Parents of children with mental health problems may experience stigma when the ideals that matter most to being considered a "good parent" are perceived as not being met, according to preliminary research led by Weill Cornell Medicine, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian investigators. Discussions with a group of these parents are helping inform new approaches to supporting parents and restoring more positive feelings about parenting skills when faced with a child's mental health struggles.
The study , published online on Oct. 6 as a special article in Psychiatric Services, identified qualities that may contribute to parents feeling more secure and respectable in raising their child, including emotional support, open communication, boundaries, and role modeling. The researchers suggest that supporting parents in fulfilling these qualities can help parents feel less self-blame and stigmatization for their child's mental health problems.
"To support children, we also need to support parents," said the study's first author Dr. Tim Becker , assistant professor of clinical psychiatry at Weill Cornell Medicine and a child psychiatrist at NewYork-Presbyterian Westchester Behavioral Health's Nichols Cottage, an inpatient unit for adolescents. "A better understanding of parents' experiences with stigma surrounding a child's mental health enables clinicians to more effectively help parents, and more empowered parents likely leads to better outcomes for children."
Prior research has found that parental stigma is related to greater parental depression and lower quality of life and can limit the parent's willingness to seek help for their child, added Dr. Becker, who is also adjunct assistant professor of clinical psychiatry at Columbia University Vagelos College of Physicians and Surgeons.
Study Interviews
For the current study, researchers conducted interviews with 24 parents who had a child with ADHD, depression, or substance use problems. Dr. Becker led the study as a research fellow in the Shaffer Scholars Program in Child Psychiatry Research at Weill Cornell Medicine and Columbia University Vagelos College of Physicians and Surgeons. Participants discussed what factors made them feel respected as a "good parent," how their child's mental health problems threatened this respect and contributed to parental stigma by undermining their identity as a good parent, and how they tried to manage and reduce this stigma and maintain a positive self-identity.
Participants described stigma as arising from their struggles to meet the core ideals of good parenting. These included emotionally supporting their child, maintaining open communication with their child, establishing appropriate boundaries, serving as a positive role model, and contributing to their child's overall well-being.
"A number of participants spoke passionately about feeling like there is not a lot of support for parents," Dr. Becker said. "They felt like they were being isolated and looked down upon."
Parents often felt judged by relatives, teachers, neighbors, and health care providers for not doing enough to prevent or address their child's mental health issues, he added.
When creating a care plan for a child with mental health challenges, clinicians should consider the stigma parents may be experiencing because it can lead to distress and self-doubt about their parenting abilities and undermine engagement in treatment.
Next Steps in Helping Parents
Traditionally, work to reduce stigma focuses on psychoeducation, in which clinicians provide parents with an explanation of their child's condition, its symptoms, and treatments, Dr. Becker said. However, this doesn't address the day-to-day stigma parents face because their child is struggling. Parents often want to actively partner with clinicians in providing support to their child, and when clinicians engage parents in strategies to support their child, it can help both the child and the parent.
Dr. Becker and his colleagues are studying a video intervention developed from their analyses of the interviews, in which an actress portrays a parent of a child with mental health problems. She describes her experience with stigma, how she got help for her child, and how, over time, she restored her sense of being a good parent. The researchers are evaluating whether the intervention reduces parental stigma and improves attitudes toward help-seeking.
Well-being in families is reciprocal, Dr. Becker said. "When there are better outcomes for the children, there are better outcomes for the parents — and vice versa."
The research reported in this story was supported by funds from the American Academy of Child Psychiatry and by the National Institute of Mental Health, part of the National Institutes of Health, through grant number R25 MH125775
