The Relation Between Parental Mental Illness and Adolescent Mental Health: The Role of Family Factors

Children of parents with a mental illness are often found to be at high risk of developing psychological problems themselves. Little is known about the role of family factors in the relation between parental and adolescent mental health. The current study focused on parent–child interaction and family environment. This cross-sectional questionnaire study included 124 families with a mentally ill parent and 127 families without a mentally ill parent who at the time of the study had children aged 11–16 years old. Parents completed questionnaires about their mental health, parent–child interaction (i.e., parental monitoring and parental support), and family environment (i.e., cohesion, expressiveness, and conflict). Adolescents reported their internalizing and externalizing problems. Path analyses were used to examine the direct associations between parental mental illness and adolescent problems as well as the indirect relations via parent–child interaction and family environment. The results showed that interaction between parents with a mental illness and their child was significantly worse compared to parents without a mental illness. The family environment of parents with mental illness was also more negative. Mentally ill parents monitored their adolescents less, which in turn related to more externalizing problems of the adolescents. No factors mediated the relation between parental mental health and adolescent internalizing problems. Moreover, no direct effects of parental support, family cohesion, and family expressiveness with externalizing problems were found. These findings imply that parental monitoring should get a specific focus of attention in existing interventions designed to prevent adolescents with a mentally ill parent from developing problems.     

Examining Relationships Between Ethnic Identity, Family Environment, and Psychological Outcomes for African American Adolescents

Ethnic identity has been linked to a number of healthy psychological outcomes for African American adolescents. The levels of conflict and cohesion in the family environment have also been found to be predictive of adolescent mental health. This study examined whether the ethnic identity and levels of conflict and cohesion in the family environments were related to adolescents’ psychological adjustment. Participants included 61 African American adolescents, ages 10–14 years old, and their parents. Hierarchical regression models were used to determine the cumulative effects of ethnic identity and family functioning on adolescent mental health, specifically adolescent levels of depression, self-esteem, and interpersonal functioning. Results indicated that having a positive ethnic identity and a cohesive family environment were most strongly associated with psychological adjustment. Implications of these results are discussed in terms of family interventions.     

Lives in a balance: perceived family functioning and the psychosocial adjustment of adolescent cancer survivors.

Childhood cancer patients have a greater likelihood of long-term survival than ever before. This study examined both the perceived family functioning of adolescents who had successfully completed treatment for pediatric cancer and the relationship between family functioning and post-treatment adjustment. Eighty-eight adolescent survivors of hematologic malignancies were assessed regarding their family functioning, mental health, self-esteem, global competence, and problem behaviors. Contrary to expectations about the influence of cancer on these families, adolescent cancer survivors reported lower levels of family cohesion than the normative sample of healthy adolescents and their families. While current age, gender, age at diagnosis, and time since treatment completion were generally not associated with adolescents' adjustment, perceived family cohesion and adaptability were strongly related to post-treatment psychological adjustment.     

A preliminary investigation of family coping styles and psychological well-being among adolescent survivors of Hurricane Katrina.

The relation between family coping styles and psychological well-being was compared for adolescents (12-17 years) displaced by Hurricane Katrina and currently living in a relocation camp (n = 50) and nonaffected adolescents (n = 31) matched on age, race, and socioeconomic status. Adolescents in the Katrina sample reported a family mobilizing strategy that reflected an increased reliance and seeking of extra-familial, community-based support but lower self-esteem and more symptoms of distress and depression. Follow-up analyses suggested that the relations between group differences in participants' hurricane-related trauma experiences and greater psychological distress may be mediated in part by the family coping strategy; exposure to increased levels of community-provided support may have unintended consequences on adolescents' psychological health. These results highlight the importance of future research on both potential benefits and costs of family coping styles in adolescents affected by a large-scale disaster.     

Relationships among parental reports of child, parent, and family functioning.

Most children with psychosocial problems do not present for treatment in mental health settings. They are managed by primary care physicians. Children with psychosocial problems often have parents and/or families with psychosocial distress. The present study measured associations between parental reports of child, parent, and family functioning in individuals in the general population. Participants were 226 parents of children, aged 2-16 years, who presented for routine primary care. Parents reported on the psychosocial functioning of themselves, their child, and their family. All correlations of measures were significant, ranging from .55 to .23. Similar to data from psychiatric samples, the psychological functioning of children, parents, and families were significantly correlated. Unlike in psychiatric settings, child mental health problems were not as closely related to parent or family distress as parent and family distress were related to each other and to child behavior problems.     

Author Index

The association between family functioning and adolescent adjustment was examined in 429 Chinese adolescents via children's and parents' reports. The ratings obtained from the different sources indicated that family functioning was significantly related to measures of (a) adolescent psychological well-being (general psychiatric morbidity, life satisfaction, purpose in life, hopelessness, and self-esteem), (b) school adjustment (perceived academic performance and school conduct), and (c) problem behavior (smoking and abusing psychotropic drugs). The findings suggest that there is an intimate link between family functioning and the psychosocial adjustment, particularly the positive mental health, of Chinese adolescents.     

Adolescent Gender and Age Differences in Responsiveness to Functional Family Therapy

The current study contributes to a sparse literature on moderators of Functional Family Therapy (FFT) by examining whether responsiveness to FFT, measured by a broad range of outcomes, varies by adolescent gender, age, and their interaction. This study was informed by 687 families (n, adolescents = 581; n, caregivers = 933) and utilized a pre–post comparison design. Fixed-effects regressions with gender, age, and their interaction included as explanatory variables were conducted to calculate the average change in youth mental health, callous–unemotional traits, academic outcomes, substance use, and family functioning. Moderation analyses revealed that according to parent report, girls had significantly greater improvements in peer problems and family functioning, and boys benefited more in increased liking of school. There were differential effects by age, such that older youth had less beneficial mental health outcomes and a smaller decrease in frequency of hash use. The gender by age interaction was significant for adolescents’ report of mental health and family functioning outcomes, which suggests that girls benefit from FFT less than boys during early adolescence, but benefit more than boys in late adolescence. This finding adds to literature which has evidenced that family functioning is particularly important for girls by suggesting that FFT is important for improving older girls’ mental health and family functioning in particular. The study’s results expand the examination of outcomes of FFT to include academic outcomes, and provide insight into key factors that should be considered in addressing adolescent behavioral problems and family functioning.     

Cortisol Awakening Response as an Index of Mental Health and Well-Being in Adolescents

Physiological measures provide a useful complement to self-report indices of mental health and well-being. The cortisol awakening response (CAR) has been associated with mental distress, but less consistently so with positive functioning. In this study, the utility of two CAR indices as a measure of the full spectrum of mental health and well-being in a sample of healthy adolescents was explored. Forty-seven adolescents (14M, 33F; mean age 13.89, SD = .73) completed questionnaires on mental distress and positive functioning, and provided three saliva samples for cortisol analysis as well as demographic and life event information. Correlational analyses revealed that both absolute CAR (CARi) and area under the curve during awakening (CAR_AUC) indices correlated positively with measures of mental distress, and inversely with measures of positive functioning. When the significant life events score was controlled, moderate to strong effects were maintained with negative and positive affect, mental well-being, satisfaction with life and perceived social support from significant others. These findings provide the first data confirming that CAR is a reliable index of positive functioning in healthy adolescents.     

Well-being and Need for Support of Adolescents with a Chronically Ill Family Member

This study investigates whether there are differences in the well-being, need for help and use of support services between adolescents with and without a chronically ill or disabled family member. It also examines the role played by the type of illness, the relationship to the family member and the nature and intensity of the help provided by the adolescent. A Dutch sample of 1581 adolescents (average age 14.6?years) completed a questionnaire in 2010 about mental health problems, pro-social behavior, need for and use of support and the illness of family members and any care tasks performed by the respondent. Young people with a sick family member had more mental health problems than their counterparts without a chronically ill family member. They also reported a greater need for and use of help and support. Performing domestic tasks was found to be a predictor for overall mental health problems. The intensity of the help given was related to the need for help by the adolescent. It is concluded that growing up with a chronically ill family member and spending a lot time performing (domestic) tasks are risk factors for adolescent mental health problems and adolescents’ need for help. Special attention is warranted for those who need support but who do not translate that need into reality by seeking help.     

Factors of biological risk and reserve associated with executive behaviors in children and adolescents with spina bifida myelomeningocele.

This study examined differences between healthy children (n = 35) and those with spina bifida myelomeningocele (SBM; n = 42) on the Behavior Rating Inventory of Executive Function (BRIEF), a measure of executive function behaviors. It also examined whether aspects of biological risk associated with SBM and reserve factors within the family could account for variability in BRIEF scores for children and adolescents with SBM. Patients in the SBM group exhibited more problems than both published norms and a local comparison group of healthy children in metacognition but not behavior regulation. Behavior regulation problems in children with SBM were predicted by parent psychological distress. More shunt-related surgeries and history of seizures predicted poorer metacognitive abilities.     

Mood reactivity to daily negative events in early adolescence: relationship to risk for psychopathology

Emotional responses to negative daily experiences in young adolescents may provide important clues to the development of psychopathology, but research is lacking. This study assessed momentary mood reactivity to daily events as a function of risk profile in a school sample, ages 11-14. High-risk (HR, n=25) and low-risk (LR, n=106) subgroups completed frequent self-reports of mood and events for 5 days. HR adolescents reported more negative events involving family and peers. Multilevel modeling results showed that negative events, especially if stressful, were associated with increased negative and decreased positive affects, with heightened responses in HR adolescents. HR adolescents with greater stress over the last 3 months showed additional increases in depressed mood following negative events. Altered reactivity to and dysfunctional appraisals of daily events may link adolescent risk profiles to later mental health problems.     

Parent-adolescent communication, family functioning, and school performance

This paper presents the results of a test of theoretical postulates proposed by Olson, Russell, and Sprenkle (1983) using a matched set of adolescents and their parents. One set of families (n = 40) consisted of adolescents who had been unsuccessful in public school and were attending alternative schools, while the other (n = 52) was a matched group of public school adolescents and their families. Results showed predicted differences in the direction of greater balanced functioning (i.e., optimal cohesion and adaptability) and more positive communication in the public school families. Public school families also perceived greater congruence between perceived and ideal family functioning. Congruence and differences between adolescent and parent perceptions, the importance of positive communication for optimal functioning, and implications for family treatment are discussed.     

Adolescents with attention deficit hyperactivity disorder: Mother-adolescent interactions,family beliefs and conflicts,and maternal psychopathology

A group of 83 adolescents with attention deficit hyperactivity disorder (ADHD) were subdivided into those with ADHD alone (n = 27) and those with ADHD and oppositional defiant disorder (ADHD/ODD, n = 56). They were compared to each other and a community control group (n = 77) on measures of family conflicts, family beliefs, maternal adjustment, and observations of mother-adolescent interactions during both a neutral and conflict discussion. Both ADHD groups had more topics on which there was conflict and more angry conflicts at home than control adolescents on parent reports. Only the ADHD/ODD adolescents reported more such conflicts, endorsed more extreme and unreasonable beliefs about their parent-teen relations, and demonstrated greater negative interactions during a neutral discussion than the control teenagers. Similarly, only mothers of the ADHD/ODD teens displayed greater negative interactions during a neutral discussion, more extreme and unreasonable beliefs about their parent-teen relations, greater personal distress, and less satisfaction in their marriages than the mothers in the control group. Most findings for the ADHD only group were between the control group and the group with mixed ADHD/ODD but did not differ from either group. Results imply that it is the combination of ODD symptoms with those of ADHD that is associated with the greater-than-normal conflicts, anger, poor communications, unreasonable beliefs, and negative interactive styles seen in ADHD adolescents. These same characteristics typify their mothers' interactions as well such that both the adolescents' ODD symptoms and maternal psychological distress (hostility) make unique contributions to the degree of conflict and anger in the parent-teen relations of ADHD adolescents.     

Family Management of Pediatric Cancer: Links with Parenting Satisfaction and Psychological Distress

Research has long acknowledged the disruptions posed by pediatric cancer diagnosis and treatment to family life. Nonetheless, the mechanisms through which the family response influences parents’ mental health in this adverse context are not fully understood. The main goal of the present study was to examine the direct and indirect links, via parenting satisfaction, between family condition management and psychological distress of parents of children with cancer. Participants were 201 parents (86.6% mothers) of children/adolescents diagnosed with cancer who completed self‐report questionnaires assessing family condition management (family life difficulty and parental mutuality), parenting satisfaction, and psychological distress (anxiety and depression). Structural equation modeling was used to test the proposed mediation model. The results showed that parenting satisfaction mediated the association between both the family condition management dimensions (family life difficulty and parental mutuality) and depression. Specifically, greater family life difficulties and lower parental mutuality were associated with lower parenting satisfaction, which, in turn, was associated with higher levels of depression. Additionally, greater family life difficulties and lower parental mutuality were directly linked to higher levels of anxiety. Multigroup analyses suggested that the model was valid across patient age groups (children vs. adolescents) and treatment status (on vs. off‐treatment). These findings reinforce the need for family‐ and parent‐based interventions in the pediatric oncology field. Interventions that target families’ difficulties and promote their resources are likely to foster parenting satisfaction and psychological adjustment.     

The Contributions of Child Behavioral Functioning and Parent Distress to Family Functioning in Pediatric Inflammatory Bowel Disease

The objective of this study was to examine the relative contributions of both parental and adolescent functioning to family functioning in adolescent patients with inflammatory bowel disease (IBD) and their families. Participants were 45 adolescents (27 male, 18 female) 13-17?years old (M?=?15.41?years, SD?=?1.32) with IBD and their parents. Families completed measures of patient behavioral functioning and depression, parent distress and family functioning. Disease severity assessments were completed via data provided by patients' gastroenterologists. Results indicated that parent-reported patient behavioral problems accounted for a significant 26% of variance in family functioning. Post-hoc analysis revealed that externalizing behavior problems accounted for the majority of this variance compared to internalizing behavior problems. These results suggest that externalizing problems may have a more significant impact on these families than previous research indicates. Moreover, externalizing behaviors may significantly impact family adaptation and should be taken into consideration during routine clinical care. Further research is needed to replicate and expand upon these findings.     

A meta-analytic review of the influence of pediatric cancer on parent and family functioning.

This study used meta-analytic methods to compare the functioning of parents of children with cancer to parents of physically healthy children or normative samples. A meta-analysis using fixed effects, weighted least squares methods was conducted on 29 studies examining psychological distress and marital and family functioning among parents of children with cancer. Mothers and fathers of children newly diagnosed with cancer reported significantly greater distress than comparison samples. Mothers reported greater distress than fathers up to 12 months postdiagnosis. Mothers of children with cancer reported higher levels of family conflict than mothers of healthy children. Findings suggest that pediatric cancer impacts parents' perceptions of self- and family functioning, especially within the 1st year following diagnosis.     

Parents of Adolescents with Mental Disorders: Improving Their Caregiving Experience

Several studies have demonstrated that the family members of adolescents with mental diseases experience distress, anxiety and depression, as well as economic strain, all of which contribute to physical and psychological caregiver morbidity. The aim of this study was to assess the effectiveness of intervention to improve the caregiving experience of the parents of mentally ill adolescents. The parents of 20 patients were assessed with the Experience of Caregiving Inventory (ECI) and the Working Alliance Inventory (WAI), while patients’ functioning and psychopathology were evaluated with the Global Assessment of Functioning (GAF) scale and the Child Behavior Check List (CBCL), respectively. Assessments were conducted over 9 months, comparing the experimental group receiving the intervention with a control group that received “standard” care. While there were no significant differences in the patients’ psychopathologies, the caregivers in the experimental group had better ECI and WAI scores. Intervention focusing on the parents seemed to improve the caregivers’ understanding of the disease’s impact on their lives irrespective of the severity of their children’s condition. This finding may be useful in developing adequate measures for the parents of adolescents with severe mental diseases to help contain their psychological distress.     

The Relationships of Family Socioeconomic Status, Parent–Adolescent Conflict, and Filial Piety to Adolescents’ Family Functioning in Mainland China

This study used structural equation modeling to examine the relationships of family socioeconomic status (SES), parent–adolescent conflict, and filial piety to family functioning among middle school and high school students in mainland China. A total of 2,341 students (1,218 girls and 1,096 boys; mean age = 15.42) completed the Chinese Family Assessment Instrument, Family Status Survey, Parent–adolescent Conflict Scale, and Filial Piety Scale. The main results showed that: (a) family SES, parent–adolescent conflict, and filial piety were significantly linked to family functioning; (b) parent–adolescent conflict and filial piety contributed more to family functioning than family SES; (c) parent–adolescent conflict mediated the relationship between reciprocal filial piety and family functioning. The results promote understanding of family processes that influence the relationships between family SES, parent–adolescent conflict, filial piety, and family functioning among middle school and high school adolescents in mainland China.     

The Longitudinal Impact of a Family-Based Communication Intervention on Observational and Self-Reports of Sexual Communication

Parents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent–adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent–adolescent sexual communication was examined at 12 months among adolescents with mental health problems. Of the 721 parent–adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent–adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent body language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11?h of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12 months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent–adolescent sexual communication among a mental health sample.     

Axis I anxiety and mental health disorders among stuttering adolescents

PurposeThe purpose of this study was to evaluate anxiety and psychological functioning among adolescents seeking speech therapy for stuttering using a structured, diagnostic interview and psychological questionnaires. This study also sought to determine whether any differences in psychological status were evident between younger and older adolescents.MethodParticipants were 37 stuttering adolescents seeking stuttering treatment. We administered the Computerized Voice Version of the Diagnostic Interview Schedule for Children, and five psychometric tests. Participants were classified into younger (12–14 years; n = 20) and older adolescents (15–17 years; n = 17).ResultsThirty-eight percent of participants attained at least one diagnosis of a mental disorder, according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; APA, 2000), with the majority of these diagnoses involving anxiety. This figure is double current estimates for general adolescent populations, and is consistent with our finding of moderate and moderate–severe quality of life impairment. Although many of the scores on psychological measures fell within the normal range, older adolescents (15–17 years) reported significantly higher anxiety, depression, reactions to stuttering, and emotional/behavioral problems, than younger adolescents (12–14 years). There was scant evidence that self-reported stuttering severity is correlated with mental health issues. There are good reasons to believe these results are conservative because many participants gave socially desirable responses about their mental health status.DiscussionThese results reveal a need for large-scale, statistically powerful assessments of anxiety and other mental disorders among stuttering adolescents with reference to control populations.Educational Objectives: The reader will be able to: (a) explain the clinical importance of assessing for mental health with stuttering adolescents, (b) state the superior method for adolescent mental health assessment and (c) state a major issue with determining the genuineness of stuttering adolescent responses to psychological assessment.