Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain

Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient’s illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.     

Family Emotional Climate and Sibling Relationship Quality: Influences on Behavioral Problems and Adaptation in Preschool-Aged Children

We examined the impact of family emotional climate and sibling relationship quality on behavioral problems and adaptation in preschool-aged children. Participants were 63 mothers with a preschool-aged child enrolled in a Southern Arizona Head Start Program. Siblings were identified as children closest in age to target child. Mothers of predominantly Mexican descent (95%) participated in home interviews during the Fall and Spring of the year children entered center-based programs. Sibling relationship quality (warmth, agonism/competition) was proposed to predict children’s adjustment (behavioral problems and adaptation) longitudinally. Results indicate that after controlling for child characteristics (temperament, child gender, birth order) and after accounting for family characteristics (family emotional expressiveness, child exposure to interparental conflict, and parental agreement on childrearing), sibling warmth made a significant and unique contribution to child adjustment as reported by mothers and teachers six months later. Findings are consistent with existing research indicating that sibling relationships impact children’s adjustment and shape young children’s lives in meaningful and marked ways. Moreover, these associations were found with an understudied sample of young children of predominantly Mexican descent in low-income families, and thus make an important contribution to knowledge in the field.     

The Role of Attachment Representation in the Relationship Between Depressive Symptomatology and Social Withdrawal in Middle Childhood

We investigated the relationships among attachment representation, social withdrawal, and depressive symptomatology in childhood. A total of 326 children aged 8 to 10 years participated in the study. Children completed a family drawing procedure to assess attachment representation, the Children's Depression Inventory and the Social Withdrawal subscale of the Personality Inventory for Youth. Social withdrawal and attachment representations indicative of attachment dysfunction were each found to be positively correlated with depressive symptomatology. Further, attachment representation was found to significantly moderate the relationship between withdrawal and depression such that the positive relationship between withdrawal and depression was attenuated in the absence of attachment representations indicative of attachment dysfunction.     

Perceived Criticism and Marital Adjustment Predict Depressive Symptoms in a Community Sample

Depressive symptoms are related to a host of negative individual and family outcomes; therefore, it is important to establish risk factors for depressive symptoms to design prevention efforts. Following studies in the marital and psychiatric literatures regarding marital factors associated with depression, we tested two potential predictors of depressive symptoms: marital adjustment and perceived spousal criticism. We assessed 249 spouses from 132 married couples from the community during their first year of marriage and at three time points over the next 10 years. Initial marital adjustment significantly predicted depressive symptoms for husbands and wives at all follow-ups. Further, perceived criticism significantly predicted depressive symptoms at the 5- and 10-year follow-ups. However, at the 1-year follow-up, this association was significant for men but not for women. Finally, a model where the contributions of marital adjustment and perceived criticism were tested together suggested that both play independent roles in predicting future depressive symptoms. These findings highlight the potential importance of increasing marital adjustment and reducing perceived criticism at the outset of marriage as a way to reduce depressive symptoms during the course of marriage.     

Child and parent evaluations of depression and aggression in psychiatric inpatient children

This investigation examined the agreement between children and their parents on measures of depression and aggression. A total of 120 inpatient children (ages 7–13) and their mothers and fathers independently completed self-report and interview measures that focused on the children's dysfunction. Children and their parents differed in their ratings of each symptom area, with children providing significantly less severe ratings than their parents. Children who met DSM III criteria for major depression or conduct disorder were significantly higher in their ratings of depression and aggression than children without these diagnoses, as reflected in both child and parent ratings. Child and parent ratings correlated in the low to moderate range on measures of children's symptoms, whereas mother and father ratings correlated in the moderate to high range. The correspondence between children and parents did not vary as a function of symptom area (depression and aggression) or assessment format (self-report and interviews). The results suggest that children are able to rate the severity of their dysfunction, although they tend to provide lowerbound estimates than do their parents.     

Reciprocal influences in children's and families' adaptation to early childhood wheezing.

OBJECTIVE: The objective of the present study was to demonstrate the reciprocal relationships between family adaptation to illness and children's medication use over time among children who presented with wheezing illness in infancy but have varying illness outcomes by age 4. DESIGN: A longitudinal design and latent growth curve models (LGM) were used to predict change in family and caregiver adaptation to illness and children's medication use over three years among 140 infants with wheezing, among families from low socioeconomic, multi-ethnic backgrounds. MAIN OUTCOME MEASURES: One LGM predicted level and change (slope) of family adaptation to illness from children's baseline medication use. The second LGM predicted level and change (slope) of children's medication use from baseline family adjustment to illness. In both models, illness severity, caregivers' psychological resources, and emergency department use were covaried with the independent variable. RESULTS: Two latent growth models were found to adequately fit the data and demonstrate full reciprocal relations between family adaptation to illness and children's medication use while accounting for baseline variables. Baseline measures of caregiver psychological functioning and illness severity were also significant predictors of family adaptation and children's medication use over time. The two models were not statistically different for children with and without active asthma at 4 years of age. CONCLUSION: Findings support the reciprocal effects model of child and family influences on pediatric illness and underscore the importance of early indicators of individual and family functioning.     

Conduct Problems, Depressive Symptomatology and Their Co-Occurring Presentation in Childhood as Predictors of Adjustment in Early Adolescence

The present study investigated patterns in the development of conduct problems (CP), depressive symptoms, and their co-occurrence, and relations to adjustment problems, over the transition from late childhood to early adolescence. Rates of depressive symptoms and CP during this developmental period vary by gender; yet, few studies involving non-clinical samples have examined co-occurring problems and adjustment outcomes across boys and girls. This study investigates the manifestation and change in CP and depressive symptom patterns in a large, multisite, gender-and ethnically-diverse sample of 431 youth from 5th to 7th grade. Indicators of CP, depressive symptoms, their co-occurrence, and adjustment outcomes were created from multiple reporters and measures. Hypotheses regarding gender differences were tested utilizing both categorical (i.e., elevated symptom groups) and continuous analyses (i.e., regressions predicting symptomatology and adjustment outcomes). Results were partially supportive of the dual failure model (Capaldi, 1991, 1992), with youth with co-occurring problems in 5th grade demonstrating significantly lower academic adjustment and social competence two years later. Both depressive symptoms and CP were risk factors for multiple negative adjustment outcomes. Co-occurring symptomatology and CP demonstrated more stability and was associated with more severe adjustment problems than depressive symptoms over time. Categorical analyses suggested that, in terms of adjustment problems, youth with co-occurring symptomatology were generally no worse off than those with CP-alone, and those with depressive symptoms-alone were similar over time to those showing no symptomatology at all. Few gender differences were noted in the relations among CP, depressive symptoms, and adjustment over time.     

The Effects of Strategic and Behavioral Family Therapies on Child Behavior and Depression

The efficacy of behavioral and strategic approaches to child-focused family therapy for child behavior and depressive symptomatology was investigated. Participants were 49 clinic-referred families who were randomly assigned to either behavioral or strategic family therapy for 8 to 12 weeks and assessed at pre- and post-test. Results showed that both forms of therapy were equally effective in reducing parent-reported behavior problems and depression in children. In addition, the relationship between child and maternal depression was explored. Significant relationships were found between pre-test levels of depression in children as reported by mothers and mothers' self-reported depression, psychological stress and level of interpersonal discomfort. The results support a relationship between child and maternal depression. The findings also suggest that child-focused family therapy can be effective for both behavioral and depressive symptoms.     

Children's Adjustment to Parental Physical Illness

We review recent empirical literature examining the impact of parent physical illness on child functioning. We review studies of illness characteristics (n = 16), individual characteristics (n = 6), and family characteristics (n = 6). Although children's self-reports indicate heightened distress, parental reports do not suggest more problematic functioning. Child adjustment appears to be more closely related to perceptions of stressfulness rather than to objective illness severity indices. Adolescent girls seem to represent a group at heightened risk. Preliminary results suggest that family variables such as cohesion, conflict, and individual and family coping styles are important predictors of child adjustment.     

The Psychological Impact of Domestic Violence on Spanish Women1

This study examined the psychological impact of partner violence on 240 Spanish women who were identified as abused, comparing them to a control group of 240 non‐abused women. The abused women suffered more long‐lasting anxiety and insomnia, severe depression, and somatic symptomatology, and also had lower self‐esteem than did the non‐abused women. The severity of the psychological abuse was correlated positively with the severity of the physical abuse, while the number of years of abuse endured correlated with the women's age and number of children. The most relevant variable for predicting severe depression, social dysfunction, anxiety and insomnia, and somatic symptoms was low self‐esteem.     

Predictors of Psychosocial and Cognitive Adaptation in Children with Sickle Cell Syndromes

Examined the role of socioecological factors (family functioning and socioeconomic variables) in predicting behavioral and cognitive adaptation in children with sickle cell syndromes (SCD). Participants included 74 African American children and adolescents with SCD and their primary caretakers. Outcomes included internalizing and externalizing behavior symptoms, as rated by caretakers, as well as intellectual abilities and academic achievement, as assessed by individually administered standardized instruments. Family functioning consisted of both caretaker adjustment and family environment (i.e., family adaptability and cohesion). Hierarchical multiple regression analyses revealed that caretaker psychological adjustment predicted externalizing behaviors, while family environment (i.e., adaptability and cohesion) predicted neither behavioral nor cognitive functioning. Socioeconomic variables alone predicted intellectual abilities and academic achievement and also contributed to the prediction of child behavioral adaptation. Results are discussed in terms of relevant sociocultural issues and implications for family-level prevention and intervention.     

Prevalence and Correlates of Depressive Symptoms Following Traumatic Brain Injuries in Children

The prevalence and correlates of depressive symptoms following childhood traumatic brain injuries (TBI) were examined using data drawn from a prospective longitudinal study. Participants included 38 children with severe TBI, 51 with moderate TBI, and 55 with orthopedic injuries (OI). Assessments occurred shortly after injury (baseline) and at 6- and 12-month follow-ups. Children completed the Child Depression Inventory (CDI). Parents rated depressive symptoms using the Child Behavior Checklist (CBC), with baseline ratings reflecting premorbid status. Assessments also included measures of children's neurocognitive functioning and the family environment. The three groups did not differ overall in self-reported symptoms on the CDI, but did display different trends over time. The three groups did not differ on parent ratings of premorbid depressive symptoms on the CBC, but parents reported more depressive symptoms in the TBI groups than in the OI group at 6- and 12-month follow-ups. Child and parent reports were correlated for children in the TBI groups, but not for those in the OI group. Depressive symptoms were related to socioeconomic status in all groups. Socioeconomic status also was a significant moderator of group differences, such that the effects of TBI were exacerbated in children from more disadvantaged homes. Although self-reports of depressive symptoms were related inconsistently to children's verbal memory, parent reports of depressive symptoms were unrelated to IQ or verbal memory. The findings suggest that TBI increases the risk of depressive symptoms, especially among more socially disadvantaged children, and that depressive symptoms are not strongly related to post-injury neurocognitive deficits.     

Comorbidity of anxiety and depression in children and adolescents.

Anxiety and depression in children and adolescents are reviewed, including differential diagnosis, assessment of symptoms, family history data, developmental features, and clinical correlates. Findings indicate that 15.9% to 61.9% of children identified as anxious or depressed have comorbid anxiety and depressive disorders and that measures of anxiety and depression are highly correlated. Family history data are inconclusive. Differences emerged among children with anxiety, depression, or both disorders. Anxious children were distinguishable from the other 2 groups in that they showed less depressive symptomatology and tended to be younger. The concurrently depressed and anxious group tended to be older and more symptomatic. In this group, the anxiety symptoms tended to predate the depressive symptoms. Findings are discussed in the context of a proposed developmental sequence.     

Mind over matter: cognitive - behavioral determinants of emotional distress in multiple sclerosis patients

Given the high incidence and unique symptomatology of depression in multiple sclerosis (MS) patients, the current study examined the role of cognitive and behavioral variables in predicting psychosocial adjustment in this population, in order to suggest psychotherapeutic interventions tailored specifically to MS patients. Data from 329 MS patients indicated that problem solving coping, acceptance coping, and challenge appraisals were associated with positive psychological adjustment (i.e., high life satisfaction, low depression and anxiety), whereas variables measuring disease severity (i.e., illness duration, subjective health status, and self-reported disability) were not associated with adjustment. These findings suggest that MS patients' psychological outcomes are more related to controllable cognitive and behavioral factors than to the physical effects of the disease. Consequently, it is expected that interventions that target these specific coping strategies and cognitive appraisals will be effective in treating the emotional effects of MS.     

父母控制与儿童心理适应的关系：儿童自我控制的中介作用

以555名小学四到六年级儿童为被试,采用问卷调查法考察父母控制与儿童心理适应的关系,以及儿童自我控制在两者关系间的中介作用。结果发现：（1）六年级儿童的自我控制水平显著高于四年级,且情绪症状显著多于四、五年级;男生多动−注意缺陷水平显著高于女生;（2）父母行为控制对儿童积极心理适应具有显著正向预测作用,对儿童消极心理适应具有显著负向预测作用;而父母心理控制对儿童积极心理适应具有显著负向预测作用,对儿童消极心理适应具有显著正向预测作用;（3）儿童自我控制在父母控制（行为控制和心理控制）与儿童多动−注意缺陷和亲社会行为的关系间起显著中介作用,在父母控制与儿童情绪症状关系间中介作用不显著。     

Cognitive-behavioral depression treatment for mothers of children with attention-deficit/hyperactivity disorder

An adaptation of the Coping With Depression Course (CWDC) was evaluated in mothers of children with attention-deficit/hyperactivity disorder (ADHD), a population at risk for depression. Mothers were randomly assigned to receive the CWDC either immediately following an intensive summer treatment program targeting their child's behavior or after a wait-list period. Measures of maternal functioning, cognitions about child behavior, parent-child and marital relationship quality, child behavior, and ADHD-related family impairment were obtained at pretreatment, posttreatment, and 5-month follow-up. The CWDC resulted in improvements in maternal depressive symptoms, maternal self-esteem, child-related cognitions, and family impairment at posttreatment compared to a wait-list control group that were maintained at follow-up. Findings suggest that the CWDC is a promising intervention for mothers of children with ADHD, particularly those with current depressive symptomatology.     

Family psychological factors in relation to children's asthma status and behavioral adjustment at age 4

The objectives of this study were to determine whether family psychosocial factors influenced asthma development by age 4, and whether family factors and early wheezing illness were associated with behavioral adjustment at age 4. Participants were 98 children enrolled in an intervention study at 9-24 months and followed to age 4. Baseline evaluations assessed infants' respiratory illness severity, family psychosocial characteristics, and parental risk factors for asthma development. Active asthma categorization at age 4 utilized both parent report and objective data. Parents completed the Child Behavior Checklist (CBCL). Caregiver single-parent status, a composite of baseline family stresses, and early wheezing illness severity were associated with active asthma at age 4. The contribution of prenatal smoke exposure and early hospitalization to active asthma varied with racial/ethnic group membership. Maternal mental health and family stresses predicted CBCL scores at age 4, whereas early illness severity and hospitalization were unrelated to CBCL scores. CBCL scores were not elevated for children with active asthma at age 4. Family factors consistent with a negative emotional environment were associated with both active asthma and adjustment problems at age 4, suggesting that both outcomes may be influenced by a common factor.     

Prevalence and correlates of depressive symptoms following traumatic brain injuries in children.

The prevalence and correlates of depressive symptoms following childhood traumatic brain injuries (TBI) were examined using data drawn from a prospective longitudinal study. Participants included 38 children with severe TBI, 51 with moderate TBI, and 55 with orthopedic injuries (OI). Assessments occurred shortly after injury (baseline) and at 6- and 12-month follow-ups. Children completed the Child Depression Inventory (CDI). Parents rated depressive symptoms using the Child Behavior Checklist (CBC), with baseline ratings reflecting premorbid status. Assessments also included measures of children's neurocognitive functioning and the family environment. The three groups did not differ overall in self-reported symptoms on the CDI, but did display different trends over time. The three groups did not differ on parent ratings of premorbid depressive symptoms on the CBC, but parents reported more depressive symptoms in the TBI groups than in the OI group at 6- and 12-month follow-ups. Child and parent reports were correlated for children in the TBI groups, but not for those in the OI group. Depressive symptoms were related to socioeconomic status in all groups. Socioeconomic status also was a significant moderator of group differences, such that the effects of TBI were exacerbated in children from more disadvantaged homes. Although self-reports of depressive symptoms were related inconsistently to children's verbal memory, parent reports of depressive symptoms were unrelated to IQ or verbal memory. The findings suggest that TBI increases the risk of depressive symptoms, especially among more socially disadvantaged children, and that depressive symptoms are not strongly related to post-injury neurocognitive deficits.     

Asthma severity, child security, and child internalizing: using story stem techniques to assess the meaning children give to family and disease-specific events

Children with persistent asthma are at increased risk for mental health problems. Although mechanisms of effect are not yet known, it may be that children are less trusting of the family as a source of support and security when they have more severe asthma. This study tested whether asthma severity is related to children's perceptions of insecurity in the family, and whether insecurity is in turn associated with child adjustment. Children (N = 168; mean age = 8 years) completed story stems pertaining to routine family events (e.g., mealtimes) and ambiguous but potentially threatening asthma events such as tightness in the chest. Responses were evaluated for the extent to which appraisals portrayed the family as responding in cohesive, security-provoking ways. Asthma severity was assessed by both objective lung function testing and primary caregiver report. Caregivers reported child symptomatology. Beyond medication adherence, caregiver education, and child age and gender, greater asthma severity predicted more internalizing and externalizing symptoms. Greater asthma severity, assessed using spirometry (but not parent report), was related to less secure child narratives of the family, which in turn related to more child internalizing symptoms. Results suggest that asthma can take a considerable toll on children's feelings of security and mental health. Furthermore, given the difficulty in assessing young children's perceptions, this study helps demonstrate the potential of story stem techniques in assessing children's appraisals of illness threat and management in the family.