ICTs and Family Functioning: A Study on Portuguese Families with Adolescents and Emerging Adults

Nowadays, information and communication technologies (ICTs) represent an integral part of contemporary family life, introducing changes in families’ functioning. Positive, negative, and mixed aspects of this influence were identified. The present study intends to understand the relationship between ICTs and family functioning among participants from two different family life cycle stages. A total of 157 Portuguese families (307 participants from 97 families with emerging adult children and 169 from 60 families with adolescents) completed measures about the use of ICTs (an adaptation of SEFT/ETEF©) and family functioning (SCORE-15). The number of ICTs and problems related to their use were higher in families with adolescent children. The use of a higher number of ICTs was related to a better level of family functioning in both family groups. However, according to the multiple regression model, the problematic situations related to ICTs use only seem to predict a worse level of family functioning in families with adolescent children. Also, parents and children of each group differed in the number of ICTs used. Some limitations, implications for family therapy, and future research directions are discussed.     

Transactional Paths Between Children and Parents in Pediatric Asthma: Associations Between Family Relationships and Adaptation

The particular challenges posed by pediatric asthma may have a negative impact on the adaptation of children and their parents. From a transactional approach it is important to examine how reciprocal links between children and parents contribute to explain their adaptation and under which conditions these associations occur. This cross-sectional study aimed at examining the direct and indirect links between children’s and parents’ perceptions of family relationships and adaptation, separately (within-subjects) and across participants (cross-lagged effects), and the role of asthma severity in moderating these associations. The sample comprised 257 children with asthma, aged between 8 and 18 years-old, and one of their parents. Both family members completed self-reported questionnaires on family relationships (cohesion and expressiveness) and adaptation indicators (quality of life and psychological functioning). Physicians assessed asthma severity. Structural Equation Modeling was used to test within-subjects and cross-lagged paths between children’s and parents’ family relationships and adaptation. The model explained 47 % of children’s and 30 % of parents’ adaptation: family relationships were positively associated with adaptation, directly for children and parents, and indirectly across family members. Asthma severity moderated the association between family relationships and health-related quality of life for children: stronger associations were observed in the presence of persistent asthma. These results highlight the need of including psychological interventions in pediatric healthcare focused on family relationships as potential targets for improving children’s and parents’ quality of life and psychological functioning, and identified the children with persistent asthma as a group that would most benefit from family-based interventions.     

Executive functioning and health-related quality of life in pediatric sickle cell disease

Research consistently indicates that children with sickle cell disease (SCD) face multiple risk factors for neurocognitive impairment. Despite this, no empirical research to date has examined the impact of neurocognitive functioning on quality of life for this pediatric group. Thus, the current study aims to examine the relationship between executive functioning and quality of life in a sample of children with SCD and further explore psychosocial and family/caregiver resources as moderators of this relationship. A total of 45 children with SCD aged 8 to 16 years and their caregivers completed measures of quality of life, behavioral ratings of executive functioning, and psychosocial functioning. Hierarchical linear regression models were utilized to determine the impact of executive functioning on quality of life and further test the interaction effects of proposed moderating variables. Controlling for age, pain, and socioeconomic status (SES), executive functioning was found to significantly predict child- and parent-reported quality of life among youth with SCD. Psychosocial resources of the primary caregiver or family was not found to moderate the relationship between executive functioning and quality of life. These results provide the first empirical evidence that lower executive skills negatively predict quality of life for children with SCD, supporting clinical and research efforts which aim to establish efficacious interventions that target cognitive decrements within this pediatric population.     

Alltag mit der Depression des Partners

Objective. Clinical research on the quality of interpersonal relationships in individuals with unipolar depression supports the idea that the family plays a major role in the development and the course of major depression. In order to further explore how family functioning relates to unipolar depression, the authors examined changes in family functioning as viewed by the patients' spouses. Methods. Interview data from 54 spouses of patients with unipolar depression were analysed as part of the baseline assessment of a study on the economic and health burden experienced by families with mentally ill relatives. Results. Having a family member with a current major depressive disorder is a general stressor for families and has implications for the health and well-being of the patient's spouse. Depressive symptoms affect a wide range of aspects of marriage and family life and result in a process of adaptation and transformation of the patient's family. Thus, in assessing burden experienced by spouses particular attention should be paid both to the social environments and to different aspects of the relationship as perceived by the patient's spouse in order to further understand the factors mediating the interaction between major depression and family functioning.     

Family Cohesion and Adaptation in Pediatric Chronic Conditions: The Missing Link of the Family’s Condition Management

The quality of family functioning has been considered an important predictor of adaptation in children with chronic conditions and their parents. Previous research suggests that beyond general family functioning, the specific experience of the family’s condition management is paramount for understanding family members’ adaptation. This study’s first goal was to compare family functioning and parents’ and children’s adaptation outcomes across four chronic conditions: asthma, diabetes, epilepsy, and obesity. Secondly, we explored the mediating role of family life difficulties and parental mutuality, as two potential paths through which family cohesion is linked to family members’ adaptation. A total of 263 parents of children (3–19 years old) with asthma (n = 77), obesity (n = 79), epilepsy (n = 52) and diabetes (n = 55) completed self-report measures of family cohesion, family life difficulty, parental mutuality, anxiety and depressive symptoms, and their children’s health-related quality of life (HrQoL). The results showed that families of children with diabetes, obesity, and epilepsy were at higher risk of experiencing family difficulties and children’s deteriorated HrQoL when compared to families of children with asthma. With regard to the links among study variables, although family cohesion had both a direct and indirect relationship with parental depressive symptoms, its links with parental anxiety symptoms and children’s HrQoL were only indirect, through family life difficulty. These associations were consistent across the four clinical groups. These findings emphasize the relevance of family-centered interventions aimed at promoting family cohesion, parents’ mutuality, and effective coping with the demands of pediatric chronic conditions.     

COMMENTARY

Salzman's commentary initially examines two theoretical considerations of the genesis of substance abuse. He elaborates on the hypothesis that changes in the family precede abuse and relates it to conceptual similarities with research on schizophrenic families. He points out that the proposed research that focuses on ongoing processes rather than causality also fails to identify factors leading to the selection of symptomatology. The author concludes with comments on his work in the area of psychoactive drugs and group functioning and suggests that the inclusion of the following methodologies in research design might be instructive: (a) the combining of self, group, and experimenter observations; (b) the comparison of family interactional patterns when the drug-abusing member is under chemical influence and when he is not; and (c) informal observations and discussions focused on the family's perception of the research as well as on task performance.     

Parental expressed emotion toward children: prediction from early family functioning

Expressed emotion (EE), an index of family member criticism and emotional overinvolvement, predicts outcome among adults and children with mental disorders. However, limited research exists on factors contributing to EE. Aims of the current study were to (a) examine EE in mothers of young children; (b) assess relationships between demographic factors and EE in a diverse sample; and (c) investigate whether family stress and functioning, including quality of marital relationship, life events, maternal stress, and family environment, predict EE. In the current study, 276 mothers completed questionnaires when their children were between 1 and 3 years of age and a measure of EE when their children were in kindergarten. Results indicated that family expressiveness was the most consistent predictor of EE. Further research seems warranted to better delineate associations between family functioning and EE.     

Apathy in dementia: relations with depression, functional competence, and quality of life

This study set out to clarify the association of apathy and depression in dementia as well as apathy's association with basic (ADLs) and instrumental (IADLs) activities of daily living and quality of life. 68 outpatients with mild dementia were assessed on apathy, depression, global cognition, traditional ADLs/IADLs, complex daily living activities requiring intact executive functioning (DAD: Disability Assessment for Dementia Scale), and quality of life. The sample was stratified into high and low global cognition groups and compared. While no relationship was found between scores on apathy and depression in the high cognition group, there was a significant relationship between apathy and depression in the low cognition group. Further, high and low cognition groups differed in the relationship between apathy and ability to perform basic and complex activities of daily living. Specifically, in the high cognition group, increased apathy was correlated with diminished ability to perform traditional IADLs as well as those activities requiring intact executive functioning (i.e., DAD). In the low cognition group, increased apathy was associated with poor performance on traditional ADLs and IADLs, but was not related to performance on independent daily activities demanding good executive functioning. Finally, increased apathy was significantly associated with worse quality of life, but this held for the high cognition group only, suggesting that dementia patients with better cognition have insight into their deficits and, perhaps, experience poor quality of life as a result.     

Parents Living with HIV in China: Family Functioning and Quality of Life

In China, HIV shifts the lifestyle of not only parents living with HIV/AIDS, but also their children, partners, and extended families. We examined factors related to the quality of life of parents living with HIV and the relation between family functioning and individual quality of life. Interviews were conducted with a total of 116 parents living with HIV/AIDS. Analyses of variance, Pearson correlations, and multiple regression analyses were performed to examine the relation between family functioning and quality of life. We found a significant association between family functioning and individual quality of life for parents living with HIV. In particular, family sociability had a strong relationship with the quality of life of parents living with HIV. Parents living with HIV from families where both parents are HIV-positive reported a lower level of family sociability than those from families with only one HIV-positive parent. HIV disclosure, family sociability, and number of children per family were found to be significant predictors of overall quality of life for the population. Study findings underscore the importance of developing interventions that improve family functioning for people living with HIV/AIDS in China.     

Concensus Rorschach interaction patterns of families with an asthmatic child

This paper reports a study of interaction in families with a child suffering from bronchial asthma. Eighteen families, subdivided into two groups according to the severity of the child's illness, were given the Consensus Rorschach following Willi's procedure. Quantitative assessments of family members on cognitive-affective functioning and social interaction were obtained. Factor analysis of quantitative scores revealed diversified interactional strategies among family member groups. Families as wholes varied as to patterns of cross-generational alliances and/or domination of different family members and could be clustered into four interactional pattern groups. There was no correlation between this grouping and the severity of the child's illness. Some measures of cognitive-affective functioning differentiated between family members of asthmatics from the two severity subgroups. The correspondence of these findings to prevailing family theories of psychosomatic illness is discussed.     

What Makes Crohn's Disease Patients Difficult to Manage? The Role of Psychosocial Factors

Most GI clinicians face the problem of a small group Crohn's Disease (CD) patients who function poorly and consume inordinate amounts of service with poor outcome. This study examines the hypothesis that psychosocial factors differentiate the CD patients who function poorly from the typical CD patient. A prototypal sample of CD patients with problems functioning, more typical CD patients (not selected for having problems in functioning), and healthy controls each completed a battery of validated psychosocial measures of disease-specific quality of life, coping skills, social support and life stress, perceived medical symptoms and life history factors. Chart data on hospital admissions, ER, GI, Surgeon, and GP visits were also collected. The CD patients with problems functioning reported more symptoms (GI and non-GI) and had many more ER, GI, and GP visits than the typical group. Psychologically, those with problems functioning had poorer quality of life and were more likely to cope using emotional discharge and support seeking. They experienced significantly more stress and reported a more chaotic family history. No differences on an experimental method of information processing biases were found between the CD groups, however. These results indicated that patients with problems functioning, selected by GI staff because they were best-case examples of functional difficulties, shared little with a matched group of typical CD patients. These patients likely require psychological as well as medical intervention to best manage their illness.     

Observations on Loss and Family Development

This article examines the role of death and loss in family developmental processes. Aspects of family development are described, followed by an exploration of the impact of loss on family functioning and development. We present a typology of initial family response styles to the death of a member as well as some immediate and longer-term patterns of adaptation after a loss. The article concludes with a case example and a discussion of multigenerational sequelae of unresolved bereavement in family systems.     

Family routines and rituals in the context of chronic conditions: A review

This paper is a systematic review of 39 empirical studies on family routines and rituals in the context of a chronic condition of a family member. The search strategy encompassed a wide spectrum of chronic conditions affecting family members from childhood/adolescence to adulthood. Twenty quantitative, 13 qualitative, 3 mixed‐methods, and 3 intervention studies published between 1995 and 2012 were reviewed. A conceptual framework of routines and rituals as key elements of family health was adopted, resulting in three main findings. First, a chronic condition in a family member impacted the frequency and nature of family's routines and rituals. Second, these whole‐family interactions held important functions for individuals and families, constituting strategic resources in the condition's management and opportunities for emotional support exchanges, and providing the family with a sense of normalcy amid the challenges posed by chronic conditions. Third, family routines and rituals were linked to positive health and adaptation outcomes for both patients and family members. Implications for future research include the need for the distinction between routines and rituals against a conceptual background, use of validated assessment methods, and empirical examination of predictors of changes in routines and rituals throughout the course of the condition and of the mechanisms linking these family events to positive outcomes. Conclusions support the inclusion of routines and rituals in a family‐centered care approach to the understanding and treatment of chronic conditions.     

Virtual special issue on theory and research on collective action in the European Journal of Social Psychology

This virtual special issue presents a collection of 23 articles that present theory and research on collective action in the European Journal of Social Psychology. The articles are organized according to four major themes that emerged. In the first section, articles on identification with the disadvantaged group, identification with the superordinate group, and identity content as predictors of collective action are summarized. The second section combines articles examining the role of sociostructural variables (permeability, legitimacy, and stability) for collective action. The third section comprises articles on the psychological implications of sociostructural variables (emotions, efficacy beliefs, threat perceptions) as predictors of collective action. In the final section, articles that highlight the dynamic perspective on collective action are presented. This issue contains articles on collective action conducted by disadvantaged groups, advantaged groups, and opinion‐based groups. After the conceptual overview, commonalities and distinctions between the articles are highlighted, and some directions for future research are outlined. Copyright © 2012 John Wiley & Sons, Ltd.     

Family resilience: a framework for clinical practice

This article presents an overview of a family resilience framework developed for clinical practice, and describes its advantages. Drawing together findings from studies of individual resilience and research on effective family functioning, key processes in family resilience are outlined in three domains: family belief systems, organizational patterns, and communication/problem-solving. Clinical practice applications are described briefly to suggest the broad utility of this conceptual framework for intervention and prevention efforts to strengthen families facing serious life challenges.     

Family factors associated with attention deficit hyperactivity disorder and emotional disorders in children

Few well-controlled studies have identified psychosocial profiles of families of boys with ADHD and boys with emotional disorders compared with normal controls. However, the clinical and theoretical literature pinpoints four domains in which distinctive profiles would be expected to occur. In this study, twenty-two mothers and thirteen fathers of twenty-two boys with ADHD; twenty mothers and fifteen fathers of twenty boys with a mood or anxiety disorder; and twenty-six mothers and sixteen fathers of twenty-seven normal controls were compared on: (1) stress, support and quality of life; (2) current family functioning; (3) parenting style and satisfaction in the family of origin and current family; and (4) current and past parental functioning. The two clinical groups showed higher levels of stress and lower levels of both social support and quality of life than did normal controls. Both clinical groups showed deficits in current family functioning, but contrary to expectations the ADHD and emotional disorder group did not show distinctly different profiles. Parents of ADHD children reported higher levels of authoritarian parenting styles, and parents from both clinical groups reported less parenting satisfaction than did normal controls in both their current families and their families of origin. Parents of children with ADHD and emotional disorders reported greater parenting satisfaction in their families of origin than in their current families. This discrepancy was greatest for parents of ADHD children. Parents of children with ADHD and emotional disorders reported greater psychological health problems and more childhood ADHD symptomatology than did normal controls. Parents of children with ADHD and emotional disorders have significant psychosocial difficulties in family and personal functioning. Family intervention is highly appropriate for families with children who are referred for help with both types of difficulties.     

Major life events, hassles, and adaptation in adolescence: confounding in the conceptualization and measurement of life stress and adjustment revisited

Prior work has suggested that methodological and conceptual confounding may play a role in the associations obtained between stressful life events, social resources, and adaptive outcome. Of particular concern in our work were (a) the source and method of assessment; (b) conceptual overlap between life stress and resource items and symptoms of disorder; and (c) induced response bias through the instructional sets of the stress measures. A second goal was to extend our understanding of the life stress-adjustment linkage in groups for whom little data of this type exist. By using multi-trait-multimethod procedures we found that both distal major life events and proximal daily stressors had important degrees of unique and shared variance with adaptive functioning, whereas the effects for social support were inconclusive. Further, the importance of considering possible sources of potential confounding in producing quite different levels of association between life stress and adaptation was underscored by the results.     

Family environments and adaptation: A clinically applicable typology

Abstract

Improved methods for assessing the interrelationships of the family environment and individuals' patterns of adaptation are needed for clinical and research purposes. To address this need, a typology of family environments based on multidimensional assessments of a representative sample of community families is presented. Seven family types were identified: 1) independence oriented, 2) achievement oriented, 3) moral/religious oriented (structured and unstructured), 4) intellectual/cultural oriented, 5) support oriented, 6) conflict oriented, and 7) disorganized. Differences in environmental stressors and coping resources were examined as mediators of the associations between the family types and family members' levels of functioning. Clinical and research applications of the typology are discussed.     

Quality of Life in Flemish Families with a Child with an Intellectual Disability: a Multilevel Study on Opinions of Family Members and the Impact of Family Member and Family Characteristics

This study examined family members’ opinions regarding their family quality of life (FQOL). Parents (n = 97) and youngsters (n = 24) of 63 families with a child with an intellectual disability (ID) receiving home-based support completed the Beach Center FQOL Scale. Multilevel models detected substantial variability in FQOL scores and in most subscale scores both within and between families. The observed differences were partly explained by the respondent’s age, the parents’ employment situation, and the support needs of the child with an ID. Role of the family member and gender of the parent could not explain this variability. By including and comparing multiple family members’ opinions, this study contributes to the methodological and conceptual discussions about measuring FQOL.     

The Evaluation of Family Functioning by the Family Assessment Device: A Systematic Review of Studies in Adult Clinical Populations

A large body of research, documenting the impact of a family's functioning on health outcomes, highlights the importance of introducing the evaluation of patients' family dynamics into clinical judgment. The Family Assessment Device (FAD) is a self‐report questionnaire designed to assess specific dimensions of family functioning. This qualitative systematic review, which follows PRISMA guidelines, aimed to identify the FAD's clinimetric properties and to report the incremental utility of its inclusion in clinical settings. A thorough literature search was performed, using both computerized and manual searches, yielding a total of 148 studies that were included in this review. The FAD has been extensively used in a variety of research contexts. In the majority of studies it was able to discriminate between clinical populations and controls and among groups of patients with different illnesses. The FAD also showed good test–retest and concurrent reliability, and modest sensitivity to change after treatment. FAD‐dysfunctional family functioning was related to several patient clinical outcomes, including lower recovery rates and adherence to treatment, longer recovery time, poorer quality of life, and increased risk of relapse and drop‐out. The present review demonstrates that the FAD is a suitable instrument for the evaluation of family functioning both in clinical and research settings.