Background
Aims of the study
Method
Systematic search
Women | Psychosis or bipolar disorder | Qualitative research |
---|---|---|
Women | Serious mental illness | Qualitative |
Grounded theory | ||
Mother | Severe mental illness | Phenomenology |
Narrative | ||
Mothers | Psychosis | Discourse |
Ethnography | ||
Mothering | Schizophrenia | Thematic |
Interpretative phenomenology interview | ||
Bipolar disorder | Focus group | |
Bipolar affective disorder | Explorative | |
Observational | ||
Constant comparative |
Inclusion and exclusion criteria
Critical appraisal
Metasynthesis analysis
Results
Quality assessment
Authors | Year | Country | Description of sample | N | Women/mothers | Ethnicity | Recruited from | Data collection | Analysis | Score & quality rating | |
---|---|---|---|---|---|---|---|---|---|---|---|
1 | Hagen & Nixon [37] | 2011 | Canada | Women recovered from some form of psychotic experience. Diagnoses not stated. Age range: 27-57 years (mean: 38). No information about parental status. No information about level of education, religion, relationship status or SES. | 18 | Women | Not stated | Word of mouth/advertise-ment in alternative health magazine | Narrative interviews | Phenome-nological data analysis | 7 B |
2 | Borba et al. [32] | 2011 | USA | Women with diagnosis of SMI (10 schizophrenia, 6 BD, 13 major depression and 1 other). Sample described as low income, urban women. Age range: 28-62 years (mean = 45.8). No information about parental status. Highest level of education: Less than a high school diploma (10), high school diploma (16), some college credits (4). Religion not stated. Marital status: Married or living as married (2), widowed (4), separated (3), divorced (7), single, never married (14). No information about religion. | 30 | Women | 28 African American 1 White, 1 other. | Community settings | Interviews | Modified constant comparative method | 8 A |
3 | Venkataraman & Ackerson [33] | 2008 | USA | Mothers with BD. Age range: 21-49 years (mean not stated). Education: High school (5), college (5). Relationship status: Single (6), married (1), cohabiting (3). SES: Low (7), middle (3). No information about religion. | 10 | Mothers | White American | Community settings | Semi-structured interviews | Constant comparative analysis | 6.5 B |
4 | Luhrmann [34] | 2008 | USA | Homeless women with psychotic symptoms. No formal diagnostic interview. Ages not stated. No information about parental status. No information about education, religion, or relationship status. | 61 | Women | Not stated | Community settings | Semi-structured interviews/observation | Not stated | 5.5 C |
5 | Ueno & Kamibeppu [44] | 2008 | Japan | Mothers with chronic mental illness (13 schizophrenia, 7 mood disorders). Age range not stated. (mean: 43). Relationship status: Married (14), separated or divorced (4), widow (1), never married (1). No information about education, religion or SES. | 20 | Mothers | Japanese | Discharged inpatient/community settings | Narrative interviews | Modified grounded theory | 7.5 B |
6 | Chermonas, Clarke & Marchinko [38] | 2008 | Canada | Women with schizophrenia (9 schizophrenia, 3 schizoaffective disorder & 2 paranoid schizophrenia). Age range: 40-73 years (median: 45). No information about parental status. Education: Less than high school (4), completed high school (2), completed or some post-secondary education (8). Marital status: Married or living common law (3), single or divorced (9), have boyfriends (3). SES: Low (8), middle (4), high (2). No information about religion. | 14 | Women | Most White/White with European Ancestry, 1 part Aboriginal, 1 Asian. | Community settings | Semi-structured interviews | Not stated | 6.5 B |
7 | Padgett et al. [35] | 2006 | USA | Formerly homeless women with SMI (5 schizophrenia, 2 schizoaffective disorder, 3 major depression, 3 BD). Age range: 31 - 62 years (mean: 50 years). 7 mothers. SES: Poor/working class (8), middle class (5). No information about education, religion or relationship status. | 13 | Women | 6 African American 5 White, 2 Latina | Community settings | In depth life history interviews | Cross case/collective case study | 9.5 A |
8 | Chiu et al. [39] | 2005 | Canada | Women with SMI (18 schizophrenia or schizophreniform disorder, 6 major depression, 4 BD, 2 major depression with psychosis/delusions). Age range: 26-67 years (mean: 46). No information about parental status. East Asian women: Education: Elementary school (1), high school (6), post-secondary education (7), no formal education (1). Religion: Christianity (7), Buddhism (2), Catholicism (1). Relationship status: Single (6), married (3), widowed (2), divorced (2). SES: Self-employed (2), on pension (2), welfare or disability (9), supported by families (2). South Asian women: Education: Elementary school (2), high school (5), post-secondary education (4), no formal education (4). Religion: Sikhism: 15. Sikhism with Hinduism: 2. Relationship status: Married (7), widowed (3), separated (2), divorced (3). SES: Employed (1), welfare or disability (5), supported by families (9). | 30 | Women | 15 East Asian 15 South Asian | Community settings | Semi structured interviews | Constant comparative analysis | 9.5 A |
9 | Edwards & Timmons [41] | 2005 | UK | Mothers with postnatal illness (3 puerperal psychosis, 2 severe postnatal depression, 1 depressive psychosis). Ages not stated. No information about education, religion, relationship or SES. | 6 | Mothers | Not stated | Discharged inpatient | Interviews | Not stated | 7.5 B |
10 | Diaz-Caneja & Johnson [42] | 2004 | UK | Mothers with SMI (8 schizophrenia, 10 BD, 4 severe depression with psychotic symptoms). 2 mothers 20-29 years, 9 mothers 30-39, 11 mothers 40+. Marital status: Currently married/living with partner (3), previously married, now not living with partner (11), widow (1), never married (7). No information about education, religion or SES. | 22 | Mothers | 13 White UK, 3 White other, 1 Black UK, 1 Black Caribbean, 1 Black African, 2 Asian, 1 Mixed | Community settings | Interviews | Thematic analysis | 8.5 B |
11 | Robertson & Lyons [43] | 2003 | UK | Mothers with experience of puerperal psychosis. Age range 28-44 years (mean = 34). No information about education, religion, relationship status or SES. | 10 | Mothers | Not stated | Community settings | Interviews | Grounded theory | 6 B |
12 | Pentland et al. [40] | 2003 | Canada | Aging women with schizophrenia (45+ years, diagnosis of schizophrenia in early adulthood). Age range: 47-65 years. 3 mothers. Marital status: Married (1), divorced (1), single (4). No information about education, religion or SES. | 6 | Women | Not stated | Community settings | In depth interviews. | Thematic analysis | 6.5 B |
13 | Sands [36] | 1995 | USA | Mothers with SMI - single, low income mothers with chronic mental illness living in a supportive residential programme. (6 schizophrenia, 1 schizotypal personality disorder, 1 major depression, 1 BD, 1 unknown.) Age range: 22-40 years (mean = 27). Education: At least high school education (6), less than high school education (3), unknown (1). No information about religion. | 10 | Mothers | 7 African American, 3 White | Community settings | Semi-structured interviews/observation | Not stated | 5.5 C |
Synthesis
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Hagen & Nixon | Borba et al. | Venkataraman & Ackerson | Luhrmann | Ueno & Kampibeppu | Chermonas et al. | Padgett et al. | Chiu et al. | Edwards & Timmons | Diaz-Caneja & Johnson | Robertson & Lyons | Pentland et al. | Sands | |
Beliefs about illness
| Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Contextual factors | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Spiritual beliefs | Yes | No | No | No | No | No | No | Yes | No | No | No | Yes | No |
The role of diagnosis | Yes | No | No | Yes | No | No | No | No | Yes | No | No | No | No |
Consequences of illness
| Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Stigma: Feeling misunderstood/judged | No | No | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | No | No |
Loss of self-determination | Yes | Yes | No | Yes | No | No | Yes | No | Yes | Yes | Yes | Yes | Yes |
Changes to roles/relationships | No | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Strategies to cope with illness
| Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Focus on children | No | No | Yes | No | Yes | No | No | No | No | Yes | No | No | Yes |
Seeking social support | Yes | Yes | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No |
Seeking support from professionals | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No |
Appearing “normal” | Yes | Yes | No | Yes | No | No | Yes | No | Yes | No | Yes | No | No |
Taking medication | No | No | No | No | No | No | No | Yes | No | Yes | No | No | Yes |
Alternatives to conventional treatment | Yes | No | No | No | No | No | Yes | Yes | No | No | No | Yes | No |