Depressive symptoms and adaptive style in children with cancer

Don't judge a book by its cover: Exploring low self-reported distress and repressive coping in a pediatric chronic pain population

Repression has been linked to greater illness, somatic symptoms, and poorer physical health, both in adult and pediatric populations. The current study examined psychological and pain profiles of children with chronic pain who may under-report levels of psychological distress at a first interdisciplinary chronic pain assessment. Children and their caregiver completed measures of psychopathology and pain intensity, while clinicians rated their levels of disability. Based on self-report measures, children were classified as "repressors" (low anxiety/high social desirability) or as "true low anxious" (low anxiety/low social desirability). Groups were then compared on psychological and pain characteristics. Compared to children with true low anxiety, repressors reported lower levels of depressive and somatic symptoms but provided higher ratings on pain intensity, pain-unpleasantness, and self-oriented perfectionism. Caregivers of repressors rated their children as having higher levels of adaptability compared to caregivers of children in the true low anxious group. Groups did not differ on clinician-rated level of disability. Children classified as repressors exhibited different profiles than children classified as having true low anxiety on both psychological outcomes and pain characteristics. Repression may be an important factor to consider for those assessing and treating children with chronic pain.

The role of alexithymia in the mental health problems of home-quarantined university students during the COVID-19 pandemic in China

Objective

While it is well known that mental health problems are common consequences of deadly pandemics, the association with alexithymia is less clear. This study examined this association in an evaluation of home-quarantined university students during the 2019/2020 COVID-19 pandemic in China.

Methods

In total, 2501 home-quarantined students from six southwest Chinese universities completed the following questionnaires: the 20-item Toronto Alexithymia Scale (TAS-20), the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL—C), and the Patients Health Questionnaire-9 (PHQ-9), after which structural equation modeling (SEM) and mediation analyses were employed to extract and evaluate the possible associations.

Results

It was found that participants with probable depression or PTSD also reported more severe alexithymia features, such as difficulties in identifying feelings (DIF) or describing feelings (DDF). Alexithymia was also found to partially mediate the effect of number of exposures on mental health problems.

Conclusion

These results suggested that implementing strategies to assist young people identify and deal with their own emotions and those of others could prevent or mitigate the mental health problems associated with deadly pandemic events. However, future longitudinal studies are needed to examine the specific involvement of DIF or DDF in people with mental health problems.

Coping and psychopathology in children with malignancy and bronchiectasis

AIM

We aimed to evaluate the coping styles and social support perceived by the children with two different chronic diseases (cancer and bronchiectasis), their mothers' coping styles and compare them with a control group without any chronic physical or psychiatric disorder.

METHODS

Our sample consisted of 114 children and adolescents, with an age range from 9 to 15 years. The data were collected by using schedule for affective disorders and schizophrenia for school-age children-present and lifetime version, kid-coping orientation to problems experienced (Kid-COPE), social support appraisals scale (SSAS), and COPE.

RESULTS

All three groups were similar with respect to age and sex distribution. Around 50% to 60% of the children in both patient groups had a psychiatric diagnosis. Remarkably, 30% of the children had an internalizing disorder. The most commonly used coping style by the mothers was religious coping in all groups. Kid-COPE scores did not significantly differ between groups. The scores on Family and Friend subscales of SSAS in the bronchiectasis group were significantly lower when compared with those of participants in hematology-oncology and control groups.

CONCLUSION

Chronic medical illnesses may have a similar psychological impact on children regardless of disease-specific clinical presentations and outcomes. Future studies need to focus on identifying protective and risk factors that potentially mediate psychosocial well-being.

Reminiscing on acute and chronic events in children with cancer and their parents: An exploratory study

BACKGROUND

Children with cancer live through intense emotional experiences that call for coping with stressful events. The narration of these events allows them to construct a detailed memory system, fostering the elaboration and attribution of meaning to the disease experience. In particular, shared memory between the parent and the child about past events (i.e., reminiscing) helps children to deal with negative emotional experiences, encouraging emotional regulation and adaptive coping strategies. The present study aims to investigate reminiscing in parent-child with cancer dyads, focusing on parents' reminiscing habits, parents' reminiscing style about acute and chronic events, and children's well-being, assessed with respect to emotional regulation and coping skills.

METHOD

Fifteen children from ages 4 to 8 years admitted to a paediatric haematology and oncology ward of an Italian hospital, and their parents were engaged in a reminiscing conversation about acute and chronic events related to disease. Moreover, some questionnaires have been proposed to evaluate parents' reminiscing habits and children's emotional regulation and coping skills. Descriptive and quantitative analyses were conducted.

RESULTS

The data showed that parents frequently practise reminiscing in everyday life, focusing on directive and socioemotional functions. In reminiscing conversations about acute and chronic events concerning their child's illness, they use an elaborative reminiscing style and an emotional reminiscing style mainly concerning chronic events. A positive correlation between this reminiscing style and children's adaptive coping strategies was found mainly in acute events. A negative correlation emerged between parents' emotional terms (emotional reminiscing) and children's difficulties in emotional regulation.

CONCLUSION

This study underlines the benefits of elaborative and emotional reminiscing conversation, in order to help children with cancer and their families to cope with acute and chronic stressful events. Reminiscing can be a useful methodology for health professionals with a view to collecting information on patients' memories of illness.

Health Professionals' Perspectives on the Nature of Distress and Low Mood in Young People with Cancer

PURPOSE

Young people with cancer are at increased risk of depression, yet evidence-based psychological interventions that are tailored to the specific needs of young people with cancer are scarce, and depression in this group may be particularly challenging to recognize and treat. The aims of this study were to (1) explore the views of health professionals in recognizing and treating low mood in young people with cancer and (2) identify the key components of an effective online treatment package for depression in this population.

METHODS

Eighteen NHS health professionals with a range of professional backgrounds working directly with young people with cancer were interviewed using a semi-structured interview schedule. Responses were analyzed using thematic analysis.

RESULTS

Five themes emerged: (1) one size doesn't fit all-the nature of depression is complex and varied, and symptoms fluctuate greatly in relation to physical health; (2) distress is completely understandable-it is important not to pathologize a normal reaction; (3) a stepping stone intervention-online interventions may promote engagement with face-to-face therapy; (4) connecting with others-the intervention should promote sharing experiences with others to reduce isolation; and (5) ownership and empowerment-lack of independence may be a cause of distress, and young people should have control of the intervention.

CONCLUSION

The nature of depression in young people with cancer is complex and multifaceted. Online guided self-help may be useful when added as a component or first step of a treatment package including face-to-face talking therapies.

Executive Functioning Mediates the Relationship Between Pain Coping and Quality of Life in Youth With Sickle Cell Disease

Objective

Sickle cell disease (SCD) is a lifelong condition characterized by pain, which is associated with reduced health-related quality of life (HRQL). Data suggest that patients with SCD vary in how they cope and their neurocognitive abilities. This study aimed to characterize executive functioning and pain coping styles in children with SCD experiencing a range of pain frequency (i.e., chronic, episodic, and asymptomatic) and to examine whether executive functioning mediates the relationship between pain coping and HRQL.

Method

Participants included 100 children and adolescents with SCD between the ages of 8 and 18 years (M = 13.53, SD = 2.8) and their parents who were recruited during outpatient SCD clinic visits in a children's hospital. Children completed questionnaires related to pain experience and pain coping. Parents completed questionnaires about demographic information, their child's executive functioning, and HRQL.

Results

Pain intensity, executive dysfunction, and engagement in emotion-focused coping (i.e., internalizing/catastrophizing and externalizing) predicted poor HRQL. In addition, engagement in emotion-focused coping predicted executive dysfunction. Multivariate analysis of covariance revealed executive functioning did not differ based on pain frequency; however, executive functioning was a significant mediator that helped explain the relationships between distraction and emotion-focused coping techniques on HRQL.

Conclusion

Findings support that executive functioning is an important factor in understanding the relationship between pain coping and HRQL in youth with SCD. Future research is warranted to examine the potential impact of executive functioning on the utility of interventions targeting adaptive pain coping in youth with SCD.

Social adjustment and repressive adaptive style in survivors of pediatric cancer

PURPOSE

The aim of the study was to explore the relationship between repressive adaptive style and self-reports of social adjustment in survivors of pediatric cancer compared to their siblings. We hypothesized that there would be a greater proportion of repressors among survivors of pediatric cancer compared to siblings, and that repressive adaptive style would be significantly associated with more positive self-reports of social adjustment.

METHODS

We utilized a cross-sectional approach. Seventy-seven families participated. Survivors of pediatric cancer (n = 77, 48% male; 8-18 years of age) and one sibling (n = 50, 48% male; 8-18 years of age) completed measures assessing repressive adaptive style and social adjustment. As well, one parent from each family completed a socio-demographic questionnaire. Questionnaire packages were mailed to eligible families who agreed to participate, and were mailed back to investigators in a pre-addressed, pre-stamped envelope.

RESULTS

Chi-square analyses revealed there was no significant difference in the proportion of repressors among survivors and siblings. Social adjustment scores were subjected to a two (group: survivor, sibling) by two (repressor, nonrepressor) ANCOVA with gender and age as covariates. There was a significant main effect of repressive adaptive style (F = 5.69, p < .05, η² = 0.05) with a modest effect. Survivors and siblings with a repressive style reported significantly higher social adjustment scores (M = 106.91, SD = 11.69) compared to nonrepressors (M = 99.57, SD = 13.45).

CONCLUSIONS

Repressive adaptive style explains some of the variance in survivors and siblings' self-reports of social adjustment. Future research should aim to better understand the role of the repressive adaptive style in survivors and siblings of children with cancer.

The Impact of a Mother's Emotional Strains and Disclosure of Cancer on Her Child's Defensiveness and Adjustment to Cancer

BACKGROUND

Defensiveness is one of the strategies that children with cancer use against psychosocial difficulties, yet it remains unclear what factors may impact children's use of defensiveness.

OBJECTIVE

The aim of this study was to explore the psychological adjustment, including use of defensive behaviors, in children who may or may not be told about the diagnosis of cancer.

METHODS

A total of 58 children and 51 mothers participated in the study. Children answered questionnaires about defensiveness, anxiety, and depression, whereas mothers completed a questionnaire of anxiety, depression, and stress and a question about disclosure of cancer to child.

RESULTS

Significant differences were found in the defensiveness and depression scores between children with full disclosure and those with no disclosure about their cancer. Although children's adjustment has been directly related to that of their mother's adjustment, we did not find this variable to be a predictor of child's adjustment. The child's defensiveness scores were a strong predictor of child's anxiety and eventually for a high risk for depression.

CONCLUSIONS

Mothers' emotional strains and lack of open disclosure about cancer significantly affect the psychosocial well-being of children.

IMPLICATIONS FOR PRACTICE

It is essential for nurses to assess the emotional adjustment and defensiveness strategies that children with cancer use. We believe that nurses caring for children with cancer have a professional responsibility to identify and understand defensive behaviors and other characteristics of psychosocial distress and advocate for psychological interventions that will help mothers and their children cope with cancer.

Psychopathology in adolescents with TLE and FLE

BACKGROUND

To describe the rates and types of psychiatric disorders among adolescents with chronic symptomatic epilepsies and to evaluate syndrome-specific differences between temporal lobe (TLE) and frontal lobe (FLE) epilepsies.

METHODS

A cross-sectional single-center study design applying the Youth Self Report (YSR) to investigate psychopathological symptoms and the Weinberger Adjustment Inventory (WAI) to investigate personality dimensions was used. Consecutive adolescents between 14 and 18 years of age with drug-resistant symptomatic TLE and FLE were investigated during pre-surgical evaluation prior to epilepsy surgery. Data from twenty-eight patients (19 with TLE and 9 with FLE) were analyzed for this report.

RESULTS

Compared with the test norm, higher prevalence rates and a wider range of psychopathological symptoms were seen in patients with TLE. This result was not seen in patients with FLE. Concerning personality dimensions, significantly higher values of repressive defensiveness and significantly lower values of positive emotion and confidence were found in patients with TLE. In contrast, significantly lower levels of distress and significantly higher levels of repressive defensiveness and denial of distress were seen in patients with FLE. Comparing TLE with FLE, a significantly higher mean score for distress, and a significantly lower mean score for positive emotion and denial of distress were found in patients with TLE.

CONCLUSION

In summary, psychiatric comorbidity was frequently found in this sample of youths with chronic drug-resistant localization-related epilepsies. Although results have to be interpreted with caution because of the small sample size, psychiatric symptomatology was significantly different between TLE and FLE. Our results show that continuous and syndrome-specific psychiatric monitoring is essential in young patients with epilepsy.

Quality of Life after Intestinal Transplantation

As technology introduces more advanced therapies, individuals have realized that quantity or length of life may not always be the ultimate goal in treating disease. The quality of life at times is as important as length of life. In this article, we review the literature regarding quality of life after intestinal transplantation. Published data on patient survival are briefly reviewed and the available studies investigating quality of life are examined. Few studies have been performed to date, but the limitations and implications of the available studies are summarized.

A systematic review of factors that influence treatment adherence in paediatric oncology patients

WHAT IS KNOWN AND OBJECTIVE

Treatment adherence is an essential component in ensuring best outcomes in the management of paediatric cancers. Compared to the adult population, treatment adherence in the paediatric population is a more complex subject which involves unique dimensions. In this study, we aimed to systematically review the literature to identify factors associated with treatment adherence in the paediatric oncology population.

METHODS

A literature search was carried out using related keywords on electronic databases.

RESULTS AND DISCUSSION

A total of 1036 articles were reviewed, and 39 articles were found to be relevant. A comprehensive review of these articles identified 17 factors that influence adherence. These factors were classified into five major categories: patient-/caregiver-related factors; therapy-related factors; condition-related factors; health system-related factors; and social/economic factors. A baby bear model was proposed to better visualize these five categories that affect treatment adherence, and a framework of questions was designed to help clinicians identify those at risk of non-adherence for early intervention.

WHAT IS NEW AND CONCLUSION

Seventeen factors reviewed were categorized into five main categories, namely patient-/caregiver-related factors, therapy-related factors, condition-related factors, health system factors and social/economic factors, as causes for poor medication adherence in the paediatric oncology population. Clinicians need to be aware that these factors can interact to influence treatment adherence and that some factors may be more relevant in specific contexts (e.g. third world countries, minority groups). The baby bear model is presented to help understand the issues affecting adherence in the paediatric oncology population, and a framework of questions is proposed to help clinicians identify patients at risk of non-adherence.

Children and adolescents coping with cancer: self- and parent reports of coping and anxiety/depression

OBJECTIVE

The diagnosis and treatment of cancer present children and adolescents with significant stress. However, research on the ways that children and adolescents cope with cancer-related stress has not yielded clear findings on the efficacy of different coping strategies, and has been limited by reliance primarily on self-reports of both coping and distress. To address this gap, the current study used a control-based model of coping to examine self- and parent reports of child/adolescent coping and symptoms of anxiety and depression in a sample of children with cancer.

METHOD

Children and adolescents (5 to 17 years old) and their parents were recruited near the time of a child's diagnosis or relapse of cancer (M = 1.30 months postdiagnosis). Child self-reports (n = 153), mother reports (n = 297), and father reports (n = 161) of children's coping and symptoms of anxiety/depression were obtained.

RESULTS

Bivariate correlations revealed significant associations for secondary control coping (efforts to adapt to source of stress; e.g., acceptance, cognitive reappraisal) and disengagement coping (e.g., avoidance, denial) with anxiety/depression within and across informants. Linear multiple regression analyses indicated that secondary control coping accounted for unique variance in symptoms of anxiety/depression both within and across informants.

CONCLUSIONS

Secondary control coping appears important for children and adolescents during early phases of treatment for cancer, and it may serve as an important target for future interventions to enhance adjustment in these children.

Differences in parent and teacher rating of everyday executive function in pediatric brain tumor survivors

We aimed to compare executive function (EF) outcomes in pediatric brain tumor (BT) survivors compared with healthy children (HC) across multiple settings. This retrospective cross-sectional study of BT survivors and age- and gender-matched HC analyzed scale patterns of parent and teacher ratings of EF (Behavior Ratings of Executive Function; BRIEF). We also analyzed relationships between groups and raters (parent/teacher) and clinical elevations across EF domains on the BRIEF. Group differences in aspects of EF emerged from parent ratings in working memory (WM), while significant interactions from teacher ratings emerged on nearly all EF scales. Parents reported impaired cognitive/behavioral flexibility in the BT group four times more than parents of HC. Teachers rated survivors significantly more poorly as a group on the majority of EF domains, and indicated clinical impairment in cognitive/behavioral flexibility, emotional regulation, self-starting/initiation, WM, and planning and organization (P/O) four to ten times more often than the teachers of HC. Overall, teacher ratings of EF impairment in pediatric BT survivors were significantly greater than parent ratings, who reported far fewer EF problems. Possible explanations for inter-rater discrepancies include potential reporting bias/response shift in parents and/or differences in EF demands across settings.

Predictors of psychological functioning in children with cancer: disposition and cumulative life stressors

OBJECTIVE

This study examined psychological functioning in children with a history of cancer and a matched sample of healthy peers, while exploring the roles of disposition and stressful life events.

METHOD

Participants were 255 children with a history of cancer and 101 demographically matched children (8-17 years). Children completed measures of depression, anxiety, and posttraumatic stress symptoms (PTSS); history of stressful life events; and dispositional factors, including optimism and a five-factor personality measure.

RESULTS

Children with cancer did not differ from peers with regard to depression and PTSS, but reported significantly lower anxiety. In hierarchical regressions, children's depression, anxiety, and PTSS scores were largely predicted by dispositional variables and, to a lesser extent, stressful life events, after controlling for demographics and health status.

CONCLUSION

Children's psychological functioning is predicted primarily by disposition, and secondarily by history of stressful life events, with health status (i.e., cancer versus control) accounting for minimal, and often non-significant variance in children's functioning. These findings further support that children with cancer are generally resilient, with factors predictive of their adjustment difficulties mirroring those of children without history of serious illness.

Psychosocial distress and functioning of Greek youth with cystic fibrosis: a cross-sectional study

Background

To assess psychosocial functioning and distress of children and adolescents with cystic fibrosis compared to healthy controls.

Methods

Thirty-six patients with cystic fibrosis aged 8–18 years (24 boys, mean age ± SD: 11.5 ± 2.6 years) and 31 sex- and age-matched healthy control subjects (18 boys, mean age ± SD: 12 ± 2.5 years) were enrolled in the study. In order to assess the self-esteem, social adjustment, and family functioning of these young people, the Culture-free Self-esteem Inventory, the Social Adjustment Scale–Self-Report, and the Family Assessment Device were administered. Emotional/ behavioral problems were assessed through the Youth Self Report and the Child Behavior Checklist given to both the subjects and their parents.

Results

No significant differences were found for self-esteem between the two study groups. Regarding social adjustment, children with cystic fibrosis reported significantly worse friendship and overall adjustment (P < 0.05). Moreover, no difference was found in the levels of family functioning between the two groups. No significant differences between the groups were found in emotional/ behavioral problems from the self-reports. On the contrary, parents of children with cystic fibrosis reported significantly higher levels of withdrawal/ depression, thought problems, and delinquent behavior (P ≤ 0.01) as compared to controls.

Conclusions

Children and adolescents with cystic fibrosis appear to be a psychosocially vulnerable group. A biopsychosocial approach should emphasize the assessment and treatment of the psychosocial distress of these patients alongside multiple somatic treatments.

Symptoms of emotional, behavioral, and social difficulties in the danish population of children and adolescents with type 1 diabetes--results of a national survey

OBJECTIVE

To assess the prevalence of psychological difficulties in Danish children and adolescents with type 1 diabetes using both child/adolescent and caregiver reports, and to investigate associations between these symptoms and metabolic control, adherence, and quality of life.

RESEARCH DESIGN AND METHOD

A total of 786 children and adolescents (8-17 years) recruited through the Danish Registry of Childhood Diabetes completed subscales of the Beck's Youth Inventories (BYI-Y), while 910 caregivers completed the Strength and Difficulties Questionnaire (SDQ). The participants also completed questionnaires assessing adherence and quality of life. BYI-Y and SDQ responses were compared with results from normative samples.

RESULTS

Children with diabetes generally reported a lower level of symptoms of depression and anxiety, while older adolescents in most cases were comparable to the normative samples. However, the numbers of patients with elevated scores were similar to normative groups, especially regarding the proportion of participants with 'Extremely elevated' scores. Caregivers of children and adolescents with diabetes generally reported the prevalence of elevated scores on the SDQ to exceed the prevalence observed in the norm sample--particularly with regard to older boys. Both BYI-Y and SDQ responses were significantly correlated with HbA1c, adherence, and quality of life.

CONCLUSIONS

This study finds Danish children and adolescents with diabetes to report lower or comparable levels of emotional difficulties compared to norms, while caregiver reports are less positive. The results therefore support the value of a multi-informant approach to the assessment of symptoms of psychological difficulty in girls and boys with diabetes.

Psychiatric functioning and quality of life in young patients with cardiac rhythm devices

BACKGROUND

Less is known about depression, anxiety and quality of life (QoL) in children and adolescents with pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) than is known in adults with these devices.

METHODS

A standardized psychiatric interview diagnosed anxiety/depressive disorders in a cross-sectional study. Self-report measures of anxiety, depression and post-traumatic stress disorder were obtained. Medical disease severity, family functioning and QoL data were collected. A total of 166 patients were enrolled (52 ICD, 114 PM; median age 15 years).

RESULTS

Prevalence of current and lifetime psychiatric disorders was higher in patients with ICDs than PMs (Current: 27% vs. 11%, P = .02; Lifetime: 52% ICD vs. 34% PM, P = .01). Patients with ICDs had more anxiety than a healthy population (25% vs. 7%, P < .01). Patients with ICDs and PMs had similar levels of depression as a healthy population (ICD 10%, PM 4%, reference 4%, P = .29). In multivariate analysis including a medical disease score, demographics, exposure to beta-blockers, activity limitations, hospitalizations, shocks and procedures, the type of device (PM versus ICD) did not predict psychiatric diagnoses when age at implantation and the severity of medical disease were controlled for. Patients with ICDs and PMs had lower physical QoL scores (ICD 45, PM 47.5, Norm 53, P ≤ .03), but similar psychosocial functioning scores (ICD 49, PM 51, Norm 51, P ≥ .16) versus a normal reference population.

CONCLUSIONS

Anxiety is highly prevalent in young patients with ICDs, but the higher rates can be attributed to medical disease severity and age at implantation instead of type of device.

Screening for anxiety symptoms and social desirability in children and adolescents living with chronic illnesses in Jordan

This research aims to investigate the rate and nature of anxiety symptoms in a group of children and adolescents living with chronic illnesses in Jordan, and their relation to social desirability in a cultural sample not previously researched. Using the Revised Children's Manifest Anxiety Scale (R-CMAS), anxiety and social desirability data were obtained from 114 children diagnosed with chronic illnesses and 162 healthy control participants. Based on children's self-report, participants were categorized according to their adaptive style paradigm as either high anxious, low anxious, or repressor. It was proposed that children who score high on social desirability and low on anxiety are repressors. The prevalence of these categories was compared across the two groups. Anxiety was reported in 9.64 percent of the chronic illnesses and 12.34 percent of the healthy peers. Using the data obtained in the present study, the rate and nature of anxiety in children with chronic illnesses were lower for children in Jordan when compared to previous studies. However, social desirability values were similar to those established in Western societies suggesting a significantly higher percentage of children identified as repressors in children with long-term illnesses. These results supported the hypothesis regarding the relationship between social desirability and expressed anxiety symptoms.

The Prevalence of Depression in Pediatric Oncology Patients Undergoing Chemotherapy Treatment in Jordan

The aim of this study was to investigate the prevalence of depression in pediatric oncology patients in Jordan, comparing them with peers who suffered from chronic conditions or were healthy. The authors investigated 58 children with cancer, 56 with chronic illnesses, and 64 healthy controls using the Arabic version of the Children’s Depression Inventory (CDI). There was no significant difference in CDI scores between children with cancer, children with chronic illnesses, and healthy controls. Using the conventional cutoff point of a score of 20 gives a prevalence of 20.68% for child-reported depression in the cancer group. This is toward the high end of the range for similar studies in other countries. The results suggest that children with cancer undergoing chemotherapy are no more likely to be depressed than children with chronic illnesses or healthy controls, although further research is warranted.

Posttraumatic growth, coping strategies, and psychological distress in adolescent survivors of cancer

Only recently have researchers begun to empirically examine positive outcomes such as posttraumatic growth in adolescent cancer. This article examines associations between posttraumatic growth, coping strategies, and psychological distress in adolescent cancer survivors. Adolescents who finished cancer treatment 2 to 10 years prior (N = 31) completed self-report measures of posttraumatic growth, coping, symptomatology, and disease-related characteristics. Younger age at diagnosis and less use of avoidant coping strategies predicted lower levels of psychological distress. Adolescents' beliefs that they were more likely to relapse and the use of more acceptance coping strategies predicted higher levels of posttraumatic growth. Adolescent cancer survivors may be capable of experiencing posttraumatic growth. Those who believe they are more prone to relapse and use more acceptance coping strategies are likely to have higher levels of posttraumatic growth. As health care professionals encourage adolescent cancer survivors to use fewer avoidant coping strategies, they can also encourage survivors to use more acceptance coping strategies.

Pediatric oncologists' practices of prescribing selective serotonin reuptake inhibitors (SSRIs) for children and adolescents with cancer: a multi-site study

OBJECTIVE

To survey pediatric oncologists regarding prescription of selective serotonin reuptake inhibitors (SSRIs) and related medications for the treatment of depression and anxiety disorders in children with cancer. Specifically, we sought to determine (a) how frequently pediatric oncologists prescribed SSRIs and what were the most commonly prescribed agents; (b) how decisions were made to prescribe, particularly whether mental health professionals were consulted; (c) how patients were monitored while on the agents; and (d) how the FDA black box warning has affected prescribing practices.

METHOD

Oncologists from nine children's cancer centers (N = 151) from across the U.S. were surveyed, responding to either on-line or paper versions of a questionnaire developed for this study.

RESULTS

A majority of oncologists (71%) reported prescribing SSRIs for their patients. Oncologists reported difficulties differentiating symptoms of depression from aspects of cancer treatment. Mental health practitioners are consulted occasionally but not routinely, and oncologists reported a need for increased mental health resources. Approximately half of oncologists (51%) reported that the FDA black box warning had not affected their practice. In addition, only 28% reported monitoring patients on SSRIs at FDA recommended intervals, and only 9% indicated assessing for suicidality.

CONCLUSIONS

Prescription of SSRIs is a common practice of pediatric oncologists, often without consultation with mental health professionals. Post-prescription monitoring appears to be suboptimal, and does not follow FDA guidelines.

Coping with chronic illness in childhood and adolescence

Chronic illnesses and medical conditions present millions of children and adolescents with significant stress that is associated with risk for emotional and behavioral problems and interferes with adherence to treatment regimens. We review research on the role of child and adolescent coping with stress as an important feature of the process of adaptation to illness. Recent findings support a control-based model of coping that includes primary control or active coping (efforts to act on the source of stress or one's emotions), secondary control or accommodative coping (efforts to adapt to the source of stress), and disengagement or passive coping (efforts to avoid or deny the stressor). Evidence suggests the efficacy of secondary control coping in successful adaptation to chronic illness in children and adolescents, disengagement coping is associated with poorer adjustment, and findings for primary control coping are mixed. Avenues for future research are highlighted.

Körperliche und psychosoziale Belastung bei Jugendlichen und jungen Erwachsenen mit einer Krebserkrankung

Zusammenfassung. Zielsetzung dieser Literaturanalyse ist die Erfassung des gegenwärtigen empirischen Erkenntnisstands zu den körperlichen und psychosozialen Belastungen bei Jugendlichen mit einer Krebserkrankung. Spezifische Fragestellungen beinhalten die Untersuchung der Art und der Auftretenshäufigkeit spezifischer Belastungen im körperlichen, psychischen und sozialen Bereich unter Berücksichtigung der krankheits- und behandlungsbezogenen Faktoren. Ziel ist es, den psychologischen und pädagogischen Unterstützungsbedarf sowie relevante Forschungsfragestellungen abzuleiten. Für den Suchzeitraum von 01/1986 bis 06/2009 konnten 33 Originalarbeiten in die Übersichtsarbeit einbezogen werden. Es wurden insgesamt 1751 Jugendliche mit einem Durchschnittsalter von 15.4 Jahren untersucht. Die Ergebnisse der Literaturanalyse zeigen, dass Jugendliche mit einer Krebserkrankung mit vielfältigen Belastungen konfrontiert sind, die alle elementaren Entwicklungsbereiche (physisch, psychisch, kognitiv und sozial) betreffen. Als besondere Belastungen zeigten sich in den Studien folgende Bereiche: die körperlichen Veränderungen, krebs- und behandlungsspezifische Erschöpfung (Fatigue) und die beeinträchtigte Lebensqualität, Ängste und Depression sowie ein verringertes Selbstwertgefühl, Sorgen, von den Freunden verlassen zu werden, Sorgen um verändertes Aussehen sowie darüber, die Schule zu versäumen. Als weiteres Ergebnis des Reviews kann festgehalten werden, dass für krebskranke Jugendliche der Aspekt Schule und Lernen einen großen Stellenwert einnimmt. Es besteht insgesamt ein großer Forschungsbedarf zu den psychosozialen und pädagogischen Unterstützungsbedürfnissen von jugendlichen Krebspatienten.

Child-related determinants of health-related quality of life in children with brain tumours 1 year after diagnosis

OBJECTIVES

Infratentorial tumour site and health-related quality of life (HRQL) 1 month after diagnosis have been shown to predict HRQL 1 year after diagnosis in children with brain tumours. This study aimed to identify additional early child-related determinants of parent- and child-report HRQL.

METHODS

Longitudinal prospective study. Semi-structured interviews took place approximately 1 and 12 months after diagnosis. HRQL was measured using the self- and parent-report Pediatric Quality of Life Scales (PedsQL 4.0) Total Scale Score and Health Utilities Index Mark 3 (HUI3) multi-attribute utility function. Child variables included performance and verbal IQ, general memory, selective attention executive function, behaviour problems, adaptive behaviour, symptoms of depression and anxiety and event related anxiety. Univariate analyses were used to identify potential early predictors of HRQL. Regression analysis was then used to identify the most important determinants of HRQL at 1 year.

RESULTS

Thirty-five patients completed the 12-month interviews. Multivariate analysis showed infratentorial tumour site remained an important determinant of HRQL 1 year after diagnosis. Infratentorial tumour site and selective attention at 1 month generally best predicted poor self- and parent-report HRQL at 12 months. Adaptive behaviour and performance IQ may be important.

CONCLUSION

Selective attention and infratentorial tumour site are most important in predicting both parent- and self-report HRQL at 1 year after diagnosis. Larger prospective studies are needed to confirm these findings. Cognitive remediation or/and pharmacological intervention, particularly aimed at children with infratentorial tumours may improve attention and subsequently HRQL and both merit further investigation.

Body weight, social competence, and cognitive functioning in survivors of childhood brain tumors

BACKGROUND

The purpose of the following article was to examine: (a) body mass index (BMI) in survivors of childhood brain tumors; (b) the association of BMI with social competence and cognitive functioning; and (c) congruency in reporting of survivors' social competence by the survivors, parents, and teachers.

PROCEDURE

Fifty-four survivors of childhood brain tumors (32 males) 8-18 years participated. BMI-for-age percentiles and BMI Z-scores (SDS) were calculated and survivors were categorized as underweight, normal, overweight, or obese, using established criteria. Informants completed measures of social competence and internalizing behaviors. Survivors also completed a test of self-perception and cognitive functioning (IQ).

RESULTS

Survivors were more underweight (15% vs. 4%), and less overweight (17% vs. 31%) than population norms (chi(2) = 38.62, P < 0.001). Parents perceived lower social competence in survivors that were underweight, had lower verbal IQ, and higher internalizing behaviors (P < 0.05). A significant interaction between BMI-for-age and IQ on self-perception of close friendships suggested that survivors with lower weight and lower IQ perceived having fewer close friendships (P < 0.05). Congruency among the three informants was moderate.

CONCLUSIONS

Survivors of childhood brain tumors are at increased risk for underweight. Underweight status is related to lower parent reported social competence and survivors' self-perception of fewer close friendships in the presence of low IQ.

The importance of the repressive coping style: findings from 30 years of research

During the last three decades there has been substantial research exploring the repressive coping style as defined by Weinberger, Schwartz, and Davidson. As "repressors," who score low on trait anxiety and high on defensiveness, account for up to 50% of certain populations, they are an essential group for psychologists to study. However, there are methodological issues in identifying repressors as well as considerable evidence that repressors avoid negative self-relevant information. Possible methods of addressing these difficulties are discussed in this review. Importantly, there is a body of evidence linking repressive coping and poor physical health, including heart disease and cancer. However, some preliminary findings suggest that repressors compared to non-repressors may be better at health behaviors that they perceive as under their personal control. This needs more extensive investigation as such behaviors are only one aspect of health and other factors may contribute to repressors' poor physical health. Possible future directions of research are discussed including: the need for systematic empirical research of a new theory of repressive coping--the Vigilance-Avoidance Theory--more longitudinal health studies, and an in-depth exploration of the physiological mechanisms which may underlie repressive coping.

Optimism and health-related quality of life in adolescents with cancer

OBJECTIVE

To delineate the relationship between optimism and health-related quality of life (HRQOL) and quality of life (QOL) in adolescents with cancer living in the Bronx, New York.

METHODS

Optimism was assessed using the Life Orientation Test, Revised (LOT-R). HRQOL and QOL were measured using the Pediatric Quality of Life Inventory, Cancer Module, Acute Version and The Pediatric Quality of Life Inventory, Generic Core Scale, respectively. Associations between optimism and HRQOL and QOL were assessed using Pearson's product-moment correlations.

RESULTS

Twenty-three adolescents participated in this study; the mean age was 16 and the majority was male. This sample was highly optimistic and reported high HRQOL and QOL. Optimism was correlated with less reported pain and hurt, better communication with doctors, higher reported psychological functioning and higher overall QOL.

CONCLUSION

Optimism is associated with higher QOL in inner city adolescents with cancer. Further research should assess whether interventions that increase optimism lead to greater QOL in this population.

Repressive adaptive style and self-reported psychological functioning in adolescent cancer survivors

Low levels of posttraumatic stress disorder (PTSD), posttraumatic stress symptoms (PTSS), and psychosocial distress have been reported in pediatric cancer survivors. One explanation is the relatively high prevalence of the repressive adaptive style (low distress, high restraint) in this population. We investigated the relationship between this adaptive style and PTSD, PTSS, and psychosocial functioning in 29 adolescent cancer survivors (12 through 18 years). Adolescents categorized as repressors (n = 14) reported moderate/large effect size differences in PTSD, PTSS, and psychosocial distress (lower) as well as QOL (better) compared to non-repressors. Furthermore, repressors reported less PTSD and QOL variability. Thus, the repressive adaptive style, pronounced in this population, may obscure systematic and clinically meaningful adaptive style group differences across psychological measures.

Associations between the repressive adaptive style and self-reported hope in Mexican American and Euro-American children

A large literature has examined the associations between Weinberger, Schwartz, and Davidson's (1979) repressive adaptive style (RAS) construct and various self-report measures of distress or unpleasant emotional states in adults and children. Fewer investigations have examined the role of RAS in self-reported positive psychology constructs. In this investigation, we used Weinberger et al.'s (1979) categorical typology to examine the associations between adaptive style and hope in Euro-American (n = 60) and Mexican American (n = 49) children (M age = 11.4 years) who were students at 1 of 3 parochial schools in a large Midwestern city. Partially supporting the hypotheses, a univariate 2 (ethnic group) x 2 (repressor group) analysis of variance indicated a significant main effect for adaptive style group but no significant main effect for ethnic group and no significant interaction effect. Results extend the literature on the associations between adaptive style and self-report instruments and indicate that (similar to self-reported measures of distress) self-reported hope may be subject to social desirability bias.

The Anger Expression Scale for Children: initial validation among healthy children and children with cancer

OBJECTIVE

To evaluate the proposed structure of the Anger Expression Scale for Children (AESC) in samples of healthy children and those with cancer, and to examine correlations between AESC subscales and other indicators of anger and hostility.

METHOD

A total of 803 children from two independent studies of healthy and ill children (mean age = 12.7, SD = 3.1) completed the AESC and other measures of anger expression and hostility, and a sub-sample of 298 of their parents completed measures of anger expression and hostility.

RESULTS

Results provided initial support for the proposed four-factor model of the AESC (Trait Anger, Anger Expression, Anger In, and Anger Control). Measurement invariance was established across groups using a series of nested tests. Correlations between AESC subscales and parent- and child-reported indices of anger, hostility, and aggression support the convergent validity of the scales.

CONCLUSIONS

Analyses supported the construct validity of the AESC and generalization of the factor structure across healthy and chronically ill children.

Repressive adaptation in a nonclinical sample: consistent and inconsistent reports of child psychosocial functioning across informants

Using multiple indicators (self-report, parent report, school grades, and disciplinary referrals), we compared the psychosocial functioning of children across Weinberger's (1990) and Weinberger, Schwartz, and Davidson's (1979) repressive adaptive style (RAS) groups. Participants included 134 children ages 10 to 13 years that were recruited from public schools and 117 of their caregivers. Relative to nonrepressors, we hypothesized repressors to evidence lower levels of self-reported distress but higher parent-reported distress on the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992). Summary scores from the BASC self-report differed significantly between repressors and nonrepressors in the expected directions. No significant group differences in parent-reported distress or school functioning emerged. Consistent with Phipps (2005), results question the predominant assumption that the RAS is associated with risk of psychosocial difficulties in children.

Stress-related mental disorders in childhood cancer survivors

BACKGROUND

This report evaluated the association between surviving pediatric cancer and receiving a diagnosis of a stress-related mental disorder (SRMD) (i.e., post-traumatic stress disorder (PTSD), acute stress disorder, or adjustment disorders).

PROCEDURE

The dataset comprised a cohort of Medicaid eligible children, ages birth to 15 years during baseline years 1996-2001 and followed at least 1 year until age 19 years or the end of 2003. Childhood cancer survivors (N = 390) identified from the SC Central Cancer Registry were frequency matched within age groups at each baseline year to children with no history of malignancy (N = 1,329). Survival curves and cumulative incidence of SRMD were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for pediatric cancer survival and selected covariates.

RESULTS

The 8-year incidence of SRMD was 18.6% (95% CI: 12.47, 24.8) among childhood cancer survivors and 7.3% (5.0, 9.6) among children with no history of malignancy, HR = 3.22 (2.17, 4.76). Significant covariates for this group included race, sex, and previous mental disorder, adjusted HR = 3.00 (2.02, 4.45). Significant predictors among the childhood cancer survivors included cancer type, age group, treatment, and previous mental disorder.

CONCLUSIONS

Given the potential benefit of interventions for those with prior psychopathology, that children are less likely to verbalize emotional problems, and the detrimental implications of undiagnosed mental disorders, the health evaluations of childhood cancer patients and the follow-up visits for the survivors should incorporate assessment for mental disorders, especially SRMD.

Symptoms of posttraumatic stress in parents of children with cancer: are they elevated relative to parents of healthy children?

OBJECTIVE

To examine posttraumatic stress symptoms (PTSS) in parents of children with cancer as a function of time since diagnosis, treatment status, and relapse history, and as compared to parents of healthy children.

METHOD

Participants included parents of 199 children with cancer, comprising a cross-sectional sample of diagnoses and treatment phases, ranging from currently on therapy to long-term survivors, and 108 parents of healthy children obtained via acquaintance control methods. Parents completed a standardized self-report measure of PTSS.

RESULTS

Within the cancer group, parental report of PTSS differed as a function of treatment status and time since diagnosis. Parents of children on active treatment endorsed similar levels of PTSS as control parents, whereas parents of children off treatment reported significantly lower levels of PTSS than did controls. Similarly, parents of long-term survivors reported significantly lower levels of PTSS than did controls, while parents of recently diagnosed children did not differ from controls on PTSS. In contrast, parents of children who had suffered a relapse reported significantly higher levels of PTSS, and were much more likely to be identified as a posttraumatic stress disorder (PTSD) case.

CONCLUSIONS

As a group, parents of children with cancer did not demonstrate any evidence of increased PTSS relative to parents of healthy children. Time since diagnosis, child treatment status, and relapse history are significant determinants of parent PTSS. Only parents of children who experienced a relapse appear to be at increased risk of PTSD. The current results appear discrepant from the existing literature, and possible explanations for these discrepancies are examined.

Depressive symptoms and SSRI use in pediatric oncology patients

This review of depressive symptoms in pediatric cancer patients describes the challenge of recognizing depression in this group, prevalence, risk factors, and treatment, primarily with the selective serotonin reuptake inhibitors (SSRIs). Pediatric oncologists prescribe SSRIs, but there is limited data regarding their use in this setting. Adverse effects, pharmacokinetics and metabolism of SSRIs are reviewed to provide a reference for physicians and inform choices for SSRI prescription. Ongoing research includes incorporation of routine screening measures for depression and future studies might focus on physician recognition and prospectively evaluating treatment for children with cancer and depressive symptoms.

Quality of life from research and clinical perspectives: an example from paediatric psycho-oncology

In clinical oncology and research, health-related quality of life (HRQL) of patients has increasingly gained attention. Although there is agreement that HRQL is a multidimensional construct incorporating primarily the patient's evaluation of his/her life, the construct lacks a uniform model of conceptualization. This article briefly outlines definitions and methods of assessing quality of life in children and adolescents. The case report of a 10-year-old boy who underwent hematopoietic stem cell transplantation views HRQL from various perspectives. Self- and proxy assessments are compared, and the expertise of psychotherapeutic work is combined with data gathered by standardized questionnaires.

The effects of response bias on self-reported quality of life among childhood cancer survivors

BACKGROUND

Several studies of long-term adjustment in childhood cancer survivors (CCS) report very positive outcomes, while other studies find significant adjustment problems. These inconsistencies have prompted some investigators to suggest survivors may be biased responders, prone to underreporting on self-report measures. This study tested the hypothesis that CCS are elevated on self-deception response bias (SDRB), and that SDRB is associated with higher ratings of quality-of-life (QOL).

METHODS

One hundred and seven adult (mean age = 31.85) survivors of childhood cancers completed a demographic questionnaire, Short Form-12 (SF-12), Functional Assessment of Cancer Therapy-General (FACT-G), and Self-Deception Enhancement scale (SDE), an SDRB measure.

RESULTS

Survivors' QOL scores were similar to normative groups, but they evidenced much higher levels of response bias. SDE scores were significantly correlated with the FACT-G, and SF-12 Mental Health (but not Physical Health) scores even after accounting for demographic and treatment-related variables.

CONCLUSIONS

CCS show a biased response style, indicating a systematic tendency to deny difficulties on QOL measures. This may complicate QOL studies by inflating survivors' reports of their socio-emotional functioning. Understanding how response bias develops may help us learn more about cancer survivors' adaptation to illness, and the effects of the illness experience on their perceptions of QOL.

Self-report of somatic symptoms in survivors of childhood cancer: effects of adaptive style

BACKGROUND

Screening for late effects in survivors of childhood cancer may be influenced by the patients' self-reporting of their somatic state. However, self report of somatic symptoms may be influenced by factors other than objectively documented physical functions. This study examined the self report of somatic symptoms in children with cancer and matched healthy control children as a function of child adaptive style.

PROCEDURE

Two groups of children age 7-18 were studied; children with cancer at least 6-month post completion of therapy (n = 120) and a group of healthy children (n = 120) matched on age, race, and gender. Children completed measures of somatic symptoms, body consciousness, and adaptive style.

RESULTS

Contrary to expectations, there were no differences between children with cancer and healthy controls in self-reported somatic symptoms, although cancer patients reported slightly lower symptomatology. In contrast, there were significant differences in self-reported somatic symptoms as a function of adaptive style. Children identified as repressors reported the lowest level of somatic symptoms and differed significantly from all other adaptive style groups.

CONCLUSION

These results do not support the prevailing hypothesis that a repressive style may be a risk factor for psychosomatic illness. However, the findings are consistent with a response bias interpretation, suggesting a general under-reporting of symptoms in repressors, including physical symptoms. These results have significant implications for health care providers and researchers following long-term survivors of childhood cancer.

Benefit Finding Scale for Children: preliminary findings from a childhood cancer population

OBJECTIVE

To describe the development of a brief measure of benefit finding for children. Data regarding the psychometrics and validity of the instrument were examined in a sample of children with cancer.

METHODS

A cross-sectional sample of children with cancer (N = 199, ages 7-18 years) completed the Benefit Finding Scale for Children (BFSC) along with measures of adaptive style, optimism/pessimism, post-traumatic stress symptoms, and health-related quality of life.

RESULTS

The BFSC was found to be a unidimensional measure with excellent internal reliability. Benefit finding was not related to age or gender, but differed as a function of race/ethnicity. No differences were found by diagnostic category, but a significant relationship was found with age at diagnosis and time elapsed since diagnosis. Small, but significant positive correlations were found with measures of optimism and self-esteem, and a negative correlation with anxiety. No relation was found between benefit finding and post-traumatic stress symtpoms or other domains of health-related quality of life.

CONCLUSION

The BFSC shows promise as a measure of benefit finding in children. The measure could be readily adapted for other populations of children experiencing trauma.