Roots of responses: A qualitative study on intergenerational transmission of illness approaches

Substantial evidence supports the intergenerational transmission of proneness to physical symptoms. In line with social learning theory, parent-child interactions significantly influence children's symptom experiences and coping strategies. However, it remains unclear how these childhood interactions translate into illness-related parenting later on. This study aims to elucidate how childhood illness-related interactions with parents shape individuals' approaches to their own children's illness.

We employed a qualitative design, integrating epidemiological data from the Lifelines Cohort to purposively sample 32 adult participants based on their own and their parents' symptom burden. Participants (53% male, aged 28-74) were interviewed using a semi-structured guide exploring experiences with illness in childhood and parenting. Transcripts were coded using a mixed deductive-inductive approach and analyzed thematically focusing on processes of modeling and reinforcement. We included a deviant case analysis.

Three parental symptom response types emerged: affective, practical, and minimizing. These were mirrored or contrasted in participants' own caregiving. Affective and practical responses were generally evaluated positively or neutrally, while minimizing responses were often viewed negatively and linked to deliberate divergence. Participants described value-driven examples they aimed to model, categorized as transparent and vulnerable, stable and calm, or tough and perseverant. Values did not always align with actual symptom responses, revealing discrepancies between intended modeling and behavioral reinforcement.

Intergenerational transmission of illness approaches varies greatly between families and is influenced by personal experiences, values and context. These findings highlight the complexity of intergenerational transmission and may inform family-based interventions to support adaptive coping in children.