Risk behaviors and externalizing behaviors in adolescents dealing with parental cancer--a controlled longitudinal study.

OBJECTIVE: The results of studies concerning levels of internalizing and externalizing behaviors in adolescent children with a parent suffering from cancer as compared with control groups or normative data are contradictory so far. Longitudinal designs using control groups are rare. No study explicitly exploring a broad range of risk behaviors in adolescent children with a parent suffering from cancer exists to date. METHODS: Therefore, 74 adolescents who have a parent with cancer (index group) were compared with 75 adolescents with healthy parents (control group) concerning several juvenile risk behaviors and externalizing behaviors. Participants were examined three times over the course of 12 months. RESULTS: No significant main effects for group or interactional effects of group with time could be found for any of the measured variables. CONCLUSIONS: Results suggest that the somatic illness of the parent is not a developmental risk that is expressed in increased levels of juvenile risk behavior. Adolescents with a parent suffering from cancer adjusted generally quite well to the parental illness, although some individuals did show signs of severe strain.

[Anticipatory grief in adolescents and young adults coping with parental cancer]. / Antizipierende Trauer bei Jugendlichen und jungen Erwachsenen mit einem an Krebs erkrankten Elternteil.

By the current state of research, it cannot be answered clearly how adolescents experience anticipatory grief and if and to which extent this process differs from anticipatory grief of adults. The present study will fill this gap by providing both a quantitative and a qualitative description of anticipatory grief processes. Therefore, 74 adolescents and young adults (11-21 years), whose parents have suffered from cancer, completed an adapted version of the "Trauerfragebogen" (Weiser u. Ochsmann, 2002). Additionally a subsample of n = 38 took part in a qualitative guided interview. Based on these interviews, 16 categories were formed, that were assigned to two types of stressors. Beside communication and prioritization of family, different symptoms of grief were the central category in the loss-oriented type, where fears of loss, compassion and concern were of crucial importance. Also categories of the restoration-oriented type were strongly present. Thus, it seems that young people generally manage to accept their new role in the stressful family situation and they have a series of coping mechanisms available to do so. This was also reflected in the quantitative data, were the subscale "Inner Strength" reached the highest value. In the counselling of adolescents with cancer-diseased parents, both loss-oriented and restoration-oriented processes should equally be recognized and encouraged.

The prevalence and type of Axis-I and Axis-II mental disorders in subjects with non-specific chronic back pain: results from a population-based study.

OBJECTIVE: To investigate the prevalence and the type of mental comorbidity in a population-based sample of subjects with non-specific chronic back pain. DESIGN: Representative population-based survey. SETTING: The city of Heidelberg (in southwestern Germany) and 10 adjacent communities. PATIENTS: From a random sample of individuals (N = 2,000), 1,091 subjects completed a questionnaire including a pain assessment. Of those, 188 subjects (17%) fulfilled the criteria for chronic back pain (≥45 days of back pain in the last 3 months) and were subsequently invited to undergo a detailed clinical examination; 131 subjects (70%) agreed to participate. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) (SCID-I + II) was used to assess current (defined as the previous 4 weeks) mental comorbidity and was completed in 110 subjects (84%) with non-specific chronic back pain. INTERVENTION: N/A. OUTCOME MEASURES: DSM-IV mental comorbidity diagnoses. RESULTS: The overall prevalence of mental comorbidity of Axis-I and -II disorders were 35.5% and 15.5%, respectively. Of Axis-I disorders, anxiety disorders (20.9%) and affective disorders (12.7%) were the most frequent. Of Axis-II disorders, 9.1% of diagnoses was of the Cluster C category (anxious/inhibited). Compared with the general population, the total rate of Axis-I comorbidity was significantly higher, while the total rate for Axis-II personality disorders was only slightly different. CONCLUSIONS: The consistent diagnoses of anxiety, fear, and avoidance in these subjects indicate that also primary care health professionals should consider anxiety disorders in patients with chronic pain, in addition to the affective disorders that are most frequently self-reported in pain patients.