Yonsei Med J.  2017 Jul;58(4):816-822. 10.3349/ymj.2017.58.4.816.

Factors Associated with Emotional Distress in Children and Adolescents during Early Treatment for Cancer

• Sohn IJ
• Han JW
• Hahn SM
• Song DH
• Lyu CJ
• Cheon KA

• KMID: 2419089
• DOI: http://doi.org/10.3349/ymj.2017.58.4.816

Abstract

PURPOSE
Children and adolescents diagnosed with cancer experience emotional distress, such as sadness, worrying, and irritability. However, there is little information about the psychological well-being of parents at the time of their child's diagnosis. We sought to identify factors that were associated with emotional distress in cancer patients as a basis for developing innovative psychological interventions.
MATERIALS AND METHODS
A retrospective chart review was performed on patients newly diagnosed with cancer at a single center in Korea from 2014 to 2016. Eighty-five patients and their mothers completed psychological inventories. To determine factors associated with emotional distress in patients, we assessed the psychological inventory results using multiple linear regression after performing correlation analysis.
RESULTS
The maternal Beck Depression Inventory-II (BDI-II) score was positively correlated with total problem scores and externalizing scores in patients aged less than 7 years. In patients aged 7-12 years, there was no significant association between the patient's emotional distress and other variables. In contrast, the maternal BDI-II score was the strongest factor associated with patient depression in adolescents.
CONCLUSION
We suggest that the most important factor affecting emotional distress in children and adolescents with cancer is maternal depression, especially in patients aged 1-6 years and aged 13-17 years. Understanding the factors associated with emotional distress of cancer patients allows us to develop early psychiatric interventions for patients and their parents at the initial psychological crisis.

Keyword

Diagnosis of cancer; depression; anxiety; mother-child relationship

MeSH Terms

Adolescent
Child
Child, Preschool
Demography
Female
Humans
Infant
Linear Models
Male
Neoplasms/*psychology/*therapy
Parents/psychology
Republic of Korea
Retrospective Studies
Stress, Psychological/*complications

Figure

• 

  Fig. 1 Correlations between maternal BDI-II score and K-CBCL score of patients aged 1–6 years. (A) Scatter plot showing a significant positive correlation between maternal BDI-II score and patient total problem score (p<0.01, r=0.373, n=47). (B) Scatter plot showing lack of correlation between maternal BDI-II score and patient internalizing score (p=0.11, r=0.239, n=47). (C) Scatter plot showing a significant positive correlation between maternal BDI-II score and patient externalizing score (p<0.05, r=0.311, n=47). Comparisons were made using the Pearson correlation. Each point represents an individual patient. BDI-II, Beck Depression Inventory-II; K-CBCL, Korean-Child Behavior Checklist.

• 

  Fig. 2 Correlation between maternal BDI-II score and CDI score of patients aged 7–12 years. Scatter plot showing lack of correlation between maternal BDI-II score and patient CDI score (p=0.99, r=0.00, n=13). Comparisons were made using the Pearson correlation. Each point represents an individual patient. BDI-II, Beck Depression Inventory-II; CDI, Children's Depression Inventory.

• 

  Fig. 3 Correlation between maternal BDI-II score and BDI-II score of patients aged 13–17 years. Scatter plot showing a significant positive correlation between maternal BDI-II score and patient BDI-II score (p<0.01, r=0.595, n=25). Comparisons were made using the Pearson correlation. Each point represents an individual patient. BDI-II, Beck Depression Inventory-II.

Reference

1. McGregor LM, Metzger ML, Sanders R, Santana VM. Pediatric cancers in the new millennium: dramatic progress, new challenges. Oncology (Williston Park). 2007; 21:809–820. PMID: 17722742.

2. Sun W, Gaynon PS, Sposto R, Wayne AS. Improving access to novel agents for childhood leukemia. Cancer. 2015; 121:1927–1936. PMID: 25678105.

3. Rodriguez EM, Dunn MJ, Zuckerman T, Vannatta K, Gerhardt CA, Compas BE. Cancer-related sources of stress for children with cancer and their parents. J Pediatr Psychol. 2012; 37:185–197. PMID: 21841187.

4. Collins JJ, Devine TD, Dick GS, Johnson EA, Kilham HA, Pinkerton CR, et al. The measurement of symptoms in young children with cancer: the validation of the Memorial Symptom Assessment Scale in children aged 7-12. J Pain Symptom Manage. 2002; 23:10–16. PMID: 11779663.

5. National Comprehensive Cancer Network. Distress management. Clinical practice guidelines. J Natl Compr Canc Netw. 2003; 1:344–374. PMID: 19761069.

6. Graves KD, Arnold SM, Love CL, Kirsh KL, Moore PG, Passik SD. Distress screening in a multidisciplinary lung cancer clinic: prevalence and predictors of clinically significant distress. Lung Cancer. 2007; 55:215–224. PMID: 17084483.

7. Barrera M, D'Agostino NM, Gibson J, Gilbert T, Weksberg R, Malkin D. Predictors and mediators of psychological adjustment in mothers of children newly diagnosed with cancer. Psychooncology. 2004; 13:630–641. PMID: 15334531.

8. Virtue SM, Manne S, Mee L, Bartell A, Sands S, Ohman-Strickland P, et al. The role of social and cognitive processes in the relationship between fear network and psychological distress among parents of children undergoing hematopoietic stem cell transplantation. J Clin Psychol Med Settings. 2014; 21:223–233. PMID: 25081956.

9. Phipps S, Long A, Hudson M, Rai SN. Symptoms of post-traumatic stress in children with cancer and their parents: effects of informant and time from diagnosis. Pediatr Blood Cancer. 2005; 45:952–959. PMID: 15806541.

10. Dunn MJ, Rodriguez EM, Barnwell AS, Grossenbacher JC, Vannatta K, Gerhardt CA, et al. Posttraumatic stress symptoms in parents of children with cancer within six months of diagnosis. Health Psychol. 2012; 31:176–185. PMID: 21942750.

11. Neu M, Matthews E, King NA, Cook PF, Laudenslager ML. Anxiety, depression, stress, and cortisol levels in mothers of children undergoing maintenance therapy for childhood acute lymphoblastic leukemia. J Pediatr Oncol Nurs. 2014; 31:104–113. PMID: 24608702.

12. Okado Y, Long AM, Phipps S. Association between parent and child distress and the moderating effects of life events in families with and without a history of pediatric cancer. J Pediatr Psychol. 2014; 39:1049–1060. PMID: 25064801.

13. Trask PC, Paterson AG, Trask CL, Bares CB, Birt J, Maan C. Parent and adolescent adjustment to pediatric cancer: associations with coping, social support, and family function. J Pediatr Oncol Nurs. 2003; 20:36–47. PMID: 12569433.

14. Kearney JA, Salley CG, Muriel AC. Standards of psychosocial care for parents of children with cancer. Pediatr Blood Cancer. 2015; 62(Suppl 5):S632–S683. PMID: 26700921.

15. Groarke A, Curtis R, Groarke JM, Hogan MJ, Gibbons A, Kerin M. Post-traumatic growth in breast cancer: how and when do distress and stress contribute? Psychooncology. 2016; 8. 08. [Epub]. DOI: 10.1002/pon.4243.

16. Andersen BL, Shapiro CL, Farrar WB, Crespin T, Wells-Digregorio S. Psychological responses to cancer recurrence. Cancer. 2005; 104:1540–1547. PMID: 16118802.

17. Stafford L, Komiti A, Bousman C, Judd F, Gibson P, Mann GB, et al. Predictors of depression and anxiety symptom trajectories in the 24 months following diagnosis of breast or gynaecologic cancer. Breast. 2016; 26:100–105. PMID: 27017248.

18. Alfonsson S, Olsson E, Hursti T, Lundh MH, Johansson B. Socio-demographic and clinical variables associated with psychological distress 1 and 3 years after breast cancer diagnosis. Support Care Cancer. 2016; 24:4017–4023. PMID: 27129841.

19. Roberts CS, Cox CE, Reintgen DS, Baile WF, Gibertini M. Influence of physician communication on newly diagnosed breast patients' psychologic adjustment and decision-making. Cancer. 1994; 74(1 Suppl):336–341. PMID: 8004605.

20. Cuisinier MC, Van Eijk JT, Jonkers R, Dokter HJ. Psychosocial care and education of the cancer patient: strengthening the physician's role. Patient Educ Couns. 1986; 8:5–16. PMID: 10300737.

21. Miller KS, Vannatta K, Compas BE, Vasey M, McGoron KD, Salley CG, et al. The role of coping and temperament in the adjustment of children with cancer. J Pediatr Psychol. 2009; 34:1135–1143. PMID: 19451171.

22. Santos S, Crespo C, Canavarro MC, Kazak AE. Parents' romantic attachment predicts family ritual meaning and family cohesion among parents and their children with cancer. J Pediatr Psychol. 2017; 42:114–124. Guest Editors: Gerhardt CA, Berg CA, et al.

23. Hayes RD, Lee W, Rayner L, Price A, Monroe B, Hansford P, et al. Gender differences in prevalence of depression among patients receiving palliative care: the role of dependency. Palliat Med. 2012; 26:696–702. PMID: 21775410.

24. Wang R, Syed IA, Nathan PC, Barr RD, Rosenberg-Yunger ZR, Klassen AF. Exploring cancer worry in adolescent and young adult survivors of childhood cancers. J Adolesc Young Adult Oncol. 2015; 4:192–199. PMID: 27077153.

25. Zebrack BJ, Corbett V, Embry L, Aguilar C, Meeske KA, Hayes-Lattin B, et al. Psychological distress and unsatisfied need for psychosocial support in adolescent and young adult cancer patients during the first year following diagnosis. Psychooncology. 2014; 23:1267–1275. PMID: 24664958.

26. Ostlund BD, Measelle JR, Laurent HK, Conradt E, Ablow JC. Shaping emotion regulation: attunement, symptomatology, and stress recovery within mother-infant dyads. Dev Psychobiol. 2017; 59:15–25. PMID: 27481553.

27. Luby JL, Belden A, Harms MP, Tillman R, Barch DM. Preschool is a sensitive period for the influence of maternal support on the trajectory of hippocampal development. Proc Natl Acad Sci U S A. 2016; 113:5742–5747. PMID: 27114522.

28. Colletti CJ, Wolfe-Christensen C, Carpentier MY, Page MC, McNall-Knapp RY, Meyer WH, et al. The relationship of parental overprotection, perceived vulnerability, and parenting stress to behavioral, emotional, and social adjustment in children with cancer. Pediatr Blood Cancer. 2008; 51:269–274. PMID: 18454464.

29. Fedele DA, Mullins LL, Wolfe-Christensen C, Carpentier MY. Longitudinal assessment of maternal parenting capacity variables and child adjustment outcomes in pediatric cancer. J Pediatr Hematol Oncol. 2011; 33:199–202. PMID: 21336169.

30. Manuel JC. Risk and resistance factors in the adaptation in mothers of children with juvenile rheumatoid arthritis. J Pediatr Psychol. 2001; 26:237–246. PMID: 11329483.

31. Manian N, Bornstein MH. Dynamics of emotion regulation in infants of clinically depressed and nondepressed mothers. J Child Psychol Psychiatry. 2009; 50:1410–1418. PMID: 19788549.

32. Foster CE, Webster MC, Weissman MM, Pilowsky DJ, Wickramaratne PJ, Rush AJ, et al. Course and severity of maternal depression: associations with family functioning and child adjustment. J Youth Adolesc. 2008; 37:906–916. PMID: 25013241.

33. Helgeson VS, Becker D, Escobar O, Siminerio L. Families with children with diabetes: implications of parent stress for parent and child health. J Pediatr Psychol. 2012; 37:467–478. PMID: 22267104.

34. Van der Graaff J, Branje S, De Wied M, Hawk S, Van Lier P, Meeus W. Perspective taking and empathic concern in adolescence: gender differences in developmental changes. Dev Psychol. 2014; 50:881–888. PMID: 24040846.

35. Eisenberg N, Cumberland A, Guthrie IK, Murphy BC, Shepard SA. Age changes in prosocial responding and moral reasoning in adolescence and early adulthood. J Res Adolesc. 2005; 15:235–260. PMID: 20592955.

36. Hinnant JB, O'Brien M. Cognitive and emotional control and perspective taking and their relations to empathy in 5-year-old children. J Genet Psychol. 2007; 168:301–322. PMID: 18200891.

37. Juth V, Silver RC, Sender L. The shared experience of adolescent and young adult cancer patients and their caregivers. Psychooncology. 2015; 24:1746–1753. PMID: 25808790.

38. Walker C, Papadopoulos L, Lipton M, Hussein M. The importance of children's illness beliefs: the Children's Illness Perception Questionnaire (CIPQ) as a reliable assessment tool for eczema and asthma. Psychol Health Med. 2006; 11:100–107. PMID: 17129899.

39. Tully EC, Donohue MR, Garcia SE. Children's empathy responses and their understanding of mother's emotions. Cogn Emot. 2015; 29:118–129. PMID: 24650197.

40. Hockenberry-Eaton M, Dilorio C, Kemp V. The relationship of illness longevity and relapse with self-perception, cancer stressors, anxiety, and coping strategies in children with cancer. J Pediatr Oncol Nurs. 1995; 12:71–79. PMID: 7612200.