Skip to main content

Advertisement

Log in

Children Facing Parental Cancer Versus Parental Death: The Buffering Effects of Positive Parenting and Emotional Expression

  • Original Paper
  • Published:
Journal of Child and Family Studies Aims and scope Submit manuscript

Abstract

The serious illness or death of a caregiver are two of the most distressing events that can befall a child, and are often temporally linked. Although both adversities may impact children’s mental health, studies have not yet attempted to disentangle the effects of parental illness versus those of parental death with regard to children’s psychological functioning. Further, there has been little empirical investigation of potential factors that may diminish risk for psychopathology following either of these adversities. The current study evaluated levels of anxiety, depression, and posttraumatic stress symptoms (PTSS) in youth age 7–13 grappling with either parental cancer (N = 31) or parental death (N = 32) and examined potential predictors of these mental health outcomes across both groups of children. Youth contending with parental cancer exhibited lower levels of PTSS than children who had experienced the death of a parent, but both groups exhibited similar levels of anxiety and depression. Expressive coping was associated with lower levels of PTSS, anxiety, and depression across both groups. An interaction effect revealed that for the bereaved group only, positive parental reinforcement and supportive caregiver communication were inversely associated with PTSS. These findings provide a foundation for future work designed to identify factors associated with distinct mental health outcomes among children facing parental cancer and/or parental death.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Abdi, H. (2010). Holm’s sequential Bonferroni procedure. In D. Salkind (Ed.), Encyclopedia of research design (pp. 1–8). Thousand Oaks, CA: Sage.

    Google Scholar 

  • American Cancer Society. (2014). Cancer facts and figures. Atlanta, GA: American Cancer Society.

    Google Scholar 

  • Angold, A., Costello, E., & Messer, S. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249.

    Google Scholar 

  • Ayers, T. S., Sandler, I. N., Twohey, J. L., & Haine, R. A. (1998). Three views of emotional expression in parentally bereaved children. In Poster presented at the annual convention of the American Psychological Association, San Francisco.

  • Birenbaum, L., Yancey, D., Philips, D., Chand, N., & Huster, G. (1999). School-age children’s and adolescents’ adjustment when a parent has cancer. Oncology Nursing Forum, 26(10), 1639–1645.

    PubMed  Google Scholar 

  • Bowlby, J. (1980). Attachment and loss: Vol. III. Loss. New York: Basic Books.

    Google Scholar 

  • Bowlby, J. (1982). Attachment and loss: Vol. I. Attachment. New York: Basic Books. (First published in 1969).

    Google Scholar 

  • Briggs-Gowan, M., & Carter, A. (1998). Preliminary acceptability and psychometrics of the infant–toddler social and emotional assessment (ITSEA): A new adult-report questionnaire. Infant Mental Health Journal, 19, 422–445.

    Article  Google Scholar 

  • Brown, R., Fuemmeler, B., Anderson, D., Jamieson, S., Simonian, S., Hall, R., & Brescia, F. (2007). Adjustment of children and their mothers with breast cancer. Journal of Pediatric Psychology, 32(3), 297–308.

    Article  PubMed  Google Scholar 

  • Campbell-Sills, L., Cohan, S. L., & Stein, M. B. (2006). Relationship of resilience to personality, coping, and psychiatric symptoms in young adults. Behaviour Research and Therapy, 44(4), 585–599.

    Article  PubMed  Google Scholar 

  • Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press.

    Google Scholar 

  • Compas, B. E., Worsham, N. L., Ey, S., & Howell, D. C. (1996). When mom or dad has cancer: II. Coping, cognitive appraisals, and psychological distress in children of cancer patients. Health Psychology, 15(3), 167–175.

    Article  PubMed  Google Scholar 

  • Dowdney, L. (2000). Childhood bereavement following parental death. Journal of Child Psychology and Psychiatry, 41, 819–830.

    Article  PubMed  Google Scholar 

  • Elhai, J., Layne, C., Steinberg, A., Brymer, M., Briggs, E., et al. (2013). Psychometric properties of the UCLA PTSD Reaction Index: Investigating actor structure findings in a national clinic-referred youth sample. Journal of Traumatic Stress, 26, 10–18.

    Article  PubMed  Google Scholar 

  • Hazzard, A., Christensen, A., & Margolin, G. (1983). Children’s perceptions of parental behaviors. Journal of Abnormal Child Psychology, 11(1), 49–59.

    Article  PubMed  Google Scholar 

  • Holm, S. (1979). A simple sequential rejective method procedure. Scandinavian Journal of Statistics, 6, 65–70.

    Google Scholar 

  • Holmbeck, G. (2002). Post-hoc probing of significant moderational and meditational effects in studies of pediatric populations. Journal of Pediatric Psychology, 27(1), 87–96.

    Article  PubMed  Google Scholar 

  • Howes, M., Hoke, L., Winterbottom, M., & Delafield, D. (2008). Psychosocial effects of breast cancer on the patient’s children. Journal of Psychosocial Oncology, 12(4), 1–21.

    Article  Google Scholar 

  • Howlader, N., Noone, A. M., Krapcho, M., Garshell, J., Miller, D., Altekruse, S. F., et al. (Eds.). (2013). SEER cancer statistics review, 1975–2011, National Cancer Institute. Bethesda MD. Retrieved from http://seer.cancer.gov/csr/1975_2011/.

  • Kaplow, J. B., Dodge, K. A., Amaya-Jackson, L., & Saxe, G. N. (2005). Pathways to PTSD, part II: Sexually abused children. American Journal of Psychiatry, 162(7), 1305–1310.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kaplow, J. B., Gipson, P., Horwitz, A., Burch, B., & King, C. (2014a). Emotional suppression mediates the relation between adverse life events and adolescent suicide: Implications for prevention. Prevention Science, 15, 177–185.

    Article  PubMed  Google Scholar 

  • Kaplow, J. B., Howell, K. H., & Layne, C. M. (2014b). Do circumstances of the death matter? Identifying socioenvironmental risks for grief-related psychopathology in bereaved youth. Journal of Traumatic Stress, 27(1), 42–49.

    Article  PubMed  Google Scholar 

  • Kaplow, J. B., & Layne, C. M. (2014). Sudden loss and psychiatric disorders across the life course: Toward a developmental lifespan theory of bereavement-related risk and resilience. American Journal of Psychiatry, 171, 807–810.

    Article  PubMed  Google Scholar 

  • Kaplow, J. B., Layne, C. M., & Pynoos, R. S. (2014c). Persistent Complex Bereavement Disorder as a call to action: Using a proposed DSM-5 diagnosis to advance the field of childhood grief. Traumatic Stress Points. http://sherwood-istss.informz.net/sherwood-istss/archives/archive_3773102.html.

  • Kaplow, J. B., Layne, C. M., & Pynoos, R. S. (2014d). Parental grief facilitation: How parents can help their bereaved children during the holidays. Traumatic Stress Points. http://sherwoodistss.informz.net/admin31/content/template.asp?sid=40989&brandid=4463&uid=10190245&mi=4449102&&ptid=0&ps=40989.

  • Kaplow, J. B., Layne, C. M., Pynoos, R. S., Cohen, J., & Lieberman, A. (2012). DSM-V diagnostic criteria for bereavement-related disorders in children and adolescents: Developmental considerations. Psychiatry, 75(3), 242–265.

    Article  Google Scholar 

  • Kaplow, J. B., Saunders, J., Angold, A., & Costello, E. (2010). Psychiatric symptoms in bereaved versus non-bereaved youth and young adults: A longitudinal, epidemiological study. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 1145–1154.

    PubMed  PubMed Central  Google Scholar 

  • Kaplow, J. B., Shapiro, D. N., Wardecker, B. M., Howell, K. H., Abelson, J. L., Worthman, C. M., & Prossin, A. R. (2013). Psychological and environmental correlates of HPA axis functioning in parentally bereaved children: Preliminary findings. Journal of Traumatic Stress, 26(2), 233–240.

    Article  PubMed  Google Scholar 

  • Krattenmacher, T., Kühne, F., Führer, D., Beierlein, V., Brähler, E., Resch, F., et al. (2013). Coping skills and mental health status in adolescents when a parent has cancer: A multicenter and multi-perspective study. Journal of Psychosomatic Research, 74, 252–259.

    Article  PubMed  Google Scholar 

  • Layne, C. M., Beck, C. J., Rimmasch, H., Southwick, J. S., Moreno, M. A., & Hobfoll, S. E. (2009). Promoting “resilient” posttraumatic adjustment in childhood and beyond: “Unpacking” life events, adjustment trajectories, resources, and interventions. In D. Brom, R. Pat-Horenczyk, & J. Ford (Eds.), Treating traumatized children: Risk, resilience, and recovery (pp. 13–47). New York: Routledge.

    Google Scholar 

  • Layne, C. M., Kaplow, J. B., & Pynoos, R. S. (2013). Persistent Complex Bereavement Disorder (PCBD) checklistYouth version 1.0. Psychological test and administration manual. University of California, Los Angeles.

  • Layne, C. M., Pynoos, R. S., Saltzman, W. R., Arslanagić, B., Black, M., Savjak, N., et al. (2001). Trauma/grief-focused group psychotherapy: School-based postwar intervention with traumatized Bosnian adolescents. Group Dynamics: Theory, Research, and Practice, 5(4), 277–290.

    Article  Google Scholar 

  • Layne, C. M., Steinberg, J. R., & Steinberg, A. M. (2014). Causal reasoning skills training for mental health practitioners: Promoting sound clinical judgment in evidence-based practice. Training and Education in Professional Psychology,. doi:10.1037/tep0000037.

    Google Scholar 

  • Layne, C. M., Warren, J. S., Saltzman, W. R., Fulton, J., Steinberg, A. M., & Pynoos, R. S. (2006). Contextual influences on post-traumatic adjustment: Retraumatization and the roles of distressing reminders, secondary adversities, and revictimization. In L. A. Schein, H. I. Spitz, G. M. Burlingame, & P. R. Muskin (Eds.), Psychological effects of catastrophic disasters: Group approaches to treatment (pp. 235–286). New York, NY: Haworth Press.

    Google Scholar 

  • March, J., Parker, J., Sullivan, K., Stallings, P., & Conners, C. (1997). The Multidimensional Anxiety Scale for Children (MASC): Factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 554–565.

    Article  PubMed  Google Scholar 

  • Melhem, N., Moritz, G., Walker, M., Shear, M., & Brent, D. (2007). Phenomenology and correlates of complicated grief in children and adolescents. The Journal of the American Academy of Child and Adolescent Psychiatry, 46(4), 493–499.

    Article  PubMed  Google Scholar 

  • Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989.

    Article  PubMed  PubMed Central  Google Scholar 

  • Osborn, T. (2007). The psychosocial impact of parental cancer on children and adolescents: A systematic review. Psycho-Oncology, 16(2), 101–126.

    Article  PubMed  Google Scholar 

  • Premack, D. (1959). Toward empirical behavior laws: I. Positive reinforcement. Psychological Review, 66(4), 219.

    Article  PubMed  Google Scholar 

  • Pynoos, R. S., Steinberg, A. M., Layne, C. M., Briggs, E. C., & Ostrowski, S. A. (2009). DSM-V PTSD diagnostic criteria for children and adolescents: A developmental perspective and recommendations. Journal of Traumatic Stress, 22(5), 391–398.

    Article  PubMed  Google Scholar 

  • Raveis, V., Siegel, K., & Karus, D. (1999). Children’s psychological distress following the death of a parent. Journal of Youth and Adolescence, 28(2), 165–180.

    Article  Google Scholar 

  • Saldinger, A., Cain, A., Kalter, N., & Lohnes, K. (1999). Anticipating parental death in families with young children. American Journal of Orthopsychiatry, 69(1), 39–48.

    Article  PubMed  Google Scholar 

  • Saldinger, A., Porterfield, K., & Cain, A. (2004). Meeting the needs of parentally bereaved children: A framework for child–centered parenting. Psychiatry: Interpersonal and Biological Processes, 67(4), 331–352.

    Article  Google Scholar 

  • Sandler, I., Ayers, T., Wolchik, S., Tein, J., Kwok, H., et al. (2003). The family bereavement program: Efficacy evaluation of a theory-based prevention program for parentally bereaved children and adolescents. Journal of Consulting and Clinical Psychology, 71(3), 587–600.

    Article  PubMed  Google Scholar 

  • Shands, M. E., Lewis, F. M., & Zahlis, E. H. (2000). Mother and child interactions about the mother’s breast cancer: An interview study. Oncology Nursing Forum, 27(1), 77–85.

    PubMed  Google Scholar 

  • Shapiro, D., Howell, K., & Kaplow, J. (2014). Associations among mother–child communication quality, childhood maladaptive grief, and depressive symptoms. Death Studies, 38(3), 172–178.

    Article  PubMed  Google Scholar 

  • Shear, K., & Shair, H. (2005). Attachment, loss, and complicated grief. Developmental Psychobiology, 47, 253–267.

    Article  PubMed  Google Scholar 

  • Steinberg, A., Brymer, M., Decker, K., & Pynoos, R. (2004). The University of California at Los Angeles post-traumatic stress disorder reaction index. Current Psychiatry Reports, 6, 96–100.

    Article  PubMed  Google Scholar 

  • Thastum, M., Johansen, M., Gubba, L., Olesen, L., & Romer, G. (2008). Coping, social relations, and communication: A qualitative exploratory study of children of parents with cancer. Clinical Child Psychology and Psychiatry, 13, 123.

    Article  PubMed  Google Scholar 

  • Trickey, D., Siddaway, A. P., Meiser-Stedman, R., Serpell, L., & Field, A. P. (2012). A meta- analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clinical Psychology Review, 32, 122–138.

    Article  PubMed  Google Scholar 

  • UNICEF. (2013). Statistics by area/HIV/AIDS: Orphan estimates. Retrieved from http://www.childinfo.org/hiv_aids_orphanestimates.php.

  • US Bureau of the Census. (2001). One-parent family groups with own children under 18, by marital status, race and Hispanic origin of the reference person. Washington, DC: US Bureau of the Census.

    Google Scholar 

Download references

Acknowledgments

The authors wish to thank Michelle Belke, Alena Grieser, Heather Hammerstrom, Harriett Jones, Georgia Stamatopoulos, and Amanda Tarantowski for their assistance with conducting interviews. We also thank Britney Wardecker and Emilie Lerner for their assistance with project coordination. We greatly appreciate the help of Damia December, Valerie Elsesser, Joanna Gross, Kara Koppinger, Mirele Mann, Meredith Merlanti, Michael Shain, Jerri Bamberger, Monica Arkin, Maggie O’Reilly Treter, Megan Ramthun, Madison Kraus, and Hannah Wolfson for their assistance with data management and data entry. Finally, we wish to acknowledge the Gilda’s Club of Grand Rapids staff for their administrative support, and all participating children, parents, and guardians. This research was supported in part by Grants NIMH K08 MH76078, Michigan Institute for Clinical and Health Research Grant, Todd Ouida Clinical Scholars Award, the Rachel Upjohn Clinical Scholars Award, the Laurence Polatsch Memorial Fund, and the Lynn Wilson Memorial Fund given to Dr. Kaplow.

Conflict of interest

Authors do not have any conflicts of interest to disclose.

Ethical standard

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent/assent was obtained from all individual participants included in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kathryn H. Howell.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Howell, K.H., Barrett-Becker, E.P., Burnside, A.N. et al. Children Facing Parental Cancer Versus Parental Death: The Buffering Effects of Positive Parenting and Emotional Expression. J Child Fam Stud 25, 152–164 (2016). https://doi.org/10.1007/s10826-015-0198-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-015-0198-3

Keywords

Navigation