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Parental Depression and Parenting Behavior as Predicators of Emotional Adjustment in Pediatric Brain Tumor Survivors

Fri, April 9, 3:15 to 4:15pm EDT (3:15 to 4:15pm EDT), Virtual

Abstract

Purpose: Even after completing treatment, pediatric cancer survivors and their parents contend with ongoing challenges. Both experience distress after diagnosis that can continue in survivorship. Associations between parent and child distress have been documented, but are not universal (Bakula, Sharkey, Perez, et al., 2019). Prediction of affective risk for pediatric brain survivors (PBTS) has often focused on medical rather than family factors (Shah, Dellarole, Peterson, et al., 2015). We aimed to evaluate associations of parental distress with child emotional adjustment, testing whether parental depression and parenting behavior accounts for differences in child depression and self-concept for PBTS and comparison classmates (CC). Our second aim was to investigate whether variation in parenting behavior moderates these indirect effects. We expected to find group differences in child adjustment that were partially accounted for by parental distress, and these indirect effects would be stronger with less positive and more intrusive parenting.
Method: PBTS (N=114, Mage=11.8 SDage=2.0, 40% female, 75% white and non-Hispanic) were recruited at three medical centers in North America. The control sample of CC (N=65, Mage=12.4 SDage=2.0, 40% female, 72% white and non-Hispanic) were recruited from classrooms of PBTS. Children and a primary caregiver (N=179, 93% mothers) completed home-based assessments. Primary caregivers completed the Beck Depression Inventory-II (BDI). Children completed the Children’s Depression Inventory-II (CDI), Harter Self-Perception Profile for Children (SPPC), and Children’s Report of Parent Behavior Inventory (CRPBI). The CRPBI assesses parental Acceptance, Behavioral Control, and Psychological Control. The SPPC assesses Global Self-Worth and perceived Social Competence. Analyses included multiple regression with post-hoc bootstrapping to test overall indirect effects of group differences in child adjustment via parent distress and moderation of indirect effects by parenting.
Results: Parents of PBTS reported higher levels of depression symptoms (d=0.39, p=.009) than parents of CC. However, PBTS and CC did not differ significantly on total depression symptoms or self-concept scores (d’s=0.01 to 0.09; p’s>.05). Additionally, PBTS and CC differed only on parent use of Behavioral Control (d=0.42, p=.009) but not on other parenting scales.
Multiple regression tested whether group differences in child depression symptoms or self-concept scores were mediated by parent depression symptoms (Figure 1). Results suggest parent depression symptoms mediate group differences in child depression symptoms but not self-concept (Table 1). No evidence was found of moderated indirect effects involving any dimension of parenting. However, all parenting domains demonstrated main effects on child depression symptoms.
Conclusion: Contrary to our expectations, we did not find evidence that PBTS reported higher levels of depression symptoms or more negative self-concept than CC. Reliance on child self-report may have led to underestimation of distress for PBTS (Schulte & Barrera, 2010). Although parents of PBTS were experiencing more depression symptoms, the association between parent and child distress was small. Parent distress accounted for variability in child depression symptoms for PBTS versus CC. Parenting practices had a main effect on child emotional adjustment but did not moderate parent-child distress concordance. Future research could consider utilizing multimodal testing for distress in parents and children, such as multiple reporters and clinician assessment.

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