Felix Amsler

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.