Parental Posttraumatic Stress Research Articles

Parent Physical and Mental Health Comorbidity and Adolescent Behavior.

The objectives of this study were to ascertain behavioral outcomes 10-11 years after 9/11 in adolescents ages 11-18 years (0-8 years old at the time of 9/11) enrolled in the World Trade Center Health Registry (Registry), and relate these outcomes to their 9/11-exposures and to parent health. Behavioral difficulties among adolescents were assessed using the adolescent-reported Strengths and Difficulties Questionnaire (SDQ). Parental post-traumatic stress disorder (PTSD) was assessed using a 9/11-specific PTSD Checklist-Civilian Version, a cut-off score of 44 or greater was considered probable PTSD. Multivariable logistic regression was used to estimate associations of 9/11-exposure and parental health with abnormal/borderline SDQ scores, adjusting for demographic variables that were significantly associated with the SDQ score in bivariate analyses. Of the 449 adolescents, 12.5% (n=56) had abnormal/borderline SDQ scores. In the multivariable model, adolescents with severe/ moderate 9/11-exposures were 2.4 times more likely to have abnormal/borderline SDQ scores compared to adolescents with mild 9/11-exposures (95% Confidence Interval (CI): 1.1-6.4). Adolescents who had a parent with 9/11-related PTSD and at least one comorbid chronic condition were 4.2 times more likely to have abnormal/borderline SDQ scores compared to adolescents with a parent who had no reported chronic health conditions. Adolescents whose parent reported 14 or more poor mental health days in the preceding 30 days were 3.4 times more likely to have abnormal/borderline SDQ scores (95% CI: 1.2-9.5) The finding that parents' health appears to influence adolescent behavior problems 10-11 years following a disaster may have implications for healthcare practitioners and disaster response planners.

Intergenerational transmission of post-traumatic stress disorder in Australian Vietnam veterans' families.

To assess the association between parental post-traumatic stress disorder (PTSD) and offspring PTSD and its specificity for other disorders in a non-clinical epidemiological cohort of Australian Vietnam veterans, their partners and their sons and daughters. Veterans were interviewed twice, in 1992-1994 and 2005-2006; partners were interviewed in 2006-2007, and their offspring in 2012-2014. A total of 125 sons and 168 daughters were interviewed from 197 families, 137 of which also included partners who were the mothers of the children. Statistical analysis used multi-level modelling to compute odds ratios and 95% confidence intervals while controlling for clustering effects within families. Parent PTSD diagnoses were examined for associations with offspring trauma exposure, PTSD and other psychiatric diagnoses. Veteran PTSD increased the risk of PTSD and no other disorder in both sons and daughters; partner PTSD did not. Veteran depression was also a risk factor for sons' PTSD, and alcohol disorder was linked to alcohol dependence in sons and PTSD in daughters, but not when controlling for veteran PTSD. We conclude that PTSD in a Vietnam veteran father increases the risk specifically for PTSD in his sons and daughters.

Parent-Reported and Self-Perceived Behavioral and Psychiatric Symptoms in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia

Introduction: Limited data are available on combined parent and self-reported behavioral symptoms in long-term survivors of childhood acute lymphoblastic leukemia (ALL) after treatment with contemporary chemotherapy only protocols. This study evaluated associations between chemotherapy exposures, parent emotional distress and reported child behavioral and psychiatric symptoms in survivors enrolled on a single institutional protocol.Methods: Survivors of childhood ALL (n=162; 49.0% male; mean [SD] age 12.1[2.6] years; time since diagnosis 7.5[1.6] years), who were at least 5 years post diagnosis and between 8-17 years of age, self-reported behavioral symptoms (Conners’ Rating Scale) during a long-term follow-up visit. Parent-report of child behavioral symptoms was collected (Behavior Assessment System for Children) during the same visit. Age- and sex-adjusted standard scores were calculated for both measures, with impairment defined as a symptom level above the 90th percentile compared to normative data. Parents also completed the Diagnostic Interview for Children and Adolescents to determine whether their child met clinical criteria for psychiatric disorders. The proportion of children meeting criteria was compared to reported frequencies in the general population. Exposures to high-dose IV methotrexate, number of intrathecal therapy doses (cytarabine, methotrexate and hydrocortisone), and age at diagnosis were analyzed with multivariable Poisson regression as predictors of child behavioral symptoms and psychiatric condition. Association of Parent education level with child outcomes was examined using univariate Poisson regression model. Parent emotional distress was assessed using the Brief Symptom Inventory 18 (BSI-18), and raw scores were converted into sex specific T-scores using national normative data. T-scores ≥ 63 were considered to represent clinically significant emotional distress. Symptoms of parent posttraumatic stress (PTS) were evaluated using the Impact of Event Scale-Revised (IES-R) and levels of stress were calculated for three subscales (thought intrusions, avoidance, and hyperarousal), consistent with PTS diagnostic criteria. Associations between parent- and self-reported symptoms in children with parent emotional distress and PTS were examined with Fisher’s exact test.Results: Compared to the expected population frequency of 10%, significantly more survivors self-reported symptoms of inattention (27.7%), hyperactivity/impulsivity (25.8%) and oppositional behavior (20%), all p’s<0.0001 (corrected for False Discovery Rate [FDR]). Parents reported their children to have more symptoms of depression (16.5%), multiple symptoms of internalizing problems (i.e. anxiety/depression; 17.1%), and attention problems (24.7%) with all p’s<0.05 (FDR). Compared to a US national survey of psychiatric conditions, parents identified significantly higher frequencies of Generalized Anxiety disorder (3.2% vs. 1.1%), Obsessive-Compulsive Disorder (10.3% vs. 1-3%), Simple/Social Phobias (22.3% vs. 15.8%) and Oppositional Defiant Disorder (15.9% vs. 8.3%), all p’s<0.05 (FDR), but not Attention-Deficit/Hyperactivity Disorder (7% vs 6.5%; Table1). Risk of significant symptoms of internalizing problems increased 8% per additional intrathecal therapy injection (Table2). Parent emotional distress was significantly associated with their report of child Obsessive-Compulsive Disorder, Simple/Social Phobias, and Oppositional Defiant Disorder, all p’s<0.05. Risk of behavior symptoms decreased 10-21% (p’s<0.05) per each additional year of parent education. Risk of self-reported hyperactivity problems increased 2.6 times among survivors whose ALL was diagnosed less than 5 years of age (95% CI=1.2-5.4, p=0.01).Conclusion: Although most long-term child survivors of ALL appear emotionally healthy, a substantial proportion appear to exhibit significant symptoms of inattention, anxiety/depression and oppositional behavior based on child and parent report. Treatment exposures are not associated with the majority of these symptoms. However, sociodemographic factors such as parent education and parental psychological status influence these outcomes providing basis for targeting vulnerable families for intervention. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Parent-child relationship quality and family transmission of parent posttraumatic stress disorder symptoms and child externalizing and internalizing symptoms following fathers' exposure to combat trauma.

Transactional cascades among child internalizing and externalizing symptoms, and fathers' and mothers' posttraumatic stress disorder (PTSD) symptoms were examined in a sample of families with a male parent who had been deployed to recent military conflicts in the Middle East. The role of parents' positive engagement and coercive interaction with their child, and family members' emotion regulation were tested as processes linking cascades of parent and child symptoms. A subsample of 183 families with deployed fathers and nondeployed mothers and their 4- to 13-year-old children who participated in a randomized control trial intervention (After Deployment: Adaptive Parenting Tools) were assessed at baseline prior to intervention, and at 12 and 24 months after baseline, using parent reports of their own and their child's symptoms. Parents' observed behavior during interaction with their children was coded using a multimethod approach at each assessment point. Reciprocal cascades among fathers' and mothers' PTSD symptoms, and child internalizing and externalizing symptoms, were observed. Fathers' and mothers' positive engagement during parent-child interaction linked their PTSD symptoms and their child's internalizing symptoms. Fathers' and mothers' coercive behavior toward their child linked their PTSD symptoms and their child's externalizing symptoms. Each family member's capacity for emotion regulation was associated with his or her adjustment problems at baseline. Implications for intervention, and for research using longitudinal models and a family-systems perspective of co-occurrence and cascades of symptoms across family members are described.

Parental Post-Traumatic Stress Symptoms as Predictors of Psychosocial Problems in Children Treated for Cancer.

The purpose of this study was to explore the association between psychosocial functioning of children treated for cancer and that of their parents. Factors associated with psychosocial functioning were also examined. The present study was a cross-sectional survey of 33 mothers and one father (mean age: 37.9), each of whom had a child that had been treated for cancer. The participants answered a package of questionnaires consisting of the Impact of Event Scale-Revised (IES-R), the Parent Experience of Child Illness (PECI), and the Child Behavior Checklist (CBCL). Information about the children’s illnesses was collected from medical records. The CBCL total problems T score was correlated with the parental IES-R total scores. Intensity of treatment independently predicted the variance of parental long-term uncertainty. In conclusion, psychosocial problems of children with cancer were associated with parental post-traumatic stress symptoms (PTSS). Provision of early, adequate support to parents who are vulnerable to PTSS will help not only the parents, but also their children with cancer.

Posttraumatic Stress in Parents of Children Diagnosed with Cancer: Hyperarousal and Avoidance as Mediators of the Relationship between Re-Experiencing and Dysphoria

BackgroundIncreased understanding of the relationships between different symptom clusters involved in posttraumatic stress symptoms (PTSS) could guide empirical research and clinical practice. The objective of the present study was to investigate whether hyperarousal and avoidance mediated the relationship between re-experiencing and dysphoria in parents of children diagnosed with cancer.MethodsLongitudinal data from parents of children receiving cancer therapy were used. PTSS were assessed using the PTSD Checklist Civilian Version at one week (T1), two (T2) and four months (T3) after diagnosis. Mediation analyses for multiple mediators were conducted for mothers (n = 122) and fathers (n = 121), respectively. The mediation model tested the assumption that the PTSS symptom clusters hyperarousal and avoidance mediated the relationship between re-experiencing and dysphoria.ResultsFor fathers, none of the hypothesized mediators were significant. For mothers, hyperarousal mediated the relationship between re-experiencing and dysphoria, but avoidance did not.ConclusionsResults suggest that hyperarousal is important for the development of dysphoria in mothers, supporting use of interventions targeting such symptoms in the early and ongoing period following the child’s diagnosis.

Exploring the impact of parental post-traumatic stress disorder on military family children: A review of the literature

ObjectivesThe number of UK service personnel who have a diagnosis of PTSD is unclear, but there has been a recent increase in referrals to services for PTSD symptomology. It is imperative to understand the impact this may have on the children of affected service families. This review of literature aimed to explore and provide insight into the experiences of services children whose parent has a diagnosis of PTSD. DesignA comprehensive review of the literature. Data sourcesOnline databases CINAHL, MEDLINE, psychARTICLES, The Psychology and Behavioural Sciences Collection and PILOTS were searched. Review methodsThe studies were chosen in keeping with a specified inclusion and exclusion criteria. The literature was critically analysed and key themes identified through the strategy of thematic analysis. ResultsFive studies met the inclusion criteria. Three key themes were identified from the five articles; secondary traumatisation; impact on the child's mental health; and impact on the child's adult relationships. ConclusionThe findings highlighted the prevalence of secondary traumatisation and a potential negative impact on the child's mental health and relationships. However, literature used in the review was conducted in countries outside of the UK, therefore the comparison of results may be compromised. This review identifies the paucity of research on this topic and highlights the need for UK based research to be carried out in this area.

Mother–child emotion dialogues in families exposed to interparental violence

ABSTRACTThis cross-sectional study examined the hypothesis that parent–child emotion dialogues among interparental violence (IPV) exposed dyads (n = 30; 4–12 years) show less quality than dialogues among nonexposed dyads (n = 30; 4–12 years). Second, we examined whether parental posttraumatic stress symptoms and parental adverse childhood experiences (ACEs) were associated with the quality of the dialogues. As expected, in the IPV-exposed group, quality of mother–child emotion dialogues was of lesser quality; dyads often showed a lack of elaboration in their dialogue; mothers showed less sensitive guidance; and children showed less cooperation and exploration, compared to dialogues, dyads, mothers, and children in the nonexposed group. Although maternal posttraumatic stress symptoms and maternal history of ACEs were significantly higher in the IPV-exposed families than in the nonexposed families, these variables were not associated with the quality of emotion dialogues. Clinical implications and study limitations are discussed.

The Impact of Deployment on Parental, Family and Child Adjustment in Military Families

Since 9/11, military service in the United States has been characterized by wartime deployments and reintegration challenges that contribute to a context of stress for military families. Research indicates the negative impact of wartime deployment on the well being of service members, military spouses, and children. Yet, few studies have considered how parental deployments may affect adjustment in young children and their families. Using deployment records and parent-reported measures from primary caregiving (N=680) and military (n=310) parents, we examined the influence of deployment on adjustment in military families with children ages 0-10years. Greater deployment exposure was related to impaired family functioning and marital instability. Parental depressive and posttraumatic stress symptoms were associated with impairments in social emotional adjustment in young children, increased anxiety in early childhood, and adjustment problems in school-age children. Conversely, parental sensitivity was associated with improved social and emotional outcomes across childhood. These findings provide guidance to developing preventive approaches for military families with young children.

Injury-related fear-avoidance and symptoms of posttraumatic stress in parents of children with burns

Parents of children with burns experience a range of psychological reactions and symptoms, and parents’ health is known to impact children's health. So far, there is little research into potential mechanisms that maintain parents’ symptoms. The aim was to investigate parental injury-related fear-avoidance, and its associations with injury severity and health measures. Parents (n=107) of children aged 0.4–18 years that sustained burns 0.1–9.0 years previously completed questionnaires on fear-avoidance, posttraumatic stress, and health of the child. Analyses showed that the average level of fear-avoidance was low and positively associated with measures of injury severity and parents’ symptoms of posttraumatic stress, and negatively associated with parents’ ratings of their child's health. In two separate multiple regressions with parents’ symptoms of PTSD and the child's health as dependent variables, fear-avoidance made the largest contribution in both models while injury severity was non-significant. Results were not related to comorbid conditions of the child, scarring, or parent-related socio-demographic variables. In summary, injury-related fear-avoidance is more likely among parents whose children sustain more severe burns. In turn, fear-avoidance contributes significantly to parents’ symptoms of PTSD and to poorer health ratings regarding the child, irrespective of injury severity or child comorbidity.

Wskaźniki stresu potraumatycznego u rodziców dzieci kończących leczenie onkologiczne – rola oceny opieki medycznej, wsparcia społecznego oraz prężności osobowej

Wskaźniki stresu potraumatycznego u rodziców dzieci kończących leczenie onkologiczne – rola oceny opieki medycznej, wsparcia społecznego oraz prężności osobowej

Health-related quality of life and mental health in parents of children with hemolytic uremic syndrome.

Little is known about health-related quality of life (HRQoL) and mental health of parents having children with a history of hemolytic uremic syndrome (HUS). This study included 63 mothers and 58 fathers of a cohort of 63 HUS-affected children. At assessment, the mean time since a child experienced an acute episode of HUS was 6.4 years. Parental HRQoL, mental health and posttraumatic stress disorder (PTSD) were assessed with standardized self-report questionnaires. Medical data were extracted from patients' hospital records. The HRQoL and mental health of both the mothers and fathers were not impaired compared to normative data. However, a shorter time since a child's acute HUS episode was a significant predictor of lower HRQoL among the mothers, while no such effect was found among the fathers. Two fathers (3%), but no mothers, met the criteria for a diagnosis of HUS-related full PTSD; one father (2%) and four mothers (6%) met the criteria for a diagnosis of HUS-related partial PTSD. Our study shows that most parents of our study sample were doing well in terms of HRQoL and mental health, although a small number met the criteria for full or partial PTSD diagnosis due to their child's HUS. We therefore recommend that healthcare providers pay special attention to parents regarding PTSD symptoms during the clinical follow-up of a HUS-affected child since some parents may benefit from psychological support.

Child and adolescent internalizing and externalizing problems 12months postburn: the potential role of preburn functioning, parental posttraumatic stress, and informant bias.

Adjustment after pediatric burn injury may be a challenge for children as well as their parents. This prospective study examined associations of internalizing and externalizing problems in children and adolescents 12 months postburn with preburn functioning, and parental acute and chronic posttraumatic stress symptoms (PTSS) from different perspectives. Child, mother, and father reports of 90 children (9–18 years), collected within the first month and 12 months postburn, were analyzed. Results indicated that overall, child and parental appraisals of pre- and postburn behavioral problems were not significantly different from reference data. Rates of (sub)clinical postburn behavioral problems ranged from 6 to 17 %, depending on the informant. Pre- and postburn behavioral problems were significantly related, but only from the parents’ perspective. Path models showed an association between parental PTSS 12 months postburn and parental reports of child internalizing problems, as well as a significant indirect relationship from parental acute stress symptoms via PTSS 12 months postburn. Notably, no associations between parental PTSS and child reports of postburn behavioral problems were found. In conclusion, parental observations of child externalizing problems appear to be influenced by their perspectives on the child’s preburn functioning, while parental observations of internalizing problems are also related to long-term parental PTSS. However, these factors seem of no great value in predicting behavioral problems from the child’s perspective, suggesting substantial informant deviations. To optimize adjustment, clinical burn practice is recommended to adopt a family perspective including parent perception of preburn functioning and parental PTSS in assessment and intervention.

Evaluation of a Family-Centered Preventive Intervention for Military Families: Parent and Child Longitudinal Outcomes

This study evaluates the longitudinal outcomes of Families OverComing Under Stress (FOCUS), a family-centered preventive intervention implemented to enhance resilience and to reduce psychological health risk in military families and children who have high levels of stress related to parental wartime military service. We performed a secondary analysis of evaluation data from a large-scale service implementation of the FOCUS intervention collected between July 2008 and December 2013 at 15 military installations in the United States and Japan. We present data for 2,615 unique families (3,499 parents and 3,810 children) with completed intake and at least 1 postintervention assessment. Longitudinal regression models with family-level random effects were used to assess the patterns of change in child and parent (civilian and military) psychological health outcomes over time. Improvement in psychological health outcomes occurred in both service member and civilian parents. Relative to intake, parental anxiety and depression symptoms were significantly reduced postintervention, and these reductions were maintained at 2 subsequent follow-up assessments. In addition, we identified an improvement over time in emotional and behavioral symptoms and in prosocial behaviors for both boys and girls. We observed reductions in the prevalence of unhealthy family functioning and child anxiety symptoms, as well as parental depression, anxiety, and posttraumatic stress symptoms from intake to follow-up. Longitudinal program evaluation data show sustained trajectories of reduced psychological health risk symptoms and improved indices of resilience in children, civilian, and active duty military parents participating in a strength-based, family-centered preventive intervention.

Mediators of Initial Acute and Later Posttraumatic Stress in Youth in a PICU*

Youth in a PICU and their parents may experience initial symptoms of acute stress disorder and later symptoms of posttraumatic stress disorder. The objective of this study was to examine potential mediators of these conditions, including youth anxiety, depression, negative affect, and hospital fear, as well as parent anxiety and depression This study involved a short longitudinal design that encompassed initial assessments in a PICU setting and later assessments 4-7 weeks after discharge. Youth and their parents completed dependent measures in the hospital and at follow-up at the youth's home or an outpatient clinic setting. Fifty youth aged 9-17 yrs were admitted to a PICU for respiratory illness/asthma (30.0%), trauma (26.0%), surgery and after surgery recovery (20.0%), infections/viral illness (8.0%), neurologic disorder (6.0%), or other (10.0%). Parents (n = 50) were also assessed. None. Measures were utilized for youth anxiety, acute stress, depression, negative affect, posttraumatic stress, and hospital fear, as well as parent anxiety, acute stress, depression, and posttraumatic stress. Some youth (26%) and parents (24%) had substantial posttraumatic stress disorder symptoms develop. Youth acute stress disorder symptoms in the PICU predicted later youth posttraumatic stress disorder symptoms, parent acute stress disorder symptoms in the PICU predicted later parent posttraumatic stress disorder symptoms, and youth acute stress disorder symptoms in the PICU predicted later parent posttraumatic stress disorder symptoms. Youth anxiety, negative affect, and hospital fear mediated initial youth acute stress disorder symptoms and later youth posttraumatic stress disorder symptoms. Youth in a pediatric intensive care unit are at increased risk for posttraumatic stress disorder and should be screened for acute stress disorder.

A Pilot Study of the Effects of Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder on Parenting

Parental posttraumatic stress disorder (PTSD) is associated with parenting difficulties. Cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD) improves PTSD symptoms, relationship adjustment, and partners’ mental health functioning. However, the impact of CBCT for PTSD on parenting competency is unknown. In this pilot study, the effects of CBCT for PTSD on parenting competency were investigated in 14 individuals (6 patients with PTSD and 8 partners) who had children under age 18. Results suggested that most participants perceived themselves as competent in their parenting prior to treatment, and some enhancements in competency occurred following CBCT for PTSD. Moreover, changes in parenting competency were associated with improvements in patient-rated PTSD. Adjunctive interventions targeting parenting and goals for future research are discussed.

Youth offspring of mothers with posttraumatic stress disorder have altered stress reactivity in response to a laboratory stressor

Parental Posttraumatic Stress Disorder (PTSD), particularly maternal PTSD, confers risk for stress-related psychopathology among offspring. Altered hypothalamic-pituitary-adrenal (HPA) axis functioning is one mechanism proposed to explain transmission of this intergenerational risk. Investigation of this mechanism has been largely limited to general stress response (e.g., diurnal cortisol), rather than reactivity in response to an acute stressor. We examined cortisol reactivity in response to a laboratory stressor among offspring of mothers with a lifetime diagnosis of PTSD (n=36) and age- and gender- matched control offspring of mothers without PTSD (n=36). Youth (67% girls; mean age=11.4, SD=2.6) participated in a developmentally sensitive laboratory stressor and had salivary cortisol assessed five times (one pre-stress, one immediate post-stress, and three recovery measures, spaced 15min apart). Results were consistent with the hypothesis that offspring of mothers with PTSD would exhibit a dysregulated, blunted cortisol reactivity profile, and control offspring would display the expected adaptive peak in cortisol response to challenge profile. Findings were maintained after controlling for youth traumatic event history, physical anxiety symptoms, and depression, as well as maternal depression. This finding contributes to the existing literature indicating that attenuated HPA axis functioning, inclusive of hyposecretion of cortisol in response to acute stress, is robust among youth of mothers with PTSD. Future research is warranted in elucidating cortisol reactivity as a link between maternal PTSD and stress-related psychopathology vulnerability among offspring.

Mental Health in Offspring of Traumatized Refugees with and without Post-traumatic Stress Disorder.

Intergenerational transmission of psychological trauma and the impact of parental post-traumatic stress disorder (PTSD) on offspring are controversially discussed. We studied 50 offspring (36 women and 14 men, mean age 42.1 years) of refugees who were severely traumatized as children at the end of World War II. From these, 25 of the refugees currently suffered from chronic PTSD, and 25 had no PTSD. Parental PTSD status did not significantly influence mental health [as per the Symptom Checklist (SCL)-90-R] or quality of life (assessed by the 36-item Short-form Health Survey) in their children. In the entire sample, frequency of talking with the mother about the flight correlated with phobic anxiety (r = 0.67, p = 0.03). Interestingly, the stated burden of having a parent with a history of flight significantly (p < 0.05) correlated with almost all subscales of the SCL-90-R. These results in a non-clinical sample do not support a specific role of parental PTSD in intergenerational trauma transmission. Our other remarkable, but preliminary, results need to be studied in larger samples using more subtle interaction or schema analyses. Copyright © 2015 John Wiley & Sons, Ltd.

Emotional distress in parents of long-term survivors of childhood acute lymphoblastic leukemia.

The current study investigated the occurrence of emotional distress in parents of long-term survivors of childhood acute lymphoblastic leukemia (ALL) and identified factors associated with parent emotional distress symptoms. Parents of 127 long-term survivors of childhood ALL treated on a chemotherapy-only protocol at St. Jude Children's Research Hospital participated in the study. Parents completed standard ratings of emotional distress, caregiver strain, and child physical, emotional, and psychosocial functioning. Multivariable hierarchical linear regression analyses were used to examine associations between symptoms of caregiver strain, survivor functioning, and parent emotional distress. Covariates included parent education, survivor age, survivor sex, and time since childhood cancer diagnosis. On average, few parents reported significant symptoms of emotional distress. Clinically significant levels of anxiety and depression were reported by 7.1% and 3.1% of parents, respectively. Only 3.9% of parents endorsed significant symptoms of posttraumatic stress. Perceived caregiver strain was significantly associated with symptoms of parent anxiety, depression, and posttraumatic stress. Parent-report of child emotional functioning was significantly associated with symptoms of parent anxiety. Most parents of long-term survivors of ALL exhibit low levels of emotional distress in the context of rates observed in the general population. Perceived caregiver strain was significantly associated with parent emotional distress. Further research is required to examine specific sources of caregiver strain, as well as other risk and protective factors associated with parent emotional distress symptoms.

Military and Veteran Families and Children: Policies and Programs for Health Maintenance and Positive Development and commentaries

Military and Veteran Families and Children: Policies and Programs for Health Maintenance and Positive Development and commentaries