Mediators for Internalizing Problems in Adolescents of Parents with Chronic Medical Condition

  • D. S. Sieh
  • F. J. Oort
  • J. M. A. Visser-Meily
  • A. M. Meijer


Parents’ chronic medical condition (CMC) is related to internalizing problem behavior in adolescents. Following the transactional stress and coping (TSC) model of Hocking and Lochman, our study examines whether the effect of illness and demographic parameters on the child’s internalizing problems is mediated by the ill parent’s quality of life, family functioning, and child adaptational processes. Participants were 160 adolescents (52 % female, mean age = 15.1 years) from 100 families affected by parental CMC. Children completed a test battery including the Youth Self-Report. Family functioning was determined with the Interactional Problem Solving Inventory (marital functioning) and the Inventory of Parent and Peer Attachment (alienation from parents). Child adaptational processes were composed by cognitive processes, methods of coping, and child report of stress. Ill parents completed the Medical Outcome Study Short-Form and the Beck Depression Inventory, assessing quality of life. We used structural equation modeling to investigate the tenability of the TSC model. After a series of step-by-step modifications, the TSC model for children with parental CMC fitted the data closely. The ill parent’s quality of life, family functioning, and children’s daily hassles and stress mediated the effect of parental CMC on adolescent internalizing problems. Children’s active problem solving and social support seeking were not directly related to internalizing problems but significantly interfered with children’s self-esteem and stress. Child adaptational processes should be accorded a central role in support programs and interventions for children with parental CMC. Health practitioners and teachers are recommended to be alert for support needs in children.


Parents' chronic medical condition Adolescent internalizing problems Stress Coping Mediator 


  1. Achenbach, T. M. (1991). Manual for the youth self-report and 1991 profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  2. Armsden, G. C., & Greenberg, M. T. (1987). The inventory of parent and peer attachment: individual differences and their relationship to psychological well-being in adolescence. Journal of Youth and Adolescence, 16, 427–453.PubMedCrossRefGoogle Scholar
  3. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression (BDI). Archives of General Psychiatry, 4, 561–571.PubMedCrossRefGoogle Scholar
  4. Bollen, K. A. (1989). Structural equations with latent variables. New York: Wiley.Google Scholar
  5. Brilstra, E. H., Rinkel, G. J. E., van der Graaf, Y., Sluzewski, M., Groen, R. J., Lo, R. T. H., et al. (2004). Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils: a prospective, observational study. Cerebrovascular Diseases, 17, 44–52.PubMedCrossRefGoogle Scholar
  6. Bronfenbrenner, U. (1977). Toward an experimental psychology of human development. American Psychologist, 32, 512–531.CrossRefGoogle Scholar
  7. Browne, M. W., & Cudeck, R. (1992). Alternative ways of assessing model fit. Sociological Methods & Research, 21, 230–258.CrossRefGoogle Scholar
  8. D’Onofrio, B. M., & Lahey, B. B. (2010). Biopsychosocial influences on the family: a decade review. Journal of Marriage and Family, 72, 762–782.PubMedCentralPubMedCrossRefGoogle Scholar
  9. Dufour, M. J., Meijer, A. M., van de Port, I., & Visser-Meily, J. M. A. (2006). Daily hassles and stress in the lives of children with chronically ill parents. Netherlands Journal of Psychology, 61, 51–64.CrossRefGoogle Scholar
  10. Fairweather, D., & Rose, N. R. (2004). Women and autoimmune diseases. Emerging Infectious Diseases, 10, 2005–2011.PubMedCrossRefGoogle Scholar
  11. Forehand, R., Biggar, H., & Kotchick, B. A. (1998). Cumulative risk across family stressors: short- and long-term effects for adolescents. Journal of Abnormal Child Psychology, 26, 119–128.PubMedCrossRefGoogle Scholar
  12. Grills, A. E., & Ollendick, T. H. (2003). Multiple informant agreement and the anxiety disorders interview schedule for parents and children. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 30–40.Google Scholar
  13. Heck, R. (2001). Multilevel modeling with SEM. In G. A. Marcoulides & R. E. Schumacker (Eds.), New developments and techniques in structural equation modeling (pp. 89–127). Mahwah: Lawrence Erlbaum Associates.Google Scholar
  14. Hocking, M. C., & Lochman, J. E. (2005). Applying the transactional stress and coping model to sickle disease and insulin-dependent diabetes mellitus: identifying psychosocial variables related to adjustment and intervention. Clinical Child and Family Psychology Review, 8, 221–246.PubMedCrossRefGoogle Scholar
  15. Hoffmann, J. P. (2006). Family structure, community context, and adolescent problem behaviors. Journal of Youth and Adolescence, 35, 867–880.CrossRefGoogle Scholar
  16. Hoffmann, J. P., & Johnson, R. A. (1998). A national portrait of family structure and adolescent drug use. Journal of Marriage and Family, 60, 633–645.CrossRefGoogle Scholar
  17. Huizinga, G. A., Visser, A., van der Graaf, W. T. A., Hoekstra, H. J., Klip, E. C., Pras, E., et al. (2005). Stress response symptoms in adolescent and young adult children of parents diagnosed with cancer. European Journal of Cancer, 41, 288–195.PubMedCrossRefGoogle Scholar
  18. Korneluk, Y. G., & Lee, C. M. (1998). Children’s adjustment of parental physical illness. Clinical Child and Family Psychology Review, 1, 179–193.PubMedCrossRefGoogle Scholar
  19. Lange, A. (1983). Interactionele probleem oplossings vragenlijst (IPOV) [Interactional problem solving inventory (IPSI)]. Deventer: Van Loghum Slaterus.Google Scholar
  20. Lange, A., Hageman, W., Markus, E., Vriend, M., & Hanewald, G. (1990). Differences in status, tradition and harmony within marriage. Netherlands Journal of Psychology, 45, 214–220.Google Scholar
  21. Lazarus, R. S., & Cohen, J. B. (1977). “Environmental stress”. In I. Altman & J. F. Wohlwill (Eds.), Human behavior and environment (vol. 2). New York: Plenum.Google Scholar
  22. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.Google Scholar
  23. Lubkin, I. M., & Larsen, P. D. (2006). Chronic illness: Impact and interventions. London: Jones and Barlett Publishers.Google Scholar
  24. Meijer, A. M., van Oostveen, S. J. E., & Stams, G. J. J. M. (2008). Caring for an ill parent: the relationship between caring, parental disease and child’s problem behaviour. Kind en Adolescent: Tijdschrift voor Pedagogiek, Psychiatrie en Psychologie, 29, 208–220.CrossRefGoogle Scholar
  25. Muthén, B. (1994). Multilevel covariance structure analysis. Sociological Methods & Research, 22, 376–398.CrossRefGoogle Scholar
  26. Pakenham, K. I., & Bursnall, S. (2006). Relations between social support, appraisal and coping and both positive and negative outcomes for children of a parent with multiple sclerosis and comparisons with children of healthy parents. Clinical Rehabilitation, 20, 709–723.PubMedCrossRefGoogle Scholar
  27. Pakenham, K. I., Bursnall, S., Chiu, J., Cannon, T., & Okochi, M. (2006). The psychosocial impact of caregiving on young people who have a parent with an illness or disability: comparisons between young caregivers and noncaregivers. Rehabilitation Psychology, 51, 113–126.CrossRefGoogle Scholar
  28. Pakenham, K. I., Bursnall, S., Chiu, J., & Cannon, T. (2007). Social support, appraisal, and both positive and negative outcomes in young caregivers. Journal of Health Psychology, 12, 89–102.PubMedCrossRefGoogle Scholar
  29. Pederson, S., & Revenson, T. A. (2005). Parental illness, family functioning, and adolescent well-being: a family ecology framework to guide research. Journal of Family Psychology, 19, 404–419.Google Scholar
  30. Schreurs, P. J. G., van de Willige, G., Brosschot, J. F., Tellegen, B., & Graus, G. M. H. (1993). Handleiding utrechtse coping lijst UCL (herziene versie) [Manual of the utrecht coping list UCL (revised version)]. Lisse: Swets & Zeitlinger.Google Scholar
  31. Sieh, D. S., Meijer, A. M., Oort, F. J., Visser-Meily, J. M. A., & van der Leij, D. A. V. (2010a). Problem behavior in children with a chronically ill parent: a meta-analysis. Clinical Child and Family Psychology Review, 13, 384–397.PubMedCentralPubMedCrossRefGoogle Scholar
  32. Sieh, D. S., Meijer, A. M., & Visser-Meily, J. M. A. (2010b). Risk factors for stress in children after parental stroke. Rehabilitation Psychology, 55, 391–397.PubMedCrossRefGoogle Scholar
  33. Sieh, D.S., Visser-Meily, J.M.A., Oort, F.J., & Meijer, A.M. (2011, June). Risk factors for problem behavior in adolescents with chronically ill parents. Poster session presented at the 119th convention of the American Psychological Association, Washington D.C.Google Scholar
  34. Sieh, D. S., Dikkers, A. L. C., Visser-Meily, J. M. A., & Meijer, A. M. (2012a). Stress in adolescents with a chronically ill parent: inspiration from Rolland’s family systems-illness model. Journal of Developmental and Physical Disabilities, 6, 591–606.Google Scholar
  35. Sieh, D. S., Visser-Meily, J. M. A., Oort, F. J., & Meijer, A. M. (2012b). Risk factors for problem behavior in adolescents of parents with a chronic medical condition. European Child and Adolescent Psychiatry, 21, 459–471.Google Scholar
  36. Thompson, R. J., Jr., & Gustafson, K. E. (1996). Adaptation to chronic childhood illness. Washington: American Psychological Association Press.CrossRefGoogle Scholar
  37. Thompson, R. J., Gil, K. M., Burbach, D. J., Keith, B. R., & Kinney, T. R. (1993). Role of child and maternal processes in the psychological adjustment of children with sickle cell disease. Journal of Consulting and Clinical Psychology, 61, 468–474.PubMedCrossRefGoogle Scholar
  38. Van der Leeuwen, C. M. C., Kraaijveld, S., Lindeman, E., & Post, M. W. M. (2012). Associations between psychological factors and quality of life rating in persons with spinal cord injury: a systematic review. Spinal Cord, 50, 174–187.Google Scholar
  39. Visser-Meily, J. M. A., & Meijer, A. M. (2006). Stroke, consequences for the family and recommendations for rehabilitation. In D. M. Devore (Ed.), Parent child relations: New research (pp. 157–174). Hauppauge: Nova.Google Scholar
  40. Visser-Meily, J. M. A., Post, M., Meijer, A. M., Maas, C., Ketelaar, M., & Lindeman, E. (2005). Children’s Adjustment to a parent’s stroke: determinants of health status and psychological problems, and the role of support from the rehabilitation team. Journal of Rehabilitation Medicine, 37, 236–241.PubMedCrossRefGoogle Scholar
  41. Visser-Meily, J. M. A., Post, M., Meijer, A. M., van de Port, I., Maas, C., & Lindeman, E. (2005). When a parent has a stroke: clinical course and prediction of mood, behaviour problems, and health status of their young children. Stroke, 36, 2436–2440.PubMedCrossRefGoogle Scholar
  42. Visser-Meily, A., Post, M., Gorter, J. W., Berlekom, S. B. V., van den Bos, T., & Lindeman, E. (2006). Rehabilitation of stroke patients needs a family-centred approach. Disability and Rehabilitation, 28, 1557–1561.PubMedCrossRefGoogle Scholar
  43. Vissser-Meily, J. M. A., Post, M. W. M., Schepers, V., & Lindeman, E. (2005). Spouses’ quality of life 1 year after stroke: prediction at the start of clinical rehabilitation. Cerebrovascular Diseases, 29, 443–448.CrossRefGoogle Scholar
  44. Wolf, J. C. van der (1995). School Perception Questionnaire. University of Amsterdam, Educational Sciences.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • D. S. Sieh
    • 1
  • F. J. Oort
    • 1
  • J. M. A. Visser-Meily
    • 2
  • A. M. Meijer
    • 1
  1. 1.Research Institute of Child Development and Education, Faculty of Social and Behavioral SciencesUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Rudolf Magnus InstituteUtrechtThe Netherlands

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