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Journal of Clinical Psychology in Medical Settings, Vol. 13, No. 3, September 2006 (C
2006)
DOI: 10.1007/s10880-006-9025-8
Risk and Resistance Factors for Psychological Distress in Icelandic Parents
of Chronically Ill Children: An Application of Wallander
and Varni’s Disability-Stress-Coping Model
H. S. Gu
›
mundsd´
ottir,1D. B. Gu
›
mundsd´
ottir,2and Ask Elklit2,3
Published online: 23 May 2006
The purpose of the study was to investigate Wallander and Varni’s (1998) disability-stress
coping model in a sample of 105 Icelandic parents of chronically ill children. The Revised
Adult Attachment Scale (RAAS), the Attributional Scale (AS), the Defence Style Question-
naire (DSQ), the Sense of Coherence Scale (SOC), the World Assumption scale (WAS), The
Coping Style Questionnaire (CSQ), The Impact on Family scale (IFS), the Trauma Symptom
Checklist (TSC), and the Harvard Trauma Questionnaire (HTQ), were completed by the
parents of children with various diseases. Despite the heterogeneity of the sample in terms
of disease type, PTSD was present in 13.2% of the parents and an additional 28.6% had sub-
clinical PTSD. Emotional coping, extent of daily care, time since diagnosis, and changes in
employment due to the disease explained 71% of the variance in HTQ total score.
KEY WORDS: chronically ill children; parents; psychological distress; PTSD; coping.
INTRODUCTION
Children’s chronic disease often involves life
threat or threat to the physical integrity of the child,
and has the potential to cause disruptions in the daily
lives of all family member and to affect their emo-
tional well–being (Houtzager et al., 2004). For those
reasons, a number of researchers within pediatric
psychology (e.g. Kazak et al., 1997; Hoekstra-
Weebers, Jaspers, Kamps, & Klip, 2001; Landolt
et al., 2002) advocate the use of a family-systems
approach and a PTSD framework (American Psy-
chiatric Association, 1994) to the study of the impact
of a child’s chronic disease. PTSD prevalence rates
found in such research have ranged from 10.2–24%
in mothers, 9.6–22% in fathers, and from 4.5–11%
in the children themselves (e.g. Kazak et al., 1997;
Kazak et al., 2004; Landolt et al., 2002; Hobbie et al.,
1Skolaskrifstofa Mosfellsbæjar, Mosfellsbær, Iceland.
2Department of Psychology, University of Aarhus, Denmark.
3Correspondence should be addressed to Ask Elklit, Jens Chr.
Skous Vej 4, DK-8000, Aarhus C, Denmark; e-mail: aske@
psy.au.dk.
2000). Such results are indicative of the chronic
disease’s potential to cause distress in families, but
concurrently give evidence that the large majority of
families are well adjusted despite being exposed to a
highly distressing experience.
Wallander and Varni’s (1998) ‘disability-stress
coping model’ was developed to encompass the ex-
periences of families of chronically ill children, and is
based on previous theories of adjustment to chronic
disease (Pless & Pinkerton, 1975), family coping
(Moos and Schaefer, 1984) and cognitive appraisal
and coping (Lazarus & Folkman, 1984). It includes
three categories of risk factors: (1) Disease/disability
parameters,(2)functional dependence, and (3) dis-
ease and non-disease related psychosocial stressors,
and three categories of resistance factors: (1) Intra-
personal factors,(2)socioecological factors, and (3)
stress processing factors (Wallander & Varni, 1998).
In accordance with this model, research evi-
dence has indicated the importance of socioecologi-
cal factors such as social support (Hoekstra-Weebers
et al., 2001), marital satisfaction (Hoekstra-Weebers,
Jaspers, Kamps, & Klip, 1998), and family cohesion
299
1068-9583/06/0900-0299/0 C
2006 Springer Science+Business Media, Inc.
