Career women's mental wellbeing in the era of population decline: the effects of working environment and family environment on the mental wellbeing.

Introduction: In recent years, it has become increasingly evident that the population in many countries has been declining. China, which was previously the world's most populous nation and is often categorized as an emerging economy, officially entered an era of population decline in 2022. The advent of this era has make China's economic development more uncertain and aging of population more pronounced. To address the population decline, the Chinese government implemented the "Three-Child Policy" to encourage childbirth, aiming to reverse the negative population growth. However, this policy has not achieved the expected goals. Instead, it has increased the pressure on women to bear children, particularly for career women, where such pressure may conflict with their existing work and family environments, subsequently affecting their mental wellbeing. Methods: A survey was conducted to investigate the mental wellbeing status of career women in Changchun City, Jilin Province, Northeast China. It analyzes the impact of working and family environments on the mental wellbeing of these women. Results: Based on the survey, this study draws five conclusions: A. The mental wellbeing status of career women varies across different ages, industries, and childbirth statuses. B. The perceived adverse impact of childbirth on the working environment may negatively affect the mental wellbeing of career women. C. The perceived adverse impact of childbirth on the family environment may negatively affect the mental wellbeing of career women. D. Career women are not satisfied with the effectiveness of current policies in protecting women's rights. E. Compared to working environments, there is a greater demand for career women in the family environments, particularly in reducing various family burdens. Discussion: The pro-natalist policies introduced in response to negative population growth can worsen the mental wellbeing of career women, while the deterioration of their mental wellbeing could further accelerate population decline. Given the current challenges, this study suggests that effectively improving the mental wellbeing of career women requires building psychological resilience among childless career women, reducing the burden of family on career women, and continuously improving policies and regulations that protect the rights of career women.

Phenome-wide profiling identifies genotype-phenotype associations in Phelan-McDermid syndrome using family-sourced data from an international registry.

BACKGROUND: Phelan-McDermid syndrome (PMS) is a rare neurodevelopmental disorder caused by 22q13 deletions that include the SHANK3 gene or pathogenic sequence variants in SHANK3. It is characterized by global developmental delay, intellectual disability, speech impairment, autism spectrum disorder, and hypotonia; other variable features include epilepsy, brain and renal malformations, and mild dysmorphic features. Here, we conducted genotype-phenotype correlation analyses using the PMS International Registry, a family-driven registry that compiles clinical data in the form of family-reported outcomes and family-sourced genetic test results. METHODS: Data from the registry were harmonized and integrated into the i2b2/tranSMART clinical and genomics data warehouse. We gathered information from 401 individuals with 22q13 deletions including SHANK3 (n = 350, ranging in size from 10 kb to 9.1 Mb) or pathogenic or likely pathogenic SHANK3 sequence variants (n = 51), and used regression models with deletion size as a potential predictor of clinical outcomes for 328 phenotypes. RESULTS: Our results showed that increased deletion size was significantly associated with delay in gross and fine motor acquisitions, a spectrum of conditions related to poor muscle tone, renal malformations, mild dysmorphic features (e.g., large fleshy hands, sacral dimple, dysplastic toenails, supernumerary teeth), lymphedema, congenital heart defects, and more frequent neuroimaging abnormalities and infections. These findings indicate that genes upstream of SHANK3 also contribute to some of the manifestations of PMS in individuals with larger deletions. We also showed that self-help skills, verbal ability and a range of psychiatric diagnoses (e.g., autism, ADHD, anxiety disorder) were more common among individuals with smaller deletions and SHANK3 variants. LIMITATIONS: Some participants were tested with targeted 22q microarrays rather than genome-wide arrays, and karyotypes were unavailable in many cases, thus precluding the analysis of the effect of other copy number variants or chromosomal rearrangements on the phenotype. CONCLUSIONS: This is the largest reported case series of individuals with PMS. Overall, we demonstrate the feasibility of using data from a family-sourced registry to conduct genotype-phenotype analyses in rare genetic disorders. We replicate and strengthen previous findings, and reveal novel associations between larger 22q13 deletions and congenital heart defects, neuroimaging abnormalities and recurrent infections.

[Diabetes, loved ones: Constraints, support, shared experiences]. / Le diabète et les proches, entre contraintes, soutien et vécus en commun.

Diabetes is a pathology that has major consequences not only for those who suffer from it, but also for those around them. Relatives can play different roles in this respect, depending on the type of relationship they have with the person with diabetes. The onset of the disease is likely to modify pre-established roles within social groups such as the family sphere, with the possibility of strengthening ties, but also of damaging them.

Efficacy of an online gatekeeper program for relatives of men at risk of suicide - a randomized controlled trial.

BACKGROUND: Men at risk for suicide are a challenging population group to reach with suicide prevention strategies. Gatekeepers hold a pivotal role in the prevention of male suicide, yet effective intervention requires them to have a level of knowledge and strategies to provide support. AIM: This study aimed to examine the efficacy of an online gatekeeper program for gatekeepers in male suicide prevention, assessing knowledge, perceived preparedness, self-efficacy, and psychopathological symptoms of gatekeepers. METHODS: Eighty-four participants were randomized to either the intervention (n = 43) or the waitlist control group (n = 41). The intervention comprised four modules providing knowledge and strategies for addressing men in suicidal crises. Outcomes included depression (PHQ-9), distress (PSS-10), burden (BAS), involvement (IEQ), as well as gatekeeper outcomes and knowledge. RESULTS: Completer analyses revealed significant improvement of depressive symptoms (d = 0.39) and an increase in gatekeeper outcomes (d = 0.58 to d = 0.84) and knowledge (d = 0.62) from baseline to post-assessment. The effects were maintained for 3 months. No significant effects could be found for burden, distress, and involvement. CONCLUSIONS: The findings indicate that a brief gatekeeper program can serve as a valuable resource. Future research should focus on examining the mental health of gatekeepers themselves and its long-term effects on intervention behavior. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00030758, registered on 05.12.2022.

The effect of work-family conflict on employee well-being among physicians: the mediating role of job satisfaction and work engagement.

BACKGROUND: Work-family conflict among physicians has many adverse consequences, like reduced work engagement and impaired well-being. However, relatively little research has been conducted on the impact of work-family conflict on specific pathways of physician well-being. The aim of this study was to determine the relationship between work-family conflict and employee well-being among physicians and to explore the mediating role of job satisfaction and work engagement in this relationship. METHODS: Using data from a cross-sectional survey of 2,480 physicians in Jilin Province, China, partial least squares structural equation modeling (PLS-SEM) was applied in this study to examine the direct and indirect effects of work-family conflict on employee well-being and to assess the mediating roles of job satisfaction and work engagement therein. RESULTS: The employee well-being score of physicians in Jilin Province was 5.16 ± 1.20. The univariate analysis results indicated significant disparities in employee well-being scores across different age groups, marital statuses, and professional titles. Work-family conflict was significantly negatively associated with employee well-being, while job satisfaction and work engagement were significantly positively associated with employee well-being. In addition, job satisfaction and work engagement were found to mediate the association between work-family conflict and employee well-being, and work engagement was considered to mediate the association between job satisfaction and employee well-being. CONCLUSIONS: Our study confirms that work-family conflict negatively affects physicians' employee well-being. Moreover, our investigation revealed that the association between work-family conflict and employee well-being is influenced by both job satisfaction and work engagement and that work engagement plays a mediating role in the link between job satisfaction and employee well-being. Therefore, we propose that hospital administrators should rationally allocate organizational resources and develop manageable schedules to enhance physicians' employee well-being.

"A cross-sectional study to assess stigma associated with tuberculosis in patients, family members, and health care staff in central India."

BACKGROUND: Stigma poses significant challenges to tuberculosis control efforts worldwide. India, bearing a substantial burden of tuberculosis cases, grapples with pervasive stigmatizing attitudes towards the disease, hindering timely diagnosis and treatment. This study aims to assess the prevalence and manifestations of tuberculosis-related stigma, shedding light on a critical yet overlooked aspect of tuberculosis management. METHODS: After obtaining informed consent, 314 participants were taken and stratified equally into three groups: patients, family members, and healthcare workers. A pre-designed questionnaire was used to calculate prevalence and assess tuberculosis stigma across various domains. Data were compiled in MS-Excel and analyzed using EPI-Info 7 by the CDC. RESULTS: Among all 314 participants, the prevalence of stigma in this study was 26.75%. A statistically significant correlation was found between stigma experienced and marital status (p = 0.013) and level of knowledge regarding tuberculosis (p < 0.001). Among the patients of tuberculosis, the odds of facing stigma are 13.25 (C.I. 95% 4.14, 42.41) times higher in females and 3 (C.I. 95% 1.005, 8.95) times higher in patients with unsatisfactory knowledge about tuberculosis compared to males and patients with satisfactory knowledge, respectively. CONCLUSION: Tuberculosis is stigmatized due to its deviation from societal norms. Societal norms dictate what is deemed acceptable or unacceptable. Females with tuberculosis encounter more stigma than males, and knowledge about tuberculosis affects stigma significantly. Patients mostly experience enacted and perceived stigma, while family members face perceived and secondary stigma. Healthcare workers tend to exhibit secondary stigma.

Linking Leading-Following and Family.

It is thought-provoking to reflect on the ways in which the idea of family arises within many leading-following situations, especially within work settings where coworkers may refer to each other as or name each other their "work family." In this paper, the author explored the ways in which the humanbecoming paradigm (Parse, 2021) and its models may be used to lead with others from a family view. There are many meaning-making moments within leading-following professional relationships that shape all constituents (families) over time. As in all unique disciplines, such as nursing, that have leadership and practice components, it is important that there is a theoretical framework serving as the foundation to co-build professional relationships.

Association between hair cortisol concentration and acute stress symptoms in family members of critically ill patients: a cross-sectional study.

OBJECTIVE: The aim of this study was to investigate whether there is an association between hair cortisol concentrations and acute stress symptoms in family members of critically ill patients. METHODS: A cross-sectional study was conducted in an adult intensive care unit of a tertiary hospital in Porto Alegre, Brazil, from August 2021 to February 2022. Family members of intensive care unit patients admitted for more than 10 days were approached for enrollment. We collected sociodemographic data and assessed resilience, religiosity, and symptoms of acute stress among family members. Samples of family members' hair were collected shortly after the interview to measure the hair cortisol concentration. RESULTS: A total of 110 family members were included in this study. Eighty-eight (80.0%) family members presented with symptoms of acute stress. The median hair cortisol concentration was 2.37pg/mg (1.16 - 5.06pg/mg). There was no significant difference in hair cortisol concentration between family members with and without acute stress symptoms (p = 0.419). According to the multivariate analysis, only the fact that the patient was alert at the time of the family member's interview was significantly associated with the prevalence of acute stress symptoms in the family member. CONCLUSION: We did not find an association between the hair cortisol concentration of family members in hair segments in the months prior to admission to the intensive care unit and the occurrence of acute stress symptoms.

Development and Implementation of a Family Presence Facilitator Curriculum for Interprofessional Use in Pediatric Medical Resuscitations.

Introduction: Family presence during pediatric medical resuscitation has myriad benefits. However, there is significant heterogeneity in provider acceptance and implementation of the family support role. We designed this curriculum to teach all members of the health care team best practices in the Family Presence Facilitator (FPF) role during pediatric medical resuscitations. Methods: We applied Kern's six-step approach to develop an FPF curriculum comprising didactic and interactive elements, along with training for simulated participants. We implemented the curriculum through (a) live sessions (30-minute didactic or 90-minute workshop) for learners; (b) a 20-minute asynchronous version of the didactic curriculum for self-directed learning; and (c) a 1-hour, monthly, in situ simulation curriculum in a pediatric emergency department setting. Curriculum evaluation surveys queried self-reported engagement, satisfaction, relevance, confidence, commitment, knowledge, skills, and attitudes in a retrospective pre/post format. Results: We collected data from 153 learners, including attendings, fellows, residents, advanced practice providers, medical students, and child life specialists, between October 2022 and September 2023. Only 22% of participants had received similar prior training. One hundred percent of learners found the curriculum enjoyable and engaging; learners also agreed the curriculum improved their knowledge and skills in providing empathetic and respectful communication (99%); nonspeculative, clear information (100%); and nonverbal support (99%). Of respondents, 100% believed the curriculum would improve the patient care experience. Discussion: Facilitating family presence during pediatric medical resuscitations is a crucial skill. Our curriculum improves self-reported confidence, knowledge, and skills among interprofessional learners. Next steps include expanding this curriculum beyond the pediatric setting.

Posttreatment health interventions for adult cancer survivors and their families: an integrated review.

PURPOSE: This review aimed to synthesize the literature regarding health interventions delivered to adult cancer survivors and their families during posttreatment phase. METHODS: An integrative literature review was conducted that included quantitative and qualitative studies. The search was carried out in four databases using the same terms or MeSH terms and included data from January 2012 to February 2024. After quality assessment, data were extracted and synthesized. The protocol was registered in PROSPERO. RESULTS: Among the seven studies included, two studies were randomized controlled trials, three were observational, and two utilized a qualitative approach. The studies originated from France, Australia, Canada, the UK, and the USA. In total, 704 participants were included, 294 were cancer survivors, 40 were non-cancer patients, 271 were family and caregivers, and 99 were healthcare professionals. The studies assessed survival durations after cancer treatment, ranging from 18 months to 6 years. The sparse interventions found across the studies used a multifaceted approach tailored to address various aspects of cancer survivorship and caregiver support. CONCLUSION: This review provides insights into the complex landscape of posttreatment support requirements for cancer survivors and their family caregivers. This finding underscores the critical necessity for additional intervention research involving comprehensive, accessible, and supportive services that address the multifaceted dimensions of survivorship for the patient and family as a unit.

How Should Clinicians Partner With Families to Promote Children's Sleep Health?

Short sleep duration, poor sleep quality, and irregular timing of sleep are prevalent sleep troubles for children, but fully assessing children's sleep environments and effectively promoting children's overall sleep health is nearly impossible during brief clinical encounters. This commentary on a case suggests strategies for navigating this problem with a patient- and family-centered approach that prioritizes identifying family sleep-related beliefs, values, and goals and maintaining flexibility when offering evidence-based recommendations to improve children's sleep.

Distributed impact of severe mental health conditions in rural Ethiopia, a qualitative study.

AIM: To explore the distributed impact of severe mental health conditions (SMHCs) among people with lived experience of SMHCs, their family members, and community members. METHODS: We conducted in-depth interviews with family key informants of people with SMHCs (n = 32), people with SMHCs (schizophrenia, bipolar disorder, and major depression) (n = 10), and community members (n = 6) in rural Ethiopia. The study was nested within a long-standing population-based cohort of people with SMHCs. Interviews were conducted in Amharic and were audiotaped. We conducted a thematic analysis. RESULTS: We identified four themes: stress and physical tolls, lost expectations, social disruption, and economic threat. Family members reported stress and hopelessness; some also tried to harm themselves. Family members reported that their relationships with each other and with the wider community were disrupted significantly. Spouses and children did not get the support they needed, leading to unmet expectations: being left alone to care for children, unable to go to school or dropping out early. The study participants with SMHCs also spoke about the impacts of their illness on other family members and the community which appeared to be a source of shame and self-isolation. Both the family and the community respondents reported the economic effect of the illness which sometimes led to selling assets, debt, unemployment, forced migration, and food insecurity. Community members emphasised the economic burden and danger related to the aggressive behavior of the person with SMHCs, while the person with the illness and their family members blamed the community for the stigma and discrimination they experienced. CONCLUSION: SMHCs have profound consequences for the person with the illness, their family members, and the community. Future interventions for SMHCs should consider household-level interventions to address economic and care needs and mitigate the intergenerational impact. The community should be considered as a resource as well as a target for intervention.

Coping style as a predictor of anxiety in relatives of patients with mental illness-a single-center study.

BACKGROUND: Relatives of patients with mental illnesses such as schizophrenia and depression experience significant levels of anxiety. Accurately predicting their anxiety levels is crucial for the development of effective anti-anxiety interventions aimed at mitigating associated adverse outcomes. METHODS: In this cross-sectional study, 238 relatives of patients with mental illness were recruited, and their responses were collected using the generalised anxiety disorder-7 (GAD-7) and simplified coping style questionnaire (SCSQ) scales. One-way analysis of variance and t-test were used to assess the mean scores of GAD-7 and SCSQ among relatives with varying characteristics. Pearson's correlations were used to examine the correlation between anxiety levels and coping style. Multi-level regression analyses were used to identify the impact of the independent variables on anxiety. RESULTS: Among all relatives of patients with mental illness who participated in this survey, 238 completed the questionnaire. Females exhibited a higher mean GAD-7 score (9.72 ± 0.25) compared to males. Among participants aged 18-25 years, the GAD-7 (8.12 ± 0.17) score was the highest. Additionally, relatives of patients experiencing their first episode or with a disease duration of < 1 year, as well as relatives of patients with schizophrenia and depression, displayed higher GAD-7 scores. Correlation analysis revealed a positive correlation between anxiety and SCSQ (negative coping styles) (r = 0.476, p < 0.01). Multi-level regression analyses demonstrated that demographic variables (R2 = 0.474, F = 21.402, p < 0.01) and SCSQ (R2 change = 0.638, F = 37.526, p < 0.01) were significantly and positively associated with anxiety among relatives of patients with mental illness. CONCLUSIONS: Most relatives of patients with mental illness experience varying levels of anxiety, which are influenced by their coping styles.

Experiences of family caregivers and nursing home staff interactions during the adaptation process of elderly individuals moving to nursing home: a qualitative study.

OBJECTIVE: To explore the interaction between family members and nursing home staff during the adjustment period of newly admitted elderly individuals in a nursing home. DESIGN: A qualitative descriptive study based on semistructured interviews; data were analysed using a thematic topic analysis approach. SETTING: Interviews were conducted face-to-face. PARTICIPANTS: An interview was undertaken with 15 nursing home staff and 12 family members of recently admitted elderly individuals in three nursing facilities from November 2022 to January 2023 in a major Chinese urban centre. RESULTS: This study identified 5 main themes and 10 subthemes. The 5 themes identified are: Information transmission and sharing, pleasant interaction atmosphere, interaction dilemmas and challenges, inadequate organisational management and the necessity and anticipation of interaction. CONCLUSION: During the process of older persons transitioning to institutional care, we discovered issues and unresolved requirements in the interactions between family members and nursing home staff. In summary, there is a need to enhance the development of an interactive environment that supports the institutionalisation of older persons. The findings derived from this study are valuable for developing interactive programmes. TRIAL REGISTRATION NUMBER: ChiCTR2100045590, date: 19 April 2021.

Development and validation of a dynamic nomogram for high care dependency during the hospital-family transition periods in older stroke patients.

BACKGROUND: This research aimed to develop and validate a dynamic nomogram for predicting the risk of high care dependency during the hospital-family transition periods in older stroke patients. METHODS: 309 older stroke patients in the hospital-family transition periods who were treated in the Department of Neurology outpatient clinics of three general hospitals in Jinzhou, Liaoning Province from June to December 2023 were selected as the training set. The patients were investigated with the General Patient Information Questionnaire, the Care Dependency Scale (CDS), the Tilburg Frailty Inventory (TFI), the Hamilton Anxiety Rating Scale (HAMA), the Hamilton Depression Rating Scale-17 (HAMD-17), and the Mini Nutrition Assessment Short Form (MNA-SF). Lasso-logistic regression analysis was used to screen the risk factors for high care dependency in older stroke patients during the hospital-family transition period, and a dynamic nomogram model was constructed. The model was uploaded in the form of a web page based on Shiny apps. The Bootstrap method was employed to repeat the process 1000 times for internal validation. The model's predictive efficacy was assessed using the calibration plot, decision curve analysis curve (DCA), and area under the curve (AUC) of the receiver operator characteristic (ROC) curve. A total of 133 older stroke patients during the hospital-family transition periods who visited the outpatient department of Neurology of three general hospitals in Jinzhou from January to March 2024 were selected as the validation set for external validation of the model. RESULTS: Based on the history of stroke, chronic disease, falls in the past 6 months, depression, malnutrition, and frailty, build a dynamic nomogram. The AUC under the ROC curves of the training set was 0.830 (95% CI: 0.784-0.875), and that of the validation set was 0.833 (95% CI: 0.766-0.900). The calibration curve was close to the ideal curve, and DCA results confirmed that the nomogram performed well in terms of clinical applicability. CONCLUSION: The online dynamic nomogram constructed in this study has good specificity, sensitivity, and clinical practicability, which can be applied to senior stroke patients as a prediction and assessment tool for high care dependency. It is of great significance to guide the development of early intervention strategies, optimize resource allocation, and reduce the care burden on families and society.

Family-based interventions versus standard care for people with schizophrenia.

BACKGROUND: People with schizophrenia often experience long-term psychosocial disabilities and frequent relapse. Family plays a key role in caring for ill relatives, which in turn probably contributes to high levels of distress and burdens for the family. Family-based interventions have been developed and applied to family members and their relatives with schizophrenia to improve their outcomes. This is an update of a Cochrane review that was last updated in 2011, which has been split into this review, one on group- versus individual-based family interventions and one on family-based cognitive versus behavioural management interventions. OBJECTIVES: To assess the effects of family-based interventions for people with schizophrenia or schizophrenia-like disorders and their families compared with standard care. SEARCH METHODS: We searched the following electronic databases from inception until April 2023: CENTRAL, Medline, Embase, PsycInfo, CINAHL, WHO International Clinical Trials Registry Platform (ICTRP), Clinicaltrials.gov, SinoMed, China Network Knowledge Infrastructure (CNKI), Wanfang, and Chinese Scientific Journals Database (VIP). We also searched the reference lists of included studies and accessible reviews for additional references. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared the effects of family-based interventions for people with schizophrenia or schizophrenia-like disorders and their families and reported at least one patient's and one family member's outcomes. In this update, we only investigated standard care as the comparator. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. The review authors independently screened studies, extracted data, and assessed risk of bias for each study using the Cochrane risk of bias tool for RCTs. We pooled data and estimated effects with the mean difference (MD), standardised mean difference (SMD), or risk ratio (RR) with 95% confidence interval (CI). We judged the certainty of evidence using GRADEpro GDT. We divided the outcomes into short-term (≤ 1 month postintervention), medium-term (> 1 to 6 months postintervention), and long-term follow-up (> 6 months postintervention), if available. MAIN RESULTS: We identified 26 RCTs in this review, with 1985 people with schizophrenia or schizophrenia-like disorders, and 2056 family members. Most family-based interventions were conducted on a weekly or biweekly basis, with duration ranging from five weeks to two years. We had substantial concerns regarding the methodological quality of the included studies given that we judged all studies at high risk of performance bias and several studies at high risk of detection, attrition or reporting bias. Low-certainty evidence indicated that family-based interventions may reduce patients' relapse at one month or less postintervention (RR 0.66, 95% CI 0.49 to 0.89; 4 RCTs, 229 participants). We downgraded the evidence by two levels due to imprecision (small number of participants) and high risk of performance, detection and attrition bias. Compared to standard care, family-based interventions probably reduce caregiver burden at one month or less postintervention (MD -5.84, 95% CI -6.77 to -4.92; 8 RCTs, 563 participants; moderate-certainty evidence) and may result in more family members shifting from high to low expressed emotion (RR 3.90, 95% CI 1.11 to 13.71; 2 RCTs, 72 participants; low-certainty evidence). Family interventions may result in little to no difference in patients' death (RR 0.48, 95% CI 0.18 to 1.32; 6 RCTs, 304 participants; low-certainty evidence) and hospital admission (≤ 1 month postintervention; RR 0.81, 95% CI 0.51 to 1.29; 2 RCTs, 153 participants; low-certainty evidence) in comparison with standard care. Due to the heterogeneous measures and various follow-up periods, we were unable to provide pooled effect estimates for patients' compliance with medication and quality of life. We were very uncertain whether family interventions resulted in enhanced compliance with medication and improved quality of life for patients. We downgraded the evidence to very low certainty due to high risk of bias across studies, inconsistency (different directions of effects across studies), and imprecision (small number of participants or CIs of most studies including the possibility of no effect). AUTHORS' CONCLUSIONS: This review synthesised the latest evidence on family interventions versus standard care for people with schizophrenia or schizophrenia-like disorders and their families. This review suggests that family interventions might improve patients' outcomes (e.g. relapse) and families' outcomes (e.g. caregiver burden and expressed emotion), with little to no difference in patients' hospital admission and adverse effects in terms of death. However, evidence on patients' compliance with medication and quality of life was very uncertain. Overall, the evidence was of moderate to very low certainty. Future large and well-designed RCTs are needed to provide more reliable evaluation of effects of family interventions in people with schizophrenia or schizophrenia-like disorders and their families.

A phenomenological investigation of kinship involvement in the lives of children whose parents have mental illness.

BACKGROUND AND PURPOSE: Mental health services rarely reach children whose parents have mental illness despite their poor outcomes. There is a need to consider how mental health practitioners can prioritize the needs of these children and their families. This study examined kinship involvement in the lives of children whose parents have mental illness. METHODS: A phenomenological design was used, interviewing 20 children (aged 10-17 years) in families with parental mental illness (PMI) in Ghana. The interview data was analysed to attain the essential features of what kinship support looks like for children and their families. RESULTS: The essential feature of kinship support for children and families with PMI is characterized by uncertainty. However, there is an overall impression that kinship is generally supportive to these families, providing respite services, assistance with daily living, emotional support and advice to children and families. Yet, there is a sense that kinship may not always be helpful to these families. CONCLUSIONS: Kinship support is integral in countries where formal mental health services are inadequate and should be explored/harnessed by mental health practitioners. The study provides directions into ways practitioners can utilize kinship as a resource when working with these families.