Clinical-Community Research Group, Projects, And Publications

Individuals differentially disclose information across online and in-person settings, depending on their level of anonymity and the type of information they are disclosing. For people with serious mental illness, the decision of when and how to disclose a mental health condition may be especially salient due to stigmatization and the potential impact of mental health on relationship satisfaction. The present study used focus groups to examine the nature of disclosure decisions during online and in-person dating among adults self-identifying with a mental health condition. For some adults with mental illness, online platforms may enable additional control and intentionality with respect to when and how to disclose their mental illness to their romantic partners.

The present study examined accounts of adults coping with mental illness who are in committed romantic relationships. A sample of 23 adults who self-identified as having a mental health diagnosis participated in focus groups to discuss strengths and struggles that they experienced in their relationships with romantic partners. These adults also shared strategies for dealing with mental health issues in their relationships and offered advice for other people with a mental health diagnosis. Participants described the need to communicate about their current mental health experiences, using their partner as a touchstone or reality check, and checking in with their partner about their mental health symptoms as strategies as important elements in navigating their romantic relationships. Adults shared common and unique relationship strengths and struggles as a result of living with mental illness and provided insightful advice for others about maintaining partner relationships.

Although most caregiving for people with serious mental illness is provided by parents, studies suggest that well siblings are often a source of care and support. Well-siblings must make decisions as to how much time and energy they can commit to caring for their sibling with mental illness compared to taking care of their own needs. The present study examines the role of family ties of adult well siblings with their ill sibling and parents in accounting for variation in sibling caregiving and individual well-being. We assessed their views of their relationships with their ill sibling and the parent most responsible for their ill sibling’s care, their attitudes toward sibling caregiving, current caregiving activities and intentions to provide care, and their self-reports of individual well-being.

Dulek, E. B., Russin, S., Rudd, M. F., Griffith, F. J., & Stein, C. H. (2021). Personal loss, parental relationships, and caregiving intentions among adult siblings of individuals with mental illness. Journal of Child and Family Studies, 30, 1607–1618. DOI:10.1007/s10826-021-01960-0

Stein, C. H., Gonzales, S. M, Walker, K., Benoit, M. F., & Russin, S. E. (2020). Self and sibling care attitudes, personal loss, and stress-related growth among siblings of adults with mental illness. American Journal of Orthopsychiatry, 90 (6), 799 – 809.

This study explores the lived experience of adult women diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) with a specific focus on gender roles and social support. Previous research has identified a potential conflict between symptoms of ADHD and societal expectations of women, in addition to a negative correlation between levels of social support and ADHD symptoms. In the current study, in-depth semi-structured interviews focusing on of societal expectations of women and social support were conducted with nine women from ages 25 to 45 diagnosed with ADD or ADHD. The interviews were qualitatively analyzed using a content analysis approach. Most participants perceived themselves as possessing different qualities than those socially expected of women; they described reacting by attempting to modify themselves to meet societal expectations, pretending to meet expectations, and intentionally flouting expectations. All participants perceived a positive relationship between ADHD symptoms and symptoms of comorbid conditions, whereas most perceived a negative relationship between level of social connectedness and ADHD symptoms and between level of social connectedness and comorbid symptoms. Some participants identified an optimal level of social connectedness and described an increase in symptoms when deviating either above or below the optimal level. Future research should further explore adaptive responding to conflicts between socially dictated gender norms and qualities of women with ADHD and examine the concept of an optimal middle level of social connection.

Stigmatization of people experiencing mental illness remains prevalent in the United States. Social stigma can result in negative outcomes for people with mental illness such as limited access to housing and employment and reduced well-being. Both social contact interventions and art exhibits may reduce stigma towards mental illness, and art making may increase feelings of self-efficacy and belongingness among people with mental illness. The present mixed methods research examined the perspectives of both artists who post their work and potential viewers in online interactions about art and mental illness intended to reduce stigma. Study 1 used qualitative interview methods with artists experiencing mental illness who post publicly about their experiences on Instagram (N = 17). Themes from interviews related broadly to art (History and Identity as an Artist, Art Career, and Art and Mental Health), mental health (Symptoms, External Barriers, Protective Factors, and Treatment), and social media (Benefits and Motivations, Risks, and Online Disclosure). Study 2 consisted of a randomized controlled trial of an asynchronous, online social contact intervention to reduce stigma towards mental illness (N = 318). Groups 1-3 viewed intervention posts created by Study 1 artists about mental illness (art and writing posts, art-only posts, or writing-only posts) and Group 4 viewed matched comparison posts not about mental illness. Study 2 results showed that participants in the intervention groups reported significantly higher mental health awareness, general sympathy, and appreciation for people with mental illness than those in the comparison group. All groups had a significant decrease in prejudice. Participants’ perceptions of posts as confusing or compelling mediated the relationship between the type of post and their ratings of state empathy. Implications for the development of cost-effective online interventions to reduce stigma towards mental illness are discussed.

My master’s thesis aimed to examine social support as a mediator in the relation between perceived discrimination and disordered and emotional eating among Women of Color and if personal resources (ethnic identity and internalization of thinness) moderate the relation between perceived discrimination and eating pathology. Perceived discrimination, eating pathology, social support, internalization of thinness, and level of ethnic identity. Three hundred and seven participants were recruited using Mechanical Turk. Results indicated that social support did not mediate the relationship between perceived discrimination and eating pathology. A significant interaction effect was observed for internalization of thinness moderating the relation between perceived discrimination and EE. Significant interaction effects were also observed for ethnic identity moderating the relation between perceived discrimination and DE. Overall, findings suggest that WOC have both personal and social resources that may mitigate the effects of perceived discrimination’s impact on eating pathology.

A small, but noteworthy, group of literature explores the relationship between mental illness and family functioning.  Typically, this research tends to focus on the impact that maternal mental illness has on parenting and outcomes among the children experiencing such parenting.  It has been well-documented that mothers experiencing mental illness experience a great number of stressors that can make parenting challenging, and that their children in turn are prone to negative outcomes that subsist into adulthood, such as difficulties in academic, social, behavioral, and mental health realms.  Furthermore, due to the increased challenges of parenting with mental illness, mothers and their children may oftentimes experience caregiver role reversal in which the children take on a caregiver role for their mothers and siblings

My master’s thesis research examined the effects of parental mental illness through a qualitative study on the experiences of young women raised by a mother living with mental illness. 10 young women provided first-person accounts on a number of different topics, including their relationship with their mother, father, siblings, and friends, feelings of obligation and parentification in their family, and positive experiences that they related to having a mother with mental illness. Qualitative content analyses indicated differences in the perceived quality of the daughters’ relationships with their mothers. Women who described a positive mother-daughter relationship also described aspects of felt obligation, caregiving, and support seeking with family and friends differently than those who described a more negative relationship with their mother. Regardless of differences in their perceptions of the relationship quality, however, all participants described positive experiences associated with having a mother with mental illness.

Parents often act as the primary caregivers of their adult children who are coping with serious mental illness. Parents report engaging in a wide variety of supportive behaviors including assistance with housing, finances, activities of daily living, and emotional advice and support. Yet, a major expectation of parental role in the western culture is that parents should facilitate the autonomy and independence of their children in adulthood.  Parental involvement can be particularly difficult for parents of adults with mental illness, as parents try to balance their desire to support their adult child’s independence with fears about their loved one’s continued mental health and well-being.  Sociological ambivalence is a construct used to describe contradictory expectations that are inherent in particular social roles such as those found in the parent role.  The present study examines issues of sociological ambivalence in parents’ reports of their relationships with adult children coping with mental illness.  A sample of 100 parents of adults with serious mental illness (bipolar disorder, major depression, schizophrenia) will complete a self-report questionnaire that includes measures of parental involvement and ambivalence, parent-child relationship quality (closeness and conflict), personal loss due to mental illness, and individual well-being (physical, psychological, social).  The research examines the role of parents’ reports of involvement and ambivalence in describing their perceptions of relationship quality with their adult child and their own feelings of personal loss as a result of their child’s mental illness.  The relative contribution of parents’ reports of ambivalence, parent–child relationship characteristics, and personal loss in describing parents’ perceptions of their own well-being is also examined.  Implications of study results for understanding normative pressures that parents face in their relationships with adult children with mental illness will be discussed.

The present study examined the views of individuals who post about social justice issues on Tumblr. Online survey methodology was used to contact actual users of Tumblr who have posted content between March 16 – April 4, 2016 identified by one of the following five hashtags: Black Lives Matter, Feminism, Racism, Social Justice, or SJW. Specifically, this online survey invited individuals who post about social justice issues to describe their perceptions of social advocacy and their engagement in social justice activities online and offline. The survey was completed by 65 individuals, and the responses of 60 were selected for inclusion in this study. Participants (n=60) were mostly white (n=36; 60%), female (n=40; 66.7%), and young adults (M=26.8, range 18-63 years) from the United States (n=43; 71.7%). The major goal of the study is to describe users’ views about their online activities concerning social justice and its relationship to their views of themselves as social activists in their everyday lives.

Psychiatric hospitalization can be viewed as a difficult life event that can cause disruptions in several life domains. Individuals who experience a psychiatric hospitalization are at a greater risk for experiencing readmission to the hospital and social stigma that can interrupt their ability to function in daily life, and even suffer work-related setbacks. Much of the research characterizes resiliency as a set of traits possessed by an individual. Studies using such measures found that adults with serious mental illness have lower resiliency scores than the general population. However, relatively little is known about specific aspects of resiliency that adults might rely upon in their adjustment to community life after psychiatric hospitalization.

Siblinghood is characterized by a tremendous stability across the lifespan, leading to considerable distress when that relationship is lost. The death of a sibling can be a particularly disruptive life event due to the family dynamics and the potential loss of parental support as well. Supportive relationships have been shown to buffer the stressful effects of bereavement, and even open up the possibility of personal growth after loss. Current research is limited in its breadth of understanding into how social support plays in a role in grieving individual's ability to cope with the death of a loved one. A network analysis would provide more nuanced information about the structure, content, and function of social support networks experienced by those who have lost a sibling through death. The present study will conduct personal network analyses on adults whose siblings have died between one and five years ago. The network analyses will provide details about the structure, content, and function of participants' networks of social support, and correlate them with known experiences associated with grieving a sibling (i.e., depression, complicated grief, and posttraumatic growth).

Depression is one of the leading causes of disability worldwide, yet research suggests that many people who experience depression never receive any sort of formal mental health treatment. Family members very often play a significant role in providing and coordinating formal and informal care for their loved ones with depression and other forms of serious mental illness. These family caregivers often experience significant amounts of stigmatization due to their relationship with a loved one with a serious mental illness. However, the existing literature on these family members and stigmatization rarely considers young adults who have a parent with a mental illness. My proposed thesis will examine the relationship between perceptions of the mother-child relationship and perceived social stigma among young adult children of mothers with depression. I am interested in examining the degree to which young adult’s perceptions of the mother-child relationship are related to their endorsement of personal stigma toward depression, their perceptions of family stigma, their engagement in advocacy activities and sense of personal empowerment, and their own psychological well-being.

Theories and research on bereavement have enumerated ways that adults cope with the death of close family members such as spouses, parents, siblings and children (Neimeyer, 2002; Parks, 1996). Yet, relatively few studies have focused on ways that adults cope with the death of close friends.  Grief and bereavement reactions are traditionally considered a “family affair” in the United States with relatively few channels for friends to express their sense of loss (Smith, 1996). Given that coping with the loss of friends is a common and inevitable part of adults’ experience, understanding ways that adults cope and make meaning of a close friend’s death is particularly important.

The present qualitative study examines narrative accounts of adults who have experienced the death of a close friend.  The study focuses on adults’ participation in traditional and digital memorials and “memory keeping” activities, the nature of support from family and friends, and ways that adults make meaning of the loss of a friend.  A qualitative research methodology was purposefully selected for the present study to give voice to the experiences of these adults and to situate their narratives in a larger literature on adaptive coping.

This project began in the context of a Clinical-Community Advanced Team practicum.  Graduate students on the team were interested in using personal accounts as a means of promoting education and advocacy and reducing stigma about serious mental illness.  These graduate students created Speaking from Experience, a speakers group of individuals who personally experience a mental illness or who have a family member who does.  Speakers give structured presentations about their experiences with mental illness in undergraduate psychology classes. 

Speaking from Experience presentations are typically given by a team of three speakers and last for about 30 minutes.  After introductions, speakers present some myths and facts about mental illness and share personal stories about their experiences.  The team of speakers then presents information about mental health advocacy and takes questions from the audience.  Speakers provide student audiences with insights into the complex reality that they face, often discussing their experiences with medication, family and social relationships, personal setbacks and gains, and offering personal advice.  The goal of Speaking from Experience is to allow undergraduates to interact with people with mental illness and their supporters who are coping, suffering, and triumphing.

The Speaking from Experience project involves recruiting and training speakers, helping to educate psychology instructors about a recovery model of mental illness, and helping to facilitate speakers’ presentations in undergraduate classrooms.  The project has been continued by graduate students in the community psychology research group.  Currently, research is being conducted to evaluate the efficacy of Speaking from Experience in reducing social stigma and promoting education and advocacy about mental illness. 

This project took place in the context of a Clinical-Community Advanced Team practicum.  The Team focused on creating resources for university students with serious mental health problems such as depression, bi-polar disorder, severe anxiety, and obsessive compulsive disorder.  We reviewed material about supported education and guidelines for access to higher education outlined in the Americans with Disabilities Act.  Using qualitative research methods and photovoice techniques (asking people to take pictures to represent their experiences), the team worked with students at BGSU coping with psychiatric disabilities to share their narratives.  The Team created a web site for students and faculty containing information, resources, and first-person accounts of students coping with serious mental health problems.

This project took place within the context of a Clinical-Community Advanced Team practicum.  Graduate students on the team were interested in working with older adults and developed a partnership with a local assisted-living facility.  Team members developed the Community Teachers Project, based on elements of empowerment theory and narrative analysis.  Team members conducted focus groups with older adults in the assisted-living facility about topics that they felt qualified to talk about as “teachers” to graduate students and undergraduates.  Team members conducted detailed individual interviews with older adults who joined the project about topics that were important in their lives.  Based on interviews, older adults and team members created written narratives that documented salient experiences in the lives of older adults.  The written narratives focused on topics such as family, jobs and career, surviving war and other challenging world events, and accounts were assembled into a book.  Copies of narrative accounts were shared with participants’ family members, assisted-living staff, other residents of the facility, and undergraduates in a celebration of the project.

This on-going research program examines the development and enactment of obligations that adults have towards their parents across the adult life course. This program of research is particularly relevant because, for the first time in history, relationships between children and their parents are primarily situated in adulthood.  Adults now typically spend more than fifty years relating to their parents.  In our research group, we have conducted a series of studies that examine felt obligation towards parents in young, middle age, and older adult samples.  We have examined the role of gender, ethnicity, social class, and marital status in adults’ reports of parental obligation, and have demonstrated the usefulness of felt obligation in describing parental care giving and individual well-being.  This program of research offers students the opportunity to investigate aspects of adult family relationships in non-distressed samples across the life course.

The economic crisis of 2008 represents the deepest global recession since the Great Depression.  Although the United States has taken determined steps to stabilize financial markets in the past year, hundreds of thousands of Americans have lost their jobs, their homes, or are struggling to maintain their way of life.  Existing studies have shown the psychological effects of economic hardship on family relationships, suggesting that economic pressure can negatively impact parents’ relationships with their children.  Previous research has not focused on the effects of economic pressure on relationships between young adults and their parents, but economic downturn may be particularly problematic for families in this phase of the life course. 

We recently conducted an intergenerational study that examined the views and perceived impact of the current economic crisis in the United State in a sample of 136 young adults and their parents from 68 families.  The research examined the role of economic pressure and perceived young adult – parent relationship quality and concerns in accounting for variation in self-reports of psychological distress for young adults and their middle age parents.  Although young adults and their parents did not significantly differ in their overall reports of the economic pressure that they face, economic pressure and relationship concerns were differentially related to anxiety and depressed mood for young adults and parents.  For young adults, reports about making economic adjustments were significantly related to self-reported anxiety and depressed mood, while relationship concerns and not economic pressures were significantly related to reports of anxiety and depressed mood for parents.  The implications of the economy for family relationships are discussed.

This project was developed and executed in the context of a Clinical-Community Advanced Team.  Using community psychology principles, four graduate students created a meaningful intervention that could be carried out within a semester without relying on financial assistance.  Through community reconnaissance, students discovered a greatly under-served population:  senior citizens living independently from their spouses in residential care.  Because no local resources existed for this population, students partnered with a local senior center and designed and facilitated a 5-week mutual help support group intervention.. Four seniors joined the group and shared their experiences with loneliness, family conflict, and larger systems issues relevant to nursing home placement.  The group also incorporated a psychoeducational component, covering topics such as social support, spiritual coping, communication with residential care staff, and self-care.  Following each group session, students and seniors shared dinner provided by the senior center.

Data from a follow-up questionnaire and semi-structured interview indicated that the group made members feel less alone and more connected and made it easy to share problems.  From a training standpoint, students gained experience integrating clinical and community psychology while developing a community based intervention.  They also learned critical skills relevant to designing, implementing and assessing a project from beginning to end.

By 2030, it is estimated that adults living in the United States over the age of 65 will more than double to approximately 72 million people.  Older adults are often marginalized by society and are a population generally neglected by community psychologists.  Research suggests that a majority of caregivers for older adults are family members, with adult children assuming primary caregiving roles for their parents.  However, little is known about the everyday lives of caregivers after their family member has been placed in a residential care facility.

The present study examined perceptions of family relationships and individual well-being among a sample of 100 adults who were designated as the primary contact for their mothers who permanently lived in a nursing care facility.  The sample of daughters (n=65) and sons (n=35) were generally around age 60, had at least two siblings, were satisfied with the institutional care that their mothers received, and visited their mother weekly or several times a week.  We found that adult children's perceptions of increased caregiver burden was significantly related to their perceptions of strained relationships with their sibling due to caregiver issues and feeling manipulated by their mother with regard to caregiver demands.  Adult children's reports of depression decreased when adult children reported feeling closer to siblings as a result of their mother's caregiving arrangement, and increased depression was related to adult's reports of strained relationships with siblings due to caregiving issues.  Qualitative analysis revealed seven themes, highlighting the complex nature of family relationships related to parental caregiving.

This study is part of a larger research project that examined the views of adults whose mothers lived permanently in a nursing care facility.  The research project included measures of coordination of mother's care among siblings, adults' felt obligation towards their mothers, and their views about how to balance caring for their aged mother with taking care of themselves.  The research project highlights the importance of understanding family relationships in the middle and older phases of the adult life course.

Recovery has been hailed as a guiding and transformative vision for community mental health services (Department of Health and Human Services, 2003).  In the past two decades, research and mental health policy have focused on defining recovery and examining the efficacy of recovery-oriented mental health services (Davidson, Lawless, Leary, 2005).  Yet, the historical context of mental health service reforms, from the deinstitutionalization movement to the recovery movement, has been lost in the scholarly discourse (Davidson, Flanagan,Roe, & Styron, 2006).  Furthermore, existing research relies exclusively on the perspective of mental health professionals to access changes in the mental health system over time, even though consumers with serious mental illness have a unique perspective on mental heath system by virtue of their lived experience.  By examining the personal accounts of twelve adults with schizophrenia, this study aimed to close gaps in our understanding of the evolution of the metal health system.

In the current study, adults with serious mental illness were viewed as historians who have a valuable perspective to share on the mental health system.  Using a qualitative research approach, 12 adults diagnosed with schizophrenia who have long-term involvement in the mental health system shared their mental health experiences and their perceptions of changes in perceptions of the mental health system over time.  Specifically, personal accounts described consumers' perceptions of their mental illness, psychiatric symptoms, inpatient and outpatient services, and community-based support systems.  Participants also had the opportunity to reflect on the role of the mental health system in their lives.  The grounded theory method of qualitative analysis will be used to explore themes from consumers' accounts and assess for characteristics of mental health reform movements, including the Consumer Support Program, Consumer/Survivor, and Recovery movements.