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Kirk S, Pryjmachuk S. 'People don't realise how much their past experiences affect them in adulthood': A qualitative study of adult siblings' experiences of growing-up with a sister/brother with a childhood life-limiting condition and their perceived support needs. Palliat Med 2024; 38:352-363. [PMID: 38342911 PMCID: PMC10955783 DOI: 10.1177/02692163231225100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
BACKGROUND There is a lack of research about the experiences and impact of having a sibling with a life-limiting condition. Studies focus on the sibling experience during childhood but the experience and impact during adulthood is unknown despite the increased life-expectancy of children with life-limiting conditions. AIM To explore adult siblings' perspectives on the experience of having a sister/brother with a childhood life-limiting condition and to identify their perceived needs and preferences for support. DESIGN A qualitative exploratory study design with data generated by semi-structured interviews and analysed using reflexive thematic analysis, underpinned by interpretivism. SETTING/PARTICIPANTS Twenty-two siblings (17-42 years old) were recruited via a children's hospice in England. RESULTS The experience of having a sibling with a life-limiting condition changes over time in response to how understandings of the meaning of a life-limiting condition develop and changing roles/relationships with parents and siblings. These experiences have an enduring impact on adult sibling's mental health which is compounded by their unmet (and sometimes unrecognised) support needs in adolescence and adulthood. Siblings described the importance of support continuing into adulthood with a focus on the provision of psychotherapy and peer support. CONCLUSIONS Having a sister/brother with a childhood life-limiting condition appeared to have a significant and ongoing impact on adult siblings but their support needs, particularly for psychotherapy and peer support, are overlooked. The findings highlight the importance of ensuring siblings are included in family assessments and that family-based interventions are developed to promote sibling-parent relationships.
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Affiliation(s)
- Susan Kirk
- School of Health Sciences, University of Manchester, Manchester, UK
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Levante A, Martis C, Del Prete CM, Martino P, Pascali F, Primiceri P, Vergari M, Lecciso F. Parentification, distress, and relationship with parents as factors shaping the relationship between adult siblings and their brother/sister with disabilities. Front Psychiatry 2023; 13:1079608. [PMID: 36741565 PMCID: PMC9889978 DOI: 10.3389/fpsyt.2022.1079608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
According to parentification theory, when the siblings of a brother/sister with disabilities assume parent-like duties, this role reversal is known as sibling-focused parentification. It has a significant impact on these siblings' distress and the quality of their family relationships; 605 Italian adult siblings (19-26 years) of people with disabilities completed the online survey. Measures of siblings' parentification, distress, quality of family relationships, social support, and perceived benefits of parentification were used. The hypothesized model aims to test, on the target sample, the distress and the quality of the relationship with parents as mediators on the interplay between the siblings' parentification and their sibling relationship. Additionally, social support and perceived benefits of parentification as protective factors were considered. Results showed that the distress and the low quality of the relationship with parents negatively affected the interplay between the siblings' parentification and the relationship with their own brother/sister with disabilities. Social support and the perceived benefits of parentification decreased the siblings' distress levels; the perceived benefits of parentification served as a protective factor for the quality of the relationship with parents. Current findings extend the knowledge regarding the risk and protective factors of the siblings' mental health when disability occurs in the family. Additionally, they inform family-based intervention programs, which should involve the whole family system for reducing distress and improving the wellbeing of siblings without disabilities.
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Affiliation(s)
- Annalisa Levante
- Department of Human and Social Sciences, University of Salento, Lecce, Italy
- Lab of Applied Psychology, Department of Human and Social Sciences, University of Salento, Lecce, Italy
| | - Chiara Martis
- Department of Human and Social Sciences, University of Salento, Lecce, Italy
| | | | - Paola Martino
- Office for Inclusion of People with Disabilities, University of Salento, Lecce, Italy
| | | | | | - Massimo Vergari
- District for Rehabilitation, Local Health Service, Lecce, Italy
| | - Flavia Lecciso
- Department of Human and Social Sciences, University of Salento, Lecce, Italy
- Lab of Applied Psychology, Department of Human and Social Sciences, University of Salento, Lecce, Italy
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Ishizaki Y, Matsuo M, Saito K, Fujihira Y. Factors Surrounding the Healthcare Transition From Pediatric to Adult Care in 5p- Syndrome: A Survey Among Healthcare Professionals. Front Pediatr 2022; 10:924343. [PMID: 35874599 PMCID: PMC9304764 DOI: 10.3389/fped.2022.924343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background The 5p- syndrome is associated with intellectual disturbance and physical complications from infancy, and patients continue treatment into adulthood. This study aimed to clarify the factors that facilitate and prevent healthcare transition from pediatric to adult care by conducting a questionnaire survey among medical professionals. Subjects The survey included 81 medical professionals nominated by an association of families of 5p- patients in Japan. The questions involved medical care for 5p- syndrome in adulthood, experience of transition, and factors facilitating a patient's transition. Responses were obtained from 32 participants, with 27 answers eligible for analysis. Results The questionnaire items involved physical symptoms and concerns regarding support and welfare prompting consult. The most common physical symptom was constipation. Regarding support and welfare, all participants had an experience of receiving consultation about care for the siblings of patients. Three (11.1%) participants had an experience of transition. Regarding the transition of patients with rare diseases or intellectual disturbance, only four (14.8%) believed that progress was being made in the transition. Discussion Only 11% of the respondents experienced the transition of patients with 5p- syndrome. Because it is difficult for highly specialized adult care providers to deal with multidisciplinary complications of 5p- syndrome and information on prognosis and natural history is not known, it is presumed that the transition of 5p- syndrome did not progress. Factors to improve the transition of patients with 5p- syndrome and are likely to be effective for the transition of patients with other rare diseases or intellectual disabilities.
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Affiliation(s)
- Yuko Ishizaki
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | - Mari Matsuo
- Institute of Medical Genetics, Tokyo Women’s Medical University, Tokyo, Japan
| | - Kayoko Saito
- Institute of Medical Genetics, Tokyo Women’s Medical University, Tokyo, Japan
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Rosenthal E, Franklin Gillette S, DuPaul GJ. Pediatric siblings of children with special health care needs: Well-being outcomes and the role of family resilience. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.1933985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Oswald TK, Rumbold AR, Kedzior SGE, Kohler M, Moore VM. Mental Health of Young Australians during the COVID-19 Pandemic: Exploring the Roles of Employment Precarity, Screen Time, and Contact with Nature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5630. [PMID: 34070331 PMCID: PMC8197562 DOI: 10.3390/ijerph18115630] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is widely understood to have contributed to mental health problems. In Australia, young people (18-24 years) have been disproportionately affected. To date, research has predominantly focused on the presence or absence of mental illness symptoms, while aspects of mental well-being have been overlooked. We aimed to explore associations between potential risk and protective factors and mental health more comprehensively, using the Complete State Model of Mental Health. An online survey of 1004 young Australians (55% female; M age = 21.23) was undertaken. Assessment of both mental illness and mental well-being enabled participants to be cross-classified into four mental health states. Those with 'Floundering' (13%) or 'Struggling' (47.5%) mental health reported symptoms of mental illness; a 'Languishing' group (25.5%) did not report symptoms of mental illness but mental well-being was compromised relative to those who were 'Flourishing' (14%) with high mental well-being. Multinomial logistic regressions were used to examine associations, adjusting for socio-demographic confounders. Protective factors associated with Flourishing mental health included being in secure employment, using screen time to connect with others, and reporting high levels of hope. Both incidental and purposive contact with nature were also associated with Flourishing, while a lack of green/bluespace within walking distance was associated with Languishing, absence of outdoor residential space was associated with Floundering, and lower neighbourhood greenness was associated with all three suboptimal mental health states. Precarious employment, financial stress, living alone, reporting decreased screen time during lockdowns, lower levels of hope, and high disruption of core beliefs were also associated with Struggling and Floundering mental health. Those who were Languishing reported somewhat less hardship and little disruption to core beliefs, but lower levels of hope compared to young people who were Flourishing. This study highlights that young adults require dedicated mental health services to deal with current burden, but should also be supported through a range of preventive strategies which target mental health risk factors, like precarious employment, and enhance protective factors, such as urban green infrastructure.
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Affiliation(s)
- Tassia K. Oswald
- Faculty of Health & Medical Sciences, School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia;
- Faculty of Health & Medical Sciences, Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia; (A.R.R.); (S.G.E.K.)
| | - Alice R. Rumbold
- Faculty of Health & Medical Sciences, Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia; (A.R.R.); (S.G.E.K.)
- South Australian Health & Medical Research Institute, SAHMRI Women and Kids, North Adelaide, SA 5006, Australia
| | - Sophie G. E. Kedzior
- Faculty of Health & Medical Sciences, Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia; (A.R.R.); (S.G.E.K.)
| | - Mark Kohler
- Faculty of Health & Medical Sciences, School of Psychology, The University of Adelaide, Adelaide, SA 5005, Australia;
- The Environment Institute, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Vivienne M. Moore
- Faculty of Health & Medical Sciences, School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia;
- Faculty of Health & Medical Sciences, Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia; (A.R.R.); (S.G.E.K.)
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Moon Y, Jung JW, Lee S. Sibling Relationships of Adolescents with Congenital Heart Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052698. [PMID: 33800133 PMCID: PMC7967429 DOI: 10.3390/ijerph18052698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/04/2021] [Indexed: 11/23/2022]
Abstract
Adolescents with congenital heart disease (CHD) continuously need family support because of their repeated follow ups, treatments, and complications. However, sibling relationships have not been well studied among adolescents with CHD. The purpose of the present study was to explore the relationships between adolescents with CHD and their siblings, and to examine these relationships according to birth order and age. Adolescents aged from 13 to 21 years who had been diagnosed with CHD and had siblings were included as participants. The Sibling Relationship Questionnaire (SRQ) was used. The SRQ consists of four factors: warmth/closeness, conflict, relative power/status, and rivalry. A univariate general linear model was conducted to identify the sibling relationship factors according to birth order and sibling ages. The score for relative power/status of participants who were the eldest sibling was higher than that of younger siblings. The score for rivalry increased as sibling age increased. Therefore, healthcare providers need to investigate sibling relationships and to explain the importance of self-identity and power balance between adolescents with CHD and their siblings to parents.
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Affiliation(s)
- Youngji Moon
- College of Nursing, The Catholic University of Korea, Seoul 03722, Korea;
| | - Jo Won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, College of Medicine, Yonsei University, Seoul 03722, Korea;
| | - Sunhee Lee
- College of Nursing, The Catholic University of Korea, Seoul 03722, Korea;
- Correspondence: ; Tel.: +82-2-2258-7414
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Strauss KA, Carson VJ, Soltys K, Young ME, Bowser LE, Puffenberger EG, Brigatti KW, Williams KB, Robinson DL, Hendrickson C, Beiler K, Taylor CM, Haas-Givler B, Chopko S, Hailey J, Muelly ER, Shellmer DA, Radcliff Z, Rodrigues A, Loeven K, Heaps AD, Mazariegos GV, Morton DH. Branched-chain α-ketoacid dehydrogenase deficiency (maple syrup urine disease): Treatment, biomarkers, and outcomes. Mol Genet Metab 2020; 129:193-206. [PMID: 31980395 DOI: 10.1016/j.ymgme.2020.01.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 12/26/2022]
Abstract
Over the past three decades, we studied 184 individuals with 174 different molecular variants of branched-chain α-ketoacid dehydrogenase activity, and here delineate essential clinical and biochemical aspects of the maple syrup urine disease (MSUD) phenotype. We collected data about treatment, survival, hospitalization, metabolic control, and liver transplantation from patients with classic (i.e., severe; n = 176), intermediate (n = 6) and intermittent (n = 2) forms of MSUD. A total of 13,589 amino acid profiles were used to analyze leucine tolerance, amino acid homeostasis, estimated cerebral amino acid uptake, quantitative responses to anabolic therapy, and metabolic control after liver transplantation. Standard instruments were used to measure neuropsychiatric outcomes. Despite advances in clinical care, classic MSUD remains a morbid and potentially fatal disorder. Stringent dietary therapy maintains metabolic variables within acceptable limits but is challenging to implement, fails to restore appropriate concentration relationships among circulating amino acids, and does not fully prevent cognitive and psychiatric disabilities. Liver transplantation eliminates the need for a prescription diet and safeguards patients from life-threatening metabolic crises, but is associated with predictable morbidities and does not reverse pre-existing neurological sequelae. There is a critical unmet need for safe and effective disease-modifying therapies for MSUD which can be implemented early in life. The biochemistry and physiology of MSUD and its response to liver transplantation afford key insights into the design of new therapies based on gene replacement or editing.
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Affiliation(s)
- Kevin A Strauss
- Clinic for Special Children, Strasburg, PA, USA; Department of Pediatrics, Penn Medicine-Lancaster General Hospital, Lancaster, PA, USA; Departments of Pediatrics and Molecular, Cell & Cancer Biology, University of Massachusetts School of Medicine, Worcester, MA, USA.
| | - Vincent J Carson
- Clinic for Special Children, Strasburg, PA, USA; Department of Pediatrics, Penn Medicine-Lancaster General Hospital, Lancaster, PA, USA
| | - Kyle Soltys
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | | | | | | | | | - Cora M Taylor
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA
| | | | - Stephanie Chopko
- Department of Pediatrics, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Emilie R Muelly
- Department of Internal Medicine, The Permanente Medical Group, Santa Clara, CA, USA
| | - Diana A Shellmer
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Zachary Radcliff
- Department of Pediatrics, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | | | | | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - D Holmes Morton
- Clinic for Special Children, Strasburg, PA, USA; Department of Pediatrics, Penn Medicine-Lancaster General Hospital, Lancaster, PA, USA; Central Pennsylvania Clinic, Belleville, PA, USA
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