title: Psychological Manifestations of Early Childhood Adversity in the Context of Chronic Hematologic Malignancy.
abstract: Myeloproliferative neoplasms (MPNs), a group of chronic hematologic malignancies, carry significant physical and psychological symptom burdens that significantly affect patients' quality of life.
  
  
  
  We sought to identify the relationship between early childhood adversity (ECA) and psychological distress in patients with MPNs, as ECA may compound symptom burden.
  
  
  
  Patients with MPNs were assessed for ECA (i.e., the Risky Families Questionnaire-subscales include abuse/neglect/chaotic home environment), distress (i.e., Distress Thermometer and Problem List), anxiety (i.e., Hospital Anxiety and Depression Scale-Anxiety [HADS-A]), depression (i.e., Hospital Anxiety and Depression Scale-Depression [HADS-D]), meeting standardized cutoff thresholds for distress (i.e., Distress Thermometer and Problem List≥ 4 or ≥ 7)/anxiety (HADS-A ≥8)/depression (HADS-D ≥ 8), and demographic factors.
  
  
  
  A total of 117 participants completed the study (78% response rate). ECA was associated with depression (p < 0.000), anxiety (p < 0.000), and distress (p < 0.000) and problem list variables emotional (p < 0.000), physical (p = 0.004), family (p = 0.01), and spiritual (p = 0.01) by bivariate analysis and only with distress (HADS) (p = 0.038) on multivariate analysis. ECA was associated with meeting cutoff threshold criteria for distress (p = 0.007), anxiety (p = 0.001), and depression (p = 0.02). ECA subscale variables abuse and chaotic home environment were associated with psychological outcomes. ECA was higher based on disease subtypes with greater symptom burden (other > polycythemia vera > myelofibrosis > essential thrombocythemia) (p = 0.047) and taking an antidepressant (p = 0.011).
  
  
  
  ECA is associated with psychological distress and meets screening criteria for anxiety and depression in patients with MPNs. ECA may help to explain individual patient trajectories, and further understanding may enhance patient-centered care among patients with MPNs.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (DCM). Electronic address: danielcurtismcfarland@gmail.com.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: McFarland
authors.affiliation: Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine.
authors.forename: Megan Johnson
authors.initials: MJ
authors.lastname: Shen
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hospital.
authors.forename: Heather
authors.initials: H
authors.lastname: Polizzi
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hospital.
authors.forename: John
authors.initials: J
authors.lastname: Mascarenhas
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hospital.
authors.forename: Marina
authors.initials: M
authors.lastname: Kremyanskaya
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center.
authors.forename: Jimmie
authors.initials: J
authors.lastname: Holland
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hospital.
authors.forename: Ronald
authors.initials: R
authors.lastname: Hoffman
mesh_terms: D001008:Anxiety Disorders / Q000150:complications* / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data*; D002908:Chronic Disease; D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: anxiety; depression; early childhood adversity; myeloproliferative disorders; psychological distress