The long-term psychological adjustment of an Australian sample of childhood cancer survivors, parents and siblings

Abstract

This research program investigated PTSD, PTSS, psychological distress, and posttraumatic growth in Australian long-term childhood cancer survivors, their parents, and their siblings (Part 1), and examines the applicability of the Ehlers & Clark (2000) cognitive model of PTSD to childhood cancer survivorship (Part 2). Results show a small but important proportion of survivors and parents develop PTSD after cancer, and although few met current criteria, full symptom recovery was rare. Across all family groups, a higher prevalence of persistent and life impacting PTSS was reported relative to the general population. Current comorbid psychological distress was reported in up to half of participants meeting PTSD since diagnosis, and survivors reported higher levels of depression relative to normative data. Posttraumatic growth following the cancer experience was reported by the overwhelming majority of participants, with growth sharing a moderate-strong positive relationship with PTSD and PTSS. Of interest are data suggesting that some growth categories share a negative association with PTSS, providing a possible explanation for the current equivocal evidence-base. When comparing across groups, the prevalence of PTSD, PTSS, and posttraumatic growth was highest for mothers, and lowest for siblings. Findings show that within families, PTSS and posttraumatic growth are likely to be shared. Survivor PTSS is positively related to parental PTSS, but no symptom relationship was revealed between survivors and siblings. Conversely, a positive relationship exists between survivors and all family groups on posttraumatic growth. Findings suggest screening and intervention is necessary for all family members, particularly mothers, with some support for a family systems approach, however symptom-symptom concordance data was relatively low with the exception of intrusive symptoms and a greater appreciation of life. Finally, Part 2 supports the generalisability of the Ehlers and Clark (2000) cognitive model of PTSD to childhood cancer survivorship, indicating that within this context, the model provides a comprehensive cognitive framework for persistent PTSD and PTSS risk assessment and intervention. In an extension of the literature, an exploratory application of this model to posttraumatic growth revealed cognitive pathways overlap between the two trauma outcomes (stress and growth). The theoretical and practical implications of these findings are discussed.