FAMILY RELATIONS, HOPELESSNESS, AND COPING RESPONSES IN CHILD PSYCHIATRIC PATIENTS AND SCHOOL CHILDREN A Thesis Submitted to The Graduate School The Chinese University of Hong Kong In Partial Fulfilment of the Requirements for the Degree of Master of Social Science In Clinical Psychology by Shing Chi Yuen Division of Psychology May 1990
78
Embed
FAMILY RELATIONS, HOPELESSNESS, AND COPING RESPONSES … · differences between child psychiatric patients and school children in family relations, hopelessness, and coping responses.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
FAMILY RELATIONS, HOPELESSNESS, AND COPING RESPONSES IN CHILD PSYCHIATRIC PATIENTS AND SCHOOL CHILDREN
A Thesis
Submitted to
The Graduate School
The Chinese University of Hong Kong
In Partial Fulfilment
of the Requirements for the Degree of
Master of Social Science
In Clinical Psychology
by
Shing Chi Yuen
Division of Psychology
May 1990
316397
.' p ,'" < \ .....
~ ...
\ \
Abstract
The present study attempted to evaluate the
differences between child psychiatric patients and
school children in family relations, hopelessness, and
coping responses. Moreover, the relationship between
these variables and children's emotional disturbance in
both child psychiatric patient sample and school
children sample, and whether coping responses could
mediate the effect of the stressor (i.e., negative
family relations) on one's emotional well-being were
investigated. Two hundred school children and thirty
child psychiatric patients were studied, one hundred and
twenty two of which are male and one hundred and eight
female, with age ranging from ten to sixteen.
Significant group differences were found in the cohesion
dimension of family relations, hopelessness, emotional
disturbance, appraisal-focused coping and information
seeking. The child psychiatric patients were more
hopeless and emotionally disturbed than the school
children. The family relations of the child psychiatric
patients were lower in cohesion than those of the school
children. The two samples differed in coping style.
While the child psychiatric patients tended to seek more
information, the school children tended to appraise
their problems more thoroughly. The results obtained in
both patient and school children samples consistently
indicated that family relations and hopelessness, but
not coping responses, were good predictors of the
subjects' emotional disturbance. It was found that the
effect of family relations was not mediated by coping
responses. The implication for the treatment approaches
dealing with children suffering from emotional disorder
was discussed.
iii
Acknowledgements
I should like to express my gratitude to Dr. C. K.
Wong, Dr. H. K. Ma, and Dr. D. Chan for their precious
and stimulating advice without which the present thesis
cannot be completed.
The students of Pentecost Primary school and S.K.H.
Li Ping Memorial Secondary School have participated in
the present study, I am grateful to them for their most
helpful cooperation. I also wish to thank the
principals and teachers concerned of these two schools
for their coordination of data collection.
Special thanks are given to Winnie So for her
valuable help and endless support. The present study is
ACKNOWLEDGEMENTS ................................ iv
TABLE OF CONTENTS ............................... v
LIST OF TABLES .................................. V 1
LIST OF APPENDICES .............................. vii
CHAPTER I - INTRODUCTION ........................ 1
The influence of family .................. . 1
Coping responses 7
Hopelessness .............................. 13
Purpose of the Present Study.............. 18
CHAPTER I I - METHOD ............................... 21
Subj ects ................................... 21
Instruments ................................ 21
Procedure .................................. 25
CHAPTER III - RESULTS ............................. 26
Differences between child psychiatric patients and school children in family relations, hopelessness, and coping responses .............. 26
Interrelationships among family relations, hopelessness, coping responses and emotional disturbance ..................................... 29
Predictive power of family relations, hopelessness and coping responses in predicting emotional disturbance ..................................... 33
The mediating effect of coping responses ........ 38
CHAPTER IV - Discussion ......................... . 41
REFERENCES 49
APPENDICES 57
v
LIST OF TABLES
Table Page
1. Intercorrelations among Coheson, Expressiveness, and Conflict in Child Psychiatric Patients and School Children ............................. 27
2. Partial Correlations among Family Relations, Hopelessness, Coping Responses, and DSRS in Child Psychiatric Patients Sample .......... 30
3. Partial Correlations among Family Relations, Hopelessness, Coping Responses, and DSRS in School Children Sample ..................... 31
4. Amount of Variance of DSRS Accounted for by Family Relations, Hopelessness, and coping Responses .................................. 35
5. Summary Table of the Results of the Stepwise Regression Analyses ........................ 37
6. Summary of the Results of Redundancy Analyses ................................... 40
vi
LIST OF APPENDICES
Appendix Page
A Alpha Values of the Instruments for the Child Psychiatric Patients and School Children ................................ 57
B Mean, Standard Deviation and t-values of Family Relations, Hopelessness, Coping Responses and DSRS Score for the Child Psychiatric Patients and school Children ............................... 58
C Mean, Standard Deviation, and t-value of Demographic Variables .................. 59
D Correlations between the Demographic Variables and Family Relation, Hopelessness, Coping Responses, and DSRS for the School Children .......... 60
E Correlations between the Demographic
F
G
H
I
Variables and Family Relation, Hopelessness, coping Responses, and DSRS for the Child Psychiatric Patients .............................. 61
Family Environment Scale .............. . 62
Depression Self-Rating Scale .......... . 66
Coping Responses Scale 67
Hopelessness Scale .................... . 68
vii
Chapter I
Introduction
1
The present study investigated family relations,
hopelessness, and coping responses of child psychiatric
patients (who suffered from emotional disorder) and school
children. Childhood emotional disorder is a diagnostic
category in International Classification of Diseases
(ICD) 9. Child psychiatric patients with this diagnosis
were found to have suffered from severe emotional
disturbance.
Family factors (e.g., parent-child relationships,
parenting style, family structures), cognitive
distortion (e.g., hopelessness) and coping responses
were the areas which most research of children's
emotional disorder or adult depression investigated
s i g n ificantly correlated with the three dimensions of
family relations and hopelessness~ Subjects wh o f elt
hopeless or whose families were low in cohesio n ,
expressiveness and high in conflict were more
e motionally disturbed.
Emotional disturbance was sig nificantly correlated
with appraisal-focused coping, information seeking and
p rob lem-solving, but not with emotion-focused c opingo
In sum, school children who employed more copin g
respon ses except those regulating emotions were l ess
emotionally disturbedo
Table 2
I:art i_01 Correla-tions among Fam i ly Rel_~tions-L Hppeles sness , Cop ing Resp o nses and D~RS l :O Ch 1}.d PS.y"'ch i.atric Pat ient Sa mple
{N= 3 0) Hope App I nform Solve Emo·t i on
Coh 023 - 01 8 -0 41* -02 6
Exp . 15 . 10 -. 38* .0 2
Conf 016 ,- 018 - . 15 - ,,1 9
Hope 10 00 -036* - ~1 2 - ,,39 *
App 1 . 00 . 50 * * .6 1 * *
I n form 1 000 048 **
Solv e 1.00
Emotion
Note~ Coh= Cohesion Exp= Exp ressiv eness Conf= Conflict Hope= Hopelessness Ap p= Appraisal - focused Coping I n form= Information Seeking Solve= Problem Solving Emotion= Emotion- focused Cop i ng
-ol S
~c 29
010
- 006
,, 29
.,31
" 36 'k
1000
30
044**
o 12
034*
06 4**
=0 0 9
= 021
~ 0 19
002
Table 3
Part i~l Correlations among Family Relations Q
Hopelessness, Coping Responses and DSRS in school Children Sample
responses could (e.g., Nezu & Ronan ) or could not
(e.g., Billings & Moos, 1981) mediate the effect of
stressor on one's emotional disturbance. Therefore,
whether coping responses mediated the effect of stressor
(i.e., negative family relations, low cohesion,
expressiveness, and high conflict) was examined.
To say that variable B mediates the effect of A on
C means that A affects B which in turn affects C rather
than A directly affecting C, that is, A-------->B------
-->C. To examine this pattern of relationship,
redundancy analysis was performed. Redundancy analysis
is carried out through three hierarchical regression
analyses. In step 1 and 2, the two independent
variables A and B will be used to predict the dependent
variable C separately. In step 3, A will be entered
after B in the equation predicting C. The difference in
the amount of variance between step 1 and step 3 is the
unique variance accounted for by A in addition to that
accounted for by B. If the effect of A on C is a direct
one, there will be little difference. If the effect of
A on C is mediated by B, the difference will be
significant.
since only three dimensions of coping responses
(appraisal-focused coping, information seeking, and
problem-solving) were significantly correlated wi t h
DSRS, redundancy analyses were performed for these three
dimensions only, and the effect of education was
controlled. The results were summarized in Table
3 9
6. In general, the results indicated that the effect of
cohesion, expressiveness and conflict was not mediated
by any dimensions of coping responses. The changes in
variance of DSRS accounted for by cohesion,
expressiveness, and conflict after partialling the
effect of coping responses were mostly below 10% of the
original amount. In child psychiatric patient sample,
none of the dimensions of coping responses correlated
significantly with DSRS. Therefore, redundancy analysis
was not performed. In sum, it could be concluded that
coping responses did not mediate the effect of family
relations and the path family relations--------> Coping
responses --------> emotional disturbance was not
supported. This finding was consistent with that
reported by Billings and Moos (1984), Asarnow, Carlson,
and Guthrie (1987), and Andrew, Tennant, Hewson, &
Vaillant (1978).
Table 6
Summary of the Results of Redundancy Analysis
1. Amount of variance of DSRS explained by Cohesion
Amount of variance of DSRS explained by Cohesion after partialling:
A. Appraisal-focused Coping B. Information Seeking C. Problem Solving
2. Amount of variance of DSRS explained by Expressiveness
Amount of variance of DSRS explained by Expressiveness after partialling:
A. Appraisal-focused Coping B. Information Seeking c. Problem Solving
3. Amount of variance of DSRS explained by Conflict
Amount of variance of DSRS explained by Conflict after partialling:
A. Appraisal-focused Coping B. Information Seeking C. Problem Solving
* 2<.05. ** 2<.01.
.13**
.12**
.12**
.12**
.07**
.05**
.06**
.06**
.10**
.09**
.09**
.10**
40
Chapter IV
Discussion
41
There were significant differences between school
children and child psychiatric patients with emotional
disorder in cohesion dimension of family relations,
hopelessness, appraisal-focused coping and information
seeking. The present study demonstrated that family
relations and hopelessness were two important factors
related to children's emotional disturbance.
Furthermore, the coping responses failed to mediate the
effects of the stressor: negative family relations.
The family relations of child psychiatric patients
were found to be more negative than those of the school
children, being lower in cohesion. The negative effect
of poor family relations on one's emotional well-being
was suggested by the significant correlations between
emotional disturbance and the three dimensions of family
relations. The present study's findings were consistent
with those reported by previous studies (e.g., Dancy &
Handal, 1980,1984; Asarnow, Carlson and Guthrie, 1987).
These findings pointed out that the role of family
factors in the development and maintenance of childhood
emotional disorder should be investigated. Moreover,
the effect of negative family relations on other family
members is also an important area to be studied.
It may also have important implication for treatment
approach helping both the child and his/her family as a
whole.
Hopelessness correlated significantly with DSRS
score in both school children sample and the child
psychiatric patient sample. In addition, child
psychiatric patients were found more hopeless than
4 2
the school children. The former tended to perceive
their future in a negative way with little hope. It
should be noted that hopelessness was the best factor
predicting emotional disturbance in both child
psychiatric patient sample and school children sample.
Therefore it is an important variable to be considered
when dealing with children's emotional problems.
Asarnow, Carlson and Guthrie (1987) also pointed out
that clinicians working with emotionally disturbed
children should be aware of the implications of their
negative cognitions and should emphasize treatment
approaches that aimed at reducing the negative biases
with which the disturbed children perceived themselves
and their world.
As a further support to the above discussion, the
results of regressing emotional disturbance on family
relations, hopelessness and coping responses separately,
and stepwise regression analyses done across the two
samples consistently demonstrated that hopelessness and
family relations were the two best predictors o f
emotional disturbance in the present study. It further
supported the perspective that family environment in
general and family relations in particular were crucial
for the well-being and adjustment of children. In
43
addition, the impact of negative expectations toward self
and future was detrimental to children's adjustment.
Even though we could not conclude that poor family
relations and being hopeless led directly to
childhood emotional disorder, their presence may at
least worsen the emotional well-being of the children.
Moreover, the assessment of one's family relations and
degree of hopelessness may help predict the risk with
which a child develops emotional disorder since these
two variables accounted for over 30% of variance of the
measure of emotional disturbance in both samples. In
clinical assessment, the information concerning these
two aspects may facilitate the clinicians' intervention.
Child psychiatric patients differed from the
school children in terms of coping style. The results
of the present study showed that child psychiatric
patients were less likely to appraise their difficulties
but more likely to gather more information from others.
They were comparable to the school children in their
tendency to employ emotion regulation coping responses
and responses aiming at problem-solving. The present
findings were consistent with Coyne and Aldwin's (1981)
that depressed people tended to gather much information
before they could act and they were less confident and
less effective in coping with their problems, which
might be due to their lack of thorough appraisal of the
problems and their resources available.
As suggested from the findings in the present
44
study, training a child's coping responses, e.g.,
thorough appraisal of the problems and resources, and
active problem solving, may help him/her alleviate
his/her emotional disturbance. Howeyer, it may not be
adequate. What is also needed for children to maintain
their emotional well-being may be a positive family
environment with good family relations, especially the
support family members provide for one another.
Moreover, maintaining a optimistic perspective towards
self, future and the world may attenuate their emotional
disturbance. In other words, a multidimensional
intervention may better help the children to recover
from their emotional disturbance. Moreover, the
enhancement of these factors may prevent the development
of childhood emotional disorder.
Coping responses failed to mediate the effect of
family relations on emotional disturbance. This result
was consistent across the two samples in the present
study. As suggested by some previous studies (e.g.,
Billings & Moos, 1984), coping responses could not
mediate the effect of stressor but retained direct
relationship with emotional disturbance. The present .
finding was consistent with this perspective. Although
coping responses could not mediate the effect of family
relations on emotional disturbance, active coping
responses (i.e., appraisal-focused coping) were
negatively correlated with emotional disturbance. As
discussed above, it might suggest that more
45
active coping responses could still alleviate the
stress one suffered. However, the fact that Coping
Responses Scale, which was originally designed for adult
subjects, might not be a good instru~ent assessing the
coping responses of child subjects makes the present
result inconclusive. Therefore, the result that coping
responses failed to mediate the effect of negative
family relations should be treated as tentative.
Three dimensions of coping responses (appraisal
focused coping, information seeking, and problem
solving) were significantly correlated with emotional
disturbance in school children sample but not in child
psychiatric patient sample. The inconsistency of the
correlations across the two samples may be due to the
small sample size of the child psychiatric patient
sample. Therefore, to assess the correlations among
coping responses and children's emotional disturbance in
future research, larger sample, especially patient
sample, is needed. In addition, possible limited range
of responses in the child psychiatric patient sample
given the small number of subject may also affect the
results. However, the small difference between the
standard deviations of DSRS in both samples makes it
less likely.
As pointed out in the literature review, coping
response is a complicated concept. There are different
theories to conceptualize it. The system developed by
Billings and Moos (1981, 1984), which was employed in
46
the present study, may only assess the frequency with
which subjects employ different dimensions of coping.
However, how effectively they use their strategies, how
sophisticated their skills are, and how they answer
the questionnaire may affect the meaning of the score
assessing their coping responses. It may also be a factor
underlying the inconsistency of relationship between
coping responses and emotional disturbance, the
absence of group difference on some dimensions of
coping responses, and the failure of coping responses to
mediate the effect of family relations. Therefore,
future research may consider using methods in addition
to self-reported inventory in assessing one's coping
responses, e.g., experimental tasks.
In sum, the results of the present study did shed
light on the intervention approaches to be adopted in
dealing with children sUffering from emotional disorder.
As mentioned above, conclusion made by Asarnow, Carlson,
and Guthrie (1987) suggested that negative cognitions
should be attended to. In addition, family environment
in general and family relations in particular should be
focused upon when treating children with emotional
problems. The family system should be intervened so as
to develop a favourable environment for children who may
then develop their active and effective coping
responses. Children, unlike adults, may not have enough
resources (e.g., maturity to sustain severe stress) to
cope with their difficulties. Although they may have
learned various coping skills, they need social or
emotional support for them to exercise their coping
skills.
47
The present study expanded the ,work by Asarnow,
Carlson and Guthrie (1987) through including school
children in the present study. In sum, when compared
with child psychiatric patients, school children
reported better family relations (higher in cohesion),
and less hopelessness. Moreover, dimensions of family
relations and hopeless were significantly correlated
with emotional disturbance and these correlations were
consistent across school children sample and child
psychiatric patient sample.
The present study has made a contribution in
adapting instruments validly used in western culture and
in testing their internal consistency when used for
Chinese subjects. DSRS and Hopelessness scale were
found to have acceptable internal consistency. In
addition, the Coping Responses Scale designed by
Billings and Moos (1981) was found to have comparable
internal consistency to the English version when used in
Chinese population. It is recommended that these
instruments be used as research tools in future research
with Chinese subjects so as to further assess their
reliability and validity, and appropriate modification
can be made.
The limitations of the present study were found in
the use of self-reported questionnaires, the items in
48
them may not be able to adequately represent the
constructs being studied. The latter shortcoming may
explain why there are so many controversies around the
relationship between coping responses . and childhood
depression. In addition, the fact that the coping
Responses Scale was originally designed for adult
subjects might affect the validity of the results in the
present study. Furthermore, the lack of standardization
of these instruments in Chinese population and the
possible cultural effect may influence the results of
the present study. The large difference between sample
size of school children and child psychiatric patients
and the small sample size of the latter may impose a
threat on the validity of the results. Last, but not
the least, the fact that the present study is a
correlational study makes its results unable to formulate
clearly the causal relationships among the variables
studied. To do so, a longitudinal study is needed.
Nonetheless, the conclusions of the present study may
serve as a stimulation for further research. Besides
longitudinal study, future research may also adopt an
experimental approach in which clear operational
definitions and rigorous control over the variables and
their confoundings are provided to replicate the pattern
of findings obtained in this and other previous
research.
49
References
Andrews, G. Tennant, C., Hewson, D. M., & Vaillant, G. E. (1978) Life event stress, social support, coping style, and risk of psychological impairment. Nervous and Mental Disease, 166, 307-316.
Asarnow, R. J. (1987) Coping strategies, self-perception, hopelessness, and perceived family environments in depressed and suicidal children. Journal of Consulting and Clinical Psychology, 55, 361-366
Asarnow, J. R. & Carlson, G. A. (1985) Depression selfrating scale: utility with child psychiatric inpatients. Journal of Consulting and Clinical Psychology, 53, 491-499.
Barker, P. (1984) Basic Child Psychiatry (4th ed.) London: Granada.
Beardslee, W. R., Bemporad, J., Keller, M. B., & Klerman, G. L. (1983) Children of parents with major affective disorder: A review. The American Journal of Psychiatry, 140, 825-832.
Beck, A. T. (1967) Depression: Causes and Treatment. Philadelphia: Univeristy of Pennsylvania Press.
Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974) The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861-865.
Bee, H.L., & Mitchell, S.K. (1984) The Developing Person: A Life- Span Approach (2nd edition). N Y: Harper & Row Publishers.
Bell, L.G., & Bell, D.C. (1982) Family climate and the role of the female adolescent: Determinants of adolescent functioning. Family Relations, 31, 519-527.
Bellack, A. S., & Hersen, M. (1988) Behavioral Assessment: A Practical Handbook. N Y: Pergamon.
Billings, A. G., & Moos, R. H. (1981) The role of coping responses and social resources in attenuating the stress of life events. Journal of Behavioral Medicine, ~, 139-157.
Billings, A. G., Cronkite, R. C., & Moos, R. H. (1983) Social- environment factors in unipolar depression: Comparisons of depressed patients and nondepressed controls. Journal of Abnormal Psychology, 92, 119-133.
50
Billings, A. G. & Moos, R. H. (1984) Coping stress, and social resources among adults with unipolar depression. Journal of Personality and Social Psychology, 46, 877-891.
Blatt, S. J., Wein, S. J., Chevron, E. & Quinlan, D. M. (1979) Parental representations and depression in normal young adults. Journal of Abnormal Psychology, 88, 388-397.
Bromet, E.J., Ed, V., & May, S. (1984) Family environments of depressed outpatients. Acta Psychiatrica Scandinavica, 69, 197- 200.
Burback, D. J., & Borduin, C. M. (1986) Parent-child relations and the etiology of depression: A review. Clinical Psychology Review, 6, 133-153.
Carlson, G. A., & Cantwell, D. P. (1980) Unmasking masked depression in children and adolescents. Journal of the American Academy of Child Psychiatry, 137, 445-449.
Chawla, P. L., & Gupt, K. (1979) A comparative study of parents of emotionally disturbed and normal children. British Journal of Psychiatry, 134, 406-411.
Cheung, P. C., & Lau, S. (1985) Self-esteem: Its relationship to the family and school social environment among Chinese adolescents. Youth and Society, 16, 438-456.
Cohen, J. & Cohen, P. (1975) Applied Multiple Regression ! Correlationsl Analysis for the Behavioral Sciences. New Jersey: John Wiley & Sons.
Cole, D. A. (1988) Hopelessness, social desirability, depression, and parasuicide in two college student samples. Journal of Consulting and Clinical Psychology, 56, 131-136.
Compas, B. E. (1987) Coping with stress during childhood and adolescence. Psychological Bulletin, 101, 393-403.
Compas, B. E., Malcarne, V. L. & Fondacaro, K. M. (1988) Coping with stressful events in older children and young adolescents. Journal of Consulting and Clinical Psychology, 56, 405-411.
Coyne, J. C., & Aldwin, C. (1981) Depression and coping in stressful episodes. Journal of Abnormal Psychology, 90, 439-447.
Coyne, J. C., Kessler, R. C., Tal, M., Turnbull, J., Wortman, C. B., & Greden, J. F. (1987) Living with a depressed person. Journal of Consulting and Clinical Psychology, 55, 347-352.
Cytryn, L. & McKnew, D. H. (1974) Factors influencing the changing clinical expression of the depressive process in children. American Journal of Psychiatry, 131, 879-881.
Dancy, B., & Handal, P. (1980) Perceived family climate of black adolescents: A function of parental marital status or perceived conflict. Journal of Community Psychology, 8, 208-214.
Dancy, B., & Handal, P. (1984) Perceived family climate, psychological adjustment, and peer relationship of black adolescents: A function of parental marital status or perceived family conflict? Journal of Community Psychology, 12, 222-229.
Doerfler, L., Mullins, L., Griffin, N., Siegel, L., & Richards, C. (1984) Problem-solving deficits in depressed children, adolescent, and adults. Cognitive Therapy and Research, ~, 489-500.
Edwards, D. W., & Kelly, J. G. (1980) Coping and adaptation: A Longitudinal study. American Journal of Community Psychology, 8, 203-215.
Folkman, S. (1984) Personal control and stress and coping processes: A theoretical analysis. Journal of Personality and Social Psychology, 46, 839-852.
Folkman, S. & Lazarus, S. (1985) If it changes it must be a process: Study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology, 48, 150-170.
Forehand, R., Brody, G., Slotkin, J., Fauber, R. & McCombs, A. (1988) Young adolescent and maternal depression: Assessment, interrelations and family predictors. Journal of Consulting and Clinical Psychology, 56, 422- 426.
Frank, G. H. (1965) The role of the family in the development of psychopathology. Psychological Bulletin, 64, 191-205.
Friedrich, W., Reasms, R., & Jacobs, J. (1982) Depression and suicidal ideation in early adolescence. Journal of Youth and Adolescence, 11, 403-407.
Gelder, M., Gath, D., & Mayou, R. (1989) Oxford Texbook of Psychiatry. Oxford: Oxford Univeristy Press.
Goldberger, L., & Breznitz, S. (1982) Handbook of stress: Theoretical and Clinical Aspects. N Y : The Free Press.
52
Gooden, W. & Toye, R. (1984) Occupational dream, relation to parents and depression in the early adult transition. Journal of Clinical Psychology, 40, 945-954.
Gotlib, I. H. & Asarnow, R. F. (1979) Interpersonal and impersonal problem-solving skills in mildly and clinically depressed university students. Journal of Consulting and Clinical Psychology, 47, 86-95.
Hahlweg, K., & Goldstein, M. J. (1984) Understanding Major Mental Disorder: The contribution of Family Interaction Research. N Y: Family Process Press.
Haley, T. M., Fine, S., Marriage, K., Moretti, M. M. & Freeman, R.J. (1985) Cognitive bias and depression in psychiatrically disturbed children and adolescents. Journal of Consulting and Clinical Psychology, 53, 535-537.
Haan, N. (1977) Coping and Defending: Process of Selfenvironment Organization. N Y : Academic Press.
Harrell, T. H. & Ryon, N. B. (1983) Cognitive-behavioral assessment of depression: Clinical validation of the automatic thoughts questionnaire. Journal of Consulting and Clinical Psychology, 51, 721-725.
Heppner, P. P., & Peterson, C. H. (1982) The development of and implications of a personal problem solving inventory. Journal of Counseling Psychology, 29, 66-75.
Holden, R. R., Mendonca, J. D., & Serin R. C. (1989) Suicide, hopelessness, and social desirability: A test of an interactive model. Journal of Consulting and Clinical Psychology, 57, 500- 504.
Holahan, C. J., & Moos, R. H. (1981) Social support and psychological distress: A longitudinal analysis. Journal of Abnormal Psychology, 90, 365-370.
Hops, H., Biglan, A., Sherman, L., Arthur, J., Friedman, L., & Osteen, V. (1987) Home observations of family interactions of depressed women. Journal of Consulting and Clinical Psychology, 55, 341-346.
Jacobson, S., Fasman, J., & Dimascio, A. (1975) Depreivation in the childhood of depressed women. Journal of Nervous and Mental Disease, 160, 5-13.
Johnson, J. E., Petzel, T. P., Dupont, M. P. & Romano, B. M. (1982) Phenomenological perceptions of parental evaluations in depressed and nondepressed college students. Journal of Clinical Psychology, 38, 56-62.
53
Kashani, J. H., Reid, J. C., Rosenberg, T. K. (1989) Levels of hopelessness in children and adolescents: A developmental perspective. Journal of Consulting and Clinical Psychology, 57, 496-499.
Kazdin, A. E. & Petti, T. A. (1982) Self-report and interview measures of childhood and adolescent depression. Journal of Child Psychology and Psychiatry, 23, 437-457.
Kazdin, A. E., French, N. H., Unis, A. S., EsveldtDawson, K., & Sherick, R. B. (1983) Hopelessness, depression, and suicidal intent among psychiatrically disturbed inpatient children. Journal of Consulting and Clinical Psychology, 51, 504-510.
Kazdin, A. E., Rodgers, A., & Colbus, D. (1986) The hopeless scale for Children: Psychometric characteristics and concurrent validity. Journal of Consulting and Clinical Psychology, 54, 241-245.
Kessler, J. W. (1988) Psychopathology of Childhood. New Jersey: Prentice Hall.
Klein, M. M., Plutchik, R., & Conte, H. R. (1973) Parental dominance-passivity and behavior problems of children. Journal of Consulting and Clinical Psychology, 40, 416-419.
Layne, C. (1983) Painful truths about depressives cognitions. Journal of Clinical Psychology, 39, 848-853.
Lefebvre, M. F. (1981) Cognitive distortion and cognitive error in depressed psychiatric and low back pain patients. Journal of Consulting and Clinical Psychology, 49, 517-525.
Lamont, J., & Gottlieb, H. (1975) Convergent recall of parental behaviors in depressed students of different racial groups. Journal of Clinical Psychology, 31, 9-11.
Lefkowitz, M. M. & Tesiny, E. P. (1985) Depression in children: Prevalance and correlates. Journal of Consulting and Clinical Psychology, 53, 647-656.
Lopez, F. G. (1986) Family structure and depression: Implications for the counseling of depressed college students. Journal of Counseling and Development, 64, 508-511.
Moos, R. H., & Moos, B. S. (1986) Family Environmental Scale Manual (2 nd ed). California: Consulting Psychologists Press, Inc.
54
Mullins, L., Siegel, L., & Hodges, K. (1985) Cognitive problem- solving and life event correlates of depressive symptoms in children. Journal of Abnormal Child Psychology, 13, 305-314.
Nezu, A. M. (1986) Cognitive appraisal of problem solving effectiveness: Relation to depression and depressive symptoms. Journal of Clinical Psychology, 42, 42-48.
Nezu, A. M., Ronan, G. F. (1985) Life stress, current problems, problem solving, and depressive symptoms: An integrative model. Journal of Consulting and Clinical Psychology, 53, 693-697.
Norusis, M. J. (1985) Advanced statistics Guide: SPSS-X. N Y: McGraw-Hill Book Company.
Orvaschel, H., Weissman, M. M., & Kidd, K. K. (1980) Children and depression: The children of depressed parents; the childhood of depressed patients; depression in children. Journal of Affective Disorders, ~, 1-16.
Oxenford, C., & Nowicki, S. (1982) Perceived family climate of students deciding to pursue counseling. Journal of American College Health, 30, 224-226.
Parker, G. (1981) Parental reports of depressives: An investigation of several explanations. Journal of Affective Disorders, 1, 131-140.
Pfeffer, C. R. (1981) The family system of suicidal children. American Journal of Psychotherapy, 35, 330-341s
Pearlin, L. I., & Schooler, C. (1981) The structure of coping. Journal of Health and Social Behavior, 19, 2-21.
Puig-Antich, J. (1980) Affective disorders in childhood. Psychiatric Clinics of North America, l, 403-424.
Quay, H. C., & Werry, J. S. (1986) Psychopathological Disorders of Childhood. N Y: John Wiley & Sons.
Raskin, A., Boothe, H. H., Reatig, Scholter-brandt, J. G., & Odle (1971) Factor analyses of normal and depressed patients' memories of parental behavior. Psychological Reports, 29, 871- 879.
Rutter, M. (1981) Stress, coping and development: Some issues and some questions. Journal of Child Psychology and Psychiatry, 22, 323-356.
55
Schwarz, J. C. , & Getter, H. (1980) Parental conflict and dominance in late adolescent: A triple interaction model. Journal of Abnormal Psychology, 89, 573-580.
Schwarz, J. C. & Zuroff, D. C. (1979) Family structure and depression in female college students: Effects of parental conflicts, decision-making power, and inconsistency of love. Journal of Abnormal Psychology, 88, 398-406.
Scoresby, A., & Christensen, B. (1976) Differences in interaction and environmental conditions of clinic and non-clinic families: Implications for counselors. Journal of Marriage and Family Counseling, ~, 63-71.
Seligman, M. E. P., Peterson, C., Kaslow, N. J., Tanenbaum, R. L., Alloy, L. B., & Abramson, L. Y. (1984) Attributional style and depressive symptoms among children. Journal of Abnormal Psychology, 93, 235-238.
Spiegel, D., & Wissler, T. (1983) Perceptions of family environment among psychiatric patients and their wives. Family Process, 22, 537-547.
spivack, G., & Shure, M. B. (1982) The cognition of social adjustment: Interpersonal cognitive problemsolving thinking. In B. B. Lahey & A. E. Kazdin (Eds) , Advances in clinical child psychology (Vol. 5, pp. 323-372). N Y: Plenum Press.
Steven, M. J., Pfost, K. S. & Wessels, A. B. (1987) The relationship of purpose in life to coping strategies and time since the death of a significant other. Journal of Counseling and Development, 65, 424-426.
Topol, P., & Reznikoff, M. (1982) Perceived peer and family relationships, hopelessness and locus of control and factors in adolescent suicide attempts. Suicide and Life-Threatening Behavior, 12, 141-150.
Vaughn, C. E. & Leff, J. P. (1976) The influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry, 129, 125-137.
Warren, L. W., & McEachren, L. (1983) Psychosocial correlates of depressive symptomatology in adult women. Journal of Abnormal Psychology. 92, 151-160.
Weissman, M. M., Prusoff, B. A., Gammon, D., Merikangas, K. R., Leckman, J. F., & Kidd, K. K. (1984) Psychopathology in the children (ages 6-18) of depressed and normal parents. Journal of the American Academy of Child Psychiatry, 23, 78-84.
56
Woody, J.D., Colley, P.E., Schlegelmilch, J., Maginn, P., & Balsanek, J. (1984) Child adjustment to parental stress following divorce. social Casework, 65, 405-412.
Appendix A
Alpha Values of the Instruments for the Child Psychiatric Patients and School Children
Child Psychiatric
Scales School
Children N Patients N
DSRS .73 200 .72 30
Hopelessness .57 200 .75 30
Appraisal-focused .43 195 .50 29 Coping
Information .68 189 .74 28 Seeking
Problem Solving .44 192 .36 28
Emotion-focused .59 188 .57 28 Coping
Cohesion .74 174 .73 30
Expressiveness .39 172 .43 29
Conflict .57 178 .68 30
57
58
Appendix B
Mean, Standard Deviation and t-value of Family Relations, Hopelessness, Coping Responses, and DSRS score for the Child Psychiatric Patients and School Children
variable Names
Cohesion
Expressiveness
Conflict
Hopelessness
Appraisal-focused Coping
Emotion-focused Coping
Information Seeking
Problem Solving
OSRS
School Children
(N=200)
Mean so
1.23 .24
1.53 .20
1.30 .22
1.31 .16
3.13 .47
2.42 .45
2.40 .62
2.84 .50
41.94 5.22
* 2<.05. ** 2<.01.
Group
Child psychiatric
Patients (N=29)
Mean So
1.37 .27 3.11**
1.60 .20 2.07*
1.48 .26 4.03**
1.38 .22 2.19**
2.69 .69 4.42**
2.38 .54 .53
2.37 .74 .20
2.55 .57 2.80**
47.97 6.85 5.65**
59
Appendix C
Mean, Standard Deviation and t-values of Demographic Variables
Group
School Child Children Psychiatric
(N=200) Patients (N=30)
Variables Mean SO Mean SO t
Education 6.91 1.34 6.03 2.46 2.90**
Age 12.37 1.77 12.67 2.25 .84
Income 2.77 1.63 2.23 1.22 1.73
No. of 3.14 3.29 1.73 2.39 2.25* Activity
* 2<.05. ** 2<.01.
60
Appendix 0
Correlation between Demographic Variables and Family Relations, Hopelessness, Coping Responses and DSRS in School Children Sample
(N=200) Sex Edu Age Act Income
Cohesion -.11 .20** .18** -.11 -.11
Expressiveness -.01 .02 -.02 -.28** -.11
Conflict -.05 .06 .03 -.04 -.07
Hopelessness -.13* .02 -.08 -.06 -.07
Appraisal-focused .01 .04 .07 .01 .08 Coping
Information Seeking .04 -.19** -.19* .26** .08
Problem Solving .09 . 11 .07 .05 .08
Emotion-focused -.07 .15* .09 .09 .02 coping
DSRS -.07 .04 .00 -.11* -.11
Note: Sex 1 'male', 2 'female'.
* 2<.05. ** 2<.01.
61
Appendix E
Correlation between Demographic Variables and Family Relations, Hopelessness, coping Responses and DSRS in Child Psychiatric Patients Sample