Exploring the Psychosocial Impact of Parental Mental Illness on Children: A Mixed-Methods Study in China

Abstract

Background: Children of parents with severe mental illness (COPSMI) are a substantial and marginalized population within society, especially in resource-limited settings. COPSMI experience a variety of adverse psychosocial outcomes and are at increased risk of developing their own mental illness. Appropriate preventative interventions can improve the psychosocial outcomes of such vulnerable children. While the last two decades have brought significant improvements in intervention programs, little is known about COPSMI in resource-limited settings, such as China. Methods: This was a convergent mixed-methods study. A cross-sectional survey was conducted concurrently with qualitative in-depth interviews. 39 families [with one parent with severe mental illness (SMI), one child and one primary caregiver in each family] were participated in the quantitative assessment, and 17 parents with SMI, 13 children, and 15 primary caregivers completed individual interviews in the qualitative section. Results: 1) Quantitative results: a) The average age of COPSMI was 12.7±3.3. Among 39 participant families, 32% SMI patients were primarily taken care of by their parents, and 36% children were primarily taken care of by their grandparents. b) Strength and Difficulty Questionnaire (SDQ): COPSMI had different levels of difficulties according to child self-rated and caregiver-rated SDQ scores. Children self-rated total SDQ scores were 8.8±4.7, and caregiver-rated total SDQ scores were 8.2±4.7. 2) Qualitative results were organized under six thematic categories: a) The costs of SMI and children’s financial sacrifices; b) ‘Missing’ parents and self-supported children; c) Fragile families and cautious children; d) Children’s experiences of parental psychiatric symptoms; e) Stressed families and hopeless children; and f) Disclosure of parental mental illness and isolation. Conclusions: While families are struggling with difficulties associated with mental illness, COPSMI in China are facing specific risks and need more support and protection. Chinese mental health professionals and social workers who work with adult mentally ill patients need a better understanding of all aspects of psychosocial impacts of parental mental health problems on children’s health.