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Castellano P, Russo PM, Mazzetti M. Exploring the Influence of Family Attitudes and Individual Psychological Factors on Antibiotic Utilization: A Pilot Study. Healthcare (Basel) 2024; 12:1213. [PMID: 38921327 PMCID: PMC11202973 DOI: 10.3390/healthcare12121213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
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.
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Affiliation(s)
- Paola Castellano
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (P.M.R.); (M.M.)
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2
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Mitchell AE, Morawska A, Casey E, Forbes E, Filus A, Fraser J, Rowell D, Johnston A, Birch S. Brief parenting intervention (Triple P) for families of children with eczema: a randomized controlled trial. J Pediatr Psychol 2024; 49:429-441. [PMID: 38598510 PMCID: PMC11175588 DOI: 10.1093/jpepsy/jsae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy and costs of a brief, group-delivered parenting intervention for families of children with eczema. METHODS A randomized controlled trial design was used. Families attending the Queensland Children's Hospital and from the community (n = 257) were assessed for eligibility (child 2-10 years, diagnosed with eczema, prescribed topical corticosteroids). Families who consented to participate (N = 59) were assessed at baseline for clinician-rated eczema severity, parent-reported eczema symptom severity, and electronically-monitored topical corticosteroid adherence (primary outcomes); and parenting behavior, parents' self-efficacy and task performance when managing eczema, eczema-related child behavior problems, and child and parent quality of life (secondary outcomes). Families were randomized (1:1, unblinded) to intervention (n = 31) or care-as-usual (n = 28). The intervention comprised two, 2-hr Healthy Living Triple P group sessions (face-to-face/online) and 28 intervention families attended one/both sessions. All families were offered standardized eczema education. Families were reassessed at 4-weeks post-intervention and 6-month follow-up, with clinician-raters blinded to condition. Costs of intervention delivery were estimated. RESULTS Multilevel modeling across assessment timepoints showed significant intervention effects for ineffective parenting (d = .60), self-efficacy (d = .74), task performance (d = .81), and confidence with managing eczema-related child behavior (d = .63), but not disease/symptom severity, treatment adherence or quality of life. Mean cost per participating family with parenting behavior (clinically) improved was $159. CONCLUSIONS Healthy Living Triple P is effective in reducing ineffective parenting practices and improving parents' self-efficacy and task performance when managing children's eczema and eczema-related behavior difficulties. There was no effect on disease/symptom severity, treatment adherence, or quality of life. CLINICAL TRIAL REGISTRATION ACTRN12618001332213.
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Affiliation(s)
- Amy E Mitchell
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Australia
- Parenting and Family Support Centre, The University of Queensland, St Lucia, Australia
- Centre for Mental Health, Griffith University, Mt Gravatt, Australia
| | - Alina Morawska
- Parenting and Family Support Centre, The University of Queensland, St Lucia, Australia
- Australian Research Council Centre of Excellence for Children and Families over the Life Course, Brisbane, Australia
| | - Emily Casey
- Dermatology Service, Queensland Children’s Hospital, Brisbane, Australia
| | - Elana Forbes
- Murdoch Children’s Research Institute, Parkville, Australia
- Monash University, Melbourne, Australia
| | - Ania Filus
- Parenting and Family Support Centre, The University of Queensland, St Lucia, Australia
| | - Jennifer Fraser
- Sydney Nursing School, University of Sydney, Sydney, Australia
| | - David Rowell
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia
| | - Aimee Johnston
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia
| | - Stephen Birch
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia
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3
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Qian K, Xu H, Chen Z, Zheng Y. Advances in pulmonary rehabilitation for children with bronchial asthma. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:518-525. [PMID: 37643985 PMCID: PMC10495252 DOI: 10.3724/zdxbyxb-2023-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
Bronchial asthma is a heterogeneous disease characterized by chronic airway inflammation and airway hyperresponsiveness. With the development of the whole-life-cycle health concept, the focus of treatment for bronchial asthma in children has gradually shifted from pharmacological control to an integrated management model of functional rehabilitation and pharmacological assistance. As a non-pharmacological integrated approach, pulmonary rehabilitation plays an equally important role in the management of childhood asthma as pharmacological treatments. Breathing techniques such as Buteyko breathing, pursed lip breathing, diaphragmatic breathing training, threshold-pressure inspiratory muscle training and yoga breathing can improve lung function indicators such as forced expiratory volume in first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and maximal voluntary ventilation (MVV) in children. Comprehensive pre-exercise assessment, development of exercise prescriptions, and implementation and evaluation of exercise effects can improve physical fitness, neuromuscular coordination, and self-confidence of children with asthma. The comprehensive interventions of health education, psychological support and nutritional intervention can improve the compliance and effectiveness of rehabilitation training. This article reviews the research progress on respiratory training, physical exercise, and comprehensive interventions in the pulmonary rehabilitation of asthmatic children, to provide theoretical basis and practical guidance for the scientific and rational management of pulmonary rehabilitation of asthmatic children in clinical settings.
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Affiliation(s)
- Kongjia Qian
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
| | - Hongzhen Xu
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
| | - Zhimin Chen
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Ying Zheng
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
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4
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Cabrera Guerrero S, Håkansson KEJ, Backer V, Ulrik CS, Rastogi D. Childhood Asthma and Parental Antidepressant Use in a Nationwide Danish Cohort. J Asthma Allergy 2023; 16:821-831. [PMID: 37576930 PMCID: PMC10422996 DOI: 10.2147/jaa.s421169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
Background Paediatric asthma is associated with caregiver depression, which in turn is associated with poor asthma control. Although sociodemographic risk factors are associated with parental depression among children with asthma, the contribution of these factors to caregiver depression in free-to-access universal healthcare settings is unknown. Methods The association between childhood asthma and parental antidepressant use was investigated in a Danish nationwide cohort of children aged 2-17 years that redeemed inhaled corticosteroids in 2015. The odds of antidepressant use were estimated in comparison to control families that were matched 1:1 on the number of siblings, residence, income, and education. Results Among the families of 28,595 children with actively treated asthma, 12% of mothers and 6.2% of fathers were on antidepressant therapy, compared to 9.3% and 5.3% in controls (p<0.001). Paediatric asthma was associated with increased odds of parental antidepressant use (OR 1.29 (1.23-1.35)), even after adjusting for parental asthma. Poor asthma control, but not higher asthma severity, was associated with higher odds of antidepressant use (1.43 (1.31-1.56)). Compared with the controls, families with two or more children with asthma had higher OR (1.42 (1.29-1.56)) than those with a single child (OR 1.27 (1.21-1.34)). Low socioeconomic status was associated with parental antidepressant use. Conclusion Caregiver depression in a Danish cohort is more prevalent among mothers than among fathers and is associated with poor asthma control in children. Antidepressant use among caregivers was associated with total family asthma burden and was independent of socioeconomic status.
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Affiliation(s)
- Silvia Cabrera Guerrero
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, Washington, DC, USA
| | | | - Vibeke Backer
- Department of Otorhinolaryngology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, Washington, DC, USA
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, Washington, DC, USA
- Pediatrics, Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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5
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Miyaji Y, Yamamoto-Hanada K, Fukuie T, Narita M, Ohya Y. Risk factors of admission in school children with severe atopic dermatitis. J Dermatol 2023; 50:72-81. [PMID: 36258264 DOI: 10.1111/1346-8138.16612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/06/2022] [Accepted: 09/28/2022] [Indexed: 01/04/2023]
Abstract
There are no data about risk factor of admission and long-term (>1 year) prognosis of proactive therapy using topical corticosteroids (TCSs) in school children. This study aims to identify the prognosis of school children over 3 years treated with proactive therapy after hospitalization due to atopic dermatitis (AD). This retrospective cohort study used electronic medical record data of schoolchildren (aged 5-19 years) with a long-term admission program for AD at the National Center for Child Health and Development from January 2008 to December 2013. Long-term prognosis at 1 and 3 years after discharge were retrospectively identified from their medical records. The most common exacerbation factor was poor adherence (51.8%). At 1 and 3 years after hospitalization, 87.3% and 74.3%, respectively, of the children used TCSs on their trunk and limbs less than twice a week. Investigator's Global Assessment of AD scores were ≤1 for 81.0%and 75.7% at 1 and 3 years after discharge, respectively. AD was well-controlled during follow-up. Rehospitalization due to AD was observed in 11.8% children. Poor adherence was biggest risk factor for admission. Children with severe AD could achieve well-controlled AD with a long-term admission AD program and home-based proactive therapy using TCSs for 3 years after discharge. Maintaining good adherence for AD treatment is required to prevent exacerbation and improve future prognosis in school children. However, we need to engage for the children who required rehospitalization.
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Affiliation(s)
- Yumiko Miyaji
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | | | - Tatsuki Fukuie
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Masami Narita
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
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6
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Qin X, Zhang W, Xu S, Ma M, Fan X, Nie X, Liu J, Ju Y, Zhang L, Li L, Li H, Liu B, Zhang Y. Characteristics and related factors of family functioning in Chinese families during early pregnancy. Front Psychol 2023; 14:1102796. [PMID: 36874800 PMCID: PMC9975155 DOI: 10.3389/fpsyg.2023.1102796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Family functioning has been found to significantly impact each family member's health mentally, physically, and socially. A number of the research has focused on the impact of impaired family functioning in general, but limited studies explore family functioning in the vulnerable period, early pregnancy. Therefore, the study aimed to investigate the characteristics and related factors in Chinese females and partners during early pregnancy. Methods The cross-sectional study enrolled 226 pregnant women and 166 partners. Assessment tools included the McMaster Family Assessment Device (FAD), Edinburgh Postnatal Depression Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, Social Support Rating Scale, and Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form. Correlation analysis was applied to investigate the related factors. Results In the present study, FAD-Behavior Control (BC) was the only dysfunctional dimension and had the highest dysfunctional rates than other dimensions. Length of time living with a partner, depressive and anxious symptoms, and quality of life were all associated with the dysfunctional family functioning of BC. Conclusions The study reinforced the important clues of family functioning during early pregnancy. Also, it provided new entry points for the general population and healthcare providers to minimize the negative impact that impaired family function might bring to a family.
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Affiliation(s)
- Xuemei Qin
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - Weiling Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - Shuyin Xu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - Mohan Ma
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - Xing Fan
- Changsha Hospital for Maternal and Child Health Care, Changsha, Hunan, China
| | - Xueqing Nie
- Changsha Hospital for Maternal and Child Health Care, Changsha, Hunan, China
| | - Jin Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - Yumeng Ju
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - Li Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - Lingjiang Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - HaoLun Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - Bangshan Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - Yan Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
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7
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Son H, Miller LE. Family Communication About Cancer in Korea: A Dyadic Analysis of Parent-Adolescent Conversation. Glob Qual Nurs Res 2023; 10:23333936231199999. [PMID: 37790199 PMCID: PMC10542324 DOI: 10.1177/23333936231199999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023] Open
Abstract
Parent-adolescent communication is important in the context of childhood cancer. However, we know little about the communication experiences between Korean adolescents and their parents. Here, we conducted a secondary analysis of interview data from a qualitative descriptive study to explore Korean parent-adolescent communication experiences as a unit. Specifically, our dyadic analysis of individual interviews with seven Korean adolescents with cancer and at least one parent included inductive analysis at the individual level and cross-analysis to generate themes. The main theme was "Experience the same thing, but see it differently," along three subthemes: (1) different expectations for parent-adolescent communication, (2) different views on communication challenges, and (3) limited sharing and no progress in the conversation. Overall, our findings provide insights into different communication expectations and preferences between Korean adolescents and parents, and reasons for communication challenges, while emphasizing the individualized assessment of parent-adolescent communication between them.
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8
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Smith K, Wang D, Canada A, Poston JM, Bee R, Hurlbert L. The biobehavioral family model with a seminarian population: A systems perspective of clinical care. Front Psychol 2022; 13:859798. [PMID: 36211836 PMCID: PMC9539678 DOI: 10.3389/fpsyg.2022.859798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Seminary students remain unstudied in the research literature despite their eminent role in caring for the wellbeing of congregants. This study aimed to conduct baseline analysis of their family of origin health, psychological health, and physiological heath by utilizing the Biobehavioral Family Model (BBFM) as a conceptual framework for understanding the associations between these constructs. Statistical analysis utilizing structural equation modeling provided support that the BBFM was a sound model for assessing the relationships between these constructs within a seminary sample. Additionally, seminarians were found to have higher rates of anxiety and depression when compared to the general population. Together, findings indicate that clinical care for seminarians may be best if implemented from a global systemic perspective.
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Affiliation(s)
- Kaitlin Smith
- Department of Counseling and Clinical Psychology, Medaille University, Buffalo, NY, United States
- *Correspondence: Kaitlin Smith,
| | - David Wang
- Fuller Theological Seminary, Pasadena, CA, United States
| | - Andrea Canada
- Rosemead School of Psychology, Biola University, La Mirada, CA, United States
| | - John M. Poston
- Rosemead School of Psychology, Biola University, La Mirada, CA, United States
| | - Rick Bee
- Rosemead School of Psychology, Biola University, La Mirada, CA, United States
| | - Lara Hurlbert
- Rosemead School of Psychology, Biola University, La Mirada, CA, United States
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9
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Card AJ. The biopsychosociotechnical model: a systems-based framework for human-centered health improvement. Health Syst (Basingstoke) 2022; 12:387-407. [PMID: 38235298 PMCID: PMC10791103 DOI: 10.1080/20476965.2022.2029584] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022] Open
Abstract
The biopsychosocial model is among the most influential frameworks for human-centered health improvement but has faced significant criticism- both conceptual and pragmatic. This paper extends and fundamentally re-structures the biopsychosocial model by combining it with sociotechnical systems theory. The resulting biopsychosociotechnical model addresses key critiques of the biopsychosocial model, providing a more "practical theory" for human-centered health improvement. It depicts the determinants of health as complex adaptive system of systems; includes the the artificial world (technology); and provides a roadmap for systems improvement by: differentiating between "health status" and "health and needs assessment", [promoting problem framing]; explaining health as an emergent property of the biopsychosociotechnical context [imposing a systems orientation]; focusing on "interventions" vs. "treatments" to modify the biopsychosociotechnical determinants of health, [expanding the solution space]; calling for a participatory design process [supporting systems awareness and goal-orientation]; and including intervention management to support the full lifecycle of health improvement.
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Affiliation(s)
- Alan J. Card
- Department of Pediatrics, UC San Diego School of Medicine, La Jolla, CA, U.S.A
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10
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Bierstetel SJ, Jiang Y, Slatcher RB, Zilioli S. Parent-child conflict and physical health trajectories among youth with asthma. J Psychosom Res 2021; 150:110606. [PMID: 34560405 PMCID: PMC8559307 DOI: 10.1016/j.jpsychores.2021.110606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the role of caregiver- and youth-reports of parent-child conflict on trajectories of asthma-related health outcomes over 2 years. METHODS In a sample of 193 youth with asthma (42.7% female; M age = 12.78) and their primary caregivers, we used a multi-method and multi-informant approach to assess self-reported parent-child conflict from youth and caregivers at both the daily and global levels at baseline. Next, we annually assessed subjective (i.e., youth self-reported asthma symptoms) and clinical (i.e., peak flow) asthma health outcomes for 2 years. RESULTS Latent growth curve models revealed an effect of baseline youth-reported global family conflict on peak flow trajectories such that youth who reported greater parent-child conflict at baseline experienced less of an increase in peak flow over time than youth who reported less parent-child conflict at baseline (standardized β = -0.27, p = .003). CONCLUSIONS Youth with asthma who perceive greater overall conflict with their caregivers experience less improvement in peak flow as they age. The research and clinical implications of these findings are discussed.
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11
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Wood BL, Woods SB, Sengupta S, Nair T. The Biobehavioral Family Model: An Evidence-Based Approach to Biopsychosocial Research, Residency Training, and Patient Care. Front Psychiatry 2021; 12:725045. [PMID: 34675826 PMCID: PMC8523802 DOI: 10.3389/fpsyt.2021.725045] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Beatrice L Wood
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States.,Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Sarah B Woods
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sourav Sengupta
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Turya Nair
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
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12
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Mitchell AE, Morawska A, Mihelic M. A systematic review of parenting interventions for child chronic health conditions. J Child Health Care 2020; 24:603-628. [PMID: 31630533 DOI: 10.1177/1367493519882850] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This systematic review summarizes the parenting intervention literature for parents of children with chronic health conditions and evaluates intervention effects on parenting (parenting skills and parenting efficacy) and child (behaviour, illness severity/control and quality of life) outcomes. Systematic searches using seven electronic databases (including CINHAL, MEDLINE and PsycINFO) were used to identify relevant papers published in English between 1997 and 2017, and reference lists were searched for additional relevant articles. Ten papers reporting on eight separate studies met inclusion criteria: three studies evaluated stand-alone parenting interventions, while the remaining five studies included parenting components in broader interventions that also targeted medically oriented aspects of illness management. Results suggest that parenting interventions may lead to improved parent self-efficacy, parenting behaviour, illness severity/control, child quality of life and child behaviour; however, intervention effects were mixed and confined to parent-report outcome measures. A paucity of studies using rigorous randomized controlled trial study designs limits the conclusions that can be drawn regarding intervention efficacy. Achieving adequate enrolment and retention of families in parenting intervention trials appears to be problematic within these clinical groups. Larger samples and more diverse clinical populations will support the reliability of future evaluations of parenting interventions in this context and improve generalizability of results.
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Affiliation(s)
- Amy E Mitchell
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Alina Morawska
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Mandy Mihelic
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Australia
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Vesterling C, Koglin U. The relationship between attachment and somatoform symptoms in children and adolescents: A systematic review and meta-analysis. J Psychosom Res 2020; 130:109932. [PMID: 31981896 DOI: 10.1016/j.jpsychores.2020.109932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Problems in childhood and adolescence are often present with recurring physical signs of illness, called somatoform symptoms. These symptoms are a common reason for consultation at both paediatric care and psychotherapeutic/psychiatric praxis. We propose that attachment is a possible predictive factor. This article provides a systematic overview of the existing research literature concerning the relationship between attachment and somatoform symptoms in children and adolescents. METHODS A systematic search for empirical articles from 1990 up to August 2018 focusing on this association was conducted. Out of six databases, 4994 studies were detected by using defined keywords. One study was added identified by checking reference lists. Finally, 15 studies were selected, which were the bases for the narrative review. Ten studies were included in meta-analysis. RESULTS Combining study results, we found that attachment cannot solely predict somatoform symptoms. Mixed results are shown. The quantitative analysis substantiated these narrative results, revealing a small but significant combined effect size of Δ ≈ .12 (95% CI .04 - .19). CONCLUSIONS The findings suggest that a relationship exists, but further investigations need to demonstrate that these are not only superficial. There are many developmental factors that affect the relationship between attachment and somatoform symptoms in children and adolescents. Further research should explore this interplay in order to gain a holistic and comprehensive understanding of the underlying mechanisms that lead to these correlations and to discover possible predicting factors.
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Affiliation(s)
- Christina Vesterling
- Department of Special Needs Education and Rehabilitation, Carl von Ossietzky University of Oldenburg, Ammerleander Heerstr. 114-118, 26129 Oldenburg, Germany.
| | - Ute Koglin
- Department of Special Needs Education and Rehabilitation, Carl von Ossietzky University of Oldenburg, Ammerleander Heerstr. 114-118, 26129 Oldenburg, Germany.
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Murphy LK, Preacher KJ, Rights JD, Rodriguez EM, Bemis H, Desjardins L, Prussien K, Winning AM, Gerhardt CA, Vannatta K, Compas BE. Maternal Communication in Childhood Cancer: Factor Analysis and Relation to Maternal Distress. J Pediatr Psychol 2019; 43:1114-1127. [PMID: 30016505 DOI: 10.1093/jpepsy/jsy054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 06/17/2018] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to characterize mothers' communication with their children in a sample of families with a new or newly relapsed pediatric cancer diagnosis, first using factor analysis and second using structural equation modeling to examine relations between self-reported maternal distress (anxiety, depression, and posttraumatic stress) and maternal communication in prospective analyses. A hierarchical model of communication was proposed, based on a theoretical framework of warmth and control. Methods The sample included 115 children (age 5-17 years) with new or newly relapsed cancer (41% leukemia, 18% lymphoma, 6% brain tumor, and 35% other) and their mothers. Mothers reported distress (Beck Anxiety Inventory, Beck Depression Inventory-II, and Impact of Events Scale-Revised) 2 months after diagnosis (Time 1). Three months later (Time 2), mother-child dyads were video-recorded discussing cancer. Maternal communication was coded with the Iowa Family Interaction Ratings Scales. Results Confirmatory factor analysis demonstrated poor fit. Exploratory factor analysis suggested a six-factor model (root mean square error of approximation = .04) with one factor reflecting Positive Communication, four factors reflecting Negative Communication (Hostile/Intrusive, Lecturing, Withdrawn, and Inconsistent), and one factor reflecting Expression of Negative Affect. Maternal distress symptoms at Time 1 were all significantly, negatively related to Positive Communication and differentially related to Negative Communication factors at Time 2. Maternal posttraumatic stress and depressive symptoms each predicted Expression of Negative Affect. Conclusions Findings provide a nuanced understanding of maternal communication in pediatric cancer and identify prospective pathways of risk between maternal distress and communication that can be targeted in intervention.
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Affiliation(s)
- Lexa K Murphy
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Jason D Rights
- Department of Psychology & Human Development, Vanderbilt University
| | - Erin M Rodriguez
- Department of Psychology & Human Development, Vanderbilt University
| | - Heather Bemis
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Kemar Prussien
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Bruce E Compas
- Department of Psychology & Human Development, Vanderbilt University
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Salvador Á, Crespo C, Barros L. Family Management of Pediatric Cancer: Links with Parenting Satisfaction and Psychological Distress. FAMILY PROCESS 2019; 58:761-777. [PMID: 30063085 DOI: 10.1111/famp.12379] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Research has long acknowledged the disruptions posed by pediatric cancer diagnosis and treatment to family life. Nonetheless, the mechanisms through which the family response influences parents' mental health in this adverse context are not fully understood. The main goal of the present study was to examine the direct and indirect links, via parenting satisfaction, between family condition management and psychological distress of parents of children with cancer. Participants were 201 parents (86.6% mothers) of children/adolescents diagnosed with cancer who completed self-report questionnaires assessing family condition management (family life difficulty and parental mutuality), parenting satisfaction, and psychological distress (anxiety and depression). Structural equation modeling was used to test the proposed mediation model. The results showed that parenting satisfaction mediated the association between both the family condition management dimensions (family life difficulty and parental mutuality) and depression. Specifically, greater family life difficulties and lower parental mutuality were associated with lower parenting satisfaction, which, in turn, was associated with higher levels of depression. Additionally, greater family life difficulties and lower parental mutuality were directly linked to higher levels of anxiety. Multigroup analyses suggested that the model was valid across patient age groups (children vs. adolescents) and treatment status (on vs. off-treatment). These findings reinforce the need for family- and parent-based interventions in the pediatric oncology field. Interventions that target families' difficulties and promote their resources are likely to foster parenting satisfaction and psychological adjustment.
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Affiliation(s)
- Ágata Salvador
- Research Center for Psychological Science, Faculty of Psychology, University of Lisbon, Lisbon, Portugal
| | - Carla Crespo
- Research Center for Psychological Science, Faculty of Psychology, University of Lisbon, Lisbon, Portugal
| | - Luísa Barros
- Research Center for Psychological Science, Faculty of Psychology, University of Lisbon, Lisbon, Portugal
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16
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Priest JB, Roberson PNE, Woods SB. In Our Lives and Under Our Skin: An Investigation of Specific Psychobiological Mediators Linking Family Relationships and Health Using the Biobehavioral Family Model. FAMILY PROCESS 2019; 58:79-99. [PMID: 29577264 DOI: 10.1111/famp.12357] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The objective of this study was to use the Biobehavioral Family Model (BBFM) to delineate which psychophysiological variables link romantic and family relationship satisfaction variables to health outcomes. Data from individuals who reported being partnered from the second wave of the National Survey of Midlife Development in the United States (MIDUS II), Project 4 (n = 812) were used to test a structural equation model which explored which psychophysiological variables potentially mediated associations between positive and negative family emotional climate variables and disease activity. This model found that current and past family variables had larger associations with the psychophysiological variables than romantic partner variables; depressive symptoms, anxiety, and inflammation partially mediated associations between family relationships and health; and, contrary to the hypotheses, romantic partner and family support were linked to worse health outcomes. However, the findings should be viewed with regard to the cross-sectional design of the study. Overall, the findings support the use of the BBFM as a model that can guide clinical interventions.
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Affiliation(s)
- Jacob B Priest
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, IA
| | | | - Sarah B Woods
- Department of Family Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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17
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Ghriwati NA, Everhart RS, Winter MA. Interactive effects of family functioning and sleep experiences on daily lung functioning in pediatric asthma: An ecological momentary assessment approach. J Asthma 2019; 57:262-270. [PMID: 30669891 DOI: 10.1080/02770903.2019.1568453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives: Children living in urban, underserved settings are at risk for experiencing sleep difficulties as well as poor asthma outcomes. The family is important for both asthma management and ensuring children are getting the necessary amount of sleep, but how family functioning and sleep patterns influence children's asthma remains unclear. Methods: Fifty-nine children (7-12 years old; 90% African American) diagnosed with asthma, and their primary caregivers, participated in this study. In a single research session, caregivers rated overall family functioning via the Family Assessment Device. Caregivers also completed daily diaries delivered via smartphone for a two-week period rating their children's daily sleep quantity and quality; a home-based spirometer (AM2) was used to assess children's pulmonary functioning across that same period. Two-level multilevel models tested associations among overall family functioning, children's sleep quality/quantity, and pulmonary functioning. Results: Child sleep quality, quantity, and general family functioning did not predict child pulmonary functioning directly. Family functioning and sleep quality interacted to predict children's pulmonary functioning; children with poor family functioning and bad/very bad sleep quality had the poorest levels of lung functioning. Conclusions: These findings highlight a subset of children who are at higher risk for poor lung functioning based on sleep quality and family functioning. Results may inform routine monitoring of family functioning and sleep difficulties at pediatric asthma visits and intervention strategies to augment children's lung functioning.
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18
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Priest JB. Examining Differentiation of Self as a Mediator in the Biobehavioral Family Model. JOURNAL OF MARITAL AND FAMILY THERAPY 2019; 45:161-175. [PMID: 29210455 DOI: 10.1111/jmft.12301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Biobehavioral Family Model (BBFM) is a biopsychosocial model of health. This model proposes that biobehavioral reactivity mediates the association between the family emotional climate and disease activity. To improve the clinical relevance of the BBFM, variables that mediate the association between family emotional climate and biobehavioral reactivity need to be tested. This study examined differentiation of self as a mediator. Using data from the Midlife Development in the United States study (n = 854), results suggested that differentiation of self mediated the association between the family and intimate partner emotional climate and mental health symptoms. These findings suggest that including differentiation of self into the BBFM may help interventions based on the model target factors that could improve health outcomes.
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19
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Wood BL, Brown ES, Lehman HK, Khan DA, Lee MJ, Miller BD. The effects of caregiver depression on childhood asthma: Pathways and mechanisms. Ann Allergy Asthma Immunol 2018; 121:421-427. [PMID: 29981440 DOI: 10.1016/j.anai.2018.06.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/14/2018] [Accepted: 06/28/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To review the literature regarding the effects of caregiver depression on childhood asthma and integrate the findings into a multilevel model of pathways by which these effects occur to further the understanding of the complex biopsychosocial nature of childhood asthma and the key role that is played by caregiver depression. DATA SOURCES PubMed was searched for articles published from 2007 to the present (10-year search), and Google Scholar was searched for articles published in 2017 and 2018 to identify the most recent publications. STUDY SELECTIONS Studies selected were recent, empirical, or meta-analytic, conducted in humans, and had specific relevance to one or more of the identified pathways. Articles published before 2007 were included if deemed essential because they addressed key pathways, for which there were no more recent articles. RESULTS Review of the literature substantiates that caregiver depression plays a key role in the socioeconomic, familial, psychological, and biological cascade of effects on childhood asthma. Childhood asthma outcomes are affected indirectly by socioeconomic status and family stress mediated by caregiver depression, which affects disease management, and/or stress and depression in the child, which, in turn, affect asthma through alterations in immune modulation and autonomic regulation. CONCLUSION Findings indicate that future research should concentrate on mediators and moderators to further clarify the complex interplay of these factors that affect childhood asthma. The findings also have substantial translational implications. Given that child stress and depression contribute to asthma disease activity and that treating caregiver depression improves child stress and depression, there is strong rationale for treating depressed caregivers of children with asthma as a component means of improving childhood asthma control.
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Affiliation(s)
- Beatrice L Wood
- Department of Psychiatry, Jacobs School of Medicine, University at Buffalo, Buffalo, New York; Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.
| | - E Sherwood Brown
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas
| | - Heather K Lehman
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, UT Southwestern Medical Center, Dallas, Texas
| | - Min Jung Lee
- Department of Internal Medicine, Division of Allergy & Immunology, UT Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas
| | - Bruce D Miller
- Department of Psychiatry, Jacobs School of Medicine, University at Buffalo, Buffalo, New York; Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
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Murphy LK, Murray CB, Compas BE. Topical Review: Integrating Findings on Direct Observation of Family Communication in Studies Comparing Pediatric Chronic Illness and Typically Developing Samples. J Pediatr Psychol 2018; 42:85-94. [PMID: 28172942 DOI: 10.1093/jpepsy/jsw051] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/16/2016] [Accepted: 05/16/2016] [Indexed: 11/13/2022] Open
Abstract
Objective To review research on observed family communication in families with children with chronic illnesses compared with families with healthy, typically developing children, and to integrate findings utilizing a unifying family communication framework. Method Topical review of studies that have directly observed family communication in pediatric populations and included a typically developing comparison group. Results Initial findings from 14 studies with diverse approaches to quantifying observed family communication suggest that families with children with chronic illnesses may demonstrate lower levels of warm and structured communication and higher levels of hostile/intrusive and withdrawn communication compared with families with healthy, typically developing children. Conclusion An integrative framework of family communication may be used in future studies that examine the occurrence, correlates, and mechanisms of family communication in pediatric populations.
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Affiliation(s)
- Lexa K Murphy
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Caitlin B Murray
- Psychology Department, Loyola University Chicago, Chicago, IL, USA
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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21
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Farrell AK, Slatcher RB, Tobin ET, Imami L, Wildman DE, Luca F, Zilioli S. Socioeconomic status, family negative emotional climate, and anti-inflammatory gene expression among youth with asthma. Psychoneuroendocrinology 2018; 91. [PMID: 29529520 PMCID: PMC5903571 DOI: 10.1016/j.psyneuen.2018.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The glucocorticoid receptor gene NR3C1 is an important down-regulator of inflammation and is typically under-expressed in individuals with low socioeconomic status (SES). Negative emotionality has been suggested as a potential mediator of SES disparities in health outcomes. In this study, we expand this literature by naturalistically assessing negative emotionality in a key emotional environment: the family. In a sample of 104 youth with asthma (10-17 years) and their primary caregiver, we assessed SES via caregiver report, emotional expression by youth and parents in the home over four days using the electronically activated recorder (EAR), and NR3C1 expression via blood collected from youth. Although there was not a direct effect of SES on NR3C1 expression, bootstrapping mediation analyses showed a significant indirect path such that lower SES was associated with a more negative family emotional climate, which in turn predicted reduced NR3C1 expression. No mediation effects were found for family positive emotional climate. This research demonstrates the importance of examining the effects of SES on emotion expression in the family context and suggests a critical biopsychosocial pathway underlying SES-based health disparities that may extend beyond youth.
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Affiliation(s)
- Allison K. Farrell
- Department of Psychology, Wayne State University, 5057 Woodward Ave,
Detroit, MI 48202,Center for Molecular Medicine and Genetics and Department of
Obstetrics and Gynecology, Wayne State University, 540 East Canfield, Detroit, MI
48201
| | - Richard B. Slatcher
- Department of Psychology, Wayne State University, 5057 Woodward Ave,
Detroit, MI 48202
| | - Erin T. Tobin
- Department of Internal Medicine, Henry Ford Health System, Detroit,
MI
| | - Ledina Imami
- Department of Psychology, Wayne State University, 5057 Woodward Ave,
Detroit, MI 48202
| | - Derek E. Wildman
- Department of Molecular & Integrative Physiology and Carl R.
Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign,
1206 West Gregory Dr, Urbana, IL 61801
| | - Francesca Luca
- Center for Molecular Medicine and Genetics and Department of
Obstetrics and Gynecology, Wayne State University, 540 East Canfield, Detroit, MI
48201
| | - Samuele Zilioli
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI 48202, United States; Department of Family Medicine and Public Health Sciences, Wayne State University, 3939 Woodward Ave, Detroit, MI 48201, United States.
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22
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How health behaviors link romantic relationship dysfunction and physical health across 20 years for middle-aged and older adults. Soc Sci Med 2018; 201:18-26. [DOI: 10.1016/j.socscimed.2018.01.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/10/2018] [Accepted: 01/27/2018] [Indexed: 12/21/2022]
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Booster GD, Oland AA, Bender BG. Psychosocial Factors in Severe Pediatric Asthma. Immunol Allergy Clin North Am 2017; 36:449-60. [PMID: 27401618 DOI: 10.1016/j.iac.2016.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Asthma is the most common chronic illness among children in the United States and can impact nearly all aspects of functioning. Most research suggests that children with severe asthma display more emotional and behavioral problems than their healthy peers. These psychological difficulties are associated with increased risk for functional impairments and problematic disease course. Multidisciplinary teams that assess and treat these psychosocial factors using psychoeducational and behavioral interventions are important for children whose asthma is poorly controlled. Future research should examine the ways in which stress, emotions, and immune functions interact, so as to develop more preventative interventions.
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Affiliation(s)
- Genery D Booster
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - Alyssa A Oland
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Bruce G Bender
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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Rolland JS. Neurocognitive Impairment: Addressing Couple and Family Challenges. FAMILY PROCESS 2017; 56:799-818. [PMID: 28887888 DOI: 10.1111/famp.12316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Conditions involving neurocognitive impairment pose enormous challenges to couples and families. However, research and practice tend to focus narrowly on immediate issues for individual caregivers and their dyadic relationship with the affected member. A broad family systems approach with attention to family processes over time is needed in training, practice, and research. In this paper, Rolland's Family Systems Illness model provides a guiding framework to consider the interaction of different psychosocial types of neurocognitive conditions and their evolution over time with individual, couple, and family life-course development. Discussion addresses key family and couple issues with mild-to-severe cognitive impairment and progressive dementias, including: communication, multigenerational legacies, threatened future neurocognitive disability, ambiguous loss, decisional capacity, reaching limits, placement decisions, issues for adult children and spousal caregivers, and the transformation of intimate bonds. Principles and guidelines are offered to help couples and families master complex challenges, deepen bonds, and forge positive pathways ahead.
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Affiliation(s)
- John S Rolland
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, and Chicago Center for Family Health, Chicago, IL
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Al G8hriwati N, Winter MA, Everhart RS. Examining Profiles of Family Functioning in Pediatric Asthma: Longitudinal Associations With Child Adjustment and Asthma Severity. J Pediatr Psychol 2017; 42:434-444. [PMID: 27803176 PMCID: PMC5896623 DOI: 10.1093/jpepsy/jsw089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/13/2022] Open
Abstract
Objective Identify profiles of functioning in families of children with asthma and examine whether profile membership predicts subsequent child mental and physical well-being. Methods Primary caregivers and children ( N = 1,030) from the Childhood Asthma Management Program completed questionnaires assessing family functioning and child adaptation at five time points. Asthma severity was also assessed via spirometry. Results Latent profile analyses identified a four-profile solution as best fitting the data: cohesive, permissive, controlling/disengaged, and controlling/enmeshed families. Distal outcome analyses using Bolck-Croon-Hagenaars techniques suggested that children from families that were more cohesive had fewer internalizing and externalizing symptoms. These associations remained stable across time. Family profiles did not differ with regards to child asthma severity. Conclusion Results highlight the importance of looking beyond the effects of distinct components of family functioning and instead using pattern-based approaches. Recommendations for incorporating screenings and services for families in pediatric care settings are provided.
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Walker VG. Exploration of the Influence of Factors Identified in the Literature on School-aged Children's Emotional Responses to Asthma. J Pediatr Nurs 2017; 33:54-62. [PMID: 28065421 PMCID: PMC5376515 DOI: 10.1016/j.pedn.2016.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/09/2016] [Accepted: 11/28/2016] [Indexed: 01/16/2023]
Abstract
Approximately 6.3 million US children suffer from asthma. The purpose of this study was to explore factors on school-aged children's emotional responses to asthma, N=85, ages 6-12. Correlations included Asthma related child emotional functioning QOL and (a) asthma severity, r=-0.30, p<0.01, (b) child internalizing behaviors, r=-0.26, p<0.05, (c) child externalizing behaviors r=-0.43, p<0.001; Caregiver emotional functioning QOL and (a) asthma severity, r=-0.39, p<0.001, (b) child internalizing behaviors, r=-0.22, p<0.05, (c) child externalizing behaviors, r=-0.25; p<0.05. Multiple regression analysis revealed that asthma severity and child externalizing problems accounted for 26% of the variance in asthma related child emotional functioning QOL, F (4, 79)=7.051, p<0.001 (asthma severity, β=-0.31, p<0.01; child externalizing problem behaviors, β=-0.43, p<0.001). Findings imply that asthma research should consider problem behaviors of school-aged children when addressing asthma related emotional functioning QOL.
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Mitchell AE, Fraser JA, Morawska A, Ramsbotham J, Yates P. Parenting and childhood atopic dermatitis: A cross-sectional study of relationships between parenting behaviour, skin care management, and disease severity in young children. Int J Nurs Stud 2016; 64:72-85. [PMID: 27693983 DOI: 10.1016/j.ijnurstu.2016.09.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The development of child behaviour and parenting difficulties is understood to undermine treatment outcomes for children with atopic dermatitis. Past research has reported on correlates of child behaviour difficulties. However, few research studies have sought to examine parenting confidence and practices in this clinical group. OBJECTIVES To examine relationships between child, parent, and family variables, parent-reported and directly-observed child and parent behaviour, parents' self-efficacy with managing difficult child behaviour, self-reported parenting strategies, and disease severity. DESIGN Cross-sectional study design. PARTICIPANTS Parent-child dyads (N=64) were recruited from the dermatology clinic of a paediatric tertiary referral hospital in Brisbane, Australia. Children had a diagnosis of atopic dermatitis of ≥3months and no other chronic health conditions except asthma, allergic rhinitis, or allergy. METHODS Parents completed self-report measures assessing child behaviour; parent depression, anxiety, and stress; parenting conflict and relationship satisfaction; self-efficacy with managing difficult child behaviour, and use of ineffective parenting strategies; and self-efficacy for managing atopic dermatitis, and performance of atopic dermatitis management tasks. The Scoring Atopic Dermatitis index was used to assess disease severity. Routine at-home treatment sessions were coded for parent and child behaviour. RESULTS Pearson's and Spearman's correlations identified relationships (p<0.05) between self-efficacy with managing difficult child behaviour and child behaviour problems, parent depression and stress, parenting conflict and relationship satisfaction, and household income. There were also relationships between each of these variables and use of ineffective parenting strategies. Greater use of ineffective parenting strategies was associated with more severe atopic dermatitis. Using multiple linear regressions, child behaviour and household income explained unique variance in self-efficacy for managing difficult child behaviour; household income alone explained unique variance in use of ineffective parenting strategies. Self-efficacy for managing difficult child behaviour and self-efficacy for managing atopic dermatitis were positively correlated (rho=0.48, p<0.001), and more successful self-reported performance of atopic dermatitis management tasks correlated with less permissive (r=0.35, p=0.005) and less authoritarian (r=0.41, p=0.001) parenting. Directly observed aversive child behaviour was associated with more severe atopic dermatitis, parent stress, and parent-reported child behaviour problems. CONCLUSION This study revealed relationships between parents' self-efficacy and parenting practices across the domains of child behaviour management and atopic dermatitis management. Parents of children with more severe atopic dermatitis may have difficulty responding to child behaviour difficulties appropriately, potentially impacting on illness management. Incorporating parent and parenting support within treatment plans may improve not only child and family wellbeing, but also treatment outcomes.
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Affiliation(s)
- Amy E Mitchell
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St. Lucia QLD 4072, Australia.
| | - Jennifer A Fraser
- Sydney Nursing School, the University of Sydney, NSW 2006, Australia.
| | - Alina Morawska
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St. Lucia QLD 4072, Australia.
| | - Joanne Ramsbotham
- School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4059, Australia.
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4059, Australia.
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Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma. J Clin Psychol Med Settings 2016; 22:179-93. [PMID: 26054697 PMCID: PMC4575360 DOI: 10.1007/s10880-015-9423-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups analyzed in previous research, scores on the Parenting Stress Index in mothers and fathers of the children with problematic severe asthma were low. Higher parenting stress was associated with higher levels of internalizing and externalizing behavioral problems in children (Child Behavior Checklist). Higher parenting stress in mothers was also associated with higher airway inflammation (FeNO). Thus, although parenting stress was suggested to be low in this group, higher parenting stress, especially in the mother, is associated with more airway inflammation and greater child behavioral problems. This indicates the importance of focusing care in this group on all possible sources of problems, i.e., disease exacerbations and behavioral problems in the child as well as parenting stress.
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Distelberg BJ, Emerson ND, Gavaza P, Tapanes D, Brown WN, Shah H, Williams-Reade J, Montgomery S. A Cost-Benefit Analysis of a Family Systems Intervention for Managing Pediatric Chronic Illness. JOURNAL OF MARITAL AND FAMILY THERAPY 2016; 42:371-382. [PMID: 27282311 PMCID: PMC4938762 DOI: 10.1111/jmft.12166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite recent increases of psychosocial programs for pediatric chronic illness, few studies have explored their economic benefits. This study investigated the costs-benefits of a family systems-based, psychosocial intervention for pediatric chronic illness (MEND: Mastering Each New Direction). A quasi-prospective study compared the 12-month pre-post direct and indirect costs of 20 families. The total cost for program was estimated to $5,320. Families incurred $15,249 less in direct and $15,627 less in indirect costs after MEND. On average, medical expenses reduced by 86% in direct and indirect costs, for a cost-benefit ratio of 0.17. Therefore, for every dollar spent on the program, families and their third payers saved approximately $5.74. Implications for healthcare policy and reimbursements are discussed.
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Morawska A, Mitchell AE, Burgess S, Fraser J. Effects of Triple P parenting intervention on child health outcomes for childhood asthma and eczema: Randomised controlled trial. Behav Res Ther 2016; 83:35-44. [PMID: 27295179 DOI: 10.1016/j.brat.2016.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 05/23/2016] [Accepted: 06/01/2016] [Indexed: 11/15/2022]
Abstract
UNLABELLED Childhood chronic health conditions have considerable impact on children. We aimed to test the efficacy of a brief, group-based parenting intervention for improving illness-related child behaviour problems, parents' self-efficacy, quality of life, parents' competence with treatment, and symptom severity. A 2 (intervention vs. care as usual) by 3 (baseline, post-intervention, 6-month follow-up) design was used, with random group assignment. Participants were 107 parents of 2- to 10-year-old children with asthma and/or eczema. Parents completed self-report questionnaires, symptom diaries, and home observations were completed. The intervention comprised two 2-h group discussions based on Triple P. Parents in the intervention group reported (i) fewer eczema-related, but not asthma-related, child behaviour problems; (ii) improved self-efficacy for managing eczema, but not asthma; (iii) better quality of life for parent and family, but not child; (iv) no change in parental treatment competence; (v) reduced symptom severity, particularly for children prescribed corticosteroid-based treatments. Results demonstrate the potential for brief parenting interventions to improve childhood chronic illness management, child health outcomes, and family wellbeing. Effects were stronger for eczema-specific outcomes compared to asthma-specific outcomes. Effects on symptom severity are very promising, and further research examining effects on objective disease severity and treatment adherence is warranted. AUSTRALIA NEW ZEALAND CLINICAL TRIALS REGISTRATION ACTRN12611000558921.
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Affiliation(s)
- Alina Morawska
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane 4072, Australia.
| | - Amy E Mitchell
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Scott Burgess
- Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD 4101, Australia.
| | - Jennifer Fraser
- Sydney Nursing School, The University of Sydney, Sydney, NSW 2006, Australia.
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Abbas T, Zilioli S, Tobin ET, Imami L, Kane HS, Saleh DJ, Slatcher RB. Youth reports of parents' romantic relationship quality: Links to physical health. Health Psychol 2016; 35:927-34. [PMID: 26998733 DOI: 10.1037/hea0000354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Prior work has shown that negative aspects (e.g., conflict) of marriage or marriage-like relationships are associated with poor health of offspring, but much less is known about the effects of positive aspects (e.g., affection) of parental romantic relationships. This study investigated links between conflict and affection within parents' romantic relationships and the health of youth with asthma. METHOD Eighty youths with asthma aged 10-17 answered daily questions over a 4-day period about conflict and affection within their parents' romantic relationship, as well as their own daily mood, asthma symptoms, and expiratory peak flow. RESULTS Multiple regression analyses revealed that romantic affection-but not conflict-was directly associated with higher expiratory peak flow. Further, there was a significant indirect effect of romantic affection via youth positive affect on lower asthma symptoms. CONCLUSION These results are the first to our knowledge to demonstrate that youth-reported positive characteristics of parents' romantic relationships are associated with better health among youth with asthma. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Heidi S Kane
- School of Behavioral and Brain Sciences, University of Texas
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32
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The Biobehavioral Family Model: Close relationships and allostatic load. Soc Sci Med 2015; 142:232-40. [DOI: 10.1016/j.socscimed.2015.08.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 08/04/2015] [Accepted: 08/14/2015] [Indexed: 11/22/2022]
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Nabors LA, Meerianos AL, Vidourek RA, King KA, Rosen BL, Zhang J, Swoboda C. Predictors of flourishing for adolescents with asthma. J Asthma 2015; 53:146-54. [PMID: 26312650 DOI: 10.3109/02770903.2015.1072722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to examine well-being or flourishing of adolescents with asthma as well as factors influencing flourishing for these adolescents. METHODS A secondary analysis of data collected for the 2011-2012 National Survey of Children's Health was conducted. Flourishing of adolescents with and without asthma was compared. Parent coping and anger, child sex and age and child flourishing were examined for adolescents with asthma. RESULTS Youth with asthma had lower flourishing than those without this disease. Positive parent coping was related to flourishing, while parent anger negatively influenced flourishing of adolescents with asthma. Interaction terms were significant, indicating that the aforementioned variables interacted with adolescent age and sex. CONCLUSIONS Study results point to a complex relationship between parent- and adolescent-level factors and adolescent well-being. Further research is needed to examine relations among flourishing and health outcomes in youth with asthma.
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Affiliation(s)
| | | | | | | | | | - Jiaqi Zhang
- b Quantitative and Mixed Methods Research Methodologies, University of Cincinnati , Cincinnati , OH , USA
| | - Christopher Swoboda
- b Quantitative and Mixed Methods Research Methodologies, University of Cincinnati , Cincinnati , OH , USA
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Wood BL, Miller BD, Lehman HK. Review of family relational stress and pediatric asthma: the value of biopsychosocial systemic models. FAMILY PROCESS 2015; 54:376-389. [PMID: 25683472 DOI: 10.1111/famp.12139] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Asthma is the most common chronic disease in children. Despite dramatic advances in pharmacological treatments, asthma remains a leading public health problem, especially in socially disadvantaged minority populations. Some experts believe that this health gap is due to the failure to address the impact of stress on the disease. Asthma is a complex disease that is influenced by multilevel factors, but the nature of these factors and their interrelations are not well understood. This paper aims to integrate social, psychological, and biological literatures on relations between family/parental stress and pediatric asthma, and to illustrate the utility of multilevel systemic models for guiding treatment and stimulating future research. We used electronic database searches and conducted an integrated analysis of selected epidemiological, longitudinal, and empirical studies. Evidence is substantial for the effects of family/parental stress on asthma mediated by both disease management and psychobiological stress pathways. However, integrative models containing specific pathways are scarce. We present two multilevel models, with supporting data, as potential prototypes for other such models. We conclude that these multilevel systems models may be of substantial heuristic value in organizing investigations of, and clinical approaches to, the complex social-biological aspects of family stress in pediatric asthma. However, additional systemic models are needed, and the models presented herein could serve as prototypes for model development.
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Affiliation(s)
- Beatrice L Wood
- Psychiatry and Pediatrics, University at Buffalo, Buffalo, NY
| | - Bruce D Miller
- Psychiatry and Pediatrics, University at Buffalo, Buffalo, NY
| | - Heather K Lehman
- Allergy and Immunology, Woman and Children's Hospital of Buffalo, Buffalo, NY
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Abstract
Improvement of medication adherence in the school-age child can lead to improvement in quality of life, decreased morbidity, and a potential decreased risk of deferred academic, social, and emotional development. The objective of this article is to review barriers to asthma medication adherence and identify evidence-based techniques that improve medication management of the asthmatic child 5 to 12 years of age. A literature review was performed and articles were obtained through database searches within Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PubMed. Research indicates that barriers to the adherence of medication regimens required for asthmatic children include poor understanding of the medication regimen, substandard education on symptom recognition and environmental triggers, rejection of the diagnosis, and a lack of support or understanding within the community. Researched techniques aimed to improve medication management in 5- to 12-year-olds include: computer-based education; workshops for parents, teachers, and children; incorporation of asthma education into classroom lessons; use of case managers; the introduction of a nurse practitioner in the school to provide care, including medication prescriptions for the asthmatic child; and assessment and evaluation of environmental and emotional triggers in the home and school. Collaboration of current data may help lead to a successful interventional model that can improve asthma management in this population.
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Affiliation(s)
- Mary Friend
- University of Cincinnati, Cincinnati, OH, USA
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Woods SB, Priest JB, Roush T. The biobehavioral family model: testing social support as an additional exogenous variable. FAMILY PROCESS 2014; 53:672-685. [PMID: 24981970 DOI: 10.1111/famp.12086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study tests the inclusion of social support as a distinct exogenous variable in the Biobehavioral Family Model (BBFM). The BBFM is a biopsychosocial approach to health that proposes that biobehavioral reactivity (anxiety and depression) mediates the relationship between family emotional climate and disease activity. Data for this study included married, English-speaking adult participants (n = 1,321; 55% female; M age = 45.2 years) from the National Comorbidity Survey Replication, a nationally representative epidemiological study of the frequency of mental disorders in the United States. Participants reported their demographics, marital functioning, social support from friends and relatives, anxiety and depression (biobehavioral reactivity), number of chronic health conditions, and number of prescription medications. Confirmatory factor analyses supported the items used in the measures of negative marital interactions, social support, and biobehavioral reactivity, as well as the use of negative marital interactions, friends' social support, and relatives' social support as distinct factors in the model. Structural equation modeling indicated a good fit of the data to the hypothesized model (χ(2) = 846.04, p = .000, SRMR = .039, CFI = .924, TLI = .914, RMSEA = .043). Negative marital interactions predicted biobehavioral reactivity (β = .38, p < .001), as did relatives' social support, inversely (β = -.16, p < .001). Biobehavioral reactivity predicted disease activity (β = .40, p < .001) and was demonstrated to be a significant mediator through tests of indirect effects. Findings are consistent with previous tests of the BBFM with adult samples, and suggest the important addition of family social support as a predicting factor in the model.
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Affiliation(s)
- Sarah B Woods
- Department of Family Sciences, Texas Woman's University, Denton, TX
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Lord JH, Young MT, Gruhn MA, Grey M, Delamater AM, Jaser SS. Effect of race and marital status on mothers' observed parenting and adolescent adjustment in youth with type 1 diabetes. J Pediatr Psychol 2014; 40:132-43. [PMID: 25248850 DOI: 10.1093/jpepsy/jsu078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To examine demographic differences in parenting behaviors and adjustment in youth with type 1 diabetes. METHODS Adolescents' psychosocial adjustment was assessed via self-reports and parent reports, and clinical data were obtained from adolescents' medical records. Mother-adolescent dyads (N = 93) engaged in a videotaped discussion task, which was coded for observed parenting behaviors. RESULTS Single and non-White mothers exhibited significantly more overinvolved and less collaborative parenting behaviors. Higher levels of overinvolved parenting and lower levels of collaborative parenting were associated with poorer adolescent adjustment (i.e., higher levels of externalizing problems). Observed parenting was not significantly associated with glycemic control. There was an indirect effect of marital status and race/ethnicity on externalizing behaviors through parenting. CONCLUSIONS The current study highlights parenting as a potential target for interventions, especially in single and minority mothers, to improve adjustment in this population.
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Affiliation(s)
- Jadienne H Lord
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
| | - Mackenzie T Young
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
| | - Meredith A Gruhn
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
| | - Margaret Grey
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
| | - Alan M Delamater
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
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Imami L, Tobin ET, Kane HS, Saleh DJ, Lupro TH, Slatcher RB. Effects of socioeconomic status on maternal and child positive behaviors in daily life among youth with asthma. J Pediatr Psychol 2014; 40:55-65. [PMID: 25150261 DOI: 10.1093/jpepsy/jsu066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Socioeconomic disadvantage is associated with poorer behavioral and emotional outcomes in children with asthma. This study investigated the associations between maternal income and education and naturalistically observed behaviors and affect during everyday parent-child interactions. METHODS 53 predominantly low-income youth with asthma, aged 10-17 years, wore a naturalistic event-sampling device, the Electronically Activated Recorder, for 4 days to assess mother and child positive behaviors and affect in daily life. RESULTS Maternal education, but not income, was positively associated with child positive behaviors, displays of mother and child positive affect, and increased maternal responsiveness. Maternal positive affect and maternal responsiveness mediated the effect of maternal education on child positive affect. CONCLUSIONS Our findings suggest that maternal education has an important influence on the socioemotional adjustment of youth with asthma and point to the importance of investigating the independent influence of socioeconomic status components on everyday parent-child interactions.
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Affiliation(s)
- Ledina Imami
- Department of Psychology, Wayne State University and School of Behavioral and Brain Sciences, The University of Texas at Dallas
| | - Erin T Tobin
- Department of Psychology, Wayne State University and School of Behavioral and Brain Sciences, The University of Texas at Dallas
| | - Heidi S Kane
- Department of Psychology, Wayne State University and School of Behavioral and Brain Sciences, The University of Texas at Dallas
| | - Daniel J Saleh
- Department of Psychology, Wayne State University and School of Behavioral and Brain Sciences, The University of Texas at Dallas
| | - Toni H Lupro
- Department of Psychology, Wayne State University and School of Behavioral and Brain Sciences, The University of Texas at Dallas
| | - Richard B Slatcher
- Department of Psychology, Wayne State University and School of Behavioral and Brain Sciences, The University of Texas at Dallas
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Wyatt TH, Li X, Huang Y, Farmer R, Reed D, Burkhart PV. Developing an interactive story for children with asthma. Nurs Clin North Am 2013; 48:271-85. [PMID: 23659813 DOI: 10.1016/j.cnur.2013.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite advancements in asthma treatment and diagnosis, asthma still remains the number 1 cause for hospitalizations in school-aged children. This usability study aimed to develop a child-friendly interactive narrative, Okay with Asthma v2.0, based on the Biopsychosocial Family Model using feedback from children. This fun and kid-friendly program encourages children to manage their own asthma with the help of peers, families, communities, and health care services. With these support structures, children can identify and avoid triggers, monitor their asthma, manage their condition with medications based on an action plan, and learn to live happily with asthma.
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Affiliation(s)
- Tami H Wyatt
- Educational Technology & Simulation, Health Information Technology & Simulation Lab, College of Nursing, University of Tennessee, Knoxville, TN 37996, USA.
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40
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Walker VG. Minority caregivers' emotional responses and perceptions of the emotional responses of their children to asthma: comparing boys and girls. Issues Ment Health Nurs 2013; 34:325-34. [PMID: 23663019 DOI: 10.3109/01612840.2012.753559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Approximately 7.1 million children in the US suffer from asthma. An exploratory qualitative study using a stratified purposive sampling method was conducted. The sample included four Latina and four African American female caregivers of children (ages 6-12) who had asthma. Caregivers were asked open-ended questions about perceptions of their children's emotional responses to asthma. Major themes and subthemes were identified with content analysis. Sons were reported as quiet when experiencing asthma. Daughters were described as being verbal, worried, excited. A question from the study was whether the children's responses were related to caregivers' (a) actions, (b) responses to asthma, and/or(c) race/ethnicity.
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Santos S, Crespo C, Silva N, Canavarro MC. Quality of life and adjustment in youths with asthma: the contributions of family rituals and the family environment. FAMILY PROCESS 2012; 51:557-69. [PMID: 23230985 DOI: 10.1111/j.1545-5300.2012.01416.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 03/30/2012] [Accepted: 03/30/2012] [Indexed: 05/23/2023]
Abstract
This cross-sectional study explored the relationships among family ritual meaning, cohesion, conflict, and health-related quality of life (both specific to chronic health conditions and in general), and the emotional and behavioral problems reported by youths with asthma. Participants included 149 Portuguese children and adolescents between the ages of 8 and 18 who had been diagnosed with asthma and attended outpatient services at three public hospitals. The results showed that stronger family ritual meaning predicted a more positive family environment (i.e., higher cohesion levels and lower conflict levels), better health-related quality of life, and fewer emotional and behavior problems in youths. Furthermore, family cohesion and conflict mediated the links between family ritual meaning and health-related quality of life, and emotional and behavioral problems. These results did not change after controlling for participant age, gender, and asthma severity. The findings of this study suggest that family ritual meaning contributes to the adaptation of youths with asthma via its positive association with the family environment. The implications for multicontextual interventions with families are briefly discussed with regard to the positive role of family rituals and of their potential as a modifiable factor in families with increased health challenges.
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Affiliation(s)
- Susana Santos
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
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Abstract
This paper applies the Biobehavioral Family Model (BBFM) of stress- related illness to the study and treatment of an adolescent with intractable asthma. The model is described, along with supportive research findings. Then a case study is presented, demonstrating how the model is clinically applied. We tell the story of an asthmatic adolescent presenting for therapy due to her intense asthmatic crises, and the case is presented to exemplify how the BBFM can help understand the family-psychobiological contribution to exacerbation of disease activity, and therefore guide treatment towards the amelioration of severe physical symptoms. Facets of the patient's intra-familial interactions are consistent with the BBFM, which support clinical validation of the model. In the case described, it is likely that additional asthma medications would not have had the desired ameliorative effect, because they did not target the family relational processes contributing to the symptoms. The recognition of the influences of family relational processes on the disease was crucial for effective intervention. The therapy incorporates and weaves together BBFM understanding of family patterns of interaction and physiological/medical concerns integrated with Bowenian intervention strategies. This case study validates the importance and usefulness of BBFM for intervention with stress-sensitive illnesses such as asthma.
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Falceto OG, Giugliani ERJ, Fernandes CLC. Problematic parent-infant relationships in two-parent families: prevalence and risk factors in a Brazilian neighborhood. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2012; 34:139-46. [DOI: 10.1590/s2237-60892012000300005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction: Although the quality of parent-child relationships is known to be associated with the offspring's mental health, little is known about the prevalence of problematic relationships in this scenario. This cross-sectional study aims to investigate the prevalence and risk factors of different types of early parent-infant relationships in a Brazilian population group. Methods: During 1 year, all families (n = 230) from an urban community of Porto Alegre, southern Brazil, with 4-month-old infants born in public hospitals were identified, and 148 were fully investigated by two family therapists. This study describes data on the 116 infants with two-parent families. Demographic, obstetric, and relational variables were collected through questionnaires and scales (Parent-Infant Relationship Global Assessment Scale, Global Assessment of Relational Functioning, and Self-Report Questionnaire). Prevalence ratios were calculated, and Poisson regression with robust variance was performed to adjust for covariates. Results: Almost 10% of mothers and 12% of fathers showed at least a significantly perturbed relationship with their 4-month-old infants. Inadequate mother-infant bonding coincided with evidence of paternal mental disorder, poor maternal social network, and discontinuation of breastfeeding at 4 months. A problematic father-infant relationship was associated with a dysfunctional couple relationship and with low infant birth weight. Conclusions: There is a high prevalence of early parent-child relationship problems, suggesting a need for health system interventions. Parent-infant relational problems are prevalent very early in life and more associated with other relational problems than with socioeconomic burden.
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Abstract
A systematic review of the literature was performed to answer the following questions (a) What factors contribute to the emotional responses of school-age children who have asthma? (b) What are the potential gaps in the literature regarding the emotional responses of school-age children (ages 6-12) who have asthma? (c) Are children with a lower socioeconomic status (SES) and those who are minorities represented in the literature proportionate to their prevalence? Two main focus areas regarding emotional responses were identified: (a) factors related to children who have asthma and (b) factors related to caregivers of children who have asthma. Internalizing disorders were reported consistently for children and caregivers of children who have asthma. Negative consequences of asthma for children included panic and asthma attacks, missed school days, and behavioral problems. Issues for caregivers included higher levels of anxiety and depressive symptoms, asthma management deficits, and lower caregiver warmth and involvement. Gaps in the literature included separated studies for children ages 6-12, a lack of a standardized method to define SES, studies that were of a more experimental nature, and a disparate number of studies of minority children and caregivers relative to their asthma prevalence.
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Woods SB, McWey LM. A biopsychosocial approach to asthma in adolescents encountering child protective services. J Pediatr Psychol 2011; 37:404-13. [PMID: 22167124 DOI: 10.1093/jpepsy/jsr104] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To further test the validity of the Biobehavioral Family Model (BBFM), a biopsychosocial approach to explaining the effects of family processes on illness, by testing the model with adolescents with asthma involved in child protective services (CPS), a sample for whom the model's constructs are highly relevant. METHODS Data are from the National Survey of Child and Adolescent Well-Being, CPS sample (n = 5,501). Adolescents with asthma (n = 101, ages 11-15 years) self-reported their negative family emotional climate (NFEC; caregiver psychological aggression and caregiver relationship quality), caregiver-adolescent relational security, and depressive symptoms. Caregivers rated adolescent health quality. Models were tested using path analyses and bootstrapping. RESULTS Path analyses and bootstrapping results demonstrate support for the BBFM in explaining health quality for this sample. CONCLUSIONS Applying the BBFM to families involved with CPS demonstrates pathways by which family processes affect health quality of adolescents with asthma, underscoring the need for biopsychosocial assessments and services.
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Affiliation(s)
- Sarah B Woods
- Department of Family & Child Sciences, The Florida State University, Tallahassee, FL 32306, USA.
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Winter MA, Fiese BH, Spagnola M, Anbar RD. Asthma severity, child security, and child internalizing: using story stem techniques to assess the meaning children give to family and disease-specific events. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2011; 25:857-867. [PMID: 22059557 PMCID: PMC4830923 DOI: 10.1037/a0026191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Children with persistent asthma are at increased risk for mental health problems. Although mechanisms of effect are not yet known, it may be that children are less trusting of the family as a source of support and security when they have more severe asthma. This study tested whether asthma severity is related to children's perceptions of insecurity in the family, and whether insecurity is in turn associated with child adjustment. Children (N = 168; mean age = 8 years) completed story stems pertaining to routine family events (e.g., mealtimes) and ambiguous but potentially threatening asthma events such as tightness in the chest. Responses were evaluated for the extent to which appraisals portrayed the family as responding in cohesive, security-provoking ways. Asthma severity was assessed by both objective lung function testing and primary caregiver report. Caregivers reported child symptomatology. Beyond medication adherence, caregiver education, and child age and gender, greater asthma severity predicted more internalizing and externalizing symptoms. Greater asthma severity, assessed using spirometry (but not parent report), was related to less secure child narratives of the family, which in turn related to more child internalizing symptoms. Results suggest that asthma can take a considerable toll on children's feelings of security and mental health. Furthermore, given the difficulty in assessing young children's perceptions, this study helps demonstrate the potential of story stem techniques in assessing children's appraisals of illness threat and management in the family.
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Affiliation(s)
- Marcia A Winter
- Department of Psychiatry, University of Rochester, Rochester, NY 14642, USA.
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Stewart M, Masuda JR, Letourneau N, Anderson S, McGhan S. "I want to meet other kids like me": support needs of children with asthma and allergies. ACTA ACUST UNITED AC 2011; 34:62-78. [PMID: 21568624 DOI: 10.3109/01460862.2011.572638] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Asthma is the most common chronic illness of childhood and the leading cause of hospitalization in young children. Asthma negatively impacts physical health, psychosocial wellbeing, and quality of life for affected children but the psychosocial support needs of children with asthma and severe have not been studied from their point of view. OBJECTIVE The objective of this study was to assess the support and education needs and preferred interventions of allergic children with asthma and/or severe allergies. METHODS Qualitative constant comparative content analysis was used to identify major themes from semi-structured individual interviews with 20 children with asthma and allergies and 35 parents. FINDINGS Children expressed frustration with the limitations imposed by asthma and allergies on their regular activities and normal lives. Parents believed that peer support--someone to whom their child could relate as a role model--could improve both their children's and their own coping. CONCLUSIONS Parents and children preferred a combination of in-person meetings and Internet support to enhance the capacity of children, reduce children's anxiety, increase their self-care skills, and self-confidence. In addition they believed a support intervention was a stepping stone to developing a community of support for children with asthma, allergies, and anaphylaxis.
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Affiliation(s)
- Miriam Stewart
- Faculty of Nursing & School of Public Health, University of Alberta, Edmonton, AB
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Kaugars AS, Zebracki K, Kichler JC, Fitzgerald CJ, Greenley RN, Alemzadeh R, Holmbeck GN. Use of the Family Interaction Macro-coding System with families of adolescents: psychometric properties among pediatric and healthy populations. J Pediatr Psychol 2010; 36:539-51. [PMID: 21097956 DOI: 10.1093/jpepsy/jsq106] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine reliability and validity data for the Family Interaction Macro-coding System (FIMS) with adolescents with spina bifida (SB), adolescents with type 1 diabetes mellitus (T1DM), and healthy adolescents and their families. METHODS Sixty-eight families of children with SB, 58 families of adolescents with T1DM, and 68 families in a healthy comparison group completed family interaction tasks and self-report questionnaires. Trained coders rated family interactions using the FIMS. RESULTS Acceptable interrater and scale reliabilities were obtained for FIMS items and subscales. Observed FIMS parental acceptance, parental behavioral control, parental psychological control, family cohesion, and family conflict scores demonstrated convergent validity with conceptually similar self-report measures. CONCLUSIONS Preliminary evidence supports the use of the FIMS with families of youths with SB and T1DM and healthy youths. Future research on overall family functioning may be enhanced by use of the FIMS.
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Affiliation(s)
- Astrida Seja Kaugars
- Department of Psychology, Marquette University, PO Box 1881, Milwaukee, WI 53201-1881, USA.
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Spagnola M, Fiese B. Preschoolers with asthma: narratives of family functioning predict behavior problems. FAMILY PROCESS 2010; 49:74-91. [PMID: 20377636 DOI: 10.1111/j.1545-5300.2010.01309.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study tested a model predicting behavior symptoms in preschoolers with asthma. Specifically, it examined the role that asthma severity and children's representations of family functioning may play in the development of child behavior problems in a sample of 53 low-income preschoolers. The study included parent report of asthma severity and a narrative story-stem method to assess children's representations of both general and disease-specific family processes. A regression model tested the inclusion of both types of family processes in predicting child internalizing and externalizing behavior. Disease severity and children's family narratives independently predicted children's behavior over and above the combined effects of demographic variables including child age, socioeconomic status, and family structure. Although children's narratives about general family functioning predicted children's behavior, narratives about family response to asthma symptoms did not. Findings support that both disease severity and family functioning are important considerations in understanding children's behavior problems in the context of asthma. Clinical applications of findings may include: (1) Informing family based-assessments to incorporate children's narratives, and (2) A focus on reducing asthma symptoms and strengthening family functioning to prevent or address child behavior problems.
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Affiliation(s)
- Mary Spagnola
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
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Fiese BH, Winter MA, Wamboldt FS, Anbar RD, Wamboldt MZ. Do family mealtime interactions mediate the association between asthma symptoms and separation anxiety? J Child Psychol Psychiatry 2010; 51:144-51. [PMID: 19754662 PMCID: PMC2804777 DOI: 10.1111/j.1469-7610.2009.02138.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Respiratory problems have been shown to be associated with the development of panic anxiety. Family members play an essential role for children to emotionally manage their symptoms. This study aimed to examine the relation between severity of respiratory symptoms in children with asthma and separation anxiety. Relying on direct observation of family interactions during a mealtime, a model is tested whereby family interactions mediate the relation between asthma severity and separation anxiety symptoms. METHODS Sixty-three children (ages 9-12 years) with persistent asthma were interviewed via the Diagnostic Interview Schedule for Children IV; family interactions were assessed via direct observation of a mealtime; primary caregivers completed the Childhood Asthma Severity Scale; youth pulmonary function was ascertained with pre- and post-bronchodilator spirometry; adherence to asthma medications was objectively tracked for six weeks. RESULTS Poorer pulmonary function and higher functional asthma severity were related to higher numbers of separation anxiety symptoms. Controlling for medication adherence, family interaction patterns mediated the relationship between poorer pulmonary function and child separation anxiety symptoms. CONCLUSIONS Family mealtime interactions may be a mechanism by which respiratory disorders are associated with separation anxiety symptoms in children, potentially through increasing the child's capacity to cognitively frame asthma symptoms as less threatening, or through increasing the child's sense of security within their family relationships.
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