Effects of parental rejection and relationship quality on depression among older rural adults

Research suggests that families have development histories which influence their responses to situations across the life course. The present study examined the effects of family relationship histories on intergenerational affection and conflict between adult children and their parents and how this affects parents' depressive symptoms. Path analysis based on matched reports of adult children and their parents revealed that parental behavior early in life affects contemporary relationships between family members, which ultimately impacts parents' depressive symptoms. Parental rejection is negatively associated with intergenerational affection, which in turn is negatively associated with depressive symptoms.     

Juvenile idiopathic arthritis: parent-child discrepancy on reports of pain and disability

OBJECTIVE: To examine the incidence and nature of disagreements about pain and functional disability between parents and their children with juvenile idiopathic arthritis (JIA) and to identify demographic and psychosocial predictors of parent-child disagreement about pain and functional disability. METHODS: Participants comprised 63 children 8-16 years of age (mean 12.36 +/- 2.61) and their parents, followed as part of a longitudinal study of pain in children. During routine rheumatology clinic visits, children and their parents completed validated measures of pain, depressive symptoms, and functional disability. RESULTS: Parents and children often disagreed as to the frequency and intensity of pain and to the degree of disability caused by arthritis. Child depressive symptoms (p < 0.01) and parental perceptions of child limitations (p < 0.02) predicted parent-child disagreement about the frequency of the child's pain. Parental perceptions of child limitations also predicted parent-child disagreement about the child's level of functional disability (p < 0.04). Those children who estimated their level of disability to be different than their parents' rating also were more depressed compared to children who agreed with their parents about their level of disability (p < 0.01). CONCLUSION: Discrepancy between parent and child reports of pain and disability in children with JIA is common. Findings suggest that such disagreements in reporting of pain and functional disability by parents and their children with JIA are associated with underlying depressive symptoms in children.     

Retirement effects on parent-adult child contacts

PURPOSE: This study examined whether parents' retirement influences their contacts (visits, telephone/letter) with adult children outside the household. DESIGN AND METHODS: The study relied on data from the National Survey of Families and Households. The sample consisted of parent-adult child dyads where parents were aged 55-75 at time 2 and adult children resided outside the household at both waves (N = 2,153 parent-adult child dyads, based on reports from 792 parents). Generalized estimating equations (GEE) with robust standard errors were used. RESULTS: Retirement has no significant effect on telephone contacts. Retired parents maintain frequent visits with children. For children living within 10 miles, mothers' retirement is associated with fewer and fathers' retirement with more visits. This trend varies by number of children, length of retirement, and child's gender. For children living more than 10 miles away, retired mothers decrease visits with childless children, whereas retired fathers increase visits with childless children. IMPLICATIONS: We attribute these findings to the gender-specific salience of child contacts for retirees and suggest that future research address children's and parents' expectations for postretirement contacts.     

Children's support for elderly parents in urban and rural China: Results from a national survey

This study examines the factors that determine adult children's financial support for elderly parents, using data from the China Survey on Support Systems for the Elderly conducted in 1992. The findings support the hypotheses of need-based transfers. In both urban and rural areas, children's financial transfers to their elderly parents are based on the parents' need, and familial support compensates for inequalities in elderly persons' access to public resources. The data also suggest that elderly support is an outcome of short- and long-term arrangements between generations. Elderly Chinese, especially those in urban areas, have short-term exchanges with their adult children, providing housing or other services and receiving financial support in return. Also, adult children's support for elderly parents may be a repayment of parental investment made in them earlier.     

Filial Piety and Parental Depressive Symptoms: All Children Matter – Evidence from Rural Northern China

Little research has considered all children while investigating adult children’s role in their older parents’ health and well-being. In this study, we examine the effect of filial piety across all children on parental depressive symptoms. A sample of 432 older parents with 1,223 adult children in a rural county in northern China rated the filial piety level for each child individually. Ratings were then combined across multiple children and organized into an ordinal variable of filial piety including three levels: all children being filial, some of the children being filial, and none of the children being filial. Ordinary least squares linear regression analyses were performed. The results reveal a significant and negative relationship between adult children’s filial piety levels and older parents’ depressive symptoms after controlling for age, gender, marital status, financial strain, chronic conditions, and social support from family and friends, respectively. That is, one level lower in the adult children’s filial piety corresponds to increase in level of older parents’ depressive symptoms. Filial piety seems to benefit older Chinese parents’ mental health net of social support from family and friends in this sample. Including information from all children in the analyses is informative for better understanding the psychological significance of filial piety for healthy aging in China.

     

Impact of social support on valued activity disability and depressive symptoms in patients with rheumatoid arthritis

OBJECTIVE: To examine the impact of instrumental and emotional support on valued life activity (VLA) disability and depressive symptoms. Instrumental support was expected to affect VLA disability; emotional support was expected to be associated with depressive symptoms and moderate the impact of VLA disability on depressive symptoms. METHODS: Data were collected over 3 years through interviews with the University of California, San Francisco, Rheumatoid Arthritis Panel. Analyses assessed whether instrumental support predicted later VLA disability and whether emotional support predicted both concurrent and later depressive symptoms. RESULTS: Receiving adequate instrumental support was associated with less subsequent VLA disability. Strong associations were noted between both VLA disability and emotional support with concurrent depressive symptoms. No relationship was found between emotional support and later depression. No evidence was found for the hypothesis that emotional support moderated the impact of VLA disability on depressive symptoms. CONCLUSION: Results highlight the need to assess different types of support and their unique impact on critical outcomes. Instrumental support is beneficial to the maintenance of valued activities, a critical factor in the psychological adjustment of individuals living with rheumatoid arthritis. Emotional support has a significant short-term impact on depression, although it may not buffer the impact of VLA disability on future depression.     

Parents who quit smoking and their adult children's smoking cessation: a 20-year follow-up study

Aims   Extending our earlier findings from a longitudinal cohort study, this study examines parents' early and late smoking cessation as predictors of their young adult children's smoking cessation.
Design   Parents' early smoking cessation status was assessed when their children were aged 8 years; parents' late smoking cessation was assessed when their children were aged 17 years. Young adult children's smoking cessation, of at least 6 months duration, was assessed at age 28 years.
Setting   Forty Washington State school districts.
Participants and measurements   Participants were 991 at least weekly smokers at age 17 whose parents were ever regular smokers and who also reported their smoking status at age 28. Questionnaire data were gathered on parents and their children (49% female and 91% Caucasian) in a longitudinal cohort (84% retention).
Findings   Among children who smoked daily at age 17, parents' quitting early (i.e. by the time their children were aged 8) was associated with a 1.7 times higher odds of these children quitting by age 28 compared to those whose parents did not quit [odds ratio (OR) 1.70; 95% confidence interval (CI) 1.23, 2.36]. Results were similar among children who smoked weekly at age 17 (OR 1.91; 95% CI 1.41, 2.58). There was a similar, but non-significant, pattern of results among those whose parents quit late.
Conclusions   Supporting our earlier findings, results suggest that parents' early smoking cessation has a long-term influence on their adult children's smoking cessation. Parents who smoke should be encouraged to quit when their children are young.     

Attrition of older adults in longitudinal surveys: detection and correction of sample selection bias using multigenerational data

OBJECTIVE: The purpose of this study was (a) to investigate whether attrition due to death and nonresponse leads to bias in estimated growth-decline trajectories when only complete data are used in longitudinal research, and (b) to examine the extent of the bias and possible solutions. METHODS: The study sample was a subset of the Longitudinal Study of Generations and included data from 208 G1-G2 parent-child dyads and 538 G2-G3 dyads over 30 years. We used a latent growth-decline curve model based on full information maximum likelihood estimation in order to compare parents' and adult children's reports on older respondents' health and intergenerational solidarity by parents' attrition status. RESULT: Results indicated that attrition due to mortality biased estimates of respondents' assessments of their functional health status over time, and parents' perceptions of the quality of the parent-child relationship deteriorated more rapidly among those who died by Time 7, but nonresponse did not seriously bias estimates of these measures. Using proxies, we found that functional impairment increased more rapidly when children reported about parents, especially in advanced old age. Discussion: These results support the use of full information in estimating growth curves where mortality is present but raise concerns when using child proxies to evaluate parental health or the quality of intergenerational relationships.     

Caregiver stress and noncaregiver stress: exploring the pathways of psychiatric morbidity

PURPOSE: This study examines depressive symptoms among adult children of elderly parents; it views the parents' care needs and child's care activities as two separate stressors, different combinations of which may affect both caregiving and noncaregiving family members. Design and Methods: A sample of 4,380 women and 3,965 men from the first wave of the Health and Retirement Study was analyzed by use of four alternative forms of multiple regression analysis. Using the Center for Epidemiological Studies Depression scale, respondents reported on their depressive symptoms, as well as on parental disability and care provided by themselves, their spouses, and siblings. RESULTS: Noncaregivers reporting severe parental disability were significantly more likely to experience depression symptoms. Evidence of increased manifestations of depression was not found among those caring for severely disabled relatives; nor was it found among those providing care in the absence of severe parental care needs. Having a caregiving sibling was associated with increased CES-D scores among noncaregivers. IMPLICATIONS: In the current literature, personal care needs of a close relative are named among significant disturbances in the lives of caregivers. By extending this approach to members of a family network regardless of caregiver status, this study allows us to distinguish the magnitude of negative outcomes of serious parental care needs while clarifying the impact uniquely attributable to caregiving activities.     

Making choices: a within-family study of caregiver selection

PURPOSE: This article reports on a within-family study to identify factors that lead mothers to expect that a particular child will serve in the role of primary caregiver. DESIGN AND METHODS: Data for this study were collected by in-person interviews with a representative sample of 566 mothers between the ages of 65 and 75 years residing in the greater Boston area, who provided detailed information regarding all of their adult children. Both multivariate and qualitative data analyses were conducted. RESULTS: Emotional closeness and similarity of gender and attitudes were strongly associated with which children mothers identified as probable caregivers. Findings regarding exchange were mixed. Mothers were more likely to name adult children who had provided them with support; however, mothers' past provision of assistance to children was unrelated to expectations regarding care. No aspects of children's availability besides proximity and employment of adult children affected mothers' expectations. In selecting a primary caregiver, mothers emphasized expressive characteristics of intergenerational relationships, rather than instrumental and contextual factors associated with children's availability. IMPLICATIONS: The findings indicated a discrepancy between maternal preference for care and actual patterns of support from adult children. Practitioners who work with older adults and their families should incorporate parents' views of the "likely" caregiver into family counseling protocols. Family counseling in both the precaregiving and actual care provision stages may be useful to clarify expected roles for children.     

Parent care and the stress process: findings from panel data

OBJECTIVE: The purpose of this study was to test with panel data an extended model of the stress process recognizing the separate effects of a parent's need for care and an adult child's caring activities. METHODS: Using data from the 1996, 1998, and 2000 waves of the Health and Retirement Study, we estimated nonlinear mixed models of mental health outcomes. We assessed mental health for separate samples of 3,350 men and 3,659 women by using an 8-item scale of depressive symptoms. We also explored the sensitivity of results to alternative measures and model specifications. RESULT: We found that female, but not male, caregivers whose parents needed care exhibited adverse mental health consequences. However, we found that, generally, both male and female non-caregivers whose parents needed care were more likely to report symptoms of depression than were non-caregivers without disabled parents. Additional findings suggest that the stress process is still more complex among married couples. DISCUSSION: This study distinguishes the outcomes of parental care needs from those attributable to caregiving activities. Adverse psychological outcomes appear to be dispersed throughout the family. To focus narrowly on active caregivers is to underestimate the social burdens of disability at older ages.     

Social Relationships and Health Among Chinese Americans With Diabetes: Does Age Make a Difference?

This study examined whether social relationships were linked to health among Chinese Americans with diabetes, and whether age moderated these links given the norm of respect for the elderly. Chinese American immigrants with type 2 diabetes (n= 163) provided questionnaire and laboratory data. Relationships were assessed with diabetes family instrumental support, emotional support, and conflicts, as well as general support. Health was assessed with subjective health, depressive symptoms, and glucose regulation. When relationship predictors were examined simultaneously, more conflicts and less general support were associated with more depressive symptoms, after adjusting for covariates. More emotional support was associated with better glucose regulation only for midlife, not older, participants. Findings underscore cultural and life-stage considerations in studying social determinants of health.     

The dyadic effects of HIV stigma on the mental health of children and their parents in South Africa

ABSTRACT

HIV stigma—both “self-stigma” toward positive individuals and “stigma by association” toward their families—is linked with adverse mental health. This study examined how stigma was associated with the mental health of parents and children in South Africa. Parent-child dyads (n?=?2,477 dyads) in South Africa participated in a cross-sectional survey. For both parents and children, greater stigma was associated with their own reports of greater anxious and depressive symptoms. Parents’ reports of stigma were associated with children’s greater anxious and depressive symptoms. Children’s reports of stigma were related to parents’ greater anxious and depressive symptoms. There was a significant interaction, such that the association between parent stigma and depression was stronger when children also reported high levels of stigma. Findings provided support the effect of HIV stigma on the mental health of families and illustrate the importance of taking a family-based approach to stigma-reduction interventions to alleviate mental health problems.     

Association between parental perception of children's vulnerability to illness and management of children's asthma

This study examined the relationship between asthma management strategies used by parents and parental perception of children's vulnerability to illness. Home interviews were conducted with 101 parents of children previously hospitalized with asthma. The child vulnerability scale (CVS) was employed to assess parents' perception of their children's vulnerability to illness. The asthma severity index (ASI) was used to measure the frequency and intensity of asthma symptoms experienced by children in the preceding 12 months. Five markers of parental asthma management were assessed: (i) school absences; (ii) visits to the general practitioner (GP); (iii) visits to the emergency room (ER); (iv) hospitalizations; and (v) whether children are using a regular preventer. After controlling for the frequency and intensity of children's asthma symptoms, parents who perceived that their children were more vulnerable to medical illness were significantly more likely to keep their children home from school (P = 0.01), were more likely to take their children to the GP for acute asthma care (P = 0.02), and were more likely to be giving their children regular preventer medication (P = 0.02). In contrast, the use of tertiary pediatric care services was not significantly associated with parental perceptions of their children's vulnerability. The results suggest that parental attitudes and beliefs about the vulnerability of their children to illness were associated with greater use of GP services by parents and more frequent school absences for children. The use of hospital services by parents appeared to be more strongly associated with the actual level of children's asthma symptoms than their vulnerability to illness.     

Child and parental personality are associated with glycaemic control in Type 1 diabetes.

AIM: Little is known about the influence of the personality of the child and the personalities of the child's parents on glycaemic control in Type 1 diabetes. Our objective was to examine the extent to which glycaemic control is associated with the child's and the parents' stable personality traits, using the Big Five personality model as the basic framework. METHODS: Participants were 64 children (aged 6-16 years) with recent-onset Type 1 diabetes and their parents. Glycaemic control (HbA(1c)) was assessed at 6 months, 1 year and 2 years after diagnosis; personality was assessed at 4-6 weeks, 6 months and 1 year after diagnosis. Associations of personality with mean HbA(1c) over 2 years were examined. RESULTS: Children with better glycaemic control had a personality pattern of high Agreeableness, high Conscientiousness and low Neuroticism. Mothers of children with better glycaemic control showed a similar personality pattern, whereas the personality of the father was only marginally related to glycaemic control. Children's Conscientiousness and mothers' Agreeableness together predicted 18% of the variability in mean HbA(1c). All associations were unchanged when we controlled for child's age. CONCLUSIONS: Glycaemic control in the child was associated with the same child and maternal personality characteristics that influence treatment adherence, health-promoting behaviours and general adjustment in adult populations. In future, studies are needed to examine attitudinal and behavioural mediators of this relationship. It is suggested that attention to the personalities of the child and the mother can help to tailor diabetes education to the individual child.     

Reduction of Secondary Smoke Exposure in Asthmatic Children: Parent Counseling

Epidemiological evidence shows that children's exposure to secondhand tobacco smoke increases their risk of respiratory illness. This study evaluated five families and their asthmatic children (aged 5-14 years) in an outpatient counseling program for reducing the children's exposure to passive smoking. Intervention included biweekly counseling/instructions for parents to limit their children's tobacco exposure. A multiple-baseline, quasiexperimental design was used for self-reported measures of the children's smoke exposure and the parents' smoking frequency. Counseling was associated with smoke exposure reduction of 40-80% from baseline for each of 5 children, with most improvements sustained during follow-up. This study provides support for the development of tobacco exposure prevention programs for children with pulmonary disease.     

The social and psychological effect of an adult child's emigration on non-immigrant Asian Indian elderly parents

The impact of immigration on parents left behind has been largely ignoredin the literature. This exploratory study uses cultural specificity theory toexamine the effect an adult child's emigration has on the familial supportsystem available to the parents left behind, and on the parent'spsychological well-being. Twenty-nine parents (age 55+) in India, who hadadult children in the United States, were selected using snowball sampling.Qualitative interviews based on a semi-structured interview schedule wereconducted during the fall and winter of 1997. Results show that althoughmost parents do not live in an extended family, they receive support fromextended family members. However, the biggest source of daily supportcomes from hired help. Hired help allows parents to live independently anddecreases reliance on informal support systems. Since hired help isrelatively inexpensive most parents can substitute help for their children.This does not alleviate feelings of loneliness and depression.     

Parental perceptions of overweight in 3-5 y olds

OBJECTIVE: To assess the accuracy of parents' perceptions of their 3 to 5 y old children's weight status in a large UK sample. METHOD: Parental perception and concern about child weight, demographic variables, and children's height and weight were obtained for 564 parent-child dyads. RESULTS: Only 1.9% of parents of overweight children and 17.1% of parents of obese children described their child as overweight. The odds of parents perceiving the child as overweight were increased for overweight (2.7; 95% CI 0.4, 16.5) and obese (28.5; 7.1, 115.4) compared with normal weight children, but were not associated with parental weight or with any demographic factors. Although few parents perceived their overweight children as overweight, more (66.2%) expressed concern about their overweight child becoming overweight in the future. Odds of concern were progressively higher for overweight (2.5; 1.6, 3.9) and obese children (4.6; 2.2, 9.7), and were also higher for parents who were themselves overweight (1.9; 1.2, 2.9) or obese (2.5; 1.3, 4.8). CONCLUSION: These findings suggest that parents of 3-5 y olds show poor awareness of their child's current weight status. Reframing discussions in terms of preventing future overweight may be an effective way to engage parents.