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

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Abstract

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.

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References

  • Achenbach, T. M. (1991). Manual for the youth self-report and 1991 profile. Burlington: University of Vermont, Department of Psychiatry.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Bollen, K. A. (1989). Structural equations with latent variables. New York: Wiley.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Bronfenbrenner, U. (1977). Toward an experimental psychology of human development. American Psychologist, 32, 512–531.

    Article  Google Scholar 

  • Browne, M. W., & Cudeck, R. (1992). Alternative ways of assessing model fit. Sociological Methods & Research, 21, 230–258.

    Article  Google Scholar 

  • D’Onofrio, B. M., & Lahey, B. B. (2010). Biopsychosocial influences on the family: a decade review. Journal of Marriage and Family, 72, 762–782.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Fairweather, D., & Rose, N. R. (2004). Women and autoimmune diseases. Emerging Infectious Diseases, 10, 2005–2011.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • Hoffmann, J. P. (2006). Family structure, community context, and adolescent problem behaviors. Journal of Youth and Adolescence, 35, 867–880.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Korneluk, Y. G., & Lee, C. M. (1998). Children’s adjustment of parental physical illness. Clinical Child and Family Psychology Review, 1, 179–193.

    Article  PubMed  Google Scholar 

  • Lange, A. (1983). Interactionele probleem oplossings vragenlijst (IPOV) [Interactional problem solving inventory (IPSI)]. Deventer: Van Loghum Slaterus.

    Google Scholar 

  • 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 

  • 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 

  • Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

    Google Scholar 

  • Lubkin, I. M., & Larsen, P. D. (2006). Chronic illness: Impact and interventions. London: Jones and Barlett Publishers.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Muthén, B. (1994). Multilevel covariance structure analysis. Sociological Methods & Research, 22, 376–398.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

  • 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 

  • 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 

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

    Book  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Wolf, J. C. van der (1995). School Perception Questionnaire. University of Amsterdam, Educational Sciences.

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Sieh, D.S., Oort, F.J., Visser-Meily, J.M.A. et al. Mediators for Internalizing Problems in Adolescents of Parents with Chronic Medical Condition. J Dev Phys Disabil 26, 67–82 (2014). https://doi.org/10.1007/s10882-013-9345-1

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