Patterns of maternal distress among children with cancer and their association with child emotional and somatic distress

OBJECTIVE: To identify patterns of distress among mothers of children with cancer over the initial 6 months of treatment and to examine these patterns as predictors of child somatic and emotional distress. METHOD: Data were gathered regarding maternal perceived stress and affective distress from mothers of children (N = 65, mean age = 8.3 years) with cancer at 2 to 5 weeks postdiagnosis, then at 12 to 14 weeks and 22 to 24 weeks. Mothers and nurses provided indexes of child somatic and emotional distress at these assessments. RESULTS: Hierarchical and k-means cluster analyses revealed four distinct patterns of maternal distress: high, moderate, declining, and low. The high maternal distress group reported higher child emotional distress at all three points but higher child somatic distress only at the final assessment. Maternal distress group was unrelated to nurse-reported child distress. CONCLUSIONS: The identification of four empirically derived patterns of maternal distress may explain some of the variance in the literature regarding parental distress vis-à-vis pediatric cancer treatment and may have relevance to intervention efforts. Differences in the relations between maternal distress groups and mother- and nurse-reported child distress underscore the importance of collecting child distress data from multiple sources.     

二孩儿童母亲的育儿压力状况及相关因素

目的:探讨二孩儿童母亲的育儿压力状况及相关因素,为制订降低儿童母亲育儿压力的决策措施提供科学依据。方法:选取南通市5所托幼机构1483名儿童的母亲(其中二孩母亲455名),采用简式育儿压力问卷(PSI-SF)、家庭亲密度和适应性量表第2版(FACES-II)进行调查。结果:二孩母亲的育儿愁苦、亲子互动失调及PSI-SF总分均高于一孩母亲(均P<0.01)。多元线性回归分析显示,有二孩,家庭月总收入越低、家庭亲密度越低、家庭适应性越差的儿童母亲PSI-SF总分越高(β=0.08、-0.06、-0.17、-0.26)。结论:南通市二孩母亲的育儿压力较高;家庭月总收入低、家庭亲密度低、家庭适应性差是儿童母亲育儿压力的相关因素。     

Psychosocial predictors of distress in parents of children undergoing stem cell or bone marrow transplantation

OBJECTIVE: To examine psychosocial predictors of distress (mood disturbance, perceived stress, caregiver burden) in parents of children undergoing stem cell or bone marrow transplantation (BMT). METHOD: Measures of prior illness experiences, premorbid child behavior problems, family environment, social support, and parental coping behavior were obtained from the resident parents of 151 children prior to the children's admission for BMT. Parents subsequently completed assessments of their mood disturbance, perceived stress, and caregiving burden on a weekly basis through week +6 post-BMT, and then monthly through month +6 post-BMT. RESULTS: Significant changes were observed in parental distress across the course of BMT. After correcting for demographic and medical factors, several significant predictors of parental distress trajectories were identified, including prior parent and patient illness-related distress, premorbid child internalizing behavior problems, the family relationship dimensions of the family environment, and parental avoidant coping behaviors. Multivariable models were developed using a hierarchical modeling approach. The best-fit model accounted for approximately 50% of the variance in parental global distress. CONCLUSIONS: Subgroups of parents at higher risk for increased distress during the acute phase of transplant have been identified. These findings can help target parents who may be in greater need of intervention aimed at reducing transplant-related distress.     

Interactions between maternal characteristics and neonatal behavior in the prediction of parenting stress and perception of infant temperament

BACKGROUND: Prenatal cocaine exposure is a marker of developmental risk. Social environmental risk factors may include maternal stress and maternal perceptions of difficult infant temperament. OBJECTIVES: To examine factors that may predict or moderate maternal ratings of parenting stress and difficult temperament in cocaine-exposed (CE) infants. METHOD: Neonatal behavior, infant temperament, parenting stress, and maternal psychopathology were measured in a large sample of infant-mother dyads with prenatal CE and a nonexposed comparison sample. Participants were drawn from an existing longitudinal data set (Maternal Lifestyle Study). RESULT: Relations between neonatal behavior and infant temperament ratings were moderated by mothers' ratings of parenting stress. Relations between neonatal cry and parenting stress were moderated by maternal psychopathology ratings. Results were unrelated to drug exposure history. CONCLUSIONS: For mothers of at risk infants (with or without prenatal CE), psychological distress affects the degree to which infant behavioral characteristics are experienced as stressful or difficult. Implications for treatment and outcome are discussed.     

Parenting stress in mothers of very-low-birth-weight (VLBW) and full-term infants: a function of infant behavioral characteristics and child-rearing attitudes

OBJECTIVE: To examine the moderating effects of child-rearing attitudes on the relation between parenting stress and infant behavioral characteristics for mothers of very-low-birth-weight (VLBW) and full-term infants. METHODS: Fifty-six 9-month-old infants (23 VLBW and 33 full-term) and their mothers were the participants. Mothers completed measures of parenting stress, child-rearing attitudes, infant temperament, and infant behavioral problems. RESULTS: The VLBW infants had a higher frequency of behavioral problems, and their mothers reported more child health concerns than the mothers of the full-term infants. Regression analyses showed that the relation between parenting stress and infant distress was moderated at medium and high levels of parental strictness for only the VLBW infants. CONCLUSIONS: The amount of stress the mothers of the VLBW infants experienced was a result of the congruence between their infant's behavioral characteristics and their own child-rearing attitudes.     

Stress, appraisal, and coping in mothers of disabled and nondisabled children.

The cognitive-behavioral model of stress and coping provided the framework for this study of mothers of physically disabled children (n = 69) and mothers of nondisabled children (n = 63). The first aim was to test for differences between groups in responses to stressful parenting events. As hypothesized, mothers of disabled children reported higher levels of depressive symptomatology. Differences in psychological distress and health status approached significance. The second aim was to explore the mediating influences of coping strategies and cognitive appraisals. As predicted, emotion-focused coping was related to increased psychological distress in mothers of disabled children whereas problem-focused coping was associated with decreased distress. Both relationships were significant even after controlling for differences in type of parenting stressor. Hierarchical regressions showed that 58 and 25% of the variance in psychological distress was explained by the independent variables; however, the predictors were different for the two groups of mothers. Factors that may explain the differential effectiveness of coping and appraisal, and clinical implications of this study are discussed.     

Child Psychopathology and Parenting Stress in Girls and Boys Having Attention Deficit Disorder With Hyperactivity

The present study examined the extent to which girls with attentiondeficit disorder with hyperactivity (ADDH) differed from ADDHboys, non-ADDH clinic-referred girls, and normal girls in parentratings of child psychopathology and parenting stress. ADDHgirls were rated as being more depressed and hyperactive thanADDH boys. However, there were no significant differences betweenADDH boys and girls on any of the 17 scales of the ParentingStress Index. Comparisons among the three groups of girls indicatedthat ADDH girls and non-ADDH clinic-referred girls did not differfrom each other on most dimensions of psychopathology but wererated as more deviant than normal girls on virtually all suchdimensions. Both ADDH and non-ADDH clinic-referred girls posedgreater stress for their mothers, and their mothers reportedgreater family and personal distress than the mothers of normalgirls. Only the mothers of non-ADDH clinic girls showed higherratings of depression, marital distress, and health problemsthan the normal girls. Ratings of parental stress were associatedwith both maternal depression and severity of child psychopathology,especially aggression, conduct problems, and hyperactivity.These findings suggest that ADDH girls and boys are quite similarin the nature of their psychopathology and do not differ fromeach other in the degree of parenting stress associated withtheir care. Instead, high parental stress is associated withchild psychopathology in general, and particularly with externalizingsymptoms.     

抑郁青少年父母亲职压力及其相关因素的研究

目的了解广州市在校抑郁青少年父母亲职压力情况,并探讨其亲职压力的影响因素。方法以贝克抑郁自评问卷（BDI）、亲职压力36项简表PSI-SF和家庭功能评定量表（FAD）为工具对220名中小学生及其父母进行调查。结果 1抑郁情绪组在亲职压力总分（F=5.63,P=0.004）及亲子互动失调（F=4.71,P=0.01）和困难孩子维度（F=7.24,P=0.001）的得分高于正常对照组;2单因素分析显示：家庭人均月收入少、父母受教育程度低的抑郁青少年,其父母亲职压力高（P〈0.01）;3抑郁青少年父母的亲职压力与家庭功能的角色（r=-0.572）、情感反应（r=-0.364）、情感介入（r=-0.549）、行为控制（r=-0.386）以及总功能（r=-0.292）均呈显著负相关（P〈0.01）;4多元回归分析结果显示：抑郁青少年的家庭功能的角色、情感介入、情感反应和家庭月均收入进入了亲职压力的回归方程,解释了总变异的49.6%。结论抑郁青少年父母普遍存在较高水平的亲职压力,其亲职压力受多种因素影响。     

Brief report: parents of children undergoing bone marrow transplantation: documenting stress and piloting a psychological intervention program

OBJECTIVE: To document levels of stress in parents of children undergoing bone marrow transplantation (BMT) over the course of hospitalization and to pilot a psychological intervention program designed to teach parents techniques for managing stress associated with their child's illness and hospitalization. METHODS: Twenty-two mothers of children (ages 2-16) undergoing BMT were followed prospectively from preadmission to three weeks posttransplant. Eleven mothers, randomly assigned to participate in a pilot intervention program, were compared with 11 control mothers receiving standard care preparation of their child's BMT. RESULTS: Repeated measures ANOVAs detected significant changes in stress over time, with most stress reported preadmission. Mothers in the intervention condition reported using more stress management techniques than mothers in the standard care condition, though the majority of analyses revealed no significant differences in stress between groups. CONCLUSIONS: Increased levels of parenting distress may occur pretransplant, suggesting the need for additional psychological intervention at that time.     

Risk and resistance factors in the adaptation in mothers of children with juvenile rheumatoid arthritis

OBJECTIVE: To examine the importance of illness severity, child functional status, psychosocial stress, intrapersonal factors, stress processing, and social-ecological factors in predicting psychological symptoms among mothers of children with juvenile rheumatoid arthritis (JRA). METHODS: Mothers of 92 children with JRA completed surveys while waiting with their children for physician appointments or during JRA meeting breaks. RESULTS: Mothers reported higher mean levels of psychological symptoms than a normative group. Higher levels of psychosocial stress predicted increased psychological symptoms after accounting for disease severity and functional status. Maternal appraisal of the illness tended to moderate the relationship between illness stress and psychological symptoms, and maternal education moderated the relationship between daily hassles stress and psychological symptoms. CONCLUSIONS: These data indicate that mothers of children with JRA are at risk for psychological distress. Inteventions that take into account the buffering effects of maternal education and appraisal may serve to decrease the effects of maternal stress.     

Parenting Stress Among Caregivers of Children With Bipolar Spectrum Disorders

Caregivers of psychiatrically impaired children experience considerable parenting stress. However, no research has evaluated parenting stress within the context of pediatric bipolar spectrum disorders (BPSD). Thus, the aim of this investigation was to identify predictors and moderators of stress among caregivers in the Longitudinal Assessment of Manic Symptoms study. Participants included 640 children and their caregivers in the Longitudinal Assessment of Manic Symptoms cohort. Children had a mean age of 9.4 ± 1.9 years (68% male, 23% BPSD); parents had a mean age of 36.5 ± 8.3 years (84% mothers). Children with BPSD had more service utilization, psychiatric diagnoses, mood and anxiety symptoms, and functional impairment but fewer disruptive behavior disorders. Caregivers of children with BPSD were more likely than caregivers of children without BPSD to have a partner, elevated depressive symptoms, antisocial tendencies, and parenting stress (Cohen’s d = .49). For the whole sample, higher child IQ, mania, anxiety, disruptive behavior, and caregiver depression predicted increased parenting stress; maternal conduct disorder predicted lower stress. Child anxiety and disruptive behavior were associated with elevated caregiver stress only for non-BPSD children. Caregivers of children with BPSD experience significant burden and thus require specialized, family-focused interventions. As stress was also elevated, to a lesser degree, among depressed caregivers of children with higher IQ, mania, anxiety, and disruptive behavior, these families may need additional supports as well. Although parents with conduct/antisocial problems evidenced lower stress, these difficulties should be monitored. Thus, parenting stress should be evaluated and addressed in the treatment of childhood mental health problems, especially BPSD.     

Parental stress in mothers of boys with duchenne muscular dystrophy

OBJECTIVE: To examine parental stress in mothers of boys with Duchenne muscular dystrophy (DMD). METHOD: Stress and its predictors were examined in mothers of boys with DMD (n = 112). Comparisons were made with mothers of healthy children (n = 800), children with cerebral palsy (CP; n = 28), siblings of boys with DMD (n = 46), and longitudinally (n = 16). RESULTS: The presence of problem child behaviors consistently predicted maternal stress. Stress related to child behavior was higher in the DMD versus the normative group. No differences in stress were found in the DMD versus CP groups. Stress related to boys with DMD versus siblings was not significantly different. Over time, maternal stress related to child variables diminished. CONCLUSION: Stress in mothers of boys with DMD is elevated, possibly due to increased problem behaviors, particularly in social interactions, rather than due to the physical demands of the disease alone.     

Parental management of fear in chronically ill and healthy children

This study was undertaken to determine the impact of children's health status on parental management of fear and avoidance, as well as the relationship between parenting strategies and children's fear and anxiety levels. Thirty-one children with a chronic life-threatening illness, 30 children with chronic non-life-threatening conditions, and 28 healthy children, and their mothers, were studied. Children's health status, by diagnosis, was not a significant determinant of maternal fear-management strategies. For chronically ill children, clinical health status, in terms of illness course, prognosis, physical impairment, and time since diagnosis were related to maternal parenting strategies and to children's levels of medically related fears. For the sample as a whole, maternal fear-management strategies were related to child sex, socioeconomic status, and mothers' trait anxiety. These results are discussed in terms the interactive effects of child characteristics, health status, fear/anxiety, and parenting strategies.     

Determinants of parenting stress in home apnea monitoring

Studied mothers of 30 infants who suffered an apneic episode and were subsequently placed on home apnea monitors, using measures of parenting stress, family resources and support, family coping activities, health locus of control, and maternal coping style involving preferences for information under threat. Comparison groups included mothers of 30 infants with mild congenital heart lesions and 30 mothers of normal healthy infants. Home monitoring was associated with increased levels of parenting stress; monitored infants were perceived as more demanding, and their mothers reported less attachment to the child. However, the magnitude of the differences between mothers of monitored and unmonitored infants was relatively small, and parenting stress outcome was more closely related to preexisting levels of family resources than to the child's health status. No significant relationship was found between stress outcome and family coping or maternal coping style.     

Relation among marital conflict,child coping,and child adjustment

The goal of this study was to simultaneously examine maternal attributions, affect, and parenting in mothers of children with and without attention deficit hyperactivity disorder (ADHD) using a multimethod approach (vignettes, confederate child video clips, and video clips of mother's own child). Of the participants, 23 were 7- to 12-year-old children (19 boys, 4 girls) with ADHD and their mothers, and 29 were 7- to 12-year-old comparison children (21 boys, 8 girls) and their mothers. Results indicated that mothers of children with ADHD attributed inattentive-impulsive behavior to less controllable and intentional factors and reported more negative affect and power assertive parenting in response to it than comparison mothers. They also attributed this behavior to more internal factors than comparison mothers but only when viewing their own children and to more global/stable factors but only when viewing their own children or a confederate child. Interestingly, mothers of children with ADHD reported more positive parenting in response to prosocial behavior while attributing this behavior to less controllable and global/stable factors than comparison mothers; compliance also was seen as less controllable, global/stable, and intentional by mothers of children with ADHD.     

Brief report: fathering a child living with HIV/AIDS: psychosocial adjustment and parenting stress

OBJECTIVE: To examine the psychosocial stressors experienced by fathers of children diagnosed with HIV/AIDS. METHODS: Thirty-one fathers whose children (ages 6 to 19) were participating in pediatric HIV clinical trials completed self-report measures of parenting stress, psychological distress, and need for psychosocial services. RESULTS: Over half of this sample experienced significantly elevated levels of both parenting stress and psychological distress compared to standardized norms. Ninety-seven percent of these men reported the need for services including gender-specific support groups, assistance with discipline, disease management, and assistance with planning for the future. CONCLUSIONS: Elevated levels of parenting stress and psychological distress in fathers of children living with HIV suggest the need for additional psychological intervention in this population.     

NEIGHBORHOOD DISORDER,PERCEPTIONS OF NEIGHBORHOOD SOCIAL CAPITAL,AND MATERNAL STRESS: EXPLORATION OF A MEDIATING MECHANISM

Stress is a critical precipitant of depression and other symptoms of mental disorder, and it is especially a concern for single mothers, given their vulnerability to various stressors. Although there is emerging research interest in parenting stress issues, few studies have examined the association between neighborhood environment and maternal stress. Even fewer studies have examined the mechanism that contributes to this relationship. Using data from a national study, the current study investigates relationships among neighborhood disorder, perceived social capital, and maternal stress among a sample of single mothers. The study finds that neighborhood disorder is positively associated with single mothers’ maternal stress, and this relationship is mediated by these mothers’ perceived social capital in the neighborhood. The findings suggest the importance of considering responsive policies and strategies to buffer the detrimental effect of problematic neighborhood environments on single mothers’ social capital, which should in turn decrease maternal stress.     

Trajectories of adjustment in mothers of children with newly diagnosed cancer: a natural history investigation

OBJECTIVES: The objectives of this study were (a) to assess negative affectivity and posttraumatic symptomatology in mothers following the diagnosis of cancer in their children; (b) to examine sociodemographic and psychosocial variables associated with change in distress over time; and (c) to identify distinct subgroups of mothers whose patterns and trajectories of adjustment can be distinguished according to available predictor data. METHODS: Two hundred and twelve mothers at seven sites were assessed just following their child's diagnosis, and again 3 months and 6 months later. Primary outcomes included measures of mood disturbance, depressive symptoms, and symptoms of posttraumatic stress. RESULTS: Overall, mothers demonstrated a pattern of mildly elevated negative affectivity and posttraumatic symptomatology initially, with steady improvements evident at 3- and 6-month follow-up. Distinct adjustment trajectories were evident within the sample as a whole, indicating subgroups of mothers with high-declining, moderate-stable, and low-stable distress levels. CONCLUSIONS: These findings highlight considerable resilience among mothers facing the stress of childhood cancer. Intervention efforts aimed at reducing maternal distress might best be targeted towards the subgroup of mothers who may be predicted to exhibit the highest level of distress.     

Resilience among African American adolescent mothers: predictors of positive parenting in early infancy

OBJECTIVE: To use Nath et al.'s (1991) conceptual model of adolescent parenting to examine the relationship between resiliency factors measured shortly after delivery and maternal parenting behavior at 6 months. METHOD: We recruited 181 first-time, adolescent African American mothers at delivery. Data on resiliency factors (maturity, self-esteem, and mother-grandmother relationships) were collected when infants were 1-4 weeks of age. Data on parental nurturance and parenting satisfaction were examined through observations and self-report at 6 months. RESULTS: Multiple regression analyses were used to examine the longitudinal impact of resiliency factors on parental nurturance and parenting satisfaction. Maternal maturity, positive self-esteem, and positive adolescent mother-grandmother relationships (characterized by autonomy and mutuality) were associated with better parenting outcomes. Maternal parenting satisfaction was lowest when infants were temperamentally difficult and mothers and grandmothers had a confrontational relationship. CONCLUSIONS: Longitudinal associations between mother-grandmother relationships at delivery and parental behavior and satisfaction 6 months later may suggest an intergenerational transmission of parenting style. Recommendations are provided for intervention programs to enhance mother-grandmother relationships in contexts where adolescents are required to live with a guardian to receive government assistance.