Akiko Ogata

Factors related to posttraumatic stress in adolescent survivors of childhood cancer and their parents

Goals of workThe purpose of this study was to investigate factors related to severe posttraumatic stress symptoms (PTSS) in adolescent survivors of childhood cancer and their parents.Materials and methodsEighty-nine families (88 adolescent survivors of childhood cancer, 87 mothers, 72 fathers) completed a self-report questionnaire. Multivariate logistic regression analyses were performed using the following risk factors for severe PTSS: trait anxiety, family functioning, demographic and medical variables.Main resultsSevere PTSS were reported by 10.9% (n=9) of the survivors, 20.7% (n=18) of the mothers, and 22.2% (n=16) of the fathers. Preliminary analyses found significant correlations of PTSS between mother–survivor (Spearman’s γ=0.377, p<0.01) and mother–father (Spearman’s γ=0.483, p<0.01). The results of multivariate analyses indicated that higher trait anxiety [odds ratio (OR):1.16; 95% confidence interval (CI): 1.03–1.31; p<0.05] and having medical sequelae (OR: 5.85; 95% CI:1.02–33.72; p<0.05) were significant factors related to PTSS for survivors. For mothers, the significant PTSS-related factors were: higher trait anxiety (OR:1.13; 95% CI:1.04–1.23; p<0.01); 5- to 9-year interval from the first diagnosis to the present investigation, compared to more than a 10-year interval (OR: 6.45; 95% CI:1.67–24.89; p<0.01); and a relatively lower rating on “roles” of family functioning (OR: 12.34; 95% CI:1.11–136.97; p<0.05). For fathers, trait anxiety was a significant related factor (OR: 1.07; 95% CI:1.01–1.14; p<0.05).ConclusionsSurvivors and their parents suffered from PTSS after long interval from completion of treatment, and PTSS-related factors varied for each family member. Appropriate allocation of responsibility for family functioning may promote the ability to decrease PTSS, especially for mothers.

Psychological distress related to patterns of family functioning among Japanese childhood cancer survivors and their parents

Objective: Family functioning appears to be a predictor of psychological distress among childhood cancer survivors and their family members; however, relatively little is known about patterns in those families that are psychologically at‐risk. The purpose of this study was to identify distinct clusters of families that include childhood cancer survivors, and to evaluate differences between the clusters with respect to anxiety, depression, and post‐traumatic stress symptoms (PTSS).

A qualitative study of decision-making by breast cancer patients about telling their children about their illness

ObjectiveMany breast cancer patients are troubled about telling their school-age children about their illness. However, little attention has been paid to the factors that encourage or discourage them from revealing the illness. This study explored decision-making by breast cancer patients about telling their children about their illness.MethodsParticipants were 30 breast cancer patients recruited from a regional cancer institution in Japan. Semi-structured interviews were conducted and content analysis was performed.ResultsSix preparatory stages of decision-making by Japanese breast cancer patients about telling their children about their illness were identified as follows: contemplation, preparation, action-hospitalization and surgery, action-adjuvant therapy, action-diagnosis, and action-prognosis. We also identified 11 categories of positive aspects and ten categories of negative aspects about revealing their illness to children. The categories of negative aspects with higher frequency were similar to those found by previous research, but categories of positive aspects were unique. The rate of reference to negative aspects in total reduces gradually as the preparatory stage advances, and in action-diagnosis and action-prognosis stages the balance between positive and negative aspects becomes about half and half.ConclusionsPatients, especially in action-hospitalization and surgery, can be expected to tell their children about their illness although they find negative aspects much more compelling than positive aspects and experience great distress. These patients have special needs for support from others.

Effectiveness of group cognitive-behavioral therapy in reducing self-stigma in Japanese psychiatric patients

OBJECTIVE There is evidence that the stigma surrounding mental illness may be greater in Japan than elsewhere. However, few Japanese studies have focused on self-stigma (the internalization of social stigma), and few interventions to reduce self-stigma exist. To remedy this deficiency, we evaluated the efficacy of group cognitive-behavioral therapy (CBT) in reducing self-stigma and examined the relationship between cognitive restructuring and self-stigma. METHODS We administered a 10-session group CBT program to 46 Japanese outpatients with anxiety and depressive symptoms (36 men, 10 women; mean age=38.57 years, SD=8.33; 20 diagnosed with mood disorders; 24 with neurotic, stress-related, or somatoform disorders; and 2 with other disorders). A pretest-posttest design was used to examine the relationship between cognitive restructuring and self-stigma. Outcomes were measured using the Japanese versions of the Devaluation-Discrimination Scale, Dysfunctional Attitude Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory State-Form, and Rosenbergs Self Esteem Scale. RESULTS Participants exhibited significant improvements in depression, anxiety, and maladjusted cognitive bias and reductions in self-stigma. Cognitive bias was significantly correlated with self-stigma. CONCLUSIONS Group CBT is effective in improving both emotional symptoms and self-stigma in outpatients with anxiety and depressive symptoms. Reduction in self-stigma plays a mediating role in alleviating emotional symptoms and improving cognition.

Behavioral characteristics of subthreshold depression.

BACKGROUND This study examines differences in behavioral characteristics among individuals who are not depressed and individuals with subthreshold depression, and depression. METHODS We conducted structured interviews with 111 undergraduate students, who also completed self-report scales. The participants were divided into a non-depression group, a subthreshold depression group, and a depression group based on results of the structured interview and the BDI-II. RESULTS There were significant differences in avoidance between depression group and other two groups. Also, for the environmental rewards, there were significant difference between the non-depressed group and the other two groups. LIMITATIONS The sample of depressed participants was small. The overall sample consisted only undergraduate students. CONCLUSIONS This study reported that there are different behavioral characteristics among non-depression, subthreshold depression, and depression groups. Whereas depression group is characterized by high frequency of avoidance and low environmental rewards, subthreshold depression group is characterized by only low environmental rewards.

Mechanisms of behavioral activation for late adolescents: Positive reinforcement mediate the relationship between activation and depressive symptoms from pre-treatment to post-treatment

BACKGROUND It is suggested that there is some support for notion that frequency of activity can lead to improved mood in behavioral activation, but this research is relatively imprecise. We investigated whether positive reinforcement mediates the relationship between activation and alleviation of depressive symptoms METHODS Late adolescents with sub-threshold depressive symptoms participated in the study. We conducted an intervention using behavioral activation with the participants. Then, pre-and post-treatment results of behavioral activation were compared. We used mediation analysis using the bootstrapping method to examine whether changes in reinforcement mediated the relationship between changes in activation and improvements in depressive symptoms. RESULTS Participants improved significantly at the post-intervention assessment, compared to the baseline assessment. Results of mediation analysis indicated that reinforcement significantly mediated the relationship between activation and depressive symptoms, whereas activation alone had no a direct effect on depressive symptoms. LIMITATIONS Further studies with more diverse samples of participants are required in order to generalize the results of this study to more diverse populations. CONCLUSIONS The study provides the first full mediational test of behavioral activation model including both measures of activation and positive reinforcement, and we found support for behavioral activations presumed mechanism of action that contact with positive reinforcement mediates the relation between activity and depression.

Psychosocial difficulties in adolescent and young adult survivors of childhood cancer

With a large number of children surviving cancer worldwide, numerous investigations have assessed psychological and social adjustment among childhood cancer survivors. According to these studies, it is unclear whether childhood cancer survivors successfully adjust to daily life after being discharged from hospital, especially for adolescent and young adult survivors who have unique needs and concerns. The primary aim of this study was to identify the factors underlying psychosocial difficulties faced by adolescent and young adult survivors in their day‐to‐day lives after being discharged from hospital.