The impact of a physically ill parent on adolescents: cross-sectional findings from a clinic population

The association between parental chronic physical illness and adolescent functional somatic symptoms

BACKGROUND

Previous studies have found that adolescents with a chronically ill parent may experience more internalizing problems. It is less clear if this association is sex-related, and whether it is specific for functional somatic symptoms (FSSs) or concerns other internalizing or externalizing problems.

METHODS

In a prospective cohort of adolescents, oversampled on emotional and behavioral problems (n = 841; mean age 14.9 years), we examined the association between parental chronic illness and adolescent's FSSs, and internalizing and externalizing problems. Adolescent's internalizing and externalizing symptoms were measured using the Youth Self Report; parental chronic physical illness was reported during an interview. Associations were tested using linear regression analyses taking into account socio-demographic confounders. We also explored gender-interaction effects.

RESULTS

Having a chronically ill parent (n = 120; 14.3 %) was associated with more FSS in girls (B = 1.05, 95%CI = [0.23, 1.88], p = .013), but not in boys (sex-interaction: p = .013). In girls, an association was also found between parental chronic illness and more internalizing problems (B = 2.68, 95%CI = [0.41, 4.95], p = .021), but this association disappeared when FSSs were excluded from the Internalizing problem scores.

LIMITATIONS

The current study has a cross-sectional design and relied on self-reported parental chronic physical illness what may have induced misclassification.

CONCLUSION

Findings suggest that having a chronically ill parent is associated with more FSSs in adolescent girls and that this association is specific for FSSs instead of general internalizing problems. Girls with a chronically ill parent may profit from interventions to prevent the development of FSSs.

A Systematic Review of Somatic Symptoms in Children With a Chronically Ill Family Member

OBJECTIVE

Somatization and functional somatic symptoms reflect conditions in which physical symptoms are not sufficiently explained by medical conditions. Literature suggests that these somatic symptoms may be related to illness exposure in the family. Children with a parent or sibling with a chronic illness may be particularly vulnerable to developing somatic symptoms. This study provides a systematic review of the literature on somatic symptoms in children with a chronically ill family member.

METHODS

A systematic review (PROSPERO registry ID: CRD42018092344) was conducted using six databases (PubMed, EMBASE, PsychINFO, Scopus, CINAHL, and Cochrane) from articles published before April 5, 2018. All authors evaluated articles by title and abstract, and then by full-text review. Relevant data were extracted by the first author and reviewed by remaining authors.

RESULTS

Twenty-seven unique studies met the criteria. Seventeen examined somatic symptoms in children with a chronically ill parent, and seven evaluated somatic symptoms in children with a chronically ill sibling. Three studies examined somatic symptoms in children with an unspecified ill relative. The strongest relationship between child somatization and familial illness was found with children with a chronically ill parent (13/17 studies). Evidence for somatic symptoms in children with an ill sibling was mixed (4/7 studies found a positive association).

CONCLUSIONS

The literature on somatic symptoms in children suggests that parental illness is related to increased somatic symptoms in children. Research examining the effects of having a sibling with an illness on somatic symptoms is mixed. Several areas of future research are outlined to further clarify the relationship between familial chronic illness and somatic symptoms.

When a parent has cancer: challenges to patients, their families and health providers

At least 14% of cancer patients live with minor children. Being a parent with cancer has far-reaching consequences for individual treatment decision-making and quality of life in patients and their families. Even though the majority of children and adolescents do not show clinically relevant symptoms of psychopathology, worries about the survival of the parent and the future development of the family are present, and experienced as distressing, in most children. Open communication by parents and clinicians has been found to be of major importance for children and adolescents in adjusting to parental cancer. Support for parents with cancer on relevant parenting issues, starting in the diagnostic phase, should be acknowledged as an important facet of cancer care to reduce the psychosocial burden for cancer patients and their families.

Children facing a family member's acute illness: A review of intervention studies

BACKGROUND

A review of psycho-educational intervention studies to benefit children adapting to a close (parent, sibling, or grandparent) family member's serious illness was conducted.

OBJECTIVES

To review the literature on studies addressing this topic, critique research methods, describe clinical outcomes, and make recommendations for future research efforts.

DATA SOURCES

Research citations from 1990 to 2005 from Medline, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, and PsycINFO databases were identified.

REVIEW METHODS

Citations were reviewed and evaluated for sample, design, theoretical framework, intervention, threats to validity, and outcomes. Reviewed studies were limited to those that included statistical analysis to evaluate interventions and outcomes.

RESULTS

Six studies were reviewed. Positive outcomes were reported for all of the interventional strategies used in the studies. Reviewed studies generally lacked a theoretical framework and a control group, were generally composed of small convenience samples, and primarily used non-tested investigator instruments. They were diverse in terms of intervention length and intensity, and measured short-term outcomes related to participant program satisfaction, rather than participant cognitive and behavioral change.

CONCLUSIONS

The paucity of interventional studies and lack of systematic empirical precision to evaluate intervention effectiveness necessitates future studies that are methodologically rigorous.

Developmental predictors of somatic symptoms in adolescents of parents with HIV: a 12-month follow-up

Adolescents of parents with HIV provide a test for proposed risk factors for somatic symptoms. This study prospectively examined family and developmental predictors of somatic symptoms in a high-risk community sample. A longitudinal latent variable model predicted adolescent somatization scores from the Brief Symptom Inventory 12 months after baseline assessment of 211 parent-adolescent pairs. In this cohort, somatic symptoms during adolescence persisted over time (p <.001) and were predicted by female gender (p <.05). In addition, (1). parental distress over pain predicted adolescent somatic symptoms at baseline and follow-up (p <.001), (2). adolescents who experienced their parents as highly rejecting reported more somatic symptoms at follow-up (p <.001), and (3). school problems correlated with somatic symptoms (p <.001), as well as parental rejection (p <.001), at baseline. These findings underscore potential relationships among parental illness, parent-child relationships, and somatic distress. Adolescents with school problems are particularly vulnerable, at least in the short run. These data support a family-based approach to treatment programs for adolescents with increased levels of somatic distress.

Attachment and interpersonal communication in somatization

The authors review the research on childhood antecedents and personality contributions to the somatoform disorders, as well as research on social influences during adulthood. Based on these data, the authors hypothesize that somatizing patients display anxious attachment behavior that derives from childhood experiences with caregivers. Early exposure to illness increases the likelihood that distress will be manifested somatically. When under stress as adults, somatizers use physical complaints to elicit care. Somatizers' interpersonal interactions with others, including physicians, ultimately lead to rejection that reinforces the somatizer's belief that he or she will be abandoned. Modification of physicians' responses to these patients may improve treatment outcomes.

Children's adjustment to parental physical illness

We review recent empirical literature examining the impact of parent physical illness on child functioning. We review studies of illness characteristics (n = 16), individual characteristics (n = 6), and family characteristics (n = 6). Although children's self-reports indicate heightened distress, parental reports do not suggest more problematic functioning. Child adjustment appears to be more closely related to perceptions of stressfulness rather than to objective illness severity indices. Adolescent girls seem to represent a group at heightened risk. Preliminary results suggest that family variables such as cohesion, conflict, and individual and family coping styles are important predictors of child adjustment.

The child's adaptation to parental medical illness: theory and clinical implications

Few resource papers are available to health care providers that address in detail the issues faced by children in adapting to serious parental illness. The current paper offers a developmental approach to understanding the responses and problems of school-age and adolescent children coping with parental medical illness. Four developmental issues are considered: security and separation anxiety, interpersonal understanding, conceptualizations of illness and death and the role of fantasy. Based on these considerations, broad guidelines for clinical interaction are suggested for health professionals working with seriously ill parents and their children.