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

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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.

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References

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Deshmukh, P., Kulkarni, G., & Lackamp, J. (2010). Inflammatory bowel disease in children: Psychological and psychiatric issues. Current Psychiatry Reports, 12, 222–228.

    Article  PubMed  Google Scholar 

  • Engstrom, I. (1999). Inflammatory bowel disease in children and adolescents: Mental health and family functioning. Journal of Pediatric Gastroenterology and Nutrition, 28, S28–S33.

    Article  PubMed  CAS  Google Scholar 

  • Epstein, N. B., Bishop, D. S., & Levin, S. (1978). The McMaster model of family functioning. Journal of Marriage and Family Counseling, 4, 19–31.

    Article  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Hanauer, S. B. (2006). Inflammatory bowel disease: Epidemiology, pathogenesis, and therapeutic opportunities. Inflammatory Bowel Diseases, 12(Suppl 1), S3–S9.

    Article  PubMed  Google Scholar 

  • 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.

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • Kovacs, M. (1992). The children’s depression inventory manual. Ontario: Multi-Health Systems, Inc.

    Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Loftus, E. V, Jr. (2004). Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology, 126, 1504–1517.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Mackner, L. M., & Crandall, W. V. (2007). Psychological factors affecting pediatric inflammatory bowel disease. Current Opinion in Pediatrics, 19, 548–552.

    Article  PubMed  Google Scholar 

  • Mackner, L. M., Crandall, W. V., & Szigethy, E. M. (2006). Psychosocial functioning in pediatric inflammatory bowel disease. Inflammatory Bowel Diseases, 12, 239–244.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • Thompson, R. J., & Gustafson, K. E. (1996). Adaptation to chronic childhood illness. Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

This study was funded by a Grant from the University of Florida Center for Pediatric Psychology and Family Studies (awarded to the fourth author) and a career development award (K23 DK079037) and Grants from the National Center for Research Resources (UL1 RR026314) and Procter & Gamble Pharmaceuticals and Prometheus Laboratories (awarded to the fifth author).

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Authors and Affiliations

  1. Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL, 32610-0165, USA

    Shana L. Schuman, Danielle M. Graef & David M. Janicke

  2. Department of Pediatrics, University of Florida, Gainesville, FL, USA

    David M. Janicke

  3. Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Wendy N. Gray & Kevin A. Hommel

Authors
  1. Shana L. Schuman
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  2. Danielle M. Graef
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  3. David M. Janicke
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  4. Wendy N. Gray
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  5. Kevin A. Hommel
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Correspondence to Shana L. Schuman.

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Schuman, S.L., Graef, D.M., Janicke, D.M. et al. An Exploration of Family Problem-Solving and Affective Involvement as Moderators Between Disease Severity and Depressive Symptoms in Adolescents with Inflammatory Bowel Disease. J Clin Psychol Med Settings 20, 488–496 (2013). https://doi.org/10.1007/s10880-013-9368-x

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