Abstract
Purpose
Research suggests a relationship between caring for a child with cancer and psychological distress in caregivers. Less evident is the role which financial difficulties might play in this relationship. We sought to determine if caring for a child with cancer was related to clinically relevant depressive symptoms among parents, whether or not financial difficulties mediated this relationship, and if financial difficulties were independently associated with symptoms of depression among parents of children with cancer.
Methods
Data are from 215 parents of children diagnosed with cancer or brain tumors (n = 75) and a comparison group of parents of healthy children (n = 140). Multiple logistic regression analyses were used to assess the factors associated with reporting clinically relevant depressive symptoms.
Results
Caring for a child with cancer was associated with increased odds of clinically relevant depressive symptoms in parents (OR = 4.93; 95 % CI 1.97–12.30), controlling for covariates. The mediating effect of financial burden on this relationship was not statistically significant. However, among parents of children with cancer, negative financial life events increased the likelihood of reporting symptoms of depression (OR = 4.89; 95 % CI 1.26–18.96).
Conclusions
Caring for a child with cancer was associated with depressive symptoms for parents. Financial difficulties were the strongest correlate of these symptoms among parents of children with cancer. Our results suggest that it may not only be the burden of caring for the child with cancer but also the associated financial difficulties that contribute to a higher likelihood of depressive symptoms in parents.
Similar content being viewed by others
Notes
The test for mediation was significant before adding covariates (p = 0.007) suggesting that we may have been underpowered to detect the effect.
This finding did reach statistical significance (p = 0.023). However, the upper end of the confidence interval is 1.00 by rounding to the second decimal place.
References
Grootenhuis MA, Last BF (1997) Adjustment and coping by parents of children with cancer: a review of the literature. Support Care Cancer 5:466–484. doi:10.1007/s005200050116
Vrijmoet-Wiersma CMJ, van Klink JMM, Kolk AM, Koopman HM, Ball LM, Egeler M (2008) Assessment of parental psychological distress in pediatric cancer: a review. J Pediatr Psychol 33(7):694–706. doi:10.1007/s00520-009-0685-4
Klassen A, Raina P, Reineking S, Dix D, Pritchard S, O'Donnell M (2007) Developing a literature base to understand the caregiving experience of parents of children with cancer: a systematic review of factors related to parental health and well-being. Support Care Cancer 15:807–818. doi:10.1007/s00520-007-0243-x
Bayat M, Erdem E, Gul Kuzucu E (2008) Depression, anxiety, hopelessness, and social support levels of the parents of children with cancer. J Pediatr Oncol Nurs 25(5):247–253. doi:10.1177/1043454208321139
Frank NC, Brown RT, Blount RL, Bunke V (2001) Predictors of affective responses of mothers and fathers of children with cancer. Psychol Oncol 10(4):293–304. doi:10.1002/pon.526
Norberg AL, Lindblad F, Boman KK (2005) Coping strategies in parents of children with cancer. Soc Sci Med 60(5):965–975. doi:10.1016/j.socscimed.2004.06.030
Dunn MJ, Rodriguez EM, Barnwell AS, Grossenbacher JC, Vannatta K, Gerhardt CA, Compas BE (2012) Posttraumatic stress symptoms in parents of children with cancer within six months of diagnosis. Health Psychol 31(2):176–185. doi:10.1037/a0025545
Norberg AL, Boman KK (2008) Parent distress in childhood cancer: a comparative evaluation of posttraumatic stress symptoms, depression and anxiety. Acta Oncol 47:267–274. doi:10.1080/02841860701558773
Allen R, Newman SP, Souhami RL (1997) Anxiety and depression in adolescent cancer: findings in patients and parents at the time of diagnosis. Eur J Cancer 33(8):1250–1255. doi:10.1016/S0959-8049(97)00176-7
Witt WP, Litzelman K, Wisk LE, Spear HA, Catrine K, Levin N, Gottlieb CA (2010) Stress-mediated quality of life outcomes in parents of childhood cancer and brain tumor survivors: a case–control study. Qual Life Res 19:995–1005. doi:10.1007/s11136-010-9666-9
Manne SL, Lesanics D, Meyers P, Wollner N, Steinherz P, Redd WH (1995) Predictors of depressive symptomology among parents of newly diagnosed children with cancer. J Pediatr Psychol 20(4):491–510. doi:10.1093/jpepsy/20.4.491
Kazak AE, Brier M, Alderfer MA, Reilly A, Fooks Parker S, Rogerwick S, Ditaranto S, Barakat LP (2012) Screening for psychological risk in pediatric cancer. Pediatr Blood Cancer 59:822–827. doi:10.1002/pbc.24166
Patel SK, Mullins W, Turk A, Dekel N, Kinjo C, Sato JK (2010) Distress screening, rater agreement, and services in pediatric oncology. Psychol Oncol 20(12):1324–1333. doi:10.1002/pon.1859
Sloper P (2000) Predictors of distress in parents of children with cancer: a prospective study. J Pediatr Psychol 25(2):79–91. doi:10.1093/jpepsy/25.2.79
Speechley KN, Noh S (1992) Surviving childhood cancer, social support, and parents' psychological adjustment. J Pediatr Psychol 17(1):15–31. doi:10.1093/jpepsy/17.1.15
Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. Springer, New York
Morrow GR, Hoagland A, Carnrike CLM Jr (1981) Social support and parental adjustment to pediatric cancer. J Consult Clin Psychol 49(5):763–765. doi:10.1037/0022-006X.49.5.763
Sloper P (1996) Needs and responses of parents following the diagnosis of childhood cancer. Child Care Health Dev 22(3):187–202. doi:10.1046/j.1365-2214.1996.788788.x
Hoekstra-Weebers JEHM, Jaspers JPC, Kamps WA, Klip EC (2001) Psychological adaptation and social support of parents of pediatric cancer patients: a prospective longitudinal study. J Pediatr Psychol 26(4):225–235. doi:10.1093/jpepsy/26.4.225
Goldbeck L (2001) Parental coping with the diagnosis of childhood cancer: gender effects, dissimilarity within couples, and quality of life. Psychol Oncol 10:325–335. doi:10.1002/pon.530
Dahlquist LM, Czyzewski DI, Copeland KG, Jones CL, Taub E, Vaughan JK (1993) Parents of children newly diagnosed with cancer: anxiety, coping, and marital distress. J Pediatr Psychol 18(3):365–376. doi:10.1093/jpepsy/18.3.365
Mulhern RK, Fairclough DL, Smith B, Douglas SM (1992) Maternal depression, assessment methods, and physical symptoms affect estimates of depressive symptomatology among children with cancer. J Pediatr Psychol 17:313–326. doi:10.1093/jpepsy/17.3.313
Witt WP, Gottlieb CA, Hampton JM, Litzelman K (2009) The impact of childhood activity limitations on parental health, mental health, and workdays lost in the United States. Acad Pediatr 9(4):263–269. doi:10.1016/j.acap.2009.02.008
Bloom BS, Knorr RS, Evans AE (1985) The epidemiology of disease expenses. The costs of caring for children with cancer. JAMA 253(16):2393–2397. doi:10.1001/jama.1985.03350400077025
Lansky SB, Black JL, Cairns NU (1983) Childhood cancer. Med Costs Cancer 52(4):762–766
Lansky SB, Cairns NU, Clark GM, Lowman J, Miller L, Trueworthy R (1979) Childhood cancer: nonmedical costs of the illness. Cancer 43(1):403–408
Monaco GP (1983) Economics as a significant contributor to family stress in childhood cancer. Prog Clin Biol Res 132E:387–394
Cohn RJ, Goodenough B, Foreman T, Suneson J (2003) Hidden financial costs in treatment for childhood cancer: an Australian study of lifestyle implications for families absorbing out-of-pocket expenses. J Pediatr Hematol Oncol 25(11):854–863
Dockerty JD, Skegg DC, Williams SM (2003) Economic effects of childhood cancer on families. J Paediatr Child Health 39(4):254–258. doi:10.1046/j.1440-1754.2003.00138.x
Heath JA, Lintuuran RM, Rigguto G, Tokatlian N, McCarthy M (2006) Childhood cancer: its impact and financial costs for Australian families. Pediatr Hematol Oncol 23(5):439–448. doi:10.1080/08880010600692526
Bridges S, Disney R (2004) Use of credit and arrears on debt among low-income families in the United Kingdom. Fisc Stud 25(1):1–25. doi:10.2139/ssrn.2200927
Berger LM, Collins JM, Cuesta L (2013) Household debt and adult depressive symptoms. Soc Sci Res Netw. doi:10.2139/ssrn.2200927
Litzelman K, Catrine K, Gangnon R (2011) Quality of life among parents of children with cancer or brain tumors: the impact of child characteristics and parental psychosocial factors. Qual Life Res 20(8):1261–1270. doi:10.1007/s11136-011-9854-2
Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401. doi:10.1177/014662167700100306
Andresen EM, Malmgren JA, Carter WB, Patrick DL (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 10(2):77–84
Norbeck JS (1984) Modification of life event questionnaires for use with female respondents. Res Nurs Health 7:61–71. doi:10.1002/nur.4770070110
Parkerson GR, Broadhead WE, Tse CK (1991) Validation of the Duke Social Support and Stress Scale. Fam Med 23(5):357–360
Imai K, Keele L, Tingley D (2010) A general approach to causal mediation analysis. Psychol Methods 15(4):309–334. doi:10.1037/a0020761
Dranove D, Millenson ML (2006) Medical bankruptcy: myth versus fact. Health Aff 25:w74–w83. doi:10.1377/hlthaff.25.w74
Himmelstein DU, Warren E, Thorne D, Woolhandler S (2005) Illness and injury as contributors to bankruptcy. Health Affair Suppl Web Exclusives:W5:63–W65:73. doi:10.1377/hlthaff.w5.63
Quitter AL, Glueckauf RL, Jackson DN (1990) Chronic parenting stress: moderating versus mediating effects of social support. J Pers Soc Psychol 59(6):1266–1278. doi:10.1037/0022-3514.59.6.1266
Weissman MM, Gammon GD, John K, Merikangas KR, Warner V, Prusoff BA, Sholomskas D (1987) Children of depressed parents: increased psychopathology and early onset of major depression. Arch Gen Psychiatry 44(10):847–853. doi:10.1001/archpsyc.1987.01800220009002
Billings AG, Moos RH (1983) Comparisons of children of depressed and nondepressed parents: a social–environmental perspective. J Abnorm Child Psychol 11(4):463–485. doi:10.1007/BF00917076
Kazak AE, Rourke MT, Rodriguez A, Reilly A (2005) Feasibility and preliminary outcomes from a pilot study of a brief psychological intervention for families of children newly diagnosed with cancer. J Pediatr Psychol 30(8):644–655. doi:10.1093/jpepsy/jsi051
Warner CM, Ludwig K, Sweeney C, Spillane C, Hogan L, Ryan J, Carrol W (2011) Treating persistent distress and anxiety in parents with children with cancer: an initial feasibility trial. J Pediatr Oncol Nurs 28(4):224–230. doi:10.1177/1043454211408105
Acknowledgments
We would like to thank the families who participated in this study, as well as the clinical and research staff who were instrumental to study recruitment. We would also like to thank the anonymous reviewers whose comments helped strengthen this manuscript. This research was supported by a grant from the National Institute of Child Health and Human Development (HD049533, W. P. Witt, Principal Investigator and Waisman Center P30 HD03352, M. M. Seltzer, Principal Investigator), UW Comprehensive Cancer Center Investigator Initiated Trial (W. P. Witt, Principal Investigator), an Agency for Healthcare Research and Quality T-32 training grant (HS00083, M. Smith, Principal Investigator), and the UW Care for Kids Foundation (W. P. Witt, Principal Investigator).
Conflicts of interest
None of the authors has a conflict of interest with this research.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Creswell, P.D., Wisk, L.E., Litzelman, K. et al. Parental depressive symptoms and childhood cancer: the importance of financial difficulties. Support Care Cancer 22, 503–511 (2014). https://doi.org/10.1007/s00520-013-2003-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-013-2003-4