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.     

Relationship between Mental Health and Burden among Primary Caregivers of Outpatients with Schizophrenia

There is growing recognition that caring for a patient with schizophrenia often results in high levels of perceived burden and poorer overall mental health for caregivers. A quantitative cross‐sectional design and standardized instruments were used to collect data from 355 primary caregivers of adults in outpatient care with schizophrenia in China. Structural equation modeling was used to examine the association between caregiver burden and mental health among primary caregivers and whether this association is influenced by personality, coping style, and family functioning, based on a diathesis–stress perspective. Goodness‐of‐fit indices (χ²/df = 1.406, GFI = 0.919, CFI = 0.957, etc.) confirmed that the modified model fit the data well. In line with the diathesis–stress model, and with this study's hypotheses, we found that caregiver burden was significantly related to mental health outcomes directly. The final model showed that personality traits, coping style, and family function influenced the relationship between caregiver burden and mental health. The neuroticism personality traits have a direct effect on caregiver burden and family functioning in this sample. Coping style had a direct effect on the caregiver burden, and family functioning had a direct effect on the caregiver burden. Our final model about primary caregivers can be applied clinically to predict mental health outcomes from caregiver burden.     

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide‐ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers’ CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers’ higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war‐exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.     

Review of Family Relational Stress and Pediatric Asthma: The Value of Biopsychosocial Systemic Models

Asthma is the most common chronic disease in children. Despite dramatic advances in pharmacological treatments, asthma remains a leading public health problem, especially in socially disadvantaged minority populations. Some experts believe that this health gap is due to the failure to address the impact of stress on the disease. Asthma is a complex disease that is influenced by multilevel factors, but the nature of these factors and their interrelations are not well understood. This paper aims to integrate social, psychological, and biological literatures on relations between family/parental stress and pediatric asthma, and to illustrate the utility of multilevel systemic models for guiding treatment and stimulating future research. We used electronic database searches and conducted an integrated analysis of selected epidemiological, longitudinal, and empirical studies. Evidence is substantial for the effects of family/parental stress on asthma mediated by both disease management and psychobiological stress pathways. However, integrative models containing specific pathways are scarce. We present two multilevel models, with supporting data, as potential prototypes for other such models. We conclude that these multilevel systems models may be of substantial heuristic value in organizing investigations of, and clinical approaches to, the complex social–biological aspects of family stress in pediatric asthma. However, additional systemic models are needed, and the models presented herein could serve as prototypes for model development.     

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.     

Reducing the Risk of Internalizing Symptoms among High‐risk Hispanic Youth through a Family Intervention: A Randomized Controlled Trial

Familias Unidas is an intervention that has been found to be efficacious in preventing and reducing substance use, sexual risk, and problem behaviors among Hispanic youth. While it does not specifically target youth internalizing symptoms, the intervention works to strengthen parenting and family factors associated with reduced risk of internalizing symptoms (i.e., depression, anxiety symptoms). This study examines the effects of Familias Unidas on internalizing symptoms among high‐risk youth, as well as the role of family level factors in the intervention's effects. A total of 242 12–17‐year‐old Hispanic youth with a history of delinquency and their primary caregivers were recruited from the school and juvenile justice systems, and randomly assigned to the Familias Unidas intervention or community practice control. A linear latent growth model was used to examine intervention effects on the trajectory of adolescent internalizing symptoms from baseline to 6 and 12 months post‐baseline. Results show that the Familias Unidas intervention was more efficacious than control in reducing youth internalizing symptoms. Baseline youth externalizing and internalizing symptoms did not moderate the intervention's effects on the trajectory of youth internalizing symptoms. While parent – adolescent communication did not significantly moderate the intervention's effects, changes in parent – adolescent communication mediated the intervention's effects on internalizing symptoms, showing stronger intervention effects for youth starting with poorer communication. Findings indicate that the Familias Unidas intervention can reduce internalizing symptoms among high‐risk Hispanic youth, and that improving parent – youth communication, a protective family factor, may be one of the mechanisms by which the intervention influences youth internalizing symptoms.     

Specificity of the Association between Marital Discord and Longitudinal Changes in Symptoms of Depression and Generalized Anxiety Disorder in the Irish Longitudinal Study on Ageing

This longitudinal study was conducted to evaluate actor and partner effects of marital discord on changes in symptoms of depression and generalized anxiety disorder (GAD) in a large population sample of Irish adults (N = 1,445 couples), adjusting for the potential confounds of quality of other social relationships and other psychopathology symptoms. The Actor–Partner Interdependence Model was used to examine actor and partner effects of marital discord on changes in symptoms of depression and GAD at a 2‐year follow‐up. Additional models examined these associations adjusting for family and friend discord and symptoms of the other type of psychopathology (depressive or GAD symptoms). Actor effects of marital discord on depressive and anxiety symptoms were greater for men than for women. There were significant, positive actor effects of marital discord on depressive symptoms for husbands and wives, which remained significant when adjusting for family and friend discord and GAD symptoms. There were significant, positive actor effects of marital discord on GAD symptoms for husbands, which remained significant when adjusting for family and friend discord and depressive symptoms. Results demonstrate that longitudinal associations between marital discord and depressive symptoms (for wives and husbands) and GAD symptoms (for husbands) are incremental to other rival explanations (family and friend discord and the other set of symptoms). Findings provide evidence for a potential causal association leading from marital discord to symptoms of depression and GAD.     

Disentangling the Relations Between Different Components of Family Socioeconomic Status and Chinese Preschoolers’ School Readiness

Family socioeconomic status (SES) has been frequently linked to children’s early development. Treating SES as an aggregated variable has many issues, as different components of SES may relate to child outcomes through divergent mechanisms. The purpose of the study was to examine whether parents’ engagement in home learning activities and children’s participation in extracurricular activities (EAs) would function as pathways through which individual SES components related to children’s school readiness. A total of 588 families with preschool‐aged children were recruited from Guangdong province in China. Children’s receptive vocabulary, Chinese reading, and early math skills were individually assessed at three time points, and children’s social skills were rated by parents. Parents reported their engagement in home learning activities with children and their children’s participation in EAs. The results showed that all three components of family SES were related to multiple aspects of children’s school readiness, but through different pathways. Parental income was related to children’s school readiness through EA participation only; parental education and occupational status were associated with school readiness via both parental engagement and child EA participation. The findings suggest that considering SES components separately will produce a more nuanced understanding of the divergent pathways through which family SES may relate to children’s school readiness. Chinese government may provide parent education programs focused on cognitive stimulation for low‐SES families to promote children’s school readiness. Furthermore, the government needs to ensure children’s equal access to EAs to prevent increasing the developmental gap among children from discrepant socioeconomic backgrounds.     

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.     

Evaluation of a Family Systems Intervention for Managing Pediatric Chronic Illness: Mastering Each New Direction (MEND)

Family systems play a crucial, albeit complex, role in pediatric chronic illness. Unfortunately, very few psychosocial interventions are available to help these stressed families navigate the developmental steps of chronic illness. A new intervention (MEND) addresses the needs of these families and applies to a broad range of chronic illnesses. This article presents this family systems intervention as well as includes preliminary program evaluation data on 22 families that graduated from the program. Results show consistently strong effects across an array of psychosocial measures. Conclusions from this preliminary study suggest that families entering MEND present with high levels of stress due to the child's chronic illness, but after MEND, the level of stress and other functioning measures are comparable to those seen in healthy families, suggesting that the program offers a significant benefit to families with pediatric chronic illness.     

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.     

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.     

Global Mental Health: A Call for Increased Awareness and Action for Family Therapists

Global mental health (GMH) is an emerging field that focuses on the need for culturally sensitive mental health services in low‐ and middle‐income countries (LMICs). While many new initiatives have been established worldwide to understand GMH needs and to provide care in LMICs, family therapists have primarily worked with families in high‐income countries. The few existing family‐based initiatives in GMH focus on psychoeducation and are typically not based on general systems theory. However, emerging trends in family therapy may enable family therapists to impact mental health issues in LMICs. These trends, which are shared interests of both family therapy and GMH, include collaborative care, a growing emphasis on the importance of culture in understanding and treating mental health issues, recognition of the ability of families to support or impede recovery from mental illness, and the use of strength‐based and evidence‐based treatments. This paper describes ways for family therapists to become active in the GMH community.     

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.     

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.     

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.     

Bidirectional Spillover in the Family across the Transition to Parenthood

Although family systems theory posits reciprocal causality between subsystems of the family, such as intimate partner violence exacerbating harsh parenting and vice versa, longitudinal studies with cross‐lagged models have been used infrequently to test these principles. As guided by the spillover model, this study examined bidirectional associations between couple dysfunction, parent–child aggression risk, and child functioning across the transition to parenthood to determine whether and how disruptions in one subsystem relate to problems in other family subsystems. Participants were 201 first‐time mothers and 151 fathers from a diverse community sample, evaluated during pregnancy, and reassessed two more times through their child's first 18 months of life. Individual and dyadic path model results indicate bidirectional spillover effects between parent–child aggression risk and child functioning for both mothers and fathers, and spillover from parent–child aggression risk to couple dysfunction for mothers but not fathers. However, limited spillover effects were identified between couple functioning and child adjustment, in contrast to previous work. Findings suggest that spillover can happen reciprocally and early in the family, supporting transactional models of behavior and highlighting the need for early family level intervention.     

A Multi‐Family Group Intervention for Adolescent Depression: The BEST MOOD Program

Depression is the most common mental disorder for young people, and it is associated with educational underachievement, self‐harm, and suicidality. Current psychological therapies for adolescent depression are usually focused only on individual‐level change and often neglect family or contextual influences. The efficacy of interventions may be enhanced with a broader therapeutic focus on family factors such as communication, conflict, support, and cohesion. This article describes a structured multi‐family group approach to the treatment of adolescent depression: Behaviour Exchange Systems Therapy for adolescent depression (BEST MOOD). BEST MOOD is a manualized intervention that is designed to address both individual and family factors in the treatment of adolescent depression. BEST MOOD adopts a family systems approach that also incorporates psychoeducation and elements of attachment theories. The program consists of eight multifamily group therapy sessions delivered over 2 hours per week, where parents attend the first four sessions and young people and siblings join from week 5. The program design is specifically aimed to engage youth who are initially resistant to treatment and to optimize youth and family mental health outcomes. This article presents an overview of the theoretical model, session content, and evaluations to date, and provides a case study to illustrate the approach.     

Applying a Family Resilience Framework in Training,Practice, and Research: Mastering the Art of the Possible

With growing interest in systemic views of human resilience, this article updates and clarifies our understanding of the concept of resilience as involving multilevel dynamic processes over time. Family resilience refers to the functioning of the family system in dealing with adversity: Assessment and intervention focus on the family impact of stressful life challenges and the family processes that foster positive adaptation for the family unit and all members. The application of a family resilience framework is discussed and illustrated in clinical and community‐based training and practice. Use of the author's research‐informed map of core processes in family resilience is briefly noted, highlighting the recursive and synergistic influences of transactional processes within families and with their social environment. Given the inherently contextual nature of the construct of resilience, varied process elements may be more or less useful, depending on different adverse situations over time, with a major crisis; disruptive transitions; or chronic multistress conditions. This perspective is attuned to the diversity of family cultures and structures, their resources and constraints, socio‐cultural and developmental influences, and the viability of varied pathways in resilience.