Poster #17 - Chronic Illness and Child Behavior Problems in Brazilian Families: the Mediation of Caregivers’ Mental Health

• In Event: Poster Session 08

Abstract

Childhood chronic illness is associated with deleterious effects on caregivers’ mental health and children’s socio-emotional development. This study investigated the mediation role of caregivers’ mental health on the association between children’s chronic illness and internalizing and externalizing problems in a sample of low socioeconomic status (SES) Brazilian families. A sample of 57 caregivers of children with chronic illness and a comparison group of 54 caregivers of healthy children participated in the study. Concerning the clinical characteristics of the chronic group, the mean time since diagnosis was 5.19 (SD = 3.36) years, and children were diagnosed with sickle cell disease (n = 11), type 1 diabetes mellitus (n = 11), asthma (n = 11) and other diagnoses such as juvenile idiopathic arthritis, and hepatitis C (n = 24). Data collection comprised family SES (Hollingshead criteria), caregivers’ sleep disturbances (PSQI), common mental disorders symptoms (SRQ-20), stress (LISS), and children’s internalizing and externalizing problems (CBCL/6-18). Figure 1 shows the mediation analysis results, performed using Structural Equation Modeling (SEM). Caregivers’ sleep disturbances (λ = 0.75), symptoms of common mental disorders (λ = 0.93), and stress (λ = 0.90) consisted of a unidimensional latent variable of general health problems (χ² [6] = 18.6, CFI = 0.97. TLI = 0.92, SRMS = 0.04, 1 – β = 0.88) that significantly mediated the association between chronic illness and children’s externalizing problems, and chronic illness and children’s internalizing problems. Children’s chronic illness was associated with higher levels of caregivers’ general mental health problems (B = 1.54, 95% CI = 0.42 – 2.83), which in turn were linked to higher externalizing problems (B = 1.91, 95% CI = 1.23 – 2.74) and internalizing problems (B = 2.32, 95% CI = 1.70 – 3.03). Two forms of mediation were found: (a) partial mediation of caregivers’ general mental health problems on children’s externalizing problems – since the direct effects of the chronic illness were significant (B = -3.92, 95% CI = -7.01 – -0.76); (b) total mediation of caregivers’ general mental health problems on children’s internalizing problems, indicated by the non-significant direct effects of chronic illness (B = -1.35, 95% CI = -1.32 – 4.04). The simple correlation between children’s chronic illness and externalizing problems was not significant. However, including the latent variable caregivers’ general mental health problems in the mediation model yielded a significant negative direct association between children’s chronic illness and externalizing problems. This result indicates that, after controlling for the effects of caregivers’ general mental health problems, part of the effect of children’s chronic illness was found to be significantly associated with higher levels of externalizing problems. In other words, if their caregivers’ mental health levels were relatively healthy, children from the chronic illnessgroup tended towards lower externalizing problems than healthy children (direct effect). However, mediated by higher levels of caregivers’ mental health problems, chronic illnesses were linked with increases in externalizing problems (indirect effect). Psychosocial intervention and policies addressing caregivers’ mental health may benefit the socio-emotional development of chronically ill children from low-income families.

Authors

• Antonio Carlos Santos da Silva, Federal University of Bahia

• Patricia Alvarenga, Federal University of Bahia
  Presenting Author

• Luísa Barros, University of Lisbon

• Euclides Jose de Mendonça Filho, McGill University