The impact of chronic physical illness, maternal depressive symptoms, family functioning, and self-esteem on symptoms of anxiety and depression in children

J Abnorm Child Psychol. 2015 Jan;43(1):177-87. doi: 10.1007/s10802-014-9893-6.


The present study extends earlier research identifying an increased risk of anxiety among children with chronic physical illness (CwCPI) by examining a more complete model that explains how physical illness leads to increased symptoms of anxiety and depression. We tested a stress-generation model linking chronic physical illness to symptoms of anxiety and depression in a population-based sample of children aged 10 to 15 years. We hypothesized that having a chronic physical illness would be associated with more symptoms of anxiety and depression, increased levels of maternal depressive symptoms, more family dysfunction, and lower self-esteem; and, that maternal depressive symptoms, family dysfunction, and child self-esteem would mediate the influence of chronic physical illness on symptoms of anxiety and depression. Data came from the National Longitudinal Survey of Children and Youth (N = 10,646). Mediating processes were analyzed using latent growth curve modeling. Childhood chronic physical illness was associated with increases in symptoms of anxiety and depression, β = 0.20, p < 0.001. Mediating effects were also observed such that chronic physical illness resulted in increases in symptoms of maternal depression and family dysfunction, leading to declines in child self-esteem, and in turn, increases in symptoms of anxiety and depression. CwCPI are at-risk for symptoms of anxiety and depression. Some of this elevated risk appears to work through family processes and child self-esteem. This study supports the use of family-centered care approaches among CwCPI to minimize burden on families and promote healthy psychological development for children.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anxiety / epidemiology*
  • Anxiety / psychology
  • Canada / epidemiology
  • Child
  • Child of Impaired Parents / psychology
  • Child of Impaired Parents / statistics & numerical data
  • Chronic Disease / epidemiology*
  • Chronic Disease / psychology
  • Comorbidity
  • Depression / epidemiology*
  • Depression / psychology
  • Family / psychology*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Mothers / psychology*
  • Mothers / statistics & numerical data
  • Self Concept*
  • Surveys and Questionnaires