Post-traumatic stress disorder and post-traumatic stress symptoms in parents of children with cancer: A review

The mediating effect of positive expectations in the relationship between social support and post-traumatic stress disorder symptoms among parents of children with acute lymphoblastic leukemia

PURPOSE

Parents of children with cancer are exposed to risks of developing post-traumatic stress disorder (PTSD) symptoms, but few studies have explored PTSD symptoms of Chinese parents of children with acute lymphoblastic leukemia (ALL). Our study aimed to examine the association between social support and PTSD symptoms and to examine the mediating effect of positive expectations in this relationship among parents of children with ALL.

METHODS

A cross-sectional study was conducted of consecutive parents of children with ALL in the Shengjing Hospital of China Medical University. A total of 177 parents eligible for this study completed questionnaires on PTSD symptoms, perceived social support, optimism and general self-efficacy anonymously. Asymptotic and resampling strategies were used to examine how positive expectations mediated the association between perceived social support and PTSD symptoms.

RESULTS

Mean score of PTSD symptoms was 37.64 ± 14.44; 29.4% of the sample scored 44 and above, 19.8% scored 50 and above. After adjusting for covariates, perceived social support was negatively associated with the total score of PTSD symptoms (β = -0.209, p < 0.01). Positive expectations were found to mediate the relationship between perceived social support and PTSD symptoms, especially for the symptoms of avoidance and hyperarousal.

CONCLUSIONS

Optimism and general self-efficacy fully mediated the association between perceived social support and PTSD symptoms. Therefore, social support and positive expectations should be included in PTSD preventions and treatments targeting Chinese parents of children with ALL.

Analysis of the Correlation between the Level of Posttraumatic Growth and Social Support among Caregivers of Children with Acute Leukemia

We investigate the current situation of stress burden and quality of life of primary caregivers of children with leukemia and analyze the correlation between their stress burden and quality of life, using the phenomenological research method in qualitative research. The posttraumatic growth experiences of the parents of children with leukemia included life perceptions (appreciation of life, change in priority of important things in life, and adjustment of self to reality); personal empowerment (increased sense of self-reliance and increased sense of self-achievement); and improvement of interpersonal relationships (increased family harmony, valuing parent-child bonding, benefiting from professional support from other parents and medical staff, and increased sense of empathy and altruism). The posttraumatic growth experiences of parents of children with leukemia are based on their roles (parenting) and responsibilities and can be used as an important basis for future trauma interventions, as well as an entry point for exploring the posttraumatic growth potential of parents of children with leukemia and ultimately improving the posttraumatic growth of parents of children with leukemia.

Posttraumatic Stress Symptoms and Disorders in Children and Adolescents with Chronic Physical Illnesses: a Meta-Analysis

The aim of the present meta-analysis was to compare levels of posttraumatic stress symptoms (PTSS) and the prevalence of posttraumatic stress disorders (PTSD) in individuals with and without pediatric chronic physical illnesses, and to analyze correlates of these symptoms. In total, 150 studies were identified that provided relevant data. On average, 11.5% of the participants with pediatric chronic physical illnesses met the criteria of PTSD (Odds Ratio 2.70). PTSS were also more common in this group than in control groups without chronic physical illnesses. While the PTSS levels did not differ across physical diseases, we found positive associations of PTSS with illness severity and duration/intensity of treatment, as well as negative associations with duration of illness, time since last treatment, treatment adherence, and family functioning. We conclude that individuals with pediatric chronic physical illnesses who experienced traumatic events should be screened for PTSS and receive psychological interventions when needed.

Self-rated health in mothers of children hospitalised for severe illnesses and mothers of healthy children: cross-sectional study

INTRODUCTION

Self-rated health (SRH) is a recognised tool for predicting morbidity and mortality.

AIM

The aim of the study was to investigate and compare SRH in a group of mothers of hospitalised children and mothers of healthy children and to indicate the variables associated with poor SRH in both groups.

METHODS

We conducted questionnaire-based cross-sectional research in a group of 184 women. Half of the respondents (n = 92) were the mothers of children hospitalised for a severe illnesses (Group H). The control group (n = 92) comprised mothers of healthy children (Group C). Self-Rated Health (SRH), Numerical Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale-Revised (IES-R) and Interpersonal Support Evaluation List (ISEL-40 v. GP) were used. In order to facilitate critical appraisal and interpretation of results, STROBE recommendations were used.

RESULTS

The prevalence of poor SRH was greater in mothers of children hospitalised for a severe illness than in those of healthy children (35 and 19%, respectively). In both groups, the risk of poor SRH was statistically significantly higher in those mothers who for the past 7 days reported at least moderate pain and in mothers who manifested anxiety symptoms. In both groups, the prevalence of poor SRH was statistically significantly lower if the respondents' children were in good health. The risk of poor SRH was associated with poor financial status in group H and with depression and at least moderate pain for the past 7 days in group C.

RELEVANCE TO CLINICAL PRACTICE

In order to provide mothers of severely ill children with high-quality health care including preventive measures, it is recommended that their health is assessed by healthcare professionals.

Family Members Dealing With Childhood Cancer: A Study on the Role of Family Functioning and Cancer Appraisal

OBJECTIVES

Childhood cancer is a life-threatening disease that poses significant challenges to the life of the diagnosed child and his/her family members. Based on the ABCX-model, the aim of the current study was to explore the association between family functioning, cancer appraisal and the individual adjustment of patients, parents and siblings.

METHODS

Participants were 60 children with leukemia or non-Hodgkin lymphoma, 172 parents and 78 siblings (115 families). Time since diagnosis varied from zero to 33 months. Patients, parents and siblings completed the Family Environment Scale (FES), Perceived Stress Scale, Situation-Specific Emotional Reactions Questionnaire and Pediatric Quality of Life Inventory/Maudsley Marital Questionnaire.

RESULTS

Family functioning and the appraisal of the cancer diagnosis proved to be related to patients', parents' and siblings' cancer-related emotions and quality of life post-diagnosis. In addition, family members differed in their perception of some family functioning domains, the appraisal of the cancer diagnosis, positive feelings and quality of life.

DISCUSSION

Our findings led to the conclusion that family functioning and the appraisal of the cancer diagnosis are important for the individual adjustment of patients, parents and siblings when facing a diagnosis of cancer in the child. Differences across members within one family and differences between families speak to the need of screening all family members and intervening at the level of individual as well as the family unit.

Posttraumatic Stress Symptoms and Disorders in Parents of Children and Adolescents With Chronic Physical Illnesses: A Meta-Analysis

The present meta-analysis analyzed whether parents of young people with pediatric chronic physical illnesses experience higher levels of posttraumatic stress symptoms (PTSS) and higher rates of posttraumatic stress disorder (PTSD) than other adults and searched for correlates of PTSS in these parents. Based on a systematic search in electronic databases, 184 studies were included in the meta-analysis. On average, 18.9% of the parents fulfilled the criteria for PTSD, and PTSS were more common among parents of young people with pediatric chronic physical illnesses than in other adults, with Hedges' g showing a 0.85 increase in standard deviation units. Parental PTSS were most prevalent among parents of children with epilepsy, g = 1.25, and diabetes, g = 1.16, and were positively associated with being the mother, r = .19; illness severity, r = .18; treatment duration/intensity, r = .21; and PTSS of the child, r = .34. In contrast, longer illness duration, r = -.19; longer time since active treatment, r = -.10; and better social resources, rs = -.17 to -.07, were associated with lower parental PTSS. The findings indicate that parents who have faced traumatic events in the context of their child's chronic illnesses should be screened for PTSS and PTSD and receive psychological interventions when needed.

Prevalence and predictors of posttraumatic stress symptoms in parents of children with ongoing treatment for cancer in South China: a multi-centered cross-sectional study

PURPOSE

Parents of children with ongoing cancer treatment are exposed to risks of developing posttraumatic stress symptoms (PTSS), but little is known about the prevalence and predictors of PTSS among Chinese parents of children with cancer. This study aimed to examine the predictors of PTSS, and explored the correlation of depression, resilience, and family functions with severe PTSS.

METHODS

This cross-sectional survey was conducted from May 2014 to September 2015 among the parents of cancer children treated in four general hospitals in South China. PTSS in the parents were measured using post-traumatic stress checklist-civilian version (PCL-C). Multiple regression analyses were performed to evaluate the predictive values of depression, resilience, family functioning, and the demographic variables for severe PTSS.

RESULTS

A total of 279 parents (192 mothers and 87 fathers) participated in the survey. Severe PTSS, as defined by a PCL-C score ≥50, were reported in 32.97% (n = 92) of the total participants, 26.44% (23/87) in the fathers and 35.94% (69/192) in the mothers. The level of PTSS was positively correlated with depression (r = 0.782, P < 0.01) and a poor general family function (r = 0.325, P < 0.01) and negatively correlated with resilience (r = -0.236, P < 0.01). Multivariate analyses indicated that depression, general family function, gender, and education level were significant predictive factors of severe PTSS in the overall parents, accounting for 64.2% of the variance in the prediction of PTSS (R ² = 0.642, F = 122.602, P = 0.000). For the mothers, depression and family function accounted for 66.5% of the variance in the prediction of PTSS (R ² = 0.665, F = 187.451, P = 0.000); for the fathers, depression and educational level accounted for 58.8% of the variance in the prediction of PTSS (R ² = 0.588, F = 59.829, P = 0.000).

CONCLUSION

Parents, especially the mothers, of children with ongoing treatment for cancer are at risk of developing PTSS. Supportive psychological interventions to attenuate the negative emotions of the parents and improve their family functions are important means to promote their natural protective mechanisms to cope with the stressful events.

Parental symptoms of posttraumatic stress after pediatric extracorporeal membrane oxygenation*

OBJECTIVE

To investigate the prevalence of posttraumatic stress symptoms in parents of children who have been supported on extracorporeal membrane oxygenation and to explore associated factors.

DESIGN

Descriptive cross-sectional study.

SETTING

A specialist pediatric tertiary center in the United Kingdom.

SUBJECTS

Parents (n = 52) of children who had been supported with extracorporeal membrane oxygenation at least 6 months previously.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Self-reported questionnaires were completed measuring posttraumatic stress symptom, family functioning, depression, anxiety, and demographic variables. Approximately 20% of parents experienced posttraumatic stress symptoms at levels suggestive of a diagnosis of posttraumatic stress disorder, irrespective of the time that had elapsed since extracorporeal membrane oxygenation. Although having a child who had ongoing illness before extracorporeal membrane oxygenation was associated with avoidance posttraumatic stress symptoms, results suggest that other previously identified risk factors, such as gender and family functioning, may not be risk factors for posttraumatic stress symptom in this population.

CONCLUSIONS

A substantial number of parents in this population experience posttraumatic stress symptom. Psychological interventions may be targeted toward those whose child has had ongoing illness before extracorporeal membrane oxygenation.

Support after the completion of cancer treatment: perspectives of Australian adolescents and their families

Young people recovering from cancer may lack adequate support post-treatment, yet little is known about the types of support and information young Australians and their families need. This study investigated adolescent/young adult cancer survivors' and their families' perceptions of care and support needs after completing cancer treatment. Seventy semi-structured interviews were conducted with 19 survivors (mean age 16.1 years), 21 mothers, 15 fathers and 15 siblings. Interviews were recorded, transcribed and analysed using the conceptual framework of Miles and Huberman. Post-treatment, participants regarded medical staff positively but were reluctant to ask for their help fearing it may deflect resources away from patients still receiving treatment. Appraisals of social workers' and psychologists' support post-treatment were mixed. Formal emotional support was rarely accessed and participants reported that any additional funds should be directed to greater psychological support in this period. Participants also reported the need for additional financial support post-treatment. Clinicians need to be aware that while young people and their families may not demand support post-treatment, they may 'suffer in silence' or burden family members and friends with the responsibility of providing emotional support, though they may be experiencing distress also.

Alexithymia in children with cancer and their siblings

OBJECTIVE

The purpose of this study was to examine the levels of alexithymia in children with cancer, in siblings of children with cancer, and in healthy controls.

METHOD

In order to compare the groups the Alexithymia Questionnaire for Children was used. The study group consisted of 97 children with cancer, 95 siblings, and 151 healthy controls.

RESULTS

The highest level of alexithymia was reported by children diagnosed with cancer, followed by their siblings. Healthy controls reported the lowest level of alexithymia. No gender differences were observed. The intensity of cancer was a significant predictor of the alexithymia score, with patients with the most severe cancers reporting the highest levels of alexithymia. No differences were found between the patients with moderately severe and least severe cancers.

CONCLUSIONS

Not only children with cancer, but also their siblings show significantly more alexithymia than their healthy counterparts. Professionals should aim at preventing or reducing the psychological problems in both patients and their siblings.