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Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness

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Abstract

The majority of women with a severe mental illness (SMI) become pregnant and have children. The aim of this systematic review and meta-synthesis was to examine the qualitative research on the experiences of motherhood in women with SMI from preconception decision making to being a mother. The experiences of the health professionals treating women with SMI were also reviewed. Eleven databases were searched for papers published up to April 25, 2012, using keywords and mesh headings. A total of 23 studies were identified that met the inclusion criteria on the views of women with SMI, eight reported the views of health professionals including one which reported both. The meta-synthesis of the 23 studies on women's views produced two overarching themes Experiences of Motherhood and Experiences of Services. Sub-themes included the following: Guilt, Coping with Dual Identities, Stigma, and Centrality of Motherhood. Four themes emerged from the synthesis of the eight papers reporting the views of health professionals: Discomfort, Stigma, Need for education, and Integration of services. An understanding of the experiences of pregnancy and motherhood for women with SMI can inform service development and provision to ensure the needs of women and their families are met.

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References

  • Ackerson BJ (2003) Coping with the dual demands of severe mental illness and parenting: the parents' perspective. Fam Soc 84(1):109–118

    Article  Google Scholar 

  • Alakus C, Conwell R, Gilbert M, Buist A, Castle D (2007) The needs of parents with a mental illness who have young children: an Australian perspective on service delivery options. International Journal of Social Psychiatry 53(4):333–339

    Article  PubMed  Google Scholar 

  • Antenatal and Postnatal Mental Health Clinical Management and Service Guideline, National Institute for Health and Clinical Excellence (2007) http://www.nice.org.uk.

  • Bassett J, Lampe C, Lloyd H (1999) Parenting: experiences and feelings of parents with a mental illness. J Ment Heal 8(6):597–604

    Article  Google Scholar 

  • Beck CT (2002) Postpartum depression: a metasynthesis. Qual Heal Res 12(4):453–472

    Article  Google Scholar 

  • BMJ (2011) Consolidated criteria for reporting qualitative research http://bmjopen.bmj.com/content/suppl/2011/02/21/bmjopen-2010 000017.DC1/bmjopen_research_checklist_000017.pdf

  • CASP: Critical Appraisal Skills Programme (2010) http://www.casp-uk.net/wp-content/uploads/2011/11/CASP_Qualitative_Appraisal_Checklist_. Accessed 11/2011

  • Chernomas WM, Clarke DE, Chisholm FA (2000) Perspectives of women living with schizophrenia. Psychiatr Serv 51(12):1517–1521

    Article  PubMed  CAS  Google Scholar 

  • Clement S, Brohan E, Jeffery D, Henderson C, Hatch S, Thornicroft G (2012) Development and psychometric properties of the barriers to access to care evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry 12(1):36 http://www.biomedcentral.com/1471-244X/12/36

    Google Scholar 

  • David DH, Styron T, Davidson L (2011) Supported parenting to meet the needs and concerns of mothers with severe mental illness. Am J Psychiatr Rehabil 14(2):137–153. doi:10.1080/15487768.2011.569668

    Article  PubMed  Google Scholar 

  • Davies B, Allen D (2007) Integrating 'mental illness' and 'motherhood': the positive use of surveillance by health professionals. A qualitative study. Int J Nurs Stud 44(3):365–376

    Article  PubMed  Google Scholar 

  • Dept of Health HG, UK (2003) Mainstreaming gender and women's mental health implementation guidance. London

  • Diaz-Caneja A, Johnson S (2004) The views and experiences of severely mentally ill mothers—a qualitative study. Social Psychiatry & Psychiatric Epidemiology 39(6):472–482

    Article  Google Scholar 

  • Dipple H, Smith S, Andrews H, Evans B (2002) The experience of motherhood in women with severe and enduring mental illness. Social Psychiatry and Psychiatric Epidemiology 37(7):336–340. doi:10.1007/s00127-002-0559-2

    Article  PubMed  Google Scholar 

  • Doucet S, Letourneau N, Blackmore ER (2012) Support needs of mothers who experience postpartum psychosis and their partners. Journal of Obstetric, Gynecologic, & Neonatal Nursing

  • Edwards E, Timmons S (2005) A qualitative study of stigma among women suffering postnatal illness. J Ment Heal 14(5):471–481. doi:10.1080/09638230500271097

    Article  Google Scholar 

  • Engqvist I, Ahlin A, Ferszt G, Nilsson K (2010) Nurses – psychiatrists' main collaborators when treating women with postpartum psychosis. J Psychiatr Ment Heal Nurs 17(6):494–502. doi:10.1111/j.1365-2850.2010.01549.x

    Article  CAS  Google Scholar 

  • Engqvist I, Ahlin A, Ferszt G, Nilsson K (2011a) Comprehensive treatment of women with postpartum psychosis across health care systems from swedish psychiatrists' perspectives. The Qualitative Report 16(1):66–83

    Google Scholar 

  • Engqvist I, Ferszt G, Ahlin A, Nilsson K (2009) Psychiatric nurses' descriptions of women with postpartum psychosis and nurses' responses: An exploratory study in Sweden. Issues in Mental Health Nursing 30(1):23–30. doi:10.1080/01612840802498268

    Article  PubMed  Google Scholar 

  • Engqvist I, Ferszt G, Åhlin A, Nilsson K (2011b) Women's experience of postpartum psychotic episodes—analyses of narratives from the Internet. Arch Psychiatr Nurs 25(5):376–387. doi:10.1016/j.apnu.2010.12.003

    Article  PubMed  Google Scholar 

  • Engqvist I, Nilsson A, Nilsson K, Sjöström B (2007) Strategies in caring for women with postpartum psychosis – an interview study with psychiatric nurses. J Clin Nurs 16(7):1333–1342. doi:10.1111/j.1365-2702.2007.01717.x

    Article  PubMed  Google Scholar 

  • Heron J, Gilbert N, Dolman C, Shah S, Beare I, Dearden S, Muckelroy N, Jones I, Ives J (2012) Information and support needs during recovery from postpartum psychosis. Archives of Women's Mental Health:1–11

  • Hollingsworth L (2004) Child custody loss among women with persistent severe mental illness. Soc Work Res 28(4):199–209

    Article  Google Scholar 

  • Howard LM (2006) Pregnancy in women with psychotic disorders. Clin Eff Nurs 9(2):201–211

    Article  Google Scholar 

  • Howard LM, Hunt K (2008) The needs of mothers with severe mental illness: a comparison of assessments of needs by staff and patients. Archives of Women’s Mental Health 11(2):131–136. doi:10.1007/s00737-008-0006-9

    Article  PubMed  Google Scholar 

  • Howard LM, Kumar C, Leese M, Thornicroft G (2002) The general fertility rate in women with psychotic disorders. Am J Psychiatry 159(6):991–997

    Article  PubMed  Google Scholar 

  • Howard LM, Kumar R, Thornicroft G (2001) Psychosocial characteristics and needs of mothers with psychotic disorders. Br J Psychiatry 178(5):427–432. doi:10.1192/bjp.178.5.427

    Article  PubMed  CAS  Google Scholar 

  • Khalifeh H, Murgatroyd C, Freeman MP, Johnson S (2009) Home treatment as an alternative to hospital admission for mothers in a mental health crisis: a qualitative study. Psychiatr Serv 60(5):634–639

    Article  PubMed  Google Scholar 

  • Krumm S, Becker T (2006) Subjective views of motherhood in women with mental illness-a sociological perspective. J Ment Heal 15(4):449–460

    Article  Google Scholar 

  • Lester H, Tritter JQ, Sorohan H (2005) Patients' and health professionals' views on primary care for people with serious mental illness: focus group study. BMJ 330(7500):1122

    Article  PubMed  Google Scholar 

  • Maddocks S, Johnson S, Wright N, Stickley T (2010) A phenomenological exploration of the lived experience of mental health nurses who care for clients with enduring mental health problems who are parents. J Psychiatr Ment Heal Nurs 17(8):674–682. doi:10.1111/j.1365-2850.2010.01582.x

    Article  CAS  Google Scholar 

  • Mays N, Pope C (2000) Assessing quality in qualitative research. BMJ 320(7226):50–52. doi:10.1136/bmj.320.7226.50

    Article  PubMed  CAS  Google Scholar 

  • McConachie S, Whitford H (2009) Mental health nurses’ attitudes towards severe perinatal mental illness. J Adv Nurs 65(4):867–876. doi:10.1111/j.1365-2648.2008.04952.x

    Article  PubMed  Google Scholar 

  • McGrath JJ, Hearle J, Jenner L, Plant K, Drummond A, Barkla J (1999) The fertility and fecundity of patients with psychoses. Acta Psychiatr Scand 99(6):441–446

    Article  PubMed  CAS  Google Scholar 

  • Meiser B, Mitchell PB, McGirr H (2005) Implications of genetic risk information in families with a high density of bipolar disorder: an exploratory study. Social Science & Medicine 60(1):109–118

    Article  Google Scholar 

  • Miller LJ (1997) Sexuality, reproduction, and family planning in women with schizophrenia. Schizophr Bull 23(4):623–635

    Article  PubMed  CAS  Google Scholar 

  • Montgomery P, Mossey S, Bailey P, Forchuk C (2011) Mothers with serious mental illness: their experience of "hitting bottom". ISRN nursing 2011:708318

  • Montgomery P, Tompkins C, Forchuk C, French S (2006) Keeping close: Mothering with serious mental illness. J Adv Nurs 54(1):20–28

    Article  PubMed  Google Scholar 

  • Mowbray CT, Oyserman D, Ross S (1995) Parenting and the significance of children for women with a serious mental illness. Journal of Mental Health Administration 22(2):189–200

    Article  Google Scholar 

  • Murray L, Cooper P, Hipwell A (2003) Mental health of parents caring for infants. Archives of Women's Mental Health 6:71–77

    Article  Google Scholar 

  • Nicholson J, Blanch A (1994) Rehabilitation for parenting roles for people with serious mental illness. Psychosocial Rehabilitation Journal

  • Nicholson J, Geller JL, Fisher WH, Dion GL (1993) State policies and programs that address the needs of mentally ill mothers in the public sector. Hospital and Community Psychiatry 44:484–484

    PubMed  CAS  Google Scholar 

  • Nicholson J, Sweeney EM, Geller JL (1998) Focus on women: Mothers with mental illness: II. Family relationships and the context of parenting. Psychiatr Serv 49(5):643–649

    PubMed  CAS  Google Scholar 

  • Noblit GW, Hare RD (1988) Meta-ethnography: Synthesizing qualitative studies, vol 11. Sage Publications.

  • Peay HL, Hooker GW, Kassem L, Biesecker BB (2009) Family risk and related education and counseling needs: perceptions of adults with bipolar disorder and siblings of adults with bipolar disorder. American Journal of Medical Genetics Part A 149A(3):364–371. doi:10.1002/ajmg.a.32696

    Article  PubMed  CAS  Google Scholar 

  • Rice MJ (2008) Evidence-based practice in psychiatric and mental health nursing: qualitative meta-synthesis. Journal of the American Psychiatric Nurses Association 14(5):382–385

    Article  PubMed  Google Scholar 

  • Robertson E, Lyons A (2003) Living with puerperal psychosis: a qualitative analysis. Psychol Psychother Theory Res Pract 76(Pt 4):411–431

    Article  Google Scholar 

  • Sandelowski M, Trimble F, Woodard EK, Barroso J (2006) From synthesis to script: transforming qualitative research findings for use in practice. Qual Heal Res 16(10):1350–1370

    Article  Google Scholar 

  • Sands RG (1995) The parenting experience of low-income single women with serious mental disorders. Fam Soc 76(2):86–96

    Google Scholar 

  • Sands RG (2004) Maternal custody status and living arrangements of children of women with severe mental illness. Heal Soc Work 29:317–325

    Article  Google Scholar 

  • Savvidou I, Bozikas VP, Hatzigeleki S, Karavatos A (2003) Narratives about their children by mothers hospitalized on a psychiatric unit. Fam Process 42(3):391–402

    Article  PubMed  Google Scholar 

  • Scottish Intercollegiate Guidelines Network: Management of perinatal mood disorders: a national clinical guideline (2012) http://www.sign.ac.uk/pdf/sign127.pdf.

  • Stanley N, Penhale B (1999) The mental health problems of mothers experiencing the child protection system. Identifying needs and appropriate responses. Child Abuse Review 8:34–35

    Article  Google Scholar 

  • Ueno R, Kamibeppu K (2008) Narratives by Japanese mothers with chronic mental illness in the Tokyo metropolitan area: their feelings toward their children and perceptions of their children's feelings. J Nerv Ment Dis 196(7):522–530

    Article  PubMed  Google Scholar 

  • Venkataraman M, Ackerson BJ (2008) Parenting among mothers with bipolar disorder: strengths, challenges, and service needs. J Fam Soc Work 11(4):389–408. doi:10.1080/10522150802441825

    Article  Google Scholar 

  • Vigod SN, Seeman MV, Ray JG, Anderson GM, Dennis CL, Grigoriadis S, Gruneir A, Kurdyak PA, Rochon PA (2012) Temporal trends in general and age-specific fertility rates among women with schizophrenia (1996‚Äì2009): a population-based study in Ontario, Canada. Schizophrenia Research

  • Walsh D, Downe S (2005) Meta-synthesis method for qualitative research: a literature review. J Adv Nurs 50(2):204–211

    Article  PubMed  Google Scholar 

  • Wan MW, Moulton S, Abel KM (2008) The service needs of mothers with schizophrenia: a qualitative study of perinatal psychiatric and antenatal workers. General hospital psychiatry 30(2):177–184

    Article  PubMed  Google Scholar 

  • Wilson L, Crowe M (2009) Parenting with a diagnosis bipolar disorder. J Adv Nurs 65(4):877–884

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Kylee Trevillion (KT) for her help with quality appraisal.

Author information

Authors and Affiliations

  1. Section of Women’s Mental Health, Health Service and Population Research Department, Box PO31 Institute of Psychiatry, King’s College London, De Crespigny Park, London, SE5 8AF, UK

    Clare Dolman & Louise M. Howard

  2. Department of Psychological Medicine and Neurology, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, CF14 14XN, UK

    Ian Jones

Authors
  1. Clare Dolman
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  2. Ian Jones
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  3. Louise M. Howard
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Corresponding author

Correspondence to Clare Dolman.

Appendix

Appendix

Quality Appraisal Form

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APPRAISAL

Please grade the answers to each question by ticking 0, 1 or 2.

Unless otherwise specified, questions should be scored as follows:

  1. 0

    Study does not meet criteria/answer question

  2. 1

    Study partially meets criteria/gives a partially satisfactory answer to the question

  3. 2

    Study fully meets criteria/gives a fully satisfactory answer to the question

If a question is not applicable to a particular study, please mark “n/a” in the adjacent comments section.

  1. 1.

    The research presents clearly stated aims

Question

Comments

Score

0

1

2

Is the study question focused in terms of the population studied?

    

Is the study question focused in terms of the outcomes considered?

    

Q1 Subtotal………………..

  1. 2.

    A qualitative methodology is appropriate for this research (e.g., does the research seek to interpret or illuminate the actions and/or subjective experiences of research participants?)

Question

Comments

Score

0

1

2

Was a qualitative methodology appropriate?

    

Q2 Subtotal………………..

Continue only if score on each of questions 1 and 2 is one or more

  1. 3.

    The context of the research was clearly described

Question

Comments

Score

0

1

2

Was the context of the research clearly described?

    

Q3 Subtotal………………..

  1. 4.

    The research design was appropriate to meet the aims of the research

Question

Comments

Score

0

1

2

Was the research design appropriate to address the aims of the research?

    

Q4 Subtotal……………….

  1. 5.

    Was the recruitment/sampling strategy appropriate to the aims of the research?

Question

Comments

Score

0

1

2

Does the study have clear inclusion criteria?

    

Does the study have clear exclusion criteria?

    

Was the sampling strategy appropriate for the aims of the research?

    

Were the subjects appropriate for the aims of the research?

    

Was the study sample representative of the research setting?

    

Does the study report on the level of non-participation?

    

Q5 Subtotal………………..

  1. 6.

    Was the data collected in a way that addressed the research issue?

Question

Comments

Score

0

1

2

Is the study setting appropriate to the aims of the research?

    

Is the method of data collection clear?

    

Is the method of data collection appropriate to the aims of the research?

    

Is the process of data collection clear?

    

Were study instruments piloted?

    

Is data saturation discussed?

    

Q6 Subtotal………………..

7.

 

Comments

Score

0

1

2

Is the data verifiable?

N.B. Data is audio or video taped (=2), researcher makes notes during data collection (=1).

   

Q7 Subtotal………………..

  1. 8.

    Were ethical considerations appropriately considered?

Question

Comments

Score

0

1

2

Did researchers obtain informed consent from all participants?

    

Was data collected in a private setting?

    

Was data sufficiently aggregated during presentation to ensure anonymity?

    

Q8 Subtotal………………..

  1. 9.

    Was data analysis sufficiently rigorous?

Question

Comments

Score

0

1

2

Is the analytical process described in detail?

    

Were steps taken to identify data that was contrary to the main findings and hypotheses of the study?

    

Were multiple analysts used to increase the rigour of the research?

    

Does the study report on level of inter-rater reliability?

    

Q9 Subtotal………………..

  1. 10.

    Was there a clear statement of findings?

Question

Comments

Score

0

1

2

Does the study clearly report its findings?

    

Q10 Subtotal………………..

  1. 11.

    How valuable was the research?

Question

Comments

Score

0

1

2

Were service users, providers or advocates involved in the development of the study?

    

Were study participants invited to receive feedback on the research?

    

Were the study findings disseminated beyond the academic community?

    

Did the study articulate clear recommendations for future policy and/or practice?

    

Did the study articulate clear recommendations for future research?

    

Q11 Subtotal………………..

Total Score (out of a maximum of 62 points)….....................

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Dolman, C., Jones, I. & Howard, L.M. Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Arch Womens Ment Health 16, 173–196 (2013). https://doi.org/10.1007/s00737-013-0336-0

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