Online Encyclopedia of Family Stress and Coping

INTRODUCTION TO THE 2008 EDITION

2008-11-08T23:59:00.000-08:00

I am pleased to welcome Dr. Lauren Papp aboard this year as co-editor of the Online Encyclopedia. The project started in the summer of 2007, when I was a visiting instructor at the University of Wisconsin-Madison, teaching Family Stress and Coping. As a way to allow the students' research papers to make some lasting contribution, I told the class we'd post the papers on the web in the form of this encyclopedia.

I came back to UW-Madison to teach in the summer of 2008, but this time I taught the course, A Family Perspective in Policymaking (HDFS 535). I thus no longer had a group of students who could be assigned to write about family stress and coping (other than where there was a policy connection).

This is where Dr. Papp came in. As a researcher of couple relationships (including conflict) and, periodically, a teacher of the Family Stress and Coping course, her academic interests fit well with the content of the Online Encyclopedia. After a conversation with her early in my 2008 visit to Madison, she generously agreed to have the students in her lab group write a set of entries during the Fall semester to create a 2008 version of the Encyclopedia. So it lives on!

It also probably helped that Taylor Reineke, a student in my 2007 class who is also in Dr. Papp's lab group, spoke well of the Encyclopedia project. Taylor enjoyed a successful volleyball career for the Badgers and appears on her way to a promising career studying and/or working with families.

All of the 2008 entries are listed (alphabetically by topic) in the right-hand column, under "Previous Posts." Just click on whatever topic interests you. To see the previous year's entries, click on "August 2007" in the right-hand column under "Archives."

Thank you,

Alan Reifman, Ph.D.
Co-Editor, Online Encyclopedia of Family Stress and Coping
Texas Tech University, Professor, Human Development and Family Studies
University of Wisconsin-Madison, Visiting Lecturer

Alzheimer's Disease

2008-11-08T21:00:00.000-08:00

by Nikki Witt

Alzheimer’s is a neurological condition impacting cognitive abilities and personality, eventually leading to dementia and death. This disease destroys brain cells and causes problems with memory, thinking and behavior. Currently, Alzheimer’s disease is the sixth leading cause of death in the US, and there is no cure (1).

10 Warning Signs of Alzheimer's (from the Alzheimer's Association)

1. Memory loss
2. Difficulty performing familiar tasks
3. Problems with language
4. Disorientation to time and space
5. Poor or decreased judgment
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative

Who suffers from Alzheimer’s disease?

It is common in individuals over 65, with an estimated 5.2 million Americans being afflicted. AD counts for over 70% of dementia cases in Americans over 71 (1).

More women than men have Alzheimer’s, but this is in part due to the fact that women have a longer life expectancy.

It is estimated that 1 out of 6 women and 1 out of 10 men at the age of 55, will develop Alzheimer's in their remaining lifetime (1).

People with lower education are more likely to develop AD as are African Americans; however, this may be tied to other risk factors.

Who provides care for the millions of Americans suffering from AD?

In 2007, 9.8 million family members, friends, and neighbors provided unpaid care for a person with Alzheimer’s disease (1). While it is common for adults to provide care for their elderly parents, studies have reveled that amount of care provided to individuals with Alzheimer’s disease is over twice as much, around 40 hours per week (1).

Most often the burden of caregiving falls on women in the family, although care provided by male spouse and relatives is increasing.

What is the impact of caring for a person with Alzheimer’s disease?

Financial/Income - 57% of people providing care are employed full or part time (1). The demands of caregiving may lead a person to reduce or change his or her work hours or possibly even quit. From this, there may be less income to support the family, increasing the financial strain.

Levels of Stress – Caregivers report that the experience is very stressful (3). These high levels of stress are related to poorer physical health. Physical effects include impaired immune system functioning, elevated blood pressure and risk of poor self-care, such as loss of sleep (2).

Caregivers may also experience secondary stress. This may result from competing demands from a spouse, children or work leading to role conflict or overload (4).

Mental Health/Depression - Around one third of caregivers report symptoms of depression and other mental health problems and these persist even after death of the patient or nursing home placement (1).

Is the impact the same for everyone?

Female caregivers have a greater reaction to problem behaviors and are overall more impacted by caregiving (4). Women are more likely to report higher levels of burden and increased role restriction than men.

This could be due to the fact that when men are caregivers, there is typically someone else around to help, serving as a source of informal support, therefore reducing burden. On the other hand, women who provide care often experience an isolating effect and are deprived of social interaction (3).

What can be done?

Caregiver stress can be mediated through the use of coping strategies such as social support and positive reappraisals (4). Emotional and outside support also reduces rates of depression in caregivers. Other forms of support include support groups, educational programs and respite care.

Caregiver information programs may be helpful to provide education, teach problem solving skills and enhance social support. In addition, family meetings are important in order to provide support and reduce the burden of the primary caregiver

Health professionals devote time and energy to monitor the health of caregivers as well as patients.

Resource

Take care of yourself: 10 ways to be a healthier caregiver (Alzheimer's Association)

References

(1) Alzheimer’s Association. (2008). Alzheimer’s disease facts and figures.

(2) Haley, W.E. (1997). The family caregiver's role in Alzheimer's disease. Neurology, 48, 25S-29S. (Abstract available here)

(3) Papastavrou, E., Kalokerinou, A., Papacostas, S.S., Tsangari, H., & Sourtzi, P. (2007). Caring for a relative with dementia: Family caregiver burden. Journal of Advanced Nursing, 58, 446-457. (Abstract available here)

(4) Robinson, K.M., Adkisson, P., & Weinrich, S. (2001). Problem behaviour, caregiver reactions, and impact among caregivers of persons with Alzheimer's disease. Journal of Advanced Nursing, 36, 573-582. (Abstract available here)

[Editor's Note (AR): Please consult the Archives in the right-hand column for other entries on the general topic of caregiving.]

Attention Deficit (Hyperactivity) Disorder and the Family

2008-11-08T20:50:00.000-08:00

by Sarah Wier

ADD stands for Attention Deficit Disorder, one of the most prevalent mental disorders affecting children today. ADD is a biological, brain-based condition that is distinguished by poor attention and lack of focus. Many people use the terms ADD and ADHD (Attention Deficit Hyperactivity Disorder) interchangeably. ADHD is ADD that also includes hyperactive and impulsive behaviors.

There are three different types within this definition of ADHD (2). Symptoms include lack of concentration, distractibility, impulsivity, and hyperactivity (3). These symptoms do not usually show themselves until the child enters school. Difficult behavior can continue through adolescence and adulthood. An estimated 3-5% of preschool and school-age children are affected by AD(H)D (1). This means around 2 million children or about 1 in every 25-30 students have the disorder.

The exact cause of AD(H)D is unknown. However, it is believed to be genetic since risk is higher among family members. Risk factors also include being male, having brain abnormalities, and maternal use of cigarettes or alcohol during pregnancy (2). Those who have AD(H)D usually have one or more simultaneous conditions as well. These could include behavioral problems, learning disabilities, anxiety, language disabilities, and depression.

AD(H)D in a marriage

There are two instances in which AD(H)D can affect family relationships. One instance is when a spouse has AD(H)D, causing stress on the marital relationship. The second instance is when a child has AD(H)D, putting strain on both the siblings and the parents. In a marriage, the spouse can bring into the relationship the characteristics that go hand in hand with AD(H)D. Examples of this could include getting distracted easily during conversations, having trouble setting clear limits resulting in unfinished tasks or missed appointment times, missing social cues such as facial expressions, voice tone, body language, etc., having trouble trusting oneself, or resenting the criticism of others which can lead to lack of motivation or hypersensitivity. These characteristics can put extreme tension on a marriage if not for the spouse’s patience and understanding (4).

AD(H)D in a parent-child relationship

In a parent-child relationship, the child can exemplify the same type of characteristics. Oftentimes, parents are not sure how to deal with their child’s behavior, so they react on impulse based off of their “gut” feelings at the moment. Unfortunately, their response is not always the best, making the matter worse than before. This turns into a cyclical pattern of stress. As mentioned before, children usually have other disorders that accompany AD(H)D that can also exacerbate the parent-child relationship (5). These can include learning disabilities, tourette syndrome, oppositional defiant disorder, conduct disorder, anxiety, depression, and bipolar disorder (6).

Treatments

There are several treatments for AD(H)D that can also relieve the stress on the family. Treatments usually consist of medication, psychotherapy, behavioral therapy, social skills training, support groups, and parenting skills training (6). Parents can also create situations that are less threatening to the child. This can include only allowing a couple of friends over at a time, dividing up big tasks into little steps to increase attention span, or giving immediate positive feedback after accomplishments. The goal is to teach the children how to control their behavior and choose the more desired conduct. Parents can also try to practice patience in an effort to understand where the AD(H)D individual is coming from (5).

Resources

CHildren and Adults with Attention Deficit/Hyperactivity Disorder

ADD Support

References

(1) Gallagher, T. (Undated). What is ADD? Retrieved September 8, 2008.

(2) Low, K. (2008). What is ADD/ADHD? Retrieved September 8, 2008.

(3) Revolution Health Group. (2007). Attention-deficit/hyperactivity disorder (ADHD). Retrieved September 8, 2008.

(4) White, M. (2004). How adult ADHD affects relationships: Strategies for coping. Retrieved September 8, 2008.

(5) Robin, A.L. Principles for parenting the adolescent with ADHD. Retrieved September 8, 2008.

(6) The National Institute of Mental Health (NIMH). (2008). Attention Deficit Hyperactivity Disorder.

[Editor's Note (AR): One of my faculty colleagues at Texas Tech, Miriam Mulsow, has done extensive research on ADHD and families.]

Caregiver Stress

2008-11-08T20:47:00.000-08:00

by Kayla Montgomery

What is a caregiver?

In order to discuss caregiver stress, one must first discuss what is and who is a caregiver. Caregiver can be both formal (or paid) and informal (unpaid). A caregiver is an individual who provides help to another person who is incapacitated and in need of help (2). Often, the recipient is elderly or suffering from problems such as Alzheimer's, strokes, cancer, brain injury and more. Because of these problems, they need help with daily activities such as shopping and cleaning and more "intense" things like taking medicine, personal hygiene needs, etc. (1).

Today, the most common type of informal caregiver is that of an adult child taking care of his or her elderly parent(s) (2). According to the Family Caregiver Alliance, 52 million Americans serve as informal or family caregivers and 59-75% of these are women. Furthermore, at least 59% of all informal caregivers are employed full-time or part-time, in addition to their caregiving responsibilities (1).

What is “caregiver stress”?

Because of the emotional and financial pressures of caregiving and the challenge of juggling work responsibilities, many caregivers experience high levels of emotional and physical "strain", termed caregiver stress. Caregiver stress can manifest in emotions such as loneliness, exhaustion, anger, frustration, and more (2).

Not only are these difficult emotions to deal with, but they have also been shown to negatively affect health. According to research, caregiver stress can increase blood pressure, decrease immune system functioning, and increase the development of depression and anxiety issues, among other physical and mental health problems. Furthermore, studies have shown that elderly spousal caregivers' mortality rate is 63% higher than that of their non-caregiver peers (1).

How can individuals prevent or relieve caregiver stress?

While informal caregiving is extremely stressful, it is also vitally important. Therefore, steps can be taken by the caregiver in order to help prevent the mental and physical effects of caregiver stress. First and foremost is recognizing that this stress is real and important. Becoming more informed on the disease through talking to doctors and nurses, or studying books and websites, can help alleviate pressure. Setting aside personal time to connect with friends and other family members can help a caregiver feel less isolated and burdened (2).

Also, there are caregiver support groups that allow one to connect with other caregivers. Setting realistic goals and prioritizing can make the task seem less insurmountable. Reaching out to friends/family and saying no to extra requests are vital ways of alleviating caregiver stress and avoiding the health problems that accompany it (2).

Resources

Family Caregiver Alliance

National Alliance for Caregiving

National Family Caregivers Association

References

(1) Family Caregiver Alliance. (2001/2005). Selected caregiver statistics. Retrieved October 10, 2008.

(2) Greene, R.C. (2008). Caregiver stress. Retrieved October 10, 2008.

Emotionally Abusive Relationships

2008-11-08T20:40:00.000-08:00

by Sarah Janus

When thinking about abusive relationships, many people often believe that emotional abuse is not as serious as physical abuse. While it may not be causing damage that is visible, it is still very harmful to a person’s self-esteem, and is a serious matter that should be dealt with in the early phases before it escalates.

There are many different tactics that the abusive partner may use that constitute emotional abuse, some of which may be easier to identify than others. A couple of these include making threats and using intimidation to make the victim fear the abuser. These threats can range from threatening to leave the relationship to threatening to hurt the victim or someone close to him or her. Emotional abuse can also take the form of manipulating the victim, playing mind games, using humiliation, and making the victim feel bad about him or herself by name calling or blaming.

Isolation and economic abuse are also common tactics that can be used by trying to control or limit the partner's freedom of travel, behavior, and use of money. The abuser often tries to justify these behaviors by saying that he or she cares about the victim’s well-being and is just trying to take care of the partner, or because the abuser is jealous and doesn’t want to lose the partner. In reality, these abusive behaviors all boil down to a need for control and power in the relationship(3).

The cycle of abuse

Many abusive relationships travel through a cycle which is commonly referred to as “The Cycle of Abuse.” It has 4 main steps, which continues throughout the duration of the couple’s relationship. The cycle is illustrated at this website.

The length and intensity of each phase may vary each time the couple travels through the phases, but there are some characteristics of each that are commonly known as the warning signs of abuse. Phase 1 begins with tension among the couple increasing, often followed by a decrease in communication. This is the time when the victim begins to feel fearful of the partner, and may compromise his or her own choices to help calm down the abuser.

The cycle then goes on to Phase 2, commonly labeled as “the incident,” where the abuser uses some form (or forms) of abuse on the victim, ranging from verbal, emotional, physical and sexual abuse. All of these different types often include some combination of anger, threats, and intimidation. After the abuse stops, the Reconciliation phase (Phase 3) is when the abuser tries to make up for his or her actions and make things right again. The abuser either apologizes and gives excuses for why the behavior occurred, or denies/minimizes the abuse, often making the victim believe it was his or her own fault that the abuse occurred.

The fourth and final phase is the Calm phase (Phase 4). The previous abusive incident is often forgotten or overlooked and the partners go back to being in their “honeymoon phase” again. There is no mention of the abuse and everything returns to normal, until something happens causing tension to build, taking the couple back to Phase 1 (1).

As an abuser goes through this cycle, it is very common for the victim to not even realize the detrimental effect that the abuser's conduct is having. While friends and family members may see the abuse, it is very common for the victim to be oblivious to the abuser’s mind games.

Some predictors

There are several factors that have shown strong correlations to being emotionally abused (2). Some of these include:

• Being female
• Being involved in a romantic relationship
• Having been physically abused by a romantic partner in the past
• Being above 20 years old

If you or someone you know is in an abusive relationship, do not hesitate to seek help. While the abuse may not seem very serious, emotional abuse has a tendency to turn into physical abuse very quickly, and the longer the relationship lasts, the harder it is to break the cycle of abuse and get out of it. There are many resources with helpful information for both men and women who are suffering in abusive relationships.

Resources

Heart 2 Heart

Kids Health

Journal of Emotional Abuse [added by Co-Editor AR]

References

Knox, D., Custis, L.L., & Zusman, M.E. (2000). Abuse in dating relationships among college students. College Student Journal, 34, 505-508.

Nemours Foundation. (2007). Teens health. Retrieved October 2008.

Pipes, R.B. & LeBov-Keeler, K. (1997). Psychological abuse among college women in exclusive heterosexual dating relationships. Sex Roles, 36, 585-603.

Media, Society, and Relationships

2008-11-08T20:35:00.000-08:00

by Crystal Cayemberg

The way in which a couple forms and carries out a relationship changes for each generation. Changes in society cause us to change our attitudes and opinions. The advancement of technology allows these new trends to spread and reach a much broader audience. For our generation, media and society influence relationships in multiple ways; a few of the largest impacts are seen through job market change, advancement of the Internet, and sexuality in television.

Job market change

According to Elizabeth Kelleher, writer for USINFO, more than half of all families in the United States are comprised of dual-earner families (1). Due to increasing financial demands, more and more families feel the need to have both parents working. This creates a difficult caseload of work for both spouses to juggle, especially when children are involved.

Oftentimes, conflicting demands from work and family tug on an individual’s limited resources and time, creating very stressful environments. The shift to women in the workforce has also shaped new gender roles within American families. Mothers find themselves especially torn between the roles of mother, worker, and spouse. This gradual shift can even create some tension between couples that are deciding how to budget for a family.

Advancement of the Internet

The advancement of the Internet has made dating a worldwide market. Many people use the Internet as a means to meet new partners. The Internet also allows today’s generation to stay connected with people around the world, thus making long-distance relationships more easily attainable. However, the Internet dating scene also has its problems. The Internet allows for a gray area in which people may explain themselves however they’d like. Couples must be careful not to get involved with an over-exaggerated Internet description of another person. The Internet also allows for very impersonal communication. Although it allows long-distance couples the chance to communicate, it does seem to bring a certain impersonal factor to communication.

Sexuality in television

According to the Teen Relationship Project, 52% of students said they feel they are influenced by the media in their dating and sexual relationships (2). Recently, sex has become a part of mainstream television. Shows are more provocative, sexual scenes are seen more frequently, the media stereotypes men and women, and sex is much more casual than it used to be. Within American society, sex has become a much more casual act. Couples are engaging in sex at an earlier age and it may be due to its exposure on TV.

As media influence society, we see the carryover effects on relationships. Although the media contain many detrimental influences and create opportunities for stress, they also allow individuals an easier means to discuss stressors caused by their families. As relationships form and families deal with changing roles, they can choose to focus on the positive impacts on their lives. They can use changing gender roles as a means to explore new opportunities. The Internet can be used as a resource for anyone dealing with stress.

Finally, television is not viewed as strictly sexual in content. There are many educational programs aired on TV as well. Couples and families can choose to use the changing trends of society as a means to discuss new attitudes and beliefs the others feel.

Resources

Cox Newspapers

Book chapter from Managing Work and Family

Stephen Blake, author on long-distance relationships

References

(1) Geed, S. (2007). Dual-earner couples. Online Encyclopedia of Family Stress and Coping. Retrieved October 15, 2008.

(2) Pepler, D., & Craig, W. (2000). Making a difference in bullying. LaMarsh Research Programme, Report Series, Report #60. LaMarsh Centre for Research on Violence and Conflict Resolution. York University. Toronto, Ontario, Canada. Retrieved October 15, 2008.

Mental Illness and Family Conflict

2008-11-08T20:30:00.000-08:00

by Aviva Levi

While every family undoubtedly faces difficult circumstances and adjustment to new situations, families with a mentally ill loved one face a variety of unique stressors and must cope with a range of family conflicts. Not only must families facing mental illness watch a family member struggle or deteriorate; they must also learn to adjust to a changing family structure and to new familial relationships. In addition, families affected by mental illness must also face further challenges such as economic stress and social stigma. Moreover, the cumulating effect of such circumstances can lead family members to experience tension and disagreement within their relationships.

Basic Contributors to Family Conflict

Mentally ill family members are often faced with the daily stressors that all families experience regularly. For example, they must perform duties as parents, employees, and spouses and their compromised capacity often hinders their ability to do so successfully. Specifically, parents diagnosed with a mental illness face countless obstacles that may certainly contribute to future family conflict. Most basically, families touched by mental illness are often faced with significant financial burdens that arise from insurance and healthcare costs and job loss (4).

In addition, research reveals that mothers with a serious mental illness are less likely than other women to receive prenatal care and more likely to use drugs and alcohol while pregnant (6). Although many factors may contribute to such findings, the complications that result from such maternal behaviors can undoubtedly lead to future family stressors and conflicts.

Furthermore, research reveals that seriously mentally ill mothers also report struggling with daily parenting responsibilities and they may subsequently lose custody of their children. Correspondingly, such mothers are less likely to seek help, thus fostering their pattern of family distress. It is not surprising, then, that mentally ill mothers frequently reported being unsatisfied with their relationship to their children (6), a finding that holds implications for the entire family system.

Family relationship outcomes

In addition to the findings that mothers with mental illness have an increased chance of being involved in the child welfare system (6), researchers have also discovered the stressful toll mental illness can take on a family within the home. In fact, current research suggests that families faced with mental illness experience significantly more days of conflict in a month than families not facing mental illness.

Moreover, specific psychopathological symptoms such as paranoia and psychotic behavior have been found to be positively correlated to instances of family conflict. The severity of such symptoms is also positively correlated to increased conflict. It is important to note, however, that the age of the mentally ill family member is negatively correlated to family conflict. That is, as a family member suffering from mental illness ages, family conflict decreases (5).

Sadly, some family members may feel skeptical or resentful of their mentally ill relative and resort to blaming or rejecting the family member. While such negative reactions may seem cruel or insensitive, research often points to family members’ high levels of emotional exhaustion resulting from the stress and conflict within the family system (1).

Interestingly, current research finds caregivers to experience a significant increase in multiple psychological symptoms. For instance, caretakers of mentally ill family members report more feelings of uncertainty, lack of continuity, frustration, and reluctance to accept their role as a caregiver (3). In addition, the disruption of the parent-child bond and the shift in family dynamics proves to be especially taxing on the family system as both phenomena reportedly lead to increased conflict. More specifically, families tend to experience more verbal abuse and physical threats or assaults from their mentally ill loved one (3).

Additional pressures affecting family relationships

As a result of such conflict, many family members of those who are mentally ill may begin to associate their home with feelings of burden, anxiety, or confusion. Additionally, some families must face the pressure of keeping a family mental illness secret to avoid the judgment and stigma that too often accompany such conditions. While attitudes and perceptions of mental illness vary widely by culture, family members faced with stigma and constant secrecy often show higher rates of depressive symptoms, as well as feelings of anger or resentment toward the mentally ill family member (4). Such emotions truly have the potential to impact multiple family relationships.

Correspondingly, siblings of those struggling with mental illness often experience a decrease in the attention they receive as their parents must spend time helping their mentally ill brother or sister get well. Feelings of resentment, jealousy, and subsequent guilt may arise in siblings when they must adjust to fewer family activities, as well as to ridicule from peers about their sibling’s condition.

Perhaps most difficult for siblings as well as other family members is the need to adapt to the cyclical nature of many severe mental illnesses. Siblings, parents, and extended family members must cope with the recurring and possibly unpredictable symptoms of a loved one (4). The erratic and inconsistent nature of many severe mental illnesses can certainly increase the stress levels of all family members and contribute to conflicting familial interactions.

Lastly, the conflict and upset in many families coping with mental illness are exacerbated by the lack of adequate community resources available. Families are often left with deficient community resources that are commonly not culturally sensitive or accommodating to families’ specific needs (2).

Conflict prevention

Fortunately, despite the stress and conflict surrounding many families touched by mental illness, families can take a variety of measures to both prevent and minimize conflict. Specifically, families must strive to involve all members in the treatment process and recognize that all family members have a vital role and a clear purpose within the family system (1).

Families must also maintain frequent and meaningful contact with mental health professionals to ensure ongoing and consistent support (2). With the help of more comprehensive and culturally sensitive resources, families can develop supportive relationships between members which will, in turn, encourage resilience and strength within the family system. Similarly, increased use of improved mental health services will help families foster positive traits such as warmth, affection, emotional support, and optimism (1).

Resources

Mental Health America

National Alliance on Mental Illness

References

(1) Cant, I.R. (2007). The secondary family: The result of strong community partnering. The Mental Health Review, 3, 30-34.

(2) Cohen, A.N., Glynn, S.M., Murray-Swank, A.B., Barrio, C., Fischer, E.P., & McCutcheon, S.J. (2008). The family forum: Directions for the implementation of family psychoeducation for severe mental illness. Psychiatric Services, 59, 40-48.

(3) Kokanovic, R., Petersen, A., & Klimidis, S. (2006). Nobody can help me… I am living through it alone: Experiences of caring for people diagnosed with mental illness in ethno cultural and linguistic minority communities. Journal of Immigrant and Minority Health, 8, 125-136.

(4) McGinty, K., Worthington, R., & Dennison, W. (2008). Patient and family advocacy: Working with individuals with comorbid mental illness and developmental disabilities and their families. Psychiatry Quarterly, 79, 193-203.

(5) Murray-Swank, A., Glynn, S., Cohen, A.N., Sherman, M., Medoff, D.P., Fang, L.J. et al. (2007). Family contact, experience of family relationships, and views about family involvement in treatment among VA consumers with serious mental illness. Journal of Rehabilitation Research and Development, 44, 801-812.

(6) Park, J.M., Soloman, P., & Mandell, D.S. (2006). Involvement in the child welfare system among mothers with serious mental illness. Psychiatric Services, 57, 493-497.

Mother-Daughter Conflict

2008-11-08T20:25:00.000-08:00

by Jenna Acker

From age two to twelve girls want to be just like their moms. They play house and dress-up in their mother’s clothes, smothering their faces in makeup. Once adolescence hits, girls no longer imitate their mothers, but instead challenge their authority and ignore their advice. Fortunately, many mothers and daughters are able to resolve this conflict when the daughter is in her 20s or 30s, and the two return to their previous best-friend status.

The conflict experienced in the mother-daughter relationship is highly correlated to the developmental stages of both women, sometimes seen as a “life cycle” relationship (2). The most challenging transition in this type of relationship is typically the daughter’s adolescence.

Independence and overinvolvement

Mothers and daughters have an incredibly intimate relationship in the first years of the child’s life, but when the daughter begins to explore the realm of independence, mothers often react by becoming overly involved. Overinvolvement is often a result of a mother’s fear of losing the close relationship with her daughter.

Overestimation of the relationship can also add stress to a mother-daughter relationship. Studies show that parents significantly overestimate the similarities between their values and their children’s values, yet children tend to underestimate their agreement of values. This suggests that parents and children may have different interpretations of the level of closeness of their relationship (2). The boundary between childhood and adulthood is blurred during adolescence and neither parent nor child knows how to define their relationship.

Egocentrism

Complicating this situation, it is hard for adolescent girls to believe that their mothers were also once teenagers (1). According to Piaget, all children go through several stages of development. During the pre-operational and formal operational stages children appear to engage in egocentric thought. Egocentrism is the inability to take another person’s perspective. According to Weinheimer, until children enter the mature stage of development, they cannot fully understand their parents’ perspective (4).

Physical changes

Mother-daughter conflict is also convoluted by the physical changes which women transition through. When a young girl begins menstruation she is often emotional and confused by the physical changes she is enduring. Similarly, when women enter menopause they experience physical changes and emotional stress. Sometimes mothers and their daughters transition through these stages at the same time, severely accentuating the different stages of life they are in with the stress of their own drastic changes (2).

Studies show that girls who go through puberty earlier in life experience more mother-daughter conflict. The conflict may have to do with the stress associated with the onset of puberty and the anguish it can create in a young girl’s life and therefore the anxiety she releases on her mother (3).

Resolution

Once girls mature they often begin to desire reconnection with their mothers. The “life cycle” relationship is taken to the next stage of life when mothers and daughters can better understand each other. Many times, when a daughter begins the transition into marriage and motherhood, the daughter once again seeks advice from her mother (2).

Resources

Discovery Health

One Tough Job

References

(1) Riera, M. (2003). Staying connected to your teenager. Perseus Books Group, Inc.

(2) Fischer, L.R. (1981). Transitions in the mother-daughter relationship. Journal of Marriage and the Family, 43, 613-622.

(3) Kim, K., & Smith, P.K. (1998). Childhood stress, behavioral symptoms and mother-daughter pubertal development. Journal of Adolescence, 21, 231-24.

(4) Weinheimer, S. (1972). Egocentrism and social influence in children. Child Development, 43, 567-578.

Newlywed Stress

2008-11-08T20:15:00.000-08:00

by Taylor Reineke

Transitioning into the married lifestyle can be an exciting yet stressful period in one’s life. According to the National Center for Health Statistics, one fifth of first marriages end within five years (4). What are the major stressors that newlyweds face? What are the implications of stress in new marriages? And what coping strategies can be implemented to prevent marital dissatisfaction within these newly formed unions?

Newlywed stressors

Research shows that newlywed stress can stem from a multitude of factors including time management, sex, in-laws, financial issues, interaction patterns, and the division of household tasks (1,5). According to a study conducted at the Center for Marriage and Family at Creighton University, the top three sources of newlywed stress include balancing time, frequency of sexual interactions, and finances (1).

Balancing time: The Center for Marriage and Family concluded that the number one stressor for newlywed couples is balancing time between work and family (1). According to the United States Bureau of Labor Statistics, over half of married-couple families contain dual-earners (7). The increasing trend away from the breadwinner mentality to the dual-earner mindset makes it much more difficult for newly married couples to balance schedules between work and time spent together.

Sexual behavior: University of Tennessee professor James McNulty discusses newlywed sex issues and other related topics in this interview [this item from Co-Editor AR].

Handling Debt/Finances: Financial stresses are prevalent in most marriages, but a specific financial issue that particularly affects the first few years of marriage is the amount of debt brought into the union (5). According to a study conducted by Skogrand et al. at Utah State University, stress from debt is not only associated with lower levels of marital adjustment and marital satisfaction, but it can also distract couples from working on their relationship (6). The major sources of debt brought into marriages include debt from automobile loans, credit cards, school loans, and medical expenses (6).

Implications for stress in new marriages

A large amount of research has demonstrated the negative effects that stress has on marital interactions. For example, a newlywed study completed at Ohio State University concluded that stress from marital disagreements has a harmful effect on health and well-being (3). Stress can lower the immune system response and increase one’s likelihood of disease (3).

Newlywed stress is also harmful because it sets the stage for interactions throughout the rest of the marriage, and can possibly contribute to divorce (5). For instance, a study of newlywed couples conducted by Gottman and colleagues found that a lack of positive affect during disagreement conversations predicted divorce years later (2).

Protective factors in newlywed marriages

What factors help to buffer newlyweds from stress and help to encourage marital adjustment and satisfaction? According to Schramm et al., factors such as “respect, appreciation, commitment, mutual affection, trust,” and religiosity all contribute to a well-adjusted marriage (5). Participating in pre-marital classes may also play a role in helping to decrease financial stress before marriage (6).

Resources

Top 10 Reasons for Newlyweds' Stress (about.com)

References

(1) Center for Marriage and Family. (2000). Time, sex, and money: The first five years of marriage. Creighton University, Omaha, NE: Center for Marriage and Family.

(2) Gottman, J.M., Coan, J., Carrere, S., & Swanson, C. (1998). Predicting marital happiness and stability from newlywed interactions. Journal of Marriage and the Family, 60, 5-22.

(3) Kiecolt-Glaser, J.K. (undated). Marital stress: Immunological, endocrinological, & health consequences. Psychoneuroimmunology (PNI) Research Program in the Institute for Behavioral Medicine Research at The Ohio State University Medical Center. Retrieved October 19, 2008.

(4) National Center for Health Statistics. (2001). First marriage, dissolution, divorce, and remarriage: United States. Advance Data from Vital and Health Statistics, 323. Retrieved October 18, 2008.

(5) Schramm, D.G., Marshall, J.P., Harris, V.W., & Lee, T.R. (2005). After “I do”: The newlywed transition. Marriage & Family Review, 38, 45–67.

(6) Skogrand, L., Schramm, D.G., Marshall, J., & Lee, T.R. (2005). The effects of debt on newlyweds and implications for education. Journal of Extension [Online], 43(3) Article 3RIB7.

(7) United States Department of Labor. (2003). Employment characteristics of families in 2002. Bureau of Labor Statistics. Retrieved October 19, 2008.

Sibling Rivalry

2008-11-08T20:00:00.000-08:00

by Kathryn Abrams

Sibling rivalry is a type of competition or animosity among brothers and sisters, blood-related or not. Eighty-two percent of people in Western countries have at least one sibling, and siblings generally spend more time together during childhood than they do with parents (1). The sibling bond is complicated and is influenced by many factors such as parental treatment, birth order, personality, and people and experiences outside the family. Sibling rivalry is particularly intense when children are very close in age and of the same gender, or when one child is intellectually or physically gifted (2).

Reasons why siblings fight

It is clear that many different things can cause siblings to fight. Most brothers and sisters experience some degree of jealousy or competition and this can flare into squabbles and bickering. But other factors also might influence how often children fight and how severe the fighting gets. Some examples include:

Evolving needs. It’s natural for children’s changing needs, anxieties, and identities to affect how they relate to one another. For example, toddlers are naturally protective of their toys and belongings, and are learning to assert their will, which they will do at every turn. So if a baby brother or sister picks up the toddler’s toy, the older child may react aggressively.

School-age children often have a strong concept of fairness and equality, so they might not understand why siblings of other ages are treated differently, or feel like one child gets preferential treatment. Teenagers, on the other hand, are developing a sense of individuality and independence, and might resent helping with household responsibilities, taking care of younger siblings, or even having to spend time together. All of these differences can influence the way children fight with one another (1).

Individual temperaments. Your children’s individual temperaments, including mood, disposition, and adaptability, and their unique personalities play a large role in how well they get along with their siblings. For example, if one child is laid back and another is easily rattled, they may often have disagreements. Similarly, a child who is especially clingy and drawn to parents for comfort and love might be resented by siblings who see this and want the same amount of attention.

Special needs/sick kids. Sometimes, a child’s special needs due to illness or learning/emotional issues may require more parental time. Other kids may pick up on this disparity and act out to get attention or out of fear of what’s happening to the other child (2).

Ways to handle conflict among siblings

While it may be common for brothers and sisters to fight, it’s certainly not pleasant for anyone in the house (3). A family can only tolerate a certain amount of conflict. So what should you do when the fighting starts? In general, encourage children to resolve the crisis themselves. If you do step in, try to resolve problems with your children, not for them. When getting involved, here are some steps to consider:

*Don’t let children make you think that everything always has to be “fair” and
“equal” –- sometimes one child needs more than the other.

*Be proactive in giving your children one-on-one attention directed to their interests and needs. For example, if one likes to go outdoors, take a walk or go to the park. If another child likes to sit and read, make time for that as well.
Let them know that they are safe, important, and needed, and that their needs will be met.

*Recognize when children just need time apart from each other and the dynamics present in the family. Try arranging separate play dates or activities for each child. And when one child is on a play date, you can spend one-on-one time with another (3).

[Editor's Note (AR): One of my faculty colleagues at Texas Tech, Sybil Hart, has published a book entitled Preventing Sibling Rivalry.]

Conclusion

Although sibling rivalry can create certain stresses, successfully overcoming these obstacles will give children resources that will serve them well later in life. Siblings learn how to share, how to come face to face with jealously, and how to accept their individual strengths and weaknesses. Best of all, as they watch capable parents handle sibling rivalry with equanimity and fairness, children will gain knowledge that will be valuable in future relationships.

Resources

Faber, A., & Mazlish, E. (2004). Siblings without rivalry: How to help your children live together so you can live too. New York: Collins Living.

Wallace, M. (1999). Birth order blues: How parents can help their children meet the challenges of their birth order. New York: Holt Paperbacks.

References

(1) Harkness, D., Shroff-Pendley, J. (2006). Sibling rivalry. Nemours Foundation: KidsHealth. Retrieved October 7, 2008.

(2) Rimm, S. (2008). Handling sibling rivalry. Child Development Institute. Retrieved October 11, 2008.

(3) Boyse, K. (2008). Sibling rivalry. University of Michigan Health System. Retrieved October 11, 2008.

INTRODUCTION TO THE 2007 EDITION

2007-08-06T23:59:00.000-07:00

Welcome to the Online Encyclopedia of Family Stress and Coping, put together by the Summer II 2007 class at the University of Wisconsin-Madison on Family Stress and Coping (HDFS 516). My thanks to the students, without whose work this resource would not have been possible.

Entries on a wide variety of topics, each written by a different student, are available below. They can also be accessed, on a topic-specific basis, via an alphabetical table of contents in the links section on the right (see Blog Archive for August 2007).

This site should always be regarded as a WORK IN PROGRESS. For any given topic, additional research findings potentially could be added, the referencing could be sharpened, etc. If you have any comments, questions, or suggestions, please e-mail me via the link to my Texas Tech faculty website.

Thank you,

Alan Reifman, Ph.D.
Editor, Online Encyclopedia of Family Stress and Coping
Texas Tech University, Associate Professor, Human Development and Family Studies
University of Wisconsin-Madison, Visiting Lecturer

Boomerang Kids

2007-08-06T18:00:00.000-07:00

by Taylor Reineke

What is a “boomerang kid”?

The phrase boomerang kid refers to an adult child who returns to live in the home of their parent(s) after leaving and being independent for a span of time (Turcotte, 2006). The pattern of moving from home to college/real world and back to home again creates a circular path which mimics the path of a boomerang…hence the terminology boomerang child.

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HOME---------------------------------------COLLEGE/REAL WORLD

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Original image from Plus Magazine. Revised by TR.

Boomerang kids should not be confused with adult children who have never left the home. This is because the time spent away from home and one’s parents changes the family dynamics differently than if the adult child never left the home (Turcotte, 2006).

How common are boomerang children?

Boomerang children are an increasing phenomenon in the United States. In the 1920s, about 20 percent of kids returned home to live with their parents. Today almost half of all the kids that leave return home to live with their parent(s) at least once in their lifetimes (Arnett, 2004).

Why is there an increasing trend of boomerang children?

In society today, adult children are more likely to return home after departure because…

∙ Increasing age of first marriage.
∙ Increasing trend in the pursuit of higher education.
∙ Chance for adult child to explore career options.
∙ Living with parents helps the adult child financially.
(Hamner & Turner, Parenting in Contemporary Society 2001).

What are some demographics of boomerang children and their families?

∙ Men are more likely than women to return home. Only 25 percent of men live on their own between the ages of 18 and 24 while 38 percent of women live independently (Farnsworth Riche, 1990). This may be because women marry younger, thus leaving the house at a younger age than men do.

∙ Well-educated children and children from well-educated families are less likely to return home. About 2/3 of children that return home have jobs (Farnsworth Riche, 1990).

∙ The parent’s level of income does not affect the likelihood of coresidence with an adult child (Turcotte, 2006).

∙ The parent’s marital status, on the other hand, does affect the return rate. The return rate of adult children is highest if the parents are married or if one of the parents is widowed. Children are less likely to return home if their parents are divorced, retired, or ill (Turcotte, 2006).

How do boomerang children affect family dynamics?

The family reactions to the adult child’s return home can range from joyous to stressful. Some parents are happy to help their children get back on their feet and genuinely enjoy their company in their home. Other parents go through a rough transition of losing their privacy by accepting their children into their homes once again (Arnett, 2004).

It is important for the parents and the adult child to have a mutual understanding of the house rules in order to successfully transition into a boomerang lifestyle. One important factor is whether or not the adult child will be helping their parents with the finances while living at home. Many parents feel like they are being taken advantage of if their child “free loads” and does not help with expenses. But if the child is in school or in the workforce, many parents do not mind helping their children out (Arnett, 2004).

References

Arnett, J. (2004). Emerging adulthood: The winding road from late teens through the twenties. Oxford University Press.

Farnsworth Riche, M. (1990). The boomerang age. American Demographics, 12, 24-53.

Hamner, T., & Turner, P. (2000). Parenting in contemporary society, 4th ed. New York: Prentice Hall.

Hunt, H. (1999). Unspinning the boomerang. Plus Magazine.
Retrieved August 1, 2007.

Turcotte, M. (2006). Parents with adult children living at home. Statistics Canada, 11, 1-9. Retrieved August 1, 2007.

Caregiving for Elderly Parents

2007-08-06T17:57:00.000-07:00

by Sybil R. Avery

The last phase of the life cycle is mature adulthood. The time of reflection in our parents’ life when they have spent more than 50 years working, raising children and possibly even assisting with the grandchildren. At this stage in their life most of them desire to spend their last days in peace and quiet. No stress- no more worries about money, paying bills, or what’s for dinner. It’s almost as if they morph into a second childhood. They are no longer the provider and caregiver but they become the ones needing care and being provided for. We all will face the golden years, eventually and look forward to seeing a familiar face when we can no longer perform everyday activities on our own.

Who are the elderly?

The elderly are those persons who are sixty five years of age and older. The elderly population in the United States is expected to double between now and the year 2050, to 80 million. By 2050, as many as 1 in 5 Americans could be elderly. Most of this growth should occur between 2010 and 2030, when the "baby boom" generation enters their elderly years. The U.S. Census Bureau has a chart predicting the elderly population.

Where in the U.S. are the elderly?

Which states have the most elderly population? According to a map of which states are the grayest by the Census Bureau (lower down in the same document as above), the states with 14% or greater of the elderly population are: North Dakota, South Dakota, Nebraska, Iowa, Missouri, Arkansas, Pennsylvania, West Virginia, Rhode Island, and Florida.

Why would an elderly parent need care?

The following health problems are common among the elderly. Some of these diseases can be controlled with proper diet and exercise but once the disease progresses out of control they can be the cause of death for many elder people. Not all of these diseases are the result of aging, but many have a higher incidence in older adults. Such conditions include:

Alzheimer's, arthritis, cancer, cardiovascular, cerebrovascular, dementia, depression, diabetes, falls/injuries, gastrointestinal, hearing impairment, heart disease, memory loss, nutrition (poor), osteoporosis, Parkinson's, pressure ulcers (bedsores), respiratory, sleep disorders, thyroid, urinary disorders, and visual impairment.

[Typing any of the preceding terms into the Wikipedia will provide a more detailed description of a given condition.]

References and Further Reading

National Family Caregivers Associations and the National Alliance for Caregiving. (2004). Family Caregiving 101: What is Family Caregiving. Retrieved August 3, 2007.

Raymond, J. (2007, June). A Guide for Caregivers. Newsweek.

Walker, L. (2007, March 14). Caregivers as unsung heroes.

Community Support Services in Wisconsin

Care Wisconsin

Dane County (Madison), Area Agency on Aging

Department of Health and Family Services -- Information on aging

Wisconsin Adult Day Services Association

Compassion Fatigue in the Helping Professions

2007-08-06T17:55:00.000-07:00

by Emily Windsor

Compassion fatigue is the type of occupational exhaustion associated with deep physical, emotional, and spiritual giving [4]. It occurs when a caregiver has repetitive empathic engagement with another person experiencing a stressful situation [2].

When we think of the ways in which we can give to others, we usually say that we can attend to others in three ways: physically, emotionally, and spiritually. This exhaustion is the result of highly demanding physical, spiritual and emotional work. As the name suggests, this burnout results in an inability to feel compassion.

Professions such as healthcare, social work, and counseling naturally predispose themselves to compassion fatigue [4]. Crisis workers are also at high risk for developing compassion fatigue. Individuals working in law enforcement or as emergency medical technicians are repeatedly exposed to crisis situations [2]. They must be physically present and available emotionally to handle the situation.

Compassion fatigue not only affects the individual, but it can also hinder interpersonal relationships outside of the workplace such as relationships with family and friends [3].

Causes

One of the main causes of compassion fatigue is the increasing management of healthcare [4]. Physicians and other caregivers are required to put in much more time dealing with bureaucratic aspects of healthcare such as negotiating contracts and completing paperwork than in the past. They are also encouraged to see more patients in less time, leaving much less time for the doctor/patient relationship that so many physicians use to replenish emotional stores [4].

Time is also a reason many providers feel that they are not able to fully reach out to their clients [4]. Full schedules and the desire to succeed (which most physicians inherently possess) drive providers to use lunch hour to return e-mails or stay late to review patient charts. Thus, in trying to save time, they eliminate the very things that replenish their physical, emotional, and spiritual stores such as exercise, family meals, friends outside of work, or meditation [3].

Identifying Compassion Fatigue

Compassion fatigue does not occur solely in care providers and crisis workers. Giving informal support to an individual can have the same effect on a friend as on a professional therapist [1]. Be aware that giving emotional support, while often beneficial and rewarding, can be draining and may set the stage for compassion fatigue.

Self-assessment for compassion fatigue

Pfifferling and Gilley [4] have developed a self-report assessment of compassion fatigue. It consists of nine statements that are answered "yes" or "no." Sample items include: "Personal concerns commonly intrude on my professional role" and "My colleagues seem to lack understanding." Answering "yes" to four or more questions may indicate that one is suffering from compassion fatigue.

Costs of Compassion Fatigue

Compassion fatigue takes a toll on a person’s entire life. Short-term and long-term emotional and physical disorders are often a result of exhaustion [2]. Often individuals suffering compassion fatigue are living a downward cycle of feeling overwhelmed and cutting out healthy eating and exercise in an effort to have more free time or make up for being stressed [4]. This results in an unhealthy physical state, which in turn does not support a healthy emotional life.

A feeling of numbness or apathy is also a byproduct of compassion fatigue [1]. In this situation, interpersonal relationships suffer as individuals feel as though they literally “have no more to give.” These relationships can include family interactions, as an individual with compassion fatigue leaves the office drained of his or her stores only to come home to the demands of children, a spouse, or partner.

Professional relationships can also decline in quality, as care providers or service workers lack the passion and caring that once drove their work. Without this drive, individuals cannot possibly provide the same service they were once able to. This can affect professionals’ interactions with their clients in a negative way [1].

How to treat Compassion Fatigue

Some tips have been suggested in the literature. Identify that you are experiencing compassion fatigue [4]. Pfifferling [4] and colleagues suggest taking time for yourself; be sure this is a habit everyday for replenishment. Be sure to replenish your emotional, physical, and spiritual stores.

Talking with someone often helps alleviate compassion fatigue by bringing the stress out of yourself and into the open [4]. Colleagues are often a good resource in this area, as they may be having similar day-to-day experiences [1]. Professional counselors are also a good source of help. They have special training and may be able to help create a recovery plan [3].

If ever you realize that you are experiencing compassion fatigue, please remember that this is not a result of a character flaw or weakness that you may have [4]. Compassion fatigue stems from the ability for empathy and quality caregiving to others; keep in mind, however, that while you are caring for others, also care for yourself.

References

1 Benoit L, Veach P, Leroy B; When you care enough to do your very best: genetic counselor experiences of compassion fatigue; Journal of Genetic Counseling; 2007 Jun; 16: 299-312.
2 Boscarino J, Figley C, Adams R; Compassion Fatigue following the September 11 Terrorist Attacks: A Study of Secondary Trauma among New York City Social Workers; International Journal of Emergency Mental Health; 2004; 6: 1-9.
3 Figley, C. Compassion Fatigue: Coping with Secondary Traumatic Stress in those who treat the Traumatized. Brunner Routledge, NY, 2002.
4 Pfifferling, JH, Gilley K; Overcoming Compassion Fatigue; Family Practice Management. 2000 Apr; 7: 39-46.

Death of a Young Child

2007-08-06T17:32:00.000-07:00

by In Eui Oh

Introduction

The death of a child is probably the worst loss that people can experience. Loss of a child is non-normative life event that is opposing to the natural development pattern because parents are more likely to die before their children. In addition, many cases of child loss are sudden and unexpected, which creates more devastating grief and shock in families. Parents’ grief is a long and painful journey, so it is important to recognize the process of grief and families’ ways of healing.

Conceptual model of parental grief

Miles (1984) and Miles and Demi (1986, 1997) (as cited in Wong, Perry, Hockenberry, Lowdermilk, & Wilson, 2006) proposed a model of parental grief. In this model, parents' responses are strongly related to parents' self-image.

There are three phases of grief in this model: acute distress, intense grief, and reorganization.

Acute distress. The first phase of the conceptual model of grief is acute distress. In this immediate grief stage, parents are often shocked and numbed. Parents may also feel sense of unreality and confusion, so disbelief and denial can occur. Outburst of emotion and crying are also common in this phase. According to Mile (1984) (as cited in Wong et al., 2006), this is the stage where parents run into the first task of grief, which is to accept the loss. Parents have to make some decisions at this stage that are right for them.

Intense grief. The second phase of the model is called intense grief where parents face many complex emotions, depression, and physical symptoms. Some people cope with feelings of loneliness, emptiness, and yearning by not talking about the loss; however, others may overcome these emotions by talking to others. During the phase of intense grief, guilt, anger, resentment, and irritability may come out. Parents who are fully aware of the reality of the loss my feel deep sadness and depression. Parents may also have physical symptoms such as fatigue, headaches, dizziness, and backaches. It may be difficult to fall asleep, and the appetite may be decrease.

Reorganization. Asking “Why?” or “Why mine?” leads to parent’s search for the meaning of life and death. As time goes by, painful feelings of grief also slowly ease and the pain becomes less recurrent. When parents are able to perform better at home and work, and when they are getting self-esteem and confidence back, reorganization is present. People begin to move on with their lives without feelings of guilty. For families who lost their babies, another pregnancy is one of the important steps. According to Kowalski (as cited in Wong et al., 2006), “bittersweet grief” refers to the response that occurs on birthdays, deathdays, and anniversaries (Wong et al., 2006).

Family practices of healing

The impact of child death is intense and it affects all the members of family. Each individual may cope with the grief in a different way; however, family shares the same experience of loss and the interactions among them influence their family practices and relationships (Nadeau, 1998; Wright & Leahey, 2000, as cited in Gudmundsdottir & Chesla, 2006).

One study conducted by Maria Gudmundsdottir and Catherine A. Chesla shows that practices and rituals are very significant to the families’ healing of loss. The article points out how families developed their own practices because of insufficient contemporary cultural practices to express and tolerate their grief (Gudmundsdottir & Chesla, 2006). Some practices were embedded into their daily practices, and others were unique habits such as smelling clothes. In this study, physicality of the child was very important especially during the early stage of grief (Gudmundsdottir & Chesla, 2006). Wong et al. (2006) also says that parents who lost their babies need tangible mementos such as a lock of hair, handprints or footprints, or pictures.

For others, the spiritual connection played an important role to feel the connection with the baby. A study conducted by Kathleen Meert, Celia Thurston, and Sherylyn Brille (2005) supports that bereaved parents have intense spiritual needs. According to the study, “parents maintained connection after the death through memories, mementos, memorials, and altruistic acts such as organ donation, volunteer work, charitable fund raising, support group development, and adoption” (Meert, Thurston & Brille, 2005, p.420). Other spiritual needs were “the need for truth; compassion; prayer, ritual, and sacred texts; connection with others; bereavement support; gratitude; meaning and purpose; trust; anger and blame; and dignity” (Meert, Thurston & Brille, 2005, p.420).

Throughout their experiences, families make meaning out of loss. According to Gudmundsdottir & Chesla (2006), family members reflect on the deeper meaning of life and death through family practices. Researchers are also noting the importance of making sense of the experience, finding benefits, and building new identity to include the loss (Neimeyer, 2002 as cited in Mckenry & Price).

Conclusion

Child loss is a horrible experience that impacts family tremendously. Even though many people focus on individual grief, families develop practices and rituals that can help them to go through the terrible experience and cope with it. It is important to recognize the process of grief and the ways how families deal with it. More society’s attention to these methods and practices that allow families to heal should be brought.

Helpful Internet Resources

Center for Loss and Life Transition

The Compassionate Friends

The Dougy Center: The National Center for Grieving Children and Families

GriefNet

National SIDS/Infant Death Resource Center(NSIDRC; cited in Mckenry & Price, 2005)

Sudden Infant Death Syndrome: Surviving the Death of a Baby

SIDS and Infant Death Survival Guide: Information and Comfort for Grieving Family and Friends and Professionals Who Seek to Help Them

When Your Baby Dies...A Gentle Guide for Teenage Parents

References

Gudmundsdottir, M., & Chesla, C. (2006). Building a new world: Habits and practices of healing following the death of a child. [Electronic version]. Journal of Family Nursing, 12(2), 143-164. Retrieved August 2, 2007, from the SAGE Journals Online database.

Mckenry, P., & Price, S. (Eds.). (2005). Families & change:Coping with stressful events and transitions (3rd ed.). Thousand Oaks: Sage Publication Inc.

Meert, K., Thurston, C., & Briller, S. (2005). The spiritual needs of parents at the time of their child's death in the pediatric intensive care unit and during bereavement: A qualitative study. [Electronic version]. Pediatric Critical Care Medicine, 6(4), 420-427. Retrieved August 2, 2007, from the MDconsult database.

Wong, D., Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2006). In Barrera P. (Ed.), Maternal child nursing care (3rd ed.). St.Louis: Mosby Inc.

Divorce and its Effect on Children

2007-08-06T17:30:00.000-07:00

by Stephanie Bilotto

According to the American Academy of Child and Adolescent Psychiatry, one in every two marriages today ends in divorce [Editor's Note (AR): One government estimate puts the figure at a 43% divorce rate for first marriages]. With this increasing rate of divorce these days, it is important to understand the effects of divorce on children, and how divorcing parents and children can cope with the event of divorce in a way that allows for the least amount of trauma to everyone in the family.

The first step that parents should take with their kids after deciding to get a divorce is to talk to them about it. Parents should explain together to their children that they are getting a divorce, and what this means for the child; the parents will no longer be living together, but both parents still love the children and the divorce will not change that.

It is also important to explain that the reason for the divorce has nothing to do with the child/children or their behavior, but rather is solely based on the relationship between the parents. This is important to highlight to the children, because very often, a child or children of divorced parents will blame themselves or something they have done for the divorce of their parents. In some cases, the child/children will assume that by behaving differently, they can even make their parents get back together.

Children coping with the divorce of their parents need constant reassurance therefore, and at any age, that the reason for the divorce has nothing to do with them, and both parents still love the children and will not stop loving them because they are getting divorced.

Just like with many other events and changes in life, a divorce can be traumatic for both the parents and children in a family. But one of the most important things to understand is that like all of the other events and changes a family will experience, divorce will be seen as either traumatic, or as a calmer transitional phase and change in the family system, depending on the child’s or children’s unique perception of the event. In other words, how traumatic or not traumatic a divorce is to a child or children, all depends upon how each child perceives and reacts to the event; the event of divorce itself is not traumatic, only the perception and experience of the child to the divorce can be traumatic.

Each child can have a completely different perception and experience to the same event; so two children in the same family that are experiencing a divorce can perceive and experience the situation in completely different ways. Therefore, it becomes necessary for parents to acknowledge this factor when coping with divorce in their families, and provide support and understanding for each of their children in such a way that fits their unique perceptions and experiences of the event, and allows each child to express themselves and their feelings about the situation.

The child’s experiences relating to the divorce can be heavily influenced by the way in which each parent experiences the divorce himself/herself. For example, if a child is exposed to a parent or parents who berate one another in front of the child, or if a parent or parents behave as though their world is falling apart and are emotional wrecks all the time due to the divorce, the child too will experience the divorce in the same way; the child will behave very emotionally, as though their own world and family is falling apart, or think that one parent or even both parents are bad, etc., because of what each parent had said about the other in front of the child.

This occurrence can then cause a child to feel obligated to take sides with one parent against the other. So another important thing to remember in helping children cope with the event of divorce, is to try to create or maintain an environment in the home in which the child/children are not exposed to the issues that the parents have with each other, and in which the parents themselves react to the divorce in the least traumatic way possible, so their children can follow their model and react in a similar fashion; without intense trauma.

Support from outside the family and home environment can also be essential to a child coping with divorce. Some children are not comfortable talking with their parents about the feelings they are experiencing about their parents’ divorce. Some children often experience anger and shame towards their parents to the news of their divorce.

Therefore, encouraging the child/children to seek support from other sources, in addition to the parents, is often essential. For example, a child may feel more comfortable discussing their feelings and experiences about the divorce to a teacher, counselor, relative, neighbor, friend, “faith-based counselor,” or even a therapist. Encouragement to discuss the child’s feelings about the divorce with another person with whom he/she feels comfortable with, and who can just listen, or respond, or even offer advice and counsel, is another important factor to remember in helping children cope with the event of divorce, and ease the child’s potentially traumatic experience of the event.

When parents with children make the decision to get a divorce, this event has the potential to be experienced by the children as very traumatic, or as less traumatic. And parents are the greatest models and influences on their children’s behavior, and how they will react and experience the divorce.

Therefore, in order to provide an environment in which the children can successfully cope with their parents’ divorce and avoid the most trauma related to the event, it is essential for parents to talk with their children and explain the situation to them in a calm and rational manner, express their love for their children and that the decision to get a divorce has nothing to do with the children or their behavior, and provide a model of coping with the divorce which the children can follow that allows for the least amount of stress, and the most amount of love, support, and encouragement, leading to positive change and results.

References

Amato, Paul R. (2000). The consequences of divorce for adults and children. Journal of Marriage and Family, 62, 1269-1287.

American Academy of Child and Adolescent Psychology. Children and divorce. 2007. Retrieved August 4, 2007.

DivorceSource.com. Children and Divorce: Telling the Children. 1996-2007. Retrieved August 4 2007.

HelpGuide.org. Children and separation/divorce: Helping your child cope. 2007. Retrieved August 4, 2007.

Sandler, Irwin N., Tein, Jenn-Yun, & West, Stephen G. (1994). Coping, stress, and the psychological symptoms of children of divorce: A cross-sectional and longitudinal study. Child Development, 65, 1744-1763.

Wallerstein, Judith S., & Kelly, Joan Berlin. Surviving the breakup: How children and parents cope with divorce. Basic Books, 1980.

Dual-Earner Couples

2007-08-06T17:27:00.000-07:00

by Shashwati Geed

One of the most significant changes in the labor force over the past decades has been a progressive rise of households where both partners pursue a full time career. Dual income households made up a substantial 42% of the workforce [1] in the US in 2005 and since the 1960’s the number of women juggling a full time career with children has almost doubled [2]. These changing workforce demographics have made it difficult for individuals to lead balanced lives in the context of their families since they are an emerging group. Often, conflicting demands from work and family tug onto their limited resources and time causing distress. 64% of Americans who participated in a survey [3] reported that time pressures on working families were getting worse while 70% of working parents reported not having enough time with their children [4].

Work-family conflict occurs when an individual has to perform multiple roles that require time, energy and commitment. An inter-role conflict occurs as role-pressures from work-family domains become incompatible in some respects [5]. The cumulative demands of these multiple roles can generate conflict from overload or interference. Overload is where total demands on time and energy resources are too great on an individual to perform the roles adequately and comfortably. Interference is where the demands at work interfere within an individual’s family domain (WIF) and demands within the family interfering with the work domain (FIW)[6].

Traditional gender and family roles are starting to break down and the male member is not necessarily the sole breadwinner in the family any longer. Traditional heterosexual relationships however, continue to be structured by gender based power differentials creating a second-shift for mothers in the household. Traditional research has mostly focused on women and their careers as sources for strain and imbalance in the household when it comes to work-family balance. Mainstream media plays its part in projecting the superwoman strategy, where the great impetus is on a female to perform a juggling act perfectly and keep the balance between her career and family. The message to employed women is that if they were just “more efficient, more organized and tried harder” they would attain the work-family balance.

Not surprisingly then, even when women are employed full time, they perform nearly 80% of the second-shift household chores and childcare [7] and the careers of husbands tend to be prioritized more than those of wives’ [8]. To quote Gutek et al. (1991) “Tradition prescribes a different emphasis between work and family for men and women.”

Some empirical research however suggests that the conflict arising between work-family in dual-career households is not that mothers today are working, but how they and their partners perceive that role change [9]. The way in which these couples divide responsibility for the family seems a better predictor of work-family conflict than the primary factor of women pursuing a full time career. Further, the degree of stress perceived by the parents seems a better predictor of distress in the household than the primary stress of dual careers [10]. Research also indicates that combining work and family is both beneficial and possible and is not always a source of strain [11].

So how do couples cope with work and family demands?

Seiber suggests the idea of work-family enrichment [12] instead of conflict – where multiple engagements arising from work and family create opportunities for personal growth and new experiences rather than conflict. If the multiple roles are viewed as high quality with enriching rewards, the shift from conflict to enrichment can be made with some lifestyle adjustments and perspective change.

Coping behavior within the family system (intrinsic)

Poloma [13] identified four tension management techniques that dual career women used to reduce dissonance. These included – defining their dual career status as favorable and advantageous to themselves and their families. They established priorities among and within their roles, for example the couple as a whole lowered domestic work expectations or by reorganizing who does what – children taking on more responsibility in the house. Respondents also reported compartmentalizing work and family as much as they could - like leaving actual work related problems as much as they could back at work and similarly with the family. Lastly, some respondents resorted to compromising their career aspirations to meet other role demands. Men often made compromises such as compromising advancement/promotion opportunities to reduce the possibility of relocation etc.

Marital equality and shared responsibility between partners seems pivotal in work-family harmony [14]. Shared housework, mutual and active contribution to childcare, joint decision making both – inside and outside the house, equal access to family’s finances are other important domains that help make the household a more equal place for the husband and wife are important in reducing the couple’s sense of balance with maintaining jobs and family life. Several households have a seemingly equal division of labor where – the wife does the “inside work” and the husband takes care of “outside work” or the wife looks after elders/children while the husband takes care of finances – though seem like equal division of labor; they in fact are not and are still somewhat defined by gender based expectations. An adjustment instead to mutually sharing all responsibilities and the tendency to value each other’s aspirations and work-life goals are important in achieving the work family balance.

Coping strategies involving external support systems

Dual earning couples often tap resources external to their family system to reduce overall stress – like hiring help for childcare, domestic work, and purchasing labor and time-saving devices [15]. Outside support in terms of friendships with other couples in similar life-stations was also valuable to these families – it helped provide a reciprocal support structure and families could cover for each other when needed on a mutually beneficial basis. Often these professionals negotiated work arrangements like job-sharing, split location employees that reduced lifestyle stress. Research on dual income couple’s life cycle stage also suggests that parents with children less than 6 years of age had the highest work-family stress and it progressively decreased with older children [16]. This suggests support for parents in different stages of family life – for instance counseling and support services at work for parents of children under 13, and not just preschoolers will help reduce stress and conflict. Workplace/societal support make it easier for couples to cope with work-family demands more easily.

References

[1] Wikipedia: Social class in the United States

[2] Waite, L., & Nielsen, M., The rise of the dual-career family: 1963-1997, Working Papers Series, University of Chicago Alfred P. Sloan Center on Parents, Children and Work.

[3] The National Partnership for Women & Families Family Matters Survey, 1998.

[4] Galinsky, E., The 1997 National Study of the Changing Workforce, Families and Work Institute, 1997.

[5] Greenhause J.H., & Beutell N.J. (1985) Sources of conflict between work and family roles. Academy of management review, 10; pp.76-78.

[6] Gutek B., Searle S., & Kelpa L. (1991). Rational versus gender role explanations for work family conflict. Journal of Applied Psychology, 76, pp.560-568.

[7] Hochschilld A., & Machung A. (1989). The second shift: Working parents and the revolutions at home. New York: Viking.

[8] Friedman S.D., & Greenhause J.H. (2000). Work and family – Allies or enemies? New York: Oxford University Press.

[9] Fuligini A.S., Galinsky E., & Poris M. (1995). The impact of parental employment on children. New York: Family and Work Institute.

[10] Hoffman LW. Effects on child. In L.W. Hoffman & F.I. Nye (Eds.), Working mothers. San Francisco: Jossey Bass.

[11] Wikipedia: Social class in the United States

[12] Kossek EE. Work family balance (online manuscript).

[13] Poloma MM. (1972) Role conflict and the married professional woman. In C. Safilios-Rothschild (Ed.), Toward a sociology of women. Lexington MA: Xerox.

[14] Schwartz P. (1994). Love between equals: How peer marriage really works. New York: Free Press.

[15] Holmstrom. The two career family. Cambridge MA: Schenkman, 1973.

[16] Staines G., & O’Connor. (1980). Conflict among work, leisure and family roles. Monthly Labor Review, 103, 35-39.

Emerging Adulthood/Transition to Adulthood

2007-08-06T17:20:00.000-07:00

by Kate Waller

Introduction

Growing up and getting older, namely going from an adolescent to an adult, is a part of life we all must go through. However, during this transition, also known as “emerging adulthood” or the “quarterlife crisis”, many stresses may arise and challenge individuals.

Emerging adulthood

“Emerging adulthood” is the phrase used to describe individuals who fall in the age group of 18-25. This period of life is characterized by identity exploration, instability, self-focus, feeling in-between, and experiencing a range of possibilities (Arnett & Tanner, 2006). Individuals within this age group may experience an array of different experiences and changes that mark their emergence from childhood into adulthood, such as moving out on their own, “stopping full-time education, starting full-time work, having a first live-in relationship, marriage, and parenthood” (Bell & Lee, 2006).

While these transitions may be seen as negative and leave individuals stressed and feeling unsure of themselves and what they want to do with their lives, there is also research suggesting that these “normative transitions may be associated with low stress because they can be perceived as both positive and normal at this life stage,” and “individuals are active in choosing the life path that is appropriate for them and their circumstances” (Bell & Lee, 2006).

Research also shows that an “earlier history of well-being and interpersonal intimacy, availability of resources from kin and non-kin, and the helpfulness of escape coping strategies were significant predictors of well-being” during and after the emerging adulthood stage (Fischer, 2005).

Five features of “emerging adulthood” (Arnett & Tanner, 2006)

Age of identity exploration: “Emerging adults” are trying to figure out who they are and what they want out of their future—namely work, love, and family.

Age of instability: “Emerging adults” may find themselves changing residences frequently —- living back at home with their parent(s), living in their own apartment for the first time, living with friends, or living with a significant other. These individuals may also find themselves changing jobs quite frequently or unemployed as well. According to Robbins & Wilner, “the average number of jobs a person has between the ages of 18 and 32 is 8.6 and 10.9% of 20-to-24 year-olds were unemployed in September 2003 vs. 6.7% in September, 2000.”

Age of self-focus: “Emerging adults” are faced with the decisions of what they want to do, where they want to go, and who they want to be with. These decisions may be endless because they are finally “freed of the parent- and society-directed routine of school.” Individuals may feel pressured to get it all sorted out before their choices become constrained by marriage, children, and a steady career.

Age of feeling in between: “Emerging adults” may still feel like kids when they are making decisions and taking responsibility for themselves. They may feel stressed when expected to act like an adult but they do not in fact feel that way.

Age of possibilities: The possibilities are endless for “emerging adults” and they may find themselves wanting a lot out of life right away, such as a high-paying job that is meaningful and well looked-upon by others, and a lasting bond with a significant other. As Arnett puts it, “If happiness is the difference between what you expect out of life and what you actually get, a lot of emerging adults are setting themselves up for unhappiness because they expect so much.”

Quarterlife crisis

“Quarterlife crisis” is a term coined by authors Alexandra Robbins and Abby Wilner (2001) in their book, Quarterlife Crisis: The Unique Challenges of Life in Your Twenties. The term is used to describe “twentysomethings” and the “single most concentrated period during which individuals relentlessly question their future and how it will follow the events of their past.”

Individuals experiencing a “quarterlife crisis” may question who they are, what they want to do with their lives, whether the decisions they are making are the right ones, etc. Many may describe the years of your twenties as being the best of your life, but individuals in this age group may experience stress and extreme uncertainty. The clear paths of goals and lines to follow throughout one's educational experiences become blurred after graduating and turn into millions of different options, with no one, clear-cut choice. While all of these possibilities may inspire hope, they may also lead to an individual feeling completely lost (Robbins & Wilner, 2001).

References

Arnett, Jeffrey Jensen, and Jennifer Lynn Tanner. Emerging Adults in America: Coming of Age in the 21st Century. Washington DC: American Psychological Association, 2006.

Bell, Sandra, and Christina Lee. "Does Timing and Sequencing of Transitions to Adulthood Make a Difference? Stress, Smoking, and Physical Activity Among Young Australian Women." International Journal of Behavioral Medicine 13: 265-274, 2006.

Fischer, Judith L. and colleagues. "Emerging Adulthood Predictors of Young Adult Personal Well Being: Moderating Roles of Gender and Marital Status." National Council on Family Relations conference, Phoenix, AZ, 2005.

Robbins, Alexandra, and Abby Wilner. Quarterlife Crisis: the Unique Challenges of Life in Your Twenties. New York: Jeremy P. Tarcher/Putnam, 2001.

Editor's Note: Please visit my Emerging Adulthood blog (AR).

Ethnicity and Cultural Differences in Family Caregiving

2007-08-06T17:17:00.000-07:00

by Chris von Spitzer

What describes a caregiver? (Janevic 2006)

Caregivers are individuals who take care of usually older adults, most often parents, the elderly or spouses, who are disabled or ill.

The people receiving the care usually need help with their basic daily tasks including, eating, dressing, bathing, toileting, giving medicine, paying bills, cooking, and house cleaning.

About one in four American families or 22.4 million households care for someone over the age of 50.

Most caregivers are middle-aged from 35-64 yrs old

About 75% of caregivers are women

What is caregiver stress? (Janevic 2006)

Caregiver stress is the emotional force that can take over a family member who has the responsibility to take care of another human being. It tends to affect a person’s physical and emotional health. When an individual is caregiving, they are taking endless amount time and effort to take care of a person. Since caregivers usually have full time jobs on the side, their own needs are put aside. Thus this can lead to depression and numerous health problems like diabetes and heart disease than non-caregivers.

Women caregivers especially are prone to feel more stress and overwhelmed. Research shows that female caregivers have more emotional and physical health problems, financial strain, and employment-related problems than male caregivers. Other studies show that people who care for their spouses are more prone to care-giving related stress than those who care for other family members.

What describes ethnic or ethnocultural groups?

Such groups are distinguished on the basis of a common locale or country of origin, a unique language, a common history, normative expectations and related customs and practices, identifiable group-held values and beliefs, and the intergenerational transmission of these shared norms and values (Pinquart & Sorensen 2004)

What are the differences between ethnic minority caregivers and white caregivers?**

(1) The relationship between stressors and outcomes?

Let’s focus on four main stressors: care recipient’s cognitive impairments, limitations in activities of daily living, frequency of memory and behavior problems, and intensity of care provision.

In the area of care recipient’s cognitive impairments, studies show that care recipient’s disruptive behavior and cognitive impairments are associated with more caregiver depression for White caregivers but not for African Americans; other authors find no significant ethnic differences in the relationship of behavior problems or cognitive impairment with psychological outcomes (Pinquart & Sorenson 2005).

In the area of limitations in activities of daily living, there has been no ethnic differences reported.

In the area of frequency of memory and behavior problems, African-American care givers, known for having such a high respect for elders, tend to not view disturbed behavior as a cause of embarrassment or social unease compared to White caregivers.

In the area of intensity of care provision, Hispanic and African Americans provide more hours of care than White caregivers. Since providing care for an elderly family member is considered more socially normative for caregivers of color than for White caregivers, the association between the intensity of care provision and caregiver depression and physical health may be weaker for African American and Hispanic caregivers. According to a study the amount of care provided is associated with depression in White but not African American caregivers (Cox 1995).

(2) The association of resources with caregiver outcomes?

Let’s focus on religious coping, informal support, availability and the use of formal support and income.

Religious coping often plays a huge role with Hispanics and African Americans. According to a study called REACH, Coon et al. (2004) and Haley et al. (2004) found that religious coping is greater for Hispanic and African American caregivers than for White caregivers.

Most of the time, religious involvement is frequently associated with more access to social support as well. Yet since religion may provide a personal coping strategy and a social support network to people with few other resources, it may also reduce the search for external caregiver resources, such as dementia-specific support groups or respite care. One would then expect that the protective effect of religion on mental and perceived physical health is stronger for African Americans and Hispanic caregivers, because of their access to alternative sources of support is so limited.

With informal support, ethnic minorities receive more support from their relatives, friends, and neighbors due to strong family and community ties (Pinquart & Sorenson 2005). African American caregivers also may be more likely than Whites to benefit from this source of support, because their family support is highly valued as a sign of “caring for one’s own” and they have a greater than average of baseline rates of stressful events.

In the area of availability and the use of formal support, African American caregivers use more informal but equal amounts of formal as do White caregivers, while Hispanic caregivers use more informal and less formal support than White caregivers (Belgrave & Bradsher, 1994).

In the area of income, African Americans and Hispanics have lower average income, higher poverty rates, and are over-represented in unskilled and service jobs than Whites. The buildup of financial stress may be a greater source of elevated levels of depression for African American and Hispanic than for White caregivers due to their limited access to resources (Pinquart & Sorensen 2005).

**Please note: “Ethnic minority caregivers” and the use of “caregivers of color” are interchangeable to denote non-White caregivers. The specific ethnic minority groups involved in this section are African Americans and Hispanics.

References & Further Reading

Belgrave, L.L. & Bradsher, J.E. (1994). Health as a factor in institutionalization: Disparities between African Americans and Whites. Research in Aging 115-141.

Coon D. W. Rubert, M.P., Solano, N.M., Mausbach, B., Kraemer, H, Arguelles, T., et al. (2004). Well-being, appraisal, and coping in Latina and Caucasian female dementia caregivers: Findings from the REACH study. Aging and Mental Health, 8, 330-345

Cox, C. (1995). Comparing the experience of black and white caregivers of dementia patients. Social Work, 3, 343-349.

Janevic, Mary. (2006) Women’s Health.Gov: The Federal Government Source for Women’s Health Information, “Caregiver Stress.”

Pinquart, M. & Sorenson, S. (2003). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. Journals of Gerontology: Psychological Sciences & Social Sciences, 58B, 112-128

Pinquart, M. & Sorenson, S. (2005). Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: A meta-analysis. The Gerontologist, 45, 90–106.

Family Leave Policy in the U.S.

2007-08-06T17:10:00.000-07:00

by Michelle Brandemuehl

This entry will discuss family policies that have the potential to alleviate family stress. The 1993 Family and Medical Leave Act (FMLA) in the United States will serve as an example.

Provisions of the FMLA of 1993

American families have changed a lot in the past few hundred years. Today, both mothers and fathers are working outside of the home, many homes are being headed by single parents, and more and more adults have to care for their elderly parents. (Shuit, 2003) All of these things can add stress to a family system, especially one in which there is an imbalance between the burdens of work and family life.

For years, the government had been debating how to handle work-family problems that many Americans were facing, by developing the Family and Medical Leave Act. The bill was vetoed twice by then-President George H.W. Bush before it was signed by his successor, President Bill Clinton, and became effective on August 5, 1993(Westerfield & Rini, 1996). According to the U.S. Department of Labor, the main provisions of the FMLA are as follows:

• FMLA entitles eligible employees to take up to 12 weeks of unpaid, job-protected leave in a 12-month period for specified family and medical reasons. The employer may elect to use the calendar year, a fixed 12-month leave or fiscal year, or a 12-month period prior to or after the commencement of leave as the 12-month period. (52 weeks is deemed to be equal to 12 months.)
• An eligible employee's FMLA leave entitlement is limited to a total of 12 work weeks of leave during any 12-month period for any one, or more, of the following reasons:
(1) The birth of the employee's son or daughter, and to care for the newborn child;
(2) The placement with the employee of a son or daughter for adoption or foster care, And to care for the newly placed child;
(3) To care for the employee's spouse, son, daughter, or parent with a serious health condition; and,
(4) Because of a serious health condition that makes the employee unable to perform one or more of the essential functions of his or her job.
• A covered employer is required to maintain group health insurance coverage for an employee on FMLA leave whenever such insurance was provided before the leave was taken and on the same terms as if the employee had continued to work.
• Upon return from FMLA leave, an employee must be restored to the employee's original job, or to an equivalent job with equivalent pay, benefits, and other terms and conditions of employment.
• The FMLA also offers intermittent leave, which can be used to miss a few hours of work here and there to attend to medical conditions (e.g. receiving chemotherapy)
• The law also requires employers to post notice of the FMLA in the workplace, visible to all employers (Westerfield & Rini, 1996).
• If one is an eligible employee, he or she may not be denied FMLA leave.

Eligibility

According to the U.S. Department of Labor, an eligible employee is an employee of a covered employer who:

• Has been employed by the employer for at least 12 months, and
• Has been employed for at least 1,250 hours of service during the 12-month period immediately preceding the commencement of the leave, and
• Is employed at a worksite where 50 or more employees are employed by the employer within 75 miles of that worksite.
• The 12 months an employee must have been employed by the employer need not be consecutive months and 52 weeks is deemed to be equal to 12 months.
• The law also requires the employee to give a 30-day notice if the leave is foreseeable (like in the case of pregnancy or birth leaves).

Limitations

There are many limitations to the FMLA and many of them are sparking an interest for change. Some of the limitations are as follows:

• The definition of immediate family in the FMLA does not include parent-in-laws, common-law spouses (in states that do not recognize common-law marriage), or domestic partners. However, even though the law doesn’t include them, it is always up to the employer’s discretion to grant a request for leave. (Westerfield and Rini, 1996)
• Leave for birth and care, or placement for adoption or foster care must conclude within 12 months of the birth or placement.
• Spouses employed by the same employer are jointly entitled to a combined total of 12 work-weeks of family leave for the birth and care of the newborn child, for placement of a child for adoption or foster care, and to care for a parent who has a serious health condition (U.S. Department of Labor).
• An affected business could exempt individuals in the top 10 percent of its payroll if it could show that the absence of these employees would cause the business “substantial and grievous economic injury.” (Elving, 1995) These employees are called “key” employees.
• Many eligible employees are unaware of their eligibility. Of the rough 55 percent of workers who are eligible for leave under FMLA, about only 2 percent take advantage of the act each year. (Stewart, 2003)
• The final and most controversial limitation of the FMLA is that it only guarantees unpaid leave.

Suggested changes to the FMLA

The FMLA was created in order to lessen the burden on people who need to take time off work in order to have a child or take care themselves or family members in times of medical instability. However, so many eligible employees cannot take advantage of the act because they cannot afford to take time off of work without maintaining a salary of some sort. Many of them then turn to public assistance. For this reason, many are asking that an amendment be made to the FMLA that sets a mandatory level of paid leave. One possible solution would be to have a fund that both the employees and employers contribute to. Opponents of paid leave argue that forcing employers to offer paid leave would only burden them more, especially small employers (Stewart, 2003). There are other suggestions for both limitations and expansions that should be made to the FMLA. Some of these suggestions include:

• Extending FMLA coverage by reducing the number of employees that need to be employed by a company (current number is 50) in order for the employees to be eligible. Opponents of this change say that small employers do not have the funds to replace workers on 12-week leaves.
• Business groups argue that the conditions of the current law allow employees to take advantage of it. They are asking for a more strict definition of a “serious illness,” with one suggesting being that “the law cover only illnesses serious enough to require 10 or more days off” (Armour, 2005). However, supporters of FMLA say that employees abusing the system is rare and this change would only hurt employees who need the coverage.
• Many employers groups would like more strict regulations on proving an illness. They would like to be able to not only get a medical note, but to have a conversation with the health care provider as to the severity of an employee’s condition (Armour, 2005).

Paid leave: California and beyond

States have the ability to extend the FMLA if they so choose. California did just this when it was the first state to sign into law an expansion of FMLA coverage and rights to include paid leave to all employees (Stewart, 2003). California’s example has caused at least sixteen states (as of November, 2002) to consider legislation providing some form of paid leave (Stewart, 2003). The California plan has the following modifications (Helm, 2004):
• All employees in the state are eligible from the moment they are employed, with a seven-day waiting period. However, businesses with fewer than 50 employees do not have to guarantee to take a worker back after the leave.
• This paid leave is funded by a new payroll tax that averages $4 per month per employee and is put towards the Family Temporary Disability Insurance (FTDI) fund.
• This fund covers up to 55 percent of a worker’s salary for the first six weeks of leave, with a maximum of $728 per week.

With these new accommodations, employees can help their loved ones (or themselves) through a health crisis without losing all financial stability. Also, because of the lesser number of employees who will need to turn to public assistance, “California could save as much as $25 million in reduced welfare payments” (Shuit, 2003).

California is the first state to implement a paid leave program, but these programs have been around in other countries for a long time now. In fact, the United States is one of only three other industrialized nations that do not offer paid leave. Many other countries have family policies that are far more liberal than California’s (Shuit, 2003).

“China, Korea, Malaysia, Indonesia, Hong Kong, and Saudi Arabia require employers to pay for maternity leave” (Shuit, 2003). In Norway, parents may receive 42 weeks of 100 percent paid leave or 52 weeks of 80 percent paid leave. Norway actually places so much importance on fathers being involved in childcare that penalties may be imposed if the leave is not utilized (Shuit, 2003).

So, in the opinion of many, the United States has a long way to go in its family policies. The cornerstone to having a healthy and committed employee is to help make sure that his/her work does not negatively spill over into his/her family life. The FMLA is a good start to family-friendly policies, and if the nation as a whole follows in the steps of California and industrialized countries outside the U.S., we should only improve from here on out.

References

Armour, Stephanie. (2005, May). Family, medical leave act at center of hot debate. USA Today, Issue Number 0734-7456.

Elving, Ronald D. (1995). Conflict and compromise: How Congress makes the law. New York: Simon & Schuster.

Helm, Burt. (2004, October). California Offers Paid Leave for All Workers. Inc. Vol. 26, Iss. 10, 30-31.

Shuit, Douglas P. (2003, January). Are you ready for paid leave?. Workforce. Vol. 82, Iss. 1, 38-42.

Stewart, Sean. (2003). PDA, FMLA, and Beyond: A brief look at past, present, and future sex discrimination laws and their effects on the teaching profession. B.Y.U. Education and Law Journal, 835-850.

U.S. Department of Labor. The Family and Medical Leave Act of 1993.

Westerfield, Jackie & Rini, Alice G. (1996). Family Medical Leave Act: Ready or Not! Nursing Management, 25-29.

Editor's Note: Another example of family policy, namely New Jersey's law on screening for postpartum depression (or risk thereof), is cited in another of our encyclopedia entries. A couple of external sites may also be useful for those interested in family policy. The webpage for my (AR) graduate course on Family Law and Public Policy at Texas Tech University is available here. Also, right here in the HDFS department at UW-Madison, Prof. Karen Bogenschneider is one of the nation's leading experts on family policy. The website for her Family Impact Seminars is available here.

Genetic Testing and Counseling

2007-08-06T17:00:00.000-07:00

by Angela Tess

Predictive genetic testing is a technology that allows an individual’s genetic information to be analyzed for disease-causing mutations, predicting the likelihood that he/she will develop symptoms in the future (National Human Genome Research Institute, 2003). Individuals with negative results are thought to be at low risk for developing a particular disorder, whereas those with positive results are at higher risk for the manifestation of a specific condition; inconclusive results are also possible. This type of testing is generally limited to families who are at risk for a specific genetic condition.

The testing process can take several weeks to complete and consists of several steps including: the decision to pursue testing, a pre-test counseling session with a genetic counselor, blood draw for genetic test, and results disclosure/post-test counseling with a genetic counselor.

Huntington’s disease (HD) and hereditary breast/ovarian cancer (HBOC) susceptibility are two adult-onset conditions where predictive genetic testing is used. Both HD and susceptibility to HBOC are passed through the family in an autosomal dominant fashion, meaning that all children of an affected parent have a 50% risk of inheriting the disease-causing mutation and developing symptoms. While both of these conditions are autosomal dominant, the genetics are still quite different, leading to possibly different appraisals of test results.

HD testing is definitive, meaning that a positive test result will almost always predict symptom development. HBOC is not as clear cut; a positive test result indicates a high risk of developing certain cancers, but cancer growth is dependent on other non-genetic factors as well (Baum, Friedman, & Zakowski, 1997).

This entry will discuss the impact of predictive genetic testing, in general, on the individual, support networks, and the individual’s children. The testing process is very stressful for the individual seeking the information. When positive test results are received, patients may mourn the loss of expectations for the future. Yet negative results may lead to survivor guilt and feelings of emptiness (Weil, 2000). No matter what the result, the naivete and perception of invincibility can be lost.

Family stress theory illustrates how appraisals and resources are moderators of an event and stress or crisis (McKenry & Price, 2005). Social support is an important factor in an individual’s ability to cope and adapt to a new situation, in this case to genetic test results. Many clinics that provide predictive testing for adult-onset disorders strongly recommend that a support person accompany the patient throughout the testing process (Williams, Schutte, Holkup, Evers, & Muilenburg, 2000). Support people are often spouses, but can include siblings, friends, parents, and adult children. In one study, 86% of women going through genetic testing for HBOC shared their test results with their sister, 71% shared with their brother, and 74% shared with a parent (Patenaude, et al., 2006). It can also be expected than most women share test results with their partner/spouse as well.

Research on the psychological impact of the test result on the support person appears to be limited, but issues seem to differ depending the relationship to the patient. Williams et al. (2002) suggested:

• Spouses transition rather smoothly into the care-giving role and must realize that the future can drastically change depending on the test results.
• Family members also transition easily into the care-giving role and may also become increasingly concerned about their own future health.
• Friends can be a strong and steady support and may need more practical information about the disease to anticipate the patient’s need for physical and emotional/psychological support. Friends often lack the experience with the disorder that other family members have, and this can sometimes be a barrier to effective supporting.
• Adult children have the potential to be steadfast supports for parents in the testing process, but they can be distracted with concern about what the test results will mean for them as well. Therefore, adult children may not be the best choice for being a sole support person in the genetic testing process.

Another issue to consider is how predictive testing for adult-onset disorders can affect non-adult children. Currently, the National Society of Genetic Counselors advises counselors to use extreme caution in addressing this type of testing on minors (NSGC, 1995). However, this does not mean that minors are not affected by a parent’s choice to pursue testing on him/herself. In one study, 37% of children between ages 6 and 13 years were told their mother’s HBOC test result, and 85% of adolescent children learned the test result (Patenaude, et al., 2006).

In families where one or more adults are affected with an adult-onset disorder, such as HD or cancer, children are exposed to the disorder at a young age and may create their own perceptions about the disease. Further, according to Weil (2000), parents who are dealing with illness may be less available physically and/or emotionally for their children, placing children at risk for parentization. This, in turn, can limit the child’s social interactions and leave them to feel isolated or become stigmatized. In an autosomal dominant disorder like HD, parents who carry the gene mutation may feel guilty for putting their children at risk to suffer from the same disorder, leading to overprotective parenting (Weil, 2000).

It is clear that the impact of predictive genetic testing for adult-onset disorders goes beyond the patient, spilling into the support people, family, and children. It is important for counselors to recognize this pattern so that all individuals can be provided with tools necessary for coping and adaptation.

References

Baum, A., Friedman, A. L., & Zakowski, S. G. (1997). Stress and genetic testing for
disease risk. Health Psychology, 16, 8-9.

McKenry, P. C. & Price, S. J. (Eds.). (2005). Families and change: Coping with stressful events and transitions, 3rd ed. Thousand Oaks, CA: Sage Publications.

National Human Genome Research Institute. (2003). A brief primer on genetic testing.

National Society of Genetic Counselors (1998). Position Statement: Prenatal and
childhood testing for adult-onset disorders.

Patenaude, A. F., Dorval, M., DiGianni, L. S., Schneider K. A., Chittenden, A., & Garber, J. E. (2006). Sharing BRCA1/2 test results with first-degree relatives: Factors predicted who women tell. Journal of Clinical Oncology, 24, 700-706.

Weil, J. (2000). Psychosocial genetic counseling. New York: University Press.

Williams, J. K., Schutte, D. L., Holkup, P. A., Evers, C., & Muilenburg, A. (2000). Psychosocial impact of predictive testing for Huntington disease on support persons. American Journal of Medical Genetics, 96, 353-359.

For another primer on genetics, please see this site.

Heart Disease (Effects of Stress On...)

2007-08-06T16:57:00.000-07:00

by Tara Kent

What is stress?

By definition, stress is defined as “an organism's total response to environmental demands or pressures” (Frey, 2006). Stress was first studied in the 1950's and the word itself was used to describe causes and experienced effects of certain pressures an individual was experiencing. Today stress is a hot topic among researchers who are trying to understand more thoroughly the health risks associated with elevated levels of stress.

How is stress identified?

The symptoms of stress can be both psychological as well as physical. The Gale Encyclopedia of Medicine (2006) states that stress-related physical illnesses include: irritable bowel syndrome, heart attacks, arthritis and chronic headaches. These illnesses are a result of long-term overstimulation of a part of the nervous system that regulates heart rate, blood pressure, and the digestive system.

Psychological illnesses result from non-optimal responses to major changes in a person’s life condition. Examples of major changes include marriage, having a child, completing college, or retirement. Unexpected changes in life are also a cause of psychological illness. For example the tragedy of 9/11 has caused researchers to study childhood traumatic grief, or CTG. CTG refers to an intense stress reaction that a person may experience following the loss of a loved one (Frey, 2006).

What is heart disease?

Heart disease can be defined by any of several abnormalities of the heart and its function in maintaining blood circulation (Columbia Electronic Encyclopedia, 2004). Coronary heart disease (CHD) is one of the most common types of abnormalities found in the United States. CHD is a result of plaque build-up within the walls of the arteries that supply the heart with oxygen and nutrients. Many heart diseases, CHD included, show no symptoms of the disease for a number of years. Often symptoms appear suddenly, as if out of nowhere, for example in the form of a heart attack.

What are the facts about heart disease in America?

Heart disease is a stress-related disease. Each year more than 650,000 people die from heart attacks in the United States and more than 29 million Americans have some form of heart or blood vessel disease (Matteson & Ivancevich, 1979).

The Mayo Clinic suggests taking the following steps to help prevent heart disease:

(1) Don’t smoke or use tobacco products
(2) Get active!
(3) Eat a heart-healthy diet
(4) Maintain a healthy weight
(5) Get regular health screenings

Editor's Note (AR): This document provides more detail on possible mechanisms linking mental health to coronary artery disease.

References:

Columbia Electronic Encyclopedia. 2004.

Frey, Rebecca J. The Gale encyclopedia of medicine. Third Edition. 2006.

Matteson, Michael T., & Ivancevich, J.M. Organizational stressors and heart disease: A research model. Academy of Management Review, 4, 347-357. 1979.

Mayo Clinic, Heart Disease Prevention

Infertility and Stress

2007-08-06T16:55:00.000-07:00

by Tammi Albrecht

Infertility takes a vast toll on individuals who are infertile and the society in which they live. Couples in their most active and productive years are distracted by the physical, financial, and emotional hardships of this disease. For these couples infertility is more than a disease, it is a devastating life crisis, which can greatly impact the couple’s general health, marriage, family relationships, job performance, and social interactions. Added to the emotional and physical toll caused by infertility is the financial burden carried by some couples seeking treatment for their disease.

Below, many aspects of infertility are addressed via a Frequently Asked Question (FAQ) format. For the first three questions -- the more medically related ones -- the answers come from the American Society for Reproductive Medicine's FAQ section.

What is infertility?

Infertility is a disease of the reproductive system that impairs one of the body’s most basic functions: the conception of children. Conception is a highly complicated process and it depends on many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg to become implanted in the uterus; and sufficient embryo quality. Finally, for the pregnancy to continue to full term the embryo must be healthy and the woman’s hormonal environment adequate for its development. When just one of these factors is impaired infertility can result.

What causes infertility?

No one can be blamed for infertility any more than anyone can be blamed for diseases such as diabetes or leukemia. In rough terms, about one-third of infertility cases can be attributed to male factors, and about one third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or is unexplained.

Problems that lead to infertility can be physical or psychological in nature. Roughly 80 percent of infertility cases are the result of physical problems such as ovulation disorder and azoospermia (no sperm cells are produced). The remaining 20% of infertility cases are the result of psychological distress or, in about 20 percent of cases, are cases in which the cause is unknown.

How is infertility treated?

Most infertility cases, 85-90 percent, are treated with conventional therapies such as drug treatment or surgical repair of reproductive organs.

Can infertility lead to stress?

Infertility often creates one of the most distressing life crises that a couple will ever experience together. The long term inability to conceive a child can evoke significant feelings of loss. Furthermore, coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional turmoil for most couples.

Hidden feelings of loss

Feelings of loss not only affect the infertile individual or couple, but their loved ones and society. Some of these hidden losses include: loss of pregnancy and birth experience, loss of genetic legacy and loss for future contributing citizens of the next generation, loss of parenting experience, loss of grandparenting relationship, loss of feelings of self worth, loss of stability in family and personal relationships, and loss of sense of spirituality and sense of hope for the future.

Living in limbo

Infertile couples are living in limbo not knowing what the future holds. They also live in limbo because they do not always know when they need to be available to run into the doctor's offices. Men may find their work schedule impacted because they need to be available for timed intercourse or to provide a specimen.

A stressful schedule

Treating infertility takes time. Appointments, research, bloodwork, ultrasound examinations, medications and emotions all take a lot of time. For those individuals who are working, doctors' appointments, phone calls to and from the doctor's office, procedures, and conferences can take a serious toll on their work availability and productivity. During some procedures, women may be in their doctor's office for 3 to 7 mornings in a row for monitoring.

Co-workers may wonder what is going on and the infertile woman may be faced with losing her privacy or losing her co-workers' patience and support. Certainly there are employment situations where an infertile woman's desire to be pregnant may have an impact on her promotions. Stress arises from trying to balance privacy and practical considerations and the everyday demands of treatment and work obligations.

The impact of medication

The medications most women take during infertility treatment can have side effects. These side effects include headaches, fatigue, and pre-menstrual symptoms such as feeling irritable, sad or moody. For those women who need to take injections, the stress of mixing medication and the injections can cause a great deal of stress. Some couples find that sharing the responsibility for mixing medication and injection can prevent all of the stress from falling on the woman and can help reduce her feelings that she is going through treatment on her own.

How can psychological treatment help individuals/couples cope with infertility?

Mental health professionals with experience in infertility treatment can help a great deal. Their primary goal is to help individuals and couples learn how to cope with the physical and emotional changes associated with infertility, as well as with the medical treatments that can be painful and intrusive. For some, the focus may be on how to deal with a partner’s response. For others, it may be on how to choose the right medical treatment or how to begin exploring other family building options. For still others, it may be on how to control stress, anxiety, or depression.

By teaching patients problem-solving strategies in a supportive environment, mental health professionals help people work through their grief, fear, and other emotions so that they can find resolution of their infertility. A good therapist can help one sort out feelings, strengthen already present coping skills, and develop new ones, and communicated with others more clearly. For many, the life crisis of inf ertility eventually proves to be an opportunity for life-enhancing personal growth.

References

American Society for Reproductive Medicine (2000-2007). Frequently Asked Questions About Infertility. Retrieved August 6, 2007.

Andrews, F.M., Abbey, A.L., & Halman, J. (1991). Stress from infertility, marriage factors, and subjective well-being of wives and husbands. Journal of Health and Social Behavior, 32, 238-253.

Glavac, I., Newton C.R., & Sherrard, W. (1999). The Fertility Problem Inventory: Measuring perceived infertility-related stress. Fertility and Sterility, 72, 54-62.

Meirow, D., Schenker, E., & Schenker, J.G. (1992). Stress and human reproduction. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 45, 1-8.

Resolve: The National Infertility Association (2004). Hidden No More. Retrieved August 3, 2007.

Editor's Note (AR): An older, but perhaps useful, reference is: Infertility: Perspectives from Stress and Coping Research, edited by Annette L. Stanton & Christine Dunkel-Schetter (a former mentor of mine), 1991, New York: Springer.

Military Stress I -- Deployment, Separation, and Reunion

2007-08-06T16:26:00.000-07:00

by Angela Oimoen

With the current situation of the war in Iraq and the continuing operations in the Middle East, the deployments of military service men and women have been “more widespread, longer and more frequent in recent years,” with more troops experiencing direct combat with higher risks of injury (Karney & Crown, 2007, 5).

The stresses on the families of men and women in the military “include ‘risk of injury or death, geographic mobility, periodic separation of the service member from the rest of the family, long working hours and shift work, residence in foreign countries, and normative pressures controlling behavior outside of working time’” (Karney & Crown, xvii).

This entry is focused solely on the effects of deployment on the families of the military service man or woman; and on the wives, husbands, girlfriends, boyfriends, children and family members dealing with the separation that comes when the deployment orders come. A separate entry covers post-deployment issues such as the consequences for families of soldiers' being wounded or dying in combat.

Effects when a couple faces deployment

“After the stress of feeling out of control of your life and marriage, deployment and separation are the second hardest things on military marriages” (Leyva, 2003, 156).

According to a 2003 US Census Bureau report, there are 1.4 million active duty men and women in the branches of the US armed forces along with 1.3 million servicemen and women in the reserves and thus 1.4 million families are dealing with the stress of a deployed loved one (US Census Bureau 1).

What is deployment and why does it cause stress?

Deployment can be defined as the time “when the service member leaves his family and goes out in the field for patrols, war games, training and real combat” (Leyva 14).

“This is a tense time for couples. The irritability, anxiety and stress might cause a couple to have difficulty being physically intimate even though they might want to make the most of the time they have left together” (Maxwell, 2006, 4).

Deployment, due to its issuance by the government, is out of the hands of both the service member and his or her spouse and family, and this “perceived lack of control” causes stress itself (Leyva 177).

What are the stresses that develop from a family member’s deployment?

In studies of spouses of those in the military, stressors include “their efforts to maintain their relationships (e.g., by minimizing opportunities for intimacy, by preventing effective problem-solving, by creating new problems to solve)” (Karney & Crown, xix).

Separation is the most difficult time, where “the service member is completely separated from their families” with mothers or wives facing new alone time and new responsibilities without their partner there for help (Gallagher, 2007, 1). “Spouses might be overwhelmed with the new responsibilities they find weighing down on them now that their service member has gone” (Maxwell 6)

A frequent occurrence to the family of a deployed loved one is anticipatory grief. Maxwell quotes Kristin Henderson to discuss this unique type of grief: “‘We’re grieving as if they’re already dead, and they’re not.’ Kristin Henderson explains what many military spouses feel but don’t talk about” (Maxwell 8). This feeling is especially felt when a loved one is going to a combat zone, a feeling that is “the same emotional reaction as someone whose loved one is dying from a terminal illness” (Maxwell 8).

Additional sources of stress are detailed briefly in the following list:

*Dealing with anticipatory grief includes recognizing the grief itself and reaching out for resources to help deal with the grief process in a healthy way (Maxwell 10).

*Women with children must deal with the stress of taking care of their children as single mothers while their husbands are away and therefore must look and plan for new child support services, babysitters, etc. (Leyva 160).

*Financial issues in families change without the help of the deployed parent, making it hard especially for families with children (Gallagher 1).

*“Military kids also face the loneliness of separation from their parent during deployments and, worse, may worry about their parent’s safety. Indeed, too much CNN for kids is not a good thing” (Leyva 161).

According to the article by Maxwell, there is a stage of phases that a family goes through when notified of a family members’ deployment:

*In the first phase, when a family first hears of a family member’s deployment, “the first stage is shock, denial and anger. The second stage is anticipation of loss. The third is emotional detachment” (Maxwell 4).

*In the second phase, of the deployment and separation, “‘husbands, wives, and children all react differently to the actual “goodbye.” There is a great sense of loss but also of hope. Fear and excitement’” (Maxwell 5).

Adapting to deployment

After a certain time, families start to adapt to the service member being deployed and begin to adapt from the separation. “They get used to the routines and begin to feel more organized and independent” (Maxwell 6).

“Experienced military wives often actually look forward to deployment. They see it as an opportunity to do the things they wouldn’t otherwise have time to do, such as continuing an education, taking a […] class, or just spending more time with friends and family members” (Leyva 159).

Successful adaptation to deployment requires many resources. According to Leyva, “while your service member is deployed, you will need the resources to take care of yourself and your family” (160) including these important factors:

*Communication with your service member is very important. “It is important for families to discuss how they are feeling about all of the changes that are taking place or going to take place. By discussing what everyone in the family is afraid or unsure of, you can help the transition occur much more smoothly” (Gallagher 1).

*Regular writing or e-mailing to your service member while deployed is important, as it allows the service member to stay involved in the family’s daily life and remain a principal parent and decision maker. “With this daily information-sharing, leaving for deployment and returning home become much easier transitions. Your service member will already be aware of and support any new rules you have imposed on your children, and he will feel less guilty about having left his family” (Leyva 158-159).

*Resources such as family, friends and getting “involved with your command family support unit” such as the wives, girlfriends and families of other deployed service members is important to keeping spirits high (Leyva 160).

*Seeking additional help or resources should be done if needed. Online support groups and websites are also available for military families. “Chaplains, ministers and counselors can help these families deal with deployment by explaining the emotional cycle of deployment and the concept of anticipatory grief” (Maxwell 11).
Coming Home

*While preparation for the service member’s homecoming is exciting, “this anticipation is not always positive. It can be filled with both hope and anxiety. Everyone has changed since they last saw each other. One spouse has experienced war; the other has grown more independent at home. Children have grown and might not even remember the returning parent” (Maxwell 6-7).

*To deal with this situation, communication is important in discussing expectations for the homecoming (Maxwell 7) as well as constantly including the deployed parent in decision-making and issues of discipline with kids, so that the child is reminded of the parent and his/her role is not forgotten within the family (Leyva 162).

*After coming home, a period of renegotiating and reintegrating of the family must occur to establish new routines and to make sure the deployed parent feels welcome and included in a similar role that he or she had before his or her departure (Maxwell 7).

“While each individual will react to deployment differently, families find comfort and strength in knowing that they are not alone and their emotions and physical symptoms are normal” (Maxwell 11-12).

References

Gallagher, Lorraine C. U.S. Military Deployment: When a Family Member Leaves. Operation Home Front. Retrieved August 5 2007.

Karney, Benjamin R., & John S. Crown. Families Under Stress: An Assessment of Data, Theory, and Research on Marriage and Divorce in the Military. Santa Monica, Ca: Rand, 2007.

Leyva, Meredith. Married to the Military: A Survival Guide for Military Wives, Girlfriends, and Women in Uniform. New York: Fireside, 2003.

Maxwell, Amy. Ministering to Military Families During Deployment. Contemporary Family Ministry, December 15, 2006. Retrieved August 5, 2007.

US Census Bureau. US Armed Forces and Veterans. April 10, 2003. Retrieved August 5, 2007.

Editor's Note: As discussed on the opening day of our course, one of the initial landmark studies in the field of family stress was Reuben Hill's (1949) book Families Under Stress, which pertained to deployment, separation, and reunion among World War II soldiers and their families.

Military Stress II -- Post-Separation, Wounded Status, and Death

2007-08-06T16:25:00.000-07:00

by Yang Xie

Beyond the initial deployment and separation phase experienced by families of military personnel, several stress-inducing scenarios can occur if or before the military member is returned home safely.

Injury during wartime

In cases in which a parent is injured in a wartime situation, the initial source of family stress stems from notification of injury. Occasionally, such notifications may be ambiguous, erroneous, or incomplete, and studies show that the anxiety in the family is increased as a result of uncertainty and psychological limbo.

The next stage involves the family visiting the military member in a clinical setting while he or she is recuperating. This necessarily disrupts the daily schedule and rhythm of the family, as well as its structure. For example, a parent may elect to leave his/her child at home in order to visit the injured person, causing children to be left alone at home or placed under the care of a babysitter. Parents will often have to miss work, and children miss school, causing a setback in family finances and education, respectively.

The stress of the family is further compounded by family members having to deal with the injury itself. In cases where the injury is severe or disfiguring, the injured is often anxious about how the injury will be received and how family members’ perceptions of that person will be changed. The injured member is often in a state of grief and emotional withdrawal, and this negatively effects the emotions and empathy offered by visiting relatives.

In dealing with visiting children, parents may decide to withhold information or disclose too much information. For example, parents may decide their children are not mature to handle a candid discussion on the nature of the injury sustained. However, such withholding of information often creates “secrets” within the family that become a unnecessary source of anxiety for children who are physically aware of the injury. Children who are told too much, on the other hand, will be privy to information that is developmentally inappropriate. This occurs when the injured parent is more concerned with meeting his/her emotional needs via communication than considering the development of the child (Cozza, Chun & Polo, 2005).

Ambiguous loss and prolonged separation

Ambiguous loss is a common thread among families of deployed military personnel. It can be succinctly defined as a scenario in which a family member is psychologically present but physically absent, or vice versa (Boss 2007). Families of military personnel experience such loss both in the prolonged separation period since deployment and in the cases where soldiers are classified as missing in action (MIA). In the former case, families live with uncertainty as to whether the military member has entered combat situations, undergone bodily harm, or experienced emotional trauma. In the latter case, families are unable to determine whether the military member will return home safely.

Both scenarios exacerbate the stress caused by reorganization of family structure because family members are no longer certain whether the change will be temporary or permanent. The emotional distress and fear caused by ambiguity has a negative effect on the family’s appraisal of the separation situation and the chronic uncertainty hinders their will to cope actively. Because of this, children of parents under prolonged or ambiguous military deployment typically tend to be more tearful, perform poorer in school, exhibit impulsive behavior, and increased attention-seeking behavior. Such effects are more pronounced in adolescents because the ambiguous loss of a parent confuses their role in the family, when at the same time teenagers face confusion about their self-identity (Huebner et al 2007).

Families of persons that are MIA, in particular, are unable to heal emotionally and resolve their grief, even 25 years after the fact. In the typical stress response sequence, family members go through the “outcry, denial, numbing, intrusion, working through and completion” stages. Those people with MIA family members are often unable to work past the intrusion phase, and they experience a state of “frozen grief” in which they find it difficult to avoid thoughts on the missing family member. Additional discontent may derive from external assumptions of the status of the missing person, such as the assumption of the government that a soldier is deceased. Such explanations give no satisfaction to surviving family members and often increase their anger and stress levels (Campbell 2000).

Death during wartime

Children with deployed parents often have a disproportionate fear of the death of the deployed member. This fear is further compounded when media coverage of military deaths is readily available and consumed, and/or the family resides on a military base where information circulates widely and quickly. Family members who hear of a military death will experience high levels of anxiety until the deceased is identified and revealed to be not a family member.

In the event of the death of a family member, however, surviving parents may become too emotionally distraught to care for children, provoking pathological emotional responses from such children. Although no empirical studies have been done that specifically focus on family stress as a result of military deaths, it is surmised that the emotional fallout will be at least equal to that due to other types of untimely deaths, and possibly eclipse it because of the intentional and violent nature of the deaths (Cozza, Chun & Polo 2005).

Coping strategies

Research has shown that the severity of distress experienced by families conforms to the ABC-X model of family stress and adaptation. Hence, those families that have significant social support from friends and family, that are economically stable, that exhibit cohesiveness as a family, and that appraise the war-induced stressor in positive light are often able to cope better than families that do not meet such criteria. As a result, the degree of distress observed among families varies widely. Spouses and children have a variety of coping strategies. These include seeking resolution, establishing independence through personal development, strengthening family ties, and improving social resources (McCubbin 1976).

References

Boss, P. (2007). Ambiguous Loss Theory: Challenges for scholars and practitioners. Family Relations, 56, 105-111.

Campbell, C., & Demi, A. (2000). Adult children of fathers missing in action (MIA): An examination of emotional distress, grief, and family hardiness. Family Relations, 49, 267-276.

Cozza, S., Chun, R., & Polo, J. (2005). Military families and children during Operation Iraqi Freedom. Psychiatric Quarterly, 76, 371-378.

Huebner, A., Mancini, J., Wilcox, R., Grass, S., & Grass, G. (2007). Parental
deployment and youth in military families: Exploring uncertainty and
ambiguous loss. Family Relations, 56, 112-122.

McCubbin, H. (1976). Coping repertoires of families adapting to prolonged war-induced separations. Journal of Marriage and the Family, 38, 461-471.

Natural Disasters and Their Effect on Family Stress

2007-08-06T16:20:00.000-07:00

by Kira Stewart

What is a Natural Disaster?

According to a document from the Kansas City, Kansas public schools:

A natural disaster is a calamity or catastrophe brought about by a natural occurrence such as a thunderstorm, tornado, earthquake, etc., which results in a disruption of the normal functioning of the facility. On the serious end of the continuum, there could be destruction of life. Related to natural disasters could be unforeseen occurrences such as water line breaks, boiler explosions, gas line leaks, power failure, fires, etc., which may have the same effects as a natural disaster.

Recognizing Signs of Disaster Related Stress

Both physical and psychological changes could be related to disaster stress. Physical changes include head or stomach aches, hearing difficulties, increased use of drugs or alcohol and disorientation or confusion. These physical changes may be coupled with psychological changes such as limited attention span, depression, fear of crowds or being alone. If you notice any disturbing changes you should seek help as soon as possible.

Helping yourself and your family

The American Psychological Association (APA) Help Center suggests the following:

There are a number of steps you can take to help restore emotional well being and a sense of control following a natural disaster, including the following:

• Give yourself time to heal. Anticipate that this will be a difficult time in your life. Allow yourself to mourn the losses you have experienced. Try to be patient with changes in your emotional state.
• Ask for support from people who care about you and who will listen and empathize with your situation. But keep in mind that your typical support system may be weakened if those who are close to you also have experienced or witnessed the trauma.
• Communicate your experience in whatever ways feel comfortable to you - such as by talking with family or close friends, or keeping a diary.

Effects on Children

According to SAMSHA's Family Guide:

It sometimes can be hard for children to put into words just how they're feeling. They have not yet developed the coping skills they need for a natural disaster. They must rely on adults to help them deal with trauma.

Children, like adults, react to trauma in different ways. You may see them return to behaviors they have outgrown. You may also see changes in their eating and sleeping patterns, or notice that they develop speech difficulties. Some kids may have unexplained aches and pains or develop new fears—like being afraid of strangers, animals, darkness, or monsters.

Children may also be afraid of leaving home, being without you, or going to school. They may cling to you and need more attention. But remember, they often can’t put their feelings into words. You may see your child acting in ways that are disobedient and disruptive, hyperactive, aggressive, or withdrawn. Many children behave this way because they need attention from you, so set aside extra time to spend together. Talk with them about how they’re feeling and give them extra hugs. Reassure them that they’re safe.

In general, it’s good to maintain a normal household routine, but for some children, temporarily reducing expectations about school work or chores at home may help as they get their lives back to normal.

According to a FEMA document:

Signs that a child is vulnerable to emotional stress include excessive fear of the dark, crying, fear of being alone and constant worry.

...parents can help their children work through their emotions by:
• Encouraging children to share their feelings and concerns.
• Reassuring children with extra affection and explaining that the family is safe and will stay together.
• Maintaining as many familiar routines as possible.
• Making bedtime a special moment of calm and comfort.
• Asking children to help with chores, projects, or planning for the future.
• Providing children with a sense of hope.

Parent’s Reactions and Family Support

According to National Association of School Psychologists document:

Parents’ adjustment is an important factor in children’s adjustment, and the adjustment of the child in turn contributes to the overall adjustment of the family. Altered family functions, separation from parents after natural disaster, and ongoing maternal preoccupation with the trauma are more predictive of trauma symptomatology in children than is the level of exposure. Thus, parents’ reactions and family support following a natural disaster are important considerations in helping children’s cope [sic].

Finally, according to a CDC document on "Preventing Violence after a Natural Disaster:"

• Be a caring parent. After any natural disaster, parents are under more stress. It is important to still continue to care for your children. Children are strongly affected by their parents' reactions.
• Keep your child safe. It is important to know who your child is with and where they are at all times.
• Ask others for help. Ask trusted friends, family, and other parents for a break if you're stressed. Breaks are needed when dealing with greater stress.
• Take a time out. Relationships become more stressful when families try to replace lost housing, jobs, and find peace. If you feel stressed, take a time out.

References

American Psychological Association. (2004). Managing Traumatic Stress: Tips for Recovering From Natural Disasters. Retrieved on August.5, 2007.

Centers for Disease Control and Prevention (). Preventing Violence after a Natural Disaster. Retrieved on August 6, 2007.

Federal Emergency Management Administration. (1999) Coping With Stress Caused by Natural Disasters. (Release Number: 1279-19). Retrieved on August. 5, 2007.

Kansas City, Kansas Public Schools. (2007). Crisis Management Natural Disasters, etc.. Retrieved August 6, 2007.

Lazarus, P.J., Jimerson, S.R., & Brock, S.E. (2003). Responding to Natural Disasters: Helping Children and Families -- Information for School Crisis Teams.National Association of School Psychologists. Retrieved August 6, 20007.

Substance Abuse and Mental Health Services Administration. (Undated). Family Guide: Keeping Youth Mentally Healthy and Drug Free -- March 15 Through 21 is Brain Awareness Week. Retrieved August 6, 2007.

Postpartum Depression

2007-08-06T16:00:00.000-07:00

by MNM

Background Information

Postpartum depression (PPD) is a relatively common and treatable disorder. Roughly 400,000 women per year experience PPD. Unfortunately, only about half of those cases are treated, leaving thousands of women suffering (Horowitz, Damato, Duffy, & Solon, 2005). It’s important to distinguish PPD from the more common “baby blues.”

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (2000), the baby blues is a transient sadness that affects 70% of women in the first ten days after birth. PPD is more similar to Major Depressive Disorder, defined by the DSM-IV-TR as a depressed mood or loss of pleasure lasting at least two weeks and accompanied by changes in appetite, sleep, energy, concentration, and daily functioning. However, PPD is distinguished from Major Depressive Disorder because of the “degree of neuroendocrine alterations and psychosocial adjustments” (DSM-IV-TR, 2000, p. 423).

Effects on the Mother

Horowitz et al. (2005) write that “even mild depression is associated with impaired maternal functioning” (p. 160). One suggestion is that depression is related to Parental Stress. Abidin’s Model of Parental Stress defines such stress as rising from the disparity between the demands of parenting and the perceived availability of supportive resources (Misri, Reebye, Mills, & Shah, 2006). Misri et al. (2006) conducted a study in which stress inventories measuring domains including Parent-Related Stress and Child-Related Stress were given to mothers with a diagnosis of PPD. The researchers found that only Parent-Related Stress met clinically significant levels, indicating that many mothers don’t perceive the infant as their main cause of stress.

Studies using the ABC-X model of stress indicate that one of the most important factors in predicting coping and stress reduction is perception of the situation. Horowitz et al.’s study provides further support for this hypothesis. They found that the evaluation of the self as a parent, especially a negative self-appraisal, is an important predictor in the development and course of PPD (2005).

Effects on the Child

PPD alters mother-infant relations, mainly by decreasing the sensitivity and responsiveness of the mother to the infant (Essex, Klein, Cho, & Kalin, 2002). According to Essex, Klein, Miech, and Smider (2001), infancy is an important time in development for attachment and emotion regulation, while the toddler stage is important for learning self-regulation. They found that children whose mothers experienced PPD during the infancy stage have higher rates of internalizing behaviors such as anxiety and depression. In contrast, girls whose mothers experienced depression during the toddler stage have higher rates of externalizing behaviors such as conduct disorders.

Essex et al. (2002) studied how PPD affects neuroendocrine functioning in children. Chronically high levels of cortisol are associated with impaired physiological, emotional, and behavioral functioning. Maternal depression appears to predispose children to heightened stress response. Maternal depression which begins in infancy and continues throughout childhood is a significant predictor of children’s elevated cortisol levels at age five years. Interestingly, children whose mothers were depressed only during the infancy period have normal cortisol levels. In addition, children with elevated cortisol levels have increased rates of mental health symptoms, further stressing the family.

Effects on the Family

Hyde, Klein, and Essex (1995), studying maternity leave and mother’s mental health, found that mothers need to be satisfied in all of their roles: worker, parent, and spouse. Satisfaction with the division of labor within the marriage is particularly important. Short maternity leaves and high marital concerns are associated with increased depression scores. Emotional support from the spouse is a strong buffer against PPD and Parental Stress (Horowitz et al., 2005).

Pinheiro et al. (2006), studying rates of paternal PPD, found that PPD scores for couples are strongly correlated. There is a 12% rate of paternal PPD in the general population, but that rate climbs to 40% when the female half of the couple is suffering from severe PPD. Cox explains, “Both are struggling in their relationship at this vulnerable time” (as cited in Pinheiro et al., 2006, p. 232).

Current Treatment and Policies

Various options for treatment of PPD include cognitive-behavioral therapy, psychotropic medications, and electroconvulsive therapy. Misri et al. (2006) found that treatment of PPD with a combination of cognitive-behavioral therapy and antidepressants resulted in a reduction in depression and anxiety scores and a lowering of parental stress.

However, one major issue with this treatment is the use of medications. According to Burt, Suri, & Altshuler (2001), a mother must balance “the benefits of breastfeeding, the potential adverse effects of untreated maternal illness on an infant’s attachment and development. . . and the effects of untreated mental illness on the mother” (p. 1001) with the little-studied risks to infant health and development resulting from medication in the breast milk.

Horowitz et al. (2005) write that all new mothers should receive periodic PPD assessment. New Jersey recently enacted a law to screen all new mothers for PPD. During pregnancy all women are asked about past history of depression or PPD, followed by questioning during postnatal doctor’s visits. The state is also funding education for women and their families (Layton, 2006). This is an important step in improving care for women with PPD.

In addition, many private companies are recognizing the problems inherent in having workers struggling with Parental Stress and PPD and are responding by creating longer paid maternity and paternity leave. The Family Medical Leave Act, enacted in 1993, mandates that employers give women 12 weeks of unpaid leave following a birth or adoption. Maternity leave is critical because it allows for physical recovery, arrangement of child care, and determining the division of labor with the spouse (Hyde et al., 1995). More pressure on employers and the government to improve maternity leave can only help alleviate the problems of Parental Stress and PPD.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, fourth edition, text revision. Washington, DC: American Psychiatric Association.

Burt, V.K., Suri, R., & Altshuler, L. (2001). The use of psychotropic medications during breast-feeding. American Journal of Psychiatry, 158, 1001-1009.

Essex, M.J., Klein, M.H., Cho, E., & Kalin, N.H. (2002). Maternal stress beginning in infancy may sensitize children to later stress exposure: Effects on cortisol and behavior. Biological Psychiatry, 52, 776-784.

Essex, M.J., Klein, M.H., Miech, R., & Smider, N.A. (2001). Timing of initial exposure to maternal major depression and children's mental health symptoms in kindergarten. British Journal of Psychiatry, 179, 151-156.

Horowitz, J.A., Damato, E.G., Duffy, M.E., & Solon, L. (2005). The relationship of maternal attributes, resources, and perceptions of postpartum experiences to depression. Research in Nursing and Health, 28, 159-171.

Hyde, J.S., Klein, M.H., & Essex, M.J. (1995). Maternity leave and women’s mental health. Psychology of Women Quarterly, 19, 257-285.

Layton, M.J. (2006, October 11). Postpartum illness screening begins. The Record. Retrieved August 3, 2007.

Misri, S., Reebye, P., Mills, L., & Shah, S. (2006). The impact of treatment intervention on parenting stress in postpartum depressed mothers: A prospective study. American Journal of Orthopsychiatry, 76, 115-119.

Pinheiro, R.T., Magalhaes, P.V.S., Horta, B.L., Pinheiro, K.A.T., de Silva, R.A., & Pinto, R.H. (2006). Is paternal postpartum depression associated with maternal postpartum depression? Population-based study in Brazil. Acta Psychiatrica Scandinavica, 113, 230-232.

"Second Shift" for Employed Mothers

2007-08-06T15:55:00.000-07:00

by Trina Buss

What is the Second Shift?

The Second Shift refers to the second part of a working mother’s day in which she comes home from a job outside of the home to her job in the home. This second shift includes housekeeping duties (preparing dinner, cleaning, doing laundry) and other responsibilities involved in taking care of the family.

Over two-thirds of mothers in the United States are now working outside of the home (Hochschild, 2003). This includes both married and single mothers. The number of working mothers is steadily increasing, with the biggest rise in the number of working mothers with small children. “In 1975, 45 percent of mothers with a youngest child between ages three and five were in the labor force; by 2000, 72 percent of such mothers were doing paid work" (Hochschild, 2003).

In examining this change in the workforce and home, Arlie Hochschild, author of the book The Second Shift, has discovered that on average, women worked 15 hours longer each week than men, adding to an extra month of 24-hour days in a year’s time.

What implications does the Second Shift have regarding stress on mothers?

Working women find one of their biggest challenges to be succeeding in their responsibilities of both their first shift (professional job or career) and second shift (home and family life). Because women are still considered to be primary caretakers of the home and family, the strain of balancing work and family still falls heavier on women versus men (Burke, 1996). And a mother’s job description continues to expand to now include chauffer and manager of each child’s busy schedule of enhancement activities (Wallis, 2004). The age-old saying is true: “A mother’s work is never done.”

In her research, Hochschild also finds that a “leisure gap” exists between men and women in the home. “Studies show that working mothers have higher self-esteem and get less depressed than housewives, but compared to their husbands, they’re more tired and get sick more often” (Hochschild, 2003).

How does this stress on mothers lead to stress on the family unit?

As Family Stress Theory explains, family stress levels depend not only on a stressor event, but on resources and perception as well (McKenry & Price, 2005). The stress on mothers of working both in and out of the home can be somewhat lessened with positive resources; however, negative resources and a lack of instrumental support can lead to a situation of crisis. Because a family unit functions as a system, high level of parental stress and crisis affect each individual person in that system as well as the entire family unit as a whole.

What can be done to help alleviate the stress of the second shift?

Family stress resulting from the second shift needs to be addressed on many levels. Husbands and families can help alleviate stress at the home level, whereas society, businesses, and organizations can help mothers at an overhead policy level.

Hochschild, discusses a gender strategy, which is “a plan of action through which a person tries to solve problems at hand, given the cultural notions of gender at play” (p. 15). A woman’s gender ideology determines whether she wants to identify with the home or work sphere as well as the nature of the power she holds in her marriage (Hochschild, 2003).

The three ideologies of marital roles Hochschild discovers are traditional, transitional, and egalitarian. The ideologies held by both the husband and wife speak to their individual expectations of the roles that they should each play in the marriage. According to Hochschild, “the interplay between a man’s gender ideology and a woman’s implies a deeper interplay between his gratitude toward her, and hers toward him” (p. 19).

Couples can reduce the stress between them by discussing their expectations (i.e., ideologies) regarding work at home, as well as by showing sincere gratitude and support for each other. Support and understanding between husband and wife can help alleviate outside stressors that can be more difficult to control.

Outside of the home, it is important for organizations to support working mothers. Companies must communicate with their employees, creating awareness of work-family policies and programs and enforcing them. Companies also need to offer constant top level corporate support for working mothers and families and all policies supporting them. This support needs to be integrated into the organizational culture. (Burke, 2006)

References

Buchan, Shari. Housework as a second shift. The OptiMST. Jun 30, 1997. Vol. 23, Iss. 2; p. 9

Gardner, Marilyn. When a part-time job equals full-time work.
Christian Science Monitor. Boston, Mass.:Feb 19, 2003. pg. 12.

Hochschild, Arlie Russell. The Second Shift. Penguin Group; 2003.

McKenry, Patrick C., & Price, Sharon J., Editors. (2005). Families and change: Coping with stressful events and transitions, 3rd Edition. Thousand Oaks, CA: Sage.

Wallis, Claudia. The case for staying home; Caught between the pressures of the
workplace and the demands of being a mom, more women are sticking with the kids. Time International (Atlantic ed.). New York: May 10, 2004. Vol. 163, Iss. 19; p. 44.

Editor's Note (AR): The following study, done as a Master's thesis by a former student of mine at Texas Tech, may also be relevant: Apparala, M. L., Reifman, A. & Munsch, J. (2003). Cross-national comparison of attitudes toward fathers’ and mothers’ participation in household tasks and childcare. Sex Roles, 48, 189-203.

Sexual Assault and Supporter Stress

2007-08-06T15:53:00.000-07:00

by Lily Servais

Introduction

Sexual assault is one of society’s biggest problems. “1 in 4 women and 1 in 6 men are sexually assaulted. It is a crime that is rarely reported to law enforcement, from 5% to 20%”(RCC Training Manual). There are many societal myths surrounding sexual assault, such as only girls walking home alone get raped. It is actually more likely that the victim will know their assailant than not. “70% to 90% of assaults are committed by someone known to the victim”(RCC). Women are not the only victims of this crime nor are men the only perpetrators.

Definitions

• “Sexual violence is any act (verbal and/or physical), which breaks a person’s trust and/or safety and is sexual in nature. The term sexual violence includes: rape, incest, child sexual assault, ritual abuse, date and acquaintance rape, marital or partner rape, sexual contact, sexual harassment, exposure and voyeurism.”
• “Rape is unwanted penetration (oral, vaginal, or anal) with any object.”
• “Sexual assaults are acts of violence where sex is used as a weapon.”
(Promoting Awareness Victim Empowerment National Website)

The victim and stress

Sexual assault is a horribly traumatic event for the victim, “nearly one third of all rape victims develop rape-related post-traumatic stress disorder (RR-PSTD or Rape Trauma Syndrome) in their lifetime”(RCC). Experiencing rape trauma syndrome can dramatically increase a victims risk for alcohol and other drug abuse problems. “Compared to women who have never been raped, victims with RR-PTSD are 13 times more likely to have alcohol abuse problems and 26 times more likely to have drug abuse problems”(RCC).

Even if a victim doesn’t experience RR-PSTD they will have a lot of different feeling during the healing process. “Shock, disorganization, denial, depression, frustration, anxiety, fear, anger, guilt, wanting normalcy and avoidance of intimacy are some examples of what a victim might be feeling”(RCC). A survivor of sexual assault has just had all of their power taken away from them. They may blame themselves; even though it is not even the tiniest bit their fault.

The supporters and stress

It is difficult for supporters to handle their own emotions while trying to provide for a loved one. Having someone you care for experience such a traumatic event may cause many feelings all are completely normal. Anger towards the perpetrator for hurting someone you care for is common. Anger may be felt towards the victim for not protecting themselves, for getting into such a dangerous situation, for not getting over it fast enough, or for not taking any of your suggestions. Anger may be felt towards yourself for not being able to protect your loved one, having survivor guilt, or for not knowing how to help.

It is also normal to feel sadness for the loved one being in pain, and sadness for how this event may affect the relationship. Example: When someone’s partner is sexually assaulted, they may not feel comfortable getting intimate either physically or emotionally for a long time after the assault. This would naturally cause strain to a relationship. Shame is another feeling that may be experienced by loved ones. In certain cultures and religions there is much emphasis placed on purity, so someone being defiled can bring shame to a family or community (RAINN website). Experiencing these emotions can be stressful, especially if you are the only person supporting the victim.

There are other ways that being part of a victim’s support network can be stressful. Since most perpetrators are known by the victim, there is a good chance the perpetrator knows the supporter, too. It could be hard to process that someone in your circle of friends, a neighbor, or family member could violate someone. Carrying this type of information around can be very stressful, especially if both the perpetrator and the victim have a close relationship with the supporter.

Being a good supporter

In a recent article from Psychology of Women Quarterly that examined the relations between assault severity, social support, avoidance coping, self-blame and coping among survivors, “the results suggest that negative social reactions and avoidance coping are the strongest correlates of PTSD symptoms and that the association typically observed between victim self-blame and PTSD symptoms may be partially due to the effect of negative social reactions from others”(Ullman et al., 2007). The article demonstrated how necessary it is for a victim to have a good, positive support network to aid in getting through such a tough time.

As a supporter, it is important to believe the victim and tell them it’s not their fault. The victim may just want to be listened to, despite what may be heard is hard to handle. Tell them they aren’t alone and there are people that can help. It is important to let them make their own decisions regarding the treatment, even if they are not the choices you’d make. A supporter can gather resources for the victim to help them make an informed decision. It is important as the supporter of a victim to take care of yourself and your emotions so you can be the most helpful to your loved one.

References and Resources

PAVE: Promoting Awareness and Victim Empowerment
National: http://www.pavingtheway.net
Local/UW: http://uwpave.rso.wisc.edu/

Dane County Rape Crisis Center: http://www.danecountyrcc.com/
Rape Crisis Center Training Manual May 2001

Rape, Abuse, & Incest National Network: http://www.rainn.org/

Ullman, S.E., Townsend, S.M., Filipas, H.H., & Starzynski, L.L. (2007). Structural models of the relations of assault severity, social support, avoidance coping, self-blame, and PTSD among sexual assault survivors. Psychology of Women Quarterly, 31, 23–37.

Social Support

2007-08-06T15:50:00.000-07:00

by Kylie Taylor

When times are rough, most people use those around them such as friends, family members, and co-workers to vent, soothe, and appease their fears and troubles. Having someone to lean on in times of need is good for our health and can make our burden seem less. “Even for the client who is a self-proclaimed loner or free spirit, absence of companionship occasionally leads to despair” (Pearson, 1986, 390).

Social support can come in many different forms and has numerous definitions. It can take the form of emotional support, informational support, and instrumental support, among others (Wikipedia). “Social support is not a single concept, but rather is a category of concepts related to the beneficial effects of social relationships” (Isaksson et al., 2007, 23). For the most part, social support is seen as a positive way to relieve stress by eliciting the help of others.

Three types of social support (based on the Wikipedia)

Emotional support involves expressing care and concern for those in need. Examples of emotional support include telling friends and loved ones going through hard times that they are loved and cared for, and letting them know that you will be there for them no matter what.

Informational support involves gathering information from those around you in order to make a task more manageable. An example of informational support comes from asking a friend or co-worker how to complete a task that you are having difficulty with.

Instrumental support involves more tangible support in order to get us through our day to day lives. Examples of instrumental support include loaning or giving money to those having financial troubles and assisting with child care.

What does social support do for us?

Judith E. Pearson explains how socially supportive relationships can improve both physical and mental health. Pearson explains that social support “is an asset to coping that contributes to the ‘striving sentiments’ for love, security, self-expression, recognition, belonging, and sexual satisfaction” (Pearson, 390).

Pearson writes briefly of a study conducted by Miller, Ingham, and Davidson (1976), which showed that having those around to count on for social support was “associated with fewer psychiatric symptoms and improved coping skills.” She writes of the importance of counselors in identifying good sources of social support for clients in order to alleviate some of their stress and aid in their coping as well as helping clients to identify those relationships that are detrimental to their physical and mental health (Pearson, 392).

Interesting topics in social support and health

Evans et al. (1989) conducted a study to assess the effects of crowding on psychological health and what effects crowding has on social support. They wanted to test the hypothesis that “the breakdown of social support under high density living conditions accounts for the relation between crowding and poorer psychological health” (Evans et al., 994). The results of their study confirmed their hypothesis that the more density in a household, the less social support received and the greater negative psychological symptoms experienced. (Editor's Note: It may strike some readers as paradoxical that having more people around can actually reduce the quality of social support. AR)

People living in high density households crave alone time more than those in low density households, which might account for some of the social support breakdown (Evans et al., 996). Although social support might be more fragile in high density homes, social support did mediate “the negative effects of perceived crowding on psychological symptoms” (Evans et al., 996). Because social support is good for our well-being, it is best for our health to live in low to medium density homes.

Social support as motivation

Isaksson and colleagues conducted a study of women who had sustained spinal cord injuries and their motivation to engage in day to day activities, or occupation. They define occupation as “...everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (productivity)” (Isaksson et al., 23).

They discovered that when an injury is sustained that inhibits someone from engaging in occupations, social support is needed as a way to continue these occupations and also gives the person esteem, in that they have people able and willing to aid them in these tasks. They found that people who had social support in these times found motivation to complete these occupations. “Motivation became evident through the women’s descriptions of social support, where confidence and togetherness were two important factors” (Isaksson et al., 26).

Social bonds and health

DeVries et al. (2006) conducted a study that put a medical spin on the connections between stress, social bonds, and healing. “Social interactions profoundly influence physiology and behavior. Depending on the specific animal and circumstances, they can be a source of stress or a means of reducing stress” (DeVries et al., 588). They studied stress in rats and hamsters and discovered that healing wounds is a much slower process when stress-induced corticosterone is released. However, those rats and hamsters that formed social bonds, therefore reducing their stress, actually healed wounds faster by the release of oxytocin through physical contact (DeVries et al., 587). This article shows that not only does social support and social bonds help our mental health, but they can also help our physical health.

References

DeVries et al. (2006). Social influences on stress responses and health. Psychoneuroendocrinology, 32, 587-603.

Evans et al. (1989). Residential density and psychological health: The mediating effects of social support. Journal of Personality and Social Psychology, 57, 994-999.

Isaksson, G., Lexell, J., & Skar, L. (2007). Social support provides motivation and ability to participate in occupation. OTJR: Occupation, Participation, and Health, 27, 23-30.

Pearson, J. (1986). The definition and measurement of social support. Journal of Counseling and Development, 64, 390-395.

Wikipedia: http://en.wikipedia.org/wiki/Social_support

Substance Abuse

2007-08-06T15:40:00.000-07:00

by Saby Cordoba

What is substance abuse?

“Substance abuse is the intentional and inappropriate use of a drug resulting in physical, emotional, financial, social, or intellectual consequences” (Goldberg 2003). According to Merriam-Webster Dictionary a drug is “something that causes addiction, habituation, or a marked change in consciousness.” Overall, substance abuse is a serious issue that involves problems with use of substances (McKenry & Price 2005).

What facts should be known?

A study done by the Health and Human Services in 2005 showed that 3.4 million people used marijuana on a daily basis. The study also showed that 70.9 % of adolescents who smoke and drink alcohol use illicit drugs.

What are some factors that may affect substance use?

There are many factors that may contribute to why people abuse substances. Some reasons may be peer pressure, the idea of being cool in front of friends. Stress/ depression, people may want to get away or get high to forget about the problems that they may be facing at home or work.

Who is at risk for substance abuse?

Substance abuse is higher with the economically disadvantaged, less educated, low income and ethnic minority groups (Schneider Institute for Health Policy 2001). In the stage of adolescence teenagers are at risk for substance abuse to. The teenage years are considered the experimentation period (Schneider Institute for Health Policy 2001). Substance abuse is believed to reach a peak from the teenage years to the age of 25 (McKenry & Price 2005). This peak in substance abuse can be because of the experimentation period and the idea that young adults are trying to find themselves or build their identity.

Who is affected by substance abuse?

First and foremost, the substance user/abuser is affected physically and mentally. Substance abuse can cause chemical changes within the human body and cause a dependence/ addiction which includes a craving for the substance or behavior (Gwinnell & Adamec 2006). With constant substance abuse one can become extremely dependent and addicted. Not only is the substance abuser affected but their family and friends may be affected as well. Family and friends may be stressed because someone they know is a substance abuser and they may not know how to help this person. Once the substance abuser is out of control all they will want is to use what they are dependent on. Therefore, they will be affected consciously; they may be drunk or high a lot of the time.

Children may also be affected if a mother is abusing substances during pregnancy. Babies can be born with fetal alcohol syndrome which can cause serious defects in the baby and alcohol withdrawal after birth.

A study done by Rounds-Bryant and Baker indicates that 72% of prisoners have a substance abuse issue. These findings correlate with the issue that adolescents with a substance abuse problem have increased behavioral issues. According to McKenry and Price “adolescents with alcohol problems had more behavioral problems, more perceived parental rejection, less parental warmth, and more association with substance-using peers than did adolescents without alcohol problems” (McKenry & Price 2005).

What are some issues substance abuse can cause?

• Behavioral problems
• Delinquency
• Health problems (liver failure, lung cancer, etc)
• Physical problems (weight loss, etc.)
• Relationship issues (rejection, trust issues, etc)
• Altered mental status (consciously unaware of situations)

How can substance abuse be prevented and treated?

Substance abuse can be prevented by educating the public on the effects of substance abuse. An important aspect of substance abuse prevention is educating children and adolescents about substance abuse, if achild is not using a substance the parental talk can lower risks of substance abuse (McKenry & Price 2005). They should be informed that the affects of substance abuse are harmful and have great negative affects.

Treatments that are available for the substance abuser are programs such as Alcoholics anonymous, narcotics anonymous, inpatients rehabilitation centers, intensive institutional programs and for personal conflicts substance abusers can also see counselors, psychologists and psychiatrists (Gwinnell & Adamec 2006). Family and friends also not only play a big role with preventing substance abuse by being great role models but can help end substance abuse by encouragement and social and emotional support.

Links for treatment centers

Alcoholics Anonymous / Narcotics Anonymous

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services Administrator (SAMHSA)

References

Goldberg, R. Drugs across the spectrum. State University of New York-Cortland. 2003.

Gwinnell, E., & Adamec, C. The encyclopedia of addictions and addictive behaviors. New York: Facts on File. 2006.

McKenry, P., & Price, S. Families and change: Coping with stressful events and transitions, 3rd edition. Thousand Oaks, CA: Sage. 2005.

Rounds-Bryant, J.L., & Baker, L. Substance dependence and level of treatment need among recently incarcerated prisoners. American Journal of Drug and Alcohol Abuse, 33, 557-561, 2007.

Schneider Institute for Health Policy. Substance abuse: The nation's number one health problem. Brandeis University. 2001

U.S. Department of Health and Human Services. 2005 National Survey on Drug Use and Health: National results, 2007.