Psychological functioning of adolescent girls at risk for breast cancer: The role of disease, individual, and family variables

In the face of maternal illness, adolescent daughters are thought to be at risk for emotional problems (e.g., Compas et al., 1994; Compas et al., 1996). This may be due to a number of variables, including those related to the functional impact of the disease, perceptions of increased personal risk, or other individual and family influences. To date, however, adolescent daughters of ill mothers remain an understudied population and variables for predicting or explaining adjustment problems in this group have not been thoroughly investigated. The purpose of this study was to examine the disease, family, and individual psychological variables that are related to adolescent girls' adjustment following maternal breast cancer. It was expected that maternal distress and family functioning would moderate the relationship between disease variables and adolescent psychological functioning. The current study included 60 mother-daughter pairs in which the mother was at least 1 year post-treatment for non-metastatic breast cancer. The mean age of mothers in the current sample was 45.4 years, and the average age of daughters was 15.5. Predictor variables examined were: (1) maternal health-related quality of life (HQL, measured with the Short Form-36; Ware et al., 1993), and adolescent perceptions of (2) disease severity, (3) personal risk for cancer, and (4) breast cancer worries (Severity Perceptions, Risk Perceptions and Worries subscales on the Breast Cancer Survey [BCS], Cappelli et al., 1999). Proposed moderators examined were: (1) family functioning (Family Assessment Measure-III; Skinner et al., 1983), and (2) maternal psychological distress (Symptoms Checklist 90-Revised; Derogatis, 1983). Adolescent psychological adjustment was the outcome variable, and was measured in two ways: (1) adolescent reports on the Youth Self Report (YSR; Achenbach, 1991), and (2) maternal reports on the Child Behavior Checklist (CBCL; Achenbach, 1991). Some support was provided for the hypothesis that adolescent role functioning moderates the relationship between certain disease-related factors and adolescent psychological adjustment. Specifically, poorer maternal HQL in the presence of greater problems with adolescent functioning within the family was associated with adolescent reports of poorer social competence. When adolescents reported high family functioning, however, no such relationship was observed, suggesting that good family functioning can help to buffer the negative effects maternal illness on adolescent social functioning. Additional analyses suggested that maternal distress levels mediate the significant association between maternal reports of adolescent problems and maternal HQL. In contrast, the relationship between maternal HQL and adolescent self-reports of psychological problems was mediated by family functioning. Results are considered in light of existing research in this area and clinical implications are discussed.