title: Posttraumatic Stress Symptoms in Parents of Pediatric Cancer Patients: A Mediational Analysis.
abstract: OBJECTIVE
  Prior research finds that anxiety and depression among parents of pediatric cancer patients are associated with posttraumatic stress symptoms in response to children's cancer. This study examined whether this relationship is mediated by parents' negative affective reactions in response to their children's cancer-related treatment procedures.
  
  
  METHODS
  Participants were parents of 101 patients within six months of diagnosis who had completed at least two treatment-related procedures. Parents completed measures of trait anxiety and depression at baseline and posttraumatic stress symptoms at 3-month follow-up assessment. On the day of each treatment procedure, parents completed measures of state anxiety immediately before and negative mood and distress immediately after the procedure.
  
  
  RESULTS
  Trait anxiety was positively associated with state anxiety immediately before procedures and negative mood after procedures. Depression was positively associated with state anxiety immediately before procedures and negative mood and distress after procedures. Both trait anxiety and depression were positively associated with posttraumatic stress symptoms at 3-months follow-up. Parent state anxiety, negative mood, and distress partially mediated the effects of trait anxiety and/or depression on posttraumatic stress symptoms. Controlling for child age and social desirability did not affect these relationships.
  
  
  CONCLUSIONS
  Parents' trait anxiety and depression may influence cancer-related posttraumatic stress partially through their effect on parents' negative affective reactions at the time of their child's treatment procedures. These findings provide a more nuanced understanding of how parents' affect in response to procedures contributes to parent posttraumatic stress and suggest that interventions targeting treatment-related affective reactions of parents with high trait anxiety and/or depression may reduce the risk for longer-term distress and posttraumatic stress symptoms.
authors.affiliation: Karmanos Cancer Institute, Population Studies and Disparities Research Program, Detroit, MI, USA ; Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA.
authors.forename: Felicity W K
authors.initials: FW
authors.lastname: Harper
authors.affiliation: Karmanos Cancer Institute, Population Studies and Disparities Research Program, Detroit, MI, USA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Peterson
authors.affiliation: Karmanos Cancer Institute, Population Studies and Disparities Research Program, Detroit, MI, USA ; Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA.
authors.forename: Terrance L
authors.initials: TL
authors.lastname: Albrecht
authors.affiliation: Wayne State University School of Medicine, Department of Pediatrics, Detroit, MI, USA ; Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Taub
authors.affiliation: St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Phipps
authors.affiliation: Karmanos Cancer Institute, Population Studies and Disparities Research Program, Detroit, MI, USA ; Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA.
authors.forename: Louis A
authors.initials: LA
authors.lastname: Penner
keywords: Anxiety; Cancer; Depression; Families; Pediatric; Posttraumatic stress