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Symptoms of Posttraumatic Stress in Parents of Children on Cancer Treatment: Factor Structure, Experiential Avoidance, and Internet-based Guided Self-help
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Psykosocial onkologi och stödjande vård, Psychosocial Oncology and Supportive Care)
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Having a child diagnosed with cancer is stressful and many parents of children on treatment for cancer report symptoms of posttraumatic stress (PTSS). The overall purpose was to, among parents of children on treatment for cancer, investigate the factor structure of PTSS; investigate the relationships between experiential avoidance (EA), rumination, PTSS and depression; and to develop, test, and evaluate a guided self-help intervention provided via the internet.

In a longitudinal study with three assessments (n = 249-203) results indicated that a four-factor solution of PTSS including the factors re-experiencing, avoidance, dysphoria, and hyper-arousal provided best fit and that the pattern and size of factor loadings were equivalent across the three assessments (Study I). In a case study with pre-, post-, and follow-up assessments a guided self-intervention was well received with clinical significant and reliable improvements in PTSS, depression, and quality of life (Study II). Furthermore, in cross-sectional analyses (n = 79) EA and rumination were positively associated with PTSS and depression and provided incremental explanation in depression while controlling for demographic characteristics, anxiety, and PTSS. In longitudinal analyses (n = 20), EA but not rumination predicted PTSS and depression while controlling for initial levels (Study III). Finally, in a randomized controlled trial with parents fulfilling the modified symptom criteria on the PTSD-Checklist allocated to guided self-help via the internet (n = 31) or to a wait-list control condition (n = 27) there was a significant intervention effect with a large effect size for the primary outcome PTSS. Similar results were observed for the secondary outcomes depression and anxiety, but not for EA and rumination. Exploratory analyses suggested that the relationships between EA and PTSS and between EA and depression were weakened in the intervention group (Study IV).

The studies included in the current thesis suggest that a four-factor solution should be used when assessing PTSS in parents of children on cancer treatment. Furthermore, rumination and EA in particular seem to be important constructs to consider when understanding PTSS and depression in this population. Finally, guided self-help via the internet shows promise in reducing PTSS and depression among parents of children on cancer treatment who report a high level of PTSS.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 65 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1051
Keyword [en]
Cancer and oncology, Children, Parents, Cognitive behavior therapy, Experiential avodiance, Posttraumatic stress symptoms, Depresssion
National Category
Pediatrics Psychology Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-234518ISBN: 978-91-554-9098-0 (print)OAI: oai:DiVA.org:uu-234518DiVA: diva2:759301
Public defence
2014-12-18, Room IX, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2014-11-26 Created: 2014-10-20 Last updated: 2015-02-03
List of papers
1. The factor structure of traumatic stress in parents of children with cancer: A longitudinal analysis
Open this publication in new window or tab >>The factor structure of traumatic stress in parents of children with cancer: A longitudinal analysis
2012 (English)In: Journal of Pediatric Psychology, ISSN 0146-8693, E-ISSN 1465-735X, Vol. 37, no 4, 448-457 p.Article in journal (Refereed) Published
Abstract [en]

Objectives To determine the factor structure of posttraumatic stress symptoms (PTSS) and assess its stability over time among parents of children diagnosed with cancer. 

Methods  Parents of children with cancer included in a longitudinal study completed the posttraumatic stress disorder (PTSD) Checklist–Civilian Version 2 weeks (n = 249) and 2 (n = 234) and 4 (n = 203) months after their child's diagnosis. Confirmatory factor analysis (CFA) was used to assess 3 models of the underlying dimensions of PTSD and invariance tests were used to assess stability over time. 

Results  A longitudinal CFA with the factors reexperiencing, avoidance, dysphoria, and hyperarousal provided best fit to the data. Invariance testing suggested that the pattern and size of loadings were equivalent across the three assessments. 

Discussions Findings tentatively suggest that PTSS among parents of children with cancer consist of four factors. Implications for research and clinical practice are discussed.

Keyword
assessment, cancer and oncology, children, longitudinal research, parent stress, psychosocial functioning
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:uu:diva-161720 (URN)10.1093/jpepsy/jsr105 (DOI)000303330600009 ()
Note

Erratum in: Journal of Pediatric Psychology (2013), 38(2): 237–240. doi: 10.1093/jpepsy/jss125

Available from: 2011-12-15 Created: 2011-11-16 Last updated: 2017-12-08Bibliographically approved
2. Guided self-help as intervention for traumatic stress in parents of children with cancer: Conceptualization, intervention strategies, and a case study
Open this publication in new window or tab >>Guided self-help as intervention for traumatic stress in parents of children with cancer: Conceptualization, intervention strategies, and a case study
2013 (English)In: Journal of psychosocial oncology, ISSN 0734-7332, E-ISSN 1540-7586, Vol. 31, no 1, 13-29 p.Article in journal (Refereed) Published
Abstract [en]

Being a parent of a child diagnosed with cancer poses an enormous stressor. Indeed, several parents have difficulties adjusting to such a situation and react with symptoms of traumatic stress, depression, and reduced quality of life. However, there is little conceptual work on behavioral mechanisms that contribute to suboptimal adaptation in these parents. The authors present a conceptualization in which experiential avoidance and rumination are suggested to contribute to increased levels of traumatic stress and suboptimal adaption. Based on this conceptualization, a recently developed intervention for parents of children with cancer, in the form of guided self-help, is presented. Finally, the authors present a successful case study as an example of the application of this intervention. Clinical implications and suggestions for future research are discussed.

Keyword
Intervention, Parents, Pediatric oncology, Self-help, Traumatic stress
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-187322 (URN)10.1080/07347332.2012.741095 (DOI)000315983500002 ()
Available from: 2012-12-05 Created: 2012-12-05 Last updated: 2017-12-07Bibliographically approved
3. Experiential Avoidance and Rumination in Parents of Children on Cancer Treatment: Relationships with Posttraumatic Stress Symptoms and Symptoms of Depression
Open this publication in new window or tab >>Experiential Avoidance and Rumination in Parents of Children on Cancer Treatment: Relationships with Posttraumatic Stress Symptoms and Symptoms of Depression
Show others...
2016 (English)In: Journal of clinical psychology in medical settings, ISSN 1068-9583, E-ISSN 1573-3572, Vol. 23, no 1, 67-76 p.Article in journal (Refereed) Published
Abstract [en]

We conducted a cross-sectional survey study to investigate whether there is a relationship between experiential avoidance (EA), rumination, post-traumatic stress symptoms (PTSS), and symptoms of depression, in parents of children on cancer treatment. Data from 79 parents (55 mothers) of 79 children with a median of three months since their cancer diagnosis were included in cross-sectional analyses. EA and rumination were positively correlated with PTSS and symptoms of depression. EA and rumination did not provide incremental explained variance in PTSS over and above that explained by symptoms of depression, while controlling for symptoms of anxiety and demographic characteristics. However, EA and rumination provided incremental explained variance in symptoms of depression over and above that explained by PTSS, while controlling for symptoms of anxiety and demographic characteristics. Rumination and EA are important constructs in the understanding of PTSS and symptoms of depression in parents of children on cancer treatment. Future research should delineate the temporal relationships between these constructs.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-234500 (URN)10.1007/s10880-015-9437-4 (DOI)000371621600007 ()26462676 (PubMedID)
Conference
Conference of the Association-of-Psychologists-in-Academic-Health-Centers (APAHC), FEB, 2015, Atlanta, GA, USA
Funder
Swedish Research Council, K2008-70X-20836-01-3, K2011-70X-20836-04-4Swedish Cancer Society, 2010/276Swedish Childhood Cancer Foundation, PROJ08/010, PRO12/028
Note

Tidigare titel: Experiential avoidance and rumination in parents of children on cancer treatment: Relationships with posttraumatic stress symptoms and depression

Available from: 2014-10-20 Created: 2014-10-20 Last updated: 2017-12-05Bibliographically approved
4. Internet-based guided self-help for parents of children on cancer treatment: A randomized controlled trial
Open this publication in new window or tab >>Internet-based guided self-help for parents of children on cancer treatment: A randomized controlled trial
Show others...
2015 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 24, no 9, 1152-1158 p.Article in journal (Refereed) Published
Abstract [en]

Objective

The aim of the study was to investigate the feasibility and preliminary efficacy of an Internet-based guided self-help intervention for posttraumatic stress symptoms (PTSS) and related symptoms in parents of children on cancer treatment.

Methods

Parents of children on cancer treatment, who fulfilled the modified symptom criteria on the PTSD Checklist, were randomly allocated to the intervention or to a wait-list control condition. The intervention group accessed a 10-week guided self-help program via the Internet based on principles from cognitve behavior therapy. The primary outcome PTSS and the secondary outcomes depression and anxiety were assessed by self-report preintervention and postintervention.

Results

Seven hundred forty-seven parents were approached and informed about the study, 92 were assessed for eligibility, and 58 were included and randomized to the intervention (n = 31) or wait list (n  = 27). Eightteen participants completed the intervention. Intention-to-treat analyses indicated a significant effect of the intervention on PTSS with a large between-group effect size at postassessment (Cohen's d = 0.88). The intervention group reported reductions in PTSS with a large within-group effect size (d = 1.62) compared with a minimal reduction in the wait-list group (d  = 0.09). There was a significant intervention effect on depression and anxiety and reductions in the intervention group with large within-group effect sizes (d = 0.85–1.09).

Conclusions

Findings indicate a low enrollment rate and considerable attrition but also that Internet-based guided self-help shows promise for parents of children on cancer treatment who report a high level of PTSS and would like to take part in an Internet-based intervention.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-234503 (URN)10.1002/pon.3788 (DOI)000360992900022 ()25728688 (PubMedID)
Funder
Swedish Research Council, K2008-70X-20836-01-3 K2011-70X-20836-04-4Swedish Cancer Society, 2010/276Swedish Childhood Cancer Foundation, PROJ08/010 PRO12/028
Available from: 2014-10-20 Created: 2014-10-20 Last updated: 2017-12-05Bibliographically approved

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