Survivors of childhood cancer and comparison peers: The influence of early family factors on distress in emerging adulthood.

This prospective study examines family predictors of distress among survivors of childhood cancer and comparison peers during the transition to emerging adulthood. Children with cancer (n = 55), comparison peers (n = 60), and parents completed measures of distress, family environment, social support, and demographic characteristics during initial treatment, as well as follow-up measures of young adult distress and demographic characteristics soon after participants turned 18 years old. Severity of initial treatment and late effects were rated by healthcare providers for participants with cancer. For all participants, mother and father report of initial parent distress was associated with their report of young adult distress at follow-up. Young adult gender moderated this association. For survivors of childhood cancer, severity of initial treatment and late effects also moderated the association between parent and young adult distress. Improving parent distress may help reduce child distress in general. For survivors specifically, ameliorating the impact of initial treatment and long-term physical problems may be beneficial. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of an empirical typology of African American family functioning.

This study empirically identified types of African American families. Adolescents (N=111) were assessed on family functioning. With cluster analytic methods, 3 types of families were identified. The cohesive-authoritative type was above average on parental education and income, averaged about 2 children, exhibited a high quality of family functioning and high self-esteem in adolescents. The conflictive-authoritarian type had average parental education and income, an average of 2.7 children, exhibited controlling and rigid discipline, and placed a high emphasis on achievement. The defensive-neglectful type was predominately headed by single mothers with below average education and income and averaged about 3 children. Such families displayed chaotic family processes, and adolescents tended to suffer from low self-esteem. The typology exhibited good reliability. The implications of the typology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning and posttraumatic stress disorder in adolescent survivors of childhood cancer.

This study investigated family functioning and relationships between family functioning and posttraumatic stress disorder (PTSD) in adolescent survivors of childhood cancer. To assess family functioning, 144 adolescent cancer survivors 1 to 12 years post–cancer treatment (M = 5.3 years) and their parents completed the Family Assessment Device (FAD). To assess PTSD, adolescents were administered a structured diagnostic interview. Nearly half (47%) of the adolescents, one fourth (25%) of mothers, and one third (30%) of fathers reported poor family functioning, exceeding the clinical cutoff on 4 or more FAD subscales. Families in which the cancer survivor had PTSD (8% of the sample) had poorer functioning than other families in the areas of problem solving, affective responsiveness, and affective involvement. Three fourths of the adolescents with PTSD came from families with categorically poor family functioning. A surprisingly high rate of poor family functioning was reported in these families of adolescent cancer survivors. Adolescents with PTSD were more than 5 times as likely to emerge from a poorly functioning family compared with a well-functioning one. This study provides evidence that family functioning is related to cancer-related posttraumatic reactions in adolescent survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining the validity of self-report assessments of family functioning: A question of the level of analysis.

Family assessment instruments attempt to measure family functioning at a particular level of the family system: individual, dyad, or family as a whole. This article introduces the concept of level validity, that is, whether an assessment measures family functioning at the level that it was intended to measure. The authors argue that whenever higher-order factors (e.g., dyadic subsystems) are the target of a measure, these factors should explain variance that is independent of their lower-order constituents (e.g., individual-level characteristics). Previously published data targeting dyadic subsystems within the family were reanalyzed using a model that controls for lower-order effects. Dyad-level factors rarely emerged independent of individual-level factors and, when they did, they did not replicate across samples. The results suggest that level validity should be tested and reported along with other aspects of construct validity before accepting such measures as valid assessments of family functioning. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Work time, work interference with family, and psychological distress.

Despite public concern about time pressures experienced by working parents, few scholars have explicitly examined the effects of work time on work-family conflict. The authors developed and tested a model of the predictors of work time and the relationships between time, work interference with family (WIF), and psychological distress. Survey data came from 513 employees in a Fortune 500 company. As predicted, several work and family characteristics were significantly related to work time. In addition, work time was significantly, positively related to WIF, which in turn was significantly, negatively related to distress. The results suggest that work time fully or partially mediates the effects of many work and family characteristics on WIF. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative effects on family functioning from psychosocial treatments: A recommendation for expanded safety monitoring.

Whereas biomedical products are required to be tested for safety with respect to vulnerable organ systems, psychosocial treatments are not required to be tested for safety with respect to vulnerable social systems such as the family. This article provides some evidence for the need to document the potential negative effects of psychosocial treatments on family-level outcomes. Three randomized controlled trials are reviewed in which independent ratings or self-reports of family functioning were measured. Each of the 3 studies compared the efficacy of a family and a nonfamily treatment. Totally unexpectedly, the nonfamily treatment in each of the 3 trials demonstrated significant declines in family functioning. The authors suggest that psychosocial treatments with vulnerable populations have the potential to produce negative side effects on families. Therefore, it is important to conduct further research to determine whether safety studies should be required for psychosocial treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multilevel analysis of whole family functioning using the McMaster Family Assessment Device.

This study demonstrates the use of multilevel modeling to examine influences on ratings of whole family functioning collected from multiple family members (N=26,614) living in 11,023 families with 1 or more dependent children aged 0 to 24 years. Results indicate that 45.7% of the variance in ratings of whole family functioning was shared among family members, whereas 54.3% was nonshared. Family-level characteristics, such as socioeconomic status (SES), family structure and composition, and family well-being, accounted for 30.6% of between-family variation (i.e., shared perceptions). Individual-level characteristics, such as sex, age, dependent child status, education, and well-being, accounted for 5.6% of within-family variance (i.e., unique perceptions). There was significant between-family variation in the relationship between dependent child status and ratings of family functioning, and increased rating discrepancies among members of the same family were linked with higher levels of family SES. The findings attest to the validity of measuring whole family functioning directly from self-report ratings provided from multiple family members. However, caution is warranted when assessments are available only from single respondents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal analyses of family functioning in veterans and their partners across treatment.

Objective: This study evaluated the relations between posttraumatic stress disorder (PTSD) symptoms and poor family functioning in veterans and their partners. Method: Data were collected from Caucasian veterans with PTSD (N = 1,822) and their partners (N = 702); mean age = 53.9 years, SD = 7.36. Veterans completed the Posttraumatic Checklist Military Version (PCL-M) and, along with their partners, completed the McMaster Family Assessment Device (FAD-12). Assessments were conducted at intake into a treatment program at 3 months and 9 months posttreatment. Results: Structural equation models (SEMs) were developed for veterans as well as for veterans and their partners. Poor family functioning for veterans at intake predicted intrusion (β = .08), hyperarousal (β = .07), and avoidance (β = .09) at 3 months posttreatment. At 3 months posttreatment, family functioning predicted hyperarousal (β = .09) and avoidance (β = .10) at 9 months. For veterans and their partners, family functioning at intake predicted avoidance (β = .07) at 3 months, and poor family functioning at 3 months predicted intrusion (β = .09) and hyperarousal (β = .14) at 9 months. The reverse pathways, with PTSD symptoms predicting poor family functioning, were only evident with avoidance (β = .06). Conclusion: Family functioning may play a role in treatment for veterans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional distress following genetic testing for hereditary breast and ovarian cancer: A meta-analytic review.

Objective: Meta-analysis was used to synthesize results of studies on emotional consequences of predictive genetic testing for BRCA1/2 mutations conferring increased risk of breast and ovarian cancer. Design: Studies assessing anxiety or cancer-specific distress before and after provision of test results (k = 20) were analyzed using a random-effects model. Moderator variables included country of data collection and personal cancer history of study participants. Main Outcome Measures: Standardized mean gain effect sizes were calculated for mutation carriers, noncarriers, and those with inconclusive results over short (0–4 weeks), moderate (5–24 weeks), or long (25–52 weeks) periods of time after testing. Results: Distress among carriers increased shortly after receiving results and returned to pretesting levels over time. Distress among noncarriers and those with inconclusive results decreased over time. Some distress patterns differed in studies conducted outside the United States and for individuals with varying cancer histories. Conclusion: Results underscore the importance of time; changes in distress observed shortly after test-result disclosure frequently differed from the pattern of distress seen subsequently. Although emotional consequences of this testing appear minimal, it remains possible that testing may affect cognitive and behavioral outcomes, which have rarely been examined through meta-analysis. Testing may also affect understudied subgroups differently. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of relationship functioning for patients with bipolar disorder and their partners.

Previous investigations have examined family functioning, including marital functioning, as an important predictor of the course of bipolar disorder, but limited research exists identifying the factors that influence relationship functioning in patients with bipolar disorder. In the current study, 56 patients with bipolar disorder and their partners were assessed for Axis II pathology, general family functioning, and relationship distress. Patient mood symptoms and Axis II pathology variables were examined as predictors of general relationship functioning (Family Assessment Device, McMaster Clinical Rating Scale, and Dyadic Adjustment Scale) in regression models. Analyses indicated that patients' depressive symptomatology was associated with patient ratings of general family functioning and couple functioning, while patients' manic symptoms were associated with partners' ratings of the romantic relationship. Partners' total Axis II pathology, but not patients' Axis II pathology, was associated with patient and partner perception of the couple's relationship. These findings highlight the importance of mood and personality pathology to relationship functioning, and represent one of the first investigations to verify the impact of personality pathology on patients' and partners' perceptions of relationship functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community Violence, Family Conflict, and Preschoolers' Socioemotional Functioning.

This study examined the relations among family conflict, community violence, and young children's socioemotional functioning and explored how children's social cognition and mothers' psychological functioning may mediate the outcomes associated with this exposure. Mothers of 431 Head Start preschoolers completed questionnaires about their family demography, exposure to community violence, family conflict, and children's distress symptoms. Children were administered a social cognition assessment, and teachers rated their behavior. Results showed that mothers' reports of children's co-witnessing of community violence were positively associated with police department crime rates, children's distress symptoms, and teachers' ratings of aggression. A path analysis revealed that children's social awareness and mothers' depressive symptoms partially mediated the effects of community violence and family conflict on outcomes for children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cancer-related fatigue: A systematic and meta-analytic review of non-pharmacological therapies for cancer patients.

[Correction Notice: An erratum for this article was reported in Vol 135(1) of Psychological Bulletin (see record 2008-18777-005). The URL to the Supplemental Materials for the article is listed incorrectly in two places in the text. The incorrect listings appear on p. 704 (in the last two lines of the third paragraph) and on p. 705 (in the third and fourth lines of the first paragraph in the second column). The correct URL for the Supplemental Materials is http://dx.doi.org/10.1037/a0012825.supp, which is provided on the first page of the article beneath the abstract.] Cancer-related fatigue (CRF) is a significant clinical problem for more than 10 million adults diagnosed with cancer each year worldwide. No "gold standard" treatment presently exists for CRF. To provide a guide for future research to improve the treatment of CRF, the authors conducted the most comprehensive combined systematic and meta-analytic review of the literature to date on non-pharmacological (psychosocial and exercise) interventions to ameliorate CRF and associated symptoms (vigor/vitality) in adults with cancer, based on 119 randomized controlled trials (RCTs) and non-RCT studies. Meta-analyses conducted on 57 RCTs indicated that exercise and psychological interventions provided reductions in CRF, with no significant differences between these 2 major types of interventions considered as a whole. Specifically, multimodal exercise and walking programs, restorative approaches, supportive-expressive, and cognitive-behavioral psychosocial interventions show promising potential for ameliorating CRF. The results also suggest that vigor and vitality are distinct phenomena from CRF with regard to responsiveness to intervention. With improved methodological approaches, further research in this area may soon provide clinicians with effective strategies for reducing CRF and enhancing the lives of millions of cancer patients and survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent and parent therapeutic alliances as predictors of dropout in multidimensional family therapy.

The authors examined the relations between adolescent-therapist and mother-therapist therapeutic alliances and dropout in multidimensional family therapy for adolescents who abuse drugs. The authors rated videotapes of family therapy sessions using observational methods to identify therapist-adolescent and therapist-mother alliances in the first 2 therapy sessions. Differences in adolescent and mother alliances in families that dropped out of therapy and families that completed therapy were compared. Results indicate that both adolescent and mother alliances with the therapist discriminated between dropout and completer families. Although no differences were observed between the 2 groups in Session 1, adolescents and mothers in the dropout group demonstrated statistically significantly lower alliance scores in Session 2 than adolescents and parents in the completer group. These findings are consistent with other research that has established a relationship between therapeutic alliance and treatment response. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analytic review of obesity prevention programs for children and adolescents: The skinny on interventions that work.

This meta-analytic review summarizes obesity prevention programs and their effects and investigates participant, intervention, delivery, and design features associated with larger effects. A literature search identified 64 prevention programs seeking to produce weight gain prevention effects, of which 21% produced significant prevention effects that were typically pre- to post effects. Larger effects emerged for programs that targeted children and adolescents (vs. preadolescents) and females, programs that were relatively brief, programs that solely targeted weight control versus other health behaviors (e.g., smoking), programs evaluated in pilot trials, and programs wherein participants must have self-selected into the intervention. Other factors, including mandated improvements in diet and exercise, sedentary behavior reduction, delivery by trained interventionists, and parental involvement, were not associated with significantly larger effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family routines and rituals--The importance of family functioning: Comment on the special section.

This diverse collection of papers highlights routines and rituals in family life. Just as individual family members bring unique styles and perspectives to the family table, to be incorporated into a family framework, so do each of these papers present rich and varied research questions, designs, and measurement strategies that enrich our understanding of family routine behavior patterns and ritual meanings. This series adds to our conceptualization of family routines and rituals within a systems perspective highlighting: 1) families are comprised of multiple levels that operate individually; interact with each other; and as a whole, reveal properties distinct from separate parts; 2) families tend toward stability in meaningful patterns of functioning; and 3) family functioning has meaning for individual outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning and mood disorders: A comparison between patients with major depressive disorder and bipolar I disorder.

Within a sample of patients with major depressive disorder (MDD; n = 121) and bipolar affective disorder (BPAD; n = 69), the authors examined (a) diagnostic differences in family functioning at acute episode, (b) diagnostic differences in family functioning at episode recovery, (c) within-group changes in family functioning from acute episode to recovery, and (d) whether within-group changes from acute episode to recovery varied by diagnosis. Using a multidimensional model, the authors evaluated interviewer, patient, and family ratings. Overall, patients with MDD and BPAD evidenced similar levels of family impairment at acute episode and recovery. Generally, patients in both groups experienced improvement in family functioning over time, yet mean scores at recovery continued to range from fair to poor. Although certain specific differences emerged, diagnostic groups appeared to be more similar than different in level and pattern of family functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of domestic violence on the maternal-child relationship and preschool-age children's functioning.

Although preschool-age children are at risk for witnessing domestic violence, the majority of research has focused on children ages 6 to 12 years. This study examines the mediating role of the mother-child relationship on preschool-age children's functioning in families experiencing domestic violence. Maternal report and behavioral observations of mother-child interactions were used to assess relationship quality. Participants consisted of 103 children and their mothers. The data fit the model well but indicated that some of the correlations were not in the expected direction. Although depressed mothers were struggling with parenting, other mothers appeared to be compensating for the violence by becoming more effective parents. Domestic violence negatively impacted children's behavior with their mothers in interactions but did not influence maternal report of problem behaviors, suggesting that the impact of domestic violence begins very early and in the realm of relationships rather than in mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working nonstandard schedules and variable shifts in low-income families: Associations with parental psychological well-being, family functioning, and child well-being.

Longitudinal data from the New Hope Project-an experimental evaluation of a work-based antipoverty program in Milwaukee, Wisconsin-was used to explore concurrent and lagged associations of nonstandard schedules and variable shifts with parental psychological well-being, regularity of family mealtimes, and child well-being among low-income families. Working a combination of variable shifts and nonstandard hours was associated concurrently with lower teacher-reported school performance and engagement and higher levels of externalizing behavior problems. Fixed nonstandard schedules were associated with lagged decreases in parent-reported school performance, whereas working variable shifts was associated with lagged increases in parent-reported school performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Widening spheres of impact: The role of forgiveness in marital and family functioning.

This study examined relations between aspects of family functioning and positive and negative dimensions of forgiveness. Increased understanding of one's partner and decreased anger about betrayal characterize positive forgiveness, whereas experiences such as holding a grudge and desiring revenge indicate negative forgiveness. The sample included 87 wives and 74 husbands who reported experiencing a significant betrayal, their partners, and their adolescent children. Analyses of reported forgiveness revealed that more negative forgiveness was associated with lower marital satisfaction for husbands and wives; trust partially mediated this relationship for husbands and wives. Greater positive forgiveness reported by husbands and wives predicted their own reports of a stronger parenting alliance, whereas greater negative forgiveness reported by husbands and wives predicted their spouses' reports of a weaker parenting alliance. For wives, more negative forgiveness also predicted higher levels of children's perceived parental conflict, and parents' reported conflict mediated this association for wives. Findings suggest that forgiveness of a marital betrayal is significantly associated with marital satisfaction, the parenting alliance, and children's perceptions of parental marital functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Extension of the rejection sensitivity construct to the interpersonal functioning of gay men.

On the basis of recent evidence suggesting that gay men are particularly likely to fear interpersonal rejection, the authors set out to extend the rejection sensitivity construct to the mental health concerns of gay men. After establishing a reliable and valid measure of the gay-related rejection sensitivity construct, the authors use this to test the mediating effect of internalized homophobia on the relationship between parental rejection of one's sexual orientation and sensitivity to future gay-related rejection. The present data support this mediational model and also establish rejection sensitivity's unique contribution to unassertive interpersonal behavior in the context of internalized homophobia and parental rejection. The authors conclude that gay-related rejection sensitivity is a useful construct for clinicians working with gay men given the impact that past gay-related rejection can have on their gay clients' present cognitive-affective-behavioral functioning. The authors discuss the possibility of revising rejection-prone schemas in clinical work with gay men. Future research is necessary to further examine the internal processing and interpersonal functioning of gay men by using existing constructs (or modifications of them) that are likely to be particularly relevant to the unique concerns of this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)