title: Psychological distress related to patterns of family functioning among Japanese childhood cancer survivors and their parents.
abstract: OBJECTIVE
  Family functioning appears to be a predictor of psychological distress among childhood cancer survivors and their family members; however, relatively little is known about patterns in those families that are psychologically at-risk. The purpose of this study was to identify distinct clusters of families that include childhood cancer survivors, and to evaluate differences between the clusters with respect to anxiety, depression, and post-traumatic stress symptoms (PTSS).
  
  
  METHODS
  Childhood cancer survivors and their parents (247 individuals: 88 adolescent cancer survivors, 87 mothers, and 72 fathers) completed self-report questionnaires. Perceptions of family functioning were assessed using the Family Relationship Index and its three dimensions (cohesiveness, expressiveness, and conflict), and individuals were classified into groups via a cluster analytic approach. State-trait anxiety, depression, and PTSS were assessed to all of the participants.
  
  
  RESULTS
  The individuals were classified into three types: One cluster featured high cohesiveness, high expressiveness, and low conflict ('Supportive-type', n=102); a second cluster featured low cohesiveness, low expressiveness, and high conflict ('Conflictive-type', n=32); and a third cluster had moderate cohesiveness, moderate expressiveness, and moderate conflict ('Intermediate-type', n=113). Among the three types, an analysis of variance revealed that 'Conflictive-type' members had the highest levels of PTSS, depression, and state-trait anxiety.
  
  
  CONCLUSIONS
  These findings suggest that perceptions of family functioning are related to psychological distress in family members of childhood cancer survivors. A family-focused intervention might be a useful approach to targeting emotional distress in these families, particularly for families with a 'Conflictive-type' family member.
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume City, Fukuoka, Japan. ohzono_shyuuichi@kurume-u.ac.jp
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ozono
authors.forename: Toshinari
authors.initials: T
authors.lastname: Saeki
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Mantani
authors.forename: Akiko
authors.initials: A
authors.lastname: Ogata
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Okamura
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ueda
authors.forename: Hiroko
authors.initials: H
authors.lastname: Inada
authors.forename: Shigeto
authors.initials: S
authors.lastname: Yamawaki
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data*; D002648:Child; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005190:Family / Q000523:psychology*; D005195:Family Relations; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000523:psychology*; D010287:Parent-Child Relations; D010290:Parents; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data*