Predictors of Psychological Functioning in Children with Cancer: Impact of Life Events and Dispositional Factors

Transcription

1 Predictors of Psychological Functioning in Children with Cancer: Impact of Life Events and Dispositional Factors Katianne Howard-Sharp, Anjoli Rowe, Kathryn Russell, Alanna Long, Sean Phipps ECRS 2014 Copenhagen, Denmark September 8, 2014

2 Background Despite the many challenges of childhood cancer, most children are adjusting well Minimal Impact Resilience (Bonnano) as the modal outcome Need for normative comparisons to avoid overestimating illness-related distress Absence of cancer-control differences highlights need to examine other factors associated with adjustment outcomes E.g., premorbid function, family environment, social support, other life stressors, disposition

3 Stressful Life Events Greater lifetime adversity associated with increased depression, anxiety and PTSS (Cloitre et al., 2009; Stuber et al., 1997) Children s cumulative exposure more predictive of psychological functioning than single specific traumatic event (Goslin et al., 2013) In children with cancer, lifetime stressful events predictive of PTSS after controlling for demographic factors, cancer factors and parental PTSS (Currier et al., 2009)

4 Disposition Personality factors more widely studied as predictors of adjustment in adults with cancer Optimism most widely studied Examined less frequently in children (trait anxiety, repressive adaptive style, optimism) Five-factor models (Neuroticism, Extraversion, Openness, Agreeableness, Conscientiousness)

5 Objectives Compare psychological functioning (symptoms of depression, anxiety, posttraumatic stress) in children with cancer and demographically similar peers Hypothesis: No differences in mean symptom levels or clinically elevated scores Examine predictors of psychological functioning, including demographic factors, health status, cumulative life stressors, and disposition Hypothesis: life stress will account for greater variance in adjustment than health status/illness factors Disposition will account for unique variance in adjustment outcomes after controlling for demographics, health status, and life events

6 Methods Children with cancer, age 8-17, recruited in 4 strata cross-sectional by time since diagnosis: (N = 255) Strata 1: 1-6 months; Strata 2: 6 months 2 years; Strata 3: 2-5 years; Strata 4: > 5years Healthy comparisons matched on age, gender, race/ethnicity, SES (N = 101) Consent indicates stress and coping in children, no mention of cancer or illness. Likewise, survey measures completed without mention of cancer/illness PTSS measure completed first, participants indicate what they consider their most stressful event If cancer patients identify event other than cancer, asked to complete PTSS measures a 2 nd time

7 Methods: Measures Outcomes Children s Depression Inventory (CDI) Screen for Anxiety-Related Disorders (SCARED) UCLA Posttraumatic Stress Disorder Index (PTSDI) Predictors Demographics, Health Status, Treatment variables (Diagnosis, Time Since Dx, Intensity (ITR-2), Relapse status) Life Events Scale (LES) Youth Life Orientation Test (Y-LOT): Optimism Child and Adolescent Five Factor Inventory (CAFFI): Neuroticism, Extraversion, Openness, Agreeableness, Conscientiousness

8 Demographics Patient Group Control Group Gender % Male Age Mean (SD) 12.7 (2.9) 12.1 (2.9) Range Race % Caucasian % African American % Other SES % Group I & II % Group III % Group IV & V Parent Participant % Mom % Dad % Other 4.7 0

9 Diagnosis & Time Since Diagnosis Diagnosis % Acute Lymphoblastic Leukemia 23.9 % Acute Myeloid Leukemia 6.3 % Hodgkin s & Non-Hodgkin s Lymphoma 13.3 % Solid Tumor 38.4 % Brain Tumor 17.3 Time since diagnosis % < 6 months 25.1 % 6 months to 2 years 24.7 % 2 years to 5 years 25.1 % > 5 years 25.1

10 Results: Cancer-Control Comparisons - Outcomes Cancer Control Depression (CDI) 6.4 (5.4) 6.8 (5.3) Anxiety (SCARED) 18.5 (11.9) 21.4 (12.0)* PTSD (UCLA - 1 st Event) 18.3 (17.7) 19.7 (16.0)

11 Results: Cancer-Control Comparisons

12 Results: Percentages Exceeding Suggested Clinical Cutoffs Cutoffs used: CDI 16 SCARED 25 PTSDI 38 Outcome Cancer Control Depression (CDI) 6.3% 6.9% Anxiety (SCARED) 27.8% 35.6% PTSS (UCLA PTSDI) 11.1% 13.9%

13 Results: Cancer-Control Comparisons - Predictors Cancer Control Life Events 8.12 (3.8) 7.25 (3.4)* Optimism 44.3 (6.9) 44.1 (6.3) Neuroticism 38.3 (9.9) 38.3 (10.4) Extraversion 58.3 (9.4) 59.9 (10.9) Openness 67.3 (11.0) 68.4 (11.1) Agreeableness 59.0 (9.1) 59.4 (8.4) Conscientiousness 64.4 (13.6) 64.9 (13.0)

14 RESULTS: Hierarchical Regressions

15 Predictors of Depression (CDI) Variable β R 2 ΔR 2 Step Gender 0.02 Race Age SES -0.16** Step Health Status 0.07 Step ** Life Events 0.32** Step ** Optimism -0.27** Extraversion -0.08* Neuroticism 0.40** Openness -0.17** Agreeableness 0.03 Conscientiousness -0.10*

16 Predictors of Clinical Anxiety (SCARED) Variable β R 2 ΔR 2 Step ** Gender 0.19** Race Age -0.23** SES -0.20** Step * Health Status 0.15** Step ** Life Events 0.35** Step ** Optimism -0.12** Extraversion -0.16* Neuroticism 0.46** Openness Agreeableness 0.09 Conscientiousness -0.01

17 Predictors of PTSS (UCLA PTSDI) Variable β R 2 ΔR 2 Step * Gender 0.06 Race Age SES -0.21*** Step Health Status 0.11 Step ** Life Events 0.36** Step *** Optimism -0.20*** Extraversion 0.04 Neuroticism 0.45** Openness Agreeableness 0.07 Conscientiousness -0.02

18 Predictors of Depression (CDI) Cancer Group Only Variable β R 2 ΔR 2 Step * Gender 0.05 Race 0.01 Age 0.01 SES -0.21** Step Dx Category (all ns) Time Since Dx Rx Intensity 0.09 Relapse 0.00 Step ** Life Events 0.35** Step ** Optimism -0.26** Extraversion Neuroticism 0.40** Openness -0.17** Agreeableness 0.03 Conscientiousness -0.09

19 Predictors of PTSS (UCLA PTSDI) Variable β R 2 ΔR 2 Step * Gender 0.06 Race Age SES -0.21*** Step Health Status 0.11 Step ** Life Events 0.36** Step *** Optimism -0.20*** Extraversion 0.04 Neuroticism 0.45** Openness Agreeableness 0.07 Conscientiousness -0.02

20 Conclusions Children with cancer generally well adjusted, with low levels of internalizing symptoms Children s psychological functioning predicted primarily by dispositional traits, and secondarily by history of stressful life events, with illness and treatment variables accounting for minimal variance

21 Conclusions Given positive adjustment of most, intervention can be focused on those patients at highest risk of adverse outcomes Major risk factors identified include disposition (e.g. low optimism, high neuroticism) and history of stressful life events

22 Conclusions Study limitations Single site Cross-sectional design Single informant shared method variance Despite these limitations, findings point to a remarkable capacity of children to adjust to major life challenges resilience is the rule, not the exception Outcomes determined primarily by nonillness-related factors; Personality trumps health history

23 THANK YOU! QUESTIONS?