The California Family Health Project: VII. Summary and Integration of Findings

In a series of reports, we have observed the relationships between four domains of family life (World View, Emotion Management, Structure/Organization, Problem Solving), and the health of husbands and wives in a community-based sample of 225 families. In this final article of the series, we provide an overview and summary of the results, by gender, including the structure and patterning of variables both within each family domain and among all four family domains analyzed together. In addition, we review the associations between each family domain and adult health (unidomain analyses), and among all four family domains taken together and adult health (multidomain analyses). Prominent differences in family and health relationships based on gender are described from the perspective of socially and culturally supported sex-role expectations and behavior. The results support the use of a multidimensional family assessment framework in health research that can lead to the further development of empirically based models of family process.     

The California Family Health Project: II. Family world view and adult health.

This article explores the pattern of relationships between family World View and adult Health in a community-based sample of 225 families. Family World View refers to the beliefs, appraisals, and values that define a family's orientation to the world. The interrelationships among eight self-reported family World View variables are described, using principal components analyses (PCA) and multidimensional scaling analyses (MDS). Derived, joint-spouse World Views also are examined using inter-battery factor analysis. The World View variables then are analyzed as a set with 14 self-reported health variables for husbands and wives separately, using canonical correlation. The PCAs for family World View yielded poor solutions for both husbands and wives. The MDS displayed the eight variables in a circular pattern for husbands and for wives, indicating the absence of a single broad dimension, or subgroupings of separate dimensions, that could be used to "describe" the domain. In the canonical analyses, family World View was a strong correlate of Health, with approximately 50% of the variance accounted for by the respective canonical variates. For husbands, what we called Family Coherence, Family Religiousness, Family Life Engagement, and Family Optimism, were correlated with Health. For wives, Family Coherence, Family Religiousness, and Family Optimism, were correlated with Health. Different patterns of health scores emerged by gender, with behavioral indicators, such as Smoking and Drinking, more salient for husbands, and mood indicators, such as Anxiety and Depression, more salient for wives.     

The California Family Health Project: IV. Family structure/organization and adult health.

This research explores the relationships between each of four "domains" of family life and the health of husbands and wives in a community-based sample of 225 families. In this article we report the association between Family Structure/Organization and adult Health. This family domain refers to the architecture of the family or the structural frame of roles and rules within which the family operates. Interrelationships among 13 self-reported, family Structure/Organization scales are described, using principle components analysis (PCA) and multidimensional scaling analysis (MDS). Derived, joint-spouse or couple Structure/Organization variables also were created using inter-battery factor analysis. The PCA yielded a poor solution, whereas the MDS yielded a good two-dimensional solution, which roughly displayed the scales in a circular pattern for both husbands and wives. The analyses indicated that no single dimension or set of separate subdimensions adequately described the Structure/Organization variables. All 13 scales than were associated with a battery of 14 adult health scales for husbands and wives separately, using canonical correlation. Different aspects of family Structure/Organization were correlated with health for husbands and wives: Organized Cohesiveness, Sex Role Traditionalism, Role Flexibility and Shared Roles for husbands; and Organized Cohesiveness and Differentiated Sharing for wives. Different patterns of health scores also emerged by gender, with behavioral indicators, such as Smoking and Drinking, more salient for husbands, and mood indicators, such as Anxiety and Depression, more salient for wives.     

The California Family Health Project: V. Family problem solving and adult health.

This article explores the relationship between family Problem Solving and the Health of adults in a community-based sample of 225 families. Family Problem Solving refers to the ways in which the family conducts itself to resolve a shared problem. Sixteen observer ratings of family Problem-Solving behavior during a 30-minute task were developed, based on the Simulated Family Activity Measure (SIM-FAM), and good interrater agreement was achieved. Principal Components Analysis (PCA) yielded a set of three well-constructed, interpretable dimensions: Problem-Solving Effectiveness, Problem-Solving Style, and Sociomotor Activity. Multidimensional scaling analyses (MDS) suggested that family problem-solving behavior involved an organized, means-end sequence of family behaviors in which aspects of style served problem-solving effectiveness. All 16 Problem-Solving variables were analyzed with a set of 14 health variables, for husbands and wives separately, using canonical correlation. No subset of Problem-Solving variables was significantly associated with a subset of Health variables for either husbands or wives, although there was a significant association between the two sets of variables when taken as a whole. Given previous research on family Problem Solving, we conclude that the absence of significant associations between particular aspects of family Problem Solving and Health may be due to our use of a community-based rather than a stressed or clinical sample. Associations between Family Problem Solving and Health might best be viewed in the context of other family variables.     

The California Family Health Project: III. Family emotion management and adult health.

This article explores the broad patterning of interrelationships between family Emotion Management and adult Health in a community-based sample of 225 families. Emotion Management refers to how emotion is expressed, acknowledged, and managed by the marital partners. Fifteen reliable-observer ratings of husband-wife behavior were made during each of three 10-minute Emotion Management Interaction Tasks (EMITs). Each of the three tasks "pulled" for the expression of a different emotional theme: loss, intimacy, or conflict. A principle components analysis of the 15 ratings yielded a poor solution. A nonmetric, multidimensional scaling analysis described a two-dimensional, bipolar display with ordering among the variables in each of two wings. One dimension reflected positive versus negative Emotion Management characteristics, and the second reflected active and overt versus passive or covert emotional expression. The pattern of relationships among the couple ratings was similar for each of the three tasks. Using canonical correlation, the couple ratings demonstrated significant associations with 14 adult Health scores for both husbands and wives for the intimacy and conflict tasks, but not for the loss task. Specific gender patterns also emerged. In general, couple overt emotional aversiveness was negatively associated with husbands' health, and couple emotional avoidance/distance was negatively associated with wives' health.     

Alzheimer's Disease: The Impact of the Family on Spouses,Offspring, and Inlaws

This article reports the findings from a study designed to identify qualities of the multigeneration family system that affected the relationship between the demands of Alzheimer's disease on the family and the health and well-being of (a) spouses, (b) offspring, and (c) offspring's spouses or “inlaws.” Members of 97 families of patients with Alzheimer's disease, recruited from four University-affiliated Alzheimer's Centers, completed detailed questionnaires and participated in a 45-minute telephone interview to assess care-strain, personal stress, appraisals of three major domains of family life (World View, Structure/Organization, and Emotion Management), and three health and well-being indices (Anxiety/Depression, Somatic Symptoms, and Well-Being). Multivariate multiple regression equations, run separately for each of the three groups of family respondents and each of the three family domains, indicated: (1) no significant associations between the severity of the elder's disease and family member health and well-being; (2) female family members reported poorer health and well-being than male family members; and (3) caregiver strain was negatively associated with family member health and well-being. Further, appraised family qualities were associated with the health and well-being of the three groups of respondents differently: directly for offspring, interactively with severity of patient disorder for inlaws, and not at all for spouses. The data suggested that some family qualities served a protective function, whereas others exacerbated the negative effects of caregiving by affecting personal health and well-being. The findings are interpreted in terms of the different roles and expectations for caregiving placed on spouses, offspring, and inlaws. It is suggested that programs of intervention for patients with Alzheimer's and other chronic diseases should focus on the multigeneration family as the context for care, rather than only on the primary caregiver.     

An Empirically Derived Typology of Families: II. Relationships with Adolescent Health

In this report from the California Family Health Project, we describe the relationship between an empirically derived family typology based on parent data, and the self-reported health and well-being of 151 adolescent offspring. The typology is comprised of four family types: Balanced, Traditional, Disconnected, and Emotionally Strained. Three adolescent health indices were constructed from 13 self-reported health variables using principal components and multidimensional scaling analyses: Physical Health, Emotional Health, and Alcohol Abstinence. ANOVA indicated that Physical Health was significantly different among adolescents in the four family types. The findings varied, however, depending upon whether the typology was based on mothers’ or fathers’ appraisals of the family. In the father-based typology, adolescents from Traditional families scored highest while those from Emotionally Strained and Balanced families scored lowest. In the mother-based typology, adolescents from Balanced, Traditional, and Emotionally Strained families scored equally high, while those from Disconnected families scored significantly lower than those from the other three family types. Differences on Abstinence were significant only in the father-based typology. Adolescents from Traditional and Emotionally Strained families drank less than adolescents from Disconnected families. No significant differences among adolescents were found for Emotional Health, and adolescent gender did not interact significantly with family type to affect any of the three health indices. Traditional and Disconnected family types had offspring who clearly stood apart with higher and lower health scores, respectively. The results are discussed in terms of the current literature on social environment and health.     

Family predictors of disease management over one year in Latino and European American patients with type 2 diabetes

Family context is thought to influence chronic disease management but few studies have longitudinally examined these relationships. Research on families and chronic illness has focused almost exclusively on European American families. In this prospective study we tested a multidimensional model of family influence on disease management in type 2 diabetes in a bi-ethnic sample of European Americans and Latinos. Specifically, we tested how baseline family characteristics (structure, world view, and emotion management) predicted change in disease management over one year in 104 European American and 57 Latino patients with type 2 diabetes. We found that emotion management predicted change in disease management in both groups of patients as hypothesized, while family world view predicted change in both ethnic groups but in the predicted direction only for European Americans. Examining family context within ethnic groups is required to elucidate unique cultural patterns. Attending to culturally unique interpretations of constructs and measures is warranted. The import of family emotion management, specifically conflict resolution, in disease management deserves further study to support clinical intervention development. Examining multiple domains of family life and multidimensional health outcomes strengthens our capacity to develop theory about family contexts and individual health.     

Book Review Section

Books reviewed in this article: Richard J. Herrnstein and Charles Murray. The Bell Curve: Intelligence and Class Structure in American Life. Jeremy Main. Quality Wars: The Triumphs and Defeats of American Business. Stephen Fineman (Ed.). Emotion in Organizations. Richard A. Swanson. Analysis for Improving Performance: Tools for Diagnosing Organizations and Documenting Workplace Expertise. David L. De Vries. Executive Selection: What We Know and What We Need To Know. Wilfred H. Drath. Why Managers Have Trouble Empowering: A Theoretical Perspective Based on Concepts of Adult Development. Ann M. Morrison, Marian M. Ruderman, and Martha Hughes- James. Making Diversity Happen: Controversies and Solutions. Marian W. Ruderman and Patricia J. Ohlott. The Realities of Management Promotion. Mark Cook. Personnel Selection and Productivity Cary L. Cooper and Ivan T. Robertson (Eds.). International Review of Industrial and Organizational Psychology, 1994, Volume 9. New York: Anthony R. Montebello. Work Teams That Work: Skills for Managing Across the Organization. T. J. Larkin and Sandar Larkin. Communicating Change: Winning Employee Support for New Business Goals. Frank H. Freeman, Katherine B. Knott, and Mary K. Schwartz (Eds.). Leadership Education 1994-1995: A Source Book. Wendell French. Human Resource Management Willem F. G. Mastenbroek. Conflict Management and Organization Development Jeffrey Goldstein. The Unshackled Organization. Phyl Smith and Lynn Kearny. Creating Workplaces Where People Can Think. Charlotte McDaniel. Health Care Benefits Problem Solver for Human Resource Professionals and Managers. R. Richard Ritti. The Ropes to Skip and the Ropes to Know: Studies in Organizational Behavior Julie Adair King. The Smart Woman's Guide to Interviewing and Salary Negotiation. Janet Hauter. The Smart Woman's Guide to Career Success. Bernard A. Ramundo. The Bargaining Manager: Enhancing Organizational Results Through Effective Negotiation. Edward E. Lawler, III. Motivation in Work Organizations. Alberto Galgano. Companywide Quality Management. Dennis Jaffe, Cynthia D. Scott, and Glen Tobe. Rekindling Commitment: How to Revitalize Yourself, Your Work, and Your Organization.     

Lessons from the Transition to Relational Teletherapy During COVID-19

When the World Health Organization declared the coronavirus outbreak a pandemic, clinicians were challenged to maintain continuity of care. Teletherapy became the primary means of service delivery for many who had never or only sparingly used it. The Family Institute at Northwestern University, in response to encouraging findings with respect to the effectiveness of teletherapy and recognizing advantages with respect to access to care, launched our teletherapy services in 2018. As a relationship-based organization, we were keen to exploit the opportunity that teletherapy provides to integrate additional members of the client system into the treatment. Over these two plus years, we have learned a great deal. Our learning was greatly accelerated by our transition to a 100% teletherapy practice in the wake of the pandemic. Teletherapy is a different context. Intentionally managing the context’s constraints and exploiting its strengths is key to providing high-quality couple and family therapy. This step is often overlooked or resisted when teletherapy is an occasional add-on to a face-to-face practice.     

Family Interaction and Individual Psychological Health

Two studies explored the relationships between individual psychological health (PH) status and perceptions of family interaction and family climate variables as perceived by young adults. Psychological health was defined within inter- and intrapersonal domains, represented by social interest and psychological hardiness. Scores on social interest and hardiness instruments were standardized and added to put the construct of psychological health into practice. Family interaction variables were measured with Family Adaptability and Cohesion Evaluation Scales-III (FACES-III), the Children's Report of Parent Behavior Inventory-30 (CRPBI-30), Parent-Adolescent Communication Scale (PAC), Family Satisfaction Scale (FSS), and the Family Environment Scale (FES). Multivariate analyses indicated that PH status was associated with several family variables, with cohesion emerging as a key dimension. Implications for counseling are discussed.     

Family Functioning of Male Alcoholics and Their Female Partners during Periods of Drinking and Abstinence

Family functioning of 20 alcoholic male veterans and their female partners was assessed in relation to drinking (wet) and abstinent (dry) intervals. Repeated measures analyses performed on the McMaster Family Assessment Device (FAD) indicated that on all 7 scales of the FAD, alcoholics and their mates perceived family functioning to be better during dry than wet periods. In contrast to their alcoholic mates, female partners gave healthier ratings to all FAD scales except Roles in the dry condition and Affective Involvement in the wet condition. According to published cutoff scores for healthy and unhealthy family functioning, alcoholics as a group viewed their wet and dry family functioning as unhealthy, although the female group regarded the family's dry Problem Solving and Behavioral Control as healthy. These findings suggest that the family functioning of alcohol-involved couples is biphasic, oscillating between drinking and abstinent periods.     

Correlates and predictors of positive mental health for school going children

The relationship between positive mental health and well-being was examined in 604 North Indian high school and secondary high school going children aged 11–18 years. The study employed various scales such as Mental Health Continuum-Short Form (MHC-SF; Keyes, 2005), Scale of Positive and Negative Experiences (SPANE) and Flourishing Scale (FS; Diener et al., 2010), World Health Organization Quality of Life-BREF (WHOQOL-BREF, 1996) and Personal Well-being Index Scale-School Going Children (PWI-SC; Cummins & Lau, 2005). The MHC-SF predicted the positive mental health and the various predictors used in this study were SPANE, FS, WHOQOL-BREF and PWI-SC. Positive mental health was found positively correlated with SPANE P, life satisfaction, personal well-being, flourishing and all four domains of quality of life (physical health, psychological well-being, social relationships and environmental health) and negatively correlated with SPANE N. Well-being measures of flourishing, SPANE P, SPANE-N, all four domains of quality of life (physical health, psychological well-being, social relationships and environmental health) significantly predicted children’s positive mental health (49% of variance) and its dimensions like emotional well-being (41% of variance), social well-being (24% of variance) and psychological well-being (47% of variance).     

Cross-national validity of dimensions of family functioning: First experiences with the Dutch version of the McMaster Family Assessment Device (FAD)

The present study describes the first psychometric findings obtained in The Netherlands with the Dutch version of the Family Assessment Device (FAD) which was originally developed in the Anglo-American cultural context. In a sample of community volunteers, confirmatory analysis (multiple-group method) provided evidence of factorial validity of the FAD measuring constructs. Only 3 out of 60 items were found to be biased and had to be deleted from their a priori defined scales. Reliability and homogeneity indices pertaining to each FAD dimension were good. Despite (very) high correlations among FAD factors/scales, further analyses were focused on determining their convergent and divergent validity which offered good support for such. A higher-order analysis which incorporated reliable scales of the FAD and the Family Environment Scale yielded a two-factor composition: General Family Functioning and Family Influence / Power and Integration. There was evidence to support the viewpoint that a general measure of family functioning may be utilized which is broader in terms of content than the already existing subscale measure termed General Functioning. In line with findings pointing to the ability of the FAD to distinguish between families of psychiatric patients and nonclinical families, the great majority of the FAD subscales, especially Problem Solving and General Functioning, were found to correlate with psychological symptom states as assessed with the Symptom Checklist-90-R. Specific subscales were found to be affected by educational level, while none were affected by sex, age, or religious affiliation. All in all, the findings confirm the further use of the FAD in the Dutch national context.     

The Family FIRO Model: Exploring Relationship Needs of “At-Risk” Families

This research investigates the conceptualization and application of the family fundamental interpersonal relations orientation(FIRO) model to an at-risk family population. The relationships between the family FIRO domains of inclusion, control, and intimacy and family functioning indices, as measured by the Family Assessment Device (FAD) subscales, were explored. An at-risk family population ( N = 43 primary caretakers) was assessed at four time intervals, using an ex post facto design with multiple linear regression model testing. The results indicated significant relationships between FIRO model domains and FAD subscales. A case example further explored the application of the family FIRO model with at-risk families.     

Validation Study of the Portuguese Version of the Family Problem Solving Communication (FPSC) Index

Within family stress theories, the way in which families communicate about their hardships and issues is crucial for the family’s stress management and functioning. In the current study, we sought to validate the Portuguese version of the Family Problem Solving Communication (FPSC) Index and examine its psychometric properties. Developed within the context of the resiliency model of family stress, adjustment and adaptation, the FPSC is a ten-item self-report measure that assesses the family communication patterns that are likely to play a role in the family’s coping with hardships and difficulties. The participants were 332 individuals between 18 and 76 years who completed the FPSC and self-report measures of family hardiness and family functioning. A confirmatory factor analysis supported the original FPSC bifactorial structure, indicating the presence of two dimensions, Affirmative Communication and Incendiary Communication. Correlations between the scale’s total score and its dimensions with the measures of family hardiness and family functioning attested to its convergent validity. Furthermore, the index demonstrated respectable to very good internal consistency and temporal stability. In conclusion, the Portuguese version of the FPSC is a valid and reliable instrument that can support the development of future empirical studies focused on family problem solving communication, especially with regard to family adaptation in different contexts of adversity.     

The World Health Organization WHOQOL-100: tests of the universality of Quality of Life in 15 different cultural groups worldwide.

The World Health Organization Quality of Life assessment (WHOQOL-100) was developed simultaneously across 15 international field centers and includes 24 facets relating to quality of life, which are grouped into 4 larger domains: physical, psychological, social relationships, and environment. It also includes 1 facet examining overall quality of life and general health perceptions. This article examines the extent to which the WHOQOL-100 assesses quality of life perceptions in different cultures and whether it is structurally comparable in these cultures. Regression analysis showed all 4 domains to be important in assessing quality of life in each of the 15 centers. Structural equation modeling suggested further support for the proposal that there are universal facets and domains that are cross-culturally important in determining quality of life and suggested that the ordering of facets within domains is comparable across cultures.