Being a Child of a Bipolar Parent Psychopathology, Social Functioning and Family Functioning Bipolar disorder does not only

affect individuals who have the disorder but also their environment, including family members. With bipolar disorder, there is a mutual influence between the affected individuals functioning and the family. Family attitudes can affect the illness course while the illness has a great impact on family distress and functioning (Reinares et al., 2004). There is no information on the perception of offspring themselves about their upbringing in a family with a parent with bipolar disorder. We studied how offspring living in a family with a bipolar parent perceived their families compared to adolescents and young adults from the general population, and we determined the impact of parental psychopathology versus offspring psychopathology on parental rearing practices (chapter 7) The focus of this thesis is on the functioning and development of children of bipolar parents for two main reasons. First, children of bipolar parents are at genetic risk for developing psychopathology, including bipolar disorder themselves (Alda, 1997; Gershon et al., 1987; McGuffin & Katz, 1989). Second, children of bipolar parents are subject to environmental stressors partially associated with parental psychopathology and its consequences. These multiple risks may contribute to multiple types of psychopathology that, in addition, are subject to developmental changes over time. For example, it is possible that the first signs of bipolar disorder are non-specific problems, such as anxiety problems, later followed by the development of a depression that subsequently evolves into a bipolar disorder with also manic episodes. In addition, little is known about the functioning of children of bipolar parents. http://repub.eur.nl/res/pub/6892/050629_Reichart-CG.pdf Children of Bipolar Parents Prevalence of psychopathology and antecedents of mood disorders By the end of 1997 the KBO-project (Dutch for Children of Bipolar Parents) was launched. The major aim of the KBO-project was to study the early development of bipolar disorder and factors influencing this development. Children of bipolar parents are at increased risk of developing psychopathology, including bipolar disorder, compared to children from the general population The lifetime risk for bipolar disorder in relatives of a bipolar proband was found to be 5-10% for firstdegree relatives compared with 0.5-1.5% for unrelated individuals (Craddock and Jones, 1999). This thesis concerns children of bipolar parents for two main reasons. First, children of bipolar parents are at genetic risk for developing psychopathology, including mood disorders (Alda, 1997; Gershon et al., 1987; McGuffin and Katz, 1989). Second, children of bipolar parents are subject to (mostly negative) environmental stressors

associated with parental psychopathology. These multiple risks may be responsible for the emergence of multiple types of psychopathology that subsequently are subject to developmental change. In addition, disorders other than a mood disorder can be precursors of bipolar disorder. For instance, an oppositional defiant disorder in childhood can be followed by the development of a unipolar disorder in adolescence which subsequently evolves via a (hypo)manic episode into a bipolar disorder in adulthood. Little is known about the effects of environmental influences on the functioning of children of bipolar parents. Therefore, the global aim of this thesis is twofold; on the one hand we wished to determine the lifetime and current prevalence of psychopathology including mood disorders among offspring of bipolar parents and on the other hand we sought to test the effects of factors influencing the presence and onset of psychopathology, including mood disorders, among offspring of bipolar parents. To achieve these aims we studied a sample of 140 children of 86 bipolar parents aged 12 to 21 years. This thesis is based on two measurements with an interval of 14 months. dissertations.ub.rug.nl/.../medicine/2004/m.wals/14_thesis.pdf Experiences of Adult offspring of parents with a mental illness: Putting together the pieces and making meaning of experiences ABSTRACT According to a 2009 Canadian national health survey approximately 12% of children under the age of 12 live in a household were the survey respondent reported one or more mood, anxiety or substance use disorder (Bassani, Padoin, Philipp & Veldhiuzen, 2009). In fact, one out of every five individuals will experience a mental illness during their lifetime. It is widely accepted that the birth rate of people who experience mental illness is the same or higher than the general population. Numerous studies have explored the topic of children of parents with a mental illness. Early research focused on understanding the adverse effects on children and specifically on identifying risk for childhood psychopathy. More recently researchers have begun to explore the positive aspects of growing up with parental mental illness in light of children who are seen as demonstrating considerable resiliency. Strength-based aspects to the experiences of growing up as a child of parental mental illness have been included in some studies. The goal of this exploratory qualitative study was to explore the experiences of adults, who as children, grew up with a mentally ill mother and/or father. The method used included recruiting study participants using purposive sampling. The data collection and analysis was informed by grounded theory including a constant comparison of interview data and data analysis. Findings in this study supported previous research related to growing up with parental mental illness. Experiences of study participants were also similar to findings in existing research. Unique findings that would be worthy of further exploration included experiences of growing up in a two parent family with a father with a mental illness. Significant challenges with transitioning from adolescence to young

adulthood were found across many of the interviews. The process of making meaning of experiences growing up in a family with parental mental illness as study participants experience their own significant life events was also found. These findings can inform policy and practice working with individuals and families who experience parental mental illness. http://www.parentalmentalillness.org/Andrea%20Harstone_FINAL%20thesis %20September%2012_2010.pdf

Living with Bipolar Disorder The experiences of the persons affected and their family members, and the outcomes of educational interventions ABSTRACT Bipolar disorder has considerable consequences for the daily life and functioning of the person affected and their family. The aim of this study was to describe the experience of living with bipolar disorder from the view of the person affected and their family. A further aim was to analyze the outcomes of educational interventions for persons with the illness and their family members in outpatient mental health care. In Papers I and II, qualitative interviews were conducted with persons diagnosed with bipolar disorder (n=18) and family members (n=17) focusing on their experiences of life with the illness. In Papers III and IV the outcomes of educational interventions for those affected (n=32) and the families (n=34) were followed-up and analyzed. Paper III included a comparative group (n=15) of persons with the illness only receiving standard treatment. Data were collected using a semi-structured interview (III) and selfassessment instruments (III-IV) on fi ve occasions, starting before the intervention and ending at the two-year follow-up. Content analysis was applied to the qualitative studies, whereas descriptive and non-parametric statistical methods were used for the quantitative studies. The educational intervention was an existing health care intervention in a unit in outpatient mental health care services consisting of ten groupsessions with different topics related to living with bipolar disorder which the group discussed and refl ected on. It is based on the assumption that communication, collaboration and discussion in these groups create interaction that facilitate development of knowledge about and capacity to manage living with the illness. The results of this thesis showed that the whole lives of the family and the member affected were infl uenced. The process of integrating the illness challenged their preunderstanding, requiring reconsideration of self among the persons affected and confi rmation of the correctness of the families experiences. Uncertainty among persons with the illness concerning their own capacity and the limited life associated with the illness infl uenced their view of the future. The younger adults avoided planning or hoping for the future, and without hope of improvement it sometimes felt hard to continue. The families were strongly committed to the care for the member with the illness, but felt

engaged in a lonely and burdensome struggle that diminished their chances of a normal life of their own. Hope for the future, suffi cient social functioning and feeling part of society was prerequisites for a manageable life for these people. The educational interventions gave them opportunity to interact and learn together with mental healthcare professional and other people within a constructive environment. The outcomes of the interventions showed that both persons with bipolar disorder and the family members increased their self-management ability as a result of their developed knowledge and their ability to meet the daily social concerns and stresses related to living with bipolar disorder improved. This thesis contributes increased knowledge concerning what it means to live with bipolardisorder in the long-term and emphasis the importance of educational interventions with a person- centred view for person affected and family members developing their capacity to manage life. The overall support from mental health care has to be further developed and designed to meet all the specifi c and different needs of those persons and their families. To supplement the promising outcomes of the educational interventions more research is needed concerning increased selfmanagement under different stages of the illness and life. https://gupea.ub.gu.se/bitstream/2077/22944/1/gupea_2077_22944_1.pdf

The effects of Parental Mental Illness on children: Pathways to Risk to resilience from Infancy to Adulthood

The research that has been conducted has shown that children who have a parent with a mental illness are at significantly greater risk for multiple psychosocial problems (Beardslee et al., 1996). Studies have noted that offspring of mentally ill parents have higher rates of psychiatric diagnoses in childhood (Friedman et al., 1996), and are more likely to show developmental delays, lower academic competence, and difficulty with social relationships (Sameroff & Seifer, 1983; Oyserman et al., 2000). In addition, these offspring are more likely to have mental health problems in adolescence and adulthood (Beardslee et al, 1998; Weissman et al., 1997). What is missing from this body of work is a focus not only on the outcomes of offspring of mentally ill parents, but also the processes through which parental psychopathology influences children. The primary aim of this dissertation was to examine the effects of early maternal\ mental illness on children across development. A sample of parents and offspring were followed over the course of 40 years, and pathways from maternal psychopathology during the first three years to offspring adaptive functioning in adulthood were examined. The three studies of this dissertation attempt to address several gaps in the current research literature, and also build off each other in order to add to our current

understanding of how parental psychopathology affects offspring adaptive functioning. http://deepblue.lib.umich.edu/bitstream/handle/2027.42/77750/lslomins_1.pdf? sequence=1 Connection, Caretaking and Conflict: The recalled Lived Experience of Adult Daughter of Bipolar Mothers ABSTRACT At present in the United States approximately four million people (one and six tenths percent) suffer from Bipolar I and Bipolar II disorders. Twenty percent of bipolar persons are not helped by medication. Each bipolar person has two parents, and may have siblings, friends, spouses, and children. All of these people are affected by the feelings and behavior of the bipolar person. The children are particularly vulnerable to behavior disorders, depression and anxiety, even if protective factors mitigate the family situation. This qualitative research addresses the events recalled by adult daughters whose mothers are bipolar: what they recalled of what they thought, felt, and did in response. Events from early childhood to the time of the interview were explored. Seidmans phenomenological interview series was the model for the interview, both in the pilot study and later when it was modified into one long interview as suggested by McCracken. This study was not retrospective. It focused on the daughters recollections and how these affected their development, their relationships, and their work or careers. The transcripts from the two pilot study participants interviewed in two-thousandtwo were included as archival material and analyzed with the transcripts from the two thousand-five interviews with the dissertation participants. The pilot study participants were recruited from a clinical setting. One dissertation participant heard about the study by word of mouth. The others responded to a newspaper advertisement. Two were twenty five, two were in their early fifties, and the rest were between thirty four and thirty nine. Two were African American, one was biracial. The remaining seven came from a wide variety of ethnic backgrounds.The data was analyzed using NVivo. It enabled comparison of themes from each life stage addressed in the interviews. These themes were recorded in forty-one tables. The most populated and enduring were role reversal, beginning in early childhood, and conflict, beginning in the high school years. Each theme persisted in the presence of the other until the time of the interviews, profoundly interfering with development, trust, intimacy, and work. These conclusions suggested both needed services and further research. http://ecommons.luc.edu/luc_diss/260/

YOUNG CARERS OF PARENTS WITH MENTAL HEALTH ISSUES ABSTRACT It is estimated that twenty percent of the Canadian population experiences a serious mental illness at some point in their lifetime. A portion of those that do so will be parents. Research indicates that in some circumstances, when a parent with a serious mental Illness needs support that they are not getting from other adults or the formal mental health care system, the caregiving responsibilities can fall to their children. Sometimes called young mncarers in literature developed in the U.K. and elsewhere, there has been little attention in Canada to this population or the implications of the term young carers. Through a critical feminist lens, a small qualitative study was undertaken to explore the lived experiences of adults looking back on having been young carers, a perspective seldom taken in the literature. The four study participants had all cared for their mothers in households with extended social networks that included fathers and siblings- an interesting counterpoint to the young carer literature, which has centered on isolated single parents with children. Participants described how they found themselves in caring roles, what their caring consisted of, and why they continued to care despite other options being available. The study reveals the intricate social pressures that the participants faced, and suggests that becoming a carer may be more complex than past studies have indicated. I examined participants stories with an eye to the structural forces that shaped their pathways as carers and their reflections on those pathways. The discussion focuses on what the participants experiences can tell us about the contemporary neoliberal political climate: how its emphases on individualism, independence and smaller government, contribute to the depletion of public mental health services and a troubling focus on sustaining young carers rather than questioning their positioning http://digitalcommons.mcmaster.ca/opendissertations/6205/

Purpose: The purpose is to introduce a qualitative study of the recalled life experience of young adults of Bipolar mother, their psychosocial development, functioning and identity. These studies identify the ups and downs of childrens mental health at different developmental stages and identify adverse conditions that may be associated with their difficulties. Rationale: I describe a rationale for using a qualitative method and a strategy for the research, define variables and other key concepts, outline their implications for data collection, and discuss the design of the instruments, the method of data collection, the population, the sampling plan, the method of recruitment and the validity and reliability of the design and the research. Finally, I address the ethical considerations and the method of data analysis. Objectives: Identify the family interactions that may affect the child Recognize the childs subjective experience of his or her parents bipolar Illness Understand the adults perception of the meaning of the recalled childhood experience to his or her daily life. Significance of the study Patient. The client will benefit from a much personalized approach of psychiatric nursing care and may indicate a better relationship with the young adult. Young adult. The study will help this group to be aware of their subjective experience of her parents Bipolar illness and will be able to recognize the positive coping skills. It will help them evaluate and normalize their own experiences. Family. It will address the family identity, its cultural, generational and individual sources of meaning. Sharing individual perceptions of this meaning and identity will assist the family in deepening and changing itself.

Nurse. It will provide a framework useful to the nurse for intervention with families in which a parent has been diagnosed with bipolar illness. It will help the clinician to develop empathy for the young adult of a bipolar mother, and patience in her treatment. It will also assist clinician in his or her efforts to work with the client in managing her relationship with her mother. Nursing Education. This will certainly be of use to the clinical social work practitioner. It may be used as well as to create or endorse community mental health policies, public or private foundation efforts that support optimal development of children in bipolar families.