Effect of depression in mothers with breast cancer on their children's concerns

A woman's breast cancer diagnosis can wreak as much havoc on her emotions as it does on her physical health. Mothers who experience bouts of depression during their battles with breast cancer may find that the effects reach beyond their own psyches to those of their children.

According to data analyzed by University of Pittsburgh researchers and reported this weekend at the American Psychosocial Oncology Society's Fourth Annual Conference in Austin, Texas, children of depressed breast cancer patients were more likely to be concerned or anxious about their mother's cancer and its implication for their families.

While children's emotional responses to their own illnesses are well-documented, this study, "The Effect of Depressed Mood in Mothers with Breast Cancer on Their Children's Illness-Related Concerns," is the first to examine the relationship between children's concerns and a mother's cancer-related depression.

"This data should prompt new considerations among oncology clinicians," said Beth R. Grabiak, M.S.N., C.R.N.P., a doctoral candidate in the health and community systems department at the University of Pittsburgh School of Nursing who led the data analysis. "We need to think about the impact depression has on the breast cancer patient's entire family as she undergoes treatment for her cancer."

The results were obtained through a secondary analysis of data from a randomized clinical trial that was funded by the National Institutes of Health and led by University of Washington researchers. That primary study, called "Enhancing Connections," collected information from a cross-section of 155 mothers with stage 1, 2 or 3 breast cancer and 155 of their children aged 8 to 12 years from six states. When more than one child was in the home, each mother selected one child to be followed by the study.

Mothers' depression was measured by the Center for Epidemiological Studies Depression Scale (CES-D), while children's concerns about the illness were determined by their responses to a 93-item questionnaire. In addition to quantifying total illness-related worries, the questionnaire responses also shed light on three subcategories: treatment-related concerns, existential concerns and family-related concerns.

When adjusting for other variables like children's age and gender, depression in mothers with breast cancer significantly predicted children having higher overall concerns about the illness. Furthermore, depression significantly predicted increased family-related worries in the children.

"It would be expected for children to worry about their mothers in the face of a difficult illness. It's somewhat surprising, however, that children's anxieties extended to concerns about the entire family," Ms. Grabiak said.

"This study's results have important implications for the mental well-being of families affected by breast cancer. Well-intentioned parents may hesitate to talk openly about the disease's emotional impact in an effort to protect their children, who in turn may attempt to hide their concerns and suffer in silence. Yet, the child's anxieties never disappear. They often are manifested in other ways, such as withdrawn behavior," Ms. Grabiak said.

Most estimates suggest that nearly one quarter of women diagnosed with breast cancer have young children, meaning that as many as 100,000 children will be impacted by the diagnosis this year alone. Ms. Grabiak suggests that, while not every breast cancer patient will become depressed, health care providers who are involved in cancer treatment should look for signs of depression in their patients, too.

"The oncology team's responsibility goes beyond treating the cancer alone," she said. "Spotting depression early and referring a mother to treatment has clear benefits for her entire family."

While this study's results are noteworthy, the subject has great potential for further exploration. Because this data was culled through a secondary study, a primary study on the topic should be conducted to further validate the results. Additionally, an examination of longitudinal data, as opposed to the cross-section examined in this work, would shed more light on the relationship of children's illness-related concerns and their mother's depression.