Transactional Relations Between Emotion Regulation and Adjustment in Caregivers of Children Diagnosed with Cancer

Abstract

Emotion regulation (ER) is a trans-diagnostic factor that has increased understanding of etiology and treatment models for psychopathology, including depression and anxiety disorders. Despite the growing body of research suggesting that deficits in ER are associated with psychopathology, little is known about the temporal relations between these variables. Although ER has often been conceptualized as a risk factor for psychopathology, research in this area has been predominantly correlational and limited the knowledge of whether ER is a predictor, concurrent marker, or consequence of psychopathology. Studying temporal relations between ER and psychopathology can yield insights into how ER contributes to the development and maintenance of psychopathology, particularly for groups of individuals at risk for mental health problems. One such at risk group is caregivers of children with cancer, who show significantly increased levels of depression and anxiety during the first year following the child’s diagnosis. Caregivers of children with cancer also experience ongoing stress beyond the initial shock of the diagnosis, including an increased need for regulating a variety of difficult emotions during their child’s treatment. In addition to being at risk for increased symptoms of psychopathology, caregivers of children with cancer also show decreased physical health, and many experience high levels of treatment related stress witnessing their child go through intensive treatment. Little work to date has examined how ER efforts in parents of children with cancer is associated with parental psychopathology, treatment related stress, and physical health during this period. The present study addresses limitations in the current research by first testing a measurement model of ER, and then examining associations between ER and adjustment in caregivers of children with cancer over the first year following diagnosis. Specifically, the study investigates a transactional model of ER and adjustment, with emphasis on assessing temporal relations among these factors. Participants consisted of 159 caregivers of children newly diagnosed with cancer who participated in a larger prospective study. Caregivers completed self-reports of their ER, psychopathology, treatment related stress, and physical health at diagnosis, 6 months post-diagnosis, and 12 months post-diagnosis. Caregiver ER was measured using the Parent’s Response to Stress Questionnaire (RSQ), and psychopathology was measured using the Center for Epidemiological Studies Depression Scale–Revised (CESD-R), the Impact of Events Scale–Revised (IES-R), and the Depression, Anxiety, and Stress Scale (DASS). Treatment related stress was assessed using the Treatment-Related Events Questionnaire (TRE), and caregivers reported on their physical health using the Caregiver Health Survey (CHS). Results supported a two factor measurement model consisting of adaptive secondary control engagement (SCE) ER strategies and maladaptive disengagement (DIS) ER strategies. Cross lagged models showed uni-directional relations between SCE and adjustment, with higher rates of psychopathology and treatment related stress prospectively predicting lower use of SCE. In contrast, higher DIS prospectively predicted higher psychopathology. Additional unexpected effects showed that better physical health prospectively predicted lower use of SCE strategies, and higher rates of psychopathology and treatment related stress prospectively predicted less use of DIS. Latent change score (LCS) models aimed at assessing dynamics of change between these factors were not successfully estimated using the current data. The current study expands on previous ER literature by showing divergent longitudinal effects between adaptive and maladaptive ER strategies with adjustment in a high risk sample of caregivers of children recently diagnosed with cancer. This study highlights the importance of ER as both a transdiagnostic predictor, as well as outcome, in relation to important markers of caregiver well-being, including psychopathology, treatment related stress, and physical health. Findings support the utility of addressing ER during prevention and intervention efforts aimed at fostering resilient outcomes for families with a child who has cancer. Implications and directions for future research in ER and pediatric cancer is highlighted.