**3.** *Final models of hierarchical multiple regression analyses with subscales of psychological well-being (PWBS) as the dependent variables (N = 905).*

*\*p < .05.*

*\*\*p < .01.*

*\*\*\*p < .001*

**Table**

#### *Interpersonal Relationships*

*The Significance of Family-of-Origin Dynamics for Adults' Health and Psychological Wellbeing… DOI: http://dx.doi.org/10.5772/intechopen.95354*

the most considerable change in *R*<sup>2</sup> was made by the block of the DoS. The block explained 21% of the variance of the functioning variable and demonstrated a medium effect size (*f* 2 = 0.27). The final model (see **Table 3**) accounted for 26.2% of the variance and showed that stronger I-position, lower emotional cutoff, younger age, and a higher level of education predict a higher level of an adult's personal growth.

The results of the prediction of positive relations were similar to those predicting previous dependent variables as all four models were significant (*F*Model1 = 34.26, *p* < .001; *F*Model2 = 95.82, *p* < .001; *F*Model3 = 76.73, *p* < .001) and the DoS block had the largest predicting power (explained 32.4% of the variance and demonstrated a large effect size, *f* 2 = 0.49). The final model (see **Table 3**) explained 43.5% of the variance and indicated that more positive relations of an adult are predicted by fewer signs of interparental avoidances perceived in childhood, lower emotional reactivity, stronger I-position, lower emotional cutoff, higher fusion with others, higher satisfaction with an emotion-based couple relationship, and female gender. The strongest predictor of positive relations in the final model was cutoff.

The four models predicting purpose in life were statistically significant (*F*Model1 = 19.91, *p* < .001; *F*Model2 = 52.66, *p* < .001; *F*Model3 = 41.69, *p* < .001) and the largest parts of the variance of dependent variable was accounted by DoS block (explained 22.7% of the variance and demonstrated a medium effect size, *f* 2 = 0.30). The final model (see **Table 1**) explained 30% of the variance and revealed that purpose in life is predicted by more harmonious interparental interactions with fewer signs of avoidances perceived in childhood, lower emotional reactivity, stronger I-position, lower emotional cutoff, younger age, and a higher level of education with the cutoff as the strongest predictor.

The results predicting self-acceptance did not distinguish from previous ones. The four models predicting the dependent variable were statistically significant (*F*Model1 = 2254, *p* < .001; *F*Model2 = 93.03, *p* < .001; *F*Model3 = 86.96, *p* < .001) and the largest parts of the variance of dependent variable was accounted by DoS block (explained 34.9% of the variance and presented a large effect size, *f* 2 = 0.54). The final model (see **Table 3**) explained 46.4% of the self-acceptance's variance. It revealed that the strongest predictor is I-position, which together with more harmonious interparental relationship perceived in childhood, lower emotional reactivity, lower emotional cutoff, higher satisfaction with an emotion-based couple relationship, and a higher level of education predict higher self-acceptance of an adult.

Finally, the results of regression analysis with PWBS total score as the dependent variable were in line with those predicting separate scales of PWBS. The block of DoS scales had the strongest effect (explained 31.5% of the variance and presented a large effect size, *f* 2 = 0.88) and the final model explained the substantial part (57.4%) of the dependent variable's variance. The results revealed that higher psychological well-being can be expected among those who in the family-of-origin observed more signs of harmonious and less of avoidant relationships between parent figures, have stronger I-position and stronger emotional ties with significant persons, are less emotionally reactive, are more satisfied with emotional interactions with a partner and have a higher level of education.

#### **3.5 Study 3**

The objective of the study was to examine a complex mediation model that includes the triangulation and family-of-origin emotional system (FOES) perceived during childhood, DoS, and satisfaction of current couple relationship as the mediators between retrospectively assessed interparental communication and adult children's physical and emotional health.

#### *3.5.1 Participants and procedure*

The online questionnaire was generated using SoSci Survey [38] and was made available to users via www.soscisurvey.de in 2020. Respondents were recruited using two methods: (1) posting an invitation to participate in the study using the web link for the survey on a social web network; (2) addressing schools with a request to disseminate the web link to the survey on schools' electronic platforms designed for parents. The first web page of the survey covered detailed informed consent information. At the end of the informed consent, respondents were asked to accept or to decline the terms described in the document.

There were three main inclusion conditions for participation in the study: being 18 years or older and being in a romantic relationship lasting for at least one year at the moment of participation in the study. The sample consisted of 257 respondents most of whom were women (*n* = 225; 88%), the mean age was 38.82 (*SD* = 9.29) years. Most of the study participants (*n* = 192, 75%) were married, 42 (16%) cohabitated, and 23 (9%) were dating a romantic partner. The average duration of the relationship was 13.52 years (*SD* = 9.07), 69% (*n* = 1716) of the respondents had children.

#### *3.5.2 Results*

**Table 4** presents basic descriptive statistics and correlations among the study variables (total scores) that were included in the mediation path model analysis.

Correlation analysis demonstrated statistically significant correlations (*p* < .001) among all variables except correlations between FOES as well as couple relationship satisfaction and physical health. The strong negative correlations were found between interparental relationship quality and triangulation as well as FOES, which


*Note: The higher scores of FOES, triangulation, and DoS reflect a worse outcome, the higher scores of interparental relationship quality, couple relationship satisfaction, physical health, and emotional health correspond to a better outcome.*

*\*p < .05.*

*\*\*p < .01.*

*\*\*\*p < .001.*

#### **Table 4.**

*Descriptive statistics and correlations among study variables included in mediation model analysis (N = 257).*

#### *The Significance of Family-of-Origin Dynamics for Adults' Health and Psychological Wellbeing… DOI: http://dx.doi.org/10.5772/intechopen.95354*

implies that better interparental relationship quality relates to lower triangulation and better nuclear family emotional system. Adults' better emotional health was moderately correlated with better interparental relationship quality, lower triangulation, better FOES, better couple relationship satisfaction as well as better physical health, and strongly correlated with higher DoS.

Next, the multiple mediation model was established to test the direct and indirect effects of independent variables on adults' physical and emotional health. **Figure 1** demonstrates the theoretical path mediation model based on the BFST. According to the theory it was expected that family-of-origin dynamics (interparental relationship quality, triangulation, and FOES) will have an indirect effect on adult children's health through DoS and satisfaction of couple relationship. On the other hand, it was anticipated that FOES and triangulation will play as the mediators in the association between interparental relationship quality and adult children's DoS.

The statistical analysis consisted of two steps: testing for model fit and for mediation with bootstrapping. According to the theory, the initial model was set to be recursive and to include paths from every independent variable to the supposed mediator and the dependent variables. However, after the correlation analysis revealed no significant correlations between FOES as well as couple relationship satisfaction and physical health, the paths were removed from couple relationship satisfaction and FOES to adults' physical health. **Figure 2** presents the results of the model for adults' health demonstrating significant direct effects.

The mediation model provided an excellent fit to the data: *χ* 2 (5) = 4.23, *p* = .52, CFI = 1.00, TLI = 1.01, GFI = 1.00, SRMR = .017, RMSEA = .00. The model explained 12% of the variance of the variable adults' physical health and 41% of the variance of adults' emotional health. The model confirmed all predicted direct effects and additionally demonstrated the direct effect of retrospectively evaluated triangulation on adults' physical and emotional health as well as the direct effect of retrospectively evaluated family emotional system on current satisfaction with couple relationship.

To explore multiple mediations in detail, the estimates of specific indirect effects and their confidence intervals were calculated separately (see **Table 5**). Based on the bootstrapping confidence intervals, significant indirect effects (full mediation) were shown from interparental relationship quality through triangulation and family emotional system on the DoS as well as through the FOES on couple relationship satisfaction. Although interparental relationship quality significantly predicted

#### **Figure 1.**

*The theoretical path mediation model of associations among the interparental relationship quality, triangulations, FOES, DoS, couple relationship satisfaction, and adults' health. Note: dotted lines – Indirect effect; solid lines – Direct effect.*

#### **Figure 2.**

*The path mediation model of associations among the interparental relationship quality, triangulation, FOES, DoS, couple relationship satisfaction, and adults' physical as well as emotional health. Note: Standardized Regression Weights (*β*), correlations, and R2 are presented. Goodness-of-fit indices: χ<sup>2</sup> (5) = 4.23, p = .52, CFI = 1.00, TLI = 1.01, GFI = 1.00, SRMR = .017, RMSEA = .00 [90% CI (.00, .08)]. Only significant direct effects are presented. \*\*\*p < .001, \*\*p < .01, \*p < .05.*


*Note: Unstandardized estimates with two tailed significance (bias-corrected percentile method) of specific indirect effects as well as standardized estimates of direct effects are presented. IPRQ = inter-parental relationship quality; T = triangulation; FOES = family-of-origin emotional system; DoS = differentiation of self; CRS = couple relationship satisfaction; EH = emotional health; PH = physical health.* 

*ns – nonsignificant.*

*\* p < .05.*

*\*\*p < .01. \*\*\*p < .001.*

#### **Table 5.**

*Direct and indirect effects in the mediation models.*

*The Significance of Family-of-Origin Dynamics for Adults' Health and Psychological Wellbeing… DOI: http://dx.doi.org/10.5772/intechopen.95354*

triangulation and FOES and explained a considerable part of their variance (46% and 37%, respectively), the independent variable as well as both mediators explained only 9% of the DoS variance.

Full mediation was found assessing multiple mediation models demonstrating that interparental communication impacts adult children's physical and emotional health indirectly through the mediators: triangulation, FOES, DoS, and satisfaction with current couple relationships in the case of emotional health. Interestingly, retrospectively evaluated triangulation in childhood had both significant indirect (through the mediator DoS) and direct effect on adults' physical and emotional health.

#### **3.6 General discussion**

The primary aim of this chapter was to present and discuss the results of three studies based on systemic ideas proposed by the BFST [17, 18]. According to the theory [17], interparental as well as parent–child interactional dynamics profoundly affect family members' psychological, social, and even physical functioning. DoS is a core phenomenon linking intrapsychic and interpersonal relationships as well as between-generational transmissions of some interactional patterns that are repeated in different generations again and again. Partners alongside some level of DoS unconsciously bring into the couple's life interactional patterns perceived and experienced in a family-of-origin thus shaping specific nuclear family emotional system. Lower levels of partners' DoS accounts for the development of destructive interactions and consequently adverse family emotional system. Children in such a family are at risk to be involved in interparental conflicts through the triangulation process and to develop accordingly lower level of DoS. Whereas Bowen suggested that any relational, mental, and physical health problem can be explained by interactions of the mentioned phenomena, three studies presented in this chapter were to explore the significance of retrospectively evaluated FOES as well as triangulation, DoS, NFES and satisfaction with couple relationship for adults' health and psychological well-being.

*The associations between family variables and adults' physical health.* Despite the sound theory, the pathways of how interparental relationship quality, triangulation, and family emotional system affect an adults' physical health are unclear. One possible path could be through the DoS: a high level of anxiety and problems in the family system decrease DoS and produce higher emotional reactivity, which in turn weakens the immune system of family members leading to their health worsening. However, there is no available research based on the BFST that would test either the role of DoS as the mediator or the family variables themselves, for the adults' physical health status.

The physical health in Study 1 was evaluated through subjective indicators such as satisfaction with own physical health as well as objective indicators such as using medications due to health problems. The results revealed a quite substantial difference in the role of the nuclear family emotional system on objective and subjective indicators of adults' physical health. NFES explained only 10 percent of the variance of objective indicators and almost the third (32%) of subjective indicators. The more severe personal distress, the more significant problems of a child, and the more destructive relationship with a partner predicted worse subjective health indicators. In general, the high number of personal and interactional problems in the family had a negative effect on the subjective evaluation of personal health. The results confirm the assumption of BFST [18] that the family emotional system reflecting the generated level of anxiety and problems in the family system influences the physical functioning of adult family members. However, as mentioned

before, although the higher personal distress and the higher total score of NFES were significantly associated with worse objective health indicators, the overall score of NFES explained only 10% of the dependent variable's variance. The results are ambiguous for two reasons. First, the state of physical health did not relate to couple discord and less constructive couple communication, although many studies demonstrated that dyadic interaction has an impact on personal health outcomes [1–3, 39, 40]. One possible explanation for such results could be related to the health measures used in the studies. The respondents were asked to report their objective physical health indicators such as physician visit frequency, the use of medications due to health problems, and reduction of working capacity due to a disease or other health problems. The cited research used subjective evaluations of physical health. Our study demonstrated that despite a significant moderate correlation (*r* = .57, *p* < .001), objective and subjective physical health indicators do not necessarily constitute a single phenomenon. Besides, the results also demonstrated that a couple relationship has an association with subjective health indicators. Thus, it could be that a family member who is experiencing high anxiety and other negative emotions due to a discord between him/her and a partner and emotional and behavior problems of a child, subjectively rates his/her physical health as deteriorated due to overall ill-feeling. However, it might be that the subjective evaluation of health conditions does not always mean actual physical health problems, and dyadic issues influence the objective state of health indirectly through other psychological variables. Second, the results, after all, correspond to BFST [17], proposing that the NFES relates to family members' physical functioning. However, NFES explained only 10 percent of objective health indicators' variance. According to the theory, one would expect a much higher percentage, because, according to the theory, family members' state of physical fitness is an outcome of NFES. Such results suggest that physical health, even though it is related to NFES, is possibly not its direct outcome, as the theory implies. Moreover, it might be that an association between NFES and adult's objective health is far more complicated than it was covered in the present study. Thus, more variables mediate or moderate the association.

Study 3 helped to look more in-depth on the associations between different family interactional variables and adults' physical as well as emotional health. The main goal was to examine a complex mediation model based on the BFST showing that family-of-origin dynamics (interparental relationship quality, triangulation, and FOES) in the past will have an indirect effect on adult children's health through DoS and satisfaction of present couple relationship. The results confirmed the Bowen's proposition, that family members' health (physical and emotional) in the present can be explained by the significant interactions in family-of-origin in the past as well as in the present. Specifically, interparental communication through the mediators – triangulation, family emotional system, and DoS – had an indirect effect on adults' physical health. In the case of emotional health, the mediation model was very similar except for additional mediator – satisfaction with couple relationship. More interestingly, the FOES did not have a significant correlation with adults' physical health and the result was very similar to that obtained in Study 1, demonstrating a very low correlation between NFES and adults' physical health. On the other hand, triangulation experienced in the family-of-origin not only had an indirect effect through the mediator DoS but also had a direct effect on adults' health (both physical and emotional). Lastly, the mediation model demonstrated the significance of DoS predicting adults' health as well as mediating between other family-of-origin variables and adults' health. Such results corroborate postulates of The BFST that different interactional processes experienced in the family-oforigin have a critical role in adult children's emotional well-being and physical functioning.

#### *The Significance of Family-of-Origin Dynamics for Adults' Health and Psychological Wellbeing… DOI: http://dx.doi.org/10.5772/intechopen.95354*

The scientific data on associations between different family-of-origin variables and adults' psychological and physical functioning are rather extensive, however somewhat inconsistent. For example, Stuart-Parrigon and Kerns [41] found that more severe partners' conflict does not predict later child anxiety that can be considered as a component of DoS and an essential criterion of psychological functioning. However, Cowan and Cowan [42] noted that the intervention aimed at the marital relationship's improvement has the potential to shape parent–child communication as well as a child's functioning. The similar results were found by other authors [43–45] showing that better parent–child relationships are found among the adults whose relationship with a partner is better. Those studies confirm the spill-over hypothesis proposing a positive association between interparental relationship quality and parent–child relationship quality [43, 46] that in part confirms Bowen's statement regarding the interparental communication as a channel to children's DoS.

Additionally, research data show that parents' ability to discuss family and partners' relationship issues openly and constructively reduce the feelings of triangulation in children that eventually impair their well-being [10, 47, 48] and is positively associated with young adult children's higher self-esteem and less perceived stress [49, 50]. Several longitudinal studies [51, 52] confirm the data produced by crosssectional studies providing empirical evidence about the significant correlations between family relationships during adolescence and functioning in adulthood. More specifically to the BFST, Peleg [6] demonstrated that individuals who have experienced more stressful life events in childhood and adolescence are of lower DoS and more prone to be involved in intergenerational triangulation, which, in turn, leads to inadequate coping with future stressful events. Such results alongside the results obtained in Study 3 tend to the conclusion that good interparental relationship quality creates a positive emotional environment for children and serves as a protective factor for children's well-being in adulthood. On contrary, poor interparental relationship quality is a detrimental factor contributing to the development of the negative family emotional system as well as to the involvement of children in the interparental discord through the triangulation process and acting as a risk factor for children's physical and emotional functioning in adulthood. However, as was mentioned before, both studies (Study 1 and 3) demonstrated quite a weak effect of family variables on adults' physical health, as they explained only 10 to 12 percent of the dependent variable's variance. This means that even a higher number of independent variables in Study 3 produced very similar results as in Study 1. Such results might question the posture of the BFST regarding the effect of family on its members' physical health. More studies are needed to re-examine the associations and look for other potential mediators linking family interactions to its members' physical health status.

*The associations between family variables and adults' psychological well-being.* Study 2 aimed to examine the predictive value of family variables such as interparental relationship quality, DoS, and satisfaction with a couple relationship on adults' psychological well-being. The results revealed that adults' DoS had the highest significant impact on their psychological well-being in comparison to other study variables such as the interparental relationship observed during childhood and satisfaction with the current couple relationship. These results are in line with other body of research [4–6, 16, 53], demonstrating that higher DoS predicts fewer psychological symptoms, higher expression of happiness, well-being, and satisfaction with life. The findings corroborate the statements of Bowen [17, 18] that the DoS is a core characteristic that determines a person's relationship with self and others, his/her ability to function under stress, and develop meaningful and close relationships which shape the experience of general well-being and functioning

daily. Additionally, the results confirm the weightiness of the DoS predicting psychological well-being in adulthood, which shows that it is the most critical phenomenon in comparison to other systemic factors explored in this study.

Interestingly, separate elements of DoS had different prediction power for the particular components of well-being. However, two almost equally strongest predictors of every component of adults' well-being were I-position and emotional cutoff, suggesting that a higher level of well-being can be found among those who have a clearer self-view, are somewhat autonomous, and maintain warm relationships with significant others [53]. In some other studies, the emotional cutoff is found to predict marital problems and dyadic adjustment [20, 53] leading to lower satisfaction with life which reflects worse psychological well-being [54]. The emotional cutoff is a process of emotional alienation from parents, siblings, and other family members with whom a person has unresolved emotional and attachment issues. The decision to reduce or cut off emotional and/or physical contact with significant others is a way to cope with the anxiety that is generated by these relationships. However, emotional cutoff does not lead to problem resolution. Rather, they become dormant and prompt greater emotional reactivity as well as fusion with current partner/spouse. Thus, adults who are capable of maintaining close and satisfactory relationships with the members of the family-of-origin have the potential to expand their emotional support system and to cope better in their current personal, social, and professional life.

Although DoS was the strongest predictor of adults' well-being, higher interparental relationship quality (specifically harmonious relationship and less avoidant relationship), as well as satisfaction with an emotion-focused couple relationship played a significant role in predicting some of the components and the total score of the psychosocial well-being as well. This suggests that adults who growing up observed supportive, affectionate, committed, and constructive interactions between parent figures and are more satisfied with emotional communication with their partner in adulthood are more prone to a higher sense of well-being. Study 3 demonstrated that interparental relationship quality perceived in childhood indirectly through the family emotional system and DoS relates to satisfaction with couple relationships in adulthood. Thus, it can be assumed, as Bowen suggested [17], that patterns of interaction between partners through triangulation, family emotional system, and DoS are transferred through generations. In adulthood, an individual with low DoS has difficulties in creating and sustaining satisfactory relationships [16, 20, 53] because one could not develop appropriate skills in the family-of-origin. Thus, adults' relationship problems, alongside with high vulnerability to stress, eventually can lead to broader psychosocial functioning difficulties and a low sense of well-being [55].

The findings propose that adults' DoS has a significant effect on their well-being both directly and indirectly – higher DoS leads to a more satisfying relationship with a partner which, in turn, has a positive impact on adults' well-being. On the other hand, higher DoS creates a positive context for a person's functioning in daily life. Results conform to other research body, providing evidence for the role of DoS as well as couple relationship in adults' psychosocial functioning [4–6, 16, 54]. Adults, who have reasonable control over their emotions in stressful situations as well as in relationships with others, and who can develop and maintain healthy and harmonious relationships while sustaining autonomous and clearly defined self, may tend to make better personal and relational decisions leading to a better adjustment during life shifts as well as a more satisfactory life in general. In line with this reasoning, the findings support the postulates of the BFST [17] regarding DoS as a central mechanism by which personal, as well as relational well-being, is generated. The DoS is a product of interactional processes in the family-of-origin and is transmitted over generations.

*The Significance of Family-of-Origin Dynamics for Adults' Health and Psychological Wellbeing… DOI: http://dx.doi.org/10.5772/intechopen.95354*

*Limitations.* Some limitations of the studies should be considered when interpreting the results. Although the statistical analysis and theory assume some causal relationships among studied variables, a cross-sectional design that as used in all three studies does not establish the actual causality. A longitudinal research approach, along with a more significant number of different variables pertinent to adults' physical health and well-being, could provide insights on the pathways that connect family interactions with the health of family members as well as its changes in the systemic context. Another limitation of all 3 studies is related to the lack of gender balance as the samples primarily consisted of women; thus, the generalizability of the results in the men population is considerably restricted. Future research should attempt to involve more male participants to find out if established associations are applicable in both gender groups.

#### *3.6.1 Conclusions*

Summarizing the results of the three studies, some general conclusions can be drawn:


#### **Acknowledgements**

Acknowledgments to Simona Celiauskaite, who participated in the development of Physical Health Scale and recruitment of the participants in Study 1.

#### **Conflict of interest**

The author declares no conflict of interest.

*Interpersonal Relationships*

#### **Author details**

Viktorija Cepukiene Vytautas Magnus University, Kaunas, Lithuania

\*Address all correspondence to: viktorija.cepukiene@vdu.lt

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*The Significance of Family-of-Origin Dynamics for Adults' Health and Psychological Wellbeing… DOI: http://dx.doi.org/10.5772/intechopen.95354*

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#### **Chapter 15**
