The evaluation of family functioning by the family assessment device: a systematic review of studies in adult clinical populations

Clinical illness course and family-related outcomes among parents with a first episode of schizophrenia spectrum disorder: a 20-year follow-up of the OPUS trial

BACKGROUND

Studies investigating parenthood and how it affects long-term outcomes are lacking among individuals with schizophrenia spectrum disorders. This study aimed to examine the life of participants 20 years after their first diagnosis with a special focus on parenthood, clinical illness course, and family-related outcomes.

METHODS

Among 578 individuals diagnosed with first-episode schizophrenia spectrum disorder between 1998 and 2000, a sample of 174 participants was reassessed at the 20-year follow-up. We compared symptom severity, remission, clinical recovery, and global functioning between 75 parents and 99 non-parents. Also, family functioning scored on the family assessment device, and the children's mental health was reported. We collected longitudinal data on psychiatric admission, supported housing, and work status via the Danish registers.

RESULTS

Participants with offspring had significantly lower psychotic (mean (s.d.) of 0.89 (1.46) v. 1.37 (1.44), p = 0.031) negative (mean [s.d.] of 1.13 [1.16] v. 1.91 [1.07], p < 0.001) and disorganized symptom scores (mean [s.d.] of 0.46 [0.80] v. 0.85 [0.95], p = 0.005) and more were in remission (59.5% v. 22.4%, p < 0.001) and in clinical recovery (29.7% v. 11.1%, p = 0.002) compared to non-parents. When investigating global functioning over 20 years, individuals becoming parents after their first diagnosis scored higher than individuals becoming parents before their first diagnosis and non-parents. Regarding family-related outcomes, 28.6% reported unhealthy family functioning, and 10% of the children experienced daily life difficulties.

CONCLUSIONS

Overall, parents have more favorable long-term outcomes than non-parents. Still, parents experience possible challenges regarding family functioning, and a minority of their children face difficulties in daily life.

Sensitivity to change of the Systemic Therapy Inventory of Change (STIC) intersession scales

Objective: The Systemic Therapy Inventory of Change (STIC) is a systemic measurement feedback system that provides therapists with feedback regarding the multidimensional clinical change in individual, couple, and family therapy. The STIC Intersession scales include Individual Problems and Strengths (IPS), Relationship with Partner (RWP), Family/Household (FH), and Child Problems and Strengths (CPS). They are administered to clients before each therapy session. The purpose of the current study is to investigate the STIC Intersession scales' sensitivity to change, the ability to detect reliable and valid changes that occur after an intervention. Method: Participants (N = 583) who voluntarily received individual, couple, or family therapy services in a randomized clinical trial attended the study. Results: By comparing the changes in pre-therapy and post-therapy scores of the STIC Intersession scales with those of the corresponding reference measures, the external sensitivity to change of the STIC Intersession scales was supported. The IPS Intersession scale showed greater change than the Beck Anxiety Inventory. However, no evidence supported the discriminant validity of CPS's change scores. Conclusion: Thus, the STIC Intersession IPS, RWP, and FH can be validly used to assess multi-systemic changes in both research and clinical work.

Does the STIC measurement and feedback system improve multisystemic outcomes in individual, couple and family therapy? A randomized clinical trial

OBJECTIVE

In a randomized clinical trial, we evaluated whether the STIC (Systemic Therapy Inventory of Change) measurement and feedback system (MFS), the first MFS to explicitly integrate the family systems perspective, improved outcomes in individual, couple and family therapy.

METHOD

Nine hundred and seventy clients seeking individual, couple or family therapy, entered therapy with 93 therapists at four sites in the Chicago metropolitan area. All therapists were trained with the STIC and participated in both Treatment as Usual (TAU) and TAU with the STIC (STIC). After agreeing to participate, clients were randomly assigned to TAU or STIC. Therapists did not know the condition to which a case was assigned, until just prior to the first session. Therapy was not time-limited or constrained, except for the use of the STIC in the STIC condition. All clients were evaluated on a non-STIC multi-systemic battery of widely used outcome measures pre-and-post therapy.

RESULTS

STIC clients improved more than TAU clients regardless of treatment modality or outcome measure. Clinically significant change was also greater for STIC than TAU clients across outcome measures.

CONCLUSION

The STIC MFS holds promise for improving outcomes beyond TAU in individual, couple, and family therapy.

Family functioning and patients' depressive symptoms: comparison in perceived family function between patients who had an acute ischaemic stroke and their primary family caregivers - a cross-sectional study

OBJECTIVES

This study aims to compare perceived family functioning between Chinese patients who had an acute ischaemic stroke (AIS) and family caregivers, and explore the association between family functioning and patients' depressive symptoms.

DESIGN

This is a cross-sectional study design.

SETTING

Stroke centres of two tertiary hospitals in Nanjing, China.

PARTICIPANTS

One hundred and sixty-nine dyads of patients who had an AIS and family caregivers.

PRIMARY AND SECONDARY OUTCOME MEASURES

Family functioning of patients who had an AIS and their primary family caregivers was assessed by the Family Assessment Device (FAD, Chinese version). Depressive symptoms of patients who had an AIS was assessed by the Centre for Epidemiological Studies Depression Scale. We test the agreement and differences in family functioning. Multivariate linear regression models were used to test the association of differences of family functioning within dyads with patients' depressive symptoms.

RESULTS

AIS families demonstrated unhealthy family functioning. A total of 115 patients (76.9%) and 124 caregivers (73.4%) had a score of 2 or higher in FAD-general functioning (GF), indicating unhealthy family functioning. The intraclass correlation coefficient of FAD subdomain between patients who had an AIS and caregivers ranged from 0.15 to 0.55, which indicating the agreement of family functioning within dyads was poor to moderate. There was a significant difference between the FAD-GF scores of the patients and those of their caregivers (Z=-2.631, p=0.009), with caregivers reporting poorer general family functioning. Poor family functioning and greater difference of perceived family functioning within dyads were related to higher level of patients' depressive symptoms (β=5.163, p<0.001, β=5.534, p<0.001, respectively).

CONCLUSIONS

These findings indicate that healthcare professionals should assess family functioning in both patients who had a stroke and caregivers. Improvement of family function and decreasing discrepancies within dyads may be helpful for relieving patients' depressive symptoms.

Association between family functioning and psychotic transition in ultra-high risk adolescents and young adults

Background

Psychotic transition (PT) is a crucial stage in schizophrenia. The Comprehensive Assessment of At-Risk Mental States (CAARMS) scale can be used to identify individuals at ultra-high risk (UHR) for psychosis and to evaluate their risk of PT. Many environmental and genetic factors have been identified as contributing to the development and decompensation of schizophrenia. This study aimed to determine if the quality of family functioning is associated with PT risk in UHR individuals aged between 11 and 25 years after 1 year of follow-up.

Methods

From January to November 2017, 45 patients aged 12 to 25 consulting for psychiatric reasons were included. Twenty-six were classified as UHR of PT at the CAARMS. Family functioning was assessed by the Family Assessment Device-Global Functioning (FAD-GF). Thirty-seven of these patients (30% men, mean age 16 ± 2.5) were reassessed at 8-14 months of recruitment. Survival analysis was used to examine the impact of family functioning on PT risk.

Results

A total of 40% of UHR patients were classified as psychotic at reassessment. Survival analysis showed that better family functioning is a significant protective factor for PT in this population.

Discussion

This result suggests that the global family functioning has an impact at 1 year on the risk of PT in the population of adolescents and young adults who consult the hospital for psychiatric reasons. A family intervention may be effective in reducing PT risk in this population and should be considered as a potential therapeutic option.

Measurement Invariance of Family Functioning Among Latina/o/x Sexual Minority Youth and Heterosexual Latina/o/x Youth

Positive family functioning is negatively associated with drug use, sexual risk behaviors, and depression; however, existing measures of family functioning were not specifically developed for Latina/o/x sexual minority youth (LSMY). This study examined the factor structure of family functioning and whether it is invariant across sexual orientation (i.e., LSMY and heterosexual Latina/o/x youth). Participants included 454 Latina/o/x youth (LSMY: n = 115, 25.3%). Results yielded a higher-order family functioning factor consisting of parental involvement, positive parenting, parent-adolescent communication, and parental monitoring. The model fit for the sample was acceptable (CFI/RMSEA = .91/.04) and configural invariance indicated that the model fit the data adequately in both groups (CFI/RMSEA = .87/.05). Fit of the metric invariance model (∆χ2 (42) = 54.83, p = .09, ΔCFI, ΔRMSEA, ΔTLI < .001) was not significantly worse than the configural model, however, the scalar invariance model (∆χ2 (42) = 80.18, p < .001, ΔCFI = .01, ΔRMSEA, ΔTLI < .001) was significantly worse than the less constrained models, suggesting that family functioning was noninvariant with regard to sexual orientation. Noninvariance may be related to the unique experiences of LSMY related to sexual orientation that are not captured in existing measures of family functioning.

Family functioning and preschool children's oral health-related quality of life

INTRODUCTION

Identifying which aspects of how a family functions are relevant to child oral health provides opportunities for interventions targeting the family context. The aim of this study was to investigate the associations of general and domain-specific family functioning with oral health-related quality of life (OHRQoL) of 3-4-year-old children.

METHODS

Cross-sectional data from 740 parent-child dyads from East London were analysed. Family functioning was assessed with the 60-item Family Assessment Device that yields scores for general functioning and six domains (roles, behaviour control, communication, affective involvement, affective responsiveness and problem solving). Children's OHRQoL was measured using the Early Childhood Oral Health Impact Scale (ECOHIS), which measures the lifetime impacts of children's oral conditions on the child (child impact section, CIS) and family (family impact section, FIS). The associations of family functioning with the ECOHIS total, CIS and FIS scores were assessed in negative binomial regression models (rate ratios [RR] and 95% confidence intervals [95% CI] were calculated), adjusting for parental sociodemographic factors and child demographic factors and caries experience.

RESULTS

Children in families with unhealthy general functioning had 1.45 (95% CI: 0.87-2.43), 1.24 (95% CI: 0.73-2.13) and 2.19 (95% CI: 1.20-3.99) times greater ECOHIS total, CIS and FIS scores, respectively, than those in families with healthy general functioning after adjustment for confounders. Unhealthy functioning in the roles domain was associated with greater ECOHIS total and FIS scores. Unhealthy functioning in the problem solving, roles and affective involvement domains were also associated with greater FIS scores.

CONCLUSIONS

Unhealthy family functioning was associated with worse child OHRQoL, especially in terms of disrupting family life. Effective assignment and undertaking of roles should be further explored as a target for intervention.

Family dysfunction is associated with chronic pain in a community-dwelling Japanese population: The Hisayama study

BACKGROUND

Poor family functioning has been reported to be associated with the severity of chronic pain in outpatients, but the association has not been fully addressed in general populations. The present study aimed to examine the association between family dysfunction levels and the presence of chronic pain in a community-dwelling Japanese population.

METHODS

A total of 2598 participants aged ≥40 years were classified as having healthy, borderline or unhealthy family functioning. Chronic pain was defined as subjective pain for three months or longer, and further classified by pain intensity, the number of chronic pain sites, pain duration and the extent of pain spread. A logistic regression model was used to compute the odds ratios (ORs) for chronic pain outcomes.

RESULTS

The prevalence of chronic pain was 49%. The age- and sex-adjusted prevalence of total and severe chronic pain were increased significantly with increasing family dysfunction levels (all p for trend <0.01). After adjusting for sociodemographic, physical, social and family structure factors, the ORs (95% confidence intervals [CI]) for having chronic pain among borderline and unhealthy groups were 1.20 (1.01-1.44) and 1.43 (1.15-1.79), respectively, as compared with a healthy family function group. The association was stronger among people who were employed and those who were living with their children. In addition, the ORs for severe chronic pain increased significantly with increasing levels of family dysfunction.

CONCLUSIONS

The family dysfunction level was positively associated with the presence as well as the severity of chronic pain in a community-dwelling population.

SIGNIFICANCE

A biopsychosocial burden due to family relationships could worsen the clinical presentation of pain. Social support or family therapy for dysfunctional families would be a potential initiative for the prevention or management of chronic pain.

Anorexia Nervosa in Adolescence: Parental Narratives Explore Causes and Responsibilities

BACKGROUND

Anorexia nervosa (AN) is a serious mental disorder with a multifactorial etiopathogenesis, adolescent girls being especially vulnerable. Parents can be a resource and occasionally a burden when their children suffer from AN; thus, parents play a key role in recovery. This study focused on parental illness theories of AN and how parents negotiate their responsibilities.

METHODS

To gain insights into this dynamic, 14 parents (11 mothers, 3 fathers) of adolescent girls were interviewed. Qualitative content analysis was used to provide an overview of the parents' assumed causes for their children's AN. We also looked for systematic differences in the assumed causes among different groups of parents (e.g., high versus low self-efficacy). A microgenetic positioning analysis of two mother-father dyads provided further insight into how they viewed the development of AN in their daughters.

RESULTS

The analysis stressed the overall helplessness of parents and their strong need to understand what was going on. Parents differed in stressing internal and external causes, which influenced whether they felt responsible and how much they felt in control and able to help.

CONCLUSIONS

Analysing the variability and dynamics shown can support therapists, especially those working systemically to change the narratives within families for better therapy compliance and outcomes.

The McMaster Family Assessment Device (FAD) dimensions involved in the prediction of adolescent depressive symptoms and their mediating role in regard to socioeconomic status

Family functioning plays an important role in explaining the high prevalence of depressive symptoms in adolescents and it is necessary to identify the family functioning characteristics responsible for this relationship. In turn, while socioeconomic status (SES) is associated with adolescent depressive symptoms, the mechanisms that explain this relationship are largely unknown. In this study, we used the McMaster Family Assessment Device (FAD) to obtain a picture of the family functioning dimensions that genuinely contribute to explaining the relationship between family functioning and adolescent depressive symptoms and analyzed the mediating effect of family functioning on the impact of SES on depressive symptoms. Regression-based conditional process analysis was used with a sample of 636 adolescents aged 12-17 years. Pratt's measures in regression analyses showed that 95% of the variance in depressive symptoms was accounted for by three of the six FAD dimensions: the ability to experience and express emotions appropriately-Affective Responsiveness-the ability to maintain adequate involvement among family members-Affective Involvement-and the ability to set and abide by rules and standards of behavior-Behavioral Control. Results also showed that the impact of SES on depressive symptoms was mediated by the existence of clear expectations about standards of behavior and behavioral patterns for handling family tasks-Behavioral Control and Roles-and, for the boys, by experiencing and expressing emotions appropriately. The results emphasize the importance of affect and clear-cut family rules to prevent adolescent depressive symptoms and suggest that the existence of family rules and roles buffer the impact of SES on adolescent wellbeing.

The development of a reliable change index and cutoff score for the SCORE-15

The Systemic Clinical Outcome and Routine Evaluation version 15 (SCORE-15) is a measure used to assess family-level change in family therapy. The SCORE-15 has been demonstrated to be a reliable and valid measure, with high clinical utility; however, the SCORE-15 lacks the ability to determine whether the change in family functioning during the course of therapy is clinically significant. This study aimed to establish a reliable change index (RCI) and clinical cutoff score so that researchers and clinicians can determine clinically significant change in family therapy. US samples of 71 clinical participants and 244 community participants completed the SCORE-15. Results indicated a cutoff score of 40.37 and an RCI of 9.52. Consequently, family members who improve their SCORE-15 score during the course of therapy by at least 9 points and who cross the threshold of 40 during the course of therapy are considered to have experienced clinically significant change.

The effectiveness of structural family therapy in repairing behavioral problems and improving family functioning in single-parent families in Iran

Family is foundational to Iranian culture and society and traditional families have been upheld by religious and political institutions since ancient times. However, the incidence of single-parent families in Iran is increasing and literature on treating dysfunction in these families in therapy is lacking. This study examines the effectiveness of structural family therapy (SFT) in addressing problems in family functioning and children's behavior in single-parent Iranian families using a single-case, multiple baseline, ABA design. Participants included five single mothers and their children who received SFT for 8 weeks following a baseline phase. Participants were assessed during the baseline, therapy, and follow-up phases using the Child Behavior Checklist and the Family Assessment Device. The data were analyzed visually and quantitatively. Results indicated that the treatment was effective in decreasing behavior problems and improving family functioning and that treatment effects were statistically significant and stable through the follow-up period. Research and clinical implications and limitations are discussed.

A multicomponent family support intervention in intensive care units: study protocol for a multicenter cluster-randomized trial (FICUS Trial)

Background

Family members of critically ill patients face considerable uncertainty and distress during their close others’ intensive care unit (ICU) stay. About 20–60% of family members experience adverse mental health outcomes post-ICU, such as symptoms of anxiety, depression, and posttraumatic stress. Guidelines recommend structured family inclusion, communication, and support, but the existing evidence base around protocolized family support interventions is modest and requires substantiation.

Methods

To test the clinical effectiveness and explore the implementation of a multicomponent, nurse-led family support intervention in ICUs, we will undertake a parallel, cluster-randomized, controlled, multicenter superiority hybrid-type 1 trial. It will include eight clusters (ICUs) per study arm, with a projected total sample size of 896 family members of adult, critically ill patients treated in the German-speaking part of Switzerland. The trial targets family members of critically ill patients with an expected ICU stay of 48 h or longer. Families in the intervention arm will receive a family support intervention in addition to usual care. The intervention consists of specialist nurse support that is mapped to the patient pathway with follow-up care and includes psycho-educational and relationship-focused family interventions, and structured, interprofessional communication, and shared decision-making with families. Families in the control arm will receive usual care. The primary study endpoint is quality of family care, operationalized as family members’ satisfaction with ICU care at discharge. Secondary endpoints include quality of communication and nurse support, family management of critical illness (functioning, resilience), and family members’ mental health (well-being, psychological distress) measured at admission, discharge, and after 3, 6, and 12 months. Data of all participants, regardless of protocol adherence, will be analyzed using linear mixed-effects models, with the individual participant as the unit of inference.

Discussion

This trial will examine the effectiveness of the family support intervention and generate knowledge of its implementability. Both types of evidence are necessary to determine whether the intervention works as intended in clinical practice and could be scaled up to other ICUs. The study findings will make a significant contribution to the current body of knowledge on effective ICU care that promotes family participation and well-being.

Trial registration

ClinicalTrials.gov NCT05280691. Prospectively registered on 20 February 2022.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06454-y.

Psychometric Qualities of the McMaster Family Assessment Device-General Functioning Subscale for Malaysian Samples

Family functioning has been associated with psychological well-being and physical health. The 12-item McMaster Family Assessment Device–General Functioning Subscale (FAD-GF) has been widely used to assess individuals’ overall level of family functioning. However, it has shown an inconsistent factor structure across various studies. The present study investigated its psychometric qualities in two studies with two different adult samples in Malaysia. In Study 1 (N = 417, 55.3% females, 19 to 26 years old), exploratory factor analyses were conducted, and four models were found: a three-factor model with 11 items, a two-factor model with 12 items, and one-factor models with six negatively worded items and six positively worded items, respectively. Study 2 (N = 358, 65.1% females, 18 to 60 years old) compared models found in past studies and those found in Study 1 through confirmatory factor analyses on another sample of adults. Among the six competing models, the two-factor model with three positively worded and three negatively worded items (i.e., FAD-GF-SF) is preferable because it did not require modification and showed a clear-cut result of goodness of fit. The subscales demonstrated satisfactory internal consistency. In conclusion, the FAD-GF-SF is a useful instrument for measuring family functioning in the Malaysian context.

Family functioning and adaptation following pediatric brain tumor: A systematic review

INTRODUCTION

Pediatric brain tumor survivors (PBTS) experience psychosocial difficulties and poor quality of life (QOL). Family functioning may be adversely impacted by the stress of diagnosis and associated symptoms, which may, in turn, affect PBTS outcomes. The objective of this study was to complete a systematic review of family functioning and psychosocial outcomes in PBTS.

METHODS

We conducted systematic searches of PubMed and PsychInfo. Full-text articles (n = 324) were screened and 14 were included. A risk-of-bias assessment was conducted to evaluate the quality of study conclusions.

RESULTS

Studies examined associations of family functioning with adaptive, social, emotional, and behavioral outcomes, and QOL. More adaptive family functioning (cohesiveness, effective communication, lower conflict) was associated with better PBTS outcomes. Studies were limited by heterogeneous/small samples and cross-sectional designs.

CONCLUSIONS

Results provide preliminary support for the relationship between family functioning and psychosocial outcomes. Common outcome measures and prospective research designs can further advance understanding.

Can telerehabilitation services combined with caregiver-mediated exercises improve early supported discharge services poststroke? A study protocol for a multicentre, observer-blinded, randomized controlled trial

BACKGROUND

Recovery of walking ability is an important goal for patients poststroke, and a basic level of mobility is critical for an early discharge home. Caregiver-mediated exercises could be a resource-efficient strategy to augment exercise therapy and improve mobility in the first months poststroke. A combination of telerehabilitation and face-to-face support, blended care, may empower patient-caregiver dyads and smoothen the transition from professional support to self-management. The Armed4Stroke study aims to investigate the effects of a caregiver-mediated exercise program using a blended care approach in addition to usual care, on recovery of mobility in the first 6 months poststroke.

METHODS

A multicentre, observer-blinded randomized clinical trial in which 74 patient-caregiver dyads will be enrolled in the first 3 months poststroke. Dyads are randomly allocated to a caregiver-mediated exercises intervention or to a control group. The primary endpoint is the self-reported mobility domain of the Stroke Impact Scale. Secondary endpoints include care transition preparedness and psychological functioning of dyads, length of inpatient stay, gait-related measures and extended ADL of patients, and caregiver burden. Outcomes are assessed at enrolment, end of treatment and 6 months follow-up.

RESULTS

During 8 weeks, caregivers are trained to become an exercise coach using a blended care approach. Dyads will receive a tailor-made, progressive training program containing task-specific exercises focusing on gait, balance, physical activity and outdoor activities. Dyads are asked to perform the training program a minimum of 5 times a week for 30 min per session, supported by a web-based telerehabilitation system with instruction videos and a messaging environment to communicate with their physiotherapist.

CONCLUSIONS

We hypothesize that the Armed4Stroke program will increase self-reported mobility and independence in ADL, facilitating an early discharge poststroke. In addition, we hypothesize that active involvement of caregivers and providing support using blended care, will improve the care transition when professional support tapers off. Therefore, the Armed4Stroke program may complement early supported discharge services.

TRIAL REGISTRATION

Netherlands Trial Register, NL7422 . Registered 11 December 2018.

Family functioning and mental wellbeing impairment during initial quarantining for the COVID-19 pandemic: A study of Canadian families

Quarantine measures imposed due to COVID-19 have negatively impacted individual wellbeing. However, the research on the factors impacting mental health and functioning of families is limited. The current study explores socio-economic and demographic factors that mediate poor family functioning, anxiety, and depressive symptoms in response to quarantine measures in Canadian parents and children. 254 Canadian families completed an online questionnaire capturing demographic information and mental wellbeing of individuals and of the whole family. Family functioning was assessed using the Family Assessment Device General Functioning subscale (FAD-GF), and individual mental wellbeing was measured with the Generalized Anxiety Disorder screener (GAD-7) and Patient Health Questionnaire (PHQ-9). Generalized linear models and logistic regression were used to model socio-demographic impacts on outcome variables. Problematic family functioning was found in 78.5% of families with a high proportion of parents reporting above-threshold symptoms of anxiety (62.9%) and depression (73.4%). Many children also reported above-threshold symptoms of anxiety (54.6%) and depression (70.7%). Family functioning was impacted by parent and child age, parental employment status and pre-existing conditions for children. Anxiety and depression experienced by parents and children was increased in families with parents aged <45, household income<$100,000 pre-existing psychiatric conditions, or having a child aged >5 years. These findings show that most Canadian families observed in this study experienced above threshold symptoms of anxiety, depression and poor family functioning. Our study provides an initial step towards identifying characteristics of at-risk families and targeting interventions to mediate negative effects of quarantining.

[Assessment of General Family Functioning: Psychometric Evaluation of the German Version of the Brief Assessment of Family Functioning Scale]

The functionality of the family system is not only a central theme in developmental psychology and family research, but also plays a key role in many physical illnesses and mental disorders. Despite its high relevance, there are only a very few brief and user-friendly self-report measures assessing general family functioning. This gap is closed by the Brief Assessment of Family Functioning Scale (BAFFS), which consists of three items of the General Functioning Scale of the internationally well-established Family Assessment Device. In this study, the German version (KSAFF) of the BAFFS was psychometrically evaluated for the first time in a large and representative general population sample (n=2463). Using multigroup confirmatory factor analyses, strong measurement invariance was shown for relevant subsamples (women vs. men; participants in partnerships with vs. without children) with good model fit. Although one of the three items, which is the only negatively formulated item, yielded insufficient psychometric item characteristics, the internal consistency was Cronbach's α=0.71. As an indication of adequate construct validity, associations of family functioning with socioeconomic status as well as with current depression and anxiety were found in accordance with the hypothesis. Although application experiences and psychometric analyses of the German version of the BAFFS in relevant clinical samples are pending, this three-item self-report measure can be recommended as an economic, user-friendly assessment device for general family functioning, particularly since it yielded satisfactory to good psychometric properties in the general population.

Family functioning and dental caries among preschool children

OBJECTIVES

To investigate the relationship of family functioning with dental caries among 3-4-year-olds and the role of family functioning in explaining the relationship of family socioeconomic status (SES) with childhood dental caries.

METHODS

Data from 761 parent-child dyads who took part in the East London Oral Health Inequalities study were analyzed. Family functioning was assessed using the 60-item family assessment device that yielded scores on general functioning and six domains (roles, communication, problem-solving, affective involvement, affective responsiveness, and behavior control). Children were clinically examined at home for dental caries. The association of family functioning and family SES (education and socioeconomic classification) with dental caries (dmft and dt scores) was tested using negative binominal regression while adjusting for child and parental demographic factors.

RESULTS

Children from families with unhealthy general functioning had 1.49 (95% CI: 1.01-2.20) and 1.84 (95% CI: 1.20-2.82) times greater dmft and dt, respectively, than those from families with healthy functioning after adjustment for confounders. The estimates for the associations of parental education and socioeconomic classification with dmft and dt were attenuated by around 12%-18% after adjusting for family functioning. Of the six family functioning domains assessed, only unhealthy behavior control in the family was associated with greater numbers of decayed teeth after adjustments.

CONCLUSIONS

This study showed that unhealthy family functioning was associated with dental caries among young children. Family functioning partly explained the relationship between family SES and childhood dental caries.

Validation of the Emotional Tone Index for Families (ETIF): A Multi-Informant Measure of Emotional Closeness

Despite the importance of emotional closeness (EC) in families, few researchers have accurately measured the construct in a systemic way. Additionally, existing measures rely on ratings from one informant, typically the mother, to provide information on closeness within the entire family system. We examined EC in 140 individuals (37 families) using the Emotional Tone Index for Families (ETIF), a novel, multi-informant measure that obtains bidirectional information about EC within every family relationship. The parent identified as most familiar with the family also completed two widely used single-informant measures: The McMaster Family Assessment Device and the Family Adaptability and Cohesion Evaluation Scales, version IV. The ETIF exhibited good test-retest reliability, high internal consistency, and concurrent validity with the single-informant measures. Though the primary respondent scores correlated highly with overall family closeness, results revealed only a modest association between closeness ratings within each dyad and parents rated higher levels of closeness toward their children than children rated closeness toward parents. These findings suggest that ratings from multiple informants provide valuable information about discrepancies in perceived closeness between family members and other complex family dynamics that cannot be captured by single-informant measures. Limitations, future directions, and implications for practice are discussed.

Quality of life and family function are poorest when both patients with heart failure and their caregivers are depressed

AIMS

Patients with heart failure (HF) and their family caregivers commonly experience depressive symptoms associated with low quality of life (QOL) at the individual level. However, there is a lack of knowledge about how QOL and family function are associated with depressive symptoms at the dyad level. The aim of this article is to compare QOL and family function among dyads stratified by depressive symptoms.

METHODS AND RESULTS

Outpatients with HF and their primary caregivers completed the Beck Depression Inventory-II for depressive symptoms, the Short Form 36 for physical and mental QOL, and the McMaster Family Assessment Device for a family function. Analysis of variance was used to compare QOL and family function among the four dyad groups. A total of 91 dyads were categorized into four groups: neither member having depressive symptoms (43.9%), only the caregiver having depressive symptoms (13.2%), only the patient having depressive symptoms (23.1%), and both members having depressive symptoms (20.9%). Dyads without depressive symptoms had the highest levels of physical and mental QOL among the groups. The dyads with both members having depressive symptoms had the lowest levels of physical and mental QOL (P < 0.001) and the lowest levels of general family functioning, problem-solving ability, and communication ability (P < 0.001). Intermediate levels of QOL were seen in dyads with only one member having depressive symptoms, and a similar pattern of intermediate scores was found in all three subscales of family function.

CONCLUSION

Dyads with both members having depressive symptoms may be at greatest risk of having poor QOL and low family functioning.

Family Functioning Assessment Instruments in Adults with a Non-Psychiatric Chronic Disease: A Systematic Review

There is little information on the evaluation of family functioning in adult patients with chronic non-psychiatric illness. The objective of this systematic review was to identify family functioning assessment instruments of known validity and reliability that have been used in health research on patients with a chronic non-psychiatric illness. We conducted a search in three biomedical databases (PubMed, Science Direct, and Web of Science), for original articles available in English or Spanish published between 2000 and 2019. The review was conducted in accordance with PRISMA guidelines. Fourteen articles were included in the review. The instruments Family Assessment Device, Family Adaptability and Cohesion Evaluation Scales, Family Functioning Health and Social Support, Family APGAR, Assessment of Strategies in Families-Effectiveness, Iceland Expressive Family Functioning, Brief Family Assessment Measure-III, and Family Relationship Index were identified. All of them are reliable instruments to evaluate family functioning in chronic patients and could be very valuable to help nurses identify families in need of a psychosocial intervention. The availability and clinical application of these instruments will allow nurses to generate knowledge on family health and care for non-psychiatric chronic conditions, and will eventually contribute to the health and wellbeing of adults with a non-psychiatric chronic disease and their families.

Parental stress during COVID-19: A brief report on the role of distance education and family resources in an Italian sample

Since the COVID-19 outbreak, school closures have affected over 1.5 billion children worldwide. Many countries implemented a rapid transition to distance education (DE), but the effects of such transition on family life remain largely underexplored. The current study used a cross-sectional, correlational survey design to explore the role of DE and family resources (parenting self-efficacy and family functioning) in perceived stress among Italian parents of first-grade children (N = 89). Results of hierarchical multiple regression indicated that, after controlling for stressful events experienced during school closure, parents’ difficulty to manage children’s DE was positively linked to levels of stress. However, this association became nonsignificant after adding family resources to the model, with more parental self-efficacy and good family functioning predicting less perceived stress. The findings underscore the importance of supporting positive resources within the family environment to reduce DE-related parental stress in the context of the ongoing COVID-19 pandemic.

Focusing on quality of life in the family caregivers of patients with schizophrenia from the perspective of family functioning: A cross-sectional study

The study aimed to explore the association between family functioning and quality of life (QOL) in family caregivers of patients with schizophrenia.Totally 121 family caregivers were surveyed in the cross-sectional study by the self-administration questionnaires about sociodemographic characteristics, family functioning and QOL. Family functioning was evaluated in terms of the family assessment device and the Family Adaptability and Cohesion Evaluation Scale II China Version. QOL was evaluated in terms of TSDHE short-form 12-item health survey, version 2. Multiple regression models were built to explore the association between QOL and family functioning.A regression analysis showed that poorer physical health of family caregivers was significantly associated with the lower educational level of caregivers, the closer kinship with patients and the multiple episodes schizophrenia. The other regression analysis showed that better family adaptability and affective responsiveness were significantly associated with the better mental health of family caregivers.Family functioning is associated with mental health rather than the physical health of family caregivers. Psychoeducational intervention could focus on family caregivers with a lower educational level and closer kinship, and those who look after patients with multiple episodes schizophrenia. Further family intervention could focus on family adaptability and affective expression in family caregivers of patients with schizophrenia.

Mental health promotion and prevention interventions in families with parental depression: A randomized controlled trial

BACKGROUND

The transgenerational transmission of affective disorders calls for integrating promotion of child development in the services offered to families with parental depression. The main objective of the present research was to examine the effectiveness and differences in the impact of two relevant interventions in Greece.

METHODS

Thirty families of depressed patients were randomly assigned to the six-to-eight session Family Talk Intervention group and 32 families were included in the lower intensity parent-only two-to-three session Let's Talk about the Children group. Depressed parents and the eldest of their children were assessed prior to the interventions and 4, 10, and 18 months following baseline assessment.

RESULTS

In both groups there were significant improvements in parent's depression, anxiety, perceived social support, parenting and family functioning, as well as improvements in child's depression, anxiety, and child emotional/behavioral problems. Child's prosocial behavior, perceived social support, and health-related quality of life were significantly improved in both groups. All positive effects were evident four months following baseline assessment and could be still documented at 1.5-year follow-up. Mixed linear models showed that family functioning and parenting to a lesser extent were associated with the greatest changes in children's psychosocial outcomes in both interventions..

LIMITATIONS

The lack of data regarding parents that refused to receive the interventions may limit generalizability of results. A further limitation is the lack of a no-intervention control group.

CONCLUSIONS

The study offers a preliminary evidence base for integrating preventive interventions for child mental health in routine clinical practice with adult depressed patients.

The Mediator Effects of Depressive Symptoms on the Relationship between Family Functioning and Quality of Life in Caregivers of Patients with Heart Failure

BACKGROUND

Caregivers of patients with heart failure (HF) report depressive symptoms and poor quality of life (QOL) related to caregiving and poor family functioning, placing them at risk for poor health.

OBJECTIVES

The purpose of this study was to examine the effect of depressive symptoms on the relationship between family functioning and quality of life in the HF caregiver.

METHODS

A sample of 92 HF caregivers were enrolled from an ambulatory clinic at a large academic medical center. A mediation analysis was used to analyze data obtained from the Family Assessment Device (FAD), the Patient Health Questionaire-9 (PHQ-9), and the Short Form-12 Health Survey Version 2 (SF-12v2).

RESULTS

Depressive symptoms were found to be a significant mediator in the relationship between family functioning and caregiver quality of life.

CONCLUSIONS

The results of this study suggest that interventions targeting caregiver depression and family functioning could be effective in enhancing HF caregivers' physical and mental QOL.

Self-Efficacy Predicts Personal and Family Adjustment Among Persons With Spinal Cord Injury or Acquired Brain Injury and Their Significant Others: A Dyadic Approach

OBJECTIVES

To investigate whether the combination of self-efficacy levels of individuals with spinal cord injury (SCI) or acquired brain injury (ABI) and their significant others, measured shortly after the start of inpatient rehabilitation, predict their personal and family adjustment 6 months after inpatient discharge.

DESIGN

Prospective longitudinal study.

SETTING

Twelve Dutch rehabilitation centers.

PARTICIPANTS

Volunteer sample consisting of dyads (N=157) of adults with SCI or ABI who were admitted to inpatient rehabilitation and their adult significant others.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Self-efficacy (General Competence Scale) and personal and family adjustment (Hospital Anxiety and Depression Scale and McMaster Family Assessment Device General Functioning).

RESULTS

In 20 dyads, both individuals with SCI or ABI and their significant others showed low self-efficacy at baseline. In 67 dyads, both showed high self-efficacy. In the low-self-efficacy dyads, 61% of the individuals with SCI or ABI and 50% of the significant others showed symptoms of anxiety 6 months after discharge, vs 23% and 30%, respectively, in the high-self-efficacy dyads. In the low-self-efficacy dyads, 56% of individuals with SCI or ABI and 50% of the significant others reported symptoms of depression, vs 20% and 27%, respectively, in the high-self-efficacy dyads. Problematic family functioning was reported by 53% of the individuals with SCI or ABI and 42% of the significant others in the low-self-efficacy dyads, vs 4% and 12%, respectively, in the high-self-efficacy dyads. Multivariate analysis of variance analyses showed that the combination of levels of self-efficacy of individuals with SCI or ABI and their significant others at the start of inpatient rehabilitation predict personal (V=0.12; F_6,302=2.8; P=.010) and family adjustment (V=0.19; F_6,252=4.3; P<.001) 6 months after discharge.

CONCLUSIONS

Low-self-efficacy dyads appear to be more at risk for personal and family adjustment problems after discharge. Screening for self-efficacy may help healthcare professionals to identify and support families at risk for long-term adjustment problems.

Correlation Analysis of the Quality of Family Functioning and Subjective Quality of Life in Rehabilitation Patients Living with Schizophrenia in the Community

Background: Recently, the community rehabilitation model for schizophrenia patients has become increasingly popular, and the Shanghai Pudong New Area has developed a relatively complete community rehabilitation model. This study analyzed the correlation between family function and subjective quality of life in the rehabilitation of patients living with schizophrenia in the community. Methods: This study evaluated persons living with schizophrenia using the Family Assessment Device and the Subjective Quality of Life Scale. A convenient sampling method was used to select 281 rehabilitation patients living with schizophrenia in the community and 166 hospitalized persons living with schizophrenia. Results: There was a significant difference in the Family Assessment Device scores between rehabilitation patients living with schizophrenia in the community and hospitalized persons living with schizophrenia (p < 0.0001). The difference in the scores of the subjective quality of life assessment between rehabilitation patients living with schizophrenia in the community and hospitalized persons living with schizophrenia was not statistically significant (p > 0.05). The regression analysis showed that quality of family function had a significant effect on the subjective quality of life in rehabilitation patients living with schizophrenia in the community and hospitalized persons living with schizophrenia. (F = 10.770 p < 0.001), (F = 2.960 p < 0.01). Conclusions: The quality of family function plays an important role in improving the subjective quality of life in rehabilitation patients living with schizophrenia in the community. It may be beneficial to add some methods to improve family function in the current model of rehabilitation in the community.

Agreement and differences regarding family functioning between patients with acquired brain injury and their partners

PRIMARY OBJECTIVE

To investigate the level of agreement and differences regarding the perception of family functioning between patients with acquired brain injury and their partners. Our hypothesis was that patients would report better family functioning than their partners.

RESEARCH DESIGN

Cross-sectional studyMethods and Procedures: Baseline data were used from 77 patient-partner dyads (87.0% stroke) who were participating in the ongoing CARE4Patient and CARE4Carer trials. Family functioning was assessed using the General Functioning subscale of the McMaster Family Assessment Device (FAD-GF). Agreement was assessed with intraclass correlation coefficient, a Bland-Altman plot, percentages absolute agreement and weighted kappa values. Differences were tested with Wilcoxon signed-rank tests.

MAIN OUTCOMES AND RESULTS

Patients and their partners differed in their perception of family functioning. Within-dyad agreement was poor regarding the overall FAD-GF scores with partners reporting significantly poorer family functioning compared to the patients (32.5% versus 18.2%). Agreement regarding the individual items ranged from slight to moderate.

CONCLUSIONS

Health care professionals should assess family functioning after stroke in both patients and their partners, and any discrepancies should be discussed with both members of the patient-partner dyad.

Retrospective Evaluation of the Correlation Between Previous Hospitalizations, the Type of Current Living Space, and Quality of Family Function

BACKGROUND AND AIM

There are important public health issues involving rehabilitation of patients living with schizophrenia in the community. The purpose of this study was to analyze the correlations between number of previous hospitalizations, living space and quality of family function in the rehabilitation of patients living with schizophrenia in the community. The study attempts to determine the potential ways to use beneficial factors in recurrent hospitalization for improving treatment and rehabilitation efforts for patients living with long-term chronic schizophrenia.

METHODS

The study included 281 rehabilitations of patients living with schizophrenia in the community. A homemade general questionnaire was used to collect information about the number of previous hospitalizations and the living space of the participants. A family assessment device was used to evaluate the quality of family function of the patients.

RESULTS

The number of previous hospitalizations of persons living with schizophrenia in the community was negatively correlated with the quality of family function (B = 0.063), and there was no statistical difference in the number of previous hospitalizations and the quality of family function of patients in different living spaces.

CONCLUSIONS

The number of previous hospitalizations had a negative impact on family function in the rehabilitation of patients living with schizophrenia in the community. Living space may not have a significant positive effect on family function or the number of previous hospitalizations.

The association between family dysfunction and admission to an acute mental health inpatient unit: a prospective study

OBJECTIVES

With the shift from deinstitutionalization to community care in mental health services, relatives of persons with severe and enduring mental illnesses have had to take over the role as primary caregivers. Disturbed family dynamics have been observed within families with an 'ill' member. Although schizophrenia and related mental illnesses are biologically based disorders, environmental stress (including stress within family relationships) plays a major role in the onset and maintenance of symptoms. With this study, we assume that family dynamics play a central role in the course of severe psychiatric illness and hypothesized that dysfunction within family systems is a prognostic indicator of hospitalization in the course of schizophrenia/bipolar and schizoaffective disorders.

METHODS

Prospective, observational cohort study evaluating family functioning of 121 patients (schizophrenia/bipolar and schizoaffective disorder) from community at baseline and followed-up over 12-month period after recruitment. Measurements included demographics, diagnosis, Family Assessment Device - General Functioning, Perceived Criticism Scale, Brief Psychiatric Rating Scale, Global Assessment of Functioning and Social Support Questionnaire-6.

RESULTS

Significant differences found between patients admitted and not admitted during the 12-month time period for age (p = 0.003), Brief Psychiatric Rating Scale (BPRS; p = 0.026), Family Assessment Device - General Functioning (FAD-GF; p = 0.007) and Social Support Questionnaire total satisfaction level (p = 0.042) at baseline. Bivariate analysis showed that those admitted into hospital were younger with a higher BPRS score, less social satisfaction and disturbed family dynamics. FAD-GF (p = 0.006) and age (p = 0.022) were significant independent predictors for admission.

CONCLUSION

This provides further evidence supporting importance of promoting better family functioning through modified family dynamics, integrating and involving family into the care of such patients.

Developmental evaluation of family functioning deficits in youths and young adults with childhood-onset bipolar disorder

BACKGROUND

Childhood-onset bipolar disorder (BD) is a serious condition that affects the patient and family. While research has documented familial dysfunction in individuals with BD, no studies have compared developmental differences in family functioning in youths with BD vs. adults with prospectively verified childhood-onset BD.

METHODS

The Family Assessment Device (FAD) was used to examine family functioning in participants with childhood-onset BD (n = 116) vs. healthy controls (HCs) (n = 108), ages 7-30 years, using multivariate analysis of covariance and multiple linear regression.

RESULTS

Participants with BD had significantly worse family functioning in all domains (problem solving, communication, roles, affective responsiveness, affective involvement, behavior control, general functioning) compared to HCs, regardless of age, IQ, and socioeconomic status. Post-hoc analyses suggested no influence for mood state, global functioning, comorbidity, and most medications, despite youths with BD presenting with greater severity in these areas than adults. Post-hoc tests eliminating participants taking lithium (n = 17) showed a significant diagnosis-by-age interaction: youths with BD had worse family problem solving and communication relative to HCs.

LIMITATIONS

Limitations include the cross-sectional design, clinical differences in youths vs. adults with BD, ambiguity in FAD instructions, participant-only report of family functioning, and lack of data on psychosocial treatments.

CONCLUSIONS

Familial dysfunction is common in childhood-onset BD and endures into adulthood. Early identification and treatment of both individual and family impairments is crucial. Further investigation into multi-level, family-based mechanisms underlying childhood-onset BD may clarify the role family factors play in the disorder, and offer avenues for the development of novel, family-focused therapeutic strategies.

Families Affected by Huntington's Disease Report Difficulties in Communication, Emotional Involvement, and Problem Solving

Background:

Family functioning in Huntington’s disease (HD) is known from previous studies to be adversely affected. However, which aspects of family functioning are disrupted is unknown, limiting the empirical basis around which to create supportive interventions.

Objective:

The aim of the current study was to assess family functioning in HD families.

Methods:

We assessed family functioning in 61 participants (38 HD gene-expanded participants and 23 family members) using the McMaster Family Assessment Device (FAD; Epstein, Baldwin and Bishop, 1983), which provides scores for seven domains of functioning: Problem Solving; Communication; Affective Involvement; Affective Responsiveness; Behavior Control; Roles; and General Family Functioning.

Results:

The most commonly reported disrupted domain for HD participants was Affective Involvement, which was reported by 39.5% of HD participants, followed closely by General Family Functioning (36.8%). For family members, the most commonly reported dysfunctional domains were Affective Involvement and Communication (both 52.2%). Furthermore, symptomatic HD participants reported more disruption to Problem Solving than pre-symptomatic HD participants. In terms of agreement between pre-symptomatic and symptomatic HD participants and their family members, all domains showed moderate to very good agreement. However, on average, family members rated Communication as more disrupted than their HD affected family member.

Conclusion:

These findings highlight the need to target areas of emotional engagement, communication skills and problem solving in family interventions in HD.

A confirmative clinimetric analysis of the 36-item Family Assessment Device

BACKGROUND

The Family Assessment Device (FAD) is a 60-item questionnaire widely used to evaluate self-reported family functioning. However, the factor structure as well as the number of items has been questioned. A shorter and more user-friendly version of the original FAD-scale, the 36-item FAD, has therefore previously been proposed, based on findings in a nonclinical population of adults.

AIMS

We aimed in this study to evaluate the brief 36-item version of the FAD in a clinical population.

METHODS

Data from a European multinational study, examining factors associated with levels of family functioning in adult cancer patients' families, were used. Both healthy and ill parents completed the 60-item version FAD. The psychometric analyses conducted were Principal Component Analysis and Mokken-analysis.

RESULTS

A total of 564 participants were included. Based on the psychometric analysis we confirmed that the 36-item version of the FAD has robust psychometric properties and can be used in clinical populations.

CONCLUSIONS

The present analysis confirmed that the 36-item version of the FAD (18 items assessing 'well-being' and 18 items assessing 'dysfunctional' family function) is a brief scale where the summed total score is a valid measure of the dimensions of family functioning. This shorter version of the FAD is, in accordance with the concept of 'measurement-based care', an easy to use scale that could be considered when the aim is to evaluate self-reported family functioning.

The Brief Assessment of Family Functioning Scale (BAFFS): a three-item version of the General Functioning Scale of the Family Assessment Device

The purpose of the present study is to compare results from the 12-item General Functioning Scale (GF-FAD) of the Family Assessment Device (FAD) to a three-item version, the Brief Assessment of Family Functioning Scale (BAFFS), designed to be used when brevity is especially important. We used principal components analysis of the GF-FAD, followed by multiple sample confirmatory factor analyses to test the robustness of the BAFFS in different samples. The BAFFS correlated highly with the GF-FAD, and demonstrated good concurrent validity with another measure of global marital functioning, the Dyadic Adjustment Scale-4 in a help-seeking sample. Like the 12-item version, the BAFFS moderately correlated with an objective, interview-based rating of family functioning, the McMaster Clinical Rating Scale. The BAFFS appears to serve as a good proxy for the GF-FAD when an ultra-brief family assessment measure is needed.

Testing the convergent and discriminant validity of the Systemic Therapy Inventory of Change Initial scales

OBJECTIVE

The Systemic Therapy Inventory of Change (STIC^®) is the first multi-systemic and multi-dimensional measurement and feedback system designed for assessment in family, couple, and individual functioning. Patients fill out the STIC Initial before the first session to identify treatment targets and provide starting values for subsequent assessments of trajectories of change. This study tested the construct validity of five of the six STIC Initial scales.

METHODS

We administered both the STIC Initial and a set of validity measures to a relatively large sample of patients. Convergent and discriminant validity were tested using both an examination of observed correlations and confirmatory factor analysis (CFA).

RESULTS

The correlations among the observed measures showed that the convergent validity coefficients were generally large, whereas the discriminant validity coefficients were moderate to small. Similarly, CFAs suggested that the STIC total scales and subscales are good indicators of the factors they were intended to measure and that the STIC total scales and subscales are weakly related to the factors they were intended to not measure.

CONCLUSION

The results supported the convergent and discriminant validity of the five scales of the STIC Initial. Clinical or methodological significance of this article: The clinical significance of this article is that it demonstrates that the STIC Initial should be useful for identifying treatment targets including both which systems, in addition to the facets within each system, that require targeting. The methodological significance is twofold. First, the use of CFA for testing convergent and discriminant validity is still relatively rare. Second, we demonstrated how to use CFA for a more stringent test of discriminant validity compared with the original approach described by Cole ( 1987 ).

The Experience in Personal Social Systems Questionnaire (EXIS.pers): Development and Psychometric Properties

This study presents the theoretical background, development, and psychometric properties of the German and English versions of the Experience in Personal Social Systems Questionnaire (EXIS.pers). It assesses how the members of a personal social system experience their situation within that system. It is designed as a research tool for interventions in which only one member of the system participates (e.g., Family Constellation Seminars). The EXIS.pers was created to measure change on the individual level relating to one's own important personal social system. In Study 1, we used exploratory factor analysis (EFA) for latent variable identification of the original German EXIS.pers (n = 179). In Studies 2 and 3, we used confirmatory factor analysis (CFA) to examine the dimensionality of the German (n = 634) and English (n = 310) EXIS.pers. Internal consistencies and cross-cultural structural equivalence were assessed. EFA indicated that a four-factor model provided best fit for the German EXIS.pers. For both the German and English EXIS.pers, CFA provided the best fit for a five-factor bi-level model that included a general factor (Experience In Personal Social Systems) and four dimensions (Belonging, Autonomy, Accord, Confidence). Good internal consistencies, external associations, and cross-cultural structural equivalence were demonstrated. This study provides first evidence for the German and English EXIS.pers as an economical and reliable measure of an individual's experience within his or her personal social systems.

Perception of social support among family caregivers of vegetative patients: A qualitative study

A vegetative state (VS) is the probable result after brain damage. After VS patients are discharged from the hospital, the responsibility of caring of them is transferred to their families, which impacts a caregiver's physical and psychological health. Social support as a valuable resource reduces the negative effects of stressful events. This study aimed to explore the perception of social support among family caregivers of VS patients. This study is a part of a larger qualitative study which used the descriptive and qualitative method. Purposeful and theoretical sampling was done, and data was gathered through face-to-face, in-depth interviews. The four categories of "Family, a supporter in all aspects," "Beautiful emanation of the nurse's role," "Revitalization via empathy and companionship," and "Defects in support," were extracted. The primary concern of participants was receiving social support which can facilitate caregiving and coping with difficulties, but there are many shortcomings in supporting these caregivers.

Reliability and validity of a short version of the general functioning subscale of the McMaster Family Assessment Device

The General Functioning 12-item subscale (GF12) of The McMaster Family Assessment Device (FAD) has been validated as a single index measure to assess family functioning. This study reports on the reliability and validity of using only the six positive items from the General Functioning subscale (GF6+). Existing data from two Western Australian studies, the Raine Study (RS) and the Western Australian Child Health Survey (WACHS), was used to analyze the psychometric properties of the GF6+ subscale. The results demonstrated that the GF6+ subscale had virtually equivalent psychometric properties and was able to identify almost all of the same families who had healthy or unhealthy levels of functioning as the full GF12 subscale. In consideration of the constraints faced by large-scale population-based surveys, the findings of this study support the use of a GF6+ subscale from the FAD, as a quick and effective tool to assess the overall functioning of families.