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PubMed2003

The Support and Family Education (SAFE) program: mental health facts for families.

Although more than half of adults who have a serious and persistent mental illness live with their families (1), less than 10 percent of families of outpatients with schizophrenia receive support or education (2). Such services fail to be provided despite the fact that family participation in well-designed psychoeducational programs has been documented as reducing relapse and readmission rates, improving involvement and adherence to treatment (3,4), and producing positive outcomes for caregivers, including improved morale, better knowledge of mental illness, enhanced feelings of empowerment, and reduced worry and displeasure about their loved ones (5,6). Moreover, the vast majority of mental health providers believe that educating families about mental illness and its treatment is very important (7). Why, then, do so few clinicians commit the requisite time and energy to providing these effective and much appreciated services? There are four sources of obstacles to the adoption of a psychosocial treatment innovation such as family psychoeducation. The obstacles stem from the psychoeducational program itself (for example, its unfamiliarity and conflicts with the existing treatment ideology); the clinicians (lack of training, experience, and competence in functioning as "teachers" with families); the host agency or institution (countervailing priorities and lack of administrative support); and the process of dissemination (lack of knowledgeable consultants or enthusiastic "champions" or advocates for family psychoeducation and lack of user-friendly curricula or program manuals). These obstacles can be overcome when practitioners and family members work together as stakeholders in the benefits that accrue from ongoing psychoeducation (8). In this month's column, Michelle Sherman, Ph.D., presents the family psychoeducation program she created at the Oklahoma City Veterans Affairs (VA) Medical Center. Dr. Sherman describes how she tailored the intervention to the VA population, thus generating the support not only of the clients and their families but also of her fellow clinicians and the VA administration. Her work demonstrates that when mental health clinicians devote time, energy, and expertise to supporting and educating caregivers, significant benefits emerge for both clients and their families.

Community Participation↗
PubMed1999

Comparing women's views on family and sexual problems in family and gynecological practices.

This study compares the role of community gynecologists and family physicians, seen from the patients' perspective. A sample of 126 female patients in family practices and 212 patients in gynecological practices were surveyed about their preferences and expectations of whether their doctor should address personal, family and sexual problems. The effects of covariates (such as the type of doctor, patient age, family status, child desire) on patient expectations were simultaneously assessed by multiple logistic regression. Between 40% and 70% of the patients contacted confirmed the family-oriented approach, both in family practices and gynecological practices. Family practice patients more frequently stressed their doctor's knowledge of personal and family aspects (odds ratio [OR] = 1.7, 95% confidence interval [95% CI] = 1.1-2.7); whereas communication about sexual problems and a possible desire to have a child was more often considered as the gynecologist's domain (OR = 2.8 [95% CI = 1.8-4.4] and OR = 1.8 [95% CI = 1.1-2.8], respectively). Female patients older than 30 years were more often interested in communication on family related affairs (OR = 2.2, 95% CI = 1.4-3.4). These data illustrate that many patients would like both their community gynecologist and their family physician to take notice of their personal and family life conditions, including sexual problems and to initiate communication about these subjects.

Adult↗
PubMed2001

Family treatment and medication dosage reduction in schizophrenia: effects on patient social functioning, family attitudes, and burden.

The effects of 2 family intervention programs (supportive family management [SFM], including monthly support groups for 2 years; or applied family management [AFM], including 1 year of behavioral family therapy plus support groups for 2 years), and 3 different neuroleptic dosage strategies (standard, low, targeted) on social functioning of patients with schizophrenia. their relatives' attitudes, and family burden were examined. AFM was associated with lower rejecting attitudes by relatives toward patients and less friction in the family perceived by patients. Patients in both AFM and SFM improved in social functioning but did not differ, whereas family burden was unchanged. Medication strategy had few effects, nor did it interact with family intervention. The addition of time-limited behavioral family therapy to monthly support groups improved family atmosphere, but did not influence patient social functioning or family burden.

Adult↗
PubMed1994

AIDS and the family: families take care.

In 1994, the International Year of the Family, the WHO's Global Program on AIDS (GPA) is marking World AIDS Day under the banner AIDS and the Family. Traditional and non-traditional families have a crucial role to play in addressing the HIV/AIDS pandemic. In the run-up to World AIDS Day--and on 1 December itself--GPA urges the world to focus on how families of all kinds are affected by AIDS, on how they can be more effective in prevention and care, and on how they can contribute to global efforts against the disease. For GPA, any group of people linked by feelings of trust, mutual support and a common destiny may be seen as a family. The concept need not be limited to ties of blood, marriage, sexual partnership or adoption. In this light, religious congregations, workers' associations, support groups of people with HIV/AIDS, gangs of street children, circles of drug injectors, collectives of sex workers and networks of governmental, nongovernmental and intergovernmental organizations may all be regarded as families within the over-arching family of humankind. Every kind of family should take care to protect its members from HIV. And all families should take care of those among them who fall ill with AIDS. Families take care. "Families whose bonds are based on love, trust, nurturing and openness are best placed to protect their members from infection and give compassionate care and support to those affected by HIV or AIDS," says Dr. Hiroshi Nakajima, Director-General of the WHO [World Health Organization].

Acquired Immunodeficiency Syndrome↗
PubMed2003

Do required preclinical courses with family physicians encourage interest in family medicine?

BACKGROUND: Many medical schools, including the University of California, San Francisco (UCSF), added required preclinical course work with family physicians in the 1990s. We examined whether current UCSF students interested in family medicine noted more contact with family physicians and more faculty support of their interest than current Stanford students and 1993 UCSF students, neither of whom had required preclinical course work with family physicians. METHODS: A questionnaire was administered to students interested in family medicine at UCSF and Stanford in February 2001, with response rates of 84% and 90%, respectively. Previously published 1993 data from UCSF were also used for comparison. Data were analyzed using chi-square and t statistics as appropriate. RESULTS: UCSF students in 2001, despite exposure to required preclinical course work with family physicians, did not perceive greater contact with family physicians than Stanford students. Stanford students perceived greater encouragement from their family medicine faculty but less from faculty overall, compared with 2001 UCSF students. UCSF students in 2001 perceived no more overall faculty encouragement than did UCSF students in 1993. CONCLUSIONS: Required preclinical course work with family physicians was not consistently associated with greater student perception of faculty support for students' interest in family medicine, nor was it demonstrated to increase the amount or quality of interested students' interaction with family medicine faculty.

Adult↗
PubMed1990

Critical care family needs: nurse-family member confederate pairs.

In this study we explored the relationship between critical care family members' perceived needs and the assessment of these needs by a confederate sample of intensive care unit (ICU) nurses. Family needs were measured by using Molter's revised Critical Care Family Needs Inventory. Data consisted of 92 confederate pairs of Critical Care Family Needs Inventory responses obtained from 92 family members of adult patients hospitalized in a variety of ICUs and 49 ICU nurses providing direct care for these patients. Paired t tests (two tailed) were calculated to detect significant differences between confederate pairs of family members' perceptions and ICU nurses' assessments of the importance of the needs studied. Family members' perceptions and ICU nurses' assessments of the most and least important critical care family needs were identified. Significant (p less than 0.001 to p less than 0.05) differences were detected between confederate pairs of family members' perceptions and ICU nurses' assessments of the importance of 15 (50%) of the critical care family needs studied. Therefore, it appears that these nurses were only moderately accurate in their assessments of critical care family needs. Implications for nursing practice, education, and research were identified and discussed.

Adolescent↗
PubMed1982

Attitudes of patients toward family care in a family practice group.

There is little information documenting the extent to which the ideal of whole family care is represented in the real world of family practice. A previous study of a suburban family practice group revealed that only 28 percent of families obtained whole family care from a single physician. Interviews were conducted on a sample of 97 of these patients in an effort to gain insights into the factors influencing the choice of a single physician or more than one physician providing their health care. There were no significant differences between same-physician and different-physician families with respect to demographic factors or attitudes toward physician characteristics and family care. Most families had no insights into the potential value of having a single physician for the whole family; indeed, only one family specifically selected a single physician with the belief that it would thereby gain better care. If the observations reported here are representative of the situation at large in the country, family physicians have an important task ahead in patient education.

Attitude to Health↗
PubMed2006

What is familial about familial bipolar disorder? Resemblance among relatives across a broad spectrum of phenotypic characteristics.

CONTEXT: Current diagnostic criteria for bipolar affective disorder define a phenotype that is highly heritable, yet clinically variable. A more homogeneous definition might facilitate genetic and other studies, but the best approach is unclear. Familial features of bipolar disorder should help define more homogeneous subtypes, but there are few data indicating which clinical features of bipolar disorder are the most familial. OBJECTIVE: To study the familiality of phenotypic features in families ascertained through individuals with bipolar affective disorder. DESIGN: The study comprises 1246 individuals in 172 multiplex families ascertained for genetic linkage studies of bipolar disorder. The familiality of 40 diverse phenotypic features was studied using mixed-effects regression analysis. RESULTS: Substance abuse, alcoholism, psychosis, history of suicide attempt, and the level of social functioning were all strongly familial in this sample. Several other traits, including clinical subtype, earliest age at onset, and comorbid panic disorder, showed a suggestion of familiality that did not hold up to conservative correction for multiple testing. CONCLUSIONS: This is the largest and most comprehensive study to assess the familiality of phenotypic features in bipolar disorder. Our results suggest that comorbid conditions and social functioning should be considered along with other familial clinical features in formulating subtypes of bipolar disorder suitable for further studies. Familial variables may help reduce diagnostic heterogeneity in genetic and other biological studies.

Adult↗
PubMed2000

Nationwide cancer family ascertainment using Finnish Cancer Registry data on family names and places of birth for 35,761 prostate cancer patients.

Identification of predisposition loci to complex diseases, such as prostate cancer, requires high-quality family material, the ascertainment of which is often laborious, time-consuming and inaccurate with conventional methods. Here, we describe a new method for rapid, nationwide cancer family ascertainment using Finnish Cancer Registry data on 35,761 prostate cancer cases over a 40-year period. As members of a prostate cancer family are likely to share the same family name and place of birth, we stratified all prostate cancer cases by these 2 parameters (10,721 different names and 596 municipalities). Data were compared with the distribution of family names and places of birth for all 3.3 million Finnish men to derive standardized prevalence ratios (SPRs). A significantly elevated SPR of prostate cancer was detected for 468 (1.6%) of the 28,459 evaluable combinations of family name and place of birth. Of the 20 highest SPR values, 19 corresponded to true nuclear families, most of these having 3 or more affected cases. Two-thirds of our 50 previously established Finnish prostate cancer families were classified among this 1.6% fraction of the highest SPR values. Finally, many of the highest SPR values originated from municipalities in southern and south-western Finland. To explore whether such clusters could highlight local founder effects, we applied genealogical research to link together several families with elevated SPRs and identified an extended family with 20 prostate cancer cases with common ancestors in the early seventeenth century. In summary, a rapid novel method was developed and validated for identification of prostate cancer families from nationwide cancer registry data and for the identification of putative regional founder effects.

Cohort Studies↗
PubMed2005

The validity of the family relationships index as a screening tool for psychological risk in families of cancer patients.

The Family Relationships Inventory (FRI) has been proposed as a measure of psychological risk however its validity has only been tested in one cross-sectional study against another measure of family functioning where patients had less than six months to live. The current study presented longitudinal data on the validity of the FRI in identifying family dysfunction, and clinical levels of depression and anxiety in 48 families where the patient had been recently diagnosed. Over the three phases, the FRI identified all families at risk of family dysfunction, 88% or more families with one or more members with clinical depression and 78% or more with a member with clinical levels of anxiety. The FRI was also far more sensitive in identifying families with a member with clinical levels of depression and anxiety than the General Functioning (FAD-GF) scale of the Family Assessment Device. Although other measures of screening adequacy (such as specificity), suggested that the FRI identified too many false positives, the higher sensitivity of the FRI makes it preferable to the FAD-GF as a screening measure for families at risk of a poor psychological outcome in the oncology setting. However, because of the FRI's poor specificity, further follow-up of those families that are identified as being at some risk of a poor psychological outcome should be undertaken before referral to a mental health professional is warranted.

Adult↗
PubMed1992

Si dios quiere: Hispanic families' experiences of caring for a seriously mentally ill family member.

Among Hispanics, the family is viewed as the primary care giver for seriously mentally ill family members. This paper reports on a study of minority families' conceptions of serious mental illness, of their interaction with mental health resources, and on the burdens experienced by families in caring for a seriously mentally ill family member. The focus of this paper is on Hispanic families in New Jersey, with some comparative data from other ethnic group families. Families' conceptions of serious mental illness are explored and analyzed to demonstrate the importance of concepts of nervios and fallo mental in shaping families' responses to their ill family member. Social support systems for families are also explored with particular attention to the role of religious institutions and religious healing as a major source of solace.

Acute Disease↗
PubMed2006

The rat prolactin gene family locus: species-specific gene family expansion.

In the rat there is a large family of paralogous genes related to prolactin (PRL). Members of the PRL family are expressed in cell- and temporal-specific patterns in the anterior pituitary, uterus, and placenta. An overriding feature of the PRL family is its association with pregnancy. In this investigation, we used information derived from the public rat genome database as a tool for identifying new members of the rat PRL family. The entire rat PRL gene family locus spans approximately 1.7 megabases (Mb) on Chromosome 17. Genes possessed either 5- or 6-exon organization patterns. We provide information on three newly identified genes orthologous to previously identified members of the mouse PRL gene family [placental lactogen-Ialpha (PL-Ialpha), PL-Ibeta, and proliferin (PLF)] and a new member of the PRL family, termed PRL-like protein-P (PLP-P). Information is also presented on the existence of multiple PLP-M transcripts, which are generated by alternative splicing. Expansion of the PRL family has occurred independently in rodents versus the cow and does not exist in the human and dog. Elucidation of the rat PRL gene family locus provides tools for studying the genetics and biology of the rat PRL family and new insights into species-specific gene family expansion.

Amino Acid Sequence↗
PubMed2005

Family functioning and psychological distress among Japanese breast cancer patients and families.

GOALS OF WORK: The purpose of this study was to develop a typology of family functioning in the families of breast cancer patients. PATIENTS AND METHODS: Seventy-four families (189 individuals: 74 patients, 54 spouses, 46 offspring, and 15 other relatives) completed self-report questionnaires. Perception of family functioning was assessed using the family relationship index (FRI) and its three dimensions (cohesiveness, expressiveness, and conflict) and was classified into groups by a cluster analytic approach. Psychological distress was assessed using the Zung self-rating depression scale (SDS) and the Zung self-rating anxiety scale (SAS). MAIN RESULTS: Cluster analysis yielded three groups of patients and their family members: one cluster with high cohesiveness, high expressiveness, and low conflict ("supportive" type: n=64); a second group with low cohesiveness, low expressiveness, and high conflict ("conflictive" type: n=65); and a third group with limited cohesiveness, limited expressiveness, and low conflict ("intermediate" type: n=60). Analysis of variance revealed that conflictive families manifested the highest level of depression and anxiety among these clusters. CONCLUSIONS: Typology of family functioning can identify psychologically at-risk families. A family-focused approach can help to reduce psychological distress, especially in conflictive families.

Adult↗
PubMed1992

Parent and adolescent perceptions of family functioning: a comparison of clinic and non-clinic families.

In this paper two studies are reported which compare (a) the perceptions of family functioning held by clinic and non-clinic adolescents, and (b) the perceptions of family functioning held by adolescents and their mothers in clinic and non-clinic families. In Study 1, matched group of clinic and non-clinic adolescents were compared on their responses to a 30-item scale (ICPS) designed to measure three factors of family functioning: Intimacy (high vs. low), Parenting Style (democratic vs. controlled) and Conflict (high vs. low). Clinic and non-clinic adolescents were also compared on their responses to a multi-dimensional measure of adolescent self-concept. Although there was little difference between the two groups of adolescents in terms of their perceptions of family functioning, there were strong relationships between the self-concept variables and the family functioning variables. In Study 2, comparisons were made between the perceptions of family functioning held by mothers and adolescents for both clinical and non-clinic families. There were no differences between the two groups of adolescents in terms of their perceptions of family functioning, although there were clear differences between the two groups of mothers. In addition, clinic adolescents and their mothers did not differ in their perceptions of the family, whereas adolescents in the non-clinic group saw their families significantly as less intimate and more conflicted than did their mothers.

Adolescent↗
PubMed2001

Impact of early onset bipolar disorder on family functioning: adolescents' perceptions of family dynamics, communication, and problems.

OBJECTIVE: This research investigated the impact of adolescent onset bipolar illness on perceived family functioning in stabilized bipolar I (B) and unipolar (U) probands, and normal controls (C). METHOD: Sample N=119: 44 bipolar 1(17 M, 27 F), 30 unipolar (9 M, 21 F), and 45 controls (19 M, 26 F). Mean ages: 19.9, 18.5 and 18.2 years, respectively. INSTRUMENTS: Family Adaptability and Cohesion Scale (FACES II), Parent-Adolescent Communication Scales (PACS), Social Adjustment Inventory for Children and Adolescents (SAICA). RESULTS: There were no significant group or sex differences between controls and mood disordered youth--assessed intermorbidly--in ratings of relationship with either parent. Bipolars acknowledged significantly more minor conflicts with parents than either unipolars or controls. Ratings by mood disordered subjects were significantly less positive in terms of shared activities and communication with siblings. Mood disordered youth and controls were not differentiated on the basis of family adaptability, and all family cohesion scores were within population norms. No significant group differences were observed in communication with parents. LIMITATIONS: This self-report study was conducted intermorbidly, does not include objective measures of family functioning, nor does it assess the effect of psychiatric illness in other family members on family functioning. CONCLUSIONS: Assessed intermorbidly, bipolar adolescents' perceptions of family dynamics do not seem to diverge significantly from controls. Further research is needed to investigate the impact of adolescent bipolar illness on family life during acute phases of the illness, as well as the effect on family functioning of psychiatric disorders in other family members.

Adolescent↗
PubMed1998

Family dynamics in families with very low birth weight and full-term infants: a pilot study.

The purpose of this pilot study was to determine differences in family health across six dimensions of functioning between families with a very low birth weight infant (VLBW) and families with a full-term infant. An epidemiologic model and Barnhill's (1979) system theory of healthy family dynamics provided the organizing framework for the study. Sixteen families with a VLBW infant and 25 families with a full-term infant were assessed for differences in family health across Barnhill's six dimensions. Independent t-tests showed no significant differences on the five dimensions of infant behavioral style. While a 2 x 3 MANOVA showed no significant differences on any of the measures by family, the Turkey HSD post hoc tests for main effect found significant differences related to the mothers' position within the family, Specifically, the position the mother maintains in the family significantly contributes to certain dimensions of family health.

Adult↗
PubMed1999

Family-building patterns and childhood mortality: a family-level analysis.

It has been suggested that altering the pace of reproduction would improve the health of women and children. For formulating intervention policies, it is important to know whether on its own such a strategy is likely to lead to risk reduction. This paper analyses mortality risk in sibships to explore the relationship between family formation factors and other household characteristics that identify women whose families are at higher risk. The analysis allows for the fact that reproductive behaviour may be modified by the family's prior experience of child death, using simultaneous equations methods to purge the model of the 'feedback' effects of death on the endogenous variable, childbearing pace. The strong relationship between reproductive pace and average risk in a family appears to be due to the association of both with other differences between households. Other aspects of family formation patterns are good indicators of which families are likely to experience excess risks to their children. These factors are associated with maternal education, but measure characteristics of the family or mother that educational attainment does not fully capture. They indicate that high-risk mothers are likely to have less control over many aspects of their lives. The pace of family building does not lead to excess average family risk, but may result, at least in part, from the concentration of risk in families with other characteristic patterns of family formation and few resources. The paper argues for a broader conception of household influences on child health and the health-related behaviour of parents.

Adolescent↗
PubMed1998

Family systems and adolescent development: shared and nonshared risk and protective factors in nondivorced and remarried families.

The primary goal of this research is to increase the goodness-of-fit between the theoretical tenets of family systems theory and quantitative methods used to test systems hypotheses. A family systems perspective is applied to two specific research questions concerning family influences on adolescent development: To what extent are familial risk and protective factors for psychopathology and competence shared or not shared by siblings and are different family relationship patterns associated with optimal adolescent adjustment in nondivorced and remarried families? Multirater and multimethod data from a national sample of 516 nondivorced and remarried families from the Nonshared Environment and Adolescent Development (NEAD) project were examined using a combination of cluster, factor, and regression analyses. Results indicated that the effects of an individual relationship on adolescent adjustment is moderated by the larger network of relationships in which it is embedded. Evidence for nonshared familial processes in predicting adolescent psychopathology was also found but only in a subset of families, and the mechanisms of influence were neither main effects nor linear, as has been assumed by research to date. Results are discussed in light of family systems models of relationship influence on development. These results illustrate how family systems theory provides a specific example of contextualism as regards the development of psychopathology in adolescence.

Adaptation, Psychological↗