The Status And Influencing Factors Of Post-traumatic Stress Symptoms Of Hospitalized Children With Cancer And Their Parents

ObjectivesTo investigate the status of Post-Traumatic Stress Symptoms（PTSS）in children with cancer and their parents,and to analyze the key influencing factors affecting PTSS in children with cancer and their parents.The structural equation model of PTSS of children with cancer and their parents was constructed to analyze the path relationship between PTSS and various influencing factors,so as to put forward specific suggestions and countermeasures,providing reference for guiding the development of personalized family intervention programs.MethodsFrom September 2021 to March 2022,children with cancer and their parents who met the inclusion criteria were selected as subjects for a cross-sectional study in three affiliated hospitals of Central South University.Research tools including general information questionnaire and Impact of Event Scale-Revised questionnaire（IES-R）,The UCLA Posttraumatic Stress Disorder-Reaction Index（UCLA PTSD-RI）,Type-D Personality Scale-14（DS14）,The Posttraumatic Cognitions Inventory（PTCI-9）,Simplified Coping Style Questionnaire（SCSQ）,Social Support Rating Scale（SSRS）,APGAR Questionnaire,Family Management Measure Scale（Fa MM）,SF-12,Peds QL^TM 4.0.EXCEL was used for double data entry and SPSS 26.0 software was used for data analysis.Statistical methods include statistical description,t-test,one-way ANOVA,nonparametric test,multiple linear regression analysis and structural equation model.Results（1）A total of 203 families with pediatric cancer were investigated,including 43 fathers（21.2%）,160 mothers（78.8%）,129 boys（63.5%）and 74 girls（36.5%）.Among the 203 parents,157（77.3%）were positive for PTSS,including 35（81.4%）fathers and 122（76.3%）mothers.Among the 203 children,16（7.9%）were PTSS positive,including 9 boys（7.0%）and 7 girls（9.5%）.There was a weak positive correlation between children with or without PTSS and parents with or without PTSS（r=0.158,P<0.05）.（2）The results of univariate analysis showed that the influencing factors of parents’PTSS were family monthly income,whether the family actively sought financial help,length of parents’care for children,duration after diagnosis of disease,and current treatment stage（P<0.05）.The education level of parents,family monthly income,whether the family actively sought financial help,length of parents’care for children,whether the tumor has metastases and the current treatment stage were the influencing factors of PTSS（P<0.05）.（3）In the correlation analysis,parents’PTSS scores were significantly positively correlated with their Type-D personality,post-traumatic cognition,negative coping and negative assessment of family management,and were significantly negatively correlated with their social support,family function,positive assessment of family management,PCS and MCS.In the correlation analysis,children’s PTSS scores were significantly positively correlated with their Type-D personality,post-traumatic cognition,negative coping,positive coping,negative assessment of family management,and significantly negatively correlated with their quality of life.（4）In multiple linear regression,parents’Type-D personality,post-traumatic cognition,positive coping and negative assessment of family management positively predicted their PTSS scores,while parents’MCS negatively predicted PTSS scores.In multiple linear regression,children’s Type-D personality and negative coping had positive predictive effects on their PTSS scores,while quality of life had negative predictive effects on their PTSS scores.（5）The structural equation model showed that parents’Type-D personality and cognitive evaluation had direct and indirect effects on parents’PTSS,negative coping had indirect effects on parents’PTSS,and negative assessment of family management had direct effects on parents’PTSS.The children’s Type-D personality and negative coping had a direct effect on PTSS,positive coping had an indirect effect on PTSS,and negative assessment of family management had a direct effect on PTSS.Conclusion（1）The incidence of PTSS in parents of children with cancer is high,and there is a significant positive correlation between PTSS in children with cancer and PTSS in parents.Therefore,great attention should be paid to the psychological status of children with cancer and their parents during hospitalization.（2）The family economic pressure and the time between diagnosis are the important factors affecting the occurrence of PTSS in children and their parents.The risk factors for parents’PTSS are the Type-D personality of the parents,the high degree of negative post-traumatic cognition,the high level of positive coping,the more negative family management results（negative assessment）,and the poor mental health degree of quality of life.The risk factors of children’s PTSS are the Type-D personality of the children,the high level of negative coping,and the poor quality of life.（3）Parents’Type-D personality and post-traumatic cognition had both direct and indirect effects on their PTSS,parents’negative coping had indirect effects on their PTSS,and parents’negative assessment of family management had direct effects on their PTSS.The children’s Type-D personality and negative coping had a direct impact on their PTSS,the children’s positive coping had an indirect impact on their PTSS,and the negative assessment of family management had a direct impact on their PTSS.The negative assessment of family management is an important mediating factor between PTSS and various influencing factors,indicating that the more difficult it is to manage family diseases,the more negative the management results are,and the more likely PTSS will occur.This has beneficial implications for the future psychological trauma intervention targeting children cancer families.For hospitalized children cancer families,paying attention to the results of family disease management and promoting family response and adaptation to the disease will be conducive to reducing the family’s post-traumatic stress response.