title: Parental emotional functioning declines with occurrence of clinical complications in pediatric hematopoietic stem cell transplant.
abstract: OBJECTIVE
  Parents' stress levels are high prior to their child's hematopoietic stem cell transplant (HSCT) and during transplant hospitalization, usually abating after discharge. Nevertheless, a subgroup of parents continues to experience frequent anxiety and mood disruption, the causes of which are not well understood. The purpose of this study was to assess whether clinical complications of HSCT could explain variation in parents' recovery of emotional functioning.
  
  
  METHODS
  Pediatric HSCT recipients (n = 165) aged 5-18 and their parents were followed over the first year post-transplant. Health-related quality of life assessments and medical chart reviews were performed at each time period (baseline, 45 days, 3, 6, and 12 months). We tested the association between clinical complications [acute and chronic graft versus host disease (aGVHD and cGVHD), organ toxicity, and infection] and longitudinally measured parental emotional functioning, as assessed by the Child Health-Ratings Inventories. The models used maximum likelihood estimation with repeated measures.
  
  
  RESULTS
  In adjusted analyses covering the early time period (45 days and 3 months), aGVHD grade ≥2, intermediate or poor organ toxicity, and systemic infection were associated with decreases in mean parental emotional functioning of 5.2 (p = 0.086), 5.8 (p = 0.052), and 5.1 (p = 0.023) points, respectively. In the later time period (6 and 12 months), systemic infection was associated with a decrease of 20 points (p < 0.0001). cGVHD was not significantly associated.
  
  
  CONCLUSIONS
  When children experience clinical complications after HSCT, parental emotional functioning can be impacted. Intervening at critical junctures could mitigate potential negative consequences for parents and their children.
authors.affiliation: Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA 02111, USA. nterrin@tuftsmedicalcenter.org
authors.forename: Norma
authors.initials: N
authors.lastname: Terrin
authors.forename: Angie Mae
authors.initials: AM
authors.lastname: Rodday
authors.forename: Hocine
authors.initials: H
authors.lastname: Tighiouart
authors.forename: Grace
authors.initials: G
authors.lastname: Chang
authors.forename: Susan K
authors.initials: SK
authors.lastname: Parsons
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003625:Data Collection; D004644:Emotions; D005260:Female; D006086:Graft vs Host Disease / Q000503:physiopathology / Q000523:psychology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D016013:Likelihood Functions; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D011788:Quality of Life; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors