Preliminary findings and implications for practice: An exploratory study of factors that influence the impact on emerging adults who grew up with a depressed parent APNA PRESENTATION BRANDY M. MECHLING PHD (C), RN, PMHCNS-BC N O VEMBER 9, 2012 Learning Objectives Identify and describe aspects of ambiguous loss in children who grow up with a depressed parent. Assess what factors might buffer the experience of a child growing gup with a depressed parent and potentially impact outcomes in young adulthood. Discuss implications of research findings regarding children of depressed parents in reference to nursing practice. Disclosure Statement: The speaker has no conflicts of interest to disclose. Background & Significance In any given year, 19 million American adults are diagnosed with depression (National Institute of Mental Health, 2009). The World Health Organization (WHO) (2006) projects that by 2020, Depression will be the #1 leading cause of disability for women and children. Studies show that 60% of youth with a depressed parent will develop psychiatric problems sometime during their childhood or adolescence (Smith, 2004). C&A of depressed parents are at risk for negative outcomes: Mood disorders Anxiety disorders Conduct disorder Substance abuse Socialization issues Mechling 1
Theoretical Framework Pauline Boss s Ambiguous Loss Theory: Ambiguous loss is an unclear, incomplete loss that causes uncertainty, interferes with meaning making, & causes lack of resolution. When a parent suffers from depression he or she is physically there, but may be psychologically absent. Boundary ambiguity is a state in which family members are uncertain in their perceptions of who is in and out of the family and performing what roles and tasks (Boss, Greenburg, & Pearce-McCall, 1990, p.2). Theoretical Framework Theoretical Propositions: The higher the boundary ambiguity in the family system, the higher the stress, the greater the individual and family dysfunction. Boss clarifies that boundary ambiguity can result from inside and outside (extended family, peers, society) of the family. Over a short period of time, boundary ambiguity may not cause dysfunction. If high and persists, the family (and its members) becomes increasingly stressed and dysfunctional. The value system of the family (i.e. religious beliefs, illness beliefs, beliefs over mastery vs. fatalism) influences the perception of boundary ambiguity. The length of time boundary ambiguity can be tolerated is influenced by the family s values. The family s perception of an event is influenced by the amount of perceived support available to assist the family. (Boss, Caron, Horbal, & Mortimer, 2009). Understanding of Parent s Depression Hope Amount of Young Caregiving + Aspects of Caregiving Social Support - Aspects of Caregiving Depression in Parent Boundary Ambiguity in Parent-Child Relationship Stress for Child Emerging Adult Outcome = Psychosocial Well-being Retrospective Experienced in the 1 st 18 years of life Current experience Mechling 2
Purpose To conduct an exploratory study of the relationships of boundary ambiguity and other factors that contribute to the psychosocial well-being of emerging adults who have experienced depression in a parent during their upbringing. Methodology In General: Exploratory, cross-sectional, correlational, mixed-methods design Sample Recruitment Power analysis: At a minimal desired statistical power level of.80, with a p-value of 0.05, an f 2 of 0.15, and seven predictor variables, the minimum required sample size equals n= 103. For a p-value of 0.01, the minimal sample size required equals n= 141. Measures: Mental Health Inventory PSWB Boundary Ambiguity Scale for Caregivers of Patients with Dementia Perceived Stress Scale Mental Health Literacy Scale Young Caregiver of Parents Inventory Herth Hope Scale Multidimensional Scale of Perceived Social Support Length of parental depressive symptoms (Data collection form) Analysis Plan Quantitative Data Bivariate correlations Strongest bivariate relationships (correlations, chi-square, and t-tests) Significance levels set at p = 0.01 to 0.05. Multiple regression Best fitting model Qualitative Data Interviews: Random, subsample (n=10) Bif Brief, semi-structured t interviews Thematic analysis Vignettes (brief personal accounts) from participant interviews will be added to support quantitative findings. Mechling 3
Demographics- Participant Characteristics Age (µ = 20.37) Frequency Percent (%) 18 20 16.7 19 25 20.8 20 22 18.3 21 28 23.3 22 11 9.2 23 and older 14 11.7 Received Therapy? Yes 49 41.2 No 70 58.8 Gender Female 98 81.7 Male 22 18.3 Race Caucasian 108 90.0 Hispanic 2 1.7 African American 2 1.7 Asian 1.8 Mixed 7 5.8 Demographics- Parent Characteristics Which parent? Frequency Percent (%) Mother 88 73.3 Father 32 26.7 Were both parents depressed? Yes 13 10.8 No 107 89.2 Parent(s) divorced? Yes 59 49.2 No 57 47.5 Never married 4 3.3 Length of symptoms (yrs.) (µ = 9.83) 0-5 23 19.2 6-10 48 35.8 11-15 39 32.5 16-20 15 12.5 Demographics- Parent / Child Relationship Characteristics Known parent whole life? Frequency Percent (%) Yes 116 96.7 No 4 3.3 Depressed parent always in the home? Yes 96 80.0 No 22 20.0 Ever separated from the depressed parent? Yes 35 29.2 No 84 70.8 Earliest memory of depression(yrs.) (µ = 9.54) Below 3 1.8 3-6 27 22.5 7-11 52 43.3 12-17 40 33.3 Mechling 4
Relationships between Psychosocial Well being and Predictor Variables Predictor Variables Pearson s r p value Boundary ambiguity.210*.021 Perceived stress.375**.0001 Length of Depressive s/s.230*.012 Caregiving Total.015.872 Positive outcomes.259**.004 Negative outcomes.260**.004 Hope.449**.0001 Understanding MH literacy.201*.028 Perceived social support.239**.009 *Correlation is significant at the 0.05 level (2 tailed). **Correlation is significant at the 0.01 level (2 tailed). Regression Analysis: Simultaneous vs. stepwise vs. forward vs. backward Overall best fitting models R 2 adjusted P-value Length of depressive s/s, BA- total, PSS-total, MSPSS-total, MHL total, & HHI-total.258 <0.00001 Length of depressive s/s, BA- total, PSS-total, MSPSS-total, MHL total, & HHI-total.258 <0.00001 Length of depressive s/s, BA- total, PSS-total, MHL total, & HHI-total.260 <0.00001 Qualitative Themes Uncertainty I was walking on egg shells. They did a good job hiding it. Parents and family members s/s, feelings, dx, & meds. What do you do with that? Making it personal words that really hurt Threats, actions Journals left out Suicide notes discovered To this day, I still worry. Mechling 5
Conclusions or So What? What does this study provide that is different? Few studies examine outcomes with the emerging adult population. No studies have used ambiguous loss theory as a lens to examine emerging adult outcomes for youth who grow up with a depressed parent. Results could lead to work with interventions for children of depressed parents. Limitations Retrospective Report Construct Validity Confounding Factors Generalizability Questions & Discussion Thank you for attending my presentation And, Go STEELERS! Mechling 6
References American College Health Association (2009). National College Health Assessment. Retrieved February 28, 2011 from http://www.achancha.org/pubs_rpts.html American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4 th ed., rev.). Washington D.C.: Author. Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469-480. Arnett, J. J. (2007). Emerging adulthood: What is it, and what is it good for? Child Development Perspectives, 1(2), 68-73 Arnett, J. J. (2010). Adolescence and emerging adulthood. New York, NY: Guilford Press. Baik, S.Y. & Bowers, B.J. (2006). Living with a mother with chronic depression: To tell or not to tell? The Internet Journal of Mental Health, (3)1. Betz, G. & Thorngren, J. M. (2006). Ambiguous loss and the family grieving process. The Family Journal (Alexandria, Va.), 14(4), 359-365. Boss, P. &. Greenberg, J. (1984). Family boundary ambiguity: A new variable in family stress theory. Family Process, 23(4), 535-546. Boss, P. (2009). The trauma and complicated grief of ambiguous loss. Pastoral Psychology, Springer Science, 1-7. Boss, P., Caron, W., Horbal, J., & Mortimer, J. (1990). Predictors of depression in caregivers of dementia patients: Boundary ambiguity and mastery. Family Process, 29, 245-254. References Boss, P., Greenburg, J.R., Pearce-McCall, D. (1990). Measurement of Boundary Ambiguity in families. Minnesota Agricultural Experiment Station, Station Bulletin, 583. Boss, P. (1999). Ambiguous Loss. Cambridge, MA: Harvard University Press. Campbell, S., Morgan-Lopez, A., Cox, M.J. & McLoyd, V.C. (2009). A latent class analysis of maternal depressive symptoms over 12 years and offspring adjustment in adolescence. Journal of Abnormal Psychology, 118(3), 479-493. Boss, P. (2004). Ambiguous loss research, theory, and practice: Reflections after 9/11. Journal of Marriage and Family, 66(3), 551-566. Fraser, E. and Pakenham, K.I. (2009). Resilience in children of parents with mental illness: Relations between mental health literacy, social connectedness and coping, and both adjustment and caregiving. Psychology Health and Medicine, 14(5), 573-584. Hammen, C., Shih, J., & Brennan, P. (2004). Intergenerational transmission of depression: Test of an interpersonal stress model in a community sample. Journal of Consulting and Clinical Psychology, 72(3), 511-522. Hammen, C. & Brennan, P. (2003). Severity, chronicity, and timing of maternal depression and risk for adolescent offspring diagnoses in a community sample. Archives of General Psychiatry, 60, 253-258. Hammen, C. Brennan, P., & Shih, J. (2004). Family discord and stress predictors of depression and other disorders in adolescent children of depressed and nondepressed women. Journal of the American Academy of Child and Adolescent Psychiatry, 43(8), 994-1002. Knutsson-Medin, L., Edlund, B., & Ramklint, M. (2007). Experiences in a group of grown-up children of mentally ill parents. Journal of Psychiatric and Mental Health Nursing, 14(8), 744. Lieb, R., Isensee, B., Hofler, M., Pfister, H., & Wittchen, H. U. (2002). Parental major depression and the risk of depression and other mental disorders in offspring. A prospective-longitudinal community study. Archives of General Psychiatry, 59, 365-374. References Meadus, R. J. & Johnson, B. (2000). The experience of being an adolescent child of a parent who has a mood disorder. Journal of Psychiatric and Mental Health Nursing, 7, 383-390. Mowbray, C. T., Bybee, D., Oyserman, D., P, Macfarlane, P., & Bowersox, N. (2006). Psychosocial outcomes for adult children of parents with severe mental illnesses: Demographic and clinical history predictors. Health & Social Work, 31(2), 99-108. Mowbray, C. T. & Mowbray, O.B. (2006). Psychosocial outcomes of adult children of mothers with depression and bipolar disorder. Journal of Emotional and Behavioral Disorders, 14(3), 130-142. National Institute of Health (2010). Healthy people 2010. Retrieved January 22, 2010 from http://www.nih.nimh.gov. National Institute of Mental Health (2010). Retrieved February 25, 2011 from http://www.nih.nimh.gov. p// O Connell, K. L. (2008). What can we learn? Adult outcomes in children of seriously mentally ill mothers. Journal of Child & Adolescent Psychiatric Nursing, (21)2, 89-104. Peisah, C., Brodaty, H., Luscombe, G., & Anstey, K. J. (2005). Children of a cohort of depressed patients 25 years on: indentifying those at risk. Australian and New Zealand Journal of Psychiatry, 39, 907-914. Polkki, P., Ervast, S., & Huupponen, M. (2005). Coping and resilience of children of a mentally ill parent. Social Work in Health Care, 39(1), 151-163. Reupert, A. & Maybery, D. (2007). Families affected by parental mental illness: A multiperspective account of issues and interventions. American Journal of Orthopsychiatry, 77(3), 362-369. Ross, L. T. & Wynne, S. (2010). Parental depression and divorce and adult children s well-being: The role of family unpredictability. Journal of Child and Family Studies, 19, 757-761. World Health Organization (2008). Retrieved October 28, 2008 from http://www.who.int/mental_health/evidence Mechling 7