Family strain and its relation to psychosocial dysfunction in children and adolescents after liver transplantation

Abstract

Parental functioning is essential to children's development. Therefore, this cross-sectional single-center study examined the prevalence of family strain in 181 parents and its associations to psychosocial functioning in their children after LT. Median age at LT was one yr. Mean time elapsed since LT was 5.8 yr. The IFS, and the SDQ were applied to parents. Family strain in the present sample was comparable to that in the German normative group of families with a chronically ill or disabled child, but families of LT recipients showed a significantly higher financial impact, impact on coping, and impact on siblings (p < 0.001). Younger age of patients at survey, a more severe clinical course, child's restrictions, and financial losses following LT were determined as significant predictors of family strain (R(2) = 0.42). Parents reported less family strain after living-related compared with deceased donation. Family strain was significantly correlated to psychosocial dysfunction in children post-LT. Present findings demonstrate a risk of maladjustment to the post-LT condition in families. They emphasize the importance of psychological assessment of parents and patients during transplant and follow-up to ensure the best achievable long-term outcome of patients.

A systematic review of parent and family functioning in pediatric solid organ transplant populations

“…Splinter and colleagues recently demonstrated that family impact of disease is similar in families of children post‐liver transplant and those of children living at home with other chronic conditions . Kaller and colleagues also found that parents of liver transplant recipients, with a mean time since transplant of 5.8 years, reported that the burdens associated with their child's condition caused greater financial impact, impact on family coping, and impact on siblings when compared to a sample of families of children with other chronic illnesses/disabilities . These results have been replicated in parents of kidney transplant recipients who endorsed high levels of family burden post‐transplant, particularly in the areas of emotional functioning and worries …”

“…With regard to child psychological functioning, greater family conflict was associated with increased externalizing behavioral problems in children post‐kidney transplant and poorer child health‐related quality of life in a mixed SOT population . Similarly, greater family stress positively correlated with increased child emotional and behavioral problems in post‐liver and post‐heart transplant populations . Fewer adjustments to family routines and lifestyle (eg, moving homes, increasing supervision of child during play) following liver transplantation were associated with better child quality of life …”

“…Associations between younger child age at time of assessment with greater parenting stress, caregiver demands, and less family efficacy for completing necessary tasks have been reported. However, two studies were unable to detect relationships between child age, parent psychological functioning, parenting stress, and family functioning .…”

Health-Related Quality of Life after Pediatric Liver Transplantation: A Qualitative Analysis of the Perspectives of Health Care Providers

“…It is important to note that parental stress has been associated with impaired clinical outcomes after LT, including poor adherence to treatment and poor health outcomes [20]. Furthermore, findings of a recent study demonstrated significant associations between family strain in parents and emotional and behavioral disturbances in children with a LT, in keeping with HCP views on the relation between parental distress and increased coping difficulties in their children [25]. While it is intuitive to think that high level of distress in parents may lead to greater adaptation struggle in their children relative to adjustment to illness, greater understanding of how this emerges and what mediates outcomes is needed in further study.…”

Liver transplant and quality of life in the pediatric population

“…Research on chronic disease in childhood has shown that the child's disease is a risk factor for HRQOL impairment in parents and high levels of parental distress [19]. It has been our observation that pediatric recipient's QOL is directly affected by family structure and the ability of caregivers to cope with stress during the pretransplant waiting period and posttransplant adjustment period.…”