The experiences of family resilience in patients with permanent colostomy and their spouses: A dyadic qualitative study

PURPOSE

With the prolonged survival time of patients with permanent colostomy for colorectal cancer, they and their spouses face tremendous pressure and development dilemmas that can easily lead to family adaptation crises. This qualitative study amid to explore the dyadic experiences of family resilience among Chinese patients with permanent colostomy and their spouses.

METHODS

A phenomenological research method was adopted. Semi-structured, in-depth, face-to-face interviews with 10 dyads of patients with permanent colostomy and their spouses were recruited through purposive sampling from a public tertiary hospital in China from March 2023 to July 2023.The Dyadic interview analysis and Colaizzi methods were used to analyze the interview data.

RESULTS

Three themes and nine subthemes were developed. (1) family crisis and dichotomous coping with stress-family crisis and coping pressure caused by enterostomy; (2) Adjustment and adaptation within the family-Joint adjustment and adaptation within the couple's family; and (3) integration and utilization of multi-dimensional social external resources (micro-level, meso-level, and macro-level).

CONCLUSIONS

Couples living with permanent colostomy often undergo a complex emotional journey, experiencing varied levels of individual stress as they navigate social interactions and daily activities, which can contribute to a decline in family adaptation. With the help of the perspective of family advantage, health practitioners should pay attention to the evaluation of individual factors and family environmental resources, to fully mobilize advantage resources and give effective interventions to improve the family and social adaptation level of patients and their spouses.

A reliability generalization meta-analysis of the family resilience assessment scale (FRAS)

PROBLEM

Practitioners and researchers frequently rely on the Family Resilience Assessment Scale (FRAS) to assess family resilience, and previous research reported varying reliability statistics for the measurements with the scale. The present study aims to generalize the reliability of the FRAS based on Cronbach's alpha coefficients reported in the selected studies.

ELIGIBILITY CRITERIA

We selected relevant research on various databases, including Web of Science, PubMed, ProQuest, Scopus, YÖK Thesis Center, DergiPark, and TR Index.

SAMPLE

Satisfying our inclusion criteria, fifty-five studies were included in the present study.

RESULTS

We calculated the reliability generalization coefficients for the FRAS total score to be 0.951 (95% CI [0.942, 0.958]) and 0.949 for Family Communication and Problem Solving, 0.792 for Utilizing Social and Economic Resources, 0.861 for Maintaining a Positive Outlook, 0.635 for Family Connectedness, 0.873 for Family Spirituality, and 0.702 for Ability to Make Meaning of Adversity.

CONCLUSIONS

In a nutshell, our findings secure substantial insights into the reliability of the FRAS and its subscales for prospective researchers and practitioners. In this study, generalized Cronbach's alpha values imply average, good, and acceptable reliability for the FRAS subscales and total score, except for Family Connectedness.

IMPLICATIONS

The distinct contribution of our research may be to reemphasize the significance of avoiding reliability induction and to raise awareness among prospective researchers of evaluating the reliability of any measurement they would obtain.

Factors influencing family resilience in adult patients with acute leukemia undergoing chemotherapy: A qualitative study

Objective

To explore the factors influencing family resilience in adult patients with acute leukemia undergoing chemotherapy, with the aim of providing a theoretical basis for the development of strategies to strengthen their family resilience.

Methods

A descriptive phenomenological qualitative research method was used to select 11 adult acute leukemia chemotherapy patients for semi-structured interviews. Colaizzi 7-step analysis and NVivo 12.0 were used to summarize information and refine themes.

Results

The main outcomes consisted of two themes and 11 sub-themes: protective factors for family resilience (positive traits, cognitive restructuring, positive family beliefs, organizational flexibility, clear communication, and social support) and risk factors for family resilience (symptom burden, self-concealment, role overload, economic distress, and social alienation).

Conclusions

Health care professionals should pay attention to screening protective and risk factors for family resilience in adult acute leukemia chemotherapy patients, affirming the positive role of internal and external resources available in the family in stressful situations, alleviating patients' negative experiences, and promoting the recovery of family function.

The impact of caregiver burden on quality of life in family caregivers of patients with advanced cancer: a moderated mediation analysis of the role of psychological distress and family resilience

BACKGROUND

The caregiver burden frequently experienced by family members tending to advanced cancer patients significantly impacts their psychological well-being and quality of life (QoL). Although family resilience might function as a mitigating factor in this relationship, its specific role remains to be elucidated. This study aims to probe the mediating effect of psychological distress on the relationship between caregiver burden and QoL, as well as the moderating effect of family resilience.

METHODS

A cross-sectional study was conducted between June 2020 and March 2021 in five tertiary hospitals in China. Data were collected on caregiver burden, family resilience, psychological distress (including anxiety and depression), and QoL. Moderated mediation analysis was performed.

RESULTS

Data analysis included 290 caregivers. It confirmed the mediating role of psychological distress in the caregiver burden-QoL relationship (P < 0.001). Both overall family resilience and the specific dimension of family communication and problem-solving (FCPS) demonstrated significant moderating effects on the "psychological distress/anxiety-QoL" paths (P < 0.05). The utilization of social and economic resources (USER) significantly moderated the association between depression and QoL (P < 0.05).

CONCLUSIONS

The study corroborates psychological distress's mediation between caregiver burden and QoL and family resilience's moderation between psychological distress and QoL. It underscores the need for minimizing psychological distress and bolstering family resilience among caregivers of advanced cancer patients. Accordingly, interventions should be tailored, inclusive of psychological assistance and promotion of family resilience, particularly focusing on FCPS and USER, to augment the caregivers' well-being and QoL.

The dyadic effects of family resilience and social support on quality of life among older adults with chronic illness and their primary caregivers in multigenerational families in China: A cross-sectional study

Older adults with chronic illness, as well as their primary caregivers in multigenerational families, may experience a complex interplay of factors that affect their quality of life (QOL). However, this interplay is not yet well-characterized for Chinese multigenerational families in particular. In this study, we analyzed how family resilience and social support affect the QOL of both older adults and caregivers in multigenerational Chinese families specifically. We enrolled 258 pairs of older adults with chronic illness and their primary caregivers in a multicenter cross-sectional study conducted in southern China in December 2021. Using the Actor-Partner Interdependence Model (APIM), we then examined the correlation between family resilience, social support, and QOL in dyadic analysis and found that QOL, family resilience, and social support for primary caregivers were better than those of older adults with chronic illness (t = 3.66-16.3, p＜0.01). These factors were found to be positively correlated (r = 0.22-0.60, p＜0.05), except for the family resilience of primary caregivers and the QOL of older adults with chronic illness (r = -0.14, p = 0.04). Additionally, actor effect results showed that when a dyadic member has high family resilience and objective social support, they tend to have a better QOL (β = 0.5-1.48, P < 0.01). However, partner effect results showed that when the primary caregiver has high family resilience, this is associated with a worse QOL for the older adult (β = -1.06, P < 0.01). Furthermore, we found that objective social support of dyads does not significantly influence their partner's QOL (β = 0.88/0.31, P＞0.05) for any pair. This suggests that medical staff should pay attention to the impact of family resilience on the QOL of older adult and caregiver dyads and explore health management plans that focus on binary coping in multigenerational families.

A latent class analysis of family resilience and its relationship with fear of recurrence in lung cancer patients: a cross-sectional study

PURPOSE

Family resilience helps cancer-affected families overcome challenges and may influence an individual's fear of cancer recurrence (FCR). Identifying distinct classes of family resilience among lung cancer patients is crucial for tailored interventions. This study aimed to identify latent classes of family resilience in lung cancer patients and explore their relationships with FCR.

METHODS

Three hundred ten lung cancer patients from three hospitals in Fujian were recruited from June to September 2021. Clinical data were extracted from medical records, while sociodemographic details, family resilience, and FCR were self-reported. A latent class analysis was performed to identify family resilience classes.

RESULTS

A 4-class solution showed the best fit. Compared to Class 1, the patients who had no comorbidities (ORs = 3.480-16.005) had an increased likelihood of belonging to Class 2 and 3, while those who were not family breadwinners (ORs = 0.118-0.176) had a decreased likelihood. Further, the patients who (1) did not lack interest/pleasure in doing things during the past 2-week period (OR = 7.057), (2) were never smokers (OR = 6.230), and (3) were urban residents (OR = 8.985) had an increased likelihood of belonging to Class 4, while those who were (1) male (OR = 0.167), (2) not the family breadwinner (OR = 0.152), and (3) had none or only one child (OR = 0.203) had a decreased likelihood of belonging to Class 4. The FCR level differed significantly among these four classes.

CONCLUSION

Our study identified four distinct classes of family resilience among Chinese lung cancer patients. FCR severity decreased with increasing levels of family resilience.

The mediating effect of family resilience between coping styles and caregiver burden in maintenance hemodialysis patients: a cross-sectional study

BACKGROUND

Primary caregivers of hemodialysis patients suffer from varying degrees of stress from their patients. Caring for hemodialysis patients can expose caregivers to many problems, leading to an increased burden of care and even impacting the quality of care. The purpose of our study was to examine whether family resilience could be a mediating variable moderating the relationship between patient coping styles and caregiver burden.

METHODS

The study was a cross-sectional and descriptive-analytical study that interviewed 173 pairs of hemodialysis patients and their caregivers at a blood purification center in a public hospital in China. The Brief Coping Styles Scale (Chinese version) was used to assess individuals' coping styles for disease and treatment. From the caregiver's perspective, the Family Resilience Assessment Scale (Chinese version) was used to understand the resilience of families, and the Zarit Caregiver Burden Scale was used to capture the caregiver's subjective experience of burden. Statistical analyses were conducted using SPSS version 23 and Amos version 26 to analyze the relationships between variables to examine for correlation and construct mediated effects models.

RESULTS

Coping styles showed a significant positive correlation with family resilience (r = 0.347, P < 0.01) and a negative correlation with caregiver burden (r = -0.379, P < 0.01). A significant negative correlation was found between family resilience and caregiver burden (r = -0.503, P < 0.01). In the mediation model, patient coping styles directly impacted caregiver burden significantly (95% CI [-0.372, -0.058]), and coping styles indirectly impacted caregiver burden by family resilience in a significant way (95% CI [-0.275, -0.098]).

CONCLUSIONS

Patient coping styles directly affect caregiver burden. Family resilience is a mediating variable between patients' coping styles and the burden on caregivers.

Independent predictors of family resilience in patients with ischemic stroke: A cross-sectional survey

Background

Globally, China bears the highest stroke burden, emphasizing the paramount importance of comprehending the influencing factors on family resilience among patients with ischemic stroke to promote their physical and mental well-being, as well as enhance the quality of their life. This understanding can concurrently assist healthcare professionals in formulating interventions aimed at fostering healthy family functioning.

Objective

To investigate the level of family resilience in patients with ischemic stroke and its predictive factors.

Methods

A total of 310 inpatients with ischemic stroke were recruited from three tertiary general hospitals in China between May and November 2021. The study employed a range of instruments for data collection, including the General data questionnaire, Family Resilience Rating Scale, Simplified Coping Style Questionnaire, Perceived Social Support Scale and Connor-Davidsion Re-silience Scale. Data analysis was conducted using SPSS 22.0 statistical software. Non-parametric tests, Spearman analysis, and multiple stepwise regression were employed to investigate the predictive variables of family resilience.

Results

A total of 303 patients successfully completed the investigation, yielding an efficacy rate of 97.74 %. The total scores for family resilience spanned from 87 to 245, with a median (P25, P75) of 187 (160, 200). The highest scores were observed in the dimension of dilemma interpretation, while the lowest scores were recorded in the dimension of social support. Family relationship (β = 0.459, P<0.001), positive coping (β = 0.182, P<0.001), out-of-family support(β = 0.156, P<0.001), in-family support (β = 0.147, P = 0.002), and optimism (β = 0.108, P = 0.013) were found to be predictive factors of family resilience.

Conclusion

Patients with high family resilience demonstrated superior family relationship, effective positive coping strategies, increased support within and outside the family, and a more optimistic attitude; these factors independently predict family resilience.

The relationship between family resilience and the psychological well-being and life satisfaction of pregnant women: the mediating role of individual resilience

BACKGROUND

Pregnancy period is an important experience in the life process of married women, which leads them to growth and development and is considered as a part of the puberty process. The aim of this research is to determine the mediating role of individual resilience in relation to family resilience, psychological well-being and life satisfaction of the pregnant women. The current study is correlational according to the practical purpose and based on data collection.

METHODES

The study population of the current research is all pregnant women in 2021, and 361 of them responded to the self-report questionnaires of family resilience, psychological well-being, life satisfaction, and individual resilience. To analysis the model, the path analysis method was used utilization spss-26 and Lisrel 10.2 software.

RESULTS

The results show a good fit of the model with the data. The results also showed a direct and significant effect between life satisfaction with obligation (β = 0.22 and t = 3.42), with challenge (β = 0.28 and t = 3.98), with control (β = 0.11 and t = 2.13), psychological well-being with obligation (β = 0.20 and t = 3.11), with challenge (β = 0.20 and t = 2.73) and with control (β = 0.45 and t = 10.34).

CONCLUSION

The upshot of this research can be considered in interventions related to pregnant women. Strengthening resilience in this group can be useful for increasing life satisfaction and psychological well-being of pregnant women.

Caregiver burden, mutuality, and family resilience in colorectal cancer caring: A mediating model analysis

PURPOSE

This study investigates the interaction between caregiver burden, mutuality, and family resilience in colorectal cancer management, and determines whether mutuality affects the effect of caregiver burden on family resilience.

METHOD

In this cross-sectional study, 295 family caregivers of colorectal cancer patients from two major public hospitals (Henan Province, China) were analyzed. Caregiver burden, mutuality, and family resilience were assessed through Chinese versions of the Zarit Burden Interview (ZBI-C), the mutuality Scale (MS-C), and the Family Resilience Questionnaire (FaREQ-C). The structural equation model and multiple mediating effect test were applied to explore the interaction between caregiver burden, mutuality, and family resilience.

RESULTS

Total and subscale scores of caregiver burden were negatively correlated with both mutuality (r = -0.54 to -0.32, P < 0.01) and family resilience (r = -0.60 to -0.26, P < 0.01). Family resilience and its four dimensions were positively correlated with mutuality (r = 0.17 to 0.51, P < 0.01). Mutuality served as a partial mediator between caregiver burden and family resilience. Caregiver burden had an indirect effect on family resilience through mutuality (β = -0.157, 95%CI: -0.316, -0.046, P = 0.009).

CONCLUSIONS

This study examined the interaction between caregiver burden, mutuality, and family resilience for colorectal cancer caring and confirmed the mediating role of mutuality in caregiver burden and family resilience. Therefore, we suggested that clinicians should develop strategies to improve the relationship between patients and caregivers so that both parties can actively manage stress and trauma experiences for improved colorectal cancer management.

Post-surgery financial toxicity and its influencing factors in colorectal cancer care: A cross-sectional study

PURPOSE

This study aimed to investigate the influence factors of financial toxicity experienced by colorectal cancer patients after surgery. The results will provide deep insights for developing effective intervention strategies to address this common issue of colorectal cancer care.

METHODS

In this cross-sectional study, we recruited 213 postoperative patients with colorectal cancer from February 2023 to July 2023 in two major public hospitals. Patients completed the General Information Questionnaire, Comprehensive Scores for Financial Toxicity (COST), Self-perceived Burden Scale (SPBS), Family Resilience Questionnaire (FaREQ), and Social Support Rating Scale (SSRS). A multiple linear regression model was used to investigate the influence factors of financial toxicity.

RESULTS

The mean score of financial toxicity was medium (18.91 ± 7.90) in this study. Financial toxicity score was negatively correlated with self-perceived burden (r = -0.333, P < 0.01) and positively associated with family resilience (r = 0.365, P < 0.01) and social support (r = 0.388, P < 0.01). Via multiple linear regression analysis, we identified seven significant factors associated with financial toxicity, including family income [(95 %CI: 1.075-3.123); P = 0.000], self-perceived burden [(95 %CI: 0.300∼-0.038); P = 0.012], stoma [(95 %CI: 5.309∼-1.682); P = 0.000], social support [(95 %CI:0.058-0.407); P = 0.009], cancer stage [(95 %CI: 2.178∼-0.170); P = 0.022], postoperative duration [(95 %CI: 1.900∼-0.332); P = 0.005], and family resilience [(95 %CI: 0.028-0.203); P = 0.010].

CONCLUSIONS

Financial toxicity was prevalent among postoperative colorectal cancer patients. Additional support and early interventions should be given to high-risk patients, including those with stomas, advanced disease stages, or experiencing longer postoperative duration. Apart from demographic factors, we identified that self-perceived burden, family resilience, and social support were also associated with financial toxicity, providing a new perspective for developing effective strategies against financial toxicity.

Social support, family resilience and psychological resilience among maintenance hemodialysis patients: a longitudinal study

BACKGROUND

Psychological distress is common in maintenance hemodialysis patients, and high psychological resilience can promote psychological well-being. The current research focuses on psychological resilience protective factors such as family resilience and social support. However, the trajectories of psychological resilience, family resilience, and social support over time and their longitudinal relationships in maintenance hemodialysis patients have not been fully explored yet. Therefore, this study aims to explore the longitudinal relationship between these factors.

METHODS

Patients who received regular hemodialysis treatment for more than three months at dialysis centers of three tertiary hospitals in Zhejiang, China, were recruited from September to December 2020. A total of 252 patients who met the inclusion and exclusion criteria completed three follow-up surveys, including social support, family resilience, and psychological resilience assessments. A repeated measures ANOVA was used to explore differences in their respective scores at different time points. The cross-lagged analysis was performed in AMOS using the maximum likelihood method to examine the the reciprocal predictive relationships between these factors.

RESULTS

Social support and psychological resilience remained relatively stable over time, whereas family resilience indicated a little increasing trend. According to the cross-lagged analysis, higher T1 social support predicted higher family resilience at T2 [β = 0.123, 95% CI (0.026-0.244)]. Further, the effects of T2 social support to T3 family resilience [β = 0.194, 95%CI (0.039-0.335)] and psychological resilience [β = 0.205, 95%CI (0.049-0.354)] were significant. Finally, the effects of T2 family resilience to T3 social support [β = 0.122, 95%CI (0.010-0.225)] and psychological resilience [β = 0.244, 95%CI (0.119-0.359)] were also significant.

CONCLUSIONS

The study showed that the directionality of the relationship appears to be from social support or family resilience to patients' psychological resilience but not vice versa. This finding reminds healthcare professionals to emphasize the vital role of social and family resources in providing appropriate support and interventions for maintenance hemodialysis patients to promote psychological resilience and mental health development.

The relationship between family communication and family resilience in Chinese parents of depressed adolescents: a serial multiple mediation of social support and psychological resilience

BACKGROUND

Family resilience plays a crucial role in helping depressed adolescents overcome challenges. However, studies examining family resilience in depressed adolescents are currently scarce. This study, guided by the family resilience framework, aimed to investigate the serial-multiple mediation of social support and psychological resilience between family communication and family resilience in Chinese families of depressed adolescents.

METHODS

In 229 parents of adolescents with major depressive disorder, 20.1% comprises of fathers, while 79.9% comprises of mothers. The mean age of depressed adolescents was 14.84 (±1.76) years, and the mean age of parents of these depressed adolescents was 43.24 (±4.67) years. The Family Resilience Assessment Scale (FRAS), the Psychological Resilience of Parents of Special Children Questionnaire, and the Social Support Rating Scale, Family Assessment Device (FAD) were used to collected data. Descriptive, univariate, and Pearson correlation analyses were used in preliminary analyses. To explore mediation, we employed a serial-multiple mediation model (PROCESS model 6).

RESULTS

Family communication was positively correlated with family resilience, social support, and psychological resilience. Mediation analysis revealed indirect effects of family communication on family resilience, which were mediated solely by either social support or psychological resilience, or through multiple mediation pathways involving both social support and psychological resilience.

CONCLUSIONS

Family communication positively and directly affects the family resilience of depressed adolescents, and a higher level of social support and psychological resilience can help improve family resilience. These findings not only provide empirical evidence supporting the family resilience framework but also have practical implications for future family interventions targeting depressed adolescents.

Development of a theory-based family resilience intervention program for parents of children with chronic diseases: A Delphi study

BACKGROUND

Long-term illness exposes children with chronic diseases to a high risk of deterioration of physical and mental health. Developing an effective family resilience intervention program is a critical concern.

OBJECTIVE

To develop a theory-based family resilience intervention program for parents of children with chronic diseases and provide a reference for clinical intervention.

METHODS

A two-phased research design, guided by the Walsh family resilience process model, was employed to develop the intervention program. In phase 1, a scoping literature review was conducted to identify the possible elements of family resilience interventions. In phase 2, a three-round Delphi survey was conducted with experts (n = 14) using an online electronic survey to obtain their consensus on the intervention content.

RESULTS

Three main components were identified: (1) strengthening family beliefs, (2) adjusting the family organization pattern, and (3) improving the family communication process. And 8 modules were developed: "introducing adversity and family resilience", "finding and strengthening positive family beliefs, and building confidence to live with the disease", "analyzing and adjusting family structure", "assisting families to increase and utilizing internal and external resources", "optimizing communication skills", "strengthening collaborative problem-solving capacity", "enhancing the family narrative ability", and "enhancing emotional expression". After 3-round Delphi, the findings indicated that the intervention program is applicable and feasible for parents of children with chronic diseases in China.

CONCLUSION

The principal merit of this study lies in the development of a family resilience intervention program for parents of children with chronic diseases. The intervention's usability and efficacy should be investigated in future studies.

IMPLICATIONS TO PRACTICE

Developing a family resilience intervention program is a critical first step toward providing effective care for parents of children with chronic diseases, and evaluating the program's feasibility and suitability in the target population is warranted.

The 4-item family resilience scale: psychometric evaluation and measurement invariance of the malay version in adolescents and young adults

BACKGROUND

The original Family Resilience Scale (FRS) is a reliable tool to assess family resilience. However, the FRS is based on the United States and parental context. Thus, the usefulness of the FRS for the adolescent and young adult population in Asian countries, particularly Malaysia remains unknown. This study translated the FRS into the Malay language and validated it on Malaysian adolescents and young adults to identify its potential as a self-report tool to assess the resilience level of their family.

METHODS

A total of 351 participants (Mage = 19.75, SDage = 3.29) were recruited in the study using purposive sampling. Confirmatory factor analysis was conducted to examine the factorial structure of the Family Resilience Scale-Malay (FRS-Malay) and measurement invariance between adolescents and young adults. Then, the scale's reliability was investigated using Cronbach's alpha, McDonald's omega coefficients, and composite reliability index. Finally, we examined the discriminant validity of the FRS-Malay by correlating its score with individual resilience score and examined the incremental validity of the scale using hierarchical multiple regression analysis to test if family resilience can explain individual well-being levels beyond and above individual resilience.

RESULTS

The findings of the confirmatory factor analysis suggest that a single-factor model is supported for both age groups. Furthermore, the scale exhibited scalar invariance between adolescents and young adults. The scale also exhibited good reliability, as the value of Cronbach's alpha, McDonald omega coefficients, and composite reliability index were above 0.80. Additionally, the Pearson correlation analysis showed a positive correlation between the FRS-Malay and individual resilience scores, which supports the discriminant validity of the scale. Similarly, the incremental validity of the scale is also supported. Specifically, family resilience had a positive correlation with well-being, even after controlling for individual resilience in the regression analysis.

CONCLUSIONS

The FRS-Malay has demonstrated good reliability and validity. The scale measures the same construct of family resilience across adolescents and young adults, making it suitable for comparisons. Therefore, this unidimensional tool is appropriate for self-reporting their perceived level of family resilience. It is also useful for studying the development and fluctuation of family resilience in the Malaysian context.

Dyadic effects of family resilience on quality of life in patients with lung cancer and spousal caregivers: The mediating role of dyadic coping

PURPOSE

This study explored the effects of family resilience on quality of life (QOL) and examined whether dyadic coping mediates these effects in patients with lung cancer and their spousal caregivers.

METHODS

In total, 313 dyads were recruited from three tertiary hospitals in Fujian Province, China, between March and July 2022. Study participants independently completed sociodemographic and clinical characteristics questionnaires, the Shortened Chinese version of the Family Resilience Assessment Scale, the Dyadic Coping Inventory, and the 8-Item Short-Form Health Survey. Data analysis utilized the actor-partner interdependence mediation model (APIMeM).

RESULTS

Family resilience of both patients with lung cancer and their spouses were positively and directly associated with their own QOL, which was mediated by dyadic coping. Family resilience did not significantly influence the partners' QOL. The APIMeM model produced acceptable fit (χ2/df = 2.857, RMSEA = 0.077, CFI = 0.992, TLI = 0.941, and NFI = 0.998).

CONCLUSION

Dyadic coping mediated both actor and partner effects between family resilience and QOL, and there was no significant direct partner effect between individual family resilience and their partner's QOL. The development of efficient family- or dyad-based interventions is essential to improve family resilience and encourage dyadic coping strategies among patients with lung cancer and their spousal caregivers who experience poor family resilience and low dyadic coping. Such interventions have the potential to enhance QOL for both parties.

Effect of stressors on family adaptation in stroke patients: A parallel multivariable mediation model

AIMS

The mechanisms underlying how stressors affect family adaptation are unclear. This study determined the relationship between stressors and family adaptation among stroke patients, particularly the parallel mediating role of family function and family resilience.

METHODS AND RESULTS

The study was conducted in the neurology ward of a tertiary hospital in China. A total of 335 stroke inpatients were interviewed face-to-face from August 2020 to March 2021. A questionnaire was administered that included demographic characteristics, the Family Inventory of Life Events and Changes, Family Apgar Index Scale, Family Hardiness Index Scale, and Family Adaptation Scale. The demographic data and correlations among the research variables were analyzed. A bootstrap method using the SPSS PROCESS macro was employed to test a mediation model. Family adaptation was negatively related to stressors (r = -0.291, p < 0.01) and positively related to family function (r = 0.531, p < 0.01) and family resilience (r = 0.393, p < 0.01). Furthermore, family function and family resilience played parallel mediating roles between stressors and family adaptation.

CONCLUSIONS

This study elaborated how stressors interacted with family adaptation through the mediation of family function and family resilience. The findings suggest that enhancement of family function and family resilience may help to improve family adaptation among stroke patients.

Relationship between illness perception and family resilience in gynecologic cancer patients: the mediating role of couple illness communication

OBJECTIVE

To analyze the current family resilience levels of Chinese patients with gynecologic cancer and explore the mediating role of couple illness communication between illness perception and family resilience to facilitate patient adaptation to cancer.

METHODS

A total of 310 patients with gynecologic cancer were selected from the gynecology ward of a tertiary care hospital in Jinan, Shandong Province, China. All participants provided their demographic and clinical information and completed the Brief Illness Perception Questionnaire (BIPQ), Couples' Illness Communication Scale (CICS), and Family Hardiness Index (FHI). The mediating effect of couple illness communication was analyzed using SPSS26.0 and Amos21.0.

RESULTS

The family resilience score of patients with gynecologic cancer was moderate (55.78 ± 8.65). Illness perception was negatively correlated with couple illness communication(p < 0.05) and family resilience(p < 0.01), while couple illness communication was positively correlated with family resilience (p < 0.01). Couple illness communication mediated the relationship between illness perception and family resilience [β = - 0.071; 95% confidence interval: (- 0.127)-(- 0.013)].

CONCLUSIONS

The family resilience of patients with gynecologic cancer must be further improved. Since couple illness communication mediates the relationship between illness perception and family resilience in this population, it is important to improve patients' illness perceptions and couple illness communication to enhance their family resilience.

Family resilience and its influencing factors among advanced cancer patients and their family caregivers: a multilevel modeling analysis

BACKGROUND

Cancer is highly prevalent worldwide. Family resilience is a positive variable that helps families burdened by advanced cancer to cope effectively. This study aimed to describe the family resilience of advanced cancer patients and caregivers in dyads and identify its influencing factors at the individual and dyadic levels.

METHODS

This multisite cross-sectional study was conducted in oncology units in five tertiary hospitals in China. A total of 270 advanced cancer patient-caregiver dyads were recruited between June 2020 and March 2021. Patients' and caregivers' family resilience was measured by the Family Resilience Assessment Scale. Data on potential influencing factors, including demographic and disease-related characteristics as well as family sense of coherence, psychological resilience, perceived social support, symptom burden, and caregiver burden, were collected. Multilevel modeling analysis was adopted to control for the interdependence of the dyads.

RESULTS

A total of 241 dyads were included in the data analysis. The mean ages of patients and caregivers were 53.96 (SD 15.37) and 45.18 (SD 13.79) years, respectively. Most caregivers were spouses and adult children (45.6% and 39.0%, respectively). Patients reported a higher mean family resilience score than caregivers (152.56 vs. 149.87, respectively). Undergoing fewer than two types of treatment and a lower symptom burden of patients predicted higher patient (B = -9.702, -0.134, respectively) and caregiver (B = -5.462, -0.096, respectively) family resilience. Patients also reported higher family resilience under the following conditions: 1) were on a medical insurance plan other than the new rural cooperative medical system (B = 6.089), 2) had a better family sense of coherence (B = 0.415), 3) whose caregivers were unmarried (B = 8.618), perceived lower social support (B = -0.145) and higher psychological resilience (B = 0.313). Caregivers who were ≤ 44 years old (B = -3.221), had similar previous caregiving experience (B = 7.706), and had a stronger family sense of coherence (B = 0.391) reported higher family resilience.

CONCLUSIONS

Our findings highlight the importance of adopting a dyadic approach when caring for advanced cancer patients and their caregivers. Dyadic longitudinal research is suggested to discover more modifiable factors of family resilience and tailored interventions are needed to obtain optimal dyadic outcomes.

Higher family and individual resilience and lower perceived stress alleviate psychological distress in female breast cancer survivors with fertility intention: a cross-sectional study

PURPOSE

The aim of this study was to explore how family resilience and individual resilience reduce perceived stress and psychological distress in young female breast cancer survivors with fertility intention.

METHODS

From June 2020 to June 2021, female breast cancer survivors were selected from the cancer centers of 10 tertiary Level A general hospitals in five cities of Sichuan Province. The survivors completed the Chinese versions of the Family Resilience Assessment Scale, Connor-Davidson Resilience Scale, Perceived Stress Scale, and a self-report distress thermometer. A multiple mediation effects test and structural equation modeling were used to explore the relationships among family resilience, individual resilience, perceived stress, and psychological distress.

RESULTS

The direct effect of family resilience on perceived stress was β = -0.320 (95% confidence interval -0.365, -0.271, P < 0.01). The direct effect of family resilience on psychological distress was β = -0.263 (95% confidence interval -0.363, -0.153, P < 0.001). The direct effect of family resilience on individual resilience was β = 0.593 (95% confidence interval 0.542-0.640, P < 0.001). The indirect effect of family resilience on psychological distress was β = -0.322 (95% confidence interval -0.373, -0.274, P < 0.001). Both perceived stress and individual resilience mediated the relationship between family resilience and psychological distress. Furthermore, a partial mediating effect of perceived stress and individual resilience on family resilience and psychological distress was observed.

CONCLUSION

Young female breast cancer survivors in China experience moderate levels of psychological distress.

National Study of Family Resilience During the COVID-19 Pandemic

The COVID-19 pandemic has significantly disrupted the lives of children and their caregivers. Recent research has examined the impact of the pandemic on child and caregiver functioning but there is a paucity of work examining the impact of the pandemic on the broader family system. The current study examined family resilience during the COVID-19 pandemic across three aims: Aim 1 tested whether meaning, control, and emotion systems form a unitary family adaption factor, Aim 2 evaluated a concurrent model of family resilience, and Aim 3 examined whether parent gender and vaccination status moderated paths in the final model. A nationally representative sample of U.S. parents (N = 796; 51.8% fathers, M age = 38.87 years, 60.3% Non-Hispanic White) completed a cross-sectional survey about themselves and one child (5-16 years old) between February-April 2021, including measures of COVID-19 family risk and protective factors, pre-existing family health vulnerabilities, race, COVID-19 stressors, and family adaptation. Confirmatory Factor Analysis demonstrated that the meaning (i.e., family making meaning of COVID-19), control (i.e., stability in routines), and emotional (i.e., family support) facets of family adaptation are unique but related. A path model revealed that there were concurrent effects from COVID-19 exposure, pre-existing vulnerabilities, and racial diversity status to the family protective, vulnerability, and adaptation variables. Additionally, parent COVID-19 vaccination status altered the association between pre-existing family health vulnerabilities and the family protective factor. Overall, results underscore the importance of examining pre-existing and concurrent risk and protective factors for family resilience during a stressful, global, and far-reaching event.

Development and effects of an internet-based family resilience-promoting program for parents of children with cancer: A randomized controlled trial

PURPOSE

The diagnosis of cancer in children can negatively impact their parents, owing to the complex treatment processes. Families with high levels of resilience can overcome these difficulties and thus perform higher family functions. We aimed to develop an internet-based family resilience-promoting program for parents of children with cancer and evaluate its effect on the levels of family resilience, depression, and family function.

METHODS

This prospective, parallel-group, randomized-controlled study that was conducted at Yonsei Cancer Center from June to October 2021 included 41 parents of children with cancer. In total, four sessions of the internet-based family resilience-promoting program, led by a nurse, were conducted individually for parents. Levels of family resilience, depression, and family function were measured before, immediately after, and 4 weeks after the program. The data were analyzed using the linear mixed-effect model, and program satisfaction was evaluated through an internet-based questionnaire and interview.

RESULTS

The experimental group (the family resilience-promoting program participants) differed more significantly from the control group in the level of change in family resilience (β = 13.214, p = 0.003, effect size = 0.374) and family function (β = 1.256, p = 0.018, effect size = 0.394). However, there was no significant difference between the groups in the level of depression (β = 2.133, p = 0.187, effect size = 0.416). All the program participants showed a high program satisfaction score of 4.75 out of 5.00 points overall.

CONCLUSIONS

The applicability of the internet-based family resilience-promoting program as an appropriate nursing intervention was verified. Its application can help the families of children with cancer adapt to the stressful situation of their children's cancer diagnosis and treatment.

Couple communication quality and family resilience among Chinese gynecologic cancer patients and their spouses: a dyadic study

PURPOSE

The purpose of this study was to explore the couple communication process for gynecologic cancer (GC) patients and their spouses. Particular attention was given to examining the relationship between couple communication quality and family resilience for GC dyads.

METHODS

In this cross-sectional study, 354 dyads were recruited from a gynecology ward of a public hospital in China. The patients and their spouses completed the Couples' Communication Quality Scale and the Family Hardiness Index. This study used the actor-partner interdependence model (APIM) to examine the effect of couple communication quality on family resilience in distinguishable GC dyads.

RESULTS

Both GC patients and their spouses reported a moderate level of couple communication quality and family resilience, but spouses reported better couple communication and family resilience than patients. With the exception of perceived response, for which only a patient actor effect was observed, the factors of couple communication quality had significant actor effects on family resilience for both patients and spouses. Additionally, four significant partner effects were found: spouse self-disclosure, stress coping, and productive action positively predicted patients' family resilience, while patient normalcy crafting positively predicted spouses' family resilience.

CONCLUSION

This study not only highlights the need for couple-based communication strategies for developing family resilience but also identifies differences in the experiences of patients and their partners, which provides a direction for future intervention research. Through the development of interventions at a dyadic level, spouses can be encouraged to actively engage in communication, which may promote mutual family resilience in a larger sense.

Association Between Maternal Health Status and Family Resilience: Results from a National Survey

OBJECTIVE

The relationship between maternal health and health outcome of offspring has been studied extensively. However, measures such as family resilience in the context of maternal health are not well understood. The objective of this study was to determine if overall maternal health status is associated with family resilience.

METHODS

Using the 2016 National Survey of Children's Health, a nationally representative survey of parents/guardians of children ages 0-17, we evaluated the association of overall maternal health status with measures of family resilience. The analysis was performed using descriptive and multivariable analyses. The study adjusted for current health insurance status, family structure of child's household, income level, highest education of adult in household, child race, primary household language, children with special health care needs, emotional support, neighborhood support, parental aggravation, and adverse childhood experiences.

RESULTS

Compared to mothers who reported their physical health to be good, mothers who had a very good/excellent physical health status reported significantly higher adjusted rates for family resilience measures [Adjusted Odds Ratio (AOR) 0.741, 95% Confidence Interval (CI) (0.640, 0.859); p < 0.001]. Results suggested also that mothers whose mental health was very good/excellent were more likely to exhibit greater family resilience as compared to those that were good [(AOR) 0.452, 95% (CI) (0.390, 0.525); p < 0.001] or poor/fair [(AOR) 0.283, 95% (CI) (0.223, 0.360); p < 0.001].

CONCLUSION

Our findings suggest that maternal mental and physical health may contribute to how families respond to adversity. Our findings highlight the importance of evaluating interventions that target both physical and mental aspects of maternal health status to better the resilience of the family unit. In the healthcare setting, maternal health services should ensure early detection and prevention of chronic conditions beyond obstetric care and detection and treatment of mental health.

Dyadic communication quality and family resilience in gynecologic cancer survivors: a study on the mediating role of perceived spousal support

PURPOSE

To analyze the level of family resilience in Chinese gynecological cancer survivors and determine whether perceived spousal support plays a mediating role in the relationship between dyadic communication quality and family resilience, enhance the confidence of families in coping with the disease together, and thus promote psychosocial adaptation to cancer.

METHODS

A total of 348 gynecologic cancer survivors were selected from a gynecologic ward in a public hospital in Shandong Province, China. All participants completed the Sociodemographic and Clinical Characteristics Questionnaire, Couples' Communication Quality Scale (CCQS), Perceived Social Support Scale (PSSS), and Family Hardiness Index (FHI). The mediating effect of perceived spousal support was estimated using the bootstrap method via IBM SPSS AMOS 21.0.

RESULTS

The mean FHI score was 53.03 ± 9.34 points, showing moderate levels of family resilience. Family resilience was shown to be significantly positively associated with both perceived spousal support and dyadic communication quality (both p < 0.01). Furthermore, perceived spousal support was shown to partially mediate the relationship between communication quality and family resilience (β = 0.141; 95% confidence interval: 0.063-0.243).

CONCLUSION

The level of family resilience in survivors of gynecologic cancer needs to be further improved, and perceived spousal support partially mediates the relationship between dyadic communication quality and family resilience within this population. Therefore, dyadic communication quality and subjective perceived spousal support should be enhanced for gynecologic cancer survivors to increase their family resilience.

The resilient process of the family after diagnosis of childhood chronic illness: a qualitative meta-synthesis

PROBLEM

Childhood chronic illness has a serious effect on the whole family. As there is yet little known about how the families adjust to the diagnosis of childhood chronic illness, this qualitative meta-synthesis aims to further our knowledge regarding the resilient process.

ELIGIBILITY CRITERIA

A meta-synthesis review was conducted to explore the resilient process of the family after diagnosis of childhood chronic illness using nine electronic databases PubMed (MEDLINE), Web of Science, the Cochrane Library, SCOPUS, PsycINFO, CINAHL, Wan Fang, CBM, and CNKI from each database's inception to December 31,2020. Snowball sampling and manual search were performed to identify other relevant studies.

SAMPLE

Seventeen qualitative studies met the inclusion criteria and were analyzed into meta-synthesis.

RESULTS

Three key meta-themes were identified across the studies: (a) disintegration and vulnerability: emotional fluctuation and household chaos; (b) adjustment and adaptation: struggle with family needs; (c) recovery and reconstruction: growth and expectation.

CONCLUSION

Family adjustment to childhood chronic illness presents a complex, multifaceted and dynamic process. Identifying characteristics of family processes provides some practical interventions for families with a chronically ill child.

IMPLICATIONS

There is a need for all health professionals and social care services to be aware of the experience of family adjustment of children diagnosed with chronic illness. The specific intervention targeted at different periods of the family adjustment process is warranted to help families to recover from crises and deal better with challenges.

Examining child flourishing, family resilience, and adversity in the 2016 National Survey of Children's Health

PURPOSE

Explore factors associated with flourishing and family resilience among children aged 6 months to 5 years old in the 2016 National Survey of Children's Health (NSCH).

DESIGN AND METHODS

Cross-sectional analysis of the 2016 NSCH was conducted using Kleinman and Norton's Regression Risk Analysis method to derive adjusted risk measures for logistic regression models to assess factors contributing to (1) child flourishing and (2) child flourishing stratified between resilient and non-resilient families.

RESULTS

In multivariable models, resilient families less often reported a child with two or more lifetime ACE exposures (ARD -0.11, 95% CI -0.15, -0.08), more likely to live in a supportive neighborhood (ARD 0.08, 95% CI 0.05,0.11), and more likely to report emotional support in raising children (ARD 0.07, 95% CI 0.12, 0.40). Accounting for ACE exposures, within resilient families, child flourishing was more likely when the child lived in a supportive neighborhood (ARD 0.09, 95% CI 0.03, 0.15), received care in a patient centered medical home (ARD 0.09, 95% CI 0.02,0.15), and when parents reported having emotional support in raising children (ARD 0.10, 95% CI 0.05, 0.17) Within non-resilient families, child flourishing was more likely when parents had emotional support in raising children (ARD 0.15, 95% CI 0.04,0.27).

CONCLUSION

Promoting emotional support for parents may bolster family resilience and help young children to flourish despite adversity.

PRACTICE IMPLICATIONS

Further research and innovative models of care are needed to optimize the role of pediatric primary care in promoting safe, stable, nurturing relationships and environments for children and families.

Family resilience of patients requiring long-term care: A meta-synthesis of qualitative studies

BACKGROUND

Long-term care of patients with chronic illnesses is an important global public health issue, compromising the well-being of family members and the family functioning. Previous studies have examined the interactive experiences and processes of various systems in the families coping with long-term care stress; however, these studies have not been systematically reviewed and integrated.

AIMS

This review aimed to synthesise the existing qualitative evidence on the experiences and processes of family resilience operate in families providing long-term care for patients with chronic illnesses and to provide suggestions for the development of interventions in future studies.

MATERIALS & METHODS

We searched databases including PubMed, CINAHL, EMBASE, Web of Science, ProQuest and CNKI from their inception to March 2022. We used the JBI Critical Appraisal Tool for qualitative studies to evaluate the quality of the included studies was evaluated according to. We followed The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. The results were integrated using the thematic and content analysis method.

RESULTS

Fourteen studies from eight countries covering 11 diseases reported on the experiences and coping processes of long-term care families. Based on McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation (FAAR), five analytical themes were synthesised: stressors (risk factors), family belief system, internal family coping strategies, external support and resilient adaptation indicators; the relationships between themes and subthemes were illustrated.

DISCUSSION

This review synthesized qualitative evidence on the experiences and processes of family resilience operate in families providing long-term care. The results of this study found that the cognition and belief of family members regarding dilemmas have a two-way effect and act on the adaptation process of family members. In family adaptation, spirituality, hope, internal and external support are extremely important. In 14 studies, caregivers were from different countries with intercultural differences, but due to less reports on this content, it is difficult to compare the differences or impact that culture or ethnicity may have.

CONCLUSIONS

Family resilience plays an important role in coping with stressors associated with the long-term care of a loved one through family belief systems, internal support systems and external support systems. The development of family resilience-based interventions for long-term care families should consider the family as a whole and further construct a multidisciplinary, multilevel and multi-type social support network to enhance family resilience.

Individual, family, and social correlates of flourishing outcomes among youth: Findings from the 2016-2017 National Survey of Children's Health

BACKGROUND

Flourishing is considered an optimal state of well-being and is associated with positive psychological outcomes. Although, individual, family, and social factors may either facilitate or impede flourishing, their unique influence on flourishing outcomes is not well-understood among youth.

OBJECTIVE

Using data from the 2016-2017 National Survey of Children's Health (NSCH), this study investigated cross-sectional associations among adverse family experiences (AFE), community safety, family resilience, parental aggravation, and flourishing among youth.

PARTICIPANTS AND SETTING

Data from the 2016-2017 NSCH (N = 51,156) were analyzed. Participants included males (n = 26,124) and females (n = 25,032) whose ages ranged from 6 to 17 years old (M = 12.14, SD = 3.45).

METHODS

After controlling for relevant demographics, adjusted odds ratios (AORs) using a single-block logistic regression determined the relative likelihood of flourishing.

RESULTS

Youth who experienced zero to one AFE (AOR = 2.10; 95% CI [1.95, 2.26]) and two to three AFEs (1.32 [1.20, 1.45]) were more likely to flourish than youth with four or more AFEs. Youth whose parents endorsed low parental aggravation (6.80 [6.41, 7.22]) and moderate parental aggravation (3.70 [3.51, 3.89]) were more likely to be flourishing than youth whose parents endorsed high parental aggravation.

CONCLUSIONS

Findings suggest that high parental aggravation is related to poorer flourishing outcomes, after considering community safety, family adversity, family resilience, and demographic characteristics. Providers should consider interventions to support the emotional regulation of parental systems as a means of maximizing developmental outcomes among youth.

Developing a model on the factors affecting family resilience in the COVID-19 pandemic: Risk and protective factors

During the COVID-19, the relationships among family members and the stress that accompanied have increasingly affected families. The first aim of this study is to test the effects of marital adjustment, perceived stress and parental self-efficacy of married couples on family resilience during the COVID-19 pandemic. The second aim of this study is to investigate whether or not family resilience, perceived stress, parental self-efficacy and marital adjustment differentiate depending on demographic and other variables in the COVID-19 pandemic. Participants consisted of 241 married individuals with at least one child between 4 and 18 years old, and data were collected online. It was found that when perceived stress increased, parental self-efficacy and marital adjustment decreased; besides, this perceived stress indirectly influenced family resilience through parental self-efficacy and marital adjustment. Similarly, it was found that pregnant participants experienced higher level of perception of stress during the COVID-19 period. It was found that the family resilience of participants who got support within the family was higher than participants who got support from outside the family. However, no differences were found between males and females. In stressful processes like the COVID-19 pandemic, each sub-system of the family (individual, couple and parent) has a significant role in the resilience level of the family as a whole. Future studies focus on experimental and can focus on programs prepared for family resilience. Intervention programs can be prepared related to stress perception, parental skills and marital adjustment of married couples and their influence on family resilience can be searched.

Mediating effects of coping styles on the relationship between family resilience and self-care status of adolescents with epilepsy transitioning to adult healthcare: A cross-sectional study in China

PURPOSE

This study aimed to explore the relationship between family resilience, coping styles, and self-care among Chinese adolescents with epilepsy.

DESIGN AND METHODS

A total of 1238 adolescents with epilepsy in nine tertiary hospitals in China participated in a cross-sectional survey conducted from May 2018 to March 2020. Structural equation modeling was used to analyze the mediating effect.

RESULTS

The total scores for family resilience and coping styles were positively correlated with the total self-care status score of adolescents with epilepsy during their transition (r = 0.209, 0.202, P < 0.01). Family resilience was positively correlated with coping style (r = 0.450, P < 0.01). The modified model's fit index included χ²/df = 1.970, P = 0.001, RMSEA = 0.054, TLI = 0.973, CFI = 0.978, GFI = 0.941, AGFI = 0.917, NFI = 0.956, and IFI = 0.978. The confidence interval (CI) was 0.004-0.140 for the indirect effect and 0.033-0.306 for the direct effect.

CONCLUSIONS

The self-care status of adolescents with epilepsy during the transitional period is closely related to coping style and family resilience. Coping style mediates family resilience and self-care status.

PRACTICE IMPLICATIONS

Healthcare teams should pay attention to the coping ability of adolescents with epilepsy to help them transition smoothly and to improve family functioning. This study provides a theoretical basis for establishing transitional care programs for adolescents with chronic illnesses. The significant mediating effect of coping style should be emphasized in modalities of healthcare that include patient participation.

Meaning Co-Construction: Facilitating Shared Family Meaning-Making in Bereavement

Meaning-oriented approaches to grief therapy have made substantial contributions by defining the internal processes of meaning-making and, more recently, clinical scholars have introduced relational approaches as means for continuing bonds with the deceased and increasing social support for the bereaved. However, the complicated interactive processes of interpersonal meaning-making pose added challenges as family members attempt to coregulate each other's grief experiences. While systemic therapists have consistently emphasized the essential role of familial relationships in fostering resilience through interpersonally constructed meaning, there remains a need for clarity in terms of the specific processes by which this occurs. The Meaning Reconstruction Model and Emotionally Focused Therapy provide process-oriented therapeutic strategies for facilitating interpersonal interactions that foster deep relational connection and self-identity transformation. In this article, we explore how these models can be integrated and applied to the dynamic needs of families who are adjusting to loss. Future clinical and research directions are also discussed.

A Trauma-Informed, Family-Centered, Virtual Home Visiting Program for Young Children: One-Year Outcomes

Military-connected families face many challenges associated with military life transitions, including deployment separations. We report on a randomized controlled trial to evaluate the efficacy of Families OverComing Under Stress-Early Childhood (FOCUS-EC) delivered through an in-home, virtual telehealth platform. FOCUS-EC is a trauma-informed, family-centered preventive intervention designed to promote family resilience and well-being. Military-connected families with 3- to 6-year-old children (194 mothers; 155 fathers; 199 children) were randomized to FOCUS-EC or an online education condition. Parent psychological health symptoms, child behavior, parenting, and parent-child relationships were examined by parent-report and observed interaction tasks for up to 12 months. Longitudinal regression models indicated that FOCUS-EC families demonstrated significantly greater improvements than online education families in parent-reported and observational measures of child behavior, parenting practices, and parent-child interaction, as well as greater reductions in parent posttraumatic stress symptoms. Findings provide support for the benefit of a virtually-delivered preventive intervention for military-connected families.

Social and Relational Health Risks and Common Mental Health Problems Among US Children: The Mitigating Role of Family Resilience and Connection to Promote Positive Socioemotional and School-Related Outcomes

Nearly 70% (67.6%) of US children with mental, emotional, and behavioral problems (MEB) experienced significant social health risks (SHR) and/or relational health risks (RHR). Shifts are needed in child mental health promotion, prevention, diagnosis, and treatment to address both RHR and SHR. Public health approaches are needed that engage families, youth, and the range of child-serving professionals in collaborative efforts to prevent and mitigate RHR and SHR and promote positive mental health at a community level. Building strong family resilience and connection may improve SR and, in turn, academic and social outcomes among all US children with or without MEB.

Family resilience in caring for drug addiction

OBJECTIVE

Teenagers are at high risk for drug addiction. Family resilience is important in preventing adolescent involvement in drug abuse. This qualitative study aims to explore the experience of family resilience based on the perspective of parents when their children are addicted to drugs.

METHOD

This qualitative study used a phenomenological method, involving eight participants based on a purposive sampling technique with inclusion criteria of mothers who have experience caring for their teenage children who have been addicted to drugs. Data qualitative was collected through in-depth interviews, field notes and observations. The data collection process was discontinued after reaching data saturation, namely after interviewing eight participants. The process of interpreting meaning is carried out to obtain the significance of the results of in-depth interviews accompanied by triangulation of methods and data using interpretive phenomenological analysis. Researchers strive to ensure the validity and reliability of the study. This research was conducted for six months in mid-2019.

RESULT

This study resulted in five themes that can be categorized into one supporting theme and four inhibiting themes. The supporting themes are acceptance of God's destiny, while the themes of limited financial conditions, lack of time together, the flexibility of a fragile family and harsh environment are categorized as inhibiting themes.

CONCLUSION

Mothers have an important role in optimizing family resilience while caring for and improving the quality of life of their children who have experienced drug addiction.

Resilience and mental health during the COVID-19 pandemic: Findings from Minnesota and Hong Kong

BACKGROUND

Previous COVID-19 pandemic research has focused on assessing the severity of psychological responses to pandemic-related stressors. Little is understood about (a) resilience as a mental health protective factor during these stressors, and (b) whether families from Eastern and Western cultures cope differently. This study examines how individual resilience and family resilience moderate the associations between pandemic-related stressors and symptoms of depression, anxiety, and stress in two culturally distinct regions.

METHODS

A total of 1,039 adults (442 from Minnesota, United States, and 597 from Hong Kong) living with at least one family member completed an online survey about COVID-19-related experiences, mental health, individual resilience and family resilience from May 20 to June 30, 2020. Predictors of depression, anxiety, and stress symptoms were examined separately using hierarchical regression analyses.

RESULTS

In both regions, pandemic-related stressors predicted higher symptoms of depression, anxiety, and stress. Individual resilience and two domains of family resilience were associated with positive mental health. In Minnesota, higher levels of individual resilience buffered the negative relationship between pandemic-related stressors and depressive symptoms; higher levels of family communication and problem solving also buffered the negative relationship between pandemic-related stressors and stress symptoms. In Hong Kong, higher family-level positive outlook magnified the negative relationship between pandemic-related stressors and anxiety symptoms.

CONCLUSIONS

Individual and family resilience is protective against the adverse psychological effects of pandemic stressors, but they vary across cultures and as exposure to pandemic-related stressors increases.

Family resilience and subjective responses to caregiving for children with epilepsy

OBJECTIVES

This study quantified caregiver burdens and the positive aspects of caregiving for the parents of children with epilepsy, with a focus on the impacts of family resilience as a protective factor for the caring process.

METHODS

This cross-sectional study was conducted among 173 parents of children with epilepsy, all of whom responded to questionnaires containing the shortened Chinese version of the Family Resilience Assessment Scale (FRAS-C), positive aspects of caregiving scale (PAC), and Chinese version of the Zarit Caregiver Burden Interview (CZBI). They also provided relevant sociodemographic data.

RESULTS

The mean CZBI total score was 22.16 (SD, 14.26; range, 0-71), while the mean PAC total score was 40.05 (SD, 11.09; range 11-55). The FRAS-C total score was positively correlated with the PAC total score (r = 0.368, p < 0.001), but negatively correlated with the CZBI total score (r = -0.301, p < 0.001). A multiple linear regression analysis showed that family resilience explained PAC and CZBI at rates of 11.4% and 5.5%, respectively.

CONCLUSIONS

Parents have both positive and negative experiences when caring for children with epilepsy. In this context, family resilience may enhance the positive aspects of caregiving while reducing the frequency of negative feelings, thus highlighting the need for clinicians to focus on adequate interventions aimed at improving family resilience.

Family resilience factors affecting family adaptation of children with cancer: A cross-sectional study

PURPOSE

Pediatric cancer impacts all family members, including parents and siblings, who strive to adjust to a multitude of changes brought about by the illness. Family resilience is an important factor in the successful adaptation of families of children with cancer. Therefore, we aimed to identify risk and protective factors for family resilience at the child, family, and community levels that affect the adaptation of families of children with cancer.

METHOD

This study employed a descriptive survey design, and data were collected from 111 parents of children undergoing treatment for cancer between April and May 2020 at a university hospital in South Korea. Based on Patterson's family resilience model, risk factors-severity of child's condition, parental depression, and stigma and discrimination-and protective factors-the child's temperament, family communication skills, and supportive health services-for family adaptation were analyzed using multiple regression analyses.

RESULTS

Among family resilience factors affecting the adaptation of families of children with cancer, parental depression (ß = -0.290, p = 0.004) and family communication skills (ß = 0.403, p < 0.001) were identified as risk and protective factors, respectively. These variables accounted for 29.3% of the variance in family adaptation (F = 7.503, p < 0.001).

CONCLUSIONS

There is a need to develop strategies such as intervention programs that focus on reducing parental depression and strengthening family communication skills to promote the adaptation of families to pediatric cancer.

Behavioral and mental health problems in adolescents with ADHD: Exploring the role of family resilience

BACKGROUND

Family resilience and its role in behavioral and mental health problems has not been well documented among U.S. adolescents, especially those with ADHD.

METHODS

Using data from the 2016 and 2017 National Survey of Children's Health (NSCH), we examined associations between family resilience connection index (FRCI) and conduct problems, depression, anxiety, and substance abuse in adolescents with ADHD aged 11-17 (n=4,169). Data were analyzed using multivariate logistic regression and chi-square tests.

RESULTS

Adolescents with ADHD who had a lower FRCI score were more likely to have conduct problems (OR:1.64, CI:1.13-2.38) and depression (OR: 3.08, CI: 2.12-4.49). There were small differences between adjusted and unadjusted odds after controlling for adverse childhood experience and other covariates.

LIMITATION

We could not assert prediction or causation, only associations among variables, due to the cross-sectional design of the 2016-2017 NSCH; however, a major advantage of the NSCH is that it includes a nationally representative sample of children and allows inferences to be made for understanding of the adolescents with ADHD in the U.S.

CONCLUSION

Findings suggest that family resilience may serve as a protective factor that leads to decreasing conduct problems, despite experiencing adversity in childhood. Targeting family resilience, in terms of teaching families ways to cope with adversities such as: a child's diagnosis of ADHD; behavioral problems, and/or other adverse experiences in children's environments, has great potential to reduce adolescents' conduct and mental health problems.

Family Resilience and Its Association with Psychosocial Adjustment of Children with Chronic Illness: A Latent Profile Analysis

PURPOSE

The purpose of this study was to investigate the characteristics of family resilience in a sample of Chinese families with children diagnosed with chronic illness using Latent Profile Analysis (LPA). In particular, we examined the association of family resilience profiles with the psychosocial adjustment of children, and identified the socio-demographic correlates of these latent profiles.

DESIGN AND METHODS

A cross-sectional study was conducted at comprehensive hospitals and children hospitals in three cities (Hangzhou, Ningbo and Wenzhou) of Zhejiang province, China. Parents (n = 277) of children diagnosed with a chronic illness completed a socio-demographic questionnaire, the Chinese version of the family resilience assessment scale, and the Strengths and Difficulties Questionnaire.

RESULTS

A three-class solution was found to demonstrate the best fit [low family resilience (74.7%), moderate family resilience (14.1%), and high family resilience (11.2%)]. One-way ANOVA revealed significant differences between the three groups with respect to peer relationship problems and pro-social behaviors of children. On multinomial logistic regression analysis, the type of childhood chronic disease, time since diagnosis, family monthly income, medical insurance, and parents employment status significantly predicted the profile membership.

CONCLUSION

Inadequate family resilience was found to be a common phenomenon in families with children affected by chronic illness. Family resilience profiles were associated with psychological adjustment of children.

PRACTICE IMPLICATION

Our findings may help inform tailored family-strength based interventions to promote better psychosocial adjustment of children with chronic illness.

Parental stress and adolescent bullying perpetration and victimization: The mediating role of adolescent anxiety and family resilience

Although past research suggests that parental stress can heighten adolescents' risk for bullying perpetration and victimization, the mechanisms underlying such a potential link and that may involve child psychological wellbeing remain unclear. Parental stress may heighten adolescents' risk for bullying involvement by elevating adolescents' anxiety and interfering with family functioning. Therefore, the current study investigated the role of adolescent anxiety and family resilience as mediators linking parental stress with adolescent bullying involvement. Sex differences in these associations were also explored. Analyses relied on data collected from 11,244 parents who participated in the 2019 National Survey of Children's Health. Parents completed surveys assessing parental stress, adolescent anxiety, family resilience, and adolescents' involvement in bullying perpetration as well as victimization. Results from structural equation models indicated that a higher level of parental stress was related to greater bullying perpetration and victimization among both male and female adolescents. Moreover, parental stress was indirectly related to bullying victimization via elevated adolescent anxiety for both girls and boys, whereas parental stress was indirectly related to bullying perpetration via reduced family resilience for boys but not girls. The findings highlight connections between adolescents' family and peer contexts and implicate adolescent anxiety and family resilience as putative mechanisms linking parental stress and bullying involvement.

Family resilience, perceived social support, and individual resilience in cancer couples: Analysis using the actor-partner interdependence mediation model

PURPOSE

This study aimed to examine the impact of family resilience on the individual resilience of couples during cancer and explore the potential mediating role of perceived social support and the moderating role of sex in this association in cancer patient-spouse dyads.

METHOD

The participants were 272 cancer patients and their spouses (N = 544) who completed the Family Resilience Assessment Scale, the Perceived Social Support Scale and the Resilience Scale. We adopted the actor-partner interdependence mediation model to examine whether and how patients' and their spouses' family resilience was associated with their own and their partners' perceived social support and individual resilience.

RESULTS

The results indicated that the patients' and their spouses' level of family resilience was positively associated with their own individual resilience directly and indirectly by increasing their own perceived social support. The family resilience of the spouses was associated with an increase in the patients' individual resilience only indirectly by increasing the patients' perceived social support. The spouse-actor effects between family resilience and individual resilience differed significantly by sex.

CONCLUSION

Enhancing family resilience and perceived social support within the family can improve individual resilience. The findings regarding the sex differences serve as a rationale for gender-based approaches to improving individual resilience in the family context.

The Correlation of Family Resilience with Sleep Quality and Depression of Parents of Children with Epilepsy

PURPOSE

The present study aims to investigate the correlation between family resilience, sleep quality, and depression in parents of children with epilepsy.

DESIGN AND METHODS

The parents of 157 children with epilepsy were assessed using the shortened Chinese version of the Family Resilience Assessment Scale (FRAS-SC) to measure the resilience level of families of children with epilepsy. The Pittsburgh Sleep Quality Index (PSQI) was used to determine the sleep quality of the subjects. The Self-Rating Depression Scale (SDS), a self-rating scale for evaluating depression, was used.

RESULTS

The FRAS-SC total score was 97.9 ± 9.0. The PSQI total score was 6.41 ± 3.79, and the detection rate of sleep disorders was 37.6%. The SDS total score was 51.63 ± 10.73, and the detection rate of moderate-severe depressive symptoms was 21.6%. The FRAS-SC total score and all items (except USR) were negatively correlated with the PSQI total score (P < .05). The FRAS-SC total score and all items were significantly and negatively correlated with the SDS total score (P < .01). The degree of explanation of family resilience for sleep quality and depression was 3.5% and 14.9%, respectively.

CONCLUSIONS

The higher the level of family resilience, the better sleep quality and the less depression the parents of children with epilepsy will get.

PRACTICAL IMPLICATIONS

Relevant intervention measures based on family resilience will help to improve the sleep quality of parents of children with epilepsy and alleviate depression. And then improve the family's ability to care for children with epilepsy.

Loss and Resilience in the Time of COVID-19: Meaning Making, Hope, and Transcendence

This article addresses the many complex and traumatic losses wrought by the COVID-19 pandemic. In contrast to individually based, symptom-focused grief work, a resilience-oriented, systemic approach with complex losses contextualizes the distress and mobilizes relational resources to support positive adaptation. Applying a family resilience framework to pandemic-related losses, discussion focuses on the importance of shared belief systems in (1) meaning-making processes; (2) a positive, hopeful outlook and active agency; and (3) transcendent values and spiritual moorings for inspiration, transformation, and positive growth. Practice guidelines are offered to facilitate adaptation and resilience.

A dataset for emotional reactions and family resilience during COVID-19 isolation period among Indonesian families

This study presents a survey dataset describing families' conditions during the COVID-19 isolation period obtained from individuals who serve as parents. A survey was conducted to measure the family's positive or negative emotional reactions and the degree of their resilience. The data were categorized into age, sex, type of family, family size, length of marriage, family's environment, and family COVID-19 status. The samples were gathered from 365 parents of Indonesian students who were willing to fill an online questionnaire. SPSS v.23.0 was used to carry out descriptive statistics and intercorrelations. Additional results from chi-square analyses are available as supplemental tables in the Mendeley repository.

A psychometric study of the Family Resilience Assessment Scale among families of children with autism spectrum disorder

Background

The family system represents a critical context within which children develop. Although raising a child with a disability may represent a challenge to this dynamic system, research demonstrates that families have the capacity to demonstrate both maladaptation and resilience in the face of related stressors. In the current study, we examined the psychometric properties of the Family Resilience Assessment Scale (FRAS) among families of children with autism spectrum disorder (ASD). This tool is the only measure of family resilience that seeks to identify within-family protective factors, including the extent to which they rely on adaptive belief systems, organizational patterns, and communication processes. Identifying protective processes utilized by those who show resilience is critical within both clinical practice and research, as it aligns with a strength-based perspective that builds on what families are doing well.

Methods

Participants included 174 caregivers of individuals with ASD (84% mothers). Caregivers completed the FRAS, as well as the Beach Center Family Quality of Life Scale. The 54-item FRAS was submitted to an exploratory factor analysis, using the iterated principal factor method with a promax rotation.

Results

Fifty-one items across 3 factors (Family Communication and Problem Solving, Utilizing Social and Economic Resources, Family Spirituality) were retained, explaining 52% of the total variance. The final scale demonstrated convergent validity with the Family Quality of Life assessment tool.

Conclusions

It is our hope that identifying the optimal scale structure will encourage other researchers to utilize this measure with families of children with ASD, thus continuing to advance the study of family resilience within this unique context.

The impact of resilience on psychological outcomes in women with threatened premature labor and spouses: a cross-sectional study in Southwest China

Background

Threatened premature labor (TPL) is a severe obstetric complication which affects the mental and physical health of both the mother and fetus. Family resilience may have protective role against psychological distress in women experiencing these pregnancy complications. There may be resilience related risk factors in TPL women, and interplays may exist among psychological variables and within couples. This study aims to examine psychological outcomes influenced by different levels of resilience, and explore psychological interactions in TPL women, spouses, and between women and spouses.

Methods

Six validated questionnaires were used to measure the psychological outcomes (Connor-Davidson resilience scale CD-RISC, Edinburgh postnatal depression scale EPDS, positive and negative affect scale PANAS, pregnancy pressure scale PPS, simplified coping style questionnaire SCSQ, social support rating scale SSRS) in 126 TPL women hospitalized in three tertiary hospitals and 104 spouses in Southwest China.

Results

Low resilient women had significantly more complicated placenta praevia, longer pediatric observation, more pressure than high resilient women. They also had significantly less active coping and positive affect, more negative affect and depression compared to high resilient women and their spouses. Although the socio-demographic characteristics of both TPL women and spouses and psychometric parameters of spouses had no significant differences, the prevalence rates of depression in spouses were notable. Compared with spouses, TPL women had a more complex interaction among these psychometric factors, with women’s resilience negatively associated with their partners’ negative affect, and their pressure positively correlated with pressure and negative affect of spouses.

Conclusions

Pregnancy complicated with placenta praevia and pediatric observation may be risk factors for resilience of women with TPL. Maternal resilience has an important impact on the psychological outcomes in TPL women. A screening for resilience, depression and other psychological outcomes in couples with TPL and early psychological intervention of low resilient couples may be appropriate to promote resilience and well-being of these families.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0603-2) contains supplementary material, which is available to authorized users.

Psychometric properties of the Family Resilience Assessment Scale: A Singaporean perspective

Families of young people with chronic illnesses are more likely to experience higher levels of stress. In turn, their ability to cope with multiple demands is likely to affect young people's adaptation. The purpose of this study was to examine psychometric properties of the Family Resilience Assessment Scale (FRAS), an assessment tool that measures the construct of family resilience. A total of 152 young people with epilepsy, aged 13 to 16years old, from KK Women's and Children's Hospital, Singapore, completed the FRAS along with the Rosenberg Self-Esteem Scale. Factor structure of the FRAS was examined. Exploratory factor analysis resulted in a 7-factor solution - meaning-making and positive outlook, transcendence and spirituality, flexibility and connectedness, social and economic resources (community), social and economic resources (neighbors), clarity and open emotional expression, and collaborative problem-solving - accounting for 83.0% of the variance. Internal consistency of the scale was high (α=0.92). Family resilience was significantly correlated with higher levels of self-esteem. Our study provides preliminary findings that suggest that FRAS is a reliable and valid scale for assessing the construct of family resilience among young people with epilepsy in Singapore.

Resilience in Families With Adolescents Suffering From Traumatic Brain Injuries

PURPOSE

This study aims to coconstruct the building blocks for an intervention program to support family resilience in conjunction with families with an adolescent suffering from traumatic brain injury and rehabilitation professionals.

DESIGN

This is a qualitative and inductive study, supported by a collaborative research approach.

METHODS

Based on the complex intervention design and validation model, the investigator follows a three-stage data collection process: (1) identifying the building blocks of the intervention program in the eyes of families and rehabilitation professionals, (2) prioritizing, and (3) validating the building blocks with the same participants.

FINDINGS

After analyzing the data, the investigator identifies five encompassing themes as the building blocks of the intervention program.

CONCLUSIONS/CLINICAL RELEVANCE

This study offers promising avenues for practitioners and researchers in nursing and other fields with respect to the implementation of concrete strategies to support the resilience process of families facing particularly difficult times in their lives.

The Child Illness and Resilience Program (CHiRP): a study protocol of a stepped care intervention to improve the resilience and wellbeing of families living with childhood chronic illness

Background

Families of children living with chronic illness are more vulnerable to mental health problems, however this can be ameliorated by a family’s resilience. The Child Illness and Resilience Program (CHiRP) will develop and evaluate a parent-focussed family intervention designed to increase the resilience and wellbeing of families living with childhood chronic illness.

Methods/Design

The study will be conducted in an Australian regional paediatric hospital and will use a stepped care intervention that increases in intensity according to parental distress. All parents of children discharged from the hospital will receive a family resilience and wellbeing factsheet (Step 1). Parents of children attending selected outpatient clinics will receive a family resilience and wellbeing activity booklet (Step 2). Parents who receive the booklet and report psychological distress at three-month follow-up will be randomised to participate in a family resilience information support group or waitlist control (Step 3). The Step 3 control group will provide data to compare the relative effectiveness of the booklet intervention alone versus the booklet combined with the group intervention for distressed parents. These participants will then receive the information support group intervention. All parents in Step 2 and 3 will complete baseline, post-intervention and six month follow up assessments. The primary outcomes of the study will be changes in scores between baseline and follow-up assessments on measures of constructs of family resilience, including parental wellbeing, family functioning, family beliefs and perceived social support. Qualitative feedback regarding the utility and acceptability of the different intervention components will also be collected.

Discussion

It is hypothesised that participation in the CHiRP intervention will be associated with positive changes in the key outcome measures. If effective, CHiRP will provide an opportunity for the health sector to deliver a standardised stepped care mental health promotion intervention to families living with childhood chronic illness.

Trial registration

Australian clinical Trials Registry ACTRN 12613000844741

Universal Trial Number (UTN): 1111-1142-8829