Barbara Steck

Prevalence and Predictors of Emotional and Behavioural Functioning of Children Where a Parent Has Cancer A Multinational Study

This study aimed to evaluate prevalence and risk factors for emotional and behavioral problems in dependent children of cancer patients using a multinational research design.

Mental health problems in children of somatically ill parents, e.g. multiple sclerosis

ObjectivesBased on the investigation of 144 families (144 patients affected by Multiple Sclerosis (MS), 109 partners, and 192 children) examined in three different European child and adolescent psychiatric University centres by means of questionnaires, we evaluated the prevalence of psychological symptoms in the offspring and associated risk factors such as duration and severity of the disease as well as depression of the ill and the healthy parent.ResultsIndicate that the severe disease of MS is associated with depression of the ill and healthy parent. Ill parents, especially ill mothers, as well as depressed ill, or depressed healthy parents evaluate their children’s mental health problems with a higher prevalence within the internalizing spectrum. Healthy parents report normal psychological adjustment of their children. If two parents present a depressive state, the prevalence of relevant psychological internalizing symptoms is twice or three times as high as the age norms.ConclusionChildren in families with a parent affected by MS and associated depression of the parental couple are at high risk of mental health problems, especially internalizing disorders. In focusing on the mental health of children one must also be aware of the potential opportunities to address the parents’ own psychological needs.

Gender-Specific Differences in the Process of Coping in Families with a Parent Affected by a Chronic Somatic Disease (e.g. Multiple Sclerosis)

Based on the investigation of 52 families and their 87 offspring by means of semistructured interviews, we evaluated the coping abilities of the parent affected by multiple sclerosis (MS), the healthy parent and their children. The results show that the gender of the child significantly influences his or her coping behaviour. Daughters cope better than sons, independently of the gender of the MS-affected parent. Only the daughter’s coping is positively affected by age and disease variables. The correlation between the coping behaviour of parents and children is significant between children and their healthy parents and even stronger between children and healthy parents of the same gender. Healthy mothers and daughters cope better with the increasing disability of the father. This is not the case for healthy fathers and sons. Gender seems to be an important moderating factor in chronic parental disease and it has complex effects on the coping capacity of children.

Disease Variables and Depression Affecting the Process of Coping in Families with a Somatically Ill Parent

Aim and Methods: Based on the investigation of 134 families with a seriously ill parent and 214 offspring, we compared – by means of semistructured psychiatric interviews – the capacity of the ill and the healthy parent and their children to cope with various diseases. We evaluated how disease characteristics such as duration and severity of the disease (assessed by the Karnofsky Index) and associated depression [measured by the Beck Depression Inventory for parents and the Depression Inventory for Children and Adolescents (Depressions-Inventar für Kinder und Jugendliche) for children] influence the coping capacity of all family members. Results: The coping capacity of patients with organic disease (cancer, multiple sclerosis, other somatic diseases) is significantly higher than that of patients with somatization disorder, whereas the depression score of patients with organic disease is significantly lower than that of patients with somatization disorders. The depression of the patient negatively influences his/her coping capacity. Children’s coping capacity does not differ with respect to the parental illness and is not influenced by their own depression. There are significant correlations between the coping capacity of children and their healthy and ill parents affected by organic disease (multiple sclerosis, other somatic diseases, cancer), but not between children and healthy and ill parents with somatization disorders. Multivariate regression analysis shows the mutual influence of coping capacities between the parental couple as well as between the parents and their children. The better the patient (partner) is able to cope with a severe disease, the higher are the values of the coping capacity of the partner (patient). Children older than 6 years with a severely ill, nondepressed and well-coping parent cope well. These results do not apply to parents with somatization disorders. Conclusions: Patients with organic disease cope better and are less depressed, whereas patients with somatization disorders have a lower coping capacity and a higher depression score. Children older than six years cope better. Comprehensive care of a patient with a severe illness has to include his/her family in order to evaluate coping capacities of all family members, particularly of small children, and to assess and treat associated parental depression.

Indication for Psychotherapy in Offspring of a Parent Affected by a Chronic Somatic Disease (e.g. Multiple Sclerosis)

Based on the transcripts of video-recorded, semi-structured interviews with 41 offspring (aged 6–18 years) of parents with multiple sclerosis, we evaluated the indication for psychotherapy. These results were then compared with the previously determined coping ability of each child/adolescent. Psychotherapy was indicated for 22 out of the 41 children/adolescents. There was a significant relation between the indication for psychotherapy and the children’s inability to cope with the parental disease.The present findings confirm the risk of mental health problems in children of somatically ill parents. In our sample, half of the children and adolescents were estimated to benefit from individual psychotherapy, which might enhance their ability to cope with the parental illness.

Gender-specific differences coping with chronic somatic disease (e.g. Multiple Sclerosis)

Summary Based on the study of 48 patients and their partners by means of semi-structured interviews, we evaluated how the ability to cope (Coping Index) with a chronic somatic disease (e.g. Multiple Sclerosis) is affected by gender, the degree of disability (assessed by the Kurtzke EDSS) and associated depression (measured by the BDI).An associated depression in a sick wife induces depressive symptoms in the healthy husband; whereas healthy wives are not affected by the depression of their sick husbands.The process of coping according to gender shows that male coping, whether as patients or partners, is influenced neither by the degree of disability nor by associated depression (their own or their partners). Women as patients or partners are influenced in their coping process by the degree of impairment (negatively for their own, positively with increasing disability of their partner). Their ability to cope is negatively affected by an associated depression (their own or their partners). The evaluation of the MS patient should include the partner to devise individualised treatment approaches.

Dreams and the Dreaming Brain

The neuroanatomy and physiology of dreams and transitional states of sleep as well as functions of dreams are described. The major types of dreams such as lucid dreaming, daydreaming, and nightmares are discussed. Modern research suggests that sleep is a well-organized activity. The sleeping brain remains active and dreaming occurs in rapid eye movement (REM) sleep periods as well as in non-REM sleep. The “dreaming machine” involves large areas of the brain, and fMRI studies reveal complex patterns of activation and inhibition of multiple cortical and subcortical brain regions. Cerebral areas producing images are turned on, which explains the visual nature of dreams. Brain areas responsible for placing objects in their physical context remain inhibited, explaining why proportions are often distorted in dreams. It is suggested that the “primary driving forces of dreaming” are found in the meso-cortico-limbic system. This circuit is implicated in emotion and reward processing. Studies show that dopaminergic modulation plays an important function in dreaming. Dreaming can be considered as an important form of feeling and thinking. In dreams the most unexpected associations happen and both logical and illogical contents are featured. Dreams offer many facets such as problem solving, creative ideas, and new insight into personal functioning. They deal with emotional regulation, represent social interactions, and lead to better self-knowledge. While dreaming the body is active, feels intensively, and has even more abilities than the awake body, for example, it can fly. In psychotherapy dream narratives allow images to be connected with emotions and a search for meaning. During or after traumatic experiences, nightmares may or may not replay the dramatic events: accompanying violent emotions may gradually change into less overwhelming feelings, a process necessary to prevent their recurrence. Dreaming can then been regarded as having a restitutive function.

The Development of Self

Early life experiences shape the specific patterns of neuronal branching and synapse formation. Neuronal connections are reorganized according to the frequency of their utilization. Anatomical, physiological, and neurochemical changes take place throughout life in a complex interplay with surrounding forces to continuously shape behavior, knowledge base, and skills of the individual. Brain plasticity allows for great adaptability but can be detrimental for infants and young children who are highly vulnerable to the long-ranging impacts of adversities and traumatic events. The development of the self and the formation of self-representations take place in a continuous process between the infant and his primary caregivers. These processes are based on interpersonal communications with all their asymmetrical needs, desires, and satisfactions. The infant’s emotional self-regulation is dependent on the affect-regulatory interactions with primary caregivers.

A confirmative clinimetric analysis of the 36-item Family Assessment Device

Abstract Background: The Family Assessment Device (FAD) is a 60-item questionnaire widely used to evaluate self-reported family functioning. However, the factor structure as well as the number of items has been questioned. A shorter and more user-friendly version of the original FAD-scale, the 36-item FAD, has therefore previously been proposed, based on findings in a nonclinical population of adults. Aims: We aimed in this study to evaluate the brief 36-item version of the FAD in a clinical population. Methods: Data from a European multinational study, examining factors associated with levels of family functioning in adult cancer patients’ families, were used. Both healthy and ill parents completed the 60-item version FAD. The psychometric analyses conducted were Principal Component Analysis and Mokken-analysis. Results: A total of 564 participants were included. Based on the psychometric analysis we confirmed that the 36-item version of the FAD has robust psychometric properties and can be used in clinical populations. Conclusions: The present analysis confirmed that the 36-item version of the FAD (18 items assessing ‘well-being’ and 18 items assessing ‘dysfunctional’ family function) is a brief scale where the summed total score is a valid measure of the dimensions of family functioning. This shorter version of the FAD is, in accordance with the concept of ‘measurement-based care’, an easy to use scale that could be considered when the aim is to evaluate self-reported family functioning.

Pain and Mind-Body

While physical pain from noxious stimuli is understood in a rather well-defined and limited framework, an all-inclusive concept of how these physical events are translated into the feeling of pain is not yet within reach: this quest directly points to the fundaments of the mind/body relationship. With increasing “encephalization” of the pain system, neuronal mechanisms evolved to allow transition from pain being a purely physical phenomenon to the experience of psychic pain. Prefrontal cortical areas as well as subcortical areas such as the amygdala and cingulate gyrus contribute to the conscious awareness and affective and cognitive evaluation of pain and form part of the multimodal areas of the pain-processing network. The affective and sensory components of pain are closely related: psychological pain activates the same neuronal pathways as those involved in physical pain.