Depressive Symptoms During Cancer Treatment: The Moderating Role of Stress and Parenting

• In Event: Poster Session 12
  In Poster Session: PS 12 Topic - Parenting & Parent-Child Relationships

Abstract

Background
The stress of pediatric cancer can have a detrimental psychological impact on children and their caregivers. High rates of depression are observed among primary caregivers, ranging from 9% to 65% in different samples. Substantial literature indicates that parental depression places children at greater risk for internalizing symptoms. Given the high rates of depression symptoms for caregivers of children with cancer, it is important to understand contextual factors that might increase the risk for transmission of internalizing symptoms to their children. Past research in non-pediatric samples has found that depressed caregivers’ parenting behaviors can contribute to their children’s internalizing. Additionally, the presence of concurrent life stressors may exacerbate the link between caregiver and child internalizing. The current study examines whether the association between caregiver and child internalizing symptoms is moderated by parenting behaviors (positive and negative affect, respect for autonomy, and negative control) or life stressors (financial strain, negative life events, and treatment-related stress) during pediatric cancer treatment.

Methods
Families with children aged 2 -18 who had recently been diagnosed with cancer were recruited as part of a larger study (n=159). Three months post-diagnosis (T1), primary caregivers were observed in a 12-minute interaction task with their children that was divided into three sections: following the child’s lead in play, directing the child, and clean up. Parenting was coded for positive affect, negative affect, respect for autonomy, and negative control. At T1, caregivers also reported on their depression symptoms, number of negative life events, the upsettingness of those events for their child, perceived financial strain, the number of treatment-related stressors, and the difficulty of these procedures for the caregiver. At T1 and six months post-diagnosis (T2), caregivers reported on their children’s depression/anxiety symptoms.

Results
Hierarchical linear regressions tested the proposed moderators of the association between T1 caregiver depression and T2 child depression/anxiety, controlling for T1 child depression/anxiety. Positive affect was a significant moderator (n=23, ΔR2=.17, p=.003), such that caregiver depression and child depression/anxiety symptoms were significantly associated among caregivers with low positive affect but not among caregivers with medium or high positive affect. Negative affect, respect for autonomy, and negative control were not significant moderators.
There was a stronger association between caregiver and child internalizing among caregivers who perceived greater financial strain, even after controlling for family income (n=43, ΔR2=.09, p=.02), as well as among children who were more upset by T1 negative life events (n=47, ΔR2=.06, p=.04). The number of treatment-related stressors, difficulty of treatment stressors, and number of negative life effects were not significant moderators.

Conclusion
During cancer treatment, the expression of positive affect in the face of adversity may be a protective factor for child psychopathology. Additionally, interventions should focus on providing families with the tools to handle the emotional toll of co-occurring life stressors in order to minimize caregiver depression and the its predictive effects on children.

Authors

• Sameen Boparai, University of Washington
  Presenting Author

• Shibani Datta, University of Washington
  Non-Presenting Author

• Emily Dube Dunning, Pennsylvania State University, University Park
  Non-Presenting Author

• Krandhasi Kodaiarasu, University of Washington
  Non-Presenting Author

• Jiaying Xu, University of Washington
  Non-Presenting Author

• Liana Galtieri, University of Washington
  Non-Presenting Author

• Laina Keim, University of Washington
  Non-Presenting Author

• Debra L. Friedman, Vanderbilt University Medical Center
  Non-Presenting Author

• Bruce Edward Compas, Vanderbilt University
  Non-Presenting Author

• Lynn Fainsilber Katz, University Of Washington
  Non-Presenting Author