Problem behavior in children of chronically ill parents: a meta-analysis

Exploring amyotrophic lateral sclerosis patients' experiences of psychological distress during the disease course in China: a qualitative study

OBJECTIVE

This study aims to explore the psychological distress course of Chinese amyotrophic lateral sclerosis (ALS) patients after the onset of the disease and to provide targeted nursing guidance.

DESIGN

The interview content was analysed qualitatively. We used seven steps of Colaizzi's method to analyse the participants' data.

SETTING

Wuhan, China, Traditional Chinese Medicine Hospital.

PARTICIPANTS

A semistructured face-to-face interview were performed among 22 people with ALS from the motor neuron disease rehabilitation centre of a tertiary Chinese medicine hospital in China.

RESULT

This study included a total of 22 participants, from whom three main themes regarding the psychological distress trajectory of ALS patients were extracted from the interview data: 'Time begins to run out' include tormented and restless waiting and shock and doubt in ALS disease confirmation, 'Family out of control' include the burden of stigma and function loss, the burden of missing family roles, the burden of marriage's emotional needs and the burden of offspring health, 'Way forward' include struggle between live and death and struggle between quality of life and the value of life.

CONCLUSION

This study outlines the psychologically distressing journey of ALS patients. Studies have pointed out the need for targeted care to address patients' various sources of psychological distress to improve their quality of life and coping ability, increase their psychological resilience and reconstruct their life beliefs.

Children as next of kin's experiences, practices, and voice in everyday life: a systematic review of studies with Norwegian data (2010-2022)

Aims: This systematic review aims to identify and describe how children of parents with mental illness, substance dependence, or severe physical illness/injury, experience and practise their everyday life. Methods: The review followed the four stepwise recommendations of Harden and colleagues when including quantitative and qualitative studies on peoples' experiences and views. In all, 23 studies with data from Norway (2010-2022) have been included. Brown and Clark's thematic analysis was applied. Results: Three themes were constructed from the reviewed articles: (a) Children practice their relational agency by actively doing practical tasks, occasionally jobs to maintain family economy, and organising fun activities with the ill parent. (b) Emotional ambivalence when their own needs were set aside in favour of the parents. They loved their parents but also felt guilt, anger, disappointment, shame, fear of inheriting the illness and longed for a 'normal' everyday life. (c) Supportive contextual factors were, for example, at least one significant adult recognising them, participating in leisure activities, socialising with friends, and talking with other peers who shared similar experiences as next of kin. Obstructive factors were lack of information and recognition as well as silence and lack of dialogue within the family and/or health professional. Conclusions: There is a strong need for more knowledge and competence on the situation and needs of these children when it comes to professionals, parents and the public. Public health initiatives are needed to honour their agency and recognise their contributions in present time to prevent psychosocial problems later in life.

Roles of physical functioning and comorbid mental illness of chronically ill parents and their spouses' health status in adolescent functioning

INTRODUCTION

Emerging research suggests that physically ill parents' psychological adjustment to illness and emotional well-being may affect adolescents' psychosocial functioning. As people with chronic medical conditions often develop mental disorders, it is important to examine the influence of comorbidity of parental physical and mental health conditions on adolescents' functioning. In addition, the physical and mental health status of the spouses/partners of chronically ill parents needs to be explored to further understand the potential impact of parental chronic illness on adolescents' psychological distress and academic performance.

METHODS

Cross-sectional data from 164 parent-adolescent pairs were collected through online surveys in the United States between 2018 and 2019. Parent participants (Mage  = 42.69, SD = 5.96) included parents who had been diagnosed with a chronic physical illness (e.g., multiple sclerosis, diabetes, chronic pain, cancer). Adolescent participants were middle- and high-school-aged children who lived with their physically ill parents (Mage  = 14.34, SD = 2.07).

RESULTS

Hierarchical regression analyses indicated that comorbid mental illness of parental chronic illness and spousal mental health status were associated with adolescents' distress. The level of physical functioning of chronically ill parents was related to adolescents' academic performance.

CONCLUSION

Parental chronic illness appears to affect adolescents' psychological and academic outcomes through distinct pathways. It is important to examine the comorbid mental health status of chronically ill parents and their spouses'/partners' mental health conditions to better understand the impact of parental chronic illness on adolescents' psychological adjustment.

The experiences and impact of the COVID-19 pandemic on young carers: practice implications and planning for future health emergencies

BACKGROUND

Young carers are children or young people aged up to 25 years old who undertake unpaid caring responsibilities for a friend or family member. Young carers faced significant challenges brought on by the COVID-19 pandemic. We explored the impact of the pandemic and associated restrictions on mental health, wellbeing and access to support in young carers in the United Kingdom (UK) to understand how to improve services, as well as support this population in future health emergencies.

METHOD

We conducted 22 qualitative semi-structured interviews from May to November 2021 with 14 young carers and eight staff working in organisations that supported them. Interviews took place remotely over video or telephone call and explored participant experiences of the pandemic and its impact on their health, wellbeing and caring responsibilities. We used reflexive thematic analysis to analyse interview transcripts.

RESULTS

We identified four overarching themes pertaining to the impact of the pandemic and associated restrictions on mental health, wellbeing and access to support in young carers in the UK: (1) challenges in protecting loved ones from the virus, (2) changes to and loss of routine, (3) reduced access to pre-pandemic informal and formal support structures and (4) better understanding of inner resilience and goals. Many participants struggled with their mental health and wellbeing as a result of pandemic related restrictions which impacted on support structures for themselves and the individual they cared for. However, positive impacts pertained to additional support provided by local authority and third sector organisations.

CONCLUSIONS

Our findings highlight some of the changes that affected young carers during the COVID-19 pandemic. The impact of changes to routine and a reduction in pre-pandemic support were the greatest concerns reported by participants in this study. The additional support provided by local authority and third sector organisations during social restrictions suggests such organisations could play a greater role in supporting this population going forward and that schools and Governments may wish to put in additional strategies and provisions to protect young carers in the future.

Norwegian health personnel's contacts and referrals for children of ill parents: an exploratory cross-sectional multi-centre study

BACKGROUND

In 2010, changes were made to the Norwegian Health Personnel Act. This led to all health personnel being obliged to support the patients' children and families. The aims of this study were to investigate whether health personnel contacted or referred the patients' children to family/friends or public services. We also investigated if there were factors in the family or the services that increased or decreased the degree of contacts and referrals. In addition the patients were asked whether the law had been a help or even a burden. This study was part of a larger multi-site study of children of ill parents conducted in five health trusts in Norway.

METHOD

We used cross-sectional data from 518 patients and 278 health personnel. The informants completed a questionnaire addressing the law. Data were analyzed by factor analysis and logistic regression.

RESULTS

The health personnel contacted/referred children to different services, but not to the degree desired by their parents. Only a few contacted family/friends, or the school and/or the public health nurse, those representing the helpers who live closest to the child, and thus well situated to participate in help and preventive efforts. The service most often referred to was the child welfare service.

CONCLUSION

The results indicate a change in contacts/referrals for children from their parents' health personnel but also reveal remaining needs for support/help for these children. Health personnel should strive to write more referrals and take more contacts than the current study suggests, to secure adequate support for children of ill parents in Norway, as intended in The Health Personnel Act.

The Psychosocial Impact of Parental Multiple Sclerosis on Children and Adolescents: A Systematic Review

BACKGROUND

Multiple sclerosis (MS) is a common debilitating neurologic disease that affects mostly young women. This review provides an overview of research on the psychosocial impact of parental MS on children to inform clinicians and support people with MS considering parenthood.

METHODS

A systematic review of the literature was performed by searching the MEDLINE, PsycINFO, and PSYNDEX databases. We included quantitative and mixed-method studies assessing psychosocial outcomes of children with a parent with MS. Studies were screened for eligibility and evaluated for risk of bias.

RESULTS

We screened 608 references, assessed 72 studies in full-text, and included 28 studies in this review. Most of the studies reported on psychosocial adjustment processes, with most results suggesting negative consequences, including difficulties with mood, behavior, or social interaction. Several studies also described associations between children with a parent with MS and increased incidences of psychiatric disorders. Nevertheless, some studies claimed that children with a parent with MS were not more likely to have psychosocial problems compared with children without a parent with MS. A few studies indicated probable positive effects of parental MS, eg potentially increased social competence. Other investigated outcomes were children's coping skills, early childhood development, body image, and effects on education, and these were unaffected or only slightly affected by having a parent with MS.

CONCLUSIONS

Having a parent with MS has a relevant effect on children. However, the heterogeneous nature and varying quality of the included studies limit the interpretability of these findings. Further research is needed to provide robust evidence.

The Influence of Parent's Cardiovascular Morbidity on Child Mental Health: Results from the National Health Interview Survey

BACKGROUND

This study assessed the association between cardiovascular disease (CVD), the leading cause of death in the United States, among parents and child mental health.

METHODS

Our sample included 9076 children aged 6 to 17 years. Data were pooled from the 2016-2018 waves of the National Health Interview Survey. We fitted a logistic regression to obtain the odds ratios in favor of child mental health problems for parental CVD. We also fitted a multinomial logistic regression to obtain the odds in favor of the severity of mental health problems (i.e., minor, definite, and severe).

RESULTS

The adjusted odds of facing difficulties for a child of a parent with CVD were 1.64 (95% CI: 1.28-2.11) times that of their peers whose parents did not have CVD. The adjusted relative risk of facing minor and definite difficulties for a child of a parent with CVD were 1.48 (95% CI: 1.13-1.94) and 2.25 (95% CI: 1.47-3.46) times that of their peers of parents without CVD.

CONCLUSIONS

The results suggest a strong association between child mental health and parental cardiovascular morbidity, demonstrating the need for the development or adaptation of existing public health interventions to facilitate mental health support for children of parents with CVD.

Living an ordinary life – yet not: the everyday life of children and adolescents living with a parent with deafblindness

Introduction

The family life of people living with one family member with deafblindness has been sparsely described.

Purpose

The aim of the study was to explore how children experience their everyday family life when having a parent with deafblindness.

Methods

An explorative study in which data have been collected by qualitative interviews of children. Qualitative content analysis has been used for analysing the data.

Results

Overall theme; Living an ordinary life—yet not, is based on four categories with subcategories. A family like any other describes: Having the same family life as their friends, Acting like other children and It is what it is. Different everyday life describes: Acknowledging differences, Adjusting to the parent’s needs and Financial strain. Being there for the parent describes: Helping the parent and Protecting the parent from harm. Being emotionally affected describes: Feelings of frustration, Feelings of compassion and Need for support.

Conclusion

Children as relatives of parents with deafblindness have been given a voice. The children live an ordinary life, but at the same time a different ordinary life. Professionals need to take the child and their needs into account when support is given.

Caregiving Responsibilities and Mental Health Outcomes in Young Adult Carers during the COVID-19 Pandemic: A Longitudinal Study

This study investigated caregiving responsibilities and associated mental health outcomes in young adult carers during the COVID-19 pandemic and had three aims: (1) to investigate differences in caregiving responsibilities across two groups of young adult carers (parental illness context vs. ill non-parent family member context) relative to non-carers, (2) to identify COVID-19/lockdown correlates of caregiving responsibilities, and (3) to examine the longitudinal associations between caregiving responsibilities and mental health outcomes. Of the 1048 Italians aged 18-29 (Mage = 24.48, SDage = 2.80; 74.33% female) who consented to complete online surveys at Time 1, 813 reported no ill family member (non-carers). Young adult carers included 162 with an ill parent and 73 with an ill non-parent family member. The study included 3 time points: 740 participants completed Time 2 assessment (Mage = 24.35, SDage = 2.81; 76.76% female), while 279 completed Time 3 assessment (Mage = 24.78, SDage = 2.72; 79.93% female). Key variables measured were 13 COVID-19/lockdown factors at Times 1 and 2, caregiving responsibilities at Time 2, and mental health outcomes at Time 3 (fear of COVID-19, anxiety, depression, wellbeing). Two COVID-19/lockdown factors were significantly correlated with higher caregiving responsibilities: insufficient home space, and greater time spent working and learning from home. As predicted, young adult carers reported higher caregiving responsibilities than non-carers, and this effect was greater in young adults caring for an ill parent compared to young adults caring for an ill non-parent family member. As expected, irrespective of family health status, caregiving responsibilities were longitudinally related to poorer mental health outcomes, operationalised as higher fear of COVID-19, anxiety, and depression, and lower wellbeing. Elevated young adult caregiving is an emerging significant public health issue that should be addressed through a multipronged approach that includes education about young adult carer needs for personnel across all relevant sectors and flexible care plans for ill family members that include a 'whole family' biopsychosocial approach.

Maternal Multiple Sclerosis and Offspring's Cognitive and Behavioral Development: What Do We Know until Now?

Multiple Sclerosis (MS) is a chronic pathological condition representing one of the main causes of neurological disability in the female young population. MS, as an immune disorder, could impact fetus development, and, considering the need for and the possibility of pharmacological treatment during pregnancy, the possible influence of medication on developmental trajectories represents a topic of great interest. We provide an overview of the available literature on the influence of maternal Multiple Sclerosis on offspring cognitive and behavioral development. A study was conducted on Pubmed, Medline and Google Scholar, considering empirical studies and reviews exclusively in the English language. Maternal MS appears not to be associated with emotional and behavioral problems, as evaluated through retrospective studies. However, a specific cognitive and behavioral phenotype, through the administration of standardized instruments, has not been delineated yet. Available studies on the topic are characterized by poor methodology and do not lead to conclusions. This overview highlights implications for further longitudinal studies which should delineate offspring developmental trajectories, taking into consideration maternal confounding factors and the exposure to pharmacological treatment in pregnancy.

The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses

Adverse childhood experiences (ACEs) are related to increased risk of common mental disorders. This umbrella review of systematic reviews and meta-analyses aimed to identify the key ACEs that are consistently associated with increased risk of mental disorders and suicidality. We searched PsycINFO, PubMed, and Google Scholar for systematic reviews and meta-analyses on the association between ACEs and common mental disorders or suicidality published from January 1, 2009 until July 11, 2019. The methodological quality of included reviews was evaluated using the AMSTAR2 checklist. The effect sizes reported in each meta-analysis were combined using a random-effects model. Meta-regressions were conducted to investigate whether associations vary by gender or age of exposure to ACEs. This review is registered with PROSPERO (CRD42019146431). We included 68 reviews with moderate (55%), low (28%) or critically low (17%) methodological quality. The median number of included studies in these reviews was 14 (2-277). Across identified reviews, 24 ACEs were associated with increased risk of common mental disorders or suicidality. ACEs were associated with a two-fold higher odds of anxiety disorders (pooled odds ratios (ORs): 1.94; 95% CI 1.82, 2.22), internalizing disorders (OR 1.76; 1.59, 1.87), depression (OR 2.01; 1.86, 2.32) and suicidality (OR 2.33; 2.11, 2.56). These associations did not significantly (P > 0.05) vary by gender or the age of exposure. ACEs are consistently associated with increased risk of common mental disorders and suicidality. Well-designed cohort studies to track the impact of ACEs, and trials of interventions to prevent them or reduce their impact should be global research priorities.

Norwegian health personnel's compliance with new legislation on children of ill parents: an exploratory cross-sectional multicentre study

Background

In 2010 the Norwegian Parliament introduced amendments to the Health Personnel Act requiring all health personnel to inform and offer help to their patients’ children and families. We evaluated whether health personnel adhered to their obligations outlined in the Act and investigated whether family and health services characteristics were associated with the degree of compliance with the legislation. Our study was part of a larger Norwegian multi-site study conducted in five health trusts across Norway, assessing the situation for families living with parental illness.

Method

A cross-sectional study using quantitative data obtained from 518 patients 246 children and 278 health personnel was performed. All informants completed a questionnaire, including an instrument corresponding to the obligations in the legislation. Descriptive analyses, factor analysis and logistic regression analysis were used.

Results

The legislation was only partially implemented in the clinics of the health trusts. Compared to estimates prior to the introduction of the new legislation, the situation had improved somewhat, but much work remains to be done to fulfil the obligations decreed by law. The more time-consuming the obligations were, the less often they were met. The substance abuse and mental health services followed up on their obligations to a greater extent than did the physical health services. Conversely, children of physically ill parents were better informed by their families than were children of parents with mental health and substance abuse disorders. When asked the same questions, reports from health personnel were more positive compared to those of children and patients regarding the legislation’s fulfillment.

Conclusion

Data suggest that there has been a change in the support offered to children of ill parents. Additional work is required, however, for the Health Personnel Act to function as fully intended.

Quality of Life of Adolescents Facing a Parental Illness: A Person-Oriented Approach

Studies that have investigated the health-related quality of life (HRQoL) of adolescents facing a parental illness showed inconsistent results, and none used a person-oriented approach allowing for a deeper understanding of their experience. The aim of this study was to compare the HRQoL of adolescents facing a parental illness to that of their peers, and to explore their HRQoL through a person-oriented approach. The sample consisted of 1324 adolescents recruited in secondary schools (11–15 years old). Adolescents completed questionnaires assessing sociodemographic characteristics, parental illness, HRQoL (KIDSCREEN-52), and academic performance and caring activities (MACA-YC18). Adolescents facing a parental illness showed significantly lower HRQoL than their peers on all dimensions. The cluster analysis yielded five patterns of HRQoL among adolescents facing a parental illness: Low HRQoL; High HRQoL; Moderate HRQoL with High Social Acceptance; High Well-Being, High Moods and Emotions, and High Social Support and Peers. These clusters differed according to demographics, the type of parental illness, illness perception, academic performance, and level of caring activities. The Low HRQoL cluster showed especially low academic performance and high level of caring activities. This multidimensional HRQoL evaluation thus helps to foreground the diversity of these adolescents’ experiences in order to better address their needs.

Quality of Life of Schoolchildren Living with a Long-Term Sick Parent: The Role of Tasks at Home, Life Circumstances and Social Support

This study investigates whether there are differences in quality of life-i.e., psychosomatic complaints and life satisfaction-between schoolchildren with and without a chronically ill or disabled parent at home. It also examines the role played by the intensity of tasks, life circumstances, and social support at home and school. In 2017, a Dutch representative sample of adolescents aged between 12 and 16 (from the Health Behaviour in School-aged Children study) completed a questionnaire about illness of family members, tasks at home, life circumstances and characteristics, social support, psychosomatic complaints and life satisfaction. In total, 5470 schoolchildren who did not have a parent with a chronic illness and 652 who did have a parent with a chronic illness were selected (average age 13.9). Stepwise multilevel logistic regression analyses in STATA were used. Schoolchildren with an ill parent had more psychosomatic complaints and lower life satisfaction than their counterparts without an ill parent, even when controlling for extra task hours, specific life circumstances and characteristics (e.g., more likely to be growing up in a single-parent family or stepfamily and more likely to be female), and lower perceived support. These aspects are also predictors of a lower quality of life. Professionals should address these aspects of the life of schoolchildren with a sick parent in such a way that they are facilitated to make a successful transition to adulthood.

Familias Divididas [divided families]: Transnational family separation and undocumented Latinx immigrant health

Undocumented Latinx immigrants (ULIs) comprise a large segment of the U.S. population, yet they remain at high risk for diminished health outcomes due to increased exposure to adverse experiences and context. Transnational family separation and the distress that accompanies it is an example of a common adverse experience that is chronic and that impacts the lives of many ULIs. However, despite how chronic and central transnationalism is to the lives of ULIs, little is known about its relation to the health outcomes of ULIs. To that end, this study examined the relation between distress due to transnational family separation and the physical and mental health of ULIs. To do so, the study utilized respondent-driven sampling and path analysis methodologies to cross-sectionally examine how distress from transnational separation was related to the physical and mental health of ULIs (n = 229). Results revealed that as distress from transnational family separation increased so too did participant's depressive (β = .25, p < .001), anxiety (β = .18, p = .006), and physical symptoms (β = .24, p < .0001). Distress from transnational family separation was also more strongly related to physical and depressive symptoms than to anxiety symptoms. Considering these results, important systemic changes to our approach to healthcare delivery and access among ULIs communities are needed to promote the well-being of this at-risk population. Recommendations for doing so are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Young Adult Carers during the Pandemic: The Effects of Parental Illness and Other Ill Family Members on COVID-19-Related and General Mental Health Outcomes

The mental health impacts of the COVID-19 pandemic on young adult carers have been neglected. This study aimed to identify COVID-19 related risk factors for young adult carers and to investigate their mental health relative to non-carer peers. Of the 1823 Italians aged 18–29 who completed an online survey, 1458 reported no ill family member (non-carers). Young adult carers included 268 with an ill parent, and 97 with an ill non-parent family member. Two mental health outcome categories were measured: COVID-19-related (risky health behaviors, loneliness, home violence, fear of COVID-19) and general (anxiety, depression, wellbeing). Six COVID-19 related risk factors were significantly correlated with poorer mental health in young adult carers. These factors constituted a COVID-19 Context Index. Compared to non-carers, young adult carers reported poorer mental health across all outcomes, as expected. The prediction that young adult carers caring for an ill parent would report poorer mental health than those caring for ill non-parent family members was evident only for the COVID-19-related mental health outcomes. The elevated rates of clinically significant distress and pandemic-related mental health problems among young adult carers highlight this group as a priority for mental health promotion interventions and whole-of-family support across multiple sectors.

Parental Illness and Life Satisfaction among Young People: A Cross-Sectional Study of the Importance of School Factors

Background: The aim of this study was to examine the relationship between parental illness and life satisfaction among Danish adolescents and the potential modifying effect of positive school experiences. Moreover, we describe the use of student counsellor services among adolescents with and without ill parents. Methods: Data included 9565 adolescents primarily aged 13–19 years, who participated in the cross-sectional Well-being Despite Study. Multilevel logistic regression models including joint effect analyses were performed. Results: Parental illness was strongly associated with life satisfaction. Negative school experiences were more frequent among adolescents with ill parents and strongly associated with low life satisfaction for all students. However, joint effect analyses did not show effect modification by school-related variables. The odds ratio of having talked to a student counsellor was highest for adolescents with multiple ill parents, compared to no ill parents. Conclusions: Parental illness is a strong predictor of low life satisfaction among adolescents; the impact depends on number of ill parents, whether parental illness is physical or mental, and their level of impairment. Positive school experiences were less frequent in adolescents of ill parents and did not counteract the effect of parental illness on life satisfaction.

Family correlates of emotional and behavioral problems in Nepali school children

Background

There is a substantial gap in our knowledge about family correlates of child emotional and behavioral problems in low- and middle-income countries (LMIC). The present study contributes to filling this gap by examining such correlates in a larger population study in Nepal.

Methods

Our study is a cross-sectional, observational study among 3840 Nepali children aged 6–18 years from 64 schools and 16 districts in the three main geographical regions in the country. We used the Nepali version of the Child Behavior Checklist (CBCL)/6-18 to assess children’s internalizing and externalizing problems and an additional background information questionnaire to assess possible family correlates which included parental education, family structure, migrant worker parents, parental mental and physical illness, family conflicts, and child-rearing. The associations between family variables and child internalizing and externalizing problems were analyzed using bivariate correlations and multiple regression.

Results

Using bivariate analysis, we found that mental and physical illness in parents, conflict in the family, parental disagreement in child-rearing, and physical punishment of child correlated positively with both Internalizing Problems and Externalizing Problems. The same associations were found by using multiple regression analysis. In addition, parental education, family structure, and migrant worker mothers were associated with Externalizing Problems. However, the effect sizes were small.

Conclusion

The results suggest that in Nepal, child mental problems were associated with several family risk factors. Further, the study points to the need of strengthening prevention- and intervention measures to minimize family risk factors of child mental health disorders.

Growing up with a Chronically Ill Family Member-The Impact on and Support Needs of Young Adult Carers: A Scoping Review

This scoping review provides an overview of the impact of growing up with a chronically ill family member on young adults (18-25 years old), and their specific needs. Young adults represent an important life stage involving a transition to adulthood, during which individuals' family situations can affect their future. We searched relevant studies following the guideline of Arskey and O'Mailley's methodological framework and the PRISMA statement guidelines for scoping reviews in PubMed, PsychInfo and reference lists to identify articles for inclusion. Studies from 2005 to 2020 were included in this review. Of the 12 studies, six qualitative studies, five quantitative studies and one mixed method study were included. Eight studies discussed the impact, including consequences at a physical and mental level, at their personal development and future perspectives, but also positive effects, such as being capable of organizing their lives. Four studies discussed the needs of young adult carers, including emotional needs, support needs with regard to stimulating autonomy (arising from internal conflicts) and developing their own identity, and the concerned attitude of involved professionals. An unambiguous definition of the target group and further well-designed research are needed to improve clarity about the role of support, so that future professionals can adequately address the needs and wishes of young adults who grow up with an ill family member.

Psychosocial functioning in adolescents growing up with chronic disease: The Dutch HBSC study

Many adolescents worldwide (indirectly) grow up with a chronic disease, which may impact their functioning and wellbeing. The objective of this study is to assess whether adolescents with a (family member with a) chronic disease differ from their healthy counterparts in terms of psychosocial functioning. Data from the Dutch 2013 HBSC-survey were used, including 7168 adolescents (Mean_age = 13.7, SD = 1.57, 50.5% female). Participants indicated whether they or one of their family members had a long-term (> 3 months) disease or disability (mental/physical) and were categorized into four groups based on disease presence (none, other, self, both). Psychosocial functioning was assessed in terms of life satisfaction, self-rated health, psychosomatic health, mental health problems, support, substance use, physical exercise, screen time, and school liking. Chronically diseased adolescents (n = 162) reported lower life satisfaction, self-rated and psychosomatic health, more mental health problems, lower peer support, more substance use, and less physical exercise compared to healthy peers. Chronically diseased adolescents who also had a family member with a chronic disease (n = 74) showed comparable outcomes on these life domains, although they did not differ from their healthy peers regarding peer support, substance use, and physical activity. Healthy adolescents with a chronically diseased family member (n = 737) reported significantly lower life satisfaction, self-rated and psychosomatic health, more mental health problems, and less family support compared to healthy peers who grew up in healthy families; however, they reported more positive outcomes than adolescents who had a chronic disease themselves.Conclusion: Having a (family member with a) chronic disease is associated with impaired psychosocial functioning on various life domains. Our findings aid in understanding the psychosocial associates of chronic disease and imply that caregivers should be observant of psychosocial problems among vulnerable adolescents to provide appropriate guidance. What is Known: • Adolescents who grow up with a (family member with a) chronic disease encounter numerous challenges that may be related to poorer developmental outcomes on the long term. What is New: • This study adds a comprehensive overview of the psychosocial functioning of adolescents with a (family member with a) chronic disease, as compared to healthy counterparts that grow up in a healthy family.

Risk and resource factors of antisocial behaviour in children and adolescents: results of the longitudinal BELLA study

BACKGROUND

Antisocial behaviour is a common phenomenon in childhood and adolescence. Information on psychosocial risk and resource factors for antisocial behaviour are important for planning targeted prevention and early intervention programs. The current study explores risk and resource factors of antisocial behaviour in children and adolescents based on population-based longitudinal data.

METHODS

We analysed longitudinal data from the German BELLA study (n = 1145; 11 to 17 year-olds) measured at three measurement points covering two years. Latent growth analysis, linear regression models and structural equation modelling were used to explore cross-sectional and longitudinal data.

RESULTS

Based on baseline data, we found that stronger self-efficacy and worse family climate were each related to stronger antisocial behaviour. Longitudinal data revealed that more severe parental mental health problems, worse family climate at baseline, deteriorating family climate over time, and more social support were each associated with increasing antisocial behaviour over time. We further found a moderating effect for family climate.

CONCLUSIONS

Our study provides important exploratory results on psychosocial risk, resource and protective factors in the context of antisocial behaviour in children and adolescents, which need confirmation by future research. Our exploratory results point in the direction that family-based interventions for antisocial behavior in children and adolescents may benefit from considering the family climate.

A dialogue system for identifying need deficiencies in moral education

Moral education refers to the cultivation of ideals, moral quality, culture, and discipline. One of its main tasks is to analyze students’ problem behaviors and identify their underlying need deficiencies. Previous psychological research has focused on studying how distinct factors affect psychological needs and problem behaviors. However, these findings have provided only scattered guidelines for identifying students’ need deficiencies, which are difficult for inexperienced teachers and parents to apply systematically. To address these issues, we attempt to answer two key research questions in this work. First, how do we define a theoretical framework so that the psychological research findings can be systematically applied to identify students’ need deficiencies? Second, can the latest AI technologies be employed to identify such need deficiencies automatically? To answer these research questions, we first build a theoretical framework to summarize all the factors relevant to the students’ problem behaviors and need deficiencies. After that, we propose and develop a task-oriented dialogue system that can properly inquire about different aspects of students’ information and automatically infer their need deficiencies. We conduct comprehensive experiments to evaluate the system’s performance with real-life cases. The results show that the built dialogue system could effectively serve as a diagnostic tool to identify the students’ need deficiencies.

Factors associated with quality of life for children affected by parental illness or substance abuse

BACKGROUND

There have been inconsistent findings from studies examining factors associated with quality of life (QoL) for children affected by parental illness.

AIM

The aim of this study was to explore factors associated with self-reported QoL in children affected by parental illness or parental substance abuse.

DESIGN

A cross-sectional multicentre study.

METHODS

The sample included 246 families with children 8-18 years recruited via ill parents who received treatment for severe physical illness, mental illness or substance abuse in specialised health services. We performed multiple linear regression analyses to examine factors associated with the children's self-reported QoL.

MAIN OUTCOME MEASURE

KIDSCREEN-27.

RESULTS

The children's self-reported QoL was positively associated with the ill parent's self-reported physical health, the children's self-reported social skills, the degree to which other adults took over the ill parent's responsibilities, provision of sibling care, provision of health care for the ill parent and positive outcome of caregiving. The children's QoL was negatively associated with the children's self-reported responsibilities due to parental illness, provision of emotional care for the ill parent, negative outcomes of caregiving and external locus of control. The model explained 63% of the variance (adjusted R2 ) in children's total QoL.

STUDY LIMITATIONS

Sampling bias may have occurred during recruitment.

CONCLUSIONS

The findings suggest factors of importance for the children's QoL. Clinicians should assess whether an ill parent's physical health may influence negatively on their ability to perform daily responsibilities at home and care for their children, and clinicians can use children's self-reported QoL to identify children who are most negatively affected.

A Model of the Effects of Parental Illness on Youth Adjustment and Family Functioning: The Moderating Effects of Psychological Flexibility on Youth Caregiving and Stress

Parental chronic illness may adversely impact youth and family functioning. This study examined a moderated mediation model of the effects of parental illness on youth and family functioning derived from the Family Ecology Framework. Consistent with this model, we predicted that youth caregiving and stress would serially mediate the adverse impacts of parental illness on youth adjustment and family functioning and that psychological flexibility would moderate these mediational mechanisms. A total of 387 youth, with parents affected by chronic illness, completed a questionnaire assessing parental illness severity, youth caregiving and stress, psychological flexibility, youth adjustment (i.e., internalizing and externalizing problems and psychological wellbeing), and family functioning. Path analyses indicated that the adverse effects of parental illness on youth adjustment and family functioning were serially mediated by youth caregiving and stress. Psychological flexibility buffered the adverse effects of these serial mediators on youth internalizing problems and psychological wellbeing. These findings identified three potential intervention targets: youth caregiving, related stress appraisals, and psychological flexibility. Given the large body of evidence showing that acceptance and commitment therapy fosters psychological flexibility, this intervention approach has the potential to address the psychosocial and mental health vulnerabilities of youth in the context of parental illness, which constitutes a serious public health issue.

The Impact of Parental Injury on Children's Mental Health Diagnoses and Classes of Psychotropic Medication by Child Age

BACKGROUND

Civilian and military research has linked parental illness and injury with increased overall mental health care and psychiatric medication use in children. Care for specific mental health conditions and medications by child age have not been reported.

OBJECTIVE

We sought to quantify the effect of parental illness and injury on child mental health care and psychiatric medication use in children overall and stratified by age.

METHODS

A self-controlled case series analyzed the impact of parental illness/injury on mental health and psychiatric medication use of military dependent children. Children were aged 2-16 years (51% male) when their parents were injured and received care in the Military Health System for 2 years before and 2 years after their parent's illness/injury. We used International Classification of Diseases 9th edition codes to identify outpatient mental healthcare visits. Outpatient care for 14 specific mental health diagnoses was classified using the Agency for Healthcare Research and Quality clinical classification system. Outpatient pharmacy records identified psychiatric medication prescriptions by therapeutic class. Parental illness/injury was identified by inclusion in the Military Health System Ill, Injured, and Wounded Warrior database. Adjusted negative binomial regression analysis compared rates of outpatient visits and medication days in the 2 years following parental illness/injury to the 2 years before the parent's illness/injury overall. Secondary analyses were stratified by age groups of 2-5 years (n = 158,620), 6-12 years (n = 239,614), and 13-16 years n = 86,768) and adjusted for parental pre-injury/illness deployment and child sex. Additional secondary analysis compared post-parental injury/illness care of children whose parents had post-traumatic stress disorder or traumatic brain injury to children of parents with physical/mental health injury/illness.

RESULTS

There were 485,002 children of 272,211 parents injured during the study period. After adjustment for child sex, years of pre-injury/illness parental deployment, and child age, parental illness/injury was associated with increased mental visits across all categories of care except developmental diagnoses. Post-parental injury visits for suicidal ideation, alcohol abuse, mood, and anxiety disorders were all doubled. For children aged 2-5 years at parental illness/injury, the largest increases in care were in psychotic, anxiety, attention deficit, and mood disorders. In children aged 6-12 years, the largest increases were in psychotic conditions, suicidal ideation, and personality disorders. In adolescents aged 13-16 years, the largest increases were for alcohol and substance abuse disorders, with visits increasing by 4-5 times. For children of all ages, parental injury was associated with increased use of all therapeutic classes of psychiatric medications; use of stimulant medications was increased in younger children and decreased in older children following parental injury (P < .001).

CONCLUSION

Parental illness/injury is associated with increased mental health care and days of psychiatric medication use in dependent children. Practitioners who care for families impacted by parental illness/injury should be cognizant of children's mental health risk. Early identification and treatment of child-related mental health issues can improve family functioning and increase military family readiness.

Identifying and Characterizing Children of Parents with a Serious Illness Using Survey and Register Data

Purpose

To estimate the prevalence and characterize children and adolescents aged 0–21 years with a physically or mentally ill parent based on registers. Further, to explore the use of register and survey data to identify parental serious illness.

Methods

The study is based on: 1) a 20% register sample of children and adolescents aged 0–21 in 2014; and 2) survey data from the Danish Youth Profile 2014 including 63,437 youth education students linked to registers. In registers, parental physical illness comprised hospital diagnoses included in the Charlson Comorbidity Index, and parental mental illness encompassed all mental diagnosis in the registers. Information about socioeconomic and demographic characteristics and use of health care services was retrieved from national registers. In the survey, students were asked if they had experienced serious illness of a parent.

Results

In the register sample of 0–21-year-olds, 25.3% had a parent with a physical or mental diagnosis, the prevalence increasing with age of the child. Compared to children without parental illness, children with an ill parent more frequently had unemployed parents, lower parental educational level, and a chronic medical condition. Analyses of the discrepancies between register and survey data revealed that 9% of the adolescents were identified as having an ill parent in both data sources and 64.1% had no identified ill parents. Moreover, a higher frequency of parental primary health care service use was seen for adolescents with an ill parent, across identification method, indicating that both methods identify adolescents with an ill parent.

Conclusion

The social inequality and elevated frequency of health problems among children and adolescents with an ill parent, underline the vulnerability of this population. Parental illness can be identified from both parental hospital diagnoses as well as self-reported by adolescents, however the two methods detect different populations. Both methods have several limitations and would benefit from further refinement and validation.

Examination of the tripartite model of youth caregiving in the context of parental illness

OBJECTIVE

This study refined the conceptualisation of youth caregiving by testing the tripartite model of youth caregiving proposed by Pakenham and Cox, comprising caregiving responsibilities, experiences, and tasks. We also investigated convergent validity of the model by examining the unique and joint contributions of the three youth caregiving components to youth adjustment outcomes.

DESIGN

A total of 681 Italian youth, 325 young carers and 356 non-carers, aged 11 to 24 years participated in a cross-sectional study.

MAIN OUTCOME MEASURES

Participants completed a questionnaire assessing demographics, youth caregiving, and psychosocial adjustment.

RESULTS

Confirmatory factor analyses revealed that compared to a one-factor model, the three-factor youth caregiving model provided a better fit to the data in the young carer and non-carer subgroups. The three youth caregiving components predicted variations in youth adjustment. Caregiving experiences were the strongest predictor of poorer youth adjustment while caregiving tasks predicted improvement in two youth adjustment outcomes in diverse youth caregiving contexts.

CONCLUSIONS

Findings support the validity of a three-factor model of youth caregiving, indicating that caregiving responsibilities, experiences, and tasks represent empirically distinct but related youth caregiving components. Interventions should mitigate the adverse and cultivate the positive effects of youth caregiving.

Parental Chronic Illness, Internalizing Problems in Young Adulthood and the Mediating Role of Adolescent Attachment to Parents: A Prospective Cohort Study

Background: Parental chronic illness is associated with an elevated risk for developing social-emotional and behavioral problems in children, in particular internalizing symptoms. This study aimed to investigate the associations between parental chronic illness when participants were adolescents and subsequent internalizing symptoms in young adulthood and whether adolescent attachment to parents or peers mediates these associations. Methods: The study used longitudinal survey data from the Youth and Mental Health Study, a cohort study including a representative sample of youth in central Norway assessed in the period from 1999 to 2000 (mean age 14.9 years) and in 2012 (mean age 27.2 years) (N = 1,266). The data consist of youth self-reports at both time points. Parental chronic illness was reported by the adolescents, quality of attachment was measured using the Inventory of Parent and Peer Attachment (IPPA), and internalizing problems were assessed in young adulthood by using the Adult Self-Report (ASR). Data were analyzed using parallel mediation analyses, controlling for adolescent sex, parental socioeconomic status, and divorce. In addition, separate analyses were conducted for adolescent girls and boys. Results: The total longitudinal effect was significant for both maternal and paternal chronic illness on internalizing problems in young adulthood. The direct effect on internalizing problems was only significant for maternal chronic illness. Attachment to fathers partially mediated the relationship between maternal chronic illness in adolescence and internalizing symptoms in young adulthood, whereas attachment to both mothers and fathers fully mediated the relationship between paternal chronic illness in adolescence and internalizing symptoms in young adulthood. A separate analysis for girls and boys indicated that the results were only significant for girls. Parental chronic illness did not play a significant indirect effect via attachment to peers on internalizing problems. Conclusions: Identifying protective factors in the pathways between parental chronic illness and mental distress in children could guide measures that promote the well-being of the child and family. The study demonstrates the importance of targeting the entire family in chronic illness care.

Psychosocial adjustment of young offspring in the context of parental type 1 and type 2 diabetes: a systematic review

AIMS

To identify all available research on psychosocial outcomes in young people who have a parent with type 1 or type 2 diabetes.

METHODS

Embase, PsychInfo, Scopus, Web of Science, PubMed and ProQuest Social Sciences databases were searched according to a registered study protocol (PROSPERO CRD42019125301). Quality assessment, data extraction and data synthesis were carried out.

RESULTS

The initial search yielded 11 599 articles, 10 of which met the criteria for this review: six for type 1 diabetes and four for type 2 diabetes. Through thematic analysis, five categories emerged related to offspring psychosocial adjustment: offspring mental health, offspring physical health, offspring personal resources, parental illness characteristics and offspring caregiving. Overall, there were few studies focusing solely on the effects of parental type 1 and type 2 diabetes on young people. From the limited available research, there is weak evidence suggesting both parental types of diabetes can adversely impact young offspring. Illness-related variables were only explored in parental type 1 diabetes studies, while offspring caregiving was only examined in parental type 2 diabetes studies.

CONCLUSIONS

Research on the effects of parental diabetes on young people is scarce; however, there was weak evidence to suggest some young people are at risk of adverse psychosocial impacts. Given the rise in the incidence of diabetes globally, there is a pressing public health need to conduct more rigorously designed studies to ascertain the extent to which young people are at risk of mental and physical health problems and to identify risk and protective factors associated with youth adjustment in the context of parental diabetes.

Validation of the Italian Young Carer of Parents Inventory-Revised (YCOPI-R)

Purpose: Parental illness or disability has wide ranging impacts on offspring. Due to the lack of an Italian contextually sensitive measure of youth caregiving, this study explored the factor structure, reliability, and validity of the Italian version of the Young Carer of Parents Inventory-Revised (YCOPI-R).Materials and methods: Seven hundred and seventy-four youth aged 11-24 (386 young carers and 388 young non-carers) completed a questionnaire regarding youth caregiving, parental illness, caregiving context variables, and youth adjustment.Results: The Italian YCOPI-R demonstrated good psychometric properties. Part A factor structure was replicated while two new factors emerged for Part B: Caregiving Stigma and Caregiving Resentment. Discriminant and convergent validity were evinced by differentiation between young carers and non-carers and associations between YCOPI-R factors and measures of caregiving activities and caregiving context. Predictive validity was supported as most Italian YCOPI-R factors were related to poorer youth adjustment, while Caregiving Confidence and Worry about Parents predicted higher levels of health-related quality of life.Conclusions: The Italian YCOPI-R is a psychometrically sound measure of caregiving experiences in Italian youth. Findings confirm the multidimensional nature of youth caregiving, the mix of costs and rewards associated with it, and the link between youth caregiving and diverse adjustment outcomes.Implications for rehabilitationGiven the global rise in the number of youth caring for an ill or disabled family member and the association between youth caregiving and greater risks for mental and physical health problems, elevated youth caregiving is a significant public health issue.The Italian version of the YCOPI-R is a valid and reliable measure of youth caregiving experiences in the Italian context.The Italian YCOPI-R offers a promising tool for better identifying young carers who are at risk for adverse psychosocial outcomes and in evaluating young carer support services and preventive interventions.

Expectations and Prospects of Young Adult Caregivers Regarding the Support of Professionals: A Qualitative Focus Group Study

There is a lack of service provision for young adult caregivers (18-25 years of age). This study aims to describe the expectations and prospects of young adult caregivers regarding support from health and education professionals. A qualitative focus group design was used. Twenty-five young Dutch adults (aged 18-25 years) who were growing up with a chronically ill family member participated in one of seven focus groups. Qualitative inductive analysis was used to identify codes and main themes. Two overarching themes with five sub-themes emerged from the focus group discussions. The overarching themes are: the 'process of approaching young adults' and the 'types of support these young adults require'. The process of approaching young adults contains the sub-themes: 'recognition, attention, and listening', 'open-minded attitude', 'reliability', and 'respecting autonomy'. The types of support this group requires contains the sub-themes: 'information and emotional support'. Health and education professionals should first and foremost be aware and listen to young adult caregivers, pay attention to them, have an open-minded attitude, respect their autonomy, and have the knowledge to provide them with information and emotional support. Further research could yield comprehensive insights into how professionals can meet these requirements and whether these results apply to male young adult caregivers and young adult caregivers not enrolled in a healthcare-related study program.

The emotional and mental health needs of young carers: what psychiatry can do

AIMS AND METHOD

To review the literature on the emotional and mental health needs of young carers of parents with mental illness and the extent to which such needs are recognised and supported by professionals. Three databases were systematically searched from 2008 to 2018, and five studies met the inclusion criteria.

RESULTS

The key findings were that young caregivers had a significantly higher dose-response mortality risk than their peers; were at increased risk of mental health difficulties, especially where the ill family member was a parent and had mental illness or misused substances; were overlooked by professionals owing to a lack of awareness; but could derive benefits from their caring role when appropriately supported.

CLINICAL IMPLICATIONS

Young carers are at increased risk regarding emotional and mental health needs; this risk could be mitigated by professionals recognising the young carer's role and including them in their parent's treatment plan.

How psychosocial interventions meet the needs of children of parents with cancer: A review and critical evaluation

INTRODUCTION

The aim of this study was to evaluate how psychosocial interventions for children aged 0-18 years of a parent with cancer meet their needs, using key needs as consumer-based "standards."

METHODS

A systematic literature review was conducted. Fifteen interventions met inclusion criteria and were assessed against six key needs identified by Ellis et al. (Eur. J. Cancer Care, 26, 2017, e12432): (1) provide children with age-appropriate information about their parent's cancer; (2) support family communication; (3) normalise and reduce feelings of isolation through peer support; (4) provide a space to share feelings; (5) individually tailor support; and (6), where appropriate, provide specialised bereavement support.

RESULTS

No intervention clearly met all six needs, but each partially addressed at least two needs, and three clearly met at least four needs. The most commonly addressed need was supporting family communication, and the least addressed need was bereavement support.

CONCLUSION

Interventions identified in this review addressed some needs of children impacted by a parent's cancer. This research provides a framework to inform the creation, modification and implementation of psychosocial support interventions that best meet the needs of these children, thereby mobilising consumer-focused service provision.

Poor academic performance in offspring of survivors with childhood or adolescent central nervous system tumor in Sweden

The number of children who were born after their parents were diagnosed with central nervous system (CNS) tumor is increasing, but it remains largely unknown regarding the academic performance of these children. We aimed to investigate whether children of survivors with childhood or adolescent CNS tumor were associated with poor academic performance. Children of survivors of CNS tumor were identified by combining the nationwide Swedish Cancer Register and the Multi-Generation Register, and those who have completed compulsory education in Sweden between 1989 and 2015 were included in our study. "Poor academic performance" was defined as a z-score of the academic performance below the 10th percentile. Conditional logistic regression and quantile regression were used to examine the association. A total of 655 children were born after their parental diagnosis of CNS tumor and they had 1.39 times higher risk of achieving poor academic performance as compared to the matched comparisons (95% CI = 1.10-1.76). The poor academic performance was even more pronounced in boys, among those with a paternal diagnosis of CNS tumor and those with a parental ependymoma. The observed association differed depending on preterm birth. In addition, the strength of the association declined with the increased quantiles of academic performance z-score. Our data suggest that parental CNS tumor affects the subsequent academic achievements among children born after the parental tumor.

Experiences of Dutch students growing up with a family member with a chronic illness: A qualitative study

Students growing up with a family member with a chronic illness often delay or drop out of school when the combination of family care and their educational programme is too demanding. This study aims to describe the themes experienced by students growing up in this situation. A qualitative focus group design was used. The recruitment for this study was done through an online survey where students could indicate whether they also wanted to participate in a focus group. Twenty-five Dutch students (age 18-25 years) who grew up with a family member with a chronic illness participated in one of the total of seven focus groups. A qualitative inductive analysis was used to identify codes and main themes. Students growing up with a family member with a chronic illness experience responsibility issues, loyalty conflicts, peer alienation, role reversal, negative influence on personal development, daily worries and confronting situations. They reported substantial impact in terms of their general well-being, their family relationships and in their choices for their future. Students articulated that growing up in this situation has a serious and substantial impact on their lives. Further research is required in order to gain comprehensive insights into the requests of these students regarding personal and family support.

Students growing up with a chronically ill family member; a survey on experienced consequences, background characteristics, and risk factors

BACKGROUND

Students living with a chronically ill family member may experience significant pressure, stress, and depression due to their caregiving situation. This may also lead to them delaying or dropping out of school when the combination of being a caregiver and their education program are too demanding. This survey study aims to explore the consequences for students of bachelor or vocational education programs when they are growing up with a chronically ill family member and the influence of various background characteristics and risk factors.

METHODS

A survey was sent to 5997 students (aged 16-25 years) enrolled in bachelor or vocational education programs in the north of the Netherlands. The content of the survey was based on a literature study and consultation with experts. Descriptive statistics, Chi-square tests, and logistic regression analyses were performed.

RESULTS

A total of 1237 students (21%) responded to the survey. A sub group of 237 (19%) students (mean age 21(2.2); 87% female) identified themselves as growing up with a chronically ill family member. More than half (54.9%) of these students indicated that they experienced negative consequences in daily life. A significant association (OR .42, p < .02) was found for these consequences and the level of education for which attending vocational education yields a higher risk. In addition, growing up with a mentally ill family member was associated with a 2.74 (p = .04) greater risk of experiencing negative consequences in daily life compared to students living with a family member with a physical disorder or multiple disorders.

CONCLUSION

Since a substantial number of students growing up with a chronically ill family member indicate serious physical, mental, and social consequences as a result of this care situation, awareness for this specific age-group is needed. Students with a mentally ill family member and students undertaking vocational education appear to be especially at risk. Further research is required in order to gain insight that is more in-depth into the exact type of problems that these students encounter and the specific needs that they have regarding support.

Effects of Household Income Change on Children's Problem Behavior: Findings From a Longitudinal Study

PURPOSE

This study aimed to examine the effect of changes in equivalized disposable household income (EHDI) on children's problem behavior.

METHODS

Data were collected from the Korean Welfare Panel Study (2006, 2009, 2012). A total of 1,005 school-aged children were included in the analysis. Children's problem behavior was measured using the Korean version of the Child Behavior Checklist. Using the generalized linear mixed model for repeated measures, we investigated the effect of actual household income changes on children's problem behavior, based on the family's EHDI.

RESULTS

Children who experienced high EHDI decrement exhibited a significant increase in problem behavior compared with those who did not experience sizable EHDI change (high decrement: β = .21, standard error = .09, p = .016). Furthermore, problem behavior was higher in girls who experienced a decrement in EHDI compared with boys.

CONCLUSIONS

These findings suggest that changes in family's economic status might negatively affect the probability of children's problem behavior when there is a large decrease in EHDI.

A systematic review of the current interventions available to support children living with parental cancer

OBJECTIVE

Children living with parental cancer are vulnerable to distress and developmental disruption. This review aims to identify current interventions to support cancer patients' children and summarise how effective these are based on children's reports.

METHODS

Between 25 May 2015 and 6 August 2018, a broad search strategy was used to identify relevant references. Seven databases were searched, and grey literature was also vetted. This review was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane guidelines.

RESULTS

Eight studies evaluating six interventions were retained. Research designs and interventions were heterogenous, and study quality was low. A limited number of significant results were reported by studies. These evidenced improvement for PTSD symptoms, emotional regulation, and depression. However, overall current interventions do not appear effective among patients' children.

CONCLUSION

Despite encouraging preliminary findings, interventions do not yet adequately support cancer patients' children. There is a need for more tailored and targeted interventions. A theoretical model conceptualising the impact of parental cancer may assist this.

PRACTICE IMPLICATIONS

Findings will assist future intervention research by promoting standardised levels of care among cancer patients' children, that is empirically supported, effective, and meets principles of non-maleficence.

Parental hospital-treated somatic illnesses and psychosis of the offspring-The Northern Finland Birth Cohort 1986 study

AIM

The aim of this study was to investigate whether parental somatic illnesses during childhood increase the risk for later psychosis in the offspring. In addition, we examined which parental illnesses in particular are associated with increased risk of psychosis in the offspring.

METHOD

The data of the Northern Finland Birth Cohort 1986 (NFBC 1986), included 9137 children born alive in northern Finland between the July 1, 1985, and the June 30, 1986. Information regarding the parents' somatic morbidity was collected through various healthcare registers up to age 28 of the cohort members.

RESULTS

Psychosis was diagnosed in 169 (1.8%) of the cohort members between the ages of 16 and 28. Accumulation of parental somatic diseases was related to later psychosis in the offspring. In addition, some specific somatic diagnostic groups of parents were emphasized in relation to psychosis in the offspring.

CONCLUSIONS

Our study findings indicated that parental somatic illness should be taken into account in the prevention of serious mental health problems in their offspring.

Disentangling the effect of out-of-home care on child mental health

BACKGROUND

Children in out-of-home care are consistently found to have poor mental health compared to children in the general population. However, UK research has so far failed to disentangle the impact of the care system on children's mental health outcomes from the effects of the adverse circumstances that led to their admission to care.

OBJECTIVE

This research investigated the association between care placement and the presence of child mental health problems after controlling for children's pre-care experiences. It also identified factors associated with mental health problems among children in care.

PARTICIPANTS AND SETTING

The sample comprised three groups of children involved with child welfare services due to maltreatment, including children in out-of-home care (n = 122), reunified children (n = 82) and those who had never been in care (n = 159).

METHODS

The mental health of the children in the three groups was compared, using information collected from their parents/foster carers and social workers.

RESULTS

The odds of a child in out-of-home care having a mental health problem were not significantly higher than those of a child who had never been in care (AOR = 1.24; p = 0.462). However, the odds of a child in out-of-home care having reactive attachment disorder (RAD) were significantly higher than those of a child who had never been in care (AOR=1.92; p = 0.032).

CONCLUSIONS

These findings make an important contribution to international debates about whether placing children in care is beneficial or detrimental to their wellbeing, and highlight a range of inter-linking factors associated with the mental health of children in out-of-home care.

Parental education and adolescent health problems due to violence, self-harm and substance use: what is the role of parental health problems?

BACKGROUND

Adolescent health problems are more prevalent in families with low socioeconomic position, but few studies have assessed the role of parental health in this association. This study examines the extent to which parental health problems, particularly those related to high-risk health behaviour, might explain the association between parental education and adolescent health problems due to violence, self-harm and substance use.

METHODS

We used longitudinal register data on a 20% representative sample of all families with children aged 0-14 years in 2000 in Finland with information on parental social background and parental and offspring health problems based on hospital discharge data. We estimated discrete-time survival models with the Karlson-Holm-Breen method on hospital admissions due to violence, self-harm and substance use among adolescents aged 13-19 years in 2001-2011 (n=145 404).

RESULTS

Hospital admissions were 2-3 times more common among offspring of basic educated parents than tertiary educated parents. Similar excess risks were observed among those with parental mental health problems and parental health problems due to violence, self-harm and substance use. The OR for offspring of basic educated parents was attenuated from OR 2.73 (95% CI 2.34 to 3.18) to OR 2.38 (2.04 to2.77) with adjustment for parental health problems, particularly those due to violence, self-harm and substance use. Having both low parental education and parental health problems showed simple cumulative effects.

CONCLUSIONS

The excess risks of hospital admissions due to violence, self-harm and substance use among adolescents with lower educated parents are largely independent of severe parental health problems.

Differences in implementation of family focused practice in hospitals: a cross-sectional study

BACKGROUND

Changes in Norwegian law and health policy require all health professionals to help safeguard the provision of information and follow-up for the children of parents with mental or physical illness, or substance abuse problems, to decrease their risk of psychosocial problems. There is a lack of knowledge on how the national changes have been received by hospital-based health professionals, and if they have led to an increase in family focused practice.

METHODS

This cross-sectional study examined the adherence of health professionals' (N = 280) in five hospitals to new guidelines for family focused practice, using a translated and generic version of Family Focused Mental Health Practice Questionnaire.

RESULTS

Overall, health professionals scored high on knowledge and skills, and were confident in working with families and children, but reported moderate levels of family support and referrals. Comparison of the five hospitals showed significant differences in terms of workplace support, knowledge and skills and family support. The smallest hospital had less workplace support and less knowledge and skills but scored medium on family support. The two largest hospitals scored highest on family support, but with significant differences on parents refusing to have conversations with children.

CONCLUSIONS

Differences in implementation of family focused practice highlight the need to tailor improvement strategies to specific barriers at the different hospitals. The use of implementation theories and improvement strategies could promote full implementation, where all families and children in need were identified and had access to family support.Trial registration The study is approved by the Regional Committee on Medical and Health Research Ethics South-East Q5 37 (reg. no. 2012/1176) and by the Privacy Ombudsman.

Health-related quality of life (HRQoL) in children of ill or substance abusing parents: examining factor structure and sub-group differences

PURPOSE

Health-related quality of life (HRQoL) may be helpful in identifying children at risk of developing adjustment problems. Few studies have focused on HRQoL among children of ill or substance abusing parents despite their considerable risk status. In the present study, we used the KIDSCREEN-27 to assess self-reported HRQoL in children and adolescents living in families with parental illness, or substance dependence. First, we tested whether the factor structure of the KIDSCREEN-27 was replicated in this population of children. Next, we examined differences in HRQoL according to age, gender, and type of parental illness. Finally, we compared levels of HRQoL in our sample to a normative reference population.

METHOD

Two hundred and forty-six children and adolescents aged 8-17 years and their ill parents participated. The construct validity of the KIDSCREEN-27 questionnaire was examined by confirmatory factor analysis (CFA). T-tests and ANOVA were used to test differences in HRQoL levels according to age, gender, and parental patient groups, and for comparisons with reference population.

RESULTS

The KIDSCREEN-27 fit the theoretical five-factor model of HRQoL reasonably well. Boys and younger children reported significantly greater well-being on physical well-being, psychological well-being, and peers and social support, compared to girls and older children. Younger children also reported significantly greater well-being at school than did older children. There were no significant differences in HRQoL between groups of children living with different type of parental illness. The children in our sample reported their physical well-being significantly lower than the reference population.

CONCLUSION

The KIDSCREEN-27 questionnaire appears to work satisfactorily among children of ill or substance abusing parents.

Parental chronic pain and internalizing symptoms in offspring: the role of adolescents' social competence - the HUNT study

Background

A growing body of research suggests that the children of parents with chronic pain are at risk for internalizing symptoms. The mechanisms of such associations have not been as thoroughly examined. The aim of the present study was to investigate whether adolescents’ social competence mediates the association between parental chronic pain and offspring internalizing symptoms as well as whether these associations are moderated by adolescent gender.

Methods

The current study was based on cross-sectional data from the Nord-Trøndelag Health Study (HUNT 3), a Norwegian population-based health survey conducted in 2006–2008. The present sample comprised adolescents who had both parents participating (n=9,681). Structural equation modeling was used for the data analysis.

Results

Our results indicated that the association between concurrent maternal and paternal chronic pain and offspring’s symptoms of anxiety and depression was partly mediated by low social competence for girls (b(SE)=0.060 [0.030], P=0.043) but not for boys (b(SE)=−0.059 [0.040], P=0.146). This suggests that these associations are moderated by offspring gender.

Conclusion

The study extends the existing literature on the possible pathways between parental chronic pain and internalizing symptoms in the offspring. Identifying protective factors in the pathways between parental chronic pain and mental distress in children could guide measures that promote the wellbeing of the child and family of chronic pain sufferers.

Mental health among children of mothers with multiple sclerosis: A Danish cohort and register-based study

BACKGROUND

Multiple sclerosis is associated with an increased risk of developing physical, cognitive, and mental health problems. Current studies have demonstrated variating outcomes of parental multiple sclerosis mental health problems and their children's mental health development.

OBJECTIVE

The purpose of this study was to investigate whether maternal multiple sclerosis is associated with the mental health status of their child.

METHODS

Data from the Danish National Birth Cohort (DNBC) were merged with information from the Danish Multiple Sclerosis Registry. Two proxies, total difficulties score and prediction of any psychiatric diagnosis based on the strengths and difficulties questionnaire, were used to measure the mental health status of the children. The two groups were compared using Mann-Whitney and logistic regression analyses.

RESULTS

For the total difficulties score the control and exposed group consisted of respectively n = 42,016 and n = 40, and for the prediction of any psychiatric diagnosis respectively n = 16,829 and n = 17. We found no statistically significant association between maternal multiple sclerosis and mental health status on neither of the proxies.

CONCLUSION

Maternal multiple sclerosis did not show any association with the mental health status of their children at age eleven. On the contrary, other studies conclude that there is an association between maternal multiple sclerosis and the child's mental health status, one especially mediated by the maternal mental health status.