Relations between social support, appraisal and coping and both positive and negative outcomes for children of a parent with multiple sclerosis and comparisons with children of healthy parents

Through the Eyes of a Young Carer: A Photo Elicitation Study of Protective Resilience

Caregiving is recognised as a source of stress with potential for negative health impacts as well as positive outcomes and development of resilience. For young carers, children, and adolescents providing care for close family members, adaptation through resilience is crucial, yet work using a resilience approach is limited. This study explored protective factors and pathways to resilience in a sample of young carers, through application of the socioecological model in caring relationships. An in-depth qualitative approach was used, with in-person interviews facilitated by auto-driven photo elicitation. Deductive thematic analysis was applied, framed by three levels (individual, community, and society) of the socioecological model of resilience. Twelve participants (nine girls and three boys) aged 5-18 years, each providing care to a family member, were recruited using opportunity and volunteer sampling via carers' centres in the southwest of England. Ten key themes were identified, four at the individual level: pre-empting challenges and planning, cognitive strategies, emotional strategies, and seeking solitude; three at the community level: family support, friendships, and pets and inanimate objects; and three at the society level: professional support, access to caregiver activities and community, and being outdoors. The location of themes at each level indicated relevance of the socioecological model to identification of protective factors in a young carer population. These findings have important applications for guidance to charities and organisations supporting young carers. Identification of factors that promote resilience offers support for the development of well-informed interventions, which harness these protective factors to develop resilience and improve health for young carers.

Coping and anxiety symptoms in family carers of dependent older people: Mediation and moderation effects of subjective caregiver burden

INTRODUCTION

Coping responses influence anxiety symptoms experienced by informal carers. However, only a few studies have investigated the longitudinal association between coping responses and anxiety symptoms in family carers. We also currently have limited knowledge on the mediating or moderating influence of subjective caregiver burden on this relationship over time. The aim of the present study was to investigate the longitudinal relationship between coping and anxiety symptoms in family carers of dependent older people, and examine the mediating or moderating role of subjective caregiver burden over time.

DESIGN

Prospective longitudinal study.

METHODS

We recruited and enrolled participants from a probability sample of 132 family carers of older dependent relatives. We measured coping strategies, anxiety symptoms, subjective caregiver burden, and several covariates (sex and intensity of care) at baseline and at 1-year follow-up. We used generalized estimating equations with multiple imputations to examine associations over time.

RESULTS

Considering both direct and indirect effects through subjective burden, anxiety symptoms were positively associated with proactive coping (B = 0.13), planning (B = 0.15), self-distraction (B = 0.24), denial (B = 1.15), venting (B = 0.94) and self-blame (B = 0.90), and negatively associated with positive reframing (B = -0.83) and acceptance (B = -0.75). Subjective caregiver burden moderated the relationship between anxiety symptoms and planning, and the use of denial as a form of coping.

CONCLUSIONS

Our results show that subjective caregiver burden is an important moderator and mediator of the longitudinal association between coping responses and anxiety symptoms in carers.

CLINICAL RELEVANCE

Proactive coping and planning when subjective burden is low, self-distraction, denial, venting, and self-blame significantly increase levels of anxiety and caregiver burden in carers over time. Acceptance and positive reframing however as coping responses are associated with lower levels of anxiety and caregiver burden long-term. Our findings highlight the need for a multi-dimensional approach in future caregiving interventions.

The association between parental chronic physical illness and adolescent functional somatic symptoms

BACKGROUND

Previous studies have found that adolescents with a chronically ill parent may experience more internalizing problems. It is less clear if this association is sex-related, and whether it is specific for functional somatic symptoms (FSSs) or concerns other internalizing or externalizing problems.

METHODS

In a prospective cohort of adolescents, oversampled on emotional and behavioral problems (n = 841; mean age 14.9 years), we examined the association between parental chronic illness and adolescent's FSSs, and internalizing and externalizing problems. Adolescent's internalizing and externalizing symptoms were measured using the Youth Self Report; parental chronic physical illness was reported during an interview. Associations were tested using linear regression analyses taking into account socio-demographic confounders. We also explored gender-interaction effects.

RESULTS

Having a chronically ill parent (n = 120; 14.3 %) was associated with more FSS in girls (B = 1.05, 95%CI = [0.23, 1.88], p = .013), but not in boys (sex-interaction: p = .013). In girls, an association was also found between parental chronic illness and more internalizing problems (B = 2.68, 95%CI = [0.41, 4.95], p = .021), but this association disappeared when FSSs were excluded from the Internalizing problem scores.

LIMITATIONS

The current study has a cross-sectional design and relied on self-reported parental chronic physical illness what may have induced misclassification.

CONCLUSION

Findings suggest that having a chronically ill parent is associated with more FSSs in adolescent girls and that this association is specific for FSSs instead of general internalizing problems. Girls with a chronically ill parent may profit from interventions to prevent the development of FSSs.

Voices from the Margins: Aotearoa/New Zealand Young Carers Reflect on Their Experiences

Young carers are a largely invisible and unsupported population of Aotearoa New Zealand (NZ) children and youth aged 25 years and under who physically, emotionally, socially, and/or spiritually support loved ones experiencing ill health, disability, substance misuse, mental illness, or advanced age. The total number of young carers in NZ is unknown because census data only capture those aged 15-25. The nine published NZ studies recommend further research, policies, and services for young carers. However, there is a lack of young carer voices to inform their implementation. This paper provides insight into the experiences and needs of 28 young carers, the largest self-identified cohort in NZ research. Throughout phenomenographic interviews, young caring was described as a natural and valued part of being in a whānau/aiga/family, aimed at supporting their loved one's holistic wellbeing. However, the overwhelming nature of caring without recognition or support resulted in poor educational, social, and mental health outcomes for young carers. This paper concludes with a contextualised NZ young carer definition and an urgent call to address the Carers' Strategy Action Plan and listen to, and deliver on, young carers' expressed needs.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Identifying Coping Strategies Used by Transgender Individuals in Response to Stressors during and after Gender-Affirming Treatments-An Explorative Study

BACKGROUND

Gender-affirming treatments are reported to improve mental health significantly. However, a substantial number of transgender individuals report a relapse in, or persistence of, mental health problems following gender-affirming treatments. This is due to multiple stressors occurring during this period, and in general as a consequence of widespread stigma and minority stress.

AIM

The aim of this pilot study was to identify different coping strategies that transgender individuals use in response to stressors prior to and following gender-affirming treatments, as mediator of mental health.

METHODS

Qualitative interviews were conducted to better understand the treatment outcomes and healthcare experiences of Dutch transgender individuals who had received gender-affirming treatments. Nineteen participants were included, of which 12 identified as (transgender) male, six as (transgender) female and one as transgender.

OUTCOMES

Inductive coding and theory-informed thematic analysis were used to assess stressors (n_codes = 335) and coping strategies (n_codes = 869).

RESULTS

Four stressor domains were identified, including lack of support system, stressors related to transition, and physical and psychosocial stressors post-transition. We identified six adaptive coping strategies of which acceptance, help seeking and adaptive cognitions concerning gender and transition were reported most frequently. Of the seven maladaptive strategies that we identified, social isolation and maladaptive cognitions concerning gender and transition were the most-reported maladaptive coping strategies Clinical implications: The results indicated that transgender individuals may experience significant stress, both transgender-specific and non-specific, prior to and following gender-affirming treatments and, as a result, use many coping strategies to adapt. Increased awareness of stressors and (mal)adaptive coping strategies may help to improve mental healthcare and overall support for transgender individuals. Strengths and Limitations: This is the first (pilot) study to provide insight into the range of stressors that transgender individuals experience during and after gender-affirming treatments, as well as the variety of coping strategies that are used to adapt. However, since this was a pilot study assumptions and generalizations of the evidence should be made cautiously.

CONCLUSION

Results of this pilot study showed that transgender individuals may undergo significant stress during and after gender-affirming medical treatment related to the treatments and the social experiences that occur during this period, and as a result, use a range of coping strategies to adapt to the stress.

Predictors of Mood Disorders in Parents With Multiple Sclerosis: The Role of Disability Level, Coping Techniques, and Perceived Social Support

BACKGROUND

Being a parent can be demanding and stressful, especially for people with chronic diseases such as multiple sclerosis (MS). Parenting can be disrupted by flareups, disease worsening, and other MS symptoms, including mobility problems, pain, fatigue, and cognitive impairment. Mood disorders, such as depression and anxiety, have been found to occur at much higher rates in people with MS than in the general population. Surprisingly, less is known about which factors may predict mood disorders in parents with MS. This study aims to identify potential demographic, clinical, and self-reported predictors that contribute to mood disorders measured by the Hospital Anxiety and Depression Scale.

METHODS

A total of 285 parents with MS completed an anonymous online questionnaire combining sociodemographic, clinical, and family characteristics and scales, validated in Italian, related to coping strategies and social support. Associations between each variable and mood disorders were assessed using univariate and multivariate logistic regression analyses.

RESULTS

Disability level, emotional and dysfunctional coping strategies, and perceived social support were significant predictors of mood disorders in parents with MS.

CONCLUSIONS

These findings confirm the importance of identifying risk factors for mood disorders in parents with MS so that early intervention can minimize mood disruptions caused by the disease.

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

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

Benefit finding moderates the relationship between young carer experiences and mental well-being

OBJECTIVE

Research has shown that some young carers face many negative consequences because of their caring experiences, whereas others seem to be unaffected or even report greater well-being. To understand how caring for a family member or close friend can have these different effects, this study compared benefit finding between young carers and their peers and examined its association with mental well-being.

DESIGN

We recruited 2,525 adolescents aged 15-21 years (59.6% female, M_age = 17.73) through the Swiss education system. They were asked to complete measures of caring experiences, benefit finding, and mental well-being. Young carers (n = 1,137), including adolescents who currently or formerly provided care, were compared to adolescents without caring experiences (n = 1,388).

RESULTS

Young carers had a higher level of overall benefit finding than non-carer peers, and their profiles of benefit finding differed regarding the dimensions of growth and empathy. The association between caring experiences and mental well-being was weaker when benefit finding was higher. Benefit finding dimensions were differently associated with mental well-being among young carers.

CONCLUSIONS

This study shows that caring is associated with benefit finding and suggests that engaging with past stressors in a positive way may promote resilience in young carers.

Family Functioning and Multiple Sclerosis: Study Protocol of a Multicentric Italian Project

Multiple Sclerosis (MS) is a chronic inflammatory and neurodegenerative disease, which not only affects physical functioning, but is also associated with cognitive impairments and great psychological distress. The combination of those symptoms may have negative consequences on the family functioning of patients with MS, with detrimental effects on both marital relationships and parental bonding. Furthermore, the presence of individual characteristics and of an adequate social support may also contribute to the quality and endurance of family relationships. Particularly, high levels of alexithymia, a personality trait that affects the recognition of a person's own emotions, have been associated with reduced interpersonal communication skills and enhanced anxiety/depressive symptoms. Therefore, the main aim of the present study is to provide an in-depth evaluation of family functioning and related factors in patients with MS and their families. In order to reach this goal, the perceived quality of family functioning, dyadic relationships, and parental bonding will be first investigated. Secondly, the possible associations between the quality of family relationships and the presence of alexithymia, psychological distress, and perceived social support will be examined. Patients with MS and their families who will consent to take part in the study will be asked to provide sociodemographic and clinical information, and to complete a series of questionnaires, presented and uploaded on an online dedicated platform. The final sample will be made up of 300 families, consecutively recruited from the Italian medical centers involved in the project. The results of the present study will shed light on the family functioning of patients with MS, through a comprehensive assessment of the main factors that are associated with family dynamics. A holistic evaluation of those aspects can help clinicians and researchers understand family dynamics in MS population better.

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

OBJECTIVE

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

DESIGN

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Appraisal and social support as moderators between stress and physical and psychological quality of life

One proposed mechanism of social support is the facilitation of primary and secondary reappraisal of stressful situations. The current study examined the expansion of the original stress-buffering hypothesis to include primary or secondary appraisal in an emerging adult population (N = 854) on physical and psychological health outcomes. The additional moderating effects of gender also were examined. Perceived social support (by the Multidimensional Survey of Perceived Social Support) significantly buffered the effects of stress from negative events (by the Risky Behaviour and Stressful Events Scale) on physical and psychological health (by the World Health Organizations Quality of Life Instrument) for females only. Neither primary nor secondary appraisal (by the Stress Appraisal Measure) acted as additional buffers for male or females. Social support may be a more salient buffer for females. Reappraisal mechanisms may have another role in the buffering pathways. Further implications and limitations were discussed.

Coping with Wolf-Hirschhorn syndrome: quality of life and psychosocial features of family carers

BACKGROUND

Wolf-Hirschhorn Syndrome (WHS) is a rare, congenital disease characterized by a distinctive facial phenotype, seizures, intellectual disability and developmental delay, and pre and postnatal growth requiring lifelong care. The psychosocial status of the family caregivers of children diagnosed with WHS is unknown. This study aims to characterize the sociodemographic and psychosocial profile of WHS caregivers and analyze how these variables impact their quality of life (QoL) and well-being.

RESULTS

The sociodemographic and clinical profile of 22 Spanish caregivers of children with WHS and the characteristics of those affected have been described. Significant relationships were found between sociodemographic and psychosocial characteristics among caregivers. The impact on the parents' QoL and negative relationship with the symptomatology were assessed. The use of engagement strategies such as problem focused coping was associated with improved psychological QoL and social support.

CONCLUSIONS

WHS caregivers share similarities in their profile and needs with caregivers of children with other rare diseases. Pychosocial support groups involving parents caring for children with the same disease could improve caregivers' well-being and QoL by strengthening their social support network and using positive coping styles.

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

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

Online Validation of a Battery of Questionnaires for the Assessment of Family Functioning and Related Factors

BACKGROUND

Family functioning relies on different factors that are related to the individual characteristics of each member, the social context in which the family nucleus is integrated, and the internal and interpersonal family factors. The Short Version of the Family Assessment Measure-III, Dyadic Adjustment Scale, Inventory of Parent and Peer Attachment, Twenty-item Toronto Alexithymia Scale, Hospital Anxiety and Depression Scale, and Multidimensional Scale of Perceived Social Support are among the most commonly employed self-report measures for the assessment of family functioning and related factors. Traditionally, these scales have been administered using paper-and-pencil versions. However, with increased access to the Internet, online administration of questionnaires has become more common. The present study aimed to validate an online version of each of the above-mentioned questionnaires in a heterogeneous sample of Italian healthy individuals.

METHODS

One-hundred participants were recruited for each questionnaire. A crossover design was used in each validation. The minimum important difference (MID) was applied to evaluate the differences in the variances of the paper-and-pencil and online format scores. A MID >0.5 is a reasonable first approximation of a threshold of important change. Taking into account the cross over design, mean difference between pencil-and-paper and online versions, and Intraclass Correlation Coefficient were also estimated by mixed models.

RESULTS

The MID was <0.5 for all the instruments used. Therefore, no significant difference was observed between the score variances of the paper-and-pencil and online formats of all the questionnaires. Moreover, for each questionnaire the difference between the means of online and paper-and-pencil administrations scores (mean O-P) was calculated. We reported 95% confidence intervals that did not include the 0; therefore, mean (O-P) was not statistically significant.

CONCLUSIONS

The current findings indicate that the online versions of all the questionnaires we administered can be considered reliable tools for the assessment of family functioning and related factors.

The effects of psychoeducational interventions on caregivers of children with cancer: A meta-analysis of randomized controlled trials

This meta-analysis aims to evaluate the best available evidence concerning the effects of psychoeducational interventions (PEIs) on the psychosocial and coping outcomes for caregivers of pediatric oncology patients. A literature search was performed using 11 databases, from inception to June 2017. Keywords such as pediatric, caregiver, parents, cancer, and intervention were used. Only randomized controlled trials (RCTs) were included. Studies with full text available online in English and those conducted of caregivers of children diagnosed with any form of cancer were included. Eleven RCTs were included in the analysis. Our meta-analysis revealed that PEIs have small to large effects on three outcomes, including post-traumatic stress symptoms (PTSSs), mood, and problem-solving skills. However, the outcomes from PEI were not superior to the usual standard of care for anxiety, depression, and social support. Our meta-analysis provided moderate evidence that PEI enhances psychological and coping outcomes. Because coping affects both physical and psychological health, health care professionals could consider including coping as a core component in PEI delivered to caregivers of children with cancer.

Caregiving Choice and Caregiver-Receiver Relation: Effects on Psychological Well-being of Family Caregivers in Canada

The psychological well-being of family caregivers is influenced by their relations with care receivers, and whether they have choice in becoming a caregiver. Limited study has explored the interaction effect of caregiver-receiver relations and caregiving choice on caregivers' psychological well-being. This study examines whether the caregiver's perceived choice moderates the association between caregiver-receiver relation and psychological well-being. Using population-based data from the 2012 Canada General Social Survey - Caregiving and Care Receiving (n = 5,285), this study applies regression and ANCOVA analyses. Results show family caregivers for spouses and children report significantly worse psychological well-being, whereas having choice to become a caregiver is associated with better psychological well-being. There was a significant moderation effect of caregiving choice on the association between caregiver-receiver relation and psychological well-being. Findings suggest that more services should be targeted for family caregivers without choice for caregiving as well as those who provide care for their children.

Coping and Anxiety in Caregivers of Dependent Older Adult Relatives

The aim of this study was to analyze the relationship between coping and anxiety in caregivers of dependent older adult relatives. A cross-sectional study was carried out in the province of Jaén (Andalusia, Spain). The convenience sample consisted of 198 family caregivers of dependent older adults. The main measurements were anxiety (Hamilton scale), coping (Brief COPE), subjective burden (Caregiver Strain Index), objective burden and sex of the caregiver. The main analyses were bivariate analysis using the Pearson correlation coefficient, and multivariate analysis using multiple linear regression. An independent regression model was developed for anxiety and each type of coping, adjusting for sex, subjective burden and objective burden. Our results demonstrate that anxiety was negatively associated with planning (partial r = −0.18), acceptance (partial r = −0.22) and humor (partial r = −0.20), and it was positively associated with self-distraction (partial r = 0.19), venting (partial r = 0.22), denial (partial r = 0.27) and self-blame (partial r = 0.25). Planning, acceptance and humor coping strategies may be protective factors of anxiety. Strategies such self-management, relief, denial and self-blame may be risk factors for anxiety.

Teachers' social support, somatic complaints and academic motivation in children and early adolescents

The study aim was to find out what is pupils perception of teachers' support and to check if different types of perceived support are connected with the level of somatic symptoms reported by students at school. Additionally the study searched for possible links between students' evaluation of teachers 'as instructors, guides and caregivers' and their motivation to attend the class and to study the subject. The results show that students perceived informative teachers' support as the most available. Prevalent somatic symptoms reported by students were those connected with tiredness, distraction, low energy and pain. Teachers' evaluation was positively linked to academic motivation. High level of perceived (1) emotional, (2) informational teachers support and a (3) high 'mark' prescribed by student to the teacher via teachers' evaluation were negatively related to somatic symptoms. Due to students composition i.e. children originating from different economic backgrounds, the support perception from this perspective was also analysed. The study results indicate that teachers' support perception by children living in harsh economic conditions depended on the division in which they attend the school.

Coping and adjustment in caregivers: A systematic review

This systematic review assessed coping and adjustment in caregivers of all ages to provide a synthesis of existing literature in the context of methodological approaches and underlying theory. Four databases were searched. Reference lists, citations and experts were consulted. In total, 27 studies (13 quantitative and 14 qualitative) were included. Coping factors associated with adjustment (problem- versus emotion-focussed coping and cognitive strategies) and psychosocial factors associated with physiological adjustment (trait anxiety, coping style and social support) were identified. Results raised methodological issues. Future research requires physiological adjustment measures and longitudinal assessment of the long-term impact of childhood caregiving. Findings inform future caregiver research and interventions.

Parental hospital-treated somatic illnesses during offspring's childhood associated with later offspring use of psychotropic medication during childhood to young adult - The 1987 Finnish Birth Cohort study

This study aimed to systematically examine whether parental hospital-treated somatic illnesses, diagnosed during an offspring's childhood (1987-1995), are associated with later use of psychotropic medication (1996-2012) by the offspring. If so, which parental somatic illnesses, in particular, increase the likelihood for later use of psychotropic medication among the offspring. The 1987 Finnish Birth Cohort study yields longitudinal nationwide follow-up data that include a complete census of children born in a single year. A total 58,551 offspring are included in this study and, of these 57,752 had a known father. Offspring who had used psychotropic medication between the ages of 9 and 24 years, more often had parents who had experienced a greater number of somatic illnesses when their child was aged under 9, compared to offspring without any use of psychotropic medication. The specific parental somatic illnesses early in life, for example disorders of female tract (OR 1.12, 95%CI 1.01-1.23), pregnancy with abortive outcome (1.18, 1.09-1.28), paternal acute infections (1.20, 1.05-1.38), and paternal symptoms, signs, and ill-defined conditions (1.21, 1.03-1.42), were found to be associated with psychotropic medication treatment using parental-related determinants; death, education, receipt of social assistance and psychiatric inpatient care as covariates. This suggests that these specific parental somatic illnesses can affect psychological well-being of the offspring. Preventive actions and support for the child, should be provided in situations where a parent with a somatic illness has limited ability to care for and rear their child.

Dealing with Chronic Illness: Experiences of Iranian Families of Persons with Multiple Sclerosis-A Qualitative Study

Background

Today family members are providing care and support to each other during illness. In particular, in chronic illness, such as multiple sclerosis, the families are more involved in caring for and supporting their patients, so they use several strategies to cope with this situation. The purpose of this study was to explore the coping strategies in family caregivers of persons with multiple sclerosis in Iran.

Methods

This is a qualitative study that was conducted through 18 family caregivers of persons with multiple sclerosis. A purposeful sampling method was used. Data were collected through semistructured and in-depth interviews conducted in Multiple Sclerosis Society and hospitals of Tabriz in Iran. The collected data was analyzed according to qualitative content analysis.

Results

Five main categories were elicited from interviews: “using spirituality,” “living with hope,” “experiencing persistence and stability,” “seeking support,” and “seeking alternative treatments.” Conclusion. The study findings can help to inform the support given to families to help them cope with the effects of caring for someone with multiple sclerosis. Health system managers and professionals by using these results are able to support patients and their families appropriately in order to improve their quality of life and alleviate the complications of disease.

Children with ill parents: extent and nature of caring activities

RATIONALE

Previous studies have shown that children may take on higher extents of caring activities if their parents are affected by severe illness or disability, especially when their parents lack access to formal and informal care.

AIMS AND OBJECTIVES

This study examined the extent and nature of caring activities done by patients' children; differences in caring activities between different types of parental illness; factors associated with caring activities.

DESIGN

An explorative cross-sectional multicentre study.

METHODS

Parents as patients in specialised healthcare services, and their children, were recruited from five health trusts in Norway. The sample included 246 children aged 8-17 years and their 238 parents with severe physical illness (neurological disease or cancer) (n = 135), mental illness (n = 75) or substance abuse (n = 28).

MAIN OUTCOME MEASURE

Multidimensional Assessment of Caring Activities (MACA-YC18).

RESULTS

A large number of children with ill parents are performing various caring activities. Increased caring activities among children due to their parent's illness were confirmed by their parents, especially with regard to personal care. We found no significant differences in the extent of caring activities between illness types, but there were some differences in the nature of these activities. Factors significantly associated with the extent and nature of caring activities were as follows: better social skills and higher external locus of control among the children; and poorer physical parental health. Parent's access to home-based services was limited.

STUDY LIMITATIONS

In recruitment of participants for the study, a sampling bias may have occurred.

CONCLUSION

To promote coping and to prevent inappropriate or extensive caring activities among children with ill parents, there is a need for increased access to flexible home-based services adapted to the type of parental illness.

User survey of Nanny Angel Network, a free childcare service for mothers with cancer

PURPOSE

The purpose of the present study was to determine user satisfaction with Nanny Angel Network (nan), a free childcare service for mothers undergoing cancer treatment.

METHODS

All 243 living mothers who had used the nan service were invited by telephone to participate in an online research survey; 197 mothers (81%) consented to participate. The survey, sent by e-mail, consisted of 39 items divided into these categories: demographics, supports, use, satisfaction, and general comments.

RESULTS

Of the 197 mothers who consented to receive the e-mailed survey, 104 (53%) completed it. More than 90% of the mothers were very satisfied with the help and support from their Nanny Angel. Many mothers mentioned that the Nanny Angel was most helpful during treatment and medical appointments, with 75% also mentioning that their Nanny Angel helped them to adhere to their scheduled medical appointments. However, 64% felt that they had not received enough visits from their Nanny Angel.

CONCLUSIONS

Satisfaction with the nan childcare provider was high, but mothers wished the service had been available to them more often. Our study highlights the importance of providing childcare to mothers with inadequate support systems, so as to allow for greater adherence to treatment and medical appointments, and for more time to recover.

Gender differences in caregiver strain, needs for support, social support, and quality of life among spousal caregivers of persons with multiple sclerosis

BACKGROUND

Caregivers of individuals with MS may experience unique caregiver strain due to the age at onset and progressive nature of the disease. Additionally, because MS is more prevalent in women, men often become spousal caregivers. However, gender differences in psychosocial adjustment among caregivers have not been fully explored.

OBJECTIVE

The purpose of this study was to explore gender differences in the need for various supports and type of social support needed, caregiver strain, and quality of life among caregivers for individuals with MS.

METHODS

106 caregivers participated in this study. Independent sample t-tests and multiple regression analyses were conducted to examine gender differences in strain, need for supports, social support, and quality of life.

RESULTS

Analyses revealed gender difference among important psychosocial variables. Specifically, women reported higher levels of caregiver strain, higher needs for emotional support, and higher perceived social support. Additionally, multiple regression analyses revealed an inverse relationship between expressed emotional needs and quality of life for men, but not for women.

CONCLUSIONS

MS caregivers experience significant strain that diminishes quality of life. Social support and needs fulfillment can act to buffer this stress; however, results indicate that this varies by gender, with gender differences observed in strain, perceived support, and expressed needs among MS caregivers. The study implications for rehabilitation research are discussed.

"I take up more responsibilities for my family's wellbeing" - A qualitative approach to the cultural aspects of resilience seen among young adults in Bengaluru, India

Resilience refers to the pursuit of positive in the face of adversity. The present study using qualitative methods aimed to identify culture-specific factors linked to resilience. Participants, (N=31, aged 16-24 years) whose parents were being treated for chronic medical conditions or psychiatric disorders at St John's Medical College Hospital, Bengaluru, were studied using Focused group discussion and In-depth interviews. Using the 'Grounded theory' approach, two major themes were identified as important factors influencing resilience: (1) Family and socially defined roles/responsibilities and in particular adherence to traditionally defined social responsibilities. (2) Participation in rituals and experiencing spirituality. Application and relevance of these themes in promoting resilience among young vulnerable adults are discussed.

Empowerment of young people who have a parent living with dementia: a social model perspective

BACKGROUND

Socially constructed disablement has marginalized young people in families where a parent has younger onset dementia (YOD). This has contributed to inadequate societal support for their complex situation. Impacts on such young people include significant involvement with mental health services for themselves. In this paper, we explored the young people's lived experiences in these families and the influencing factors to enable these young people to be included and supported within their community.

METHODS

In this qualitative research study, the social model of disability was used as the theoretical framework in conducting a thematic analysis of interviews with 12 participants.

RESULTS

Three themes emerged; invisibility highlighting the issues of marginalization; connectivity foregrounding the engagement of young people with family, friends and their social networks, and being empowered through claiming their basic human right to receive the age appropriate support they needed.

CONCLUSION

The current plight of young people living with a parent with YOD demands a fundamental shift by society in developing inclusive cross-sectorial cooperation linking service providers across youth and dementia sectors. This requires working in partnership with the service users responding to the identified needs of individual family members.

Adults' recollections and perceptions of childhood caregiving to a parent with significant physical disability

BACKGROUND

Caregiving roles of children <18 years of age living with parents with health conditions or disability have been studied extensively abroad, but little U.S. research has examined the caregiving activities and perceptions of children with parents with significant physical disability.

OBJECTIVE

To examine children's caregiving activities for their disabled parent, childhood perceptions of these activities, and adult views of this caregiving.

METHODS

We conducted 1-h, semi-structured, open-ended interviews with 20 persons age ≥21 years who as children (age < 18 years) had a parent with significant mobility disability. We used conventional content analysis to identify themes.

RESULTS

Interviewees' mean (standard deviation) age was 36.7 (13.8) years; 4 were male. As children, most interviewees assisted their disabled parent with activities of daily living (ADLs) and instrumental ADLs; some children provided more medical supports. Several parents, especially of older interviewees, did not seek their children's care. Interviewees reported both positive and negative childhood attitudes about caregiving. Roughly half recalled as children feeling proud, special, or otherwise positively toward caregiving activities, while about one-third viewed caregiving as just part of their daily reality (i.e., simply needing to be done). Approximately half remembered also feeling resentful, primarily from time demands, insufficient appreciation, and being different from their peers. Interviewees reported gender and cultural factors affecting their caregiving roles and perceptions.

CONCLUSIONS

Children can provide significant care to parents with physical disability. Understanding better their roles and perceptions could suggest ways to improve these experiences for both child and parent.

Parents' expressed emotion and mood, rather than their physical disability are associated with adolescent adjustment: a longitudinal study of families with a parent with multiple sclerosis

OBJECTIVE

This study investigated the impact of the severity of parental multiple sclerosis, parents' expressed emotion and psychological well-being on offspring's psychological difficulties.

DESIGN

A longitudinal study including baseline and 6-month follow-up data collected from parents and children.

SUBJECTS

Adolescents (n=75), their parents with multiple sclerosis (n=56) and the partner without multiple sclerosis (n=40).

MAIN MEASURES

Parents completed the Hospital Anxiety and Depression Scale and the Five Minutes Speech Sample, a standardised interview of expressed emotion towards their child. Parents with multiple sclerosis also completed the Expanded Disability Status Scale, a measure of illness severity. Adolescents completed the Strength and Difficulties Questionnaire, a self-report measure of psychological difficulties.

RESULTS

Higher depression scores of the parents with multiple sclerosis at baseline correlated with increased adolescents' internalising symptoms at 6-month follow-up (γdep=0.31, P=.004). Higher expressed emotion scores of parents with multiple sclerosis at baseline were associated with increased adolescent externalising symptoms at 6-month follow-up (γEE=4.35, P=.052). There was no direct effect of severity, duration or type of multiple sclerosis on adolescents' adjustment at baseline or follow-up.

CONCLUSIONS

Emotional distress and expressed emotion in parents with multiple sclerosis, rather than the severity and type of multiple sclerosis had an impact on adolescents' psychological difficulties.

Impact on children of a parent with ALS: a case-control study

BACKGROUND

Numerous studies have explored how patients and their caregivers cope with amyotrophic lateral sclerosis (ALS), but the literature completely lacks research on the psychological impact of the disease on patients' children. The aim of our study was to investigate the emotional and psychological impact of a parent with ALS on school-age children and adolescents in terms of problem behavior, adjustment, and personality characteristics.

METHODS

The study involved 23 children (mean age = 10.62 years, six females) with a parent suffering from ALS, and both their parents. Children were matched for age, gender, and birth-order with a control group of children with healthy parents. They were administered the Youth Self Report (YSR) questionnaire and the Rorschach Comprehensive System, and their healthy parent completed the Child Behavior Checklist (CBCL).

RESULTS

Findings clearly showed that, compared with controls, children with a parent who had ALS had several clinically significant adverse emotional and behavioral consequences, with emotional and behavioral problems, internalizing problems, anxiety and depressive symptoms. Children of a parent with ALS scored higher than controls for the Total Problems, Internalizing Problems, Anxious/Depressed and Withdrawn/Depressed scales in the YSR. A relevant percentage of children fell within the clinical range (42.9%) and borderline range (28.6%) for Internalizing Problems. The Rorschach CS confirmed the substantial impact of ALS in a parent on their offspring in terms of internalizing behavior and depression, with adjustment difficulties, psychological pain, and thought problems.

CONCLUSION

Our findings indicate that school-aged children and adolescents with a parent who has ALS are vulnerable and carry a substantially higher risk of internalizing behavior, depressive symptoms, and reactive problems than children with healthy parents. Families affected may need support to cope with such an overwhelming disease.

Informing the children when a parent is diagnosed as having multiple sclerosis

BACKGROUND

The aim of this study was to gain an understanding of how health-care services can support the empowerment of children when a parent is diagnosed as having multiple sclerosis (MS). The study focuses on what information parents with MS, their partners, and their children desire from health-care professionals.

METHODS

Focus group interviews were conducted with nine adolescents, nine parents with diagnosed MS, and five partners representing members of ten families.

RESULTS

The main finding was that parents with MS, their partners, and the adolescents stressed their need to be well informed about the disease. Information should be provided at the time of diagnosis and then offered regularly throughout the disease course. The information should be suited to the recipient's level of maturity and individualized to reflect the parent's clinical picture.

CONCLUSIONS

It is usually beneficial for children if their parents feel informed about the illness and encourage their children to ask questions and discuss the situation. This knowledge, gained from several sources, is likely to be of value for health-care professionals and their ongoing efforts to improve services for parents with MS, their partners, and their children.

Children and adolescents adjustment to parental multiple sclerosis: a systematic review

BACKGROUND

Families are the primary source of support and care for most children. In Western societies, 4 to 12% of children live in households where a parent has a chronic illness. Exposure to early-life stressors, including parenting stress, parental depression and parental chronic disease could lead to harmful changes in children's social, emotional or behavioural functioning. Little is known about the child living with a parent who has Multiple Sclerosis (MS). We systematically reviewed the literature regarding possible effects of having a parent with MS on the child's or adolescent's psychosocial adjustment.

METHODS

The following databases: MEDLINE, PsychInfo, CINAHL, EMBASE, Web of Knowledge, ERIC, and ProQuest Digital Dissertations were searched (from 1806 to December 2012). References from relevant articles were also manually searched. Selected studies were evaluated using the Graphic Appraisal Tool for Epidemiology (GATE).

RESULTS

The search yielded 3133 titles; 70 articles were selected for full text review. Eighteen studies met inclusion criteria. Fourteen studies employed quantitative techniques, of which 13 were cross-sectional and one was longitudinal. Four studies were both qualitative and cross-sectional in design. Only 2 of 18 studies were rated as having high methodological quality. Overall, eight studies reported that children of MS patients exhibited negative psychosocial traits compared with children of "healthy" parents. Specifically for adolescents, greater family responsibilities were linked to lower social relationships and higher distress. Three studies indicated that parental MS was associated with positive adjustment in children and adolescents, such as higher personal competence, while four found no statistically significant differences.

CONCLUSION

Although having a parent with MS was often reported to have negative psychosocial effects on children and adolescents, there was a lack of consensus and some positive aspects were also found. However, few high quality studies were identified which makes it difficult to draw evidence-based conclusions at this point. There are potentially important, long-term impacts of early life stressors, such as having a parent with a chronic disease, on subsequent life chances and health, and thus more extensive and higher quality research in this area is greatly needed.

Psychosocial profiles of children with achondroplasia in terms of their short stature-related stress: a nationwide survey in Japan

AIMS AND OBJECTIVES

To assess psychosocial profiles of children with achondroplasia using a nationwide survey.

BACKGROUND

Achondroplasia, showing short stature and disproportionately short limbs, causes physical inconvenience such as difficulty in reaching high objects. It is, however, still controversial whether the condition is associated with psychological problems, especially in childhood.

DESIGN

A cross-sectional descriptive design was employed.

METHODS

To evaluate psychosocial profiles and adaptation processes in children with achondroplasia, we developed an inventory of scales based on the psychological stress model of which conceptual framework was comprised of stressor, coping process, coping resource and adaptation outcome domains. Participants were recruited nationwide through the largest advocacy support group for achondroplasia in Japan. Of the 130 group members, 73 X-ray-diagnosed patients, aged 8-18 years, completed the inventory of questionnaires to be analysed.

RESULTS

As for the stressor domain, patients experienced short stature-related unpleasant experiences more frequently (z-score: +1·3 in average, +3·9 in physical inconvenience). Nevertheless, these experiences had little effect on the coping process (threat appraisal: -0·2, control appraisal: +0·1) and the adaptation outcome (stress response: +0·3, self-concept: 0·0). Interestingly, self-efficacy in the coping resource domain was noticeably increased (+3·1) and was strongly correlated with most variables in the coping process and in adaptation outcome domains.

CONCLUSIONS

Although the children with achondroplasia experienced more short stature-related stressors, there was no evidence of any psychosocial maladaptation. This finding suggests that coping process as well as coping resources such as self-efficacy could be important targets for promoting psychological adjustment in children with achondroplasia.

RELEVANCE TO CLINICAL PRACTICE

To help children with achondroplasia adapt socially, nurses and other healthcare providers should routinely assess their psychological adaptation process, especially cognitive appraisal and self-efficacy.

Parenting with a disability and child mental health: a propensity score analysis

Little research has examined the impact of having a parent with a disability on child mental health. This study used data from 7,116 families of children who participated in the 2006 National Health Interview Survey and propensity score matching (PSM) to investigate this question. Prior to PSM, differences in Child Mental Health Brief scores were significant with a moderate effect size. After PSM, differences in Child Mental Health Brief scores were still significant, but the effect size was small. Results indicate that much of the mental health risk for children of parents with disabilities is connected to related issues.

The relationship between parental depressive symptoms, family type, and adolescent functioning

It is evident that parental depressive symptoms negatively influence adolescent behavior and various psychosocial outcomes. Certain family types like families with a chronically ill parent and single parent families are more vulnerable to parental depressive symptoms. However, the relationship between these symptoms, family type, and adolescent functioning remains largely unclear. This study examined relations between self-report of parental depressive symptoms and adolescent functioning in 86 two-parent families including a parent with a chronic medical condition, 94 families with healthy single parents, and 69 families with 2 healthy parents (comparison group). Parents completed the Beck Depression Inventory. Adolescents filled in the Youth Self-Report measuring problem behavior, and other instruments measuring psychosocial outcomes (stress, grade point average, school problems, and self-esteem). Multilevel analyses were used to examine the effects of family type, parental depressive symptoms, adolescents' gender and age, and interaction effects on adolescent functioning. The results indicated that adolescents with chronically ill and single parents had a lower grade point average (p<.01) than the comparison group. Adolescents of single parents reported more internalizing problems (p<.01) and externalizing problems (p<.05) than children from the other family types. Parental depressive symptoms were strongly related to child report of stress (p<.001). Adolescents of depressed chronically ill parents were particularly vulnerable to internalizing problems (interaction effect, p<.05). Older children and girls, and especially older girls, displayed more internalizing problems and stress. It can be concluded that growing up with a chronically ill parent in a family with 2 parents may have less impact on adolescent problem behavior than growing up in a single parent family. Health practitioners are encouraged to be attentive to the unique and combined influence of family type and parental depressive symptoms on adolescent functioning. Older and female adolescents deserve particular attention.

Caregiving Choice and Emotional Stress Among Cancer Caregivers

Caring for a relative or friend with cancer may be highly demanding and emotionally burdensome. Theory suggests that personal characteristics of a caregiver may contribute directly to a caregiver's emotional health. An underexplored variable is a caregiver's perception of choice in providing care to a relative or friend. Thus, this study sought to characterize perceived choice in providing care among family cancer caregivers and examine its association with emotional stress. This study is a secondary analysis of cross-sectional telephone interviews of 1,247 family caregivers, which included 104 cancer caregivers. The findings indicated that a high majority of cancer caregivers expressed elevated emotional stress. Most caregivers perceived themselves to have had a choice in providing care; however, a perceived lack of choice in providing care was significantly associated with greater emotional stress. Assessing clinical and policy-related strategies for alleviating concerns related to choice may be of value in the cancer context.

Exploration of the Short-Term and Long-Term Effects of Parental Illness on Children’s Educational and Behavioral Functioning Using a Large Taiwanese Sample

This study used data from Waves I and II of the Taiwan Educational Panel Survey (TEPS) to explore the potential short-term and long-term effects of parental illness and health condition on children’s behavioral and educational functioning. A sample of 11,018 junior high school students and their parents and teachers in Taiwan were included in this present study. The results supported previous work that parental illness may place children at slight risk for poor psychosocial adjustment and behavioral problems. Parental illness was associated with lower adaptive skills and more behavioral problems in children. Children of ill parents showed resilience in their educational functioning in the event of parental illness as children’s academic achievement and learning skills were not related to parental illness/health condition.

Differential Outcomes of Adolescents with Chronically Ill and Healthy Parents

Approximately 10% of children grow up with a parent who has been diagnosed with a chronic medical condition (CMC) and seem to be at risk for adjustment difficulties. We examined differences in behavioral, psychosocial and academic outcomes between 161 adolescents from 101 families with a chronically ill parent and 112 adolescents from 68 families with healthy parents, accounting for statistical dependence within siblings. Children between 10 and 20 years and their parents were visited at home and filled in questionnaires. Multilevel analyses showed that 20-60% of the variance in most adolescent outcomes was due to the family cluster effect, especially in internalizing problem behavior, caregiving variables and quality of parent attachment. Conversely, the variance in stress and coping variables and grade point average (GPA) was mainly due to individual characteristics. Adolescents with parents affected by CMC displayed more internalizing problems than the comparison group and scored higher on frequency of household chores, caregiving responsibilities, activity restrictions, isolation, daily hassles and stress. In addition, their grade point average was comparatively worse. No group differences in externalizing problems, coping skills and quality of parent attachment were found. In conclusion, the family cluster effect largely explains adolescent outcomes and should be accounted for. Adolescents with parents affected by CMC are subject to an increased risk for internalizing problems, adverse caregiving characteristics, daily hassles, stress and a low GPA. According to a family-centered approach, school counselors and health care practitioners should be alert to adjustment difficulties of children with a chronically ill parent.

Interventions for children coping with parental multiple sclerosis: a systematic review

PURPOSE

A systematic review was conducted to explore ways to assist children of parents with multiple sclerosis (MS) in developing positive coping strategies.

DATA SOURCES

Multiple databases including Academic Search Complex, CINAHL plus with full text, Health Source: Nursing Academic Edition, Medline with full text, and Psychology and Behavioral Sciences Collection. The review was not limited by year of publication.

CONCLUSIONS

Evidence demonstrates children of parents with MS who increase their coping skills, social support, and knowledge of the disease process exhibit decreased emotional distress and increased overall life satisfaction.

IMPLICATIONS FOR PRACTICE

Future research needs to explore the effects of intervention programs designed specifically to target different age levels and promote coping strategies, social support, and knowledge of MS. Healthcare providers need to address the family's needs, including children, when a parent is diagnosed with MS.

Stress in Adolescents with a Chronically Ill Parent: Inspiration from Rolland's Family Systems-Illness Model

This article was inspired by Rolland's Family Systems-Illness (FSI) model, aiming to predict adolescent stress as a function of parental illness type. Ninety-nine parents with a chronic medical condition, 82 partners, and 158 adolescent children (51 % girls; mean age = 15.1 years) participated in this Dutch study. The Dutch Stress Questionnaire for Children was used to measure child report of stress. Ill parents completed the Beck Depression Inventory. Children filled in a scale of the Inventory of Parent and Peer Attachment measuring the quality of parent attachment. Both parents filled in the Parent-Child-Interaction Questionnaire-Revised. We conducted multilevel regression analyses including illness type, the ill parent's depressive symptoms, family functioning (quality of marital relationship, parent-child interaction, and parent attachment), and adolescents' gender and age. Four regression analyses were performed separately for each illness type as defined by disability (Model 1), and onset (Model 2), course (Model 3), and outcome of illness (Model 4). In all models, higher adolescent stress scores were linked to lower quality of parent-child interaction and parent attachment, and adolescents' female gender. The four models explained approximately 37 % of the variance in adolescent stress between individuals and 43-44 % of the variance in adolescent stress between families. Adolescent stress was not related to parental illness type. Our results partially supported the FSI model stating that family functioning is essential in point of child adjustment to parental illness. In the chronic stage of parental illness, adolescent stress does not seem to vary depending on illness type.

Risk factors for problem behavior in adolescents of parents with a chronic medical condition

A wide array of risk factors for problem behavior in adolescents with chronically ill parents emerges from the literature. This study aims to identify those factors with the highest impact on internalizing problem behavior (anxious, depressed and withdrawn behavior, and somatic complaints) and externalizing problem behavior (aggressive and rule-breaking behavior) as measured by the Youth Self-Report (YSR). The YSR was filled in by 160 adolescents (mean age = 15.1 years) from 100 families (102 chronically ill parents and 83 healthy spouses). Linear mixed model analyses were used, enabling separation of variance attributable to individual factors and variance attributable to family membership (i.e., family cluster effect). Predictors were child, parent, illness-related and family characteristics. The results showed that almost half of the variance in internalizing problem scores was explained by family membership, while externalizing problems were mainly explained by individual factors. Roughly 60 % of the variance in internalizing problems was predicted by illness duration, adolescents' feeling of isolation, daily hassles affecting personal life and alienation from the mother. Approximately a third of the variance in externalizing problems was predicted by adolescents' male gender, daily hassles concerning ill parents and alienation from both parents. In conclusion, the variance in adolescent problem behavior is largely accounted for by family membership, children's daily hassles and parent-child attachment. To prevent marginalization of adolescents with a chronically ill parent, it is important to be alert for signs of problem behavior and foster the peer and family support system.

The diurnal salivary cortisol pattern of adolescents from families with single, ill and healthy parents

OBJECTIVE

Adolescents of single and/or chronically ill parents (target groups) reportedly have elevated psychological stress. However, their salivary cortisol pattern as part of the physiological stress system has not been compared to controls. The aim of this study is to examine differential outcomes in the diurnal cortisol pattern of the target groups.

METHODS

In total, 100 adolescents of three groups with either single, chronically ill or two healthy parents were compared on cortisol. Three salivary cortisol samples were taken after awakening, one sample at noon and one sample at 20:00 p.m. during a non-school day. Group differences and interaction effects between measurement (5 times), group membership and covariates were tested through linear mixed modeling, repeated measures. Covariates were children's sex and age, socioeconomic status (SES) and parental depression as measured with the Beck Depression Inventory.

RESULTS

The three groups did not differ significantly concerning the amount of salivary cortisol, even after controlling for the covariates. The target groups had a lower SES than adolescents with two healthy parents. In addition, chronically ill parents were more depressed than single and healthy parents. Male sex and older age of the child, and lower parental depression were associated with increased cortisol values throughout the day.

CONCLUSION

Research on cortisol in children should control for children's sex and age, and parental depression. Adolescents with single and/or chronically ill parents displayed a healthy pattern of diurnal salivary cortisol.

Psychological symptoms in children of parents with chronic pain-the HUNT study

The aim of the present study was to investigate the associations between parental chronic pain and anxiety, depression, and conduct problems in adolescents. The current study was based on cross-sectional surveys performed during 2006 to 2008 from the Nord Trøndelag Health Study (HUNT 3 and Young-HUNT 3). The sample consisted of 3227 adolescents aged 13 to 18 years for whom information was available on parental chronic pain and health statuses. Separate analyses were conducted for girls and boys. The results indicated that if both parents experienced chronic pain, there was an increased risk of symptoms of anxiety and depression in girls (OR=2.17, CI=1.36-3.45, P=.001) and boys (OR=2.33, CI=1.17-4.63, P=.016) compared with children for whom neither parent had chronic pain. Girls had an increased risk of conduct problems in school if their mothers had chronic pain (OR=1.33, CI=1.02-1.74, P=.034). These results remained after adjusting for the possible effects of confounding factors and parental mental health. The results suggest that the presence of both maternal and paternal chronic pain is a high risk factor for internalizing symptoms in both girls and boys. The present study offers insights that should prove useful in clinical work and further large-scale research.