Companion Animals As Evokers of Connection and Responsibility Among Individuals With Serious Mental Illness: A Systematic Review of Qualitative Findings
Evidence is mounting in support of animal-assisted therapies (AAT) and activities (AAA) as adjunct interventions for serious mental illness (SMI), however, there is minimal empirical consideration of whether or how living with a companion animal may impact SMI and mental health recovery. Given there are many more people living with SMI who simply live with one or more companion animals (a.k.a., “pets”) - as opposed to individuals with SMI involved in AAA or AAT - the purpose of this paper was to systematically review and summarize existing research relating to how living with a companion animal(s) may impact SMI. Because the majority of such research is qualitative, a qualitative systematic review method was applied using recommendations from the Cochrane Qualitative Methods Group (Noyes, J., Popay, J., Pearson, A., Hannes, K., and Booth, A., 2011).
Inclusion criteria included qualitative studies reporting findings relating to having a SMI and living with a companion animal(s). An exhaustive bibliographic search was conducted using a broad range of terms: ("mental health consumer" or "psychiatric survivor" or "severe mental illness" or "schizophren*" or "schizoaffective" or bipolar or "serious mental illness" or "psychiatric disability" or “psychiatric rehabilitation” or “mental health recovery”) AND ("emotional support pet" or "pet guardian*" or "pet owner*" or "companion animal"). The following databases were searched: Academic Search Complete; CINAHL Plus with Full Text; Education Research Complete; Health Source - Consumer Edition; Health Source: Nursing/Academic Edition; MEDLINE; Psychology and Behavioral Sciences Collection; PsycINFO; Social Work Abstracts; SocINDEX; Sociological Collection; Vocational and Career Collection; Women's Studies International; and AgeLine. The search yielded six hits: four peer-reviewed studies; one duplicate record; and one letter. Of the four studies, three utilized qualitative methods. Given the data transformation level (topical/thematic rather than interpretive) in these studies, a qualitative meta-summary approach (Saini, M. & Sclonsky, A., 2012; Sandelowski & Barroso, 2003) was used entailing a meta-content analysis of themes across studies.
All studies utilized thematic analysis of data obtained through semi-structured individual interviews. In the first study (n=44), three themes emerged: connectedness; emotional stability; and responsibility. In the second study (n=177), four themes emerged: connectedness; empathy/therapy; self-efficacy; and pets as family. In the third study (n=4), five themes emerged: belonging/connectedness; continuity, action/self-construction; participation; and acceptance. Connectedness emerged as the most frequent single theme across these studies. Responsibility, self-efficacy, and action/self-construction entailed similar content relating to caring for another being who was dependent; in combination, these themes were likewise represented across studies. Examples of quotes for both responsibility and self-efficacy included statements from individuals who reported wanting to commit suicide but refraining due to feeling responsible for their respective companion animals.
This review summarizes preliminary evidence of perceived benefits of living with companion animals among individuals with SMI. In particular, living with a companion animal reportedly evoked connection and responsibility. Substantiating content related to these themes suggests having a companion animal may be an overlooked protective factor in suicidality. Given individuals with SMI are at disproportionate risk of suicide, additional research is warranted to explore such.