The Influence of Parental Distress on Child Depressive Symptoms in Juvenile Rheumatic Diseases: The Moderating Effect of Illness Intrusiveness

Abstract

Objective To examine the role of children’s illness-related cognitive appraisals in the parent-child adjustment relationship in a sample of children and adolescents with juvenile rheumatic disease (JRD). Specifically, we tested the moderating effect of children’s perceived illness-induced barriers (i.e., illness intrusiveness) in the parent distress–child depressive symptom re-lationship. Methods Participants were 45 children and adolescents (ages 9 –17) diagnosed with JRD. Children completed measures of depressive symptoms (Children’s Depression Inven-tory), functional disability (Juvenile Arthritis and Functional Assessment Report), and illness intrusiveness (Illness Intrusiveness Scale–adapted for children); parents completed a brief mea-sure of global distress (Brief Symptom Inventory). The pediatric rheumatologist provided func-tional disability ratings following a routine physical exam. Results Both increased parental distress and child illness intrusiveness were associated with greater child depressive symptoms. Direct effects were qualified by a significant Parent Distress × Illness Intrusiveness interaction. The influence of general parental distress on child depressive symptoms was enhanced under conditions of increased child-reported illness intrusiveness. Conclusions Results support transactional conceptualizations of child adjustment to chronic illness. Findings also empha-