Mother-child communication and maternal depressive symptoms in families of children with cancer: integrating macro and micro levels of analysis

Parent-Child Communication Incongruence in Pediatric Healthcare

Parents play a key role in providing children with health-related information and emotional support. This communication occurs both in their homes and in pediatric healthcare environments, such as hospitals, outpatient clinics, and primary care offices. Often, this occurs within situations entailing heightened stress for both the parent and the child. There is considerable research within the communication literature regarding the nature of both verbal and nonverbal communication, along with the way in which these communication modalities are either similar (i.e., congruent) or dissimilar (i.e., incongruent) to one another. However, less is known about communication congruency/incongruency, specifically in parent-child relationships, or within healthcare environments. In this narrative review, we explore the concept of verbal and nonverbal communication incongruence, specifically within the context of parent-child communication in a pediatric healthcare setting. We present an overview of verbal and nonverbal communication and propose the Communication Incongruence Model to encapsulate how verbal and nonverbal communication streams are used and synthesized by parents and children. We discuss the nature and possible reasons for parental communication incongruence within pediatric settings, along with the consequences of incongruent communication. Finally, we suggest a number of hypotheses derived from the model that can be tested empirically and used to guide future research directions and influence potential clinical applications.

Associations between parental depression, communication, and self-worth of siblings bereaved by cancer

A child's death from cancer may increase the risk for poor self-worth in bereaved siblings. Furthermore, bereaved parents may experience depressive symptoms and communicate differently with their surviving children. However, limited research has examined family factors associated with self-worth in bereaved siblings. Thus, we examined: (a) differences in parental depressive symptoms, parent-child communication, and sibling self-worth between bereaved and nonbereaved families and (b) indirect effects of parental depressive symptoms and communication quality on the association between bereavement and sibling self-worth. Bereaved parents and siblings were recruited 3-12 months after a child's death from cancer. Bereaved (n = 72) and nonbereaved families of classmates (n = 58) completed home-based questionnaires upon enrollment (T1), and 48 bereaved and 45 nonbereaved families completed 1-year follow-up (T2). Relative to controls at T1 and T2, bereaved mothers, but not fathers, reported more depressive symptoms. Bereaved siblings reported poorer maternal and similar paternal communication, and similar levels of self-worth compared to controls. Both cross-sectional and longitudinal serial mediation models for mothers were significant. Bereaved mothers were at greater risk for depressive symptoms, which adversely affected sibling self-worth over time through disrupted mother-child communication. The father sample was limited, but the cross-sectional model was nonsignificant. Mothers and fathers may grieve differently and may require different therapeutic approaches. Family-centered interventions should target bereaved mothers' emotional adjustment and communication to enhance sibling self-worth. Additionally, clinicians should bolster other sources of support for bereaved siblings to promote adaptive outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family Communication About Cancer in Korea: A Dyadic Analysis of Parent-Adolescent Conversation

Parent-adolescent communication is important in the context of childhood cancer. However, we know little about the communication experiences between Korean adolescents and their parents. Here, we conducted a secondary analysis of interview data from a qualitative descriptive study to explore Korean parent-adolescent communication experiences as a unit. Specifically, our dyadic analysis of individual interviews with seven Korean adolescents with cancer and at least one parent included inductive analysis at the individual level and cross-analysis to generate themes. The main theme was "Experience the same thing, but see it differently," along three subthemes: (1) different expectations for parent-adolescent communication, (2) different views on communication challenges, and (3) limited sharing and no progress in the conversation. Overall, our findings provide insights into different communication expectations and preferences between Korean adolescents and parents, and reasons for communication challenges, while emphasizing the individualized assessment of parent-adolescent communication between them.

The Family Talk Intervention in Pediatric Oncology: Ill Children's Descriptions of Feasibility and Potential Effects

Background: There are few scientifically evaluated psychosocial interventions in pediatric oncology, despite the needs for families. The family-based psychosocial intervention "The Family Talk Intervention" (FTI) has shown promising results in other care contexts and was therefore pilot-tested in pediatric oncology. In this study, we examined the experiences of participating in FTI from ill children's perspectives regarding feasibility and potential effects. Methods: This pilot study involved 26 families in pediatric oncology that had participated in FTI. The paper is focused on those ill children who answered surveys (n = 19) and/or participated in interviews (n = 11) when FTI had ended. Data were analyzed with descriptive statistics and thematic analysis. Results: For most ill children, FTI came at the right time, included a reasonable number of meetings, and the length of the meetings was appropriate. The children felt listened to and understood by the interventionists and almost all children reported that FTI had helped them in some way. The children's perceptions indicated that FTI improved communication within the family and strengthened family relations. Children reported that the parents and their siblings seemed to feel better after participation and became more understanding. Discussion: The findings of this pilot study indicated that a full-scale study could be valuable from the ill children's perspective, as FTI was reported as feasible and had positive effects. The findings showed that FTI gave families an opportunity to open up communication about the illness, adjust their behaviors, and strengthen family relationships. Trial registration: ClinicalTrials.gov Identifier NCT03650530.

Family resilience factors affecting family adaptation of children with cancer: A cross-sectional study

PURPOSE

Pediatric cancer impacts all family members, including parents and siblings, who strive to adjust to a multitude of changes brought about by the illness. Family resilience is an important factor in the successful adaptation of families of children with cancer. Therefore, we aimed to identify risk and protective factors for family resilience at the child, family, and community levels that affect the adaptation of families of children with cancer.

METHOD

This study employed a descriptive survey design, and data were collected from 111 parents of children undergoing treatment for cancer between April and May 2020 at a university hospital in South Korea. Based on Patterson's family resilience model, risk factors-severity of child's condition, parental depression, and stigma and discrimination-and protective factors-the child's temperament, family communication skills, and supportive health services-for family adaptation were analyzed using multiple regression analyses.

RESULTS

Among family resilience factors affecting the adaptation of families of children with cancer, parental depression (ß = -0.290, p = 0.004) and family communication skills (ß = 0.403, p < 0.001) were identified as risk and protective factors, respectively. These variables accounted for 29.3% of the variance in family adaptation (F = 7.503, p < 0.001).

CONCLUSIONS

There is a need to develop strategies such as intervention programs that focus on reducing parental depression and strengthening family communication skills to promote the adaptation of families to pediatric cancer.

Primary and secondary caregiver depressive symptoms and family functioning following a pediatric cancer diagnosis: an exploration of the buffering hypothesis

OBJECTIVE

After diagnosis, caregivers of children with cancer, particularly mothers or primary caregivers (PCs), often show elevated depressive symptoms which may negatively impact family functioning. We tested PC and secondary caregiver (SC) depressive symptoms as predictors of family, co-parenting, and marital functioning and whether having a non-depressed SC buffers against potential negative effects of PC depressive symptoms.

METHODS

Families (N = 137) were recruited from two major children's hospitals following a diagnosis of pediatric cancer. Caregivers completed self-report measures of depressive symptoms (Center for Epidemiological Studies-Depression Scale; Depression, Anxiety, and Stress Scale) and marital functioning (Dyadic Adjustment Scale) at 1-month post-diagnosis. A subset of families (n = 75) completed videotaped interaction tasks at approximately 3-months post-diagnosis that were coded for family and co-parenting interactions.

RESULTS

Higher PC depressive symptoms at 1-month post-diagnosis was associated with higher adaptability and lower conflict in family functioning. PC depressive symptoms were also associated lower dyadic consensus and lower dyadic satisfaction. SC depressive symptoms were not significantly associated with any family/co-parenting/marital functioning variables. Significant interaction analyses suggested that SC depressive symptoms moderated the effect of PC depressive symptoms on family cohesion, withdrawn parenting, and affective expression in the marriage, such that the relationship between PC depressive symptoms and poorer functioning was attenuated when SC depressive symptoms were at low or average levels.

CONCLUSIONS

Having a nondepressed SC buffered against negative effects of PC depressive symptoms on certain domains of family, coparenting, and marital functioning. SCs may play a protective role for families of children with cancer.

Observed Maternal Coping Socialization and Child Internalizing Symptoms: The Roles of Maternal Depressive Symptoms and Peer Stress

Empirical evidence relying primarily on questionnaire reports indicates parent coping socialization messages play an important role in children's psychological functioning. The present study utilized a multi-informant, multi-method design to build on previous coping socialization research in childhood and adolescence. A novel coding system was developed to measure observed parental socialization of coping messages from observations of a discussion-based peer stress task. Questionnaires and direct observations were obtained from mothers with and without a history of depression (N = 116; 50% with a history of depression) and their children (9 to 15 years). Observed maternal coping socialization messages were not significantly correlated with mother or child reports of child internalizing symptoms in bivariate analyses. However, in multiple linear regression analyses, current maternal depressive symptoms and children's level of peer stress emerged as significant moderators of the association between observed maternal coping socialization messages and children's internalizing symptoms. The conceptual and methodological contributions of the current study are discussed, limitations and strengths are noted, and implications for future research are outlined.

Communication Challenges in Korean Families Coping With Adolescent Cancer

PURPOSE

To examine the family communication experience of Korean adolescents with cancer and their parents, including how adolescents and their parents verbally share feelings and concerns related to the adolescent's cancer diagnosis with one another, and how emotional communication affects parent-adolescent relationships and the family's coping abilities.

PARTICIPANTS & SETTING

20 participants (10 adolescents with cancer, aged 13-19 years, and their parents) at a university-affiliated hospital in Seoul, South Korea.

METHODOLOGIC APPROACH

Individual, semistructured interviews were conducted and analyzed based on a qualitative descriptive approach. Conventional content analysis was employed to analyze the data.

FINDINGS

The overarching core theme developed from the content analysis and theme generation was "I cannot share my feelings." This core theme is represented by three main themes.

IMPLICATIONS FOR NURSING

Increased need for nursing awareness and culturally relevant assessment of emotional family communication needs between Korean adolescents with cancer and their family caregivers are necessary.

Hilfreiche psychosoziale Unterstützung für Eltern in der pädiatrischen Onkologie

Hintergrund

Krebserkrankungen im Kindes- und Jugendalter haben Auswirkungen auf die gesamte Familie – auch für die betroffenen Eltern hinsichtlich psychischer Aspekte. Gegenwärtig existieren nur wenige Untersuchungen zu den Anforderungen an hilfreiche psychosoziale Unterstützungsangebote für Eltern.

Ziel der Arbeit

Zur Gewinnung weiterer Erkenntnisse für die psychosoziale Versorgung wurden Eigenschaften und inhaltliche Komponenten von hilfreichen psychosozialen Unterstützungsangeboten für Eltern mit an Krebs erkrankten Kindern untersucht.

Methodik

Im Rahmen einer qualitativen Studie wurden N = 15 Expert_innen verschiedener Disziplinen und Standorte aus Akut- und Rehakliniken sowie ambulant tätige Kolleg_innen eingeschlossen. Die Durchführung basierte auf einem teilstrukturierten Interviewleitfaden. Die Auswertung erfolgte anhand der qualitativen Inhaltsanalyse.

Ergebnisse

Grundsätzlich erachteten die eingeschlossenen Expert_innen niedrigschwellige und flexible Angebote als ideale psychosoziale Unterstützungsform. Hinsichtlich des optimalen Zeitpunkts zeigte sich hingegen ein heterogenes Bild. Inhaltlich wurden häufig die Förderung der Familienkohäsion, der Kommunikationsfähigkeiten sowie der Selbstfürsorge, aber auch Erziehungsthemen und angenehme gemeinsame Aktivitäten in der Gemeinschaft als essenziell angesehen.

Diskussion

Die psychosoziale Versorgung von Eltern mit an Krebs erkrankten Kindern ist herausfordernd, da die Langzeitverläufe individuell und dynamisch fluktuierend beschrieben werden. Eine Kombination aus verschiedenen Interventionsformaten (Präsenztermine vs. E‑Health-Module, Gruppen‑, Einzel- oder partnerschaftliche Sitzungen, strukturiert vs. themenoffen) scheint am praktikabelsten zu sein.

Maternal Communication in Childhood Cancer: Factor Analysis and Relation to Maternal Distress

Objective

This study aimed to characterize mothers' communication with their children in a sample of families with a new or newly relapsed pediatric cancer diagnosis, first using factor analysis and second using structural equation modeling to examine relations between self-reported maternal distress (anxiety, depression, and posttraumatic stress) and maternal communication in prospective analyses. A hierarchical model of communication was proposed, based on a theoretical framework of warmth and control.

Methods

The sample included 115 children (age 5-17 years) with new or newly relapsed cancer (41% leukemia, 18% lymphoma, 6% brain tumor, and 35% other) and their mothers. Mothers reported distress (Beck Anxiety Inventory, Beck Depression Inventory-II, and Impact of Events Scale-Revised) 2 months after diagnosis (Time 1). Three months later (Time 2), mother-child dyads were video-recorded discussing cancer. Maternal communication was coded with the Iowa Family Interaction Ratings Scales.

Results

Confirmatory factor analysis demonstrated poor fit. Exploratory factor analysis suggested a six-factor model (root mean square error of approximation = .04) with one factor reflecting Positive Communication, four factors reflecting Negative Communication (Hostile/Intrusive, Lecturing, Withdrawn, and Inconsistent), and one factor reflecting Expression of Negative Affect. Maternal distress symptoms at Time 1 were all significantly, negatively related to Positive Communication and differentially related to Negative Communication factors at Time 2. Maternal posttraumatic stress and depressive symptoms each predicted Expression of Negative Affect.

Conclusions

Findings provide a nuanced understanding of maternal communication in pediatric cancer and identify prospective pathways of risk between maternal distress and communication that can be targeted in intervention.

Responsive Parenting Behaviors and Cognitive Function in Children With Sickle Cell Disease

OBJECTIVE

Children with sickle cell disease (SCD) are at increased risk for cognitive impairment as a result in part from biological characteristics of the disease; however, limited research has explored possible social and contextual factors associated with risk for cognitive problems. The primary aim of the present study was to examine the relation between children's cognitive functioning and responsive parenting, a potentially important contextual factor in children with SCD, accounting for family socioeconomic disadvantage, child disease severity, and caregivers' perceived stress.

METHODS

Forty-eight children completed standardized cognitive assessments and caregivers provided self-reports of general and disease-related stress. Parent-child dyads completed a video recorded puzzle-solving task and observed parenting was quantified using two coding systems. Bivariate Pearson correlations were used to assess preliminary hypotheses, and linear multiple regression analyses were used to assess the primary hypothesis.

RESULTS

Results suggested that increased levels of parental stress were related to fewer observations of responsive parenting and provided evidence of an association between children's cognitive function and responsive parenting. Specifically, increased disease-related parent stress and reduced parental use of expansive language were associated with significantly lower cognitive functioning in children with SCD.

CONCLUSIONS

Findings suggest that social environmental factors along with disease characteristics are sources of risk for cognitive problems with children with SCD. Further, these findings highlight the need to develop targeted interventions for parents of children with SCD to decrease levels of stress and enhance parenting skills, with the aim improving cognitive functioning in youth.

Communication with children and adolescents about the diagnosis of their own life-threatening condition

When a child is diagnosed with a life-threatening condition, one of the most challenging tasks facing health-care professionals is how to communicate this to the child, and to their parents or caregivers. Evidence-based guidelines are urgently needed for all health-care settings, from tertiary referral centres in high-income countries to resource limited environments in low-income and middle-income countries, where rates of child mortality are high. We place this Review in the context of children's developing understanding of illness and death. We review the effect of communication on children's emotional, behavioural, and social functioning, as well as treatment adherence, disease progression, and wider family relationships. We consider the factors that influence the process of communication and the preferences of children, families, and health-care professionals about how to convey the diagnosis. Critically, the barriers and challenges to effective communication are explored. Finally, we outline principles for communicating with children, parents, and caregivers, generated from a workshop of international experts.

Longitudinal associations among maternal depressive symptoms, child emotional caretaking, and anxious/depressed symptoms in pediatric cancer

Research has shown that children experience increased emotional distress when engaging in emotional caretaking of a parent. The current study is the first to examine this process in families in which the source of the stress is the child's illness. Prospective associations were tested among mothers' depressive symptoms near the time of their child's cancer diagnosis, mothers' expressed distress and their child's emotional caretaking during an interaction task, and child anxious/depressed symptoms at 1 year postdiagnosis. Families (N = 78) were recruited from two pediatric hospitals soon after their child's (Ages 5-18) new diagnosis or relapse of cancer. Mothers reported on their own depressive symptoms and their child's anxious/depressed symptoms near the time of diagnosis or recurrence (Time 1) and 1 year later (Time 3). At Time 2 (4 months after Time 1), mother-child dyads completed a video-recorded discussion of their experience with cancer that was coded for observed maternal expressed distress (anxiety, sadness) and observed child emotional caretaking. Maternal expressed distress during the interaction was significantly related to more emotional caretaking behaviors by both boys and girls. Results of a moderated mediation model showed that child emotional caretaking at Time 2 significantly mediated the relation between maternal depressive symptoms at Time 1 and child anxious/depressed symptoms at Time 3 for girls but not for boys. The findings suggest that children's emotional caretaking behaviors contribute to subsequent anxious/depressed symptoms for girls, but not for boys, with cancer. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Maternal Coping and Depressive Symptoms as Predictors of Mother-Child Communication About a Child's Cancer

OBJECTIVE

This study sought to identify possible associations between maternal coping and depression and subsequent mother-child communication about cancer following the child's diagnosis. 

METHOD

Mothers (N = 100) reported on coping and depressive symptoms shortly after the child's diagnosis (M = 1.9 months). Subsequently, we observed children (age 5-17 years; M = 10.2 years; 48% female; 81% White) and mothers discussing cancer and coded maternal communication. 

RESULTS

Higher primary and secondary control coping, and lower depressive symptoms, were generally correlated with more positive, and less harsh and withdrawn communication. In regression models, higher primary control coping (i.e., coping efforts to change the stressor or one's emotional reaction to the stressor) independently predicted less withdrawn communication, and depressive symptoms mediated relations between coping and harsh communication. 

CONCLUSIONS

Maternal primary control coping and depressive symptoms predict mothers' subsequent harsh and withdrawn communication about cancer.

Depression and distress in caregivers of children with brain tumors undergoing treatment: psychosocial factors as moderators

OBJECTIVE

This study's objectives were to examine the effects of depression on the distress of caregivers of children with brain tumors and to identify the factors moderating depression and caregiver distress.

METHODS

Participants were 82 caregivers of children with brain tumors undergoing treatment in the National Cancer Center of South Korea. The depression subscale of the Symptom Checklist 90-Revised (SCL-90-R) and the Burden of a Primary Caregiver (BPC) Scale were used to measure participants' depression and caregiver distress, respectively. The Korean version of the Parenting Sense of Competence (K-PSOC) Scale, Family Environmental Scale-Revised (K-FES-R), and the DUKE-UNC Functional Social Support Questionnaire-S (DUKE-UNC-FSSQ) were used to assess parental efficacy, family relationships, and perceived social support, respectively.

RESULTS

Younger patient age, lower family income, and caregivers' greater number of years of education significantly predicted caregiver distress. Caregivers with depression experienced significantly more distress than those without depression. The interaction of depression with parenting efficacy and social support affected caregiver distress. For highly depressed caregivers, parental efficacy, social support, and family relationships played weaker roles as protective factors against caregiver distress. High parental efficacy and social support were protective factors against distress in caregivers without depression.

CONCLUSIONS

A multi-dimensional assessment of the psychosocial factors that may affect caregivers of children with brain tumors should precede interventions for distress management. Interventions tailored to individuals' psychosocial factors are needed.

Longitudinal associations among maternal communication and adolescent posttraumatic stress symptoms after cancer diagnosis

OBJECTIVE

The purpose of this study was to prospectively examine adolescent and maternal posttraumatic stress symptoms (PTSS) and maternal communication from time near cancer diagnosis to 12-month follow-up to identify potential risk factors for adolescent PTSS.

METHODS

Forty-one adolescents with cancer (10-17 years, 54% female) and their mothers self-reported PTSS at T1 (two months after cancer diagnosis) and T3 (1-year follow-up). At T2 (3 months after T1), mother-adolescent dyads were videotaped discussing cancer, and maternal communication was coded with macro (harsh and withdrawn) and micro (solicits and validations) systems.

RESULTS

Adolescent PTSS at T1 was associated with adolescent PTSS at T3. Greater maternal PTSS at T1 predicted greater harsh maternal communication at T2. There was an indirect effect of maternal PTSS at T1 on adolescent PTSS at T3 through maternal validations at T2.

CONCLUSIONS

Findings underscore the importance of maternal PTSS, maternal communication, and subsequent adolescent PTSS over the course of treatment of childhood cancer. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Depressive symptoms in adults with spina bifida

OBJECTIVE

To examine the prevalence of depressive symptoms in adults with spina bifida and identify contributing factors for depressive symptomatology.

METHOD

Retrospective Cohort Study. Data collection was conducted at a regional adult spina bifida clinic. A total of 190 charts from adult patients with spina bifida were included. The main outcome measures were the Beck Depression Inventory-II (BDI-II) and the mobility domain of the Craig Handicap Assessment Reporting Technique-Short Form (CHART-SF).

RESULTS

Of the 190 participants, 49 (25.8%) had BDI-II scores (14+) indicative of depressive symptomatology. Sixty-nine (36.3%) were on antidepressants to treat depressive symptoms, and 31 (63.3%) of those with clinical symptoms of depression were on antidepressants. Participants with a history of depressive symptoms may be as high as 45.7% if both participants with BDI-II scores 14+ and those with antidepressant use specifically for the purposes of depression treatment are combined. In this population, lower CHART-SF mobility score, expressing "emotional concerns" as a reason for the visit on an intake sheet, and use of antidepressant medications were significantly associated with depressive symptoms.

CONCLUSIONS

Depressive symptomatology appears to be common and undertreated in this cohort of adults with spina bifida, which may warrant screening for emotional concerns in routine clinic appointments. Significant depressive symptoms are associated with fewer hours out of bed and fewer days leaving the house. Additional research is needed to assess the impact of interventions directed toward mobility on depression and in the treatment of depression in this patient population.

Developing and modifying behavioral coding schemes in pediatric psychology: a practical guide

OBJECTIVES

To provide a concise and practical guide to the development, modification, and use of behavioral coding schemes for observational data in pediatric psychology.

METHODS

This article provides a review of relevant literature and experience in developing and refining behavioral coding schemes.

RESULTS

A step-by-step guide to developing and/or modifying behavioral coding schemes is provided. Major steps include refining a research question, developing or refining the coding manual, piloting and refining the coding manual, and implementing the coding scheme. Major tasks within each step are discussed, and pediatric psychology examples are provided throughout.

CONCLUSIONS

Behavioral coding can be a complex and time-intensive process, but the approach is invaluable in allowing researchers to address clinically relevant research questions in ways that would not otherwise be possible.

Observed macro- and micro-level parenting behaviors during preadolescent family interactions as predictors of adjustment in emerging adults with and without spina bifida

OBJECTIVE

To examine observed autonomy-promoting and -inhibiting parenting behaviors during preadolescence as predictors of adjustment outcomes in emerging adults with and without spina bifida (SB).

METHODS

Demographic and videotaped interaction data were collected from families with 8/9-year-old children with SB (n = 68) and a matched group of typically developing youth (n = 68). Observed interaction data were coded with macro- and micro-coding schemes. Measures of emerging adulthood adjustment were collected 10 years later (ages 18/19 years; n = 50 and n = 60 for SB and comparison groups, respectively).

RESULTS

Autonomy-promoting (behavioral control, autonomy-relatedness) and -inhibiting (psychological control) observed preadolescent parenting behaviors prospectively predicted emerging adulthood adjustment, particularly within educational, social, and emotional domains. Interestingly, high parent undermining of relatedness predicted better educational and social adjustment in the SB sample

CONCLUSIONS

Parenting behaviors related to autonomy have long-term consequences for adjustment in emerging adults with and without SB.