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Siblings of Disabled Children: Effects of Chronic Stress in the Family

Siblings of Disabled Children: Effects of Chronic Stress in the Family Abstract • We examined the effects of chronic stress in families of severely disabled children on psychopathology in siblings. We present findings from a five-year follow-up of 192 siblings of disabled children and a geographically based probability sample of 284 children (controls), who were 6 to 18 years old at initial assessment (time 1) and 11 to 23 years old at follow-up (time 2). Data on the Psychiatric Screening Inventory were obtained from mothers at times 1 and 2. Additionally, at time 2 the Diagnostic Interview Schedule for Children was administered to the children themselves. At follow-up, the siblings' picture according to mothers' assessment appears worse than it did initially: in addition to the excess in aggressive symptoms seen at time 1, they manifested an excess in depressive affect and social isolation. The time 2 interviews with the children themselves show that the siblings scored significantly higher than controls on depressive symptoms, although the rate of DSM-III major depression was not significantly different. An excess in depressive symptoms was observed also in mothers of disabled children, who, like the siblings, were not at increased risk for major depression. References 1. Rutter M: Children of Sick Parents: An Environmental and Psychiatric Study . New York, Oxford University Press Inc, 1966. 2. Goodyer IM, Gatzanis S, Kolvin I: The impact of recent undesirable life events on psychiatric disorders in childhood and adolescence . Br J Psychiatry , in press. 3. Robins LN: Sturdy childhood predictors of adult antisocial behaviour: Replications from longitudinal studies . Psychol Med 1978;8:611-622.Crossref 4. Salkever DS: Parental opportunity costs and other economic costs of children's disabling conditions , in Hobbs N, Perrin JM (eds): Issues in the Care of Children with Chronic Illness . San Francisco, Jossey-Bass Inc, Publishers, 1985, pp 864-879. 5. Breslau N, Salkever DS, Staruch KS: Women's labor force activity and responsibilities for disabled dependents: A study of families with disabled children . J Health Soc Behav 1982;23:169-182.Crossref 6. Breslau N, Staruch KS, Mortimer EA Jr: Psychological distress in mothers of disabled children . AJDC 1982;136:682-686. 7. Breslau N: Family care of disabled children: Effects on siblings and mothers , in Rubin L, Thompson GH, Bilenker RM (eds): Comprehensive Management of Cerebral Palsy . New York, Grune & Stratton, 1983. 8. Breslau N, Davis GC: Chronic stress and major depression . Arch Gen Psychiatry 1986;43:309-314.Crossref 9. Crain A, Sussman MB, Weil WB: Effects of a disabled child on marital integration and related measures of family functioning . J Health Hum Behav 1966;7:122-127.Crossref 10. Lawler RH, Nakielny W, Wright NA: Psychological implications of cystic fibrosis . Can Med Assoc J 1966;94:1043-1048. 11. Binger CM: Childhood leukemia: Emotional impact on patient and family . N Engl J Med 1969;280:414-418.Crossref 12. Mass A, Kaplan A: Restrictions of families to chronic hemodialysis . Psychother Psychosom 1975;25:20-26.Crossref 13. Lavigne JV, Ryan M: Psychologic adjustment of siblings of children with chronic illness . Pediatrics 1979;63:616-627. 14. Ablin AR, Feurstein RC, Kushner JH, Zoger S, Mikkelsen C, Gath A: The school-age siblings of mongol children . Br J Psychiatry 1973;123:161-167.Crossref 15. Tew B, Lawrence KM: Mothers, brothers and sisters of patients with spina bifida . Dev Med Child Neurol 1973;15( (suppl 29) ):69-76.Crossref 16. Gayton WF, Friedman SB, Tavormina JB, Tucker F: Children with cystic fibrosis: I. Psychological test findings of patients, siblings, and parents . Pediatrics 1977;59:888-894. 17. Drotar D, Doershuk CF, Stern RC, Boat CF, Boyer W, Matthews L: Psychosocial functioning of children with cystic fibrosis . Pediatrics 1981;67:338-343. 18. Breslau N, Weitzman M, Messenger K: Psychologic functioning of siblings of disabled children . Pediatrics 1981;67:344-353. 19. Breslau N: Siblings of disabled children: Birth-order and age spacing effects . J Abnorm Child Psychol 1982;10:85-96.Crossref 20. Langner TS, Gersten JC, McCarthy ED, Eisenberg JG: A screening inventory for assessing psychiatric impairment in children 6 to 18 . J Consult Clin Psychol 1976;44:286-296.Crossref 21. Robins LN: Continuities and discontinuities in the psychiatric disorders of children , in Mechanic D (ed): Handbook of Health, Health Care and the Health Professions . New York, Free Press, 1983, pp 195-219. 22. Gersten JC, Langner TS, Eisenberg JG, Simcha-Fagan O, McCarthy ED: Stability and change in types of behavioral disturbance of children and adolescents . J Abnorm Child Psychol 1976;4:111-127.Crossref 23. Lapouse R, Monk J: An epidemiologic study of behavior characteristics in children . Am J Public Health 1958;48:1134-1144.Crossref 24. Moretti MM, Fine MB, Haley G, Marriage K: Childhood and adolescent depression: Child-report versus parent-report information . J Am Acad Child Psychiatry 1985;24:298-302.Crossref 25. Kashani JH, Orvaschel H, Burk JP, Reid JC: Informant variance: The issue of parent-child disagreement . J Am Acad Child Psychiatry 1985;24:437-441.Crossref 26. Orvaschel H, Weissman MM, Padian N, Lowe TL: Assessing psychopathology in children of psychiatrically disturbed parents: A pilot study . J Am Acad Child Psychiatry 1981;20:112-122.Crossref 27. Costello AJ, Edelbrock C, Dulcan MK, Kalas R, Klaric SH: Development and Testing of the NIMH Diagnostic Interview Schedule for Children in a Clinic Population . Rockville, Md, Center for Epidemiologic Studies, National Institute of Mental Health, 1984. 28. Edelbrock C, Costello AJ, Dulcan MK, Kalas R, Conover NC: Age differences in the reliability of the psychiatric interview of the child . Child Dev 1985;56:265-275.Crossref 29. Orvaschel H: Psychiatric interviews suitable for use in research with children and adolescents . Psychopharmacol Bull 1986;21:737-745. 30. Nunnally JC: Psychometric Theory . New York, McGraw-Hill International Book Co, 1967, p 218. 31. Weissman MM, Gammon GD, John K, Merikangas KR, Warner V, Prusoff BA, Sholomskas D: Children of depressed parents: Increased psychopathology and early onset of major depression . Arch Gen Psychiatry 1987;44:847-853.Crossref 32. Rutter M: Stress, coping, and development , in Garmzy N, Rutter M (eds): Stress, coping, and development in children . New York, McGraw-Hill International Book Co, 1983, pp 1-42. 33. Orvaschel H: Maternal depression and child dysfunction: Children at risk . Adv Clin Child Psychol 1983;6:169-197. 34. Weissman MM, Paykel ES, Klerman GL: The depressed woman as a mother . Soc Psychiatry 1972;7:98-108.Crossref 35. Keller MB, Beardslee WR, Dorer DJ, Lavori PW, Samuelson H, Klerman GL: Impact of severity and chronicity of parental affective illness on adaptive functioning and psychopathology in their children . Arch Gen Psychiatry 1986;43:930-937.Crossref 36. Rutter M, Shaffer D: DSM-III: A step forward or back in terms of the classification of child psychiatric disorders? J Am Acad Child Psychiatry 1980;19:371-394.Crossref 37. Achenbach TM: DSM-III in light of empirical research on the classification of child psychopathology . J Am Acad Child Psychiatry 1980;19:395-412.Crossref 38. Thoits PA: Multiple identities and psychological well-being . Am Soc Rev 1983;48:174-187.Crossref 39. Henderson SP, Duncan-Jones P, Byrne D, Scott R, Adcock S: Social bonds, adversity and neurosis , in Robins LN, Clayton PJ, Wing JK (eds): The Social Consequences of Psychiatric Illness . New York, Brunner/Mazel Inc, 1980, pp 176-182. 40. Brown G, Harris T: Social Origins of Depression: A Study of Psychiatric Disorders in Women . London, Tavistock Publications Ltd, 1978. 41. Dohrenwend BP, Oksenberg L, Shrout PE, Dohrenwend BS, Cook D: What Brief Psychiatric Screening Scales Measure: Health Survey Research Methods: Third Biennial Research Conference, US Dept of Health and Human Services publication (PHS) 81-3268, 1979, pp 188-198. 42. Klerman GL: The nosology and diagnosis of depressive disorders , in Grinspoon L (ed): Psychiatry Update . Washington, DC, American Psychiatric Press Inc, 1983, vol 2, pp 356-382. 43. Weissman MM, Boyd JH: The epidemiology of affective disorders: Rates of risk factors , in Grinspoon L (ed): Psychiatry Update . Washington, DC, American Psychiatric Press Inc, 1983, vol 2, pp 406-428. 44. Crandall DL, Dohrenwend BP: Some relations among psychiatric symptoms, organic illness, and social class . Am J Psychiatry 1967;123:1527-1538. 45. Seiler LH: The 22-item screening scale used in field studies of mental illness: A question of substance, and a question of theory . J Health Soc Behav 1973;14:252-264.Crossref 46. Dohrenwend BP: Some issues in the definition and measurement of psychiatric disorders in general populations, in Proceedings of the 14th National Meeting of the Public Health Conferences on Records and Statistics, US Dept of Health, Education, and Welfare publication 74-1214, 1973. 47. Breslau N: Depressive symptoms, major depression and generalized anxiety: A comparison of self-reports on CES-D and results from diagnostic interviews . Psychiatry Res 1985;15:219-229.Crossref 48. Kandel DB, Davies M: Adult sequelae of adolescent depressive symptoms . Arch Gen Psychiatry 1986;43:255-262.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Siblings of Disabled Children: Effects of Chronic Stress in the Family

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1987.01800240014003
Publisher site
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Abstract

Abstract • We examined the effects of chronic stress in families of severely disabled children on psychopathology in siblings. We present findings from a five-year follow-up of 192 siblings of disabled children and a geographically based probability sample of 284 children (controls), who were 6 to 18 years old at initial assessment (time 1) and 11 to 23 years old at follow-up (time 2). Data on the Psychiatric Screening Inventory were obtained from mothers at times 1 and 2. Additionally, at time 2 the Diagnostic Interview Schedule for Children was administered to the children themselves. At follow-up, the siblings' picture according to mothers' assessment appears worse than it did initially: in addition to the excess in aggressive symptoms seen at time 1, they manifested an excess in depressive affect and social isolation. The time 2 interviews with the children themselves show that the siblings scored significantly higher than controls on depressive symptoms, although the rate of DSM-III major depression was not significantly different. An excess in depressive symptoms was observed also in mothers of disabled children, who, like the siblings, were not at increased risk for major depression. References 1. Rutter M: Children of Sick Parents: An Environmental and Psychiatric Study . New York, Oxford University Press Inc, 1966. 2. Goodyer IM, Gatzanis S, Kolvin I: The impact of recent undesirable life events on psychiatric disorders in childhood and adolescence . Br J Psychiatry , in press. 3. Robins LN: Sturdy childhood predictors of adult antisocial behaviour: Replications from longitudinal studies . Psychol Med 1978;8:611-622.Crossref 4. Salkever DS: Parental opportunity costs and other economic costs of children's disabling conditions , in Hobbs N, Perrin JM (eds): Issues in the Care of Children with Chronic Illness . San Francisco, Jossey-Bass Inc, Publishers, 1985, pp 864-879. 5. Breslau N, Salkever DS, Staruch KS: Women's labor force activity and responsibilities for disabled dependents: A study of families with disabled children . J Health Soc Behav 1982;23:169-182.Crossref 6. Breslau N, Staruch KS, Mortimer EA Jr: Psychological distress in mothers of disabled children . AJDC 1982;136:682-686. 7. Breslau N: Family care of disabled children: Effects on siblings and mothers , in Rubin L, Thompson GH, Bilenker RM (eds): Comprehensive Management of Cerebral Palsy . New York, Grune & Stratton, 1983. 8. Breslau N, Davis GC: Chronic stress and major depression . Arch Gen Psychiatry 1986;43:309-314.Crossref 9. Crain A, Sussman MB, Weil WB: Effects of a disabled child on marital integration and related measures of family functioning . J Health Hum Behav 1966;7:122-127.Crossref 10. Lawler RH, Nakielny W, Wright NA: Psychological implications of cystic fibrosis . Can Med Assoc J 1966;94:1043-1048. 11. Binger CM: Childhood leukemia: Emotional impact on patient and family . N Engl J Med 1969;280:414-418.Crossref 12. Mass A, Kaplan A: Restrictions of families to chronic hemodialysis . Psychother Psychosom 1975;25:20-26.Crossref 13. Lavigne JV, Ryan M: Psychologic adjustment of siblings of children with chronic illness . Pediatrics 1979;63:616-627. 14. Ablin AR, Feurstein RC, Kushner JH, Zoger S, Mikkelsen C, Gath A: The school-age siblings of mongol children . Br J Psychiatry 1973;123:161-167.Crossref 15. Tew B, Lawrence KM: Mothers, brothers and sisters of patients with spina bifida . Dev Med Child Neurol 1973;15( (suppl 29) ):69-76.Crossref 16. Gayton WF, Friedman SB, Tavormina JB, Tucker F: Children with cystic fibrosis: I. Psychological test findings of patients, siblings, and parents . Pediatrics 1977;59:888-894. 17. Drotar D, Doershuk CF, Stern RC, Boat CF, Boyer W, Matthews L: Psychosocial functioning of children with cystic fibrosis . Pediatrics 1981;67:338-343. 18. Breslau N, Weitzman M, Messenger K: Psychologic functioning of siblings of disabled children . Pediatrics 1981;67:344-353. 19. Breslau N: Siblings of disabled children: Birth-order and age spacing effects . J Abnorm Child Psychol 1982;10:85-96.Crossref 20. Langner TS, Gersten JC, McCarthy ED, Eisenberg JG: A screening inventory for assessing psychiatric impairment in children 6 to 18 . J Consult Clin Psychol 1976;44:286-296.Crossref 21. Robins LN: Continuities and discontinuities in the psychiatric disorders of children , in Mechanic D (ed): Handbook of Health, Health Care and the Health Professions . New York, Free Press, 1983, pp 195-219. 22. Gersten JC, Langner TS, Eisenberg JG, Simcha-Fagan O, McCarthy ED: Stability and change in types of behavioral disturbance of children and adolescents . J Abnorm Child Psychol 1976;4:111-127.Crossref 23. Lapouse R, Monk J: An epidemiologic study of behavior characteristics in children . Am J Public Health 1958;48:1134-1144.Crossref 24. Moretti MM, Fine MB, Haley G, Marriage K: Childhood and adolescent depression: Child-report versus parent-report information . J Am Acad Child Psychiatry 1985;24:298-302.Crossref 25. Kashani JH, Orvaschel H, Burk JP, Reid JC: Informant variance: The issue of parent-child disagreement . J Am Acad Child Psychiatry 1985;24:437-441.Crossref 26. Orvaschel H, Weissman MM, Padian N, Lowe TL: Assessing psychopathology in children of psychiatrically disturbed parents: A pilot study . J Am Acad Child Psychiatry 1981;20:112-122.Crossref 27. Costello AJ, Edelbrock C, Dulcan MK, Kalas R, Klaric SH: Development and Testing of the NIMH Diagnostic Interview Schedule for Children in a Clinic Population . Rockville, Md, Center for Epidemiologic Studies, National Institute of Mental Health, 1984. 28. Edelbrock C, Costello AJ, Dulcan MK, Kalas R, Conover NC: Age differences in the reliability of the psychiatric interview of the child . Child Dev 1985;56:265-275.Crossref 29. Orvaschel H: Psychiatric interviews suitable for use in research with children and adolescents . Psychopharmacol Bull 1986;21:737-745. 30. Nunnally JC: Psychometric Theory . New York, McGraw-Hill International Book Co, 1967, p 218. 31. Weissman MM, Gammon GD, John K, Merikangas KR, Warner V, Prusoff BA, Sholomskas D: Children of depressed parents: Increased psychopathology and early onset of major depression . Arch Gen Psychiatry 1987;44:847-853.Crossref 32. Rutter M: Stress, coping, and development , in Garmzy N, Rutter M (eds): Stress, coping, and development in children . New York, McGraw-Hill International Book Co, 1983, pp 1-42. 33. Orvaschel H: Maternal depression and child dysfunction: Children at risk . Adv Clin Child Psychol 1983;6:169-197. 34. Weissman MM, Paykel ES, Klerman GL: The depressed woman as a mother . Soc Psychiatry 1972;7:98-108.Crossref 35. Keller MB, Beardslee WR, Dorer DJ, Lavori PW, Samuelson H, Klerman GL: Impact of severity and chronicity of parental affective illness on adaptive functioning and psychopathology in their children . Arch Gen Psychiatry 1986;43:930-937.Crossref 36. Rutter M, Shaffer D: DSM-III: A step forward or back in terms of the classification of child psychiatric disorders? J Am Acad Child Psychiatry 1980;19:371-394.Crossref 37. Achenbach TM: DSM-III in light of empirical research on the classification of child psychopathology . J Am Acad Child Psychiatry 1980;19:395-412.Crossref 38. Thoits PA: Multiple identities and psychological well-being . Am Soc Rev 1983;48:174-187.Crossref 39. Henderson SP, Duncan-Jones P, Byrne D, Scott R, Adcock S: Social bonds, adversity and neurosis , in Robins LN, Clayton PJ, Wing JK (eds): The Social Consequences of Psychiatric Illness . New York, Brunner/Mazel Inc, 1980, pp 176-182. 40. Brown G, Harris T: Social Origins of Depression: A Study of Psychiatric Disorders in Women . London, Tavistock Publications Ltd, 1978. 41. Dohrenwend BP, Oksenberg L, Shrout PE, Dohrenwend BS, Cook D: What Brief Psychiatric Screening Scales Measure: Health Survey Research Methods: Third Biennial Research Conference, US Dept of Health and Human Services publication (PHS) 81-3268, 1979, pp 188-198. 42. Klerman GL: The nosology and diagnosis of depressive disorders , in Grinspoon L (ed): Psychiatry Update . Washington, DC, American Psychiatric Press Inc, 1983, vol 2, pp 356-382. 43. Weissman MM, Boyd JH: The epidemiology of affective disorders: Rates of risk factors , in Grinspoon L (ed): Psychiatry Update . Washington, DC, American Psychiatric Press Inc, 1983, vol 2, pp 406-428. 44. Crandall DL, Dohrenwend BP: Some relations among psychiatric symptoms, organic illness, and social class . Am J Psychiatry 1967;123:1527-1538. 45. Seiler LH: The 22-item screening scale used in field studies of mental illness: A question of substance, and a question of theory . J Health Soc Behav 1973;14:252-264.Crossref 46. Dohrenwend BP: Some issues in the definition and measurement of psychiatric disorders in general populations, in Proceedings of the 14th National Meeting of the Public Health Conferences on Records and Statistics, US Dept of Health, Education, and Welfare publication 74-1214, 1973. 47. Breslau N: Depressive symptoms, major depression and generalized anxiety: A comparison of self-reports on CES-D and results from diagnostic interviews . Psychiatry Res 1985;15:219-229.Crossref 48. Kandel DB, Davies M: Adult sequelae of adolescent depressive symptoms . Arch Gen Psychiatry 1986;43:255-262.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Dec 1, 1987

References