Introduction
Methodology
Eligibility Criteria
Literature Search and Screening
Concepts | Keywords |
---|---|
(1) Qualitative | ((("semi-structured" or semistructured or unstructured or informal or "in-depth" or indepth or "face-to-face" or structured or guide) adj3 (discussion* or questionnaire*)) or (focus group* or qualitative or ethnograph* or fieldwork or "field work" or "key informant")).ti,ab. or interview*.tw. or interviews as topic/ or focus groups/ or narration/ or qualitative research/ or experience*.tw. or perception*.tw |
(2) Bipolar | (BD or BD1 or BD2 or BDi or BDii or BDNOS or bi-polar or bipolar or manic or mania or hypomania or hypomanic or hypo-mania or hypo-manic).tw. or Bipolar Disorder/ |
(3) Parent | (parent* or mother* or maternal* or father* or paternal* or famil*).tw. or parents/ |
(4) Child | (child* or neonat* or newborn* or new-born* or infant* or baby or babies or toddler* or pre-school* or preschool* or school* or youth* or pre-adolescen* or adolescen* or teen* or kindergarten* or nurser*).tw. or adolescent/ or exp child/ or exp infant/ |
(5) = 1 and 2 and 3 and 4 (6) = Limit 5 to English (7) = limit 6 to yr = “1994–2023” |
Data Extraction and Analysis
Quality Assessment
Reflexivity Statement
Results
Study Characteristics
Author, year, location | Study aima | Sample description | Verification of diagnosis | Recruitment method | Data collection / analysis | Main themes | Eligible sample information |
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Anke et al. (2019), Norway | Investigate postpartum relapse risk perceptions among women with BD | Pregnant or postpartum women with BD I or II (n = 26) | Documented diagnosis | Mental health clinics, child services, well-baby clinics, and maternity wards | Semi-structured interviews / Inductive TA | - Perinatal concerns: Illness relapse; Early mothering; Perinatal impact on child; Illness impact on partner - Perinatal resources & preparations: Support network and personal strategies | Mothers with BD (n = 13), aged 25–37 (mean = 32.9) |
Aldridge (2006), UK | Assess experiences of children caring for parents with mental illness | Parents with chronic mental illness, their caregiving children, and key workers | Not stated | UK’s young carers projects | “One-to-one interview” / Not stated | - Children’s care responsibilities: Role adaptation (not just role transference) - Positive outcomes: Caring help reinforce parent–child bonds - Family needs: Children’s care fills the gap in health and social care services - Parenting capacity: Mutable and self-perceived - Recognizing children’s contribution and needs | OPBD (n = 1) |
Backer et al. (2017), UK | Examine how living with a parent with BD affects young children’s emotional health | OPBD (4–12 years old) | Self-reported | UK user-led BD organization | Computer-assisted, semi-structured interviews (In My Shoes) / TA | - Perception of parents: Parent with BD, ‘well’ parent - Knowledge and awareness of BD: Communication about illness, description of illness - Managing family life with a parent with BD: Emotional effects on child; ‘Independent’ child; Source of support; Avoidance and coping - Living in a family with BD | OPBD (n = 10), aged 4 to 10 years |
Bee et al. (2013), UK | Assess quality of life for children in families coping with severe mental illness | Not stated | Self-reported | Advertisement or external emails | Focus groups (professionals) and open-ended interviews (children and parents) / Inductive TA | - Emotional wellbeing - Social wellbeing - Economic wellbeing - Family context and experiences - Self-esteem and self-actualization | OPBD (n = 1) and mother with BD (n = 1) |
Campos et al. (2018), Brazil | Exploring adult perceptions of maternal BD diagnosed in their childhood and its implications | Adults whose mothers, now in psychiatric treatment, were diagnosed with BD during their childhood | Documented diagnosis | Adult Psychiatry outpatient clinic of the University Hospital | Semi-structured interviews / Content analysis | - Childhood: Caregiving burdens, guilt and insecurity - Adolescence: Maternal rejection, shame, social isolation, and premature adult roles - Adult life: Balancing personal sacrifices with coping strategies | Adult OPBD (n = 7) |
Chen et al. (2021), China | Explore the parenting & family experiences of mothers managing mental illness | Mothers with current or past mental illness, with at least one child under 18 | Self-reported | Social media advertising and online peer support groups | Semi-structured interviews / IPA | - Motherhood as a central identity - Stigma of Maternal Mental Illness - Impact of mental illness on parenting: Impact of fluctuating moods on parenting; Feeling guilty, overwhelmed, and helplessness; Self-acceptance - Perceptions about the impact of the mental illness on children: Hereditary worries; Impact on children’s development; Reducing the negative impact on children - Experiences of talking to children about mental illness - How having children impacts mothers’ mental illness and their recovery - Support obtained and needed: Helpful support; Unhelpful support; Support needed | Mothers with BD (n = 3, OPBD: 4–10 years) |
Chen et al. (2023), China | Understand parenting & family experiences of fathers with mental illness | Fathers with current or past mental illness, with at least one child under 18 | Self-reported | Social media advertising and online peer support groups | Semi-structured interviews / IPA | - Mental illness undermines fatherhood images - Parenting in the context of mental illness: Positive father-child interaction; Parenting disengagement; Harsh parenting; Inconsistent parenting - Concerns about the negative impact of their illness on children: Fear & Protection - Children as a burden and a source of hope - Stigma - Relying on family support: Isolation & connection; Further needs - Unmet professional and peer support needs: Lack of professional support; Professional/peer support needs | Fathers with BD (n = 3, OPBD: 5–12 years) |
Davison & Scott (2018), USA | Explore attitudes toward interventions for OPBD | (1) Parents with BD I or II (n = 6, 2 fathers, 4 mothers, median = 48 years) (2) OPBD (n = 7, 3 boys, 4 girls, aged 12–26, median = 16, without psychological Issues) | Not stated | Parents with BD: A mental health conference or local clinical services; OPBD: Community professional network | Open-ended Interviews / TA | - Information and knowledge about BD - Parents with BD: Identification and modification of risk; Uncertainties and expectations for the future - OPBD: Concerns about Parents with BD; Acceptable models of support | As stated in the ‘Sample description’ |
Liu et al. (2022), Taiwan | Assess adult children’s perceptions of family resilience, its barriers, and cultural influences when a parent has BD | OPBD (n = 20, aged 20 or over, excluding those with parents having other mental illness) | Documented diagnosis | Acute psychiatric ward | Semi-structured interviews / IPA | - Family resilience: Ill parents try to be good parents; Parents’ personal strengths; Parents’ positive attitudes toward BD; Flexible family roles; Strong family bonds; families’ social connections - Barriers to family resilience: Poor parenting/family function, conflict between parents, poor mental health literacy | OPBD with quotes about experiences up to 18 years old (n = 4, comprising 3 females and 1 male) |
Mulvey et al. (2022), USA | Explore motherhood experiences of criminally involved women | Mother with Axis I disorders and daily functional impairments on the SMI probation caseload (n = 48) | Documented diagnosis | Serious Mentally Ill probation caseload | Semi-structured life-course interviews / Unspecified inductive approach | - Normative mothering - Aspiring to break the cycle - Constrained mothering - Failure and state intervention - Children as parents - Children as a catalyst for change | Mothers with BD (n = 12), aged 20s-50s |
Pattanayak & Sagar (2012), India | Understand the perspectives of patients with BD and their family members regarding family risk and genetic counseling | Patients with BD (n = 5); Family members of patients with BD (n = 11) | Documented diagnosis | Outpatient psychiatric clinic | Open-ended interviews / TA (Boyatzis, 1998) | - Emphasis on external/situational causes - Cultural beliefs govern causal explanation - Help-seeking: a shared decision - Perceived genetic risk low, yet worrisome - Concerns mainly about future generations - Desire to alter perceived genetic risk - Knowledge of precise risk both helpful and anxiety-inducing - Unmet need for preventive information | One mother with BD: (35 years); One father with BD (31 years) |
Petrowski & Stein (2016), USA | Assess role reversal and obligation in young adult daughters; study family bonds and maternal mental illness impact | Daughters of a mother with long-term mental illness (n = 10, aged 18–22) | Daughter-reported | Online student research participation system and undergraduate courses | Semi-structured interviews / Content analysis | - Parentification - Felt obligation - Relationship with father and siblings - Positive growth | One 18-year-old daughter of a BD mother |
Reupert et al. (2012), Australia | Explore the experiences of children with a parent who has a dual diagnosis | Children with a parent having dual diagnosis of mental illness and substance abuse (n = 12, aged 8–15) | Not stated | Through an organization focused on families with a parent having dual diagnosis | Semi-structured interviews / IPA | - Meaning of family - Understanding the parent and his or her illness - coping and reacting - preferred supports | One 8-year-old girl of a mother with BD and marijuana abuse; A 14-year-old boy of a father with BD, ADHD, marijuana & alcohol abuse |
Stallard et al. (2004), UK | Assess parent and child perspectives on the impact of the parent’s mental illness | Parent with mental illness (n = 24, receiving outpatient care in CMHT) and their dependent children (n = 26) | Not stated | CMHT | Semi-structured interviews / Not stated | - Adult mental health team barriers: Time pressures and limited resources; Client-focused approach; Lack of child-/family-focused skills; Protecting the needs of the adults - Parental barriers: Adult needs dominate; Parental denial & fears; Protecting the children - Child barriers | Mother with BD (n = 1) |
Tjoflat & Ramvi (2013), Norway | Experiences of parenting while managing BD | Parents with BD (n = 6; 5 mothers; aged 31–50; children under 18; No other mental illnesses) | Documented diagnosis | CMHT | Semi-structured interviews / IPA | - Balancing BD and parenting - Need for support versus perceiving stigma - Dependence on their children - Change and growth | As stated in the ‘Sample description’ |
Venkataraman & Ackerson (2008), USA | Assess parenting strengths, challenges, and needs in mothers with BD | Mothers with BD I or II (n = 10, 8 BD-I and 2 BD-II) | Documented diagnosis | CMHT and support groups | Semi-structured interviews / Constant comparison of the GT | - Strengths in parenting: Child importance; Positive traits; Lessons from own parents - Challenges in parenting: Impact of depression/mania; Swings in parenting; Discipline issues; Child-related stress - Service needs: Discipline help; Support groups; Crisis services; Managing child behavior; Other needs | As stated in the ‘Sample description’ |
Venkataraman (2011), USA | Explore the perspectives of children of mothers with BD in the parenting | OPBD without psychiatric diagnosis (n = 4, Aged 5–13) | Not stated | CMHT and support groups | Semi-structured interviews / Constant comparison of the GT | - Strengths in parenting: Helpful; Humor; Setting limits; Being available - Challenges in parenting: Oversleeping; Anger; Unpredictable moods; Dependency on children - Other finding: Fear of having or getting the disorder | As stated in the ‘Sample description’ |
Vivanco & Grandon (2016), Chile | Experiences raised by a parent with serious mental illness | Children (aged 18–29) of people with serious mental illness (5 schizophrenia, 6 BD) | Not stated | Referral by mental health facility staff | Semi-structured interviews and a group interview / TA | - Childhood: Fear, vulnerability; concerns for parent safety; uncertainty; sadness; and family protection - Adolescence: Family burden; guilt; role changes; identity formation; difficulty relating to parents; grief; feelings of abandonment and loss; impact of medication, preserving parental role; adapting to change - Young adulthood: Family loyalty; challenges in separating from the family; stigma | Adult OPBD (n = 5) |
Wilson & Crowe (2009), New Zealand | How parents with BD view their parenting role | Parents with BD (n = 5, 4 mothers, 1 father) | Not stated | Not stated | Unspecified interviews, DSM-IV and popular texts / Critical discourse analysis | - Moderation - Monitoring emotional regulation | As stated in the ‘Sample description’ |
Author (Year) | Codes | The Multifaceted Landscape of Parenting | The Evolving Dynamics of Child-Parent Relationships | The Dual Nature of Childcare for Parents with BD | Navigating Parental Challenges with BD | ||||||||
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Parental Engagement | Parental Emotional Regulation | Parental Consistency | From Limited to Comprehensive Under-standing | From Reactive to Proactive Coping | From Compassionate to Overwhelmed Care | Childcare as Top Priority vs Self-Care | Childcare as Emotional Comfort vs Strain | Childcare as Motivation Promoter. Vs Underminer | Mindful and Proactive Strategies to Parent Children | Empathetic and Empowering Measures to Support Parent | Transparent and Tactful Communication to Strengthen Parent–Child Relationship | ||
Aldridge (2006) | 2 | v | v | ||||||||||
Anke et al. (2019) | 10 | v | v | v | v | v | |||||||
Backer et al. (2017) | 28 | v | v | v | v | v | v | v | |||||
Bee et al. (2013) | 2 | v | v | ||||||||||
Campos et al. (2018) | 10 | v | v | v | v | ||||||||
Chen et al. (2021) | 29 | v | v | v | v | v | v | v | v | v | |||
Chen et al. (2023) | 24 | v | v | v | v | v | v | v | v | ||||
Davison & Scott (2018) | 6 | v | v | v | |||||||||
Liu et al. (2022) | 6 | v | v | v | |||||||||
Mulvey et al. (2022) | 16 | v | v | v | v | v | v | v | v | v | v | ||
Pattanayak & Sagar (2011) | 3 | v | |||||||||||
Petrowski & Stein (2016) | 5 | v | v | v | |||||||||
Reupert et al. (2012) | 3 | v | v | v | |||||||||
Stallard et al. (2004) | 3 | v | |||||||||||
Tjoflat & Ramvj (2013) | 24 | v | v | v | v | v | v | v | v | v | v | v | v |
Venkataraman & Ackerson (2008) | 29 | v | v | v | v | v | v | v | v | v | v | ||
Venkataraman (2011) | 19 | v | v | v | v | v | v | ||||||
Vivanco & Grandon (2016) | 8 | v | v | v | v | ||||||||
Wilson & Crowe (2009) | 7 | v | v | v |
Quality Assessment
First author (Year) | Clear statement of research aims | Appropriate use of qualitative methods | Research design aligned with research aims | Recruitment strategy suitable for research aims | Data collection addressing the research issue | Adequate consideration of researcher-participant relationship | Proper ethical considerations | Rigorous data analysis | Clear presentation of findings | Value of the research | Score |
---|---|---|---|---|---|---|---|---|---|---|---|
Anke et al. (2019) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
Aldridge (2006) | Yes (1) | Yes (1) | PA (0.5) | PA (0.5) | PA (0.5) | No (0) | PA (0.5) | PA (0.5) | PA (0.5) | PA (0.5) | Moderate (6) |
Backer et al. (2017) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
Bee et al. (2013) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
Campos et al. (2018) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
Chen et al. (2021) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9.5) |
Chen et al. (2023) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9.5) |
Davison & Scott (2018) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
Liu et al. (2022) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
Mulvey et al. (2022) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | PA (0.5) | Yes (1) | PA (0.5) | Yes (1) | Moderate (8) |
Pattanayak & Sagar (2011) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | High (8.5) |
Petrowski & Stein (2016) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | High (9) |
Reupert et al. (2012) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (10) |
Stallard et al. (2004) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | PA (0.5) | Yes (1) | Yes (1) | High (8.5) |
Tjoflat & Ramvi (2013) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
Venkataraman & Ackerson (2008) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | No (0) | No (0) | Yes (1) | Yes (1) | Yes (1) | Moderate (6.5) |
Venkataraman (2011) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | High (9) |
Vivanco & Grandon (2016) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | Yes (1) | No (0) | PA (0.5) | Yes (1) | Yes (1) | Yes (1) | High (8.5) |
Wilson & Crowe (2009) | Yes (1) | Yes (1) | Yes (1) | PA (0.5) | Yes (1) | No (0) | Yes (1) | PA (0.5) | PA (0.5) | Yes (1) | Moderate (7.5) |