The Center for Research and Study of the Family, School of Social Work, University of Haifa, Haifa, Israel.
Department of Psychology, University of Washington, Seattle, WA, USA.
Psychooncology. 2018 Apr;27(4):1244-1250. doi: 10.1002/pon.4661. Epub 2018 Mar 1.
Pediatric cancer is highly stressful for parents. The current prospective study examines the impact of several stressors (financial strain, life threat, treatment intensity, treatment-related events, and negative life events) on the trajectory of marital adjustment across the first year following diagnosis. We examined whether average level of stressors across the year was related to (1) levels of marital adjustment at the end of the first year of treatment and () the rate of change in marital adjustment.
One hundred and thirty families of children newly diagnosed with cancer (M age = 6.33 years, SD = 3.61) participated. Primary caregivers provided 12 monthly reports on marital adjustment and stressors.
Multilevel models indicated that although marital adjustment was stable across the first year on average, random effect estimates suggested that this was the result of differing trajectories between families (eg, some increasing and others decreasing). Five individual stress constructs and a cumulative stress composite were then used to predict this variability. Higher average economic strain was related to consistently poorer marital adjustment across time. Higher average frequency of treatment-related events and negative life events were associated with decreasing adjustment over time and lower adjustment at the end of the first year of treatment. Perception of life threat and treatment intensity were not associated with final levels or trajectory of adjustment. Finally, higher cumulative stress was associated with consistently poorer marital adjustment across time.
Implications for identification of at-risk families are discussed, and importance of delivering tailored interventions for this population.
儿童癌症对父母来说压力很大。本前瞻性研究考察了多种压力源（经济压力、生命威胁、治疗强度、治疗相关事件和负面生活事件）对诊断后第一年婚姻适应轨迹的影响。我们研究了一年内压力源的平均水平是否与（1）治疗第一年结束时的婚姻调整水平和（2）婚姻调整变化率有关。
130 个新诊断为癌症的儿童家庭（M 年龄=6.33 岁，SD=3.61）参与了研究。主要照顾者每月报告一次婚姻调整和压力源。
多层次模型表明，尽管婚姻调整在平均水平上在第一年是稳定的，但随机效应估计表明，这是家庭之间轨迹不同的结果（例如，一些家庭在增加，而另一些家庭在减少）。然后使用五个单独的压力结构和一个累积压力综合来预测这种可变性。较高的平均经济压力与随时间推移持续较差的婚姻调整有关。较高的治疗相关事件和负面生活事件的平均频率与随时间调整下降和治疗第一年结束时调整较低有关。对生命威胁和治疗强度的感知与最终调整水平或调整轨迹无关。最后，较高的累积压力与随时间推移持续较差的婚姻调整有关。
讨论了识别高危家庭的意义，并强调了为这一人群提供量身定制干预措施的重要性。
