Divorce and physical health: A three-level meta-analysis.

Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between individuals' physical health and psychological adjustment, potential post-divorce health problems are of concern. Yet, empirical evidence is lacking on the magnitude of the overall physical health risk after divorce, on possible differences across specific pathologies, and on factors that may increase or reduce this risk. The current meta-analysis addresses these issues. We identified 94 studies including u = 248 relevant effect sizes, based on N = 1,384,507 participants. Generally, compared to married individuals, divorcees showed significantly worse self-reported health (OR = 1.20, [1.08-1.33]), experienced more physical symptoms (OR = 1.34, [1.17-1.53]), and had a higher risk for diabetes (OR = 1.18 [1.05-1.33]), joint pathologies (OR = 1.24, [1.14-1.34]), cardiovascular (OR = 1.24, [1.09-1.41]) and cerebrovascular conditions (OR = 1.31, [1.14-1.51]), and sexually transmitted diseases (OR = 2.48, [1.32-4.64]). However, they had no increased risk of hypertension, hypercholesterolemia, cancer and cancer development, disabilities or limitations, or cognitive pathologies. Nor did divorcees significantly differ from married individuals when aggregating all pathologies to measure overall physical health problems (OR = 1.14, [0.85 to 1.54]). Yet, moderation analyses revealed that being female, unemployed, childless, or having a lower education constitutes a higher risk for overall physical health problems after divorce. The same applied to having a heavy alcohol consumption, lack of exercise, and being overweight. Our meta-analysis shows that divorcees are at heightened risk of certain pathologies, with sexually transmitted diseases as a particular post-divorce hazard. These findings call for more awareness among counsellors and physicians on divorcees' health conditions and the characteristics that make divorcees even more vulnerable to health problems.

The efficacy of postdivorce intervention programs for children: A meta-analytical review.

Preventive postdivorce interventions aim to help children cope with divorce and promote their adjustment. Nevertheless, questions remain regarding the concrete outcomes of these interventions and the intervention characteristics that influence them. This meta-analysis of 30 studies analyzes the efficacy of postdivorce interventions on children's symptomatology, personal resources, and adaptation to divorce. Likewise, it explores whether the intervention impacts the putative mediators from the family context and whether the characteristics of the studies themselves also influence the results. Using a data set of N = 4344 individuals, 258 effect sizes were calculated. Random effects analyses evidenced the impact of the interventions on specific variables instead of on children's global adjustment. There were no significant effects on children's mental health outcomes, and none of these effects were qualified by the moderators that were examined. Preventive postdivorce interventions had significant effects, specifically on children's divorce adjustment and self-esteem. The study of the moderators found that the interventions were generally homogeneous, and only one of the 20 moderators examined had a significant effect. Based on children's age, the interventions had an impact on family functioning only when they involved younger children, but this result should be interpreted with caution due to the small sample of studies. This meta-analysis provides evidence of the relevance of postdivorce interventions to critical variables as well as information about the role of the intervention characteristics in the effects and makes suggestions for future research on divorce interventions that encompass both practical and empirical developments.

Parental Perception of Child Vulnerability in Parents of Young Children.

OBJECTIVE: Parental perception that one's child may be vulnerable to a threatening illness appears to be negatively associated with the child's socioemotional development. However, there are no studies that have analyzed the association of these dysfunctional parental perceptions on the emotional development of children who have not suffered a previous serious illness. The main objective of the present study was to study the relationship between parental perception of child vulnerability (PPCV) and children's socioemotional development, hypothesizing that PPCV is associated both directly and indirectly with children's socioemotional development through parental reflective functioning and parental competence. METHODS: The study involved 433 mothers and 113 fathers of infants between 0 and 3 years. RESULTS: PPCV was negatively associated with children's socioemotional development. Likewise, PPCV was indirectly and positively related to children's socioemotional development through the dimension of Interest and Curiosity of parental reflective functioning and parental competence. CONCLUSIONS: The literature has shown that parental dysfunctional perceptions about the health of their children can be negatively associated with children's socioemotional development. However, if these concerns are associated with increased interest and curiosity about the mental states of the child, this may actually promote the child's socioemotional development.

Cost-Benefit Analysis of an Intervention in Divorced Parents: Implications for Society, Public Administrations and Family Visitation Centers.

Families going through conflictive divorce processes are at increased risk of developing mental health problems. The Egokitzen program is a group intervention for parents who have undergone a divorce process, funded by the public administration. Budgetary constraints cause funding institutions to be interested in the effectiveness and economic efficiency of these programs. Therefore, the objective of this research is to carry out an efficiency analysis of the Egokitzen program, implemented by family visitation centers in Spain, through a cost-benefit analysis, to determine whether the positive impact on symptomatology (measured using CBCL and SCL-90 instruments) is translated into a positive economic impact for society. A sample of 382 parents participated. Costs will be first identified and valued; secondly, benefits achieved with the program will be identified through a prevalence analysis and, finally, the cost-benefit comparative analysis will be carried out. Additionally, a sensitivity analysis will be performed. The results obtained in the analysis indicate that for every euro spent on this program, the public administration and society save 3.10 euros in future interventions through medical costs and productivity losses. The study has practical implications for public administration, organizations, and the family visitation centers that implement the program.

Custody and Child Symptomatology in High Conflict Divorce: An Analysis of Latent Profiles.

BACKGROUND: There is much controversy about the impact of joint physical custody on child symptomatology in the context of high interparental conflict. In this study we analyzed child symptomatology with person-centered methodology, identifying differential profiles, considering post-divorce custody, parental symptomatology, and coparenting variables. We examined the association between these profiles and child symptomatology, as well as the mediating role of parenting in that association. METHOD: The participants were 303 divorced or separated Spanish parents with high interparental conflict. We used the study of latent profiles and the INDIRECT procedure in Mplus. We also controlled for the variables age and number of children, new partners, frequency of the relationship with the ex-partner, time elapsed since the divorce, and gender of the parent. RESULTS: From the parents' perspective, the profile characterized by low parental symptomatology and high coparenting, regardless of the type of custody, was related to children exhibiting less somatic, anxious, and depressive symptomatology, and aggressive behavior. The mediating role of parenting was also identified. CONCLUSIONS: Parental symptomatology, coparenting, and parenting are essential for understanding post-divorce child symptomatology and the study highlights importance of person-centered multidimensional models.

A Pilot Study of Younger Sibling Adaptation: Contributions of Individual Variables, Daily Stress, Interparental Conflict and Older Sibling's Variables.

Older siblings are powerful socialization agents, playing a significant role in the sociocognitive, social, and emotional development of their younger siblings. However, there are few clues about the variables that explain younger sibling's adaptation. The objective of this pilot study was to identify the determinants of younger siblings' adaptation and to analyze the role played by personal, sibling, family and older siblings' variables using 50 dyads of siblings aged between 7 and 18 years. The variables considered were the sibling relationships and the maladaptation of older siblings, and individual (sex, number of siblings, extroversion, and agreeableness) and contextual variables (interparental conflict, daily stress) were controlled. Hierarchical multiple regressions provided evidence in favor of the model that analyzed the younger siblings' maladaptation to school, showing positive associations both with the older siblings' level of school maladaptation and with sibling conflict. In addition, the study highlighted the relevance of the trait of agreeableness and of family stress in the adaptation of younger siblings.

Measuring Perceptions of the Therapeutic Alliance in Individual, Family, and Group Therapy from a Systemic Perspective: Structural Validity of the SOFTA-s.

This study examined the multidimensional structure of the client and therapist versions of the self-report measure, System for Observing Family Therapy Alliances (SOFTA-s; Friedlander, Escudero, & Heatherington, Therapeutic alliances in couple and family therapy: An empirically informed guide to practice. Washington, DC: American Psychological Association, 2006) across three distinct therapeutic modalities (individual, family, group). Specifically, we investigated whether the originally theorized model of four first-order factors (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System, and Shared Sense of Purpose within the Family) would be reflected in a second-order factor (Therapeutic Alliance). The sample included 105 therapists who worked with 858 clients (165 individuals, 233 families, and 43 groups) in several Spanish community agencies. To control for dependent data, we used multilevel modeling. Results of the multilevel confirmatory factor analyses showed adequate reliabilities, fit indices, and factor loadings across the three therapy contexts for both versions of the measure (client and therapist). Adequate measurement invariance was also found across respondents and therapy modalities. Taken together, these results support the structural validity of the SOFTA-s, a brief and flexible self-report alliance measure that can be used reliably in clinical practice as well as in studies of individual, family, and group therapy.

Este estudio examinó la estructura multidimensional de las versiones del paciente y del terapeuta de la herramienta de medición por autoinforme, "Sistema de Observación de Alianza Terapéutica en Intervención Familiar" (System for Observing Family Therapy Alliances, SOFTA-s; Friedlander, Escudero, & Heatherington, 2006) entre tres modalidades terapéuticas diferentes (individual, familiar, grupal). Específicamente, investigamos si el modelo teorizado originalmente de cuatro factores de primer orden (participación en el proceso terapéutico, conexión emocional con el terapeuta, seguridad dentro del sistema terapéutico y un objetivo en común dentro de la familia) se reflejaría en un factor de segundo orden (alianza terapéutica). La muestra consistió en 105 terapeutas que trabajaron con 858 pacientes (165 individuos, 233 familias y 43 grupos) en varios organismos de comunidades españolas. Para evaluar los datos dependientes, utilizamos el modelo multinivel. Los resultados de los análisis factoriales confirmatorios multinivel demostraron fiabilidades, índices de ajuste y cargas factoriales adecuadas entre los tres contextos de terapia para ambas versiones de la herramienta de medición (paciente y terapeuta). También se halló una invariancia de medición adecuada entre los encuestados y las modalidades de terapia. En conjunto, estos resultados respaldan la validez estructural del SOFTA-s, una herramienta de medición de la alianza breve y flexible por autoinforme que puede utilizarse de manera fiable en la práctica clínica, así como en estudios de la terapia individual, familiar y grupal. Este estudio examinó la estructura multidimensional de las versiones del paciente y del terapeuta de la herramienta de medición por autoinforme, "Sistema de Observación de Alianza Terapéutica en Intervención Familiar" (System for Observing Family Therapy Alliances, SOFTA-s; Friedlander, Escudero, & Heatherington, 2006) entre tres modalidades terapéuticas diferentes (individual, familiar, grupal). Específicamente, investigamos si el modelo teorizado originalmente de cuatro factores de primer orden (participación en el proceso terapéutico, conexión emocional con el terapeuta, seguridad dentro del sistema terapéutico y un objetivo en común dentro de la familia) se reflejaría en un factor de segundo orden (alianza terapéutica). La muestra consistió en 105 terapeutas que trabajaron con 858 pacientes (165 individuos, 233 familias y 43 grupos) en varios organismos de comunidades españolas. Para evaluar los datos dependientes, utilizamos el modelo multinivel. Los resultados de los análisis factoriales confirmatorios multinivel demostraron fiabilidades, índices de ajuste y cargas factoriales adecuadas entre los tres contextos de terapia para ambas versiones de la herramienta de medición (paciente y terapeuta). También se halló una invariancia de medición adecuada entre los encuestados y las modalidades de terapia. En conjunto, estos resultados respaldan la validez estructural del SOFTA-s, una herramienta de medición de la alianza breve y flexible por autoinforme que puede utilizarse de manera fiable en la práctica clínica, así como en estudios de la terapia individual, familiar y grupal.

Transnational links and family functioning in reunited Latin American families: Premigration variables' impact.

OBJECTIVES: Transnational ties refer to the affective, communicative, and economic relationships that migrant families build between the societies of origin and destination. Investigations of such ties are very scarce. In the present study, focused on Latin American migrant women, transnational ties are considered a protective factor of family functioning, conditioned by premigratory variables. The working hypothesis is that increased frequency of reunited mothers' communication with and remittances to their children during the period of separation prior to the reunion will be linked to better communication, cohesion, flexibility, satisfaction, and family resources, according to the reunited mothers' perception. METHOD: The sample consisted of 81 mothers of Latin American reunited families. Most of them (61.7%) have 2 or 3 children and 75.3% have already reunited all of their children in Bizkaia. The frequency of communication between family members in the societies of origin and destination and the frequency of remittances were the transnational variables. To observe family functioning, we used the Circumplex Model. A mediation model was tested through structural equation modeling. RESULTS: The results of the study confirmed the mediator role of the transnational variables, especially the frequency of transnational communications, partially or fully moderating the impact of the premigratory variables, and positively associated with family functioning, in terms of greater cohesion, flexibility, communication, satisfaction, and perception of resources. CONCLUSIONS: This study has highlighted the role of these ties, which lead to more functional family dynamics. It is necessary to promote new forms of transnational communication that favor subsequent family reunification. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychometrics of the SCL-90-R and Development and Testing of Brief Versions SCL-45 and SCL-9 in Infertile Couples.

BACKGROUND: Although infertile couples are mentally healthy, dealing with infertility and assisted reproductive technology (ART) treatment is usually associated with psychological distress. It would therefore be useful to have short, multidimensional instruments to be able to identify people who present more intense emotional reactions and follow up their emotional distress throughout the ART. OBJECTIVES: The goals of the study were to analyze the psychometric adequacy of the original 90-item version of the Symptom Checklist (SCL-90) in a sample of Spanish women and their partners undergoing ART, as well as to develop and analyze two brief versions of the SCL-90, given the absence of adequate short versions for this population. METHODS: A cross-sectional design for patients and their partners in the process of ART through in vitro fertilization was used. The two brief scales were obtained, which took into account the levels of variance explained by the items and confirmatory factor analysis. RESULTS: Two brief instruments were developed. The first, with 45 items (SCL-45-I Infertility), includes nine subdimensions: Somatization, Interpersonal Sensitivity, Obsessive-Compulsive Disorder, Depression, Anxiety, Hostility, Paranoid Ideation, Phobic Anxiety, and Psychoticism. The second instrument contains nine items (SCL-9-I or Global Severity Index [GSI]), one item for each dimension. Both instruments were psychometrically adequate (SCL-45-I: χ/df = 7.24, RMSEA = .057, 95% CI [.056, .059], CFI = .97, NNFI = .97, SRMR = .049; SCL-9-I: χ/df = 9.66, RMSEA = .068, 95% CI [.061, .076], CFI = .97, NNFI = .96, SRMR = .035). Measurement invariance analysis by gender was conducted, and the instruments were shown to be suitable for both men and women. DISCUSSION: The suitability of the SCL-90-R for use in ART was verified, and two valid instruments-useful and easy to use for nurses, psychologists, and other care providers-were developed.

Marital functioning and treatment outcome in couples undergoing assisted reproduction.

AIM: To investigate the relationship between the quality of marital functioning and communication, individual psychological symptomatology, and pregnancy achievement in couples undergoing assisted reproduction. BACKGROUND: The results concerning marital functioning and the feasibility of pregnancy yield contradictory outcomes and the quality of the relationship of the couple undergoing assisted reproduction has not been analysed from systemic models. Our hypothesis is that when undergoing assisted reproduction treatment (ART), the couple's functioning and communication will be related to the pregnancy rate. DESIGN: This study employs a cross-sectional design with couples receiving ART. METHODS: Spanish heterosexual couples (N = 185) completed the self-report instruments. The data were collected from 2010 - 2015. All the couples completed at least one treatment process, or at least 1 year had gone by since beginning the treatment. RESULTS: The association between couple relationship quality and the individual psychological symptomatology experienced during the assisted reproduction process was confirmed in men and women. Although both members of the couple experienced an increase of symptomatology, only men's symptomatology was statistically significantly linked to pregnancy achievement. CONCLUSION: It is necessary to support the couple from the assisted reproduction centres, promoting cohesion, flexibility, and communication in the relationship. The intervention process should also be understood from a systemic perspective; that is, considering dyadic transactions as a systemic unit. Two aspects seem to be especially relevant for clinical nurses in ART: (a) the man's role is crucial for treatment success; (b) the woman's communication is crucial to the process.

A single Spanish version of maternal and paternal postnatal attachment scales: validation and conceptual analysis.

BACKGROUND: Postnatal bonding constitutes a major process during the postpartum period, and there is evidence that bonding difficulties have negative consequences for parents' mental health and the child's development. However, the conceptualization of postnatal bonding presents inconsistencies, as well as problems in having instruments that encompasses the father figure. The objective was to adapt the maternal postnatal attachment scale (MPAS) and the paternal postnatal attachment scale (PPAS) to Spanish, to evaluate its validity and reliability and to analyze the construct dimensionality of both questionnaires from a gender perspective. METHODS: Instrumental design. In 2016-2017, a sample of 571 mothers and 376 fathers, with children between 6 and 11 months of age, responded to the Spanish version of MPAS and PPAS, respectively. After a process of translation-back-translation of the instrument, we empirically analyzed the internal consistency (Cronbach alpha, composite reliability (CR)) construct and concurrent validity (with regard to postpartum depression and dyadic adjustment). Additionally, we studied the instrument's content validity, using the Delphi methodology; and the differential analysis in both samples (mothers and fathers), examining the invariance. RESULTS: A short version of 15 items was obtained, common for mothers and fathers. The results of the Delphi methodology showed a 100% inter-judge agreement, highlighting the absence of differences in the adequacy of the items as a function of the parents' gender. Confirmatory factor analysis showed a good fit of three original factors proposed by the authors. The global Cronbach alpha coefficients in the total sample were adequate (mothers, 0.70; fathers, 0.78); and Cronbach alpha of each dimension in the case of mothers was 0.50 (Quality of bonding), 0.55 (Absence of hostility), and 0.60 (Pleasure in interaction); in the case of fathers, it was respectively 0.54, 0.64, and 0.72. CR of each dimension were: quality of bonding, 0.74 in mothers and 0.80 in fathers; absence of hostility, 0.93 in mothers and 0.94 in fathers; pleasure in interaction, 0.83 in mothers and 0.90 in fathers. With regard to the analysis of group invariance, the results revealed empirical evidence of configural and metric invariance. Concurrent validity showed moderate negative correlations for postnatal depression (mothers, r = -0.41, p < 0.001; fathers, r = -0.38, p < 0.001), and positive correlations for dyadic adjustment (mothers, r = 0.39, p < 0.001; fathers, r = 0.44, p < 0.001). DISCUSSION: A new version of the instrument was generated, with good psychometric properties, adequate for use both with mothers and with fathers. This scale helps evaluate postnatal maternal and paternal bonding, allowing to study it from within the family system, a necessary step forward to advance perinatal mental health.

Parental perception of child vulnerability and parental competence: The role of postnatal depression and parental stress in fathers and mothers.

INTRODUCTION: Parents' perception that their child may be vulnerable to serious life-threatening illnesses can have negative effects on how they exercise their parenting. No studies have yet been carried out on parent´s perception of their child's vulnerability, when the child has not suffered a severe illness. This study tries to analyze the relationship between parent´s perception of their children´s vulnerability and parental competence, and analyzes the mediating role of postnatal depression and parental stress. METHOD: The study was carried out on mothers and fathers of full-term infants who did not have any serious illnesses. A total of 965 people (385 fathers and 580 mothers) participated in the study. RESULTS: The results revealed an association between parental perception of their child's vulnerability and parent's perception of parental competence through depression and parental stress. However, this association was different for fathers and mothers. CONCLUSION: The variable of perception of child's vulnerability was a relevant factor to understand parental competence.

Metric Goodness of the Adult Prosocialness Scale. Comparative Study of Italy and Spain.

The main goal of the study is to analyze the metric goodness of the Spanish version of the Adult Prosocialness Scale (Caprara, Steca, Zelli, & Capanna, 2005). Analysis of construct and concurrent validity in two similar samples of young adults, a Spanish sample (target of the adaptation) and an Italian sample (source language), revealed the adequacy of the Spanish version of instrument, with adequate fit of the model in the Spanish group, χ2(96) = 405.28, p = .001, RMSEA = .071, CFI = .94, GFI = .93, and the Italian group χ2(97) = 224.5, p = .001, RMSEA = .075, CFI = .91, GFI = .90. The results also replicated the adequacy of the instrument found in the Italian sample, as the configural and metric invariance was verified in both groups. Analyses of benevolent and power values related to prosociality and differences between genders supported the validity of the scale. In short, the present study confirms the adequacy and sensitivity of the instrument to study prosociality in young adults in a Spanish sample.

Psychometric Properties of the Spanish version of the Family Adaptability and Cohesion Evaluation Scale IV.

INTRODUCTION: Building on the expanding cross cultural interest in FACES, the Spanish version of the Family Adaptability and Cohesion Evaluation Scale (FACES IV), aimed at the assessment of the dimensions of cohesion and flexibility of the Circumplex Model, was validated following the author´s guidelines. METHOD: The sample was composed by 665 college students. Besides, FACES II was also used and family communication, satisfaction, stress and strengths were also measured. RESULTS: The results supported its psychometric adequacy. Construct validity, concurrent and discriminant validity of all the scales were confirmed, maintaining the original structure of the instrument, with 6 scales, 4 Unbalanced scales (Disengaged, Enmeshed, Rigid, and Chaotic), and two Balanced scales (Cohesion and Flexibility). Additionally, the ratio scores confirmed the curvilinearity of the model. CONCLUSION: All the results supported the adequacy of the Spanish version, which is also promising for use in educational settings, in counseling and in research. Findings with the Spanish version of FACES IV are similar to findings in the United States and other countries.

Maternal Antenatal Attachment Scale (MAAS): adaptation to Spanish and proposal for a brief version of 12 items.

The psychometric properties of the adapted Spanish version of the Maternal Antenatal Attachment Scale were examined. The main goal was to investigate the reliability and construct validity of the conceptual structure of Condon's proposal. Five hundred twenty-five pregnant women, attending maternal education classes in Bizkaia (Spain), answered the translated and back-translated version of the Maternal Antenatal Attachment Scale. This scale comprises 19 items with five answer choices divided into two subscales: quality of attachment and intensity of attachment. Participants also answered a questionnaire about the reproductive history that was developed ad hoc for the present study. The Spanish adaptation of the Maternal Antenatal Attachment Scale final version comprises 12 items: seven items have been removed due to their inadequate psychometric properties. Internal consistency of the inventory is moderate-high (.73) and it ranges from .68 (intensity of attachment) to .75 (quality of attachment) for the dimensions. Three alternative structural models were proven using a confirmatory factor analysis. Lastly, the two-related-factor model was chosen, as it obtained suitable fit indexes (χ (2) = 102.28; p < .001; goodness-of-fit index (GFI) = .92; comparative fit index (CFI) = .95; root mean square error of approximation (RMSEA) = .042, 90 % CI [.030-.054]). Due to its adequate psychometric properties, the Spanish version of the Maternal Antenatal Attachment Scale can be proposed as a suitable instrument for the purpose of measuring antenatal attachment. The study of antenatal attachment helps to detect possible difficulties for the mother in establishing an affective relationship with the foetus. This may affect the foetus growth, delivery and the future mother-child relationship.