Les enjeux psychologiques des droits de l'enfant et de l'exercice de l'autorité parentale en situation de maladie mentale du parent

Après avoir rappelé la condition actuelle des parents qui présentent des troubles mentaux graves (TMG), nous nous consacrons à l'étude des besoins insatisfaits en lien avec d'une part, l'auto-stigmatisation et la qualité du fonctionnement parental d'autre part. Notre échantillon comprend cent parents avec un TMG de type schizophrénie, trouble bipolaire ou trouble dépressif majeur ont été rempli le Camberwell Assessment of Needs (CAN Section 1, Phelan, 1995 ; Stefanatou et al., 2014), la version abrégée du Internalized Stigma for Mental Illness (ISMI, Boyd et al., 2014, Paraskevoulakou et al., 2017), le Parental Styles and Dimensions Questionnaire (PSDQ, Robinson etal., 2001 ; Antonopoulou & Tsitsas, 2011) et le Parental Acceptance and Rejection Questionnaire Parent version (Parent PARQ ; Rohner, 2008 ; Tsaousis, Mascha & Giovazolias, 2015). Dans notre échantillon, le nombre de besoins insatisfaits est positivement corrélé à l'auto-stigmatisation et ce pour toutes les dimensions de l'ISMI, ainsi que pour son score total. Le nombre de besoins insatisfaits est corrélé négativement aux pratiques et aux styles parentaux les plus adéquats. Il est associé positivement aux scores totaux du PARQ et du PSDQ et aux pratiques les plus problématiques. Selon les analyses corrélationnelles et de régression qui ont été menées pour identifier les facteurs déterminants pour le fonctionnement parental, l'ISMI est associé indépendamment au PARQ et au PSDQ. Globalement, plus le nombre de besoins insatisfaits est accru, plus l'auto-stigmatisation est intense et le fonctionnement parental problématique. Les domaines qui devraient être ciblés pour combler les failles institutionnelles concernent les relations parents-enfants et les relations de couple. Par ailleurs, les patients qui ont une forte tendance à l'auto-stigmatisation et qui présentent des caractéristiques cliniques typiquement associés à la sévérité du trouble (type et ancienneté du diagnostic, antécédents familiaux) devraient être prioritairement associés à des mesures de soutien à la parentalité. Il en ressort que dans les domaines qui se rapportent à la famille, les parents avec un TMG rencontrent des difficultés d'une ampleur telle que des soutiens doivent leur être apportés. Les dispositifs les plus adaptés seraient ceux qui proposeraient des actions coordonnées visant à la fois traitement mental, soutien parental et lutte contre l'auto-stigmatisationAfter recalling the current conditions of parents with severe mental illness (SMI), we examined whether patients who report serious difficulties remaining unaddressed by existing services, feel more self-stigmatized and adopt less adequate parenting functioning.100 participants with schizophrenia, bipolar disorder or major depressive disorder completed the Camberwell Assessment of Needs (CAN Section 1, Phelan, 1995 ; Stefanatou et al., 2014), the abbreviated version of the Internalized Stigma for Mental Illness scale (Boyd et al., 2014 ;Paraskevoulakou, 2017), the Parental Styles and Dimensions Questionnaire (PSDQ, Robinson et al., 2001 ; Antonopoulou & Tsitsas, 2011) and the Parental Acceptance and Rejection Questionnaire (Parent PARQ, Rohner, 2008 ; Tsaousis, Mascha & Giovazolias, 2015). In our sample, significant associations were revealed between the CAN and the ISMI measures and both the PARQ and PSDQ total scores. More precisely, unmet needs were positively correlated with the total score and dimensions of the ISMI. The less adequate styles and practices were positively correlated with the unmet needs and the majority of the ISMI dimensions. The CAN and the ISMI measures were negatively associated with optimal styles and practices. Overall, higher unmet needs and internalized stigma levels were associated with more problematic parental styles and practices.The multiple linear regression analysis indicated that the ISMI measure was independently associated with both the PARQ and PSDQ total scores, and that the type of disorder, as well as the characteristics typically associated with the severity of the disorder (chronicity, family antecedents of mental illness) had a predictive value for the quality of SMI parenting. Our results broaden understanding of institutional issues regarding SMI parenting assistance. Family needs should be prioritarily addressed, especially for sub-groups we identified as being atrisk for less adequate parenting and increased help needs. Furthermore, since high self-stigmatization of SMI parents is predictive of poorer parental practices and styles, internalized stigma reduction and strength-based interventions to SMI parents are crucial directions for future recovery-oriented effort

Mental Illness Related Internalized Stigma: Psychometric Properties of the Brief ISMI Scale in Greece.

AIMS: Since evaluation regarding the impact of mental illness related internalized stigma is scarce, there is a great need for psychometric instruments which could contribute to understanding its adverse effects among Greek patients with severe mental illness. The Brief Internalized Stigma of Mental Illness (ISMI) scale is one of the most widely used measures designed to assess the subjective experience of stigma related to mental illness. The present study aimed to investigate the psychometric properties of the Greek version of the Brief ISMI scale. In addition to presenting psychometric findings, we explored the relationship of the Greek version of the Brief ISMI subscales with indicators of self-esteem and quality of life. METHODS: 272 outpatients (108 males, 164 females) meeting the DSM-IV TR criteria for severe mental disorder (schizophrenia, bipolar disorder, major depression) completed the Brief ISMI, the RSES and the WHOQOL-BREF scales. Patients reported age and educational level. A retest was conducted with 124 patients. RESULTS: The Chronbach's alpha coefficient was 0 0.83. The test-retest reliability coefficients varied from 0.81 to 0.91, indicating substantial agreement. The ICC was for the total score 0.83 and for the two factors, 0.69 and 0.77 respectively. Factor analysis provided strong evidence for a two factor model. Factors 1 and 2 were named respectively "how others view me" and "how I view myself". They were negatively correlated with both RSES and WHOQOL-BREF scales, as well as with educational level. Factor 2 was significantly associated with the type of diagnosis. CONCLUSIONS: The Greek version of the Brief ISMI scale can be used as a reliable and valid tool for assessing mental illness related internalized stigma among Greek patients with severe mental illness