a mental illness. The present study reveals that the bibliotherapy appears well adapted to the developmental level of school-age children. Discussion: This study presents a book that shows promise for supporting the resilience of elementary school-aged children having a parent with a mental illness. Results highlight the importance of tailoring the content and modalities of interventions to the developmental level, needs and preferences of elementary school-aged children. The relevance of a collaborative method is also discussed, thus providing knowledge regarding this type of approach for the development of interventions targeting children.

Perceived Support and Sense of Social Belonging in Young Adults Who Have a Parent With a Mental Illness.

This participatory action research explores the perceived social support of youth whose parents have a mental illness during their transition to adulthood. Social support is an important protection factor during this developmental period, but few studies have explored how these young adults perceive their social support. Nor has any study assessed whether participation in a group-based participatory action research project could improve these youth's sense of support. Purpose: (1) identify which aspects of social support these youth spontaneously address when talking about their experiences in Photovoice workshops; (2) explore how participants view these types of workshops as a good way to improve their sense of social support and belonging. Methodology: Ten young adults (nine women and one man) between the ages of 18 and 25 who have at least one parent with a mental illness participated in Photovoice meetings in 2019. These group meetings aimed to explore and share their experiences as young adults whose parents have a mental illness. The testimonies were combined with data obtained from the abbreviated version of the Social Provisions Scale and the Scale of Social Belonging. Results: The quantitative results suggest that participants consider their social support levels to be high, but their qualitative statements highlight low level or absence of parental support in terms of emotional, informative or instrumental levels. They see themselves as an important source of support for their parent and discuss the importance of having other supports figures (romantic partner, employer, friends, sibling, etc.). Conversely, they have difficulty asking for help for various reasons (including fear of stigma). They consider that their participation in this Photovoice project allowed them to feel heard, supported and to develop a sense of belonging to a group. Discussion: To conclude, clinical issues to be considered for psychosocial intervention with young adults of parents with a mental illness are discussed.

Promotion of Wellbeing for Children of Parents With Mental Illness: A Model Protocol for Research and Intervention.

Background: The main objective of this project is to create a research and intervention model to promote large-scale implementation and evaluations of generic very brief interventions for children of parents with mental disorders (COPMI). Feasible interventions for COPMI aged 0-18 years are highly needed, as this is a large high-risk group in society. Reducing behavioral problems and enhancing wellbeing for families with parents affected by any mental disorder are important preventive initiatives. One key prevention strategy is to reduce the risk and expression of psychopathology in children and to promote wellbeing. The present model protocol offers an intervention for children of parents with mental disorders internationally based on a model already implemented in the Netherlands and Norway. Methods: Participants will be parents receiving treatment in mental health services in participating countries and their minor children aged 6-18 years. Participants should be randomized into an intervention group or control group. Data should be retrieved from electronic patient journals (demographics, DSM 5/ICD-10, SCID, MINI) as well as from assessment measures administered at baseline and follow-up, including the KIDSCREEN-27, Strengths and Difficulties Questionnaire (SDQ), Parents' Evaluations of Developmental Status (PEDS), Parenting Sense of Competence (PSOC), Resilience Scale for Adolescence (READ), Guilt and Shame Questionnaire for Adolescents of Parents with Mental Illness (GSQ-APMI), Mental Health Literacy Scale, and Parent-Child Communication Scale. Results: The hypothesis is that there will be improvements of child behavioral and emotional problems, and outcomes in the project will be reported in terms of parent´s diagnosis, child behavioral and emotional problems, child wellbeing, family communication and functioning, as well as participants' satisfaction. Discussion: This multi-site international protocol will focus the attention of European scientific and policy makers toward COPMI. This young segment of the population is presently almost completely neglected in most European health policies, despite having a large burden of disability and being at risk of transgenerational transmission of psychopathology. We will further discuss the feasibility of a very brief intervention aiming at preventing mental disorders in young people.

[Prevalence and associated factors of depression symptoms in fathers of children aged 6 months to 17 years in Québec]. / Prévalence et Facteurs Associés aux Symptômes Dépressifs chez les Pères d'enfant 6 mois-17 ans au Québec.

OBJECTIVES: In fathers, depression symptoms experienced during pregnancy and after childbirth represent a depression risk factor during the child first months. Since depression can have a huge impact on their subsequent involvement with the child, this issue is worrisome and requires consideration. Until now, however, few studies have dealt with paternal depression and its determinants beyond the perinatal period. METHOD: This study uses data from a representative provincial survey conducted with 1342 fathers of children aged 6 months to 17 years. It documents the prevalence of moderate and severe depression symptoms with the CES-D scale as well as associated factors. RESULTS: Findings show prevalence rates ranging from 3% to 10% depending on depression symptom severity and children age. Associated factors include problematic use of alcohol, no employment, stress related to balancing work and family, domestic violence environment, and low revenue and social support. CONCLUSION: These results are interpreted in light of the role and involvement fathers keep in their child's life. They also stress the importance of identifying depression symptoms in this population beyond the perinatal period while monitoring the symptom intensity.

OBJECTIFS: Chez les pères, les symptômes dépressifs vécus pendant la grossesse et après la naissance représentent un facteur de risque de la dépression dans les premiers mois de vie de l'enfant. Puisque celle-ci peut avoir de lourdes conséquences sur leur engagement ultérieur auprès de l'enfant, cette problématique est préoccupante et nécessite qu'on s'y attarde. Or à ce jour, peu d'études ont porté sur la dépression paternelle et sur ses déterminants au-delà de la période périnatale. MÉTHODE: Cette étude utilise les données d'une enquête provinciale représentative réalisée auprès de 1342 pères d'enfants âgés de 6 mois à 17 ans. Elle documente la prévalence des symptômes dépressifs modérés et graves à l'aide du CES-D ainsi que leurs facteurs associés. RÉSUTATS: Les résultats montrent des prévalences variant de 3% à 10% selon la gravité des symptômes dépressifs et l'âge des enfants. Parmi les facteurs associés, on retrouve la consommation problématique d'alcool, l'absence d'un emploi, le stress lié à la conciliation famille-travail, le climat de violence conjugale ainsi que de faibles revenu et soutien social. CONCLUSION: Ces résultats sont interprétés à la lumière du rôle et de l'engagement des pères dans la vie de l'enfant et soulèvent l'importance d'identifier auprès de cette population les symptômes dépressifs au-delà de la période périnatale tout en portant une attention à l'intensité de ces symptômes.

[Epidemiology of depressive and anxiety disorders among Quebec children and adolescents]. / Épidémiologie des troubles dépressifs et anxieux chez les enfants et les adolescents québécois.

Epidemiology of child and adolescent mental health is a relatively new discipline, particularly in the province of Quebec. Some work has however estimated the prevalence of the most common mental disorders among young people, such as anxiety and depression, as well as identified associated individual, family and socio-economic variables. This article has two objectives: to present a review of major epidemiological research findings in child psychiatry conducted in the province of Quebec and highlight the contribution of these findings for public health. To achieve these objectives, this article presents the results of research related to three themes: 1) measurement and identification of anxiety and depressive disorders in children and adolescents, 2) the prevalence of these disorders and comorbidity, 3) the correlates of anxiety and depressive disorders identified in epidemiological studies. The authors will then highlight future implications of these results across Québec policies in the field of public health.

Associations Between Extracurricular Activity and Self-Regulation: A Longitudinal Study From 5 to 10 Years of Age.

PURPOSE: Health promotion in youth is likely to benefit from enhancing academic achievement and physical activity. The present study examines how kindergarten childhood self-regulation skills and behaviors predict involvement in both structured and unstructured physical and nonphysical extracurricular activities in the fourth grade. As a second objective this study also investigated how kindergarten childhood participation in extracurricular activities predicts classroom engagement, reflective of self-regulation, by the fourth grade. DESIGN: Secondary analyses were conducted using prospective-longitudinal data. SETTING: The Quebec Longitudinal Study of Child Development, Quebec, Canada. SUBJECTS: Participants were randomly selected at birth from a stratified sample of 2694 born in Québec, Canada, between 1997 and 1998. Participants were included if they had complete data on teacher ratings of child self-regulation as measured by classroom engagement and parent ratings of sports participation (n = 935). MEASURES: Teachers reported self-regulation skills in children through a measure of classroom engagement. Parents provided reports of child participation extracurricular activities. ANALYSIS: Ordinary least-squares regressions were conducted. RESULTS: A higher-frequency kindergarten involvement with structured physical activities was associated with fourth-grade classroom engagement (ß = .061, 95% confidence interval [CI]: .017, .104). Better kindergarten classroom engagement predicted more frequent participation in fourth-grade structured physical activities (ß = .799, 95% CI: .405, 1.192) and team sports (ß = .408, 95% CI: .207, .608). CONCLUSION: Results suggest mutual relations between physical activity and self-regulation from kindergarten to grade four. This suggests strong learning skills indicative of self-regulation and opportunities to participate in supervised physical activities or sports teams may help children develop healthy dispositions and behaviors in emerging adolescence.

Reliability, validity, and clinical use of the Dominic Interactive: a DSM-based, self-report screen for school-aged children.

OBJECTIVES: As no single informant can be considered the gold standard of child psychopathology, interviewing of children regarding their own symptoms is necessary. Our study focused on the reliability, validity, and clinical use of the Dominic Interactive (DI), a multimedia self-report screen to assess symptoms for the most frequent Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, mental disorders in school-aged children. METHODS: A sample of 585 children aged 6 to 11 years from the community and psychiatric clinics was used to analyze the internal consistency, the test-retest estimate of reliability, and the criterion-related validity of the DI against the referral status. In addition, cross-informant correlation coefficients between this instrument (child report) and the Child Symptom Inventory (parent report) were explored in a subsample of 292 participants. RESULTS: For the total sample, Cronbach alpha coefficients ranged from 0.63 to 0.91. Test-retest kappas varied from 0.42 to 0.62 for categories based on cut-off points, except for specific phobias. Intraclass correlation coefficients ranged from 0.70 to 0.81 for symptom scales. The DI discriminated between referred and non-referred children in psychiatric clinics for all symptom scales. Significant cross-informant correlation coefficients were higher for the externalizing symptoms (0.35 to 0.48) than the internalizing symptoms (0.14 to 0.27). CONCLUSIONS: Findings of our study reasonably support adequate psychometric properties of the DI. This instrument offers a developmentally sensitive screening method to obtain unique information from young children about their mental health problems in front-line services, psychiatric clinics, and research settings.

Objectifs : Comme aucun indicateur unique ne peut être considéré comme étant l'étalon de référence de la psychopathologie pédiatrique, il est nécessaire d'interviewer les enfants à l'égard de leurs propres symptômes. Notre étude portait sur la fiabilité, la validité et l'utilisation clinique du Dominique interactif (DI), un instrument multimédia auto-déclaré servant à évaluer chez les enfants d'âge scolaire, les symptômes des troubles mentaux les plus fréquents du Manuel diagnostique et statistique des troubles mentaux, 4e édition, texte révisé. Méthodes : Un échantillon de 585 enfants de 6 à 11 ans de cliniques communautaires et psychiatriques a été utilisé pour analyser la cohérence interne, l'estimation test­retest de la fiabilité, et la validité liée à un critère du DI contre l'état des sujets référés. En outre, les coefficients de corrélation inter-indicateurs entre cet instrument (rapport des enfants) et l'inventaire des symptômes des enfants (rapport des parents) ont été explorés dans un sous-échantillon de 292 participants. Résultats : Pour le total de l'échantillon, les coefficients alpha de Cronbach se situaient entre 0,63 et 0,91. Les kappas test­retest variaient de 0,42 à 0,62 pour les catégories basées sur les seuils d'inclusion, excepté pour les phobies spécifiques. Les coefficients de corrélation intraclasse allaient de 0,70 à 0,81 pour les échelles de symptômes. Le DI discriminait entre les enfants référés et non référés à des cliniques psychiatriques pour toutes les échelles de symptômes. Les coefficients de corrélation inter-indicateurs significatifs étaient plus élevés pour les symptômes externalisants (0,35 à 0,48) que pour les symptômes internalisants (0,14 à 0,27). Conclusions : Les résultats de notre étude soutiennent raisonnablement les propriétés psychométriques adéquates du DI. Cet instrument offre une méthode de dépistage sensible au stade du développement afin d'obtenir des renseignements uniques de la part des jeunes enfants sur leurs problèmes de santé mentale dans les services de première ligne, les cliniques psychiatriques, et les milieux de recherche.

Maternal Lifetime Depressive/Anxiety Disorders and Children's Internalizing Symptoms: The Importance of Family Context.

OBJECTIVES: This study investigated the interaction effects between mothers' lifetime depressive/anxiety disorders and other psychosocial correlates of 6 to 11 year-old children's self-reported internalizing symptoms in the Quebec Child Mental Health Survey. METHOD: A representative subsample of 1,490 Quebec children aged 6 to 11 years was selected from the original sample. Multiple linear regression analyses were performed using children's internalizing symptoms and child, family and socioeconomic characteristics. RESULTS: Four variables interacted significantly with mothers' lifetime depressive/anxiety disorders to predict 6 to 11 year-old children's internalizing symptoms: child age (t=2.415, P=0.016), mother's caring behaviours (t=2.950, P=0.003), mother's punitive behaviours (t=2.629, P=0.009) and parental social support (t=2.272, P=0.023). CONCLUSION: Results highlight the important contribution of the family context to the intergenerational transmission of internalizing symptoms and the relevance of taking into account children's developmental period. They support the importance of early screening of children's self-reported internalizing symptoms, among children of depressed/anxious parents. It is suggested to develop preventive intervention programs oriented towards children of depressed/anxious parents and exposed to relational difficulties.

Psychometric properties of a pictorial instrument for assessing psychopathology in youth aged 12 to 15 years: the Dominic Interactive for Adolescents.

OBJECTIVES: Over the last 15 years, adequate psychometric properties of the different versions of the Dominic led to the development of the Dominic Interactive for Adolescents (DIA). The DIA is a Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, Text Revision-based self-administered computerized pictorial instrument for assessing the most frequent mental disorders in adolescents aged 12 to 15 years. Our study aims to verify the internal consistency, the test-retest estimate of reliability, and the criterion-related validity of this instrument. METHOD: The total sample included 607 adolescents living in the Montreal urban area recruited from the community (465 French-speaking) and the clinical population (142 French-speaking). Internal consistency was evaluated by Cronbach's alpha coefficients and test-retest estimate of reliability by the kappas and intraclass correlation coefficients (ICCs). Two criteria are indicative of criterion-related validity of the DIA: clinical judgment on the presence or absence of symptoms (scored independently by 3 judges) and the adolescents' referrals to outpatient psychiatric clinics. RESULTS: For most symptom scales of the DIA, Cronbach's alpha coefficients varied from 0.69 to 0.89, test-retest kappas were 0.50 or greater, and ICCs ranged from 0.78 to 0.87. The criterion-related validity was demonstrated for symptoms, symptom scales, and the categories based on the symptom scale cut-off points. CONCLUSION: As no informant can be considered the criterion standard of psychopathology, the interview with adolescents regarding their own symptoms is necessary. Findings from our study reasonably support adequate psychometric properties of the DIA in adolescents aged 12 to 15 years.

Correlates of depressive disorders in the Quebec general population 6 to 14 years of age.

There are relatively few community-based epidemiological studies in which correlates of depressive disorders were identified through multivariate analyses in children and adolescents aged 6--14 years. Moreover, several family characteristics (e.g., parent-child relationship) have never been explored in this regard. The purpose of this study was twofold. Using data from the Quebec Child Mental Health Survey, it sought: (1) to identify psychosocial correlates associated with depressive disorder in two age-groups (6--11 and 12-14 years) according to informant (child/adolescent, parent); and (2) to interpret the relative importance of correlates by ranking variables according to strength and consistency of association across age-groups. Logistic regression models show correlates to be inconsistent across informants. The ranking of correlates indicates a major contribution of only-child status/ordinal position, parent's major depressive disorder, stressful family events, and parent-child relationship, thereby supporting the hypothesis of the relevance of family context in the development of depression.