پیوند پدری و فشار خون در بزرگسالان جوان خانواده های سالم و طلاق

Abstract Objective The father–child relationship may uniquely affect offspring's physical and psychological health. Divorce may change the nature of the father–child bond and the long-term health consequences of paternal parenting behaviors. The current study investigated a possible biological pathway from father–child relationship quality to physical health outcomes in young adults. Methods Cardiovascular stress reactivity to a lab-based challenge task and ambulatory blood pressure (ABP) were measured in young adults (mean age=20.1 years) from divorced (n=50) and intact, married (n=49) families. Participants completed self-report measures of paternal control and caring during childhood.

Introduction Parenting has been implicated as an important influence on children's health [1] and [2], yet this relation is primarily supported by studies of maternal parenting behaviors, with scarce attention to the significant role of fathers in the family context [3], [4] and [5]. However, a positive father–child relationship may promote a child's social and emotional development [6], [7] and [8]. Importantly, the father–child relationship can be affected by the quality of spousal relations; thus, the consequences of paternal parenting behaviors are best examined in the context of marital stability. When marital discord develops, fathers may display carryover effects in their relations with their children [9], and evidence suggests that children are highly reactive to paternal marital-related distress [10]. The nature and meaning of the father–child relationship may be particularly susceptible to the negative effects of divorce, as marital dissolution may reduce the amount of time children spend with their fathers [11] and reduce children's exposure to typically adaptive paternal parenting practices [12]. Much research has examined the effects of parental divorce and father–child relationships on children's psychological adjustment; less is known about effects on physical health [13]. In general, parental divorce has been found to pose an increased risk for health problems in children [14] and [15], adolescents, young adults [16], and middle-aged adults [17]. Among young adults from divorced families, poor father–child relationships were associated with somatic complaints, more reported days sick, and poorer overall self-rated health [18] and [19]. The current study explores cardiovascular reactivity and ambulatory cardiovascular activity (important markers of cardiovascular disease risk) as one potential pathway linking father–child relationships to physical health outcomes. Cardiovascular reactivity is a relatively stable phenomenon that can be measured in childhood as an indicator of risk for future health problems [20], even before physical signs of disease are evident [21]. A considerable research literature links exaggerated cardiovascular reactivity with elevated risk for hypertension or coronary heart disease [22]. Large-scale population studies have also consistently confirmed the increased morbidity and mortality associated with elevated ambulatory blood pressure (ABP) [23] and [24]. Among the diverse qualities of fathers' parenting behaviors, care and control are consistently featured in theories of both normal and pathological child development [25], and these merit attention when considering paternal influences on child well-being. General population samples found a number of negative outcomes associated with paternal overcontrolling behavior, including greater worrying behavior [26] and distress in social functioning [27] in adolescence, as well as more interpersonal problems in adulthood [28]. Children's feelings of closeness with fathers [6] and their satisfaction with the paternal–child relationship [29] have demonstrated positive associations with children's psychological well-being. These relations are not limited to children's mental health. Among boys, paternal overcontrol has been associated with more physical health complaints [30] and greater cardiovascular reactivity during stressful laboratory tasks when combined with low paternal support [31]. In one of the few studies that examined the differential effects of maternal and paternal parenting behaviors, Bell and Belsky [32] found that lower blood pressure was observed among boys and girls exposed to higher levels of paternal (but not maternal) support and closeness. Importantly, the magnitude of the effects of paternal care and control on child outcomes may be weaker in cases of divorce [6] and [33]. Several processes may link parental divorce and paternal care/control to children's cardiovascular activity. Divorce can produce a general sense of vulnerability to abandonment or loss [34] and has been linked to increased attention to threat cues [35], exaggerated threat appraisals [36], and emotional and biological sensitivity toward potential threat [37] and [38]. For children of divorce, a sense of vulnerability may be particularly salient when fathers leave the home and the availability of a primary caregiving source becomes unclear [39]. Frequent parental conflict preceding and following marital dissolution may also contribute to exaggerated cardiovascular stress reactivity and chronic activation of the sympathetic-adrenomedullary (SAM) system [40], [41], [42] and [43]. Little is known about the unique role of the father–child relationship during childhood on cardiovascular functioning in young adulthood, particularly within the context of parental divorce. The focus of this study was on the impact of the father–child relationship during childhood on two measures of cardiovascular activity in young adulthood—reactivity to an acute lab-based challenge task and ABP in participants' natural environments. It was hypothesized that lower perceived father caring behavior and higher perceived father controlling behavior during childhood would predict higher cardiovascular reactivity and ABP in young adulthood. Given observed divorce-related changes in the role of the father, a key question was whether the father–child bond exerts comparable effects across family contexts after accounting for the influence of maternal caring and controlling behavior. Although weaker relations between paternal–child relationship variables and child outcomes have been observed in cases of divorce as compared with intact families [6] and [33], other evidence suggests the contrary [44]. Moreover, existing research has specified outcomes that are mainly psychological, rather than physical, in nature. Accordingly, no a priori hypotheses were made about differences in the relation of the father–child bond to cardiovascular outcomes in divorced versus intact families.

Results Reactivity to the challenge task SBP reactivity Repeated-measures GLMs were used to evaluate the interactions of father caring by family group and father control by family group in the prediction of SBP reactivity, controlling for gender, income, and time spent with the father. Results are displayed in Table 2. The interaction of family group by father caring did not predict SBP reactivity. The main effect of perceived father caring was also not significant. However, the interaction of father control and family group predicted SBP reactivity (see Fig. 1). Tests of within-subjects contrasts were significant for the changes from baseline to preparation (P=.034), from baseline to speech (P=.011), and from speech to recovery (P=.032). Within-group tests revealed that higher control was associated with greater reactivity in the divorce group (P=.023) but did not predict reactivity in the intact group (P=.14). Table 2. Summary of blood pressure reactivity results df F P η2 SBP reactivity 2, 164 .08 Family Group×Father Caring 0.229 .80 Family Group×Father Control 4.45 .013 Family group 0.66 .52 Father caring 1.49 .23 Father control 0.056 .95 DBP reactivity 3, 211 .09 Family Group×Father Caring 0.208 .86 Family Group×Father Control 4.02 .013 Family group 0.954 .40 Father caring 2.75 .053 Father control 0.996 .39 Table options Interaction of family group and father control on SBP reactivity to the speech ... Fig. 1. Interaction of family group and father control on SBP reactivity to the speech task. Figure options Maternal control (P=.31), maternal caring (P=.58), and time spent with the mother (P=.22) did not predict SBP reactivity, and the family group by father control interaction remained significant after including these variables in the model (P=.011). Family conflict (P=.72), current anxiety symptoms (P=.63), and current depressive symptoms (P=.47) did not predict SBP reactivity, and the family group by father control interaction remained significant after including these variables in the model (P=.013). Within the divorce group, post hoc analyses evaluated age at the time of the divorce and post-divorce living arrangements. Age at divorce was not a significant predictor of SBP reactivity (P=.10), and the impact of father control on SBP remained significant after adjusting for age at divorce (P=.031). Similarly, living arrangements after the divorce did not predict SBP reactivity (P=.48), and father control remained a significant predictor of reactivity after adjusting for living arrangements (P=.037). DBP reactivity Results were similar for DBP reactivity to the challenge task and are also displayed in Table 2. The interaction of father caring and family group did not predict DBP reactivity. The main effect of perceived father caring approached significance. The interaction of father control and family group significantly predicted DBP reactivity. The graphical pattern of results for the interaction of father control and family group was similar to the pattern for SBP reactivity shown in Fig. 1. Tests of within-subjects contrasts were significant for the changes from baseline to preparation (P=.009) and from baseline to speech (P=.006) and approached significance for the speech-to-recovery period (P=.085). Within-group analyses were significant for the divorce group only (P=.009; intact group, P=.18), such that higher father control predicted increased DBP reactivity in the divorce group. Maternal control (P=.34), maternal caring (P=.55), and time spent with the mother (P=.07) did not predict DBP reactivity, and the family group by father control interaction remained significant after including these variables in the model (P=.024). Family conflict (P=.33), current anxiety symptoms (P=.89), and current depressive symptoms (P=.93) did not predict DBP reactivity, and the family group by father control interaction remained significant after including these variables in the model (P=.018). Within the divorce group, age at divorce did not predict DBP reactivity (P=.44), and father control remained significant in the model (P=.011). Similarly, living arrangements did not predict DBP reactivity (P=.86), and father control remained significant in the model with living arrangements (P=.043). ABP Ambulatory SBP Analyses next evaluated the interactive effects of family group, father control, and father caring on ambulatory SBP. Results are displayed in Table 3. The interaction of family group and father caring was significant (see Fig. 2). Tests of simple slopes were significant for the intact group (P=.029) but not the divorce group (P=.37). Within the intact group, higher father caring was associated with lower ambulatory SBP. The interaction of family group and father control was also significant (see Fig. 3). Tests of simple slopes revealed that higher father control was associated with higher ambulatory SBP within the divorce group (P=.023) but did not predict SBP in the intact group (P=.22). Table 3. Summary of ABP results df β t P Pseudo-R2 Ambulatory SBP 80 .09 Family Group×Father Caring .273 2.86 .005 Family Group×Father Control .332 2.31 .023 Family group −.637 −0.584 .56 Father caring −.027 −0.261 .80 Father control .078 0.550 .58 Ambulatory DBP 79 <.01 Family Group×Father Caring .128 1.85 .068 Family Group×Father Control .161 1.54 .127 Family group .363 0.457 .65 Father caring −.057 −0.768 .45 Father control −.001 −0.014 .99 Table options Interaction of family group and father caring on ambulatory SBP. Fig. 2. Interaction of family group and father caring on ambulatory SBP. Figure options Interaction of family group and father control on ambulatory SBP. Fig. 3. Interaction of family group and father control on ambulatory SBP. Figure options Maternal caring (P=.95), maternal control (P=.74), and time spent with the mother (P=.95) did not predict ambulatory SBP, and both the father caring by family group interaction (P=.015) and the father control by family group interaction (P=.036) remained significant after controlling for these variables. Family conflict (P=.15) and current anxiety symptoms (P=.08) did not predict ambulatory SBP. Higher depressive symptoms predicted lower ambulatory SBP [β=−.394, t(75)=2.5, P=0.02, 95% confidence limits=−0.71, −.079]; however, both the father caring by family group interaction (P=.001) and the father control by family group interaction (P=.022) remained significant after controlling for these variables. Within the divorce group only, age at divorce was not a significant predictor of ambulatory SBP (P=.65), and father control remained significant after adjusting for age at divorce (P=.022). Post-divorce living arrangements did not predict ambulatory SBP (P=.84), and father control remained significant after adjusting for living arrangements (P=.028). Ambulatory DBP Results for analyses of ambulatory DBP are displayed in Table 3. The interaction of family group and father caring did not reach significance for the prediction of ambulatory DBP. The interaction of family group and father control also did not reach significance for the prediction of ambulatory DBP. There were no main effects of family group, father caring, and father control on ambulatory DBP.