Parental HIV infection has been associated with negative outcomes for children, and parenting skills appear to be one mechanism operating in that association. The present study focuses on the relations between maternal stress, parenting, and child functioning among families where the mother is living with HIV. Sixty-nine mothers with at least one child between 6 and 12 years old completed questionnaires at the baseline assessment of an intervention designed to facilitate maternal disclosure of HIV status. Respondents were assessed using multiple measures of stress/anxiety, and parenting skills and child outcomes, including the Parenting Stress Index, the RAND Mental Health Inventory, the Family Routines Questionnaire, and the Child Behavior Checklist. Covariance structural modeling was used to assess the variable relationships, with latent constructs created for maternal anxiety/stress, parenting skills, and child problem behaviors (both direct and indirect effects were evaluated, with a model-based bootstrap used to verify model stability). Results demonstrated that maternal stress was negatively associated with a broad range of parenting skills, and that parenting skills were negatively associated with child problem behaviors. Mothers living with HIV who are anxious about their own health and functioning, and who were more stressed in their parental role, were more likely to exhibit poorer parenting skills—specifically to engage children less frequently in family routines (e.g., eating meals together, having a bedtime routine), poorer parent-child communication, and poorer and less consistent parenting discipline. Not uncommonly, mothers living with HIV experience a range of stressors above and beyond those related to their illness (e.g., poverty, residence in high risk and low resource communities, discrimination). Results demonstrate the need for interventions designed to decrease maternal stress and enhance parenting skills for families affected by HIV.
HIV; maternal stress; parenting; child functioning
The influence of premature birth of an infant in female-headed, single-parent families together or in conjunction with family environment factors, such as employment of the mother, on the mother-premature child relationship has not been considered in past studies.
To explore differences in parent-child and family relationships for employed and nonemployed single mothers of low–birth-weight (LBW) and full-term preschool children and to describe the relationships of the mothers employment status, employment history, and employment attitude-behavior consistency to parent-child and family relationships.
Single mothers with LBW (n = 60) and full-term (n = 61) preschool children provided data on their employment situation, the Parenting Stress Index, the Feetham Family Functioning Survey, and the Home Observation for Measurement of the Environment.
Employed mothers had more positive perceptions and provided more enriching home environments for their children. Greater attitude-behavior consistency was associated with more positive perceptions of the parental role.
Thus, in single-parent families, employment and consistency are positive influences on the mother-child relationship.
maternal-child; low-birth-weight infants; single-parent families; maternal employment
Although fathers’ stress has been shown to have important implications for children’s health and well-being, few studies of children with type 1 diabetes have considered paternal parenting stress. The current study contributes to the literature by exploring correlates of fathers’ pediatric parenting stress in a sample of young children with type 1 diabetes. Forty-three fathers of children 2–6 years old with type 1 diabetes completed self-report questionnaires examining pediatric parenting stress, child behavior, participation in diabetes management tasks, and parental psychological resources. Results of multiple regression show that fathers’ pediatric parenting stress is positively associated with state anxiety and mother-reported difficult child behavior. These findings suggest that fathers may experience parenting stress differently than mothers, and that their experiences may have implications not only for their own level of anxiety, but also for their children’s behavior.
fathers; parenting stress; type 1 diabetes; early childhood
This article was inspired by Rolland’s Family Systems-Illness (FSI) model, aiming to predict adolescent stress as a function of parental illness type. Ninety-nine parents with a chronic medical condition, 82 partners, and 158 adolescent children (51 % girls; mean age = 15.1 years) participated in this Dutch study. The Dutch Stress Questionnaire for Children was used to measure child report of stress. Ill parents completed the Beck Depression Inventory. Children filled in a scale of the Inventory of Parent and Peer Attachment measuring the quality of parent attachment. Both parents filled in the Parent-Child-Interaction Questionnaire-Revised. We conducted multilevel regression analyses including illness type, the ill parent’s depressive symptoms, family functioning (quality of marital relationship, parent-child interaction, and parent attachment), and adolescents’ gender and age. Four regression analyses were performed separately for each illness type as defined by disability (Model 1), and onset (Model 2), course (Model 3), and outcome of illness (Model 4). In all models, higher adolescent stress scores were linked to lower quality of parent-child interaction and parent attachment, and adolescents’ female gender. The four models explained approximately 37 % of the variance in adolescent stress between individuals and 43-44 % of the variance in adolescent stress between families. Adolescent stress was not related to parental illness type. Our results partially supported the FSI model stating that family functioning is essential in point of child adjustment to parental illness. In the chronic stage of parental illness, adolescent stress does not seem to vary depending on illness type.
Chronic medical condition; Adolescent; Stress; Family-systems illness model
Objective To examine resolution of the diagnosis among parents of children with phenylketonuria (PKU) as a mechanism of adjustment for parents and children. Methods Reaction to diagnosis interviews were conducted with 52 mothers and 47 fathers of 55 children with PKU aged 2–12 years. The parents also completed questionnaires assessing their personal adjustment (stress symptoms), their child's adjustment (behavior problems), and coping variables (personal hopefulness and coping strategies). Results Most mothers (69%) and fathers (77%) were resolved to their child's diagnosis. Lower levels of parent stress were explained by higher personal hopefulness (14% of the variance for mothers and 21% for fathers) and resolution of the diagnosis (15% of the variance for mothers and 6% for fathers) after taking account of demographic variables and severity of the child's PKU. Parent resolution, however, did not contribute independently to the variance explained in child behavior problems after taking account of coping variables and severity of PKU. Conclusions Resolution of the diagnosis of PKU is a strong indicator of parent adjustment, and assessment of parent reactions should be considered an integral component of clinical care. Further research is warranted in relation to the implications of parent resolution for the child's response to PKU through different development stages and the effectiveness of interventions in aiding parent resolution.
adjustment; child; coping; PKU; parent; resolution of the diagnosis
Previous research has found associations between parental feeding practices and children's eating behaviour and weight status. Prospective research is needed to elucidate these relationships.
One hundred and fifty-six mothers of 2- to 4-year-old children completed questionnaires including measures of maternal feeding practices (pressure to eat, restriction, monitoring and modelling of healthy eating), child eating behaviour (food responsiveness, food fussiness and interest in food), and mother reported child height and weight. The questionnaire was repeated 12 months later. Regression analyses were used to find longitudinal associations between maternal feeding practices, child eating behaviour and child body mass index (BMI).
Modelling of healthy eating predicted lower child food fussiness and higher interest in food one year later, and pressure to eat predicted lower child interest in food. Restriction did not predict changes in child eating behaviour. Maternal feeding practices did not prospectively predict child food responsiveness or child BMI.
Maternal feeding practices appear to influence young children's eating behaviour but not weight status in the short term.
Asthma is the most common chronic disease of childhood and its prevalence is increasing all over the world. Asthma influences on many aspects of family daily life. Health care of children with chronic asthma can have deep impact on health and welfare of the family members. Studies showed a relation between the life quality of children suffering from asthma and the anxiety level of parents. These parents are looking for ways to confront with their stress, to reduce their anxiety in encountering with their asthmatic children, and to improve their performance. This research was accomplished with the aim of determining the influence of massage therapy on anxiety level of mothers with asthmatic children.
This was a quasi-experimental study with two groups and a pretest and posttest design. The samples of research were 60 mothers of 5-14 year-old asthmatic children who were under treatment in medical centers of Isfahan. They were randomly divided into two groups of control and massage therapy by convenience sampling method. The data were collected by standard Spielberger questionnaire. Mothers of massage group were trained to massage head, neck, face, shoulder, hand, leg, and back of their children every night before bedtime for one month while there was no intervention for the control group during this month except the standard treatment. In both groups, the Spielberger standard questionnaire was filled by mothers. The data were analyzed by descriptive analysis, independent t-test, paired-t test, and chi-square test.
The results showed no significant difference in mean anxiety level between the two groups before the intervention but there was a significant difference between them after intervention (p < 0.03). Also, there was a significant difference in mean level of anxiety score of mothers before and after the intervention in massage group (p < 0.001).
The anxiety level of mothers can be reduced by effective utilization of daily child massage therapy and giving an active role to the mothers in caring and treating the child. Daily massage helped mothers to have more sense of participation in caring their children and as a non-pharmacological method can be accompanied with pharmacological methods.
Asthma; anxiety; children; massage therapy; mothers
In this longitudinal study, we examined the relationship between the sources and functions of social support and dimensions of child- and parent-related stress for mothers of young children with mild developmental delays.
Sixty-three mothers completed assessments of stress and support at two time points.
Multiple regression analyses revealed that parenting support during the early childhood period (i.e., advice on problems specific to their child and assistance with child care responsibilities), irrespective of source, consistently predicted most dimensions of parent stress assessed during the early elementary years and contributed unique variance. General support (i.e., primarily emotional support and validation) from various sources had other, less widespread effects on parental stress.
The multi-dimensional perspective of the construct of social support that emerged suggested mechanisms mediating the relationship between support and stress and provided a framework for intervention.
parent stress; social support; developmental delay
Examined whether mother-child discrepancies in perceived child behavior problems relate to dysfunctional interactions between mother and child and stress in the mother. Participants included 239 children (6–16 years old; 58 girls, 181 boys) referred for oppositional, aggressive, and antisocial behavior, and their mothers. Mother-child discrepancies in perceived child behavior problems were related to mother-child conflict. Moreover, maternal stress mediated this relationship. The findings suggest that discrepancies among mother and child evaluations of child functioning are not merely reflections of different perspectives or artifacts of the assessment process, but can form components of conceptual models that can be developed and tested to examine the interrelations among critical domains of child, parent, and family functioning.
attribution bias context; disagreement; discrepancies; stress; conflict
The limited number of systematic, controlled studies that assess the safety and efficacy of psychotropic medications for children reinforce the hesitation and reluctance of parents to administer such medications. The aim of this study was to investigate the attitudes of parents of children with psychiatric disorders, towards psychotropic medication.
A 20-item questionnaire was distributed to 140 parents during their first contact with an outpatient child psychiatric service. The questionnaire comprised of questions regarding the opinions, knowledge and attitudes of parents towards children's psychotropic medication. Sociodemographic data concerning parents and children were also recorded. Frequency tables were created and the chi-square test and Fisher's exact tests were used for the comparison of the participants' responses according to sex, educational level, age and gender of the child and use of medication.
Respondents were mostly mothers aged 25–45 years. Children for whom they asked for help with were mostly boys, aged between 6 and 12 years old. A total of 83% of the subjects stated that they knew psychotropic drugs are classified into categories, each having a distinct mechanism of action and effectiveness. A total of 40% believe that there is a proper use of psychotropic medication, while 20% believe that psychiatrists unnecessarily use high doses of psychotropic medication. A total of 80% fear psychotropic agents more than other types of medication. Most parents are afraid to administer psychotropic medication to their child when compared to any other medication, and believe that psychotherapy is the most effective method of dealing with every kind of mental disorders, including childhood schizophrenia (65%). The belief that children who take psychotropic medication from early childhood are more likely to develop drug addiction later is correlated with the parental level of education.
Parents' opinions and beliefs are not in line with scientific facts. This suggests a need to further inform the parents on the safety and efficacy of psychotropic medication in order to improve treatment compliance.
Behavioural disturbances in the child, the mother-child and family relationships, and the family social structure were studied in a representative sample of the whole range of asthmatic children and compared with a control group of normal children. Behavioural disturbances occurred more often and at a statistically significant level only in the small group of children with severe and continuing asthma. These children were those with severe chronic airways obstruction as assessed physiologically and also with the most severe allergic manifestations.
Predominant in the mother-child relations was an over-concern to protect the child's health in those children with continuing asthma at 14 years of age. The families of the very severely affected group of children showed evidence of more stress than other families. Socioeconomic conditions were not significantly different in any group of asthmatic children compared with the control group.
Experiencing some degree of parenting stress is virtually unavoidable, particularly as children enter early adolescence and assert their independence. In this study, we examined how parenting stress attributed to the parent, the child, or the dyad changed in mean level and relative standing across their child’s transition to adolescence. We also compared mothers and fathers from the same families in terms of parenting stress and explored how one parent’s stress affected the other parent’s stress.
Participants included 222 European American parents (111 mothers and 111 fathers), assessed when their children were 10 and 14 years old.
Parenting stress was highly stable from 10 to 14 years. Total parenting stress increased across time, and was attributable to stress due to increased parent-child dysfunctional interaction, not parental distress or stress due to child behavior. Mothers and fathers agreed moderately in their relative standing and in the average levels of parenting stress in the three different domains of parenting stress at each time point. Mothers’ and fathers’ stress across domains were sometimes related.
Mothers’ and fathers’ increased parenting stress across their child’s transition to adolescence seems to derive from parent-child interaction rather than qualities of the parent or the child per se. Finding ways to maintain parent-child communication and closeness may protect parents and families from increased stress during this vulnerable time.
Parents of children with a chronic condition such as juvenile arthritis must cope with greater demands than those living with a healthy child. They must adopt different behaviours in order to lessen the impact on the family structure. Parental coping refers to the parent's specific cognitive and behavioural efforts to reduce or manage a demand on the family system. The aims of this study were: to describe coping in a cohort of parents of children with JIA; to determine whether quality of life is associated with parental coping; to explore whether socio-demographic factors such as child's age, family socioeconomic status and family structure are associated with parental coping. One hundred eighty-two parents caring for a child with JIA completed a postal survey at three times over a one-year period, which included the Juvenile Arthritis Quality of Life Questionnaire (JAQQ), the Coping Health Inventory for Parents (CHIP) and questionnaires describing socio-demographic characteristics. Linear mixed models were employed to analyse the association between the child's quality of life and parental coping. Mean total QoL scores (JAQQ) showed that children experienced difficulty in completing specified activities at most just below 25% of the time and results fall off slightly following the 6 month time point. Mean parental coping scores for the CHIP subscales at baseline were 38.4 ± 9.0, 33.4 ± 11.6, 16.5 ± 6.1, for Maintaining Family Integration (maximum score 57), Maintaining Social Support (maximum score 54) and Understanding the Medical Situation (maximum score 24), respectively. Understanding the Medical Situation was deemed most useful. The child's QoL was associated with parental coping. Parents of children with greater psychosocial dysfunction used more coping behaviours related to Understanding the Medical Situation (β coefficient, 0.73; 95% CI, 0.01, 1.45). These findings underscore the importance of helping parents of children with JIA better understand their child's medical situation.
Valid measures of physical activity correlates in preschool children are lacking. This study aimed to assess the validity, factor structure and internal consistency of a maternal questionnaire on potential correlates of four-year-old children's physical activity.
The questionnaire was designed to measure the following constructs: child personal factors; parental support and self-efficacy for providing support; parental rules and restrictions; maternal attitudes and perceptions; maternal behaviour; barriers to physical activity; and the home and local environments. Two separate studies were conducted. Study I included 24 mothers of four-year-old children who completed the questionnaire then participated in a telephone interview covering similar items to the questionnaire. To assess validity, the agreement between interview and questionnaire responses was assessed using Cohen's kappa and percentage agreement. Study II involved 398 mothers of four-year-old children participating in the Southampton Women's Survey. In this study, principal components analysis was used to explore the factor structure of the questionnaire to aid future analyses with these data. The internal consistency of the factors identified was assessed using Cronbach's alpha.
Kappa scores showed 30% of items to have moderate agreement or above, 23% to have fair agreement and 47% to have slight or poor agreement. However, 89% of items had fair agreement as assessed by percentage agreement (≥ 66%). Limited variation in responses to variables is likely to have contributed to some of the low kappa values. Six questions had a low kappa and low percentage agreement (defined as poor validity); these included questions from the child personal factors, maternal self-efficacy, rules and restrictions, and local environment domains. The principal components analysis identified eleven factors and found several variables to stand alone. Eight of the composite factors identified had acceptable internal consistency (α ≥ 0.60) and three fell just short of achieving this (0.60 > α > 0.50).
Overall, this maternal questionnaire had reasonable validity and internal consistency for assessing potential correlates of physical activity in young children. With minor revision, this could be a useful tool for future research in this area. This, in turn, will aid the development of interventions to promote physical activity in this age group.
This study employed a mixed-method design to test sex-specific parent-child pain associations. Subjects were 179 chronic pain patients aged 11–19 years (mean = 14.34; 72% female) presenting for treatment at a multidisciplinary, tertiary clinic. Mothers and children completed questionnaires prior to their clinic visit, including measures of children’s pain, functioning and psychological characteristics. Mothers also reported on their own pain and psychological functioning. Interviews were conducted with a sub-sample of 34 mothers and children prior to the clinic visit and analyzed using a grounded theory approach. The quantitative data suggest stronger mother-daughter than mother-son pain relationships. The qualitative data suggest that girls’ pain and pain-related disability is related to an overly enmeshed mother-daughter relationship and the presence of maternal models of pain, while boys’ pain and disability is linked to male pain models and criticism and to maternal worry and solicitousness. Boys and girls appear to have developmentally incongruous levels of autonomy and conformity to maternal expectations. The mixed-method data suggest distinct trajectories through which mother and father involvement may be linked to chronic pain in adolescent boys and girls.
Sex differences; parent-child relationships; chronic pain
To assess parental stress levels of mothers of children less than 6 years old with eczema and compare these levels with those reported for other chronic childhood illnesses.
Mothers were recruited from hospital‐based out‐patient clinics (55%) or while their child was an in‐patient (45%) for management of eczema. Maternal stress was measured utilising the Parenting Stress Index‐Long Form (PSI) in 33 mothers. The severity of the eczema at the time of interview was documented by the Eczema Area and Severity Index (EASI) score and the Investigators' Global Assessment (IGA) score.
The children with eczema had a mean age of 2.8 years. Mothers of children aged 5 years or less with eczema exhibited significantly higher total stress scores (mean PSI 259.6, 95% CI 244.9 to 274.3) as compared to mothers of normal children (PSI 222.8, 95% CI 221.4 to 224.2) and children with other chronic disorders such as insulin‐dependent diabetes (PSI 218.1, 95% CI 204.7 to 231.6) and profound deafness (PSI 221.7, 95% CI 206.4 to 237.0). Stress scores in the parental domain (138.2, 95% CI 128.9 to 147.6) did not differ significantly from the scores of parents of children with severe disabilities such as those requiring home enteral feeding (135.2, 95% CI 129.3 to 141.1) and those with Rett syndrome (132.8, 95% CI 125.0 to 140.6).
Moderate to severe childhood eczema should be regarded as a significant illness in which maternal stress is equivalent to that associated with the care of children with severe developmental and physical problems.
eczema; mothers; preschool; psychological stress
This study examined the role of multiple children's emotions and parental anxiety during parent–child interactions of anxiety disordered (AD) and nonanxious (NA) children ages 7 to 13 years. Families (mother, father, child) each discussed three recent and real separate situations in which the child experienced anxiety, anger, and happiness. Results revealed significant differences in behavior between parents of AD and NA children. Maternal behavior, but not paternal behavior, was related to the emotion the child was experiencing. Mothers of AD children displayed greater intrusive involvement than mothers of NA children in those situations in which the child was experiencing negative affect. A significant interaction was evident between maternal anxiety disorder and emotion, whereby anxious mothers were more intrusive in situations involving anxiety and anger (compared to positive emotion situations), whereas nonanxious mothers were more intrusive only during situations involving anger.
In pediatric oncology, effective clinic–based management of acute and long–term distress in families calls for investigation of determinants of parents' psychological response to the child's cancer. We examined the relationship between parents' prior exposure to traumatic life events (TLE) and the occurrence of posttraumatic stress symptoms (PTSS) following their child's cancer diagnosis. Factors mediating the TLE–PTSS relationship were analyzed.
The study comprised 169 parents (97 mothers, 72 fathers) of 103 cancer diagnosed children (median age: 5,9 years; range 0.1–19.7 years). Thirty five parents were of immigrant origin (20.7%). Prior TLE were collated using a standardized questionnaire, PTSS was assessed using the Impact of Events–Revised (IES–R) questionnaire covering intrusion, avoidance and hyperarousal symptoms. The predictive significance of prior TLE on PTSS was tested in adjusted regression models.
Mothers demonstrated more severe PTSS across all symptom dimensions. TLE were associated with significantly increased hyperarousal symptoms. Parents' gender, age and immigrant status did not significantly influence the TLE–PTSS relationship.
Prior traumatic life–events aggravate posttraumatic hyperarousal symptoms. In clinic–based psychological care of parents of high–risk pediatric patients, attention needs to be paid to life history, and to heightened vulnerability to PTSS associated with female gender.
Most studies report that being parents of a child with cancer is a stressful experience, but these have tended to focus on mothers and few have included both parents. Moreover, studies have focussed on families in Western countries and none have been published examining the psychological outcomes for parents living in an Arabic country.
This research explores the stress levels of Jordanian parents caring for a child with cancer in order to identify the psychological needs of parents in this environment and to explore how mothers and fathers stress levels might differ.
The study was carried out in Jordan using the Perceived Stress Scale 10-items (PSS10). The questionnaire was completed by 300 couples with a child who has cancer and a comparison group of 528 couples where the children do not have any serious illness. Multivariate backward regression analysis was carried out.
Analysis adjusting for spousal stress and sociodemographic predictors revealed that stress levels of mothers with a child who had cancer remained significantly higher than mothers whose children did not have any serious illness (p < 0.001). However, having a child with cancer did not show a significant association with the fathers’ reported stress scores (p = 0.476) when spousal stress was in the model, but was highly significant once that was removed (p < 0.001).
Parental stress was analysed for those with a child who has cancer and in models which included spouse’s stress scores, sociodemographic and cancer-related predictors 64 % of the variance was explained for mothers (adjusted R2 = 0.64, p < 0.001) and fathers (adjusted R2 = 0.64, p < 0.001). Models excluding spousal stress scores explained just 26 % of the variance for fathers and 22 % for mothers.
This is the first study into the psychological outcomes for parents living in an Arabic country who care for a child with cancer. Both mothers and fathers with a child diagnosed with cancer reported higher stress levels than those from the normal Jordanian parent population. Mothers and fathers of children with cancer reported significantly different levels of stress to each other but models reveal significant contributions of the stress score of fathers upon mothers, and vice versa. The findings provide evidence of the need for psychological support to be developed for families caring for a child with cancer in Jordan.
Parents; Children; Cancer; Stress; Caregivers; Mothers; Fathers
Parenting stresses have consistently been found to be higher in parents of children with intellectual disabilities (ID); yet, some families are able to be resilient and thrive in the face of these challenges. Despite the considerable research on stress in families of ID, there is still little known about the stability and compensatory factors associated with everyday parenting stresses.
Trajectories of daily parenting stress were studied for both mothers and fathers of children with ID across child ages 36–60 months, as were specific familial risk and resilience factors that affect these trajectories, including psychological well-being of each parent, marital adjustment and positive parent–child relationships.
Mothers’ daily parenting stress significantly increased over time, while fathers’ daily parenting stress remained more constant. Decreases in mothers’ daily parenting stress trajectory were associated with both mother and father’s well-being and perceived marital adjustment, as well as a positive father–child relationship. However, decreases in fathers’ daily parenting stress trajectory were only affected by mother’s well-being and both parents’ perceived marital adjustment.
Parenting stress processes are not shared entirely across the preschool period in parents of children with ID. Although individual parent characteristics and high-quality dyadic relationships contribute to emerging resilience in parents of children with ID, parents also affect each others’ more resilient adaptations in ways that have not been previously considered.
fathers; intellectual disability; mothers; parenting stress; resilience
There are few validated instruments measuring parental beliefs about parent–child feeding relations and child compliance during meals.
To test the validity of the Feeding Demands Questionnaire, a parent-report instrument designed to measure parents’ beliefs about how their child should eat.
Participants were 85 mothers of 3- to 7-year-old same-sex twin pairs or sibling pairs, and their children. Mothers completed the eight-item Feeding Demands Questionnaire and the Child Feeding Questionnaire, plus measures of depression and fear of fat.
Psychometric evaluations of the Feeding Demands Questionnaire included principal components analysis, Cronbach’s α for internal consistency, tests for convergent and discriminant validities, and Flesh-Kincaid for readability.
The Feeding Demands Questionnaire had three underlying factors: anger/frustration, food amount demandingness, and food type demandingness, for which subscales were computed. The Feeding Demands Questionnaire showed acceptable internal consistency (α ranging from .70 to .86) and was written at the 4.8th grade level. Mothers reporting greater anger/frustration during feeding were more likely to pressure their children to eat, while those reporting greater demands about the type of foods their children eat were more likely to monitor child fat intake. Mothers reporting greater demands about the amount of food their children eat were more likely to restrict eating, pressure children to eat, and monitor their fat intake.
The Feeding Demands Questionnaire appears valid for assessing maternal beliefs that children should comply with rules for eating and frustration during feeding. Different demand beliefs can underlie different feeding practices.
This observational study explores pathways towards any past year use of child mental health services.
Data from the 2002 National Survey of American Families were used to explore the relationship between past month maternal mental health and past year child mental health services use. Observations were limited to the 8072 most knowledgeable adults who were the mothers of target children aged 6–11. Logistic regressions were performed to determine the odds of any child mental health service use followed by path analyses using Maximum Likelihood estimation with robust standard errors.
Multiple factors were associated with odds of any child mental health service use. In the path analytic model poor past month maternal mental health was associated with increased aggravation which in turn was associated with increased use of mental health visits. Negative child behaviors as reported by the mother were also associated with increased maternal aggravation and increased service use.
Parental perception of child behaviors influences treatment seeking, both directly and indirectly through parental aggravation. Parental mental health influences tolerance for child behaviors. Findings are consistent with other studies. Interventions should address the entire family and their psychosocial circumstances through collaboration between multiple service sectors.
Child Mental Health; Service Use; Maternal Mental Health
To determine the psychological consequences for parents of children with Down's syndrome of having received a false negative result on prenatal screening.
Comparison of adjustment of parents who received a false negative result with that of parents not offered a test and those who declined a test.
Parents were interviewed in their own homes.
Parents of 179 children with Down's syndrome (mean age 4 (range 2-6) years).
Main outcome measures
Anxiety, depression, parenting stress, attitudes towards the child, and attributions of blame for the birth of the affected child.
Overall, regardless of screening history, parents adjusted well to having a child with Down's syndrome. Compared with mothers who declined a test, mothers in the false negative group had higher parenting stress (mean score 81.2 v 71.8, P=0.016, 95% confidence interval for the difference 1.8 to 17.0) and more negative attitudes towards their children (124.9 v 134.2, P=0.009, −16.2 to −2.4). Fathers in the false negative group had higher parenting stress test scores (77.8 v 70.0, P=0.046, 1.5 to 14.2) than fathers not offered a test. Mothers in the false negative group were more likely to blame others for the outcome than mothers who had not been offered the test (28% v 13%, P=0.032, 3% to 27%). Mothers and fathers in the false negative group were more likely to blame others for this outcome than parents who had declined a test (mothers 28% v 0%, P=0.001, 19% to 37%; fathers 27% v 0%, P=0.004, 17% to 38%). Blaming others was associated with poorer adjustment for mothers and fathers.
A false negative result on prenatal screening seems to have a small adverse effect on parental adjustment evident two to six years after the birth of an affected child.
Several school-based fruit and vegetable interventions include activities to involve parents, but not much is know about the effectiveness of such a family component on child and parent intake levels. The current study evaluated the effects of the multi-component school-based intervention, 'the Pro Children Study', on mothers' intake levels. Furthermore, associations between level of involvement in the project and improvement in the mothers' intake levels were assessed.
Effect was evaluated in a cluster randomized controlled trial in Spain, Norway and the Netherlands among mothers of 11-year-olds. Of the 1253 mothers with complete data at baseline, 754 and 476 had complete data at first and second follow-up respectively. Fruit and vegetable intake, level of involvement and demographic variables were assessed by a parental questionnaire. Data was analyzed using multilevel regression analyses.
Results showed no effect of the intervention on mothers' fruit and vegetable intake after one year and two year follow-up. Participation rate for the different activities varied by activity and by country, e.g. 3.7–9.4% visited the website, while 26.4–72.6% of the mothers participated in the home work assignments. Results further showed that higher involvement levels were associated with higher intake at follow-up.
The Pro Children Intervention could not increase the fruit and vegetable consumption of the mothers of participating pupils, which might be explained by the low involvement in the project. More research is needed to increase mothers' involvement in school-based interventions.
To test the hypothesis that among children of lower socioeconomic status (SES), children of single mothers would have relatively worse access to care than children in two-parent families, but there would be no access difference by family structure among children in higher SES families.
The National Health Interview Surveys of 1993–95, including 63,054 children.
Logistic regression was used to examine the relationship between the child's family structure (single-mother or two-parent family) and three measures of health care access and utilization: having no physician visits in the past year, having no usual source of health care, and having unmet health care needs. To examine how these relationships varied at different levels of SES, the models were stratified on maternal education level as the SES variable. The stratified models adjusted for maternal employment, child's health status, race and ethnicity, and child's age. Models were fit to examine the additional effects of health insurance coverage on the relationships between family structure, access to care, and SES.
Children of single mothers, compared with children living with two parents, were as likely to have had no physician visit in the past year; were slightly more likely to have no usual source of health care; and were more likely to have an unmet health care need. These relationships differed by mother's education. As expected, children of single mothers had similar access to care as children in two-parent families at high levels of maternal education, for the access measures of no physician visits in the past year and no usual source of care. However, at low levels of maternal education, children of single mothers appeared to have better access to care than children in two-parent families. Once health insurance was added to adjusted models, there was no significant socioeconomic variation in the relationships between family structure and physician visits or usual source of care, and there were no significant disparities by family structure at the highest levels of maternal education. There were no family structure differences in unmet needs at low maternal education, whereas children of single mothers had more unmet needs at high levels of maternal education, even after adjustment for insurance coverage.
At high levels of maternal education, family structure did not influence physician visits or having a usual source of care, as expected. However, at low levels of maternal education, single mothers appeared to be better at accessing care for their children. Health insurance coverage explained some of the access differences by family structure. Medicaid is important for children of single mothers, but children in two-parent families whose mothers are less educated do not always have access to that resource. Public health insurance coverage is critical to ensure adequate health care access and utilization among children of less educated mothers, regardless of family structure.
Family structure; access to health care; health insurance; socioeconomic factors