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

OBJECTIVE: This study sought to identify possible associations between maternal coping and depression and subsequent mother-child communication about cancer following the child's diagnosis. METHOD: Mothers (N = 100) reported on coping and depressive symptoms shortly after the child's diagnosis (M = 1.9 months). Subsequently, we observed children (age 5-17 years; M = 10.2 years; 48% female; 81% White) and mothers discussing cancer and coded maternal communication. RESULTS: Higher primary and secondary control coping, and lower depressive symptoms, were generally correlated with more positive, and less harsh and withdrawn communication. In regression models, higher primary control coping (i.e., coping efforts to change the stressor or one's emotional reaction to the stressor) independently predicted less withdrawn communication, and depressive symptoms mediated relations between coping and harsh communication. CONCLUSIONS: Maternal primary control coping and depressive symptoms predict mothers' subsequent harsh and withdrawn communication about cancer.

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

OBJECTIVES: This study examines associations between maternal depressive symptoms and macro- and micro-level aspects of mothers' communication about their children's cancer. METHODS: Mothers reported depressive symptoms after diagnosis or relapse (child mean age = 10.4 years; 53% male). Mother-child dyads (N = 94) were subsequently observed discussing the child's cancer and maternal communication was coded. RESULTS: Macro-level indicators (positive and negative communication) were associated with certain micro-level indicators of communication (topic maintenance, reflections, reframes, and imperatives). Higher depressive symptoms predicted lower positive communication and higher negative communication. Maternal reflections and imperatives predicted positive communication, and topic maintenance and reframes predicted negative communication, beyond child age, family income, and depressive symptoms. CONCLUSIONS: Findings suggest concrete targets for improving communication in families after diagnosis or relapse.

Cancer-related sources of stress for children with cancer and their parents.

OBJECTIVES: The current study examines reports and correlates of cancer-specific stressors in children with cancer and their parents. Measures Mothers (n = 191) and fathers (n = 95) reported on their own and their child's stressors, general perceived stress, and posttraumatic stress symptoms. Children (n = 106) completed self-reports of their own stressors and posttraumatic stress symptoms. RESULTS: Mother and father self-reports were positively correlated, but mothers reported higher levels of stressors than fathers. Child and parent reports of children's stressors were positively correlated, but parents rated physical effects as more stressful while children rated role-functioning stressors as more stressful. Parents' and childrens' reports of stressors were also positively associated with general perceived stress and posttraumatic stress symptoms. CONCLUSIONS: The findings extend research on stress in children with cancer and their parents, and may help inform research on risk and intervention in pediatric cancer populations.

Coping with chronic illness in childhood and adolescence.

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

Self-reported and laboratory-based responses to stress in children with recurrent pain and anxiety.

OBJECTIVE: To examine heart rate (HR) responses to and coping with stress in children with recurrent abdominal pain (RAP), anxiety, and healthy controls. METHODS: A clinical sample (children with RAP and children with anxiety) was compared to control children on self-reported and HR responses to stress and a laboratory test of pain tolerance and intensity (cold pressor). RESULTS: Children in the clinical sample had elevated HRs compared to healthy controls before, during, and after laboratory tasks. Self-reported stress reactivity to social stress was positively correlated with HR at all study time intervals. Secondary control coping with social stress was negatively correlated with HR at most study time intervals. Internalizing symptoms were positively correlated with HR and self-reported stress reactivity. CONCLUSIONS: Stress reactivity, as reflected in both self-reported and HR responses to laboratory stressors, is related to the presence of both RAP and anxiety in children.

Direct observation of mother-child communication in pediatric cancer: assessment of verbal and non-verbal behavior and emotion.

OBJECTIVE: To examine the acceptability and feasibility of coding observed verbal and nonverbal behavioral and emotional components of mother-child communication among families of children with cancer. METHODS: Mother-child dyads (N=33, children ages 5-17 years) were asked to engage in a videotaped 15-min conversation about the child's cancer. Coding was done using the Iowa Family Interaction Rating Scale (IFIRS). RESULTS: Acceptability and feasibility of direct observation in this population were partially supported: 58% consented and 81% of those (47% of all eligible dyads) completed the task; trained raters achieved 78% agreement in ratings across codes. The construct validity of the IFIRS was demonstrated by expected associations within and between positive and negative behavioral/emotional code ratings and between mothers' and children's corresponding code ratings. CONCLUSIONS: Direct observation of mother-child communication about childhood cancer has the potential to be an acceptable and feasible method of assessing verbal and nonverbal behavior and emotion in this population.

Anxiety and somatic complaints in children with recurrent abdominal pain and anxiety disorders.

OBJECTIVE: To compare anxiety symptoms and disorders in children and adolescents with recurrent abdominal pain (RAP), anxiety disorders, and healthy control children. METHODS: Twenty-one children with RAP (nine males, mean age = 11.05) were compared to 21 children with anxiety disorders (11 males, mean age = 12.29), and 21 children without pain or anxiety (nine males, mean age = 11.57) using diagnostic interviews and continuous measures of anxiety and other internalizing symptoms. RESULTS: Sixty-seven percent of children with RAP met criteria for an anxiety disorder. Children with RAP were higher than well children but not significantly different from children with anxiety on total internalizing and anxiety symptoms. CONCLUSIONS: RAP and anxiety are closely related. Further understanding between these disorders is essential to understanding the development and progression of RAP, and to inform the prevention and treatment of the disorder.

Mothers and fathers coping with their children's cancer: Individual and interpersonal processes.

OBJECTIVE: To examine individual and interpersonal processes of coping and emotional distress in a sample of mothers and fathers of children with recently diagnosed cancer. METHOD: A sample of 317 mothers and 166 fathers of 334 children were recruited near the time of the child's cancer diagnosis or relapse (M = 1.4 months, SD = 1.2). Mothers and fathers completed standardized measures of coping and depressive symptoms. RESULTS: Analyses of individual coping responses revealed that, for both mothers and fathers, primary control coping (e.g., problem solving, emotional modulation) and secondary control coping (e.g., acceptance, cognitive reappraisal) were associated with lower depressive symptoms. Interpersonal analyses of coping and distress indicated that mothers' and fathers' coping as well as depressive symptoms were significantly correlated. Actor-partner interdependence model analyses indicated that mothers' coping was associated with fathers' depressive symptoms. Significant interactions also suggested that mothers' secondary control coping may have a compensatory effect against fathers' use of disengagement coping, both for themselves and their husbands. CONCLUSION: Mothers' and fathers' adaptation to a child's cancer diagnosis and treatment are characterized by both individual and interpersonal processes, with secondary control coping playing a central role in both of these processes. Implications for interventions to enhance effective coping for parents of children with cancer are highlighted.

Cognitive reappraisal and secondary control coping: associations with working memory, positive and negative affect, and symptoms of anxiety/depression.

The current study examined the relations of measures of cognitive reappraisal and secondary control coping with working memory abilities, positive and negative affect, and symptoms of anxiety and depression in young adults (N=124). Results indicate significant relations between working memory abilities and reports of secondary control coping and between reports of secondary control coping and cognitive reappraisal. Associations were also found between measures of secondary control coping and cognitive reappraisal and positive and negative affect and symptoms of depression and anxiety. Further, the findings suggest that reports of cognitive reappraisal may be more strongly predictive of positive affect whereas secondary control coping may be more strongly predictive of negative affect and symptoms of depression and anxiety. Overall, the results suggest that current measures of secondary control coping and cognitive reappraisal capture related but distinct constructs and suggest that the assessment of working memory may be more strongly related to secondary control coping in predicting individual differences in distress.

Posttraumatic stress symptoms in parents of children with cancer within six months of diagnosis.

OBJECTIVE: To investigate levels and correlates of posttraumatic stress symptoms (PTSS) in mothers and fathers of children and youth with cancer. METHODS: Mothers (n = 191) and fathers (n = 95), representing 195 families of children and youth with cancer, completed measures of PTSS (Impact of Event Scale-Revised), depression (Beck Depression Inventory-II), and anxiety (Beck Anxiety Inventory) between 2 and 22 weeks after their child's cancer diagnosis or recurrence of initial diagnosis. RESULTS: Substantial subgroups of mothers (41%) and fathers (30%) reported levels of PTSS that exceeded cut-offs for elevated symptoms, and these subgroups of parents were characterized by heightened symptoms of depression and anxiety. Fathers of children and youth treated for relapse reported higher rates of elevated PTSS than fathers of children and youth treated for first-time diagnosis, but mothers' rates were similar. Mothers and fathers reported comparable mean levels of PTSS that were strongly positively correlated with symptoms of anxiety and depression. PTSS and other symptoms of distress were negatively related to education level for fathers. CONCLUSION: These findings provide additional evidence that mothers and fathers experience substantial PTSS near the time of their child or adolescent's cancer diagnosis during the first 6 months of treatment. Results suggest that PTSS may be part of a broader pattern of emotional distress and that a substantial portion of both mothers and fathers of children and youth with cancer may be in need of supportive mental health services within the first 6 months of their child's diagnosis.