Coping and attention: implications for child health and pediatric conditions.

Child health and illness are best conceptualized in terms of the interaction of biological, psychological, and social processes. Among the central factors in biopsychosocial models of health and illness are processes of coping and attention in response to stress. As a guide to research on biopsychosocial processes in child health and illness, a dual-process model of responses to stress is described, distinguishing between stress responses that are involuntary/automatic and those responses that are voluntary/controlled. Research on coping with stress is briefly reviewed, along with research on attentional processes in response to stress. The relationships between coping and attention are highlighted, along with the implications of this research for understanding children's health and illness. Throughout the article, examples are drawn from research on pediatric recurrent abdominal pain to illustrate important aspects of coping and attention.

Coping with stress during childhood and adolescence: problems, progress, and potential in theory and research.

Progress and issues in the study of coping with stress during childhood and adolescence are reviewed. Definitions of coping are considered, and the relationship between coping and other aspects of responses to stress (e.g., temperament and stress reactivity) is described. Questionnaire, interview, and observation measures of child and adolescent coping are evaluated with regard to reliability and validity. Studies of the association of coping with symptoms of psychopathology and social and academic competence are reviewed. Initial progress has been made in the conceptualization and measurement of coping, and substantial evidence has accumulated on the association between coping and adjustment. Problems still remain in the conceptualization and measurement of coping in young people, however, and aspects of the development and correlates of coping remain to be identified. An agenda for future research on child-adolescent coping is outlined.

Responses to stress in adolescence: measurement of coping and involuntary stress responses.

The development of a measure of coping and involuntary stress responses in adolescence is described. The Responses to Stress Questionnaire (RSQ) reflects a conceptual model that includes volitional coping efforts and involuntary responses to specific stressful events or specified domains of stress. The psychometric characteristics of the RSQ were examined across 4 domains of stress in 3 samples of adolescents and parent reports obtained in 2 samples. The factor structure of the RSQ was tested and replicated with an adequate degree of fit using confirmatory factor analysis across 3 stressors in 2 samples. Internal consistency and retest reliability for the 5 factors were adequate to excellent. Concurrent validity was established through correlations with another measure of coping, heart rate reactivity, and correlations of self- and parent-reports. Significant correlations with both adolescents' and parents' reports of internalizing and externalizing symptoms were consistent with hypotheses.

Intrusive thoughts and avoidance in breast cancer: Individual differences and association with psychological distress.

Abstract Eighty-five women with newly diagnosed breast cancer were classified on the basis of high and low levels of cancer-related intrusive thoughts and avoidance at diagnosis, and their psychological adjustment was studied prospectively at 3 and 6 months post diagnosis. Patients who initially reported high levels of both intrusive thoughts and avoidance and those who reported high levels of intrusive thoughts but low avoidance experienced the highest levels of anxiety and depression symptoms, and continued intrusive thoughts and avoidance. Patients who were high in avoidance but low in intrusive thoughts also experienced adjustment problems, including increased intrusive thoughts, when compared with patients who were low in both types of symptoms. The findings highlight the value of considering subgroup differences in patterns of intrusion and avoidance as predictors of subsequent psychological adjustment to breast cancer.

Self-blame attributions in women with newly diagnosed breast cancer: a prospective study of psychological adjustment.

Associations between self-blame and anxiety and depression symptoms in a sample of 76 women with breast cancer were investigated. At diagnosis, behavioral self-blame was associated with increased distress; at 3 months postdiagnosis, characterological self-blame was positively associated with affective symptoms and behavioral self-blame approached significance (p = .07); and at 6 months, behavioral self-blame was related to increased distress. Prospective analyses revealed that characterological self-blame at diagnosis approached significance in predicting distress at 3 months (p = .055) and was significant in predicting distress at 6 months and at 1 year after diagnosis. These data indicate that behavioral self-blame is a correlate of concurrent affective symptoms, whereas characterological self-blame predicts increased distress over time. Implications for social-cognitive processes in adaptation to breast cancer are discussed.

Psychological adjustment in breast cancer: processes of emotional distress.

The process of psychological adjustment to breast cancer was examined at diagnosis and at 3- and 6-month follow-ups in a sample of 80 women with Stage I-Stage IV breast cancer. At diagnosis, symptoms of anxiety/depression were predicted by low dispositional optimism, and this path was partially mediated by use of emotion-focused disengagement coping. Younger age also was predictive of anxiety/depression symptoms at time of diagnosis, and this relationship was fully mediated by magnitude of intrusive thoughts. At 3 months, changes in anxiety/depression symptoms were predicted only by intrusive thoughts. At 6 months, low dispositional optimism reemerged as a significant predictor of changes in anxiety/depression and again was partially mediated by the use of emotion-focused disengagement coping. Independent effects for problem-focused engagement and disengagement and emotion-focused engagement coping were also found at 6 months. Implications of these data for psychosocial interventions with breast cancer patients are highlighted.

Adjustment to breast cancer: age-related differences in coping and emotional distress.

Women who are diagnosed with breast cancer are at high risk for experiencing affective distress; however, previous research suggests that older women may be less likely than younger women to experience extreme distress. Two issues remain unclear regarding age and affective distress: (a) the psychological processes that account for the association of age and distress, and (b) whether this association remains stable over the course of treatment and recovery from breast cancer. This study investigated symptoms of anxiety and depression in 80 women ages 36-80 years old with newly diagnosed breast cancer near the time of their diagnosis and at 3 and 6 months post-diagnosis. Disease severity and coping style were also examined. Symptoms of anxiety/depression and age were negatively correlated near the time of diagnosis. Path analysis controlling for disease severity revealed that coping involving the ventilation of emotion fully mediated the effect of age on symptoms of anxiety and depression. However, the association of age with symptoms of anxiety/depression was no longer significant at 3 and 6 months post-diagnosis, although emotional ventilation still predicted greater emotional distress at 6 months. These findings suggest that age is a salient factor to consider in the psychological adjustment of women with breast cancer near the time of initial diagnosis, with younger women exhibiting greater affective distress and a tendency to engage in less adaptive ways of coping. However, younger and older women do not differ in their adjustment over the subsequent course of their treatment and initial recovery. The use of emotional ventilation coping remains associated with poorer adjustment, independent of patients' age.

Sampling of empirically supported psychological treatments from health psychology: smoking, chronic pain, cancer, and bulimia nervosa.

Interventions in health psychology and behavioral medicine represent an integral area of research for the development of psychological therapies to enhance health behaviors, manage symptoms and sequelae of disease, treat psychological symptoms and disorders, prolong survival in the face of a life-threatening illness, and improve quality of life. A sampling of interventions in health psychology and behavioral medicine is offered that meet the criteria for empirically supported treatments for smoking cessation, chronic pain, cancer, and bulimia nervosa. Evidence for empirically supported treatments is identified, along with promising interventions that do not yet meet the criteria as outlined by D. L. Chambless and S. D. Hollon (1998). Evidence for the effectiveness and clinical significance of these interventions is reviewed, and issues in this area of research are outlined.

Gender differences in depressive symptoms in adolescence: comparison of national samples of clinically referred and nonreferred youths.

Gender differences in depressed mood, a syndrome of mixed anxiety-depression, and an analogue of major depressive disorder were compared in parents' and adolescents' reports in 2 large, demographically matched national samples of clinically referred and nonreferred adolescents. Referral status accounted for the greatest share of the variance in these problems. Gender differences were moderate in size and consistent in referred youths, with referred girls scoring higher than referred boys on all measures, whereas gender differences in nonreferred adolescents were either nonsignificant or small in magnitude. Gender differences were also larger in magnitude in adolescents' self-reports than in parents' reports. The interaction of age and gender was nonsignificant in all analyses. Implications for understanding the extent of gender differences in adolescents' depressive symptoms are highlighted.

Covariation of the anxious-depressed syndrome during adolescence: separating fact from artifact.

Nosological (symptom overlap) and methodological (informant) artifact in the covariation of an empirically derived syndrome of anxious-depressed symptoms with 7 other syndromes of emotional and behavior problems was examined in reports by parents, teachers, and adolescents on a nationally representative sample of 908 adolescents. Although minor symptom overlap was observed and the effects of informant were significant, the anxious-depressed syndrome covaried significantly with all other syndromes after controlling for these effects. Indices of covariation controlling for informant effects were all significant and ranged for all syndromes except for delinquent behavior from .619 to .681, reflecting significant covariation of the anxious-depressed syndrome with both externalizing and internalizing syndromes. Covariation of the anxious-depressed syndrome and delinquent behavior was .470. Implications for research on the comorbidity-covariation of depressive syndromes during childhood and adolescence are highlighted.

The Familial Cancer Program of the Vermont Cancer Center: Development of a Cancer Genetics Program in a Rural Area.

In response to many scientific discoveries linking cancer in certain families to inherited factors, the Vermont Cancer Center established the Familial Cancer Program (FCP) in December 1993. This multifaceted program combines the expertise of clinicians and researchers in many disciplines, including genetics, oncology, psychology, and molecular biology. The program's goals are identification of families in its region with excess cancer, provision of clinical services to such families, and use of research protocols when available and appropriate. This article describes the experience of setting up a familial cancer program in a rural area and discusses both successes and challenges in such an endeavor.

When mom or dad has cancer: II. Coping, cognitive appraisals, and psychological distress in children of cancer patients.

Cognitive appraisals and coping were examined in children, adolescents, and young adults (N = 134) faced with the diagnosis of cancer in a parent. All 3 age groups perceived low personal control and high external control over their parent's illness and used relatively little problem-focused coping. Adolescents and young adults reported more emotion-focused coping and dual-focused coping (both problem- and emotion-focused in intent) than did preadolescent children. Stage and prognosis of parent's cancer were related to appraisals of greater seriousness and stressfulness, and to more avoidance; however, only appraisals of stress were related to symptoms of anxiety-depression. Emotion-focused coping was related to greater avoidance and to higher symptoms of anxiety-depression; coping and control beliefs did not interact in their association with anxiety-depression symptoms.

Adjustment of children and adolescents to parental cancer. Parents' and children's perspectives.

BACKGROUND: Little empirical evidence exists to address the impact of a diagnosis of cancer of a father or mother on his or her children. Previous studies have found inconsistencies in the levels of distress reported for children of a parent with cancer, which may be a function of who (parent or child) was reporting on the child's symptoms and when the reports were taken (near diagnosis or months or years later). METHODS: This study examined parents' and children's reports of emotional and behavioral problems in children and adolescents from 76 patient families in which a mother or father was recently diagnosed with cancer. RESULTS: Parents' reports indicated little or no evidence of emotional distress or disruptive behavior in their children regardless of the child's age or sex, or whether the mother or father was ill. Children's reports differed significantly from those of their parents, with adolescent girls reporting the highest levels of symptoms of anxiety/depression and aggressive behavior. Children's reports of their emotional distress declined from an initial assessment 10 weeks after their parents' diagnosis to a follow-up 4 months later, whereas parents' reports of their children's distress did not change with time. CONCLUSIONS: Children's symptoms of psychologic distress varied considerably according to their age, sex, whether their mother or father had cancer, and whether they themselves or their parents were reporting the symptoms. Adolescent girls whose mothers had cancer reported the highest levels of distress. When children did report elevated levels of psychologic symptoms, their parents did not appear to be aware of their distress and rated their children as asymptomatic. These findings suggest that health professionals may need to assist parents in recognizing and coping with their children's distress when it is present.

Stress and anxious-depressed symptoms among adolescents: searching for mechanisms of risk.

This study was an examination of the possible mechanisms of risk among adolescents (n = 55) exposed to the stress associated with the diagnosis of cancer in a parent. Girls whose mothers had cancer reported significantly more anxious-depressed symptoms than girls whose fathers were ill or boys whose mothers or fathers had cancer. Increased family responsibilities and the use of ruminative coping were examined as possible mechanisms leading to increased distress in girls with ill mothers. Although girls reported the use of more ruminative coping, rumination did not account for the impact of maternal cancer on girls' distress. Girls whose mothers were ill reported more stressful events reflecting family responsibilities. Furthermore, family responsibility stress fully accounted for the interaction of gender of the ill parent and gender of the adolescent in predicting anxious-depressed symptoms.

Cognitive factors in adjustment to cancer: attributions of self-blame and perceptions of control.

We examined attributions of behavioral and characterological self-blame and perceptions of control over disease progression and recurrence as predictors of symptoms of psychological distress in a sample of adult men and women with cancer. Data were obtained near the time of diagnosis and a 4-month follow-up. Initial levels of behavioral and characterological self-blame were unrelated to concurrent psychological distress. Initial characterological self-blame as well as the interaction of characterological and behavioral self-blame was predictive of psychological distress 4 months later. Perceptions of control over cancer recurrence were unrelated to psychological distress near diagnosis or at follow-up, and control beliefs did not function as a mediator of self-blame. Initial levels of psychological distress predicted characterological but not behavioral self-blame at follow-up, suggesting a reciprocal relationship between characterological self-blame and distress.

When mom or dad has cancer: markers of psychological distress in cancer patients, spouses, and children.

This study assessed anxiety/depression and stress response symptoms in adult cancer patients (n = 117), spouses (n = 76), and their children (n = 110, ages 6 to 30 years old) near the patients' diagnoses to identify family members at risk for psychological maladjustment. Patients' and family members' distress was related to appraisals of the seriousness and stressfulness of the cancer but not related to objective characteristics of the disease. Patients and spouses did not differ in anxiety/depression or in stress-response symptoms. Both stress-response and anxiety/depression symptoms differed in children as a function of age, sex of child, and sex of patient. Adolescent girls whose mothers had cancer were the most significantly distressed. Implications for understanding the impact of cancer on the family are highlighted.

Predictors of cancer progression in young adult men and women: avoidance, intrusive thoughts, and psychological symptoms.

Psychological symptoms, avoidance, and intrusive thoughts were examined prospectively as predictors of cancer progression over a period of 1 year. Sixty-six male and female cancer patients who differed in their diagnoses and initial disease-severity ratings participated. Measures of psychological factors, disease severity, and type of treatment were obtained near time of diagnosis and disease status (no cancer, continued or recurrent cancer, or deceased) 1 year later. Cross-sectional analyses near the time of diagnosis showed that initial psychological variables were intercorrelated with one another but unrelated to initial disease prognosis. Longitudinal findings revealed that, after controlling for initial disease parameters and age, avoidance predicted disease status 1 year later; however, neither psychological symptoms nor intrusive thoughts and emotions accounted for additional variance in disease outcomes.