title: Family-oriented multilevel study on the psychological functioning of adolescent children having a mother with cancer.
abstract: OBJECTIVE
  This study aims to identify the predictive power of adolescents', parents', and illness characteristics on the functioning of adolescents when a mother has cancer.
  
  
  METHODS
  Two hundred and seventy-one adolescents, 128 mothers with cancer, and 96 spouses completed standardized questionnaires 1-5 years after diagnosis. Stress response symptoms (SRS), internalizing and externalizing problems were assessed in adolescents. Parents' SRS, trait anxiety, marital satisfaction, and parent-adolescent communication were assessed in parents. Descriptive statistics and multilevel analyses accounting for non-independence of observations within groups were used.
  
  
  RESULTS
  Descriptive analyses showed clinically elevated SRS in 20% of the sons and 30% of the daughters. Daughters experienced more internalizing problems than norm group girls. Multilevel analyses showed that adolescents' female gender and older age were associated with impaired child functioning. Higher levels of parents' trait anxiety and SRS, marital dissatisfaction, and poorer parent-adolescent communication were significant predictors also. Recurrent disease was associated with SRS and internalizing problems, and more intensive treatment with externalizing problems. Female gender and poorer parent-adolescent communication were overall the best predictors.
  
  
  CONCLUSIONS
  Having a mother with cancer may have far-reaching consequences for more than a quarter of the adolescent offspring. The multilevel approach of this study identified individual-level adolescent' risk characteristics as well as family-level risk characteristics for mental health problems. Adolescents at risk should be referred to health-care professionals specialized in working with families to help them to adapt to their parent's illness.
authors.affiliation: UMCG School of Nursing and Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. g.a.huizinga@wenckebach.umcg.nl
authors.forename: Gea A
authors.initials: GA
authors.lastname: Huizinga
authors.forename: Annemieke
authors.initials: A
authors.lastname: Visser
authors.forename: Winette T A
authors.initials: WT
authors.lastname: Van der Graaf
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
authors.forename: Roy E
authors.initials: RE
authors.lastname: Stewart
authors.forename: Josette E H M
authors.initials: JE
authors.lastname: Hoekstra-Weebers
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology*; D002675:Child, Preschool; D005195:Family Relations; D005260:Female; D006801:Humans; D008297:Male; D009035:Mothers; D009369:Neoplasms / Q000523:psychology*; D012737:Sex Factors; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology