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Semerci R, Uysal G, Açikgöz A, Demirer P. The Predictive Power of Religious Coping on Care Burden, Depression, Stress, and Anxiety of Parents of Pediatric Oncology Patients in Turkey. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02096-3. [PMID: 39127992 DOI: 10.1007/s10943-024-02096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/23/2024] [Indexed: 08/12/2024]
Abstract
This study aimed to determine the predictive power of religious coping of parents of children with cancer on caregiver burden, depression, anxiety, and stress in Turkey. It was designed as a descriptive and cross-sectional study, utilizing correlational analysis and regression models to explore associations between variables. Data were collected from 164 parents in the pediatric hematology-oncology clinics of a university hospital between November 2023 and March 2024. There was a negative correlation between caregiver burden score and negative and positive religious coping scores. Caregiver burden scores were positively correlated with depression, anxiety, and stress scores. Results indicated that caregiver burden, education level, employment status, family structure, family income, and age at diagnosis significantly predicted positive religious coping. For negative religious coping, caregiver burden, education level, family structure, and family income were significant predictors. This suggests that religious coping may help reduce caregiver burden, underscoring the importance of promoting constructive coping strategies to support caregivers' well-being.
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Affiliation(s)
| | - Gülzade Uysal
- Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Turkey.
| | - Ayfer Açikgöz
- Faculty of Health Sciences, Osmangazi Eskisehir University, Eskişehir, Turkey
| | - Pınar Demirer
- Division of Pediatric Hematology and Oncology, Istanbul University, Istanbul, Turkey
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Gajda J, Johns C, Zimmermann T. Impact of pediatric cancer on parents' relationships. Eur J Oncol Nurs 2024; 69:102514. [PMID: 38340643 DOI: 10.1016/j.ejon.2024.102514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE Cancer in children leads to changes in family life, which can also affect the stability and quality of the parents' relationships. Studies show that parents' educational level, duration of partnership until diagnosis, child's cancer, and grandparents' relationship stability may influence parental partnership. The aim of this study was to investigate the influence of childhood cancer on the stability and quality of parental relationships in Germany. METHODS N = 74 parents of children with cancer aged 28-65 years (M = 41.9, SD = 7.6) completed questions on the stability and quality of their partnership as well as parental distress, depression, and anxiety. Stability was compared with the separation rate in the general population, and quality was compared using norm data from the German version of the Quality of Marriage Index (QMI-D; Zimmermann et al., 2019). A regression model was developed to predict mothers' current partnership quality. RESULTS The proportion of separated and divorced people was 12.2 % compared to 14. % in the general population. Retrospectively assessed partnership quality at time of diagnosis was significantly lower than in the German general population (p < .05). Higher anxiety proved to be the most significant predictor of maternal lower partnership satisfaction assessed at the time of the survey. DISCUSSION Parents of children with cancer did not show an increased separation rate. The partnership quality at the time of diagnosis was significantly lower, but was still above the cut-off of 34, suggesting predominant resilience of parental partnerships. However, some of parents showed significantly lower satisfaction. Future studies should identify parents who are more likely to experience a deterioration in partnership satisfaction or separation so that partnership interventions can be offered where appropriate.
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Affiliation(s)
- Jana Gajda
- Department of Psychosomatics and Psychotherapy, Hannover Medical School, Germany
| | - Charlotte Johns
- Department of Psychosomatics and Psychotherapy, Hannover Medical School, Germany
| | - Tanja Zimmermann
- Department of Psychosomatics and Psychotherapy, Hannover Medical School, Germany.
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Hovén E, Ljungman L, Sveen J, Skoglund C, Ljungman G, Ljung R, Wikman A. Losing a child to adolescent cancer: A register-based cohort study of psychotropic medication use in bereaved parents. Cancer Med 2023; 12:6148-6160. [PMID: 36218005 PMCID: PMC10028064 DOI: 10.1002/cam4.5347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/09/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate the short- and long-term risk of psychotropic medication use in parents who lose a child to cancer diagnosed in adolescence. METHODS This is a Swedish nationwide register-based study including 184 bereaved mothers and 184 bereaved fathers of 184 children diagnosed with cancer in adolescence. Logistic regression analyses, adjusted for sociodemographic characteristics and history of mental health problems, were performed to estimate risk of a prescription of psychotropic medication (anxiolytics, hypnotics/sedatives, antidepressants) in cancer-bereaved parents from 1 year before to 5 years after the child's death, with a general population sample of non-bereaved parents (n = 3291) as referents. RESULTS At the year of the child's death, 28%-36% of mothers and 11%-20% of fathers had a prescription of anxiolytics, hypnotics/sedatives or antidepressants. The corresponding percentages for non-bereaved mothers and fathers were 7%-12% and 4%-7%, respectively. Compared to non-bereaved mothers, bereaved mothers showed higher odds of prescriptions from 1 year before up to four (anxiolytics) and 5 years (hypnotics/sedatives and antidepressants) after the child's death. Bereaved fathers showed higher odds than non-bereaved fathers of prescriptions from 1 year before up to the year of (anxiolytics and hypnotics/sedatives) and 1 year after (antidepressants) the child's death. No differences in odds between bereaved and non-bereaved fathers were found at 2 years after the child's death. Being unmarried, born outside Sweden, and having a history of mental health problems were associated with higher odds of prescribed medications. CONCLUSIONS Indicative of mental health problems of clinical importance, cancer-bereaved parents had a higher prevalence of use of psychotropic medication. A decrease in medication use was evident with time, but still at 5 years after the child's death mothers displayed a higher use while fathers showed no difference to non-bereaved fathers after 2 years.
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Affiliation(s)
- Emma Hovén
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Childhood Cancer Research Unit, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Lisa Ljungman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Josefin Sveen
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Center for Crisis PsychologyUniversity of BergenBergenNorway
| | | | - Gustaf Ljungman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Pediatric OncologyUppsala University HospitalUppsalaSweden
| | - Rickard Ljung
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Anna Wikman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
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Wikman A, Hovén E, Alvariza A, Lövgren M, Kreicbergs U, Skoglund C, Fransson E, Ljungman G, Ljung R, Ljungman L. Psychotropic medication use in parents of survivors of adolescent cancer: A register-based cohort study. Cancer Med 2022; 11:4341-4353. [PMID: 35474312 DOI: 10.1002/cam4.4780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim was to investigate psychotropic medication use in parents of survivors of adolescent cancer from the acute post-diagnostic phase and up to 2 years following the cancer diagnosis. METHODS This study had a nationwide register-based cohort design comparing psychotropic medication use in parents of adolescent survivors of cancer (n = 2323) to use in parents of cancer-free controls (n = 20,868). Cox proportional hazards models, adjusted for cancer diagnostic group, parents' age, country of birth, education level, marital status and previous mental health problems estimated the risk of use from the time of the cancer diagnosis up to 2 years later. RESULTS During the first 6 months after the cancer diagnosis, both mothers and fathers had an increased risk of use of anxiolytics (mothers: HRadj 1.71, 95% CI 1.30-2.25; fathers: HRadj 1.57, 95% CI 1.10-2.45) and hypnotics/sedatives (mothers: HRadj 1.53, 95% CI 1.23-1.90; fathers: HRadj 1.32, 95% CI 1.00-1.75). For fathers with a prescription of psychotropic medication during the first 6 months after the cancer diagnosis, the risk remained increased after 6 months (HRadj 1.66, 95% CI 1.04-2.65). From 6 months after the cancer diagnosis, only the risk of antidepressant use among mothers was increased (HRadj 1.38, 95% CI 1.08-1.76). Risk factors included being divorced/widowed, born in a non-Nordic country, older age and having had previous mental health problems. CONCLUSION Our study results show that during the immediate post-diagnostic phase, mothers and fathers of survivors of adolescent cancer are at increased risk of use of anxiolytics and sedatives, whereas only mothers are at increased risk of antidepressant use from 6 months until 2 years after the diagnosis. Further, previous mental health problems were shown to be the strongest risk factor for psychotropic medication use in both mothers and fathers, pointing to the particular vulnerability of these parents.
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Affiliation(s)
- Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Hovén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Advanced Pediatric Home Care, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rickard Ljung
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Metsä-Simola NS, Remes HM, Hiltunen EM, Martikainen PT. Changes in parents' psychotropic medication use following child's cancer diagnosis: A fixed-effects register-study in Finland. Cancer Med 2022; 11:3145-3155. [PMID: 35345057 PMCID: PMC9385598 DOI: 10.1002/cam4.4662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/20/2022] [Accepted: 02/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Symptoms of depression and anxiety are elevated among parents of children with cancer. However, knowledge of parents' psychotropic medication use following child's cancer diagnosis is scarce. METHODS We use longitudinal Finnish register data on 3266 mothers and 2687 fathers whose child (aged 0-19) was diagnosed with cancer during 2000-2016. We record mothers' and fathers' psychotropic medication use (at least one annual purchase of anxiolytics, hypnotics, sedatives, or antidepressants) 5 years before and after the child's diagnosis and assess within-individual changes in medication use by time since diagnosis, cancer type, child's age, presence of siblings, and parent's living arrangements and education using linear probability models with the individual fixed-effects estimator. The fixed-effects models compare each parent's annual probability of psychotropic medication use after diagnosis to their annual probability of medication use during the 5-year period before the diagnosis. RESULTS Psychotropic medication use was more common among mothers than fathers already before the child's diagnosis, 11.2% versus 7.3%. Immediately after diagnosis, psychotropic medication use increased by 6.0 (95% CI 4.8-7.2) percentage points among mothers and by 3.2 (CI 2.1-4.2) percentage points among fathers. Among fathers, medication use returned to pre-diagnosis level by the second year, except among those whose child was diagnosed with acute lymphoblastic leukemia or lymphoblastic lymphoma. Among mothers of children with a central nervous system cancer, medication use remained persistently elevated during the 5-year follow-up. For mothers with other under-aged children or whose diagnosed child was younger than 10 years, the return to pre-diagnosis level was also slow. CONCLUSIONS Having a child with cancer clearly increases parents' psychotropic medication use. The increase is smaller and more short-lived among fathers, but among mothers its duration depends on both cancer type and family characteristics. Our results suggest that an increased care burden poses particular strain to the long-term mental well-being of mothers.
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Affiliation(s)
| | - Hanna M Remes
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Elina M Hiltunen
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Pekka T Martikainen
- Population Research Unit, University of Helsinki, Helsinki, Finland.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Laboratory of Public Health, Max Planck Institute for Demographic Research, Rostock, Germany
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von Heymann A, Alef-Defoe S, Salem H, Andersen EAW, Dalton SO, Schmiegelow K, Aw Wadt K, Falck Winther J, Johansen C, Bidstrup PE. Risk of somatic hospitalization in parents after cancer in a child, a nationwide cohort study. Psychooncology 2022; 31:1196-1203. [PMID: 35194898 DOI: 10.1002/pon.5909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/24/2022] [Accepted: 02/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The diagnosis of cancer in a child is a profoundly stressful experience. The impact on parents' somatic health, including lifestyle-related diseases, however, is unresolved. METHODS We conducted a nationwide population- and register-based study with parents of all children under age 20 diagnosed with cancer in Denmark between 1998 - 2013 and parents of cancer-free children, matched (1:10) on child's age and family type. We estimated hazard ratios (HR) with 95% confidence intervals (CI) in Cox proportional hazard models for thirteen major International Classification of Diseases-10 disease-groups, selected stress- and lifestyle-related disease-groups and investigated moderation by time since diagnosis, parental sex, and cancer type. RESULTS Among n=7797 parents of children with cancer compared with n=74,388 parents of cancer-free children (51% mothers, mean age 42), we found no overall pattern of increased risk for 13 broad disease-groups. We found increases in digestive system diseases (HR1.06, 95% CI1.01-1.12), genitourinary system diseases (HR 1.08, 95% CI 1.02-1.14), and neoplasms (HR 1.20, 95% CI 1.13-1.27), the latter attributable mostly to increased rates of tobacco-related cancers and mothers' diet-related cancers. CONCLUSIONS This is the first attempt to document the impact of childhood cancer on parents' somatic health. With the exception of increased risk for neoplasms, likely due to shared genetic or lifestyle factors, our findings offer the reassuring message, that the burden of caring for a child with cancer does not in general increase parents' risk for somatic diseases. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Annika von Heymann
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen.,Cancer Survivorship and Treatment Late Effects, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet
| | - Sierra Alef-Defoe
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen
| | - Hanin Salem
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen
| | | | | | - Kjeld Schmiegelow
- University Hospital Rigshospitalet, Institute of Clinical Medicine, Medical Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Karin Aw Wadt
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen.,Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen.,Cancer Survivorship and Treatment Late Effects, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet
| | - Pernille Envold Bidstrup
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Hsu J, Sansom-Daly UM, Hetherington K, Ellis SJ, Donoghoe MW, Cohn RJ, Zentella-Tusie A, Wakefield CE. Health service and medication use of parents of childhood cancer survivors: a controlled comparison study. Acta Oncol 2021; 60:1325-1334. [PMID: 34308777 DOI: 10.1080/0284186x.2021.1955968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Parents of childhood cancer survivors may be vulnerable to experiencing poor health outcomes, but little is known about how these parents use healthcare. This study investigated the nature and extent of survivors' parents' healthcare and medication use relative to a comparison group. We also examined whether demographic or cancer-related factors were related to healthcare use and whether healthcare use was associated with parents' general functioning. METHODS We conducted a cross-sectional study involving 55 parents of cancer survivors recruited through eight Australian hospitals, and 135 parents of children without a cancer diagnosis, through an online recruitment platform. Participants responded to a questionnaire assessing their health service usage, regular medications, general functioning (engagement activities including work/study) and anxiety and depression symptoms (using PROMIS short forms). We performed regression analysis to determine factors related to healthcare and medication use in parents of survivors. RESULTS More parents of survivors reported accessing mental health services than comparison parents (56% vs. 33%, p=.003), mainly due to their use of social workers. Fewer parents of survivors reported accessing other community health services, particularly general practitioners (51% vs. 78%, p<.001). Having a child survivor who was male was associated with greater use of community health services (B= -0.67, p=.008). No other demographic or cancer-related variables were associated with health service use. Health service use was not associated with general functioning, but greater medication use was associated with higher anxiety scores (B = 1.41, p=.008). CONCLUSION Parents of childhood cancer survivors showed different patterns of health service use relative to comparison parents, but the extent of their use was not significantly linked with demographic or cancer-related variables. Comprehensive assessment of parents' needs in clinical encounters remains vital to identify and appropriately match support needs with available services.
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Affiliation(s)
- Jing Hsu
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Ursula M. Sansom-Daly
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - Kate Hetherington
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Sarah J. Ellis
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Mark W. Donoghoe
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, Australia
| | - Richard J. Cohn
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Alejandra Zentella-Tusie
- Psychology Area, Superior Institute of Psychological Studies (ISEP) University, Barcelona, Spain
| | - Claire E. Wakefield
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
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Christensen SR, Carlsen LT. From well-known to changed everyday family life in families with childhood cancer: A grounded theory of disrupted family dynamic. Psychooncology 2021; 31:282-289. [PMID: 34505326 DOI: 10.1002/pon.5809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Families affected by childhood cancer need to adapt either temporarily or permanently. This study identifies variables that influence this adaption in positive or negative ways by presenting a classic grounded theory. METHODS This inductive, qualitative study included 69 childhood cancer patients, 39 siblings, 42 parents, and 24 childhood cancer survivors from 104 families. RESULTS The families enter a social process after diagnosis characterized by either shuttling between the well-known and the new or being in a situation with both aspects. The extent depends on the stage of the treatment (initial phase, during treatment, or the end of the course of treatment) and on four variables: (1) the diagnosis and prognosis; (2) the course of the disease, including duration of treatment or hospitalizations, and separation from the remaining family; (3) the child's current state, including symptoms, hospitalizations, and current risk of death or relapse; and (4) whether previous and current needs have been met. CONCLUSIONS These variables offer a possible explanation of insufficient coping strategies, and they should be used to identify potentially vulnerable families. The dynamic of the variables imply that families should be reevaluated during each of the three phases, as the risk of changes to the family's everyday life may increase and therefore their needs may also change.
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Affiliation(s)
- Sophie Rex Christensen
- Patient Support and Community Activities, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Line Thoft Carlsen
- Patient Support and Community Activities, Danish Cancer Society Research Center, Copenhagen, Denmark.,Denmark Department of Sociology and Social Work, Aalborg University, Aalborg, Denmark
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Chen HH, Wang IA, Fang SY, Chou YJ, Chen CY. Gender differences in the risk of depressive disorders following the loss of a young child: a nationwide population-based longitudinal study. BMC Psychiatry 2021; 21:414. [PMID: 34416852 PMCID: PMC8377956 DOI: 10.1186/s12888-021-03421-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Losing a child to death is one of the most stressful life events experienced in adulthood. The aim of the current study is to investigate parental risk of seeking treatment for major depression disorders (MDD) after a child's death and to explore whether such connection may operate differentially by parents' prior medical condition. METHODS We studied a retrospective cohort of 7245 parents (2987 mothers and 4258 fathers) identified in the National Health Insurance Research Database of Taiwan (NHIRD) who had lost a child with age between 1 and 12 years. For comparison, the parents of 1:4 birth year- and gender-matched non-deceased children were retrieved (16,512 mothers and 17,753 fathers). Gender-specific Cox regression analyses were performed to estimate risk. RESULTS Nearly 5.0% and 2.4% of bereaved mothers and fathers sought treatment for MDD within three years after a child's death, significantly higher than 0.8% and 0.5% in the non-bereaved parents. With covariate adjustment, the hazard ratio (HR) for maternal and paternal seeking treatment for MDD was estimated 4.71 (95% confidence interval [CI]: 3.35-6.64) and 1.93 (95% CI: 1.27-2.95), respectively. The increased risk of MDD varied by prior disease history; specifically, the increased risk of seeking treatment for MDD was especially prominent for those without chronic physical condition (CPC) (e.g., mothers with CPC: aHR = 2.38, 95% CI: 1.56-3.65 vs. no CPC: aHR = 9.55, 95% CI: 6.17-14.79). CONCLUSIONS After the death of a child, parental elevated risk of MDD was especially prominent for the women and those without prior medical condition. Effective strategies addressing bereavement may require family-based, integrated physical and mental healthcare and even extended counseling service.
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Affiliation(s)
- Hsin-Hung Chen
- grid.278247.c0000 0004 0604 5314Division of Pediatric Neurosurgery, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, St. Linong, Taipei City, Taiwan 112
| | - I-An Wang
- grid.59784.370000000406229172Center of Neuropsychiatric Center, National Health Research Institutes, Zhunan, Taiwan
| | - Shao-You Fang
- grid.59784.370000000406229172Center of Neuropsychiatric Center, National Health Research Institutes, Zhunan, Taiwan
| | - Yiing-Jenq Chou
- grid.260539.b0000 0001 2059 7017Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, St. Linong, Taipei City, Taiwan 112
| | - Chuan-Yu Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, St. Linong, Taipei City, Taiwan, 112. .,Center of Neuropsychiatric Center, National Health Research Institutes, Zhunan, Taiwan.
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Mader L, Frederiksen LE, Bidstrup PE, Hargreave M, Kjær SK, Kuehni CE, Nielsen TT, Krøyer A, Winther JF, Erdmann F. Hospital Contacts for Psychiatric Disorders in Parents of Children With Cancer in Denmark. JNCI Cancer Spectr 2021; 5:pkab036. [PMID: 34085001 PMCID: PMC8164824 DOI: 10.1093/jncics/pkab036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background Having a child diagnosed with cancer is a devastating experience that may affect parents' mental health. We aimed to assess the risk of hospital contacts for psychiatric disorders in parents of children with cancer. Methods We conducted a nationwide population-based cohort study using Danish registry data. Parents of children diagnosed with cancer between 1982 and 2014 (n = 6689 mothers, n = 5509 fathers) were matched with comparison parents of cancer-free children (n = 67 544 mothers, n = 55 756 fathers). We used Cox proportional hazards models to estimate the risk of hospital contacts for any psychiatric disorder and specific disorders. Cox models were also used to investigate sociodemographic and cancer-related risk factors for psychiatric disorders. Results Incidence rates of hospital contacts for any psychiatric disorder were 426 per 100 000 person-years in mothers of children with cancer and 345 per 100 000 person-years in comparison mothers. For fathers, the respective incidence rates were 260 and 262 cases per 100 000 person-years. Compared with parents of cancer-free children, mothers of children with cancer were at an increased risk of hospital contacts for any psychiatric disorder (hazard ratio = 1.23, 95% confidence interval = 1.12 to 1.36), whereas no elevated risk was seen in fathers (hazard ratio = 0.99, 95% confidence interval = 0.87 to 1.13). Among mothers, risks were particularly elevated for affective and stress-related disorders. Parents of deceased children and children diagnosed at a younger age were at particular risk of hospital contacts for psychiatric disorders. Conclusion Hospital contacts for psychiatric disorders were overall rare. Health-care professionals should draw attention to subgroups of vulnerable parents to meet their needs of support and adequate treatment.
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Affiliation(s)
- Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Marie Hargreave
- Virus, Lifestyle and Genes Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjær
- Virus, Lifestyle and Genes Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | | | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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11
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Salem H, Kazak AE, Andersen EW, Belmonte F, Johansen C, Schmiegelow K, Winther JF, Wehner PS, Hasle H, Rosthøj S, Bidstrup PE. Home-based cognitive behavioural therapy for families of young children with cancer (FAMOS): A nationwide randomised controlled trial. Pediatr Blood Cancer 2021; 68:e28853. [PMID: 33369038 DOI: 10.1002/pbc.28853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Evidence-based knowledge is needed to reduce psychological symptoms in families of young children with cancer after treatment ends. OBJECTIVE To evaluate the effect of a psychotherapeutic intervention, FAMily-Oriented Support (FAMOS) on parents of young children after cancer treatment. METHODS All families of children aged 0-6 years who had been treated for cancer at one of the four paediatric oncology departments in Denmark were invited to participate after ending intensive medical treatment. The families were randomly assigned 1:1 to up to seven sessions of FAMOS, a cognitive-behavioural manualised home intervention, for 6 months or to usual psychosocial care. The primary outcome was parents' symptoms of posttraumatic stress disorder (PTSD) at 6 and 12 months after enrolment. The secondary outcomes were parents' symptoms of depression and anxiety. RESULTS We enrolled 109 families (204 parents). Parents in the intervention group did not show a statistically significant decrease in symptoms of PTSD as compared with the control group at 6 months (predicted mean difference, -0.10; 95% confidence interval [CI] -0.19, 0.01), but a statistically significant decrease was seen at 12 months (predicted mean difference, -0.15; 95% CI -0.28, -0.02), and they had significantly lower symptoms of depression at both 6 and 12 months. Differences in reductions in symptoms of anxiety were not statistically significant. CONCLUSIONS The FAMOS intervention reduced parents' symptoms of PTSD and depression. Next step is to also report on psychological effects in the children and siblings (clinicaltrials.gov: NCT02200731).
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Affiliation(s)
- Hanin Salem
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne E Kazak
- Nemours Children's Health System, Wilmington, Delaware
| | | | - Federica Belmonte
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Late Effect Research Unit, Oncology Clinic, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Institute of Clinical Medicine, Medical Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, and Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
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12
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Marsland AL, Walsh CP, Cleary JL, Vaisleib AD, Farrell C, Woods WC, Tersak JM, Wright A, Ewing LJ. Efficacy of a Stress Management Intervention for Mothers of Children with Cancer. J Pediatr Psychol 2020; 45:jsaa058. [PMID: 32705121 DOI: 10.1093/jpepsy/jsaa058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Mothers of children with cancer confront life stress that can impact their psychological and physical health and, in turn, the health of the family. Recommendations advocate preemptive stress-management interventions; however, few studies have investigated their efficacy. Here, we report results of a parallel randomized pilot trial examining health benefits of a stress management intervention designed to teach coping skills. METHODS One hundred twenty mothers (age 36 ± 8 years) of children newly diagnosed with cancer were randomized to a 12-session stress management intervention (n = 60) or usual care (n = 60). Sessions took place in the inpatient or outpatient setting of a children's hospital. Primary outcome variables included psychological function and physical health assessed preintervention and postintervention and at 6-month follow-up (∼12 months postdiagnosis). RESULTS Enrollment, retention, and satisfaction data supported feasibility and acceptability. Latent change score models showed the intervention reduced perceived stress (d = -0.37, p = 0.03), anxiety symptoms (ds = -0.38 and -0.56, ps < .03) and, a nonsignificant effect for depressive symptoms (d = -0.29, p = .11) across the 6 months following diagnosis. Intervention participants also endorsed fewer depressive symptoms than controls ∼12 months after diagnosis. The intervention improved stress management skills, which associated with the psychological benefits of participation. There were no intervention-related changes in perceived health or markers of inflammation. CONCLUSION Intervention-related improvements in stress management skills may result in better psychological health in the face of caring for a child with cancer. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02022449.
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13
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Mader L, Hargreave M, Frederiksen LE, Bidstrup PE, Dalton SO, Kjaer SK, Nielsen TT, Kroyer A, Winther JF, Erdmann F. The impact of childhood cancer on parental separation, divorce, and family planning in Denmark. Cancer 2020; 126:3330-3340. [PMID: 32449155 DOI: 10.1002/cncr.32901] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Childhood cancer is a devastating experience for the family. The objective of the current study was to assess the impact of having a child with cancer on parental separation, divorce, and future family planning among families residing in Denmark. METHODS The authors conducted a nationwide cohort study using Danish registry data. Parents of children diagnosed with cancer between 1982 and 2014 (7066 children and 12,418 case parents) were matched with 10 comparison parents of cancer-free children per case parent (69,993 children and 125,014 comparison parents). We used discrete-time Cox regression models to compare the risk of separation (end of cohabitation) and divorce between case and comparison parents, and to identify risk factors for separation and divorce among case parents only. Descriptive statistics were used to compare family planning between case and comparison parents. RESULTS Case parents were found to have a slightly lower risk of separation (hazard ratio, 0.96; 95% confidence interval, 0.93-0.99) and divorce (hazard ratio, 0.92; 95% confidence interval, 0.87-0.97) than comparison parents. The authors found that case parents who were aged <45 years, with short education (an International Standard Classification of Education code indicating early childhood education, primary education, and lower secondary education), and who were unemployed were at an increased risk of separation and divorce. Moreover, the parents of children diagnosed with cancer at a young age (aged <15 years) were more likely to separate or divorce. No differences with regard to the total number of children and time to a next child after the cancer diagnosis were observed between case and comparison parents. CONCLUSIONS Having a child with cancer was not associated with an overall adverse impact on parents' risk of separation or divorce and future family planning. These encouraging findings should be communicated to parents to support them along their child's cancer trajectory.
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Affiliation(s)
- Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marie Hargreave
- Virus, Lifestyle and Genes Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Services, Zealand University Hospital, Naestved, Denmark
| | - Susanne K Kjaer
- Virus, Lifestyle and Genes Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Anja Kroyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
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14
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Hovén E, Hagström J, Pöder U, Grönqvist H, von Essen L. Parents' needs of support following the loss of a child to cancer: a Swedish, prospective, longitudinal, multi-centre study. Acta Oncol 2020; 59:351-357. [PMID: 31702406 DOI: 10.1080/0284186x.2019.1686535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Parents' needs of support following the loss of a child to cancer and whether these needs are met are not fully known. This study aimed to describe parents' needs, opportunity, and benefit of support from healthcare professionals and significant others from shortly after, up to five years after bereavement.Material and methods: Data were collected at nine months (T5, n = 20), eighteen months (T6, n = 37), and five years after the child's death (T7, n = 38). Parents answered questions via telephone about need, opportunity, and benefit of talking to psychologists, social workers, partners, and friends. Needs were examined in relation to parent and child characteristics, including sex, age, and parent posttraumatic stress symptoms (PTSS).Results: The proportion reporting a need of support from psychologists varied from 56% and 46% at T5 to 20% and 6% at T7 (mothers and fathers, respectively). All mothers and 90% of fathers reported a need of support from social workers at T5. At T7, the corresponding percentages were 30% and 6%. More mothers than fathers reported a need of support from friends at T7 (p = .001). The proportion reporting a need of support from psychologists, social workers, and friends decreased over time (all p ≤ .050). Parents reporting a higher level of PTSS were more likely to report a need of support from social workers at T6 (p = .040) and from psychologists (p = .011) and social workers (p = .012) at T7. Opportunities for support from healthcare professionals varied, most reported need of and opportunity for support from significant others. Almost all reported benefit from received support.Conclusion: Bereaved parents need and benefit of support from healthcare professionals and significant others. Results show a need for improved access to psychosocial services, even at five years post bereavement. Large-scale studies are needed to better understand the associations between parent and child characteristics and support needs.
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Affiliation(s)
- Emma Hovén
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Josefin Hagström
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ulrika Pöder
- Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Helena Grönqvist
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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15
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The impact of childhood cancer on parental working status and income in Denmark: Patterns over time and determinants of adverse changes. Int J Cancer 2020; 147:1006-1017. [DOI: 10.1002/ijc.32867] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/18/2019] [Accepted: 01/07/2020] [Indexed: 12/17/2022]
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