research article

Family Environment and Coping Strategies for Families Dealing with Children that are Blind or Visually Impaired

Emma Mayo Pais1*, Eva Taboda Ares1, Patricia Iglesias Souto1, José Eulogio Real Deus2, Agustín Dosil Maceira1

1Department of Evolutionary Psychology and of the Education (Faculty of Psychology), University of Santiago de Compostela (USC), Spain

2Department of Methods of Investigation and Diagnosis in Education (Faculty of Psychology), University of Santiago de Compostela (USC), Spain 

*Corresponding author: Emma Mayo Pais, Department of Evolutionary Psychology and Education, Faculty of Psychology, Campus Universitario Sur, s / n, 15782. Santiago de Compostela, Spain. Tel: +34981563100; Email: emma.mayo@usc.es 
Received Date: 07 September, 2018; Accepted Date: 21 September, 2018; Published Date: 01 October, 2018

Citation: Mayo, M.E.; Taboada, E.M.; Iglesias, P.M.; Real, J.E.; Dosil, A. (2018) Family Environment and Coping Strategies for Families Dealing with Children that are Blind or Visually Impaired. Curr Perspect Depress Anxiety: CPDA-101. DOI: 10.29011/CPDA-101. 100001

1.       Abstract 

The birth of a child with visual impairment creates a burden and stress on the family unit. This study analyzes the coping strategies used by parents with children that have a visual impairment and the correlation this has with the family environment that is perceived. Participated in this investigation a total of one hundred and twelve (112) subjects with at least a son with visual impairment in the Autonomous Community of Galicia (Spain). All of the subjects responded to the Coping Strategies Questionnaire-Spanish version- (C.S.Q.), the Family Environment Scale (F.E.S) and a questionnaire built ad hoc to explore aspects related to the impact of the diagnosis. The results indicate that the preferred coping factors are counting your blessings, wishful thinking and positive thinking. At the same time, a conflictive family environment implies limited strategies in the search for solutions. 
2.       Keywords: Blindness; Coping Strategies; Disability; Family; Family Environment; Visual Impairment. 

3.       Introduction
The studies on vital family cycles were initiated with the study of sociology of the family. The main concept is that the family changes its ways and its functions during the course of time following a sequence that is more or less structured and that can be classified in stages [1]. During each stage there is a learning period and a fulfillment of certain tasks. Between each stage there is a moment of transition that is usually inaugurated by a certain event or ritual that represents the change towards a new stage: marriage, pregnancy, the birth of the first child and the children to come, schooling, the children’s adolescence and their future independence, retirement, etc. These vital family cycles can be modified by specific acts or circumstances, such as, amongst others, the birth of a child with a disability that can create a great challenge for the parents who must take on the responsibility of this diagnosis [2]. 
Coping is a process that begins when the threat is perceived, intervening between this and the results observed and whose main objective is to regulate the emotional conflict and to eliminate the threat [3]. In the Transactional Model of Stress and Coping, coping is defined as “the constantly changing efforts of cognitive and behavioral attitudes that develop in order to manage the specific external and internal demands that can be evaluated as excessive or abundant of the resources that an individual may have” [4]. For these authors there exists two types of coping strategies, one is the resolution of the problems and the other an emotional regulation. The first one is directed towards the manipulation or altering of the problem that is causing the uneasiness or an increase of resources in order to confront the problem. For example, the designing of a new method for solving the problems or finding professional assistance that can serve as a guide. The second one is a strategy for emotional regulation that is centered on emotions and the reduction of stress associated with the situation [5,4]. Consider that people will use this second strategy when they experiment that the stress is lasting and un-modifiable such as, for example, the death of a loved one. Examples of these types of strategies are crying, distraction, sleeping, drinking, etc. Coping strategies operate so as to diminish the perturbing feeling associated with the threat, in such a way that the less negative effects there are, we can state that the coping process is more effective. 
The studies on coping strategies for families in cases of disability generally indicate that the stress and the burden of the diagnosis can harm the family [6]. Also, it has been found that all of the family members of the child with multiple disabilities, including visual impairment, experiment a variety of forms of stress that were considered clinically significant and that required a clinical intervention [7,8]. Studied how mothers reacted when faced with the diagnosis of their child’s visual impairment and [9] focused on coping strategies, emotions, and problems and preoccupations of the mothers of children with a visual impairment, without taking into account the parental perspective. 
There is a substantial amount of empirical evidence regarding the impact that a disability can have on a family and its consequential adaptation. Its influence is such that for many years researchers have classified the families in that a member suffers a disability, as poorly integrated and pathological. Perhaps as a consequence of this, there exists an ample and generalized negative evaluation on the adaptation of a family in which one of its members has a disability [10,11]. This occurs without taking into account that the condition of the disability is specific to each person in relation to the variables of its context and that each family gathers a series of characteristics that make them one and only and different in comparison to the rest. For this reason, it is impossible to address the family’s adaptation in a broad and unlimited way. 
In regards to the family environment, the relationship between the mother and the father is very important and a child with a chronic condition or a disability can cause tension in this relationship. For example, it has been observed that the mother tends to displace or reduce the importance of her fulfillment to her responsibility and role as a spouse, due to the fact that she dedicates a large part of her efforts to taking care of the child with the disability [12,13].Although in other cases, the child with a chronic illness or with a disability can improve this relationship [14]. 
If we focus on visual impairment, several investigators indicate that the experience of taking care of a child with a visual disability is oftentimes stressful and challenging and can become a threat to the members of the family [9,15,16]. Having a child with a visual disability in the family can cause preoccupation regarding the constant implication and time the child requires, the attitudes of others, and the localization of the appropriate educative programs, etc. It can also cause uncertainty regarding the future, it unfavorably affects the siblings and it creates symptoms of psychological maladjustments and marital problems [9,16]. However, if the proper coping strategies and resources to face the circumstances in an effective manner are used (finding networks of assistance inside and outside of the family) many of these families can pose a good balance and consequently, a good family atmosphere. 
Scientific literature collects references related with the coping strategies of child cancer on behalf of the parents. This is how [17] distinguish methods of coping strategies such as isolation, denial, the search for spiritual guidance through the help of religion, or anticipated mourning among others. We have not found similar studies that analyze the utilization of coping strategies and the family atmosphere perceived by the parents of children with a visual disability. 
The objective of this investigation is dual. On one hand, to determine if the coping strategies of the parents of the children with the visual impairment follow the same pattern as those in the cases of child cancer, and on the other hand to analyze the existing correlation between the strategies of confrontation utilized and the family atmosphere perceived. 
4.       Method 
4.1    Participants 
A total of fifty-six (56) families participated in this investigation and at least one child that is affiliated with the ONCE (in English, The National Association of Blind Spaniards) located in the autonomous region of Galicia, Spain. There was a total of one hundred and twelve (112) subjects (50% fathers and 50 % mothers). 
The median age of the fathers was 41-year-old (SD 6.92) within a range of 20 to 61 years old and the median age of the mothers was 38 years old (SD 6.59), within a range of 20 to 57 years old. 
A 94.6% of the parents were married and lived primarily in a semi-urban (46.4%) or urban (37.5%) environment. The educational and economic levels are low or semi-low and it is primarily the majority of the fathers who are actively employed. High percentages (60.7%) of the subjects have not had any more children since the birth of the child with the visual disability Table 1. 
Only 28.6% of the children with the disability are completely blind. In the majority of the cases the visual impairment is not associated to another pathology (57.1%), is congenital (82.1%) or there are no other existing cases within the family (78.6%).
4.2    Instruments 
All of the subjects responded to the Coping Strategies Questionnaire (C.S.Q.) (Spanish version) [18], with the goal of analyzing the following ways of coping: positive thinking, the blaming of others, wishful thinking, the search for social support, the search for solutions, emotional repression, the analysis of advantages, religiosity, self-blame, resignation and escape. This was also the case on the Family Environment Scale (F.E.S) [19], utilized to evaluate and describe the interpersonal relationships between the members of the family, the aspects of development that are the most important within the family and its basic structure. As well as on, a constructed questionnaire created ad hoc for the purpose of a more thorough investigation whose main objective was to explore the different aspects related to the impact of the diagnosis of the visual disability on the family (the parental bond, the parental perception of the impairment and the effects of the disability). Two versions were created, one for the father and the other for the mother in order to collect, in the latter case, specific information regarding the pregnancy and the birth. 
4.3    Procedure
One hundred families (100) that had at least one child between the ages of 0 and 18 years old and that were affiliated with the ONCE of the Autonomous region of Galicia, Spain were contacted by telephone. Their collaboration in the investigation and their consent to be sent the necessary documentation to their homes in order to complete the questionnaires and mail it back was requested. After one month from the date of the mailing, the rate of return of the documentation (the questionnaires from both parents) thoroughly completed was 56%, very superior to the one usually obtained by this means (approximately 20%). 
5.       Results 
The quantitative analysis revealed that both parents coincided in highlighting that their preferred factors of coping were the counting of blessings, wishful thinking and positive thinking, but that in the mothers’ cases this last strategy is shared with the seeking of solutions Table 2.
 
To see if there were any significant differences between the fathers and the mothers in regards to the coping strategies used we carried out a Student’s t-test. The mothers stated that they significantly used the seeking of solutions more frequently than the fathers (t = 2.72; p .01) and also the seeking of social support (t = 2.46; p .05) and religiosity (t = 3.01; p.05) Table 2. 
In regards to the perception of family environment, there were no significant statistical differences between the parents; both coincided in stating that they used active-recreational methods the most, and as a last option the independence and conflict Table 3.
To calculate if there exists a relationship between the coping strategies used and the family atmosphere perceived by the parents we used Pearson’s Correlation Index. In using this index, we found that there was a significant correlation between the parents who used positives thinking and who perceived an achievement-orientation family atmosphere (p .01; r = .26), intellectual-cultural (p .01; r= .31), active-recreational (p .01; r = .35), and moral-religious (p .01; r = .27). This correlation was also obtained between the factor seek solutions and the intellectual-cultural family environment (p .01; r = .31) and active -recreational (p .01; r = .25), and between the factor of religiosity and the family atmosphere achievement-orientation (p .01; r = .25) and moral-religious (p .01; r = .48). On the other hand, the use of inappropriate coping factors such as placing the blame on others, on oneself or trying to escape from the problem can be related to family atmospheres that lack cohesion and organization. In the same respect, a conflictive family environment contains less strategies in the seeking of solutions of the problem that has presented itself to the family (in this case, the visual impairment of a child) Table 4.
6.       Discussion 
We have not found in the literature any in-depth study about the use of coping strategies by fathers and mothers of children with disabilities in order to compare our data, but our results coincide with those of [17] in which they highlight that in cases of child cancer the conduct of coping most utilized is religiosity (among others such as denial, the development of limited hopes and anticipated mourning). In our research we found significant differences between both parents in the seeking of solutions (p .01), as well as in the seeking of social support and religiosity (p .05), coping factors that were used more by the mothers than by the fathers. We believe, as indicated in other research [20], that these differences in the use of coping strategies could be related to the fact that mothers exercise the role of primary caregiver, which leads them, mostly, to conduct behaviors such as looking for information, planning and raising possibilities (seeking of solutions) or looking for people to solve the problem, ask for instrumental support, etc. (seeking of social support). 
We also found that religiosity, as a conduct of coping, is related to the morality-religiosity of the family environment. This relation suggests that practices and values of an ethical and religious nature are perceived as being important in the family environment and help parents to deal with the problem of the visual impairment. 
In our research, no differences were found between fathers and mothers regarding the family environment. According to several authors, it can be attributed to the high cohesion expressed to adapt to the new situation that has arisen [20-22]. 
It has also been found that there is a significant relationship between the family environment and disability coping. It has important implications for the intervention, as it was found that a family environment with cohesion, organization, intellectual-cultural, active-recreational and moral-religious, is positively related to the use of adaptive coping strategies. When family members are interpenetrated, help and support each other, present a clear organization and structure planning the activities and responsibilities of the family, show interest in political, social, intellectual and cultural activities, participate in activities of active-recreational type and give importance to ethical and religious practices and values, they will face disability in an adaptive way, which favors support among members of the family and readjustment of its relationships and functions [20,23]. 
If these findings were to be confirmed in further investigations, we could learn which coping strategies should be promoted to the parents. This could be done in order to teach them how to better confront and adapt to the traumatic situation that arises with the diagnosis of a visual impairment of a child and how to develop guidelines on modifying the family atmosphere. This would permit the families to receive a specific psychological aide to assist them in coping with the situation, as well as enable them to modify, as much as possible, certain social factors that can turn them into problematic families.


 

FATHER’S

MOTHER’S

AGE

 

 

20-30 years old

3.60%

10.80%

31-40 years old

48.30%

48.30%

41-50 years old

41.10%

37.50%

51-61 years old

7.20%

3.60%

MARITAL STATE

 

 

Single

1.80%

1.80%

Married

94.60%

94.60%

Separated or Divorced

1.80%

1.80%

Living with partner

1.80%

1.80%

EDUCATIONAL LEVEL

 

 

Without studies

5.40%

1.80%

Elementary school

50%

44.60%

High School Degree

28.60%

33.90%

University Degree

12.50%

17.90%

Technical Degree

1.80%

1.80%

No response

1.70%

0%

SOCIO-ECONOMIC LEVEL

 

 

Low (< 600/month)

8.90%

8.90%

Mid-low (600-1000/month)

23.20%

23.20%

Mid (1000-1500/month)

1.80%

1.80%

Mid-High (1500-2000/month)

2.50%

2.50%

High (> than 2000/month)

0%

0%

PLACE OF RESIDENCY

 

 

Rural (< 5000 inhabitants)

14.30%

14.30%

Semi-urban (5000-50000 inhabitants)

46.40%

46.40%

Urban (> 50000 inhabitants)

37.50%

37.50%

No response

1.80%

1.80%

EMPLOYMENT

 

 

Active

89.30%

48.20%

Unemployed

5.40%

48.20%

Incapacitated

3.60%

1.80%

Retired or Leave of absence

1.80%

1.80%

NUMBER OF CHILDREN

 

60.70%

One

60.70%

37.50%

More than one

37.50%

1.80%

The child with the visual deficiency is a twin

1.80%

1.80%

Table 1: Socio-demographic characteristics of the sample.

 

FATHER’S (n = 56)

MOTHER’S (n = 56)

M

SD

M

SD

t

Blamed your-self Seek social support

2.05

1.10

1.95

1.04

-0.45

Seek social support

2.78

1.06

3.28

1.07

2.46*

Seek solutions

3.09

1.01

3.60

0.91

2.72**

Count your blessing

3.90

0.90

4.01

1.03

0.60

Blamed others

1.80

0.73

1.98

0.92

1.10

Problem avoidance

1.96

0.75

1.94

0.78

-0.11

Wishful thinking

3.50

0.99

3.66

0.91

0.89

Positives thinking

3.41

0.92

3.60

0.80

1.16

Religiosity

1.82

0.98

2.50

1.34

3.01*

Repressed emotional

3.10

0.65

3.09

0.56

-0.09

Resignation

3.12

1.12

3.25

1.32

0.57

*p .05

**p .01

Table 2: Coping behaviors of the father and of the mother.

 

FATHER’S (n = 56)

MOTHER’S ( n = 56)

M

SD

M

SD

t

Achievement-Orientation

50.34

6.78

49.77

7.83

-0.42

Independence

46.95

8.95

44.43

8.36

-1.53

Cohesion

52.56

8.5

52.91

8.66

0.21

Conflict

46.13

6.87

47.16

6.93

0.79

Control

49.93

8.58

50.14

7.78

0.14

Expressiveness

52.34

8.61

50.57

9.35

-1.04

Intellectual-Cultural

50.53

9.64

53.21

9.12

1.51

Moral-Religious

47.82

9.48

49.18

8.31

0.81

Organization

51.35

9.25

53.38

9.04

1.17

Active-Recreational

53.62

8.43

54.52

7.92

0.58

There are no significant differences

Table 3: The family atmosphere, perceived by the father and the by the mother.

 

1

2

3

4

5

6

7

8

9

10

Positives Thinking

0.20*

0.18

-0.12

0.06

0.26**

0.31**

0.35**

0.27**

0.08

0.01

Blamed others

-0.34**

-0.11

0.11

0.18

0.04

-0.02

-0.12

0.01

-0.19

-0.04

Wishful Thinking

-0.10

-0.24*

-0.09

0.01

-0.02

0.01

-0.1

-0.01

0.03

0.14

Seek social support

0.09

-0.06

-0.07

-0.12

0.12

0.14

0.06

0.22*

-0.03

0.06

Seek solutions

0.24*

0.03

-0.26**

-0.09

0.09

0.31**

0.25**

0.16

0.09

-0.11

Repressed emotional

0.15

0.05

-0.19*

0.02

-0.23

0.07

0.11

0.13

-0.01

-0.08

Count your blessing

0.04

0.00

-0.18

0.09

0.18

0.17

0.19

0.09

-0.11

0.02

Religiosity

0.09

-0.12

-0.02

-0.06

0.25**

0.16

0.06

0.48**

0.16

0.06

Blamed your-self

-0.27**

0.00

0.02

0.24*

-0.06

-0.05

-0.06

-0.14

-.22*

-0.14

Resignation

0.06

0.01

0.05

-0.02

-0.02

0.13

0.13

0.00

-0.07

-0.03

Problem avoidance

-0.18

-0.02

0.07

0.05

-0.12

-0.06

-0.06

-0.12

-0.25**

-0.09

1 = Cohesion; 2 = Expressiveness; 3 = Conflict; 4 = Independence; 5 = Achievement-Orientation; 6 = Intellectual-Cultural; 7 = Active-Recreational; 8 = Moral-Religious; 9 = Organization; 10 = Control

* The correlation is significant to the level .05 (bilateral).

** The correlation is significant to the level .01 (bilateral).

Table 4: The correlation between the family environment and coping strategies.

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