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PubMed1996

Self-concept, family functioning and problem type: a replication and extension of a study of clinic and non-clinic adolescents.

PURPOSE: This study replicates and extends previous research into self-concept and perceptions of family functioning held by clinic and nonclinic adolescents (1). METHOD: Thirty-five male and 28 female adolescents who sought help from a school counselor for family problems (n = 26) and for educational problems (n = 37) formed the clinic group. A nonclinic group was formed by adolescents who had experienced the same problems but had not sought help. The two groups were matched in terms of age and sex of respondents. Respondents' were clustered into two groups based on their ratings of family functioning. One cluster was characterised by high conflict, the other by high democratic parenting style and intimacy. RESULTS: Three MANOVAs with sets of scales (academic, social, and other scales) from the Self-Description Questionnaire II (2) as the dependent variables and with group (clinic/nonclinic), family functioning cluster, and sex as the independent variables confirmed the findings of the previous research. That is, there were multivariate effects on the three sets of self-concept scales. Significant univariate differences between the clinic and nonclinic groups were present for seven of the 11 individual self-concept scales, with higher mean ratings of self-concept shown by the nonclinic group. A range of sex effects and cluster effects were found, however, differences between the reported problem types did not show any consistent effect. CONCLUSIONS: The major point to be drawn from this research is the identification of a very clear difference between the self-concept of adolescents who seek professional care and those who do not.

Adolescent↗
PubMed2004

The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients' illness characteristics on depression and anxiety.

A diagnosis of cancer is a very stressful event for the patients and their families. Patients, partners and other family members can suffer from clinical levels of depression and severe levels of anxiety and stress reactions. The similarity in levels of distress between patients and partners and patients and offspring suggests that there are common factors that impact on families' distress levels. The current study examined levels of depression and anxiety in newly diagnosed adult patients (n = 48) and their adult relatives (n = 99). Family functioning and patients' illness characteristics were identified as factors that might impact on families' depression and anxiety. Results from multilevel models indicated that family functioning was important. Families that were able to act openly, express feelings directly, and solve problems effectively had lower levels of depression. Direct communication of information within the family was associated with lower levels of anxiety. Aside from differences anxiety due to cancer type, patients' illness characteristics appear to be risk factors in patients' but not relatives' depression and anxiety. The results from the current study suggest that researchers and clinicians need to be family-focused as cancer affects the whole family, not just the patient.

Anxiety↗
PubMed2004

The marital and family functioning of adults with ADHD and their spouses.

Little is known about the family relationships of adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the marital adjustment and family functioning of 33 married adults with ADHD and their spouses was compared to 26 non-ADHD control participants and their spouses. Results revealed that married adults with ADHD reported poorer overall marital adjustment on the Dyadic Adjustment Scale (DAS; Spanier, 1989) and more family dysfunction on the Family Assessment Device (FAD; Eptein, Baldwin, & Bishop, 1983) than control adults. The spouses of adults with ADHD did not differ from control spouses in reports of overall marital adjustment and family dysfunction. A greater proportion of their marital adjustment scores, however, fell within the maladjusted range. The ADHD adults' perceptions of the health of their marriages and families were more negative than their spouses' perceptions. The way in which spouses of ADHD adults compensated for their partners' difficulties were explored through clinical interviews. The findings in this study underscore the need for assessments and treatments to address marital and family functioning of adults with ADHD.

Adaptation, Psychological↗
PubMed2005

Adaptive, emotional, and family functioning of children with obsessive-compulsive disorder and comorbid attention deficit hyperactivity disorder.

OBJECTIVE: The purpose of the study was to examine adaptive, emotional, and family functioning in a well-characterized group of children and adolescents with obsessive-compulsive disorder (OCD) and to evaluate the influence of comorbid attention deficit hyperactivity disorder (ADHD) on the levels of impairment in various functional domains. METHOD: The study group included 287 children and adolescents (191 boys, 96 girls) ages 7-18 years. Fifty-six subjects had a diagnosis of OCD only, 43 had both OCD and ADHD, 95 had ADHD, and 93 were unaffected comparison children. Best estimate DSM-IV diagnoses were assigned on the basis of structured interviews and clinical ratings. The children's functioning was evaluated with a comprehensive battery of well-established, standardized measures, including the Vineland Adaptive Behavior Scales, parents' ratings of social and family functioning, and children's self-reports of emotional adjustment. RESULTS: The children with OCD only were more impaired than were unaffected comparison subjects in most areas of adaptive functioning and emotional adjustment. Children with OCD plus ADHD had additional difficulties in social functioning, school problems, and self-reported depression. Impairment in daily living skills, reduced number of activities, and self-reported anxiety were uniquely associated with the diagnosis of OCD. Family dysfunction was associated with ADHD but not with OCD. CONCLUSIONS: Children and adolescents with OCD are impaired in multiple domains of adaptive and emotional functioning. When comorbid ADHD is present, there is an additional burden on social, school, and family functioning.

Adaptation, Psychological↗
PubMed1994

Family functioning and its implications for palliative care.

Palliative care programs are based on the principle that care should be directed to the family as a unit. However, existing guidelines for care of the family tend to be described in general terms. Analysis of data from a series of three research studies describing the experience of twenty-three families caring for a terminally ill member revealed that family functioning influenced their experience. The dimensions of family functioning are described and guidelines for working with families are proposed.

Adaptation, Psychological↗
PubMed1996

Psychosocial and family functioning in children with insulin-dependent diabetes at diagnosis and one year later.

Examined the initial impact and subsequent adjustment to the diagnosis of insulin-dependent diabetes mellitus (IDDM). Children between 1 and 14 years of age and their families were assessed several weeks after diagnosis and again a year later using standardized measures of child behavior, parental mental health, and family functioning. Immediately after diagnosis, the children and both parents exhibited mild symptoms of psychological distress but these had largely resolved at 12-month follow-up. The impact of IDDM diagnosis on family functioning varied with informant, SES, and the age of the child, with an overall tendency for families to become less flexible over the year. Findings suggest that most children and their parents exhibit satisfactory individual adjustment after a period of initial stress but family functioning is affected in complex ways. Serial follow-up of the cohort is planned to establish whether the current findings are predictive of longer term outcome.

Adaptation, Psychological↗
PubMed2005

Mental health, family function and obesity in African-American women.

CONTEXT: African-American women are disproportionately affected by obesity and its related diseases. How psychological and psychosocial factors that affect this population differ across weight categories remains poorly understood. PURPOSE: To determine whether poor mental health and family functioning are associated with obesity in African-American women. METHODS: African-American women patients aged 21-65 years were interviewed at three primary care centers. Four well-established assessment tools were used to measure general mental and physical health status, family functioning, depressive symptoms and anxiety levels. Demographics, health behaviors and family and personal histories of overweight were assessed. RESULTS: Among 113 patients, after controlling for age and parity, obese women had significantly higher anxiety levels, poorer perception of their physical health, more often were overweight as a child, had overweight parents or siblings and experienced more psychosocial problems in their family growing up, compared to overweight and normal weight women. CONCLUSIONS: The observed findings of poor mental health, perception of physical health and family function in obese African-American women support a need for clinical attention and further study.

Adult↗
PubMed1990

Family functioning and major depression: an overview.

The authors review the evidence supporting the idea that the family plays a major role in the development and course of major depression. They find that the family pathology evident during an acute depressive episode continues after the patient's remission; that the course of depressive illness, relapse rates, and suicidal behavior are all affected by family functioning; and that children of depressed parents are at high risk for psychopathology. The authors explore unresolved issues regarding our understanding of the factors mediating the interaction between major depression and family functioning, concluding that there is evidence to support family and marital interventions, particularly in the treatment of depressed women.

Acute Disease↗
PubMed2005

The association of child condition severity with family functioning and relationship with health care providers among children and youth with special health care needs in Alabama.

OBJECTIVE: The purpose of the present study is to assess how the severity of a child's condition affects family functioning and the relationship with health care providers among children with special health care needs in Alabama. METHODS: Using the data from the National Survey of Children with Special Health Care Needs (CSHCN), three variables were used as measures of condition severity: responses to the CSHCN screener questions, whether condition affected the ability to do things for children and youth with special health care needs (CYSHCN), and the level of severity of CYSHCN's condition. The dependent variables included family functioning and provider relationship. RESULTS: CYSHCN who only take prescription medicine for their chronic condition (MO) had lower condition severity from those who have other needs (NMO). In NMO CYSHCN, higher condition severity was associated with increased strain on family functioning outcomes and higher unmet needs in provider relationship outcomes, adjusted for demographic and insurance variables. Families of NMO CYSHCN with a more severe condition spent more temporal and financial resources and had a higher need for professional care coordination, and were less likely to have sensitive providers. CONCLUSIONS: Severity of condition is an important factor increasing strain on family resources and relationship with the provider. Our results indicate the need for professional care coordination and family support, particularly among those families in which there is a NMO CYSHCN with a more severe condition. This finding supports the mandate that all CYSHCN should have their health care coordinated and provided in the context of a medical home.

Adolescent↗
PubMed1994

Parents of children with asthma: an examination of family hardiness, family stressors, and family functioning.

As the incidence, severity, and mortality associated with asthma has risen, the numbers of families caring for children has grown. This study used a descriptive correlational design to examine relationships among family hardiness, family stressors, and family functioning in families of children with asthma using the Resiliency Model of Family Stress, Adjustment, and Adaptation. The Family Hardiness Index, Family Stress Index, and Faces II instruments were completed by 27 parents of children with asthma. Correlations were found to be significant. Family type was also determined.

Adaptation, Psychological↗
PubMed1990

The impact of family functioning on health changes in children with cystic fibrosis.

Family stress, family and personal resources, and parental coping were operationalized from self-report questionnaires completed by mothers and fathers in 72 two-parent families who had a child with cystic fibrosis (CF). Three-month and 15-month changes in clinically recorded measures of the CF child's height and weight data and pulmonary functioning were correlated with the family functioning variables. Each of the four criterion indices of CF child health changes were regressed separately on the significant family functioning variables. Twenty-two percent of the variance in 15-month height and weight changes were explained by family stress, family resources, and parental coping. Family functioning variables also explained 17% of the variance in 3-month pulmonary functioning changes and 15% of the variance in 3-month height and weight changes. These findings suggest that the way in which the family functions has indirect effects on critical indices of a CF child's health. These data lend support to an increased focus by physicians and other medical professionals on the health of the total family system as a way to enhance outcomes for children with CF.

Adaptation, Psychological↗
PubMed1996

Resilience and vulnerability among preschool children: family functioning, temperament, and behavior problems.

OBJECTIVE: To examine the effects of child temperament and stressful family functioning on child behavior problems among preschool children. METHOD: One hundred forty-five preschool children, aged 2 to 5 years, were evaluated by teachers, mothers, and independent observers. Teachers reported on child temperament; from these ratings, two dimensions of temperament were derived: difficult/easy and approachability. Mothers reported on two dimensions of family functioning: conflict and expressiveness. Both teachers and independent observers rated child behavior problems. RESULTS: Children with more difficult temperaments who were in high-conflict families had the most internalizing and externalizing behavior problems, while children with easy temperaments had fewer such problems, regardless of levels of family conflict. Difficult children whose families were highly expressive engaged in the most observed aggression. CONCLUSIONS: Results suggest that temperament is involved in both protective and vulnerability processes. A difficult temperament operates as a vulnerability factor for internalizing and externalizing behavior problems and observed aggression, while an easy temperament functions as a protective mechanism for these outcomes.

Child Behavior Disorders↗
PubMed1990

Differences in family functioning among bulimics, repeat dieters, and nondieters.

This article examined bulimics' (n = 31) perceptions of how their families function relative to a group of women at risk for developing bulimia (repeat dieters) (n = 61) and a group not at risk for an eating disorder (nondieters) (n = 59). The results indicated that bulimics perceive their families to be more dysfunctional than do repeat dieters or nondieters. The bulimics reported poorer general family functioning, more affective involvement, less affective responsiveness, poorer family communication, poorer problem-solving skills, and poorer behavior control. The hypothesis that repeat dieters would evidence more family dysfunction relative to the nondieters was not supported. The results are discussed in terms of how family variables may contribute etiologically to bulimia.

Adolescent↗
PubMed1992

Family functioning during a critical illness: a systems theory perspective.

In this article the effects of critical illness on family functioning are described within a systems theory framework. As identified in the literature, family vulnerabilities and strengths that impede or support family functioning during the time a member has a critical illness are discussed. Strategies that nurses can use to assist families of critically ill patients are explored. A challenge to expand family-centered care across various settings is extended.

Adaptation, Psychological↗
PubMed1997

The adolescents assessment of family functioning.

The aim of this study was to find out in what way adolescents assess their families and family functioning. An 34-item scale in self-report format was administered to 154 high school students and 34 patients in diagnostic procedure before entering psychotherapy in order to explore basic elements of family functioning (structure, affect, communication; behaviour control, ethic values transmission, intimacy and idealization, and elements of family dysfunction). The results showed that adolescents in general assessed their families as growth and individuation supportive. The adolescents in the clinical sample presented more dissatisfaction with their families and elements of family dysfunctions were more emphasized.

Adolescent↗
PubMed1992

Family therapy for Dutch drug users: the relationship between family functioning and success.

This article reports treatment outcome in families with drug problems after a family therapy intervention. An attempt is made to determine what changes occur in family functioning in the course of treatment with family therapy, and how these changes relate to prolonged abstinence and improvement in social functioning in drug misusers. The results indicate that, overall, most families, one year after the start of family therapy, changed in the predicted direction as determined by an observation instrument. Furthermore, success in treatment for the drug misuser was most likely to occur in families in which the parents communicated with each other in a predominantly negative way at the beginning of therapy, and when, in the course of therapy, a significant change occurred toward a more positive supportive manner of communicating.

Adult↗
PubMed2006

Family functioning in the caregivers of patients with dementia: one-year follow-up.

Caregivers for relatives with dementia can maintain their quality of life without specific intervention. It is unclear which variables are protective and which variables are aggravating for the caregiver. To assess the impact of family functioning on caregiver burden over time, the authors had caregivers of out patients with dementia complete self-report questionnaires at recruitment and at 1 year. At recruitment, 63% of caregivers were female, with a mean age of 62 years. Mean patient age was 73 years. The average number of caregiving years was 3.1. Caregivers were more likely to be spouses (61%). After 1-year, caregivers who stayed in the study reported no change in burden, reward, quality of life, or overall family functioning, although the patient's activities of daily living and level of disability were perceived to have significantly deteriorated. Caregivers who reported poor family functioning at initial assessment had higher ratings of strain and burden.

Adult↗
PubMed2006

[Family functioning, personality disorders, and depressive and anxiety symptoms in the mothers of children with food refusal].

OBJECTIVE: A review of the literature reveals that feeding problems during early childhood can be related to maternal psychiatric disorders. We aimed to evaluate the personality disorders, levels of depression and anxiety symptoms in the mothers of children with food refusal in addition to family functioning. METHOD: Thirty children aged between 1 and 6 years admitted to the clinic for food refusal and their mothers were included in the study. The control group consisted of 30 healthy children and their mothers. The Beck Depression Inventory, State-Trait Anxiety Inventory, McMaster Family Assessment Device and Structured Clinical Interview for DSM-III-R Personality Disorders were performed in mothers, and the presence of any personality disorders was evaluated with the SCID-II Interview. RESULTS: The depression and anxiety scores of the mothers of patients were higher than those of the controls. Perceived family functioning by mothers of patients was more problematic than that of the controls. Rates of maternal personality disorders were not significantly different between the two groups. CONCLUSION: Food refusal is not only related to characteristics of the child or his/her mother, but also to problems in family functioning. An integrative approach which evaluates the whole family is helpful to assess and treat children with food refusal.

Adult↗