Mothers’ Physical Illness in One- and Two-Parent Families

Abstract

Parental physical illness has been associated with a variety of negative child outcomes but the mechanisms explaining this relationship are not fully understood. Additionally, few studies have explored what role, if any, marital status may play in this relationship. This study used prospective longitudinal survey data from 382 two-parent and 182 single-parent families in the Iowa Youth and Families and Single Parents Project to explore the relationship between maternal illness and parenting with depressed affect as a potential mediator. Multiple group structural equation modeling was used to investigate whether the relationships between these indicators were the same for single and married mothers. Analyses revealed associations between mothers’ illness and parenting for both single and married mothers, but mothers’ depressed affect played a meditational role for single mothers, which was not evident with married mothers. Both the empirical and clinical implications of these findings are discussed.

Keywords

family health single parents adolescents parent/child relations mother-child relationship

Parental physical illness has been associated with a variety of negative child outcomes including increased rates of childhood depression (Osborn, 2007), anxiety disorders, illicit drug use (Lester et al. 2006), social isolation (Vannatta, Grollman, Noll, & Gerhardt, 2008), school absenteeism, somatic complaints, internalizing and externalizing behavior problems (Evans, Keenan, & Shipton 2007), and poor long-term economic well-being (Wagmiller, Lennon, & Kuang, 2008). Although the link between parents’ physical illness and negative child outcomes has been established, the mechanisms that explain this relationship are not fully understood.

Armistead, Klein, and Forehand (1995) proposed that parental depression, marital conflict, and disrupted parenting serve as mediators in the relationship between parental illness and negative child outcomes with particular emphasis on disrupted parenting. However, this schematic model focuses primarily on parents who are married and does not address what mechanisms are involved when single parents are experiencing physical illness. Considering that single parents are more likely to have poor physical (Lorenz, Wickrama, Conger, & Elder, 2006) and mental (Cairney, Boyle, Offord, & Racine, 2003) health and higher rates of parental stress (Anderson & Hammen, 1993) when compared with their married peers, it is worthwhile to investigate the effects of parental health on single parent families so that the appropriate supports and interventions can be provided to reduce the negative impact that parental illness has on parents and children. As a link between disrupted parenting and negative child outcomes is already well established (Maccoby & Martin, 1983), the purpose of this article is to investigate whether a relationship between maternal illness and disrupted parenting exists and if that relationship differs depending on marital status.

Potential Mechanisms

Studies of parental physical illness and child outcomes have begun to explore the roles of such mechanisms as disrupted parenting and parents’ mental health (Armistead et al., 1995). Parenting remains a challenging task when one is in good health and the physical limitations associated with physical illness may only serve to exacerbate these parenting challenges. In a qualitative study by Helseth and Ulfsaet (2005), one of the biggest challenges reported by parents diagnosed with cancer was feeling torn between tending to their own health needs and tending to the daily needs of their children. Parents reported that their illness limited their energy, resulting in decreased stamina which, in turn, detracted from the time and energy typically reserved for their children. Similar sentiments were echoed in qualitative interviews with children of parents with inflammatory bowel disease who reported their parents being withdrawn and not spending as much time with them due to illness (Mukherjee, Sloper, & Lewin 2002). A lack of time and attention for children has also been documented quantitatively. Parents with multiple sclerosis and rheumatoid arthritis reported spending less time with their children (White, Mendoza, White, & Bond, 2009) and HIV positive mothers rated themselves as having lower quality positive-parenting and monitoring behaviors (Kotchick et al., 1997) when compared with healthy controls. Taken together these studies suggest that parental illness has the potential to negatively impact the quantity and quality of parent–child interactions.

Furthermore, extensive support has been found for a link between parental depression and negative parenting practices (for a review, see Goodman, 2007). Given that research has shown that poor physical health is linked to increased rates of depression in adults (Katon, Lin, & Kroenke, 2007), it is reasonable to suppose that an association between parental illness and parenting may be partially explained by parental depression. Supporting this, a study by Schmitt et al. (2008) found that parental depression mediated the relationship between parental cancer and poor family functioning. Research suggests that mothers with chronic pain reported significantly greater difficulty with performing daily parenting tasks when compared with healthy controls but that this was mediated entirely by mothers’ depression (Evans, Shipton, & Keenan, 2005). Additionally, mothers with chronic pain who experience impaired physical functioning were more likely to report lower relationship quality with their children and to discipline their children in a more authoritarian manner (Evans, Shipton, & Keenan, 2006). These few studies support the claim that mental health and parenting are negatively affected by parental illness. However, the generalizability of these studies is limited since they focus on a very specific sample, parents with cancer and chronic pain suffers. The purpose of the current study is to explore these mechanisms in a broader community sample.

The Importance of Parenting

Past research has established parental monitoring and inductive reasoning during adolescence to be important to healthy development by reducing rates of aggression and involvement in antisocial behavior as well as increasing self-esteem and prosocial behaviors (Krevans & Gibbs, 1996; Maccoby & Martin, 1983; Shuster, Li, & Shi, 2012). Parental monitoring includes being aware of an adolescent’s activities and behaviors, whereas inductive reasoning can be viewed as guiding adolescents to rationally reflect on their behavior while considering the consequences of their actions. Parental illness has the potential to disrupt these parenting practices as it is a considerable source of stress for parents (Abidin, 1995). As research has supported other forms of parental stress negatively affecting parental monitoring and inductive reasoning (Ritchie & Holden, 1998), and consequently childhood outcomes (Conger et al., 1993; Dishion & McMahon, 1998; Krevans & Gibbs, 1996), it is likely that the stress of parental illness may have similar negative consequences on parenting practices. This is especially salient when considering that research suggest that adolescents are especially vulnerable to the negative consequences associated with parental illness (Armistead et al., 1995).

Single Mothers

Physical Health

As they are often the sole provider of emotional, financial, and tangible support in the household, single parents may especially struggle with the daily demands of parenting, termed parenting daily hassles (Crnic & Low, 2002). Research suggests that single parents are more vulnerable to the negative effects of parenting daily hassles than parents from two-parent families (Anderson & Hammen, 1993). Additionally, single mothers are more likely to suffer disproportionately greater somatic health problems than individuals living in two-parent families (Johner, 2007), suggesting that family-wide barriers to illness may exist in two-parent families that are not present in single-parent families. Moreover, in the event that physical illness reduces a one’s ability to parent to their full ability, there is often no other adult present in the house that can offer assistance or support. Therefore, it is possible that parenting daily hassles are compounded by the stress of parental illness for single parents in particular. In a pilot study of mothers with breast cancer, Lewis, Zahlis, Shands, Sinsheimer, and Hammond (1996) found that when compared with married mothers, single mothers reported decreased quality of parenting and higher rates of depression and such illness-related pressures as cancer treatment negatively affecting mothers’ ability to spend time with their children and maintain the household. In support of marital status potentially playing a differential role in the relationship between physical health and family well-being, one study investigating the effects of overall family health problems on mothers’ parenting confidence suggests that different mechanisms may be in place for mothers who are living with a partner and those who are single (Ontai, Sano, Hatton, & Conger, 2008). As one of the few studies to examine both acute and chronic health problems, the authors found that family health problems had a direct negative effect on the parental confidence of single mothers, but for mothers who were living with a partner, this relationship was completely mediated by perceived parental support, suggesting that the effects of physical illness on the family differ by marital status. The authors posit that parenting daily hassles are exacerbated by illness and that the presence of a partner in the home, who can serve as a form of social support, may help to alleviate some of the negative effects of these daily hassles. Conversely, in another study, researchers explored the effects of maternal chronic illness in single parent families and found no support for a link between maternal illness and child outcomes (Annunziato, Rakotomihamina, & Rubacka, 2007). The researchers posit that the null findings may be due to positive parenting serving as a moderator in the relationship between illness and child outcomes, something that was not explored in the study. Furthermore, this cross-sectional study did not compare these outcome variables to two-parent families and did not explore the possibility that mothers’ illness may have longitudinal effects on child outcomes. Regardless, these conflicting findings highlight the need for additional research in this area.

Mental Health

Given the association between depression and physical illness (Katon et al., 2007) as well as disrupted parenting (Goodman, 2007), it is especially concerning that single mothers suffer disproportionally higher rates of depression than mothers living with a partner (Cairney et al., 2003) even before considering the impact that physical health may have on the individual. Whether this heightened vulnerability to depression plays a role in the relationship between parental illness and parenting behaviors for single mothers is unclear at this time and will be further investigated in this study.

Defining and Studying Physical Illness

In his family systems-illness model, Rolland (1994) posits that families’ adjustment to a family member’s illness is based on multiple aspects of illness. While it is not the intent of this article to provide a detailed review of Rolland’s treatment model, it is worth noting that in the family systems-illness model, illness is not a unidimensional problem that families face, but a multifaceted and dynamic stressor that differs from family to family. Despite the possibility of multiple aspects of illness affecting the family, researchers of parental health rarely consider the effects of more than one aspect of illness at a time on the family (e.g., classifying individuals as healthy because they lack a diagnosis of the specific illness being studied). The current study goes beyond simply dichotomizing physical health into healthy versus ill and attempts to operationalize illness as a complex stressor by considering the possibility that mothers may experience multiple health problems that can differ in severity and impact.

The Current Study

In summary, parental illness has been linked to negative child outcomes. Disrupted parenting and parents’ depression have been proposed as potential mediators in this relationship. Single parents may be especially vulnerable to the negative effects of parental illness due to their increased likelihood of mental and physical health problems. However, research investigating differences in the effects of parental illness on single and married parents is limited. The purpose of this article is to investigate the relationship between parental illness, parental depressive symptomatology, and parenting in single versus married mothers.

The first goal of this article is to determine if there is a link between mother’s physical illness and their parenting. It is hypothesized that regardless of marital status, frequency and severity of parental illness will be predictive of disrupted parenting, measured here as decreased parental monitoring and inductive reasoning (Hypothesis 1). The second goal of this article is to determine if mothers’ depressed affect plays a mediating role between parental illness and parenting behaviors and if this role is the same for single and married mothers. It is anticipated that mothers’ depressed affect will serve as a mediator in the relationship between parental illness and parenting for all parents (Hypothesis 2). However, given that single parents are more likely to experience depression (Cairney et al., 2003) and may be more prone to the negative effects of parenting daily hassles resulting from physical illness (Ontai et al., 2008), we hypothesize that the meditational pathways for single mothers will have a higher significance when compared with married mothers (Hypothesis 3).

Method

Sample and Design

This article used data from the Iowa Youth and Families Project (IYFP) and the Single Parents Project (SPP). The IYFP is a longitudinal study of 451 families living in rural Iowa spanning the years 1989 to 1993 (Conger & Elder, 1994). Families were eligible to participate in the IYFP if they had a child enrolled in the seventh grade in 1989 who was living with both biological parents and a sibling within 4 years of age of the target child. Approximately 78% of eligible families participated in data collection.

At the time of enrollment of the IYFP, the mean age of the child was 13.17 years with 236 female and 215 male target children enrolled from White, middle- to lower-middle-class families who lived in rural communities. Approximately 1% of the population in rural Iowa in 1989 was considered an ethnic minority; therefore, all the families enrolled in the IYFP were Caucasian. The median family income was $33,700 in 1988, the year before the first wave of data collection. Average ages of fathers and mothers on first contact for the study were 40.01 years (SD = 4.86) and 38.01 years (SD = 4.10), respectively. Family size averaged 4.95, ranging from 4 to 13. Sample retention was more than 90% from 1989 to 1994 (for a more detailed review of the IYFP, see Conger & Elder, 1994).

The SPP began in 1991 when a cohort of 207 age-matched ninth graders was added to the already existing IYFP sample. The target children in this cohort had a sibling within 3 years of age and lived in a single-parent, mother-headed home. Inclusion criteria for the SPP mothers included permanent separation from their husbands, separation occurring within 2 years prior to enrollment, and the husband from whom they had recently separated was the biological parent of the target child. The median family income for families from the SPP, including child support and government assistance was $21,521 in 1991, and mothers had a mean level of 13 years of education (for a more detailed review of the SPP, see Simons, 1996).

For these analyses data from 1991 and 1992 (henceforth referred to as Wave 1 and Wave 2, respectively), in which the target child would have been in 9th and 10th grade respectively, were used. Any families between Waves 1 and 2 that experienced a change in marital status were excluded from these analyses to minimize any impact marital transition (Hetherington, 1991) may have had on the family. This resulted in the exclusion of 13 IYFP and 19 SPP families. Finally, only participants with no missing data on all control variables were included in the final analysis (n = 62 excluded). Mothers from the IYFP who were excluded due to recent change in marital status had significantly lower scores on inductive reasoning variables than married mothers in the IYFP sample. No other significant differences were found between those included and excluded from the analysis for both married and single mothers separately. The final sample resulted in a total of 382 married mothers and 182 single mothers.

Families for the IYFP were recruited for participation in 1989 via seventh grade classes in 34 public and private schools in eight rural counties in Iowa. Letters were sent to all eligible families describing the project and families were contacted via telephone or personal visit and asked to participate. Similar procedures were followed to recruit SPP families with recruitment taking place via ninth-grade classes in 1991. However, due to the stringent eligibility criteria of the SPP, the geographic regions were expanded to include 104 rural communities in Iowa.

A trained interviewer visited families at home twice a year during each year of data collection. Each interview session lasted approximately 2 hours and took place within 2 weeks of the other. During the first session, family members completed a set of questionnaires on family member characteristics and economic circumstances. During the second visit, families were videotaped while engaging in structured interaction tasks. These data will not be used for this study and will therefore not be discussed further.

Measures

Mothers’ Physical Health Status

At Wave 1 mothers were given a list of 48 different illnesses and health problems and were asked to indicate whether, during the past 12 months, they had experienced any problems with any of the symptoms or diseases listed. Three of the illnesses listed (depression, anxiety reaction, and nervous breakdown) are often associated with mental, rather than physical, health problems and were therefore excluded from all further analyses. The dichotomous responses (0 = no, 1 = yes) were summed to form a frequency of illness score. Each illness listed was also assigned an impact score that corresponds with the rank value of Wyler, Masuda, and Holmes’ (1968) Seriousness of Illness Rating Scale, in which both physicians and the general public ranked 126 different illnesses in terms of severity (see the appendix for complete list of illnesses in the current study and their corresponding impact scores). The validity and reproducibility of The Seriousness of Illness Rating Scale has been previously established with high concordance rates in the severity ranking of each item among physicians and medical residents (Wyler, Masuda, & Holmes, 1970) and between self-report and physician diagnoses (Kobasa, Maddi, & Puccetti, 1982). For the current study, the rank values for illnesses that mothers endorsed were averaged together to form a severity of illness score. Similar approaches have been taken by other researchers examining the severity of conditions (see Chipperfield, Perry, Bailis, Ruthig, & Chuchmach, 2007, for an example). Mothers who endorsed no illnesses during the year were given a severity score of zero.

Mothers’ Depressive Symptomatology

At Wave 2, mothers completed the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977). The CES-D consists of 20 items and was designed to assess depressive symptomatology within the general population. Mothers were instructed to “Circle the number for each statement which best describes how often you felt or behaved this way during the past week.” Answers were given on a 4-point Likert-type scale ranging from 0 (rarely or none of the time) to 3 (most or all of the time). Scores were then converted to a binary score based on the established cut point of 16 being indicative of high depressive symptomatology (Radloff, 1977) with a score of 1 indicating high symptomatology and a score of 0 indicating low symptomatology. Past research indicates that these cut points have good sensitivity and specificity and high internal consistency (Lewisohn, Seeley, Roberts, & Allen, 1997).

Parenting

At Wave 2, children reported on 8 items regarding his or her mother’s child rearing practices. Children were asked to rate how his or her mother related to the child on a 5-point Likert-type scale ranging from (0) always to (4) never. The child monitoring subscale consists of 4 items with such questions as “In the course of the day, how often does your mom know where you are?” The inductive reasoning subscale consists of 4 items with questions such as “How often does your mom discipline by reasoning, explaining, or talking to you.” Scores for each subscale were summed and standardized. Cronbach’s alpha values for the monitoring and inductive reasoning subscales were .72 and .85, respectively.

Covariates

Self-reports of mother’s age and education were included as control variables. Additionally, an income to needs variable was computed by dividing total family income by the family size. Child’s gender was also included as a covariate. All covariates were assessed at Wave 1.

Data Analyses

Mplus 5.2 (Muthén & Muthén, 2009) was used to conduct multiple group Structural Equation Modeling (SEM) for these analyses to compare single and married mothers. Prior to testing SEM models, data were determined to be missing at random as per recommendations by Shafer and Graham (2002). A weighted least squares with mean and variance adjustment estimator was used because it provides useful fit indices that are advantageous with categorical indicators such as mother’s depressive symptomatology. Pathways were run from severity and frequency of illness to mother’s depressive symptomatology and both parenting outcomes as well as from depressive symptomatology to parenting outcomes. To evaluate the fit of the structural models, several fit indices were used, including the chi-square goodness of fit statistic, the root mean square error of approximation (RMSEA; Browne & Cudeck, 1992), the Tucker–Lewis index (TLI; Tucker & Lewis, 1973), and the comparative fit index (CFI; Bentler, 1990), all of which have been typically used as indices of practical fit. Finally, bootstrapping was used to test for indirect effects (Mackinnon, Lockwood, & Williams, 2004).

Results

The final sample for analysis was 382 married and 182 single mothers. Table 1 contains the descriptive statistics for all variables used in testing the theoretical model. When compared with married mothers, single mothers experienced higher depressive symptomatology, F(1, 563) = 9.42, p = .002; were younger in age, F(1, 562) = 9.730, p = .002; and had lower income-to-needs ratios, F(1, 562) = 18.393, p = .000. Figures 1 and 2 present the results of the multiple group SEM analyses for married and single mothers, respectively. The practical indices of fit indicated that the final model was a consistent with the data (χ² = 407.66, df = 60, p < .01; TLI = 1.0, CFI = 1.0, RMSEA = .000). Correlations among study variables for both married and single mothers are listed in Table 2.

Table 1.

Descriptive Statistics of Observed Variables by Group and Total Sample.

	Married mothers (n = 382)			Single mothers (n = 182)			Total sample (n = 564)
Observed variable	M	SD	p	M	SD	p	M	SD
Frequency of illness	3.29	2.18	1.0	3.73	2.74	1.0	3.43	2.38
Severity of illness	27.24	17.91	.99	29.43	18.44	1.0	27.95	18.10
Monitoring	15.50	2.67	.96	15.17	2.83	.97	15.40	2.72
Induction	14.02	3.36	.96	14.07	3.43	.97	14.03	3.38
Income-to-needs	2.82	2.92	1.0	1.86	1.08	1.0	2.51	2.52
Mother’s age	40.76	3.99	1.0	39.66	3.81	1.0	40.34	3.98
Mother’s education	13.45	1.69	1.0	13.56	1.90	1.0	13.47	1.76
Child is male^a	.46		1.0	.45		1.0	.46
High depressive symptomatology^a	.17		.96	.26		.97	.20

Note. p represents the portion of data present for each variable.

Variables are reported as the proportion of items endorsed.

Figure 1.

Empirical results of multiple group structural equation model for married mothers.

Figure 2.

Empirical results of multiple group structural equation model for single mothers.

Table 2.

Summary of Correlations of Variables as a Function of Marital Status.

Measure	1	2	3	4	5
1. Frequency of illness	—	.49***	.40***	.09	.02
2. Severity of illness	.53***	—	.11	−.04	.07
3. Depressive symptomatology	.21***	.18***	—	−.21***	−.21***
4. Monitoring	−.05	−.11*	−.03	—	.48***
5. Inductive reasoning	−.09	−.09	−.14**	.50***	—

Note. Correlations for married mothers (n = 382) are reported below the diagonal, and correlations for single mothers (n = 182) are reported above the diagonal.

p ≤ .05. **p ≤ .01. ***p ≤ .001.

As shown in Figure 1, for married mothers severity of illness had a direct negative effect on children’s reports of monitoring (β = −0.11, p < .05). Increased frequency of illness corresponded to an increase in mothers’ depressive symptomatology (β = .15, p < .05), but no significant pathways were evident between mothers’ depressive symptomatology and monitoring or inductive reasoning. As shown in Figure 2, results for single mothers reveal a different relationship between mothers’ illness and parenting behaviors. Similar to married mothers, severity of illness had a direct negative effect on the children’s report of monitoring (β = −0.15, p < .05). However, frequency of illness, also predicted children’s reports of monitoring (β = .28, p < .01). Furthermore, mothers’ frequency of illness was predictive of mothers’ depressive symptomatology (β = .44, p < .01). Mothers’ depressive symptomatology was predictive of decreased monitoring (β = −.32, p < .01) and inductive reasoning (β = −.28, p < .01). Tests for indirect effects revealed support for mediation for single mothers only with mothers’ depressive symptomatology significantly mediating the relationship between frequency of illness and monitoring (β = −.14, p < .05) and trend level mediation for the relationship between frequency of illness and inductive reasoning (β = −.12, p < .10).

Discussion

The current study is one of the first to explore differences in the relationship between maternal illness and disrupted behaviors in single and married mothers by using a large community sample. The utilization of a longitudinal study design and the inclusion of illness frequency and severity are also unique additions to the literature. The first goal of this article was to determine if there was an association between parental physical illness and parenting behaviors for single and married mothers. Results partially support the hypothesis (Hypothesis 1) that mothers’ poor physical health would be negatively associated with disrupted parenting in the form of decreased parental monitoring and inductive reasoning. For married and single mothers, experiencing more severe illness was associated with decreased parental monitoring. However, for single mothers, direct pathways from frequency of illness to monitoring were evident and indirect pathways were evident from frequency of illness to monitoring and inductive reasoning.

The second goal of this article was to determine whether mothers’ depressive symptoms played a mediating role between illness and parenting and if this role was the same for single and married mothers. It was hypothesized that depressive symptoms would play a mediating role in the relationship between physical illness and parenting regardless of marital status (Hypothesis 2), but that the meditational role of depressive symptoms would differ depending on marital status (Hypothesis 3). Although results supported Hypothesis 3, support for Hypothesis 2 was not evident. Single mothers’ depressive symptoms fully mediated the relationship between mothers’ frequency of illness and inductive reasoning and partially mediated the relationship between frequency of illness and monitoring. However, this same relationship was not evident for married mothers. Although married mothers’ frequency of illness increased the likelihood of mothers’ reporting depressive symptoms, depressive symptoms did not further contribute to parenting. These results suggest that for single mothers, physical illness is more likely to result in depressive symptoms, which disrupts parenting. For married mothers, although illness is likely to result in increased rates of depressive symptoms, these depressive symptoms do not directly affect parenting. There are several possible reasons for these differences. Given single mothers’ heightened vulnerability to depression (Cairney et al., 2003) and parenting daily hassles (Anderson & Hammen, 1993), it is possible that the presence of a spouse in the home serves as a buffer against the added daily hassles of illness. Although illness continues to heighten married and single mothers risk for depression, it seems that the spouse can serve as a barrier for the link between depression and parenting. This possibility is supported by research that suggests that it is marital conflict that mediates the relationship between parental depression and disrupted parenting (Conger & Conger, 2002), so parenting may only be disrupted for married mothers whose depression resulted in increased conflict in the home. Additionally, the presence of a spouse may afford mothers more opportunity to attend to their own health needs than they would be able to when being solely responsible for their children’s needs. This possibility is in line with research that suggests that partner support serves as a buffer to the negative effects of illness on parenting (Ontai et al., 2008). Additional research is needed to further understand the role of spousal support in the relationship between maternal illness and parenting behaviors.

Perhaps the most interesting finding to come from these analyses is that, depending on mothers’ marital status, different aspects of parental illness affect parenting. Severity of illness appears to have a similar direct negative effect on monitoring for both single and married mothers, but frequency of illness further influences the parenting of single mothers in a manner that is not evident with married mothers. For single mothers, frequency of illness has a direct positive effect on monitoring as well as increasing the likelihood of mothers’ depressive symptoms which in turn, negatively affects both monitoring and inductive reasoning. This difference suggests that increased frequency of illness, in particular, may create an added challenge for single mothers, which is not evident with their married peers. It is possible that more frequent illness is associated with more added stressors above those associated with severity of illness. For instance, having multiple illnesses over the course of a year may result in more missed work for doctors’ visits and recovery. If a single mother works for an hourly wage, missed work could increase financial stressors placed on the family whereas a spouse may be able to continue to provide financially for the family when the other is unable to work. As we did not measure employment status of mothers this is speculative in nature, however a financial link was between income-to-needs and mothers’ illness was evident for single mothers that was not present for married mothers (see Figure 2) suggesting maternal illness may be more a more complex stressor for single mothers. Future research should explore the role of employment and socioeconomic status in the relationship between single mothers; illness and parenting behaviors.

Limitations and Future Directions

As with all empirical work, this study is not without its limitations. The homogeneity of this sample limits the generalizability of the findings. All participants in this study were Caucasian and from rural areas, highlighting the need for research on parental illness to extend to minority groups and urban populations. Additionally, single mothers in this study were recently divorced and results cannot be generalized to mother who have never married. Moreover, since this research focuses on mothers, the results cannot be generalized to what processes take place within the family when fathers are ill. It is possible that different processes may affect the family in the face of paternal illness. It is also important to consider that only physical illnesses were included in the analyses. Physical health that was compromised by injury was not included.

An additional limitation of this study is the lack of data available on medications and access to treatment. It is possible that access to health care and medicinal interventions affect the impact of illness on the family. Additionally, as some of the illnesses measured were acute rather than chronic, it is possible that the illness may have abated prior to mothers experiencing depression. However, it is noteworthy that similar results were evident when the analyses were run with all measures collected concurrently. Therefore, the longitudinal analysis were retained in the current study as it is more appropriate for mediational analyses and provides support for the notion that stress associated with physical illness may have long-term consequences on mental health. Regardless, the results should be interpreted with caution.

A final area that needs to be considered when interpreting the results of this study is the exclusion of any married couples that had recently experienced a transition may limit the conclusions regarding married couples to a very specific population. It is possible that for couples in less stable or happy marriages, pathways similar to those of single mothers may emerge or that depression may play a more meditational role in the relationship between illness and parenting behaviors.

Conclusions

Considering these findings, mental and physical health care providers should be cognizant of the potential for mothers’ physical illness to negatively affect the whole family and should be prepared to refer them for more specialized help and support if necessary. Single mothers are especially vulnerable to the negative effects of physical illness and may benefit from interventions that promote mental health in the face of physical illness. This study adds to the current literature by suggesting that these specific aspects of illness may function differently depending on family status.

Footnotes

Appendix

Illnesses and Symptoms Severity Scores

Directions: Please think about all the health problems you may have experienced. During the past 12 months have you had any problems with any of the symptoms or diseases listed below?

Symptom/illness	Severity score
Common cold	8
Psoriasis	40
Low blood pressure	44
Bronchitis	47
Shingles	49
Migraine	56
Irregular heart beats	64
Anemia	66
Sore throat	11
Depression	Excluded from analyses
Hyperthyroid	77
Glaucoma	79
Arthritis	82
Peptic ulcer	89
High blood pressure	91
Chest pain	97
Sinus infection	32
Diabetes	99
Hardening of the arteries	101
Cirrhosis of the liver	107
Blood clot in the lung	111
Heart failure	119
Brain infection	121
Cancer	125
Dizziness	31
Hemorrhoids	42
Eczema	45
Hyperventilation	48
Mononucleosis	50
Goiter	59
Anxiety reaction	Excluded from analyses
Infection in the middle ear	38
Pneumonia	71
Kidney infection	75
Asthma	78
Gallstones	81
Kidney stones	88
Pancreatitis	90
Collapsed lung	94
Leukemia	126
Nervous breakdown	Excluded from analyses
Blood clot in blood vessel	100
Emphysema	102
Parkinson’s disease	108
Stroke	113
Heart attack	120
Multiple sclerosis	122
Bleeding in the brain	123

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is currently supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Mental Health, and the American Recovery and Reinvestment Act (HD064687, HD051746, MH051361, and HD047573). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Support for earlier years of the study also came from multiple sources, including the National Institute of Mental Health (MH00567, MH19734, MH43270, MH59355, MH62989, and MH48165), the National Institute on Drug Abuse (DA05347), the National Institute of Child Health and Human Development (HD027724), the Bureau of Maternal and Child Health (MCJ-109572), and the MacArthur Foundation Research Network on Successful Adolescent Development Among Youth in High-Risk Settings.

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