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Inclusion of a close family member (e.g., the spouse) in psychosocial interventions for chronic illness may be more efficacious than focusing solely on the patient. This article reviews and synthesizes [...]

L. Fisher's (2005) article "Family, Ethnicity, and Chronic Disease: An Ongoing Story With a New Twist" asks an important question for clinical care, namely, "Why do some families do relatively [...]

This paper describes a social-developmental approach to interventions in chronic illness using naturally occurring processes of change during family life-cycle transitions to promote more positive developmental outcomes. Clinical interventions can help build resilience by creating a therapeutic collaboration designed to help patients improve their use of existing and new resources in multiple systems. They can then better meet demands of the illness as it impacts on shared development. A case example of a 13-year-old daughter with complex, chronic health problems and developmental disabilities illustrates clinical interventions designed to promote family resilience during the entry into adolescence and a transition in schooling. This approach involves focusing on the family's own definition of the current problem and relevant history, constructing a multidimensional, coherent story of the illness and its impact that recognizes stressors yet highlights strengths, and normalizing their strategies for stability under circumstances of developmental stress. These interventions with mother, daughter, and family helped improve health efficacy, communication toward mutual understanding and shared problem solving, and better use of existing and new resources to enhance current and future developmental adaptation. Keywords: chronic illness; family development; promoting resilience

This article investigates the mental and physical health of the spouses of chronically ill patients. Topics include depression, self-efficacy, sleep quality, and quality of life.

Researchers have focussed extensively on the costs of caregiving while potential rewards to the caregiver have gone virtually ignored. Using semi-structured interviews, the range of outcomes of the caregiving situation was examined for caregivers and care receivers in intergenerational relationships. The focus was on the meaning of the caregiving experience for caregiving daughters and their unmarried, elderly mothers. The sample consisted of 29 mother-daughter pairs. Care recipients were not cognitively disabled (demented) but were in need of help with the tasks of daily living (shopping, household maintenance, bureaucratic mediation). Mothers and daughters were interviewed about the mothers' health, the nature of the caregiving responsibilities, and the caregiving situation. They also answered questions concerning their relationship. Using the concepts of social exchange theory, which states that people try to minimize costs and maximize rewards in their relationships with others, thirteen pairs (45 percent) were classified as intrinsic pairs, meaning that the caregiving-care recipient relationship was characterized by joint rewards, few costs, minimal conflict, and mutual concern for the other. Ten pairs (34 percent) were labelled as ambivalent: rewards were gained only at significant cost for at least one member of the pair. Joint activities were rarely mutually rewarding, conflict was present, and in general only one woman was concerned with the outcome for the other. The remaining 6 pairs (21 percent) were labelled conflicted pairs. They experienced few rewards in their relationship and frequent costs. Rewarding joint activities were absent and both perceived severe conflict in the relationship. Concern was for their own outcome, not for the outcome of their partner. The results underscore the failure of many studies to attend to the positive outcomes of caregiving-care recipient relationships. Such outcomes do exist. The results also indicate that social exchange theory offers a useful context within which to study these relationships. (Consumer Summary produced by Reliance Medical Information, Inc.)

This study examined the role family support plays in insulating chronic pain patients from maladaptive behaviors associated with their pain. Two hundred and thirty-three patients who described their family as always being supportive and never having any conflicts were compared with 275 chronic pain patients who endorsed having family disharmony and limited support. One year after completing an out-patient pain program a random sample of 181 of these patients were followed to determine the extent to which family support influenced treatment outcome. The patients who reported having non-supportive families tended to have liability and work-related injuries, relied on medication, reported having more pain sites and used more pain descriptors in describing their pain. These patients also tended to show more pain behaviors and more emotional distress compared with pain patients coming from supportive families. On follow-up, patients who described their families as being supportive reported significantly less pain intensity, less reliance on medication and greater activity levels. They tended to be working and not to have gone elsewhere for treatment of their pain compared with patients who described their family as non-supportive. The results of this study demonstrate that perceived support is an important factor in the rehabilitation of chronic pain patients.

This research reports on the effects of parents' chronic kidney disease on the entire family. Qualitative analysis of the question, 'My illness has affected me and my family in the following ways' was conducted using data from parents (N = 123) on either dialysis or with a kidney transplant. Analysis indicates gender-specific roles, parent-child relationships, and family dynamics in general are affected by living with parental kidney disease. Suggestions for families and practitioners are given.

The intent of this paper is to provide a systematic overview of the health and family literature related to stress and coping in marriages affected by chronic illness such as [...]