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Hensler, I., Sveen, J., Cernvall, M. & Arnberg, F. (2019). PTSD Coach Sweden: A Self-Management App for Trauma-Related Symptoms: A RCT study protocol evaluating a self-help app for posttraumatic stress in a Swedish community sample. Paper presented at ESTSS2019 (European Society for Traumatic Stress Studies), Rotterdam, Netherlands, 14-16 June 2019. European Journal of Psychotraumatology, 10(S1), Article ID 4–010.
Open this publication in new window or tab >>PTSD Coach Sweden: A Self-Management App for Trauma-Related Symptoms: A RCT study protocol evaluating a self-help app for posttraumatic stress in a Swedish community sample
2019 (English)In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 10, no S1, article id 4–010Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Resources to administer evidence-based care for PTSD and trauma-related complications are scarce, especially in particular geographical areas, during mass casualty situations and for individuals with subclinical symptoms as clinics prioritize more severe cases. Effective interventions for PTSD through technical platforms could disseminate information and self-management strategies to decrease individual suffering and societal costs. Assessment at multiple time points can elucidate which aspects of an intervention that are effective, in addition to the evolution of intervention use and well-being over time. 

Objective: Evaluate an app-administered self-help intervention (PTSD Coach Sweden) aiming to reduce and manage PTSD symptoms and other related complications. 

Method: In this trial, 200 participants from Sweden who have experienced a traumatic event in the past two years and who report posttraumatic stress symptoms will be randomized to three months use of the app or waitlist. The primary endpoint is self-rated PTSD symptom severity at three months, with follow-up at six and nine months. Secondary outcomes include depressive symptoms, physical symptoms, functional impairment and health care use. Ecological momentary assessment of health status and use of strategies corresponding to app content is used for 21 days during the first three months.

Results: Lessons learned and recommendations from the preparations of app-based intervention trials are presented. Available data from the primary endpoint are presented. 

Conclusions: App-based interventions hold promise to increase outreach, but further trials are needed. Several challenges introduced when preparing an app-based intervention are discussed.

Keywords
PTSD, posttraumatic stress, app intervention
National Category
Psychiatry
Research subject
Psychiatry; Psychology
Identifiers
urn:nbn:se:uu:diva-391388 (URN)10.1080/20008198.2019.1613837 (DOI)
Conference
ESTSS2019 (European Society for Traumatic Stress Studies), Rotterdam, Netherlands, 14-16 June 2019
Available from: 2019-08-22 Created: 2019-08-22 Last updated: 2019-08-26Bibliographically approved
Cernvall, M., Sveen, J., Bergh Johannesson, K. & Arnberg, F. (2018). A pilot study of user satisfaction and perceived helpfulness of the Swedish version of the mobile app PTSD Coach. European Journal of Psychotraumatology, 9(Suppl 1), Article ID 1472990.
Open this publication in new window or tab >>A pilot study of user satisfaction and perceived helpfulness of the Swedish version of the mobile app PTSD Coach
2018 (English)In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 9, no Suppl 1, article id 1472990Article in journal (Refereed) Published
Abstract [en]

Background: There is a need for accessible interventions in the aftermath of traumatic events with documented efficacy for preventing or reducing negative mental health consequences. The PTSD Coach is a mobile app that has shown to be effective in reducing symptoms of posttraumatic stress (PTSS). Objective: The purpose of the current study was to evaluate the user satisfaction, perceived helpfulness and potential reductions of PTSS and symptoms of depression among participants using the Swedish version of the PTSD Coach. Method: This was an uncontrolled pre-test post-test open trial including participants recruited from the community via advertisement and from an ongoing observational study who had experienced a potentially traumatic event in the last five years. Participants had access to the Swedish PTSD Coach app for four weeks. Results: Eleven participants (mean age = 38.6, female = 8) completed the study. Nine of the participants met criteria for full or partial PTSD. Results from the PTSD Coach Survey indicated that participants found the app slightly to moderately helpful and were slightly to moderately satisfied with the app. Nominal but not statistically significant reductions of medium effect sizes in PTSS (PCL-5) and depression (PHQ-9) from pre- to post-assessment were found. In interviews, participants indicated that they found elements such as learning about PTSD, breathing exercises and monitoring symptoms helpful in managing symptoms. However, several participants indicated that they had not used the app as much as they had intended to. Participants also had suggestions for improvements such as enhanced app structure and better guidance regarding how to use the app. Conclusions: The perceived helpfulness and user satisfaction were slightly lower compared to research on the original version of the app. Experiences from the study are discussed and a future controlled study of the Swedish version of the PTSD Coach is suggested.

Keywords
PTSD Coach, Posttraumatic stress, mobile apps, mobile phone intervention, smartphones, • Participants found the Swedish version of the PTSD Coach slightly to moderately helpful.• There were nominal but statistically non-significant reductions of symptoms of PTSD and depression with medium effect sizes.• Participants had suggestions for improvement of the app.
National Category
Psychiatry
Research subject
Psychiatry; Psychology
Identifiers
urn:nbn:se:uu:diva-357141 (URN)10.1080/20008198.2018.1472990 (DOI)000469464200001 ()29805783 (PubMedID)
Funder
Swedish National Board of Health and Welfare
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-08-19Bibliographically approved
Ljungman, L., Cernvall, M., Ghaderi, A., Ljungman, G., von Essen, L. & Ljótsson, B. (2018). An open trial of individualized face-to-face cognitive behavior therapy for psychological distress in parents of children after end of treatment for childhood cancer including a cognitive behavioral conceptualization. PeerJ, 6, Article ID e4570.
Open this publication in new window or tab >>An open trial of individualized face-to-face cognitive behavior therapy for psychological distress in parents of children after end of treatment for childhood cancer including a cognitive behavioral conceptualization
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2018 (English)In: PeerJ, ISSN 2167-8359, E-ISSN 2167-8359, Vol. 6, article id e4570Article in journal (Refereed) Published
Abstract [en]

Objective

A subgroup of parents of children who have been treated for childhood cancer report high levels of psychological distress. To date there is no empirically supported psychological treatment targeting cancer-related psychological distress in this population. The aim of the current study was to test the feasibility and preliminarily evaluate the effect of individualized face-to-face cognitive behavior therapy (CBT) for parents of children after the end of treatment for childhood cancer. A secondary aim was to present a cognitive behavioral conceptualization of cancer-related distress for these parents.

Methods

An open trial was conducted where 15 parents of children who had completed successful treatment for cancer three months to five years earlier and who reported psychological distress related to a child’s previous cancer disease were provided CBT at a maximum of 15 sessions. Participants were assessed at baseline, post-intervention, and three-month follow-up using self-reported psychological distress (including posttraumatic stress symptoms (PTSS), depression, and anxiety) and the diagnostic Mini-International Neuropsychiatric Interview. Feasibility outcomes relating to recruitment, data collection, and delivery of the treatment were also examined. Individual case formulations for each participant guided the intervention and these were aggregated and presented in a conceptualization detailing core symptoms and their suggested maintenance mechanisms.

Results

A total of 93% of the participants completed the treatment and all of them completed the follow-up assessment. From baseline to post-assessment, parents reported significant improvements in PTSS, depression, and anxiety with medium to large effect sizes (Cohen’s d = 0.65–0.92). Results were maintained or improved at a three-month follow-up. At baseline, seven (47%) participants fulfilled the diagnostic criteria for major depressive disorder and four (29%) fulfilled the criteria for posttraumatic stress disorder, compared to none at a post-assessment and a follow-up assessment. The resulting cognitive behavioral conceptualization suggests traumatic stress and depression as the core features of distress, and avoidance and inactivity is suggested as the core maintenance mechanisms.

Conclusion

The treatment was feasible and acceptable to the participants. Significant improvements in distress were observed during the study. Overall, results suggest that the psychological treatment for parents of children after end of treatment for childhood cancer used in the current study is promising and should be tested and evaluated in future studies.

National Category
Cancer and Oncology Psychology
Identifiers
urn:nbn:se:uu:diva-349407 (URN)10.7717/peerj.4570 (DOI)000429852600001 ()29666751 (PubMedID)
Funder
Swedish Research Council, VR521-2010-3042; VR521-2014-3337Swedish Cancer Society, CAN2013/580;CAN2014/613
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-06-19Bibliographically approved
Woodford, J., Wikman, A., Einhorn, K., Cernvall, M., Grönqvist, H., Romppala, A. & von Essen, L. (2018). Attitudes and Preferences Toward a Hypothetical Trial of an Internet-Administered Psychological Intervention for Parents of Children Treated for Cancer: Web-Based Survey. Journal of Medical Internet Research, 5(4), Article ID e10085.
Open this publication in new window or tab >>Attitudes and Preferences Toward a Hypothetical Trial of an Internet-Administered Psychological Intervention for Parents of Children Treated for Cancer: Web-Based Survey
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2018 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 5, no 4, article id e10085Article in journal (Refereed) Published
Abstract [en]

Background:

Clinical trials are often challenged with issues of recruitment and retention. Little is known concerning general attitudes and preferences toward trial design and willingness to participate among parents of children treated for cancer. Furthermore, willingness to participate in internet-administered psychological interventions remains unexplored. In this study, we examined attitudes and preferences of the population regarding study procedures for a hypothetical trial of an internet-administered psychological intervention. In addition, differences in the response rate between modes of study invitation and willingness to engage in internet-administered interventions were examined.

Objective:

The primary objective of this study was to examine attitudes and preferences toward participating in an internet-administrated psychological intervention. The secondary objective was to examine the response rates and help-seeking behavior among parents of children treated for cancer.

Methods:

A cross-sectional, Web-based survey was conducted with parents of children who had completed cancer treatment. This Web-based survey examined self-reported emotional distress, prior help-seeking and receipt of psychological support, past research participation, attitudes toward research, preferences concerning recruitment procedures, and attitudes toward different types of trial design.

Results:

Of all the parents invited, 32.0% (112/350) completed the survey, with no difference in response rate between modes of study invitation (χ21=0.6, P=.45). The majority (80/112, 71.4%) of parents responded that they had experienced past emotional distress. Responses indicated high (56/112, 50.0%) or somewhat high trust in research (51/112, 45.5%), and the majority of parents would accept, or maybe accept, internet-administered psychological support if offered (83/112, 74.1%). In addition, responses showed a preference for postal study invitation letters (86/112, 76.8%), sent by a researcher (84/112, 75.0%) with additional study information provided on the Web via text (81/112, 72.3%) and video (66/112, 58.9%). Overall, parents responded that trials utilizing a waiting list control, active alternative treatment control, or a patient-preference design were acceptable.

Conclusions:

Parents of children treated for cancer appear willing to participate in trials examining internet-administered psychological support. Findings of this study will inform the design of a feasibility trial examining internet-administered psychological support for the population.

Keywords
Cancer, Parents, eHealth, Clinical Trial, Depression, Anxiety
National Category
Health Sciences Clinical Medicine Psychology
Research subject
Psychology; Health Care Research
Identifiers
urn:nbn:se:uu:diva-357971 (URN)10.2196/10085 (DOI)000453827700001 ()
Funder
Swedish Research Council, K2015-99X-20836-08-4Swedish Cancer Society, 140790
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2019-09-10Bibliographically approved
Wikman, A., Kukkola, L., Börjesson, H., Cernvall, M., Woodford, J., Grönqvist, H. & von Essen, L. (2018). Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach. Journal of Medical Internet Research, 20(4), Article ID e133.
Open this publication in new window or tab >>Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach
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2018 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 4, article id e133Article in journal (Refereed) Published
Abstract [en]

Background: Parenting a child through cancer is a distressing experience, and a subgroup of parents report negative long-term psychological consequences years after treatment completion. However, there is a lack of evidence-based psychological interventions for parents who experience distress in relation to a child’s cancer disease after end of treatment.

Objective: One aim of this study was to develop an internet-administered, cognitive behavior therapy–based, psychological, guided, self-help intervention (ENGAGE) for parents of children previously treated for cancer. Another aim was to identify acceptable procedures for future feasibility and efficacy studies testing and evaluating the intervention.

Methods: Participatory action research methodology was used. The study included face-to-face workshops and related Web-based exercises. A total of 6 parents (4 mothers, 2 fathers) of children previously treated for cancer were involved as parent research partners. Moreover, 2 clinical psychologists were involved as expert research partners. Research partners and research group members worked collaboratively throughout the study. Data were analyzed iteratively using written summaries of the workshops and Web-based exercises parallel to data collection.

Results: A 10-week, internet-administered, cognitive behavior therapy–based, psychological, guided, self-help intervention (ENGAGE) was developed in collaboration with parent research partners and expert research partners. The content of the intervention, mode and frequency of e-therapist support, and the individualized approach for feedback were modified based on the research partner input. Shared solutions were reached regarding the type and timing of support from an e-therapist (eg, initial video or telephone call, multiple methods of e-therapist contact), duration and timing of intervention (eg, 10 weeks, 30-min assessments), and the removal of unnecessary support functions (eg, removal of chat and forum functions). Preferences for study procedures in future studies testing and evaluating the intervention were discussed; consensus was not reached for all aspects.

Conclusions: To the best of our knowledge, this study is the first use of a participatory action research approach to develop a psychological intervention for parents of children previously treated for cancer and to identify acceptable study procedures. Involvement of parents with lived experience was vital in the development of a potentially relevant and acceptable intervention for this population.

Keywords
cognitive therapy; psychology, clinical; e-therapy; community participation; Sweden
National Category
Psychology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-349408 (URN)10.2196/jmir.9457 (DOI)000430392800001 ()29669710 (PubMedID)
Funder
Swedish Research Council, K2015-99X-20836-08-4Swedish Cancer Society, 140790
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-06-19Bibliographically approved
Kuhn, E., van der Meer, C., Owen, J. E., Hoffman, J. E., Cash, R., Carrese, P., . . . Iversen, T. (2018). PTSD Coach around the world. mHealth, 4, Article ID 15.
Open this publication in new window or tab >>PTSD Coach around the world
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2018 (English)In: mHealth, ISSN 2306-9740, Vol. 4, article id 15Article in journal (Refereed) Published
Abstract [en]

Posttraumatic stress disorder (PTSD) is a global public health problem. Unfortunately, many individuals with PTSD do not receive professional care due to a lack of available providers, stigma about mental illness, and other concerns. Technology-based interventions, including mobile phone applications (apps) may be a viable means of surmounting such barriers and reaching and helping those in need. Given this potential, in 2011 the U.S Veterans Affairs National Center for PTSD released PTSD Coach, a mobile app intended to provide psycho-education and self-management tools for trauma survivors with PTSD symptoms. Emerging research on PTSD Coach demonstrates high user satisfaction, feasibility, and improvement in PTSD symptoms and other psychosocial outcomes. A model of openly sharing the app's source code and content has resulted in versions being created by individuals in six other countries: Australia, Canada, The Netherlands, Germany, Sweden, and Denmark. These versions are described, highlighting their significant adaptations, enhancements, and expansions to the original PTSD Coach app as well as emerging research on them. It is clear that the sharing of app source code and content has benefited this emerging PTSD Coach community, as well as the populations they are targeting. Despite this success, challenges remain especially reaching trauma survivors in areas where few or no other mental health resources exist.

Keywords
Posttraumatic stress disorder (PTSD), mobile applications (mobile apps), public health, smartphones, trauma
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-357139 (URN)10.21037/mhealth.2018.05.01 (DOI)29963560 (PubMedID)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-01-08Bibliographically approved
Woodford, J., Wikman, A., Cernvall, M., Ljungman, G., Romppala, A., Grönqvist, H. & von Essen, L. (2018). Study protocol for a feasibility study of an internet-administered, guided, CBT-based, self-help intervention (ENGAGE) for parents of children previously treated for cancer. BMJ Open, 8(6), Article ID e023708.
Open this publication in new window or tab >>Study protocol for a feasibility study of an internet-administered, guided, CBT-based, self-help intervention (ENGAGE) for parents of children previously treated for cancer
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 6, article id e023708Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: A subgroup of parents of children previously treated for cancer report long-term psychological distress after end of treatment. However, needs for psychological support are commonly unmet and there is a lack of evidence-based treatments tailored to the specific needs of this population. An internet-administered, guided, cognitive-behavioural therapy-based, self-help intervention (ENGAGE) for parents of children previously treated for cancer may provide a solution. The aim is to examine the feasibility and acceptability of the intervention ENGAGE and the study procedures for a future controlled trial.

METHODS AND ANALYSIS: The study has an uncontrolled within-group design with an embedded qualitative and quantitative process evaluation. Potential participants are parents of children previously treated for cancer, living in Sweden, recruited via their child's personal identification number (via the Swedish Childhood Cancer Registry and the Swedish Tax Agency). Parents are invited randomly with information packs sent to home addresses. Further interest in participating can be registered via information on relevant websites. The study aims to recruit 50 parents who will receive the intervention ENGAGE which is designed to be delivered over a 10-week period, and comprises one introductory chapter followed by up to 10 intervention modules addressing key concerns identified for the population. Consistent with feasibility study objectives, primary outcomes relate to recruitment, attrition, data collection, study resources, intervention delivery and acceptability. Clinical outcomes (post-traumatic stress, depression, anxiety, fear of cancer recurrence, psychological inflexibility and experiential avoidance, depressed inactivity, fatigue, quality of life and self-compassion) will be measured at baseline, post-treatment (12 weeks) and 6-month follow-up.

ETHICS AND DISSEMINATION: The Regional Ethical Review Board in Uppsala, Sweden has granted approval for the study (Dnr: 2017/527). Results will be disseminated to relevant healthcare and patient communities, in peer-reviewed and popular science journals, and at scientific and clinical conferences.

TRIAL REGISTRATION NUMBER: ISRCTN57233429; Pre-results.

Keywords
anxiety, clinical trial, depression, eHealth, parents
National Category
Psychology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-355488 (URN)10.1136/bmjopen-2018-023708 (DOI)000435567900114 ()29903802 (PubMedID)
Funder
Swedish Research Council, K2015-99X-20836-08-4Swedish Cancer Society, 170709Swedish Childhood Cancer Foundation, PR2017-0005
Available from: 2018-06-29 Created: 2018-06-29 Last updated: 2018-09-20Bibliographically approved
Sveen, J., Bergh Johannesson, K., Cernvall, M. & Arnberg, F. (2018). Trajectories of prolonged grief one to six years after a natural disaster. PLoS ONE, 13(12), Article ID e0209757.
Open this publication in new window or tab >>Trajectories of prolonged grief one to six years after a natural disaster
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 12, article id e0209757Article in journal (Refereed) Published
Abstract [en]

Background

The long-term trajectories of prolonged grief are poorly understood. The aims were to examine the course of grief among bereaved disaster survivors up to six years post loss and factors predicting worse bereavement outcome. A third aim was to explore differences in grief indicators between trajectories.

Methods

Bereaved Swedish tourists who survived the 2004 Indian Ocean tsunamis responded to surveys including the Inventory of Complicated Grief 1 to 6 years after the disaster. Latent growth mixture modeling was used to identify longitudinal trajectories of grief. Multinomial logistic regression analysis was used to examine predictors of class membership.

Results

Three trajectories were identified: resilient (41% of the sample), recovering (48%), and chronic (11%). The strongest predictor of chronic grief was the loss of one’s child. When examining grief indicators, the chronic trajectory was characterized by not accepting the loss, while yearning was common in all trajectories.

Conclusions

This study highlights the importance of considering how traumatically bereaved individuals can be affected by loss for several years after a disaster, especially after losing one’s child. An inability to accept the loss, more so than yearning, appears to characterize bereaved survivors at risk of a chronic trajectory of grief.

National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-372693 (URN)10.1371/journal.pone.0209757 (DOI)000454149400078 ()30576369 (PubMedID)
Funder
Swedish National Board of Health and Welfare, 44676/2012
Available from: 2019-01-09 Created: 2019-01-09 Last updated: 2019-01-15Bibliographically approved
Kukkola, L., Hovén, E., Cernvall, M., von Essen, L. & Grönqvist, H. (2017). Perceptions of support among Swedish parents of children after end of successful cancer treatment: A prospective, longitudinal study. Acta Oncologica, 56(12), 1705-1711
Open this publication in new window or tab >>Perceptions of support among Swedish parents of children after end of successful cancer treatment: A prospective, longitudinal study
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2017 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 56, no 12, p. 1705-1711Article in journal (Refereed) Published
Abstract [en]

Introduction: Most children survive childhood cancer, however parenting a child diagnosed with cancer is a major challenge. The main aim of the current study was to describe Swedish parents’ need, opportunity and benefit of support from healthcare professionals and significant others after end of a child’s successful cancer treatment.

Material and methods: Data was collected from approximately one week after end of successful treatment/six months after transplantation (T4, n ¼ 212) up to five years thereafter (T7, n ¼ 137). Parents answered questions via telephone about need, opportunity and benefit of talking to psychologists, social workers, partners and friends.

Results: The proportion reporting need of support from healthcare professionals varied between 73% (mothers’ need of support from social workers, T4) and 7% (fathers’ need of support from psychologists/social workers, T7). Need of support from significant others varied between 99% (mothers’ and fathers’ need of support from partners, T4) and 27% (fathers’ need of support from friends, T7). The proportion reporting need of support decreased over time (p < .001), no decrease occurred from three months after end of treatment/nine months after transplantation (T5) to one year after end of treatment/18 months after transplantation (T6). More mothers than fathers reported need of support from friends at T5 (p < .001) and T7 (p < .05) and from psychologists at T7 (p < .05). Opportunities for support from healthcare professionals varied, most reported opportunity for support from significant others. Almost all reported benefit from received support.

Conclusion: A declining number reports a need of support over time, however subgroups report an unmet need and almost every parent perceive support from healthcare professionals as beneficial. More parents should get access to psychosocial support services after end of a child’s cancer treatment/transplantation.

National Category
Cancer and Oncology Psychology
Identifiers
urn:nbn:se:uu:diva-330769 (URN)10.1080/0284186X.2017.1374554 (DOI)000418118800006 ()28971717 (PubMedID)
Funder
Swedish Research Council, K2008-70X-20836-01-3; K2011-70X-20836-04-4; K2015-99X-20836-08-4Swedish Cancer Society, 2007/1015; 2010/726; 2014/613Swedish Childhood Cancer Foundation, PROJ08/010U‐Care: Better Psychosocial Care at Lower Cost? Evidence-based assessment and Psychosocial Care via Internet, a Swedish Example, 2009-1093
Available from: 2017-10-03 Created: 2017-10-03 Last updated: 2018-01-22Bibliographically approved
Wikman, A., Ljungman, L., Pingel, R., Hagedoorn, M., Sanderman, R., von Essen, L. & Cernvall, M. (2017). The interdependence of posttraumatic stress symptoms in parental dyads during and after their child’s treatment for cancer. Acta Oncologica, 56(12), 1698-1704
Open this publication in new window or tab >>The interdependence of posttraumatic stress symptoms in parental dyads during and after their child’s treatment for cancer
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2017 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 56, no 12, p. 1698-1704Article in journal (Refereed) Published
Abstract [en]

Background: Cancer in a child is highly distressing and some parents are at increased risk for developing posttraumatic stress symptoms (PTSS). However, the interdependence of PTSS in parental dyads has rarely been accounted for. The aim was to explore the dyadic relationship of PTSS in parents of children diagnosed with cancer.

Material and methods: The sample includes 150 parents (75 dyads) of 75 children diagnosed with cancer in Sweden during 2002–2004, with follow-up until one year after end of treatment. Data on PTSS from six assessments were included. The first three assessments were carried out during treatment and the remaining after end of treatment. Actor-partner interdependence models were estimated using a structural equation modeling approach to explore the dyadic relationship of PTSS. Actor effects refer to intra-individual dependency over time, and partner effects refer to inter-individual dependency over time, i.e., how much an individual’s symptom levels are affected by their partner’s symptom levels at the previous assessment.

Results: Results show both actor and partner effects during the child’s treatment. Only an actor effect remained following end of treatment where level of PTSS at one assessment was associated with the level of PTSS at the subsequent assessment. The association between mothers’ and fathers’ PTSS did not remain after end of treatment.

Conclusions: Parents appear to react as an interdependent emotional system during the child’s treatment but this effect disappears after end of treatment. Results suggest psychological interventions for parents during the child’s cancer treatment should also be sensitive to and address the influence that distress in one partner may have on the other.

National Category
Psychology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-327201 (URN)10.1080/0284186X.2017.1355562 (DOI)000418118800005 ()28760061 (PubMedID)
Funder
Swedish Research Council, K2008-70X-20836-01-3K; 2011-70X-20836-04-4; K2015-99X-20836-08-4Swedish Cancer Society, 2007/1015; 2010/726; 2013/580; 2014/613Swedish Childhood Cancer Foundation, PROJ08/010
Available from: 2017-08-07 Created: 2017-08-07 Last updated: 2018-01-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-7237-4429

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