In Our Lives and Under Our Skin: An Investigation of Specific Psychobiological Mediators Linking Family Relationships and Health Using the Biobehavioral Family Model

Exploring the Influence of Family Attitudes and Individual Psychological Factors on Antibiotic Utilization: A Pilot Study

The inappropriate use of antibiotics gives rise to detrimental consequences, both physical and emotional, with a decreased quality of life and higher levels of anxiety and depression. The current observational study aimed to investigate the association between awareness, beliefs, and behaviors toward antibiotics, highlighting the modulating role of individual and psychological factors in response to illness and medication. Through an online questionnaire, several psychological indexes, as well as knowledge of, attitude toward, and experiences with antibiotics, both individual and family-related, were assessed in a sample of 100 responders (74 females, mean age 33.37 ± 11.36). A positive association between intake behavior, awareness, and individual attitude emerged. Familial approach to antibiotics appears as a predictor of individual attitude and behavior toward these drugs, and awareness about antibiotic risks mediate the relationship between the tendency to be more compliant with prescriptions (R2 = 0.300; MSE = 1.541; F(2, 98) = 20.737; p < 0.0001). Moreover, individuals with a personality characterized by higher conscientiousness are more aware of antibiotic risks (p < 0.01), whereas individuals with a lower awareness are those with higher indexes of psychophysical discomfort (i.e., anxiety, perceived stress, somatization) and levels of emotional rebound (p < 0.05). Anxiety (F(3, 96) = 3.874; p = 0.012; R2 = 0.108) and somatization (F(2, 97) = 3.114; p = 0.030; R2 = 0.089) also significatively moderated the intake behavior, despite the family approach. Overall, the current study provides preliminary findings regarding the way in which family experiences and individual psychological aspects may be influencing factors in the behavior and attitude towards antibiotics and can be used to plan patient-centered therapeutic communication and education.

Does it add up? Educational achievement mediates child maltreatment subtypes to allostatic load

BACKGROUND

Childhood maltreatment (CM) has been linked to higher levels of allostatic load (AL) and educational achievement is a possible pathway and may differ across gender. It is also critical to determine if CM severity or specific subtypes of CM are more or less influential.

OBJECTIVE

This study examined educational achievement as a mediator linking cumulative and individual types of CM to AL and examined gender as a moderator.

PARTICIPANTS AND SETTING

Using two waves of data, 897 adults from the study Midlife in the United States were analyzed.

METHODS

Multiple group structural equation models stratified across gender to test were used cumulative maltreatment and maltreatment subtypes to AL and test gender as a moderator.

RESULTS

Overall CM was associated with educational achievement (β = -0.12, p < .01) and AL (β = 0.11, p < .05) and education was inversely associated with AL (β = -0.17, p < .001) in men but not women. The subtypes model revealed that physical abuse predicted lower level of education achievement (β = -0.20, p < .001) and among men. Educational achievement, in turn, was associated with lower levels of AL (β = -0.02, p = .002). Educational achievement was a possible pathway linking physical abuse to AL (β = 0.02, 95 % CI [0.001, 0.040]) among men but was non-significant in women. Gender did not moderate any of the pathways.

CONCLUSIONS

Educational achievement is a potentially modifiable social determinant of health that can be a focus of prevention and intervention efforts among men who were maltreated, particularly for those who experienced physical abuse.

The biobehavioral family model and the family relational assessment protocol: Map and GPS for family systems training

The Biobehavioral Family Model (BBFM) was developed and evolved as a heuristic research model to support the investigation of pathways by which family relational function impacts individual family member wellbeing and disorder. Recently, the BBFM and its related assessment approach, the Family Relational Process Assessment Protocol (FRAP), have emerged as tools for clinical practice and training. The BBFM model will be presented, along with definitions of the dimensions constructed in the model, and research evidence in support of the model. To illustrate how the BBFM and FRAP are used in training, instructions for conducting the FRAP will be presented. Then, transcripts from two contrasting families participating in one of the interaction tasks will illustrate how, in training, the FRAP is interpreted through the BBFM lens to illuminate how these patterns of family relationship impact the identified patient. Finally, three applications of this training approach will exemplify the use of the BBFM and FRAP in the context of a Child and Adolescent Psychiatry Fellowship, a Family Medicine Fellowship, and a Family Therapy Training Program in Istanbul, Turkey. Limitations and future directions for the application of the BBFM in the exploration of multicultural aspects of family function for clinical and training purposes will be discussed.

Depressed mood and environmental mastery as potential pathways linking family relationship quality and disease self-management for African Americans with hypertension

African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, M_age  = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.

An application of the Biobehavioral Family Model: Examining the impact of maternal depression on child asthma mediated by insecure attachment and child depression

OBJECTIVE

Child asthma disparities are prevalent in socio-economically stressed single-parent families. Stress impacts childhood asthma mediated by immune and autonomic pathways, but specific family stress pathways are not well established. This study tests the hypothesis, derived from a version of the Biobehavioral Family Model, that single parent maternal depression impacts child asthma mediated by insecure attachment and child depression.

METHODS

In a cross-sectional study, children with asthma (age 7-17 years old) from a socio-economically disadvantaged population and their single parent mothers (N = 202) were assessed for depression and attachment security. Child asthma disease activity was assessed by symptom report and lung function tests. Structural equation modeling (SEM) was used to test a model in which caregiver depression impacts child asthma disease activity mediated by insecure attachment and child depression.

RESULTS

SEM results indicated that maternal depression statistically predicted child depression (β = 0.21, p < 0.01) and insecure mother-child attachment (β = 0.17, p < 0.05). In addition, insecure attachment statistically predicted child depression (β = 0.50, p < 0.001). Child depression mediated the adverse effects of maternal depression and insecure attachment on child asthma disease activity (β = 0.43, p < 0.01). There was no direct effect of insecure attachment on child asthma.

CONCLUSION

In single-parent families, maternal depression may impact child asthma disease activity, mediated serially by insecure attachment and child depression. Longitudinal and/or intervention studies are needed to establish a causal effect. These findings suggest that caregiver depression and parent-child relationships may be important targets for family intervention. These interventions may help improve child asthma outcomes and reduce health disparities.

Family profiles based on family life satisfaction in dual-earner households with adolescent children in Chile

Research has stressed the importance of the family domain for the individual's well-being, but the heterogeneity/homogeneity of satisfaction with family life between and within families have not previously assessed. This study identifies family profiles based on the level of family life satisfaction in mother-father-adolescent triads and determines whether profiles differ in terms of the three family members' perceived family support, importance assigned to the family, both parents' work-life balance and mental health, and the household's economic situation. The sample was composed of 303 families of different-sex dual-earner parents with one child aged between 10 and 17 years, from Temuco, Chile. A Latent Profile Analysis was used to identify three profiles: Families with low family satisfaction (17.80%), Families with medium family satisfaction (68.14%), and Families with high family satisfaction (14.06%). Profiles also differed in the three family members' perceived family support and importance assigned to the family, both parents' work-life balance and mental health, and in the household's income. Mothers, fathers, and adolescents in these profiles also differed from one another in these variables. The main variable related to the family members' satisfaction with family life was the parents' mental health problems. Family life satisfaction in dual-earner couples with adolescent children is heterogenous, and these profiles draw attention to indicators of parent-child well-being. Families with lower levels of family satisfaction require particular attention in research and interventions, as these families may report a lower household income, and the parents may experience higher rates of depression, anxiety, and stress, and diverging levels of work-life balance.

Allostatic Load and Its Impact on Health: A Systematic Review

INTRODUCTION

Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria.

OBJECTIVE

To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature.

METHODS

PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations.

RESULTS

A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings.

CONCLUSIONS

The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.

Childhood Allergies: The Role of Maternal Depression and Anxiety, and Family Strain

Maternal mental disorder and a negative family emotional climate are a great source of stress for many children, yet their role in the childhood development or expression of asthma and allergies remains poorly understood, particularly beyond the first 1–2 years of life. The current study tested whether childhood allergy onset and symptomatology would be predicted by (1) perinatal and any time exposure to maternal depression or anxiety and (2) current family emotional strain (whole family, mother-child). UK mothers of children aged 2–12 years (N = 328) living with them completed an online survey of measures. Children exposed to maternal depression were almost twice as likely to be diagnosed and almost five times as likely to screen positive for an allergic disorder. Perinatal depression was linked to childhood allergies, but more moderately. Any anxiety exposure, and not specific to the perinatal period, predicted allergy status. Family emotional strain contributed independently to variance in concurrent child allergic symptomatology. All results were independent of potential confounders and current mental distress. The findings highlight the importance of maternal mental health and family function in the child’s neuro-immune development, and that these factors need to be addressed in the treatment of childhood allergic disorders.

The Biobehavioral Family Model: An Evidence-Based Approach to Biopsychosocial Research, Residency Training, and Patient Care

Engel's biopsychosocial model, based in systems theory, assumes the reciprocal influence of biological, psychological, and social factors on one another and on mental and physical health. However, the model's application to scientific study is limited by its lack of specificity, thus constraining its implementation in training and healthcare environments. The Biobehavioral Family Model (BBFM) is one model that can facilitate specification and integration of biopsychosocial conceptualization and treatment of illness. The model identifies specific pathways by which family relationships (i.e., family emotional climate) impact disease activity, through psychobiological mechanisms (i.e., biobehavioral reactivity). Furthermore, it is capable of identifying positive and negative effects of family process in the same model, and can be applied across cultural contexts. The BBFM has been applied to the study of child health outcomes, including pediatric asthma, and adult health, including for underserved primary care patients, minoritized samples, and persons with chronic pain, for example. The BBFM also serves as a guide for training and clinical practice; two such applications are presented, including the use of the BBFM in family medicine residency and child and adolescent psychiatry fellowship programs. Specific teaching and clinical approaches derived from the BBFM are described in both contexts, including the use of didactic lecture, patient interview guides, assessment protocol, and family-oriented care. Future directions for the application of the BBFM include incorporating temporal dynamics and developmental trajectories in the model, extending testable theory of family and individual resilience, examining causes of health disparities, and developing family-based prevention and intervention efforts to ameliorate contributing factors to disease. Ultimately, research and successful applications of the BBFM could inform policy to improve the lives of families, and provide additional support for the value of a biopsychosocial approach to medicine.

The Critical Need to Recognize That Families Matter for Adult Health: A Systematic Review of the Literature

A systemic approach to researching families and health should capture the complex network within which family members are embedded, including multiple family relationships and larger systems of health care. However, much of the families and health research focused on adult family members has focused solely on intimate partnerships, usually the marital relationship. This neglects the remainder of the powerfully influencing family relationships adults retain, and may increasingly focus on as they age. We conducted a systematic review of the families and adult health literature, retaining 72 articles which were subsequently thematically coded to highlight main foci of this area of research. Results highlight six themes, which include family relationship quality, family composition, behavioral factors in health and health care, psychophysiological mediators, caregiving, and aging health. Findings support an underrepresentation of family members, other than the intimate partner, in research on adult health.

COVID-19 Interconnectedness: Health Inequity, the Climate Crisis, and Collective Trauma

The COVID-19 pandemic brings to the forefront the complex interconnected dilemmas of globalization, health equity, economic security, environmental justice, and collective trauma, severely impacting the marginalized and people of color in the United States. This lack of access to and the quality of healthcare, affordable housing, and lack of financial resources also continue to have a more significant impact on documented and undocumented immigrants. This paper aims at examining these critical issues and developing a framework for family therapists to address these challenges by focusing on four interrelated dimensions: cultural values, social determinants of health, collective trauma, and the ethical and moral responsibility of family therapists. Given the fact that family therapists may unwittingly function as the best ally of an economic and political system that perpetuates institutionalized racism and class discrimination, we need to utilize a set of principles, values, and practices that are not just palliative or after the fact but bring forth into the psychotherapeutic and policy work a politics of care. Therefore, a strong call to promote and advocate for the broader continuum of health and critical thinking preparing professionals to meet the challenges of health equity, as well as economic and environmental justice, is needed. The issues discussed in this paper are specific to the United States despite their relevance to family therapy as a field. We are mindful not to generalize the United States' reality to the rest of the world, recognizing that issues discussed in this paper could potentially contribute to international discourse.

Family versus intimate partners: Estimating who matters more for health in a 20-year longitudinal study

This study tested the extent to which the emotional climate (positive and negative relationship quality) in family relationships and intimate partnerships are each uniquely linked to specific domains of aging health outcomes, over and above the impact of earlier health. Data included partnered participants who completed all three waves of the Midlife Development in the United States (MIDUS). We used measures of family and intimate partner strain and support, at MIDUS 1, 2, and 3, and estimated the effects of each on subsequent morbidity and health appraisal (i.e., 10 and 20 years later). Autoregressive cross-lagged paths were modeled using maximum likelihood estimation with robust standard errors. Family strain was associated with later health in both the morbidity, χ²(35) = 411.01, p < .001; root mean square error of approximation (RMSEA) = .062, comparative fit index (CFI) = .952; standardized root-mean-square residual (SRMR) = .034 and health appraisal, χ²(35) = 376.80, p < .001; RMSEA = .058, CFI = .956; SRMR = .032 models. Morbidity and health appraisal also predicted later family emotional climate, reciprocally. Intimate partner emotional climate-health pathways were nonsignificant at each wave, in both models. Results are novel and may be the first to indicate the quality of family relationships are a more powerful predictor of aging health than the quality of intimate partnerships. Findings implicate the health of adults should be considered in the systemic context of families. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Marital Strain, Support, and Alcohol Use: Results from a Twin Design Statistically Controlling for Genetic Confounding

Background: Marriage is one of the most frequently examined sources of social support and has been shown to protect against alcohol use and abuse. This study examines the relationship between perceived marital strain and support, and alcohol use controlling for additive genetic influence. Methods: Data from monozygotic (MZ) (n = 320) and dizygotic (DZ) (n = 464) twin pairs from the second wave of the National Survey of Midlife Development in the United States (MIDUS II) were used to test whether past year marital strain and support were associated with recent alcohol use. Generalized linear mixed models (GLMM) were estimated, allowing us to control for additive genetic and shared environmental influences as variance components. Results: Marital strain and support had positive, statistically significant associations with alcohol use. However, only the relationship between marital strain and alcohol use remained after controlling for variance in alcohol use attributed to genetics. Conclusions: After accounting for genetics, midlife adults still appear to cope with marital strain via alcohol use. However, this coping is unlikely to result in heavy episodic drinking or alcohol use disorder without other compounding factors.

Stressful Life Events and Physical and Psychological Health: Mediating Effects of Differentiation of Self in a Spanish Sample

The pathways between differentiation of self and health remain only partly elucidated. This cross-cultural study sought to test Bowen's hypothesis about the associations between differentiation, stressful life events, and physical and psychological health, in a sample of 466 Spanish adults. Results show that people with higher levels of differentiation were less prone to physical ailments (e.g., heart disease, cancer, or blood disorders) and psychological symptoms (e.g., depression or anxiety). Further, differentiation mediated the association between stress (i.e., perceived negativity of stress in the past year and number of stressful events across the lifetime) and physical and psychological health. The current research provides cross-cultural empirical evidence for the links between differentiation and mind and body health in a Mediterranean culture.