Indirect Effects of Parental Coping on Children’s Psychosocial Adjustment in the Context of Pediatric Cancer

Thesis (Ph.D.)--University of Washington, 2016-08

A significant body of literature suggests that children with cancer are at an increased risk for psychosocial maladjustment. Parents’ adjustment and family functioning have been identified as among the strongest predictors of child adjustment to cancer. Emerging research has implicated parents’ individual and dyadic coping as predictors of parents’ psychological and marital adjustment in the face of stressful experiences. Coping has historically been defined and categorized in numerous ways, but recent studies suggest that a control model of coping is particularly salient when examining uncontrollable stressors, such as medical illnesses. While relations between parents’ coping and parents’ psychosocial adjustment, and between parental adjustment and children’s adjustment have been examined separately, no studies have tested relations among these three constructs in a single model. The current study examined the indirect effects of parents’ individual and dyadic coping on children’s psychosocial adjustment through parents’ psychopathology and marital adjustment. Primary and secondary caregivers of 130 children who were newly diagnosed with cancer completed questionnaire at diagnosis, 6 months post-diagnosis, and 12 months post-diagnosis. Caregivers’ coping was measured using the Parent’s Response to Stress Questionnaire, psychopathology was measured using the Center for Epidemiological Studies—Depression (CES-D), the Impact of Events Scale—Revised (IES-R), and the Penn State Worry Questionnaire (PSWQ), and marital adjustment was measured using the Dyadic Adjustment Scale (DAS). Primary caregivers’ also reported on children’s psychosocial adjustment using the Child Behavior Checklist (CBCL) and the UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI). All questionnaires were completed at all three time points. Indirect effects models were tested using regression. Results suggested significant indirect effects of primary control engagement coping (PCEC) on children’s internalizing, externalizing, and posttraumatic stress symptoms through caregivers’ psychopathology. Contrary to our hypotheses, models examining the indirect effects of secondary control engagement coping (SCEC), disengagement coping (DC), and dyadic coping on children’s adjustment through caregivers’ psychopathology and marital adjustment were not supported. Results of exploratory analyses examining the indirect effects using a contemporaneous approach suggested significant indirect effects of SCEC and DC on children’s adjustment through caregivers’ psychopathology, and an indirect effect of DC on children’s posttraumatic stress symptoms through caregivers’ marital adjustment. Despite paucity of significant indirect effects, the current study highlights potential importance of examining caregivers’ functioning in understanding children’s psychosocial adjustment among children with cancer. The results of the current study add to what is known about the relations among caregiver and child functioning by focusing on caregivers’ coping as risk factor in a longitudinal model. Implications and potential avenues for future research in pediatric psycho-oncology are highlighted.