Parental Chronic Illness Impact on Children: Family Status, Aspects of Relationships and Patients’ Illness Perceptions in Association with the Total Score of CBCL and SCL90
DOI:
https://doi.org/10.47604/ijp.3494Keywords:
Parental Chronic Illness, Children’s Mental Health, Family RelationshipsAbstract
Purpose: The goal of this study is to define in which ways certain conditions of parental chronic illness affect children’s mental health. Precisely, we expect to find answers in a series of research questions about the relation between demographic characteristics of chronic patients, family status, family relationships, role of illness as perceived subjectively by parents and the Scores in the Child Behavior Checklist (CBCL) and Symptom Checklist 90 Revised (SCL-90-R). Current study’s aim is to define whether and how family conditions mediate children’s psychological impact due to parental chronic illness.
Methodology: The study adopted a qualitative descriptive research design. To collect data, we administered questionnaires to a Greek non-probability purposeful sample of chronically ill parents (N = 182) having children up to 18-years-old. The participants were recruited via on line communities. All the scales have good or excellent reliability (Cronbach’s alpha values greater than 0.8). All ethical requirements and General Data Protection Regulations (GDPR) were followed. Ethics committee of National and Kapodistrian University of Athens approval number is: 674/22/05/2025. The IBM SPSS Statistics 24 software was used for the analysis and the significance level of the tests was set at 0.05. Tables were also used to present the data.
Findings: Main findings of the study as revealed from the analysis are the following: patients’ relationship status (married / in relationship vs divorced or single) and support received by their partner are significantly related with the total CBCL scores. Among married patients, 6.2% of their children are in borderline or clinical range, whereas the corresponding percentage for those that are divorced, or single parents is 18.9% (p=0.023). The percentage of the children who are in borderline or clinical range for emotional or behavioral problems is significantly higher among the patients who receive a little or none support by their partner (20.5%) compared with children of patients that receive a lot or moderate support (6.1%, p=0.007). Patients that declare that the role of illness in their life is heavy score on average significantly higher in the total scale of SCL90 than those that declare that the role of illness is moderate or minimum (1.05 ± 0.75 vs. 0.66 ± 0.48, p=0.001). Patients who declare that the illness has affected their child also score on average significantly higher in the total scale of SCL90 than those that don’t believe or are not sure that illness has affected their child (1.07 ± 0.70 vs. 0.78 ± 0.69, p=0.001). Patients whose child’s reaction about the illness is acceptance score significantly lower in the total scale of SCL90 than those that their child’s reaction was fear / anxiety / sadness (0.74 ± 0.61 vs. 1.01 ± 0.62, p=0.005).
Unique Contribution to Theory, Practice and Policy: The present study suggests that regardless of the kind of chronic illness or severity spectrum, the patient’s subjective positivity towards the illness, the strong bond between partners and the patient’s feeling of support, seem to be fundamental mediators of parent/patient feeling of coping and children’s wellbeing. The family’s climate, the couple’s positive relationship and the availability of the healthy parent or even the ill one to relate to, seem to reduce negative outcomes of illness and children’s psychological burden. Given the strong association between children’s wellbeing and family relationships, we can assume the importance to include the entire family in chronic illness care policies and measures. Identifying protective factors in the context of interaction between parental chronic illness and mental distress in children could guide mental health promotion strategics to enhance all family members well-being.
Downloads
References
Afzelius, M., Plantin, L., & Östman, M. (2018). Families living with parental mental illness and their experiences of family interventions. Journal of Psychiatric and Mental Health Nursing, 25(2), 69–77. https://doi.org/10.1111/jpm.12438
Alberti, K. G. M., Zimmet, P., & Shaw, J. (2005). The metabolic syndrome—a new worldwide definition. The Lancet, 366(9491), 1059–1062. https://doi.org/10.1016/S0140-6736(05)67402-8
Amato, P. R. (2010). Research on divorce: Continuing trends and new developments. Journal of Marriage and Family, 72(3), 650–666. https://doi.org/10.1111/j.1741-3737.2010.00723.x
Anderson, R., & Bury, M. (Eds.). (2024). Living with chronic illness: The experience of patients and their families. Taylor & Francis.
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Lawrence Erlbaum.
Barkmann, C., Romer, G., Watson, M., & Schulte-Markwort, M. (2007). Parental physical illness as a risk for psychosocial maladjustment in children and adolescents: Epidemiological findings from a national survey in Germany. Psychosomatics, 48(6), 476–481. https://doi.org/10.1176/appi.psy.48.6.476
Batulan, Z., Bhimla, A., & Higginbotham, E. J. (2024). Advancing research on chronic conditions in women. Journal of Women’s Health. Advance online publication. https://doi.org/10.1089/jwh.2024.0000
Baxter, J., Weston, R., & Qu, L. (2011). Family structure, co-parental relationship quality, post-separation paternal involvement and children’s emotional wellbeing. Journal of Family Studies, 17(2), 86–109. https://doi.org/10.5172/jfs.2011.17.2.86
Beardslee, W. R., Gladstone, T. R., Wright, E. J., & Cooper, A. B. (2003). A family-based approach to the prevention of depressive symptoms in children at risk: Evidence of parental and child change. Pediatrics, 112(2), e119–e131. https://doi.org/10.1542/peds.112.2.e119
Becker, S. (2017, May 29–31). Young carers international: Reflections on 25 years of research, campaigning and life. In Swedish Family Care Competence Centre (Ed.), Proceedings of the 2nd International Conference: Every child has the right to family (pp. 1–12). Nationellt kompetenscentrum anhöriga.
Bell, M. F., Bayliss, D. M., Glauert, R., Harrison, A., & Ohan, J. L. (2019). Children of parents who have been hospitalised with psychiatric disorders are at risk of poor school readiness. Epidemiology and Psychiatric Sciences, 28(5), 508–520. https://doi.org/10.1017/S2045796018000060
Bowlby, J. (1958). The nature of the child’s tie to his mother. International Journal of Psycho-Analysis, 39, 350–373.
Brickman Bhutta, C. (2012). Not by the book: Facebook as a sampling frame. Sociological Methods & Research, 41(1), 57–88. https://doi.org/10.1177/0049124112440795
Buehler, C., & Gerard, J. M. (2002). Marital conflict, ineffective parenting, and children’s and adolescents’ maladjustment. Journal of Marriage and Family, 64(1), 78–92. https://doi.org/10.1111/j.1741-3737.2002.00078.x
Brody, G. H., & Ge, X. (2001). Linking parenting processes and self-regulation to psychological functioning and alcohol use during early adolescence. Journal of Family Psychology, 15(1), 82–94. https://doi.org/10.1037/0893-3200.15.1.82
Chen, E., & Miller, G. E. (2012). “Shift-and-persist” strategies: Why low socioeconomic status isn’t always bad for health. Perspectives on Psychological Science, 7(2), 135–158. https://doi.org/10.1177/1745691612436694
Christakis, N. A., & Allison, P. D. (2006). Mortality after the hospitalization of a spouse. New England Journal of Medicine, 354(7), 719–730. https://doi.org/10.1056/NEJMsa050196
Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). SAGE Publications.
Craigie, F. C., Walker, B. L., & Squires, J. E. (2010). Healthcare provider support for families with parental chronic illness: A report from the Caring for Families Study. University of Maine, Center for Research on Family.
Carlsson, E., Frostell, A., & Olsson, E. (2014). Children’s psychological stress in relation to parental somatic illness. Scandinavian Journal of Caring Sciences, 28(4), 744–751. https://doi.org/10.1111/scs.12100
Compas, B. E., Jaser, S. S., Bettis, A. H., Watson, K. H., Gruhn, M. A., Dunbar, J. P., Williams, E., & Thigpen, J. C. (2017). Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review. Psychological Bulletin, 143(9), 939–991. https://doi.org/10.1037/bul0000110
Compas, B. E., Jaser, S. S., Dunn, M. J., & Rodriguez, E. M. (2012). Coping with chronic illness in childhood and adolescence. Annual Review of Clinical Psychology, 8(1), 455–480. https://doi.org/10.1146/annurev-clinpsy-032511-143108
Derogatis, L. R. (1993). Brief Symptom Inventory (BSI): Administration, scoring, and procedures manual (4th ed.). National Computer Systems.
Derogatis, L. R., & Cleary, P. A. (1977). Confirmation of the dimensional structure of the SCL-90: A study in construct validation. Journal of Clinical Psychology, 33(4), 981–989. https://doi.org/10.1002/1097-4679(197710)33:4<981::AID-JCLP2270330412>3.0.CO;2-0
Donias, S., Karastergiou, A., & Manos, N. (1991). Standardization of the symptom checklist-90-R rating scale in a Greek population. Psychiatriki, 2(1), 42–48.
Edwards, B., & Clarke, V. (2004). The psychological impact of a cancer diagnosis on families: The influence of family functioning and patients’ illness characteristics on depression and anxiety. Psycho‐Oncology, 13(8), 562–576. https://doi.org/10.1002/pon.773
Ellis, S. J., Wakefield, C. E., Antill, G., Burns, M., & Patterson, P. (2017). Supporting children facing a parent’s cancer diagnosis: A systematic review of children’s psychosocial needs and existing interventions. European Journal of Cancer Care, 26(1), e12432. https://doi.org/10.1111/ecc.12432
Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
Falkov, A. (1998). Crossing bridges: Training resources for working with mentally ill parents and their children. Department of Health.
Falkov, A. (2012). The family model handbook: An integrated approach to supporting mentally ill parents and their children. Pavilion Publishing.
Fendrich, M., Warner, V., & Weissman, M. M. (1990). Family risk factors, parental depression, and psychopathology in offspring. Developmental Psychology, 26(1), 40–50. https://doi.org/10.1037/0012-1649.26.1.40
Giallo, R., Bahreinian, S., Brown, S., Cooklin, A., Kingston, D., Kozyrskyj, A., & Nicholson, J. (2013). Maternal depressive symptoms across early childhood and offspring emotional–behavioral and learning outcomes: A prospective study. Journal of Affective Disorders, 149(1–3), 81–89. https://doi.org/10.1016/j.jad.2013.01.009
Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x
Goodman, S. H., Rouse, M. H., Connell, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review, 14(1), 1–27. https://doi.org/10.1007/s10567-010-0080-1
Goodman, S. H., & Gotlib, I. H. (1999). Risk for psychopathology in the children of depressed mothers: A developmental model for understanding mechanisms of transmission. Psychological Review, 106(3), 458–490. https://doi.org/10.1037/0033-295X.106.3.458
Gorin, S. (2004). Understanding what children say: Children’s experiences of domestic violence, parental substance misuse, and parental health problems. Child & Family Social Work, 9(2), 129–140. https://doi.org/10.1111/j.1365-2206.2004.00324.x
Grant, K. E., Compas, B. E., Thurm, A. E., McMahon, S. D., & Gipson, P. Y. (2004). Stressors and child and adolescent psychopathology: Measurement issues and prospective effects. Journal of Clinical Child and Adolescent Psychology, 33(2), 412–425. https://doi.org/10.1207/s15374424jccp3302_23
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O’Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J., Duda, S. N., & REDCap Consortium. (2019). The REDCap consortium: Building an international community of software partners. Journal of Biomedical Informatics, 95, 103208. https://doi.org/10.1016/j.jbi.2019.103208
Hosman, C. M. H., van Doesum, K. T. M., & van Santvoort, F. (2009). Prevention of emotional problems and psychiatric risks in children of parents with a mental illness in the Netherlands: I. The scientific basis to a comprehensive approach. Australian e-Journal for the Advancement of Mental Health, 8(3), 250–263. https://doi.org/10.5172/jamh.8.3.250
Hughes, E. K., & Gullone, E. (2010). Internalizing symptoms and disorders in families of adolescents: A review of family systems research. Clinical Psychology Review, 30(2), 187–198. https://doi.org/10.1016/j.cpr.2009.10.002
Jaser, S. S., Fear, J. M., Reeslund, K. L., Champion, J. E., Reising, M. M., & Compas, B. E. (2008). Maternal sadness and adolescents’ responses to stress in offspring of mothers with and without a history of depression. Journal of Clinical Child & Adolescent Psychology, 37(4), 736–746. https://doi.org/10.1080/15374410802359742
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593
Koutra, K., Simos, P., Triliva, S., Lionis, C., & Vgontzas, A. N. (2014). Linking parental depression to the family’s functioning: A study in the postnatal period. Journal of Affective Disorders, 160, 134–141. https://doi.org/10.1016/j.jad.2013.12.028
Koutra, K., Roumeliotaki, T., Kyriklaki, A., Kampouri, M., Sarri, K., Vassilaki, M., Bitsios, P., Kogevinas, M., & Chatzi, L. (2017). Maternal depression and personality traits in association with child neuropsychological and behavioral development at preschool age: The Rhea Mother–Child Cohort in Crete, Greece. Journal of Affective Disorders, 217, 89–98. https://doi.org/10.1016/j.jad.2017.03.050
Kumar, P., & Mattanah, J. F. (2018). Parental illness and adolescent adjustment: The mediating role of attachment. Journal of Child and Family Studies, 27(10), 3110–3121. https://doi.org/10.1007/s10826-018-1141-0
Lauritzen, C., & Reedtz, C. (2016). Support for children of mental health service users in Norway. Mental Health & Prevention, 4(1), 23–29. https://doi.org/10.1016/j.mhp.2015.12.002
Leen-Feldner, E. W., Reardon, L. E., & Zvolensky, M. J. (2007). Pubertal status and emotional reactivity to a voluntary hyperventilation challenge predicting panic symptoms and somatic complaints. Behaviour Research and Therapy, 45(12), 3047–3059. https://doi.org/10.1016/j.brat.2007.08.009
Leijdesdorff, S., van Doesum, K. T. M., Popma, A., Klaassen, R., & van Amelsvoort, T. (2017). Prevalence of psychopathology in children of parents with mental illness and/or addiction: An up-to-date narrative review. Current Opinion in Psychiatry, 30(4), 312–317. https://doi.org/10.1097/YCO.0000000000000341
Leijdesdorff, S., van Doesum, K. T. M., Popma, A., & van Amelsvoort, T. (2020). Prevalence of mental illness and its risk factors in children of parents with mental illness: Results from a Dutch population survey. European Child & Adolescent Psychiatry, 29(6), 807–818. https://doi.org/10.1007/s00787-019-01367-4
Lewis, F. M., Brandt, P. A., Cochrane, B. B., Griffith, K. A., & Grant, M. (2008). The enhancing connections program: Pilot study of a cancer parenting program. Journal of Cancer Education, 23(1), 10–20. https://doi.org/10.1080/08858190701821209
Lichtwarck-Aschoff, A., van Rooij, F. B., & Kleinjan, M. (2012). Family processes and adolescents’ internalizing and externalizing problems: An analysis with the dynamic systems approach. Development and Psychopathology, 24(3), 1113–1125. https://doi.org/10.1017/S095457941200057X
Lindsey, M. A., Brandt, N. E., Becker, K. D., Lee, B. R., Barth, R. P., Daleiden, E. L., & Chorpita, B. F. (2014). Identifying the common elements of evidence-based interventions for children’s mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 53(7), 739–752. https://doi.org/10.1016/j.jaac.2014.03.007
Lovejoy, M. C., Graczyk, P. A., O’Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior: A meta-analytic review. Clinical Psychology Review, 20(5), 561–592. https://doi.org/10.1016/S0272-7358(98)00100-7
Masten, A. S., & Monn, A. R. (2015). Resilience in children and families facing adversity: Principles for intervention and prevention. In M. Ungar (Ed.), Handbook for working with children and youth: Pathways to resilience across cultures and contexts (pp. 141–160). Sage.
Maybery, D., Reupert, A., Patrick, K., Goodyear, M., & Cripps, K. (2009). Prevalence of parental mental illness in Australian families. Psychiatric Bulletin, 33(1), 22–26. https://doi.org/10.1192/pb.bp.107.018861
Meiser-Stedman, R., McKinnon, A., Dixon, C., Boyle, A., Smith, P., & Dalgleish, T. (2019). A core role for cognitive processes in the development of posttraumatic stress in children. Journal of Child Psychology and Psychiatry, 60(8), 875–883. https://doi.org/10.1111/jcpp.13062
Miller, L., Warner, V., Wickramaratne, P., & Weissman, M. (1999). Self-esteem and depression: Ten year follow-up of mothers and offspring. Journal of Affective Disorders, 52(1–3), 41–49. https://doi.org/10.1016/S0165-0327(98)00099-1
Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
National Health Service. (2019). The NHS long term plan. https://www.longtermplan.nhs.uk/
Niemelä, M., Toikka, S., Punamäki, R. L., Pajulo, M., & Solantaus, T. (2012). Pilot evaluation of the Let’s Talk about Children intervention: Parents’ and practitioners’ experiences. Journal of Psychiatric and Mental Health Nursing, 19(5), 452–463. https://doi.org/10.1111/j.1365-2850.2011.01814.x
Nøvik, T. S., Myhre, M. C., & Vikan, A. (2013). Children of chronically ill parents: Predictors of health-related quality of life. Scandinavian Journal of Psychology, 54(5), 441–447. https://doi.org/10.1111/sjop.12067
O’Connell, M. E., Boat, T., & Warner, K. E. (Eds.). (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. National Academies Press. https://doi.org/10.17226/12480
Östman, M., & Afzelius, M. (2011). Children of parents with a mental illness: Prevalence and needs for support. Social Psychiatry and Psychiatric Epidemiology, 46(7), 659–665. https://doi.org/10.1007/s00127-010-0246-2
Pakenham, K. I., & Cox, S. (2012). The effects of parental illness and other ill family members on youth caregiving experiences. Psychology & Health, 27(8), 927–941. https://doi.org/10.1080/08870446.2011.630735
Pakenham, K. I., Chiu, J., Bursnall, S., & Cannon, T. (2007). Relations between social support, appraisal, and coping and both positive and negative outcomes in young carers. Journal of Health Psychology, 12(1), 89–102. https://doi.org/10.1177/1359105307071743
Patterson, J. M. (2002). Integrating family resilience and family stress theory. Journal of Marriage and Family, 64(2), 349–360. https://doi.org/10.1111/j.1741-3737.2002.00349.x
Pears, K. C., & Capaldi, D. M. (2001). Intergenerational transmission of abuse: A two-generational prospective study of an at-risk sample. Child Abuse & Neglect, 25(11), 1439–1461. https://doi.org/10.1016/S0145-2134(01)00286-1
Pihkala, H., & Johansson, E. E. (2008). Long-term follow-up of children of parents with psychiatric problems: Psychiatric health and social functioning. Nordic Journal of Psychiatry, 62(2), 133–141. https://doi.org/10.1080/08039480801959450
Reupert, A., & Maybery, D. (2010). “Families affected by parental mental illness: A multiperspective account of issues and interventions.” American Journal of Orthopsychiatry, 80(3), 362–369. https://doi.org/10.1111/j.1939-0025.2010.01040.x
Reupert, A., Maybery, D., & Kowalenko, N. (2013). Children whose parents have a mental illness: Prevalence, need and treatment. Medical Journal of Australia, 199(3), S7–S9. https://doi.org/10.5694/mja11.11200
Repetti, R. L., Taylor, S. E., & Seeman, T. E. (2002). Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin, 128(2), 330–366. https://doi.org/10.1037/0033-2909.128.2.330
Scott, J., Fowler, D., McGorry, P., Birchwood, M., Killackey, E., Christensen, H., & Hickie, I. (2013). Adolescents and young adults who are not in employment, education, or training. BMJ, 347, f5270. https://doi.org/10.1136/bmj.f5270
Segrin, C., & Flora, J. (2019). Family communication (3rd ed.). Routledge. https://doi.org/10.4324/9781351068229
Sieh, D. S., Meijer, A. M., Oort, F. J., Visser-Meily, J. M. A., & Van der Leij, D. A. V. (2010). Problem behavior in children of chronically ill parents: A meta-analysis. Clinical Child and Family Psychology Review, 13(4), 384–397. https://doi.org/10.1007/s10567-010-0074-z
Sieh, D. S., Visser-Meily, J. M. A., Meijer, A. M., & Van der Leij, D. A. V. (2012). Risk factors for problem behavior in adolescents of parents with a chronic medical condition. European Child & Adolescent Psychiatry, 21(8), 459–471. https://doi.org/10.1007/s00787-012-0279-4
Solantaus, T., Paavonen, E. J., Toikka, S., & Punamäki, R. L. (2010). Preventive interventions in families with parental depression: Children’s psychosocial symptoms and prosocial behaviour. European Child & Adolescent Psychiatry, 19(12), 883–892. https://doi.org/10.1007/s00787-010-0135-3
Stojanovich, L. (2010). Stress and autoimmunity. Autoimmunity Reviews, 9(5), A271–A276. https://doi.org/10.1016/j.autrev.2009.11.010
Streeck-Fischer, A., & van der Kolk, B. A. (2000). Down will come baby, cradle and all: Diagnostic and therapeutic implications of chronic trauma on child development. Australian and New Zealand Journal of Psychiatry, 34(6), 903–918. https://doi.org/10.1080/000486700265
Van Doesum, K. T. M., Hosman, C. M. H., & Riksen-Walraven, J. M. (2005). A model-based intervention for depressed mothers and their infants. Infant Mental Health Journal, 26(2), 157–176. https://doi.org/10.1002/imhj.20038
Van Santvoort, F., Hosman, C. M. H., Janssens, J. M. A. M., & van Doesum, K. T. M. (2014). Effectiveness of preventive support groups for children of mentally ill parents: A randomized controlled trial. European Child & Adolescent Psychiatry, 23(6), 473–484. https://doi.org/10.1007/s00787-013-0474-z
Weissman, M. M., Wickramaratne, P., Nomura, Y., Warner, V., Pilowsky, D., & Verdeli, H. (2006). Offspring of depressed parents: 20 years later. American Journal of Psychiatry, 163(6), 1001–1008. https://doi.org/10.1176/ajp.2006.163.6.1001
World Health Organization. (2001). The world health report 2001: Mental health—New understanding, new hope. World Health Organization. https://apps.who.int/iris/handle/10665/42390
World Health Organization. (2013). Mental health action plan 2013–2020. World Health Organization. https://apps.who.int/iris/handle/10665/89966
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Theodora Arkouli, Vassiliki Lissy Canellopoulos
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
