Families living with severe mental illness: a literature review

Schizophrenia is a severe mental illness, which is stressful not only for patients, but also for family members. Numerous studies have demonstrated that family caregivers of persons with a severe mental illness suffer from significant stresses, experience moderately high levels of burden, and often receive inadequate assistance from mental health professionals. Effective family functioning in families with schizophrenia may be influenced by a variety of psychosocial factors. The purpose of this article was to present a review of the social science literature related to families living with schizophrenia that has been published during the last three decades. There is general agreement in the literature that a multitude of variables affect families with a severe mental illness, such as schizophrenia. Therefore, this literature review examined the most frequently investigated variables (coping, psychological distress and caregiver burden, social support, caregiver resiliency and depression, and client behavioral problems) as they are related to families and schizophrenia.     

Interpersonal violence and mental illness: a literature review

There is a perception that people with a mental illness are dangerous. However, there are still arguments in the research literature as to whether the evidence supports this perception. The major aim of this paper is to review the findings of these studies in regard to the risk of violent behaviour in people with mental illness. An additional aim is to give an overview of the risk factors for violence in people with a mental illness. This systematic search of the literature resulted in good evidence that diagnoses such as schizophrenia and personality disorder are associated with an increased risk of violent behaviour. Substance abuse was the risk factor most associated with an increase in the risk of violent behaviour in people with a mental illness. However, there are substantial differences in the methods used in studies of the risk in violence in people with mental illness resulting in a large variability in the estimates of risk. One of the major causes of variation may be due to the different definitions of violence that are used. The need remains, therefore, for a meta-analysis of this literature based on clear definitions of violence in order to get a more accurate estimate of the risk of violence in people with a mental illness.     

Burden of mental illness on the family: a critical review

The burden that a family experiences as a result of one of its members having a chronic mental illness has been the subject of research since the mid-1950s. A review of the findings in the research literature, an examination of the conceptual and operational definitions of burden, and an evaluation of methodological issues are provided. Finally, based on this critical review, suggestions are offered for future research.     

The role of cognitive appraisal in adaptation to traumatic stress in adults with serious mental illness: a critical review

A compelling body of literature suggests that negative appraisal may be associated with adverse reactions to traumatic stress. However, very few studies have examined how appraisal influences posttraumatic adaptation in people with serious mental illness (SMI) despite evidence of disproportionately high prevalence rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) in this population. The purpose of this article is to provide a critical analysis of the theoretical and empirical literature on cognitive appraisal and psychological adaptation to traumatic stress with a specific focus on individuals diagnosed with SMI. It will be argued that appraisal is a key correlate that may partially account for higher rates of PTSD in people diagnosed with major mood and schizophrenia-spectrum disorders, meriting special consideration for future research.     

Keeping close: mothering with serious mental illness

AIM: The aim of this paper is to describe the experiences of mothers with serious mental illness from their perspectives and how they attempted to manage their mothering circumstances. BACKGROUND: The desire to mother in women with serious mental illness is increasingly acknowledged by healthcare professionals. For these women, mothering is often framed as a pathological problem needing professional intervention. Yet little is known about mothering and illness from the perspectives of the mothers themselves. METHOD: Using Glaser's grounded theory approach and both purposive and theoretical sampling, interviews were conducted with 20 mothers who were receiving treatment for mental health problems. The data were collected in 2002. FINDINGS: We found the core category of Keeping close described mothers' efforts to have meaningful relationships with their children in the context of illness and suffering. To this end, mothers chose strategies that would hide illness for the sake of protecting their roles and their children. These strategies--masking, censoring speech, doing motherwork and seeking help--served to imitate ideal perceptions of mothering while making illness invisible to their children. Mothering in illness, however, became a vortex of contradictions, resulting in mothers 'hitting bottom', a point in time when they realized they could not keep close via pretences. To return to the valued place of mother, they sought treatment, hoping to learn how to be with their children authentically. CONCLUSION: To assist mothers with serious mental illness, healthcare professionals must be sensitive to the social and cultural context in which they mother in order to create healthier possibilities for nurturing their children.     

Exploring lived experiences of persons with severe mental illness: a review of the literature

This paper describes a literature review concerning the use of phenomenology to explore the experiences of persons with severe mental illness. Data from 35 publications were abstracted and summarized. The congruence between philosophical underpinnings and methods are critiqued. Findings of individual studies are summarized and reveal desires for normalcy, social relationships, meaningful activities, and opportunities for involvement and participation in treatment. The experience of suffering demonstrated the grave effect of severe mental illness on the individual's life experience. Utilization of phenomenology as a philosophy and methodology can guide the development of interventions that honor individual experience and meaning.     

Living with serious mental illness: the desire for normalcy

This article describes the desire for normalcy as experienced by 6 men and 13 women with serious mental illness based on secondary analysis of data from two previous qualitative studies. Original data were collected by structured and semi-structured interviews, and thematic analysis was done. Major categories of desire for normalcy are having normal things and experiences; doing meaningful activities; and being well, safe, free, and independent. Self-care actions to promote and maintain normalcy are identified, and finding are discussed in relation to Orem's self-care deficit theory of nursing. Implications for nursing theory, research, and practice are addressed.     

Mothers with mental health problems: a systematic review

Mothers with mental health problems meet challenges in coping with their condition, the responsibility of child rearing, and fulfilling their role as a mother. The aim of this study was to create a synthesis of the previous research on mothers with mental health problems and the challenges they face. A systematic literature search of international databases was undertaken, covering the period between January 1998 and April 2009. Nineteen articles met the inclusion criteria. The analysis process involved skimming, comprehending, analyzing, and synthesizing. Three themes emerged: the vulnerability of mothers with mental health problems, the fear of being perceived as not good enough as a mother, and concern that the children might develop mental health problems. In conclusion, the focus of the research field is shifting from viewing the mother's mental health problems from an individualistic perspective to considering them in a broader context of relational, economic, and environmental factors and on the basis of the mother-child relationship being characterized by interdependence.     

Recovery from serious mental illness: a concept analysis

This paper examines the concept of recovery in the context of serious mental illness. The analysis uses literature from multiple health care disciplines and different uses of "recovery" in every- day language, technical applications, and popular culture. This iterative process concludes with a definition of recovery from serious mental illness: a nonlinear process of self-organization and adaptation that offsets the personal disintegration of mental illness and enables the individual to reconceive his or her sense of self and well-being on all biopsychosocial levels. The relevance of the concept is reevaluated with this definition for potential usage in the mental health care setting.     

Role of the mental health nurse towards physical health care in serious mental illness: an integrative review of 10 years of UK literature

People with serious mental illness have significantly poorer physical health compared to the general population. Mental health nurses are in a prime position to help reduce unacceptable death in this population. A literature search was undertaken to identify the role of the mental health nurse in regards to physical health care, intervention, and attaining the necessary knowledge to address the physical health needs of people in the UK with serious mental illness. Of 254 papers identified, nine met the inclusion criteria. An integrative literature review found that mental health nurses are not routinely supported by physical health-care education and training, with many expressing role ambiguity. Inpatient setting correlated to a less positive role attitude; poor primary-secondary care interface communication compounded the problem of this vulnerable population having their physical health needs identified and met.     

Children living with a parent who has a mental illness: a critical analysis of the literature and research implications

This article provides an analysis and assessment of the literature that deals with children of a parent who has a mental illness. It argues that children's perspectives about living with a parent who has a mental illness have not been taken into consideration. A survey of the literature indicates that it can be divided into sections that include: the family context of the child, risks associated with the child's stage of growth and development, characteristics associated with resilience, and existing interventions. In general, research studies have examined factors that are associated with the presence or absence of children's pathology and have relied on researchers' normative judgments to denote narrow views of pathology, and diagnostic and behavioral measures. The article will propose a program of research that addresses the issues raised in our analysis.     

Medication decision-making by persons with serious mental illness

The Interaction Model of Client Health Behavior (IMCHB) has been established as a useful model in guiding research and development of individually tailored clinical interventions. The constructs of client singularity, client-provider interaction, and health outcomes guided an examination of medication decision-making by persons with serious mental illness (SMI). Client motivation is discussed as it relates to participation in the client-provider interaction and subsequent medication adherence and quality of life. Decisional control, the specific element of the client-provider interaction that affects medication decision-making, is considered in relation to consumer roles and responsibility for medication management. As psychotropic medications remain the single most effective treatment for reducing the active symptoms of psychosis, this look at medication decision-making may have significant implications for nursing.     

Web technology for persons with serious mental illness

Based on preliminary studies using staff focus groups and consumer interviews, a web-based homepage portal was developed for use by staff and consumers in community mental health clinics. Standard user-testing methods were used to interview and observe participants who were discharge-ready from a state psychiatric facility. As the participants navigated the portal, they "talked aloud" and were presented scenarios to gain their opinions about design and content. The final result was a web portal with communication, education and support features that was ready for further development to deal with issues of privacy, confidentiality, and security, with the ultimate goal of improving patient outcomes.     

Respite care for caregivers and people with severe mental illness: literature review

AIM: The aim of this study was to review research literature over the past 10 years on respite care for people affected by severe mental illness; and identify key implications for nursing practice in provision of respite care for family caregivers of people with severe mental illness. BACKGROUND: Family caregivers play an important role in health care, but need regular breaks to maintain their own health and well-being. Respite care is one of the few services available with a primary focus on supporting family caregivers. In most developed countries the notion of respite care as an extension of the health care service has been embraced, evidenced by a growing body of literature in health and health-related disciplines. METHODS: An initial literature search was undertaken using the key words "respite", "short-term care", "shared care" and "day care" in major electronic databases for nursing, psychiatry, psychology and sociology literature between 1967 and 2002, identifying 704 articles. Closer examination of the literature from 1993 to 2002 on gaps and trends in respite care for people affected by severe mental illness was conducted. This is discussed in the context of the broader literature, particularly on dementia, where the mainstream research on respite care is found. RESULTS: The majority of family caregiving studies identified a need for greater quality, quantity, variety and flexibility in respite provision, and the literature has remained largely silent in relation to those affected by severe mental illness. There are contradictory findings on outcomes of respite care services and a lack of controlled empirical studies and evaluative research on effectiveness. CONCLUSIONS: Respite care is beneficial for caregivers, there is significant unmet need in provision of services for the mentally ill, and greater flexibility and the needs of caregivers should be recognised and addressed.     

Smoking cessation and serious mental illness

A focus group methodology was employed to identify personal, social, and environmental factors that affect smoking cessation in persons with serious mental illness. Four focus groups were held: two for those who had attempted to quit smoking and two for those who had never attempted to quit. Smoking is central to daily survival in patients with serious mental illness. Social and environmental reinforcement can both assist and hinder efforts to stop smoking. Smoke-free environments influence decisions to quit smoking if positive social comparisons with nonsmokers occur. Peer modeling and interpersonal connections with nonsmokers can offer links to forming supportive nonsmoking relationships.     

Effectiveness of weight management interventions for people with serious mental illness who receive treatment with atypical antipsychotic medications. A literature review

Weight gain associated with treatment with atypical antipsychotic medication has been widely recognized as a risk factor for the development of diabetes and cardiovascular diseases. A systematic search was conducted of major databases and of citations for material about the effectiveness of weight management interventions for people with serious mental illness who receive treatment with atypical antipsychotic medications. Studies were included if the focus was on improvement in weight profile through the application of psychoeducational or exercise and dietary interventions and where outcome measures were reported and presented in recognized values. Out of 221 studies, 19 met the inclusion criteria and after assessment of the quality of the studies, eight were selected for detailed review.