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Macroeconomic crises occur cyclically, entailing devastating social consequences for individuals and families. Previous research addressing families' responses to socioeconomic upheavals has been mainly conducted with couples with young or adolescent children. Less research attention has been given to middle-aged couples with emerging adult children who might be struggling to support their offspring's transition to adulthood emotionally and financially. The present study examines the impact of economic stressors on family and individual functioning reported by couples with emerging adult children in Portugal. Using a sample of 317 heterosexual middle-aged couples, structural equation models were built to assess the links between economic hardship, economic pressure, and family functioning and psychological well-being. Following an actor-partner interdependence model (APIM) approach, both actor and partner effects were tested. The results showed that greater economic hardship was indirectly linked with (a) poor family functioning as reported by men and women, via the economic pressure felt by men, revealing an actor and a partner effect and (b) poor psychological well-being via each partner's own feeling of economic pressure, revealing only actor effects. Findings also indicated that economic stress processes may operate differently across socioeconomic status (SES) groups, with men from low/medium-low SES reporting a more pronounced association between economic pressure and family functioning. This study added support to previous literature on the adverse impact of economic stressors on family and individual functioning, extending family economic stress research to the Portuguese cultural setting and to an understudied stage of the family life cycle. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Although emerging adults (i.e., individuals aged 18-29 years old) may be at a lesser risk of COVID-19 severe illness and mortality, studies have found that the negative impact of COVID-19 on mental health and well-being is higher among emerging adults when compared to other age groups. The current study aimed to identify profile(s) based on resilience resources, which could help emerging adults in managing the disruptions to their lives following the pandemic. A cross-national sample of 1,768 emerging adults from China, Italy, Lithuania, Portugal, Slovenia, and the US was utilized to identify profiles based on different resilience dimensions (ego-resiliency, positivity, religiosity, socioeconomic status, family support, peer support). Results of the Latent Profile Analysis suggest the presence of four different profiles: no resources, only peer, only family, and well-equipped. The association of these profiles with demographic variables, adulthood markers, self-perceived COVID-19 impact, present well-being, and future life perception was investigated. Implications for resilience theory as well as for future interventions are discussed.The online version contains supplementary material available at 10.1007/s12144-022-03658-y.

The aim of present study was to develop the Portuguese version of the Silent Interparental Conflict Scale (SICS). This research examined the psychometric properties of this scale that evaluates marker characteristics of silent conflict and its perceived costs and benefits for individuals in a relationship. Participants were 173 individuals in a relationship who filled out the following measures: SICS, Family Environment Scale, Kansas Marital Satisfaction Scale and Brief Symptom Inventory. We conducted a confirmatory factor analysis to test the SICS factorial structure and computed correlations between its scores and those of other relevant constructs to contribute to this scale’s construct validity. The confirmatory factor analysis revealed an acceptable fit for the three-factor structure (marker, costs, and benefits of silent interparental conflict). The total score of SICS demonstrated very good internal consistency (αs > .80) and it was negatively correlated with scores of family cohesion, expressiveness, and marital satisfaction; conversely, it was positively correlated with scores of family conflict and psychological symptoms. Results support the use the SICS in Portuguese contexts. Silent conflict is a construct readily recognized, and this self-report questionnaire proved to be a valid instrument to assess this form of conflict between members of a couple.

The term parental alienation refers to the negative influence of one parent over a child’s perception of the other parent (targeted parent). The aim of this research was to gain further understanding of targeted parents’ experience of parental alienation from their own perspectives. For this qualitative study, a thematic analysis of semi-structured interviews with eight participants aged between 33 and 51 years was conducted. The data from individual semi-structured interviews enabled the identification of four main themes: perception of personal impact, coping strategies, family relationships and support network. Parents identified a serious impairment of their physical and emotional well-being and mainly identified emotion-focused coping strategies to deal with this adverse ongoing situation. Furthermore, they reported changes in key relationships, with emphasis on difficulties in family and social contexts. The contribution of the findings to research and interventions with parents and families experiencing parental alienation are discussed.

Childhood cancer is a traumatic experience for survivors and their families. The experience of this disease affects survivors' and families' quality of life, even years after it occurs. The purpose of the present study was to assess if the caregivers' posttraumatic stress symptoms mediated the associations between survivors' posttraumatic stress symptoms and caregivers' quality of life, in a sample of 46 dyads of caregivers and childhood cancer survivors. Survivors and caregivers completed the PCL-5, and caregivers completed the WHOQOL-bref. Results showed that survivors' and caregivers' posttraumatic stress symptoms scores and caregivers' quality of life were associated. The caregivers' posttraumatic stress symptoms mediated the relationship between survivors' posttraumatic stress symptoms and caregivers' quality of life. Knowing posttraumatic stress symptoms direct and indirect effects on caregivers' quality of life contributes to understand their experience and to develop intervention strategies with this population.

The main aim of the present study was to examine the psychological adaptation and beliefs of parents who identified themselves as experiencing a situation of parental alienation (targeted parents). Firstly, we compared psychological adaptation (depression, satisfaction with life) and belief in an unjust world in targeted parents and parents from the community. Secondly, we examined the associations between individual (depression, belief in an unjust world) and family (child behavior related to parental alienation, other parent’s alienating behavior and triangulation) factors and satisfaction with life in targeted parents. A cross-sectional study was conducted with two sub-samples (N = 106) who completed self-report questionnaires assessing depression symptoms, belief in an unjust world, and satisfaction with life. Targeted parents additionally reported on parental alienation and triangulation measures. Results showed that targeted parents presented higher scores of depression symptoms and of beliefs in an unjust world and lower scores in satisfaction with life, compared to parents in the community. Standard multiple regression analysis showed a significant contribution of depression, belief in an unjust world and child behavior related to parental alienation for the satisfaction with life of targeted parents. The findings provide an important contribution to characterize targeted parents’ psychological adaptation and beliefs, and to identify correlates of poorer satisfaction with life in the adverse context of parental alienation.

Thinking about the future is paramount in emerging adulthood. The present study examines the role of economic strain during macroeconomic hard times and family functioning on emerging adults’ domain-specific future hopes and fears and their links with psychological well-being. Participating were 418 Portuguese emerging adults aged 18–30, mean ( M) = 22.4; standard deviation ( SD) = 2.8. Results from path analysis showed that greater economic strain was associated with a higher number of financial resources–related hopes and fears, positive levels of family functioning were associated with a higher number of work/career-related hopes and fears, and a higher number of property-related hopes were associated with a greater psychological well-being. Multigroup analyses indicated that these associations were moderated by living arrangements but not by participants’ sex, age, occupational status, and socioeconomic status. In sum, this study shed light on emerging adults’ lives during times of financial instability in Portugal.

The purpose of this study was to examine the direct and indirect links between the perception of family-centered care (FCC) and psychological well-being via the perceived self-efficacy of parents of children with cancer. This study also sought to identify the potential moderators of these links (treatment status and patient age). This cross-sectional study was conducted at the pediatric oncology wards of two Portuguese public hospitals. The consecutive sample comprised 251 parents (87.6% mothers) of children/adolescents (8−20 years old) diagnosed with cancer. Participants completed self-report questionnaires measuring their perception of family-centered care (family-centered services and providing general information), perceived self-efficacy (regarding healthcare and parenting role) and psychological wellbeing. Results from the Structural Equation Modeling suggested that parents’ perception of FCC was indirectly, but not directly, linked to psychological well-being via perceived self-efficacy. Multi-group analyses suggested that this mediation model was valid across treatment status (on vs. off-treatment) and patient age groups (children vs. adolescents). These findings highlighted that, through the implementation of FCC, healthcare professionals may promote parents’ perceived self-efficacy and, consequently, their psychological well-being. Results also suggest that FCC may equally operate on parents’ psychosocial functioning, regardless of treatment status or patient age. Overall, our findings reinforced the benefits of FCC practices in pediatric oncology wards.

Nowadays, emerging adults live in a context of macroeconomic uncertainty. As the major processes of one’s identity exploration currently occur in emerging adulthood, understanding how these individuals foresee their future is of special interest. The purpose of this study was 2-fold: (i) to investigate future orientation (FO) in a sample of Portuguese emerging adults and (ii) to validate the Portuguese version of the Hopes and Fears Questionnaire. Data from 332 individuals were analyzed. Results demonstrated that participants’ future hopes and fears were mainly pertaining to education, work/career, and family/marriage. Participants also reported concerns related to their financial resources. Thus, the results showed that participants’ FO reflected major tasks associated with their development stage, as well as contextual factors, such as macroeconomic trends. This study contributed to the knowledge of emerging adulthood in Portugal, simultaneously providing a useful and reliable measure to evaluate emerging adults’ FO in that country.

Children and adolescents living in residential childcare have a higher prevalence of mental health problems as a result of a history of adverse childhood experiences. Therefore, this population should be a priority target for mental health preventive interventions. The current study analyses the effectiveness of the Wave by Wave surf therapy program, that combines surfing with a psychological group intervention, through a randomized controlled trial. Seventy-three youth (7-17 years) living in residential care participated in the study. Main mental health outcomes (adjustment problems, depression, anxiety, and wellbeing) and secondary outcomes (self-efficacy, self-regulation, sleep quality, physical activity, pro-social behavior, and social connectivity) were assessed at pre- and post-intervention. The results indicated a significant impact of the intervention on mental health outcomes reported by the key residential worker, with medium to large effect sizes. Specifically, after the intervention, there was a significant reduction in the total emotional and behavioural problems, and a significant increase of youth pro-social behaviour and quality of life that was not observed for the waiting list group. There were no significant effects on other measures reported by the children (e.g., depression and anxiety, self-esteem, emotion regulation, social connectedness, sleep quality, physical activity) and on executive functions measures. The Wave by Wave program seems to be an effective intervention to reduce behavior problems and to promote pro-social behavior in a high-risk sample. The absence of significant effects on other dimensions may indicate the need of some complementary support to address specific difficulties of this population. Efectividad de una intervención preventiva psicológica y de surf combinada con niños y adolescentes en cuidado residencial: Un ensayo controlado aleatorizado. Los niños y adolescentes que viven en acogimiento residencial tienen una mayor prevalencia de problemas de salud mental. Por lo tanto, esta población debe ser un objetivo prioritario para las intervenciones preventivas de salud mental. El estudio actual analiza la efectividad del programa Wave by Wave, que combina el surf con una intervención psicológica grupal, a través de un ensayo controlado aleatorio. Setenta y tres jóvenes (7-17 años) que viven en acogimiento residencial participaron en el estudio. Los principales resultados de salud mental (problemas de ajuste, depresión, ansiedad y bienestar) y los resultados secundarios (autoeficacia, autorregulación, calidad del sueño, actividad física, comportamiento prosocial y conectividad social) se evaluaron antes y después de intervención. Los resultados indicaron un impacto significativo de la intervención sobre los resultados de salud mental reportados por el cuidador en la residencia. Específicamente, después de la intervención, hubo una reducción significativa en los problemas emocionales y conductuales totales, y un aumento significativo del comportamiento prosocial de los jóvenes y de la calidad de vida que no se observó en el grupo control. No hubo efectos significativos en otras medidas reportadas por los niños (ex., depresión y ansiedad, autoestima) y en las medidas de las funciones ejecutivas. El programa Wave by Wave parece ser una intervención efectiva para reducir los problemas de comportamiento y promover el comportamiento prosocial en una muestra de alto riesgo. La ausencia de efectos significativos en otras dimensiones puede indicar la necesidad de algún apoyo complementario para abordar las dificultades específicas de esta población..

Objective The aim of this study was to examine the contribution of individual (positive reappraisal) and family factors (parenting satisfaction, couple relationship quality, and family life difficulty) to the psychological well-being (PWB) of parents of children/adolescents diagnosed with cancer. Methods This cross-sectional study was conducted at two pediatric oncology wards in Portugal. Two-hundred and five parents of pediatric patients with cancer completed self-report questionnaires assessing the use of positive reappraisal as a coping strategy, parenting satisfaction, relationship quality, family life difficulty, and PWB. Sociodemographic and clinical data were also assessed. Results Standard multiple regression analysis showed a significant contribution of both individual- and family-level factors to parents' PWB. Specifically, the use of positive reappraisal as a coping strategy, parenting satisfaction, and relationship quality were associated with higher PWB; conversely, family life difficulty was linked to lower PWB. Sociodemographic (child's age and family's socioeconomic status) and clinical variables (time since diagnosis and treatment status) were not associated with PWB. Conclusions The present study identified potential resources for parents' adaptation to this stressful situation, contributing with insightful conclusions for both research and clinical practice. Screening and addressing both individual- and family-level aspects may be crucial to foster parents' well-being when a child is diagnosed with cancer.

ObjetivoEste estudo teve como objetivo caracterizar as perceções parentais dos Cuidados Centrados na Família (CCF) em função de fatores sociodemográficos e clínicos no contexto da oncologia pediátrica em Portugal.MétodoParticiparam neste estudo 204 cuidadores de crianças com cancro acompanhadas em duas unidades de oncologia pediátrica. Os participantes forneceram dados sociodemográficos e preencheram a Medida dos Processos de Cuidados (MPOC-20), composta por duas subescalas: Serviços e Informação Geral. Os médicos oncologistas pediátricos facultaram informação clínica.ResultadosA idade de crianças e pais estava positivamente associada às perceções parentais dos CCF (Serviços e Informação Geral) como mais centrados na família. Análises multivariadas da variância revelaram que pais de crianças (vs. adolescentes), pais que concluíram o ensino superior (vs. escolaridade igual/inferior ao 12º ano) e pais de crianças em tratamento antineoplásico (vs. fora de tratamento) percecionaram os cuidados como menos centrados na família (Serviços e Informação Geral). Não se verificaram diferenças em função do tempo desde o diagnóstico, do número de internamentos e da intensidade do tratamento.ConclusãoOs resultados sugerem que os pais mais novos que concluíram o ensino superior, pais de crianças mais novas e a receber tratamento, poderão constituir grupos em maior risco de percecionar os cuidados de saúde como menos centrados na família.

The financial burden of childhood cancer may contribute to the distress that parents experience during and after treatment. Inconsistent relationships between financial burden and parental psychological distress highlight the need to identify psychosocial factors that may moderate this relationship. In this study, we aimed to determine if family ritual meaning moderates the relationship between financial burden and anxiety and depression symptoms among mothers of children with cancer. Portuguese mothers of children with cancer on-treatment and off-treatment (N = 244) completed measures of financial burden, anxiety and depression symptoms, and family ritual meaning. Moderating effects were tested using hierarchical multiple regression analyses. Family ritual meaning buffered the effect of financial burden on anxiety, but not on depression symptoms. The relationship between financial burden and anxiety symptoms was not significant when mothers endorsed higher levels of family ritual meaning. Although preliminary, the current findings suggest that high levels of perceived family ritual meaning may constitute a protective factor against the effect of financial burden on mothers' anxiety symptoms. Promoting family ritual meaning might be an effective approach to reducing anxiety symptoms of mothers of children with cancer in the context of financial burden. (PsycINFO Database Record

The present study is a systematic review of empirical literature from the last 35 years on families' responses to economic distress in the context of macroeconomic crises. Thirty-nine studies published between 1983 and 2015 in 12 countries were identified, resulting in 3 main findings. First, economic distress was associated with negative changes in family dynamics, specifically couple relationships and parenting. Second, protective factors were found to buffer the adverse effects of economic distress on family and individual outcomes. Third, the results suggest that individual responses to macroeconomic crises may be moderated by sex. Implications for future research encompass using validated assessment instruments, including participants beyond 2-parent families with adolescent children and conducting both longitudinal and qualitative studies that focus on the processes and meanings of adaptation within this risk context. Conclusions highlighted the need to assist families dealing with macroeconomic crises' demands, encouraging the development and validation of macrosystemic intervention programs. (PsycINFO Database Record

The quality of family functioning has been considered an important predictor of adaptation in children with chronic conditions and their parents. Previous research suggests that beyond general family functioning, the specific experience of the family’s condition management is paramount for understanding family members’ adaptation. This study’s first goal was to compare family functioning and parents’ and children’s adaptation outcomes across four chronic conditions: asthma, diabetes, epilepsy, and obesity. Secondly, we explored the mediating role of family life difficulties and parental mutuality, as two potential paths through which family cohesion is linked to family members’ adaptation. A total of 263 parents of children (3–19 years old) with asthma (n = 77), obesity (n = 79), epilepsy (n = 52) and diabetes (n = 55) completed self-report measures of family cohesion, family life difficulty, parental mutuality, anxiety and depressive symptoms, and their children’s health-related quality of life (HrQoL). The results showed that families of children with diabetes, obesity, and epilepsy were at higher risk of experiencing family difficulties and children’s deteriorated HrQoL when compared to families of children with asthma. With regard to the links among study variables, although family cohesion had both a direct and indirect relationship with parental depressive symptoms, its links with parental anxiety symptoms and children’s HrQoL were only indirect, through family life difficulty. These associations were consistent across the four clinical groups. These findings emphasize the relevance of family-centered interventions aimed at promoting family cohesion, parents’ mutuality, and effective coping with the demands of pediatric chronic conditions.

INTRODUCTION Family-centered care (FCC) is a health-care delivery approach endorsing the support and participation of families. To date, little research has addressed the associations between FCC and adaptation outcomes specifically in the context of pediatric cancer. The main objective of this research was to identify the direct and indirect associations, through caregiving burden, between parents' FCC and quality of life (QoL) and life satisfaction. METHOD Participants were 204 parents of children diagnosed with cancer. Parents answered the Measure of Processes of Care questionnaire to evaluate their perceptions of FCC in 2 domains: family-centered services and provision of general information. Perceptions of caregiving burden (Revised Burden Measure), QoL (EUROHIS-QoL-8), and life satisfaction (Satisfaction with Life Scale) were also assessed. Pediatric oncologists provided information on the child's diagnosis and treatment status. RESULTS Findings showed that when parents perceived their children's health care as more family-centered, they also reported lower caregiving burden. Family-centered services were indirectly linked to QoL and life satisfaction through caregiving burden. DISCUSSION This research suggests that the way parents perceive formal care, namely as being more or less family-centered, may influence the burden they experience as caregivers of a child with cancer and, indirectly, their adaptation. These findings highlight the relevance of gaining greater understanding of the interaction between the family and the health-care systems in the context of pediatric cancer.

Moral vitalism refers to a tendency to view good and evil as actual forces that can influence people and events. The Moral Vitalism Scale had been designed to assess moral vitalism in a brief survey form. Previous studies established the reliability and validity of the scale in US-American and Australian samples. In this study, the cross-cultural comparability of the scale was tested across 28 different cultural groups worldwide through measurement invariance tests. A series of exact invariance tests marginally supported partial metric invariance, however, an approximate invariance approach provided evidence of partial scalar invariance for a 5-item measure. The established level of measurement invariance allows for comparisons of latent means across cultures. We conclude that the brief measure of moral vitalism is invariant across 28 cultures and can be used to estimate levels of moral vitalism with the same precision across very different cultural settings. WOS:000540977000011 2-s2.0-85086354439 PMID: 32516333 Science Citation Index Expanded - Social Sciences Citation Index Q2 Article Uluslararası işbirliği ile yapılan - EVET Haziran 2020 YÖK - 2019-20

The current study aims to describe the relationships between emerging adults and their families and how these evolve over emerging adult years. Through a systematic review of the literature, we extracted data from 38 empirical studies, which met the following inclusion criteria: published since 2000, included emerging adults and/or their relatives as participants, and focused on family relationships. The results showed that most studies examined the parent-child relationship, providing insight into the relational renegotiations occurring during emerging adulthood and into inter-generational discrepancies in the way that parents and children viewed their relationships. Family support was also found to be of substantial relevance during this developmental stage. In addition, sex, age, living arrangements, family structure, socioeconomic status (SES), ethnicity and cultural contexts emerged as key factors influencing family relationships in varied ways. Implications for future research include the need to consider the family as the unit of analysis and to collect data from multiple family members; to conduct longitudinal studies in order to better understand changes in family relationships across emerging adulthood; and to focus on family relationships beyond the parent-child dyads, namely on sibling and grandparent-grandchildren relationships. In conclusion, this review provided a renewed perspective on family relationships during the transition to adulthood, contributing to clinical insights on individual and familial shifts in the fast-paced and complex contemporary context.

Research has long acknowledged the disruptions posed by pediatric cancer diagnosis and treatment to family life. Nonetheless, the mechanisms through which the family response influences parents' mental health in this adverse context are not fully understood. The main goal of the present study was to examine the direct and indirect links, via parenting satisfaction, between family condition management and psychological distress of parents of children with cancer. Participants were 201 parents (86.6% mothers) of children/adolescents diagnosed with cancer who completed self-report questionnaires assessing family condition management (family life difficulty and parental mutuality), parenting satisfaction, and psychological distress (anxiety and depression). Structural equation modeling was used to test the proposed mediation model. The results showed that parenting satisfaction mediated the association between both the family condition management dimensions (family life difficulty and parental mutuality) and depression. Specifically, greater family life difficulties and lower parental mutuality were associated with lower parenting satisfaction, which, in turn, was associated with higher levels of depression. Additionally, greater family life difficulties and lower parental mutuality were directly linked to higher levels of anxiety. Multigroup analyses suggested that the model was valid across patient age groups (children vs. adolescents) and treatment status (on vs. off-treatment). These findings reinforce the need for family- and parent-based interventions in the pediatric oncology field. Interventions that target families' difficulties and promote their resources are likely to foster parenting satisfaction and psychological adjustment.Desde hace tiempo, las investigaciones han reconocido las dificultades que plantea el diagnóstico de cáncer infantil y el tratamiento para la vida familiar. No obstante, los mecanismos a través de los cuales la respuesta de la familia influye en la salud mental de los padres en este contexto adverso no se comprenden totalmente. El objetivo principal del presente estudio fue analizar los vínculos directos e indirectos, mediante la satisfacción con la crianza, entre el manejo de la enfermedad por parte de la familia y el distrés psicológico de los padres de niños con cáncer. Los participantes fueron 201 padres (86.6% madres) de niños/adolescentes diagnosticados con cáncer quienes contestaron cuestionarios de autoinforme que evaluaban el manejo de la enfermedad por parte de la familia (la dificultad para la vida familiar y la reciprocidad parental), la satisfacción con la crianza y el distrés psicológico (ansiedad y depresión). Se utilizó el modelo de ecuaciones estructurales para evaluar el modelo de mediación propuesto. Los resultados demostraron que la satisfacción con la crianza medió la asociación entre las dimensiones de manejo de la enfermedad por parte de la familia (la dificultad para la vida familiar y la reciprocidad parental) y la depresión. Específicamente, una mayor dificultad para la vida familiar y una menor reciprocidad parental estuvieron asociadas con una menor satisfacción con la crianza, la cual, a su vez, estuvo asociada con niveles más altos de depresión. Además, una mayor dificultad para la vida familiar y una menor reciprocidad parental estuvieron asociadas directamente con niveles más altos de ansiedad. Los análisis multigrupo sugirieron que el modelo era válido entre los grupos etarios de pacientes (niños frente a adolescentes) y el estado del tratamiento (en tratamiento frente a sin tratamiento). Estos hallazgos reafirman la necesidad de realizar intervenciones para la familia y los padres en el ámbito de la oncología pediátrica. Probablemente, las intervenciones que se ocupen de las dificultades de las familias y promuevan sus recursos fomentarán la satisfacción con la crianza y la adaptación psicológica.研究很早就承认了儿科癌症诊断和治疗对于家庭生活的干扰. 然而家庭反应如何在这一不良背景下影响家长心理健康的机制还没有被完全理解.该研究的主要目的是通过亲职满意度考察家庭情况管理和患有癌症儿童家长的心理困扰之间的联系.参与者为201名被诊断患有癌症的儿童/青少年的家长(86.6% 是母亲).这些参与者完成了评估家庭情况管理(家庭生活困难和家长相互性)自我报告问卷,亲职满意度以及心理困扰(焦虑和抑郁).我们使用结构性等式模型来测试所提出的调和模型.研究结果显示亲职满意度调节家庭情况管理维度(家庭生活困难和家长相互性)以及抑郁之间的关联. 特别是,较多的家庭生活困难和较低的家长相互性和较低的亲职满意度相关, 而较低的亲职满意度又和较高的抑郁水平相关.此外,较多的家庭生活困难和较低的家长相互性直接和较高水平的焦虑相关.多小组分析显示该模型在不同患者年龄组(儿童和青少年)和治疗状况都适用.这些发现增强了儿科肿瘤领域对于以家庭和家长为基础的干预措施的需求.针对家庭困难并促进其资源的干预措施可能促进亲职满意度和心理调适.

Introduction The current study examined the psychometric properties of the Portuguese version of the Family Distress Index (FDI). The FDI is an 8-item self-report measure that assesses family maladaptation, providing an index of family outcomes within the resiliency model of family stress, adjustment, and adaptation. Method Participants were 459 adults, who completed measures of family distress (FDI) and family functioning (Systemic Clinical Outcome Routine Evaluation; SCORE-15). Results Exploratory and confirmatory factor analyses supported a unidimensional factorial structure. Results also indicated that the FDI has good internal consistency and temporal stability. The positive and significant correlation between FDI and SCORE-15' scores demonstrated its convergent validity. Through receiver operating characteristic (ROC) analysis, we determined a cut-off score of 12 for identifying probable family distress. Discussion In sum, the Portuguese version of the FDI is a valid and reliable instrument, which can foster the development of future empirical studies focused on family adaptation in diverse contexts of adversity, namely in health care settings. (PsycINFO Database Record

This cross-sectional study examined the associations between family ritual meaning and 3 indicators of parental adaptation (anxious and depressive symptoms and quality of life) via 2 dimensions of parental competence-satisfaction and efficacy-in parents of children with epilepsy. Two hundred Portuguese parents of children diagnosed with epilepsy for at least 6 months completed self-report measures assessing the main study variables. Our results showed that when parents reported stronger family ritual meaning, they also reported higher levels of parental satisfaction and efficacy, which were in turn were associated with lower psychological distress (anxious and depressive symptoms) and better quality of life of parents. This pattern of results was significant regardless of the severity of children's epilepsy, age group, and family socioeconomic level. In the context of pediatric epilepsy, empirical evidence was found for the role of family ritual meaning in being directly and indirectly associated with parents' adaptation outcomes by higher levels of parental satisfaction and efficacy. Focusing intervention targets on what families naturally do and recognize as their own ritual meaning may be a favorable route to address those at risk of psychological distress and lower quality of life. (PsycINFO Database Record

This study aimed to examine the direct and indirect effects of hope on health-related quality of life (HRQoL) via anxiety of children/adolescents with cancer. We proposed to test if the mediation model was moderated by the child/adolescent’s treatment status. The participants were 211 children/adolescents diagnosed with cancer, divided into two clinical groups according to treatment status: 97 patients on-treatment and 114 off-treatment. Self-reported questionnaires measured the youths’ hope, anxiety, and HRQoL perceptions. The results revealed that children/adolescents on- and off-treatment only differed in levels of HRQoL, with a more compromised HRQoL found for the on-treatment group. Hope was positively associated with HRQoL, directly and indirectly via anxiety reduction. Moreover, only the association between anxiety and HRQoL was moderated by clinical group, revealing stronger associations for on-treatment patients. Findings highlight the importance of hope as a decisive resource in pediatric cancer adaptation, which may be strategically targeted in psycho-oncological interventions.

Treatment for pediatric cancer requires periodic and long hospital admissions. The intensity and frequency of the interactions taking place in the treatment setting indicate that this is a context to which children and their families can feel connected. This study’s main goal was to develop the Connectedness to Treatment Setting Scale (CTSS-Pediatric Cancer), a 10-item scale assessing children’s and parents’ connectedness to the health setting where children receive cancer treatment. Participants were 128 dyads of children receiving treatment at two Portuguese public hospitals and their parents. Two exploratory factor analyses with children’s and parents’ data separately and a dyadic confirmatory factor analysis with the whole sample supported a second-order factorial structure of the CTSS-Pediatric Cancer, where three dimensions (Sense of Belonging, Comfort and Emotional Care) loaded onto a total score of connectedness. Findings suggest that the CTSS-Pediatric Cancer is a valid and useful assessment measure.

Parents play a key role in how children deal with epilepsy. When diagnosed with health conditions, people seek comparison information from fellow patients and families, and this information has consequences for how they evaluate their situation. This study examined the moderating role of parents' social comparison orientation in the associations between family management (parental perceptions of family life difficulties and child's daily life) and adaptation outcomes of children with epilepsy (HRQoL and perceived stigma). Participants included 201 dyads of children with epilepsy and either their mother or father. The results showed that when parents perceived higher difficulties managing their child's epilepsy and/or reported that their child was more affected by this condition, children reported higher perceived stigma and worse HRQoL only when parents had a higher social comparison orientation. Our results are innovative in showing that when parents have a higher social comparison orientation, their children may be at increased risk of poorer outcomes.

Adolescence is a sensitive period for the development of depressive-anxious symptomatology. The practice of family rituals and perceived social connectedness have been indicated as protective factors for adolescents´ adjustment, however the existing empirical research is still scarce. The present research examined the relationships among family ritual meaning, social connectedness, anxiety and depression among Portuguese students. A total of 248 students (52.8 % female) aged between 15 and 20 years old (M = 16.27, SD = 1.22) participated in this study. The participants completed self-report measures (Family Ritual Questionnaire, Social Connectedness Scale—Revised, and Hospital Anxiety and Depression Scale). Results showed that family ritual meaning was positively related to social connectedness and negatively related to depression. Social connectedness was negatively associated with anxiety and depression. Gender was only associated with anxiety, and age wasn’t significantly correlated with any of the variables. Mediation analysis demonstrated that family ritual meaning was negatively linked to both depression (indirect effect = −.07; CI = −.13/−.02) and anxiety symptoms (indirect effect = −.06; CI = −.11/−.01) via social connectedness. These results clarified one of the possible paths through which family ritual meaning influences depressive-anxious symptomatology in adolescence. Taking into account the protective role of family ritual meaning and social connectedness, future interventions can be designed in order to reduce and prevent anxiety and depression in this particular developmental stage. Contributions and limitations of this study are presented along with suggestions for further investigation.

ObjetivoEste estudo teve como objetivos apresentar a versão portuguesa da Escala de Classificação da Intensidade do Tratamento 3.0, uma medida objetiva para avaliar a intensidade do tratamento no cancro pediátrico, e comparar a qualidade de vida relacionada com a saúde (QdVrS) em crianças/adolescentes com diferentes níveis de intensidade do tratamento.MétodoA amostra foi constituída por 129 crianças/adolescentes com cancro (98 em tratamento e 31 fora de tratamento). A intensidade do tratamento foi classificada pelos médicos oncologistas pediátricos com a Escala de Classificação da Intensidade do Tratamento 3.0 e a QdVrS foi avaliada pelas crianças/adolescentes através do DISABKIDS Chronic Generic Measure (DCGM-12).ResultadosAs análises do coeficiente de Kappa revelaram excelentes índices de fiabilidade interavaliadores. Verificou-se a existência de diferenças estatisticamente significativas na QdVrS de acordo com o nível de intensidade do tratamento. Comparações post-hoc revelaram níveis de QdVrS superiores em crianças/adolescentes com tratamentos de intensidade 2 comparativamente aos de intensidade 3 e 4.ConclusãoOs dados evidenciam a importância de intervenções para melhorar a QdVrS junto de potenciais grupos de risco, definidas de acordo com a intensidade do tratamento.

The aim of this study was to analyze the direct and indirect effects, via parents' behavioral disengagement coping, of caregiving burden on the quality of life (QL) of parents and their children with neurodevelopmental conditions. Self-completion questionnaires on the target variables were administered to a sample of 156 parents who had a child with a neurodevelopmental condition, namely epilepsy (n = 65) and cerebral palsy (n = 91). Structural equation modeling was used to test a mediation model and ascertain direct and indirect effects among study variables. Significant direct effects of caregiving burden on parents' and their children's QL were found. Additionally, caregiving burden had a significant indirect effect on parents' QL, via behavioral disengagement, but not on their children's QL. Finally, this model was found to be invariant across conditions and patients' age groups. Caregiving burden may be elected as a strategic intervention target to improve parent-child QL outcomes in neuropediatric settings. Parents should be encouraged to avoid or reduce behavioral disengagement coping in relation to their caregiving stress, and alternatively adopt active coping strategies that may positively affect their children's QL and impede or attenuate the deleterious effects of caregiving burden on their own QL.

Background Children's health-related quality of life (HrQoL) and psychological problems are important outcomes to consider in clinical decision making in paediatric asthma. However, children's and parents' reports often differ. The present study aimed to examine the levels of agreement/disagreement between children's and parents' reports of HrQoL and psychological problems and to identify socio-demographic, clinical and family variables associated with the extent and direction of (dis)agreement. Methods The sample comprised 279 dyads of Portuguese children with asthma who were between 8 and 18 years of age (M = 12.13; SD = 2.56) and one of their parents. The participants completed self- and proxy-reported questionnaires on paediatric generic HrQoL (KIDSCREEN-10), chronic-generic HrQoL (DISABKIDS-37) and psychological problems (Strengths and Difficulties Questionnaire). Children's and parents' perceptions of family relationships were measured with the Family Environment Scale and the caregiving burden was assessed using the Revised Burden Measure. Results The child–parent agreement on reported HrQoL and psychological problems was poor to moderate (intraclass correlation coefficients between 0.32 and 0.47). The rates of child–parent discrepancies ranged between 52.7% (psychological problems) and 68.8% (generic HrQoL), with 50.5% and 31.5% of the parents reporting worse generic and chronic-generic HrQoL, respectively, and 33.3% reporting more psychological problems than their children. The extent and direction of disagreement were better explained by family factors than by socio-demographic and clinical variables: a greater caregiving burden was associated with increased discrepancies in both directions and children's and parents' perceptions of less positive family relationships were associated with discrepancies in different directions. Conclusions Routine assessment of paediatric HrQoL and psychological problems in healthcare and research contexts should include self- and parent-reported data as complementary sources of information, and also consider the family context. The additional cost of conducting a more in-depth assessment of paediatric adaptation outcomes can be offset through more efficient allocation of health resources.

Introduction. The KIDSCREEN and DISABKIDS questionnaires constitute a modular system for assessing the health-related quality of life (HrQoL) of children/adolescents. Objective: This study was aimed at examining the factorial structure of the Portuguese patient- and parent-reported versions of the DISABKIDS-Asthma Module (AsM) and its invariance across age groups and informants, as well as to examine their reliability and construct validity. Method. The sample included 140 children/adolescents aged 8-18 years, who were diagnosed with asthma, and one of their parents. Both family members assessed HrQoL at the generic (KIDSCREEN-10), chronic-generic (DISABKIDS-12) and asthma-specific (DISABKIDS-AsM) levels. Asthma severity was classified by physicians using Global Initiative for Asthma (GINA) guidelines. Results. Confirmatory factor analysis attested the factorial validity of the correlated two-factor model of the DISABKIDS-AsM, but the low average variance extracted by each factor (Impact and Worry) suggested that a one-factor structure would better fit the Portuguese data. The one-factor model had an acceptable fit (χ2/df = 1.97; comparative fit index = 0.94; root mean square error of approximation = 0.08) and was invariant between age groups (children vs. adolescents) and informants (patient-reports vs. parent-reports). The resulting global index of asthma-specific HrQoL presented good reliability and convergent validity with the generic and chronic-generic measures. The DISABKIDS instruments also detected significant differences in HrQoL regarding asthma severity groups. Conclusion. The DISABKIDS-AsM may be regarded as a specific one-dimensional questionnaire, which, besides suiting pediatric patients in different developmental stages and enabling reliable proxy-reports, is sensitive to asthma clinical characteristics and is cross-culturally comparable, thus representing a valuable tool for assessing asthma-specific HrQoL as a primary health outcome in clinical practice and research contexts. This study was supported by the R&D Unit Institute of Cognitive Psychology, Vocational and Social Development of the University of Coimbra (PEst-OE/PSI/UI0192/2011) and by the Portuguese Foundation for Science and Technology (PhD Grant SFRH/BD/69885/2010).

This study examined the direct and indirect links, via the caregiving burden, between parents’ perceptions about the severity of their child’s illness and its interference in his or her life and the parents’ quality of life (QoL). The participants were 277 parents of children with malignant cancer, divided into two clinical groups according to treatment status: 126 parents of children on-treatment and 151 parents of children off-treatment. Self-reported questionnaires assessed parents’ perceptions of illness severity and interference in the child’s life, caregiving burden and QoL. Pediatric oncologists provided information about diagnosis, treatment status and intensity. Parents of children on-treatment reported more negative perceptions about the illness (severity and interference), higher levels of caregiving burden and worse QoL, when compared to parents of children off-treatment. Furthermore, parents’ perceptions about their child’s illness (severity and interference) were negatively linked to parents’ QoL through caregiving burden. Additionally, the link between caregiving burden and parents’ QoL was moderated by child treatment status, with stronger associations found for parents of children on-treatment. This study’s findings are discussed in terms of their relevant implications for intervention with families in the pediatric cancer context.

This study had two main objectives: first, to examine the direct and indirect effects, via social support, of caregiving burden on the adaptation outcomes of children/adolescents with cerebral palsy and their parents; and second, to assess the invariance of such models in clinical vs. healthy subsamples. Participants were 210 dyads of children/adolescents and one of their parents (total N=420), divided in 93 dyads of children/adolescents with cerebral palsy and 117 dyads of children/adolescents with no medical diagnosis. Data on caregiving burden, social support and adaptation outcomes were obtained through self-report questionnaires. Caregiving burden was linked to parents and their children's psychological maladjustment and quality of life both directly (except for children's quality of life) and indirectly through social support. Findings were invariant across clinical and healthy subsamples. Caregiving burden may influence adaptation outcomes of children/adolescents with CP and their parents both directly and via their social support perceptions. These patterns are similar to those observed in typically developing children/adolescents.

Introduction. The particular challenges posed by pediatric asthma may have a negative impact on the adaptation of children and their parents. From a transactional approach it is important to examine how reciprocal links between children and parents contribute to explain their adaptation and under which conditions these associations occur. This cross-sectional study aimed at examining the direct and indirect links between children’s and parents’ perceptions of family relationships and adaptation, separately (within-subjects) and across participants (cross-lagged effects), and the role of asthma severity in moderating these associations. Method. The sample comprised 257 children with asthma, aged between 8 and 18 years-old, and one of their parents. Both family members completed self-reported questionnaires on family relationships (cohesion and expressiveness) and adaptation indicators (quality of life and psychological functioning). Physicians assessed asthma severity. Structural Equation Modeling was used to test within-subjects and cross-lagged paths between children’s and parents’ family relationships and adaptation. Results. The model explained 47% of children’s and 30% of parents’ adaptation: family relationships were positively associated with adaptation, directly for children and parents, and indirectly across family members. Asthma severity moderated the association between family relationships and health-related quality of life for children: stronger associations were observed in the presence of persistent asthma. Conclusion. These results highlight the need of including psychological interventions in pediatric healthcare focused on family relationships as potential targets for improving children’s and parents’ quality of life and psychological functioning, and identified the children with persistent asthma as a group that would most benefit from family-based interventions. This study was supported by the R&D Unit Institute of Cognitive Psychology, Vocational and Social Development of the University of Coimbra (PEst-OE/PSI/UI0192/2011) and by the Portuguese Foundation for Science and Technology (PhD Grant SFRH/BD/69885/2010).

Despite recent trends toward greater societal acceptance of LGBT individuals in many Western countries, the elevated chances of being confronted by rejection and hostility or fear are still likely to lead to detrimental psychological health outcomes for this population. The current study assesses how the family can be a resource for psychological well-being. Based on self-determination theory and the family ritual literature, we hypothesize that the various family rituals enhance the chances that the human need for relatedness will be satisfied and positively contribute to the degree to which the person flourishes in life. Second, we test which factors mediate this pathway. For this purpose, a 3-factorial scale (Family Ritual Appraisal Scale) that assesses the appraisal with which LGBT adults evaluate the participation in family rituals was developed. In a multiple-mediation analysis, 3 factors (inclusion of self, inclusion of partner, and sense of obligation) were found to mediate significantly the degree by which family rituals lead to higher levels of relatedness in the family and thereby to higher levels of flourishing. Together, the results suggest that it is meaningful to assess the ways in which family rituals are conducted and experienced by individual family members on the effects of family rituals on psychological well-being. (PsycINFO Database Record

This commentary draws on Shaver and Mikulincer's (2012) article to discuss key aspects of adult attachment, family theory, and research. First, a reflection is presented on why the historical development of attachment theory calls for a better understanding of the role of the whole-family context. Second, the issue of the cross-fertilization of research traditions related to attachment theory and family systems theory is addressed. Third, a brief overview of research on attachment and family processes is presented. Finally, to illustrate the relationship between attachment and whole-family variables, the particular example of family rituals is discussed. More precisely, a mediational hypothesis is discussed, whereby attachment security is linked to positive outcomes for families via the development of meaningful family rituals.

This cross-sectional study explored the relationships among family ritual meaning, cohesion, conflict, and health-related quality of life (both specific to chronic health conditions and in general), and the emotional and behavioral problems reported by youths with asthma. Participants included 149 Portuguese children and adolescents between the ages of 8 and 18 who had been diagnosed with asthma and attended outpatient services at three public hospitals. The results showed that stronger family ritual meaning predicted a more positive family environment (i.e., higher cohesion levels and lower conflict levels), better health-related quality of life, and fewer emotional and behavior problems in youths. Furthermore, family cohesion and conflict mediated the links between family ritual meaning and health-related quality of life, and emotional and behavioral problems. These results did not change after controlling for participant age, gender, and asthma severity. The findings of this study suggest that family ritual meaning contributes to the adaptation of youths with asthma via its positive association with the family environment. The implications for multicontextual interventions with families are briefly discussed with regard to the positive role of family rituals and of their potential as a modifiable factor in families with increased health challenges. 摘要 本项横断研究探索家庭仪式意义、团结、冲突和健康相关的生活质量(既包括具体的慢性健康疾病,也包括一般状况)与患有哮喘的年轻人所报告的情感和行为问题之间的关系。研究参与者包括149名年龄介于8至18岁之间的葡萄牙儿童和青少年,他们被诊断为患有哮喘,并在三家公共医院门诊看过病。结果显示,家庭仪式意义愈强,预示的家庭环境就愈正面(即,团结程度愈高,冲突程度愈低),年轻人健康方面的生活质量愈好,情感和行为问题也愈少。此外,家庭团结和冲突对家庭仪式意义和健康方面生活质量与情感和行为问题之间的关联性起协调作用。在控制了具体年龄、性别和哮喘严重程度之后,这些结果未发生变化。本研究的发现表明,家庭仪式意义通过其与家庭环境的正面关系,对年轻哮喘患者轻人的适应起作用。本文就家庭仪式的正面作用以及它们在经历不断增加的健康挑战的家庭充当可修正因子的潜力作用,简要探讨了其在家庭多情境治疗中的意义。 RESUMEN Este estudio transversal analizo las relaciones entre el significado de los rituales familiares, la unidad, el conflicto y la calidad de vida relacionada con la salud (tanto la especifica de las enfermedades cronicas como en general), y los problemas afectivos y de conducta informados por los jovenes que padecen asma. Los participantes fueron 149 ninos y adolescentes portugueses de entre 8 y 18 anos a quienes se les habia diagnosticado asma y recibian servicios ambulatorios en tres hospitales publicos. Los resultados indicaron que el significado mas fuerte de los rituales familiares predijo un entorno familiar mas positivo (p. ej.: niveles de unidad mas altos y niveles de conflicto mas bajos), mejor calidad de vida relacionada con la salud y menos problemas afectivos y de conducta en los jovenes. Ademas, la unidad familiar y el conflicto mediaron los vinculos entre el significado de los rituales familiares y la calidad de vida relacionada con la salud, y los problemas afectivos y de conducta. Estos resultados no cambiaron despues de tener en cuenta la edad, el sexo y la gravedad del asma de los participantes. Los resultados de este estudio sugieren que el significado de los rituales familiares contribuye a la adaptacion de los jovenes con asma mediante su asociacion positiva con el entorno familiar. Se debaten brevemente las consecuencias de las intervenciones multicontextuales en las familias con respecto al papel positivo que desempenan los rituales familiares y su potencial como factor modificable en las familias con mayor cantidad de problemas de salud.

Recent research has shown a growing interest in the assessment of Health-Related Quality of Life (HRQoL) in children and adolescents with chronic health conditions as a subjective health outcome. However, HRQol in the pediatric population with cerebral palsy (CP) is still understudied, with scarce research assessing self-reported HRQoL and its links with other psychological variables. The present research examined self-reported HRQoL in 64 Portuguese children and adolescents with CP. Results showed that higher HRQoL (generic and specific to chronic health conditions) was significantly related to lower levels of psychopathological symptoms, higher levels of prosocial behavior and a lower need for social activities. Gender moderated the link between prosocial behavior and HRQoL (specific to chronic conditions), which was significant for girls but not for boys. Finally, the need for social activities mediated the associations between psychopathology symptoms and both measures of HRQoL.

In this study we investigated the links between caregiver burden, family environment, and quality of life in 97 pairs of children with asthma and the one who was determined to be the primary family caregiver. Using structural equation modeling, within-participant analyses showed that family environment was positively linked to quality of life for both children and parents. Across-participant analyses demonstrated that parents’ positive perceptions of family environment were associated with parents’ and children’s improved quality of life. In addition, parents’ perceptions of family environment mediated the link between caregiver burden and parents’ and children’s quality of life. Implications for intervention with families are discussed in light of this study’s important results.

In this cross-sectional study we analyzed the links between marital quality and intimacy, body image, and psychological quality of life (PQoL) of breast cancer patients, as well as the moderating role of cancer phase (treatment, survivorship) on the aforementioned links. We also evaluated whether body image mediated the associations between marital relationship variables and PQoL. An analysis of the data from 128 patients (66 undergoing treatment, 62 survivors) indicated that the majority of links between variables were significant only during the treatment phase. Mediating effect of body image on the associations between relationship variables and PQoL was found only at the treatment phase.

Objective Family functioning is associated with adaptation in pediatric illness. This study examines the role of parents’ relationships (specifically romantic attachment) as a predictor of family ritual meaning and family cohesion for parents and their children with cancer. Methods The dyads, 58 partnered Portuguese parents and their children in treatment, reported on family ritual meaning and family cohesion at Time 1 (T1) and after 6 months (T2). Parents also completed the questionnaire assessing romantic attachment at T1. Results Parents’ avoidant attachment, but not anxious attachment, predicted lower family ritual meaning and family cohesion after 6 months. T2 family ritual meaning mediated the relationship between T1 avoidant attachment and T2 family cohesion. Conclusions Parents’ avoidant attachment may have a negative effect on family functioning in parents and children. Clinical intervention to address avoidant attachment or/and to promote family ritual meaning may help strengthen family ties.

Objective To examine the mediating role of stigma on the links between family cohesion and quality of life (QoL) in children with epilepsy and their parents. Participants were 192 families attending three Portuguese public hospitals. Children and parents completed self-report measures of family cohesion, stigma, QoL, and health-related QoL (HRQoL). Neurologists assessed clinical variables. Structural equation modeling within the framework of the actor-partner interdependence model was used. The final model showed a good fit to the data, explaining 43% and 35% of the QoL outcomes of children and parents, respectively. Family cohesion was positively linked to QoL outcomes, directly for children and parents, and indirectly for children only, by way of negative links with perceived stigma. At the dyadic level, parents' perceptions of family cohesion were positively associated with children's HRQoL. A routine screening of those patients experiencing poorer HRQoL should include the assessment of family relationships and stigma.

Objective Family rituals are associated with adaptive functioning in pediatric illness, including quality of life (QoL). This article explores the role of family cohesion and hope as mediators of this association in children with cancer and their parents. Methods Portuguese children with cancer (N ¼ 389), on- and off-treatment, and one of their parents completed self-report measures. Structural equation modeling was used to examine direct and indirect links between family rituals and QoL. Results When children and parents reported higher levels of family rituals, they also reported more family cohesion and hope, which were linked to better QoL. At the dyadic level, children’s QoL was related to parents’ family rituals through the child’s family cohesion. This model was valid across child’s age-group, treatment status, and socioeconomic status. Conclusions Family rituals are important in promoting QoL in pediatric cancer via family cohesion and hope individually and via family cohesion in terms of parent–child interactions.

This paper is a systematic review of 39 empirical studies on family routines and rituals in the context of a chronic condition of a family member. The search strategy encompassed a wide spectrum of chronic conditions affecting family members from childhood/adolescence to adulthood. Twenty quantitative, 13 qualitative, 3 mixed-methods, and 3 intervention studies published between 1995 and 2012 were reviewed. A conceptual framework of routines and rituals as key elements of family health was adopted, resulting in three main findings. First, a chronic condition in a family member impacted the frequency and nature of family's routines and rituals. Second, these whole-family interactions held important functions for individuals and families, constituting strategic resources in the condition's management and opportunities for emotional support exchanges, and providing the family with a sense of normalcy amid the challenges posed by chronic conditions. Third, family routines and rituals were linked to positive health and adaptation outcomes for both patients and family members. Implications for future research include the need for the distinction between routines and rituals against a conceptual background, use of validated assessment methods, and empirical examination of predictors of changes in routines and rituals throughout the course of the condition and of the mechanisms linking these family events to positive outcomes. Conclusions support the inclusion of routines and rituals in a family-centered care approach to the understanding and treatment of chronic conditions.

This study had two main objectives: first, to describe the social support and psychological maladjustment of children and adolescents with cerebral palsy (CP); and second, to test a mediation model where psychological maladjustment was hypothesized to mediate the link between social support and health-related quality of life (HRQL). In addition, the moderating role of gender and age was examined for this mediation model.Self- and proxy-report questionnaires on the aforementioned variables were administered to a sample of 96 children/adolescents with CP and 118 healthy controls, as well as one of their parents. Univariate and multivariate analyses of covariance were conducted to examine differences in social support and psychological maladjustment, respectively. PROCESS computational tool was used for path analysis-based mediation, moderation and moderated mediation analyses.Children/adolescents with CP reported lower levels of social support than their healthy peers, but no significant differences emerged in terms of their psychological maladjustment. For children/adolescents with CP, internalizing and externalizing problems were found to mediate the link between social support and HRQL, and these indirect effects were not conditional upon age or gender.Children and adolescents with CP are likely have more negative perceptions of social support, but not necessarily more psychological adjustment problems than their healthy, able-bodied peers. Results further suggest that interventions targeting social support perceptions may positively affect HRQL outcomes in children/adolescents with CP, through the improvement of internalizing and externalizing dimensions of their psychological adjustment.Social support perceptions are important intervention targets in psychosocial rehabilitation with children and adolescents with CP. Children and adolescents with CP do not necessarily present increased psychological maladjustment. Interventions targeting these children and adolescents' social support may promote their psychological adjustment and health-related quality of life. Developmental specificities, such as age and gender differences, should be considered when planning and implementing psychosocial interventions.

The present study investigated the role of connectedness to the family and school contexts on future orientation of New Zealand adolescents. Participants were 1774 young people (51.9% female) aged between 9 and 16 years at time 1 of the study, who reported their connectedness to family and school and their perceptions of future orientation at three times of measurement one year apart. Structural equation modelling was used to test the combined role of family and school connectedness on future orientation over time. Findings supported a multiple mediation model in that adolescents' connectedness to family and school predicted more positive perceptions of future orientation both directly and indirectly via the effect of the context variables on each other.

This longitudinal study examined the role of coping strategies and posttraumatic growth (PTG) on the psychological adjustment to breast cancer trajectory. The participants were 50 women assessed at the time of surgery (T1), during adjuvant treatment (T2) and six months after the end of treatment (T3). Women completed questionnaires assessing coping strategies, PTG and psychological adjustment (psychological quality of life, anxiety and depression). Results showed that the greatest impact of breast cancer on women's adjustment occurred at T1, when patients were significantly more anxious than in the other phases of the disease. The type of surgery and adjuvant treatment did not account for the course of PTG and adjustment. Coping through seeking social support and using cognitive strategies at T1 were linked to psychological quality of life and depression at T3 via PTG dimension of personal resources and skills at T2. Findings emphasise the value of promoting adaptive coping strategies and PTG in order to improve psychological adjustment in breast cancer patients.

This research examined the longitudinal links between perceptions of family rituals, family cohesion, and adolescents' well-being in 713 adolescent-parent/caregiver dyads in New Zealand. Parents (86% mothers) assessed family ritual meaning and family cohesion, and adolescents (10 to 16 years old at Time 1) reported on family cohesion and well-being at two times of measurement with a 1-year interval. Structural equation modeling (SEM) was used to assess stability coefficients, cross-lagged effects, and to test a multistep mediation model. Results showed longitudinal bidirectional effects between perceptions of family ritual meaning and family cohesion (for parents), and between perceptions of family cohesion from parents/caregivers and adolescents. In addition, family ritual meaning was found to be linked to adolescents' well-being indirectly via parents' and adolescents' family cohesion. Results support and expand previous research on the direct and indirect effects of family rituals in family and individual positive outcomes.