Family Relationship Problems Research Articles

Maternal perceptions of social context and adherence to maternal and child health (MCH) clinic recommendations among marginalized Bedouin mothers.

National maternal and child health (MCH) care systems often deliver universal health care recommendations that do not take into consideration the social context of infant care (IC) for marginalized groups. We examined associations between maternal perceptions of social context (MPSC) and adherence by minority Bedouin mothers in Israel to three commonly recommended IC practices. We conducted personal interviews with 464 mothers visiting 14 MCH clinics using a structured questionnaire based on findings from a previous focus-group study, and guided by constructs of the Health Beliefs Model. Items were tested for validity and reliability. We used multivariate analysis to identify MPSC constructs associated with adherence to MCH clinic recommendations (timely postnatal first visit, sustaining breastfeeding, and use of infant car seat). Social context, when perceived as a barrier to IC, was negatively associated with adherence to timely first postnatal MCH clinic visit (odds ratio, 95 %, confidence intervals (OR 1.45, 95 % CI 1.24, 1.70) and use of infant car seat (OR 1.43, 95 % CI 1.21, 1.69). However, social context was positively associated with sustained breastfeeding (OR 0.54, 95 % CI 0.37, 0.79). Perceptions of the severity of infant health problems, and family financial and relationship problems had less significant associations with adherence to MCH clinic recommendations. Adherence by marginalized mothers to MCH clinic recommendations is related to their perceptions of social context. When there are higher financial and other living conditions barriers mothers tend toward lower adherence to these recommendations. MCH policy makers and service providers must consider MPSC in planning and delivery of MCH recommendations.

Psychosocial complications of coronary artery disease.

Background:Cardiovascular diseases are the leading causes of death around the world. The coronary artery disease (CAD) is one of the most common diseases in this category, which can be the trigger to various psychosocial complications. We believe that inadequate attention has been paid to this issue.Objectives:The purpose of the present study was to explore the psychosocial complications of CAD from the Iranian patients’ perspective.Patients and Methods:A qualitative design based on the content analysis approach was used to collect the data and analyze the perspective of 18 Iranian patients suffered from CAD, chosen by a purposeful sampling strategy. Semi-structured interviews were held in order to collect the data. Sampling was continued until the data saturation. The data were analyzed using qualitative content analysis approach by MAXQUDA 2010 software.Results:This study revealed the theme of the patients’ challenges with CAD. This theme consisted of: "primary challenges," including doubting early diagnosis and treatment, and feeling being different from others; "psychological issues," including preoccupation, fear of death and surgical intervention, recurrence stress , anxiety and depression; "problems of life," including financial problems, work-related problems, and family-related problems; and "sociocultural issues," including change in perspective of people towards the patient, and cultural issues.Conclusions:Although the management of physical problems in patients with CAD is important, psychosocial effects of this disease is more important. Thus, health care personnel should pay ample attention to identify and resolve psychosocial problems of these patients. Results of this study can be used to empower these patients.

Adolescents’ Self-reported Running Away from Home and Suicide Attempts During a Period of Economic Recession in Greece

Running away from home and suicide attempts during adolescence are high-risk behaviors for safety and health, and a “way out” from negative life experiences. To examine the self-reported prevalence of running away and suicide attempts among adolescents in Greece in the midst of a severe economic recession which is exerting pressure on families, and to identify associated psychosocial factors. Data were drawn from a nationally representative school survey (n = 23,279, 15–19 years old). Students answered in their classrooms an anonymous questionnaire under the supervision of trained researchers. Each behavior was reported by one in nine adolescents (11.3 % for lifetime suicide attempts and 11.6 % for lifetime running away). Among those who reported the one behavior, a quarter also reported the other. Logistic regression analyses indicated that these behaviors share several common psychosocial correlates: family related (quality of parental relationships, parental monitoring), school related (poor performance and dissatisfaction), substance use, and emotional, psychological and behavioral problems. Gender was a significant correlate but in opposite directions for running away (more common among boys) and suicide attempts (more common among girls). Socioeconomic status was not a significant correlate for either behavior, possibly because the impact of the economic crisis on parents had not yet filtered down to their children in 2011 (the survey year). Findings suggest the need for timely interventions towards vulnerable youth and their families by identifying personal, familial and school factors associated with these two health- and life-compromising behaviors.

Children and adolescents treated for post-traumatic stress disorder at the Free State Psychiatric Complex

<p><strong>Background.</strong> Children and adolescents can develop post-traumatic stress disorder (PTSD) after exposure to a range of traumatic events, including domestic, political or community violence, violent crime, physical and sexual abuse, hijacking, witnessing a violent crime and motor vehicle accidents. This is particularly critical given the substantial challenge that PTSD poses to the healthy physical, cognitive and emotional development of children and adolescents.</p><p><strong>Methods.</strong> The clinical records of 1 229 children (age 2 - 11 years) and adolescents (age 12 - 18 years) treated at the Child Mental Health Unit of the Free State Psychiatric Complex (FSPC) were screened for the diagnosis of PTSD and analysed for the purpose of this study.</p><p><strong>Results.</strong> Forty-nine (4.0%) of the children and adolescents treated at the unit were diagnosed with PTSD, of whom most were female (63.3%). Approximately 22% of the participants had comorbid major depressive disorder. The main traumatic event in both groups was witnessing the death of a close relative (32.7%), followed by sexual assault (25%), rape (25%) and physical attack (10.2%). Associated stressors identified included problems at school (55.1%), isolation (39%), fear or anxiety (37%), problematic family relationships (29%), emotional (27%) and physical (23%) abuse, and lack of social support (23%). Most of the participants (59.2%) received psychotherapy.</p><p><strong>Conclusions.</strong> Children and adolescents referred to the FSPC are also exposed to traumatic events which lead to the development of PTSD. The Free State is a sprawling province with remote areas where specialist services and facilities are limited. It is therefore recommended that preventive programmes, training opportunities and consultation services are implemented to identify and treat children and adolescents with PTSD. Schools with limited access to psychological services and large classrooms, impeding the diagnosis and treatment of PTSD specifically, face similar challenges. Reinforcement of professional services and the upgrading of facilities will decrease the burden on the Child Mental Health Unit, but will require collaborative efforts from role players such as the National Departments of Health and Education.</p>

Children and adolescents treated for post-traumatic stress disorder at the Free State Psychiatric Complex

Background. Children and adolescents can develop post-traumatic stress disorder (PTSD) after exposure to a range of traumatic events, including domestic, political or community violence, violent crime, physical and sexual abuse, hijacking, witnessing a violent crime and motor vehicle accidents. This is particularly critical given the substantial challenge that PTSD poses to the healthy physical, cognitive and emotional development of children and adolescents. Methods. The clinical records of 1 229 children (age 2 - 11 years) and adolescents (age 12 - 18 years) treated at the Child Mental Health Unit of the Free State Psychiatric Complex (FSPC) were screened for the diagnosis of PTSD and analysed for the purpose of this study. Results. Forty-nine (4.0%) of the children and adolescents treated at the unit were diagnosed with PTSD, of whom most were female (63.3%). Approximately 22% of the participants had comorbid major depressive disorder. The main traumatic event in both groups was witnessing the death of a close relative (32.7%), followed by sexual assault (25%), rape (25%) and physical attack (10.2%). Associated stressors identified included problems at school (55.1%), isolation (39%), fear or anxiety (37%), problematic family relationships (29%), emotional (27%) and physical (23%) abuse, and lack of social support (23%). Most of the participants (59.2%) received psychotherapy. Conclusions. Children and adolescents referred to the FSPC are also exposed to traumatic events which lead to the development of PTSD. The Free State is a sprawling province with remote areas where specialist services and facilities are limited. It is therefore recommended that preventive programmes, training opportunities and consultation services are implemented to identify and treat children and adolescents with PTSD. Schools with limited access to psychological services and large classrooms, impeding the diagnosis and treatment of PTSD specifically, face similar challenges. Reinforcement of professional services and the upgrading of facilities will decrease the burden on the Child Mental Health Unit, but will require collaborative efforts from role players such as the National Departments of Health and Education.

Parents' competence and social skills in siblings of disabled children

In this study we aimed to determine whether or not the siblings of children with disabilities have more emotional (stress levels) and relational (parental education levels, family functioning levels, relational and behavioral problems of children while at school), problems than do their peers. We selected 32 couples (16 with and 16 without children with low intellectual ability) and administered self-report questionnaires. Results confirmed the association between family characteristics and the emotional and relational difficulties of siblings of children with disabilities. In our analysis of the relational experience of siblings, a significant difference emerged in comparison to their peers in families with nondisabled children.

First Offenders With Psychosis

Within the early/late start typology of offenders with schizophrenia, a third type, first offenders (FO), has been proposed. The aim of this study was to examine the justification of this first offender type. Retrospective file study consisted of 97 early starters (ES), 100 late starters, and 26 FO. Variables in different domains were scored. There were significant differences between the groups within the domains life functioning, abuse and family-related problems, psychiatric functioning, substance misuse, antisocial personality, and offense characteristics. Most differences were between the ES and FO. The existence of the first offender type is justified by the present findings. These findings underscore the importance of offender subtyping for better offender treatment interventions.

Lack of Adherence to Follow-Up Visits After Bariatric Surgery: Reasons and Outcome

A substantial number of patients undergoing bariatric surgery are lost to follow-up for unknown reasons, which may cause an overestimation of the benefits of operation. The aim of this study was to identify the reasons of failure to attend controls after bariatric surgery and the relationship with poor weight loss. A retrospective analysis of a prospective database including all patients undergoing bariatric surgery from January 2004 to February 2012 was performed. Nonadherence was defined as missing any scheduled control visit for more than 6 months. Contact was attempted (mail, telephone, and e-mail), and responders were requested to complete a questionnaire. Forty-six (17.5%) out of 263 patients were considered nonadherent. Thirty-three (71.7%) of these patients completed the questionnaire. The main reasons for nonadherence were work- (36.4%) and family-related (18.2%) problems or having moved outside the city or to the country (15.2%). The percentage of nonadherent patients aged ≤45 years was greater as compared with those aged >45 years [28 (60.1%) vs 18 (42.2%), respectively, P = 0.034]. Likewise, of the 30 patients with unsuccessful weight loss (<50% EWL), seven (30.4%) were in the nonadherent group while 23 (10.6%) in the adherent group (P = 0.046). Finally, 96.9% of patients were completely satisfied with surgery and would recommend the procedure to other morbid obese patients. The nonadherence rate to follow-up visits after bariatric surgery was 17.5%, mainly associated with work-related problems. Nonadherence was greater in patients aged ≤45 years and in those with poor weight loss.

Preventive Intervention for Living Donor Psychosocial Outcomes: Feasibility and Efficacy in a Randomized Controlled Trial

There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes—psychosocial variables in somatic, psychological and family interpersonal relationship domains—were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p = 0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p = 0.038), lower rates of fatigue (p = 0.021) and pain (p = 0.016), shorter recovery times (p = 0.041) and fewer unexpected medical problems (p = 0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p = 0.046) and fewer unexpected family-related problems (p = 0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial.

Counselling in humanitarian settings: a retrospective analysis of 18 individual-focused non-specialised counselling programmes

BackgroundMédecins Sans Frontières (MSF) provides individual counselling interventions in medical humanitarian programmes in contexts affected by conflict and violence. Although mental health and psychosocial interventions are a common part of the humanitarian response, little is known about how the profile and outcomes for individuals seeking care differs across contexts. We did a retrospective analysis of routine programme data to determine who accessed MSF counselling services and why, and the individual and programmatic risk factors for poor outcomes.MethodsWe analysed data from 18 mental health projects run by MSF in 2009 in eight countries. Outcome measures were client-rating scores (1–10 scale; 1 worst) for complaint severity and functioning and counsellor assessment. The effect of client and programme factors on outcomes was assessed by multiple regression analysis. Logistic regression was used to assess binary outcome variables.Results48704 counselling sessions were held with 14963 individuals. Excluding women-focused projects, 66.8% of patients were women. Mean (SD) age was 33.3 (14.1) years. Anxiety-related complaints were the most common (35.0%), followed by family-related problems (15.7%), mood-related problems (14.1%) and physical complaints (13.7%). Only 2.0% presented with a serious mental health condition. 27.2% did not identify a traumatic precipitating event. 24.6% identified domestic discord or violence and 17.5% psychological violence as the precipitating event. 6244 (43.9%) had only one session. For 91% of 7837 who returned, the counsellor reported the problem had decreased or resolved. The mean (SD) complaint rating improved by 4.7 (2.4) points (p < 0.001) and by 4.2 (2.3, p < 0.001) for functional rating. Risk factors for poorer outcomes were few sessions, non-conflict setting (stable or societal violence settings), serious mental health condition, or attending a large, recently opened project.ConclusionsThe majority of clients accessing counselling services present with anxiety related complaints. Attrition rates were high. Good outcomes were recorded among those who attended for more than one visit. Lessons learned included the importance of adaptation of approach in non-conflict contexts such as societal violence or post-conflict contexts. There is a need for further research to evaluate the intervention against a control group.

Commuters’ Psychosocial Profile and Their Involvement in Child Rearing at Home

The “commuter family” is recently on the rise in Malaysia. Though the impact of commuter families in maintaining the balance and harmony among family members remains debatable, studies relevant to this topic have been lacking in Malaysia. This paper aims to investigate the impact of commuter family on the commuters’ psychosocial state and their children's education. Using the qualitative approach, a total of 14 commuters were interviewed. Findings suggested that commuters with positive psychosocial characteristics had less emotional problems when handling children education as well as relationships with family members and friends. In contrast, commuters with negative psychosocial characteristics have more communication and family-related problems. In summary, the issues surrounding commuter families need to be addressed to ensure that family types do not affect over the years, the stability and harmony of the family institution in Malaysia and elsewhere.

Hwa-Byung Among Middle-Aged Korean Women: Family Relationships, Gender-Role Attitudes, and Self-Esteem

We surveyed 395 Korean middle-aged women and examined how their perceptions of family relationships, gender-role attitudes, and self-esteem were associated with Hwa-Byung (HB; Korean anger syndrome). Our regression analyses revealed that participants who reported worse family relationship problems experienced more HB symptoms. Having profeminist, egalitarian attitudes toward women's gender roles was also associated with more HB symptoms. Self-esteem was not significantly associated with HB. Based on the results, we suggest that what is crucial to understanding HB is not how women evaluate themselves, but rather the level of stress caused by family relationship problems and their perception of women's roles.

Health priorities and perceived health determinants among Western Australians attending the 2011 LGBTI Perth Pride Fairday Festival

Although data exist demonstrating poorer health indicators on a range of health outcomes for lesbian, gay, bisexual, transsexual and intersex (LGBTI) people, there is little information as to how this group perceives the relative importance of different health issues or what the underlying reasons behind poorer health may be. A self-completed survey was administered to people attending the October 2011 LGBTI Perth Pride Fairday Festival. Three hundred and fifty-one people completed the survey, resulting in a total of 335 useable surveys. One hundred and seventy-eight participants identified as female, 145 as male, four as transgender and eight as other genders. Depression, anxiety, excessive worry or panic attacks and problems in family relationships were reported as the most important individual health issues, whereas depression, suicide and HIV/AIDS were seen as the most important health issues affecting the LGBTI community. Discrimination was rated the most important social factor impacting on the health and well being of this community. When members of the LGBTI community were asked to rank health issues of importance both individually and as a community, the results indicate that mental health issues are of prime concern. Discrimination and the stress of living as part of this minority group were seen as contributing to this. Health promotion and public health need to be responsive to these issues if real gains are to be made in reducing the health inequities affecting this group. So what? This research highlights the link between social justice, social inclusion and health outcomes. The health of LGBTI people is rarely considered by mainstream agencies, despite poorer health outcomes. Sensitive and targeted public health interventions that resonate with the community and that acknowledge the impact of being part of this marginalised group are required.

Chest Pain in Children

Objectives: Chest pain (CP) is a common cause of referral the children to Hospital. The objective of this study is to describe current magnitude, causes, rate of cardiac chest pain, associated risk factors, and what is the ideal approach for this group of patients in pediatric emergency department and cardiology unit in. Patients and methods: this is prospective hospital based cross sectional study done in Pediatric Department, King Fahad Hospital Albaha Kingdom of Saudi Arabia from Jan 2010 till Jan 2013. The patients are aged from 5 to 12 year. A chest pain protocol was performed by Pediatrician on every patient, including a detailed history, full physical examination, complete blood count, ESR, blood sugar, electrolytes, (ECG) electrocardiogram, and Echocardiography. EEG had done only for patients with positive family history of seizure disorder.?Holter ECG done for pts with significant cardiac signs, and stress ECG done only for 2 pts. Patients with sickle cell anemia, CNS diseases, trauma associated chest pain, and syndromic pts, with chest pain are excluded. Statistical analysis was performed using the Odds, Odd-ratio and 95% CI. Results: 225 patients were seen in this study. 126 pts are male (56%) and 99 female (44%). Electrocardiography (ECG) and Echocardiography were done to all pts. Holter ECG monitoring done in 10 pts (4%). Idiopathic Chest Pain is the most common cause diagnosed in 125 patients (56%), it is more common in elder pts >10 yr and it is a diagnosis of exclusion. Musculoskeletal causes account for (16 %. Pulmonary causes account for 13%. Cardiac causes, account for 15 pts. (7%), Gastrointestinal causes account for 4%. Psychological causes account for 10 pts (4%), school and family related problems are the most common psychological problems.. Conclusion: Idiopathic chest pain is the most common in children and slightly more common in males. Cardiac causes are rare. Detailed history, full clinical examination, CXR, and ECG can diagnose the majority causes. Echocardiography, Holter ECG, and EEG reserved for some cases when associated with significant cardiac or neurological symptoms and signs.

2212 – Again starting

In a situation of imminent discharge with a serious problem such as no adherence, vague and imprecise concept of the concept of psychosis, poor support and family support, poor social relationships and social skills, little emotional resonance and leave the residence, what do we do? In this case we opted for patient referral to a rehabilitation unit as the TC. This is where targets are raised to make an Individual treatment plan: improving disease awareness and treatment adherence, family information about the disease, extend relationships and use of leisure time, reduction of negative symptoms and residential support. The patient is 32 years old, daughter of separated parents, diagnosed schizophrenic psychosis with 7 hospital admissions in the last 9 years. The disease is associated with the consumption of toxic. There are changes in the character, family relationship problems, clinical delusional and hallucinatory behavior disorders with numerous leaks of the home and making marginal life. Prior to the TC is trying two leads to Area Rehabilitation Unit with treatment failure after cessation of medication. After two years of follow up in TC have achieved most of the objectives proposed at the beginning, normalizing, as far as possible, the life of the patient.

Majority of Parents Involve in Girls Higher Secondary Schools in Jammu and Kashmir: A Case Study of Anantnag &amp; Kulgam Districts of Kashmir Province.

As majority of people give top priority to their boys as compared to girls and girls are consciously ignored and parents give less importance to girls education. Therefore, there is possibility for girls to become victim of various types of psychological problems. The study aimed to explored parents' majority of parents involve in girls higher secondary schools in Jammu and Kashmir with reference to girl student's problems in Anantnag & Kulgam Districts of Kashmir Province(J &K). Understanding of students' problems relating to their education like not doing home assignments, absenteeism from school, lack of interest in learning, health related problems like any typical disease (s), psychological problems like students' inferiority complexes, telling lies, remaining disturbed, being isolated and introvert in school, interpersonal relations and maladjustment problems, personal family related problems like separation between parents, financial problems. Such problems affect on students' behavior at school and causes lack of interest in learning. Information from parents about the nature of students' problems can help teachers in understanding problems. At the same time parents involvement in schools can raise some problems for teachers however, such problems may be controlled through proper leadership and administration.

Recovery capital in the process of change—differences and similarities between groups of clients treated for alcohol or drug problems

The study investigated clients' retrospective descriptions of the impact of treatment interventions as well as other contextual factors in the clients' process of recovery. The data set was divided into two groups based on the clients' social integration, one marginalized and one integrated group, and analyzed for qualitative group-related differences in common factors described by the clients. The results showed some group-related differences in the process of change. When a process of change was initiated, family-related problems were more often severe for clients in the marginalized group than for those in the integrated group. Important factors for maintaining positive change were to a greater extent present in the integrated group while the marginalized group recreated them during treatment, for example by creating new social networks and getting employment. With these differences in mind, both groups stressed the same type of factors as important for a process of change. This might suggest that although the clients in the marginalized group had restored their external social conditions during treatment, their actual recovery capital was in general more fragile than that of clients in the integrated group and hence these clients might be in need of extended support after treatment.

Conductas de riesgo social y de salud en adolescentes. Propuesta de intervención contextualizada para un caso de bullying

Social and personal risk behaviours are extending behaviours among adolescents. Drugs abuse and problems in family and school relationships stand out among these behaviours, where bullying is detected, every time more, as a social dysfunction. This paper presents (1) the analysis of some social and personal well being risk behaviour among adolescents (N=1239) secondary school pupils, (612 boys and 627 girls) and (2) a context intervention proposal for a class-group (n=27), where bullying were detected performed by 2 bullies, 2 victims and 1 provoke-victim pupils. Findings point out that, more than one in four pupils shows social and health risk behaviour, such as drugs abuse or drive under alcoholics’ effects. We did not find differences in drugs consume between boys and girls but boys score higher in other risk behaviours. We also observed high relations among risk behaviours, scholar failure and bullying. Analysis for the intact group-class revealed that bully pupils present a high level of scholar failure and perpetrate other delinquent actions and they find support in their friends and family. The intervention proposal for this group is oriented not only for those pupils involved in bullying, but also for all educative agents.

Prevalence of Problematic Video Gaming among Ontario Adolescents

Video game playing has become a very popular activity among adolescents. Its impact on the mental health and well-being of players is just beginning to be explored. This paper reports on the prevalence of problematic gaming in a representative sample of 2,832 Ontario students in grades 7 to 12. The survey included questions about the school grade, family and school related problems, frequency of video game playing and video game related problems as measured by the Problem Video Game Playing scale (PVP). Most of the students (85 %) reported playing video games in the past year and 18.3 % reported playing video games daily. Slightly less then 1 in 10 of the students (9.4 %) endorsed 5 or more of the PVP items (males 15.1 %; females 3.1 %). Further research is required to delineate the concept of excessive video game playing, its relation to other addictions, and the impact on adolescents’ psychosocial functioning.

Couple/family therapy for posttraumatic stress disorder: Review to facilitate interpretation of VA/DOD Clinical Practice Guideline

A well-documented association exists among Veterans' posttraumatic stress disorder (PTSD) symptoms, family relationship problems, and mental health problems in partners and children of Veterans. This article reviews the recommendations regarding couple/family therapy offered in the newest version of the Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress. We then provide a heuristic for clinicians, researchers, and policy makers to consider when incorporating couple/family interventions into Veterans' mental health services. The range of research that has been conducted on couple/family therapy for Veterans with PTSD is reviewed using this heuristic, and suggestions for clinical practice are offered.