Breaking bad news: communication around parental multiple sclerosis with children

Families, Systems & Health, March, 2009 by Elena Paliokosta, Stavroula Diareme, Gerasimos Kolaitis, Emmanuel Tsalamanios, Spyros Ferentinos, Sofia Anasontzi, Eirini Lympinaki, Alkis Tsiantis, John Tsiantis, Clementine Karageorgiou, George Romer

Another possible explanation about this finding could be that children having no information came from families with recently diagnosed parental MS that could not yet influence the child's emotional functioning. This parental attitude could be then explained both in terms of denial as a normal stage of mourning process and of time required for adjusting themselves to the new situation, before discussing it with their children. However, this explanation does not seem to hold as a general explanation since the correlation between the amount of information provided to children and the illness' duration was not found to be significant.

Another interesting finding of our study was the difference between mothers' and fathers' reports of child problems (evaluated by CBCL scores). Mothers' reports about their children's social behavior and internalizing behaviors, as well as emotional and behavioral difficulties in total, were related to the amount of information about MS children had. Children, who had "partial information" about the parental illness, exhibited significantly more problems according to their mothers, as compared with children who had explicit information about the parental illness or children who knew nothing about it. Differences between parental reports on children's health status, is an issue discussed in the literature and it seems likely that socioeconomic status, parental health and gender may explain differences in mothers' and fathers' reports (Barnes et al., 2002; Waters et al., 2000). Regarding the impact of parental illness particularly, maternal reports achieved better agreement with adolescents' self-reports in a study about the impact of parental cancer (Visser at al, 2005).

As previously mentioned, no correlations were found between communication around illness and family functioning as estimated by FAD. Also, illness-induced impairment of parental functioning was not correlated with communication around illness in the family. However, paternal but not maternal depression was significantly correlated with communication around illness. The more depressed the father, the more information the family provided to the child about parental illness. This result could imply that depression of the father promoted communication around illness in the family context. An explanation for this could be that parental depression is associated with greater severity and impairment of MS that makes disclosure inevitable. This is supported by a positive statistically significant correlation between paternal BDI scores and Karnofsky scores of ill fathers (but not ill mothers) in our sample. Steck et al. (2007) studied families from three countries (including Greece) that a parent having MS, and found a positive correlation between parental depression and illness duration. Such a hypothesis could partly explain the above result even if we did not find a significant correlation between communication and illness duration. In any case, depressive symptoms are very common (73%) in patients with MS, and subclinical syndromes may go unrecognized and untreated (Diareme et al., 2005; Feinstein & Feinstein, 2001). Depression's influence on family communication is therefore very important and should be taken into serious consideration by professionals when dealing with families of ill parents.