Children as next of kin's experiences, practices, and voice in everyday life: a systematic review of studies with Norwegian data (2010-2022).

Aims: This systematic review aims to identify and describe how children of parents with mental illness, substance dependence, or severe physical illness/injury, experience and practise their everyday life. Methods: The review followed the four stepwise recommendations of Harden and colleagues when including quantitative and qualitative studies on peoples' experiences and views. In all, 23 studies with data from Norway (2010-2022) have been included. Brown and Clark's thematic analysis was applied. Results: Three themes were constructed from the reviewed articles: (a) Children practice their relational agency by actively doing practical tasks, occasionally jobs to maintain family economy, and organising fun activities with the ill parent. (b) Emotional ambivalence when their own needs were set aside in favour of the parents. They loved their parents but also felt guilt, anger, disappointment, shame, fear of inheriting the illness and longed for a 'normal' everyday life. (c) Supportive contextual factors were, for example, at least one significant adult recognising them, participating in leisure activities, socialising with friends, and talking with other peers who shared similar experiences as next of kin. Obstructive factors were lack of information and recognition as well as silence and lack of dialogue within the family and/or health professional. Conclusions: There is a strong need for more knowledge and competence on the situation and needs of these children when it comes to professionals, parents and the public. Public health initiatives are needed to honour their agency and recognise their contributions in present time to prevent psychosocial problems later in life.

How is my child doing - parental understanding of their children when a parent has cancer.

To explore the difficulties parents face when understanding their children's reactions to parental cancer and parents' reactions to their children's perceived needs.Qualitative interviews with cancer patients and their partners.Eleven patients and seven partners took part. Their children were aged 1-15 years. Eight patients were mothers and cancer was diagnosed median 28 (7-104) months ago.Inductive analysis with systematic text condensation.Parents were groping in the dark when understanding their children's reactions. They observed signs of distress in their children, but often avoided communication about emotional reactions. We suggest parental difficulties in containing own and children's emotions as an important cause for this situation.Parents lacked relevant support offers for the family as a unit. Identification of children's difficulties cannot be based on parental evaluation alone. We suggest family support as part of standard care for patients with minor children.

Experiences with the routine use of the Edinburgh Postnatal Depression Scale from health visitors' and midwives' perspectives - An exploratory qualitative study.

BACKGROUND: The Edinburgh Postnatal Depression Scale has been practiced as a routine screening for postnatal depression at a municipal health care centre for more than ten years. OBJECTIVES: The aim of this study was to examine how health visitors and midwives perceive and practice this routine screening. STUDY DESIGN: We chose an exploratory qualitative approach, with analysis of data from focus group interviews. METHODS: Ten health visitors and two midwives participated in two focus group interviews by sharing their thoughts and reflections. The analysis was performed in collaboration with all authors according to thematic network analysis. FINDINGS: The Edinburgh Postnatal Depression Scale is well accepted as a screening tool. In addition to giving health visitors and midwives information about mothers who need special attention concerning mental health challenges, the Edinburgh Postnatal Depression Scale is a tool for talking about problems related to early motherhood. A trusting relationship is a prerequisite for these conversations. The health visitors seldom use the word 'depression' in contact with the individual mother. They sometimes lose opportunities to identify mothers in need of help because of a tight time schedule and social and cultural factors. Collaboration on a daily basis with colleagues and family therapists, and monthly guidance from mental health professionals are necessary to secure professional quality and confidence. CONCLUSION: The Edinburgh Postnatal Depression Scale is a useful screening tool, but there are social and cultural challenges, and the available time during screening consultations is often too short. Collaboration with and guidance from other professionals are necessary.

Burdened parents sharing their concerns for their children with the doctor. The impact of trust in general practice: a qualitative study.

Objective: The aim of this study was to recognise the preconditions experienced by general practitioners (GPs) in addressing the children's needs when ill and substance abusing parents consult for their own health problems. Design: Qualitative analysis of 38 case stories told by GPs in focus group interviews. Setting: Focus group interviews of four continuing medical education groups for GPs in western Norway. Subjects: 27 GPs (nine females) with at least 5 years' experiences in general practice. Results: Different aspects of the GPs' perceived mandate of trust from the parents was a precondition for the children's situation to be addressed. In some case stories the participants took an open mandate from the parent for granted, while in others they assumed that the parent did not want to discuss their family situation. Sometimes the participants had faith that by continuing with their ordinary GP tasks, they might obtain a more open mandate of trust. Their evaluation of the mandate of trust seemed to impact on how the GP could adopt a mediating role between the parents and various support agencies, thus supporting children who were at risk. Discussion/conclusion: The children most at risk may remain invisible in GPs' encounters with their parents, possibly because their parent's health problems and overall situation overshadow the children's situation. The mandate of trust from burdened parents to GPs can be a fruitful concept in understanding the interaction regarding the welfare of the parent's children. Negotiating the mandate of trust with parents by explicitly addressing trust and having an ongoing discussion about the mandate and its limits might be an option to secure the children support if necessary. KEY POINTS Offering children of burdened parents information and support can be crucial for health promotion and illness prevention. A general practitioner's (GP's) evaluation of the trust parents have in them can determine the extent of support children receive. Depending on the parents' level of trust, GPs may take a mediating role between support services and parents for the benefit of the children. A negotiation concerning the trust parents have in the GP may open up possibilities for GPs to offer children necessary support.

Overcoming Clinician and Parent Ambivalence: General Practitioners' Support of Children of Parents With Physical or Mental Illness and/or Substance Abuse.

Children who are next of kin to parents with physical or mental illness and/or substance abuse need access to mental health support and several cost-effective interventions are available. Because most parents in the target group often consult general practitioners (GPs), GPs may have a crucial role in identifying burdened children and ensuring their follow-up. However, this important topic has received little attention in clinical discussions and research. In response to the knowledge gap, we conducted the research project Burdened Children as Next of Kin and the General Practitioner. Four sub-studies have been completed and published: a sub-study with qualitative analysis of focus group interviews with GPs (paper 1), a qualitative analysis of focus group interviews with adolescents as next of kin (paper 2), and a qualitative analysis of individual interviews with parents with illness and/or substance abuse (paper 3). The results from these sub-studies were incorporated in a survey sent to members of a nationwide GP organization (paper 4). The aim of the present sub-study was to gain further knowledge about conditions for the encounters between GPs and parents with impairments to be supportive for the children as next of kin. The material of the present sub-study derived from the project's four previous sub-studies and comprised a secondary analysis of the four prior sub-studies. We conducted an overarching thematic analysis of these sub-studies' results sections. We searched for statements from the GPs, the adolescents, and the parents on their experiences and evaluations of the needs of the children and their families, and the possible ways of accommodating these needs in general practice. The analysis shows that both GPs and parents were ambivalent about addressing the topic of the patients' children during consultations. This was the case although the GPs were in a good position to identify these vulnerable children, and the parents were worried about their children's situations. Possible strategies for GPs to overcome this ambivalence can be to (1) strengthen their competence in the topic, (2) gradually build trusting relationships with parents, and (3) gradually gain contextual knowledge about the families' situations. GPs can do this by performing ordinary GP tasks and acknowledging the parents' efforts to give their children good daily lives.

How can the general practitioner support adolescent children of ill or substance-abusing parents? A qualitative study among adolescents.

OBJECTIVES: To explore significant experiences of adolescents as next of kin that the general practitioner (GP) should identify and recognize. DESIGN: Qualitative study with focus-group interviews. SUBJECTS AND SETTING: Three focus-group interviews were conducted with a total of 15 Norwegian adolescents each with an ill or substance-abusing parent. The participants were recruited from existing support groups. RESULTS: The adolescents' days were dominated by unpredictability in their family situation and their own exhausting efforts to keep up an ordinary youth life. Mostly, they consulted GPs for somatic complaints. In encounters with the GP, they wanted to be met both as a unique person and as a member of a family with burdens. Their expectations from the GP were partly negatively formed by their experiences. Some had experienced that both their own and their parent's health problems were not addressed properly. Others reported that the GP did not act when he or she should have been concerned about their adverse life situation. The GP may contribute to better long-term psychosocial outcomes by ensuring that the adolescents receive information about the parent's illness and have someone to talk to about their feelings and experiences. In addition, the GP may help by supporting their participation in relieving activities. CONCLUSION: Burdened adolescents seek a GP most often for somatic complaints. The GP has a potential to support them by taking the initiative to talk about their life situation, and by recognizing their special efforts. Key points Little is known about how a general practitioner can support adolescents with ill or substance-abusing parents. Adolescents experience unpredictability in life and strive to find balance between their own needs and the restrictions caused by parental illness. In encounters with adolescents having ill parents, the GP should take the initiative to talk about their family situation. The GP may help them by recognizing their experiences and struggles, give information, offer talks and support coping strategies.

Ill and substance-abusing parents: how can the general practitioner help their children? A qualitative study.

BACKGROUND: Severe illness among parents may interfere with their parenting. Children having ill or substance-abusing parents are at risk of own health problems and psychosocial difficulties. The health care system should identify families in need of help and provide the help needed. For ill parents, it can be difficult to seek help and advices for their parenting. The aim of this study was to identify important factors for the general practitioner (GP) to bear in mind during encounters with ill and substance-abusing parents, to enable the GP to provide appropriate support for the children. METHOD: A qualitative approach was chosen and the data material was semi-structured individual interviews with 12 parents with mental illness, substance abuse or severe somatic illness. The participants were recruited through GPs in Norway, and the interviews were performed in 2014. We used systematic text condensation for analysis. RESULTS: It was important for the participants that the GP was oriented about their family and children's situation. They wanted to be regarded as competent parents in ordinary families; however, they were aware that their illness affected their parenting. They expressed a need for advice about how to inform the children of their illness and talk to them about their challenges, and, if necessary, utilize helpers who could inform the children and talk to them directly. There were often many agencies involved, and it was important that the helpers cooperated and shared information. In addition, the parents were in need of information about support services. CONCLUSION: Ill parents in this study conveyed a double message to their helpers. They wanted to be considered as responsible and well-intended parents who wished the best for their children. At the same time they needed support in parenting. The GP should take the time to listen to the parents' first spontaneous description about an ordinary daily life (while realising that it may not necessarily be an accurate report), then explore their worries and needs of support.

To give the invisible child priority: children as next of kin in general practice.

OBJECTIVE: To explore general practitioners' (GPs') experiences in helping children as next of kin of drug-addicted, mentally ill, or severely somatic ill adults. These children are at risk of long-term mental and somatic health problems. DESIGN: Qualitative focus-group study. SETTING: Focus-group interviews were conducted in western Norway with a total of 27 GPs. Participants were encouraged to share stories from clinical encounters with parents who had one of the above-mentioned problems and to discuss the GP's role in relation to helping the patients' children. RESULTS: The GPs brought up many examples of how they could aid children as next of kin, including identifying children at risk, counselling the parents, and taking part in collaboration with other healthcare professionals and social workers. They also experienced some barriers in fulfilling their potential. There were time constraints, the GPs had their main focus on the patient present in a consultation, and the child was often outside the attention of the doctors, or the GPs could be afraid of hurting or losing their vulnerable patients, thus avoiding bringing up the patients' children as a subject for discussion. CONCLUSIONS: Norwegian GPs are in a good position to help children as next of kin and doctors make a great effort to support many of them. Still, support of these children by GPs often seems to depend not on careful consideration of what is best for the patient and the child in the long run, but more on short-term convenience reasons.

"You may wade through them without seeing them": general practitioners and their young patients with mental health problems.

OBJECTIVE: To gain insight into the management of children and adolescents with mental health problems by their GPs as the GPs describe it. DESIGN: A qualitative analysis of data from focus group interviews with GPs. SETTING: Western Coast of Norway. SUBJECTS: A strategic sample of 19 GPs. RESULTS: According to the informants psychosomatic and other internalizing disorders are the most frequent mental health problems in their practice. Their assessments were based on history taking, physical examination and acquired knowledge of development and prevalence of common health problems. Their interventions mostly consisted of parental counselling. Their assessments and interventions to a lesser extent relied on specific knowledge in child and adolescent psychiatry. CONCLUSION: The interested GP is in a good position to provide services to these patients. They have the parents' trust, insight into family and local community, and essential general medical knowledge about management of mental health problems in this age group. There is need for mutual research and educational programmes between GPs and child and adolescent psychiatry to explore the interface between the fields.

"It's about focusing on the mother's mental health'': screening for postnatal depression seen from the health visitors' perspective--a qualitative study.

AIMS: This study examines experiences from the implementation of EPDS as a routine screening for postnatal depression in a health centre seen from health visitors' perspective. METHODS: A qualitative approach was chosen to shed light on this issue. Six experienced health visitors and one midwife participated in a focus group interview sharing their experiences and expectations. RESULTS: The analysis indicate that the EPDS screening turned out to be a useful tool for the health visitors to adress mental health issues in health promotion and preventive work with mothers and newborns. The EPDS screening shifted the focus in the consultation from the child solely to also encompass the mother and the relation between them. A precondition for this was that the implementation process was gradual and on the health visitors own terms, likewise that there was a follow-up chain including supervision given to the health visitors, in order to provide help for the mothers who need more help than the health centre can offer. CONCLUSIONS: Our study shows that acceptability for routine screening with EPDS amongst health visitors is possible to achieve.

Video interaction guidance offered to mothers with postnatal depression: experiences from a pilot study.

In the period January-August 2003, a pilot study took place connected to a research project where video interaction guidance with postnatal depressed mothers was a central part. We wanted to gain some experiences with video interaction guidance with focus on the baby. The data were collected through interviews and video recordings and analysed in a phenomenological perspective. In short, the experiences from the guidance's with the six mothers can be described as follows: the mothers experienced their own coping, the mothers engaged in mutual dialogue with their babies and the mothers suffering was recognized. Our hypothesis is that the pictures on the TV screen are especially powerful to bring forth a change in the mothers' self-image.

[General practitioner and mental diseases among children and adolescents]. / Fastlegen og psykisk sykdom blant barn og ungdom.

BACKGROUND: Child and adolescent psychiatry in primary health care is scarcely investigated. The purpose of this article is to describe some aspects of the role of the general practitioner in the care of young patients with psychiatric problems. MATERIAL AND METHODS: Data were collected from four focus group interviews with 19 general practitioners. The material was analysed in a phenomenological perspective. The aim was to develop new and documented descriptions seen from the participants' point of view, interpreted within the framework of available knowledge about care for children and adolescents with psychiatric problems. RESULTS AND INTERPRETATION: The general practitioner is in a good position to provide psychiatric care for these patients because of his or her unique knowledge about the families and the local communities. They have their patients' confidence and acquired skills from their unselected practice to recognise serious and abnormal conditions. The majority of the informants did not feel sufficiently skilled in order to treat more specific child and adolescent psychiatric disorders. Some informants were actively involved in multidisciplinary networks concerning their young patients, while others were neither involved nor informed about it. In addition, local health and welfare services to a lesser extent involved these doctors. Because of this, children and adolescents who might have been assessed and treated in primary health care could be referred directly to specialists. A need for guidance and updating on relevant knowledge from the specialist health care was expressed. From the results we might assume that specialists might give some general practitioners the professional security needed in order to take on the role of medical co-coordinator of the multidisciplinary services to young patients with mental health problems.