Navigate Chronic Illness: Antecedents and Consequences of Family Resilience

Abstract

Chronic illnesses impose significant burdens on patients and their families, emphasizing the need for effective coping mechanisms like family resilience. This systematic review examined the antecedents and consequences of family resilience in chronic illness care. Electronic databases were searched for articles published between 2018 and April 2024. Eligible studies focused on antecedents and consequences of family resilience in families managing chronic illness. Twenty-six studies were included in the review. Five key antecedents were identified: caregiver burden, coping, dyadic communication, self-efficacy, and social support. The five primary consequences were caregiver burden, psychological distress, quality of life, resilience, and self-management. These findings provide a foundation for developing targeted interventions to enhance family resilience, emphasizing the importance of resilience-building programs in healthcare. By addressing both immediate needs and long-term challenges, these interventions can empower families to better manage the complexities of chronic illness, ultimately improving outcomes for both patients and caregivers.

Keywords

family resilience chronic illness systematic review meta-analysis

Chronic illnesses are defined as long-term conditions requiring ongoing management (Dowrick et al., 2005). Globally, the prevalence of chronic illnesses is rising, with these conditions accounting for 74% of all deaths worldwide in 2019, an increase from 67% in 2010 (Thomas et al., 2023). Examples include diabetes, hypertension, stroke, coronary artery disease, cancer, asthma, and mental health disorders (Goodman et al., 2013). The nature of chronic illnesses gives rise to numerous adverse outcomes, including prolonged hospitalization and increased healthcare utilization (Brunner-La Rocca et al., 2020; Sporinova et al., 2019), which impose substantial emotional, physical, and financial burdens on both patients and their families. The impacts of chronic illness extend beyond the individual, affecting immediate family members who often assume caregiving roles. These responsibilities can disrupt family routines, strain relationships, and challenge traditional household roles (Qama et al., 2022). Families may experience diminished cohesion, elevated stress levels, and a decline in overall functioning as they attempt to accommodate the patient's needs and navigate the uncertainties of the illness trajectory (Qualls, 2016; Schulz et al., 2020). Financial strain, emotional exhaustion, and changes in social dynamics are common consequences, often leading to a reduced quality of life for all family members (Ghasemi et al., 2020; Monteiro et al., 2024). This highlights the critical need for effective management strategies for chronic illnesses, which must address not only patients’ medical and self-management needs but also the essential role of family caregivers. Among these strategies, family resilience has emerged as a crucial factor in mitigating the adverse impacts of chronic illness on family functioning (Shapiro, 2013). Enhancing family resilience may facilitate improved care for patients while fostering better outcomes for their families.

Family Resilience in Chronic Illness Care

As conceptualized by Froma Walsh, family resilience is defined as a family's capacity to withstand and recover from adversity (Walsh, 1996). It involves three key processes: belief systems, which influence how families interpret adversity, maintain a positive outlook, and draw on transcendence and spirituality to navigate challenges; organizational patterns, which include maintaining strong family connections, adapting flexibly to new challenges, and leveraging social and economic networks to ensure stability and mobilize resources; and communication or problem-solving skills, which include clear communication, open emotional expression, and collaborative approaches to resolving issues (Walsh, 2003, 2016). These processes enable families to mobilize effectively during periods of significant stress, take proactive measures, buffer disruptions, reduce the risk of dysfunction, and support positive adaptation and resourcefulness (Walsh, 2021). In the context of chronic illness care, family resilience has been shown to play a pivotal role in addressing the multifaceted challenges associated with these conditions. Such challenges include the prolonged demands of caregiving, emotional strain, and financial burdens. Research consistently highlights that family resilience not only strengthens individual family members but also fortifies the family unit as a whole, enabling them to navigate the complexities of chronic illness more effectively (Park et al., 2022; Suparit et al., 2023).

The exploration of family resilience in the context of chronic illness is particularly significant due to the complex and multifaceted nature of these conditions, which often involve fluctuating symptoms and long-term care needs (Faccio et al., 2018). While existing research has examined various dimensions of family resilience, comprehensive syntheses remain limited. For example, one systematic review investigated the experiences and adaptive processes of family resilience in long-term care (Kuang et al., 2023). Another review focused on cancer treatment, identifying key factors that influence family resilience (Shao et al., 2023). Additionally, Huang et al. conducted a meta-synthesis of qualitative studies on family resilience in the context of childhood chronic illnesses (Huang et al., 2022). Although these studies provide valuable insights, their findings are either narrowly focused on specific populations or limited to qualitative methodologies.

The Present Study

Despite the growing body of evidence, no comprehensive systematic review has yet summarized both the antecedents and consequences of family resilience across diverse chronic illness contexts. Furthermore, much of the existing literature has centered on younger populations or specific conditions, neglecting middle-aged and older adults who face unique challenges due to the increasing prevalence of chronic comorbidities in these age groups. Research indicates that middle-aged adults aged 45 years and older represent a demographic with a rising prevalence of comorbid chronic diseases, often requiring complex care management (Taylor et al., 2019). This population frequently encounters overlapping conditions such as diabetes, hypertension, and cardiovascular diseases, alongside caregiving responsibilities for aging parents or younger dependents, further compounding their stress and caregiving burdens.

To address these gaps, this systematic review and meta-analysis aims to identify key factors influencing family resilience in the context of chronic illness, particularly among adults aged 45 and older, and to clarify its impact on the health and well-being of both patients and caregivers. By synthesizing findings across diverse chronic illness contexts and focusing on middle-aged and older populations, this review seeks to provide a robust evidence base for designing effective interventions. Such strategies are critical for enhancing family resilience, improving quality of life, and promoting better health outcomes for individuals with chronic illnesses and their families.

Method

Search Strategy

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Page et al., 2021), a comprehensive search was conducted to identify relevant articles published from 2018 to April 2024. This timeframe was selected to ensure the inclusion of the most recent and relevant evidence on family resilience in the context of chronic illness. The databases searched included PubMed, SCOPUS, ScienceDirect, PsycINFO, Thai Citation Index (TCI), and Google Scholar, using the search terms “family resilience” AND (“factors OR “predictors” OR “relationships” OR “cross-sectional”) AND (“chronic illness” OR “chronic disease” OR “chronic condition”). To capture a broad range of chronic illness studies (Goodman et al., 2013), additional terms included “hypertension,” “heart failure,” “coronary artery disease,” “stroke,” “arthritis,” “asthma,” “cancer,” “chronic kidney disease,” “chronic obstructive pulmonary disease,” “dementia,” “depression,” “diabetes,” “human immunodeficiency virus (HIV),” schizophrenia,” “substance abuse disorders,” “affective disorder,” “mood disorder,” and “bipolar disorder.” Articles were initially screened based on their titles, abstracts, and keywords, followed by a thorough review of full-text articles to determine their eligibility for inclusion in this review.

Conceptual Model of Family Resilience

This review was guided by a conceptual model of family resilience, which served as a theoretical framework for evaluating the included studies. Family resilience was defined and operationalized as a dynamic process of adaptive responses to adversity, consistent with Walsh's framework (Walsh, 2016, 2021). This framework categorizes family resilience into three core domains: belief systems, organizational patterns, and communication or problem-solving skills. These domains informed the identification and categorization of antecedents and consequences of family resilience.

Studies were included if they explicitly investigated family resilience, defined by the presence of one or more domains outlined in Walsh's framework, or if they measured constructs directly aligned with this conceptualization (e.g., belief systems or communication skills). Antecedents were defined as predictors or factors contributing to family resilience, such as demographic, psychological, or environmental variables. Consequences were defined as outcomes associated with family resilience, including improved quality of life, reduced caregiver burden, or enhanced family functioning. These definitions were employed to ensure consistency and clarity in identifying and categorizing findings across the included studies.

Eligibility Criteria and Study Selection

The inclusion criteria were as follows: (1) studies involving families with at least one middle-aged or older adult member (aged 45 years or above) diagnosed with a chronic illness, (2) studies encompassing chronic illness patients or their family caregivers, (3) research employing quantitative research designs (e.g., cross-sectional, observational, cohort, or case-control studies) or mixed methods designs, (4) studies evaluating family resilience as either a predictor or outcome variable, (5) investigations exploring factors or predictors of family resilience and its correlation with outcomes, and (6) studies published in English or Thai.

The exclusion criteria were as follows: (1) studies that did not involve families with chronic illness or focused exclusively on individual resilience without considering family dynamics, (2) abstract-only articles, reviews, editorials, commentaries, case reports, and qualitative studies, (3) studies lacking sufficient statistical data for inclusion in the meta-analysis, or (4) studies that did not specify the age of the patient population. Two authors (CS and DR) independently evaluated the titles and abstracts for relevance, resolving any discrepancies through discussion within the research team.

Data Extraction

Two authors (CR and DR) independently extracted and cross-checked all data. Any discrepancies were resolved through ongoing discussions among the research team until a consensus was reached. Data extraction tables were generated using Excel, including (1) study characteristics such as authors, publication year, and country, (2) participant details including population, chronic illness type, patient age, and sample size, (3) methods for measuring family resilience, (4) primary findings regarding antecedents and consequences of family resilience, and (5) statistical data necessary for meta-analysis preparation.

Quality Assessment

The quality of the included studies was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS tool) (Downes et al., 2016), which consists of 20 items evaluating various aspects of cross-sectional studies, with responses rated as yes (1) and no or don’t know (0). Studies were categorized into three quality levels based on their total score as a percentage: high quality (above 80%), moderate quality (between 60% and 80%), or low quality (below 60%). Two authors (CS and DR) independently evaluated the quality of each study. Any disagreements were resolved through team discussions.

Statistical Analysis

Meta-analyses were performed using effect sizes derived from correlation coefficients between family resilience and various constructs, including antecedents and consequences. Most studies directly reported correlation coefficients (r). For studies that provided standardized regression coefficients (β) instead, these were converted into correlation coefficients following the procedure recommended by Peterson and Brown (2005). Correlation coefficients were transformed into Fisher's Z and estimated with 95% confidence intervals (CIs) using a random-effects model. A random-effects model was chosen for this analysis to account for variability across studies. Unlike a fixed-effects model, which assumes that all included studies estimate a single true effect size, a random-effects model acknowledges that differences in study populations, methodologies, and contexts can lead to variations in the true effect size. This model is particularly suitable for meta-analyses involving diverse studies, as it provides a more generalizable estimate of the average effect size while incorporating both within-study and between-study variability. Heterogeneity among studies was assessed using Cochrane's Q test and I² statistics (Borenstein, 2022). Egger's test was used to evaluate the presence of publication bias. All statistical analyses were conducted using RStudio software (v. 4.3.1) and the metafor packages (Viechtbauer, 2010).

Results

Characteristics of Included Studies

In this systematic review, database searches identified a total of 1,783 articles, with 1,234 articles remaining after duplicates were removed. After screening the titles and abstracts, 71 articles underwent full-text review. Finally, 26 studies were included in the meta-analysis. Some studies were excluded for various reasons, such as not measuring family resilience, involving the general population instead of the target population, being duplicates, or not specifying participant ages. This process is illustrated in Fig. 1.

A total of 26 studies, involving 7,191 participants, were included in this review. The majority of the research was conducted in China (n = 22), followed by South Korea (n = 2), Thailand (n = 1), and Italy (n = 1). Among these, three studies from South Korea and Italy were carried out in high-income countries. Of the 26 articles, 25 employed quantitative designs, including 23 cross-sectional and 2 longitudinal studies, while one study utilized a mixed methods design. The studies primarily focused on patients (n = 13), patient-family caregiver dyads (n = 9), and family caregivers (n = 4). Participants represented various chronic illnesses, with the majority addressing cancer (n = 17), followed by stroke (n = 4), chronic renal failure (n = 3), chronic wounds (n = 1), and dementia (n = 1). The most commonly used measurement tool was the Family Resilience Assessment Scale (FRAS) (n = 15), followed by the Walsh Family Resilience Questionnaire (WFRQ) (n = 3). Antecedents of family resilience were identified in 10 studies, while consequences of family resilience were reported in 19 studies. All included studies were peer-reviewed, and their quality was evaluated using the AXIS tool. The evaluation categorized 16 studies as high quality, 8 as moderate quality, and 2 as low quality. A summary of study characteristics is presented in Table 1.

Table 1.

Characteristics of Included Studies.

Author (year)	Country	Chronic illness type	Patient age (M ± SD)	Population	N	Family resilience measurement	Antecedent of family resilience	Consequences of family resilience	Quality assessment
Cui et al. (2023)	China	Cancer	53.96 ± 15.37	Patient/caregiver dyads	241	FRAS	Family sense of coherence; symptom burden; caregiver burden; resilience; social support	-	High
Ahn and Kim (2022)	South Korea	Cancer	63.39 ± 13.34	Caregiver	117	FRS-C	-	Distress; quality of life	Moderate
Han et al. (2024)	China	Stroke	61.86 ± 8.76	Patient	242	FRAS	Self-efficacy; caregiver burden; family functioning; social support	-	Low
Qiu et al. (2024)	China	Chronic wounds	>60 (76.6%)	Patient	269	WFRQ	-	Fatalism; self-management	Moderate
Wang et al. (2024)	China	Chronic renal failure	57.40 ± 13.56	Patient	252	FRAS	Resilience	Social support	High
Chang et al. (2022)	China	Cancer	50.00 ± 10.80	Patient	252	FRAS	-	Functional exercise adherence; resilience	High
Shao et al. (2024a)	China	Cancer	58.20 ± 11.81	Caregiver	295	FaREQ	Mutuality; caregiver burden	-	High
Chen et al. (2023a)	China	Cancer	50.74 ± 10.63	Patient	348	FHI	Dyadic communication quality; perceived spousal support	-	High
Chen et al. (2023b)	China	Cancer	50.50 ± 10.40	Patient/caregiver dyads	354	FHI	Dyadic communication quality		High
Kim et al. (2018)	South Korea	Dementia	80.47 ± 6.62	Caregiver	224	Family sense of control scale; family strength scale; family role stability scale; family cohesion scale; family resources scale; positive communication process	Family stress; social support	Family adaptation	Moderate
Zhang et al. (2022)	China	Stroke	61.80 ± 12.40	Patient	288 (T0255 (T1)242 (T3)237 (T4)	FRAS	Subjective support; self-efficacy; family atmosphere; caregiver-patient relationship (sibling)	-	High
Qiu et al. (2021)	China	Chronic renal failure	57.60 ± 13.83	Patient	258	FRAS	-	Resilience	High
Ke et al. (2023)	China	Cancer	56.96 ± 10.80	Patient/caregiver dyads	313	FRAS	-	Dyadic coping; quality of life	High
Lu (2024)	China	Stroke	≤60 (42.9%)61–74 (39.6%)≥75 (17.5%)	Patient	303	Family resilience rating scale	Social support; resilience; positive coping; family relationship; optimism	-	High
Brivio et al. (2021)	Italy	Cancer	51.07 ± 7.93	Patient	154	WFRQ	-	Positive affect; negative affect	Moderate
Liu et al. (2023)	China	Chronic renal failure	45–65 (37.6%)65–80 (37.0%)≥80 (6.4%)	Patient	173	FRAS	Social alienation	Caregiver burden; coping style	Moderate
Shao et al. (2024b)	China	Cancer	57.67 ± 11.69	Patient	202	FaREQ	-	Financial toxicity	High
Thananchai and Surakarn (2022)	Thailand	Stroke	61.30 ± 10.50	Caregiver	176	WFRQ	-	Social support; coping	Low
Li et al. (2019)	China	Cancer	49.00 ± 9.00	Patient/caregiver dyads	108	FRAS	-	Post-traumatic growth; caregiver burden; quality of life	Moderate
Tao et al. (2024)	China	Cancer	30–49 (46.4%)50–59 (36.7%)≥60 (10.5%)	Patient/caregiver dyads	392	FRAS	-	Perceived stress; fear of cancer recurrence	High
Xu et al. (2023)	China	Cancer	49.72 ± 11.26	Patient	310	FHI	-	Illness perception; couple illness communication	High
Li et al. (2018)	China	Cancer	49.00 ± 9.00	Patient/caregiver dyads	108	FRAS	-	Resilience; caregiver burden	Moderate
Chen et al. (2021)	China	Cancer	46.30 ± 14.32	Patient/caregiver dyads	272	FRAS	-	Social support; resilience	High
Yan et al. (2021)	China	Cancer	47.50 ± 10.90	Patient/caregiver dyads	104	FRAS	-	Post-traumatic stress symptoms	High
Tao et al. (2023)	China	Cancer	30–39 (25.0%)40–49 (59.2%)≥60 (10.5%)	Patient	387	FRAS	-	Resilience; perceived stress; psychological distress	Moderate
Tao et al. (2022)	China	Cancer	40–49 (31.1%)50–59 (37.5%)≥60 (30.3%)	Patient/caregiver dyads	315	FRAS	-	Resilience; caregiver burden	High

M: mean; SD: standard deviation; FRAS: Family Resilience Assessment Scale; FRS-C: Family Resilience Scale-Cancer; WFRQ: Walsh Family Resilience Questionnaire; FaREQ: Family Resilience Questionnaire; FHI: Family Hardiness Index.

Antecedents and Consequences of Family Resilience

In the analysis of 26 reviewed studies, random-effects meta-analyses were conducted on antecedents and consequences reported in more than two studies to assess their association with family resilience. Antecedents and consequences mentioned in only one study were excluded from the pooled effect size analysis.

To examine the relationship between antecedents and family resilience (Table 2), the meta-analysis revealed significant positive associations between coping (r = 0.48, 95% CI: 0.21, 0.69) (Fig. 2), dyadic communication (r = 0.24, 95% CI: 0.18, 0.30) (Fig. 3), self-efficacy (r = 0.29, 95% CI: 0.24, 0.34) (Fig. 4), social support (r = 0.37, 95% CI: 0.29, 0.45) (Fig. 5), and family resilience. Additionally, a significant negative association was found between caregiver burden and family resilience (r = −0.34, 95% CI: −0.54, −0.10) (Fig. 6). However, there was a nonsignificant association between resilience and family resilience (r = 0.31, 95% CI: −0.07, 0.61) (Fig. 7). As expected, heterogeneity between the studies was substantial for all analyses (I² ranging from 81.7% to 96.9%), except for self-efficacy, which showed no heterogeneity. Publication bias was not detected for all analyses except dyadic communication, where it was present. This should be taken into account when interpreting the results.

Table 2.

Random-Effect Model of the Antecedents of Family Resilience.

Variables	k	N	Mean r effect size, random-effects model	95% confidence intervals		Test of null		Heterogeneity				Egger's regression
Variables	k	N	Mean r effect size, random-effects model	Lower 95% CI	Upper 95% CI	Z	p-value	Q	df	p-value	I ²	t	df	p-value
Coping	2	479	0.48	0.21	0.69	3.32	.001	11.12	1	.001	91.0	-	-	-
Dyadic communication	15	5,260	0.24	0.18	0.30	7.40	.000	76.61	14	.000	81.7	4.46	13	.001
Self-efficacy	5	1,264	0.29	0.24	0.34	10.18	.000	4.25	4	.373	6.0	0.99	3	.394
Social support	15	3,749	0.37	0.29	0.45	8.45	.000	117.11	14	.000	88.0	−1.24	13	.235
Resilience	3	785	0.31	−0.07	0.61	1.62	.105	64.42	2	.000	96.9	-	-	-
Caregiver burden	4	1,019	−0.34	−0.54	−0.10	−2.74	.006	52.41	3	.000	94.3	2.68	2	.116

k = number of studies, n = number of subjects, df = degree of freedom.

To examine the relationship between consequences and family resilience (Table 3), the meta-analysis revealed significant positive associations between quality of life (r = 0.29, 95% CI: 0.08, 0.48) (Fig. 8), resilience (r = 0.43, 95% CI: 0.34, 0.51) (Fig. 9), self-management (r = 0.76, 95% CI: 0.58, 0.87) (Fig. 10), and family resilience. Significant negative associations were found between caregiver burden (r = −0.35, 95% CI: −0.46, −0.22) (Fig. 11), psychological distress (r = -0.35, 95% CI: −0.48, −0.21) (Fig. 12), and family resilience. As expected, heterogeneity between the studies was substantial for all analyses (I² ranging from 68.5% to 92.4%). Publication bias was not detected for all analyses.

Table 3.

Random-Effect Model of the Consequences of Family Resilience.

Variables	k	n	Mean r effect size, random-effects model	95% confidence intervals		Test of null		Heterogeneity				Egger's regression
Variables	k	n	Mean r effect size, random-effects model	Lower 95% CI	Upper 95% CI	Z	p-value	Q	df	p-value	I ²	t	df	p-value
Quality of life	6	1477	0.29	0.08	0.48	2.70	.007	62.90	5	.000	92.1	2.19	4	.093
Resilience	12	3182	0.43	0.34	0.51	8.89	.000	94.16	11	.000	88.3	−0.88	10	.400
Self-management	2	461	0.76	0.58	0.87	5.94	.000	12.54	1	.000	92.0	-	-	-
Caregiver burden	4	704	−0.35	−0.46	−0.22	−5.28	.000	9.52	3	.023	68.5	−0.43	2	.709
Psychological distress	8	1699	−0.35	−0.48	−0.21	−4.58	.000	92.46	7	.000	92.4	1.40	6	.212

k = number of studies, n = number of subjects, df = degree of freedom.

Discussion

This systematic review comprehensively examined the antecedents and consequences of family resilience in chronic illness contexts. It revealed consistent associations between family resilience and factors such as caregiver burden, coping strategies, dyadic communication, self-efficacy, and social support. Additionally, the study identified significant outcomes of family resilience, including enhanced quality of life, reduced caregiver burden, decreased psychological distress, improved self-management, and increased individual resilience. Importantly, individual resilience did not show a significant association with family resilience.

Antecedents of Family Resilience

The significant positive correlation between coping and family resilience underscores the crucial role effective coping strategies play in fostering resilience within families. Consistent with previous studies, individuals who engage in active coping or problem-focused coping tend to exhibit higher levels of family resilience (Qin et al., 2024; Zhang et al., 2024). These coping strategies enable families to navigate the ongoing stressors and demands associated with chronic illness more effectively. Families employing adaptive coping mechanisms are better equipped to handle the challenges of chronic illness care (Sheth et al., 2023). Problem-focused coping allows families to tackle the issues directly, fostering a sense of control and competence in managing the illness (Kristofferzon et al., 2018). Additionally, adaptive coping mechanisms contribute to better communication and stronger family bonds, as family members are more likely to share their experiences and support each other through difficult times (Gonzalez et al., 2023). In essence, families that develop and utilize effective coping strategies are more adept at navigating the chronic stress associated with long-term illness, leading to a more resilient family system overall.

Positive dyadic communication between family members, particularly between patients and caregivers, emerged as a significant antecedent of family resilience. Consistent with previous studies (Chen et al., 2023b; Venetis et al., 2020), effective dyadic communication is associated with higher levels of family resilience. Clear communication is crucial in chronic illness management by ensuring all family members are informed about the patient's needs, treatment plans, and care adjustments (Wollney et al., 2024). Transparency prevents misunderstanding that can lead to errors or conflicts, allowing for more efficient and coordinated care efforts. Supportive communication also provides emotional encouragement and improved chronic illness care (Rosland & Piette, 2010). Knowing that they can rely on each other for emotional makes family members more resilient. Additionally, open communication empowers family members to take an active role in managing illness, building confidence and competence in handling the challenges that chronic illness presents (Wittenberg et al., 2017). Therefore, fostering effective communication within families should be central to interventions aimed at enhancing family resilience in chronic illness care.

The significant positive relationship between self-efficacy and family resilience highlights the importance of self-efficacy in chronic illness contexts. Patients with higher self-efficacy are more likely to enhance family resilience (Han et al., 2024). This means they believe in their capacity to manage various demands, from adhering to treatment plans to making necessary lifestyle adjustments (Farley, 2020). This belief enables them to approach these tasks proactively rather than feeling overwhelmed. Confident patients are better able to follow medical advice, attend appointments, and maintain health routines (Al-Harithy & Wazqar, 2021). Families with self-efficacious patients likely experience less tension and more effective collaboration in managing the illness (Hoffman, 2013). Therefore, enhancing self-efficacy within families should be a key focus of interventions aimed at improving family resilience in chronic illness care. By fostering confidence and competence, these interventions can help families navigate the complexities and stresses of chronic disease more effectively, leading to better health outcomes and stronger family bonds.

Social support has shown a significant positive association with family resilience, highlighting its crucial role in managing chronic illness care. This aligns with previous studies (Cui et al., 2023; Wang et al., 2024), suggesting that individuals receiving adequate social support tend to exhibit higher family resilience. Social support offers both practical assistance and emotional comfort, collectively alleviating burdens on primary caregivers (Del-Pino-Casado et al., 2018). In chronic illness management, social support serves various roles. It includes tangible aid, enabling caregivers to effectively manage responsibilities such as daily tasks and medical care. Additionally, emotional encouragement and companionship provide reassurance and validation, thereby enhancing resilience by bolstering caregivers’ ability to cope with stress and uncertainty (Antelo Ameijeiras & Espinosa, 2023). Interventions aimed at enhancing family resilience in chronic illness care should prioritize facilitating access to social support networks. By fostering supportive relationships, these interventions empower families to navigate the complexities of chronic illness more effectively, ultimately improving their quality of life and strengthening overall family resilience.

A negative association between caregiver burden and family resilience has been identified, aligning with prior research (Cui et al., 2023; Shao et al., 2024). Individuals experiencing lower caregiver burden tend to exhibit higher levels of family resilience in the context of chronic illness. Lower caregiver burden allows family members to focus more on proactive and coordinated care strategies rather than being overwhelmed by stress and fatigue (Papastavrou et al., 2012). This enables them to manage the ongoing challenges of chronic illness more effectively, engage in meaningful interactions, share experiences, and provide mutual support (Tziaka et al., 2024). This contributes to a more resilient family system capable of facing the adversities associated with chronic illness. Interventions aimed at reducing caregiver burden are essential for promoting family resilience. These interventions can include providing access to respite care, offering practical assistance with daily tasks, and facilitating support groups for caregivers. By alleviating some of the pressures on caregivers, these measures can help families better navigate the complexities of chronic illness more effectively (Bialon & Coke, 2012).

Consequences of Family Resilience

Family resilience is positively associated with a higher quality of life for both patients and caregivers, highlighting its crucial role in managing chronic illness. Resilient families are more capable of preserving a sense of normalcy and well-being despite the numerous challenges chronic illness presents (Zhang et al., 2023). This capability is essential for both patients and caregivers, as it leads to better mental and emotional health, more effective disease management, and an overall improved quality of life (Cui et al., 2024; Ke et al., 2023). Therefore, interventions that enhance family resilience should be a key component of chronic illness care. Healthcare providers can help families by supporting them in building resilience to improve their quality of life and sustain well-being amidst the ongoing challenges of chronic illness.

Family resilience was positively associated with individual resilience, demonstrating the interconnected nature of these concepts. In chronic illness contexts, individual resilience refers to the ability to adapt to adversity and manage stressors associated with the condition (Cal et al., 2015). Family resilience creates a supportive environment that nurtures this personal strength (Benzies & Mychasiuk, 2009). Families that practice open communication, provide emotional support, and share responsibilities foster a nurturing atmosphere, empowering each member to confront the illness with confidence and determination. This positive association suggests that interventions aimed at enhancing family resilience can yield dual benefits (Qiu et al., 2021). They not only bolster the family's collective ability to manage the illness but also enhance the individual resilience of each member.

Higher family resilience is associated with improved self-management practices. This relationship highlights the ability of resilient families to adopt and sustain strategies for effectively managing symptoms and treatment regimens. Self-management in chronic illness includes activities such as adhering to medication schedules, monitoring symptoms, making lifestyle changes, and seeking timely medical intervention (Dineen-Griffin et al., 2019). Resilient families effectively distribute caregiving responsibilities, reducing the burden on any single member and fostering a collaborative approach to care (Deist & Greeff, 2015). These families are better equipped to handle the complexities and demands of chronic illness. Therefore, interventions aimed at enhancing family resilience can significantly improve a family's capacity to manage chronic illness. Healthcare providers should promote family-centered approaches to care, recognizing that supporting the entire family unit can lead to better self-management outcomes.

Lower levels of psychological distress were observed in resilient families, highlighting the crucial role of family resilience in addressing the emotional and mental health challenges associated with chronic illness. Resilient families typically develop and use effective coping strategies and strong social support systems, which enable them to manage the stress and emotional burden of chronic illness more efficiently (Tao et al., 2023). These families are better prepared to navigate the ongoing challenges of chronic illness, including fluctuating health conditions, complex treatment regimens, and the emotional strain of caregiving. This capacity to manage stress effectively results in lower levels of psychological distress. Interventions aimed at strengthening family resilience can empower families to better cope with the psychological demands of chronic illness. Moreover, connecting families with community resources and support groups can provide the external support needed to reduce psychological distress (George et al., 2020).

The significant negative association between family resilience and caregiver burden highlights the protective role of family resilience in managing chronic illness. Resilient families can devise effective strategies for handling everyday tasks, such as managing medication schedules, coordinating medical appointments, and adapting to changes in the patient's condition (Kitko et al., 2020). This proactive approach helps prevent crises and reduces the need for reactive, stress-inducing interventions. Lower caregiver burden in resilient families enhances overall family functioning (Ghasemi et al., 2020). When caregivers experience less overwhelm, they are better able to provide higher-quality care to the patient and maintain their own health and well-being (Northouse et al., 2012). This contributes to a more positive caregiving experience and better outcomes for both caregivers and patients.

Integration of Cultural Influences on Family Resilience

The predominance of studies conducted in China (22 out of 26) highlights the potential cultural influence on the conceptualization and operationalization of family resilience within this review. China, as a collectivist society, emphasizes interdependence, familial obligations, and strong social ties, which may amplify the role of family dynamics in resilience-building (Zhou et al., 2023). For example, collectivist cultures often prioritize group well-being over individual goals, fostering a sense of shared responsibility in caregiving and mutual support among family members (Subramaniam & Mehta, 2024). This cultural framework likely strengthens the association between social support and family resilience, as family members are more inclined to rely on and support one another during adversities, such as chronic illness management.

Additionally, traditional Chinese cultural values, including filial piety, emphasize the moral duty of children to care for their aging parents, potentially enhancing caregiver commitment and family cohesion in managing chronic illnesses (Xiao et al., 2024). However, this strong cultural expectation may also contribute to increased caregiver burden when resources or support systems are insufficient. The emphasis on hierarchical roles within families in collectivist societies may also influence how family resilience manifests. For instance, the elder family member or caregiver often assumes a leadership role in decision-making and problem-solving, which aligns with the “organizational patterns” domain of Walsh's framework. This dynamic could enhance the family's ability to coordinate caregiving efforts and adapt to illness-related challenges, but it might also create stress if the caregiver lacks adequate support or resources. Furthermore, collectivist values may shape the measurement of family resilience, as tools like the Family Resilience Assessment Scale (FRAS) and Walsh Family Resilience Questionnaire (WFRQ) could reflect Western-centric constructs. The applicability of these tools in a collectivist context warrants careful consideration. For example, dimensions such as individual self-efficacy may be less emphasized compared to collective efficacy or family interdependence in resilience-building.

Implications for Family Counselors

Family counselors play a pivotal role in enhancing family resilience in the context of chronic illness by addressing key factors such as coping strategies, dyadic communication, self-efficacy, social support, and caregiver burden. Through culturally sensitive, family-centered approaches, counselors can foster open communication, reduce psychological distress, and improve the overall quality of life for patients and caregivers. Interventions that build resilience not only strengthen the family unit but also empower individuals to navigate the challenges of chronic illness with confidence and competence. By connecting families to community resources, providing psychoeducation, and tailoring interventions to both individual and collective needs, counselors can create sustainable frameworks for resilience-building. Ultimately, these efforts contribute to healthier family dynamics, enhanced caregiving experiences, and better health outcomes in chronic illness care.

Limitations and Future Directions

This study investigates family resilience in the context of chronic illness, providing insights into family dynamics in coping with chronic health conditions. It emphasizes the internal and external resources families use to manage their well-being and address chronic health challenges. Despite these contributions, several limitations are notable. First, included studies varied significantly in measurement tools for family resilience leading to heterogeneity in outcomes. The FRAS and WFRQ, the most commonly used tools, differ in the dimensions they assess, which may not fully align with the conceptual framework outlined in this review. This variability complicates the interpretation of pooled effect sizes and highlights the need for caution in generalizing findings. Additionally, subgroup analysis to address these differences was infeasible due to the limited number of studies. Future research should prioritize the development of standardized, culturally sensitive measures that align with comprehensive frameworks, enabling more consistent and interpretable findings in family resilience research across diverse populations and chronic illness contexts. Second, the study included a wide range of participants––patients, caregivers, and patient-caregiver dyads––across diverse chronic illnesses. While inclusive, this diversity complicates direct comparisons and may obscure specific resilience factors for different family subgroups. Future research should explore distinct factors driving family resilience in both patients and caregivers, focusing on dyadic coping. This investigation would clarify their communication about illnesses and collaboration in managing chronic conditions, potentially influencing family resilience for both groups. Third, most studies were conducted in China, a middle-income country, potentially limiting global variations in family resilience dynamics due to specific cultural, social, and healthcare system factors unique to China. Future research should extend to diverse global settings to capture variability in family resilience across different cultural and socioeconomic contexts. Finally, the meta-analysis relied on correlation coefficients, inherently limiting causal inference. While correlations offer insights into associations, they do not establish causality or temporal relationships between variables. Future longitudinal studies are essential to track changes in family resilience over time and establish causal relationships.

Conclusions

This systematic review and meta-analysis emphasize the vital role of family resilience in managing chronic illness, shedding light on the complex interplay between family dynamics and chronic disease management. By identifying key antecedents such as coping, dyadic communication, self-efficacy, and social support, as well as consequences like improved quality of life, reduced caregiver burden, and enhanced self-management, the study lays the groundwork for creating effective, evidence-based strategies to support families. The insights gained from this research can inform the development of targeted interventions and integrated care models that not only address the immediate needs of patients but also empower families to manage the long-term challenges associated with chronic illness more effectively.

Footnotes

Authors’ Contributions

CS and DR conceived the study. Title and abstract screening were completed by CS and DR, and full-text screening and data extraction were completed by CS and DR. CS conducted meta-analyses and drafted the manuscript. All authors read, revised, and approved the final manuscript.

Data Availability

All data generated or analyzed during this study are included in this published article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

ORCID iD

Charin Suwanwong

Darawan Raksat

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research was funded by the Faculty of Humanities, Srinakharinwirot University (GRANT 594/2566).

Faculty of Humanities, Srinakharinwirot University (grant number GRANT 594/2566).

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Navigate Chronic Illness: Antecedents and Consequences of Family Resilience—A Systematic Review and Meta-Analysis

Abstract

Keywords

Family Resilience in Chronic Illness Care

The Present Study

Method

Search Strategy

Conceptual Model of Family Resilience

Eligibility Criteria and Study Selection

Data Extraction

Quality Assessment

Statistical Analysis

Results

Characteristics of Included Studies

Antecedents and Consequences of Family Resilience

Discussion

Antecedents of Family Resilience

Consequences of Family Resilience

Integration of Cultural Influences on Family Resilience

Implications for Family Counselors

Limitations and Future Directions

Conclusions

Footnotes

Authors’ Contributions

Data Availability

Declaration of Conflicting Interests

ORCID iD

Funding

References