Factors Impacting the Mental Health of the Caregivers of Children with Asthma in China: Effects of Family Socioeconomic Status,Symptoms Control,Proneness to Shame,and Family Functioning

Caregiver mental health is widely considered to be an important factor influencing children's asthma symptoms. The present study aimed to examine key factors that contribute to caregiver mental health in pediatric asthma with a Chinese sample. Two hundred participants reported their family socioeconomic status (SES), proneness to shame, asthma symptoms control of their child, family functioning, and their depression and anxiety symptoms. Results suggested that low family SES, low family functioning, and a high level of shame proneness were associated with high levels of anxiety and depression for caregivers. Family functioning mediated the effects of SES and shame on caregiver mental health and also moderated the effects of SES and shame on caregiver depression. This study highlights the importance of reducing experience of shame and enhancing family functioning in families affected by pediatric asthma.     

Caregiver Expressed Emotion and Psychiatric Symptoms in African‐Americans with Schizophrenia: An Attempt to Understand the Paradoxical Relationship

Expressed emotion (EE) is a family environmental construct that assesses how much criticism, hostility, and/or emotional over‐involvement a family member expresses about a patient (Hooley, Annual Review of Clinical Psychology, 2007, 3, 329). Having high levels of EE within the family environment has generally been associated with poorer patient outcomes for schizophrenia and a range of other disorders. Paradoxically, for African‐American patients, high‐EE may be associated with a better symptom course (Rosenfarb, Bellack, & Aziz, Journal of Abnormal Psychology, 2006, 115, 112). However, this finding is in need of additional support and, if confirmed, clarification. In line with previous research, using a sample of 30 patients with schizophrenia and their primary caregivers, we hypothesized that having a caregiver classified as low‐EE would be associated with greater patient symptom severity. We also aimed to better understand why this pattern may exist by examining the content of interviews taken from the Five‐Minute Speech Sample. Results supported study hypotheses. In line with Rosenfarb et al. (2006), having a low‐EE caregiver was associated with greater symptom severity in African‐American patients. A content analysis uncovered some interesting patterns that may help elucidate this finding. Results of this study suggest that attempts to lower high‐EE in African Americans may, in fact, be counterproductive.     

Stigma,Expressed Emotion,and Quality of Life in Caregivers of Individuals with Dementia

Expressed emotion (EE) is a measure of a caregiver's critical and emotionally overinvolved (EOI; e.g., intrusive, self‐sacrificing) attitudes and behaviors toward a person with a mental illness. Mounting evidence indicates that high levels of these critical and EOI attitudes and behaviors (collectively termed high EE) in family members are associated with a poorer course of illness for people with a range of disorders, including dementia (Nomura et al., 2005). However, less is known about factors that might trigger high EE and how high EE might impact dementia caregivers’ own mental health. In this study we propose that caregivers who perceive stigma from their relative's illness may be more likely to be critical or intrusive (high EOI) toward their relative in an attempt to control symptomatic behaviors. We further hypothesized that high EE would partially mediate the link between stigma and quality of life (QoL) as there is some evidence that high EE is associated with poorer mental health in caregivers themselves (Safavi et al., 2015). In line with study hypotheses and using a sample of 106 dementia caregivers, we found that greater caregiver stigma was associated with both high EE (for criticism and EOI) and with poorer QoL. Mediational analyses further confirmed that high EE accounts for much of the association between stigma and poorer QoL. Study results suggest that addressing caregiver stigma in therapy could reduce levels of high EE and indirectly therefore improve caregiver QoL. Intervening directly to reduce high EE could also improve caregiver QoL.     

Cultivating Resilience in Families Who Foster: Understanding How Families Cope and Adapt Over Time

Families who foster offer essential care for children and youth when their own parents are unable to provide for their safety and well‐being. Foster caregivers face many challenges including increased workload, emotional distress, and the difficulties associated with health and mental health problems that are more common in children in foster care. Despite these stressors, many families are able to sustain fostering while maintaining or enhancing functioning of their unit. This qualitative study applied an adaptational process model of family resilience that emerged in previous studies to examine narratives of persistent, long‐term, and multiple fostering experiences. Data corroborated previous research in two ways. Family resilience was again described as a transactional process of coping and adaptation that evolves over time. This process was cultivated through the activation of 10 family strengths that are important in different ways, during varied phases.     

Longitudinal Effects of Latino Parent Cultural Stress,Depressive Symptoms,and Family Functioning on Youth Emotional Well‐Being and Health Risk Behaviors

U.S. Latino parents can face cultural stressors in the form of acculturative stress, perceived discrimination, and a negative context of reception. It stands to reason that these cultural stressors may negatively impact Latino youth's emotional well‐being and health risk behaviors by increasing parents' depressive symptoms and compromising the overall functioning of the family. To test this possibility, we analyzed data from a six‐wave longitudinal study with 302 recently immigrated (<5 years in the United States) Latino parents (74% mothers, M_age = 41.09 years) and their adolescent children (47% female, M_age = 14.51 years). Results of a cross‐lagged analysis indicated that parent cultural stress predicted greater parent depressive symptoms (and not vice versa). Both parent cultural stress and depressive symptoms, in turn, predicted lower parent‐reported family functioning, which mediated the links from parent cultural stress and depressive symptoms to youth alcohol and cigarette use. Parent cultural stress also predicted lower youth‐reported family functioning, which mediated the link from parent cultural stress to youth self‐esteem. Finally, mediation analyses indicated that parent cultural stress predicted youth alcohol use by a way of parent depressive symptoms and parent‐reported family functioning. Our findings point to parent depressive symptoms and family functioning as key mediators in the links from parent cultural stress to youth emotional well‐being and health risk behaviors. We discuss implications for research and preventive interventions.     

COGNITIVE AND SOCIOEMOTIONAL FUNCTIONING AT 4½ YEARS IN CHILDREN BORN TO MOTHERS WHO HAVE RECEIVED TREATMENT FOR SUBSTANCE‐ABUSE PROBLEMS WHILE PREGNANT

Cognitive and socioemotional functioning at 4½ years of age were examined in children born to mothers with substance‐abuse problems (n = 22) recruited from residential treatment institutions while pregnant, and then compared to children born to mothers with mental health problems (n = 18) and children from a low‐risk group (n = 26). No significant group differences in cognitive functioning were found, but the children born to mothers with substance‐abuse problems showed more caregiver‐reported socioemotional problems than did the low‐risk children, like the children born to mothers with mental health problems. Birth weight had an effect on internalizing problems at 4½ years and mediated the relation between group and socioemotional problems, although not when controlling for caregiver education, single parenthood, and anxiety and depression. At 4½ years, 7 children born to mothers with substance‐abuse problems were placed in foster care. These children had lower birth weight and higher caregiver‐rated internalizing problems. In addition to emphasizing the importance of the quality of the prenatal environment, this study suggests that families with previous substance abuse are in need of long‐term follow‐up to address socioemotional problems and enhance further positive child cognitive development. The foster‐placed children may be in particular need of long‐term follow‐up.     

In Our Lives and Under Our Skin: An Investigation of Specific Psychobiological Mediators Linking Family Relationships and Health Using the Biobehavioral Family Model

The objective of this study was to use the Biobehavioral Family Model (BBFM) to delineate which psychophysiological variables link romantic and family relationship satisfaction variables to health outcomes. Data from individuals who reported being partnered from the second wave of the National Survey of Midlife Development in the United States (MIDUS II), Project 4 (n = 812) were used to test a structural equation model which explored which psychophysiological variables potentially mediated associations between positive and negative family emotional climate variables and disease activity. This model found that current and past family variables had larger associations with the psychophysiological variables than romantic partner variables; depressive symptoms, anxiety, and inflammation partially mediated associations between family relationships and health; and, contrary to the hypotheses, romantic partner and family support were linked to worse health outcomes. However, the findings should be viewed with regard to the cross‐sectional design of the study. Overall, the findings support the use of the BBFM as a model that can guide clinical interventions.     

Profession Differences in Family Focused Practice in the Adult Mental Health System

There is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This article sought to determine practice differences between the differing professions working in adult mental health services in terms of their family focused work. Three hundred and seven adult mental health professionals completed a cross‐sectional survey of family focused practices in adult mental health services. Findings highlight that social workers engaged in more family focused practice compared to psychiatric nurses, who performed consistently the lowest on direct family care, compared to both social workers and psychologists. Clear skill, knowledge, and confidence differences are indicated between the professions. The article concludes by offering direction for future profession education and training in family focused practices.     

Prospective Pilot Study of the Mastering Each New Direction Psychosocial Family Systems Program for Pediatric Chronic Illness

Psychosocial interventions for pediatric chronic illness (CI) have been shown to support health management. Interventions that include a family systems approach offer potentially stronger and more sustainable improvements. This study explores the biopsychosocial benefits of a novel family systems psychosocial intervention (MEND: Mastering Each New Direction). Forty‐five families participated in a 21‐session intensive outpatient family systems‐based program for pediatric CI. Within this single arm design, families were measured on five domains of Health‐Related Quality of Life (HRQL) self‐report measures; Stress, Cognitive Functioning, Mental Health, Child HRQL, Family Functioning. Both survey and biological measures (stress: catecholamine) were used in the study. Results from multivariate general linear models showed positive pre‐, post‐, and 3‐month posteffects in all five domains. The program effects ranged from small to moderate (η² = .07–.64). The largest program effects were seen in the domains of cognitive functioning (η² = .64) and stress (η² = .27). Also, between disease groups, differences are noted and future implications for research and clinical practice are discussed. Conclusions suggest that the MEND program may be useful in helping families manage pediatric chronic illnesses. Study results also add to the growing body of literature suggesting that psychosocial interventions for pediatric chronic illness benefit from a family systems level of intervention.     

CAREGIVER'S DEPRESSIVE SYMPTOMS AND YOUNG CHILDREN'S SOCIOEMOTIONAL DEVELOPMENT DELAYS: A CROSS‐SECTIONAL STUDY IN POOR RURAL AREAS OF CHINA

Poverty and its associated factors put people at risk for depression. The aims of this study were to describe the prevalence of depressive symptoms (DS) of primary caregivers and socioemotional development (SED) delays of young children in poor rural areas of China, and to explore the association between them. Cross‐sectional data of 2,664 children aged 3 to 35 months and their primary caregivers were used for analysis. Characteristics of the child, caregiver, and family were collected through face‐to‐face caregiver interviews. DS were assessed by the Zung Self‐Rating Depression Scale (W.W. Zung, 1965, as cited in World Health Organization, 2016b ), and SED was evaluated by the Ages and Stage Questionnaires: Social‐Emotional (J. Squires, D. Bricker, & L. Potter, 1997). The χ² test, stratification analysis, and logistic regression analyses were used to explore the association. Among the caregivers, 40.3% (95% confidence interval [CI] [38.4, 42.1]), reported DS. Caregivers who were male, older and ethnic minorities as well as had a low level of education, a low family income, or more children were more likely to have DS. Of the children, 24.4% (95% CI [22.8, 26.0]) were recognized with SED delays. Older children displayed more delays than did younger children, but no significant differences between males and females were found. SED delays were significantly associated with mother outmigrating, male caregivers, older age, ethnic minorities, and low education or families with a single parent, low‐income, and having more children. Caregivers having DS, odds ratio (OR) = 2.40, 95% CI [1.99, 2.88], was a significant predictor of increased odds of SED delays; other factors were single‐parent family, OR = 1.99, 95% CI [1.37, 2.89], inadequate care, OR = 1.69, 95% CI [1.30, 2.21], physical punishment, OR = 1.61, 95% CI [1.33, 1.95], ethnic minorities, OR = 1.41, 95% CI [1.17, 1.71], and child age in months, OR = 1.03, 95% CI [1.02, 1.04], according to the logistic regression analysis. DS are prevalent among caregivers with young children in poor rural areas. Interventions to improve the mental health of caregivers and their parenting behaviors are needed to improve children's SED.     

CAREGIVER SENSITIVITY AND CONSISTENCY AND CHILDREN'S PRIOR FAMILY EXPERIENCE AS CONTEXTS FOR EARLY DEVELOPMENT WITHIN INSTITUTIONS

The current study addressed whether two institution‐wide interventions in St. Petersburg, Russian Federation, that increased caregiver sensitivity (Training Only: TO) or both caregiver sensitivity and consistency (Training plus Structural Changes: T+SC) promoted better socioemotional and cognitive development than did a No Intervention (NoI) institution during the first year of life for children who were placed soon after birth. It also assessed whether having spent less than 9 versus 9 to 36 months with a family prior to institutionalization was related to children's subsequent socioemotional and cognitive development within these three institutions. The Battelle Developmental Inventory (J. Newborg, J.R. Stock, L. Wnek, J. Guidubaldi, & J. Svinicki, 1988) was used to assess the socioemotional and cognitive functioning of children in NoI (n = 95), TO (n = 104), and T+SC (n = 86) at two to three time points during their first 6 to 12 months of residency. Results suggest that improving caregiver sensitivity can improve the cognitive development of infants in the first year of institutionalization whereas improving caregiver consistency in addition to sensitivity is more beneficial for socioemotional development than is sensitivity alone. Similarly, for children in T+SC, longer time with a family prior to institutionalization (consistent caregiver, unknown sensitivity) was associated with better socioemotional, but not cognitive, baseline scores and more rapid cognitive than socioemotional development during institutionalization. These results suggest caregiver sensitivity is more highly related to cognitive development whereas caregiver consistency is more related to socioemotional development in the first years of life.     

The Dynamic Interplay Between Satisfaction With Intimate Relationship Functioning and Daily Mood in Low‐Income Outpatients

Substantial research supports bidirectional links between intimate relationship discord and individual psychopathology, including depressive symptoms. However, few studies have utilized daily diary methods to capture the micro‐level processes underlying the association between couple discord and depression, particularly among populations that are at elevated risk for both interpersonal and individual dysfunction. To address this gap, we examined whether daily changes in satisfaction with relationship functioning were associated with daily changes in negative affect and positive affect over the span of 2 weeks among mental health outpatients of low socioeconomic status. Participants were 53 low‐income outpatients from community mental health clinics who completed a semi‐structured interview about the quality of their intimate relationships followed by 14 daily reports of positive and negative mood and satisfaction with relationship functioning across several domains. Growth curve analytic techniques revealed the hypothesized bidirectional relations. Decline in satisfaction with relationship functioning predicted escalation in negative affect and deterioration in positive affect over 2 weeks, and deterioration of mood predicted declining satisfaction with relationship functioning. This study extends existing knowledge about couple dysfunction and individual psychopathology by highlighting the immediate nature of this dynamic process as it unfolds over time.     

Preparing the Field for Feasibility Testing of a Parenting Intervention for War‐Affected Mothers in Northern Uganda

In this article, we discuss the successful implementation of an adapted evidence‐based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long‐term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance‐use disorders. The processes described here cover a 4‐year period culminating in the implementation of the nine‐session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.     

A Model‐Based Cluster Analysis of Maternal Emotion Regulation and Relations to Parenting Behavior

In a diverse community sample of mothers (N = 108) and their preschool‐aged children (M_age = 3.50 years), this study conducted person‐oriented analyses of maternal emotion regulation (ER) based on a multimethod assessment incorporating physiological, observational, and self‐report indicators. A model‐based cluster analysis was applied to five indicators of maternal ER: maternal self‐report, observed negative affect in a parent–child interaction, baseline respiratory sinus arrhythmia (RSA), and RSA suppression across two laboratory tasks. Model‐based cluster analyses revealed four maternal ER profiles, including a group of mothers with average ER functioning, characterized by socioeconomic advantage and more positive parenting behavior. A dysregulated cluster demonstrated the greatest challenges with parenting and dyadic interactions. Two clusters of intermediate dysregulation were also identified. Implications for assessment and applications to parenting interventions are discussed.     

Mental and physical health of spouse caregivers: the role of personality.

Although personal resources of caregivers, such as coping skills and social support, have been shown to be important in understanding caregiver stress and health outcomes, personality traits have not previously been considered. The purpose of this study was to examine the association between the personality traits of neuroticism and dispositional optimism and mental and physical health outcomes. It was predicted that personality would have direct effects, and indirect effects through perceived stress, on health outcomes. Participants were spouse caregivers of patients diagnosed with Alzheimer's disease. Results showed that neuroticism and optimism were significantly related to mental and physical health. Furthermore, neuroticism had significant direct effects on all of the health outcomes, and substantial indirect effects, through perceived stress, on mental health outcomes. Optimism showed stronger indirect than direct effects on all health outcomes. These findings demonstrate the importance of including personality of the caregiver in theoretical and empirical models of the caregiving process.     

Neurocognitive Impairment: Addressing Couple and Family Challenges

Conditions involving neurocognitive impairment pose enormous challenges to couples and families. However, research and practice tend to focus narrowly on immediate issues for individual caregivers and their dyadic relationship with the affected member. A broad family systems approach with attention to family processes over time is needed in training, practice, and research. In this paper, Rolland's Family Systems Illness model provides a guiding framework to consider the interaction of different psychosocial types of neurocognitive conditions and their evolution over time with individual, couple, and family life‐course development. Discussion addresses key family and couple issues with mild‐to‐severe cognitive impairment and progressive dementias, including: communication, multigenerational legacies, threatened future neurocognitive disability, ambiguous loss, decisional capacity, reaching limits, placement decisions, issues for adult children and spousal caregivers, and the transformation of intimate bonds. Principles and guidelines are offered to help couples and families master complex challenges, deepen bonds, and forge positive pathways ahead.     

A Typology of Interactional Patterns Between Youth and Their Stepfathers: Associations with Family Relationship Quality and Youth Well‐Being

Stepfamilies are an increasingly common family form, many of which are headed by a resident mother and stepfather. Stepfather–child relationships exert notable influence on stepfamily stability and individual well‐being. Although various stepfather roles have been observed, more research is warranted by which stepfather–child interactions are explored holistically and across a variety of life domains (e.g., recreational, personal, academic, and disciplinary). Thus, the primary purpose of the current study is to explore varying interactional patterns between youth and their stepfathers. A latent class analysis is conducted using a representative sample of 1,183 youth (53% female; mean age = 15.64 years, SD = 1.70 years; 62% non‐Hispanic White) residing in mother–stepfather families from Wave I of the National Longitudinal Study of Adolescent to Adult Health. Latent‐class enumeration processes support a four‐class solution, with latent classes representing inactive, academically oriented, casually connected, and versatile and involved patterns of youth–stepparent interaction. Notable differences and similarities are evident across patterns with respect to family relationship quality, youth well‐being, and socio‐demographic characteristics. Differences are most stark between the inactive and versatile and involved patterns. Ultimately, the results showcase notable variation in youth–stepparent interactional patterns, and one size does not necessarily fit all stepfamilies. Family practitioners should be mindful of variation in youth–stepparent interactional patterns and assist stepfamilies in seeking out stepparent–child dynamics that are most compatible with the needs and dynamics of the larger family system.     

Mid‐ and Long‐Term Effects of Family Constellation Seminars in a General Population Sample: 8‐ and 12‐Month Follow‐Up

In a previous randomized controlled trial (RCT), short‐term efficacy of family constellation seminars (FCSs) in a general population sample was demonstrated. In this article, we examined mid‐ and long‐term stability of these effects. Participants were 104 adults (M = 47 years; SD = 9; 84% female) who were part of the intervention group in the original RCT (3‐day FCS; 64 active participants and 40 observing participants). FCSs were carried out according to manuals. It was predicted that FCSs would improve psychological functioning (Outcome Questionnaire OQ‐45.2) at 8‐ and 12‐month follow‐up. Additionally, we assessed the effects of FCSs on psychological distress, motivational incongruence, individuals’ experience in their personal social systems, and overall goal attainment. Participants yielded significant improvement in psychological functioning (d = 0.41 at 8‐month follow‐up, p = .000; d = 0.40 at 12‐month follow‐up, p = .000). Results were confirmed for psychological distress, motivational incongruence, the participants’ experience in their personal social systems, and overall goal attainment. No adverse events were reported. This study provides first evidence for the mid‐ and long‐term efficacy of FCSs in a nonclinical population. The implications of the findings are discussed.