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PubMed1998

Kidney transplants from living donors: how donation affects family dynamics.

Living donors continue to provide the optimum outcome for kidney transplant recipients, yet information is limited on how donation can affect the donor and his or her family. Questionnaires returned by 524 donors whose donor nephrectomies took place between August 1, 1985 and December 31, 1996 at the University of Minnesota were analyzed to determine if perioperative complications influence their quality of life, among other emotional and lifestyle areas. Results showed that donors have a higher quality of life than the general population, confirming they have an increased self-worth and positive self-esteem. An overwhelming 96% would donate again. However, donation was self-reported as more stressful when complications were experienced (P = .003) and when donors were female (P = .041). Relatives other than immediate family members (extended relatives) were more likely to be among the 4% who said they would not donate again. Available support, financial impact, and relationship changes as a result of donation also were revealed. Relevant results from this larger study are discussed as they relate to how the renal donor and transplant family are affected.

Adolescent↗
PubMed1989

The impact of a child with sickle cell disease on family dynamics.

This paper has reviewed research and other papers that have furthered our understanding of the impact of the presence of a child with sickle cell disease on the family. The research suggests that the primary parent in such a family experiences additional emotional strain much like primary parents of children with other chronic illnesses have been found to exhibit. The research also suggests that the ill child's presence influences interpersonal relationships within the family. Specifically, there is some evidence that the relationship between the parents and the relationship between the parent and other offspring may be affected adversely. The only evidence for an adverse impact on the relationship between the parent and the chronically ill child was in our research when considering only single-parent families. The research also suggests that the family environment is affected. In particular, the research suggests that the level of conflict and organization within the family was less favorable than within the control families. Moreover, the research suggests that the child's presence reduces the ability of the primary parent to participate in social activities outside of the family. Secondary parents, on the other hand, report less satisfaction with the extent to which their own individual needs are being met within the family. The available research also suggests that other factors mediate the impact of the child's illness on the family. In particular, parents with more knowledge about the illness and more social support available appear to cope more favorably with the illness. Moreover, the available research also suggests that the family also impacts on how the patient responds to the illness. Specifically, the more psychosocial stressors within the family, the less effectively the patient copes with the illness. In addition, the more social support available to the patient from the family and other significant others, the more likely the patient is to comply with the treatment regimen. Finally, two methodological issues have been discussed. First, a tendency is evident for parents to deny any impact on the family when asked directly but to demonstrate the impact when the responses of these parents are compared to the responses of a comparison group. This suggests a need for more studies that involve a comparison group in the design. Second, the small sample sizes in many of the studies reflect the lack of adequate sample in individual geographic locales. This suggests a need for more collaborative research projects such as the CSSCD project to increase sample size.

Adult↗
PubMed2003

Teenage pregnancy among African-Americans: a qualitative examination of maternal education, teenage pregnancy, family dynamics, and conflict resolution.

This qualitative study is derived from interviews conducted during a larger quantitative study that examined facilitators and barrier to communication and negotiations in African American families whose teen daughters had one or more unwed teen pregnancies. Based on the larger study's findings that the education of the teens mother was a statistically significant factor in teen pregnancy, 17 robust interviews were analyzed in this study and sorted on variables of maternal education and teen pregnancies. From the analysis of the data, seven themes emerged. Findings indicated that almost all girls reported a lack of contact with a father and girls of higher educated mothers tended to have more supportive family structures than did girls of lower educated mothers. Most of the families rejected the teen pregnancy, although later some accepted the infant. In comparison to mothers with a higher level of education, mothers with a lower level of education leaned toward more absolutist and negative solutions without full discussions about ideas of sex with their teens. Discussion indicated the need for interventions based on negotiation principles and tactics.

Adolescent↗
PubMed1996

The influence of expressed emotion, family dynamics, and symptom type on the social adjustment of schizophrenic young adults.

BACKGROUND: The goal of this study was to test a path analytic model that reflects the hypothesis that family cohesion and family adaptability underlie family members' expressed emotion (critical comments and emotional overinvolvement), that these family variables underlie the preponderance of positive symptoms in a patient with schizophrenia 9 months after relatives are interviewed, and that all of these variables influence the patient's social adjustment at follow-up. METHODS: The subjects were 69 patients who met the DSM-III-R criteria for schizophrenia and 108 of their relatives. Relatives were assessed with the Camberwell Family Interview and the Family Adaptability and Cohesion Evaluation Scales III. Patients were interviewed 9 months later with the Brief Psychiatric Rating Scale and the Social Adjustment Scale II. RESULTS: Significant amounts of variance were explained by the model for three of the five social adjustment components. Neither family cohesion nor adaptability was associated with either critical comments or emotional overinvolvement. Family cohesion was negatively associated and emotional overinvolvement was positively associated with a preponderance of positive symptoms. Greater family adaptability was associated with lower social adjustment scores, and greater emotional overinvolvement was associated with higher social adjustment. Cohesion had a significant positive indirect effect on social adjustment through its association with symptom type. CONCLUSIONS: Critics of expressed emotion will be pleased to see that one component of high expressed emotion (emotional overinvolvement) is actually associated with a better social outcome in patients. Proponents of the expressed emotion concept will be pleased to see the applicability of expressed emotion to other facets of schizophrenic outcome. The results highlight the importance of using the expressed emotion scales in their continuous rather than dichotomized state and of analyzing critical comments and emotional overinvolvement separately.

Adolescent↗
PubMed2005

The social and family dynamics behind the uptake of cataract surgery: findings from Kilimanjaro region, Tanzania.

AIMS: To describe and understand better the barriers that elderly cataract patients in Kilimanjaro region (Tanzania) experience at the family level in order to access surgery. METHODS: A phenomenological study carried out in the catchment area of a teaching hospital in Kilimanjaro Region. 60 semi-structured interviews were conducted with patients and ex-cataract patients. RESULTS: The perceived need for sight and for surgery appears partly socially constructed at the family level. It was found that women were less likely to express a need for sight for fear of being seen as a burden. Furthermore, young heads of family are more inclined to support old men than old women. The consensus is that asking children for help can be difficult. Going for cataract surgery must be seen as a social process where elderly patients might have to wait or negotiate support for weeks, months, or even years. CONCLUSIONS: Eye programmes must promote the benefits of cataract surgery to all family members, not just to the patient. A changing social climate, changing expectations of vision, and evolving cost sharing systems will have significant, sometimes contradictory, impacts on use of eye care services. Strategies for reaching those without access to financial resources need to be strengthened.

Aged↗