Journal of Clinical Psychology in Medical Settings

, Volume 20, Issue 4, pp 488–496

An Exploration of Family Problem-Solving and Affective Involvement as Moderators Between Disease Severity and Depressive Symptoms in Adolescents with Inflammatory Bowel Disease

  • Shana L. Schuman
  • Danielle M. Graef
  • David M. Janicke
  • Wendy N. Gray
  • Kevin A. Hommel
Article

Abstract

Little is known about how family functioning relates to psychosocial functioning of youth with inflammatory bowel disease (IBD). The study aim was to examine family problem solving and affective involvement as moderators between adolescent disease severity and depressive symptoms. Participants were 122 adolescents with IBD and their parents. Measures included self-reported and parent-reported adolescent depressive symptoms, parent-reported family functioning, and physician-completed measures of disease severity. Disease severity was a significant predictor of adolescent-reported depressive symptoms, but not parent-reported adolescent depressive symptoms. Family affective involvement significantly predicted parent-reported adolescent depressive symptoms, while family problem-solving significantly predicted adolescent self-report of depressive symptoms. Neither affective involvement nor problem-solving served as moderators. Family affective involvement may play an important role in adolescent emotional functioning but may not moderate the effect of disease severity on depressive symptoms. Research should continue to examine effects of family functioning on youth emotional functioning and include a sample with a wider range of disease severity to determine if interventions aimed to enhance family functioning are warranted.

Keywords

Adolescent Inflammatory bowel disease Disease severity Family functioning Depression 

References

  1. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms and profiles. Burlington: University of Vermont Research Center for Children, Youth, and Families.Google Scholar
  2. Alderfer, M. A., Fiese, B. H., Gold, J. I., Cutuli, J. J., Holmbeck, G. N., Goldbeck, L., et al. (2008). Evidence-based assessment in pediatric psychology: Family measures. Journal of Pediatric Psychology, 33, 1046–1061.PubMedCrossRefGoogle Scholar
  3. Bousvaros, A., Sylvester, F., Kugathasan, S., Szigethy, E., Fiocchi, C., Colletti, R., et al. (2006). Challenges in pediatric inflammatory bowel disease. Inflammatory Bowel Diseases, 12, 885–913.PubMedCrossRefGoogle Scholar
  4. Burke, P., Meyer, V., Kocoshis, S., Orenstein, D. M., Chandra, R., Nord, D. J., et al. (1989). Depression and anxiety in pediatric inflammatory bowel disease and cystic fibrosis. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 948–951.PubMedCrossRefGoogle Scholar
  5. Burke, P., Neigut, D., Kocoshis, S., Chandra, R., & Sauer, J. (1994). Correlates of depression in new onset pediatric inflammatory bowel disease. Child Psychiatry and Human Development, 24, 275–283.PubMedCrossRefGoogle Scholar
  6. Deshmukh, P., Kulkarni, G., & Lackamp, J. (2010). Inflammatory bowel disease in children: Psychological and psychiatric issues. Current Psychiatry Reports, 12, 222–228.PubMedCrossRefGoogle Scholar
  7. Engstrom, I. (1999). Inflammatory bowel disease in children and adolescents: Mental health and family functioning. Journal of Pediatric Gastroenterology and Nutrition, 28, S28–S33.PubMedCrossRefGoogle Scholar
  8. Epstein, N. B., Bishop, D. S., & Levin, S. (1978). The McMaster model of family functioning. Journal of Marriage and Family Counseling, 4, 19–31.CrossRefGoogle Scholar
  9. Fanjiang, G., Russell, G. H., & Katz, A. J. (2007). Short- and long-term response to and weaning from infliximab therapy in pediatric ulcerative colitis. Journal of Pediatric Gastroenterology and Nutrition, 44, 312–317.PubMedCrossRefGoogle Scholar
  10. Gold, N., Issenman, R., Roberts, J., & Watt, S. (2000). Well-adjusted children: An alternate view of children with inflammatory bowel disease and functional gastrointestinal complaints. Inflammatory Bowel Diseases, 6, 1–7.PubMedCrossRefGoogle Scholar
  11. Gray, W. N., Denson, L. A., Baldassano, R. N., & Hommel, K. A. (2011). Disease activity, behavioral dysfunction, and health-related quality of life in adolescents with inflammatory bowel disease. Inflammatory Bowel Diseases, 17, 1581–1586.PubMedCrossRefGoogle Scholar
  12. Greenley, R. N., Hommel, K. A., Nebel, J., Raboin, T., Li, S. H., Simpson, P., et al. (2010). A meta-analytic review of the psychosocial adjustment of youth with inflammatory bowel disease. Journal of Pediatric Psychology, 35, 857–869.PubMedCrossRefGoogle Scholar
  13. Greenley, R. N., Kunz, J. H., Biank, V., Martinez, A., Miranda, A., Noe, J., et al. (2012). Identifying youth nonadherence in clinical settings: Data-based recommendations for children and adolescents with inflammatory bowel disease. Inflammatory Bowel Diseases, 18, 1254–1259.PubMedCrossRefGoogle Scholar
  14. Hanauer, S. B. (2006). Inflammatory bowel disease: Epidemiology, pathogenesis, and therapeutic opportunities. Inflammatory Bowel Diseases, 12(Suppl 1), S3–S9.PubMedCrossRefGoogle Scholar
  15. Hayes, A.F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]. http://afhayes.com/public/process2012.pdf. Accessed 18 Jan 2013.
  16. Herzer, M., Denson, L. A., Baldassano, R. N., & Hommel, K. A. (2011). Family functioning and health-related quality of life in adolescents with pediatric inflammatory bowel disease. European Journal of Gastroenterology and Hepatology, 23, 95–100.PubMedCrossRefGoogle Scholar
  17. Herzer, M., Godiwala, N., Hommel, K. A., Driscoll, K., Mitchell, M., Crosby, L. E., et al. (2010). Family functioning in the context of pediatric chronic conditions. Journal of Developmental and Behavioral Pediatrics, 31, 26–34.PubMedCrossRefGoogle Scholar
  18. Holmbeck, G. N., Li, S. T., Schurman, J. V., Friedman, D., & Coakley, R. M. (2002). Collecting and managing multisource and multimethod data in studies of pediatric populations. Journal of Pediatric Psychology, 27, 5–18.PubMedCrossRefGoogle Scholar
  19. Hommel, K. A., Denson, L. A., & Baldassano, R. N. (2011). Oral medication adherence and disease severity in pediatric inflammatory bowel disease. European Journal of Gastroenterology and Hepatology, 23, 250–254.PubMedCrossRefGoogle Scholar
  20. Hommel, K. A., Denson, L. A., Crandall, W. V., & Mackner, L. M. (2008). Behavioral functioning and treatment adherence in pediatric inflammatory bowel disease: Review and recommendations for practice. Gastroenterology and Hepatology, 4, 785.PubMedGoogle Scholar
  21. Hyams, J. S., Ferry, G. D., Mandel, F. S., Gryboski, J. D., Kibort, P. M., Kirschner, B. S., et al. (1991). Development and validation of a pediatric Crohn’s disease activity index. Journal of Pediatric Gastroenterology and Nutrition, 12, 439–447.PubMedGoogle Scholar
  22. Kappelman, M. D., Crandall, W. V., Colletti, R. B., Goudie, A., Leibowitz, I. H., Duffy, L., et al. (2011). Short pediatric Crohn’s disease activity index for quality improvement and observational research. Inflammatory Bowel Diseases, 17, 112–117.PubMedCrossRefGoogle Scholar
  23. Kappelman, M. D., Rifas-Shiman, S. L., Kleinman, K., Ollendorf, D., Bousvaros, A., Grand, R. J., et al. (2007). The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Clinical Gastroenterology and Hepatology, 5, 1424–1429.PubMedCrossRefGoogle Scholar
  24. Kazak, A. E., Rourke, M. T., & Navsaria, N. (2009). Families and other systems in pediatric psychology. In M. C. Roberts & R. G. Steele (Eds.), Handbook of pediatric psychology (4th ed., pp. 656–671). New York: Guilford Press.Google Scholar
  25. Kovacs, M. (1992). The children’s depression inventory manual. Ontario: Multi-Health Systems, Inc.Google Scholar
  26. Lichtiger, S., Present, D. H., Kornbluth, A., Gelernt, I., Bauer, J., Galler, G., et al. (1994). Cyclosporine in severe ulcerative colitis refractory to steroid therapy. The New England Journal of Medicine, 330, 1841–1845.PubMedCrossRefGoogle Scholar
  27. Loftus, E. V, Jr. (2004). Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology, 126, 1504–1517.PubMedCrossRefGoogle Scholar
  28. Mackner, L. M., Bickmeier, R. M., & Crandall, W. V. (2012). Academic achievement, attendance, and school-related quality of life in pediatric inflammatory bowel disease. Journal of Developmental and Behavioral Pediatrics, 33, 106–111.PubMedGoogle Scholar
  29. Mackner, L. M., & Crandall, W. V. (2007). Psychological factors affecting pediatric inflammatory bowel disease. Current Opinion in Pediatrics, 19, 548–552.PubMedCrossRefGoogle Scholar
  30. Mackner, L. M., Crandall, W. V., & Szigethy, E. M. (2006). Psychosocial functioning in pediatric inflammatory bowel disease. Inflammatory Bowel Diseases, 12, 239–244.PubMedCrossRefGoogle Scholar
  31. Mahid, S. S., Mulhall, A. M., Gholson, R. D., Eichenberger, M. R., & Galandiuk, S. (2008). Inflammatory bowel disease and African Americans: A systematic review. Inflammatory Bowel Diseases, 14, 960–967.PubMedCrossRefGoogle Scholar
  32. Miller, I. W., Epstein, N. B., Bishop, D. S., & Keitner, G. I. (1985). The McMaster family assessment device: Reliability and validity. Journal of Marital and Family Therapy, 11, 345–356.CrossRefGoogle Scholar
  33. Rodenburg, R., Meijer, A. M., Dekovic, M., & Aldenkamp, A. P. (2005). Family factors and psychopathology in children with epilepsy: A literature review. Epilepsy and Behavior, 6, 488–503.PubMedCrossRefGoogle Scholar
  34. Sitarenios, G., & Stein, S. (2004). Use of the children’s depression inventory. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (3rd ed., Vol. 2, pp. 4–11). Mahwah: Lawrence Erlbaum Associates.Google Scholar
  35. Szigethy, E., Levy-Warren, A., Whitton, S., Bousvaros, A., Gauvreau, K., Leichtner, A. M., et al. (2004). Depressive symptoms and inflammatory bowel disease in children and adolescents: A cross-sectional study. Journal of Pediatric Gastroenterology and Nutrition, 39, 395–403.PubMedCrossRefGoogle Scholar
  36. Thompson, R. J., & Gustafson, K. E. (1996). Adaptation to chronic childhood illness. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  37. Turner, D., Griffiths, A. M., Walters, T. D., Seah, T., Markowitz, J., Pfefferkorn, M., et al. (2012). Mathematical weighting of the pediatric Crohn’s disease activity index (PCDAI) and comparison with its other short versions. Inflammatory Bowel Diseases, 18, 55–62.PubMedCrossRefGoogle Scholar
  38. Wallander, J. L., Varni, J. W., Babani, L., Banis, H. T., & Wilcox, K. T. (1989). Family resources as resistance factors for psychological maladjustment in chronically ill and handicapped children. Journal of Pediatric Psychology, 14, 157–173.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Shana L. Schuman
    • 1
  • Danielle M. Graef
    • 1
  • David M. Janicke
    • 1
    • 2
  • Wendy N. Gray
    • 3
  • Kevin A. Hommel
    • 3
  1. 1.Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleUSA
  2. 2.Department of PediatricsUniversity of FloridaGainesvilleUSA
  3. 3.Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-ManagementCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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