Parent Perceptions of Illness Uncertainty and Child Depressive Symptoms in Juvenile Rheumatic Diseases: Examining Caregiver Demand and Parent Distress as Mediators

J Pediatr Psychol. 2016 Oct;41(9):941-51. doi: 10.1093/jpepsy/jsw004. Epub 2016 Feb 19.


Objective: Examine caregiver demand and general parent distress as mediators in the parent illness uncertainty-child depressive symptom association in youth with juvenile rheumatic diseases.

Methods: Children and adolescents completed the Child Depression Inventory; caregivers completed the Parent Perceptions of Uncertainty Scale, the Care for My Child with Rheumatic Disease Scale, and the Brief Symptom Inventory. The pediatric rheumatologist provided ratings of clinical disease status.

Results: Analyses revealed significant direct associations between illness uncertainty and caregiver demand, and between caregiver demand and both parent distress and child depressive symptoms. Results also revealed significant parent uncertainty → caregiver demand → parent distress and parent uncertainty → caregiver demand → child depressive symptom indirect paths.

Conclusions: Results highlight the role of illness appraisals in adjustment to juvenile rheumatic diseases, and provide preliminary evidence that parent appraisals of illness uncertainty impact parent distress and child depressive symptoms indirectly through increased perceptions of caregiver demand.

Keywords: caregiver demand; child depressive symptoms; illness uncertainty; juvenile rheumatic diseases; parent distress.; parent–child adjustment.

MeSH terms

  • Adaptation, Psychological
  • Adolescent
  • Caregivers / psychology
  • Child
  • Cross-Sectional Studies
  • Depression / diagnosis
  • Depression / etiology*
  • Female
  • Humans
  • Male
  • Parent-Child Relations*
  • Parents / psychology*
  • Perception*
  • Psychiatric Status Rating Scales
  • Psychological Tests
  • Rheumatic Diseases / psychology*
  • Stress, Psychological / diagnosis
  • Stress, Psychological / etiology*
  • Uncertainty*