Families with a child who has a chronic disorder (CD) may face increased caregiving demands and shifting family dynamics, which can pose risks to family relationships and mental health. The overarching aim of this thesis was to expand existing knowledge on the impact of childhood CD on family relationships and mental health. In a sequential mixed methods design, qualitative and quantitative methods were employed to explore various aspects of family relationships and mental health. This design enabled exploration of the distinct challenges faced by individual family members and captured some the complexity of family relationships and mental health. The thesis is embedded within a systems theoretical framework, positing that families are constantly interacting with both their immediate family and the broader social context. Data were collected during two stages of the Sibling Project, where the first stage aimed to map family experiences and develop interventions for families of children with a CD (Vatne et al., 2019), and the second stage was a randomized controlled trial of an intervention designed to enhance sibling mental health and family communication (SIBS-RCT; Kirchhofer, Fredriksen, et al., 2025).
Study 1 was a qualitative study, with the main aim of understanding more about fathers’ perceptions of their couple relationships in the context of parenting a child with a CD. The study was derived from semi-structured interviews with seven fathers of children with a CD. Through qualitative conventional content analysis, focusing on participants’ descriptions of couple relationships, my co-authors and I found that the participants’ descriptions could be grouped into two main categories: Couplehood and Co-parenting. The fathers described their partners as romantic partners, co-parents, and collaborators. The participants also described that couple communication and emotional expression within couples were altered by their parenting situation. Furthermore, the participants described an unequal division of labour within the co-parenting unit, and feeling influenced by cultural masculinity norms regarding their own involvement as partners and parents. The findings informed the aim and design of Study 2, regarding potential gender differences in mental health and the predictive value of child disorder severity.
The main aim of Study 2 was to evaluate and compare mental health scores in mothers and fathers of children with a chronic disorder and explore the predictive value of perceived child disorder severity. My co-authors and I analysed baseline measures of parental mental health and perceived diagnosis severity from the SIBS-RCT. Both maternal and paternal mental health scores were significantly higher than Norwegian norms. Mothers showed significantly higher scores on both measures compared to fathers, with a medium standardized mean difference. Perceived diagnosis severity explained a small proportion of the variance in mothers’ mental health, and a medium proportion of the variance in fathers’ mental health. While the association between perceived disorder severity and mental health differed between mothers and fathers, this difference was not statistically significant. Discrepancy between maternal and paternal perceived disorder severity did not significantly explain variance in mental health for mothers or fathers.
Study 3 built on Studies 1 and 2 and aimed to explore the longitudinal dynamics of mother and sibling mental health in families of children with CD. Study 3 estimated bivariate latent change score models with baseline and 12-month measures of mental health and adjustment from the SIBS-RCT. Sibling measures of mental health and adjustment were paired with maternal mental health in two separate models. My co-authors and I found that sibling mental health and adjustment were significantly correlated at baseline, indicating that sibling mental health was related to their adjustment to the critical family situation. However, these measures did not predict each other over time, suggesting they are distinct areas of concern. Moreover, there were no significant bidirectional relationships between the degree of change in maternal mental health and sibling mental health or adjustment.
Findings from this thesis suggest that parental couple relationships may be altered in the context of parenting a child with a CD, particularly communication and emotional expression within the parent couple. Further, findings suggest that there are gender-specific challenges in parenting a child with a CD. Also, subjective perception of child disorder severity seems to play a substantial role for parental mental health. Finally, the lack of a bidirectional relationship between maternal mental health and sibling mental health or adjustment underscores the context dependency of mental health trajectories in families of children with a CD, highlighting the importance of considering multiple simultaneous moderating factors on the adjustment of individual family members.
Several key implications for practice are suggested: When working with families of children with a CD, communication patterns and emotional expression within the parental couple should be a central focus. It is also essential to actively involve fathers in their children’s health care, both to support their engagement and to ensure a comprehensive understanding of family needs. Practitioners should assess the mental health of both mothers and fathers, as both may experience elevated symptoms and require professional support. Paediatric health care needs to take into account the complex and evolving context in which each family operates.
This thesis also provides theoretical contributions. The findings illustrate how multilevel factors simultaneously influence all family members, aligning with bio-ecological and systems theoretical frameworks for understanding family relationships and mental health in families of children with a CD. Furthermore, the findings underscore the multilevel nature of the transactional model of development by supporting its central proposition that developmental trajectories are shaped by reciprocal interactions between biological and environmental factors operating simultaneously.
In conclusion, this thesis contributes to the body of knowledge about the complex ways in which having a child with a chronic disorder impacts family relationships and mental health. Future research should focus on longitudinal studies that span multiple stages of family adaption to childhood CDs, capturing long-term variations in family dynamics and mental health. Additionally, qualitative research involving both mothers and fathers is needed to better understand the drivers of relationship and mental health outcomes.