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儿童癌症中父母的痛苦:创伤后应激症状、抑郁和焦虑的比较评估

Parent distress in childhood cancer: a comparative evaluation of posttraumatic stress symptoms, depression and anxiety.

作者信息

Norberg Annika Lindahl, Boman Krister K

机构信息

Department of Woman and Child Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden.

出版信息

Acta Oncol. 2008;47(2):267-274. doi: 10.1080/02841860701558773.

Abstract

The aim was to assess symptoms consistent with posttraumatic stress (PTS; cognitive intrusions, avoidance, arousal) related to the child's illness, and generic distress (anxiety, depression) in parents of childhood cancer patients. Outcomes were compared to normative and relevant reference data, and analysed for their dependence on time passed since diagnosis. Swedish parents (266 mothers, 208 fathers) were recruited at two centres. Data from a clinical sample of posttraumatic stress disorder (PTSD) patients and parents of healthy children were used for comparison. The Impact of Events Scale (IES-R) was used for assessing PTS symptoms, and self-report scales for anxiety and depression. Elevated stress and generic distress varied as a function of time from diagnosis. Up to 12% of parents for whom >5 years had passed since diagnosis still reported equally, or more intrusive thoughts, avoidance and arousal when contrasted to patients suffering from PTSD. Parents of recently diagnosed children had more cancer-related intrusive thoughts than those of long-term survivors. Heightened anxiety and depression was most prominent in mothers and fathers up to 2.5 years after diagnosis. In conclusion, severe generic distress characterises the first years after diagnosis, and initially common PTS symptoms are found in a considerable portion of parents years after diagnosis. Clinically, attention should be paid to continuous parent support needs. Individual variation vis-à-vis distress vulnerability should be acknowledged, and presupposed gender differences avoided. When treatment situation asks the most of parents' collaboration, many are under pressure of severe stress.

摘要

本研究旨在评估与儿童疾病相关的创伤后应激症状(PTS;认知侵入、回避、觉醒),以及儿童癌症患者父母的一般困扰(焦虑、抑郁)。将结果与标准和相关参考数据进行比较,并分析其与诊断后经过时间的相关性。在两个中心招募了瑞典父母(266名母亲,208名父亲)。来自创伤后应激障碍(PTSD)患者临床样本和健康儿童父母的数据用于比较。使用事件影响量表(IES-R)评估PTS症状,使用自我报告量表评估焦虑和抑郁。应激和一般困扰水平随诊断后的时间而变化。自诊断后已过去5年以上的父母中,高达12%的人报告的侵入性想法、回避和觉醒程度与PTSD患者相当,甚至更多。与长期幸存者的父母相比,近期诊断出孩子患癌的父母有更多与癌症相关的侵入性想法。在诊断后长达2.5年的时间里,母亲和父亲的焦虑和抑郁加剧最为明显。总之,严重的一般困扰是诊断后最初几年的特征,并且在诊断多年后,相当一部分父母中仍能发现最初常见的PTS症状。在临床上,应关注父母持续的支持需求。应认识到个体在困扰易感性方面的差异,避免预设的性别差异。当治疗需要父母最大程度的合作时,许多父母承受着巨大的压力。

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