[The mental health of only children and of siblings with cancer - first results of a multicenter study in Germany]. / Psychische Gesundheit von Einzelkindern und Kindern mit Geschwistern, deren Eltern an Krebs erkrankt sind. Ergebnisse einer multizentrischen Studie in Deutschland.

BACKGROUND: Children of parents with cancer are at risk of developing mental disorders. RESULTS from divorce research also reveal that sibling relationships can protect the mental health of children in difficult times. OBJECTIVE: Does having a sibling help to cope with an oncological disease of a parent and thus act as a protective factor? METHODS: A group of 271 children were examined in a multicenter study. 54 % made use of the offered psychosocial support. Only children (N = 89) and children with siblings (N = 182) were compared with respect to their mental health (Strength and Difficulties Questionnaire, SDQ, parental and self-assessment). RESULTS: The group comparison between only children and siblings showed no significant differences in the SDQ (assessed by healthy/ill parent). In the self-assessment 2 % of the only children and 9 % of the siblings showed significant results on the SDQ. The group comparison between only children and children with siblings failed to reveal any important differences in mental health. The study indicates that a negative relationship quality (Sibling Relationship Questionnaire, SRQ) is associated with increased problems in the peer group. CONCLUSIONS: The existence of a sibling is not per se a protective factor. Only children do not show more signs of emotional stress than children with siblings.

Protecting children from the consequences of divorce: a longitudinal study of the effects of parenting on children's coping processes.

This study examines whether intervention-induced changes in mother-child relationship quality and discipline led to short-term (6 months) and long-term (6 years) changes in children's coping processes in a sample of 240 youth aged 9-12 years when assessed initially. Data were from a randomized, experimental trial of a parenting-focused preventive intervention designed to improve children's postdivorce adjustment. Three-wave prospective mediational analyses revealed that intervention-induced improvements in relationship quality led to increases in coping efficacy at 6 months and to increases in coping efficacy and active coping at 6 years. Tests of the mediated effects were significant for all 3 indirect paths. Results are discussed in terms of pathways to adaptive coping and implications for the implementation of preventive interventions targeting coping.

Intimate partner violence: the role of the pediatrician.

The American Academy of Pediatrics and its members recognize the importance of improving the physician's ability to recognize intimate partner violence (IPV) and understand its effects on child health and development and its role in the continuum of family violence. Pediatricians are in a unique position to identify abused caregivers in pediatric settings and to evaluate and treat children raised in homes in which IPV may occur. Children exposed to IPV are at increased risk of being abused and neglected and are more likely to develop adverse health, behavioral, psychological, and social disorders later in life. Identifying IPV, therefore, may be one of the most effective means of preventing child abuse and identifying caregivers and children who may be in need of treatment and/or therapy. Pediatricians should be aware of the profound effects of exposure to IPV on children.

Fathering by partner-abusive men: attitudes on children's exposure to interparental conflict and risk factors for child abuse.

A substantial body of research concludes that children in homes marked by intimate partner violence (IPV) and conflict are at increased risk for maladjustment. Although studies often attribute these difficulties to the aggressive acts witnessed, other research and theoretical work suggests that disrupted parenting and co-occurring child maltreatment play an equally critical role in the onset of the children's psychological and behavioral problems. Despite the clear importance of parenting in the context of IPV, relatively little scholarship has been devoted to the topic, particularly when it comes to examining fathers. The current study sought to better understand the paternal relationships of men arrested for spouse/partner abuse, to examine their beliefs about children's exposure to interparental conflict and to identify the specific factors that may place their children at risk for maltreatment. The data consisted of questionnaires administered to 3,824 men attending a court-ordered evaluation after they were convicted of assaulting an intimate partner. Analyses revealed that most of the men had some type of fathering role with underage children (n = 2,508; 65.6%) and in most cases these relationships continued following their arrest. Although the majority of the men acknowledged that their children had been exposed to interparental conflicts, few perceived that their children had been affected by the arguing. Also of concern was the fact that risk factors for child maltreatment were highly prevalent in this population. Implications of these findings and suggestions for those working with domestic offenders are discussed.

[Psychosocial stress in children of somatically ill parents. Perspectives of mental health prevention]. / Psychosoziale Belastungen bei Kindern körperlich kranker Eltern: Perspektiven der seelischen Gesundheitsvorsorge.

Irrespective of their well-known increased risk for mental health problems, children of somatically ill parents are a clinically underserved as well as under-researched group. In this article, the authors introduce the epidemiologic and clinical relevance of this topic and present a theoretical framework for understanding the sequelae of a serious parental illness on minor-age children, based on family dynamics and developmental concepts. This is followed by a comprehensive review of current empirical studies in this field, with a special emphasis on results from a transnational European collaborative study (COSIP = Children of Somatically Ill Parents), which was coordinated by the last author. The most important recommendations from intervention concepts published to date are summarized. Some outlooks for clinical practice as well as future research are presented.

A síndrome da criança com o membro superior imobilizado para infusão venosa: uma contribuição da semiologia para o cuidado de Enfermagem / The child with an upper limb immobilized for intravenous infusion syndrome (a contribution form semiology for nursing care)

Estudo de natureza quanti-qualitativa que descreve a "síndrome da criança com o membro superior imobilizado par infusão venosa", fundamentada na incidência de sinais indicativos dos sentimentos de ansiedade, dor, medo e tristeza, observados em 123 crianças de 11 hospitais públicos e registrados num instrumento de observação, e que, além disto, conceitua as "síndromes da assistência de Enfermagem", termos que foram cunhados pela autora. Conclui-se que o comportamento do profissional de Enfermagem na técnica em apreço necessita ser revisto para evitar a referida síndrome, e com esta finalidade medidas profiláticas são sugeridas

[Evaluation of preventive group intervention for children of divorce]. / Evaluation eines präventiven Gruppenangebots für Scheidungskinder.

Following the results of American intervention programs for children of divorce, the effects of a preventive group program for 10 to 12 year old children of divorced families were studied within a pretest-posttest design. The aim of the intervention was to decrease children's fears, increase their feelings of self-esteem and to improve the relationship to their parents. The program consists of 10 group-sessions about divorce related changes and experiences in the children families and 3 evenings for their parents. Subjects were 5 boys and 2 girls. The results show that after the intervention fears are decreased, feelings of self-esteem are increased and the subjective perception of the own family is more positive than before. The results are discussed in terms of the further development of interventions for children of divorce.

[The Linz model: separation--divorce--new beginning]. / Das Linzer Modell: Trennung--Scheidung--Neubeginn.

The Linz-Project is a secondary-preventive and therapeutic model for coping with divorce. It contains a children's group (for children with age 8-12) and parallelly a parent group. The authors describe context, theoretical and practical fundamentals, aims, methods, basic structure and process of this specific group model. Their article outlines similarities and differences to other group models for coping with divorce and resumes the experiences with the Linz-Project.

Interviews with psychiatric inpatients about professional intervention with regard to their children.

A description of mentally ill parents' experience and points of view concerning professional intervention in relation to their young children is presented in this paper. The results are from an interview survey designed with the purpose of improving the basis for cooperation between mentally ill patients and professionals, when intervention in relation to these patients' children is needed. Fifty consecutively admitted psychiatric inpatients with children 0-10 years old were interviewed by child psychiatrists and their information constitutes the study material. Data concerning the family situations and children have been published previously. One quarter of the patients had experienced having children placed in institutions or with foster families. Forty per cent had never received professional help related to their children. One third of the patients expressed a need for support, which was not presently received. A large group of patients did not know where to go for help related to children or would not be comfortable doing so. When making a global assessment of the childrens' situation based on the study material the child psychiatrists found reason for concern in regard to approximately 80% of the children. In most cases their views were in accordance with those of the mentally ill parents. Clinical implications concerning planning of intervention in regard to children of mentally ill parents are discussed.

The victimization of children: a developmental perspective.

A framework is presented for a new field called developmental victomology, and two major branches are described. One would analyze developmental changes that affect children's risk for victimization, particularly in three areas: children's suitability as targets, their ability to protect themselves, and the environments they inhabit. A second branch would focus on developmental processes that affect children's reactions to victimizations and in particular, developmental tasks and critical periods, the process of cognitive appraisal, and the forms of symptom expression.

Preventive intervention groups for parentally bereaved children.

A model of time-limited intervention groups for parentally bereaved children is described, and common emergent themes are discussed. These suggest that youngsters continue to struggle with death-related stress well beyond the time of the loss. The need to maintain an emotional attachment to internal representations of the deceased parent appears to be an important component of the bereavement process.

Threat of missile attacks in the Gulf War: mothers' perceptions of young children's reactions.

Mothers' perceptions of their infants' and toddlers' reactions to stressors related to the Gulf War were examined. Substantial distress reactions were displayed in somatic symptoms, behavioral disturbances, difficulties in routine functioning, and regressive behavior. Coping reactions were manifested in cooperative, helpful, and symbolic behavior. Reactions were found to be related to proximity to missile target zones, family reactions, and age of the child.

Children's exposure to community violence: following a path from concern to research to action.

This paper discusses the antecedents and current progress of an ongoing program of research on the nature, extent, and consequences of children's direct and indirect exposure to violent events and settings. Involvement in such research has sensitized the authors to difficult ethical and methodological challenges that, we believe, merit consideration by mental health scientists and policy markers. Resolution of those challenges has substantive implications for both subsequent research and the application of resultant findings.

Community violence, children's development, and mass media: in pursuit of new insights, new goals, and new strategies.

Community violence that victimizes children is an unmitigated evil that is exacerbated by vast economic and social forces that leave people in central cities and the rural countryside adrift on seas of rolelessness, hopelessness, group disintegration, and alienation. The contemporary drug scene and the easy availability of guns greatly intensify violence on a local scale, while crimes of violence, especially with guns, appear to be level or declining in the nation as a whole. Claims that the persistently high levels of violence in mass media, mostly television, are largely responsible for violence in society represent narrow views of very large issues. These narrow views overlook essential elements of both phenomena--violence and media. Direct models of interpersonal violence in families and in the community probably give rise to more violent behavior than indirect models in media. Disinhibitory and provocative aspects of media probably do as much or more to trigger violent behavior than violent narratives and violent actions. Comprehensive meta-analysis indicates that prosocial messages on television can have greater effects on behavior than antisocial messages. These data support the contention that mass media can play a strong and positive role in alleviating some of the distress of victims of community violence, and in redirecting the behavior of some of its perpetrators so as to protect the children.

Linking empirically based theory and evaluation: the Family Bereavement Program.

Evaluated the effects of a theoretically derived program to prevent mental health problems in children who had experienced the death of a parent. The program was designed to improve variables in the family environment which were specified as mediators of the effects of parental death on child mental health. The evaluation design involved the random assignment of families to either an intervention or control group. The program led to parental ratings of increased warmth in their relationships with their children, increased satisfaction with their social support, and the maintenance of family discussion of grief-related issues. The program also led to parent ratings of decreased conduct disorder and depression problems and overall problems in older children. Significant correlations between the family environment variables and child mental health problems provided further empirical support for the theory underlying the program. Implications for program redesign were derived by reconsidering the adequacy of the program components to change theoretically mediating variables.

Theory-based screening for prevention: focusing on mediating processes in children of divorce.

Prevention programs in mental health theoretically can benefit from selecting participants who have a greater likelihood of developing psychological problems because of their exposure to the putative mediators targeted for change in an intervention. Screening on mediators may increase statistical power to detect program effects, enhance the cost-effectiveness of intervention trials, and decrease the possibility of iatrogenic effects. The circumstances that optimize the strategy of screening on the basis of mediating variables are discussed, and data are presented to illustrate the development of a mediational selection strategy to identify families who might best benefit from a preventive intervention for children of divorce. In addition, we present evidence that adjustment problems for children experiencing a divorce, as with most mental health problems, are not the result of one specific factor, but are jointly determined by several mediating processes that occur subsequent to the divorce. The mediational selection strategy developed illustrates the utility of measuring a set of mediational processes central to conferring risk for mental health problems to children of divorce.

Comparison of mediational selected strategies and sequential designs for preventive trials: comments on a proposal by Pillow et al.

Compared the strengths and weaknesses of a novel intervention design strategy called mediational selection, proposed by Pillow et al. (1991), with designs based on a sequence of trials, that is, those which build on prior work and at each stage are administered to subjects from subpopulations who have high risk or as yet poorly quantified risk. Both designs would be most useful in short-term preventive trials. The goals behind these two approaches, however, are quite different. Mediational selection strategies attempt to improve the chances that an intervention developed to modify theoretically important mediational factors will have significant impact by selecting a subject subpopulation that is expected to benefit the most. Sequential designs attempt to identify the extent to which an intervention succeeds or fails to work in subpopulations and allows for adjustment of the intervention to these subpopulations as necessary.

Mediational screening: is the benefit worth the cost?

Argued that Pillow et al. (1991) may have overestimated the benefits of mediational screening and underestimated the costs involved in the procedure. The three benefits they suggest: increased statistical power to detect prevention effects, increased cost-effectiveness, and decreased iatrogenic effects are shown to be modest at best. Costs associated with misclassifying people as either false positives or false negatives are considered in the total cost/benefit analysis of mediational screening. Because we cannot accurately predict who will react to the occurrence of life stress by developing the conditions we are interested in preventing, universal interventions are advocated.