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Parenting under pressure: a cross-sectional questionnaire study of psychological distress, parenting concerns, self-efficacy, and emotion regulation in parents with cancer
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health. Uppsala University, WoMHeR (Centre for Women’s Mental Health during the Reproductive Lifespan). Uppsala Univ Hosp, Womens & Childrens Hlth, SE-75185 Uppsala, Sweden..ORCID iD: 0000-0003-4230-702x
Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.ORCID iD: 0000-0001-5527-8796
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Arts, Centre for Gender Research.ORCID iD: 0000-0003-0987-7055
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2024 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 63Article in journal (Refereed) Published
Abstract [en]

Background and purpose: As many as one in four adults with cancer have children under 18 years. Balancing parenting and cancer is challenging and can be a source of psychological distress. This study aimed to examine psychological distress in parents with cancer and its associations with parenting concerns, self -efficacy, and emotion regulation.

Materials and methods: This was a cross-sectional questionnaire study of 406 parents (aged 25-60 years) diagnosed with cancer within the last 5 years, with at least one dependent child (<= 18 years). Parents completed questionnaires on psychological distress (DASS-21), parenting concerns (PCQ), self -efficacy (GSE), emotion regulation (ERQ), mental and physical health, and sociodemographics. Data were analysed using multiple logistic regressions on depression (yes/no), anxiety (yes/no), and stress (yes/no).

Results: Higher parenting concerns were associated with greater odds of depression (OR = 2.33, 95% CI: 1.64-3.31), anxiety (OR = 2.30, 95% CI: 1.64-3.20), and stress (OR = 3.21, 95% CI: 2.20-4.69) when adjusting for health and sociodemographic factors. Poorer self -efficacy was associated with increased odds of anxiety (OR = 0.94, 95% CI: 0.89-0.99, p < 0.05), whereas lower use of cognitive reappraisal and higher use of expressive suppression increased the odds of depression (OR = 0.76, 95% CI: 0.59-0.98 | OR = 1.46, 95% CI: 1.18-1.80).

Interpretation: The findings highlight the complexity of parental well-being in relation to parenthood and cancer, stressing the need for interventions that address relevant psychological factors to improve overall mental health in this population.

Place, publisher, year, edition, pages
Medical Journals Sweden, 2024. Vol. 63
Keywords [en]
Neoplasms, parents, parenting concerns, psychological distress, depression, anxiety, stress
National Category
Public Health, Global Health and Social Medicine
Identifiers
URN: urn:nbn:se:uu:diva-534954DOI: 10.2340/1651-226X.2024.40404ISI: 001257252200003PubMedID: 38910314OAI: oai:DiVA.org:uu-534954DiVA, id: diva2:1888340
Funder
Swedish Cancer Society, 200824Swedish Research Council, 2020-02080Available from: 2024-08-12 Created: 2024-08-12 Last updated: 2025-04-20Bibliographically approved
In thesis
1. Navigating parenting and cancer: Understanding parenting concerns, challenges, and supporting psychological well-being in parents with cancer
Open this publication in new window or tab >>Navigating parenting and cancer: Understanding parenting concerns, challenges, and supporting psychological well-being in parents with cancer
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many adults diagnosed with cancer are parents of dependent children. Balancing the roles of a patient and a parent is a stressor, with parenting concerns linked to elevated psychological distress. Despite this, the psychosocial support needs of parents with cancer are oftentimes not met. Addressing these gaps in support is essential to promote the psychological well-being of both parents and their families.

The overall aim of this thesis was to explore parenting concerns, challenges, and psychological distress among parents with cancer, assess psychosocial support needs, and evaluate the feasibility of a psychological intervention for parents. First, a systematic review was conducted to identify existing psychosocial interventions for parents with cancer (study I). Then, parents’ experiences and challenges in relation to cancer was explored in interviews (study II), and a cross-sectional survey examined levels of psychological distress and associated factors, including parenting concerns, self-efficacy, and emotion regulation (study III). A psychometric evaluation assessed the Swedish version of the Parenting Concerns Questionnaire (PCQ, study IV), and finally, a pilot study of online affect-focused psychodynamic psychotherapy for parents explored its feasibility, acceptability, safety and preliminary effects (study V).

The findings show that parenting concerns are central in parents’ lives. Study I identified 22 psychosocial interventions, some of which were promising but most were not formally evaluated. Study II highlighted the difficulties being both a parent and a patient, and how cancer impacted parenting and roles in the family. Parenting could serve as a source of stress or resilience. In study III, one in three parents reported symptoms above cut-off for depression, anxiety, or stress, and 16% experienced all three. Higher parenting concerns, low self-efficacy, and maladaptive emotion regulation were associated with increased psychological distress. Study IV assessed the Parenting Concerns Questionnaire (PCQ) as valid and reliable overall. In study V, affect-focused psychodynamic psychotherapy (AFT) was experienced as feasible, relevant, and beneficial in reducing psychological distress.

This thesis underscores that parenting with cancer reflects a complex interplay of individual, relational, and structural factors, highlighting the need for holistic psychosocial support that acknowledges parents not only as patients but as part of a family.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2025. p. 107
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2155
Keywords
Neoplasms, cancer, parenting, parenting concerns, psychological distress, psychological interventions
National Category
Cancer and Oncology Applied Psychology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-554977 (URN)978-91-513-2493-7 (ISBN)
Public defence
2025-06-12, Sal IV, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2025-05-22 Created: 2025-04-20 Last updated: 2025-05-22

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Romare Strandh, MariaStålberg, KarinSörensdotter, RenitaLjungman, LisaWikman, Anna

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