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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The hypothesis that parental alcoholism and co-occurring antisocial behavior would be indirectly linked to child externalizing behavior problems through child lack of control, current levels of parent depression, family conflict, and parent-child conflict was tested using manifest variable regression analysis. Participants were a community sample of 125 families with an alcoholic father and 83 ecologically matched but nonsubstance abusing families involved in the first 2 waves of an ongoing longitudinal study (with 3 years between each wave). All families had a biological son who was 3-5 years old at study onset. Results revealed that child lack of control mediated the relation between paternal alcoholism and the son's subsequent externalizing behavior problems. Family conflict was a significant mediator of maternal and paternal lifetime antisocial behavior effects and father-son conflict mediated paternal lifetime antisocial behavior effects. Study implications are discussed within the context of parental socialization of antisocial behavior.
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PMID:Parental alcoholism and co-occurring antisocial behavior: prospective relationships to externalizing behavior problems in their young sons. 1132 32

Looking at the field as a whole through metaanalysis, Shadish et al concluded (based on 162 studies) that marital and family therapies were significantly more effective than no treatment and at least as effective as other forms of psychotherapy. Although these reviews and others are positive, individual studies raise many questions. For instance, based on research findings, family treatments increasingly have become standard care for patients with schizophrenia. It remains unclear what degree and type of family involvement is needed for which patients at which stage of their disorder. In the area of anxiety and depression, there are too few studies to make any strong conclusion. Although investigators such as Barrett, Cobham, and Diamond have produced some positive results, the Lewinsohn and Clark studies fail to demonstrate the added benefit of family involvement. Although Brent's study showed CBT to reduce depression faster, family therapy and supportive therapy did just as well in the long run, and family conflict was a strong risk factor for relapse. In the area of anorexia, Russell and Robins produced strong results from family interventions, whereas Geist found no difference between different types of family interventions. Family treatments for obesity have been inconsistent. In a metaanalysis of 41 studies, parental involvement did not contribute significantly to outcomes. In the Epstein study, however, which included 5- and 10-year follow-up, the results of family intervention were impressive. Although many of these studies can be cited for various methodologic flaws, the most consistent problem is that sample sizes are too small to detect difference between two or more active treatments. The most consistent findings (and most well-done, large studies) that support the efficacy of family-based interventions are done with externalizing problems. Work groups led by Patterson, Eisenstadt, Webster-Stratton, Alexander, and Henggeler all have produced impressive reductions of oppositional and antisocial behavior. Clinical programs that treat these populations without using a family-based intervention as at least a component of a treatment package are seriously ignoring the findings of contemporary intervention science. Programs of research by Henggeler, Szapocznik, and Liddle demonstrate similarly impressive results for substance abusing adolescents. Although preliminary results from the Dennis et al study suggest that various treatment approaches may benefit this population. Family interventions have had less success in reducing ADHD symptoms, yet these psychosocial treatments have been essential in reducing much of the family and school behavior problems associated with this disorder. Many investigators would agree that a combined medication and family treatment approach may be the treatment of choice for children with ADHD. In fact, many studies across various disorders suggest that patients respond best to comprehensive treatment packages, of which a family treatment is at least one component. Although the data are promising, many challenges lie ahead. Although collectively many family intervention studies exist, many disorders lack enough rigorous and large-scale investigations to make any strong conclusions. Kazdin argues that sample sizes of 150 are essential to detect significant differences between active treatments, and few of the reviewed studies include these kinds of patient numbers. Furthermore, not enough committed and sophisticated family treatment researchers have carried out some of the major studies. For example, the Brent study on depression and the Barkley study of ADHD, although testing family approaches, lacked well-developed and published treatment manuals, a demonstration of the necessary expertise to supervise these treatments, and data about training and adherence to these models. Although the absence of expertise limits investigator allegiance biases, treatment development and modification are essential for tailoring family treatments to target family processes specific to each disorder. Investigators such as Patterson and Liddle have invested great effort in rigorously dismantling the treatment process, identifying and refining essential ingredients, and repackaging more potent treatment protocols. This process has paid off well. Programmatic treatment development is needed for many disorders to address myriad questions. What are the essential disorder-specific family processes that should be targeted by interventions? Hostility, criticism, communication, attachment and autonomy, attributional sets, and behavior management are important processes of family life, but each may have more relative importance for specific disorders. With a greater understanding of these processes, treatments could be tailored to target these mechanisms more efficiently and effectively. (ABSTRACT TRUNCATED)
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PMID:Current status of family intervention science. 1144 17

Recent empirical work on the distribution, determinants, and consequences of children and adolescents' witnessing of community violence are reviewed. Major findings across studies indicate that males, ethnic minorities, and urban residents are at increased risk for witnessing violence, and that higher rates of PTSD, depression, distress, aggression, and externalizing behavior disturbances are reported among those who witness violence. Degree of family conflict, domestic violence, and family support were demonstrated to modify the impact of exposure to violence. Research and policy recommendations are offered.
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PMID:Youth exposure to violence: prevalence, risks, and consequences. 1149 32

Self-care as both treatment and prevention is assuming new importance for several reasons: chronic illness, which calls for self-care is becoming a more serious global problem; illnesses that are related to unhealthy behavior are more common; medical care is becoming more participative because of increased individualism; the costs of care make it necessary for more care to be assumed by patients; and new technology expands what people can do for themselves. Self-care is relevant to the enhancement of health, the prevention of illness; the management of disease, particularly chronic illnesses; and rehabilitation to reduce disability. Barriers to self-care include mental attitudes of depression and denial, addictions, cultural factors, low intelligence and illiteracy, and family conflict. Self-care is enhanced by a sustaining relationship with a health professional, trustworthy information, patient education that is culturally sensitive, technological aids, financial and other positive incentives, and peer group support. Self-care is a growing dimension of health care that needs and deserves further research and innovation.
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PMID:Empowering individuals as carers of their own health. 1169 92

This study examined the association between fathers' alcoholism and other risk factors such as parental depression, family conflict, infant temperament, and parent-infant attachment. The quality of parent-infant interactions was hypothesized to be a proximal mediator of the associations among alcoholism and other risk factors and attachment. The participants were 223 families (104 nonalcoholic families and 119 alcoholic families) with 12-month-old infants recruited through birth records. Infants in families with two parents with alcohol problem had significantly higher rates of insecure attachment with both parents. Structural Equations Modeling indicated that the fathers' alcohol problem was associated with lower paternal sensitivity (higher negative affect, lower positive engagement, and lower sensitive responding) during father-infant play interactions, and this in tum was associated with higher risk for infant attachment insecurity with fathers. The association between the fathers' alcohol problem and infant attachment security with the mother was mediated by matemal depression, and matemal alcohol problems and family conflict were associated with maternal sensitivity during play interactions. These results indicate that the fathers' alcoholism is associated with higher family risk including the quality of the parent-infant relationship; infant attachment develops in a family context; and this context has a significant association with attachment security.
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PMID:Mother-infant and father-infant attachment among alcoholic families. 1203 Jun 91

Children of substance abusing parents have an elevated risk for experiencing disruptions in household composition and for engaging in problem behaviors. This study investigated whether multiple parent figure transitions predicted the likelihood of delinquency and drug use among a sample of early adolescents with parents receiving methadone treatment for opiate addiction. Controlling for baseline delinquency, child characteristics, family conflict, parental depression, and parent criminal history, a greater number of parenting disruptions during the longitudinal study period was associated with a higher probability of delinquent behavior. Gender moderated the effect of parent figure transitions in a parallel analysis for drug use. After accounting for baseline drug use and potentially confounding factors, only adolescent females had a higher likelihood of drug use as the number of family disruptions increased. In contrast, age was strongly associated with drug use for males. A subgroup of youths who experienced tremendous family instability and had no single consistent parent figure during the study period were at extreme risk for delinquent behavior. The findings are interpreted in terms of cumulative stress resulting from multiple parenting disruptions over time and differential influences on the expression of problem behaviors depending on gender.
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PMID:Parent figure transitions and delinquency and drug use among early adolescent children of substance abusers. 1221 58

Theories of emotional contagion suggest that spouses mutually experience affective or emotional states. However, empirical support for this theory is limited. Using a dyadic approach, this study examines affect similarity of depressive symptoms between elders with vision impairment and their spouses. As part of an investigation on older couples dealing with disability, 123 elders dealing with a recent vision loss and their spouses were interviewed. Guided by a stress process model, predictors of spouse depressive symptoms were examined. Hierarchical regression analyses revealed that the spouse's race, health, care-giving appraisal, self-efficacy, conflict with other family members regarding their partner, and their partner's depressive symptoms significantly predicted spouse depression. Specifically, spouses who were white, in poorer health, experienced more care-giving burden, had more family conflict, and poorer self-efficacy, were more likely to be depressed. Entered in the final step, elder depression uniquely contributed to the prediction of spouse depression. This points to affect similarity among spouses, which suggests that when one spouse is depressed, the other spouse is likely to experience a similar depressive symptomatology.
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PMID:Is it contagious? Affect similarity among spouses. 1221 95

The effects of mother and daughter reproductive changes on maternal perceptions regarding the family are assessed. Mother and daughter reproductive status changes were examined in terms of their effects on family relations and mother and daughter well-being. Controls were made for mother and daughter age and heaviness. 144 mothers (37-59 years) and daughters (14-18 years) were selected from a study of white, middle to upper middle income families in large Eastern metropolitan areas. Mothers were typically well educated and employed and from 2-parent homes; 50% were 1st born. Moos' Family Environment Scale was used to measure family functioning; other measures included daughter's age at menarche, mother's menstrual status, the Ponderal index of mother and daughter heaviness, the Center for Epidemiological Studies-Depression scale, an abbreviated version of the Eating Attitudes Test, and Satisfaction with Body Parts scale of Padin, Lerner and Spiro. Self-administered questionnaires were mailed after agreement to participate was confirmed by phone. Analysis of covariance was used to analyze the effect of menstrual status controlling for age on family cohesion or conflict, and the effect of perception of family cohesion or conflict on well-being. Factor-covariate interactions were tested for, and none were found based on the Bonferroni procedure. The cross-sectional results show that early adolescent maturation is not related to increases in family conflict compared with on-time or late maturers, in contrast to Hill's study results. There was no link between perceptions of family conflict on the well-being of mother or daughter. Family cohesion was important to mother and daughter well-being, but was not associated with mother's reproductive status or daughter's reproductive timing. For mothers, the effect was on depression and body image. For daughters, the most important variable was maternal perceptions of family cohesion for all measures of well-being. Daughters' perceptions of well-being were not associated with any well-being measures. Mother's menstrual status and interaction with daughter's menarcheal timing were related to maternal dieting behavior and bulimic symptoms. For daughters, mother's reproductive status and daughter's reproductive timing was significantly related to dieting behavior. Maternal age was related to maternal well-being (depression).
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PMID:Effect of reproductive status changes on family functioning and well-being of mothers and daughters. 1228 21

To examine how parental limit setting, family conflict, and perception of family experience influence severity of alcohol and drug problems, and important gender differences in these relationships, we interviewed consecutive intakes, aged 12 to 18 years, at 4 chemical dependency programs of a large group-model nonprofit health maintenance organization (HMO) (n=419). The Family Conflict, Limit Setting, and Positive Family Experience scales correlated with substance dependence (p<0.01, p<0.01, p<0.05, respectively). Depression also correlated with family conflict (p<0.01), absence of limit setting (p<0.01), poor family experience (p<0.01) and dependence symptoms (p<0.01). Number of substance-using friends correlated with number of dependence symptoms (p<0.01). Gender differences included the following: (1) girls scoring higher in family conflict (p=0.0002), negative perceptions of family experience (p<0.0017), and lower in absence of limit setting (p<0.0001); (2) how family environment predicted problem severity: absence of limit setting was significant for boys and girls but family conflict for boys only; (3) girls had more dependence symptoms (p=<0.0001), psychiatric diagnoses (e.g., depression (p<0.0003), anxiety (p<0.0002), conduct disorder (p=0.07)), and substance-abusing family members (53 % versus 39%; p=0.006). To conclude, family and peers influence severity of alcohol and drug problems in adolescents.
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PMID:Family environment factors and substance abuse severity in an HMO adolescent treatment population. 1511 75

Patients with both depression and drug dependence are at an elevated risk for suicide, yet suicide remains rare and difficult to predict. Clinical and demographic features associated with suicide risk among depressed opiate-dependent patients were examined using baseline data from the Addiction Severity Index and Hamilton Depression Scale. Female gender, violent behavior in the past thirty days and lifetime, and less education correlated with a history of suicide attempts. Family conflict and depression severity correlated with current suicidal ideation. When evaluating opiate-dependent patients with depressive disorders, these features should be considered in efforts to identify those at heightened risk for suicide and plan interventions.
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PMID:Suicide risk in depressed methadone-maintained patients: associations with clinical and demographic characteristics. 1537 Sep 31


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