Milestone achievement in emerging adulthood in spina bifida: a longitudinal investigation of parental expectations.

AIM: To assess changes over time in parents' expectations of adult milestone achievement (college attendance, full-time job attainment, independent living, marriage, parenthood) for young people with spina bifida, to examine how expectancies relate to actual milestone achievement, and to compare milestone achievement in emerging adults with spina bifida with that of peers with typical development. METHOD: Sixty-eight families of children with spina bifida (mean age 8y 4mo, 37 males, 31 females) and 68 families of children with typical development (mean age 8y 6mo, 37 males, 31 females) participated at Time 1. At all subsequent timepoints, parents of young people with spina bifida were asked to rate their expectations of emerging adulthood milestone achievement. At Time 7, when participants were 22 to 23 years old, milestone achievement was assessed. RESULTS: Parents of young people with spina bifida lowered their expectations over time for most milestones; parents of children with higher cognitive ability reported decreases of lower magnitude. Parent expectancies were optimistic and unrelated to actual milestone achievement. Emerging adults with spina bifida were less likely than individuals with typical development to achieve all milestones. INTERPRETATION: Optimistic parental expectations may be adaptive for children with spina bifida and their families, although it is important for families to set realistic goals. Healthcare providers serve a key role in helping families of young people with spina bifida prepare for emerging adulthood.

Resilience and Disruption in Observed Family Interactions in Youth With and Without Spina Bifida: An Eight-Year, Five-Wave Longitudinal Study.

OBJECTIVE: To examine differences between families of youth with spina bifida (SB) and families of typically developing (TD) youth on family-, parent-, and youth-level variables across preadolescence and adolescence. METHODS: Participants were 68 families of youth with SB and 68 families of TD youth. Ratings of observed family interactions were collected every 2 years at 5 time points (Time 1: ages 8-9 years; Time 5: ages 16-17 years). RESULTS: For families of youth with SB: families displayed less cohesion and more maternal psychological control during preadolescence (ages 8-9 years); parents presented as more united and displayed less dyadic conflict, and youth displayed less conflict behavior during the transition to adolescence (ages 10-13 years); mothers displayed more behavioral control during middle (ages 14-15 years) and late (ages 16-17 years) adolescence; youth displayed less engagement and more dependent behavior at every time point. CONCLUSIONS: Findings highlight areas of resilience and disruption in families of youth with SB across adolescence.

Depression and Disordered Eating in the Obese Person.

Three mental health problems commonly associated with obesity are major depression, binge eating disorder (BED), and Night Eating Syndrome (NES). Evidence from both cross-sectional and longitudinal studies support independent relationships between obesity and depression, and between obesity and binge eating. These problems are most prevalent in severely obese individuals (Class III obesity; a body mass index (BMI) of >40kgm(2)), many of whom seek bariatric surgery, and we briefly review whether the presence of pre-operative depression, BED or NES affects post-operative outcomes. Historically depressed individuals have been screened out of weight loss trials due to concerns of worsening mood with weight loss. Such practices have precluded the development of effective treatments for depressed, obese individuals, leaving large numbers of people without appropriate care. We present recent advances in this area, and attempt to answer whether depressed individuals can lose clinically significant amounts of weight, show improvements in mood, and adhere to the demands of a weight loss intervention.

A systematic review of psychosocial interventions to improve cancer caregiver quality of life.

OBJECTIVE: To evaluate and estimate the effect of psychosocial interventions on improving the quality of life (QoL) of adult cancer caregivers. METHODS: We conducted a systematic review of randomized controlled trials among adult cancer caregivers published from 1947 to 2011. Rigorous inclusion criteria included randomization of caregivers, use of control groups, and at least one active psychosocial intervention where caregiver QoL was measured. A pair of raters independently reviewed all abstracts, and studies were assessed for quality using an 11-item PEDro coding scale. Data were extracted, examined, and synthesized using a narrative approach. RESULTS: Six randomized controlled trials met inclusion criteria out of 1066 identified abstracts. Studies were rejected because of methodological flaws and failure to report a measure of caregiver QoL. A total of 1115 caregivers were included at baseline measurements. Estimated effect sizes for included studies were nil to small ranging from 0.048 to 0.271. Studies with larger effect sizes targeted caregivers' problem-solving and communication skills. CONCLUSIONS: Interventions targeting problem-solving and communication skills may ease the burdens related to patient care and role changes associated with care while improving caregiver's overall QoL. Further research is needed to establish efficacy of interventions across all stages of the 2cancer caregiving experience, especially focusing on issues of caregiver retention, caregiver relationships to the cancer patient, and individual differences in caregiver experiences with different types of cancer.