Depressive Symptoms in Parents of Children with Spina Bifida: A Review of the Literature

To review the literature on the prevalence of depressive symptoms in parents of children with spina bifida (SB) and factors related to these symptoms. A search was conducted using the major health databases (CINAHL, MEDLINE, and PsycINFO). Nineteen studies were identified that met inclusion and exclusion criteria. A context, process, and outcome framework was used to organize the findings. This review identified both: (a) a high prevalence of parental depressive symptoms (PDS); and (b) specific factors: demographics, condition, child, family functioning, and parent factors that explained 32-67% of parent depressive symptoms (PDS). Although contextual factors were important, they alone were not sufficient to explain PDS. Process factors accounted for more variance in PDS than context factors. Findings warrant implementation of depression screening in parents of children with spina bifida. This review identified factors related to PDS and highlighted gaps in the literature to guide future research.

Factors associated with parent depressive symptoms and family quality of life in parents of adolescents and young adults with and without Spina Bifida

PURPOSE

The purpose of this study was to explore factors related to parental depressive symptoms (PDS) and family quality of life (FQOL) in parents of adolescents and young adults (AYA) with and without a specific chronic health condition (CHC), spina bifida.

METHODS

Two hundred and nine parents of AYA (112 with SB; and 97 without) and their AYA (46% males and 54% females) took part in a multi-site cross-sectional descriptive correlational study. In telephone interviews parents reported on measures of family satisfaction, resources, cohesion, stress, demographic and clinical data.

RESULTS

In the multivariate analyses, 38% of the variance of PDS was explained by family income, family resources and parent stress. Having a child with SB was not predictive of PDS. However, having a child with SB, along with family satisfaction, parent stress and PDS explained 49% of the variance of FQOL. PDS partially mediate the relationship of family resources and FQOL.

CONCLUSION

PDS, family stress, and resources should be evaluated routinely, especially for those with low income. Parents of AYA with SB who have elevated PDS are at increased risk of having lower reported FQOL.

Continued development of the family management style framework

Based on a review of 64 published reports, this article addresses the implications of current research for the further development of the Family Management Style Framework (FMSF). Articles are published in 46 different journals, including 13 in nursing and 12 in interdisciplinary outlets. Most studies are based on samples of less than 50 individuals. The review provides continuing support for the 8 dimensions of the framework, with between 8 and 16 reports supporting the relevance of each. Changes to the sociocultural component of the framework are proposed as well as wording changes to reflect the broader applicability of the framework. The family's social network, health care and education professionals, and resources predominate as key influences on family management.

A comparison of parenting stress between mothers of children with spina bifida and able-bodied controls

OBJECTIVES

To compare parenting stress between mothers of children with spina bifida (SB) and able bodied controls.

METHODS

Sixty-six mothers of children with SB and controls (matched for age, sex and ethnicity) completed the Parenting Stress Index Short Form (PSI/SF) and General Health Questionnaire-12 (GHQ-12). Each child's adaptive skills was assessed using the Vineland Adaptive Behaviour Scales (VABS).

RESULTS

Mothers of children with SB had significantly higher scores for GHQ-12 and the Parental Distress (PD), Parent-Child Dysfunctional Interaction (P-CDI) and Difficult Child (DC) sub-scales of the PSI/SF, even after adjusting for socioeconomic and caregiver status. Single parent status, having a child with SB and higher Life Stress scores were associated with higher PD and DC scores. Lower VABS scores were associated with higher P-CDI scores.

CONCLUSION

Factors such as recent life change events, single parent status and the child's adaptive skills modify the impact of spina bifida on parenting stress.

Maternal mental health in families of children with spina bifida

BACKGROUND

this study aimed to compare mental health of mothers of children with spina bifida with mothers of able-bodied controls.

METHODS

eighty-one mothers of children with spina bifida aged 1-18 years completed the General Health Questionnaire-12 (GHQ-12) and Parenting Stress Index Short Form (PSI/SF). The controls were 69 mothers of children with acute, non-disabling illnesses. Each child's adaptive skills were assessed using the Vineland Adaptive Behaviour Scales (VABS). Logistic regression analysis was used to determine factors related to a high GHQ score (≥ 3) in all patients.

RESULTS

compared to the controls, mothers of children with spina bifida had lower educational levels and were more likely to be the main caregivers and not working. Nineteen (23.5%) of them had a high GHQ score compared to 5 (7.2%) of the controls. They also had significantly higher scores for total PSI/SF and the parent domain, difficult child (DC) and parent-child dysfunctional interaction subscales. Children with spina bifida had lower scores for the composite VABS and communication, socialization, daily living skills and motor sub-domain than the controls. Spina bifida (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.30-14.23), higher DC scores (OR 1.1, 95% CI 1.00-1.16), and higher life stress scores (OR 1.1, 95% CI 1.01-1.71) were associated with a high GHQ score.

CONCLUSION

spina bifida, recent stressful life change events and maternal perception of a child as 'difficult' are associated with poor maternal psychological health.

Implications of family environment and language development: comparing typically developing children to those with spina bifida

INTRODUCTION

This study examines the effect of family environment on language performance in children with myelomeningocele compared with age- and education-matched controls selected from the same geographic region.

METHODS

Seventy-five monolingual (English) speaking children with myelomeningocele [males: 30; ages: 7-16 years; mean age: 10 years 1 month, standard deviation (SD) 2 years 7 months] and 35 typically developing children (males: 16; ages 7-16 years; mean age: 10 years 9 months, SD 2 years 6 months) participated in the study. The Comprehensive Assessment of Spoken Language (CASL) and the Wechsler tests of intelligence were administered individually to all participants. The CASL measures four subsystems: lexical, syntactic, supralinguistic and pragmatic. Parents completed the Family Environment Scale (FES) questionnaire and provided background demographic information. Standard independent sample t-tests, chi-squared and Fisher's exact tests were used to make simple comparisons between groups for age, socio-economic status, gender and ethnicity. Spearman correlation coefficients were used to detect associations between language and FES data. Group differences for the language and FES scores were analysed with a multivariate analysis of variance at a P-value of 0.05.

RESULTS

For the myelomeningocele group, both Spearman correlation and partial correlation analyses revealed statistically significant positive relationships for the FES 'intellectual-cultural orientation' (ICO) variable and language performance in all subsystems (P < 0.01). For controls, positive associations were seen between: (1) ICO and lexical/semantic and syntactic subsystems; and (2) FES 'independence' and lexical/semantic and supralinguistic tasks.

CONCLUSIONS

The relationship between language performance and family environment appears statistically and intuitively sound. As in our previous study, the positive link between family focus on intellectually and culturally enhancing activities and language performance among children with myelomeningocele and shunted hydrocephalus remains robust. Knowledge of this relationship should assist parents and professionals in supporting language development through activities within the natural learning environment.

How do mothers and fathers who have a child with a disability describe their adaptation/ transformation process?

This qualitative study explored the adaptation/transformation process in mothers and fathers at the individual, parental, marital and extrafamilial levels, and the similarities and differences in their experience of living with a child with cerebral palsy. Interviews were conducted with 13 mothers and 13 fathers of children with cerebral palsy. The results show that mothers and fathers are more likely to view the situation differently than similarly. For both parents, the situation offers the potential for transformation. Complementarity between mothers and fathers is an important factor in each of the adaptation or transformation subsystems. Both parents embark on a journey that changes their beliefs about difference, apply their new knowledge to every aspect of their life, and endeavour to normalize their situation.

Parents' social adjustment in families of children with spina bifida: a theory-driven review

OBJECTIVE

Five theoretical hypotheses about the impact of spina bifida (SB) on parents' social adjustment in the parent-child, the marital and the family-level relationship were tested.

METHODS

PsycInfo, Medline and reference lists were searched. This yielded 27 eligible reports. Effect sizes (Hedges' d) were computed to estimate the impact of SB.

RESULTS

Overall, the effects of SB were small to negligible on the affective dimensions of parents' relationships. The few effects that were found tended to be positive. The most important negative effects of SB were found in the parent-child relationship (parenting stress and overprotection).

CONCLUSIONS

Support was found for the resilience-disruption hypothesis, the role-division hypothesis and the miscarried-helping hypothesis, but not for the marital-disruption hypothesis or the marginality hypothesis.

Gender differences and similarities in the experience of parenting a child with a health problem: current state of knowledge

The birth of a child is a transitional situation that triggers stress in the family and each person has to use adjustment strategies allowing them to reposition gradually in relation to themselves and other members of the family, and to make space for the new arrival. When the child has a health problem, the stress on the parents is correspondingly greater. Research shows that fathers and mothers of a child with a health problem experience this ordeal differently. This article reports on the current state of knowledge about the experience of fathers and mothers of a child with a health problem, and suggests new directions for research to provide a fuller understanding of their experience.

Family functioning in children and adolescents with spina bifida: an evidence-based review of research and interventions

Research on the adjustment of families of children with spina bifida is reviewed, with a focus on delineating the impact of spina bifida on family functioning, the strengths and weaknesses of past research, and the needs for future evidence-based research on family interventions with this population. PsychINFO and MEDLINE literature searches were used to identify studies of family functioning and family-based interventions for children with spina bifida. Identified studies were empirically evaluated for the presence or absence of key methodological or analytic criteria. Thirty-two studies of family functioning were identified from 25 separate research groups; most studies displayed significant methodological limitations. No published studies of interventions to promote adaptive family functioning were identified. Methodologically sound, longitudinal, and theory-driven studies of family functioning are needed, as are randomized family-based intervention trials to promote adaptive functioning and better psychosocial outcomes in families of children with spina bifida. Specific recommendations for future work as well as clinical implications are noted.

L’expérience des pères et mères ayant un enfant atteint d’un problème de santé : état actuel des connaissances*

La naissance d’un enfant est une situation transitionnelle qui suscite un stress au sein de la famille et implique la mise en oeuvre de stratégies adaptatives qui permettront graduellement à chacun de se resituer face à lui-même et face à l’autre et de faire une place à ce nouvel être. Lorsque l’enfant présente un problème de santé, le stress ressenti par les parents est d’autant plus important. Les recherches montrent que les pères et les mères d’enfant atteint d’un problème de santé vivent différemment cette expérience. Cet article vise à faire le point sur l’état actuel des connaissances de l’expérience des pères et des mères d’enfant atteint d’une problématique de santé et à proposer de nouvelles avenues de recherche permettant une meilleure compréhension de leur expérience.

Influence of family environment on language outcomes in children with myelomeningocele

BACKGROUND

Previously, our studies demonstrated language differences impacting academic performance among children with myelomeningocele and shunted hydrocephalus (MMSH). This follow-up study considers the environmental facilitators within families (achievement orientation, intellectual-cultural orientation, active recreational orientation, independence) among a cohort of children with MMSH and their relationship to language performance.

METHODS

Fifty-eight monolingual, English-speaking children (36 females; mean age: 10.1 years; age range: 7-16 years) with MMSH were evaluated. Exclusionary criteria were prior shunt infection; seizure or shunt malfunction within the previous 3 months; uncorrected visual or auditory impairments; prior diagnoses of mental retardation or attention deficit disorder. The Comprehensive Assessment of Spoken Language (CASL) and the Wechsler Abbreviated Scale of Intelligence (WASI) were administered individually to all participants. The CASL Measures four subsystems: lexical, syntactic, supralinguistic and pragmatic. Parents completed the Family Environment Scale (FES) questionnaire and provided background demographic information. Spearman correlation analyses and partial correlation analyses were performed.

RESULTS

Mean intelligence scores for the MMSH group: full scale IQ 92.2 (SD = 11.9). The CASL revealed statistically significant difficulty for supralinguistic and pragmatic (or social) language tasks. FES scores fell within the average range for the group. Spearman correlation and partial correlation analyses revealed statistically significant positive relationships for the FES 'intellectual-cultural orientation' variable and performance within the four language subsystems. Socio-economic status (SES) characteristics were analyzed and did not discriminate language performance when the intellectual-cultural orientation factor was taken into account.

CONCLUSION

The role of family facilitators on language skills in children with MMSH has not previously been described. The relationship between language performance and the families' value on intellectual/cultural activities seems both statistically and intuitively sound. Focused interest in the integration of family values and practices should assist developmental specialists in supporting families and children within their most natural environment.

Parents' psychological adjustment in families of children with spina bifida: a meta-analysis

BACKGROUND

Spina Bifida (SB) is the second most common birth defect worldwide. Since the chances of survival in children with severe SB-forms have increased, medical care has shifted its emphasis from life-saving interventions to fostering the quality of life for these children and their families. Little is known, however, about the impact of SB on family adjustment. Reviewers have struggled to synthesize the few contradictory studies available. In this systematic review a new attempt was made to summarize the findings by using meta-analysis and by delimiting the scope of review to one concept of family adjustment: Parents' psychological adjustment. The questions addressed were: (a) do parents of children with SB have more psychological distress than controls? (b) do mothers and fathers differ? and (c) which factors correlate with variations in psychological adjustment?

METHODS

PsycInfo, Medline, and reference lists were scanned. Thirty-three relevant studies were identified of which 15 were eligible for meta-analysis.

RESULTS

SB had a negative medium-large effect on parents' psychological adjustment. The effect was more heterogeneous for mothers than for fathers. In the reviewed studies child factors (age, conduct problems, emotional problems, and mental retardation), parent factors (SES, hope, appraised stress, coping, and parenting competence), family factors (family income, partner relationship, and family climate), and environmental factors (social support) were found to be associated with variations in parents' psychological adjustment.

CONCLUSION

Meta-analysis proved to be helpful in organizing studies. Clinical implications indicate a need to be especially alert to psychological suffering in mothers of children with SB. Future research should increase sample sizes through multi-center collaborations.

Mothers' expressed emotion towards children with and without intellectual disabilities

OBJECTIVES

To identify factors associated with maternal expressed emotion (EE) towards their child with intellectual disability (ID).

DESIGN AND METHOD

A total of 33 mothers who had a child with ID and at least one child without disabilities between the ages of 4 and 14 years participated in the study. Mothers completed self-assessment questionnaires which addressed their sense of parenting competence, beliefs about child-rearing practices, and their reports of behavioural and emotional problems of their child with ID. Telephone interviews were conducted to assess maternal EE towards the child with ID and towards a sibling using the Five Minute Speech Sample (FMSS; Magana et al. 1986), and also to assess the adaptive behaviour of the child with ID using the Vineland Adaptive Behaviour Scale (VABS; Sparrow et al. 1984).

RESULTS

Mothers with high EE towards their child with ID were more satisfied with their parenting ability, and their children had more behaviour problems. Analysis of differential maternal parenting, through comparisons of EE towards their two children, showed that mothers were more negative towards their child with ID for all domains of the FMSS except dissatisfaction.

CONCLUSIONS

A small number of factors associated with maternal EE towards children with ID were identified. Differences in maternal EE towards their child with ID and their other child suggest that EE is child-driven rather than a general maternal characteristic. Implications of the data for future research are discussed.

Children With Chronic Continence Problems

For families who are raising children with myelomeningocele, bowel and bladder incontinence presents unique challenges for everyday life. The Parenting and Childhood Chronicity model is used to describe the work of raising a child with a chronic condition in 6 areas, including medical care, adapted parenting, dealing with the systems, caring for siblings, maintaining relationships, and personal coping (keeping yourself going). This article provides an overview of the physiologic and developmental challenges inherent in this neural tube defect and illustrates the work that is involved in the child's care and the challenges of maintaining a balance in family life. Clinical implications are discussed, including the setting of appropriate expectations, providing parents with accurate information, ensuring that a focus on continence is not at the expense of other important aspects of the child's functioning, and supporting parents in their interaction with the school system. The medical team, consisting of nursing, urology, nephrology, and psychology working together, can be a strong support for families.

The Experience of Parenting an Adolescent with Spina Bifida

Parents of adolescents with spina bifida (SB) face unique challenges of which they may not be aware. The purpose of this study was to heighten awareness of the challenge of parenting such adolescents. This enhanced understanding can help rehabilitation professionals optimize their interventions with families. In this qualitative study, which was part of a larger mixed-method descriptive investigation exploring adaptation by adolescents with SB, we used content analysis to evaluate 20 parent interviews for common domain, themes, and subthemes. The analysis yielded four major domains: (a) daily life experiences, (b) the dance of individuation, (c) reflections on parenting, and (d) practice suggestions for healthcare professionals. Overall, experiences of the parents were positive. Parents described meeting daily demands and balancing independence-dependence needs with the adolescent as major challenges. Rehabilitation professionals must provide guidance to foster autonomy, decision making, cognitive skill building, and coping skills to help parents and adolescents manage independence-dependence issues and multiple life demands.