Journal of Abnormal Child Psychology

, Volume 43, Issue 1, pp 177–187 | Cite as

The Impact of Chronic Physical Illness, Maternal Depressive Symptoms, Family Functioning, and Self-esteem on Symptoms of Anxiety and Depression in Children

  • Mark A. FerroEmail author
  • Michael H. Boyle


The present study extends earlier research identifying an increased risk of anxiety among children with chronic physical illness (CwCPI) by examining a more complete model that explains how physical illness leads to increased symptoms of anxiety and depression. We tested a stress-generation model linking chronic physical illness to symptoms of anxiety and depression in a population-based sample of children aged 10 to 15 years. We hypothesized that having a chronic physical illness would be associated with more symptoms of anxiety and depression, increased levels of maternal depressive symptoms, more family dysfunction, and lower self-esteem; and, that maternal depressive symptoms, family dysfunction, and child self-esteem would mediate the influence of chronic physical illness on symptoms of anxiety and depression. Data came from the National Longitudinal Survey of Children and Youth (N = 10,646). Mediating processes were analyzed using latent growth curve modeling. Childhood chronic physical illness was associated with increases in symptoms of anxiety and depression, β = 0.20, p < 0.001. Mediating effects were also observed such that chronic physical illness resulted in increases in symptoms of maternal depression and family dysfunction, leading to declines in child self-esteem, and in turn, increases in symptoms of anxiety and depression. CwCPI are at-risk for symptoms of anxiety and depression. Some of this elevated risk appears to work through family processes and child self-esteem. This study supports the use of family-centered care approaches among CwCPI to minimize burden on families and promote healthy psychological development for children.


Anxiety Behavior Chronic illness Cohort study Depression Growth modeling Mediation Stress-generation 


Conflict of Interest

Dr. Ferro was the recipient of a Banting Postdoctoral Fellowship from the Government of Canada and is currently supported by a Research Early Career Award from Hamilton Health Sciences. Dr. Boyle holds a Canada Research Chair (Tier I) in the Social Determinants of Child Health from the Canadian Institutes of Health Research. While the research and analyses are based on data from Statistics Canada, the opinions expressed do not represent the views of Statistics Canada.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Offord Centre for Child StudiesMcMaster UniversityHamiltonCanada
  2. 2.Department of PediatricsMcMaster University, Health Sciences CentreHamiltonCanada
  3. 3.Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada
  4. 4.CanChild Centre for Childhood Disability ResearchMcMaster University, Institute for Applied Health SciencesHamiltonCanada
  5. 5.Department of Clinical Epidemiology and BiostatisticsMcMaster University, Health Sciences CentreHamiltonCanada

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