Showing papers in "Families, Systems, & Health in 2008"

Mild traumatic brain injury: Impact on identity and ambiguous loss in the family.

Abstract: Research has revealed that almost half of relationships will end in divorce or separation when one member experiences a head injury. Many patients are not diagnosed initially, or for several months or years after their injury. Persons dealing with the numerous long-term cognitive and physical problems accompanying mild traumatic brain injury (MTBI) may develop a profound sense of “loss of self.” This loss of self, manifest as identity ambiguity on the part of the MTBI subject may be strongly correlated with perceptions of boundary ambiguity on the part of the subject and family resulting from the situation of ambiguous loss. Early recognition and intervention may prevent relational and marital breakdown as well as unnecessary distress to family members. This article discusses the theoretical foundations of our research, preliminary findings of our ongoing qualitative study, and implications for future research and clinical intervention.

Impacts of HIV/AIDS Stigma on Family Identity and Interactions in China

Abstract: This study examines the impact of HIV-related stigma on families living with HIV/AIDS in China. In-depth, semistructured interviews were conducted with 30 people living with HIV/AIDS and with 15 of their family members, including spouses, parents, and siblings. Findings show that HIV-related stigma is associated with bringing shame to the family, losing family "face," and damaging within-family relations and broader family social networks. HIV/AIDS stigma was reported to have major impacts on family identity and interactions. In order to cope with these pressures, families reported joining self-support programs, educating family members, and helping other families. This study illustrates that HIV-related stigma is an issue faced by entire families in China, points to specific aspects of family life in which these impacts take place, and suggests the importance of including families in HIV/AIDS and stigma reduction interventions.

Autonomy Support From Family and Friends and Weight Loss in College Women

Abstract: This study examined the effect of autonomy support and autonomous self-regulation on self-reported weight loss Participants reported significantly greater weight loss when they perceived their family and friends as autonomy supportive of their weight loss efforts Autonomy support from family and friends was also shown to moderate the effects of an experimental intervention that was delivered in an autonomy-supportive or controlling manner Furthermore, autonomy support was significantly related to autonomous self-regulation, but its effects on weight loss held true even after controlling for self-regulation, suggesting an independent role of autonomy support from important others Finally, the effects of autonomy support were distinguished from more directive support from significant others, which did not show similar effects These findings point to the potential usefulness of developing intervention strategies focused on facilitating the autonomy-supportive behavior of significant others

Medical family therapy: A model for addressing mental health disparities among Latinos.

Abstract: The Latino population in the United States is growing at an exponential rate. As a medically underserved population, Latinos experience many health disparities, including those related to mental health. Current research suggests that Latinos in the United States are at high risk for problems such as anxiety, depression, somatization disorders, and substance abuse, yet, often these health needs go unmet. This article suggests that an effective method of reaching and treating more Latinos is through medical family therapy. Because Latinos may be more likely to seek help from a physician for mental health complaints, and because marriage and family therapists may be most culturally congruent in their orientation to therapy, collaboration between health care providers and medical family therapists is logical.

Couple-Oriented Education and Support Intervention for Osteoarthritis: Effects on Spouses’ Support and Responses to Patient Pain

Abstract: The purpose of this study was to determine whether a couple-oriented education and support intervention for osteoarthritis was more efficacious than a similar patient-oriented intervention in terms of enhancing spouses' support of patients and their positive and negative responses to patient pain. Repeated-measures analyses of covariance with the completers sample (N = 103 dyads) showed that at the postintervention assessment, patients in the couple-oriented intervention reported a greater decrease in their spouses' punishing responses (e.g., anger, irritation) than did patients in the patient-oriented intervention. In addition, a trend effect was observed in regard to the advantage of couple-oriented intervention for increasing spouses' attempts to distract patients from their pain. At the 6-month follow-up, patients in the couple-oriented intervention reported greater increased spouse support than those in the patient-oriented intervention. Findings illustrate the value of examining change in specific types of marital interactions targeted in a couples intervention, and the need to strengthen the impact of future couple-oriented interventions.

Disclosure of Positive BRCA1/2-Mutation Status in Young Couples: The Journey From Uncertainty to Bonding Through Partner Support.

Abstract: BRCA1/2-positive women who learn their mutation status early in the life-course face unique challenges related to navigating the tasks of young adulthood. Using qualitative methods and grounded theory, the authors analyzed in-depth interviews with 11 women aged 26 to 35 who learned their mutation status before marriage. Their narratives illustrate the complexity of relationship formation, and highlight the potential for relationship-bonding and intimacy-building in the course of sharing mutation information. Disclosing BRCA mutation status to dating partners is often preceded by feelings of fear and anxiety, yet many participants reported that doing so has positive effects on relationships. Partners' abilities to respond with interest, empathy, and affection are associated with in creased future intimacy, consistent with generally accepted principles within the family/couple systems field. Individual cancer risk perception and familial cancer experiences may affect the disclosure experience, which can be understood via Attachment Theory. Our findings provide clinical insight, identify new areas for research, and suggest ways to assist this unique population in their adjustment to being BRCA mutation-positive.

The Impact of Uncertainty Associated with a Child’s Chronic Health Condition on Parents’ Health

Abstract: We investigated whether uncertainty about the impact of children's chronic health conditions on their daily lives leads to changes in mothers' and fathers' mental and physical health. Three waves of data were collected over three years from parents of 228 children with chronic health conditions. Parents reported their level of uncertainty about how the child's health condition affected the child's daily life, as well as measures of their own mental and physical health at each wave of data collection. Results of structural equation models indicate that, among mothers, more illness-related uncertainty was associated with a subsequent increase in psychological symptoms relative to other mothers in the study. Psychological symptoms, in turn, were associated with a subsequent increase in physical symptoms among mothers. Uncertainty did not affect fathers' health. Illness-related uncertainty may be a risk factor for psychological and physical symptoms in mothers of children with chronic health conditions. As such, interventions that address uncertainty related to the child's chronic health condition may improve psychological and physical well-being of mothers of children with chronic health conditions.

The Relationship of Parent Self-Focused Negative Attributions to Ratings of Parental Overprotection, Perceived Child Vulnerability, and Parenting Stress

Abstract: The present study describes an examination of the relationship of parent self-focused negative attributions to specific parenting variables, namely parental overprotection, perceived child vulnerability, and parenting stress Parents of children diagnosed with one of three chronic illnesses, Type 1 diabetes (DM1), asthma (AS), or cystic fibrosis (CF), completed self-report measures of attributions for illness-unrelated events, parental overprotection, perceived child vulnerability, and parenting stress Results indicated that parent self-focused negative attributions were significantly associated with parenting stress among the combined and DM1-only samples In addition, parent self-focused negative attributions were associated with perceived child vulnerability among the CF-only group, whereas selffocused negative attributions were not associated with any of the parenting variables within the AS-only group The current results suggest that parent self-focused negative attributions may exert illness-specific influences on other cognitive processes (eg, perceptions of child vulnerability, perceptions of stress), which have the potential to influence child adjustment outcomes

Pediatric Asthma and Problems in Attention, Concentration, and Impulsivity: Disruption of the Family Management System.

Abstract: RATIONALE: This study assesses the relationships between ADHD symptoms, specific family asthma management domains, and pediatric asthma morbidity. METHODS: Participants were 110 children with asthma and a respective parent (ages 7-17, X = 11.6 years, 25% ethnic/racial minority). Parents completed measures of asthma morbidity and report of child ADHD symptoms. Children completed measures of attention, concentration, and impulsivity. Families participated in the Family Asthma Management System Scale (FAMSS) interview to assess the effectiveness of eight features of asthma management. RESULTS: Parent report of ADHD symptoms and poor child performance on a computerized task of sustained visual attention were associated with asthma morbidity. Paper and pencil tasks of visual attention, and an index of auditory attention, were not related to asthma morbidity. Modest associations were found between parent report of ADHD symptoms, child performance-based indicators of attention and concentration, and features of family asthma management, although not across all measures. The family response to asthma partially mediated the relationship between ADHD symptoms and morbidity. CONCLUSIONS: ADHD symptoms are modestly associated with difficulties in family asthma management.

Students Against Nicotine and Tobacco Addiction (S.A.N.T.A.): Community-Based Participatory Research in a High-Risk Young Adult Population

Abstract: Students Against Nicotine and Tobacco Addiction (S.A.N.T.A.) is a community-based participatory research project involving an active collaboration between University health providers and Job Corps students, administrators, teachers, counselors, and staff. In this article, we describe the project, its evolution, and key strategies that have employed over the course of the initiative and its ongoing efforts.

Care coordination between medical and early intervention services: Family and provider perspectives.

Abstract: The purpose of this exploratory study is to identify facilitators and barriers to care coordination between medical and early intervention (EI) providers for children with special health care needs and their families. Fifty adults participated in one of six focus groups. Participants included parents/caregivers, pediatricians, hospital therapy providers, and EI providers. Guiding questions were designed to obtain participants perceptions. All focus groups were audiotaped and transcribed. Transcript analysis included identification of open codes, grouping into axial codes and using constant comparative methods in data analysis. The two primary researchers established interrater reliability (κ = 0.85) before data analysis. The six themes that emerged from data analysis are as follows: (1) information exchange; (2) approaches toward child and family care; (3) supporting family social and emotional needs; (4) perceptions of service provider roles; (5) communication among parents and providers; and (6) understanding service delivery systems. Focus group participants suggested that provider roles should be defined and family and child strengths and needs should be addressed. Recommendations for improved care coordination were provided and include communication training and skill building and using technology to enhance communication and collaboration.