TY - JOUR A1 - Möller, B. A1 - Stegemann, T. A1 - Romer, Georg T1 - Psychosoziale Belastungen bei Kindern körperlich kranker Eltern: Perspektiven der seelischen Gesundheitsvorsorge JF - Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz N2 - Irrespective of their well-known increased risk for mental health problems, children of somatically ill parents are a clinically underserved as well as under-researched group. In this article, the authors introduce the epidemiologic and clinical relevance of this topic and present a theoretical framework for understanding the sequelae of a serious parental illness on minor-age children, based on family dynamics and developmental concepts. This is followed by a comprehensive review of current empirical studies in this field, with a special emphasis on results from a transnational European collaborative study (COSIP = Children of Somatically Ill Parents), which was coordinated by the last author. The most important recommendations from intervention concepts published to date are summarized. Some outlooks for clinical practice as well as future research are presented. KW - Adaptation KW - Psychological KW - Adolescent KW - Anxiety Disorders/epidemiology/prevention {\&} control/psychology KW - Child KW - Child of Impaired Parents/psychology KW - Child Reactive Disorders/epidemiology/prevention {\&} control/psychology KW - Preschool KW - Cross-Cultural Comparison KW - Cross-Sectional Studies KW - Depressive Disorder/epidemiology/prevention {\&} control/psychology KW - Developmental Disabilities/epidemiology/prevention {\&} control/psychology KW - Family Relations KW - Family Therapy KW - Female KW - Germany KW - Health Education KW - Health Surveys KW - Humans KW - Infant KW - Newborn KW - Pregnancy KW - Risk Factors KW - Somatoform Disorders/epidemiology/prevention {\&} control/psychology KW - Stress KW - Psychological/complications Y1 - 2008 U6 - http://dx.doi.org/10.1007/s00103-008-0542-5 SN - 1436-9990 VL - 51 SP - 657 EP - 663 ER - TY - JOUR A1 - Möller, Birgit A1 - Schreier, Herbert A1 - Li, Alice A1 - Romer, Georg T1 - Gender identity disorder in children and adolescents JF - Current problems in pediatric and adolescent health care KW - Adolescent KW - Child KW - Preschool KW - Female KW - Gender Identity KW - Homosexuality KW - Humans KW - Male KW - Parent-Child Relations KW - Psychosexual Development KW - Transsexualism Y1 - 2009 U6 - http://dx.doi.org/10.1016/j.cppeds.2009.02.001 VL - 39 SP - 117 EP - 143 ER - TY - JOUR A1 - Krattenmacher, Thomas A1 - Kühne, Franziska A1 - Führer, Daniel A1 - Ernst, Johanna A1 - Brähler, Elmar A1 - Herzog, Wolfgang A1 - Klitzing, Kai A1 - Flechtner, Hans-Henning A1 - Bergelt, Corinna A1 - Romer, Georg A1 - Möller, Birgit T1 - Kinder krebskranker Eltern - elterliches Coping, familiäres Funktionsniveau und psychosoziale Anpassung der Kinder JF - Praxis der Kinderpsychologie und Kinderpsychiatrie N2 - Children exposed to parental cancer have an increased risk of mental health problems. However, the parental illness itself and its features do not predict children's psychological adjustment. Parent- and family-related factors are more predictive for children's well-being and the incidence of psychopathological symptoms, respectively. This study focuses on parental ways of coping with illness from both, the ill and healthy parent's perspective, and the relationship with family functioning and children's adjustment. Results show a significant impact of parental coping styles on children's health-related quality of life and psychopathological symptoms and, furthermore, that this relationship is mediated by aspects of family functioning. This study support the importance of family systems approaches. Implications for further studies and practical issues are discussed. KW - Adaptation KW - Psychological KW - Adolescent KW - Adult KW - Child KW - Child of Impaired Parents/psychology KW - Preschool KW - Family Relations KW - Female KW - Germany KW - Humans KW - Male KW - Neoplasms/psychology KW - Parents/psychology KW - Quality of Life/psychology KW - Social Adjustment KW - Surveys and Questionnaires Y1 - 2012 U6 - http://dx.doi.org/10.13109/prkk.2012.61.6.447 SN - 0032-7034 VL - 61 SP - 447 EP - 462 ER - TY - JOUR A1 - Bergelt, Corinna A1 - Ernst, Johanna Christine A1 - Beierlein, Volker A1 - Inhestern, Laura A1 - Holes, Sarah A1 - Möller, Birgit A1 - Romer, Georg A1 - Koch, Uwe T1 - Reaktive Veränderungen in Befinden und Verhalten von Kindern bei elterlicher Krebserkrankung--Ergebnisse einer epidemiologischen Patientenbefragung JF - Praxis der Kinderpsychologie und Kinderpsychiatrie N2 - Children of cancer patients are at risk for developing psychological symptoms. The parental appraisal of the child's psychological condition is a key variable for the utilization of child-centred psychosocial services. This study aimed at the systematic analysis of parental appraisals of changes in the emotional condition or behaviour of their children. We conducted an epidemiologic survey with a sample size of 1,809 patients with different cancer diagnoses, giving information about 2,581 children aged 21 years or younger at time of diagnosis. Quantitative information on children's distress during the disease and on changes in psychological condition or behaviour and qualitative information on the kind of changes were analysed. About half of the children were considered to be psychologically strongly affected during the disease. For about 25 % negative changes in psychological condition or behaviour are reported, positive changes are reported for 20 % of the children. Negative changes are most frequently described in young children (up to five years), positive changes are most frequently described in young adults (18 to 21 years). The results indicate that from the cancer parent's view many children are substantially distressed. Thus, the implementation of additional preventive psychosocial services seems reasonable and necessary. KW - Adolescent KW - Adult KW - Child KW - Child Behavior Disorders/diagnosis/epidemiology/psychology KW - Child of Impaired Parents/psychology KW - Child Reactive Disorders/diagnosis/epidemiology/psychology KW - Preschool KW - Cross-Sectional Studies KW - Female KW - Germany KW - Health Surveys KW - Humans KW - Infant KW - Male KW - Middle Aged KW - Neoplasms/epidemiology/psychology KW - Personality Assessment KW - Resilience KW - Psychological KW - Young Adult Y1 - 2012 U6 - http://dx.doi.org/10.13109/prkk.2012.61.6.378 SN - 0032-7034 VL - 61 SP - 378 EP - 395 ER - TY - JOUR A1 - Krattenmacher, Thomas A1 - Kühne, Franziska A1 - Führer, Daniel A1 - Beierlein, Volker A1 - Brähler, Elmar A1 - Resch, Franz A1 - Klitzing, Kai V. A1 - Flechtner, Hans-Henning A1 - Bergelt, Corinna A1 - Romer, Georg A1 - Möller, Birgit T1 - Coping skills and mental health status in adolescents when a parent has cancer: a multicenter and multi-perspective study JF - Journal of psychosomatic research N2 - OBJECTIVE Parental cancer increases the risk of psychosocial problems in adolescents. We investigated the frequency and efficacy of adolescents' coping strategies and relationships between those strategies and mental health status. Age and gender differences regarding coping and mental health were also investigated. METHODS In total, 214 adolescents from 167 families participated in a cross-sectional, multicenter study. All participants were recruited from standard oncological care. Among the participants, 52% utilized a child-centered intervention program. Adolescents' coping skills were measured using KIDCOPE. Mental health status was rated by adolescents and parents by the SDQ for symptomatology and the KIDSCREEN for well-being. RESULTS We found that 29% of the adolescents showed emotional and behavioral problems. We found gender differences in mental health status but not in coping. Adolescents used a broad spectrum of coping strategies. Active problem-solving, distraction, acceptance, wishful thinking and seeking social support were the most frequently used coping strategies. The utilization of certain coping skills was mediated by their perceived efficacy. Problem-focused or approach-oriented coping strategies generally are associated with better mental health, while avoidance-oriented coping are associated with worse mental health. Emotion-focused coping was associated with both lower and higher mental health. CONCLUSION The strategies used by adolescents to cope with parental cancer are associated with their mental health. Problem-solving and approach-oriented coping strategies should be facilitated by psychological interventions regardless of age and gender. Age and gender differences in adolescents' mental health should be further investigated because these differences are not explained by differences in coping strategies. KW - Adaptation KW - Psychological/classification/physiology KW - Adolescent KW - Adult KW - Age Factors KW - Aged KW - Child KW - Cross-Sectional Studies KW - Female KW - Humans KW - Male KW - Mental Disorders/epidemiology/etiology KW - Middle Aged KW - Neoplasms/psychology KW - Parents KW - Psychiatric Status Rating Scales Y1 - 2013 U6 - http://dx.doi.org/10.1016/j.jpsychores.2012.10.003 VL - 74 SP - 252 EP - 259 ER - TY - JOUR A1 - Kühne, Franziska A1 - Haagen, Miriam A1 - Baldus, Christiane A1 - Diareme, Stavroula A1 - Grether, Andrea A1 - Schmitt, Florence A1 - Stanescu, Dan A1 - Stöckl, Margit A1 - Thastum, Mikael A1 - Möller, Birgit A1 - Romer, Georg T1 - Implementation of preventive mental health services for children of physically ill parents: experiences in seven European countries and health care systems JF - General hospital psychiatry N2 - OBJECTIVE Parental physical disease is a family issue, but families' minor children are seldom considered. The current study analyzed experiences with implementation of counseling for families with physically ill parents and minor children during a European multisite pilot project. METHOD Implementation protocols of seven European partner centers collaborating in a joint research project were analyzed by Mayring's qualitative content analysis. Both an inductive approach and a deductive approach were chosen. Satisfaction of families and therapists was considered based on information from three partner centers. RESULTS Satisfaction with counseling was rather high. Mentioned problems referred to aspects related to liaison partners, family-related aspects and physicians' concerns. Recommendations related to contacting families, liaising with other professions, implementing counseling together with a research project, and training. Results are integrated in the current dissemination literature. CONCLUSION Successful implementation was mostly determined by aspects of interdisciplinary cooperation and communication, perceived relative advantage and organizational premises. With regard to this kind of innovative child-centered family mental health services, top-down and bottom-up implementation strategies should be combined, and strategies of maintenance and sustainability should be considered from the very beginning. KW - Adolescent KW - Child KW - Child Health Services KW - Child of Impaired Parents/psychology KW - Preschool KW - Counseling KW - Europe KW - Humans KW - Mental Health Services KW - Patient Satisfaction KW - Pilot Projects KW - Preventive Health Services/organization {\&} administration KW - Program Development KW - Qualitative Research KW - Surveys and Questionnaires Y1 - 2013 U6 - http://dx.doi.org/10.1016/j.genhosppsych.2012.10.005 VL - 35 SP - 147 EP - 153 ER - TY - JOUR A1 - Kühne, Franziska A1 - Krattenmacher, Thomas A1 - Bergelt, Corinna A1 - Beierlein, Volker A1 - Herzog, Wolfgang A1 - V Klitzing, Kai A1 - Weschenfelder-Stachwitz, Heike A1 - Romer, Georg A1 - Möller, Birgit T1 - There is still so much ahead of us - Family functioning in families of palliative cancer patients JF - Families, systems & health : the journal of collaborative family healthcare N2 - Adopting a systems approach, parental cancer has its impact on patients, spouses, and dependent children. The purpose of the current study was to examine family functioning dependent on parental disease stage and on family member perspective in families of cancer patients with adolescent children. The cross-sectional study was conducted within a German multisite research project of families before their first child-centered counseling encounter. The sample comprised individuals nested within N = 169 families. Analyses performed included analysis of covariance (ANCOVA) and intraclass correlation. Open answers were analyzed following quantitative content analysis procedures. Between 15% and 36% of family members reported dysfunctional general functioning scores. Parents indicated more dysfunctional scores on the Family Assessment Device scale Roles, and adolescents more dysfunctional Communication scores. Regarding assessment of family functioning, there was higher agreement in families with parents in a palliative situation. For adolescents with parents in palliation, incidents because of the disease tend to become more dominant, and spending time with the family tends to become even more important. As our study pointed out, parental cancer, and especially parental palliative disease, is associated with both perceived critical and positive aspects in family functioning. Supporting families in these concerns as well as encouraging perceptions of positive aspects are important components of psycho-oncological interventions for families with dependent children. KW - Adolescent KW - Adult KW - Aged KW - Analysis of Variance KW - Child KW - Child of Impaired Parents/psychology KW - Cross-Sectional Studies KW - Family Relations KW - Female KW - Germany KW - Humans KW - Male KW - Middle Aged KW - Neoplasms KW - Palliative Care KW - Self Report Y1 - 2013 U6 - http://dx.doi.org/10.1037/a0032274 VL - 31 SP - 181 EP - 193 ER - TY - JOUR A1 - Krattenmacher, Thomas A1 - Kühne, Franziska A1 - Halverscheid, Susanne A1 - Wiegand-Grefe, Silke A1 - Bergelt, Corinna A1 - Romer, Georg A1 - Möller, Birgit T1 - A comparison of the emotional and behavioral problems of children of patients with cancer or a mental disorder and their association with parental quality of life JF - Journal of psychosomatic research N2 - OBJECTIVE To compare the emotional and behavioral problems of children of patients suffering from cancer or a mental disorder and their association with parental quality of life. METHODS A total of 223 children from 136 families and their 160 parents were investigated from multiple perspectives in a cross-sectional study. The consistency of different adjustment reports between family members was examined. Through mixed models, the differences between parental HRQoL and the children's symptomatology were studied with regard to the type of parental illness. The prediction of children's adjustment through parental HRQoL was further examined. Additionally, gender and age of the children were considered. RESULTS Half of the children exhibited psychosocial problems. Gender and age differences were independent of the type of parental disease. In families with parental cancer, the reports of children's adjustment were more consistent between family members than in families where a parental mental disorder was present. We found differences in HRQoL between families with mentally ill parents and those with parental cancer patients. Specifically, the healthy partners of mentally ill parents showed worse HRQoL compared with healthy partners of cancer patients. Healthy parents' reduced HRQoL was associated with worse adjustment in their children, regardless of the type of parental illness, but this result was not found for ill parents. CONCLUSION Family members confronted with parental cancer or mental disorders are more burdened compared with those from the normal population, independently of the type of disease. Our results indicate that the type of a parental disease has no direct effect on children's adjustment. However, there are disease-specific effects on parental HRQoL, which are associated with children's adjustment. KW - Adolescent KW - Affective Symptoms/psychology KW - Child KW - Female KW - Humans KW - Male KW - Mental Disorders/psychology KW - Neoplasms/psychology KW - Parent-Child Relations KW - Parents/psychology KW - Quality of Life Y1 - 2014 U6 - http://dx.doi.org/10.1016/j.jpsychores.2013.11.020 VL - 76 SP - 213 EP - 220 ER - TY - JOUR A1 - Bultmann, Johanna Christine A1 - Beierlein, Volker A1 - Romer, Georg A1 - Möller, Birgit A1 - Koch, Uwe A1 - Bergelt, Corinna T1 - Parental cancer: Health-related quality of life and current psychosocial support needs of cancer survivors and their children JF - International journal of cancer N2 - The presence of cancer and additional parental responsibilities can increase strain for individual patients as well as for their children. The construct of health-related quality of life (HRQL) is appropriate to measure a combination of physical, mental and social consequences as a result of disease. However, previous research has merely focused on symptom checklists. This study addresses the following questions: (i) does HRQL in children and their parents with cancer differ compared to the general population? (ii) Are there any variables that are associated with HRQL in children? (iii) What are current psychosocial support needs? A population-based survey of 976 survivors (<6 years post diagnosis) with minor children between 6 and 18 years (n = 1,449) was conducted with two German cancer registries. HRQL was assessed using SF-8 (survivors) and Kidscreen (children). The results were compared to normative populations, and predictors associated with HRQL in children were evaluated within a multilevel model. We found that the HRQL in children was better compared to the norm. Only children with support needs had worse HRQL. Older age, having a mother with cancer, having a parent not living together with a partner, and worse parental physical and mental health influenced HRQL in children. Illness characteristics were irrelevant. Even with a mean of 3.5 years after diagnosis, survivors had lower physical and mental health compared to the norm. Our findings reinforce the need for health professionals to pay attention to younger patients and their children. Even years after diagnosis, life might not have returned to normal. KW - Adolescent KW - Adult KW - Child KW - Child Health Services KW - Cross-Sectional Studies KW - Female KW - Follow-Up Studies KW - Health Services Needs and Demand KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Needs Assessment KW - Neoplasms/psychology KW - Parents/psychology KW - Prognosis KW - Psychology KW - Quality of Life KW - Social Support KW - Stress KW - Psychological KW - Surveys and Questionnaires KW - Survivors/psychology Y1 - 2014 U6 - http://dx.doi.org/10.1002/ijc.28905 VL - 135 SP - 2668 EP - 2677 ER - TY - JOUR A1 - Becker, Inga A1 - Gjergji-Lama, Voltisa A1 - Romer, Georg A1 - Möller, Birgit T1 - Merkmale von Kindern und Jugendlichen mit Geschlechtsdysphorie in der Hamburger Spezialsprechstunde JF - Praxis der Kinderpsychologie und Kinderpsychiatrie N2 - Given the increasing demand for counselling in gender dysphoria in childhood in Germany, there is a definite need for empirical data on characteristics and developmental trajectories of this clinical group. This study aimed to provide a first overview by assessing demographic characteristics and developmental trajectories of a group of gender variant boys and girls referred to the specialised Gender Identity Clinic in Hamburg. Data were extracted from medical charts, transcribed and analysed using qualitative content analysis methods. Categories were set up by inductive-deductive reasoning based on the patients' parents' and clinicians' information in the files. Between 2006 and 2010, 45 gender variant children and adolescents were seen by clinicians; 88.9% (n = 40) of these were diagnosed with gender identity disorder (ICD-10). Within this group, the referral rates for girls were higher than for boys (1:1.5). Gender dysphoric girls were on average older than the boys and a higher percentage of girls was referred to the clinic at the beginning of adolescence (> 12 years of age). At the same time, more girls reported an early onset age. More girls made statements about their (same-sex) sexual orientation during adolescence and wishes for gender confirming medical interventions. More girls than boys revealed self-mutilation in the past or present as well as suicidal thoughts and/or attempts. Results indicate that the presentation of clinically referred gender dysphoric girls differs from the characteristics boys present in Germany; especially with respect to the most salient age differences. Therefore, these two groups require different awareness and individual treatment approaches. KW - Adolescent KW - Age Factors KW - Child KW - Preschool KW - Cooperative Behavior KW - Cross-Sectional Studies KW - Female KW - Gender Identity KW - Germany KW - Gonadal Steroid Hormones/therapeutic use KW - Humans KW - Interdisciplinary Communication KW - Male KW - Outpatient Clinics KW - Hospital KW - Psychotherapy KW - Puberty/drug effects/psychology KW - Referral and Consultation KW - Self Mutilation/epidemiology/psychology KW - Sex Factors KW - Suicidal Ideation KW - Transsexualism/diagnosis/epidemiology/psychology/therapy Y1 - 2014 SN - 0032-7034 VL - 63 SP - 486 EP - 509 ER -