Quality of Life of Schoolchildren Living with a Long-Term Sick Parent: The Role of Tasks at Home, Life Circumstances and Social Support.

This study investigates whether there are differences in quality of life-i.e., psychosomatic complaints and life satisfaction-between schoolchildren with and without a chronically ill or disabled parent at home. It also examines the role played by the intensity of tasks, life circumstances, and social support at home and school. In 2017, a Dutch representative sample of adolescents aged between 12 and 16 (from the Health Behaviour in School-aged Children study) completed a questionnaire about illness of family members, tasks at home, life circumstances and characteristics, social support, psychosomatic complaints and life satisfaction. In total, 5470 schoolchildren who did not have a parent with a chronic illness and 652 who did have a parent with a chronic illness were selected (average age 13.9). Stepwise multilevel logistic regression analyses in STATA were used. Schoolchildren with an ill parent had more psychosomatic complaints and lower life satisfaction than their counterparts without an ill parent, even when controlling for extra task hours, specific life circumstances and characteristics (e.g., more likely to be growing up in a single-parent family or stepfamily and more likely to be female), and lower perceived support. These aspects are also predictors of a lower quality of life. Professionals should address these aspects of the life of schoolchildren with a sick parent in such a way that they are facilitated to make a successful transition to adulthood.

The relationship of personal budgets with independence, participation and quality of life; a secondary analysis of survey data using propensity score matching.

OBJECTIVES: Personal budgets for social and health care have been introduced in many European countries over recent decades. The assumption is that people with a personal budget are able to purchase care that matches their needs more closely and therefore experience greater independence and improved well-being. The question is whether this assumption is true. Little research has been carried out on this and the research that has been carried out is inconclusive and hampered by methodological limitations. METHODS: We performed a secondary analysis of data collected in a survey among persons who had submitted an application for social support. Propensity score matching was used to investigate whether people with a personal budget experience better independence, participation in society and quality of life than comparable people using conventionally organised help. RESULTS: After matching, no significant effects of the personal budget were initially found. A sensitivity analysis that excluded the variable sense of mastery from the calculation of the propensity scores, showed a significantly greater independence for those using a personal budget. CONCLUSION: There may be several reasons for this lack of effect. First, perhaps there are no effects. It is also possible that effects can only be found in specific situations and/or specific groups.

Influence of municipal policy and individual characteristics on the use of informal and formal domestic help in the Netherlands.

BACKGROUND: The responsibility for care and social support in the Netherlands has been decentralized to the municipalities, on the assumption that they are able to organise care and social support more effectively and efficiently. Municipalities are responsible for offering citizens the social support they need. They have policy discretion to decide how and to what extent they encourage and support the use of informal help. This article explored whether the local policy focus on informal or formal help influences the actual take-up of domestic help. METHODS: Data on 567 physically disabled people who use informal or formal help in the household were linked to local policy data in 167 municipalities. We performed multilevel multinomial regression analyses. Since we expected that local policy will have more influence on people with slight or moderate disabilities, cohabitees and people aged under 75, cross-level interaction terms were included between characteristics of local policy and of individuals. RESULTS: The findings reveal differences between municipalities in their policy on support and differences in the use of formal or informal support between municipalities. CONCLUSIONS: We found no relationship between local emphasis on informal help and the use of informal help. Possible explanations: some people have a small social network, people using informal help did not apply for municipality support or even do not know the possibility exists.

Growing Up With the Right to Marry: Sexual Attraction, Substance Use, and Well-Being of Dutch Adolescents.

PURPOSE: To assess the well-being and substance use of sexual minority adolescents growing up in a tolerant society, we examined differences among same-sex attracted (SSA), those who do not know their attraction yet (not yet attracted [NYA]), and heterosexual Dutch adolescents. METHODS: Unadjusted and adjusted logistic and linear multilevel analyses were performed using representative data of the 2013 Health Behaviour in School-Aged Children study (N = 5,995; 11-16 years old). The adjusted analyses controlled for sociodemographics (gender, age, education type, ethnicity, urbanicity, and religion). RESULTS: Adjusted results showed that SSA adolescents substantially more often reported alcohol use (adjusted odds ratio [AOR] = 2.01), tobacco smoking (AOR = 2.37), and cannabis smoking (AOR = 3.52) than their heterosexual peers, while NYA participants less often reported alcohol use (AOR = .57) and equal levels of tobacco (AOR = .71) and cannabis smoking (AOR = .87) compared with heterosexual adolescents. SSA adolescents reported lower levels of life satisfaction (b = -1.25) and higher levels of psychosomatic complaints (b = .61) and emotional problems (b = 1.57) than heterosexual adolescents. NYA adolescents reported equal levels of life satisfaction (b = -.18) and psychosomatic complaints (b = .06) as heterosexual adolescents, but higher levels of emotional problems (b = .51). CONCLUSIONS: In Dutch society, with over 20 years of inclusive policies for sexual minorities and generally tolerant population attitudes toward sexual minorities, SSA adolescents are still at increased risk of substance use and have lower levels of well-being compared with peers.

Positive and negative evaluation of caregiving among three different types of informal care relationships.

Based on the caregiver stress model, we examined how care demands, caregiver motivation, coping style and external support are associated with positive evaluation and caregiver burden among spousal, adult child and other types of care relations. Data from a sample of Dutch informal caregivers of 1,685 older persons (55 and older) were analyzed employing multivariate linear regression analyses for each of the care relationship types. Spouses (N = 206) report high positive evaluation and high burden, adult children (N = 1,093) report low positive evaluation, and other caregivers (N = 386) report high positive evaluation and a low burden. Multivariate linear regression analyses showed that motives and external support were important for positive evaluation but the impact varied among types of caregivers, whereas care demands and not asking for help were associated with burden for all types. Only among 'other' caregiver relationships, positive evaluation was negatively associated with burden. It is concluded that results confirm the dual nature of caregiving among spouses and children. The care context and motivation of the different types of caregivers explain their differences in care evaluation. Various interventions for types of caregivers are discussed.

Are informal caregivers less happy than noncaregivers? Happiness and the intensity of caregiving in combination with paid and voluntary work.

Informal caregivers are one of the pillars of home health care. In the Netherlands, the free help they provide to sick or disabled family members, acquaintances or friends exceeds the number of hours of home care provided by professionals. While the government welcomes their contribution, there is concern about the potential burden their work imposes on them. On the one hand, there is concern that informal caregiving could be experienced as a burden and diminish subjective well-being; on the other, helping others as a meaningful activity might increase their subjective well-being. Happiness ratings (as an indicator of subjective well-being) of persons whose involvement in informal caregiving, voluntary work and paid work ranged from none to full time were analysed using multivariate regression models, which also took into account levels of physical disability and socio-economic characteristics (age, sex, household composition, education level). The sample consisted of 336 informal caregivers and 1765 noncaregivers in the Dutch population. In line with the subjective well-being assumption, the results suggest that caregivers are happier than noncaregivers when they provide care for <6 hours a week; and in line with the burden assumption, the results show that providing care for more than 11 hours a week is associated with lower levels of happiness. Other results contradicted the burden assumption that combining caregiving with paid or voluntary work is associated with more time burden and less happiness. The result that combining caregiving with paid employment or volunteering is related to higher rates of happiness confirms the subjective well-being assumption. It is concluded that these cross-sectional results open ways to longitudinal research that can inform governments in the development of policies to support informal caregivers.

The structure of the extended psychosis phenotype in early adolescence--a cross-sample replication.

The extended psychosis phenotype, or the expression of nonclinical positive psychotic experiences, is already prevalent in adolescence and has a dose-response risk relationship with later psychotic disorder. In 2 large adolescent general population samples (n = 5422 and n = 2230), prevalence and structure of the extended psychosis phenotype was investigated. Positive psychotic experiences, broadly defined, were reported by the majority of adolescents. Exploratory analysis with Structural Equation Modelling (Exploratory Factor Analysis followed by Confirmatory Factor Analysis [CFA]) in sample 1 suggested that psychotic experiences were best represented by 5 underlying dimensions; CFA in sample 2 provided a replication of this model. Dimensions were labeled Hallucinations, Delusions, Paranoia, Grandiosity, and Paranormal beliefs. Prevalences differed strongly, Hallucinations having the lowest and Paranoia having the highest rates. Girls reported more experiences on all dimensions, except Grandiosity, and from age 12 to 16 years rates increased. Hallucinations, Delusions, and Paranoia, but not Grandiosity and Paranormal beliefs, were associated with distress and general measures of psychopathology. Thus, only some of the dimensions of the extended psychosis phenotype in young people may represent a continuum with more severe psychopathology and predict later psychiatric disorder.

Multiple dimensions of attitudes about homosexuality: development of a multifaceted scale measuring attitudes toward homosexuality.

Attitudes toward homosexuality are complex. To get a comprehensive view on the attitudes of people, different dimensions need to be included in research. Based on a review of the literature, we distinguish five dimensions: acceptance of homosexuality in a general sense; attitude toward equal rights; reactions to homosexuality "at close quarters"; reactions to homosexuality in public; and so-called modern homonegativity. In a study on a representative sample of Dutch Defence personnel (N = 1,607) we tested this model. Structural equation modeling of several items measuring the attitude toward homosexuality offers a six factor solution. These six factors are more or less comparable to the five dimensions we distinguished. The dimension "reactions to homosexuality at close quarters" is, however, empirically split in a dimension on affective reactions to homosexuality and homosexual persons in general and a dimension on affective reaction to homosexual friends or acquaintances.

Are persons with physical disabilities who participate in society healthier and happier? Structural equation modelling of objective participation and subjective well-being.

In many countries, governments pursue a policy of offering persons with disabilities greater opportunities for participation in society, based on the assumption that this will also improve their subjective well-being. Currently, however, it is not known whether this assumption is valid. In this study we relate the objective participation and the subjective well-being aspects of both disabled and non-disabled persons to an array of social and health-related determinants. Linear structural equation modelling of data of a sample selection of the Dutch population is analysed. The sample size is 5,826, including 642 respondents with physical disabilities. In terms of objective participation, the persons with disabilities are at a greater disadvantage as regards labour participation than is the case for social and cultural participation. When it comes to subjective well-being, we find that the persons with disabilities are more likely to lag behind in perceived physical health than in mental health and happiness. In a multivariate model relating objective participation to subjective health and happiness, correlations are much weaker than expected. It is striking to find that participation, perceived health and happiness are much less closely related than is often assumed. Their determinants differ widely in nature and strength. The empirical model leads to rejection of the hypothesis that higher participation by the persons with disabilities is associated with higher subjective well-being.

Explaining service use for mental health problems in the Dutch general population: the role of resources, emotional disorder and functional impairment.

OBJECTIVE: To analyse explanations of service use in terms of resources, emotional (mood or anxiety) disorder and functional impairment. METHOD: Data was derived from a prospective cohort study in a sample representative (n = 4848) of the Dutch adult general population. RESULTS: The occurrence of an emotional (mood or anxiety) disorder led to a greater use of services as a partial consequence of the functional impairments that accompanied the disorder, but this applied only to primary care services and not to specialised mental health services. After adjustment for the influence of all other determinants in the model, people with more education and those with higher neuroticism scores were more likely to use specialised services in particular. CONCLUSIONS: Future research could benefit from applying the models derived here to further clarify the use of the two service modalities, as well as to assess additional psychological resources.

Separation-individuation revisited: on the interplay of parent-adolescent relations, identity and emotional adjustment in adolescence.

The objective of this study was to test our alternative interpretation of the separation-individuation hypothesis. This interpretation states that separation from the parents is not a precondition for individuation, but rather separation and individuation are two parallel processes of development during adolescence. We investigated our interpretation in two ways. Firstly, we looked at descriptive age differences in parental support and development of relational and societal identity. Secondly, we investigated the variation with age of the associations between parental support and emotional adjustment, and identity and emotional adjustment. Data of a representative Dutch sample of 2814 adolescents, aged 12-24 were used. In both cases, the findings supported our interpretation of the separation-individuation hypothesis and similar results were found in the descriptive analyses and the structural equation models. Parental support decreased with age, and so too did its association with emotional adjustment. In other words, as adolescents become older, they experience less parental support, while its importance for their emotional adjustment also declines. The opposite pattern was observed with respect to identity development: as adolescents become older, their relational and societal identity commitments develop, and the degree to which these commitments are developed also becomes more important for their emotional adjustment.