Carer Health
A child being diagnosed with a chronic health condition has been reported to cause mental health problems in parents and this has also been found in parents of children with epilepsy.(Ellis, Upton & Thompson 2000) (Dumas, Gibson & Albin 1989; Holmes & Deb 2003; Rodenburg et al. 2005; Shore et al. 2002) Depressive symptoms in parents, particularly mothers, have been reported when they care for a child diagnosed with epilepsy.(Austin et al. 2004a; Ferro et al. 2011a; Ferro et al. 2011b; Mu, Kuo & Chang 2005; Rodenburg et al. 2007; Rodenburg et al. 2005; Shore et al. 2002) Shore et al stated that depression may be more likely to occur in mothers caring for a child with epilepsy due to the demands placed upon them whilst caring for a child with a chronic condition, the stigma associated with seizures and the high rate of behaviour problems.(Shore et al. 2002) Other studies have found that parental depression resulted from uncertainty and ambiguity that surrounded the diagnosis of epilepsy.(Mu 2005; Mu, Kuo & Chang 2005; Mu 2008b)
Thus it could be concluded that it is the demands and subsequently the stress caused by these factors that contribute to the likelihood of depression occurring in parents. This was found in a study conducted by Rodenburg et al with their findings showing an association between parental depression and parental stress.(Rodenburg et al. 2007) Shore et al found from 115 mothers that depression in mothers of children with epilepsy was significantly associated with low income, low satisfaction with family relationships and higher levels of behaviour problems.(Shore et al. 2002) The association between parental distress along with decreased mental health and child
behaviour problems appears to be a widely reported finding when the child is diagnosed with epilepsy.(Austin & Caplan 2007; Austin et al. 2004a; Ferro et al. 2011a; Wirrell et al. 2008)
The importance of studying whether depressive symptoms were occurring in parents caring for a child with chronic conditions is the impact that it has been said to have on the child. In a review by Rodenburg, maternal depression was said to contribute to the likelihood of a child developing psychopathology.(Rodenburg et al. 2005) Chiou et al found that higher parental depression was associated with children diagnosed with epilepsy having a poorer self-concept.(Chiou & Hsieh 2008a) A study involving 51 mothers showed that increased maternal depression was significantly associated with child maladjustment when their child was diagnosed with a conduct disorder. (Dumas, Gibson & Albin 1989)Shore et al also supported the notion that maternal depression has a wide impact when the diagnosis is epilepsy, by stating that depressive symptoms caused a disruption in family routines and day-to-day life.(Shore et al. 2002)
Carer Locus of Control
A locus of control refers to the extent that an individual believes that their actions influence events.(Perrin & Shapiro 1985) Rotter first proposed that there are two variations in a person’s locus of control, that they are either external or internal.(Rotter 1990) External locus of control is the degree that an outcome is viewed a being ‘a function of chance, luck or fate, is under the control of powerful others, or is simply unpredictable’.(Rotter 1990) Internal is the opposite of this notion, which an event occurs to individuals as a ‘contingent on their own behaviour and characteristics’.(Rotter 1990)
The interest in the belief that individuals have different locus of control is due to the concept that it is a mediator between stress and wellbeing.(Glenn et al. 2009; Parkes 1984; Siman-Tov & Kaniel 2011)
Studies that have examined the relationship between stress and locus of control have suggested that an external locus of control is positively correlated with increased parental stress experienced when a child has been diagnosed with a chronic condition. (Glenn et al. 2009; Siman-Tov & Kaniel 2011) Goldbeck also echoed these sentiments by describing external locus of control as being a maladaptive technique due to the passive patient behaviour that the beliefs generate.(Goldbeck & Bundschuh 2007)
A study by Perrin et al compared locus of control between mothers of children with no health complaints, the control group, to mothers of children with seizures. No group sizes were given. Perrin et al demonstrated that mothers of children with seizures obtained higher scores for beliefs in the subgroup ‘powerful others’ and slightly lower scores in the subgroup ‘internal’ than the normal population. Overall it was said that mothers exhibited a more external locus of control.(Perrin & Shapiro 1985) Another study of 187 parents of children with different health conditions, including epilepsy, found that maternal locus of control and a child’s intelligence level predicted child adjustment, with internal locus of control producing a strong positive relationship with adjustment.(Perrin, Ayoub & Willett 1993)
Carer Coping
Austin et al described coping as ‘action strategies related to family relationships, parenting and supporting the child’s successful adjustment’. (Austin & Caplan 2007) Duffy stated in her review of parental coping and childhood epilepsy, that it was essential for parents to maintain their coping strategies, as by doing so, parental wellbeing is preserved and therefore family wellbeing will be too.(Duffy 2011) Mu et al supported this notion, stating that in the study of 316 mothers whose child had been diagnosed with epilepsy, efficient coping patterns were found to maintain family coherence and unity.(Mu, Kuo & Chang 2005)
Carver et al stated that coping is context-dependent, that the way in which people cope is derived from the nature of the stress and the interactions between the stressors and the environment.(Carver, Scheier & Weintraub 1989) However, different studies have indicated that specific types of coping strategies are associated with more stress. In Rodenburg’s review of parents whose child has epilepsy, it was suggested that a general lack of parenting coping resources might cause increased parenting stress.(Rodenburg et al. 2005) Rodenburg et al identified in their study of 91 parents of children with epilepsy, that particular types of coping strategies either served to increase or decrease parenting stress. Problem focused coping strategies decreased parenting stress, whilst emotional focused coping strategies were a significant contributor to parental stress.(Rodenburg et al. 2007)
Mitchell et al followed 119 families presenting with a child having seizures over at least 6 months and found that families who used more medical guidance and greater
physician contact, acted as a form of instrumental support. This resulted in a reduction of parental stress and a greater adherence to medication.(Mitchell, Scheier & Baker 2000) This may highlight the different coping strategies employed when parents feel that they are under a lot of stress, that those experiencing significant stress will seek medical guidance and physician support as a form of instrumental coping mechanism.