Benefits and Changes for Family to Family Graduates

Family members of people with serious mental illnesses (SMI) need information and support to cope with the considerable stresses they experience. The Family to Family Education Program (FtF) is a structured, peer-led, 12-week information and support self-help class for such individuals. Previous research by Dixon et al. (2004) shows reduced subjective burden and increased empowerment among graduates. The present study sought to understand what processes take place during FtF participation that might lead to these benefits, as a first step in building a conceptual model of how FtF causes its effects, using semi-structured interviews with 31 FtF graduates. Qualitative data analysis suggested that new factual and emotional information from FtF shifts interviewees' understanding of their situation and that skills acquired through FtF then allow participants to incorporate these new perspectives into more adaptive behaviors. These changes led to both proximal and distal benefits for the FtF participants interviewed. The results are discussed in the context of self-help, stress-and-coping, and trauma recovery theories.     

Links Between Life Course Trajectories of Family Dysfunction and Anxiety During Middle Childhood

Using data from three waves of a large Canadian data set, we examine the relationship between two middle childhood trajectory variables, family dysfunction and anxiety. We draw upon family systems theory and developmental psychopathology, while attempting to expand their boundaries by capitalizing on the strengths within both approaches. Our data treatment strategy, guided by the life course analytical framework, included separate multivariate logits to examine this relationship, with and without the extent to, which selected explanatory risk variables predicted belonging to the highest family dysfunction trajectory. We also explored possible interactions between anxiety and explanatory risk variables. Supporting our hypothesis, a prolonged duration of high doses of family dysfunction was associated with the most extreme developmental trajectories of anxious behavior during middle childhood for both boys and girls. This relationship prevailed above and beyond the influence of other correlates of family dysfunction such as marital transition, socioeconomic status, family size, and depressive symptoms experienced by the informant (mostly mothers). Specific details regarding the sample, characteristics of measures, and unspecified estimates and their standard errors per data source are available from the first author in the form of tables and figures.     

Ten years of longitudinal research on U.S. adolescent sexual behavior: Developmental correlates of sexual intercourse,and the importance of age,gender and ethnic background

We integrated findings from 35 recent, longitudinal studies of the onset of heterosexual intercourse. Correlates of adolescent sexual intercourse onset, whether in early (before age 16) or middle (ages 16–18) adolescence, included living with other than two biological parents, being less monitored by parents, having more advanced physical maturity and more involvement in dating behavior, and having more permissive attitudes toward sex. When studies were organized by age of participants, the onset of intercourse was more strongly associated with alcohol use, delinquency, school problems and (for girls) depressive symptoms in Early studies (sexual intercourse by age 15 or before only) than was found in studies classified as Middle (assessment of sexual intercourse up to age 18) or Late (knowledge of those who delayed until after age 18). Although more research is needed, additional factors were associated with delaying first sexual intercourse until after age 18, including religious attitudes and anxiety, with some factors more relevant for girls and some more applicable to boys. In total, the evidence suggests there are many similarities, but also some important differences, in the correlates associated with early versus middle versus later onset of sexual intercourse. This seems to signify more than one pathway (set of distal and proximal correlates) associated with sexual behavior during adolescence that should be tested in future research. Throughout the review, we highlight differences in the correlates of girls’ versus boys’ sexual intercourse and how race/ethnicity moderates associations. These gender and racial/ethnic differences were found largely in analyses of family processes, school and religion, and parent education. We end by summarizing several priority areas for future research.     

A family history of psychopathology modifies the decrement in cognitive control among patients with HIV/AIDS

The present study was designed to evaluate the effect of HIV/AIDS on cognitive control and to determine if the effect is modified by familial risk for either alcohol or mood disorders. Sixty HIV-1 seropositive and 75 seronegative volunteers were assigned to four subgroups defined by the crossing of a diagnosis of alcohol dependence in the biological father with diagnoses of either major depressive disorder or bipolar disorder in the biological mother. Cognitive control was evaluated during a task in which subjects were asked, on occasion, to inhibit the impulse to respond in the same physical direction as the stimulus and instead respond in the opposite direction. Event related brain potentials and measures of task performance were recorded. The task evoked a negative shift in a late slow potential (SP) as well as an increment in reaction time when cognitive control was challenged. An important finding was an interaction between trial type, HIV/AIDS, and family history: HIV/AIDS and family history each attenuated the negative shift in the SP to such a degree that no further attenuation could be accomplished by the other. The effects of familial risk for alcohol versus mood disorders were equivalent. In conclusion, the absence of change in a late slow potential following a challenge to cognitive control may represent a marker of familial risk for both externalizing and internalizing disorders. The effects of familial risk on this slow potential are sufficiently robust as to attenuate the effects of HIV/AIDS on the probable generators of the response: the anterior cingulate and prefrontal cortex.     

A Family’s Coming Out Process: Systemic Change and Multiple Realities

The paucity of investigative studies exploring the coming out process of families was the impetus for this case study with a six member family-of-choice. In-depth interviews highlight the complexities of negotiating family rules, journey with the family as they struggled with their new identity, and reveal how the reflexive process contributed to the family’s co-creation of new stories. The four themes that emerged (embracing gay identity, integrating as a family, building social networks, and social awakening), offer details of how the family reconfigured from the rubble of confusion to become more cohesive, awakened and empowered. Implications for clinical practice with families with gay members are addressed.     

Qualitative Research in Marriage and Family Therapy: Who is in the Interview?

Qualitative interviews are a rich means of gathering information from families. The qualitative interviewer has a choice of interviewing individual family members, multiple family members at the same time, or a combination. The configuration of interviewees is a choice guided by the epistemology of the researcher, research aims, and questions. This article reviews the literature on interviewing different configurations of family members. A content analysis was conducted on articles in the marriage and family therapy literature from 1990 to 2005. Over half of the articles were conducted with individual family members separate from their families. This finding is discussed in the context of the decision regarding whom to interview.     

Health-Related Quality of Life in a National Sample of Caregivers: Findings from the Behavioral Risk Factor Surveillance System

Purpose Recent national public health agendas, such as Healthy People 2010, call for improved public health surveillance and health promotion programs for people with disabilities and their caregivers. The goal of this study was to understand the public health impact of caregiving on health-related quality of life (HRQoL) using population-level data. Design & Methods A cross-sectional study design was used. 184,450 adults surveyed during the 2000 national Behavioral Risk Factor Surveillance System survey formed the sample. Binary logistic regression models ascertained differences between caregivers and non-caregivers in reporting reduced (“fair” or “poor”) health. Ordinary least squares regression (OLS) and multinomial logistic regression models examined the influence of caregiving status on HRQoL, measured as categories of healthy days reported in the last 30 days and the number of days reported as physical and mental health not good in the last 30 days. Results Sixteen percent (16%) of the survey respondents were caregivers. There was an interaction effect between caregiving status and age of the caregiver. In the fully adjusted models, caregivers <55 years old had a 35% increased risk of having fair or poor health (odds ratio [OR] = 1.35, 95% confidence interval [CI] 1.28, 1.43) as compared to non-caregivers in that age group, while caregivers 55 years and older had a 3% decreased risk in having fair or poor health (OR = 0.97, 95% confidence interval [CI] 0.92, 1.03) compared to non-caregivers of the same age. In the adjusted models that examined the association of caregiving and healthy days, younger caregivers similarly showed larger deficits in both mental and physical HRQoL compared to older caregivers. For example combining mental and physical days, caregivers <55 had 1.44 fewer healthy days (β = −1.44, standard error (SE) = 0.07), while caregivers 55+ had 0.55 fewer days *β = −0.55, standard error (SE) = 0.13 (compared to non-caregivers in their respective age groups). Implications With increasing population age and the projected increase in caregivers, it is important that we understand the social and public health burden of caregiving and begin to identify interventions to sustain the HRQoL of caregivers. We found that caregivers have a slight to modest decline in HRQoL compared to non-caregivers, and that caregiving affects the HRQoL of younger adults more than older adults. Further research at the population level as to the type and level of burden of caregiving is needed.     

Interactive Genetic Counseling Role-Play: A Novel Educational Strategy for Family Physicians

Background Family physicians (FPs) are increasingly involved in delivering genetic services. Familiarization with aspects of genetic counseling may enable FPs to help patients make informed choices. Purpose Exploration of interactive role-play as a means to raise FPs’ awareness of the process and content of genetic counseling. Methods FPs attending two large Canadian family medicine conferences in 2005 were eligible—93 participated. FPs discussed a case during a one-on-one session with a genetic counselor. Evaluation involved pre and post intervention questionnaires Results FPs’ baseline genetic knowledge was self-rated as uniformly poor. Baseline confidence was highest in eliciting family history and providing psychosocial support and lowest in discussing risks/benefits of genetic testing and counseling process. Post-intervention, 80% of FPs had better appreciation of family history and 97% indicated this was an effective learning experience. Conclusions Role-play with FPs is effective in raising awareness of the process and content of genetic counseling and may be applied to other health disciplines. This research was funded by: The Canadian Institutes of Health Research (CIHR) Institute of Genetics, The Genetics Education Project (funded by the Ontario Women’s Health Council), and GeneSens (funded by a CIHR Interdisciplinary Capacity Enhancement Team Grant).     

Diagnosis of Fabry Disease via Analysis of Family History

Fabry disease is an X-linked lysosomal storage condition caused by a deficiency of α-galactosidase A. In order to determine the average number of family members who are diagnosed with Fabry disease following the diagnosis of a proband, four lysosomal storage disease centers across the United States reviewed the completed pedigrees of their Fabry disease patients. In addition, data from three Fabry disease families from other centers were submitted by patients directly. The pedigree review found 74 probands (54 males and 20 females) who had 357 diagnosed family members, of which 223 were female (60.5%) and 146 were male (39.5%). Analysis found that, on average, there were five family members diagnosed with Fabry disease for every proband. Now that enzyme replacement therapy (ERT) is available for the treatment of Fabry disease, this finding emphasizes the need for all health care professionals to ensure a detailed pedigree has been constructed for each patient affected by Fabry disease and to encourage testing and evaluation of all at-risk family members.     

Predictors of Growth and Distress Following Childhood Parentification: A Retrospective Exploratory Study

While most of the existing literature has focused on the risks associated with parentification, we examined the potential benefits (i.e., posttraumatic growth) associated with parentification. Predictors of posttraumatic growth explored in our study included: attachment, differentiation of self, parentification, and resiliency. Partial support was found for the predictor variables leading to posttraumatic growth, with resilience emerging as the strongest predictor; resilience explained 14% of the variance in posttraumatic growth. These findings suggest that future research might explore additional resiliency factors that explain positive psychological outcomes related to childhood parentification.