Anxiety and depression in mothers of children undergoing bone marrow transplant: symptom prevalence and use of the Beck depression and Beck anxiety inventories as screening instruments

Anxiety and Depression in Parents of Children Undergoing Hematopoietic Stem Cell Transplant (HSCT)

Hematopoietic stem cell transplantation (HSCT) is a well-established therapy tool for several malignant and non-malignant diseases. Parents of children undergoing HSCT experience physiological distress for various reasons such as intensive caregiving, potential complications, and medically intensive process. The purpose of this study was to explore anxiety/depression in parents of children who underwent HSCT and the associated self-reported characteristics.

METHOD AND MATERIAL

In the present study were enrolled 100 parents of children who underwent HSCT. Data were collected by the completion of the "Hospital Anxiety and Depression Scale (HADs)," which also included parents' characteristics. The statistical significance level was p < 0.05.

RESULTS

Of the 100 participants, 81% and 64% of parents experienced anxiety and depression, respectively, based on HADs scores. A statistically significant association was observed between parental anxiety and gender (p = 0.017), frequency of visiting the hospitalized child (p = 0.023), whether they desired family members to remain in hospital (p = 0.033), as well as with the need for participation in daily care (p = 0.023), for help based on personal needs (p = 0.026), for scheduled meetings with parents having same problems (p = 0.006), for contact with hospital after discharge (p = 0.035), and for written information (p = 0.044). In terms of depression, a statistically significant association was observed with difficulties during the hospital stay (p = 0.034), whether they desired other family members to remain in hospital (p = 0.009), as well as with the need for opportunities or time for questions (p = 0.004), for scheduled meetings with parents having the same problems (p = 0.026), and for contact with hospital after discharge (p = 0.038).

CONCLUSION

Anxiety and depression were associated with possibility of family members to remain in the hospital as well as with the need for scheduled meetings with parents having the same problems and for contact after hospital discharge. Based on the findings presented, it is suggested that understanding parents' needs and perceptions is fundamental to the development of appropriate interventions that address their worries.

Prevalence and factors associated with depressive and anxiety symptoms among Palestinian medical students

BACKGROUND

Co-existence of depression and anxiety can be associated with severe detrimental consequences to the physical, mental and social wellbeing of the affected populations. This study was conducted to determine prevalence of depressive and anxiety symptoms among Palestinian medical students and to investigate associations between sociodemographic factors of the students with depressive and anxiety symptoms.

METHODS

This study was conducted in a cross-sectional observational design using a questionnaire in the period between September 2018 and April 2019 in a major university in the West Bank of Palestine. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) and anxiety symptoms were assessed using the Beck Anxiety Inventory (BAI). The questionnaire also collected the sociodemographic characteristics of the students. Reliability of the questionnaire was tested using the test re-test method. A total of 425 medical students were invited to participate in the study.

RESULTS

Of those invited, 286 students completed the questionnaire, giving a response rate of 67.3%. More than half (56.6%) of the students had minimal depression, 20.3% had mild depression, 14.0% had moderate depression, 9.1% had severe depression, 23.4% had no anxiety, 29.7% had mild to moderate anxiety, 25.5% had moderate to severe anxiety, and 21.3% had severe anxiety. Multiple linear regression analysis showed that academic stage (p-value < 0.01), Grade Point Average (p-value < 0.01), mental health status (p-value < 0.001), ever attempted suicide (p-value < 0.05), and religious commitment (p-value < 0.01) were predictors of BDI-II scores. Multiple linear regression analysis showed that academic stage (p-value < 0.05) and mental health status (p-value < 0.001) were predictors of BAI scores.

CONCLUSIONS

Depressive and anxiety symptoms were prevalent among Palestinian medical students in a major university in the West Bank of Palestine. Interventions might be designed to improve self-rated mental health of medical students in their academic years, ameliorate study conditions, and provision of counseling services to improve spirituality might be effective in reducing symptoms of depression and anxiety among medical students in Palestine. Future studies are still needed to investigate if these interventions could be useful in reducing depressive and anxiety symptoms among Palestinian medical students.

Parent Psychological and Physical Health Outcomes in Pediatric Hematopoietic Stem Cell Transplantation

BACKGROUND

Parents of children undergoing hematopoietic stem cell transplantation (HSCT) are at risk of adverse health outcomes due to their intense caregiver demands.

OBJECTIVE

The aim of this study was to describe adverse health outcomes in parents of children who survived an allogeneic HSCT done within the past 1 to 10 years.

METHODS

This cross-sectional study, conducted at a children's hospital in the western United States, enrolled English- and Spanish-speaking parents of children who survived allogeneic HSCT between 2005 and 2015. Outcome measures included Beck Anxiety and Depression Inventories, Perceived Stress and Parent Stress Scales, Physical Symptom Inventory, and Short-Form 36 version 2. Parent scores were compared with normative means. Subsequently, the parent sample was stratified by the amount of time since their child's HSCT for comparison between groups.

RESULTS

Fifty-four mothers and 7 fathers (n = 61) were enrolled. Global mental health scores were lower for parents in the sample compared with norms (P = .003). Parents in the sample reported moderate anxiety and depression (20% and 23%, respectively), yet reported less parenting stress and superior health outcomes compared with norms (P < .001). Social functioning and general health scores were lower for parents whose children survived an allogeneic HSCT done within the past 1 to 4.99 years (P = .012).

CONCLUSION

Parents of survivors of allogeneic HSCT may concurrently experience posttraumatic growth and stress following their child's HSCT.

IMPLICATIONS FOR PRACTICE

Health screening and psychological support for parents of children post-HSCT may help to identify parents at risk of adverse outcomes and allow for early, targeted interventions.

Acupuncture for insomnia with short sleep duration: protocol for a randomised controlled trial

INTRODUCTION

Insomnia with short sleep duration has a more serious negative impact on patient health. The existing literature suggests that medication therapy is more effective for this phenotype of insomnia compared with cognitive-behavioural therapy. However, the potential side effects of hypnotic medications hinder their clinical application. Acupuncture has been widely used in the treatment of insomnia, but it remains unclear whether it has therapeutic efficacy for insomnia with short sleep duration. The purpose of this trial is to evaluate the efficacy and safety of acupuncture for insomnia with short sleep duration.

METHODS AND ANALYSIS

This study is designed as a randomised, single-centre, single-blinded, placebo acupuncture controlled trial involving 152 participants. Eligible patients will be divided into two groups according to the objective total sleep time: insomnia with normal sleep duration group and insomnia with short sleep duration group. Then, patients in each group will be randomly assigned to two subgroups, the treatment group (acupuncture) and the control group (placebo acupuncture), in a 1:1 ratio with 38 subjects in each subgroup. The primary outcome is the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. Secondary outcomes are actigraphy, the Beck Anxiety Inventory, the Beck Depression Inventory and the Fatigue Severity Scale. All adverse effects will be assessed by the Treatment Emergent Symptom Scale. Outcomes will be evaluated at baseline, post treatment, as well as at 1-week and 1-month follow-up.

ETHICS AND DISSEMINATION

This protocol has been approved by the ethics committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine (no. 2019-17). Written informed consent will be obtained from all participants. The results will be disseminated through peer-reviewed journals for publications.

TRIAL REGISTRATION NUMBER

ChiCTR1900023473; Pre-results.

Association Between Gender Confirmation Treatments and Perceived Gender Congruence, Body Image Satisfaction, and Mental Health in a Cohort of Transgender Individuals

BACKGROUND

Transgender individuals sometimes seek gender confirmation treatments (GCT), including hormone therapy (HT) and/or surgical change of the chest and genitalia ("top" and "bottom" gender confirmation surgeries). These treatments may ameliorate distress resulting from the incongruence between one's physical appearance and gender identity.

AIM

The aim was to examine the degree to which individuals' body-gender congruence, body image satisfaction, depression, and anxiety differed by GCT groups in cohorts of transmasculine (TM) and transfeminine (TF) individuals.

METHODS

The Study of Transition, Outcomes, and Gender is a cohort study of transgender individuals recruited from 3 health plans located in Georgia, Northern California, and Southern California; cohort members were recruited to complete a survey between 2015-2017. Participants were asked about: history of GCT; body-gender congruence; body image satisfaction; depression; and anxiety. Participants were categorized as having received: (1) no GCT to date; (2) HT only; (3) top surgery; (4) partial bottom surgery; and (5) definitive bottom surgery.

OUTCOMES

Outcomes of interest included body-gender congruence, body image satisfaction, depression, and anxiety.

RESULTS

Of the 2,136 individuals invited to participate, 697 subjects (33%) completed the survey, including 347 TM and 350 TF individuals. The proportion of participants with low body-gender congruence scores was significantly higher in the "no treatment" group (prevalence ratio [PR] = 3.96, 95% CI 2.72-5.75) compared to the definitive bottom surgery group. The PR for depression comparing participants who reported no treatment relative to those who had definitive surgery was 1.94 (95% CI 1.42-2.66); the corresponding PR for anxiety was 4.33 (95% CI 1.83-10.54).

CLINICAL TRANSLATION

Withholding or delaying GCT until depression or anxiety have been treated may not be the optimal treatment course given the benefits of reduced levels of distress after undergoing these interventions.

CONCLUSIONS

Strengths include the well-defined sampling frame, which allowed correcting for non-response, a sample with approximately equal numbers of TF and TM participants, and the ability to combine data on HT and gender confirmation surgeries. Limitations include the cross-sectional design and the fact that participants may not be representative of the transgender population in the United States. Body-gender congruence and body image satisfaction were higher, and depression and anxiety were lower among individuals who had more extensive GCT compared to those who received less treatment or no treatment at all. Owen-Smith AA, Gerth J, Sineath RC, et al. Association Between Gender Confirmation Treatments and Perceived Gender Congruence, Body Image Satisfaction and Mental Health in a Cohort Of Transgender Individuals. J Sex Med 2018;15:591-600.

Pilot Study of Parent Psychophysiologic Outcomes in Pediatric Hematopoietic Stem Cell Transplantation

BACKGROUND

Parents of children undergoing hematopoietic stem cell transplantation (HSCT) are at risk for psychological distress. This distress may result in aberrant immune, inflammatory, or endocrine effects. These physiologic outcomes have not been reported previously.

MAIN OBJECTIVE

The aim of this study is to examine the feasibility of longitudinal testing of psychophysiological parameters of stress in parents of children undergoing HSCT.

METHODS

This pilot study was conducted at a large children's hospital in the Midwest and included parents of children who received autologous or allogeneic HSCT. Time points included before the start of HSCT conditioning and day +30, +60, and +100. Outcome variables included parent-perceived stress, lymphocyte subsets, C-reactive protein (CRP), proinflammatory cytokines, salivary cortisol, and salivary amylase. Effect sizes were calculated for each outcome.

RESULTS

Twelve parent-child dyads were enrolled (10 mothers, 2 fathers). Missing data were minimal. Parent-perceived stress significantly increased from pre-HSCT through day +100, and parent CD3+ T-lymphocyte counts decreased from pre-HSCT through day +100. No significant effects were observed for salivary studies, CRP, or proinflammatory cytokines. Effect sizes ranged from 1.23 (perceived stress) to 0.07 (CRP).

CONCLUSION

The results of this study suggest that it is feasible longitudinally measure parent psychophysiologic outcomes in the pediatric HSCT setting. In addition, parent-perceived stress increased linearly from start of conditioning through day +100, whereas parent T-lymphocyte counts decreased concurrently.

IMPLICATIONS FOR PRACTICE

Routine psychological and physical health screening of parents of children undergoing HSCT is needed. Multidisciplinary psychosocial support services should be offered to parents at regular intervals during their child's HSCT.

A randomized clinical trial of a parent-focused social-cognitive processing intervention for caregivers of children undergoing hematopoetic stem cell transplantation

OBJECTIVE

Providing care to one's child during and after a hematopoietic stem cell transplant (HSCT) is a universally stressful experience, but few psychological interventions have been developed to reduce caregiver distress. The goal of this study was to test the efficacy of a brief cognitive-behavioral intervention delivered to primary caregivers.

METHOD

Two hundred eighteen caregivers were assigned either best-practice psychosocial care (BPC) or a parent social-cognitive intervention program (P-SCIP). The 5 session P-SCIP was delivered during the HSCT hospitalization. Caregivers completed measures of distress, optimism, coping, and fear appraisals preintervention, 1, 6 months, and 1 year.

RESULTS

P-SCIP reduced caregiver's distress significantly more than BPC between the pretransplant assessment (Time 1) and 1-month follow-up assessment (Time 2). P-SCIP had a stronger effect than BPC among caregivers who began the hospitalization reporting higher depression and anxiety, and among caregivers whose children developed graft-versus-host disease (GvHD). Long-term treatment effects of P-SCIP were seen in traumatic distress among caregivers who reported higher anxiety pretransplant as well as among caregivers whose children had GvHD at HSCT discharge.

CONCLUSIONS

Screening caregivers for elevations in pretransplant anxiety and targeting interventions specifically to these caregivers, as well as targeting caregivers to children who develop GvHD, may prove beneficial.

Psychological distress and psychiatric diagnoses among primary caregivers of children undergoing hematopoietic stem cell transplant: an examination of prevalence, correlates, and racial/ethnic differences

OBJECTIVE

The aims of the study were to examine the prevalence of self-reported psychological distress, examine the prevalence of interview-rated psychiatric diagnoses, identify correlates of psychological distress and psychiatric diagnosis and examine racial/ethnic group differences on measures of psychological distress among primary caregivers of children preparing to undergo hematopoietic stem cell transplant (HSCT).

METHODS

Caregivers (N = 215) completed the Beck Anxiety Inventory, Beck Depression Inventory (BDI), Impact of Events Scale, and a psychiatric interview assessing major depressive disorder, generalized anxiety disorder and panic disorder. Regression analyses examined correlates of distress and psychiatric diagnosis. Comparisons were made between racial/ethnic groups.

RESULTS

Posttraumatic stress symptoms were reported by 54% of caregivers during the time preparing for the child's HSCT. Twenty-seven percent of caregivers met diagnostic criteria for at least one of the psychiatric diagnoses during this time. Few factors were associated with distress or psychiatric diagnosis, except the child scheduled for allogeneic transplant, being married and prior psychological/psychiatric care. Sociodemographic factors accounted for racial/ethnic group differences, except that Hispanic/Latino caregivers reported higher BDI scores than non-Hispanic white caregivers.

CONCLUSION

Caregivers may be at greater risk of posttraumatic stress symptoms than anxiety or depression. Prior psychological/psychiatric treatment is a risk factor for greater psychological distress and psychiatric diagnosis during this time. Racial differences are mostly due to sociodemographic factors.

The role of social and cognitive processes in the relationship between fear network and psychological distress among parents of children undergoing hematopoietic stem cell transplantation

The current study examined whether cognitive and social processing variables mediated the relationship between fear network and depression among parents of children undergoing hematopoietic stem cell transplant (HSCT). Parents whose children were initiating HSCT (N = 179) completed survey measures including fear network, Beck Depression Inventory, cognitive processing variables (positive reappraisal and self-blame) and social processing variables (emotional support and holding back from sharing concerns). Fear network was positively correlated with depression (p < .001). Self-blame and holding back emerged as individual partial mediators in the relationship between fear network and depression. Together they accounted for 34.3% of the variance in the relationship between fear network and depression. Positive reappraisal and emotional support did not have significant mediating effects. Social and cognitive processes, specifically self-blame and holding back from sharing concerns, play a negative role in parents' psychological adaptation to fears surrounding a child's HSCT.

Patterns of psychological responses in parents of children that underwent stem cell transplantation

OBJECTIVE

Hematopoietic stem cell transplantation (HSCT) is curative in several life-threatening pediatric diseases but may affect children and their families inducing depression, anxiety, burnout symptoms, and post-traumatic stress symptoms, as well as post-traumatic growth (PTG). The aim of this study was to investigate the co-occurrence of different aspects of such responses in parents of children that had undergone HSCT.

METHODS

Questionnaires were completed by 260 parents (146 mothers and 114 fathers) 11-198 months after HSCT: the Hospital Anxiety and Depression Scale, the Shirom-Melamed Burnout Questionnaire, the post-traumatic stress disorders checklist, civilian version, and the PTG inventory. Additional variables were also investigated: perceived support, time elapsed since HSCT, job stress, partner-relationship satisfaction, trauma appraisal, and the child's health problems. A hierarchical cluster analysis and a k-means cluster analysis were used to identify patterns of psychological responses.

RESULTS

Four clusters of parents with different psychological responses were identified. One cluster (n = 40) significantly differed from the other groups and reported levels of depression, anxiety, burnout symptoms, and post-traumatic stress symptoms above the cut-off. In contrast, another cluster (n = 66) reported higher levels of PTG than the other groups did.

CONCLUSIONS

This study shows a subgroup of parents maintaining high levels of several aspects of distress years after HSCT. Differences between clusters might be explained by differences in perceived support, the child's health problems, job stress, and partner-relationship satisfaction.

Impact of a parent-based interdisciplinary intervention for mothers on adjustment in children newly diagnosed with cancer

OBJECTIVE

To determine if maternal distress predicts child adjustment outcomes or if child adjustment outcomes predict maternal distress among children newly diagnosed with cancer, and if a parent-focused intervention has downstream effects on child adjustment.

METHODS

Mothers (n = 52) were randomly assigned to a clinic-based, interdisciplinary intervention for parents of children newly diagnosed with cancer. Measures of maternal distress and child adjustment were collected at baseline, posttreatment, and follow-up.

RESULTS

A lagged relationship was identified between maternal distress and child internalizing symptoms, but not externalizing symptoms. The parent intervention reduced child internalizing and externalizing symptoms at follow-up. Only the child internalizing symptoms effect was mediated by reduced maternal distress. The child externalizing symptoms effect was mediated by unobserved parent factors.

CONCLUSIONS

This study provides support for illness adjustment and coping models that emphasize the role of parent factors in driving child adjustment outcomes and is encouraging for future parent-focused intervention research.

Parental emotional functioning declines with occurrence of clinical complications in pediatric hematopoietic stem cell transplant

PURPOSE

Parents' stress levels are high prior to their child's hematopoietic stem cell transplant (HSCT) and during transplant hospitalization, usually abating after discharge. Nevertheless, a subgroup of parents continues to experience frequent anxiety and mood disruption, the causes of which are not well understood. The purpose of this study was to assess whether clinical complications of HSCT could explain variation in parents' recovery of emotional functioning.

METHODS

Pediatric HSCT recipients (n = 165) aged 5-18 and their parents were followed over the first year post-transplant. Health-related quality of life assessments and medical chart reviews were performed at each time period (baseline, 45 days, 3, 6, and 12 months). We tested the association between clinical complications [acute and chronic graft versus host disease (aGVHD and cGVHD), organ toxicity, and infection] and longitudinally measured parental emotional functioning, as assessed by the Child Health-Ratings Inventories. The models used maximum likelihood estimation with repeated measures.

RESULTS

In adjusted analyses covering the early time period (45 days and 3 months), aGVHD grade ≥2, intermediate or poor organ toxicity, and systemic infection were associated with decreases in mean parental emotional functioning of 5.2 (p = 0.086), 5.8 (p = 0.052), and 5.1 (p = 0.023) points, respectively. In the later time period (6 and 12 months), systemic infection was associated with a decrease of 20 points (p < 0.0001). cGVHD was not significantly associated.

CONCLUSIONS

When children experience clinical complications after HSCT, parental emotional functioning can be impacted. Intervening at critical junctures could mitigate potential negative consequences for parents and their children.

Performance of the parent emotional functioning (PREMO) screener in parents of children undergoing hematopoietic stem cell transplantation

PURPOSE

Parents of children undergoing hematopoietic stem cell transplantation (HSCT) may face emotional distress while managing intense treatments with uncertain outcomes. We evaluated a brief parental emotional functioning (PREMO) screener from a health-related quality of life instrument to identify parental emotional distress, as measured by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID).

METHODS

As part of a longitudinal pediatric HSCT study, parents (N = 165) completed the Child Health Ratings Inventories, which contain the 7-item PREMO screener. Some parents (n = 117) also completed SCID modules for Anxiety, Mood, and Adjustment disorders at baseline and/or 12 months. A composite outcome was created for threshold or subthreshold levels of any of these disorders. Receiver operating characteristic (ROC) analysis assessed how the PREMO screener predicted emotional distress as measured by the SCID. A prediction model was then built.

RESULTS

Fifty-two percent of parents completing the SCID had an Axis I disorder at baseline, while 41 % had an Axis I disorder at 12 months. The area under the ROC curve was 0.75 for the PREMO screener and 0.81 for the prediction model.

CONCLUSIONS

The PREMO screener may identify parents with, or at risk for, emotional distress and facilitate further evaluation and intervention.

Clinical outcomes and health-related quality of life (HRQOL) following haemopoietic stem cell transplantation (HSCT) for paediatric leukaemia

BACKGROUND

Haemopoietic stem cell transplantation (HSCT) is a life-saving but intensive procedure associated with potentially severe adverse late effects. We aimed to determine morbidity and health-related quality of life (HRQOL) in a sample of survivors aged 8-18 years at least 1 year post HSCT for paediatric acute leukaemia, compared with a non-transplanted group of survivors matched for age, gender, initial disease and time since treatment.

METHODS

Families (N = 54; HSCT n= 29) recruited from four UK centres completed measures of child behaviour and school attendance, HRQOL and finances. Mothers completed measures of their own well-being. Clinical outcome data were extracted from medical records.

RESULTS

Children in the HSCT group had significantly more late effects and had received more tests for vision, bone, dental and skin health, and thyroid, lung, and gonadal function than the non-transplanted group. HRQOL scores for the HSCT group were significantly lower in all domains compared with the non-transplanted group and population norms, but were not significantly related to clinical indices. Mothers in the HSCT group had significantly poorer mental well-being than population norms.

CONCLUSION

Significant morbidity and compromised HRQOL was found in survivors of HSCT. The burden of caring for a child after HSCT has a continuing toll on mothers' well-being.The importance of counselling families about possible long-term consequences is emphasized.

Examining relationships between anxiety and dangerous driving

Driving anxiety that has developed following crashes has been studied relatively frequently, but anxiety per se and its effects on driving has not as yet garnered much attention in the literature. The current study included 1121 participants and found higher levels of general anxiety were related to a wide variety of dangerous driving behaviors. While there were clear and expected sex differences on many dangerous driving variables, there were still more such differences with regard to anxiety levels and independent of sex, higher levels of anxiety were associated with greater levels of dangerous driving. Of particular import, it was found that the high anxiety group had caused significantly more crashes and engaged in more DUI episodes than the low and/or medium anxiety groups. Taken as a whole, the results suggest there is a tremendous need for more research in the area of anxiety and dangerous driving and that interventions for highly anxious drivers may well be warranted.

Parents' experiences one year on from their child's hematopoietic stem cell transplant for primary immunodeficiency

This study explored parental experience one year after hematopoietic stem cell transplant for primary immunodeficiency. Eight parents whose child had undergone transplant were interviewed one year after their child's transplant. Transcripts were analysed using interpretative phenomenological analysis. Four themes emerged: parents' paradoxical existence within an 'abnormal normality'; isolation felt by parents; gender differences between mothers and fathers; and the 'positive growth' parents attribute to their experience. As well as describing stressful or traumatic experiences they identified aspects of post-traumatic growth. The methodology used allowed contrasting experiences to emerge and highlights the importance of follow-up for parents as well as children.

Parental stress before, during, and after pediatric stem cell transplantation: a review article

Goals of work

Pediatric stem cell transplantation (SCT) is a stressful treatment for children with relapsed or high-risk malignancies, immune deficiencies and certain blood diseases. Parents of children undergoing SCT can experience ongoing stress related to the SCT period. The aim of this article was to present a literature review of articles on parental distress and adaptation before, during, and after SCT and to identify risk and protective factors.

Materials and methods

The review was conducted systematically by using PubMed, Web of Science, PsychInfo, and Picarta databases. Eighteen articles met our inclusion criteria: publishing date between January 1, 1990 and January 1, 2009; studies concerning parents of children undergoing SCT; studies examining the psychological adjustment and/or stress reactions of parents as primary outcomes and studies available in English.

Main results

Highest levels of parental stress are reported in the period preceding SCT and during the acute phase. Stress levels decrease steadily after discharge in most parents. However, in a subgroup of parents, stress levels still remain elevated post-SCT. Parents most at risk in the longer term display highest levels of stress during the acute phase of the SCT.

Conclusions

Psychosocial assessment before SCT, during the acute phase and in the longer term, is necessary to identify parents in need for support and follow-up care.

Qualitative analysis of the role of culture in coping themes of Latina and European American mothers of children with cancer

It has been well established that mothers of children diagnosed with cancer experience high levels of distress. Latina mothers may be at risk for higher levels of distress related to language barriers, cultural factors, and economic, immigration, and acculturation stressors. Despite the increasing US Latino population, few studies have examined the role of culture within pediatric oncology, including how mothers cope with their child's cancer. This study used qualitative analysis of 24 sessions from 3 Latina and 3 European American mothers of children recently diagnosed with cancer. The session transcripts were divided into a total of 2328 thought segments that were then analyzed for themes using a collaborative iterative process. Analysis identified 9 shared coping themes that included, with some variations: gathering information, professional help-seeking, activities, problem solving, positive thinking, present orientation, reframing, avoidance, and religion. Three themes were culture specific: only European American mothers discussed compromise, whereas normalization and perspective taking were unique to the Latina mothers and suggest that the cultural value of simpatía influences coping. Clinical and research recommendations are discussed.

Parental depression and family environment predict distress in children before stem cell transplantation

OBJECTIVE

To examine parental symptoms of depression, family environment, and interaction of these parent and family factors in explaining severity of distress in children scheduled to undergo stem cell or bone marrow transplantation.

METHOD

A self-report measure of illness-related distress, adjusted to reflect the experience of medical diagnosis and associated stressors was completed by 146 youth scheduled to undergo stem cell or bone marrow transplantation. Measures of parental depressive symptoms and family environment (cohesion, expressiveness, and conflict) were completed by the resident parent.

RESULTS

Parental symptoms of depression, family cohesion, and family expressiveness emerged as significant predictors of child-reported distress. Additionally, significant parental depression x family cohesion and parental depression x family expressiveness interactions emerged as predictors of the intensity of the child's distress. When parental depressive symptomatology was high, child distress was high regardless of family environment. However, when parental depressive symptomatology was low, family cohesion and expression served as protective factors against child distress.

CONCLUSION

Parental depressive symptomatology and family functioning relate to child distress in an interactive manner. These findings inform future directions for research, including interventions for parents aimed at promoting child adjustment during the pediatric cancer experience.

Screening for anxiety and depression in community mental health: the beck anxiety and depression inventories

Accurate diagnosis is key to providing quality services in community mental health. This research examined the ability of the Beck Anxiety and Depression Inventories to identify anxiety and depression in community settings. The diagnostic accuracy of these instruments was compared with the Structured Clinical Interview for DSM-IV in a sample of 288 distressed women seeking treatment for their children. Operating characteristic curves indicated the Beck Anxiety and Depression Inventories hold utility as screens for panic and major depressive disorder, respectively. Deploying these instruments as initial screens in a tiered diagnostic system may improve diagnostic accuracy in community settings.

Optimism and life events as predictors of fear appraisals in mothers of children undergoing hematopoietic stem cell transplantation

Although mothers' fear appraisals about their child's future health and well-being affect their own psychological adjustment to their child's hematopoietic stem cell transplantation (HSCT), little is known about antecedents of maternal fear appraisals. This longitudinal study investigated several potential antecedents of these fear appraisals: maternal optimism, recent negative life events, lifetime history of traumatic events, and medical characteristics of the child's disease and HSCT course. One hundred-forty mothers were interviewed during their child's hospitalization for HSCT and at 3-and 6-months post-HSCT. Structural equation modeling was used to test a model of hypothesized relations. Consistent with predictions, lower optimism and a greater number of negative life events were independently associated with greater maternal fear appraisals. Contrary to expectations, lifetime history of trauma was not associated with maternal fear appraisals. Mothers' fear appraisals during their child's hospitalization were, in turn, associated with their fear appraisals up to 6 months later. These data identify a subset of mothers who may be particularly in need of an intervention to increase optimistic coping strategies, improve coping with negative life events, and reduce fear appraisals to improve their adjustment following their child's HSCT.

Pre-bereavement meaning and post-bereavement distress in mothers of children who underwent haematopoietic stem cell transplantation

OBJECTIVES

The purpose of this study was to explore the association of meaning-making with psychological adjustment to bereavement among mothers of children who had undergone haematopoietic stem cell transplantation (HSCT).

DESIGN

A prospective research design was used. Regression analyses were conducted to determine the relations between pre-bereavement variables (distress, searching for meaning, and finding meaning) and distress post-bereavement.

METHODS

Thirty-five mothers of children who had undergone HSCT were interviewed at the time of their child's HSCT and 3 months post-bereavement.

RESULTS

Mothers who reported searching for meaning at HSCT reported greater post-bereavement distress, and mothers who reported finding meaning at HSCT reported less post-bereavement distress. Distress at HSCT and the number of days between the time of death and the post-bereavement time point were also found to be significant predictors of post-bereavement distress.

CONCLUSIONS

This study provides partial support for the role of meaning in adjustment to loss.

A meta-analysis of the effects of psychological interventions in pediatric oncology on outcomes of psychological distress and adjustment

OBJECTIVE

To estimate the effectiveness of psychological interventions in pediatric oncology on decreasing psychological distress and increasing psychological adjustment using meta-analytic methods.

METHODS

A meta-analysis was conducted on 12 psychological intervention studies in pediatric oncology using a weighted least squares (WLS) approach and random effect models.

RESULTS

Effect sizes significantly different from zero were found for parent distress (mean = 0.35, 95% CI = 0.20-0.49, n = 7) and parent adjustment (mean = 0.23, 95% CI = 0.07-0.40, n = 5). Effect sizes for child distress, child adjustment, parent-reported child distress, and parent-reported child adjustment were not significantly different from zero.

CONCLUSIONS

Psychological interventions in pediatric oncology show promise in decreasing distress and improving the adjustment of parents of children with cancer but may have minimal effects for child outcomes. Methodological issues of intervention research are discussed.

Symptoms of post-traumatic stress in children with cancer and their parents: effects of informant and time from diagnosis

BACKGROUND

Post-traumatic stress disorder (PTSD) has been put forth as a model for understanding the adjustment of children with cancer and their parents, but findings in the literature regarding the prevalence of post-traumatic stress symptoms (PTSS) have been mixed. This study examined PTSS levels in both patients and parents as a function of time elapsed from diagnosis, and by use of parent versus child reports for assessing patient PTSS.

PROCEDURE

Four groups of patients (total N = 162) differing in time elapsed since diagnosis were assessed with standardized measures of PTSS. Patients reported on their own symptoms, while parents reported on their symptoms as well as symptoms in their child.

RESULTS

Significant differences between groups were observed on all patient PTSS measures. Recently diagnosed patients obtained higher PTSS scores than survivors more than 5 years from diagnosis. Likewise, parents of recently diagnosed patients self-reported significantly higher levels of PTSS than parents of long-term survivors. Parent-child correlations were high and no differences were observed between parent and patient report of patient PTSS. Comparison with historical control data suggests that levels of PTSS in patients are very low.

CONCLUSION

Concordance between parent and child reports of child PTSS suggests that data may be obtained with reasonable confidence from either if only one informant is available. Higher levels of PTSS in patients who are recently diagnosed (and their parents) in comparison to long-term survivors, suggest that the symptoms reported reflect primarily a concurrent response to ongoing acute stressors, rather than a post-traumatic re-experiencing of past traumas. This, in combination with the low levels of patient PTSS raise questions regarding the utility of PTSD as a model for understanding patient and parent adjustment to childhood cancer.

Maternal Perspectives on Children’s Health-Related Quality of Life During the First Year After Pediatric Hematopoietic Stem Cell Transplant

OBJECTIVE

To assess the longitudinal health-related quality of life (HRQL) of children receiving hematopoietic stem cell transplantation (HSCT).

METHODS

Mothers (N = 160) of HSCT recipients aged 5-20 at six US transplant centers completed the Child Health Ratings Inventories (CHRIs), the Disease Impairment Inventory (DSII)-HSCT module, and the Short Form (SF)-36 at baseline, 3, 6, and 12 months.

RESULTS

HRQL domain scores at baseline varied by recipient age and program site. Longitudinal data over the first year post-HSCT revealed lowest functioning at baseline and 3 months, with largest improvement in functioning between the 3 and 6-months assessments and continued improvement from 6 to 12 months. Recipients of unrelated donor transplants had steepest declines in functioning at 3 months and great HSCT-specific issues at 3 and 6 months. Among children who survived the first year, functioning at 12 months was similar across transplant types and surpassed baseline scores. Children who did not survive the first year exhibited deterioration in HRQL in the months before death and trajectories were strikingly different than for survivors.

CONCLUSIONS

This study offers the first glimpse of the 12-month trajectory of HRQL following pediatric HSCT from mothers' perspectives. This study also highlights the importance of and approaches to addressing missing data in longitudinal research.

Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: report of a multisite randomized trial

Mothers of children with cancer experience significant distress associated with their children's diagnosis and treatment. The efficacy of problem-solving skills training (PSST), a cognitive-behavioral intervention based on problem-solving therapy, was assessed among 430 English- and Spanish-speaking mothers of recently diagnosed patients. Participants were randomized to usual psychosocial care (UPC; n=213) or UPC plus 8 sessions of PSST (PSST; n=217). Compared with UPC mothers, PSST mothers reported significantly enhanced problem-solving skills and significantly decreased negative affectivity. Although effects were largest immediately after PSST, several differences in problem-solving skills and distress levels persisted to the 3-month follow-up. In general, efficacy for Spanish-speaking mothers exceeded that for English-speaking mothers. Findings also suggest young, single mothers profit most from PSST.

Mothers’ perceptions of benefit following pediatric stem cell transplantation: a longitudinal investigation of the roles of optimism, medical risk, and sociodemographic resources

BACKGROUND

This longitudinal study investigated the course and predictors of benefit finding among 144 mothers of children undergoing hematopoietic stem cell transplantation (HSCT), a severely stressful and life-threatening medical procedure.

PURPOSE

Children's medical risk and mothers' dispositional optimism and sociodemographic resources were examined as predictors of benefit finding. The association between benefit finding and mothers' psychosocial adaptation was also investigated.

METHODS

Assessments occurred during hospitalization for HSCT (Time 1 [T1]) and 6 months later (Time 2 [T2]).

RESULTS

Hierarchial multiple regression analyses revealed that predictors of benefit finding differed systematically across assessments, with optimism and medical risk predicting benefit finding at both time points but sociodemographic resources predicting only T2 benefit findings. Benefit finding did not predict psychosocial adaptation until optimism was considered as a moderator of their relation: T1 benefit finding was positively associated with T2 adaptation only for mothers high in optimism.

CONCLUSION

The need for longitudinal research on posttrauma adaptation and the utility of considering the natural history of the trauma are discussed.

Patterns of distress in parents of children undergoing stem cell transplantation

Parents (N = 151) of children undergoing bone marrow or stem cell transplantation (BMT) were assessed in a prospective, longitudinal design with repeated measures of distress (mood disturbance, perceived stress, caregiver burden). Parents were assessed weekly from admission for BMT (week-1) through week +6 post-BMT, followed by monthly assessments through month +6. Concurrent measures of child distress (somatic distress, mood disturbance) were also obtained by parent and child report. Parents demonstrate modest, but significant elevations in distress, particularly during the early period from admission through week +3. Elevations in parental distress are transient, and appear to be largely resolved by 4-6 months post-BMT. Parental distress was unrelated to child age, gender, diagnosis, or type of transplant, but was significantly related to parental socioeconomic status (SES). Parents from lower SES backgrounds reported greater levels of distress throughout the BMT process. Moderate correlations were observed between measures of parent and child distress, and level of child distress at the time of admission for BMT was predictive parental distress trajectories across the acute phase of BMT. These findings point to appropriate targets for intervention to reduce transplant-related distress.

Changes in mothers' basic beliefs following a child's bone marrow transplantation: the role of prior trauma and negative life events

This longitudinal study examined the relation between life stress and basic beliefs about self-worth and the benevolence and meaningfulness of the world among mothers of children undergoing bone marrow transplantation (BMT). One hundred mothers completed study measures during the child's hospitalization for BMT and 1 year later. Prior trauma and recent negative events were associated with basic beliefs during hospitalization and also with changes in basic beliefs in the subsequent year, with distress mediating some of these relations. Findings also demonstrated relations between basic beliefs and physical and mental functioning. However, each basic belief exhibited different relations with study variables, suggesting the need to investigate them separately.

Anxiety, depressive, and posttraumatic stress disorders among mothers of pediatric survivors of hematopoietic stem cell transplantation

OBJECTIVE

To examine the prevalence and predictors of anxiety, depression, and posttraumatic stress disorder among mothers of children who underwent hematopoietic stem cell transplantation (HSCT).

METHODS

A total of 111 mothers of children who survived HSCT completed self-report measures of psychological functioning at the time of HSCT and self-report measures and a structured psychiatric interview 18 months after HSCT. Demographic data and medical data were also collected.

RESULTS

Approximately 20% of mothers had clinically significant distress reactions. When subthreshold posttraumatic stress disorder was included, nearly one third of mothers met the criterion for persistent distress. Mothers with 1 of the 4 psychiatric diagnoses reported a significantly lower quality of life, suggesting that the diagnoses had an impact on their general quality of life. Mothers who had 1 of the 4 diagnoses at 18 months were younger and had higher anxiety and depressive symptoms at the time of HSCT.

CONCLUSIONS

A subset of mothers of children who survive HSCT may require psychological intervention. Mothers who are most at risk are younger and evidence anxiety and depressive symptoms at the time of transplantation.

Perceived partner critical and avoidant behaviors as predictors of anxious and depressive symptoms among mothers of children undergoing hemopaietic stem cell transplantation

This prospective study examined the role of perceived partner criticism and avoidance in the anxiety and depressive symptoms of 148 mothers of children undergoing hemopaietic stem cell transplantation (HSCT). The roles of indicators of transplantation risk and posttransplantation medical course were also examined. Perceived partner criticism (e.g., criticizing coping efforts) and perceived partner avoidance (e.g., changing the topic), objective indicators of transplantation risk, and anxiety and depressive symptoms were assessed at the time of HSCT and again 3 and 6 months later. Growth curve modeling analyses indicated that perceived partner criticism was associated with higher average depressive symptoms. However, perceived partner criticism did not predict changes in mother's anxiety. Contrary to predictions, perceived partner avoidance was associated with decreases in maternal anxiety.

Coping and the course of mother's depressive symptoms during and after pediatric bone marrow transplantation

OBJECTIVE

To evaluate the role of maternal coping strategies in depressive symptoms experienced by mothers of children undergoing bone marrow transplantation (BMT).

METHOD

A total of 207 mothers completed measures of coping and depressive symptoms at the time of the child's BMT, 3 and 6 months post-BMT. The sample was collected between 1998 and 2002. The acceptance rate was 73%. The contribution of demographic, illness and treatment parameters, and mothers' concerns about the child were also evaluated. Growth curve modeling was used to evaluate the role of coping in the course of depressive symptoms. Both main effects and interactions of coping strategies with time of assessment were evaluated.

RESULTS

Acceptance and humor were associated with reductions in maternal depressive symptoms, and planning and alcohol/substance use were associated with increases in maternal depressive symptoms. Positive reframing, use of emotional support, and use of religion were associated with the course of depressive symptoms, but the magnitude of associations differed depending on the use of the coping strategies at the time of transplantation. Mothers' fears about the child also predicted depressive symptoms.

CONCLUSIONS

Acceptance and humor may be targets for behavioral interventions to reduce mothers' depressive symptoms during and after pediatric BMT hospitalization.