Pathways From Childhood Sociomoral Sensitivity in Friendship, Insecurity, and Peer Rejection to Adult Friendship Quality.

Across the life span, friendship is an important component of people's support networks. This article explores the developmental roots of adult friendship intimacy and satisfaction, taking into consideration the early interplay between sociomoral sensitivity in friendship, insecurity in peer contexts, and peer rejection. Data (N = 176) came from the longitudinal study "Individual Development and Social Structure." Respondents were surveyed repeatedly from age 7 to 37 years. Autoregressive cross-lagged panel models show that sociomoral sensitivity in friendship protects adolescents from peer rejection and is reciprocally associated with insecurity. Childhood and adolescent sociomoral sensitivity antecede early adult friendship intimacy, which, in turn, antecedes friendship satisfaction in mid-adulthood. The findings indicate a sequence of pathways from sociomoral sensitivity developed early in life to friendship quality in adulthood.

The Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital and Depression Scale (HADS-A) as screening tools for generalized anxiety disorder among cancer patients.

OBJECTIVE: Anxiety in cancer patients may represent a normal psychological reaction. To detect patients with pathological levels, appropriate screeners with established cut-offs are needed. Given that previous research is sparse, we investigated the diagnostic accuracy of 2 frequently used screening tools in detecting generalized anxiety disorder (GAD). METHODS: We used data of a multicenter study including 2141 cancer patients. Diagnostic accuracy was investigated for the Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital Anxiety and Depression Scale (HADS-A). GAD, assessed with the Composite International Diagnostic Interview for Oncology, served as a reference standard. Overall accuracy was measured with the area under the receiver operating characteristics curve (AUC). The AUC of the 2 screeners were statistically compared. We also calculated accuracy measures for selected cut-offs. RESULTS: Diagnostic accuracy could be interpreted as adequate for both screeners, with an identical AUC of .81 (95% CI: .79-.82). Consequently, the 2 screeners did not differ in their performance (P = .86). The best balance between sensitivity and specificity was found for cut-offs ≥7 (GAD-7) and ≥8 (HADS-A). The officially recommended thresholds for the GAD-7 (≥ 10) and the HADS-A (≥11) showed low sensitivities of 55% and 48%, respectively. CONCLUSIONS: The GAD-7 and HADS-A showed AUC of adequate diagnostic accuracy and hence are applicable for GAD screening in cancer patients. Nevertheless, the choice of optimal cut-offs should be carefully evaluated.

Quality of life in cancer patients-a comparison of inpatient, outpatient, and rehabilitation settings.

PURPOSE: The aim of this study was to compare quality of life (QoL) data from cancer patients in different clinical settings with data from the general population. METHODS: A sample of 4020 German cancer patients (1735 inpatients, 1324 outpatients, 961 participants in rehabilitation treatment) was tested with the EORTC QLQ-C30. RESULTS: Compared with the general population, cancer patients reported markedly worse QoL. There were clinically significant differences on all 15 scales of the EORTC QLQ-C30 (except one). For the sum score, averaging across 13 scales, the effect size of the difference between cancer patients and the general population was d = 1.16. Inpatients reported the greatest detriments to QoL, followed by the rehabilitation patients and the outpatients (mean sum scores 68.6, 71.0, and 72.3, respectively, compared with 89.2 in the general population). Mean scores for different groups of cancer sites are given separately for the three settings. CONCLUSION: The detriments to QoL were stronger than in comparable studies conducted on data from clinical trials. Since these detriments were found in all three settings to a similar degree, health care providers should offer their services not only to inpatients but to outpatients and patients treated in rehabilitation clinics as well. The data can be used for QoL comparisons of assessments from different settings.

The Influence of Adult and Peer Role Models on Children' and Adolescents' Sharing Decisions.

This study explores how the age (adult vs. peer) and the suggestion (to be fair vs. unfair) of models affect the sharing decisions of 9- and 12-year-olds (N = 365) from Italy and Singapore. Results demonstrate a developmental shift in the influence of models on children's and adolescents' sharing decisions in both cultures: Children's decisions were more affected by an adult model's suggestion than by that of a peer model, whereas the opposite was true for adolescents. Regardless of the models' influence, participants considered equal sharing to be the fair choice and reported being happier when their sharing decisions were generous. Our results highlight the crucial importance of social and developmental factors for the promotion of fairness judgments and emotions.

Effects of patient-centered communication on anxiety, negative affect, and trust in the physician in delivering a cancer diagnosis: A randomized, experimental study.

BACKGROUND: When bad news about a cancer diagnosis is being delivered, patient-centered communication (PCC) has been considered important for patients' adjustment and well-being. However, few studies have explored how interpersonal skills might help cancer patients cope with anxiety and distress during bad-news encounters. METHODS: A prospective, experimental design was used to investigate the impact of the physician communication style during a bad-news encounter. Ninety-eight cancer patients and 92 unaffected subjects of both sexes were randomly assigned to view a video of a clinician delivering a first cancer diagnosis with either an enhanced patient-centered communication (E-PCC) style or a low patient-centered communication (L-PCC) style. Participants rated state anxiety and negative affect before and immediately after the video exposure, whereas trust in the physician was rated after the video exposure only. Main and interaction effects were analyzed with generalized linear models. RESULTS: Viewing the disclosure of a cancer diagnosis resulted in a substantial increase in state anxiety and negative affect among all participants. This emotional response was moderated by the physician's communication style: Participants viewing an oncologist displaying an E-PCC style were significantly less anxious than those watching an oncologist displaying an L-PCC style. They also reported significantly higher trust in the physician. CONCLUSIONS: Under a threatening, anxiety-provoking disclosure of bad news, a short sequence of empathic PCC influences subjects' psychological state, insofar that they report feeling less anxious and more trustful of the oncologist. Video exposure appears to be a valuable method for investigating the impact of a physician's communication style during critical encounters. Cancer 2017;123:3167-75. © 2017 American Cancer Society.

The Hospital Anxiety and Depression Scale (HADS) and the 9-item Patient Health Questionnaire (PHQ-9) as screening instruments for depression in patients with cancer.

BACKGROUND: Depression screening in patients with cancer is recommended by major clinical guidelines, although the evidence on individual screening tools is limited for this population. Here, the authors assess and compare the diagnostic accuracy of 2 established screening instruments: the depression modules of the 9-item Patient Health Questionnaire (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS-D), in a representative sample of patients with cancer. METHODS: This multicenter study was conducted with a proportional, stratified, random sample of 2141 patients with cancer across all major tumor sites and treatment settings. The PHQ-9 and HADS-D were assessed and compared in terms of diagnostic accuracy and receiver operating characteristic (ROC) curves for Diagnostic and Statistical Manual of Mental Disorders, 4th edition diagnosis of major depressive disorder using the Composite International Diagnostic Interview for Oncology as the criterion standard. RESULTS: The diagnostic accuracy of the PHQ-9 and HADS-D was fair for diagnosing major depressive disorder, with areas under the ROC curves of 0.78 (95% confidence interval, 0.76-0.79) and 0.75 (95% confidence interval, 0.74-0.77), respectively. The 2 questionnaires did not differ significantly in their areas under the ROC curves (P = .15). The PHQ-9 with a cutoff score ≥7 had the best screening performance, with a sensitivity of 83% (95% confidence interval, 78%-89%) and a specificity of 61% (95% confidence interval, 59%-63%). The American Society of Clinical Oncology guideline screening algorithm had a sensitivity of 44% (95% confidence interval, 36%-51%) and a specificity of 84% (95% confidence interval, 83%-85%). CONCLUSIONS: In patients with cancer, the screening performance of both the PHQ-9 and the HADS-D was limited compared with a standardized diagnostic interview. Costs and benefits of routinely screening all patients with cancer should be weighed carefully. Cancer 2017;123:4236-4243. © 2017 American Cancer Society.

Utilization of professional psychological care in a large German sample of cancer patients.

OBJECTIVE: Although one-third of cancer patients are perceived to have a need for psychological support based on the percentage of mental disorders, little is known about the actual utilization of psychological care in cancer. We aimed to assess cancer patients' reported use of psychological care and its correlates in a large, representative sample. METHODS: In a multicenter, cross-sectional study in Germany, 4020 cancer patients (mean age 58 years, 51% women) were evaluated. We obtained self-reports of use of psychotherapy and psychological counseling. We measured distress with the Distress Thermometer, symptoms of depression with the Patient Health Questionnaire, anxiety with the Generalized Anxiety Disorder Scale, and social support with the Illness-specific Social Support Scale. In a subsample of 2141, we evaluated the presence of a mental disorder using the Composite International Diagnostic Interview. RESULTS: In total, 28.9% (95% confidence interval 27.4%-30.4%) reported having used psychotherapy or psychological counseling or both because of distress due to cancer. Independent correlates of utilization included age (odds ratio [OR] = 0.97 per year], sex (male, OR = 0.55), social support (OR = 0.96), symptoms of depression (OR = 1.04) and anxiety (OR = 1.08), the diagnosis of a mental disorder (OR = 1.68), and a positive attitude toward psychosocial support (OR = 1.27). Less than half of those currently diagnosed with a mental disorder reported having taken up psychological support offers. CONCLUSION: Special efforts should be made to reach populations that report low utilization of psychological care in spite of having a need for support.

Women at familial risk of breast cancer electing for prophylactic mastectomy: frequencies, procedures, and decision-making characteristics.

BACKGROUND: Some women of families at high risk of breast cancer (BC) choose prophylactic mastectomy (PM) in spite of ambiguous evidence for survival benefits. The aim of this study was to investigate counselees' characteristics, decisions on PM, and frequencies of different procedures to better understand how to tailor interventions. PATIENTS AND METHODS: Eight hundred and forty-nine counselees who attended interdisciplinary consultation for genetic risk adjustment at the University Hospital Heidelberg between July 2009 and July 2011 received a tripartite questionnaire addressing sociodemographic characteristics, psychological parameters, behavioural questions, and medical data. RESULTS: Six hundred and twelve of the 849 counselees (72%) returned the questionnaire. Four hundred were classified as high risk of genetic BC (19.5% BRCA mutation carriers; 4% unclassified variant (UV); and 76.5% calculated as high risk by pedigree). Two hundred and thirteen out of 400 (53%) were diagnosed with BC. Fourteen out of 54 (27%) BRCA mutation carriers with BC chose contralateral PM (CPM) compared to 24/126 (14%) without a mutation but with a personal BC history (p = 0.2175). Of those without BC, 12/27 (44%) mutation carriers opted for bilateral PM (BPM) compared to none without a mutation (p < 0.0001). Women who received any PM (CPM and BPM) reported a higher emotional burden from partners (p = 0.003) and family (p = 0.008), more worries regarding children and family (p = 0.003) and were associated with positive mutation status and higher heterozygous and lifetime risk (all p < 0.001). CONCLUSION: Although evidence on survival benefit is unclear in several clinical situations, a relevant number of counselees opt for PM. Counselees may decide based on other reasons than survival benefit.

Adherence to the breast cancer surveillance program for women at risk for familial breast and ovarian cancer versus overscreening: a monocenter study in Germany.

Breast cancer (BC) is the leading cancer among women worldwide and in 5-10 % of cases is of hereditary origin, mainly due to BRCA1/2 mutations. Therefore, the German Consortium for Familial Breast and Ovarian Cancer (HBOC) with its 15 specialized academic centers offers families at high risk for familial/hereditary cancer a multimodal breast cancer surveillance program (MBCS) with regular breast MRI, mammography, ultrasound, and palpation. So far, we know a lot about the psychological effects of genetic testing, but we know little about risk-correlated adherence to MBCS or prophylactic surgery over time. The aim of this study was to investigate counselees' adherence to recommendations for MBCS in order to adjust the care supply and define predictors for incompliance. All counselees, who attended HBOC consultation at the University Hospital Heidelberg between July 01, 2009 and July 01, 2011 were eligible to participate. A tripartite questionnaire containing sociodemographic information, psychological parameters, behavioral questions, and medical data collection from the German consortium were used. A high participation rate was achieved among the study population, with 72 % returning the questionnaire. This study showed a rate of 59 % of full-adherers to the MBCS. Significant predictors for partial or full adherence were having children (p = 0.0221), younger daughters (p = 0.01795), a higher awareness of the topic HBOC (p = 0.01795, p < 0.0001), a higher perceived breast cancer risk (p < 0.0001), and worries (p = 0.0008)/impairment (p = 0.0257) by it. Although the current data suggest a good adherence of MBCS, prospective studies are needed to understand counselees' needs to further improve surveillance programs and adherence to them. Adherence to the breast cancer surveillance program for women at risk for familial breast and ovarian cancer versus overscreening-a monocenter study in Germany.

Twelve-Month and Lifetime Prevalence of Mental Disorders in Cancer Patients.

BACKGROUND: Psychological problems are common in cancer patients. For the purpose of planning psycho-oncological interventions and services tailored to the specific needs of different cancer patient populations, it is necessary to know to what extent psychological problems meet the criteria of mental disorders. The purpose of this study was to estimate the 12-month and lifetime prevalence rates of mental disorders in cancer patients. METHODS: A representative sample of patients with different tumour entities and tumour stages (n = 2,141) in outpatient, inpatient and rehabilitation settings underwent the standardized computer-assisted Composite International Diagnostic Interview for mental disorders adapted for cancer patients (CIDI-O). RESULTS: The overall 12-month prevalence for any mental disorder was 39.4% (95% CI: 37.3-41.5), that for anxiety disorders was 15.8% (95% CI: 14.4-17.4), 12.5% (95% CI: 11.3-14.0) for mood disorders, 9.5% (95% CI: 8.3-10.9) for somatoform disorders, 7.3% (95% CI: 6.2-8.5) for nicotine dependence, 3.7% (95% CI: 3.0-4.6) for disorders due to general medical condition, and 1.1% (95% CI: 0.7-1.6) for alcohol abuse or dependence. Lifetime prevalence for any mental disorder was 56.3% (95% CI 54.1-58.6), that for anxiety disorders was 24.1% (95% CI: 22.3-25.9), 20.5% (95% CI: 18.9-22.3) for mood disorders, 19.9% (95% CI: 18.3-21.7) for somatoform disorders, 18.2% (95% CI: 16.6-20.0) for nicotine dependence, 6.4% (95% CI: 5.4-7.6) for alcohol abuse or dependence, 4.6% (95% CI: 3.8-5.6) for disorders due to general medical condition, and 0.2% (95% CI: 0.1-0.6) for eating disorders. CONCLUSIONS: Mental disorders are highly prevalent in cancer patients, indicating the need for provision of continuous psycho-oncological support from inpatient to outpatient care, leading to an appropriate allocation of direct personnel and other resources.

STRESSORS, SYMPTOM PROFILE, AND PREDICTORS OF ADJUSTMENT DISORDER IN CANCER PATIENTS. RESULTS FROM AN EPIDEMIOLOGICAL STUDY WITH THE COMPOSITE INTERNATIONAL DIAGNOSTIC INTERVIEW, ADAPTATION FOR ONCOLOGY (CIDI-O).

BACKGROUND: We aimed to investigate type and frequency of stressors, predominant symptom profiles, and predictors of adjustment disorders (AD) in cancer patients across major tumor entities. METHODS: In this epidemiological study, we examined 2,141 cancer patients out of 4,020 screened with the Composite International Diagnostic Interview, adaptation for oncology (CIDI-O). AD were operationalized as subthreshold disorders according to DSM-IV criteria. RESULTS: In our sample, 265 out of 2,141 patients (12.4%) met all criteria for AD (unweighted 4-week prevalence). The disclosure of the cancer diagnosis, relapse or metastases, and cancer treatments were most frequently described as stressors associated with depressive or anxious symptoms. With regard to AD symptom profiles, patients showed high prevalence rates of affective symptoms according to the DSM-IV criteria of Major Depression: The highest prevalence rates were found for cognitive disturbances (concentration and memory problems) (88%), sleeping disturbances (86%), and depressive mood (83%). We found sex, education, and metastasis as significant predictors for AD. Higher education was the most influential predictor. Men were half as likely to report symptoms fulfilling the AD criteria as women. Patients with metastasized tumors had a more than 80% higher risk of AD than those without metastasis. However, the explained variance of our model is very small (Nagelkerke's R² = 0.08). CONCLUSIONS: Patients with AD can be identified using a standardized instrument and deserve clinical attention, as they often show severe clinical symptoms and impairments. Improving the clinical conceptualization of AD by the adding-on of potential stress-response-symptoms is necessary to identify severe psychological strain.

Long-term experiences with genetic consultation in people with hereditary breast and ovarian cancer.

PURPOSE: Advances in genetics and increased public awareness increased the demand for interdisciplinary genetic outpatient consultation (IOGC). Communicating cancer risk is complex, and ideally information transfer should be individualized. Although psychological experiences with genetic testing have been studied in detail, studies on long-term experiences with IOGC and information transfer are lacking. We assessed patients' understanding and satisfaction with IOGC in families at risk of hereditary breast and ovarian cancer (HBOC) with the aim of informing best clinical practice, improving compliance and informed decision-making. METHODS: Female counselees referred for IOGC between July 1, 2009 and July 1, 2011 were eligible. Data were collected using a 47-item postal questionnaire to assess sociodemographic, psychological, behavioral parameters. Overall satisfaction and personal usefulness of IOGC were assessed with a five-point, and risk perception with a visual analog scale. Data were analyzed using Spearman rank, Wilcoxon U or Chi-squared test. RESULTS: 612 (72 %) of 849 women participated reported being highly satisfied (75 %, n = 430) and declared personal usefulness (73 %, n = 421) on average 3.5 years after IOGC. Women deemed "high risk" assessed their risk of developing BC as significantly higher than non-high-risk counselees (3.2 versus 3.0, p = 0.00484). Risk perception was lower in BRCA1/2 mutation carriers than in women with unclassified variants or no mutation (2.8 versus 3.5 and 3.1, respectively). CONCLUSION: Women with an HBOC background have additional needs to achieve long-term satisfaction after IOGC. Prospective studies are required to optimize care for the increasing number of people who seek genetic consultation, particularly as the complexity of genetics knowledge increases.

Performance status and depressive symptoms as predictors of quality of life in cancer patients. A structural equation modeling analysis.

OBJECTIVE: This study aimed to examine whether depressive symptoms and performance status are independent predictors of both the physical and psychological domains of health-related quality of life (HRQoL) in cancer patients. METHODS: A sample of 4020 cancer patients (mean age 58 years, 51% women) was evaluated. Depressive symptoms were measured with the patient health questionnaire and HRQoL with the European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30. The impact of the illness on everyday activities was assessed with physician ratings of both the Karnofsky performance status and the Eastern Cooperative Oncology Group performance status. The simultaneous effects of depression and performance status on quality of life outcomes were estimated using structural equation modeling. RESULTS: Both depressive symptoms and performance status independently predicted the physical and psychological domains of HRQoL. However, the impact of depressive symptoms on the physical HRQoL was stronger than the impact of performance status on the psychological HRQoL. CONCLUSION: Our results suggest that comorbid depressive symptoms are independently associated with both physical and psychological HRQoL in cancer patients after controlling for the physician-rated performance status. Thus, comorbid depression should be taken into account when evaluating reduced HRQoL in cancer patients. To support a causal impact of depression on HRQoL, intervention studies are needed to show that improving depression enhances cancer patients' HRQoL.

[The mental health of only children and of siblings with cancer - first results of a multicenter study in Germany]. / Psychische Gesundheit von Einzelkindern und Kindern mit Geschwistern, deren Eltern an Krebs erkrankt sind. Ergebnisse einer multizentrischen Studie in Deutschland.

BACKGROUND: Children of parents with cancer are at risk of developing mental disorders. RESULTS from divorce research also reveal that sibling relationships can protect the mental health of children in difficult times. OBJECTIVE: Does having a sibling help to cope with an oncological disease of a parent and thus act as a protective factor? METHODS: A group of 271 children were examined in a multicenter study. 54 % made use of the offered psychosocial support. Only children (N = 89) and children with siblings (N = 182) were compared with respect to their mental health (Strength and Difficulties Questionnaire, SDQ, parental and self-assessment). RESULTS: The group comparison between only children and siblings showed no significant differences in the SDQ (assessed by healthy/ill parent). In the self-assessment 2 % of the only children and 9 % of the siblings showed significant results on the SDQ. The group comparison between only children and children with siblings failed to reveal any important differences in mental health. The study indicates that a negative relationship quality (Sibling Relationship Questionnaire, SRQ) is associated with increased problems in the peer group. CONCLUSIONS: The existence of a sibling is not per se a protective factor. Only children do not show more signs of emotional stress than children with siblings.

Psychological distress in cancer patients with underage children: gender-specific differences.

BACKGROUND: Findings on gender differences in the psychological distress of cancer patients have been inconsistent. The objectives of the current study were to examine whether being a parent differentially modulates anxiety and depression in men and women and to compare whether psychological distress differs in male and female patients with and without children. METHODS: There were 235 patients (77% female, 23% male) with different cancer types included in the group with underage children (age <18 years). The comparison group with no children comprised 85 patients. Psychological distress was assessed via the Hospital Anxiety and Depression Scale within 12 months after first diagnosis or during treatment of metastases. RESULTS: In the patient group with underage children, women tended to report more anxiety than men. The comparison with the patient group without children, however, revealed that men were significantly more affected by anxiety when they had children, whereas in women, anxiety ratings did not differ between the groups. Men tended to report more depressive symptoms, but depression was not differentially associated with parenthood. A binary logistic regression showed that in men with cancer, anxiety, as well as depression, was highly related to unemployment. In women, occurrence of metastases as well as suffering from other cancer types than breast cancer was associated with higher ratings of anxiety. CONCLUSION: Even though our findings need to be supported in future investigations using larger sample sizes, they imply that male cancer patients with underage children are in particular need of psychosocial support.

Risk behaviors and externalizing behaviors in adolescents dealing with parental cancer--a controlled longitudinal study.

OBJECTIVE: The results of studies concerning levels of internalizing and externalizing behaviors in adolescent children with a parent suffering from cancer as compared with control groups or normative data are contradictory so far. Longitudinal designs using control groups are rare. No study explicitly exploring a broad range of risk behaviors in adolescent children with a parent suffering from cancer exists to date. METHODS: Therefore, 74 adolescents who have a parent with cancer (index group) were compared with 75 adolescents with healthy parents (control group) concerning several juvenile risk behaviors and externalizing behaviors. Participants were examined three times over the course of 12 months. RESULTS: No significant main effects for group or interactional effects of group with time could be found for any of the measured variables. CONCLUSIONS: Results suggest that the somatic illness of the parent is not a developmental risk that is expressed in increased levels of juvenile risk behavior. Adolescents with a parent suffering from cancer adjusted generally quite well to the parental illness, although some individuals did show signs of severe strain.

[Parenthood and cancer: dyadic analysis of psychological distress and -health-related quality of life of cancer parents with minor children]. / Elternschaft und Krebserkrankung: Dyadische Analyse von psychosozialer Belastung und gesundheitsbezogener Lebensqualität von krebskranken Eltern minderjähriger Kinder.

The purpose of this study was the analysis of psychological distress and health-related quality of life (HRQoL) of parents with minor children during curative resp. palliative treatment.Cross-sectional design with a sample of N=89 parent dyads. Dyadic analysis of demographic, illness and family variables via mixed linear models.Patients and healthy partners indicated psychological distress on different subscales. Intradyadic correlations were small-moderate. Most important predictors of psychological distress and HRQoL were treatment stadium, gender, family functioning, and employment status.Dependent on demographic variables, psychooncological support was evident mainly for parents in palliative care and for families with dysfunctional functioning.

[KoMPASS--design, implementation and experiences concerning a structured communication skills training for physicians dealing with oncology]. / KoMPASS - Konzeption, Implementierung und Erfahrungen mit einem strukturierten Kommunikationstraining für onkologisch tätige Ärzte.

Goal of the KoMPASS project is to develop and test a training program that effectively improves oncologists' communication skills. The training draws with regard to concept, content and didactic methods to the specific challenges arising in interactions with cancer patients. Concept and didactical methods for an intensive training (KoMPASS Training) are being presented and complemented with experiences gathered during 39 trainings with 335 physicians, as well as findings from the training evaluation by participants. The participants' feedback after 4 months indicates successful transfer into clinical practice along with personal relief, improved self-efficacy, and communicative competencies. Even experienced practitioners ascribe high practical usefulness, and personal learning achievements to the KoMPASS training. The results of the concomitant study concerning self-efficacy, empathy, work-related stress and communicative competence will be published later.

["I do not worry about ...!" How the Berkeley Puppet Interview may reveal self-report of psychological symptoms of 4 to 8 years old children exposed to parental cancer]. / "Ich mach mir keine Sorgen ...!" Wie 4- bis 8-jährige Kinder krebskranker Eltern im Berkeley Puppet Interview psychische Symptome selbst einschätzen.

The Berkeley Puppet Interview (BPI) enables us to investigate psychological symptoms of children aged four to eight years under a multi-informant perspective by the means of self and parent report measures. 45 families with one parent suffering from cancer have been examined with regard to internalizing and externalizing symptoms of the children. Results have been compared to two different age-appropriate samples (Swiss preschool study of Basel and German KiGGS study). A small, highly selective sample of twelve children aged four to eight years could have been examined both from the self and parent perspective. Our results show, that four to eight year old children of cancer patients do not differ from other children of the same age in the way they express emotional symptoms in the BPI, but they are judged more emotionally burdened than other children by their parents (SDQ). Self and parent report do not significantly correlate. It seems as if parents in families struck by a cancer disease see their children's emotional symptoms more pronounced than the children themselves do express in the puppet interview. Implications for clinical and research practice will be discussed.

Prevalence of mental disorders, psychosocial distress and need for psychosocial support in cancer patients - study protocol of an epidemiological multi-center study.

BACKGROUND: Empirical studies investigating the prevalence of mental disorders and psychological distress in cancer patients have gained increasing importance during recent years, particularly with the objective to develop and implement psychosocial interventions within the cancer care system. Primary purpose of this epidemiological cross-sectional multi-center study is to detect the 4-week-, 12-month-, and lifetime prevalence rates of comorbid mental disorders and to further assess psychological distress and psychosocial support needs in cancer patients across all major tumor entities within the in- and outpatient oncological health care and rehabilitation settings in Germany. METHODS/DESIGN: In this multicenter, epidemiological cross-sectional study, cancer patients across all major tumor entities will be enrolled from acute care hospitals, outpatient cancer care facilities, and rehabilitation centers in five major study centers in Germany: Freiburg, Hamburg, Heidelberg, Leipzig and Würzburg. A proportional stratified random sample based on the nationwide incidence of all cancer diagnoses in Germany is used. Patients are consecutively recruited in all centers. On the basis of a depression screener (PHQ-9) 50% of the participants that score below the cutoff point of 9 and all patients scoring above are assessed using the Composite International Diagnostic Interview for Oncology (CIDI-O). In addition, all patients complete validated questionnaires measuring emotional distress, information and psychosocial support needs as well as quality of life. DISCUSSION: Epidemiological data on the prevalence of mental disorders and distress provide detailed and valid information for the estimation of the demands for the type and extent of psychosocial support interventions. The data will provide information about specific demographic, functional, cancer- and treatment-related risk factors for mental comorbidity and psychosocial distress, specific supportive care needs and use of psychosocial support offers.