Utility of the Illness Intrusiveness Scale in parents of children diagnosed with juvenile rheumatic diseases

Exploratory factor analysis of the Illness Intrusiveness Rating Scale for parents of children with atypical genital appearance due to differences of sex development (DSD)

OBJECTIVE

Illness intrusiveness refers to the subjective cognitive appraisal of a chronic health condition interfering in daily, valued activities and may be highly relevant for parents of children with atypical genital appearance due to differences of sex development (DSD). However, a measure of illness intrusiveness has not been validated for this population. The current study aimed to evaluate the factor structure of the Illness Intrusiveness Scale for Parents (IIS-P) and examine convergent validity.

METHODS

Participants included 102 parents (Mage = 33.39 years, SD = 6.48; 58% mothers) of 65 children (<2 years old) diagnosed with DSD participating in a larger, longitudinal study. Parents completed the IIS-P as well as self-report measures of stigma, and anxious and depressive symptoms. An exploratory factor analysis (EFA) was conducted.

RESULTS

EFA results supported a 1-factor intrusiveness solution (α = .93), as well as a 2-factor solution measuring intrusiveness on daily living (α = .92) and community connectedness (α = .85). The 1-factor solution and both factors of the 2-factor solution demonstrated significant convergent validity with stigma as well as anxious and depressive symptoms.

CONCLUSIONS

Support emerged for both 1- and 2-factor solutions of the IIS-P in parents of children with DSD. The decision to evaluate illness intrusiveness as a total score or to examine the subscales of daily living and community connectedness should be tailored to the unique aims of researchers and clinicians. Future research should conduct a confirmatory factor analysis with both 1- and 2-factor models with larger, more diverse samples of caregivers.

The Combined Effects of Youth and Parent Illness Intrusiveness on Depressive Symptoms in Adolescents with Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) presents physical and emotional challenges for families and imposes significant lifestyle intrusions on both youth and parents. The present study examined the effects of IBD disease activity and youth illness intrusiveness on depressive symptoms in adolescents, and the moderating influence of parent illness intrusiveness on these associations. Adolescents and parents completed measures of illness intrusiveness; youth completed a measure of depressive symptoms. Physicians provided estimates of IBD disease activity. Mediation analysis revealed an IBD disease activity → youth intrusiveness → youth depressive symptoms indirect effect. Moderated mediation analyses revealed this indirect effect to be greater among youth whose parents endorsed more IBD-related intrusions. Youth encountering greater activity disruptions related to IBD are vulnerable to depressive symptoms. When parents also experience IBD-induced intrusions, youth are at even greater risk for depressive symptoms. Clinical implications are discussed within the context of youths' and parents' experiences of IBD.

Stigma by Association: Parent Stigma and Youth Adjustment in Inflammatory Bowel Disease

OBJECTIVE

Examine the indirect association between parents' experience of stigma (i.e., associative stigma) and youth depressive symptoms through the serial effects of associative stigma on parent and youth illness intrusiveness in pediatric inflammatory bowel disease (IBD).

METHODS

During routine clinic visits, 150 youth with well-controlled IBD (ages 10-18 years) completed measures of perceived illness intrusiveness and depressive symptoms. Parents completed measures of associative stigma and illness intrusiveness. Pediatric gastroenterologists provided ratings of IBD disease severity.

RESULTS

Structural equation modeling revealed significant direct associations for associative stigma → parent illness intrusiveness, parent illness intrusiveness → youth illness intrusiveness, and youth illness intrusiveness → youth depressive symptoms. Results also revealed a significant associative stigma → parent illness intrusiveness → youth illness intrusiveness→ youth depressive symptoms serial mediation path, indicating that parents' experience of associative stigma indirectly influenced youth depressive symptoms through its sequential effects on parent and youth perceived illness intrusiveness.

CONCLUSIONS

Parents who face stigma related to their child's IBD (i.e., associative stigma) are more likely to experience IBD-induced lifestyle intrusions (i.e., illness intrusiveness), which in turn is associated with youths' illness intrusiveness and ultimately youth depressive symptoms. These findings provide further evidence for the important role of illness-related stigma in pediatric IBD, particularly the transactional relation between parents' associative stigma and youths' illness appraisals and emotional functioning. The clinical implications of our results for addressing adjustment difficulties in youth with IBD are also discussed.

Illness intrusiveness in parents of youth with type 1 diabetes: A longitudinal study

OBJECTIVE

Type 1 diabetes in youth has a wide-ranging impact on families. This study aimed at a better understanding of experiences and difficulties that parents may encounter in their lives. Parental illness intrusiveness (ie, a parent's perception that the illness of one's child interferes with one's personal life) was prospectively examined in mothers and fathers.

METHODS

Parental dyads (n = 291) completed four annual questionnaires on parental illness intrusiveness, depressive symptoms, and treatment adherence of their child. Youth reported on their treatment adherence.

RESULTS

First, cross-lagged models showed that mothers' illness intrusiveness predicted relative increases in both mothers' and fathers' illness intrusiveness over time. Similar effects were found for fathers. Second, paired-samplest tests revealed higher illness intrusiveness in mothers at baseline. Latent growth curve modeling showed that mothers' illness intrusiveness generally decreased over time, while fathers' illness intrusiveness remained constant. Third, from a person-centered approach, multivariate latent class growth analysis identified three classes of parental couples: one with low and decreasing illness intrusiveness (54%), one with slightly elevated illness intrusiveness that remained stable over time (37%), and one with high illness intrusiveness that decreased in mothers but remained stable in fathers (9%). More parental depressive symptoms were reported in this latter class, while treatment adherence did not differ among the classes.

CONCLUSIONS

Most parents in this sample reported rather low illness intrusiveness over time, yet some experienced a major impact of the illness. Examining parental illness intrusiveness may provide a better understanding of the specific challenges parents are confronted with.

Emotional distress among parent caregivers of adolescents with sickle cell disease: Association with patients and caregivers variables

Evidence suggests that impairment in caregiver wellbeing can alter the quality of care in children with sickle cell disease. We examined 121 parent caregivers of adolescents with sickle cell disease for emotional distress and disruptions to caregiver lifestyle and interests. Participants were predominantly mothers 92(76%) with mean age, 43.59 ( SD = 6.39) years. Four in every ten caregivers had emotional distress, and this was predicted by frequent hospital attendance and disruptions in caregiver lifestyle, relationships, and interests. Psychosocial support to promote resilience and adaptive coping-styles to deal with the stress from unforeseen crises, frequent hospital visits, and lifestyle disruptions are indicated to improve caregiver wellbeing.

Parental illness intrusiveness and youth glycaemic control in type 1 diabetes: intergenerational associations and processes

OBJECTIVE

This study examined associations between the functioning of youth with type 1 diabetes and their parents, including parenting dimensions as intervening mechanisms. The study adds to the existing literature by focusing on (1) the concept of parental illness intrusiveness; (2) the (understudied) periods of adolescence and emerging adulthood; and (3) maternal and paternal functioning.

DESIGN

Questionnaires were completed by 317 patient-mother dyads and 277 patient-father dyads. All patients (aged 14-25) had type 1 diabetes. The hypothesised model was compared to an alternative model using structural equation modelling.

MAIN OUTCOME MEASURES

Youth reported on depressive symptoms and treatment adherence; Physicians provided HbA_1c-values. Parents reported on illness intrusiveness, depressive symptoms, and their child's treatment adherence. Patients and parents reported on psychological control and overprotection.

RESULTS

The hypothesised path model had a good fit to the data. Parental illness intrusiveness was positively associated with depressive symptoms and both were positively related to overprotection and psychological control. Psychological control was positively related to patients' depressive symptoms and negatively to treatment adherence. Poorer treatment adherence was associated with worse HbA_1c-values.

CONCLUSION

These findings underscore the relevance of parental illness intrusiveness and emphasise the importance of mothers' and fathers' roles throughout adolescence and emerging adulthood.

Psychometric properties of the parent́s perception uncertainty in illness scale, spanish version

OBJECTIVE

To analyze the psychometric properties of the Parents' Perception of Uncertainty in Illness Scale, parents/children, adapted to Spanish.

METHOD

A descriptive methodological study involving the translation into Spanish of the Parents' Perception of Uncertainty in Illness Scale, parents/children, and analysis of their face validity, content validity, construct validity and internal consistency.

RESULTS

The original version of the scale in English was translated into Spanish, and approved by its author. Six face validity items with comprehension difficulty were reported; which were reviewed and adapted, keeping its structure. The global content validity index with expert appraisal was 0.94. In the exploratory analysis of factors, 3 dimensions were identified: ambiguity and lack of information, unpredictability and lack of clarity, with a KMO=0.846, which accumulated 91.5% of the explained variance. The internal consistency of the scale yielded a Cronbach alpha of 0.86 demonstrating a good level of correlation between items.

CONCLUSION

The Spanish version of "Parent's Perception of Uncertainty in Illness Scale" is a valid and reliable tool that can be used to determine the level of uncertainty of parents facing the illness of their children.

Meta-Analysis: Caregiver and Youth Uncertainty in Pediatric Chronic Illness

Objective

To conduct a systematic review on the construct of illness uncertainty in caregivers and youth as related to the following: demographic and illness variables, psychological functioning, illness-related distress, and reaction/coping style.

Methods

A meta-analysis was conducted with articles assessing the associations between illness uncertainty and variables of interest that were published between November 1983 and June 2016 ( n = 58).

Results

Psychological functioning and illness-related distress had primarily medium effect sizes. Demographic and illness variables had small effect sizes. More positive and fewer negative reaction/coping styles were associated with less illness uncertainty, with primarily small effects.

Conclusions

Illness uncertainty may be an important factor that influences psychological functioning and distress and coping in the context of pediatric chronic illness. However, additional research is needed to determine more precise mean effect sizes, as well as the potential efficacy of intervention to address uncertainty. adolescents, children, chronic illness, coping skills and adjustment, meta-analysis, parents, psychosocial functioning.