Publication Date

2018-05-09

Availability

Embargoed

Embargo Period

2019-05-09

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Nursing (Nursing)

Date of Defense

2017-12-19

First Committee Member

Victoria B. Mitrani

Second Committee Member

Brian E. McCabe

Third Committee Member

Guillermo J. Prado

Fourth Committee Member

Anthony J. Roberson

Abstract

Maternal mental disorders (MD), including substance use, are chronic conditions associated with poor child mental health. Yet, some children of these mothers thrive and experience healthy development and functioning. Despite this, little research examines protective factors, e.g., parenting practices and self-management beliefs and behaviors, in children of mothers with MD. This dissertation was ancillary to a randomized trial of a family-based intervention for mothers with MD and their children. The aims of this dissertation were to: 1) examine whether maternal positive parenting practices are related to adolescent emotional (internalizing) and behavioral (externalizing) problems, after controlling for mother’s psychological distress and substance use, 2) gain an understanding of adolescents’ individual-level resources regarding their abilities to self-manage, and 3) describe the challenges, problem-solving approaches, and lessons learned of conducting community-based, family research among mothers with MD and their children. Theories guiding this study were Ecodevelopmental Theory, and the Individual and Family Self-Management Theory. Aim 1 was conducted through secondary analysis of baseline data from a randomized trial of a family-based intervention (hereafter referred to as the parent trial) with 90 mothers and 118 adolescents. For Aim 2, qualitative interviews with 19 adolescents of mothers from the parent study were conducted. Aim 3 was conducted through a review of administrative proceedings from the parent trial (e.g. study team meeting/contact notes, IRB modifications, study enrollment and contact logs and reports) and were analyzed to inform challenges and lessons learned in conducting community-based research with families affected by maternal mental disorders. Findings from the quantitative analysis demonstrated significant relationships between 1) the mother’s substance use and child externalizing problems, 2) the mother’s psychological distress and child internalizing problems, and 3) the mother’s parental involvement and child internalizing and externalizing problems. Three major themes emerged from the qualitative analysis: (1) the construction of healthy, positive self-concepts, (2) resolving demands through engaging in various forms of self-regulation during normal and challenging situations, and (3) balanced socialization – the interplay between individualism and social connections. Challenges identified related to participant recruitment, retention, burden, and service needs; community provider engagement; and protection of vulnerable participants. Three “lessons learned” in addressing such challenges included: 1) building relationships with members of vulnerable populations; 2) community provider engagement when seeing the value to their clients; and 3) organized flexibility. This study provides information on individual and parental factors that can protect adolescents of mothers with mental disorders and their families and approaches to overcome challenges conducting research with these families. This information is intended to inform clinical practice, policy and future research.

Keywords

adolescent mental health; maternal mental disorders; positive parenting practices; self-management; protective factors; at-risk families

Available for download on Thursday, May 09, 2019

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