title: Psychological disorders among children and the parents of children undergoing cancer workup.
abstract: OBJECTIVE
  This paper evaluates the association between psychological problems and cancer workup in children aged less than 20 and their parents. Assessment of the potential psychological stress in these children and their parents has been inadequately studied in the past.
  
  
  METHODS
  A retrospective cohort study of anxiety or depression among children and the parents of children undergoing cancer workup, based on Deseret Mutual Benefit Administrators (DMBA) claims data and corresponding enrollment files for dependent children aged less than 20, from 1998 to 2002 in the United States and Canada.
  
  
  RESULTS
  Less than 20% of cancer workups are followed by cancer diagnosis and treatment. Children with a "cancer workup only" are 89% more likely to experience anxiety/depression than are children without a cancer-related claim; that is, the rate per 100,000 person-years of anxiety/depression is 7,222 for children with a cancer workup only compared with 3,824 for children without a cancer-related claim. Mothers of children with cancer workup are 37% more likely to experience anxiety/depression. Children are significantly more likely to experience anxiety/depression if one or both of their parents experience anxiety/depression. The increased risk is influenced by whether the child experiences both cancer workup and treatment (359% higher), by cancer workup only (308% higher), and by no cancer workup or treatment (295% higher). Finally, the rate of anxiety/depression among children with cancer workup and their mothers was significantly lower in homes with more children.
  
  
  CONCLUSIONS
  A cancer workup alone is sufficient to significantly increase the risk of anxiety/depression in children undergoing cancer workup and in their parents. The ability of a child undergoing a cancer workup to cope is influenced by the mental health of their parents. More children in the home are protective against anxiety/depression in children undergoing cancer workup and in their mothers.
authors.affiliation: Department of Health Science, College of Health and Human Performance, Brigham Young University, Provo, Utah 84602, USA. Ray_Merrill@byu.edu
authors.forename: Ray M
authors.initials: RM
authors.lastname: Merrill
authors.forename: R Justin
authors.initials: RJ
authors.lastname: Brown
authors.forename: Stephen
authors.initials: S
authors.lastname: Alder
authors.forename: Randy K
authors.initials: RK
authors.lastname: Baker
authors.forename: A Dean
authors.initials: AD
authors.lastname: Byrd
authors.forename: George L
authors.initials: GL
authors.lastname: White
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Lyon