Posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in families of adolescent childhood cancer survivors

OBJECTIVE: To describe rates and concordance of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in adolescent childhood cancer survivors and their mothers and fathers. METHOD: Participants were 150 adolescent survivors of childhood cancer, 146 mothers, and 103 fathers who completed the Impact of Events Scale-Revised, the Posttraumatic Stress Disorder Reaction Index, and the PTSD module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. RESULTS: PTSS are common in families of childhood cancer survivors. Parents reported more symptomatology than former patients. Mothers and fathers had relatively equal rates of current PTSD and levels of PTSS. Nearly 30% of mothers met diagnostic criteria since their child's diagnosis, with 13.7% currently experiencing PTSD. Nearly 20% of families had at least one parent with current PTSD. Ninety-nine percent of the sample had at least one family member reexperiencing symptoms. CONCLUSIONS: Both PTSD and PTSS help in understanding the experience of adolescent cancer survivors and their families. Within families of childhood cancer survivors, it is likely that some member may be experiencing treatable bothersome memories, arousal, or avoidance specific to the cancer experience.     

Families Surviving Childhood Cancerf: A Comparison of Posttraumatic Stress Symptoms with Families of Healthy Children

Compared posttraumatic stress symptoms in 309 8-to 20-year-oldsurvivors of childhood cancer and their parents with healthychildren and their parents who responded to child-related stressors.The relationship of child demographic, cancer and treatment,and family and social support factors with posttraumatic stresssymptoms was analyzed also. Results indicate that mothers andfathers of childhood cancer survivors showed significantly higherlevels of posttraumatic stress symptoms than comparison parents.The survivors themselves did not differ from their healthy counterparts.Past perceived life threat and family and social support resourcescontributed to posttraumatic stress symptoms in survivors andtheir parents. Survivor mother and child and survivor fatherand child symptoms were associated. Implications for the long-termfunctioning of families of survivors and suggestions for preventiveinterventions are discussed.     

Parental distress during pediatric leukemia and posttraumatic stress symptoms (PTSS) after treatment ends

OBJECTIVE: To evaluate prospectively the association between parental anxiety during treatment for childhood leukemia and posttraumatic stress symptoms (PTSS) after treatment ends. A secondary goal is to explore concurrent variables associated with parental avoidance after treatment ends. METHODS: This is a longitudinal follow-up study of 113 parents of children treated for leukemia who previously participated in a study of procedural distress during treatment. Data included parental self-report questionnaires completed during treatment and after treatment. RESULTS: Using hierarchical multiple regression, we found anxiety during treatment to be a significant predictor of later PTSS for mothers, but not fathers. Anxiety, self-efficacy, posttraumatic growth and length of time since treatment ended were associated with parental avoidance. CONCLUSIONS: Highly anxious parents are at risk for PTSS and may benefit from approaches that decrease anxiety during treatment and afterward. Enhancing self-efficacy related to follow-up care and identifying positive aspects of the traumatic experiences are suggested as treatment approaches for families after cancer treatment.     

Identity in adolescent survivors of childhood cancer

OBJECTIVE: To investigate identify formation among adolescent survivors of childhood cancer. Family functioning, perceived emotional support from family and peers, life stress, and anxiety produced by the cancer experience also were examined as they influenced identity development. METHOD: Participants were 52 adolescent survivors and their mothers recruited from a medical center and 42 healthy adolescent counterparts and their mothers recruited from the community. RESULTS: A greater frequency of survivors than their healthy peers was found within the foreclosed identity status. Factors associated with the foreclosed identity status included the cancer diagnosis, symptoms of posttraumatic stress disorder (PTSD), and family functioning characterized by greater levels of conflict. CONCLUSIONS: Data were interpreted to suggest that the foreclosed identity status may serve a protective function in assisting survivors to cope with the stressors of the cancer experience.     

Brief report: does posttraumatic stress apply to siblings of childhood cancer survivors?

OBJECTIVE: To investigate whether adolescent siblings of childhood cancer survivors experience posttraumatic stress (PTS). METHODS: Participants included 78 adolescent siblings of adolescent cancer survivors who completed self-report measures of anxiety, PTS, and perceptions of the cancer experience. RESULTS: Nearly half (49%) of our sample reported mild PTS and 32% indicated moderate to severe levels. One fourth of siblings thought their brother/sister would die during treatment; over half found the cancer experience scary and difficult. These perceptions were related to PTS. Siblings reported more PTS symptoms than a reference group of nonaffected teens but had similar levels of general anxiety. CONCLUSIONS: Levels of PTS are elevated for siblings of childhood cancer survivors. Thus, PTS may be a useful model for understanding siblings' long-term reactions to cancer. Future research and clinical efforts should consider the needs of siblings of childhood cancer survivors in a family context.     

Posttraumatic growth in accident survivors: openness and optimism as predictors of its constructive or illusory sides

Posttraumatic growth (PTG), the phenomenon of self-reported positive outcomes of trauma, is assumed to consist of two sides: a constructive and an illusory side. This study investigates the relationship between PTG and its possible illusory and constructive predictors, as well as the moderating role of posttraumatic stress disorder (PTSD) severity. One-hundred two motor vehicle accident (MVA) survivors with full, subsyndromal, and without PTSD were assessed by multiple psychometric measures targeting PTSD severity, posttraumatic growth, optimism, and openness to experience. Hierarchical regression analysis yielded differential interaction effects between PTSD severity and optimism, as well as openness facets pointing to the moderating role of PTSD severity in the prediction of an illusory and a constructive factor in PTG.     

Risk of posttraumatic stress symptoms: a comparison of child survivors of pediatric cancer and parental bereavement

OBJECTIVE: To compare the risk of posttraumatic stress (PTS) symptoms and the mediating effect of perceived future threat on the risk of PTS symptoms among survivors of pediatric cancer and children who had a parent die. METHODS: Seventy-eight children (39 survivors of cancer, 39 bereaved) completed self-report measures of PTS symptoms, depression, anxiety, and perceived risk of future threat for the event they experienced. RESULTS: The children who lost a parent reported significantly more PTS symptoms than the survivors of cancer. The effect of group status (survivor of cancer vs. bereaved) on PTS symptomatology was partly mediated by the children's perceived risk of future threat. CONCLUSIONS: The rate of PTS symptoms was found to be higher among children who had lost a parent than among survivors of pediatric cancer. This difference may partly be explained by their perceived risk of a future threat. Clinical implications are discussed.     

Brief Report: Parenting Stress and Quality of Life During Treatment for Childhood Leukemia Predicts Child and Parent Adjustment After Treatment Ends

Evaluated relationships between parenting stress and parent-ratedchild quality of life during treatment for childhood leukemiaand later parental posttraumatic stress symptoms and parentand child anxiety after completion of cancer treatment in 29families of patients with leukemia. Correlations among in-treatmentand off-treatment variables showed strong patterns of associationbetween parenting stress during treatment and later parentaladjustment, for both mothers and fathers. Parent-rated childquality of life was also significantly associated with lateradjustment for mothers and children. Despite the small sample,data point to the importance and consistency of parental reactionsfrom diagnosis through the end of treatment and have clinicalimplications for psychosocial services during and after treatment.     

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

Objective To examine posttraumatic stress symptoms (PTSS) inparents of children with cancer as a function of time sincediagnosis, treatment status, and relapse history, and as comparedto parents of healthy children. Method Participants includedparents of 199 children with cancer, comprising a cross-sectionalsample of diagnoses and treatment phases, ranging from currentlyon therapy to long-term survivors, and 108 parents of healthychildren obtained via acquaintance control methods. Parentscompleted a standardized self-report measure of PTSS. ResultsWithin the cancer group, parental report of PTSS differed asa function of treatment status and time since diagnosis. Parentsof children on active treatment endorsed similar levels of PTSSas control parents, whereas parents of children off treatmentreported significantly lower levels of PTSS than did controls.Similarly, parents of long-term survivors reported significantlylower levels of PTSS than did controls, while parents of recentlydiagnosed children did not differ from controls on PTSS. Incontrast, parents of children who had suffered a relapse reportedsignificantly higher levels of PTSS, and were much more likelyto be identified as a posttraumatic stress disorder (PTSD) case.Conclusions As a group, parents of children with cancer didnot demonstrate any evidence of increased PTSS relative to parentsof healthy children. Time since diagnosis, child treatment status,and relapse history are significant determinants of parent PTSS.Only parents of children who experienced a relapse appear tobe at increased risk of PTSD. The current results appear discrepantfrom the existing literature, and possible explanations forthese discrepancies are examined.     

A systematic and conceptual review of posttraumatic stress in childhood cancer survivors and their parents

Recent years have witnessed a rapid acceleration in the recognition and documentation of posttraumatic stress disorder (PTSD) and posttraumatic stress symptomatology (PTSS) in childhood cancer survivors and their parents. However, applicability of PTSD both diagnostically and conceptually to cancer-related traumatic responses remains poorly articulated within the current literature. Following an outline of childhood cancer and PTSD, this paper critically examines the applicability of such a diagnosis to this clinical population. It then systematically reviews the current evidence base (24 studies) on PTSD and PTSS in childhood cancer survivors and their parents. Prevalence of PTSD and PTSS, as well as associated predictors, in this clinical population varies widely. Findings are considered in the light of a number of contemporary theories of PTSD. Limitations within current conceptualizations of PTSD are highlighted with respect to the nature of cancer as a traumatic event and the specific features of traumatic stress manifestations in childhood cancer survivors and their parents. Finally, a number of pertinent research areas are elucidated which are argued to warrant further investigation.     

Brief report: post-traumatic stress during emerging adulthood in survivors of pediatric cancer

OBJECTIVE: To examine post-traumatic stress symptoms (PTSS) and disorder (PTSD) among survivors of childhood cancer and comparison peers during the transition to emerging adulthood. METHOD: From elementary and middle school, we prospectively followed a cohort of 56 cancer survivors, 60 comparison peers, and their parents. Assessments were completed after the youth's 18th birthday using questionnaires and a semi-structured psychiatric interview. Healthcare providers rated treatment severity and late effects. RESULTS: Survivors and comparison peers did not differ on rates of PTSS or PTSD, but comparison peers reported more dissociative experiences than survivors. Late effects were associated with a greater number of past PTSS. Of the 16 cancer survivors who reported a traumatic event, five (31%) were cancer-related. CONCLUSIONS: Levels of PTSS were similar for survivors and comparison peers. Research with other potentially traumatic diseases or treatments (e.g., amputations, brain tumors) is needed. The role of methodology and contextual factors in the assessment of PTSS/PTSD is discussed.     

Brief report: the impact of maternal posttraumatic stress disorder symptoms and child gender on risk for persistent posttraumatic stress disorder symptoms in child trauma victims

OBJECTIVE: To longitudinally examine the impact of maternal posttraumatic stress disorder symptoms (PTSS) on child adjustment following a child's traumatic injury, focusing on child gender differences. METHODS: Forty-one child traumatic injury victims aged 8-18 years and their biological mothers were interviewed over two follow-ups (6 weeks and 7 months). Children were administered the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for Children and Adolescents (CAPS-CA), whereas mothers completed the CAPS. RESULTS: Six weeks post trauma, maternal PTSS were significantly related to PTSS in boys but not in girls. However, at 7 months, maternal PTSS were strongly related to child PTSS in both boys and girls. Significant 6-week maternal distress-child gender interactions suggested that maternal PTSS, especially avoidance, predicted greater 7-month PTSS but that this was primarily because of a significant relationship in females. CONCLUSIONS: Maternal distress was found to negatively impact subsequent child adjustment, particularly in females. These results underscore the importance of considering family-centered interventions for child PTSD, especially in girls.     

Posttraumatic growth in cancer: Reality or illusion?

Research in posttraumatic growth (PTG) among cancer patients has been triggered primarily by the inclusion of serious illnesses among the events that can lead to posttraumatic stress disorder (PTSD); increasing survival rates among cancer patients; and, attempts at encouraging a positive psychology that focuses on a patient's ability to fight adversity. The difficulties encountered in clearly defining the processes associated with this subjective feeling of growth following recovery raise doubts concerning the real or illusory nature of the phenomenon and its adaptative value. This paper explains why cancer may be different than other traumas and why PTG may interact with this ecology of circumstances in different ways. Difficulty in identifying a single stressor, the internal source of the event, cancer as a future, ongoing and chronic integration threat, and greater perceived control differences between cancer and others traumas. This review brings together the latest studies of PTG in cancer, and focuses in the debate of the real or illusory nature of the PTG and his adaptative value. The ongoing threat, uncertainty and vulnerability associated with cancer are the variables that have been related most consistently with PTG and tend to confuse the relationship between PTG and emotional well-being, too.     

Parental posttraumatic stress symptoms as a moderator of child's acute biological response and subsequent posttraumatic stress symptoms in pediatric injury patients

OBJECTIVE: To examine how parental responses following pediatric injury may influence their child's posttraumatic stress symptoms (PTSS). METHODS: Heart rate (HR) from 82 pediatric injury patients was measured during emergency medical services (EMSs) transport and following hospital admission. Twelve-hour urinary cortisol levels were assessed upon admission. Child PTSS and parental PTSS and general distress were assessed 6 weeks and 6 months after trauma. RESULTS: Six-week parental PTSS predicted 6-month child PTSS even after controlling for demographics and general parent distress (DeltaR(2) = .08, p = .03). Parental PTSS moderated the relationship between (a) child cortisol levels and 6-month child PTSS (DeltaR2 = .08, p = .03) and between (b) hospital HR and 6-month child PTSS (DeltaR2 = .09, p = .03). CONCLUSION: The present findings suggest that parental response to trauma may interact with child acute physiological responses to predict persistent child PTSS.     

Predictors of intentions to use tobacco among adolescent survivors of cancer

OBJECTIVE: To examine the relationship between knowledge of tobacco-related health risks, perceptions of vulnerability to these health risks, and future intentions to use tobacco in a sample of adolescent survivors of cancer. METHODS: Written self-report questionnaires were administered to 46 survivors, 10-18 years of age (61% males, 93.5% Caucasian). RESULTS: Overall, survivors were generally knowledgeable about tobacco-related health risks, perceived themselves to be vulnerable to these health risks, and reported low future intentions to use tobacco. Regression analyses indicated that demographic factors, treatment-related variables, knowledge, and perceived vulnerability explained 28% of the variance in intentions scores, F:(6, 39) = 2.52, p <.05. Age and knowledge were significant predictors, indicating that older adolescent survivors and those with lower knowledge scores reported greater intentions to use tobacco. CONCLUSIONS: Young survivors will benefit from risk counseling interventions that educate them about their susceptibility to specific tobacco-related health risks secondary to their cancer treatment. Intensive tobacco prevention programs that target older adolescents should be developed.     

正念干预对癌症患者创伤后成长干预效果的meta分析

目的:评价正念干预(MBI)对癌症患者创伤后成长(PTG)的干预效果。方法:计算机检索Cochrane library、PubMed、Embase、Web of Science、CBM、VIP、WangFang Data和CNKI数据库中MBI对癌症患者PTG的随机对照试验(RCT)。两名研究者按照纳入排除标准独立筛选文献、进行文献质量评价并从中提取数据,采用RevMan 5.3软件进行数据分析。结果:共纳入9篇RCT,合计822例患者。Meta分析结果显示,实施MBI后,干预组患者的PTG水平优于对照组,差异有统计学意义[MD=7.27,95%CI=(4.75~9.79),P<0.001],干预效果能维持到干预后3个月[MD=8.64,95%CI=(7.20~10.08),P<0.001]。与对照组相比,线上干预模式对癌症患者PTG的改善效果不明显,差异无统计学意义[MD=3.59,95%CI=(-1.22~8.41),P>0.05],而面对面的小组干预模式能促进癌症患者PTG水平的提高[MD=7.87,95%CI=(5.19~10.54),P<0.001]。结论:正念干预有助于提高癌症患者的创伤后成长水平,面对面小组干预模式比线上干预模式在提升患者的创伤后成长水平上效果更佳。     

The relationship of coping strategies, social support, and attachment style with posttraumatic growth in cancer survivors

This cross-sectional study investigated attachment style, coping strategies, social support, and posttraumatic growth (PTG) in 54 cancer survivors. Secure attachment was significantly associated with active coping, positive reframing, and religion, and these were all associated with PTG. Insecure types of attachment and social support variables were unrelated to PTG. Regression analysis suggests that positive reframing and religion as coping strategies may mediate the relationship between secure attachment and PTG.     

Posttraumatic stress and related impairment in survivors of childhood cancer in early adulthood compared to healthy peers

OBJECTIVE: To compare rates of posttraumatic stress disorder (PTSD) and related impairment between childhood cancer survivors in early adulthood and healthy peers. METHODS: Cancer survivors (n = 57) and comparison group (n = 83) completed measures of PTSD, depression, health-related quality of life (HRQOL), mood, and satisfaction with life (SWL). RESULTS: The cancer survivor group was more likely to have PTSD than the control group (odds ratio = 4.67, p < .05) but was not more likely to experience subclinical PTSD symptoms. The groups differed on physical HRQOL, F(1, 140) = 15.02, p < .001, and positive affect, F(1, 140) = 7.03, p < .01, but did not differ on depression, SWL, psychosocial HRQOL, and negative mood. Those in the survivor group with PTSD (n = 10) experienced more depression and negative affect, worse HRQOL and SWL, perceived their cancer to impact developmental tasks more, and were older at the time of diagnosis compared with those without PTSD (n = 47). CONCLUSIONS: Although most are well adjusted, childhood cancer survivors in early adulthood are more likely to have PTSD and to experience significant impairment compared with healthy peers.     

Insecure family bases and adolescent drug abuse: a new approach to family patterns of attachment

A new approach to assessing family attachment patterns is presented, using a composite measure of individual attachment representations based on the Bartholomew Attachment Interview. A cluster analysis yielded three different patterns in a sample of N = 37 families with a drug dependent adolescent (age 14 - 25) and both biological parents. A "triangulated" pattern (mothers: preoccupied; fathers: dismissing; adolescents: fearful) was found in 65% of the sample. A total of 19% showed an "insecure" pattern (mothers, fathers, and adolescents: fearful) and 16% a "near-secure" pattern (mothers and adolescents: secure; fathers preoccupied). Preliminary comparisons between these groups indicate differences in comorbid psychiatric disorders, in individual and family functioning, but not in addiction severity. There is a trend towards differences in outcome of family therapy. Implications for treatment and further research are discussed.     

Posttraumatic stress disorder in parents of children with newly diagnosed type 1 diabetes

OBJECTIVE: To determine rates of posttraumatic stress disorder (PTSD) and symptoms in mothers and fathers of children with newly diagnosed type 1 diabetes. METHODS: Parents of 38 children with newly diagnosed type 1 diabetes were assessed with the Posttraumatic Diagnostic Scale 6 weeks after diagnosis. RESULTS: Twenty-four percent of the mothers and 22% of the fathers met full diagnostic criteria for current PTSD. In addition, 51% of the mothers and 41% of the fathers met criteria for partial or subclinical PTSD. Co-occurence of PTSD in couples was very low. Posttraumatic stress symptomatology did not correlate with age and gender of the child, socioeconomic status, family structure, or length of hospital stay. CONCLUSIONS: The findings support applicability of a posttraumatic stress model for investigating the psychological impact of type 1 diabetes on parents.