Psychological Growth in Carers of People with Mental Illness

1. Psychological Growth in Carers of People with Mental Illness Name: Zafiroula (Zefi) Vlahodimitrakou Supervisors: Dr Elizabeth Temple and Professor Anthony Love Research completion: June , 2012

2. “That which does not kill us makes us stronger.” (Nietzche, 1888)

3. Mental illness and carers • Reduction in in-patient care for mental illness & and shift in focus to the community • People experiencing acute episodes of mental illness are being treated at home • 15 % of Australians are carers (Pirkis et al., 2011) • Best Practice= families are included (Hughes, 2009)

4. The caring role 1 Carer defined Mental health carer- someone who provides informal practical and emotional support to someone with a mental health issue including relatives, friends or neighbours (Clements, 1996) The contribution of carers • 104 hpw (average) caring • Hold Australia’s mental health system together (Hughes, 2009).

5. The caring role 2 Difficulties often accompanying the caring role: • Trauma • Burden • Lowest collective wellbeing • Reduced physical, mental and emotional health • High depression rates • 20.6% carers are unemployed • Economic losses/hardship & financial security compromised • Higher levels of ill-health • Social isolation • Decreased life opportunities • Stigma • Difficulty accessing support services (Cummins et al., 2007)

6. The caring role 3 • ‘Silver lining effect’ • The Cognitive Model of Caregiving: carer appraisals -> positive and or negative cognitive and affective changes -> outcomes affective wellbeing of self and care recipient (Kuipers, Onwumere, & Bebbington, 2011) • BENEFITS: • Growth, self-empowerment & advocacy (Muhlbauer, 2002) • Pride & learning inner strengths (Johansson, Carlson, Ahlin, & Anderson, 2010) • Increased resiliency (Mays & Lund, 1999) • Positive changes in relationships with care recipient (Perkins et al., 2004)

7. Posttraumatic Growth (PTG)/ Psychological Growth • PTG is the experience of positive psychological changes that occur in the way of a traumatic event as a result of the subsequent struggle with what happened (Tedeschi & Calhoun, 2004) • Both a process and an outcome • Can emerge both in the absence and presence of posttraumatic stress • Occurs as the result of any experience perceived as traumatic • It is not appropriate to use the term “PTG” to label changes that may occur in cares of people with mental illness because often there is no “post” for this population • The term “psychological growth” is appropriate

8. Adapted from “Handbook of Posttraumatic Growth”, by L. G. Calhoun., and R. G. Tedeschi, 2006, p. 8.

9. Tedeschi’sand Calhoun’s PTG Model (2006)

10. Conceptualising positive carer outcomes: Psychological growth • Caring.....Traumatic? • Traumatic event: circumstances where there is a violation of relatively resistant cognitive core assumptions held by an individual about the world and the self (Janoff-Bulman, 2006) • Chronic sorrow (Roods, 2002) • Barton and Jackson (2005) found that 1/3 of carers (n = 37) of people with early psychosis met criteria for PTSD

11. Rationale for research on positive psychological growth in carers • For clinicians: - Assist with the assessment and treatment of carer complex emotions-Information about factors sustaining caregiving - Detection of crucial aspects of effective intervention • For carers: • Inclusion of + and - aspects of caregiving experiences into life narrative may be beneficial • By identifying areas of satisfaction in growth, carers may focus less on the negative aspects of providing care, feel a greater sense of accomplishment, and express more positive feelings about their relationship with the person they care for .........?????????

12. Aims • Broad aim: • To identify positive changes in the psychological growth of carers as a result of their caregiving journey. • Specific aim: • To examine the relationship between psychological growth and situational meaning, active and passive coping and informal and formal social support.

13. Research Variables • Situational meaning: meaning found in caregiving • Active coping: problem-focused and active emotion-focused coping • Passive coping: emotion-focused avoidant coping • Informal social support: practical, emotional and material assistance people can access from personal network (Machielse, 2006)

14. Method 1 • Participants: • N= 33 female, 12 male, M age = 41.5 years • Recruited- Mind Australia, snowballing & social media • Inclusion criteria- carer, aged 18+ & proficient in reading and writing in English • Materials: • Demographics questionnaire • Posttraumatic Growth Inventory • Finding Meaning through caregiving Scale • Brief COPE • Multidimensional Scale of Perceived Social Support • Procedure: • Questionnaire- hard-copy, online survey (20-35 min approximate duration)

15. Findings • Moderately high levels of psychological growth • Strong +relationship between situational meaning & psychological growth • Greater active coping  greater situational meaning  higher psychological growth • No significant relationship between passive coping and psychological growth • Greater access to informal social support greater situational meaning  higher psychological growth

16. Implications • Holistic representation of carer’s experiences • Signal for researchers indicating under-investigated area • The promotion of positive adjustment to caregiving • Counterbalance tendency to view caregiving in largely negative terms • Reinforce eudaimonic mental health perspective

17. Questions……………………………………Thank you for your time!!!