Parental management of fear in chronically ill and healthy children

This study was undertaken to determine the impact of children's health status on parental management of fear and avoidance, as well as the relationship between parenting strategies and children's fear and anxiety levels. Thirty-one children with a chronic life-threatening illness, 30 children with chronic non-life-threatening conditions, and 28 healthy children, and their mothers, were studied. Children's health status, by diagnosis, was not a significant determinant of maternal fear-management strategies. For chronically ill children, clinical health status, in terms of illness course, prognosis, physical impairment, and time since diagnosis were related to maternal parenting strategies and to children's levels of medically related fears. For the sample as a whole, maternal fear-management strategies were related to child sex, socioeconomic status, and mothers' trait anxiety. These results are discussed in terms the interactive effects of child characteristics, health status, fear/anxiety, and parenting strategies.     

Families of chronically ill children: a systems and social-ecological model of adaptation and challenge

A family systems model is presented for understanding adaptation and coping in childhood chronic illness. The importance of a systems perspective in work with children and families who may not display psychopathology is stressed. A general overview of systems and social-ecological theories relevant to children with chronic illnesses and their families is presented. Literature on stress and coping in these families is reviewed, then some of the unique issues that merit consideration in this area of research and intervention are examined. Finally, the importance of these models for responding to the growing number of families with children with AIDS is discussed.     

Sleep problems and fatigue in chronically ill women

The objective of this study was to understand the quality and quantity of sleep in women with multiple sclerosis (MS) or rheumatoid arthritis (RA), who also had young children, and how their sleep behaviors were associated with their fatigue. A cross-sectional sample of mothers with MS and RA and a well comparison group completed mailed surveys. Participants included 103 mothers with MS, 68 mothers with RA, and 91 well mothers. Mothers answered questions about their sleep, fatigue, pain, and depression. Women with chronic illnesses reported more problems going to sleep than did well women, with pain, depression, or both as significant covariates. Women with chronic illnesses reported that their sleep was interrupted less often by their children than did well women. Sleep quality and quantity were worse for women with RA who were experiencing a flare. Mothers with chronic illnesses experienced more sleep problems, which was associated with their pain and depression.     

Adaptive tasks, coping and quality of life of chronically ill patients: the cases of Parkinson's disease and chronic fatigue syndrome

This article is a report of a larger study on the relationship between adaptive tasks, coping and quality of life, taking Parkinson's disease and chronic fatigue syndrome (CFS) as examples. The concept of adaptive tasks or disease-related stressors testing the adaptive capacities of chronically ill patients (N=134) was explored by applying the method of concept mapping. Results show that patients both with Parkinson's disease and with CFS generally refer to the same themes when asked for the adaptive tasks their disease brings about. However, the actual contents of these adaptive tasks differ as well as their impact on coping and quality of life. In the case of patients with Parkinson's disease, objective disease characteristics appear to be more important in predicting quality of life than in the case of patients with CFS, whose evaluation of adaptive tasks is predictive of quality of life.     

Measuring marital distress in couples with chronically ill children: the Dyadic Adjustment Scale.

The idea that couples with chronically ill children are particularly at risk for marital distress has been supported by clinical observation and empirical research. Three recent controlled studies, however, did not find evidence for this increased risk. A possible explanation for the discrepant findings is that these three studies employed Spanier's Dyadic Adjustment Scale (DAS) as a unidimensional measure of marital adjustment. To develop a better understanding of the discrepant findings of risk for marital distress in couples with chronically ill children, the present study examined both the appropriateness of the DAS's published norms as well as the criterion validity of the DAS for use in this population of couples. Three hundred and sixteen parents (158 couples) from a large urban pediatric health care setting completed a survey investigating interest and need to participate in an intervention program for marital distress. Results indicated that this instrument can reliably predict marital distress in this population of couples, however, mean DAS scores are higher than those established by Spanier.     

Parent-adolescent communication and psychological symptoms among adolescents with chronically ill parents

OBJECTIVE: To examine the psychological adjustment of adolescents living with a chronically ill parent and the relationship between psychological symptoms and communication with both their healthy and ill parents. METHOD: Adolescents, healthy parents, and ill parents from 38 families completed questionnaires regarding adolescent psychological symptoms, including posttraumatic stress symptoms, and parent-adolescent communication. RESULTS: Adolescent anxiety, depression, and behavior problems were within the subclinical ranges while approximately one-third of adolescents reported clinical levels of posttraumatic stress symptoms. Openness, but not problems, in communication between adolescents and their parents varied as a function of the parent's health status (healthy or ill) and parent sex. Adolescents reported poorer communication with healthy mothers; however only the quality of communication with healthy parents was related to adolescent psychological symptoms. CONCLUSIONS: Many adolescents with severely ill parents appear to experience clinically significant posttraumatic stress symptoms, therefore assessment for these symptoms in this population is important. Communication with a healthy parent may serve significant and unique functions for adolescents with ill parents, making communication between adolescents and their healthy parent a potentially useful target for clinical intervention.     

Pain coping strategies and depression in rheumatoid arthritis

A study was conducted to examine the role of pain episodes and the role of active and passive pain coping strategies in predicting depression in 287 patients with rheumatoid arthritis (RA). The independent effects of pain and pain coping strategies, as well as the interaction effects between pain and pain coping strategies on depression, were evaluated cross-sectionally and prospectively over a 6-month interval. The cross-sectional findings revealed that pain, passive coping, and the interaction between pain and passive coping contributed independent variance, all accounting for higher depression. Of principal interest was the finding that the frequent use of passive pain coping strategies in the face of high pain contributed to the most severe level of depression over time. These results were obtained after controlling for the potentially confounding effects of prior depression, functional disability, and medication status. These data imply that there may be a potential benefit of developing techniques to reduce the use of passive pain coping strategies to deal with chronic arthritis pain in cognitive-behavioral pain management programs.     

Perceived need for spiritual and religious treatment options in chronically ill individuals

The objective of the study was to examine the desire for spiritual and religious treatment options in chronically ill adults. Email interview data (N = 12) generated themes for religion, spirituality, and desired treatments. The resultant questionnaire data (N = 83) analysed the popularity of treatments. Thirty-five wide-ranging spiritual and religious treatment options were identified for use in the questionnaire; 47 per cent of the sample was interested in spiritual or religious treatments. There is a need for spiritual and religious treatment options, and translation of treatments into practice would assist coping for many people.     

Specific coping strategies of Africans during urbanization: comparing cardiovascular responses and perception of health data

Specific coping mechanisms of Africans during urbanization were compared to and correlated with cardiovascular responses and perception of health data. Subjects included men (N=286) and women (N=360). The COPE questionnaire classified subjects as active (AC) or passive (PC) copers and the General Health Questionnaire measured subjective perception of health. The Finapres recorded blood pressure continuously before and during application of a handgrip test. Analyses adjusting for age, body mass index and resting cardiovascular data revealed that AC rural subjects showed predominantly cardiac responses and PC rural subjects predominantly vascular responses. All urbanized African men and women showed higher resting blood pressure, vascular responsiveness and hypertension prevalences than their rural counterparts. All rural AC subjects, especially women, and all urban PC subjects, especially men, reported a poorer perception of health. In conclusion, subjects with a PC style showed a predominantly vascular response in rural and urban areas whereas subjects with an AC style seem to shift from a predominant cardiac output response to a predominant vascular resistance response when moving from a rural to an urban area.     

Play as a predictor of coping and distress in children during invasive dental procedure

Investigated the relations among play, coping and distress in children undergoing an invasive dental procedure. A positive relation between play and coping and a negative relation between coping and distress and between play and distress were predicted. Subjects were 37 pedodontic patients (mean age = 8.1 years). Immediately prior to the dental procedure, children's play was assessed using the Affect in Play Scale (Russ, 1985,1993). Coping and distress were assessed during and after the dental procedure by observer report, dentist report, and child self-report. As predicted, children who were "good" players implemented a greater number and variety of cognitive coping strategies (rs ranged from .52 to .55, p < .05) and reported less distress, r(34) = -53, p < .05, during the procedure than children who expressed less affect and fantasy in their play.     

Online self-management interventions for chronically ill patients: Cognitive impairment and technology issues

IntroductionAs the fraction of the population with chronic diseases continues to grow, methods and/or technologies must be found to help the chronically ill to take more responsibility to self-manage their illnesses. Internet based and/or mobile support for disease self-management interventions have often proved effective, but patients with chronic illnesses may have co-occurring cognitive impairment, making it more difficult for them to cope with technologies. Many older patients are also not familiar with technologies or they may have cognitive disabilities or dementia that reduce their ability to self-manage their healthcare. On-line solutions to the needs of chronically ill patients must be investigated and acted upon with care in an integrated manner, since resources invested in these solutions will be lost if patients do not adopt and continue to use them successfully.ObjectivesTo review the capabilities of online and mobile support for self-management of chronic illnesses, and the impacts that age and disease-related issues have on these interventions, including cognitive impairment and lack of access or familiarity with Internet or mobile technologies.MethodsThis study includes a review of the co-occurrence of cognitive impairment with chronic diseases, and discusses how cognitive impairment, dyadic caregiver patient support, patient efficacy with technology, and smart home technologies can impact the effectiveness and sustainability of online support for disease self-management.ResultsDisease self-management interventions (SMIs) using online patient centered support can often enable patients to manage their own chronic illnesses. However, our findings show that cognitive impairment often co-occurs in patients with chronic disease. This, along with age-related increases in multiple chronic illnesses and lack of technology efficacy, can be obstacles to Internet and mobile support for chronic disease self-management.ConclusionPatients with chronic diseases may have greater than expected difficulties in using Internet and mobile technologies for disease self-management, often due to cognitive impairment or unfamiliarity with technology. Approaches to dealing with such barriers include suitable integration of solutions involving patient–caregiver dyads, better design of online applications, careful attention to technology adoption and sustainability, and smart home technologies.     

Coping strategies and associated features of medically ill patients

This study examined the psychological and behavioral correlates of three major coping strategies used by medically ill patients in dealing with their illness; namely, confrontation, avoidance, and acceptance-resignation. The subjects consisted of 223 male medical patients with a variety of life-threatening and chronic illnesses. Coping responses were measured by the Medical Coping Modes Questionnaire, while other variables were tapped by a variety of self-report and test measures, as well as by interview data. Significant correlates were found for each of the coping strategies accounting for 10 to 53% of the variance. These included demographic, illness, and psychological variables. Employment of acceptance-resignation as a coping strategy was particularly evident in patients with little expectation of recovery and a lack of hope. Effectiveness of coping appeared to be negatively linked to frequent use of avoidance and acceptance-resignation in life-threatened patients. Overall, it seems that a variety of variables across several domains accompany the use of a particular coping strategy; that choice of a specific strategy is most likely multidetermined; and that the configuration of variables associated with a particular strategy is likely to be different for each coping strategy. Coping behavior is a subtle, multifashioned expression the complete grasp of which demands an integrative approach.     

Prodromes, coping strategies and psychological interventions in bipolar disorders

Bipolar disorder is known to be highly recurrent and people with bipolar illnesses often experience high degrees of interpersonal and social impairment. The emergence of prodromal symptoms not only causes distress but may also predispose patients to greater risk of a full relapse. Studies have found that patients can report prodromes reliably. Common mania prodromes include decreased need for sleep, increased activities, being more sociable and racing thoughts while common depression prodromes are loss of interest, not being able to put worries aside and interrupted sleep. Furthermore, patients' coping with prodromal symptoms predicted relapses in bipolar disorder. These findings have led to a handful of randomized controlled studies which aimed at teaching patients relevant and adaptive coping strategies in dealing with bipolar prodromes as part of the intervention strategies and the results are very encouraging. The packages in these studies are of different complexity. The mode of intervention also varied from individual work, group work to family work. This paper also examines the differential effects of these interventions.