Parental cancer and children’s well-being : understanding the potential role of psychological stress

Early life stress has a major influence on one’s health through the life course. During childhood, early experience may not only affect the normal brain development, but also influence the susceptibility to mental and physical disorders. A cancer diagnosis in a parent may cause substantial distress in the children, who may have to confront and adapt to short- and long-term changes in their lives and subsequently experience a higher risk of physical and psychosocial problems. Therefore, the first aim of this thesis was to examine whether parental cancer is associated with physical and mental health problems in the affected children using data from the Swedish national registers. Further, to explore the potential mechanism determining the impact of stress on children’ health, we focused on the brain development in childhood and investigated the association between stress biomarkers and brain morphology, using data from a Dutch population-based cohort. In Study I, we assessed the association between parental cancer and risk of injury in a large representative sample of Swedish children. We found that parental cancer was associated with a higher risk of hospital contacts for injury, particularly during the first year after the cancer diagnosis and when the parent experienced a psychiatric illness after the cancer diagnosis. The risk increment reduced during the second and third years and became null afterwards. Given the observed higher risk of adverse physical health in terms of injury, we further investigated the influence of parental cancer on adverse mental health in terms of psychiatric disorders among children. In Study II, we constructed a matched cohort, and separately examined the associations between parental cancer diagnosed during pregnancy or after birth and clinical diagnoses of psychiatric disorders or use of prescribed psychiatric medications. Paternal but not maternal cancer during pregnancy appeared to be associated with a higher risk of psychiatric disorders, primary among girls. Parental cancer after birth conferred a higher risk of clinical diagnoses of psychiatric disorders, particularly stress reaction and adjustment disorders. The affected children also experienced a higher risk of use of prescribed psychiatric medications, particularly anxiolytics. The latter associations were most pronounced for parental cancer with poor expected survival and for parental death after cancer diagnosis. In Study III, we focused on other domains of mental and physical health affected by parental cancer. We examined the associations of parental cancer with intellectual performance, stress resilience, and physical fitness among boys that underwent the compulsory military conscription examination during early adulthood. We observed positive associations of parental cancer with low stress resilience and low physical fitness, with stronger associations noted for parental cancer with poor expected survival and for a loss of parent through death after cancer diagnosis. No overall association was observed between parental cancer and intellectual performance, but the parental cancer with poor expected survival or resulting in a death of the parent was associated with a higher risk of low intellectual performance. The hypothalamic-pituitary-adrenal (HPA) axis is one of the most extensively studied stress systems. Detection of glucocorticoids in hair has emerged as an approach to measuring HPA activity retrospectively. In Study IV, we assessed the associations of hair cortisol and cortisone concentrations with brain morphology in a population-based sample of young children in Rotterdam, the Netherlands. The regions of interest analyses showed that hair cortisol and cortisone concentrations were positively associated with cortical surface area in the parietal lobe. However, an inverse association was found between hair cortisol or cortisone concentration and hippocampal volume in children with behavioral problems. The vertex-wise analyses with correction for multiple testing did, however, not show any association of hair cortisol or cortisone concentration with cortical thickness, cortical surface area or gyrification. In conclusion, parental cancer, a potent early life stressful event, is associated with a higher risk of physical and mental health outcomes, including injuries, psychiatric disorders, low intellectual performance, low stress resilience, and low physical fitness. Although we did not find clear associations of hair cortisol and cortisone concentrations with brain morphology in typically developing children, children that are evidently exposed to psychological stress should be provided adequate support and care to prevent from stress-related health outcomes

The Chinese version of the Pediatric Quality of Life Inventory™ (PedsQL™) 3.0 Asthma Module: reliability and validity

<p>Abstract</p> <p>Background</p> <p>Health-related quality of life (HRQOL) has been recognized as an important health outcome measurement for pediatric patients. One of the most promising instruments in measuring pediatric HRQOL emerged in recent years is the Pediatric Quality of Life Inventory (PedsQL™). The PedsQL™ 3.0 Asthma Module, one of the PedsQL™disease-specific scales, was designed to measure HRQOL dimensions specifically tailored for pediatric asthma. The present study is aimed to evaluate the psychometric properties of the Chinese version of the PedsQL™ 3.0 Asthma Module.</p> <p>Methods</p> <p>The PedsQL™ 3.0 Asthma Module was translated into Chinese following the PedsQL™ Measurement Model Translation Methodology. The Chinese version scale was administered to 204 children with asthma and 337 parents of children with asthma from four Triple A hospitals. The psychometric properties were then evaluated.</p> <p>Results</p> <p>The percentage of missing value for each item of the scale ranged from 0.00% to 8.31%. All child self-report subscales and parent proxy-report subscales approached or exceeded the minimum reliability standard of 0.70 for alpha coefficient, except 3 subscales of Young Child (aged 5-7) self-report (alphas ranging from 0.59 to 0.68). Test-retest reliability was satisfactory with intraclass correlation coefficients (ICCs) which exceeded the recommended standard of 0.80 in all subscales. Correlation coefficients between items and their hypothesized subscales were higher than those with other subscales. The PedsQL™ 3.0 Asthma Module distinguished between outpatients and inpatients. Patients with mild asthma reported higher scores than those with moderate/severe asthma in majority of subscales. The intercorrelations among the PedsQL™ 3.0 Asthma Module subscales and the PedsQL™ 4.0 Generic Core Scales were in medium to large effect size. The child self-report scores were consistent with the parent proxy-report scores.</p> <p>Conclusions</p> <p>The Chinese version of the PedsQL™ 3.0 Asthma Module has acceptable psychometric properties, except the internal consistency reliability for Young Child (aged 5-7) self-report. Further studies should be focused on testing responsiveness of the Chinese version scale in longitudinal studies, evaluating the reliability and validity of the scale for the patients with severe asthma or teens independently, and assessing HRQOL of children with asthma in other areas.</p

Childhood injury after a parental cancer diagnosis

A parental cancer diagnosis is psychologically straining for the whole family. We investigated whether a parental cancer diagnosis is associated with a higher-than-expected risk of injury among children by using a Swedish nationwide register-based cohort study. Compared to children without parental cancer, children with parental cancer had a higher rate of hospital contact for injury during the first year after parental cancer diagnosis (hazard ratio [HR] = 1.27, 95% confidence interval [CI] = 1.22-1.33), especially when the parent had a comorbid psychiatric disorder after cancer diagnosis (HR = 1.41, 95% CI = 1.08-1.85). The rate increment declined during the second and third year after parental cancer diagnosis (HR = 1.10, 95% CI = 1.07-1.14) and became null afterwards (HR = 1.01, 95% CI = 0.99-1.03). Children with parental cancer also had a higher rate of repeated injuries than the other children (HR = 1.13, 95% CI = 1.12-1.15). Given the high rate of injury among children in the general population, our findings may have important public health implications

The Chinese version of the Pediatric Quality of Life Inventory™ (PedsQL™) Family Impact Module: cross-cultural adaptation and psychometric evaluation

<p>Abstract</p> <p>Background</p> <p>A pediatric chronic health condition not only influences a child's life, but also has impacts on parent health-related quality of life (HRQOL) and family functioning. To provide care and social support to these families, a psychometrically well-developed instrument for measuring these impacts is of great importance. The present study is aimed to evaluate the psychometric properties of the Chinese version of the PedsQL™ Family Impact Module.</p> <p>Methods</p> <p>The cross-cultural adaptation of the PedsQL™ Family Impact Module was performed following the PedsQL™ Measurement Model Translation Methodology. The Chinese version of the PedsQL™ Family Impact Module was administered to 136 parents of children with asthma and 264 parents of children with heart disease from four Triple A hospitals. The psychometric properties such as feasibility, internal consistency reliability, item-subscale correlations and construct validity were evaluated.</p> <p>Results</p> <p>The percentage of missing item responses was less than 0.1% for both asthma and heart disease sample groups. The Chinese version of the PedsQL™ Family Impact Module showed ceiling effects but had acceptable reliability (Cronbach's Alpha Coefficients were higher than 0.7 in all the subscales except "Daily Activities" in the asthma sample group). There were higher correlation coefficients between items and their hypothesized subscales than those with other subscales. The asthma sample group reported higher parent HRQOL and family functioning than the heart disease sample group. In the heart disease sample group, parents of outpatients reported higher parent HRQOL and family functioning than parents of inpatients. Confirmatory factor analysis showed that the instrument had marginally acceptable construct validity with some Goodness-of-Fit indices not reaching the standard indicating acceptable model fit.</p> <p>Conclusions</p> <p>The Chinese version of the PedsQL™ Family Impact Module has adequate psychometric properties and could be used to assess the impacts of pediatric asthma or pediatric heart disease on parent HRQOL and family functioning in China. This instrument should be field tested on parents of children with other chronic medical conditions in other areas. Construct validity tested by confirmatory factor analysis and test-retest reliability should be further assessed.</p

Association of prenatal trajectories of depressive and anxiety symptoms with neurodevelopment of children aged 0-24 months: A prospective study

BackgroundPrenatal depression and anxiety can significantly impact a child’s neurodevelopment. However, the specific timing and patterns of these maternal psychological symptoms during pregnancy that influence the child’s neurodevelopment remain unclear. This study aimed to investigate the associations of maternal depressive and anxiety symptoms across pregnancy trimesters and their trajectories with neurodevelopmental outcomes in children aged 0 to 24 months.MethodsA total of 16,229 singletons born between January 2020 and December 2023 were included in this prospective study. Maternal depressive and anxiety symptoms in each trimester of pregnancy were assessed by Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scale, respectively. The neurodevelopmental status of children aged 0-24 months was assessed by the Ages and Stages Questionnaire-Third Edition. Group-based trajectory model was employed to identify distinct trajectories of prenatal depressive and anxiety symptoms throughout pregnancy. Poisson regression was used to assess the associations of maternal depressive and anxiety symptoms, as well as their trajectories, with the child’s neurodevelopment.ResultsA total of 1,791 (11.04%) children had neurodevelopmental delay in the communication domain, 1,127 (6.94%) in the gross motor domain, 1,750 (10.78%) in the fine motor domain, 1,137 (7.01%) in the problem-solving domain, and 1,724 (10.62%) in the personal-social domain. Maternal depressive and anxiety symptoms during pregnancy, especially in the second and third trimester, were associated with a higher risk of neurodevelopmental delay in all domains, with the most profound impact observed in the fine motor domain. Four trajectories were identified for prenatal depressive and anxiety symptoms, respectively. Compared with children whose mothers had low level of depressive or anxiety symptoms throughout pregnancy, children whose mothers experienced consistently moderate or high level of these symptoms had a higher risk of neurodevelopmental delay, while children whose mothers experienced moderate level of depressive or anxiety symptoms that decreased to low levels after the first trimester did not show a different risk of neurodevelopmental delay.ConclusionMaternal depressive and anxiety symptoms during pregnancy have an adverse impact on the neurodevelopment in offspring. This study highlights the importance of improving the mental health of pregnant women in order to support optimal neurodevelopment for their children

Impact of parental cancer on IQ, stress resilience, and physical fitness in young men

Background: A parental cancer diagnosis is a stressful life event, potentially leading to increased risks of mental and physical problems among children. This study aimed to investigate the associations of parental cancer with IQ, stress resilience, and physical fitness of the affected men during early adulthood. Materials and methods In this Swedish population-based study, we included 465,249 men born during 1973–1983 who underwent the military conscription examination around the age of 18 years. We identified cancer diagnoses among the parents of these men from the Cancer Register. IQ, stress resilience, and physical fitness of the men were assessed at the time of conscription and categorized into three levels: low, moderate, and high (reference category). We used multinomial logistic regression to assess the studied associations. Results: Overall, parental cancer was associated with higher risks of low stress resilience (relative risk ratio [RRR]: 1.09 [95% confidence interval (CI) 1.04–1.15]) and low physical fitness (RRR: 1.12 [95% CI 1.05–1.19]). Stronger associations were observed for parental cancer with a poor expected prognosis (low stress resilience: RRR: 1.59 [95% CI 1.31–1.94]; low physical fitness: RRR: 1.45 [95% CI 1.14–1.85]) and for parental death after cancer diagnosis (low stress resilience: RRR: 1.29 [95% CI 1.16–1.43]; low physical fitness: RRR: 1.40 [95% CI 1.23–1.59]). Although there was no overall association between parental cancer and IQ, parental death after cancer diagnosis was associated with a higher risk of low IQ (RRR: 1.11 [95% CI 1.01–1.24]). Conclusion: Parental cancer, particularly severe and fatal type, is associated with higher risks of low stress resilience and low physical fitness among men during early adulthood. Men who experienced parental death after cancer diagnosis also have a higher risk of low IQ

Psychological and physiological impacts of a fast-track diagnostic workup for men with suspected prostate cancer : Preliminary report from a randomized clinical trial

Funding Information: This study was funded by The Swedish Cancer Society (CF2016/795 and 2018/765) and Nyckelfonden, Örebro, Sweden (2015). The funders had no role in the design and conduct of the study, collection, analysis, and interpretation of the data, and writing and approval of the manuscript. Funding Information: This study was funded by The Swedish Cancer Society (CF2016/795 and 2018/765) and Nyckelfonden, ?rebro, Sweden (2015). The funders had no role in the design and conduct of the study, collection, analysis, and interpretation of the data, and writing and approval of the manuscript. This randomized clinical trial was approved by the ethics committee at ?rebro University Hospital and was registered at the ISRCTN registry www.isrctn.com (No. ISRCTN45953686). Written informed consent was obtained from all individual participants included in the study. All authors accept the publication of this work and all patients provided signed inform consent to use their data. The datasets generated and/or analyzed during the current study are not publicly available to protect participant confidentiality but can be partly provided from authors on reasonable request. The authors declare that they have no competing interest. This study was funded by The Swedish Cancer Society (CF2016/795 and 2018/765) and Nyckelfonden, ?rebro, Sweden (2015). The funders had no role in the design and conduct of the study, collection, analysis, and interpretation of the data, and writing and approval of the manuscript. JZ, RC, OA, SOA, UV, FF, and KF conceived of and designed the study; JZ, SD, JC, AME, JF, OA, and SOA contributed to collection of the data; JZ and RC analyzed the data; JZ drafted the manuscript; JZ, RC, SD, JC, AME, JF, OA, SOA, UV, FF, and KF revised the manuscript critically for important intellectual content; All authors read and approved the final manuscript. The authors thank all the subjects who have participated in this clinical trial.Peer reviewe