Parenting under pressure: a cross-sectional questionnaire study of psychological distress, parenting concerns, self-efficacy, and emotion regulation in parents with cancer
DOI:
https://doi.org/10.2340/1651-226X.2024.40404Keywords:
neoplasms, parents, parenting concerns, psychological distress, depression, anxiety, stressAbstract
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.
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References
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA A Cancer J Clin. 2021;71:209–49.
https://doi.org/10.3322/caac.21660 DOI: https://doi.org/10.3322/caac.21660
McFarland DC, Holland JC. The management of psychological issues in oncology. Clin Adv Hematol Oncol. 2016;14(12):999–1009.
Mehnert A, Hartung TJ, Friedrich M, et al. One in two cancer patients is significantly distressed: prevalence and indicators of distress. Psychooncology. 2018;27:75–82.
https://doi.org/10.1002/pon.4464 DOI: https://doi.org/10.1002/pon.4464
Vehling S, Mehnert-Theuerkauf A, Philipp R, et al. Prevalence of mental disorders in patients with cancer compared to matched controls – secondary analysis of two nationally representative surveys. Acta Oncol. 2022;61:7–13.
https://doi.org/10.1080/0284186X.2021.1992008 DOI: https://doi.org/10.1080/0284186X.2021.1992008
nhestern L, Bultmann JC, Johannsen LM, et al. Estimates of prevalence rates of cancer patients with children and well-being in affected children: a systematic review on population-based findings. Front Psychiatry. 2021;12:765314.
https://doi.org/10.3389/fpsyt.2021.765314 DOI: https://doi.org/10.3389/fpsyt.2021.765314
Arès I, Lebel S, Bielajew C. The impact of motherhood on perceived stress, llness intrusiveness and fear of cancer recurrence in young breast cancer survivors over time. Psychol Health. 2014;29:651–70.
https://doi.org/10.1080/08870446.2014.881998 DOI: https://doi.org/10.1080/08870446.2014.881998
Park EM, Deal AM, Check DK, et al. Parenting concerns, quality of life, and psychological distress in patients with advanced cancer: parents with advanced cancer. Psychooncology. 2016;25:942–8.
https://doi.org/10.1002/pon.3935 DOI: https://doi.org/10.1002/pon.3935
ohannsen L, Brandt M, Frerichs W, et al. The impact of cancer on the mental health of patients parenting minor children: a systematic review of quantitative evidence. Psychooncology. 2022;31:869–78.
https://doi.org/10.1002/pon.5912 DOI: https://doi.org/10.1002/pon.5912
Walczak A, McDonald F, Patterson P, et al. How does parental cancer affect adolescent and young adult offspring? A systematic review. Int J Nurs Stud. 2018;77:54–80.
https://doi.org/10.1016/j.ijnurstu.2017.08.017 DOI: https://doi.org/10.1016/j.ijnurstu.2017.08.017
Semple CJ, McCance T. Parents’ experience of cancer who have young children: a literature review. Cancer Nurs. 2010;33:110–18.
https://doi.org/10.1097/NCC.0b013e3181c024bb DOI: https://doi.org/10.1097/NCC.0b013e3181c024bb
Kuswanto CN, Stafford L, Sharp J, et al. Psychological distress, role, and dentity changes in mothers following a diagnosis of cancer: a systematic eview. Psychooncology. 2018;27:2700–8.
https://doi.org/10.1002/pon.4904 DOI: https://doi.org/10.1002/pon.4904
Matuszczak-Świgoń J, Bakiera L. Experiences of adults as parents with cancer: a systematic review and thematic synthesis of qualitative studies. J Psychosoc Oncol. 2021;39:765–88.
https://doi.org/10.1080/07347332.2020.1859662 DOI: https://doi.org/10.1080/07347332.2020.1859662
nhestern L, Bultmann JC, Beierlein V, et al. Psychometric properties of the parenting concerns questionnaire in cancer survivors with minor and young adult children. Psychooncology. 2016;25:1092–8.
https://doi.org/10.1002/pon.4049 DOI: https://doi.org/10.1002/pon.4049
Tavares R, Brandão T, Matos PM. Mothers with breast cancer: a mixed-method systematic review on the impact on the parent-child relationship. Psychooncology. 2018;27:367–75.
https://doi.org/10.1002/pon.4451 DOI: https://doi.org/10.1002/pon.4451
Chin J-C, Chen Y-Y. Mother-child dyad support needs to be expressed by mothers diagnosed with breast cancer. J Clin Nurs. 2022;32:3995–4008.
https://doi.org/10.1111/jocn.16509 DOI: https://doi.org/10.1111/jocn.16509
Faccio F, Mascheroni E, Ionio C, et al. Motherhood during or after breast cancer diagnosis: a qualitative study. Eur J Cancer Care. 2020;29:e13214.
https://doi.org/10.1111/ecc.13214 DOI: https://doi.org/10.1111/ecc.13214
Park EM, Jensen C, Song M-K, et al. Talking with children about prognosis: the decisions and experiences of mothers with metastatic cancer. JCO Oncol Pract. 2021;17:e840–7.
https://doi.org/10.1200/OP.21.00003 DOI: https://doi.org/10.1200/OP.21.00003
Stinesen-Kollberg K, Thorsteinsdottir T, Wilderäng U, et al. Worry about one’s own children, psychological well-being, and interest in psychosocial intervention. Psychooncology. 2013;22:2117–23.
https://doi.org/10.1002/pon.3266 DOI: https://doi.org/10.1002/pon.3266
Moore CW, Rauch PK, Baer L, et al. Parenting changes in adults with cancer: parenting changes in adults with cancer. Cancer. 2015;121:3551–7.
https://doi.org/10.1002/cncr.29525 DOI: https://doi.org/10.1002/cncr.29525
Jones TL, Prinz RJ. Potential roles of parental self-efficacy in parent and child adjustment: a review. Clin Psychol Rev. 2005;25:341–63.
https://doi.org/10.1016/j.cpr.2004.12.004 DOI: https://doi.org/10.1016/j.cpr.2004.12.004
Peh CX, Liu J, Bishop GD, et al. Emotion regulation and emotional distress: the mediating role of hope on reappraisal and anxiety/depression in newly diagnosed cancer patients. Psychooncology. 2017;26:1191–7.
https://doi.org/10.1002/pon.4297 DOI: https://doi.org/10.1002/pon.4297
Babore A, Bramanti SM, Lombardi L, et al. The role of depression and emotion regulation on parenting stress in a sample of mothers with cancer. Support Care Cancer. 2019;27:1271–7.
https://doi.org/10.1007/s00520-018-4611-5 DOI: https://doi.org/10.1007/s00520-018-4611-5
Vaughan E, Koczwara B, Kemp E, et al. Exploring emotion regulation as a mediator of the relationship between resilience and distress in cancer. Psychooncology. 2019;28:1506–12.
https://doi.org/10.1002/pon.5107 DOI: https://doi.org/10.1002/pon.5107
Romare Strandh M, Hovén E, Sörensdotter R, et al. The Complexity of Being a Parent in the Hospital and a Patient at Home: A Qualitative Study on Parenting Concerns and Challenges Among Parents With Cancer. Cancer Nurs. Published online September 21, 2023. doi:10.1097/NCC.0000000000001276 DOI: https://doi.org/10.1097/NCC.0000000000001276
Adeyemi OJ, Gill TL, Paul R, et al. Evaluating the association of self-reported psychological distress and self-rated health on survival times among women with breast cancer in the U.S. PLoS One. 2021;16:e0260481.
https://doi.org/10.1371/journal.pone.0260481 DOI: https://doi.org/10.1371/journal.pone.0260481
Romare Strandh M, Hovén E, Sörensdotter R, et al. Psychosocial interventions targeting parenting distress among parents with cancer – a systematic review and narrative synthesis of available interventions. Crit Rev Oncol/Hematol. 2023;191:104119.
https://doi.org/10.1016/j.critrevonc.2023.104119 DOI: https://doi.org/10.1016/j.critrevonc.2023.104119
Henry JD, Crawford JR. The short-form version of the depression anxiety stress scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44:227–39.
https://doi.org/10.1348/014466505X29657 DOI: https://doi.org/10.1348/014466505X29657
Muriel AC, Moore CW, Baer L, et al. Measuring psychosocial distress and parenting concerns among adults with cancer: the parenting concerns questionnaire. Cancer. 2012;118:5671–8.
https://doi.org/10.1002/cncr.27572 DOI: https://doi.org/10.1002/cncr.27572
Taber KS. The use of Cronbach’s alpha when developing and reporting research instruments in science education. Res Sci Educ. 2018;48:1273–96.
https://doi.org/10.1007/s11165-016-9602-2 DOI: https://doi.org/10.1007/s11165-016-9602-2
Schwarzer R, Jerusalem M. General self-efficacy scale [Internet]. 2012 [cited 11-09-2023]. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/t00393-000
Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol. 2003;85:348–62.
https://doi.org/10.1037/0022-3514.85.2.348 DOI: https://doi.org/10.1037/0022-3514.85.2.348
Meggiolaro E, Berardi MA, Andritsch E, et al. Cancer patients’ emotional distress, coping styles and perception of doctor-patient interaction in European cancer settings. Pall Supp Care. 2016;14:204–11.
https://doi.org/10.1017/S1478951515000760 DOI: https://doi.org/10.1017/S1478951515000760
Kuswanto CN, Stafford L, Schofield P, et al. Self-compassion and parenting efficacy among mothers who are breast cancer survivors: implications for psychological distress. J Health Psychol. 2024;29:425–37.
https://doi.org/10.1177/13591053231222162 DOI: https://doi.org/10.1177/13591053231222162
Park EM, Tan X, Stephenson EM, et al. Psychometric analysis of the parenting concerns questionnaire in women with metastatic cancer. J Pain Sympt Manage. 2018;55:451–7.
https://doi.org/10.1016/j.jpainsymman.2017.09.021 DOI: https://doi.org/10.1016/j.jpainsymman.2017.09.021
Tavares R, Brandão T, Matos PM. The parenting concerns questionnaire: a validation study with Portuguese parents with cancer. Eur J Cancer Care. 2020;29:e13315.
https://doi.org/10.1111/ecc.13315 DOI: https://doi.org/10.1111/ecc.13315
Phillips F, Prezio EA, Currin‐McCulloch J, et al. Wonders & worries: a randomized clinical trial of a psychosocial intervention for children who have a parent with cancer. Psychooncology. 2022;31:1399–411.
https://doi.org/10.1002/pon.5943 DOI: https://doi.org/10.1002/pon.5943
Zhang A, Wang K, Acquati C, et al. Age as a moderator for the association between depression and self-rated health among cancer survivors: a U.S. based population study. J Psychosoc Oncol. 2023;41:377–92.
https://doi.org/10.1080/07347332.2022.2124393 DOI: https://doi.org/10.1080/07347332.2022.2124393
Inhestern L, Bultmann JC, Beierlein V, et al. Understanding parenting concerns in cancer survivors with minor and young-adult children. J Psychosom Res. 2016;87:1–6.
https://doi.org/10.1016/j.jpsychores.2016.05.008 DOI: https://doi.org/10.1016/j.jpsychores.2016.05.008
Kusurkar R. Critical synthesis package: general self-efficacy scale (GSE). MedEdPORTAL. 2013;9(1):9576.
https://doi.org/10.15766/mep_2374-8265.9576 DOI: https://doi.org/10.15766/mep_2374-8265.9576
Lewis FM, Brandt PA, Cochrane BB, et al. The enhancing connections program: a six-state randomized clinical trial of a cancer parenting program. J Consult Clin Psychol. 2015;83:12–23.
https://doi.org/10.1037/a0038219 DOI: https://doi.org/10.1037/a0038219
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Copyright (c) 2023 Maria Romare Strandh, Pia Enebrink, Karin Stålberg, Renita Sörensdotter, Lisa Ljungman, Anna Wikman
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Cancerfonden
Grant numbers 20 0824 Pj -
Vetenskapsrådet
Grant numbers 2020-02080