Lisa Ljungman

Does time heal all wounds? A longitudinal study of the development of posttraumatic stress symptoms in parents of survivors of childhood cancer and bereaved parents.

A lack of longitudinal studies has hampered the understanding of the development of posttraumatic stress symptoms (PTSS) in parents of children diagnosed with cancer. This study examines level of PTSS and prevalence of posttraumatic stress disorder (PTSD) from shortly after diagnosis up to 5 years after end of treatment or childs death, in mothers and fathers.

Internet-based guided self-help for parents of children on cancer treatment : A randomized controlled trial

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.

Experiential Avoidance and Rumination in Parents of Children on Cancer Treatment: Relationships with Posttraumatic Stress Symptoms and Symptoms of Depression

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.

Parents of children diagnosed with cancer: work situation and sick leave, a five-year post end-of-treatment or a child’s death follow-up study

Abstract Background: Cancer in a child is associated with a significant impact on parental employment. We assessed the proportions of parents of survivors and bereaved parents working and reporting sick leave five years after end of successful treatment (ST)/child’s death (T7) compared with one year after end of ST/child’s death (T6) and the association between partial post-traumatic stress disorder (PTSD) and work situation and sick leave at T7. Participants and procedure: The sample included 152 parents of survivors (77 mothers, 75 fathers) and 42 bereaved parents (22 mothers, 20 fathers) of children diagnosed with cancer in Sweden. Results: The proportions of parents working or reporting sick leave did not differ among mothers and fathers of survivors (92% vs. 96% working, 20% vs. 18% on sick leave) or among bereaved mothers and fathers (91% vs. 90% working, 14% vs. 20% on sick leave) at T7. There was no change from T6 to T7 in the proportion of fathers working (fathers of survivors 91% vs. 96%, bereaved fathers 95% vs. 90%). Although more mothers of survivors (92% vs. 82%) and bereaved mothers (91% vs. 77%) worked at T7 than at T6, this increase was not significant. Fewer bereaved mothers reported sick leave at T7 than at T6 (14% vs. 59%, p < 0.05). Although more fathers reported sick leave at T7 than at T6 (fathers of survivors 18% vs. 8%, bereaved fathers 20% vs. 15%), this was not significant. Partial PTSD was not associated with parents’ work situation or sick leave at T7. Conclusion: Results suggest little adverse effect on work situation and sick leave among parents of survivors and bereaved parents five years after end of ST/child’s death from cancer. However, the pattern of change observed differed between parents, which could potentially indicate possible delayed consequences for fathers not captured in the present paper.

Impressions That Last: Particularly Negative and Positive Experiences Reported by Parents Five Years after the End of a Child’s Successful Cancer Treatment or Death

Objective To describe the experience of parenting a child diagnosed with cancer by examining particularly negative and positive experiences reported by parents of childhood cancer survivors and parents of children lost to cancer. Methods 168 parents (88 mothers, 80 fathers) participated. Data were collected five years after the end of successful treatment or the child’s death. The parents’ experiences were identified by open-ended semi-structured questions about particularly negative and positive experiences of the child’s cancer. An inductive approach was used in which the manifest verbal content of the answers was analysed using content analysis. Results The analysis revealed eight categories of negative experience (child late effects; distressing events; healthcare; impaired relationships; long-term psychological consequences; own reactions; surrounding institutions; the fact that the child got cancer) and seven categories of positive experience (healthcare; improved relationships; long-term consequences for the child; personal development; support systems; treatment outcome; unexpected joy). The categories were related to past events or to the present situation. The findings indicate variations in experiences between parents of survivors and bereaved parents, and between fathers and mothers, as some experiences were only reported by parents of survivors and some experiences were only reported by mothers. Conclusions The results highlight the importance of past and present events to parents, and accordingly the long-lasting impact of paediatric cancer on parents. The results also point to the wide range of negative as well as positive experiences involved in parenting a child diagnosed with cancer, and provide a comprehensive understanding of the overall experience for parents of children with cancer. Specifically, the findings give guidance to healthcare providers by illustrating the need to provide healthcare personnel with continuous training in communication skills, offering parents opportunities to meet other parents in the same situation and increasing the access to psychosocial supportive services and psychological care.

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

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.

The interdependence of posttraumatic stress symptoms in parental dyads during and after their child's treatment for cancer

Abstract 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.

Posttraumatic Stress in Parents of Children Diagnosed with Cancer : Hyperarousal and Avoidance as Mediators of the Relationship between Re-Experiencing and Dysphoria

Background Increased understanding of the relationships between different symptom clusters involved in posttraumatic stress symptoms (PTSS) could guide empirical research and clinical practice. The objective of the present study was to investigate whether hyperarousal and avoidance mediated the relationship between re-experiencing and dysphoria in parents of children diagnosed with cancer. Methods Longitudinal data from parents of children receiving cancer therapy were used. PTSS were assessed using the PTSD Checklist Civilian Version at one week (T1), two (T2) and four months (T3) after diagnosis. Mediation analyses for multiple mediators were conducted for mothers (n = 122) and fathers (n = 121), respectively. The mediation model tested the assumption that the PTSS symptom clusters hyperarousal and avoidance mediated the relationship between re-experiencing and dysphoria. Results For fathers, none of the hypothesized mediators were significant. For mothers, hyperarousal mediated the relationship between re-experiencing and dysphoria, but avoidance did not. Conclusions Results suggest that hyperarousal is important for the development of dysphoria in mothers, supporting use of interventions targeting such symptoms in the early and ongoing period following the child’s diagnosis.

Internet-based Guided Self-help for Parents of Children Diagnosed with Cancer: 1-year Follow-up of a Randomized Controlled Trial

 Background/purpose: Many people living with cancer experience depression. Research suggests that the therapeutic effect of exercise on depression is similar to pharmacotherapy or psychological intervention, yet cancer survivors are under-exercising compared to recommended doses. Self-efficacy may be a factor to explain exercise engagement. This cross-sectional study investigated whether exercise task self-efficacy (ETSE) was associated with exercise engagement, further examining differences between cancer survivors with and without elevated depressive symptoms. Methods: Ninety-seven cancer survivors (60.8 ±9.9 years) were mailed self-report questionnaires on ETSE, exercise engagement, and depressive symptoms. A Hospital Anxiety and Depression Scale D cutoff score (≥8) was used to assign participants to a symptomatic (n = 34) or non-symptomatic group (n = 63). An independent t-test was used to examine differences in ETSE between groups. Correlational analyses were used to examine relationships between exercise task self-efficacy and exercise engagement. Results: There was a significant difference in the degree of exercise task self-efficacy between cancer survivors with (M=35.74, SD= 31.47) and without (M=57.30, SD= 26.71) depressive symptoms, t(95) =_3.56, p<0.01, with a large effect size (d =0.74). A positive association was found between ETSE and exercise engagement, r(95)= 0.49, p<0.01, which was similar for both groups. Conclusions: Exercise task self-efficacy appears to influence exercise engagement independently of mood status, but people with higher levels of depression symptoms tend to have lower self-efficacy. Therefore, future research should examine interventions to enhance exercise task self-efficacy, thereby potentially increasing exercise engagement in cancer survivors. Research Implications: These findings demonstrated that cancer survivors with depressive symptoms have low ETSE and that ETSE can predict exercise engagement. This suggests a role for enhancing ETSE to influence exercise engagement in cancer survivors. Future research could investigate causality between ETSE and exercise engagement and interventions to enhance ETSE. The findings of the present study could assist with more definitive research which could aid clinicians interested in behavioral change with regard to exercise engagement and improvement of depressive symptomatology in cancer survivors. Practice Implications: The findings illustrate that exercise self-efficacy predicts exercise engagement, independently of mood. Therefore, clinicians working with depressed or non-depressed cancer survivors should initially target increasing exercise self-efficacy as opposed to reinforcing the positive health benefits of increased physical activity.

A Cognitive Behavioural Conceptualization of Psychological Distress in Parents of Children Previously Treated for Cancer

A smartphone application is a feasible way to deliver information and resources to carers while they are looking after someone receiving cancer treatment. A smartphone application is an appropriate resource for carers regardless of their age or gender.A Cognitive Behavioural Conceptualization of Psychological Distress in Parents of Children Previously Treated for Cancer5 Risk for psychological distress among cancer patients with a familial history of Indian Residential School attendance: Results from the 2008‐10 First Nations Regional Health Survey Mrs. Maike van Niekerk* | Dr. Amy Bombay Dalhousie University, Halifax, Canada; Dalhousie University, Halifax,